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Full-Text Articles in Medicine and Health Sciences

55-Word Stories: Insight Into Healthcare, Nancy E. Krusen Oct 2029

55-Word Stories: Insight Into Healthcare, Nancy E. Krusen

Translational Science in Occupation

Narrative medicine and health humanities focus on arts, ethics, and clinical practice. Many health education programs incorporate creative activities to facilitate learner self-awareness and insight. We include them to address programmatic themes of professional growth and translational science.


Immediate Vs Delayed Feedback In A Progressive Musculoskeletal E-Module Case For Clinical Reasoning Development, Megan Frazee, Krista Gipson, Elizabeth Lyden, Stephanie Langel Aug 2024

Immediate Vs Delayed Feedback In A Progressive Musculoskeletal E-Module Case For Clinical Reasoning Development, Megan Frazee, Krista Gipson, Elizabeth Lyden, Stephanie Langel

Innovations in Health Sciences Education Journal

Introduction: Clinical reasoning (CR) skills are essential when preparing healthcare students to transition to clinical practice. The purpose of this study was to evaluate the effects of feedback timing within a case-based learning (CBL) e-module. The secondary aim was to examine the longitudinal impact on student performance within a standardized patient (SP) simulation and their overall course grade at the end of the semester.

Review of Literature: Feedback is a powerful teaching method to improve student learning. However, there are highly conflicting results regarding the best frequency and timing of feedback. This may be influenced by the level of the …


From Textbooks To Clinical Practice: Selecting And Implementing Outcomes Measures In Stroke Rehabilitation, Stacie Mae Larreau Christensen, Monica Dial Apr 2024

From Textbooks To Clinical Practice: Selecting And Implementing Outcomes Measures In Stroke Rehabilitation, Stacie Mae Larreau Christensen, Monica Dial

Posters and Presentations: Physical Therapy

No abstract provided.


Exploring The Interplay Between Physical Activity Wellness, Social Networks, And Academic Performance In Pt Students, Grace C. Johnson, Kellie Gossman, Tessa Wells, Betsy J. Becker Apr 2024

Exploring The Interplay Between Physical Activity Wellness, Social Networks, And Academic Performance In Pt Students, Grace C. Johnson, Kellie Gossman, Tessa Wells, Betsy J. Becker

Posters and Presentations: Physical Therapy

Purpose

Recognizing the intersection of peer influence, physical activity, student wellness, and academic performance, this study aims to provide insights that can inform educational practices and promote success among future physical therapist (PT) students. The study's purpose is to investigate the associations between students' physical activity wellness scores, their social networks, and academic performance within the school environment. The research questions are (1) Do students tend to form friendships with classmates who exhibit similar physical activity wellness scores and student achievement? and (2) How do the Exercise Factor scores of PT students align with published normative values?

Subjects: 124 students …


Designing Effective E-Learning Modules: Exploring Best Practices In Module Navigation, Stacie Mae Larreau Christensen, Lukas Pohlmann, Elizabeth Lyden, Elizabeth L. Beam, Stephanie Langel Feb 2024

Designing Effective E-Learning Modules: Exploring Best Practices In Module Navigation, Stacie Mae Larreau Christensen, Lukas Pohlmann, Elizabeth Lyden, Elizabeth L. Beam, Stephanie Langel

Posters and Presentations: Physical Therapy

No abstract provided.


Knowledge Translation Through A Camera Lens, Nancy E. Krusen Jan 2024

Knowledge Translation Through A Camera Lens, Nancy E. Krusen

Translational Science in Occupation

The journal Translational Science in Occupation (TSO) embraces art and science through the inclusion of a humanities section within the journal. Health humanities gives insight into the human condition (Health Humanities Consortium, 2021). Health humanities enables us to explore daily life occupation, reveal our similarities and differences, and to translate human experience through a variety of media. The following photographs represent concepts of knowledge translation through my camera lens.


Pilot Study Evaluating A Brief Chronic Pain Education Program In Occupational Therapy Practitioners, Occupational Therapy Students, And Lay People, Rose Mcandrew, Jacob Sturtevant, Vicki K. Kaskutas Jan 2024

Pilot Study Evaluating A Brief Chronic Pain Education Program In Occupational Therapy Practitioners, Occupational Therapy Students, And Lay People, Rose Mcandrew, Jacob Sturtevant, Vicki K. Kaskutas

Translational Science in Occupation

Background: Chronic pain and resultant disability can persist long after tissue healing. Past research suggests educating individuals about chronic pain is efficacious in changing knowledge, health beliefs, and healthcare utilization. This study piloted an educational intervention to teach participants about the nature of chronic, nociplastic pain.

