Quality of Occupational Therapy Research in India - A Descriptive Review.

Background: Occupational therapy (OT) enhances functional independence in the daily activities of people with disabilities and subsequently their quality of life. Research in OT generates evidence to provide safe and effective services to the disabled. However, OT research in India has been shown to have various methodological limitations. These methodological limitations are expected to impact the quality of OT research as well as the evidence derived from this research to inform decision-making in rehabilitation. The majority of the OT research is disseminated and promoted through the All India Occupational Therapists' Association's (AIOTA) annual national conference (ANC). Analyzing the abstracts, selected for the presentation at the ANC could help understand and strategically improve the quality of OT research in India. Objectives: To explore and describe the quality of OT research in India. Study Design: Descriptive analysis. Methods: Descriptive, nonsystematic review and analysis of the key methodological aspects of the conference abstracts submitted for the AIOTA ANC published in the Indian Journal of OT (IJOT) from 2017 to 2021 was carried out. Information related to the methodological aspects of the research abstracts was extracted using a data extraction form and the data were synthesized and reported descriptively. Results: About 218 abstracts had been selected for either poster or oral presentations in the AIOTA ANC. All the abstracts were included for the review. A total of 8055 participants were recruited for the studies conducted from 2017 to 2021. About 5757 (72%) of the participants were recruited for cross-sectional studies. Nearly 72 (33%) of the abstracts presented were related to cross-sectional studies, 52 (24%) were case studies and 66 (30%) were experimental studies. However, research designs implying highest level of evidence such as systematic reviews were only 4 (2%) and randomized controlled trials were only 9 (4%) with 297 participants. Notably, 203 (98%) of the all the studies evaluating effectiveness of interventions or aiming to investigate associations reported positive results with statistically significant improvements and associations. Conclusion: The review provides invaluable information related to the quality of OT research in India. It implies the need to improve the scientific rigor of the evidence generated in relation to OT research in India. This review also implies the need for a radical change and strengthening of OT research within OT education and professional practice in India. National and global OT associations need to prioritize good quality OT research by enhancing the research skills and competencies of OTs in India. This could help promote evidence-based OT science and develop the OT profession in the world's second-most populous country. In addition, it is also expected to encourage those OT researchers who have been striving to build OT research standards in India.

Exploring the Research Priorities for Occupational Therapy in India: A Descriptive Review.

Background: Occupational therapists are considered an important workforce for the rehabilitation of persons with disabilities globally. However, in India, the profession is just beginning to gain recognition within the national and state-level systems for health care. One of the reasons for this could be the paucity of specific research related to the development of occupational therapy (OT) and its benefits to the health systems. Therefore, it is of immense public health importance to explore the priorities and gaps in OT research in India. A vast majority of the OT research in India is promoted and disseminated through the All-India Occupational Therapists Association (AIOTA) and its annual national conference (ANC). Objectives: The objective of this study is to descriptively review the conference abstracts of the AIOTA ANC published in the Indian Journal of OT (IJOT), an official publication of the AIOTA, from 2017 to 2021. Study Design: The study design was a descriptive, nonsystematic review. Methods: Review of the abstracts selected for the AIOTA ANC published in the IJOT from 2017 to 2021. A data extraction form was developed and used to synthesize data related to the clinical and demographic characteristics of OT research in India. Results: The search yielded 218 abstracts. State-level trends indicated that close to 85% of the research submissions were from four states and no submissions from the northeastern states until 2020. Nearly 60% of the abstracts were clinical research with OT interventions. About 40% of these research abstracts were related to pediatrics, followed by neurology (17%), musculoskeletal (15%), mental health (10%), and ergonomics and assistive technology (8%). There were 1%-2% of research abstracts submitted related to coronavirus disease-2019 (COVID-19) and geriatrics. About 85% of the research abstracts were related to impairment (39%), activity limitation (26%), and social participation (22%). Conclusion: This review highlights the need for diversifying the research in OT in India. This is particularly important in relation to expanding from selected states to pan-India research and development, especially in the northeastern states. Furthermore, the focus of OT research must move beyond impairments and approach disability from the biopsychosocial perspective. It is also very important to diversify the research in OT to areas that are of public health importance such as COVID-19, geriatrics, noncommunicable diseases, and rehabilitation in health systems. Priority setting for research in OT in India is an important implication of this review.

Comparing algorithms for assessing upper limb use with inertial measurement units.

