Occupational Performance Outcomes Research Articles

Designing an occupation-based group intervention for adult inpatient rehabilitation: Partnering with clinicians and patients using a nominal group technique design.

Occupation-based interventions use engagement in a person's daily activities to achieve change. There is growing research into the use of occupation-based group interventions in the inpatient rehabilitation setting. It remains unclear whether occupation-based groups offer comparable outcomes to occupation-based interventions delivered individually; this research will precede a clinical trial aimed at comparing these two approaches for improving occupational performance outcomes. This study details the process of co-designing the intervention. Partnering with clinicians and patients in the design of healthcare interventions can promote patient-centred care, enhance uptake, and improve applicability and sustainability of the intervention to that setting. A modified nominal group technique (NGT) design was applied to facilitate two meetings and an electronic survey with an expert panel of clinicians and patients. Twelve participants (n = 4 occupational therapists, n = 1 registered nurse, n = 1 physiotherapist, n = 1 occupational therapy assistant, n = 1 occupational therapy manager, and n = 4 patients) were purposively recruited. A modified approach to the technique's four stages was used: silent generation, round robin, clarification, and voting. Consensus was set at >50%. Qualitative data from group discussions were analysed thematically. All participants agreed the intervention should include patient-centred, goal-directed, practice of daily activities, including breakfast and lunch preparation, domestic tasks, and laundry. Other components that were agreed included where the groups could run, group size, eligibility criteria, and frequency. Key themes from clinicians included needing a goal-directed intervention, focused on progressing towards hospital discharge; time and resource requirements were also discussed. Patients emphasised the importance of building social connections, opportunity to engage in meaningful activity, and the importance of linking participation to patient goals. Through collaboration with clinicians and patients, an occupation-based group intervention considering the available evidence, alongside clinical, experiential, and contextual sources of knowledge was developed; this resulted in an evidence-based, patient-centred, and contextually relevant intervention.

Addressing Participation in Adults With Postconcussive Symptoms Using Cognitive Strategy Training: A Feasibility Trial.

Some people experience persistent symptoms after a concussion that greatly affect occupational performance. To evaluate the feasibility and preliminary effect of metacognitive strategy training in a sample of adults with postconcussive symptoms. Single-group, prospective design. University research laboratory. Adults with persistent concussive symptoms affecting function (N = 14). Ten 45-min sessions of a metacognitive strategy training intervention, Cognitive Orientation to daily Occupational Performance (CO-OP). Assessed feasibility outcomes included recruitment, retention, and adherence rates, and intervention acceptability was evaluated with the Client Satisfaction Questionnaire-8. The preliminary effect was measured on occupational performance (Canadian Occupational Performance Measure), concussive symptoms (Neurobehavioral Symptom Inventory), sleep (Pittsburgh Sleep Quality Inventory), vision (College of Optometrists in Vision Development-Quality of Life Outcomes Assessment), and cognition outcomes (Dysexecutive Questionnaire, Weekly Calendar Planning Activity, and National Institutes of Health Toolbox Cognition Battery). Acceptable recruitment (32%), retention (93%), and adherence rates (100%) were observed, along with a high level of acceptability to participants. Large intervention effects were present for occupational performance, general concussive symptoms, and cognitive functioning. Findings suggest that the CO-OP is feasible to administer for adults with postconcussive symptoms and perceived as suitable for the needs of this population. Feasibility findings, coupled with improvements in occupational performance outcomes, provide the foundation for a future larger scale trial. Plain-Language Summary: The Cognitive Orientation to daily Occupational Performance intervention is practical to use to address the functional impact of persistent concussive symptoms in adults. Further research is needed to evaluate the efficacy of the CO-OP intervention with this population.

Student-led activities of daily living group program in a hospital inpatient rehabilitation setting.

