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Mälstam E, Asaba E, Åkesson E, Guidetti S, Patomella AH. The Feasibility of Make My Day-A Randomized Controlled Pilot Trial of a Stroke Prevention Program in Primary Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6828. [PMID: 37835098 PMCID: PMC10572257 DOI: 10.3390/ijerph20196828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023]
Abstract
Incorporating and sustaining engaging everyday activities (EEAs) in everyday life holds potential for improving health and wellbeing; thus, there is reason to explore EEAs as a behavioral change technique in stroke prevention. The aim of this study was to evaluate the feasibility of the stroke prevention program Make My Day (MMD) for people with moderate-to-high risk for stroke in a primary healthcare setting, where EEAs are utilized to promote healthy activity patterns. A randomized controlled pilot trial was designed to evaluate the feasibility of MMD. Twenty-nine persons at risk for stroke were recruited and randomized into either an intervention group (n = 14) receiving MMD or a control group (n = 15) receiving brief health advice and support with goal setting. The results suggest that MMD is feasible, with timely recruitment, overall high response rates and study completion, and sensitivity to change in key outcome measures. Moreover, the results demonstrate that the application of EEAs can be useful for promoting behavioral change in stroke prevention. Recommendations for improvements for a full-scale trial include recruiting a relevant sample, using reliability- and validity-tested outcome measures, and implementing strategies to limit missing data.
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Affiliation(s)
- Emelie Mälstam
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, 141-52 Stockholm, Sweden; (E.A.); (S.G.); (A.-H.P.)
- Department of Occupational and Public Health Sciences, Faculty of Health and Occupational Studies, University of Gävle, 801-76 Gävle, Sweden
| | - Eric Asaba
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, 141-52 Stockholm, Sweden; (E.A.); (S.G.); (A.-H.P.)
- Unit for Research, Development, and Education, Stockholm’s Sjukhem Foundation, 112-19 Stockholm, Sweden;
| | - Elisabet Åkesson
- Unit for Research, Development, and Education, Stockholm’s Sjukhem Foundation, 112-19 Stockholm, Sweden;
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, 141-52 Stockholm, Sweden
| | - Susanne Guidetti
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, 141-52 Stockholm, Sweden; (E.A.); (S.G.); (A.-H.P.)
- Women’s Health and Allied Health Professionals Theme Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, 171-76 Stockholm, Sweden
| | - Ann-Helen Patomella
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, 141-52 Stockholm, Sweden; (E.A.); (S.G.); (A.-H.P.)
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Hernandez R, Schneider S, Wagman P, Håkansson C, Spruijt-Metz D, Pyatak EA. Validity and Reliability of the Occupational Balance Questionnaire (OBQ11) in a U.S. Sample of Adults With Type 1 Diabetes. Am J Occup Ther 2023; 77:7704205120. [PMID: 37624996 PMCID: PMC10494968 DOI: 10.5014/ajot.2023.050173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
IMPORTANCE Although occupational balance (OB) is a construct of importance to occupational therapy, existing OB assessments have not been validated in clinical populations. OBJECTIVE To examine the validity and reliability of the 11-item version of the Occupational Balance Questionnaire (OBQ11) in U.S. adults with Type 1 diabetes. DESIGN Data were analyzed from adults with Type 1 diabetes enrolled in a larger longitudinal study examining the relationships among blood glucose, emotion, and functioning. Dimensionality of the OBQ11 was assessed with item response theory (IRT); convergent validity was tested by examining whether associations between the OBQ11 and other constructs were consistent with a priori hypotheses. SETTING Three outpatient clinical sites in the United States. PARTICIPANTS Data from 208 U.S. adults with Type 1 diabetes were included in the analyses (42% Latino, 29% White, 14% African American, 7% multiethnic, and 8% other). OUTCOMES AND MEASURES Assessments administered include the OBQ11, Patient Health Questionnaire (depression), and Diabetes Self-Management Questionnaire. RESULTS Overall, results from IRT models and correlational tests supported the reliability and validity of the OBQ11. For instance, higher scores on the OBQ11 were significantly associated with better self-ratings of diabetes management behaviors (r = .28, p < .001), lower depression symptoms (r = -.53, p < .001), and greater positive affect (r = .32, p < .001). A single-factor generalized partial credit model fit the OBQ11 acceptably well, supporting its unidimensionality. CONCLUSIONS AND RELEVANCE The OBQ11 may be a reliable and valid measure of OB appropriate for use in clinical populations such as adults with diabetes. What This Article Adds: OB is not often formally assessed by occupational therapists in the United States, even though the contributions of OB to health and well-being are core components of the philosophy of occupational therapy. The current evidence supports the validity of the OBQ11 in a clinical population of adults with Type 1 diabetes and demonstrates significant associations between OB and health management behaviors. Study results may encourage greater consideration and assessment of OB in occupational therapy clinical practice in the United States.
