Occupational Therapists Research Articles

Positive Provocative Testing and Symptom Evaluation for Detecting Upper Extremity Repetitive Use Injuries Among Endoscopists

Background: Endoscopists have reported experiencing musculoskeletal pain, yet a comprehensive and objective investigation into repetitive use symptoms or injuries has not been conducted. We aim to evaluate a cohort of endoscopists for upper extremity repetitive use injury. Methods: We employed a 43 author-developed questionnaire as well as the validated QuickDASH (Disability of Arm, Shoulder, Hand) questionnaire. Subjects were evaluated by occupational therapists to identify clinical evidence of injury. Demographic factors, reported symptoms, and signs of injury were then analyzed. Results: Overall, 34.3% reported experiencing pain while 17.1% reported numbness. In the prior week, 48.5% of participants had been bothered by pain, 11.4% felt tingling, 17.1% experienced interrupted sleep, and 17.1% reported limitations in work duties. Physical testing revealed that many endoscopists had below-normal strength in their right grip (48.6%) and left grip (42.9%), and 88.6% had below-normal pinch strengths for their age and gender. Additionally, 71.4% of the group had at least one abnormal positive provocative test. Participants who reported numbness at night (p=0.015) and those who reported current pain (p<0.001) reported higher DASH disability scores. Current pain was also associated with performing 20+ procedures per week (p=.007). Those with a positive provocative test of the neck or elbow were likely to have below-normal pinch (p<.05) and grip strength (p<.05). Performing ERCP 20-60% of the week was more likely to result in decreased bilateral pinch strength. Conclusions: Our study found a high prevalence of repetitive use injury symptoms among endoscopists, corroborated by objective physical examination and testing.

Paediatricians’ knowledge of paediatric feeding disorders in Jordan

Purpose To investigate paediatricians’ knowledge about paediatric feeding disorders and the role of speech-language pathologists and occupational therapists and whether their work setting or years of experience influenced their knowledge. Method A cross-sectional survey design was used. The total score was out of 62 which included a subscale score of knowledge about paediatric feeding disorders out of 50 and a subscale score of knowledge about the role of rehabilitation team out of 12. Descriptive statistics were conducted and two-way ANOVA investigated the effect of two independent variables on the scores, that is, work setting and years of experience. Result A total of 191 paediatricians (138 male and 53 female) participated. The mean total score of participants was M = 29.90 years (SD =12.20), range (12–60). Paediatric feeding disorders were not evaluated nor managed by 26.7% and 23% of participants, respectively. Evaluation procedures for paediatric feeding disorders included bedside evaluation (75.9%), ultrasound (71.2%), videofluoroscopy (52.9%), endoscopy, and/or flexible/fiberoptic endoscopic evaluation of swallowing (50.8%). The most common treatment was drug treatment (64.92%). Speech-language pathologists and occupational therapists were considered to be members of the multidisciplinary team by 63.87% and 28.80% of participants, respectively. Referrals to speech-language pathologists and occupational therapists were made by 44.5% and 36.13% of participants, respectively. Significant differences for the independent variables of work setting (p < 0.01) and years of experience (p < 0.01) were found, indicating greater knowledge for paediatricians working in private settings and for those with less years’ experience. Conclusion There is a need for professional educational programs for paediatricians in Jordan, especially for those working in public settings. Such programmes need to focus on the nature of paediatric feeding disorders and the current evidence for management, as well as the roles and contributions of the multidisciplinary rehabilitation team.

A qualitative exploration of the therapeutic characteristics of the art of therapy: Perspectives on Ayres Sensory Integration.

