Occupational therapy activities and intervention techniques for clients with stroke in six rehabilitation hospitals. Portable upper extremity robotics is as efficacious as upper extremity rehabilitative therapy: a randomized controlled pilot trial Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol Occupation in lifestyle redesign: the Well Elderly Study Occupational Therapy Program. Occupational therapy in multiple system atrophy: a pilot randomized controlled trial. Efficacy of combined physical and occupational therapy in patients with conservatively treated distal radius fracture: randomized controlled trial Effects of Constraint-Induced Therapy Versus Bilateral Arm Training on Motor Performance, Daily Functions, and Quality of Life in Stroke Survivors Effect of Therapist-Based Versus Robot-Assisted Bilateral Arm Training on Motor Control, Functional Performance, and Quality of Life After Chronic Stroke: A Clinical Trial A randomised controlled trial evaluating the effects of two workstation interventions on upper body pain and incident musculoskeletal disorders among computer operators Embedding health-promoting changes into the daily lives of independent-living older adults: long-term follow-up of occupational therapy intervention. Effects of Treatment Intensity in Upper Limb Robot-Assisted Therapy for Chronic Stroke Unpacking the black box of therapy – a pilot study to describe occupational therapy and physiotherapy interventions for people with stroke Effects of participatory ergonomic intervention on the development of upper extremity musculoskeletal disorders and disability in office employees using a computer Occupational therapy for independent-living older adults. A randomized controlled trial. Cost-effectiveness of multidisciplinary treatment in sick-listed patients with upper extremity musculoskeletal disorders: a randomized, controlled trial with one-year follow-up Clinical evaluation of Functional Electrical Therapy in acute hemiplegic subjects. A prospective randomized controlled trial comparing occupational therapy with independent exercises after volar plate fixation of a fracture of the distal part of the radius.
OBJECTIVE To prospect ively monitor occupational therapy activities and intervention techniques used during inpatient stroke rehabilitation in order to provide a description of current clinical practice . METHODS Data were collected prospect ively from 954 clients with stroke receiving occupational therapy from six U.S. rehabilitation hospitals . Descriptive statistics summarized frequency , intensity , and duration of occupational therapy sessions ; proportion of time spent in 16 therapeutic activities ; and proportion of those activities that included any of 31 interventions . RESULTS Clients received on average 11.8 days ( SD = 7.2 ) of occupational therapy , with each session lasting on average 39.4 min ( SD = 16.9 ) . Upper-extremity control ( 22.9 % of treatment time ) and dressing ( 14.2 % of treatment time ) were the most frequently provided activities . Interventions provided most frequently during upper-extremity control activities were strengthening , motor learning , and postural awareness . CONCLUSION Occupational therapy provided reflected an integration of treatment approaches . Upper-extremity control and basic activities of daily living were the most frequent activities . A small proportion of sessions addressed community integration Objective : To compare the efficacy of a repetitive task-specific practice regimen integrating a portable , electromyography-controlled brace called the ‘ Myomo ’ versus usual care repetitive task-specific practice in subjects with chronic , moderate upper extremity impairment . Subjects : Sixteen subjects ( 7 males ; mean age 57.0 ± 11.02 years ; mean time post stroke 75.0 ± 87.63 months ; 5 left-sided strokes ) exhibiting chronic , stable , moderate upper extremity impairment . Interventions : Subjects were administered repetitive task-specific practice in which they participated in valued , functional tasks using their paretic upper extremities . Both groups were supervised by a therapist and were administered therapy targeting their paretic upper extremities that was 30 minutes in duration , occurring 3 days/week for eight weeks . One group participated in repetitive task-specific practice entirely while wearing the portable robotic , while the other performed the same activity regimen manually . Main outcome measures : The upper extremity Fugl-Meyer , Canadian Occupational Performance Measure and Stroke Impact Scale were administered on two occasions before intervention and once after intervention . Results : After intervention , groups exhibited nearly identical Fugl-Meyer score increases of ≈2.1 points ; the group using robotics exhibited larger score changes on all but one of the Canadian Occupational Performance Measure and Stroke Impact Scale subscales , including a 12.5-point increase on the Stroke Impact Scale recovery subscale . Conclusions : Findings suggest that therapist-supervised repetitive task-specific practice integrating robotics is as efficacious as manual practice in subjects with moderate upper extremity impairment Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 This article describes an innovative preventive occupational therapy intervention for well older adults , the  Well Elderly Treatment Program . In a previously reported large-scale r and omized effectiveness study , this intervention was found to be highly successful in enhancing the physical and mental health , occupational functioning , and life satisfaction of multicultural , community-dwelling elders . In this article , the philosophical background , manner of development , topical content , methods of program delivery , and mechanisms underlying the program 's positive effects are discussed , along with implication s for occupational therapy practice . The treatment was based on application of occupational science theory and research and emphasized the therapeutic process of lifestyle re design in enabling the participants to actively and strategically select an individualized pattern of personally satisfying and health-promoting occupations . The wide-ranging effectiveness of the program supports the occupational therapy profession 's emphasis on occupation in affecting health and positions practitioners to extend their services to the realm of preventive interventions There is some evidence that rehabilitation therapies may be useful in progressive neurological conditions , but this usefulness has not been studied in multiple system atrophy ( MSA ) to date . The aim of this small pilot study was to identify the feasibility of a larger r and omized controlled trial of occupational therapy and to report preliminary data on the impact of occupational therapy on disability , mood , and health-related quality of life in patients with MSA . Patient groups were comparable for age , gender distribution , type of MSA , and severity . The active occupational therapy intervention group experienced a significant reduction of Unified Parkinson 's Disease Rating Scale ( total score and Activities of Daily Living [ ADL ] section ) , and PDQ-39 scores ( total scores and ADL subsection ) . An occupational therapy program may improve functional abilities in patients with mild to moderate MSA . A larger multicenter study is needed Summary Aim To evaluate the efficacy of combined physical and occupational therapy in comparison with physical therapy alone in patients with conservatively treated distal radius fracture . Methods Sixty-one participants , conservatively treated after a distal radius fracture , were included in a r and omized and single-blind trial . Group A had physical therapy only  ( n = 31 ) and group B had  physical and occupational therapy ( n = 30 ) . The assessment was performed three times : upon inclusion in the study in the first week after removal of the cast ( T1 ) , immediately after the end of the rehabilitation ( T2 ) , and 1 month after completing the rehabilitation ( T3 ) . The passive wrist range-of-motion , grip strength , and Disabilities of Arm , Shoulder and H and ( DASH ) score were used as rehabilitation outcomes . Results Rehabilitation outcomes were analyzed using two-way mixed analysis of variance . The effect of time was statistically significant ( p < 0.001 ) for all outcomes . The group ( therapy ) factor was statistically significant for grip strength only ( p = 0.038 ) . The interaction effect was statistically significant for rotation ( p = 0.034 ) and grip strength ( p = 0.021 ) . A comparison between time points T3:T1 showed statistically significant difference in grip strength in favor of group B 67 % ( 95 % CI 60–74 % ) versus group A 53 % ( 95 % CI 45–61 % ) , p = 0.024 . Conclusion The combined therapy result ed in a statistically significant increase of grip strength in comparison with isolated physical therapy in the period of 12–16 weeks after the fracture . This effectiveness was not confirmed with DASH score results Background and Objective . This study investigated the relative effects of distributed constraint-induced therapy ( CIT ) and bilateral arm training ( BAT ) on motor performance , daily function , functional use of the affected arm , and quality of life in patients with hemiparetic stroke . Methods . A total of 60 patients were r and omized to  distributed CIT , BAT , or a control intervention of less specific but active therapy . Each group received intensive training for 2 hours/day , 5 days/week , for 3 weeks . Pretreatment and posttreatment measures included the Fugl — Meyer Assessment ( FMA ) , Functional Independence Measure ( FIM ) , Motor Activity Log ( MAL ) , and Stroke Impact Scale ( SIS ) . The proximal and distal scores of FMA were used to examine separate upper limb ( UL ) elements of movement . Results . The distributed CIT and BAT groups showed better performance in the overall and the distal part score of the FMA than the control group . The BAT group exhibited greater gains in the proximal part score of the FMA than the distributed CIT and control groups . Enhanced performance was found for the distributed CIT group in the MAL , the subtest of locomotion in the FIM , and certain domains of the SIS ( eg , ADL/IADL ) . Conclusion . BAT may uniquely improve proximal UL motor impairment . In contrast , distributed CIT may produce greater functional gains for the affected UL in subjects with mild to moderate chronic hemiparesis Background Although bilateral arm training ( BAT ) has been widely studied , the comparative effects of therapist-based BAT ( TBAT ) versus robot-assisted BAT ( RBAT ) remains unknown . Objective This study compared the efficacy of TBAT , RBAT , and a control treatment ( CT ) on motor control , functional performance , and quality of life after chronic stroke . Design A r and omized , pretest-posttest , control group design was used . Methods Forty-two patients ( mean age=54.49 years , SD=9.69 ; mean length of time since stroke onset=17.62 months , SD=10.50 ) were r and omly assigned to TBAT , RBAT , and CT groups . Each group received treatment for 90 to 105 minutes per session , 5 sessions on weekdays , for 4 weeks . Outcome measures included kinematic analyses , the Fugl-Meyer Assessment ( FMA ) , the Motor Activity Log , and the Stroke Impact Scale ( SIS ) . Results Large and significant effects were found in the kinematic variables , distal part of upper-limb motor impairment , and certain aspects of quality of life in favor of TBAT or RBAT . Specifically , the TBAT group demonstrated significantly better temporal efficiency and smoothness , straighter trunk motion , and less trunk compensation compared with the CT and RBAT groups . The RBAT group had increased shoulder flexion compared with the CT and TBAT groups . On the FMA , the TBAT group showed higher distal part scores than the CT group . On the SIS , the RBAT group had better strength subscale , physical function domain , and total scores than the CT group . Limitations This study recruited patients with mild spasticity and without cognitive impairment . Conclusions Compared with CT , TBAT and RBAT exhibited differential effects on outcome measures . Therapist-based BAT may improve temporal efficiency , smoothness , trunk control , and motor impairment of the distal upper limb .  Robot-assisted BAT may improve shoulder flexion and quality of life Background : Call centre work with computers is associated with increased rates of upper body pain and musculoskeletal disorders . Methods : This one year , r and omised controlled intervention trial evaluated the effects of a wide forearm support surface and a trackball on upper body pain severity and incident musculoskeletal disorders among 182 call centre operators at a large healthcare company . Participants were r and omised to receive ( 1  ) ergonomics training only , ( 2 ) training plus a trackball , ( 3 ) training plus a forearm support , or ( 4 ) training plus a trackball and forearm support . Outcome measures were weekly pain severity scores and diagnosis of incident musculoskeletal disorder in the upper extremities or the neck/shoulder region based on physical examination performed by a physician blinded to intervention . Analyses using Cox proportional hazard models and linear regression models adjusted for demographic factors , baseline pain levels , and psychosocial job factors . Results : Post-intervention , 63 participants were diagnosed with one or more incident musculoskeletal disorders  . Hazard rate ratios showed a protective effect of the armboard for neck/shoulder disorders ( HR = 0.49 , 95 % CI 0.24 to 0.97 ) after adjusting for baseline pain levels and demographic and psychosocial factors . The armboard also significantly reduced neck/shoulder pain ( p = 0.01 ) and right upper extremity pain ( p = 0.002 ) in comparison to the control group . A return-on-investment model predicted a full return of armboard and installation costs within 10.6 months . Conclusion : Providing a large forearm support combined with ergonomic training is an effective intervention to prevent upper body musculoskeletal disorders and reduce upper body pain associated with computer work among call centre employees The Well Elderly Study was a r and omized trial in independent-living older adults that found significant health , function , and quality of life benefits attributable to a 9-month program in preventive occupational therapy ( OT ) .  All participants completing the trial were followed for an additional 6 months without further intervention and then reevaluated using the same battery of instruments . Long-term benefit attributable to preventive OT was found for the quality of interaction scale of the Functional Status Question naire and for six of eight scales on the R AND SF-36 : physical functioning , role functioning , vitality , social functioning , role emotional , and general mental health ( p<.05 ) . Approximately 90 % of the therapeutic gain observed following OT treatment was retained in follow-up . The finding of a sustained effect for preventive OT is of great public health relevance given the looming health care cost crisis associated with our nation 's exp and ing elderly population Background and Objectives . Robot-assisted therapy ( RT ) is a current promising intervention in stroke rehabilitation , but more research is warranted for examining its efficacy and the dose – benefit relation . The authors investigated the effects of higher intensity versus lower intensity RT on movements of forearm pronation – supination and wrist flexion – extension relative to conventional rehabilitation ( CR ) in patients poststroke for a mean of 21 months . Methods . In this pilot study , 18 patients with initial mean Fugl-Meyer Assessment ( FMA ) of 37 to 44 for the upper extremity were r and omized to higher intensity RT , lower intensity RT , or CR intervention for 4 weeks . The dose of the higher intensity RT was twice the number of repetitions in the lower intensity RT . Outcome measures at pretreatment and posttreatment were administered to patients to evaluate beneficial and adverse effects of interventions . Primary outcomes were the FMA and Medical Research Council scale . Results . There were significant differences in motor function ( P = .04 ) and daily performance ( P = .03 ) among the 3 groups . The higher intensity RT group showed better improvement in motor function , muscle strength , performance of daily activities , and bimanual ability than the other 2 groups . The intensive RT intervention did not induce higher levels of an oxidative DNA