Occupational therapy for community dwelling elderly people: a systematic review

OBJECTIVE: Occupational therapy might play an important role in maintaining independent living for community dwelling elderly people. The aim of this systematic review is to determine whether occupational therapy improves outcome for people who are >/=60 years and are living independently. METHODS: An extensive search in MEDLINE, CINAHL, EMBASE, AMED and SCISEARCH until July 2002 was performed. Studies with controlled and uncontrolled designs were included. Six intervention categories were distinguished and individually analysed using a best-evidence synthesis, based on the type of design, the methodological quality, type of outcome measures and statistical significance of findings. RESULTS: 17 studies were included, ten of which were randomised clinical trials. Six randomised clinical trials had a high methodological quality. Strong evidence is present for the efficacy of advising on assistive devices as part of a home hazards assessment on functional ability. There is some evidence for the efficacy of training of skills combined with a home hazard assessment in decreasing the incidence of falls in elderly people at high risk of falling. Some evidence is available for the efficacy of comprehensive occupational therapy on functional ability, social participation and quality of life. Insufficient evidence is present for the efficacy of counselling the primary caregiver of dementia patients about maintaining the patient's functional abilities. CONCLUSION: This review shows that occupational therapy interventions for community dwelling elderly people results in positive outcomes. Future research in the efficacy of occupational therapy in elderly patient groups such as people with dementia is recommended. Furthermore, research into tailoring interventions to the needs of elderly patients is recommended. (aut.ref.

Occupational therapy for stroke patients - A systematic review

Ergotherapie helpt patiënten die een beroerte gehad hebben bij het revalideren. Ook mensen met reumatoïde artritis (RA) hebben baat bij ergotherapie, onder andere door instructie over gewrichtsbeschermende maatregelen. Dit blijkt uit NIVEL onderzoek in opdracht van het Reumafonds en het College voor Zorgverzekeringen (CvZ). NIVEL onderzoeker Esther Steultjens vergeleek, schiftte en analyseerde de resultaten van al het onderzoek naar de effectiviteit van ergotherapie bij Reumatoïde Artritis (37 wetenschappelijke studies) en beroertes (32 wetenschappelijke studies) van de afgelopen 40 jaar. De resultaten zijn gebaseerd op een klein aantal, omdat de meeste gevonden studies van beperkte kwaliteit zijn. Beroerte Steultjens concludeert dat bij mensen die een beroerte gehad hebben ergotherapie de sociale participatie en de zelfredzaamheid bevordert. Vaardigheidstraining leidt ook tot enige verbetering van de zelfredzaamheid. Ze vond onvoldoende bewijs voor het nut van spalken om de spierspanning te verminderen. Per jaar krijgen ongeveer 32.000 mensen in Nederland een beroerte. Na een jaar heeft 66% van de overlevenden problemen met zelfstandig functioneren, driekwart van de overlevenden heeft problemen met een zinvolle tijdsbesteding. Steultjens: "Uit dit onderzoek blijkt dat ergotherapie een belangrijke rol heeft in de multidisciplinaire aanpak van de revalidatie van mensen met een beroerte." Reumatoïde artritis (RA) Steultjens concludeert dat er bewijs is dat ergotherapie bij mensen met RA een positief effect heeft op het kunnen verrichten van dagelijkse activiteiten en op het verlichten van pijn. Vooral instructies over het nemen van gewrichtsbeschermende maatregelen hebben invloed op het functioneren. Het spalken van aangedane ledematen lijkt de pijn te verminderen, ook al kan het de patiënt hinderen bij het bewegen. RA is een chronische ontsteking van de gewrichten die het dagelijks functioneren van ongeveer 145.000 Nederlanders beperkt. Ergotherapie is een vorm van paramedisch handelen die zich richt op het verbeteren van het dagelijks functioneren. De ergotherapeutische behandeling streeft ernaar het uitvoeren van taken te vergemakkelijken door met de patiënten sommige dagelijkse activiteiten te trainen en ze voor andere compensatiestrategieën aan te leren. Andere onderdelen van de ergotherapeutische behandeling zijn het geven van leefstijladviezen (zoals gewrichtsbeschermende of energiebesparende maatregelen) en advies/instructie over hulpmiddelen en spalktherapie. Het onderzoek is opgezet en uitgevoerd volgens de richtlijnen van de Cochrane Collaboration. Dit is een internationale organisatie die het maken, actualiseren en verspreiden van de resultaten van systematisch literatuuronderzoek naar de effecten van gezondheidszorg tot doel heeft. Arthritis Care & Research, Volume 47, Issue 6, 2002 Occupational therapy for rheumatoid arthritis: A systematic review Esther M. J. Steultjens , Joost Dekker, Lex M. Bouter, Dirkjan van Schaardenburg, Marie-Antoinette H. van Kuyk, Cornelia H. M. van den Ende Arthritis Care & Research is het Official Journal of the Association of Rheumatology Health Professionals

