Cognitive Behavioral Therapy for Insomnia Improves Sleep Outcomes in Individuals With Concussion: A Preliminary Randomized Wait-List Control Study.

OBJECTIVE: Cognitive behavioral therapy for insomnia (CBT-I) is the gold standard treatment for insomnia, but there is limited evidence on the treatment effect of CBT-I in individuals after a concussion. Therefore, the main purpose of this study was to evaluate the treatment effect of CBT-I on sleep outcomes and postconcussion symptoms. SETTING: This study was conducted at an academic institution. The CBT-I sessions were conducted using a teleconferencing system (Zoom). PARTICIPANTS: Participants were eligible to participate if they were at least 4 weeks post- concussion, aged 18 to 64 years, and scored 10 or more on the Insomnia Severity Index. A total of 40 people were enrolled; 32 participants were included in analyses. DESIGN: This was a randomized controlled wait-list study. Participants were randomized into starting the CBT-I intervention immediately after the baseline assessment or into the wait-list group for 6 weeks before starting CBT-I. Assessments were performed at baseline, 6, 12, and 18 weeks. MAIN MEASURES: The primary outcome was the Insomnia Severity Index. Secondary measures included the Pittsburg Sleep Quality Index, Post-Concussion Symptom Scale, and Beck Depression and Anxiety Inventories. Statistical analyses included a repeated-measures analysis of variance, t tests, and mixed linear regression modeling. RESULTS: There was a group-by-time interaction for the sleep outcomes but not for the concussion or mood outcomes. Differences were seen between groups on sleep outcomes, symptom severity, and depression. The treatment effect was maintained following CBT-I for all outcomes. Improvement in sleep outcomes was predictive of improvement in postconcussion symptom severity and number of symptoms. CONCLUSIONS: CBT-I reduces insomnia in individuals with concussions, and improved sleep was associated with lower postconcussion and mood symptoms. These effects were maintained 6 to 12 weeks following the intervention.

Occupational therapy gender imbalance; revisiting a lingering issue.

BACKGROUND: Recently, it has been suggested that gender disparity in Occupational Therapy has to do with segregated gendered job norms that position female dominated professions as a 'step down' for many males. Interestingly, this suggestion was not underpinned by experiences of males in the profession. AIMS AND METHODS: Thirteen male Occupational Therapists with a variety of backgrounds were invited to this Round Table research, focussing on the broader issue of the existing gender imbalance in Occupational Therapy. RESULTS: Two themes emerged: 'The core values of the profession', and 'Broadening the scope of the profession'; none of them suggesting that male/female imbalance was necessarily the most pressing issue. CONCLUSIONS: A gender-unrelated approach to everyday problem-solving was put forward to achieve increased diversity in Occupational Therapists' backgrounds, better reflecting the people they serve. By broadening the scope and the way the profession is presented, and encouraging innovative and more entrepreneurially driven approaches, diversity in the workforce could be further facilitated. These findings are discussed within the context of 'The mutual constitution of cultures and selves' model. SIGNIFICANCE: Diversity in the Occupational therapy workforce could be further facilitated with a shift in focus away from the male/female perspective to an intersectional approach.

Item-Level Psychometrics of the Meaningful Activity Participation Assessment (MAPA) Scale.

This study investigates the psychometric properties of the Meaningful Activity Participation Assessment-Meaning (MAPA-M) scale using the Rasch measurement model. For the psychometric properties of MAPA-M, principal component analysis, Rasch analysis, and differential item functioning analysis were conducted. Participants in this study were 480 older adults from the USC Well Elderly 2 study, recruited from 21 locations in the Los Angeles metropolitan area. There were eight items with DIF, but they were accepted because they assumed unidimensionality and showed good person invariance. The 25 items assuming unidimensionality of MAPA-M had values between 0.6 and 1.4 in infit and Outfit MnSq, and all ZSTD values were less than 2.0. The 25 items demonstrated a conceptual item-difficulty hierarchy. The person strata value was 2.68, which is equivalent to a reliability index value of .76. The findings indicate that the revised scale can accurately and reliably measure meaningful activities by older adults.

Engaging with nature and work: associations among the built and natural environment, experiences outside, and job engagement and creativity.

