Longitudinal change in parent postsecondary expectations for youth with disabilities.

PURPOSE: Expectations held by parents of youth with disabilities contribute to decision making and planning for adulthood. This study investigated longitudinal stability of parent expectations about the transition to adulthood for youth with disabilities (i.e., likelihood of obtaining postsecondary education, living independently, becoming financially self-sufficient) and how the stability of parent expectations was related to adult outcomes. MATERIALS AND METHODS: Participants were parents of 3640 youth who participated in the National Longitudinal Transition Study-2 (NLTS2) waves 1 and 2 and had available data related to parent expectations. RESULTS: Parent expectations were moderately correlated across waves; however, over one-third of parents changed their expectations across waves, including directional shifts (e.g., changing from thinking they probably will achieve the outcome to probably will not achieve it). Directional shifts in parent expectations between waves 1 and 2 significantly predicted young adult outcomes at wave 5. The children of parents who demonstrated uncertainty, as indicated by directional expectation shifts, were less likely live independently as young adults. Family involvement in the transition process is critical and should continue to be advocated for in both policy and practice. Improved supports may be warranted for families who experience uncertainty.Implications for rehabilitationPractitioners should recognize that parents of youth with disabilities have expectations for their child's transition to adulthood that may change over time and are influenced by factors such as youth age, disability classification, gender, and socioeconomic status.The ways parents' expectations change over time may have lasting implications for their child; specifically, we identified that youth of parents who change their expectations negatively (by shifting to expect less independence) are less likely to attain certain adult milestones.Parents experiencing uncertainty about their youths' postsecondary potential may require additional support and resources to understand their child's strengths and challenges, consider available services, and ultimately to promote more independent outcomes for the youth.

Differences in Youth and Parent Postsecondary Expectations for Youth with Disabilities.

BACKGROUND: Parent expectations are known to be significant predictors of postsecondary outcomes among youth with disabilities. However, little is known about the relationship between parent and youth expectations and their differential prediction of postsecondary outcomes among youth with disabilities. OBJECTIVE: To determine the relationship between parent and youth expectations among students with disabilities in the United States. METHODS: Through analysis of the National Longitudinal Transition Study-2 (NLTS2), we compared wave two parent and youth expectations across disability categories (N=1,940) and explored the extent to which they predicted youth postsecondary outcomes. RESULTS: We identified that parent and youth expectations are related but significantly different, with parents consistently holding less independent expectations than youth. Both parent and youth expectations were identified as significant predictors of postsecondary outcomes, with youth expectations more strongly predicting education and independent living outcomes, and parent expectations more strongly predicting employment and Social Security benefit outcomes. CONCLUSIONS: Transition providers should work with parents and youth to develop collaborative goals and expectations to best support youth with disabilities for independent activities in adulthood.

Thoroughness and Psychometrics of Fidelity Measures in Occupational and Physical Therapy: A Systematic Review.

OBJECTIVE: This study evaluated the thoroughness and psychometric properties of fidelity measures used by or of relevance to occupational or physical therapy. METHOD: A systematic review of the literature was completed. Assessments used to measure occupational or physical therapy intervention fidelity were evaluated for thoroughness, reliability, validity, and clinical utility. RESULTS: Eight fidelity measures met inclusion criteria for this systematic review. Most of the measures had moderate levels of thoroughness in the coverage of key aspects of fidelity, reported adequate to excellent reliability and validity, and were highly variable in clinical utility. CONCLUSION: Additional research is recommended to validate existing occupational or physical therapy fidelity measures and to develop novel measures for other occupational therapy and physical therapy interventions. Clinicians and researchers must place greater emphasis on the development and implementation of fidelity measures to ensure uniformity in intervention delivery and high-quality, evidence-based care.

Ohio Modified Arm-Motor Ability Test (OMAAT): An Optimized Measure of Upper Extremity Functional Limitation in Hemiparetic Stroke.

