Lindsey Shomer OTD, OTR/L, CEAS, LRC (she/her/hers)

Importance. Fibromyalgia is a complex chronic pain condition for which effective nonpharmacological treatment interventions are lacking. Objective: To explore the effects of an occupational therapy intervention for fibromyalgia on client-reported outcomes of pain interference, self-efficacy, mood, and function.

Design. Retrospective cohort study using a chart review method.

Setting. Outpatient clinic.

Participants. Twenty-one adults with fibromyalgia (M age = 54 yr).

Intervention. A 10-wk occupational therapy group intervention using a Lifestyle Redesign® (LRD) approach.

Outcomes and Measures. The Brief Pain Inventory, Pain Self-Efficacy Scale, Beck Depression Inventory (BDI), and the Fibromyalgia Impact Questionnaire (FIQ) or the Revised Fibromyalgia Impact Questionnaire were administered at the first and last sessions of the program.

Results. Between 2015 and 2018, 37 clients entered the program, and 21 completed it. Changes in group averages exceeded the minimal clinically important difference for the BDI and the FIQ. Eighty-one percent of clients who completed the program had a clinically significant improvement on one or more of the outcome measures.

Conclusions and Relevance. The findings demonstrate the potential benefit of occupational therapy as a complementary approach to pharmacological treatment for people with fibromyalgia. Preliminary evidence suggests that a 10-wk occupational therapy group intervention using an LRD approach may reduce symptoms of depression and decrease the impact on daily function for people with fibromyalgia.

Keywords. fibromyalgia, pain, clients, personal satisfaction, self efficacy, life style, depressive disorders

Surveys have shown that 60% of neurologists and 57.4% of headache specialists in the United States reported at least one symptom of burnout. Other studies suggest that neurologists experience some of the highest rates of burnout compared to other physician groups along with lowest rates of work-life balance. Burnout symptoms include emotional exhaustion, physical symptoms, decreased performance, and career dissatisfaction. Mindfulness based stress reduction, relaxation techniques, and cognitive behavioral interventions have been shown to reduce burnout. Spurred by the knowledge of the disproportionate rates of burnout in neurologists, a new mindfulness training program was developed and implemented amongst an interdisciplinary headache team at an academic medical center. The purpose of this study is to explain the program development and implementation of a new mindfulness training curriculum and present the outcomes on burnout and professional quality of life amongst interdisciplinary headache team members.

Background. According to the Centers for Disease Control, an estimated 2.5 million people in the United States sustain a traumatic brain injury (TBI) annually, and about 75% of them are classified as concussions or other forms of mild TBI. An estimated 15-30% of people who have a concussion will develop post-concussion syndrome. PCS is characterized by the persistence of symptoms including headaches, dizziness, fatigue, irritability, insomnia, concentration difficulty or memory difficulty and increases a person’s risk for developing depression. While rest is the primary treatment for acute concussion, treatment of PCS focuses on gradual reintegration and learning how to cope, manage and prevent symptom onset. Evidence demonstrates that patient education, compensatory cognitive strategies, gradual reintroduction to physical activity, and mental health interventions can improve symptoms of PCS. Occupational therapists (OTs) have a skillset and broad practice domain that allows practitioners to significantly contribute to the care of those with post-concussion syndrome.

This poster aims to demonstrate the role that OTs play using a lifestyle behavioral approach for managing post-concussion syndrome, and present a case study of a patient who received OT treatment to demonstrate the effectiveness of a lifestyle based treatment for post-concussion syndrome.

Methods. Lifestyle Redesign® is an OT behavioral treatment approach that facilitates the development of health-promoting habits and routines and is shown to improve health management and slow disease progression. OT treatment for post-concussion syndrome focuses on helping patients understand the disease process and learn how to gradually reintegrate in to their daily activities and manage their persistent symptoms through active participation in their functional activities. Treatment topics can include activity pacing, energy management, body mechanics, sleep hygiene and positioning, physical activity, stress and depression management, headache management, community and work reintegration and more.

Results. To demonstrate how OT interventions are administered with this population, a clinical case study for a 47 year-old female patient with a diagnosis of post-concussion syndrome and comorbid diagnoses of migraine and occipital neuralgia is presented. OT treatment was provided at an outpatient clinic and followed a typical clinical plan of care. The patient was seen for an evaluation and 10 treatment sessions over 4.5 months.

Conclusion. This summarizes lifestyle and behavioral OT treatment approaches that can be used to treat a person with post-concussion syndrome and illustrates the effectiveness of OT for improving a patients symptoms, quality of life, and functional engagement. A larger sample size of patients to assess clinical outcome data will improve the significance of these results.

Objectives. Chronic migraine (CM) affects up to 5% of the global population and negatively impacts a person’s quality of life and ability to engage in daily activities. While primary care physicians and neurologists frequently treat CM with pharmacological interventions, lifestyle, behavioral and physical rehabilitation provided by occupational therapists (OT) and physical therapists (PT) can be effective for treating and managing CM. At the USC Keck Medical Center a multidisciplinary team including neurologists, OTs, PTs and pain psychologists has been established to treat patients with head, neck and facial pain disorders, including CM.

