About

Brittany Hand, PhD, OTR/L, is an Associate Professor at the School of Health and Rehabilitation Sciences. Her research centers on optimizing health service delivery and patient health outcomes among adults on the autism spectrum and other patient populations. She conducts health services research to study healthcare access, utilization, and costs at both population and local levels. Dr. Hand is particularly interested in designing solutions to overcome barriers to primary care for autistic adults, partnering with key stakeholders in funded projects. Her work aims to improve healthcare experiences and outcomes for individuals with autism and other disabilities, contributing to the fields of health services and outcomes research.

Research topics

• Medicine
• Psychology
• Physical therapy
• Clinical psychology
• Psychiatry

Selected publications

• Falls and Fall-Related Injuries and Hospitalizations in Autistic Older Adults: A Medicare Data Study

  Autism · 2026-04-27

  articleOpen accessSenior author

  Fall-related injuries are a major public health issue for older adults, contributing to mortality, morbidity, decreased functional ability, loss of independence, and increased healthcare costs. Autistic older adults may be at greater risk for falls due to motor coordination difficulties and antipsychotic medication use. This cohort study used multivariable logistic regression to compare the odds of falling and negative binomial regression to compare the rate of fall-related injuries. Data from Medicare Standard Analytical Files (2013-2021) for autistic and non-autistic older adults aged 65+ were analyzed. The sample included 13,732 autistic and 25,497 matched non-autistic older adults. Our dependent variables were (1) falls, (2) unique fall-related injuries, and (3) fall-related hospitalizations. Overall, 47.4% of autistic older adults had a fall compared to 31.5% of non-autistic older adults. Autistic older adults also had more fall-related injuries and hospitalizations. Accounting for duration of observation, autistic older adults had significantly higher odds of any fall (odds ratio = 1.99; 95% confidence interval = 1.89-2.08), rate of fall-related injuries (incidence rate ratio = 1.93; 95% confidence interval = 1.86-2.01), and rate of fall-related hospitalizations (incidence rate ratio = 1.43; 95% confidence interval = 1.35-1.51) than non-autistic older adults. These findings highlight the need for targeted fall prevention strategies for autistic older adults to reduce morbidity and mortality.Lay AbstractFalls are a big problem for older adults, often causing injuries and making it hard for them to live independently. Autistic older adults might be at higher risk of falling because of movement difficulties. However, no one has studied how often autistic older adults fall. Our study looked at the difference in fall rates, injuries, and hospitalizations between autistic and non-autistic older adults. We used Medicare data from 2013 to 2021 and included people aged 65 and older. We had 13,732 autistic older adults and 25,497 non-autistic older adults in our study. We matched them based on factors like sex, race, and health status to make sure the comparison was fair. We found that almost half (47.4%) of autistic older adults had a fall, compared to only 31.5% of non-autistic older adults. Autistic older adults also had more injuries and hospitalizations from falls. They had about double the likelihood of falling than non-autistic older adults. The rates of injuries and hospitalizations from falls were more about double for autistic older adults compared to non-autistic older adults. These results suggest that we need special programs to help prevent falls and support the health of autistic older adults.

