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Cardiac Problems and its Relationship with Quality of Life and Performance Problems

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Cardiac Problems and its Relationship with Quality of Life and Performance Problems

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The purpose of this article was to describe the functional consequences of patients with cardiac diseases and to analyze the relationship between the limitations they were experiencing in occupations and their daily quality of life.

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[Purpose] To describe the functional consequences of patients with cardiac diseases and analyze associations between activity limitations and quality of life. [Subjects and Methods] Seventy subjects (mean age: 60.1±12.0 years) were being treated by Physical Medicine and Rehabilitation and Cardiology Departments were included in the study. Activity limitations and participation restrictions as perceived by the individual were measured by the Canadian Occupational Performance Measure (COPM). The Nottingham Extended Activities of Daily Living (NEADL) Scale was used to describe limitations in daily living activities. To detect the impact of activity limitations on quality of life the Nottingham Health Profile (NHP) was used. [Results] The subjects described 46 different types of problematic activities. The five most identified problems were walking (45.7%), climbing up the stairs (41.4%), bathing (30%), dressing (28.6%) and outings (27.1%). The associations between COPM performance score with all subgroups of NEADL and NHP; total, energy, physical abilities subgroups, were statistically significant. [Conclusion] Our results showed that patients with cardiac diseases reported problems with a wide range of activities, and that also quality of life may be affected by activities of daily living. COPM can be provided as a patient-focused outcome measure, and it may be a useful tool for identifying those problems.

Information related to the author

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Activity performance problems of patients with cardiac diseases and their impact on quality of life

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Purpose] To describe the functional consequences of patients with cardiac diseases and analyze associations between activity limitations and quality of life. [Subjects and Methods] Seventy subjects (mean age: 60.1±12.0 years) were being treated by Physical Medicine and Rehabilitation and Cardiology Departments were included in the study.

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This article talks about the effect of aerobic exercise on lung function and quality of life with asthma. I think aerobic exercise would be beneficial for clients with asthma, and the evidence in this meta-analysis agrees.

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Effects of continuous aerobic exercise on lung function and quality of life with asthma

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Use of Virtual reality in Ischemic heart disease rehabilitation. 

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Use of Virtual reality in Ischemic heart disease rehabilitation. 

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The purpose of this study is to determine if the use of virtual reality could be beneficial to treating those with ischemic heart disease as a complementary tool to other forms of rehabilitation.

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Affiliations

¹ International Doctorate School, Rey Juan Carlos University, 28922 Madrid, Spain.

² Clínica de Fisioterapia Physiocare, 28026 Madrid, Spain.

³ Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain.

⁴ Cardiac Rehabilitation Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, 28922 Madrid, Spain.

⁵ Rehabilitation Service, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain.

⁶ Cardiology Service, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain.

Free PMC article

Randomized Controlled Trial

Free PMC article

Affiliations

¹ International Doctorate School, Rey Juan Carlos University, 28922 Madrid, Spain.

² Clínica de Fisioterapia Physiocare, 28026 Madrid, Spain.

³ Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain.

⁴ Cardiac Rehabilitation Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, 28922 Madrid, Spain.

⁵ Rehabilitation Service, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain.

⁶ Cardiology Service, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain.

Abstract

(1) Background: The aim of the present study was to determine the effects of a virtual reality (VR) program, as a complementary tool to a conventional cardiac rehabilitation (CR) program in phase II of patients with ischemic heart disease compared to a conventional treatment group. (2) Methods: A single blinded randomized clinical trial was conducted. The patients were randomized to a control group (CG) or an experimental group (EG). The EG carried out a training based on VR of aerobic exercise using the XBOX ONE console and Kinect sensor. Ergometry, metabolic equivalents (METS), Functional Independence Measure, 6-min walk test (6MWT), the Short Form Health Survey-36 Questionnaire (SF-36), the Beck Depression Inventory-II, and the degree of satisfaction and adherence to treatment were used as outcome measures. (3) Results: Our results showed no statistically significant differences between the two groups. Statistical analysis within group for the EG showed statistically significant changes in the variables HR final ergometry, ergometry minutes, % ergometry, METS, final HR 6MWT, 6MWT distance, 6MWT number of laps, and for the SF-36 and Beck Depression Inventory-II. (4) Conclusion: A VR-based video game program, as an adjunct tool to a CR program, showed improvements in ergometry, METS, resistance to fatigue and health-related quality of life with excellent adherence and satisfaction perceived by patients with ischemic heart disease in phase II.

Keywords: cardiac rehabilitation; ischemic heart disease; physical exercise; video consoles; video games; virtual reality.

Conflict of interest statement

The authors declare no conflict of interest.

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national center for biotechnology information

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Effects of Virtual Reality on Cardiac Rehabilitation Programs for Ischemic Heart Disease: A Randomized Pilot Clinical Trial - PubMed

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(1) Background: The aim of the present study was to determine the effects of a virtual reality (VR) program, as a complementary tool to a conventional cardiac rehabilitation (CR) program in phase II of patients with ischemic heart disease compared to a conventional treatment group. (2) Methods: A si ...

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This article follows a case study that focuses on treating symptoms that follow Congestive heart failure such as fatigue, depression, and independence/goals needed to perform ADLs. This study focuses on techniques to help the clients with these areas they noted to be problematic.

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Affiliations

¹ a Department of Community Medicine and Rehabilitation , Occupational Therapy, Umeå University, Umeå , Sweden.

² b Department of Public Health and Clinical Medicine , Research Unit, Medcine Skellefteå, Umeå University , Skellefteå , Sweden.

³ c Department of Public Health and Clinical Medicine , Family Medicine, Umeå University , Umeå , Sweden.

⁴ d Department of Nursing , Umeå University , Umeå , Sweden.

Affiliations

¹ a Department of Community Medicine and Rehabilitation , Occupational Therapy, Umeå University, Umeå , Sweden.

² b Department of Public Health and Clinical Medicine , Research Unit, Medcine Skellefteå, Umeå University , Skellefteå , Sweden.

³ c Department of Public Health and Clinical Medicine , Family Medicine, Umeå University , Umeå , Sweden.