Occupational therapists have vital roles in inpatient rehabilitation to focus on independence in activities of daily living. Occupational therapy interventions are uniquely designed to address goals of service users and can be delivered individually or in group formats. Group interventions promote service users' mutual support and enable therapists to increase frequency and intensity of service provision. Student-led programs have become an attractive model, benefiting students while providing positive treatment outcomes for service users. There is an emerging body of literature that explores service users' and students' satisfaction with student-led group models of practice within inpatient rehabilitation and occupational performance outcomes of service users participating in student-led programs. This study aimed to explore the satisfaction of service users and students in addition to the self-reported occupational performance outcomes of a student-led activities of daily living group program in inpatient rehabilitation. Data from 33 service users and seven students were collected retrospectively. The intervention involved a student-led activities of daily living group program, consisting of three groups: breakfast, morning tea, and home readiness group. All service users and students completed unique satisfaction surveys at the conclusion of their participation in the student-led program. Service users completed a self-reported activities of daily living performance measure pre- and post-program. Findings were reported in descriptive statistics, and pre- and post-program data were compared with the Wilcoxon signed-rank test. All students were satisfied with the student-led program. Majority of service users were satisfied with all components of the student-led program. Median scores for self-reported performance increased significantly following the student-led program (P < 0.001). This study highlighted that service users and students were satisfied with the service delivery of a student-led activities of daily living group program. The program was effective in addressing self-reported performance for service users in inpatient rehabilitation. The findings from this study have potential to inform clinical practice on the implementation of student-led programs in occupational therapy settings.

Interventions to improve the occupational performance of people with post stroke upper limb apraxia – A systematic review and meta-analysis

Introduction: Upper limb apraxia is a post stroke disorder affecting the persons’ ability to perform everyday activities. This review aimed to determine the effectiveness of interventions on occupational performance outcomes. Method: A systematic review of literature (2000-2022) across five electronic databases was conducted. PRISMA guidelines were applied. Data were pooled using RevMan. Findings: Four studies reporting findings from three randomised controlled trials were included. The methodological quality of studies was low. Three treatment approaches were reported: (1) strategy training (2) gesture training (3) combined gesture and strategy training. Strategy training alone or in combination with gesture training was significantly more effective than control interventions in improving occupational performance scores (FEM, mean difference: 1.08, 95% confidence interval: −6.01–8.16, I2 = 0%). Conclusion: This review provides low quality evidence to support the use of strategy training alone, or in combination with gesture training, by Occupational Therapists to improve occupational performance and apraxia scores post intervention among people with post stroke upper limb apraxia.

Study protocol for a randomised controlled trial to determine the efficacy of an intensive seated postural intervention delivered with robotic and rigid trunk support systems

IntroductionChildren with cerebral palsy (CP) classified as gross motor function classification system (GMFCS) levels III–IV demonstrate impaired sitting and reaching control abilities that hamper their overall functional performance. Yet, efficacious...

International society of sports nutrition position stand: tactical athlete nutrition.

ABSTRACTThis position stand aims to provide an evidence-based summary of the energy and nutritional demands of tactical athletes to promote optimal health and performance while keeping in mind the unique challenges faced due to work schedules, job demands, and austere environments. After a critical analysis of the literature, the following nutritional guidelines represent the position of the International Society of Sports Nutrition (ISSN).General RecommendationsNutritional considerations should include the provision and timing of adequate calories, macronutrients, and fluid to meet daily needs as well as strategic nutritional supplementation to improve physical, cognitive, and occupational performance outcomes; reduce risk of injury, obesity, and cardiometabolic disease; reduce the potential for a fatal mistake; and promote occupational readiness.Military RecommendationsEnergy demands should be met by utilizing the Military Dietary Reference Intakes (MDRIs) established and codified in Army Regulation 40-25. Although research is somewhat limited, military personnel may also benefit from caffeine, creatine monohydrate, essential amino acids, protein, omega-3-fatty acids, beta-alanine, and L-tyrosine supplementation, especially during high-stress conditions.First Responder RecommendationsSpecific energy needs are unknown and may vary depending on occupation-specific tasks. It is likely the general caloric intake and macronutrient guidelines for recreational athletes or the Acceptable Macronutrient Distribution Ranges for the general healthy adult population may benefit first responders. Strategies such as implementing wellness policies, setting up supportive food environments, encouraging healthier food systems, and using community resources to offer evidence-based nutrition classes are inexpensive and potentially meaningful ways to improve physical activity and diet habits. The following provides a more detailed overview of the literature and recommendations for these populations.

