Occupational adaptation of people living with fibromyalgia: A Systematic Review with Thematic Synthesis

Introduction : La fibromyalgie (FM) est un syndrome de douleur chronique primaire comprenant plusieurs symptômes comme de la fatigue et des troubles du sommeil. Plusieurs études suggèrent que la FM affecte la réalisation des occupations. Certaines personnes arrivent à s’adapter à l’expérience de la FM alors que pour d’autres, il est plus difficile de maintenir une routine satisfaisante. Le but de cette étude est de comprendre le processus d’adaptation occupationnelle des personnes atteintes de la FM. Méthode : Une revue systématique de la littérature avec synthèse thématique d’articles qualitatifs a été réalisée selon la méthode de Thomas et Harden dans les articles publiés avant février 2020. La recherche a été effectuée dans les bases de données AMHED, CINAHL, MedLine, OT Seeker, OTD Base et PsycInfo à l’aide d’une stratégie de recherche comprenant les mots-clés occupation et FM. Les articles en anglais ou en français abordant des composantes de l’adaptation occupationnelle ont été inclus. Les articles documentant les effets d’une intervention ou présentant plusieurs conditions non distinguées dans les résultats ont été exclus. Deux étudiants-chercheurs ont évalué indépendamment la qualité des articles sélectionnés à l’aide de la liste du Critical Appraisal Skills Programme. Puis, une synthèse thématique a été réalisée par l’étudiante responsable du projet à l’aide du Modèle de l’Occupation Humaine. Résultats : Un total de 555 articles a été identifié, puis 333 articles ont été évalués suite au retrait des doublons. Après l’évaluation du titre et des résumés de ces articles, 44 articles ont été lus intégralement. Douze articles qualitatifs ont finalement été inclus dans l’étude. La synthèse révèle que l’environnement social est très important dans le processus d’adaptation occupationnelle, particulièrement le soutien des proches. Les enjeux identitaires sont également cruciaux, car une redéfinition de l’identité est souvent nécessaire. La compétence occupationnelle est grandement affectée par l'expérience de la FM en raison de la difficulté à accomplir les activités réalisées autrefois. L’adaptation occupationnelle est un défi pour certains individus, mais le maintien d’une routine et l'intégration de stratégies de gestion agissent comme facilitateurs. Conclusion : Le soutien de l'environnement social serait particulièrement essentiel pour permettre l'adaptation occupationnelle d’une personne atteinte de la FM. L’adaptation occupationnelle est un processus complexe et dynamique requérant une évaluation de l’ensemble de ses composantes, notamment l’identité et la compétence occupationnelle.Introduction: Fibromyalgia (FM) is a primary chronic pain syndrome with several symptoms such as fatigue and sleep disturbances. Several studies suggest that FM affects the participation in various occupations. Some people can adapt to the FM experience while for others it is more difficult to maintain a routine. The purpose of this study is to understand the process of occupational adaptation of people with FM. Methods: A systematic review of qualitative research was performed using the method of Thomas and Harden for articles published before February 2020. The databases AMHED, CINAHL, MedLine, OT Seeker, OTD Base and PsycInfo were searched using a search strategy that included the keywords occupation and FM. Articles in English or French addressing components of occupational adaptation were included. Articles documenting the effects of an intervention or presenting several conditions not distinguished in the results were excluded. Two students independently assessed the quality of the selected articles with the Critical Appraisal Skills Programme checklist. A thematic synthesis was then conducted by the student in charge of the project using the Model of Human Occupation. Results: A total of 555 articles were identified and 333 of them were evaluated following the removal of duplicates. After evaluation of the titles and summaries of these articles, 44 articles were read. Twelve qualitative articles were finally included in the study. The synthesis reveals that the social environment is very important in the process of occupational adaptation, particularly the support of relatives. Identity issues are also crucial, and some people must redefine their identity. Occupational competence is greatly affected by FM experience due to the difficulty of performing in some activities. Occupational adaptation is an issue for some individuals but maintaining a routine and integrating management strategies act as facilitators. Conclusion: Support from the social environment seems to facilitate occupational adjustment for a person with FM. Occupational adjustment is a complex and dynamic process that requires an assessment of all its components, including identity and occupational competence

Injuries and frequent use of emergency department services: a systematic review

Objective To review all studies having examined the association between patients with physical injuries and frequent emergency department (ED) attendance or return visits.Design Systematic review.Data source Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO databases were searched up to and including July 2019.Eligibility criteria English and French language publications reporting on frequent use of ED services (frequent attendance and return visits), evaluating injured patients and using regression analysis.Data extraction and synthesis Two independent reviewers screened the search results, and assessed methodological quality using the Joanna Briggs Institute tool for prevalence studies. Results were collated and summarised using a narrative synthesis. A sensitivity analysis was performed to evaluate the repercussions of removing a study that did not meet the quality criteria.Results Of the 2184 studies yielded by this search, 1957 remained after the removal of duplicates. Seventy-eight studies underwent full-text screening leaving nine that met the eligibility criteria and were included in this study: five retrospective cohort studies; two prospective cohort studies; one cross-sectional study; and one case-control study. Different types of injuries were represented, including fractures, trauma and physical injuries related to falls, domestic violence or accidents. Sample sizes ranged from 200 to 1 259 809. Six studies included a geriatric population while three addressed a younger population. Of the four studies evaluating the relationship between injuries and frequent ED use, three reported an association. Additionally, of the five studies in which the dependent variable was return ED visits, three articles identified a positive association with injuries.Conclusions Physical injuries appear to be associated with frequent use of ED services (frequent ED attendance as well as return ED visits). Further research into factors including relevant youth-related covariates such as substance abuse and different types of traumas should be undertaken to bridge the gap in understanding this association

Occupational Therapy’s Unique Contribution to Chronic Pain Management: A Scoping Review

Occupational therapy (OT) makes a unique contribution to chronic pain (CP) management due to its overarching focus on occupation. The aim of this scoping review was to describe current knowledge about this contribution by documenting OT roles, models, assessments, and intervention methods used with adults living with CP. A systematic search exploring 10 databases and gray literature from 2006 to 2017 was conducted. Fifty-two sources were retained and analysed. Results bring forward the main role of OT being improving activities and participation (76.9 %), the Canadian Model of Occupational Performance (9.6 %), and the Canadian Occupational Performance Measure (21.2 %). Within the 30 reported interventions, 73.3% related directly to the person, 20% pertained to occupation (activities and participation), and 6.7% addressed environmental factors. The distinction and complementarity between the bottom-up and the top-down approaches to OT intervention were discussed. This review highlights OT specificity in adult CP management