Occupational Therapy Practitioners Research Articles

Spreading Standardized Documentation of Pediatric Occupational and Physical Therapy Dose: A Quality Improvement Initiative.

Clinicians and researchers can leverage clinical documentation of therapy services for quality improvement and research purposes. However, documentation is often institution specific and may not adequately capture the dose of therapy delivered, thus limiting collaboration. To implement documentation of pediatric occupational and physical therapy dose from one institution to another institution. Dose documentation includes the frequency, intensity, time, and type of interventions delivered (FITT Epic® Flowsheet) at each session. Prospective time-series quality improvement study. Two large urban pediatric hospitals. Occupational and physical therapy staff members. Staff training and feedback loops utilizing existing groups. The process measure (number of available staff trained and using the FITT Epic Flowsheet over time) and the outcome measure (percentage of FITT Epic Flowsheets used for treatment visits each month) were analyzed using a statistical process control chart. The balancing measure (percentage of notes closed before 7 p.m. on the same day as the encounter) was analyzed using mean per month across three time periods. Fifty-seven staff members (68%) attended formal training. On average, clinicians documented 90% of sessions using the FITT Epic Flowsheet after implementation. There was no change observed in the balancing measure. Documentation of dose was spread from one institution to another. Shared documentation will facilitate future collaboration for quality improvement and research purposes. Occupational therapy practitioners and leaders should consider implementing documentation with common dose elements. Plain-Language Summary: Occupational therapy documentation is often institution specific and may not adequately capture the dose of therapy (frequency, intensity, time) or types of interventions that were delivered, thus limiting opportunities for collaboration between institutions. This article adds to the literature on administrative supports for clinical and quality improvement research by illustrating a specific example of how documentation of dose can be shared from one institution to another. The data show that clinicians at one institution started using a new style of documentation using the FITT Epic® Flowsheet and shared discrete dose elements with another institution, creating new opportunities for collaboration. Shared documentation can facilitate future collaboration for quality improvement and research purposes.

Working together or apart? Impact of interprofessional education on collaborative competencies of applied behavior analysis and occupational therapy practitioners

ABSTRACT Applied behavior analysis and occupational therapy practitioners uniquely serve neurodivergent individuals, despite interprofessional contention. While some qualitative research exists, there is a need for quantitative and mixed-methods evaluation of evidence-based strategies to improve the collaboration between occupational therapy practitioners and applied behavioral analysis professionals. This study aimed to improve collaboration for enhanced outcomes between individuals from these two professions. This program assessed change in collaborative competencies of occupational therapy and applied behavior analysis professionals, following virtual interprofessional education initiative provided by a licensed certificant from each profession. Interprofessional Collaborative Competencies Attainment Survey, open-ended survey questions and recorded focus group were used to evaluate program impacts. Quantitative results were analyzed using paired-sample t-tests and revealed statistically significant increases in participants’ whole scores (p<.05). Qualitative analysis revealed the value of practical, problem-based learning. This study demonstrated the potentiality of virtual interprofessional education, question-answer dialogue, and actionable strategies. Future studies can increase sample size and implement longer-term models.

Validation of an Instrument That Measures Factors Affecting Saudi Parents' Tolerance of Risky Play: A Rasch Analysis.

Benefits of children's participation in risky play are broadly recognized. However, most related research originates in Western countries; none focuses on outdoor play in Eastern countries, including Saudi Arabia. Furthermore, although the literature identifies varying perspectives on risky play among parents, there is no objective measure to assess personal, situational, and cultural factors shaping their risk tolerance. To establish the construct validity and internal reliability of data gathered with the newly developed Factors Affecting Tolerance for Risk in Play Scale (FAC-TRiPS). Instrument development. Online survey. Ninety Saudi parents with children ages 7 to 10 yr. The FAC-TRiPS, a 17-item, self-report measure. We used Rasch analysis (Winsteps 4.4.4) to establish evidence for construct validity (item fit, match of item difficulty and parent tolerance, principal-components results) and internal reliability (person reliability index). Item fit analysis revealed that data from 15 of 17 items (88%) conformed to Rasch model expectations. Item difficulty closely matched parents' risk tolerance level. The principal-components analysis of residuals demonstrated that observed variance (49.6%) closely matched expected variance (49.7%). The first contrast's unexplained variance had an eigenvalue slightly greater than 2.5, suggesting possible multidimensionality. The person reliability index was .90. Preliminary analysis suggests that the FAC-TRiPS yields valid, reliable data measuring factors that influence parents' risk tolerance. Further research is needed. Plain-Language Summary: This study contributes to the knowledge of how parents in Eastern countries perceive risky play. The Factors Affecting Tolerance for Risk in Play Scale (FAC-TRiPS) is a newly developed tool that occupational therapy practitioners can use to understand parents' beliefs about and tolerance for their children's participation in risky play. The findings facilitate an understanding of the complex nature of parenting when determining whether to allow children to participate in risky play activities.

