Cognitive Behavioral Therapy for Insomnia Improves Sleep Outcomes in Individuals With Concussion: A Preliminary Randomized Wait-List Control Study

OBJECTIVE

Cognitive behavioral therapy for insomnia (CBT-I) is the gold standard treatment for insomnia, but there is limited evidence on the treatment effect of CBT-I in individuals after a concussion. Therefore, the main purpose of this study was to evaluate the treatment effect of CBT-I on sleep outcomes and postconcussion symptoms.

SETTING

This study was conducted at an academic institution. The CBT-I sessions were conducted using a teleconferencing system (Zoom).

PARTICIPANTS

Participants were eligible to participate if they were at least 4 weeks post- concussion, aged 18 to 64 years, and scored 10 or more on the Insomnia Severity Index. A total of 40 people were enrolled; 32 participants were included in analyses.

DESIGN

This was a randomized controlled wait-list study. Participants were randomized into starting the CBT-I intervention immediately after the baseline assessment or into the wait-list group for 6 weeks before starting CBT-I. Assessments were performed at baseline, 6, 12, and 18 weeks.

MAIN MEASURES

The primary outcome was the Insomnia Severity Index. Secondary measures included the Pittsburg Sleep Quality Index, Post-Concussion Symptom Scale, and Beck Depression and Anxiety Inventories. Statistical analyses included a repeated-measures analysis of variance, t tests, and mixed linear regression modeling.

RESULTS

There was a group-by-time interaction for the sleep outcomes but not for the concussion or mood outcomes. Differences were seen between groups on sleep outcomes, symptom severity, and depression. The treatment effect was maintained following CBT-I for all outcomes. Improvement in sleep outcomes was predictive of improvement in postconcussion symptom severity and number of symptoms.

CONCLUSIONS

CBT-I reduces insomnia in individuals with concussions, and improved sleep was associated with lower postconcussion and mood symptoms. These effects were maintained 6 to 12 weeks following the intervention.

Engaging with nature and work: associations among the built and natural environment, experiences outside, and job engagement and creativity

Introduction

There is substantial evidence that contact with nature is related to positive health and well-being outcomes, but extensions of this research to work-related outcomes is sparse. Some organizations are redesigning workspaces to incorporate nature and adopting nature-related policies, warranting a need for empirical studies that test the influence of nature on employee outcomes.

Methods

The present mixed-methods study tests and extends the biophilic work design model to examine associations among the built and natural environment at work and home, experiences of time spent outside (i.e., amount of time outside, enjoyment of time outside, outdoor activities), and motivational work outcomes (i.e., job engagement and creativity). Objective geographic data were combined with quantitative and qualitative survey responses from working adults (N = 803).

Results

Our results broadly indicate that individuals who work and live in areas with greater natural amenities (i.e., access to water, topographic variation, temperate climates) spend more time outside and enjoy time outside to a greater degree, and these experiences are in turn associated with greater engagement and creativity at work. We did not find evidence that the surrounding built environment (i.e., urbanity) at work or home was associated with outdoor experiences or work-related outcomes. Additionally, six categories of outdoor activities were identified in the qualitative analyses - leisure activities, relaxation, physical activities, social interactions, tasks and errands, and travel.

Discussion

The findings from this study provide evidence that the natural environment, particularly at home, can benefit work-related outcomes via greater time and enjoyment of time outside. This study has implications for employee time use and organizational effectiveness.

Item-Level Psychometrics of the Meaningful Activity Participation Assessment (MAPA) Scale

This study investigates the psychometric properties of the Meaningful Activity Participation Assessment-Meaning (MAPA-M) scale using the Rasch measurement model. For the psychometric properties of MAPA-M, principal component analysis, Rasch analysis, and differential item functioning analysis were conducted. Participants in this study were 480 older adults from the USC Well Elderly 2 study, recruited from 21 locations in the Los Angeles metropolitan area. There were eight items with DIF, but they were accepted because they assumed unidimensionality and showed good person invariance. The 25 items assuming unidimensionality of MAPA-M had values between 0.6 and 1.4 in infit and Outfit MnSq, and all ZSTD values were less than 2.0. The 25 items demonstrated a conceptual item-difficulty hierarchy. The person strata value was 2.68, which is equivalent to a reliability index value of .76. The findings indicate that the revised scale can accurately and reliably measure meaningful activities by older adults.

Occupational therapy gender imbalance; revisiting a lingering issue

BACKGROUND

Recently, it has been suggested that gender disparity in Occupational Therapy has to do with segregated gendered job norms that position female dominated professions as a 'step down' for many males. Interestingly, this suggestion was not underpinned by experiences of males in the profession.

AIMS AND METHODS

Thirteen male Occupational Therapists with a variety of backgrounds were invited to this Round Table research, focussing on the broader issue of the existing gender imbalance in Occupational Therapy.

RESULTS

Two themes emerged: 'The core values of the profession', and 'Broadening the scope of the profession'; none of them suggesting that male/female imbalance was necessarily the most pressing issue.

