Peer-Reviewed Journal Articles

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Predictors of Employment for Patients with Psychiatric Disorders—A Literature Review
(2007) Fan, Chia-Wei; Pan, Ay-Woan; Chang, Y
The Use of the Model of Human Occupation to Classify Domains of Vocational Assessments for Individuals with Mental Illness: A Literature Review
(2009) Fan, Chia-Wei; Pan, Ay-Woan
Motivational Change Over the Course of Hippotherapy: An Exploratory Study of Three Children with Autism
(2010) Fan, Chia‐Wei; Smith, Caitlin; Kielhofner, Gary; Taylor, Renee
This article describes the findings from a research study looking at the motivational pathways of children with autism while participating in a 16‐week hippotherapy intervention. The Pediatric Volitional Questionnaire (PVQ) was used to document quantitative data for the changes in motivation that each child experienced, and videotaping was used for qualitative information. The study found that the motivation of children with autism will take highly individual pathways over time, and will be dependent on environmental factors.
A Psychometric Study of the Model of Human Occupation Screening Tool (MOHOST)
(2010) Kielhofner, Gary
Objective: This study examined the psychometric properties of the Model of Human Occupation Screening Tool (MOHOST) using item response theory and classical test theory approaches for clients with psychiatric disorders. Methods: Data, including demographic variables and scores on the MOHOST and a version of the Health of the Nation Outcomes Scale, were retrieved from case records of 1039 adult psychiatric service users. Results: Participants ranged in age from 18 to 102 and 57% were female and 43% were male. Most (94%) were unemployed, retired, or receiving other education or training. The items that make up each of the MOHOST subscales demonstrated good discriminant validity and excellent goodness of fit showing that the items measured the MOHO constructs unidimensionally. All subscales were able to distinguish clients into at least three statistically distinct strata and showed convergence with an independent measure of functioning. Conclusion: Findings from this study must take into account implicit limitations associated with the use of Rasch analysis and classical test theory. At the same time, results did support use of the MOHOST for research and clinical purposes. The MOHOST demonstrated good construct validity, item separation reliability, and concurrent validity. As a measure of occupational participation, the MOHOST offers practitioners and researchers a valid and reliable measure of volition, habituation, communication/interaction skills, process skills, motor skills, and environmental influences on participation.
Examining the Validity of the Model of Human Occupation Screening Tool: Using Classical Test Theory and Item Response Theory
(2011) Pan, Ay-Woan; Fan, Chia-Wei; Chung, LyInn; Chen, Tsyr-Jang; Kielhofner, Gary; Wu, Ming-Yi; Chen, Yun-Ling
Introduction: This study examined the psychometric properties of the Model of Human Occupation Screening Tool, using both item response theory and classical test theory. Method: One hundred and one people with mental health problems, aged 18–65 years, were recruited. The Chinese version of the Model of Human Occupation Screening Tool, the National Taiwan University Hospital Symptom Checklist, the Volitional Questionnaire, the Assessment of Communication and Interaction Skills, and the Mini Mental State Examination were administered. Rasch analysis and correlational analysis were used to examine the construct, convergent, divergent validity and known group validity. Results: Rasch analysis confirmed that there were six subscales within the Chinese version of Model of Human Occupation Screening Tool. The Volitional Questionnaire strongly correlated with the volition subscale (r = 0.583). The Assessment of Communication and Interaction Skills strongly correlated with the communication and interaction subscale (r = 0.815). The Mini Mental State Examination was moderately correlated with the process subscale (ρ = 0.334) and the symptomatology was not associated with any of the subscales as expected. There were significant differences on selected subscale scores across four known groups of participants. Conclusion: The Chinese version of the Model of Human Occupation Screening Tool was valid when applied to people with mental health problems.