Since Dr. Jean Ayres first ignited the spark that became Ayres Sensory Integration® others have followed, inspired by her legacy to continue her dedicated life's work. This theoretical approach continues to evolve, yet its fundamental core principles remain true to Dr Ayres's original ideal. Empowering practitioners to set the just right challenge, an inviting therapeutic relationship, and to entice engagement through play was conceptualized as the art of therapy. This qualitative phenomenological study explores the therapeutic characteristics of the art of therapy, emphasizing the just right challenge, the therapeutic relationship and the experience of flow from the occupational therapist's viewpoint. Eight participants kept reflective journals and engaged in semi-structured interviews which were analyzed using reflective thematic analysis. Three overarching themes were developed; 1) "The Human Connection" exploring components of the therapeutic relationship; 2) "Setting the Scene" investigating how the just right challenge is set, including the preparation and external factors involved; 3) "Magic Happens! The Optimal Experience" exploring a sense of achievement, how flow feels and how it is learned. Participants shared their unique therapeutic observations and provided clear insight into their understanding of the art of therapy. The findings demonstrated that this concept is complex and multifaceted with learning enhanced through mentorship and hands-on experiences. This highlighted the significant implications for the education and ongoing mentoring of both practicing and new clinicians. This study provided novel insight into the field of occupational therapy using Ayres Sensory Integration® by developing a deeper understanding of therapists' experiences of the art of therapy.

Improving comprehensive geriatric assessments with the clinical frailty scale: a focus group study

BackgroundThe purpose of this study is to exploratively evaluate the geriatric team’s views on the implementation of the Comprehensive Geriatric Assessment (CGA) and Clinical Frailty Scale (CFS) on frail older people with acute orthopaedic disorders who are cared for in two geriatric care wards in the southwest of Sweden.MethodsA qualitative design with focus groups was applied, based on a social constructivist research tradition. This approach differs from other qualitative methods, such as interviews, in that it encourages interaction between research participants and contributes to shedding light on a collective understanding of the world. This means that the analysis is based on the group’s collective input, not individual statements. The study group consisted of 21 professionals participating in four focus groups, with five to six participants per group. The participants in each group represented different professions within the geriatric team, including nurses, nursing assistants, physicians, occupational therapists, and physiotherapists.ResultsThe results underscore the importance of the CFS as the basis for CGA, emphasizing the effectiveness of the scale as a shared instrument promoting collaboration in healthcare. Our study uniquely points out the lack of research exploring the team-based use of tools for conducting a frailty assessment using the CFS. The study also highlights the importance of effective teamwork and a person-centred approach. The balance between person-centred care and what is feasible within the organization is crucial to providing the best possible care for patients.ConclusionsIn Sweden, as in other places, how healthcare staff experience their work is key to the quality of care. The study concludes that positive staff experiences with new approaches drive healthcare improvement, benefiting patients and society. This highlights the potential for further improvements in healthcare delivery through continued innovation and collaboration.Trial registrationClinical trial number: not applicable.

Fit and ready together: classroom staff training for implementation of a daily exercise program in specialized classroom settings for autistic students

Engaging in physical activity is mentally, emotionally, and physically beneficial for children (Centers for Disease Control and Prevention, 2022). Autistic children access fewer physical activities in the community than their neurotypical peers (Must et al, 2014). Autistic students need greater access to structured fitness opportunities to enhance their physical well-being, emotional wellness, and cognition for school participation. The purpose of this capstone project was for staff serving self-contained classrooms specialized for middle school autistic students in an urban public school district in the United States, to be trained on and to implement the Fit and Ready Together program, a classroom-based daily exercise program designed by an occupational therapist (OT). Classroom staff participants were trained on the program over two 30-minute trainings, followed by their daily implementation of the program in their classrooms with fading program developer support over a four-week period. Pre- and post-program surveys were compared to measure participants’ perceptions regarding the benefits of incorporating structured fitness routines in their classrooms, and overall classroom engagement was rated by participants over the four-week implementation period. Results of the program indicate that Fit and Ready Together is a viable program that promotes autistic student engagement in fitness and leisure opportunities within their classrooms. School-based OTs can support autistic students and facilitate opportunities within the classroom for greater access to meaningful occupations of structured physical and leisure activities. Further research may include program development and implementation over a longer time frame, with a larger sample size, and with incorporation of evidence-based components to target peer interactions.

Comparative effects of arithmetic, speech, and motor dual-task walking on gait in stroke survivors: a cross-sectional study

BackgroundThe application of dual-task walking paradigms for gait assessment in stroke patients is critical, where varying concurrent tasks may elicit distinct gait patterns of dual-task interference. This study assessed the acute effects of different types of dual tasks on gait in stroke patients during task performance, informing occupational, and physical therapists about care recommendations to prevent patients from falling and improve their balance function in daily life.MethodsA total of 19 stroke patients (52.7 ± 6.9 years old) performed the walking-only and dual-task walking (motor, arithmetic and speech) task test while a 3D motion capture system measured the gait parameters (the gait spatial-temporal parameters, sagittal angle of lower-limb joints, gait parameter variability and dual-task cost). One-way repeated measures ANOVA was used to test the effects of the above four walking conditions on gait parameters.ResultsArithmetic task and speech task interference can affect the gait of stroke patients (P &amp;lt; 0.05). Arithmetic task interference has the greatest impact on step speed, cadence, single support phase, hip joint range in support period and has the greatest dual-task cost, speech task interference has the greatest impact on cadence coefficient of variation (P &amp;lt; 0.05). The motor task was not significantly different from walking-only (P &amp;gt;0.05).ConclusionBoth arithmetic and speech tasks have a great impact on gait in stroke patients. Faced with cognitive interference, stroke patients spontaneously adopted a “cautious gait” walking pattern. In future rehabilitation training, diversity of task types is critical for gait rehabilitation training based on the walking ability of the patients.

A mixed methods realist analysis of telehealth delivery of complex wheelchair assessment in Aotearoa New Zealand: contexts, mechanisms, and outcomes

Purpose This study examined telehealth delivery of complex wheelchair assessment in Aotearoa New Zealand, specifically: what works, for whom, and in which contexts, with exploration of culturally specific factors for indigenous Māori. Materials and Methods A mixed methods realist evaluation was conducted with remote specialist assessors (physiotherapists and occupational therapists), on-site assistants, and wheelchair users. Interviews/focus groups, mobility goal achievement, satisfaction, and fidelity of tele-delivered assessment of wheelchair and seating (tAWS) contributed to Context-Mechanism-Outcome configurations (CMOc). Results Four remote specialist assessors delivered tAWS, but it was declined by on-site assistants in 78% of cases in which specialist assessors perceived it could work. When tAWS was delivered to wheelchair users (N = 5), the majority of goals were achieved, with high service satisfaction. CMOc’s highlight the influence of system design in the uptake of telehealth by health professionals. Conclusions While therapists can navigate complexity for successful tAWS, therapist and system barriers limit its uptake, particularly confidence in conducting assessment and use of technology among the non-adopters. Telehealth specific training in culturally-responsive rehabilitation is recommended. This evaluation contributes to telehealth program theory and the mechanisms to be addressed for telehealth to meet its potential to enhance equity in health outcomes.

Development of a self-report questionnaire for evaluating the occupational performance and satisfaction in daily occupations in seven occupational areas of university students with game addiction

Background: Nowadays, the prevalence of internet usage for university students’ game playing is increasing worldwide. However, overabundant gaming may lead to game addiction. Studies have demonstrated that game addiction increases the risks of health problems. Moreover, it also decreases occupational performance via cognitive and psychosocial skill reduction. In occupational therapy, cognitive and psychosocial performance are necessary for daily activities. Furthermore, occupational satisfaction also correlates positively with participation in occupations. Thus, occupational therapists should know the occupational performance and satisfaction in daily occupations of university students with game addiction to explore occupational issues and plan interventions. However, an instrument for evaluating the occupational performance and satisfaction in daily occupations of university students with game addiction has never been investigated. Objective: This study developed a questionnaire to evaluate the occupational performance and satisfaction in the daily occupation of university students with game addition. Materials and methods: The questionnaire, comprising 22 items, assessed the impacts of game addiction on occupational performance and satisfaction in daily occupations of seven occupational areas. Afterwards, the psychometric properties of the questionnaire were investigated in 78 university students with game addiction. Results: This study showed that the questionnaire had sufficient content and construct validity for evaluating the impacts of game addiction on occupational performance and satisfaction in the daily occupations of university students. Moreover, the internal consistency of the questionnaire in occupational performance is good (Cronbach’s alpha coefficient =0.812). Also, the internal consistency of the questionnaire in satisfaction of daily occupation is good (Cronbach’s alpha coefficient =0.82). Conclusion: The questionnaire is valid and reliable for evaluating the occupational performance and satisfaction in daily occupation of university students with game addiction. Screening these components can provide a new occupational therapy tool for such students.

