The American Journal of Occupational Therapy (AJOT) is an official publication of the American Occupational Therapy Association, Inc. and is published 6 times per year. This peer reviewed journal focuses on research, practice, and health care issues in the field of occupational therapy.    AOTA members receive 6 issues of AJOT per year and have online access to archived abstracts and full-text articles. Nonmembers may view abstracts online but must purchase full-text articles.

The American Journal of Occupational Therapy (AJOT) is the official publication of the American Occupational Therapy Association, Inc. It is published six times a year. This peer-reviewed journal focuses on research, practice, and healthcare issues in the field of occupational therapy. AOTA members receive six issues of AJOT per year and have online access to archived abstracts and full-text articles. Non-members may view abstracts online but must purchase full-text articles.

《美国职业治疗杂志》（American Journal of Occupational Therapy，AJOT）是美国职业治疗协会（AOTA）的官方出版物，每年出版6期。该期刊经过同行评审，专注于职业治疗领域的研究、实践和医疗保健问题。AOTA会员每年可获得6期AJOT，并可在线访问存档的摘要和全文文章。非会员可以在线查看摘要，但必须购买全文文章。

American Journal of Occupational Therapy

The effects of robot-assisted task-oriented training with tangible objects among patients with stroke remain unknown.To investigate the effects of robot-assisted therapy (RT) with a Gloreha device on sensorimotor and hand function and ability to perform activities of daily living (ADLs) among patients with stroke.Randomized, crossover-controlled, assessor-blinded study.Rehabilitation clinic.Patients (N = 24) with moderate motor and sensory deficits.Patients participated in 12 RT sessions and 12 conventional therapy (CT) sessions, with order counterbalanced, for 6 wk, with a 1-mo washout period.Performance was assessed four times: before and after RT and before and after CT. Outcomes were measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Box and Block Test, electromyography of the extensor digitorum communis (EDC) and brachioradialis, and a grip dynamometer for motor function; Semmes-Weinstein hand monofilament and the Revised Nottingham Sensory Assessment for sensory function; and the Modified Barthel Index (MBI) for ADL ability.RT resulted in significantly improved FMA-UE proximal (p = .038) and total (p = .046) and MBI (p = .030) scores. Participants' EDC muscles exhibited higher efficacy during the small-block grasping task of the Box and Block Test after RT than after CT (p = .050).RT with the Gloreha device can facilitate whole-limb function, leading to beneficial effects on arm motor function, EDC muscle recruitment efficacy, and ADL ability for people with subacute and chronic stroke.The evidence suggests that a task-oriented approach combined with the Gloreha device can facilitate engagement in whole-limb active movement and efficiently promote functional recovery.

Hsin-Chieh Lee

Fen-Ling Kuo

Yen-Nung Lin

Tsan-Hon Liou

Jui-Chi Lin

Shih-Wei Huang

Effects of Robot-Assisted Rehabilitation on Hand Function of People With Stroke: A Randomized, Crossover-Controlled, Assessor-Blinded Study

机器人辅助康复对中风患者手部功能的影响：一项随机、交叉对照、评估者盲法的研究

Abstract Date Presented 03/28/20 This qualitative study explored the effect of mindful meditation on reduction of stress in young adults through an online survey of open-ended questions using Qualtrics. Participants were recruited from a closed Facebook meditation community and various social media outlets. Qualitative data was analyzed using content analysis until saturation was reached. Multiple researchers and data collection from multiple sources ensured triangulation, rigor, and trustworthiness of the data. Primary Author and Speaker: Jian Jones Additional Authors and Speakers: Gabriell Herrera, Stephen Johnson, Priya Mistry, Barbara Kornblau, Debora Oliveira