CONCLUSIONS

A gender-unrelated approach to everyday problem-solving was put forward to achieve increased diversity in Occupational Therapists' backgrounds, better reflecting the people they serve. By broadening the scope and the way the profession is presented, and encouraging innovative and more entrepreneurially driven approaches, diversity in the workforce could be further facilitated. These findings are discussed within the context of 'The mutual constitution of cultures and selves' model.

SIGNIFICANCE

Diversity in the Occupational therapy workforce could be further facilitated with a shift in focus away from the male/female perspective to an intersectional approach.

Assessing Cognitive Behavioral Therapy for Insomnia to Improve Sleep Outcomes in Individuals With a Concussion: Protocol for a Delayed Randomized Controlled Trial

BACKGROUND

Sleep disturbances post concussion have been associated with more frequent and severe concussion symptoms and may contribute to poorer recovery. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for insomnia; however, it remains unclear if this treatment method is effective in improving sleep outcomes and reducing concomitant postconcussion symptoms.

OBJECTIVE

The hypotheses for this study are that (1) CBT-I will improve sleep outcomes and (2) CBT-I will improve concomitant postconcussion symptoms.

METHODS

In total, 40 individuals who are within ≥4 weeks of postconcussion injury and have insomnia symptoms will be enrolled in this randomized controlled trial. Participants will be randomized into either a group that starts a 6-week CBT-I program immediately after baseline or a waitlist control group that starts CBT-I following a 6-week waiting period. All participants will be reassessed 6, 12, and 18 weeks after baseline. Standardized assessments measuring sleep outcomes, postconcussion symptoms, and mood will be used. Linear regression and t tests will be used for statistical analyses.

RESULTS

Enrollment of 40 participants was completed July 2022, data collection will be completed in November 2022, and publication of main findings is anticipated in May 2023. It is anticipated that participants experience reduced insomnia symptoms and postconcussion symptoms following CBT-I and these improvements will be retained for at least 12 weeks. Additionally, we expect to observe a positive correlation between sleep and postconcussion symptom improvement.

CONCLUSIONS

Successful completion of this pilot study will allow for a better understanding of the treatment of insomnia and postconcussion symptoms in individuals following a concussion.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04885205; https://clinicaltrials.gov/ct2/show/NCT04885205.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/38608.

Validation of the Persian Version of the Engagement in Meaningful Activities Survey (EMAS) in an Iranian Stroke Population: Predictors of Participation in Meaningful Activities

IMPORTANCE

The inability to participate in meaningful activities is one of stroke survivors' main difficulties and has a negative effect on their satisfaction and quality of life.

OBJECTIVE

To assess the reliability and validity of the Persian version of the Engagement in Meaningful Activities Survey (EMAS-P) and predictors of participation in meaningful activity among chronic stroke survivors.

DESIGN

Cross-sectional.

SETTING

Medical and rehabilitation centers.

PARTICIPANTS

One hundred twenty-three people (75 men, 48 women) with chronic stroke.

OUTCOMES AND MEASURES

Participants were evaluated with the EMAS-P, Satisfaction With Life Scale (SWLS), Center for Epidemiologic Studies Depression Scale, Purpose in Life Test-Short Form (PIL-SF), 36-Item Short Form Health Survey (SF-36), and Life Satisfaction Index-Z (LSI-Z).

RESULTS

The EMAS-P showed good internal consistency (Cronbach's α = .95) and test-retest reliability (intraclass correlation coefficient = .87 for EMAS-P total score). Test-retest reliability for each EMAS-P item was moderate (κ = .40-.65). A significant correlation between the EMAS-P and PIL-SF (r = .86), SWLS (r = .83), LSI-Z (r = .75), and SF-36 subscales (rs = .52-.83) indicated the appropriate convergent validity. The EMAS-P's discriminative validity was also confirmed for age, depression level, and disability level among people with chronic stroke. Depression, disability level, gender, and fatigue were significant predictors of EMAS-P score.

CONCLUSIONS AND RELEVANCE

The results indicate that the EMAS-P has acceptable reliability and validity among Iranian people with chronic stroke. Moreover, the EMAS-P showed good discriminant validity for age, depression, and disability level among them. What This Article Adds: The EMAS-P is a reliable and valid scale for assessing the engagement of Iranian chronic stroke survivors in meaningful activities and thus should be helpful in both clinical research and practice.

Development of the Japanese Version of the Engagement in Meaningful Activities Survey

OBJECTIVES

To create a Japanese version of the Engagement in Meaningful Activities Survey (EMAS) and assess internal consistency, test-retest reliability, convergent and structural validity.

METHOD

We conducted a cultural translation and validation study of the Japanese version of the EMAS (EMAS-J) in a sample of 96 community-dwelling older adults in the Tohoku Region of Japan.

