Mary Egan

Ottawa Panel Evidence-Based Clinical Practice Guidelines for Aerobic Fitness Exercises in the Management of Fibromyalgia: Part 1

Background and Purpose: The objective of this study was to create guidelines for the use of aerobic fitness exercises in the management of adult patients (>18 years of age) with fibromyalgia, as defined by the 1990 American College of Rheumatology criteria. Methods: Following Cochrane Collaboration methods, the Ottawa Methods Group found and synthesized evidence from comparative controlled trials and formed the Ottawa Panel, with nominated experts from key stakeholder organizations. The Ottawa Panel then developed criteria for grading the recommendations based on experimental design (I for randomized controlled trials, II for nonrandomized studies) and strength of evidence (A, B, C+, C, D+, D, or D−). From the rigorous literature search, 13 randomized control trials and 3 controlled clinical trials were selected. Statistical analysis was based on Cochrane Collaboration methods. Continuous data were calculated with weighted mean differences between the intervention and control groups, and dichotomous data were analyzed with relative risks. Clinical improvement was calculated using absolute benefit and relative difference in change from baseline. Clinical significance was attained when an improvement of 15% relative to a control was found. Results: There were 24 positive recommendations: 10 grade A, 1 grade B, and 13 grade C+. Of these 24 positive recommendations, only 5 were of clinical benefit. Discussion and Conclusion: The Ottawa Panel recommends aerobic fitness exercises for the management of fibromyalgia as a result of the emerging evidence (grades A, B, and C+, although most trials were rated low quality) shown in the literature.

Long-Term Continuous Use of Benzodiazepines by Older Adults in Quebec: Prevalence, Incidence and Risk Factors

OBJECTIVE: To determine the prevalence and incidence of long‐term use of benzodiazepines and to assess patient‐, prescriber‐, and drug‐related risk factors.

Ottawa Panel Evidence-Based Clinical Practice Guidelines for Strengthening Exercises in the Management of Fibromyalgia: Part 2

Background and Purpose: The objective of this study was to create guidelines for the use of strengthening exercises in the management of adult patients (>18 years of age) with fibromyalgia (FM), as defined by the 1990 American College of Rheumatology criteria. Methods: Following Cochrane Collaboration methods, the Ottawa Methods Group found and synthesized evidence from comparative controlled trials and formed the Ottawa Panel, with nominated experts from key stakeholder organizations. The Ottawa Panel then developed criteria for grading the recommendations based on experimental design (I for randomized controlled trials, II for nonrandomized studies) and strength of evidence (A, B, C+, C, D+, D, or D−). From the rigorous literature search, 5 randomized controlled trials were selected. Statistical analysis was based on Cochrane Collaboration methods. Continuous data were calculated with weighted mean differences between the intervention and control groups, and dichotomous data were analyzed with relative risks. Clinical improvement was calculated using absolute benefit and relative difference in change from baseline. Clinical significance was attained when an improvement of 15% relative to a control was found. Results: There were 5 positive recommendations: 2 grade A and 3 grade C+. All 5 were of clinical benefit. Discussion and Conclusion: The Ottawa Panel recommends strengthening exercises for the management of fibromyalgia as a result of the emerging evidence (grades A, B, and C+, although most trials were rated low quality) shown in the literature.

A Systematic Review of Interventions to Improve Handwriting

Background. Handwriting difficulties are among the most common reasons for referral of children to occupational therapy. Purpose. To determine the effectiveness of handwriting interventions. Methods. A systematic review was carried out. Included studies were randomized or nonrandomized controlled trials of interventions that could be used by an occupational therapist to improve written output (printing or writing) among school-aged children identified as having difficulties with handwriting. Electronic searches of relevant databases were conducted up to January 2010. Findings. Eleven studies met the inclusion criteria. These studies tested (1) relaxation and practice with or without EMG, (2) sensory-based training without handwriting practice, and (3) handwriting-based practice (including sensory-focused or cognitive focused handwriting practice). Regardless of treatment type, interventions that did not include handwriting practice and those that included less than 20 practice sessions were ineffective. Implications. Effective occupational therapy for improving handwriting must include adequate handwriting practice.

Considering Spirituality in Occupational Therapy Practice

Despite its prominent place in the Occupational Therapy Guidelines for client-centred practice, the exact role of spirituality in clinical practice has been difficult to delineate. In this paper current concepts of spirituality are outlined and ways in which these concepts have been applied in health care are described. To illustrate these spiritual concepts, the experiences of individuals whom the authors have met in their clinical practice are outlined in a series of vignettes. Finally, a revision of the model of occupational performance which enhances consideration of spirituality in occupational therapy practice is proposed, and some guidelines for occupational therapists wishing to incorporate spiritual concerns in therapy are suggested.

Ottawa Panel evidence-based clinical practice guidelines for the management of osteoarthritis in adults who are obese or overweight.