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Affiliation(s)
- Raymond Hernandez
- Raymond Hernandez, PhD, OTR/L, is Postdoctoral Scholar, Dornsife Center for Economic & Social Research, University of Southern California, Los Angeles;
| | - Stefan Schneider
- Stefan Schneider, PhD, is Senior Research Scientist, Dornsife Center for Economic & Social Research, and Professor, Department of Psychology, University of Southern California, Los Angeles
| | - Petra Wagman
- Petra Wagman, PhD, Reg OT, is Associate Professor, Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Carita Håkansson
- Carita Håkansson, PhD, Reg OT, is Senior Lecturer, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Donna Spruijt-Metz
- Donna Spruijt-Metz, PhD, MFA, was Director of the USC mHealth Collaboratory, Dornsife Center for Economic & Social Research; Director of Responsible Conduct in Research, Keck School of Medicine; and Professor, Department of Psychology, University of Southern California, Los Angeles, at the time of this research
| | - Elizabeth A Pyatak
- Elizabeth A. Pyatak, PhD, OTR/L, CDCES, DipACLM, FAOTA, is Associate Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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Mälstam E, Patomella AH, Asaba E. Incorporating new ways of doing by learning from everyday experiences and interactions using a multifactorial mHealth app. Digit Health 2023; 9:20552076221149293. [PMID: 36762023 PMCID: PMC9903038 DOI: 10.1177/20552076221149293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/18/2022] [Indexed: 01/28/2023] Open
Abstract
Background Digital health innovations can support the prevention and management of risk factors for cardiovascular diseases, such as stroke. However, little is known about people's everyday experiences of digitally augmented stroke-prevention programmes combining onsite group sessions including peers and healthcare professionals with interaction and support from a multifactorial mHealth app. Objective The aim of this study was to explore how people with stroke risk experienced interaction with a multifactorial mHealth app as support in the make my day stroke-prevention programme. Methods Repeated interviews and observations with 12 adults with moderate to high stroke risk were analysed using a constant comparative method informed by constructive grounded theory. Results Incorporating new ways of doing into everyday life involves a process through which participants learn from both being and doing in different environments (e.g., digital, physical and social). Digital self-monitoring combined with seemingly trivial everyday experiences played central roles in the process of increasing awareness of health and stroke risks, and providing tools to support increased self-reflection on everyday behaviours. Adoption of positive health behaviours in everyday life was supported or hindered by how easy to use and personally relevant the mHealth app was perceived to be. Conclusions An experience-based group programme together with a personally relevant multifactorial mHealth app can be supportive in stroke prevention to increase general health literacy and stroke risk literacy, and promote the incorporation of new ways of doing in everyday life. Routines of doing digital self-monitoring and health-promoting activities were however strongly influenced by different environments in which choices are presented. It is therefore important to explore how both self-monitoring and health-promoting activities can be incorporated into everyday routines for different individuals. Research should also explore how personally relevant mHealth can be developed and integrated into prevention practices in primary healthcare.
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Affiliation(s)
- Emelie Mälstam
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden,Faculty of Health and Occupational Studies, Department of Public Health and Sport Science, University of Gävle, Gävle, Sweden,Emelie Mälstam, Department of Neurobiology, Caring Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden. Alfred Nobels Allé 23, Plan 4, 141 83, Huddinge.
| | - Ann-Helen Patomella
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Eric Asaba
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden,Unit for Research, Development and Education, Stockholms Sjukhem Foundation, Stockholm, Sweden,Graduate School of Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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Krpalek D, Cheung C, White N, Lao S, Islas-Guadarrama N, Griffin A, Javaherian-Dysinger H. Describing Occupational Therapy Services in Primary Care Settings: A Qualitative Study. Occup Ther Health Care 2022:1-19. [PMID: 36534600 DOI: 10.1080/07380577.2022.2156023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
As occupational therapists gain recognition for their work in primary care, it is important to explore the services they provide within these settings. A qualitative study was employed whereby six licensed occupational therapists within the United States were invited via email to engage in semi-structured interviews. Interview transcripts were analyzed individually by six researchers and as a team using consensus coding. Four themes emerged: "Primary Care Benefits", "Occupational Therapy Process and Distinct Value", "Primary Care Interventions", and "Complexities of Primary Care: Patient Conditions and Challenges." Occupational therapists described a range of benefits to being positioned within primary care. Problem solving around patient barriers, funding and logistical challenges are important considerations. Emphasizing 'occupation-based practice' and 'doing' within therapy are vital for occupational therapists who wish to advocate for their services and apply their distinct skill set within primary care settings.
