Search Results (42)

Background/Objectives: There is limited empirical evidence on the feasibility of inclusive, community-based exercise programs for older adults with long-term mobility disabilities. This pilot study investigated the feasibility and preliminary effectiveness of a community-based high-intensity functional training (HIFT) intervention. Methods: This single-group pre–post feasibility trial was delivered across four community-based HIFT facilities. Thirteen participants enrolled, and 10 (mean age 69.8 ± 6.7 years; 60% female) completed baseline assessments, two onboarding sessions, and thrice-weekly group-based workouts across 16 weeks. Physical function was assessed using the Canadian Occupational Performance Measure (COPM), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, Modified Falls Efficacy Scale (MFES), and standardized tests of mobility, balance, and strength. Exploratory outcomes included body mass index (BMI), waist circumference, work capacity, and quality of life (QOL). Results: Recruitment, retention, and attendance rates were 38%, 77%, and 58% (80% including make-up sessions), respectively. The intervention was safe and well-tolerated, with one fall-related adverse event. Self-reported functional outcomes demonstrated small to large effects, with large improvements in participant-identified functional activities (d = 1.03–1.54) and fall efficacy (d = 0.97), and a small effect for standardized physical function (d = 0.36) Endurance improved substantially (d = 1.01), while mobility, balance, and strength outcomes reflected maintenance or small to moderate gains (d = 0.08–0.55). BMI remained stable (d = 0.05), work capacity increased with moderate to large effects (d = 0.61–1.43), and QOL improved modestly (d = 0.20). Exit interviews reinforced high acceptability, highlighting individualized adaptations, supportive trainers, and the group-based context as motivating contextual factors. Conclusions: A community-based HIFT program is feasible and acceptable for older adults with mobility disabilities. Full article

Repeated exposure to low-level blast overpressure (BOP) during controlled detonations is an emerging occupational health concern for military breachers and Special Operations Forces personnel, given accumulating evidence that chronic exposure may produce subtle, subclinical neurotrauma. This study derived a latent neuroinjury construct integrating three complementary domains of brain health—post-concussive symptoms, working-memory performance, and circulating biomarkers—to determine whether breachers exhibit coherent patterns of neurobiological alteration. Symptom severity was assessed using the Rivermead Post-Concussion Questionnaire (RPQ), and working memory was assessed with the N-Back task and a panel of thirteen neuroproteomic biomarkers was measured reflecting astroglial activation, neuronal and axonal injury, oxidative stress, inflammatory signaling, and neurotrophic regulation. Experienced Canadian Armed Forces breachers with extensive occupational BOP exposure were compared with unexposed controls. Bayesian latent-variable modeling provided probabilistic evidence for a chronic, subclinical neurobiological signal, with the strongest contributions arising from self-reported symptoms and smaller but consistent contributions from the biomarker domain. Working-memory performance did not load substantively on the latent factor. Several RPQ items and circulating biomarkers showed robust loadings, and the latent neuroinjury factor was elevated in breachers relative to controls (97% posterior probability). The pattern is broadly consistent with subclinical neurobiological stress in the absence of measurable cognitive impairment, suggesting early or compensated physiological alterations rather than overt dysfunction. This multidomain, biomarker-informed framework provides a mechanistically grounded and scalable approach for identifying subtle neurobiological strain in military personnel routinely exposed to repetitive low-level blast. It may offer value for risk stratification, operational health surveillance, and the longitudinal monitoring of neurobiological change in high-risk occupations. Full article