The The innovative development of the aphasia speech application for Thai adults with aphasia

Background: The growing trend of internet usage among the Thai population, both in terms of user numbers and time spent online, has led to a growing demand for self-training applications. This trend presents opportunities to enhance access to healthcare services, especially in speech rehabilitation for aphasic patients. However, Thailand faces a shortage of speech-language pathologists (SLPs), making mobile applications a viable solution to expand access to treatment and improve patient outcomes. Objective: This study aimed to develop a digital tool for speech training in adult aphasic patients under the supervision of SLPs and a multidisciplinary team. It also sought to evaluate the tool’s effectiveness in improving speech outcomes for aphasic patients and assess user satisfaction among healthcare professionals, healthy participants, aphasic patients, and their caregivers. Materials and methods: This developmental research was conducted in four phases, starting with a literature review, developing the speech training application, expert validation of the application’s content, and tool implementation. The application was tested with 15 SLPs, six physicians, six nurses, six occupational therapists, six physical therapists, six healthy participants, 15 aphasic patients, and 15 caregivers. Based on the feedback from these diverse groups, the application was further refined to address suggestions and improve its usability. The application’s efficiency was measured through satisfaction surveys, while its effectiveness was evaluated using Thai adaptation of the Western Aphasia Battery test (WAB-Thai). Pre- and post-training scores were compared following 12 traditional speech therapy sessions with the Aphasia Speech application, each lasting 60 minutes over three months. Results: Satisfaction levels among healthcare professionals and healthy participants ranged from 4.0 to 4.2, whereas satisfaction levels among patients and caregivers were 3.9 to 4.6, indicating high satisfaction. The WAB-Thai scores showed statistically significant improvements in all areas, including fluency, comprehension, repetition, naming, reading, and the Aphasia Quotient (AQ) scores, with p&lt;0.05. Conclusion: The developed application significantly enhanced the effectiveness of speech training, as evidenced by improved language and speech outcomes across all metrics. High satisfaction levels from users supported its implementation as a valuable tool for continuing speech therapy at home. Further refinements are necessary to optimize its usability, with plans for broader dissemination among healthcare providers to address the shortage of SLPs in underserved regions.

Development of dysphagia screening questionnaire for Thai older adults

Background: Oropharyngeal dysphagia is a common condition in the older person and can lead to serious complications. In Thailand, there is currently no standardized dysphagia screening tool for gathering preliminary information about clients for early evaluation and intervention. Objective: This study aimed to develop a dysphagia risk screening tool for older persons and investigate its psychometric properties. This study examined the content validity, criterion validity, and test-retest of the Geriatric Dysphagia Risk Screening Tool (GDRST). Materials and methods: 26 questions were developed from literature review and expert opinion. Five expert occupational therapists examined content validity. The Index of Congruence (IOC) was calculated from five experts, and the items that showed IOC scores of over 0.5 were incorporated into the target screening tool. Thirty older adults who had a risk of dysphagia (Mean±SD, 66.13±4.66 years) participated in the study. The internal consistency was assessed using Cronbach’s alpha. An intraclass correlation coefficient (ICC) was used to examine the test-retest reliability of the screening tool. The criterion validity of the GDRST was evaluated by investigating the relationships between a score of the Functional Oral Intake Scale (FOIS) and the Swallowing Quality Assessment Form for Occupational Therapists (SQAOT) using Spearman’s correlation coefficients. Results: Based on the literature review and occupational therapy expert opinions, the screening tool covers three domains, including the cognition domain, oral phase swallowing ability domain, and pharyngeal phase swallowing ability domain. Content validity IOC scores were between 0.6 and 1.0 for all items. The internal consistency of the GDRST was high, with 0.971 Cronbach’s alpha for the test. The screening tool had excellent test-retest reliability on all items (p&lt;0.05). The score of the GDRST was significantly correlated with the score of FOIS (r=-0.468, p=0.009), and SQAOT (r=-0.705, p=0.000). Conclusion: The GDRST demonstrated excellent reliability and validity against the clinical assessment. It was simple to administer and could be beneficial for screening older people in the community for dysphagia.

