Structured Abstract
Brain Injury Structured Abstract - BI #3
A functional approach to treatment may produce better functional performance
CITATION: Neistadt, M. E. (1992). Occupational therapy treatments for constructional deficits. American Journal of Occupational Therapy, 46(2), 141-148.
LEVEL OF EVIDENCE: IA2b
This randomized 2 group treatment comparison design study, sample size ranged above 20 per condition (22 vs. 23; total 45) with moderate internal validity and moderate external validity provided a IA level of evidence.
RESEARCH OBJECTIVE/QUESTION
To compare the effects of individual food preparation training (adaptive treatment) and individual parquetry block assembly (remedial treatment) on constructional deficits in adult men with traumatic brain injury.
DESIGN
|
X |
RCT |
|
Single Case |
|
Case Control |
| |
Cohort |
|
Before-After |
|
Cross-Sectional |
Randomized Controlled Trial or Randomized Clinical Trial. This type of study is generally referred to as a Type 1 study. An RCT is usually composed of a set of persons who are chosen or have volunteered for the study. Volunteers are then divided into two or more groups that are similar in characteristics. In this study, one group receives treatment and the other group(s) do not. Therefore, different treatment methods can be compared during one study. Clients were randomly assigned to either the adaptive or remedial treatment.
SAMPLING PROCEDURE
| |
Random |
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Consecutive |
| |
Controlled |
X |
Convenience |
Individuals were chosen strictly on a volunteer basis for completion of the study.
SAMPLE
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N = 45 |
M age = 33.2 |
Male = 45 |
Ethnicity = NR |
Female = 0 |
NR = Not reported
The traumatic brain injury diagnosis was not well defined. The eligibility criteria were not restricted but wide. Participants were all male and ranged in age from 18 to 55 years. Participants' ethnicity was not reported. Participants were at least 6 months post-injury. The participants' coma duration was not reported. The participants' average length of time since head injury was 7.9 years (SD = 6.6).
PARTICIPANT CHARACTERISTICS
Mixed chronic traumatic brain injury (open, closed, anoxic)
MEDICAL DIAGNOSIS/CLINICAL DISORDER
Traumatic Brain Injury
OT TREATMENT DIAGNOSIS
Physical Substrates: Sensory Motor Substrates: Motor Coordination & Dexterity: Fine motor incoordination, manipulation deficit, lack of dexterity.
OUTCOMES
Motor: fine coordination/dexterity
|
Measures |
Reliability |
Validity |
|
1. Line Bisection Test |
NR |
NR |
|
2. Jebsen Hand Function Test |
0.91-.078 |
NR |
|
3. WAIS-R Block Design Subtest |
Test/Retest 0.92 |
NR |
|
4. Parquetry Block Test |
Test/Retest .92 |
NR |
|
5. RKE-R (Rabideau Kitchen Evaluation - Revised) |
Test/Retest .80 agreement 91% |
NR |
NR = Not Reported
Outcome - OT terminology
I. Performance Components
3. Motor
g. Fine Coordination/Dexterity
Outcome - ICIDH-2 terminology
Body Structure: Fine Coordination
INTERVENTION
Two treatment groups
1. Functional: Snacks & hot beverages
2. Remedial: Parquetry block assembly
Description
Functional Adaptive Treatment: Therapist's provided training in the preparation of snacks and hot beverages using the same cueing procedures with all subjects.
Parquetry Block Assembly Remedial Treatment: Therapists provided training in parquetry block assembly using the same cueing procedure with all subjects.
Who delivered
Functional Adaptive
Treatment |
Parquetry Block Assembly
Remedial Treatment |
|
· 16 Evaluators
· 13 Senior and masters level occupational therapy students
· 2 Occupational therapists
· 1 Counselor |
· 5 Treaters
· Author (occupational therapist)
· 4 Masters level occupational therapy students
· 1 Occupational therapist |
Setting
10 long-term rehabilitation head injury centers in Massachusetts: 8 Centers were residential, 2 centers were outpatient
Frequency
3 Times a week , 30 minute sessions
Duration
6 Weeks in addition to their regular rehabilitation program
Follow-up
Pre- and Post-treatment
RESULTS
Series of analyses of variance (ANOVA's) and paired t tests.
| |
Remedial Group |
Adaptive Group |
|
Parquetry Block Test |
r = .70, p = .0002 |
r = .27, p = .2004 |
|
WAIS R., Block Design |
r = .32, p = .1311 |
r = .48, p = .0182 |
|
RKE-R |
r = .32, p = .1785 |
r = .51, p = .0115 |
Key Results:
- Age did not correlate significantly with the pretest scores for the Parquetry Block Test, WAIS-R Block design, or RKE-R
- ANOVAs that included age did not show any significant age or age-by-treatment interaction effects
- The perceptual skills group improved significantly more than the functional group on the Parquetry Block Test
- There was no significant difference between the two groups in improvement on the WAIS-R Block design subtest
- There was no statistically significant difference between the two groups in improvement on the RKE-R after treatment
- The remedial group performed significantly better on the Parquetry Block Test on the post-test and the functional group performed significantly better on the RKE-R
CONCLUSIONS
Biases
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Attention |
X |
Masking/blinding |
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Drop outs |
| |
Contamination |
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Co-intervention |
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- Learning in head injury patients is task specific
- Learning using functional approach may be the best way to facilitate improved functional activity performance
- The improvements seen in other test scores for the two treatment groups reflect a practice effect from pretest to post-test rather than a transfer of learning
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice - Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Beatriz C. Abreu, PhD, OTR, FAOTA, and colleagues. For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