The Test–Retest Reliability and the Minimal Detectable Change of the Purdue Pegboard Test in Schizophrenia
(2013) Lee, Posen; Liu, Chin-Hsuan; Fan, Chia-Wei; Lu, Chi-Pang; Lu, Wen-Shian; Hsieh, Ching-Lin
Background/Purpose: The Purdue pegboard test is widely used in measuring the hand dexterity of patients with schizophrenia. In patients with schizophrenia, the test–retest reliability and minimal detectable change (MDC) of this test remain largely unknown, limiting the interpretability of this popular measure. The purpose of this study was to estimate the test–retest reliability and the MDC of the Purdue pegboard test for patients with schizophrenia. Methods: A total of 147 patients with schizophrenia participated in this study. The participants were administrated the five subtests of the Purdue pegboard test, three trials in a row at both of the two sessions 1 week apart. The intraclass correlation coefficient (ICC) was used to examine the test–retest reliability and the MDC was calculated on the basis of standard error of measurement. Results: The test–retest reliabilities of the five subtests were moderate to good (ICC = 0.73–0.88). The MDC (MDC%) was 3.0 (22.9%) for the dominant hand subtest, 3.1 (26.1%) for the nondominant hand subtest, 3.0 (31.7%) for the both hands subtest, 6.1 (17.7%) for the dominant + nondominant + both hands subtest, and 8.5 (35.3%) for the assembly subtest. Conclusion: Our results reveal that the Purdue pegboard test has moderate-to-good test–retest reliability but substantial random measurement error. These findings should enable clinicians and researchers to monitor and interpret the changes in the hand dexterity of patients with schizophrenia more accurately and confidently.
Evaluating the Psychometric Properties of a Clinical Vocational Rehabilitation Outcome Measurement: The Assessment of Work Performance
(2013) Fan, Chia-Wei; Taylor, Renée R.; Ekbladh, Elin; Hemmingsson, Helena; Sandqvist, Jan
This study examined the validity and reliability of the Assessment of Work Performance (AWP) using Rasch analysis. The AWP was administered to 365 clients with a variety of work-related problems. Rasch analysis and principal component analysis were used to examine the appropriateness of the rating scales and unidimensionality of AWP items. The person-response validity, internal consistency, targeting appropriateness, and differential item function were also analyzed. The Rasch analysis confirmed the 4-point rating scale, and the item set met the criteria of unidimensionality. The AWP exhibited satisfactory person-response validity and internal consistency. Among the three subdomains, the targeting of item-difficulty was sufficient in the motor skills and process skills subdomains. Differential item functioning was found across gender and diagnoses. This study presented evidence to support that the AWP functioned as a reliable and valid assessment in assessing work performance.
Work Environment Impact Scale: Testing the Psychometric Properties of the Swedish Version
(2014) Ekbladh, Elin; Fan, Chia-Wei; Sandqvist, Jan; Hemmingsson, Helena; Taylor, Renée
BACKGROUND: The Work Environment Impact Scale (WEIS) is an assessment that focuses on the fit between a person and his or her work environment. It is based on Kielhofner's Model of Human Occupation and designed to gather information on how clients experience their work environment. OBJECTIVE: The aim of this study was to examine the psychometric properties of the Swedish version of the WEIS assessment instrument. METHOD: In total, 95 ratings on the 17-item WEIS were obtained from a sample of clients with experience of sick leave due to different medical conditions. Rasch analysis was used to analyze the data. RESULTS: Overall, the WEIS items together cohered to form a single construct of increasingly challenging work environmental factors. The hierarchical ordering of the items along the continuum followed a logical and expected pattern, and the participants were validly measured by the scale. The three occupational therapists serving as raters validly used the scale, but demonstrated a relatively high rater separation index, indicating differences in rater severity. CONCLUSION: The findings provide evidence that the Swedish version of the WEIS is a psychometrically sound assessment across diagnoses and occupations, which can provide valuable information about experiences of work environment challenges.
Assessing therapeutic communication during rehabilitation: The Clinical Assessment of Modes
(2016) Fan, Chia-Wei; Taylor, Renee R.
