Interventions for Instrumental Activities of Daily Living Among Adults With Multiple Sclerosis: A Systematic Review.

IMPORTANCE: Occupational therapy practitioners need updated information about interventions that may improve or maintain functional changes in instrumental activity of daily living (IADL) engagement caused by multiple sclerosis (MS). OBJECTIVE: To conduct a narrative synthesis of updated evidence on interventions within the scope of occupational therapy to improve or maintain performance of and participation in IADLs among adults with MS. DATA SOURCES: CINAHL, MEDLINE in PubMed, Cochrane, OTseeker, and PsycINFO. Study Selection and Data Collection: This systematic review followed the Cochrane Collaboration methodology and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting a systematic review. Inclusion criteria were Level 1 or 2 evidence, published in English, published from January 2011 to December 2018, intervention within the occupational therapy scope of practice, and at least one IADL outcome measure. FINDINGS: Nineteen randomized controlled trials (including pilot and feasibility trials) and 1 preintervention-postintervention study met inclusion criteria. Results of this review show strong strength of evidence for coaching interventions in addressing physical activity (PA) routines and moderate support in addressing medication routines. Moderate strength of evidence was found with mixed results for interventions involving coaching plus prescribed PA in improving PA participation. CONCLUSIONS AND RELEVANCE: This systematic review supports occupational therapy practitioners addressing PA and medication health management and maintenance IADLs through the use of coaching interventions when treating people with MS. Other IADLs were addressed by the articles in this review but require more evidence to make clinical recommendations. What This Article Adds: Occupational therapy practitioners' skills in promoting habits and routines paired with utilization of evidence-supported coaching interventions can support independence with health management and reduce the negative impact of MS on daily activity participation.

Occupational Therapy Practice Guidelines for Adults With Multiple Sclerosis.

IMPORTANCE: Occupational therapy practitioners play an important role in addressing the occupational performance and participation needs of adults with multiple sclerosis (MS) and their caregivers. OBJECTIVE: This Practice Guideline aims to help occupational therapy practitioners, as well as the people who manage, reimburse, or set policy regarding occupational therapy services, understand occupational therapy's role in providing services to adults with MS and their caregivers. This guideline can also serve as a reference for health care professionals, health care managers, educators, regulators, third-party payers, managed care organizations, and researchers. METHOD: We examined, synthesized, and integrated the results of four systematic reviews into clinical recommendations. Three systematic reviews specified occupational domains as outcomes of interest, and one focused on interventions for caregivers of people with MS. RESULTS: Twenty-one articles from the systematic reviews with strong or moderate strength of evidence served as the basis for the clinical recommendations. CONCLUSIONS AND RECOMMENDATIONS: Four interventions benefited participation in the domains of activities of daily living or sleep. Two interventions improved participation in the domain of instrumental activities of daily living. One intervention improved work participation. Two interventions benefited caregivers and the quality of the relationship between the caregiver and person with MS. Other potentially appropriate interventions or areas to address on the basis of existing or emerging evidence are discussed in the Limitations: Gaps in the Evidence and Conclusions sections. What This Article Adds: This Practice Guideline provides a summary and application of the current evidence supporting occupational therapy intervention for adults with MS. It includes case examples and decision-making algorithms to support occupational therapy practitioners in addressing client goals.

Multidisciplinary Team Treatment Approaches to Chronic Daily Headaches.

OBJECTIVE: In this review, we focus on nonmedication treatment approaches to chronic daily headaches and chronic migraine. We review the current scientific data on studies using multimodal treatments, especially physical therapy and occupational therapy, and provide recommendations on the formation of interdisciplinary headache teams. BACKGROUND: Chronic daily headache, which includes chronic migraine, is a particularly challenging clinical entity which often involves multiple headache types and comorbidities. A team approach in treating these patients may be particularly useful. DESIGN/METHODS: We review all current studies performed with at least one or more other modality in addition to usual medical treatment, with a focus on physical and occupational therapy. Emphasis on physical and occupational therapy with an explanation of their methods and role in multidisciplinary treatment is a pivotal part of this review. We also suggest approaches to setting up a multimodality clinic for the busy headache clinician. CONCLUSION: Setting up a collaborative, multidisciplinary team of specialists in headache practices with the goal of modifying physical, environmental, and psychological triggers for chronic daily headaches may facilitate treatment of these refractory patients.

Lifestyle Redesign® for Chronic Pain Management: A Retrospective Clinical Efficacy Study.

OBJECTIVE: Our objective was to determine the efficacy of a Lifestyle Redesign® intervention for people living with chronic pain on quality of life (QOL), function, self-efficacy, and pain levels. METHOD: Clinical outcomes were collected from 45 patients who completed an individual outpatient Lifestyle Redesign occupational therapy program for chronic pain as part of their usual plan of medical care. Outcome measures included the Canadian Occupational Performance Measure, the 36-Item Short-Form Survey, the Brief Pain Inventory, and the Pain Self-Efficacy Questionnaire. We analyzed scores using paired-samples t tests. RESULTS: Significant changes were observed in occupational performance and satisfaction scores, physical and social functioning, role limitations due to physical and emotional problems, energy and fatigue, general health, and pain self-efficacy. CONCLUSION: Lifestyle Redesign interventions, when integrated into a patient's medical plan of care, can improve patient functioning, self-efficacy, and QOL.