Purpose in Life as an Explicit Outcome of Occupational Therapy

Purpose in life is increasingly understood to be important to health and well-being. Despite occupational therapy's long history of using occupations to advance health and the linkage between a subclass of occupations and purpose in life, the term is nearly absent from the American Occupational Therapy Association's documents and the profession's empirical literature. We propose that the profession explicitly name purpose in life as among our intervention outcomes and address disruptions of purpose in life in practice. This can be accomplished by first investing in purpose in our own lives, discussing the topic with colleagues and students, identifying possible purpose disruptions in our clients, and using direct or indirect intervention approaches to help clients reconnect to purpose in their lives. By explicitly naming purpose in life as part of the domain of occupational therapy, we become poised to leverage human occupation to address both a broad societal gap and our clients' needs for a renewal of purpose in life.

Feasibility of a Group-Based Purpose Renewal Intervention for Cancer Survivors Via Zoom

The COVID-19 pandemic contributed to both existential distress and the rapid adoption of telehealth-based services. Little is known about the feasibility of delivering group occupational therapy intervention to address purpose-related existential distress via face-to-face synchronous videoconferencing. The objective of the study was to evaluate the feasibility of providing a purpose in life renewal intervention to breast cancer survivors via Zoom. Descriptive data were collected on acceptability and implementability of the intervention. Limited-efficacy testing involved a prospective pretest-posttest study where participants with breast cancer (n = 15) received an eight-session purpose renewal group intervention plus a Zoom tutorial. Participants completed standardized measures of meaning and purpose at pretest and posttest, and a forced-choice Purpose Status Question. The purpose renewal intervention was acceptable and implementable via Zoom. Pre-post changes in purpose in life were not statistically significant. Group-based purpose in life renewal intervention is acceptable and implementable when delivered via Zoom.

Preliminary Efficacy of an Occupation-Oriented Purpose in Life Intervention After Breast Cancer

Background. Purpose in life is important to health and well-being; purpose disruption often goes unidentified after breast cancer. Purpose. To evaluate the efficacy of a purpose renewal intervention and utility of a screening question for identifying people with purpose-related distress. Method. In this prospective pretest-posttest study, participants with breast cancer received an 8-session purpose renewal group intervention (n = 35). Participants completed standardized measures of meaning and purpose at pretest, posttest, and two-month follow-up and a forced-choice Purpose Status Question (PSQ) at pretest. Findings. Participants made statistically significant pretest-to-posttest and pretest-to-follow-up improvements. The PSQ demonstrated construct validity: 40% of participants lacked purpose direction at pretest and this subgroup made significantly greater improvements than participants who reported purpose direction at pretest. Implications. The PSQ warrants further study as a screener to identify people with purpose-related distress. Many breast cancer survivors may benefit from a purpose in life intervention; a subgroup may benefit more.

Cognitive Dysfunction: Feasibility of a Brief Intervention to Help Breast Cancer Survivors

BACKGROUND

Many cancer survivors experience cancer-related cognitive dysfunction (CRCD), which is believed to be the result of multiple contributing biologic, situational, and personal factors. Efficacious, clinically implementable interventions addressing the multifactorial nature of CRCD are needed.

OBJECTIVES

This study evaluated the feasibility of an intervention to help breast cancer survivors mitigate the effects of modifiable factors that contribute to CRCD and improve cognitive functioning.

METHODS

A single-group pre-/post-test design was used. Treatment fidelity was tracked to evaluate implementability; attendance rates, experience surveys, and homework engagement were used to characterize acceptability. Pre- and post-test cognitive functioning, stress, fatigue, and mood were measured to evaluate preliminary efficacy.

FINDINGS

The intervention was implementable and acceptable to participants. Participants made statistically significant improvements.

Can service members with mild traumatic brain injury learn to develop implementation intentions for self-identified goals?

PURPOSE

Goal achievement relies heavily on executive functions, which may be compromised following mild traumatic brain injury (mTBI). Implementation intentions (II) have been found to help people act in accordance with their goals. II are written statements that describe a behavior that a person plans to enact when they encounter some form of anticipated trigger or stimulus. We evaluated the feasibility of teaching participants with mTBI to develop II for self-identified goals within the context of cognitive rehabilitation.

METHODS

Soldiers with mTBI were recruited from a traumatic brain injury clinic. During the intervention, participants were assigned to develop an II for one of three self-identified goals every day. Descriptive methods were used to examine implementability and acceptability of the II training protocol as well as the extent to which participants learned to develop II for their own goals.

RESULTS

The II training protocol was found to be highly implementable and acceptable to participants. Overall, participants (n = 16) were able to develop II related to their self-identified goals, which primarily focused on managing cognitive problems. For the most part, participants developed II that involved event- rather than time- or somatic/feeling-based triggers.

CONCLUSION AND IMPLICATIONS

Participants with mTBI were able to learn to develop II for their self-identified goals. Further study is needed to determine whether adding II to cognitive rehabilitation advances patient goal achievement.IMPLICATIONS FOR REHABILITATIONIt is feasible to incorporate training in implementation intentions (predetermined "if/when-then" plans that are intended to link specific situational triggers with actions) in metacognitive strategy instruction for patients with mild traumatic brain injury.Participants with mild traumatic brain injury in this study demonstrated that they were able to develop implementation intentions for multiple self-identified rehabilitation goals, which holds promise for also teaching patients with mild cognitive impairment from other conditions.Learning to develop implementation intentions may help patients with mild traumatic brain injury initiate a range of other cognitive strategies in their everyday lives.Implementation intentions have the potential to help patients enact goal behaviors associated with their rehabilitation goals, making cognitive rehabilitation more "customizable" and relevant to clients' specific needs.

