ImportanceConversation-related clinical skills are central to Objective Structured Clinical Examinations (OSCEs) in occupational therapy. However, real-time examiner scoring is resource-intensive and may overlook students' specific skills. Transcript-based scoring with Chat Generative Pre-Trained Transformer (ChatGPT) may address these limitations.ObjectiveTo develop a ChatGPT-based assessment for chief-complaint interview OSCEs (G-ACE) and examine criterion validity against expert-consensus ratings, test-retest reliability, and inter-rater reliability.DesignSecondary analysis of de-identified transcripts from 8-min chief-complaint interviews with a simulated patient with stroke during an OSCE.SettingsA university in northern Taiwan.ParticipantsFifty-eight de-identified transcripts from undergraduate occupational therapy students.ResultsCriterion validity was acceptable for "Primary Symptoms and Related Feelings" and "Impact on Daily Life" items (weighted kappa ≥ 0.60), but lower for "Rehabilitation Expectations" and "Communication Skills" items (0.18-0.59). For domain and total scores, intraclass correlation coefficients (ICCs) were 0.17 to 0.78 and percentages of mean absolute errors (MAE%s) were 4.6% to 20.7%. Test-retest reliability was acceptable at the item level (weighted kappa = 0.68-1.00), and acceptable to good at the domain and total score levels (ICC = 0.65-0.85; MAE% = 2.3%-9.1%). Inter-rater reliability was acceptable for most domain and total scores (ICCs = 0.52-0.78; MAE%s = 1.3%-12.0%), except for the "Rehabilitation Expectations" domain (ICCs = 0.17-0.30; MAE%s = 1.3%-7.3%).Conclusion and RelevanceThe G-ACE demonstrated generally acceptable test-retest reliability and small absolute differences from expert ratings for domain and total scores. Because some items showed lower consistency with expert ratings, formative feedback should be interpreted cautiously based on transcript evidence.
ImportanceLGBTQ + clients experience healthcare barriers that may shape daily routines, health management, and participation. Little is known about occupational therapy referral pathways and outcomes in LGBTQ + affirming primary care.ObjectiveTo describe referral characteristics, occupational performance concerns, intervention focus, and client-reported outcomes among LGBTQ + clients referred to occupational therapy.DesignRetrospective pilot program evaluation using clinical documentation and outcome data from July 2025 through March 2026, with a June 2026 analysis cutoff.SettingTwo Midwestern primary care settings where occupational therapy screening and referral processes were developed; ongoing intervention occurred through outpatient occupational therapy.ParticipantsThirty-nine referred clients were included in descriptive analyses; 38 received intervention beyond evaluation; 21 had complete baseline and follow-up Canadian Occupational Performance Measure data.InterventionIndividualized outpatient occupational therapy focused on client-identified concerns.Outcomes and MeasuresReferral and treatment characteristics, occupational performance concerns, coded occupational focus, and Canadian Occupational Performance Measure Performance and Satisfaction ratings.ResultsCommon concerns included instrumental activities of daily living (94.9%), health management/self-management (92.3%), activities of daily living (82.1%), and work or school participation (82.1%). The most common primary intervention focus was health management and chronic condition self-management (65.8%). Among participants with outcome data, COPM Performance scores improved by 2.29 points and Satisfaction scores improved by 2.58 points.Conclusions and RelevanceOccupational therapy may support LGBTQ + clients referred from primary care by addressing needs related to health management, routines, self-care, and participation through individualized outpatient intervention. Prospective multisite research is needed.
