Occupational therapy - Essay Example

The present essay presents a systematic review, which throws light on the question How effective are Occupational Therapy interventions for strokepatients The essay is a report, which is presented in the School of Health and Social Sciences, Coventry University, towards the degree of Bachelor of Science With Honors in Occupational Therapy on the 15th Feb 2006. CONTENTS ABSTRACT CONTENTS LIST OF TABLES 4 INTRODUCTION 5 Background Relevance to Occupational Therapy Literature Review METHODOLOGY 10 What is a systematic review Literature search The systematic review process DISCUSSION &CONCLUSION REFERENCES Abstract The objective of the present systematic review is to establish the effectiveness for occupational therapy interventions for stroke patients. The background information of stroke is presented scientifically together with the rationale for the systematic review including its relevance to occupational therapy. The present study efficiency reflects in its systematic search of the literature, a methodological quality appraisal and the scientific focus of data for analysis and discussion. The Database that were accessed on-line via the Internet were AHMED (allied health focus), ASSIA (social science focus), PUBMED (medical focus), CINAHL (allied health focus), ERIC (educational focus) and MEDLINE (medical focus). The systematic review of the English literature revealed that occupational therapy is of benefit for the treatment of stroke patients. The review identified small but significant effect size for the efficacy of occupational therapy intervention for stroke patients. It was noted that the amount of evidence with respect to specific interventions is limited. The sample size of most of the studies was too small to confirm the efficiency of occupational therapy for stroke patients. Well-designed, randomized studies with a large sample sized clinical trials are required to prove efficiently the efficiency of occupational therapy in stroke patients. Background An important aim of occupational therapy practitioners is to hold with precious regard a match that proves beneficial to the individual between the person's abilities, the occupation and the environmental demands (Creek, 2003). The patients that present themselves to the occupational therapist often are suffering from a chronic condition that affects their daily performance (Driessen, 1997). The limitation at the level of activity and participation decrease the level of health (Reilly, 1962). Thus, the performance of active action against the present diseased condition of the patient is an important aspect with which the occupational therapist deals with due concentration and regard. Relevance to Occupational Therapy Occupational therapy can be defined as skilled treatments that aid individuals in accomplishing independence in all areas of their lives. Thus, occupational therapy provides the people with the skills that are crucial for independent and satisfying lives. The services provided by occupational therapist includes: Customized programs of treatment in an attempt to impart improvement in an individual's ability to perform daily activities. Thus, imparting greater independence to the individual and thereby improving the quality of life. Evaluations of the working and living place with an aim to present recommendations for adaptation Assessment of skills of performance and treatment Recommendations for adaptive equipment and training for efficient usage Impartment of guidance to members of family and caregivers The study of occupational therapy practitioners therefore holds the focus of education on the study of human growth and development with specific emphasis on the cognitive, affective, physical and environmental components of illness and injury. The professionals in the field of occupational therapy thus hold the perquisite of having a bachelors of Science degree in occupational therapy. Literature review The present literature review holds its area of focus on addressing the effectiveness of Occupational therapy in stroke patients. Since the relevance of the occupational therapy has been targeted on stroke patients, we find it important to introduce stroke with respect to medical literature. A stroke can be considered as a process that involves one or more blood vessels in the brain, which causes an immediate development of a focal neurological deficit. The deficit acts as a reflection of the location and size of brain injury. The three separate entities that are recognized in this context are the transient ischemic attacks (TIA), stroke in evolution and completed stroke. It is important to mention here that majority of strokes result due to atherosclerotic disease of the cerebral arteries. In addition, embolism from the heart or ulcerated atherosclerotic plaques in the carotid artery also result in the causation of strokes, The cerebral hemorrhages are mostly a result of hypertension but can also be due to rupture of an aneurysm. The less common causes of stroke include excessive anticoagulation, inflammatory disease of cerebral blood and trauma. Thus, the important reasons for the causation of stroke indicate the complexity of the disease and the need of prescription from the hands of an expert team inclusive of an occupational therapist. The focus of attention was held on the reviews that have presented their existence to the medicine world earlier and have their dealings with the same aspects of occupational therapy. We discovered from the long established approach of literature survey that functional ability showed a significant improvement in the stroke patients after comprehensive occupational therapy (Steultjens, et al., 2003; Trombly & Ma, 2002; Ma & Trombly, 2002; Wilkins, 2003). Thus, the scope of occupational therapy in the area of stroke treatment has long been accepted and valued. It has been focused by experts and realized by the people. We therefore thought it essential to address the importance of occupational therapy interventions in the stroke patients. Though the acceptance of the topic is broad our focus is limited to the proved effectives and the presentation of the best and the most relevant data. The choice of papers for inclusion in this literature review was entirely based on the amount of significance they hold to the effectiveness of occupational therapy approach. Thus, the choice rested on the most relevant and interesting studies as pertinent to the present work. The interest of the paper was to present how important occupational therapy in addressing the needs and demands of the stroke patients with therapeutic effectiveness. We in no case present a devaluation criterion for the studies not included in the present review. The review in itself held a very broad aspect