Shared Decision Making and Reducing the Use of Low-Value Occupational Therapy Interventions.

Shared decision making (SDM), or the process by which clients actively work with health care professionals to make informed decisions about health care options, is critical to value-based, client-centered care and representing client preferences as part of the occupational therapy process. With the enactment of the Patient Protection and Affordable Care Act and the continued focus on patient-centered care models and quality indicators, occupational therapy practitioners must be prepared to engage in SDM. In this Health Policy Perspectives article, we provide considerations about how occupational therapy practitioners may use Choosing Wisely® recommendations to engage clients in SDM and provide high-quality evidence-based care.

The Relationship Between Pre-Pregnancy Attempts to Lose Weight and Gestational Weight Gain: An Exploratory Primary Care Prospective Cohort Study.

OBJECTIVE: The primary objective of this study was to explore the association between weight cycling in the 6 months prior to pregnancy and gestational weight gain concordance with the 2009 Institute of Medicine guidelines for weight gain in pregnancy. METHODS: This was a prospective cohort study. Participants were women aged 18 years or older with a singleton pregnancy who had a prenatal appointment between April 1 and August 31, 2019. Eligible women completed a questionnaire that assessed their pre-pregnancy attempts to lose weight, measured with a modified version of the Weight Cycling subscale within the Revised Restraint Scale. After delivery, participants' last recorded gestational weight before delivery, and corresponding gestational ages were obtained from prenatal records. RESULTS: One hundred and ninety-five pregnant women consented to participate in the study (a 95.6% response rate). Of them, 5 were excluded; therefore, 190 participants were included in the analysis. One-third of participants had attempted to lose weight in the 6 months before pregnancy. Logistic regression showed that for every one-unit increase in Weight Cycling score, the odds of excess gestational weight gain increased by a factor of 1.32. CONCLUSION: Women's pre-conceptual efforts to enter pregnancy at a lower BMI should be approached in a manner that avoids pre-pregnancy weight cycling.

Responding to COVID-19: Resilience in Occupational Therapy.

This special issue of the American Journal of Occupational Therapy highlights the contribution of occupational therapy practitioners to the care of clients during the coronavirus disease 2019 (COVID-19) pandemic. The case studies and articles exemplify the resilience of practitioners and the importance of occupational therapy interventions in addressing the physical, cognitive, psychological, and social needs of clients, their families, and care providers. We encourage practitioners to be inventive, to be collaborative, and to contribute to research regarding the benefits of occupational therapy for this population.

Occupational Therapy Practice Guidelines for Children and Youth Ages 5-21 Years.

IMPORTANCE: Demand is increasing for activity- and occupation-based interventions to address occupational performance and support maximal participation of children and youth. OBJECTIVE: This Practice Guideline was developed to guide decision making and support best practices in service delivery for children and youth ages 5-21 yr at home, at school, and in the community. METHOD: The results from three systematic reviews (SRs) of activity- and occupation-based interventions for children and youth ages 5-21 yr were reviewed, synthesized, and translated into recommendations for education, practice, and research. RESULTS: One hundred eighty-five articles were included in the three SRs examining the evidence for interventions to promote activities of daily living, instrumental activities of daily living, play and leisure, and rest and sleep; to improve mental health, positive behavior, and social participation; and to enhance learning, academic achievement, and successful participation in school. The reviews provide evidence for interventions associated with typical concerns addressed by occupational therapy practitioners. CONCLUSIONS AND RECOMMENDATIONS: On the basis of the evidence, this guideline recommends that occupational therapy practitioners consistently collaborate with families and caregivers and provide services in the natural context of the desired occupation. The evidence also supports group service models and models that include peer mediation; these models can promote participation across areas of occupation. Skills-based training and therapeutic practice in the context of valued occupations are recommended over isolated sensorimotor approaches. Technology, manualized programs, and sports activities can be effective but should be evaluated and matched to age, diagnosis, and outcomes as guided by the evidence. WHAT THIS ARTICLE ADDS: When guided by evidence, activity- and occupation-based interventions are effective in promoting participation and enhancing performance in valued occupations of children and youth ages 5-21 yr.

Activity- and Occupation-Based Interventions to Support Mental Health, Positive Behavior, and Social Participation for Children and Youth: A Systematic Review.

