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Biomedical subjects

M B Holm

Publications and source records attributed to M B Holm.

At least 19 recordsLinked to original sources
PubMed2001

Task independence, safety, and adequacy among nondisabled and osteoarthritis-disabled older women.

OBJECTIVE: To examine the constructs of task independence, safety, and adequacy. METHOD: Fifty-seven nondisabled (ND) and 56 osteoarthritis-disabled (OAK) women were observed performing daily tasks. RESULTS: Intercorrelations among the constructs of independence and adequacy were uniformly high, while the relationship of safety to these constructs was moderate and more variable, although stronger in the OAK group. Task performance of the OAK group was consistently less adequate and independent than that of the ND group; however, the groups were generally equivalent in safety. For individual tasks, adequacy best differentiated between the groups. In both groups, those who performed independently also performed safely, but fewer independent OAK participants also performed totally adequately. CONCLUSION: The majority of older women who perform tasks independently also perform them safely and adequately; for a clinically significant minority, independence is not always synonymous with safe and adequate performance. Patients may be placed at risk if independence is the only construct used to determine disability.

Activities of Daily Living↗
PubMed2000

Excess disability during morning care in nursing home residents with dementia.

Excess disability was examined in 17 nursing home residents with dementia by comparing their performance of morning care tasks under two activities of daily living (ADL) caregiving approaches-a dependence-supportive one under usual care and an independence-supportive one under functional rehabilitation. The results suggest that excess disability in severely cognitively impaired and functionally disabled residents can be reduced by increasing opportunities for independent activity, and substituting nondirective and directive verbal assists for physical assists. Further, the findings indicate that increased independence in ADL can be achieved without increasing disruptive behaviors and can foster appropriate requests for task-related help during caregiving. Functional rehabilitation, however, requires more time than usual care.

Activities of Daily Living↗
PubMed1999

Improving morning care routines of nursing home residents with dementia.

OBJECTIVES: This study examined the effectiveness of a behavioral rehabilitation intervention for improving the performance of morning care activities of daily living (ADL) of nursing home residents with dementia. DESIGN: Participants and their caregivers were observed for 5 days each under conditions of Usual Care (naturalistic) and Skill Elicitation (intervention), and for 15 days under Habit Training (intervention follow-up). Observations involved the ADL categories of DRESSING, OTHER ADL, and NO ADL. A 3 x 3 design (condition x ADL category) was used. SETTING: Observations occurred in five proprietary nursing homes in Pittsburgh, Pennsylvania. PARTICIPANTS: The participants were 58 women and 26 men, mean age 82 years (range = 64-97, SD = 6.3), with Probable Alzheimer 's disease (AD) (n = 19) and Possible AD (n = 65), with a mean MMSE score of 6.07. INTERVENTION: Condition 1, Usual Care, was the naturalistic caregiving condition. Condition 2, Skill Elicitation, consisted of an individualized behavioral rehabilitation intervention designed to identify and elicit retained ADL skills. Under Condition 3, Habit Training, the behavioral rehabilitation intervention was continued to reinforce and solidify retained skills and to facilitate further functional gains. MEASUREMENTS: A computer-assisted data collection system was used to document in real-time the assists used by caregivers, the participants' ADL performance, and the participants' responses to caregiving, including disruptive behavior. RESULTS: Compared with Usual Care, during Skill Elicitation participants increased the proportion of time engaged in nonassisted and assisted dressing significantly and increased their overall participation in ADL, with a concomitant significant decrease in disruptive behavior. These functional gains were demonstrated within 5 days of initiating the behavioral rehabilitation intervention and were maintained for 3 weeks during Habit Training. Physical assists were provided for significantly smaller proportions of a morning care session during Skill Elicitation and Habit Training compared with Usual Care. CONCLUSIONS: Even very severely cognitively impaired and functionally disabled nursing home residents can respond to a systematically implemented behavioral rehabilitation intervention. Their rapid response to this intervention suggests that it is alleviating excess disabilities brought on by care patterns rather than retraining ADL task performance. Residents with dementia benefit from behavioral rehabilitation by becoming more appropriately involved in their care and being less disruptive. However, behavioral rehabilitative care takes considerably more time than usual care.

Activities of Daily Living↗
PubMed1999

Observational data collection using computer and manual methods: which informs best?

Computer and manual systems were used simultaneously to record observations of nursing home residents with dementia during a study designed to improve their dressing performance. This article differentiates the overlapping and unique features of the two data collection systems and discusses the clinical and research utility of each system. Although the computer system was more suited to clinical research and the manual system to clinical practice, when used in tandem each system provided data about the residents' performance that could be used for both clinical research and clinical practice, and complemented or expanded upon data generated by the other system.

