Occupational Therapy Interventions in Chronic Pain – A Systematic Review

The use of interventions based on the best available evidence in occupational therapy is essential, and evaluation of research is part of an evidence‐based practice. The aim of this study was to assess the quality of studies describing and evaluating the effects of occupational therapy interventions on chronic pain. A systematic review of studies with diverse designs was carried out. A quality assessment was conducted, and the level of evidence was defined using the Research Pyramid Model. Of 19 included studies, three received the highest evidence level, and three were considered to be of high quality. The clinical recommendations that can be derived from this study are the following: occupational therapy interventions should start from the identified needs of the person with chronic pain; no support exists for the effectiveness of electromyographic biofeedback training as a supplement, more studies are needed to confirm this result; the efficacy of instructions on body mechanics was significant during work‐hardening treatment; and occupational therapists need to perform and present more clinical studies of high quality and high‐evidence level to build up a trustworthy arsenal of evidence‐based interventions, for example, in persons with chronic pain. Copyright © 2015 John Wiley & Sons, Ltd.     

Occupational Therapy Management Strategies for Infants With Neonatal Abstinence Syndrome: Scoping Review

With opioid use in North America rising, there is a growing incidence of neonatal abstinence syndrome (NAS). Infants with NAS experience withdrawal signs that interfere with their occupational performance in activities of daily living. This scoping review aims to identify the non-pharmacologic interventions currently used in the treatment of infants with NAS that fall within the scope of the occupational therapy profession. Searching three databases, articles were independently reviewed by two authors to meet defined inclusion criteria. Forty-five articles were included, and the interventions identified and organized according to the Person-Environment-Occupation Model. The non-pharmacologic interventions identified fall within the scope of the occupational therapy profession. Initiating occupational therapy services in an acute care setting may have the potential to improve occupational performance and engagement for these infants from an early age.     

Cost‐effectiveness of Occupational Therapy in Older People: Systematic Review of Randomized Controlled Trials

A systematic review of the cost‐effectiveness of occupational therapy for older people was conducted. MEDLINE, CINAHL, Web of Science, PsycINFO, Cochrane Library, OT seeker and unpublished trials registers were searched. Reference lists of all potentially eligible studies were searched with no language restrictions. We included trial‐based full economic evaluations that considered both costs and outcomes in occupational therapy for older people compared with standard care (i.e. other therapy) or no intervention. We reviewed each trial for methodological quality using the Cochrane risk of bias tool and assessed the quality of economic evaluations using a Drummond checklist. In the results of this review, we included five eligible studies (1–5) that were randomized controlled trials with high‐quality economic evaluation. Two studies were full economic evaluations of interventions for fall prevention (1 and 2); two studies were full economic evaluations of preventive occupational therapy interventions (3 and 4; one was a comparison of an occupational therapy group with a social work group); one study was a full economic evaluation of occupational therapy for individuals with dementia (5). Two of the studies (one was preventive occupational therapy [3] and the other was occupational therapy for dementia [5]) found a significant effect and confirmed the cost‐effectiveness of occupational therapy for older people compared with the control group. These studies found that occupational therapy for older people was clinically effective and cost‐effective in comparison with standard care or other therapies. With reference to their clinical implication, these intervention studies (using a client‐centred approach) suggested potentially cost‐effective means to motivate clients to maintain their own health. However, this review has limitations because of the high heterogeneity of the reviewed studies on full economic evaluations of occupational therapy for older people. Future studies on the cost‐effectiveness of occupational therapy in older people are strongly warranted. Copyright © 2015 John Wiley & Sons, Ltd.     

