This capstone project is a training program development and evaluation project. The purpose of the project was to develop, pilot, and evaluate an evidence-based health literacy training program for occupational therapy professionals. Occupational therapy strives to be a science-driven profession, which provides client-centered care. Health literacy is a client-centered factor for which occupational therapy professionals require additional training to best serve their clients in all settings and across the lifespan. A review of health literacy literature was used in this project to develop the training program and offers a science-driven approach to this client-centered factor for occupational therapists to better serve their clients and their families. This program development project included pilot presentations of the training program at two locations, followed by the collection of feedback from the participants. The feedback was used to conduct a training program evaluation, which offered a platform for enhancements for future versions of the training program. The final objective of the project is to offer a program improvement plan and subsequently publish the evidence-based health literacy training program to make it available to all practicing occupational therapy professionals.

The aim of this study is to describe breast cancer survivors' experiences and the associated meanings participating in their important activities during and after breast cancer treatment and the relationship among the survivor, environment, occupation, and performance, using a concurrent mixed method design. Ten survivors between the ages of 45 and 64 with Stage I, II, or III breast cancer who had been treated consecutively with surgery, chemotherapy, and radiation therapy were recruited for the study. Each survivor completed the Activity Card Sort-modified scoring system (ACSm) during the first and last week of radiation therapy and 3 and 6 months post radiation therapy. Additionally, each survivor participated in a semi-structured interview at the end of radiation therapy and 6 months afterwards. Qualitative data was analyzed using interpretative phenomenological analysis (IPA) to understand the survivors' experiences participating in their most important activities. The means and standard deviations of the proportion of activities resumed for the participants' global and category activities were calculated at each time point. A desire to resume participation in meaningful activities emerged from the data and demonstrated the interrelationship between environment, person, and occupation. Themes from the last week of radiation were (a) individual outlook influences how activities are approached, (b) social support reduces the stress of life, (c) side effects influence how activities are completed, and (d) personal and treatment stresses and struggles influenced their perspectives on life. At 6 months post radiation therapy, the themes were (a) emotional effect on activities, (b) life after cancer has changed due to cancer diagnosis and treatment, and (c) side effects continue to influence daily activities. Using the seven stages of analyzing mixed method data developed by Onwuegbuzie and Teddlie (2003), the qualitative and quantitative data were integrated. The results illustrated that the participants resumed a greater proportion of instrumental activities, which were reported consistently as one of their five most important activities. Additionally, supportive extrinsic factors appeared to be more influential in resuming participation important activities than intrinsic factors. Findings from this study support using the Person-Environment-Occupational-Performance (PEOP) model to develop treatment plans for women undergoing or recovering from breast cancer treatment.

The aim of this study was to make changes to how occupational therapists in a transitional care unit setting provide education about Cognitive Performance Test (CPT) scores to caregivers of those patients with dementia or suspected dementia. Caregiver education for this population is important, as the incidence of persons living with Alzheimer's disease and other dementias is expected to grow dramatically in the coming two decades. This study used a Participatory Action Research (PAR) approach to gather input from occupational therapists and caregivers of patients evaluated with the CPT. Interviews of caregivers indicated that they were unhappy with the education they received from therapists. Caregivers wanted a more collaborative relationship with therapists, and were sensitive to the experience of their loved one in occupational therapy in general, as well as to the approach to the education and the tone and language used to convey information about CPT scores. Therapists, with the caregiver input, worked together to develop education that reflected the needs of the caregivers, creating a new process, new tools and more opportunities for therapist- caregiver interactions. Interviews with a second group of caregivers who experienced the new education process revealed that they had a different, more positive experience overall with the new caregiver education process. This finding suggests that PAR as a methodology is well suited to facilitate changes to support development of client centered occupational therapy practice.

