A randomized controlled trial protocol investigating effectiveness of an activity-pacing program for deconditioned older adults

Abstract

French

Background.

Acute hospitalization of older adults can lead to deconditioning and the need for rehabilitation to facilitate a return to home and previous lifestyle. An occupational therapy intervention to combat deconditioning is activity pacing, an active self-management strategy where individuals learn to modify how and when activities are completed with the aim of improving participation in occupation.

Purpose.

This study will examine the effectiveness of occupational therapy with activity pacing during rehabilitation for deconditioned older adults.

Method.

A randomized controlled trial is proposed with inclusion criteria of older adults, 65+ years old, living independently in the community prior to admission, with adequate cognition and language to participate in the intervention. Participation, health status, self-efficacy in daily activities, self-efficacy in activity pacing techniques, and symptom management (pain and fatigue) will be measured at admission, discharge, and 3 months postdischarge.

Implications.

Determining if an activity-pacing program is effective will provide occupational therapists with evidence to support service delivery.

Keywords

Aged Geriatrics Independent living Occupational therapy Subacute care

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References

Abu-Awad

Unsworth

C. A.

Coulson

Sarigiannis

(2014). Using the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) to measure client participation outcomes. British Journal of Occupational Therapy, 77, 44–49. doi:10.4276/030802214X13916969446958

Antcliff

Keeley

Campbell

Oldham

Woby

(2013). The development of an activity pacing questionnaire for chronic pain and/or fatigue: A Delphi technique. Physiotherapy, 99, 241–246. doi:10.1016/j.physio.2012.12.003

Australasian Rehabilitation Outcomes Centre. (2017). The AROC annual report: The state of rehabilitation in Australia 2017. Retrieved from http://ahsri.uow.edu.au

Baztán

J. J.

Gálvez

C. P.

Socorro

(2009). Recovery of functional impairment after acute illness and mortality: One-year follow-up study. Gerontology, 55, 269–274. doi:10.1159/000193068

Brazier

J. E.

Walters

S. J.

Nicholl

J. P.

Kohler

(1996). Using the SF-36 and EuroQol on an elderly population. Quality of Life Research, 5, 195–204. doi:10.1007/bf00434741

Canadian Medical Association. (2016). The state of seniors health care in Canada. Retrieved from https://www.cma.ca/En/Lists/Medias/the-state-of-seniors-health-care-in-canada-september-2016.pdf

Chan

A.-W.

Tetzlaff

J. M.

Altman

D. G.

Laupacis

Gøtzsche

P. C.

Krleža-Jerić

… Moher

. (2013). SPIRIT 2013 statement: Defining standard protocol items for clinical trials. Annals of Internal Medicine, 158, 200–207. doi:10.7326/0003-4819-158-3-201302050-00583

Charlson

M. E.

Pompei

Ales

K. L.

MacKenzie

C. R.

(1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40, 373–383. doi:10.1016/0021-9681(87)90171-8

Chia

E. M.

Chia

E. M.

Rochtchina

Wang

J. J.

Mitchell

(2006). Utility and validity of the self-administered SF-36: Findings from an older population. Annals of the Academy of Medicine, Singapore, 35, 461–467.

10.

Coster

(2013). Making the best match: Selecting outcome measures for clinical trials and outcome studies. American Journal of Occupational Therapy, 67, 162–170. doi:10.5014/ajot.2013.006015

11.

Covinsky

K. E.

Palmer

R. M.

Fortinsky

R. H.

Counsell

S. R.

Stewart

A. L.

Kresevic

… Landefeld

C. S

. (2003). Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age. Journal of the American Geriatrics Society, 51, 451–458. doi:10.1046/j.1532-5415.2003.51152.x

12.

Covinsky

K. E.

Pierluissi

Johnston

C. B.

(2011). Hospitalization-associated disability: “She was probably able to ambulate, but I’m not sure.” JAMA: Journal of the American Medical Association, 306, 1782–1793. doi:10.1001/jama.2011.1556

13.

