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1.
J Rehabil Med ; 52(1): jrm00010, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31820814

RESUMO

OBJECTIVE: To explore the use of applied cognitive strategy behaviours during performance of daily activities in people with Parkinson's disease. DESIGN: Quantitative cross-sectional design. METHODS: A total of 190 persons living at home with non-dementing Parkinson's disease were videotaped while performing a self-chosen activity in their natural environment. The videotaped performance was scored using the "Perceive, Recall, Plan and Perform System of Task Analysis" to measure: (i) performance mastery; and (ii) effective use of 34 cognitive strategy behaviours covering: attention and sensory processing (Perceive), accessing task-related knowledge (Recall), response planning and evaluation (Plan) and performance control (Perform). Mean performance mastery and a hierarchy of least to most effective applied cognitive strategy behaviours were determined for the total group and for 2 sub-groups based on disease severity. A multi-faceted Rasch model was used for data analysis. RESULTS: Mean performance mastery was 56% (standard deviation (SD) 28). Least efficient cognitive strategy behaviours were those used for planning, evaluating and controlling performance and most efficient strategies were those used for sensory discrimination and recalling factual information. More advanced disease indicated less efficient use of applied cognition. CONCLUSION: The results suggest that the efficiency of applied cognitive strategy behaviours is compromised in a certain pattern in people with Parkinson's disease, and that it declines with disease progression.

2.
Disabil Rehabil ; : 1-8, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429344

RESUMO

Purpose: To understand how the social network of patients with acquired brain injury facilitates or hinders resumption of their activities, such as social and leisure activities, and how this affects patients' well-being and quality of life. Methods: Thematic analysis was applied to 70 narratives about family members, friends, neighbors and colleagues helping or hindering patients in resuming their activities. The narratives were derived from social workers with extensive experience with brain-injured patients and their social networks. Results: The narratives show that an available, understanding and well-informed network enhances activity resumption by being inclusive and encouraging patients to develop their skills. This is in line with earlier studies based on patients' experiences. Whereas the patient-based studies emphasize that being unsupportive or overprotective hinders patients from resuming their activities, this study also shows that preventing patients from meeting others or placing too-high demands results in activity loss, social isolation and reduced well-being and quality of life. Conclusions: Several social network factors play a role in activity resumption, well-being, and quality of life of after brain injury. Early after the brain injury, rehabilitation professionals should work with patients' family members, friends, and others and educate them about how to provide adequate support. IMPLICATIONS FOR REHABILITATION Since the patient's social network is an important determinant of activity resumption, rehabilitation professionals should analyze its features soon after brain injury, such as whether patients have an understanding network that encourages them and includes them in their activities. Since especially close network members tend to be protective of or place high demands on the patient, rehabilitation professionals should explain to them the importance of activity resumption for the patient's wellbeing and the adverse effects of being overprotective or over-demanding. Rehabilitation professionals should include other network members, such as friends or colleagues, in the rehabilitation process and educate them about how to support patients in resuming their activities.

3.
Disabil Rehabil ; 41(18): 2223-2234, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29661038

RESUMO

Purpose: Map the literature about valued activities and informal caregiving post stroke and determine the nature, extent, and consequences of caregivers' activity changes. Methods: A scoping review was undertaken, searching Pubmed, Cinahl, PsycInfo, and Google Scholar. Two researchers independently identified relevant articles, extracted study characteristics and findings, and assigned codes describing the topics and outcomes. Using thematic analysis, the main study topics and study outcomes were described. Results: The search yielded 662 studies, 30 of which were included. These were mainly qualitative and cross-sectional studies assessing caregivers' activity changes and related factors, or exploring caregivers' feelings, needs and strategies to deal with their activity challenges. Although caregivers often lost their social and leisure activities, which made them feel unhappy and socially isolated, we found no studies about professional interventions to help caregivers maintain their activities. Over the years, caregivers' activity levels generally increased. However, some caregivers suffered from sustained activity loss, which, in turn, relates to depression. Conclusion: Loss of valued activities is common for stroke caregivers. Although high-level evidence is lacking, our results suggest that sustained activity loss can cause stroke caregivers to experience poor mental health and wellbeing. Suggestions to help caregivers maintain their valued activities are presented. Implications for rehabilitation Not only stroke survivors but also their informal caregivers tend to lose their valued activities, such as their social and leisure activities. Although many caregivers manage to resume their valued activities over time, others suffer from sustained activity loss up to at least two years post stroke. Loss of valued activities in stroke caregivers can result in lower levels of wellbeing, depression, and social isolation. Rehabilitation professionals should screen stroke caregivers for activity loss and assist them in resuming their valued activities and maintaining their social contacts.

