Three Perspectives on Older Adults' Daily Performance, Health, and Technology Use During COVID-19: Focus Group Study.

Background: During COVID-19 lockdowns, older adults' engagement in daily activities was severely affected, causing negative physical and mental health implications. Technology flourished as a means of performing daily activities in this complex situation; however, older adults often struggled to effectively use these opportunities. Despite the important role of older adults' social environments-including their families and health professionals-in influencing their technology use, research into their unique perspectives is lacking. Objective: This study aimed to explore the daily activity performance, health, and technology use experiences of healthy independent Israeli adults (aged ≥65 years) during COVID-19 from a 3-dimensional perspective: older adults, older adults' family members, and health professionals. Methods: Nine online focus groups, averaging 6-7 participants per group, were conducted with older adults, family members, and health professionals (N=59). Data were analyzed using thematic analysis and constant comparative methods. Results: The intertwining of daily activity performance and health emerged as a central theme, with differences between the groups. Older adults prioritized their self-fulfilling routines based on motivation and choice, especially in social-familial activities. In contrast, family members and health professionals focused on serious physical and mental health COVID-19-related consequences. A consensus among all three groups revealed the meaningful role of technology use during this period in bridging functional limitations. Participants delved into technology's transformative power, focusing on the need for technology to get engaged in daily activities. Conclusions: This study illustrates the profound interplay between daily activity performances, physical and mental health, and technology use, using a 3-dimensional approach. Its focus on technology's uses and benefits sheds light on what older adults need to increase their technology use. Interventions for improving digital activity performance can be tailored to meet older adults' needs and preferences by focusing on motivational and preference-related activities.

Daily Functional Characteristics and Health Among Older Adults During COVID-19: A Structural Equation Modeling Approach.

Within a few years, 1 in 6 people will be aged 60 years or older. Extreme situations, such as the COVID-19 crisis, constitute a challenge to older adults. However, the literature on the daily functional characteristics of older adults in the past and during the COVID-19 crisis and their relationships to their physical and mental health is scarce. This study aimed to examine the past and present daily functional factors associated with physical and mental health in older adults. Using an online platform, 204 Israelis aged 60 years and older reported their physical health symptoms and anxiety levels. They completed questionnaires about past (negative life events and childhood daily functional self-actualization) and present (adulthood daily functional self-actualization, functional cognition and sleep quality) factors. Structural equation modeling revealed correlations between functional cognition and childhood daily functional self-actualization (ß = -.18) and anxiety (ß = .15); adulthood daily functional self-actualization and past negative life events (ß = -.18), anxiety (ß = -.50), and physical symptoms (ß = -16); and sleep quality and past childhood daily functional self-actualization (ß = -.19), negative life events (ß = .22), anxiety (ß = .18), and physical symptoms (ß = .40). These findings shed light on potential functional factors for older adults' health, indicating that these functional factors play a vital role in reducing health problems in later life.

"You Need to Set a Daily Schedule": Understanding Successful Aging via Three-Sided Viewpoints.

This study aimed to identify the constructs related to successful aging in the context of engagement in social and productive activities. A qualitative design was used to explore three viewpoints on the aging period with 9 focus groups (3 each for adults 65 years or older, older adults' family members, and health professionals) and 18 interviews with older adults (older adults Mage = 71.7 years, Standard Deviation = 4.62). The transcripts were analyzed using constructivist grounded theory principles. Three categories were identified for successful aging: (a) engagement with life, including social participation, fixed/flexible schedule, time, and meaningful occupation; (b) self-management abilities, including producing daily schedules, independence, and initiation/striving toward goals; and (c) diversity among older adults, including their views on retirement, being active or not, and their dreams/values/goals. Considering the diverse nature of older adults, recognizing the importance of life engagement and self-management abilities emphasizes the necessity for an occupation-based, self-tailored approach to enable successful aging.

Achieving trust in health-behavior-change artificial intelligence apps (HBC-AIApp) development: A multi-perspective guide.