Background/Objectives: To investigate the impact of a routine botulinum toxin type A (BoNT-A) injection in combination with outpatient therapy on the daily activities of stroke survivors with upper extremity spasticity and to facilitate patient-centred assessment focusing on individual needs during daily life. Methods: Design: Observational study across one treatment cycle (3 months). Setting: Spasticity outpatient clinic of a neurorehabilitation hospital in Germany. Participants: Adult stroke survivors (n = 27) with upper extremity spasticity receiving routine BoNT-A treatment. Interventions: Participants received one BoNT-A injection and outpatient therapies as part of their routine management. Augmented assessment was conducted directly before the injection (T0), and at 4 to 6 weeks (Tmax1) and 12 to 14 weeks (T2) following the injection. Main outcome measures: The Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling (GAS), and Arm Activity Measure (ArmA). Secondary outcome measures: The Resistance to Passive Movement Scale (REPAS), Motricity Index (MI), SF-12v2 Health Survey (SF-12v2), Global Clinical Impression (GCI), and importance of and satisfaction with the BoNT-A treatment. Results: Performance of individually selected daily activities and satisfaction with their performance (COPM), passive care tasks (ArmA, part A), and resistance to passive movement (REPAS) significantly improved from T0 to Tmax1. Improvements largely remained at T2. Individual goals were all set at the activities and participation levels of the International Classification of Functioning, Disability and Health. These improved for 75% of participants and were fully attained by 33.3% at Tmax1. Responder analysis indicated that COPM and ArmA improvements were clinically significant for up to 50% of participants. Active upper extremity use (ArmA, part B), health-related quality of life (SF-12v2), and upper extremity strength (MI) remained unchanged. Conclusions: Our results indicate that BoNT-A in combination with routine outpatient therapy positively influenced the individually valued daily activities of stroke survivors. COPM, GAS, and ArmA are suitable for facilitating a patient-centred and daily life-oriented spasticity management post-stroke. Full article

Impairments of executive function following acquired brain injury including stroke (ABI) contribute significantly to long-lasting everyday difficulties in life. Pilot work on the CO-OP Approach^TM (Cognitive Orientation to daily Occupational Performance Approach), a contextualized strategy training intervention, with ABI adults with executive dysfunction showed improved performance on untrained everyday life tasks and cognitive flexibility. Objective: Our objective was to determine the efficacy of the CO-OP Approach relative to usual occupational therapy (UOT) for community-dwelling adult survivors of ABI with executive dysfunction. Methods: Eighty-seven participants were randomized to receive CO-OP (n = 45) or UOT (n = 42) in their homes. All participants identified five personally meaningful, everyday life goals (using the Canadian Occupational Performance Measure (COPM)) and received up to 15 one-hour treatment sessions twice per week. Three goals were trained, and two were untrained. Interventions were provided by occupational therapists registered with their regulatory college. The CO-OP group was trained to apply a meta-cognitive strategy to three goals. The UOT group received therapy based on the clinicians’ (experienced in community settings) determination. Testers were masked to the participants’ group. Analysis at the primary outcome (Post-test, ~10 weeks following baseline) was on an intent-to-treat basis. Results: Participants in the CO-OP group had a mean age of 57.5 years, a mean time post-ABI of 5.3 years, and were 57.8% men. Those in the usual OT group had a mean age of 54.7 years, a mean time post-ABI of 6.2 years, and were 69.0% men. The CO-OP group reported statistically significant higher improvements on COPM performance and satisfaction scores post-test for untrained and trained goals. However, these benefits were not retained at follow-up (three months post-baseline). Conclusions: The CO-OP Approach^TM shows promise for improving performance in everyday life goals for individuals with chronic ABI relative to usual community occupational therapy. Achieving retention of these benefits remains a challenge. Full article

Objective: This study aims to evaluate the effectiveness of a combined rehabilitative program integrating Graded Motor Imagery (GMI) and Occupational Therapy in improving upper limb function and autonomy in individuals with acquired brain injuries (ABIs), including stroke and traumatic brain injury. Methods: Twelve patients (mean age of 56.4 years) underwent a six-week intervention combining GMI and Occupational Therapy. Outcome measures included the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), Jebsen Taylor Hand Function Test (JTHFT), Canadian Occupational Performance Measure (COPM), 12-Item Short Form Health Survey (SF-12), Numeric Rating Scale for pain (NRS), and Montreal Cognitive Assessment (MoCA). Assessments were conducted at baseline, post-treatment, and at 3- and 6-month follow-ups. Data were analyzed using the Wilcoxon signed-rank test. Results: Statistically significant improvements (p < 0.05) were found in upper limb function (DASH), occupational performance and satisfaction (COPM), and physical health status (SF-12 physical component). Specific gains in hand function—particularly in writing and eating—were detected using the JTHFT. No significant changes were observed in pain perception or mental health outcomes. Conclusions: The integration of GMI with Occupational Therapy appears to be a promising and well-tolerated intervention for enhancing motor function and daily life participation in individuals with ABI. Although the small sample limits generalizability, these preliminary findings support further investigation through larger, controlled studies. Full article

