Efficacy of the cognitive orientation to daily occupational performance with Brazilian children with developmental coordination disorder

Background: Children with Developmental Coordination Disorder (DCD) have difficulties performing daily activities which reflects negatively on participation, impacting their lives.

Objectives: To examine the effects of the cognitive orientation to daily occupational performance Approach (CO-OP Approach) protocol on occupational performance and satisfaction of Brazilian children who have DCD; to examine whether children could transfer strategies and skills learned during CO-OP to untrained goals.

Methods: A pre-post group comparison design with eight boys aged 6–10 years old. Children participated in 12 CO-OP sessions with their parents twice a week, with an extra session added to the protocol for parents´ orientation. The Canadian Occupational Performance Measure and the Performance Quality Rating Scale were used as outcome measures. The study was registered by the United States Institutes of Health at ClinicalTrials.gov (NCT03112746).

Results: Intervention resulted in higher, clinically and statistically significant, occupational performance measures according to parents, children’s, and external evaluators’ perspectives. All children improved occupational performance on their selected goals and five children could transfer the ability to use cognitive strategies to tasks not addressed in therapy.

Conclusions: This study provides initial directions for future research to investigate the applicability and to implement CO-OP approach on pediatric settings in Brazil.     

Effects of dog-assisted intervention on quality of life in nursing home residents with dementia

Background: People with dementia often have a poor quality of life. Therefore, methods that can improve their life situation must be identified. One promising method is dog-assisted intervention.

Aim: This study aimed to investigate the effects of dog-assisted intervention on quality of life in nursing home residents with dementia.

Materials and methods: A one-group, pretest post-test study design was used. Quality of life was measured using the QUALID in 59 nursing home residents prior to and after a dog-assisted intervention. Non-parametric tests were used to analyze the data, and effect sizes were calculated.

Results: The participants’ total scores improved significantly between baseline and post-test 1 (p?=?<?0.001) and worsened significantly at post-test 2 (p?=?0.025). The largest effect size was found for the item ‘Verbalization suggests discomfort’ (p?=?0.001).

Conclusion: The results indicate that dog-assisted interventions can have positive effects on quality of life in nursing home residents with moderate to severe dementia.

Significance: The results contribute to a growing knowledge base about non-pharmacological methods that can be used in dementia care. Occupational therapists should consider dog-assisted interventions when planning activities that can reduce the illness burden and improve the quality of life for people with dementia.     

Viewpoints on how students with autism can best navigate university

Background: Despite recognition of the challenges faced by students with autism spectrum disorders (ASD) there is limited understanding of the barriers and facilitators to participation in major life areas, such as being a university student.

Aim/Objective: This research aimed to examine viewpoints on what affects the success of Australian university students with ASD.

Material and Method: Q-methodology was used to describe the viewpoints of university students with ASD, their parents and their mentors, on success at university for students with ASD. A total of 57 participants completed the Q-sort.

Results/Findings: Three viewpoints emerged; Individualised Support, Contextual Support and Social Support.

Conclusions: This study highlighted that supports need to be individualized to the barriers and facilitators faced by Australian students with ASD. Supports also need to be contextualized to the built and social environments of universities.

Significance: This study supports the premise that environmental interventions can be effective in facilitating participation in major life areas, such as university education. Peer mentoring for students with ASD may have utility for this group, but should be extended to include social, emotional and psychological support.     

Body Mass Index (BMI) and Infectious/Febrile Episodes in Children with Intermediate Risk Acute Lymphoblastic Leukemia (IR ALL)

The incidence of treatment related mortality in children with acute lymphoblastic leukemia (ALL) is reported to be between 2% and 4% with infections being the leading cause.

Aim: To establish a relationship between body mass index at diagnosis (BMI 0), after protocol I therapy completion (BMI I) and the incidence rate ratio (IRR) of infectious/febrile episodes in children with ALL intermediate risk.

Methods: Thirty one consecutive patients (2–18 years old, with a male to female ratio of 19/12) with newly diagnosed ALL that were treated uniformly according to ALL IC 2009 protocol were included in this analysis.

Results: A BMI decrease of at least 5% during protocol I therapy and BMI 1 under 15th percentile score corresponds significantly with higher IRR (with P-values 0.04 and 0.006 respectively) during the whole intensive therapy.

