Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Project. In this Evidence Connection article, I describe a clinical case report of an older adult with a chronic condition and his daughter who received home health occupational therapy services. I discuss the occupational therapy evaluation and intervention processes with these clients to support chronic condition self-management, coping skills, and problem solving, drawing on findings from the systematic review on the effectiveness of interventions for care partners of people with chronic conditions published in the July/August 2021 issue of the American Journal of Occupational Therapy. It is my hope that this Evidence Connection article can be used to inform and guide clinical decision making when working with older adults with chronic conditions and their care partners.

Date Presented 04/7/21 A pilot for integrating OT into a Department of Corrections Community Supervision Center was implemented. This pilot sought to use OT assessment and intervention for justice-involved individuals to address skill building, increase problem solving, and further explore the needs and barriers to re-entry, including maintenance of supervision to prevent recidivism. This pilot highlighted a gap in life skills training for this population and this program's impact. Primary Author and Speaker: Ariana Gonzalez Additional Authors and Speakers: Megan Davis, Emily Gralinski, Stephanie Monforte,and Jacqueline Strausser

Importance: The aging of the population is generating increased demand for occupational therapy practitioners to address the occupational performance of those experiencing low vision. Objective: This Practice Guideline, which is informed by systematic reviews on interventions for older adults with low vision, is meant to serve as a reference for occupational therapy practitioners to guide best practice in service delivery, improve quality of care, enhance consumer satisfaction, and justify occupational therapy services to external stakeholders. Interventions included in this guideline address performance of activities of daily living (ADLs) and instrumental activities of daily living (IADLs), reading, and leisure and social participation. Method: We examined, synthesized, and integrated the results of three systematic reviews into recommendations for practice, education, and research. Results: Thirty-eight articles were included in the systematic reviews, which served as the basis for clinical recommendations. A case study describes translation and application of the recommendations to clinical practice. Conclusions and Recommendations: Strong evidence supports the role of occupational therapy for older adults with low vision. On the basis of the evidence, we recommend routine use of low vision rehabilitation for ADL and IADL impairments, multicomponent interventions to improve ADL and IADL performance and leisure and social participation, stand-based electronic magnification to enhance reading, and visual skills training to enhance reading for clients with a central field impairment. We recommend using client-centered problem-solving training to enhance ADL and IADL performance, reading, and leisure and social participation. Mainstream technology may be considered for use on a case-by-case basis to enhance reading performance. Finally, adapted tango may be considered for use on a case-by-case basis to enhance ADL and IADL performance and leisure and social participation. What This Article Adds: This Practice Guideline provides a summary of the current evidence supporting occupational therapy intervention for older adults with low vision. It summarizes the emerging literature supporting the use of mainstream technology and provides additional support for the use of multicomponent intervention strategies.

Importance: Leaders in the occupational therapy profession have called for occupational therapy’s inclusion in primary care, but little is known about the occupational needs of patients in this setting. Objective: To explore the need for and potential role of occupational therapy in a team-based primary care clinic. Design: A qualitative descriptive study using a convenience sample of clinicians and patients. Meetings and semistructured interviews were recorded, transcribed, and coded by multiple coders using a general immersion–crystallization approach to identify relevant themes. Setting: Outpatient complex care clinic of an urban academic medical center. Participants: The study included a voluntary sample of clinicians and patients from the complex care clinic. Patients were recruited from a staff-provided list; eligible patients had attended the clinic for at least 1 yr. All patients had multiple chronic conditions and were uninsured or received Medicaid. Results: Researchers attended 10 clinician team meetings and conducted 13 patient interviews and 10 clinician interviews. Four domains of patient need were identified by both patients and clinicians: complex medical management, patients’ limited resources, mental health needs, and challenges to occupation. Clinicians also identified cognitive–behavioral challenges affecting care, including lack of engagement and poor problem solving. Conclusions and Relevance: The makeup of the clinic team reflected their intent to address medical, socioeconomic, and mental health domains. However, cognitive–behavioral challenges and patients’ occupational limitations were not consistently addressed. Thus, patients had unmet needs that occupational therapy practitioners were qualified to address. What this Article Adds: This study adds to the available literature examining patient needs and clinician challenges in a primary care clinic. Patients have occupational needs that are not being addressed in primary care, indicating a need for occupational therapy in this setting.

OBJECTIVE. A national study explored the use of simulated learning experiences in U.S. occupational therapy and occupational therapy assistant entry-level academic programs. METHOD. Program faculty at 245 of 310 occupational therapy assistant and occupational therapy entry-level programs completed a self-reported 23-question online survey on the use of simulation and its challenges and benefits. Data were analyzed using frequency, percentage, and thematic coding. RESULTS. Of 245 programs, 175 (71%) reported using simulation, with the most common teaching methods incorporating human actors and students and video cases. Simulated scenarios were primarily presented in intervention courses (90%). Faculty provided feedback that benefits of the simulated experience were increased critical reasoning, problem solving and decision making, and communication among students. Challenges were time, cost, and scheduling. CONCLUSION. Findings were similar to those in the literature in terms of simulated learning’s uses, benefits, and challenges. Further research on student learning outcomes and pedagogy in occupational therapy is recommended.