Occupational Performance and Hand Function in People With Parkinson’s Disease After Participation in Lee Silverman Voice Treatment (LSVT) BIG®

People with Parkinson's disease (PD) experience motor and functional impairment that can negatively affect daily living and participation. To examine the occupational performance and hand function outcomes of people with PD who participated in a Lee Silverman Voice Treatment (LSVT) BIG® program. Retrospective record review. Outcomes were extracted from patient charts at a hospital outpatient clinic. Sixty-six clinic outpatients with PD who completed the LSVT BIG program. An occupational therapist and a physical therapist who were certified in LSVT BIG administration delivered the 16-session LSVT BIG program. Outcomes and Measures: The Canadian Occupational Performance Measure (COPM), grip strength, and Minnesota Manual Dexterity Test (MMDT) were administered before and after participation in LSVT BIG training. For participant-identified COPM goals, pre-post changes were significant, ranging from 3 to 6 points for performance and satisfaction (p < .001). Grip strength in both hands showed significant gains; median scores for the right hand increased from 55.0 lb (interquartile range [IQR] 41.0, 70.0) to 64.0 lb (IQR 46.0, 80.0; p < .001) and for the left hand from 52.0 lb (IQR 39.0, 64.0) to 63.0 lb (IQR 44.5, 79.5; p < .001). MMDT median scores for right to left also significantly improved, from 124.0 s (IQR 113.0, 181.0) to 119.5 s (IQR 105.5, 163.5; p = .014). Participation in the LSVT BIG program can improve perceived occupational performance and satisfaction and produce gains in hand strength and dexterity for people with PD. What This Article Adds: This study is the first retrospective review of data on occupational performance and hand function outcomes after participation in the LSVT BIG program. The findings of beneficial outcomes support the use of LSVT BIG in occupational therapy services to increase functional abilities among people with PD.

An exploration of engagement in community based creative activities as an occupation for older adults

Purpose The purpose of this study was to explore the experiences of older adults (aged 60 and over) participating in community-based creative arts. With an ever increasing ageing population, understanding the benefits of leisure occupations such as community creative arts will be vital for Occupational Therapists in facilitating participation and active engagement. Design/methodology/approach An empirical qualitative research design with an interpretive phenomenological approach was undertaken. A purposive sampling method enlisted four older adult volunteers whose experiences of creative arts were explored through semi-structured interviews. Interview data were analysed thematically. Findings Participants identified many benefits of engaging in community creative arts. Four main themes were identified, namely, “personal benefits”, “choice” in their occupation, “encouragement” to and from others, with the environment facilitating “socialising”. These resulted in improved occupational performance and positive well-being outcomes. Originality/value The study complements national policy and extends evidence-based practice on the potential well-being benefits on older adults. In support of the preventative agenda, occupational therapists may apply these findings to increase social prescribing within practice.

Evidence to Inform Occupational Therapy Intervention With Adults With Intellectual Disability: A Scoping Review.

Occupational therapy practitioners use a range of habilitative and compensatory approaches to teach new skills or modify tasks and environments to address occupational performance among adults with intellectual disability (ID); therefore, they must identify and use available evidence to guide intervention planning. To summarize the scope of evidence that can inform occupational therapy intervention with adults with primary or comorbid ID. Articles published in peer-reviewed journals between January 2002 and January 2018 and indexed in PubMed, CINAHL, PsycINFO, and Scopus. Study Selection and Data Collection: A total of 159 articles met inclusion criteria and contained information on occupational therapy intervention with adults ages 18 yr or older with primary or coexisting ID. Fifty-seven of the 159 articles focused on intervention to address occupational performance outcomes (i.e., employment, self-care, leisure and social interaction, community participation). A wide range of literature is available to support occupational therapy intervention with adults with ID. Occupational therapy practitioners may be less knowledgeable about this evidence because much of it is located in non-occupational therapy or international journals. What This Article Adds: This scoping review provides occupational therapy practitioners with evidence to support high-quality occupational therapy intervention with adults with ID.