Conclusion: Some relationships between BMI reduction and higher IRR in ALL patients were found, but their significance is limited by the size of the group analyzed.     

Defining sensory modulation: A review of the concept and a contemporary definition for application by occupational therapists

Background: Sensory interventions are prevalent amongst adult mental health practitioners and are supported by major stakeholders and policy makers across the world. The term commonly used by occupational therapists applying sensory practices is sensory modulation, however this term has evolved.

Aims: This paper aims to investigate and clarify the definition of ‘sensory modulation’ for application by occupational therapists.

Method: A framework guided this concept analysis on sensory modulation. A summative content analysis approach was employed to code results.

Results: Six conceptual themes for sensory modulation were identified. 81% of authors defined sensory modulation as consisting of more than one of these themes. 18% of authors defined sensory modulation as both a neurophysiological process and means to regulate behaviour.

Conclusion: The concept of sensory modulation has evolved in occupational therapy practice. The authors summarise with the following proposed definition of sensory modulation for contemporary occupational therapy practice: ‘Sensory modulation is considered a twofold process. It originates in the central nervous system as the neurological ability to regulate and process sensory stimuli; this subsequently offers the individual an opportunity to respond behaviourally to the stimulus’.

Significance: A contemporary definition of ‘sensory modulation’ has been identified for occupational therapy practice.     

Exploring the lived experience of homelessness from an occupational perspective

Background: Working in homelessness is a growing area of practice for occupational therapists, however, there is limited literature on the lived experiences of homelessness and occupational engagement

Study aim: To explore the lived experience of homeless men in relation to how they engaged in day-to-day occupations when sleeping rough or hostel dwelling

Methods: Data were gathered from five men residing in a homeless hostel in the UK. Data collection included semi-structured interviews and photographic diaries. Data were analyzed using Interpretative Phenomenological Analysis

Results: Participants described their experiences of occupational engagement whilst sleeping on the streets which included engaging in survival occupations, the significance of apparently ordinary occupations and moving beyond survival occupations. The homeless hostel provided opportunities for occupational engagement that the men perceived in an idiosyncratic manner. The men described benefits of engaging in novel occupations and reengaging in known occupations. Occupational injustices were a common theme that occurred throughout participants experiences

Conclusion: This study has highlighted the diversity of occupational engagement for ‘roofless’ or ‘houseless’ participants and how different individuals experience occupational adaption

Significance: This study has furthered understandings of the concept of ‘survival occupations’ and the importance of community resources to facilitate occupational engagement whilst homeless.     

The Norwegian Occupational Balance Questionnaire (OBQ11-N) – development and pilot study

Background: The concept occupational balance has been linked with health and well-being, and it is therefore viewed as an important concept for occupational therapy practice, theory and research. To operationalize and measure occupational balance, the Occupational Balance Questionnaire (OBQ) was developed in Sweden. To date, no Norwegian translations of the OBQ exists.

Aim: To describe the process of developing a Norwegian version of the 11-items Occupational Balance Questionnaire (OBQ11-N) and to evaluate its feasibility and face validity.

Methods: The development process followed a predetermined series of steps, including forward and back translation and cognitive interviews with a pilot sample.

Results: The pilot study sample (n?=?8) varied with respect to age, gender and education level. There was high level of agreement between the participants with regard to their understanding of the content of the items. Three of the items were slightly modified in terms of words and phrasing.

Conclusion: The OBQ11-N was developed according to established translation guidelines and appears to be feasible and have good face validity.

Significance: The OBQ11-N may prove useful for assessing occupational balance and associated factors in Norwegian population groups. However, more research is needed to establish the Norwegian version of the questionnaire as psychometrically valid.     

Re-imagining occupational therapy clients as communities: Presenting the community-centred practice framework

Background: Occupational therapists’ are increasingly working with communities and providing services at the community level. There is, however, a lack of conceptual frameworks to guide this work.

Aim: The aim of this article is to present a new conceptual framework for community-centered practice in occupational therapy.

Material and Method: The conceptual framework was developed from qualitative multi-case research on exemplars of community participation. The first was, a network of Canadian food security programs, and the second, a rural Australian community banking initiative. Key themes were identified from across the case studies, and cross-case findings interpreted using occupational therapy and occupational science knowledge, and relevant social theory. The outcome is a four-stage, occupation-focused, community-centered practice framework.

