Occupational therapy and pulmonary rehabilitation of disabled COPD patients.
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BACKGROUND: Occupational therapy (OT) has been defined as a task of rehabilitation for disabled patients, giving them maximal function and independence to sustain specific activities of daily living. OBJECTIVES: To evaluate the effectiveness of OT as an adjunctive measuring during pulmonary rehabilitation (PR) of hospitalized COPD patients. METHODS: A prospective clinical trial with parallel groups was undertaken in severely disabled COPD patients (n = 71, age 73 +/- 5 years). They were assigned to either OT+PR (n = 47, FEV1 46 +/- 21%pred.) or PR (n = 24, FEV1 44 +/- 12%pred.). PR consisted of eighteen 3-hour daily sessions, whilst OT (domestic activities) was added 3 times a week up to nine 1-hour sessions. Six-min walk (6MWD) with evaluation of BORG dyspnea (D) and leg fatigue (F) scores at end of effort, breathlessness sensation (B) by means of the MRC scale as well as the number of functions lost in the Basic Activity of Daily Living (BADL) categories were assessed as outcomes before (T0) and after (T1) rehabilitation. RESULTS: 6MWD (from 165 +/- 63 to 233 +/- 66 and from 187 +/- 52 to 234 +/- 65 m in the OT+PR and PR groups, respectively), D (from 4.9 +/- 2.1 to 3.2 +/- 1.6 and from 5.3 +/- 2.1 to 3.4 +/- 2.1), F (from 6.1 +/- 0.5 to 4.5 +/- 1.7 and from 5.9 +/- 0.8 to 4.3 +/- 0.8) and B (from 4.3 +/- 0.9 to 3.0 +/- 0.9 and from 4.2 +/- 1.0 to 3.2 +/- 0.8) had similarly improved (p < 0.01) in both groups at T1. The percentage distribution of patients across the BADL categories significantly changed (p = 0.004) in OT+PR (from 17 to 61%, from 70 to 34% and from 23 to 5% in categories A, B and C, respectively) but not in the PR group. CONCLUSIONS: The addition of OT to comprehensive PR is able to specifically improve the outcome of severely disabled COPD inpatients. (+info)
Therapy outcome measures for allied health practitioners in Australia: the AusTOMs.
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OBJECTIVE: The aim of this study was to develop a valid and reliable measure of therapy outcome for three allied health professions in Australia: speech pathology, occupational therapy, and physiotherapy. The Australian Therapy Outcome Measures (AusTOMs) enable measurement of the differences in client profiles and patterns of services provision across health care settings. In this paper we describe phase 1 of the study: the development and preliminary validation of the AusTOMs. METHOD: The UK TOMs, developed by Enderby, were scrutinized by the research team. A pilot core scale was developed, based on the structure of the TOM. Focus groups of expert clinicians for each profession, across the state of Victoria in Australia, analysed and refined the scales further. A mail-out survey was then sent to therapists across Australia to assess both face and content validity of the AusTOMs. MAIN RESULTS: A new tool, the AusTOM, was developed and tailored to the needs of each profession, with input from specialist clinicians and allied health researchers. The face and content validity of the new scales were assessed, and good consensus was obtained for the wording and content validity of the scales. The discriminative validity, concurrent validity, and reliability of the tool are now being evaluated. CONCLUSION: We have produced an outcome measure in the Australian context for speech pathology, physiotherapy, and occupational therapy. There are six speech pathology scales, nine physiotherapy scales, and 11 occupational therapy scales in the AusTOMs. A clinician chooses the relevant scale(s) for the client (based on the goals of therapy) and makes a rating across all domains for each scale. Further papers will report on the reliability, validity, and clinical usefulness of the AusTOMs. (+info)
Back pain rehabilitation.
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BACKGROUND: Back pain is a universal problem that becomes persistent in 5-10% of patients following an acute episode. This makes it one of the most costly areas of health care in Australia. OBJECTIVE: This article outlines the paradigm that general practitioners should adopt to assist the patient to live with their pain experience. DISCUSSION: The development of persistent back pain is not a static process but one that is heavily influenced by the context in which it occurs. Patient characteristics, health care providers and the health system environment contribute and interact to promote the development of persistent pain. Health care providers involved in managing persistent pain should remain confidant, positive and reassuring. They should encourage activity, discourage fear avoidance behaviour, and consider rehabilitation early before illness beliefs become entrenched. Multidisciplinary rehabilitation, when used early, aims to improve function and assist in the return to work process; when used late, it aims to prevent worsening disability and increased coping for patients. (+info)
Individual patient data meta-analysis of randomized controlled trials of community occupational therapy for stroke patients.
