Surveying the Landscape of Persistent Concussive Symptoms in Adults Through an Occupational Lens.

IMPORTANCE: Little is known about how and to what extent persistent concussive symptoms affect occupational performance in adults. OBJECTIVE: To evaluate the impact of persistent postconcussive symptoms on occupational performance. DESIGN: A cross-sectional study design was used in which the occupational performance needs of adults with persistent concussion symptoms were identified by a trained occupational therapist via semistructured interview. SETTING: University research space. PARTICIPANTS: Adults ages 18 to 60 yr experiencing persistent concussion symptoms. OUTCOMES AND MEASURES: Occupational performance was evaluated using the Canadian Occupational Performance Measure. Data were then categorized by two researchers using the Occupational Therapy Practice Framework: Domain and Process (4th ed.). RESULTS: The most commonly affected occupational performance areas included education and work, social participation, and performance of instrumental activities of daily living. CONCLUSIONS AND RELEVANCE: Aligning with prior knowledge of the impact of psychosocial difficulties and higher order cognitive deficits on daily life, performance of complex occupations is heavily affected in adults with persistent concussive symptoms. Plain-Language Summary: The functional impact of symptoms that adults experience postconcussion becomes apparent as they return to their life occupations. The results of this study showed that adults with persistent concussive symptoms more commonly experienced occupational challenges with participation in education, social activities, and the performance of instrumental activities of daily living, with subtle, important variations in symptoms across adults. Detailed, client-centered evaluation of occupational performance changes postconcussion is an area of potential growth for occupational therapy practice and research.

Addressing Participation in Adults With Postconcussive Symptoms Using Cognitive Strategy Training: A Feasibility Trial.

IMPORTANCE: Some people experience persistent symptoms after a concussion that greatly affect occupational performance. OBJECTIVE: To evaluate the feasibility and preliminary effect of metacognitive strategy training in a sample of adults with postconcussive symptoms. DESIGN: Single-group, prospective design. SETTING: University research laboratory. PARTICIPANTS: Adults with persistent concussive symptoms affecting function (N = 14). INTERVENTION: Ten 45-min sessions of a metacognitive strategy training intervention, Cognitive Orientation to daily Occupational Performance (CO-OP). OUTCOMES AND MEASURES: Assessed feasibility outcomes included recruitment, retention, and adherence rates, and intervention acceptability was evaluated with the Client Satisfaction Questionnaire-8. The preliminary effect was measured on occupational performance (Canadian Occupational Performance Measure), concussive symptoms (Neurobehavioral Symptom Inventory), sleep (Pittsburgh Sleep Quality Inventory), vision (College of Optometrists in Vision Development-Quality of Life Outcomes Assessment), and cognition outcomes (Dysexecutive Questionnaire, Weekly Calendar Planning Activity, and National Institutes of Health Toolbox Cognition Battery). RESULTS: Acceptable recruitment (32%), retention (93%), and adherence rates (100%) were observed, along with a high level of acceptability to participants. Large intervention effects were present for occupational performance, general concussive symptoms, and cognitive functioning. CONCLUSIONS AND RELEVANCE: Findings suggest that the CO-OP is feasible to administer for adults with postconcussive symptoms and perceived as suitable for the needs of this population. Feasibility findings, coupled with improvements in occupational performance outcomes, provide the foundation for a future larger scale trial. Plain-Language Summary: The Cognitive Orientation to daily Occupational Performance intervention is practical to use to address the functional impact of persistent concussive symptoms in adults. Further research is needed to evaluate the efficacy of the CO-OP intervention with this population.

Occupational Therapy Practice Guidelines for People With Parkinson's Disease.

