Occupational Therapy and the IMPACT Act: Part 2. A Systematic Review of Evidence for Functional Status, Medication Reconciliation, and Skin Integrity Interventions

Importance: Interventions that promote function, medication reconciliation, and skin integrity assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing health care costs. Objective: In this systematic review, we focus on three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: functional status, medication reconciliation, and skin integrity. Data Sources: We conducted a search of the literature published between 2009 and 2019 in CINAHL, Cochrane, MEDLINE, PsycINFO, OTseeker, and Scopus. We also hand searched the systematic reviews and meta-analyses in our search results for articles that met our inclusion criteria. Study Selection and Data Collection: This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Findings: We found 47 articles that address the three outcome areas. Regarding functional status, low strength of evidence is available for cognition and functional mobility interventions to support functional performance, moderate strength of evidence supports interventions for vision, and moderate evidence supports task-oriented and individualized interventions to promote activities of daily living (ADL) outcomes among people with neurological conditions. Strong strength of evidence supports individualized occupational therapy interventions focusing on medication adherence. Low strength of evidence was found for occupational therapy interventions to reduce pressure ulcers and promote skin integrity. Conclusion and Relevance: The evidence supports occupational therapy interventions to improve functional status in ADLs and medication management. Additional research is needed that examines the outcomes of occupational therapy interventions for other areas of function and skin integrity. What This Article Adds: We found evidence to support occupational therapy interventions that align with value-based measures in the three outcome areas of interest. The effectiveness of these interventions highlights the viability of occupational therapy as an essential profession and the worth of occupational therapy to the public, potential clients, and payers.

Occupational Therapy and the IMPACT Act: Part 1. A Systematic Review of Evidence for Fall Prevention and Reduction, Community Discharge and Reintegration, and Readmission Prevention Interventions

Importance: Interventions that prevent falls, facilitate discharge after hospitalization, and reduce hospital readmissions assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing costs. Objective: In this systematic review, we address three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: prevention and reduction of falls, facilitation of community discharge and reintegration, and prevention of hospital readmission. Data Sources: We conducted a search of the literature published between 2009 and 2019. Study Selection and Data Collection: We developed operational definitions to help us identify articles that answered the search question for each outcome area. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Findings: We found 53 articles that address the three outcome areas. Regarding the prevention and reduction of falls, low strength of evidence is available for interventions focusing on a single fall risk and for customized interventions addressing multiple risks. Moderate strength of evidence supports structured community fall risk prevention interventions. Low strength of evidence was found for community discharge and reintegration interventions that include physical activity and educational programming. Low to moderate strength of evidence was found for readmission prevention interventions for patients with four types of condition. Conclusion and Relevance: Several intervention themes in the three outcome areas of interest are supported by few studies or by studies with a moderate risk of bias. Additional research is needed that supports the value of occupational therapy interventions in these outcome areas. What This Article Adds: Our study provides important insights into the state of the evidence related to occupational therapy interventions to address three outcome areas of the IMPACT Act.

Occupational Therapy and the IMPACT Act: Part 1. A Systematic Review of Evidence for Fall Prevention and Reduction, Community Discharge and Reintegration, and Readmission Prevention Interventions

Importance: Interventions that prevent falls, facilitate discharge after hospitalization, and reduce hospital readmissions assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing costs. Objective: In this systematic review, we address three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: prevention and reduction of falls, facilitation of community discharge and reintegration, and prevention of hospital readmission. Data Sources: We conducted a search of the literature published between 2009 and 2019. Study Selection and Data Collection: We developed operational definitions to help us identify articles that answered the search question for each outcome area. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Findings: We found 53 articles that address the three outcome areas. Regarding the prevention and reduction of falls, low strength of evidence is available for interventions focusing on a single fall risk and for customized interventions addressing multiple risks. Moderate strength of evidence supports structured community fall risk prevention interventions. Low strength of evidence was found for community discharge and reintegration interventions that include physical activity and educational programming. Low to moderate strength of evidence was found for readmission prevention interventions for patients with four types of condition. Conclusion and Relevance: Several intervention themes in the three outcome areas of interest are supported by few studies or by studies with a moderate risk of bias. Additional research is needed that supports the value of occupational therapy interventions in these outcome areas. What This Article Adds: Our study provides important insights into the state of the evidence related to occupational therapy interventions to address three outcome areas of the IMPACT Act.

Occupational Therapy Interventions for People With Parkinson’s Disease

Evidence Connection articles provide a clinical application of the evidence from the systematic reviews developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of an older adult recently diagnosed with Parkinson’s disease. The occupational therapy assessment and intervention process in the outpatient clinic is described. This Evidence Connection article is based on findings from an AOTA systematic review on interventions within the scope of occupational therapy practice to improve and maintain participation in education, work, volunteering, and leisure and social activities among adults with Parkinson’s disease. Each article in this series summarizes the evidence from the systematic reviews on a given topic and presents an application of the evidence as it relates to a clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can inform and guide professional reasoning.

