American Journal of Occupational Therapy

The American Journal of Occupational Therapy (AJOT) retains its ranking as the top-rated occupational therapy journal in North America by maintaining its commitment to publishing high-quality research aimed at occupational therapy professionals. As the needs and scope of the profession continue to expand, AJOT will continue to serve as a resource to practitioners, academics, and administrators to help guide best practices. Communication and engagement with readers will be facilitated through the new AJOT website as well as the new AJOT: Authors and Issues series. The journal seeks to expand its scope through its website, manuscript submission platform, and new ways to engage readers.

AJOT remains committed to publishing rigorous, peer-reviewed research so that occupational therapy professionals can make informed, evidence-based decisions about best practices across a variety of contexts.

Occupational therapy practitioners have the opportunity to promote development for all children as new service delivery models are established for pediatric primary care. Three action steps are identified: (1) advocacy for legislation that requires developmental screenings and surveillance, (2) support of culturally responsive developmental monitoring, and (3) building evidence for occupational therapy in primary care settings. This article describes the role of occupational therapy practitioners on pediatric interprofessional teams in encouraging family capacity within the scope of health promotion and universal developmental monitoring.

This Health Policy Perspectives column identifies three action steps to promote development for all children as new service delivery models are established for pediatric primary care.

With the continued evolution of health care reform and payment models, it is imperative that the occupational therapy profession consistently and clearly articulate its distinct value. As payment models shift from paying for the volume of services provided to paying for the value of services, the field of occupational therapy must be sure to implement high-quality care by translating evidence into practice and facilitating improvements in client outcomes. Yet the process of translating evidence-based interventions and programs to real-world settings can be quite complex, and successful implementation often requires active collaboration across occupational therapy stakeholders. In this Health Policy Perspectives article, we provide occupational therapy educators, practitioners, and researchers with key recommendations for how the profession can translate evidence into practice, ultimately leading to the improvement of client outcomes and the provision of value-based care.

This Health Policy Perspectives article provides occupational therapy educators, practitioners, and researchers with recommendations for how the profession can translate evidence into practice, ultimately leading to improved client outcomes and the provision of value-based care.

Traditional measurement approaches in health care focus on group data, virtually ignoring the individual client. To demonstrate the distinct value of occupational therapy, we need a measurement model that focuses on the person and generates outputs to inform daily practice. Traditional methods of establishing norms and predictive validity do not inform the development of interventions and goal setting. In this Eleanor Clarke Slagle Lecture, I use a person-centered measurement model that focuses on the person, versus the instrument, to demonstrate how person-centered measurement can be immediately used to identify the just-right challenge for the client. Person-centered measurement can be both the basis for designing interventions specific to the client and the foundation for setting empirically appropriate short-term and long-term goals. Occupational therapy practitioners can lead health care by immediately applying person-centered measurement to address the needs of individual clients and, moreover, to reveal the distinct value of occupational therapy.

In this Eleanor Clarke Slagle Lecture, the author uses a person-centered measurement model that focuses on the person, versus the instrument, to demonstrate how person-centered measurement can be immediately used to identify the just-right challenge for the client.

This Eleanor Clarke Slagle lecture describes the author’s work with marginalized populations, including homeless adults with mental illness, premature aging conditions, and poor literacy; women who became homeless as a result of domestic violence; children in impoverished, urban school systems reading below grade level; and adults with severe and chronic mental illness that impeded their ability to secure employment, housing, and independent community living. The author illustrates how and why occupational therapy practitioners should become part of the primary care team that evaluates the impact of multiple disorders on marginalized populations’ daily life activities, provides services to optimize community participation, and provides environmental modifications to enhance safety and function.

This Eleanor Clarke Slagle lecture examines the occupational therapy profession’s work with marginalized populations, particularly adults with mental illness who have experienced homelessness, and calls on practitioners to improve the lives of this population by providing services as well by joining primary care teams to identify the impact of multiple disorders on the daily life skills clients need to leave the shelter system and transition to and maintain supported housing.

Importance: People with Parkinson’s disease (PD) experience motor and functional impairment that can negatively affect daily living and participation.

Objective: To examine the occupational performance and hand function outcomes of people with PD who participated in a Lee Silverman Voice Treatment (LSVT) BIG^® program.

Design: Retrospective record review.

Setting: Outcomes were extracted from patient charts at a hospital outpatient clinic.

