Occupational therapy for community dwelling elderly people: a systematic review.

Tratamiento con intervenciones psicosociales en la fase aguda y de mantenimiento del paciente adulto con diagnóstico de esquizofrenia

To summarize the research evidence available from systematic reviews of the efficacy of occupational therapy (OT) for practitioners, researchers, purchasing organizations and policy-makers. The search for systematic reviews was conducted in PubMed and the Cochrane Library (October 2004). The reviews included were those that utilized a systematic search for evidence with regard to OT for specific patient groups. Data were summarized for patient group, interventions, outcome domains, type of study designs included, method of data synthesis and conclusions. Fourteen systematic reviews were included. Three reviews related to rheumatoid arthritis, four reviewed stroke and four focused on elderly people. Reviews of Parkinson's disease, multiple sclerosis, Huntington's disease, cerebral palsy and mental illnesses were also identified. The reviews of rheumatoid arthritis, stroke and elderly people showed evidence of the efficacy of OT in increasing functional abilities. Positive results were presented for quality of life and social participation in elderly people and stroke respectively. The efficacy of OT in all other patient groups is unknown due to insufficient evidence. This summary shows that elderly people and people with stroke or rheumatoid arthritis can expect to benefit from comprehensive OT. Evidence of the efficacy of specific interventions is sparse and should be addressed in future research. The evidence that does exist should be incorporated into OT practice.

Higher level of functional incapacity and invalidity is noted in palliative patients, as a result of disease progression, which is the reason for a significant decrease in the quality of life not only of these patients, but also of the family members who care for them. Physical therapy and occupational therapy are aimed at improving the patient's quality of life through rehabilitation measures to restore body function, ensure physical independence and activity, optimal physical condition and well-being, and patient adaptation in the environment. Aim: to review modern literary sources regarding the relevance of physical therapy and occupational therapy in palliative and hospice care. The search for literary sources was carried out in international scientometric databases: PubMed, Scopus, Web of Science, Google Scholar. The search depth is 13 years (from 2010 to 2022). The review indicates that physical therapy and occupational therapy in palliative and hospice medicine around the world are not used enough today. These two specialties of interdisciplinary treatment in palliative and hospice medicine play an important integral role, which is manifested in improving the quality of life of both patients and their family members who care for them through the use of a wide variety of methods. Hospice physical therapists not only help patients to support/keep functional abilities as long as possible, but also to reduce the burden on persons who care for terminally ill patients. Physical and occupational therapy have numerous benefits for patients with progressive life-threatening illnesses in palliative and hospice care. Physical therapy in palliative and hospice care can have a preventive, educational, and/or supportive function depending on the patient's situation. There is especially large deficiency in palliative physical therapy and occupational therapy among adolescents and young people, which requires wide implementation with high-quality training of relevant specialists. Physical therapy and occupational therapy play an important role in palliative and hospice care; all patients in palliative and hospice care, regardless of illness or severity, should have access to physical and occupational therapy based on individual needs.

The field of occupational therapy (OT) is a healthcare field that is impactful on the lives of many individuals however there is currently a lack of awareness of the field of OT due to a lack of knowledge of and interest in OT among healthcare providers and the public (Richards and Valleé, 2020). The Aim of Research. The purpose of this project is to advocate for the field of OT and assess if an introductory presentation and hands-on lab about OT’s scope can improve the interest in OT among high school students in both rural and urban environments. Methods. The Study included an introductory workshop on the field of OT that was presented to the three high schools of Bret Harte High School (BHHS), Calaveras High School (CHS), and Pioneer High School (PHS). This workshop consisted of a 30-minute presentation followed by a hands-on lab. The hands-on lab did vary in length based on the school and introduced the students to commonly used OT assistive devices (AD). To assess the outcome of the workshop, the students completed a pre- and post-test survey that assessed their interest in and understanding of OT. Results. At the beginning of the workshop, the students had low interest in and knowledge of OT. Following the completion of the workshop, BHHS and PHS had a greater interest in and knowledge of OT with their mean interest score rising 4.79 points (p < 0.05) and 4.28 (p < 0.05), respectively. BHHS and PHS mean knowledge scores rose by 5.79 (p < 0.001) and 4.39 (p < 0.001), respectively. CHS showed a different outcome as the students’ interest in OT did rise by 2.91, but it was not statistically significant as p > 0.05. The mean knowledge score for Calaveras did rise significantly with the mean score rising by 7 (p < 0.001). Conclusion. High School students have a low awareness of and interest in the field of OT, however an introductory OT workshop can effectively increase their knowledge and interest in OT. Based on this, it is assumed that this project was successful at advocating for the field of OT and had shown that it can be a valuable advocacy tool for increasing awareness of OT, to scaffold students’ career interests, and is a plausible option for advocacy.

