Performance of Medication Tasks: Relationship Among Patient-Reported Outcomes, Performance-Based Assessments, and Objective Assessments.

IMPORTANCE: Occupational therapy practitioners use standardized assessments to guide their clinical decision-making, but it is unclear how well performance on standardized assessments translates to performance at home. OBJECTIVE: To understand the concurrent and predictive validity of patient-reported outcomes and performance-based assessments for monitoring performance at home within the context of medication management and adherence. DESIGN: Exploratory study. SETTING: Participants completed standardized assessments in a lab or at home, which were followed by home-based electronic monitoring of medication adherence. PARTICIPANTS: Sixty community-dwelling adults with hypertension or stroke who independently took antihypertensive medications. OUTCOMES AND MEASURES: Participants completed the Hill-Bone Medication Adherence Scale, the Hill-Bone Medication Adherence Reasons Scale, the Performance Assessment of Self-Care Skills Medication Management subtask, and the Executive Function Performance Test-Enhanced Medication Management subtest. Then, they used an electronic pill cap to monitor medication adherence at home for 1 month. RESULTS: Patient-reported outcomes and performance-based assessments in the context of medication management and adherence demonstrated poor concurrent and predictive validity to medication adherence at home. CONCLUSIONS AND RELEVANCE: There is a gap between what people think they will do, what they can do on a standardized assessment, and what they actually do at home. Future research is needed to strengthen concurrent and predictive validity to clinically meaningful outcomes. Plain-Language Summary: Occupational therapy practitioners should use caution when using standardized assessments to try to predict client performance at home. They should also continue to use a battery of assessments, clinical reasoning, and client preferences to guide their decision-making for monitoring performance at home within the context of medication management and adherence.

MeTooOT: Sexual Harassment Experiences of Occupational Therapy Academics and Recommendations for Systemic Change.

Sexual harassment is pervasive in academic health fields. Although a predominantly female profession, early career academics and trainees in occupational therapy (OT) remain vulnerable to sexual harassment. We aimed to describe experiences of sexual harassment of female-identifying academic OT practitioners. We conducted surveys and interviews using Interpretive Phenomenological Analysis to examine participants' experiences. Ten participants completed the survey and/or interview. Experiences ranged from inappropriate comments to persistent sexual assault. Four themes (blurred lines, unbalanced consequences, "how did I get here?" and "we don't talk about it") were generated based on participant responses. Power dynamics and the cultures and values of the OT profession were underlying elements of all themes. The consequences of sexual harassment were severe and affected personal and professional growth. For OT research and education to thrive, stronger support for victims and consistent, appropriate consequences for perpetrators are necessary to minimize negative outcomes for victims.

Effect of Occupational Therapy in Promoting Medication Adherence in Primary Care: A Randomized Controlled Trial.

IMPORTANCE: The Integrative Medication Self-Management Intervention (IMedS) is a manualized occupational therapy intervention designed to improve adherence to medications. The intervention influences medication adherence and facilitates new medication habits and routines; however, it has not been tested in a community clinical setting. OBJECTIVE: To test the efficacy of the IMedS to address medication adherence rates among community-dwelling adults with hypertension (HTN), Type 2 diabetes mellitus (T2DM), or both. DESIGN: Randomized controlled trial using a pretest-posttest control group design. SETTING: Primary care clinic in a large federally qualified health center. PARTICIPANTS: Adults with uncontrolled HTN, T2DM, or both. INTERVENTION: Participants were divided into two groups: The control group received treatment as usual (TAU) per the primary care protocol, and the intervention IMedS group received TAU and the IMedS intervention. OUTCOMES AND MEASURES: Primary outcome: seven-item version of the Adherence to Refills and Medication Scale (ARMS-7), pill count, blood pressure, hemoglobin A1c, or all of these. RESULTS: The proportion of adherent participants increased in both groups, but between groups, changes were not statistically significant. Post hoc comparisons of the results of a mixed analysis of variance for ARMS-7 measurements indicated that the occupational therapy intervention had a unique effect, compared with that for the TAU control group (dc = 0.65). Effect scores for pill count (d = 0.55) also suggested that the occupational therapy intervention positively affected adherence. CONCLUSIONS AND RELEVANCE: Occupational therapists can provide assessment and intervention to positively influence medication adherence in a primary care setting. What This Article Adds: This article provides a better understanding of the occupational therapist's role in addressing medication management and adherence on the interdisciplinary primary care medical team.