Mothering is a complex and multifaceted occupation that encompasses the nurturing work that women engage in. It addition, it has been established that ethnicity, class, and gender have effects on motherhood that need to be taken into account when looking at the occupations of motherhood across cultures. One important task that occurs within a mothers’ daily routine is that of making meals for their children. This dissertation sought to gain a rich, in-depth description of the phenomenon of the mealtime experience for African American mothers of low socioeconomic status and young children living in an inner-city environment in the Midwest. This study used a phenomenological approach with modified photovoice and photo-elicitation interviews to capture the essence of mealtime for African American mothers raising young children. Six mothers were recruited for the study and consented to two in-depth interviews. Individual interviewing occurred along with a second photo elicitation interview with the participant’s photographs. Phenomenological analyses were used for textual data; the photographs were analyzed separately and then together with the textual data from the photo-elicitation interviews. Results of this study indicated the intricate complexities of the occupation of mealtime and mothering with African American mothers. From the photo-elicitation interviews, five themes and three subthemes emerged: (a) Sometimes it doesn’t happen smoothly, (b) We’re all together, (c) We sit there and we talk, (d) It’s an accomplishment, and (e) We’re in the kitchen together. Three subthemes also emerged: (a) Putting in the effort, (b) It was kind of a teaching moment, and (c) It’s like déjà vu. This research (a) promotes a greater understanding of mothers’ perceptions around mealtime with their young children, especially those mothers who have varied cultural and socioeconomic backgrounds; and (b) suggests a need for increased family-centered and culturally aware training. This study demonstrates how photo techniques can enhance the depth of phenomenological analysis to explicate meaning around mealtime occupations with a diverse group of mothers.

Background: Palpation is an examination technique used to diagnose and treat myofascial pain syndrome (MPS) and fibromyalgia (FM). Currently, there is no validated technique for classifying the results. A valid and reliable pressure pain threshold scale (PPTS) may provide a means for clinicians to grade, document, and report findings. The purpose of this dissertation was to validate a PPTS in patients diagnosed with MPS and FM. Design and Methods: An observational study. Participants who met the inclusion criteria were placed into three equal groups: MPS, FM, and control. All participants underwent one, two-part testing sessions using the American College of Rheumatology criteria. Part-I consisted of palpation with a digital pressure sensor and part-II utilized an algometer. For each tender point (18-total), the participants graded their level of discomfort using the visual analog scale (VAS) and manual tender point rating survey (MTPS) and the examiner graded their response using the PPTS (e.g. ordinal scale with increasing severity from 0-4). Analysis: Intrarater reliability was calculated using the intraclass correlation coefficient model 3, k. Concurrent validity between the PPTS, VAS, and MTPS was calculated using the spearman rank correlation coefficient. A receiver operating characteristic curve was used to determine the minimal cut-off value between groups. Results: Eighty-four participants were included in the analysis. The PPTS had good intrarater reliability (ICC ≥.88). A moderate to excellent relationship was found between the PPTS and VAS for all groups with the algometer and digital pressure sensor (rho ≥.61). A moderate to excellent relationship was found between the PPTS and MTPS for all groups with the algometer (rho≥.68) and for the MPS and control group with the digital pressure sensor (rho ≥.71). There was a little to moderate relationship (rho=.01-.50) between the PPTS and MTPS for the FM group with the digital pressure sensor. A cut-off value of 2 on the PPTS differentiated participants with MPS and FM from controls. Discussion: The results provide preliminary evidence validating the PPTS for patients with MPS and FM. Future research should determine interrater reliability, diagnostic accuracy, and efficacy of the PPTS with other chronic pain and orthopedic conditions.

