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Table 2.

Summary of Evidence From Studies

Author/Year Study Objectives Level/Design/Participants Intervention and Outcome Measures Results Study Limitations 
Dickerson, Reistetter, Davis, & Monahan (2011) To illustrate how general practice occupationaltherapists have the skills and knowledge to address driving as a valued occupation using an algorithm based on the Occupational Therapy Practice Framework 
  • Descriptive study

  • Convenience sample of occupational therapists’ and driving rehabilitation specialists’ assessment results of patients’ abilities to return to driving

  • Embedded Level II quasi-experimental, multivariate group design

  • N = 61; 55 completed; 56% female, 81% White; 15% Black; 4% other or unknown

  • Mean age: 50.22 yr

  • Convenience samples of two driving evaluation centers that used same IADL assessment

  • 22 had neurological disorders; 5 cognitive issues or dementia; 13 healthy older adults living in the community

  • Those who did not complete either the AMPS or the BTW assessment were excluded.

 
  • InterventionNone

  • Outcome MeasuresAlgorithm for general practice occupational therapists when considering the complex instrumental activity of daily living of driving

  • AMPS outcomes were compared with BTW driving assessment outcomes.

 
  • Occupational therapists using observational performance evaluation of IADLs can assist in determining who might be an at-risk driver, which may be more cost- and time-effective than referring to a Driving Rehabilitation Specialist.

  • Significant relationship was found between driving ability and the AMPS scores. On-road driving had a significant effect on AMPS process scores but not on AMPS motor scores.

  • People with the lowest process skills should not be referred for a BTW assessment.

 
  • No data from use of algorithm.

  • Small sample size. Two different centers with multiple driving rehab specialists and different AMPS raters. Different BTW routes related to locations.

 
Jensen & Padilla (2011) To review the evidence to determine the effectiveness of interventions to prevent falls in persons with AD and related dementias 
  • Level I

  • Systematic review

  • N = 12 articles: 7 Level I: 3 SR, 4 RCT; 4 Level III, 1 Level IV

  • Inclusion criteria: Population of people with AD or dementias, and intervention approaches considered to fit within the scope of occupational therapy practice

 
  • InterventionsInterventions included were categorized as exercise/motor, staff-directed interventions, multidisciplinary interventions, multifaceted, and single intervention fall reduction strategies.

  • Outcome Measures

    • Changes in frequency of falls

    • Meta-analysis

    • Severity of fall injuries

 
  • Motor intervention focused on improved gait, balance, and strength, and multidisciplinary interventions, including staff training on awareness and prevention, benefited the population most.

  • Multifaceted intervention had better results than single-focus interventions.

 
Small sample sizes, staff training inconsistency, nonequivalent groups, limited intervention periods, heterogeneity of studies, dropout rates, inconsistencies in separating population with dementia from total population receiving interventions, lack of statistical reporting. 
Letts, Edwards, et al. (2011) To review the evidence for the effect of interventions designed to establish, modify, and maintain ADLs, IADLs, leisure, and social participation on QoL, health and wellness, and client and caregiver satisfaction for people with AD and related dementias 
  • Level I

  • Systematic review

  • N = 26 studies: 7 Level I RCTs, 1 Level II, 11 Level III, and 7 Level IV

  • Inclusion criteria: Peer-reviewed scientific literature published in English.

  • Sample populations: Studies related to occupations, QoL, health and wellness, and client and caregiver satisfaction Populations within studies included individuals with AD or related dementias and/or their caregivers.

  • Exclusion criteria: Data from presentations, conference proceedings, non-peer-reviewed research literature, research reports, dissertations and theses.

 
  • Interventions

    • Assistive devices for physical assistance, cognitive assistance

    • Staff and caregiver training for feeding/eating and use of family style meals

    • Home-based interventions and residential facility interventions for clients and caregivers re: using compensatory and environmental strategies

    • Neuropsychological rehabilitation

    • Tailored Activity Program; kit-based activity intervention and sensorimotor recreational items

    • Music therapy

    • Walking when able, conversation or cognitive simulation from an individual volunteer

    • Reminiscence and drama groups

  • Outcome Measures

    • Frequencies

    • Percentages

    • p values

 
  • Studies showed low to moderate evidence for training and using assistive physical and cognitive devices for individuals with early stage dementias to participate in daily activities. There was moderate to strong evidence for training caregivers and staff in strategies for meals, and self-care participation with improved perceptions of QoL and basic physical health for both parties.

  • Studies showed moderate to strong support for improved perceptions of QoL by providing in-home support and intervention for caregivers and clients.

  • There was moderate to strong evidence that providing tailored and structured leisure activities for clients and caregivers improved performance, communication, engagement, and perceived satisfaction. Moderate to strong evidence supported that social participation opportunities in small groups or 1:1 improved perception of well-being by clients and caregivers. The drama group was not found to be a viable activity for this population.

