Evidence-Based Practice

ASOT Vision in Action Conference

January 24th, 2013

Jordan Trull, OTS

EFFECTIVE OCCUPATIONAL THERAPY INTERVENTIONS FOR INCREASED FUNCTIONAL USE OF THE AFFECTED

EXTREMITY AND OVERALL QUALITY OF LIFE IN ADULTS WITH POST-STROKE HEMIPARESIS

JUSTIFICATION FOR RESEARCH

• Stroke is the number one leading cause of adult disability, and it is estimated that 5.4 million Americans are living with the effects of stroke

• On average, an individual in the U.S. has a stroke occurrence every 40 seconds and accounts for a yearly total of approximately 795,000 individuals

• Increasing prevalence of diagnosed stroke over time; the large majority of these individuals experience associated residual upper limb dysfunction

• This population encompasses an substantial facet of OT that spans across most settings

WHERE IS THE EVIDENCE?

• Sources (Databases utilized):• Academic Search Premier

• AJOT

• CINAHL (Cumulative Index to Nursing and Allied Health Literature)

• EBSCO

• OT Search

WHAT IS THE EVIDENCE SUPPORTING CONSTRAINT-INDUCED MOVEMENT THERAPY

(CIMT)?• Burns, Burridge, & Pickering (2007)

• CIMT yielded significant results among study participants regarding functional performance in conjunction with traditional OT

• QUALITY of movement increased

• Participants reported increases in satisfaction

and quality of life (QOL)

WHAT IS THE EVIDENCE SUPPORTING GAME CONTROLLER TREATMENT FOR UPPER

EXTREMITY RECOVERY?• Hijmans, Hale, Satherley, McMillan, & King (2011)

• Facilitated motor-related movement re-learning among participants

• Emphasis on repetitive bilateral movements, neuroplasticity

WHAT IS THE EVIDENCE SUPPORTING MIRROR THERAPY (MT) AS AN ADJUNCT TO

TRADITIONAL OT?• Wu, Huang, Chen, Lin, & Yang (2013)

• As an adjunct to traditional therapeutic activites, preliminary significant results were found regarding upper extremity movement using MT

• Both outcome measures (Kinematic variables and FMA) yielded significiant improvement

WHAT IS THE EVIDENCE SUPPORTING COGNITIVE-BASED TREATMENT?

• Polatajko, McEwen, Ryan, & Baum, (2012)

• Significant results regarding movement quality among participants and attainment of goals

• The cognitive aspect should always remain in the forefront of therapy

• Empowering and partnering with the client is crucial

WHAT DOES THIS EVIDENCE TELL US?

• Mirror Therapy (MT) provided benefit as an adjunct to therapy and accelerate the functional recovery of a hemiparetic upper extremity following stroke

• Constraint-induced Movement Therapy (CIMT) proved to be a substantially beneficial treatment strategy for individuals with post-stroke hemiparesis/upper extremity dysfunction

• Movement-based controllers and associated technology can significantly improve client performance

• Quality of Life (QOL) tends to increase with newfound increased function of previous upper limb dysfunction (Higher levels of independence= Increased QOL)

RESEARCH LIMITATIONS

• Small sample size

• Differing degrees of upper extremity dysfunction and stroke type

• Difficult to establish generalizability across populations

• Researcher/participant bias

IMPLICATIONS FOR FUTURE PRACTICE

• Evidence-based practice and associated interventions are rapidly evolving

• Embracing evidence-based new technological and innovative treatments should always remain in the forefront of practice

• It is the responsibility of every practitioner to establish diligence and vigilance regarding current/up-to-date research that can benefit a client base

• Further research is necessary to strengthen the foundation of current results for efficient clinical utility

QUESTIONS/COMMENTS?