Jian Jones

Gabriell Herrera

Stephen Johnson

Priya Mistry

Barbara Kornblau

Debora Oliveira

Mindful Meditation to Reduce Stress in Young Adults

正念冥想对减轻青年压力的作用

There is a paucity of research that explores the effectiveness of sensory integration interventions in the school setting.To test the effectiveness of a sensory integration intervention paired with teacher consultation, aligned with the principles of Ayres Sensory Integration® and the Sensory Therapies and Research Frame of Reference, to improve functional regulation and active participation in school for students with sensory integration and processing differences.Concurrent, multiple-baseline, single-subject design.Public elementary school in the United States.Students (N = 3; ages 5-8 yr) whose sensory integration and processing differences were affecting their school occupational performance and were not remediated by integrated support.For 15 wk, each student had one-to-one sensory integration intervention 2×/wk for 30 min and a consultation between the occupational therapist and teacher weekly for 10 min.The dependent variables, functional regulation and active participation, were measured weekly. The Short Child Occupational Profile and Behavior Assessment System for Children, Third Edition, were given before and after intervention. Goal Attainment Scaling and semistructured interviews with the teachers and participants were completed after intervention.All 3 students showed meaningful improvement in functional regulation and active participation in the classroom during the intervention period as demonstrated by a 2-SD band method or celeration line analysis. All additional measures noted positive change.Findings suggest that sensory integration intervention with consultation in the education setting can improve school performance and participation for children with sensory integration and processing challenges. What This Article Adds: This study offers an evidence-based model of service delivery for the school setting that is effective in improving the functional regulation and active participation of students whose sensory integration and processing challenges interfere with occupational engagement and are not mitigated by embedded supports.

Colleen Cameron Whiting

Sarah A. Schoen

Linda Niemeyer

A Sensory Integration Intervention in the School Setting to Support Performance and Participation: A Multiple-Baseline Study

学校环境中感觉统合干预对支持表现和参与度的多基线研究

The purpose of this phenomenological study was to obtain caregivers' perspectives on the impact of the sensory environment on participation in daily activities of their young children with autism spectrum disorders (ASD). Interviews were completed with 34 caregivers of children with ASD ages 3-7 yr. Results strongly suggest that parents and caregivers were pivotal in enabling participation for their children through the implementation of specific strategies and a parental decision-making process. The decision-making process considered amount of effort necessary to support participation and whether participation in a given activity was perceived as essential or nonessential. Strategies enabled participation and reduced the effort required to support the child's participation. Strategies either directly related to the sensory factors of the environment or focused on reducing behavioral responses associated with sensory factors. In this study, we identified important considerations to enhance participation in the home and community environments for children with ASD.

Beth Pfeiffer

Wendy Coster

Gretchen Snethen

Maggie Derstine

Aimee Piller

Carole Tucker

Am J Occup Ther

Caregivers’ Perspectives on the Sensory Environment and Participation in Daily Activities of Children With Autism Spectrum Disorder

自闭症谱系障碍儿童的感官环境和日常活动参与：照护者的视角

Abstract As occupational therapy research advances and the body of evidence supporting effective interventions continues to grow, there is a need to expedite the transfer of research findings into practice, and the use of intervention development frameworks becomes increasingly essential. In this column, we introduce the Multiphase Optimization Strategy (MOST), an engineering-inspired framework for the development, optimization, and evaluation of multicomponent interventions. MOST allows for the systematic development and evaluation of optimized interventions that prioritize effectiveness within constraints like affordability, scalability, and efficiency. Using MOST while developing an intervention may reduce the delay between intervention development and real-world implementation. Moreover, adopting MOST will bolster the use of rigorous research designs in occupational therapy studies and foster shared terminology with other disciplines that have successfully applied this framework across a range of health priorities and conditions. Thus, we advocate integrating MOST into occupational therapy intervention development research.