Feasibility of Customized Pillboxes to Enhance Medication Adherence: A Randomized Controlled Trial.

OBJECTIVE: To test the (1) feasibility of an assistive technology based pillbox intervention on medication adherence; (2) feasibility of trial procedures; and (3) preliminary effectiveness of the pillbox intervention on medication adherence. DESIGN: A single-blinded randomized controlled clinical trial was conducted during 2-4 weeks. SETTING: Researchers recruited a convenience sample to participate in this university laboratory-based study. PARTICIPANTS: English-speaking consumers of 2 or more daily medications (N=15) participated in the study. Individuals with cognitive impairment or who did not manage their own medications were excluded. INTERVENTIONS: Participants were randomized to 1 of 3 pillbox interventions: (1) standard-of-care pillbox; (2) customized off-the-shelf pillbox; or (3) customized 3-dimensional (3D) printed pillbox. MAIN OUTCOME MEASURES: Outcome measures were divided among the 3 goals of the study. In addition to feasibility metrics, the Adherence to Refills and Medications Scale was used to measure the primary outcome measure, medication adherence. The Quebec User Evaluation of Satisfaction with Assistive Technology was used to measure pillbox satisfaction. RESULTS: Researchers successfully administered 6 standard-of-care, 5 custom off-the-shelf, and 4 custom 3D printed pillboxes. Compared with the standard-of-care pillboxes, customized 3D printed pillboxes had large (d=1.04) and customized off-the-shelf pillboxes had medium (d=0.67) effects on medication adherence. CONCLUSIONS: Prescription of customized pillboxes using a manualized and novel assistive technology approach that leverages 3D printing is feasible.

Inclusion of People with Disabilities in Research to Improve Medication Adherence: A Systematic Review.

People with disabilities have high rates of chronic health conditions and often require complex medication regimens to manage their health. Approximately 20-50% of people with disabilities fail to take their medication as prescribed. It is unclear, however, to what extent the literature describes the effectiveness of medication adherence interventions for people with disabilities. In this review, the inclusion and exclusion criteria of the 182 studies included in the Cochrane Review on Interventions for Enhancing Medication Adherence were evaluated for their inclusion of people with disabilities. Of the studies, 1% excluded persons for hearing impairment, 3% for motor impairment, 7% for visual impairment, and 32% for cognitive impairment. Most studies (65%) did not exclude persons based on specific impairment. Medication event monitoring systems were used in 21% of studies, and investigators excluded people unable to use this device in 5% of studies. Caregiver assistance was an exclusion criteria in 4% of studies. Additional barriers like the ability of investigators to exclude persons based on their judgement were found. These barriers exist in addition to the known barriers affecting persons with disabilities, such as accessibility of research facilities and access to transportation. These data suggest that people with disabilities are systemically excluded from the medication adherence intervention literature. Subsequently, it cannot be assumed that current adherence interventions are effective for people with disabilities. More research is needed to understand how to address medication adherence for people with disabilities.

Methodology and feasibility of a 3D printed assistive technology intervention.

Three-dimensional (3D) printing now allows rehabilitation professionals to design and manufacture assistive technologies in a few hours. However, there is limited guidance for researchers and clinicians for implementing 3D printing assistive technology interventions and measuring their outcomes. The goal of this study was to develop a standardized 3D printing assistive technology intervention and a research methodology, using pillboxes as an example. Fourteen pillbox users engaged in a study comparing their use of an off-the-shelf pillbox to a customized 3D printed pillbox. Study outcomes were evaluated on feasibility (recruitment capability, study procedures and outcome measures, acceptability of the study procedures, the research team's ability to manage and implement the study, and the participant's preliminary response to intervention). Participant outcomes were measured on satisfaction with the device and medication adherence. Fourteen participants completed the study and received customized 3D printed pillboxes. The study design performed well on all aspects of feasibility except the research team's ability to manage and implement the study, as they experienced several technical issues. Notably, the participants reported improved device satisfaction and medication adherence with the 3D printed device with large effect sizes. The 3D printed assistive technology intervention is a replicable process that supports professionals in printing their own assistive technologies. Recommendations are made to further enhance feasibility of 3D printing assistive technology studies. Future research is warranted.IMPLICATIONS FOR REHABILITATION3D printing is an increasingly feasible approach allowing for the design and manufacture of customized assistive technologyEvaluation for assistive technology that will be 3D printed should include information about the person's activities, routines, skills, abilities, and preferences. Evaluation of outcomes should include satisfaction with the device and a functional measure.3D printed assistive technology interventions should include the collaboration between the assistive technology professional and client. It should also include device training.Future 3D printing research studies should report pragmatic data including printing device, time to print, and number of errors.

