Occupational Therapy in Postacute Care for Survivors of COVID-19: Research Gaps We Need to Fill

Occupations to Enhance Responsibility Among Patients With Parkinson's Disease: An International Delphi Study

IMPORTANCE

The ability to perform voluntary actions is disrupted in Parkinson's disease (PD). Voluntary activities play a critical role in generating sense of agency, which underpins the concept of responsibility for people's daily occupations and their outcomes. According to this concept, the dearth of research regarding the concept of responsibility in rehabilitation hampers practitioners in delivering evidence-based care.

OBJECTIVE

To generate a list of occupations that enhance an inherent sense of responsibility among people with PD that is based on consensus among experts.

DESIGN

An anonymous and iterative Delphi study with two rounds.

SETTING

Electronic survey.

PARTICIPANTS

One hundred sixteen experts participated in the first round of the study, and 95 participated in the second round.

OUTCOMES AND MEASURES

Panelists rated the level of inherent responsibility in each occupation and the importance of types of patient-related information on a 5-point Likert scale. Consensus was defined as reaching an interquartile range of >1.

RESULTS

In the first round, consensus was reached on 19 occupations and all 38 types of patient-related information. Also, an additional 15 occupations and 16 types of patient-related information were added to the lists. Consensus was reached for all occupations and patient-related information presented in the second round.

CONCLUSIONS AND RELEVANCE

Our results indicate that 61 occupations were deemed to enhance a moderate to a very high inherent sense of responsibility among people with PD. In addition, a wide range of patient-related information is considered very important or important while these occupation-focused interventions are delivered. What This Article Adds: Subjective knowledge of one's actions and their consequences lies behind people's daily occupations. Considering this knowledge when administering occupation-focused interventions can be beneficial for individuals with PD.

Association Between COVID-19 and Activities of Daily Living in Older Adults

Older adults gradually decrease their independence with activities of daily living (ADL) due to aging. The coronavirus disease-19 (COVID-19), the recent pandemic, can accelerate the decline in functions, such as ADL. This study aimed to examine whether there is an association between positive COVID-19 results and decreased independence with ADL in older adults. Data for a total of 3,118 older adults were extracted from the 2020 National Health and Aging Trends Study-COVID-19. A total of 71 (2.29%) participants presented with positive COVID-19 tests. There was a significant association between a positive COVID-19 result and decreased independence with ADL (relative risk [RR] = 1.47, 95% confidence interval [CI] = [1.11, 1.96], p = .0079). The study findings revealed that COVID-19 survivors had a high risk of decreased independence with ADL. These findings indicate that COVID-19 survivors have residual functional deficits and would need comprehensive health care services.

Exploring the Ability to Perform Activities of Daily Living and Cognitive Status after Hospitalization with COVID-19: A Multiple Case Study

Background

Multidisciplinary rehabilitation including occupational therapy after COVID-19 is recommended. However, evidence on how COVID-19 affects the ability to perform activities of daily living (ADL) is sparse.

Objective

The aim of this study was to explore the ability to perform ADL and cognitive status in patients with COVID-19 at time of discharge and three months postdischarge.

Methods

This prospective multiple case study included adults with COVID-19, who at time of discharge had decreased ADL performance compared to habitual functional level. Data collection included Assessment of Motor and Process Skills (AMPS) and Montreal Cognitive Assessment (MoCA) at discharge and three-month follow-up. Exploratory analysis was used to identify similarities and trends within and across cases.

Results

Eleven patients were included. 75% had a significant increase in motor ability measures, and 27% had a significant increase in process ability measures at follow-up. 67% of follow-up cases showed mild cognitive impairment, where executive functioning and memory were most predominant.

Conclusions

The ability to perform ADL was affected at discharge and at three-month follow-up. Furthermore, mild cognitive impairment was present at both hospital discharge and follow-up in most cases. Significance. Occupational therapists can apply performance-based assessments to identify the need for rehabilitation of ADL in patients with COVID-19 during and posthospitalization.

Effect of cardiovascular training on functional capacity in post-acute rehabilitation of COVID-19 patients

Introduction: In the overall strategy of developing the optimal treatment of patients after COVID-19 infection, recommended by the World Health Organization, rehabilitation plays one of the key roles in improving the functional capacity of these patients and thus their quality of life. The aim of this study was to investigate the effect of cardiovascular training during post-acute rehabilitation on the functional capacity of patients after moderate COVID-19 pneumonia. Methods: The prospective study included 84 patients of both sexes, mean age 57.92 ± 11.79 years, who were hospitalised at the Institute of Physical Medicine and Rehabilitation ''Dr Miroslav Zotović'' Banja Luka due to moderate pneumonia caused by the COVID-19 virus and after they finished acute rehabilitation. All patients underwent cardiovascular training three times per week and occupational therapy during 28 days of stationary post-acute rehabilitation. The follow-up parameter was a six-minute walk (6-MWT) test at admission and discharge from post-acute rehabilitation. Student t-test for paired samples was used for statistical analysis, and the value of p < 0.05 was taken as statistical significance. Results: The functional capacity of the cardiovascular and respiratory system was statistically significantly improved at discharge compared to admission (p < 0.05). Conclusion: Targeted cardiovascular training during post-acute rehabilitation leads to improvement of functional capacities of patients after moderate COVID-19 pneumonia.