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De Coninck L, Declercq A, Bouckaert L, Döpp C, Graff MJL, Aertgeerts B. Promoting meaningful activities by occupational therapy in elderly care in Belgium: the ProMOTE intervention. BMC Geriatr 2024; 24:275. [PMID: 38509458 PMCID: PMC10953191 DOI: 10.1186/s12877-024-04797-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 02/08/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Older 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. AIM To 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. METHODS A 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. RESULTS The 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. CONCLUSION This 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.
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Affiliation(s)
- Leen De Coninck
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7, Leuven, 3000, Belgium.
- CEBAM Belgian Center for Evidence-based Medicine vzw, Kapucijnenvoer 7, Leuven, 3000, Belgium.
| | - Anja Declercq
- LUCAS Center for Care Research and Consultancy & CESO Center for Sociological Research, KU Leuven, Minderbroedersstraat 8, Leuven, 3000, Belgium
| | - Leen Bouckaert
- Department of Occupational Therapy, Artevelde University of Applied Sciences, Voetweg 66, Ghent, 9000, Belgium
| | - Carola Döpp
- Scientific Institute for Quality of Health Care, Department of Rehabilitation, Radboudumc Research Institute, Radboud University Medical Center, Houtlaan 4, Nijmegen, 6525 XZ, The Netherlands
| | - Maud J L Graff
- Scientific Institute for Quality of Health Care, Department of Rehabilitation, Radboudumc Research Institute, Radboud University Medical Center, Houtlaan 4, Nijmegen, 6525 XZ, The Netherlands
| | - Bert Aertgeerts
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7, Leuven, 3000, Belgium.
- CEBAM Belgian Center for Evidence-based Medicine vzw, Kapucijnenvoer 7, Leuven, 3000, Belgium.
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Mitterfellner R, D'Cunha NM, Isbel S. Occupation-Based Interventions to Improve Occupational Performance Among Older Adults Living in Long-Term Care: A Systematic Review. Am J Occup Ther 2024; 78:7801205140. [PMID: 38231082 DOI: 10.5014/ajot.2024.050441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
IMPORTANCE Evidence for the positive effects of occupation-based interventions on occupational performance is increasing; however, little is known about the impacts of occupation-based interventions on older adults living in long-term care. OBJECTIVE To consolidate the evidence on the effectiveness of occupation-based interventions for improving occupational performance among older adults living in long-term care. DATA SOURCES MEDLINE, CINAHL, PsycINFO, SCOPUS, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from journal-database inception to February 2023. STUDY SELECTION AND DATA COLLECTION This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles were peer-reviewed studies published in English that evaluated occupation-based interventions for older adults living in long-term care and used validated tools to measure occupational performance. FINDINGS Seventeen articles, with 2,974 participants, were identified. The reviewed studies included 6 Level 1b randomized controlled trials, 5 Level 2b studies of various study designs, and 5 Level 3b studies with quasi-experimental designs. Across studies, heterogeneous measures were used to assess occupational performance. All studies implemented client-centered, occupation-based interventions designed and/or delivered by occupational therapists. Interventions were tailored to residents' goals, interests, or abilities to improve occupational performance and participation, and inconsistent effects were reported. CONCLUSIONS AND RELEVANCE Moderate evidence supports the use of occupation-based interventions tailored to individual residents and incorporation of physical activities for improving the occupational performance of older adults living in long-term care. Currently, evidence for care partner involvement and multilevel occupation-based interventions is limited. Plain-Language Summary: This study adds to the evidence base indicating that occupation-based interventions have the potential to promote the occupational performance of older adults living in long-term care. High-quality randomized controlled trials with longer term follow-up and assessment of clinically meaningful outcomes are critical for developing the evidence base in this practice setting.
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Affiliation(s)
- Rachael Mitterfellner
- Rachael Mitterfellner, MOT, BMedSc, is Occupational Therapist, Canberra Health Services, and Professional Associate, Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia. At the time of this research, Mitterfellner was Postgraduate Research Student, School of Exercise and Rehabilitation Sciences, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Nathan M D'Cunha
- Nathan M. D'Cunha, PhD(Health), BHumNutr(Hons), is Assistant Professor, Human Nutrition, School of Exercise and Rehabilitation Sciences, Faculty of Health, and Theme Lead (Dementia and Cognition), Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Stephen Isbel
- Stephen Isbel, HScD, MOT, MHA, BAppSc(OT), GCTE, is Professor, Occupational Therapy, School of Exercise and Rehabilitation Sciences, Faculty of Health, and Theme Lead (Innovative Care Models), Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia;
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Hagelskjær V, Bülow CV, Nielsen KT, Henriksen M, Wæhrens EE. Effectiveness of an individualised occupational therapy intervention programme (ABLE) using adaptational strategies on activities of daily living among persons with chronic conditions: A randomised controlled trial (RCT). Clin Rehabil 2023; 37:1637-1655. [PMID: 37309135 DOI: 10.1177/02692155231180720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Compare the effectiveness of a problem-solving, individualised, home-based occupational therapy intervention (ABLE 2.0), to usual occupational therapy, on activities of daily living (ADL) ability in persons with chronic conditions. DESIGN A single-centre, double-blinded, randomised controlled trial with 10- and 26-week follow-up. SETTING A Danish municipality. SUBJECTS Persons with chronic conditions experiencing problems performing ADL tasks (n = 80). INTERVENTIONS ABLE 2.0 was compared with usual occupational therapy. MAIN MEASURES Coprimary outcomes were self-reported ADL ability (ADL-Interview Performance) and observed ADL motor ability (Assessment of Motor and Process Skills) at Week 10. Secondary outcomes were self-reported ADL ability (ADL-Interview Performance) and observed ADL motor ability (Assessment of Motor and Process Skills) at Week 26, and perceived satisfaction with ADL ability (ADL-Interview Satisfaction) and observed ADL process ability (Assessment of Motor and Process Skills) at Weeks 10 and 26. RESULTS In total, 78 persons were randomly assigned: 40 to usual occupational therapy and 38 to ABLE 2.0. No statistically significant nor clinically relevant difference between group mean changes in primary outcomes was identified from baseline to Week 10 (ADL-Interview Performance [-0.16; 95% CI: -0.38 to 0.06] and Assessment of Motor and Process Skills ADL motor ability [-0.1; 95% CI: -0.3 to 0.1]). At Week 26, a statistically significant and clinically relevant difference was found in Assessment of Motor and Process Skills ADL motor ability (LS mean change: -0.3; 95% CI: -0.5 to -0.1) between groups. CONCLUSION ABLE 2.0 was effective in improving observed ADL motor ability at 26 weeks.
