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Item Pilot Testing and Validation of an Educational Game on Transportation Challenges for Mobility Device Users(MDPI, 2024) Candiotti, Jorge L.; Park, Sangmi; Lee, Chang Dae; Rafferty, Evan J.; Cooper, Rosemarie; Cooper, Rory A.; Occupational Therapy, School of Health and Human SciencesDespite the increasing use of assistive mobility devices, practical education to navigate real-world ground transportation barriers is lacking. The educational board game, called HERL-Town, was developed to teach safe and effective navigation for mobility device users (MDUs) in the community. The study examined the initial validity, reliability, and overall quality of HERL-Town as an educational tool for overcoming transportation barriers in real-world environments. HERL-Town featured fifty scenarios focused on transportation barriers and strategies, which were assessed for content validity, while the game quality was evaluated using the Model for the Evaluation of Educational Games (MEEGA+) tool. Twenty-three experienced MDUs and four caregivers participated in the study. The results indicated a good quality score of 60.15 and forty-five scenarios met the content validity standards. The overall reliability of the scenarios was moderate (ICC = 0.729). Early psychometric findings suggest HERL-Town as a promising effective educational game for helping new MDUs and their travel companions navigate safe and effective ground transportation barriers, hence enhancing their confidence, independence, and participation in the community.Item Gender as Occupation: The "Doing" of Authentic Expression and Reciprocally Affirming Care for Transgender Individuals(WMU, 2023) DeRolf, Annie; Belkiewitz, Johnna; Wasmuth, Sally; Occupational Therapy, School of Health and Human SciencesThe current predominant view of gender as binary, alongside limited training of affirmative care practices, is severely and negatively impacting transgender and gender diverse (TGD) people. This paper urges the re-conceptualization of gender as an occupation, suggesting that gender is a doing that allows for positive identity development, roles, habits, and routines. Doing gender facilitates meaning-making and the ability to engage in other occupations. However, occupational injustices rooted in discrimination, stigma, and/or implicit biases impede TGD people’s ability to engage in the doing of gender and other occupations. Articulation of conceptual guidelines and interventions to support TGD people’s ability to do gender and other occupations is a critical area of need in occupational therapy literature and practice. In accordance with the profession’s ethical mandate to promote occupational justice, it is critical that occupational therapists become educated and involved in providing affirmative services to support occupational participation for this population.Item Application of a Model of Family-Centered Harm Reduction in Community-Based Programming(WMU, 2023) Belkiewitz, Johnna; Wilburn, Victoria G.; Larson, Sydney; Schrader, Kate; Occupational Therapy, School of Health and Human SciencesCoupling high substance use disorder rates with the effects of the COVID-19 pandemic, our nation faces a growing mental health crisis and a shortage of adequately trained mental and behavioral health providers. As occupational therapists work toward recognition as qualified providers in this practice area, we must ensure that future therapists can meet client needs. Traditional mental and behavioral health educational practices in occupational therapy use a model of harm reduction that minimizes negative outcomes for a select subset of the population engaging in specific “high-risk” behaviors, such as individuals engaging in substance use and sexual activity. Expanding our understanding of the harm reduction model and incorporating a more holistic trauma-informed care lens can better ensure beneficence for all clients. To do this, educational institutions must train students to identify harm in all of its contexts, such as the household dysfunction of cohabitating with a family member with substance use disorder, and apply practical treatments for addressing the impacts of dynamic family systems through occupation-based interventions. This paper illustrates a family-centered harm reduction model and offers a community-based educational intervention that allows occupational therapy students to gain valuable trauma-informed care practice skills through hands-on experiences.Item Applying the Ecological Model of Human Performance and the SlutWalk Movement to Support those Affected by Rape Culture in the Context of Occupational Therapy(WMU, 2023) Klukken, Angela; Wasmuth, Sally; Occupational Therapy, School of Health and Human SciencesImproving the occupational lives of others is at the heart of occupational therapy practice. Advocacy for clientele is central to this improvement, both at individual and structural levels. We argue that interventions in the Ecological Model of Human Performance (EHP) and the social movement theSlutWalk can offer increased opportunity for occupational therapists to address the harmful implications for clients affected by sexual assault and rape culture. In addition, through the principles of the EHP and the SlutWalk, we propose that occupational therapists can have a hand in eradicating the culture that facilitates and tolerates sexual violence. This paper highlights the barriers women and sexual assault survivors may face to equitable occupational participation, where occupational therapists may establish/restore, alter, create, prevent, and adapt intervention approaches in the client’s context to elicit optimal engagement in meaningful