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  • 刊频： Bimonthly, 1999-
  • NLM标题： Am J Occup Ther
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  • 1.

    【2hr】Pilot Study of Let’s Get Organized: A Group Intervention for Improving Time Management

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    机译 让我们井井有条的先导研究：改善时间管理的团体干预
    摘要：Importance: There is a need for evidence-based occupational therapy interventions to enhance time management in people with time management difficulties.Objective: To pilot test the first part of the Let’s Get Organized (LGO) occupational therapy intervention in a Swedish context by exploring enhancements of time management skills, aspects of executive functioning, and satisfaction with daily occupations in people with time management difficulties because of neurodevelopmental or mental disorders.Design: One-group pretest–posttest design with 3-mo follow-up.Setting: Outpatient psychiatric and habilitation settings.Participants: Fifty-five people with confirmed or suspected mental or neurodevelopmental disorder and self-reported difficulties with time management in daily life.Intervention: Swedish version of Let’s Get Organized (LGO–S) Part 1, with structured training in the use of cognitive assistive techniques and strategies using trial-and-error learning strategies in 10 weekly group sessions of 1.5 hr.Outcomes and Measures: Time management, organization and planning, and emotional regulation were measured with the Swedish version of the Assessment of Time Management Skills (ATMS–S). Executive functioning was measured with the Swedish version of the Weekly Calendar Planning Activity, and satisfaction with daily occupations was assessed with the Satisfaction With Daily Occupations measure.Results: Participants displayed significantly improved time management, organization and planning skills, and emotional regulation, as well as satisfaction with daily occupations. Aspects of executive functioning were partly improved. ATMS–S results were sustained at 3-mo follow-up.Conclusion and Relevance: LGO–S Part 1 is a promising intervention for improving time management skills and satisfaction with daily occupations and should be investigated further.What This Article Adds: This study shows that LGO–S Part 1 is feasible for use in psychiatric and habilitation outpatient services. The results are promising for improved time management skills, organization and planning skills, and satisfaction with daily occupations and need to be confirmed in further studies.
  • 2.

    【2hr】Somatosensory Discrimination in People With Autism Spectrum Disorder: A Scoping Review

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    机译 自闭症谱系障碍患者的体感歧视：研究范围
    摘要：Importance: Sensory symptoms in people with autism spectrum disorder (ASD) are commonly reported by researchers. However, an often overlooked sensory aspect of ASD is sensory discrimination in general, and somatosensory discrimination in particular.Objective: To examine what has and what has not yet been learned concerning the somatosensory discrimination abilities of people with ASD and to reveal gaps warranting further research.Design: Scoping review of clinical studies published 1995–2017 located through searches of PsycNET, PubMed, ERIC, and Google Scholar. Inclusion criteria were English-language peer-reviewed studies with (1) participants diagnosed with ASD, (2) a specific somatosensory discrimination measure, and (3) a comparison group. No age or intellectual exclusion criteria were established; studies were excluded if they were theoretical or descriptive, did not incorporate a control group, focused only on neurology or genetics, or used simple threshold detection measures or somatosensory measures integrated with other measures. The final search yielded 12 comparative articles discussing tactile and proprioceptive discrimination in people with ASD.Results: Overall, most results showed atypical somatosensory discrimination in people with ASD, especially among young children. The relationship between sensory discrimination abilities and other sensory symptoms and ASD symptoms is briefly discussed.Conclusions and Relevance: Heterogeneous findings concerning somatosensory discrimination in people with ASD shed light on underlying mechanisms of these disorders and can contribute to improvement of occupational therapy intervention for this population.What This Article Adds: The occupational therapy evaluation of people with ASD can benefit from addressing somatosensory discrimination and its contribution to other clinical symptoms. This type of assessment can help improve intervention strategies for people with ASD by promoting a focus on the effect of discrimination deficits on daily function.
  • 3.

