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Online Advanced Release
Articles appearing in this "Online Advanced Release" section have been peer-reviewed and accepted for publication in the OTJR: Occupation, Participation and Health and posted online before print publication. Articles appear on this site after copyediting and author corrections, but before final proofing. The content of the article will usually remain unchanged, and possible further corrections are fairly minor. The final published article will specify the issue and page numbers. Once the final version is available in print, the version posted here will be removed from this site.
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Table of Contents
Systematic Review of Interventions to Improve or Augment Handwriting Ability in Adult Clients
Kathleen E. Yancosek, PhD, OTR/L, CHT; Dana Howell, PhD, OTD, OTR/L
Submitted 3/26/10; Accepted 5/13/10; Posted 7/27/10
This systematic review examined research related to interventions that addressed handwriting deficits in adults with impaired upper limb motor coordination resulting from central and peripheral nervous system injury or illness. The clinical question was, “Based on current research, what is/are the recommended intervention(s) to improve, augment, or replace handwriting skills among adult clients with upper limb motor deficits?” A research protocol was followed, which was modified to include pediatric literature after an initial search of interventions for adults proved limited. Four studies related to adults and 10 related to pediatrics were included in the review and all were evaluated for quality using standardized procedures. The adult studies addressed the use of voice recognition software and hand dominance transfer training. Available evidence for interventions with children with handwriting deficits centered around these clinical options: Cognition Orientation to Daily Occupational Performance, task-orientated self-instruction, ergonomic modifications to a desk, school-based intervention (emphasis on visual motor skills and practice), sensory diet with therapeutic listening, therapeutic practice, and a graphomotor program. Improvement in handwriting skill emerged from seven of the 10 pediatric studies. Direct practice of handwriting tasks was common to all successful studies and missing in studies that failed to show skill improvement. It may be logical to conclude that intervention strategies should include direct practice of handwriting, whether the client is an adult or a child. Further research on handwriting intervention programs specifically for adult clients and the inclusion of direct practice as intervention is warranted.
doi: 10.3928/15394492-20100722-03
Personal Projects of Boys With Developmental Coordination Disorder
Anne A. Poulsen, PhD, BOccThy (Hons); Fiona M. Barker, BOccThy (Hons); Jenny Ziviani, PhD, MEd, BAppSc (OccThy)
Submitted 2/1/10; Accepted 5/15/10; Posted 7/27/10
Understanding the leisure perspectives of preadolescent boys with developmental coordination disorder (DCD) requires more than documenting time-use patterns. This study to explored the use of the Personal Projects Analysis for Children (PPA-C) to improve depth of understanding about personally meaningful leisure participation for this population. Sixty boys with DCD and 113 boys without DCD completed the PPA-C. Boys with DCD reported significantly fewer personal projects involving physical activities; fewer friends with whom to complete personal projects; more solitary leisure projects; and fewer personally meaningful personal projects in total than the comparison group. The PPA-C findings provided ecologically sensitive and personally salient information about leisure time participation from the perspectives of boys with and without DCD. The low frequency of self-reported social and physical activity personal projects for boys with DCD has not been previously detailed in this way. Occupational therapists are challenged to be vigilant regarding restricted leisure portfolios and expectations about activity participation in boys with DCD, with further research and advocacy for balanced portfolios of personally meaningful leisure.
doi: 10.3928/15394492-20100722-02
Time Use of Mothers With Adolescents: A Lasting Impact of a Child’s Disability
Terry K. Crowe, PhD, OTR/L, FAOTA; Hallie J. Michael, MOT, OTR/L
Submitted 2/22/10; Accepted 5/11/10; Posted 7/27/10
The purpose of this study was to compare the time use of mothers with adolescents with disabilities and mothers of adolescents without disabilities. Twenty mothers of adolescents (13 to 19 years old) with disabilities and 20 mothers of adolescents without disabilities completed time diaries for a period of seven 24-hour days. Mothers of adolescents with disabilities spent significantly more time in activities related to supervising their adolescents and less time in participation and socialization activities than mothers of adolescents without disabilities. As a child gets older, there is generally a decrease in the amount of time all mothers spend in childcare activities. However, mothers’ occupations are impacted by having a child with a disability. Professionals working in partnership with families need to understand that the role of being a mother evolves as a child matures, and that a mother’s time demands may impact the occupational engagement of all family members.
