Construct validity and internal consistency reliability of the Loewenstein occupational therapy cognitive assessment (LOTCA).

BACKGROUND: Cognitive abilities are essential for children's development and independence. Various cognitive assessments, standardized in Western cultures, have yet to be investigated for their multicultural suitability. AIMS: To explore the suitability of the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) for a Jordanian population. METHODS: Observed cases of 442 Jordanian children aged 6-12 were used to perform exploratory factor analyses using principal components with Varimax rotation (construct validity evidence) and to compute Cronbach's α coefficient (internal consistency reliability). RESULTS: High total performance on four subscales and a slightly lower total performance on two subscales were observed. Observed performance increased with age on three subtests, whereas a more modest increase was observed on the other three subscales. The expected one-factorial solution confirming the LOTCA's subscales homogeneity (unidimensionality) structure was found on five of six subscales. Variance explained by the subscales ranged from 39 to 82% and internal consistency reliability measured by Cronbach's alpha ranged from .42 to .78. CONCLUSIONS: Satisfactory construct validity and internal consistency reliability were demonstrated on two subscales applicable to Jordanian children without adaptation. With adequate cross-cultural adaptation, increasing internal consistency reliability in other subscales could make the LOTCA an effective tool for assessing cognitive abilities in this population.

Sleep Patterns of Emergency Department Nurses on Workdays and Days Off.

BACKGROUND: Shift workers, particularly night workers, are prone to disrupted circadian rhythms and sleep deprivation resulting in fatigue and sleepiness, thereby endangering patient safety. Little is known about the sleep patterns of emergency nurses who work highly variable around-the-clock schedules to meet the demands of fluctuating patient census and acuities throughout the 24-hour period. PURPOSE: The purpose of this pilot study was to determine whether there are shift-related sleep pattern differences in emergency department nurses over seven consecutive 24-hour periods that include both workdays and days off. METHODS: A New Jersey mailing list (1514 members) was rented from the Emergency Nurses' Association. Three hundred on this list were systematically sampled and invited by mail to participate. The final sample consisted of 35 emergency nurses. Participants wore actigraphs for 24 hours each day for 7 days and completed sleep diaries upon awakening from their daily main sleep periods. Queries included caffeine and hypnotics usage. The nurses also completed the Standard Shiftwork Index General Biographical Information Section for demographic and scheduling data. Participants received a $50 honorarium upon completion of the protocol. The actigraph data were downloaded into a personal computer using Act Millennium and analyzed with Action W software (Ambulatory Monitoring, Inc., Ardsley, NY, USA). RESULTS: Sleep durations ranged from 6.6 to 8.1 hours on workdays and from 6.2 to 8.1 hours on days off. There were no significant shift- or workday-related differences in sleep patterns. However, trends indicated that, regardless of shift, workday sleep became more disturbed and less efficient toward the end of the week. Daily caffeine usage was reported by 85.9% of the sample. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Shift working nurses need to obtain adequate and consistent sleep on workdays and days off throughout the work week to reduce fatigue and to provide safe patient care. Understanding the sleep patterns of emergency nurses and their schedules is critical to facilitating the development of shift-specific sleep promotion interventions to enhance sleep and thereby counteract fatigue.

Ability of the National Board for Certification in Occupational Therapy Practice Test to Estimate the Probability of First-Time Pass Status on the National Certification Exam.

OBJECTIVE: To estimate the ability of the National Board for Certification in Occupational Therapy (NBCOT) practice test to predict first-time pass status on the NBCOT Occupational Therapist Registered exam. METHOD: Performance ratios for the four NBCOT practice test domains were used to develop a logistic regression model for estimating the probability of first-time pass status on the NBCOT exam. RESULTS: Of 65 students who graduated during academic years 2010-2013, 41 (63%) attained first-time pass status. The logistic regression model was a good fit. The variance explained ranged from 22% to 29%. The odds of first-time no-pass status were associated with performance ratios on Domains 1 and 2 but not Domains 3 and 4. CONCLUSION: To maximize the probability of students' attaining first-time pass status, faculty should consider ways to increase their exposure to the tasks and skills required for implementation of intervention plans (Domains 3 and 4).

Assessing occupational therapy students' clinical competence for entry-level work-related practice.