RESULTS

Internal consistency of the EMAS-J (α = .91) was very good. Low to moderate correlations were found with indicators of health-related quality of life, depression, and life purpose and meaning. Exploratory factor analysis indicated a two-factor structure within the EMAS-J; cultural differences in item-factor composition compared with previously reported EMAS factor structures are discussed.

IMPLICATIONS

The EMAS-J is a reliable and valid assessment of engagement in meaningful activities for older adults in Japan. The assessment can be used to evaluate the effects of occupation-based interventions upon health and well-being.

Follow-Up Analyses From a Wait-List Controlled Trial of Occupational Therapist-Delivered Cognitive-Behavioral Therapy for Insomnia Among Veterans With Chronic Insomnia

IMPORTANCE

Veterans often experience chronic insomnia, and professionals capable of delivering effective interventions to address this problem are lacking.

OBJECTIVE

To evaluate the efficacy of the Restoring Effective Sleep Tranquility (REST) program, an occupational therapist-led cognitive-behavioral therapy for insomnia (CBT-I) intervention to treat sleep problems among post- 9/11 veterans.

DESIGN

Wait-list controlled trial with 3-mo follow-up.

SETTING

Community-based veteran support program in a Mountain West university.

PARTICIPANTS

Fifteen post-9/11 veterans with sleep disturbances who were assigned to either the REST intervention or a wait-list control group. Outcomes and Measures: Sleep-related, health-related, and participation-related patient-reported outcomes (PROs) and daily sleep diary variables.

RESULTS

Wait-list controlled trial benefits included improved sleep-related (e.g., sleep disturbance), health-related (e.g., depression), and participation-related (e.g., meaningful activity) PROs. Findings were confirmed after participants in both the intervention and the control groups (n = 13) received the REST intervention, including improved daily sleep diary outcomes (e.g., sleep efficiency). All gains were maintained at 3 mo.

CONCLUSIONS AND RELEVANCE

Occupational therapy practitioners with advanced training in CBT-I have the potential to safely deliver an effective CBT-I intervention to veterans with sleep disturbances in a community-based setting. What This Article Adds: Occupational therapy practitioners with sleep-related education and training can positively affect the well-being of their clients through improving sleep participation.

Combat exposure undermines student veterans' achievement of a meaningful life through its association with health-related symptoms: A longitudinal study

Objective: To understand whether symptoms of health conditions explain the negative association between combat exposure and student Veterans' achievement of a meaningful life. Participants: 153 combat Veterans enrolled in college between November 2013 and April 2018. Methods: Through an online survey, participants reported combat exposure, health status (symptoms of conditions such as depression), and aspects of a meaningful life (belonging, self-understanding, and doing) at two time points. Path analysis was used to explore whether baseline health status mediated the relationship between combat exposure and belonging, self-understanding, and doing at follow-up. Results: Indirect effects indicated that the negative influence of combat on student Veterans' sense of belonging, self-understanding, and doing at follow-up was mediated by poor health at baseline. Conclusions: Combat exposure may contribute to the development of health conditions, which in turn limit student Veterans' experience of three aspects of a meaningful life: a sense of belonging, self-understanding, and doing.

Psychometric properties of Meaningful Activity Participation Assessment (MAPA) in chronic stroke survivors

BACKGROUND

Meaningful Activity Participation Assessment (MAPA) is an appropriate tool for assessing both objective and subjective aspects of participation.

OBJECTIVES

This study aimed to investigate the psychometric properties of MAPA in chronic stroke survivors.

METHODS

Translation of MAPA was done according to the standard protocol of forward-backward translation. One hundred and seven chronic stroke survivors participated in this study. In addition to the MAPA, they were assessed by Satisfaction With Life Scale (SWLS), Center for Epidemiologic Studies of Depression Scale (CES-D), Life Satisfaction Index-Z (LSI-Z), Purpose in Life Test-Short Form (PIL-SF), and 36-Item Short-Form Survey (SF-36). To investigate the test-retest reliability, 37 participants were reassessed by MAPA after two weeks. Reliability, construct and known-groups validity were evaluated for MAPA.

RESULTS

The results showed an acceptable internal consistency (Cronbach's α = 0.79) and good test-retest reliability (ICC = 0.92) of MAPA. A significant moderate to high correlation was found between the MAPA and PIL-SF, CES-D, LSI-Z, SWLS, and different subscales of SF-36 (r = 0.32-0.65). MAPA showed good ability to differentiate between young adults (age≤ 65 years) and older adults (age> 65 years) with chronic stroke (P = .005) as well as between chronic stroke survivors with different levels of disability (P < .001).

CONCLUSIONS

The MAPA has appropriate reliability and validity in chronic stroke survivors and is suggested to be used in research and clinical settings.

Protective and Health-Related Factors Contributing to Resilience Among Student Veterans: A Classification Approach

IMPORTANCE

Occupational therapists can foster student veterans' resilience, but targets for intervention must be developed.

OBJECTIVE

To explain factors influencing student veterans' successful adaptation to past combat exposure, we hypothesized that participants with high life meaning would have greater levels of protective factors and lower levels of health conditions than those with low life meaning.

