Carri Hand

Rehabilitation in a primary care setting for persons with chronic illness – a randomized controlled trial

Aim The primary objective of this study was to determine whether adults with a chronic illness within a primary care setting who received a rehabilitation intervention in this setting showed greater improvement in health status and had fewer hospital admissions and emergency room visits compared with adults who do not receive the intervention. Background More than half of Canadians (16 million people) live with chronic illness. Persons with chronic illness in primary care, especially older persons who are most at risk for functional decline, are currently not receiving effective management. Methods A randomized controlled trial was used. A rehabilitation multi-component intervention was delivered by a physiotherapist (PT) and occupational therapist in a primary care setting and included collaborative goal setting for rehabilitation needs, a six-week chronic disease self-management (SM) workshop, referral to community programs and a web-based education programme. Findings Three hundred and three patients participated, n = 152 intervention group and n = 151 in the control group. There was a significant difference between the groups for planned hospital days ( F = 6.3, P = 0.00) with an adjusted difference 0.60 day per person, and increased satisfaction with rehabilitation services however no difference on health status or emergency room visits. This rehabilitation intervention which had a strong SM component prevented planned hospitalizations that resulted in a conservative estimated cost saving from reduced hospitalizations of

Neighbourhood influences on participation in activities among older adults with chronic health conditions

65 000. Future research needs to examine which patient groups with chronic illness show positive responses to rehabilitation and self-management.

Construct validity of the late life function and disability instrument for adults with chronic conditions

We examined the relationships between perceptions of neighbourhood characteristics and satisfaction with participation in everyday activities among 248 older adults with chronic health conditions in Hamilton, Ontario, Canada. We used a cross-sectional survey to collect data regarding neighbourhood characteristics, social support, social network size, and individual characteristics. Path analysis showed that fewer neighbourhood problems directly predict higher levels of satisfaction with participation. Neighbourhood cohesion indirectly predicts participation by predicting social support, which predicts participation. Neighbourhood safety indirectly predicts participation by predicting increased social cohesion and neighbourhood amenities may influence participation similarly. Changes to neighbourhood characteristics have the potential to facilitate participation in daily activities for older adults with chronic health conditions.

An examination of social support influences on participation for older adults with chronic health conditions.

Objectives. To evaluate the validity of the late life function and disability instrument (LLFDI) when applied to adults aged 44–65 years with chronic conditions. Design. We applied a convergent cross-sectional construct validity design to examine the association between the LLFDI subscales and the medical outcomes study (MOS) 36-Item Health Survey Physical Component Score (SF36 PCS), MOS Physical Functioning scale (PF10), 2-minute walk distance (2MWD) and 8-foot walk test (8FWT). Participants. Our sample consisted of 174 community-dwelling adults age 45–65 years with one or more chronic conditions. Setting. Participants were enrolled at a multidisciplinary family health practice. Results. The LLFDI function correlated strongly with the PF10 (r = 0.84) and moderately with the 2MWD (r = 0.53) and 8FWT (r = −0.48). The LLFDI disability limitation correlated moderately with the SF36 PCS, 2MWD and 8FWT (r = 0.67, 0.45, −0.32, respectively). The LLFDI disability frequency correlated moderately with the SF36 PCS, 2MWD and 8FWT (r = 0.44, 0.33, −0.31). Ninety-five percent confidence intervals on all correlation coefficients excluded zero. Conclusion. Cross-sectional convergent validity of the LLFDI was supported when applied to adults 45–65 years of age with chronic conditions.

Neighborhood Influences on Participation among Older Adults with Chronic Health Conditions: A Scoping Review

Abstract Social support can improve participation in everyday activities among older adults with chronic health conditions, but the specific types of support that are needed are unclear. Purpose: This study examined the types of social support that most strongly predict participation in everyday activities. Method: Two hundred and twenty-seven participants completed a self-administered cross-sectional survey. The sample included adults aged 60 years or more with arthritis, diabetes, chronic obstructive pulmonary disease and/or heart disease. Participation was defined as satisfaction with participation in 11 life areas. Social support was defined as availability of tangible, affectionate, emotional/informational and positive social interaction support. Results: Multiple regression analyses showed that participants who perceived greater tangible support and positive social interaction support had higher satisfaction with participation than participants with lower levels of these types of support. Conclusions: Targeting and developing tangible and social interaction support may help to facilitate satisfaction with participation for older adults with chronic conditions. Creating networks for companionship appears equally as important as providing support for daily living needs. Implications for Rehabilitation Varying types of social support can improve participation in older adults with chronic health conditions. Tangible support and positive social interaction support are the strongest predictors of participation. Creating networks for companionship may be equally as important as providing support for daily living needs.

An Agenda for Occupational Therapy's Contribution to Collaborative Chronic Disease Research

Older adults with chronic health conditions face difficulties participating in everyday occupations but may gain support to do so from neighborhood environments. This article describes research regarding neighborhood influences on participation in this population. A scoping review identified 689 articles, of which 15 met the selection criteria. Findings indicate that neighborhood economic status, services/resources, mobility resources/barriers, physical problems, cohesion, and safety are linked to participation in older adults and older adults with chronic conditions. Most studies measured participation frequency or limitations and did not consider social support as a covariate. These findings can guide research to examine a range of neighborhood characteristics while considering the effects of the individuals characteristics and social support. Longitudinal and qualitative research can also help to understand this complex area of study.

