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.

The Portuguese Performance Assessment of Self-Care Skills Measure: Validity and Reliability.

Performance Assessment of Self-Care Skills (PASS) is a performance-based scale developed in the United States. Because of cultural differences, a Portuguese version was developed, then validated in the Portuguese population and tested ensuring reliability. The objective of this study was to create and test psychometric properties of a Portuguese version of PASS. A linguistic validation on older adults with physical/cognitive disabilities enabled us to validate P-PASS. Some original tasks were changed. Data were analyzed by PASS constructs (independence-safety adequacy), age, and gender. Construct validity (known-group analyses, factor analyses), with 98 individuals yielded excellent results. Reliability between two observers for 30 participants yielded almost perfect agreement for all three constructs. Independence scores were highest, followed by safety and adequacy. Men presented greater independence, as well as participants <60 years. We obtained results comparable with the original version. Conclusion. P-PASS is valid and reliable for the Portuguese population, enabling effective assessment of function and measurement of health outcomes.

Promoting Physical Activity in Older Adults With Knee Osteoarthritis and Hypertension: A Randomized Controlled Trial.

A 6-month self-efficacy intervention was compared with attention-control intervention on physical activity, clinical outcomes, and mediators immediate postintervention and 6-month postintervention in 182 older adults with knee osteoarthritis and hypertension using a randomized controlled trial design. The intervention group received six weekly individual physical therapy sessions for lower-extremity exercise and fitness walking and nine biweekly nurse telephone counseling sessions. The attention-control group received six weekly and nine biweekly nurse telephone sessions on health topics. Lower-extremity exercise was assessed by e-diary; fitness walking was assessed by accelerometer and e-diary; blood pressure was assessed by automated monitor; function was assessed by performance-based tests and questionnaires; and pain, self-efficacy, and outcome expectancy were assessed by questionnaires. Self-reported lower-extremity exercise and fitness walking, function, pain, self-efficacy, and outcome expectancy showed significant group or group by time effects favoring intervention. The intervention did not improve physical activity by accelerometer and blood pressure. Mean minutes of fitness walking fell short of the 150 min/week goal.

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.

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.

Performance-Based Impairment Measures as Predictors of Early-Stage Activity Limitations in Community-Dwelling Older Adults.

OBJECTIVE: The objective of the current investigation was to explore performance-based predictors of decline in the performance quality of everyday tasks as a first step for early identification, screening, and referral to minimize disability in community-dwelling older adults. METHOD: This was a secondary analysis of data from 256 community-based older women. Mobility, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) were measured using the Performance Assessment of Self-Care Skills (PASS). Logistic regression models explored cognitive and motor predictors of performance quality while controlling for demographics and diagnoses. RESULTS: Functional reach ( p = .049) and cognition ( p = .012) were predictive of mobility quality, whereas balance ( p = .007) and the Keitel Function ( p = .005) were predictive of ADL quality. Manipulation and cognitive measures were predictive of cognitive and physical IADL quality. DISCUSSION: Cognitive and physical screens are both important to identify older adults at risk for disability.

Functional assessment in mental health: lessons from occupational therapy.

Occupational therapists have been conducting functional assessments since World War I, and this accumulated experience has taught us several critical lessons. First, a comprehensive profile of a patient's functioning requires multiple assessment methods. Second, assessment content and measurement constructs must change with the times. Third, technology can enhance and extend functional assessment. Fourth, performance-based assessments of everyday activities can also be used to measure body functions/impairments. However, while deconstructing activities into body functions/impairments is possible, the results do not reflect patients' abilities to integrate the cognitive, motor, sensory and affective functions necessary to complete a complex activity. Finally, the differential complexity of everyday activities that a patient can master or successfully complete can also provide a ruler with which to measure progress.

Los terapeutas ocupacionales han realizado evaluaciones funcionales desde la Primera Guerra Mundial, y esta experiencia acumulada nos ha enseñado algunas lecciones importantes. Primero, un perfil comprensivo del funcionamiento de un paciente requiere de mùltiples métodos de evaluación. Segundo, el contenido de la evaluación y los constructos de medición deben cambiar con los tiempos. Tercero, la tecnología puede reforzar y ampliar la evaluación funcional. Cuarto, las evaluaciones basadas en el desempeño de las actividades diarias también se pueden emplear para medir las funciones y deterioros corporales. Sin embargo, aunque es posible la deconstrucción de las actividades en funciones y deterioros corporales, los resultados no reflejan las capacidades de los pacientes para integrar las funciones cognitivas, motoras, sensoriales y afectivas necesarias para completar una actividad compleja. Por último, la complejidad diferencial de las actividades diarias que un paciente puede dominar o completar exitosamente también puede aportar una regla con la cual medir el progreso.

