Canadian Occupational Performance Measure Research Articles

Improving Participation among Youth with Disabilities within Their Unique Socio-Cultural Context during COVID-19 Pandemic: Initial Evaluation

Participation in meaningful activities is important for quality of life among youth with disabilities; yet participation is often restricted during adverse times. This study aimed to explore the effectiveness of the Pathways and Resources for Engagement and Participation (PREP) intervention among ultra-Orthodox Jewish Israeli youth with disabilities during the COVID-19 pandemic. A 20-week single-subject research design with multiple baselines measuring participation goals/activities was employed with two youths (15 and 19 years old) combining quantitative and qualitative descriptive data. Changes in participation levels were measured biweekly using the Canadian Occupational Performance Measure; COPM; participation patterns were measured using the Participation and Environment Measure-Children and Youth; PEM-CY pre- and post-intervention; parents' satisfaction was measured using the Client Satisfaction Questionnaire, CSQ-8. Semi-structured interviews were conducted post-intervention. Both participants significantly improved participation in all selected goals and participation patterns, and were highly satisfied with the intervention. The interviews revealed additional information on personal and environmental barriers, factors supporting intervention, and intervention effects. The results indicated that an environment-centered and family-centered approach can potentially improve the participation of youths with disabilities within their unique socio-cultural context, during adverse times. Flexibility, creativity, and collaboration with others also contributed to intervention success.

Safety, Feasibility and Efficacy of Lokomat® and Armeo®Spring Training in Deconditioned Paediatric, Adolescent and Young Adult Cancer Patients

Rehabilitation robotics is a field of study which aims to understand and augment rehabilitation through the use of robotics devices. This proof of concept study aimed to test the safety (no. adverse events, incidence of infection), feasibility (program demand, adherence, participant satisfaction) and efficacy (Peak Oxygen uptake (VO2peak), 6-min walk test, gait speeds, Canadian Occupational Performance Measure, quality of life) of Lokomat® and Armeo®Spring training in children and adolescents and young adults (AYAs) during or soon after cancer treatment. This was a 6-week single arm pre-post study. Cancer patients with significant musculoskeletal, neurological, gait and/or upper limb deficiency aged 5 to 25 years were recruited. The rehabilitation program included access to two robotic orthoses: the Lokomat® and/or Armeo®Spring. Robotic devices utilised real-time biofeedback and computer games to engage and guide participants through a repetitive functional range of movement aimed at improving functional deficiencies. Progressive increases in exercise intensity and duration were encouraged. Twentey-eight participants were approached for study; twenty-one consented. Seventy-six percent completed the six-week intervention with an overall adherence of 83%. The mean participant satisfaction score was 8.8/10. Forty-nine adverse events were recorded throughout the course of the study, forty-five grade 1, three grade 2 and one grade 3. No adverse events led to withdrawal from the study. Preliminary efficacy results indicate large beneficial effects on VO2peak (r = 0.63), 10 m comfortable pace walk (r = 0.51) and maximal pace walk (r = 0.60), 6-min walk test (r = 0.60), maximal back and leg strength (r = 0.71), trunk flexibility (r = 0.60), The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30) (r = 0.61), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT F) r = 0.53 and the Canadian Occupational Performance Measure, satisfaction (r = 0.88) and performance scores (r = 0.83), and moderate beneficial effects on Leisure Score Index (LSI) (r = 0.30). Our results suggest that Lokomat® and Armeo®Spring training is safe and feasible for use in children and AYAs who are currently undergoing or have recently completed cancer therapy. A larger controlled trial investigating the efficacy of robotics rehabilitation in this cohort is warranted.