⁴ d Department of Nursing , Umeå University , Umeå , Sweden.

Abstract

Aim: The purpose of this study was to describe clients and occupational therapists (OTs) experiences of a home-based programme focusing energy conservation strategies (ECS) for clients with chronic heart failure (CHF).

Methods: The programme, based on occupational therapy intervention process model (OTIPM), was led by two OTs in primary health care. Five clients' self-reported activities of daily living (ADL), fatigue, depression, goal achievements and use of ECS. Furthermore, both clients and OTs were individually interviewed.

Results: The clients reported mild depression, severe fatigue and both increased and decreased independence in ADL. Most goals were achieved, and multiple ECS were used. Clients perceived that they worked collaboratively with the OTs and gained professional support to enhance daily activities. The OTs experienced knowledge and structure and found benefits from the programme, but doubted the possibility of using it in clinical practice.

Conclusions: This study, despite having few participants, indicates that both the OTs and the clients experienced that the specialized programme gave structure to the OTs work, provided knowledge about CHF and valuable energy conservation strategies. The programme supported the OTs in working in a more comprehensive client-centred way. However, its feasibility needs to be further evaluated.

Keywords: Activities of daily living; case study; energy conservation; goal achievement; intervention.

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Maitra KK, Erway F. Maitra KK, et al. Am J Occup Ther. 2006 May-Jun;60(3):298-310. doi: 10.5014/ajot.60.3.298. Am J Occup Ther. 2006. PMID: 16776397

Determining whether occupational therapy goals match between pairs of occupational therapists and their clients: a cross-sectional study.

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national center for biotechnology information

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A client-centred programme focusing energy conservation for people with heart failure - PubMed

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This study, despite having few participants, indicates that both the OTs and the clients experienced that the specialized programme gave structure to the OTs work, provided knowledge about CHF and valuable energy conservation strategies. The programme supported the OTs in working in a more comprehen ...

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The effect of the Continuous Care Model on treatment adherence in patients with myocardial infarction - Brent 

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The effect of the Continuous Care Model on treatment adherence in patients with myocardial infarction - Brent 

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Activity and Participation Levels During and After Cardiac Rehabilitation Program in People With Cardiac Conditions

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Activity and Participation Levels During and After Cardiac Rehabilitation Program in People With Cardiac Conditions

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The purpose of this study is to observe changes in motivation, fatigue, cognition, physical activity and participation level for those with chronic cardiac conditions, after rehabilitation services. This study also explains the role of occupational therapists in post acute and post cardiac settings for this population.

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Activity and Participation Levels During and After Cardiac Rehabilitation Program in People With Cardiac Conditions: Prospective Observational Study | American Journal of Occupational Therapy

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The purpose of this study was to evaluate changes of lung function and symptoms after participants had management and adaptation of the home environment by Occupational Therapists.

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Corresponding Author

Occupational Therapist, Doctoral Candidate

Department of Respiratory Medicine, Örebro University Hospital, and Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden

Department of Respiratory Medicine, Örebro University Hospital, S‐701 85 Örebro, Sweden. Search for more papers by this author

First published:

Abstract

The purpose of this study was to evaluate changes of lung function, respiratory symptoms and indoor air quality after reducing allergens and indoor pollutants in the home environment of people with asthma (n = 21). A quasi‐experimental pre‐/post‐test design with one group of participants was implemented. The interventions included removal of wall‐to‐wall carpets (n = 14) or improvement of indoor air exchange (n = 7). Participants' lung function, symptoms, medication and type‐1 allergy were recorded before and after the intervention. The indoor environment was monitored at house calls by an occupational therapist using conventional physical, biological and chemical methods. There was an improvement of lung function evidenced by an increased mean Forced Expiratory Volume (FEV ₁ %) and a reduction of airway obstruction (reversibility, % of baseline value), which indicate an improved asthmatic condition. Lung function assessed by vital capacity, bronchial hyper‐responsiveness, mean of Peak Expiratory Flow, symptom score and medicine consumption did not change significantly. There was a tendency that the amount of airborne dust (p=0.06) was reduced in the indoor environment. Relative humidity, carbon dioxide, formaldehyde and house dust mite levels had decreased after the intervention, but not significantly. Asthma symptoms related to the home environment are probably caused by several factors. When people with asthma suffer from increased symptoms in the home, house calls should be performed routinely. Dust samples from beds and carpets for analysis of allergens give information about exposure, and environmental assessments should be performed before interventions. Occupational therapists can make a valuable contribution in evaluating the home environment and suggesting ergonomic adaptations for individuals with asthma. Copyright © 2002 Whurr Publishers Ltd.

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Occupational therapy adaptation of the home environment in Sweden for people with asthma

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Corresponding Author Occupational Therapist, Doctoral Candidate Department of Respiratory Medicine, Örebro University Hospital, and Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden Department of Respiratory Medicine, Örebro University Hospital, S‐701 85 Örebro, Sweden.

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This article had the focus of describing the limitations in occupational performance in the elderly with this condition. Strategies were given to maintain daily activities. There was an emphasis on meaningful occupations throughout the text.

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Abstract
Aim: The aim of this study was to describe experiences of limitations in occupational performance and strategies for managing daily activities among the elderly with chronic heart failure (CHF). Methods: Ten participants from primary healthcare with a confirmed diagnosis of CHF were interviewed. The interviews were analysed using qualitative content analysis. Results: The first theme, "Redefining an active life, aware of one's impaired body", was based on four sub-themes: realizing one's limited activity ability; striving to preserve an active life; focusing on meaningful activities; and changing vs. not changing habits and roles. The second theme, "Planning activities and balancing the degree of effort", was based on three sub-themes: limiting, organizing, and rationalizing activities; adjusting activities to today's ability; and using technology and adapting the environment. Conclusions: Elderly people with CHF are struggling with an ongoing process of occupational adaptation due to periodical physical decline and fluctuating day-to-day ability. This highlights a need for information on strategies from a holistic perspective and client-centred occupational therapy interventions.