Attitudes and perceived barriers to evidence-based practice among occupational therapists in Jordan.

Evidence-based practice (EBP) refers to the clinical decision-making process incorporating the best available evidence from research, therapists' clinical experience, and patient values. The current study aimed to examine the experience of Jordanian occupational therapy practitioners (OTs) in using EBP and to identify the perceived barriers to implementing EBP among OTs in Jordan. The study utilized a cross-sectional descriptive study design. A questionnaire was emailed to OTs who have been working in Jordan for the last six months of their practice in a clinical setting. The majority of the participants had a positive attitude toward EBP. However, they reported several barriers to implementing EBP, including a lack of tools and equipment in clinical settings as a major barrier (65.8%). National collaborative actions are needed to develop strategies to improve the utilization of EBP in occupational therapy (OT) practice and to overcome the barriers therapists experience with implementing EBP.

Technology trends in practice: A survey of occupational therapy practitioners.

Given the evolving digital revolution, technology and digital tools are becoming inseparable from work and daily occupations. Occupational therapy practitioners (OTPs) focus on supporting individuals in their desired and needed activities. Many of these daily activities (i.e., online banking, shopping, social media, smartphone use) require digital skills at a growing rate, and insufficient technological skills may subject individuals to limited engagement and social isolation. To understand OTPs attitudes regarding technology utilization. We surveyed 109 OTPs about their attitudes, work practices, and barriers to addressing their clients' digital technological functioning. The findings of our study suggest that while OTPs acknowledge the importance and potential benefit of technology for their clients, there is a notable professional gap in the training and skills of OTPs to support their clients' digital functioning effectively and to integrate technology into their practice. There is a need to improve and expand OTP's digital skills and knowledge regarding addressing clients' digital functioning and technology implementation in occupational therapy practice.

Occupational Therapy’s Role in Post-Secondary Education Transition: A Critical Appraisal and Classification of Assessments

ABSTRACT There is a need to continue to amplify the value of occupational therapy for individuals with disabilities who are transitioning from secondary education to adult settings, such as vocational and post-secondary educational environments. Literature evidences a lack of practitioner knowledge of assessments and evaluations within the scope of occupational therapy for individuals receiving transition services. The purpose of this critical appraisal was to synthesize information regarding available assessment tools, designed to understand an individual’s strengths, capacities, and preferences for a better-informed transition process. Following critical appraisal of inclusion criteria via constant-comparative analysis, evidence-supported assessment tools were sought and classified into five distinct categories: transition-focused, occupation-based, vocational, life-skills, and self-determination assessments. Results included appraisal of each tool for population targeted, constructs assessed, and best practices in administration. This classification can support occupational therapy practitioners collaborating with individuals and families facing a transition into adulthood, informing the process through more carefully matched assessment.

Occupational therapy assessments and interventions for patients with ankylosing spondylitis: a scoping review protocol.