Participants: Sixty-six clinic outpatients with PD who completed the LSVT BIG program.

Intervention: 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.

Results: 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).

Conclusions and Relevance: 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.

This study, the first retrospective review of data on occupational performance and hand function outcomes after participation in the Lee Silverman Voice Treatment (LSVT) BIG program, support the use of the program to increase functional abilities in people with Parkinson’s disease.

Importance: Occupational therapists are the primary clinicians tasked with management of the more affected upper extremity (UE) after stroke. However, there is a paucity of efficacious, easy-to-use, inexpensive interventions to increase poststroke UE function.

Objective: To compare the effect of a multimodal mental practice (MMMP) regimen with a repetitive task practice (RTP)–only regimen on paretic UE functional limitation.

Design: Secondary analysis of randomized controlled pilot study data.

Setting: Outpatient clinical rehabilitation laboratory.

Participants: Eighteen chronic stroke survivors exhibiting moderate, stable UE impairment.

Intervention: Participants administered RTP only participated in 45-min, one-on-one occupational therapy sessions 3 times per week for 10 wk; participants administered MMMP completed time-matched UE training sessions consisting of action observation, RTP, and mental practice, delivered in 15-min increments.

Outcomes and Measures: The Action Research Arm Test, the UE section of the Fugl-Meyer Scale, and the Hand subscale of the Stroke Impact Scale (Version 3.0) were administered 1 wk before and 1 wk after intervention.

Results: The MMMP group exhibited significantly larger (p < .01) increases on all three outcome measures compared with the RTP group and surpassed minimal clinically important difference standards for all three UE outcome measures.

Conclusions and Relevance: Because of the time-matched duration of MMMP and RTP, findings suggest that MMMP may be just as feasible as RTP to implement in clinical settings. Efforts to replicate results of this study in a large-scale trial are warranted.

What This Article Adds: This study shows the efficacy of an easy-to-use protocol that significantly increased affected arm function even years after stroke.

Findings suggest that multimodal mental practice increases affected arm function in stroke survivors more than mental practice only.

Importance: Occupational therapy using an Ayres Sensory Integration^® (ASI) approach is a common intervention that has not been extensively studied in children with idiopathic sensory processing and integration challenges (e.g., without a diagnosis of autism).

Objective: To test the effectiveness of ASI using measures related to motor coordination and functional performance in children with a sensory-based motor disorder (SBMD).

Design: Nonconcurrent, multiple baseline, single subject.

Setting: Outpatient clinic that was part of a children’s hospital in an urban setting.

Participants: Three boys (ages 5–8 yr) with an SBMD.

Intervention: Each participant received ASI 3 times per week for 10 wk.

Outcomes and Measures: Three motor probes were measured weekly. Pre- and posttest assessments included goal attainment scaling (GAS) and the Bruininks–Oseretsky Test of Motor Proficiency–Second Edition (BOT–2).

Results: All 3 participants showed improvements in motor probes during the intervention period on the basis of a 2 SD band method of analysis. Statistically significant improvements were noted across GAS goals, and positive changes were found on the BOT–2, with large effect sizes.

Conclusions and Relevance: Findings suggest improved motor performance and high goal achievement using ASI for children with idiopathic sensory processing and integration challenges.

What This Article Adds: This study adds to a body of literature suggesting that ASI is effective in increasing functional performance in children with sensory processing and integration challenges. Future studies using multiple baseline designs are feasible in the clinic setting and can help build the evidence base for ASI.

This study adds to a body of literature suggesting that Ayres Sensory Integration® is effective in increasing functional goals in children with sensory processing and integration challenges.

Importance: Virtual reality in head-mounted displays (HMD-VR) may be a valuable tool in occupational therapy to address anxiety. Findings from the virtual reality exposure therapy (VRET) literature may facilitate translation of HMD-VR to occupational therapy psychosocial practice.

Objective: To explore how HMD-VR has been used to treat anxiety through VRET and could be translated to occupational therapy.

Data Sources: We searched seven electronic databases for articles published between 2000 and 2020: CINAHL, Cochrane Library, Embase, ERIC, Ovid MEDLINE, PsycINFO, and Web of Science. Search terms included HMD-VR constructs, products, and therapy concepts.

