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Wall G, Isbel S, Gustafsson L, Pearce C. Occupation-based interventions to improve occupational performance and participation in the hospital setting: a systematic review. Disabil Rehabil 2024; 46:2747-2768. [PMID: 37524307 DOI: 10.1080/09638288.2023.2236021] [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: 12/15/2022] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE To critically review the evidence for occupation-based interventions in improving occupational performance and participation outcomes in the hospital setting. METHODS Five databases were searched from 2000-2022. Peer-reviewed studies of any design investigating the impact of occupation-based interventions in the hospital setting were included. Methodological quality was assessed using the appropriate tool for each study design. Following data extraction, a narrative synthesis was conducted. RESULTS Thirty-three studies comprising of 26 experimental, five non-experimental, and two mixed methods studies were included (n = 1646 participants). Results indicate good evidence to support occupation-based interventions to improve occupational performance and participation outcomes in inpatient rehabilitation; it is unclear whether they are more effective than any control/alternative intervention. Research in the acute and mental health hospital settings were scarcer. Understanding the benefits of occupation-based interventions was enhanced through qualitative results including improving independence and confidence to discharge home, increasing motivation for therapy, connecting with others, and peer-based learning. CONCLUSIONS Heterogeneity and methodological weaknesses across existing studies limits the conclusions that can be drawn on the impact of occupation-based interventions in the hospital setting. More rigorous research should be conducted with better reporting of intervention design and the use of robust measures of occupational performance.Implications For RehabilitationThe use of occupation-based interventions should be considered to improve occupational performance and participation outcomes in the hospital setting.There is good evidence to support the impact of occupation-based interventions on improving occupational performance and participation outcomes in the inpatient rehabilitation setting; evidence in the acute and mental health settings is scarcer.Occupation-based interventions are valued by both patients and clinicians for their impact on patient outcomes and the patient experience.
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Affiliation(s)
- Gemma Wall
- Discipline of Occupational Therapy, Faculty of Health, University of Canberra, Canberra, Australia
- Occupational Therapy Department, University of Canberra Hospital, Canberra, Australia
| | - Stephen Isbel
- Discipline of Occupational Therapy, Faculty of Health, University of Canberra, Canberra, Australia
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Nathan, Australia
| | - Claire Pearce
- Discipline of Occupational Therapy, Faculty of Health, University of Canberra, Canberra, Australia
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Chiu EC, Chi FC, Chen PT. Investigation of the home-reablement program on rehabilitation outcomes for people with stroke: A pilot study. Medicine (Baltimore) 2021; 100:e26515. [PMID: 34190182 PMCID: PMC8257914 DOI: 10.1097/md.0000000000026515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Reablement is 1 approach to conduct rehabilitation in the community (ie, home environment), which aims to enhance an individual's functional ability to perform everyday activities that individuals perceive as important. We investigated the effects of a home-reablement program on different rehabilitation outcomes in people with stroke. METHODS A single-blind randomized clinical trial was conducted. Twenty-six people with stroke were randomly assigned to the home-reablement group or control group. For 6 weeks, participants in the home-reablement group received training for activities of daily living (ADL) that they perceived as important but difficult to perform. Participants in the control group received conventional rehabilitation in the hospital. Outcome measures included the Fugl-Meyer Assessment for the upper-extremity (FMA-UE) and the Stroke Impact Scale 3.0 (SIS 3.0) subscales. RESULTS No statistically significant differences between the 2 groups were noticed in the FMA-UE and the SIS 3.0 subscales (P = .226-1.000). Small effect size (success rate difference = 0.12-0.25) were noticed in the FMA-UE and the 5 SIS 3.0 subscales. The home-reablement group exhibited a greater proportion of participants with scores greater than the minimal detectable change in the FMA-UE and the 6 SIS 3.0 subscales (ie, strength, ADL/instrumental ADL, mobility, emotion, memory, and participation). CONCLUSIONS People with stroke that underwent the 6-week home-reablement program showed potential for improving their motor function, ADL/instrumental ADL, emotion, memory, and activity participation.
