AOTA

Stacy Smallfield, DrOT, MSOT, OTR/L, BCG, FAOTA, is Associate Program Director and Capstone Coordinator, Division of Occupational Therapy, College of Allied Health Professions, University of Nebraska Medical Center, Omaha. At the time of the study, Smallfield was Associate Professor of Occupational Therapy and Medicine and Assistant Director, Occupational Therapy Entry-Level Professional Programs, Washington University School of Medicine, St. Louis, MO

Lea Fang, OTD, OTR/L, is Occupational Therapist, SSM Health Physical Therapy, St. Louis, MO. At the time of the study, Fang was Doctoral Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO

Darby Kyler, OTD, OTR/L, is Occupational Therapist. At the time of the study, Kyler was Doctoral Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO

Credit: .1 AOTA CEU (1.25 NBCOT PDU/1 contact hour)

Objectives:

1. Understand the effects of chronic conditions on ADLs, rest and sleep, and emotional health in adults 

2. Discuss occupational therapy's role in self-management for adults with diabetes and other chronic conditions to increase independence and self-efficacy

3. Identify evidence-based occupational therapy interventions for adults with diabetes and other chronic conditions to improve ADLs and rest and sleep for adults living in community-based settings.

Importance: Chronic conditions often cause functional impairments in activities of daily living (ADLs) and rest and sleep, leading to decreased independence and self-efficacy.

Objective: To aid occupational therapy practitioners in making informed decisions regarding self-management interventions to improve ADLs and rest and sleep for community-dwelling adults with chronic conditions.

Data Sources: We identified literature published from 1995 to 2019 through searches of the Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, CINAHL, and OTseeker. Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to abstract and assess data quality and validity. The review followed American Occupational Therapy Association Evidence-Based Practice Project methodology. Studies addressing self-management interventions for community-dwelling adults ages 18 and older with chronic cardiovascular disease, Type 2 diabetes, heart disease, hypertension, chronic respiratory problems, or kidney disease were included. Findings: Fifteen articles met inclusion criteria and were categorized into ADLs and sleep. Strong evidence supports education to improve diabetic foot self-care. Low evidence addresses exercise and education to improve ADLs for people with heart disease and chronic obstructive pulmonary disease. Moderate evidence supports mind–body self-care education to enhance sleep.

Conclusions and Relevance: Occupational therapy practitioners working with adults with diabetes are encouraged to routinely offer education that includes discussion of risk factors and daily foot inspections and hygiene. When addressing sleep, education that addresses sleep hygiene, nutrition, relaxation techniques, and physical activity should routinely be provided to adults with chronic conditions. Further research is needed to understand the dosage needed.

What This Article Adds: This systematic review supports the role of occupational therapy in providing self-management interventions to address ADLs and sleep for adults with diabetes and other chronic conditions.

Chronic conditions, such as diabetes, heart disease, stroke, cancer, and obesity, are the leading and most preventable causes of death and disability (Centers for Disease Control and Prevention [CDC], 2019). Chronic conditions account for 75% to 90% of total health care spending in the United States (CDC, 2020; Lewin Group, 2010; Moses et al., 2013). Depending on the type of condition or course of the illness, physical changes from a chronic condition may cause functional impairments, leading to decreased independence and self-efficacy (American Occupational Therapy Association [AOTA], 2015; Kim & Choi, 2015; Maresova et al., 2019). Occupational therapy practitioners who work with adults with chronic conditions have an important role in addressing participation in meaningful daily activities (AOTA, 2015). The focus of this review is on the occupations of activities of daily living (ADLs) and rest and sleep. ADLs, including bathing, toileting, dressing, eating, and personal hygiene and grooming, are an important aspect of everyday life for adults. These activities are “fundamental to survival and to living in a social world” because they are Citation: Smallfield, S., Fang, L., & Kyler, D. (2021). Self-management interventions to improve activities of daily living and rest and sleep for adults with chronic conditions: