American Journal of Occupational Therapy

This study examined data of older adults who had sustained a stroke and their ability to participate in the community following rehabilitation. There were 95 participants in this study to determine the interaction effect of functional limitation and social support on community participation. The findings indicate that for people who had sustained a cerebrovascular accident, community participation was more related to their ability to do for themselves, rather than the support that was available to them. The implications of these findings for future practice, programs, and research are discussed.

The emotional impact of surviving a stroke has not received the same attention as physical aspects. This is particularly true regarding how stroke survivors cope during inpatient rehabilitation. This study examined the coping strategies used by stroke survivors undergoing inpatient rehabilitation and the relationships between demographic or clinical variables and coping behaviors. This case series examined 16 acute stroke survivors via standardized assessments and a medical records review completed during the first week of inpatient rehabilitation.

Stroke survivors used combinations of multiple coping strategies. All stroke survivors used a higher number and frequency of adaptive rather than maladaptive strategies. Women used a higher number of adaptive strategies. Stroke survivors with depression used maladaptive coping strategies more frequently, whereas those presenting with a greater number and severity of comorbidities used adaptive coping strategies more frequently. Stroke survivors with higher levels of coping self-efficacy used the strategies of active coping and positive reframing more frequently.

Based on these results, it is recommended direct-care providers place greater emphasis on objectifying the emotional consequences of stroke. Further research is recommended regarding understanding the relationship between coping and outcomes.

OBJECTIVE. Occupational therapists are routinely involved in upper-extremity rehabilitation in persons with stroke. Recently we have reported that self-speech can be used to facilitate simple reach in young and older adults. The purpose of this study is to examine whether self-speech-induced facilitation of simple reach can be translated in persons with stroke.

METHOD. Following a counterbalanced repeated-measure design, seven persons with right brain stroke performed reaching and placing a glass on a cabinet shelf under four concurrent speech conditions of vocalizing the word “yeah” with both hemiplegic and nonhemiplegic sides. These four conditions are self-vocalization, external vocalization, imaginary vocalization, and no vocalization. Consistent with our previous study, in this study we also recorded the movement kinematics of angular movement of the upper arm.

RESULTS. Reaching velocity was significantly higher under self-vocalization conditions compared to the reaching velocity under no vocalization or other vocalization conditions (p < .05). Motor performance in terms of velocity, nonhemiparetic side was significantly better than hemiparetic side (p < .05).

CONCLUSION. The results suggest that self-speech can be used in facilitating movements in patients with stroke. When working with patients with right hemispheric stroke, therapists might explore possibilities of using patient’s self-speech to enhance the quality of movement performance.

Some occupational therapists report that they do not feel adequately prepared to perform the arduous tasks involved in integrating research into their practice. To explore how research utilization can be conducted by practicing clinicians, self-reported research utilization behaviors of a sample of 11 occupational therapists practicing in adult stroke rehabilitation were analyzed. The constant comparison of the interview data revealed that participants’ clinical experiences, engagement in continuing education, involvement in research activities, and their mentoring of students contributed to their capacity to translate research evidence into practice. The results of the study suggest a model for enhancing research utilization capacity through professional development. Implications for practitioners, provider organizations, educators, and regulators of occupational therapy are discussed.

The general objective of the “Rehabilitation Medicine Summit: Building Research Capacity” was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were: (1) researchers; (2) research culture, environment, and infrastructure; (3) funding; (4) partnerships; and (5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to pursue the agendas outlined in this report.

OBJECTIVE. To evaluate factors associated with randomized controlled trial patient recruitment by therapists.

METHOD. Survey of 18 (of a possible 26) therapists who had agreed to recruit patients for a randomized controlled trial (78% response rate).

RESULTS. Sixteen respondents had enrolled at least one patient. The site at which the therapist worked neither influenced the likelihood that a therapist would contact the researcher nor influenced the recruitment rate. Seventeen respondents reported that they contacted the researcher to discuss one or more of their patients for potential inclusion in the trial. Factors reported by therapists as reasons why they did not recommend the trial to eligible patients were not specific to study inclusion or exclusion criteria, rather were linked to personal judgments about patient suitability for the study. Regression analysis indicated that being enrolled or having completed master’s level postgraduate studies, and choosing not to refer patients because of concern for their poor medical prognosis were the only factors that significantly influenced recruitment rate (p < 0.001).

CONCLUSION. Recruitment practices vary amongst therapists. Selection of therapists with postgraduate qualifications as recruiters may be an effective way to enhance recruitment rate.

OBJECTIVES. The aim of this study was to examine the measurement properties of the Test of Visual-Perceptual Skills–Revised (TVPS–R).

METHODS. A group of 356 typically developing children 5–11 years of age completed the TVPS–R along with three criterion measures.

RESULTS. Several of the TVPS–R items had item–total subscale correlation coefficients were lower than the 0.20 correlation criteria. Cronbach’s alpha coefficients varied between 0.74 and 0.84 for the seven subscales. The perceptual quotient (PQ) reliability coefficient for the age levels ranged between 0.79 and 0.91. The PQ total group reliability coefficient was 0.96.

