OTJR: Occupational Therapy Journal of Research

The traditional method of presenting quantitative research findings based on the statistical results of null hypothesis testing can limit the ability of clinicians and consumers to translate research findings into meaningful information for treatment planning and evaluation. In this article, the authors compare results from an illustrative study based on traditional statistical methods, including a t test and p values, to a more clinically useful approach using confidence levels. The process of calculating confidence levels using the basic quantitative information included in most clinical research articles is described. The argument is made that confidence levels do not replace traditional (null) hypothesis testing. Rather, they facilitate the interpretation of statistical findings, improve clinical decision making, and support the development of evidence-based occupational therapy practice.

This study compared the perspectives of employed and unemployed individuals with psychiatric disabilities regarding factors influencing employment. Ninety-six employed and 113 unemployed individuals completed questionnaires assessing the importance of several factors in successfully maintaining employment. These factors included psychiatric symptoms; the person's ability, work habits, and attitudes; and environmental factors. Exploratory factor analyses supported a unidimensional structure for each of the four subscales, with high internal consistency estimates across all subscales (coefficient alpha values ranging from 0.84 to 0.95). The results indicated no significant differences between the two groups in mean ratings for the items and subscales. Employed people perceived psychiatric symptoms as being more important than the other three subscales; however, in comparison, unemployed people gave the highest mean rating to environmental factors (e.g., employer's acceptance, absence of stigma, working in a safe environment, and supportive family). Overall, the two groups had moderate agreement on the most important influences on employment. Implications for services are discussed.

This study investigated the late effects of childhood cancer on participation and quality of life. Ninety-two percent of survivors (9 to 18 years of age) reported living with late effects of lower extremity pain and numbness, memory and attention deficits, and fatigue, depression, or both. Semistructured interviews with 25 survivors using the Canadian Occupational Performance Measure and the Adolescent Activity Card Sort captured frequencies, interests, and barriers for a range of activities. Survivors reported diminished engagement in vigorous leisure activities, chores, and community activities. Lower engagement in social activities was correlated with lower quality of life scores, as measured by the Pediatric Cancer Quality of Life Inventory-32. Despite these findings of significant cognitive and physical problems, none of the 25 survivors had individualized education programs in school, nor were any receiving occupational therapy at the time the survey was completed. The findings emphasize the importance of advocacy for occupational therapy services for survivors of childhood cancer and examination of adolescent survivor participation in, and goals for, typical activities.

The effects of two handwriting intervention programs for students with handwriting difficulties were compared. Students in grades 2 to 4 were randomly assigned to a sensorimotor intervention (n = 19), a task-oriented intervention (n = 19), or a nontreatment control group (n = 17). Both intervention programs also included “higher-level” functions (e.g., cognitive or executive functions). Handwriting speed and legibility were measured before, immediately after (Stage 1), and 4 months after (Stage 2) intervention. At Stage 1, statistically significant gains in handwriting performance were noted in both intervention groups, but not in the control group. Additionally, the task-oriented group scored significantly higher than the control group in overall legibility. At Stage 2, statistically significant gains were noted in both intervention groups. Thus, although neither program was found to have an advantage in terms of its unique components, it appears that students with handwriting difficulties may benefit from intervention programs that include instruction in “higher-level” strategies to support and enhance their handwriting performance.

The authors illustrate a three-stage process for developing assessments that are consistent with occupational therapists' conceptualizations of the interactions among individuals, environments, and occupations. Existing Test of Playfulness (ToP) and Test of Environmental Supportiveness (TOES) data from 265 children aged 15 months to 12 years were used. In Phase 1, the ToP was altered by dropping the statistical adjustment for rater severity (facet). In Phase 2, raw TOES scores, collapsed into categories, were added as a measured facet; the resulting assessment was examined for evidence of validity and reliability. In Phase 3, the assessment was found to be a clinically useful tool. The authors showed that environmental supportiveness has a significant effect on observed playfulness and that it can be measured and accounted for in an assessment. The process is representative of methods that could allow therapists to predict how a client's score on a measure of occupational performance might change in a different environment.