Developing a Manualized Occupational Therapy Diabetes Management Intervention: Resilient, Empowered, Active Living With Diabetes

Equine Assisted Occupational Therapy for Children with Adhd (Astride): Protocol Development and Preliminary Study

Objective

Children with Attention Deficit Hyperactivity Disorder (ADHD) are often referred to Equine-Assisted Services (EAS) for therapy despite lack of validated protocols in the field. This paper reports the development and validation of ASTride (ADHD Skills Therapy): a protocol of Equine-Assisted Occupational Therapy (EAOT) intervention for children aged 6-12 with ADHD. The intervention addresses deficits in cognitive-emotional functions and participation.

Method

Phase one of the intervention development includes theoretical framework and core content based on an in-depth review of existing literature. Subsequently, the intervention protocol was revised by a panel of experts. Phase two includes a pilot study, during which five children diagnosed with ADHD (mean age= 10.40 year, SD 2.966) participated in a 12-week EAOT intervention according to the suggested protocol, with pre- and post-assessments conducted.

Results

Statistically significant improvements were found in executive functions, as reflected in the Behavioral Regulation Index (BRI) total score. Additionally, hope perception and everyday performance improved following the intervention.

Conclusions

Results support the feasibility of ASTride intervention protocol for the improvement of cognitive and emotional functions as well as everyday performance.

Development and preliminary feasibility evaluation of occupation-centered diabetes self-management intervention

Introduction

Occupational therapy practice framework provides a valuable structure for guiding clinical practice in occupational therapy based on the profession’s philosophical assumptions and areas of concern. This study aims to address the development and preliminary feasibility and acceptability evaluation of diabetes self-management intervention based on the framework and available literature.

Method

The research consisted of two phases. During the first phase, the research team conducted the relevant literature review, analyzed it deductively, and classified it in accordance with the concepts of the occupational therapy practice framework. Then, they modeled the intervention and formulated its components. In the second phase, they undertook the developed intervention on seven people with type-2 diabetes. The participants' attendance and their satisfaction with the program were evaluated to investigate its feasibility and acceptability.

Results

The research team developed an intervention named Occupational Therapy Diabetes Self-Management which focuses on the occupational nature of self-management and addresses various factors of its integrations with individuals’ daily lives. Feasibility and acceptability evaluation of the Occupational Therapy Diabetes Self-Management indicated that the participants' attendance and satisfaction with the program were 92.86% and 9.43 out of 10, respectively.

Conclusion

The Occupational Therapy Diabetes Self-Management is evidence-based, feasible, and an acceptable intervention to guide future research and clinical practice on occupational therapy.

Upper Extremity Task-Specific Training: Manual Development and Implementation Research within Inpatient Rehabilitation

A structured program of manualization and implementation of neurologic upper extremity task-specific training was developed at an inpatient rehabilitation hospital. The study used the Consolidated Framework for Implementation Research and engaged 31 stakeholders in manual refinement and examination of barriers after a year of training and use. Occupational therapists, occupational therapy assistants, and clinical educators provided input for manual revisions until consensus was achieved on usability, applicability, and implementation. Practitioners reported barriers such as intervention complexity, insufficient idea sharing for implementation, and a lack of motivators outside of the organization. The results can inform future implementation research in occupational therapy.Supplemental data for this article is available online at https://doi.org/10.1080/07380577.2021.1938338 .

Addressing Diabetes in Primary Care: Hybrid Effectiveness-Implementation Study of Lifestyle Redesign® Occupational Therapy

IMPORTANCE

Primary health care is rapidly developing as an occupational therapy practice area. Yet, to date, little evidence supports occupational therapy's feasibility and efficacy in primary care settings.

OBJECTIVE

To report on the implementation and preliminary clinical outcomes of a Lifestyle Redesign^® (LR)-occupational therapy (LR-OT) diabetes management intervention in a primary care clinic.

DESIGN

Patients were randomized to be offered LR-OT or to a no-contact comparison group (data not reported). We assessed implementation outcomes using mixed methods.

SETTING

Safety-net primary care clinic.

PARTICIPANTS

Clinic providers and staff; English- or Spanish-speaking clinic patients ages 18-75 yr with diabetes and a current hemoglobin A1c (HbA1c) ≥ 9.0%.

INTERVENTION

Eight 1-hr individual sessions of LR-OT focused on diabetes management.

