干预多发性硬化症成年人工具性日常生活活动的系统评价。

Interventions for Instrumental Activities of Daily Living Among Adults With Multiple Sclerosis: A Systematic Review.

机构信息

Rebecca Cunningham, OTD, OTR/L, MSCS, is Assistant Professor of Clinical Occupational Therapy, Herman Ostrow School of Dentistry, USC Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;

Ashley Uyeshiro Simon, OTD, OTR/L, MSCS, is Associate Professor of Clinical Occupational Therapy, Herman Ostrow School of Dentistry, USC Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles.

出版信息

Am J Occup Ther. 2022 Mar 1;76(2). doi: 10.5014/ajot.2022.049092.

DOI:10.5014/ajot.2022.049092

PMID:35226064

Abstract

IMPORTANCE

Occupational therapy practitioners need updated information about interventions that may improve or maintain functional changes in instrumental activity of daily living (IADL) engagement caused by multiple sclerosis (MS).

OBJECTIVE

To conduct a narrative synthesis of updated evidence on interventions within the scope of occupational therapy to improve or maintain performance of and participation in IADLs among adults with MS.

DATA SOURCES

CINAHL, MEDLINE in PubMed, Cochrane, OTseeker, and PsycINFO. Study Selection and Data Collection: This systematic review followed the Cochrane Collaboration methodology and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting a systematic review. Inclusion criteria were Level 1 or 2 evidence, published in English, published from January 2011 to December 2018, intervention within the occupational therapy scope of practice, and at least one IADL outcome measure.

FINDINGS

Nineteen randomized controlled trials (including pilot and feasibility trials) and 1 preintervention-postintervention study met inclusion criteria. Results of this review show strong strength of evidence for coaching interventions in addressing physical activity (PA) routines and moderate support in addressing medication routines. Moderate strength of evidence was found with mixed results for interventions involving coaching plus prescribed PA in improving PA participation.

CONCLUSIONS AND RELEVANCE

This systematic review supports occupational therapy practitioners addressing PA and medication health management and maintenance IADLs through the use of coaching interventions when treating people with MS. Other IADLs were addressed by the articles in this review but require more evidence to make clinical recommendations. What This Article Adds: Occupational therapy practitioners' skills in promoting habits and routines paired with utilization of evidence-supported coaching interventions can support independence with health management and reduce the negative impact of MS on daily activity participation.

摘要

重要性

职业治疗师需要更新关于干预措施的信息，这些干预措施可能会改善或维持多发性硬化症（MS）导致的工具性日常生活活动（IADL）参与的功能变化。

目的

对职业治疗范围内改善或维持 MS 成人 IADL 表现和参与的干预措施进行更新证据的叙述性综合。

数据来源

CINAHL、MEDLINE in PubMed、Cochrane、OTseeker 和 PsycINFO。

研究选择和数据收集

本系统评价遵循 Cochrane 协作方法，并根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行报告，以进行系统评价。纳入标准为 1 级或 2 级证据，以英文发表，发表于 2011 年 1 月至 2018 年 12 月，干预措施在职业治疗范围内，至少有一个 IADL 结果测量。

发现

19 项随机对照试验（包括试点和可行性试验）和 1 项干预前-干预后研究符合纳入标准。本综述的结果表明，教练干预在解决体育活动（PA）常规方面具有很强的证据强度，在解决药物常规方面具有适度的支持。在涉及教练加规定 PA 以改善 PA 参与的干预措施中，发现中等强度的证据，但结果存在混合。

结论和相关性

本系统评价支持职业治疗师在治疗多发性硬化症患者时通过使用教练干预来解决体育活动和药物健康管理以及维持 IADL。本综述中的文章还涉及其他 IADL，但需要更多证据来提出临床建议。这篇文章增加了什么：职业治疗师促进习惯和常规的技能，加上利用证据支持的教练干预，可以支持健康管理的独立性，并减少多发性硬化症对日常活动参与的负面影响。