 
Small sample sizes; no replication studies; small amount of high-level evidence; limited number of studies at each disease stage; mixed disease stages; and limited ability for generalization. 
Letts, Minezes, et al. (2011) To review the evidence for the effect of interventions designed to modify and maintain perceptual abilities on the occupational performance of people with AD and related dementias 
  • Level I

  • Systematic review

  • N = 31 studies: 10 Level I, including SRs, RCTs, and meta-analyses; 6 Level II; 6 Level III; 7 Level IV; and 2 qualitative

  • Inclusion criteria: Studies related to interventions designed to improve or modify and maintain perceptual abilities in individuals with AD and related dementias. Peer-reviewed scientific literature published in English.

  • Exclusion criteria: Data from presentations, conference proceedings, non-peer-reviewed research literature, research reports, dissertations and theses.

 
  • InterventionsInterventions provided were either for maintaining perceptual ability through compensatory methods, including light intensity/optical intervention, use of visual barriers, environmental design, or way-finding programs, or targeted to change perceptual abilities through multisensory or Snoezelen® intervention, sensory integration, group therapy, and exposure to sensory stimuli.

  • Outcome Measures

    • Descriptive statistics

    • Percentages

    • t tests

    • p values

    • Means

 
  • Studies showed low to moderate evidence for use of increased light intensity during mealtime to increase consumption and decrease agitation. Optical interventions may decrease hallucinations and agitation. Moderate evidence supports the use of visual barriers to deter exiting through doors while wandering.

  • There was low to moderate evidence for use of environmental designs of murals and l-shaped corridors for decreasing agitation and increasing sitting time. Mixed evidence supported the effectiveness of way-finding programs. Low evidence supported the use of multisensory stimulation and Snoezelen® interventions.

  • No evidence supported the use of sensory integration with this population. Low evidence supported group intervention for perceptual improvements related to occupational performance.

 
Small sample size; no replication studies; studies conducted during various stages of the disease process; limited number of studies related to each stage of the disease process; inadequate statistical analysis in some studies; limited ability for generalization; limited carryover of benefits of intervention. 
Padilla (2011a) To review the evidence for the efficacy of environment-based intervention on the affect, behavior, and performance of people with AD and related dementias 
  • Level I

  • Systematic review

  • 34 studies: 25 Level I, 16 SRs and 9 RCTs; 7 Level II; 1 Level III; 1 Level IV

  • Inclusion criteria: Studies related to environment-based interventions, affect, behavior, and performance of people with AD and related dementias. Peer-reviewed scientific literature published in English.

  • Exclusion criteria: Data from presentations, conference proceedings, non-peer-reviewed research literature, research reports, dissertations and theses.

 
  • InterventionsEnvironmental, multisensory (Snoezelen and Montessori), bright light therapy, ambient music, natural sounds, and aromatherapy.

  • Outcome MeasurePercentages

 
There was mixed evidence for use of environmental interventions to improve functional performance or for the benefits of aroma therapy and bright light therapy. Environmental modifications of occluding door knobs and doorways decreased exiting behavior. Pictures with names on room doors assisted some clients to locate their own room independently. Montessori activities, ambient music, and clients’ preferred music decreased agitation. Active music promoted engagement and reality orientation. There was minimal support for Snoezelen multisensory intervention. Small sample sizes; nonequivalent controls; no replication of study question, designs, or methods; no generalization available. 
Padilla (2011b) To review the evidence for the effectiveness of modification of activity demands in the care of people with AD 
  • Level I

  • Systematic review

  • N = 10 studies: 7 Level I: 6 RCTs, 1 SR; 3 Level III

  • Inclusion criteria: Studies related to interventions designed to modify activity demands of self-care and leisure, and individuals with AD or related dementias and/or their caregivers. Peer-reviewed scientific literature published in English.

  • Exclusion criteria: Data from presentations, conference proceedings, non-peer-reviewed research literature, research reports, dissertations and theses.

 
  • InterventionMatching client skills/interests, using cues, and providing compensatory and environmental strategies such as environmental modifications, adaptive equipment, and caregiver education.

  • Outcome MeasuresNone reported

 
Improvement of participation in ADLs and other occupations can occur by selecting and/or modifying activities that match the person’s highest level of retained skills; setting up the environment; labeling the environment; providing short concise verbal cues; providing visual cues; removing distractions; and training the caregiver. Small sample sizes; convenience samples; lack of blinding in all but one study; inconsistent or unclear measurement procedures; minimal to no follow-up measures of treatment outcomes. 
Peralta-Catipon & Hwang (2011) To explore personal factors that can predict health-related lifestyles of community-dwelling older adults 
  • Descriptive study

  • Convenience sample

  • N = 253 community-dwelling older adults residing in Southern California with adequate cognitive and English language capabilities. 1,048 women, 105 men; age range 55–92 yr; mostly unemployed or retired. Included representation from White, African-American, Asian/Pacific Islander, and Hispanic/Latino ethnic groups.

