1
|
Josman N, Atiya Y, Dagan T, Issa E, Demeter N. Assessing Functional Cognition and Health During COVID-19 Pandemic: Gender Differences Among Community-Dwelling Adults. J Prim Care Community Health 2023; 14:21501319231218801. [PMID: 38097506 PMCID: PMC10725103 DOI: 10.1177/21501319231218801] [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: 09/28/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION/OBJECTIVES The COVID-19 pandemic has long-term implications for adult health and function, whether or not people were infected with the disease. Although cognitive disruptions are among the major symptoms of COVID-19, most research focused on managing medical symptoms, such as respiratory symptoms or pain. Thus, less is known about the pandemic's long-term implications for assessing functional cognition. This study aimed to examine COVID-19's effects on community-dwelling adults' functional cognition and health, comparing gender differences. METHODS This cross-sectional study divided 118 community-dwelling adults (25 previously infected with COVID-19) into gender groups. Primary outcome measures included the Daily Living Questionnaire (DLQ) and short form health status survey, SF-12. RESULTS No significant differences were found in functional cognition or health between participants who had contracted COVID-19 and those who remained healthy, but men had better functional cognition and health measures in comparison with women. CONCLUSIONS Gender differences in functional cognition and health state may relate to gender-based family roles. It is essential to assess functional cognition of young adults who were exposed to a pandemic, such as COVID-19, because it may significantly affect their health and functional status. The DLQ is a reliable, valid assessment of functional cognition that may suit individuals who previously contracted COVID-19.
Collapse
|
2
|
Occupational therapist-guided cognitive interventions in critically ill patients: a feasibility randomized controlled trial. Can J Anaesth 2023; 70:139-150. [PMID: 36385466 PMCID: PMC9668395 DOI: 10.1007/s12630-022-02351-9] [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: 11/02/2021] [Revised: 06/25/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Intensive care unit (ICU) delirium is a common complication of critical illness requiring a multimodal approach to management. We assessed the feasibility of a novel occupational therapist (OT)-guided cognitive intervention protocol, titrated according to sedation level, in critically ill patients. METHODS Patients aged ≥ 18 yr admitted to a medical/surgical ICU were randomized to the standard delirium prevention protocol or to the OT-guided cognitive intervention protocol in addition to standard of care. The target enrolment number was N = 112. Due to the COVID-19 pandemic, the study enrolment period was truncated. The primary outcome was feasibility of the intervention as measured by the proportion of eligible cognitive interventions delivered by the OT. Secondary outcomes included feasibility of goal session length (20 min), participant clinical outcomes (delirium prevalence and duration, cognitive status, functional status, quality of life, and ICU length of stay), and a description of methodological challenges and solutions for future research. RESULTS Seventy patients were enrolled and 69 patients were included in the final analysis. The majority of OT-guided sessions (110/137; 80%) were completed. The mean (standard deviation [SD]) number of sessions per patient was 4.1 (3.8). The goal session length was achieved (mean [SD], 19.8 [3.1] min), with few sessions (8/110; 7%) terminated early per patient request. CONCLUSION This novel OT-guided cognitive intervention protocol is feasible in medical/surgical ICU patients. A larger randomized controlled trial is required to determine the impact of such a protocol on delirium prevalence or duration. STUDY REGISTRATION www. CLINICALTRIALS gov (NCT03604809); registered 18 June 2018.
Collapse
|
3
|
Radomski MV, Giles GM, Carroll G, Anheluk M, Yunek J. Cognitive Interventions to Improve a Specific Cognitive Impairment for Adults With TBI (June 2013-October 2020). Am J Occup Ther 2022; 76:23933. [PMID: 36166674 DOI: 10.5014/ajot.2022/76s2017] [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
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on cognitive interventions to improve a specific cognitive impairment for adults with TBI.