  PublisherOA PDFDOI

• Cochlear Implant User Affect and Reported Quality of Life

  JAMA Otolaryngology–Head & Neck Surgery · 2026-01-08

  articleOpen access

  Importance: The use of patient-reported outcome measures to assess outcomes in adults who use cochlear implants has increased, as highlighted by the inclusion of the Cochlear Implant Quality of Life (CIQOL) instruments in the Minimal Speech Testing Battery, version 3. However, the self-reported nature of these instruments raises questions regarding how psychosocial characteristics impact responses. Objective: To assess whether affect and CIQOL domain scores change over time and whether affect is associated with CIQOL domain scores. Design, Setting, and Participants: Prospective longitudinal cohort study in adult cochlear implant candidates (aged 18-89 years) meeting indications for cochlear implantation based on bilateral moderate to profound hearing loss with aided sentence recognition scores 60% or less between September 19, 2019, and October 8, 2021, in a single tertiary otolaryngology referral center. Patients receiving a second cochlear implant and those without Montreal Cognitive Assessment scores were excluded. Follow-up duration was 1 year. Data analysis was performed between October 15, 2023, and August 5, 2025. Main Outcomes and Measures: Standard speech recognition tasks, the CIQOL-35 Profile, and the Positive Affect and Negative Affect Schedule (PANAS) at 4 time points were used: pre-cochlear implantation and at 3, 6, and 12 months post activation. Cohen d was used to calculate effect sizes of changes in PANAS and CIQOL domain scores. Multivariable repeated-measure mixed-effect linear models were applied to determine how positive affect and negative affect scores were associated with CIQOL domain scores. Results: Initially, 60 participants were enrolled, and 45 participants (75%) completed the study (25 female [55.6%]; median age at implantation, 67.0 [IQR, 55.0-72.0] years). From pre-cochlear implant to 12 months post activation, all CIQOL-35 domains improved. The smallest median increase was 17.7 points in listening effort domain (baseline median, 20.6 [IQR, 9.3-28.3] compared with end point median, 38.3 [IQR, 31.7-51.8]; Cohen d = 1.12; 95% CI, 0.67-1.57) and the largest was 27.8 points in the environment domain (baseline median, 31.2 [IQR, 20.6-45.1] compared with end point median, 59.0 [IQR, 48.9-65.7]; Cohen d = 1.25; 95% CI, 0.79-1.72). Positive affect increased by a median of 2 points (baseline median, 35.0 [IQR, 28.0-38.0] compared with end point median, 37.0 [IQR, 33.0-41.0]; Cohen d = 0.61; 95% CI, 0.17-1.05), and negative affect decreased by a median of 5 points (baseline median, 19.0 [IQR, 16.0-23.0] compared with end point median, 14.0 [IQR, 10.0-19.0]; Cohen d = -0.60; 95% CI, -1.04 to -0.16). In multivariable models, the regression coefficients for positive and negative affect were associated with CIQOL domain scores. For positive affect, coefficients ranged from 0.7 (95% CI, 0.4-1.0) in the communication domain to 1.4 (95% CI, 1.0-1.9) in the social domain. For negative affect, coefficients ranged from -0.8 (95% CI, -1.2 to -0.4) in the environment domain to -1.6 (95% CI, -2.1 to -1.2) in the social domain, which represented the highest regression coefficients observed across all domains and both affect measures. Conclusions and Relevance: In this study, patient affect was associated with CIQOL-35 domain scores, particularly in social and emotional areas. However, due to low regression coefficients, changes in affect were unlikely to be associated with clinically meaningful changes in CIQOL domain scores.

  PublisherOA PDFDOI

• Risk of dementia and related neurocognitive disorders among autistic and non-autistic older adults: role of established risk factors

  Age and Ageing · 2026-01-30

  articleOpen accessSenior author

  BACKGROUND: Neurocognitive disorders (i.e. dementia) are a leading cause of cognitive decline and loss of independence among older adults. While reported rates are higher among autistic adults, it is unclear whether this disparity persists after accounting for known risk factors. OBJECTIVE: We compared neurocognitive disorder risk between autistic and non-autistic older adults after adjusting for known risk factors and evaluated whether risk factors moderated this disparity. We replicated our analyses among subsets of autistic older adults with and without co-occurring intellectual disability (ID). DESIGN: Retrospective longitudinal cohort study. SETTING: National Medicare Standard Analytical Files (2013-21). PARTICIPANTS: The sample included 9201 autistic and 18 356 non-autistic older adults aged 65 or older, who were matched on demographic and clinical characteristics. METHODS: Our dependent variable was time to neurocognitive disorder, defined as years between age 65 or older and the date of first diagnosis. RESULTS: Autistic older adults had a 20% higher adjusted risk of neurocognitive disorders than non-autistic older adults (95% CI = 14%-25%; P < .001). Risk was highest among autistic adults with co-occurring ID [adjusted subhazard ratio (SHR) = 1.46; 95% CI = 1.36-1.57]. The disparity between cohorts was amplified in the presence of most known risk factors, notably hypertension (SHR = 2.04; 95% CI = 1.79-2.32), high cholesterol (SHR = 1.60; 95% CI = 1.46-1.75), depression (SHR = 1.52; 95% CI = 1.42-1.62), and type 2 diabetes (SHR = 1.45; 95% CI = 1.36-1.55). CONCLUSIONS: Autistic older adults, particularly those with ID, face significantly higher risk of neurocognitive disorders even after adjusting for known risk factors. These findings emphasise that risk factors may impact the autistic population differently and highlight the need for early screening and tailored prevention strategies.