The Effect of Kinesio Taping Over the Gluteal Muscles on Activity and Participation in Children with Unilateral Cerebral Palsy: A Preliminary Randomized Controlled Study

Background: Insufficiencies of gluteus medius and maximus muscles in children with unilateral cerebral palsy (CP) may restrict activity and participation by affecting gait, gross motor functions, and balance. Objectives: The present study aimed to elucidate the effect of Kinesio taping (KT) applied to the gluteus medius and maximus muscles on activity and participation in children with CP. Methods: The study was completed with 20 children with unilateral CP who were randomly divided into 2 groups: The KT group received KT and physiotherapy (n = 11), and the control group received only physiotherapy (n = 9). The KT application was administered for 4 weeks. The activity was evaluated with a BTS G-Walk Spatiotemporal Gait Analysis System, Timed Up and Go test (TUG), Functional Mobility Scale (FMS), Gross Motor Function Measure (GMFM), and Pediatric Balance Scale (PBS); in addition, participation was evaluated using the Canadian Occupational Performance Measure (COPM). Results: The KT group showed significant improvements in the gait parameter (cadence; P = 0.009), pelvic tilt symmetry (P = 0.017), pelvic rotation symmetry (P = 0.018), gait symmetry (P < 0.001), FMS (P = 0.07), TUG, GMFM, PBS, and COPM scores (P < 0.001) in the medium-term compared to the control group. It was also found that gait (cadence; P = 0.004) and functional mobility (P < 0.001) improved in the immediate term than in the KT group. Conclusions: KT combined with conventional physiotherapy can improve cadence and functional mobility in the immediate term, as well as gait and pelvic symmetry, functional mobility, gross motor function, balance, and participation in the medium term in children with unilateral CP. Further randomized controlled studies addressing large samples and long-term effects are warranted.

The Effect of Kinesio Taping Over the Gluteal Muscles on Activity and Participation in Children with Unilateral Cerebral Palsy: A Preliminary Randomized Controlled Study

Background: Insufficiencies of gluteus medius and maximus muscles in children with unilateral cerebral palsy (CP) may restrict activity and participation by affecting gait, gross motor functions, and balance. Objectives: The present study aimed to elucidate the effect of Kinesio taping (KT) applied to the gluteus medius and maximus muscles on activity and participation in children with CP. Methods: The study was completed with 20 children with unilateral CP who were randomly divided into 2 groups: The KT group received KT and physiotherapy (n = 11), and the control group received only physiotherapy (n = 9). The KT application was administered for 4 weeks. The activity was evaluated with a BTS G-Walk Spatiotemporal Gait Analysis System, Timed Up and Go test (TUG), Functional Mobility Scale (FMS), Gross Motor Function Measure (GMFM), and Pediatric Balance Scale (PBS); in addition, participation was evaluated using the Canadian Occupational Performance Measure (COPM). Results: The KT group showed significant improvements in the gait parameter (cadence; P = 0.009), pelvic tilt symmetry (P = 0.017), pelvic rotation symmetry (P = 0.018), gait symmetry (P < 0.001), FMS (P = 0.07), TUG, GMFM, PBS, and COPM scores (P < 0.001) in the medium-term compared to the control group. It was also found that gait (cadence; P = 0.004) and functional mobility (P < 0.001) improved in the immediate term than in the KT group. Conclusions: KT combined with conventional physiotherapy can improve cadence and functional mobility in the immediate term, as well as gait and pelvic symmetry, functional mobility, gross motor function, balance, and participation in the medium term in children with unilateral CP. Further randomized controlled studies addressing large samples and long-term effects are warranted.

Clinical, Radiographic, and Patient-Perceived Outcome After Radial Hemi-Wrist Arthroplasty With a New Implant: 20 Cases With 5-Year Follow-up.

