BACKGROUND:

People aging with long-term physical disabilities are living longer and experiencing the challenges of aging, including the onset of secondary and age-related health conditions. People aging with long-term physical disabilities are at high risk of falls, fall injuries, diminished functional abilities, and compromised participation. However, no available programs support people aging with long-term physical disabilities to participate safely at home and in the community. The proposed study is to examine the feasibility and efficacy of an adapted intervention: removing environmental barriers to independent living. Method

/DESIGN:

A single-blinded randomized controlled trial will be conducted. Participants who are 45–65 years old; self-report difficulty with ⩾2 daily activities; have had a physical disability for ⩾5 years; and live within 60 mi of the research lab are eligible. All participants will receive an initial in-home evaluation before randomization. The treatment group will receive removing environmental barriers to independent living (total five visits) intervention, which is tailored. The waitlist control group will be offered the same intervention after 6-month follow-up. Expected outcomes are high acceptability, fidelity, and adherence; low safety risk; improved community participation and daily activities performance; and fewer environmental barriers and fall hazards.

DISCUSSION:

Findings will serve as preliminary evidence for occupational therapy community practice. Outcomes will also inform future large, pragmatic trials. Trial Registration: ClinicalTrials.gov identifier NCT04589988

AIM:

To explore the relationship between rehabilitation therapies and development in children with cerebral palsy (CP).

METHOD:

We conducted a prospective, longitudinal study involving 656 children with CP (mean age [SD] 6y [2y 8mo] at study entry; 1y 6mo-11y 11mo; 287 females, 369 males), and their parents. Children were assessed two to five times over 2 years by therapists using standardized measures of balance and walking endurance. Parents completed questionnaires on demographics, rehabilitation therapies, and their children's performance in self-care and participation in recreation. Therapists and parents collaboratively classified children's Gross Motor Function Classification System (GMFCS) levels. We created longitudinal graphs for each GMFCS level, depicting change across time using centiles. Using multinomial models, we analyzed the relationship between therapies (amount, focus, family-centeredness, and the extent therapies met children's needs) and whether change in balance, walking endurance, and participation was 'more than' and 'less than' the reference of 'as expected'.

RESULTS:

Children were more likely to progress 'more than expected' when participating in recreation when therapies were family-centered, met children's needs, and focused on structured play/recreation. A focus on health and well-being was positively associated with participation and self-care. The amount of therapy did not predict outcomes.

INTERPRETATION:

Therapy services that are family-centered, consider the needs of the child, and focus on structured play/recreational activities and health/well-being may enhance the development of children with CP.

WHAT THIS PAPER ADDS:

Family-centered rehabilitation therapies were positively associated with greater participation in family/recreation activities and walking endurance. Parental perception that rehabilitation therapies met children's needs was associated with greater participation in family/recreation activities. Structured play, recreational activities, and health/well-being are important for self-care and participation when planning rehabilitation therapy. The amount of rehabilitation therapy was not related to developmental outcomes.

This article has no abstract

The Human Immunodeficiency Virus (HIV) infection, Hepatitis B Virus (HBV) infection and Hepatitis C Virus (HCV) infection are the most important blood borne occupational viral infection. Estimates of the prevalence of HIV infection in Italy is between 0.24 and 0.26%. The implementation of HIV screening strategies in the general population will decrease the proportion of patients with unknown HIV serostatus and the improvement of anti HIV therapie will decrease the proportion of HIV infected patients with detectable viraemia. The increate sensitivity of HBVDNA assays will prompt the definition of cut off levels for the definition of the infectivity of HBsAg positive health workers. The availability of highly effective and well tollerate oral antivirals could increase the proportion of treatable HBsAg positive health workers. The highly elevated success rates in the treatment of acute HCV infection will support strategies aimed at an early identification of occupational HCV infections. The tailoring of anti HCV schedules allows to optimize anti HCV treatment of health workers with chronic hepatitis C and the availability of new anti HCV will open an horizon of success in the treatment of chronic hepatitis C in health workers.

OBJECTIVE:

Leg discomfort and oedema are commonly attributed to a venous disorder (CVD) or chronic venous insufficiency (CVI) and treated with compression hosiery. The pressure needed to achieve clinical benefit is a matter of debate.

DESIGN:

We performed a meta-analysis of randomised controlled trials (RCT) that compared stockings exerting an ankle pressure of 10-20mmHg with placebo or no treatment and with stockings exerting a pressure of more than 20mmHg.

