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Interventions to enhance cognitive and executive function performance are essential for the child's performance in current and future occupations. Occupational therapy practitioners are critical members of early intervention, education, and healthcare teams. Practitioners are distinctly qualified to address cognitive functioning within the context of occupational performance by providing evidence-based interventions to children and their families as well as training caregivers and teams to enhance cognitive and executive functioning (EF) performance. The purpose of this review was to update the previous systematic review on this topic. The focused question guiding the selection of research studies was: "What is the evidence for the effectiveness for interventions within the scope of occupational therapy practice to promote cognitive development and prevent further delay for children 0-5 and their families?" Due to the breadth of the review, the results were divided into two articles. This article (Part 1) focuses on cognitive interventions for children birth to 5 years with known conditions while Part 2, also in this issue, will address findings on interventions for children at risk due to environmental factors and promoting cognitive development for children birth to 5 years. [For Part 2, see EJ1333259.]

Aim: This article is the second part of a systematic review updates and broadens a previous systematic review (Frolek Clark & Schlabach, 2010) to examine the evidence for of interventions within the scope of occupational therapy practice to enhance cognitive and pre-academic development in young children with or without at-risk factors. This article is Part 2 of the review and will focus on interventions for children at-risk from environmental factors and interventions that promoting cognitive development in children ages birth to 5 years. Part 1 is published separately and focuses on children with specific diagnoses. Methods: A systematic search of studies published from 2010 to 2020 using MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Twenty-seven studies met the inclusion criteria and were critically appraised: 19 Level I, 6 Level II, and 2 Level III evidence (Part 2). Two themes are discussed within this paper (Part 2): Children At-Risk of Cognitive Delays due to Environmental Factors, and Promoting Cognitive Development. Strong strength of evidence exists for cognitive and executive functioning training programs, literacy programs, and parent interactions focused on child's needs. Strong strength of evidence indicates explicit Tier II interventions assist preschool children in learning early literacy skills (e.g., print knowledge, letter names, letter sounds). Moderate strength of evidence supports using movement or play to enhance cognitive and executive functions in preschoolers. Conclusions: Occupational therapy practitioners working in home and preschool programs can use these evidence-based interventions to enhance cognitive development, executive functions, and pre-academic functions performance for young children with or without risk factors. Part 1 of the review also appears in this issue. [For Part 1, see EJ1333335.]

Importance: Sustaining a stroke frequently leads to difficulties in returning to work, leisure, and social participation. These outcomes are important for occupational therapy practitioners to address. Objective: To determine the current evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve social participation, work, and leisure among adults poststroke. Data Sources: MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases. Study Selection and Data Collection: Primary inclusion criteria were peer-reviewed journal articles published between January 1, 2009, and December 31, 2019, within the scope of occupational therapy that evaluated an intervention to address work, leisure, or social participation poststroke (levels of evidence ranged from Level 1b to Level 2b). Reviewers assessed records for inclusion, quality, and validity following Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Findings: Forty-seven articles met the inclusion criteria. Forty-four articles related to social participation were categorized as follows: occupation-based approaches, metacognitive strategy training, education and training approaches, impairment-based approaches, and enriched environment approaches. Three articles related to work and 3 articles related to leisure were not further categorized (2 articles were each included in two categories). Seventeen Level 1b and 30 Level 2b articles were included. The strength of evidence to support occupational therapy interventions for social participation, work, and leisure outcomes is predominantly low. Conclusions and Relevance: Occupational therapy interventions may improve work, leisure, and social participation outcomes poststroke, with the strongest evidence existing for client education, upper extremity training, and cognitive training for improving social participation. What This Article Adds: Occupational therapy practitioners may use the available literature along with clinical reasoning to improve work, leisure, and social participation outcomes among clients poststroke. Additional research is required to build stronger evidence to support clinical decision making in stroke rehabilitation in these areas. This review supports the use of the available literature for client education, upper extremity training, and cognitive training alongside clinical reasoning to improve work, leisure, and social participation outcomes among clients poststroke. [ABSTRACT FROM AUTHOR]