DESIGN

Longitudinal panel study with two measurements. Participants were classified by level of combat exposure (high-low) and life meaning (high-low) at follow-up, yielding four possible classifications (e.g., resilient group: high combat exposure, high life meaning). Linear mixed models were fit to obtain adjusted means of protective factors and health conditions for each classification; independent-samples t tests were used to examine differences between classifications.

SETTING

Community.

PARTICIPANTS

Convenience sample of 153 combat-exposed student veterans.

OUTCOMES AND MEASURES

Psychometrically sound measures of combat exposure, life meaning, protective factors (social and instructor autonomy support, coping ability, academic self-efficacy, social-community participation, and meaningful activity), and health conditions (posttraumatic stress [PTSD], depression, somatic symptoms).

RESULTS

Groups with high life meaning at follow-up in response to both levels of combat exposure reported greater meaningful activity and coping ability and fewer depressive symptoms. Participants with high life meaning in response to low combat exposure had greater social support and fewer somatic symptoms; participants with high life meaning in response to high combat exposure had lower PTSD.

CONCLUSIONS AND RELEVANCE

Occupational therapists may foster student veterans' resilience by promoting meaningful activity, social support, and coping ability while managing symptoms of health conditions.

WHAT THIS ARTICLE ADDS

To the best of our knowledge, this study is the first to offer empirical support for potential targets of occupational therapy intervention that address student veterans' successful adaptation to combat exposure. Findings suggest that researchers should develop and test interventions that facilitate successful engagement in meaningful and shared activities and that occupational therapists should work within multidisciplinary teams to bolster coping ability and manage symptoms of combat-related health conditions.

Factors distinguishing veterans participating in supported education services from veterans on campus: Evidence supporting modifiable intervention targets

OBJECTIVE

The purpose of this study was to identify specific and modifiable supported education (SEd) service needs for the veteran population. To do so, we compared veterans participating in SEd services to other veterans on campus with respect to service-related challenges, community reintegration, and academic-related challenges. Identifying independent factors that distinguish veterans receiving SEd services from other veterans on campus may help operationalize interventions that target the unique challenges in this vulnerable population.

METHOD

This study used an exploratory cross-sectional design. We used logistic regression on 410 veterans attending college. Models tested whether sociodemographic characteristics (e.g., age), service-related challenges (e.g., combat exposure), academic-related challenges (e.g., academic self-efficacy), and aspects of community reintegration (e.g., employment status) distinguished veterans receiving SEd services (n = 94) from veterans on campus (n = 316).

RESULTS

Veterans who reported (a) more severe combat exposure, (b) more severe posttraumatic stress disorder (PTSD) symptoms, (c) service-related mild traumatic brain injury (mTBI), (d) lower levels of academic self-efficacy, and (e) no paid employment were more likely to participate in SEd services.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

This study established several factors that distinguished veterans receiving SEd services from veterans on campus. Findings indicate that SEd education services for veterans should: (a) apply principles of trauma-informed care, (b) mitigate the influence of PTSD and/or mTBI upon academic success and community reintegration, (c) promote academic self-efficacy, and (d) integrate principles of supported employment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Participation Is Associated With Well-Being Among Community-Based Veterans: An Investigation of Coping Ability, Meaningful Activity, and Social Support as Mediating Mechanisms

IMPORTANCE

Occupational therapy practitioners can use therapeutic activity to promote veterans' well-being, but the mechanisms through which participation promotes well-being are poorly understood.

OBJECTIVE

To examine whether coping ability, meaningful activity, and social support mediate the relationship between participation and two indicators of veterans' overall well-being: life meaning (psychological well-being) and life satisfaction (subjective well-being).

DESIGN

Explanatory cross-sectional design. We used two multiple mediation models to test whether coping ability, meaningful activity, and social support explained the relationship between participation and both life meaning and life satisfaction. Models were adjusted for demographic characteristics and service-related health conditions (e.g., posttraumatic stress disorder).

SETTING

Community.

PARTICIPANTS

Three hundred eighty-nine community-based veterans attending college.

INTERVENTION

None.

OUTCOMES AND MEASURES

Measures of participation, coping ability, meaningful activity, social support, life meaning, life satisfaction, and service-related health conditions.

RESULTS

Meaningfulness of activity partially explained the relationship between participation and both psychological well-being (B = 0.16, standard error [SE] = 0.04, 99% confidence interval [CI] [0.07, 0.27]) and subjective well-being (B = 0.14, SE = 0.03, 99% CI [0.07, 0.24]). Social support partially explained the relationship between participation and subjective well-being (B = 0.05, SE = 0.02, 99% CI [0.01, 0.11]). These findings persisted when symptoms of service-related health conditions were accounted for.

CONCLUSIONS AND RELEVANCE

Veterans' participation is associated with a greater sense of meaningful activity and social support, which in turn promotes psychological and subjective well-being. Occupational therapy practitioners may promote veterans' well-being by supporting engagement in activities that elicit meaning and enable social interaction, although further study is needed.

