The effect of occupational therapy services on hospital readmission for patients with cancer in acute care settings: a retrospective data analysis.

PURPOSE: This study examined how the use of occupational therapy services affected the likelihood of hospital readmission within 30 days for patients with cancer diagnoses. METHODOLOGY: This was a retrospective observational study. Patient medical records were analyzed from a National Cancer Institute Hospital over a 5-year period with a sample size of 6614 patients included for analysis in an unadjusted logistic regression model and 1920 patients analyzed in an adjusted logistic regression model. Various factors, including the use of occupational therapy services as well as individual factors such as pain levels, cancer stage, and living environment, were considered in relation to readmission status. Logistic regression analyses were used to assess the provision of occupational therapy service's association with 30-day hospital readmissions. RESULTS: Patients who received occupational therapy services had a statistically significant decrease in their risk of a 30-day hospital readmission compared to patients with cancer who did not receive occupational therapy services. In an unadjusted analysis, patients with cancer who had occupational therapy services were 33.5% (OR = 0.665) less likely to be readmitted within 30 days compared to a patient who did not have occupational therapy services (p < 0.001). In an analysis after adjusting for patient health-related factors, patients with cancer who had occupational therapy services were 22.2% (OR = 0.778) less likely to readmit to a hospital compared to a patient who did not have occupational therapy services (p < 0.046). CONCLUSION: The results of the study are intended to contribute to the body of knowledge on the benefits of occupational therapy services on an individual as well as a health systems-based level for patients with cancer diagnoses while hospitalized. IMPLICATIONS FOR CANCER SURVIVORS: The knowledge of the utility of occupational therapy services for patients with cancer diagnoses while in the hospital can assist providers, patients, and hospital leadership in understanding some of the potential benefits for patient care and healthcare systems at large while seeking to avoid the deleterious effects from a hospital readmission.

A Qualitative Descriptive Exploration of the Experiences of Burn Therapists.

Exposure to patients who have experienced major traumatic events places burn therapists at risk of developing high levels of anxiety and stress, directly impacting their quality of life. Poor professional quality of life has been associated with negative physical and emotional characteristics in healthcare professionals and may subsequently influence patient safety and satisfaction, job retention, and productivity. The purpose of this study was to understand and describe the experiences of occupational and physical therapists who provide acute therapy to people who have sustained burn injuries. Semistructured interviews were completed with 10 participants (8 females and 7 physical therapists) for this qualitative descriptive study. Conventional content analysis was used to analyze the data collected from semistructured interviews. Six themes emerged after content analysis: (1) the importance of therapeutic relationships to patient successes and therapists' retention; (2) the autonomy and flexibility of burn therapists; (3) the impact of career longevity on compassion; (4) the uniqueness of burn team relationships and camaraderie; (5) the challenges of operating within the business of a healthcare system; and (6) the physical, mental, and emotional challenges to the burn therapists' resiliency. This research brings to light the physical, mental, and emotional challenges that impact burn therapists' resiliency, and which should be considered when creating programs to increase retention and professional quality of life in this professional population.

The Costs of Caring: Quantifying Compassion Fatigue and Compassion Satisfaction in Burn Therapists.

Recovery from a severe burn injury requires early and aggressive therapy, which is often painful and distressing to the patient. Burn therapists who guide these interventions may be prone to experiencing secondary trauma and compassion fatigue through repeated exposure to difficult situations. At the same time, therapists may gain a sense of purpose and altruism from their work, fostering compassion satisfaction. Despite being well documented in other health professions, compassion fatigue and compassion satisfaction have not been sufficiently explored among burn therapists. This study aimed to quantify and characterize burn therapists' compassion fatigue and satisfaction using the Professional Quality of Life scale and to answer the question of what job-related factors may impact these outcomes. A total of 143 burn therapists participated in this study. Results revealed compassion fatigue subsale scores of burnout and secondary traumatic stress in the low or moderate range and compassion satisfaction scores in the moderate or high ranges for all participants. This study presents new knowledge for the field of burn care in its quantification of professional quality of life in burn therapists. While burn therapists experienced moderate-to-high levels of compassion satisfaction in their work, burnout and stress also approached moderate levels. Years of practice was a significant predictor of compassion. Although the reasons for this are not clear, it may be related to increased competence or confidence in practice and may suggest a need for different support strategies for practitioners at each stage of their burn therapy career.

A Scoping Review of Compassion Fatigue and Compassion Satisfaction in Burn Therapists.