Influence of Dementia on Vision-Related Functional Performance Among Patients With Type 2 Diabetes.

Complications of Type 2 diabetes mellitus (T2DM) leading to vision loss may increase the risk of dementia. The relationship between diabetic retinopathy severity and visual acuity (VA) has been explored, but the impact of dementia on vision-related functional performance in patients with T2DM is less understood. To investigate the association of diabetes-related eye problems with dementia and the impact of dementia on vision-related quality of life (VRQoL) and activities of daily living (ADLs) in patients with T2DM. Retrospective cohort and nested case-control study. Health care institution. Substudy 1 included 4,454 patients with T2DM. In Substudy 2, 33 patients with T2DM and dementia (male, n = 15; M age = 78.7 yr) were compared with 67 matched control participants (male, n = 36; M age = 76.6 yr). Patients with and without dementia were assessed with the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) and the Revised Self-Report Assessment of Functional Visual Performance (R-SRAFVP). Substudy 1 showed a borderline significant association between proliferative diabetic retinopathy and dementia. In Substudy 2, functional vision, particularly in the overall scales and three subscales of the R-SRAFVP and four subscales of the NEI-VFQ 25, declined significantly among patients with T2DM and dementia, but no significant differences were found in VA. The findings illustrate the complex relationships among T2DM, dementia, VRQoL, and vision-dependent ADL and suggest that occupational therapists who care for patients with T2DM and dementia should pay close attention to patients' functional vision. Plain-Language Summary: Complications of Type 2 diabetes mellitus (T2DM) that lead to vision loss may increase the risk of dementia. People with T2DM and dementia show a significant decline in functional vision. This study investigated the relationship between diabetes-related eye problems and dementia as well as the impact of dementia on vision-related quality of life and activities of daily living for patients with T2DM. The study demonstrates the complex relationships among dementia, T2DM, eye conditions, and vision-related function. The results highlight the importance of a functional vision assessment for patients with T2DM and dementia. Occupational therapists who care for patients with T2DM and dementia should pay close attention to patients' functional vision, which will guide them in assessment and intervention planning.

Evaluating physical and occupational therapists’ and assistants’ experiences implementing an electronic health record-based intervention to support peri-operative patients’ use of non-pharmacological pain management techniques.

Evaluating physical and occupational therapists’ and assistants’ experiences implementing an electronic health record-based intervention to support peri-operative patients’ use of non-pharmacological pain management techniques.

What do Professionals Think of Specific Care Recommendations for Vascular Cognitive Impairment? A Delphi Study With Health Care Professionals.

Vascular cognitive impairment (VCI) is an umbrella term covering all cognitive impairment from mild cognitive deficits to dementia due to vascular etiologies. VCI is highly prevalent within dementia and stroke care pathways, but specific recommendations for care for people with VCI are lacking. Therefore, we formulated specific recommendations for care for people with VCI and tested these in a panel of health care professionals. Modified Delphi study. Purposefully sampled health care professionals in the dementia and stroke fields. Based on Dutch care standards for dementia and stroke and previous studies, the research team formulated 27 statements. In 3 rounds, participants were asked on a 4-point Likert scale how much they agreed with statements. They could elaborate on their answer in open fields. After each round, level of agreement was calculated. Subsequently, it was evaluated whether consensus was reached. Qualitative data guided potential modifications to the statements and was analyzed for overarching themes in argumentation. Thirty-four participants (primary and secondary care physicians, nurses, psychologists, occupational therapists, and case managers in dementia care) were included in the expert panel. Of the formulated statements, 23 were accepted after 3 rounds. Accepted statements included recommendations on recognition and management of specific symptoms, awareness of care opportunities in and collaboration between care pathways and networks, and the importance of timely care. Some nuancing comments were raised on feasibility and specificity of the recommendations. Experts agreed on multiple specific recommendations for VCI care across the patient journey, balancing specific and targeted care with further integration of the different care networks. Despite some concerns on feasibility and the balance between disease-centered and person-centered care, the expert-agreed statements can provide guidance in striving toward tailored care and aid in bringing together stroke and dementia networks for people with VCI.