Study Selection and Data Collection: We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to report studies implementing VRET to treat anxiety. At least two reviewers assessed each citation, and a third resolved disagreements. Articles were included if they were in English, reported experimental data, and used HMD-VR. Letters, commentaries, book chapters, technical descriptions, theoretical papers, conference proceedings (≤4 pages), and reviews were excluded.

Findings: Twenty-eight studies used HMD-VR to treat posttraumatic stress disorder (n = 3), specific phobias (n = 19), and performance-based social anxiety (n = 6); protocols and levels of evidence varied (randomized controlled trials, n = 11; controlled trials without randomization, n = 6; case–control or cohort studies, n = 11). Qualitative examination indicates HMD-VR is an effective treatment tool.

Conclusions and Relevance: HMD-VR can be a valuable tool for occupational therapy to simulate environments where clients with anxiety disorders participate. Eliciting presence through multisensory features and body representation may enhance outcomes.

What This Article Adds: Drawing from the VRET literature, this scoping review suggests that HMD-VR can be used by occupational therapy practitioners to simulate ecologically valid environments, evaluate client responses to fearful stimuli, and remediate anxiety though immersion in virtual tasks when participation in natural contexts is unfeasible. Having ecologically valid environments is particularly important for people with anxiety disorders because they need support to cope when they encounter triggers in everyday life environments.

This scoping review suggests that HMD-VR can be used by occupational therapy practitioners to simulate ecologically valid environments, evaluate client responses to fearful stimuli, and remediate anxiety though immersion in virtual tasks when participation in natural contexts is unfeasible.

Importance: Understanding the impact of endometriosis symptoms on patients’ activities of daily living (ADLs) is a priority to establish effective and personalized intervention programs.

Objective: To explore limitations in ADLs and instrumental ADLs (IADLs) and their association with pelvic pain (PP), chronic fatigue, and pain-catastrophizing thoughts among women with endometriosis.

Design: Cross-sectional study.

Setting: Spain.

Participants: Two hundred thirty women with endometriosis.

Outcomes and Measures: Information regarding performance of ADLs (Barthel Index) and IADLs (Lawton–Brody questionnaire), PP intensity (Numeric Rating Scale), chronic fatigue (Piper Fatigue Scale), and pain-catastrophizing thoughts (Pain Catastrophizing Scale) was gathered. Multivariate regression analyses were created, and mediating effects of fatigue and pain-catastrophizing thoughts on the association between PP and ADL and IADL limitations were assessed.

Results: The prevalence of limitations in at least one ADL and one IADL was 22.6% (95% confidence interval [CI] [17.2, 28.1]) and 39.1% (95% CI [32.8, 45.5]), respectively. Limitations in bowel continence, housework, shopping, and meal preparation were reported most frequently. Women reporting severe PP showed higher risk for ADL (odds ratio [OR] = 3.33, 95% CI [1.10, 10.10]) and IADL (OR = 7.99, 95% CI [2.86, 22.34]) limitations. Chronic fatigue and pain-catastrophizing thoughts were also positively related to ADL–IADL limitations, showing a mediating effect on the association between PP and ADL–IADL limitations.

Conclusions and Relevance: This study reveals the widespread presence of difficulties in ADL–IADL performance among women with endometriosis, with some symptoms underlying these difficulties in occupational performance. This study points to the need for cost-effective occupational therapy interventions for affected women.

What This Article Adds: This research shows that the occupational performance of women with endometriosis is frequently impaired; therefore, the effectiveness of occupational therapy interventions should be addressed in the near future.

This study reveals the widespread presence of difficulties in ADL and IADL performance among women with endometriosis and points to the need for cost-effective occupational therapy interventions for women with this condition.

Importance: Robust and psychometrically sound performance-based outcome measures are needed for clinical trials of occupational therapy interventions for children with autism.

Objective: To demonstrate a systematic approach for choosing psychometrically sound performance-based outcome measures of daily living skills and socialization for use in clinical trials of occupational therapy interventions for children with autism.

Design: Rapid literature review to identify appropriate measures for studies with this population followed by quality indicator ratings and a nominal group process.

Setting: University.

Participants: Four experts in autism and pediatric outcome measurement.

Outcomes and Measures: Twenty-one outcome measures of daily living skills and socialization were identified and reviewed.

Results: Seven measures met the inclusion criteria. The Assessment of Motor and Process Skills and the Evaluation of Social Interaction–Second Edition, received the highest ratings and group consensus. Several other measures were also scored highly.

