A Fall Prevention Feasibility Trial for People With HIV and Alcohol Use.

Alcohol contributes to higher fall risk in people living with HIV (PLWH), yet fall prevention trials for PWH with alcohol use are lacking. To assess the feasibility of conducting a randomized controlled trial of a 10-week online fall prevention intervention tailored for PLWH with alcohol use. The intervention consisted of weekly virtual group discussions, individual phone check-ins, and home exercises. Of those eligible, 53.5% (23/43) enrolled (12 to the intervention and 11 to control). Mean age was 58 years; 82.6% had a past 6-month fall; 65.2% had alcohol use disorder; and 95.7% completed postintervention assessments. The intervention was highly rated (Client Satisfaction Questionnaire-8 score M = 30.4, SD = 1.6) with a wide range of group and individual phone session attendance. Preliminary analyses suggest the intervention may reduce the odds of falling and alcohol use frequency. Findings support the feasibility of a larger randomized trial. ClinicalTrials.gov Identifier: NCT04804579.

A fall prevention feasibility trial for people with HIV and alcohol useAlcohol contributes to higher fall risk in people living with HIV (PLWH), yet fall prevention studies for PLWH with alcohol use are lacking. We conducted a 10-week online fall prevention intervention for PLWH (n = 23) with recent alcohol use to assess if the intervention was feasible and acceptable for PLWH. The intervention consisted of weekly virtual group discussions and individual phone check-ins with an occupational therapist and a customized home exercise program. The mean age was 58 years. Almost all fell in the past 6 months (82.6%), had impaired physical functioning (91.3%), and had alcohol use disorder (65.2%). Participants reported high intervention satisfaction. Preliminary analyses suggest that the intervention may reduce the odds of falling and alcohol use frequency. Findings support the feasibility of an online fall prevention intervention study for PLWH.

Factors contributing to whether or not people with obesity undergo bariatric surgery.

BACKGROUND: Bariatric surgery has been suggested as a safe and effective way to treat obesity by facilitating weight loss, but factors that predict the likelihood of bariatric surgery are unknown. The objective of this study was to describe factors associated with individuals with obesity that influence their decision to undergo bariatric surgery. SUBJECTS AND METHODS: The study design was a cross-sectional study and participants were recruited via a survey link posted on the Obesity Action Coalition website. Demographic data, medical data, weight loss program data, and reports of personal experiences were gathered via an online survey. A multivariate logistic regression model was conducted to examine predictors associated with bariatric surgery (N = 4192). RESULTS: Participants who took phentermine (OR=2.983), Phentermine-topiramate (Qsymia) (OR=2.863), Naltrexone-bupropion (Contrave) (OR=3.246), or Liraglutide (Saxenda) (OR=2.144) had a higher likelihood of undergoing bariatric surgery for weight loss. Participants with type 2 diabetes (OR=1.728), post-traumatic stress disorder (PTSD) (OR=1.489), or COVID-19 (OR=3.852) had a higher likelihood of undergoing bariatric surgery while sleep apnea (OR=0.760) was associated with a lower likelihood of receiving surgery. Those who used MyFitnessPal™ (OR=2.232), Noom™ (OR=1.400), Jenny Craig™ (OR=1.533), or Keto (OR=1.664) for weight loss had a higher likelihood of obtaining bariatric surgery. Personal trauma experiences of sexual abuse (OR=1.982) and physical abuse (OR=1.490) were more associated with participants who underwent surgery. CONCLUSIONS: A variety of characteristics were associated with decisions to undergo bariatric surgery. These findings may help to determine ways to support individuals who are considering bariatric surgery.

Study Protocol for a Pilot Randomized Trial of a Virtual Occupational Therapy Fall Prevention Intervention for People With HIV and Alcohol Use.

