Occupational Therapy Evaluation Research Articles

An Occupation-Based Review of Outcome Measures used to Assess Hand Function after Burn Injury.

While occupation began as the central concept of occupational therapy at the dawn of the profession, the use of occupation throughout the therapy process, including assessment, has wavered in recent decades. Occupation is defined as meaningful and purposeful activities that individuals do to occupy their time and attention. The use of occupation-based assessments is vital to establishing care with an occupational focus. The purpose of this paper is to review the outcome assessment tools commonly used in the burn literature to evaluate hand function and critique the presence of occupation in each assessment using the Occupation-Based Practice Assessment (OBPA). Knowledge of the occupational nature of assessments is important to the delivery of an occupational therapy evaluation comprised of a battery of assessments inclusive of discrete measures of movement as well as performance-based tools to represent the person from an occupational perspective. Many outcome measures used in upper extremity burn rehabilitation are discrete in nature and do not measure occupations of clients. The Suitcase Packing Activity (SPA) may be a viable addition to an assessment battery to address this essential need.

Effect of pre-transplant functional status on length of hospital stay in patients undergoing allogeneic hematopoietic stem cell transplant in an outpatient transplant program.

6560 Background: The use of reduced intensity conditioning regimens including non-myeloablative regimens in allogeneic hematopoietic stem cell transplant (allo SCT), has expanded the pool of transplant candidates in the United States. Nonetheless, allo SCT, is associated with significant morbidity and mortality especially in patients 65 and older. In our outpatient transplant program, allo SCT patients undergo a comprehensive physical and occupational therapy (PT/OT) evaluation pre-transplant. Methods: We retrospectively reviewed all patients undergoing an allo SCT between January 2019 and December 2022 who had a PT/OT evaluation pre-transplant. We analyzed lower extremity functional scale (LEFS) and fatigue score (FACIT). The FACIT score is a patient reported outcome tool where the lower the score, the less fatigue impacts a patient’s performance. Results: We identified 218 patients who had at least one variable reported. Eighty-one patients were 65 years of age or older. All patients in the 65 and older group had a RIC or NMA conditioning regimen. In the 65 and older group, 72.8% had an HCTCI score of 3 or more compared to 59.1% in the group younger than 65. In patients younger than 65, those who had a lower LEFS (ie less lower extremity strength), had a statistically significant longer hospital stay of 15.5 days compared to 9 days (p=0.003). In patients 65 and older, lower FACIT scores (ie less patient reported fatigue), resulted in a statistically significant shorter hospital stay of 7.5 days compared to 13 days (p=0.019). In addition, there was a trend towards shorter hospital stays in patient 65 and older who had a higher LEFS of 5 days compared to 12.5 days (p=0.07). There was no difference in survival outcomes but there was a trend towards better overall survival in patients 65 and older with high LEFS (p=0.08) and a trend towards better NRM in this group (p=0.11). Conclusions: Our study highlights the need for comprehensive assessments in patients undergoing allo SCT. Geriatric functional status assessments are necessary to determine patients at risk for complications and to optimize such patients with exercise and cognitive rehabilitation programs prior to allo SCT. [Table: see text]

Occupational Therapy Interventions for Caregivers of People Who Have Experienced Stroke

Abstract Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Project. Each article in this series summarizes the evidence from 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 decision-making. In this Evidence Connection article, we provide a case report of a caregiver of a patient who had experienced a stroke. The occupational therapy evaluation and intervention process is described.

Preliminary assessment of a standardized vision screening guideline in a pediatric inpatient rehabilitation unit.

This study aimed to evaluate the impact of a standardized vision screen guideline on occupational therapy vision screens in a pediatric inpatient rehabilitation unit. Charts of patients admitted to a pediatric inpatient rehabilitation before guideline implementation (n = 47) versus charts after implementation (n = 47) were randomly, retrospectively reviewed to explore differences in visual skills screened and use of standardized assessments. Significant improvements (p < = 0.05) were found in the number of visual skills screened (p = 0.034), use of standardized assessments (p = 0.005), and screening of the specific visual skills of accommodative amplitude (p = 0.05), suppression (p = 0.015), and double vision (p < 0.001). Implementation of a standardized vision screen guideline improved the frequency of vision screens during occupational therapy evaluations in a pediatric inpatient rehabilitation unit. The use of standardized assessments may also improve the quality of vision screens by encouraging staff to complete more comprehensive vision screens, including screening more visual skills, and by prompting use of standardized assessments, which can improve accuracy of screening procedures.