Activities of Daily Living↗
PubMed1998

Predictors of functional disability in patients with rheumatoid arthritis.

OBJECTIVE: Using the World Health Organization's classification system of the consequences of disease, this study sought to examine the impact of physical and psychological impairment variables, beyond that contributed by social, demographic, and disease variables, on the functional disability of a rheumatoid arthritis (RA) sample. Data collected during an acute episode were used to predict concurrent and future disability status. METHOD: A secondary data analysis of 85 adults hospitalized for exacerbations in arthritis was undertaken. Disability was assessed with the Health Assessment Questionnaire. Physical impairment was measured with the Keitel Function Test and Pain Analog Scales, and psychological impairment was measured with the Center for Epidemiologic Studies Depression Scale and the Perceived Self-Efficacy Scale for People with Arthritis. RESULTS: Our findings indicated that physical impairment, demographic, and disease variables accounted for 64% of the explained variance in disability during the concurrent episode. Psychological impairment as well as demographic and disease variables accounted for 49% of the explained variance in future disability status. CONCLUSION: The combined influence of demographic characteristics and the consequences of the pathology of RA experienced as physical and psychological impairments contributed differentially to disability during concurrent and future time periods.

Activities of Daily Living↗
PubMed1997

Evaluation of daily living tasks: the home care advantage.

Occupational therapists working in home care have an advantage over those working in other settings because they can observe the influence of the naturalistic context on task performance. However, to use this advantage, therapists working in home care must use an evaluation approach that enables them to capture the client-task-context transaction. In this article, we discuss the ability of four "evaluation approaches"--norm-referenced, criterion-referenced, dynamic, informal--to provide information about the client-task-context transaction that therapists need in order to plan effective intervention. The potential of each approach for identifying clients' performance problems, suggesting etiologies, determining rehabilitation potential, and guiding intervention is analyzed, and the appropriateness of each approach for application in the home is appraised. This analysis highlights the utility of combining the criterion-referenced and dynamic assessment approaches for use in home care. A sequential process for integrating these two approaches is provided, and the proposed outcomes to be obtained from this process are identified.

Activities of Daily Living↗
PubMed1997

A pilot study of the theoretical and technical competence and appropriate education for the use of nine physical agent modalities in occupational therapy practice.

OBJECTIVE: This study described occupational therapy practitioners' perceptions about the content and method of training or education necessary for gaining theoretical and technical competence in the use of nine physical agent modalities (PAMs). METHOD: A survey was developed and sent to 543 members of the Physical Disabilities Special Interest Section of the American Occupational Therapy Association who had identified their primary area of practice as hand therapy. One hundred and fifty-one completed surveys (28% response rate) were returned. RESULTS: The respondents indicated that theoretical and technical expertise necessary for competent use of PAMs varied according to the type of modality being considered. Continuing education courses were identified as the best method for gaining theoretical and technical competence for the use of deep thermal agents, such as ultrasound and electrical stimulation agents, whereas entry-level professional education and one-the-job training were identified as most appropriate for superficial thermal agents, such as paraffin bath and hot and cold packs. CONCLUSION: The results suggest that considerations regarding the type and amount of education necessary for gaining theoretical and technical competence in the use of PAMs depend on the type of modality being addressed. These differences should be considered in the future development of competency objectives for the use of PAMs.

Adult↗
PubMed1997

Prediction of academic and clinical performance of occupational therapy students in an entry-level master's program.

OBJECTIVE: The relationships between clinical outcomes and predictors used to screen applicants for entrance into a Master in Occupational Therapy (MOT) program were examined. METHOD: MOT student records from 1986 to 1992 were used to gather data for three dependent variables and six predictor (independent) variables. The dependent variables used to gauge student success were grade point average in occupational therapy courses (OT-GPA), client attendance at an on-site clinic, and therapy outcomes of clients at that clinic. The predictor variables were undergraduate GPA, scores on the three sections of the Graduate Record Examination, reference forms, and essays. RESULTS: The models used to predict OT-GPA and therapy outcomes were significant (p < .05), and the incremental validity of several predictors was established. The model used to predict client attendance was not significant. CONCLUSION: The findings regarding OT-GPA support the continued use of all the predictors except the reference forms. Although it was possible to develop a model to predict client outcomes, the usefulness of the model is difficult to interpret.

Achievement↗
PubMed1996

Perceptions of computer literacy among occupational therapy students.