The aim of this study is to understand how a multidisciplinary treatment approach can be used for CM, explain the role of neurology, OT and PT, and present a case study to demonstrate the effectiveness of a multidisciplinary approach.

Methods. A neurologist initially evaluates the patient and will refer the patient to OT, PT and pain psychology as needed to provide multidisciplinary care. Lifestyle Redesign® is a behavioral OT technique that facilitates the development of health-promoting habits and routines, and has been shown to improve health management and slow disease progression. LR OT treatment for CM focuses on assessing how a person’s daily activities are impacted by their migraines and providing patient education and training of lifestyle factors that can improve their self-management of migraines. PTs help to assist patients’ recognition and management of musculoskeletal, postural, stress, and fatigued-related triggers. PTs will prescribe exercises to improve postural strength and aerobic endurance and perform manual therapy to improve cervical and thoracic spine mobility and reduce musculoskeletal triggers to decrease frequency and intensity of migraine pain.

Results. A 36 year-old female patient who works as a chef with a diagnosis of CM without aura was used for this case study. She had worsening of headaches for 8 months and was experiencing left-sided neck tightness and jaw pain. Neurology evaluated the client, implemented pharmacological changes, and referred the patient to OT and PT. LR OT and PT treatment was provided at outpatient clinics where the patient was seen for 8 sessions, by each discipline, over the course of 3 months. OT treatment topics included sleep hygiene and positioning, activity pacing, stress management, trigger identification, ergonomics and time management. PT prescribed exercises to improve strength of deep neck flexors, scapular stabilizers, and core muscles and spine flexibility to improve postural mechanics and tolerance to complete daily and work-related tasks. PT treatment also included manual therapy to reduce neck and jaw symptoms.

Conclusion. This case study demonstrates the effectiveness of using a multidisciplinary approach for treating chronic migraine and improving a patient’s symptoms, quality of life and function.

Objectives. According to the Centers for Disease Control, an estimated 2.5 million people in the United States sustain a traumatic brain injury (TBI) annually, and about 75% are classified as concussions or other forms of mild TBI. An estimated 15–30% of people who have a concussion may develop post-concussion syndrome (PCS), which is characterized by the persistence of symptoms including headaches, dizziness, fatigue, irritability, insomnia, concentration or memory difficulty, and increased risk for depression. Treatment of PCS focuses on gradual activity reintegration, functional rehabilitation, and learning how to cope, manage and prevent symptom onset. Evidence demonstrates that patient education, compensatory cognitive strategies, graded physical activity, and mental health interventions can improve symptoms of PCS and related headaches. Occupational therapists (OTs) are typically involved in acute concussion treatment for physical and cognitive rehabilitation, but OTs can also provide lifestyle and behavioral treatment for management and rehabilitation of PCS with headache (PCSH). To demonstrate the methodology and efficacy of lifestyle behavioral OT for managing PCSH, clinical outcomes for a group of patients with PCSH who attended individual outpatient OT treatment is presented.

Methods. Lifestyle Redesign® is a module-based behavioral OT technique that facilitates the development of health-promoting habits and routines, and has been shown to improve health management and slow disease progression. LR OT treatment for PCSH focuses on helping patients understand the disease process, gradually reintegrate into functional daily activities, and manage persistent symptoms through active participation in self-management habits. Treatment topics can include eating routines, activity pacing, energy management, body mechanics, sleep hygiene and positioning, physical activity, stress and depression management, and community/work reintegration.

Clinical outcome data for a small sample of patients with PCSH receiving LR OT outpatient clinic-based treatment as part of their typical plan of neurological care were collected to determine efficacy of treatment. Inclusion criteria was diagnosis of PCSH, and attendance of 3 or more sessions of OT. Outcome measures were completed at initial evaluation and discharge, and included the SF-36 Quality of Life Scale, Canadian Occupational Performance Measure (COPM), Headache Impact Test-6 (HIT-6), Headache Management Self-Efficacy Scale (HMSE), Migraine Specific Quality of Life Questionnaire (MSQL), and Migraine Disability Assessment Questionnaire (MIDAS).

Results. Seven patients’ clinical outcomes were collected (two male, five female). The average age of the patients was 36 years, and the average number of OT sessions had between evaluation and discharge was 7.14. On average, patients demonstrated improvements in almost all outcome measures, with the most substantial gains noted in certain SF-36 subscales (role limitations due to physical or emotional problems, energy and fatigue, social function), COPM Performance and Satisfaction scores, HMSE score, and MIDAS number of headache days.

Conclusion. These clinical case studies contribute to the evidence that lifestyle and behavioral OT treatment can be used to successfully help patients with PCSH improve their self-management abilities, symptoms, quality of life, and function. More research with a larger sample size of patients is needed to further investigate the significance to which lifestyle and behavioral OT can improve PCSH.

