Importance: Readmission to the hospital can lead to poorer patient outcomes and increased health care costs. The effect of occupational therapy interventions for adult hospitalized patients on readmission rates has not been previously evaluated. Objective: To systematically examine the published literature to determine the effects of occupational therapy interventions for adult hospitalized patients on readmission rates. Data Sources: Systematic search of five electronic databases was performed from database inception until May 2020, supplemented by citation and reference list searches. Study Selection and Data Collection: This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered prospectively; methodological quality of the included studies was assessed using the Downs and Black checklist. Meta-analyses were conducted with clinically homogeneous data; the overall body of evidence was graded for quality. Findings: Meta-analysis of 7 studies with 16,718 participants provided low-quality evidence that 1-mo readmission rates were reduced when adult patients hospitalized for general medical and surgical care received additional occupational therapy interventions compared with standard care. Subgroup analysis of 4 studies provided moderate-quality evidence that interventions focusing on the transition from hospital to the community were effective in reducing 1-mo readmissions to hospitals compared with standard care. Conclusions and Relevance: Occupational therapy interventions can be effective in reducing readmissions among some adult hospitalized patient populations, including those admitted for surgery or management of acute medical conditions, with stronger evidence to support transitional care interventions. What This Article Adds: Occupational therapy interventions can be effective in reducing readmissions among adult hospitalized patients. There is a continued need for occupational therapy practitioners to understand their value and contribution to reducing avoidable readmissions to hospitals.

Importance: Research supports the clinical effectiveness of hospital-based occupational therapy to improve functional outcomes, but no synthesis of economic evaluations of occupational therapy services provided in these settings has been published. Objective: To determine the economic value of occupational therapy services in acute and subacute care settings. Data Sources: MEDLINE, CINAHL, CENTRAL, EconLit, Embase, National Health Services Economic Evaluation Database, PsycINFO, ProQuest (Health and Medicine and Social Science subsets only), OTseeker, and gray literature. Study Selection and Data Collection: Eligible studies used trial-based or modeled economic analyses and included an adult population (ages ≥18 yr) and occupational therapy assessments or interventions provided in acute and subacute care. Two authors independently assessed abstracts and then full text. Articles were then appraised using the Evers Consensus on Health Economic Criteria. Findings: The authors identified 13,176 unique abstracts and assessed 190 full-text articles for eligibility. Ten studies were included in the systematic review; they varied in their primary objectives, methodology, costs, and outcomes. Studies examined the cost–benefit, cost-effectiveness, cost–utility, or cost minimization of a range of occupational therapy services. Five studies suggested that occupational therapy services offer value for money (lower cost, higher benefit); 4 suggested that they offer higher cost and benefits. One study that investigated upper limb rehabilitation did not indicate value for money. Conclusions and Relevance: The findings suggest that occupational therapy for adults poststroke and post–traumatic brain injury, acute discharge planning, and pre– and post–hip replacement is cost-effective, but further research is needed to substantiate these findings. What This Article Adds: The findings provide preliminary evidence of the economic effectiveness of occupational therapy in acute and subacute care.

This Eleanor Clarke Slagle lecture describes the author’s work with marginalized populations, including homeless adults with mental illness, premature aging conditions, and poor literacy; women who became homeless as a result of domestic violence; children in impoverished, urban school systems reading below grade level; and adults with severe and chronic mental illness that impeded their ability to secure employment, housing, and independent community living. The author illustrates how and why occupational therapy practitioners should become part of the primary care team that evaluates the impact of multiple disorders on marginalized populations’ daily life activities, provides services to optimize community participation, and provides environmental modifications to enhance safety and function.

Importance: Evidence of the effectiveness of cognitive activity and preparatory tasks in improving the cognitive skills and functional performance of people with cognitive decline is limited. Objective: To examine the efficacy of a high-ecological cognitive intervention. Design: Quasi-experimental, pretest–posttest design with nonequivalent control. Setting: Community. Participants: Older adults with mild cognitive impairment from two senior centers. Intervention: Twelve 90-min weekly group sessions of a high-ecological cognitive intervention using simulated everyday cognitive tasks (experimental group) and of nutrition education (active control group). Outcomes and Measures: Cognitive skills were measured with the Color Trails Test (CTT), the Contextual Memory Test (CMT; Immediate Recall [CMT–Im] and Delayed Recall [CMT–De] tasks), and the Wechsler Adult Intelligence Scale–Fourth Edition Digit Span subtest (Digits Forward and Digits Backward). Cognitive–functional performance was measured with the Rivermead Behavioural Memory Test–Third Edition (RBMT–3; Immediate Recall [RBMT–3–Im] and Delayed Recall [RBMT–3–De] tasks) and the Cognitive Failures Questionnaire (CFQ). Results: Thirty-seven participants (M age = 70.84 yr; 70.3% women) met the inclusion criteria for analysis (20 participants in the intervention group, 17 participants in the control group). Multivariate linear regression showed that the intervention group improved significantly more than the control group on the CTT, CMT–Im, and RBMT–3–Im but not on the CMT–De, RBMT–3–De, and CFQ. Conclusions and Relevance: Twelve 90-min weekly group sessions of a high-ecological cognitive intervention improved attention, executive function, immediate memory, and objective cognitive–functional performance with immediate-memory task demands. What This Article Adds: Carefully designed and structured simulated everyday cognitive tasks can be used as a cognitive training agent to improve both cognitive skills and objective cognitive–functional performance. The effectiveness of group-based cognitive interventions depends on the skills of occupational therapy practitioners in activity analysis and grading.