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Affiliation(s)
- Vita Hagelskjær
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Occupational Therapy, VIA University College, Holstebro, Denmark
| | - Cecilie von Bülow
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kristina Tomra Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Occupational Therapy, University College of Northern Denmark, Aalborg, Denmark
| | - Marius Henriksen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Eva Ejlersen Wæhrens
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Nielsen LM, Polatajko H, Brandi M, Nielsen TL. Feasibility of using the Cognitive Orientation to daily Occupational Performance in a population of Danish stroke survivors: Adaptation and study protocol. Scand J Occup Ther 2023; 30:1511-1522. [PMID: 37726001 DOI: 10.1080/11038128.2023.2258202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND A need was identified for an occupational therapy intervention for stroke survivors in a Danish municipal healthcare setting with emphasis on its ability to transfer and generalise what is learned in occupational therapy to everyday life post therapy. Being a possible candidate, the Cognitive Orientation to daily Occupational Performance (CO-OP) approach needed to be adapted to the target group and context, and its feasibility needed examination regarding reach, dose, intervention components, fidelity, perceived value, benefits, harms, and potential outcomes. AIM To adapt the CO-OP to a Danish healthcare setting and present a protocol for examining its feasibility. MATERIAL AND METHODS The Adapting interventions to new contexts (ADAPT) guidance was followed to (1) Assess the rationale for intervention and consider intervention-context fit, (2) Plan and undertake adaptations, and (3) Plan a feasibility study. RESULTS Intervention materials and procedures were translated and adapted for home-based occupational therapy with people in the subacute phase of stroke. A protocol was developed to examine feasibility aspects. Quantitative and qualitative evaluations were planned and measurements chosen. CONCLUSIONS AND SIGNIFICANCE The planned feasibility study will contribute to further developing and refining the intervention before performing a possible large-scale effectiveness study.
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Affiliation(s)
- Louise Moeldrup Nielsen
- Research Centre for Health and Welfare Technology, Programme for rehabilitation, VIA University College, Aarhus, Denmark
- Department of Occupational Therapy in Aarhus, VIA University College, Aarhus, Denmark
| | - Helene Polatajko
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Mette Brandi
- Neurocenter of the Municipality of Aarhus, Aarhus, Denmark
| | - Tove Lise Nielsen
- Research Centre for Health and Welfare Technology, Programme for rehabilitation, VIA University College, Aarhus, Denmark
- Department of Occupational Therapy in Aarhus, VIA University College, Aarhus, Denmark
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Tieman J, Morgan D, Jones K, Gordon S, Chakraborty A. Allied health professionals' contribution to care at end of life in aged care settings. Aust J Prim Health 2023; 29:341-348. [PMID: 36740449 DOI: 10.1071/py22178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/08/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Australian population is aging, and the proportion of older Australians will continue to grow over the coming decades. However, there is a lack of research published on the specific roles and responsibilities of allied health professionals (AHPs) providing palliative care within an aged care context. Understanding the roles and needs of AHPs providing care during the last months of life in the community and aged care facilities could contribute to workforce planning, targeted information and improved care. METHODS In total, 108 eSurveys were collected between November 2019 to May 2020 from three allied health professions working in government-funded aged care; the majority of these being in residential aged care. Descriptive data are reported on the provision of care in key palliative care domains, care settings and practice activity. RESULTS Nearly all respondents reported they had worked with older Australians who had palliative care needs. However, over one-third of respondents reported low levels of confidence in supporting clients or residents with palliative care needs. The majority indicated they would benefit from additional education and training and support in palliative care. CONCLUSIONS This study investigated the role of the allied health workforce in contributing to the care of older Australians at the end of life. It has also demonstrated that there are gaps in practice activity and work role that must be addressed to ensure this workforce can support older people with palliative care needs in receipt of aged care services.
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Affiliation(s)
- Jennifer Tieman
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia
| | - Deidre Morgan
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia
| | - Kelly Jones
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia
| | - Sue Gordon
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia
| | - Amal Chakraborty
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia; and University of Sydney, Sydney, NSW, Australia
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Hirvonen H, Johansson A. Lifestyle Redesign ® with independent living older adults in countries other than the USA. Scand J Occup Ther 2023; 30:109-124. [PMID: 35298311 DOI: 10.1080/11038128.2022.2046848] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Health promotion services need to be developed to respond to the needs of an ageing population. Lifestyle Redesign® (LR®) is an occupational therapy intervention that has been addressed as cost-effective in the USA. AIMS/OBJECTIVES This scoping review aimed to identify how the LR® has been implemented and what the results have been with older adults living independently in countries other than the USA. MATERIAL AND METHODS Sixteen studies were included. Quantitative results were interpreted through the numeric data and qualitative results through inductive thematic analysis. RESULTS The delivery of the LR® shared both similarities and differences with the original LR®, and the variations concerned interventions length, facilitators, and the outcome measures used. In the quantitative results, there was often a positive trend in intervention groups' health-related quality of life, mental health, and occupational performance; in qualitative results, there was improvement in self-esteem and possibilities in building new communities. CONCLUSIONS AND SIGNIFICANCE The original LR® was often transferrable into cultural settings other than the USA and many positive outcomes in the health and well-being of older adults were addressed. However, to understand the feasibility and effectiveness of the LR®, scientific research and publications need to be enhanced.
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Affiliation(s)
- Henna Hirvonen
- Coronaria Rehabilitation and Therapy Services, Vantaa, Finland
| | - Ann Johansson
- School of Health and Welfare, Department of Rehabilitation, Jönköping University, Jönköping, Sweden
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Nielsen TL, Holst-Stensborg HW, Nielsen LM. Strengthening problem-solving skills through occupational therapy to improve older adults' occupational performance - A systematic review. Scand J Occup Ther 2023; 30:1-13. [PMID: 35995214 DOI: 10.1080/11038128.2022.2112281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Evidence supports the role of occupational therapy (OT) for older adults, and therapeutic use of problem solving may provide a way to improve older adult's occupational performance.Aim: To assess the effectiveness and describe the contents of OT interventions aimed at improving older adults' occupational performance by strengthening their problem-solving skills.Material and Methods: This systematic review followed the phases recommended by the Cochrane Collaboration. The following databases were searched for clinical trials on OT for populations 65+ years: CINAHL, EMBASE, MEDLINE and PsycINFO. The Cochrane risk-of-bias tool (RoB-2) and the GRADE approach were used to assess the quality of the evidence. Results were presented in tables and by narrative syntheses.Results: Five studies were included comprising a total of 685 participants. In four studies, OT with a problem-solving approach outperformed control conditions post intervention. The interventions involved problem identification, analysis, strategy development and implementation. Although no serious risk of bias was detected in the individual studies, the quality of evidence was deemed low due to inconsistent and imprecise results.Conclusions: Low-quality evidence suggests that strengthening older adults' problem-solving skills may improve their occupational performance.Significance: Further investigation is required before firm practice recommendations can be prepared.