IMPORTANCE: Occupational therapy practitioners address the occupational performance and participation needs of people with Parkinson's disease (PD) and their care partners. OBJECTIVE: This Practice Guideline is informed by systematic reviews on the use of occupational therapy interventions to promote participation in occupations for people with PD and to facilitate their caregivers' participation in the caregiver role. This guideline is meant to support practitioners' clinical decision making when working with people with PD and their care partners. METHOD: We examined and synthesized the results of four systematic reviews and integrated those results into clinical recommendations for practice. RESULTS: Thirty-three articles from the systematic reviews served as the basis for the clinical recommendations in this Practice Guideline. Clinical recommendations are provided for interventions that have strong or moderate supporting evidence. CONCLUSION AND RECOMMENDATIONS: Multidisciplinary, tailored, goal-oriented intervention is recommended for people with PD. Various forms of exercise can be used to improve activities of daily living and instrumental activities of daily living performance and social participation, and interventions should incorporate health behavior change techniques to support adequate physical activity levels in daily life. Mindfulness meditation and exercise can be used to support sleep, and task-oriented training can be used to improve performance of specific tasks. Occupational therapy practitioners should incorporate self-management, coaching, compensatory, cognitive-behavioral, and other approaches into multicomponent treatment plans depending on the client's needs and goals. Additional potentially appropriate intervention approaches or areas to address are discussed on the basis of existing or emerging evidence and expert opinion. What This Article Adds: This Practice Guideline provides a summary and applications of the current evidence supporting occupational therapy intervention for people with PD. It includes case examples and suggested decision-making algorithms to support practitioners in addressing client goals.

Screening Tools: They're So Quick! What's the Issue?

Screening tools are needed in occupational therapy practice to determine which clients require formal evaluation. Because screening tools also tell us who does not require formal evaluation, they are key to improved clinical efficiency. Screening tools are brief, easy to administer, and often freely available. These qualities also lead to misuse of screening tools, including using them to measure progress over time or to serve as a confirmatory assessment on which to base treatment planning. We present additional common missteps of screening tool use, including a lack of consideration for a tool's psychometric properties, and exemplars of these common misuses in adult and pediatric practice. Finally, we offer solutions to address these concerns.

Role of Occupational Therapy in Facilitating Participation Among Caregivers of People With Parkinson's Disease: A Systematic Review.

IMPORTANCE: Caregivers play a critical role in facilitating the performance of people with Parkinson's disease (PD). Knowledge on how occupational therapy practitioners can mitigate the negative effects of caregiving is needed to enable caregiver participation. OBJECTIVE: To explore the effectiveness of interventions within the scope of occupational therapy practice for caregivers of people with PD to facilitate or maintain their participation in the caregiver role. DATA SOURCES: We conducted a systematic review of the literature published in CINAHL, MEDLINE, PsycINFO, and OTseeker between 2011 and 2019. Article reference lists were also hand searched for additional articles. Study Selection and Data Collection: Articles were screened and evaluated using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The review was conducted in accordance with steps outlined by the American Occupational Therapy Association's Evidence-Based Practice Project. FINDINGS: Six articles met the inclusion criteria. Interventions in each article were distinct, prohibiting theme development. Overall, the strength of evidence was low, and the risk of bias was high. None of the studies included in this review were obtained from the occupational therapy literature. CONCLUSIONS AND RELEVANCE: Little evidence is available to support interventions within the scope of occupational therapy practice for caregivers of people with PD. Existing evidence suggests that interventions need to be flexible (e.g., in terms of time, cost, and delivery method) and tailored to the unique needs of this population. What This Article Adds: There is a continued need to develop occupational therapy interventions that support participation in the caregiving role for caregivers of people with PD.

Feasibility of the Lee Silverman Voice Treatment-BIG Intervention in Stroke.

Lee Silverman Voice Treatment-BIG (LSVT BIG) has been used in Parkinson's disease and in two case studies with individuals post-stroke. The purpose of this study was to examine the feasibility, acceptability, and preliminary clinical effect of the LSVT BIG program for individuals post-stroke. This study was a waitlist crossover design. Outcomes were assessed at baseline, after 4 weeks, and after crossover. The primary outcomes were feasibility and acceptability; clinical outcomes were also assessed. We contacted 888 potential participants. Of the 35% of individuals who were interested in the study, most were ineligible to participate because they lacked transportation to the clinic. Five individuals were eligible and enrolled in the study. All completed 100% of in-clinic sessions. Four participants rated their occupational performance higher after the LSVT BIG intervention. It is feasible to deliver the LSVT BIG in the chronic stroke population. Individuals who complete the protocol demonstrate clinically relevant improvements.