ICF classification of therapeutic goals for outpatient episodes of neurorehabilitation in post-stroke and Parkinson disease

PurposeTo understand therapeutic priorities, a secondary data analysis on a retrospective cohort was conducted to classify rehabilitation goals according to the International Classification of Functioning, Disability, and Health (ICF).Materials and MethodsTherapeutic goals from an initial outpatient physical or occupational therapy evaluation for patients post-stroke or with Parkinson disease, were classified into Level 1 of the ICF. Goals in the Activity and Participation component were further sub-classified as activity capacity or activity performance (self-report or direct) in daily life.Results776 goals across 104 participants were classified into Level 1 of the ICF. The majority, 73% (563/776) were classified as Activity and Participation, 20% (155/776) as Body Function and 2% (17/776) as Environmental Factors. Fifty-two percent (400/776) of all goals were classified as activity capacity and 21% (163/776) as activity performance in daily life, with 21% (160/776) of goals measuring self-report activity performance in daily life and less than 1% (3/776) of goals measuring direct activity performance in daily life.ConclusionsWhile the majority of therapeutic goals were classified into the Activity and Participation component, less than 1% of goals measured direct activity performance in daily life. If people seek outpatient rehabilitation to improve functioning in their real-world environment, therapeutic goal setting should reflect this.

Cost-effectiveness of occupational therapy for older adults: a protocol for an updated systematic review

IntroductionThe ageing populations in developed countries are a global concern, with increasing numbers of older adults facing physical, cognitive and psychological challenges, resulting in reduced quality of life and higher...

Effects of real-time VR clinical practice on reducing the stigma toward dementia among students of occupational therapy: A randomized controlled trial.

This study aimed to examine the effects of real-time online clinical practice using real-time virtual reality (VR) compared with 2D PC screening on reducing stigma toward dementia, and to investigate the feasibility of online clinical practice using VR. A single-center, open-label, randomized controlled trial was conducted. Occupational therapy students were randomized to view occupational therapy evaluation screens for dementia patients using a VR headset or 2D monitor. The Attitudes Toward Dementia Scale (ADS), the Dementia Knowledge Scale (DKS), and Images of the Elderly with Dementia (IED) were assessed before and after the intervention. The level of clinical practice satisfaction and the System Usability Scale (SUS) were also assessed. The number of subjects in the intervention and control groups was 10 and 9, respectively. In ADS scores and IED, the main effect was shown in both groups and did not show interactions. In DKS scores, the main effect and interaction were not shown. The VR headset tended to be more usable than the 2D monitor in terms of usability. Satisfaction ratings indicated the characteristics of a realistic clinical experience through real-time VR viewing. Real-time VR and 2D online clinical practice could reduce the stigma toward dementia, but there were no significant differences between the types. The real-time VR experience was more similar to actual clinical practice than a 2D PC screening due to the sense of immersion, but issues in blinding and lack of audio and video quality were found.

Components of Outpatient Child and Youth Concurrent Disorders Programs: A Critical Interpretive Synthesis: Composantes des programmes de troubles concomitants des enfants et des jeunes ambulatoires : une synthèse interprétative critique.

Co-occurring mental health and substance use disorders (concurrent disorders) lead to significant morbidity in children and youth. Programs for integrated treatment of concurrent disorders have been developed; however, there exists little guidance outlining their structure and activities. Our objective was to synthesize available information on outpatient child and youth concurrent disorders programs and produce a comprehensive framework detailing the components of such programs. We used a four-stage critical interpretive synthesis design: (1) systematic review of published and grey literature, (2) data abstraction to identify program components and purposive sampling to fill identified gaps, (3) organization of components into a structured framework, (4) feedback from programs. We employed an iterative process by which programs reviewed data abstraction and framework development and provided feedback. Through systematic review (yielding 1,408 records total and 7 records eligible for inclusion) and outreach strategies (yielding an additional 7 eligible records), we identified 11 programs (4 American, 7 Canadian) and 2 theoretical models from which data could be abstracted. Program activities were categorized into 12 overarching constructs that make up the components of the framework: accessibility, engagement, family involvement, integrated assessment, psychotherapy for patients, psychotherapy for families, medication management, health promotion, case management, vocational support, recreation and social support, and transition services. Program components are informed by the philosophical orientation of the program and models of care. This framework considers health system factors, clinical service factors, program development, and community partnership that impact program structure and activities. Multidisciplinary teams provide care and include addiction medicine, psychiatry, psychology, nursing, social work, occupational therapy, recreation therapy, peer support, and program evaluation. We developed a comprehensive framework describing components of child and youth outpatient concurrent disorders programs. This framework may assist programs currently operating, and those in development, to reflect on their structure and activities.