Background: People living with HIV (PLWH) are at risk for falls due to polypharmacy, unhealthy substance (risky alcohol and/or illicit drug) use, low physical activity, and frailty combined with typical age-related physical changes. Fall prevention is needed to reduce the morbidity related to falls and fractures, however, there is a paucity of data on the design of a fall prevention intervention and whether it can be delivered virtually. We describe the protocol of a pilot randomized trial of a virtual occupational therapy fall prevention intervention for people with HIV at high risk for falls and recent alcohol and/or drug use. Method: PLWH will be recruited from the Boston ARCH 4F Cohort study, an observational study of PLWH to examine the impact of alcohol on falls. Trial participants will be randomized to either an occupational therapy-led fall prevention intervention or provided with written education about fall prevention and alcohol use (control). The 10-week fall prevention intervention was based upon results from qualitative interviews with PLWH about falls and will consist of weekly virtual group sessions, home exercises and phone-check-ins, delivered by occupational therapists. The primary outcome measures will be number of groups attended and a participant-completed satisfaction survey. Change in number of falls, alcohol and other drug use, and physical functioning will be examined. Discussion: A virtual occupational therapy fall prevention intervention addresses the emerging concern of fall risk in PLWH and alcohol use. This pilot study will provide preliminary estimates of fall-related outcomes as well as feasibility of study procedures for a larger trial. ClinicalTrialsgov Identifier: NCT04804579. Boston University Protocol Record H-41041.

Pivoting in Context: Using the Forging Alliances in Interdisciplinary Rehabilitation Research Model to Collaborate During COVID-19.

ABSTRACT: With the onset of the COVID-19 pandemic, researchers have been faced with challenges in maintaining interdisciplinary research collaborations. The purpose of this article is to apply and expand a previously introduced model to sustaining new interdisciplinary research collaborations: Forging Alliances in Interdisciplinary Rehabilitation Research (FAIRR). FAIRR is a logic model that can be used as a guide to create interdisciplinary rehabilitation research teams. In this article, the authors propose expanding FAIRR by including strategies for sustaining interdisciplinary rehabilitation research collaborations: modifying inputs (resources needed to assemble a team and to conduct research activities), shifting activities (steps taken to move the interdisciplinary collaboration forward), and examining what impacts the fit between inputs and activities. Two examples are used to highlight the application of the FAIRR model to interdisciplinary collaborations during COVID-19.

Initial evaluation of the effects of an environmental-focused problem-solving intervention for transition-age young people with developmental disabilities: Project TEAM.

AIM: Project TEAM (Teens making Environment and Activity Modifications) teaches transition-age young people with developmental disabilities, including those with co-occurring intellectual or cognitive disabilities, to identify and resolve environmental barriers to participation. We examined its effects on young people's attainment of participation goals, knowledge, problem-solving, self-determination, and self-efficacy. METHOD: We used a quasi-experimental, repeated measures design (initial, outcome, 6-week follow-up) with two groups: (1) Project TEAM (28 males, 19 females; mean age 17y 6mo); and (2) goal-setting comparison (21 males, 14 females; mean age 17y 6mo). A matched convenience sample was recruited in two US states. Attainment of participation goals and goal attainment scaling (GAS) T scores were compared at outcome. Differences between groups for all other outcomes were analyzed using linear mixed effects models. RESULTS: At outcome, Project TEAM participants demonstrated greater knowledge (estimated mean difference: 1.82; confidence interval [CI]: 0.90, 2.74) and ability to apply knowledge during participation (GAS: t[75]=4.21; CI: 5.21, 14.57) compared to goal-setting. While both groups achieved significant improvements in knowledge, problem-solving, and self-determination, increases in parent reported self-determination remained at 6-week follow-up only for Project TEAM (estimated mean difference: 4.65; CI: 1.32, 7.98). Significantly more Project TEAM participants attained their participation goals by follow-up (Project TEAM=97.6%, goal-setting=77.1%, p=0.009). INTERPRETATION: Both approaches support attainment of participation goals. Although inconclusive, Project TEAM may uniquely support young people with developmental disabilities to act in a self-determined manner and apply an environmental problem-solving approach over time. WHAT THIS PAPER ADDS: Individualized goal-setting, alone or during Project TEAM (Teens making Environment and Activity Modifications) appears to support attainment of participation goals. Project TEAM appears to support young people with developmental disabilities to apply an environmental problem-solving approach to participation barriers. Parents of young people with developmental disabilities report sustained changes in self-determination 6 weeks after Project TEAM.

Factors Associated with Community Participation among Individuals Who Have Experienced Homelessness.