Findings: The Community-Centred Practice Framework can be used by occupational therapists to understand and apply a community-centered practice approach. The four stages are: (1) Community Identity, (2) Community Occupations, (3) Community Resources and Barriers, and (4) Participation Enablement.

Conclusions: Further research is needed to trial and critically evaluate the framework, to assess its usefulness as a robust, occupation-focused, frame of reference to guide community-centered practice in occupational therapy.

Significance: The proposed framework should assist occupational therapists to conceptualize community-centered practice, and to utilize and apply theory.     

Meaningful engagement and person-centered residential dementia care: A critical interpretive synthesis

Background: People with moderate to advanced dementia living in residential care are at risk of occupational deprivation. Person-centered care has been adopted as a guiding principle in the provision of residential care for older adults with dementia. In this context, there has been shift in occupational therapy practice from addressing occupational performance towards focusing on meaningful engagement. While both meaningful engagement and person-centered care have been well researched the relationship between the two concepts is poorly understood.

Aim: A critical interpretative synthesis was conducted to determine how principles of person-centered care inform occupational therapy practice in relation to promotion of meaningful engagement among residents with moderate to advanced dementia.

Methods: A systematic search of research addressing meaningful engagement of people with moderate to advanced dementia identified 26 papers.

Results: Papers were classified as theoretical papers and empirical research. Two overarching constructs emerged, namely promoting a culture of collaborative care and understanding the resident as a person with a past, present and future.

Conclusions: Occupational deprivation prevails and person-centered care is not fully addressed if opportunities for growth and engagement for residents with moderate to advanced dementia is not extended beyond their life history.

Significance: Creating continued opportunities for building agency of residents with dementia could promote occupational justice in residential care.     

Moderating parenting stress in ethnic minority parents of children with developmental delays

Objective: We explored the relationship between acculturation and parenting stress among parents of children with developmental delays (DD) and investigated family support as a potential moderator.

Methods: Participants included 99 parents of young children with DD. Standardized measures were used to evaluate the variables of interest and a multiple linear regression analysis was employed to test the moderation effect.

Results: Our results indicated that the relationship between acculturation and parenting stress depended on the level of family support. More specifically, low levels of acculturation were associated with increased parenting stress at high levels of family support but not low levels of family support.

Conclusions: Minority parents of children with DDs may be at risk for especially high levels of parenting stress due to the additive stress of adapting to a new culture and parenting a child with special needs. Implications for intervention and future research are discussed.     

Measuring perceived outcomes from participating at a clubhouse for persons with mental illness: Psychometric properties and associated factors

Background: The clubhouses are part of a growing international movement concerned with providing work-oriented psychosocial rehabilitation for people with a history of mental illness. Instruments used for measuring outcomes from clubhouse participation is in a developing phase.

Aims: This study aimed to assess psychometric properties of an outcome survey tool used at a Norwegian clubhouse, and to explore factors associated with members’ perceived outcomes from participation at the clubhouse.

Methods: A cross-sectional design was used. The instrument’s factor structure was examined with Principal Components Analysis (PCA), and internal consistency was assessed with Cronbach’s α. Associations with the derived outcome scale score were examined with linear regression analysis.

Results: All scale items belonged to the same latent factor, and internal consistency of the items was α?=?0.81. Members, who used the clubhouse more frequently perceived the outcomes from participating to be better, compared to their counterparts.

Conclusion: The outcome scale was unidimensional and the items fit well together. Active members were likely to evaluate outcomes of clubhouse participation as more positive, compared to less active members.

Significance: The scale can be useful for exploring clubhouse members’ perceptions of the outcomes they relate to their participation at the clubhouse.     

Planning for outdoor play: Government and family decision-making

Background: Despite indisputable developmental benefits of outdoor play, children with disabilities can experience play inequity. Play decisions are multifactorial; influenced by children’s skills and their familial and community environments. Government agencies have responsibilities for equity and inclusion of people with disabilities; including in play.

Aim: This multiple-perspective case study aimed to understand outdoor play decision-making for children with disabilities from the perspectives and interactions of: local government and families of primary school-aged children with disabilities.

Material and method: Five mothers, four local government employees, and two not-for-profit organization representatives participated in semi-structured interviews. Inductive and iterative analyzes involved first understanding perspectives of individuals, then stakeholders (local government and families), and finally similarities and differences through cross-case analysis.