BackgroundOlder people want to age in place. Despite advancing functional limitations and their desire of aging in place, they are not always faithful to therapy that maintains independence and promotes safety. Occupational therapists can facilitate aging in place. Occupational therapy is defined as the therapeutic use of everyday life occupations with persons, groups, or populations for the purpose of enhancing or enabling participation.AimTo describe the content a high-adherence-to-therapy and evidence-based occupational therapy intervention to optimize functional performance and social participation of home-based physically frail older adults and wellbeing of their informal caregiver, and the research activities undertaken to design this intervention.MethodsA roadmap was created to develop the occupational therapy intervention. This roadmap is based on the Medical Research Council (MRC) framework and is supplemented with elements of the Intervention Mapping approach. The TIDieR checklist is applied to describe the intervention in detail. A systematic review and two qualitative studies substantiated the content of the intervention scientifically.ResultsThe application of the first two phases of the MRC framework resulted in the ProMOTE intervention (Promoting Meaningful activities by Occupational Therapy in Elderly). The ProMOTE intervention is a high-adherence-to-therapy occupational therapy intervention that consists of six steps and describes in detail the evidence-based components that are required to obtain an operational intervention for occupational therapy practice.ConclusionThis study transparently reflects on the process of a high-quality occupational therapy intervention to optimize the functional performance and social participation of the home-based physically frail older adult and describes the ProMOTE intervention in detail. The ProMOTE intervention contributes to safely aging in place and to maintaining social participation. The designed intervention goes beyond a description of the ‘what’. The added value lies in the interweaving of the ‘why’ and ‘how’. By describing the ‘how’, our study makes the concept of ‘therapeutic use-of-self’ operational throughout the six steps of the occupational therapy intervention. A further rigorous study of the effect of the ProMOTE intervention on adherence, functional performance and social participation is recommended based to facilitate the implementation of this intervention on a national level in Belgium.

Despite drug and surgical therapies for Parkinson's disease, patients develop progressive disability. It has both motor and non-motor symptomatology, and their interaction with their environment can be very complex. The role of the occupational therapist is to support the patient and help them maintain their usual level of self-care, work and leisure activities for as long as possible. When it is no longer possible to maintain their usual activities, occupational therapists support individuals in changing and adapting their relationship with their physical and social environment to develop new valued activities and roles. To compare the efficacy and effectiveness of occupational therapy with placebo or no interventions (control group) in patients with Parkinson's disease. Relevant trials were identified by electronic searches of MEDLINE (1966-April 2007), EMBASE (1974-2000), CINAHL (1982-April 2007), Psycinfo (1806-April 2007), Ovid OLDMEDLINE (1950-1965), ISI Web of Knowledge (1981-April 2007), National Library for Health (NLH) (April 2007), Nursing, Midwifery and Allied Health (NMAP) (April 2007), Intute: Medicine (December 2005), Proquest Nursing Journals (PNJ, 1986 - April 2007); rehabilitation databases: AMED (1985-April 2007), MANTIS (1880-2000), REHABDATA (1956-2000), REHADAT (2000), GEROLIT (1979-2000); English language databases of foreign language research and third world publications: Pascal (1984-2000), LILACS (1982- April 2007), MedCarib (17th Century-April 2007), JICST-EPlus (1985-2000), AIM (1993-April 2007), IMEMR (1984-April 2007), grey literature databases: SIGLE (1980-2000), ISI-ISTP (1982-April 2007), DISSABS (1999-2000), Conference Papers Index (CPI, 1982-2000) and Aslib Index to Theses (AIT, 1716- April 2006), The Cochrane Controlled Trials Register (Issue 2, 2007), the CenterWatch Clinical Trials listing service (April 2007), the metaRegister of Controlled Trials (mRCT, April 2007), Current controlled trials (CCT) (April 2007), ClinicalTrials.gov (April 2007), CRISP (1972-April 2007), PEDro (April 2007), NIDRR (April 2007) and NRR (April 2007) and the reference lists of identified studies and other reviews were examined. Only randomised controlled trials (RCT) were included, however those trials that allowed quasi-random methods of allocation were allowed. Data was abstracted independently by two authors and differences were settled by discussion. Two trials were identified with 84 patients in total. Although both trials reported a positive effect from occupational therapy, all of the improvements were small. The trials did not have adequate placebo treatments, used small numbers of patients and the method of randomisation and concealment of allocation was not specified in one trial. These methodological problems could potentially lead to bias from a number of sources reducing the strength of the studies further. Considering the significant methodological flaws in the studies, the small number of patients examined, and the possibility of publication bias, there is insufficient evidence to support or refute the efficacy of occupational therapy in Parkinson's disease. There is now a consensus as to UK current and best practice in occupational therapy when treating people with Parkinson's disease. We now require large well designed placebo-controlled RCTs to demonstrate occupational therapy's effectiveness in Parkinson's disease. Outcome measures with particular relevance to patients, carers, occupational therapists and physicians should be chosen and the patients monitored for at least six months to determine the duration of benefit. The trials should be reported using CONSORT guidelines.