WHAT THIS ARTICLE ADDS

This is among the first studies to test mechanisms underlying the relationship between veterans' engagement in activities and their overall well-being. Results may inform treatment theories for activity-based interventions in the veteran population. For example, results indicate that occupational therapy interventions that facilitate engagement in meaningful and shared activities could be developed to promote veterans' well-being.

Novel Effect Size Interpretation Guidelines and an Evaluation of Statistical Power in Rehabilitation Research

OBJECTIVE

First, to establish empirically-based effect size interpretation guidelines for rehabilitation treatment effects. Second, to evaluate statistical power in rehabilitation research.

DATA SOURCES

The Cochrane Database of Systematic Reviews was searched through June 2019.

STUDY SELECTION

Meta-analyses included in the Cochrane Database of Systematic Reviews with "rehabilitation" as a keyword and clearly evaluated a rehabilitation intervention.

DATA EXTRACTION

We extracted Cohen's d effect sizes and associated sample sizes for treatment and comparison groups. Two independent investigators classified the interventions into 4 categories using the Rehabilitation Treatment Specification System. The 25th, 50th, and 75th percentile values within the effect size distribution were used to establish interpretation guidelines for small, medium, and large effects, respectively. A priori power analyses established sample sizes needed to detect the empirically-based values for small, medium, and large effects. Post-hoc power analyses using median sample sizes revealed whether the "typical" rehabilitation study was sufficiently powered to detect the empirically-based values. Post hoc power analyses established the statistical power of each test based on the sample size and reported effect size.

DATA SYNTHESIS

We analyzed 3381 effect sizes extracted from 99 meta-analyses. Interpretation guidelines for small effects ranged from 0.08 to 0.15; medium effects ranged from 0.19 to 0.36; and large effects ranged from 0.41 to 0.67. We present sample sizes needed to detect these values based on a priori power analyses. Post hoc power analyses revealed that a "typical" rehabilitation study lacks sufficient power to detect the empirically-based values. Post hoc power analyses using reported sample sizes and effects indicated the studies were underpowered, with median power ranging from 0.14 to 0.23.

CONCLUSIONS

This study presented novel and empirically-based interpretation guidelines for small, medium, and large rehabilitation treatment effects. The observed effect size distributions differed across intervention categories, indicating that researchers should use category-specific guidelines. Furthermore, many published rehabilitation studies are underpowered.

Protective factors that mitigate the indirect risk of combat exposure upon meaning in life: A longitudinal study of student veterans

OBJECTIVE

Studies of combat emphasize its impact upon health-related outcomes (e.g., depression). Little is known regarding the risk that combat poses to positive outcomes, such as meaning in life, and factors that mitigate this risk. We sought to investigate whether combat poses an indirect risk to life meaning and protective factors that mitigate this risk.

METHOD

Through an online survey at 2 time points, 153 combat-exposed veterans enrolled in college reported combat exposure, health status (posttraumatic stress disorder, depressive, somatic symptoms), meaning in life, and protective factors (social support, instructor autonomy support, coping ability, academic self-efficacy, social and community participation, and meaningful activity). We used path analysis to (a) explore whether baseline health status and life meaning mediated the relationship between combat and follow-up life meaning, and (b) test whether protective factors promoted life meaning despite combat and health status (combat-related risk).

RESULTS

The relationship between combat and follow-up life meaning was mediated by baseline health status and life meaning. Meaningful activity and coping ability were associated with greater life meaning independently of combat-related risk. The indirect effect of combat upon life meaning was weakened when social support, instructor autonomy support, coping ability, and academic self-efficacy were high.

CONCLUSIONS

Combat is associated with worse health status, in turn limiting student veterans' life meaning. This supports an expanded conception of combat-related risk, in which the effect of combat upon positive outcomes is emphasized. Findings indicate that the proposed protective factors may mitigate combat-related risk. We discuss implications for research and practice. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Equine-assisted interventions for veterans with service-related health conditions: a systematic mapping review

BACKGROUND

Evidence-based treatments for service-related health conditions such as posttraumatic stress disorder (PTSD), depression, and traumatic brain injury (TBI) are not effective for all veterans. Equine-assisted interventions are emerging as an additional treatment modality, but little is known regarding the safe and effective delivery of these interventions. This study aimed to describe the following features of the body of literature concerning equine-assisted interventions among veterans: 1) veterans who have participated in equine-assisted interventions; 2) specific characteristics of equine-assisted interventions in veterans; and 3) the specific characteristics of research on equine-assisted interventions in veterans.

METHODS

We conducted a systematic mapping review of peer-reviewed literature reporting on equine-assisted interventions among veterans between 1980 and 2017. Searches of nine databases yielded 3336 unique records, six of which met the inclusion criteria and were reviewed. Data relevant to the study aims were extracted and analyzed.

