Caitlin G. Dobson OTR/L

Objective. To synthesize research about clinical reasoning and decision-making among therapists in inpatient rehabilitation facilities about how they organize care and use their treatment time.

Data sources. PubMed, CINAHL, and PsycINFO were searched for relevant empirical studies published prior to January 13, 2026.

Review methods. Scoping review. The review process was organized using Covidence. Included studies featured descriptions of clinical decisions explained by occupational therapists, physical therapists, and speech therapists in inpatient rehabilitation facilities. Two reviewers coded the extracted themes through inductive analysis using Dedoose.

Results. Of 1239 articles identified through the search process, 51 met inclusion criteria. We identified six factors across studies that contributed to therapists' clinical decision-making including: (1) consideration of non-medical circumstances (with sub-themes of understanding the patient's perspective, presence of families and caregivers, and assessment of patient resources); (2) collaboration and roles within care teams; (3) within-session communication techniques; (4) knowledge-base and the influence of experience; (5) medical and safety considerations; and (6) balancing institutional priorities within treatment. We created a concept map showing connections across these six factors.

Conclusion. The process of making decisions about therapy time and organization of care within inpatient rehabilitation settings is complex and requires integration of multiple factors. Therapists usually prefer familiar approaches to complex or time-intensive ones, and local culture shapes decision-making norms. Future research may examine how these factors relate to patient outcomes and implementation of practice changes such as introduction of new evidence-based treatments or assessment tools.

Keywords. Clinical decision-making, problem solving, hospitals, rehabilitation, attitude of health personnel, subacute care.

Objective. To describe the characteristics of patients enrolled in disorders of consciousness (DoC) rehabilitation programs and to examine factors associated with improvement beyond measurement error on neurobehavioral function. Outcomes for adults with DoC after severe brain injury are highly variable and difficult to predict. Applying a minimal detectable change (MDC) threshold to change measures can identify help to distinguish true improvement or decline from random fluctuation. We also evaluated whether change in neurobehavioral function during the first 2 weeks of rehabilitation was associated with change between 2 and 4 weeks.

Design. Retrospective cohort study. Data were generated as part of standard clinical care.

Setting. Postacute inpatient facilities with specialized DoC programs at 2 large, urban health care systems.

Participants. Adults with DoC after severe brain injury (N=696).

Interventions. Not applicable.

Main Outcome Measure. Improvement beyond measurement error, calculated as the MDC with a 90% confidence interval (9 units) on the Coma Recovery Scale-Revised (CRS-R), using an equal-interval 0-100 unit transformed total measure. The MDC threshold was applied to change in CRS-R total measure from first to last CRS-R administration (up to 60 elapsed).

Results. Two-thirds of the sample (n=445) improved beyond the MDC on the CRS-R; 23 participants declined beyond measurement error, and 228 participants changed less than the MDC. Patients with less time elapsed between injury and first CRS-R assessment were more likely to improve beyond the MDC. Change during the first 2 weeks of rehabilitation was not associated with change between 2 and 4 weeks.

Conclusions. Our results underscore the importance of measuring change with greater precision for adults with DoC, as within-state change (or lack thereof) could inform rehabilitation treatment decisions about whether interventions are working as intended.

Keywords. Brain injuries, Consciousness disorders, Neurologic rehabilitation, Outcome assessment, Recovery of function, Rehabilitation

Student veterans may find reintegration into civilian life difficult, largely due to social factors. This study used occupational therapy practitioners to facilitate photovoice to gain insight into participants’ social experiences transitioning from military to student civilian life. Fifteen photovoice pieces were generated from discussions, photos, and narratives from the seven male participants. Five themes were identified: Camaraderie, Alienation, Identifying Challenges, Rising to the Challenges, and Diversity and Military and Veteran Students. The study has disseminated the photovoice pieces to generate awareness and shape programs and services on campus consistent with a respectful, radically welcoming, military-affirming campus supporting student academic success.

Keywords. Higher education; social support; military students; community-based participatory action research; personal narratives

Two independent research teams led by graduate students from clinical disciplines studied the lived experiences of student veterans transitioning from the military into higher education. Additionally, these projects provided graduate students with training in the research process, application of evidence-based practice in preparation for professional responsibilities and advancement, and collaboration with student veteran stakeholders as coinvestigators and project team members. One study piloted a student veteran orientation course with the aid of veteran stakeholders to better address the overall needs of student veterans on campus. The other study engaged student veteran participants as coinvestigators using the photovoice methodology to illuminate their perspectives on social relationships. Findings in each study added greater depth to previously discovered trends, and revealed insights into student veteran educational priorities, the impact of the transition process on social roles and relationships, graduate research project design, and community advocacy. This study added insight into the factors that affect student veterans’ higher education experience, which can be used to inform future studies conducted at the graduate level, examine interdisciplinary approaches to research and advocacy, amplify the voice of student veterans, and encourage interaction in research between civilian and veteran students.

Purpose. To examine the parent's perspective on how the child's diagnosis of a developmental disability, the weight-management support of the healthcare provider and parental self-care and role modeling influenced the child's weight-related behavior, (i.e. nutrition, physical and sedentary activity).

Design and methods. This qualitative study, guided by Bronfenbrenner's Ecological System's Theory, used a one-on-one semi-structured telephone interview conducted with 15 parents of children 5–16 years of age with spina bifida or Down syndrome. Interviews were professionally transcribed and thematically analyzed. In addition, parents reported height and weight for themselves and their child.

Results. Three overarching themes within the context of how the child's diagnosis influenced the child's weight-related behaviors emerged: 1) Developmental Characteristics or Condition-Related Factors captured qualities of the child's condition and interactions with the healthcare system; 2) Social Consequences encompassed the influence of the diagnosis on relationships of the child and family members; and 3) Parenting Influences and Practices captured three types of responses including parent perceptions of the diagnosis, parenting behaviors, and parental self-care behaviors, each influencing the child's weight-related behaviors.

Conclusions. Parents illuminated the social and medical challenges that the family encountered due to the child's diagnosis. These challenges directly and indirectly influenced the child's physical and sedentary activity and nutritional intake. Although challenges were present, the strength and determined attitudes of the families became apparent.

Keywords. Developmental disability; Obesity; Family; Nutrition; Physical activity