Caregiver Support Role in Occupational Therapy Video Telehealth: A Scoping Review.

Caregiver involvement may facilitate patient participation in occupational therapy (OT) video telehealth. However, little is known about the extent to which caregivers participate and what they do. This scoping review aims to, 1) describe the caregiver role supporting patient participation in OT video telehealth, and, 2) identify barriers and facilitators to caregiver involvement. Findings reveal caregiver involvement in a range of OT evaluation and intervention processes, with details on what caregivers did overall lacking. Barriers and facilitators are also described. This study underscores the need for clear and robust descriptions of caregiver participation to increase best practices in video telehealth.

Evaluation of Occupational Therapy and Music Therapy Co-Treatment in the Neonatal Intensive Care Unit

Aims To examine co-treatment with music therapy and occupational therapy with infants in the neonatal intensive care unit (NICU). Methods A quasi-experimental design was used to study the effect of standard care occupational therapy (SCOT) vs co-treatment with music therapy (Co-Tx) on behavioral state and physiologic measures. 46 participants were enrolled in the study. Interventions were implemented in approximately 20-minute sessions. Physiologic measures, heart rate (HR) and oxygen saturation (SpO2), were collected using Sickbay. Behavioral measures were collected using The Face, Legs, Activity, Cry, and Consolability (FLACC) Pain Assessment Tool. Results Mean heartrates during Co-Tx (161.3 ± 15.4 BPM) did not differ significantly compared to SCOT (161.8 ± 15.7 BPM). In unadjusted comparisons, mean SpO2 levels were significantly higher during Co-Tx than SCOT (95.48 ± 3.43% vs. 95.12 ± 3.71%, p = 0.046). There was a significant decrease in pre- to post-test FLACC scores for Co-Tx when compared to SCOT (decrease of 0.97 ± 1.96 vs. 0.61 ± 1.65, p = 0.023). In adjusted comparisons, there were no statistically significant differences in physiological outcomes. Conclusions Co-treatment with music therapy may create a more stable and regulated environment for NICU infants. Further research is recommended on music therapy co-treatment with rehabilitative therapies.

Reduced time to imaging, length of stay, and hospital charges following implementation of a novel postoperative pathway for craniotomy.

The authors created a postoperative postanesthesia care unit (PACU) pathway to bypass routine intensive care unit (ICU) admissions of patients undergoing routine craniotomies, to improve ICU resource utilization and reduce overall hospital costs and lengths of stay while maintaining quality of care and patient satisfaction. In the present study, the authors evaluated this novel PACU-to-floor clinical pathway for a subset of patients undergoing craniotomy with a case time under 5 hours and blood loss under 500 ml. A single-institution retrospective cohort study was performed to compare 202 patients enrolled in the PACU-to-floor pathway and 193 historical controls who would have met pathway inclusion criteria. The pathway cohort consisted of all adult supratentorial brain tumor cases from the second half of January 2021 to the end of January 2022 that met the study inclusion criteria. Control cases were selected from the beginning of January 2020 to halfway through January 2021. The authors also discuss common themes of similar previously published pathways and the logistical and clinical barriers overcome for successful PACU pathway implementation. Pathway enrollees had a median age of 61 years (IQR 49-69 years) and 53% were female. Age, sex, pathology, and American Society of Anesthesiologists physical status distributions were similar between pathway and control patients (p > 0.05). Most of the pathway cases (96%) were performed on weekdays, and 31% had start times before noon. Nineteen percent of pathway patients had 30-day readmissions, most frequently for headache (16%) and syncope (10%), whereas 18% of control patients had 30-day readmissions (p = 0.897). The average time to MRI was 6 hours faster for pathway patients (p < 0.001) and the time to inpatient physical therapy and/or occupational therapy evaluation was 4.1 hours faster (p = 0.046). The average total length of stay was 0.7 days shorter for pathway patients (p = 0.02). A home discharge occurred in 86% of pathway cases compared to 81% of controls (p = 0.225). The average total hospitalization charges were $13,448 lower for pathway patients, representing a 7.4% decrease (p = 0.0012, adjusted model). Seven pathway cases were escalated to the ICU postoperatively because of attending physician preference (2 cases), agitation (1 case), and new postoperative neurological deficits (4 cases), resulting in a 96.5% rate of successful discharge from the pathway. In bypassing the ICU, critical care resource utilization was improved by releasing 0.95 ICU days per patient, or 185 ICU days across the cohort. The featured PACU-to-floor pathway reduces the stay of postoperative craniotomy patients and does not increase the risk of early hospital readmission.

