Meaningful Engagement as a Predictor of Psychological Well-Being for Adults With Low Income.

IMPORTANCE: The activities that people engage in influence their well-being. Adults with low income have limited resources, which can affect their engagement in meaningful activities. Exploring the connection between meaningful engagement and well-being is an important step in providing occupational justice for this marginalized population. OBJECTIVE: To examine whether engagement in meaningful activities uniquely contributes to well-being for adults with low income after controlling for demographic variables. DESIGN: Cross-sectional exploratory study design. SETTING: Community agencies serving adults with low income, a local library, and a university union hall in northwest Ohio. PARTICIPANTS: Adults with low income (N = 186). OUTCOMES AND MEASURES: Participants completed a demographic questionnaire, the Engagement in Meaningful Activities Survey (EMAS), and the World Health Organization-5 Wellbeing Index (WHO-5). We examined the influence of demographics and EMAS on the WHO-5. RESULTS: We identified a moderate correlation between the EMAS and WHO-5 (r = .52, p ≤ .05). Linear regression revealed an R2 = .27, F(7, 164) = 8.75, p < .001, with the EMAS and participant attributes as predictor variables. The R2 changed to .02 (p = .85) without the EMAS in the model. CONCLUSIONS AND RELEVANCE: Findings support the need for and use of meaningful activities to support well-being and health for adults with low income. What This Article Adds: Findings build on the evidence supporting the role of engagement in meaningful activities by drawing connections to a well-known and widely used measure of subjective psychological well-being and applying these connections to adults with low income. Occupational therapy practitioners can use measures such as the EMAS to strategically infuse aspects of meaning that promote engagement and foster well-being.

An Internet-Based Self-Management Intervention to Reduce Fatigue Among People With Traumatic Brain Injury: A Pilot Randomized Controlled Trial.

IMPORTANCE: Fatigue is a chronic and distressing sequela of traumatic brain injury (TBI). Little evidence exists for the efficacy of interventions that address post-TBI fatigue. OBJECTIVE: To evaluate the preliminary efficacy of a self-management intervention (Maximizing Energy; MAX) for reducing the impact (primary outcome) and severity of fatigue on daily life, improving fatigue experience, and increasing participation compared with a health education (HE) intervention. DESIGN: Pilot randomized controlled trial (RCT). SETTING: Community. PARTICIPANTS: Forty-one participants randomly assigned to the MAX (n = 20) or HE (n = 21) intervention. INTERVENTIONS: The MAX intervention included problem-solving therapy with energy conservation education to teach participants fatigue management. The HE intervention included diet, exercise, and energy conservation education. Both interventions (30 min/day, 2 days/wk for 8 wk) were delivered online by occupational therapists. OUTCOME AND MEASURES: The primary outcome was the modified Fatigue Impact Scale (mFIS). Outcome measures were collected at baseline, postintervention, and 4- and 8-wk postintervention. RESULTS: At 8 wk postintervention, participants in the MAX group reported significantly lower levels of fatigue impact (mFIS) than those in the HE group, F(1, 107) = 29.54, p = .01; Cohen's d = 0.87; 95% confidence interval [0.18, 1.55]. CONCLUSIONS AND RELEVANCE: These findings provide preliminary evidence that the MAX intervention may decrease the impact of fatigue on daily life among people with post-TBI fatigue. What This Article Adds: An internet-based, self-management intervention combining occupational therapy- delivered energy conservation education with cognitive-behavioral therapy seems to reduce fatigue impact and severity among people with post-TBI fatigue. Future appropriately powered RCTs could positively contribute to the evidence available to occupational therapy practitioners for this chronic, debilitating, and often overlooked symptom.

Promoting Routines of Exploration and Play during Mealtime: Estimated Effects and Identified Barriers.

Promoting Routines of Exploration and Play during Mealtime (Mealtime PREP) is an intervention designed to support healthy dietary variety in children. To estimate the effects of this intervention, we recruited 20 parents and children (aged 1-5 years) with sensory food aversions to participate in a pilot study. Parents were coached to enhance daily child meals using Mealtime PREP. Our primary outcome was acceptance of targeted food (number of bites) over time. Descriptive statistics and effect sizes are reported. Moderate effects were observed for acceptance of targeted food. Mealtime PREP warrants additional research to examine effects in larger, more diverse samples.