Distal component loosening is a common mode of failure in total wrist arthroplasty (TWA). A radial hemi-wrist arthroplasty (RHWA) has the potential to avoid problems related to the distal component in TWA. The aim of this study is to investigate clinical outcomes following surgical treatment with a new RHWA design. In this pilot study of 20 consecutive RHWAs, patients were assessed preoperatively and postoperatively for range of motion, grip strength, Visual Analog Scale (VAS) pain scores, and functional scoring using Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH), and Canadian Occupational Performance Measure. Radiographs were analyzed at 12 months and 5 years (mean, 5.1 years) postoperatively. A total of 46 secondary surgeries were undertaken in 16 wrists, including 7 revisions. Another 6 patients are waiting for revision to radiocarpal arthrodesis. In non-revised patients, the DASH and PRWE scores improved, and wrist range of motion remained largely unchanged except for wrist flexion, which decreased. The VAS pain score during activity was reduced, and hand grip strength remained largely unchanged. The new implant resulted in improved functional scoring and improved VAS pain scores in non-revised patients, but many cases needed secondary surgery due to persistent pain. The high revision rate is a major concern, and further use of the implant in its current form cannot be recommended.

Patients’ Expectations Before Initiation of Intrathecal Baclofen Treatment: A Longitudinal Study with 1-Year Follow-Up

To investigate patients' expectations, met/unmet expectations and satisfaction with intrathecal baclofen treatment in relation to effect on spasticity, pain intensity, sleep quality, occupational performance, well-being and self-efficacy. A prospective longitudinal study with follow-up at 1 year. Consecutive patients, age ≥ 18 years with a disabling spasticity of cerebral or spinal origin selected for intrathecal baclofen treatment at 2 university hospitals in Sweden were included. From August 2016 to June 2019, 35 patients began intrathecal baclofen treatment; 29 patients were included and completed the study. Baseline and 1-year follow-up included assessment of spasticity by physiotherapists, a semi-structured interview regarding occupational performance using the Canadian Occupational Performance Measure and a questionnaire. Overall satisfaction with treatment and satisfaction with occupational performance were reported as moderate. Important variables that explained satisfaction with occupational performance were improvements in performance, expectations and performance before treatment. Patients had higher expectations compared with the 1-year outcomes regarding occupational performance, spasticity, pain intensity and sleep quality, although improvements were reported. A thorough discussion of goal setting with intrathecal baclofen treatment before implantation is necessary to give patients individual and realistic expectations.

Is There a Relationship Between Perceived Activity Performance-Satisfaction Level and Quality of Life in Activities of Daily Living in Adults with Plantar Fasciitis?

Aim: Plantar fasciitis (PF) is a disease that negatively affects quality of life (QOL) and activities of daily living and is the most common cause of heel pain. The aim of this study is to examine the relationship between QOL, perceived activity performance and satisfaction in adults with PF and to determine the activities that have problems in daily living.
 Materials and Methods: A total of 96 participants, 26 male and 70 female, aged between 18-65 years, with a mean age of 53.88±6.41 years diagnosed with PF completed the study. The Nottingham Health Profile was used to determine the QOL, the Canadian Occupational Performance Measure was used to determine the perceived activity performance and satisfaction level.
 Results: The findings show the perceived activity performance and satisfaction levels of individuals with PF are negatively related to pain and energy levels, which are sub-dimensions of QOL (p=0.001; p=0.017; p=0.001; p=0.018). Moreover, it has been determined individuals have problems in many activities, such as walking, working, going up and down stairs, housecleaning and sleeping.
 Conclusion: This study showed the QOL of individuals with PF decreases as activity performance and satisfaction level decrease. Pain is one of the most important factors affecting activity performance, and recurrent and increasing pain with activity may have limited activity participation in individuals with PF. Therefore, pain should be considered as a priority in the evaluation and intervention plans of individuals with PF. Also, activity-based intervention plans should be developed for activities where these individuals have problems in daily living.

A six-participant pilot single-subject study of an individualized pain management program for people with spinal cord injury.