 
  • InterventionNone

  • Outcome Measures

    • Health Enhancement Lifestyle Profile (HELP; Hwang, 2010)

    • Univariate correlational/ comparative statistics and multivariate modeling

 
The number of chronic diseases or impairments and self-rated health were two strong predictors for the overall HELP (R2 = 0.571; p = .0001) and an individual’s health lifestyle. Demographic characteristics of age, gender, race, education, and employment status impacted lifestyle behaviors. Convenience sample, unable to generalize from study; not all personal factors that could relate to health lifestyles were captured in this study. 
Schepens, Panzer, & Goldberg (2011) To determine whether tailoring multimedia fall prevention education using different instructional strategies increases older adults’ fall threats knowledge and fall prevention behaviors 
  • Level I

  • RCT, three groups

  • N = 53 community-dwelling older adults recruited by fliers or person-to-person solicitation at senior housing and community facilities

  • Inclusion criteria: Community-dwelling, aged 65+ yr; English-speaking; reported normal or corrected to normal vision and hearing; alert and oriented to person, place and time; and able to follow three-step commands.

  • Exclusion criteria: Diagnosed mental disorder or neurological disease that may affect cognition; a diagnosed learning disability; a history of vertigo, chronic ear infections, or motion sickness.

 
  • InterventionsInterviews, medical and fall histories, and mobility were recorded. Interventions implemented components of the Multimedia Fall Prevention (MFP) system. Participants were randomized into one of two education groups (MFP + Authenticity group or MFP + Motivation group) or a control group (no falls education). MFP consists of 10 video clips of real-life vignettes of everyday situations in common environments using pretest and posttest assessment for measuring fall threats knowledge. The Authenticity group based on situated learning theory had 5 MFP 45 s videos selected through the MFP software that related to the contexts of each of the individuals in the group. Motivation group based on the Attention-Relevance-Confidence-Satisfaction model had 5 MFP 45 s videos selected through MFP software plus a clear statement of the program goals and benefits.

  • Outcome Measures

    • Fall prevention behaviors

    • Fall status

    • Fall threats knowledge

 
Both intervention groups showed knowledge gains and greater posttest knowledge than controls. The motivation group engaged in significantly more fall prevention behaviors over 1 mo than either the control group or Authenticity education group. Tailoring fall prevention education by addressing authenticity and motivation successfully improved fall threats knowledge. Unequal gender representation, with 81% female participants. Self-report of falls and fall prevention behaviors. Convenience sample limits generalization of this study. 
Schmid et al. (2011) To assess change in fear of falling (FoF) over the first 6 mo after a stroke and compare 6-mo anxiety, depression, balance, and QoL scores between individuals with and without baseline FoF at time of hospital discharge 
  • Descriptive study

  • Prospective longitudinal pilot study

  • Convenience sample from an inner-city, university-affiliated urban hospital

  • Participants were hospitalized for an acute stroke (ischemic or hemorrhagic) at the time of enrollment; no prior stroke history; referred to occupational or physical therapy for physical deficits; obtained a score of ≥3 on the 6-item Mini Mental State Examination; lived within a 60-mile radius of the city.

  • Exclusion criteria: Lack of a telephone or address, inability to verbally communicate; therapy referral for sensory, cognitive, or speech deficits only.

  • 64% male; 50% White and African American

 
  • Intervention6 mo of time between baseline data collection and 6-mo follow up.

  • Outcome Measures

    • Modified Rankin Scale (mRs) for stroke-related disability

    • Modified Falls Efficacy Scale (MFES) to measure FoF

    • Berg Balance Scale (BBS) for balance

    • Generalized Anxiety Disorder–7 (GAD–7) for anxiety

    • Patient Health Questionnaire (PHQ–9) for Depression

    • Stroke Specific Quality of Life Scale (SSQoL) for quality of life

  • Parametric statistics for all analyses using SPSS v17

  • Post hoc analysis

 
18 participants completed the study. FoF decreased and balance increased significantly over the 6 mo after stoke. Participants with baseline FoF had significantly higher anxiety and depression scores and decreased QoL scores 6 mo poststroke compared with those who did not. Post hoc analysis indicated those with FoF at baseline were significantly more likely to have lower MFES scores at 6 mo poststroke. Pilot study limits generalization to the poststroke population; limited sample size and demographic area; did not address whether participants were on medications for anxiety or depression or intensity or type of therapy participants may have received during the 6-mo interval. 
Stav, Snider Weidley, & Love (2011) To identify key barriers to developing and sustaining driving and community mobility programs 
  • Descriptive study

  • Survey

  • N = 24,945 occupational therapists, managers, and institutional leaders were invited to participate. 2,869 participants were included in the final analysis. 73% were occupational therapy practitioners, 18% were managers; 9% were administrators.