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Affiliation(s)
- Tove Lise Nielsen
- Department of Occupational Therapy, VIA University College, Aarhus, Denmark.,Programme for rehabilitation, Research Centre for Health and Welfare Technology, VIA University College, Aarhus, Denmark
| | | | - Louise Moeldrup Nielsen
- Department of Occupational Therapy, VIA University College, Aarhus, Denmark.,Programme for rehabilitation, Research Centre for Health and Welfare Technology, VIA University College, Aarhus, Denmark
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Madsen CMT, Bisgaard SK, Primdahl J, Christensen JR, von Bülow C. A Systematic Review of Job Loss Prevention Interventions for Persons with Inflammatory Arthritis. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:866-885. [PMID: 33782815 DOI: 10.1007/s10926-021-09972-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
Purpose To present an overview of the evidence of the effect of job loss prevention interventions, aiming to improve work ability and decrease absenteeism and/or job loss in persons with inflammatory arthritis (IA). Method A systematic literature search in the databases PubMed, EMBASE, CINAHL, PsycINFO and the Cochrane Library was conducted. A search strategy used in a review from 2014 was copied and additional keywords were added with no time restriction. The Cochrane Risk of Bias Tool (RoB 1) was used for quality assessment and the overall quality of each study was determined using predetermined cut-off criteria, categorising studies to be of good-, acceptable- or low quality. Results were summarised narratively. Results Six randomised controlled trials (published in seven articles) were included, one of good quality and five of acceptable quality. One study identified significant improvements in work ability, while three found no significant difference between groups. One study identified significant difference in absenteeism, while two studies identified no difference between the intervention and control groups. Two studies identified significant reduction in job loss, while two studies identified no group difference. The inconsistent results may be due to heterogeneity in interventions and outcome measures used, and the results should therefore be interpreted with caution. Conclusion The results indicate that job loss prevention interventions may have an effect on work ability, absenteeism and in particular job loss among persons with IA. Further good-quality studies regarding job loss prevention interventions for people with IA are still recommended.
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Affiliation(s)
| | - Sara Kjær Bisgaard
- Department of Public Health, University of Southern Denmark Mark, J.B. Winsløws Vej 9B, 5000, Odense C, Denmark
| | - Jette Primdahl
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Engelshøjgade 9A, 6400, Sønderborg, Denmark
- Hospital of Southern Jutland, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
| | | | - Cecilie von Bülow
- Department of Public Health, University of Southern Denmark Mark, J.B. Winsløws Vej 9B, 5000, Odense C, Denmark
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
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Hagelskjær V, Nielsen KT, von Bulow C, Oestergaard LG, Graff M, Wæhrens EE. Evaluating a complex intervention addressing ability to perform activities of daily living among persons with chronic conditions: study protocol for a randomised controlled trial (ABLE). BMJ Open 2021; 11:e051722. [PMID: 34836902 PMCID: PMC8628341 DOI: 10.1136/bmjopen-2021-051722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The need to develop and evaluate interventions, addressing problems performing activities of daily living (ADL) among persons with chronic conditions, is evident. Guided by the British Medical Research Council's guidance on how to develop and evaluate complex interventions, the occupational therapy programme (A Better everyday LifE (ABLE)) was developed and feasibility tested. The aim of this protocol is to report the planned design and methods for evaluating effectiveness, process and cost-effectiveness of the programme. METHODS AND ANALYSIS The evaluation is designed as a randomised controlled trial with blinded assessors and investigators. Eighty participants with chronic conditions and ADL problems are randomly allocated to ABLE or usual occupational therapy. Data for effectiveness and cost-effectiveness evaluations are collected at baseline (week 0), post intervention (week 10) and follow-up (week 26). Coprimary outcomes are self-reported ADL ability (ADL-Interview (ADL-I) performance) and observed ADL motor ability (Assessment of Motor and Process Skills (AMPS)). Secondary outcomes are perceived satisfaction with ADL ability (ADL-I satisfaction); and observed ADL process ability (AMPS). Explorative outcomes are occupational balance (Occupational Balance Questionnaire); perceived change (Client-Weighted Problems Questionnaire) and general health (first question of the MOS 36-item Short Form Survey Instrument). The process evaluation is based on quantitative data from registration forms and qualitative interview data, collected during and after the intervention period. A realist evaluation approach is applied. A programme theory expresses how context (C) and mechanisms (M) in the programme may lead to certain outcomes (O), in so-called CMO configurations. Outcomes in the cost-effectiveness evaluation are quality-adjusted life years (EuroQool 5-dimension) and changes in ADL ability (AMPS, ADL-I). Costs are estimated from microcosting and national registers. ETHICS AND DISSEMINATION Danish Data Protection Service Agency approval: Journal-nr.: P-2020-203. The Ethical Committee confirmed no approval needed: Journal-nr.: 19 045 758. Dissemination for study participants, in peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER NCT04295837.
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Affiliation(s)
- Vita Hagelskjær
- Copenhagen University, Bispebjerg and Frederiksberg Hospital, The Parker Institute, Copenhagen, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
- Department of Occupational Therapy, VIA University College, Holstebro, Denmark
| | - Kristina Tomra Nielsen
- Copenhagen University, Bispebjerg and Frederiksberg Hospital, The Parker Institute, Copenhagen, Denmark
- Department of Occupational Therapy, University College of Northern Denmark (UCN), Aalborg, Denmark
| | - Cecilie von Bulow
- Copenhagen University, Bispebjerg and Frederiksberg Hospital, The Parker Institute, Copenhagen, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Lisa Gregersen Oestergaard
- Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
- DEFACTUM, Department of Public Health and Rehabilitation, Central Denmark Region, Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Maud Graff
- Department of Rehabilitation & Scientific Institute for Quality of Care Research, Radboud University Medical Center, Nijmegen, Netherlands
| | - Eva Ejlersen Wæhrens
- Copenhagen University, Bispebjerg and Frederiksberg Hospital, The Parker Institute, Copenhagen, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
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Wæhrens EE, Nielsen KT, Cutchin M, Fritz H, Jonsson H, la Cour K. Fostering Change Through Occupation-Based Intervention: An International Joint Group Concept Mapping Study. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2021; 42:10-21. [PMID: 34474628 DOI: 10.1177/15394492211038283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Further consolidation and clarity regarding occupation as a means to foster change in interventions are needed. The study aimed to utilize the knowledge of occupational scholars to systematically determine what is required to use occupation as means to foster change within occupation-based interventions and to generate a conceptual model from those results. Group Concept Mapping involved the following: preparation, generation of ideas, structuring of statements, data analysis, interpretation of maps, and development of conceptual model. Fifty-two international occupational scholars brainstormed 125 ideas. A cluster rating map with nine clusters posed the foundation for a conceptual model with seven themes, namely, artful use of occupation, evidence-based use of occupation, collaboration to promote occupation, coordinating intervention fit, client factors, sociocultural context, and structural influences. The conceptual model, capturing dimensions and dynamics required for using occupation to foster change, may guide future research into occupation-based interventions.
