The Effect of Occupational Therapy-Based Instrumental Activities of Daily Living Intervention in People With Disabilities

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.

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.

Eligibility Criteria:
Inclusion Criteria:

* were to be 18 years of age or older,
* to have a score of 17 and below according to the Lawton-Brody Instrumental Activity of Daily Living Scale,
* to have a score of 24 and above in the Modified Mini-Mental test.

Exclusion Criteria:

* not participating regularly in the intervention program.
* Having a communication problem that prevented the participant from completing the assessment and the kits;