A systematic review of cognitive stimulation therapy for older adults with mild to moderate dementia: an occupational therapy perspective

In response to the need for effective non-pharmacological approaches for individuals with mild to moderate dementia, cognitive stimulation therapy (CST) interventions aim to optimize cognitive function. The present literature review explored the effectiveness of CST and the congruence of this approach with occupational therapy. Twenty-four databases and 13 "grey" sources were searched. Relevant papers were analysed using the McMaster Critical Literature Review Guidelines, the Modified Jadad Quality Scale and the Oxford Centre for Evidence-based Medicine Levels of Evidence Scale. To establish the congruence of CST with occupational therapy, themes were identified using the International Classification of Functioning and professional values outlined by the Canadian Association of Occupational Therapists. Twelve studies demonstrated a trend towards delayed cognitive decline following CST. This intervention strategy is congruent with occupational therapy values and may provide a useful structural framework to build rehabilitation programmes for this population. Psychometric properties of the McMaster Guidelines have not yet been established, and there is no standardized way to extract quantitative data from this measure. There is a need for further research exploring outcomes of CST interventions within the context of everyday function in individuals experiencing cognitive decline.     

Enabling independence: restorative approaches to home care provision for frail older adults

This study reviews the 'real world' potential (i.e. efficacy and effectiveness) of restorative approaches towards home care for frail older adults. Such approaches aim to go beyond traditional home care goals of 'maintenance' and 'support' towards improvements in functional status and quality of life. Our review of the literature included searches of health and gerontology databases as well as 'grey literature' across Australia, the UK and the USA. We provide an initial overview of the efficacy of a range of single component restorative interventions, including occupational therapy, physical therapy, health education and social rehabilitation. In order to answer questions about the overall efficacy and cost-effectiveness of restorative home care provision, we also review the nature of in-house programmes across the three nations as well as the evidence base for such programmes, particularly when they have been compared to home care 'as usual'. A range of positive outcomes has emerged, including improved quality of life and functional status and reduced costs associated with a reduction in the ongoing use of home care services postintervention. Questions remain about which components are most beneficial, which clients are likely to receive the greatest benefit, and the appropriate intensity and duration of such interventions.     

Clinical heterogeneity was a common problem in Cochrane reviews of physiotherapy and occupational therapy

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.     

Treatments for chronic fatigue syndrome

AIMS: To review studies evaluating the treatment of chronic fatigue and chronic fatigue syndrome, to describe predictors of response to treatment and to discuss the role of the occupational health physician. METHODS: A literature search was carried out using Medline and PsychInfo. RESULTS: Studies evaluating cognitive behaviour therapy, graded exercise therapy, pharmacological interventions (e.g. antidepressants and corticosteroids), immunological interventions and nutritional supplements were reviewed. The most promising results have been found with cognitive behaviour therapy and graded exercise therapy, and some predictors of outcome have been identified. Most of the other interventions were evaluated in just one or two studies and therefore evidence is insufficient to draw firm conclusions. CONCLUSIONS: By applying the models of fatigue that form the bases for cognitive behaviour therapy and graded exercise therapy, occupational health physicians may play an important role in helping the patients with chronic fatigue syndrome to reduce their symptoms, improve their functioning and return to work.     

Interventions Addressing Injury among Agricultural Workers: A Systematic Review

Agriculture is consistently rated as one of the most dangerous industries by the United States Bureau of Labor Statistics. As such, there is a demonstrable need for the prevention and management of injuries among agricultural workers. It is critical that injuries are managed in order to allow individuals the means to continue participating in meaningful and necessary tasks on the farm or ranch. The purpose of this systematic review was to determine whether interventions within the scope of occupational therapy were effective in addressing injury prevention and management among agricultural workers in order to determine what role occupational therapists currently serve among this population. A systematic review was completed of scientific, peer-reviewed literature published between January 2012 and January 2018. Databases included MEDLINE, PsychINFO, OTSeeker, OTSearch, CINAHL, PubMed, and the Cochrane Database of Systematic Reviews. A total of 479 articles were initially identified. Of these, 22 were selected for screening, and five were ultimately included in this review. Themes identified included education, musculoskeletal interventions, and environmental adaptations. Moderate evidence exists for the efficacy of interventions within the scope of occupational therapy practice for prevention and management of injury for agricultural workers. Further research including randomization and intervention specific studies is required to improve the level of evidence.     

