The Effect of Occupational Therapy-Based Instrumental Activities of Daily Living Intervention in People With Disabilities
Condition: Disability Physical
Study type: Interventional

Summary: 
      The aim of this study was to investigate the effects of occupational therapy-based
      instrumental activities of daily living intervention on stress levels, quality of life, and
      participation in people with disability. The participants were recruited from the Etimesgut
      Family and Life Center in Ankara. In this study, an individualized occupational therapy-based
      instrumental activities of daily living intervention were implemented for a total of 8 weeks,
      lasting 16 sessions, which included an intervention group (n=9) and a control group (n=9).
      Changes before and after the intervention were assessed with the Lawton-Brody Instrumental
      Activities of Daily Living Scale, Waisman Activities of Daily Living Scale, Modified
      Mini-Mental State Examination Test, SF-36 Health Survey Questionnaire, Perceived Stress
      Scale, and Community Integration Questionnaire.
    

Detailed description: 
      The concept of disability refers to the limitation in activity and social participation and
      loss of function due to the inability to fulfill the roles expected from the people depending
      on the level of development, sex, and social factors resulting from an impairment or
      handicap. The number of people with disabilities is increasing daily in the world, and it was
      determined that 15.6% of the population over 18 has a disability. People with disabilities
      experience problems in activities such as bathing, dressing, eating, shopping, money
      management, preparing food, cleaning, and using drugs, due to physical, cognitive, sensory,
      and psychosocial impairments. The above-mentioned activities are the tasks of everyday life
      called activities of daily living (ADL). ADLs are classified as basic activities of daily
      living (basic ADLs; bathing, eating, toilet, etc.), and instrumental activities of daily
      living (IADLs; shopping, money management, meal preparation, shopping, dog walking, paying
      bills, etc.).

      People with disabilities need IADLs to a large extent in order to continue living more
      independently in the community. IADLs are meaningful and purposeful activities that give
      meaning to people's lives and reflect their social values and cultures. IADLs include
      activities such as taking care of others, using public transport, health management, and
      household chores, and have a more complex structure than basic ADLs. Unlike basic ADLs, IADLs
      require more complex cognitive skills such as planning, organization, decision-making, and
      executive functions, or fine motor, visual sharpness, or hearing skills. In addition, IADLs
      are also affected by contextual factors (age, sex, habits, education, culture, environment,
      etc.) independently of daily living activities. Because IADLs are carried out in many social
      areas outside the home and include activities based on the people's home, work, school, and
      social participation. Factors such as environmental suitability, social stigma, and stress of
      people with disabilities, limit participation in their IADLs and negatively affect their
      quality of life. Therefore, it is seen that low social participation, decreased quality of
      life, and increased perceived stress are closely related to IADL performance problems.

      In the literature, it is seen that intervention methods are used to improve the IADLs of
      people with disabilities. Clarke et al. implemented an 8-week physiotherapy and occupational
      therapy-based intervention program in people with mild and moderate Parkinson's disease
      (n=762). They made individualized practices on sleep, fatigue, personal care, dressing,
      in-home mobility, housework, and environmental problems within the scope of the intervention.
      As a result, it was observed that there was a significant increase in IADL performance, and
      they recommended the use of activity-based intensified intervention programs for future
      studies. In a survey study conducted with 105 hand therapists in the USA, 97% of therapists
      stated that interventions that include meaningful and purposeful activities would be more
      beneficial for people with upper extremity problems, rather than traditional intervention
      programs using physical agent modalities or progressive resistance exercises. Egan et al.
      reported a significant increase in the performance and satisfaction levels of self-care,
      productivity and leisure activities of the therapy group in the activity-based intervention
      program applied to improve the occupational performance of 16 people with stroke. Studies
      with high levels of evidence have emphasized that the use of the daily living activities in
      intervention programs improves the quality of life of people with disabilities. Politis et
      al. implemented a 4-week kit-based intervention that included activities of daily living for
      37 people with dementia. As a result of the intervention, it was found that the increased
      quality of life and decreased apathy in people with dementia. It has been stated that the use
      of kits in intervention programs is relatively inexpensive compared to traditional
      intervention programs, it is colorful and interesting, is enthusiastically welcomed by
      people, and it is easy to build. In another study, it was determined that 10 activity kits
      used to improve the leisure activities of people with Alzheimer's and dementia living in
      nursing homes increased the quality of life of people.

      In occupational therapy, Dy and Yancosek, who developed IADLs kits consisting of daily living
      activities, created an 8-week intervention program within the scope of hand rehabilitation.
      Activity kits were used to examine the personal opinions of occupational therapists in terms
      of the ease of application of the kits before and after they were applied to people. As a
      result, the use of activity kits in evaluation and interventions has been suggested because
      they are easy and functional compared to biomechanical intervention programs. Berlet and
      Kaskutas prepared 10 activity kits in the hand therapy clinic for 642 people who have
      undergone hand surgery, for the areas of basic and instrumental ADLs where they have the most
      difficulty. They sent the prepared kits to 30 occupational therapists working in the fields
      of hand and community rehabilitation and received their opinions about these kits.
      Occupational therapists stated that the kits eliminate the waste of time in building the
      materials to be used during the intervention and increase the efficiency of the intervention
      as it deals with the occupational performance of the kits.

      In the systematic reviews, it is seen that studies examining the effects of interventions for
      IADLs are more common in the elderly and that IADL interventions for people with disabilities
      are limited. In addition, in studies with IADL kits, programs that develop fine motor skills
      were focused on. According to the studies, it was thought that the proposed IADL
      interventions to increase the independence of individuals with disabilities should be planned
      with a new approach. Therefore, it was aimed to examine the effect of the intervention to be
      made with the kits created for IADLs on people with disabilities. Specifically, The aim of
      this study was to investigate the effect of occupational therapy-based instrumental
      activities of daily living intervention on stress levels, quality of life, and participation
      in people with disabilities.
    

Intervention name(s): occupational therapy-based instrumental daily living activities intervention; Quite recreation activity
Intervention type(s): Other; Other
Intervention description(s): Occupational therapy-based instrumental activities of daily living intervention were applied to 9 people with disabilities in the intervention group, with sessions consisting of 45 minutes twice a week (totally 8 weeks/16 sessions). While the activity intervention program was being created for the intervention group, the problem areas in the ADL and IADL determined by the evaluations made before the intervention were identified. Ten occupation kits including 2 ADLs (dressing and feeding nutrition), and 8 IADLs (laundry, meal preparation, light cleaning, paperwork, use of technology, lifting and carrying, fine motor and gross motor leisure groups) were used as interventions. Various materials (jar, shirt, spoon, teapot, play dough, stapler, plastic bag, sponge, etc.) were prepared to be used in each occupation kit and to simulate daily activities.; For the control group, information about the scope, duration and requirements of the research was shared throughout the process. During this period, reading activities continued. The final evaluation of all participants was made at the end of the 8th week of the study and the study was completed.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Participation; Stress Level; Quality of Life; Instrumental Activities of Daily Living