American Journal of Occupational Therapy

Federally qualified health centers (FQHCs) provide low- or no-cost primary care to medically underserved populations such as homeless or low-income people, migrant workers, and members of marginalized cultural groups. Occupational therapy services have the potential to help improve the health and functioning of FQHC patients. Using a FQHC serving American Indian/Alaska Native populations as a case example, we describe how occupational therapy is well suited to help meet the needs of medically underserved populations. We then examine options for integrating occupational therapy into this unique primary care setting, discuss related administrative and policy considerations, and propose possible solutions to identified barriers.

Cancer survivors are at risk for occupational performance issues related to activities of daily living, instrumental activities of daily living, work, and social and community participation. Occupational therapy practitioners can address these performance issues by offering services within existing community cancer survivorship programs that focus on adaptive and compensatory strategies to facilitate meaningful lifestyles and optimize health and well-being. Occupational therapy services do not currently exist at these community sites, nor are occupational therapy practitioners recognized as providers in existing community cancer survivorship programs. Recognition of practitioners’ distinct value in cancer survivorship, advocacy for occupational therapy services in the community, development of supporting documentation for occupational therapy’s role in community survivorship, and research on the efficacy of interventions in community cancer survivorship are needed to expand occupational therapy’s role with this growing population.

OBJECTIVE. This qualitative study examined the experience of occupational engagement in low-income Latina breast cancer survivors and suggests the potential for occupational therapy practitioners to improve health outcomes in this vulnerable and underserved population.

METHOD. Semistructured interviews were conducted with 9 participants. Inductive analysis was used to code for themes and patterns related to occupational engagement and quality of life (QOL).

RESULTS. Lack of occupational engagement negatively affected QOL, but participation in occupations such as religious activity and caregiving promoted well-being. Financial concerns and communication barriers decreased QOL.

CONCLUSION. Breast cancer can have a negative impact on occupational engagement in low-income Latina breast cancer survivors; however, some occupations may increase QOL. Socioeconomic status and cultural values influence occupational engagement and QOL. Occupational therapy practitioners can improve health outcomes in this population through awareness of relevant sociocultural factors and attention to appropriate patient communication.

This article is the first part of a systematic review of evidence for the effectiveness of cancer rehabilitation interventions within the scope of occupational therapy that address the activity and participation needs of adult cancer survivors. This article focuses on the importance of physical activity and symptom management. Strong evidence supports the use of exercise for cancer-related fatigue and indicates that lymphedema is not exacerbated by exercise. Moderate evidence supports the use of yoga to relieve anxiety and depression and indicates that exercise as a whole may contribute to a return to precancer levels of sexual activity. The results of this review support inclusion of occupational therapy in cancer rehabilitation and reveal a significant need for more research to explore ways occupational therapy can positively influence the outcomes of cancer survivors. Part 2 of the review also appears in this issue.

This article is the second part of a systematic review of evidence for the effectiveness of cancer rehabilitation interventions within the scope of occupational therapy that address the activity and participation needs of adult cancer survivors. This article focuses on the use of multidisciplinary rehabilitation and interventions that address psychosocial outcomes, sexuality, and return to work. Strong evidence indicates that multidisciplinary rehabilitation benefits cancer survivors and that psychosocial strategies can reduce anxiety and depression. Moderate evidence indicates that interventions can support survivors in returning to the level of sexuality desired and help with return to work. Part 1 of the review also appears in this issue.

Parents of children with autism spectrum disorder (ASD) may have difficulty engaging their children through play, thus affecting the parent–child relationship and parental self-efficacy. This study intended to examine children’s sensory profile and adults’ playfulness as predictors of parental self-efficacy. A total of 136 parents of children ages 3–7 yr completed the Short Sensory Profile, the Playfulness Scale for Adults, and the Tool to Measure Parenting Self-Efficacy. For the parental couples of children with ASD, the most relevant predictor of general parental self-efficacy was the child’s sensory profile. However, adult playfulness resulted in the most relevant predictor of emotional parental self-efficacy. Findings suggest the importance of considering play as a relevant co-occupation that must be acknowledged when intervening with families of children with ASD and considering the child’s sensory modulation abilities, as well as parents’ playfulness and sense of self-efficacy, as potential outcomes when designing and evaluating treatment programs.

This article describes two studies that focused on parents’ expectations and satisfaction with occupational therapy intervention for their children (N = 208). The first study determined the psychometric properties of the Parents as Partners in Intervention (PAPI) Questionnaire set (n = 146). The 2nd study examined parental expectations, satisfaction, and perception of their child’s functional gains from individual- (n = 30 parents) and group- (n = 32 parents) based interventions. Overall, the results of these studies further support the PAPI Questionnaire set's validity and reliability and suggest that parents’ expectations are high and not necessarily in line with their actual satisfaction with the outcomes of their child’s intervention and functional gains.