Community occupational therapists' clinical reasoning: identifying tacit knowledge

Background: Occupational therapy interventions in the community, a fast expanding practice setting, are central to an important social priority, the ability to live at home. These interventions generally involve only a small number of home visits, which aim at maximising the safety and autonomy of community‐dwelling clients. Knowing how community occupational therapists determine their interventions, i.e. their clinical reasoning, can improve intervention efficacy. However, occupational therapists are often uninformed about and neglect the importance of clinical reasoning, which could underoptimise their interventions. Aim: To synthesise current knowledge about community occupational therapists’ clinical reasoning. Method: A scoping study of the literature on community occupational therapists’ clinical reasoning was undertaken. Results: Fifteen textbooks and 25 articles, including six focussing on community occupational therapists’ clinical reasoning, were reviewed. Community occupational therapists’ clinical reasoning is influenced by internal and external factors. Internal factors include past experiences, expertise and perceived complexity of a problem. One of the external factors, practice context (e.g. organisational or cultural imperatives, physical location of intervention), particularly shapes community occupational therapists’ clinical reasoning, which is interactive, complex and multidimensional. However, the exact influence of many factors (personal context, organisational and legal aspects of health care, lack of resources and increased number of referrals) remains unclear. Conclusion: Further studies are needed to understand better the influence of internal and external factors. The extent to which these factors mould the way community occupational therapists think and act could have a direct influence on the services they provide to their clients.     

Clinical management of carpal tunnel syndrome: A 12‐year review of outcomes

Carpal tunnel syndrome (CTS) is a disorder frequently encountered by occupational health care specialists. The health care management of this disorder has involved a diverse set of clinical procedures. The present article is a review of the literature related to CTS with an emphasis on occupational‐related CTS. MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycLIT, and NIOSHTIC databases from 1985–1997 were searched for treatment outcome studies related to CTS. Treatments of interest included surgery, physical therapy, drug therapy, chiropractic treatment, biobehavioral interventions, and occupational rehabilitation. A systematic review of the effects of these interventions on symptoms, medical status, function, return to work, psychological well‐being, and patient satisfaction was completed. Compared to other treatments, the majority of studies assessed the effects of surgical interventions. Endoscopic release was associated with higher levels of physical functioning and fewer days to return to work when compared to open release. Limited evidence indicated: 1) steroid injections and oral use of B6 were associated with pain reduction; 2) in comparison to splinting, range of motion exercises appeared to be associated with less pain and fewer days to return to work; 3) cognitive behavior therapy yielded reductions in pain, anxiety, and depression; and, 4) multidisciplinary occupational rehabilitation was associated with a higher percentage of chronic cases returning to work than usual care. Workers' compensation status was associated with increased time to return to work following surgery. Conclusions are preliminary due to the small number of well‐controlled studies, variability in duration of symptoms and disability, and the broad range of reported outcome measures. While there are several opinions regarding effective treatment, there is very little scientific support for the range of options currently used in practice. Despite the emerging evidence of the multivariate nature of CTS, the majority of outcome studies have focused on single interventions directed at individual etiological factors or symptoms and functional limitations secondary to CTS. Am. J. Ind. Med. 35:232–245, 1999. © 1999 Wiley‐Liss, Inc.     

Integrating health literacy into occupational therapy: findings from a scoping review

This paper aims to report ways of integrating health literacy into occupational therapy practice. Health literacy is defined as the ability to access, understand, evaluate, and communicate information as a way to promote, maintain, and improve health in various settings over the life-course. A scoping study of the scientific and grey literature on health and, specifically, occupational therapy and health promotion was done from 1980 to May 2010. Five databases were searched by combining key words (i) "health literacy" with (ii) "rehabilitation", "occupational therapy", or "health promotion". Data were extracted from 44 documents: five textbooks, nine reports, and 29 articles. The literature on health literacy needs enhancing in both quantity and quality. Nevertheless, six ways of integrating health literacy into occupational therapy practice were identified (frequency; %): occupational therapists should (i) be informed about and recognize health literacy (27; 61.4), (ii) standardize their practice (10; 22.7), (iii) make information accessible (37; 84.1), (iv) interact optimally with clients (26; 59.1), (v) intervene (29; 65.9) and (vi) collaborate to increase health literacy (21; 47.7). Since health literacy can directly impact on intervention efficacy, further studies are needed on how to integrate health literacy into occupational therapy practice.     