Effectiveness of Cognitive Orientation to Daily Occupational Performance in Parkinson’s Disease: A Case Report

Introduction: Parkinson’s disease is a chronic progressive neurodegenerative disorder causing impaired motor function and various non-motor symptoms. One of the most common problems in Parkinson’s patients is occupational performance problems. The cognitive orientation to daily occupational performance (CO-OP) is one of the client-centered and problem-solving approaches in occupational therapy evaluations and interventions. This study aims to determine the effectiveness of the CO-OP approach on perceived satisfaction and occupational performance in a 62-year-old woman with Parkinson’s disease.&#x0D; Case Description: The client was a 62-year-old woman with moderate cognitive impairment, stage 3 on the Hoehn and Yahr scale, and signs of depression. In our case study, the outcome measures were the Canadian occupational performance measure (COPM), functional independence measure (FIM), Montreal cognitive assessment (MOCA), and Beck depression inventory-II (BDI-II). We administered the CO-OP intervention for six weeks. Sessions were performed twice a week for one hour per session.&#x0D; Results: The results indicate that the CO-OP intervention improves the client’s satisfaction, occupational performance, and functional independence. Although the results from this single case cannot be generalized, the findings suggest that CO-OP intervention may help improve satisfaction and occupational performance in adults with Parkinson’s disease. Further investigation is necessary.&#x0D; Conclusion: These results suggest that CO-OP can be a valuable occupational therapy interventions for individuals with Parkinson’s disease. We recommend that occupational therapists consider using this approach in their practice to improve the occupational performance of their patients with Parkinson’s disease.

565 Rehabilitation Time to Evaluation Report: A Quality Improvement Study

Abstract Introduction Successful rehabilitation of patients with burn injuries requires an in-depth occupational therapy (OT) and physical therapy (PT) evaluation early in the acute phase of a patient’s injury to develop a detailed therapy plan of care. In addition, it is a standard of the American Burn Association for verified burn centers to have a comprehensive rehabilitation program designed for burn patients within 24 hours of admission. However, there is no standardized report for tracking timeliness of issuing PT/OT orders or completion of therapy evaluations by PT/OT after a patient is admitted to a burn unit. This quality improvement study details the creation of a “Time to PT/OT Order Placement and Evaluation Completion Report” and results of a quality improvement process used to improve these metrics. Methods A multi-disciplinary workgroup was created and included a burn surgeon, PT and program nurse coordinator and an electronic report was created in collaboration with the hospital’s business intelligence team. The report included the following metrics: average time from admission to PT/OT order placement, average time from PT/OT order placement to therapist acknowledgement, and average time from PT/OT order placement to therapist completion of initial evaluation. A baseline report was run (3-months) and results were analyzed. A quality improvement process was then put into place including education of burn attending physicians, fellows, and rotating residents on timeliness of therapy order placement, therapy staff education on findings and a new process for morning coordination of burn therapist caseloads to prioritize new evaluations, and initiation of monthly reporting at the burn joint practice committee meetings. The report was then run for an additional 3-months and results were analyzed. Results Baseline and post-quality improvement process results (3-month averages) were as follows: Average time from admission to PT/OT order placement increased from 3.4 to 8.3 hrs, average time from PT/OT order placement to therapist acknowledgement decreased from 43.2 to 31.5 hrs, and average time from PT/OT order placement to therapist completion of evaluation decreased from 43.6 to 35.1 hrs. Conclusions After development of this report findings showed that the quality improvement process used to improve timeliness of inpatient PT/OT initial evaluation completion was effective. In addition, this report has been useful for metric reporting during burn joint practice committee meetings, the ABA verification process and burn therapy staffing/daily caseload management. Applicability of Research to Practice This report could be used by other burn centers to help track and improve timeliness of initial PT/OT evaluations for acute burns. In addition, metrics created from this report could be used for the ABA verification process and help justify burn unit therapy staffing needs.

