Novice Occupational Therapy Practitioners' Use of Occupation in Practice: A Scoping Review.

An occupation-centered perspective is a foundational component defining occupational therapy practice. A scoping review was conducted of research studies from 2002 - 2020 describing novice occupational therapy practitioners and occupation. Ten articles met the inclusion criteria. Novices acknowledged that using occupation was a source of professional tension, describing a mismatch between their education and workplace expectations. The cognitive load of occupation-centered practice influenced novices' avoidance of occupation. Few articles address novices' experiences using occupation in their practice. Existing research primarily addresses barriers limiting novices' use of occupation such as lack of supervision and confidence.

Psychosocial influences in the development of cumulative trauma disorders.

STUDY DESIGN: This study is a single-phase, qualitative study using grounded theory methodology. INTRODUCTION: Cumulative trauma disorders (CTDs) are musculoskeletal disorders that impact health and productivity. CTD risk factors are present in the workplace, home, and community. Occupational and physical therapists specializing in hand and upper extremity rehabilitation (hand therapists) are widely involved with this population. Hand therapists often employ a medical model in the assessment and treatment of these conditions; however, the medical model has not proven to be consistently effective in relieving symptoms or producing a durable return to daily living activities. PURPOSE OF THE STUDY: The purpose of this study was to explore the lived experiences of individuals diagnosed with CTD, and investigate the psychosocial phenomena influencing CTD development as an impediment to occupational performance. METHODS: The principal investigator recruited 11 participants who met specific inclusion criteria, then used semi-structured interviews aimed at exploring the lived experiences of the participants while investigating the psychosocial phenomenon influencing CTD development. Interviews were transcribed and analyzed using a process of constant comparison, up until saturation occurred. Trustworthiness techniques were used in the data analysis phase and included peer reviews and member checking. FINDINGS: The findings suggest that many psychosocial factors contribute to the development and impact of CTDs, at both onset of symptoms and throughout the duration of the condition. A significant number of contextual factors influence participants' function, behavior, relationships, and the course of medical care. Themes derived from the participants' expressions, included the following: 1) an initial strategy of "work through the pain," can be detrimental to symptom resolution and leads to progressive failure to meet role expectations, 2) a pervasive notion of CTDs as "an invisible disability," leaving participants feeling isolated and frustrated when significant others fail to offer support or reject them, 3) participants often delayed reporting symptom development to employers, family members, and medical personnel, risking permanent injury and disability, 4) a "stigma" is attached to CTDs that encourages isolation; however, the social support of even one significant other in a person's life can facilitate adaptation. DISCUSSION AND CONCLUSION: All participants experienced hardship because of their conditions; however, two of the eleven participants capably navigated the process, using past experience and support from family and employer to successfully adapt. These findings offer support that CTDs are adaptive disorders. The study's conclusion suggests a new model to describe CTD dysfunction and presents new ways of thinking for clinicians who treat the CTD population.

Associations between self-generated strategy use and MET-Home performance in adults with stroke.

Self-generated strategy use has substantial potential for improving community living outcomes in adults with impaired executive function after stroke. However, little is known about how self-generated strategies support task performance in people with post-stroke executive function impairments living in the community. We explored strategy use among home-dwelling persons with stroke and neurologically-healthy control participants during the Multiple Errands Test-Home Version (MET-Home), a context-specific assessment with evidence of ecological validity designed to examine how post-stroke executive dysfunction manifests during task performance in the home environment. For persons with stroke, significant associations were identified between planning and tasks accurately completed on the MET-Home. Significant associations were also identified among the control participants for self-monitoring, multitasking, and "using the environment" strategies. These associations are related to enhanced MET-Home performance on sub-scores for levels of accuracy, passes, and total time. Rehabilitation interventions that focus on reinforcing self-generated strategy use may support community living outcomes in persons with post-stroke executive function impairments, but this area needs additional investigation.

In-home contextual reality: a qualitative analysis using the Multiple Errands Test Home Version (MET-Home).

