Economic evaluations of occupational therapy approaches for people with cognitive and/or functional decline: A systematic review

Characteristics of Occupational Therapy Interventions to Promote Healthy Aging: Protocol for a Scoping Review

BACKGROUND

Healthy aging is a pressing public health priority. Focusing on what people do every day may be a meaningful approach to lifestyle change, suggesting a need for occupation therapy interventions to promote healthy aging. A preliminary database search was conducted, and no current or underway systematic or scoping reviews on the topic were identified. Developing an overview of studies of occupational therapy interventions to promote healthy aging is a necessary first step to understanding the existing knowledge and increasing the impact of future interventions. This scoping review will build on previously conducted reviews.

OBJECTIVE

This scoping review will identify the following: (1) what occupational therapy interventions exist for promoting healthy aging in community-dwelling adults? and (2) what are the intervention characteristics, their evaluated outcome, and the impact observed?

METHODS

This protocol was reviewed by 2 occupational therapists as part of a patient and public involvement consultation. The review will consider all studies and publications of occupational therapy focused on promoting healthy aging in community-dwelling adults who are aged 18 years and older. Databases to be searched are AMED, CINAHL, Cochrane Library, Embase, JBI EBP database, MEDLINE, OAlster, PsycINFO, PsycArticles, ProQuest Dissertations & Theses, ProQuest nursing and allied health source, PubMed, and Science Direct. Studies published in any language will be included. Titles and abstracts will be screened against the inclusion criteria using Covidence (Veritas Health Innovation). Potentially relevant studies will be retrieved in full and assessed against the inclusion criteria. No date limiters will be used. Study selection will be completed by 2 independent reviewers. Data will be extracted using a data extraction tool, including descriptive characteristics of the participants including age, sex, and socioeconomic status. Data will be charted using the TIDieR (Template for Intervention Description and Replication) checklist in alignment with the review objectives. The scoping review will be reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) statement.

RESULTS

The research began in October 2023, and the results are expected to be published in 2024.

CONCLUSIONS

This scoping review will produce valuable information about occupation-based interventions to promote healthy aging to support the development of an occupational therapy intervention.

TRIAL REGISTRATION

Open Science Framework 5k36d; https://osf.io/5k36d/.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55198.

Cost-effectiveness of occupational therapy for older adults: a protocol for an updated systematic review

INTRODUCTION

The ageing populations in developed countries are a global concern, with increasing numbers of older adults facing physical, cognitive and psychological challenges, resulting in reduced quality of life and higher healthcare costs. Healthcare expenditure worldwide has been on the rise, especially among older adults, emphasising the importance of enabling independent living while reducing healthcare costs. Occupational therapy holds promising outcomes in promoting functional independence and enhancing the quality of life for older adults, but research on its cost-effectiveness remains limited. This systematic review aims to evaluate the recent evidence on the cost-effectiveness of occupational therapy interventions for older adults from a pragmatic perspective.

METHODS AND ANALYSIS

This systematic review will cover full economic evaluations, including cost-effectiveness, cost-utility and cost-benefit analyses, by reviewing randomised and cluster randomised controlled trials. The participants will be aged over 65 years without disease or disability restrictions. Primary outcomes will be assessed using functional status and quality-of-life assessments. Studies published before July 2023 will be searched in PubMed, Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, with no language restrictions.

ETHICS AND DISSEMINATION

Ethical approval is not required for this literature-based systematic review. The study's findings will update the evaluation of occupational therapy's cost-effectiveness in older adults and will be made public by publishing them in scholarly journals.

PROSPERO REGISTRATION NUMBER

CRD42023453558.

Economic evaluations of electronic health interventions for people with age-related cognitive impairment and their caregivers: A systematic review

OBJECTS

Dementia has physical, social and economic impacts, causing considerable distress for people with age-related cognitive impairment (PWACI) and their caregivers. Electronic health (e-health) interventions can provide convenient education to improve the coping competence of caregivers and have become an important approach to supporting them. Understanding the economic evidence of e-health interventions will facilitate the decision making and implementation of integrating e-health into routine health services. The present review aimed to appraise economic evidence related to e-health interventions for PWACI and their caregivers.

METHODS

We systematically searched multiple cross-disciplinary databases from inception to February 28, 2023. Two reviewers independently selected the trials, assessed the quality, and checked the data. A descriptive-analytical narrative method was used to analyze the review findings.

RESULTS

Thirteen studies were analyzed, including 12 randomized controlled trials and one quasi-experimental study. All included studies were conducted in developed countries. The included studies reported limited economic information. There were six cost-effectiveness analysis, five cost-consequence analysis and one partial economic evaluation. The included studies were heterogeneous, and varied in quality. The results demonstrated that e-health multicomponent interventions can reduce the cost of health service utilization in short term (10-104 weeks).

CONCLUSIONS

Few studies calculated the incremental cost-effectiveness ratio to evaluate the cost-effectiveness of e-health interventions. Preliminary evidence indicates that e-health interventions can reduce the cost of health service utilization in the short term, but the cost-effectiveness of e-health interventions hasn't been identified. More robust evidence is needed to clarify the value of e-health interventions for PWACI and their caregivers.

