Adapting the Multiple Sclerosis Functional Composite for Telehealth Administration Using Videoconference Delivery: Methodological Considerations and Interrater Reliability.

Objective: To describe the adaptations made and to examine interrater reliability and feasibility of administering a telehealth version of the Multiple Sclerosis Functional Composite (tele-MSFC). Design: The Multiple Sclerosis Functional Composite (MSFC) is a commonly used, in-person clinical outcome assessment. It is composed of the timed 25-Foot Walk Test (T25FWT), Nine-Hole Peg Test (NHPT), and Paced Auditory Serial Addition Test (PASAT). The MSFC was adapted for videoconference administration as part of a larger clinical trial. One of the adaptations included administering a timed 12.5-Foot Walk Test (T12.5FWT) for participants who did not have adequate space in their homes for the T25FWT. Participants, examiners, and raters completed surveys online about their satisfaction and experience with tele-MSFC. Setting: Participants underwent the tele-MSFC in their homes using a laptop or smartphone while examiners scored the tele-MSFC in real-time at a remote location. Participants: Community-dwelling adults (n=61) with mild-to-moderate multiple sclerosis (MS) symptoms. Interventions: Not applicable. Main Outcome Measure: Tele-MSFC. Results: Intraclass correlation coefficients (ICC) assessed interrater reliability between the examiner and 2 independent raters who later scored a recording of the tele-MSFC. Interrater reliability was excellent (ICC>0.90) for all tests, including the T12.5FWT. Participants were highly satisfied with tele-MSFC. However, challenges included adequate space for T25FWT, technical difficulties, and safety and privacy considerations of individuals with moderate impairments who were requested to have their caregivers present during testing. Conclusion: The tele-MSFC is reliable and feasible to administer with adaptations for community-dwelling adults with mild to moderate MS symptoms. Further validation of T12.5FWT is needed.

The Revised American Occupational Therapy Association Fieldwork Performance Evaluations: Evaluation of Internal Structure, Response Processes, and Precision-Part 2.

IMPORTANCE: There is an evidence-based need to assess the validity and reliability/precision of the revised American Occupational Therapy Association's Fieldwork Performance Evaluation (FWPE) items for the occupational therapy student (OTS) and the occupational therapy assistant student (OTAS). OBJECTIVE: To evaluate evidence of validity in relation to response processes, internal structure, and precision of the FWPEs. DESIGN: Cross-sectional study design. SETTING: OTS and OTAS fieldwork practice settings, United States. PARTICIPANTS: Two hundred sixty-seven fieldwork educators participated in total, providing 228 OTS evaluations and 39 OTAS evaluations. OUTCOMES AND MEASURES: A Rasch model was used to evaluate aspects of validity and precision. RESULTS: The rating scales provided evidence of the tools' overall validity. Thirty-two of 37 items on the FWPE for the OTS, and 27 of 31 items on the FWPE for the OTAS demonstrated acceptable fit, but the evidence of unidimensionality in the subscales and in the total scales was not fully supported. The total/reduced FWPE scales were able to separate students into at least four distinct groups of fieldwork performance. The relationships between the current and revised FWPEs indicate that the new scales measure different but related constructs of student fieldwork performance, compared with the current version. CONCLUSIONS AND RELEVANCE: The findings support that the revised FWPEs for the OTS and OTAS demonstrate preliminary evidence of internal structure, response processes, and precision, supporting evidence-based practice in fieldwork evaluations. What This Article Adds: This article highlights evidence demonstrating the validity and precision of the revised American Occupational Therapy Association's Fieldwork Performance Evaluation items and supports academic and fieldwork settings for occupational therapy students and occupational therapy assistant students.

Occupational Therapy Practice Guidelines for Adults With Multiple Sclerosis.