    【2hr】Reference Values for the Adolescent/Adult Sensory Profile in Spain

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    机译 西班牙青少年/成人感官档案的参考值
    摘要：Importance: In Spain, only one culturally adapted assessment tool is available for children between ages 3 and 11 yr. There are no assessments of adolescent and adult sensory processing, and no normative data.Objective: To obtain reference values for the Adolescent/Adult Sensory Profile (AASP) in Spain for adolescents (aged 11–17) and adults (aged 18–64 and ≥65).Design: A multivariate analysis of variance was used to compare specific mean values (−2, −1, +1, and +2 standard deviation [SD]) by age group, gender, geographic area, education level, and employment status.Participants: We randomly recruited 787 participants (55.8% female) aged 11 yr or older (mean age = 32.1, SD = 21.1) in Spain. We excluded those with a diagnosis of depression, chronic disease (e.g., diabetes, cancer, neurological disease), or cognitive disability and those who used medication that could affect the central nervous system.Results: Quadrant mean (SD) scores ranged from 29.3 (6.6) for low registration to 49.1 (8.3) for sensory seeking, with significant differences by age group (p < .001) in all quadrants. Significant differences were also found for scores in different quadrants by gender, geographic area, education level, and employment status. Although statistically significant, the differences between scores were not clinically relevant; the mean scores fell within the typical range for sensory processing.Conclusions and Relevance: We offer reference values for the cultural adaptation to Spain of the AASP and recommend its use for the typically developing Spanish population ages 11 and older.What This Article Adds: We provide normative data for the AASP for three age groups of the Spanish population: adolescents, adults, and older adults.
  • 4.

    【2hr】Health Through Activity: Initial Evaluation of an In-Home Intervention for Older Adults With Cancer

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    机译 通过活动实现健康：老年癌症家庭干预的初步评估
    摘要：OBJECTIVE. The objective of this study was to assess the feasibility of conducting a future full-scale trial to test the efficacy of an in-home occupational therapy intervention designed to reduce disability in older adult cancer survivors.METHOD. Participants reporting activity limitations during or after cancer treatment were enrolled in a Phase 1 pilot randomized controlled trial comparing the 6-wk intervention (n = 30) to usual care (n = 29). Descriptive data on retention rates were collected to assess feasibility of intervention and study procedures. Potential efficacy was explored through participants’ self-reported disability, quality of life, activity level, and behavioral activation at 0, 8, and 16 wk after enrollment.RESULTS. Retention rates were high regarding completion of the intervention (90%) and outcome assessments (90% of usual-care participants and 80% of intervention participants). Outcomes consistently favored the intervention group, although group differences were small.CONCLUSION. The procedures were feasible to implement and acceptable to participants.
  • 5.

    【2hr】Identifying Homogeneous Outcome Groups in Adult Rehabilitation Using Cluster Analysis

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    机译 使用聚类分析确定成人康复中的同质结果组
    摘要：Importance: Adults receiving occupational therapy in inpatient rehabilitation are a heterogeneous population with differing needs, outcomes, and rehabilitation processes. Outcome studies based on what works for all clients may obscure the needs of population subgroups who benefit unequally from rehabilitation services.Objective: To identify subgroups on the basis of client satisfaction and progress in functional self-care among a diverse rehabilitation population and to understand subgroup differences in occupational therapy and rehabilitation processes and client discharge status.Design: Using an existing dataset, we used K-means cluster analysis of demographics, status at admission, and the outcomes of satisfaction and change in self-care to identify five homogeneous outcome groups. Occupational therapy and rehabilitation processes and discharge status were compared across subgroups.Setting: Inpatient rehabilitation hospital.Participants: The dataset included 1,099 inpatients age 18 yr and older who received occupational therapy over a 27-mo period.Measures: Admission measures included the Inpatient Rehabilitation Facility–Patient Assessment Instrument and self-care items of the FIM™. The Satisfaction with Continuum of Care–Revised was administered after discharge.Results: Five subgroups showed statistically different patterns of medical complications, functional self-care, rates of progress, satisfaction with intervention, and course of treatment. The profile of each group suggests differing therapeutic needs. Although all groups made significant gains in functional self-care, two groups continued to need physical assistance at discharge.Conclusions and Relevance: Cluster analysis proved useful in segmenting a typical heterogeneous rehabilitation population into more homogeneous subgroups to enhance understanding of clinical needs and to potentially increase the potency of outcomes research.What This Article Adds: This research identified subgroups within a typical population of rehabilitation clients receiving occupational therapy and identified their unique needs and outcomes using cluster analysis techniques.
  • 6.