activity.Item Discovering Provider Awareness of Mobility Assistive Technologies and Clinical Guidelines- A Comparative Analysis with Consumer Responses(Wolters Kluwer, 2024) Lee, Chang Dae; Peterson, Sara; Joseph, James; McKernan, Gina; Cooper, Rosemarie; Koontz, Alicia M.; Dicianno, Brad E.; Cooper, Rory A.; Occupational Therapy, School of Health and Human SciencesObjective: This study aims to enhance the accessibility and quality of mobility-assistive technology by investigating and bridging knowledge gaps between mobility-assistive technology providers and consumers with ambulatory limitations. Design: A survey was conducted among mobility-assistive technology providers in the United States, consisting of sections on awareness, knowledge importance and desire, and knowledge sources. The responses were compared to data collected from consumers in a previous study. Results: A total of 144 mobility-assistive technology providers participated, with 60% having received academic or professional training in relevant fields. Analysis revealed significant knowledge gaps between providers and consumers, particularly in assistive technology assessment tools and knowledge sources. Moderate gaps were also observed in areas such as clinical practice guidelines, desired mobility-assistive technology information, and knowledge sources. However, the gaps in other areas were relatively small. Conclusions: This study highlights the knowledge gaps between mobility-assistive technology providers and consumers, hindering the optimal utilization and fulfillment of user needs. Providers possess valuable information that consumers may lack, positioning them as primary knowledge sources. Addressing these gaps through targeted interventions, improved communication channels, and enhanced education can enhance the utilization of mobility-assistive technology and improve outcomes for individuals with ambulatory limitations.Item Current State, Needs, and Opportunities for Wearable Robots in Military Medical Rehabilitation and Force Protection(MDPI, 2024) Cooper, Rory A.; Smolinski, George; Candiotti, Jorge L.; Satpute, Shantanu; Grindle, Garrett G.; Sparling, Tawnee L.; Nordstrom, Michelle J.; Yuan, Xiaoning; Symsack, Allison; Lee, Chang Dae; Vitiello, Nicola; Knezevic, Steven; Sugar, Thomas G.; Schneider, Urs; Kopp, Verena; Holl, Mirjam; Gaunaurd, Ignacio; Gailey, Robert; Bonato, Paolo; Poropatich, Ron; Adet, David J.; Clemente, Francesco; Abbas, James; Pasquina, Paul F.; Occupational Therapy, School of Health and Human SciencesDespite advances in wearable robots across various fields, there is no consensus definition or design framework for the application of this technology in rehabilitation or musculoskeletal (MSK) injury prevention. This paper aims to define wearable robots and explore their applications and challenges for military rehabilitation and force protection for MSK injury prevention. We conducted a modified Delphi method, including a steering group and 14 panelists with 10+ years of expertise in wearable robots. Panelists presented current wearable robots currently in use or in development for rehabilitation or assistance use in the military workforce and healthcare. The steering group and panelists met to obtain a consensus on the wearable robot definition applicable for rehabilitation or primary injury prevention. Panelists unanimously agreed that wearable robots can be grouped into three main applications, as follows: (1) primary and secondary MSK injury prevention, (2) enhancement of military activities and tasks, and (3) rehabilitation and reintegration. Each application was presented within the context of its target population and state-of-the-art technology currently in use or under development. Capturing expert opinions, this study defines wearable robots for military rehabilitation and MSK injury prevention, identifies health outcomes and assessment tools, and outlines design requirements for future advancements.Item Wheeled mobility use outcomes: a systematic review protocol of measurement properties(Wolters Kluwer, 2024-09) Mendoza, Kiera; Loeser, Madison; Ouellet, Béatrice; Best, Krista L.; Paula, Rushton W.; Kenyon, Lisa K.; Hinrichs, Rachel J.; Chase, TonyNumerous tools have been developed to measure constructs related to wheelchair use. Currently, no toolkit comprehensively details assessments of wheeled mobility device use based on the quality of their measurement properties. The current review aims to systematically identify high-quality assessment tools that measure different aspects of wheeled mobility use. The objectives are two-fold: i) to synthesize outcome measures that assess use of wheeled mobility devices, and ii) to evaluate measurement properties of the assessment tools. The populations of interest are manual wheelchair users, power wheelchair users, and scooter users of any age, diagnosis, or setting. Instruments of any type will be included. The JBI methodology for systematic reviews of measurement properties will guide this review. A search strategy will be developed to search the following databases: MEDLINE (Ovid), Embase, CINAHL (EBSCOhost), PsycINFO (EBSCOhost), PsycTests (EBSCOhost), Web of Science, and Google Scholar. The article selection process, data extraction, and quality appraisal will be performed by 2 independent reviewers, with a third reviewer being consulted to achieve consensus. The methodological quality of the studies will be assessed through the Consensus Standards for the Selection of Measurement Instruments (COSMIN) Risk of Bias tool and the COSMIN Checklist. The quality of the pooled evidence and individual measurement properties will be graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the