Use of Occupation-Based Measures in LSVT BIG Research: A Case Study.

Parkinson's disease (PD) is a neurodegenerative disorder that results in a variety of motor and nonmotor symptoms that impact occupational performance. To our knowledge, no study has investigated the effect of LSVT BIG using occupational performance outcome measures. The objective of this study was to determine the effects of LSVT BIG on occupational performance with an individual with PD. The participant, a 73-year-old retired female with mild PD, completed the LSVT BIG program. Researchers measured changes in occupational performance using the Canadian Occupational Performance Measure (COPM) and the Performance Assessment of Self-Care Skills (PASS). Results indicated improved client perceptions of occupational performance and satisfaction on the COPM and improved independence and adequacy on the PASS. Despite the positive findings of this study that support the use occupational performance measures to evaluate change within LSVT BIG literature, future research should be conducted to determine causality of identified occupational performance improvements and time course of improvements.

Lee Silverman Voice Treatment BIG® for a Person With Stroke.

The extant literature suggests the Lee Silverman Voice Treatment BIG® (LSVT BIG) program is an effective intervention for persons with Parkinson's disease; however, no literature or research on the use of this program as an intervention for persons with stroke exists. We examined the effects of the LSVT BIG program for a 52-yr-old community-dwelling woman with mild to moderate upper extremity hemiparesis 2 yr after a stroke and the feasibility of delivering the home exercise component of the program in a game-based format. We made measurements at pretest, posttest, and 6-wk follow-up. The participant demonstrated self-reported improvements in occupational performance and satisfaction and large improvements in upper extremity motor function. The next step in this research is to deliver LSVT BIG and a home game-based program with a larger, more diverse population of persons with chronic stroke to further determine the effectiveness and appropriateness of this intervention.

Reliability and validity of the Haitian Creole PHQ-9.

BACKGROUND: There is limited information on depression in Haitians and this is partly attributable to the absence of culturally and linguistically adapted measures for depression. OBJECTIVE: To perform a psychometric evaluation of the Haitian-Creole version of the PHQ-9 administered to men who have sex with men (MSM) in the Republic of Haiti. DESIGN: This study uses a cross-sectional design and data are from the Integrated Behavioral and Biological HIV Survey (IBBS) for MSM in Haiti. PARTICIPANTS: Inclusion criteria required that participants be male, ≥ 18 years, report sexual relations with a male partner in the last 12 months, and lived in Haiti during the past 3 months. Respondent Driven Sampling was used for participant recruitment. MAIN MEASURES: A structured questionnaire was verbally administered in Haitian-Creole capturing information on sociodemographics, sexual behaviors, human immunodeficiency virus (HIV) status and depressive symptomatology using the PHQ-9. Psychometric analyses of the translated PHQ-9 assessed unidimensionality, factor structure, reliability, construct validity, and differential item functioning (DIF) across subgroups (age, educational level, sexual orientation and HIV status). KEY RESULTS: In a study population of 1,028 MSM, the Haitian-Creole version of the PHQ-9 is unidimensional, has moderately high internal consistency reliability (α = 0.78), and shows evidence of construct validity where HIV-positive subjects have greater depression (p = 0.002). There is no evidence of DIF across age, education, sexual orientation or HIV status. HIV-positive MSM are twice as likely to screen positive for moderately severe and severe depressive symptoms compared to their HIV-negative counterparts. CONCLUSIONS: There is strong evidence for the psychometric adequacy of the translated PHQ-9 screening tool as a measure of depression with MSM in Haiti. Future research is necessary to examine the predictive validity of depression for subsequent health behaviors or clinical outcomes among Haitian MSM.