Conclusions and Relevance: Careful assessment of psychometric properties is an important component of choosing outcome measures for a clinical trial, but burden of assessment and study objectives are important considerations.

What This Article Adds: This project demonstrates use of a systematic process for choosing outcome measures for a planned clinical trial.

The authors describe a systematic process for identification and rating of performance-based outcome measures that can be used to identify appropriate outcome measures for occupational therapy clinical trials.

Importance: Vestibular and proprioceptive functions play a critical role in occupational performance and participation. Assessment of these functions in a reliable and valid manner is part of a comprehensive assessment in the Ayres Sensory Integration^® frame of reference, commonly applied in pediatric occupational therapy.

Objective: To report on reliability and validity of six tests of vestibular and proprioceptive functions of the Evaluation in Ayres Sensory Integration (EASI).

Design: We used Rasch analyses to examine and modify the number of items and scoring categories on the six tests and known-groups analysis to examine group differences. We evaluated internal consistency using Cronbach’s α and Rasch person reliability.

Participants: The sample contained typically developing children (n = 150) and children with sensory integration concerns (n = 84); all participated voluntarily.

Outcomes and Measures: The EASI is used to measure sensory and motor functions in children ages 3 to 12 yr. The six tests of vestibular and proprioceptive functions were analyzed in this study.

Results: Data from >96% of items conformed to the expectations of the model. We found statistically significant group differences (ps < .001–.128; ds = 0.20–1.31), with the typically developing children group scoring significantly higher on all but one test, and moderate to strong evidence of internal consistency (Rasch person-reliability indices ≥ 0.80; strata > 3) for five of six tests.

Conclusions and Relevance: The EASI vestibular and proprioceptive tests have strong construct validity and internal reliability, indicating that they are psychometrically sound clinical measures.

What This Article Adds: The development of occupational therapy assessments with strong psychometric properties, such as the EASI tests of vestibular and proprioceptive functions, enhances clinical practice and research by elucidating the factors affecting participation in accurate and dependable ways so that occupational therapy interventions can be focused and effective.

The researchers report on the reliability and validity of six tests of vestibular and proprioceptive functions of the Evaluation in Ayres Sensory Integration^® (EASI).

Importance: The effectiveness of robotic therapy in stroke rehabilitation has been established by many studies, and occupational therapists should consider using robotics in their clinical practice. However, little is known about occupational therapy practitioners’ experience using robotics.

Objective: To explore occupational therapists’ perceptions of the mechanisms and outcomes of occupational therapy using robotics with chronic stroke patients.

Design: Qualitative study with semistructured focus group interviews. Data were analyzed using thematic analysis.

Setting: Hospitals and institutions in Japan in which occupational therapists used robotics in their clinical practice.

Participants: Twenty-seven occupational therapists with experience in using robotics with chronic stroke patients as a self-training method that involved repetitive movements of a paralyzed upper extremity. Participants were interviewed in nine focus groups.

Results: Five themes—(1) body function, (2) values, (3) performance skills, (4) occupational performance, and (5) participation—and 12 subthemes were identified on the basis of the Occupational Therapy Practice Framework: Domain and Process (3rd ed.). Participants indicated that robotics improved patients’ body function and promoted a desire for independence, which resulted in improved occupational performance and participation in their desired occupations.

Conclusions and Relevance: Occupational therapists regarded robotics as an adjunct to other therapy, which improved patients’ body function and promoted their desire for independence.

What This Article Adds: Findings from this research provide insights into using robotics to enhance occupational therapy practice.

Findings from this research provide insights into using robotics to enhance occupational therapy practice.

Importance: Managing health requires extensive time and effort, especially in the early stages of a new illness. Although important, health management occupations contribute to treatment burden, disrupt engagement in other occupations, and galvanize the incorporation of the illness into identity. This is especially true for young adults after first-episode psychosis (FEP).

Objective: To explore the impact of health management occupations on the social participation of young adults after FEP.

Design: Qualitative study.

Setting: Community with participants from primarily urban environments.

Participants: Five adults between 18 and 30 yr old who experienced FEP within the previous 5 yr. Data collection occurred through semistructured interviews, participant observations, and discourse elicitation.

Outcomes and Measures: Two participant observations per month for 6 mo with 4 study participants; six observations total for a 5th participant.

Results: Health management dominated participants’ occupations immediately after FEP and hindered their social participation as they experienced a liminal space (i.e., transition space) in their life trajectory. Some participants were “stuck” in this space and deferred life goals to focus on illness management, whereas others used the liminal space as a space for growth and transformation.