Design: Pre-post study using three groups: occupational therapy (OT) practitioners, OT students, and lay people.

Methods: Participants rated their agreement with four statements pre-intervention regarding the relationship between chronic pain, tissue damage, and activity performance to ascertain accurate knowledge. Participants were presented with studies comparing acute and chronic pain and acknowledging that some people …


Translational Science Is Occupation, Stacy Smallfield, Wanda J. Mahoney Jan 2024

Translational Science Is Occupation, Stacy Smallfield, Wanda J. Mahoney

Translational Science in Occupation

No abstract provided.


Editorial Welcome, Stacy Smallfield, Nancy Krusen, Nicole Martino Jan 2024

Editorial Welcome, Stacy Smallfield, Nancy Krusen, Nicole Martino

Translational Science in Occupation

No abstract provided.


Evaluation Of A Student Experiential Learning Clinic For Hand Therapy Using A Logic Model, Rose Mcandrew, Nathaniel Baniqued, Vicki Kaskutas Jan 2024

Evaluation Of A Student Experiential Learning Clinic For Hand Therapy Using A Logic Model, Rose Mcandrew, Nathaniel Baniqued, Vicki Kaskutas

Translational Science in Occupation

Student clinics (SC) provide experiential learning opportunities in occupational therapy (OT) education that develop clinical reasoning, while providing much needed rehabilitation to under and un-insured patients in the community. The Student Experiential Learning Clinic for Hand Therapy (SELC-HT) is a SC that used a logic model for planning, implementing, and evaluating the SELC-HT. The purpose of this study is to report on outcome data on students and patients, as outlined in the evaluation phase of the logic model.

The 13 OT master/doctorate students, who delivered care in the SELC-HT, demonstrated growth in self-reported hand therapy knowledge (p=0.002) measured with …


Routines And Attitudes Of Smartphone And Tablet Use For Social Connection Among Rural Older Adults, Amanda U. Davis, Chelsea Conrad, Maya Dupree, Deja Myers, Monica Le Jan 2024

Routines And Attitudes Of Smartphone And Tablet Use For Social Connection Among Rural Older Adults, Amanda U. Davis, Chelsea Conrad, Maya Dupree, Deja Myers, Monica Le

Translational Science in Occupation

Background: Loneliness is associated with negative health outcomes for older adults. Social connection may occur using information and communication technologies (ICTs), such as smartphones and tablets and interventions to increase ICT use have shown positive results. Purpose: This study aims to investigate the routines and attitudes of smartphone and tablet use for social connection and secondarily, determine if there is an association between the routines and attitudes and connection. Methods: Participants completed a survey with questions that included demographics, 3-item UCLA Loneliness Scale, Brief Sense of Community Scale, and open-ended questions. Results: Participants (N=21, median age of 76-80) report …


Occupational Therapy Interventions For Visual Impairments Among Adolescents With Mild Traumatic Brain Injury, Olivia Vander Haar, Molly Whitlow, Sarah Fellman Jan 2024

Occupational Therapy Interventions For Visual Impairments Among Adolescents With Mild Traumatic Brain Injury, Olivia Vander Haar, Molly Whitlow, Sarah Fellman

Student Systematic Reviews: Occupational Therapy

PUPROSE: The purpose of this systematic review was to synthesize the evidence of occupational therapy (OT) interventions for adolescents who have sustained a mTBI and experience visual dysfunction.

DESIGN AND METHOD: A systematic review of peer-reviewed literature was conducted. Articles were included if participants were eight to nineteen years of age and diagnosed with an mTBI. Titles and abstracts of 506 articles from three databases were screened. The full text of 26 articles was reviewed. Seven met inclusion criteria. The U.S. Preventive Services Task Force levels of certainty and grade definitions described the strength of evidence.

RESULTS: Physical conditioning, vision …


Intersections Of Occupational Therapy And Translational Science, M Nicole Martino Jan 2024

Intersections Of Occupational Therapy And Translational Science, M Nicole Martino

Translational Science in Occupation

No abstract provided.