  PublisherOA PDFDOI

• Mental health outcomes associated with applied behavior analysis in a US national sample of privately insured autistic youth

  Autism · 2025-11-09 · 1 citations

  articleCorresponding

  Applied behavior analysis is a widely used intervention for autistic youth, though its mental health impacts remain under-researched. This study aims to investigate the association between applied behavior analysis therapy and post-traumatic stress disorder, suicidality, mental health hospitalization rates, and length of mental health hospitalizations using a national database of privately insured youth under 18. We matched 17,120 autistic youth who received applied behavior analysis with a control group of autistic youth with no record of applied behavior analysis and clustered them into four applied behavior analysis dose groups using two-stage bisecting k-medians clustering. Then, we used negative binomial regression and logistic regression to compare outcomes for the applied behavior analysis and non-applied behavior analysis groups. Overall, applied behavior analysis receipt was associated with 30% higher odds of experiencing a mental health hospitalization (odds ratio = 1.30, p &lt; 0.001) and a 32% higher incidence rate of these hospitalizations (incidence rate ratio = 1.32, p &lt; 0.001). Our analysis found no relationship between applied behavior analysis dosing and the other tracked mental health outcomes. These results indicate the need for more quantitative analysis with more comprehensive records of applied behavior analysis receipt to fully investigate claims of ABA resulting in adverse adult mental health outcomes. Lay abstract Autistic youth often receive applied behavior analysis (ABA) therapy, but some autistic adults who had ABA as youth say it harmed their mental health as adults. We looked at the relationship between ABA and post-traumatic stress disorder (PTSD), suicidality, mental health hospitalization rates, and length of mental health hospitalizations among autistic youth. We used private health insurance claims data to look at how ABA receipt was related to those mental health outcomes. We divided autistic youth into groups based on how much ABA they received, so we could see if different amounts of ABA had different associations with mental health. There were 17,120 autistic youth in the group that did not receive ABA, and 17,120 autistic youth in the group that did receive ABA. In this sample, ABA therapy was associated with a greater use of acute mental health services; autistic youth in the ABA group had an overall risk that was 30% higher for mental health hospitalizations; and a 32% greater frequency of mental health hospitalizations. These results suggest that there may be a relationship between mental health hospitalizations and getting ABA. However, more work is needed to fully understand the impact of ABA therapy on mental health outcomes.

  PublisherDOI

• State Policy Variability &amp; the Role of OT in Promoting More Equitable Autism Educational Identification

  American Journal of Occupational Therapy · 2025-07-30

  article

  Abstract Date Presented 04/03/2025 Variability in state special education policy may contribute to underidentification of individuals with autism. OTs can play a crucial role in improving the accuracy and equity of autism special education eligibility via a sensory processing assessment. Primary Author and Speaker: Amy Watson-Grace Additional Authors and Speakers: Jewel Elias Crasta Contributing Authors: Gia Barboza-Salerno, Brittany Hand, Katherine Walton, Michelle Failla

  PublisherDOI

• Standardized Assessment Use in Stroke Rehabilitation: Findings From a Cross-Sectional Survey of Occupational Therapy Practitioners