OBJECTIVE. This study applied Rasch analysis to test four versions of the Clinical Assessment of Modes (CAM), an assessment based on Taylor’s Intentional Relationship Model: CAM–P, which assesses clients’ pretreatment preferences; CAM–E, clients’ treatment experience; CAM–T, therapists’ self-reported perspective; and CAM–O, an observer rating scale. METHOD. The CAM–P was administered to 63 inpatients. The CAM–E was administered to 110 inpatients and outpatients. Trained raters rated therapists’ modes with 59 inpatients and outpatients on the CAM–O. The CAM–T was administered to 38 therapists. Analyses of reliability and validity were conducted. RESULTS. The CAM demonstrated adequate construct validity. All versions showed acceptable internal consistency and unidimensionality within each of the subscales. Disorder between the 5 points on the ordinal rating scale was found for the client measures (CAM–P, CAM–E) and was resolved by modifying the ratings to encompass a 4-point scale. CONCLUSION. The four CAM versions are reliable and valid measures of therapeutic communication in rehabilitation.
Examining changes in occupational participation in forensic patients using the Model of Human Occupation Screening Tool
(2016) Fan, Chia-Wei; Morley, Mary; Garnham, Mike; Heasman, David; Taylor, Renee
Introduction: In occupational therapy, there has been an increased interest in patients’ occupational participation within forensic settings. This retrospective study involved a longitudinal analysis of occupational participation within six forensic hospitals in England. The aim was to contribute to the understanding of forensic patients’ occupational participation over a two-year period. Methods: The Model of Human Occupation Screening Tool (MOHOST) was rated by 78 occupational therapists on 489 patients in low and medium secure units who were receiving occupational therapy over two years. The many-faceted Rasch Model was used to convert their MOHOST scores at each time point into interval scales. Regression analysis was used to examine changes in occupational participation over time. Results: Patients’ overall occupational participation improved over time. Specifically, participation improved in five of the six MOHOST subdomains, which included their motivation for occupation, pattern of occupation, communication/interaction skills, process skills, and environment. Patients did not demonstrate significant change in their motor skills, which varied as expected. In addition, patients in low secure units had better occupational participation than those in medium secure settings. Conclusion: Our findings indicated improvements in the patients’ occupational participation over the 2-year period. Further investigations are needed to understand factors contributing to change.
Interprofessional Education for Health Science Students’ Attitudes and Readiness to Work Interprofessionally: A Prospective Cohort Study
(2018) Kim, Young Joo; Radloff, Jennifer C.; Stokes, C. Kim; Lysaght, Christine R.
Background: Interprofessional education of healthcare providers is necessary to foster collaborative practice and improve patient outcomes. Objective: To examine the effectiveness of the single-session interprofessional education in improving interprofessional attitudes, increasing knowledge of healthcare professions, and improving perceived-readiness for working interprofessionally and with older adults in students in occupational therapy, physical therapy, and physician assistant graduate programs. Methods: We used a prospective, pre–post cohort design. Fall risk evaluation for older adults was selected as the topic of the 4-hour interprofessional education session. Graduate students from three professional programs including occupational therapy (n = 20), physical therapy (n = 26), and physician assistant studies (n = 35) participated in the study, and 17 older adults aged 65 years or older volunteered for the session. Our primary outcome measure was the Interprofessional Attitudes Scale measuring interprofessional attitudes, and our secondary outcome measure was the study-specific questionnaire measuring the direct effect of our interprofessional education session. Results: Graduate students showed significant improvements in the subscale of teamwork, roles, and responsibilities in the Interprofessional Attitudes Scale. Students also showed significant improvements in “understanding of other professions,” “perceived-readiness to work interprofessionally,” and “perceived-readiness to work with older adults” in the study-specific questionnaire. Ceiling effects were observed in most of the subscales in the Interprofessional Attitudes Scale. Conclusion: This study demonstrates that a single 4-hour interprofessional education session can improve interprofessional attitudes, knowledge of other professions, and perceived-readiness of health science graduate students to work interprofessionally and to work with older adults.
Using Case-based Learning to Facilitate Clinical Reasoning Across Practice Courses in an Occupational Therapy Curriculum
(2019) Murphy, Lynne F.; Radloff, Jennifer C.
