Primary study

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Determining the Marginal Cost Differences of a Telehealth Versus an In-person Occupational Therapy Evaluation Session for Stroke Survivors Using Time-driven Activity-based Costing.

Year 2023
Journal Archives of physical medicine and rehabilitation
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OBJECTIVE:

To estimate the marginal cost differences and care delivery process of a telerehabilitation vs outpatient session.

DESIGN:

This study used a time-driven activity-based costing approach including (1) observation of rehabilitation sessions and creation of manual time stamps, (2) structured and recorded interviews with 2 occupational therapists familiar with outpatient therapy and 2 therapists familiar with telerehabilitation, (3) collection of standard wages for providers, and (4) the creation of an iterative flowchart of both an outpatient and telerehabilitation session care delivery process.

SETTING:

Telerehabilitation and outpatient therapy evaluation.

PARTICIPANTS:

Three therapists familiar with care deliver for telerehabilitation or outpatient therapy (N=3).

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURES:

Marginal cost difference between telerehabilitation and outpatient therapy evaluations.

RESULTS:

Overall, telerehabilitation ($225.41) was more costly than outpatient therapy ($168.29) per session for a cost difference of $57.12. Primary time drivers of this finding were initial phone calls (0 minutes for OP therapists vs 35 minutes for TR) and post documentation (5 minutes for OP vs 30 minutes for TR) demands for telerehabilitation.

CONCLUSIONS:

Telerehabilitation is an emerging platform with the potential to reduce costs, improve health care inequities, and facilitate better patient outcomes. Improvements in documentation practices, staffing, technology, and reimbursement structuring would allow for a more successful translation.

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Interactive scalp acupuncture combined with suspension digital occupational therapy for upper limb motor dysfunction after stroke: a multi-center randomized controlled trial.

Year 2024
Authors Xu L , Zhang Z , Xu W , Liu H , Han X , Wang M
Journal Zhongguo zhen jiu = Chinese acupuncture & moxibustion
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OBJECTIVES:

To observe the effects of interactive scalp acupuncture on upper limb motor function and activities of daily living in patients with upper limb motor dysfunction after stroke.

METHODS:

One hundred and twenty patients with upper limb motor dysfunction after stroke were randomly divided into an observation group(60 cases, 2 cases dropped out)and a control group(60 cases, 1 case dropped out). Both groups were treated with routine medication and rehabilitation. The observation group was treated with interactive scalp acupuncture combined with suspension digital occupational therapy, interactive scalp acupuncture was applied at middle 2/5 of the parietal and temporal anterior oblique line, middle 2/5 of the parietal and temporal posterior oblique line and second lateral line of parietal of the hemiparalysis contralateral side, 30 min each time.The control group was treated with suspension digital occupational therapy alone. The treatment was given once a day, 5 times a week for 4 weeks in the two groups. The scores of Fugl-Meyer assessment scale of upper extremity(FMA-UE), action research arm test(ARAT), the modified Barthel index (MBI) and surface electromyography(sEMG)signal of the biceps and triceps on the affected side were observed before and after treatment in the two groups, and the clinical efficacy was evaluated.

RESULTS:

After treatment, the FMA-UE, ARAT and MBI scores were increased compared with those before treatment in both groups(P<0.05), the changes of the observation group were greater than those in the control group(P<0.05). After treatment, the integrated electromyography(iEMG)value and root mean square(RMS)value of the biceps and triceps on the affected side during elbow flexion and extension were increased compared with those before treatment in both groups(P<0.05), the changes of the observation group were greater than those in the control group(P<0.05). The total effective rate was 94.8%(55/58) in the observation group, which was higher than 83.1%(49/59) in the control group(P<0.05).

CONCLUSIONS:

Interactive scalp acupuncture could improve upper limb motor function and activities of daily living in patients with upper limb motor dysfunction after stroke.

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Home-based Exercise Program(HEP) Vs. Institution-based Occupational Therapy(IOT) in improving hand skills in post Collies' fractures: A comparative study.

