Functional Changes After Occupational Therapy Among Individuals With a Distal Radius Fracture: A Longitudinal Study.

IMPORTANCE: Identifying the outcomes of occupational therapy after a distal radius fracture (DRF) is important so that effective strategies can be developed to mitigate the consequences associated with this common fracture. OBJECTIVE: To determine whether participation in occupational therapy improved functional status. Secondary objectives were to assess its effects on body functions and to examine the association between changes in outcome measures and occupational therapy-related factors. DESIGN: Longitudinal, with consecutive sampling over a 12-mo period. SETTING: Outpatient rehabilitation service. PARTICIPANTS: Participants were 38 adults with a unilateral DRF (ages 31-75 yr.; 81.6% female). INTERVENTION: Multicomponent occupational therapy, including supplemental techniques and activity-based interventions. OUTCOMES AND MEASURES: Functional status and body functions were assessed before and after therapy. RESULTS: All standardized measures of functional status showed significant improvements, which were large in size. Several body functions improved significantly (pain, sleep, wrist and forearm movements, and grip strength fraction), and effect sizes ranged from medium to large. For several outcome variables, earlier therapy was significantly associated with better results; moreover, the likelihood of achieving better outcomes was significantly higher among participants who attended more sessions. CONCLUSIONS AND RELEVANCE: Occupational therapy services have an important role to play after a DRF in terms of returning to daily activities and reducing impairments in body functions. Earlier intervention and attending a higher number of occupational therapy sessions are likely to further improve these outcomes. What This Article Adds: Because the effects of occupational therapy among people with a DRF remain uncertain, we quantified the outcomes of this intervention in an outpatient rehabilitation service, revealing medium to large improvements in the performance of daily activities and in various body functions. Our findings identified two factors associated with better results: early initiation of therapy and a higher number of occupational therapy sessions.

Changes in social functioning and engagement during canine-assisted intervention for children with neurodevelopmental disorders in the context of an early intervention service.

PURPOSE: The objectives were to evaluate the feasibility of early implementation of a canine-assisted intervention (CAI) for children with neurodevelopmental disorders, and to determine the changes in social functioning and in engagement experienced by the participants. MATERIALS AND METHODS: A CAI consisting of 24 sessions was piloted in an intra-subject quasi-experimental longitudinal design. The outcome measures were the Assessment of Communication and Interaction Skills (ACIS) and Individual Child Engagement Record-Revised (ICER-R). RESULTS: No adverse events or side-effects were noted. The sample consisted of 44 participants (median age 37 months). A total of 33 children (75%) attended all sessions. Main results showed that after completing the intervention, the overall ACIS score improved significantly (p < 0.001); the effect size was large. There was a significant improvement in the scales of the ICER-R from baseline to the final assessment: overall engagement (p < 0.001), frequency of repetitive behaviours (p < 0.001), frequency of interaction between the child and adults (p < 0.001), and the quality of this interaction (p < 0.001); the effect sizes ranged from medium to large. CONCLUSIONS: The early application was feasible. The results in the areas of social functioning and engagement suggest that this CAI may be a useful complementary strategy in early therapeutic intervention with these children. WHAT THIS PAPER ADDS?: The results of implementation of a canine-assisted intervention (CAI) at an early therapeutic intervention unit for children with neurodevelopmental disorders are not known. This research supported the feasibility and positive impact of a CAI in a population consisting of children with neurodevelopmental disorders in the earliest stages of their life, with similar proportions of participants with global developmental delay and autism spectrum disorder. The study was pioneering in the development of this form of actions in an early intervention service for children with these health conditions. The intervention appears feasible and the results extend the existing evidence base for this intervention modality. The findings suggest significant improvements of a medium to large size in the domains of communication skills and social relations, engagement levels, frequency and quality of interaction with adults and repetitive behaviours after 12 and 24 weekly CAI sessions.

A pilot randomized controlled trial of aquatic-based activities in a group occupational therapy program for adults living with serious mental illness in Spain.

Although aquatic-based interventions are increasingly used in the psychiatric rehabilitation services, the effects of this type of community program as an adjuvant therapy for psychosocial problems of people with serious mental illness (SMI) have been under-explored. This research evaluated the feasibility and outcomes of an occupational therapy program consisting of aquatic-based activities (AA-OT program) in the community in Spain. This study is the first randomized controlled trial (RCT) on this topic. This pilot trial was conducted with a sample of 16 adults with SMI who were randomly allocated to the AA-OT program plus treatment as usual or treatment as usual alone (eight in each group). The AA-OT program included activation of daily living skills, warm-up, group activities/tasks, and relaxation. It consisted of two sessions per week over 12 weeks. Outcomes were evaluated at week 0 and 12. A total of 14 participants (87.5%) completed the trial. No adverse events or side-effects were noted. Comparisons between the two groups on change scores showed that participants in the intervention group showed significant improvements in several outcome measures: psychosocial problems (HoNOS), two health-related quality of life scales (SF-36: Physical Functioning and Mental Health), and performance of social activities (Activity and Social Relations scale). Satisfaction with the program was high. In conclusion, the results support the feasibility and potential benefits of this occupational therapy program. 12 weeks of aquatic-based activities in a group intervention may enhance the outcomes of psychiatric rehabilitation improving the severity of psychosocial problems, patient-reported health status, and social relations. This community-based program may be beneficial as a non-pharmacologic method in the illness management and recovery of people with SMI. The findings from this pilot trial need to be confirmed in a large, fully-powered RCT.