for dealing and presenting and therefore the relevance was sorted as per the occupational preference of the occupational therapist. The main concern of the review was to present a brief outline of the effectives of occupational therapy in the area of treatment of stroke patients and this was realized with scientific and professional stand throughout the review. Methodology What is systematic review A systematic review holds the essential identity of being a combination product of research evidence on a given topic following a specific procedure. For the purpose of writing a systematic review, the research being done and the papers being written on the topic of focus are searched, critically appraised and re-analyzed so that when the findings present themselves they provide a reliable summary. Thus, systematic review provides evidence available as pertinent to the topic of focus. For the purpose of the review an explicit method should be preferably adopted. This is because it minimizes bias and thus enhances reliability. The systematic review can establish if research findings can be provided a general look across populations and to other relevant treatment settings. However, it should be considered that different studies many a times adopt different designs, settings and participants. Thus, the sample-collected for the purpose of systematic review is not homogenous and its heterogeneity can also hold the drawback of posing danger to the reliability of the review. It is also important to point out here that systematic reviews are mainly based on randomized controlled trials but can also be inclusive of other research designs. However, preference in the presentation of systematic reviews is always held to the randomized controlled trials because of competitive research design. This is because other research designs present less reliability and applicability potential to the study they deal with. We, therefore in the present systematic review have held our focus of attention chiefly inclined to the randomized controlled trials. Literature search Criteria for selection of evidence as pertinent to the topic of focus The preference of data collection was set on journals since they present the most appropriate and refined source for data collection for the systematic review. The search of various databases was done using scientific logic and approach. Internet was used as the chief source for data collection. The other search medium consisted of hand search. Search strategy The question of effectiveness of occupational therapy interventions as applicable to the stroke patients is specific. However, it still holds inter-disciplinary involvement of professionals. It was therefore thought on grounds of scientific logic that the research should be broad and should be inclusive of allied health, medical, educational and social science perspectives. The preference of search was on the British occupational therapy literature and RCTs as published in England. However, for the review to hold a greater area of presentation the specified publication in the English language was done and this was inclusive of literature published to places other than Britain. It was also decided that evidence collection shall hold its attention to a wider methodological perspectives than RCTs,. The concern was to review the most current evidence available in preference. Databases accessed on-line via the Internet were: AHMED (allied health focus) ASSIA (social science focus) PUBMED (medical focus) CINAHL (allied health focus) ERIC (educational focus) MEDLINE (medical focus) Keywords and search terms: From the question: How effective are occupational therapy interventions for stroke patients The following keywords were chosen: Occupational therap* (truncated to access citations contain therapy and therapist, $ used for OVID) Stroke These were combined using the Boolean operator AND to create the search terms ' Occupational therap* AND Stroke' Hand search strategy Few studies were produced through a hand search of the British Journal of Occupational Therapists. Other studies found in this way were duplicated in the database search. Outcomes of the search . Literature search was mainly done on the electronic database. Other sources of publications included, "related articles" that were identified through Pubmed. All of the retrieved abstracts and titles were reviewed to determine eligibility and relevance. In total 275 abstracts and titles were obtained through electronic search, of these 6, full text papers were deemed most relevant and were retrieved. Thus, 6 unique studies met the inclusion criteria of this review. The studies included with inclusion criteria preference for the present study are as under: Barrett, J., Watkins, C., Plant, R., Dickinson, H., Clayton, L., Sharma, A., et al. (2001). The COSTAR wheelchair study: a two-center pilot study of self-propulsion in a wheelchair in early stroke rehabilitation. Clin Rehabil,15, 32-41. Donkervoort, M., Dekker, J., Stehmann, S.J., & Deelman, B.G. (2001). Efficacy of strategy training in left hemisphere stroke patients with apraxia: a randomized clinical trial. Neuropsychol Rehabil, 11, 549 -66. Logan, P.A., Ahern, J., Gladman, J.R.F., & Lincoln, N.B. (1997). A randomized controlled trial of enhanced social service occupational therapy for stroke patients. Clin Rehabil, 11, 107-113. Richards, L.G., Latham, N.K., Jette, D.U., Rosenberg, L., Smout, R.J., & DeJong, G. (2005). Characterizing occupational therapy practice in stroke rehabilitation. Arch Phys Med Rehabil, 86, S51-S60. Walker, M.F., Gladman, J.R.F., Lincoln, N.B., Siemonsma, P., & Whiteley, T. (1999) Occupational therapy for stroke patients not admitted to hospital: a randomised controlled trial. Lancet, 354,278 -80. The systematic review process We would like to mention here that several scientific studies were brought to the scientific evaluation and study ground by means of present literature survey (Donkervoort M, et al., 2001; Goldenberg & Hagmann, 1998; Goldenberg, et al., 2001; Sderback, 1988; Tham & Tegnr, 1997; Thomas, et al., 1994; Van Heugten, et al., 1998; Weinberg, et al., 1977; Walker, et al., 1996). Amongst this an important study was performed by Donkervoort (2001) and colleagues. The study studied the efficacy of strategy training in left hemisphere stroke patients with apraxia. The present study was a randomized controlled trial. The inclusion criteria of patients for the present study was left hemisphere stroke with presence of greater than four weeks and less than two years. The age group of the patients selected for the present study consisted of those greater than 24 years and less than 95 years old with no brain damage. Other important criterion that was considered for inclusion in the study was apraxia. The