biomarker . Conclusions . Higher intensity of RT that assists forearm and wrist movements may lead to greater improvement in motor ability and functional performance in stroke patients . A sample size of only 20 to 25 in each arm of a larger r and omized controlled trial is needed to confirm the findings for similar subjects Objective : To describe the components used in the practice of occupational therapy and physiotherapy for people with stroke and to examine variability between services . Design : A time-sampling strategy in which therapists recorded their face-to-face interventions with stroke patients during 12 weeks over a total of 17 months . Setting s and subjects : Six occupational therapists and seven physiotherapists from four services ( three day hospitals and one domiciliary stroke rehabilitation service ) recorded interventions with 89 stroke patients recruited to a larger r and omized controlled trial . Main outcome measures : Frequencies of use of interventions , together with other details about delivery of therapy , were recorded using a data collection booklet and coding system design ed by the participating therapists . Results : The median treatment time for a session was 45 minutes . The most frequently recorded components of physiotherapy intervention were ‘ walking ’ , ‘ st and ing balance ’ and ‘ upper limb movement pattern ’ , and of occupational therapy ‘ physical function ’ , ‘ social and leisure activities ' and ‘ other ’ . There was variability between the services in terms of median treatment time , use of intervention codes , frequency of treatment sessions , amount of time spent working with assistance and amount of group work . Conclusions : The findings support the view that occupational therapy and physiotherapy with people with stroke are not homogeneous activities , and vary between therapists and services . Recommendations include further development of the tool , and use of other method ologies to explore the process and nature of stroke rehabilitation Objective : To evaluate the participatory ergonomic method on the development of upper extremity musculoskeletal disorders and disability in office employees . Methods : This study is a r and omized controlled intervention study . It comprised 116 office workers using computers . Those in the intervention group were taught office ergonomics and the risk assessment method . Cox proportional hazards model and generalized estimating equations ( GEEs ) were used . Results : In the 10-month postintervention follow-up , the possibility of developing symptoms was 50.9 % . According to multivariate analysis results , the possibility of developing symptoms on the right side of the neck and in the right wrist and h and was significantly less in the intervention group than in the control group ( p<0.05 ) . Neck disability/symptom scores over time were significantly lower in the intervention group compared with the control group ( p<0.05 ) . Conclusion : The participatory ergonomic intervention decreases the possibility of musculoskeletal complaints and disability/symptom level in office workers CONTEXT Preventive health programs may mitigate against the health risks of older adulthood . OBJECTIVE To evaluate the effectiveness of preventive occupational therapy ( OT ) services specifically tailored for multiethnic , independent-living older adults . Design .-A r and omized controlled trial . SETTING Two government subsidized apartment complexes for independent-living older adults . SUBJECTS A total of 361 culturally diverse volunteers aged 60 years or older . INTERVENTION An OT group , a social activity control group , and a nontreatment control group . The period of treatment was 9 months . MAIN OUTCOME MEASURES A battery of self-administered question naires design ed to measure physical and social function , self-rated health , life satisfaction , and depressive symptoms . RESULTS Benefit attributable to OT treatment was found for the quality of interaction scale on the Functional Status Question naire ( P=.03 ) , Life Satisfaction Index-Z ( P=.03 ) , Medical Outcomes Study Health Perception Survey ( P=.05 ) , and for 7 of 8 scales on the R AND 36-Item Health Status Survey , Short Form : bodily pain ( P=.03 ) , physical functioning ( P=.008 ) , role limitations attributable to health problems ( P=.02 ) , vitality ( P=.004 ) , social functioning ( P=.05 ) , role limitations attributable to emotional problems ( P=.05 ) , and general mental health ( P=.02 ) . CONCLUSIONS Significant benefits for the OT preventive treatment group were found across various health , function , and quality -of-life domains . Because the control groups tended to decline over the study interval , our results suggest that preventive health programs based on OT may mitigate against the health risks of older adulthood Objective : To determine the effectiveness and cost-effectiveness of a return-to-work outpatient multidisciplinary treatment programme for sick-listed workers with non-specific upper extremity musculoskeletal complaints . Methods : A r and omized controlled trial with a 1-year follow-up was carried out . Thirty-eight subjects were allocated to multidisciplinary treatment ( intervention , n=23 ) , or to usual care provided by occupational health services ( n=15 ) . The intervention consisted of psychological and physical sessions provided by a medical specialist , a psychologist , a physiotherapist and an occupational therapist . It aims at reconditioning , “ de-medicalizing ” , unrestrained moving and return-to-work . The intervention process was evaluated on compliance to the protocol and the effectiveness of its components . The individual outcome variable was the severity of complaints . The societal outcomes included return-to-work and costs . Measurements were performed at baseline and after 2 , 6 and 12 months . Mixed model analyses were used for analysis . Results : The intervention achieves its aims : physical disabilities ( P=0.039 ) , kinesiophobia ( P<0.001 ) and physical functioning ( P=0.016 ) improved significantly as compared to usual care . In addition , the intervention was significantly more effective in reducing the severity of complaints than usual care . The intervention was equally effective compared to usual care in terms of return-to-work ( 86 % in the intervention group vs. 73 % in the usual care group ) . The extra total costs and the extra gains in terms of return-to-work were not significantly higher for the intervention as compared to usual care after 12 months . Conclusion : Multidisciplinary treatment affects individuals positively , but shows no significant difference in ( cost- ) effectiveness on the societal level as compared to usual care This paper describes a clinical r and omized single-blinded study of the effects of Functional Electrical Therapy ( FET ) on the paretic arms of subjects with acute hemiplegia caused by strokes .  FET is an exercise program that comprises voluntary arm movements and opening , closing , holding , and releasing of objects that are assisted by a neural prosthesis ( electrical stimulation ) . FET consisted of a 30 min everyday exercise for 3 consecutive weeks in addition to conventional therapy .  Twenty-eight acute hemiplegic subjects participated in a 6 mo study . The subjects were divided into lower functioning groups ( LFGs ) and higher functioning groups ( HFGs ) based on their capacity to voluntarily extend the wrist and fingers against the gravity , and were r and omly assigned to controls or FET groups . The outcomes included the Upper Extremity Function Test , the coordination of elbow and shoulder movements , spasticity of key muscles of the paretic arm , and Reduced Upper Extremity Motor Activity Log .  FET and control groups showed a recovery trend in all outcome measures . The gains in  FET groups were much larger compared with the gains in control groups . The speed of recovery in FET groups was substantially faster compared with the recovery rate in control groups during the first 3 weeks ( treatment ) . The LFG subjects showed less improvement than the HFG in both the FET and control groups BACKGROUND The effect of formal occupational therapy on recovery after open reduction and volar plate fixation of a fracture of the distal part of the radius is uncertain . We hypothesized that there would be no difference in wrist function and arm-specific disability six months after open reduction and volar plate fixation of a distal radial fracture between patients who receive formal occupational therapy and those with instructions for independent exercises .  METHODS Ninety-four patients with an unstable distal radial fracture treated with open reduction and volar locking plate fixation were enrolled in a prospect i ve r and omized controlled trial comparing exercises done under the supervision of an occupational therapist with surgeon-directed independent exercises . The primary study question addressed combined wrist flexion and extension six months after surgery Secondary study questions addressed wrist motion , grip strength , Gartl and and Werley scores , Mayo wrist scores , and DASH ( Disabilities of the Arm , Shoulder and H and ) scores at three months and six months after surgery . RESULTS There was a significant difference in the mean arc of wrist flexion and extension six months after surgery ( 118 ° versus 129 ° ) , favoring patients prescribed independent exercises . Three months after surgery , there was a significant difference in mean pinch strength ( 80 % versus 90 % ) , mean grip strength ( 66 % versus 81 % ) , and mean Gartl and and Werley scores , favoring patients prescribed independent exercises . At six months , there was a significant difference in mean wrist extension ( 55 ° versus 62 ° ) , ulnar deviation ( 82 % versus 93 % ) , mean supination ( 84 ° versus 90 ° ) , mean grip strength ( 81 % versus 92 % ) , and mean Mayo score , favoring patients prescribed independent exercises . There were no differences in arm-specific disability ( DASH score ) at any time point . CONCLUSIONS Prescription of formal occupational therapy does not improve the average motion or disability score after volar locking plate fixation of a fracture of the distal part of the radius
The strongest evidence supports postsurgical early active motion protocol s and splinting for various conditions .
Very few studies have examined occupation-based interventions .
Occupational therapy practitioners are key health care providers for people with musculoskeletal disorders of the distal upper extremity .
It is imperative that practitioners underst and the most effective and efficient means for remediating impairments and supporting clients in progressing to independence in purpose ful occupations .
This systematic review provides an up date to a previous review by summarizing articles published between 2006 and July 2014 related to the focused question , What is the evidence for the effect of occupational therapy interventions on functional outcomes for adults with musculoskeletal disorders of the forearm , wrist , and h and ?