Link: http://ajot.aota.org/article.aspx?articleid=1863114&resultClick=1
This article used 6 other articles to review effects of exercise on ADL performance of those with Alzheimer's Disease. Occupational therapy intervention that includes aerobic and strengthening exercises may help improve independence in ADLs and improve physical performance in people with Alzheimer's. More research needs to done to identify specific components of intervention and optimal dosage to develop clinical guidelines. At my SNF placement, I have worked with many residents with Alzheimer's. We do use strength training with most patients is they are able to do it, and we also work to increase endurance as well. It is good to see evidence to back up treatment.

Link: http://www.ottoolkit.com/blog/good-habits-stop-falls/
I just thought this was a cool diagram/picture/handout for older adults about falling and thought I would share.

This AOTA newletter discusses a new article (which I was unable to find more than the abstract) with evidence that OT is the only area that has been able to reduce hospital admissions. Increased spending had a significant relationship with heart failure, pneumonia, and acute myocardial infarction. This article uses the quote "occupational therapy places a unique and immediate focus on patients' functional and social needs, which can be important drivers of readmission if left unaddressed." I really agree with this statement. Being an OT in the hospital, one of the main things you address is "is this person safe to go home?" These are the six areas identified are interventions OT used that can lower hospital re-admission rates:
1. Provide recommendations and training for caregivers.
2. Determine whether patients can safely live independently, or require further rehabilitation or nursing care.
3. Address existing disabilities with assistive devices so patients can safely perform activities of daily living (e.g., using the bathroom, bathing, getting dressed, making a meal).
4. Perform home safety assessments before discharge to suggest modifications.
5. Assess cognition and the ability to physically manipulate things like medication containers, and provide training when necessary.
6. Work with physical therapists to increase the intensity of inpatient rehabilitation.
Frequent hospital re-admission do not make a hospital look good, and I know this is an area that many hospitals are working to improve. This article shows that OT is a low cost way to decrease the number of re-admits.

Link to article: http://www.aota.org/Publications-News/AOTANews/2016/Occupational-Therapy-Reduces-Hospital-Readmissions.aspx

Leland, N., Elliott, S., & Murphy, S. (2012). Occupational therapy in fall prevention: current evidence and future prevention. American Journal of Occuaptional Therapy, 66, 149-160. Doi: 10.5014/ajot.2012.002733
Link: http://ajot.aota.org/article.aspx?articleid=1851552&resultClick=3

Currently there is not much evidence surrounding falls, prevention, intervention post falls, and occupational therapy, however as OTs we work with those who have fallen on a regular basis. This article highlights the areas in which more research in warranted to further our understanding, knowledge of falls, and effective interventions. Some of these areas include modifying fall risk behaviors (e.g., reducing fear of falling), managing postural hypotension, managing medications, and recommending appropriate footwear to decrease fall risk among community-dwelling older adults. When looking at exercise interventions, they found 2 types of exercise programs in use for falls, functional exercise and complementary/alternative exercise. For functional exercise, varying results were found. One study found embedding exercise into daily routines to be effective in reducing falls whereas another study found functional exercise (i.e, walking, self-care, home/group exercises) were ineffective in reducing fall risk. More exercise is needed in this areas to show occupational therapy's role in reducing fall risk, helping clients post fall, and effective interventions.

* Hand, C., Law, M., & McColl, M.A. (2011). Occupational therapy for interventions for chronic diseases: A scoping review. American Journal of Occupational Therapy, 65, 428-436. Doi: 10.5014/ajot.2011.002071
Link: http://ajot.aota.org/Article.aspx?articleid=1851489

This scoping review used 16 RCT's to review evidence regarding OT's effectiveness of interventions to improve occupational outcomes for adults with chronic diseases (cardiovascular disease, COPD, depression, RA). Only 4 studies used compared intervention groups to control groups to see improvement in areas of BADLs and IADLs. 10/16 studies found significant differences between intervention and control groups for at least one occupational outcomes - activities of daily living, functional self-efficacy, social or work function, psychological health, general health, or quality of life. However, there were limitation in this study, and that is that not all studies looked at the same outcomes, for example not all looked at BADLs and IALDS as mentioned previously. This means that there is less evidence supporting each area of occupational outcomes. Another limitation is that the articles does not discuss details of interventions beyond whether or not they had success. Overall, OT was able to increase basic ADL ability for those with chronic diseases. Almost everyone I work with at the SNF has at least 1 chronic disease and it's great to see that we can have effect with ADLS for these people, and help them to live a better life, being able to do more while living with a chronic condition.