4.
Occup Ther Int ; 2018: 5716947, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29977174

RESUMO

Background: Engagement in everyday activities is important for the health and wellbeing of children. Children with mitochondrial disorders have impaired energy production leading to limitations in activity. It is unknown which activities these children perform and if the nature of activities of low-functioning children differs from average-functioning children. Therefore, this pilot study explored the activities reported in patient records of a heterogeneous group of children with genetically confirmed mitochondrial disorders. Methods: A retrospective qualitative directed content analysis by health care professionals reported activities (as part of their professional reasoning obligations) in hospital patient records of children with mitochondrial disorder. Results: Seventeen patient records, presenting notes on capacities and performed activities, showed an overview of everyday activities that covered the categories: self-care, house chores, therapy, school, computing, hobby, play, sports, and mobility/transport. The activity categories of low-functioning children did not differ from average-functioning children, although descriptions of specific activities differed between groups. Conclusion: This pilot exploration indicates that the types of activities that children with mitochondrial disorders perform are not necessarily linked to the child's impairments. However, differences in levels of independence, assistive device usage, and energy costs seem to exist. Future research should address the child's perspective on, and meaning of, activity performances.


Assuntos
Atividades Cotidianas , Atividades de Lazer , Doenças Mitocondriais/reabilitação , Autocuidado , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Projetos Piloto , Estudos Retrospectivos , Equipamentos de Autoajuda
5.
Scand J Occup Ther ; 24(1): 65-73, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27648497

RESUMO

BACKGROUND: The Perceive, Recall, Plan & Perform (PRPP) system of task analysis might be feasible to evaluate occupational performance and information processing strategies for persons with Parkinson's disease (PD). AIM: To evaluate: (1) the random error between raters (inter-rater study), (2) the random error within raters (intra-rater study), and (3) the internal consistency of the PRPP. MATERIALS AND METHODS: (1) video-recorded performance of meaningful activities of 13 Dutch persons with PD, scored independently by 38 Dutch PRPP trained occupational therapists were included in the analysis. The random error between raters was analyzed with two-way random Intraclass Correlation Coefficients (ICC). (2) Four videos were scored twice by 30 raters (6 week time interval). The random error within raters was analyzed using one-way random ICC's. (3) Internal consistency study: data of 190 persons with PD were analyzed using Cronbach's alpha (α). RESULTS: Inter-rater reliability ranged from slight to moderate (ICC= 0.06-0.43). The mean intra-rater reliability ranged from moderate to almost perfect (ICC= 0.60-0.83). Internal consistency is good (α = 0.60-0.86). CONCLUSION: The limited inter-rater reliability but adequate intra-rater reliability and internal consistency show the feasibility of the PRPP when used for persons with PD. Implications for reliable clinical use are discussed.


Assuntos
Atividades Cotidianas/psicologia , Doença de Parkinson/psicologia , Psicometria/métodos , Análise e Desempenho de Tarefas , Adulto , Idoso , Feminino , Avaliação Geriátrica/métodos , Humanos , Masculino , Países Baixos , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Gravação em Vídeo
6.
J Rehabil Med ; 46(6): 527-31, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24658367

