Date Presented 04/03/2025
We introduce positive preliminary results from an innovative intervention combining behavioral activation and techniques from OT to help older adults with multimorbidity better engage in health-promoting daily activity.
Primary Author and Speaker: Tara C. Klinedinst
Additional Authors and Speakers: Nicholas Hollman
Contributing Authors: Darla E. Kendzor, Carrie Ciro
PURPOSE: Nearly half of older adults in the U.S. have multimorbidity in addition to functional limitations that restrict health-promoting daily activity (e.g., sleep, medication-taking, exercise). We tested an innovative combination of behavioral activation and occupational therapy (OT) techniques to improve performance of meaningful, health-promoting daily activity.
DESIGN: This was a randomized controlled trial (ActiveOT vs. brief education control) delivered by occupational therapists in 10 weekly sessions in participant homes. The primary outcome is performance of health-promoting daily activity, measured by the Canadian Occupational Performance Measure (COPM) at baseline, 10, and 22 weeks.
METHOD: We report mean scores and between group Cohen’s d effect sizes (n = 17 tx, n = 14 control).
RESULTS: On average, participants were 73.0 years old (SD = 6.9), majority female (n = 25), and White (n =1 Black, n = 1 Hispanic/Latino). They had a mean of 3.9 chronic conditions (SD = 1.4), and 1.9 functional limitations (SD = 1.7). At 10-week follow-up, the mean COPM performance score for the ActiveOT group (M = 7.0, SD = 1.5) was significantly higher than the control group (M = 5.3, (SD = 1.7), p <0.01, d = 1.04). This trend continued at 22 weeks, where the ActiveOT scores (M = 7.5 (SD = 1.2)) were significantly higher than control (M = 5.5 (SD = 2.1), p <0.01, d = 1.16). Further, 77% of the ActiveOT group reported clinically significant improvements on the COPM (MCID = 2).
DISCUSSION: Although scores increased for both groups, the ActiveOT group significantly improved compared to control. This study is in progress (aiming for n = 40) but shows promise for improving performance of health-promoting daily activity in a difficult-to-treat population.
IMPACT STATEMENT: New approaches are needed to help older adults manage multimorbidity; combining techniques from behavioral activation and OT can improve performance of health-promoting daily activity.
References
Klinedinst, T. C., Ciro, C. A., & Kendzor, D. E. (2023). A pilot, randomized, feasibility study to improve health self-management behaviors in older adults with multiple chronic conditions and functional limitations: Protocol for the Behavioral Activation and Occupational Therapy Trial (BA+ OT). Journal of Multimorbidity and Comorbidity, 13.
Kanter, J. W., Manos, R. C., Bowe, W. M., Baruch, D. E., Busch, A. M., & Rusch, L. C. (2010). What is behavioral activation?: A review of the empirical literature. Clinical psychology review, 30(6), 608–620.
Law, M., Baptiste, S., McColl, M., Opzoomer, A., Polatajko, H., & Pollock, N. (1990). The Canadian occupational performance measure: an outcome measure for occupational therapy. Canadian Journal of Occupational Therapy, 57(2), 82–87.