This case report describes the implementation of participation-based occupational therapy for children with physical disabilities and their siblings in two families. Case 1 was a girl with myelomeningocele spina bifida and her brother, and case 2 was a boy with cerebral palsy and his sister. Goals targeted joint participation in play. The Sibling Participation in Occupational Therapy (SPOT) approach adapted the Collaborative Process for Action Plans to Achieve Children’s Participation Goals in order to assess goal-related factors and develop actionable steps to achieve the goal. Corresponding interventions addressing performance skills differed across cases and related to all children’s ages, interests, and functional abilities. The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) measured sibling dyad’s achievement of their family’s goal, and participants completed an experiential questionnaire. Parent COPM ratings demonstrated a meaningful increase in performance and satisfaction, and the therapist and parent ratings of the GAS met or exceeded expected achievement. Parents and sibling dyads reported positive experiences in SPOT. The outcomes support the use of a participation-based approach inclusive of siblings that is consistent with family-centered practice to facilitate participation in meaningful joint sibling activities with families who have a child with a physical disability. Full article

Background: People with post-stroke cognitive impairment (PSCI) are at increased risk of recurrent stroke, dementia, and accelerated cognitive decline. Objective: To examine the feasibility, safety, acceptability, and suitability of a virtually-delivered vascular risk reduction intervention that integrates tailored cognitive strategy training for people with executive function (EF) impairments post-stroke. Methods: This case series included eight participants who completed up to ten virtual sessions focused on vascular risk reduction and metacognitive strategy training. Sessions averaged 40 min over a 4–5-week period. Results: The intervention was found to be feasible, safe, and acceptable. The recruitment rate was 66.7%, and the retention rate was 87.5% (7 of 8 completed the training). No serious adverse events were reported. Most participants demonstrated improvements on the Canadian Occupational Performance Measure (COPM), with mean performance and satisfaction change scores of 1.22 ± 0.87 and 1.18 ± 0.83, respectively. Conclusions: This technology-enabled intervention was feasible and acceptable for individuals with post-stroke EF impairments. Virtual delivery was a key factor in its accessibility and success. The results are promising for improving self-management of vascular risk factors, warranting further study in larger trials. Full article

Short- and long-term hand function was evaluated in adult patients with deep dermal and full-thickness hand burns after treatment with enzymatic debridement (NexoBrid^® MediWound Ltd., Yavne, Israel), assessing the results at discharge and 3, 6, and 12 months post-burn. This prospective cohort study was performed in the Burn Center in Beverwijk between March 2017 and December 2019. Hand function was assessed using Modified Kapandji Index scores, the Jebsen-Taylor Hand Function Test, and range of motion; scar quality using the Patient and Observer Scar Assessment Scale version 2.0; and quality of life using the Quick Disability Arm Shoulder Hand Questionnaire and the Canadian Occupational Performance Measure. Ten patients (14 hand burns) were included. The need for a skin graft after NexoBrid^® was 86%, and 50% needed additional surgical excision before skin grafting. Digits 3 and 4 achieved near-to-normal total active motion, and at least 50% of the hands achieved a normal range within the Jebsen-Taylor Hand Function Test in four items at 12 months post-burn. Scar quality and quality of life improved significantly over time. The present study can be considered as a proof-of-concept study for future clinical trials on enzymatic debridement for hand burns. Full article