Year 2014
Authors Sen, Rupali
Journal Indian Journal of Occupational Therapy (Indian Journal of Occupational Therapy)
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AIMS:

1. To evaluate the effectiveness of home based exercise program 2. To involve the patient & his family members in treatment program. 3. To enhance self esteem of patients 4. To restore or reinforce functional capabilities. Hypothesis: Home-based exercise program in colles' fractures is also effective like institutional based occupational therapy. Methodology: Subjects: 30 nos. Procedure: A screening had been done among post colles' fracture patients those are attending outdoor occupational therapy department, NIOH with the help of FAS (Functional Assessment Scale), which is based on pain and functional capacity, and randomly choose 30no patients within the age group of 25 - 45years. Among them 15 are included in the control group and 15 in the experimental group. The subjects in each group were evaluated pre therapeutically by using the following instruments. Instrumentation: • VAS • MMDT • Tracker version 5 software (Goniometer, Dynamometer, Pinch meter) Intervention: After pre therapeutic evaluation, the control group underwent institution based Occupational therapy(IOT) where as the experimental group adhere to home based exercise program(HEP). The followup evaluation was done after 6-weeks for each group to find out the improvement in hand skills. Data analysis: SPSS version-13 was used. Paired t-test for each variables are comparatively measured where p < 0.05.

RESULTS:

This study significantly shows that self introduced home based exercise program and need based institutional occupational therapy both are equally effective in improving hand skills.

CONCLUSIONS:

Based on the results of the present study, it can be concluded that both HEP and IOT are equally important for reducing pain & stiffness and also for increasing pain free ROM, muscle strength and hand skills in post colles' fractures.

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Evaluating the Feasibility, Acceptance, and Beneficial Effects of Online Occupational Therapy for Post–COVID-19 Condition: Protocol for a Randomized Controlled Trial (ErgoLoCo Study) (Preprint)

Year 2023
Pre-print JMIR Research Protocols
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BACKGROUND:

Post–COVID-19 syndrome (PCS; also known as “long COVID”) is a relatively novel disease comprising physical, psychological, and cognitive complaints persisting several weeks to months after acute infection with SARS-CoV-2. Approximately 10% of patients with COVID-19 are affected by long-term symptoms. However, effective treatment strategies are lacking. The ErgoLoCo (Occupational Therapy [Ergotherapie] for Long COVID) study was designed to develop and evaluate a novel occupational therapy (OT) concept of online delivery of therapy for long COVID.

OBJECTIVE:

The primary study objective is to assess the feasibility of the online OT intervention in PCS. Secondary aims include the evaluation of online OT concerning cognitive problems, occupational performance, and social participation. METHODS This randomized controlled interventional pilot study involves parallel mixed methods process analyses and a realist evaluation approach. A total of 80 clients with PCS aged at least 16 years will be recruited into two interventional groups. The control cohort (watch and wait) comprises 80 clients with long COVID. Treatment is provided through teletherapy (n=40) or delivery of prerecorded videos (n=40) using the same standardized OT concept twice weekly over 12 weeks. Analyses of quantitative questionnaires and qualitative interviews based on the theoretical framework of acceptability will be performed to assess feasibility. Focus group meetings will be used to assess how acceptable and helpful the intervention was to the participating occupational therapists. Standardized tests will be used to assess the initial efficacy of the intervention on neurocognitive performance; limitations in mobility, self-care, and everyday activities; pain; disabilities; quality of life (QoL); social participation; and anxiety and depression in PCS, and the possible effects of online OT on these complaints.

RESULTS:

The German Ministry of Education and Research provided funding for this research in March 2022. Data collection took place from October 2022 to August 31, 2023. Data analysis will be completed by the end of April 2024. We anticipate publishing the results in the fall of 2024.

CONCLUSIONS:

Despite the enormous clinical need, effective and scalable treatment options for OT clients who have PCS remain scarce. The ErgoLoCo study will assess whether online-delivered OT is a feasible treatment approach in PCS. Furthermore, this study will assess the effect of the intervention on cognitive symptoms, QoL, and occupational performance and participation in everyday life. Particular emphasis will be placed on the experiences of clients and occupational therapists with digitally delivered OT. This study will pave the way for novel and effective treatment strategies in PCS. CLINICALTRIAL German Clinical Trial Registry DRKS00029990; https://drks.de/search/de/trial/DRKS00029990 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/50230

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A Pilot Randomized Controlled Trial Examining the Efficacy of the Motor Skill Occupational Therapy Intervention ON ASD (MOTION-ASD) on Functional Performance in Young Autistic Children

Year 2024
Authors Jin, Y.R. , Lin, L.-Y.
Journal Archives of Physical Medicine and Rehabilitation
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The Effects of Yoga on OT Students...American Occupational Therapy Association Annual Conference & Expo, April 4-7, 2019, New Orleans, Louisiana.

