Stephen C L LauStephanie JudyckiMikayla MixOlivia DePaul...
11页
查看更多>>摘要：Self-management is a critical component of stroke rehabilitation. A better understanding of the use of theory and behavior change techniques (BCTs) informs the development of more effective stroke self-management interventions. To examine what theories and BCTs have been applied in stroke self-management interventions; investigate the extent to which these interventions encourage implementation of behavior changes; and appraise their effectiveness to enhance self-efficacy, quality of life, and functional independence. Ovid MEDLINE, Embase, Scopus, CINAHL, Cochrane Library, and ClinicalTrials.gov were searched from inception to May 26, 2020. Randomized controlled trials (RCTs) in six databases were reviewed for inclusion and analysis. We included trials that involved community-dwelling adult stroke survivors, assessed the effectiveness of self-management interventions, and explicitly mentioned the use of theory in the development of the intervention. We assessed use of theory and BCTs using the Theory Coding Scheme and BCT taxonomy v1, respectively. A total of 3,049 studies were screened, and 13 RCTs were included. The predominant theory and BCT categories were Social Cognitive Theory (7 studies) and goals and planning (12 studies), respectively. Significant and small effect sizes were found for self-efficacy (0.27) and functional independence (0.19). Theory-based self-management interventions have the potential to enhance stroke outcomes. Systematic reporting on the use of theory and BCTs is recommended to enhance clarity and facilitate evaluations of future interventions. What This Article Adds: This review supports and guides occupational therapy practitioners to use theory-based self-management intervention as a routine part of stroke rehabilitation to improve stroke survivors' experience in the community.
查看更多>>摘要：Patients with schizophrenia tend to have severe deficits in theory of mind, which may limit their interpretation of others' behaviors and thereby hamper social participation. Commonly used measures of theory of mind assess the ability to understand various social situations (e.g., implied meaning or hinting, faux pas), but these measures do not yield valid, reliable, and gender unbiased results to inform interventions for managing theory-of-mind deficits. We used understanding of implied meaning, which appears to be a unidimensional construct highly correlated with social competence, as a promising starting point to develop a theory-of-mind assessment. To develop a Rasch-calibrated computerized test of implied meaning. Cross-sectional design. Psychiatric hospitals and community. 344 participants (240 patients with schizophrenia and 104 healthy adults). We initially developed 27 items for the Computerized Implied Meaning Test. After inappropriate items (12 misfit items and 1 gender-biased item) were removed, the remaining 14 items showed acceptable model fit to the Rasch model (infit = 0.84-1.16; outfit = 0.65-1.34) and the one-factor model (comparative fit index = .91, standardized root mean square residual = .05, root-mean-square error of approximation = .08). Most patients (81.7%) achieved individual Rasch reliability of ≥.90. Healthy participants performed significantly better on the test than patients with schizophrenia (Cohen's d = 2.5, p < .001). Our preliminary findings suggest that the Computerized Implied Meaning Test may provide reliable, valid, and gender-unbiased results for patients with schizophrenia. What This Article Adds: We developed a new measure for assessing theory-of-mind ability in patients with schizophrenia that consists of items targeting the understanding of implied meaning. Preliminary findings suggest that the Computerized Implied Meaning Test is reliable, valid, and gender unbiased and may be used in evaluating patients' theory-of-mind deficits and relevant factors.
Brian P JohnsonJill WhitallSandy McCombe WallerKelly P Westlake...
5页
查看更多>>摘要：Few tools are available to assess bimanual deficits after stroke. To develop the Bimanual Assessment Measure (BAM), which assesses a person's hand coordination in both preferred and prestroke roles (i.e., stabilizer or manipulator). Development and psychometric testing of the BAM. Research laboratory. People with chronic stroke (n = 24), age-matched controls (n = 23), and occupational therapists (n = 40). We assessed the BAM's internal consistency, reliability, and face and known-groups validity. Items were selected as meaningful tasks that represented a range of bimanual coordination requirements (e.g., symmetrical forces and timing, asymmetrical forces and timing, time-limited reactive movement). Focus groups of people with stroke and occupational therapists provided input into BAM development. The BAM was found to have excellent reliability and internal consistency and face and known-groups validity. The BAM is a valid, reliable measure for people with chronic stroke that identifies bimanual coordination deficits beyond unimanual impairments and the potential capacity for people to return to prestroke hand roles (i.e., as a manipulator). What This Article Adds: This article introduces the BAM as a new assessment measure of bimanual functioning with the potential capacity to restore prestroke hand roles as either a manipulator or a stabilizer among people with chronic stroke.
Emily MoenAlison McLeanLara A BoydJulia Schmidt...