METHODS:

RCT were retrieved and analysed with the tools of the Cochrane Collaboration. Each study was reviewed independently. Subjective dichotomous and continuous factors and objective findings were pooled for statistical treatment.

RESULTS:

Eleven RCT fulfilled the predefined criteria. They included 1453 randomised subjects, 794 healthy people exposed to various forms of stress, 552 patients with a chronic venous disorder or chronic venous insufficiency and 141 patients after varicose vein surgery. Over all, compression with 10-20mmHg had a clear effect on oedema and symptoms as compared with <10mmHg pressure, placebo stockings, or no treatment (p<.0001). No study showed a difference between 10-20 and >20mmHg stockings.

CONCLUSIONS:

Despite important methodological heterogeneity and sometimes sub-standard reporting the meta-analysis suggests that leg compression with 10-15mmHg is an effective treatment for CVD. Less pressure is ineffective and higher pressure may be of no additional benefit.

Background: Psychological factors have been reported to affect chronic pain and may lead to inactivity after total knee arthroplasty. This study aimed to determine whether the use of an activity diary for goal setting during occupational therapy would reduce pain, and improve psychological and physical performance in patients after total knee arthroplasty. Methods: A total of 41 total knee arthroplasty participants from two cohorts were recruited in the study and allocated by convenience to either the experimental group using an activity diary (n = 20) or the control group (n = 21). Occupational therapy intervention (1–2 weeks postoperatively) to promote goal achievement was performed in both groups, and self-monitoring was performed in the diary group by using the activity diary. The outcome indices were Canadian Occupational Performance Measure, pain (resting pain, walking pain), pain catastrophizing (rumination, helplessness, and magnification), anxiety, depression, pain self-efficacy, and physical activity level. Data were evaluated by using analysis of variance analyses with post hoc tests. Results: A time-by-group interaction emerged for Canadian Occupational Performance Measure, walking pain, pain catastrophizing, anxiety, depression, and physical activity level (p < 0.05), both favouring the diary group. The diary group also showed greater improvement in Canadian Occupational Performance Measure, walking pain, anxiety, and physical activity levels at four weeks postoperatively, compared to the control group (p < 0.05). Conclusion: The use of the activity diary in this study increased occupational therapy effectiveness, reduced patients’ pain, and prevented a decline in physical performance. We believe that the use of an activity diary is an effective and feasible addition for total knee arthroplasty patients.

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BACKGROUND:

</b>A community-based occupational therapy intervention for people with mild to moderate dementia and their family carers (Community Occupational Therapy in Dementia (COTiD)) was found clinically and cost effective in the Netherlands but not in Germany. This highlights the need to adapt and implement complex interventions to specific national contexts. The current trial aims to evaluate the United Kingdom-adapted occupational therapy intervention for people with mild to moderate dementia and their family carers living in the community (COTiD-UK) compared with treatment as usual.<b>Methods/design: </b>This study is a multi-centre, parallel-group, pragmatic randomised trial with internal pilot. We aim to allocate 480 pairs, with each pair comprising a person with mild to moderate dementia and a family carer, who provides at least 4 hours of practical support per week, at random between COTiD-UK and treatment as usual. We shall assess participants at baseline, 12 and 26 weeks, and by telephone at 52 and 78 weeks (first 40% of recruits only) after randomisation. The primary outcome measure is the Bristol Activities of Daily Living Scale (BADLS) at 26 weeks. Secondary outcome measures will include quality of life, mood, and resource use. To assess intervention delivery, and client experience, we shall collect qualitative data via audio recordings of COTiD-UK sessions and conduct semi-structured interviews with pairs and occupational therapists.<b>

DISCUSSION:

</b>COTiD-UK is an evidence-based person-centred intervention that reflects the current priority to enable people with dementia to remain in their own homes by improving their capabilities whilst reducing carer burden. If COTiD-UK is clinically and cost effective, this has major implications for the future delivery of dementia services across the UK.<b>Trial Registration: </b>Current Controlled Trials ISRCTN10748953 Date of registration: 18 September 2014.