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Affiliation(s)
- Dragana Krpalek
- Department of Occupational Therapy, Loma Linda University, Loma Linda, CA, USA
| | - Candice Cheung
- Department of Occupational Therapy, Loma Linda University, Loma Linda, CA, USA
| | - Naomi White
- Department of Occupational Therapy, Loma Linda University, Loma Linda, CA, USA
| | - Sydney Lao
- Department of Occupational Therapy, Loma Linda University, Loma Linda, CA, USA
| | | | - Alyssa Griffin
- Department of Occupational Therapy, Loma Linda University, Loma Linda, CA, USA
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Shomer L, Roll SC. Lifestyle Redesign® Intervention for Psychological Well-Being and Function in People With Fibromyalgia: A Retrospective Cohort Study. Am J Occup Ther 2022; 76:23976. [PMID: 36485013 DOI: 10.5014/ajot.2022.049243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Fibromyalgia is a complex chronic pain condition for which effective nonpharmacological treatment interventions are lacking. OBJECTIVE To explore the effects of an occupational therapy intervention for fibromyalgia on client-reported outcomes of pain interference, self-efficacy, mood, and function. DESIGN Retrospective cohort study using a chart review method. SETTING Outpatient clinic. PARTICIPANTS Twenty-one adults with fibromyalgia (M age = 54 yr). INTERVENTION A 10-wk occupational therapy group intervention using a Lifestyle Redesign® (LRD) approach. OUTCOMES AND MEASURES The Brief Pain Inventory, Pain Self-Efficacy Scale, Beck Depression Inventory (BDI), and the Fibromyalgia Impact Questionnaire (FIQ) or the Revised Fibromyalgia Impact Questionnaire were administered at the first and last sessions of the program. RESULTS Between 2015 and 2018, 37 clients entered the program, and 21 completed it. Changes in group averages exceeded the minimal clinically important difference for the BDI and the FIQ. Eighty-one percent of clients who completed the program had a clinically significant improvement on one or more of the outcome measures. CONCLUSIONS AND RELEVANCE The findings demonstrate the potential benefit of occupational therapy as a complementary approach to pharmacological treatment for people with fibromyalgia. Preliminary evidence suggests that a 10-wk occupational therapy group intervention using an LRD approach may reduce symptoms of depression and decrease the impact on daily function for people with fibromyalgia. What This Article Adds: Occupational therapy should be considered as a nonpharmacological intervention for adults with fibromyalgia to improve psychological well-being and function.
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Affiliation(s)
- Lindsey Shomer
- Lindsey Shomer, OTD, OTR/L, CEAS, is Associate Professor of Clinical Occupational Therapy, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;
| | - Shawn C Roll
- Shawn C. Roll, PhD, OTR/L, RMSKS, FAOTA, FAIUM, is Associate Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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Weaver JA, Read H, Martino MN, Balog EJ, Sinha-Bhamra M, Corcoran M. Exploring Knowledge Translation Concepts in U.S. Occupational Therapy Research: A Content Analysis. Am J Occup Ther 2022; 76:23899. [PMID: 35998268 DOI: 10.5014/ajot.2022.049127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE As a new Accreditation Council for Occupational Therapy Education® standard, knowledge translation (KT) is an important concept to occupational therapy. A better understanding of KT in occupational therapy research could inform its relevance to occupational therapy education, research, and practice. OBJECTIVE To answer the question "To what extent does published U.S.-based occupational therapy research that is explicitly underpinned by a KT theory, model, or framework reflect processes and concepts outlined in the knowledge-to-action (KTA) framework?" DESIGN A systematic search was conducted to purposively sample U.S.-based occupational therapy research. A content analysis of 11 articles explored concepts of the KTA framework. OUTCOMES AND MEASURES KTA was used as a conceptual foundation. RESULTS Multiple sources of data mapped onto concepts in the knowledge creation cycle and each of the first five concepts of the knowledge action cycle. We found that three concepts from the knowledge action cycle-monitor knowledge use, evaluate outcomes, and sustain knowledge use-were not well represented in the sample. CONCLUSIONS AND RELEVANCE Future research on the monitoring, evaluation, and sustained use of occupational therapy interventions is needed. The adoption of new interventions is important, and the knowledge of how they are sustained in practice will facilitate the clinical integration of future interventions. What This Article Adds: Occupational therapy research that uses KT lacks an emphasis on monitoring and sustaining evidence-informed interventions. Future research on the integration of such interventions into clinical practice is needed so that best practices in occupational therapy can be promoted.