Importance: The recovery model in mental health involves person-driven care and informed decision making to enhance engagement in meaningful activities and inclusion in society. To facilitate the recovery process, occupational therapy practitioners must support their clients in understanding how their participation in meaningful occupation is intimately related to their health and well-being. Objective: To explore whether engaging in an occupational reflection intervention on an inpatient psychiatric unit can support the recovery of adults living with serious mental illness (SMI). Design: Using a phenomenological design, we conducted semistructured interviews to assess whether participation in an occupational reflection intervention supported recovery. Setting: An inpatient psychiatric unit at a university medical center. Participants: We recruited 10 adults living with SMI using purposive sampling. Intervention: Participants engaged in a structured occupational reflection intervention using the Occupational Experience Profile (OEP). The OEP is a time-use diary that captures respondents’ subjective experiences of pleasure, productivity, restoration, and connection in relation to their participation in occupations over 24 hr. Study participants engaged in collaborative analyses regarding their OEP results to explore their subjective experiences in relation to their occupational participation. Outcomes and Measures: Participant self-report during interviews. Results: Engaging in structured reflection affected participants’ experiences of recovery by promoting insight into and awareness of how occupations affect mental health, encouraging positive reframing of occupational experience, and facilitating identification of strategies to support recovery and meaningful participation after discharge. Conclusions and Relevance: Occupational reflection can promote the recovery of adults living with SMI. What This Article Adds: A structured occupational reflection intervention can help adults living with SMI in inpatient psychiatric units to understand the close relationship between their participation in occupations and their health. This process provides valuable insight to clients regarding how to support their recovery through engagement in meaningful occupation.

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. In this qualitative, phenomenological study, 15 stroke survivors indicated that performing moderate to vigorous physical activity (PA), performing activities of daily living (ADLs), and avoiding sedentary behavior were important types of PA. For adults with stroke for whom moderate PA is challenging, performing ADLs may be an acceptable alternative. OT practitioners can assist clients to decrease sedentary behavior and increase PA through the performance of meaningful activities and occupations. Primary Author and Speaker: Ryan Bailey Contributing Authors: Jennifer Stevenson

Date Presented 04/22/21 The Occupational Adaptation Practice Guide (OAPG) is an instrument used to operationalize the theory of occupational adaptation and promote client-centered care. This study assessed the usability and reliability of the OAPG in an inpatient rehabilitation setting. The results indicate a high percentage of agreement for the person and environment sections of the instrument. All respondents agreed that the OAPG promotes client-centered care, but results regarding its efficiency were mixed . Primary Author and Speaker: Jackie Green Additional Authors and Speakers: Ashley Marks, Jamison Hogan, Brett Campbell, and Dustin Cox

Date Presented 04/7/21 This study describes the feasibility of a combined telehealth intervention of computerized cognitive training together with occupation-based treatment for patients with cancer-related cognitive impairment (CRCI). The intervention was found feasible, and positive outcomes on occupational performance, cognitive functions, quality of life, and mood were revealed. This treatment can possibly add to the therapeutic landscape of CRCI, which currently impairs the life of millions worldwide. Primary Author and Speaker: Yafit Gilboa Contributing Authors: Anita Tollen, Marie Holmefur

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This study describes adults with intellectual and developmental disabilities (IDD) in the acute-care hospital setting and identifies differences in their experience compared with those of patients without IDD. Comparative analysis between the two samples revealed differences in the length of stay, insurance provider, discharge environment, and number of OT visits per day. This study affects the field of OT by increasing awareness of the utilization patterns of health care services for patients with IDD. Primary Author and Speaker: Samantha Conrad Additional Authors and Speakers: Molly Bathje, Matthew Medick, and Molly Ross Contributing Authors: Louis Fogg

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This study examined how adults treated with cancer rated their confidence in and difficulty performing activities of daily living (ADLs) and how that was related to receiving OT services. Participants who attended OT had statistically significantly higher confidence in ADLs compared to those who did not attend. Nearly 75% of participants reported experiencing difficulty completing ADLs after cancer diagnosis. OTs can advocate for referrals to OT and target function in treatment. Primary Author and Speaker: Brittany A. Boyer Additional Authors and Speakers: Katherine McVey, Leah Gossard Contributing Authors: Anna M. Quigg, Stacy Buckingham-Howes