 
  • InterventionA Web-based survey form was developed that included demographics about respondents and settings and addressed the question of barriers to development of driving and community mobility programs.

  • Outcome MeasuresFrequencies and percentages

 
Data revealed widespread barriers that were largely contextual in nature, related to fiscal support, infrastructure, physical environment, and institutional culture. The barriers were highly correlated with each other and did not discriminate across region, practitioner level, or facility type. Low return rate; lack of interdisciplinary perspective. 
Thinnes & Padilla (2011) To identify the effectiveness of intervention strategies directed at caregivers of people with Alzheimer’s disease and related dementias and their ability to sustain participation in that role 
  • Level I

  • Systematic review

  • N = 43; 35 Level I: 22 RCTs, 10 SRs, 3 meta-analyses; 3 Level II; 5 Level III

  • Five reports were occupational therapy–specific (4 RCTs and 1 meta-analysis).

  • Inclusion criteria: Studies that addressed supportive and educational strategies for caregivers of individuals with AD or related dementias. Peer-reviewed scientific literature published in English.

  • Exclusion criteria: Data from presentations, conference proceedings, non-peer-reviewed research literature, research reports, dissertations and theses.

 
  • InterventionsOccupational therapy sessions provided caregivers with education, knowledge of AD, problem-solving, task simplification, communication, and simple home modifications. Therapy provided direct caregiver and joint caregiver/client intervention about AD, coping and stress management strategies, social skills training to help caregivers interact with clients with AD, behavior management skills, psycho-education strategies, utilization of support groups, relationships, daily living skills, self-esteem, planning for the future, legal issues, financial and health considerations, family intervention of counseling, support groups respite information, and home-based interventions. Participants received technology-mediated interventions such as weekly phone calls and video-based caregiver education. Participants also received respite care.

  • Outcome Measures

    • Caregiver depression

    • Competency

    • Family conflict

    • Cost effectiveness

    • Carryover

    • Length at home before nursing home admission

    • Care-recipient behaviors

    • Caregiver self-efficacy

    • Mortality

    • Psychological well-being

    • QoL

 
  • Inclusion of occupational therapy was found to decrease the need for assistance, reduce behavioral occurrences, and increase mastery and self-efficacy with continued post-intervention carryover and was suggestive of high cost-effectiveness.

  • Direct interventions to caregivers improved coping skills and caregiving skills and mediated depression, fatigue, hostility, and anxiety. Joint interventions of caregivers with patients improved both the caregiver and care-receiver’s coping with stress and sense of well-being, mediated depression, and reduced family conflict in the early stages of dementia. Joint multimodal programs slowed down functional decline of the care recipient and improved caregiver knowledge and confidence.

  • Family intervention improved coping with mediated depression and delayed institutionalization of the care recipient. Home-based interventions require more research but appear to have a positive effect.

  • Technology-based interventions of telephone conversations and counseling had a positive effect. Video-based caregiver education was no more effective than telephone or Internet-based education. Respite did not demonstrate significant long-term benefits or adverse effects, but did provide short-term relief of caregivers’ anxiety and depression. Adult day programs were helpful in alleviating care-related stress.

 
Sample size, convenience samples, methodologies, limited follow-up of interventions; heterogeneity of study designs and sample characteristics; subjective measures; high attrition; subjective self-report; inconsistent assessment procedures among testing sites; heterogeneity in type, dose, and intensity of interventions. 
Yuen & Burik (2011) To examine the preclinical curricular content pertaining to driving evaluation and rehabilitation (DE/R) included in professional entry-level occupational therapy programs. 
  • Descriptive study

  • Survey

  • Directors of the 144 accredited professional entry occupational therapy programs in the United States were invited to participate.

  • N = 90 self-selected directors or designees from professional entry occupational therapy programs

 
  • InterventionAn 8-item questionnaire with 7 closed-ended items and 1 open-ended item was administered on Survey Monkey. Questions included specifics about the academic program, extent of course structure, and topics related to DE/R in the curriculum.