Purpose: 1, to determine effect of education and exercise on neck pain, disability, cervical posture and muscle function in office workers with sub-clinical neck symptoms; 2, to determine differences in forward head posture in preferred and standardized posture, and 3, to explore the influence of time on work posture in a sub-group of office workers. Subjects: Sixty-six office workers with sub-clinical neck symptoms who utilize computers at least 4 hours per day participated. A sub-group of 27 were videotaped to assess posture over a workday. Methods: Videotaping was performed 15 minutes of the first and last hour of the workday for analysis of the craniovertebral angle. Cervical posture using the CROM was measured on all subjects in standardized and preferred positioning of the trunk and lower extremities. Subjects were randomly assigned to one of three groups: education only (EOG), education and exercise (EEG), or control (CG). Pre and post-test measurements of pain (Visual Analog Scale), disability (NeckDisability Index), forward head posture (FHP), and deep cervical flexor muscle function (Craniocervical Flexion Test and Short Neck Flexor Endurance Test) were assessed for change within group as well as differences between groups over the 8 week period. Results: No difference was found for FHP over 8 hours in the subgroup. FHP was greater in preferred position compared to standardized by 7.59 mm (95% CI 6.27-8.92, p<.001). Median and mean scores improved for all 3 groups on pain and disability with greater improvement in intervention groups. FHP was unchanged/slightly worse in the CG and EOG, and improved in the EEG. Muscle function improved for the EEG. Statistical significance was not found for change scores between groups. Posttest scores were statistically significant for the NDI between EEG (20.45) and the CG (34.47), p=.042, and between the EEG and the EOG (34.59), p=.023 using Kruskall Wallis with adjusted significance for pairwise comparisons. Discussion/Conclusions: Posture over the workday did not change, differences were found based on preferred and standardized positions. Exercise and education intervention for those with sub-clinical neck symptoms show promise but did not demonstrate significance improvement over controls in this study.

Many long-term wheelchair users find themselves unable to accomplish their former daily routines due to fatigue and weakness caused by cardiopulmonary decompensation (CPD). This study showed that long-term survivors of quadriplegia can improve stamina and strength, and therefore participation in daily life occupations, through participation in a regular exercise program using equipment specifically designed for them. Increased aerobic capacity, achieved through regular exercise, has proven with many populations to increase stamina and strength, thereby increasing participation in daily occupations. Whether decompensated survivors of quadriplegia could achieve this was unknown. Until recently there was no way to increase their aerobic capacity due to limited bodily function and lack of accessible fitness equipment. In this study, UPPERTONE, a recently designed fitness system for quadriplegics, was used by six veterans who had survived C-5–C-7 quadriplegia for between 18 and 48 years. They exercised for approximately 45 minutes three times a week for 36 sessions. Baseline level of exercise intensity (weight hefted and number of repetitions as tolerated) and heart rate were recorded and changes were recorded throughout the program. Subjects were interviewed regarding past and present daily life activities. They kept a daily log of activities throughout the study. Using the Canadian Occupational Performance Measure (COPM), subjects were pre-tested, rating their importance of self-identified problems with daily occupations caused by CPD and their performance in and satisfaction with those problem activities. Post-testing showed changes as a result of study participation. Subjects improved COPM scores an average of 7.4 points (greatest 17 points and least 1.5 points), reflecting satisfaction with their ability to perform identified daily activities with less fatigue. Weight hefted increased from an initial average of 22.35 lb. to 52.5 lb. Exercise heart rate increased from an average of 84.8 to 95.2. Subjects were enthusiastic regarding ability to use UPPERTONE independently and their improved quality of life. Clinicians and long-term wheelchair users with a variety of disabilities should understand CPD, its ramifications and the benefits of exercise to this population. Clients who regain ability to care for themselves will enjoy improved quality of life and have less need for long-term care.