Importance: Practitioners need to be familiar with, and involved in, managing quality-related adverse events in postacute care. Objective: To determine interventions within the scope of occupational therapy that address preventable adverse events in adult postacute inpatient and home health settings. Data Sources: Articles published from January 1995 through 2019 identified through searches of MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases. Study Selection and Data Collection: Articles were collected, evaluated, and analyzed by two independent reviewers. They were assessed and synthesized with a goal of informing clinical practice. Findings: Twenty-four articles were included in the review. Of the 10 Centers for Medicare & Medicaid Services preventable adverse events, 6 were addressed: diabetes management (n = 2), dysphagia (n = 5), infection control (n = 1), pressure ulcers (n = 6), falls (n = 5), and discharge management (n = 5). There was strong strength of evidence that exercise programs should, when appropriate, be implemented in both inpatient and home health settings to decrease the risk of falls. There was moderate strength of evidence that practitioners could consider implementing a facility wide evidence-based pressure ulcer program; providing multidisciplinary rehabilitation and swallow strengthening exercises for dysphagia; implementing a multidisciplinary, multicomponent falls program; and using a manualized depression intervention in home health to decrease hospital readmission. Conclusions and Relevance: The review highlights the importance of preventable adverse events and of occupational therapy practitioners acknowledging and managing these events to enhance health outcomes and to control health care costs. What This Article Adds: Many interventions typically performed by occupational therapy practitioners address preventable adverse events. The review highlights the importance of practitioners being aware of this category of impairment or injury. This review highlights the importance of preventable adverse events and the importance of occupational therapy practitioners acknowledging and managing these events to enhance health outcomes and control health care costs. [ABSTRACT FROM AUTHOR]

Importance: Instrumental activities of daily living (IADLs) are important for independence, safety, and productivity, and people with Parkinson's disease (PD) can experience IADL limitations. Occupational therapy practitioners should address IADLs with their clients with PD. Objective: To systematically review the evidence for the effectiveness of occupational therapy interventions to improve or maintain IADL function in adults with PD. Data Sources: MEDLINE, CINAHL, PsycINFO, OTseeker, and Cochrane databases from January 2011 to December 2018. Study Selection and Data Collection: Primary inclusion criteria were peer-reviewed journal articles describing Level 1–3 studies that tested the effect of an intervention within the scope of occupational therapy on an IADL outcome in people with PD. Three reviewers assessed records for inclusion, quality, and validity following Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Findings: Twenty-two studies met the inclusion criteria and were categorized into four themes on the basis of primary focus or type of intervention: physical activity, specific IADL-focused, cognitive rehabilitation, and individualized occupational therapy interventions. There were 9 Level 1b, 9 Level 2b, and 4 Level 3b studies. Strong strength of evidence was found for the beneficial effect of occupational therapy–related interventions for physical activity levels and handwriting, moderate strength of evidence for IADL participation and medication adherence, and low strength of evidence for cognitive rehabilitation. Conclusions and Relevance: Occupational therapy interventions can improve health management and maintenance (i.e., physical activity levels, medication management), handwriting, and IADL participation for people with PD. Further research is needed on cognitive rehabilitation. This review is limited by the small number of studies that specifically addressed IADL function in treatment and as an outcome. What This Article Adds: Occupational therapy intervention can be effective in improving or maintaining IADL performance and participation in people with PD. Occupational therapy practitioners can address IADL function through physical activity interventions, interventions targeting handwriting and medication adherence, and individualized occupational therapy interventions. [ABSTRACT FROM AUTHOR]