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BACKGROUND AND PURPOSE: Trials of occupational therapy for stroke patients living in the community have varied in their findings. It is unclear why these discrepancies have occurred. METHODS: Trials were identified from searches of the Cochrane Library and other sources. The primary outcome measure was the Nottingham Extended Activities of Daily Living (NEADL) score at the end of intervention. Secondary outcome measures included the Barthel Index or the Rivermead ADL (Personal ADL), General Health Questionnaire (GHQ), Nottingham Leisure Questionnaire (NLQ), and death. Data were analyzed using linear or logistic regression with a random effect for trial and adjustment for age, gender, baseline dependency, and method of follow-up. Subgroup analyses compared any occupational therapy intervention with control. RESULTS: We included 8 single-blind randomized controlled trials incorporating 1143 patients. Occupational therapy was associated with higher NEADL scores at the end of intervention (weighted mean difference [WMD], 1.30 points, 95% confidence intervals [CI], 0.47 to 2.13) and higher leisure scores at the end of intervention (WMD, 1.51 points; 95% CI, 0.24 to 2.79). Occupational therapy emphasizing activities of daily living (ADL) was associated with improved end of intervention NEADL (WMD, 1.61 points; 95% CI, 0.72 to 2.49) and personal activities of daily living (odds ratio [OR], 0.65; 95% CI, 0.46 to 0.91), but not NLQ. Leisure-based occupational therapy improved end of intervention NLQ (WMD, 1.96 points; 95% CI, 0.27 to 3.66) but not NEADL or PADL. CONCLUSIONS: Community occupational therapy significantly improved personal and extended activities of daily living and leisure activity in patients with stroke. Better outcomes were found with targeted interventions. (+info)
Occupational therapy for community dwelling elderly people: a systematic review.
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OBJECTIVE: Occupational therapy might play an important role in maintaining independent living for community dwelling elderly people. The aim of this systematic review is to determine whether occupational therapy improves outcome for people who are >/=60 years and are living independently. METHODS: An extensive search in MEDLINE, CINAHL, EMBASE, AMED and SCISEARCH until July 2002 was performed. Studies with controlled and uncontrolled designs were included. Six intervention categories were distinguished and individually analysed using a best-evidence synthesis, based on the type of design, the methodological quality, type of outcome measures and statistical significance of findings. RESULTS: 17 studies were included, ten of which were randomised clinical trials. Six randomised clinical trials had a high methodological quality. Strong evidence is present for the efficacy of advising on assistive devices as part of a home hazards assessment on functional ability. There is some evidence for the efficacy of training of skills combined with a home hazard assessment in decreasing the incidence of falls in elderly people at high risk of falling. Some evidence is available for the efficacy of comprehensive occupational therapy on functional ability, social participation and quality of life. Insufficient evidence is present for the efficacy of counselling the primary caregiver of dementia patients about maintaining the patient's functional abilities. CONCLUSION: This review shows that occupational therapy interventions for community dwelling elderly people results in positive outcomes. Future research in the efficacy of occupational therapy in elderly patient groups such as people with dementia is recommended. Furthermore, research into tailoring interventions to the needs of elderly patients is recommended. (+info)
Are occupational therapists more effective than social workers when assessing frail older people? Results of CAMELOT, a randomised controlled trial.