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Affiliation(s)
- Eva Ejlersen Wæhrens
- University of Southern Denmark, Odense, Denmark.,Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Kristina Tomra Nielsen
- University of Southern Denmark, Odense, Denmark.,Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,University College of Northern Denmark, Aalborg, Denmark
| | - Malcolm Cutchin
- Pacific Northwest University of Health Sciences, Yakima, WA, USA
| | - Heather Fritz
- Pacific Northwest University of Health Sciences, Yakima, WA, USA
| | - Hans Jonsson
- University of Southern Denmark, Odense, Denmark.,Karolinska Institutet, Stockholm, Sweden
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Hansen AØ, Kristensen HK, Cederlund R, Möller S, Tromborg H. An occupation-based intervention in patients with hand-related disorders grouped using the sense of coherence scale-A randomized controlled trial. J Hand Ther 2021; 33:455-469. [PMID: 32156580 DOI: 10.1016/j.jht.2019.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 09/20/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A nonblinded randomized controlled trial. INTRODUCTION Occupation-based interventions are superior to physical exercise-based interventions in patients with activity limitations. However, only a few studies have examined the effect in patients with hand-related disorders. Patients recover heterogeneously, which could be due to personal factors, such as sense of coherence (SOC). PURPOSE OF THE STUDY To investigate the effectiveness of an occupation-based intervention for patients with hand-related disorders and whether SOC can give an indication of the expected effects. METHODS A total of 504 patients were stratified into three SOC groups and then randomized to either an occupation-based intervention, including physical exercises (OBI) or a physical exercise-based occupation-focused intervention. The primary outcome, functioning, was measured using the Disability of the Arm, Shoulder and Hand questionnaire. Primary endpoint was at three months. Patients were followed up for a year. RESULTS No significant difference was found in primary outcome analysis. Nevertheless, patients receiving OBI had a statistically significant and greater change in satisfaction with their occupational performance at one, two, and three months follow-up. Patients with a weak SOC had worse functioning and lower health-related quality of life than those in the other groups, at all times. CONCLUSIONS OBI as delivered in this study was not superior to physical exercise-based occupation-focused intervention in this patient group. However, in taking a client-centered approach, we recommend that OBI be based on individual needs, given that patients had a statistically greater change in score regarding satisfaction with their occupational performance. It is evident that patients with a weaker SOC have a lower level of functioning. This knowledge should inform clinical practice.
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Affiliation(s)
- Alice Ørts Hansen
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark; Department of Orthopaedic Surgery, Odense University Hospital, Odense C, Denmark; Department of Rehabilitation, Odense University Hospital, Odense C, Denmark.
| | - Hanne Kaae Kristensen
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark; Department of Rehabilitation, Odense University Hospital, Odense C, Denmark; Health Sciences Research Center, University College Lillebaelt, Odense M, Denmark
| | | | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark; OPEN - Odense Patient data Explorative Network, Odense University Hospital, Odense C, Denmark
| | - Hans Tromborg
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark; Department of Orthopaedic Surgery, Odense University Hospital, Odense C, Denmark
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Hagelskjær V, Nielsen KT, von Bülow C, Graff M, Wæhrens EE. 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. Pilot Feasibility Stud 2021; 7:122. [PMID: 34116727 PMCID: PMC8192272 DOI: 10.1186/s40814-021-00861-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Vita Hagelskjær
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark. .,Occupational Science & Occupational Therapy, User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark. .,Department of Occupational Therapy, VIA University College, Holstebro, Denmark.
| | - Kristina Tomra Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Occupational Therapy, University College of Northern Denmark, Aalborg, Denmark
| | - Cecilie von Bülow
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Occupational Science & Occupational Therapy, User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Maud Graff
- Department of Rehabilitation & Scientific Institute for Quality of Care Research, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eva Ejlersen Wæhrens
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Occupational Science & Occupational Therapy, User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
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13
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Schepens Niemiec SL, Vigen CLP, Martínez J, Blanchard J, Carlson M. Long-Term Follow-Up of a Lifestyle Intervention for Late-Midlife, Rural-Dwelling Latinos in Primary Care. Am J Occup Ther 2021; 75:7502205020p1-7502205020p11. [PMID: 33657344 PMCID: PMC7929605 DOI: 10.5014/ajot.2021.042861] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Importance: Rural-dwelling Latinos are an underresourced population in need of accessible and effective wellness programs. Objective: To evaluate patients’ long-term health-related outcomes after lifestyle intervention. Design: An uncontrolled pilot trial assessing change in health from pretreatment to long-term follow-up (12 mo after intervention completion, no contact) and from posttreatment to long-term follow-up. Setting: Rural, community-based primary care. Participants: Latino and Hispanic safety-net primary care patients, ages 50 to 64 yr. Intervention: A culturally tailored, 4-mo lifestyle intervention co-led by occupational therapy practitioners and Latino community health workers that features telehealth and in-home sessions covering topics such as healthy eating and navigating health care. Outcomes and Measures: Self-reported and physiological outcomes: symptom–well-being (primary), stress, sleep disturbance, social satisfaction, physical activity, patient activation, blood pressure, and weight. Exit interviews addressed health experiences and intervention impact on participants’ lives. Results: Participants (N = 27) demonstrated clinically significant pretreatment to long-term follow-up benefits in all symptom–well-being dimensions (Cohen’s d ≥ 0.8, p ≤ .004), with additional gains from posttreatment to long-term follow-up (d ≥ 0.4, p ≤ .05). Significant improvements from pre- to posttreatment in systolic blood pressure, stress, and social role and activity satisfaction were maintained at long-term follow-up. No changes were observed in weight, physical activity, or diastolic blood pressure. Participants described the intervention’s sustained positive effect on their wellness. Conclusions and Relevance: A lifestyle intervention led by occupational therapy practitioners and community health workers in a primary care context has potential to achieve long-term health benefits in rural-dwelling, late-midlife Latinos. What This Article Adds: This study reveals that rural, late-midlife Latinos showed long-lasting improvements in psychological and physical health after finishing a program that helped them make healthy lifestyle choices. This finding supports the unique contribution of occupational therapy in primary care settings.