Meirav Rosenfeld

Yael Goverover

Kate Guastaferro

Enhancing Occupational Therapy Interventions by Integrating the Multiphase Optimization Strategy Framework

通过整合多阶段优化策略框架来增强职业治疗干预措施

Importance: Because of the complexity of their child’s diabetes management, parents often assume all care duties and report needing additional assistance to resume family routines. Objective: To examine the preliminary efficacy of a telehealth occupation-based coaching intervention for rural parents of a child living with Type 1 diabetes (T1D) to improve child glycemic levels, family quality of life, and parental self-efficacy. Design: Double-blinded, two-arm, pilot randomized controlled trial. Setting: Telehealth video conferencing at home. Participants: 16 dyads of rural parents and children ages 2 to 12 yr diagnosed with T1D. Intervention: Occupation-based coaching delivered through telehealth sessions, once weekly for 12 wk, informed by community partners. Outcomes and Measures: Child measures: hemoglobin A1c and glucose time in range. Family measures: Parenting Sense of Competence, World Health Organization Quality of Life Brief Questionnaire, Goal Attainment Scale, Evidence of Independent Capacity Rating Scale (EICRS), and caregiver talk. Results: Families in the intervention group were more likely to achieve family-centered participation goals (p = .006) than those in the controlled group. Caregiver talk increased significantly over the 12-wk period (p = .034), and the average rating on the EICRS also improved significantly (p &amp;lt; .001). There were no statistically significant changes in glycemic levels or family quality of life. Conclusions and Relevance: OBC may be more efficacious in helping families to improve health management routines after a child’s diagnosis with T1D than usual endocrinology care alone. Most child health outcomes were in target range at the start of the study; therefore, it was not expected to see significant improvements. Plain-Language Summary: Occupational therapy is an untapped resource in the provision of care for children with Type 1 diabetes (T1D). Occupational therapy practitioners can also provide families with evidence-based support to address the self-management skills of children with this chronic condition. This clinical trial examined the preliminary efficacy of a new 12-wk telehealth occupational therapy intervention for rural families with a child living with T1D to improve caregiver diabetes management skills, family participation, and child health. Families who received occupational therapy services were more likely to improve their family participation in meaningful activities and diabetes self-efficacy; however, there were no differences in the child’s health outcomes or the family’s quality of life.

Vanessa D. Jewell

Marion Russell

Julia Shin

Yongyue Qi

Amy A. Abbott

Emily Knezevich

Telehealth Occupation-Based Coaching for Rural Parents of Children With Type 1 Diabetes: A Randomized Controlled Trial

基于远程医疗的职业指导对农村1型糖尿病患儿父母的影响：一项随机对照试验

Importance: The application of interpersonal skills is considered therapeutic use of self, a pillar of occupational therapy practice, and a required competency for occupational therapy education (American Occupational Therapy Association [AOTA], 2020). Medical improvisation (medical improv) uses the principles of improvisational theater to enhance professional competencies and shows promising results in health professions education (Gao et al., 2019). Objective: To understand the effect of medical improv on occupational therapy students’ therapeutic use of self. Design: A 6-wk randomized controlled waitlist trial. Setting: Occupational therapy education. Participants: A cohort of 36 occupational therapy students. Intervention: Two 2-hr sessions of medical improvisation. Outcomes and Measures: Standardized patients rated students’ therapeutic use of self with the Empathy and Clarity Rating Scale (Terregino et al., 2019), and students completed the Self-Efficacy for Therapeutic Use of Self (SETUS; Yazdani et al., 2021). Data were analyzed using independent samples t tests and multivariate mixed-methods models. Results: There was a significant difference between the intervention and waitlist control group in three SETUS subtests (modes, p = .004; traits, p = .04; total score, p = .03) and a significant interaction effect in SETUS modes (p = .03). The waitlist control group responded with comparable increases, and all participants demonstrated a significant increase in self-efficacy of therapeutic use of self after the medical improv intervention (p &amp;lt; .001). Conclusions and Relevance: These findings provide the first evidence for the positive effects of medical improv in building self-efficacy of therapeutic use of self in occupational therapy students. Plain-Language Summary: Medical improvisation (medical improv) in health professions education uses the principles of theatrical improvisation to build the interpersonal skills of students. This study’s application of medical improv to occupational therapy education found significant change in students’ self-efficacy of therapeutic use of self. The inclusion of medical improv in occupational therapy education can better prepare students to build and maintain therapeutic relationships.