    【2hr】Complex Task Performance Assessment (CTPA) and Functional Cognition in People With Parkinson’s Disease

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    机译 帕金森氏病患者的复杂任务绩效评估（CTPA）和功能认知
    摘要：OBJECTIVE. The objective of this study was to determine how Parkinson’s disease (PD) affects functional cognition as assessed by the Complex Task Performance Assessment (CTPA) and to examine the associations of CTPA performance with other indicators of executive function in people with PD.METHOD. Volunteers with PD without dementia (n = 20) and community control participants (n = 19) completed neuropsychological testing, patient-reported outcome measures, and the CTPA.RESULTS. There were no group differences for CTPA performance accuracy; however, the PD group took longer to complete the CTPA than did the control group. In the PD group, inefficient CTPA performance correlated with poorer cognitive flexibility and worse reported everyday shifting and task monitoring.CONCLUSION. Decreased executive function, namely cognitive flexibility and attentional control, may impair functional cognition in people with PD. Future studies with larger, more diverse samples are warranted to determine the discriminant validity and sensitivity of the CTPA. Use of performance-based assessments such as the CTPA may increase the understanding of functional cognition in people with PD.
  • 7.

    【2hr】Visual Field Impairment and Driver Fitness: A 1-Year Review of Crashes and Traffic Violations

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    机译 视野障碍和驾驶员适应性：一年的事故和交通违规审查
    摘要：Importance: Occupational therapists frequently assess the fitness to drive of people with visual field impairment, but the relationship between these assessments and driving performance over time is not well understood.Objective: To determine traffic violation and crash incidence over a 1-yr period for drivers with visual field impairment.Design: Retrospective review of medical and driving records.Setting: British Columbia, Canada.Participants: Participants (N = 445) were ages 26–74 yr with binocular, corrected visual acuity of ≥20/50. Goldmann visual field tests were reviewed to stratify participants on the basis of visual field impairment and whether impairments exceeded licensing standards.Outcome and Measures: Traffic records were reviewed to determine group-specific traffic violations and crash incidence during the year after the visual field test.Results: Of 445 participants, 292 held a valid driver’s license during the designated period. Participants not meeting the licensing standards were less likely to become licensed than participants who met the standards. The results indicate that drivers with visual field impairment did not have a higher probability of crashes or violations than drivers without visual field impairment.Conclusion: Drivers with visual field impairment who retained a driver’s license did not have an increased probability of crashes in the following year. A larger, prospective, mixed methods study of long-term driving behaviors among people with visual field impairment is recommended.What This Article Adds: This study provides preliminary data on the 1-yr incidence of traffic violations and crashes among people with visual field impairment.
  • 8.

    【2hr】Capturing Upper Limb Gross Motor Categories Using the Kinect® Sensor

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    机译 使用Kinect®传感器捕获上肢总电机类别
    摘要：Importance: Along with growth in telerehabilitation, a concurrent need has arisen for standardized methods of tele-evaluation.Objective: To examine the feasibility of using the Kinect sensor in an objective, computerized clinical assessment of upper limb motor categories.Design: We developed a computerized Mallet classification using the Kinect sensor. Accuracy of computer scoring was assessed on the basis of reference scores determined collaboratively by multiple evaluators from reviewing video recording of movements. In addition, using the reference score, we assessed the accuracy of the typical clinical procedure in which scores were determined immediately on the basis of visual observation. The accuracy of the computer scores was compared with that of the typical clinical procedure.Setting: Research laboratory.Participants: Seven patients with stroke and 10 healthy adult participants. Healthy participants intentionally achieved predetermined scores.Outcomes and Measures: Accuracy of the computer scores in comparison with accuracy of the typical clinical procedure (immediate visual assessment).Results: The computerized assessment placed participants’ upper limb movements in motor categories as accurately as did typical clinical procedures.Conclusions and Relevance: Computerized clinical assessment using the Kinect sensor promises to facilitate tele-evaluation and complement telehealth applications.What This Article Adds: Computerized clinical assessment can enable patients to conduct evaluations remotely in their homes without therapists present.
  • 9.