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Affiliation(s)
- Stacey L Schepens Niemiec
- Stacey L. Schepens Niemiec, PhD, OTR/L, is Associate Professor of Research, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;
| | - Cheryl L P Vigen
- Cheryl L. P. Vigen, PhD, is Associate Professor of Research, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Jenny Martínez
- Jenny Martínez, OTD, OTR/L, BCG, is Associate Professor, Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA
| | - Jeanine Blanchard
- Jeanine Blanchard, PhD, OTR/L, is Project Manager, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Mike Carlson
- Mike Carlson, PhD, is Professor of Research, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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14
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Nielsen KT, Guidetti S, von Bülow C, Klokker L, Wæhrens EE. Feasibility of ABLE 1.0-a program aiming at enhancing the ability to perform activities of daily living in persons with chronic conditions. Pilot Feasibility Stud 2021; 7:52. [PMID: 33602338 PMCID: PMC7891027 DOI: 10.1186/s40814-021-00790-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 02/04/2021] [Indexed: 12/31/2022] Open
Abstract
Background The “A Better everyday LifE” (ABLE) intervention was developed to accommodate the need of a program addressing ability to perform activities of daily living (ADL) in persons with chronic conditions living at home. During intervention development, it is necessary to evaluate relevant aspects of the feasibility of a program. Thus, the aim was to evaluate the feasibility of content and delivery of ABLE version 1.0. Methods A one group pre- and post-test design was applied. Thirty persons with chronic conditions, two occupational therapists (OTs), and five occupational therapy students (OTSs) participated. ABLE 1.0 is an 8-week program consisting of ADL evaluation (session 1); goal setting and reasons for ADL problems (session 2); intervention (sessions 3–7); and re-evaluation (final session), conducted in the clients’ home-setting and local area. Sessions 1–4 and the final session was mandatory. To evaluate the feasibility of content and delivery, the OTs, after each session, reported on applied intervention component(s), time-use, needed equipment, adjustments, meaningfulness, confidence, progress toward goal attainment, and side effects using registration forms. The clients reported on progress toward goal attainment, meaningfulness, and satisfaction. Clinically relevant improvements in ADL ability were identified using the ADL-Interview (ADL-I) and the Assessment of Motor and Process Skills (AMPS). Goal attainment was evaluated using the Goal Attainment Scaling (GAS). Results Twenty clients (67%) completed ABLE 1.0 and received four sessions (median = 4, range 4–7) each lasting between 30 and 94 min. Most frequently applied component was “Changing habits related to task performance”. Generally, OTs reported having the needed equipment. Deviations from the manual were made by omission of GAS and AMPS and less than mandatory number of sessions per client. The OTs reported confidence in delivering the program and the clients perceived the program as meaningful and satisfying, and experienced progress toward goal attainment. Goal attainment was found in 52% of the goals. Sixteen (80%) clients obtained clinically relevant improvements in self-reported or observed ADL ability. Conclusions The content and delivery of ABLE 1.0 was feasible. However, the study revealed a need to adjust the recruitment procedure and make minor changes in the intervention manual. A pilot randomized controlled trial (RCT) study is recommended. Trial registration The study was registered at ClinicalTrials.gov with registration no. NCT03335709 on November 8, 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00790-7.
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Affiliation(s)
- Kristina Tomra Nielsen
- Department of Occupational Therapy, University College of Northern Denmark (UCN), Selma Lagerløfs vej 2, DK-9220, Aalborg Ø, Denmark. .,The ADL Unit, the Parker Institute, Copenhagen University Hospital Bispebjerg - Frederiksberg, Nordre Fasanvej 57, Road 8, entrance 19, DK-2000, Frederiksberg, Denmark. .,The Research Initiative for Activity Studies and Occupational Therapy, Research Unit for General Practice, Department of Public Health, University of Southern Denmark (SDU), J.B. Winsløwsvej 9, DK-5000, Odense, Denmark.
| | - Susanne Guidetti
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Alfred Nobels Allé 23, SE-141 83, Huddinge, Sweden
| | - Cecilie von Bülow
- The ADL Unit, the Parker Institute, Copenhagen University Hospital Bispebjerg - Frederiksberg, Nordre Fasanvej 57, Road 8, entrance 19, DK-2000, Frederiksberg, Denmark.,The Research Initiative for Activity Studies and Occupational Therapy, Research Unit for General Practice, Department of Public Health, University of Southern Denmark (SDU), J.B. Winsløwsvej 9, DK-5000, Odense, Denmark
| | - Louise Klokker
- The Musculoskeletal Statistics Unit, the Parker Institute, Copenhagen University Hospital Bispebjerg - Frederiksberg, Nordre Fasanvej 57, Road 8, entrance 19, DK-2000, Frederiksberg, Denmark
| | - Eva Ejlersen Wæhrens
- The ADL Unit, the Parker Institute, Copenhagen University Hospital Bispebjerg - Frederiksberg, Nordre Fasanvej 57, Road 8, entrance 19, DK-2000, Frederiksberg, Denmark.,The Research Initiative for Activity Studies and Occupational Therapy, Research Unit for General Practice, Department of Public Health, University of Southern Denmark (SDU), J.B. Winsløwsvej 9, DK-5000, Odense, Denmark
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15
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Tokuda K, Maruta M, Shimokihara S, Han G, Tomori K, Tabira T. Self-Selection of Interesting Occupation Facilitates Cognitive Response to the Task: An Event-Related Potential Study. Front Hum Neurosci 2020; 14:299. [PMID: 32848674 PMCID: PMC7417604 DOI: 10.3389/fnhum.2020.00299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/03/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Keiichiro Tokuda
- Department of Rehabilitation, Medical Corporation, Gyokusyoukai Takada Hospital, Kagoshima, Japan
- *Correspondence: Keiichiro Tokuda
| | - Michio Maruta
- Doctoral Program of Clinical Neuropsychiatry, Graduate School of Health Science, Kagoshima University, Kagoshima, Japan
- Department of Rehabilitation, Medical Corporation, Sansyukai, Okatsu Hospital, Kagoshima, Japan
| | - Suguru Shimokihara
- Department of Rehabilitation, Medical Corporation, Nissyoukai Minamikagoshimasakura Hospital, Kagoshima, Japan
| | - Gwanghee Han
- Doctoral Program of Clinical Neuropsychiatry, Graduate School of Health Science, Kagoshima University, Kagoshima, Japan
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto, Japan
| | - Kounosuke Tomori
- Department of Occupational Therapy, School of Health Science, Tokyo University of Technology, Nishikamata, Ota-Ku, Japan
| | - Takayuki Tabira
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
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16
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Nielsen TL, Nielsen LM. Can strengthening older adults' problem-solving skills through occupational therapy improve their occupational performance? A protocol for a systematic review and meta-analysis. Scand J Occup Ther 2020; 28:348-353. [PMID: 32544358 DOI: 10.1080/11038128.2020.1775886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Older adults' occupational performance is challenged due to chronic health conditions, aging processes, and deteriorating functioning. Thus, their occupational performance cannot be expected to remain stable in the long term after an occupational therapy intervention. Older adults may therefore need to strengthen their problem-solving skills during occupational therapy not only to solve current occupational performance issues but also to maintain their improvements and deal with new such issues a later point in time. AIMS This systematic review and meta-analysis aims to identify, analyse and present current scientific knowledge about the effectiveness and contents of occupational therapy interventions aimed at improving older adults' occupational performance by strengthening their problem-solving skills. METHODS MEDLINE, EMBASE, CINAHL and PsycINFO will be searched systematically to identify trials of occupational therapy interventions aimed at improving older adults' occupational performance by strengthening their problem-solving skills. We will include randomized controlled trials and quasi-experimental trials in populations aged 65+. Three reviewers will independently screen and select references, extract data and assess the quality of included studies using the Cochrane Collaboration's risk of bias tool. SIGNIFICANCE The findings can inform and inspire clinical practice and will help to identify the need for further research.