Statement of the problem. Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. It affects over 2.5 million people worldwide and approximately 350,000 Americans with new cases diagnosed weekly. MS significantly impacts activity participation, general health status, and quality of life. An extensive literature review reveals a gap in the rehabilitation and MS literature regarding evidence of the effectiveness of occupational therapy rehabilitation programs or occupational therapy wellness programs to improve the activity participation, general health and well-being, and quality of life for people living with MS. Methods. This randomized controlled trial (RCT) compared the long-term impact of an occupational therapy rehabilitation program, an occupational therapy wellness program, and a social activity program (control), on the occupational performance, general health and well-being, and quality of life of people living with MS, through repeated measures. Assessment tools used to measure occupational performance, general health and well-being and quality of life were the Occupational Self-Assessment, the Short Form-36 version 2 and the Quality of Life Inventory. Quality of life is a primary outcome in the provision of healthcare services for the chronically ill, and is the predominant measure in this clinical research, hence the choice of these assessment tools. Results. The effect of each of the group programs, rehabilitation, wellness and a social activity group was compared. Data were analyzed with MANOVA. The results yielded that the occupational therapy wellness group demonstrated a statistically significantly positive difference in the mental component summary measure of the SF-36v2 over the occupational therapy rehabilitation group (p = .093), two months post intervention. The results further revealed that the occupational therapy wellness group demonstrated a statistically significantly positive difference in the environmental impact scale of the OSA over the occupational therapy rehabilitation group (p = .115) and the social activity group (p = .065), over a period of three months. Conclusions. In this study an occupational therapy wellness approach showed statistically significantly positive effects on the environmental impact and mental health of people with MS over the long-term. This study also demonstrated the clinical significance associated with an occupational therapy rehabilitation and an occupational therapy wellness approach. These findings therefore contribute to evidence-based practice for the most effective occupational therapy interventions for persons with MS. This study was supported by grant #NSU012001 from the National Multiple Sclerosis Foundation and the Nova Southeastern University President's Scholarship Award 2001.

Objective. The research goal was to determine if behaviors indicative of sensory processing dysfunction are present in children with autism, if these behaviors can be grouped into distinctive patterns, and if there is a relationship between sensory processing dysfunction and self-care abilities. Method. Parents of 30 male children with autism ages 2–4 completed a Dunn Sensory Profile and a Vineland Adaptive Behavior Scale. A one sample t-test and Spearman rho calculation were used for data analysis. Results. Sixty percent of the 3–4 year old group scored below negative 1 standard deviation on the Sensory Profile. This group also exhibited a pattern of sensory dysfunction in auditory, tactile, and oral systems. For the total group, there was a statistically significant correlation (rs = .646, p = .01) between the scores on Dunn Sensory Profile and Vineland and a statistically significant correlation (p = .05) between system threshold scores and Vineland. Conclusion. The data endorse a difference in sensory responsivity in children with autism which has a specific pattern. A relationship between sensory processing and the occupation of self-care is present. Response threshold is related to a child's self care performance. There is a developmental trend of increased atypical sensory behaviors in children with autism that may have clinical significance for the occupational therapist.

Supported by a research grant from the Multiple Sclerosis Foundation, this randomized controlled trial was designed to compare the effectiveness of two occupational therapy interventions and a social activity intervention on the lives of people with multiple sclerosis. A multi-group pretest-posttest control group design was used to test the hypothesis that there would be a difference in impact between an occupational therapy rehabilitation intervention, a social activity intervention, and an occupational therapy wellness intervention on the occupational performance, quality of life, and general health status of people with MS. Multiple sclerosis affects approximately 350,000 Americans. It potentially limits occupational engagement in activities, roles, and meaningful participation in society. The economic impact both to the individual and to society is estimated to be 6 billion dollars annually. The literature described traditional occupational therapy (OT) practice for this population and highlighted some limitations of studies measuring the outcomes of traditional rehabilitation approaches. The literature suggested that health promotion and wellness approaches hold promise to improve health and quality of life for people with MS. Therefore, in an effort to contribute to evidence-based occupational therapy practice, two different occupational therapy interventions were developed: one based on the rehabilitation and biomechanical frames of reference and the Model of Human Occupation (MOHO) and the other, a wellness intervention, based on the Person Environment Occupational Performance Model (PEOPM) and the MOHO. Participants were recruited from MS membership organizations. Those who met the inclusion criteria and who elected to participate in the study were randomly assigned to one of the two occupational therapy interventions or to a social activity control group. The Occupational Self Assessment, the SF-36, and the Quality of Life Inventory were administered at the beginning and upon completion of 10 sessions held weekly. The results suggest that both of the occupational therapy interventions used in this study can have a positive impact on the health and well-being and quality of life of people with MS, as compared to a social activity group. The researcher concluded that further occupational therapy research is needed that addresses quality, of life outcomes for people with MS and that other methods of assessing occupational performance outcomes need to be explored. A number of theoretical frameworks and models both within and outside the occupational therapy profession are recommended to guide the development of occupational therapy practice and outcome studies for this population.