The complexity of daily occupations in multiple sclerosis

Randomized Controlled Trial of Occupational Performance Coaching for Adults With Multiple Sclerosis

OBJECTIVE

To determine if the receipt of occupational performance coaching (OPC) by adults living with multiple sclerosis (MS) improves participants' satisfaction with performance in daily activities (primary outcome); improves perceived performance in daily activities, resilience, autonomy, and participation; and reduces illness intrusiveness and effect of MS (secondary outcomes).

DESIGN

Two-group randomized clinical trial with a waitlist control.

SETTING

Community.

PARTICIPANTS

Convenience sample of adults with MS were recruited through a research registry. Eighty-three individuals were approached; 35 were assessed for eligibility and 31 were enrolled and 30 completed baseline assessment (Final sample size, N=30). Participants were English-speaking, were without serious cognitive impairment or severe depression, and were not receiving other coaching interventions.

INTERVENTIONS

Six telephone sessions of OPC were delivered by a trained facilitator over 10 weeks. Initial sessions focused on goal setting, prioritization, and action planning. Subsequent sessions involved goal and action plan review, discussion of facilitators and barriers, and goal and plan refinement.

MAIN OUTCOME MEASURES

Primary outcome was participants' satisfaction with performance in daily activities, as measured by the Canadian Occupational Performance Measure (COPM). Secondary outcome measures included the COPM performance rating, Connor-Davidson Resilience Scale, Impact on Participation and Autonomy Questionnaire, Adapted Illness Intrusiveness Rating Scale, and MS Impact Scale. Measures were administered by a blinded assessor at baseline, 10 weeks, and 2 months.

RESULTS

Participants in the intervention and waitlist control groups were equivalent on demographic and outcome measures at baseline. At 10 weeks, the intervention group had significantly higher COPM ratings for both satisfaction (P<.001) and performance (P=.002). No other outcomes were significantly different. For the intervention group, the benefits of OPC were maintained at 2 months.

CONCLUSIONS

OPC led to improved satisfaction with performance and performance in daily activities. Future research with a larger sample is needed to determine other effects and who benefits most from OPC.

Performance of Activities of daily living in people with multiple sclerosis

OBJECTIVE

Multiple sclerosis (MS) may result in activity and participation limitations, including the performance of activities of daily living (ADL). This study aims at systematically investigate ADL performance by using Assessment of Motor and Process Skills (AMPS) in people with MS (PwMS) of all disease types and within the Kurtzke Expanded Disability Status Scale (EDSS) range from 1.0 - 8.0.

METHODS

Eight multiple sclerosis (MS) centres participated in data collection of a consecutive sample of PwMS. Participants were referred for assessment to occupational therapy (OT) by treating physician or recruited from neurology department in each hospital and assessed by EDSS and AMPS. The AMPS is an observational, criterion referenced ADL assessment, providing values for a person's ADL performance in terms of motor and process skills. Criterion referenced cut-off scores were established at 2.0 for motor skills and at 1.0 for process skills and both values above the cut-off score indicate competent (independent, safe, efficient and effortless) ADL performance. Process skills refer to the act of carrying out a series of actions and is summarized in terms of efficiency, like initiating without pauses, continuing actions through to completion, performing actions in logical order (sequences), choosing, and completing the task as planned (heeds).

RESULTS

Two hundred and ten PwMS were recruited (48 +/- 13 years of age, 145 women/65 men, average disease duration was 11.8 +/- 9.6 years, average EDSS was 4.8+/-1.8). Average motor skills score was 1.01+/- 1.12 (indicating need for assistance with evidence of increased clumsiness/physical effort) and average process skills score was 1.02 +/- 0.66 (risk zone, questionable efficiency and more likely to need assistance). Overall, motor skills and process skills decreased with increasing EDSS score. No need for assistance in motor skills was indicated in subjects with lower EDSS scores (1.0 - 2.5). In higher EDSS group (≥4.5), 57% of subjects needed assistance in motor skills and 27% in process skills. The competency in process skills was either questionable or reduced within all EDSS scores. However, 33-38% of subjects with higher EDSS scores (6.0-8.5) showed competent performance in process skills. Overall correlation between motor and process scores was moderate (r = 0.56, p<0.0001), but no significant relationships between motor and process skills were found in the lower EDSS (1-2.5) and high EDSS scores (8-8.5). Further, EDSS and disease type were significant predictors, explaining 52.7% of motor skills and 22.3% of process skills performance.