We investigated a visual–perceptual and haptic–perceptual training program to enhance motor skills and Chinese handwriting performance among children with handwriting difficulties. The participants were 28 first- and second-grade children with handwriting difficulties. They were matched according to age and then randomly assigned into a control group or an experimental group. Participants in the experimental group received 12 sessions of a training program, whereas those in the control group received conventional handwriting training. The Test of Visual Perceptual Skills—Third Edition (TVPS–3), Tactual Performance Test (TPT), and Battery of Chinese Basic Literacy (BCBL) were all administered before and after 6 wk of intervention. Repeated-measures analysis of variance revealed that the experimental group showed significant improvement on the TVPS–3 but not on the TPT. Along with the improved visual–perceptual skills, the experimental group showed a significant difference in far-point copy speed and handwriting accuracy, as reflected in the BCBL.

The purpose of this national survey was to explore perceptions of professional reward among occupational therapist (OT) and occupational therapy assistant (OTA) academic fieldwork coordinators (AFWCs). Agreement was found in ranking the value of six role factors: (1) fieldwork data management, (2) fieldwork site management, (3) fieldwork teaching and consultation, (4) departmental and institutional compliance, (5) scholarship and accreditation, and (6) laying groundwork for students in fieldwork. Both levels of AFWC indicated teaching and consultation had the highest value and data management the least. OT AFWCs placed significantly higher value on publishing articles and lower value on educating fieldwork educators about role delineation than OTA AFWCs. Five themes emerged regarding professional reward: (1) intrinsic reward, (2) collaboration, (3) development of the profession, (4) feeling appreciated, and (5) student success. AFWCs value activities involving personal interaction, promoting professional development, and facilitating student success. Results have implications for AFWC collaboration, workload distribution, and scholarship.

OBJECTIVE. Occupation is considered core and threshold knowledge for occupational therapy, yet how it is conveyed through education is not well understood. This study examined how the concept of occupation was taught in occupational therapy and occupational therapy assistant curricula in the United States.

METHOD. Using a qualitative descriptive research design, in-depth interviews, video recordings, and artifacts of teaching occupation were collected from 25 programs, chosen using stratified random sampling. Interview data were analyzed using an inductive, constant comparative approach; video and artifact data were analyzed deductively using findings from the interviews.

RESULTS. Instructional methods were innovative and ranged from didactic to experiential. The degree to which occupation was present in instruction ranged from explicit to implicit to absent.

CONCLUSION. Although educators valued teaching occupation, the concept was still elusive in some instructional methods and materials. Occupation knowledge and pedagogical content knowledge may have influenced how explicitly occupation was taught.

OBJECTIVE. The aim of this study was to illustrate the use of serial trichotomization with five common tests of cognition to achieve greater precision in screening for fitness to drive.

METHOD. We collected data (using the Montreal Cognitive Assessment, Motor-Free Visual Perception Test, Clock-Drawing Test, Trail Making Test Part A and B [Trails B], and an on-road driving test) from 83 people referred for a driving evaluation. We identified cutpoints for 100% sensitivity and specificity for each test; the driving test was the gold standard. Using serial trichotomization, we classified drivers as either “Pass,” “Fail,” or “Indeterminate.”

RESULTS. Trails B had the best sensitivity and specificity (66.3% of participants correctly classified). After applying serial trichotomization, we correctly identified the driving test outcome for 78.3% of participants.

CONCLUSION. A screening strategy using serial trichotomization of multiple test results may reduce uncertainty about fitness to drive.

OBJECTIVE. To demonstrate that g-force technology can be used to help older adults with cognitive impairment improve their driving safety as part of an in-car video feedback intervention.

METHOD. Unsafe driving events triggered g-forces leading to capture of video clips. The program included 3 mo of monitoring without intervention, 3 mo of intervention (weekly written progress reports, a DVD of unsafe driving events, and weekly telephone contacts), and 3 mo of postintervention monitoring.

RESULTS. Mean total unsafe driving events per 1,000 miles were reduced from baseline by 38% for 9 of 12 participants during the intervention and by 55% for 7 participants during postintervention monitoring. Mean total unsafe driving severity scores per 1,000 miles were reduced from baseline by 43% during the intervention and by 56% during postintervention monitoring.

CONCLUSION. Preliminary results suggest that driving safety among older drivers with cognitive impairment can be improved using a behavior modification approach aimed at problem behaviors detected in their natural driving environment.

OBJECTIVE. Junior tenure-track faculty report high levels of stress and low satisfaction; the increasingly competitive funding environment compounds this discontent. We examined factors associated with junior investigators who were thinking about quitting research.

METHOD. Data were collected as part of a program evaluation of an interdisciplinary research mentoring program in an academic medical center.

RESULTS. Of the 62 mentees, 44 responded to the survey (71%). When asked “In the past year, have you considered quitting research?” 39 mentees answered the question; 17 (44%) answered in the affirmative. Those who had considered quitting had lower scores on the Clinical Research Appraisal Inventory–12 (CRAI–12) and job satisfaction and higher scores on burnout. In a regression model, we found that only CRAI–12 scores were significantly, inversely associated with thinking about quitting.