Findings: Local government focused more on physical access, than social inclusion. Local government met only minimal requirements and had little engagement with families. This resulted in poor understanding and action around family needs and preferences when designing public outdoor play spaces.

Conclusion and significance: To increase meaningful choice and participation in outdoor play, government understanding of family values and agency around engagement with local government needs to improve. Supporting familial collective capabilities requires understanding interactions between individuals, play, disability, and outdoor play environments.     

Long-Term Quality of Life and Nutritional Status of Patients with Head and Neck Cancer

Disease and therapy of head and neck cancer impair quality of life (QOL). QOL varies profoundly during therapy and follow-up.

Aim: We sought to monitor QOL and nutritional status of patients before, during and after therapy (AT).

Patients and methods: This study evaluates QOL by using the EORTC-questionnaires QLQ-C30 and H&N35, body weight and plasma albumin up to two years AT.

Results: Chemoradiotherapy is the period of the most profound QOL-impairment. Postoperative QOL almost reaches preoperative levels just before adjuvant therapy and does not differ significantly from pretherapeutic QOL. Long-term QOL is not significantly deteriorated. Patients have an average weight loss of 17%. Nutritional supplements are used continuously. Xerostomia and sticky saliva are chronic symptoms that persist AT.

Conclusions: QOL is an important parameter for the evaluation of therapy success. Head and neck cancer and its therapy cause permanent xerostomia, sticky saliva and need of nutritional supplements. Adequate patient information, psychooncological counseling, analgesia and nutritional support may alleviate QOL impairment.     

Rationale and Design of an Online Educational Program Using Game-Based Learning to Improve Nutrition and Physical Activity Outcomes Among University Students in the United Kingdom

Objective: To assess the impact of an online game-based educational program on nutrition knowledge and dietary and physical activity habits among university students in the United Kingdom.

Design: Randomized controlled trial with pre- and postintervention comparisons.

Setting: Two higher education settings in London, UK.

Subjects: Current undergraduate and postgraduate students of two universities (n?=?88) aged 18–34 years are randomly allocated to an intervention (n?=?44) or a control group (n?=?44).

Intervention: The intervention group will receive access to an educational website and online quizzes with gamification elements, including information about healthy eating and physical activity. The control group will receive no information. Duration of the intervention will be 10 weeks.

Measures of Outcome: Primary outcome is nutrition knowledge. Secondary outcomes include dietary and activity habits. Nutrition knowledge and dietary and activity habits will be assessed using questionnaires. Weekly steps will be counted using pedometers. Assessment of anthropometric and metabolic risk factors will take place.

Analysis: Quantitative analysis will investigate changes in nutrition knowledge between the two groups of the study population. Linear regression analysis will be used, if the data follow the normal distribution (otherwise binomial regression analysis), to examine whether field of study, residence status, body mass index (BMI), and demographic factors affect nutrition knowledge. Associations between changes in knowledge and dietary and physical activity behavior will be assessed by correlations.

Conclusions/Implications: The study will provide insights with regard to the design and use of online game-playing as a cost-effective approach to improve nutritional knowledge among university students.     

The conflicted practice: Municipal occupational therapists’ experiences with assessment of clients with cognitive impairments

Background: The practice of Norwegian occupational therapists (OTs) in municipal practice is a little explored area and with the Coordination Reform Act from 2012, Norwegian OTs in municipal practice have received responsibilities concerning clients with cognitive impairments. The aim of this study was to explore municipal OTs experiences with assessment of clients with cognitive impairments.

Method: Fourteen individual interviews with OTs who worked with clients with cognitive impairments, were conducted. An inductive thematic analysis, using text condensation and coding, was performed.

Results: The results revealed three themes; power of occupation, advantages and disadvantages of assessments used and the need for competencies within municipal services. The participants emphasized using observation in the assessment process and reflected on pros and cons of the standardized assessment tools they used. They expressed a need for competence development, although it was difficult to prioritize to do so.

Conclusion: This study illustrated a conflicted practice related to choices OTs make in their practices. They valued the importance of working occupation based, however, they chose to use impairment based standardized assessments. They expressed a need to engage in professional development, but due to heavy workloads, the limited power they experienced and lack of knowledge, this was difficult.     