6页
查看更多>>摘要：Concussions are common among children and youth. To date, the pediatric concussion literature has focused on quantitative reports of the effects of concussion and return-to-activity guidelines. However, the subjective experiences of children and youth returning to occupations postconcussion have largely been ignored. An understanding of these experiences is critical to inform effective concussion management. To investigate the experiences of children and youth returning to occupations after sustaining a concussion and the impacts on their future engagement in occupation. Qualitative interpretive description was used for data analysis and interpretation. Community. Children and youth ages 11 to 18 yr from a cohort study were recruited to be interviewed about their experiences of engaging in occupations postconcussion. Interviews were conducted 3 to 24 mo postconcussion, transcribed verbatim, and analyzed using interpretive description to identify themes. Eight children and youth (5 male, 3 female) were included. Analyses revealed three themes of the experiences of children and youth returning to occupations after concussion: diverse experiences of concussion, knowledge is key to concussion management, and concussions affect occupational engagement. This study highlights the importance of considering a person's needs to enable effective concussion treatment plans. The results suggest the need for an occupation-based framework to guide interventions in pediatric concussion management. What This Article Adds: Our findings indicate that children and youth report variable recovery patterns, a lack of knowledge about concussion recovery, and a negative effect of concussion on occupational engagement.
查看更多>>摘要：Understanding the long-term participation restrictions after breast cancer (BC) is crucial for developing occupation-based interventions. To (1) compare women's participation during the BC subacute phase (2 yr postdiagnosis) with the chronic (5 yr postdiagnosis) phase, (2) explore factors associated with participation in the chronic phase, and (3) describe strategies women use to overcome participation restrictions. Descriptive longitudinal study. A community health service in Israel. A convenience sample of 30 women (M age = 53.9 yr, SD = 8.3) diagnosed with BC (Stages 1-3). Demographic and BC-related symptom questionnaires; an adapted version of the Activity Card Sort, used to assess retained activity levels (RALs) compared with prediagnosis activity levels in sociocultural, physical, and instrumental domains; the Canadian Occupational Performance Measure; and one open-ended qualitative question, "How were you able to retain your participation in daily activities despite the long-term effects of BC?" Significantly higher total RALs were found in most domains for women in the chronic (M = 0.93 RAL, SD = 0.27) compared with the subacute (M = 0.71, SD = 0.22) phase, t(29) = 4.72, p < .001. Almost half the women achieved clinically significant change in their meaningful activities. Lower levels of participation were significantly correlated with higher symptom severity. The qualitative findings indicated that coping strategies, such as positive thinking and changing priorities, helped in managing women's participation. Participation restrictions and residual BC-related symptoms 5 yr postdiagnosis demonstrated the need for a comprehensive evaluation and early occupational therapy intervention to prevent long-term restrictions. What This Article Adds: This study highlights the value of a comprehensive assessment of daily participation (i.e., participation in various activity domains and in specific individual meaningful activities) of women with BC. The combination of quantitative and qualitative analysis provided a subjective perspective and deeper understanding of the associations among long-term symptoms, participation restrictions, and coping strategies.
Clare C BassileJacqueline S PfefferTheresa M MorroneJoel Stein...
8页
查看更多>>摘要：The American Heart Association and American Stroke Association recommend early identification of level of rehabilitative care as a priority after stroke. To evaluate the utility of the Activity Measure for Post-Acute Care (AM-PAC) "6 Clicks" Daily Activity and Basic Mobility forms to determine the next level of rehabilitation after hospitalization for adults with stroke. Retrospective cohort design using medical records from 2015 to 2016. Major urban hospital. Patients admitted to the stroke service, with a confirmed stroke, who were seen by a physical or occupational therapist; who had a 6 Clicks Basic Mobility or Daily Activity score at initial evaluation; and who were discharged to home, an acute inpatient rehabilitation facility (IRF), or a subacute skilled nursing facility (SNF). Length of stay and discharge destination. Seven hundred four participants (M age = 68.28 yr; 51.21% female) were included. Analysis of variance and receiver operating characteristic curves were performed. Daily Activity scores were highest for home discharge, lower for IRF discharge, and lowest for SNF discharge; Basic Mobility showed a similar pattern. Cutoff values distinguishing home from further inpatient rehabilitation were 44.50 for Basic Mobility and 39.40 for Daily Activity scores (area under the curve [AUC] = .82 for both forms), with scores of 34.59 (AUC = 0.64) and 31.32 (AUC = 0.67) separating IRF from SNF, respectively. Therapists should incorporate 6 Clicks scores into their discharge planning. What This Article Adds: This research demonstrates the utility of an outcome measure in the acute care setting that assists in planning discharge destination for patients with stroke.
Francine M SeruyaEmily FeitAlexys TiradoDiana Ottomanelli...
10页
查看更多>>摘要：Best practice guidelines and legal mandates have deemed parent engagement an essential component of early intervention (EI). Parent coaching is an intervention and a model of service delivery used in occupational therapy practice that is designed to integrate parents into the therapy session. To examine the current definitions of coaching and the ways in which U.S. occupational therapy practitioners are using coaching models in EI. We systematically searched 11 databases-CINAHL Complete, CINAHL with full text, Education Research Complete, ERIC, PsycARTICLES, PsycINFO, Teacher Reference Center, Academic Search Premier, Academic Search Complete, Socindex with full text, and Social Work Abstracts-for articles published from 2000 through 2020. A total of 178 articles were retrieved, and 60 underwent full-text review. The final review included 16 studies of varying designs in which occupational therapy was one of the interventions and in which various definitions of coaching and models were used. The concepts inherent in coaching models were consistent across studies. There was little emphasis on the efficacy of coaching models as related to goal attainment. Coaching is a viable intervention in EI. Studies are needed to assess the efficacy of the parent coaching model in achieving child and family outcomes and the training needed to provide the intervention appropriately. What This Article Adds: This scoping review explores existing research on coaching interventions and models used by occupational therapists in EI. Findings indicate that this is an area of opportunity because the model of parent coaching strongly aligns with the professional scope of occupational therapy practice.