Importance Intersection Rules Subtest timing is a potential predictor of the DriveSafe outcome score in DriveSafe DriveAware (DSDA) assessment. Objective To examine whether Intersection Rules completion time is associated with DriveSafe outcome within the DSDA assessment. Design Retrospective, observational pilot study using secondary data. Setting Australian metropolitan fitness-to-drive clinic. Participants Of 169 participants (median age = 80; 61.5% male), 104 categorised into non-pass group of DriveSafe subtest formed ‘cases’, whilst 65 who passed were ‘controls’. Outcomes and Measures Primary predictor: Intersection Rules Subtest completion time in seconds. Primary outcome: DriveSafe subtest outcome, categorised as pass/non-pass. Relationships analysed using logistic regression and receiver operating characteristic (ROC) curve analysis. Results Longer Intersection Rules Subtest time significantly predicted lower DriveSafe subtest outcome (non-pass) scores, with each additional 60 s increasing odds of failure by 93.7% (odds ratio [OR] = 1.94, 95% confidence interval [CI] [1.40, 2.68], p < .001). A ROC curve analysis revealed an area under the curve of 0.73 (95% CI: [.654, .807]). An optimal cut-off of 213.5 s showed high specificity (86.2%) (95% CI: [75.3, 93.5]) but modest sensitivity (48.1%) (95% CI: [38.2, 58.1]) for a non-pass result. Conclusions and Relevance Intersection Rules Subtest completion time was associated with DriveSafe outcome in this pilot study. The current findings support future study of this timing metric, which may have potential as a clinical decision-support indicator, a ‘Detect and Pause’ step, after prospective validation and DSDA protocol sequence modification.
Importance Spinal cord injury (SCI) extends beyond the injured individual to intimate partners, often altering shared occupations, relational roles, and well-being. Understanding dyadic processes is critical for occupational therapy practice. Objective To examine associations among dyadic adjustment, relationship satisfaction, and well-being in SCI dyads using an actor–partner interdependence model. Design Cross-sectional dyadic study using baseline data from an intervention trial (SupportGroove). Setting Health care institutions and community-based settings. Participants Eighty-two community-dwelling SCI–partner dyads (164 adults; mean ages: SCI, 50.1 ± 15.7; partners, 48.5 ± 14.5 years), 3 months to 5 years postinjury. Outcomes and Measures Self-report; Revised Dyadic Adjustment Scale, Couples Satisfaction Index-4, and Neuro-QoL Positive Affect and Well-Being. Results Dyadic adjustment was significantly and positively associated with relationship satisfaction among SCI participants ( β = 0.66, standard error [SE] = 0.09, p < .001), indicating a large effect. A similar significant positive association was observed among partners ( β = 0.47, SE = 0.11, p < .001), reflecting a medium effect size. Additionally, partners’ relationship satisfaction was significantly and positively related to their own well-being ( β = 0.35, SE = 0.14, p = .010), with a medium effect. No other structural equation model paths reached statistical significance ( p > .05). Conclusions and Relevance Dyadic adjustment influences how both members of the SCI dyad perceive their relationship. However, relationship satisfaction contributes to well-being primarily for partners rather than for individuals with SCI. These findings support a dyadic approach to occupational therapy and rehabilitation that considers relationship functioning and well-being in both members of the dyad.
Importance Although individuals with thumb carpometacarpal (CMC1) osteoarthritis (OA) commonly experience participation restrictions, participation-focused outcome measures remain underinvestigated, and clinicians primarily rely on assessments of impairments in body structures and functions. Objective To determine the concurrent validity, test–retest reliability, and precision of the Activity Card Sort 3 (ACS3) in individuals with nonoperative CMC1 OA. Design Single-cohort observational psychometric study with repeated measures over a 2-week interval. Setting Remote assessments conducted via videoconferencing. Participants Thirty-three adults with radiographically confirmed CMC1 OA completed two virtual assessments approximately 2 weeks apart. Outcomes and Measures Concurrent validity was examined by comparing ACS3 domain and total scores with the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Test–retest reliability of the “current,” “previous,” and “% retained” activities scores was evaluated using intraclass correlation coefficients (ICC 3,1 ). Precision was assessed using the standard error of measurement and minimal detectable change. Results The ACS3 demonstrated good concurrent validity through strong associations with conceptually related WHODAS 2.0 domains. “Current” and “% retained” scores demonstrated good-to-excellent test–retest reliability across all domains. “Current” scores consistently showed the highest reliability and precision. “Previous” scores demonstrated lower reliability and greater measurement error, suggesting recall bias. Carrying forward “previous” scores from session 1 to session 2 improved the reliability of “% retained” scores. Conclusions and Relevance The ACS3 is a valid and reliable measure of participation for individuals with nonoperative CMC1 OA. The “current” and “% retained” scores may support occupational therapy practitioners in conducting participation-focused assessment of persons with CMC1 OA.