Occupational performance goals and outcomes of time-related interventions for children with ADHD

Background Children with attention deficit hyperactivity disorder (ADHD) have difficulties with occupational performance, related to difficulties with time-processing ability. Aims To examine the outcome of a multimodal time-related intervention designed to support children aged 9–15 years with ADHD, to achieve their occupational performance goals and improve satisfaction with occupational performance. A further aim was to compare the children’s ratings of outcome with their parents’ ratings and to analyse the occupational performance goals. Material and Methods A pre-post design was used. Participants were 27 children, aged 9–15 years. Children and parents rated occupational performance and satisfaction at baseline and follow-up, after 24 weeks, using the Canadian Occupational Performance Measure (COPM). The intervention consisted of time-skills training and time-assistive devices (TADs). Descriptive and non-parametric statistics were used. Results Significant improvements were found in reported performance and satisfaction. Children’s were higher than those of their parents. Most goals were about carrying out daily routines, knowing the duration of an activity and knowing what will happen in the near future. Conclusion and significance The study contributes to knowledge about suitable interventions for children with ADHD who have time-related difficulties. Occupational therapy interventions, including TADs and time-skills training, resulted in significantly improved occupational performance.

The Impact of an Occupation-Based Program for Incarcerated Women With Intellectual and Developmental Disabilities (IDD)

Abstract Date Presented 03/28/20 Utilizing a stepped wedge randomized control and repeated measures design, this study indicated improved occupational performance and participation outcomes for incarcerated women with intellectual and developmental disabilities (IDD). The outcomes of this study have strong potential utility for enhancing the rehabilitation of incarcerated individuals with IDD and advocating for the consistent inclusion of OT within criminal justice service-provider teams. Primary Author and Speaker: Laurie Stelter Contributing Authors: Cynthia Evetts

Occupational Performance Outcome for Survivors of Childhood Cancer: Feasibility of the Canadian Occupational Performance Measure

The aim of the study was to determine the feasibility of the Persian version of the Canadian Occupational Performance Measure (COPM) to assess self-reported occupational performance in a group of children with cancer at least one-year post-cancer diagnosis and intervention and to describe the self-reported occupational performance problems of children with cancer. Forty-three children with cancer (mean age 11.59 years; SD 4.94) participated in a cross-sectional study, using a convenience sampling approach. Performance and satisfaction were assessed through a validated Persian version of the COPM and feasibility and ease of administration were also considered. This study showed that feasibility was found to be adequate and this measurement was perceived as easy to understand; completion took from 20 to 51 minutes. Children with cancer prioritized 115 occupations within six of the nine COPM subcategories. Among the prioritized occupations, the highest number was found in self-care 61.7%, followed by productivity (26%), and leisure (12.1%). The mean ratings of performance varied from 3.7 to 8.4. The lowest mean rating was in the subgroup play/school (3.7). For satisfaction, the mean ratings were from 2.6 to 5.2, with functional mobility as the highest and play/school the lowest. The results support the use of the COPM in clinical practice for children with cancer. Based on these findings, children with cancer perceive problems with occupations related to all aspects of daily life. This underlines the need to provide rehabilitation services, especially occupational therapy services for these children.