Renegotiating environments to achieve participation: A metasynthesis of qualitative chronic disease research: Restructurer les environnements pour favoriser la participation / Une métasynthèse de la recherche qualitative sur les maladies chroniques

Background. To meet the needs of adults with chronic diseases, Canadian health care is moving toward more interdisciplinary, collaborative practice. There is limited high-quality evidence to support practice in this area. Occupational therapists can play a significant role in this area of practice and research. Purpose. To develop an agenda of priority areas within collaborative chronic disease research to which occupational therapy can make a contribution. Methods. The project involved literature and Internet review, a consensus meeting with a range of stakeholders, a surveyofoccupationaltherapists, andsynthesisoffindingstocreatearesearchagenda. Findings. An interdisciplinary and intersectoral group of stakeholders identified seven main priority areas. One priority is specific to occupational therapy while the remaining six cross disciplines. Implications. The research agenda can support funding applications and encourage interdisciplinary research collaboration to ultimately produce research evidence that can benefit people with chronic diseases.

Associations between neighbourhood characteristics and community mobility in older adults with chronic health conditions

Background. Qualitative studies describe environmental influences on participation in adults with chronic disease, but translating these findings into practice can be difficult. Purpose. This study sought to synthesize qualitative research findings regarding the influence of environmental factors on participation among adults with chronic disease. Methods. Searching revealed 31 articles that describe the link between environment and participation for adults with osteoarthritis, rheumatoid arthritis, diabetes mellitus, heart disease, cancer, chronic obstructive pulmonary disease, and/or depression. Study findings were analyzed using metasynthesis methods to identify themes. Findings. For adults with chronic disease, renegotiating their environments and occupations to achieve, maintain, or rework their participation involves understanding support processes, being ordinary and able, navigating systems, and navigating physical environments. Implications. Key areas that occupational therapy interventions can target are facilitating constructive collaboration between client and support person, fostering connections with others, recognizing cultural pressure to be ordinary and able, and advocating for supportive policy and practice. Description. Les études qualitatives décrivent l’influence des facteurs environnementaux sur la participation des adultes atteints de maladies chroniques; toutefois, il est parfois difficile d’appliquer ces résultats dans la pratique. But. Cette étude tentait de faire une synthèse des résultats des études qualitatives portant sur l’influence des facteurs environnementaux sur la participation des adultes atteints de maladies chroniques. Méthodologie. La recherche a permis de mettre en relief 31 articles qui décrivent le lien qui existe entre l’environnement et la participation chez des adultes atteints d’ostéoarthrite, d’arthrite rhumatoïde, de diabète sucré, de maladie cardiaque, de cancer, de maladie pulmonaire obstructive chronique ou de dépression. Les résultats des études ont été analysés à l’aide de méthodes de métasynthèse, en vue de dégager des thèmes. Résultats. Chez les adultes atteints de maladies chroniques, la restructuration de leurs environnements et occupations en vue de réaliser, de poursuivre ou de repenser leur participation exige la compréhension de plusieurs facteurs, dont les suivants: les mécanismes de soutien, le désir d’être ‘normal et apte’, la capacité de naviguer à travers les différents systèmes et la capacité de naviguer dans les environnements physiques. Conséquences. Les principaux aspects que les interventions ergothérapiques peuvent cibler sont les suivants: favoriser la collaboration constructive entre le client et la personne qui offre du soutien; faciliter l’établissement de liens avec les autres; reconnaître les pressions culturelles qui s’exercent sur les personnes afin qu’elles soient ‘normales et aptes’; et plaider en faveur de politiques et de pratiques fondées sur le soutien.

Occupational therapy in primary care: Results from a national survey

Abstract Purpose: To explore associations between perceptions of neighbourhood built and social characteristics and satisfaction with community mobility in older adults with chronic health conditions. Method: Two hundred and thirty-seven community-dwelling adults aged 60 years or more with one or more of arthritis (osteoarthritis or rheumatoid arthritis), chronic obstructive pulmonary disease, diabetes or heart disease completed a cross-sectional, mailed survey. The survey addressed community mobility and 11 neighbourhood characteristics: amenities (three types), problems (six), social cohesion and safety. Analysis involved logistic regression modeling for each neighbourhood characteristic. Results: Satisfaction with community mobility was associated with perception of no traffic problems (OR = 3.0, 95% CI = 1.4–6.2, p ≤ 0.05) and neighbourhood safety (OR = 3.4, 95% CI = 1.2–9.8, p ≤ 0.05), adjusted for age, ability to walk several blocks and depressive symptoms. Conclusion: Satisfaction with community mobility is associated with neighbourhood safety and no traffic problems among older adults with chronic conditions. While further research is needed to explore these neighbourhood characteristics in more detail and to examine causation, addressing these neighbourhood characteristics in health services or community initiatives may help promote community mobility in this population. Implications for Rehabilitation Community mobility, or the ability to move about one’s community, is a key aspect of participation that enables other aspects of community participation. Good community mobility is associated with perception of no traffic problems and neighbourhood safety among older adults. Considering and addressing a broad range of environmental influences has the potential to improve community mobility in older adults, beyond traditional approaches. Health professionals can work with clients to develop strategies to avoid traffic and safety problems and can work with communities to develop safe spaces within neighbourhoods, to improve community mobility in older adults.

Understanding Social Isolation Among Urban Aging Adults: Informing Occupation-Based Approaches:

Background. To support integration of occupational therapy in primary care and research in this area, it is critical to document examples of occupational therapy in primary care. Purpose. This study describes occupational therapy roles and models of practice used in primary care. Method. An electronic survey was sent to occupational therapists across Canada. Participants were identified using purposive and snowball sampling strategies. Descriptive statistics were used to analyze the data. Findings. Respondents (n = 52) were almost exclusively working on interprofessional teams. Intervention was provided most frequently to individual clients, and services were provided both within the home/community and in the clinic. Occupational therapists offered a range of health promotion and prevention services, predominantly to adults and older adults. A number of supports and barriers to the integration of occupational therapy were identified. Implications. A growing number of occupational therapists are working in primary care providing a broad range of services across the life span.