查看更多>>摘要：Identifying the extent and predictors of burnout among occupational therapy practitioners is important so strategies can be developed to reduce burnout and mitigate associated consequences within the profession. To investigate the prevalence and determinants of burnout reported by U.S. occupational therapy practitioners. Cross-sectional survey. Occupational therapy practitioners working in a wide range of clinical settings who spent at least 50% of their time in direct patient care and who had been employed continuously for more than 6 mo. The outcome of interest was burnout, which was measured using the Emotional Exhaustion, Depersonalization, and Personal Accomplishment subscales of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Predictor variables included sociodemographic and workplace characteristics. The relationship between MBI-HSS subscale scores and predictor variables was jointly estimated using a multivariate multivariable linear regression analysis. One hundred seventy-eight occupational therapy practitioners completed the survey. Higher perceived level of supervisor support, satisfaction with income, and educational attainment were associated with lower MBI-HSS subscale scores (ps = .001, .002, and .005, respectively). Burnout among occupational therapy practitioners can be conceptualized as an issue of workplace health and safety. Various stakeholder groups can consider potential systematic interventions involving measures to promote positive supervisor support in the workplace and salary negotiation skills for early-stage clinicians. Future research should explore broad interventions to reduce burnout among clinicians. What This Article Adds: We estimated the extent and predictors of burnout among U.S. occupational therapy practitioners. Future research, advocacy, and policy should address structural-level interventions to promote workplace cultures and conditions that can protect the occupational therapy workforce from burnout.
查看更多>>摘要：People with chronic mental illness (CMI) are at high risk of poor cardiorespiratory fitness as a result of sedentary behavior and physical inactivity. Occupational therapy practitioners play a key role as advocates for positive lifestyle change for people with CMI. To determine the relationships between occupational therapy activities and cardiorespiratory fitness among inpatients with CMI. This retrospective research included three phases: descriptive cohort, case-control, and cross-sectional studies. Psychiatric inpatient facility. Inpatients with CMI, ages 18 to 65 yr (N = 325). Data were collected over a 12-mo period. Each daily occupational therapy activity performed by participants was converted to energy expenditure (in kcal). Cardiorespiratory fitness was measured by means of the 3-Minute Step Test. After daily occupational therapy activities, significantly more participants increased cardiorespiratory fitness than declined (McNemar χ2 [1] = 29.18, p < .05). Prevocational activities and moderate- to high-intensity exercises met the optimal energy expenditure level (>352 kcal) necessary to achieve an increase in cardiorespiratory fitness. Occupational therapists in psychiatric inpatient settings should prescribe individualized occupation-based or physical activities that meet the optimal daily energy expenditure for each client to improve their cardiorespiratory function. What This Article Adds: This study is one of the first attempts to explore cardiorespiratory fitness outcomes after daily occupational therapy activities for people with CMI. Physical benefits unfolded throughout psychiatric care, echoing the profession's stance on holistic practice.
Ketki D RainaJennifer Q MorseDenise ChisholmEllen M Whyte...
8页
查看更多>>摘要：Fatigue is a chronic and distressing sequela of traumatic brain injury (TBI). Little evidence exists for the efficacy of interventions that address post-TBI fatigue. To evaluate the preliminary efficacy of a self-management intervention (Maximizing Energy; MAX) for reducing the impact (primary outcome) and severity of fatigue on daily life, improving fatigue experience, and increasing participation compared with a health education (HE) intervention. Pilot randomized controlled trial (RCT). Community. Forty-one participants randomly assigned to the MAX (n = 20) or HE (n = 21) intervention. The MAX intervention included problem-solving therapy with energy conservation education to teach participants fatigue management. The HE intervention included diet, exercise, and energy conservation education. Both interventions (30 min/day, 2 days/wk for 8 wk) were delivered online by occupational therapists. The primary outcome was the modified Fatigue Impact Scale (mFIS). Outcome measures were collected at baseline, postintervention, and 4- and 8-wk postintervention. At 8 wk postintervention, participants in the MAX group reported significantly lower levels of fatigue impact (mFIS) than those in the HE group, F(1, 107) = 29.54, p = .01; Cohen's d = 0.87; 95% confidence interval [0.18, 1.55]. These findings provide preliminary evidence that the MAX intervention may decrease the impact of fatigue on daily life among people with post-TBI fatigue. What This Article Adds: An internet-based, self-management intervention combining occupational therapy- delivered energy conservation education with cognitive-behavioral therapy seems to reduce fatigue impact and severity among people with post-TBI fatigue. Future appropriately powered RCTs could positively contribute to the evidence available to occupational therapy practitioners for this chronic, debilitating, and often overlooked symptom.
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