Integrating health literacy into occupational therapy: Findings from a scoping review

Abstract

This paper aims to report ways of integrating health literacy into occupational therapy practice. Health literacy is defined as the ability to access, understand, evaluate, and communicate information as a way to promote, maintain, and improve health in various settings over the life-course. A scoping study of the scientific and grey literature on health and, specifically, occupational therapy and health promotion was done from 1980 to May 2010. Five databases were searched by combining key words (i) “health literacy” with (ii) “rehabilitation”, “occupational therapy”, or “health promotion”. Data were extracted from 44 documents: five textbooks, nine reports, and 29 articles. The literature on health literacy needs enhancing in both quantity and quality. Nevertheless, six ways of integrating health literacy into occupational therapy practice were identified (frequency; %): occupational therapists should (i) be informed about and recognize health literacy (27; 61.4), (ii) standardize their practice (10; 22.7), (iii) make information accessible (37; 84.1), (iv) interact optimally with clients (26; 59.1), (v) intervene (29; 65.9) and (vi) collaborate to increase health literacy (21; 47.7). Since health literacy can directly impact on intervention efficacy, further studies are needed on how to integrate health literacy into occupational therapy practice.     

Interventions to prevent back pain and back injury in nurses: a systematic review

A systematic literature review was undertaken to assess the effectiveness of interventions that aim to prevent back pain and back injury in nurses. Ten relevant databases were searched; these were examined and reference lists checked. Two reviewers applied selection criteria, assessed methodological quality and extracted data from trials. A qualitative synthesis of evidence was undertaken and sensitivity analyses performed. Eight randomised controlled trials and eight non-randomised controlled trials met eligibility criteria. Overall, study quality was poor, with only one trial classified as high quality. There was no strong evidence regarding the efficacy of any interventions aiming to prevent back pain and injury in nurses. The review identified moderate level evidence from multiple trials that manual handling training in isolation is not effective and multidimensional interventions are effective in preventing back pain and injury in nurses. Single trials provided moderate evidence that stress management programs do not prevent back pain and limited evidence that lumbar supports are effective in preventing back injury in nurses. There is conflicting evidence regarding the efficacy of exercise interventions and the provision of manual handling equipment and training. This review highlights the need for high quality randomised controlled studies to examine the effectiveness of interventions to prevent back pain and injury in nursing populations. Implications for future research are discussed.     

The effectiveness of interventions for preventing injuries in the construction industry: a systematic review

BACKGROUND: Occupational injury rates among construction workers are the highest among the major industries. A number of injury-prevention interventions have been proposed, yet the effectiveness of these is uncertain. Thus a systematic review evaluating the effectiveness of interventions for preventing occupational injuries among construction workers was conducted. METHODS: Seven databases were searched, from the earliest available dates through June 2006, for published findings of injury prevention in construction studies. Acceptable study designs included RCTs; controlled before-after studies; and interrupted time series (ITS). Effect sizes of similar interventions were pooled into a meta-analysis in January 2007. RESULTS: Of 7522 titles found, four ITS studies and one controlled ITS study met the inclusion criteria. The overall methodologic quality was low. No indications of publication bias were found. Findings from a safety-campaign study and a drug-free-workplace study indicated that both interventions significantly reduced the level and the trend of injuries. Three studies that evaluated legislation did not decrease the level (ES 0.69; 95% CI=-1.70, 3.09) and made the downward trend (ES 0.28; 95% CI=0.05, 0.51) of injuries less favorable. CONCLUSIONS: Limited evidence was found for the effectiveness of a multifaceted safety campaign and a multifaceted drug program, but no evidence was found that legislation is effective to prevent nonfatal or fatal injuries in the construction industry.     