Les ergothérapeutes ont mené des évaluations fonctionnelles depuis la première guerre mondiale et cette accumulation d'expérience nous a enseigné plusieurs leçons essentielles. Tout d'abord, de nombreuses méthodes d'évaluation sont nécessaires pour établir le profil complet du fonctionnement d'un patient. Deuxièmement, le contenu de l'évaluation et les méthodes de mesure doivent évoluer avec le temps. Troisièmement, la technologie peut améliorer et élargir l'évaluation fonctionnelle. Quatrièmement, les évaluations basées sur la performance des activités quotidiennes peuvent aussi être utilisées pour mesurer le fonctionnement du corps (ou les troubles du fonctionnement). Toutefois, bien qu'il soit possible de décomposer les activités du quotidien par fonction, les résultats obtenus ne reflètent pas la manière dont les patients sont capables de coordonner leurs fonctions cognitives, motrices, sensorielles et affectives pour effectuer une activité complexe. Enfin, différents niveaux de complexité des diverses activités quotidiennes qu'un patient peut maîtriser ou exécuter avec succès peuvent aussi fournir une règle permettant de mesurer le progrès.

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.

Somatosensation Differences in Older Adults with and Without Diabetes, and by Age Group.

The purpose of this study was to determine differences in somatosensation between older adults with and without type 2 diabetes among three age groups (60s, 70s, and 80s). We recruited 67 adults with type 2 diabetes and 67 age-matched adults without diabetes, aged 60-85. Data were collected using measures in Somatosensory Domain of the National Institute of Health (NIH) Toolbox. We found significant differences in the total scores of five tests examining kinesthesia, tactile sensation, and stereognosis among the three age groups. For all significant differences, the nondiabetes group and those in their 60s and 70s had better functioning than the diabetes group and those in their 80s. The NIH Toolbox-Somatosensory Tools used in this study may be more suitable to discriminate among age groups rather than diagnostic groups.

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.

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.

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.

Can performance on daily activities discriminate between older adults with normal cognitive function and those with mild cognitive impairment?

OBJECTIVES: To examine whether preclinical disability in performance of cognitively focused instrumental activity of daily living (C-IADL) tasks can discriminate between older adults with normal cognitive function and those with mild cognitive impairment (MCI) and, secondarily, to determine the two tasks with the strongest psychometric properties and assess their discriminative ability so as to generate diagnosis-relevant information about cognitive changes associated with MCI and mild neurocognitive disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria. DESIGN: Secondary analyses of cross-sectional data from a cohort of individuals diagnosed with normal cognitive function or MCI. SETTING: Pittsburgh, Pennsylvania. PARTICIPANTS: Older adults with remitted major depression (N = 157). MEASUREMENTS: Diagnosis of cognitive status was made at the Alzheimer's Disease Research Center, University of Pittsburgh. Performance on eight C-IADLs was measured using the criterion-referenced, observation-based Performance Assessment of Self-Care Skills (PASS). RESULTS: Ninety-six older adults with normal cognitive function (mean age 72.5 ± 5.9) and 61 with MCI (mean age 75.5 ± 6.3) participated. The eight C-IADLs demonstrated 81% accuracy in discriminating cognitive status (area under the receiver operating characteristic curve (AUC) = 0.81, P < .001). Two tasks (shopping and checkbook balancing) were the most discriminating (AUC = 0.80, P < .001); they demonstrated similar ability as all eight C-IADLs in determining cognitive status. Assessing performance on these two C-IADLs takes 10 to 15 minutes. CONCLUSION: This is the first demonstration of the discriminative ability of preclinical disability to distinguish older adults with MCI from cognitively normal older adults. These findings highlight potential tasks that, when measured using the observation-based PASS, demonstrate greater effort for individuals with MCI. These tasks may be considered when attempting to diagnose MCI or mild neurocognitive disorder in clinical practice and research.

Does social support impact depression in caregivers of adults ageing with spinal cord injuries?

OBJECTIVE: The objective of this study was to examine the role of social support in predicting depression in caregivers of adults aging with spinal cord injuries. DESIGN: Cross-sectional secondary data analyses were conducted for this study. SETTING: Participants were recruited from multiple community locations in Pittsburgh, PA and Miami, FL. SUBJECTS: Community-dwelling caregivers of aging adults with spinal cord injuries (N = 173) were interviewed as part of a multisite randomized controlled trial. MAIN MEASURES: The Center for Epidemiological Studies Depression Scale measured caregiver depression symptom levels. A hierarchical multiple regression analysis examined the effect of social support (social integration, received social support, and negative social interactions) on depressive symptom levels for the caregivers of adults aging with spinal cord injuries, controlling for demographic characteristics, and caregiving characteristics. RESULTS: Caregivers were, on average, 53 years old (SD = 15) and care-recipients were 55 years old (SD = 13). Average Center for Epidemiological Studies Depression Scale scores indicated that 69 (40%) of caregivers had significant depressive symptoms (mean 8.69, SD = 5.5). Negative social interactions (ß = 0.27, P< 0.01) and social integration ( ß = -0.25, P< 0.01) were significant independent predictors of depressive symptom levels in caregivers of adults aging with spinal cord injuries. CONCLUSIONS: Findings demonstrate that negative social interactions and social integration are associated with the burden in caregivers of adults aging with spinal cord injuries. Negative social interactions and social integration should be investigated in assessments and interventions intended to target caregiver depressive symptom levels.

Motor and tactile-perceptual skill differences between individuals with high-functioning autism and typically developing individuals ages 5-21.