Occupational therapy interventions in pulmonary rehabilitation – an update in the COVID-19 ERA

Background. As symptoms of COVID-19 infection are varying in severity and type, the long-term disability is yet to be established due to a short time-window since the pandemic started. Most survivors will have persistent pulmonary symptoms even after the infection, which raises the awareness of the importance of pulmonary rehabilitation in these patients, as they are mostly young, with severely diminished quality of life as they are unable to perform their basic activities of daily living as before. Occupational therapy is a form of rehabilitation treatment aimed at maximizing functionality and independence in performing activities of daily living, improvement of the patient’s autonomy and prevention of further functional decline. Objective. The purpose of the current work is to review the most important occupational therapy interventions applicable during a pulmonary rehabilitation program for chronic pulmonary pathologies, that can also be applied in COVID-19 survivors with persistent respiratory symptoms. Discussion. The main objectives of occupational therapy in pulmonary rehabilitation are training using breathing techniques at rest and during task performance, upper limbs training to increase exercise tolerance, programming and simplifying daily activities, informing patients of the importance of asking for help, planning the day/week, organizing the environment, educating the patient. All these objectives can be achieved in a simple way and at low-cost. Conclusions. Occupational therapy intervention during comprehensive pulmonary rehabilitation must be promoted to specifically evaluate and solve problems related to respiratory disability. Occupational tasks should be related to symptoms occurring during specific activities. Standardized protocols and definition of outcomes during occupational therapy intervention are lacking. Keywords: occupational therapy, pulmonary rehabilitation, COVID-19, activities of daily living, quality of life,

Patients’ experiences of occupational therapy within a multidisciplinary pain management programme: A qualitative study

Background Occupational problems are common for adults experiencing chronic pain, but occupational therapists are not always accessed as part of the multidisciplinary team. Despite evidence of benefit for work-focused interventions, there is limited evidence for broader benefit from occupational therapy interventions within the context of multidisciplinary pain management. The aim of this study was to explore the experiences of programme attendees who received structured intervention from an occupational therapist as part of a multidisciplinary pain management programme, and gain an understanding as to how they felt it influenced changes they made to occupational participation. Method A qualitative approach was undertaken with 9 individual patients recruited from a group pain management programme for adults with chronic low back pain. Semi-structured interviews were carried out, recorded and transcribed. Thematic analysis was used to identify themes in the data. Results Three key themes were identified: 1) the helpfulness of activity pacing techniques 2) the value of participating in a therapeutic activity-based session and 3) an increased understanding of the importance of leisure and creative activities in the context of their lives. Conclusion Participants perceived the specific occupational therapy content of the programme to be helpful in a number of different ways. The findings suggest that occupational therapy can be important in facilitating patients to apply theoretical techniques in the real world, thereby increasing the likelihood of long term benefit.

A scoping review of occupational therapy interventions in the treatment of people with substance use disorders

Purpose Diagnosis of substance use disorders and addictive behaviours are growing worldwide. It is timely to examine and collate literature on the nature of occupational therapy intervention in this field, to increase understanding of current practice and inform future directions. The purpose of this paper is to source and synthesise literature on occupational therapy interventions used in the treatment of people experiencing addiction. Design/methodology/approach Four databases were searched in August 2019. A total of 597 titles were screened, and 18 studies with varying methods met inclusion criteria. A narrative synthesis of the included literature was arranged into themes to summarise key findings. Findings Findings were grouped into three themes about occupational therapy provision to people experiencing addiction: single occupation focused intervention; skills training (including sub-themes on daily living skills and vocational skills); and establishing a community-based sober routine. Research limitations/implications Further research on this topic should focus on efficacy of treatments and build on current findings to develop more rigorous research with appropriate sample sizes to support evidence-based practice. Originality/value This study presents a synthesis of how occupational therapy interventions have been used to treat people experiencing addiction issues. Findings indicate occupational therapy appears to fit well within addiction treatment and assert that occupational therapy is most supportive when interventions go beyond the teaching of skills alone to prioritise occupational engagement and client centred practice.