OBJECTIVE: Trust determines the success of Health-Behavior-Change Artificial Intelligence Apps (HBC-AIApp). Developers of such apps need theory-based practical methods that can guide them in achieving such trust. Our study aimed to develop a comprehensive conceptual model and development process that can guide developers how to build HBC-AIApp in order to support trust creation among the app's users. METHODS: We apply a multi-disciplinary approach where medical informatics, human-centered design, and holistic health methods are integrated to address the trust challenge in HBC-AIApps. The integration extends a conceptual model of trust in AI developed by Jermutus et al., whose properties guide the extension of the IDEAS (integrate, design, assess, and share) HBC-App development process. RESULTS: The HBC-AIApp framework consists of three main blocks: (1) system development methods that study the users' complex reality, hence, their perceptions, needs, goals and environment; (2) mediators and other stakeholders who are important for developing and operating the HBC-AIApp, boundary objects that examine users' activities via the HBC-AIApp; and (3) the HBC-AIApp's structural components, AI logic, and physical implementation. These blocks come together to provide the extended conceptual model of trust in HBC-AIApps and the extended IDEAS process. DISCUSSION: The developed HBC-AIApp framework drew from our own experience in developing trust in HBC-AIApp. Further research will focus on studying the application of the proposed comprehensive HBC-AIApp development framework and whether applying it supports trust creation in such apps.

Children with ADHD Symptomatology: Does POET Improve Their Daily Routine Management?

Children with attention-deficit/hyperactivity disorder (ADHD) struggle with executive delays while managing their daily tasks. This is a secondary analysis of existing data from open-label research examining the efficacy of Parental Occupational Executive Training (POET). It further examines POET's efficacy in increasing young children's (3.83 to 7.08 years) executive control over daily routines, and in decreasing their ADHD symptoms. Additionally, the second analysis investigates which of the children's increased capabilities is better associated with the change in their daily routine management following the intervention. Parents of children with ADHD symptomatology (N = 72, 55 boys) received eight POET sessions. They completed standardised ADHD symptomatology, executive management of daily routines, and executive functions (EF) questionnaires at pretest, post-test, and 3-month follow-up. Children's ADHD symptoms and their management of daily routines significantly improved following the POET intervention. The children's score changes in EF accounted for 37% of the variance in their improved routine management. These findings suggest that interventions aiming to increase children's executive control over their daily routines should improve their broader array of EF besides decreasing core ADHD symptoms.

Using machine learning to modify and enhance the daily living questionnaire.

The Daily Living Questionnaire (DLQ) constitutes one of a number of functional cognitive measures, commonly employed in a range of medical and rehabilitation settings. One of the drawbacks of the DLQ is its length which poses an obstacle to conducting efficient and widespread screening of the public and which incurs inaccuracies due to the length and fatigue of the subjects. Objective: This study aims to use Machine Learning (ML) to modify and abridge the DLQ without compromising its fidelity and accuracy. Method: Participants were interviewed in two separate research studies conducted in the United States of America and Israel, and one unified file was created for ML analysis. An ML-based Computerized Adaptive Testing (ML-CAT) algorithm was applied to the DLQ database to create an adaptive testing instrument-with a shortened test form adapted to individual test scores. Results: The ML-CAT approach was shown to reduce the number of tests required on average by 25% per individual when predicting each of the seven DLQ output scores independently and reduce by over 50% when predicting all seven scores concurrently using a single model. These results maintained an accuracy of 95% (5% error) across subject scores. The study pinpoints which DLQ items are more informative in predicting DLQ scores. Conclusions: Applying the ML-CAT model can thus serve to modify, refine and even abridge the current DLQ, thereby enabling wider community screening while also enhancing clinical and research utility.

Basic Activity of Daily Living Evaluation of Children with Autism Spectrum Disorder: Do-Eat Washy Adaption Preliminary Psychometric Characteristics.