The proposed scoping review aims to explore the literature on the occupational therapy (OT) scope of practice for patients with ankylosing spondylitis (AS), including assessment methods and intervention approaches used by OT practitioners, areas of impairment addressed, and practice settings where OT practitioners provide services. AS is a type of spondyloarthritis primarily involving inflammation of the spine. Studies have begun to examine the role of OT in addressing pain, function, and disability among AS patients. Given the increased recognition of OT services for this population, a comprehensive understanding of the assessment methods and intervention approaches used by OT practitioners when working with AS would benefit clinicians, providers, and patients and support future research efforts. The review will consider studies that include participants of any age diagnosed with AS and any form of OT assessment and intervention. All relevant published and unpublished studies will be considered, without date or language limitations, including all primary studies, gray literature, text and opinion papers, and clinical guidelines. The review will follow the JBI methodology for scoping reviews. Searches will be conducted in MEDLINE (PubMed), Embase, CINAHL (EBSCOhost), Scopus (EBSCOhost), PsycINFO, ProQuest Dissertations and Theses Global, SportDiscus (EBSCOhost), OTDBase, OTSeeker, and Google Scholar. Two independent reviewers will extract data from selected papers using a standardized tool modified for the review. The results will be presented using frequency tables and will be accompanied by a narrative summary. https://doi.org/10.17605/OSF.IO/VPY56.

Occupational Therapists' Perspectives and Role With Illness-Induced Trauma From Medical Conditions.

Illness-induced trauma (IIT) might cause a disruption in an individual's occupational performance. To examine occupational therapy practitioners' (OTPs) perspectives and role in addressing IIT. In this descriptive mixed-methods design, 24 OTPs completed an online survey and 10 OTPs participated in a semi-structured 1:1 interview. Survey questions asked about knowledge regarding IIT. Interviews addressed incorporation of IIT knowledge and trauma-informed care (TIC) into practice. Quantitative results showed most OTPs (64%) did not receive TIC training and believed training was inadequate. Qualitative results indicated three major themes: "Impact on Rehabilitation," "Variety of OT Approaches for IIT," and "Barriers to Providing Trauma-Informed Care." Although OTPs report inconsistencies with incorporating TIC into practice, there are similarities with foundational OT skills and TIC. Findings suggest OTPs utilize a TIC approach to support clients with IIT to process and re-engage in meaningful occupations.

Performance of Medication Tasks: Relationship Among Patient-Reported Outcomes, Performance-Based Assessments, and Objective Assessments.

Occupational therapy practitioners use standardized assessments to guide their clinical decision-making, but it is unclear how well performance on standardized assessments translates to performance at home. To understand the concurrent and predictive validity of patient-reported outcomes and performance-based assessments for monitoring performance at home within the context of medication management and adherence. Exploratory study. Participants completed standardized assessments in a lab or at home, which were followed by home-based electronic monitoring of medication adherence. Sixty community-dwelling adults with hypertension or stroke who independently took antihypertensive medications. Participants completed the Hill-Bone Medication Adherence Scale, the Hill-Bone Medication Adherence Reasons Scale, the Performance Assessment of Self-Care Skills Medication Management subtask, and the Executive Function Performance Test-Enhanced Medication Management subtest. Then, they used an electronic pill cap to monitor medication adherence at home for 1 month. Patient-reported outcomes and performance-based assessments in the context of medication management and adherence demonstrated poor concurrent and predictive validity to medication adherence at home. There is a gap between what people think they will do, what they can do on a standardized assessment, and what they actually do at home. Future research is needed to strengthen concurrent and predictive validity to clinically meaningful outcomes. Plain-Language Summary: Occupational therapy practitioners should use caution when using standardized assessments to try to predict client performance at home. They should also continue to use a battery of assessments, clinical reasoning, and client preferences to guide their decision-making for monitoring performance at home within the context of medication management and adherence.

Occupational Therapy Practice Guidelines for Autistic People Across the Lifespan.