intervention group was given apraxia strategy training and the reference group was given conventional occupational therapy. The findings of the present study were evaluated by the means of Barthel index, Functional motor test, apraxia test and ADL observation. The duration of treatment for the intervention group was 15 hours in 25 sessions and that of reference group was 19 hours in 27 sessions. The study revealed that training of skills and activities to overcome the disability as experienced in the performance of cognitive functions could be answered with significant ability by the occupational therapy intervention. In another important study, Logan (2004) and colleagues performed a randomized controlled trial of occupational mobility after stroke therapy intervention. For the purpose of the present study the settings that were selected for experimental data collection include general practice registers, social services departments, a primary care rehabilitation service, and a geriatric day hospital. The participants for the present research study consisted of 168 community dwelling people with a clinical diagnosis of stroke in previous 36 months. Amongst the 108 participants with the aim of better exposure to more thorough research design 86 were allocated to the intervention group and 82 to the control group. The interventions that were presented for the present study consisted of the leaflets that described local transport services for disabled people (control group) and leaflets with assessment and up to seven intervention sessions by an occupational therapist (intervention group). Thus, the study design was well established with a place of reason and value to both the control and intervention group. The main outcome measures were the responses to postal questionnaire at four and 10 months. The primary outcomes of the present study were whether participants got out of the house to the level as desired by them. The secondary outcome measures were responses on the number of journeys made outdoors in the past 30 days and scores as obtained on the Nottingham extended activities of daily living scale. Other secondary data collection sources included Nottingham leisure questionnaire and general health questionnaire. The results as obtained from the present study revealed that the participants in the present study were likely to get out of the house to the desired number of times at four months (relative risk 1.72, 95% confidence interval 1.25 to 2.37). The capability of moving out of the house to the desired number of times was also present at 10 months (1.74, 1.24 to 2.44). The results further revealed that the treatment group presented more number of journeys outdoors in the month that held its presence just before the assessment at both four months (median 37 in intervention group, 14 in control group: P < 0.01) and 10 months (median 42 in intervention group, 14 in control group: P < 0.01). It was observed that the mobility scores on the Nottingham extended activities of daily living scores were higher to a significant level in the intervention group. However, no significant differences in the other secondary outcomes were observed. No significant differences were observed in these measures at 10 months. The experts concluded with confidence that occupational therapy intervention at home resulted in an increase in the outdoor mobility in stroke patients. The success of occupational therapy treatment holds its prominent presence in increasing outdoor mobility in both short and longer term. The greatest benefit of occupational therapy treatment was observed in the stroke patients with the worse self-reported outdoor mobility at the beginning of the treatment. The reason for this can be resting on the ground that they had maximum to gain. In addition, one essential finding of the study was that the benefits in mobility as observed by means of occupational therapy interventions were not lost with time. Thus, long-lasting and significant benefits in outdoor mobility of the stroke patients were observed by the incorporation of occupational therapy intervention in the treatment regimen of stroke patients. This study in itself places high the important place that occupational therapy holds in the act of enhancing the outdoor mobility of stroke patients. Thus, occupational therapy being so well-conversant and confident in the treatment of diseases and disorders like stroke can be considered as an essential therapeutic member in the service of stroke patients. Another important study was performed by Walker (1999) and colleagues and had its publication in Lancet. The objective of the study was to perform a randomized controlled trial as relevant to occupational therapy for stroke patients who were not admitted to hospital. The background studies revealed to the researchers that around 22-60% of stoke patients are not admitted to the hospitals and thus remain in the community, frequently without co-coordinated rehabilitation. Thus, the aim of the study was to asses the efficacy of an occupational therapy intervention for stroke patients who were not admitted to the hospitals. The method of the study was a single blind randomized controlled trial. The participants were from Nottingham and Derbyshire. The patients selected for inclusion in the present study were allocated randomly to up to 5 months of occupational therapy treatment at home or to no intervention in case of control group. The absence of intervention in control group was one month after their stroke. The aim of the occupational therapy treatment procedure was to encourage independence in personal and instrumental activities that are crucial for efficient living. The assessment for the purpose of bringing to knowledge their improvement projected by occupational therapy means was done by primary outcome measure of the scores on the extended activities of daily living (EDL) scale at 6 months. The outcome measures were taken at baseline i.e. before randomization and at 6 months. Other outcome measures that were included for the study included the Barthel index, the general health questionnaire 28, the London handicap scale and the carer strain index. An independent assessor who was not aware of treatment allocation performed all the essential assessments. The analysis was restricted to the data from completed questionnaires. The total number of participants in the present study consisted of 185 patients. Out of these 94 were in the occupational therapy group and 91 were in the control group. Amongst these 22 patients were not assessed at 6 months. The findings of the present study revealed that the patients who were treated by means of occupational therapy exhibited a significantly higher median scores than the controls on: the EADL scale (16 v s 12, p Read More