An Occupation-Based Review of Outcome Measures used to Assess Hand Function after Burn Injury.

While occupation began as the central concept of occupational therapy at the dawn of the profession, the use of occupation throughout the therapy process, including assessment, has wavered in recent decades. Occupation is defined as meaningful and purposeful activities that individuals do to occupy their time and attention. The use of occupation-based assessments is vital to establishing care with an occupational focus. The purpose of this paper is to review the outcome assessment tools commonly used in the burn literature to evaluate hand function and critique the presence of occupation in each assessment using the Occupation-Based Practice Assessment (OBPA). Knowledge of the occupational nature of assessments is important to the delivery of an occupational therapy evaluation comprised of a battery of assessments inclusive of discrete measures of movement as well as performance-based tools to represent the person from an occupational perspective. Many outcome measures used in upper extremity burn rehabilitation are discrete in nature and do not measure occupations of clients. The Suitcase Packing Activity (SPA) may be a viable addition to an assessment battery to address this essential need.

Establishment of Reliability of the Occupation-Based Practice Assessment.

The profession's foundational construct, occupation, is therapeutically effective, but there remains inconsistent use as a therapeutic medium. A psychometrically strong tool can measure and maximize the use of occupation. This study establishes preliminary psychometric properties of the Occupation-Based Practice Assessment (OBPA). This methodological study tested inter-rater reliability using simulated video cases to examine the OBPA. Overall reliability was acceptable at .868. All subsections were acceptable including Meaning and Purposeful Occupation (.871), Therapeutic Intent (.819), and Engaged Participation (.807). Two items, Context (.946) and Actual Doing (.981), demonstrated excellent reliability; while three items, Meaning (.747), Adaptation (.799), and Participation (.735), fell slightly below the acceptable level. Preliminary investigation of the OBPA reveals acceptable inter-rater reliability and suggests potential for use following additional in-vivo testing to measure therapeutic interactions to enhance student learning, optimize clinical practice, facilitate professional development, evaluate programs, and quantify occupation-based practice in research.

Updated systematic review on older adult community mobility and driver licensing policies.

An updated systematic review of literature related to the effects of driver licensing policies, community mobility programs, and driving cessation programs on older adult performance and participation was completed as a part of the American Occupational Therapy Association's Evidence-Based Literature Review Project. The results revealed that relicensing policies instituted by states yield inconsistent results in terms of reducing traffic crashes, traffic violations, and traffic-related fatalities. The evidence related to community mobility and driving cessation programs has suggested that programming to support the transition from driving to other modes of mobility can be beneficial for older adults and their family members. In addition, community contexts that are supportive of pedestrian travel significantly increase this mode of mobility. This evidence-based review informs occupational therapy practice and suggests that increased therapeutic attention should be directed toward supportive transitions from driving and sustaining community mobility for optimal engagement and participation.

Consensus statements on occupational therapy education and professional development related to driving and community mobility.

Professional and postprofessional education for occupational therapy practitioners in the area of driving and community mobility has been inconsistent and not sufficient to meet the growing community mobility needs of the aging population. This article reviews the current expectations of entry-level occupational therapy education, the postprofessional credentialing opportunities, and the professional development path for occupational therapy practitioners. Finally, consensus statements are presented to move both entry-level and professional education forward in the area of driving and community mobility.

Systematic review of occupational engagement and health outcomes among community-dwelling older adults.

We conducted this systematic review, one of four related to productive aging, to explore the existing evidence for the health benefits of engagement in occupations and activities among older adults. The review incorporates the breadth of areas of occupation in which older adults engage and the range of health benefits derived from that engagement. The results of this review demonstrate the multidisciplinary appreciation for occupational engagement and associated well-being and elucidate the health effects of engagement in a wide variety of occupations and activities. Additionally, the results of this systematic review support occupational therapy's historical ideologies and core philosophies linking occupational engagement to improved health and well-being. The findings suggest an increasing role for occupational therapy service delivery in community-based health promotion and prevention efforts to meet the everyday activity and health needs of the growing older adult population.

Occupational therapy and older drivers: research, education, and practice.

Occupational therapists facilitate independence and support participation in occupations that are personally meaningful to clients to enhance well-being and quality of life. Among the occupations addressed by occupational therapists is the instrumental activity of daily living (IADL) of driving. Occupational therapists are particularly concerned with older adult engagement in driving because of the vital contributions driving and community mobility make to engagement in other activities and subsequently quality of life. This article includes the current status of occupational therapy research, education, and practice and presents the role of the occupational therapist as a member of the team with regard to older drivers.

Background and methodology of the older driver evidence-based systematic literature review.

In response to demands of health care and community-based systems, occupational therapy practitioners are eager to provide effective services that are client centered, supported by evidence, and delivered in an efficient and cost-effective manner. Findings from the scientific literature provide a source of legitimacy and authority for informing and guiding practice in all areas, including driving and community mobility with older adults. A systematic review examined studies designed to enhance the driving ability, performance, and safety of older adults. This article presents an overview of the methodology used to develop the focused questions related to the person, vehicle, infrastructure, and policy and community mobility; conduct the literature review; and establish quality control. It includes a summary of the evidence and implications of the review for clinical practice, education, and research to ultimately identify interventions effective in supporting older adult participation and engagement in occupation.

Review of the evidence related to older adult community mobility and driver licensure policies.

A systematic review of literature related to the effects of drivers' license policies and community mobility programs on older adult participation was completed as a part of the American Occupational Therapy Association's Evidence-Based Literature Review Project. The results revealed that states can achieve a goal of reducing traffic crashes, traffic violations, and traffic-related fatalities through relicensing policies requiring in-person renewal and vision testing as well as driving restrictions. Evidence suggests that failure to consider the continued community mobility needs of older adults can result in increasing fatalities among senior citizens using other modes of community mobility. This evidence-based review is informative for occupational therapy practice; however, it does not reveal the association between policy and community mobility interventions and improved engagement and participation. There is a role for occupational therapy in policy development and community mobility programming to promote engagement in occupation to support participation.

Predictability of clinical assessments for driving performance.

PROBLEM: As the number of older drivers grows, it is increasingly important to accurately identify at-risk drivers. This study tested clinical assessments predictive of real-time driving performance. METHOD: Selected assessment tools considered important in the identification of at-risk older drivers represented the domains of vision, cognition, motor performance, and driving knowledge. Participants were administered the battery of assessments followed by an on-road test. A univariate analysis was conducted to identify significant factors (<.05) to be included in a multivariate regression model. RESULTS: Assessments identified as independently associated with driving performance in the regression model included: FACTTM Contrast sensitivity slide-B, Rapid Pace Walk, UFOV rating, and MMSE total score. DISCUSSION: The domains of vision, cognitive, and motor performance were represented in the predictive model. SUMMARY: Due to the dynamic nature of the driving task, it is not likely that a single assessment tool will identify at risk drivers. IMPACT ON INDUSTRY: By standardizing the selection of clinical assessments used in driving evaluations, practitioners should be able to provide services more efficiently, more objectively, and more accurately to identify at-risk drivers.

Driving and community mobility.

Attention to driving and community mobility is a growing area of concern due to the implications across the life span, association to occupational engagement, and relevance to other organizational entities (see Appendix B). The skills, knowledge base, and scope of practice of occupational therapy enhanced by additional training in driver rehabilitation place the profession of occupational therapy in the forefront of driving and community mobility services. The focus on injury prevention, engagement in occupation, and the intervention strategies used in driver rehabilitation and community mobility services are consistent with the Philosophical Base of Occupational Therapy (AOTA, 1995) and, therefore, warrant attention in all areas of occupational therapy practice.