Direct Awards in Germany – Design And Effects

Institute of Transport and Logistics Studies. Faculty of Economics and Business. The University of Sydne

The use of PROMIS measures in clinical studies in patients with inflammatory arthritis: a systematic review

Purpose: Although the use of Patient-Reported Outcomes Measurement Information System (PROMIS) measures is widely advocated, little is known on their use in patients with inflammatory arthritis. We systematically describe the use and outcomes of PROMIS measures in clinical studies involving people with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA). Methods: A systematic review was conducted according to the PRISMA guidelines. Through a systematic search of nine electronic databases, clinical studies including patients with RA or axSpA and reporting the use of PROMIS measure were selected. Study characteristics, details of PROMIS measures and their outcomes, if available, were extracted. Results: In total, 29 studies described in 40 articles met the inclusion criteria, of which 25 studies included RA patients, three studies included axSpA patients and one study included both RA and axSpA patients. The use of two general PROMIS measures (PROMIS Global Health, PROMIS-29) and 13 different domain-specific PROMIS measures was reported, of which the PROMIS Pain Interference (n = 17), Physical Function (n = 14), Fatigue (n = 13), and Depression (n = 12) measures were most frequently used. Twenty-one studies reported their results in terms of T-scores. Most T-scores were worse than the general population mean, indicating impairments of health status. Eight studies did not report actual data but rather measurement properties of the PROMIS measures. Conclusion: There was considerable variety regarding the different PROMIS measures used, with the PROMIS Pain interference, Physical function, Fatigue, and Depression measures being the most frequently used. In order to facilitate the comparisons across studies, more standardization of the selection of PROMIS measures is needed.Orthopaedics, Trauma Surgery and Rehabilitatio

Physical therapy in patients with rheumatoid arthritis and axial spondyloarthritis: the patients' perspective

Objective: To assess the duration, frequency, and content of individual physical therapy (PT) in patients with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA). Method: In this cross-sectional study, an electronic questionnaire aimed at people with RA and axSpA was distributed through various communication channels of the Dutch Arthritis Foundation. It comprised questions on sociodemographic and health characteristics, received PT (currently and/or in the past year) and, if applicable, its duration, frequency, and content (active exercises, manual treatment, physical modalities, and/or counselling/education). Results: The study included 257 and 94 patients with self-reported diagnoses of RA and axSpA, of whom 163 (63%) and 77 (82%) currently or had recently received individual PT. The duration of individual PT was long-term (> 3 months) in 79% of RA and 83% of axSpA patients, with an average frequency of once per week in most. Although active exercises and counselling/education were each reported by >= 73% of the patients with RA and axSpA who received long-term individual PT, passive treatment modalities were also often offered (>= 89%), in particular massage, kinesiotaping, and/or passive mobilization. The same pattern was seen in patients receiving short-term PT. Conclusion: The majority of patients with RA and axSpA received PT currently or in the past year, usually individually, long-term, and at a frequency of once a week. Although active exercises and education are recommended in guidelines, passive treatment options that are not advised were relatively often reported. An implementation study to identify barriers and facilitators regarding adherence to clinical practice guidelines seems warranted.Orthopaedics, Trauma Surgery and Rehabilitatio