Single-subject repeated measures design. To explore the impacts of a novel individualized interdisciplinary pain self-management program for persons living with spinal cord injury pain. A large rehabilitation institute for adults with physical disabilities in Quebec city (Quebec, Canada). Six persons having sustained a spinal cord injury and experiencing chronic pain participated. Following a five-week pre-intervention phase (baseline repeated measures) and a clinical evaluation, individualized intervention objectives were developed in collaboration with each participant. Then, participants completed a ten-week intensive intervention and a six-month consolidation phase. The program included cognitive behavioral therapy, and physical and pharmacological interventions, which were group- and individual-based. Outcome measures were the Canadian Occupational Performance Measure (COPM), the French-Canadian Chronic Pain Self-efficacy Scale (FC-CPSES), the Brief Pain Inventory (BPI), and the Hospital Anxiety and Depression Scale (HADS). For five out of the six participants, a majority of outcomes improved during either of the intervention phases or both. Improvements in occupational performance were clinically significant for three participants. Pain interference and anxiety improved significantly in five participants, while pain self-efficacy and depressive symptoms improved in four participants. The results suggest that the pain self-management program was effective to reduce the impact of spinal cord injury pain. Further research is needed to replicate these results in a larger study and comprehend the factors favoring or undermining improvements with such programs, as well as their persistence over time.

Baseline Range of Motion, Strength, Motor Function, and Participation in Youth with Hutchinson-Gilford Progeria Syndrome

Aims Limited information is available on impairments, activity limitations and participation restrictions in youth with Hutchinson-Gilford progeria syndrome (HGPS), a rare genetic premature aging disease. The purposes were to: (1) describe range of motion (ROM), grip, pinch and quadriceps strength, functional balance, walking endurance, and gross motor limitations and participation restrictions; (2) evaluate the association between ROM impairments and age; and (3) evaluate the association between the Gross Motor Function Measure-88 (GMFM) scores and lower extremity (LE) ROM, quadriceps strength, and age. Methods Upper and LE ROM, grip, pinch and quadriceps strength, Timed Up and Go (TUG), Six Minute Walk Test, GMFM-88, and Canadian Occupational Performance Measure data were recorded for 38 participants with HGPS. Results All youth exhibited ROM impairments and most displayed decreased grip and pinch strength, walking endurance, and gross motor skills when compared to same-aged peers. However, the majority had good functional balance with TUG scores in the normal range. Participation restrictions included difficulty keeping up with peers when walking and difficulty completing activities of daily living. Some ROM measurements were negatively associated with age indicating that older participants had more extensive ROM limitation than younger participants. Conclusions Physical and occupational therapists can use this information when evaluating youth with HGPS, designing a plan of care, and providing treatment interventions.

Impact of coronavirus disease pandemic on performance and satisfaction, physical activity, and quality of life of the elderly.

The aim of this study was to examine the effects of the coronavirus disease pandemic in the elderly. A total of 140 elderly with a mean age of 71.30±6.00 years (69 females, 71 males) who spent the coronavirus disease pandemic period at home were included. Canadian Occupational Performance Measure, Visual Analog Scale (for pain intensity at rest and activity), International Physical Activity Questionnaire-Short Form, and EuroQol Five-Dimensional Questionnaire, Three-Level Version Health States were used in the evaluation. Two scores are obtained in Canadian Occupational Performance Measure: one for performance and one for satisfaction. EuroQol Five-Dimensional Questionnaire, Three-Level Version consists of two parts: EuroQol Five-Dimensional Questionnaire, Three-Level Version descriptive system and EuroQol Five-Dimensional Questionnaire, Three-Level Version Visual Analog Scale. While female gender (p=0.006, p=0.001), using walking assistant (p=0.001, p=0.001), being single/widow (p=0.031, p=0.007), and history of falling (p=0.004, p=0.001) made difference in Visual Analog Scale (rest, activity), female gender (p=0.013) and being single/widow (p=0.020) made difference in satisfaction scores of Canadian Occupational Performance Measure. Female gender (p=0.001), using walking assistant (p=0.001), and history of falling (p=0.010) made difference in EuroQol Five-Dimensional Questionnaire, Three-Level Version descriptive system. In addition, performance scores of Canadian Occupational Performance Measure had a low correlation with Visual Analog Scale (rest r=-0.198, p=0.019; activity r=-0.188, p=0.026) and had a moderate correlation with EuroQol Five-Dimensional Questionnaire, Three-Level Version descriptive system (r=0.327, p=0.001) and EuroQol Five-Dimensional Questionnaire, Three-Level Version Visual Analog Scale (r=0.307, p=0.001). Satisfaction scores of Canadian Occupational Performance Measure had a low correlation with Visual Analog Scale (rest r=-0.247, p=0.003; activity r=-0.223, p=0.008) and had a moderate correlation with EuroQol Five-Dimensional Questionnaire, Three-Level Version descriptive system (r=0.399, p=0.001) and EuroQol Five-Dimensional Questionnaire, Three-Level Version Visual Analog Scale (r=0.306, p=0.001). The elderly who were women, single/widowed, using walking assistant, and having a history of falling were more affected during the coronavirus disease period.