Adults with stroke frequently experience executive dysfunction. Despite the range of assessments that examine the effects of executive dysfunction on daily tasks, there remains a paucity of literature that examines the influence of the environment on performance in the community. The MET-Home is an ecologically valid assessment for examining post-stroke executive dysfunction in the home environment. This qualitative study explores the relationship between the environment and MET-Home performance among home-dwelling adults with stroke and matched controls. Using a descriptive qualitative approach, we analysed video, interview, and observation notes from a MET-Home validation study. An overarching theme of interplay between everyday task performance and the home environment produced further themes: naturalistically emerging supports and barriers and environment as strategy. Within naturalistically emerging supports and barriers, five contextual sub-themes were discovered: physical environment, social environment, temporal context, virtual context, and personal context. Within environment as strategy, we identified four sub-themes: reducing distractions, using everyday technologies, planning in context, and seeking social support. These findings extend the conceptualisation of how we evaluate executive dysfunction in the context of the community to also consider the inherent influence of the environment.

From Hospital to Home to Participation: A Position Paper on Transition Planning Poststroke.

Based on a review of the evidence, members of the American Congress of Rehabilitation Medicine Stroke Group's Movement Interventions Task Force offer these 5 recommendations to help improve transitions of care for patients and their caregivers: (1) improving communication processes; (2) using transition specialists; (3) implementing a patient-centered discharge checklist; (4) using standardized outcome measures; and (5) establishing partnerships with community wellness programs. Because of changes in health care policy, there are incentives to improve transitions during stroke rehabilitation. Although transition management programs often include multidisciplinary teams, medication management, caregiver education, and follow-up care management, there is a lack of a comprehensive and standardized approach to implement transition management protocols during poststroke rehabilitation. This article uses the Transitions of Care (TOC) model to conceptualize how to facilitate a comprehensive patient-centered hand off at discharge to maximize patient functioning and health. Specifically, this article reviews current guidelines and provides an evidence summary of several commonly cited approaches (Early Supported Discharge, planned predischarge home visits, discharge checklists) to manage TOC, followed by a description of documented barriers to effective transitions. Patient-centered and standardized transition management may improve community integration, activities of daily living performance, and quality of life for stroke survivors while also decreasing hospital readmission rates during the transition from hospital to home to community.

Measuring Reliability of Movement With Accelerometry: Fitbit® Versus ActiGraph®.

OBJECTIVE: We sought to determine the reliability of the Fitbit® Flex™ compared with the ActiGraph® Bluetooth® Smart wGT3X-BT wireless activity monitor and to contribute to the clinical utility of accelerometry measurement of upper extremity (UE) movement. METHOD: Two studies were conducted at different sites with healthy adult participants. In Study 1, participants wore both accelerometers on both wrists during everyday activities for a 24-hr period. In Study 2, participants wore both accelerometers on the dominant wrist for 4 hr during an active period of the day. All participants wore the accelerometers during regular daily activities. RESULTS: Data recorded from the Fitbit and the ActiGraph showed a high positive correlation; however, the Fitbit recorded significantly fewer movements than the ActiGraph. CONCLUSION: Although the Fitbit and the ActiGraph measure UE activity similarly, the Fitbit was not as sensitive as the ActiGraph. This study provides informative data on the clinical utility of the Fitbit compared with the ActiGraph.

Development, Reliability, and Validity of the Multiple Errands Test Home Version (MET-Home) in Adults With Stroke.

OBJECTIVE: Our objective was to perform initial psychometric analysis of the Multiple Errands Test Home Version (MET-Home), which was designed to assess the influence of poststroke executive dysfunction on in-home task performance. METHOD: We examined the reliability and validity of the MET-Home in adults with stroke (n = 23) and individually matched control participants (n = 23). All participants completed a series of assessments during a single in-home visit. RESULTS: Notable differences in MET-Home subscores were discovered between participants with stroke and control participants. Participants with stroke omitted more tasks, broke more rules, passed by tasks more often, and were less efficient than matched control participants. The MET-Home demonstrated evidence of adequate internal consistency, excellent interrater reliability, and significant moderate associations with several tests. CONCLUSION: This preliminary study suggests that the MET-Home differentiates between adults with stroke and matched control participants. The MET-Home provides evidence of initial reliability and validity among adults with stroke.

Cognitive Assessment Trends in Home Health Care for Adults With Mild Stroke.

OBJECTIVE: This article describes current trends in cognitive assessment use for adults with mild stroke by home health practitioners in the United States. METHOD: Participants were 56 home health occupational therapists and occupational therapy assistants. A self-administered survey about use of cognitive assessment tools in home health care and influences on their use was conducted. RESULTS: Ninety-six percent of participants assessed cognition in adults with mild stroke. Nonstandardized assessments were the most widely used method for evaluating cognition in the home health setting. Influences such as specialized training in specific assessments, confidence, and productivity requirements may have affected the practitioners' cognitive assessment decisions in home health care. CONCLUSION: Although cognitive assessments are widely used in home health care, occupational therapy practitioners are selecting nonstandardized assessments most frequently to assess cognition.