Objectives. Complex Regional Pain Syndrome (CRPS) is a neuropathic condition that can cause extreme pain, have a significant impact on function, and has the potential to become chronic. Occupational therapy (OT) helps individuals increase participation and function through the use of everyday activities, and uses those activities as both a means and an end to treatment goals. Lifestyle Redesign® is a behavioral occupational therapy technique that aims to modify a person’s daily habits and routines in order to manage a chronic condition, and has been shown to improve quality of life and slow disease progression. The purpose of this report is to demonstrate the efficacy of Lifestyle Redesign® occupational therapy in CRPS pain management, using a clinical case study of a 53 year-old male patient with chronic CRPS Type I in bilateral hands.

Methods. As this was a clinical case study, the treatment administered followed a typical clinical plan of care based on the patient’s evaluation, and did not contain any treatment modifications for research purposes.

Results. The patient was seen for 12 visits over 8 months, and demonstrated clinical improvements shown in Table 1. Outcomes used included the RAND SF-36 Health Survey, Canadian Occupational Performance Measure (COPM), Brief Pain Inventory (BPI), and Pain Self-Efficacy Questionnaire (PSEQ).

Conclusion. This case study illustrates how OT can significantly improve a patient’s quality of life and pain self-management skills, in order to improve function and decrease pain. More rigorous research about the efficacy of Lifestyle Redesign® OT in treating CRPS is needed to enhance evidence-based practice.

Objectives. Severe headache and migraine pain affect as much as 15% of Americans, according to the American Academy of Pain Medicine. Primary care physicians, neurologists, physical therapists, and psychologists are well-known members of a multidisciplinary pain program, but occupational therapy (OT) for headache management has not been well researched. OTs can offer a vital perspective on behavioral, emotional, and nonpharmacological headache treatment approaches. The aim of this study is to explain the role that OT can play in effective headache treatment among a multidisciplinary team, and present the outcomes of a program development study for quality improvement.

Methods. This study collected and assessed clinical outcome data of patients who entered an outpatient OT program for chronic headaches at the USC Occupational Therapy Faculty Practice, many of which were referred by other disciplines of the USC Multidisciplinary Headache Team. OTs used a Lifestyle Redesign® approach which facilitates the development of health-promoting habits and routines for improved health management and disease prevention. Patients met with OTs once every 1–2 weeks and completed outcome measures at admission, 8th session, and at discharge.

Results. Preliminary results indicate patients receiving OT for headache management for four or more sessions (n = 129) demonstrated increases in self-management skills, physical abilities, emotional functioning, and overall quality of life and decreases in average pain levels and functional impact on activities of daily living.

Conclusion. The results of this study strongly suggest that an OT lifestyle and behavioral modification program for chronic headaches and migraines is an effective treatment.

Objectives. Fibromyalgia is a chronic condition affecting more than 5 million Americans. It affects a person’s ability to engage in activities of daily living (ADL) and current treatment approaches include both pharmacological and non-pharmacological therapies. Occupational therapists (OTs) are qualified providers to treat patients with fibromyalgia, yet there is a lack of research available. OTs help people manage pain by identifying activities or behaviors that aggravate pain, teaching methods to limit the frequency or duration of painful episodes, and facilitating increased engagement and independence for ADLs at home, work or in the community. Lifestyle Redesign® (LRD) is an evidence- based, OT behavioral approach which promotes the development of health promoting habits and routines for improved health management and disease prevention. This presentation aims to educate providers and patients about OT as an available treatment option for this population and presents on the development and outcomes of a 10-week Lifestyle Redesign® group treatment pilot program that was developed at the USC Occupational Therapy Faculty Practice.

Methods. This retrospective study collected and assessed outcome data of patients (n = 7) who entered the outpatient OT treatment group as part of their usual plan of care.

Results. The clinical outcomes of this pilot program are currently being analyzed and will available at the time of the presentation.

Conclusion. Patients with fibromyalgia should be referred to OT if they are having difficulty managing their symptoms and it is interfering with their functional engagement in activities of daily living.

Background. Occupational therapists (OTs) offer a vital perspective on behavioral, emotional, and other non-pharmacological headache treatment approaches to improve patient self-management of headaches, yet OTs’ involvement in comprehensive headache care is relatively infrequent. The aim of this study is to explain the role of OT in headache treatment, and present the outcomes of a program development study.

Methods. This was a retrospective program development and quality improvement study that collected and assessed clinical outcome data of patients who entered an outpatient OT program for headaches. An OT lifestyle modification approach was used, which has been shown to develop health-promoting habits and routines for improved health management and disease prevention.

Patients were referred to OT by primary care physicians, neurologists and pain specialists. Patients were pursuing usual courses of treatment, and there were no clinical interventions administered that differed from regular care. Participants completed outcome measures at admission, 8th session, and at discharge.

Results. The clinical outcomes of this quality improvement study are currently being entered and analyzed and will be available for the conference.

Conclusion. OTs can provide vital treatment for patients with headache disorders, helping them to improve self-management of headaches by using lifestyle modifications. More neurology, primary care, pain specialists, and headache care teams should consider occupational therapy as a part of the regular plan of care for patients with headaches.