Date Presented 04/22/21 This study analyzed the effects of yoga participation with active and passive ergonomic instruction on improving range of motion at the neck and shoulder, decreasing pain, and reducing perceived stress in a group of graduate students. Results show range of motion improvements when yoga and active ergonomic interventions are implemented for graduate students who spend prolonged periods of time sitting. No significant effects of these interventions were seen for pain or perceived stress. Primary Author and Speaker: David Plutschack Additional Authors and Speakers: James Wersal Contributing Authors: Sandra Winter, Sherrilene Classen

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Chronic pain is a debilitating condition that disrupts engagement in meaningful occupations. Self-efficacy may be a protective factor in reducing pain-related disability and promoting effective chronic pain management. After participating in the 8-week Merging Yoga and Self-Management Skills program, dyads with chronic pain reported increased self-efficacy of varying degrees. Significant improvement in self-efficacy related to physical function was reported. Primary Author and Speaker: Charla Kinkel Contributing Authors: Arlene Schmid, Christine A. Fruhauf, Karen Atler, and Haylee A. Candray

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The PRESS to Function Approach is designed to provide a systematic method of evaluating upper extremity function of musculoskeletal disorders. It is based on six constructs: pain, range of motion, edema, strength, sensibility, and functional ability. The approach avoids rendering incomplete hand and upper extremity evaluations and reassessments. The acronym is catchy enough for the novice therapist to make a mental check of what areas may be relevant during the session. Primary Author and Speaker: Phyllis Ross Additional Authors and Speakers: Felecia Banks

Date Presented 04/12/21 OTs and other health care professionals learn about assessment and intervention for pain in their entry level educational programs. The aim of this study was to identifying gaps and strengths in interdisciplinary health profession curricula as it relates to pain and subsequently the opioid crisis. Participants completed a survey and a focus group. Results show a mutual desire among faculty and students to implement additional pain education. Primary Author and Speaker: Lauren Grasenick Contributing Authors: Abigail Herman, Mairead Gormley, Erica Di Meo, Jessica Leonard

Date Presented 04/13/21 This study investigated the impact of a short-term occupation-based program on pain, fatigue, and occupational performance of women with cancer that took place over 1 week. Activities focused on physical, emotional, sensory, and social aspects of functioning. The study demonstrated that participation in this 1-week program decreases pain and fatigue and improves occupational performance and satisfaction for women with cancer living in the community. Primary Author and Speaker: Rochelle Mendonca Additional Authors and Speakers: Abigail Sanders, Courtney Wood, and Esther Cargill

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This study describes the prevalence of leisure participation for older adults with and without pain. The results show that older adults may not be participating in a variety of leisure, but mostly in passive activities, such as watching television. Those with pain participate in leisure significantly less than those without pain. The results of this study enhance OTs' knowledge of leisure prioritization and participation among older adults. Primary Author and Speaker: Haley Feller Contributing Authors: Nancy Baker

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. OTs and other health care professionals frequently experience low back pain. This has been associated with multifidus cross-sectional area in various populations, but not previously in health care workers. This project observed multifidus cross-sectional area in OTs and other health care personnel. A pain group was compared with a nonpain group to assess differences between them. At the S1 level (with a trend at L5), those with more pain had smaller multifidus. Primary Author and Speaker: Robert E. Larson Contributing Authors: Ulrike H. Mitchell, A. Wayne Johnson

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The goal of the study was to examine the implications of a variety of hand-related diagnoses using the broad prospective of the International Classification of Functioning, Disability and Health. The hand-condition group reported significantly (p < .05) lower perceived quality of life (QoL), higher levels of disability, and reduced hand strength and dexterity in comparison with a healthy control group. Personal factors, hand function, and pain explained 29% of the variance in QoL. The results support the application of a broader biopsychosocial approach in hand therapy practice. Primary Author and Speaker: Danit Langer Contributing Authors: Avigayil Horwitz, Hanna Melchior, and Adina Maeir