Community participation is an important goal for people who have experienced homelessness. The aim of this study was to use the International Classification of Functioning, Disability and Health (ICF) as a framework to examine factors associated with community participation among people who are homeless or recently housed through housing programs. Participants (n = 120) recruited from six housing placement and search programs completed measures of community participation (including productivity, social and leisure, and community-services-use domains), psychiatric and physical symptoms, functional limitations, and a demographic form. Multiple regression analyses were used to identify predictors of overall community participation and subdomain scores. Results suggested that cognitive and mobility limitations, relationship status, and housing status significantly predicted both overall participation and participation in productivity and social and leisure subdomains. Participants who were housed through housing programs, who had cognitive and mobility limitations, and who were single showed less community participation. The findings suggest that activity limitations and environmental and personal factors may need to be addressed in efforts to enhance community participation in this population.

Accessibility patterns and community integration among previously homeless adults: a Geographic Information Systems (GIS) approach.

Although a desired rehabilitation goal, research continues to document that community integration significantly lags behind housing stability success rates for people of a variety of ages who used to be homeless. While accessibility to resources is an environmental factor that may promote or impede integration activity, there has been little empirical investigation into the impact of proximity of community features on resource use and integration. Using a Geographic Information Systems (GIS) approach, the current study examines how accessibility or proximity to community features in Boston, United States related to the types of locations used and the size of an individual's "activity space," or spatial presence in the community. Significant findings include an inverse relationship between activity space size and proximity to the number and type of community features in one's immediate area. Specifically, larger activity spaces were associated with neighborhoods with less community features, and smaller activity spaces corresponded with greater availability of resources within one's immediate area. Activity space size also varied, however, based on proximity to different types of resources, namely transportation and health care. Greater community function, or the ability to navigate and use community resources, was associated with better accessibility and feeling part of the community. Finally, proximity to a greater number of individual identified preferred community features was associated with better social integration. The current study suggests the ongoing challenges of successful integration may vary not just based on accessibility to, but relative importance of, specific community features and affinity with one's surroundings. Community integration researchers and housing providers may need to attend to the meaning attached to resources, not just presence or use in the community.

Measuring community integration using Geographic Information Systems (GIS) and participatory mapping for people who were once homeless.

Measures of community integration rely on self-report assessments that often quantify physical or social participation, but fail to capture the individual׳s spatial presence in the community. The current study documents the activity space, or area of daily experiences, of 37 individuals who were once homeless through participatory mapping and Geographic Information Systems (GIS). Contrary to expectations, there was no significant relationship between activity space size and community integration measures, except a negative association with physical integration. Further analysis revealed, however, that continued use of homeless services, geographically spread throughout the city, was associated with larger activity space size, but may be counterproductive to social and psychological integration efforts. Analysis of the types of locations identified revealed high importance given to leisure locations and ongoing involvement with medical and mental health locations. Finally, community integration outcomes did not differ significantly by demographics or housing type, but rather degree of family involvement and feeling like home, factors that may have more potential for change.

Change patterns of homeless individuals with mental illness: a multiple case study.

This multiple case study illuminates the individual change trajectories of four homeless men with mental illnesses who participated in a manualized life skills intervention to improve housing retention. Readiness-to-change, life skills knowledge and trauma symptoms were measured at baseline, post-intervention and at 3-6 months follow-up. Cluster analysis identified two patterns of readiness-to-change: engaged and pre-engaged. Change is non-linear and baseline readiness is not necessary to benefit from the intervention. Examining individuals' lives in context illuminated the change process and demonstrated that varied patterns can lead to successful outcomes for housing stability and community reintegration.

Psychometric Properties of the Practical Skills Test (PST).

The Practical Skills Test (PST) is a new assessment of individuals' knowledge of life skills. We evaluated the PST's reliability, validity, and sensitivity to change among a homeless population. Participants were 123 homeless persons in a longitudinal experimental study who were assessed before and after intervention with the PST, Allen Cognitive Level Screen-2000 (ACLS-2000), and Impact of Event Scale-Revised (IES-R). The PST showed generally good internal consistency, no floor effects, and limited ceiling effects (<20% on each test). Supportive evidence for the PST's convergent validity was seen in its moderate correlations with the ACLS-2000; we found no significant correlation with the IES-R. Paired t tests indicated that the PST is sensitive to changes in life skills after intervention, but effect sizes were small. The results suggest that the PST has generally good reliability and validity. However, ceiling effects suggest an area for further development.