Importance: People with Parkinson's disease (PD) commonly experience difficulty in performing activities of daily living (ADLs), which affects their perceived quality of life. Objective: To examine the evidence for the effectiveness of interventions within the scope of occupational therapy to improve performance and participation in ADLs, rest, and sleep in adults with PD. Data Sources: Databases searched were MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane Collection. Included articles were published between January 2011 and December 2018. Study Selection and Data Collection: Articles describing Level 1b, 2b, and 3b studies that examined outcomes related to ADLs, rest, and sleep in people with PD were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Findings: Forty-five articles (10 Level 1b, 27 Level 2b, and 8 Level 3b) met the inclusion criteria. Conclusions and Relevance: Strong strength of evidence was found to support inpatient multidisciplinary intensive rehabilitation treatment (MIRT) to improve ADLs, and moderate strength of evidence that MIRT improves sleep performance. Low strength of evidence was present for outpatient occupational therapy to improve ADL and sleep outcomes. Low strength of evidence was found for resistance exercise programs to improve ADLs, but moderate strength of evidence indicates that multimodal exercise programs and targeted exercise programs can improve ADLs. Low to moderate strength of evidence suggested that alternative therapies and cognitive–behavioral therapy have a positive impact on ADLs and sleep. These results can be used to inform evidence-based occupational therapy practice. What This Article Adds: This article provides information for practitioners on the effectiveness of interventions within the scope of occupational therapy practice to improve ADLs and sleep. [ABSTRACT FROM AUTHOR]

Importance: Caregivers play a critical role in facilitating the performance of people with Parkinson's disease (PD). Knowledge on how occupational therapy practitioners can mitigate the negative effects of caregiving is needed to enable caregiver participation. Objective: To explore the effectiveness of interventions within the scope of occupational therapy practice for caregivers of people with PD to facilitate or maintain their participation in the caregiver role. Data Sources: We conducted a systematic review of the literature published in CINAHL, MEDLINE, PsycINFO, and OTseeker between 2011 and 2019. Article reference lists were also hand searched for additional articles. Study Selection and Data Collection: Articles were screened and evaluated using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The review was conducted in accordance with steps outlined by the American Occupational Therapy Association's Evidence-Based Practice Project. Findings: Six articles met the inclusion criteria. Interventions in each article were distinct, prohibiting theme development. Overall, the strength of evidence was low, and the risk of bias was high. None of the studies included in this review were obtained from the occupational therapy literature. Conclusions and Relevance: Little evidence is available to support interventions within the scope of occupational therapy practice for caregivers of people with PD. Existing evidence suggests that interventions need to be flexible (e.g., in terms of time, cost, and delivery method) and tailored to the unique needs of this population. What This Article Adds: There is a continued need to develop occupational therapy interventions that support participation in the caregiving role for caregivers of people with PD. [ABSTRACT FROM AUTHOR]

Introduction: Successfully maintaining (managing) paid employment can be a challenge as people negotiate the cancer care pathway and survivorship. Little research explores the influence of age on this situation. The purpose of this project was to explore the role of age in managing employment for survivors from age 45 to 64 years. Method: A qualitative descriptive design was conducted to explore the intersection of age and managing employment for cancer survivors. In-depth semi-structured interviews were conducted with 19 United States cancer survivors (lung, breast, colorectal). Interviews were conducted in person or by phone. Verbatim transcripts were analyzed using thematic analysis. Codes were grouped by categories, incorporated into separate topical files, and then aggregated into broader emergent themes. Findings: Survivors are not just "returning" to work after treatment. They are often managing work both during and after treatment. Age may have benefits but can also provide barriers to positive survivorship and employment experiences. Fulfilling the role of employee and maintaining a worker identity was a strong driver for many participants. Again, this was potentially both a support and a barrier. It was discovered that health care providers provided little support to facilitate employment. Conclusion: Age is a factor that is poorly understood but influences both health and personal aspects of the experience of managing paid employment during and after cancer treatment. Occupational therapy practitioners should acknowledge this important role in addressing cancer survivorship. [ABSTRACT FROM AUTHOR]

Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of a person who underwent a total knee replacement due to severe osteoarthritis of his left knee. The occupational therapy assessment and intervention process both before and after surgery in the home setting is described. Findings from the systematic review (Dorsey & Bradshaw, 2017) on this topic were published in the January/February 2017 issue of the American Journal of Occupational Therapy and in AOTA's Occupational Therapy Practice Guidelines for Adults With Musculoskeletal Conditions. Each article in this series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical reasoning. [ABSTRACT FROM AUTHOR]

OBJECTIVE. We examined the effectiveness of interventions within the scope of occupational therapy to improve the performance of instrumental activities of daily living (IADLs) for community-dwelling older adults. METHOD. We searched and examined the literature (2008 through 2016) using four electronic databases. Fourteen studies met the inclusion criteria and were critically appraised and synthesized. RESULTS. Analysis revealed four thematic areas: cognitive, self-management, prevention, and homebased multidisciplinary rehabilitation interventions. Strong evidence supports the use of tailored, multidisciplinary, home-based care programs to support older adults to maintain IADL improvements over time and the use of cognitive interventions to improve memory, executive function, functional status, and everyday problem solving. In addition, strong evidence indicates that tailored home-based preventive sessions were beneficial to mediate functional disability and satisfaction with performance. CONCLUSION. Evidence supports tailored interventions designed to enhance IADL performance. More studies are needed that focus on IADLs specifically and that use IADLs in their interventions. [ABSTRACT FROM AUTHOR]

Evidence Connection articles summarize the evidence from the published reviews on a given topic (in this article, cancer) and present an application of the evidence to a related clinical case. This Evidence Connection describes a case report of a man with non-Hodgkin's lymphoma who underwent an allogenic stem cell transplant. The occupational therapy assessment and treatment processes for an outpatient rehabilitation setting are described. Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Project. [ABSTRACT FROM AUTHOR]

This article is the second part of a systematic review of evidence for the effectiveness of cancer rehabilitation interventions within the scope of occupational therapy that address the activity and participation needs of adult cancer survivors. This article focuses on the use of multidisciplinary rehabilitation and interventions that address psychosocial outcomes, sexuality, and return to work. Strong evidence indicates that multidisciplinary rehabilitation benefits cancer survivors and that psychosocial strategies can reduce anxiety and depression. Moderate evidence indicates that interventions can support survivors in returning to the level of sexuality desired and help with return to work. Part 1 of the review also appears in this issue. [ABSTRACT FROM AUTHOR]

This article is the first part of a systematic review of evidence for the effectiveness of cancer rehabilitation interventions within the scope of occupational therapy that address the activity and participation needs of adult cancer survivors. This article focuses on the importance of physical activity and symptom management. Strong evidence supports the use of exercise for cancer-related fatigue and indicates that lymphedema is not exacerbated by exercise. Moderate evidence supports the use of yoga to relieve anxiety and depression and indicates that exercise as a whole may contribute to a return to precancer levels of sexual activity. The results of this review support inclusion of occupational therapy in cancer rehabilitation and reveal a significant need for more research to explore ways occupational therapy can positively influence the outcomes of cancer survivors. Part 2 of the review also appears in this issue. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate how the environment influenced the intervention choices occupational therapists made for patients recovering from a stroke in an inpatient rehabilitation hospital. Three occupational therapists were observed providing intervention for six patients over a 16-month period. Treatment spaces included a therapy gym, gym with kitchen combination, and a home-like space. Furniture was added to the therapy gym to be more home-like midway through the study. Observations included therapist selection of treatment location and interventions, and observational data of the environment and interactions among therapists and patients. This study found that inpatient rehabilitation environments did influence interventions. The occupational therapists provided therapy in the standard therapy gym environment most often, whether it was enhanced to be more home-like or not, and predominately used preparatory methods. [ABSTRACT FROM AUTHOR]

Written patient education materials from an inpatient rehabilitation setting were assessed. The average reading level was 16th grade. Twenty documents were revised, and the average reading level was lowered to 5th grade. Focus groups with clinicians and clients were conducted to assess the materials. [ABSTRACT FROM AUTHOR]