Randomised controlled trial of an occupational therapy intervention to increase outdoor mobility after stroke. (41/332)

OBJECTIVE: To evaluate an occupational therapy intervention to improve outdoor mobility after stroke. DESIGN: Randomised controlled trial. SETTING: General practice registers, social services departments, a primary care rehabilitation service, and a geriatric day hospital. PARTICIPANTS: 168 community dwelling people with a clinical diagnosis of stroke in previous 36 months: 86 were allocated to the intervention group and 82 to the control group. INTERVENTIONS: Leaflets describing local transport services for disabled people (control group) and leaflets with assessment and up to seven intervention sessions by an occupational therapist (intervention group). MAIN OUTCOME MEASURES: Responses to postal questionnaires at four and 10 months: primary outcome measure was response to whether participant got out of the house as much as he or she would like, and secondary outcome measures were response to how many journeys outdoors had been made in the past month and scores on the Nottingham extended activities of daily living scale, Nottingham leisure questionnaire, and general health questionnaire. RESULTS: Participants in the treatment group were more likely to get out of the house as often as they wanted at both four months (relative risk 1.72, 95% confidence interval 1.25 to 2.37) and 10 months (1.74, 1.24 to 2.44). The treatment group reported more journeys outdoors in the month before assessment at both four months (median 37 in intervention group, 14 in control group: P < 0.01) and 10 months (median 42 in intervention group, 14 in control group: P < 0.01). At four months the mobility scores on the Nottingham extended activities of daily living scale were significantly higher in the intervention group, but there were no significant differences in the other secondary outcomes. No significant differences were observed in these measures at 10 months. CONCLUSION: A targeted occupational therapy intervention at home increases outdoor mobility in people after stroke.  (+info)

Content comparison of occupation-based instruments in adult rheumatology and musculoskeletal rehabilitation based on the International Classification of Functioning, Disability and Health. (42/332)

OBJECTIVE: To compare the content of clinical, occupation-based instruments that are used in adult rheumatology and musculoskeletal rehabilitation in occupational therapy based on the International Classification of Functioning, Disability and Health (ICF). METHODS: Clinical instruments of occupational performance and occupation in adult rehabilitation and rheumatology were identified in a literature search. All items of these instruments were linked to the ICF categories according to 10 linking rules. On the basis of the linking, the content of these instruments was compared and the relationship between the capacity and performance component explored. RESULTS: The following 7 instruments were identified: the Canadian Occupational Performance Measure, the Assessment of Motor and Process Skills, the Sequential Occupational Dexterity Assessment, the Jebson Taylor Hand Function Test, the Moberg Picking Up Test, the Button Test, and the Functional Dexterity Test. The items of the 7 instruments were linked to 53 different ICF categories. Five items could not be linked to the ICF. The areas covered by the 7 occupation-based instruments differ importantly: The main focus of all 7 instruments is on the ICF component activities and participation. Body functions are covered by 2 instruments. Two instruments were linked to 1 single ICF category only. CONCLUSION: Clinicians and researchers who need to select an occupation-based instrument must be aware of the areas that are covered by this instrument and the potential areas that are not covered at all.  (+info)

Relationship between rehabilitation therapies and outcome of stroke patients in Israel: a preliminary study. (43/332)

