Independence In Self-care Activities Research Articles

Exploring the use of assistive products to promote functional independence in self-care activities in the bathroom.

In homes, problems in daily functioning of older people often occur in the bathroom, especially in the transfers to the toilet and/or shower/bath. Assistive products have the potential to maximise functional independence (i.e. performance without assistance from another person) in everyday activities; however, more research is needed to better understand the impact of this technology on independence in the transfers in the bathroom. Additionally, little is known about the role of the environmental factors in the process of implementing bathroom adaptations. Therefore, this cross-sectional study aimed to examine the relationship between the use of assistive products and independence in the transfers in the bathroom. The secondary objective was to determine the role of the environmental factors in predicting the implementation of bathroom adaptations. 193 community-dwelling older adults with disabilities in the basic activities of daily life, who requested public long-term care services in Spain, were included. Data was collected in the participant´s homes using a standardised assessment procedure. There was no significant association between the number of categories of assistive products used in the toilet transfer and the independent performance of this task. In a multivariate model, the number of categories of assistive products used in the transfer to shower/bath was positively associated with the independent performance of this transfer (OR = 2.59, 95%CI = 1.48–4.53; p = 0.001). A multivariate analysis revealed that social functioning was significantly associated with the implementation of a bathroom adaptation; social risk was lower in participants who made an adaptation (OR = 0.76, 95%CI = 0.63–0.93; p = 0.006). Assistive products may play an important role in promoting independence in the bathroom. Assistive product needs should be addressed when planning community-based interventions aimed at improving daily life. Moreover, social functioning had a strong influence on the installation of bathroom adaptations, suggesting the importance of paying special attention to social factors in the home adaptations planning process.

A qualitative study of patient-centered goal-setting in geriatric rehabilitation: patient and professional perspectives

Objective: To characterize how rehabilitation goals of older patients change over time and to explore professionals’ attitudes toward patient-centered goal-setting and their perspectives on rehabilitation goals. Design: Qualitative interview study. Setting: Three geriatric rehabilitation centers. Subjects: Ten patients (aged ⩾ 80), who had recently received inpatient geriatric rehabilitation, and seven professionals were purposively recruited. Methods: Semi-structured interviews. Patients were interviewed in the third or fourth week after discharge from inpatient rehabilitation, to reflect on their inpatient goals and to investigate long-term goals now that they were at home. A thematic analysis was performed. Results: During inpatient rehabilitation, participants’ main goals were regaining independence in self-care activities and going home. Post-discharge, patients were not at their baseline functioning level. Rehabilitation goals appeared to shift over time, and once at home, patients formulated more ambitious rehabilitation goals that were related to regaining full independence and being able to perform activities. Although professionals thought goal-setting together with the patient is important, they also stated that older individuals often are either unable to formulate goals or they set unrealistic ones. In addition, professionals indicated that goals have to be related to discharge criteria, such as performing basic self-care activities, and rehabilitation revolves around getting patients ready for discharge. Conclusion: During inpatient rehabilitation, patient goals are related to going home. After discharge, patients have ambitious goals, related to their premorbid functioning level. Rehabilitation services should distinguish between goals that are important while patients are inpatient and goals that are important after discharge.

Independence in self-care activities in children with myelomeningocele: exploring factors based on the International Classification of Function model