Behavioral Activation Approach to Parent Training: Feasibility of Promoting Routines of Exploration and Play During Mealtime (Mealtime PREP).

OBJECTIVE: Systematic approaches are needed to help parents with young children adopt healthy routines. This study examined the feasibility (home data collection, protocol adherence, intervention acceptance) of using a behavioral activation (BA) approach to train parents of children with sensory food aversions. METHOD: Parents of young children (18-36 mo) were trained using the novel Promoting Routines of Exploration and Play During Mealtime intervention. Measures included video-recorded meals, Fidelity Checklist, Treatment Acceptability Questionnaire, and Behavioral Pediatrics Feeding Assessment Scale. Descriptive statistics were used. RESULTS: Eleven children and their parents completed the study. Two of three feasibility benchmarks were met. Intervention acceptance was high (mean score = 43/48). On average, parents used three more intervention strategies after training than at baseline. CONCLUSION: Using a BA approach to parent training shows promise for altering daily mealtime routines. Delivering this intervention in the home is feasible and received acceptable ratings among this sample.

Feasibility of a Cognitive Behavioral Intervention to Manage Fatigue in Individuals With Traumatic Brain Injury: A Pilot Study.

OBJECTIVE: To evaluate the feasibility of conducting a randomized clinical trial of an Internet-based manualized intervention to teach individuals with traumatic brain injury to manage their fatigue. SETTING: Community dwelling. PARTICIPANTS: Forty-one participants randomized to Maximizing Energy (MAX) intervention group (n = 20) and Health Education group (n = 21). INTERVENTION: The experimental group (MAX intervention) received an 8-week program that combined education and Problem-Solving Therapy to teach individuals to manage fatigue-related problems. The attention control group received health education. MEASURES: Primary outcome measures pertained to the feasibility of conducting the trial. Secondary outcomes were fatigue impact and fatigue severity assessed at baseline and postintervention. RESULTS: Of the 65 participants referred, 41 were enrolled (63% recruitment rate), of which 3 withdrew (92% retention rate). Participants in the experimental and control groups completed their homework 75% and 85% of the time, respectively, and were equally engaged in the sessions. Participants in the experimental group were able to learn and implement the MAX intervention steps. Effect sizes for all measures ranged from small (-0.17) to medium (-0.58) in favor of the intervention group. CONCLUSION: Findings from the study suggest that the MAX intervention is feasible to administer to individuals with post-traumatic brain injury fatigue.

Wheelchair Transfer Simulations to Enhance Procedural Skills and Clinical Reasoning.

OBJECTIVE: We describe an educational intervention that involved simulation scenarios of medically complex patients to teach transfer training and promote clinical reasoning. METHOD: Scenarios were developed with practitioner input that described (1) a patient who was acutely ill, (2) a critical medical management event that occurred during a bed-to-wheelchair transfer of the patient, and (3) an occupational need. Transfer training, using the scenarios, occurred in a high-technology laboratory with SimMan(®) and a mock hospital suite. Evaluation was based on student performance and perceptions of simulation effectiveness. RESULTS: On average, students completed 66%-88% of the transfer items correctly. Student performance suggested that the simulation scenarios were more difficult than practitioners rated them. Students rated the simulation scenarios as effective teaching tools. CONCLUSION: Scenario use in simulations for transfer training makes a positive curricular contribution to teaching procedural skills and clinical reasoning simultaneously.

Simulation Strategies to Teach Patient Transfers: Self-Efficacy by Strategy.

OBJECTIVE: We evaluated the effects of transfer training-after training in the classroom and in the high-technology simulation laboratory (WISER Center)-on students' perceptions of their self-efficacy for knowledge, skill, and safety in executing dependent transfers. METHOD: After classroom training, occupational therapy students were randomized to three teaching groups on the basis of the amount of participation and observation opportunities provided at the WISER Center-observation dominant, participation dominant, and participation only. RESULTS: The participation-dominant group reported an increase in knowledge self-efficacy over time compared with the observation-dominant and participation-only groups. Over time, self-efficacy ratings increased for all students, regardless of group. CONCLUSION: Simulation scenarios implemented at the WISER Center provided a useful adjunct to classroom training in transfer skills. Both participatory and observational experiences contributed to the development of students' perceptions of their ability to manage acutely ill and medically complex patients.

