Structured Abstract
Stroke Structured Abstract - S #16
Client centered intervention may improve activities of daily living and discharge environment for stroke clients
CITATION: Gibson, J. W., & Schkade, J. K. (1997). Occupational adaptation intervention with patients with cerebrovasular accident: A clinical study. American Journal of Occupational Therapy, 51, 523-529.
LEVEL OF EVIDENCE: IIB3b
RESEARCH QUESTION
What is the effect of the use of the Occupational Adaptation (OA) frame of reference in the evaluation and treatment of stroke patients?
DESIGN
Cohort.
25 former patients served as the Control Cohort and 25 patients admitted after the OA program was implemented served as the Treatment Cohort.
SAMPLING PROCEDURE/INCLUSION CRITERIA
The subjects in the Control Cohort were selected through chart review of the most recently discharged patients with cerebral vascular accident (CVA) until 25 who met the inclusion criteria were identified. After the OA was implemented, all patients with CVA admitted to acute care were treated with the new approach.
All subjects met the following inclusion criteria: (a) they were hospitalized in acute care after onset of CVA; (b) they were at least 60 years old; (c) they were seen for OT treatment starting in acute care and followed through rehabilitation at the same facility; (d) they received the customary amount of OT intervention in acute care; and (e) they met criteria for acceptance into the rehabilitation program, including (1) ability to tolerate a minimum of 3 hours of therapy daily, (2) ability to follow directions, and (3) demonstrated potential for improvement of functional skills.
SAMPLE
|
N = 50 |
Male = 20 |
Female = 30 |
Mean age = 74 |
|
LCVA = 26 |
RCVA = 24 |
Attrition = no |
|
x |
Acute |
|
Chronic |
OUTCOME MEASURES
Institution-developed ADL Scale (no reliability established)
Discharge environment
INTERVENTION DESCRIPTION
Treatment Cohort: Occupational Adaptation: (1) Patients identify their role and context, which becomes the focus of intervention, (2) in addition to the therapist's evaluation, patients regularly evaluate their own progress toward carrying out requirements of the occupational role and context, and (3) therapists' intervention targets a combination of component abilities and performance skills.
Control Cohort: Standard occupational therapy evaluations and treatment.
WHO DELIVERED INTERVENTION
OTs
SETTING
Clinic
FREQUENCY & DURATION
Length of stay in rehab was 3.28 weeks for the Control Cohort and 2.12 weeks for the Treatment Cohort, a significant difference (p = .002).
No other details of dosage were reported.
RESULTS
Between Groups/Conditions/Times:
Data indicate that the Treatment Cohort achieved significantly higher levels of functional independence (p = .005, r = .36) and were discharged to less restrictive environments significantly more frequently (p = .027, r = .27) compared with the Control Cohort.
Within Groups/Conditions/Times:
The effect size r for the ADL scale for the Treatment Cohort was .77 and .40 for the Control Cohort; however, these effect sizes were confounded with maturation effects because no control group (i.e., group with no treatment at all) was included in the design.
THREATS TO VALIDITY
Therapists who delivered treatment may have known the hypothesis, so the result may be biased (expectation). Causal relationships cannot be established between the independent and dependent measures because of the design.
AUTHORS' CONCLUSIONS
Use of intervention guided by the OA frame of reference was associated with improved functional independence and discharge to less-restrictive environments for this group of patients with CVA.
REVIEWERS' CONCLUSIONS
This study suggests the importance of a client-centered approach focusing on a patient's role and context in treatment planning. In addition, letting stroke patients regularly evaluate their progress toward treatment goals seemed to have larger effects in improving their ADL performance and discharge environment than the traditional OT intervention using standard evaluations and treatments offered at this facility. Lastly, this study suggests that interventions should target a combination of component abilities and occupational activities.
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 Hui-ing Ma, ScD, OTR, and Catherine A. Trombly, ScD, OTR/L, FAOTA.
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.