Occupational therapy practitioners need evidence to support interventions that promote subjective well-being among autistic people and their families through optimal engagement and participation in occupations. These Practice Guidelines are informed by systematic reviews to expand knowledge of interventions that promote access, inclusion, engagement, and optimal participation in occupations that are meaningful to autistic people. Our intent was to foster occupational therapy practitioners' clinical decision-making and reasoning when working with autistic people and their care partners. These Practice Guidelines were developed on the basis of four systematic reviews, supporting evidence and literature, along with continued revisions and integration through an iterative and collaborative process. A total of 98 articles were included in the systematic reviews, which are the foundation for practice recommendations in these guidelines. Forty-eight of the systematic review articles were used to inform the clinical recommendations included in these Practice Guidelines. Strong to moderate evidence indicates the need for multidisciplinary, goal-oriented interventions to support autistic people in different contexts. Although there is only emerging evidence in the inclusion of autistic people's strengths, interests, and perspectives to guide occupational therapy interventions, such practices can enhance the delivery of neurodiversity-affirming and trauma-informed practices. In addition, evidence is needed to support participation in activities of daily living (ADLs) for autistic youths. We recommend the use of strengths-based language to describe autistic people and the use of environmental adaptations, care partner education, and coaching to enhance occupational therapy service delivery. Plain-Language Summary: The literature is sparse regarding neurodiversity-affirming and trauma-informed practices for autistic youths, as well as for participation in activities of daily living (ADLs). These Practice Guidelines provide new information on positive mental health development; self-determination; ADLs, instrumental ADLs, play, and leisure occupations for children, adolescents, and adults; person-centered planning for adolescents and adults; and rest and sleep. Information on health management is also provided. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel etal., 2021; Kenny etal., 2016). However, we respect the use of person-first language and have made a conscious decision to include research articles that have used this language.

Effectiveness of Video Prompting Versus Picture Prompting in Improving Daily Living Skills of Autistic Children.

Static picture (SP) schedules are an established intervention for children with autism spectrum disorder (ASD), but the use of video modeling (VM) has not been thoroughly investigated. To compare the effectiveness of VM prompts versus SP prompts in improving autistic children's independence with daily living skills. An experimental alternating treatment design. Approved private school for children with disabilities. Seventeen participants (13 male and 4 female; ages 9-18 yr) with an ASD diagnosis. Visual prompts using a tablet were provided during task participation, with data collected in two phases. Type and frequency of the prompts required to complete the task were documented for each participant during the intervention session. Both VM and SP conditions resulted in improvements in at least one phase. Most participants demonstrated a decrease in the number of required cues to complete the task and an increase in independence to complete the task. The decrease in number of cues required from baseline to end of data collection indicated clinically meaningful improvement in task completion. Both VM and SP prompts resulted in an increase in independence in daily living skills, with most participants demonstrating improvement in either condition, indicating that the use of visual prompts (either VM or SP) is effective with the ASD population. Plain-Language Summary: Occupational therapy practitioners who work with autistic children and adolescents often identify improving daily living skills as a goal area. Findings from this study build on evidence that supports the use of a visual aid (either static picture or video modeling) to improve autistic children's acquisition of daily living skills. The findings also highlight emerging evidence related to the level of function and effectiveness associated with the type of visual cue. Positionality Statement: This article primarily uses identity-first language (i.e., autistic person) and at times person-first language (i.e., person with autism) to reflect the variability in the language preferences of the autism community (Lord etal., 2022).

Environmental Modifications for People With Intellectual and Developmental Disabilities: A Policy Analysis of Medicaid Home- and Community-Based Services.

Environmental modifications are targets for occupational therapy intervention because they support activities of daily living, self-efficacy, personal control, independence, and community living for people with intellectual and developmental disabilities (IDDs). To examine how environmental modifications were provided to people with IDDs through Medicaid home- and community-based services (HCBS) waivers across the United States in fiscal year (FY) 2021. Using a mixed-methods policy analysis, we examined FY 2021 Medicaid HCBS 1915(c) waivers from across the United States to examine whether, and how, states provided environmental modifications to people with IDDs. In FY 2021, 35 states projected spending $68.8 million on environmental modifications for 12,671 people with IDDs. The purpose of environmental modifications was most often to promote the health, welfare, and safety of people with IDDs (82.68%), and to promote their independence (69.29%). The most common examples of environmental modifications included ramps and/or lifts (70.08%), widening doorways and/or hallways (61.42%), bathroom modifications (58.27%), specialized electrical and/or plumbing for medical equipment (54.33%), and grab bars and/or handrails (53.54%). HCBS waiver data on environmental modifications for people with IDDs enhances an understanding of this funding source and provides a foundation of advocacy for occupational therapy practitioners to support people with IDDs with living, as well as aging, in the community rather than in institutions. An expansion of environmental modifications in HCBS for people with IDDs aligns with the aim of Medicaid HCBS waivers to promote community integration, self-determination, and independence, which are all benefits of environmental modifications. Plain-Language Summary: This study can help occupational therapy practitioners determine what funding sources are available in their state to help their clients with intellectual and developmental disabilities access environmental modifications. The findings can also help guide advocacy and lobbying efforts to expand access to environmental modifications.