Exploring The Usefulness Of Pre-Visit Materials For Children With Autism At A Public Museum, Jennifer K. Fortuna, Elaine Chamberlain, Libby Filice, Madeline Kurt, Taylor Porter, Shannon Twichell, Stephanie Ogren Jan 2024

Exploring The Usefulness Of Pre-Visit Materials For Children With Autism At A Public Museum, Jennifer K. Fortuna, Elaine Chamberlain, Libby Filice, Madeline Kurt, Taylor Porter, Shannon Twichell, Stephanie Ogren

Translational Science in Occupation

Abstract

Children with autism spectrum disorder (ASD) participate in community-based settings at lower rates than typically developing children. Museums provide a structured, predictable, and supportive place for children with ASD to learn. Visiting a museum may create unique challenges for children with ASD and their families. Sensory processing disorder (SPD) is a common barrier to participation that makes it difficult to process information coming in through the senses. For children who are easily overstimulated, crowds, noise, and long lines can be a source of anxiety and stress. Providing pre-visit materials such as social stories, accessibility maps, and communication books can …


The Role Of An Occupational Therapy Practitioner In Professional Advocacy: A Scoping Review, Sarah Mckinnon, Natalie Petrone, Amanda Tarbet Jan 2024

The Role Of An Occupational Therapy Practitioner In Professional Advocacy: A Scoping Review, Sarah Mckinnon, Natalie Petrone, Amanda Tarbet

Translational Science in Occupation

Background: Participation in professional advocacy amongst occupational therapy practitioners (OTPs) is necessary for strengthening the profession. Although advocacy remains essential for practice, specific activities of OTPs in professional advocacy remain inconsistent and unclear.

Purpose: To examine the activities occupational therapy practitioners are engaging in related to professional advocacy. To identify key strategies and future opportunities to strengthen OT practitioner participation in professional advocacy.

Methods: We systematically searched 4 databases and 1 search engine for relevant articles- MEDLINE via PubMed, The Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete via Ebscohost, ERIC via Ebscohost, APA PsycInfo …


Examining Occupation-Based Outcome Measure Use In A Neurologic Outpatient Occupational Therapy Setting: A Knowledge Translation Initiative, Elizabeth Yost, Suzanne Trojanowski, Taylor Jarnigin, Kevin De Bear, Amy Yorke Jan 2024

Examining Occupation-Based Outcome Measure Use In A Neurologic Outpatient Occupational Therapy Setting: A Knowledge Translation Initiative, Elizabeth Yost, Suzanne Trojanowski, Taylor Jarnigin, Kevin De Bear, Amy Yorke

Translational Science in Occupation

Abstract

Importance: Occupation-based outcome measures (OBOMs) are an evidence-based recommendation for occupational therapy evaluations. Knowledge translation (KT) is a process used to help integrate evidence into clinical practice. The authors identified a KT opportunity to examine occupational therapy practitioners’ (OTPs) use of outcome measures in an outpatient practice setting and assess a Know-Do Gap as the first step in the Action phase of a KT initiative.

Objective: Describe the frequency and types of outcome measures documented in occupational therapy (OT) evaluations, with a focus on OBOMs.

Design: Cross-sectional descriptive study.

Setting: Three outpatient clinic sites (under one parent company) in …


Mapping Occupational Therapy Interventions In Adult Patients With Post-Covid Diagnosis: A Scoping Review, Jennifer Ng, Hannah Franks, Marissa Halvorson, Sarah Malone, Claudia L. Hilton Phd, Karthik Mani Jan 2024

Mapping Occupational Therapy Interventions In Adult Patients With Post-Covid Diagnosis: A Scoping Review, Jennifer Ng, Hannah Franks, Marissa Halvorson, Sarah Malone, Claudia L. Hilton Phd, Karthik Mani

Translational Science in Occupation

Importance: Post-COVID patients experience difficulties in their everyday lives due to the persistent nature of their symptoms. This scoping review explores the role of occupational therapists in treating post-COVID patients and examines occupational therapy intervention options for this population.

Objective: This scoping review seeks to answer the following questions: What does the literature say about the role of occupational therapy with post-COVID patients? Which rehabilitation interventions are currently being utilized for treatment? How often are occupational therapists involved in the treatment of and research of post-COVID patient care?