CONCLUSION

Problems in ADL performance were found in EDSS categories 1.0 to 8.0 and in all disease types, therefore it is advisable to screen all PwMS for ADL deficits and provide relevant rehabilitation interventions.

Optimising the development of sustainable internet-based occupational therapy interventions: Important key actions and perspectives to consider

BACKGROUND

By examining the health needs of the general population and utilising the potential of digitalisation as a driving force, new internet-based services need to be developed in occupational therapy. However, existing guidelines for the development of complex interventions provide scant information on how to develop internet-based interventions.

AIM

The aim of this paper is to share experiences and illustrate important key actions and new perspectives to consider during the innovation process of developing and designing an internet-based occupational therapy intervention.

METHOD AND MATERIALS

International guidelines for intervention development was reviewed to add important perspectives in the innovation process.

RESULTS

The illustration focuses on five key actions in the development phase to highlight new perspectives and questions important to consider when designing new internet-based occupational therapy interventions.

CONCLUSION

The new perspectives can complement existing guidelines to enhance the development of more effective and sustainable internet-based interventions.

SIGNIFICANCE

The illustration provided has potential to improve the sustainability in innovation processes of new internet-based occupational therapy interventions.

Occupational therapy addressing the ability to perform activities of daily living among persons living with chronic conditions: a randomised controlled pilot study of ABLE 2.0

BACKGROUND

The ABLE intervention was developed to enhance the ability to perform activities of daily living (ADL) tasks among persons living with chronic conditions. ABLE is a generic, home-based, individualised, 8-week occupational therapy intervention program, developed to be delivered in Danish municipalities. In a previous study, the feasibility of ABLE was evaluated in terms of content and delivery. In this pilot study, the remaining feasibility aspects of a randomised controlled trial including (i) trial procedures (recruitment and retention), (ii) randomisation, (iii) adherence to program, (iv) feasibility of additional outcome measurements, and (iv) access to information on usual occupational therapy were evaluated.

METHODS

The study was conducted in a Danish municipality, using a two-armed parallel randomised controlled design, planning a recruitment strategy including 20 persons living with one/more chronic conditions and experiencing problems performing ADL. The following progression criteria were used to determine if a future full-scale randomised controlled trial was feasible: (i) recruitment (50% met the eligibility criteria) and retention (80%), (ii) randomisation (80% accepted randomisation, procedure was executed as planned), (iii) adherence to program (100% followed the treatment protocol), (iv) outcome measurements (80% of the participants delivered relevantly and fully answered questionnaires), and (v) usual occupational therapy (extraction of needed information was successful).

RESULTS

Due to the COVID-19 pandemic, the study was truncated resulting in limited but sufficient data to answer most of the study questions. (i) Eighteen of 37 eligible persons (48.6%) were recruited; of those treated (n = 6), all remained (100%); (ii) 18 accepted randomisation (100%), and procedure was effective; (iii) ABLE was delivered with adherence (100%); (iv) 92.3-100% of the participants gave relevant and complete answers in two of three questionnaires; and (v) needed information on usual occupational therapy was extractable in seven of nine aspects.

CONCLUSIONS

Proceeding to full-scale trial is recommendable; however, a few adjustments on outcome measurements, inclusion criteria and extraction of information on usual occupational therapy are needed.

TRIAL REGISTRATION

The study was registered at ClinicalTrials.gov (Identifier: NCT04295837 ) on December 5th, 2019. Retrospectively registered.

Activities of daily living in Parkinson's disease: Time/gender perspective

OBJECTIVE

The objectives of this study were to explore the changes in the activities of daily living (ADL) in persons with Parkinson's disease (pwPD) over time and to investigate possible differences in ADL performance between men and women with PD.