This preliminary study aims to demonstrate the reliability and validity of the adapted Do-Eat Basic activities of daily living (BADL) assessment for children with autism spectrum disorder (ASD). Participants were 53 children ages 6-10 years: 17 diagnosed with high-severity ASD (HS-ASD) and 16 with low-severity ASD according to the DSM-5 and based on the CARS-2, and 20 controls with typical development. Measurement tools were the adapted Do-Eat Washy (Washy), Participation in Childhood Occupations Questionnaire (PICO-Q), and Pediatric Evaluation of Disability Inventory (PEDI). The Washy domains exhibited high internal consistency (α = 0.841-0.856). Significant differences were found between the HS-ASD and other groups in the Washy domains, exhibiting discriminant validity. The Washy convergent and concurrent validity indicated good results. A highly substantial negative correlation was shown between the Washy and three PICO-Q ADL difficulty-in-performance items (p < 0.001): bathing (-0.550), hygiene (-0.571), and handwashing (-0.733). The Washy performance scores and the PEDI total score demonstrated a strong correlation. (r = 0.799, p < 0.001). Primary results indicate that, following further research on larger representative samples, the Washy may be a reliable and valid tool for assessing BADL among children with ASD.

Work-MAP Telehealth Metacognitive Work-Performance Intervention for Adults With ADHD: Randomized Controlled Trial.

The literature highlighted the need for evidence-based occupational therapy teleinterventions to improve work participation among adults with attention-deficit/hyperactivity disorder (ADHD). This study aimed to assess the efficacy of a self-tailored, metacognitive, telehealth intervention to enhance the performance of adults with ADHD at work (Work-MAP). The outcome measures were efficacy and satisfaction with performing self-selected work goals, executive functions, and quality of life. Participants in this randomized controlled trial were 46 adults with ADHD. Group A (n = 31) received the synchronous, hybrid-telehealth intervention in 11-weekly 1-hour individual sessions. Group B (n = 15) completed the intervention after a waiting phase. Following the intervention, participants showed and maintained significant improvements in all outcome measures (strong-to-moderate significant effects) to the 3-month follow-up. The Work-MAP teleintervention appears effective for improving work participation (i.e., performance), executive functions, and quality of life of adults with ADHD.

The development of a home-based technology to improve gait in people with Parkinson's disease: a feasibility study.

BACKGROUND: People with Parkinson's disease (PwP) may experience gait impairment and freezing of gait (FOG), a major cause of falls. External cueing, including visual (e.g., spaced lines on the floor) and auditory (e.g., rhythmic metronome beats) stimuli, are considered effective in alleviating mobility deficits and FOG. Currently, there is a need for a technology that delivers automatic, individually adjusted cues in the homes of PwP. The aims of this feasibility study were to describe the first step toward the development of a home-based technology that delivers external cues, test its effect on gait, and assess user experience. METHODS: Iterative system development was performed by our multidisciplinary team. The system was designed to deliver visual and auditory cues: light stripes projected on the floor and metronome beats, separately. Initial testing was performed using the feedback of five healthy elderly individuals on the cues' clarity (clear visibility of the light stripes and the sound of metronome beats) and discomfort experienced. A pilot study was subsequently conducted in the homes of 15 PwP with daily FOG. We measured participants' walking under three conditions: baseline (with no cues), walking with light stripes, and walking to metronome beats. Outcome measures included step length and step time. User experience was also captured in semi-structured interviews. RESULTS: Repeated-measures ANOVA of gait assessment in PwP revealed that light stripes significantly improved step length (p = 0.009) and step time (p = 0.019) of PwP. No significant changes were measured in the metronome condition. PwP reported that both cueing modalities improved their gait, confidence, and stability. Most PwP did not report any discomfort in either modality and expressed a desire to have such a technology in their homes. The metronome was preferred by the majority of participants. CONCLUSIONS: This feasibility study demonstrated the usability and potential effect of a novel cueing technology on gait, and represents an important first step toward the development of a technology aimed to prevent FOG by delivering individually adjusted cues automatically. A further full-scale study is needed. Trial registration This study was registered in ClinicalTrials.gov at 1/2/2022 NCT05211687.

Development and pilot test of a pregnancy decision making tool for women with physical disabilities.