Year 2019
Journal American Journal of Occupational Therapy
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Date Presented 05/04/19 The purpose of this study was to examine the effectiveness of yoga on stress and anxiety levels within the OT college student population compared to a matched control group performing physical exercise alone. Findings supported the use of yoga as a stress-reduction tool. This research aligns with previously reported literature stating that yoga has a positive impact in reducing stress levels and suggests that academic programs implement scheduled stress management curricula for students. Primary Author and Speaker: BrieLynn Sturm Additional Authors and Speakers: Melinda Cozzolino Contributing Authors: Sebastian Harenberg

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Brain-computer interface combined with mental practice and occupational therapy enhances upper limb motor recovery, activities of daily living, and participation in subacute stroke

Year 2022
Journal Frontiers in neurology
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BACKGROUND:

We investigated the effects of brain-computer interface (BCI) combined with mental practice (MP) and occupational therapy (OT) on performance in activities of daily living (ADL) in stroke survivors.

METHODS:

Participants were randomized into two groups: experimental (n = 23, BCI controlling a hand exoskeleton combined with MP and OT) and control (n = 21, OT). Subjects were assessed with the functional independence measure (FIM), motor activity log (MAL), amount of use (MAL-AOM), and quality of movement (MAL-QOM). The box and blocks test (BBT) and the Jebsen hand functional test (JHFT) were used for the primary outcome of performance in ADL, while the Fugl-Meyer Assessment was used for the secondary outcome. Exoskeleton activation and the degree of motor imagery (measured as event-related desynchronization) were assessed in the experimental group. For the BCI, the EEG electrodes were placed on the regions of FC3, C3, CP3, FC4, C4, and CP4, according to the international 10-20 EEG system. The exoskeleton was placed on the affected hand. MP was based on functional tasks. OT consisted of ADL training, muscle mobilization, reaching tasks, manipulation and prehension, mirror therapy, and high-frequency therapeutic vibration. The protocol lasted 1 h, five times a week, for 2 weeks.

RESULTS:

There was a difference between baseline and post-intervention analysis for the experimental group in all evaluations: FIM (p = 0.001, d = 0.56), MAL-AOM (p = 0.001, d = 0.83), MAL-QOM (p = 0.006, d = 0.84), BBT (p = 0.004, d = 0.40), and JHFT (p = 0.001, d = 0.45). Within the experimental group, post-intervention improvements were detected in the degree of motor imagery (p < 0.001) and the amount of exoskeleton activations (p < 0.001). For the control group, differences were detected for MAL-AOM (p = 0.001, d = 0.72), MAL-QOM (p = 0.013, d = 0.50), and BBT (p = 0.005, d = 0.23). Notably, the effect sizes were larger for the experimental group. No differences were detected between groups at post-intervention.

CONCLUSION:

BCI combined with MP and OT is a promising tool for promoting sensorimotor recovery of the upper limb and functional independence in subacute post-stroke survivors.

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A feasibility randomised controlled trial of pre-operative occupational therapy to optimise recovery for patients undergoing primary total hip replacement for osteoarthritis (PROOF-THR).

Year 2016
Journal Clinical rehabilitation
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OBJECTIVE:

To assess the feasibility of a pre-operative occupational therapy intervention for patients undergoing primary total hip replacement.

DESIGN:

Single blinded feasibility randomised controlled trial, with data collection prior to the intervention, and at 4, 12, and 26 weeks following surgery.

SETTING:

Recruitment from two NHS orthopaedic outpatient centres in the West Midlands, UK. Subjects: Patients awaiting primary total hip replacement due to osteoarthritis were recruited. Following pre-operative assessment, patients were individually randomised to intervention or control by a computer-generated block randomisation algorithm stratified by age and centre.

INTERVENTIONS:

The intervention group received a pre-surgery home visit by an occupational therapist who discussed expectations, assessed home safety, and provided appropriate adaptive equipment. The control group received treatment as usual. Outcomes: The study assessed the feasibility of recruitment procedures, delivery of the intervention, appropriateness of outcome measures and data collection methods. Health related quality of life and resource use were recorded at 4, 12 and 26 weeks.

RESULTS:

Forty-four participants were recruited, 21 were randomised to the occupational therapy intervention and 23 to usual care. Analysis of 26 week data included 18 participants in the intervention group and 21 in the control. The intervention was delivered successfully with no withdrawals or crossovers; 5/44 were lost to follow-up with further missing data for participation and resource use.

CONCLUSIONS:

The feasibility study provided the information required to conduct a definitive trial. Burden of assessment would need to be addressed. A total of 219 patients would be required in an efficacy trial.