MATERIALS & METHODS

One hundred twenty-nine persons (76 men) with a clinically established PD self-assessed their ADL performance from the time of diagnosis up to 8 years follow-up using the ADL taxonomy. Other demographic and clinical data (motor state, cognition, depression) were also collected and subjected to further analysis.

RESULTS

Nine of 12 domains in the ADL taxonomy showed a change over time (Eating and Drinking [P = .009], Mobility [P < .001], Toilet activities [P = .031], Dressing [P < .001], Personal hygiene [P < .001], Communication [P < .001], Cooking [P = .001], Shopping [P < .001] and Cleaning [P < .001]). In addition to time, two domains, (Shopping [P = .007] and Cleaning [P = .027]) also showed an effect of gender with worse scores in women. The nine ADL domains showing effect of time, showed temporary improvement at 12 months follow-up, most probably due to dopaminergic medication. All nine domains deteriorated at later follow-up.

CONCLUSIONS

As expected, there was deterioration in self-assessed performance in the majority od ADL domains over time. Women assessed their ADLs worse in two domains (Shopping and Cleaning) probably reflecting a general gender-related activity pattern rather than being a PD-specific finding.

Assessing the quality of life in patients with multiple sclerosis in Kuwait: a cross sectional study

The main objective of this paper was to assess the level and the determinants of quality of life (QOL) amongst patients with multiple sclerosis (MS). A cross-sectional study was conducted among a convenience sample of 200 adult MS patients. Inclusion criteria were: MS diagnosis for at least one year, and aged 21+ years. However, exclusion criteria were: having other neurological diseases, serious cardiovascular, orthopedic or other disability precluding participation. Self-administered questionnaire employed MSQOL-54 with two outcomes: Physical Health Composite (PHC) and mental health composite (MHC). Satisfaction with Daily Occupation scale was adopted through face to face interviews. The median of PHC and MHC scores were 48.9/100, and 53.4/100 respectively. Multivariate analysis revealed that unemployment was a determinant of poor PHC, while low monthly income was a predictor of poor MHC. Additionally, low endurance and sensory problems were associated with poor PHC, and MHC, while motor problems were allied with only poor PHC. Patient's satisfaction level with performing activities of daily living was positively associated with PHC and MHC. Assessment of QOL is suggested to be comprised in medical settings.

Psychometric evaluation of the Finnish version of the impact on participation and autonomy questionnaire in persons with multiple sclerosis

OBJECTIVE

The objective of this study was to evaluate the psychometric properties of the impact on participation and autonomy (IPA) questionnaire. The Finnish version of IPA (IPAFin) was translated into Finnish using the protocol for linguistic validation for patient-reported outcomes instruments.

METHODS

A total of 194 persons with multiple sclerosis (MS) (mean age 50 years SD 9, 72% female) with moderate to severe disability participated in this study. A confirmatory factor analysis (CFA) was used to confirm the four factor structure of the IPAFin. The work and educational opportunities domain was excluded from analysis, because it was only applicable to 51 persons. Internal consistency was investigated by calculating Cronbach's alpha.

RESULTS

CFA confirmed the construct validity of the IPA (standardized root mean square residual (SRMR) = 0.06, comparative fit index (CFI) = 0.93, Tucker-Lewis index =0.93, root mean square error of approximation (RMSEA) = 0.06), indicating a good fit to the model. There was no difference in the models for females and males. Cronbach's alpha for the domains ranged between 0.80 and 0.91, indicating good homogeneity.

CONCLUSIONS

The construct validity and reliability of the IPAFin is acceptable. IPAFin is a suitable measure of participation in persons with MS.

A pilot mixed methods investigation of the use of Oswestry standing frames in the homes of nine people with severe multiple sclerosis

PURPOSE

People with multiple sclerosis (MS) commonly experience muscle weakness which limits their ability to stand. Supported standing may minimise the secondary complications of prolonged sitting but evidence for this is scarce. This study investigated the effects of regular standing in an Oswestry frame on some secondary complications of immobility and explored the lived experience of standing.