  • Outcome Measures

    • Descriptive statistics

    • Content analysis

 
Eight of 90 programs included content related to DE/R in required courses; 9 offered DE/R required courses. Some offered electives. Half of the programs used specialists. Most had access to a driving rehab program. Unable to determine whether the nonresponding programs offer content related to DE/R. Occupational therapy assistant programs not included. Did not explore the depth and breadth of DE/R quality content. 
Author/Year Study Objectives Level/Design/Participants Intervention and Outcome Measures Results Study Limitations 
Dickerson, Reistetter, Davis, & Monahan (2011) To illustrate how general practice occupationaltherapists have the skills and knowledge to address driving as a valued occupation using an algorithm based on the Occupational Therapy Practice Framework 
  • Descriptive study

  • Convenience sample of occupational therapists’ and driving rehabilitation specialists’ assessment results of patients’ abilities to return to driving

  • Embedded Level II quasi-experimental, multivariate group design

  • N = 61; 55 completed; 56% female, 81% White; 15% Black; 4% other or unknown

  • Mean age: 50.22 yr

  • Convenience samples of two driving evaluation centers that used same IADL assessment

  • 22 had neurological disorders; 5 cognitive issues or dementia; 13 healthy older adults living in the community

  • Those who did not complete either the AMPS or the BTW assessment were excluded.

 
  • InterventionNone

  • Outcome MeasuresAlgorithm for general practice occupational therapists when considering the complex instrumental activity of daily living of driving

  • AMPS outcomes were compared with BTW driving assessment outcomes.

 
  • Occupational therapists using observational performance evaluation of IADLs can assist in determining who might be an at-risk driver, which may be more cost- and time-effective than referring to a Driving Rehabilitation Specialist.

  • Significant relationship was found between driving ability and the AMPS scores. On-road driving had a significant effect on AMPS process scores but not on AMPS motor scores.

  • People with the lowest process skills should not be referred for a BTW assessment.

 
  • No data from use of algorithm.

  • Small sample size. Two different centers with multiple driving rehab specialists and different AMPS raters. Different BTW routes related to locations.

 
Jensen & Padilla (2011) To review the evidence to determine the effectiveness of interventions to prevent falls in persons with AD and related dementias 
  • Level I

  • Systematic review

  • N = 12 articles: 7 Level I: 3 SR, 4 RCT; 4 Level III, 1 Level IV

  • Inclusion criteria: Population of people with AD or dementias, and intervention approaches considered to fit within the scope of occupational therapy practice

 
  • InterventionsInterventions included were categorized as exercise/motor, staff-directed interventions, multidisciplinary interventions, multifaceted, and single intervention fall reduction strategies.

  • Outcome Measures

    • Changes in frequency of falls

    • Meta-analysis

    • Severity of fall injuries

 
  • Motor intervention focused on improved gait, balance, and strength, and multidisciplinary interventions, including staff training on awareness and prevention, benefited the population most.

  • Multifaceted intervention had better results than single-focus interventions.

 
Small sample sizes, staff training inconsistency, nonequivalent groups, limited intervention periods, heterogeneity of studies, dropout rates, inconsistencies in separating population with dementia from total population receiving interventions, lack of statistical reporting. 
Letts, Edwards, et al. (2011) To review the evidence for the effect of interventions designed to establish, modify, and maintain ADLs, IADLs, leisure, and social participation on QoL, health and wellness, and client and caregiver satisfaction for people with AD and related dementias 
  • Level I

  • Systematic review

  • N = 26 studies: 7 Level I RCTs, 1 Level II, 11 Level III, and 7 Level IV

  • Inclusion criteria: Peer-reviewed scientific literature published in English.

  • Sample populations: Studies related to occupations, QoL, health and wellness, and client and caregiver satisfaction Populations within studies included individuals with AD or related dementias and/or their caregivers.

  • Exclusion criteria: Data from presentations, conference proceedings, non-peer-reviewed research literature, research reports, dissertations and theses.

 
  • Interventions

    • Assistive devices for physical assistance, cognitive assistance

    • Staff and caregiver training for feeding/eating and use of family style meals

    • Home-based interventions and residential facility interventions for clients and caregivers re: using compensatory and environmental strategies

    • Neuropsychological rehabilitation

    • Tailored Activity Program; kit-based activity intervention and sensorimotor recreational items

    • Music therapy

    • Walking when able, conversation or cognitive simulation from an individual volunteer

    • Reminiscence and drama groups

  • Outcome Measures

    • Frequencies

    • Percentages

    • p values

 
  • Studies showed low to moderate evidence for training and using assistive physical and cognitive devices for individuals with early stage dementias to participate in daily activities. There was moderate to strong evidence for training caregivers and staff in strategies for meals, and self-care participation with improved perceptions of QoL and basic physical health for both parties.

  • Studies showed moderate to strong support for improved perceptions of QoL by providing in-home support and intervention for caregivers and clients.

  • There was moderate to strong evidence that providing tailored and structured leisure activities for clients and caregivers improved performance, communication, engagement, and perceived satisfaction. Moderate to strong evidence supported that social participation opportunities in small groups or 1:1 improved perception of well-being by clients and caregivers. The drama group was not found to be a viable activity for this population.