FRI0488-HPR Are occupational therapy interventions included in the most commonly used european clinical-practice guidelines for the management of osteoarthritis?

Various conservative treatment options for repetitive strain injury are widely used, despite questionable evidence of their effectiveness. This systematic review evaluates the effectiveness of these treatment options for relieving symptoms of repetitive strain injury and improving activities of daily living. Searches in Medline and Embase, with additional reference checking resulted in 15 eligible trials for this review. Methodological quality was assessed, and data-extraction was performed. With the use of a "best-evidence synthesis", no strong evidence was found for the effectiveness of any of the treatment options. There is limited evidence that multidisciplinary rehabilitation, ergonomic intervention measures, exercises, and spinal manipulation combined with soft tissue therapy are effective in providing symptom relief or improving activities of daily living. There is conflicting evidence for the effectiveness of behavioral therapy. In conclusion, little is known about the effectiveness of conservative treatment options for repetitive strain injury. To establish strong evidence, more high-quality trials are needed.

Introduction Sarcomas of bone and soft tissue are rare neoplasms with diverse histology and biologic behavior. Approximately 6,600 new cases of soft-tissue sarcoma and 2,500 new cases of bone sarcoma present each year.1 Most of these tumors develop in the extremities. An increased understanding of sarcoma biology, advances in diagnostic imaging modalities, the development of effective adjuvant therapy regimens, and the application of new technologies and techniques for surgical resection and reconstruction have changed the nature and scope of treatment for these tumors. These advances have helped shape current surgical strategies and have prompted an increase in technically demanding limb-sparing surgical procedures. Successful limb conservation preserves, repairs, or reconstructs critical structures necessary for limb function without compromising the oncologic objective of complete tumor extirpation. Because of several factors, the number of patients who are candidates for limb conservation is increasing without a significant increase in the risk of local tumor recurrence or an adverse effect on overall patient survival.2-4 The factors causing this result include refinements in diagnostic and extirpative approaches, improvements in bone and joint reconstruction, and better techniques for coverage of soft-tissue defects. These developments have prompted a critical evaluation of the variables affecting limb preservation, functional outcome, and quality of life for the sarcoma survivor. This report discusses the strategies used at The University of Texas M.D. Anderson Cancer Center to improve the quality of life for patients diagnosed with these complex extremity tumors. Four case examples illustrate the range of clinical challenges confronting the sarcoma oncology team as members try to attain a better patient outcome using multimodality therapy and limb-sparing surgery.

In recent years, there has been much debate on the treatment of whiplash-associated disorders (WAD). It is not clear if the treatments commonly employed are effective, and concerns have been raised on the available scientific evidence of many of these treatments. The aim of this study was to review the literature systematically to analyze the evidence basis of many commonly used treatments for patients suffering from WAD, both in the acute and the chronic state. A computer-assisted search of the databases Medline (from 1962 to May 2003), CINAHL (1960-2003), Embase (1976-2003), and Psychinfo (1960-2003) was conducted as well as a check of the reference lists of relevant studies. All randomized controlled trials (RCTs) were retrieved and systematically analyzed with three common instruments of measurement of methodological quality. A qualitative analysis ("best-evidence synthesis") was performed. The methodological quality of 26 RCTs was analyzed. The median quality scores for all three instruments were poor. Based on the degrees of evidence and the practical obstacles, the following treatments can be recommended: Early physical activity in acute WAD, radiofrequency neurotomy, combination of cognitive behavioral therapy with physical therapy interventions, and coordination exercise therapy in chronic WAD. High-quality RCTs are not common in the field of WAD. More research is needed, particularly on the treatment of chronic WAD.