IMPORTANCE: Occupational therapy practitioners play an important role in addressing the occupational performance and participation needs of adults with multiple sclerosis (MS) and their caregivers. OBJECTIVE: This Practice Guideline aims to help occupational therapy practitioners, as well as the people who manage, reimburse, or set policy regarding occupational therapy services, understand occupational therapy's role in providing services to adults with MS and their caregivers. This guideline can also serve as a reference for health care professionals, health care managers, educators, regulators, third-party payers, managed care organizations, and researchers. METHOD: We examined, synthesized, and integrated the results of four systematic reviews into clinical recommendations. Three systematic reviews specified occupational domains as outcomes of interest, and one focused on interventions for caregivers of people with MS. RESULTS: Twenty-one articles from the systematic reviews with strong or moderate strength of evidence served as the basis for the clinical recommendations. CONCLUSIONS AND RECOMMENDATIONS: Four interventions benefited participation in the domains of activities of daily living or sleep. Two interventions improved participation in the domain of instrumental activities of daily living. One intervention improved work participation. Two interventions benefited caregivers and the quality of the relationship between the caregiver and person with MS. Other potentially appropriate interventions or areas to address on the basis of existing or emerging evidence are discussed in the Limitations: Gaps in the Evidence and Conclusions sections. What This Article Adds: This Practice Guideline provides a summary and application of the current evidence supporting occupational therapy intervention for adults with MS. It includes case examples and decision-making algorithms to support occupational therapy practitioners in addressing client goals.

The Revised American Occupational Therapy Association Fieldwork Performance Evaluations: Evaluation of Content Validity-Part 1.

IMPORTANCE: Occupational therapy education and practice has changed over time; however, items on the American Occupational Therapy Association's (AOTA's) Fieldwork Performance Evaluations (FWPEs) for the Occupational Therapy Student (OTS) and Occupational Therapy Assistant Student (OTAS) have not been updated in more than two decades. OBJECTIVE: To explore evidence of validity in relation to test content of the revised FWPEs for the OTS and OTAS. DESIGN: A qualitative study using cognitive interviews was conducted to gather perspectives on the revised FWPEs, including updated items and a proposed rating scale. A content analysis approach was used to link patterns in responses to stable, meaningful constructs to further align and refine content of the tool before further validation. SETTING: Fieldwork sites and academic settings. PARTICIPANTS: Eighteen fieldwork educators (FWEs) and academic fieldwork coordinators. RESULTS: Seven areas for refinement were identified: (1) relevance to a variety of practice settings, (2) overlapping and redundant items, (3) long item statements, (4) double- and triple-barreled item statements, (5) alignment between OTS and OTAS items, (6) further alignment with AOTA and Accreditation Council for Occupational Therapy Education documents and contemporary practice, and (7) wording and features of the proposed rating scale. The findings guided revisions of FWPE content. CONCLUSIONS AND RELEVANCE: Cognitive interviewing was a critical step in refining the FWPE items to support content validity. The issues identified may not have been detected using traditional approaches to survey development and therefore were critical in maximizing the validity and usefulness of the final items, which will ultimately benefit fieldwork educators and students. WHAT THIS ARTICLE ADDS: This study resulted in refinements to FWPE items before the next step in the validation process, ultimately improving the final FWPE items. In addition, this article outlines a process that other researchers can use to validate similar tools.

Occupational Therapy Interventions for Adults With Multiple Sclerosis.

This Evidence Connection describes a case report of a woman with an exacerbation of multiple sclerosis (MS), applying the evidence for intervention from the systematic reviews on MS that were conducted in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice Project. The occupational therapy assessment and treatment processes for an inpatient rehabilitation setting are described. Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the AOTA's Evidence-Based Practice Project.

A Scholarship of Practice Revisited: Creating Community-Engaged Occupational Therapy Practitioners, Educators, and Scholars.

Trends in policy, practice, and research point to the need for a community-engaged Scholarship of Practice (SOP) model that can be used to inform the development of occupational therapy practitioners, educators, and researchers. This article describes a community-engaged SOP model, the evidence justifying the need for such a model, and strategies to effectively create community-engaged practitioners, educators and career scientists within occupational therapy. We highlight several examples of community-based participatory research to further inform this model, and in turn, translate this knowledge back to communities for action and systems change that can affect the lives of people with disabilities and the communities in which they seek to live and participate long term.

Role for Occupational Therapy in Community Mental Health: Using Policy to Advance Scholarship of Practice.

Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.

Goals set after completing a teleconference-delivered program for managing multiple sclerosis fatigue.