RESUMO

OBJECTIVE: Despite beneficial effects on communication and process measures, client-centred practice has been shown to result in poor functional outcomes. To examine a potential explanation for poor functional outcomes, this paper aims to assess whether in client-centred therapy more time is spent on diagnostic consultation and less time on actual treatment compared to usual care. METHOD: A multicentre cluster randomised controlled trial was performed. Thirteen hospitals and rehabilitation centres, 29 therapists and 269 outpatients with multiple sclerosis participated. Measurements included an inventory of diagnostic and treatment goals, the number of sessions, therapy duration and therapy intensity. RESULTS: In client-centred therapy, more sessions were used for diagnostic consultation (10.9% points difference, p = 0.030); the time needed to formulate the first treatment goal was longer (11.4 days difference, p = 0.041); there was a tendency towards more goals directed to diagnostic issues (0.69 goals difference, p = 0.056), spending more hours on indirect issues (1.16 h difference, p = 0.051) and towards a longer total therapy period (1.56 months difference, p = 0.058) than in usual care. CONCLUSION: Client-centred therapy resulted in more intensive diagnostic evaluation and less intensive treatment. This suggests that client-centred therapy should be adjusted towards a more proportional distribution of time devoted to diagnostic evaluation versus actual treatment.


Assuntos
Esclerose Múltipla/diagnóstico , Esclerose Múltipla/reabilitação , Terapia Ocupacional , Assistência Centrada no Paciente/métodos , Adulto , Estudos de Casos e Controles , Comunicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente , Assistência Centrada no Paciente/estatística & dados numéricos , Resultado do Tratamento
7.
Cochrane Database Syst Rev ; (6): CD010116, 2013 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-23740541

RESUMO

BACKGROUND: Stroke is a worldwide problem and is a leading cause of adult disability, resulting in dependency in activities of daily living (ADL) for around half of stroke survivors. It is estimated that up to 25% of all care home residents in the USA and in the UK have had a stroke. Stroke survivors who reside in care homes are likely to be more physically and cognitively impaired and therefore more dependent than those able to remain in their own home. Overall, 75% of care home residents are classified as severely disabled, and those with stroke are likely to have high levels of immobility, incontinence and confusion, as well as additional co-morbidities. It is not known whether this clinically complex population could benefit from occupational therapy in the same way as community-dwelling stroke survivors. The care home population with stroke differs from the general stroke population living at home, and a review was needed to examine the benefits of occupational therapy provided to this specific group. This review therefore focused on occupational therapy interventions for ADL for stroke survivors residing in care homes. OBJECTIVES: To measure the effects of occupational therapy interventions (provided directly by an occupational therapist or under the supervision of an occupational therapist) targeted at improving, restoring and maintaining independence in ADL among stroke survivors residing in long-term institutional care, termed collectively as 'care homes'. As a secondary objective, we aimed to evaluate occupational therapy interventions for reducing complications such as depression and low mood. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (August 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, September 2012), MEDLINE (1948 to September 2012), EMBASE (1980 to September 2012), CINAHL (1982 to September 2012) and 10 additional bibliographic databases and six trials registers. We also handsearched seven journals, checked reference lists and obtained further information from individual trialists. SELECTION CRITERIA: Randomised controlled trials investigating the impact of an occupational therapy intervention for care home residents with stroke versus standard care. DATA COLLECTION AND ANALYSIS: The lead review author performed all searches. Two review authors then independently assessed all titles and abstracts of studies and selected trials for inclusion, with a third review author resolving any discrepancies. The same two review authors independently extracted data from all included published sources to ensure reliability. Primary outcomes were performance in ADL at the end of scheduled follow-up and death or a poor outcome. Secondary outcomes aimed to reflect the domains targeted by an occupational therapy intervention. MAIN RESULTS: We included in the review one study involving 118 participants. We found one ongoing study that also met the inclusion criteria for the review, but the data were not yet available. AUTHORS' CONCLUSIONS: We found insufficient evidence to support or refute the efficacy of occupational therapy interventions for improving, restoring or maintaining independence in ADL for stroke survivors residing in care homes. The effectiveness of occupational therapy for the population of stroke survivors residing in care homes remains unclear, and further research in this area is warranted.