BACKGROUND: The purpose of occupational therapy (OT) educational programs is to graduate effective clinicians who join the job market with competencies consistent with the expected entry-level practice. To attain an effective process of clinical competence development, OT educational programs design competence-based curricula to instill pre-licensure readiness in their graduating students for entry-level work-related practice. OBJECTIVES: The purpose of the study was to perform a retrospective outcome competence assessment for evaluating OT students participating in the first three consecutive offerings of a graduate seminar intended to assess and increase pre-licensure skills and knowledge required for entry-level evidence-based work-related practice. The assessment examined differences in post vs. pre-seminar National Board Certificate Occupational Therapy (NBCOT) practice test score caused by (a) main time of test-taking effect; (b) main class effect; and (c) tine and class interaction effect. PARTICIPANTS: 62 students. METHODS: A total of 62 students who graduated from the program during the three academic years 2008, 2009 and 2010 participated in the study. RESULTS: Post vs. pre-seminar NBCOT practice test score was significantly higher across the three-year period and increased significantly in each of the three classes. Interaction effect did not alter the pattern of post vs. pre-seminar score increase in each class. CONCLUSIONS: The significant time and class main effects validated the effectiveness of the seminars in increasing post vs. pre-seminar practice test score in each of the three classes. The significant time x class interaction effect validated the pattern of post vs. pre-seminar score increase regardless of the class sequence.

Lower urinary tract symptoms in men with Parkinson disease.

PURPOSE: The aim of this study was to examine the prevalence, presentation, and predictors of lower urinary tract symptoms (LUTS) in men with idiopathic Parkinson disease (PD). METHODS: Guided by the Theory of Unpleasant Symptoms, this retrospective exploratory study used data abstracted from admission clinical records of 271 male patients with idiopathic PD enrolled in a movement disorders clinic at a large metropolitan Veterans Affairs Medical Center in the eastern region of the United States. Data from the admission questionnaire, Unified Parkinson's Disease Rating Scale, and Mini Mental State Examination were abstracted by trained research assistants. Interrater reliability for the abstraction process was 0.99 in a randomly selected 10% sample of records. Descriptive statistics were used to determine the prevalence of LUTS. Logistic regression was used to determine LUTS risk factors and predictors. RESULTS: At least one LUTS was reported by 40.2% of participants. Incontinence was the most prevalent symptom, affecting almost 25% of participants, followed by nocturia (14.8%) and frequency (13.7%). Of the 10 identified risk factors for LUTS, four significant predictors were discovered: number of non-PD medications (p < .05), PD duration (p < .05), number of comorbidities (p < .05), and history of a hernia diagnosis (p < .05). CONCLUSIONS: Assessment for LUTS should be a component of every evaluation of a patient with PD. Our findings offer a preliminary profile of the male PD patient with LUTS, which is an important step toward effective screening, detection, and access to care and treatment. Next steps in research include further work to identify predictors of LUTS in both male and female PD populations, explore patient perspectives, begin trials of interventions for LUTS in the PD population, and analyze the economic impact.

Validity testing of the stopwatch urine stream interruption test in radical prostatectomy patients.

OBJECTIVE: To assess convergent validity of the stopwatch urine stream interruption test (UST). Specific aims were to describe relationships among stopwatch UST scores and 4 common clinical indices of pelvic floor muscle strength: 24-hour urine leakage, confidence in performing pelvic muscle exercise, 24-hour pad count, and daily pelvic muscle exercise count. DESIGN: Secondary analysis; instrumentation study. METHODS: The final sample consisted of baseline stopwatch UST scores and measurements of comparison variables from 47 participants in a randomized clinical trial of 3 approaches to pelvic floor training for patients with urinary incontinence following radical prostatectomy. The sample size provided 80% power to detect correlations of moderate strength or higher. The stopwatch UST was conducted in an examination room at the study site by trained study personnel (MP, ADC, JP, SM). Measurements of comparison variables were obtained from 3 instruments: 24-hour pad test, Broome pelvic muscle self-efficacy scale, and 3-day bladder diary. Relationships among study variables were evaluated with Pearson correlation coefficients. RESULTS: Stopwatch UST scores were moderately correlated with 24-hour urine leakage on the 24-hour pad test (r = 0.35, P < .05), the most robust comparison measure. Correlations between stopwatch UST scores and all other comparison measures were in the appropriate direction, although weak, and did not reach statistical significance. CONCLUSION: Findings suggest that the stopwatch UST may be a valid index of pelvic floor muscle strength in men following radical prostatectomy. With further testing, the stopwatch UST could become a valuable clinical tool for assessing pelvic floor muscle strength in radical prostatectomy patients with urinary incontinence.