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Remote central effects of botulinum toxin type A as adjuvant to intense occupational therapy in the early stage of stroke: A Type II fMRI randomised controlled trial

Year 2021
Journal Toxicon
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Introduction: Improvements in motor function following interventions incorporating botulinum toxin type A (BTX-A) remain controversial, with existing studies yielding contrasting results.1-3 The mechanisms underlying BTX-A remote central effects are still under investigation. It is hypothesized that the toxin administration strategy may play a role in producing such differing outcomes. We tested a strategy based on modulating muscle synergies. Aim: The aim of the study was to investigate the clinical and remote central effects of an occupational therapy intervention combined with adjunctive BTX-A compared to the same occupational therapy without the adjuvant application of the toxin. Methods: A two-group, parallel, pre-post, randomized controlled trial was performed. The clinical effects of occupational therapy when performed following BTX-A injections to disinhibit finger flexors (n=5) was compared to those of an equal dose of occupational therapy alone (n=6). Motor dexterity and function were assessed using the Fugl-Meyer Scale, Motor Index, Arm Activity Measure, 9-Hole Peg Test, and Box and Block Test, and differences were analysed using ANCOVA. Brain activity was examined using functional magnetic resonance imaging (fMRI), and between-group differences were analysed using contrast statistical parametric mapping. Results: Both groups started in statistically similar conditions. Both treatments provided significant clinical improvements compared to baseline. The total differences in change score on the Fugl-Meyer Scale and Motor Index were larger, though not significantly, in the toxin-treated group than in the control group (Figure). When the toxin is administered, activity in the brain is more localised and appears more in the right hemisphere in subjects in the toxin-treated group and more in the left in those in the control group. Conclusions: Functional improvements were observed in the toxin-treated group, but the effect size compared to the control group was too small to provide definitive results. Post-treatment contrast analysis of the fMRI scans suggests that the toxin reduces cortical and cerebellar overexcitation. Findings are limited by the small cohort size. Funding: FOE received Mexican Research Council CONACYT CB-2014-01-237251. Keywords: Neurorehabilitation; Botulinum toxin; fMRI; Stroke [Formula presented] References 1. Demetrios M, Khan F, Turner-Stokes L, Brand C, McSweeney S. Multidisciplinary rehabilitation following botulinum toxin and other focal intramuscular treatment for post-stroke spasticity. Cochrane Database Syst Rev. 2013 Jun 5;(6):CD009689. 2. Shaw L, Rodgers H, Price C, et al; BoTULS Investigators. Bo

TULS:

a multicentre randomised controlled trial to evaluate the clinical effectiveness and cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A. Health Technol Assess. 2010; 14(26):1-142. 3. Shaw LC, Price CIM, van Wijck FMJ, et al; BoTULS Investigators. Botulinum toxin for the upper limb after stroke (BoTULS) trial: effect on impairment, activity limitation, and pain. Stroke. 2011;42(5):1371-1379.

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Unclassified

Comparing the Effectiveness of Role-Play Simulation versus Real Patient Transferal Skills Training in Occupational Therapy Students in Saudi-Arabia- A Quasi-Experimental Study.

Year 2023
Authors Meny A , Hayat A , Eldigire M , Kaleem M , Alharbi N , Albaz N - More
Journal Advances in medical education and practice
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PURPOSE:

To compare the effectiveness of using role-play simulation as a possible alternative to real-patient training to teach transferal skills to occupational therapy students.

PATIENTS AND METHODS:

Seventy-one occupational therapy students (including those in their second, third and fourth years) participated in a quasi-experimental study. The students were randomly divided into two groups. One group received role-play simulation at the university. The other received training on real patients with mild to moderate stroke and spinal cord injury (one session/week for six weeks) in clinical (inpatient) settings in Jeddah to learn patient transferring skills. Student performance was taken as a measure of teaching method effectiveness, and was evaluated by using a validated OSCE-type assessment tool developed at the end of training. The tool showed good reliability (Cronbach's α was > 0.7) and inter-reliability (Kappa < 0.001).

RESULTS:

A total number of 71 students participated in the study. The majority of the students were female (66.2%, N=47) and 33.8% (N=24) were male. About 33.8% (N=24) of students were in the second year, 29.6% (N=21) were in the third year and 36.6% (N=26) were in the fourth year. There were 36 (49.3%) students in the simulation group The mean age of the students was 20.70 (SD=1.2). There was no significant difference in the students' performance in both groups with a P-value of 0.139.

CONCLUSION:

Role-play simulation can effectively be used for students' training as there was no difference in the outcome of the students' performance in patient transferring skills in both groups. This finding can help in designing and implementing training through simulation, especially in situations where training on severely ill patients may be a safety risk.

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