The Effect of Occupation-Based Modified Constraint-Induced Movement Therapy on the Participation of Children with Cerebral Palsy: A Single-Blind Randomized Controlled Trial.

This study investigates the impact of modified constraint-induced movement therapy (m-CIMT), accompanied by occupation-based and activity analysis, on the participation of children with hemiplegia. Twenty-three participants were randomly assigned to the intervention and control groups. The intervention group received occupation-based m-CIMT (m-CIMT along with occupation-based and activity analysis), while the control group received m-CIMT without occupation-based and activity analysis. The intervention was conducted one hour per day, three days a week, for four weeks. The primary outcomes revealed no significant differences between groups in promoting the participation of children with hemiplegia in the activities of daily living (ADL). However, scores were higher in the intervention group with a medium to large effect size (Canadian occupational performance measure: F(1,19)=2.14, P=0.160, η2P=0.101, Canadian occupational performance measure-satisfaction: F(1,19)=1.53, P=0.231, η2P=0.075, Goal attainment scaling: F(1,19)=5.55, P=0.029, η2P=0.226). This effect remained during the follow-up period. The secondary outcomes indicated no significant differences between groups in improving the manual ability of the children. However, scores were higher in the intervention group with a medium to large effect size (ABILHAND-Kids: F(1,19)=0.64, P=0.434, η2P=0.033, pediatric motor activity log- how long: F(1,19)=3.53, P=0.076, η2P=0.157, pediatric motor activity log- how well: F(1,19)=2.59, P=0.124, η2P=0.120). This effect was sustainable during the follow-up period. m-CIMT accompanied by occupation-based and activity analysis and the client-centered paradigm substantially enhances the manual ability of children with hemiplegia and their participation in the ADL.

O processo de adaptação e desempenho ocupacional de mães de crianças no transtorno do espectro autista

Abstract Introduction Adapting to a child with Autism Spectrum Disorder (ASD) can impact the occupational performance of mothers because of the care they demand, which can lead to difficulties in carrying out their occupations. Objective To investigate the occupational performance and adaptation of mothers to their children with ASD. Method Cross-sectional, descriptive, quantitative and qualitative study conducted with 11 mothers of children with ASD aged 2-9 years. Data were collected using the Parental Disability Adaptation Scale (EPAD) and the Canadian Occupational Performance Measure (COPM). EPAD data were analyzed by adding the scores of each participant and calculating the general average, whereas COPM data were analyzed from the values assigned to performance and satisfaction. Results The mothers were well adapted to their children; however, they evaluated the presence of functional problems for occupational performance after their birth. Functional problems in the productivity category, specifically in work performance due to the demands of caring for the children, were mentioned by most mothers. In the self-care category, some mothers reported problems related to going to the salon and taking a shower. In the leisure category, some mothers indicated problems with reading, physical activity, traveling and/or visiting friends. Conclusion The mothers in this study reported that adapting to their children with ASD involves factors such as transmission of the diagnosis, information, children characteristics, socioeconomic conditions, resilience, and personal beliefs and expectations. In conclusion, the mothers of children with ASD investigated presented functional problems regarding their occupational performance after the birth of these children.

International Classification of Function, Disability and Health (ICF) Word Mapping to Determine the Human Functioning Associated with Upper Extremity Surgery for Tetraplegia.

