Jewell Vanessa D, Russell Marion, Shin Julia, Qi Yongyue, Abbott Amy A, Knezevich Emily
Vanessa D. Jewell, PhD, OTR/L, FAOTA, is Associate Professor, Division of Occupational Science and Occupational Therapy and Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill;
Marion Russell, OTD, MOTR/L, SCFES, is Assistant Professor, Department of Occupational Therapy, Creighton University, Omaha, NE.
Am J Occup Ther. 2025 Jan 1;79(1). doi: 10.5014/ajot.2025.050831.
Because of the complexity of their child's diabetes management, parents often assume all care duties and report needing additional assistance to resume family routines.
To examine the preliminary efficacy of a telehealth occupation-based coaching intervention for rural parents of a child living with Type 1 diabetes (T1D) to improve child glycemic levels, family quality of life, and parental self-efficacy.
Double-blinded, two-arm, pilot randomized controlled trial.
Telehealth video conferencing at home.
16 dyads of rural parents and children ages 2 to 12 yr diagnosed with T1D.
Occupation-based coaching delivered through telehealth sessions, once weekly for 12 wk, informed by community partners.
Child measures: hemoglobin A1c and glucose time in range. Family measures: Parenting Sense of Competence, World Health Organization Quality of Life Brief Questionnaire, Goal Attainment Scale, Evidence of Independent Capacity Rating Scale (EICRS), and caregiver talk.
Families in the intervention group were more likely to achieve family-centered participation goals (p = .006) than those in the controlled group. Caregiver talk increased significantly over the 12-wk period (p = .034), and the average rating on the EICRS also improved significantly (p < .001). There were no statistically significant changes in glycemic levels or family quality of life.
OBC may be more efficacious in helping families to improve health management routines after a child's diagnosis with T1D than usual endocrinology care alone. Most child health outcomes were in target range at the start of the study; therefore, it was not expected to see significant improvements. Plain-Language Summary: Occupational therapy is an untapped resource in the provision of care for children with Type 1 diabetes (T1D). Occupational therapy practitioners can also provide families with evidence-based support to address the self-management skills of children with this chronic condition. This clinical trial examined the preliminary efficacy of a new 12-wk telehealth occupational therapy intervention for rural families with a child living with T1D to improve caregiver diabetes management skills, family participation, and child health. Families who received occupational therapy services were more likely to improve their family participation in meaningful activities and diabetes self-efficacy; however, there were no differences in the child's health outcomes or the family's quality of life.
由于孩子糖尿病管理的复杂性，父母常常承担所有的护理职责，并表示需要额外帮助以恢复家庭日常。
研究基于远程医疗职业指导干预对农村1型糖尿病（T1D）患儿父母的初步疗效，以改善孩子的血糖水平、家庭生活质量和父母的自我效能感。
双盲、双臂、试点随机对照试验。
在家中进行远程医疗视频会议。
16对农村父母及其2至12岁被诊断为T1D的孩子。
通过远程医疗会议提供基于职业的指导，每周一次，共12周，由社区合作伙伴提供信息。
孩子的测量指标：糖化血红蛋白和血糖处于目标范围的时间。家庭测量指标：育儿胜任感、世界卫生组织生活质量简表、目标达成量表、独立能力评定量表证据（EICRS）和照顾者谈话。
与对照组相比，干预组家庭更有可能实现以家庭为中心的参与目标（p = 0.006）。在12周期间，照顾者谈话显著增加（p = 0.034），EICRS的平均评分也显著提高（p < 0.001）。血糖水平和家庭生活质量没有统计学上的显著变化。
与单纯常规内分泌治疗相比，基于职业的指导在帮助家庭改善孩子被诊断为T1D后的健康管理日常方面可能更有效。大多数儿童健康指标在研究开始时就处于目标范围内；因此，预计不会有显著改善。
职业治疗在为1型糖尿病（T1D）患儿提供护理方面是一种未被充分利用的资源。职业治疗从业者还可以为家庭提供循证支持，以解决患有这种慢性病的儿童的自我管理技能问题。这项临床试验研究了一项为期12周的新型远程医疗职业治疗干预对农村患有T1D患儿家庭的初步疗效，以提高照顾者的糖尿病管理技能、家庭参与度和儿童健康水平。接受职业治疗服务的家庭更有可能改善其家庭对有意义活动的参与度和糖尿病自我效能感；然而，孩子的健康指标和家庭生活质量没有差异。