The various existing measures to quantify upper limb use from wrist-worn inertial measurement units can be grouped into three categories: 1) Thresholded activity counting, 2) Gross movement score and 3) machine learning. However, there is currently no direct comparison of all these measures on a single dataset. While machine learning is a promising approach to detecting upper limb use, there is currently no knowledge of the information used by machine learning measures and the data-related factors that influence their performance. The current study conducted a direct comparison of the 1) thresholded activity counting measures, 2) gross movement score,3) a hybrid activity counting and gross movement score measure (introduced in this study), and 4) machine learning measures for detecting upper-limb use, using previously collected data. Two additional analyses were also performed to understand the nature of the information used by machine learning measures and the influence of data on the performance of machine learning measures. The intra-subject random forest machine learning measure detected upper limb use more accurately than all other measures, confirming previous observations in the literature. Among the non-machine learning (or traditional) algorithms, the hybrid activity counting and gross movement score measure performed better than the other measures. Further analysis of the random forest measure revealed that this measure used information about the forearm's orientation and amount of movement to detect upper limb use. The performance of machine learning measures was influenced by the types of movements and the proportion of functional data in the training/testing datasets. The study outcomes show that machine learning measures perform better than traditional measures and shed some light on how these methods detect upper-limb use. However, in the absence of annotated data for training machine learning measures, the hybrid activity counting and gross movement score measure presents a reasonable alternative. We believe this paper presents a step towards understanding and optimizing measures for upper limb use assessment using wearable sensors.

Return to work status in rehabilitated South Indian persons with spinal cord injury: a cross-sectional survey.

STUDY DESIGN: Cross-sectional, retrospective survey. OBJECTIVE: To find the factors influencing the return to work status (RTW) in persons with spinal cord injury (SCI). SETTING: Tertiary care university teaching hospital, India. METHODS: A total of 109 community-dwelling persons with SCI who had been previously rehabilitated and were residing within a 100 km radius from our rehabilitation center were recruited. The return to work status in addition to the demographic, injury, work, environment, physical, and psychosocial characteristics were self-reported via interview. RESULTS: The return to work rate was 82%. The odds of a return to work post injury was 93 times higher for persons who reported high self-motivation when compared to persons who reported low self-motivation (OR = 93.6, 95% CI 10.5-836.6). The odds of a return to work were nine times higher for persons who reported adequate social support from the family and in the community when compared to those who reported inadequate social support (OR = 8.9, 95% CI 10.5-52.6). Other factors significantly associated with return to work status include younger age at injury, being single, lower level of lesion, vocational training, independence in self-care, and accessibility and mobility to all places. CONCLUSION: Motivation and social support are critical to successful return to work following SCI. Comprehensive multidisciplinary rehabilitation, which targets vocational goals, improvements in individual functioning and mobility, and community access are important for successful employment outcomes.

Cognitive rehabilitation for adults with traumatic brain injury to improve occupational outcomes.

BACKGROUND: Cognitive impairment in people with traumatic brain injury (TBI) could affect multiple facets of their daily functioning. Cognitive rehabilitation brings about clinically significant improvement in certain cognitive skills. However, it is uncertain if these improved cognitive skills lead to betterments in other key aspects of daily living. We evaluated whether cognitive rehabilitation for people with TBI improves return to work, independence in daily activities, community integration and quality of life. OBJECTIVES: To evaluate the effects of cognitive rehabilitation on return to work, independence in daily activities, community integration (occupational outcomes) and quality of life in people with traumatic brain injury, and to determine which cognitive rehabilitation strategy better achieves these outcomes. SEARCH METHODS: We searched CENTRAL (the Cochrane Library; 2017, Issue 3), MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), and clinical trials registries up to 30 March 2017. SELECTION CRITERIA: We identified all available randomized controlled trials of cognitive rehabilitation compared with any other non-pharmacological intervention for people with TBI. We included studies that reported at least one outcome related to : return to work, independence in activities of daily living (ADL), community integration and quality of life. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials. We used standard methodological procedures expected by Cochrane. We evaluated heterogeneity among the included studies and performed meta-analysis only when we could include more than one study in a comparison. We used the online computer programme GRADEpro to assess the quality of evidence, and generate 'Summary of findings' tables. MAIN RESULTS: We included nine studies with 790 participants. Three trials (160 participants) compared cognitive rehabilitation versus no treatment, four trials (144 participants) compared cognitive rehabilitation versus conventional treatment, one trial (120 participants) compared hospital-based cognitive rehabilitation versus home programme and one trial (366 participants) compared one cognitive strategy versus another. Among the included studies, we judged three to be of low risk of bias.There was no difference between cognitive rehabilitation and no intervention in return to work (risk ratio (RR) 1.80, 95% confidence interval (CI) 0.74 to 4.39, 1 study; very low-quality evidence). There was no difference between biweekly cognitive rehabilitation for eight weeks and no treatment in community integration (Sydney Psychosocial Reintegration Scale): mean difference (MD) -2.90, 95% CI -12.57 to 6.77, 1 study; low-quality evidence). There was no difference in quality of life between cognitive rehabilitation and no intervention immediately following the 12-week intervention(MD 0.30, 95% CI -0.18 to 0.78, 1 study; low-quality evidence). No study reported effects on independence in ADL.There was no difference between cognitive rehabilitation and conventional treatment in return to work status at six months' follow-up in one study (RR 1.43, 95% CI 0.87 to 2.33; low-quality evidence); independence in ADL at three to four weeks' follow-up in two studies (standardized mean difference (SMD) -0.01, 95% CI -0.62 to 0.61; very low-quality evidence); community integration at three weeks' to six months' follow-up in three studies (Community Integration Questionnaire: MD 0.05, 95% CI -1.51 to 1.62; low-quality evidence) and quality of life at six months' follow-up in one study (Perceived Quality of Life scale: MD 6.50, 95% CI -2.57 to 15.57; moderate-quality evidence).For active duty military personnel with moderate-to-severe closed head injury, there was no difference between eight weeks of cognitive rehabilitation administered as a home programme and hospital-based cognitive rehabilitation in achieving return to work at one year' follow-up in one study (RR 0.95, 95% CI 0.85 to 1.05; moderate-quality evidence). The study did not report effects on independence in ADL, community integration or quality of life.There was no difference between one cognitive rehabilitation strategy (cognitive didactic) and another (functional experiential) for adult veterans or active duty military service personnel with moderate-to-severe TBI (one study with 366 participants and one year' follow-up) on return to work (RR 1.10, 95% CI 0.83 to 1.46; moderate-quality evidence), or on independence in ADL (RR 0.90, 95% CI 0.75 to 1.08; low-quality evidence). The study did not report effects on community integration or quality of life.None of the studies reported adverse effects of cognitive rehabilitation. AUTHORS' CONCLUSIONS: There is insufficient good-quality evidence to support the role of cognitive rehabilitation when compared to no intervention or conventional rehabilitation in improving return to work, independence in ADL, community integration or quality of life in adults with TBI. There is moderate-quality evidence that cognitive rehabilitation provided as a home programme is similar to hospital-based cognitive rehabilitation in improving return to work status among active duty military personnel with moderate-to-severe TBI. Moderate-quality evidence suggests that one cognitive rehabilitation strategy (cognitive didactic) is no better than another (functional experiential) in achieving return to work in veterans or military personnel with TBI.