Evaluation of improvement of functional independence in a multicentre cohort of rehabilitation outpatients with neurological conditions.

PURPOSE: The objectives were to examine: (1) the changes in independence in basic activities of daily living (ADL) following an outpatient occupational therapy (OT) intervention in people with neurological conditions; (2) the factors associated with good relative functional gain (RFG) and with good OT efficiency; (3) and the effects on instrumental activities of daily living (IADL) and caregiver assistance. MATERIALS AND METHODS: A prospective observational study examining changes in a multicentre cohort (three urban hospitals). Ninety-eight adults were assessed on admission and after intervention. Barthel Index was the primary outcome (ADL). RESULTS: Acquired brain damage (ABI) was the most frequent diagnosis (84.7%). There was an improvement in ADL (p < 0.001); the effect size (r) was large (r = 0.59). RFG was good for 88.8% of participants. A good RFG was significantly associated with ABI, a lower number of hours of caregiver assistance, and a greater intensity of OT. The OT efficiency was good for 43.9% of participants. Factors significantly associated with good efficiency were being young and male patients, and receiving fewer hours of caregiver assistance. Secondary measures were improved: IADL (p < 0.001) and hours of caregiver assistance (p < 0.001). CONCLUSIONS: This study suggests that the intervention is an effective approach to improve functional independence.Implications for rehabilitationLittle is known about the outcomes of outpatient occupational therapy intervention in neurorehabilitation services for the adult population with neurological diseases.In a multicentre cohort of neurorehabilitation outpatients, the occupational therapy intervention can lead to improvements in the level of independence in basic and instrumental daily activities, as well as reducing the hours of caregiver assistance.A good relative functional gain is associated with acquired brain injury, a lower number of hours of assistance, and a greater intensity of occupational therapy.The factors associated with good efficiency are being younger, male patients, and receiving fewer hours of assistance.

Independence in Daily Activities after Stroke among Occupational Therapy Patients and Its Relationship with Unilateral Neglect.

More research is needed to better understand the impact of occupational therapy (OT) in stroke patients and syndromes of unilateral neglect (UN) and anosognosia. A prospective, observational, longitudinal design was conducted on a sample of 27 OT patients. The objectives were to examine: (1) the presence of UN and anosognosia; (2) the functional outcomes; and (3) the association of UN at baseline with functional status at discharge from OT. The outcomes were Barthel (functional independence) and the Rivermead Mobility Index (RMI). The baseline proportion of participants with UN was 33% according to the Star Cancellation Test (STC), and 48.1% according to the Catherine Bergego Scale (CBS) therapist-version. There was a significant difference between the therapist and participant-rated CBS scores (p = 0.004). Functional independence improved significantly between the initial and final assessments (p < 0.001); the effect size (r) was large (r = 0.61). There was a significant improvement in RMI scores (p < 0.001), which was large in size (r = 0.59). Both the STC and CBS-therapist scores were significantly correlated with the Barthel (p < 0.001, p = 0.005, respectively) and with the RMI (p = 0.004, p = 0.028, respectively). The participants substantially enhanced their functional status skills. UN and anosognosia were common problems, and neglect was associated with worse OT program outcomes.

Assessing the Outcomes of an Animal-Assisted Intervention in a Paediatric Day Hospital: Perceptions of Children and Parents.

There is a growing interest in the use of animal-assisted intervention (AAI) as a non-pharmacological strategy to improve child welfare in hospitals. However, the efficacy of implementation of programmes based on activities with dogs in a paediatric day hospital is not known. An intra-subject quasi-experimental longitudinal design was used for the purpose of assessing the feasibility of such an intervention, as well as exploring the perceptions of its outcomes by children and parents/guardians. A total of 55 children in outpatient care at a paediatric day hospital participated in an AAI session. The application of this intervention was feasible. Self-assessment by the paediatric patients revealed a statistically significant improvement in their emotional state after the session, which was large in size. Parents confirmed this improvement in their child, perceiving significant changes in their mood, which were large in size. This study suggests that AAI is an effective approach when it comes to promoting the emotional welfare of children during their stay in hospital care environments. Participating in recreational occupations with dogs could contribute in a relevant and efficient way to the development of significant and gratifying experiences and to a more positive perception of healthcare centres on the part of children.

