Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This study provides a foundation for the use of an occupation-based outcome measure in conjunction with a strengths-based approach for use with persons with a diagnosed substance abuse disorder (SUD). Eighteen participants were assessed in a forensic residential treatment facility to explore the utility of the Occupational Circumstances Assessment Interview and Rating Scale. Participants also took the Values in Action Inventory of Strengths to assess character strengths. Primary Author and Speaker: Jeffrey Sargent Additional Authors and Speakers: Kristin Valdes

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. In this pretest–posttest pilot study, OT students’ knowledge of and involvement in political processes was assessed using the Political Astuteness Inventory (PAI) before and after an educational session on health policy. The results of the study support using education to improve political astuteness and that the PAI can be used as an outcome measure for programs designed to improve this skill. Primary Author and Speaker: Luis Arabit Additional Authors and Speakers: Gina Frassetto, Brandon Fukuda, and Candice Garrett Contributing Authors: Matthew Horwinski, Jenna Roxanne

Importance: Vision impairments are common after traumatic brain injury (TBI). Little evidence exists to assist clinicians with effective interventions for impaired oculomotor skills in people with TBI. Objective: To pilot a randomized controlled trial (RCT) of oculomotor treatment in TBI rehabilitation. Design: An impairment-based oculomotor protocol was compared with an activity-based standard of care in a two-group RCT. Participants were masked to assignment. Setting: Inpatient rehabilitation. Participants: For 1 yr, 138 people with TBI, ages 18–65 yr, were screened. Twenty-six were eligible; 6 declined. Inclusion criteria: oculomotor impairment. Exclusion criteria: inpatient stay <6 wk, blind, no functional arm use, unable to follow a three-step command, attention <30 min, or in another clinical trial. Intervention: Participants were randomized into an experimental group (n = 10) receiving the Six Eye Exercises protocol or a control group (n = 10) receiving a standard-of-care protocol for 30 min/day, 5 days/wk, for 4 wk. Oculomotor and related functional impairments were measured at baseline and posttreatment. Outcomes and Measures: Measures were chosen before the start. Primary outcome measure: Craig Hospital Eye Evaluation Rating Scale for oculomotor status. Secondary measures for functional status: King-Devick Test, Delis–Kaplan Executive Function System Trail Making Test: Condition 1 Visual Scanning, Modified Nelson–Denny Reading Test, and Subjective Vision Symptom Scale. Results: Sixteen participants finished. Fatigue was the primary reason for withdrawal. No other negative effects were noted. Selected outcome measures captured positive improvements in both groups. Conclusions and Relevance: Study findings suggest conducting an appropriately powered RCT to evaluate efficacy of oculomotor treatment in this population. What This Article Adds: Oculomotor dysfunction seems to improve during inpatient TBI rehabilitation with remedial treatment. Best practice in occupational therapy has not yet been established. An appropriately powered RCT could positively contribute to the evidence available to clinicians.

Importance: Underutilization of hospice occupational therapy may be attributable to a lack of evidence on efficacy. Objective: To conduct a scoping review of occupational therapy outcome studies to ascertain how efficacy is captured in the literature. Data Sources: PubMed, CINAHL, MEDLINE, Scopus, Directory of Open Access Journals, Web of Science, OT Search, and Google Scholar. Study Selection and Data Collection: Search terms: hospice, palliative care, occupational therapy, rehabilitation, outcome measure, and assessment. Inclusion criteria: research studies in English, centered on adult hospice care, published between January 1997 and September 2017, and investigated occupational therapy efficacy with an outcome measure. Exclusion criteria: systematic reviews, participants not at terminal disease end stages, or intervention program reviews lacking differentiated occupational therapy outcomes. Findings: Seven articles met the inclusion criteria. Findings include frequent use of noncontrolled, quasi-experimental, prospective research designs; a focus on occupational performance; and no generally accepted hospice occupational therapy outcome measure. Conclusion and Relevance: Outcome measures of participation in end-of-life occupations and environmental influences on occupational engagement are needed to effectively support occupational therapy practice and research with people who are terminally ill. What This Article Adds: Occupational therapy in end-of-life care is growing in complexity yet remains low in utilization. This review adds insights into current practice and future research foci for the profession.

OBJECTIVE. We investigated the effects on motor and daily function of robot-assisted therapies in people with chronic stroke using the Bi-Manu-Track (BMT) and InMotion 3.0 (IMT) compared with control treatment (CT). METHOD. In this comparative efficacy trial, 30 participants were randomized to receive BMT, IMT, or CT. Outcome measures included the Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motor Activity Log (MAL), and Medical Research Council (MRC) scale. RESULTS. The IMT group improved more in FMA and proximal MAS scores than the BMT group (both ps < .01) and the CT group (p < .01 and p = .03, respectively). The IMT and BMT groups showed clinically relevant improvements after treatment on the MRC rather than the MAL. CONCLUSION. The results indicate that the IMT might improve motor function. The IMT and BMT groups showed similar benefits for muscle power but limited improvements in self-perceived use of the affected arm.