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Affiliation(s)
- Jennifer A Weaver
- Jennifer A. Weaver, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO;
| | - Halley Read
- Halley Read, MOT, OTR/L, is Clinical Assistant Professor, School of Occupational Therapy, College of Health Professions, Pacific University, Hillsboro, OR
| | - M Nicole Martino
- M. Nicole Martino, PhD, OTR/L, is Assistant Professor, Division of Occupational Therapy Education, Department of Health and Rehabilitation Sciences, University of Nebraska Medical Center, Omaha
| | - Emily J Balog
- Emily J. Balog, PhD, OTR/L, is Assistant Professor and Doctoral Capstone Coordinator, Occupational Therapy Doctorate Program, Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, Newark, NJ
| | - Monika Sinha-Bhamra
- Monika Sinha-Bhamra, MPH, OTR/L, is PhD Candidate, Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, DC
| | - Mary Corcoran
- Mary Corcoran, PhD, OTR/L, FAOTA, is Professor Emerita, Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, DC
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Glasdam S, Oute J, Stjernswärd S. Critical perspectives on implementation of evidence-based practice in occupational therapy – Exemplified by Lifestyle Redesign® in a Danish context. Br J Occup Ther 2021. [DOI: 10.1177/03080226211011401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Evidence-based practice is an increasing demand in occupational therapy (OT), although multiple barriers can hinder the translation of research knowledge into practice. The article illuminates the transformation of results from a randomised controlled trial into a practice development project with future practice implementation in mind. Method A case study was carried out, consisting of a comparison of the US randomised controlled trials (RCTs) Lifestyle Redesign® and the derived Danish practice development project. Results The study showed how results from RCTs of Lifestyle Redesign® were transformed into a practice development project with intentions to implement the programme in a Danish context. The modifications of the US RCT into a practice development project in Denmark compromised the study’s scientific execution. The practice development project was used to legitimise the intervention within OT locally by testing an evidence-based intervention, without using associated scientific tools and without considering barriers and facilitators for implementing the project in clinical practice. Conclusion Research design compromises in practice development projects may have implications for the internal and external dynamics of professionalisation processes regarding OT and the recognition of OT as a scientific discipline and an autonomous profession, nationally and internationally.
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Affiliation(s)
- Stinne Glasdam
- Integrative Health Research, Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
| | - Jeppe Oute
- Faculty of Health and Social Sciences, Department of Health, Social and Welfare Studies, Campus Drammen, Drammen, Norway
| | - Sigrid Stjernswärd
- Health-promoting Complex Interventions, Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
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Mälstam E, Asaba E, Åkesson E, Guidetti S, Patomella AH. 'Weaving lifestyle habits': Complex pathways to health for persons at risk for stroke. Scand J Occup Ther 2021; 29:152-164. [PMID: 33813996 DOI: 10.1080/11038128.2021.1903991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND It is important to understand how healthy lifestyle habits can be developed as they are essential in cardiovascular disease (CVD) prevention. There is limited knowledge regarding whether, and how, engaging occupations (things that people do and occupy themselves with) can promote and help sustain healthy lifestyle habits for persons at risk for CVDs, including stroke. AIM The aim was to develop knowledge of how engaging in occupations can contribute to changes in lifestyle habits among persons at risk for stroke. METHODS Six adults presenting with stroke risk factors were interviewed on several occasions after participating in an occupation-focused stroke prevention programme. Grounded theory was utilised, and constant comparative methods guided the analysis. FINDINGS Changing lifestyle habits was perceived as a complex process, much like weaving a fabric with many parallel and interlacing threads. Literacy of both health and occupations and participation in engaging occupations were important facilitators for promoting healthy lifestyle habits, yet engagement in health-promoting occupations was described as conditioned behaviour. CONCLUSIONS CVD prevention programmes can benefit from incorporating engaging occupations to promote healthy lifestyle habits and literacy of health and occupations. However, contextual factors conditioning health and occupations should be considered when developing and implementing sustainable interventions.