Acknowledgements

The authors would like to thank the participants in the study. This work was supported by funding from the National Research School in General Practice (VR-funded), Swedish Heart and Lung Association (local and national), the Foundation for Medical Research in Skellefteå, the Swedish Association of Occupational Therapists, Inga-Britt and Jan-Axel Bränholm Foundation, Detlof stiftelse, Department of Community Medicine and Rehabilitation Umeå University, and Research Grants for Västerbotten County Council (FoU and ALF).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Occupational performance and strategies for managing daily life among the elderly with heart failure

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Abstract Aim: The aim of this study was to describe experiences of limitations in occupational performance and strategies for managing daily activities among the elderly with chronic heart failure (CHF). Methods: Ten participants from primary healthcare with a confirmed diagnosis of CHF were interviewed. The interviews were analysed using qualitative content analysis.

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This article covers the condition of CHD and discusses how symptoms of the condition impact performance on physical activities. It was found that an improved ability to perform physical activities will ensure higher functional status and a better daily quality of living.

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Coronary heart disease (CHD) constitutes a significant cause of morbidity and mortality in the elderly population. CHD is managed under physician guidance. The management is primarily pharmacological, aimed at alleviating patient suffering and improving the clinical outcome. This approach ignores the functional aspect of CHD. The objective of this study was to explore the relationship between the symptoms experienced by a group of frail elders due to coronary heart disease and the performance of physical activities. A group of 33 frail elders with CHD residing in the region of Western New York were interviewed over a period of 6 months using the LIFEware(r) Cardiac Assessment Form (CAF). The results indicate mild to moderate relationships between the symptoms experienced and the performance of physical activities. We suggest the use of occupational therapy intervention aimed at improving the performance of physical activities in frail elders symptomatic with CHD. The intervention could include the use of assistive devices and energy conservation techniques. An improved ability to perform physical activities will ensure a higher functional status and a better quality of daily living.

Additional information

Notes on contributors

Carl V. GrangerJennifer R. Johnson was a graduate student in the School of Occupational Therapy, Texas Woman's University, Houston, TX at the time of this study. She is currently employed as an Occupational Therapist at Touro Infirmary in New Orleans, LADebra Stewart is Lecturer, School of Rehabilitation Science, McMaster University and staff therapist at Erinoak Centre, Missis-sauga, Ontario. She is currently completing a MSc (Design, Measurement and Evaluation) at McMaster University.Ronald L. Mace (deceased, June 29, 1998) was also affiliated with The Center for Universal Design, School of Design, North Carolina University.Lois Rosage and Geraldine Shaw are Occupational Therapist Consultants who provide evaluations for the housing programs at the Philadelphia Corporation for Aging.Debbie Rand is Occupational Therapist, Beit Rivka Geriatric Rehabilitation Hospital, Petach Tikva, Israel. She completed this study in partial fulfillment of the requirements for the Master of Science degree in Occupational Therapy, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem. Her mailing address is 50 Heh B'Eyar Street, Apartment 5, Rosh Ha'Ayin, Israel, 48056.Maureen McKenna is a Licensed Physical Therapist and Licensed Marriage and Family Therapist in California. Her Current position is: Assistant Professor of Physical Therapy, Wheeling Jesuit University, 316 Washington Avenue, Wheeling, WV 26003.Heather Lambert was funded in part by a Health Canada NHRDP Fellowship, a REPAR Fellowship, a doctoral bursary from the Fonds de la Recherche en Santé du Quebec, and a Canadian Occupational Therapy Foundation-Royal Canadian Legion Fellowship in Gerontology.

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functional limitation and occupational therapy intervention

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The Role of Coronary Heart Disease (CHD) in Functional Limitation in Community Dwelling Elders

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Coronary heart disease (CHD) constitutes a significant cause of morbidity and mortality in the elderly population. CHD is managed under physician guidance. The management is primarily pharmacological, aimed at alleviating patient suffering and improving the clinical outcome. This approach ignores the functional aspect of CHD.

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This article reviews evidence that is associated with OT interventions delivered alone or with a multidisciplinary team. The article discusses how to improve occupational outcomes for adults with conditions like CHD.

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Appraisal Area

Proportion of Studies Meeting Criterion

Purpose clearly stated?

16/16

Literature reviewed?

16/16

Appropriate design?

16/16

Random allocation?

16/16

Blinded evaluators?

15/16

Sample size justified?a

12/16

Similar groups (size and characteristics)?

15/16

Outcome measure valid and reliable?

13/16

Intervention described?

16/16

Contamination or cointervention avoided?

15/16

Results: Appropriate analyses?

15/16

Reported statistical significance?

15/16

Provided reasons for drop-outs?

16/16

Conclusions fit results?

16/16

Authors

Professions Involved, Format

Frequency, Intensity, Duration

Approach

Studies With at Least One Significant, Positive Result

Bendstrup, Ingemann Jensen, Holm, & Bengtsson (1997)

Multidisciplinary-group (occupational therapist, physiotherapist, nurse, physician)

Griffiths et al. (2000)

6 wk, 3 sessions of 2 hr/wk

Education on coping, psychological issues, and exercise, then patient-run weekly group if desired

Hammond & Freeman (2001, 2004)

Occupational therapist-group

4 sessions, 2 hrs each

Educational-behavioral joint protection arthritis education

Schene, Koeter, Kikkert, Swinkels, & McCrone (2007)

Occupational therapist-individual and group

1 yr (5 assessment visits in 4 wk, then 24 weekly group sessions and 12 1:1 sessions, then 3 1:1 follow-up visits over 20 wk)

Studies With Nonsignificant Results

Kraaimaat Brons, Geenen, & Bijlsma (1995)

Occupational therapist-group

10 wk, 2 hr/wk

Coping with limitations, energy conservation, joint protection, and assistive devices

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Occupational Therapy Interventions for Chronic Diseases: A Scoping Review | American Journal of Occupational Therapy

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Appraisal Area Proportion of Studies Meeting Criterion Purpose clearly stated? 16/16 Literature reviewed? 16/16 Appropriate design? 16/16 Random allocation? 16/16 Blinded evaluators? 15/16 Sample size justified?a 12/16 Similar groups (size and characteristics)? 15/16 Outcome measure valid and reliable? 13/16 Intervention described? 16/16 Contamination or cointervention avoided? 15/16 Results: Appropriate analyses?