Understanding human functioning and disablement, the contributing factors and their interactions in individuals with tetraplegia is important since elective upper extremity (UE) reconstructive surgery is now offered earlier after injury prior to full recognition of what lies ahead. Qualitative and quantitative data were available from a prior series of mixed methods studies, including a case series design capturing the patients' lived-experience perspectives of nerve or tendon transfer surgery, or not as the case may be. The objective of this study was to perform secondary data analysis to determine whether the recommended outcome tools being used by clinicians reflect the all important domains of functioning identified by people with tetraplegia who were considering UE reconstructive procedures. The original 18 candidate themes derived from qualitative analysis were reviewed in retrospect, along with a content analysis of the tools' questions, undertaking word mapping links to the ICF taxonomy. The outcomes tools included in the content analysis were the Canadian Occupational Performance Measure, the Capabilities of Upper Extremity Questionnaire, The Personal Wellbeing Index, and the Grasp and Release Test. Comparison between clinical outcomes tools and the patient lived-experience data uniquely identified links to Chapter1 (b) Mental functions, which include consciousness, orientation, temperament/personality, energy/drive, and higher-level cognition.

Cognitive Orientation to daily Occupational Performance (CO-OP) for Older Adults After a Hip Fracture: A Pilot Study

In-home therapy provides the opportunity for rehabilitation intervention to be completed in the context of the patient's natural environment. However, most studies have focused on the effects of physical exercise, leaving a gap in understanding the effectiveness of a more task-oriented intervention that addresses individual preferences. To assess the feasibility and preliminary efficacy of the Cognitive Orientation to daily Occupational PerformanceTM (CO-OP) approach, delivered at home with older adults after a hip fracture to improve functional outcomes. Single-arm quasi-experimental design. Patients' home. Nine participants (age ≥60 yr) being discharged home from an inpatient rehabilitation ward in a geriatric hospital in a central city in Israel. Up to 10 1-hr weekly face-to-face sessions in using the CO-OP approach. The Canadian Occupational Performance Measure was used to measure performance and satisfaction with the patients' level of participation in daily functioning. A 30% recruitment rate, an 81% retention rate, were observed, with 88% of the participants expressing high to very high overall satisfaction with the intervention. Friedman test results indicated statistically significant improvements in occupational performance and satisfaction on trained and untrained goals (p < .01). The findings suggest that a home-based CO-OP intervention is feasible and potentially beneficial for older adults who are returning home after a hip fracture. What This Article Adds: This study shows that a task-oriented intervention can be effective in helping older adults return home successfully after a hip fracture.

Goal setting, goal attainment and quality of life of children following selective dorsal rhizotomy.

The aim of this study is to describe the individualized occupational performance issues identified by parents/carers and children prior to selective dorsal rhizotomy (SDR) surgery and analyse change up to 2 years post surgery in goal attainment and quality of life (QoL). The Australian SDR Research Registry (trial registration: ACTRN12618000985280) was used to extract data for individualized goals, goal attainment and QoL based on the Canadian Occupational Performance Measure (COPM) and the Cerebral Palsy Quality of Life Questionnaire for Children (CP QOL-Child parent-proxy) at baseline and 1 and 2 years following SDR. Change in mean scores was analysed using linear mixed models. Fifty-two children had COPM scores at baseline and 1 and/or 2 years post, of which 28 had two QoL scores. COPM problem areas included leisure (n = 39), productivity (n = 37) and self-care (n = 173). The most common goals were walking (26.1%), participation in physical activities (17.7%) and transitions (14.1%). Mean COPM scores improved significantly between baseline to 1 year and baseline to 2 years (P < 0.001). Mean QoL scores improved between baseline to 1 year for functional QoL domains: participation and physical health (P = 0.003) and pain and impact of disability (P = 0.011). Collaborative goal setting is an integral part of family-centred rehabilitation practice. The COPM was an appropriate individualized outcome measure in identifying meaningful goals for our SDR cohort. Results demonstrate improved scores in goal attainment and improvement in functional QoL domains. This paper highlights the need to include outcomes that measure daily life experiences.