Reducing Veterans’ Symptoms of Depression, Anxiety, Stress, and Posttraumatic Stress, and Enhancing Engagement in Occupations with SCUBA Diving and Occupational Therapy

Veterans face significant occupational and mental health challenges. This article explores whether an occupational therapy program in combination with SCUBA diving can enhance occupational performance and mental health outcomes for veterans more than SCUBA diving alone. A two-group random assignment pretest–posttest design was implemented to compare outcomes across two groups. Veterans in Group 1 (n = 7) completed SCUBA diving while those in Group 2 (n = 8) completed SCUBA diving in combination with occupational therapy. Outcomes were measured using the Canadian Occupational Performance Measure, PTSD Checklist for DSM-5, and the Depression, Anxiety and Stress Scale. Both groups participated in a semi-structured focus group post-participation. Additionally, those in Group 2 engaged in follow-up phone interviews. Trial registration number: NCT03928392. All participants significantly improved their occupational performance and satisfaction with performance, and reduced symptoms of PTSD, depression and stress. Those in Group 2 also experienced significant reductions in anxiety levels and reported applying learned interventions to daily life. Participating in SCUBA diving may contribute to reduced symptoms of PTSD, depression and stress among veterans. Engaging in occupational therapy may additionally contribute to reduced symptoms of anxiety and aid in therapeutic application of interventions to daily life.

ReActivate—A Goal-Orientated Rehabilitation Program for Adolescent and Young Adult Cancer Survivors

Background: Adolescent and young adult (AYA) cancer survivors tend to have poorer physical and mental health outcomes than their healthy peers or survivors of childhood cancer. This study evaluated the feasibility and acceptability of ReActivate, an 8-week, group-based, goal-orientated rehabilitation program for AYA cancer survivors. Methods: A prospective, single-site cohort study was conducted of all AYA cancer survivors who self-referred to the ReActivate program. Participants were 21 (60%) males and 14 (40%) females, who ranged in age from 16 to 25 years (M = 21.05, SD = 2.62). Weekly group sessions comprised 1 hour of physical activity, followed by 1 hour of education or self-management sessions. The AYAs completed measures assessing physical functioning (ie, cardiovascular fitness, and muscular endurance and strength), psychosocial outcomes (ie, health-related quality of life), and occupational performance. Results: The ReActivate program was found to be feasible and acceptable, with an 87% completion rate and a median attendance rate of 7 sessions (range = 3-8). There were statistically significant increases across most of the physical functioning, health-related quality of life, and perceived occupational performance and satisfaction outcomes, with Cohen's d effect sizes ranging from small to large. Conclusion: The ReActivate program was feasible and acceptable and may have a positive effect on AYA cancer survivors' physical, psychosocial, and occupational functioning. While the findings require replication in a randomized controlled trial, the program has the capacity to optimize delivery of patient care and health resources by bridging the gap that currently exists between the acute and primary care settings.

A meta-analysis of the relationship between occupational commitment and job performance

Using a random effects model, we meta-analytically estimated the true correlations between occupational commitment (OCC) and performance outcomes. We analyzed 69 empirical studies related to OCC and job performance correlations, and addressed 4 issues: First, we identified that OCC was significantly related to task performance and overall organizational citizenship behavior. Second, we distinguished between the effects of OCC on individual and organizational citizenship behavior. Third, we identified potential moderators of the OCC–performance correlation. Finally, we compared the predictive validity of affective organizational commitment versus OCC in predicting performance outcomes. The results support that OCC explains incremental variance in task performance and organizational citizenship behavior, which suggests that OCC should be given greater emphasis in performance management programs.

Transitional Justice Housing in Forensic Mental Health: Considering Consumer Lived Experience

Abstract Date Presented 04/04/19 Consideration of transitional housing in the forensic mental-health context has been limited. Largely, macro outcome measurement (recidivism or community tenure) has guided this work. While compelling, this does not speak to occupational performance outcomes or the practical impacts of day-to-day participation for consumers. Employing a qualitative phenomenological methodology, this study focuses upon consumer lived experience in transitional housing within the forensic mental-health context. Primary Author and Speaker: Clark Heard Contributing Authors: Jared Scott, Allan Tetzlaff, Heather Lumley

Occupational Performance and Functional Outcomes in People With Parkinson’s Disease: Lee Silverman Voice Treatment BIG

Abstract Date Presented 4/19/2018 A chart review of people with Parkinson’s disease (PD) who completed a Lee Silverman Voice Treatment BIG program showed positive outcomes in occupational performance and functional hand skills. These novel findings offer evidence for using this program to manage chronic symptoms of PD. Primary Author and Speaker: Barbara M. Doucet Additional Authors and Speakers: Mark Blanchard

Impact of multi-modal web-based rehabilitation on occupational performance and upper limb outcomes: pilot randomized trial in children with acquired brain injuries.

