Latest in Lifestyle Redesign®
January 2024

LR IRL — Lifestyle Redesign in Real Life

Sprouting new self-care roots

In September of last year, Carmen found herself confronting something that she had long ignored: her type 2 diabetes. She was in recovery following a total hip replacement surgery that almost did not get scheduled due to her blood sugar levels being “too high for surgery”. Up until this point, Carmen had not been concerned about her health; she had some aches and pains but she was able to carry on with her roles as a mother and grandmother without a second thought, and now she was having to confront not only her physical pain, but also the invisible consequences of diabetes.

Carmen was new to the LA General primary care clinic where she met Esequiel Jimenez, the clinic’s OTD resident who provides occupational therapy Lifestyle Redesign services to patients with diagnosed type 2 diabetes and/or hypertension. In their first meeting together, Carmen shared that she had noticed herself being more sedentary since having undergone surgery; she used to be more involved with her grandchildren, enjoyed gardening and knitting, and even joined her husband for short walks in the mornings, however, all of these activities had come to an abrupt stop. At the same time, she was sitting with confusion as to why her diabetes “was a concern” (and almost derailed her plans for surgery). These two key takeaways stood out to Esequiel and served as the foundation from which his therapeutic relationship with Carmen would build upon.

Before Carmen could receive education about diabetes management, Esequiel recognized that it was critical to address her physical safety, specifically, considerations related to her recent hip surgery. Together they reviewed anterior hip precautions and fall risks within her home environment, something Carmen vaguely remembered doing immediately post-op, however, she noted, this was the first time she was provided personalized visual reminders in her native language: Spanish. This established a sense of trust within the therapeutic relationship they were co-creating and gave Carmen a boost of confidence in her ability to take what she was learning and apply it to her daily life.

The foundation of trust Carmen and Esequiel had built together allowed the pair to productively address the elephant in the room: diabetes. They started with reviewing the basics, such as how diabetes develops, why monitoring blood sugar is so important, and what helps keep blood sugar levels in-range. This was all information Carmen had heard before, to some extent, however, receiving diabetes education through a collaborative, personalized approach helped Carmen to not only begin to understand her diabetes, but also start considering small changes she could make to help her diabetes feel more manageable.

Within three visits, Carmen began pairing blood sugar checks with her morning and evening routine of brushing her teeth; this enabled her to have more awareness about her blood sugar levels and discuss with Esequiel the factors that may be contributing to elevated readings. One contributing factor was her sedentary lifestyle; Carmen’s mobility had been limited since her surgery and she was feeling more isolated because of it. Together, Carmen and Esequiel explored past interests of hers and prioritized activities that were not only physical in nature, but also positively influenced her mental health; ultimately, Carmen gravitated towards wanting to return to gardening.

By their fourth session together, the duo had collaboratively created a personalized plan for Carmen to start and grow her garden; the plan included which herbs to start with (cilantro and parsley were the most promising given the season) as well as what materials she would need. After this session, Carmen and her husband got to work setting up her raised flower beds and this new commotion caught the attention of their youngest grandchild who would spend weekends with their grandparents. She decided to try involving her grandchild and, by the time she spoke to Esequiel next, Carmen was excited to report that her grandchild was helping her learn more about herbs through looking up YouTube videos on their new iPad. Gardening had not only become a daily physical activity for Carmen (which did positively impact her blood sugar levels), but also a beloved intergenerational activity.

Carmen and Esequiel are still working together to this day and continue to explore small yet impactful behavior changes that will positively impact not only her diabetes, but Carmen’s overall health and well-being.

When asked about how her participation in Lifestyle Redesign OT has impacted the way she manages her health, Carmen shared:

“Me di cuenta que mi salud no nomás es tomando medicina. Saber dónde están mis niveles de azúcar en la sangre en la mañana y antes de irme a la cama me han enseñado mucho sobre mí mismo. Me ha hecho más consciente de mi cuerpo y he notado cuánto estrés puede afectar mis niveles de azúcar en la sangre. He aprendido a cuidar mejor de mí mismo. Mi motivación es vivir más tiempo para ver a mis nietos crecer.”

“I realized that my health is not just taking medicine. Knowing where my blood sugars are in the morning and before going to bed have taught me a lot about myself. It has made me more aware of my body and I have noticed how much stress can affect my blood sugars. I have learned how to better take care of myself. My motivation is to live longer to see my grandchildren grow up.”

Read more about the value of occupational therapy in primary care in the Research Spotlight section below.

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Research Spotlight

Occupational therapy services in primary care: A scoping review

A comprehensive scoping review by authors Catherine Donnelly, Leanne Leclair, Carri Hand, Pamela Wener, and Lori Letts explores the evolving role of occupational therapy in primary care, shedding light on the profession’s contributions to patient care. Interprofessional primary care teams play a vital role in providing access to comprehensive and coordinated care for individuals living with chronic conditions. Yet, occupational therapy’s integration into primary care faces challenges, primarily due to a lack of understanding of the profession’s role both within our profession and by other team members. This review addresses this gap by examining and describing the current evidence regarding occupational therapy services in primary care.

