Efficacy Of Occupational Therapy Interventions Research Articles

Effects of Occupational Therapy Intervention on Motor Cognitive Behavioural Development of Infant Born Pre-term: A Systematic Review

Aim: To synthesize the existing literature and determine the efficacy of occupational therapy intervention, startingin the neonatal intensive care unit (NICU), on the motor, cognitive, and behavioural outcomes of Indian infantsborn pre-term.Method: Databases were searched for randomized controlled trials, quasi-randomized controlled trials, pre andpost studies etc of occupational therapy early intervention for infants with a gestational age of less than 37 weeks,initiated in the NICU and delivered by a therapist or parent with therapist support. Quality was evaluated usingthe Cochrane standardized risk of bias assessment tool. Recommendations were made using the Grading ofRecommendations, Assessment, Development and Evaluations approach.Results: Ten studies met the inclusion criteria. Studies were categorized into four intervention categories: (1)nesting, positioning and diaper sizing; (2) multi-sensory stimulation; (3) KMC (skin to skin care) (4) oral-motorintervention. Risk of bias varied from low to high or was unclear.Interpretation: Preliminary support indicates that occupational therapy improves motor and cognitive outcomesin the short-term and possibly long-term. Occupational therapy intervention programmes for pre-term infantshave a positive influence on cognitive and motor outcomes during infancy. A great deal of heterogeneity betweenstudies was due to the variety of early developmental intervention programmes tested and to gestational agesof included pre-term infants; thus, comparisons of intervention programmes were limited. Further research isneeded to determine which early developmental interventions are most effective in improving cognitive andmotor outcomes, and to discern the longer-term effects of these programmes.

Efficacy of Occupational Therapy Interventions on Quality of Life in Patients with Parkinson's Disease: A Systematic Review and Meta-Analysis.

To review studies assessing the efficacy of occupational therapy interventions on quality of life in patients with Parkinson's disease. We followed the international guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Databases (PubMed, Physiotherapy Evidence Database, OTsekeer, Scopus, Cinhal, and Web of Science) were searched to identify randomized controlled trials of occupational therapy interventions in patients with Parkinson's disease up to 2019 and with no restriction on language. The primary outcome of the meta-analysis was the evaluation of quality of life following occupational therapy interventions. Because of the heterogeneity of the studies, we examined the data by using a random effect model. We identified 15 randomized controlled trials that met the inclusion criteria, and 4 of these were included in the meta-analysis. Studies with a follow-up of 2 to 3 months showed that occupational therapy interventions significantly improved the quality of life in patients with Parkinson's disease, with a mean difference of -2.08 (95% confidence interval, -2.52 to -1.64; P < 0.00001). Studies reporting a longer follow-up (6-12 months) also showed that occupational therapy interventions improved the quality of life, with a mean difference of -2.56 (95% confidence interval, -3.52 to -1.61; P < 0.00001). Different occupational therapy interventions may be effective in improving the quality of life in patients with Parkinson's disease. However, because of the limited number of studies available, the strength of the evidence should be considered moderate.

Daily Life Experiences: Challenges, Strategies, and Implications for Therapy in Postural Tachycardia Syndrome (POTS)

Postural tachycardia syndrome (POTS) is a condition of orthostatic intolerance which often leads to significant functional deficits. This study explores narrative responses from a large cohort (n = 958) of individuals with POTS in describing daily life challenges and the use of strategies to manage these difficulties. Data was coded and emergent themes provided insight into daily life experiences including successful interventions and a wealth of gaps in treatment that remain unaddressed. This led to the development of clinical recommendations for occupational therapy treatment of individuals with POTS. Further research is indicated including clinical trials to demonstrate the efficacy of occupational therapy intervention.

Improving Occupational Performance in Pediatric Hematopoietic Cell Transplant Recipients.

There is a critical gap in the literature regarding the efficacy of occupational therapy interventions for pediatric hematopoietic cell transplantation (HCT) patients. To demonstrate that occupational therapy 4-5×/wk during inpatient hospitalization positively affects strength, coordination, and independence in activities of daily living (ADLs) of pediatric patients during HCT. Retrospective study. Inpatient bone marrow transplant unit at a children's hospital. Thirty-two pediatric patients admitted for HCT. Patients were seen by an occupational therapist as part of an interdisciplinary program. Interventions included play and leisure engagement, upper extremity therapeutic exercises, fine motor activities, and ADL training. Strength, coordination, and daily living skills data were documented prospectively and analyzed retrospectively to compare differences between patients seen by occupational therapy at high versus low frequency. For grip strength (dynamometer), fine motor dexterity (the 9-Hole Peg Test), and independence in ADLs (an ADL functional measure and the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test Daily Activities), the high-frequency group had a significantly smaller decrease in performance from time of admission at pretransplant (baseline) to peak decline after transplant. Grip strength and ADL scores for the high-frequency group returned to baseline at time of discharge more readily than for the low-frequency group. Participation in occupational therapy 4-5×/wk had positive effects on strength, coordination, and independence in ADLs for patients undergoing HCT. This article provides evidence that occupational therapists are an important part of the interdisciplinary team treating pediatric bone marrow transplant patients. It also demonstrates that occupational therapy interventions delivered at a high frequency can have a positive impact on upper extremity strength and independence in ADLs.