Occupational Therapy Interventions After a Sports-Related Concussion

AbstractEvidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Project and illustrate how the research evidence from the reviews can be used to inform and guide clinical decision making. Each article in this series summarizes the evidence from published reviews on a given topic and presents an application of the evidence to a related clinical case. This Evidence Connection article presents a case report of a college student receiving occupational therapy services after sustaining repeated sports-related concussions. The occupational therapy evaluation and intervention process is described. Systematic review briefs on interventions for people with traumatic brain injury were published in Vol. 76 (Suppl. 2) of the American Journal of Occupational Therapy.

Validity and Reliability of the Turkish Version of the Revised Low Vision Independence Measure (LVIM-R).

Few tools are available for assessing the activity performance of people with low vision. Additional practical instruments are required for occupational therapy evaluation. To evaluate the validity and reliability of the Turkish version of the Revised Low Vision Independence Measure (LVIM-R). We analyzed Turkish LVIM-R items using confirmatory factor analysis with parceling. Test-retest reliability was measured using the intraclass correlation coefficient (ICC). The study was conducted between April 2020 and July 2021. Ophthalmology clinic. The study included 89 people with low vision who applied to an ophthalmology training and research clinic. Participants were age ≥18 yr, had visual acuity of 0.5 to 1.3 logarithms of the minimum angle of resolution, and consented to participate. Not applicable. Turkish version of the LVIM-R, a self-report measure of activity performance for people with low vision. In the principal-components analysis, the highest eigenvalue was Armor's θ = .966. ICCs were .995 for Visual Field or Scotoma, .997 for Visual Acuity, and .997 for Total score. Other results included χ2 = 9.566 (p = .297), comparative fit index = .998, Tucker-Lewis Index = .996, and root mean square error of approximation = .047. Goodness-of-fit indices support the structural validity of the two-factor model. The Turkish version of the LVIM-R is a valid and reliable assessment tool for occupational therapy practice in low vision rehabilitation. What This Article Adds: The Turkish LVIM-R is a valid and reliable assessment for use in low vision rehabilitation.

Determining the Marginal Cost Differences of a Telehealth Versus an In-person Occupational Therapy Evaluation Session for Stroke Survivors Using Time-driven Activity-based Costing

ObjectiveTo estimate the marginal cost differences and care delivery process of a telerehabilitation vs outpatient session. DesignThis study used a time-driven activity-based costing approach including (1) observation of rehabilitation sessions and creation of manual time stamps, (2) structured and recorded interviews with 2 occupational therapists familiar with outpatient therapy and 2 therapists familiar with telerehabilitation, (3) collection of standard wages for providers, and (4) the creation of an iterative flowchart of both an outpatient and telerehabilitation session care delivery process. SettingTelerehabilitation and outpatient therapy evaluation. ParticipantsThree therapists familiar with care deliver for telerehabilitation or outpatient therapy (N=3). InterventionsNot applicable. Main Outcome MeasuresMarginal cost difference between telerehabilitation and outpatient therapy evaluations. ResultsOverall, telerehabilitation ($225.41) was more costly than outpatient therapy ($168.29) per session for a cost difference of $57.12. Primary time drivers of this finding were initial phone calls (0 minutes for OP therapists vs 35 minutes for TR) and post documentation (5 minutes for OP vs 30 minutes for TR) demands for telerehabilitation. ConclusionsTelerehabilitation is an emerging platform with the potential to reduce costs, improve health care inequities, and facilitate better patient outcomes. Improvements in documentation practices, staffing, technology, and reimbursement structuring would allow for a more successful translation.

Self-awareness predicts fitness to drive among adults referred to occupational therapy evaluation.