Purpose: To investigate the relationship between disease factors, body functions and structures, activities, personal and environmental factors with independence in self-care activities in children with myelomeningocele (MMC), utilizing the International Classification of Function model.Method: 113 children with MMC, aged 3–18 years were assessed during an annual MMC-clinic visit. Data on the personal and environmental factors, disease factors, hand function, mobility, visual perception, cognition, and communication were assessed in relation to the Pediatric Evaluation of Disability Inventory (PEDI) self-care domain.Results: The mean PEDI caregiver assistance score was 22.1 (ranged between <10 and 62) well below the norms. The most significant determinant of dependence in self-care activities was the presence of hydrocephalus, a child with hydrocephalus scored a mean of 9.2 points less on the PEDI caregiver scale (p = 0.02). By using a linear regression, the most significant factors associated with the PEDI scores among children with hydrocephalus were the age of the child, function of the non-dominant hand, ambulation, and cognitive function.Conclusion: In children with MMC the presence of hydrocephalus appears to be more significantly associated with functional independence than the neurological level. The International Classification of Function model provides an in-depth multidisciplinary model that facilitates in investigating independence in self-care activities in children with MMC. It is important to take personal factors and various functional impairments into account when working with these children to promote independence.Implications for RehabilitationWhen working with children with myelomeningocele on independence in daily living activities, it is necessary that health professionals demonstrate a holistic view of the child and his/her disability.Health professionals should take into account information on all factors of the International Classification of Function, in order to help the children, achieve maximal independence.It is important for health professionals to consider presence or lack of hydrocephalus when working with children with myelomeningocele to achieve functional gains.Improving upper extremity function and cognitive ability in children with myelomeningocele may help promote independence in activities of daily living.It is necessary for health professionals to continue to work with children with myelomeningocele on maximizing independence as they get older, for it is possible for them to achieve independence at a later age.While this study did not explore participation, this is an essential part of the International Classification of Function and is generally related to function. Participation allows a child to be involved in life situations, contributes to life satisfaction and prepares children for critical adult roles. It is therefore important to assess and monitor this measure. Further studies should examine associations between independence in self-care activities and participation.

Activities of daily living in people with lower limb amputation: outcomes of an intervention to reduce dependence in pre-prosthetic phase

Purpose: The main objective was to assess the change in the functional independence in basic activities of daily living (ADL) following a pre-prosthetic intervention in people with lower-limb amputation (LLA). Secondary objectives were to identify the factors contributing to the success of this intervention, and to analyze the effects on the presence of unmet needs for home adaptation.Method: The ADL intervention was early and pre-prosthetic; it was focused on six self-care activities. Fifty-two adults with LLA, who required assistance in self-care, were included. Functional independence (Barthel) was assessed at baseline and after intervention (T2). Successful intervention was defined as independent performance of all self-care activities.Results: There was a significant improvement in Barthel scores between baseline and T2 in toileting (p < 0.001), bed-chair transfers (p < 0.001), dressing (p < 0.001), bathing/showering (p < 0.001), and feeding (p = 0.025). The proportion of homes with an unmet need for adaptation decreased significantly in bathroom (p = 0.008) and other internal areas (p = 0.031). Intervention was successful for 61.5% of participants. In a multivariate model, age was significantly associated with successful intervention (OR 0.66, 95%CI 0.52–0.83).Conclusions: A short and pre-prosthetic ADL intervention improves functional independence and reduces the need for home adaptation. ADL programs should be included in rehabilitation strategies.Implications for RehabilitationBecause basic activities of daily living (ADL) can be seriously compromised after a lower-limb amputation, it is important for this population to improve or maintain their level of independence.A short and pre-prosthetic ADL intervention is an effective method for an early recovery of functional independence in self-care activities and promotes home adaptation.Age is an important determinant of functional recovery, and most subjects can achieve independence in basic ADL regardless of the level of amputation.A pre-prosthetic ADL program should be included in rehabilitation strategies for adults with lower-limb amputation.

Occupational therapy in rheumatoid arthritis: what rheumatologists need to know?

Interventions focusing on education and self-management of rheumatoid arthritis (RA) by the patient improves adherence and effectiveness of early treatment. The combination of pharmacologic and rehabilitation treatment aims to maximize the possibilities of intervention, delaying the appearance of new symptoms, reducing disability and minimizing sequelae, decreasing the impact of symptoms on patient's functionality. Occupational therapy is a health profession that aims to improve the performance of daily activities by the patient, providing means for the prevention of functional limitations, adaptation to lifestyle changes and maintenance or improvement of psychosocial health. Due to the systemic nature of RA, multidisciplinary follow-up is necessary for the proper management of the impact of the disease on various aspects of life. As a member of the health team, occupational therapists objective to improve and maintaining functional capacity of the patient, preventing the progression of deformities, assisting the process of understanding and coping with the disease and providing means for carrying out the activities required for the engagement of the individual in meaningful occupations, favoring autonomy and independence in self-care activities, employment, educational, social and leisure. The objective of this review is to familiarize the rheumatologist with the tools used for assessment and intervention in occupational therapy, focusing on the application of these principles to the treatment of patients with RA.