OBJECTIVE: Educational programs for the occupational therapist and the occupational therapy assistant are mandated to include content on technologies in their curricula. Given the increasing use of technology skills among occupational therapists, especially computer technology skills, it seemed judicious to ascertain the current and desired levels of skill of occupational therapy students as well as their opinions about computer technology. METHOD: Program directors from five baccalaureate-level curricula distributed the Computer Opinion Survey and the Computer Knowledge Survey to 109 junior and senior occupational therapy students. The students were instructed to complete and return questionnaires to their program directors who, in turn, forwarded the questionnaires to the principal investigators. RESULTS: Respondents were generally positive about computer technology, and the level of knowledge they desired about computer technology applications in occupational therapy was much greater than their current level of knowledge. Although respondents' positive attitudes were significantly correlated with their current levels of computer knowledge, no significant relationship was established among positive attitudes, current levels of computer knowledge, and number of computer courses completed before entering an occupational therapy curriculum. CONCLUSIONS: Even though the respondents were computer literate (i.e., they had a general working knowledge of the uses, limitations, and impact of computers), no relationship was established between their previous computer course work and their current knowledge of the use of computer technology in occupational therapy. The linkage between generic computer literacy and knowledge of its relationship to the use of computer technology in occupational therapy was not evident to this sample of junior and senior students.

Adult↗
PubMed1996

Comparison of standard and alternative health assessment questionnaire scoring procedures for documenting functional outcomes in patients with rheumatoid arthritis.

OBJECTIVE: To compare statistical properties of data from the Health Assessment Questionnaire (HAQ) with those from an alternative version (AHAQ) that used a different scoring system for the item categories and disability index. Comparisons included descriptive statistics, correlations, and inferential statistics to determine whether the AHAQ would be a more sensitive measure of change in functional status. METHODS: The subjects were 107 adults diagnosed with rheumatoid arthritis and hospitalized for exacerbations in their arthritis or arthritis related joint surgery. Disability was assessed upon admission to hospital and at one year followup with the HAQ. AHAQ scores were generated for the item categories making up the disability index by taking the mean of the item scores in a category instead of the worst item score; the disability index was the mean of the alternative category scores. RESULTS: The standard method of scoring the HAQ was found to generate greater variance on category scores, lower correlations between category scores and the total disability index, and lower correlations between first and 2nd administrations of the instrument, compared to the AHAQ. HAQ disability index scores also correlated slightly lower than those of AHAQ to scores from the HAQ pain scales, and to scores from 2 other measures of functional disability. In addition, the AHAQ was found to be more powerful in detecting functional changes at one year followup. CONCLUSION: Because of its statistical properties the AHAQ scoring method may be preferable to the HAQ method when the instrument is used for documenting change in functional outcomes.

Aged↗
PubMed1994

The effect of music on repetitive disruptive vocalizations of persons with dementia.

OBJECTIVE: This study examined the effect of classical music and favorite music on the repetitive disruptive vocalizations of long-term-care facility (LTCF) residents with dementia of the Alzheimer's type (DAT). METHOD: Three subjects diagnosed with DAT who had a history of repetitive disruptive vocalizations were selected for the study. Three single-subject withdrawal designs (ABA, ACA, and ABCA) were used to assess subjects' repetitive disruptive vocalizations during each phase: no intervention (A); relaxing, classical music (B); and favorite music (C). RESULTS: Classical music and favorite music significantly decreased the number of vocalizations in two of the three subjects (p < .05). CONCLUSION: These findings support a method that was effective in decreasing the disruptive vocalization pattern common in those with DAT in the least restrictive manner, as mandated by the Omnibus Budget Reconciliation Act of 1987.

Aged↗
PubMed1994

Reinjury prevention follow-through for clients with cumulative trauma disorders.

OBJECTIVES: Fifteen subjects with upper extremity work-related cumulative trauma disorders were involved in a quality improvement study to determine their self-reported degree of follow-through with reinjury prevention regimens. The effect of cuing was also studied. METHOD: During occupational therapy, subjects were involved in an educational session that focused on recommendations in ergonomic equipment, therapeutic maintenance techniques, body mechanics, and work simplification techniques. Follow-through with reinjury prevention education was evaluated and rated via telephone interviews approximately 2 weeks (T1) and 4 weeks (T2) after the educational session. Subjects did not know the questions they would be asked at T1, but were cued that their progress would be checked again at T2. Dependent t tests were conducted to compare the mean number of recommendations for which complete follow-through was expected with the mean number of recommendations at T1 and T2 that were implemented completely. RESULTS: A significantly lower degree was found of absolute completion of recommendations at T1 and T2 than had been anticipated (p < .002). No significant difference between T1 and T2 was found, indicating that cuing at T1 had little effect on subjects' actual follow-through rate. CONCLUSION: The implications of these findings for occupational therapists support the need for further research in reinjury prevention and employer education.