Introduction: There is substantial evidence that contact with nature is related to positive health and well-being outcomes, but extensions of this research to work-related outcomes is sparse. Some organizations are redesigning workspaces to incorporate nature and adopting nature-related policies, warranting a need for empirical studies that test the influence of nature on employee outcomes. Methods: The present mixed-methods study tests and extends the biophilic work design model to examine associations among the built and natural environment at work and home, experiences of time spent outside (i.e., amount of time outside, enjoyment of time outside, outdoor activities), and motivational work outcomes (i.e., job engagement and creativity). Objective geographic data were combined with quantitative and qualitative survey responses from working adults (N = 803). Results: Our results broadly indicate that individuals who work and live in areas with greater natural amenities (i.e., access to water, topographic variation, temperate climates) spend more time outside and enjoy time outside to a greater degree, and these experiences are in turn associated with greater engagement and creativity at work. We did not find evidence that the surrounding built environment (i.e., urbanity) at work or home was associated with outdoor experiences or work-related outcomes. Additionally, six categories of outdoor activities were identified in the qualitative analyses - leisure activities, relaxation, physical activities, social interactions, tasks and errands, and travel. Discussion: The findings from this study provide evidence that the natural environment, particularly at home, can benefit work-related outcomes via greater time and enjoyment of time outside. This study has implications for employee time use and organizational effectiveness.

Assessing Cognitive Behavioral Therapy for Insomnia to Improve Sleep Outcomes in Individuals With a Concussion: Protocol for a Delayed Randomized Controlled Trial.

BACKGROUND: Sleep disturbances post concussion have been associated with more frequent and severe concussion symptoms and may contribute to poorer recovery. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for insomnia; however, it remains unclear if this treatment method is effective in improving sleep outcomes and reducing concomitant postconcussion symptoms. OBJECTIVE: The hypotheses for this study are that (1) CBT-I will improve sleep outcomes and (2) CBT-I will improve concomitant postconcussion symptoms. METHODS: In total, 40 individuals who are within ≥4 weeks of postconcussion injury and have insomnia symptoms will be enrolled in this randomized controlled trial. Participants will be randomized into either a group that starts a 6-week CBT-I program immediately after baseline or a waitlist control group that starts CBT-I following a 6-week waiting period. All participants will be reassessed 6, 12, and 18 weeks after baseline. Standardized assessments measuring sleep outcomes, postconcussion symptoms, and mood will be used. Linear regression and t tests will be used for statistical analyses. RESULTS: Enrollment of 40 participants was completed July 2022, data collection will be completed in November 2022, and publication of main findings is anticipated in May 2023. It is anticipated that participants experience reduced insomnia symptoms and postconcussion symptoms following CBT-I and these improvements will be retained for at least 12 weeks. Additionally, we expect to observe a positive correlation between sleep and postconcussion symptom improvement. CONCLUSIONS: Successful completion of this pilot study will allow for a better understanding of the treatment of insomnia and postconcussion symptoms in individuals following a concussion. TRIAL REGISTRATION: ClinicalTrials.gov NCT04885205; https://clinicaltrials.gov/ct2/show/NCT04885205. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/38608.

Validation of the Persian Version of the Engagement in Meaningful Activities Survey (EMAS) in an Iranian Stroke Population: Predictors of Participation in Meaningful Activities.

IMPORTANCE: The inability to participate in meaningful activities is one of stroke survivors' main difficulties and has a negative effect on their satisfaction and quality of life. OBJECTIVE: To assess the reliability and validity of the Persian version of the Engagement in Meaningful Activities Survey (EMAS-P) and predictors of participation in meaningful activity among chronic stroke survivors. DESIGN: Cross-sectional. SETTING: Medical and rehabilitation centers. PARTICIPANTS: One hundred twenty-three people (75 men, 48 women) with chronic stroke. OUTCOMES AND MEASURES: Participants were evaluated with the EMAS-P, Satisfaction With Life Scale (SWLS), Center for Epidemiologic Studies Depression Scale, Purpose in Life Test-Short Form (PIL-SF), 36-Item Short Form Health Survey (SF-36), and Life Satisfaction Index-Z (LSI-Z). RESULTS: The EMAS-P showed good internal consistency (Cronbach's α = .95) and test-retest reliability (intraclass correlation coefficient = .87 for EMAS-P total score). Test-retest reliability for each EMAS-P item was moderate (κ = .40-.65). A significant correlation between the EMAS-P and PIL-SF (r = .86), SWLS (r = .83), LSI-Z (r = .75), and SF-36 subscales (rs = .52-.83) indicated the appropriate convergent validity. The EMAS-P's discriminative validity was also confirmed for age, depression level, and disability level among people with chronic stroke. Depression, disability level, gender, and fatigue were significant predictors of EMAS-P score. CONCLUSIONS AND RELEVANCE: The results indicate that the EMAS-P has acceptable reliability and validity among Iranian people with chronic stroke. Moreover, the EMAS-P showed good discriminant validity for age, depression, and disability level among them. What This Article Adds: The EMAS-P is a reliable and valid scale for assessing the engagement of Iranian chronic stroke survivors in meaningful activities and thus should be helpful in both clinical research and practice.