Date Presented 4/7/2016 Half of people fail to take their medications as prescribed. This presentation describes an occupational therapy medication management intervention and, using single-subject data, it explores the efficacy of occupational therapy on medication adherence in adults with chronic health conditions. Primary Author and Speaker: Jaclyn K. Schwartz Additional Authors and Speakers: Stefanie Woelfel, Elizabeth Seidel, Lindsey Marszalkowski, Emily Nowicki, Melissa Mutch, Kimberly Grogan

Monitoring the dementia care quality is key for healthcare services. Dementia care quality indicators (QIs) have been reported in the literature, fragmented by setting or stage of care. We aimed to conduct an umbrella review (review of systematic reviews) to identify, evaluate, and summarize dementia care QIs throughout the disease trajectory. We conducted an umbrella review reporting the development, review, or testing of dementia care QIs. We used a structured search in MEDLINE (Ovid), PsycINFO (EBSCO), Cochrane Library, and LILACS. Two researchers independently screened titles, abstracts, and full-texts. QIs from included articles were extracted by one reviewer and checked by a second one. The AMSTAR 2 and AIRE tools were used to assess the methodological quality of reviews and QIs, respectively. Included QIs were categorized and coded based on their stage of care (initial assessment after diagnosis, follow-up and treatment, and end-of-life), type of indicator (structure, process, outcome), and specific aspects of care measured. Six systematic reviews were included, comprising 554 dementia care QIs that were synthesized into 120 QIs. 86 (72%) were classified as process, 20 (16%) as structure, and 14 (12%) as outcome indicators. 32 QIs (27%) are recommended exclusively for community settings, 7 (6%) for hospital settings, and 81 (67%) for more than one care setting. The 120 QIs are related to 60 different aspects of care, with advanced care planning and having an individualized healthcare plan being the most frequently quoted QIs. The quality of systematic reviews was low to critically low, and over a third of QIs were considered to have high methodological quality. Our umbrella review synthesized a broad overview of dementia care QIs, facilitating healthcare organizations to monitor and improve areas in need. Future research should focus on validating these QIs in local contexts.

Substance use disorders (SUDs) are associated with persistent occupational dysfunctions, which disrupt daily routines, role performance, social participation, and engagement in meaningful activities of daily living. Beyond neurobiological effects, substance use reorganizes occupational identity, competence and occupational patterns, resulting in long-term functional impairment. Occupational therapy (OT) addresses these disruptions across the continuum of care. This chapter provides a comprehensive overview of occupational dysfunction associated with substance use disorders and synthesizes recent evidence on occupational assessment and intervention strategies. In this chapter key occupation-based assessment tools are reviewed, highlighting their usefulness in evaluating participation, cognition, psychosocial functioning, and vocational readiness; and evidence-informed occupational therapy interventions are discussed. Particular emphasis is placed on the Indian context, examining rehabilitation needs, service delivery challenges, and emerging occupational therapy practices within de-addiction and mental health settings. The chapter underscores the potential of occupational therapy to support recovery, community reintegration, and sustained participation, while also identifying gaps in research, training, and service integration that warrant further development.

This paper explores the contemporary challenges and possibilities that cyberculture adds to occupational therapy. This analysis is necessary because we are experiencing a gradual and irreversible virtualisation of our everyday life and actions along with the expansion of cyberspace. The theoretical techniques of occupational therapy and the theories of Pierre Levy suggest that these challenges are at a minimum on two levels: (1) the need to update our object of intervention: human participation and occupation in the context of cyberculture, and (2) the identification and creation of current demands and new methods of intervention, respectively, in this field that originate from the ethical, aesthetic, political, and social shaping of human relations. Key words: Occupational therapy, cyberculture, social participation, communication, human occupation

Evidence Connection articles provide a clinical application of practice guidelines developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Program. Each article in the series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. The articles illustrate how the research evidence from the practice guidelines can be used to inform and guide clinical decision making. In this Evidence Connection article, we describe a case report of a child receiving occupational therapy services and summarize the evaluation and intervention processes for supporting sleep, activities of daily living, and social participation. The practice guideline on this topic was published in the July/August 2020 issue of the American Journal of Occupational Therapy (Cahill &amp; Beisbier, 2020).