The scoping review identified 129 relevant articles, and categorized assessments and interventions provided by occupational therapists in primary care settings, emphasizing their attention to individual needs, daily activities, and environmental factors. Its findings emphasize the unique contributions of occupational therapy in connecting people to services, addressing social determinants of health, and advocating for a just society. The review underscores the need for ongoing efforts to solidify and integrate occupational therapy into primary care globally, especially as the field evolves to meet the complex health and social needs of diverse populations.

In addition to the scoping review, the authors developed a sister document, Occupational Therapy and Primary Care: A Vision for the Path Forward, created for the Canadian Association of Occupational Therapists (CAOT).

With regard to the importance of increasing occupational therapy’s presence in primary care, Dr. Donnelly shared, “Primary care is in crisis — with greater numbers of people not having access to a provider than ever before. Team based primary care has been identified as a key solution and occupational therapists are well positioned to play an important role on these teams. The scoping review highlights the growing occupational therapy research in primary care — particularly in the last five years. The review also highlights the breadth of occupational therapy practice — truly enabling the profession to work to their broadest scope of practice and with an emphasis on health promotion and wellness.”

Optimizing occupations, habits, and routines for health and well-being with Lifestyle Redesign®: A synthesis and scoping review

A recent article by Beth Pyatak, Kristine Carandang, Chantelle Rice Collins and Mike Carlson provides a definitive synthesis of the Lifestyle Redesign intervention framework in occupational therapy, shedding light on its evolution and multifaceted applications. Originally designed for healthy older adults, Lifestyle Redesign has expanded its reach to diverse populations and conditions. However, challenges in dissemination and misconceptions about its exclusive application to the elderly have limited its broader impact, motivating the authors to clarify the characteristics of Lifestyle Redesign in this article.

The Lifestyle Redesign intervention framework is distinguished by five defining characteristics:

• Emphasizes orchestration of the complexities of regularly performed activities, habits, and routines and their impact on well-being.
• Applies to a wide range of individuals facing lifestyle-related challenges to health, extending beyond applications for specific medical conditions.
• Prioritizes therapist-client collaboration and individualization, recognizing clients as experts and fostering intrinsic motivation.
• Conceptualizes health broadly, encompassing physical, mental, cognitive, social, spiritual, and emotional well-being.
• Requires delivery by occupational therapy practitioners with advanced training in Lifestyle Redesign.

The scoping review presented in the article indicates positive outcomes in domains such as mental and social functioning, quality of life, and disease management. The intervention’s adaptability is evident in its application across diverse populations and settings, and ongoing research is exploring innovative modes of delivery, such as telehealth, extending the reach of Lifestyle Redesign. Looking forward, the article envisions Lifestyle Redesign‘s potential expansion into new populations, settings, and delivery modes, aligning with emerging healthcare paradigms.

In discussing the intent behind the publication, Dr. Rice Collins shared, “Defining the Lifestyle Redesign intervention framework and its key characteristics has been a vital part of the dissemination process. Writing this article provided a unique opportunity to pause and reflect on the existing applications of and evidence for Lifestyle Redesign in order to distill the intervention to its core elements. It now serves as a launch pad for sharing Lifestyle Redesign with others through the certification, mentored practice, clinical trainings, and future publications.” 

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Upcoming Opportunities

Webinar: Optimizing Occupations, Habits, and Routines for Health and Well-being: An Overview of the Lifestyle Redesign Intervention Framework
February 22, 2024

Date: Thursday, February 22, 2024
Time: 12-1pm Pacific Time
Location: Zoom
Audience: This is an introductory level activity designed for OT practitioners, however, all levels of experience are welcome as are all areas of practice. Registration is required to join the webinar.
Cost: This webinar is offered at no cost.

In this 1-hour “lunch-and-learn” webinar, authors Dr. Beth Pyatak and Dr. Chantelle Rice Collins will lead participants in a deep dive into their recent publication (highlighted in the Research Spotlight section above). The speakers will outline the Lifestyle Redesign intervention framework’s core characteristics and draw upon a case study to illustrate the application of Lifestyle Redesign in clinical practice, including an overview of the findings from evaluation, long term goal setting, treatment topics addressed, and outcomes from treatment. In addition, the speakers will highlight key findings from the scoping review conducted for this publication, showcasing the intervention’s adaptability in its application across diverse populations and settings.

OTFP Fellowship

The USC Occupational Therapy Faculty Practice (OTFP) Fellowship is designed to foster the development of expertise in administering the Lifestyle Redesign intervention to individuals living with chronic physical and mental health conditions. The fellowship will expedite the process for receiving certification in Lifestyle Redesign as fellows will complete the didactic content and clinical hour requirements needed to apply for Lifestyle Redesign Certification.

The fellowship is anticipated to start Summer 2024 with applications opening soon!

If you have additional questions about the fellowship, please reach out to Dr. Chantelle Rice Collins (.(JavaScript must be enabled to view this email address)).