doi: 10.3928/15394492-20100722-01
The Role of Occupational Therapy in Diabetes Self-Management Interventions
Elizabeth A. Pyatak, MA, OTR/L
Submitted 11/19/09; Accepted 5/14/10; Posted 6/25/10
Approximately 23.6 million people in the United States are living with diabetes, a disease that is a leading cause of disabling conditions including blindness, kidney failure, amputations, heart disease, and stroke. Although these complications of diabetes can be delayed or prevented through intensive diabetes self-management (DSM), maintaining control of the disease can be burdensome and negatively impact quality of life. Occupational therapy has a largely untapped potential to assist individuals who struggle with managing diabetes in the context of everyday life, yet there is little discussion of DSM in the occupational therapy literature. The author conducts a systematic review of the existing occupational therapy literature on diabetes, examines the current state of DSM interventions, and discusses a potential role for occupational therapy using programs such as Lifestyle Redesign®.
doi: 10.3928/15394492-20100622-01
Renee R. Taylor, PhD; Sun Wook Lee, MS, OTR/L; Gary Kielhofner, DrPH, OTR/L, FAOTA
Submitted 12/23/09; Accepted 4/16/10; Posted 5/26/10
Although occupational therapy literature emphasizes the importance of therapeutic use of self, there have been few studies of the interpersonal strategies used in response to different client needs. This study sought to explore therapists’ use of self according to the Intentional Relationship Model by examining the use of different modes of interacting with clients. A questionnaire was mailed to a random sample of 1,000 practicing occupational therapists. Sixty-four percent responded and 563 met inclusion criteria. Modes used most to least often were: encouraging, collaborating, problem-solving, instructing, and empathizing. Mode use did not differ according to client population. Therapists who experienced more difficult behaviors and emotions reported higher levels of using all modes. Therapists facing difficult behavior in general were more likely to report use of the instructing and problem-solving modes. Therapists with anxious clients reported greater use of the problem-solving mode, whereas therapists with depressed clients reported increased use of problem-solving, collaborating, and empathizing modes. Implications for occupational therapy practice and education are discussed.
doi: 10.3928/15394492-20100521-02
Beyond My Front Door: The Occupational and Social Participation of Adults With Spinal Cord Injury
Pollie Price, PhD, OTR/L; Stephanie Stephensen; Lesha Krantz, MOT; Kristine Ward, MOT/L
Submitted 9/27/09; Accepted 4/5/10; Posted 5/26/10
This study investigated how individuals in the community 1 to 5 years after spinal cord injury characterized their occupational and social participation, life satisfaction, and aspects of their occupational therapy that influenced their participation. Semi-structured, open-ended interviews were conducted with 11 individuals referred by occupational therapists who specialize in spinal cord injury rehabilitation and/or are regarded as practicing from an occupation-based perspective. Narrative analysis of data revealed that the participants went through an adaptive process, using many strategies to adjust their attitudes about disability, manage identity, participate in the community, and belong socially. Several approaches were used by therapists to promote the individuals’ participation in occupations and social life.