Activities and adaptation in late-life depression: a qualitative study.

OBJECTIVE. We sought to understand activity choices of older adults when they were depressed. METHOD. Each community-dwelling participant (n = 27) completed one semistructured interview while in recovery for at least 3 mo. but less than 7 mo. Transcripts were coded to identify relevant themes. RESULTS. Six themes emerged that explained activities participants continued while depressed, and four themes described activities they stopped. CONCLUSION. Older adults maintained many instrumental activities of daily living while depressed, and some actively adapted activities so they could continue them. Some intentionally stopped activities to direct limited energy to their highest priority activities. To guide effective intervention, it is critical for occupational therapy practitioners to complete a client-centered qualitative assessment to understand what and, most important, why activities are continued or stopped. Each theme for activities continued and activities stopped lends itself to intervention strategies.

Examining the Relationship Between Meaningful Engagement and Well-Being Across Men and Women.

While engagement in meaningful activities is associated with well-being, the influence of gender on this relationship is unknown. The study aims to (a) examine the difference between meaningful engagement and well-being for individuals who identify as men and women and (b) explore the association between engagement and well-being in men and women. In this observational study, 256 community-dwelling individuals completed meaningful engagement and well-being measures. Between-group t tests indicated no significant differences between men and women for engagement (t = 0.595, p = .552) and well-being (t = 0.818, p = .414). There were fair, positive correlations (rs = .376; p < .01) between engagement and well-being for men and moderate positive correlations (rs = .567; p < .01) between engagement and well-being for women. Self-identified gender may influence the relationship between engagement in meaningful activities and the sense of well-being it provides.

Exploring Similarities and Differences in How Meaningful Activities Influence Well-being for Males and FemalesThe study examines the similarities and differences between meaningful engagement and well-being for males and females. Community-dwelling adults completed a demographic questionnaire, the Engagement in Meaningful Activities Survey (EMAS), and the World Health Organization­5 Well-being Index (WHO-5). A total of 256 people participated. There were no differences in the extent of meaningful engagement or well-being between males and females. However, females demonstrated a stronger relationship between engaging in meaningful activities and increased well-being. This indicates that females are more likely to improve their well-being by engaging in activities they find meaningful than males. Cultural and personal stereotypes influence what is considered meaningful and can consequently impact how meaningful engagement connects to well-being. Gender stereotypes are influential on cultural and personal levels and could be influencing the meaning males and females experience during engagement in certain activities. Increasing our understanding of the meaning people experience during everyday tasks can help inform occupational therapy interventions and enhance well-being as an outcome of therapy. More research is needed to further establish the reliability of validity of the EMAS in varied populations. In addition, future research should expand participant options for gender identity rather than restricting it to two choices (male, female).

Unique contribution of fatigue to disability in community-dwelling adults with traumatic brain injury.

OBJECTIVE: To examine the unique contribution of fatigue to self-reported disability in community-dwelling adults with traumatic brain injury (TBI). DESIGN: A cross-sectional cohort design. SETTING: Community dwellings. PARTICIPANTS: Adults (N=50) with a history of mild to severe TBI were assessed. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: This study assessed the contribution of fatigue (Modified Fatigue Impact Scale) to disability (Mayo-Portland Adaptability Inventory), controlling for executive functions (Frontal Systems Behavior Scale), depression status (major depression in partial remission/current major depression/depressive symptoms or no history of depression), and initial injury severity (uncomplicated mild, complicated mild, moderate, or severe). RESULTS: Fatigue was found to contribute uniquely to the variance in self-reported disability (ß=.47, P<.001) after controlling for injury severity, executive functions, and depression status. The overall model was significant (F(4,45)=17.32, P<.001) and explained 61% of the variance in self-reported disability, with fatigue alone accounting for 12% of the variance in self-reported disability (F(1,45)=13.97, P<.001). CONCLUSIONS: Fatigue contributes uniquely to disability status among community-dwelling adults with chronic TBI, independent of injury severity, executive functions, and depression. Addressing fatigue through targeted interventions may help to improve self-perceived disability in this population.