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The goal of this poster is to provide information and foster conversation about the development, clinical use, and content validity of the Occupational Therapy Anticipatory Awareness Test (OTAAT). The OTAAT is a newly developed, performance-based assessment tool that addresses a gap in the assessment of anticipatory awareness for individuals with neurological conditions. Discussion about participation in future research and validation processes will be facilitated. Primary Author and Speaker: Danielle Mahoney Additional Authors and Speakers: Lenin Grajo, Glen Gillen

Date Presented 04/22/21 Sickle cell disease (SCD) is a genetic blood disorder that is characterized by chronic anemia that can cause both serious physical and neurological complications. In this study, we analyze the deleterious effects that SCD can have on cognition and the importance of evaluations and interventions provided by OTs and the interprofessional team alike in working with this population. Primary Author and Speaker: Deborah Blady Additional Authors and Speakers: Huda Yousef, Hanan Khalil Contributing Authors: Khalid El-Salem, Ziad Hawamdeh, and Patrícia Almeida

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This small-scale, descriptive qualitative study examines the perspectives of parents who have transition-aged adolescents with autism spectrum disorder on the topics of disability studies, advocacy, and adulthood expectations for their adolescents. In addition, the study attempts to determine the acceptability of disability studies content in potential parent programming related to transition for this population. Primary Author and Speaker: Janvi Patel Contributing Authors: Lindsay Sauve

Date Presented 04/13/21 Gravitational insecurity presents significant challenges throughout the life span. This poster examines performance of typical adults on a standardized assessment of gravitational insecurity originally designed for children, to determine if adaptation to its use was needed for use with adults. Age, self-reported fearfulness to movement, and performance on individual items were all examined as factors potentially impacting use of the assessment with adults. Primary Author and Speaker: Teresa A. May-Benson Additional Authors and Speakers: Lenin Grajo

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The participants were able to identify adaptive behaviors during the intervention and improved and transferred their abilities to other daily contexts 1 month after the intervention. The results highlight the efficiency of a video-modeling-based intervention for adults with mild to moderate intellectual and developmental disabilities, for improving their social and work-related behaviors. This may reinforce the development and adaption of the intervention to their unique needs to support successful integration into the vocational world. Primary Author and Speaker: Sharon Zlotnik Additional Authors and Speakers: Yfat Ben Refael, Eynat Gal Contributing Authors: Patrice Tamar Weiss

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This scoping review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, reviews and critiques the efficacy of interventions used to remediate handwriting skills of adults poststroke. Data sources were OT SEARCH, PubMed Central, PubMed, PsycInfo, CINAHL, and MEDLINE. Search terms were CVA, stroke, adults, handwriting, fine motor, rehabilitation, and remediation. Nineteen studies were critiqued and organized by intervention type. Few studies address remediation of handwriting skills of adults poststroke. More research is needed. Primary Author and Speaker: Beth Ekelman Contributing Authors: Kaylee A. Buchenic, Sara E. Connelly, Mallory M. Deel, Morgan M. Haynik,Joseph Morrison, and Kelle Deboth

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Primary care encounters can be challenging for adults with autism spectrum disorder. The purpose of this presentation is to identify challenges experienced by this population as well as strategies to mitigate these difficulties. Primary Author and Speaker: Leah I. Stein Duker Additional Authors and Speakers: Elizabeth Pfeiffer, Amber Davidson, and Hee Kyung Sadie Kim

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Supported decision making is an emerging practice that OTs can use to promote participation, positive transition, and self-determination for people with intellectual and developmental disabilities (IDD). This presentation will report research studying the experiences of adults with IDD using supported decision making and discuss opportunities for OT intervention. Primary Author and Speaker: Evan Dean Additional Authors and Speakers: Brad Linnenkamp

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Participants with postconcussion syndrome were taught breathing exercises and given a heart rate variability (HRV) monitor to promote reduced anxiety. Outcome measures included the Perceived Stress Scale, HRV, and anxiety tracking. Each measure improved for participants by the study's conclusion. Primary Author and Speaker: Kelsee Hove Contributing Authors: Callie Lodden, Emily Mock, Mariah Roe, Lindsey Schulz, and Jillian Jones

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. A quantitative study was conducted to determine if a correlation existed between dynamic grip strength and hand function in healthy subjects across the life span. Outcomes were measured using the Baltimore Therapeutic Equipment grip tool and the Jebsen Hand Function Test. An insufficient statistical correlation existed between timed Jebsen Hand Function results and dynamic hand strength values to support the use of test results as a clinical indicator of functionality or intervention planning. Primary Author and Speaker: Cindy W. Poole