  OTJR Occupational Therapy Journal of Research · 2025-10-07

  article

  Standardized outcome measures, like the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), support stroke rehabilitation; however, occupational therapy practitioners report minimal use due to limited knowledge, time, and administrative support. The objective of this study was to examine practitioners’ perceived acceptability, appropriateness, and feasibility of using the FMA-UE, attitudes toward standardized outcome measures, and strategies to support use. A cross-sectional survey was conducted using the Acceptability of Intervention Measure, Intervention Appropriateness Measure, Feasibility of Intervention Measure, and Evidence-Based Practice Attitudes Scale. Spearman correlations assessed relationships among variables. Practitioners ( n = 102) perceived the FMA-UE as acceptable, appropriate, and feasible. Acceptability ( r = .34, p &lt; .001), appropriateness ( r = .35, p &lt; .001), and feasibility ( r = .32, p &lt; .01) were significantly correlated with openness to FMA-UE use. Despite positive perceptions of the FMA-UE and outcome measures, consistent implementation remains limited. Further research should examine strategies to enhance use.

  PublisherDOI

• Formative evaluation of PREPARE for Autistic Adults: An adult autism training for resident physicians designed with autistic adults and family members

  2025-01-03

  preprintOpen access1st authorCorresponding

  Efforts are intensifying nationwide to better prepare physicians to deliver high-quality, patient-centered care for adults with disabilities like autism. To address this need, we partnered with autistic adults and their families to develop a training program for resident physicians called Promoting Residents’ Excellence in Patient-centered cARE (PREPARE) for Autistic Adults. Here, we describe a formative evaluation of the training. We recruited residents at one institution to participate in the eight-week virtual training, which included six pre-recorded lectures, six facilitator-led case studies, and two standardized patient encounters. Participants completed pre- and post-training autism knowledge assessments, rated acceptability and appropriateness, and participated in qualitative interviews to identify improvement opportunities. We analyzed quantitative data with descriptive statistics, knowledge changes with Cohen’s d, and qualitative interviews with inductive thematic analysis. Participants’ (n=14) median completion rate was 76.9% of training components. They rated acceptability and appropriateness highly and demonstrated large knowledge gains (d=0.94). We identified four main qualitative themes: 1) Flexibility facilitates participation, 2) High-value experiences increase acceptability, 3) Practicalities affecting participation, and 4) It’s made me a better doctor. We revised the training based on feedback, including clarifying or adding content, modifying standardized patient encounter logistics, and adding optional components for residency programs to supplement core PREPARE content. The National Institutes of Health recognizes people with disabilities as experiencing health disparities and identified disability training, like PREPARE, as a strategy to mitigate these disparities. These results provide information for continued refinement. Our next steps include examining the effectiveness of the revised training and dissemination.

  PublisherDOI

• Prospective Evaluation of the Associations Between Pre-Cochlear Implant Abilities and Cochlear Implant Quality of Life-35 Profile Domain Scores

  Ear and Hearing · 2025-09-26 · 1 citations

  article

  OBJECTIVES: Although most cochlear implant (CI) research has focused on speech recognition ability as the primary outcome measure, research on self-reported, real-world functional outcomes as measured using patient-reported outcome measures is more limited but emerging. The present study explores the association between several pre-CI psychophysical and self-reported functional measures and corresponding CI quality of life (CIQOL) domain scores after implantation. DESIGN: A longitudinal study design was used involving 45 participants who underwent cochlear implantation for their first CI for traditional bilateral hearing loss indications. Participants completed the CIQOL-35 Profile and a battery of domain-specific functional assessments pre-CI and at 3, 6, and 12 months post-CI-activation. Statistical analyses included multivariable repeated measures models to determine associations between pre-CI functional assessment scores and CIQOL domain scores. RESULTS: Relative to their pre-CI abilities, participants demonstrated significant improvements in all CIQOL domains at 12-months post-CI, with varying effect sizes ( d range = 0.80 to 1.25). Moreover, pre-CI positive affect was significantly and positively associated with CIQOL-Emotional domain scores ( β = 0.7 [0.02 to 1.2]), and pre-CI social function/participation was significantly and positively associated with CIQOL-Social domain scores ( β = 1.0 [0.3 to 1.8]). No significant associations were identified between pre-CI speech recognition abilities and CIQOL Communication domain scores, or other pre-CI function measures and their corresponding CIQOL domain scores. CONCLUSIONS: The results demonstrated associations between pre-CI positive affect and social function/participation on post-CI Emotional and Social CIQOL scores, respectively. However, other pre-CI functional assessments, particularly pre-CI speech recognition abilities, were not associated with CIQOL domain outcome scores.