A Scoping Review on Work Experiences of Nurses After Being Diagnosed With Cancer.

PROBLEM IDENTIFICATION: To map key concepts underpinning work-related studies about nurses with cancer and identify knowledge gaps. LITERATURE REVIEW: A search was conducted in the PubMed®, CINAHL®, and PsycINFO® databases for articles about nurses with cancer and work-related topics published through March 2023. DATA EVALUATION: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist was used to report results, and the JBI critical appraisal tools were used to assess the quality of studies. Eleven articles were included. SYNTHESIS: The following four critical concepts were identified: role adjustments at work, cancer impacts on work, organizational support, and translating insights gained from cancer experience into work. Research gaps identified by the scoping review were a lack of theoretical or conceptual frameworks, lack of syntheses of main ideas, and lack of clear data about participants' socioeconomic status across studies. IMPLICATIONS FOR RESEARCH: Minimal research exists to map predictors, outcomes, or intervention targets to guide organizational strategies to support nurses' retention in the nursing workforce. A guiding framework, recruitment of diverse nurses, and focus on the four critical concepts identified in this scoping review are suggested for future research.

Outcomes of a multicomponent physical activity program for sedentary, community-dwelling older adults.

This single-group repeated-measures pilot study evaluated the effects of a 10-wk, multicomponent, best-practice exercise program on physical activity, performance of activities of daily living (ADLs), physical performance, and depression in community-dwelling older adults from low-income households (N = 15). Comparison of pretest and posttest scores using a one-tailed paired-samples t test showed improvement (p < .05) for 2 of 3 ADL domains on the Activity Measure-Post Acute Care and for 6 physical-performance measures of the Senior Fitness Test. Repeated-measures ANOVA revealed significant main effects for 3 of 8 physical activity measures using the Yale Physical Activity Scale. Retention rate was 78.9%, and the adherence rate for group sessions was 89.7%. Results suggest that participation in a multicomponent, best-practice physical activity program may positively affect sedentary, community-dwelling older adults' physical activity, ADL performance, and physical performance.

Disability in late-life major depression: patterns of self-reported task abilities, task habits, and observed task performance.

This article describes patterns of concordance/discordance between self-reported abilities ("can do") and habits ("does do") and observed task performance of daily living tasks in three groups of older adults: late life depression with mild cognitive impairment (n=53), late life depression without mild cognitive impairment (n=64), and non-depressed, cognitively normal controls (n=31). Self-reported data were gathered by interview in participants' homes, followed by observation of task performance. Significant differences in the patterns of response were found between controls and respondents with both late life depression and mild cognitive impairment for the cognitive instrumental activities, and between the two depressed groups and controls for the physical instrumental activities. For both sets of activities, controls exhibited the greatest overestimation of task performance. No differences were found among the groups for the less complex functional mobility and personal care tasks. However, for the more complex instrumental activities, concordance was close to, or less than, chance. The findings led us to conclude that when performance testing is not feasible, self-reports of functional status that focus on habits may be more accurate than those that focus on abilities.

Patterns of mild cognitive impairment after treatment of depression in the elderly.

OBJECTIVES: Late-life depression (LLD) is associated with persistent cognitive impairment in a subset of individuals. The purpose of this study was to 1) examine the frequency and characteristics of cognitive diagnoses (Mild Cognitive Impairment [MCI], dementia) among remitted elderly depressed subjects and 2) to compare the prevalence rate and correlates of cognitive diagnoses with those of comparison subjects. DESIGN: Crosssectional. SETTING: Outpatient geriatric mental health clinic. PARTICIPANTS: The authors examined cognitive diagnoses among 109 subjects age 65 and older, after depression treatment response and 65 never-depressed, age- and education-equated comparison subjects. MEASUREMENTS: Cognitive diagnoses were independently established by the University of Pittsburgh's Alzheimer's Disease Research Center. Bivariate and multivariate analyses were conducted to examine the role of specific risk factors for cognitive diagnosis among depressed subjects. RESULTS: Relative to comparison subjects, nearly twice as many depressed subjects were diagnosed with MCI or dementia (48% versus 28%). Of the 109 depressed subjects, 38% were diagnosed with MCI (63% amnestic, 37% nonamnestic). The majority of amnestic MCI subjects (85%) had the multiple domain subtype. Age, but not age of onset or lifetime depression duration, predicted cognitive diagnosis. CONCLUSIONS: Despite adequate depression treatment response, 48% of remitted depressed subjects had a cognitive diagnosis. Of the 38% diagnosed with MCI, there was high representation among both the amnestic and the nonamnestic subtypes, suggesting heterogeneity in cognitive course and outcomes in LLD.