Creditor

M. C.

(1993). Hazards of hospitalization of the elderly. Annals of Internal Medicine, 118, 219–223. doi:10.7326/0003-4819-118-3-199302010-00011

14.

Cuperus

Vliet Vlieland

Brodin

Hammond

Kjeken

Lund

… Roškar

. (2016). Characterizing the concept of activity pacing as a non-pharmacological intervention in rheumatology care: Results of an international Delphi survey. Scandinavian Journal of Rheumatology, 45, 66–74. doi:10.3109/03009742.2015.1052552

15.

de Groot

Beckerman

Lankhorst

G. J.

Bouter

L. M

. (2003). How to measure comorbidity: A critical review of available methods. Journal of Clinical Epidemiology, 56, 221–229. doi:10.1016/S0895-4356(02)00585 -1

16.

Faul

Erdfelder

Lang

A.-G.

Buchner

(2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191. doi:10.3758/BF03193146

17.

Fisher

A. G.

(2013). Occupation-centred, occupation-based, occupation-focused: Same, same or different? Scandinavian Journal of Occupational Therapy, 20, 162–173. doi:10.3109/11038128.2012.754492

18.

Gage

Noh

Polatajko

H. J.

Kaspar

(1994). Measuring perceived self-efficacy in occupational therapy. American Journal of Occupational Therapy, 48, 783–790. doi:10.5014/ajot.48.9.783

19.

Gage

Polatajko

H. J.

(1994). Enhancing occupational performance through an understanding of perceived self-efficacy. American Journal of Occupational Therapy, 48, 452–461. doi:10.5014/ajot.48.5.452

20.

Gill

T. M.

Allore

H. G.

Gahbauer

E. A.

Murphy

T. E.

(2010). Change in disability after hospitalization or restricted activity in older persons. JAMA: Journal of the American Medical Association, 304, 1919–1928. doi:10.1001/jama.2010.1568

21.

Gill

T. M.

Allore

H. G.

Holford

T. R.

Guo

(2004). Hospitalization, restricted activity, and the development of disability among older persons. JAMA: Journal of the American Medical Association, 292, 2115–2124. doi:10.1001/jama.292.17.2115

22.

Goudsmit

E. M.

Nijs

Jason

L. A.

Wallman

K. E.

(2012). Pacing as a strategy to improve energy management in myalgic encephalomyelitis/chronic fatigue syndrome: A consensus document. Disability and Rehabilitation, 34, 1140–1147. doi:10.3109/09638288.2011.635746

23.

Granger

C. V. M. D.

Hamilton

B. B. M. D. P.

Keith

R. A. P.

Zielezny

M. P.

Sherwin

F. S. M. A.

(1986). Advances in functional assessment for medical rehabilitation. Topics in Geriatric Rehabilitation, 1(3), 59–74. doi:10.1097/00013614-198604000-00007

24.

Hammell

K. R. W.

(2016). Empowerment and occupation: A new perspective. Canadian Journal of Occupational Therapy, 83, 281–287. doi:10.1177/0008417416652910

25.

Jamieson-Lega

Berry

Brown

C. A.

(2013). Pacing: A concept analysis of the chronic pain intervention. Pain Research & Management, 18, 207–2013. doi:10.1155/2013/686179

26.

Kortebein

(2009). Rehabilitation for hospital-associated deconditioning. American Journal of Physical Medicine and Rehabilitation, 88, 66–77. doi:10.1097/PHM.0b013e3181838f70

27.

Levasseur

Couture

(2015). Coping strategies associated with participation and quality of life in older adults. Canadian Journal of Occupational Therapy, 82, 44–53. doi:10.1177/0008417414552188

28.

Liepold

Mathiowetz

(2005). Reliability and validity of the Self-Efficacy for Performing Energy Conservation Strategies Assessment for persons with multiple sclerosis. Occupational Therapy International, 12, 234–249. doi:10.1002/oti.5

29.

Maruish

M. E.

(Ed.). (2011). User’s manual for the SF-36v2 Health Survey (3rd ed.). Lincoln, RI: QualityMetric.

30.