BACKGROUND: The relationship between the amount of rehabilitation therapy and functional outcome in stroke patients has not been established. OBJECTIVES: To evaluate the effectiveness of inpatient rehabilitation for post-acute stroke, and examine the relationship between intensity of therapies and functional status at discharge. METHODS: We evaluated 50 first-stroke patients, average age 63 years, in a prospective descriptive study. The impairment and Functional Independence Measurement were assessed both at admission to rehabilitation and at discharge. Patients were monitored weekly during their stay by means of discipline-specific measures of activity level. Predictor variables included intensity of physical, occupational and speech therapies; demographic characteristics; length of stay; and time since the stroke. RESULTS: A significant reduction in impairment was observed at discharge. The predictors of gains and activity level at discharge as well as motor vs. cognitive components of the FIM were neither consistent nor did they occur in the same trend of functional improvement. Greater FIM motor level at discharge was associated with younger age, higher admission motor and cognitive level, and receipt of any speech therapy, while greater FIM cognitive level was associated with higher cognitive level at admission, shorter interval from onset to admission, and more intense occupational therapy. More intense OT was associated with greater and more cognitive improvement during the hospitalization. CONCLUSION: Since the sample was relatively small and heterogenous in terms of the patients' functional abilities, the findings cannot be generalized to the whole population of stroke patients. Further efforts to identify the best timing, modalities, intensity and frequency of the various treatments are needed to improve the cost-benefit equation of rehabilitation in stroke patients.  (+info)

Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention--a randomised controlled trial. (44/332)

OBJECTIVES: To determine the effectiveness of multifactorial intervention to prevent falls in cognitively intact older persons with recurrent falls. DESIGN: Randomised controlled trial of multifactorial (medical, physiotherapy and occupational therapy) post-fall assessment and intervention compared with conventional care. SETTING: Accident & Emergency departments in a university teaching hospital and associated district general hospital. SUBJECTS: 313 cognitively intact men and women aged over 65 years presenting to Accident & Emergency with a fall or fall-related injury and at least one additional fall in the preceding year; 159 randomised to assessment and intervention and 154 to conventional care. OUTCOME MEASURES: primary outcome was the number of falls and fallers in 1 year after recruitment. Secondary outcomes included injury rates, fall-related hospital admissions, mortality and fear of falling. RESULTS: There were 36% fewer falls in the intervention group (relative risk 0.64, 95% confidence interval 0.46-0.90). The proportion of subjects continuing to fall (65% (94/144) compared with 68% (102/149) relative risk 0.95, 95% confidence interval 0.81-1.12), and the number of fall-related attendances and hospital admissions was not different between groups. Duration of hospital admission was reduced (mean difference admission duration 3.6 days, 95% confidence interval 0.1-7.6) and falls efficacy was better in the intervention group (mean difference in Activities Specific Balance Confidence Score of 7.5, 95% confidence interval 0.72-14.2). CONCLUSION: Multifactorial intervention is effective at reducing the fall burden in cognitively intact older persons with recurrent falls attending Accident & Emergency, but does not reduce the proportion of subjects still falling.  (+info)

Goal attainment scaling as a measure of change in infants with motor delays. (45/332)

Goal attainment scaling (GAS) is an individualized criterion-referenced measure of change that has several unique features, compared with the behavioral objective, and five possible levels of attainment for each goal. The validity of GAS as a measure of motor change was investigated in 65 infants, 3 to 30 months of age, with motor delays. For each infant, two goals to be attained within a 6-month period of intervention were established. After the 6-month period, the mean GAS T-score of 55.4 was significantly higher than the expected mean of 50. This finding indicated that the infants' motor change exceeded the therapists' expectations. Neither the type nor the category of goal influenced the therapists' ability to select outcomes that the infants were capable of achieving. Because moderate and low correlations were found between GAS T-scores and Peabody gross motor and fine motor change scores, the two assessments appear to measure different aspects of motor development. Selected child, family, and program variables were examined as sources of bias in GAS T-scores. Motor delay was the only variable that biased GAS T-scores; infants who were less delayed had higher GAS T-scores. The results indicate that GAS was responsive to change in individualized motor goals and support the model of GAS as an idiosyncratic measure. The unique features of GAS offer advantages for measurement of motor change compared with the behavioral objective and norm-referenced developmental scales.  (+info)

Systematic review of therapies for osteoarthritis of the hand. (46/332)