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Affiliation(s)
- En-Chi Chiu
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Fang-Chi Chi
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Taipei City Long-Term Care Management Center, Taipei, Taiwan
| | - Pei-Tsen Chen
- Department of Physical Medicine and Rehabilitation, Cardinal Tien Hospital, New Taipei City, Taiwan
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Hoffmann T, Eames S. There is insufficient or mixed evidence about which interventions can improve occupational performance for people with cognitive impairment after stroke. Aust Occup Ther J 2017; 64:85-86. [PMID: 28181286 DOI: 10.1111/1440-1630.12345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine Bond University, Australia
| | - Sally Eames
- Rehabilitation, Community, Indigenous and Subacute Services, Metro North Hospital and Health Service Queensland Health, Brisbane, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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George S, Gustafsson L. Strong evidence for activity of daily living interventions improving functional performance in home and community settings in stroke rehabilitation. Aust Occup Ther J 2017; 64:87-88. [DOI: 10.1111/1440-1630.12346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Stacey George
- Department of Rehabilitation, Aged and Extended Care Flinders University; Adelaide South Australia Australia
| | - Louise Gustafsson
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Queensland Australia
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Nilsen DM, Gillen G, Geller D, Hreha K, Osei E, Saleem GT. Effectiveness of interventions to improve occupational performance of people with motor impairments after stroke: an evidence-based review. Am J Occup Ther 2015; 69:6901180030p1-9. [PMID: 25553742 DOI: 10.5014/ajot.2015.011965] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We conducted a review to determine the effectiveness of interventions to improve occupational performance in people with motor impairments after stroke as part of the American Occupational Therapy Association's Evidence-Based Practice Project. One hundred forty-nine studies met inclusion criteria. Findings related to key outcomes from select interventions are presented. Results suggest that a variety of effective interventions are available to improve occupational performance after stroke. Evidence suggests that repetitive task practice, constraint-induced or modified constraint-induced movement therapy, strengthening and exercise, mental practice, virtual reality, mirror therapy, and action observation can improve upper-extremity function, balance and mobility, and/or activity and participation. Commonalities among several of the effective interventions include the use of goal-directed, individualized tasks that promote frequent repetitions of task-related or task-specific movements.
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Affiliation(s)
- Dawn M Nilsen
- Dawn M. Nilsen, EdD, OTL, is Assistant Professor of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University, New York, NY;
| | - Glen Gillen
- Glen Gillen, EdD, OTR/L, FAOTA, is Associate Professor of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University, New York, NY
| | - Daniel Geller
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Kimberly Hreha
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Ellen Osei
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Ghazala T Saleem
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Hildebrand MW. Effectiveness of interventions for adults with psychological or emotional impairment after stroke: an evidence-based review. Am J Occup Ther 2015; 69:6901180050p1-9. [PMID: 25553744 DOI: 10.5014/ajot.2015.012054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This evidence-based review was conducted to evaluate the effectiveness of occupational therapy interventions to prevent or mitigate the effects of psychological or emotional impairments after stroke. Thirty-nine journal articles met the inclusion criteria. Six types of interventions were identified that addressed depression, anxiety, or mental health-related quality of life: exercise or movement based, behavioral therapy and stroke education, behavioral therapy only, stroke education only, care support and coordination, and community-based interventions that included occupational therapy. Evidence from well-conducted research supports using problem-solving or motivational interviewing behavioral techniques to address depression. The evidence is inconclusive for using multicomponent exercise programs to combat depression after stroke and for the use of stroke education and care support and coordination interventions to address poststroke anxiety. One study provided support for an intensive multidisciplinary home program in improving depression, anxiety, and health-related quality of life. The implications of the findings for practice, research, and education are discussed.
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Affiliation(s)
- Mary W Hildebrand
- Mary W. Hildebrand, OTD, OTR/L, is Associate Professor, Occupational Therapy, MGH Institute of Health Professions, Boston, MA;
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Wolf TJ, Chuh A, Floyd T, McInnis K, Williams E. Effectiveness of occupation-based interventions to improve areas of occupation and social participation after stroke: an evidence-based review. Am J Occup Ther 2015; 69:6901180060p1-11. [PMID: 25553745 PMCID: PMC4281705 DOI: 10.5014/ajot.2015.012195] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This evidence-based review examined the evidence supporting the use of occupation-based interventions to improve areas of occupation and social participation poststroke. A total of 39 studies met the inclusion criteria and were critically evaluated. Most of the literature targeted activity of daily living (ADL)-based interventions and collectively provided strong evidence for the use of occupation-based interventions to improve ADL performance. The evidence related to instrumental ADLs was much more disparate, with limited evidence to support the use of virtual reality interventions and emerging evidence to support driver education programs to improve occupational performance poststroke. Only 6 studies addressed leisure, social participation, or rest and sleep, with sufficient evidence to support only leisure-based interventions. The implications of this review for research, education, and practice in occupational therapy are also discussed.