Mining concepts of health responsibility using text mining and exploratory graph analysis

Background: Occupational therapists need to know about people’s beliefs about personal responsibility for health to help them pursue everyday activities.

Aim: The study aims to employ state-of-the-art quantitative approaches to understand people’s views of health and responsibility at different ages.

Methods: A mixed method approach was adopted, using text mining to extract information from 233 interviews with participants aged 5 to 96 years, and then exploratory graph analysis to estimate the number of latent variables. The fit of the structure estimated via the exploratory graph analysis was verified using confirmatory factor analysis.

Results: Exploratory graph analysis estimated three dimensions of health responsibility: (1) creating good health habits and feeling good; (2) thinking about one’s own health and wanting to improve it; and 3) adopting explicitly normative attitudes to take care of one’s health. The comparison between the three dimensions among age groups showed, in general, that children and adolescents, as well as the old elderly (>73 years old) expressed ideas about personal responsibility for health less than young adults, adults and young elderly.

Conclusions: Occupational therapists’ knowledge of the concepts of health responsibility is of value when working with a patient’s health, but an identified challenge is how to engage children and older persons.     

Understanding the experiences of married Southern African women in protecting themselves from HIV/AIDS: a systematic review and meta-synthesis

Background: Whilst marriage has been repeatedly identified in the literature as an HIV risk factor amongst Southern African women, not much is known about women’s perception of their role, experiences and strategies used to address HIV risks in the context of a marriage.

Aims: The aim of the study was to synthesise perceptions, experiences and strategies of married Southern African women in the prevention of HIV.

Methods: A systematic review of qualitative studies was conducted. Three electronic databases (Medline, Cinahl and PsycINFO) were systematically searched to identify relevant literature. The meta-synthesis process followed Sandelowski and Barroso’s [2007. Handbook for Synthesizing Qualitative Research. Springer Publishing Company] recommendations.

Results: Of 7 609 papers, 15 were included in the review. The quality of the included studies was variable. In the final synthesis stage, three broad analytic themes emerged: contextual background, cues to preventive behaviour, and HIV prevention strategies.

Implications: Findings were used to develop a conceptual framework for studying HIV/AIDS prevention experiences of married Southern African women.     

Occupation as marker of self: Occupation in relation to self among people with advanced cancer

Background: Living with advanced cancer can have a profound impact on the person’s self. A person’s self is influenced by various aspects of daily life, including engagement in occupation. From an occupational perspective, little research has been done to explore how the self of people with advanced cancer is formed through their engagement in occupation.

Aim: The purpose of this study was to explore how people with advanced cancer experience that their sense of self is formed through engagement in occupation.

Methods: A total of 28 interviews were conducted with 22 people with advanced cancer. Grounded theory guided the collection and analysis of data.

Results: ‘Occupation as marker of self’ was identified as the core category. Occupations served as markers of the participants’ self (1) by mirroring their abilities and positioning of their self in the illness trajectory; and (2) as means of expressing their self. The core category provided explanations about how the participants’ experiences of occupation influenced their self-perceptions, as explained in the sub-categories ‘defining the self through occupation’ and ‘reassessing self and accepting limitations’.

Conclusions: For people with advanced cancer, engagement in occupation influences their self as current abilities become apparent and positions of their self can be created and expressed.     

Vocational support in mental health service delivery in Australia

Background: Individuals experiencing severe and persistent mental illness report a desire to gain and sustain work. Individual Placement and Support (IPS) is an evidence-based approach to vocational rehabilitation to support competitive employment outcomes.

Aim/Objective: This study aimed to evaluate whether a joint-governance management partnership, between a clinical adult mental health and an employment service, could deliver a sustained IPS program in Australia.

Materials and Method: The methodology entailed a Clinical Data Mining approach, to examine records from seven years of implementation of IPS in one setting within an Australian public mental health service context.

Results/Findings: Despite the prevalence of schizophrenia spectrum diagnoses and an older mean age (39 years), indicating that a large proportion of the cohort had experienced serious mental illness for over twenty years, findings were that 46.3% of participants achieved employment.

Conclusions: This is an excellent result and is comparable to the only randomised control trial, with adult services, in the Australian context, which found a 42.5% employment rate possible under IPS compared with just 23.5% with referral to external employment services.

Significance: More extensive trialling of IPS across clinical services is required, in Australia and internationally, including fidelity protocols, for knowledge translation to be achieved.