Occupational and physical therapists who routinely provide potentially painful and distressing rehabilitation to burn survivors are at risk for developing compassion fatigue. Burn therapists may also experience compassion satisfaction based on the successes their patients accomplish. The purpose of this review was to synthesize the literature related to compassion fatigue and satisfaction in therapists who work with burn survivors, explore previously reported predictors and mediators of (and responses to) these constructs, and identify gaps in the literature. Original, peer-reviewed papers published from journal inception to May 2023 were obtained from 5 electronic bibliographic databases: CINAHL, Embase, PsycINFO, PubMed, and Web of Science. Studies were eligible if they (1) reported compassion fatigue or its related concepts and (2) focused on occupational or physical therapists who work with burn survivors directly or as a member of a multidisciplinary burn treatment team. The initial search revealed 284 articles, 2 of which met inclusion criteria and are summarized in this scoping review. Neither article focused solely on burn therapists but examined the experiences of multidisciplinary burn team members working in single burn centers in North America. Both studies used a cross-sectional survey-based design to assess concepts related to compassion fatigue and compassion satisfaction. This scoping review uncovered important gaps in the literature related to compassion fatigue or satisfaction in burn therapists. More research is needed to better understand the interplay between concepts as well as their relationship to burn therapists' outcomes.

Studying the Specificity of Research Reporting for Ayres Sensory Integration® Interventions in the Published Literature: A Scoping Review.

IMPORTANCE: A contributing factor to the gap between research publication and clinical implementation is the lack of specificity used when reporting findings. OBJECTIVE: This scoping review used the Rehabilitation Treatment Specification System (RTSS) to determine which elements of specificity are most often present and omitted from research using Ayres Sensory Integration® (ASI). DATA SOURCES: The following databases were searched: PubMed, CINAHL, PsycINFO, Cochrane Library, and ERIC. STUDY SELECTION AND DATA COLLECTION: Eligible studies used ASI in an outpatient setting with children who had sensory integration or processing difficulties. Studies selected were quantitative (Level 1, 2, 3, or 4), available in full text, peer reviewed, and published in English within the past 20 yr. FINDINGS: Of the 22 studies that met inclusion criteria, 100% included ingredients (actions of the therapist), 63% included mechanisms of action (reasoning behind these actions), 86% included targets, and 23% described client progression. We also found that 49% of all ingredients were listed in conjunction with a target, 15% were listed in conjunction with a mechanism of action, and 11% were listed in conjunction with both a target and a mechanism of action. CONCLUSIONS AND RELEVANCE: Findings indicate that many studies list ingredients but often omit the mechanism of action. This omission makes replication of the intervention increasingly difficult and prevents a deeper understanding of the clinical reasoning process behind the intervention. Plain-Language Summary: Gaps identified in this scoping review highlight inconsistencies in the reporting of treatment specificity that may affect the replication and translation of Ayres Sensory Integration® (ASI) research into practice.

State of the Journal, 2023.

The American Journal of Occupational Therapy (AJOT) has maintained its top-ranking status in the field of occupational therapy, as evidenced by an increase in its 2-yr impact factor. As the Editor-in-Chief enters her second 3-yr term, the journal faces both challenges and opportunities stemming from trends in academic publishing. The editorial team seeks to navigate these shifts while fostering meaningful research dissemination and translation. Key outcomes for 2023 showcase the journal's dedication to addressing diverse occupational therapy needs. A special issue on autism and mental health in 2023 and upcoming themes on recovery after neurological injury and play in occupational therapy in 2024 exemplify AJOT's commitment to relevant topics. The AJOT Authors & Issues interview series and an active presence on social media platforms further bolster research engagement and translation. Despite challenges, AJOT's impact factor and rankings in the rehabilitation category have demonstrated its global influence and leadership. The journal's commitment to diversity, equity, and inclusion (DEI) is evident through initiatives such as AJOT's DEI Committee and DEI article collection, as well as AJOT's comprehensive approach to combating bias. As AJOT looks ahead to 2024, its goals include reviving State of the Science articles, updating our Author Guidelines to incorporate artificial intelligence and bias-free language policies, and fostering engagement through the AJOT Instagram account and monthly AJOT Authors & Issues discussions. With its dedication to rigorous research and meaningful translation, AJOT remains a crucial resource for occupational therapy professionals striving to make evidence-based decisions.

Improving Standards of Research Reporting in Intervention Research: Considerations for the Rehabilitation Treatment Specification System Model.