Improving social participation of children with autism spectrum disorder: Pilot testing of an early animal-assisted intervention in Spain.

Children with autism spectrum disorder (ASD) experience moderate to profound challenges in relation to the skills required for social participation. Animal-assisted intervention (AAI) is increasingly used within early community care. However, the results of its early application in this population group are not known. This pilot study aimed to explore the feasibility of an early intervention based on the use of therapy dogs and to examine their impact on communication and social interaction skills. A within-subject quasi-experimental longitudinal design was used. The instruments for measuring results were the Assessment of Communication and Interaction Skills (ACIS) and Animal-assisted Therapy Flow Sheet, both based on observation. A total of 19 children with confirmed or probable ASD (with mean age of 46.2 months), cared for in a Spanish therapeutic unit, participated in a median of nine AAI sessions, with a mean duration of 19.9 min per session. The total ACIS score increased significantly between the initial and final assessments of the study, with communication and social interaction skills improving with a large effect size. In the Animal-assisted Therapy Flow Sheet instrument, statistically significant improvements were found in most of the items that evaluate the frequency of child-dog social relationships (look at the dog, touch it, talk to it and get involved in an activity with the animal) and child-therapist relationships (look at the therapist and talk to him/her); the effect sizes ranged from medium to large. In conclusion, the early application of an AAI is feasible and seems to improve communication and social interaction skills, both essential elements for social participation. The results suggest that this intervention may be a beneficial non-pharmacological therapy as a complementary approach within community care for children with ASD in the early years of their life.

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.

Promoting functional independence in people with Alzheimer's disease: Outcomes of a home-based occupational therapy intervention in Spain.

Nonpharmacologic therapies such as occupational therapy (OT) are promising for people with Alzheimer's disease (AD). However, more research is needed to better understand the effectiveness of home-based OT programs. This pilot study aimed to assess the effects of a home-based, high-intensity and multicomponent OT intervention on the activities of daily living of people with AD in Spain. The secondary objective was to examine its impact on the cognitive functions. A multiple-baseline intrasubject design was used. Twenty-one community-dwelling older adults with mild AD (mean age 78.6 years) and their primary caregivers participated in a 12-week home-based OT program. This intervention was replicated for 8 weeks after a 1.5-month intervention withdrawal period. The intervention followed a holistic, biopsychosocial and client-centred approach and consisted of the following components: meaningful activities/tasks, cognitive stimulation, activation of psychomotor and sensory skills, home modification, caregiver counselling and training in daily living skills. Functional independence was the primary outcome (Barthel Index). The cognitive functions were assessed by the Loewenstein Occupational Therapy Cognitive Assessment-Geriatric (LOTCA-G). Data were analysed using nonparametric tests. Main results showed that after completing the OT program, 6.5 months after the moment of inclusion, the level of functional independence improved significantly and the effect size was large. Moreover, there was a significant moderate-to-substantial improvement in several cognitive functions after each of the two intervention periods: place orientation, time orientation and attention/concentration. In summary, the findings give a great deal of information as a basis for further research. This study provides evidence that an intensive home-based OT intervention has a positive influence on daily activities and some cognitive functions, suggesting that this program may be beneficial as a nonpharmacological supplementary tool in health and social care for people with AD living in the community.

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 Rehabilitation Because 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.

Homebound status among middle-aged and older adults with disabilities in ADLs and its associations with clinical, functional, and environmental factors.

BACKGROUND: Homebound status is associated with poor health, comorbidity, and mortality and represents a major challenge for health systems. However, its prevalence among people with disabilities in the basic activities of daily living (ADLs) is unknown. OBJECTIVES: The objectives were to: (1) examine the prevalence of the homebound status among middle-aged and older adults with disabilities in ADLs, and (2) identify its clinical, functional, and environmental determinants. METHODS: This study included 221 community-dwelling subjects, aged ≥50 years, who applied for long-term care services at the Office for Legal Certification of Long-term Care Need of Coruña (Spain). Each subject had a disability in ADLs and was interviewed by a trained examiner in the subject's home. The participants were considered homebound if they remained inside their home during the previous week. MEASURES: Demographic, clinical, functional, and environmental factors. Multiple logistic regression was used to determine the factors associated with homebound status. RESULTS: The prevalence of homebound status was 39.8%. A multivariate analysis revealed that the presence of architectural barriers at the home entrance (stairs [OR: 6.67, p < 0.001] or a heavy door [OR: 2.83, p = 0.023]), walking ability limitations (OR: 3.26, p = 0.006), and higher age (OR: 1.05, p = 0.04) were associated with homebound status. CONCLUSIONS: Homebound status is a highly prevalent problem among middle-aged and older adults with disabilities in ADLs. Architectural factors in the home and walking ability limitations seem to be important predictors, suggesting that health care interventions should target home adaptations and mobility skills as a means to preventing or decreasing homebound status.