 
Small sample sizes; no replication studies; small amount of high-level evidence; limited number of studies at each disease stage; mixed disease stages; and limited ability for generalization. 
Letts, Minezes, et al. (2011) To review the evidence for the effect of interventions designed to modify and maintain perceptual abilities on the occupational performance of people with AD and related dementias 
  • Level I

  • Systematic review

  • N = 31 studies: 10 Level I, including SRs, RCTs, and meta-analyses; 6 Level II; 6 Level III; 7 Level IV; and 2 qualitative

  • Inclusion criteria: Studies related to interventions designed to improve or modify and maintain perceptual abilities in individuals with AD and related dementias. Peer-reviewed scientific literature published in English.

  • Exclusion criteria: Data from presentations, conference proceedings, non-peer-reviewed research literature, research reports, dissertations and theses.

 
  • InterventionsInterventions provided were either for maintaining perceptual ability through compensatory methods, including light intensity/optical intervention, use of visual barriers, environmental design, or way-finding programs, or targeted to change perceptual abilities through multisensory or Snoezelen® intervention, sensory integration, group therapy, and exposure to sensory stimuli.

  • Outcome Measures

    • Descriptive statistics

    • Percentages

    • t tests

    • p values

    • Means

 
  • Studies showed low to moderate evidence for use of increased light intensity during mealtime to increase consumption and decrease agitation. Optical interventions may decrease hallucinations and agitation. Moderate evidence supports the use of visual barriers to deter exiting through doors while wandering.

  • There was low to moderate evidence for use of environmental designs of murals and l-shaped corridors for decreasing agitation and increasing sitting time. Mixed evidence supported the effectiveness of way-finding programs. Low evidence supported the use of multisensory stimulation and Snoezelen® interventions.

  • No evidence supported the use of sensory integration with this population. Low evidence supported group intervention for perceptual improvements related to occupational performance.

 
Small sample size; no replication studies; studies conducted during various stages of the disease process; limited number of studies related to each stage of the disease process; inadequate statistical analysis in some studies; limited ability for generalization; limited carryover of benefits of intervention. 
Padilla (2011a) To review the evidence for the efficacy of environment-based intervention on the affect, behavior, and performance of people with AD and related dementias 
  • Level I

  • Systematic review

  • 34 studies: 25 Level I, 16 SRs and 9 RCTs; 7 Level II; 1 Level III; 1 Level IV

  • Inclusion criteria: Studies related to environment-based interventions, affect, behavior, and performance of people with AD and related dementias. Peer-reviewed scientific literature published in English.

  • Exclusion criteria: Data from presentations, conference proceedings, non-peer-reviewed research literature, research reports, dissertations and theses.

 
  • InterventionsEnvironmental, multisensory (Snoezelen and Montessori), bright light therapy, ambient music, natural sounds, and aromatherapy.

  • Outcome MeasurePercentages

 
There was mixed evidence for use of environmental interventions to improve functional performance or for the benefits of aroma therapy and bright light therapy. Environmental modifications of occluding door knobs and doorways decreased exiting behavior. Pictures with names on room doors assisted some clients to locate their own room independently. Montessori activities, ambient music, and clients’ preferred music decreased agitation. Active music promoted engagement and reality orientation. There was minimal support for Snoezelen multisensory intervention. Small sample sizes; nonequivalent controls; no replication of study question, designs, or methods; no generalization available. 
Padilla (2011b) To review the evidence for the effectiveness of modification of activity demands in the care of people with AD 
  • Level I

  • Systematic review

  • N = 10 studies: 7 Level I: 6 RCTs, 1 SR; 3 Level III

  • Inclusion criteria: Studies related to interventions designed to modify activity demands of self-care and leisure, and individuals with AD or related dementias and/or their caregivers. Peer-reviewed scientific literature published in English.

  • Exclusion criteria: Data from presentations, conference proceedings, non-peer-reviewed research literature, research reports, dissertations and theses.

 
  • InterventionMatching client skills/interests, using cues, and providing compensatory and environmental strategies such as environmental modifications, adaptive equipment, and caregiver education.

  • Outcome MeasuresNone reported

 
Improvement of participation in ADLs and other occupations can occur by selecting and/or modifying activities that match the person’s highest level of retained skills; setting up the environment; labeling the environment; providing short concise verbal cues; providing visual cues; removing distractions; and training the caregiver. Small sample sizes; convenience samples; lack of blinding in all but one study; inconsistent or unclear measurement procedures; minimal to no follow-up measures of treatment outcomes. 
Peralta-Catipon & Hwang (2011) To explore personal factors that can predict health-related lifestyles of community-dwelling older adults 
  • Descriptive study

  • Convenience sample

  • N = 253 community-dwelling older adults residing in Southern California with adequate cognitive and English language capabilities. 1,048 women, 105 men; age range 55–92 yr; mostly unemployed or retired. Included representation from White, African-American, Asian/Pacific Islander, and Hispanic/Latino ethnic groups.