Data Sources: Articles were obtained through an exhaustive search in the following …


Computer-Based Simulation In Occupational Therapy Lecture Courses: A Program Evaluation Of Simulation Implementation, Lacy Wright, Lauren Foster, Lisa Mische Lawson Jan 2024

Computer-Based Simulation In Occupational Therapy Lecture Courses: A Program Evaluation Of Simulation Implementation, Lacy Wright, Lauren Foster, Lisa Mische Lawson

Translational Science in Occupation

The COVID-19 pandemic expedited the use of computer-based simulations in occupational therapy educational programs. Research supports computer-based simulations as an alternative to in-person clinical fieldwork experiences. However, a knowledge gap exists for the instructional design and implementation of computer-based simulations within occupational therapy lecture courses. In this program evaluation, faculty explored and implemented computer-based simulations in pediatric lecture courses, combining simulation best practices and varying instructional designs. Entry-level occupational therapy doctorate students shared their perspectives through a survey design quality improvement study. Student responses were gathered using the Simulation Evaluation Tool-Modified (SET-M) questionnaire and Student Feedback Survey to gather quantitative …


Interventions For Care Partners Of Adults With Dementia: A Systematic Review, Makenzie Kay Homan, Azia Marie Ourada, Reannon Taylor Rieber, Grace Delaney Tynan Nov 2023

Interventions For Care Partners Of Adults With Dementia: A Systematic Review, Makenzie Kay Homan, Azia Marie Ourada, Reannon Taylor Rieber, Grace Delaney Tynan

Student Systematic Reviews: Occupational Therapy

Interventions for Care Partners of Adults with Dementia: A Systematic Review

PURPOSE: It is estimated that 8.5 million people are informal care partners for people with dementia (Friedman et al., 2015), which is a challenging role associated with emotional strain, anxiety and depression, increased care partner burden, poorer quality of life (QoL), financial strain, and lack of support (Hellis & Mukaetova-Ladinska, 2023). It is important for occupational therapy practitioners (OTPs) to use the most effective interventions that can be implemented to preserve informal care partners’ health, wellbeing, and quality of life (QoL) (Hellis & Mukaetova-Ladinska, 2023). The purpose of this …


Botulinum Toxin Type A Injections For Refractory Abdominal Dystonia: A Case Report, William J. Naber Ii, Jodi M. Wilhelm, Kurt A. Kuhlman, Gabriel Howard Nov 2023

Botulinum Toxin Type A Injections For Refractory Abdominal Dystonia: A Case Report, William J. Naber Ii, Jodi M. Wilhelm, Kurt A. Kuhlman, Gabriel Howard

Graduate Medical Education Research Journal

Background: A 58-year-old male with chronic bilateral treatment resistant abdominal spasms secondary complications of ascites/ alcoholic cirrhosis. Spasms would occur 4-5 times/day, lasting minutes to hours despite a 2-year course of therapeutic and pharmacological interventions. Due to treatment refraction, 6 uniformly spaced botulinum toxin type A (BTX-A) injections were placed per side, using electromyography for audible intramuscular syringe placement confirmation, while visual confirmation was made via ultrasound. During the initial trial, 6 evenly spaced injections were performed bilaterally, uniformly distributing 80U/side. Injections began bilaterally just medial to the junction of the inferior rib cage border/ anterior axillary line and progressed …


Occupational Therapy Interventions That Influence Quality Of Life Of Care Partners Of Children With Developmental Disabilities: A Systematic Review, Alaina Akey, Maggie Alsup, Madison Cockerill, Sydney Wondra Nov 2023

Occupational Therapy Interventions That Influence Quality Of Life Of Care Partners Of Children With Developmental Disabilities: A Systematic Review, Alaina Akey, Maggie Alsup, Madison Cockerill, Sydney Wondra

Student Systematic Reviews: Occupational Therapy

TITLE: Occupational Therapy Interventions that Influence Quality of Life of Care Partners of Children with Developmental Disabilities: A Systematic Review

PURPOSE: In the United States, 1 in 6 children have one or more developmental disabilities (Center for Disease Control and Prevention, 2022). Children with developmental disabilities require a higher level of care and support in comparison to their typically developing peers (Akyurek et al., 2023). Due to this increased need for assistance, care partners may experience greater psychological, physical, social, and financial hardships that can impact their overall quality of life (Murphy et al., 2006). Although the scope of occupational …