A DESCRIPTIVE REVIEW OF THE COGNITIVE ORIENTATION TO DAILY OCCUPATIONAL PERFORMANCE (CO-OP) APPROACH AND ITS IMPACT ON MOBILITY PROBLEMS IN CHILDREN WITH DEVELOPMENTAL COORDINATION DISORDER

Introduction: Motor skills and functional mobility are mainly necessary for children to perform motor tasks especially their activity daily living. These skills are extremely essential for independence in self-care activities. Delays in self-care may be evident in children with motor problems. Treatment approaches are used by occupational therapists to improve motor function. In recent decades, cognitive orientation to daily occupational performance (also known as CO-OP) is one of the therapeutic approaches. CO-OP is a client-centered and individualized approach. This study reviews the evidence for the effectiveness of the CO-OP approach on motor function in children with developmental coordination disorder. Materials and Methods: In this study, a comprehensive review of the literature was conducted via PubMed, Proquest, Informa, Scopus and Google Scholar data bases. The keywords used in this search were “motor-based occupational performance problems”, “CO-OP”. All articles were initially evaluated according to inclusion and exclusion criteria and then selected articles were reviewed. Results: Of 60 articles found, 8 articles met the inclusion and exclusion criteria and were considered as appropriate for this study. Conclusion: The review of the studies showed that CO-OP approach is an appropriate approach to improving motor-based occupational performance of children with motor problems. Keywords: Motor-based occupational performance, CO-OP approach, Motor performance problems, Cognitive strategies

A cluster randomised controlled trial of an occupational therapy intervention for residents with stroke living in UK care homes (OTCH): study protocol

BackgroundThe occupational therapy (OT) in care homes study (OTCH) aims to investigate the effect of a targeted course of individual OT (with task training, provision of adaptive equipment, minor environmental adaptations and staff education) for stroke survivors living in care homes, compared to usual care.Methods/DesignA cluster randomised controlled trial of United Kingdom (UK) care homes (n = 90) with residents (n = 900) who have suffered a stroke or transient ischaemic attack (TIA), and who are not receiving end-of-life care. Homes will be stratified by centre and by type of care provided and randomised (50:50) using computer generated blocked randomisation within strata to receive either the OT intervention (3 months intervention from an occupational therapist) or control (usual care). Staff training on facilitating independence and mobility and the use of adaptive equipment, will be delivered to every home, with control homes receiving this after the 12 month follow-up.Allocation will be concealed from the independent assessors, but the treating therapists, and residents will not be masked to the intervention. Measurements are taken at baseline prior to randomisation and at 3, 6 and 12 months post randomisation. The primary outcome measure is independence in self-care activities of daily living (Barthel Activities of Daily Living Index). Secondary outcome measures are mobility (Rivermead Mobility Index), mood (Geriatric Depression Scale), preference based quality of life measured from EQ-5D and costs associated with each intervention group. Quality adjusted life years (QALYs) will be derived based on the EQ-5D scores. Cost effectiveness analysis will be estimated and measured by incremental cost effectiveness ratio. Adverse events will be recorded.DiscussionThis study will be the largest cluster randomised controlled trial of OT in care homes to date and will clarify the currently inconclusive literature on the efficacy of OT for stroke and TIA survivors residing in care homes.Trial registrationISRCTN00757750

Efeitos da estimulação elétrica funcional nos músculos do punho e dedos em indivíduos hemiparéticos: uma revisão sistemática da literatura

Effects of functional electrical stimulation applied to the wrist and finger muscles of hemiparetic subjects: a systematic review of the literature Background: a systematization of the available evidence regarding the effects of electrical stimulation for hemiplegic patients following stroke is needed. Objective: to conduct a systematic review of the literature related to the effects of functional electrical stimulation for the wrist and finger muscles of adult hemiplegic patients. Method: a search for studies documenting the effects of electrical stimulation on neuromuscular, musculoskeletal and functional characteristics was carried out in Medline, Lilacs and PEDro databases between February and March 2006. Data were extracted in a standardized manner from each study, and methodological quality was assessed using the PEDro scale. Results: Eight randomized studies were reviewed. The scores on the methodological quality of revised studies were between 3/10 and 7/10 in the PEDro scale. Although the diversity of protocols, participants’ characteristics and instrumentation prevented pooling of results, a synthesis in levels of evidence demonstrated strong evidence for positive effects of electrical stimulation on muscle strength, tonus, motor function and use of the upper limb in daily life. Moderate evidence was found for effects on dexterity and limited evidence for effects on motor coordination and independence in self-care activities. There was no evidence for gains in range of active wrist extension. Conclusion: Despite methodological limitations, randomized studies reported positive effects of electrical stimulation on wrist and fingers, suggesting that this therapy might be effective for promoting function of the affected upper limb of hemiplegic individuals.

