The effectiveness of physical, psychological, and functional interventions in treating clients with multiple sclerosis: a meta-analysis.

This article provides a meta-analysis of the current best evidence for the use of occupational therapy with clients with multiple sclerosis (MS). A review of the literature identified 23 articles that examined the effectiveness of occupational therapy-related treatments on clients with MS. Meta-analytic analysis suggests that occupational therapy-related treatments were effective in treating the deficits associated with MS (r = .52), particularly for outcomes in the capacity and ability (r = .52; e.g., muscle strength, range of motion, mood) and task and activity (r = .57; e.g., dressing, bathing, ambulation) levels. A review of the research designs used to study MS suggests that more rigorous research is necessary to fully understand treatment effectiveness. Further, more research must be done to establish the effectiveness of occupational therapy treatment at the life role level.

The effectiveness of occupational therapy-related treatments for persons with Parkinson's disease: a meta-analytic review.

Given the current changes in health care, being able to obtain and use research evidence that supports occupational therapy treatment has become increasingly important. The purpose of this study was to synthesize available evidence on the effectiveness of occupational therapy-related treatments for persons with Parkinson's disease. A meta-analysis was performed to achieve this synthesis. The results revealed small to moderate positive effects of intervention on outcomes related to clients' capacities and abilities as well as for outcomes related to function during activities and tasks. Limitations in the research reviewed for this meta-analysis may have resulted in an underestimation of treatment effects. Occupational therapists can use results from this meta-analysis to communicate with clients about the possible benefits of participating in occupational therapy.

From the general to the specific. Using meta-analytic reports in clinical decision making.

The purpose of this article is to describe how health practitioners can interpret the results from published meta-analytic reports of intervention effectiveness and efficacy studies, and then communicate those results, in a manner that helps patients make critical clinical and life decisions. The problem of using research evidence in clinical decision making is one of moving from generalized findings about intervention effectiveness to a prediction for a specific patient. To move toward a reasonable prediction, practitioners need information from a meta-analytic report that enables them to identify and understand the distribution of outcome results that are most applicable to a specific patient. Relevancy, effectiveness, and interpretation forms of information are discussed in this article. The focus is on the interpretation of the effect size statistics d and r for understanding the variation in responses that the patient might experience with an intervention.

The relationship between the Evaluation Tool of Children's Handwriting and teachers' perceptions of handwriting legibility.

OBJECTIVE: The purpose of this study was to investigate the relationship between the Evaluation Tool of Children's Handwriting (ETCH) and teachers perception of handwriting legibility METHODS: The ETCH was administered to 45 first-grade students with illegible handwriting as reported by their teachers. The teachers completed a teachers questionnaire at the same time to indicate the children's level of handwriting difficulties both in general and in specific tasks that resemble the test tasks of the ETCH. RESULTS: There was no significant relationship between the ETCH scores and the teacher questionnaire scores in either general legibility or task-specific legibility. CONCLUSION: The ecological validity of the ETCH, in reference to the teachers' perception of handwriting legibility, was not established. Further changes for scoring criteria may be warranted before the ETCH can be used with confidence that the scores obtained are meaningfully related to actual performance in the classroom as determined by teachers.

Participation in daily living tasks among older adults with fear of falling.

OBJECTIVE: This study investigated patterns of participation in daily living tasks by older adults with fear of falling. The relationship between reported participation in a broad set of daily living tasks and the risk of falling involved in task performance--or activity-related risk--as judged by occupational therapists was examined. Further, several characteristics of older adults that have been associated with fear of falling were examined to determine which older adults had patterns of participation most strongly associated with the activity-related risk. METHOD: Thirty-eight occupational therapists were surveyed and asked to judge the activity-related risk in performing specific daily living tasks. Additional data were obtained from 339 older adults with fear of falling who participated in a previous study on the effectiveness of an intervention to reduce fear of falling. Older adults' participation in daily living tasks as measured by items of the Sickness Impact Profile was correlated with the judgments of activity-related risk controlling for potential confounding factors. Univariate regression analyses and t tests were used to determine whether several characteristics of older adults were associated with the relationship between participation and activity-related risk. RESULTS: Small to moderate significant relationships were found between older adults' participation in daily living tasks and the activity-related risk as judged by occupational therapists (r = -.25, p < .0001). Older adults with the lowest confidence in ability regarding falls had the strongest relationships. CONCLUSION: Activity-related risk is an aspect of daily living tasks that relates to participation in activities by older adults with fear of falling. Knowledge of the activity-related risk involved in daily living tasks can be used to facilitate occupational performance in clients with fear of falling and associated activity restriction.