Development of the Japanese Version of the Engagement in Meaningful Activities Survey.

OBJECTIVES: To create a Japanese version of the Engagement in Meaningful Activities Survey (EMAS) and assess internal consistency, test-retest reliability, convergent and structural validity. METHOD: We conducted a cultural translation and validation study of the Japanese version of the EMAS (EMAS-J) in a sample of 96 community-dwelling older adults in the Tohoku Region of Japan. RESULTS: Internal consistency of the EMAS-J (α = .91) was very good. Low to moderate correlations were found with indicators of health-related quality of life, depression, and life purpose and meaning. Exploratory factor analysis indicated a two-factor structure within the EMAS-J; cultural differences in item-factor composition compared with previously reported EMAS factor structures are discussed. IMPLICATIONS: The EMAS-J is a reliable and valid assessment of engagement in meaningful activities for older adults in Japan. The assessment can be used to evaluate the effects of occupation-based interventions upon health and well-being.

Follow-Up Analyses From a Wait-List Controlled Trial of Occupational Therapist-Delivered Cognitive-Behavioral Therapy for Insomnia Among Veterans With Chronic Insomnia.

IMPORTANCE: Veterans often experience chronic insomnia, and professionals capable of delivering effective interventions to address this problem are lacking. OBJECTIVE: To evaluate the efficacy of the Restoring Effective Sleep Tranquility (REST) program, an occupational therapist-led cognitive-behavioral therapy for insomnia (CBT-I) intervention to treat sleep problems among post- 9/11 veterans. DESIGN: Wait-list controlled trial with 3-mo follow-up. SETTING: Community-based veteran support program in a Mountain West university. PARTICIPANTS: Fifteen post-9/11 veterans with sleep disturbances who were assigned to either the REST intervention or a wait-list control group. Outcomes and Measures: Sleep-related, health-related, and participation-related patient-reported outcomes (PROs) and daily sleep diary variables. RESULTS: Wait-list controlled trial benefits included improved sleep-related (e.g., sleep disturbance), health-related (e.g., depression), and participation-related (e.g., meaningful activity) PROs. Findings were confirmed after participants in both the intervention and the control groups (n = 13) received the REST intervention, including improved daily sleep diary outcomes (e.g., sleep efficiency). All gains were maintained at 3 mo. CONCLUSIONS AND RELEVANCE: Occupational therapy practitioners with advanced training in CBT-I have the potential to safely deliver an effective CBT-I intervention to veterans with sleep disturbances in a community-based setting. What This Article Adds: Occupational therapy practitioners with sleep-related education and training can positively affect the well-being of their clients through improving sleep participation.

Protective factors that mitigate the indirect risk of combat exposure upon meaning in life: A longitudinal study of student veterans.