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This article covers the role of occupational therapy in the rehabilitative process, an then goes into more specific disabilities OT's can help with in terms of the COPD condition.

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This article was completed to try and gain an understanding of the experiences of individual's that have been diagnosed with COPD, and how their condition has impacted their occupational behaviors.

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Chronic Obstructive Pulmonary Disease and Engagement in Occupation | American Journal of Occupational Therapy

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This article expands on the roles an Occupational Therapist will play in burn care delivery. It touches on evaluation, assessment
and what can be expected of the OT. (MaryAnne)

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This article discusses how early intervention through the use of occupational therapy effects clients who suffered burns to the hands.

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Language: English | French

Summary

One of the main goals in the rehabilitation process of patients with burn to their hands is their return to society and their professional occupation, which has a direct positive influence on these patients' quality of life. The goal of this research project was to investigate the effect of early intervention with occupational therapy in patients with burns to their hands. The study included 30 patients with second or third degree hand burns. Patients were added to the study 12 days after their burn wounds and grafted areas had healed. They had 3 sessions of occupational therapy per week for 8 weeks. These sessions included active and passive range of motion exercises, active resistive exercises, stretching exercises and practicing activities of daily living. Functionality of the hand was assessed before and after the 8 weeks of occupational therapy using the DASH questionnaire. The average initial DASH score before intervention with occupational therapy was 60.9, and after 8 weeks of occupational therapy it was 33.9 (average difference between the pre-intervention and post-intervention DASH scores is 27 points, p < 0.001). After 8 weeks of occupational therapy, patients performed activities of daily living with a lot less difficulty, and an increase in functionality of the hands was observed. This study suggests that early intervention with rehabilitative therapies is advantageous and may result in improved hand function.

Keywords: occupational therapy, hand surgery, burns

Résumé

Un des buts de la rééducation des patients aux mains brûlées est la réinsertion à la société et au travail, ce qui a une influence directe sur leur qualité de vie. Le but de cette étude était d'évaluer l'effet de l'introduction précoce de l'ergothérapie dans le programme de rééducation de 30 patients brûlés des mains (2ème et 3ème degrés). Ce programme, comprenant 3 séances d'ergothérapie hebdomadaires pendant 8 semaines, débutait 12 j après la cicatrisation. Les séances comportaient des exercices moteurs actifs et passifs, des exercices actifs contre résistance, des étirements et des exercices mimant les mouvements de la vie quotidienne. Les capacités fonctionnelles des mains étaient évaluées avant et en fin de programme, en utilisant le questionnaire DASH. Il était initialement de 60,9 et de 33,9 en fin de programme (différence 27 points, p< 0,001). Après 8 semaines d'ergothérapie, les patients avaient beaucoup moins de difficulté à réaliser les gestes de la vie courante et on observait une augmentation des capacités fonctionnelles des mains. Cette étude suggère que l'introduction précoce de l'ergothérapie peut permettre une amélioration de la fonction des mains brûlées.

Introduction

Burn injuries are one of the most devastating and acute threats to global health. Furthermore, they suspend a person's quality of life and health. Burn injuries destroy the skin and the connective tissue underneath. This leads to scarring, and in the case of hand burns, it causes unpleasant alterations to the shape of the patient's hands. These drastic alterations consequently lead to psychological consequences for the patient.

Burn scars are both a functional and cosmetic burden for the patient. Additionally, patients are at risk for contracture in the area of the burn. Overall, epithelialization occurs in the natural process of wound healing. Delay in application of skin grafts during the process of epithelialization changes the shape of the scar and puts the patient at risk for contracture. Contracture begins in the joints, followed by the muscles and tendons, and in the end it causes a decrease in the range of motion of joints.

Hands are an essential component in carrying out everyday activities and are one of the most vulnerable parts of the human body. Even though each hand is less than 3.0% of the total surface area of the body, the hands make up more than 80.0% of severe burn cases. The American Burn Society declared that hand burns fall under the "major damage" category. Burns to the hand comprise 6.0% of total injuries to the hands. By losing hand functionality, people lose 54% of their total functionality. In addition to causing functional dysfunction, burns to the hands also have biological, social and psychological consequences. They limit the social and professional life of patients, and as a result damage the individual's quality of life. It is important to have a comprehensive treatment plan for hand burn patients because even minor burns to the hands have social, psychological and cosmetic consequences in addition to limiting functionality.

The most important principle in treatment is early intervention and rehabilitation. Additionally, passive motion, focused treatment, and using surgical repair and skin grafts contribute to the overall treatment process. This requires cooperation among an interdisciplinary team that includes plastic surgeons, physical therapists, occupational therapists and psychologists. For the best quality of treatment, the involvement of each member of the team should begin as early as the day the patient is admitted to hospital.

Rehabilitation of burn patients involves a specialized process which includes restoring and improving their strength, helping them understand the extent of their burn problem, and encouraging activity in the burn area after the incident. The main focus of rehabilitation is both restoring functionality and improving the cosmetic appearance of the burn areas. Hand functionality is defined as "the ability to use hands in activities of daily living", like dressing oneself, cooking or toileting. Restoring hand functionality is one of the most important goals of burn rehab programs. Patients who are able to return to society and their professional life have a better quality of life than those who can't. Reaching desired functionality levels requires targeted planning, implementation of the plan and monitoring of the effectiveness of the rehabilitation interventions in restoring hand functionality.

The roles of physical therapists and occupational therapists in the burn centre include: prescribing splints and using compressive therapies to maintain proper conditions for healing and prevent deformity, facilitating the patient in adapting to activities of daily living by providing assistive devices, and training patients to use them. Additionally, they develop therapeutic activities to increase flexibility and reduce tension in the skin, maintaining range of motion and muscle strength and increasing overall functionality.