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Affiliation(s)
- Timothy J Wolf
- Timothy J. Wolf, OTD, MSCI, OTR/L, is Assistant Professor, Program in Occupational Therapy and Department of Neurology, School of Medicine, Washington University, St. Louis, MO;
| | - Adrianna Chuh
- Adrianna Chuh, MSOT, is Graduate Student, Program in Occupational Therapy, School of Medicine, Washington University, St. Louis, MO
| | - Tracy Floyd
- Tracy Floyd, MS, OTR/L, is Battalion Rehab Manager, U.S. Army, Warrior Transition Battalion, Fort Belvoir, VA
| | - Karen McInnis
- Karen McInnis, MSOT, is Graduate Student, Program in Occupational Therapy, School of Medicine, Washington University, St. Louis, MO
| | - Elizabeth Williams
- Elizabeth Williams, MSOT, is Graduate Student, Program in Occupational Therapy, School of Medicine, Washington University, St. Louis, MO
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Gillen G, Nilsen DM, Attridge J, Banakos E, Morgan M, Winterbottom L, York W. Effectiveness of Interventions to Improve Occupational Performance of People With Cognitive Impairments After Stroke: An Evidence-Based Review. Am J Occup Ther 2014; 69:6901180040p1-9. [PMID: 25553743 DOI: 10.5014/ajot.2015.012138] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
This evidence-based review was conducted to determine which interventions are effective in improving occupational performance after stroke. Forty-six articles met the inclusion criteria and were examined. Interventions for the following impairments were reviewed: general cognitive deficits, executive dysfunction, apraxia, memory loss, attention deficits, visual field deficits (included because of their close relationship with neglect), and unilateral neglect. Evidence is available from a variety of clinical trials to guide interventions regarding general cognition, apraxia, and neglect. The evidence regarding interventions for executive dysfunction and memory loss is limited. There is insufficient evidence regarding impairments of attention and mixed evidence regarding interventions for visual field deficits. The effective interventions have some commonalities, including being performance focused, involving strategy training, and using a compensatory as opposed to a remediation approach. The implications of the findings for practice, research, and education are discussed.
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Affiliation(s)
- Glen Gillen
- Glen Gillen, EdD, OTR, FAOTA, is Associate Professor of Rehabilitation and Regenerative Medicine (Occupational Therapy), Programs in Occupational Therapy, Columbia University Medical Center, Columbia University, New York, NY;
| | - Dawn M. Nilsen
- Dawn M. Nilsen, EdD, OTL, is Assistant Professor of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University Medical Center, New York, NY
| | - Jessica Attridge
- Jessica Attridge, MS, OTR, Erasmia Banakos, MS, OTR, Marie Morgan, MS, OTR, Lauren Winterbottom, MS, OTR, and Wesley York, MS, OTR, were Graduate Students, Programs in Occupational Therapy, Columbia University, New York, NY, at the time of this review
| | - Erasmia Banakos
- Jessica Attridge, MS, OTR, Erasmia Banakos, MS, OTR, Marie Morgan, MS, OTR, Lauren Winterbottom, MS, OTR, and Wesley York, MS, OTR, were Graduate Students, Programs in Occupational Therapy, Columbia University, New York, NY, at the time of this review
| | - Marie Morgan
- Jessica Attridge, MS, OTR, Erasmia Banakos, MS, OTR, Marie Morgan, MS, OTR, Lauren Winterbottom, MS, OTR, and Wesley York, MS, OTR, were Graduate Students, Programs in Occupational Therapy, Columbia University, New York, NY, at the time of this review
| | - Lauren Winterbottom
- Jessica Attridge, MS, OTR, Erasmia Banakos, MS, OTR, Marie Morgan, MS, OTR, Lauren Winterbottom, MS, OTR, and Wesley York, MS, OTR, were Graduate Students, Programs in Occupational Therapy, Columbia University, New York, NY, at the time of this review
| | - Wesley York
- Jessica Attridge, MS, OTR, Erasmia Banakos, MS, OTR, Marie Morgan, MS, OTR, Lauren Winterbottom, MS, OTR, and Wesley York, MS, OTR, were Graduate Students, Programs in Occupational Therapy, Columbia University, New York, NY, at the time of this review
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