OBJECTIVE: Design and pilot test a new decision making tool for women with physical disabilities (impairment of physical function due to chronic conditions) considering pregnancy. DATA SOURCES AND STUDY SETTING: Quantitative surveys and qualitative interviews were collected from participants living in the community. STUDY DESIGN: Clinical guidelines and survey and focus group data about pregnancy informational and decisional needs guided content development. The tool was pilot tested in a 12-week trial with participants with physical disabilities considering or actively planning a pregnancy. Feasibility outcomes were acceptability, implementation, and demand (collected at end of the trial); preliminary efficacy focused on decisional conflict and readiness (baseline, 6 weeks, and end of trial). DATA COLLECTION: Survey data were collected using an online form. One-on-one interviews were conducted to learn more about experience using the tool. PRINCIPAL FINDINGS: Thirty eight participants with mild, moderate, or severe physical disabilities participated. Feasibility outcomes indicated that the tool provided participants with information, guiding questions, and helped them to consider multiple aspects of the decision about pregnancy. Most participants responded positively to the new decision making tool, finding it easy to use and the information balanced. Feedback highlighted opportunity for improvement, such as more specific information, peer stories, and the limitations of a paper format. There was significant linear effect of time, with increased decisional certainty and readiness, values clarity, and decisional support (partial η2 [90% CI] = 0.310 [0.08, 0.46], 0.435 [0.19, 0.60], 0.134 [0, 0.29], 0.178 [0.01, 0.35], respectively). Decisional certainty and readiness had high observed power (96.7% and 99.3%, respectively) with lower observed power for clarity and support (60.6% and 75.1%, respectively). CONCLUSIONS: The new tool shows promise for supporting women with physical disabilities in navigating pregnancy decision making. Future development of complementary strategies to support health care providers will help improve shared decision making and patient-centered care.

Early identification of subjective cognitive functional decline among patients with Parkinson's disease: a longitudinal pilot study.

Practical methods for early identification of Parkinson's disease (PD) mild cognitive impairment (PD-MCI) through changes in real-life daily functioning are scarce. The aim of the study was to examine whether the cognitive functional (CF) feature, comprising of seven self-reported Movement Disorder Society's (MDS) Unified Parkinson's Disease Rating Scale (UPDRS) items, predicts PD patients' cognitive functional status after a year. We conducted a 1-year follow-up of 34 PD patients (50-78 year; 70.6% men) suspected of MCI using the following measures: the MDS-UPDRS, UPDRS-CF feature, Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), Parkinson's Disease Cognitive Functional Rating Scale (PD-CFRS), and Daily Living Questionnaire (DLQ). The first and second UPDRS-CF feature scores, and additional measures at the 1-year follow-up significantly correlated. Hierarchical regression revealed that the initial MoCA, TMT, and BDI scores predicted the second UPDRS-CF, and the first UPDRS-CF predicted 31% of the second PD-CFRS score variance. Depression moderated the relationship between the first UPDRS-CF score and the DLQ Part A. These results suggest practical, self-reported, daily functional markers for identifying gradual decline in PD patients. They consider the patients' heterogeneity, underlying cognitive pathology, and implications on daily functioning, health, and well-being.

Children Who Experience Unintentional Injuries: Their Functional Profiles.

Unintentional injuries are accidents that pose a major health problem among school children. This study compared the functional behavior and executive function characteristics of school-aged children who experienced unintentional injuries with those of controls who had not been injured. We investigated the background characteristics of injured children, injury characteristics, and parents' perceptions of the children's functional behaviors and executive function abilities. The study included 53 children aged 6 years to 18 years. Of them, 32 had experienced unintentional injuries. The 21 children who had not experienced unintentional injuries served as a control group matched for age and living environment. Parents of both groups completed (1) a demographic questionnaire addressing their children's background, daily functional behavior characteristics, and injury characteristics and (2) the Behavior Rating Inventory of Executive Function (BRIEF). Sixty percent of the children in the research (injured) group had been prediagnosed with learning disabilities or attention deficit hyperactivity disorders, compared with no child in the control (uninjured) group. Most injuries were limb fractures (60%) and sustained outside the home (50%). Parents of children who had been injured expressed significantly more concerns about their children's daily behavior than did parents of the control group and reported their children as usually, but not always, independent and responsible. Compared with the children in the uninjured group, the children in the injured group had significantly lower executive function abilities in the BRIEF's eight subscales, total behavioral regulation and metacognitive indices, and global executive function scores (p < .001). Children with certain diagnoses, functional behavior features, and deficient executive function abilities may be at risk for unintentional injuries. Raising occupational therapists' awareness of these aspects may contribute to identifying, treating, and preventing accidental injuries among at-risk children.

