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   2021| January-March  | Volume 53 | Issue 1  
    Online since June 22, 2021

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Occupational Therapy for Reducing Disabilities in Persons with Disabilities in India: A Systematic Review
Sureshkumar Kamalakannan, Manigandan Chockalingam, Lakshmanan Sethuraman, Shobana Devi Moorthy, Thirumugam Muthuvel
January-March 2021, 53(1):4-14
Background: The current evidence for occupational therapy practice, teaching, and research is replicated and implemented significantly from high-income countries in India. Therefore, a systematic review and an evaluation of existing evidence for occupational therapy (OT) to reduce disabilities including impairments, activity limitations, and participation restriction in persons with disabilities (PWD) in India are warranted. Objectives: The objective of this review was to evaluate the effectiveness of OT interventions for reducing disabilities in PWD in India. Study Design: Systematic review. Methods: We searched the Cochrane CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, AMED, and Web of Science. A hand search was also carried out in selected Indian journals, OT-specific databases, and repositories, such as Indian Journal of Occupational Therapy, Indian Journal of Physiotherapy and Occupational Therapy, OT Seekers, World Federation of Occupational Therapy Bulletin, Asia Pacific Occupational Therapists Regional Group, and clinical trials registers. The search was restricted to published studies conducted in India during 2000–2021. We included randomized controlled trials (RCTs) of an occupational therapy intervention delivered by OTs for PWD, where the effects of the intervention were evaluated using any relevant disability outcome measure. Studies without access to full text were excluded. Two review authors independently completed screening, and one author reviewed the full text of the screened studies. Another pair of authors extracted data from included studies for prespecified disability outcomes, and two authors assessed the risk of bias in the included studies. Results: We identified seven RCTs of occupational therapy interventions for PWD in India with 305 participants in total. All seven studies were very different in terms of their objective, participants, comparison, and outcomes. Allocation concealment and blinding and risk of bias were high in five trials. All the trials reported impairment outcomes with a statistically significant difference between the experimental arm and the control arm in terms of their primary outcomes except one. Given the sample size and the risk of bias in each of the included trials, the effect size has to be understood and interpreted with utmost caution. Conclusion: Overall, this review establishes the paucity of evidence for occupational therapy for PWD in India. Building the capacity for rigorous and relevant scientific research in occupational therapy would enable bridging the gaps in evidence for occupational therapy in India.
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Scope of practice boundary violation in occupational therapy: An online survey of practitioners' perceptions in India
Karthik Mani
January-March 2021, 53(1):15-22
Background: Occupational therapy (OT) practice in India is yet to be regulated at the national level. This presents a significant challenge to the OT community in India as it would be difficult for them to defend themselves if other professionals violate the scope of practice (SOP) boundaries. Objectives: The aim is to explore the views of occupational therapists (OTs) related to the issue of SOP boundary violation in OT practice in India. Study Design: An online survey research design was chosen to conduct this study. A 10-item electronic survey (9 with response options and one open ended) was developed based on the research question. Methods: An online survey link generated through SurveyMonkey was E-mailed to 760 OTs in India, identified through convenient sampling. The survey link was also shared on four WhatsApp Messenger groups (TNAIOTA Official Group, OTist Group, Clinic OT, and IPOTPDG1) with many Indian OTs (snowball sampling). Data were collected from January 29, to February 29, 2020. Results: The number of responses received was 126. One hundred and nine (87%) respondents believed that other professionals encroach OT's SOP boundaries knowingly or unknowingly. This belief is strong among all OTs across the nation, regardless of gender and practice experience. Conclusions: Many OTs in India believe that individuals belonging to other professions step into the domain of OT knowingly or unknowingly. Enacting an OT practice legislation, establishing a regulatory body at the national level and increasing them at state levels, endorsing an official SOP document, educating stakeholders, and engaging in awareness promotion initiatives would help mitigate the issue to a great extent. Ongoing and strategic efforts by the OT community in India are warranted.
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Effect of occupational therapy on cognitive functions and occupational performances in hospitalized patients with mental-health disorder: A single-arm interventional study
Pooja Pankaj Mehta
January-March 2021, 53(1):23-30
Background: Cognitive dysfunction, a distressing outcome of mental-health disorders (MHDs), hinders an individual's occupational performance (OP). OP is the outcome of dynamic interaction between a person, their unique environment and occupation. With only pharmacological treatment, symptom reduction was not in pace with the recovery rate of cognitive and OP dysfunction resulting persistence of these dysfunctions even post-hospital discharge. Hence, occupational therapy (OT) intervention before discharge would be required, for patient's functioning at premorbid level postdischarge. However, till date, very few Indian studies on the effect of OT on cognition and OP in individuals with MHDs are done with under-representation of the client population. Objectives: To study the effect of OT on cognitive functions and OP in hospitalized patients with MHDs. Study Design: A single-arm interventional study was conducted. Methods: Based on the selection criteria, 88 patients who were (aged 18–55 years) diagnosed with MHDs and were admitted in the hospital were enrolled after screening during their first visit to OT department using the purposive sampling method. Participants recruited were categorized into diagnostic groups: schizophrenia, neurotic disorders, mood disorders, and alcohol-substance use disorders for data analysis. Patients were assessed on Mini-Mental State Examination (MMSE) and comprehensive OT evaluation (COTE) scale pre- and post-therapy after 3 weeks, i.e. after 6 sessions. Cognitive-OP focused-OT intervention was given twice a week. Results: The descriptive data analysis showed an increase in performance posttherapy for all subtests (except Language-praxis subtest in Group-Neurotic Disorders) and overall scores of both assessments in all the groups. Total MMSE performance both pre- and post-therapy was better than total COTE performance in all the groups. Posttherapy, maximum improvement was observed in Recall among MMSE subtests and in Task-behavior among COTE subtests across all groups. Inferential data analysis showed highly significant improvement posttherapy for total MMSE and total COTE scores (P < 0.01, 95% confidence interval: Groups: schizophrenia [(−3.218, −2.302) and (15.991, 18.329)], neurotic disorders [(−3.169, −1.631) and (13.230, 18.970)], mood disorders [(−3.100, −1.650) and (15.095, 19.155)] and Group: alcohol and substance-use disorders [(−4.210, −1.456) and (17.855, 22.47)] respectively). Conclusion: OT intervention is effective in improving cognitive and OP in hospitalized patients with MHDs.