CONCLUSION. Factors associated with thinking about quitting included lower confidence in research skills, reduced job satisfaction, and higher levels of burnout.

OBJECTIVE. This systematic review investigated the role of home modification interventions to improve participation outcomes for community-living adults and older adults.

METHOD. Thirty-six articles met the inclusion criteria. The majority of the studies investigated older adult populations and used occupational therapists as interventionists.

RESULTS. Strong evidence was found for home modification interventions to improve function for people with a variety of health conditions and for both single and multicomponent interventions that included home modifications to reduce the rate and risk of falls among older adults. Moderate evidence was found for improved caregiving for people with dementia.

CONCLUSION. Comprehensive, higher intensity interventions demonstrated greater efficacy to improve occupational performance. Emerging evidence was also found for the role of occupational therapy in providing effective home modification interventions. Implications for occupational therapy practice, education, and research are discussed.

OBJECTIVE. To understand how two types of aerobic exercise affect upper-extremity motor recovery post-stroke. Our aims were to (1) evaluate the feasibility of having people who had a stroke complete an aerobic exercise intervention and (2) determine whether forced or voluntary exercise differentially facilitates upper-extremity recovery when paired with task practice.

METHOD. Seventeen participants with chronic stroke completed twenty-four 90-min sessions over 8 wk. Aerobic exercise was immediately followed by task practice. Participants were randomized to forced or voluntary aerobic exercise groups or to task practice only.

RESULTS. Improvement on the Fugl-Meyer Assessment exceeded the minimal clinically important difference: 12.3, 4.8, and 4.4 for the forced exercise, voluntary exercise, and repetitive task practice–only groups, respectively. Only the forced exercise group exhibited a statistically significant improvement.

CONCLUSION. People with chronic stroke can safely complete intensive aerobic exercise. Forced aerobic exercise may be optimal in facilitating motor recovery associated with task practice.

Occupational therapy is a field with a long-standing history of recommending and implementing interventions designed to improve the quality of life of clients with disabilities. Often, the interventions are individualized to meet the needs of this diverse group of clients in dynamic settings. Identifying effective and efficient interventions for such a diverse group of clients and settings requires a flexible research approach. Single-case experimental designs (SCEDs) allow practitioners and researchers to answer experimental questions within the context of rigorous research designs. The purpose of this article is to highlight the similarities between the mission of occupational therapy and SCEDs. Recommendations for designing single-case studies with the framework provided by the Single-Case Reporting Guideline in Behavioral Interventions are provided. In addition, common problems and proposed solutions, along with implications for practitioners and researchers, are provided.

Occupational therapists are constantly searching for engaging, high-technology interactive tasks that provide immediate feedback to evaluate and train clients with visual scanning deficits. This study examined the relationship between two tools: the VISION COACH™ interactive light board and the Functional Object Detection^© (FOD) Advanced driving simulator scenario. Fifty-four healthy drivers, ages 21–66 yr, were divided into three age groups. Participants performed braking response and visual target (E) detection tasks of the FOD Advanced driving scenario, followed by two sets of three trials using the VISION COACH Full Field 60 task. Results showed no significant effect of age on FOD Advanced performance but a significant effect of age on VISION COACH performance. Correlations showed that participants’ performance on both braking and E detection tasks were significantly positively correlated with performance on the VISION COACH (.37 < r < .40, p < .01). These tools provide new options for therapists.

Pediatric occupational therapy practitioners frequently provide interventions for children with differences in sensory processing and integration. Confusion exists regarding how best to intervene with these children and about how to describe and document methods. Some practitioners hold the misconception that Ayres Sensory Integration intervention is the only approach that can and should be used with this population. The issue is that occupational therapy practitioners must treat the whole client in varied environments; to do so effectively, multiple approaches to intervention often are required. This article presents a framework for conceptualizing interventions for children with differences in sensory processing and integration that incorporates multiple evidence-based approaches. To best meet the needs of the children and families seeking occupational therapy services, interventions must be focused on participation and should be multifaceted.

The American Occupational Therapy Association (AOTA) Evidence-Based Practice Project has developed a table summarizing the research opportunities on people with autism spectrum disorder. The table provides an overview of the state of the current available evidence on interventions within the scope of occupational therapy practice and is based on the systematic reviews from the AOTA Evidence-Based Practice Guidelines Series. Researchers, students, and clinicians can use this information in developing innovative research to answer important questions within the occupational therapy field.

This case report provides an overview of the psychometric properties and clinical utility of the My Vocational Situation (MVS) instrument. The accompanying hypothetical case description illustrates how clinicians could use the MVS to evaluate vocational preferences and outcomes and how the MVS can be used to inform treatment planning and rehabilitation decision making. The information contained in this report is intended to familiarize clinicians with the administration and scoring of the MVS, the psychometric information necessary to interpret results obtained from the MVS, and how the results could be used to provide comprehensive, patient-centered care. It is important to note that the information provided represents only a sample of the available research literature on the MVS.