Anticipatory Awareness and Actual Handwriting Performance Measures among Adolescents with Deficient Executive Functions.

This secondary analysis explores differences and correlations between handwriting anticipatory awareness (time estimation, expected performance, and expected difficulty) before a paragraph copying task and actual performance time and legibility among adolescents with executive function deficits (EFD) versus neurotypical adolescents. Eighty-one adolescents (10-18 years old; 41 with EFD and daily functioning difficulties as per parent reports) estimated their time, expected performance, and expected difficulty before the paragraph copying task using the Self-Awareness of Performance Questionnaire (SAP-Q). Time duration was assessed using the Computerized Penmanship Evaluation Tool (ComPET) software, and legibility was scored using the Handwriting Legibility Scale (HLS). Significant between-group differences were found in actual time duration (ComPET), HLS total score and legibility components, and three SAP-Q questions. Both groups estimated significantly more performance time than their actual performance duration. The adolescents with EFD underestimated their performance before the handwriting task. Significant correlations were found between actual performance, anticipatory awareness, and Executive Function (EF) in both groups. Their performance predictions were significantly correlated with their EF and product's legibility. The results highlight the potential relationships between anticipatory awareness and actual handwriting performance (time duration and legibility) of adolescents with and without EFD. Further studies may analyze the benefits of focusing on both EF and anticipatory awareness for handwriting improvement among populations with EF deficits.

Handwriting and Motor-Related Daily Performance among Adolescents with Dysgraphia and Their Impact on Physical Health-Related Quality of Life.

Knowledge is limited about dysgraphia in adolescence and its association with daily motor-related daily performance and health-related quality of life (HRQOL). This study aimed to (1) compare and (2) examine correlations between handwriting measures, motor-related daily performance, and HRQOL of adolescents with and without dysgraphia and (3) examine the contribution of motor-related daily performance and handwriting measures to predict their physical HRQOL. There were eighty adolescents (13-18 yr): half with dysgraphia and half matched controls without dysgraphia per the Handwriting Proficiency Screening Questionnaire and Handwriting Legibility Scale participated. They copied a paragraph script onto a paper attached to the Computerized Penmanship Evaluation Tool digitizer and completed the World Health Organization Quality of Life Questionnaire-brief version and the Adult Developmental Coordination Disorder Checklist (ADC). We found significant between-group differences in motor-related daily performance, handwriting measures, and HRQOL and significant correlations between HRQOL and handwriting process measures and motor-coordination ability. Handwriting measures predicted 25%, and the ADC A and C subscales 45.6%, of the research group's physical QOL domain score variability. Notably, the control group's current perceptions of their motor-coordination performance (ADC-C) predicted 36.5% of the variance in physical QOL. Dysgraphia's negative effects during childhood and adolescence may reduce adolescents' HRQOL now and into adulthood.

Technology use characteristics among older adults during the COVID-19 pandemic: A cross-cultural survey.

Personal computers, tablets, and smartphones may support older adults' engagement when people are required to stay home and opportunities to engage in meaningful activities are reduced during the COVID-19 period. This study aims to screen older adults' technology-use characteristics across social, leisure, and education domains during the COVID-19 pandemic from a crosscultural viewpoint. The sample included 576 participants aged 60 and older from France (n = 62), Spain (n = 110), and Israel (n = 404). Participants completed the technology-use survey, which consists of questions about their facilities, technology usability, need for adaptations to support technology use, and changes in technology use since COVID-19. Significant differences were found between countries in facilities, χ2 (2) = 25.16, p < .001, and usability, χ2 (2) = 64.14, p < .001, across the three domains. Furthermore, 34% of technological usability was predicted by country and facilities, F (4, 568) = 72.39, p < .001. Participants noted a willingness to use technology if it was adapted for social (61%-73%), leisure (51%-71%), or educational (67%-76%) activities and that they devoted substantially more time to technology across domains (>58%) due to COVID-19. These findings highlight culture and facilities as factors that play an imperative role in supporting and enhancing the usability of technology among older adults.

Handwriting legibility across different writing tasks in school-aged children.