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Rehabilitation outcomes of persons with severe traumatic brain injury: A cross-sectional survey
CatherineJudithHossanna , Selvaraj Samuelkamaleshkumar, Ranjan Aruna, Suresh Annpatriciacatherine, Stephen Reethajanetsurekha, Arumugam Elango
January-March 2021, 53(1):31-38
Background: The recent literature regarding functional outcomes and the effectiveness of rehabilitation for persons with severe traumatic brain injury (TBI) suggests that these patients are capable of significant functional recovery over a period of months to years after injury. However, the researches concerning this are very limited. Therefore, this study has been conducted to study the rehabilitation outcomes in persons with severe TBI. Objective: To study the rehabilitation outcomes of persons with severe TBI who have completed 8–16 weeks of residential, postacute rehabilitation. Study Design: A cross-sectional survey study design was chosen. Methods: This study was done in Rehabilitation center of Christian Medical College, Vellore. Forty-two patients with severe TBI who completed rehabilitation from January 2014 to November 2016 were selected for this study. Usual care was provided to the participants in a transdisciplinary service delivery model. The Wessex Head Injury Matrix (WHIM), Coma Recovery Scale Revised (CRS-R), Addenbrooke's Cognitive Examination-III (ACE-III), Modified Barthel Index (MBI), Disability Rating Scale, and Community reintegration Questionnaire (CIQ) were used based on the International Classification of Functioning framework to assess the functional gains achieved during and after the rehabilitation process that include admission, discharge, and follow-up. Results: Significant improvements in CRS-R (confidence interval [CI]: −2.879 to − 0.741; P = 0.000), WHIM (CI: −10.42 to − 2.96; P = 0.000), ACE-III (CI: −8.23 to − 26.15; P = 0.000), and MBI (CI: −15.32 to − 39.18; P = 0.000) were found from admission to discharge. A significant change in disability was observed at discharge (CI: 3.79–6.07; P = 0.000) and at follow-up (CI: 0.87–1.75; P = 0.000). Marital status was influencing the CRS-R (CI: −0.82–6.79; P = 0.011) and the WHIM scores (CI: −0.619–14.12; P = 0.047). The mean follow-up CIQ score was 9.77 (standard deviation = 7.01). Only socioeconomic status was influencing CIQ (CI: 2.90–12.98; P = 0.003). Conclusion: Participants showed significant functional gains after the residential, post-acute rehabilitation program. These functional gains were not reflected in their community reintegration.
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National commission for allied and health-care professions act 2021 and the central council of occupational therapy
Anil Kumar Srivastava, Neeraj Mishra
January-March 2021, 53(1):1-3
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Behavioral intervention for bladder control and its impact on quality of life in persons with traumatic paraplegia: A one-arm interventional study
Aradhana Nayak, Ram Kumar Sahu
January-March 2021, 53(1):39-43
Background: Injury to spinal cord results in many neurological problems, and bladder dysfunction is one of the major factors affecting quality of life (QOL). Improvement in bladder control leads to improvement of psychosocial well-being related to urinary incontinence, thereby enhancing QOL. The effect of behavioral intervention (BI) on bladder control is well documented in patients with urinary incontinence. However, very few evidences are available on its effect in patients with traumatic paraplegia in Indian context. Objectives: The study objective was to determine the effect of BI on bladder control and QOL in patients with traumatic paraplegia and to find the relationship between status of bladder control and QOL. Study Design: This was a one-arm interventional study design. Methods: Initial screening was done by using the American Spinal Injury Association (ASIA) Impairment Scale, and thirty six traumatic paraplegics were recruited for the study. BI along with traditional bladder management was provided to them for 8 weeks, and after this period, home exercise program was prescribed. Pre- and postintervention data were recorded using Urogenital Distress Inventory short form (UDI-6) and Incontinence QOL (IQOL). Follow-up data were recorded 6 months after completion of intervention to measure the retention effect. Results: Friedman test showed a significant difference (P = 0.000 and 95% confidence interval [95% CI]: 0.000–0.080) across preintervention, postintervention, and follow-up data for both outcome measures. Post hoc Wilcoxon signed-rank test showed a significant difference (P = 0.000 and 95% CI: 0.000–0.080) between preintervention and postintervention scores as well as preintervention and follow-up scores for both the outcome measures. No significant difference was noted on analysis of postintervention and follow-up scores (P=0.472 and 95% CI: 0.026-0.052) for UDI-6 and (P=0.743 and 95% CI:0.000-0.0130) for IQOL. When preintervention scores of UDI-6 and IQOL were correlated using Kendall's tau correlation coefficient, it gave a high negative correlation (−0.725), which implied that the poorer status of bladder control is related to poorer QOL. Conclusion: BI was an effective technique in improving bladder control, aid to faster improvement when used along with other traditional bladder management techniques in patients with traumatic paraplegia leading better QOL seen over a period of 6 months.
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National Commission for Allied and Healthc are Professions Bill 2021

January-March 2021, 53(1):44-46
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