This secondary analysis quantified the psychometric properties of the Ohio Modified Arm-Motor Ability Test (OMAAT) in a sample of neurologically stable chronic stroke survivors (n = 67, 40 men; mean age 59.8 yr, standard deviation = 12.8; 42 White, 23 Black, 2 other; 92.5% right-sided lesion; 44 ischemic stroke). Findings indicate high OMAAT internal consistency (Cronbach's α = .97, ordinal α = .98, Gugiu's bootstrap reliability = .97), unidimensionality, and strong positive factor loadings for all 20 OMAAT items. Convergent validity between OMAAT and Action Research Arm Test total scores was strong (r = .90, p < .0001). The OMAAT is the first short measure of upper extremity functional limitation available to clinicians and researchers that includes an administration manual and that has been examined using nonparametric psychometrics. A detailed administration manual is provided as a supplement to this article.

Characteristics of Students Receiving Occupational Therapy Services in Transition and Factors Related to Postsecondary Success.

OBJECTIVE: This study had a twofold purpose: (1) identify the characteristics of people with disabilities who received occupational therapy services during their transition to adulthood and (2) determine factors associated with their successful postsecondary transition. METHOD: This study was a secondary analysis of National Longitudinal Transition Study-2 data. Data analyses include descriptive statistics, binary logistic regression, and simple linear regression. RESULTS: Autism, cerebral palsy, and intellectual disability were the most commonly reported disability classifications. Participation in postsecondary education was significantly associated with functional use of arms and hands. Postsecondary employment was significantly associated with verbal comprehension. Participation in community activities was significantly related to students' health status, and participation in community service was significantly related to students' functional use of arms and hands. CONCLUSION: Providing transition services to students with disabilities remains an emerging area of practice. Occupational therapy practitioners may contribute to transition teams by intervening to improve functional abilities and health status.

Development and Psychometric Evaluation of the Vocational Fit Assessment (VFA).

OBJECTIVE: The objective of this study was to determine the psychometric properties of the Vocational Fit Assessment (VFA) by examining its factor structure and subscale reliability. METHOD: This prospective cross-sectional study used two surveys (one for worker abilities and one for job demands) to collect the data needed for the psychometric evaluation of the VFA. Latent parallel analysis and ordinal exploratory factor analysis were used to iteratively refine VFA subscales. RESULTS: Ten unidimensional subscales emerged from factor analysis of VFA items: (1) Cognitive Abilities, (2) Communication Skills, (3) Computer Skills, (4) Higher Task-Related Abilities, (5) Interpersonal Skills, (6) Lower Task-Related Abilities, (7) Physical Abilities, (8) Safety, (9) Self-Determination, and (10) Work Structure. Subscale internal consistency (ordinal α) was ≥.86 for VFA for worker abilities and ≥.77 for VFA for job demands. CONCLUSION: The unidimensional structure of VFA subscales and estimates of internal consistency lend initial evidence in support of their reliability and validity.

Healthy Habits for Children: Leveraging Existing Evidence to Demonstrate Value.

Healthy habits is a psychoeducational construct that refers to the preventive practice of analyzing and then adapting the sleep, physical, and eating routines of children in ways that enhance health and well-being. This approach is based on evidence that demonstrates the positive therapeutic value of engaging in proactive, healthful behaviors. In addressing healthy habits, occupational therapy practitioners have an opportunity to contribute to the Triple Aim of health care reform while demonstrating the value of occupational therapy in educational, medical, community, and other settings.

Rasch Analysis of the Wrist and Hand Fugl-Meyer: Dimensionality and Item-Level Characteristics.

BACKGROUND AND PURPOSE: Clinical administration of the wrist stability, wrist mobility, and hand items of the upper-extremity Fugl-Meyer (W/H UE FM) may provide a rigorous, easily administered, bedside measure of motor impairment in mildly impaired stroke survivors. The purpose of this study was to evaluate the item structure of the W/H UE FM to better understand its measurement properties using Rasch analysis. METHODS: This was a secondary analysis of W/H UE FM data arising from clinical trials of mildly impaired stroke survivors using latent parallel analysis, ordinal factor analysis, and partial credit model Rasch analyses. RESULTS: Latent parallel analysis and ordinal factor analysis indicated that all W/H UE FM items represent a single unidimensional construct, wrist and hand motor ability. Rasch analysis of data from 150 mildly impaired stroke survivors (94 men; mean age, 57.1 ± 11.4 years; mean time since stroke, 19.5 months) revealed that the W/H UE FM operated as a reliable, valid, and effective measure of wrist and hand motor ability. These data were compatible with Rasch model assumptions and are consistent with previous W/H UE FM research. Mass flexion and extension movements were the least difficult W/H UE FM items while the radial and hook grasp items were the most difficult. DISCUSSION AND CONCLUSION: The W/H UE FM is well suited to mildly impaired stroke survivors who exhibit the ability to perform mass flexion and mass extension movements. The full-scale UE FM may be preferable for stroke survivors with lower levels of ability.Video abstract available for additional insight from the authors (Supplemental Digital Content 1, http://links.lww.com/JNPT/A108).