    【2hr】Evaluation of an Occupation-Based Retreat for Women After Pregnancy or Infant Loss

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    机译 孕妇或婴儿流产后基于职业的务虚会的评估
    摘要：Importance: Pregnancy loss and infant death are unexpected, traumatic, life-changing events. The role of occupational therapy practitioners in treating this population is not well defined.Objective: To describe the outcomes of an occupation-based residential retreat for women who have experienced pregnancy or infant loss.Design: Program evaluation.Setting: Seven residential retreats for bereaved mothers.Participants: One hundred forty-one women who experienced perinatal loss.Intervention: Residential retreats that were held in natural settings and included occupation-based activities such as group discussions, yoga, meditation, crafts, and rituals to facilitate grieving and healing processes after perinatal loss.Outcomes and Measures: The Beck Depression Inventory, PTSD Checklist–Civilian Version, Self-Compassion Scale, and Multidimensional Scale of Perceived Social Support were collected pre- and postretreat.Results: Statistically significant improvements were seen in women’s depression, trauma, self-compassion, and perceived social support from pre- to postretreat.Conclusions and Relevance: At present, occupational therapy practitioners support this population primarily by providing referrals and information about local resources. However, as occupational therapy practice in primary care settings grows, so too do possibilities for the development of occupational therapy–related interventions to support maternal mental health.What This Article Adds: This article provides preliminary support for occupation-based retreats as a treatment for improving maternal mental health after perinatal loss.
  • 10.

    【2hr】Measurement Validity of the Low Vision Independence Measure (LVIM)

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    机译 弱视独立测量（LVIM）的测量有效性
    摘要：OBJECTIVE. This study’s objective was to test the psychometrics of Low Vision Independence Measure (LVIM) using the Rasch model.METHOD. A cohort design was used with 93 participants receiving occupational therapy for low vision. Confirmatory factor analysis (CFA) with a parceling approach was used to test the LVIM factors and Rasch analysis to examine item-level psychometrics.RESULTS. Participants’ average age was 78.9 yr (standard deviation = 12.1), and the majority were female (72.8%) with macular degeneration (62.3%). The CFA revealed two measurement factors: visual field or scotoma (n = 28) and visual acuity (n = 24). We removed six misfitting items, and the two factors of the revised LVIM demonstrated good rating scale function, good internal consistency (person reliability: visual field, .87; visual acuity, .90), good precision (person strata: visual field, 3.91; visual acuity, 4.40), no ceiling or floor effects, and no differential item functioning.CONCLUSION. The revised LVIM demonstrates good psychometrics on the Rasch model and can be used as a valid outcome measure in low vision rehabilitation.
  • 11.

    【2hr】Occupational Challenges in Military Service Members With Chronic Mild Traumatic Brain Injury

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    机译 慢性轻度颅脑外伤在兵役中的职业挑战
    摘要：OBJECTIVE. The purpose of this study was to identify the needs of military service members with chronic symptoms after mild traumatic brain injury (mTBI) that fall within the scope of occupational therapy practice.METHOD. In this qualitative descriptive study, service members with a history of mTBI (N = 12) participated in semistructured interviews about their injury history, symptoms, daily routines, challenges, and plans.RESULTS. Two main themes were identified: occupational changes and plans for the future. Occupational changes contains six subthemes: (1) rest and sleep, (2) activities of daily living and instrumental activities of daily living, (3) work, (4) social participation, (5) play and leisure, and (6) education. Plans for the future contains three subthemes: (1) supports, (2) barriers, and (3) fears.CONCLUSION. Occupational therapists who work with this population should consider all areas of occupation, especially sleep, during assessment and treatment planning. Some clients may require additional support for preparing for civilian life.
  • 12.