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Affiliation(s)
- Tove Lise Nielsen
- Department of Occupational Therapy, VIA University College, Aarhus, Denmark.,Programme for rehabilitation, VIA University College Research Centre for Health and Welfare Technology, Aarhus, Denmark
| | - Louise Moeldrup Nielsen
- Department of Occupational Therapy, VIA University College, Aarhus, Denmark.,Programme for rehabilitation, VIA University College Research Centre for Health and Welfare Technology, Aarhus, Denmark
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Pergolotti M, Deal AM, Williams GR, Bryant AL, McCarthy L, Nyrop KA, Covington KR, Reeve BB, Basch E, Muss HB. Older Adults with Cancer: A Randomized Controlled Trial of Occupational and Physical Therapy. J Am Geriatr Soc 2020; 67:953-960. [PMID: 31034594 DOI: 10.1111/jgs.15930] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 03/01/2019] [Accepted: 03/20/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The impact of occupational therapy (OT) and physical therapy (PT) on functional outcomes in older adults with cancer is unknown. DESIGN Two-arm single-institution randomized controlled trial of outpatient OT/PT. SETTING Comprehensive cancer center with two off-site OT/PT clinics. PARTICIPANTS We recruited adults 65 years and older with a recent diagnosis or recurrence of cancer within 5 years, with at least one functional limitation as identified by a geriatric assessment. Participants were randomized to OT/PT or usual care. INTERVENTION Rehabilitation consisted of individualized OT and PT that addressed functional activities and strength/endurance needs. MEASUREMENTS Primary outcome was functional status as measured by the Nottingham Extended Activities of Daily Living scale. Secondary outcomes were Patient-Reported Outcomes Measurement Information System-Global Mental Health (GMH) and Global Physical Health (GPH), ability to participate in Social Roles (SR), physical function, and activity expectations and self-efficacy (Possibilities for Activity Scale [PActS]). RESULTS Among those recruited (N = 63), only 45 patients (71%) were evaluable due to loss of follow-up and/or nonreceipt of intervention. The median age was 74 years; 53% were female, and 91% were white. Overall, 30% patients had hematologic malignancies, 30% breast cancer, and 16% colorectal cancers. A total of 65% were in active treatment; 49% had stage 3 or 4 disease. At follow-up, both OT/PT (P = .02) and usual care (P = .03) groups experienced a decline in functional status. PActS scores between groups (P = .04) was significantly improved in the intervention group. GMH and SR met criteria for minimally important clinical difference favoring the intervention, but not statistical significance. Several barriers were noted in the implementation of the intervention program: recruitment, concerns about cost, distance, scheduling, and limited treatment provided. CONCLUSION OT/PT may positively influence activity expectations and self-efficacy. Future research needs to address significant barriers to implementation to increase use of OT/PT services and access to quality care. J Am Geriatr Soc 67:953-960, 2019.
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Affiliation(s)
- Mackenzi Pergolotti
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado.,ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, Pennsylvania
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Grant R Williams
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ashley L Bryant
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lauren McCarthy
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kirsten A Nyrop
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kelley R Covington
- Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado
| | - Bryce B Reeve
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Center for Health Measurement, Department of Population Health Sciences and Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Nielsen KT, la Cour K, Christensen JR, Pilegaard MS, von Bülow C, Brandt Å, Peoples H, Jonsson H, Wæhrens EE. Lessons learned about occupation-focused and occupation-based interventions: A synthesis using group concept mapping methodology. Scand J Occup Ther 2019; 27:481-492. [PMID: 30661484 DOI: 10.1080/11038128.2018.1561940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Occupational therapy (OT) is based on the core assumption that humans are active beings through engagement in occupations. Within OT, occupation is typically used as primary means and/or ends i.e. occupation-focused and/or occupation-based interventions are employed. Studies evaluating such interventions are limited.Objectives: To synthesize experiences about occupation-focused and/or occupation-based interventions. Hence, to identify, organize and prioritize experiences with employing occupation as a core element in OT intervention studies.Methods: Participants were OT PhD students and researchers involved in studies concerning occupation-focused and/or occupation-based interventions. Group Concept Mapping was applied.Results: Based on 133 ideas, a conceptual model emerged encompassing two overall dimensions concerning 'developing interventions' and 'planning intervention studies', respectively. Moreover, ten themes related to one or both dimensions were defined and 94 ideas across clusters had high importance ratings.Conclusion: Synthesis of participants' experiences indicates that 'doing' as agent of change is a core element of OT interventions. Moreover, a multi-level perspective is needed to reach sustainable changes in doing. Group- and peer-support can work as amplifier for change, and flexibility is important during intervention. Such complex interventions need special design and mixed methods in the development, and evaluation of outcome needs to address occupation.
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Affiliation(s)
- Kristina Tomra Nielsen
- The Research Initiative for Activity Studies and Occupational Therapy, General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,The ADL unit, The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.,Department of Occupational Therapy, University College of Northern Denmark, Aalborg, Denmark
| | - Karen la Cour
- The Research Initiative for Activity Studies and Occupational Therapy, General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Nyborg, Denmark
| | - Jeanette Reffstrup Christensen
- The Research Initiative for Activity Studies and Occupational Therapy, General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Research Unit for Physical Activity and Health at Work, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Marc Sampedro Pilegaard
- The Research Initiative for Activity Studies and Occupational Therapy, General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Cecilie von Bülow
- The Research Initiative for Activity Studies and Occupational Therapy, General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,The ADL unit, The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Åse Brandt
- The Research Initiative for Activity Studies and Occupational Therapy, General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,The National Board of Social Services, Odense, Denmark
| | - Hanne Peoples
- The Research Initiative for Activity Studies and Occupational Therapy, General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Center, University College Lillebaelt, Odense, Denmark
| | - Hans Jonsson
- The Research Initiative for Activity Studies and Occupational Therapy, General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Eva Ejlersen Wæhrens
- The Research Initiative for Activity Studies and Occupational Therapy, General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,The ADL unit, The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark
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Nagayama H, Kobayashi N, Ishibashi Y, Kobayashi R, Murai C, Yamauchi K. Cost and outcome of occupation-based practice for community dwelling frail elderly: a pilot study. Clin Interv Aging 2018; 13:1177-1182. [PMID: 29983552 PMCID: PMC6027685 DOI: 10.2147/cia.s163381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this pilot study was to determine the effectiveness and costs of the occupation-based practice for community dwelling frail elderly. Design Pilot pre-post design without a control group. Setting A care management center involving 37 local elderly. Subject The final analysis included 26 frail elderly in a community dwelling center. Intervention The intervention was occupation-based practice involving setting of client-centered goals, observation of real living situations, and provision of advice on the individual problem of real occupation. Outcome The outcome was the Frenchay Activities Index (FAI), which is used to evaluate the instrumental activities of daily living (IADL). Additionally, the frequency, duration, and cost of the intervention were calculated. Results Regarding the FAI score before and after the interventions, there were significant improvements in all items except work (P<0.05, effect size [r]: 0.67–0.93). A total of 15 people out of 26 (57.7%) showed improvement in activities of daily living. The frequency of interventions was 3.7 (95% confidence interval [CI]: 2.83–4.48), and the duration was 7.4 weeks (95% CI: 5.27–9.42). The average intervention cost was $258 (95% CI: 200.4–317.4). Conclusion The results of this study showed that occupation-based practice has a potential to improve IADL in frail elderly, with low frequency of intervention, within a short-term, and direct cost reduction. We believe that this pilot study will contribute to future clinical studies for frail elderly, and the findings can be easily applied to daily clinical intervention. A well-designed prospective randomized-controlled trial is necessary to verify these results.