 
  • InterventionNone

  • Outcome Measures

    • Health Enhancement Lifestyle Profile (HELP; Hwang, 2010)

    • Univariate correlational/ comparative statistics and multivariate modeling

 
The number of chronic diseases or impairments and self-rated health were two strong predictors for the overall HELP (R2 = 0.571; p = .0001) and an individual’s health lifestyle. Demographic characteristics of age, gender, race, education, and employment status impacted lifestyle behaviors. Convenience sample, unable to generalize from study; not all personal factors that could relate to health lifestyles were captured in this study. 
Schepens, Panzer, & Goldberg (2011) To determine whether tailoring multimedia fall prevention education using different instructional strategies increases older adults’ fall threats knowledge and fall prevention behaviors 
  • Level I

  • RCT, three groups

  • N = 53 community-dwelling older adults recruited by fliers or person-to-person solicitation at senior housing and community facilities

  • Inclusion criteria: Community-dwelling, aged 65+ yr; English-speaking; reported normal or corrected to normal vision and hearing; alert and oriented to person, place and time; and able to follow three-step commands.

  • Exclusion criteria: Diagnosed mental disorder or neurological disease that may affect cognition; a diagnosed learning disability; a history of vertigo, chronic ear infections, or motion sickness.

 
  • InterventionsInterviews, medical and fall histories, and mobility were recorded. Interventions implemented components of the Multimedia Fall Prevention (MFP) system. Participants were randomized into one of two education groups (MFP + Authenticity group or MFP + Motivation group) or a control group (no falls education). MFP consists of 10 video clips of real-life vignettes of everyday situations in common environments using pretest and posttest assessment for measuring fall threats knowledge. The Authenticity group based on situated learning theory had 5 MFP 45 s videos selected through the MFP software that related to the contexts of each of the individuals in the group. Motivation group based on the Attention-Relevance-Confidence-Satisfaction model had 5 MFP 45 s videos selected through MFP software plus a clear statement of the program goals and benefits.

  • Outcome Measures

    • Fall prevention behaviors

    • Fall status

    • Fall threats knowledge

 
Both intervention groups showed knowledge gains and greater posttest knowledge than controls. The motivation group engaged in significantly more fall prevention behaviors over 1 mo than either the control group or Authenticity education group. Tailoring fall prevention education by addressing authenticity and motivation successfully improved fall threats knowledge. Unequal gender representation, with 81% female participants. Self-report of falls and fall prevention behaviors. Convenience sample limits generalization of this study. 
Schmid et al. (2011) To assess change in fear of falling (FoF) over the first 6 mo after a stroke and compare 6-mo anxiety, depression, balance, and QoL scores between individuals with and without baseline FoF at time of hospital discharge 
  • Descriptive study

  • Prospective longitudinal pilot study

  • Convenience sample from an inner-city, university-affiliated urban hospital

  • Participants were hospitalized for an acute stroke (ischemic or hemorrhagic) at the time of enrollment; no prior stroke history; referred to occupational or physical therapy for physical deficits; obtained a score of ≥3 on the 6-item Mini Mental State Examination; lived within a 60-mile radius of the city.

  • Exclusion criteria: Lack of a telephone or address, inability to verbally communicate; therapy referral for sensory, cognitive, or speech deficits only.

  • 64% male; 50% White and African American

 
  • Intervention6 mo of time between baseline data collection and 6-mo follow up.

  • Outcome Measures

    • Modified Rankin Scale (mRs) for stroke-related disability

    • Modified Falls Efficacy Scale (MFES) to measure FoF

    • Berg Balance Scale (BBS) for balance

    • Generalized Anxiety Disorder–7 (GAD–7) for anxiety

    • Patient Health Questionnaire (PHQ–9) for Depression

    • Stroke Specific Quality of Life Scale (SSQoL) for quality of life

  • Parametric statistics for all analyses using SPSS v17

  • Post hoc analysis

 
18 participants completed the study. FoF decreased and balance increased significantly over the 6 mo after stoke. Participants with baseline FoF had significantly higher anxiety and depression scores and decreased QoL scores 6 mo poststroke compared with those who did not. Post hoc analysis indicated those with FoF at baseline were significantly more likely to have lower MFES scores at 6 mo poststroke. Pilot study limits generalization to the poststroke population; limited sample size and demographic area; did not address whether participants were on medications for anxiety or depression or intensity or type of therapy participants may have received during the 6-mo interval. 
Stav, Snider Weidley, & Love (2011) To identify key barriers to developing and sustaining driving and community mobility programs 
  • Descriptive study

  • Survey

  • N = 24,945 occupational therapists, managers, and institutional leaders were invited to participate. 2,869 participants were included in the final analysis. 73% were occupational therapy practitioners, 18% were managers; 9% were administrators.