Although occupational therapy educators have historically used cases as a means to prepare students for clinical practice, there is little evidence that this instructional method actually facilitates clinical reasoning. This convergent, parallel mixed methods study examined how the use of varied case formats, built on the tenets of case-based learning, facilitated specific components of clinical reasoning, and explored how the cases contributed to readiness for professional practice. Case formats included text, video, role-playing, simulated patients, and a client. Case-based learning activities included application of models and frames of reference, conducting assessments, planning and implementing interventions, clinical documentation, and identification of reasoning used. All cases included the opportunity for instructors to provide direct and appropriate feedback, and facilitation of student reflection on their performance. The Self-Assessment of Clinical Reflection and Reasoning (SACRR) was used for quantitative data analysis and detected statistically significant changes in the use of theory and frames of reference to inform practice and in student reasoning about interventions, following case-based learning. Student surveys allowed for pragmatic qualitative analysis, and identified the themes of self-awareness, confidence, and developing competence related to readiness for fieldwork and clinical practice. Student preferences for case format and benefits of varied types of cases were identified. Case-based learning used different case formats, and contributed to the occupational therapy student transition from a clinical reasoning novice to an advanced beginner. Knowledge of this process is useful to occupational therapy educators in structuring case-based learning activities to influencing reasoning.
Rehabilitation Intervention for Individuals with Heart Failure and Fatigue to Reduce Fatigue Impact: A Feasibility Study
(2019) Kim, Young Joo; Radloff, Jennifer C.; Crane, Patricia A.; Bolin, Linda P.
Objective: To investigate feasibility of recruitment, tablet use in intervention delivery, and use of self-report outcome measures and to analyze the effect of Energy Conservation plus Problem-Solving Therapy versus Health Education interventions for individuals with heart failure-associated fatigue. Methods: This feasibility study was a block-randomized controlled trial involving 23 adults, blinded to their group assignment, in a rural southern area in the United States. Individuals with heart failure and fatigue received the interventions for 6 weeks through videoconferencing or telephone. Participants were taught to solve their fatigue-related problems using energy conservation strategies and the process of Problem-Solving Therapy or educated about health-related topics. Results: The recruitment rate was 23%. All participants completed the study participation according to their group assignment, except for one participant in the Energy Conservation plus Problem-Solving Therapy group. Participants primarily used the tablet (n=21) rather than the phone (n=2). Self-report errors were noted on Activity Card Sort (n=23). Reported fatigue was significantly lower for both the Energy Conservation plus Problem-Solving Therapy (p=0.03, r=0.49) and Health Education (p=0.004, r=0.64) groups. The Health Education group reported significantly lower fatigue impact (p=0.019, r=0.48). Participation was significantly different in low-physical demand leisure activities (p=0.008; r=0.55) favoring the Energy Conservation plus Problem-Solving Therapy group. Conclusion: The recruitment and delivery of the interventions were feasible. Activity Card Sort may not be appropriate for this study population due to recall bias. The interventions warrant future research to reduce fatigue and decrease participation in sedentary activities (Clinical Trial Registration number: NCT03820674).
Treating Chronic Nonmalignant Pain: Evidence and Faith-based Approaches
(2019) Snell, Sarah; Hughes, Tia; Fore, Carolyn; Lukman, Roy; Morgan, Brett
A significant portion of the world's population is impacted by chronic pain; in the United States, chronic pain costs billions annually in treatment and lost productivity. A needs assessment was conducted to evaluate the prevalence of chronic nonmalignant pain (CNMP) at a university occupational therapy clinic over a 3-month period; recommendations were made to improve pain management at the clinic and referring hospital system. Graded Chronic Pain Scale 2.0 results indicated the prevalence of CNMP was a significant problem. Three evidence-based interventions based on the biblically based CREATION Health Model were developed.