RESULTS

Equine-assisted interventions among veterans disproportionately targeted psychosocial outcomes and yielded promising results. The detailed methods of EAI varied in the reported studies, ranging from communicating with the horse to mounted exercises. There was also great diversity in outcome measurement. The state of theoretical development regarding the mechanisms by which equine-assisted interventions benefit the veteran population is currently underdeveloped. Studies provided insufficient detail with respect to the description of the intervention, reasons for attrition, and the dose-response relationship.

CONCLUSIONS

Scientific development of equine-assisted interventions targeting psychosocial outcomes among veterans is warranted to establish their efficacy. Targeted outcomes should be expanded, including outcomes more closely aligned with the nature of polytraumatic injuries. Future research must also emphasize the theoretical development of equine-assisted interventions for veterans and thoroughly describe the participants, components of the intervention, factors contributing to attrition, and optimal dose-response relationships.

Participation, Meaningful Activity, and Social Support Among U.S. Student Service Members/Veterans

Student service members/veterans (SSM/Vs) may experience diminished social support and meaningful activity due to health-related sequelae, in turn threatening their community reintegration. Social and community participation may foster both social support and meaningful activity. This study assessed whether social and community participation explained social support and meaningful activity and evaluated the psychometric properties of the Veterans' Social and Community Participation Assessment (VSCPA). Online surveys generated responses to the VSCPA, indicators of social support, meaningful activity, health-related challenges, and demographic characteristics. Multiple regression models explored predictors of social support and meaningful activity. The VSCPA comprised three components: active community participation, familial and household participation, and social participation. These components exhibited positive associations with social support and meaningful activity and negative relationships with health-related sequelae. Targeting social and community participation among SSM/Vs may be a fruitful means by which occupational therapists bolster social support and meaningful activity.

Feasibility of a Lifestyle Redesign®-Inspired Intervention for Well Older Adults

OBJECTIVE

We examined the feasibility of Aging Well by Design, a Lifestyle Redesign^®-inspired intervention for community-dwelling older adults. The original Lifestyle Redesign program was shortened to 3 mo and implemented as a community outreach program of a major health care system.

METHOD

Community-dwelling older adults participated in the 12-wk program, which emphasized an occupational approach to healthy aging. Outcomes evaluated were recruitment, attendance, resource use, participant satisfaction, and subjective benefit to participants.

RESULTS

The 13 participants, ages 66-88 yr, attended an average of 10 of 12 sessions. The intervention was completed as planned, physical resources were suitable, and financial resources were adequate. Participants expressed satisfaction with the program's facilitator, group discussions, and materials. Perceived benefits were social relationships, awareness of community resources, and change in attitude toward aging.

CONCLUSION

Implementation of a 3-mo Lifestyle Redesign-inspired program within a health care system was feasible.

Restoring effective sleep tranquility (REST): A feasibility and pilot study

Introduction

The purpose of this pilot study was to establish the feasibility of completing a future controlled trial of a multi-component cognitive behavioral therapy for insomnia program for military veterans with sleep disturbance.

Method

This was a single-arm feasibility and pilot study. Participants were United States post-9/11 veterans with service-connected injuries, university students, and had self-reported sleep disturbances. Restoring Effective Sleep Tranquility was a multi-component cognitive behavioral therapy for insomnia intervention consisting of seven sessions of group therapy and eight 1:1 sessions delivered by occupational therapists. Feasibility and pilot indicators were process, resources, management, and scientific, including pre–post-assessments of sleep difficulties, dysfunctional sleep beliefs, participation, and pain interference.

Findings

Indicators were supportive of feasibility, including reduced sleep difficulties (for example Medical Outcomes Study Sleep Measure [t = 3.29, p = .02]), reduced nightmares: t = 2.79, p = .03; fewer dysfunctional sleep beliefs: t = 3.63, p = .01, and greater ability to participate in social roles: t = –2.86, p = .03, along with trends towards improved satisfaction with participation and reduced pain interference.

Conclusion

The Restoring Effective Sleep Tranquility program may reduce sleep difficulties and improve participation in US veterans with service-connected injuries, and evidence indicates a controlled trial would be feasible to deliver.

Protective and Vulnerability Factors Contributing to Resilience in Post-9/11 Veterans With Service-Related Injuries in Postsecondary Education

OBJECTIVE

To examine differences in psychosocial protective factors (social support, meaningful occupation, and academic self-efficacy) and health-related vulnerability factors (posttraumatic stress, depression, and somatic symptoms) contributing to resilience in post-9/11 veterans with service-related injuries and nonveterans in postsecondary education.

METHOD

A cross-sectional, matched-participants design using propensity score matching was used to test differences in mean levels of protective and vulnerability factors between injured veterans (n = 26) and nonveterans (n = 19); zero-order correlations explored relationships among study variables.

RESULTS

The veteran sample demonstrated lower levels of psychosocial protective factors and higher levels of health-related vulnerability factors compared with nonveterans (|0.49| to |1.56|). Psychosocial protective factors were consistently negatively associated with health-related vulnerability factors (-.27 to -.63).