doi: 10.3928/15394492-20100521-01
Ted Brown, PhD, BScOT(Hons), OTR, AccOT
Submitted 11/16/09; Accepted 3/25/10; Posted 4/27/10
Visual perceptual skills of adults are often assessed by occupational therapists using standardized tests. The Motor-Free Visual Perception Test–Third Edition (MVPT-3) is a frequently used test, although its construct validity has not been thoroughly evaluated. The purpose of the study was to consider the construct validity of the MVPT-3 by evaluating its scalability/interval level measurement, unidimensionality, lack of differential item functioning (DIF), and hierarchical ordering of its items when completed by a group of adult participants. The visual perceptual performance scores from a sample of 221 participants 20 years or older (49 adults with neurological impairment and 172 adults without) were used to complete a Rasch analysis (RA) of the MVPT-3. When analyzed using RA, the MVPT-3 exhibited adequate measurement properties. However, several MVPT-3 scales exhibited RA misfit (items 40, 45, 54, 56, 61, 64) or DIF (items 57, 60, 61). The construct validity, scalability, unidimensionality, hierarchical ordering, and lack of DIF requirements were met by most (87.7%; 8 of 65 items) of the MVPT-3 scale items. When using the MVPT-3 to assess adult clients, clinicians should consider the items that exhibited RA misfit or DIF when interpreting scores.
doi: 10.3928/15394492-20100422-01
Healthy Habit Changes in Pre-professional College Students: Adherence, Supports, and Barriers
Claudia List Hilton, PhD, OTR/L, SROT, FAOTA; Ashley Ann Ackermann, MOT, OTR/L; Diane Lynn Smith, PhD, OTR/L, FAOTA
Submitted 10/14/09; Accepted 2/14/10; Posted 3/25/10
This study examined the impact of participation in a wellness assignment on healthy habit changes in pre-professional undergraduate students. Participants consisted of 58 students enrolled in an undergraduate occupational science health and wellness course. Students were given an assignment to alter three to five habits that would improve their wellness over the semester, and follow-up surveys tracked their adherence to the changes. The assignment and outcomes were retrospectively analyzed using social cognitive and self-determination theories. Students believed that participation in the assignment increased (1) their own wellness status, (2) their understanding of how to impact their own wellness, and (3) their ability to understand client and therapist perspectives on making habit changes. The outcomes suggest that using the principles of social cognitive and self-determination theories appears to support the success of and adherence to healthy habit changes. Implications for occupational therapy educators and practitioners in the use of these theoretical models to support behavior changes are discussed.
doi: 10.3928/15394492-20100325-01
Belief in Doing and Knowledge in Being Mothers With Arthritis
Linda Del Fabro Smith, MSc, BSc(OT); Melinda Suto, PhD, OT(C); Andrew Chalmers, MD; Catherine L. Backman, PhD, OT(C)
Submitted 2/19/09; Accepted 12/1/09; Posted 2/25/10
The aim of this qualitative study was to provide insight on how mothers with inflammatory arthritis experience mothering occupations in the presence of arthritis and how this experience affects participation and occupational identity. Narrative inquiry explored the experiences of eight mothers with inflammatory arthritis who had children younger than 14 years. Data collection included two interviews, participant observation, and document review. Analysis focused on each full account as told by participants before comparing stories to develop an overarching storyline. Storylines are presented as narratives that describe the mother’s experiences of identifying with the role of mother, participation, fatigue, and the social context in which mothering occurs. “Just because I can’t do, doesn’t mean I’m not a mom” emerged as the main storyline. Belief in doing and knowledge in being mothers offset many of the negative effects of arthritis.
doi: 10.3928/15394492-20100222-01
Convergent Validity of the Engagement in Meaningful Activities Survey in a College Sample
Aaron M. Eakman, PhD, OTR/L
Submitted 7/9/09; Accepted 10/29/09; Posted 1/26/10
The Engagement in Meaningful Activities Survey (EMAS) (Goldberg, Brintnell, & Goldberg, 2002) demonstrated sufficient psychometric properties in a sample of 122 adults. The EMAS was found to have adequate test–retest (r = .71) and internal consistency (α = .88) reliability; significant positive correlations between the EMAS and the subscales of the Basic Psychological Needs Scale and the Sources of Meaning Profile and negative zero-order correlations were found with short form versions of the Boredom Proneness Scale and the Depression, Anxiety, and Stress Scales. Step-wise multiple regression analysis results showed the Sources of Meaning Profile, Boredom Proneness Scale, and Competence subscale of the Basic Psychological Needs scale best predicted the EMAS. These results lend additional construct validity evidence in support of the EMAS as a brief measure of meaningful activity participation.