COSMIN Criteria for Good Measurement Properties recommendations. Measurement properties of each instrument will be described, with the goal of developing a toolkit that identifies appropriate assessment tools for wheeled mobility use outcomes.Item Bridging the Humanities and Health Care With Theatre: Theory and Outcomes of a Theatre-Based Model for Enhancing Psychiatric Care via Stigma Reduction(APA, 2022-12-22) Wasmuth, Sally; Pritchard, Kevin T.; Belkiewitz , Johnna; Occupational Therapy, School of Health and Human SciencesObjective: This article describes the rational, methods, implementation, and effectiveness of Identity Development Evolution and Sharing (IDEAS), an evidence-supported, narrative theater-based training that reduces stigma among health care providers to increase health care equity in psychiatric rehabilitation. Method: The IDEAS model has been used to reduce provider bias toward patients. From May 2017 to January 2020, we interviewed people from three patient groups who have been harmed by stigma, including Black women, transgender, and gender-diverse people, and people with substance use disorders. These interviews informed the creation of three theatrical scripts that were performed by professional actors for audiences of health care providers from January 2020 to May 2022. The performances aimed to raise conscious awareness of implicit provider biases and to provide a reflective opportunity to ameliorate these biases. The purpose of IDEAS is to improve experiences in health care settings such as psychiatric rehabilitation of patients from groups who have been harmed by stigma. We used paired-samples t tests to compare pre/postprovider stigma, measured via the Acceptance and Action Questionnaire-Stigma (AAQ-S). Results: Sociodemographic factors for providers who viewed IDEAS were similar across all three performances. IDEAS significantly decreased AAQ-S scores (t = 11.32, df = 50, M = 13.65, 95% confidence limit: [11.32, 15.97], p < .0001). Conclusions and implications for practice: IDEAS reduces provider stigma to support positive clinical encounters with diverse patient populations. These findings are relevant for psychiatric rehabilitation settings, which seek to establish positive rapport between providers and patients.Item Exploring autobiographical memory functions in Korean older adults: Development and application of the Korean version of Thinking About Life Experiences scale (TALE-K)(2021) Park, Sangmi; Lee, Chang Dae; Kim, Tae HuiObjective: The aim of this study was to develop a Korean version of the Thinking About Life Experiences scale (TALE-K) and to analyze the characteristics of autobiographical memory function (AMF) in community-dwelling older adults Methods: To develop TALE-K, a translation and back-translation procedure followed by an understanding test was performed. Then, a survey was conducted to examine the associations of AMF with psychosocial variables using TALE-K, Index of Well-Being (IWB), Meaning in life scale for older adults, Revised UCLA Loneliness Scale (RULS), Medical Outcomes Study Social Support Survey (MOS-SSS), Brief Resilience Scale (BRS). Results: Data from 75 community-dwelling older adults were used for the final analysis. The average scores of all three subscales of TALE-K were below 3 points (less frequent than occasionally). The correlation results showed that TALE-K total score was significantly associated with IWB and the Meaning in life scale for older adults. The multiple linear regression results presented that higher AMF was significantly associated with higher IWB, along with having siblings, higher meaning in life and resilience, and lower loneliness. Conclusion: Including a validation study of TALE-K, studies for understanding the characteristics of AMF in older adults using TALE-K are needed.Item Psychometric properties of self-reported instruments for occupational balance: A COSMIN-based systematic review(Taylor & Francis, 2023-08-14) Park, Sangmi; Lee, Chang DaeIntroduction Instruments being used currently to evaluate Occupational Balance (OB) are all self-report outcome measures which demand robust psychometric properties for precise assessment. This study aimed to systematically review the psychometric properties of the current OB instruments. Methods For this systematic review, COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 were adopted. Peer-reviewed articles published between January 2010 and February 2021 were searched for in PubMed, Cochrane, Web of Science, and PsycINFO databases. Search terms were full names and abbreviations of the OB instruments: Life Balance Inventory (LBI), Meaningful Activity Wants and Needs Assessment (MAWNA), Occupational Balance Questionnaire (OBQ), and Occupational Balance-Questionnaire (OB-Quest). Results Of the 400 articles identified in a systematic database search, 12 studies from 10 articles were analysed. Five instruments, including the revised version of the OBQ (i.e., OBQ11), were analysed within the COSMIN taxonomy. The LBI demonstrated ‘high’ evidence for insufficient structural validity. The others demonstrated ‘moderate’ or ‘high’ evidence for indeterminate structural validity. Less than sufficient structural validity led to indeterminate internal consistency across five instruments, and their quality of evidence varied from ‘very low’ to ‘high’. The MAWNA and OBQ demonstrated ‘very low’ evidence for sufficient reliability. Conclusion OB instruments with psychometric properties of sufficient overall ratings supported by ‘high’ quality of evidence are unavailable. Further studies are required to clarify the concept of OB, to examine more diverse psychometrics of OB instruments, and to consolidate their robustness.