Results of a 2-week novel robotic rehabilitation program in 18 children with prior hemispherectomy

BackgroundPartial preservation of sensory and motor functions in the contralateral extremities after hemispherectomy is likely secondary to cortical reorganization of the remaining hemisphere and can be improved by rehabilitation. This study aims to investigate behavioral changes that may occur after a 2-week novel robotic rehabilitation program in 18 children with prior anatomic hemispherectomy. Other conventional rehabilitation methods were also reviewed and compared. MethodsThis study examined the impact of a novel robotic rehabilitation 2-week program on 18 hemispherectomy patients (average age 14.3 ± 3.9 years; age at hemispherectomy 5.6 ± 4.5 years). ResultsStatistically significant improvements were seen in the six-minute walk test (29 m, p < 0.001), Canadian Occupational Performance Measure performance (1.64 points, p = 0.002) and satisfaction (2.49 points, p = 0.001), and individual perceived performance on survey (1.72 points, p = 0.042). Fifteen patients showed improvement in the upper extremity Fugl-Meyer scores with an average increase of 3 points (p = 0.006). ConclusionThis study demonstrates clinically meaningful and statistically significant improvements in motor function and behavior following a novel robotic rehabilitation two-week program.

Effects of Integrative Autism Therapy on Multiple Physical, Sensory, Cognitive, and Social Integration Domains in Children and Adolescents with Autism Spectrum Disorder: A 4-Week Follow-Up Study.

This study aimed to compare the effects of conventional autism therapy (CAT) and integrative autism therapy (IAT) in children and adolescents with autism spectrum disorder (ASD). A convenience sample of 24 children with ASD was recruited and underwent either CAT or IAT for 60 min/day, twice a week, for 20 sessions over 10 weeks. Outcome measures included the following: (1) physical domain (pediatric balance scale, PBS), (2) sensory domain (short sensory profile), (3) cognitive domains (functional independence measure, FIM; and childhood autism rating scale), and (4) social integration domain (Canadian occupational performance measure, COPM; short falls efficacy scale; and pediatrics quality of life questionnaire). Two-way repeated analysis of variance (ANOVA) was used to determine the intervention-related changes in the four domains across the pre-test, post-test, and follow-up test at p &lt; 0.05. ANOVA showed significant interaction effects on the PBS, FIM, and COPM (p &lt; 0.05) variables. Moreover, time main effects (p &lt; 0.05) were observed in all four domain variables, but no group main effect was noted. This study provides promising evidence that IAT is more effective than CAT for managing children and adolescents with ASD.

Strategy-training post-stroke via tele-rehabilitation: a pilot randomized controlled trial

Purpose Long-term limitations in social participation are common after stroke. Whether these can be attenuated through a tele-rehabilitation approach is unknown. We were particularly interested in examining transfer of learning effects which could result in broader improvements in social participation. Methods We adapted a strategy training rehabilitation approach (tele-CO-OP) for remote delivery. Participants with chronic stroke were randomized to receive the intervention (EXPT) or to a wait list (Control). Feasibility and acceptability were measured via attendance scores, satisfaction with the training and therapist evaluation of engagement with the training. The primary outcome measure was the Canadian Occupational Performance Measure (COPM), a standardized semi-structured interview which elicits difficulties in day-to-day life. Results Seventeen participants were randomized. Tele-CO-OP was found to be feasible and acceptable: participants reported high satisfaction and engagement, and missed few sessions. Large effect sizes for transfer of learning effects were observed in favor of receiving tele-CO-OP vs being waitlisted. Significant benefits were also conferred to the Control group following receipt of tele-CO-OP. The intervention also appeared to improve mood. Conclusions This exploratory study demonstrates the feasibility and acceptability of tele-CO-OP and provides preliminary evidence for transfer of learning effects to untrained everyday social participation activities. Trial registration number: NCT02724813

Hand characteristics and functional abilities in predicting return to work in adult workers with traumatic hand injury.