Conclusions and Relevance: Health management occupations are essential; however, overemphasizing health management can hinder social participation and quality of life. Occupational therapy practitioners can assist clients with moving through liminal spaces after diagnosis by supporting participation beyond mental health treatment environments, helping clients to imagine alternative life trajectories, and finding strategies to reduce overall treatment burden.

What This Article Adds: The concept of liminality holds promise for understanding and supporting health management and social participation after FEP.

A study of 5 adults with first-episode psychosis (FEP) found that health management dominated participants’ occupations immediately after FEP and hindered their social participation as they experienced a liminal space (i.e., transition space) in their life trajectory.

Importance: The Canadian Occupational Performance Measure (COPM) is widely used in clinical practice and research. However, the measurement properties of the COPM were not reviewed using rigorous systematic methodology.

Objective: To evaluate the measurement properties of the COPM.

Data Sources: MEDLINE, Web of Science, Scopus, OTseeker, and Cochrane Library.

Study Selection and Data Collection: We used the updated COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist to evaluate the measurement properties of the COPM reported in relevant studies.

Findings: Our search identified 35 articles that reported measurement properties for the COPM with samples that differed in age, country, diagnosis, and disease stage. For content validity, the evidence was inconsistent and of low quality; no studies assessed structural validity. For reliability, the internal consistency was indeterminate and of low quality. One study reported indeterminate and very low quality evidence for cross-cultural validity. According to the evidence reported in these studies, the COPM has inconsistent and moderate reliability, construct validity, and responsiveness and insufficient and high-quality evidence for criterion validity.

Conclusions and Relevance: Our review of the evidence using the COSMIN Risk of Bias checklist indicates that the Canadian Occupational Performance Measure lacks high-quality validation.

What This Article Adds: High-quality validation of the Canadian Occupational Performance Measure is lacking. Further examination of its measurement properties using updated relevant guidelines is required.

The authors’ review of the evidence using the COSMIN Risk of Bias checklist suggests that the Canadian Occupational Performance Measure lacks high-quality validation.

Importance: Insufficient voluntary forearm movements are associated with ineffective and inefficient functional performance among people poststroke. Although evidence supports the application of the occupational therapy task-oriented (OTTO) approach for this population, the training protocol does not explicitly address the role of forearm rotation movements. In addition, a need exists for theoretical support for orthotic interventions for people poststroke.

Objective: To examine the efficacy of (1) a forearm rotation orthosis, (2) the OTTO approach, and (3) the combination of the two with people poststroke with a hemiparetic arm.

Design: Stratified, randomized, two-group, single-blinded, repeated-measures design.

Setting: Rehabilitation clinic.

Participants: Participants (N = 14) with a diagnosis of stroke and at least 10° of voluntary shoulder and elbow movement.

Intervention: Participants were stratified into three groups by motor function (mild, moderate, severe) and randomly assigned either to 6 wk of no treatment followed by 6 wk of OTTO or to 6 wk of orthotic intervention followed by 6 wk of orthosis plus OTTO.

Outcomes and Measures: Primary outcome measures were the Canadian Occupational Performance Measure (COPM), Wolf Motor Function Test (WMFT), and Motor Activity Log (MAL), administered at baseline (Week 1), at the end of Phase 1 (Week 7), and at the end of Phase 2 (Week 15) by blinded evaluators.

Results: Both groups showed clinically important improvements on the COPM. No significant differences were found on the WMFT or MAL.

Conclusions and Relevance: The OTTO intervention provides clinically important benefits in self-perceived functional performance to people poststroke.

What This Article Adds: The OTTO approach is an occupation-focused intervention that aims at functional performance and emphasizes clients' active engagement throughout the process. The findings suggest that the protocol of the OTTO intervention and its efficacy are appropriate for clinical practice.

The OTTO intervention provided clinically important benefits in self-perceived functional performance to people poststroke.

Importance: What occupational science (OS) knowledge may be essential to occupational therapy practice has not been systematically explored.

Objective: To identify and gain expert consensus on OS concepts viewed as essential to occupational therapy practice.