Background: Occupational therapy (OT) interventions on activities of daily living (ADL), cognitive functions, and physical function in middle-aged and older people with chronic stroke. Methods: A systematic review search until November 2024 using five generic databases: PubMed/Medline, Web of Science, Scopus, ScienceDirect, and OT seeker. The PRISMA checklist, RoB 2 (Cochrane, London, UK), and GRADEpro (Evidence Prime Inc., Hamilton, CA) tools assessed the evidence’s methodological quality and certainty. The protocol was registered in PROSPERO (code: CRD42024568225). Results: Of 1733 records were identified across the databases, nine studies were analyzed using the PICOS format. The meta-analysis revealed significant improvements in independent performance of activities of daily living (ADL), as measured by the Canadian Occupational Performance Measure (COPM), in favor of the experimental groups (p = 0.03). No significant differences were found for the other variables analyzed. Conclusions: Performance on ADLs improved significantly according to the COPM, whereas no significant improvements in cognitive or physical function were observed among middle-aged and older chronic stroke survivors. Individual studies highlight the potential benefits of OT interventions that combine cognitive, motor, and technological approaches, such as virtual reality and brain stimulation. Full article

Background/Objectives: This study aimed to evaluate whether integrating coping strategies into occupational therapy (OT) enhances functional recovery and psychological adaptation after total knee arthroplasty (TKA). Methods: Twenty-eight patients who underwent TKA were equally assigned to an intervention and control group. Both groups received standard goal-oriented OT, while only the intervention group underwent structured training in pain coping strategies using the “Coping List”. Treatment effects were assessed using Canadian Occupational Performance Measure (COPM), pain, anxiety, depression, and pain-related disability scores. Results: A total of 210 coping strategies were identified, with the intervention group adopting an average of 15.1 additional strategies per patient. Strategies were categorized into six domains: physical, psychological and cognitive, social support, relaxation, daily activities, and medication management. The intervention group showed significantly greater improvements in COPM performance scores (7.6 ± 1.7 vs. 5.5 ± 2.6; p = 0.048) and COPM satisfaction scores (7.9 ± 2.0 vs. 5.6 ± 2.8; p = 0.049) compared to the control group. Conclusions: The findings suggest that individualized coping strategies integrated with physical rehabilitation can help patients achieve postoperative goals, enhance recovery, and improve overall well-being. Incorporating such strategies into OT appears to be effective in early-postoperative rehabilitation. Clinical trial number: This study’s clinical trial registration information is available online at UMIN (UMIN000050536). Full article

Background/Objectives: Cerebral palsy (CP) is the most common childhood motor disorder, with unilateral cerebral palsy (UCP) presenting with asymmetrical motor function that can cause decreased upper limb function. Constraint-Induced Movement Therapy (CIMT) is an evidence-based intervention that addresses upper limb functional limitations, but further study on combining interventions with CIMT is warranted. Combining CIMT with virtual reality (VR) is hypothesized to enhance engagement and therapeutic outcomes. This study compared the effectiveness of CIMT alone versus CIMT combined with VR (CIMT + VR) in improving upper limb function and occupational performance in children with UCP. Methods: A blinded, randomized, controlled trial included children aged 5–13 years with Manual Ability Classification System (MACS) levels I–III. The participants were randomized into CIMT or CIMT + VR groups and completed a standardized 10-day camp protocol (60 h). Pre-intervention and post-intervention assessments included the Assisting Hand Assessment (AHA) and the Canadian Occupational Performance Measure (COPM). Secondary measures included acceptability ratings of VR devices and fidelity. Results: Thirty-two participants, with a mean age of 9 years and 3 months (3 years 1 month), MACS I = 4, II = 20, and III = 8, completed this study. CIMT and CIMT + VR led to significant improvements in upper limb function, with no statistically significant differences between the groups in bilateral hand use and occupational performance. Conclusions: These findings reinforce the efficacy of CIMT while highlighting the potential of VR to enhance engagement when the child prefers to interact with the technology, underscoring the importance of individualized approaches that consider a child’s preferences and responsiveness to different intervention modalities. Full article