Community participation measures for people with disabilities: a systematic review of content from an international classification of functioning, disability and health perspective.

OBJECTIVE: To identify instruments that measure community participation in people with disabilities and to evaluate which domains, to what extent, and how precisely they address this construct. The review aims to provide information to guide the selection of community participation instruments and to identify limitations of existing measures. DATA SOURCES: A systematic search was performed in PubMed, CINAHL, and PsychINFO in February and March 2012. The latest systematic reviews and references of searched articles were also reviewed to check for measures that were not identified in the initial search. STUDY SELECTION: Instruments were included if they (1) were a self-report questionnaire; (2) measured community participation, participation, or community integration; (3) measured actual participation (rather than subjective experience); (4) had available information on the instrument content and measurement properties; (5) were designed for adults; and (6) were applicable for all disabled populations. DATA EXTRACTION: Instruments were obtained from identified full-text articles, reference lists, or websites. Two researchers independently reviewed each selected instrument to determine which of their items measure community participation. These items were then classified using 9 community participation domains from the International Classification of Functioning, Disability and Health to reflect each instrument's domain coverage. DATA SYNTHESIS: Seventeen instruments were identified as containing community participation items, 2 of which were 100% composed of community participation items. The rest of the instruments included 8.7% to 73.1% items measuring community participation. The domain coverage varied from 3 to 8 domains across the instruments. CONCLUSIONS: None of the 17 instruments covered the full breadth of community participation domains, but each addressed community participation to some extent. New instruments that evaluate community participation more comprehensively will be needed in the future.

Readiness-to-change cluster profiles among adults with mental illness who were homeless participating in a life skills intervention.

This longitudinal study examined differences in intervention outcomes based on readiness-to-change cluster profiles among 73 adults with a mental illness at risk for homelessness participating in a manualized life skills intervention. Intervention topics included money management, food management, safe community participation, and room- and self-care. Life skill knowledge and readiness-to-change, measured using the University of Rhode Island Change Assessment, was examined at baseline, post-intervention, and 3-6 months later. Two scoring patterns emerged for readiness-to-change at each time point: Pre-Engaged and Engaged. Participants who were Engaged at the time of assessment scored significantly better than Pre-Engaged on post-intervention life skill testing, however group identification changed over time. Baseline readiness-to-change did not predict future performance or attrition, and therefore may not provide accurate indication of client investment for future learning or participation. Further investigation is needed to determine what factors contribute to Engaged membership.

Cognitive predictors of life skill intervention outcomes for adults with mental illness at risk for homelessness.

OBJECTIVE: We investigated the effectiveness of a life skills intervention for people with mental illness who have been homeless. METHOD: In this longitudinal outcomes study, we used Situated Learning Theory (Lave & Wenger, 1991) to provide group and individual sessions to 38 participants from two housing programs after completing baseline Allen Cognitive Level Screen-2000 (ACLS-2000; Allen Conferences, 2000) and Practical Skills Tests (PSTs). Data were analyzed using linear mixed-effects regression models. RESULTS: The PST scores of participants with higher ACLS-2000 scores significantly increased over time (food management, p = .021; money management, p = .039; safe community participation, p = .02). Participants with lower ACLS-2000 scores demonstrated an even greater change over time. CONCLUSION: Most participants, including those with lower ACLS-2000 scores, improved and retained life skills knowledge over time, challenging the premise that people with mental illness should be excluded from mixed-level group interventions.

Trauma symptoms of individuals with mental illness at risk for homelessness participating in a life skills intervention.

This study investigated 1) trauma symptom changes following the implementation of a life skills intervention; 2) the relationship between demographic characteristics, cognitive functioning, life skill knowledge and changes in trauma symptoms; and 3) predictive factors of trauma symptoms during housing transitions. Participants (N=72) enrolled in intervention modules to increase residential stability (room and self-care, money management, nutrition management or safe community participation), completed the Impact of Event Scale-Revised, ACLS-2000 and a Practical Skills Test at baseline, post-intervention and 3 and 6 months later to examine differences in trauma symptoms and treatment outcomes. Trauma symptoms were highest at baseline and decreased significantly for most participants over time. For a subgroup of females experiencing abuse and individuals who were homeless less than 1 year, there was an increase in symptoms at 3 months post-intervention (highest rate of housing transition). This small convenience sample represents a limited geographic area. Replication of the study with larger groups for generalization, and further investigation into the specific impact of symptoms on function were recommended for future research.