The main focus of occupational therapy is to help people maintain and improve their ability to function in their professional life, and carry out daily and leisure activities in order to return to a normal social life. Early intervention with occupational therapy may be beneficial for reaching optimal functional outcomes, especially since the hand is one of the areas most at risk for contracture of burn injuries. Therefore, a comprehensive occupational therapy program is needed to help patients regain most of their hand functionality. The purpose of this study was to investigate the effectiveness of occupational therapy in improving hand functionality.

Methods

This protocol was approved by the Ethics Committee of the Iran Medical University (IR.IUMS.REC.1396.32184). Patients were provided with a detailed explanation of the research objectives. Informed consent was then obtained from those who wished to participate in the research study. Patients were selected based on availability at the time.

This was a proof of concept study that included 30 patients with second or third degree burns to their hands, aged between 18 to 50 years old. These patients were referred to the Shahid Motahari Hospital in Tehran. The study only included patients 12 days after the day their burn wounds had healed. These patients had undergone early tangential excision with STSG or conservative anagement with dressings. Dressed superficial wounds healed after 5-10 days and grafted wounds healed in 5 days. During the healing period, active and passive physiotherapy with or without splint was given in all flexor surface and extensor surfaces of hand wounds. Patients who did not want to participate in the occupational therapy treatment sessions, or missed 4 or more sessions, were excluded from the study.

The patients were referred to the Occupational Therapy Department in Shahid Motahari Hospital. Patients were provided with a demographic questionnaire on both personal information and burn information. The functionality of the patient's hands was evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Each patient was given an initial DASH score for their hand functionality before beginning 8 weeks of occupational therapy.

The DASH questionnaire is comprised of 38 items. There are 30 main questions, 4 questions in the "work module" and 4 questions in the "sports/performing arts module". The DASH questionnaire is completed by the patient. Score ranges from 0 to 100, with 0 indicating no disability and 100 indicating full disability. The degree of disability of the upper limb is assessed using the 5-point Likert Scale.

All patients were given occupational therapy for 8 weeks. The patients met with an occupational therapist 3 times a week, for 1-1.5 hours per session. All of the treatment sessions were provided by senior occupational therapists.

The exercises included but were not limited to the following:

edema reduction

positioning (splint if necessary)

range of motion exercises

passive and active range of motion

active resistive exercises

stretching exercises

practising activities of daily living using the injured hand

using a spoon

getting dressed

opening and closing bottles, zippers and buttons

After the patients had undergone 8 weeks of occupational therapy, the DASH questionnaire was completed again. By comparing pre-therapy DASH scores with post-therapy scores, we were able to evaluate the effect of occupational therapy on patients with burns to their hands.

The results of this test were assessed using mean and frequency values. A KS Test was used to compare the pre-therapy and post-therapy DASH Scores. The results were verified using a Wilcoxon test. All the data were analyzed using the SPSS Software, Version 19 (SPSS Inc, Chicago, Ill). The significance was set as P < 0.05.

Results

A total of 30 patients (16 males, 14 females) with an average age of 35.9 ± 9.9 years old were included in the study. Of these, 93.3% had second or third degree burns. For 33% of the patients, hot liquids were involved in causing the burn, 30% were burned with gas and the others were burned by electricity, chemicals or flames. The total burn surface area in patients was 20.86 ± 14.90. The burn areas are presented in Table I.

Hand functionality results

The average DASH score before occupational therapy was 60.9, and the average score after occupational therapy was 33.9 (a difference of 27 points). This indicates that before occupational therapy intervention, patients had a lot of difficulty performing activities of daily living (ADLs) but after intervention they faced less challenges with ADLs.

During the early stages of treatment, patients experienced pain, weakness and moderate to severe limitations. By the latter stages of treatment, patients had less pain and less weakness. The DASH results are presented in Table II.

Discussion

Patients who experience hand burns face long-term functional deficits. Following their burn, patients face challenges such as limited range of motion, joint articulation and a decrease in functionality. With early intervention and comprehensive treatment from an occupational therapy team to restore maximum performance, controlling the degree of wrinkling, splinting, exercise, and scar treatment, it is possible to move patients towards a full recovery and return to activities of daily living. The ultimate goal is for the patient to be fully autonomous in performing activities of daily living. Through consistent participation in a rehabilitation program, an increase in range of motion, improvement in coordination and restoration of power can be observed in patients' hands. Patients who participate in these collaborative efforts with the interdisciplinary team have a greater chance of regaining full independence, returning to their daily activities and having a better quality of life.

For the duration of this study, patients received about 24-36 hours of occupational therapy over the course of 8 weeks. Elevation exercises, reversible massage, ACE bandages and passive mobilization were among the tools that were used to reduce swelling. Splinting, passive and active mobilization and stretching exercises were used to treat scars. Splinting, passive and active mobilization and stretching exercises were also used to prevent contracture. Functional improvement was observed in the patients' hands, with DASH scores before occupational therapy being 60.9 and going down to 33.9 after therapy. The average change was 27 points.

There is no difference between patients with burns isolated to the hands, or if other areas of the body are involved in addition to the hands. As shown in Table I, only 5 out of the 30 patients in this study had burns strictly limited to the hands. Other studies have supported this data, with a study by Abdelfettah et al. showing the DASH score going down from 71.56 to 19.27 after rehabilitation in 18 patients. Even though there are other studies that are similar to the one we performed, they utilize different methods to evaluate functionality. For example, in the study performed by Rrecaj et al., activities of daily living were not included in their method for assessing functionality because none of their patients had any complaints regarding their activities of daily living. However, assessing range of motion and hand strength after rehabilitation exercises showed the importance of physical therapy and occupational therapy in preventing contracture, improving range of motion, increasing muscle strength and even improving cosmetic results. Two other studies, one by Schneider et al. and another by Omar et al., began intervention in patients as soon as they were hospitalized. Hand functionality was verified by the Jebson and Motor Test. This study and similar studies performed previously in this area indicate that including occupational therapy treatment is effective in the rehabilitation process of hand burn patients. In a study performed by Tang et al. it was shown that even patients with moderate to severe burns who participated in rehabilitation interventions had improved physical and mental health, performed better in their activities of daily living and experienced a better quality of life overall.