Background and Purpose The objective of this review was to construct an updated evidence-based clinical practice guideline on the use of physical activity and diet for the management of osteoarthritis (OA) in adults (>18 years of age) who are obese or overweight (body mass index ≥25 kg/m2). Data Sources Articles were extracted from the following databases: MEDLINE, EMBASE (Current Contents), SPORTDiscus, SUM, Scopus, CINAHL, AMED, BIOMED, PubMed, ERIC, the Cochrane Controlled Trials, and PEDro. Study Selection The Ottawa Panel and research assistance team strictly applied the inclusion and exclusion criteria from previous Ottawa Panel publications. Data Extraction An a priori literature search was conducted for articles related to obesity and OA of the lower extremities that were published from January 1, 1966, to November 30, 2010. Inclusion criteria and the methods to grade the recommendations were created by the Ottawa Panel. Data Synthesis Recommendations were graded based on the strength of evidence (A, B, C, C+, D, D+, or D−) as well as experimental design (I for randomized controlled trials and II for nonrandomized studies). In agreement with previous Ottawa Panel methods, Cochrane Collaboration methods were utilized for statistical analysis. Clinical significance was established by an improvement of ≥15% in the experimental group compared with the control group. There were a total of 79 recommendations from 9 articles. From these recommendations, there were 36 positive recommendations: 21 grade A and 15 grade C+. There were no grade B recommendations, and all recommendations were of clinical benefit. Limitations Further research is needed, as more than half of the trials were of low methodological quality. Conclusions This review suggests that physical activity and diet programs are beneficial, specifically for pain relief (9 grade A recommendations) and improved functional status (6 grade A and 7 grade C+ recommendations), for adults with OA who are obese or overweight. The Ottawa Panel was able to demonstrate that when comparing physical activity alone, diet alone, physical activity combined with diet, and control groups, the intervention including physical activity and diet produced the most beneficial results.

The Client-Centred Evidence-Based Practice of Occupational Therapy.

Evidence-based practice has its roots in evidence-based medicine. This term refers to the formulation of treatment decision using the best available research evidence. While the concept has gained increased attention among health care workers in the recent past, practice based on scientific evidence has been recommended for over 300 years. However, all health-related professions continue to report difficulties adopting evidence-based practice. Notably, practitioners are often concerned that results of population-based research may not be relevant for their specific patients. This may be of particular concern for occupational therapists who aim to provide client-centred intervention, taking into consideration individual characteristics of the client, the environment and the occupation. As well, those wishing to practice evidence-based occupational therapy must determine which decisions are made during the course of therapy and what evidence may impact on these decisions. The Occupational Performance Process Model (Fearing, Law & Clark, 1997) outlines the occupational therapy problem solving process and assists therapists to integrate knowledge from both client and therapist. A framework for evidence-based occupational therapy is presented, based on this model.

Methods to Enhance Verbal Communication between Individuals with Alzheimer's Disease and Their Formal and Informal Caregivers: A Systematic Review

Alzheimers disease is the leading cause of dementia in older adults. Although memory problems are the most characteristic symptom of this disorder, many individuals also experience progressive problems with communication. This systematic review investigates the effectiveness of methods to improve the verbal communication of individuals with Alzheimers disease with their caregivers. The following databases were reviewed: PsychINFO, CINAHL, EMBASE, MEDLINE, REHABDATA, and COMDIS. The inclusion criteria were: (i) experimentally based studies, (ii) quantitative results, (iii) intervention aimed at improving verbal communication of the affected individual with a caregiver, and (iv) at least 50% of the sample having a confirmed diagnosis of Alzheimers disease. A total of 13 studies met all of the inclusion criteria. One technique emerged as potentially effective: the use of memory aids combined with specific caregiver training programs. The strength of this evidence was restricted by methodological limitations of the studies. Both adoption of and further research on these interventions are recommended.

Factors associated with a second hip fracture: a systematic review:

Objective: To provide a systematic review of factors associated with subsequent hip fracture among individuals who have fractured a hip. Data sources: We searched Ageline, CINAHL, EMBASE and MEDLINE, from database inceptions to the week of 5 June 2006. Review methods: Studies were selected if they provided information regarding risk of subsequent hip fracture among individuals who had fractured a hip. Study quality was assessed using the Jadad criteria for randomized controlled trials (RCTs) and a simple scale based on the MOOSE criteria for cohort studies. Results: Four RCTs and seven cohort studies were identified. Older age, cognitive impairment and lower bone mass appear to increase the risk of subsequent fracture, as did impaired depth perception, impaired mobility, previous falls, dizziness and poor or fair self-perceived health. Pharmacologic treatment for osteoporosis decreased the risk of subsequent fracture. Use of hip protectors by community-dwelling seniors did not appear to protect against a second fracture. Conclusion: A number of easily observed risk factors may help identify those individuals at higher risk for subsequent fracture.

Description of children identified by physicians as having developmental coordination disorder

The aim of this study was to describe in detail a large group of children aged 4 to 12 years who were diagnosed with developmental coordination disorder (DCD) by physicians following a rigorous multidisciplinary procedure. As part of a community‐based DCD knowledge translation program, physicians received specialized training and were invited to identify children with probable DCD who were referred for further investigation to help confirm the diagnosis. Of 116 children (87 males, 29 females; age range 4y 1mo ‐ 12y 11mo, mean age 8y) identified as having probable DCD by physician participants, 88 (76%) were subsequently diagnosed with DCD and 77.3% of these demonstrated a high degree of motor impairment. All children who were diagnosed experienced difficulties in self‐care and/or academic or leisure activities. The male:female ratio was 3:1 and the incidence of preterm births among this sample was 12.5%. We conclude that, given the expense involved with ruling out differential diagnoses, it can be difficult to adhere rigorously to diagnostic criteria for DCD in clinical practice and research. This description of a group of children actually diagnosed with DCD helps to clarify the characteristics of these children as well as issues related to the refinement of diagnostic criteria.