Collapse
Affiliation(s)
- Mary Vining Radomski
- Mary Vining Radomski, PhD, OTR/L, FAOTA, is Director, Courage Kenny Research, Courage Kenny Research Center/Allina Health
| | - Gordon Muir Giles
- Gordon Muir Giles, PhD, OTR/L, is Professor, Samuel Merritt University
| | - Ginger Carroll
- Ginger Carroll, MS, OT/L, CPPM, Courage Kenny Research Center/Allina Health
| | - Mattie Anheluk
- Mattie Anheluk, MOT, OTR/L, Courage Kenny Rehabilitation Institute- Minneapolis/Allina Health
| | - Joe Yunek
- Joe Yunek, MS, OTR/L, Courage Kenny Rehabilitation Institute- Minneapolis/Allina Health
| |
Collapse
|
4
|
Al-Heizan MO, Marks TS, Giles GM, Edwards DF. Further Validation of the Menu Task: Functional Cognition Screening for Older Adults. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2022; 42:286-294. [PMID: 35899792 DOI: 10.1177/15394492221110546] [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: 11/15/2022]
Abstract
Occupational therapists need a brief tool to identify the potential for functional cognitive deficits leading to impaired occupational performance. The objective is to establish the sensitivity and specificity, concurrent and known-group validity of the Menu Task by comparison with performance on the Weekly Calendar Planning Activity (WCPA). Using a cross-sectional design, we administered the Menu Task and the WCPA to a community-dwelling convenience sample of 287 adults aged from 55 to 93 years. The receiver operating characteristic (ROC) analysis estimated sensitivity and specificity. Concurrent and known-group construct validity was examined by comparing scores on the Menu Task with the WCPA scores. As a result, a new cutoff score of 9 was established for the Menu Task (area under the curve [AUC] = 0.80, sensitivity = 0.89, 95% confidence interval [CI] = [0.73, 0.97]; specificity = 0.58, 95% CI = [0.52, 0.64]). Both concurrent and construct validity were supported. The Menu Task demonstrates sensitivity to functional cognitive impairments in a community sample.
Collapse
Affiliation(s)
| | | | - Gordon M Giles
- Samuel Merritt University, Oakland, CA, USA.,Crestwood Behavioral Health, Inc., Sacramento, CA, USA
| | | |
Collapse
|
5
|
Watters K, Marks TS, Edwards DF, Skidmore ER, Giles GM. A Framework for Addressing Clients' Functional Cognitive Deficits After COVID-19. Am J Occup Ther 2021; 75:7511347010p1-7511347010p7. [PMID: 34405800 DOI: 10.5014/ajot.2021.049308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Occupational therapy's focus on functional cognition offers a distinct approach to the assessment of and intervention for occupational performance deficits that may follow coronavirus disease 2019 (COVID-19). Although the majority of people survive COVID-19, many people experience persistent functional cognitive sequelae severe enough to interfere with occupational performance. After COVID-19, people may be categorized as either (1) those who experience severe or critical illness requiring hospitalization or (2) those with mild to moderate presentations of the virus without hospitalization. A third group of those who do not have ongoing signs of active infection but who experience new, lasting, or deteriorating symptoms has begun to emerge and may represent a distinct COVID-19 long-haul syndrome. By following the Occupational Therapy Practice Framework and using established processes for occupational therapy assessment and treatment of functional cognition, occupational therapy practitioners can tailor assessments and interventions to meet clients' needs.