Matuska

Mathiowetz

Finlayson

(2007). Use and perceived effectiveness of energy conservation strategies for managing multiple sclerosis fatigue. American Journal of Occupational Therapy, 61, 62–69. doi:10.5014/ajot.61.1.62

31.

McHorney

C. A.

Ware

J. E.

Jr Lu

J. F.

Sherbourne

C. D.

(1994). The MOS 36-Item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care, 32(1), 40–66. doi:10.1097/00005650-199303000-00006

32.

McHorney

C. A.

Ware

J. E.

Jr Raczek

A. E.

(1993). The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 31, 247–263. doi:10.1097/00005650-199303000-00006

33.

Nielson

W. R.

Jensen

M. P.

Karsdorp

P. A.

Vlaeyen

J. W.

(2013). Activity pacing in chronic pain: Concepts, evidence, and future directions. Clinical Journal of Pain, 29, 461–468. doi:10.1097/AJP.0b013e3182608561

34.

Norman

G. R.

Sloan

J. A.

Wyrwich

K. W.

(2003). Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Medical Care, 41, 582–592. doi:10.1097/01.MLR.0000062554.74615.4C

35.

Scott

Unsworth

C. A.

Fricke

Taylor

(2006). Reliability of the Australian Therapy Outcome Measures for Occupational Therapy Self-Care Scale. Australian Occupational Therapy Journal, 53, 265–276. doi:10.1111/j.1440-1630.2006.00584.x

36.

Siebens

Aronow

Edwards

Ghasemi

(2000). A randomized controlled trial of exercise to improve outcomes of acute hospitalization in older adults. Journal of the American Geriatrics Society, 48, 1545–1552. doi:10.1111/j.1532-5415.2000.tb03862.x

37.

Swigris

J. J.

Brown

K. K.

Behr

du Bois

R. M.

King

T. E.

Raghu

Wamboldt

F. S.

(2010). The SF-36 and SGRQ: Validity and first look at minimum important differences in IPF. Respiratory Medicine, 104, 296–304. doi:10.1016/j.rmed.2009.09.006

38.

Timmer

A. J.

(2016). Activity Pacing Assessment. Melbourne, Australia: Ramsay Health Care.

39.

Timmer

A. J.

Unsworth

C. A.

Taylor

N. F.

(2014). Rehabilitation interventions with deconditioned older adults following an acute hospital admission: A systematic review. Clinical Rehabilitation, 28, 1078–1086. doi:10.1177/0269215514530998

40.

Timmer

A. J.

Unsworth

C. A.

Taylor

N. F.

(2015). Occupational therapy inpatient rehabilitation interventions with deconditioned older adults following an acute hospital admission: A Delphi study. Australian Occupational Therapy Journal, 62, 41–49. doi:10.1111/1440-1630.12169

41.

Unsworth

Coulson

Swinton

Cole

Sarigiannis

(2015). Determination of the minimal clinically important difference on the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT). Disability and Rehabilitation, 37, 997–1003. doi:10.3109/09638288.2014.952450

42.

Unsworth

Duckett

Duncombe

Perry

Skeat

Taylor

(2004). Validity of the AusTOM scales: A comparison of the AusTOMs and EuroQol-5D. Health and Quality of Life Outcomes, 2, Article 64. doi:10.1186/1477-7525-2-64

43.

Unsworth

Duncombe

(2014). Australian Therapy Outcome Measures for Occupational Therapy (OT-AusTOMs) 3rd Edition. Melbourne, Australia: La Trobe University.

44.

Ware

J. E. J. P.

Sherbourne

C. D. P.

(1992). The MOS 36-ltem Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30, 473–483. doi:10.1097/00005650-199206000-00002

45.

Sahadevan

Ding

(2006). Factors associated with functional decline of hospitalised older persons following discharge from an acute geriatric unit. Annals of the Academy of Medicine, Singapore, 35(1), 17–23.

46.

Zisberg

Shadmi

Gur-Yaish

Tonkikh

Sinoff

(2015). Hospital-associated functional decline: The role of hospitalization processes beyond individual risk factors. Journal of the American Geriatrics Society, 63, 55–62. doi:10.1111/jgs.13193