CONCLUSION

Post-9/11 veterans with service-related injuries are at a substantial disadvantage in terms of resilience; lower protective factors and elevated vulnerability factors may increase their risk for poor campus integration and impede academic achievement.

Resilience Protective and Vulnerability Factors in Post-9/11 Veterans With Service-Related Trauma in Postsecondary Education

Date Presented 4/16/2015

Among post-9/11 veterans with service-related trauma who were in college, lower social support, lower meaningful occupation, and lower academic self-efficacy—as well as higher posttraumatic stress, higher depression, and higher somatic pain—were found when they were compared with a matched sample. This highlights the need for occupational therapy services.

Psychometric properties and factor structure of the 13-item satisfaction with daily occupations scale when used with people with mental health problems

Background

In mental health care practice and research it is increasingly recognized that clients’ subjective perceptions of everyday occupations, such as satisfaction, are important in recovery from mental illness. Instruments thus need to be developed to assess satisfaction with everyday occupations. The aim of the present study was to assess psychometric properties of the 13-item Satisfaction with Daily Occupation (SDO-13) when used with people with mental health problems, including its internal consistency, factor structure, construct validity and whether the scale produced ceiling or floor effects. An additional question concerned if the factor structure varied whether the participants were, or were not, presently engaged in the activity they rated.

Methods

The interview-based SDO-13 includes items pertaining to work/studies, leisure, home maintenance, and self-care occupations. Whether the person currently performs an occupation or not, he/she is asked to indicate his/her satisfaction with that occupation. The SDO-13 was completed with 184 persons with mental illness. Residual variables were created to remove the variation linked with currently performing the targeted occupation or not and to assess the factor structure of the SDO-13. The indicators of general satisfaction with daily occupations, self-esteem and global functioning were used to assess construct validity. The statistical methods included tests of homogeneity, confirmatory factor analysis and Pearson correlations.

Results

The internal consistency was satisfactory at 0.79. A three-factor solution indicated that the construct behind the SDO-13 was composed of three facets; Taking care of oneself and the home, Work and studies, and Leisure and relaxation. The same factor structure was valid for both original scores and the residuals. An expected pattern of correlations with the indicators was mainly found, suggesting basic construct validity. No ceiling or floor effects were found.

Conclusions

Taken together, the findings suggest the SDO-13 is a reliable and robust instrument that may be used to get an overview of the satisfaction people living with mental illness derive from their daily occupations.

Relationships between meaningful activity, basic psychological needs, and meaning in life: test of the meaningful activity and life meaning model

The author of this study proposed and examined a theoretical model in which meaningful activity fulfills basic psychological needs and contributes to meaning in life. Hypotheses derived from the Meaningful Activity and Life Meaning model and tested within this study included: (1) meaningful activity will be associated with meaning in life, (2) meaningful activity will be associated with basic psychological needs, and (3) basic psychological needs will partially mediate the relationship between meaningful activity and meaning in life. Structural equation modeling with latent variables was used to test the study hypotheses. A total of 591 undergraduate and graduate students completed the Engagement in Meaningful Activities Survey, the Basic Psychological Needs Scales (i.e., autonomy, competence, and relatedness), and the Presence subscale of the Meaning in Life Questionnaire. Results from the study were in full support of each hypothesis and indicate the important role meaningful activity may serve in fostering meaning in life.

A prospective longitudinal study testing relationships between meaningful activities, basic psychological needs fulfillment, and meaning in life

The current study used a prospective longitudinal design to determine whether change in meaningful activity over an 11-month period could help explain change in meaning in life in a sample of 174 undergraduate and graduate students. The Engagement in Meaningful Activities Survey, Basic Psychological Needs Scales (i.e., autonomy, competence, relatedness), and the Meaning in Life Questionnaire were used as indicators of the constructs of meaningful activity, basic psychological needs fulfillment, and meaning and purpose in life. The findings were in support of the study hypotheses and indicated that change in meaningful activity explained both change in basic psychological needs fulfillment (i.e., autonomy, competence, relatedness) and change in meaning in life. Further, this study reports findings consistent with results from cross-sectional studies in support of the hypothesis that change in meaningful activity may influence change in meaning in life through two pathways: a direct path of influence from meaningful activity to meaning in life and an indirect path through change in basic psychological needs fulfillment. The current study contributes to a growing literature implicating subjective evaluations of day-to-day action (or meaningful activity) as a fruitful means for exploring relationships between occupation and well-being.

Measurement characteristics of the engagement in meaningful activities survey in an age-diverse sample

OBJECTIVE

This study evaluated the measurement characteristics of the Engagement in Meaningful Activities Survey (EMAS) in an age-diverse sample.

METHOD

The sample included 154 older adults and 122 college students (age range = 18-100 yr). A Rasch-Andrich rating scale model was used to evaluate the EMAS. Analyses addressed rating scale design, person and item fit, item hierarchy, model unidimensionality, and differential item functioning.

