A Mixed-Methods Examination of Lost Occupational Choice in Retirement

Lost work opportunity and forced retirement demonstrate negative health impacts related to occupational deprivation. Measuring occupational loss during the retirement transition can be problematic. The objective of the study is to clarify measurement of involuntary retirement in its relationship to occupational loss and deprivation. Using an explanatory sequential mixed-methods design, survey data on unemployment, forced retirement, and earlier-than-planned retirement from 195 screened retirees yielded 102 reporting at least one lost work opportunity event, with 18 interviewed about occupational loss within the analytic timeframe. Planned retirement age was similar for full-employment and lost work opportunity groups. Actual retirement age was earlier in the lost work opportunity sample (age 57.5 compared with 61.2). Interviews identified a 22% discrepancy between forced retirement reported in survey versus interview data. Themes emerging from the interviews indicated financial and identity challenges from lost work opportunity, a dialectical trade-off between lost opportunity and daily freedom, and overall resilience.

Piloting GETCare: A Goal-Based Education and Skills Training Program for Caregivers

PURPOSE

Many individuals with stroke require informal caregiver support. These caregivers are often unprepared and overwhelmed. This study assesses the feasibility and acceptability of GETCare, a remote Goal-based Education and skills Training program for Caregivers caring for an individual poststroke.

DESIGN

Single-arm mixed-methods pilot trial was performed.

METHODS

The GETCare program is a 5-week remote, individually administered program for informal stroke caregivers that includes education, skills training, guided goal setting, and resource recommendations. Quantitative data were analyzed using descriptive statistics and qualitative data via a deductive approach.

RESULTS

Twenty-eight caregivers were recruited with 18 caregivers completing the program. These 18 caregivers reported high satisfaction, and over 75% reported program content was at least quite helpful. Caregivers suggested that the length of the program was appropriate, indicated that weekly check-ins were helpful, and supported this program for informal caregivers across the time trajectory poststroke. Eight of 10 caregivers who dropped out of the program were caring for someone 0-4 months poststroke.

CONCLUSIONS

Caregivers positively received the GETCare program, which was uniquely structured to provide resources and skills for this high-need population. This pilot study provides valuable insight for future remote interventions poststroke.

CLINICAL RELEVANCE TO PRACTICE OF NURSING

Results provide foundational knowledge in how to better support caregivers through guided goal setting and individualized education.

Factors Affecting Participation of Children with Cerebral Palsy in Meaningful Activities: Systematic Review

This is a systematic review using PRISMA guidelines to review the factors affecting participation of children with cerebral palsy (CP), the most common childhood motor disability. Inclusion criteria consisted of publications in a peer-reviewed journal between 2000 and 2018, and at I, II, III, and IV levels of AOTA Evidence. After the title, abstract, and a full text screening, 31 articles met eligibility to be included. The studies examined ADLs (12), IADLs (9), play and leisure (19), and social participation (14), but only 3 in rest/sleep, 1 in work, and 8 in education. Gross motor and manual function, CP type, home, and community physical environment, were the most common factors affecting individuals' participation with CP. Results imply occupational therapists must evaluate clients on all factors shown to facilitate or inhibit participation to ensure an adequate intervention plan. However, evaluating every individual case in the occupational therapy process is time-consuming and difficult. Based on this study's findings, we suggest occupational therapists prioritize evaluating motor skills (gross and fine), the most influential of the factors in all areas of participation. Occupational therapists also could advocate for policy around community environmental barrier removal.

Rehabilitation Is a Global Health Priority

Optimizing functioning at all ages is a major global public health goal. Rehabilitation is unique in its contribution to this public health agenda because of its focus on optimizing function. In this editorial, the editors of leading rehabilitation journals make the case for fully integrating rehabilitation into a nation's health system and strengthening it specifically at the primary care level to increase access and achieve its full potential. Authors submitting papers to rehabilitation journals are encouraged to consider the global health policy implications of their research when they prepare their research reports for publication and to make these implications explicit.

Not Just Mortality and Morbidity but Also Function: Opportunities and Challenges for Occupational Therapy in the World Health Organization's Rehabilitation 2030 Initiative

The World Health Organization's (WHO's) new focus on rehabilitation offers great opportunities for occupational therapy. Recognizing that the problems in daily function created by the aging of the world's population and the increasing prevalence of chronic health conditions require rehabilitation to be a vital part of health systems, the World Health Organization brought a variety of stakeholders together in 2017 and 2019 to help them develop the Rehabilitation 2030 initiative. Occupational therapy was represented by the World Federation of Occupational Therapists, the American Journal of Occupational Therapy, the Canadian Journal of Occupational Therapy, editorial board members of several occupational therapy journals, and other occupational therapy researchers. A major challenge to meeting the goal of sufficient rehabilitation services to meet global need is the worldwide shortage of occupational therapists. This shortage can be attributed to a paucity of knowledge about occupational therapy as a health care profession, lack of understanding of the occupational therapy scope of practice, the cost of education required to become an occupational therapist, and the need for occupational therapy salaries to offset educational costs. Nonetheless, ongoing success in research and clinical outcomes will increase knowledge of the value of occupational therapy and increase the size of the profession. WHO's focus on function is to be lauded. Yet, occupational therapists must not be content with an emphasis on function. They also need to advocate for contextual changes that eliminate barriers to participation and engagement experienced by people with disability.