OBJECTIVE: To systematically review published randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological therapies in patients with hand osteoarthritis (OA), with an emphasis on trial methodology. METHODS: RCTs published between 1966 and August 2004 were identified by searching several electronic data sources as well as by searching reference lists. Details of study demographics, methodology, quality and outcomes were analyzed. A meta-analysis was planned, if feasible. RESULTS: Thirty-one RCTs evaluating various pharmacological and non-pharmacological therapies in hand OA were analyzed in this systematic review. When compared with hip and knee OA, there are surprisingly few published RCTs in hand OA. Generally, these RCTs are of low quality. RCTs are weakened by a lack of consistent case definition and by a lack of standardized outcome assessments. The methods used for randomization, blinding, and allocation concealment were rarely described. The number and location of symptomatic hand joints per treatment group at baseline was usually not stated. The number and location of evaluated hand joints at the end of the study was also usually not stated. A meta-analysis could not be performed since most of the treatments studied did not have more than one identical comparison to allow pooling of the data. CONCLUSION: It is apparent that hand OA is a more complex area in which to study the efficacy of therapies when compared to hip and knee OA. Consensus guidelines are urgently needed to help improve the design and conduct of RCTs in hand OA. Additional RCTs of high quality that follow consensus recommendations are needed to evaluate the wide range of possible therapeutic options available for patients with hand OA.  (+info)

Design and utility of a web-based computer-assisted instructional tool for neuroanatomy self-study and review for physical and occupational therapy graduate students. (47/332)

The cadaver continues to be the primary tool to teach human gross anatomy. However, cadavers are not available to students outside of the teaching laboratory. A solution is to make course content available through computer-assisted instruction (CAI). While CAI is commonly used as an ancillary teaching tool for anatomy, use of screen space, annotations that obscure the image, and restricted interactivity have limited the utility of such teaching tools. To address these limitations, we designed a Web-based CAI tool that optimizes use of screen space, uses annotations that do not decrease the clarity of the images, and incorporates interactivity across different operating systems and browsers. To assess the design and utility of our CAI tool, we conducted a prospective evaluation of 43 graduate students enrolled in neuroanatomy taught by the Divisions of Physical and Occupational Therapy at the University of Utah, College of Health. A questionnaire addressed navigation, clarity of the images, benefit of the CAI tool, and rating of the CAI tool compared to traditional learning tools. Results showed that 88% of the respondents strongly agreed that the CAI tool was easy to navigate and overall beneficial. Eighty-four percent strongly agreed that the CAI tool was educational in structure identification and had clear images. Furthermore, 95% of the respondents thought that the CAI tool was much to somewhat better than traditional learning tools. We conclude that the design of a CAI tool, with minimal limitations, provides a useful ancillary tool for human neuroanatomy instruction.  (+info)

Assessment of capacity for myoelectric control: a new Rasch-built measure of prosthetic hand control. (48/332)

OBJECTIVE: To report the results from a Rasch rating scale analysis of the Assessment of Capacity for Myoelectric Control (ACMC) implemented to evaluate internal scale validity, person response validity, separation reliability, targeting and responsiveness of the measures over time. DESIGN: Longitudinal data (18 months) from a prospective study of development of capacity for myoelectric control in children and adults were used for the analysis. PATIENTS: A consecutive sample of 75 subjects (43 males, 32 females) with upper limb reduction deficiency or amputation and myoelectric prosthetic hands referred for occupational therapy from September 2000 to March 2002. Participants' ages ranged from 2 to 57 years. METHODS: Outcome measure was the ACMC. Occupational therapists completed 210 assessments at an arm prosthesis centre in Sweden. A two-faceted rating scale analysis of the data was performed. RESULTS: All 30 ACMC items and 96.2% of participants demonstrated goodness-of-fit to the rating scale model for the ACMC. Separation and SE values suggested adequate reliability of the item and person estimates. CONCLUSION: The items demonstrated internal scale validity and the participants demonstrated person response validity. The ACMC was well targeted and sensitive enough to detect expected change in ability.  (+info)