Diana R. Feldhacker, OTD, OTR/L, BCPR, is Department Chair and Assistant Professor in Occupational Therapy, Department of Occupational Therapy, Des Moines University, Des Moines, IA;
Whitney Lucas Molitor, PhD, OTD, OTR/L, BCG, is Assistant Professor, Department of Occupational Therapy, and Undergraduate Public Health Program Director, University of South Dakota, Vermillion.
Am J Occup Ther. 2022 Jan 1;76(1). doi: 10.5014/ajot.2022.049324.
Interventions that promote function, medication reconciliation, and skin integrity assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing health care costs.
In this systematic review, we focus on three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: functional status, medication reconciliation, and skin integrity.
We conducted a search of the literature published between 2009 and 2019 in CINAHL, Cochrane, MEDLINE, PsycINFO, OTseeker, and Scopus. We also hand searched the systematic reviews and meta-analyses in our search results for articles that met our inclusion criteria. Study Selection and Data Collection: This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
We found 47 articles that address the three outcome areas. Regarding functional status, low strength of evidence is available for cognition and functional mobility interventions to support functional performance, moderate strength of evidence supports interventions for vision, and moderate evidence supports task-oriented and individualized interventions to promote activities of daily living (ADL) outcomes among people with neurological conditions. Strong strength of evidence supports individualized occupational therapy interventions focusing on medication adherence. Low strength of evidence was found for occupational therapy interventions to reduce pressure ulcers and promote skin integrity. Conclusion and Relevance: The evidence supports occupational therapy interventions to improve functional status in ADLs and medication management. Additional research is needed that examines the outcomes of occupational therapy interventions for other areas of function and skin integrity. What This Article Adds: We found evidence to support occupational therapy interventions that align with value-based measures in the three outcome areas of interest. The effectiveness of these interventions highlights the viability of occupational therapy as an essential profession and the worth of occupational therapy to the public, potential clients, and payers.
促进功能、药物重整和皮肤完整性的干预措施可帮助职业治疗师展示专业价值、提高质量并降低医疗保健成本。
在这项系统评价中，我们重点关注 2014 年《改善医疗保险康复期后护理转型法案》（IMPACT 法案）的三个结果领域：功能状态、药物重整和皮肤完整性。
我们对 2009 年至 2019 年间在 CINAHL、Cochrane、MEDLINE、PsycINFO、OTseeker 和 Scopus 发表的文献进行了检索。我们还在检索结果中对系统评价和荟萃分析进行了手工检索，以查找符合纳入标准的文章。
本研究使用了系统评价和荟萃分析的首选报告项目指南。
我们发现了 47 篇涉及三个结果领域的文章。关于功能状态，认知和功能性移动干预措施支持功能表现的证据强度较低，干预措施支持视力的证据强度中等，任务导向和个体化干预措施支持神经疾病患者日常生活活动（ADL）结果的证据强度中等。有强有力的证据支持以药物依从性为重点的个体化职业治疗干预措施。有较低强度的证据支持职业治疗干预措施来减少压疮和促进皮肤完整性。
证据支持职业治疗干预措施改善 ADL 中的功能状态和药物管理。需要进一步研究以检查职业治疗干预措施在其他功能领域和皮肤完整性方面的结果。
我们发现了证据支持与三个感兴趣的结果领域的基于价值的措施相一致的职业治疗干预措施。这些干预措施的有效性突出了职业治疗作为一个重要专业的可行性，以及职业治疗对公众、潜在客户和支付者的价值。
