Deborah Lieberman

Method for the Systematic Reviews on Occupational Therapy and Early Intervention and Early Childhood Services

Systematic reviews of literature relevant to early intervention and early childhood services are important to the practice of occupational therapy. We describe the five questions that served as the focus for the systematic reviews of the effectiveness of occupational therapy interventions in early intervention and early childhood services. We include the background for the reviews; the process followed for each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. The final number of articles included in each systematic review; a summary of the themes of the results; the strengths and limitations of the findings; and implications for practice, education, and research are presented.

Methodology for the Systematic Reviews on Occupation- and Activity-Based Intervention Related to Productive Aging

Systematic reviews of the literature relevant to community-dwelling older adults are important to the practice of occupational therapy. We describe the four questions that served as the focus for the systematic reviews of the effectiveness of occupational therapy interventions for older adults living in the community. This article includes the background for the reviews; the process followed for each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. The final number of articles included in each systematic review; a summary of the results; the strengths and limitations of the findings; and implications for practice, education, and research are presented.

Effect of Home Modification Interventions on the Participation of Community-Dwelling Adults With Health Conditions: A Systematic Review.

OBJECTIVE. This systematic review investigated the role of home modification interventions to improve participation outcomes for community-living adults and older adults. METHOD. Thirty-six articles met the inclusion criteria. The majority of the studies investigated older adult populations and used occupational therapists as interventionists. RESULTS. Strong evidence was found for home modification interventions to improve function for people with a variety of health conditions and for both single and multicomponent interventions that included home modifications to reduce the rate and risk of falls among older adults. Moderate evidence was found for improved caregiving for people with dementia. CONCLUSION. Comprehensive, higher intensity interventions demonstrated greater efficacy to improve occupational performance. Emerging evidence was also found for the role of occupational therapy in providing effective home modification interventions. Implications for occupational therapy practice, education, and research are discussed.

Using Evidence to Promote the Distinct Value of Occupational Therapy

Christina A.Metzler is Chief Public Affairs Officer, AOTA, Bethesda, MD. Providing best practice has always been at the forefront of occupational therapy. With the advent of health care reform in public and private sectors, the passage of the Patient Protection and Affordable Care Act (ACA; Pub. L. 111–148), and ongoingMedicare reforms, payers andhealth care systems are requiring more and more evidence-based practice (EBP), resulting in definable outcomes that will affect payment. Since 1998, the American Occupational Therapy Association (AOTA) Evidence-Based Practice project has promoted best practice by developing and providing resources that enable occupational therapy practitioners to access and use research evidence that supports their practice. AOTA’s (2007)Centennial Vision includes and has strengthened the goal of using evidence and provides a clear path for occupational therapy practitioners working with all persons, groups, and populations by stressing excellence in service that is informed by evidence. One of the primary purposes of EBP is the use of evidence to inform and guide clinical decision making. This framework follows the evidence-based philosophy of Sackett, Rosenberg, Gray, Haynes, and Richardson (1996) and requires the integration of information from three sources: (1) clinical experience and reasoning, (2) preferences of clients and their families, and (3) findings from the best available research. In a recent article, Lamb and Metzler (2014) stretched the boundaries of this framework to include policy implications and discussed the importance of linking the value of occupational therapy to the priorities of the health care system, one ofwhich ismanaging chronic conditions. According to Berwick, Nolan, and Whittington (2008), value can be determined through the model of the triple aim, a concept developed to frame better ways to provide health care while reducing costs (Beasley, 2009). Berwick and colleagues identified the goals of triple aim as “(1) improving the individual experience of care, (2) improving the health of populations, and (3) reducing the per capita costs of care for populations” (p. 760). The triple aim provides the mechanism to link existing evidence to occupational therapy’s role in improving quality of care, increasing the efficiency of the system, and reducing health care costs (Lamb&Metzler, 2014). The AOTA Practice Guidelines series provides a major evidence resource for occupational therapy practitioners. Practice guidelines provide clinicians and educators with a concise summary of the existing evidence on a given topic and use clinical examples that demonstrate how to integrate the research findings into practice. Current evidence for AOTA’s practice guidelines is based on findings from systematic reviews that cover key concepts of interventions within the scope of occupational therapy practice. Content experts with experience in critically appraising, synthesizing, and summarizing the research literature

Method for the Systematic Reviews on Occupational Therapy and Neurodegenerative Diseases

Systematic reviews of the literature relevant to neurodegenerative diseases, including Parkinsons disease (PD), multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS), are important to the practice of occupational therapy. We describe the four questions that served as the focus for systematic reviews of the effectiveness of occupational therapy interventions for PD, MS, and ALS. We include the background for the reviews; the process followed for addressing each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. The final number of articles included in each systematic review; a summary of the themes of the results; the strengths and limitations of the findings; and implications for practice, education, and research are presented.

Method for the Evidence-Based Reviews on Occupational Therapy and Stroke

Evidence-based reviews of the literature relevant to adults with stroke are important to the practice of occupational therapy. We describe the four questions that served as the focus for the evidence-based reviews of the effectiveness of occupational therapy interventions for adults with stroke. The questions include occupation- and activity-based interventions to improve occupational performance and social participation after stroke, as well as interventions for motor, cognitive, and psychological and emotional impairments after stroke. We include the background for the reviews; the process followed for addressing each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. The final number of articles included in each evidence-based review; a summary of the themes of the results; the strengths and limitations of the findings; and implications for practice, education, and research are presented.

Methodology for the systematic reviews on occupational therapy interventions for older adults with low vision.

Systematic reviews of the literature relevant to older adults with low vision are important to the practice of occupational therapy. This article describes the four questions that served as the focus for the systematic reviews of the effectiveness of occupational therapy interventions for older adults with low vision. We describe the background for the reviews; the process followed for each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. In addition, we present the final number of articles included in each systematic review; a summary of the results, strengths, and limitations of the findings; and implications for practice, education, and research.

Method for the Systematic Reviews on Occupational Therapy and Driving and Community Mobility for Older Adults

Systematic reviews of literature relevant to driving and community mobility for older adults are important to the practice of occupational therapy. We describe the four questions that served as the focus for the systematic reviews of the effectiveness of occupational therapy assessments and interventions for driving and community mobility for older adults. We include the background for the reviews; the process followed for each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. The final number of articles included in each systematic review, a summary of the themes of the results, the strengths and limitations of the findings, and the implications for practice, education, and research are presented.

Occupational Therapy Interventions for Adolescents With Autism Spectrum Disorder.

Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of an adolescent with autism spectrum disorder. The occupational therapy assessment and treatment processes for school, home, community, and transition settings are described. Findings from the systematic reviews on this topic were published in the September/October 2015 issue of the American Journal of Occupational Therapy and in AOTA’s Occupational Therapy Practice Guidelines for Individuals With Autism Spectrum Disorder. Each article in this series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision making.

Occupational Therapy Interventions for Adults With Traumatic Brain Injury

This Evidence Connection describes a case report of an adult with traumatic brain injury (TBI), applying the evidence for intervention from the systematic reviews on TBI that were conducted in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. The occupational therapy assessment and treatment processes for hospital, home, and community settings are described. Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with AOTA’s Evidence-Based Practice Project.