We examined motor and tactile-perceptual skills in individuals with high-functioning autism (IHFA) and matched typically developing individuals (TDI) ages 5-21 years. Grip strength, motor speed and coordination were impaired in IHFA compared to matched TDI, and the differences between groups varied with age. Although tactile-perceptual skills of IHFA were impaired compared to TDI on several measures, impairments were significant only for stereognosis. Motor and tactile-perceptual skills should be assessed in children with IHFA and intervention should begin early because these skills are essential to school performance. Impairments in coordination and stereognosis suggest a broad though selective under-development of the circuitry for higher order abilities regardless of domain that is important in the search for the underlying disturbances in neurological development.

Role of social support in predicting caregiver burden.

OBJECTIVE: To examine the unique contribution of social support to burden in caregivers of adults aging with spinal cord injury (SCI). DESIGN: Secondary analyses of cross-sectional data from a large cohort of adults aging with SCI and their primary caregivers. SETTING: Multiple community locations. PARTICIPANTS: Caregivers of community-dwelling adults aging with SCI (n=173) were interviewed as part of a multisite randomized controlled trial. The mean age ± SD of caregivers was 53±15 years and of care-recipients, 55±13 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The primary outcome was caregiver burden measured with the Abridged Version of the Zarit Burden Interview. A hierarchical multiple regression analysis examined the effects of social supports (social integration, received social support, and negative social interactions) on burden in caregivers of adults aging with SCI while controlling for demographic characteristics and caregiving characteristics. RESULTS: After controlling for demographic characteristics and caregiving characteristics, social integration (ß=-.16, P<.05), received social support (ß=-.15, P<.05), and negative social interactions (ß=.21, P<.01) were significant independent predictors of caregiver burden. CONCLUSIONS: Findings demonstrate that social support is an important factor associated with burden in caregivers of adults aging with SCI. Social support should be considered for assessments and interventions designed to identify and reduce caregiver burden.

The development and validation of the vestibular activities and participation measure.

OBJECTIVES: To develop and validate a new self-report outcome measure named the Vestibular Activities and Participation (VAP) for people with vestibular disorders to examine their activities and participation according to the International Classification of Functioning Disability and Health. DESIGN: Delphi iterative survey for the development of the VAP and validation study. SETTING: Tertiary balance clinic. PARTICIPANTS: A panel of worldwide experts (n=17) in vestibular dysfunction participated in the development of the VAP, and patients (N=58) with vestibular disorders were enrolled in the validation of the VAP. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: For the development of the VAP, an Internet-based survey of 55 activities and participation items was presented to the panel of experts and the percentage agreement per item was calculated. For the validation of the VAP, the VAP was completed twice to examine the test-retest reliability, the World Health Organization Disability Assessment Schedule II (WHODAS II) was used to examine the concurrent validity with the VAP, and the Dizziness Handicap Inventory (DHI) was used to examine the convergent validity of the VAP. RESULTS: After 2 rounds of the Delphi technique, the VAP was developed. The VAP total score had excellent test-retest reliability (intraclass correlation coefficient=.95; confidence interval=.91-.97) and good to excellent agreement per item indicated by the unweighted kappa (.41-.80) and the weighted kappa (.58-.94). The minimum detectable change at 95% confidence level of the VAP score was .58. The VAP had strong correlation (ρ=.70; P<.05) with the WHODAS II and moderate to strong correlations (ρ=.54-.74) with the DHI subscale and total scores. After adjustment for age, we found sex and self-reported imbalance to be independent explanatory variables of the transformed VAP total score. CONCLUSIONS: The VAP measure was developed to examine the disabling effect of vestibular disorders on people's activities and participation based on a standardized framework (the International Classification of Functioning Disability and Health). The VAP demonstrated excellent reliability and was validated with external instruments in people with vestibular disorders.

Cognition in older adults with bipolar disorder versus major depressive disorder.

OBJECTIVES: Bipolar disorder (BD) and major depressive disorder (MDD) are associated with cognitive dysfunction in older age during both acute mood episodes and remitted states. The purpose of this study was to investigate for the first time the similarities and differences in the cognitive function of older adults with BD and MDD that may shed light on mechanisms of cognitive decline. METHODS: A total of 165 subjects with BD (n = 43) or MDD (n = 122), ages ≥ 65 years [mean (SD) 74.2 (6.2)], were assessed when euthymic, using comprehensive measures of cognitive function and cognitive-instrumental activities of daily living (C-IADLs). Test results were standardized using a group of mentally healthy individuals (n = 92) of comparable age and education level. RESULTS: Subjects with BD and MDD were impaired across all cognitive domains compared with controls, most prominently in Information Processing Speed/Executive Function. Despite the protective effects of having higher education and lower vascular burden, BD subjects were more impaired across all cognitive domains compared with MDD subjects. Subjects with BD and MDD did not differ significantly in C-IADLs. CONCLUSION: In older age, patients with BD have worse overall cognitive function than patients with MDD. Our findings suggest that factors intrinsic to BD appear to be related to cognitive deterioration and support the understanding that BD is associated with cognitive decline.