    【2hr】Sensory Features and Family Functioning in Families of Children With Autism and Developmental Disabilities: Longitudinal Associations

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    机译 自闭症和发育障碍儿童家庭的感觉特征和家庭功能：纵向关联
    摘要：Importance: Children with autism spectrum disorder (ASD) and other developmental disabilities (DD) commonly display unusual responses to sensory input. Previous work has suggested concurrent associations linking sensory features with aspects of family functioning, including activity participation and caregiver strain. What is unknown, however, is the extent to which sensory features affect family functioning over time, as well as the influence of received services on these relationships.Objective: To assess hypothesized longitudinal associations between sensory features and family functioning and examine interactions by group and service usage (i.e., educational and therapy services).Design: Multigroup longitudinal observational study.Setting: Community.Participants: A volunteer sample of 81 children (50 with ASD, 31 with DD; 76% male), ages 2–12 yr, and their caregivers participated in assessments at two points, 3.3 yr apart on average.Outcomes and Measures: Key measures included the Sensory Experiences Questionnaire, Sensory Profile, Sensory Processing Assessment for Young Children, Tactile Defensiveness and Discrimination Test–Revised, Caregiver Strain Questionnaire, and Home and Community Activities Scale. We also measured the amount of time children received educational and therapy services.Results: Regression analyses confirmed long-term associations linking sensory features with aspects of activity participation and caregiver strain in this population; group and service usage interactions were also identified.Conclusions and Relevance: Sensory features can affect the everyday experiences of both children and caregivers. It is important for practitioners to understand the potentially enduring effects of children’s sensory features on family functioning so as to begin to identify supportive interventions with more optimal long-term effects.
  • 13.

    【2hr】Handgrip Strength: A Comparison of Values Obtained From the NHANES and NIH Toolbox Studies

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    机译 握力：从NHANES和NIH工具箱研究获得的值的比较
    摘要：Importance: Handgrip dynamometry is probably the most commonly used method to characterize overall human muscle strength.Objective: To compare and summarize grip strength measurements obtained from two population-based studies.Design: Secondary data analysis.Setting and Participants: Data from (1) the 2011–2014 National Health and Nutrition Examination Survey (NHANES) with 13,918 participants and (2) the 2011 normative phase of the National Institutes of Health (NIH) Toolbox project with 3,594 participants.Outcomes and Measures: The NHANES values used were the mean and best of three trials; the NIH Toolbox value used was the one maximum trial after a practice trial.Results: General linear model analysis revealed that values obtained from the NIH Toolbox differed from NHANES best values but not from NHANES mean values. The analysis also indicated, regardless of the values used, that grip strength differed significantly between dominant and nondominant sides, males and females, and age groups. We provide updated reference values for handgrip strength.Conclusions and Relevance: On the basis of these analyses, we summarize grip strength measures obtained from the NHANES and NIH Toolbox for side, gender, and age group strata. Reference values are essential to assist in the interpretation of testing results and clinical decision making.
  • 14.

    【2hr】Cognitive, Emotional, and Physical Functioning as Predictors of Paid Employment in People With Stroke, Traumatic Brain Injury, and Spinal Cord Injury

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    机译 认知，情感和身体功能作为中风，颅脑外伤和脊髓损伤患者带薪工作的预测指标
    摘要：OBJECTIVE. Our objective was to examine demographic, cognitive, emotional, and physical factors that predict return to paid employment for people after neurological injury.METHOD. Four hundred eighty adults with stroke (n = 149), traumatic brain injury (n = 155), and spinal cord injury (n = 176) completed an occupational outcome questionnaire and physical, emotional, and cognitive assessments at three rehabilitation facilities.RESULTS. Odds of employment were predicted by being married or partnered, having more education, requiring fewer prompts for task sequencing, and having higher inhibitory control (but were not predicted by specific type of injury). Participants who returned to work within 3 mo were more likely to work with the same employer and to take a full-time position than those who returned later.CONCLUSION. Executive functioning, in particular sequencing and inhibitory control, strongly predicts employment and highlights the importance of cognitive strategy training during occupational therapy with people who have sustained neurological injuries.
  • 15.