METHODS

Nine people with MS participated in a mixed-methods study over 48 weeks. Single-case experiments were used. Outcomes included: Amended Motor Club Assessment, Canadian Occupational Performance Measure, Penn Spasm Scale, bowel frequency and a numerical pain-scale. The qualitative strand used a case-study approach with a phenomenological perspective.

RESULTS

Significant improvements (p < 0.05) were demonstrated for individuals in strength, ADL and spasms but not in bowel frequency or pain. Subjective improvements occurred in continence, clonus and fall-rate. Being upright or strengthened by standing enabled participants to re-engage with activities and re-establish themselves within relationship roles. This engendered a sense of achievement and increased optimism.

CONCLUSION

This study provides preliminary evidence of the effectiveness of regular frame-standing in improving strength, function, spasms, continence and fall-rate in people with severe MS. Standing reinstated a sense of belonging and optimism by restoring important life-roles and feelings of normality as participants regained previously valued activities. Implications for Rehabilitation Regular standing in an Oswestry frame may improve functional ability in people with severe MS. Regular frame standing may have a positive psychological effect on people with severe MS. Self-management of a standing regime may be feasible.

Proving the Effectiveness of Community Occupational Therapy in the Equipment and Adaptation Setting Using the Canadian Occupational Performance Measure

The Community Occupational Therapy Service (Equipment and Adaptations) at Worcestershire Health and Care National Health Service Trust, Redditch and Bromsgrove Locality identified the need to find an outcome measure that would determine its effectiveness. The Canadian Occupational Performance Measure was chosen as a client-centred, reliable, and validated outcome measure that was integrated within existing paperwork. The process followed is outlined in this practice analysis.

The service completed 1,869 Canadian Occupational Performance Measure scores, which showed a statistically significant increase in client ratings of performance and satisfaction in 90% of clients, illustrating the effectiveness of the service. The aim of this practice analysis is to explain the process that this service followed to integrate the Canadian Occupational Performance Measure into practice and, thus, share the benefit of using it as an outcome measure with colleagues who work in a similar setting. The authors highlight the importance of continuing with the Canadian Occupational Performance Measure and look to develop its use further.

Dexterity, visual perception, and activities of daily living in persons with multiple sclerosis

ABSTRACT The purposes of this study were to compare dexterity, visual perception, and abilities to carry out activities of daily living (ADL) in persons with different multiple sclerosis (MS) subtypes and to determine what relationships exist between the three variables. Fifty-six persons with MS were administered tests of dexterity, visual perception, and ADL ability. Demographic variables and scores on Kurtzke's Expanded Disability Status Scale were also collected. Scores from the chronic-progressive group were significantly higher than those of the benign and progressive-relapsing groups for the Nine-Hole Peg Test-Left Hand, Grooved Peg Test, and Functional Status Index (except Functional Status Index-Pain). There were no differences between the MS groups for any demographic variables except on the Expanded Disability Status Scale. Visual perception did not correlate with dexterity or ADL ability, and only dexterity scores for the left hand correlated with ADL ability. Persons with the severer subtype of MS were significantly impaired compared with the least severe group for dexterity and ADL ability. Decreased dexterity was associated with needing more assistance and having more perceived difficulty with ADL.

Self-perceived performance and satisfaction with performance of daily activities in persons with multiple sclerosis following interdisciplinary rehabilitation

PURPOSE

To assess self-perceived performance and satisfaction with performance of daily activities in persons with multiple sclerosis (MS) on admission to and at discharge from interdisciplinary rehabilitation.

METHOD

A retrospective study with a pre-post design. Twenty-seven women and 16 men with MS (mean age 51 years; median EDSS 6.5) participated in an individualised, goal-oriented, interdisciplinary, rehabilitation programme (average length 4 weeks). The Canadian Occupational Performance Measure (COPM) was used on admission to rehabilitation and at discharge.

RESULTS

On admission, the persons prioritised 216 activities that they perceived difficult to perform (mean number 3, range 2-8). Of these, 136 (63%) were in the COPM area of self-care, 52 (24%) in productivity and 28 (13%) in leisure. The lowest mean ratings of performance were found in the subgroups active recreation, community management and socialisation, and for satisfaction in the subgroup socialisation. For about 60% of the 216 prioritised activities, ratings of COPM performance as well as satisfaction were higher at discharge than on admission. For 18 (42%) and 24 (56%) persons, respectively, the mean change scores of performance and of satisfaction were equal to or greater than 2.0 at discharge, indicating a clinically significant change.