Assuntos
Pessoas com Deficiência/reabilitação , Casas de Saúde , Terapia Ocupacional/métodos , Reabilitação do Acidente Vascular Cerebral , Atividades Cotidianas , Adulto , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Disabil Rehabil ; 35(19): 1636-46, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23343363

RESUMO

PURPOSE: To assess the efficacy of client-centred occupational therapy (OT) according to a client-centred process framework, as compared to usual care OT, in patients with multiple sclerosis (MS). METHOD: A multicentre cluster randomised controlled trial with the institution (i.e. hospital or rehabilitation centre) as the unit of randomisation was performed. A total of 269 outpatients with MS, 13 hospitals and rehabilitation centres and 29 occupational therapists participated. Primary outcomes included measures of disability, participation and autonomy. Secondary outcomes included fatigue, generic health-related quality of life, quality and evaluation of therapy, therapy compliance and therapy frequency. Measurements were taken at baseline, four months and at eight months follow-up. RESULTS: Primary outcome measures did not show significant differences between the two interventions. Secondary outcomes revealed significant differences in favour of the usual care OT on fatigue (physical scale and total scale) and health-related quality of life (bodily pain and vitality) at four months. After eight months only significant differences on mental health were found. Process outcomes (i.e. the information scale of therapy quality and the client-centredness of the organisation) were in favour of the client-centred intervention. CONCLUSION: Because the client-centred intervention resulted in no effects on the primary outcomes and small but negative effects on the secondary functional outcomes, we should seriously reconsider the application of client-centred practice. IMPLICATIONS FOR REHABILITATION: An increasing number of interventions claim to incorporate client-centred practice. Client-centred practice is associated with improved satisfaction but the effects on functional health-related outcomes have not been fully evaluated. The findings of this study show that the process outcomes of therapy were in favour of the client-centred intervention, but no effects were found on the primary outcomes and negative effects on the secondary functional health outcomes. It is suggested that the implementation of client-centred practice should be adjusted in order to achieve optimal health outcomes.


Assuntos
Esclerose Múltipla/terapia , Terapia Ocupacional/métodos , Satisfação do Paciente/estatística & dados numéricos , Assistência Centrada no Paciente/métodos , /estatística & dados numéricos , Adulto , Análise por Conglomerados , Avaliação da Deficiência , Feminino , Nível de Saúde , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/reabilitação , Países Baixos , Aceitação pelo Paciente de Cuidados de Saúde , Indicadores de Qualidade em Assistência à Saúde , Qualidade de Vida , Perfil de Impacto da Doença , Fatores Socioeconômicos , Fatores de Tempo
9.
Occup Ther Int ; 19(1): 17-27, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22468272

RESUMO

This study explored how the evidenced-based practise (EBP) is perceived by Dutch occupational therapists (OTs), what sources of research data are used to make clinical decisions, and what barriers are identified in implementing EBP. A self-administered, pre-tested, questionnaire was distributed through an email survey and postal mail among the 200 randomly stratified selected OTs out of a total population of 2,019 Dutch OTs. Analyses of data comprised descriptive statistics of all variables and test statistics to evaluate the differences between demographical groups. Dutch OTs have a very positive attitude toward the EBP. Barriers experienced are mostly related to a lack of skills needed to implement the EBP and to the characteristics of the work environment. The attitude, experiences and barriers are mainly similar to research findings in other countries or professions. A unique barrier to the implementation of the EBP found in this study was that Dutch OTs perceived evidence written in a foreign (non-Dutch) language as a barrier to using evidence in non-Dutch languages. The results of the study, derived from a partly representative group of working OTs, implicate universal problems regarding the effective implementation of the EBP. Solutions to increase the implementation of the EBP from an international point of view are called for and need to be evaluated.