The Mobility Intensive Training (Mob-IT) protocol is an innovative intervention focused on motor learning to improve the mobility of children with cerebral palsy (CP). The objective was to describe the feasibility and intervention fidelity of Mob-IT. A single-subject experimental study was conducted with four children with CP, a median age of 11 (7–13) years, and a Gross Motor Function Classification System I–III. The Mob-IT included 24 h of practice of mobility goals, delivered three times a week in 2 h sessions over four weeks. Feasibility was assessed using the Qualitative Feedback Questionnaire (QFQ), evaluating adherence, acceptability, adverse effects, the clarity of procedures, and intervention time. The Canadian Occupational Performance Measure (COPM) was used to assess participant and caregiver satisfaction. Fidelity was measured by the type of feedback provided (intrinsic vs. extrinsic), task challenge level, and intervention volume. Participants reported good acceptance, few adverse effects, and satisfaction with the outcomes. The intervention adhered to the proposed principles, with a focus on extrinsic feedback and tasks showing progression over time. Time was well spent, being 78% focused on activities and using mostly extrinsic-focused feedback. The Mob-IT protocol was considered feasible and faithful to its principles. As this is a feasibility study, the results indicate the need to expand the intervention to a larger, randomized study. Full article

Background/Objectives: This quasi-experimental study examined the effectiveness of an intensive, group-based pediatric constraint-induced movement therapy (pCIMT) program for young children. Methods: Thirty-five children aged 21 months to 6 years, with unilateral hemiparesis (HP), or weakness on one side of the body from varying etiologies, participated in a 4-week intensive, interprofessional, theme- and group-based pCIMT clinic program in the Midwest, United States. The program ran for 4 weeks with 3 h of therapy per day, 5 days per week with 3 weeks of 24 h casting for the unaffected arm, followed by 1 week of bimanual focus. Outcome measures included the Quality Upper Extremity Skills Test (QUEST), Assisting Hand Assessment (AHA), Canadian Occupational Performance Measure (COPM), and Pediatric Evaluation of Disability Inventory (PEDI). Results: The participants statistically significantly improved the unilateral function of the HP arm in four of five QUEST variables (p < 0.009), bimanual coordination as measured by the AHA (p < 0.001), and some areas of occupational performance as measured by the COPM (p < 0.001) and PEDI (p < 0.05). Conclusions: This study revealed the intensive, group-based pCIMT clinic model was effective and feasible to implement with the support from various stakeholders. Full article

The aim of this study is to evaluate the relationship between clinical severity and functionality, occupational performance, and health-related quality of life in patients hospitalized with pulmonary embolism. Pulmonary embolism patients were grouped by clinical severity using the Pulmonary Embolism Severity Index. Those scoring ≥160 were in the high-severity group (HSG); those scoring < 160 in the low–moderate group (LMSG). The main variables were functionality assessed by the World Health Organization Disability Assessment Schedule (WHODAS), self-perception of occupational performance assessed by the Canadian Occupational Performance Measure (COPM), pain and fatigue assessed by a Visual Analogue Scale (VAS), and health-related quality of life assessed by the EuroQol-5Dimensions (EQ-5D). Patients were evaluated at hospital admission and at 1-month and 3-month follow-up. At admission, there were significant differences between groups in the WHODAS and health-related quality of life in favor of the LMSG. At 1-month and at 3-month follow-up, there were significant differences between the LMSG and HSG in WHODAS, COMP, NRS pain, fatigue and EQ-5D scores in favor of the LMSG. An association exists between clinical severity and mid-term functionality, self-perception of occupational performance, pain, fatigue, and health-related quality of life in PE patients. Full article

A safety plateau in the construction industry has been reported in the US and Canada, which has prompted researchers to seek new factors affecting construction safety performance. Tapping into advancements in the theory of human and organizational behaviors can yield valuable new perspectives. Therefore, by leveraging the advancement of the Job Demand Control Support model in the field of occupational safety and health, this paper firstly tested the impact of one newly added hindrance stressor (i.e., interpersonal conflicts on construction sites) by researchers on organizational behaviors on the safety performance of construction workers, based on two cross-sectional studies in the US and Canada. Differentiations were made between conflicts with supervisors and conflicts with coworkers. One personal resource factor, i.e., individual resilience, was also considered in this paper. A “causal” chain that shows the mitigation impact of individual resilience on conflicts with supervisors or coworkers, and the adverse impact of conflicts with supervisors or coworkers, on unsafe events were found to hold true for both US and Canadian construction sites, based on the results from measurement invariance tests and structural equation modelling. Recommendations regarding how to improve construction workers’ individual resilience and reduce interpersonal conflicts on site, thereby reducing safety incidents on site, are provided. Full article