OBJECTIVE. We examined the effectiveness of modified constraint-induced movement therapy (mCIMT) in treating infants with hemiplegic cerebral palsy and compared therapy outcomes with a nonconstraining bimanual therapy (BIM) of equal intensity. METHOD. In a single-blinded randomized controlled trial, 33 infants with hemiplegia (mean corrected age = 11.1 mo, standard deviation = 2.2) received either mCIMT (n = 17) or BIM (n = 16). Both interventions included home programs encouraging the use of the affected hand during daily 1-hr play sessions for 8 wk. Outcome measures were administered pre- and posttreatment and included the Mini-Assisting Hand Assessment for babies and the Functional Inventory. At baseline, parents also filled out the Dimensions of Mastery Questionnaire. RESULTS. Both groups demonstrated a significantly large and equal improvement in hand and gross motor function posttreatment (p < .001) and high treatment compliance. CONCLUSION. mCIMT and BIM are equally effective methods for treating infants with hemiplegia.

This systematic review addresses the question “What is the efficacy of occupational therapy using Ayres Sensory Integration^® (ASI) to support functioning and participation as defined by the International Classification of Functioning, Disability and Health for persons with challenges in processing and integrating sensory information that interfere with everyday life participation?” Three randomized controlled trials, 1 retroactive analysis, and 1 single-subject ABA design published from 2007 to 2015, all of which happened to study children with autism, met inclusion criteria. The evidence is strong that ASI intervention demonstrates positive outcomes for improving individually generated goals of functioning and participation as measured by Goal Attainment Scaling for children with autism. Moderate evidence supported improvements in impairment-level outcomes of improvement in autistic behaviors and skills-based outcomes of reduction in caregiver assistance with self-care activities. Child outcomes in play, sensory–motor, and language skills and reduced caregiver assistance with social skills had emerging but insufficient evidence.

Many children and youth with and without disabilities are affected by challenges in processing and integrating sensations. Occupational therapy practitioners serve a pivotal role in the evaluation and treatment of this population. This special section of the American Journal of Occupational Therapy includes articles that elucidate the relationship between sensory processing and participation in valued occupations as well as articles that guide best practice, including systematic reviews on common occupational therapy interventions for children and youth with challenges in processing and integrating sensation. This editorial elaborates on key issues for future research.

This systematic review examines the evidence for the effectiveness of cognitive and occupation-based interventions to improve self-regulation in children and youth who have challenges in processing and integrating sensory information. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guided the methodology. Five studies identified through a comprehensive database search met the inclusion criteria and were separated into categories of cognitive and occupation-based interventions. Articles that did not specifically measure sensory integration (SI) or processing challenges were omitted. Synthesis of the articles suggests that self-regulation (e.g., sensory processing, emotional regulation, executive functioning, social function) improved with cognitive and occupation-based interventions. Because the number of studies that measured sensory processing or SI challenges was limited, researchers are encouraged to include these measures in future research to understand the impact of a broader range of cognitive and occupation-based interventions.

OBJECTIVE. The purpose of this systematic review was to describe the evidence for the effectiveness of interventions designed to establish, modify, and maintain occupations for adults with Alzheimer’s disease (AD) and related neurocognitive disorders. METHOD. Titles and abstracts of 2,597 articles were reviewed, of which 256 were retrieved for full review and 52 met inclusion criteria. U.S. Preventive Services Task Force levels of certainty and grade definitions were used to describe the strength of evidence. RESULTS. Articles were categorized into five themes: occupation-based, sleep, cognitive, physical exercise, and multicomponent interventions. Strong evidence supports the benefits of occupation-based interventions, physical exercise, and error-reduction learning. CONCLUSION. Occupational therapy practitioners should integrate daily occupations, physical exercise, and error-reduction techniques into the daily routine of adults with AD to enhance occupational performance and delay functional decline. Future research should focus on establishing consensus on types and dosage of exercise and cognitive interventions.

OBJECTIVE. The Health Promoting Activities Scale (HPAS) measures the self-rated frequency with which adults participate in activities that promote health. We evaluated the internal consistency, construct validity, and intrarater reliability of the HPAS with a cohort of mothers (N = 56) of school-age children. METHOD. We used an online survey that included the HPAS and measures of mental and physical health. Statistical analysis included intraclass correlation coefficients (ICCs), measurement error, error range, limits of agreement, and minimum detectable change (MDC). RESULTS. The HPAS showed good internal consistency (Cronbach’s α = .73). Construct validity was supported by a significant difference in HPAS scores among participants grouped by physical activity level; no other differences were significant. Results included a high aggregate ICC of .90 and an MDC of 5 points. CONCLUSION. Our evaluation of the HPAS revealed good reliability and stability, suggesting suitability for ongoing evaluation as an outcome measure.

OBJECTIVE. To estimate the ability of the National Board for Certification in Occupational Therapy (NBCOT) practice test to predict first-time pass status on the NBCOT Occupational Therapist Registered exam. METHOD. Performance ratios for the four NBCOT practice test domains were used to develop a logistic regression model for estimating the probability of first-time pass status on the NBCOT exam. RESULTS. Of 65 students who graduated during academic years 2010–2013, 41 (63%) attained first-time pass status. The logistic regression model was a good fit. The variance explained ranged from 22% to 29%. The odds of first-time no-pass status were associated with performance ratios on Domains 1 and 2 but not Domains 3 and 4. CONCLUSION. To maximize the probability of students’ attaining first-time pass status, faculty should consider ways to increase their exposure to the tasks and skills required for implementation of intervention plans (Domains 3 and 4).

