CORRIENTES CLÁSICAS
STERNBERG Y LUBART (1997)
5.5.1 Environmental setting
The location of the occupational therapy intervention can depend on the personal possibilities of the patient, the intervention goals and the availability of occupational therapy in the
patient’s area. However, the question is what specific considerations apply to PwPs. Key question 24
Scientific basis
In addition to the finding that the occupational performance of PwPs is influenced by the environment and context, it is also reported that their ability to generalize is usually limited (41;42;158). For these reasons, experts state that it is best for training at the activity level to take place in the patient’s own environment (41;42).
One study has specifically focused on evaluating the effect of a home-based physical therapy intervention on the quality of walking and transfers at home and in the hospital (196). This study found that the quality of transfers and walking at home had improved (p<0.0007, total score on Parkinson Activity Scale 12.6% increase) six weeks after stopping the intervention. In the hospital, the improvement was far less significant (p= 0.03, total score Parkinson Activity Scale 5% increase). This study underscores the opinion of experts that the training effect is context-specific.
Conclusion
Level 3 There are indications that learned motor skills are better performed in the environment in which the PwP has practiced them.
B Nieuwboer, 2001
Other considerations
Occupational therapy intervention goals are aimed at maintaining or improving meaningful occupational performance and this is connected to the context in which the patients live and work. In light of the above conclusion, interventions in which skills and activities are practiced seem most appropriate in the context in which the occupational performance normally takes place.
Recommendation 24
It deserves recommendation to conduct the occupational therapy sessions in the relevant context (home, leisure or working environment) if the interventions are directed at improving activity performance or skills.
5.5.2 Time
Key question 25
What is an appropriate time of day for intervention sessions for PwPs with highly fluctuating performance?
Scientific basis
There are no studies which have compared the effectiveness of interventions during the on
Society for Physical Therapy (KNGF), it is recommended that the practicing of activities should take place during both the on phase and the off phase (11).
Conclusion
Level 4 Experts believe that PwPs should practice activities during both the on phase and the off phase.
D Keus, 2004
Other considerations
The working group is of the opinion that the aim of the intervention and the type of
intervention determine the appropriate time of the intervention. It is preferable for strategies or alternatives to optimize occupational performance to be explained and taught during the on
phase because this is when cognitive performance is optimal and the patient is more capable of processing new information. However, the application of alternatives and practice of new skills takes place at moments that the patient needs the strategies or alternatives most and this can be during either the on phase or the off phase.
Recommendation 25
When a PwP experiences response fluctuations, it deserves recommendation to plan the time of intervention such that:
the learning of new strategies preferably occurs during the on phase
the application of strategies and alternatives is preferably practiced at moments when strategies and alternatives are needed by the Pwp
5.5.3 Delivery form
An intervention can take place in groups or individually. Group intervention is usually
financially attractive to the organization. The question is in which situations group intervention or individual intervention provide added value from the perspective of effectiveness.
Key question 26
What delivery format is preferable for the occupational therapy intervention: group intervention or individual intervention?
Scientific basis
There have been no studies which compare the effectiveness of group or individual
intervention on PwPs. Regarding group interventions, an occupational therapy intervention program addressing self-management for PwPs and their caregivers is described in the literature (176). The subjective evaluation of the participating PwPs indicates that contact with other PwPs and learning from one another in the group was positively experienced. Whether this group intervention had a positive effect on the performance in meaningful activities in the patient’s own context has not been studied.
Problems with alternating attention and generalization of learned skills to a new situation influence a PwP ability to learn (see scientific basis in Section 5.3). Considering this, the working group concludes that when the patient is required to apply performance skills in activities in his own context, individual intervention can be more effective than group intervention.
Conclusion
Level n/a The added value of contact with other PwPs during a group intervention has not been studied regarding results in improved performance in meaningful activities in the patient’s own context.
Level 4 The working group believes that, for PwPs, individual intervention is more effective than group intervention for learning to apply performance skills in activities in the patient’s own context.
D working group
Other considerations
The working group is of the opinion that group interventions can be useful when they involve the transfer of knowledge (e.g. what occupational therapy can offer or Parkinson’s disease in relation to meaningful occupational performance) or the mutual sharing of knowledge and experiences. From practical experience, however, the working group observes that for some patients contact with other patients has a negative influence (i.e. when attention is severely affected)
Recommendation 26
Individual interventions are preferable above interventions in a group setting when interventions are directed at training occupational performance skills in activities.
Group intervention can be considered for programs that are aimed at providing information and exchanging experiences about general disease related problems or topics.