Neurological and functional status following cardiac arrest: method and tool utility.

INTRODUCTION: Assessing the neurological and disability status of cardiac arrest (CA) survivors is important for evaluating the outcomes of resuscitation interventions. The Cerebral Performance Category (CPC)--the standard outcome measurement after CA--has been criticized for its poorly defined, subjective criteria, lack of information regarding its psychometric properties, and poor relationships with long-term measures of disability and quality of life (QOL). This study examined the relationships among the CPC and measures of global disability and QOL at discharge from the hospital and at 1 month after CA. METHODS: Twenty-one CA survivors participated in the study. A medical chart review was conducted at the time of discharge to determine CPC and Modified Rankin Scale (mRS) scores, while 1-month in-person interview was conducted to collect mRS and Health Utilities Index Mark 3 (HUI3) scores. Data collected during the interview were used to determine follow-up CPC scores. RESULTS: The strength of relationships among measures at discharge and 1 month ranged between fair to good. An examination of scatter plots revealed substantial variability and a wide distribution of chart review and 1-month mRS and HUI3 scores within each CPC category. CPC scores obtained through chart review were significantly better than the CPC 1-month scores, thus overestimating the participants' cognitive and disability status 1 month later. CONCLUSION: When compared to disability and quality of life measures, it is apparent that the CPC has limited ability to discriminate between mild and moderate brain injury. The validity of using the chart review method for obtaining scores is questionable.

Influence of the environment on activity performance in older women with heart failure.

PURPOSE: To examine the influence of the environment on activity performance in older women with heart failure living in the community. METHOD: The cross-sectional study included 55 older women with heart failure. Differences in activity performance collected through performance observation in the clinic and home were analysed with repeated measures ANOVAs and paired samples t-tests. RESULTS: Overall, the influence of the environment in the clinic was neutral for activity independence, and disabling for activity safety and activity adequacy at the global level. At the domain level, functional mobility and personal care were more independent but equally safe and adequate in the clinic compared to the home, cognitively-oriented instrumental activities were less independent, safe and adequate in the clinic compared to the home, and physically-oriented instrumental activities were equally independent, but less safe and adequate in the clinic compared to the home. At the activity level, 6 activities were positively influenced by the environment in the clinic and 13 activities were negatively influenced. CONCLUSIONS: Findings suggest that the influence of the environment can be neutral, enabling, or disabling depending on the global scores or level of analysis being considered.

Solving fatigue-related problems with cardiac arrest survivors living in the community.

AIM: The aim was to describe fatigue-related problems reported by post-cardiac arrest adults with chronic fatigue and energy conservation strategies generated using an Energy Conservation plus Problem Solving Therapy intervention. METHODS: Following an introduction to the intervention process outlined in a Participant Workbook, participants engaged in the telephone intervention by identifying one to two fatigue-related problems. They then brainstormed with the interventionist to identify potential strategies to reduce fatigue, tested them, and either modified the strategies or moved to the next problem over three to five sessions. RESULTS: Eighteen cardiac arrest survivors with chronic fatigue identified instrumental activities of daily living and leisure activities as fatigue-related activities more frequently than basic activities of daily living. Energy Conservation strategies used most frequently were: plan ahead, pace yourself, delegate to others, and simplify the task. CONCLUSION: Post-cardiac arrest adults living in the community with chronic fatigue can return to previous daily activities by using energy conservation strategies such as planning ahead, pacing tasks, delegating tasks, and simplifying tasks.

An intervention for cardiac arrest survivors with chronic fatigue: A feasibility study with preliminary outcomes.