Importance: Students with dysgraphia often receive test accommodations to enhance their handwriting legibility or speed. However, these accommodations are seldom individualized to ensure that they actually improve the performance of a specific student. Therefore, a need exists for an evidence-based protocol (henceforth, the Protocol) for selecting individually tailored test accommodations for students with dysgraphia. Objective: To establish the Protocol’s content validity, interrater reliability, and preliminary outcomes through a pilot study. Design: Descriptive and exploratory design. Setting: Research laboratory at a large university in central Israel. Participants: The sample consisted of 25 students (mean age = 24.9 yr, standard deviation = 2.1), of whom 88.0% were male. Inclusion criteria included a previous diagnosis of a specific learning disability and handwriting difficulties. Exclusion criteria were a physical condition or medication intake that may have affected students’ handwriting or typing ability. Results: The Protocol was found to have face validity and high interrater reliability (κ = .80). Its initial use showed that the most suitable accommodations for students with dysgraphia varied and were not always intuitive (e.g., extended time was not always the best accommodation for students with slow handwriting). Conclusions and Relevance: The Protocol appears to be a promising tool to assist occupational therapists in selecting the most appropriate accommodations for students with dysgraphia in a systematic manner. However, additional studies are required to further support these results. What This Article Adds: This study indicates that the selection of the most appropriate accommodation for students with dysgraphia is not always intuitive. It describes a Protocol that enables occupational therapists to select accommodations that are tailored to students’ writing abilities, following a systematic process, while considering the students’ writing performance with and without accommodations.

Evidence Connection articles provide clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of an older adult who was referred to outpatient occupational therapy services due to chronic back pain from herniated discs. Findings from the systematic review of occupational therapy for community-dwelling older adults were published in the July/August 2018 issue of the American Journal of Occupational Therapy ( Berger et al., 2018 ; Elliott & Leland, 2018 ; Hunter & Kearney, 2018 ; Liu et al., 2018 ; Smallfield & Lucas Molitor, 2018a , 2018b ) and in the American Occupational Therapy Association’s Occupational Therapy Practice Guidelines for Productive Aging for Community-Dwelling Older Adults. Each article in the Evidence Connection series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. These articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision making.

OBJECTIVE. Randomized controlled trial (RCT) interventions often rely on p values, where statistical significance is assumed to provide evidence of an intervention effect. This study provides a secondary data analysis of the Well Elderly II RCT using multiple approaches that examine clinical meaningfulness. METHOD. We reanalyzed the Well Elderly II RCT using effect size, standard deviation, standard error of measurement, minimal difference, a fragility index, an assessment of poor scores at baseline, and an analysis with a small subgroup of participants removed. RESULTS. Although some participants improved on several scales, most stayed the same, and a small subset declined. Omitting a small subgroup of participants led to nonsignificant p values. CONCLUSION. There is evidence that disparities in baseline scores and regression to the mean may have created the appearance of an intervention effect. Our methods of considering clinical meaningfulness suggest improved approaches to analyzing RCT data.

This article establishes and examines occupational therapists’ role in perinatal care and proposes a health promotion approach for new and expectant mothers. The author demonstrates the importance of maintaining meaningful occupational engagement during this critical life stage by incorporating evidence from orthopedic, rehabilitation, and hand therapy research. New and expectant mothers are at high risk for upper extremity (UE) conditions such as carpal tunnel syndrome, De Quervain’s tenosynovitis, and tendinosis of the UE. Occupational therapists with basic knowledge of hand therapy are well prepared to manage these conditions conservatively. An occupation-based model and framework are presented to ensure a holistic view of the target population. Topics pertinent to this population include postural techniques, repetitive tasks, patient education, and strengthening related to the perinatal period.

Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of a person recently diagnosed with fibromyalgia. The occupational therapy assessment and intervention process in the home setting is described. Findings from the systematic review ( Poole & Siegel, 2017 ) on this topic were published in the January/February 2017 issue of the American Journal of Occupational Therapy and in AOTA’s Occupational Therapy Practice Guidelines for Adults With Arthritis and Other Rheumatic Conditions ( Poole et al., 2017 ). Each article in this series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical reasoning.

OBJECTIVE. This study assessed the feasibility and preliminary efficacy of an online-assisted, occupational therapist–delivered, cognitive–behavioral therapy intervention to promote physical function in patients with knee osteoarthritis (KOA). METHOD. Fifty-seven participants with KOA were randomized 2:1 to the Engage program (eight clinic-based sessions supported by online modules) or usual care. Using analysis of covariance, we estimated Engage’s effect on physical function (Western Ontario and McMaster Universities Osteoarthritis Index’s Physical Function subscale [WOMAC–PF]) at 6 mo. RESULTS. Data were analyzed on 46 completers. Engage was associated with a small effect (η² = 0.01) on the WOMAC–PF. More Engage participants than controls reported much or very much improvement (45% vs. 13%; p = .03). Satisfaction was high, and 30 of 31 participants attended six sessions or more. CONCLUSION. An online-supported cognitive–behavioral program for people with KOA delivered by occupational therapists is feasible and may contribute to improved physical function.

Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of a person who underwent a total knee replacement due to severe osteoarthritis of his left knee. The occupational therapy assessment and intervention process both before and after surgery in the home setting is described. Findings from the systematic review ( Dorsey & Bradshaw, 2017 ) on this topic were published in the January/February 2017 issue of the American Journal of Occupational Therapy and in AOTA’s Occupational Therapy Practice Guidelines for Adults With Musculoskeletal Conditions. Each article in this series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical reasoning.

OBJECTIVE. The purpose of this study was to investigate the gender differences in psychosocial and physical outcomes in users of lower-extremity prostheses who became amputees after the 2010 earthquake in Haiti. METHOD. We enrolled 140 unilateral amputees in this cross-sectional study in Port-au-Prince, Haiti. Trained staff administered the assessments by reading the questions aloud to participants. Participants completed the Trinity Amputation and Prosthesis Experience Scales and Locomotor Capabilities Index about 2 yr after the earthquake. RESULTS. We found no gender differences in psychosocial adjustment and physical outcomes, except for strenuous physical activities and phantom pain, and both genders reported difficulty in social adjustment. After controlling for strenuous physical activities and phantom pain, we found that men showed worse psychosocial adjustment than women. CONCLUSION. Services for psychosocial adjustment are critical for traumatic amputees and should be incorporated into rehabilitation programs after a disaster. Interventions should consider gender roles in the indigenous culture.

OBJECTIVE. The purpose of this study was to understand the age-related changes, adaptations, and contexts that support older workers in the manufacturing sector. METHOD. In a multiple-case study, 10 older workers from two manufacturing companies completed the Job Content Questionnaire, Health and Productivity Questionnaire, and semistructured interviews and underwent task observations for 8 hr over 4 mo. RESULTS. Age-related changes affecting job tasks included near vision, upper extremity strength, grip strength, joint stiffness, and endurance. Older workers adapted job tasks by changing their work style, using equipment available, and relying on close coworkers for assistance. They adapted their personal lifestyle to maintain the energy necessary to meet job demands. Organizational contexts that supported older workers highlighted job control, social support, and mutual respect. CONCLUSION. This study suggests that occupational therapy practitioners can provide individualized adaptations, environmental modifications, and health promotion strategies to help older workers meet job demands while balancing work and home occupations.

OBJECTIVE. Proximal humerus fractures are highly traumatic and debilitating. Surgical fixation may be contraindicated in older clients, thus requiring a systematic rehabilitation protocol. These clients may suffer loss of independence and require long-term assistance if not treated properly. METHOD. In this case report, we describe the occupation-based conservative rehabilitation of a retired male client after a four-part proximal humerus fracture. Outcome measurements used were the QuickDASH, the Numeric Rating Scale for Pain, goniometric measurements, and manual muscle testing. Repeated measures were used to collect data throughout a 12-mo period. RESULTS. Scores and measurements demonstrated improvement in all four outcome measures with clinically notable improvements achieved and maintained throughout the 12-mo period. The client reported a full return to activity. CONCLUSION. The techniques presented can be used by clinicians to create treatment plans, achievable functional goals, and realistic expectations for their clients. The protocol can aid clinicians in achieving objective milestones through occupation-based interventions.

This Evidence Connection describes a case report of a man with non-Hodgkin’s lymphoma who underwent an allogenic stem cell transplant. The occupational therapy assessment and treatment processes for an outpatient rehabilitation setting are described. Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Project.

OBJECTIVE. Our objective was to determine the efficacy of a Lifestyle Redesign^® intervention for people living with chronic pain on quality of life (QOL), function, self-efficacy, and pain levels. METHOD. Clinical outcomes were collected from 45 patients who completed an individual outpatient Lifestyle Redesign occupational therapy program for chronic pain as part of their usual plan of medical care. Outcome measures included the Canadian Occupational Performance Measure, the 36-Item Short-Form Survey, the Brief Pain Inventory, and the Pain Self-Efficacy Questionnaire. We analyzed scores using paired-samples t tests. RESULTS. Significant changes were observed in occupational performance and satisfaction scores, physical and social functioning, role limitations due to physical and emotional problems, energy and fatigue, general health, and pain self-efficacy. CONCLUSION. Lifestyle Redesign interventions, when integrated into a patient’s medical plan of care, can improve patient functioning, self-efficacy, and QOL.