State of the Journal, 2019

The American Journal of Occupational Therapy (AJOT) remains the most highly ranked occupational therapy journal, as measured by its journal impact factor. AJOT's goals are to remain occupational therapy's leading research journal, publish high-quality research that reflects the breadth of research related to occupational therapy, and have disciplinary and interdisciplinary impact.

Boundaries of the Construct of Unemployment in the Preretirement Years: Exploring an Expanded Measurement of Lost-Work Opportunity

There is uncertainty related to whether retirement negatively affects health-possibly due to complexity around retirement decisions. Lost-work opportunity through unemployment or forced retirement has been shown to negatively affect health. Lost-work opportunity can be captured in two measurement fields, either a reported experience of being forced into retirement or reported unemployment. However, 17% of individuals retiring due to the loss of work opportunity identified in qualitative interviewing (i.e., unemployment, temporary lay-offs, company buy-outs, forced relocations, etc.) do not report this unemployment or involuntary retirement in quantitative survey responses. We propose broadening the conceptualization of late-career unemployment to incorporate other lost work opportunity scenarios. Using the Health and Retirement Study (HRS), a lost-work opportunity score (LOS) was computed from items indicating unemployment and forced or unplanned retirement. Correlations were computed between this LOS and all continuous variables in the RAND longitudinal compilation of the HRS to determine its convergent and discriminant validity. The LOS demonstrated a Chronbach's alpha of α = .82 and had convergent validity with constructs of employment (9 variables), finances (36 variables), and health (14 variables), as predicted by the literature on retirement timing. No other continuous variables in the HRS were identified with a moderate or strong correlation to LOS, demonstrating discriminant validity. Further research should explore whether a combination of variables in the HRS can improve the accuracy of measuring lost-work opportunity. Improved precision in measurement, through an expanded conceptualization of lost-work opportunity, may help explicate the retirement-related factors that affect health, to inform policy and support healthy aging decisions at a societal level.

State of the Journal, 2018

The American Journal of Occupational Therapy (AJOT) continues to be the most highly ranked occupational therapy journal as measured by its Journal Citation Reports impact factor (its 5-yr impact factor is now 3.325). AJOT’s goal is to remain occupational therapy’s leading research journal with disciplinary and interdisciplinary impact. AJOT instituted measures starting in January 2018 to address increasing concerns about research reproducibility and study reporting methods. Starting in 2019, AJOT will be distributed online only and will offer an annual “Best of” print compendium to AOTA members.

State of the Journal, 2017

The American Journal of Occupational Therapy (AJOT) has had another successful year, with increases in its journal impact factor and its ranking among rehabilitation journals indexed by Journal Citation Reports. The number of submissions has increased, with manuscripts received from 28 countries. Readership has also increased. AJOT remains the top-ranked occupational therapy journal in the world. In addition to its usual focus on publishing research broadly related to occupational therapy, AJOT created a Centennial section in each issue to celebrate the Centennial of the American Occupational Therapy Association. Centennial section topics were determined on the basis of their relevance to occupational therapy history and to future or emerging or increasing practice areas in occupational therapy. In her presidential address at the American Occupational Therapy Association's 2017 Annual Conference & Centennial Celebration, Amy Lamb honored occupational therapy's past and embraced its future. Occupational therapy practitioners have the power to serve as change agents, demonstrating their value during everyday opportunities as they design the future of occupational therapy.

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.

AJOT Celebrates AOTA's Centennial

Each issue of the 2017 volume of the American Journal of Occupational Therapy will feature a special Centennial Topics section containing two to four articles related to a specific theme. The goal is to acknowledge occupational therapy's history while focusing on the future of the profession. The Centennial Topics section is intended to help occupational therapy professionals in all aspects of the profession take stock of how far the profession has come and to spark interest in the many exciting paths for the future development of the field.

State of the Journal, 2016

The American Journal of Occupational Therapy (AJOT) had a successful 2016. From September 2015 to September 2016, the number of manuscripts submitted remained steady at 255. Manuscripts were received from 30 non-U.S. countries, compared with 23 countries in 2015. AJOT continues to have the highest impact factor and to be the highest ranked of the occupational therapy journals listed in Journal Citation Reports. AJOT continues to focus on publishing research articles on aspects of occupational therapy among varied populations with diverse acute and chronic conditions. Changes in 2016 include requiring authors to register clinical trials at public trial registration sites and welcoming new associate editors and reviewers to the AJOT family.