Person and Environment Factors Supporting Self-Care Performance and Social Participation After Mild Stroke.

Mild stroke survivors seldom receive occupational therapy services as their deficits are assumed to be minor enough to not affect their daily occupations. Yet many mild stroke survivors report deficits in self-care performance and social participation. This study investigates person and environment factors influencing self-care performance and social participation among mild stroke survivors, using the Person-Environment-Occupation-Performance (PEOP) model. A retrospective cohort analysis of 736 mild stroke survivors was conducted using electronic health records. Person factors included demographic characteristics and clinical characteristics, and environment factors included the Social Vulnerability Index. The analysis included logistic regression. Approximately, 10% of patients reported deficits in self-care or social participation. Disability level was the only person factor associated with self-care performance. Person factors affecting social participation included mobility and unemployment. Socioeconomic status was associated with both occupation measures. Occupational therapy practitioners must address the person and environment factors affecting mild stroke survivors' self-care performance and social participation.

Teachers’ Perspectives on Best Occupational Therapy Service Provision in School-Based Practice: A Qualitative Study

ABSTRACT There is currently limited evidence regarding teachers’ perspectives of push-in and pull-out occupational therapy services in the school-based setting. Occupational therapy services can be delivered in different combinations and often vary based on the needs of the student, needs of the teacher and classroom, need for academic time, and need for social interactions. To examine teachers’ perspectives of push-in and pull-out services, a qualitative approach was used. Thirty-nine participants were recruited using a combination of convenience, snowball, purposive, and voluntary response sampling. Data was collected via a multiple choice and open response online survey. Thematic analysis was completed with the identification of six themes. Pros and cons of both push-in and pull-out service delivery, carryover, and modifications were discussed. Conclusively, most teachers preferred a combination of push-in and pull-out services, highlighting the importance of communication, collaboration, carryover, and finding the just-right fit for each student to best support their needs and learning styles. The findings of this study will better provide school-based occupational therapy practitioners with context for selecting the most appropriate service delivery model for each student.

Enlightening Stakeholders on the COVID-19 Pandemic Impacts and Preparation for Minimizing Future Pandemics’ Negative Effects on Occupational Therapists

The COVID-19 pandemic has affected all aspects of professional disciplines including occupational therapy; however, little is known about how much of an impact the COVID-19 pandemic affected occupational therapy practice in Ghana. This study examined the impacts, coping strategies, and COVID-19 pandemic lessons for occupational therapy practices in the future. A descriptive qualitative design was employed with a purposive and convenience sampling methods to recruit occupational therapists from four practice settings in Ghana. Semi-structured interviews were conducted with seven participants. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Four major themes were identified from the analysis enlightening stakeholders on the impact and preparation for minimizing the impact of future pandemics on the workloads of an occupational therapist. The major themes are (1) impacts of the COVID-19 on occupational therapy practice and practitioners; (2) aspects or domains of work significantly affected by the pandemic; (3) the existing strategies employed to handle the challenges; and (4) strategies to minimize these challenges in the future. The current study has enlightened stakeholders on the need to make alternate preparations including telehealth, continuous support for telehealth infrastructures, training of practitioners, and research to adapt intervention strategies effectively.