Setting goals can be a valuable skill to self-manage multiple sclerosis (MS) fatigue. A better understanding of the goals set by people with MS after completing a fatigue management program can assist health care professionals with tailoring interventions for clients. This study aimed to describe the focus of goals set by people with MS after a teleconference-delivered fatigue management program and to evaluate the extent to which participants were able to achieve their goals over time. In total, 485 goals were set by 81 participants. Over a follow-up period, 64 participants rated 284 goals regarding progress made toward goal achievement. Approximately 50% of the rated goals were considered achieved. The most common type of goal achieved was that of instrumental activities of daily living. Short-term goals were more likely to be achieved. This study highlights the need for and importance of promoting and teaching goal-setting skills to people with MS.

Facilitating a teleconference-delivered fatigue management program: perspectives of occupational therapists.

BACKGROUND: Telehealth refers to the provision of health information and services across a geographical distance. Little is known about the experiences of occupational therapists using this method of service delivery. PURPOSE: The study explored the process of facilitating a telehealth intervention from the perspective of occupational therapists. METHOD: Occupational therapists completed SOAP (Subjective, Objective, Assessment, and Plan) notes after facilitating group-based, teleconference-delivered fatigue management groups to people with multiple sclerosis. Notes were also documented after therapist team meetings. All SOAP notes and field notes were subjected to thematic analysis. FINDINGS: Five major themes were identified. "Managing time" was the central theme and was facilitated by professional foundation and challenged by logistics. Managing time contributed to challenging work, which led to the realization that it can work! IMPLICATIONS: Based on study findings, the theory and research on clinical reasoning, professional development, and adult learning are relevant to developing curricula that prepare occupational therapists for using telehealth approaches in practice.

Impact of comorbidity on fatigue management intervention outcomes among people with multiple sclerosis: an exploratory investigation.

This exploratory secondary analysis examined whether the presence of six chronic health conditions moderated the effectiveness of a teleconference-delivered fatigue self-management education program for people with multiple sclerosis (MS). The longitudinal data used were from a randomized controlled trial involving 181 community-dwelling adults with MS. The primary outcome was fatigue impact, as measured by the Fatigue Impact Scale (FIS). Mixed-effects analysis of variance (ANOVA) models were used to determine the best-fitting model. Just under 65% (n = 112) of participants had at least one comorbid condition. Only diabetes and arthritis moderated all three FIS subscales over time. People with diabetes were slower to show improvement after intervention than people without diabetes. People with arthritis made much more dramatic initial gains compared with people without arthritis but had difficulty maintaining those gains over time. The results point to the need for greater attention to the impact of comorbidities on rehabilitation interventions. These exploratory findings suggest that fatigue self-management education protocols may need to be customized to people who are trying to incorporate MS fatigue self-management behaviors while simultaneously managing diabetes or arthritis.

Outcome moderators of a fatigue management program for people with multiple sclerosis.

OBJECTIVE: We determined whether age, gender, work status, or impairment moderated fatigue management program outcomes for people with multiple sclerosis (MS). METHOD: We conducted a secondary analysis of longitudinal data from a randomized controlled trial using mixed-effects models (N = 181) and examined outcomes of fatigue impact, mental health, physical health, and self-efficacy. Measures were collected before and immediately after intervention and at 6 wk, 3 mo, and 6 mo postintervention. RESULTS: Younger participants experienced greater reductions in fatigue impact and greater improvements in self-efficacy over time than did older participants, but we found no age differences in physical or mental health. Participants with less impairment experienced greater mental health gains and were more likely to retain these gains over time than were participants with greater impairment. Although women experienced greater fatigue impact benefits, men experienced greater mental health benefits. Work status did not moderate outcomes. CONCLUSION: Fatigue management program outcomes for people with MS are moderated by age, gender, and impairment.

Recruiting for caregiver education research: perspectives of caregivers of people with multiple sclerosis.