We determined whether a widely used assessment of visual–motor skills, the Beery–Buktenica Developmental Test of Visual–Motor Integration (VMI), is appropriate for use as an outcome measure for handwriting interventions. A two-group pretest–posttest design was used with 207 kindergarten, first-grade, and second-grade students. Two well-established handwriting measures and the VMI were administered pre- and postintervention. The intervention group participated in the Size Matters Handwriting Program for 40 sessions, and the control group received standard instruction. Paired and independent-samples t tests were used to analyze group differences. The intervention group demonstrated significant improvements on the handwriting measures, with change scores having mostly large effect sizes. We found no significant difference in change scores on the VMI, t(202) = 1.19, p = .23. Results of this study suggest that the VMI may not detect changes in handwriting related to occupational therapy intervention.

OBJECTIVE. We investigated the feasibility of delivering an individualized, progressive, high-repetition upper-extremity (UE) task-specific training protocol for people with stroke in the inpatient rehabilitation setting. METHOD. Fifteen patients with UE paresis participated in this study. Task-specific UE training was scheduled for 60 min/day, 4 days/wk, during occupational therapy for the duration of a participant’s inpatient stay. During each session, participants were challenged to complete ≥300 repetitions of various tasks. RESULTS. Participants averaged 289 repetitions/session, spending 47 of 60 min in active training. Participants improved on impairment and activity level outcome measures. CONCLUSION. People with stroke in an inpatient setting can achieve hundreds of repetitions of task-specific training in 1-hr sessions. As expected, all participants improved on functional outcome measures. Future studies are needed to determine whether this high-repetition training program results in better outcomes than current UE interventions.

Selecting an appropriate outcome measure is a critical step in designing valid and useful clinical trials and outcome studies. This selection process needs to extend beyond examining basic psychometric properties to consider additional features of instruments that may affect their validity and utility for the study’s purpose. This article discusses these additional factors and their potential impact on outcome measurement. Guidelines are proposed to help clinical researchers and consumers of clinical research literature evaluate the match between the study purpose, population, and instrument.

OBJECTIVE. We investigated the effect of constraint-induced therapy (CIT) plus eye patching (EP), CIT alone, and conventional treatment on functional performance, eye movement, and trunk–arm kinematics in stroke patients with neglect syndrome. METHOD. Twenty-four participants were recruited and randomly allocated to three intervention groups. All participants received intervention 2 hr/day, 5 days/wk, for 3 wk. Outcome measures included the Catherine Bergego Scale, eye movement, and trunk–arm kinematic analysis. RESULTS. The CIT + EP and CIT groups demonstrated larger improvements in functional performance than the control group. The CIT group showed better performance with left fixation points than the CIT+EP group and shorter reaction time than the control group. The CIT + EP group improved more in preplanned control and leftward trunk shift than the other two groups. CONCLUSION. CIT + EP and CIT were more effective interventions than conventional treatment of patients with neglect syndrome in daily functional performance.

OBJECTIVES. The objective was to benchmark upper-limb outcomes for clients after stroke by confirming a local benchmark and comparing this benchmark with data from a prospective sample. METHOD. Expert occupational therapists were surveyed to confirm benchmark sample data (n = 20). Treatment sample data (n = 20) were collected at three subacute units. Outcomes were recorded using the Australian Therapy Outcome Measures for Occupational Therapy Upper-Limb Use scale. RESULTS. Results confirmed benchmark sample scores. Treatment sample participants were significantly younger than the benchmark sample; however, a two-way analysis of variance indicated that both samples improved to a similar degree. CONCLUSION. Therapists at the facilities where the treatment was provided can feel confident that they are meeting benchmark standards and may strive in the future to achieve better outcomes. Further benchmarking studies are required to encourage therapists to evaluate their performance and implement strategies to improve the efficiency and effectiveness of practice.

This article describes the organization, curriculum, and outcomes for New Stories/New Cultures, an activity-based program for after-school enrichment in five schools in the low-income neighborhood near a major American university. The program encourages students (70% Hispanic-American, 30% African-American) to experience themselves as producers of culture, not just as consumers. Its methods include (a) creative team use of video equipment and other expressive media and (b) lessons about media literacy (i.e., making critical choices about images and activities depicted in popular culture and commercials). Outcome measures with the cohort of fifth and sixth graders support the program’s occupation-based philosophy. They show that students are more likely to experience themselves as building skills when engaged in activities that are both challenging and enjoyable. The students reported greatest engagement and enjoyment in activities that were creative, team-based, and involving media production. These same activities were correlated with increased self-esteem. The term direct cultural intervention is used to describe the application of occupational principles and critical perspectives to provide a population with conceptual tools and skills for interpreting and successfully navigating the social world.