Assuntos
Pessoal Técnico de Saúde/psicologia , Atitude do Pessoal de Saúde , Prática Clínica Baseada em Evidências , Terapia Ocupacional , Adulto , Competência Clínica , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Países Baixos , Cultura Organizacional , Inquéritos e Questionários , Adulto Jovem
10.
Int Psychogeriatr ; 24(4): 659-65, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22166513

RESUMO

BACKGROUND: The aim of this study is to evaluate aspects of inter-rater reliability of the Perceive, Recall, Plan, and Perform (PRPP) system of task analysis for assessing daily functioning of home-dwelling dementia patients. METHOD: Videotaped recordings of 30 German patients with dementia performing a relevant daily task in their own homes were scored independently by ten Dutch PRPP trained occupational therapists, randomly selected from a pool of 25. Intra-class correlations (ICC) (one-way single measure) were calculated for PRPP Stage One independence score, and PRPP Stage Two information processing scale, quadrant scales, and subquadrant scales from a total of 300 PRPP scores. RESULTS: ICCs for Stage One PRPP independence score were good to excellent (0.63; 0.94) for both individual rater and test reliability. The Stage Two PRPP total score showed moderate correlations (0.46) for the single rater absolute agreement and excellent agreement (0.90) for test reliability. The four quadrant scale scores of the PRPP showed limited single rater absolute agreement (0.37-0.39) but excellent average test agreement (0.85-0.87). All subquadrants of information processing showed limited single rater absolute agreement (0.26-0.38) and good to excellent average test agreement (0.78-0.86). This suggests that the PRPP total is reliable in assessing information processing during activity performance in dementia patients. CONCLUSIONS: The PRPP is a reliable measure to evaluate individual performances of routines and tasks in community-living dementia patients by multiple raters. Future research should address reliability and validity features of the PRPP for dementia patients with incorporation of criterion-referenced test characteristics.


Assuntos
Demência/diagnóstico , Avaliação Geriátrica/métodos , Atividades Cotidianas/psicologia , Idoso , Idoso de 80 Anos ou mais , Demência/psicologia , Feminino , Humanos , Vida Independente/psicologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Gravação em Vídeo
11.
J Clin Epidemiol ; 59(9): 914-9, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16895813

RESUMO

BACKGROUND AND OBJECTIVE: To identify the strategies used to deal with the clinical heterogeneity of interventions and multiple outcome measures used in Cochrane reviews on physiotherapy and occupational therapy. METHODS: A search for systematic reviews on physiotherapy and occupational therapy in the Cochrane Library was performed. Data on the method of categorization of interventions, on measures, and on the method of data synthesis were systematically extracted. RESULTS: 52 reviews were identified. In 22 (42%) reviews only one index intervention was evaluated, in the other 30 reviews index interventions were categorized. A large diversity in the number and type of outcome measures was found (median 6.5, range 1-23). In 48% of the reviews one or more primary outcome measures were defined. In 52% of the reviews no quantitative data synthesis was performed, whereas five different methods for qualitative data synthesis were applied in 11 reviews. CONCLUSIONS: Limitation to a few outcome measures and explicit procedures for the categorization of interventions might increase the transparency and reproducibility of systematic reviews on physiotherapy and occupational therapy. Qualitative data synthesis is not often applied, although it is a useful tool to summarize results if a quantitative synthesis is not appropriate. International consensus on a method for qualitative synthesis is clearly needed.


Assuntos
Medicina Baseada em Evidências/métodos , Terapia Ocupacional , Modalidades de Fisioterapia , Interpretação Estatística de Dados , Humanos , Projetos de Pesquisa , Resultado do Tratamento
12.
Clin Rehabil ; 19(3): 247-54, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15859525

RESUMO

OBJECTIVE: To summarize the research evidence available from systematic reviews of the efficacy of occupational therapy (OT) for practitioners, researchers, purchasing organizations and policy-makers. DATA SOURCE: The search for systematic reviews was conducted in PubMed and the Cochrane Library (October 2004). METHODS: The reviews included were those that utilized a systematic search for evidence with regard to OT for specific patient groups. Data were summarized for patient group, interventions, outcome domains, type of study designs included, method of data synthesis and conclusions. RESULTS: Fourteen systematic reviews were included. Three reviews related to rheumatoid arthritis, four reviewed stroke and four focused on elderly people. Reviews of Parkinson's disease, multiple sclerosis, Huntington's disease, cerebral palsy and mental illnesses were also identified. The reviews of rheumatoid arthritis, stroke and elderly people showed evidence of the efficacy of OT in increasing functional abilities. Positive results were presented for quality of life and social participation in elderly people and stroke respectively. The efficacy of OT in all other patient groups is unknown due to insufficient evidence. CONCLUSION: This summary shows that elderly people and people with stroke or rheumatoid arthritis can expect to benefit from comprehensive OT. Evidence of the efficacy of specific interventions is sparse and should be addressed in future research. The evidence that does exist should be incorporated into OT practice.


