Marian Keglovits

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.

In-Home Occupational Performance Evaluation for Providing Assistance (I–HOPE Assist): An Assessment for Informal Caregivers

Home modification interventions have the potential to provide support to informal caregivers; however, the impact of these interventions on caregivers is understudied, and adequate assessments are lacking. This study describes the development and preliminary psychometric properties of a performance-based assessment that identifies environmental barriers to performance of daily caregiving activities. An existing assessment of person-environment fit was modified using key informant interviews and was administered to 31 informal caregivers. The In-Home Occupational Performance Evaluation for Providing Assistance demonstrated reliability across raters, good internal consistency for all subscales, and convergent validity with existing measures. This assessment has the potential to guide home modification interventions and measure the impact on informal caregiving in the home.

Feasibility of a novel intervention to improve participation after stroke

Introduction Stroke is a leading cause of serious, long-term disability in the United States. With shorter inpatient hospital stays, more time in rehabilitation is devoted to medical stabilization and less on skills to regain independence in daily activities. The transition home may be an opportunity for intervention focused on regaining independence. We propose an enhanced rehabilitation transition program called Community Participation Transition after Stroke. Method A prospective, randomized, single-blinded, parallel-group pilot study was completed with 15 participants to demonstrate feasibility. Findings Fidelity to the protocol was achieved: The Community Participation Transition after Stroke group received 81% of the planned minutes and 83% of the intervention visits. There was no difference between groups for healthcare utilization or falls. Adherence was 85% at three months and 71% at nine months for the home modification intervention. At 6 months, scores improved by 17.39 points for the Community Participation Transition after Stroke group, and 1.30 points for the control group. Environmental barriers decreased in both groups. Conclusion This pilot study demonstrated that it is feasible to implement a community participation intervention during the period of transitioning home from inpatient rehabilitation for stroke survivors. Additional studies are necessary to determine the efficacy of the intervention.

Evidence to Improve Physical Activity among Medically Underserved Older adults: A Scoping Review

Background and Objectives Participation in leisure physical activity (PA) and engagement in PA interventions among older adults is influenced by socioeconomic status (SES), race/ethnicity, and environment. However, studies of PA for medically underserved older adults have not yet been systematically evaluated. The objective of this study is to map the nature and extent of research conducted on PA participation, interventions, and components of effective leisure PA programs for medically underserved older adults. Research Design and Methods The five-stage approach was used to conduct this scoping review. We searched PubMed, CINAHL, and Cochrane Library for peer-reviewed studies published between 2006 and 2016. Data extracted from selected studies included study population, study type, purpose of intent, evidence level, barriers to PA participation, and components of PA intervention. Results Three hundred and ninety-two articles were identified, and 60 studies were included in the final data charting. Existing literature showed that most studies remained descriptive in nature, and few intervention studies have achieved a high level of evidence. Among 21 intervention studies, only 4 were explicitly conducted for older adults. Culturally adapted materials, race/ethnicity-specific barriers and facilitators, and form of intervention were important components for intervention programs. Discussion and Implications Findings indicate that more studies are needed to reduce health disparities related to PA participation for medically underserved older adults. Intervention components such as race/ethnicity-relevant barriers and facilitators and culturally sensitive materials are also needed for PA interventions targeting underserved older adults in order to provide evidence for best practices.

In-Home Medication Management Performance Evaluation (HOME–Rx): A Validity Study

OBJECTIVE. This study assessed the initial psychometric properties of a novel in‐home, performance‐based instrument for older adults called the In‐Home Medication Management Performance Evaluation (HOME‐Rx). METHOD. Content validity of the HOME‐Rx was determined through the multistep content validity index (CVI) process. Content experts provided qualitative and quantitative judgment of the instrument’s ability to measure medication management. The assessment’s target population provided qualitative feedback. CVI outcomes informed instrument revisions. RESULTS. Content experts (n = 7) were in agreement that the overall instrument was valid for measuring medication management (scale‐level CVI = .95). Six items were deleted because of low agreement (itemlevel CVI <.80). Twenty‐nine minor edits were made to the order of questions and language. Older adult participants (n = 5) reported the instrument was relevant, acceptable, and easy to understand. CONCLUSION. The HOME‐Rx appears to be a relevant and valid method to assess performance barriers to medication management in the home. Murphy, M. C., Somerville, E., Keglovits, M., Hu, Y.‐L., & Stark, S. (2017). In‐Home Medication Management Performance Evaluation (HOME‐RX): A validity study.

Feasibility Trial of Tailored Home Modifications: Process Outcomes

OBJECTIVE. The aim of this study was to conduct a process evaluation to examine the implementation of a randomized controlled trial of home modifications designed to reduce the risk of falls and improve daily activity performance among community‐dwelling older adults. METHOD. A process evaluation was conducted alongside a blinded, randomized sham‐controlled trial (n = 92). Participants were followed for 1 yr after intervention. The process evaluation was framed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. RESULTS. The treatment group improved daily activity performance over 12 mo compared with the sham control group (F = 4.13; p = .024). The intervention elements and dose were delivered with greater than 90% accuracy. Participants reported a 91% adherence rate at 12 mo. CONCLUSION. The complex intervention of home modifications examined in this study is acceptable to older adults, is feasible, and can be delivered with high fidelity for frail, community‐dwelling older adults.