This systematic review examined evidence regarding the effectiveness of interventions within the scope of occupational therapy practice to maintain, restore, and improve performance in leisure and social participation for older adults with low vision. We identified and reviewed 13 articles that met the inclusion criteria. Four themes related to interventions to improve leisure and social participation emerged from the literature review: using a problem-solving approach, delivering a combination of services, providing skills training, and making home visits and environmental adaptations. The strongest evidence supports using a problem-solving approach to improve leisure and social participation for older adults with low vision. Evidence was moderate supporting the delivery of a combination of services, either by one professional or through an interdisciplinary approach. Results for the effectiveness of skills training and home visits and home adaptations were mixed. Implications for practice, education, and research are discussed.

OBJECTIVE. We investigated the effects of an explicit problem-solving skills training program using a meta componential approach with 33 outpatients with moderate acquired brain injury, in the Hong Kong context. METHOD. We compared an experimental training intervention with this explicit problem-solving approach, which taught metacomponential strategies, with a conventional cognitive training approach that did not have this explicit metacognitive training. RESULTS. We found significant advantages for the experimental group on the Metacomponential Interview measure in association with the explicit metacomponential training, but transfer to the real-life problem-solving measures was not evidenced in statistically significant findings. Small sample size, limited time of intervention, and some limitations with these tools may have been contributing factors to these results. CONCLUSION. The training program was demonstrated to have a significantly greater effect than the conventional training approach on metacomponential functioning and the component of problem representation. However, these benefits were not transferable to real-life situations.

This commentary provides an analysis of an article by Gere, Capps, Mitchell, and Grubbs (2009) about sensory sensitivities of gifted children. The article reports that children who are gifted are more sensitive to sensory experiences. Researchers hypothesized that children's sensitivities contribute to their excellent problem-solving skills and might contribute to their challenges with social interaction. The coexistence of a helpful and challenging characteristic that may be related to sensory sensitivity suggests the need for additional intervention paradigms that support all aspects of children's participation. The Gere et al. (2009) study invites occupational therapists to consider broader perspectives about who would benefit from services and how we might provide services in a school context. This article offers suggestions that would strengthen future studies with gifted children and outlines strategies for evidence-based practice that include children who are gifted.

Within occupational therapy education, there has been increased attention to curricula and courses that emphasize problem solving, clinical reasoning, and synthesis of information across traditional discipline-specific boundaries. This article describes the development, implementation, and outcomes of a problem-based learning course entitled Selected Cases in Occupational Therapy. The course was designed to help students to integrate the various elements of a specific occupational therapy curriculum and to enhance their abilities to respond to an ever-changing health care environment. An evaluation of the course by the first 11 students who completed it revealed both strengths and weaknesses. Students responded that the course enhanced their professional behavior, including interpersonal communication skills, team work, and follow-through with professional responsibilities; helped them to integrate the various elements of the total occupational therapy academic program; enhanced their clinical reasoning skills by providing a structure for thinking through clinical issues; and provided personal gain or benefit (i.e., students perceived the course to be a valuable, realistic, and motivating experience). The students also identified several specific course elements that contributed to its integrating function, including content, class session format, and students’ role. Identified course weaknesses included the methods of evaluating student performance and the format and content of specific cases.

The purpose of this study was to construct and validate a problem-solving version of the existing Allen Cognitive Level Test (ACL) (Allen, 1985). The new problem-solving version of the ACL (ACL–PS) follows the theoretical developments of the cognitive disability theory and the information processing approach. It was constructed to provide a more accurate assessment of the problem-solving process as well as task performance, especially at the higher cognitive levels. Both tests were administered to a psychiatric adolescent group (n = 49) who were subdivided according to diagnosis and to a matched nondysfunctional control group (n = 29). The results showed that both the ACL and the ACL–PS differentiated significantly between the patients and the control subjects and among the patient groups. At Level 6 of the ACL, none of the subjects needed any demonstration, with all scores distributed between independent performance or performance following verbal instructions only, that is, problem-solving phases that were added with the ACL–PS. The scoring of the ACL–PS is provided in addition to detailed scoring of the cognitive levels. It is suggested that the ACL–PS be implemented as a clinical evaluative tool with adolescents.

This study used the information-processing approach to conceptualize planning and problem-solving abilities and to expand the theoretical and empirical data base of Claudia Allen’s cognitive disability model. The congruent validity of the Allen Cognitive Levels (ACL) test as a measure of cognition, specifically of the fluid information-processing abilities that underlie learning, was investigated. Criterion measures used were subtests of the Wechsler Adult Intelligence Scale–Revised edition (WAIS–R). Forty adult psychiatric patients participated in the study. Spearman r coefficients showed moderately high correlations between the ACL test and the WAIS-R subtests measuring fluid abilities, and Performance scale IQ. These results indicate that Allen’s model and test can be useful in guiding occupational therapy planning when expected outcomes depend on the patient’s learning potential.

The process of treatment planning requires the effective application of complex problem-solving skills. The occupational therapy literature has described components of this process and has identified both the difficulty educators have in teaching and the difficulty clinicians have in articulating the process of clinical problem solving. This paper presents a conceptual model of the dynamic process of occupational therapy treatment planning based on the case method of problem solving. An analysis of the process provides a basis for academic and clinical educators to effectively instruct and supervise students in treatment planning. An analysis of critical concepts related to each stage is followed by (a) common clinical errors committed by students and new therapists and (b) suggestions for supervisory approaches specific to errors at each stage.