RESULTS

Category functioning was improved by reducing the EMAS item responses to four categories. Adequate person response validity was established, and all but one EMAS item demonstrated an ideal fit to the Rasch measurement model. After establishing the item hierarchy, I found the EMAS to be a unidimensional measure. Differential item functioning was not detected using Bonferroni-adjusted statistical criteria.

CONCLUSION

The results confirm the potential to validly measure subjective qualities of meaningful activity participation. The EMAS can be used to evaluate processes and outcomes central to occupational therapy practice and to aid in the design of therapeutic occupations.

Relationships between Meaningful Activity, Basic Psychological Needs, and Meaning in Life: Test of the Meaningful Activity and Life Meaning Model

The author of this study proposed and examined a theoretical model in which meaningful activity fulfills basic psychological needs and contributes to meaning in life. Hypotheses derived from the Meaningful Activity and Life Meaning model and tested within this study included: (1) meaningful activity will be associated with meaning in life, (2) meaningful activity will be associated with basic psychological needs, and (3) basic psychological needs will partially mediate the relationship between meaningful activity and meaning in life. Structural equation modeling with latent variables was used to test the study hypotheses. A total of 591 undergraduate and graduate students completed the Engagement in Meaningful Activities Survey, the Basic Psychological Needs Scales (i.e., autonomy, competence, and relatedness), and the Presence subscale of the Meaning in Life Questionnaire. Results from the study were in full support of each hypothesis and indicate the important role meaningful activity may serve in fostering meaning in life.

Factor Structure, Reliability and Convergent Validity of the Engagement in Meaningful Activities Survey for Older Adults

This study evaluated the psychometric properties of the Engagement in Meaningful Activities Survey (EMAS) (Goldberg, Brintnell, & Goldberg, 2002) in a sample of older adults living in the greater Los Angeles area. The EMAS evidenced moderate test-retest reliability (r = .56) and good internal consistency (α = .89). Exploratory factor analysis (principal components) discerned a two-component structure within the EMAS, indicative of Personal-Competence and Social-Experiential meaning. The EMAS demonstrated theoretically predicted zero-order correlations with measures of meaning and purpose in life, depressive symptomology, life satisfaction, and health-related quality of life. Regression analyses discerned that purpose and meaning in life consistently predicted the EMAS and its components. Furthermore, persons reporting greater levels of Social-Experiential relative to Personal-Competence meaning had the lowest levels of physical health-related quality of life. This study offers initial evidence in support of the EMAS as a valid measure of meaningful activity in older adults.

Convergent Validity of the Engagement in Meaningful Activities Survey in a College Sample

The Engagement in Meaningful Activities Survey (EMAS) (Goldberg, Brintnell, & Goldberg, 2002) demonstrated sufficient psychometric properties in a sample of 122 adults. The EMAS was found to have adequate test—retest (r = .71) and internal consistency (α = .88) reliability; significant positive correlations between the EMAS and the subscales of the Basic Psychological Needs Scale and the Sources of Meaning Profile and negative zero-order correlations were found with short form versions of the Boredom Proneness Scale and the Depression, Anxiety, and Stress Scales. Step-wise multiple regression analysis results showed the Sources of Meaning Profile, Boredom Proneness Scale, and Competence subscale of the Basic Psychological Needs scale best predicted the EMAS. These results lend additional construct validity evidence in support of the EMAS as a brief measure of meaningful activity participation.

The Meaningful Activity Participation Assessment: a measure of engagement in personally valued activities

The Meaningful Activity Participation Assessment (MAPA), a recently developed 28-item tool designed to measure the meaningfulness of activity, was tested in a sample of 154 older adults. The MAPA evidenced a sufficient level of internal consistency and test-retest reliability and correlated as theoretically predicted with the Life Satisfaction Index-Z, the Satisfaction with Life Scale, the Engagement in Meaningful Activities Survey, the Purpose in Life Test, the Center for Epidemiologic Studies Depression Inventory and the Rand SF-36v2 Health Survey subscales. Zero-order correlations consistently demonstrated meaningful relationships between the MAPA and scales of psychosocial well-being and health-related quality of life. Results from multiple regression analyses further substantiated these findings, as greater meaningful activity participation was associated with better psychological well-being and health-related quality of life. The MAPA appears to be a reliable and valid measure of meaningful activity, incorporating both subjective and objective indicators of activity engagement.

The relationship between neuropsychological functioning and instrumental activities of daily living following acquired brain injury

The present study examined the ecological validity of neuropsychological tests relative to instrumental activities of daily living (IADLs) among 55 participants in a post-acute brain injury rehabilitation program. Stronger intellectual abilities, visual memory, delayed memory, verbal learning, and cognitive flexibility were significantly associated with success on the IADL tasks. However, each IADL task placed unique demands on cognitive abilities. Behavioral ratings of attention span and frustration tolerance also were positively related to task completion. Multiple aspects of patient functioning (neuropsychological abilities, self-regulatory behaviors), as well as task characteristics, must be considered to predict outcomes in everyday functioning.