OBJECTIVE: Studies of combat emphasize its impact upon health-related outcomes (e.g., depression). Little is known regarding the risk that combat poses to positive outcomes, such as meaning in life, and factors that mitigate this risk. We sought to investigate whether combat poses an indirect risk to life meaning and protective factors that mitigate this risk. METHOD: Through an online survey at 2 time points, 153 combat-exposed veterans enrolled in college reported combat exposure, health status (posttraumatic stress disorder, depressive, somatic symptoms), meaning in life, and protective factors (social support, instructor autonomy support, coping ability, academic self-efficacy, social and community participation, and meaningful activity). We used path analysis to (a) explore whether baseline health status and life meaning mediated the relationship between combat and follow-up life meaning, and (b) test whether protective factors promoted life meaning despite combat and health status (combat-related risk). RESULTS: The relationship between combat and follow-up life meaning was mediated by baseline health status and life meaning. Meaningful activity and coping ability were associated with greater life meaning independently of combat-related risk. The indirect effect of combat upon life meaning was weakened when social support, instructor autonomy support, coping ability, and academic self-efficacy were high. CONCLUSIONS: Combat is associated with worse health status, in turn limiting student veterans' life meaning. This supports an expanded conception of combat-related risk, in which the effect of combat upon positive outcomes is emphasized. Findings indicate that the proposed protective factors may mitigate combat-related risk. We discuss implications for research and practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Assessing invariance of cannabis use motives by veteran status and binary gender identity among college students.

Student service members/veterans (SSM/V) are distinct from non-veteran students in a variety of ways, including in their cannabis use patterns and potentially their motives for cannabis use. Additionally, previous research has shown that men and women endorse different motives for their cannabis use. The present study was designed to assess whether a popular measure of cannabis use motives is invariant across veteran status and gender identity. Based on previous research, we hypothesized that cannabis motives would show invariance across SSM/V men, SSM/V women, non-veteran men, and non-veteran women (n = 1,011, SSM/V = 553) among those who indicated using cannabis at least once in their lifetime. Results from the four-group invariance testing procedure revealed metric invariance. This suggests that while the factor structure and factor loadings are invariant, there are differences at the intercept level for cannabis motives across groups. The same items load onto the same latent constructs and the strength of the items loading onto the latent factors was also the same across groups. The demonstrated invariance has implications for use in SSM/V and non-veteran clients. As this scale is brief, it could easily be used as a screening tool or used to guide intervention content.

Combat exposure undermines student veterans' achievement of a meaningful life through its association with health-related symptoms: A longitudinal study.

Objective: To understand whether symptoms of health conditions explain the negative association between combat exposure and student Veterans' achievement of a meaningful life. Participants: 153 combat Veterans enrolled in college between November 2013 and April 2018. Methods: Through an online survey, participants reported combat exposure, health status (symptoms of conditions such as depression), and aspects of a meaningful life (belonging, self-understanding, and doing) at two time points. Path analysis was used to explore whether baseline health status mediated the relationship between combat exposure and belonging, self-understanding, and doing at follow-up. Results: Indirect effects indicated that the negative influence of combat on student Veterans' sense of belonging, self-understanding, and doing at follow-up was mediated by poor health at baseline. Conclusions: Combat exposure may contribute to the development of health conditions, which in turn limit student Veterans' experience of three aspects of a meaningful life: a sense of belonging, self-understanding, and doing.

Psychometric properties of Meaningful Activity Participation Assessment (MAPA) in chronic stroke survivors.

BACKGROUND: Meaningful Activity Participation Assessment (MAPA) is an appropriate tool for assessing both objective and subjective aspects of participation. OBJECTIVES: This study aimed to investigate the psychometric properties of MAPA in chronic stroke survivors. METHODS: Translation of MAPA was done according to the standard protocol of forward-backward translation. One hundred and seven chronic stroke survivors participated in this study. In addition to the MAPA, they were assessed by Satisfaction With Life Scale (SWLS), Center for Epidemiologic Studies of Depression Scale (CES-D), Life Satisfaction Index-Z (LSI-Z), Purpose in Life Test-Short Form (PIL-SF), and 36-Item Short-Form Survey (SF-36). To investigate the test-retest reliability, 37 participants were reassessed by MAPA after two weeks. Reliability, construct and known-groups validity were evaluated for MAPA. RESULTS: The results showed an acceptable internal consistency (Cronbach's α = 0.79) and good test-retest reliability (ICC = 0.92) of MAPA. A significant moderate to high correlation was found between the MAPA and PIL-SF, CES-D, LSI-Z, SWLS, and different subscales of SF-36 (r = 0.32-0.65). MAPA showed good ability to differentiate between young adults (age≤ 65 years) and older adults (age> 65 years) with chronic stroke (P = .005) as well as between chronic stroke survivors with different levels of disability (P < .001). CONCLUSIONS: The MAPA has appropriate reliability and validity in chronic stroke survivors and is suggested to be used in research and clinical settings.