Comparison of 2 self-adhesive resin cements with or without a self-etching primer.

Self-adhesive resin cements that eliminate the primer step have been introduced to simplify the bonding protocol for indirect restorations. The aim of the present study was to compare the shear bond strengths (SBSs) of 2 self-adhesive resin cements used with or without a self-etching primer. The hypothesis was that adding a separate primer component to the self-adhesive systems would increase the SBS at the tooth-adhesive interface. One hundred twenty extracted human molars were hemisectioned and embedded in epoxy. Specimens were polished to expose enamel or dentin surfaces and randomly assigned to 12 test groups (n = 20). The tested variables were (1) the type of bonded tissue (enamel or dentin); (2) the cement used; (3) whether the cement was applied with or without a primer; (4) and whether the primer was air dried or photopolymerized. Bonding jigs were used to apply the self-adhesive resin cement to the tooth surfaces. A 2-minute self-cure was followed by 20 seconds of light curing. Specimens were stored in water for 24 hours and then subjected to SBS testing in a universal testing machine. Fractured specimens were examined under a microscope to determine the modes of failure. Mean SBS values were compared using a paired Student t test (with post hoc Tukey test) and an analysis of variance (α = 0.05). Compared to the control groups, the air-dried primer groups showed SBSs that were 4-6 times greater for the specimens bonded to dentin and 2-3 times greater for specimens bonded to enamel. The photopolymerized primer groups followed the same trend. The photopolymerized groups showed higher percentages of cohesive tooth failure than did air-dried primer groups. Placement of a self-etching primer prior to a self-adhesive resin cement significantly increased the SBS to tooth structure of the "all-in-1" resin cements that were tested. Photopolymerizing the primer did not significantly increase the bond strength.

Role of Occupational Therapy Practitioners in Mass Market Technology Research and Development.

Performance of many activities of daily living and instrumental activities of daily living involve technology, such as an electric toothbrush or a self-checkout register at the grocery store. Unfortunately, more than 60 million people with disabilities in the United States struggle to use these technologies because of inaccessible designs. Occupational therapy practitioners have a unique expertise in the design of accessible equipment. Practitioners have been involved in the design of adaptive and assistive equipment targeting use by people with disabilities since occupational therapy's beginnings. However, few occupational therapy professionals currently work in the research and development of everyday technologies. This article explores the role of the occupational therapy practitioner on the technology design team, discusses barriers to current practice, and makes recommendations to the profession.

Lithium continuation therapy following ketamine in patients with treatment resistant unipolar depression: a randomized controlled trial.

The N-methyl-D-aspartate (NMDA) receptor antagonist ketamine is associated with rapid but transient antidepressant effects in patients with treatment resistant unipolar depression (TRD). Based on work suggesting that ketamine and lithium may share overlapping mechanisms of action, we tested lithium compared to placebo as a continuation strategy following ketamine in subjects with TRD. Participants who met all eligibility criteria and showed at least an initial partial response to a single intravenous infusion of ketamine 0.5 mg/kg were randomized under double-blind conditions to lithium or matching placebo before receiving an additional three infusions of ketamine. Subsequent to the ketamine treatments, participants remained on lithium or placebo during a double-blind continuation phase. The primary study outcome was depression severity as measured by the Montgomery-Åsberg Depression Rating Scale compared between the two groups at Study Day 28, which occurred ~2 weeks following the final ketamine of four infusions. Forty-seven participants with TRD were enrolled in the study and underwent an initial ketamine infusion, of whom 34 participants were deemed to have at least a partial antidepressant response and were eligible for randomization. Comparison between treatment with daily oral lithium (n = 18) or matching placebo (n = 16) at the primary outcome showed no difference in depression severity between groups (t32 = 0.11, p = 0.91, 95% CI [-7.87, 8.76]). There was no difference between lithium and placebo in continuing the acute antidepressant response to ketamine. The identification of a safe and effective strategy for preventing depression relapse following an acute course of ketamine treatment remains an important goal for future studies.

Classification of Mild Stroke: A Mapping Review.