Parental hopes for therapy outcomes: children with sensory modulation disorders.

OBJECTIVE: Understanding parents' hopes for therapy outcomes is essential to family-centered care. This qualitative study explored parents' points of view regarding their hopes for the outcomes of occupational therapy using a sensory integration treatment approach. METHOD: Data were collected as part of a larger research project on the effectiveness of rehabilitating children who have sensory modulation disorders. Five interviews were randomly selected from 17 parent interviews conducted in the larger study. Data were analyzed using grounded theory methods. FINDINGS: Three themes pertinent to the occupations of children and two themes related to the occupations of parenting and sustaining family life emerged. Child-focused outcomes include social participation, self-regulation, and perceived competence. Parent-focused outcomes include learning strategies to support children and obtaining personal validation. DISCUSSION: Interventions are proposed that relate to children's participation in contexts in which they live, learn, and play, as well as the support of parents in the occupations of parenting.

A kinematic study of contextual effects on reaching performance in persons with and without stroke: influences of object availability.

OBJECTIVE: To examine the effects of context on reaching performance in neurologically impaired and intact populations. Context was varied by the presence or absence of objects used to complete a task. DESIGN: A counterbalanced repeated-measures design. SETTING: A motor control laboratory in a university setting. PARTICIPANTS: Fourteen persons with stroke and 25 neurologically intact adults. INTERVENTIONS: Each participant was tested under two conditions: the presence of the object, in which the participant reached forward with the impaired arm (or corresponding arm) to scoop coins off the table into the other hand; and the absence of the object, in which the participant reached forward to the place where the coins would be placed in the condition of object present. MAIN OUTCOME MEASURES: Kinematic Variables of movement time, total displacement, peak velocity, percentage of reach where peak velocity occurs, and movement units (derived from acceleration data) for reaching tasks. RESULTS: The condition of using real objects elicited kinematically better performance of reaching movements than the condition of performing movements without relevant objects present. Better performance was reflected by shorter movement time, less total displacement, higher peak velocity, greater percentage of reach where peak velocity occurs, and fewer movement units. CONCLUSION: The results of this study showed that the condition of object present elicited better performance of movements represented by kinematic variables than the condition of object absent. The clinical implication is that the use of real and functional objects might be an effective way of facilitating efficient, smooth, and coordinated movement with the impaired arm in persons with stroke. This study, however, should be replicated and extended to confirm the validity of its findings and to allow for generalization in various functional activities.

The effect of keeping an end-product on intrinsic motivation.

OBJECTIVE: According to literature in occupational therapy and psychology, intrinsic motivation is thought to be enhanced if people can keep the end-product of an activity. The purpose of this study was to examine the effect of keeping an end-product on intrinsic motivation. METHOD: Fifty participants chose one of four activities (painting a ceramic vase, decorating cookies, stringing beads for a necklace, creating stationery) and performed two conditions (keep, no-keep) in counterbalanced order. Participants were timed in each condition and, after each condition, ranked their self-determination and competence, which are psychological needs underlying intrinsic motivation. Participants were interviewed at the end of the study to examine their experiences. RESULTS: Participants worked significantly longer on a chosen activity when the end-product could be kept and rated themselves significantly more self-determined and competent after performing the keep condition. However, further analysis revealed that these results depended on the activity chosen. CONCLUSION: The findings support that keeping an end-product can enhance performance of an activity. However, because results were not consistent across all activity choices, further research is needed to characterize the meaningfulness of particular activities.

Communicating with clients about treatment outcomes: the use of meta-analytic evidence in collaborative treatment planning.

The purpose of this article is to describe how therapists can use information from the research literature, specifically from meta-analyses, to inform clients and their family members about probable outcomes of participating, or not participating, in treatment. Meta-analyses are particularly useful to clinicians because they summarize findings from a large number of outcome studies in a rigorous, comprehensive, and concise format. The quantitative presentation of meta-analyses may be daunting to those who are not familiar with meta-analytic procedures and statistics. Therefore, this article describes a simple method for making clinically relevant interpretations of meta-analytic results. Furthermore, specific examples that are based on actual meta-analyses are given as models for communicating with clients and their family members about treatment outcomes in order to facilitate collaboration during treatment planning.

Effects of object affordances on reaching performance in persons with and without cerebrovascular accident.