Hand injuries affect a person's functioning, thus impeding their abilities to return to work. There is a limited understanding in return to work of the overall predictors when including hand characteristics and functional abilities. Therefore, it is essential to identify the most relevant predictors in return to work among individuals with a hand injury. (1) To compare hand function characteristics and functional abilities of injured workers who have or have not returned to work. (2) To estimate hand function characteristics and functional abilities as predictors to return to work. One hundred and fifteen adult workers with hand injuries aged 18- 59 years old from five general hospitals in Malaysia participated in a cross-sectional study. Predictors were estimated using logistic regression. There was a significant association between occupational sector (p = 0.012), injury duration (p = 0.024), occupational performance (p = 0.009) and satisfaction with performance (p < 0.001), grip strength of injured hand (p = 0.045- 0.002) and the Disability of Arm, Shoulder and Hand (DASH) disability/symptom (p = 0.001) with the person's return to work status. Significant predictors of return to work were identified using the Canadian Occupational Performance Measure (COPM) satisfaction's score, DASH disability/symptoms' score and duration of the injury. As two main predictors of return to work were COPM satisfaction and DASH disability/symptoms, occupational therapists working in rehabilitation should focus on achieving functional performance and satisfaction within the optimal time.

Harmony at HOME (Help Online Modifying the Environment): Proof‐of‐concept clinical trial of an innovative telehealth intervention for adults with Alzheimer’s disease with behavioral symptoms

AbstractBackgroundNearly 90% of adults diagnosed with Alzheimer’s disease and related dementias experience behavioral symptoms (e.g., agitation, depression, anxiety, apathy). Current pharmacological treatment options lack high efficacy and pose dangerous side effects. Innovative approaches are needed to enhance care for these symptoms. This study aimed to assess feasibility of Harmony at HOME (Help Online Modifying the Environment), a telehealth occupational therapy intervention for community‐dwelling adults with Alzheimer’s disease exhibiting behavioral symptoms (ClinicalTrials.gov Identifier: NCT04555616).MethodUsing a single‐blind, three‐arm, randomized controlled trial design, participants were enrolled into one of the following arms: 1) individualized intervention (I) with tailored training regarding sensory stimulation to facilitate adaptive behavior and functional performance; 2) standardized intervention (S) curriculum for care partner training; and a 3) control arm (C) receiving standard of care. Both intervention arms received sensory stimulation tool kits to facilitate behavioral regulation. All participants completed 6 telehealth visits, one per week, with an occupational therapist. The primary outcome of feasibility was measured by attendance to weekly visits, and secondary outcomes included change in patient performance in functional activity assessed via the Canadian Occupational Performance Measure and change in neuropsychiatric symptoms assessed via the Neuropsychiatric Inventory Questionnaire.ResultThirty dyads (person with Alzheimer’s disease and their care partner) agreed to participation and were randomized. Analyses demonstrate the intervention is feasible with high adherence to weekly visits (I = 88%; S = 100%; C = 60%; p = 0.06) and high participant retention within the individualized arm (I = 80%; S = 60%; C = 50%; p‐value = 0.14). While the study was not powered to compare secondary outcomes among groups, within group exploratory analyses show promise for the individualized intervention. Improvements were observed in patient performance (baseline x̄ = 4.3; post intervention x̄ = 6.6; p = 0.04; Cohen’s d = 1.0). The individualized intervention also shows promise in reduction of behavioral symptoms (baseline x̄ = 11.55; post intervention x̄ = 8.6; p‐value = 0.06) and caregiver distress (baseline x̄ = 15.2; post intervention x̄ = 9.9; p‐value = 0.03).ConclusionThis Stage 1 feasibility study identified that the Harmony at HOME intervention was feasible for community‐dwelling adults with Alzheimer’s disease and behavioral symptoms. The intervention offers promise for improved patient performance in functional activities and behavioral symptoms with a long‐term goal to prolong community residency for this population.