Sleep and psychomotor vigilance in female shiftworkers.

The purpose of this study was to evaluate the relationships between sleep and psychomotor vigilance in female nurses and the changes in these variables over time. Participants comprised 16 staff registered nurses (10 day, 6 night; aged 30-65 years [M = 47.6; SD = 8.1]) who wore wrist actigraphs continuously and completed a 10-min psychomotor vigilance test (PVT-192, Ambulatory Monitoring, Inc., Ardsley, New York) and the Stanford Sleepiness Scale (SSS) in their homes before and after work for three consecutive 24-hr periods. Repeated measures ANOVA revealed that night nurses slept significantly less than day nurses, F(1, 15) = 26.06, p ≤ .001; M = 227.88 ± 37.03 min versus M = 365.75 ± 59.01 min, respectively, daily for three consecutive days. Night nurses napped more frequently and had more changes in the length of their main sleep periods than day nurses. Day nurses reported more wake episodes during main sleep periods. Night nurses were sleepier after work than day nurses; both groups had increased sleepiness after work for the first 2 days and similar psychomotor vigilance test results. These findings suggest that sleep deprivation, irregular sleep patterns, and sleepiness are significant issues for shiftworking nurses. Future study of the characteristics of sleep and sleepiness in a larger sample would be useful to evaluate the focus for interventions to improve sleep and alertness in shiftworking nurses.

Concurrent validity of the wide range assessment of visual motor abilities in typically developing children ages 4 to 11 years.

Pediatric clinicians working with school-age children use the Wide Range Assessment of Visual Motor Abilities (WRAVMA) as a method for evaluating visual perception and motor skills in children despite limited information on concurrent validity. Whether it may be substituted for the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI) and has suitable estimates of concurrent validity were examined with a convenience sample of 91 typically developing children ages 4 to 11 years. No systematic concurrent validity between the WRAVMA and the VMI emerged. Only two subtests of the WRAVMA (Matching with Visual Perception, and Pegboard with Motor Coordination) gave scores statistically significantly correlated with those on the VMI, and these correlations were weak, accounting for very small amounts of the shared variance. As such, they have low clinical relevance. These findings do not provide evidence of concurrent validity to support the use of WRAVMA as an alternative method for the VMI for assessing children's visual perception and motor skills.

An outcome assessment for evaluating occupational therapy students' proficiency and skills required for passing the NBCOT computer-based certification test.

The objective the current study was to perform an outcome assessment of occupational therapy students participating in the first offering of a graduate seminar. This seminar was designed to increase their proficiency and skills required for passing the computer-based test (CBT) NBCOT certification exam. Four outcome measures were assessed: pre- and post-seminar NBCOT CBT practice tests score and pre- and post-seminar NBCOT CBT numbers of areas of weakness delineated by NBCOT. Our hypotheses expected that the student score and number of identified areas of weakness at the post-seminar NBCOT practice testing to demonstrate: H1--a score increase over pre-seminar practice testing; and H2--a decrease in the number of areas of weakness delineated by NBCOT over pre-seminar practice testing. All 13 graduating occupational therapy students participated in the seminar and were the subjects of this assessment. The Wilcoxon test (1-tailed) was employed to test the research hypotheses. A significant (Z = 3.11, p = 0.002) post- over pre-seminar practice test score increase was found. No significant post- over pre-seminar practice testing decrease in number of areas of weakness was found.

Clinical value of the VMI supplemental tests: a modified replication study.