The Role of the Built Environment in the Disablement Process

The Disablement Process model explicates the transition from health conditions to disability and specifically emphasizes the role of intervening factors that speed up or slow down the pathway between pathology and disability. We used hierarchical Poisson regression analyses with data on older adults from central North Carolina to examine the role of the built environment as a modifying factor in the pathway between lower extremity functional limitations and activities of daily living. We found that, despite declining physical function, older adults report greater independence in instrumental activities when they live in environments with more land-use diversity. Independence in self-care activities is modified by housing density, in part through the effect of substandard and inadequate housing.

A Survey of Assistive Equipment Use by Older People following Hospital Discharge

Occupational therapists prescribe assistive equipment to increase clients' independence in self-care activities. This study examined clients' use of assistive equipment post-discharge and explored the factors that might have influenced use. The participants were 127 clients (mean age 78.7 years, 62.2% men) who were issued one or more items of assistive equipment while inpatients at a metropolitan hospital. At approximately 10 weeks post-discharge, the participants completed a postal questionnaire. Of the 407 items of equipment prescribed, 363 (89.2%) were used, with three types of equipment (bathboards, hand-held shower hoses and stair rails) having 100% use. The participants who lived alone were more likely to use toileting equipment and shower chairs than the participants who did not live alone (p&lt;0.05). The long-handled equipment had the lowest usage rates. For unused equipment, 16.5% was not used because it was no longer needed and 9.3% because the participants reported that they had never really needed it. Overall, 91.3% of the participants reported that they had received adequate training in the use of the equipment. Although most of the participants used prescribed assistive equipment, recommendations based on a client-centred approach to the prescription process are made to increase clients' use of equipment further.

Standardised Assessment: A Comparison of the Community Dependency Index and the Barthel Index with an Elderly Hip Fracture Population

The Community Dependency Index (CDI) is a standardised outcome measure of independence in self-care activities, based upon the Barthel Index, for the assessment of disabled and elderly people living in the community. The operational definitions take account of the influence that the environment has on a person's ability to carry out activities of daily living. This paper reports the results of a longitudinal study of two groups of community-dwelling elderly people who had sustained a hip fracture. The inter-rater reliability of the CDI was assessed, the agreement between the CDI and the Barthel Index was assessed and the sensitivity to change over time of the two measures was compared. The CDI was found to be equally as sensitive to a change in overall scores as the Barthel Index but tended to give lower scores. This trend has important implications for its use as an outcome measure of independence in activities of daily living following trauma.

An acute care unit for elderly medical patients did not increase hospital costs

Covinsky Ke, King Jr Jt, Quinn Lm , Et AL. Do acute care for elders units increase hospital costs? A cost analysis using the hospital perspective. J Am Geriatr Soc...

Assistive devices used by home-based elderly persons with arthritis.

This article examines assistive device use by home-based elderly persons with arthritis. Sixty-six persons were interviewed for the State University of New York at Buffalo (University at Buffalo) Rehabilitation Engineering Research Center Consumer Assessment Study, which sought information on need for and current use of assistive devices. Subjects were assigned to a moderate or a severe arthritis group according to the impact of arthritis on their activities. Subjects in the severe arthritis group had more chronic diseases, a higher level of pain, and a lower level of independence in self-care activities than subjects in the moderate arthritis group. Similarities between the groups included relatively poor health, high rate of medication use, depression, use of a high number of assistive devices (about 10 per person), and an expressed need for additional devices, such as reachers, magnifiers, grab bars, jar openers, and hearing aids. Generally, there was a high rate of satisfaction with the assistive devices used. Most subjects missed being able to participate in at least one activity; most of these activities were active and many related to leisure time. Findings also revealed that subjects had inadequate information on assistive devices, which suggests the importance of more occupational therapy involvement with elderly persons in selecting devices.

