Zhao Jun, Fan Kaipeng, Zheng Suqin, Xie Guangyao, Niu Xuekang, Pang Jinkuo, Zhang Huihuang, Wu Xin, Qu Jiayang
Rehabilitation Assessment and Treatment Center, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
School of Rehabilitation Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Front Neurol. 2024 Jul 22;15:1391993. doi: 10.3389/fneur.2024.1391993. eCollection 2024.
Delirium poses a major challenge to global health care, yet there is currently a dearth of single effective interventions or medications. Particularly, addressing delirium induced by critical illness is a complex process. Occupational therapy is considered to have a high potential for use in the prevention of delirium, as it involves both cognitive training and training in ADL. To comprehensively analyze the effect of occupational therapy on delirium prevention, we evaluated the effects of occupational therapy vs. standard non-pharmacological prevention on incidence and duration of delirium, clinical outcomes and rehabilitation outcomes in critically ill patients.
The data sources, including PubMed/Medline, Web of Science, EMBASE, and Cochrane Library, were comprehensively searched from their inception until 15 October 2023. Following the PICOS principle, a systematic screening of literature was conducted to identify relevant studies. Subsequently, the quality assessment was performed to evaluate the risk of bias in the included literature. Finally, outcome measures from each study were extracted and comprehensive analysis was conducted using Review Manager 5.4.
A total of four clinical trials met the selection criteria. The pooled analysis indicated no significant difference in the incidence and duration of delirium between the OT group and standard non-pharmacological interventions. A comprehensive analysis of clinical outcomes revealed that OT did not significantly reduce the length of hospital stay or ICU stay. Meanwhile, there was no significant difference in mortality rates between the two groups. It is noteworthy that although grip strength levels did not exhibit significant improvement following OT intervention, there were obvious enhancements observed in ADL and MMSE scores.
Although occupational therapy may not be the most effective in preventing delirium, it has been shown to significantly improve ADL and cognitive function among critically ill patients. Therefore, we contend that occupational therapy is a valuable component of a comprehensive multidisciplinary approach to managing delirium. In the future, high-quality researches are warranted to optimize the implementation of occupational therapy interventions for delirium prevention and further enhance their benefits for patients.
谵妄给全球医疗保健带来了重大挑战，但目前缺乏单一有效的干预措施或药物。特别是，解决危重病引起的谵妄是一个复杂的过程。职业治疗被认为在预防谵妄方面具有很高的应用潜力，因为它既涉及认知训练，也涉及日常生活活动（ADL）训练。为了全面分析职业治疗对预防谵妄的效果，我们评估了职业治疗与标准非药物预防措施对危重病患者谵妄的发生率、持续时间、临床结局和康复结局的影响。
全面检索了包括PubMed/Medline、Web of Science、EMBASE和Cochrane图书馆在内的数据来源，检索时间从其创建至2023年10月15日。按照PICOS原则，对文献进行系统筛选以确定相关研究。随后，进行质量评估以评估纳入文献中的偏倚风险。最后，提取每项研究的结局指标，并使用Review Manager 5.4进行综合分析。
共有四项临床试验符合入选标准。汇总分析表明，职业治疗组与标准非药物干预措施在谵妄的发生率和持续时间上无显著差异。对临床结局的综合分析显示，职业治疗并未显著缩短住院时间或重症监护病房（ICU）住院时间。同时，两组之间的死亡率无显著差异。值得注意的是，尽管职业治疗干预后握力水平未显示出显著改善，但在ADL和简易精神状态检查表（MMSE）评分方面有明显提高。
虽然职业治疗在预防谵妄方面可能不是最有效的，但已证明它能显著改善危重病患者的ADL和认知功能。因此，我们认为职业治疗是管理谵妄的综合多学科方法的重要组成部分。未来，需要高质量的研究来优化职业治疗干预措施在预防谵妄方面的实施，并进一步提高其对患者的益处。