Driving is associated with independence, well-being, quality of life, and an active lifestyle. Driving requires cognitive, motor, and visual skills, including self-awareness and processing speed. This study examines whether driver self-awareness, motor processing speed, and cognitive processing speed can predict fitness to drive among individuals referred to occupational therapy evaluation due to concerns about their driving ability. In this cross-sectional study, 39 participants were referred to off- and on-road driving evaluation to determine their fitness to drive due to changes in health status, advanced age, license renewal requirement, or prior automobile accidents. A registered occupational therapist (OT) classified 23 of the participants as fit to drive and 16 as unfit to drive. Motor and cognitive processing speed were assessed by the Stationary Perception-Reaction Timer and the Color Trails Test, respectively. Driving self-awareness was assessed by comparing the DI and OT evaluations to the participants' estimation of their own on-road driving performance. The fit-to-drive participants had a better motor and cognitive processing speed than those unfit-to-drive. The unfit-to-drive group overestimated their driving ability, whereas the fit-to-drive group accurately or almost accurately estimated their driving ability. Driving self-awareness was a significant predictor of participants' fitness to drive. This study demonstrates the importance of self-awareness for predicting fitness to drive among people at risk for compromised driving skills. Thus, driving self-awareness should be addressed as part of fitness-to-drive evaluations and interventions.

Health Literacy and Occupational Therapy: A Discussion on Assessing and Addressing Limited Health Literacy

Health literacy is multidimensional and goes beyond simply education level. In addition, age, gender, race and ethnicity, social network, and income level, among other things, can contribute to the level of health literacy and affect health outcomes. Many Americans cannot make sound decisions regarding their health care because of limited health literacy, yet health literacy is rarely considered during an occupational therapy evaluation and subsequent plan of care. This manuscript informs occupational therapists on strategies to address limited health literacy by using literature and evidence.

Occupational Therapy: An Essential Component of Support for Young Children With Cancer.

We established a multidisciplinary early childhood clinic to support infants and toddlers receiving cancer treatment. The access to occupational therapy (OT) in this population is unknown. To describe the access to OT for infants and toddlers with cancer. We retrospectively reviewed medical records to determine the frequency and characteristics of children with cancer who were referred to OT. Demographic data, medical information, and frequency of referrals were extracted from September 2015 to September 2018. Of the 134 patients, 112 (83.6%) received an OT evaluation: 88.4% were referred for hospital-based OT services; 42.0% were recommended for services upon returning home. Between-group comparisons revealed significant differences in referrals for home- or community-based OT services based on age and disease. OT is crucial to treatment plans that address the developmental needs of young pediatric oncology patients during hospitalization and thereafter. Recommendations for monitoring this vulnerable population are provided.

Psychological Factors Predicting Functional Ability and Participation After Hip Fracture.

Positive psychological factors have been related to better outcomes among adults with various health conditions. To predict functional ability and participation in older adults who had experienced a hip fracture on the basis of data at admission to acute (inpatient) rehabilitation. We measured physical factors, as well as positive and negative psychological factors, at three time points. Prospective and cross-sectional cohort study. Data collection occurred during admission, at discharge, and 6 mo after rehabilitation. Inpatient geriatric rehabilitation center and follow-up at home. Seventy-one older adults (M age = 78.58 yr, SD = 6.09) who had sustained a hip fracture because of a fall and who attended acute rehabilitation; 55 completed follow-up assessments 6 mo after discharge from rehabilitation. Participants completed the Adult Hope Scale, Life Orientation Test, Positive Affect Questionnaire, Geriatric Depression Scale (at admission only), hand-grip strength measures, Numeric Pain Rating Scale, and FIM® Motor domain (mFIM) before and after acute rehabilitation and after 6 mo. The Activity Card Sort (ACS) was administered only at follow-up. Outcome measures were the mFIM and ACS. At 6-mo follow-up, functional ability was correlated more with optimism than with age, gender, or hand-grip strength measured at admission. Participation was predicted by age, the hope-agency component, and pain in walking at admission; however, the hope-agency component was only marginally significant. At discharge, functional ability was strongly predicted by age, hand-grip strength, and mFIM scores at admission. Optimism and hope played a role in explaining rehabilitation outcomes at 6-mo follow-up. Occupational therapy evaluation should address positive psychological factors, and intervention should aim to strengthen these factors as powerful aids in older adults' recovery from hip fractures. What This Article Adds: This study reflects the philosophy of occupational therapy, which places great emphasis on the connection between clients' mind-body-spirit and their participation in daily life occupations.