A Randomized Trial of Care in a Hospital Medical Unit Especially Designed to Improve the Functional Outcomes of Acutely Ill Older Patients

Older persons who re hospitalized for acute illnesses often lose their independence and are discharged to institutions for long-term care. We studied 651 patients 70 years of age or older who were admitted for general medical care at a teaching hospital; these patients were randomly assigned to receive usual care or to be cared for in a special unit designed to help older persons maintain or achieve independence in self-care activities. The key elements of this program were a specially prepared environment (with, for example, uncluttered hallways, large clocks and calendars, and handrails); patient-centered care emphasizing independence, including specific protocols for prevention of disability and for rehabilitation; discharge planning with the goal of returning the patient to his or her home; and intensive review of medical care to minimize the adverse effects of procedures and medications. The main outcome we measured ws the change from admission to discharge in the number of five basic activities of daily living (bathing, getting dressed, using the toilet, moving from a bed to a chair, and eating) that the patient could perform independently. Twenty-four patients in each group died in the hospital. At the time of discharge, 65 (21 percent) of the 303 surviving patients in the intervention group were classified as much better in terms of their ability to perform basic activities of daily living, 39 (13 percent) as better, 151 (50 percent) as unchanged, 22 (7 percent) as worse, and 26 (9 percent) as much worse. In the usual care group, 40 (13 percent) of the 300 surviving patients were classified as much better, 33 (11 percent) as better, 163 (54 percent) as unchanged, 39 (13 percent) as worse, and 25 (8 percent) as much worse (P = 0.009). The difference between the groups remained significant (P = 0.04) in a multivariable model in which we controlled for potentially confounding base-line characteristics of the patients. Lengths of stay and hospital charges were similar in the two groups. Fewer patients assigned to the intervention group were discharged to long-term care institutions (43 patients [14 percent], as compared with 67 patients [22 percent] in the usual-care group; P = 0.01). Among the 493 patients discharged to private homes, similar proportions (about 10 percent) in the two groups were admitted to long-term care institutions during the three months after discharge. Specific changes in the provision of acute hospital care can improve the ability of a heterogeneous group of acutely ill older patients to perform basic activities of daily living at the time of discharge from the hospital and can reduce the frequency of discharge to institutions for long-term care.

The relationships between weight-bearing asymmetry after stroke, motor function and activities of daily living

A survey of 90 stroke patients was undertaken to examine the pattern of weight distribution when standing and its relationship with motor function and independence in self-care activities. Weight distribution was measured with a computerised limb load monitor, motor function with the Rivermead Motor Assessment Scale and activities of daily living (ADL) with the 10-point ADL scale. Stroke patients showed an asymmetry in weight distribution, with the majority (79%) favouring the unaffected leg. The degree of asymmetry correlated significantly with motor function (rs= −0.45, P<0.001) and ADL (rs= −0.35, P<0.001). The results support the treatment goal currently used by both physiotherapists and occupational therapists of re-educating the symmetrical stance of stroke patients. It is noted that further studies are needed to evaluate therapists′ success in achieving this goal.

Disabled patients in acute hospital wards

Seventy-five patients who had a clinically diagnosed disabling disease and who usually had difficulty with one or more activities of selfcare were identified in a 10-month survey of the acute wards of a large teaching hospital. Their dependence on assistance for specific activities at home and in the acute wards was recorded by a research nurse in interviews carried out in the patient's home within two weeks of hospital discharge. The study showed that although most of the disabled patients were able to continue with their daily selfcare activities, their increased dependence on assistance in hospital in comparison with their home was often due to limitations in the provision and use of ward facilities. The effects of these limitations on the selfcare of disabled patients are illustrated. It is concluded that disabled patients would enjoy greater independence in selfcare activities in acute wards and could be less dependent on nursing staff if there was improvement in ward design and the provision of aids and equipment whilst the abilities of disabled patients for selfcare were recognised by ward staff.

The Effect of an Exercise Program on Self-Care Activities for the Institutionalized Elderly

Abstract A range-of-motion exercise program was carried out experimentally using ten elderly residents of an intermediate care facility in the State of Virginia. The effects on independence in self-care activities were measured against a control group. The treatment program consisted of eight exercise classes ranging over a four-week period. The control group did not perform any of the exercises assigned in the treatment program. Both groups were pre- and post-tested using The Performance Test of Activities of Daily Living, an observational instrument designed to test 16 separate tasks of daily living. The exercise group showed no significant differences, however, in post-testing of their independent self-care abilities. Only two residents showed improvement when tested individually. It is suggested that the limitations of the study be taken into account when the results are considered.