P4 medicine and pediatric occupational therapy.

Pediatric occupational therapy practitioners face a complex and ever-changing health care environment, creating many challenges and opportunities. P4 medicine is a systems approach to health care that emphasizes proactive wellness over reactive acute care disease management. The four Ps of P4 medicine stand for predictive, personalized, preventive, and participatory, concepts that align well with the practice of pediatric occupational therapy. P4 medicine offers a model for pediatric occupational therapy practitioners to demonstrate the value of occupational therapy services.

Protocol development, treatment fidelity, adherence to treatment, and quality control.

Occupational therapy leaders have emphasized the importance of intervention effectiveness research. The CONSORT and TREND checklists have been suggested as useful tools for reporting the results of randomized and nonrandomized studies, respectively. Despite such recommendations, research protocols and reports continue to underutilize the available tools, a situation reflecting limited resources for and experience with the conduct of effectiveness research. To address this issue, and using the CONSORT statement to structure the analysis, this article discusses strategies for optimization of protocol development, treatment fidelity, adherence to treatment, and quality control. We recommend several approaches to increase the quality of research throughout these various processes. Examples of implementation from our laboratory provide evidence of the utility of these strategies.

Recruitment, retention, and blinding in clinical trials.

The recruitment and retention of participants and the blinding of participants, health care providers, and data collectors present challenges for clinical trial investigators. This article reviews challenges and alternative strategies associated with these three important clinical trial activities. Common recruiting pitfalls, including low sample size, unfriendly study designs, suboptimal testing locations, and untimely recruitment are discussed together with strategies for overcoming these barriers. The use of active controls, technology-supported visit reminders, and up-front scheduling is recommended to prevent attrition and maximize retention of participants. Blinding is conceptualized as the process of concealing research design elements from key players in the research process. Strategies for blinding participants, health care providers, and data collectors are suggested.

Paretic upper extremity movement gains are retained 3 months after training with an electrical stimulation neuroprosthesis.

OBJECTIVE: To determine retention of upper extremity (UE) motor changes 3 months after participation in a regimen in which subjects with moderate UE hemiparesis engaged in repetitive task-specific training using an electrical stimulation neuroprosthesis (ESN). DESIGN: Prospective, blinded, cohort, pre-post study. SETTING: Outpatient rehabilitation hospital. PARTICIPANTS: Individuals (N=24) in the chronic stage of stroke exhibiting stable UE hemiparesis (11 men; mean age, 57.9±9.5y; age range, 39-75y; mean time since stroke at time of repetitive task-specific practice [RTP] using ESN intervention start, 36.7mo; range of onset, 7-162mo). INTERVENTION: As part of a larger trial, subjects had been randomly assigned to receive an 8-week regimen comprised of RTP on valued activities using the ESN. This observational study assessed this single group's paretic UE motor levels immediately after, and 3 months after, the intervention. MAIN OUTCOME MEASURES: The Fugl-Meyer (FM) assessment of sensorimotor impairment, the Action Research Arm Test (ARAT), the Arm Motor Ability Test (AMAT), and the Box and Block Test (BBT). RESULTS: None of the scores significantly changed from the period directly after intervention to the test 3-months follow-up (FM: t=1.64; ARAT: t=2.17; AMAT: t=.76, .92, and 1.01 for the functional ability, quality of movement, and time scales, respectively; BBT: t=.36; adjusted t critical value to reject the null [t(crit)]=2.90, 2-tailed α=.008 to preserve experiment-wise error rate of .05). CONCLUSIONS: Subjects exhibited no changes in the various functional tests, indicating that changes in paretic UE movement realized through RTP using ESN appear to be retained 3 months after the intervention has concluded. This was the first study to our knowledge to examine the longer-term effects of RTP using an ESN in any population.