Occupational Therapy Feeding Interventions In The Neonatal Intensive Care Unit: A Systematic Review, Karly Boehm, Lindsey Brechbill, Johana Cedillo, Sara Mengler, Allyson Thomas Nov 2023

Occupational Therapy Feeding Interventions In The Neonatal Intensive Care Unit: A Systematic Review, Karly Boehm, Lindsey Brechbill, Johana Cedillo, Sara Mengler, Allyson Thomas

Student Systematic Reviews: Occupational Therapy

No abstract provided.


Effectiveness Of Occupational Therapy Interventions To Enhance Occupational Performance For Survivors Of Domestic Abuse: A Systematic Review, Mackenzie R. Post, Aubrianna Hohensee, Taylor Fisher, Amanda Malashock Nov 2023

Effectiveness Of Occupational Therapy Interventions To Enhance Occupational Performance For Survivors Of Domestic Abuse: A Systematic Review, Mackenzie R. Post, Aubrianna Hohensee, Taylor Fisher, Amanda Malashock

Student Systematic Reviews: Occupational Therapy

TITLE: Effectiveness of Occupational Therapy Interventions to Enhance Occupational Performance for Survivors of Domestic Abuse: A Systematic Review

PURPOSE: An average of 20 people per minute experience domestic abuse in the United States (Black et al., 2011). People who experience abuse have poor physical and mental health outcomes which can include depressive symptoms, substance use, developing chronic disease, chronic mental illness, and injury (Coker et al., 2002). Occupational practitioners are equipped to address this issue because they have specific training on life skills, lifestyle management, adaptive coping strategies, time management, and personal values, which can help minimize the negative health …


Occupational Therapy Interventions To Improve Functional Cognition In Older Adults After Stroke: A Systematic Review, Brady A. Harrison, Alexa A. Preissler, Emilea R. Rogers, Allison D. Singh Nov 2023

Occupational Therapy Interventions To Improve Functional Cognition In Older Adults After Stroke: A Systematic Review, Brady A. Harrison, Alexa A. Preissler, Emilea R. Rogers, Allison D. Singh

Student Systematic Reviews: Occupational Therapy

PURPOSE Cerebral vascular accidents (CVA) are a leading cause of cognitive impairment in the United States, and 80% of CVA survivors experience new or worsening impairment (Knight-Greenfield et al., 2019; Zhang et al., 2021). Functional cognition is vital to an individual’s participation in occupations that are necessary and meaningful to them. Occupational therapy practitioners play a unique role in addressing functional cognition through intervention planning and implementation. The purpose of this study is to understand the most effective occupational therapy interventions addressing functional cognition in older adults post CVA.

DESIGN We conducted a systematized review of articles pertaining to occupational …


Does Implementation Of A Lifestyle Medicine Curriculum Affect Student Wellness During Doctor Of Physical Therapy Education?, Betsy J. Becker, Kathleen G. Volkman, Tessa Wells, Nicole M. Sleddens, Teresa Cochran Oct 2023

Does Implementation Of A Lifestyle Medicine Curriculum Affect Student Wellness During Doctor Of Physical Therapy Education?, Betsy J. Becker, Kathleen G. Volkman, Tessa Wells, Nicole M. Sleddens, Teresa Cochran

Posters and Presentations: Physical Therapy

Background

Current healthcare environments amplify the need for educational systems to forge healthy workforces to withstand stressors. Our study examines the effects of embedding a lifestyle medicine curriculum on student wellness in a Doctor of Physical Therapy (DPT) Program, simultaneously preparing students to implement lifestyle medicine with future patients and communities.