Adult↗
PubMed1994

Cerebrovascular accident: relationship of demographic, diagnostic, and occupational therapy antecedents to rehabilitation outcomes.

OBJECTIVE: This study was conducted to identify factors that were significant in predicting occupational therapy treatment choices and discharge outcomes after inpatient rehabilitation for 112 patients who had experienced a cerebrovascular accident. METHOD: A retrospective descriptive study was conducted. RESULTS: According to discriminant function analysis, the cerebrovascular accident disability score (i.e., level of functional disability) during the initial evaluation period was the predictor of discharge outcomes with the most clinical significance. A greater proportion of occupational therapy assessment units was the most influential occupational therapy factor associated with a positive discharge outcome. In one inpatient rehabilitation setting, a greater proportion of occupational therapy intervention for all study subjects was directed at the level of impairment compared to the level of disability. CONCLUSION: Shorter inpatient stays, as well as shifts to outpatient rehabilitation, may require occupational therapists to examine whether intervention at the level of impairment or disability yields the best functional outcomes for patients who have sustained a cerebrovascular accident.

Adult↗
PubMed1994

Stability and change in functional assessment of patients with geropsychiatric disorders.

OBJECTIVES: Functional assessments of patients with geropsychiatric disorders accomplished by self-rating, informant rating, and performance test were compared. METHOD: Fifty-eight inpatients with major depression or progressive dementia were evaluated on three occasions over 6 months with informant and patient versions of the Activities of Daily Living Scale of the Older Americans Resources and Services Multidimensional Functional Assessment (OARS-ADL) and with the Performance Assessment of Self-Care Skills (PASS). RESULTS: Patients' scores became significantly worse (p < .01) on the informant version of the OARS-ADL and the PASS. Self-ratings with the OARS-ADL did not worsen significantly (p > .05). CONCLUSION: Agreement between informant rating and performance test concerning functional status of patients with dementia was good. Elderly patients with depression may experience subtle deterioration that only becomes apparent on performance tests.

Activities of Daily Living↗
PubMed1994

Activities of daily living capabilities and values of long-term-care facility residents.

OBJECTIVE: The Minimum Data Set for Nursing Home Resident Assessment and Care Screening was used to compare staff-report and self-report of residents' capabilities in eight activities of daily living (ADLs) in one long-term-care facility (LTCF). METHOD: The relative values residents placed on independence in each of the eight ADLs were compared with their self-reported capabilities in those ADLs. Subjects were 30 LTCF residents ranging in age from 45 to 96 years. RESULTS: Residents perceived themselves to be significantly more capable than did staff members for dressing (p < .05), toileting (p < .01). locomotion (p < .05), and personal hygiene (p < .001). For five of the ADLs, residents tended to report high capability in the ALDs they valued most. CONCLUSION: These findings support the need to include resident self-assessment in treatment planning, because staff members' and residents' perceptions of ADL capabilities may differ.

Activities of Daily Living↗
PubMed1993

Effectiveness of occupational therapy for reducing restraint use in a psychiatric setting.

Patients who received occupational therapy services (OT Group) and those who did not (NOT Group) were compared in a retrospective record review to determine the efficacy of occupational therapy in reducing the need for restraint in a state psychiatric hospital. There were 60 subjects with an Axis I diagnosis in each group who met the qualifications of a continuous 90-day minimum inpatient status during 1990. The amount of time each subject spent in restraint, seclusion, or restraint and seclusion, and free from confinement served as the dependent variables. Results showed no differences between the OT Group and the NOT Group for time spent in confinement. A major limitation in this study was the lack of specificity in the documentation of occupational therapy services.

Adult↗
PubMed1993

Program planning: the clinical utility of three activities of daily living assessment tools.

A jury of five occupational therapy experts was used to evaluate the clinical utility of three activities of daily living assessment tools that were originally designed for purposes other than individualized occupational therapy assessment or program planning. The three tools were the Index of Independence in Activities of Daily Living, PULSES Profile, and Physical Self-Maintenance Scale. Using the results from each tool, scored for a simulated patient with a right cerebrovascular accident, as well as medical information about the patient, the jury members were asked to plan a treatment program. The consensus of the jury was that the results from each tool did not provide enough information to help them identify the patient's specific performance problems or the causes of those problems. Therefore, the three tools were considered to have low clinical utility for planning individualized occupational therapy treatment. For use in planning an individualized treatment program, an activities of daily living assessment tool should provide specific information about which component of a task the patient found difficult or was unable to do and the type and level of assistance required.

Activities of Daily Living↗