Importance: Instrumental activities of daily living (IADLs) are important for independence, safety, and productivity, and people with Parkinson’s disease (PD) can experience IADL limitations. Occupational therapy practitioners should address IADLs with their clients with PD. Objective: To systematically review the evidence for the effectiveness of occupational therapy interventions to improve or maintain IADL function in adults with PD. Data Sources: MEDLINE, CINAHL, PsycINFO, OTseeker, and Cochrane databases from January 2011 to December 2018. Study Selection and Data Collection: Primary inclusion criteria were peer-reviewed journal articles describing Level 1–3 studies that tested the effect of an intervention within the scope of occupational therapy on an IADL outcome in people with PD. Three reviewers assessed records for inclusion, quality, and validity following Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Findings: Twenty-two studies met the inclusion criteria and were categorized into four themes on the basis of primary focus or type of intervention: physical activity, specific IADL-focused, cognitive rehabilitation, and individualized occupational therapy interventions. There were 9 Level 1b, 9 Level 2b, and 4 Level 3b studies. Strong strength of evidence was found for the beneficial effect of occupational therapy–related interventions for physical activity levels and handwriting, moderate strength of evidence for IADL participation and medication adherence, and low strength of evidence for cognitive rehabilitation. Conclusions and Relevance: Occupational therapy interventions can improve health management and maintenance (i.e., physical activity levels, medication management), handwriting, and IADL participation for people with PD. Further research is needed on cognitive rehabilitation. This review is limited by the small number of studies that specifically addressed IADL function in treatment and as an outcome. What This Article Adds: Occupational therapy intervention can be effective in improving or maintaining IADL performance and participation in people with PD. Occupational therapy practitioners can address IADL function through physical activity interventions, interventions targeting handwriting and medication adherence, and individualized occupational therapy interventions.

OBJECTIVE. The objective of this study was to determine how Parkinson’s disease (PD) affects functional cognition as assessed by the Complex Task Performance Assessment (CTPA) and to examine the associations of CTPA performance with other indicators of executive function in people with PD. METHOD. Volunteers with PD without dementia (n = 20) and community control participants (n = 19) completed neuropsychological testing, patient-reported outcome measures, and the CTPA. RESULTS. There were no group differences for CTPA performance accuracy; however, the PD group took longer to complete the CTPA than did the control group. In the PD group, inefficient CTPA performance correlated with poorer cognitive flexibility and worse reported everyday shifting and task monitoring. CONCLUSION. Decreased executive function, namely cognitive flexibility and attentional control, may impair functional cognition in people with PD. Future studies with larger, more diverse samples are warranted to determine the discriminant validity and sensitivity of the CTPA. Use of performance-based assessments such as the CTPA may increase the understanding of functional cognition in people with PD.

Date Presented 4/20/2018 Neuropsychological and patient-reported outcome measures may not fully characterize cognitive dysfunction in people with early Parkinson’s disease (PD). Performance-based measures can guide the development of interventions to address functional cognition and increase participation and quality of life in people with PD. Primary Author and Speaker: Erin R. Foster Additional Authors and Speakers: Alison Cara Kwalwaser Contributing Authors: Timothy Wolf, Carolyn Baum

OBJECTIVE. To investigate the performance of cognitively demanding instrumental activities of daily living (IADLs) among people with Parkinson’s disease (PD) without dementia. METHOD. Seventy-seven participants with PD and 57 participants without PD underwent standardized, performance-based IADL evaluation using the Performance Assessment of Self-care Skills. Activity performance was rated for independence, adequacy, and safety. RESULTS. The PD group had lower independence and adequacy scores than the non-PD group for almost every activity. Medication management, shopping, and sharp utensil use were the activities most sensitive to group differences. In the PD group, older age, lower Mini-Mental State Examination scores, and decreased motor function were associated with poorer IADL performance. CONCLUSIONS. People with relatively early and mild PD demonstrated measurable deficits in the performance of cognitively demanding IADLs. This work highlights the importance of using objective assessments of IADL function to detect early functional changes in people with PD.

This issue of AJOT adds to the growing and evolving understanding of the effectiveness of occupational therapy—related interventions to meet the needs of people living with neurodegenerative diseases.

We describe the results of a systematic review of the literature on occupational therapy–related interventions for people with Parkinson’s disease (PD). Three broad categories of intervention emerged: (1) exercise or physical activity; (2) environmental cues, stimuli, and objects; and (3) self-management and cognitive–behavioral strategies. Moderate to strong evidence exists for task-specific benefits of targeted physical activity training on motor performance, postural stability, and balance. Low to moderate evidence indicates that more complex, multimodal activity training supports improvement in functional movement activities. The evidence is moderate that the use of external supports during functional mobility or other movement activities has positive effects on motor control. In addition, moderate evidence is available that individualized interventions focused on promoting participant wellness initiatives and personal control by means of cognitive–behavioral strategies can improve targeted areas of quality of life. The implications for practice, education, and research are discussed.

OBJECTIVE. We investigated participation levels and relationships among cognition, depression, and participation for people with severe congestive heart failure (CHF). METHOD. People with severe CHF (New York Heart Association Class III or IV) awaiting heart transplantation (N = 27) completed standardized tests of cognition and self-report measures of executive dysfunction, depressive symptoms, and participation. RESULTS. Possible depression (64%) and cognitive impairment (15%–59%) were prevalent. Participants reported significant reductions in participation across all activity domains since CHF diagnosis (ps < .001). Worse executive dysfunction and depressive symptoms were associated with reduced participation and together accounted for 35%–46% of the variance in participation (ps < .01). CONCLUSION. Participation restrictions associated with CHF are not limited to physically demanding activities and are significantly associated with executive dysfunction and depression. Cardiac rehabilitation should address cognitive and psychological functioning in the context of all life situations instead of focusing solely on physical function and disability.