Occupational therapy students’ self-efficacy for therapeutic use of self: Development and associated factors
(2020) Fan, Chia-Wei; Carstensen, Tove; Småstuen, Milada C.; Yazdani, Farzaneh; Ellingham, Brian; Bonsaksen, Tore
Occupational therapy students need to develop self-efficacy for therapeutic use of self in practice. This longitudinal study examined Norwegian occupational therapy students’ self-efficacy for therapeutic use of self over a 16-month period and investigated predictors of their end-point self-efficacy. One hundred and eleven students from two universities completed a self-efficacy questionnaire related to the use of self after a workshop, and at 3-month, 10-month, and 16-month follow-up. The students’ self-efficacy development was analyzed with linear mixed effect models, while factors associated with self-efficacy were investigated with linear regressions. The students from both universities showed a linear increase in self-efficacy for therapeutic mode use (p < 0.001), recognizing clients’ interpersonal characteristics (p < 0.001), and managing interpersonal events (p < 0.001). However, for the students from University 1 the largest increase occurred in an early phase, whereas for the students from University 2 the largest increase occurred in a late phase. Only baseline scores were associated with the end-point measure at 16-month follow-up. The study indicates that students’ self-efficacy for therapeutic use of self increased during the follow-up period and adds to the knowledge about occupational therapy students’ self-efficacy development related to understanding and managing client-therapist interactions.
Psychosocial variables related to weight-related self-stigma in physical activity among young adults across weight status
(2020) Fung, Xavier C. C.; Pakpour, Amir H.; Wu, Ya-Ke; Fan, Chia-Wei; Lin, Chung-Ying; Tsang, Hector W. H.
A healthy lifestyle with sufficient physical activity (PA) can contribute to weight management. Yet, many people do not maintain a healthy lifestyle. To explain PA, we propose a model that incorporates the Theory of Planned Behavior (TPB) with weight-related self-stigma. We recruited 325 young adults to complete questionnaires regarding their physical activities, weight-related self-stigma, and TPB factors. We used structural equation modeling to examine the model fit and the path invariance across weight groups. The model showed excellent model fit, but path invariance was not supported. Weight-related self-stigma significantly explained the perceived behavioral control, behavioral intention, and engagement of PA. People without overweight and people with overweight have different considerations for PA. Weight-related self-stigma is important for PA as well. To promote a healthy lifestyle, healthcare providers should provide different suggestions or interventions that suit their patients’ weight-related concerns.
Exploring culture and therapeutic communication: Therapeutic mode use by occupational therapists in the United States and Singapore
(2020) Wong, Su Ren; Fan, Chia-Wei; Polatajko, Helene
Importance: According to the Intentional Relationship Model, six therapeutic modes characterize client–therapist interactions in occupational therapy: advocating, collaborating, empathizing, encouraging, instructing, and problem solving. However, whether these modes hold across cultural contexts is not clear. Objective: To compare therapeutic mode use in occupational therapy interactions in the United States and Singapore. Design: Cross-sectional observational study; questionnaires were collected and compared from two convenience samples of occupational therapists from the United States and Singapore, and results were analyzed using t tests and general linear modeling. Setting: Large tertiary hospitals. Participants: Occupational therapists were recruited if they had at least 6 mo experience in their clinical specialty. Adult client participants were recruited if they had or planned to have at least three occupational therapy sessions. Outcomes and Measures: The therapist version of the Clinical Assessment of Modes (CAM–T) was used to assess occupational therapists’ therapeutic mode use in interactions with specific clients. Results: A total of 74 U.S. and 39 Singaporean client–therapist interactions were assessed. U.S. therapists were more likely to use the upper end of the response scale; after we corrected for this, the pattern of mode use was similar in both cultural contexts, with instructing mode used the most. In absolute terms, U.S. therapists used the instructing mode more frequently than Singaporean therapists. Conclusion and Relevance: Further research should be done to examine the sociocultural factors that affect responses on the CAM–T and mode use. What This Article Adds: This study is the first to compare therapeutic mode use in different cultural settings. With the globalization of occupational therapy practice, it is important to consider the generalizability of occupational therapy concepts across cultures.
Validating the Persian Intuitive Eating Scale-2 among breast cancer survivors who are overweight/obese
(2020) Nejati, Babak; Fan, Chia-Wei; Boone, William J.; Griffiths, Mark D.; Lin, Chung-Ying; Pakpour, Amir H.