IMPORTANCE: Children and youth are often challenged to maintain well-being, positive behavior, and social participation. OBJECTIVE: To identify evidence for occupational therapy interventions for children and youth with and at risk for mental health concerns. DATA SOURCES: Articles published in English-language peer-reviewed journals between January 2010 and March 2017 identified through searches of MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane databases. STUDY SELECTION AND DATA COLLECTIO: : The methodology in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to complete the review. Of 5,310 articles screened by title and abstract, 357 were retrieved for full-text review, and 62 met inclusion criteria. Articles describing interventions that were activity or occupation based were included. Conference proceedings, non-peer reviewed publications, dissertations, theses, and presentations were excluded. FINDINGS: Of the 62 studies included in the review, 20 (32%) were Level I studies, 22 (36%) were Level II studies, and 20 (32%) were Level III studies. Articles were categorized by type: outdoor camps, video and computer games, productive occupations and life skills, meditation, animal-assisted interventions, creative arts, play, sports, and yoga. Moderate to strong evidence supports the use of yoga and sports. Moderate-strength evidence supports the use of play and creative arts. Evidence for the use of animal-assisted interventions, meditation, video and computer games, and productive occupations was of low strength. CONCLUSION AND RELEVANCE: Substantial evidence exists to support the use of activity- and occupation-based interventions to address the mental health, behavioral, and social participation concerns of children and youth. Occupational therapy practitioners should match the desired outcome of therapy with the appropriate intervention to provide the best and most effective services to their clients. WHAT THIS ARTICLE ADDS: This review provides additional support for the use of activity- and occupation-based interventions (i.e., those that involve active participation) to improve the behavior, social participation, and mental health of children and youth.

Linking the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) to the International Classification of Function.

PURPOSE: The purpose of the current study was to examine how comprehensively the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) addresses Activity and Participation components of the International Classification of Functioning, Disability, and Health (ICF). METHODS: Two raters individually linked the 276 items of the PEDI-CAT to the ICF using ICF linking rules, the PEDI-CAT manual, and the ICF browser. Agreement between reviewers was evaluated, and reliability of the linking process was assessed using Cohen's κ. RESULTS: All 9 chapters of Activity and Participation were represented within the PEDI-CAT. The highest frequency of representation was in Mobility (43%) and Self-care (20%) chapters. Agreement between the 2 raters was strong (κ = 0.84). Two items were not definable in the ICF, and 3 linked to Body Function codes. CONCLUSIONS: The PEDI-CAT was strongly representative of the Activities and Participation component of the ICF. The linking process had substantial reliability.

Interventions to Promote Diabetes Self-Management in Children and Youth: A Scoping Review.

As children and youth with diabetes grow up, they become increasingly responsible for controlling and monitoring their condition. We conducted a scoping review to explore the research literature on self-management interventions for children and youth with diabetes. Eleven studies met the inclusion criteria. Some of the studies reviewed combined the participant population so that children with Type 1 as well as children with Type 2 diabetes were included. The majority of the studies focused on children age 14 yr or older and provided self-management education, self-management support, or both. Parent involvement was a key component of the majority of the interventions, and the use of technology was evident in 3 studies. The findings highlight factors that occupational therapy practitioners should consider when working with pediatric diabetes teams to select self-management interventions.

Perspectives on the Use of Standardized Parents to Teach Collaboration to Graduate Occupational Therapy Students.

OBJECTIVE: Pediatric occupational therapy practitioners interview parents on a daily basis to gain important patient information and develop collaborative intervention goals. A standardized parent experience was developed to help master's-level occupational therapy students gain the skills needed to interview parents after their child's traumatic injury. This article describes the pedagogical approach used to develop the standardized parent experience and reports the students' general perspectives related to this assignment. METHOD: Outcome data were collected through focus groups (n = 9) and document review (n = 12) and then analyzed for themes. RESULTS: Two main themes emerged from the data: It felt real and It helped me to think deeper. CONCLUSION: A standardized parent experience may help occupational therapy students develop the habits of mind associated with collaboration.

Results of a School-Based Evidence-Based Practice Initiative.