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Affiliation(s)
- Hirofumi Nagayama
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Japan
| | - Norikazu Kobayashi
- Division of Occupational Therapy, Faculty of Health Sciences, Tokyo Metropolitan University, Arakawa, Japan
| | - Yu Ishibashi
- Division of Occupational Therapy, Faculty of Health Sciences, Tokyo Metropolitan University, Arakawa, Japan
| | - Ryuji Kobayashi
- Division of Occupational Therapy, Faculty of Health Sciences, Tokyo Metropolitan University, Arakawa, Japan
| | - Chika Murai
- Department of Occupational Therapy, Ishikawa Prefectural Takamatsu Hospital, Kahoku, Japan
| | - Keita Yamauchi
- Graduate School of Health Management, Keio University, Fujisawa, Japan
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Poulsen HS, Hansen AØ. Occupational performance problems identified by 507 patients: An insight that can guide occupation-based hand therapy. HAND THERAPY 2018. [DOI: 10.1177/1758998318784316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Several barriers challenge the use of occupation-based interventions in hand therapy. An outpatient clinical setting can be prepared in such a way as to address the most common occupational performance problems which might promote an occupation-based intervention. To this end, more knowledge is needed about which problems patients with hand-related disorders consider most important. Methods Interviews using the Canadian Occupational Performance Measure (COPM)were conducted with 507 patients. Data were entered into Microsoft Excel in the COPM categories: Self-care, productivity and leisure and analysed using descriptive statistics. Data concerning main problem areas were categorized according to the Taxonomic Code of Occupational Performance (TCOP). The analysis included the number of prioritized occupational performance problems (NPOPP) in each COPM category/subcategory; the NPOPP in each category is relative to gender and age and the most frequent problems. Results The total NPOPP was 2384. Problems within productivity and self-care constituted the largest proportion, respectively, 46% and 40%. Gender or age affected the NPOPP in each category to a limited extend. Problems were expressed at all levels in the TCOP, except the lowest level. The most frequently expressed problem was use of utensils when eating. Conclusion The problems mostly concern productivity and self-care, regardless of gender or age. Patients consider problems at the levels of occupation, activities, tasks and actions to be important and meaningful to address in their intervention. This study provides useful knowledge that can be applied when preparing a setting to address the most common problems, which could lead to the promotion of occupation-based interventions.
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Affiliation(s)
- Helle S Poulsen
- Department of Rehabilitation, Odense University Hospital, Odense, Denmark
| | - Alice Ø Hansen
- Department of Rehabilitation, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Research Unit for Rehabilitation, University of Southern Denmark, Odense, Denmark
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Nielsen LM, Maribo T, Kirkegaard H, Petersen KS, Lisby M, Oestergaard LG. Effectiveness of the "Elderly Activity Performance Intervention" on elderly patients' discharge from a short-stay unit at the emergency department: a quasi-experimental trial. Clin Interv Aging 2018; 13:737-747. [PMID: 29731615 PMCID: PMC5927350 DOI: 10.2147/cia.s162623] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose To examine the effectiveness of the Elderly Activity Performance Intervention on reducing the risk of readmission in elderly patients discharged from a short-stay unit at the emergency department. Patients and methods The study was conducted as a nonrandomized, quasi-experimental trial. Three hundred and seventy-five elderly patients were included and allocated to the Elderly Activity Performance Intervention (n=144) or usual practice (n=231). The intervention consisted of 1) assessment of the patients’ performance of daily activities, 2) referral to further rehabilitation, and 3) follow-up visit the day after discharge. Primary outcome was readmission (yes/no) within 26 weeks. The study was registered in ClinicalTrial.gov (NCT02078466). Results No between-group differences were found in readmission. Overall, 44% of the patients in the intervention group and 42% in the usual practice group were readmitted within 26 weeks (risk difference=0.02, 95% CI: [−0.08; 0.12] and risk ratio=1.05, 95% CI: [0.83; 1.33]). No between-group differences were found in any of the secondary outcomes. Conclusion The Elderly Activity Performance Intervention showed no effectiveness in reducing the risk of readmission in elderly patients discharged from a short-stay unit at the emergency department. The study revealed that 60% of the elderly patients had a need for further rehabilitation after discharge.
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Affiliation(s)
- Louise Moeldrup Nielsen
- Department of Occupational Therapy, VIA University College.,Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital
| | - Thomas Maribo
- Department of Public Health, Aarhus University, DEFACTUM
| | - Hans Kirkegaard
- Department of Clinical Medicine, Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus
| | | | - Marianne Lisby
- Department of Clinical Medicine, Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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22
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Pilegaard MS, la Cour K, Gregersen Oestergaard L, Johnsen AT, Lindahl-Jacobsen L, Højris I, Brandt Å. The 'Cancer Home-Life Intervention': A randomised controlled trial evaluating the efficacy of an occupational therapy-based intervention in people with advanced cancer. Palliat Med 2018; 32:744-756. [PMID: 29299957 PMCID: PMC5881790 DOI: 10.1177/0269216317747199] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND People with advanced cancer face difficulties with their everyday activities at home that may reduce their health-related quality of life. To address these difficulties, we developed the 'Cancer Home-Life Intervention'. AIM To evaluate the efficacy of the 'Cancer Home Life-Intervention' compared with usual care with regard to patients' performance of, and participation in, everyday activities, and their health-related quality of life. DESIGN AND INTERVENTION A randomised controlled trial ( ClinicalTrials.gov NCT02356627). The 'Cancer Home-Life Intervention' is a brief, tailored, occupational therapy-based and adaptive programme for people with advanced cancer targeting the performance of their prioritised everyday activities. SETTING/PARTICIPANTS Home-living adults diagnosed with advanced cancer experiencing functional limitations were recruited from two Danish hospitals. They were assessed at baseline, and at 6 and 12 weeks of follow-up. The primary outcome was activities of daily living motor ability. Secondary outcomes were activities of daily living process ability, difficulty performing prioritised everyday activities, participation restrictions and health-related quality of life. RESULTS A total of 242 participants were randomised either to the intervention group ( n = 121) or the control group ( n = 121). No effect was found on the primary outcome (between-group mean change: -0.04 logits (95% confidence interval: -0.23 to 0.15); p = 0.69). Nor was any effect on the secondary outcomes observed. CONCLUSION In most cases, the 'Cancer Home-Life Intervention' was delivered through only one home visit and one follow-up telephone contact, which not was effective in maintaining or improving participants' everyday activities and health-related quality of life. Future research should pay even more attention to intervention development and feasibility testing.
