Date Presented 04/13/21
Individuals with intellectual disabilities have a high risk for obesity. The effectiveness of community-based interventions at improving obesity-related outcomes was assessed. Results showed low to moderate evidence for nutritional, physical activity, and health knowledge and self-efficacy outcomes and low evidence for physical fitness. OTs are well suited to align community-based interventions with meaningful outcomes to improve the health and well-being of people with intellectual disabilities.
Primary Author and Speaker: Yasmeena Ougayour
Additional Authors and Speakers: Stacey Reynolds
BACKGROUND: People with intellectual disabilities (ID) are at a high risk of obesity and associated diseases. These individuals face unique barriers to healthcare including reduced access, decreased quality of care, and decreased health promotion opportunities. Health promotion interventions that take place in traditional healthcare settings such as hospitals and clinics may not adequately address these barriers or meet the unique needs of people with ID. Community-based interventions provide people with ID easier access to treatment, ‘user-friendly' resources, and involvement of caregivers and family. They are a viable alternative to traditional interventions.
PURPOSE: The purpose of this systematic review was to assess the effectiveness of community-based interventions at improving obesity-related health outcomes for people with intellectual disabilities.
DESIGN: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were used to conduct a systematic search on the effectiveness of community-based interventions on obesity-related outcomes for adults with ID.
METHOD: Five databases were searched including PubMed, PsycINFO, OTSeeker, PEDro and CINAHL Plus. Keywords were related to intellectual disability, community-based intervention, workshop, training, outreach, mentor, and health. Article inclusion criteria included: (a) adults diagnosed with ID; (b) community-based interventions; (c) outcomes related to obesity or obesity-related behaviors; and (d) were identified as Levels of Evidence I, II, or III based on The American Occupational Therapy Association's (AOTA) guidelines. For the purpose of this systematic review, community-based intervention was defined as a direct intervention that could have taken place in a variety of community settings such as mentoring, outreach, or sports programs. Interventions that took place outside the United States were excluded. The initial search across all 5 databases identified 2,445 citations. After removal of duplicates and screening of titles and abstracts, 31 remained for full text review. Nine articles met inclusion criteria (1 Level I, 3 Level II, 5 Level III).
RESULTS: Community-based interventions occurred across multiple settings and included a total of 345 participants. Results are organized by the outcomes addressed: nutrition, physical activity, health status, health knowledge and self-efficacy. The strength of evidence for each outcome category was assigned from insufficient to strong according to the AOTA Systematic Review Guidelines for strength of evidence. Low to moderate evidence was found for the effectiveness of community-based interventions on nutrition (low), physical activity (mixed), health status (mixed), health knowledge (moderate) and self-efficacy (moderate) outcomes.
CONCLUSION: Emerging evidence supports the use of community-based interventions on health promotion for people with ID. Community-based interventions can contribute to accessible, client-centered practice as they often work directly with local partners, finding ways to decrease barriers to participation.
IMPLICATIONS: Occupational therapists (OTs) are well-suited to align community-based interventions with meaningful outcomes to improve the health and well-being of people with ID. Due to their unique skills in activity analysis and modification, OTs are perfectly positioned to take part in both the prevention and treatment of obesity.
References
Marks, B., Sisirak, J., & Chang, Y. (2013). Efficacy of the healthmatters program train-the-trainer model. Journal of Applied Research in Intellectual Disabilities, 26, 319-334. https://doi.org/10.1111/jar12045
Barwick, R. B., Tillman, M. D., Stopka, C. B., Dipnarine, K., Delisle, A., & Sayedul Huq, M. (2012). Physical capacity and functional abilities improve in young adults with intellectual disabilities after functional training. Journal of Strength and Conditioning Research, 26(6), 1638–1643. https://doi.org/10.1519/JSC.0b013e318234e860
Bodde, A. E., Seo, D., Frey, G. C., Puymbroeck, M. V., & Lohrmann, D. K. (2012). The effect of a designed health education intervention on physical activity knowledge and participation of adults with intellectual disabilities. American Journal of Health Promotion, 26(5), 313-316. https://doi.org/10.4278/ajhp.100408-arb-112
Tamse, T. R., Tillman, M. D., Stopka, C. B., Weimer, A. C., Abrams, G. L., & Issa, I. M. (2010). Supervised moderate intensity resistance exercise training improves strength in Special Olympic athletes. Journal of Strength and Conditioning Research, 24(3), 695–700. https://doi.org/10.1519/JSC.0b013e3181c7b46b
