Assessment of Awareness of Disability measures among persons with acquired brain injury.

BACKGROUND: Limited self-awareness of disabilities can compromise individuals' occupational performance. PURPOSE: The Assessment of Awareness of Disability (AAD) provides occupational therapists with a standardized methodology for measuring clients'self-awareness when performing activities of daily living (ADL). This is the first study that formally examines the stability of the AAD measures. METHODS: The AAD was administered twice to 15 participants with acquired brain injury (ABI) within one or two days. One participant's data were excluded because significant changes in his ADL process abilities were detected. Two criteria were used to examine the stability of the remaining 14 participants' AAD measures: standardized difference Z-scores and a difference of 0.65 logits. FINDINGS: All 14 participants' AAD measures were stable on the basis of theirZ-scores; 13 participants' measures were stable based on the 0.65 logit difference. IMPLICATIONS: Occupational therapists can have confidence that the AAD generates stable measures when administered to adults with ABI.

ADL skill profiles across three psychiatric diagnoses.

BACKGROUND: Occupational therapists' ability to develop diagnostic-specific ADL intervention strategies is facilitated by an understanding of the ADL abilities of diagnostic groups. AIM: To determine whether there are significant differences in ADL ability and ADL skill profiles between samples of persons with bipolar disorder depression (n=158), bipolar disorder mania (n=200), and schizophrenia (n=200). Methods. All participants were assessed using the Assessment of Motor and Process Skills (AMPS). Mean ADL ability and skill item calibrations were compared between the three diagnostic samples. FINDINGS: No clinically significant differences were found in mean ADL ability. The ADL process skill item "Attends" was more difficult for those with bipolar disorder mania than for those with bipolar disorder depression. This difference did not disrupt the measurement model. IMPLICATIONS: The findings fail to support the idea that valid predictions of skill performance can be made on the basis of psychiatric diagnosis. Thus, occupational performance must be assessed individually. The findings also provide solid evidence that valid measures of ADL ability are generated when persons with bipolar disorder and schizophrenia complete the AMPS. Intervention strategies are recommended to address limitations in the skill Attends among persons with bipolar disorder manic episode.

Relation between post-stroke satisfaction with time use, perceived social support and depressive symptoms.

PURPOSE: To determine if perceived level of social support and number of depressive symptoms differentiates those who are satisfied with their time use post-stroke from those who are dissatisfied. METHOD: Secondary analysis of data of 54 subjects grouped by yes/no responses to 'Are you satisfied with how you spend your time?' Perceived social support and number of depressive symptoms were evaluated using the MOS Social Support Scale and Geriatric Depression Scale respectively. RESULTS: Time use satisfaction was high (64.8%). Dissatisfied subjects reported lower affectionate support and fewer positive social interactions (t < -2.70, p < 0.009) as well as higher levels of depression (t = 2.06, p = 0.05). Dissatisfied subjects were more likely to endorse only three Geriatric Depression Scale items (i.e., 'dropped activities', 'often bored', and 'often felt helpless') (chi2(1) > 7.27, p < 0.007). CONCLUSIONS: Persons post-stroke who are dissatisfied with their time use may not be depressed but may benefit from participation in meaningful social occupations.

Occupational well-being: rethinking occupational therapy outcomes.

BACKGROUND: Outcomes in occupational therapy focus largely on increasing and enhancing the quality of clients' occupational performance, and thus, the importance of clients'subjective experiences of their occupations are often overshadowed. PURPOSE: In this paper, the concept of occupational well-being is introduced. Our intent is to extend the focus beyond occupational performance and draw attention to individuals' subjective occupational experiences. KEY ISSUES: We contend that occupational well-being is enhanced when individuals' occupational needs, including their needs for accomplishment, affirmation, agency, coherence, companionship, pleasure, and renewal are consistently met. IMPLICATIONS: Occupational therapists can play a vital role in enabling clients to compose or re-orchestrate their occupational lives so they are able to meet their occupational needs more consistently. This role may be fulfilled by intervening directly with clients or by indirectly influencing clients' occupational lives or society at large to effect changes at an environmental or organizational level.

Construction and validation of a fatigue impact scale for daily administration (D-FIS).

The fatigue impact scale (FIS) was developed previously as a symptom-specific profile measure of health-related quality of life (HRQoL) for use in medical conditions in which fatigue is a prominent chronic symptom. Thus, it was not developed to be a responsive measure of daily changes in fatigue. This study describes the development and initial validation of an adaptation of the FIS for daily use. Items for the daily fatigue impact scale (D-FIS) were selected from the pool of original FIS items through Rasch analyses of existing data. The reduced-item FIS was administered to a sample of 93 subjects with flu-like illness, 25 of whom were followed for a 21-day period. Rasch analyses were used to further reduce the scale to a minimum number of items that represented a unidimensional measure of self-reported fatigue impact. This 8-item D-FIS demonstrated good relations to flu symptom ratings and to other general health ratings. It also proved to be a responsive measure of change in reported fatigue impact for subjects who were followed longitudinally. This initial validation study indicates that the D-FIS has considerable promise as a valid measure of the subjective daily experience of fatigue.