Participation Is Associated With Well-Being Among Community-Based Veterans: An Investigation of Coping Ability, Meaningful Activity, and Social Support as Mediating Mechanisms.

IMPORTANCE: Occupational therapy practitioners can use therapeutic activity to promote veterans' well-being, but the mechanisms through which participation promotes well-being are poorly understood. OBJECTIVE: To examine whether coping ability, meaningful activity, and social support mediate the relationship between participation and two indicators of veterans' overall well-being: life meaning (psychological well-being) and life satisfaction (subjective well-being). DESIGN: Explanatory cross-sectional design. We used two multiple mediation models to test whether coping ability, meaningful activity, and social support explained the relationship between participation and both life meaning and life satisfaction. Models were adjusted for demographic characteristics and service-related health conditions (e.g., posttraumatic stress disorder). SETTING: Community. PARTICIPANTS: Three hundred eighty-nine community-based veterans attending college. INTERVENTION: None. OUTCOMES AND MEASURES: Measures of participation, coping ability, meaningful activity, social support, life meaning, life satisfaction, and service-related health conditions. RESULTS: Meaningfulness of activity partially explained the relationship between participation and both psychological well-being (B = 0.16, standard error [SE] = 0.04, 99% confidence interval [CI] [0.07, 0.27]) and subjective well-being (B = 0.14, SE = 0.03, 99% CI [0.07, 0.24]). Social support partially explained the relationship between participation and subjective well-being (B = 0.05, SE = 0.02, 99% CI [0.01, 0.11]). These findings persisted when symptoms of service-related health conditions were accounted for. CONCLUSIONS AND RELEVANCE: Veterans' participation is associated with a greater sense of meaningful activity and social support, which in turn promotes psychological and subjective well-being. Occupational therapy practitioners may promote veterans' well-being by supporting engagement in activities that elicit meaning and enable social interaction, although further study is needed. WHAT THIS ARTICLE ADDS: This is among the first studies to test mechanisms underlying the relationship between veterans' engagement in activities and their overall well-being. Results may inform treatment theories for activity-based interventions in the veteran population. For example, results indicate that occupational therapy interventions that facilitate engagement in meaningful and shared activities could be developed to promote veterans' well-being.

Protective and Health-Related Factors Contributing to Resilience Among Student Veterans: A Classification Approach.

IMPORTANCE: Occupational therapists can foster student veterans' resilience, but targets for intervention must be developed. OBJECTIVE: To explain factors influencing student veterans' successful adaptation to past combat exposure, we hypothesized that participants with high life meaning would have greater levels of protective factors and lower levels of health conditions than those with low life meaning. DESIGN: Longitudinal panel study with two measurements. Participants were classified by level of combat exposure (high-low) and life meaning (high-low) at follow-up, yielding four possible classifications (e.g., resilient group: high combat exposure, high life meaning). Linear mixed models were fit to obtain adjusted means of protective factors and health conditions for each classification; independent-samples t tests were used to examine differences between classifications. SETTING: Community. PARTICIPANTS: Convenience sample of 153 combat-exposed student veterans. OUTCOMES AND MEASURES: Psychometrically sound measures of combat exposure, life meaning, protective factors (social and instructor autonomy support, coping ability, academic self-efficacy, social-community participation, and meaningful activity), and health conditions (posttraumatic stress [PTSD], depression, somatic symptoms). RESULTS: Groups with high life meaning at follow-up in response to both levels of combat exposure reported greater meaningful activity and coping ability and fewer depressive symptoms. Participants with high life meaning in response to low combat exposure had greater social support and fewer somatic symptoms; participants with high life meaning in response to high combat exposure had lower PTSD. CONCLUSIONS AND RELEVANCE: Occupational therapists may foster student veterans' resilience by promoting meaningful activity, social support, and coping ability while managing symptoms of health conditions. WHAT THIS ARTICLE ADDS: To the best of our knowledge, this study is the first to offer empirical support for potential targets of occupational therapy intervention that address student veterans' successful adaptation to combat exposure. Findings suggest that researchers should develop and test interventions that facilitate successful engagement in meaningful and shared activities and that occupational therapists should work within multidisciplinary teams to bolster coping ability and manage symptoms of combat-related health conditions.