Implementation Intentions for Self-Selected Occupational Therapy Goals: Two Case Reports

OBJECTIVE

We evaluated the feasibility of an intervention combining metacognitive strategy instruction (MSI) with training in implementation intentions for adults with mild traumatic brain injury (mTBI). Implementation intentions are written premade decision statements specifying when, where, and how goal behaviors are to be enacted.

METHOD

Two participants with mTBI received a six-session intervention that included setting a daily implementation intention for an occupational therapy goal. A scoring rubric was used to evaluate the quality of implementation intentions; goal achievement was measured using the Canadian Occupational Performance Measure (COPM) and goal attainment scaling.

RESULTS

All implementation intentions received perfect quality scores, suggesting participants learned to correctly craft implementation intentions. Improvements in COPM self-ratings exceeded minimal detectable change values; goal attainment levels indicated better-than-expected goal achievement.

CONCLUSION

An intervention combining MSI and implementation intention training appears to be feasible. As an adjunct to MSI, implementation intentions may contribute to clients' ability to achieve their own occupational performance goals. Further study is needed.

Focus Forward: Outcomes of a Brief Occupational Therapy Intervention for Cancer-Related Cognitive Dysfunction

Date Presented 3/30/2017

Results of this pilot and feasibility study indicate that women with breast cancer who received a brief occupational therapy intervention for cancer-related cognitive dysfunction experienced pre–post improvements in self-reported cognition and occupational functioning.

Primary Author and Speaker: Shayne Hopkins

Contributing Authors: Mary Vining Radomski, Marsha Finkelstein, Mattie Anheluk, Kristin Berling, Michele Darger, Kim Grabe, M. Tracy Morrison, Joette Zola, Nancy Hutchison

Effectiveness of Interventions to Address Cognitive Impairments and Improve Occupational Performance After Traumatic Brain Injury: A Systematic Review

OBJECTIVE. To determine the effectiveness of interventions addressing cognitive impairments to improve occupational performance for people with traumatic brain injury.

METHOD. A total of 37 studies met inclusion criteria: 9 Level I systematic reviews, 14 Level I studies, 5 Level II studies, and 9 Level III studies.

RESULTS. Strong evidence supports use of direct attention training, dual-task training, and strategy training to optimize executive functioning, encoding, and use of memory compensations, including assistive technology. However, in most studies, occupational performance was a secondary outcome, if it was evaluated at all.

CONCLUSION. Although evidence supports many intervention approaches used by occupational therapy practitioners to address cognitive impairments of adults with traumatic brain injury, more studies are needed in which occupational performance is the primary outcome of cognitive intervention.

Nucleosome positioning and composition modulate in silico chromatin flexibility

The dynamic organization of chromatin plays an essential role in the regulation of gene expression and in other fundamental cellular processes. The underlying physical basis of these activities lies in the sequential positioning, chemical composition, and intermolecular interactions of the nucleosomes-the familiar assemblies of ∼150 DNA base pairs and eight histone proteins-found on chromatin fibers. Here we introduce a mesoscale model of short nucleosomal arrays and a computational framework that make it possible to incorporate detailed structural features of DNA and histones in simulations of short chromatin constructs. We explore the effects of nucleosome positioning and the presence or absence of cationic N-terminal histone tails on the 'local' inter-nucleosomal interactions and the global deformations of the simulated chains. The correspondence between the predicted and observed effects of nucleosome composition and numbers on the long-range communication between the ends of designed nucleosome arrays lends credence to the model and to the molecular insights gleaned from the simulated structures. We also extract effective nucleosome-nucleosome potentials from the simulations and implement the potentials in a larger-scale computational treatment of regularly repeating chromatin fibers. Our results reveal a remarkable effect of nucleosome spacing on chromatin flexibility, with small changes in DNA linker length significantly altering the interactions of nucleosomes and the dimensions of the fiber as a whole. In addition, we find that these changes in nucleosome positioning influence the statistical properties of long chromatin constructs. That is, simulated chromatin fibers with the same number of nucleosomes exhibit polymeric behaviors ranging from Gaussian to worm-like, depending upon nucleosome spacing. These findings suggest that the physical and mechanical properties of chromatin can span a wide range of behaviors, depending on nucleosome positioning, and that care must be taken in the choice of models used to interpret the experimental properties of long chromatin fibers.

Attitudes and educational practices of obstetric providers regarding infant hepatitis B vaccination

OBJECTIVE

To survey the current knowledge, attitudes, and practices of obstetric providers regarding the education of pregnant women about infant hepatitis B vaccination.

METHODS

A questionnaire was mailed to 264 physicians providing obstetric services in San Francisco. Of these, 113 were confirmed to be providing prenatal care.

RESULTS

Seventy-six obstetric providers returned completed questionnaires. Among eligible respondents, 79% believed that hepatitis B vaccine should be administered to all infants at birth, and 92% believed that it is feasible to educate all expectant mothers about infant hepatitis B vaccination. However, only 53% of respondents provided such education to all their pregnant patients. Only 23% provided education about other routine childhood immunizations.

CONCLUSIONS

Obstetric providers in San Francisco are willing to educate pregnant patients about hepatitis B vaccination but are not always doing so. Providing education in a consistent manner may improve infant hepatitis B vaccination rates and may increase coverage with other childhood vaccines.