Design: A complex, convergent mixed-methods Delphi design with an international panel of OS experts randomly assigned to two parallel groups. In Round 1, each group generated OS concepts; in Rounds 2 and 3, they rated the degree to which each concept was essential to occupational therapy. Data were analyzed separately for each group. A fourth round combined the two groups and used carefully merged concept definitions from both groups to validate consensus on essential concepts arising from the prior rounds.

Participants: Fifty-two nominated experts from 22 countries who met a priori criteria participated in the 14-mo study.

Results: Of 62 experts invited, 52 (Group A = 24, Group B = 28) participated in the first round, and 42 (81%) completed the full-group final round. Eleven concepts met the consensus threshold (≥70%) established for the study. Additional analysis compared parallel- and full-group results to carefully discern conceptual similarities and differences, especially with near-consensus concepts.

Conclusions and Relevance: Substantial expert agreement was established for several OS concepts viewed as essential, providing a basis for future studies to refine the concepts for occupational therapy education and practice.

What This Article Adds: The results of this research provide a systematically derived preliminary basis for selecting OS content for occupational therapy educational programs and preliminary concepts for organizing OS knowledge germane to occupational therapy practice.

Substantial expert agreement was established for several occupational science concepts viewed as essential, providing a basis for future studies to refine the concepts for occupational therapy education and practice.

Importance: For the first time in recent history, people worldwide have faced severe restrictions in occupations because of the measures adopted by governments to contain the coronavirus disease 2019 (COVID-19) crisis.

Objective: To determine the limitations on participation of occupational therapists and occupational therapy students during “lockdown” and their impact on social determinants of health.

Design: A cross-sectional, descriptive study conducted via an online survey.

Participants: A total of 488 occupational therapists and occupational therapy students in North America, South America, and Europe.

Outcomes and Measures: A questionnaire consisting of the World Health Organization Disability Assessment Schedule 2.0 of the International Classification of Functioning, Disability and Health and items developed to assess the impact of lockdown on daily life was emailed to occupational therapy professional associations, organizations, and universities between April and June 2020. It was available in English, Spanish, and Portuguese and met all the parameters listed in the Declaration of Helsinki.

Results: The roles and routines of people across the developed world have been affected by lockdown measures. The study shows marked differences between participants in the domains of getting along and life activities, as well as influence on the environment. Moreover, South American participants experienced these difficulties to a greater extent than European participants.

Conclusions and Relevance: This study quantifies the limitations in the participation of occupational therapists and occupational therapy students and the relationship of occupation to social determinants of health.

What This Article Adds: The results of this research corroborate the relationship between health and occupation and highlight elements, such as the environment and context, that are important in occupational therapy. Therapists’ ability to analyze occupation in relation to contextual and cultural factors will benefit clients.

Results of this survey research quantify limitations in the participation of occupational therapists and occupational therapy students and the relationship of occupation to social determinants of health.

A confluence of factors during 2020 placed needed attention on the social and structural determinants of health, systemic racism, and social injustice. Institutions across the country are taking a hard look at themselves to evaluate how they are complicit in perpetuating these problems and what role they have in dismantling them. In this article, we discuss the influence of systemic racism on the profession of occupational therapy, noting that the profession lacks a clear plan, informed by stakeholders, on how to address it. The American Occupational Therapy Association hosted a series of listening sessions titled “Be Heard—We’re Listening” in June and July 2020 to learn about the experiences of occupational therapy students, practitioners, and educators who are Black, Indigenous, and People of Color (BIPOC). The listening session participants provided ideas for change and recommendations that establish a call to action for persons, groups, and populations.

The American Occupational Therapy Association hosted a series of listening sessions in June and July 2020 to learn about the experiences of occupational therapy students, practitioners, and educators who are Black, Indigenous, and People of Color (BIPOC), resulting in ideas for change and recommendations that establish a call to action for persons, groups, and populations.

Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Project. In this Evidence Connection article, I describe a clinical case report of an older adult with a chronic condition and his daughter who received home health occupational therapy services. I discuss the occupational therapy evaluation and intervention processes with these clients to support chronic condition self-management, coping skills, and problem solving, drawing on findings from the systematic review on the effectiveness of interventions for care partners of people with chronic conditions published in the July/August 2021 issue of the American Journal of Occupational Therapy. It is my hope that this Evidence Connection article can be used to inform and guide clinical decision making when working with older adults with chronic conditions and their care partners.

In this Evidence Connection article, the author describes a clinical case report of an older adult with a chronic condition who, with his daughter, received home health occupational therapy services.