Cynthia Selim

Jessica Tsotsoros

Catana Brown

Lynne Jeffries

Carrie Ciro

Impact of Medical Improvisation on Therapeutic Use of Self: A Randomized Controlled Waitlist Study

医疗即兴对自我治疗应用的影响：一项随机对照等待名单研究

Importance: Medicare’s Comprehensive Care for Joint Replacement (CJR) program rewards hospitals for reducing total Medicare spending. Despite the benefits of occupational therapy (OT) for patient outcomes and spending, little is known about how CJR affects hospital provision of acute occupational OT services. Objective: Determine whether CJR changed acute OT provision and whether higher acute OT provision was associated with CJR rewards. Design: Cohort study with randomization. Setting: Hospitals. Participants: Patients covered by Medicare who were discharged after major joint replacement surgery (n = 1,006,938) in 722 hospitals randomly selected for treatment under CJR and 859 hospitals in the control group, before (July 2014–June 2015) and after (April 2016–December 2018) CJR in the United States. Outcomes and Measures: National Medicare inpatient claims data were used to examine diagnoses and per-hospitalization acute OT provision (OT costs, patient receipt of OT, and OT share of hospitalization costs). CJR files were used to determine hospital rewards (CJR dollars per discharge). Results: CJR did not affect acute OT provision in terms of per-hospitalization OT costs, patient receipt of OT, or OT share of total hospitalization costs. Each additional dollar of OT spent by hospitals was associated with an increase of $1.99 CJR reward dollars (95% confidence interval [0.82, 3.16]). Conclusions and Relevance: These results indicate that hospitals did not increase acute OT as part of their improvement strategy under CJR, despite the potential for acute OT to yield financial returns on investment. Plain-Language Summary: Medicare’s Comprehensive Care for Joint Replacement (CJR) bundled payment program rewards hospitals for low Medicare spending from hospitalization through 90 days postdischarge. Although occupational therapy (OT) improves patient-centered care and reduces Medicare spending, it is unknown whether hospitals modified (or targeted) acute OT services when treating older patients who were hospitalized for major joint replacement surgery under CJR. We used national Medicare data to characterize the variation in hospital use of acute OT and to identify how CJR affected acute OT use by hospitals. We then examined whether acute OT use was associated with financial returns on investment by hospitals in CJR. We found that acute OT use did not change under CJR, even though higher OT use was correlated with larger financial rewards for CJR hospitals. Future research should focus on quantifying the value-added of OT on patient outcomes and Medicare spending.

Jun Li

Yvonne Monti

Andrew Ryan

Hospitals Did Not Increase Acute Occupational Therapy Provision Despite Positive Associations With Hospital Performance Under Medicare’s Comprehensive Care for Joint Replacement Program

尽管与医疗保险全面护理关节置换计划下的医院绩效呈正相关，医院并未增加急性职业治疗服务供给

Importance: Driving is a complex occupation requiring the interplay of high-level cognitive, physical, sensory, and behavioral skills for safe performance. Occupational therapists need to routinely address driving with adults as an occupational performance area. Further research is needed to determine whether performance-based assessment tools can support occupational therapists in screening client driving potential. Objective: To conduct a pilot study to determine whether the Multiple Errands Test–Home Version (MET–Home), as a performance-based assessment, either alone or in combination with other assessments, should be further investigated for use by occupational therapists to screen clients’ driving potential. Design: Cross-sectional pilot study. Setting: Private in-clinic and community setting, including participants’ homes. Participants: Convenience sampling recruited 28 participants through private occupational therapy driver assessors. Outcomes and Measures: Participants underwent a comprehensive in-clinic and behind-the-wheel assessment, as per standard practice, and three additional cognitive tests. Data were summarized with descriptive statistics, and univariate analyses were used to examine the relationships between cognitive assessment scores and driving outcomes. Results: The MET–Home, as a stand-alone tool and in combination with other cognitive assessment scores, was not associated with driving outcomes (pass–fail). However, participant self-assessment of their MET–Home performance was associated with driving outcomes (pass–fail; p = .014). Conclusions and Relevance: Although our findings suggest that the MET–Home is unlikely to screen for driving potential, further research of performance-based assessment tool use by occupational therapists is needed to support identification of the optimal type and timing of client referral for comprehensive assessment. Plain-Language Summary: The Multiple Errands Test–Home Version (MET–Home) is commonly completed by occupational therapists. Although this pilot study revealed that MET–Home scores were not associated with driving outcomes, performance-based assessments such as the MET–Home have the potential to guide occupational therapists when screening clients to determine when further, comprehensive assessment is indicated.