Caregiver education programs can support participants in a role that is often challenging. Research is needed to determine the effectiveness of these programs; however, recruitment for such studies can be difficult. The objectives of this study were to explore 1) how multiple sclerosis (MS) caregivers respond to recruitment materials for a research study evaluating a caregiver education program, including aspects of the materials that encourage or discourage their interest in participation; and 2) what recommendations MS caregivers have for improving study recruitment advertising. Qualitative interviews were conducted with seven MS caregivers. Participants were asked about their reactions to advertisements for a pilot study intended to evaluate an MS caregiver education program. Participants were also asked to reflect on factors that would influence their decision to participate in the program and to provide suggestions to improve recruitment materials. Data were analyzed using a constant-comparative approach. Study findings indicated that the language and visual design of the advertisements influenced the participants' initial responses. Some caregivers first responded to the fact that the program was part of a research study, and these caregivers had overall negative responses to the advertising, such as concern that the program was being "tested." Other caregivers first considered the personal relevance of the program. These caregivers had neutral-to-positive responses to the flyers and weighed the relevance of the program against the research and logistical aspects. Participants provided recommendations to improve the recruitment materials. While recruiting for caregiver education research can be challenging, piloting recruitment materials and using a variety of advertising options may improve response.

Randomized trial of a teleconference-delivered fatigue management program for people with multiple sclerosis.

BACKGROUND: Previous studies support the efficacy and effectiveness of face-to-face group-based fatigue management education for people with multiple sclerosis (MS). Nevertheless, many people are unable to access these programs due to environmental barriers. OBJECTIVES: To test the efficacy and effectiveness of a group-based, teleconference-delivered fatigue management program for people with MS. METHODS: A randomly allocated two-group time series design with a wait-list control group was used. In total 190 participants were allocated (94 intervention, 96 wait-list control). Primary outcomes (fatigue impact, fatigue severity, health-related quality of life (HRQOL)) were measured before, immediately after, at 6 weeks, 3 months, and 6 months post. Secondary outcome (self-efficacy) was measured at the same points. Effectiveness (intent-to-treat) and efficacy (per protocol) analyses were conducted. RESULTS: The program was more effective and efficacious than control for reducing fatigue impact but not fatigue severity. Before and after comparisons with the pooled sample demonstrated efficacy and effectiveness for fatigue impact, fatigue severity, and 6 of 8 HRQOL dimensions. Changes were maintained for 6 months with small to moderate effect sizes. CONCLUSION: The results offer strong support for the viability of teleconference-delivered fatigue management education for enabling people with MS to manage this disabling symptom.

Use of the Occupational Therapy Task-Oriented Approach to optimize the motor performance of a client with cognitive limitations.

This case report describes the use of the Occupational Therapy Task-Oriented Approach with a client with occupational performance limitations after a cerebral vascular accident. The Occupational Therapy Task-Oriented Approach is often suggested as a preferred neurorehabilitation intervention to improve occupational performance by optimizing motor behavior. One common critique of this approach, however, is that it may seem inappropriate or have limited application for clients with cognitive deficits. This case report demonstrates how an occupational therapist working in an inpatient rehabilitation setting used the occupational therapy task-oriented evaluation framework and treatment principles described by Mathiowetz (2004) with a person with significant cognitive limitations. This approach was effective in assisting the client in meeting her long-term goals, maximizing her participation in meaningful occupations, and successfully transitioning to home with her daughter.

Development of an educational programme for caregivers of people aging with multiple sclerosis.

This article describes a three-phase project to identify and develop an occupational therapy response to the challenges experienced by caregivers of middle-aged and older adults with multiple sclerosis (MS). In Phase 1 302 caregivers of middle-aged and older adults with MS were interviewed by telephone to identify the care-giving challenges they experienced. A total of eight challenges were identified, with the four most prevalent ones including finding and using formal support services, managing the emotional aspects of caregiving, doing the physical aspects of care-giving and dealing with informal supports. In Phase 2 a comprehensive literature review was conducted to identify existing caregiver education programmes that could be used to address these challenges. None of the 21 programmes that were located addressed all of the challenges identified through the Phase 1 interviews. In response, a new five-session psycho-educational group programme entitled 'Meeting the Challenges of MS' was developed in Phase 3. The programme was empirically grounded in Phase 1 findings, and drew on theory to guide group process and sequencing. The findings from Phases 1 and 2 and the resulting programme cannot be generalized to caregivers of younger adults with MS, although the steps taken to develop this programme have the potential for replication with other populations served by occupational therapists.