Collapse
Affiliation(s)
- Kelsey Watters
- Kelsey Watters, MS, OTR/L, BCPR, is Clinical Practice Leader for Occupational Therapy and Functional Cognition and Vision Therapist, Shirley Ryan AbilityLab, Chicago, IL;
| | - Timothy S Marks
- Timothy S. Marks, MS, OTR/L, is Occupational Therapist, UW Health, University Hospital, Madison, WI, and Doctoral Student in Kinesiology, Department of Kinesiology-Occupational Therapy, University of Wisconsin-Madison
| | - Dorothy F Edwards
- Dorothy F. Edwards, PhD, is Professor, Departments of Kinesiology-Occupational Therapy and Medicine, and Associate Dean of Research, School of Education, University of Wisconsin-Madison
| | - Elizabeth R Skidmore
- Elizabeth R. Skidmore, PhD, OTR/L, FAOTA, FACRM, is Professor, Department of Occupational Therapy, and Associate Dean of Research, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Gordon Muir Giles
- Gordon Muir Giles, PhD, OTR/L, FAOTA, is Professor, Samuel Merritt University, Oakland, CA, and Director of Neurobehavioral Services, Crestwood Behavioral Health, Inc., Sacramento, CA
| |
Collapse
|
6
|
Jones C, Miguel-Cruz A, Brémault-Phillips S. Technology Acceptance and Usability of the BrainFx SCREEN in Canadian Military Members and Veterans With Posttraumatic Stress Disorder and Mild Traumatic Brain Injury: Mixed Methods UTAUT Study. JMIR Rehabil Assist Technol 2021; 8:e26078. [PMID: 33983125 PMCID: PMC8160786 DOI: 10.2196/26078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/12/2021] [Accepted: 04/11/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Canadian Armed Forces service members (CAF-SMs) and veterans exhibit higher rates of injuries and illnesses, such as posttraumatic stress disorder (PTSD) and traumatic brain injury, which can cause and exacerbate cognitive dysfunction. Computerized neurocognitive assessment tools have demonstrated increased reliability and efficiency compared with traditional cognitive assessment tools. Without assessing the degree of technology acceptance and perceptions of usability to end users, it is difficult to determine whether a technology-based assessment will be used successfully in wider clinical practice. The Unified Theory of Acceptance and Use of Technology model is commonly used to address the technology acceptance and usability of applications in five domains. OBJECTIVE This study aims to determine the technology acceptance and usability of a neurocognitive assessment tool, which was titled BrainFx SCREEN, among CAF-SMs and veterans with PTSD by using the Unified Theory of Acceptance and Use of Technology model. METHODS This mixed methods embedded pilot study included CAF-SMs and veterans (N=21) aged 18-60 years with a diagnosis of PTSD who completed pre- and postquestionnaires on the same day the BrainFx SCREEN was used. A partial least squares structural equation model was used to analyze the questionnaire results. Qualitative data were assessed using thematic analysis. RESULTS Facilitating conditions, which were the most notable predictors of behavioral intention, increased after using the BrainFx SCREEN, whereas effort expectancy decreased. Performance expectancy, effort expectancy, and social interaction were not factors that could predict behavioral intention. Participants who reported a previous mild traumatic brain injury were significantly more likely to report current symptoms of cognitive impairment. The BrainFx SCREEN is a feasible, usable, and accepted assessment tool for CAF-SMs and veterans who experience PTSD. CONCLUSIONS As military health care systems integrate technological innovations to improve the services and care provided, research must continue to address the acceptability and use of these novel assessments and interventions.
Collapse
Affiliation(s)
- Chelsea Jones
- Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- 1 Field Ambulance Physical Rehabilitation Department, Canadian Forces Health Services, Department of National Defense, Edmonton, AB, Canada
- Leiden University Medical Centre, Leiden, Netherlands
| | - Antonio Miguel-Cruz
- Department of Occupational Therapy, Faculty of Rehabilitation, University of Alberta, Edmonton, AB, Canada
- Glenrose Rehabilitation Hospital Research Innovation and Technology, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Suzette Brémault-Phillips
- Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
7
|
Radomski MV, Giles GM, Owens J, Showers M, Rabusch S, Kreiger R, Zola J, Kath K. Can service members with mild traumatic brain injury learn to develop implementation intentions for self-identified goals? Disabil Rehabil 2020; 44:2640-2647. [PMID: 33147426 DOI: 10.1080/09638288.2020.1841309] [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: 10/23/2022]
Abstract
PURPOSE Goal achievement relies heavily on executive functions, which may be compromised following mild traumatic brain injury (mTBI). Implementation intentions (II) have been found to help people act in accordance with their goals. II are written statements that describe a behavior that a person plans to enact when they encounter some form of anticipated trigger or stimulus. We evaluated the feasibility of teaching participants with mTBI to develop II for self-identified goals within the context of cognitive rehabilitation. METHODS Soldiers with mTBI were recruited from a traumatic brain injury clinic. During the intervention, participants were assigned to develop an II for one of three self-identified goals every day. Descriptive methods were used to examine implementability and acceptability of the II training protocol as well as the extent to which participants learned to develop II for their own goals. RESULTS The II training protocol was found to be highly implementable and acceptable to participants. Overall, participants (n = 16) were able to develop II related to their self-identified goals, which primarily focused on managing cognitive problems. For the most part, participants developed II that involved event- rather than time- or somatic/feeling-based triggers. CONCLUSION AND IMPLICATIONS Participants with mTBI were able to learn to develop II for their self-identified goals. Further study is needed to determine whether adding II to cognitive rehabilitation advances patient goal achievement.IMPLICATIONS FOR REHABILITATIONIt is feasible to incorporate training in implementation intentions (predetermined "if/when-then" plans that are intended to link specific situational triggers with actions) in metacognitive strategy instruction for patients with mild traumatic brain injury.Participants with mild traumatic brain injury in this study demonstrated that they were able to develop implementation intentions for multiple self-identified rehabilitation goals, which holds promise for also teaching patients with mild cognitive impairment from other conditions.Learning to develop implementation intentions may help patients with mild traumatic brain injury initiate a range of other cognitive strategies in their everyday lives.Implementation intentions have the potential to help patients enact goal behaviors associated with their rehabilitation goals, making cognitive rehabilitation more "customizable" and relevant to clients' specific needs.