The Home and Caregiving: Rethinking Space and Its Meaning
Rachel Mayes, BAppSc (OT) Hons, PhD; Rosemary Cant, BEd(Hons), Med(WA), PhD(N’cle); Lindy Clemson, BAppSc (OT), MAppSc (OT), PhD
Submitted 3/26/09; Accepted 9/6/09; Posted 1/26/10
Occupational therapists are routinely engaged in the homes of their clients with disabilities, providing consultation on the use and modification of space to improve functional independence. The meaning of home space is currently underexplored. This study describes the meaning and use of home space for mothers who are primary caregivers for a child or adolescent with disabilities and high support needs. This article reports data from two empirical studies of mothers of children and adolescents with disabilities. In-depth interviews were conducted with 80 mothers across the two studies. Interview transcripts were analyzed with a grounded theory approach. Access around the home for a family member with disabilities allowed mothers to combine caring with other home management activities. However, preventing access or excluding the family member with a disability from some areas of the home enabled the mothers to resist the medicalization of their homes and create a personal space for themselves. Full access to the home for the child with disabilities was rarely a desirable outcome. Decisions about the home and how it should be modified to improve function become more complex when the needs of family members are taken into account. Meaning ascribed to space within the home is integral to how the space is used and whether a family member with a disability is included or excluded from the space. For occupational therapists, the meaning that clients and their families ascribe to various spaces within the home is as important as the use of space.
Reliability and Validity of the Health Enhancement Lifestyle Profile (HELP)
Jengliang Eric Hwang, PhD, OTR/L
Submitted 6/22/09; Accepted 9/18/09; Posted 12/25/09
The Health Enhancement Lifestyle Profile (HELP) is a self-report measure for examining various aspects of health-related lifestyle in older adults through seven scales (Exercise; Diet; Work, Education, and Social Participation; Leisure; Activities of Daily Living; Psychological Wellness and Spiritual Participation; and Other Health Promotion and Risk Behaviors). The current study examined the reliability and validity of the HELP scales through classic test theory. The resultant alpha coefficients ranged from .75 to .92 among the scales, indicating acceptable to good internal consistency reliability. Construct validity was also supported by the interrelationships found among the HELP scales and the statistically significant correlations shown between HELP results and global health status (i.e., number of chronic conditions, self-related health). HELP scales can help occupational therapists identify and monitor health promotion occupations and risk behaviors and measure the outcome of services aimed at promoting healthy lifestyles in older adults.
Falls Self-Efficacy Among Adults With Multiple Sclerosis: A Phenomenological Study
Elizabeth W. Peterson, PhD, OTR/L, FAOTA; Gary Kielhofner, DrPH, OTR/L, FAOTA; Kerstin Tham, PhD, OT reg; Lena von Koch, PhD, RPT
Submitted 4/16/09; Accepted 9/18/09; Posted 11/25/09
This phenomenological study explored and described the lived experience of falls self-efficacy (i.e., perceived self-efficacy in avoiding a fall during basic activities of daily living) among six individuals with multiple sclerosis and its relationship to their overall volition and occupational lives. Participants were interviewed three times over a 3-month period. All interviews were analyzed using the Empirical, Phenomenological, Psychological method. One main theme (managing fall risk as a means of supporting activity) and six subthemes were reflected in participants’ lived experiences: (1) understanding personal multiple sclerosis symptoms, abilities, and fall risk; (2) accepting one’s changed capacity; (3) focusing on what you can control; (4) ongoing learning by doing; (5) vigilance while doing; and (6) taking personal responsibility to reduce fall risk. The findings show how falls self-efficacy operates as part of a larger volitional process and can be used to inform the development of fall prevention programs for individuals living with multiple sclerosis.