Investigating the Impact of the COVID-19 Pandemic on Occupational Therapy Practitioners

Investigating the Impact of the COVID-19 Pandemic on Occupational Therapy Practitioners

The Role of an Occupational Therapy Practitioner in Professional Advocacy: a Scoping Review

The Role of an Occupational Therapy Practitioner in Professional Advocacy: a Scoping Review

An Interdisciplinary Protocol for Ventriculoperitoneal Shunt Patient Selection in Normal Pressure Hydrocephalus

BackgroundNormal pressure hydrocephalus (NPH) can be treated with ventriculoperitoneal shunt (VPS) placement, but no broadly implemented indication for VPS exists. MethodsOur protocol consists of physical therapy and occupational therapy practitioners administering validated tests of gait, balance, and cognition before and after lumbar drain (LD) placement. Specific tests include: Timed “Up & Go”, Tinetti Gait and Balance Assessment, Berg Balance Scale, Mini Mental Status Exam, Trail Making Test Part B, and the Rey Auditory and Visual Learning Test. Minimal clinically important difference values for each test were determined from literature review. A retrospective review of patients treated under this protocol was performed. The primary outcomes were candidacy for VPS based on the protocol and patient-reported symptomatic improvement after VPS placement. Results48/75 (64%) patients received VPS. 43/48 (89.6%) of those shunted reported improved symptoms at 6 week follow up. However, 10/22 (45.5%) reported worsening symptoms at 1 year follow up. The mean Tinetti score significantly increased after LD in patients who improved with VPS compared to the no shunt group (4.27 vs -0.48, p<0.001). 6/33 (18%) patients with post-op imaging had a subdural fluid collection identified and 3/49 (6%) had other complications, including 1 seizure, 1 intracerebral hemorrhage, and 1 stroke. ConclusionsStandardized assessment of gait, balance, and cognition before and after temporary CSF diversion identifies patients with NPH likely to benefit from VPS placement with a low complication rate. One year after VPS, approximately half of patients had symptoms recur.

Challenging Norms: The Impact of Transgender and Gender-Diverse Realities on Work and School Participation.

Disruption in school and the workplace are health concerns for transgender people. To evaluate transgender individuals' thoughts and comfort with how others perceive their gender identity (social affirmation) and its association with outness in the workplace and mistreatment at work or school. Cross-sectional survey. Survey respondents older than age 18 yr from the Study of Transition, Outcomes & Gender cohort (N = 696; n = 350 assigned male at birth, n = 346 assigned female at birth [AFAB]). Ever "out" to employer and treated unfairly at work or school or fired from job. Predictors were high social affirmation and comfort with how others perceive own gender identity. Descriptive statistics and logistic regression were used for analyses. Individuals reporting high social affirmation were less likely to experience mistreatment at work or school than those with low social affirmation (odds ratio [OR] = 0.57, 95% confidence interval [CI] [0.38, 0.86]). Individuals AFAB who felt comfortable with how others perceived their gender identity were less likely to be out to their employers than individuals AFAB who did not (OR = 0.45; 95% CI [0.20, 0.97]). Individuals with high social affirmation were less likely to experience work or school mistreatment, and feeling comfortable with how others perceive their gender identity did not signify the need to be out. Plain-Language Summary: Occupational therapy practitioners can play a pivotal role when working with transgender individuals by assisting in creating new routines for self-presentation at work or school, navigating social environments, and providing guidance in self-advocacy skills. Individuals assigned male at birth may be in greater need because they report lower levels of social affirmation and acceptance at school and work than individuals assigned female at birth.

Engagement in Meaningful Activity Mediates the Relationship Between Stressful Life Events and Functional Resilience.

Resilience during stressful life events is a priority for administering the most client-centered care as possible. Occupational therapy practitioners have the unique opportunity to support resilience through promoting meaningful participation. The current study aims to understand the associations between meaningful activity engagement, resilience, and stressful life events. We specifically focused on answering if meaningful participation mediates the relationship between stressful life events and resilience. 492 participants from a non-clinical convenience sample of Amazon's MTurk completed the study. Participants completed an online survey and reported their experiences of stressful life events, resilience, well-being, and meaningful participation. We used SPSS and PROCESS to analyze our data. Stressful event severity and resilience were inversely related. When accounting for the effect of meaningful participation, the relationship became non-significant, indicating evidence of mediation. Implications: Focusing on measuring meaningful participation may be worth studying in further research.