Normal aging presents subtle cognitive changes that can be detected before meeting the criteria for Mild cognitive impairment (MCI). Older people with low cognitive reserve and who receive limited cognitive stimulation are at greater risk of deterioration. In this regard, cognitive stimulation (CS) has been identified as an intervention that reduces this risk, provided that its design takes into account the differences in the level of cognitive reserve (CR) acquired throughout life and the baseline level of cognitive functioning. The general objective of this study is to evaluate, through a randomized clinical trial, the effectiveness of a computerized cognitive stimulation program, designed and adapted from Occupational Therapy based on the level of cognitive reserve in older adults in Primary Care. 100 participants will be randomized in a stratified manner according to the level of cognitive reserve (low/moderate/high), assigning 50 participants to the control group and 50 participants to the intervention group. The intervention group will carry out a computerized cognitive stimulation intervention designed and adapted from occupational therapy according to the level of cognitive reserve, through the “stimulus” platform. The main result expected to be achieved is the improvement of higher brain functions. As secondary results, we expect that those cognitive aspects most vulnerable to aging will decrease more slowly (in areas such as memory, executive function, attention and processing speed), and that the cognitive reserve of the participants will increase, in addition to being able to balance gender differences in these aspects. We think that these results can have a positive impact on the creation of adapted, meaningful and stimulating CS programs in older adults to prevent MCI and experience healthier aging.

OBJECTIVE:

Upper limb paralysis, which is a sequela of stroke, limits patients’ activities of daily living and lowers quality of life. The objective of this study was to examine the effects of peripheral nerve stimulation on hemiparetic upper limb functional recovery in chronic stroke patients undergoing low-frequency repetitive transcranial magnetic stimulation and occupational therapy.

METHODS:

The subjects were chronic stroke patients who participated in a two-week inpatient programme including repetitive transcranial magnetic stimulation and occupational therapy. There were two groups of patients: the peripheral nerve stimulation group (11 patients who underwent peripheral nerve stimulation) and the control group (11 patients who previously participated in the same inpatient programme but without peripheral nerve stimulation, selected via propensity score matching). The peripheral nerve stimulation group had 1 h of peripheral nerve stimulation on the median and ulnar nerves during occupational therapy. The outcome measures were the Wolf Motor Function Test, Fugl-Meyer Assessment, and Motor Activity Log.

RESULTS:

Wolf Motor Function Test, Fugl-Meyer Assessment, and Motor Activity Log showed significant improvement after the intervention in the peripheral nerve stimulation group. Particularly, the Fugl-Meyer Assessment hand score significantly improved in the peripheral nerve stimulation group compared to that in the control group (median change: 2 versus 0; p = 0.021, r = 0.49).

CONCLUSION:

The combined use of peripheral nerve stimulation with occupational therapy after repetitive transcranial magnetic stimulation may result in a better functional recovery of in hemiparetic upper limb. Peripheral nerve stimulation with stimulation above the sensory threshold and below the motor threshold is easy to combine with occupational therapy upper limb function training and is therefore clinically useful.

OBJECTIVE:

To evaluate the benefit of adding occupational therapy or physiotherapy interventions to a standard rehabilitation programme targeted for chronic widespread pain.

DESIGN:

Randomized active-controlled non-blinded trial.

SUBJECTS:

Women with chronic widespread pain recruited in a tertiary outpatient clinic.

METHODS:

Participants were randomized to a two-week, group-based standard rehabilitation programme followed by 16 weeks of group-based occupational therapy (Group BOT, n = 43) or 16 weeks of group-based physiotherapy (Group BPT, n = 42). Group A only received the two-week rehabilitation programme acting as comparator (n = 96).

OUTCOMES:

Primary outcomes were the Assessment of Motor and Process Skills and Short Form-36 (SF36) Mental Component Summary score.

RESULTS:

Mean changes in motor and process ability measures were clinically and statistically insignificant and without differences across the three groups assessed 88 weeks from baseline. Motor ability measures: -0.006 (95% confidence interval (CI): -0.244 to 0.233) in Group BOT; -0.045 (95% CI.: -0.291 to 0.202) in Group BPT; and -0.017 (95% CI.: -0.248 to 0.213) in Group A, P = 0.903. Process ability measures: 0.087 (95% CI.: -0.056 to 0.231) in Group BOT; 0.075 (95% CI.: -0.075 to 0.226) in Group BPT; and 0.072 (95% CI.: -0.067 to 0.211) in Group A, P = 0.924. Mean changes in patient-reported outcomes were likewise small; clinically and statistically insignificant; and independent of group allocation, except for the SF36 mental component summary score in the BPT group: 8.58 (95% CI.: 1.75 to 15.41).

CONCLUSION:

Participants were on average stable in observation-based measures of functional ability and patient-reported outcomes, except in overall mental well-being, favouring the enhanced intervention. Efficacy of additional interventions on functional ability remains uncertain.