Effectiveness of longstanding exercise therapy compared with usual care for people with rheumatoid arthritis and severe functional limitations: a randomised controlled trial

Objectives To compare the effectiveness of longstanding (>52 weeks), supervised exercise therapy with usual care in adults with rheumatoid arthritis (RA) and severe functional limitations.Methods Participants were randomised 1:1 to the intervention (individualised goal-setting, active exercises, education and self-management regarding physical activity) or usual care. Primary endpoint was the change in the Patient-Specific Complaints activity ranked 1 (PSC1, 0–10) at 52 weeks. Secondary endpoints included the PSC activities ranked 2 and 3 (PSC2, PSC3), Health Assessment Questionnaire-Disability Index (HAQ-DI), Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL), 6-minute walk test (6MWT), Patient Reported Outcome Measurement Information System Physical Function-10 (PROMIS PF-10) and the Short Form-36 Physical and Mental Component Summary Scales (SF-36 PCS and MCS). (Serious) Adverse events (AEs) were recorded. Measurements were done by blinded assessors. Analyses at 52 weeks were based on the intention-to-treat principle.Results In total, 217 people (90% female, age 58.8 (SD 12.9) years) were randomised (n=104 intervention, n=98 usual care available for analyses). At 52 weeks, the improvement of the PSC1 was significantly larger in the intervention group (mean difference (95% CI) −1.7 (−2.4, –1.0)). Except for the SF-36 MCS, all secondary outcomes showed significantly greater improvements favouring the intervention (PSC2 −1.8 (−2.4, –1.1), PSC3 −1.7 (−2.4, −1.0), PROMIS PF-10 +3.09 (1.80, 4.38), HAQ-DI −0.17 (−0.29, –0.06), RAQoL −2.03 (−3.39, –0.69), SF-36 PCS +3.83 (1.49, 6.17) and 6MWT +56 (38, 75) m). One mild, transient AE occurred in the intervention group.Conclusion Longstanding, supervised exercise therapy was more effective than usual care in people with RA and severe functional limitations.Orthopaedics, Trauma Surgery and Rehabilitatio

Divination: Exemplifying and Configuring Archetypes in Ceramics

Abstract/Summary Dissertation Divination: Exemplifying and Configuring Archetypes in Ceramics is a study of my research practice. The cards of the tarot can be used as a conceptual framework and source of inspiration for making ceramic sculptures. The cards can be used to understand the creative process as an expression of archetypes. My dissertation discusses these archetypes from the tarot cards, both in their historical operation, their manifestation in my art practice, as well as, examining approaches taken to these archetypes by other artists such as Salvador Dali and Niki de Saint Phalle. The theoretical basis for the dissertation is informed by the writings of Carl G. Jung who has proposed concepts dealing with creativity, coincidence, a collective unconscious and archetypes. These ideas form a model for the understanding of my studio work. As background, the dissertation examines examples of artworks that could be seen to be drawn from a collective unconscious. Studio Work The studio work consists of a series of ceramic sculptures formulating the archetypes that I have derived from the tarot cards. The three dimensional clay, with found inclusions, examines the idea of specific archetypes. These archetypes are titled in the works including: The Fool, Strength, The Magician, Tarot Sun, The Empress II, The Lovers, Empress l, The Chariot I and II The Angel Temperance, The Tarot Devil and The World. The ceramic objects have been created in clay using handbuilding techniques. The clay was such that it could include found ceramic pieces and be refired. The pieces have been re-fired many times to achieve a variety of glaze effects. The works range in size from 30-60 cms approximately and include freestanding sculptures and complementing flat wall works