Evidence for OT: OT predischarge home assessments for patients w/ hip fractures reduce hospital readmissions

A recent randomized control trial in Clinical Rehabilitation indicates that predischarge home assessments by an occupational therapist have a number of benefits for patients with hip fractures, including: 
1. Reduced risk of readmissions to hospital 
2. Increased functional independence at six months, and
3. Possible reduction in falls during the 30 days following discharge.

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Evidence for OT: Economic evaluations of falls prevention programs

A recent review in the Journal of American Geriatric Society indicates that investing in falls prevention programs for adults aged 60 and older is cost-effective. 

The authors performed a systematic review of economic evaluations on falls prevention programs for older adults in the community and residential care facilities. 

Home assessment programs were the most cost‐effective type of program for community‐dwelling older adults, and were found to be more cost effective as the age of participant increases. The home assessment programs included interventions that are often delivered by occupational therapists, including home modifications and home safety assessments.  

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Evidence for your Practice: Multidisciplinary, aerobic, motor-cognitive and intensive rehabilitation treatment for Parkinson's disease

Article: Ferrazzoli, D., Ortelli, P., Zivi, I., Cian, V., Urso, E., Ghilardi, M. F., ... & Frazzitta, G. (2018). Efficacy of intensive multidisciplinary rehabilitation in Parkinson’s disease: a randomised controlled study. J Neurol Neurosurg Psychiatry, jnnp-2017.

Study Aim: To evaluate whether a multidisciplinary, aerobic, motor-cognitive and intensive rehabilitation treatment (MIRT) improves the quality of life of patients with PD in the short-term and long-term period.

Population: Patients with a diagnosis of idiopathic Parkinson's disease.

Intervention: MIRT is a 4-week programme delivered in a hospital setting, and includes:

• Four daily rehabilitative sessions for 5 days and 1 hour of physical exercise on the sixth day
• Sessions with a physical therapist, occupational therapist and speech language pathologist.

The occupational therapy sessions focus on hand dexterity, writing and activities of daily living.

Key findings: 

• Patients’ self-perception of mobility, autonomy in ADLs, emotional well-being, needing of social support, cognition, communicative abilities and bodily discomfort are enhanced after MIRT.
• This improvement was maintained along a 3-month follow-up period.

Bottom line for OT: As part of an interdisciplinary team, occupational therapy treatment can make lasting improvements in quality of life for patients with Parkinson's disease. 

Read the open access article here

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Evidence for your Practice: Modified wheelchair arm-support to reduce shoulder pain in stroke patients

Article for Review:

Pan, R., Zhou, M., Cai, H., Guo, Y., Zhan, L., Li, M., ... & Chen, H. (2017). A randomized controlled trial of a modified wheelchair arm-support to reduce shoulder pain in stroke patients. Clinical Rehabilitation, 0269215517714830.

This study aimed to evaluate the effect of modified wheelchair arm-support to mitigate hemiplegic shoulder pain and reduce pain frequency in stroke patients.This support consisted of a board designed to support the arm, with a thick handle equipped at the end of the board which could be held by hand. The primary outcome measure was the Visual Analogue Pain Scale or Numeric Pain Rating Scale.

Conclusion:

Patients who received a modified arm support experienced less pain than the control group at 4 and 12 weeks. Using the modified wheelchair arm-support could lead to the mitigation of hemiplegic shoulder pain and reduction in pain incidence in stroke patients. It may also improve the patients’ quality of life.

Read full text here

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Evidence for Occupational Therapy at your Fingertips

Are you an advocate for the value of occupational therapy? Looking for some evidence to present to your supervisor, MLA, MP or other decision maker?

Check out the CAOT-BC webpage Benefits & Value of OT for resources demonstrating the value and effectiveness of occupational therapy. These include:

• A list of recently published journals and evidence
• Four infographics

Have something to add? Send us your personal or practice stories, project or research results and any other evidence for occupational therapy to caotbc@caot.ca

Evidence for your Practice: CI-PCM Program for Treatment of Alzheimer's Disease

Article for Review: Reisberg, B., Shao, Y., Golomb, J., Monteiro, I., Torossian, C., Boksay, I., ... & Sidhu, J. (2017). Comprehensive, Individualized, Person-Centered Management of Community-Residing Persons with Moderate-to-Severe Alzheimer Disease: A Randomized Controlled Trial. Dementia and geriatric cognitive disorders, 43(1-2), 100-117.

This clinician-blinded, randomized, controlled, parallel-group study aimed to examine added benefits of a Comprehensive, Individualized, Person-Centered Management (CI-PCM) program to memantine (pharmacological) treatment for people with advanced Alzheimer’s Disease. The CI-PCM program (which includes home visits, caregiver training and support groups) was compared to usual community care based on an ADL inventory and NYU-CIBIC-Plus assessment. CI-PCM program benefits were 967% greater than memantine treatment alone.

Conclusion:

Results indicate substantial benefits with the management program for people with advanced Alzheimer’s Disease (~10 times improved results than those usually observed with both).

Bottom Line: 

Occupational therapists have the skills and knowledge to deliver disease management programs and tailor delivery to the needs of individual clients. There is significant evidence that this intervention is effective at improving function for people with Alzheimer's Disease. 

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Evidence for OT: In-Home Occupational Therapy Curbs Depression in Visually Impaired Patients

Photo credit: skobo via Foter.com / CC BY-NC-SA

Findings from a recent study in Investigative Ophthalmology & Visual Science, suggest that in-home occupational therapy reduces the rate and severity of depression in people with impaired vision. 

Researchers compared depression risk scores for two treatment groups: occupational therapy (6 sessions focused on performance of activities that participants rated as difficult and important), and supportive therapy (an equal number of talk therapy sessions with a social worker). 