Background: In school, children are required to perform a range of handwriting tasks. The writing needs to be legible to the child and other readers. The aim of this study was to examine handwriting legibility across different writing tasks and to explore which components might predict overall handwriting legibility. Methods: This was a secondary analysis of data from 148 school-aged children across writing scripts obtained from the Detailed Assessment of Speed of Handwriting: copying-best, copying-quickly and free-writing. Results: Results showed that letter formation was the major predictor of the total HLS score, and significant differences in handwriting legibility were found across the three tasks. Conclusions: The HLS is a practical tool that can benefit occupational therapists who work in schools by assessing handwriting legibility across different handwriting tasks.

Work participation, sensory processing and sleep quality in adults with attention-deficit hyperactive disorder.

BACKGROUND: Although studies have indicated significant effects of attention-deficit hyperactive disorder (ADHD) on work participation, the mechanism underlying work participation of adults with ADHD is still unclear. OBJECTIVE: Following the World Health Organization's international classification of functioning, disability, and health concepts, this study compares sensory processing and sleep quality (body functions) with work participation among adults with and without ADHD and examines predictive relationships among adults with ADHD. METHODS: Sixty-nine adults with ADHD and 52 matched controls completed a sociodemographic questionnaire, the Adult/Adolescent Sensory Profile, the Mini Sleep Questionnaire, and the Occupational Questionnaire. RESULTS: The ADHD group had significantly poorer body functions, sensory processing (i.e., low registration, sensory-sensitivity, and sensation-avoiding patterns), sleep quality, and work performance compared to the control group (p < .001). For adults with ADHD, sensory sensitivity accounted for 10.9%, and sleep quality accounted for 22.0%, of the variance in their work performance. CONCLUSIONS: The deficient body functions of adults with ADHD may affect their work performance and therefore should be considered in further research, as well as in clinical applications.

Capturing Subjective Mild Cognitive Decline in Parkinson's Disease.

This study aimed to capture subjective daily functional cognitive decline among patients with Parkinson's disease. Participants (40-79 y; 78 with Parkinson's disease and 41 healthy matched controls) completed the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Parkinson's Disease Cognitive Functional Rating Scale (CFRS), Daily Living Questionnaire (DLQ), and Time Organisation and Participation Scale (TOPS) questionnaires. Patients with Parkinson's disease were divided into groups with or without suspected mild cognitive decline according to their scores on the Cognitive Functional (CF) feature, which is based on certain items of the MDS-UPDRS. Significant between-group differences were found in the DLQ and TOPS scores. Significant correlations were found among the questionnaire results, with specific DLQ and TOPS items accounting for 35% of the variance in the CF feature, which correlated with daily cognitive functional states. This study's results are relevant for detecting subtle deficits in Parkinson's disease patients suspected of mild cognitive decline, which can affect health and quality of life and relates to risk for later dementia.

Relationships between executive functions and sensory patterns among adults with specific learning disabilities as reflected in their daily functioning.

Adults with specific learning disabilities (e.g., dyslexia, dysgraphia, and dyscalculia) reveal limitations in daily functioning in various life domains. Following previous evidence of deficient executive functions and unique sensory patterns in this population, this study examined how relationships between these two domains are expressed in daily functioning. Participants included 55 adults with specific learning disabilities and 55 controls matched by age, gender, socioeconomic status, and education. Participants completed a sociodemographic questionnaire, the Behavioral Rating Inventory of Executive Functions-adult version, and the Adolescent/Adult Sensory Profile. Results indicated significant relationships between executive functions (per the Behavioral Rating Inventory of Executive Functions-adult version) and sensory patterns (per the Adolescent/Adult Sensory Profile) as reflected in daily functioning. The low sensory registration pattern predicted 12% to 16% of the variance in the behavioral regulation index, metacognitive index, and general executive composite scores and was a significant predictor of specific executive function abilities. Results indicated that the difficulties of adults with specific learning disabilities in using executive function abilities efficiently might be tied to a high sensory threshold and passive self-regulation strategies. A deeper understanding of this population's sensory-executive mechanisms may improve evaluation and intervention processes. This understanding can consequently increase executive abilities for improved daily functioning and life satisfaction.