To determine whether the multi-modal web-based rehabilitation 'Move it to improve it' (Mitii) is more effective than wait list control (usual care) to improve occupational performance, upper limb function, and visual perception in children with acquired brain injury (ABI). Fifty-eight randomly allocated children (53% males; mean age 11y 11mo, SD 2y 6mo; Manual Abilities Classification Scale equivalent I=32, II=24, III=2; mean Full-scale IQ 75.8, SD 16.2) received either 20 weeks of Mitii (n=29) or usual care (n=29). Mitii comprised upper limb, cognitive, visual perception, and gross motor tasks, recommended for 30 minutes per day, 6 days per week, over 20 weeks. Outcomes were the Assessment of Motor and Process Skills (AMPS), Melbourne Assessment of Unilateral Upper Limb Function, Jebsen-Taylor Test of Hand Function, Test of Visual Perceptual Skills, Assisting Hand Assessment (AHA), and Canadian Occupational Performance Measure. The primary comparison at 20 weeks between groups on the AMPS process and motor measures used generalized estimating equations. Groups were equivalent at baseline. Participants completed on average 17.6 hours (range 0-46h) of Mitii. There were no differences between groups on the primary outcome (AMPS process: estimated mean difference -0.1, 95% CI -0.3 to 0.2, p=0.589; and AMPS motor: estimated mean difference 0.2, 95% CI -0.1 to 0.5, p=0.192). There were no differences between groups on overall visual perception, upper limb, and occupational performance outcomes. Mitii led to negligible changes on all primary and secondary outcomes compared with usual care. This likely reflects the small dose achieved and poses questions around the acceptability and feasibility of home-delivered Mitii in this population of children with ABI.

Accessibility and quality of rehabilitative services among migrants in Germany

Migrants comprise a large proportion of the population in Germany. As compared to non-migrants they are at a higher risk with respect tor occupational accidents, occupational diseases and early retirement due to disability. Tertiary preventive services such as rehabilitation, consequently, are of high relevance for this population group. We provide an overview of the accessibility and quality of preventive services among migrants residing in Germany using medical rehabilitation (tertiary prevention) as an example. We also present strategies which aim to improve health care for this population group. Summary of quantitative routine data analyses and of qualitative interviews with patients and health care professionals in rehabilitative care. Migrants utilize rehabilitative health care services less often than non-migrants. Those who undergo medical rehabilitation report a lower satisfaction with health care and show less favorable health outcomes than non-migrants. This, for instance, becomes evident in the occupational performance and subjective treatment outcome after rehabilitation. Socioeconomic, sociodemographic and health factors only partially explain these associations. In addition, there is evidence that migrants face various barriers which affect the accessibility and quality of health care services. Health care institutions have to provide services which are more sensitive to the heterogeneity of the population in order to reduce barriers in health care. Diversity management can contribute to this goal.

Setting measurable goals with young people: Qualitative feedback from the Goal Attainment Scale in youth mental health

Introduction Measuring occupational performance is an essential part of clinical practice; however, there is little research on service user perceptions of measures. The aim of this investigation was to explore the acceptability and utility of one occupational performance outcome measure, Goal Attainment Scaling, with young people (12–25 years old) seeking psychological help. Method Semi-structured interviews were conducted with ten young people seeking help from a youth mental health clinic. Interviews were audio taped and a field diary kept. Interviews were transcribed verbatim and analysed using content analysis. Results were verified by member checking. Results All participants were able to engage in using Goal Attainment Scaling to set goals for therapy, and reported the process to be useful. The participants identified the physical location and ownership of the scale was important to help motivate them to work on their goals. Conclusion Young help-seekers see Goal Attainment Scaling as an acceptable tool to facilitate the establishment of functional goals. Young service users were particularly keen to maintain control over the physical location of completed forms.