Factors Influencing Occupational Therapy Practitioners' Use of Push-In and Pull-Out Service Delivery Models in the School System

Date Presented 4/8/2016

This study examined the current practice patterns of school-based therapists to determine whether more push-in than pull-out services were being used. This study also identified facilitators and barriers to providing more push-in services by school-based therapists.

Primary Author and Speaker: Heather Watt

Additional Author and Speaker: Lorie Gage Richards

Implicit learning of a motor skill after mild and moderate stroke

Objective: To determine if adults in the subacute phase post moderate or mild stroke could learn a motor task under implicit practice conditions.

Design: Non-randomized, between-group design.

Setting: Subjects' homes.

Subjects: Sample of convenience of 15 adults with moderate stroke, 22 adults with mild stroke, and 32 age-matched controls. Stroke severity was determined using the Orpington Prognostic Scale.

Intervention: Practice of movements to target switches in two conditions, a repeated series and a random series. Practice was organized into a single session of six blocks of 80 trials such that blocks 1 and 2 were the random series, blocks 3 and 4 the repeated series, block 5 the random series, and block 6 the repeated series. Explicit knowledge of the two conditions was not provided.

Main measures: The mean response time and the coefficient of variation were calculated for each block for each group.

Results: Regardless of group, participants had a slower response time when practice was unexpectedly switched from the repeated to random condition. The response time and coefficient of variation for those with moderate stroke were persistently greater than those with mild stroke and controls, who were not different from each other.

Conclusions: Implicit motor learning is preserved in adults with moderate stroke and may be a viable strategy for teaching motor skills in rehabilitation. The clinician should be aware that subjects with moderate stroke, even when performing with the less affected upper extremity, have significantly slower and more variable movements than those with mild stroke and controls.

State of the Journal, 2015

The American Journal of Occupational Therapy (AJOT) had a successful 2015. From September 2014 to September 2015, the number of manuscripts submitted had increased by 35%. Manuscripts were received from 23 countries, compared with 17 countries in 2014. AJOT continues to have the highest impact factor and to be the highest ranked of the occupational therapy journals listed in Journal Citation Reports. AJOT continues to focus on publishing research articles on aspects of occupational therapy among varied populations with diverse acute and chronic conditions. Additional changes for 2015 include new associate editors, a significantly enlarged pool of reviewers from across the globe, continuous publishing, pay-per-view, updated author guidelines, and the adoption of clinical trial registration requirements effective January 1, 2016.

Reliability and Sensitivity to Change of Goal Attainment Scaling in Occupational Therapy Nonclassroom Educational Experiences

Occupational therapy programs are charged with measuring student progress in nonclassroom experiential components (American Occupational Therapy Association, 2012). Currently, the major nonclassroom educational experience is Level II fieldwork. Level II performance is assessed using the Fieldwork Performance Evaluation, which is inappropriate for measuring doctoral-level experiential component achievement. This study's purpose was to determine test-retest reliability and sensitivity of Goal Attainment Scaling (GAS) for assessing skill development in nonclassroom occupational therapy experiences. GAS demonstrated high test-retest reliability for each of the five goals, and we found a significant amount of change on the GAS, with higher scores at the 12-wk than at the 6-wk assessment. Results indicate that the GAS is reliable and sensitive to changes in student performance on Level II fieldwork and may therefore warrant investigation as a valid tool to measure student performance in the entry-level doctoral experiential component.

Welcome From the New Editor-in-Chief

AJOT’s new Editor-in-Chief describes her goals for the journal.

Reliability of upper extremity kinematics while performing different tasks in individuals with stroke

Assessments of upper extremity performance typically include qualitative rather than quantitative measures of functional ability. Kinematic analysis is an objective, discriminative measure that quantifies movement biomechanics; however, the use within the poststroke impaired upper extremity is not well established. The purpose of this study was to examine the reliability of upper extremity kinematics in 18 individuals with stroke and 9 healthy controls. Participants performed reaching and grasping tasks over 2 separate days and metrics included movement time, peak velocity, index of curvature, trunk displacement, maximum aperture, and percentage of the movement cycle where maximum aperture occurred. The results showed moderate to high intraclass correlation and low standard error of measurement values for most variables, demonstrating that kinematic analysis may be a feasible and useful tool to quantify upper extremity movement after stroke.

Implicit learning of a perceptual-motor skill after stroke

BACKGROUND AND PURPOSE

A motor skill can be learned implicitly, without awareness of what is being learned. The purpose of this study was to examine the ability of adults who had unilateral stroke to learn implicitly a perceptual-motor task.

SUBJECTS

Subjects were 47 people who were poststroke and 36 control subjects.