Persons with mild stroke experience motor and cognitive impairments that negatively affect their health and quality of life. To address these deficits, it is essential for clinicians and researchers to precisely identify mild stroke survivors. Despite the fact that half of all strokes are categorized as mild, no standards exist on what constitutes a "mild" stroke. The purpose of this study is to summarize the current classification of mild stroke using a mapping review approach. Strategies to categorize "mild stroke" severity were explored in 188 papers indexed in the PubMed database. The results indicate that there was substantial variability in the procedures and scoring criteria used to determine mild stroke. To identify persons with mild stroke, researchers have largely applied assessment instruments developed to inform acute stroke care (eg, National Institutes of Health Stroke Scale, Modified Rankin Scale, Barthel Index). Unfortunately, these approaches demonstrate floor effects and fail to detect the long-term disabling impairments that often limit the outcomes of mild stroke survivors. Additional research is warranted to suggest an evidence-based mild stroke categorization strategy that enhances diagnosis, treatment, and referral decisions to the benefit of mild stroke survivors.

Resting-state functional connectivity and inflexibility of daily emotions in major depression.

BACKGROUND: Major Depressive Disorder (MDD) is characterized by aberrant resting-state functional connectivity (FC) in anterior cingulate regions (e.g., subgenual anterior cingulate [sgACC]) and by negative emotional functioning that is inflexible or resistant to change. METHODS: MDD (N = 33) and control (CTL; N = 31) adults completed a resting-state scan, followed by a smartphone-based Experience Sampling Methodology (ESM) protocol surveying 10 positive and negative emotions 5 times per day for 21 days. We used multilevel modeling to assess moment-to-moment emotional inflexibility (i.e., strong temporal connections between emotions). We examined group differences in whole-brain FC analysis of bilateral sgACC, and then examined associations between emotional experiences and the extracted FC values within each group. RESULTS: As predicted, MDDs had inflexibility in sadness and avoidance (p < .001, FDR-corrected p < .05), indicating that these emotional experiences persist in depression. MDDs showed weaker FC between the right sgACC and pregenual/dorsal anterior cingulate (pg/dACC) than did CTLs (FWE-corrected, voxelwise p = .01). Importantly, sgACC-pg/dACC FC predicted sadness inflexibility in both MDDs (p = .046) and CTLs (p = .033), suggesting that sgACC FC is associated with day-to-day negative emotions. LIMITATIONS: Other maladaptive behaviors likely also affect the flexibility of negative emotions. We cannot generalize our finding of a positive relation between sgACC FC and inflexibility of sadness to individuals with more chronic depression or who have recovered from depression. CONCLUSIONS: Our preliminary findings suggest that connections between portions of the ACC contribute to the persistence of negative emotions and are important in identifying a brain mechanism that may underlie the maintenance of sadness in daily life.

An Exploratory Survey of Physical Rehabilitation Occupational Therapy Practice Patterns.

A computer-assisted survey was developed and administered to 66 occupational therapists working in adult physical rehabilitation to explore how and to what extent occupational therapists evaluate and treat medication management impairments. Approximately 90% of the sample evaluate and treat medication management, but only about 25% addressed medication management on a consistent basis. This suggests that current medication management service provision levels may be insufficient to meet clients' needs. Research is warranted to understand and improve occupational therapists' abilities to address medication management in practice.

Longitudinal decreases in suicidal ideation are associated with increases in salience network coherence in depressed adolescents.

BACKGROUND: Suicidal ideation (SI) is an important predictor of suicide attempt, yet SI is difficult to predict. Given that SI begins in adolescence when brain networks are maturing, it is important to understand associations between network functioning and changes in severity of SI. METHODS: Thirty-three depressed adolescents were administered the Columbia-Suicide Severity Rating Scale to assess SI and completed resting-state fMRI at baseline (T1) and 6 months later (T2). We computed coherence in the executive control (ECN), default mode (DMN), salience (SN), and non-relevant noise networks and then examined the association between changes in brain network coherence and changes in SI severity from T1 to T2. RESULTS: A greater reduction in severity of SI was associated with a stronger increase in SN coherence from T1 to T2. There were no associations between the other networks and SI. LIMITATIONS: We cannot generalize our findings to more psychiatrically diverse samples. More time-points are necessary to understand the trajectory of SI and SN coherence change. CONCLUSIONS: Our finding that reductions in SI are associated with increases in SN coherence extends previous cross-sectional results documenting a negative association between SI severity and SN coherence. The SN is involved in coordinating activation of ECN and DMN in response to salient information. Given this regulatory role of the SN, the association between SN coherence and SI suggests that adolescents with reduced SN coherence might more easily engage in harmful thoughts. Thus, the SN may be particularly relevant as a target for treatment applications in depressed adolescents.