  PublisherDOI

• Early Cochlear Implant Outcomes Predict Long-Term Speech Recognition

  Ear and Hearing · 2025-12-17

  articleOpen access

  OBJECTIVES: Early identification of cochlear implant (CI) users at risk for poor audiological outcomes may allow for timely intervention to optimize long-term CI benefit. This longitudinal study aims to develop and evaluate logistic regression models that can predict patients' 12-months speech recognition performance from their early speech recognition scores and other patient factors. DESIGN: This retrospective cohort study included 625 postlingually deafened, adult CI users with bilateral hearing loss from 2 tertiary CI centers. Logistic regressions were fit to model the likelihood of a clinically significant improvement in consonant-nucleus-consonant (CNC) word scores at 12-months postimplantation. All models included sex, race, age at implantation, duration of deafness, and pre-CI CNC score. The model performance benefit of adding CNC improvement status (improved versus not improved, with improvement defined as scoring beyond the upper limit of the 95% confidence interval of the preoperative score) at 1- or 3-months postactivation to the baseline models was evaluated by comparing the area under the receiver operating characteristic curve (AUC). Data were combined across institutions and then separated into training and validation cohorts at a 3:1 ratio. Models were developed using the training cohort (n = 469) and then applied to the validation cohort (n = 156). RESULTS: Of the 625 patients included, 513 patients (82%) demonstrated improvement in CI-only CNC word recognition scores at 12-months postimplantation compared with their preimplantation scores. Early improvement was strongly associated with long-term outcomes. Patients were more likely to improve by 12 months if they improved by 1 month (odds ratio = 45.72) or 3 months (odds ratio = 22.22) postimplantation. Model performances were similar across the training and validation cohorts. In the validation cohort, the model using 3-months data had the highest predictive accuracy (AUC = 0.92), followed by the 1-month model (AUC = 0.88), and the baseline preoperative model (AUC = 0.77). Based on the regression coefficients obtained from the training cohort, equations can successfully estimate the probability of CNC improvement at 12 months postimplantation for CI patients. CONCLUSIONS: Models that included CNC score improvements at 1 month demonstrated good predictive discrimination, while those incorporating 3-months improvements showed excellent discrimination in both the training and validation cohorts. This study highlights the importance of assessing early post-CI speech recognition improvement and proposes a regression model that clinicians can use in real-time to provide early estimates of their patients' probability of 12-months CNC improvement.

  PublisherOA PDFDOI

• Comparing Autistic and Non-Autistic Older Adults’ Fall-Related Hospitalization Care and Outcomes

  Journal of General Internal Medicine · 2025-10-20

  articleSenior authorCorresponding
  PublisherDOI

Frequent coauthors

• Daniel Gilmore

  The Ohio State University

  20 shared

• Daniel L. Coury

  Nationwide Children's Hospital

  16 shared

• Craig A. Velozo

  Medical University of South Carolina

  14 shared

• Amy Darragh

  The Ohio State University

  13 shared

• Christopher Hanks

  Society of General Internal Medicine

  13 shared

• Jennifer H. Garvin

  Richard L. Roudebush VA Medical Center

  12 shared

• Anne Longo

  The Ohio State University

  11 shared

• Mark R. Schmeler

  University of Pittsburgh

  10 shared

Education

• PhD, Health and Rehabilitation Sciences

  The Ohio State University

  2016

• Master of Occupational Therapy, Occupational Therapy

  The Ohio State University

  2013

• Bachelor of Science, Biology

  The Ohio State University

  2011

Awards & honors

• 2022 – Paper named one of top 20 significant advances in aut…
• 2024-2027 – Programmatic Panel Member, Autism Research Progr…
• 2021-2025 – Loan Repayment Program Award for Clinical Resear…
• 2019 – KL2 Career Development Award, Center for Clinical and…
• 2021 – Research Mentoring Training Endorsement, Office of Po…