METHODS

Participants performed sequences of hand movements in response to target lights in 2 conditions: a patterned sequence and a random sequence. Participants were not given explicit knowledge of the presence of the 2 conditions. Those who had stroke performed with the upper-extremity ipsilateral to the lesion.

RESULTS

Subjects who had stroke performed more slowly than control subjects. For both groups, times decreased with practice of the patterned sequence, increased with introduction of the random sequence, and decreased again with reintroduction of the patterned sequence. Group differences persisted in a retention test given the next day of the patterned sequence, and both groups showed decreased times over the course of the retention test.

DISCUSSION AND CONCLUSION

People with stroke are able to learn a perceptual-motor task even without explicit instructions regarding the patterned sequence embedded in the task.

Posture effects on grip strength

OBJECTIVE

To examine whether grip strengths were different when measured in supine and sitting positions.

DESIGN

Comparison, convenience sample.

SETTING

Community.

PARTICIPANTS

Seventy-four healthy adult participants with no history of psychiatric or neurological dysfunction, or upper extremity orthopedic dysfunction after the age of 18.

INTERVENTIONS

Participants performed grips with each hand while sitting and standing. Shoulder was adducted and extended, with the elbow flexed, and wrist and forearm in neutral.

MAIN OUTCOME MEASURE

The mean of the three trials with each hand in each posture.

RESULTS

Men were stronger (49kg) than women (29kg; p < .001). Right hands were stronger (41kg) than left (39kg; p < .001). However, grip strengths while sitting were equivalent to those tested while supine (p > .59).

CONCLUSIONS

Using identical upper extremity positions, grip strength is equivalent when tested in the supine and sitting positions. Thus, when determining grip strength, grips measured while the subject is supine can be compared with norms collected while the subject is sitting, provided the upper extremity position is invariant.

How forearm position affects grip strength

OBJECTIVE

Several studies have indicated that changing body positions results in altered grip strengths. Although one might expect that grip strength would be influenced by the position of the forearm during gripping due to the biomechanical properties of the forearm and hand muscles, no investigations of this variable have been undertaken.

METHOD

This study examined the effect on grip strength of moving the forearm among supinated, neutral, and pronated positions while maintaining the standard position recommended by the American Society of Hand Therapists. The mean of three grip trials in each position was recorded for each of 106 subjects.

RESULTS

Grips in forearm supination were the strongest, followed by grips in the neutral position. Grips in pronation were the weakest.

CONCLUSIONS

The changes in grip strength observed with variations in forearm position further support the necessity of a standard position for testing grip strength. The knowledge of how changes in body position affect the strength of the grip can be used to design environments and tools to maximize biomechanical abilities.

What the passenger contributes to passenger comfort

An individual's reaction to a vehicle environment depends not only on the physical inputs but also on the characteristics of the individual. Surveys of airline passengers were conducted on board regularly scheduled commuter flights. Sex of the respondent and attitude toward flying were found to have import nt influences on passenger comfort. Individual differences were also found regarding (1) perceptions of environmental variables, (2) the importance of factors as determinants of comfort, and (3) the ease of and frequency of performing activities in flight.

Models of human reaction to vehicle environments

Models for predicting human comfort responses to environmental variables are presented for diverse vehicles. Air mode studies reveal that comfort is a function of vertical and transverse accelerations, noise levels and seat factors, as well as manoeuvre conditions. Comfort models for ground-based vehicles involve roll rates and noise levels.

Concorde: ride quality and passenger reactions

On four Concorde flights, recordings of environmental characteristics during flight were made and questionnaires were distributed to passengers to assess their reactions during and 24 h after their flight. The Concorde users were mostly traveling for business reasons. Most respondents were flying the Concorde for the first time. Passengers were satisfied with the Concorde, found it comfortable, and were able to perform a variety of activities in flight. On the day after their flight, respondents felt good, rested, and active. They reported less jet lag as a result of their Concorde flight than they had previously experienced on other transatlantic flights. Most respondents are likely to use the Concorde again.

Recognition thresholds as a function of word length

Several experiments investigated the effect of word length on recognition thresholds for both familiar English words and unfamiliar pseudowords, the thresholds measured both with and without a stimulus mask. For familiar English words, length had no effect either with or without a mask. For unfamiliar pseudowords, length had a dramatic effect both with and without a mask.

Ride Quality Evaluation II: Modelling of Airline Passenger Comfort

Quantitative environmental and subjective data obtained aboard commercial airlines are used to model passenger reaction. Several models for comfort are compared. The manner in which the overall response to the flight environment depends on the time history is examined and the variability about the mean response discussed. The relationship to passenger satisfaction is presented giving a quantitative means of relating the physical environment to passenger acceptance. The proposed models give aircraft designers and operators a method by which they may seek to maximize passenger comfort and therefore satisfaction.