Women with breast cancer are at risk of being overweight/obese which may consequently increase mortality. Intuitive eating is an adaptive eating behavior which might be beneficial for weight outcomes. The present study validated the Persian Intuitive Eating Scale-2 (IES-2) among overweight/obese Iranian females with breast cancer. Women who were overweight/obese with breast cancer (n = 762; mean ± SD age = 55.1 ± 5.7 years) completed the following questionnaires: IES-2, General Self-Efficacy Scale (GSE-6), Hospital Anxiety and Depression Scale (HADS), Short Form-12 (SF-12), Weight Bias Internalization Scale (WBIS), Body Appreciation Scale-2 (BAS-2), and Eating Attitudes Test (EAT-26). Confirmatory factor analysis (CFA) and Rasch analysis were applied to examine the psychometric properties of the IES-2. Associations between IES-2 score and other scale scores were assessed. CFA and Rasch analysis suggested that the Persian IES-2 had robust psychometric properties and all IES-2 items were meaningful in their embedded domains. The four-factor structure of the Persian IES-2 was confirmed. Concurrent validity was supported by the positive correlations between the IES-2 score and scores on the GSE-6, SF-12 mental component, and BAS-2. Negative correlations were found between the IES-2 score and the HADS (anxiety and depression subscales), WBIS, and EAT-26. The present study demonstrated that the Persian IES-2 is a well-designed instrument and is applicable for women who are overweight/obese with breast cancer.
Influence of Interprofessional Communication on Discharge Decisions in Prelicensure Healthcare Learners
(2020) Stokes, C. Kim; Lysaght, Christine; Kim, Young; Lin, Chia-Cheng; Murphy, Lynne; Radloff, Jennifer C.
Introduction: Readiness in interprofessional practice is expected of graduating health professionals. This study examined the effectiveness of education on interprofessional communication around discharge destination decisions of healthcare learners utilizing standardized patients in an objective structured clinical examination (OSCE). Methods: Occupational therapy (OT, n = 26), physical therapy (PT, n = 27), and physician assistant (PA, n = 35) learners individually assessed a standardized patient (SP) in a simulated acute care setting and chose a discharge destination from a list of options. Next, learners considered other team member perspectives, either in an interprofessional team huddle or through review of written documentation, before meeting with the SP as a team and finalizing discharge destination decisions. Learner decisions were compared to expert opinion using cross tabulation. Results: Overall, learners in both intervention groups significantly improved their discharge decisions matched with expert opinion (Team Huddle, p = 0.001; Written Communication, p = 0.006) without a significant difference between the Team Huddle and Written Communication groups (p = .774). Variance was noted among disciplines with statistical significance only noted between OT learners and learners from the other professions (Team Huddle, p = 0.004; Written Communication, p = 0.016). Conclusion: Interprofessional collaboration through either team huddle or written communication improves discharge decision-making with compatible effectiveness between them.
Psychometric evaluation of the Finnish translation of the assessment of communication and interaction skills (ACIS-FI)
(2020) Fan, Chia-Wei
Background: The Model of Human Occupation (MOHO) is a widely used conceptual practice model in Finland. Therefore, Finnish translations of valid and reliable MOHO assessments are needed. Objective: The primary objective of this study was to examine the psychometric properties of the Finnish translation of the Assessment of Communication and Interaction Skills (ACIS-FI) using the many-facet Rasch model approach. Methods and Materials: Twenty-eight occupational therapists completed an in-person training workshop on the ACIS-FI and participated as raters in this study. One hundred and forty-eight clients were rated using the ACIS-FI. Rating scale functioning, unidimensionality, person validity and rater severity, item targeting, and item and person separation statistics were examined. Results: The rating scales demonstrated adequate functioning; the rating category ‘deficit’ was infrequently adopted by the raters. The ACIS-FI had satisfactory construct validity, as confirmed by all items exhibiting unidimensionality within a single construct (i.e. communication and interaction skills), and appropriate item fit. Validity was further confirmed through low person misfit (6%) and low rater misfit (3.6%). No ceiling or floor effects were found. The ACIS-FI was able to separate clients into four levels of communication and interaction skills. Conclusions: This study offers evidence for the validity of the ACIS-FI as a measure of communication and interaction skills in occupational therapy. Significance: The ACIS-FI offers Finnish practitioners and researchers a valid tool to measure communication and interactions skills that is theoretically grounded in the MOHO.

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