Novel Effect Size Interpretation Guidelines and an Evaluation of Statistical Power in Rehabilitation Research.

OBJECTIVE: First, to establish empirically-based effect size interpretation guidelines for rehabilitation treatment effects. Second, to evaluate statistical power in rehabilitation research. DATA SOURCES: The Cochrane Database of Systematic Reviews was searched through June 2019. STUDY SELECTION: Meta-analyses included in the Cochrane Database of Systematic Reviews with "rehabilitation" as a keyword and clearly evaluated a rehabilitation intervention. DATA EXTRACTION: We extracted Cohen's d effect sizes and associated sample sizes for treatment and comparison groups. Two independent investigators classified the interventions into 4 categories using the Rehabilitation Treatment Specification System. The 25th, 50th, and 75th percentile values within the effect size distribution were used to establish interpretation guidelines for small, medium, and large effects, respectively. A priori power analyses established sample sizes needed to detect the empirically-based values for small, medium, and large effects. Post-hoc power analyses using median sample sizes revealed whether the "typical" rehabilitation study was sufficiently powered to detect the empirically-based values. Post hoc power analyses established the statistical power of each test based on the sample size and reported effect size. DATA SYNTHESIS: We analyzed 3381 effect sizes extracted from 99 meta-analyses. Interpretation guidelines for small effects ranged from 0.08 to 0.15; medium effects ranged from 0.19 to 0.36; and large effects ranged from 0.41 to 0.67. We present sample sizes needed to detect these values based on a priori power analyses. Post hoc power analyses revealed that a "typical" rehabilitation study lacks sufficient power to detect the empirically-based values. Post hoc power analyses using reported sample sizes and effects indicated the studies were underpowered, with median power ranging from 0.14 to 0.23. CONCLUSIONS: This study presented novel and empirically-based interpretation guidelines for small, medium, and large rehabilitation treatment effects. The observed effect size distributions differed across intervention categories, indicating that researchers should use category-specific guidelines. Furthermore, many published rehabilitation studies are underpowered.

Factors distinguishing veterans participating in supported education services from veterans on campus: Evidence supporting modifiable intervention targets.

OBJECTIVE: The purpose of this study was to identify specific and modifiable supported education (SEd) service needs for the veteran population. To do so, we compared veterans participating in SEd services to other veterans on campus with respect to service-related challenges, community reintegration, and academic-related challenges. Identifying independent factors that distinguish veterans receiving SEd services from other veterans on campus may help operationalize interventions that target the unique challenges in this vulnerable population. METHOD: This study used an exploratory cross-sectional design. We used logistic regression on 410 veterans attending college. Models tested whether sociodemographic characteristics (e.g., age), service-related challenges (e.g., combat exposure), academic-related challenges (e.g., academic self-efficacy), and aspects of community reintegration (e.g., employment status) distinguished veterans receiving SEd services (n = 94) from veterans on campus (n = 316). RESULTS: Veterans who reported (a) more severe combat exposure, (b) more severe posttraumatic stress disorder (PTSD) symptoms, (c) service-related mild traumatic brain injury (mTBI), (d) lower levels of academic self-efficacy, and (e) no paid employment were more likely to participate in SEd services. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study established several factors that distinguished veterans receiving SEd services from veterans on campus. Findings indicate that SEd education services for veterans should: (a) apply principles of trauma-informed care, (b) mitigate the influence of PTSD and/or mTBI upon academic success and community reintegration, (c) promote academic self-efficacy, and (d) integrate principles of supported employment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Equine-assisted interventions for veterans with service-related health conditions: a systematic mapping review.