The Meaning of Occupational Gaps in Everyday Life in the First Year After Stroke
Gunilla Eriksson, OT, PhD; Kerstin Tham, OT, PhD
Submitted 1/8/09; Accepted 9/6/09; Posted 11/25/09
This longitudinal study identified how occupational gaps were characterized in people’s lived experiences of performing everyday occupations during the first year after stroke. Four participants were interviewed four times during the year after stroke. The data were collected and analyzed using the Empirical, Phenomenological, Psychological method. Five main characteristics were identified: (1) encountering occupational gaps in formerly taken-for-granted activities, (2) striving to narrow gaps in desired occupations, (3) recognizing oneself in doing, (4) searching for a new sense of self through doing, and (5) creating strategies to enable doing. The findings show the importance of being able to preserve some sense of self in everyday doings after a life course disruption caused by stroke. Important implications for clinical practice include sensitivity to clients’ experiences during this process, enablement of experiences in occupations promoting recognition, and support of clients in recapturing desired occupations.
Predictors of Research Utilization Among Pediatric Occupational Therapists
Ted Brown, PhD, MSc, MPA, BScOT (Hons), OT(C), OTR, AccOT; Mei Hui Tseng, ScD, OTR; Jacqueline Casey, MSc, BSc (Hons) OT, PgCHEP; Rachael McDonald, PhD, PGDip(Biomech), BAppSc(OT); Carissa Lyons, Bpsych
Submitted 3/14/09; Accepted 7/22/09; Posted 10/26/09
Evidence-based practice and research utilization activities by clinicians enable clients to receive the best, most current health care available. This study investigated the factors predicting pediatric occupational therapists’ attitudes toward evidence-based practice and research utilization in Australia, the United Kingdom, and Taiwan. Questionnaires were received from 696 participants (response rate = 56.58%) who completed the Edmonton Research Orientation Survey (EROS), the Research Knowledge, Attitudes and Practices of Research Survey (KAP Survey), and the Barriers to Research Utilization Scale (BARRIERS). The results of the multiple linear regression analysis indicated the strongest predictor of research utilization was “level of academic occupational therapy qualification,” which was found to be predictive of all of the EROS subscales. The second EROS subscale, “research involvement,” had the largest number of predictive factors. To increase research utilization among pediatric occupational therapists, it is important to be mindful of which aspects of research require improvement so that strategies with the greatest impact and influence can be implemented.
Hands-On Learning Versus Learning by Demonstration at Three Recall Points in University Students
Morna Kathleen Hearns, MOT, OTR/L; Barbara Kopp Miller, PhD; David L. Nelson, PhD, OTR/L, FAOTA
Submitted 2/28/09; Accepted 5/4/09; Posted 8/25/09
This randomized study compared the effect of two teaching/learning methods (hands-on versus demonstration) on immediate, 15-minute, and 24/48-hour recall in 60 university students. Each student either made no-bake cookies or observed the demonstrated process. Inter-rater reliability concerning recall scores was strong (intraclass correlation coefficient = .98). Analysis of variance across all three levels of recall supported the hands-on condition (F [1,58] = 4.45, p = .039). However, only one of the three t tests (recall at 24/48 hours) comparing hands-on learning to demonstration at the three points of recall, was statistically significant (t [58] = 2.48, p = .008, with effect size d = .648). Generally, the results are consistent with occupational therapy theory, but the lack of a statistically significant difference in terms of immediate recall requires probing as to the meaningfulness of the occupational form to the particular individuals being observed. Meta-analysis of various studies investigating this important principle of occupational therapy is needed to clarify the results of this study in the context of other related studies.
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