Occupational therapy for care home residents with stroke.

Stroke is a worldwide problem and is a leading cause of adult disability, resulting in dependency in activities of daily living (ADL) for around half of stroke survivors. It is estimated that up to 25% of all care home residents in the USA and in the UK have had a stroke.Stroke survivors who reside in care homes are likely to be more physically and cognitively impaired and therefore more dependent than those able to remain in their own home. Overall, 75% of care home residents are classified as severely disabled, and those with stroke are likely to have high levels of immobility, incontinence and confusion, as well as additional co-morbidities. It is not known whether this clinically complex population could benefit from occupational therapy in the same way as community-dwelling stroke survivors. The care home population with stroke differs from the general stroke population living at home, and a review was needed to examine the benefits of occupational therapy provided to this specific group. This review therefore focused on occupational therapy interventions for ADL for stroke survivors residing in care homes. To measure the effects of occupational therapy interventions (provided directly by an occupational therapist or under the supervision of an occupational therapist) targeted at improving, restoring and maintaining independence in ADL among stroke survivors residing in long-term institutional care, termed collectively as 'care homes'. As a secondary objective, we aimed to evaluate occupational therapy interventions for reducing complications such as depression and low mood. We searched the Cochrane Stroke Group Trials Register (August 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, September 2012), MEDLINE (1948 to September 2012), EMBASE (1980 to September 2012), CINAHL (1982 to September 2012) and 10 additional bibliographic databases and six trials registers. We also handsearched seven journals, checked reference lists and obtained further information from individual trialists. Randomised controlled trials investigating the impact of an occupational therapy intervention for care home residents with stroke versus standard care. The lead review author performed all searches. Two review authors then independently assessed all titles and abstracts of studies and selected trials for inclusion, with a third review author resolving any discrepancies. The same two review authors independently extracted data from all included published sources to ensure reliability. Primary outcomes were performance in ADL at the end of scheduled follow-up and death or a poor outcome. Secondary outcomes aimed to reflect the domains targeted by an occupational therapy intervention. We included in the review one study involving 118 participants. We found one ongoing study that also met the inclusion criteria for the review, but the data were not yet available. We found insufficient evidence to support or refute the efficacy of occupational therapy interventions for improving, restoring or maintaining independence in ADL for stroke survivors residing in care homes. The effectiveness of occupational therapy for the population of stroke survivors residing in care homes remains unclear, and further research in this area is warranted.

Occupational therapy needs of patients with thoracic cancer at the time of diagnosis: findings of a dedicated rehabilitation service

Guidelines recommend screening patients with cancer to identify their rehabilitation needs. To help quantify this area of need and associated workload from an occupational therapy perspective in patients with thoracic cancer, we report the experiences of a dedicated rehabilitation service. Consecutive patients were screened soon after diagnosis using items associated with occupational performance in the Sheffield Profile for Assessment and Referral for Care questionnaire. Those reporting predetermined levels of distress underwent a full occupational therapy evaluation; this generated a problem list from which individualised goals and interventions were instigated. Of 540 patients screened, 273 (51 %) reported levels of distress which warranted a full occupational therapy assessment. Of these, 260 (95%) reported a total of 681 problems (median of 4 [2-5] per patient). Mostly these lay within the domain of self care (553, 78%) in the categories of transfers, functional mobility and bathing/showering. A total of 646 goals (median of 2 [1-3] per patient) were formulated, resulting in 652 individual interventions, most frequently the provision of equipment (79%) or advice (32%) and referral to another professional/agency (23%). Patients considered that most goals were achieved (98%) and that the provision of equipment was useful (97%). About half of patients with thoracic cancer screened have occupational therapy needs around the time of diagnosis. Problems are mostly in the area of self-care, with equipment provision the most frequent intervention provided. Future work should examine the efficacy of occupational therapy interventions further.

Occupational therapy in fall prevention: current evidence and future directions.

Falls are a serious public health concern among older adults in the United States. Although many fall prevention recommendations exist, such as those published by the American Geriatrics Society (AGS) and the British Geriatrics Society (BGS) in 2010, the specific role of occupational therapy in these efforts is unclear. This article presents a scoping review of current published research documenting the role of occupational therapy in fall prevention interventions among community-dwelling older adults, structured by the AGS and BGS guidelines. We identified evidence for occupational therapy practitioner involvement in fall prevention in environmental modifications, exercise, and multifactorial and multicomponent interventions. Although research documenting the efficacy of occupational therapy interventions is identified as part of the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; American Occupational Therapy Association, 2008), we identified little or no such research examining interventions to modify behaviors (e.g., fear of falling), manage postural hypotension, recommend appropriate footwear, and manage medications. Although occupational therapy is represented in the fall prevention research, the evidence for the profession's role in many areas is still lacking.