BACKGROUND: Evidence-based treatments for service-related health conditions such as posttraumatic stress disorder (PTSD), depression, and traumatic brain injury (TBI) are not effective for all veterans. Equine-assisted interventions are emerging as an additional treatment modality, but little is known regarding the safe and effective delivery of these interventions. This study aimed to describe the following features of the body of literature concerning equine-assisted interventions among veterans: 1) veterans who have participated in equine-assisted interventions; 2) specific characteristics of equine-assisted interventions in veterans; and 3) the specific characteristics of research on equine-assisted interventions in veterans. METHODS: We conducted a systematic mapping review of peer-reviewed literature reporting on equine-assisted interventions among veterans between 1980 and 2017. Searches of nine databases yielded 3336 unique records, six of which met the inclusion criteria and were reviewed. Data relevant to the study aims were extracted and analyzed. RESULTS: Equine-assisted interventions among veterans disproportionately targeted psychosocial outcomes and yielded promising results. The detailed methods of EAI varied in the reported studies, ranging from communicating with the horse to mounted exercises. There was also great diversity in outcome measurement. The state of theoretical development regarding the mechanisms by which equine-assisted interventions benefit the veteran population is currently underdeveloped. Studies provided insufficient detail with respect to the description of the intervention, reasons for attrition, and the dose-response relationship. CONCLUSIONS: Scientific development of equine-assisted interventions targeting psychosocial outcomes among veterans is warranted to establish their efficacy. Targeted outcomes should be expanded, including outcomes more closely aligned with the nature of polytraumatic injuries. Future research must also emphasize the theoretical development of equine-assisted interventions for veterans and thoroughly describe the participants, components of the intervention, factors contributing to attrition, and optimal dose-response relationships.

Participation, Meaningful Activity, and Social Support Among U.S. Student Service Members/Veterans.

Student service members/veterans (SSM/Vs) may experience diminished social support and meaningful activity due to health-related sequelae, in turn threatening their community reintegration. Social and community participation may foster both social support and meaningful activity. This study assessed whether social and community participation explained social support and meaningful activity and evaluated the psychometric properties of the Veterans' Social and Community Participation Assessment (VSCPA). Online surveys generated responses to the VSCPA, indicators of social support, meaningful activity, health-related challenges, and demographic characteristics. Multiple regression models explored predictors of social support and meaningful activity. The VSCPA comprised three components: active community participation, familial and household participation, and social participation. These components exhibited positive associations with social support and meaningful activity and negative relationships with health-related sequelae. Targeting social and community participation among SSM/Vs may be a fruitful means by which occupational therapists bolster social support and meaningful activity.

College students' experiences of hedonia and eudaimonia in their everyday activities: Degrés d'hédonisme et d'eudémonisme éprouvés par des étudiants du niveau universitaire au fil de leurs activités quotidiennes.

BACKGROUND: Experiences of hedonia (i.e., seeking pleasure) and eudaimonia (i.e., actualizing human potential in pursuit of meaningful goals) are central to the study of human well-being. PURPOSE: This study sought to examine levels of hedonia (pleasure) and eudaimonia (productivity) in a convenience sample of college (university) students' ( n = 264) daily activities, controlling for levels of perceived stress. METHOD: Data were gathered using a 24-hr time-use recall diary designed to assess objective and subjective information about everyday activities. Descriptions of self-reported everyday activities were coded into 20 activity types. FINDINGS: Activities reported high in pleasure were eating, listening to music/watching movies, and exercise. Activities reported as high in productivity were studying and working. Activities reported as high in both pleasure and productivity were reported less frequently and often had a recognizable outcome or provided social connection. IMPLICATIONS: Developing a greater understanding of how college students experience their daily activities could strengthen programs designed to enable students to manage stress and sustain their well-being.

Feasibility of a Lifestyle Redesign®-Inspired Intervention for Well Older Adults.

OBJECTIVE: We examined the feasibility of Aging Well by Design, a Lifestyle Redesign®-inspired intervention for community-dwelling older adults. The original Lifestyle Redesign program was shortened to 3 mo and implemented as a community outreach program of a major health care system. METHOD: Community-dwelling older adults participated in the 12-wk program, which emphasized an occupational approach to healthy aging. Outcomes evaluated were recruitment, attendance, resource use, participant satisfaction, and subjective benefit to participants. RESULTS: The 13 participants, ages 66-88 yr, attended an average of 10 of 12 sessions. The intervention was completed as planned, physical resources were suitable, and financial resources were adequate. Participants expressed satisfaction with the program's facilitator, group discussions, and materials. Perceived benefits were social relationships, awareness of community resources, and change in attitude toward aging. CONCLUSION: Implementation of a 3-mo Lifestyle Redesign-inspired program within a health care system was feasible.