Hayley M. Scott

Anne M. Baker

Carolyn A. Unsworth

The Multiple Errands Test–Home Version and Its Association With Driving Potential: A Pilot Study

多项差事测试-家庭版及其与驾驶潜力的关联：一项试点研究

Importance: Toileting difficulties have a significant impact on the daily lives of children with cerebral palsy (CP), yet research on this issue remains inadequate. There is a critical need to better understand the challenges health care professionals face in addressing toileting difficulties. Objective: To explore challenges faced by health care professionals in toileting evaluation and interventions for children with CP ages 6–18 yr. Design: A mixed-methods study with a two-phase exploratory sequential design and using a global Delphi consensus technique. Setting: Email communication. Participants: Fifty-two national and international allied health professionals and 16 mothers of children with CP were involved in the preparation of the Delphi questionnaire. Additionally, 162 professionals participated in the Delphi study. Outcomes and Measures: Challenges were identified and refined iteratively through the Delphi questionnaire. Consensus was measured using a Likert scale, considering agreement percentages and median scores. Results: The study revealed strong consensus (94.4%), emphasizing the need for comprehensive training, particularly in working with pediatric populations. Concerns about limited research on and training in toileting function (88.9%) and challenges such as inadequate assessment environments and sanitation facilities (96.9%) underscore the need for practical and innovative educational methods to illustrate toileting procedures. Additionally, the findings highlight concerns about toileting issues and diverse commitment levels among professionals. Conclusions and Relevance: This study pinpointed critical challenges in toileting management for children with CP. These high-consensus findings stress the urgent need for holistic strategies, comprehensive education, and interdisciplinary collaboration to improve the quality of life and independence of these children. Plain-Language Summary: Toileting difficulties have a significant impact on the daily lives of children with cerebral palsy (CP), yet research on this issue remains inadequate. This study highlights significant gaps faced by health care professionals in understanding and addressing challenges in toileting evaluation and intervention for children with CP. Insights from professionals stress the critical need for global collaboration, standardized assessments, and improved education to effectively tackle CP-related toileting issues for children.

Azade Riyahi

Afsoon Hassani Mehraban

Mehdi Rassafiani

Zahra Pournasiri

Malahat Akbarfahimi

Challenges in Toileting Evaluation and Interventions for Children With Cerebral Palsy: A Delphi Study

脑瘫儿童如厕评估与干预的挑战：一项德尔菲研究

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ISSN	0272-9490, 1943-7676
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hQoIdU	医学(4区)医学康复医学(4区)

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American Journal of Occupational Therapy

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Effects of Robot-Assisted Rehabilitation on Hand Function of People With Stroke: A Randomized, Crossover-Controlled, Assessor-Blinded Study

Mindful Meditation to Reduce Stress in Young Adults

A Sensory Integration Intervention in the School Setting to Support Performance and Participation: A Multiple-Baseline Study

Caregivers’ Perspectives on the Sensory Environment and Participation in Daily Activities of Children With Autism Spectrum Disorder

Enhancing Occupational Therapy Interventions by Integrating the Multiphase Optimization Strategy Framework

Telehealth Occupation-Based Coaching for Rural Parents of Children With Type 1 Diabetes: A Randomized Controlled Trial

Impact of Medical Improvisation on Therapeutic Use of Self: A Randomized Controlled Waitlist Study

Hospitals Did Not Increase Acute Occupational Therapy Provision Despite Positive Associations With Hospital Performance Under Medicare’s Comprehensive Care for Joint Replacement Program

The Multiple Errands Test–Home Version and Its Association With Driving Potential: A Pilot Study

Challenges in Toileting Evaluation and Interventions for Children With Cerebral Palsy: A Delphi Study