    【2hr】Parents’ Strategies to Support Mealtime Participation of Their Children With Autism Spectrum Disorder

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    机译 父母自闭症谱系支持子女进餐的策略
    摘要：OBJECTIVE. We identified and described the strategies parents use to support the mealtime participation of their child with autism spectrum disorder (ASD).METHOD. Twelve families with children with ASD (ages 2–7 yr) participated in videotaped mealtime observations. Qualitative content analysis was used to identify strategies families used to facilitate participation.RESULTS. Six categories were identified: (1) parent intervening and ignoring, (2) meal preparation and adaptability, (3) play and imagination, (4) distractions, (5) positive reinforcements, and (6) modeling. Props—common child objects that support the child’s mealtime participation—were used in the context of multiple strategies. In addition, increased parental vigilance emerged as an important component of all family mealtimes.CONCLUSION. Families used multiple strategies within and across mealtimes, highlighting the individualistic nature of feeding challenges. Understanding parent mealtime strategies allows for further investigation into the efficacy and development of intervention strategies to promote mealtime participation of children with ASD.
  • 16.

    【2hr】Masthead

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    机译 刊头
    • 作者：
    • 刊名：The American Journal of Occupational Therapy
    • 2019年第5期
    摘要：
  • 17.

    【2hr】Occupational Therapy in Primary Care: Positioned and Prepared to Be a Vital Part of the Team

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    机译 基层医疗的职业治疗：定位并准备成为团队的重要组成部分
    • 作者：Katie Jordan
    • 刊名：The American Journal of Occupational Therapy
    • 2019年第5期
    摘要：now deeply cherished statement that “man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health” (p. 1) was followed a few years later with a question to current and future occupational therapy practitioners. In 1966, Reilly asked how the profession would respond to the challenges of an expanding knowledge base, accelerating health care costs, and escalating regulatory burden. Visionary Wilma West, a contemporary of Reilly’s, expanded on these themes by focusing on ways occupational therapy practitioners could leverage the breadth and depth of their practice to confront these challenges. These issues are now paramount in the primary care arena. An expanding body of literature, including the articles in a special section in this issue of the American Journal of Occupational Therapy, supports occupational therapy’s role as a vital part of the solution to contemporary health care challenges. Occupational therapy practitioners are educationally prepared and successfully poised through policy to engage in evidence-based practice in the primary care environment.
  • 18.

    【2hr】Influence of Lifestyle Redesign® on Health, Social Participation, Leisure, and Mobility of Older French-Canadians

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    机译 生活方式重新设计®对法裔加拿大老人的健康，社会参与，休闲和流动性的影响
    摘要：Importance: Developed in California to enable community-dwelling older adults to maintain healthy and meaningful activities, Lifestyle Redesign® is a well-known cost-effective preventive occupational therapy intervention. The impact of a newly adapted French version on older French-Canadians was, however, unknown.Objective: To explore the influence of Lifestyle Redesign on older French-Canadians’ health, social participation, leisure, and mobility.Design: A mixed-methods design included a preexperimental component (questionnaires administered before and after the intervention and 3 and 6 mo postintervention) and an exploratory descriptive qualitative clinical study. Individual semidirected interviews were digitally audiotaped and transcribed, then underwent thematic content analysis using mix extraction grids.Setting: Community.Participants: Sixteen volunteers (10 women) aged 65–90 yr (mean = 76.4, standard deviation = 7.6), 10 without and 6 with disabilities. Inclusion criteria were age ≥65 yr, normal cognitive functions, residence in a conventional or senior home, and French speaking.Intervention: French-Canadian 6-mo version of Lifestyle Redesign.Outcomes and Measures: Health, social participation, leisure, and mobility were measured using the 36-item Short Form Health Survey, Social Participation Scale, Leisure Profile, and Life-Space Assessment, as well as a semistructured interview guide.Results: The French-Canadian Lifestyle Redesign had a beneficial effect on participants’ mental health (p = .02) and interest in leisure (p = .02) and, in those with disabilities, social participation (p = .03) and attitudes toward leisure (p = .04). Participants reported positive effects on their mental health, leisure, mobility, and social participation, including frequency and quality of social interactions, and indicated that having an occupational routine fostered better health. None of the participants reported no effect.Conclusion and Relevance: The translated and culturally adapted Lifestyle Redesign is a promising occupational therapy intervention for community-dwelling older French-Canadians.What This Article Adds: This study sheds light on the influence of the French-Canadian version of the intervention not only on older adults’ health and social participation but also on their leisure activities and life-space mobility, two important outcomes not addressed in previous Lifestyle Redesign studies. Moreover, this study provides an in-depth understanding of the Lifestyle Redesign experience of French-Canadian older adults with and without disabilities, including participants with significant communication and mobility disabilities.
  • 19.