Collapse
Affiliation(s)
| | - Gordon Muir Giles
- Occupational Therapy Programs, Samuel Merritt University, Oakland, CA, USA.,Neurobehavioral Services, Crestwood Behavioral Health, Inc, Sacramento, CA, USA
| | - Jenny Owens
- Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - Mark Showers
- Fort Campbell Intrepid Spirit, Fort Campbell, KY, USA
| | - Stacey Rabusch
- Courage Kenny Research Center, Allina Health, Minneapolis, MN, USA
| | - Rob Kreiger
- Courage Kenny Research Center, Allina Health, Minneapolis, MN, USA
| | - Joette Zola
- Courage Kenny Rehabilitation Institute, Allina Health, Minneapolis, MN, USA
| | - Kristina Kath
- Courage Kenny Research Center, Allina Health, Minneapolis, MN, USA
| |
Collapse
|
8
|
Giles GM, Edwards DF, Baum C, Furniss J, Skidmore E, Wolf T, Leland NE. Making Functional Cognition a Professional Priority. Am J Occup Ther 2020; 74:7401090010p1-7401090010p6. [PMID: 32078504 PMCID: PMC7018454 DOI: 10.5014/ajot.2020.741002] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Functional cognition is a critical domain of concern for occupational therapy practice. As the health care system moves to assessing value through achievement of quality outcomes, the field of occupational therapy must address the inclusion of functional cognition in evaluation and treatment. Evidence indicates that impaired cognition contributes to risk of hospital readmission and poor overall health outcomes across diagnostic groups. Moreover, expenditure on occupational therapy services that address functional cognition has been shown to lower hospital readmission rates. To improve client outcomes, occupational therapists must consistently screen for and, when appropriate, evaluate and treat functional cognition impairments and consider functional cognition in the discharge planning process. Occupational therapy professionals must make a proactive, coordinated effort to establish the profession's role in evaluating and treating clients' limitations in functional cognition as a means to achieving improved quality care and client outcomes.
Collapse
Affiliation(s)
- Gordon Muir Giles
- Dorothy Farrar Edwards, PhD, is Professor of Kinesiology and Medicine, Department of Kinesiology, University of Wisconsin-Madison
| | - Dorothy Farrar Edwards
- Dorothy Farrar Edwards, PhD, is Professor of Kinesiology and Medicine, Department of Kinesiology, University of Wisconsin-Madison
| | - Carolyn Baum
- Carolyn Baum, PhD, OTR, FAOTA, is Professor of Occupational Therapy, Neurology and Social Work, Department of Occupational Therapy, Washington University in St. Louis, St. Louis, MO
| | - Jeremy Furniss
- Jeremy Furniss, OTD, OTR/L, BCG, is Vice President, Knowledge and Data Science, American Occupational Therapy Association, North Bethesda, MD
| | - Elizabeth Skidmore
- Elizabeth Skidmore, PhD, OTR/L, is Professor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Timothy Wolf
- Timothy Wolf, OTD, PhD, OTR/L, FAOTA, is Associate Professor, Department of Occupational Therapy, School of Health Professions, University of Missouri, Columbia
| | - Natalie E Leland
- Natalie E. Leland, PhD, OTR/L, BCG, FAOTA, FGSA, is Associate Professor and Vice Chair for Research, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|