Assuntos
Terapia Ocupacional , Idoso , Artrite Reumatoide/reabilitação , Paralisia Cerebral/reabilitação , Humanos , Transtornos Mentais/reabilitação , Doenças Neurodegenerativas/reabilitação , Reabilitação do Acidente Vascular Cerebral , Resultado do Tratamento
13.
Age Ageing ; 33(5): 453-60, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15315918

RESUMO

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.


Assuntos
Atividades Cotidianas , Doença Crônica/reabilitação , Terapia Ocupacional , Idoso , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Clin Rehabil ; 18(1): 1-14, 2004 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-14763715

RESUMO

OBJECTIVE: Occupational therapy (OT) for cerebral palsy focuses on the development of skills necessary for the performance of activities of daily living. The aim of this systematic review was to determine whether OT interventions improve outcome for children with cerebral palsy (CP). METHODS: An extensive search in MEDLINE, CINAHL, EMBASE, AMED and SCISEARCH was performed. Studies with controlled and uncontrolled designs were included. Six intervention categories were distinguished and individually analysed using a best-evidence synthesis. This synthesis is based on the type of design, the methodological quality, the type of outcome measures and the statistical significance of the findings. RESULTS: Seventeen studies were included in this review, seven of which were randomized controlled trials (RCTs). One RCT had a high methodological quality. The analyses resulted in insufficient evidence of the efficacy of occupational therapy in all intervention categories, due to the low methodological quality of studies presenting statistically nonsignificant results. CONCLUSION: Despite the reasonable number of studies identified, the inconclusive findings regarding the efficacy of occupational therapy for children with cerebral palsy may be a reflection of the difficulties in efficacy research in OT for children with CP. Future research should critically reflect on methodological issues.


Assuntos
Paralisia Cerebral/terapia , Terapia Ocupacional , Criança , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Stroke ; 34(3): 676-87, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12624291

RESUMO

BACKGROUND AND PURPOSE: Occupational therapy (OT) is an important aspect of stroke rehabilitation. The objective of this study was to determine from the available literature whether OT interventions improve outcome for stroke patients. METHODS: An extensive search in MEDLINE, CINAHL, EMBASE, AMED, and SCISEARCH was performed. Studies with controlled and uncontrolled designs were included. Seven intervention categories were distinguished and separately analyzed. If a quantitative approach (meta-analysis) of data analysis was not appropriate, a qualitative approach (best-evidence synthesis), based on the type of design, methodological quality, and significant findings of outcome and/or process measures, was performed. RESULTS: Thirty-two studies were included in this review, of which 18 were randomized controlled trials. Ten randomized controlled trials had a high methodological quality. For the comprehensive OT intervention, the pooled standardized mean difference for primary activities of daily living (ADL) (0.46; CI, 0.04 to 0.88), extended ADL (0.32; CI, 0.00 to 0.64), and social participation (0.33; CI, 0.03 to 0.62) favored treatment. For the training of skills intervention, some evidence for improvement in primary ADL was found. Insufficient evidence was found to indicate that the provision of splints is effective in decreasing muscle tone. CONCLUSIONS: This review identified small but significant effect sizes for the efficacy of comprehensive OT on primary ADL, extended ADL, and social participation. These results correspond to the outcome of a systematic review of intensified rehabilitation for stroke patients. The amount of evidence with respect to specific interventions, however, is limited. More research is needed to enable evidence-based OT for stroke patients.


Assuntos
Terapia Ocupacional/estatística & dados numéricos , Reabilitação do Acidente Vascular Cerebral , Atividades Cotidianas , Bases de Dados Factuais/estatística & dados numéricos , Humanos , Relações Interpessoais , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos
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