Replication and application of research in clinical practice require that interventions be described in detail by the producers of that research. Lack of treatment specificity in publications is thought to contribute to the nearly 17-yr gap between the publication and clinical implementation of best practices. In this editorial I explore a means of addressing this problem in the Rehabilitation Treatment Specification System (RTSS) and present an application of the RTSS to sensory integration intervention.

Neurophysiological Correlates of Sensory-Based Phenotypes in ASD.

Children with autism spectrum disorder frequently present with atypical behavioral responses to sensory stimuli, as well as differences in autonomic nervous system (ANS) and neuroendocrine activity. However, no one consistent pattern appears to explain these differences within this heterogeneous population. To conceptualize more homogenous ASD subgroups, sensory-based subtypes have been explored. One subtyping mechanism groups children by sensory responsivity pattern in addition to sensory domain. Differences in nervous system responsivity to sensory input within this sensory-based subtyping scheme have not yet been investigated. This exploratory study used ANS indices (respiratory sinus arrhythmia [RSA], skin conductance level) and neuroendocrine (salivary cortisol) response to examine patterns differentiating these subtypes. Significant differences in RSA were found during baseline, and during tactile, tone and movement stimuli (p < 0.05). Subtype membership was predicted by RSA changes during auditory stimulation and recovery periods (p < 0.05). Results confirm that children with an adaptive sensory responsivity subtype differ from those children with sensory processing dysfunction, however, physiological variables did not distinguish between children with different patterns of sensory processing dysfunction.

Higher Frequency of Acute Occupational Therapy Services Is Associated With Reduced Hospital Readmissions.

IMPORTANCE: Hospital readmissions are associated with poor patient outcomes, including higher risk for mortality, nutritional concerns, deconditioning, and higher costs. OBJECTIVE: To evaluate how acute occupational therapy service delivery factors affect readmission risk. DESIGN: Cross-sectional, retrospective study. SETTING: Single academic medical center. PARTICIPANTS: Medicare inpatients with a diagnosis included in the Hospital Readmissions Reduction Program (HRRP; N = 17,618). Data were collected from medical records at a large urban hospital in southeastern Wisconsin. Outcomes and Measures: Logistic regression models were estimated to examine the association between acute occupational therapy service delivery factors and odds of readmission. In addition, the types of acute occupational therapy services for readmitted versus not-readmitted patients were compared. RESULTS: Patients had significantly higher odds of readmission if they received occupational therapy services while hospitalized (odds ratio [OR] = 1.18, 95% confidence interval [CI] [1.07, 1.31]). However, patshients who received acute occupational therapy services had significantly lower odds of readmission if they received a higher frequency (OR = 0.99, 95% CI [0.99,1.00]) of acute occupational therapy services. A significantly higher proportion of patients who were not readmitted, compared with patients who were readmitted, received activities of daily living (ADL) or self-care training (p < .01). CONCLUSIONS AND RELEVANCE: For patients with HRRP-qualifying diagnoses who received acute occupational therapy services, higher frequency of acute occupational therapy services was linked with lower odds of readmission. Readmitted patients were less likely to have received ADL or self-care training while hospitalized. What This Article Adds: Identifying factors of acute occupational therapy services that reduce the odds of readmission for Medicare patients may help to improve patient outcomes and further define occupational therapy's role in the U.S. quality-focused health care system.

Impact of Acute Self-Care Indicators and Social Factors on Medicare Inpatient Readmission Risk.

IMPORTANCE: Readmissions are costly for Medicare and are associated with poor patient outcomes. OBJECTIVE: To determine whether two domains relevant to acute occupational therapy practice-self-care status and social factors-were associated with readmissions for Medicare patients in the Medicare Hospital Readmissions Reduction Program (HRRP). DESIGN: Cross-sectional, retrospective study. SETTING: Single academic medical center. PARTICIPANTS: Medicare inpatients with a diagnosis included in the HRRP (N = 17,618). Outcomes and Measures: Three logistic regression models were estimated to examine the associations among (1) self-care status and 30-day readmission, (2) social support and 30-day readmission, and (3) housing situation and 30-day readmission. Subgroup analyses were conducted for the individual HRRP diagnoses. RESULTS: No associations were found between acute self-care status, social support, or housing situation and 30-day readmission when all HRRP diagnoses were examined together. However, higher levels of independence with self-care were significantly associated with reduced odds of readmission for patients with pneumonia. CONCLUSIONS AND RELEVANCE: The findings for patients with pneumonia are consistent with those of other studies done in the acute care setting. Deficiencies in acute occupational therapy documentation may have affected the findings for the other HRRP diagnoses. What This Article Adds: This study is the first to examine the association between acute self-care status (as documented by acute care occupational therapy practitioners) and readmission.

