Elyse Kimbrell OTD, OTR/L

There are currently more than 6.2 million adults diagnosed with heart failure in the United States (American Heart Association [AHA], 2022). Heart failure is a progressive condition associated with high mortality in which the heart gradually loses its ability to circulate blood and nutrients throughout the body (AHA, 2022). The resulting symptoms, such as shortness of breath, edema, and decreased activity tolerance, severely impact quality of life and can lead to recurrent hospitalizations (Norberg et al., 2014). As the disease progresses towards end-stage heart failure, the heart becomes refractory to medical management requiring consideration of advanced heart therapies including heart transplantation and mechanical circulatory support (MCS) (Dolapoglu et al., 2018).

Importance. Patients in intensive care units (ICUs) experience complex functional, physical, and cognitive needs that affect their engagement in activities of daily living (ADLs). Occupational therapy practitioners are uniquely positioned to address these needs to optimize patients’ functional recovery.

Objective. To examine occupational therapy–specific interventions as they relate to early engagement for patients in the ICU.

Data Sources. CINAHL, PubMed, ProQuest, OTseeker, and Cochrane Library databases.

Study Selection and Data Collection. The Cochrane methodology was used to collect, evaluate, and analyze articles, then reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines for conducting a systematic review. Articles published from January 2012 to December 2021 evaluating adults who received occupational therapy interventions in ICUs with Level 1b, 2b, or 3b evidence were included.

Findings. Nine articles met the inclusion criteria and the research objective. Findings showed moderate evidence for ADLs, physical rehabilitation, and cognitive interventions in promoting functional outcomes for patients in the ICU.

Conclusions and Relevance. This systematic review introduces the term early engagement to describe occupational therapy–specific interventions for patients recovering in the ICU and supports occupational therapy’s role in this setting. Further research is needed to strengthen the evidence for occupational therapy–specific interventions and early engagement in the ICU.

Plain-Language Summary. Patients in the intensive care unit experience complex needs that affect their participation in activities of daily living (ADLs). Current research demonstrates moderate evidence for early engagement with ADLs, physical rehabilitation, and cognitive interventions performed by occupational therapy practitioners. This systematic review introduces the term early engagement, which captures how occupational therapy practitioners provide holistic interventions for patients in the intensive care unit to promote patient well-being and functional recovery.

AOTA Taxonomy. ADLs, evidence-based practice/knowledge translation, interprofessional practice and intraprofessional practice, occupations and activities, older adults, quality and value-based care, scope of practice

Keywords. intensive care unit, physical rehabilitation, systematic reviews, cognition, intensive care, occupational therapists

Introduction. Patients recovering from cardiothoracic surgery in acute care experience physical and psychosocial challenges impacting participation in activities of daily living. Occupational therapists are well positioned to address these needs; however, there is little evidence exploring occupational therapy’s role in this area.

Method. This retrospective study of electronic medical records examined changes in activities of daily living participation for adult patients (n = 37) who received occupational therapy in acute care while recovering from cardiothoracic surgery via median sternotomy. Wilcoxon signed-rank tests and paired t-tests compared patients’ scores on the Functional Independence Measure (FIM) and Activity Measure for Post-Acute Care “6-Clicks” Daily Activity Inpatient Short Form at occupational therapy evaluation and discharge from their inpatient stay.

Results. Patients showed statistically significant improvements on both assessments in activities of daily living participation while receiving occupational therapy services following cardiothoracic surgery. Lower body dressing, toileting, and bed mobility showed the greatest increases in the FIM categories.

Conclusion. Occupational therapists are valuable in addressing the complex needs of patients recovering from cardiothoracic surgery in acute care. Continued research is needed to provide further evidence supporting occupational therapy’s unique role in this setting.

Health care in the United States is changing rapidly. Advances in medical technology, a growing need to manage chronic conditions for a longer period of time, and increased access to health care services through the Patient Protection and Affordable Care Act of 2010 all contribute to the United States spending more of its annual gross domestic product on health care than any other country (Clancy & Fraser, 2015). Despite dedicating more than $3.2 trillion annually to health care...

Tags. Quality & Value-Based Care