Conclusion

Long-term goals of occupational therapy include restoring patient autonomy in performing activities of daily living such as carrying items, opening and closing doors, using keys, writing, eating, dressing and personal care. This study has shown that with occupational therapy intervention, such as utilization of active or passive exercises, stretching exercises, proper positioning with a splint, and training patients how to perform activities of daily living, patients are better able to perform such activities with less difficulty. Performance evaluation with the DASH questionnaire allows therapists to follow up on patient improvement and functional ability.

Limitations

Due to the low number of samples included in the study, the results of the study are not completely reliable. Moreover it is not a comparative study (with or without occupational therapy) that would allow proper assessment of the effect of occupational therapy. Secondly, utilization of more precise questionnaires that can be used in conjunction with the DASH questionnaire would add to the validity of the results.

References

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Effectiveness of incorporating occupational therapy in rehabilitation of hand burn patients

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One of the main goals in the rehabilitation process of patients with burn to their hands is their return to society and their professional occupation, which has a direct positive influence on these patients' quality of life. The goal of this research ...

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This article covers Occupational Therapy Interventions with adults with cancer. The interventions include but are not limited to energy conversation strategies, problem solving, signs and symptoms, as well as education.

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Occupational Therapy Interventions for Adults With Cancer | American Journal of Occupational Therapy

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This article covers occupational therapy interventions with cancer patients that have metastatic disease. It was found in this article that assessments focused on independent living skills, sensorimotor components, and therapeutic adaptations assisted with the role of care with cancer patients.

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Occupational Therapy Intervention for Cancer Patients With Metastatic Disease | American Journal of Occupational Therapy

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AIDS is considered the nation's number one health problem. This article reviews current facts about AIDS including transmission and clinical symptomatology. General precautions and recommended intervention strategies are also presented.

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AIDS: Guidelines for Occupational Therapy Intervention | American Journal of Occupational Therapy

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This article covers how OT can be used in children with HIV/AIDS. There is not much research that has explored how a child's play can be affected by HIV/AIDS. (Jess)

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This article covers activities of daily living in those that have experienced a lower limb amputation and how interventions can reduce dependence in pre-prosthetic phase. ADL intervention programs were used.

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Purpose: The main objective was to assess the change in the functional independence in basic activities of daily living (ADL) following a pre-prosthetic intervention in people with lower-limb amputation (LLA). Secondary objectives were to identify the factors contributing to the success of this intervention, and to analyze the effects on the presence of unmet needs for home adaptation.

Method: The ADL intervention was early and pre-prosthetic; it was focused on six self-care activities. Fifty-two adults with LLA, who required assistance in self-care, were included. Functional independence (Barthel) was assessed at baseline and after intervention (T2). Successful intervention was defined as independent performance of all self-care activities.

Results: There was a significant improvement in Barthel scores between baseline and T2 in toileting ( p < 0.001), bed-chair transfers ( p < 0.001), dressing ( p < 0.001), bathing/showering ( p < 0.001), and feeding ( p = 0.025). The proportion of homes with an unmet need for adaptation decreased significantly in bathroom ( p = 0.008) and other internal areas ( p  = 0.031). Intervention was successful for 61.5% of participants. In a multivariate model, age was significantly associated with successful intervention (OR 0.66, 95%CI 0.52-0.83).

Conclusions: A short and pre-prosthetic ADL intervention improves functional independence and reduces the need for home adaptation. ADL programs should be included in rehabilitation strategies.

Implications for Rehabilitation

Because basic activities of daily living (ADL) can be seriously compromised after a lower-limb amputation, it is important for this population to improve or maintain their level of independence.

A short and pre-prosthetic ADL intervention is an effective method for an early recovery of functional independence in self-care activities and promotes home adaptation.

Age is an important determinant of functional recovery, and most subjects can achieve independence in basic ADL regardless of the level of amputation.

A pre-prosthetic ADL program should be included in rehabilitation strategies for adults with lower-limb amputation.

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Activities of daily living in people with lower limb amputation: outcomes of an intervention to reduce dependence in pre-prosthetic phase

# data[].attributes.attachment_link.description
Purpose: The main objective was to assess the change in the functional independence in basic activities of daily living (ADL) following a pre-prosthetic intervention in people with lower-limb amputation (LLA). Secondary objectives were to identify the factors contributing to the success of this intervention, and to analyze the effects on the presence of unmet needs for home adaptation.

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This article discusses how lower-level amputations in children affect balance and mobility. In understanding patterns in gait movements and balance for children, the design of prosthetics and mobility rehabilitation protocols can improve for the children going into adulthood.

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This article covers interventions for adults that have experienced a stroke. Within the article, the Bergego scale, the Fugl Meyer assessment, and the Beck Depression Inventory were all used to assess the patient. Occupation based interventions were used, as well as RTP, VST, and AO.

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Occupational Therapy Interventions for Adults With Stroke | American Journal of Occupational Therapy

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This article covers patient interventions and occupational therapy association with CVA, Rheumatoid Arthritis, and Progressive Diseases of the CNS.

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A substantial proportion of the patients treated by occupational therapists have a chronic disease. The aim of this study was to describe the outlines of occupational therapy treatment for three specific groups of chronic diseases: progressive neurological diseases, cerebrovascular accident and rheumatoid arthritis. A total of 143 therapists, working in 49 occupational therapy departments in The Netherlands, were asked to complete a standard registration form based on the ICIDH. This form consisted of three sections: (a) patient characteristics, (b) occupational therapy diagnosis and treatment goals in terms of ICIDH and (c) treatment characteristics. The present study concerns 507 patients: 102 had progressive neurological diseases (PND), 338 had CVA and 67 had rheumatoid arthritis (RA). Our results showed that each patient group was characterized by a specific treatment approach. Especially at the level of treatment programmes substantial differences between groups were observed. Besides the clear differences, similarities in approaches were found between the PND and RA group, e.g. total time spent on therapy differed largely between the PND and RA patients (both averages 6 h) and the CVA patients (average 14 h).