State of the Journal, 2022.

The American Journal of Occupational Therapy (AJOT) had another successful year reaching our highest 2-yr impact factor in history (2.813) and regaining our position as the highest ranking occupational therapy journal in the world. Our expanded social media platforms and online resources continue to expand access and help occupational therapy practitioners translate research into practice. The journal's goals moving forward include enhancing opportunities for student involvement, enhancing standards for rigor and reporting, and updating official AJOT documents and resources to reflect best practices for bias-free language and the use of race/ethnicity data in research publications.

State of the Journal, 2021.

The American Journal of Occupational Therapy (AJOT) retains its ranking as the top-rated occupational therapy journal in North America by maintaining its commitment to publishing high-quality research aimed at occupational therapy professionals. As the needs and scope of the profession continue to expand, AJOT will continue to serve as a resource to practitioners, academics, and administrators to help guide best practices. Communication and engagement with readers will be facilitated through the new AJOT website as well as the new AJOT: Authors and Issues series. The journal seeks to expand its scope through its website, manuscript submission platform, and new ways to engage readers.

Effectiveness of Occupational Therapy Using a Sensory Integration Approach: A Multiple-Baseline Design Study.

IMPORTANCE: Occupational therapy using an Ayres Sensory Integration® (ASI) approach is a common intervention that has not been extensively studied in children with idiopathic sensory processing and integration challenges (e.g., without a diagnosis of autism). OBJECTIVE: To test the effectiveness of ASI using measures related to motor coordination and functional performance in children with a sensory-based motor disorder (SBMD). DESIGN: Nonconcurrent, multiple baseline, single subject. SETTING: Outpatient clinic that was part of a children's hospital in an urban setting. PARTICIPANTS: Three boys (ages 5-8 yr) with an SBMD. INTERVENTION: Each participant received ASI 3 times per week for 10 wk. Outcomes and Measures: Three motor probes were measured weekly. Pre- and posttest assessments included goal attainment scaling (GAS) and the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition (BOT-2). RESULTS: All 3 participants showed improvements in motor probes during the intervention period on the basis of a 2 SD band method of analysis. Statistically significant improvements were noted across GAS goals, and positive changes were found on the BOT-2, with large effect sizes. CONCLUSIONS AND RELEVANCE: Findings suggest improved motor performance and high goal achievement using ASI for children with idiopathic sensory processing and integration challenges. What This Article Adds: This study adds to a body of literature suggesting that ASI is effective in increasing functional performance in children with sensory processing and integration challenges. Future studies using multiple baseline designs are feasible in the clinic setting and can help build the evidence base for ASI.

State of the Journal, 2021.

The American Journal of Occupational Therapy (AJOT) retains its ranking as the top-rated occupational therapy journal in North America by maintaining its commitment to publishing high-quality research aimed at occupational therapy professionals. As the needs and scope of the profession continue to expand, AJOT will continue to serve as a resource to practitioners, academics, and administrators to help guide best practices. Communication and engagement with readers will be facilitated through the new AJOT website as well as the new AJOT: Authors and Issues series. The journal seeks to expand its scope through its website, manuscript submission platform, and new ways to engage readers.

Occupational Therapy Management of a Moderate COVID-19 Disease Process in a Skilled Nursing Facility: A Case Report.

Older adults living in skilled nursing facilities (SNFs) and long-term care facilities are particularly susceptible to the coronavirus disease 2019 virus and face unique challenges during their rehabilitation process. This case report highlights the disease and rehabilitation course of an older adult who received all of his medical and rehabilitative treatment while residing in a SNF. The occupational therapy evaluation and intervention processes, as well as the client's response to intervention, are described. The client's positive outcomes are linked directly to occupational therapy's ability to incorporate medical, physical, and psychosocial aspects into part of the interdisciplinary model of care in a SNF.

The Effectiveness of Bilateral Alternating Tactile Stimulation for Improving Sleep in Children with Sensory over-Responsivity.

The objective of this study was to explore the effectiveness of Touchpoints™ on improving sleep in children with sensory over-responsivity, specifically, whether wearing Touchpoints™ on the sleep setting before bed would improve children's sleep. Using three study phases (baseline, intervention, and withdrawal), eight young children with sensory over-responsivity and sleep deficits wore Touchpoints™ on their ankles before bed during the intervention phase. Data was collected using an activity tracker to measure sleep latency, sleep duration, number of nighttime awakenings and sleep efficiency as well as parent report. Results indicated that participants did not demonstrate any significant changes in sleep efficiency, sleep duration, or number of awakenings but demonstrated a significant improvement in sleep latency. Parents also reported improvement in their child's sleep quality. Results suggest Touchpoints™ before bedtime may decrease the time it takes for children with sensory over-responsivity to fall asleep and improve parental perceptions of children's sleep quality.