Mental health disorders and functioning of women in domestic violence shelters.

This study investigates the presence of mental health symptoms and disorders reported by 74 women in a domestic violence shelter and the impact of those symptoms on function in work, school, and social encounters. Findings are compared to estimates of U.S. women generally, based on a national sample of over 65,000 women drawn from the 1995 National Health Interview Survey. The sheltered sample presents significantly higher rates of mental conditions and functional impairments affecting their work, school, and social functioning. These women are also less educated and poorer and use more health services than the U.S. population. Mental health conditions must be identified in shelters to improve functioning and facilitate independence from abusers.

Outcomes of a life skills intervention for homeless adults with mental illness.

A manualized life skills intervention based on empowerment theory and situated learning was tested on 51 homeless adults with mental illness living in emergency or single room occupancy housing. The intervention improved skills in food, money, room, and self-care management and safe community participation. Participation included baseline measures with intervention post-tests and three and six month follow up measures. Comparisons were made to examine effectiveness between modules. There were significant improvements over time for the room and self-care and safe community participation modules, whereas the other modules did not reach statistical significance. The results suggest that through intervention this population may develop and retain the life skills needed to maintain residential stability.

Occupational identity, occupational competence and occupational settings (environment): influences on return to work in men living with HIV/AIDS.

AIMS: The aim of this study was to examine and describe the relationship between the efforts of twelve men living with AIDS to reestablish a worker role following completion of a vocational rehabilitation program and changes in their occupational identity, occupational competence and perception of occupational settings (environment). METHODS: A series of in-depth interviews were conducted, transcribed and analyzed via categorical content analysis using sections of the text as the unit of analysis. FINDINGS: Findings illustrate how constructs measured by the sub-scales of the OPHI-II may be helpful in understanding how persons frame past, present and anticipated experiences as they attempt to reestablish a life role lost after the onset of disability. The findings are supported by the quantitative item hierarchies of the occupational identity, occupational competence and occupational settings (environment) scales established in earlier quantitative research via Rasch analysis. CONCLUSION: The constructs of occupational identity, occupational competence and occupational settings (environment) are useful constructs to aid in understanding the experiences and narratives of persons attempting to reenter a major life role.

Worker role identity development of women with disabilities who experience domestic violence.

This two-year longitudinal qualitative study explored worker role identity development of seven women with disabilities who experienced domestic violence. Yearly semi-structured interviews and monthly follow up calls elucidated the meaning of work in women's lives and the development of role identity during transitions from shelters to the community. Participants aged 26-47, were from two domestic violence shelters and an independent living center in the Midwestern United States. Data analyses, using constant comparative methods, a peer team and member checking, revealed that women's work roles remained in a state of identity diffusion. Identity diffusion in the worker role was delineated into three themes: role ambivalence, impact of disability, and relationship of the worker role to other roles. Study findings suggest a conflict between staff urgency to support women's return to work and economic self-sufficiency, and women's readiness to assume stronger work identities.

Improving services for lesbian clients: what do domestic violence agencies need to do?

In her 2004 master's thesis Simpson identified that lesbian victims of domestic violence who are seeking services face systemic, institutional, and individual barriers. For this qualitative study, building on that work, we used in-depth interviews with six staff members who represented both a traditional domestic violence agency and a lesbian social service agency providing domestic violence services. The interviews revealed policy changes that might be made: institutional inclusion, assessment of language and literature, training and supervision, and institutional evaluation and quality assurance. These changes may improve the experiences of lesbian victims who are seeking services from domestic violence agencies. Each change, with specific examples provided, is discussed.

Homeless youth: causes, consequences and the role of occupational therapy.

SUMMARY This paper reviews the current literature on youth homelessness in the United States and the role of occupational therapy with this population. Youth homelessness is increasing with many youths becoming homeless due to a myriad of causes such as abusive situations in their homes and decreases in affordable housing. Definitions, causes, physical and mental health consequences and the impact of homelessness on youths' development into adult roles are discussed. The role of occupational therapy is described with a focus on useful assessments and intervention principles. Finally, a case study is presented to illustrate the use of these assessments and occupational therapy intervention with a female youth living in an emergency shelter.