* Mayer, F., Scharhag-Rosenberg, F., Carlsohn, A., Cassel, M., Muller, S., & Scharhag, J. (2011). The intensity and effects of strength training in elderly. Deutsches Arzteblatt International, 108(21), 359-364. Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117172/
This systematic review searched and utilized articles that appeared in the past 5 years about the effects and dose-response relationship of strength training in the elderly. The goal of strength training in the elderly is to reduce the loss of muscle mass and the resulting loss of motor function. This study found that strength training in the elderly increase muscle strength by increasing muscle mass and improving recruitment of motor units as well as increasing their firing rate. This article also found that to improve the rate of force development, training requires a higher intensity.
"The results of a recent Cochrane review including 121 randomized controlled trials (with some 6700 participants) showed that in most studies, strength (resistance) training is done 2 to 3 times per week. As a rule, this results in a notable increase in muscle strength, a moderate increase in the distance covered walking, a better performance for rising from a sitting position, and a subjectively higher mobility. Furthermore, increased stamina, an increased mitochondrial capacity, and a drop in the resting heart rate have been shown." I really like this quote because it shows how strength training relates to functions our clients need to complete ADLs. At my facility, strength training is a common preparatory activity, so this article gave me confidence that even though it may not be occupation based, it can still add to how clients are able to complete ADLs.
Overall, strength training does have positive effects on the elderly to increase strength, muscle mass, and ability.

This article is a systematic review of community treatment for chronic disease. I found this interesting because almost all patients I saw in the hospital has at least one chronic condition. This article looked at previous articles to see effectiveness of OT on those with chronic condition and their occupational performance. Articles included had evidence for effective OT intervention in areas of: activities of daily living, functional self-efficacy, social or work function, psychological health, general health, or quality of life. However, little evidence showed effect oh physical function and health. This study was focused on OT in the community setting compared to acute. I think this is something that OT could play a bigger role in the acute setting. We often touch on patient's disease and why they are in the hospital and education on the disease/ways to change habits. But this is not our main function at this level of care. However, there is potential for OT to be more involved in this area and increasing education.

Article: http://ajot.aota.org/article.aspx?articleid=1851489&resultClick=3

This study is a randomized control trial looking at early mobility with patients in the ICU. While in the ICU patients are often immobile, sedated, and are prone to loss strength, become weak, and experience delirium. Early mobility with OT/PT can work to lessen these effects on patients in the ICU. The patients who received therapy and an interruption in sedation had a higher chance of returning to functional status upon discharge from the hospital. They also experienced shorter periods of delirium. Patients who received therapy with the mobility protocol also had an average of less days on the ventilator than the control group. This study shows why PT and OT are an essential part of the ICU treatment team. Patients who are medically stable enough to participate are able to tolerate treatment well, are safe, and have better outcomes at discharge.

Article: http://download.springer.com/static/pdf/300/art%253A10.1186%252Fcc9262.pdf?originUrl=http%3A%2F%2Fccforum.biomedcentral.com%2Farticle%2F10.1186%2Fcc9262&token2=exp=1470971874~acl=%2Fstatic%2Fpdf%2F300%2Fart%25253A10.1186%25252Fcc9262.pdf*~hmac=eee46d958a80ff04367a8e2df48b469a0e944fcd7ce18d8db733f2a0afb24574

One of my FE's actually showed me this article, but I thought it was very interesting and a niche of OT we had not talked about in class. I did not know OT was involved in wound management, but there is a niche for this, and this is something that OT helps to manage at Doctor's Hospital. We complete a procedure called pulsed lavage. This is where you use a gun to squirt saline into a wound while there is also suction. We use this on open abscess wounds. At Doctor's this falls into OT's realm because these wounds, when on the upper extremity often impede daily function for ADL's, strength and ROM. When the wound is on the lower body, PT manages the wound. This is a procedure that I have really grown to like. It's something different to deal with on occasion. This article discusses why OT should be involved in wound management. Often the patients we treat with this are IV drug abusers. These abscess often cause a major decrease in ROM which prevents them from completing ADL's. Occasionally these patients will also require a splint as well to keep from losing further ROM while their extremity is healing. I found this very interesting.

Article: http://ajot.aota.org/article.aspx?articleid=1853065&resultClick=3
You have to open the PDF to view the entire article.

Video: https://www.youtube.com/watch?v=2mNH0N95I5I
I couldn't find a video where this is done on a smaller wound, but this is the same instrument if anyone is more curious. We suction the tip of the gun over the wound as much as possible and keep it there with saline and suction to help clean the wound.

This article suggests that case management can play a role in preventing acute readmissions, and that OT can also play a role in this. I liked this article because it aligns with what I have experienced during my fieldwork at the hospital. We work very closely with social work and the RN case managers. Social workers and case managers often look to OT/PT/ST for recommendations on discharge planning and equipment needs. This article also discusses utilizing outcome measures as predictors of function. For example, if someone is a high fall risk or has a low AMPAC score they have a higher risk of a readmission if they do not receive therapy. Part of my in-service this semester was helping with Skills Day with a focus on outcome measures. Ohio Health is trying to make initiatives to use outcome measure with every patient, which I think will be very beneficial. This way we can show the need to lack thereof for therapy, have data on patients, and can work to determine how these scores relate to readmissions. This article also points out that some readmissions cannot be always be stopped. Not all patients are compliant with medications, diets, etc. With these patients education is a key part of eval and treatment. I could really relate my experience this semester to this article. OT is an instrumental part with dealing with discharge recommendations and other needs. We can also help explain deficits and why patients have discharge needs to social work, case management and family. When a patient needs further therapy after their hospital stay, I think we as OT's need to be advocates and push for this option.

Article: http://ajot.aota.org/article.aspx?articleid=1867344&resultClick=3