Improvement of thenar bulk appearance in index finger pollicization with adipofascial flap fashioned from pouce flottant/rudimentary thumb.

Improvement of thenar bulk appearance in index finger pollicization with adipofascial flap fashioned from pouce flottant/rudimentary thumb.

B.C. occupational therapist follows her instincts to build a unique career: An interview with Miini Teng

B.C. occupational therapist follows her instincts to build a unique career: An interview with Miini Teng

End-of-Life Conversations With Adult Patients and Their Families: An Evidence-based Guide for Occupational and Physical Therapists.

End-of-Life Conversations With Adult Patients and Their Families: An Evidence-based Guide for Occupational and Physical Therapists.

Introducing a practice guide for occupational therapists: Supporting online groups for adults living with mental health issues

Introducing a practice guide for occupational therapists: Supporting online groups for adults living with mental health issues

Telecommunications affordability: Technology access policy awareness for occupational therapists

Telecommunications affordability: Technology access policy awareness for occupational therapists

Determining the success of clinical outcomes for thumb immobilization compared to no thumb immobilization in adult non-displaced, non-surgically managed scaphoid fractures: A systematic review.

Determining the success of clinical outcomes for thumb immobilization compared to no thumb immobilization in adult non-displaced, non-surgically managed scaphoid fractures: A systematic review.

The Rural Hand Therapy Project: A mixed methods study in a regional health service.

Rural occupations carry a high risk of hand injury. In rural locations, provision of hand injury rehabilitation often falls to generalist occupational therapists. However, these therapists' capacity to provide hand injury assessment and treatment is limited. The Rural Hand Therapy Project (RHTP) was developed to improve access to hand therapy for patients living in rural areas by supporting rural generalist occupational therapists to provide hand therapy. The aim of this study was to investigate the impact, acceptability and experience of the RHTP for patients and clinicians. A convergent mixed methods design was used. Adult outpatients with a hand injury, referred by a regional hospital orthopaedic department, were reviewed pre-intervention and post-intervention via patient questionnaires and chart audits. The intervention was the method of hand therapy provision measured as the standard model of care (regional specialised service) and alternate model of care (RHTP). The outcome measures recorded patients' perspectives of treatment efficacy using the DASH, PSQ-18 and the SF-36. Semistructured interviews were conducted to evaluate the clinicians' experience of the RHTP. No consumers were involved in the study conceptualisation or analysis. Sixty-seven people were eligible and 52 people completed the study. Data were available for 33 patients treated via the standard model of care and for 19 patients treated via the RHTP. No significant difference was found between the two groups with regard to patient satisfaction, level of improvement and fidelity of service. The qualitative data obtained from interviews with eight clinicians revealed four major themes: a rural generalist that provides specialist care; increasing rural demand; flexible and proactive care; and 'if we stopped it now, we would go backward'. This study demonstrated that the RHTP provided similar outcomes for hand therapy care for rural and remote patients when compared to their regional counterparts. Consideration of context and potential unintended impacts are important in implementation. Hand injury treatment can be hard to access in rural areas compared to less rural areas. The Rural Hand Therapy Project was started to improve access to hand therapy treatment for people from rural areas. The program uses a few methods. These include: a regional therapist can see complex patients for their first session; better written and verbal reports about patient care; increased access for rural staff to training and advice from regional staff. The aim of the study was to look at what patients and staff from rural areas thought of the program and if the program achieved improvements. Fifty-two people were part of this study. We measured if people living in rural areas, whose care was helped by the program, were as happy with their care as people living in a regional area. We also measured if these rural people made the same gains as those living in a regional area. We also talked to the rural staff to know what they thought of the program. The study showed that the patients from a rural area were as happy with their treatment as the regional hospital patients. Both groups got the same level of care and made the same amount of gains. Rural staff thought the program was useful. The study also showed some findings about the increased cost to rural sites to deliver hand therapy and the challenge of deciding which people should be treated first.