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Affiliation(s)
- Emelie Mälstam
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden.,Faculty of Health and Occupational Studies, Department of Public Health and Sport Science, University of Gävle, Gävle, Sweden
| | - Eric Asaba
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden.,Unit for Research, Development and Education, Stockholms Sjukhem Foundation, Stockholm, Sweden.,Graduate School of Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Elisabet Åkesson
- Unit for Research, Development and Education, Stockholms Sjukhem Foundation, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society (NVS), Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Guidetti
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Ann-Helen Patomella
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
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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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Lowry M, Morrissey EC, Dinneen SF. Piloting an Intervention to Improve Outcomes in Young Adults Living With Type 1 Diabetes: The Experience of the D1 Now Support Worker. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:799589. [PMID: 36994338 PMCID: PMC10012156 DOI: 10.3389/fcdhc.2021.799589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022]
Abstract
Introduction D1 Now is a novel intervention which aims to support self-management and clinic engagement and improve outcomes in young adults (18-25 years) living with type 1 diabetes in Ireland. It has been developed using a systematic, theoretical, user-centred approach. The specific role of the Support Worker, one of three components of the D1 Now intervention, was developed to provide continuity and build relationships between young adults and their diabetes team. Methods A Support Worker - an Occupational Therapist, who had a background in youth mental health - was hired as part of the D1 Now pilot randomised controlled trial and was based in one intervention site to join the existing diabetes team. Discussion The Support Worker aimed to provide an accessible and consistent point of contact for young adults, facilitated conversations about distress, and encouraged graded goal setting and collaborative problem solving. The role afforded her with a unique window into the lived experiences of young adults with type 1 diabetes where she observed the ongoing negotiation of life and living alongside diabetes care and management. The prevalence of diabetes distress was high in the study cohort with particular challenges associated with 'all or nothing' thinking patterns as well as disordered eating behaviours. The Support Worker also played an advocacy role in supporting the diabetes team's awareness of young adults' needs and explored current barriers to care. Preliminary findings from the D1 Now pilot have identified that the role of the Support Worker was viewed positively from the perspective of young adults with type 1 diabetes.
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Affiliation(s)
- Michelle Lowry
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Eimear C. Morrissey
- School of Medicine, National University of Ireland, Galway, Ireland
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Sean F. Dinneen
- School of Medicine, National University of Ireland, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
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Role of Occupational Therapy in Primary Care. Am J Occup Ther 2020; 74:7413410040p1-7413410040p16. [DOI: 10.5014/ajot.2020.74s3001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
The American Occupational Therapy Association (AOTA) affirms that occupational therapy practitioners1 are well prepared to contribute to interprofessional collaborative care teams addressing the primary care needs of individuals across the life course. Because of an increased focus on preventive population health and social determinants of health by health care organizations, synergy between primary care and occupational therapy is growing, with support for client-centered,2 comprehensive whole-person care, health promotion and prevention, disease self-management, and quality of life (Halle et al., 2018). Occupational therapy practitioners’ distinct knowledge of the significant impact that roles, habits, and routines have on health and wellness makes their contribution to primary care valuable (AOTA, 2020b). Occupational therapy’s focus on meaningful engagement in occupations is relevant and vital to participation in individual, family, and community life (AOTA, 2020c). In addition, occupational therapy practitioners’ holistic and population perspectives allow them to be effective both as interprofessional health care team members and as direct care providers to support client, family, and community needs in primary care delivery models (Leland et al., 2017). The purposes of this position paper are to define primary care and to describe occupational therapy’s evolving and advancing role in primary care, including expansion of services into specialty primary care areas such as pediatric primary care and obstetrics and gynecology (AOTA, 2018).
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Synovec CE, Aceituno L. Social justice considerations for occupational therapy: The role of addressing social determinants of health in unstably housed populations. Work 2020; 65:235-246. [PMID: 32007967 DOI: 10.3233/wor-203074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Populations of those experiencing homelessness in the United States expand beyond those living in shelters and on the streets. Many individuals living in poverty experience housing instability, as well as refugee populations who experience deprivation of social resources due to displacement. These populations are significantly affected by social determinants of health (SDOH). OBJECTIVE A current policy and literature review was completed to assess prominent SDOH impacting unstably housed populations in the United States, including refugees, encountered in occupational therapy practice. Review of evidence-based practice to address SDOH was completed to provide recommendations for practitioners across healthcare settings. RESULTS A review of policy and its impact on those experiencing housing instability or recently resettled identifies several significant barriers to full occupational performance and health management. Several specific occupational therapy interventions exist to address these barriers and are in alignment with current practice. CONCLUSION Occupational therapy practitioners across practice settings should consider how current housing status and social determinants of health may impact their clients' occupational performance and ability to manage health conditions.