PURPOSE: To carry out a modified replication of the study performed by Kulp and Sortor evaluating the clinical value of the information provided by Beery's visual-motor supplemental tests of Visual Perception (VP) and Motor Coordination (MC) in normally developed children. The objectives were to (a) estimate the correlations among the three tests scores; (b) assess the predictive power of the VP and MC scores in explaining the variance in Visual-Motor Integration (VMI) scores; and (c) examine whether poor performance on the VMI is related to poor performance on VP or MC. METHODS.: A convenience sample of 71 children ages 4 and 5 years (M = 4.62 +/- 0.43) participated in the study. RESULTS: The supplemental tests significantly (F = 9.59; dF = 2; p < or = 0. 001) explained 22% of the variance in VMI performance. Only VP was significantly related to VMI (beta = 0.39; T = 3.49) accounting for the total amount of explained variance. Using the study population norms, 11 children (16% of total sample) did poorly on the VMI; of those 11, 73% did poorly on the VP, and none did poorly on the MC. None of these 11 did poorly on both the VP and MC. Nine percent of total sample who did poorly on the VP performed within the norm on the VMI. Thirteen percent who performed poorly on the MC performed within the norm on the VMI. Using the VMI published norms, 14 children (20% of total sample) who did poorly on the VP performed within the norm on the VMI. Forty-eight percent who did poorly on MC performed within the norm on the VMI. CONCLUSIONS: Findings supported Kulp and Sortor's conclusions that each area should be individually evaluated during visual-perceptual assessment of children regardless of performance on the VMI.

Psychometric properties of the Male Urogenital Distress Inventory (MUDI) and Male Urinary Symptom Impact Questionnaire (MUSIQ) in patients following radical prostatectomy.

INTRODUCTION: Research instruments can be used to assess the impact of lower urinary tract symptoms on health-related quality of life. Evaluating the reliability, validity, and sensitivity of two of these instruments provides evidence concerning their readiness for use in research and clinical settings. OBJECTIVE: The researchers evaluated psychometric properties of the Male Urogenital Distress Inventory and Male Urinary Symptom Impact Questionnaire in men suffering from lower urinary tract symptoms following radical prostatectomy. METHOD: The internal consistency reliability, concurrent validity, construct validity, and sensitivity of both instruments were evaluated in a cohort of men who participated in a larger study of nursing's impact on quality of life post-prostatectomy. RESULTS: The reliability, validity, and sensitivity of both instruments were supported in this population. CONCLUSIONS: Initial support is provided for use of the instruments to measure the effect of interventions for lower urinary tract symptoms and urine leakage on health-related quality of life during the first 6 months of recovery from radical prostatectomy; however, further research with a larger and more diverse sample is needed prior to using the instruments in clinical settings.

Continuous quality improvement as an innovation: which nursing facilities adopt it?

PURPOSE: We identify environmental and organizational predictors that best discriminate between formal continuous quality improvement (CQI) adopters and nonadopters in nursing homes (NHs) and create a diagnostic profile for facility administrators and policy makers to promote CQI. DESIGN AND METHODS: We performed a cross-sectional survey of licensed NH administrators in New Jersey in 1999, using The Nursing Care Quality Improvement Survey ( Zinn, Weech, & Brannon, 1998) and The New Jersey NH Profiles Chart. We also performed a discriminant analysis. Of 350 NHs, 46% returned completed questionnaires. RESULTS: Using variance innovation, resource dependence, and institutional perspectives for our framework, we found that new requirements, environmental competition, organizational time and structural facilitators, and manager training made statistically significant contributions to discriminating between formal CQI adopters and nonadopters. IMPLICATIONS: Regardless of size, NHs adopt formal CQI to meet external expectations of new regulations and accreditation criteria. CQI adoption is facilitated by information systems, flexible use of personnel, and team supports, as well as CQI training for managers. This profile of adopters can guide administrators and policy makers in promoting CQI for NHs, and it can help NHs already interested in CQI focus internal resources on key facilitators.

The clubhouse model: An outcome study on attendance, work attainment and status, and hospitalization recidivism.

The purpose of this outcome study is to assess the effectiveness of one clubhouse program model, Connections Clubhouse. The study was conducted on 117 randomly selected members attending Connections Clubhouse from January 1998 to June 1999. The study examines the effect of attendance rates on members' employment attainment and status, and on rate of hospitalization recidivism. Rate of hospitalization recidivism was conceptualized as the difference between number of hospitalizations after enrollment and before enrollment in the program. It is hypothesized that adult psychiatric patients, with a high rate of attendance at Connections Clubhouse, will demonstrate (a) a high rate of employment attainment and more advanced employment status; and (b) a low rate of hospitalization recidivism as compared to those with a low attendance rate. As hypothesized, the proportion of members with a high rate of attendance with no employment of any kind was significantly lower than the proportion of members with a low rate of attendance. Though less pronounced, the proportion of members with a high rate of attendance holding a more advanced employment status was significantly higher than the proportion of members with a low rate of attendance. As expected, the recidivism rate of members with a high rate of attendance was significantly lower than for members with a low rate of attendance.