OBJECTIVE: To investigate the effects of a 17-mo initiative designed to increase practitioners' knowledge and skills related to evidence-based practice (EBP) in the schools. METHOD: We evaluated participants' EBP knowledge and skills at pretest and posttest using the Adapted Fresno Test (AFT) and collected their perceptions through a survey. RESULTS: Participants demonstrated significant improvements in their EBP knowledge and skills after participating in this initiative as measured by changes in AFT scores. A significant difference was noted in scores between pretest (µ=43.9, SD=32.67) and posttest (µ=74.66, SD=33.99), t(28)=-5.645, p<.001. CONCLUSION: This initiative was influential in increasing school-based practitioners' EBP knowledge and skills.

National survey of occupational therapy practitioners' involvement in response to intervention.

OBJECTIVE. We sought to describe occupational therapy practitioners' perceived levels of preparedness for and involvement in school-based Response to Intervention (RtI) initiatives. METHOD. We mailed a survey to a random sample of 1,000 practitioners from the American Occupational Therapy Association's Early Intervention and School Systems Special Interest Section. RESULTS. Of 295 returned surveys (29.9% response rate), 19 were excluded because of missing or incomplete data. Three-quarters of respondents (77.6%) reported that their districts implemented RtI. Two-thirds of respondents (66.3%) indicated that lack of resources limited their involvement in RtI; two-thirds (67%) said that district guidelines that describe expectations for practitioners' involvement would help increase their participation. Many respondents cited the need for continuing education and supported moving from a caseload to a workload model. CONCLUSION. Occupational therapy practitioners would benefit from specific district guidelines outlining the services they are able to provide within the context of RtI.

Survivors of brain injury: the narrative experiences of being a college or university student.

BACKGROUND: The deficits associated with a brain injury may pose many challenges to young adult students. PURPOSE: The purpose of this study was to conduct an in-depth exploration of the experiences and processes individuals who self-identify as having a brain injury go through during college or university to overcome obstacles. METHOD: This study used a basic interpretative qualitative design. Data were collected through semi-structured interviews and analyzed with the constant comparative method. FINDINGS: Three themes emerged: balancing act, reality versus injury, and square peg in a round hole. Participants discussed personal strategies that they used to help them be successful. Despite these strategies, the participants continued to feel out of place and felt that seeking disability services would further set them apart from their non-injured peers. IMPLICATIONS: Individuals post-brain injury may benefit from occupational therapy services to reduce the challenges associated with functioning in the student role in college and university environments.

Transformation in Teaching-Learning: Emerging Possibilities with Interprofessional Education.

As the global community continues to face increasing mobility, rising healthcare costs, and decreasing or inaccessible healthcare resources, healthcare providers must be able to work together effectively in addressing the needs of progressively older and diverse persons and populations. In this column, the notion of interprofessional education (IPE) is explored and a model proposed for implementation in an institution offering graduate programs in nursing and occupational therapy. While the proposed model was developed for two disciplinary programs in a specific institution, the recommendations offered may easily be adapted for use in academic institutions offering varied and unique healthcare professional programs.

A systematic review of more than one dose of misoprostol after mifepristone for abortion up to 10 weeks of gestation.

OBJECTIVES: This review aimed to assess the effectiveness, acceptability and safety of regimens that include mifepristone and multiple misoprostol doses for abortion up to 10 weeks of gestation. METHODS: We searched MEDLINE and reference lists for English-language reports (published between January 1990 and September 2005) of trials evaluating a medication abortion regimen consisting of mifepristone and multiple doses of misoprostol. Eligible trials had to either be restricted to women with less than 10 weeks' gestation or report stratified results that allowed the extraction of data for this subset. RESULTS: Although we identified 26 eligible studies, only 3 were randomized controlled trials (RCTs), comparing regimens that differed in the repeat-dose misoprostol component. These trials did not detect differences in effectiveness between the randomized groups. One RCT found evidence of higher effectiveness from repeat misoprostol doses among a subgroup of women with more advanced gestations. CONCLUSIONS: Although clinicians often prescribe a repeat dose of misoprostol to increase effectiveness in medication abortion, the effect of the repeat dose has not been established. Because mifepristone followed by a single misoprostol dose is highly effective in inducing abortion, determining the effect of a repeat misoprostol dose would require a large sample size. The resource expenditure on such large trials might not be warranted. Any future studies should use induction-to-completion time to measure effectiveness and should assess acceptability and side effects.