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Pyatak EA, Carlson M, Vigen CLP, Blanchard J, Niemiec SS, Sideris J, Baranek GT. Contextualizing the Positive Effects of the Well Elderly 2 Trial: A Response to Schelly and Ohl (2019). Am J Occup Ther 2020; 73:7306205100p1-7306205100p11. [PMID: 31891349 DOI: 10.5014/ajot.2019.038752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE A recent reanalysis of data from the Well Elderly (WE) 2 study purportedly indicated that the intervention did not achieve clinically meaningful or statistically significant effects; this article addresses these criticisms. OBJECTIVE To contextualize the WE 2 study as targeting a nonclinical population and demonstrate that the intervention produced substantively important, statistically significant effects. DESIGN Secondary analysis of WE 2 intervention-based pre-post change scores. SETTING The original trial occurred primarily in senior centers and senior housing facilities in greater Los Angeles. PARTICIPANTS Independent-living older adults (N = 324) who were assessed before and after intervention. INTERVENTION The WE intervention, a version of the Lifestyle Redesign® (LR) approach, was administered by occupational therapists over 6 mo by means of group and individual sessions. OUTCOMES AND MEASURES The 36-item Short Form Health Survey, the Life Satisfaction Index-Z, and the Center for Epidemiologic Studies Depression Scale. RESULTS The WE intervention was associated with statistically significant improvement on 10 of 12 outcome variables that were examined. CONCLUSIONS AND RELEVANCE Because the WE intervention was hypothesized to reduce age-related decline and followed a population-oriented approach, the expectation that average results would be clinically meaningful was inappropriate. The intervention produced positive effects across a wide array of outcome domains. In settings in which clinical meaningfulness is an appropriate index of intervention outcomes, evidence suggests that LR produces effects that are clinically meaningful. As an evidence-based intervention, LR should be considered useful both in population-oriented contexts and in addressing discrete health conditions. WHAT THIS ARTICLE ADDS Valid analyses demonstrate that the positive experimental effects of the WE 2 study are, in fact, genuine and cost-effective, and LR in clinically oriented contexts has produced statistically significant, clinically meaningful results. Clearly and accurately representing the evidence base of occupational therapy in prevention and chronic care is of critical importance to advance the field as a whole.
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Affiliation(s)
- Elizabeth A Pyatak
- Elizabeth A. Pyatak, PhD, OTR/L, CDE, FAOTA, is Associate Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles; .,E. A. Pyatak and M. Carlson contributed equally to the conceptualization and writing of this article and should be considered co-first authors
| | - Mike Carlson
- Mike Carlson, PhD, is Professor of Research, 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, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Jeanine Blanchard
- Jeanine Blanchard, PhD, OTR/L, is Project Manager, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Stacey Schepens Niemiec
- Stacey Schepens Niemiec, PhD, OTR/L, is Assistant Professor of Research, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - John Sideris
- John Sideris, PhD, is Professor of Research, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Grace T Baranek
- Grace T. Baranek, PhD, OTR/L, FAOTA, is Associate Dean, Chair, and Mrs. T. H. Chan Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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Jordan K. Occupational Therapy in Primary Care: Positioned and Prepared to Be a Vital Part of the Team. Am J Occup Ther 2019; 73:7305170010p1-7305170010p6. [PMID: 31484019 DOI: 10.5014/ajot.2019.735002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Reilly's (1962) now deeply cherished statement that "man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health" (p. 1) was followed a few years later with a question to current and future occupational therapy practitioners. In 1966, Reilly asked how the profession would respond to the challenges of an expanding knowledge base, accelerating health care costs, and escalating regulatory burden. Visionary Wilma West, a contemporary of Reilly's, expanded on these themes by focusing on ways occupational therapy practitioners could leverage the breadth and depth of their practice to confront these challenges. These issues are now paramount in the primary care arena. An expanding body of literature, including the articles in a special section in this issue of the American Journal of Occupational Therapy, supports occupational therapy's role as a vital part of the solution to contemporary health care challenges. Occupational therapy practitioners are educationally prepared and successfully poised through policy to engage in evidence-based practice in the primary care environment.
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Affiliation(s)
- Katie Jordan
- Katie Jordan, OTD, OTR/L, is Professor of Clinical Occupational Therapy and Associate Chair of Clinical Occupational Therapy Services, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;
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