Results from the principal component analysis indicated that the majority of the TVPS–R items loaded on a dominant first factor. Confirmatory factor analytic models were assessed using four different goodness-of-fit indices. Two of the fit indices supported the unidimensional assumption (RMR and CFI), while two of the fit indices did not support the TVPS–R one-factor model (chi-square and RMSEA). A unitary motor-free visual-perceptual factor was not found.

CONCLUSION. The TVPS–R PQ should not be used as an overall performance summary score. Of the seven TVPS–R subscales, five can be used with confidence (visual discrimination, visual-spatial relationships, visual-sequential memory, visual figure ground, and visual-closure) whereas the visual memory and visual-sequential memory subscales are not recommended.

OBJECTIVE. The purpose of this study was to compare the time use of mothers of children with disabilities with the time use of mothers of children without disabilities.

METHOD. Sixty mothers with children 3 to 14 years of age (30 mothers with children with disabilities and 30 mothers with children without disabilities) completed time diaries over seven 24-hour days.

RESULTS. Significant differences were found between the two groups when comparing mean hours spent per week by mothers in occupations involving child-care activities and recreational activities. Mothers of children with disabilities spent significantly more time in child-care activities and significantly less time in recreational activities. In addition, mothers of children with disabilities reported fewer typical days and rated the quality of days as poorer. As children got older, the gap between the time mothers devoted to child care increased between the two groups.

CONCLUSION. The type of occupations a mother participates in varies significantly dependent upon whether a child in the family has a disability and the age of the child. Professionals need to work collaboratively with families to assist parents to meet the family’s daily needs particularly in light of the time demands of the mother.

The Perceived Efficacy and Goal Setting System (PEGS) is an instrument and a process that enables children with disabilities to reflect on their ability to perform everyday occupations and to identify goals for occupational therapy intervention. In this study, 117 children with disabilities in grades 1–3 completed the PEGS with occupational therapists who work in school settings. Children from 6–9 years of age with a variety of disabilities were able to self-report perceptions of their effectiveness performing 24 activities that would be expected of them each day. Parents and teachers, who completed a parallel questionnaire, rated their abilities lower than the children did. The School Function Assessment, a measure of the amount and type of support required for school participation, had low correlations with the Parent and Teacher PEGS questionnaires and did not correlate with the Child PEGS. No differences in perceived efficacy were found for children across grades or gender; however, differences were found across types of disabilities. Children were able to use the perceived efficacy information to identify and prioritize goals for intervention and these goals remained stable 2 weeks later. Occupational therapists can use the PEGS within a client-centered practice to help the child set goals for therapy and to incorporate explicitly the perspectives of parents and teachers.

PURPOSE. This pioneer study examines the visual-motor and visual-perceptual performance of Israeli and Palestinian children, and makes comparisons among these respective populations according to age, place of residence, and parental education. In addition, the study evaluates the validity of standardized assessment tools for use with Palestinian children, with the view of establishing a sound assessment battery for this underserved population.

METHODS. Participants included 101 Israeli and 125 Palestinian children from kindergarten, first grade, and second grade who underwent visual-motor and visual-perceptual tests.

RESULTS. Significant differences were found between the two cultural groups in all assessments. Results also refer to grade, place of residence, and parents’ education variables.

CONCLUSIONS. Although culture influences children’s performance, children from different societies should be screened and, when necessary, evaluated and treated in order to enable their optimal functioning at school. The validity of the assessment tools used, expressed in the ability to differentiate between Israeli and Palestinian children, should be further studied in order to suggest that these assessments may be considered as part of an evaluation battery for determining the school readiness and ability to advance in grade level among Palestinian children.

CONTEXT. Well-reported randomized controlled trials (RCTs) are necessary for evidenced-based practice in the field of occupational therapy.

OBJECTIVE. The primary purpose of this study was to analyze the quality of reporting in selected RCTs relevant to occupational therapy by using the Nelson-Moberg Expanded CONSORT Instrument (NMECI). The interrater reliability of the NMECI was also tested.

METHOD. The 201-sub-item NMECI was developed by the authors to clarify the 22-item CONSORT Statement, each item of which raises several issues. Fourteen RCTs obtained through the OTseeker database were analyzed independently by the authors.

RESULTS. The 14 articles complied with slightly more than half of the sub-items of the NMECI (M = 104.2, SD = 32.9 for the main rater). The only area of full compliance involved reporting of objectives and hypotheses; areas of frequent noncompliance included reporting of adverse events, randomization, and blinding. The intraclass correlation coefficient assessing level of interrater agreement on the total NMECI score was .95, indicating strong agreement overall. For the 176 kappas that could be computed on individual sub-items, the median kappa was .85, with an inter-quartile range from .58 to 1, indicating high levels of agreement for most items. However, 29 kappas fell below the moderate level of agreement (.40).

CONCLUSIONS. The field of occupational therapy needs increased sophistication in conducting and reporting RCTs. The NMECI shows promise in evaluating the quality of RCTs, given refinements to some items.