OUTCOMES AND MEASURES

Clinical and health behavior outcomes were assessed via electronic medical record (EMR) review and self-report surveys of patients receiving LR-OT at initial evaluation and discharge. We assessed implementation outcomes (acceptability, appropriateness, feasibility, fidelity, efficiency, and timeliness) using patient and staff surveys, interviews, focus groups, and observations.

RESULTS

Seventy-three patients were offered LR-OT: 51 completed one or more sessions, and 38 completed the program. Clinical outcomes among program completers indicate beneficial changes in HbA1c, diabetes self-care, and health status. Implementation challenges included a need for patient and staff education, securing adequate workspace, and establishing a referral process. Factors contributing to implementation success included strong buy-in from clinic leadership, colocation, and shared EMR documentation.

CONCLUSIONS AND RELEVANCE

LR-OT is a feasible approach to enhancing service delivery and clinical outcomes in primary care.

WHAT THIS ARTICLE ADDS

This study provides insight into factors that may create challenges or contribute to the success of implementing occupational therapy services within primary health care settings. In addition, this study provides preliminary evidence of occupational therapy's effectiveness in improving clinical outcomes among ethnically diverse, low-income patients with diabetes in a safety-net primary care setting.

The Role of Occupational Therapy in Secondary Prevention of Diabetes

Diabetes mellitus is becoming a global health concern due to its prevalence and projected growth. Despite a growing number of interventions for secondary prevention of diabetes, there is a persistent poor glycemic control and poor adherence to the prescribed diabetes management regimen. In light of the tremendous costs of diabetes to both individuals and the society, it is pressing to find effective ways to improve diabetes self-management (DSM) and treatment adherence. Occupational therapists can bring values to the diabetes care team by evaluating multiple levels of influence on DSM, addressing personal and environmental barriers to well-being and DSM, and supporting patients to develop of a highly complex competences and skills to satisfactorily self-manage diabetes. This article summarizes two evidence-based, well-structured occupational therapy (OT) programs that use activity-based treatments and psychosocial strategies, respectively, to improve DSM abilities and to enhance quality of life. As the needs of adolescents with diabetes are quite different from other diabetic populations, this article also provides a summary of pediatric OT interventions that aim to facilitate autonomy and development of DSM ability among adolescents with diabetes. Evidence indicates that OT interventions can improve the quality of life and treatment adherence in patients with diabetes and hence should be continued and built on to address the increasing needs of diabetic populations.

Neuro-occupation: A self-organizing approach to conflate the brain, context, and occupation

BACKGROUND.

Neuro-occupation was coined to conflate three distinctly different concepts: the brain, context, and occupation. Discussing neuro-occupation has been more of an academic exercise rather than cogently researched for everyday practice, perhaps due to the seemingly incongruity among the concepts.

PURPOSE.

This article traces the self-organization approach, an assumption of complex systems, to understand how the concepts can be conflated.

METHOD.

Deductive category application, a qualitative descriptive method for tracing theoretical assumptions, was drawn from the lived experiences of 11 Iranian participants with cerebrovascular accidents. Matrix construction aided collection of data for analysis.

FINDINGS.

The self-organization approach, underpinning neuro-occupation, was shown to be traceable, explaining how occupational participation may be influenced by the brain circular causality and perturbations provided by the context.

IMPLICATIONS.

By understanding the dynamics of self-organization, occupational therapists can identify and create salient features that may motivate and enable clients to enhance occupational participation.

Understanding diabetes self-management using the Model of Human Occupation

Introduction

Over 400 million people worldwide are living with diabetes. Research suggests that people struggle to manage their diabetes and an in-depth understanding of the lived experience of diabetes is required to inform and promote occupational therapy practice. This article reports on one part of a PhD study into the role of occupational therapy in diabetes self-management.

Method

Semi-structured interviews using an intuitive inquiry methodology were conducted with 22 people with diabetes in three separate studies. Analysis of the lived experience of all participants was drawn together to explore the understanding of diabetes self-management from an occupational perspective using the Model of Human Occupation.

Findings

The occupation of diabetes self-management was conceptualised with seven inter-related occupational forms. Challenges were related to occupational identity, volition, habituation, performance capacity and the context in which these took place.

Conclusion

This study, embedded in the experiences of those with diabetes, suggests that occupational therapy has a distinct role in diabetes self-management, through seeing this self-management as an occupation. The use of the Model of Human Occupation enables a focus on the characteristics of the occupational forms and how these might be adapted for successful occupational engagement.