Mirror therapy enhances motor performance in the paretic upper limb after stroke: a pilot randomized controlled trial.

OBJECTIVE: To investigate the effectiveness of mirror therapy (MT) combined with bilateral arm training and graded activities to improve motor performance in the paretic upper limb after stroke. DESIGN: Randomized, controlled, assessor-blinded study. SETTING: Inpatient stroke rehabilitation center of a tertiary care teaching hospital. PARTICIPANTS: Patients with first-time ischemic or hemorrhagic stroke (N=20), confined to the territory of the middle cerebral artery, occurring <6 months before the commencement of the study. INTERVENTION: The MT and control group participants underwent a patient-specific multidisciplinary rehabilitation program including conventional occupational therapy, physical therapy, and speech therapy for 5 d/wk, 6 h/d, over 3 weeks. The participants in the MT group received 1 hour of MT in addition to the conventional stroke rehabilitation. MAIN OUTCOME MEASURES: The Upper Extremity Fugl-Meyer Assessment for motor recovery, Brunnstrom stages of motor recovery for the arm and hand, Box and Block Test for gross manual hand dexterity, and modified Ashworth scale to assess the spasticity. RESULTS: After 3 weeks of MT, mean change scores were significantly greater in the MT group than in the control group for the Fugl-Meyer Assessment (P=.008), Brunnstrom stages of motor recovery for the arm (P=.003) and hand (P=.003), and the Box and Block Test (P=.022). No significant difference was found between the groups for modified Ashworth scale (P=.647). CONCLUSIONS: MT when combined with bilateral arm training and graded activities was effective in improving motor performance of the paretic upper limb after stroke compared with conventional therapy without MT.

Community reintegration in rehabilitated South Indian persons with spinal cord injury.

OBJECTIVES: To explore community reintegration in rehabilitated South Indian persons with spinal cord injury (SCI) and to compare the level of community reintegration based on demographic variables. DESIGN: Survey. SETTING: Rehabilitation center of a tertiary care university teaching hospital. PARTICIPANTS: Community-dwelling persons with SCI (N=104). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Craig Handicap Assessment and Reporting Technique (CHART). RESULTS: The mean scores for each CHART domain were physical independence 98+/-5, social Integration 96+/-11, cognitive independence 92+/-17, occupation 70+/-34, mobility 65+/-18, and economic self sufficiency 53+/-40. Demographic variables showed no statistically significant difference with any of the CHART domains except for age and mobility, level of education, and social integration. CONCLUSIONS: Persons with SCI in rural South India who have completed comprehensive, mostly self-financed, rehabilitation with an emphasis on achieving functional ambulation, family support, and self-employment and who attend a regular annual follow-up show a high level of community reintegration in physical independence, social integration, and cognitive independence. CHART scores in the domains of occupation, mobility, and economic self-sufficiency showed lower levels of community reintegration.