OBJECTIVE: This study investigated whether affording objects with different levels of functional support would have an impact on reaching performance in patients after cerebrovascular accident (CVA) and in adults who were neurologically intact. Reaching performance was quantitatively analyzed, using several kinematic variables. METHOD: Two groups, 14 participants after CVA and 24 age-matched adults who were neurologically intact, performed a food chopping task under two conditions: enriched affordances and impoverished affordances. Enriched affordances involved reaching forward to a chopper and pushing down on the handle to chop a fresh mushroom. Impoverished affordances involved reaching forward to a simulated chopper (i.e., a chopper covered with cardboard) without anything in it and then pushing the handle down. Reaching movement was measured by a three-dimensional motion analysis system. RESULTS: For the CVA group, the enriched condition of reaching to chop the mushroom resulted in more efficient, direct, smooth, and preplanned movement than the impoverished condition of reaching to push on the chopper handle. The neurologically intact group responded similarly except that the participants' movement was equally smooth, as measured by movement unit, between the two testing conditions. Force generation, as characterized by peak velocity, was similar for both conditions for both groups. CONCLUSION: The finding that enriched affordances had a positive effect on movement kinematics in both CVA and neurologically intact groups suggests that providing natural objects for completing a task and providing functional information on the objects may enhance the functional performance of persons who have had a CVA. These findings should be replicated and extended to confirm the validity of these effects and allow for generalization.

Working well with others: the prediction of students' clinical performance.

OBJECTIVE: The purpose of this study was to determine whether multivariate measurement at the initiation of students' training in occupational therapy could predict clinical performance in Level II fieldwork. METHOD: Forty-five students in their first semester were videotaped in pairs and completed personality and emotional communication measures related to the potential for working well with others. Two years later, the students' clinical performance was rated by Level II fieldwork supervisors. RESULTS: In the physical rehabilitation fieldwork setting, students who were conventional and quietly concerned were rated higher than students who were unconventional, talkative, and less other-centered. In the pediatric rehabilitation setting, students who were autonomous and nonverbally perceptive were rated higher than students who were interdependent and less perceptive. In the psychiatric rehabilitation setting, students who were emotionally reactive to facial but not body cues of emotion were rated higher than students who had low emotional reactivity and were less perceptive to facial but not body cues. CONCLUSION: The varying institutional cultures, types of patients, and roles of occupational therapy across fieldwork settings may require different sets of attributes for working well with others. Educators and supervisors should be aware of these possible differences when fashioning Level I fieldwork experiences.

Therapist-child interaction in the middle minutes of sensory integration treatment.

The purpose of this study was to describe the management of challenge during therapist-child interaction in sensory integration treatment. This descriptive and relational study of the middle minutes of treatment sessions partially replicated an earlier study of the beginning minutes. One-minute videotape clips taken from the middle minutes of 38 treatment sessions were shown to therapist judges who rated qualities of therapist and child behavior. Two patterns emerged from the correlations of ratings: work and playfulness. Work for the child involved trying hard, cooperating and seeking assistance, whereas work for the therapist involved assisting and guiding the child. Play for the child included enjoying the activity, being successful and confident, and trying hard. For the therapist, play involved being creative and behaving playfully. Patterns of work and play were different across different levels of challenge to the child.

In-hand manipulation in young children: translation movements.

OBJECTIVE: The purpose of this study was to look at the development of in-hand translation skills in young children; that is, the child's ability to move a small object from the fingers into the palm and from the palm to the fingers. Three questions were asked: (a) Do boys' and girls' performance differ significantly? (b) Does the performance of the children improve with age? and (c) Can periods of rapid improvement with age be seen on the tasks presented? METHOD: In-hand manipulation translation was measured with a pegboard task for 154 right-handed children between 3-0 years and 6-11 years of age and 13 adults. Participants were videotaped as they picked up two to five pegs, one at a time; stored them in the hand; and moved the pegs out of storage to place them in the pegboard. The number of pegs handled in each trial as well as the methods used to move the peg to and from the palm were recorded. RESULTS: Boys and girls did not show significant differences in their performance, but when slight differences did occur, they favored the girls. Age was found to be a significant factor in both the number of pegs handled and the method used in handling them. The older children tended to place more pegs successfully and were more likely to use the methods most commonly used by the adults. A major finding was the marked difference in how the children solved the problem of moving the peg in and out of the palm compared with the adults. The adults used gravity to assist the movement of the peg; the children tended to use methods that allowed them to maintain contact with the peg throughout the movement. CONCLUSION: In-hand manipulation translation skills appear to have a long developmental course. Children are closer to adults in their ability to perform the task than in the methods that they use. This study shows the importance of observing how children perform tasks, not just whether they complete the tasks. Differences in the methods used help to determine efficiency. Observation of these skills in children may expand a therapist's understanding of children's fine motor abilities.