    【2hr】Addressing Diabetes in Primary Care: Hybrid Effectiveness–Implementation Study of Lifestyle Redesign® Occupational Therapy

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    机译 解决初级保健中的糖尿病：LifestyleRedesign®职业疗法的综合功效-实施研究
    摘要：Importance: Primary health care is rapidly developing as an occupational therapy practice area. Yet, to date, little evidence supports occupational therapy’s feasibility and efficacy in primary care settings.Objective: To report on the implementation and preliminary clinical outcomes of a Lifestyle Redesign® (LR)–occupational therapy (LR–OT) diabetes management intervention in a primary care clinic.Design: Patients were randomized to be offered LR–OT or to a no-contact comparison group (data not reported). We assessed implementation outcomes using mixed methods.Setting: Safety-net primary care clinic.Participants: Clinic providers and staff; English- or Spanish-speaking clinic patients ages 18–75 yr with diabetes and a current hemoglobin A1c (HbA1c) ≥ 9.0%.Intervention: Eight 1-hr individual sessions of LR–OT focused on diabetes management.Outcomes and Measures: Clinical and health behavior outcomes were assessed via electronic medical record (EMR) review and self-report surveys of patients receiving LR–OT at initial evaluation and discharge. We assessed implementation outcomes (acceptability, appropriateness, feasibility, fidelity, efficiency, and timeliness) using patient and staff surveys, interviews, focus groups, and observations.Results: Seventy-three patients were offered LR–OT: 51 completed one or more sessions, and 38 completed the program. Clinical outcomes among program completers indicate beneficial changes in HbA1c, diabetes self-care, and health status. Implementation challenges included a need for patient and staff education, securing adequate workspace, and establishing a referral process. Factors contributing to implementation success included strong buy-in from clinic leadership, colocation, and shared EMR documentation.Conclusions and Relevance: LR–OT is a feasible approach to enhancing service delivery and clinical outcomes in primary care.What This Article Adds: This study provides insight into factors that may create challenges or contribute to the success of implementing occupational therapy services within primary health care settings. In addition, this study provides preliminary evidence of occupational therapy’s effectiveness in improving clinical outcomes among ethnically diverse, low-income patients with diabetes in a safety-net primary care setting.
  • 20.

    【2hr】Examining Primary Care Health Encounters for Adults With Autism Spectrum Disorder

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    机译 检查患有自闭症谱系障碍的成年人的初级保健健康遭遇
    摘要：OBJECTIVE. Our objective was to identify perceived barriers and strategies to improve primary care encounters, as reported by adults with autism spectrum disorder (ASD), caregivers of adults with ASD, and primary care providers (PCPs) treating adults with ASD.METHOD. As part of a larger mixed-methods design, adults with ASD, caregivers, and PCPs (N = 78) in Los Angeles and Philadelphia completed surveys examining barriers to care and strategies to improve care.RESULTS. Multiple barriers to care were reported by adults with ASD and caregivers, including communication and sensory challenges. Adults with ASD and caregivers reported minimal use of strategies during primary care visits but indicated that those used were helpful during care. Expert PCPs reported using strategies more frequently than novice PCPs. All respondent groups endorsed that strategies had the potential to improve care in the future for adults with ASD.CONCLUSION. Opportunities exist for occupational therapy collaboration in primary health care and primary care education to improve care for adults with ASD.
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