 
  • InterventionA Web-based survey form was developed that included demographics about respondents and settings and addressed the question of barriers to development of driving and community mobility programs.

  • Outcome MeasuresFrequencies and percentages

 
Data revealed widespread barriers that were largely contextual in nature, related to fiscal support, infrastructure, physical environment, and institutional culture. The barriers were highly correlated with each other and did not discriminate across region, practitioner level, or facility type. Low return rate; lack of interdisciplinary perspective. 
Thinnes & Padilla (2011) To identify the effectiveness of intervention strategies directed at caregivers of people with Alzheimer’s disease and related dementias and their ability to sustain participation in that role 
  • Level I

  • Systematic review

  • N = 43; 35 Level I: 22 RCTs, 10 SRs, 3 meta-analyses; 3 Level II; 5 Level III

  • Five reports were occupational therapy–specific (4 RCTs and 1 meta-analysis).

  • Inclusion criteria: Studies that addressed supportive and educational strategies for caregivers of individuals with AD or related dementias. Peer-reviewed scientific literature published in English.

  • Exclusion criteria: Data from presentations, conference proceedings, non-peer-reviewed research literature, research reports, dissertations and theses.

 
  • InterventionsOccupational therapy sessions provided caregivers with education, knowledge of AD, problem-solving, task simplification, communication, and simple home modifications. Therapy provided direct caregiver and joint caregiver/client intervention about AD, coping and stress management strategies, social skills training to help caregivers interact with clients with AD, behavior management skills, psycho-education strategies, utilization of support groups, relationships, daily living skills, self-esteem, planning for the future, legal issues, financial and health considerations, family intervention of counseling, support groups respite information, and home-based interventions. Participants received technology-mediated interventions such as weekly phone calls and video-based caregiver education. Participants also received respite care.

  • Outcome Measures

    • Caregiver depression

    • Competency

    • Family conflict

    • Cost effectiveness

    • Carryover

    • Length at home before nursing home admission

    • Care-recipient behaviors

    • Caregiver self-efficacy

    • Mortality

    • Psychological well-being

    • QoL

 
  • Inclusion of occupational therapy was found to decrease the need for assistance, reduce behavioral occurrences, and increase mastery and self-efficacy with continued post-intervention carryover and was suggestive of high cost-effectiveness.

  • Direct interventions to caregivers improved coping skills and caregiving skills and mediated depression, fatigue, hostility, and anxiety. Joint interventions of caregivers with patients improved both the caregiver and care-receiver’s coping with stress and sense of well-being, mediated depression, and reduced family conflict in the early stages of dementia. Joint multimodal programs slowed down functional decline of the care recipient and improved caregiver knowledge and confidence.

  • Family intervention improved coping with mediated depression and delayed institutionalization of the care recipient. Home-based interventions require more research but appear to have a positive effect.

  • Technology-based interventions of telephone conversations and counseling had a positive effect. Video-based caregiver education was no more effective than telephone or Internet-based education. Respite did not demonstrate significant long-term benefits or adverse effects, but did provide short-term relief of caregivers’ anxiety and depression. Adult day programs were helpful in alleviating care-related stress.

 
Sample size, convenience samples, methodologies, limited follow-up of interventions; heterogeneity of study designs and sample characteristics; subjective measures; high attrition; subjective self-report; inconsistent assessment procedures among testing sites; heterogeneity in type, dose, and intensity of interventions. 
Yuen & Burik (2011) To examine the preclinical curricular content pertaining to driving evaluation and rehabilitation (DE/R) included in professional entry-level occupational therapy programs. 
  • Descriptive study

  • Survey

  • Directors of the 144 accredited professional entry occupational therapy programs in the United States were invited to participate.

  • N = 90 self-selected directors or designees from professional entry occupational therapy programs

 
  • InterventionAn 8-item questionnaire with 7 closed-ended items and 1 open-ended item was administered on Survey Monkey. Questions included specifics about the academic program, extent of course structure, and topics related to DE/R in the curriculum.

  • Outcome Measures

    • Descriptive statistics

    • Content analysis

 
Eight of 90 programs included content related to DE/R in required courses; 9 offered DE/R required courses. Some offered electives. Half of the programs used specialists. Most had access to a driving rehab program. Unable to determine whether the nonresponding programs offer content related to DE/R. Occupational therapy assistant programs not included. Did not explore the depth and breadth of DE/R quality content. 

Note. AD = Alzheimer’s disease; ADLs = activities of daily living; AMPS = Assessment of Motor and Process Skills; BTW = behind the wheel; IADLs = instrumental activities of daily living; QoL = quality of life; RCT = randomized controlled trial; SR = systematic review.

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