State of the Journal, 2020.

Throughout this challenging year, the American Journal of Occupational Therapy (AJOT) has stayed committed to publishing high-quality research so that occupational therapy professionals can make informed decisions about best practice. As we look to the future with a new Editor-in-Chief, our goals are to remain the leading journal for our profession while enhancing our engagement with readers, improving our review process, and ensuring that a diverse group of reviewers and associate editors are able to assume leadership positions with the journal.

Sensory Over-Responsivity as an Added Dimension in ADHD.

Years of research have added to our understanding of Attention Deficit Hyperactivity Disorder (ADHD). None-the-less there is still much that is poorly understood. There is a need for, and ongoing interest in, developing a deeper understanding of this disorder to optimally identify risk and better inform treatment. Here, we present a compilation of findings examining ADHD both behaviorally and using neurophysiologic markers. Drawing on early work of McIntosh and co-investigators, we examined response to sensory challenge in children with ADHD, measuring HPA activity and electrodermal response (EDR) secondary to sensory stressors. In addition, we have examined the relationship between these physiologic measures, and reports of behavioral sensory over-responsivity and anxiety. Findings suggest that sensory responsivity differentiates among children with ADHD and warrants consideration. We link these findings with research conducted both prior to and after our own work and emphasize that there a growing knowledge supporting a relationship between ADHD and sensory over-responsivity, but more research is needed. Given the call from the National Institute of Health to move toward a more dimensional diagnostic process for mental health concerns, and away from the more routine categorical diagnostic process, we suggest sensory over-responsivity as a dimension in the diagnostic process for children with ADHD.

Multifaceted Approach to Enhance Pill-Swallowing Ability in Children and Adults With Barth Syndrome.

IMPORTANCE: People with Barth syndrome (BTHS) present with sensory and motor deficits that affect their ability to swallow medications in solid form. Inability to swallow pills can reduce opportunities for people with BTHS to participate in clinical trial research. OBJECTIVE: To evaluate the effectiveness of a brief, multifaceted pill-swallowing program that used evidence-based training methods. DESIGN: Pretest-posttest with 6-mo follow-up. SETTING: Community setting. PARTICIPANTS: A convenience sample of children, adolescents, and adults with a genetically confirmed diagnosis of BTHS. INTERVENTION: Possible intervention strategies included behavioral approaches (e.g., shaping), adaptive approaches, and positioning approaches. Interventions were tailored to each participant's needs and were carried out by occupational therapy practitioners with advanced training in feeding and eating. OUTCOMES AND MEASURES: Pill-swallowing milestones were ranked on a scale ranging from 0 to 12; participants were scored pretraining, immediately posttraining, and at 6-mo posttraining. RESULTS: Sixteen participants with BTHS, ages 6-34 yr, participated in the training. Fourteen of the 16 participants demonstrated improvement in their pill-swallowing ability. Overall, there was a statistically significant change in pill-swallowing ability from pretraining to posttraining, and these changes were maintained after 6 mo. CONCLUSION: and Relevance: This study suggests that a brief multifaceted training approach, led by trained professionals, may be effective for helping people with sensory and motor deficits learn to swallow pills independently. WHAT THIS ARTICLE ADDS: Very little has been published in the occupational therapy literature describing how to teach the skill of pill swallowing to clients or how to measure progress toward this goal. This study tested the outcomes of a multifaceted approach to pill swallowing that can be conducted by occupational therapy practitioners; a novel measurement approach is also introduced that can be used with clients in clinical practice.

Using a Multifaceted Approach to Working With Children Who Have Differences in Sensory Processing and Integration.

Pediatric occupational therapy practitioners frequently provide interventions for children with differences in sensory processing and integration. Confusion exists regarding how best to intervene with these children and about how to describe and document methods. Some practitioners hold the misconception that Ayres Sensory Integration intervention is the only approach that can and should be used with this population. The issue is that occupational therapy practitioners must treat the whole client in varied environments; to do so effectively, multiple approaches to intervention often are required. This article presents a framework for conceptualizing interventions for children with differences in sensory processing and integration that incorporates multiple evidence-based approaches. To best meet the needs of the children and families seeking occupational therapy services, interventions must be focused on participation and should be multifaceted.