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OBJECTIVES: To compare the effectiveness of occupational therapist-led assessments of older people on dependency and service costs with that of social worker-led assessments. DESIGN: Pragmatic community-based randomised controlled trial over 2 years 4 months. SETTING: Cambridgeshire, UK. PARTICIPANTS: 321 older people aged 65 and over living in their own homes and 113 carers. INTERVENTION: participants were randomised to two groups, to receive either occupational therapist-led or social worker-led assessment. OUTCOME MEASURES: Primary outcome was dependency (Community Dependency Index). Secondary outcomes included quality of life scores (EQ-5D) and psychological outlook (Perceived Stress Scale (PSS)). Outcome measures for carers included Carer Assessment of Difficulty Index (CADI), PSS and EQ-5D, collected at baseline, 4 and 8 months. Resource use data were collected from professional practice records, participants and carers at final follow-up. RESULTS: 264 (82%) of the randomised participants completed the study. No between-group statistically significant differences were found, except that carers in the occupational therapist arm had significantly better EQ-5D scores at the 8 month follow-up (thermometer P = 0.03) and in the social worker arm better CADI scores on stress (P = 0.047) and amount of caring (P = 0.049). CONCLUSIONS: There was no clear difference in patient-centred effectiveness measures between occupational therapists and social workers in assessing frail older people and their carers in the community. More extensive use of primary care health services by occupational therapists may have contributed to the differences in EQ-5D scores for carers. Delays in making occupational therapy assessments and in completing recommended housing adaptations may have contributed to these negative findings. (+info)
Occupational therapy compared with social work assessment for older people. An economic evaluation alongside the CAMELOT randomised controlled trial.
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OBJECTIVES: To compare costs and outcome of occupational therapy-led assessment with social worker-led assessment of older people, in terms of their independence and quality of life. DESIGN: Cost-effectiveness analysis alongside a randomised controlled trial. The analysis took viewpoints of health services and patients. The primary outcome measure for cost-effectiveness was dependency using the Community Dependency Index (CDI). Secondary outcomes included utility scores based on the EuroQoL (EQ-5D). Resource use was measured for each patient, from clinical records and from patient carer interviews at 8 months. Unit costs of health and social care resources were derived from local sources and national datasets. Cost-effectiveness was analysed using cost-effectiveness acceptability curves. RESULTS: There were no differences between the two arms of the trial in terms of cost-effectiveness. There is an apparent increase in mean cost per case for the occupational therapy arm but this is not statistically significant (mean difference in cost per case 542 pounds, 95% CI 434-1,519 pounds). Mean total costs of care per participant were 4,379 pounds and 3,837 pounds for the occupational therapy and social work arms, respectively. At best the intervention would improve outcomes at a cost of 14,000 pounds per quality-adjusted life year (QALY). The probability of such an outcome was <50%. CONCLUSIONS: From a policy perspective, the lack of difference in clinical and cost-effectiveness means that either a social work or an occupational therapy service is successful in making care assessments that enable an older person to remain in their own home. (+info)
Validity of the AusTOM scales: a comparison of the AusTOMs and EuroQol-5D.
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BACKGROUND: Clinicians require brief outcome measures in their busy daily practice to document global client outcomes. Based on the UK Therapy Outcome Measure, the Australian Therapy Outcome Measures were designed to capture global therapy outcomes of occupational therapy, physiotherapy and speech pathology in the Australian clinical context. The aim of this study was to investigate the construct (convergent) validity of the Australian Therapy Outcome Measures (AusTOMs) by comparing it with the EuroQuol-5D (EQ-5D). METHODS: The research was a prospective, longitudinal cohort study, with data collected over a seven month time period. The study was conducted at a total of 13 metropolitan and rural health-care sites including acute, sub-acute and community facilities. Two-hundred and five clients were asked to score themselves on the EQ-5D, and the same clients were scored by approximately 115 therapists (physiotherapists, speech pathologists and occupational therapists) using the AusTOMs at admission and discharge. Clients were consecutive admissions who agreed to participate in the study. Clients of all diagnoses, aged 18 years and over (a criteria of the EQ-5D), and able to give informed consent were scored on the measures. Spearman rank order correlation coefficients were used to analyze the relationships between scores from the two tools. The clients were scored on the AusTOMs and EQ-5D. RESULTS: There were many health care areas where correlations were expected and found between scores on the AusTOMs and the EQ-5D. CONCLUSION: In the quest to measure the effectiveness of therapy services, managers, health care founders and clinicians are urgently seeking to undertake the first step by identifying tools that can measure therapy outcome. AusTOMs is one tool that can measure global client outcomes following therapy. In this study, it was found that on the whole, the AusTOMs and the EQ-5D measure similar constructs. Hence, although the validity of a tool is never 'proven', this study offers preliminary support for the construct validity of AusTOMs. (+info)