CONCLUSIONS

Persons with MS can experience problems with all types of daily activities upon admission to rehabilitation, but also perceive improvements in their performance and satisfaction with performance in these activities at discharge from rehabilitation. Using patient-reported outcome measures, such as the COPM, may contribute to a broader understanding of the benefits of interdisciplinary rehabilitation in persons with MS. Implications for Rehabilitation Persons with MS can perceive problems with all types of daily activities which have to be considered during interdisciplinary rehabilitation. Following interdisciplinary rehabilitation, persons with MS can perceive improvements in their performance and satisfaction with performance in all types of daily activities. Patient-reported outcome measures can contribute to a broader understanding of the benefits of interdisciplinary rehabilitation in persons with MS.

Environmental factors affecting the daily functioning of jordanian individuals with multiple sclerosis

Occupational therapists must consider the hindering and facilitating effects of the environment on patients' functional performance when planning therapeutic interventions. The purpose of this study was to explore environmental factors that hinder, and available services that facilitate, the daily functioning of Jordanian individuals with multiple sclerosis (MS) as perceived by the patients themselves. A sample of 103 Jordanian individuals with MS completed a questionnaire on hindering environmental factors and facilitative services. Factors and services were identified according to their description in the World Health Organization's International Classification of Functioning, Disability and Health. Environmental factors that were reported by the participants to be most hindering to their daily functioning were stores and malls (74.2%), noise (87.1%), attitudes of immediate family (52.0%), and government policies and regulations (52.2%). Moreover, the participants reported that psychological services were the least available facilitative services in the community (83.8%). Weak-to-moderate but significant correlations were found between a number of demographic variables and perceived hindering factors. The study results indicate that hindering factors, facilitative services, and demographic variables should be given greater attention by rehabilitation practitioners (especially occupational therapists) when planning intervention programs for Jordanian individuals with MS.

Occupational Adaptation in People with Multiple Sclerosis

The aim of this study was to gain an enhanced understanding of how people with multiple sclerosis experience their occupational adaptation. Ten people with multiple sclerosis were interviewed and the constant comparative method was used to analyze the data. Their occupational adaptation was experienced as a constant struggle and non-linear, and served as the means of achieving either a desired self or a desired family life. Adaptations of occupations differed according to the evolving goals of the participants. The findings showed that the participants often selected occupational adaptations to meet their family needs over their own. These findings can help professionals to establish where their clients with multiple sclerosis are in the adaptation process and offer appropriate client-centered interventions.

Impact on activities of daily living using a functional electrical stimulation device to improve dropped foot in people with multiple sclerosis, measured by the Canadian Occupational Performance Measure

Background: Dropped foot is a common problem following multiple sclerosis. Functional electrical stimulation can elicit an active muscle contraction providing dorsiflexion and eversion.

Objective: To determine if the Odstock dropped foot stimulator (ODFS), improved Activities of Daily Living for people with multiple sclerosis.

Method: 64 people with unilateral dropped foot due to secondary progressive multiple sclerosis took part in a randomized controlled trial. Research volunteers were assigned to a group using the ODFS or a group who received physiotherapy exercises for 18 weeks. Outcome measures were the Canadian Occupational Performance Measure (COPM) and a falls diary.

Results: Results of 53 research volunteers are reported. Improvements in performance and satisfaction scores were greater in the ODFS group than the exercise group; ( p < 0.05). Use of the ODFS was also perceived as effective in reducing tripping and increasing walking distance. The median number of falls were 5 in the ODFS group and 18 in the exercise group ( p = 0.036) over the study period.

Conclusion: The study shows that people with multiple sclerosis using the ODFS increased their COPM performance and satisfaction scores of their identified problems of Activities of Daily Living more than a matched group who received physiotherapy exercises. ODFS users also experienced fewer falls.