A greater reduction in depression risk score was observed for the occupational therapy treatment group, and only 12% of participants in this group reported worsening of symptoms, compared to 26% for the the supportive therapy group. 

According to  Ashley Deemer, O.D., instructor of ophthalmology at the Johns Hopkins University School of Medicine, “It is good practice not only to refer low vision patients to a mental health expert, but to also suggest low vision rehabilitation and occupational therapy, which could have a huge impact on our patients’ lives.”

Read the full story from Johns Hopkins Medicine

Occupational Therapists and Sleep

Photo credit: Idhren via Foter.com / CC BY-SA

Not sleeping well? OT can help! 

Occupational therapist Donald Fogelberg, Ph.D., OTR/L, discusses the distinct value of occupational therapy services to help you get a better night’s sleep in a 5-minute AOTA Everyday Evidence Podcast. 

Check out AOTA's Tip Sheet on the role of occupational therapy in rest and sleep.

Art Matters: Findings from the Art Studios Impact Study

Image Credit: http://vrtas.ca/about/the-art-studios/

The Art Studios is a community psychosocial rehabiliation program that uses art-making as the medium to engage clients living with mental illness in learning and practicing life skills. The program is run by occupational therapists, rehabilitation assistants, art instructors, peer support workers and volunteer. 

The Art Studios Impact Study is a one-year program evaluation to begin to document the benefits of the program. The purpose of the study was to evaluate the impact of participation in the Art Studios program on members' psychosocial recovery, well-being, and achievement of goals specific to engaging in everyday life activities. 

CAOT-BC was present for Art Matters - an evening of findings presentation, sharing of individual perspectives, networking and discussion at the Art Studios. 

Image Credit: http://vrtas.ca/about/the-art-studios/

Key messages from the study...

Art Studios participants demonstrating measurable and meaningful improvement in their capacity to engage in practice and relevant life activities 

Art Studios participants showed stability in measures of psychosocial recovery, self-esteem, and health/disability. 

The positive impact of the Art Studios on its members' lives is profoundly apparent in narrative data, indicating that participants attribute achievement of recovery goals to a learning environment that is safe and non-judgmental, with abundant feedback. This enables them to gain confidence and a sense of self-worth to move into increasingly challenging roles and responsibilities and contribute to the community. 

For more information about this study and the status of academic papers, please contact: 
Catherine Backman, Professor/Principle Investigator or Natasha Damiano, Research Coordinator 

Higher Hospital Spending on Occupational Therapy Could Save Province of BC $13 Million!

A recent study[1] conducted by researchers at Johns Hopkins Bloomberg School of Public Health and University of Maryland School of Medicine examined 30-day readmission rates for heart failure, pneumonia, and acute myocardial infarction at over 2,000 American hospitals. Nineteen spending categories were considered (including pharmacy, medical/surgical supplies, physical therapy, OT, speech pathology, etc.).

The researchers found that occupational therapy is the only spending category where additional spending has a statistically significant association with lower readmission rates for all three medical conditions. In addition, researchers noted that for all 3 condition samples, not more than 30% of patients received OT services and spending, and average spending on OT per patient was relatively low ($12-$20). This led the authors to suggest that increasing OT services to reach more patients is a feasible option for hospital CEOs.

As noted by the researchers, occupational therapists focus on whether or not a patient can be safely discharged into his or her environment, and services address a range of factors that affect patient health outside of the hospital (such as ADL needs and social environment). In this way, OT is well-positioned to address risk factors for readmissions.

Read the AOTA news release

What does this mean for BC?

A 2015 study[2] conducted by UBC’s School of Population and Public Health examined readmission rates for 18 BC hospitals for the same three conditions, and estimated that between 2010 and 2013, readmissions cost the province of BC $13 million, not including physician fees. This is in addition to any costs associated with patients unable to access hospital care due to unanticipated readmissions.

This suggests that increased hospital spending on occupational therapy could save the province of BC millions of dollars. 

Read the UBC news release

What can you do?

Spread the word! Share this information with you co-workers, colleagues and supervisors. Tweet, post on Facebook, email …. Whatever works for you. Just make sure to let us know: @caot-bc, caotbc@caot.ca

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[1] Rogers, A. T., Bai, G., Lavin, R. A., & Anderson, G. F. (2016). Higher hospital spending on occupational therapy is associated with lower readmission rates. Medical Care Research and Review, 1–19. https://doi.org/10.1177/1077558716666981

[2] Hellsten, E., Liu, G., Yue, E., Gao, G., & Sutherland, J. M. (2016). Improving hospital quality through payment reforms A policy impact analysis in British Columbia. Healthcare Management Forum, 29 (1), 33-38. 

OT rated by parents as "best therapy" for Autism

Over 8000 parents belonging to MyAutismTeam.com (a social network of more than 28,000 parents of individuals with autism) answered the following question “What therapies, if any, worked best for your child”?  

The answer? Here are the therapies parents reported as working best for their children, rank-ordered by percent of mentions and including only those therapies that received at least 1% of mentions:

1. Occupational Therapy – 39%
2. Speech Therapy – 27%
3. ABA Therapy – 15%
4. Social Skills Classes – 8%
5. Hippotherapy (OT through horseback riding) – 2%
6. GFCF Diet – 2%
7. Psychiatrist/Psychologist sessions – 2%
8. (5-way tie, each with 1%): Floor Time, RDI, PECs, Swimming, PRT
Other therapies / keywords listed that got less than 1% of mentions

• Mainstream schooling – 0.1%
• iPad – 0.1%
• Vision therapy, aqua therapy
• Vitamin supplements, Chelation, Hyperbaric Chambers – (all combined these last three terms received less than one-tenth of one percent of mentions)

Read the full article here.