Methods

In a DPT program, we implemented a lifestyle medicine curriculum grounded within the Social-Ecological Model. This framework emphasizes student success in the program’s pre-clinical phases, creates a purposeful “ripple effect” threading wellness strategies among peers, patients, and communities, and emphasizes wellness as a clinician over the 32-month curriculum. …


Exploring First Semester Allied Health Students’ Transition To Graduate School Through The Lens Of Occupational Adaptation, Carly E. Williams, Jessica N. O'Brien, Rebecca E. Dodick, Jillian M. Bell, Jennifer O. Knauth, Lorrie A. George-Paschal, Nancy Krusen, Jacquie Rainey Sep 2023

Exploring First Semester Allied Health Students’ Transition To Graduate School Through The Lens Of Occupational Adaptation, Carly E. Williams, Jessica N. O'Brien, Rebecca E. Dodick, Jillian M. Bell, Jennifer O. Knauth, Lorrie A. George-Paschal, Nancy Krusen, Jacquie Rainey

Innovations in Health Sciences Education Journal

The purpose of the study was to examine experiences of students transitioning into graduate allied health programs within a public university in the United States. Researchers assessed students’ occupational adaptation as well as factors that facilitated and inhibited their transition. Researchers collected data using the Relative Mastery Scale (RMS) (George-Paschal, Krusen, & Fan, 2022) and a researcher-developed transition survey. Participants included 129 students from three allied-health professions. Researchers conducted a mixed ANOVA to explore differences in RMS ratings across three disciplines. There was a statistically significant increase in RMS ratings over time for all disciplines and statistically significant differences between …


Improving Peripheral Nerve Regeneration Through Rehabilitation And Biomaterial-Based Drug Delivery Strategies, Yunfan Kong Aug 2023

Improving Peripheral Nerve Regeneration Through Rehabilitation And Biomaterial-Based Drug Delivery Strategies, Yunfan Kong

Theses & Dissertations

Peripheral nerve injury (PNI) is a common problem worldwide, with trauma being a common cause. PNI can lead to loss of sensory and motor functions, chronic neuropathic pain, and mental health issues, significantly impacting patients' family life, work, and social situation. Recent studies revealed that beyond the topical injury site at peripheral nerves, PNIs can also induce dysfunctions in the central nervous system (CNS) by causing maladaptive plasticity, which will result in exaggeration and exacerbation of the pathological condition caused by primary injuries. The common therapy strategies for PNI treatment are using sutures, nerve autografts or conduits in cases requiring …


Occupational Therapy Interventions For Activities Of Daily Living In Adults Post-Traumatic Brain Injury With Visual Symptoms: A Systematic Review, Danielle Adams Jan 2023

Occupational Therapy Interventions For Activities Of Daily Living In Adults Post-Traumatic Brain Injury With Visual Symptoms: A Systematic Review, Danielle Adams

Student Systematic Reviews: Occupational Therapy

No abstract provided.


Social Participation In People With Developmental Disabilities: A Systematic Review, Anna Squiers, Madison Mckeever, Sydney Fitzgibbons Jan 2023

Social Participation In People With Developmental Disabilities: A Systematic Review, Anna Squiers, Madison Mckeever, Sydney Fitzgibbons

Student Systematic Reviews: Occupational Therapy

TITLE:

Social participation in people with a developmental disability: A systematic review

PURPOSE:

People with developmental disabilities often experience difficulty with social skills and engagement in social interactions. One in six children aged 3-17 have a developmental disability (CDC, 2023). People with developmental disabilities experience loneliness, which can affect participation in meaningful occupations (Petroutsou et al., 2018). Participating in social interactions can decrease stress and anxiety and improve overall quality of life (CDC, 2023). The purpose of this systematic review was to determine occupational therapy interventions that increase social participation for people with developmental disabilities.

DESIGN:

We conducted a systematic …


Occupational Therapy Intervention For Survivors Of Sex Trafficking: A Systematic Review, Alexis Spicer, Jensen Antilla, Madeleine Hubka, Sheridan Widhelm Jan 2023

Occupational Therapy Intervention For Survivors Of Sex Trafficking: A Systematic Review, Alexis Spicer, Jensen Antilla, Madeleine Hubka, Sheridan Widhelm

Student Systematic Reviews: Occupational Therapy

PURPOSE: There are an estimated 15,000 to 50,000 women and children are forced into sex trafficking every year in the United States (Heinze, 2021). Sex trafficking leaves a lasting impact on survivors’ mental health and quality of life and presents these individuals with a complex set of barriers to occupational performance including various psychological challenges as well as cognitive impairments (Boyanapalli, 2020). Exposure to sex trafficking affects all aspects of a person’s life including work, community and social participation, self-care, and leisure (United Nations Office on Drugs and Crime, 2019). Occupational therapists are equipped to address these domains. The purpose …