Loss, gain, and the reframing of perspectives in long-term stroke survivors: a dynamic experience of quality of life.

PURPOSE: Little is known about stroke survivors' subjective quality of life experience. The purpose of this study was to understand the lived experience of quality of life in 6 long-term stroke survivors. METHOD: Using a phenomenological design, we interviewed participants (who were 21 months to 11 years post stroke) twice and gave them journals to write in between interviews. Data were evaluated using thematic analysis. RESULTS: The main theme, "It makes me feel like a human again," integrates 2 subthemes - activity loss: "That's what I miss" and awakening: "Reality comes to your world." The main theme describes quality of life as a constantly changing experience, and the subthemes elaborate on the process of change. CONCLUSION: Themes described quality of life as a dynamic experience that changed as activities of value were lost or gained and as participants experienced changes in their perspectives, beliefs, values, and behaviors. The discussion examines these themes through the lens of the Model of Human Occupation and the Shifting Perspectives Model of Chronic Illness. Clinical implications of the results are also discussed.

Validity of the Sock Test for Sitting Balance: A Functional Sitting Balance Assessment.

There is a relationship between sitting balance and self-care functioning, but no occupation-based sitting balance assessment. The objective of this study was to determine whether the Sock Test for Sitting Balance (STSB) is a valid balance assessment for use by therapists in acute care. Results of the STSB were compared with those of the Adapted Functional Reach (AFR), the Functional Independence Measure (FIM™) chair transfer, and the Kansas University Sitting Balance Scale (KUSBS), in both hospitalized and healthy participants. There is a significant relationship between STSB results and AFR results for all participants (rs = -.382, p = .012). Relationships between STSB results and score on the FIM™ Chair Transfer subscale (p = .001), and score on the KUSBS (p = .003) are significant. The STSB can differentiate between a hospitalized population and healthy population (p = .017). Criterion and known-groups validity are demonstrated, but should be confirmed with further testing.

Understanding the Experience of Early Supported Discharge from the Perspective of Patients with Stroke and Their Carers and Health Care Providers: A Qualitative Review.

A systematic review of qualitative studies that examined the experience of early supported discharge (ESD) from the perspective of patients with stroke and their caregivers and health care providers revealed an emphasis on psychosocial aspects-the patient-provider relationship, the value of the home environment, and the ability to tailor treatment to meet patient-oriented goals. Patients, caregivers, and providers stressed the importance of clear and systematic communication throughout the ESD process to support transitions, prevent duplication of services, foster trust in relationships, and ensure that patients and caregivers have the knowledge and skills required to manage a chronic condition long term.

Task Oriented Training and Evaluation at Home.

Principles of experience-dependent plasticity, motor learning theory, and the theory of Occupational Adaptation coalesce into a translational model for practice in neurorehabilitation. The objective of this study was to explore the effectiveness of a Task Oriented Training and Evaluation at Home (TOTE Home) program completed by people with subacute stroke, and whether effects persisted 1 month after this training. A single-subject design included a maximum of 30, 1hour sessions of training conducted in participants' homes. Repeated target measures of accelerometry and level of confidence were used to assess movement and confidence in weaker arm use through baseline, intervention, and follow-up phases of TOTE Home. Four participants completed TOTE Home and each demonstrated improvement in movement and confidence in function. The degree of improvement varied between participants, but a detectable change was evident in outcome measures. TOTE Home, using client-centered, salient tasks not only improved motor function but also facilitated an adaptive response demonstrated in continued improvement beyond the intervention.

Client Perceptions of Task-Oriented Training at Home: "I Forgot I Was Sick".

Task-oriented training is a contemporary intervention based on behavioral neuroscience and recent models of motor learning. It can logically be guided by the theory of occupational adaptation. This report presents the perceptions of four participants who underwent task-oriented training at home (TOTE Home) for upper extremity hemiparesis following a stroke. Guided by principles of motor learning and the theory of occupational adaptation, a directed content analysis was used with field notes recorded during the TOTE Home. Three themes emerged: salience of the activity within context, desire for mastery by creating the just right challenge, and adapted self-perception of abilities. While motor learning principles informed the method of task practice and feedback, it was the person's desire to perform meaningful, relevant activities that drove the adaptive process. This study provided insight in the perceptions and experiences of participants undergoing TOTE Home.