Mothers in Recovery: An Occupational Perspective

The purposes of this study were to discover the stories of mothers regarding their journeys to addiction and through recovery, to explore the impact of addiction on the occupational performance of mothers and to identify the factors perceived by these mothers as important in their treatment. A narrative inquiry with thematic analysis of data was utilized; semi-structured interviews were conducted with 10 women in treatment for alcohol or other drug addiction who were all mothers of minor children. Alterations in occupational identity, occupational performance patterns and performance capacity were revealed. Environmental elements contributing to addiction and those important in recovery were identified and included structure (or the lack of it) and the persons populating the social environment. This qualitative study is not generalizable and should be viewed as relevant to these informants in this context; participants had histories of chronic substance addiction and are not representative of all addictions patients. Findings can be viewed within the context of other research to help enrich the reader's understanding of the complexity of issues. Further research is recommended to test the efficacy of occupational therapy interventions for substance addictions. Possible intervention studies might include those focused on environmental structure, exploration of interests in treatment and co-occupations of mother and child.

Incoordination of a sequential motor task in Parkinson's disease

The quality of life in persons with Parkinson's disease (PD) has increased significantly with improved medicines. However, as the disease progresses difficulty in performing activities of daily life occur and occupational therapy intervention is sought (Deane et al., 2001). Reviews describing the efficacy of occupational therapy intervention in PD are inconclusive (Murphy and Tickle-Degnen, 2001; Gaudet, 2002). The purpose of this study is to establish an occupational therapy protocol for PD based upon research on motor control, sensory feedback and bradykinesia. As a first stage, the present study investigated the contribution of sensory feedback in generating the most prevalent symptoms of PD, that is, bradykinesia. Fast reach-to-grasp movement without kinesthetic or visual dependence in PD patients under on-drug and off-drug conditions were investigated. Seven normal participants and 11 patients with PD voluntarily participated in the study. Movements of the upper arm as a measure of reach, and movements of the index finger as a measure of grasp were recorded using magnetic trackers. Compared to the normal participants, this index to upper arm movement relationship was severely disturbed in the patients with PD and was improved following medications. Inter-onset latency (IOL), that is, the time lag between the initiation of upper arm movement and index movement, was significantly longer in PD patients compared to normal subjects. Medications reduced IOL which lead to improvement of the relationship of upper arm and index. The results suggest that bradykinesia is due to the breakdown of co-ordination between joint movements as a result of presumably slow executive processing of motor programmes. Individual joint movements are initiated out of sequence resulting in uncoordinated movements even with antiparkinsonian drugs. It is suggested that occupational therapy intervention in PD patients should be directed to occupations that require co-ordination of joint movements essential for successful completion of various activities of daily living tasks.

Measuring the outcome of occupational therapy: Tools and resources

Current pressures to document outcomes and demonstrate the efficacy of occupational therapy intervention arise from fiscal restraints as much as from the humanitarian desire to provide the best quality health care to consumers. However, measuring outcomes is important in facilitating mutual goal setting, increasing the focus of therapy on the client, monitoring client progress, as well as demonstrating that therapy is valuable. The aims of this article are to provide the reader with an overview of what outcomes research is and to provide resources to aid the selection of outcomes assessments in a variety of practice areas. This article adopts the latest version of the World Health Organisation’s health classification system (International Classification of Impairments, Activities and Participation), as an organizing framework, and promotes the use of this framework when undertaking outcomes research.

Special Feature

This study addressed the current lack of research on the efficacy of occupational therapy intervention for older females after hip fracture. A quasi-experimental design was employed that compared two theoretical approaches to occupational therapy intervention. The research hypotheses of the study were that individuals who received occupational therapy intervention based on the Occupational Adaptation Frame of Reference would experience a greater sense of relative mastery, greater functional performance on a patient-chosen task, and greater functional independence on eight self-care tasks than individuals whose intervention was based on a biomechanical approach.

Approaches to Treating Dysphagia in Patients With Brain Injury

Dysphagia and its treatment in patients with brain injury are multifactorial. Treatment provided should address each deficit area relevant to dysphagia and should be consistent with current trends and knowledge. This article describes the subskills that compose the ability to swallow and their treatment in patients with brain injury. The available literature describing treatment and its efficacy relevant to each subskill area is reviewed. Specific areas for documenting efficacy of occupational therapy interventions are described.

Play Behavior and Occupational Therapy

The effectiveness of treatment methods on a person's ability to carry out occupational roles competently is of interest to occupational therapists. This case study demonstrated how play, as an occupational role of childhood and as a measure of competence, can be used to evaluate the effectiveness of occupational therapy that uses a sensory integrative approach. The positive changes in C.C.'s play behavior support the basic philosophy of sensory integration, which states that an increase in sensory integrative functions will improve competence (in this study, competence is defined as play), that is, that a person will have the ability to carry out occupational roles in an adaptive and competent manner. In addition, improvements in other areas, such as the organization and execution of self-care skills and improvements in gross and fine motor skills, provide further support to sensory integrative philosophy. Further exploration of these concepts would add to a growing body of knowledge aimed at the documentation of the effectiveness and efficacy of occupational therapy interventions.