Measuring Value: Cost-Effectiveness Analysis for Occupational Therapy

Stroke rehabilitation is expensive, and recent changes to Medicare reimbursement demand more efficient interventions. The use of cost-effectiveness analysis (CEA) can help occupational therapy practitioners, rehabilitation directors, and payers better understand the value of occupational therapy and decide whether or not to implement new treatments. The objective of this article is to illustrate the contribution of CEA to stroke rehabilitation using a hypothetical new intervention as an example. What This Article Adds: This article facilitates an understanding of the importance of CEA to occupational therapy. It also explains how CEA improves consistency with reporting standards for cost-effectiveness studies.

Economic Effects of Occupational Therapy Services for Adults in Acute and Subacute Care Settings: A Systematic Review

IMPORTANCE

Research supports the clinical effectiveness of hospital-based occupational therapy to improve functional outcomes, but no synthesis of economic evaluations of occupational therapy services provided in these settings has been published.

OBJECTIVE

To determine the economic value of occupational therapy services in acute and subacute care settings.

DATA SOURCES

MEDLINE, CINAHL, CENTRAL, EconLit, Embase, National Health Services Economic Evaluation Database, PsycINFO, ProQuest (Health and Medicine and Social Science subsets only), OTseeker, and gray literature. Study Selection and Data Collection: Eligible studies used trial-based or modeled economic analyses and included an adult population (ages ≥18 yr) and occupational therapy assessments or interventions provided in acute and subacute care. Two authors independently assessed abstracts and then full text. Articles were then appraised using the Evers Consensus on Health Economic Criteria.

FINDINGS

The authors identified 13,176 unique abstracts and assessed 190 full-text articles for eligibility. Ten studies were included in the systematic review; they varied in their primary objectives, methodology, costs, and outcomes. Studies examined the cost-benefit, cost-effectiveness, cost-utility, or cost minimization of a range of occupational therapy services. Five studies suggested that occupational therapy services offer value for money (lower cost, higher benefit); 4 suggested that they offer higher cost and benefits. One study that investigated upper limb rehabilitation did not indicate value for money.

CONCLUSIONS AND RELEVANCE

The findings suggest that occupational therapy for adults poststroke and post-traumatic brain injury, acute discharge planning, and pre- and post-hip replacement is cost-effective, but further research is needed to substantiate these findings. What This Article Adds: The findings provide preliminary evidence of the economic effectiveness of occupational therapy in acute and subacute care.

Improving outcomes for people with mild cognitive impairment: An Australian mixed-methods pilot study

OBJECTIVE

This pilot study tested the feasibility and acceptability of an innovative functional task exercise program to ameliorate mild cognitive impairment.

METHODS

The functional task exercise program was trialled on community-dwelling adults aged 60 years or older. The 10-week program was conducted in regional Australia and evaluated for acceptability and feasibility. Outcomes were assessed pre- and post- intervention and at three-month follow-up. Structured interviews were conducted with caregivers and participants at the end of the program.

RESULTS

Acceptability was demonstrated, with approximately 80% of the 23 participants completing the program. Clinical improvements were demonstrated in several cognitive and functional measures using an uncontrolled pre-post test design. Qualitative findings suggest feasibility as the program was viewed positively by participants and caregivers.

CONCLUSION

The functional exercise program was acceptable, was feasible and improved outcomes in an Australian context. Research is urgently needed to identify and treat people with mild cognitive impairment living in the community.

A second chance: Experiences and outcomes of people with dementia and their families participating in a dementia reablement program

Rationale:

Evidence-based reablement programs for people with dementia and their caregivers are not routinely implemented in practice. These programs have been shown to be effective in delaying functional decline and improving caregiver wellbeing. Yet, little is known about the experiences of those participating in such programs.

Aim:

To describe experiences and outcomes of participating in a dementia reablement program, the Care of Persons with dementia in their Environments (COPE), in Australia.

Methods:

Purposeful sampling was used and semi-structured interviews were completed with people with dementia and their caregivers who received the COPE program in two different states in Australia. The interviews explored the participants’ experiences with the program as well as how they are managing after program completion. Thematic analysis was used to identify themes from the interviews. A Likert scale was used to rate the value of the program.

Results:

Ten dyads (person with dementia and/or their caregiver) were interviewed. Participation in the program was rated (mostly) very valuable. The ongoing collaboration between the therapist and caregiver was considered empowering. The program promoted participation in everyday activities for the person with dementia and appeared to give a ‘second chance’ to remain in their own homes and communities.

Conclusion:

Participation in reablement programs (such as the COPE program) has the potential to re-engage people with dementia in meaningful roles and activities in their chosen environments. A therapeutic relationship and individualized intervention approaches tailored to the participants’ needs and readiness foster positive experiences and confidence.

What Does the Australian General Public Know About Treatments for Dementia? A Population Survey

Objective: To identify the Australian general population’s awareness regarding the presence and effectiveness of treatments for dementia. Method: An online survey administered through a consumer panel provider (PureProfile). Included were people aged 18 years or above living in Australia. The survey asked participants about their knowledge of treatments for dementia and attitudes toward the effectiveness of evidence-based treatments. Results: Of the 1,001 participants, more than half (63.5%) could not spontaneously name any treatments that improved outcomes for people with dementia. When asked about the efficacy of specific treatments, “brain training” was considered to be “very likely” to be effective by approximately half (49.4%) of the participants followed by “education for caregivers” (46.2%) and “healthy diet” (43.4%). Discussion: Knowledge of treatments for dementia among the Australian public is poor. There is a need to better educate the public about treatments that have demonstrated effectiveness to improve their uptake and use.