自我管理干预措施对改善慢性病成人日常活动和休息睡眠的效果：系统评价。

Self-Management Interventions to Improve Activities of Daily Living and Rest and Sleep for Adults With Chronic Conditions: A Systematic Review.

机构信息

Stacy Smallfield, DrOT, MSOT, OTR/L, BCG, FAOTA, is Associate Program Director and Capstone Coordinator, Division of Occupational Therapy, College of Allied Health Professions, University of Nebraska Medical Center, Omaha. At the time of the study, Smallfield was Associate Professor of Occupational Therapy and Medicine and Assistant Director, Occupational Therapy Entry-Level Professional Programs, Washington University School of Medicine, St. Louis, MO;

Lea Fang, OTD, OTR/L, is Occupational Therapist, SSM Health Physical Therapy, St. Louis, MO. At the time of the study, Fang was Doctoral Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO.

出版信息

Am J Occup Ther. 2021 Jul 1;75(4). doi: 10.5014/ajot.2021.046946.

DOI:10.5014/ajot.2021.046946

PMID:34780611

Abstract

IMPORTANCE

Chronic conditions often cause functional impairments in activities of daily living (ADLs) and rest and sleep, leading to decreased independence and self-efficacy.

OBJECTIVE

To aid occupational therapy practitioners in making informed decisions regarding self-management interventions to improve ADLs and rest and sleep for community-dwelling adults with chronic conditions.

DATA SOURCES

We identified literature published from 1995 to 2019 through searches of the Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, CINAHL, and OTseeker. Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to abstract and assess data quality and validity. The review followed American Occupational Therapy Association Evidence-Based Practice Project methodology. Studies addressing self-management interventions for community-dwelling adults ages 18 and older with chronic cardiovascular disease, Type 2 diabetes, heart disease, hypertension, chronic respiratory problems, or kidney disease were included.

FINDINGS

Fifteen articles met inclusion criteria and were categorized into ADLs and sleep. Strong evidence supports education to improve diabetic foot self-care. Low evidence addresses exercise and education to improve ADLs for people with heart disease and chronic obstructive pulmonary disease. Moderate evidence supports mind-body self-care education to enhance sleep.

CONCLUSIONS AND RELEVANCE

Occupational therapy practitioners working with adults with diabetes are encouraged to routinely offer education that includes discussion of risk factors and daily foot inspections and hygiene. When addressing sleep, education that addresses sleep hygiene, nutrition, relaxation techniques, and physical activity should routinely be provided to adults with chronic conditions. Further research is needed to understand the dosage needed. What This Article Adds: This systematic review supports the role of occupational therapy in providing self-management interventions to address ADLs and sleep for adults with diabetes and other chronic conditions.

摘要

重要性

慢性疾病常导致日常生活活动（ADLs）和休息睡眠出现功能障碍，导致独立性和自我效能下降。

目的

帮助职业治疗师在针对改善社区居住的慢性疾病成年人的 ADLs 和休息睡眠的自我管理干预措施方面做出明智的决策。

数据来源

我们通过对 Cochrane 系统评价数据库、MEDLINE、PsycINFO、CINAHL 和 OTseeker 的检索，确定了 1995 年至 2019 年发表的文献。研究选择和数据收集：使用系统评价和荟萃分析的 Preferred Reporting Items 指南来提取和评估数据质量和有效性。该综述遵循美国职业治疗协会循证实践项目方法。研究对象为年龄在 18 岁及以上、患有慢性心血管疾病、2 型糖尿病、心脏病、高血压、慢性呼吸问题或肾脏疾病的社区居住成年人的自我管理干预措施。

发现

符合纳入标准的文章有 15 篇，分为 ADLs 和睡眠。有强有力的证据支持教育可以改善糖尿病足的自我护理。关于运动和教育改善心脏病和慢性阻塞性肺疾病患者 ADLs 的证据很少。有中等强度的证据支持身心自我保健教育来改善睡眠。

结论和相关性

鼓励与糖尿病成年人合作的职业治疗师定期提供包括危险因素和日常足部检查和卫生教育的教育。在解决睡眠问题时，应定期向慢性疾病成年人提供有关睡眠卫生、营养、放松技术和身体活动的教育。需要进一步研究以了解所需的剂量。这篇文章的新增内容：本系统评价支持职业治疗在为糖尿病和其他慢性疾病成年人提供自我管理干预措施以解决 ADLs 和睡眠问题方面的作用。