Occupational Therapy Intervention Improves Glycemic Control and Quality of Life Among Young Adults With Diabetes: the Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) Randomized Controlled Trial

OBJECTIVE

To assess the efficacy of a manualized occupational therapy (OT) intervention (Resilient, Empowered, Active Living with Diabetes [REAL Diabetes]) to improve glycemic control and psychosocial well-being among ethnically diverse young adults with low socioeconomic status (SES) who have type 1 or type 2 diabetes.

RESEARCH DESIGN AND METHODS

Eighty-one young adults (age 22.6 ± 3.5 years; hemoglobin A_1c [HbA_1c] = 10.8%/95 mmol/mol ± 1.9%/20.8 mmol/mol) were randomly assigned to the REAL Diabetes intervention group (IG) or an attention control group (CG) over 6 months. IG participants received biweekly sessions guided by a manual composed of seven content modules; CG participants received standardized educational materials and biweekly phone calls. Blinded assessors collected data at baseline and 6 months. The primary outcome was HbA_1c; secondary outcomes included diabetes self-care, diabetes-related quality of life (QOL), diabetes distress, depressive symptoms, and life satisfaction. Change scores were analyzed using Wilcoxon rank sum tests.

RESULTS

Intent-to-treat analyses showed that IG participants showed significant improvement in HbA_1c (-0.57%/6.2 mmol/mol vs. +0.36%/3.9 mmol/mol, P = 0.01), diabetes-related QOL (+0.7 vs. +0.15, P = 0.04), and habit strength for checking blood glucose (+3.9 vs. +1.7, P = 0.05) as compared with CG participants. There was no statistically significant effect modification by sex, ethnicity, diabetes type, recruitment site, or SES. No study-related serious adverse events were reported.

CONCLUSIONS

The REAL Diabetes intervention improved blood glucose control and diabetes-related QOL among a typically hard-to-reach population, thus providing evidence that a structured OT intervention may be beneficial in improving both clinical and psychosocial outcomes among individuals with diabetes.

Feasibility of a Manualized Occupation-Based Diabetes Management Intervention

OBJECTIVE

We investigated the feasibility and acceptability of an occupational therapy intervention targeting diabetes management for underserved young adults.

METHOD

Eight participants completed the intervention and a battery of assessments at baseline and after the intervention. At completion, the participants and occupational therapist were interviewed about their experiences with the study. Four categories of assessment questions were used to guide the study: process, resource, management, and scientific.

RESULTS

Successes included recruitment; fulfillment of tasks by staff and partnering clinics; adequate space, financial support, and equipment; and meaningfulness of the intervention for participants. Challenges included scheduling participants for the intervention and follow-up focus groups and providing client centeredness and flexibility while reducing burden on the intervener.

CONCLUSION

This feasibility study allowed us to make necessary revisions to our study protocol before implementing a larger pilot study.

Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) study: Methodology and baseline characteristics of a randomized controlled trial evaluating an occupation-based diabetes management intervention for young adults

OVERVIEW

This paper describes the study protocol used to evaluate the Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) intervention and reports on baseline characteristics of recruited participants. REAL Diabetes is an activity-based intervention designed to address the needs of young adults diagnosed with type 1 (T1D) or type 2 diabetes (T2D) from low socioeconomic status or racial/ethnic minority backgrounds. The REAL intervention incorporates tailored delivery of seven content modules addressing various dimensions of health and well-being as they relate to diabetes, delivered by a licensed occupational therapist.

METHODS

In this pilot randomized controlled trial, participants are assigned to the REAL Diabetes intervention or an attention control condition. The study's primary recruitment strategies included in-person recruitment at diabetes clinics, mass mailings to clinic patients, and social media advertising. Data collection includes baseline and 6-month assessments of primary outcomes, secondary outcomes, and hypothesized mediators of intervention effects, as well as ongoing process evaluation assessment to ensure study protocol adherence and intervention fidelity.

RESULTS

At baseline, participants (n=81) were 51% female, 78% Latino, and on average 22.6years old with an average HbA1c of 10.8%. A majority of participants (61.7%) demonstrated clinically significant diabetes distress and 27.2% reported symptoms consistent with major depressive disorder. Compared to participants with T1D, participants with T2D had lower diabetes-related self-efficacy and problem-solving skills. Compared to participants recruited at clinics, participants recruited through other strategies had greater diabetes knowledge but weaker medication adherence.

DISCUSSION

Participants in the REAL study demonstrate clinically significant medical and psychosocial needs.