O olhar do terapeuta ocupacional para as infâncias: reflexões a partir de uma experiência em uma escola pública/The ocupational herapist's view of childhood: reflections from an experience in a public school

Introdução: A unificação do conceito de infância é uma produção sócio-histórica, que se reverbera até os dias atuais, gerando desigualdades por não ser coerente a todas as realidades. No campo da saúde, ainda se produz cuidado pautado em um paradigma dominante: branco, burguês e higienista, refletindo em intervenções que não consideram o contexto de escassez de recursos vivenciado por muitas crianças brasileiras. Objetivo: Este estudo tem o objetivo de problematizar o olhar unificado da infância nas intervenções da Terapia Ocupacional, no campo da saúde e sua interface com a educação, a partir da experiência com crianças moradoras de um complexo de favelas no município do Rio de Janeiro/RJ. Método: Trata-se de um estudo, de caráter exploratório, de base qualitativa, que adotou a observação direta e notas em um diário de campo como ferramentas metodológicas no decurso da pesquisa. Resultado/Discussão: As crianças acompanhadas nesta pesquisa apresentaram o encargo do cuidado da casa e de crianças menores e, aparente, normalização da violência como modo de viver a constante negação de direitos básicos. Os profissionais da escola relatam os responsáveis como desinteressados e ausentes quanto à vida escolar dos alunos, contudo, na narrativa trazida pelas crianças, essa ausência se justifica pelas longas jornadas de trabalho enfrentadas pelos responsáveis. Conclusão: Sugere-se que mais literaturas abordando esse tema sejam produzidas e discutidas para que a prática da Terapia Ocupacional se alinhe cada vez mais aos contextos reais tão diversos vividos pelas pessoas. Palavras-chave: Infâncias. Vulnerabilidade. Saúde. Favela. EscolaAbstractIntroduction: The unification of the concept of childhood is a socio-historical production that reverberates to the present day, generating inequalities because it isn’t coherent to all realities. In the field of health care we still produce a practice based on a dominant paradigm: white, bourgeois and hygienist, reflecting on interventions that do not consider the context of scarcity of resources experienced by many Brazilian children. Objective: This study aims to problematize the unified view of childhood in occupational therapy interventions in the field of health care and its interface with education, based on the experience with children living in a slum complex in the city of Rio de Janeiro / RJ. Method: This is an exploratory, qualitative study that adopted direct observation and notes in a field diary as methodological tools in the course of the research. Result/Discussion: The children monitored in this research presented the burden of caring for the home and younger children and apparent normalization of violence as a way of living the constant denial of basic rights. The school professionals report the guardians as disinterested and absent as to the students' school life, however in the narrative brought by the children, this absence is justified by the long working hours faced by the guardians. Conclusion: It is suggested that more literature addressing this theme be produced and discussed so that the practice of Occupational Therapy is more and more aligned with these contexts so real and so diverse experienced by these people.Keywords: Childhood. Vulnerability. Health. Slum. Shanty town. School. ResumenIntroducción: La unificación del concepto de infancia es una producción socio histórica que repercute hasta la actualidad, ocasionando desigualdades por no ser coherente con todas las realidades. En el campo de la salud se sigue produciendo a partir de un paradigma dominante: blanco, burgués e higienista, reflejando sobre intervenciones que no consideran el contexto de escasez de recursos que viven muchos niños brasileños. Objetivo: Este estudio tiene como objetivo problematizar la visión unificada de la infancia en las intervenciones de terapia ocupacional en el campo de la salud y su interfaz con la educación, a partir de la experiencia con niños que viven en un complejo de tugurios en la ciudad de Rio de Janeiro/RJ. Método: Se trata de un estudio exploratorio, cualitativo que adoptó la observación directa y las anotaciones en un diario de campo como herramientas metodológicas en el curso de la investigación. Resultado/Discusión: Los niños monitoreados en esta investigación presentaron la carga de cuidar de los niños más pequeños y la aparente normalización de la violencia como una forma de vivir la constante negación de los derechos básicos. Los profesionales de la escuela relatan que los padres, estos niños, son desinteresados y ausentes en cuanto a la vida escolar de los alumnos, sin embargo, en la narrativa que traen los niños esta ausencia se justifica por las largas jornadas laborales que enfrentan los padres y madres. Conclusión: Se sugiere producir y discutir más literatura que aborde este tema para que la práctica de la Terapia Ocupacional esté cada vez más alineada con los contextos reales tan diversos vividos por las personas.Palabras clave: Infancia. Vulnerabilidad. Salud. Tugurios. Escuela.

Occupational Therapy Interventions for Older Adults With Chronic Conditions and Their Care Partners

Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Project. In this Evidence Connection article, I describe a clinical case report of an older adult with a chronic condition and his daughter who received home health occupational therapy services. I discuss the occupational therapy evaluation and intervention processes with these clients to support chronic condition self-management, coping skills, and problem solving, drawing on findings from the systematic review on the effectiveness of interventions for care partners of people with chronic conditions published in the July/August 2021 issue of the American Journal of Occupational Therapy. It is my hope that this Evidence Connection article can be used to inform and guide clinical decision making when working with older adults with chronic conditions and their care partners.