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Affiliation(s)
- Marc Sampedro Pilegaard
- 1 The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,2 OPEN - Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Karen la Cour
- 1 The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,2 OPEN - Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Lisa Gregersen Oestergaard
- 3 Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,4 Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anna Thit Johnsen
- 5 Department of Psychology, University of Southern Denmark, Odense, Denmark.,6 Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Inger Højris
- 8 Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Åse Brandt
- 1 The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,2 OPEN - Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,9 Centre for Disability and Mental Vulnerability, The National Board of Social Services, Odense, Denmark
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23
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Nielsen TL, Bjerrum M, Nielsen CV, Petersen KS. Older adults’ experiences and expectations after discharge from home-based occupational therapy. Br J Occup Ther 2018. [DOI: 10.1177/0308022618756217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tove Lise Nielsen
- Assistant Professor, PhD candidate, Department of Occupational Therapy, VIA University College, Aarhus, Denmark; Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark; DEFACTUM Central Denmark Region, Aarhus, Denmark
| | - Merete Bjerrum
- Associate Professor, Department of Public Health, Section for Nursing Science, Aarhus University, Aarhus, Denmark
| | - Claus Vinther Nielsen
- Professor, Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark; DEFACTUM Central Denmark Region, Aarhus, Denmark
| | - Kirsten Schultz Petersen
- Associate Professor, Department of Health science and Technology, Faculty of Medicine, Public Health and Epidemiology Group, Aalborg University, Aalborg, Denmark; DEFACTUM Central Denmark Region, Aarhus, Denmark
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24
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Nielsen TL, Andersen NT, Petersen KS, Polatajko H, Nielsen CV. Intensive client-centred occupational therapy in the home improves older adults' occupational performance. Results from a Danish randomized controlled trial. Scand J Occup Ther 2018; 26:325-342. [PMID: 29325486 DOI: 10.1080/11038128.2018.1424236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is growing interest in enabling older adults' occupational performance. We tested whether 11 weeks of intensive client-centred occupational therapy (ICC-OT) was superior to usual practice in improving the occupational performance of home-dwelling older adults. METHODS An assessor-masked randomized controlled trial among adults 60 + with chronic health issues, who received or applied for homecare services. Recruitment took place September 2012 to April 2014. All participants received practical and personal assistance and meal delivery as needed. In addition, they were randomized to receive either a maximum 22 sessions of occupation-based ICC-OT (N = 59) or to receive usual practice with a maximum three sessions of occupational therapy (N = 60). The primary outcome was self-rated occupational performance assessed with the Canadian Occupational Performance Measure (COPM). RESULTS No important adverse events occurred. ICC-OT was accepted by 46 participants (88%), usual practice by 60 (100%). After 3 months, the ICC-OT-group had improved 1.86 points on COPM performance; the Usual-Practice group had improved 0.61 points. The between-group difference was statistically significant (95% confidence interval 0.50 to 2.02), t-test: p = 0.001. CONCLUSIONS ICC-OT improved older adults' occupational performance more effectively than usual practice. This result may benefit older adults and support programmatic changes.
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Affiliation(s)
- Tove Lise Nielsen
- a Section for Clinical Social Medicine and Rehabilitation, Department of Public Health , Aarhus University , Aarhus , Denmark.,b Department of Occupational Therapy , VIA University College , Aarhus , Denmark.,c DEFACTUM Central Denmark Region , Aarhus , Denmark
| | - Niels Trolle Andersen
- d Section for Biostatistics, Department of Public Health , Aarhus University , Aarhus , Denmark
| | - Kirsten Schultz Petersen
- e Department of Health Science and Technology, The Faculty of Medicine, Public Health and Epidemiology Group , Aalborg University , Aalborg , Denmark
| | - Helene Polatajko
- f Department of Occupational Science and Occupational Therapy, and Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada
| | - Claus Vinther Nielsen
- a Section for Clinical Social Medicine and Rehabilitation, Department of Public Health , Aarhus University , Aarhus , Denmark.,c DEFACTUM Central Denmark Region , Aarhus , Denmark
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25
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Farley E, McCarthy L, Pergolotti M. Rehabilitation Strategies in Older Adult Oncology Patients: a Focus on Occupational and Physical Therapy. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0228-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Nagayama H, Tomori K, Ohno K, Takahashi K, Nagatani R, Izumi R, Moriwaki K, Yamauchi K. Cost effectiveness of the occupation-based approach for subacute stroke patients: result of a randomized controlled trial. Top Stroke Rehabil 2017; 24:337-344. [PMID: 28198661 DOI: 10.1080/10749357.2017.1289686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE The cost effectiveness of occupational therapy for subacute stroke patients is unclear in the extant literature. Consequently, this study determined the cost effectiveness of the occupation-based approach using Aid for Decision-Making in Occupation Choice (ADOC) for subacute stroke patients compared with an impairment-based approach. METHODS We conducted an economic evaluation from a societal perspective alongside a pilot randomized controlled trial, with a single blind assessor for participants in 10 subacute rehabilitation units in Japan. The intervention group received occupation-based goal setting using ADOC, with interventions focused on meaningful occupations. The control group received an impairment-based approach focused on restoring capacities. For both groups, occupational-therapy intervention was administered more than five times per week, for over 40 min each time, and they received physical and speech therapy prior to discharge. The main outcomes were quality-adjusted life years (QALYs) and total costs. Further, sensitivity analyses were performed to examine the influence of parameter uncertainty on the base case results. RESULTS The final number of participants was 24 in each of the two groups. In terms of QALYs, the intervention group is significantly higher than the control group (p = 0.001, difference 95% CI: 0.002-0.008) and total costs are not statistically significant. Applying a willingness-to-pay threshold of JPY 5 million/QALY, the probability of the occupation-based approach using ADOC being cost effective was estimated to be 65.3%. CONCLUSIONS The results show that the occupation-based approach is associated with significantly improved QALYs and has potential cost effectiveness, compared with the impairment-based approach.
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Affiliation(s)
- Hirofumi Nagayama
- a Department of Occupational Therapy , Kanagawa University of Human Services , Yokosuka , Japan.,g Graduate School of Health Management , Keio University , Fujisawa , Japan
| | - Kounosuke Tomori
- b Unit of Rehabilitation Sciences , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Kanta Ohno
- c IMS Itabashi Rehabilitation Hospital , Itabashi , Japan
| | - Kayoko Takahashi
- d Department of Occupational Therapy, School of Allied Health Sciences , Kitasato University , Sagamihara , Japan
| | - Ryutaro Nagatani
- a Department of Occupational Therapy , Kanagawa University of Human Services , Yokosuka , Japan
| | - Ryota Izumi
- e Department of Occupational Therapy , Seirei Christopher University , Hamamatsu , Japan
| | - Kensuke Moriwaki
- f Department of Medical Statistics , Kobe Pharmaceutical University , Kobe , Japan
| | - Keita Yamauchi
- g Graduate School of Health Management , Keio University , Fujisawa , Japan
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