Beyond good practice: Issues in working with people with intellectual disability and high support needs

Many more people with an intellectual disability now live in the community as a result of de-institutionalization. Occupational therapy is one service that assists people with intellectual disabilities to participate as fully as possible in their local communities. Despite the potential benefits of occupational therapy, there is little written about the types of interventions used and the effectiveness of their outcomes with people with intellectual disabilities. The present interview study about current occupational therapy practice with people with intellectual disabilities and high support needs was conducted with experienced Australian clinicians. Positive outcomes for clients with high support needs were achieved in two ways: (i) by what therapists do; and (ii) by the features of the therapy relationship. In addition, interventions that indirectly empowered clients and changed others' perceptions were seen to have the most positive effect. The findings are discussed with regard to current occupational therapy literature and implications for occupational practice and education are presented.     

Correction to: Objective understanding of the Nutri-score front-of-pack label by European consumers and its effect on food choices: an online experimental study

There is increasing concern about the time people spend in sedentary behaviour, including screen time, leisure and occupational sitting. The number of both primary research studies (published trials) and reviews has been growing rapidly in this research area. A summary of the highest level of evidence that provides a broader quantitative synthesis of diverse types of interventions is needed. This research is to articulate the evidence of efficacy of sedentary behaviour interventions to inform interventions to reduce sitting time. The umbrella review, therefore, synthesised systematic reviews that conducted meta-analyses of interventions aiming at reducing sedentary behaviour outcomes across all age group and settings. A systematic search was conducted on six databases (MEDLINE Complete, PsycINFO, CINAHL, Global Health via EBSCOhost platform, EMBASE, and Cochrane Central Register of Systematic Reviews). Included articles were systematic reviews with meta-analysis of interventions aiming at reducing sedentary behaviour (screen time, sitting time or sedentary time) in the general population across all age group. Seventeen reviews met the inclusion criteria (7 in children and adolescent, 10 in adults). All reviews of sedentary behaviour interventions in children and adolescents investigated intervention effectiveness in reducing screen time. Six out of 11 meta-analyses (reported in 7 reviews) showed small but significant changes in viewing time. All reviews of sedentary behaviour interventions in office workplaces indicated substantial reduction in occupational sitting time (range: 39.6 to 100 min per 8-h workday). Sub-group analyses reported a trend favouring environmental change components such as sit-stand desks, active permissive workstations etc. Meta-analyses indicated that sedentary behaviour interventions were superior to physical activity alone interventions or combined physical activity and sedentary behaviour interventions in reducing sitting time. The current systematic reviews and meta-analyses supported sedentary behaviour interventions for reducing occupational sitting time in particular, with small changes seen in screen time in children and adolescents. Future research should explore approaches to maintaining behaviour change beyond the intervention period and investigate the potential of sedentary behaviour reduction interventions in older age groups in non-occupational settings.     

Occupational therapists' assessments of adults with long-term pain: the Swedish experience

The purposes of this study were to describe the needs for occupational therapy among people of working age with long-term pain, and to describe treatment interventions based on these assessments. Occupational therapists working in primary health care and/or with special interest in pain management (n=109) assessed 113 people aged 18-58 years with long-term pain with the Occupational Therapy Needs Assessment--Pain (OTNA--P) questionnaire. The occupational therapists recommended treatment interventions where appropriate. The results generated categories of needs that have implications for interventions: 1) need for patient education, 2) needs due to limitations in activity performance, 3) needs due to patient's discouragement, 4) need as a result of patient's dependency and 5) needs related to work. The suggested interventions focused on increased knowledge of how to handle daily occupations, mainly categorized as education and stress management' and behavioural' interventions. Significant correlations were found between the assessed needs and the suggested interventions. The results of this study could assist in developing guidelines for practitioners working in occupational therapy pain management programmes. It is recommended that further research is done on the effectiveness of occupational therapy interventions with patients with long-term pain.