Feasibility and Preliminary Efficacy of an Occupational Therapy Intervention for Older Adults With Chronic Conditions in a Primary Care Clinic

Abstract

Importance: Occupational therapy can play a role in primary care management of chronic diseases among older adults. Objective: To assess the feasibility of delivering a primary care occupation-focused intervention (Integrated PRimary care and Occupational therapy for Aging and Chronic disease Treatment to preserve Independence and Functioning, or i-PROACTIF) for older adults with chronic disease. Design: Feasibility study comparing i-PROACTIF with complex care management using a two-group randomized controlled trial design with data gathered at baseline and during and after the 8-wk intervention. Setting: Family medicine clinic serving an urban, low-income, working-class community. Outcomes and Measures: Feasibility indicators were recruitment, retention, utility of clinical assessments, and acceptability of interventions assessed through feedback surveys completed by patients and primary care providers (PCPs). Patient outcomes, including perspectives on chronic illness care, occupational performance, and overall well-being, were collected using standardized, validated measures and analyzed descriptively. Participants: Eighteen adult volunteers, ages ≥50 yr, with heart disease, arthritis, and uncontrolled diabetes completed the study. Ten PCPs completed feedback surveys. Intervention: i-PROACTIF focuses on preserving functional independence, is based on the Person–Environment–Occupation framework, and consists of two assessment sessions and six weekly treatment sessions. Results: Recruitment goals were achieved, with an 86% retention rate. Clinical measures unearthed deficits in areas that were unreported or underreported by patients. Participants reported being extremely satisfied with the intervention. Physicians and nurses also supported the intervention. Both groups showed improved scores on most outcomes. Conclusion and Relevance: Delivering and evaluating i-PROACTIF was feasible and acceptable. Future efficacy trials are needed before it can be used in clinical settings. What This Article Adds: The results of this study can inform future occupational therapy interventions and clinical trials in primary care for older adults with chronic conditions.

Mindfulness-based stress reduction for community-dwelling older adults with subjective cognitive decline (SCD) and mild cognitive impairment (MCI) in primary care: a mixed-methods feasibility randomized control trial

“…Health promotion and prevention-related activities (75%) followed by group-based interventions (14%) were the most frequently described interventions in this setting [56], and this aligns well with our study noting the benefits of such an occupational therapy-led MBSR group. A study by Mirza et al (2020) determined that an occupational therapy group-based intervention in primary care was feasible, acceptable and highly satisfying to older adults living with chronic conditions [57] which further supports our findings. These findings are consistent with many other studies showing that an occupational therapist-led MBSR is feasible for practice among participants with MCI or mild dementia [58], as demonstrated by the qualitative data of the focus group and noting low attrition; high completion; and a 100% follow-up.…”

The effectiveness of occupational therapy for mental health disorders in primary care: A systematic review

“…A second reason for a sparse evidence base may be associated with the limited use of quantifiable mental health outcomes that are commonly used in medical and primary care settings. The researchers identified several trials with OT interventions that did not include screening and/or symptom measures of mood disorders, such as anxiety and depression, or serious mental illness, such as acute psychosis and schizophrenia (Brandt et al, 2016; Dopp et al, 2015; Egan et al, 2007; Graff et al, 2006; Martensson et al, 1999; Mirza et al, 2020; Richardson et al, 2010; ). In addition, a subset of excluded studies involved non-primary care populations and settings, including individuals with dementia (Dopp et al, 2015; Graff et al, 2006), and those with a recent cerebrovascular accident (Egan et al, 2007), chronic pain (Martensson et al, 1999), and cancer (Brandt et al, 2016).…”