AIM: The primary aim was to examine the feasibility of recruiting and retaining participants for an Energy Conservation+Problem Solving Therapy (EC+PST) intervention delivered over the telephone, to evaluate the acceptability of the intervention, and to assess the appropriateness of the outcome measures. The secondary aim was to evaluate the preliminary intervention effect on fatigue impact, activity performance, and participation in daily activities in post-cardiac arrest (CA) adults with chronic fatigue. METHODS: This feasibility study used a prospective, pre-post experimental design. Individuals who were at least 3 months post-CA with moderate-to-severe fatigue were eligible to participate. By participating in EC+PST intervention sessions, participants learned how to apply EC strategies to solve their fatigue-related problems. Participants were assessed before and after completing the intervention using outcome measures assessing fatigue, activity performance, and participation in daily activities. RESULTS: Eighteen CA survivors with chronic fatigue successfully completed the intervention and the assessments with high satisfaction. We observed a 15% recruitment rate and ceiling effects on two outcome measures of perceived-performance in daily activities. Significant decreases in the impact of physical (p=.001) and cognitive (p=.006) fatigue of CA survivors were observed with small to moderate effect sizes of r=0.23-0.25 after receiving the EC+PST intervention. CONCLUSION: The delivery of EC+PST intervention over the telephone is feasible, and the intervention is highly acceptable to CA survivors with chronic fatigue. Also, the EC+PST intervention seems promising in reducing the impact of physical and cognitive fatigue of CA survivors.

Functional Outcomes: One Year after a Cardiac Arrest.

OBJECTIVE: The study aim was to characterize the time-course of recovery in impairments, activity limitations, participation restrictions, disability, and quality of life during the first year after cardiac arrest. Secondarily, the study described the associations between the instruments used to measure each of these domains. METHODS: Measures of global disability (Cerebral Performance Category, CPC, Modified Rankin Scale, mRS), quality of life, activity limitations, participation restrictions, and affective and cognitive impairments were administered to 29 participants 1, 6, and 12 months after cardiac arrest. RESULTS: Global measures of disability indicated recovery between one month and one year after cardiac arrest (mean CPC: 2.1 versus 1.69, P < 0.05; mean mRS: 2.55 versus 1.83, P < 0.05). While global measures of disability were moderately associated with participation, they were poorly associated with other measures. The cohort endorsed depressive symptomatology throughout the year but did not have detectable cognitive impairment. CONCLUSIONS: Recovery from cardiac arrest is multifaceted and recovery continues for months depending upon the measures being used. Measures of global disability, reintegration into the community, and quality of life yield different information. Future clinical trials should include a combination of measures to yield the most complete representation of recovery after cardiac arrest.

Development and validation of the Cerebral Performance Categories-Extended (CPC-E).

BACKGROUND: Optimizing resuscitation efforts after cardiac arrest (CA) requires valid and reliable measurements of functional outcomes. The Cerebral Performance Category (CPC), the historical "gold" standard outcome measure post-CA, lacks psychometric validation. The purpose of this study was to establish the psychometric properties of a revised CPC: the CPC-Extended (CPC-E). METHODS: The study had two phases: We established content validity of the CPC-E by identifying existing domains in the CPC, by adding new domains following a literature review, and iterative input from a panel of CA and rehabilitation experts. We tested the CPC-E's feasibility, intra-rater (IR) reliability and inter-rater reliability (IRR) using retrospective reviews of the electronic medical records (EMR) and "in-person" in-hospital administration. RESULTS: The CPC-E has 10 domains. For both IR and IRR record reviews, 5/10 domains had frequent missing data and in three instances, intraclass correlation coefficients (ICC) could not be calculated. Of the scores that could be calculated, ICC ranged from poor to high (n=30; 0.46-1.0) and poor to high (n=50; -0.16 to 0.93) for IR and IRR, respectively. No data were missing for the "in-person" IRR for the 10 domains and ICC ranged from good to excellent (n=26; 0.79-1.00). In-hospital and post-discharge domains were completed in under 7 min. CONCLUSIONS: The CPC-E is a valid and clinically feasible outcome measure for describing post-CA impairment and disability status. In-person hospital administration of the CPC-E yields more complete data and good to excellent inter-rater reliability compared to retrospective EMR review.