Additional information

Notes on contributors

M.-J. DriessenIt is with great sadness that we have to inform the readership of the Journal that shortly after completing the final editorial work on this Special Issue, Professor Kalman Jacob Mann was seriously injured in a car accident and subsequently died.Professor Mann was responsible for establishing the two Hadassah Hospitals and Community Health Centres in Jerusalem and for the past 20 years headed the Presidium of Yad Sarah, Israel's largest community based, volunteer operated organization which provides a spectrum of free or nominal cost home care services nation-wide.We offer our condolences to his family and friends, and trust that this Special Issue stands as a testament to his work in the field.

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Occupational therapy for patients with chronic diseases: CVA, rheumatoid arthritis and progressive diseases of the central nervous system

# data[].attributes.attachment_link.description
A substantial proportion of the patients treated by occupational therapists have a chronic disease. The aim of this study was to describe the outlines of occupational therapy treatment for three specific groups of chronic diseases: progressive neurological diseases, cerebrovascular accident and rheumatoid arthritis.

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This article covers the result of the COPM administered to clients following TBI.

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This article covers occupational therapy treatments during an inpatient spinal cord injury rehabilitation. The interventions mentioned include ROM, stretching, education, and therapeutic activities that can include fine motor management, manual therapy, vestibular training, edema management, etc.

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Background

Occupational therapy (OT) is a critical component of the rehabilitation process after spinal cord injury (SCI), the constitution of which has not been studied or documented in full detail previously.

Objective

To describe the type and distribution of SCI rehabilitation OT activities, including the amount of time spent on evaluation and treatment, and to discuss predictors (patient and injury characteristics) of the amount of time dedicated to OT treatment activities.

Methods

Six inpatient rehabilitation centers enrolled 600 patients with traumatic SCI in the first year of the SCIRehab. Occupational therapists documented 32 512 therapy sessions including time spent and specifics of each therapeutic activity. Analysis of variance and contingency tables/chi-square tests were used to test differences across neurologic injury groups for continuous and categorical variables.

Results

SCIRehab patients received a mean total of 52 hours of OT over the course of their rehabilitation stay. Statistically significant differences among four neurologic injury groups were seen in time spent on each OT activity. The activities that consumed the most OT time (individual and group sessions combined) were strengthening/endurance exercises, activities of daily living (ADLs), range of motion (ROM)/stretching, education, and a grouping of 'therapeutic activities' that included tenodesis training, fine motor activities, manual therapy, vestibular training, edema management, breathing exercise, cognitive retraining, visual/perceptual training desensitization, and don/doff adaptive equipment. Seventy-seven percent of OT work occurred in individual treatment sessions, with the most frequent OT activity involving ADLs. The variation in time (mean minutes per week) spent on OT ROM/stretching, ADLs, transfer training, assessment, and therapeutic activities can be explained in part by patient and injury characteristics, such as admission Functional Independence Measure (FIM) score, neurologic injury group, and the medical severity of illness score.

Conclusion

OT treatment patterns for patients with traumatic SCI show much variation in activity selection and time spent on activities, within and among neurologic level of injury groups. Some of the variation can be explained by patient and injury characteristics. Almost all patients with SCI participated in strengthening/endurance and ROM/stretching exercises during OT treatment and these two activities are where the most time was spent when therapy provided in individual and group settings was combined. ADL work consumed the most time in individual therapy sessions.

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Occupational therapy treatment time during inpatient spinal cord injury rehabilitation

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Background Occupational therapy (OT) is a critical component of the rehabilitation process after spinal cord injury (SCI), the constitution of which has not been studied or documented in full detail previously.

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This article quantifies the amount of upper and lower extremity movement repetitions that occur during an inpatient stay and examines changes made over the course of rehab. These changes are facilitated and examined by both the OT and PT.

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Observed therapy sessions

A trained observer recorded all activities that a patient performed, occurring under the direction of a physical therapist, occupational therapist, or rehabilitation assistant. The observations most often included PT and OT sessions, but also included supplementary sessions with rehabilitation assistants occurring in the rehabilitation area and on the ward. As we wanted to measure typical active therapy sessions, the first measurement occurred in the second week after admission to avoid observation of sessions involving assessments. Observers recorded all PT and OT therapy activities that occurred on two days within that week period. The final measurement took place in the second-last week before discharge to avoid discharge planning and re-assessment activities. Again, two days within that week were observed. While patients were assessed at different times post-injury, our choice of measurement time is a clinically relevant option as it uses specific criteria for admission to inpatient rehabilitation services and ensures that patients are ready to be engaged in intensive rehabilitation activities. To be admitted for inpatient rehabilitation from acute care, patients must: be medically stable and would benefit from a short-stay interdisciplinary rehab program, be able to follow simple commands, be able to learn and recall enough information from day-to-day in order to participate, have identified specified rehab goals that are attainable, and have adequate cognition, motivation, behaviour and endurance to benefit from an intensive rehabilitation program. Criteria for discharge from inpatient services includes having achieved goals for inpatient rehabilitation, the patient no longer making any functional gains, the patient refusing to participate in active rehabilitation, or they are medically unstable.

Therapy sessions were included for observation if more than 50% of therapeutic time was comprised of physical rehabilitation. Therapeutic time was defined as any activity undertaken by the therapist with the goal of treating the patient and included physical rehabilitation, education, assessments, and interventions designed to improve functional independence. Sessions were excluded if more than 50% of therapeutic time was comprised of admission or discharge assessments, equipment fitting, or non-motor issues (e.g. discharge planning, education). Thus, our criteria allowed us to assess therapeutic repetitions under a best-case scenario, and omitting sessions not representative of the majority of therapy sessions. Non-therapeutic time was defined as any activity that occurred but was not for treating the patient's condition, such as talking, resting, changing location, or setting up for the next activity. If a session did not occur on a scheduled day or did not meet the criteria indicated above, an additional day of therapy was observed if it occurred within one-week of the first day of data collection.

Standardization between trained and new observers was accomplished by an orientation where new observers were familiarized with the data collection protocol and then recorded sessions with an experienced observer. The lead investigator and the observer compared therapy observation data sheets following therapy sessions, feedback was provided, and further sessions were recorded under supervision until the data recorded were at ≥95% agreement. In addition to the lead investigator, 4 individuals (1 physical therapist, 3 research assistants) observed therapy sessions over the course of the study.

During observed therapy sessions, the observer situated themselves such that they were able to clearly see and hear the therapy session while being a distance away such that their presence did not interfere with therapy delivery. Moreover, observers did not engage the therapist or patient during the session.

To record information, the observer used a stopwatch and data collection sheets to document the type of therapy (PT or OT), repetitions, movement classification, and duration of activity. Movements were classified via a taxonomy () modified from others. The categories used in this study included: upper extremity (including all arm and hand movements), hand (a subset including only repetitions of the hand/wrist), lower extremity (including all lower extremity activity), and stepping (a subset of lower extremity including only stepping on flat surfaces or ascending/descending stairs). As we wished to include only those repetitions that contributed most to motor and functional recovery (, and ), we excluded passive movements.

On the occasion that the patient was undergoing two therapeutic activities at the same time (e.g., simultaneous upper and lower extremity repetitions), both movements were recorded and included as therapeutic activities. In calculating therapeutic time in a session, we subtracted non-therapeutic time (e.g., resting) from total therapy time to avoid the possibility of therapeutic time being longer than the actual session time.

Outside of therapy observation, patients were asked how many minutes of structured group classes they attended that day. These classes were not observed as patients were not followed outside of individual PT and OT therapy sessions. Group classes included wheelchair skills, pulleys (upper body), and hand function.

Clinical outcome measures

Clinical outcome measures were collected on a separate day within the admission and discharge data collection periods.

The Spinal Cord Independence Measure measures the ability of SCI patients to accomplish ADLs in the area of self-care, respiration and sphincter management, and mobility, and is scored from 0-100 with higher scores indicating better functional independence. The measure has excellent validity and reliability.

Ambulatory patients were assessed with the Walking Index for SCI II, designed to gauge ambulation over a 10-meter distance with ambulation aids and physical assistance. Locomotor ability is assessed on a 0 to 20 hierarchical scale where a lower number indicates higher impairment. This assessment shows excellent reliability and validity.

Grip strength was tested using a hand-held Jamar Dynamometer (Nicholas MMT, Lafayette Instrument, Lafayette, IN). Patients performed three maximal voluntary contractions, with at least 30 seconds of rest between trials. The trials were averaged to obtain a mean score in kilograms. Measurements were taken with the patient seated, the elbow bent at 90 degrees, and hand in a neutral position. This test is reliable and valid for assessing grip in healthy and hand-injured populations.

The Graded Redefined Assessment of Strength, Sensibility and Prehension was used with patients with tetraplegia to evaluate muscle, sensory, and grasping function. This assessment involves scoring six functional tasks and assessing upper extremity strength and sensibility (i.e., perception of sensation) of the hands; scores for each hand are summed (0 to116) with higher scores indicating better hand function. The assessment has demonstrated reliability and validity in the SCI population.

Demographic information was collected for age, gender, injury level (paraplegia/tetraplegia), ASIA Impairment Scale score, aetiology (traumatic or non-traumatic), and length of stay in acute care and rehabilitation.

Data analysis

For OT and PT, therapy time and repetitions were calculated by averaging sessions occurring over two days to obtain a daily therapy value. Descriptive statistics for patient demographics are included in . Clinical outcome measures are presented in and the therapeutic time and movement repetition data for patients with paraplegia and tetraplegia is presented in and , respectively. We also provide descriptive data for the tetraplegia group separated by complete and incomplete SCI status (), but this data is not assessed statistically due to the small size of these subsets and overlap with other analyses. Additionally, we present data for those patients able to ambulate by the time of their discharge assessment because it is likely that their therapy sessions involved ambulatory goals and activities (). Wilcoxon signed rank tests determined whether therapy times (total time, therapeutic time) and movement repetitions (total upper extremity, hand, total lower extremity, steps) changed over the rehabilitation stay from admission to discharge; Z value and effect size ( r) are documented (small effect size = 0.1; medium effect size = 0.3; large effect size = 0.5). For clinical outcome measures, means, standard deviations, and confidence intervals for admission and discharge are documented. As defined by Cohen, a small effect size was 0.01, a medium effect size was 0.06 and a large effect size was 0.14.

Statistical software, SPSS 17 (SPSS Inc., Chicago, IL USA) was used for the analysis. Given the number of tests employed, a Benjamini-Hochberg calculated alpha was used to correct for multiple comparisons and minimize type I error. Based on the number of comparisons and p-values, a Benjamini-Hochberg alpha value of 0.008 was calculated and utilized. Reported values are medians unless stated otherwise.

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Movement Repetitions in Physical and Occupational Therapy during Spinal Cord Injury Rehabilitation

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A trained observer recorded all activities that a patient performed, occurring under the direction of a physical therapist, occupational therapist, or rehabilitation assistant. The observations most often included PT and OT sessions, but also included supplementary sessions with rehabilitation assistants occurring in the rehabilitation area and on the ward.

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This article covers the effectiveness of different Occupational Therapy Interventions for musculoskeletal shoulder conditions. Interventions for fractures, adhesive capsulitis, pain, cuff tears, and impingement syndrome.

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Effectiveness of Occupational Therapy Interventions for Musculoskeletal Shoulder Conditions: A Systematic Review | American Journal of Occupational Therapy

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This article discusses how LE musculoskeletal disorders can have a major impact on one's ability to participate in everyday activities. It also discusses how OT interventions have a strong role in those with hip fractures, LE joint replacements, LE amputations or limb loss, and nonsurgical osteoarthritis and pain. (Jess)

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This article covers the effects of occupational performance and satisfaction following mild to severe TBI

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This article covers how occupational therapy can be used as memory rehab for patients with tbi. The interventions included COMP and COMP-MST training programs. -Tanginique N.

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This article covers how OT can be used with people who have traumatic brain injuries. The main focus on this particular article is on oculomotor treatment.
-Tanginique N