Use of Electrophysical Agents to Maximize Clinical Outcomes in Older Adults

PURPOSE: This study explores how the use of electrophysical agents (EPAs) as an adjunct to traditional occupational therapy (OT) interventions can further enhance functional outcomes of older adults with chronic conditions. Federal and state reform initiatives (e.g., IMPACT Act, Triple Aim Initiative) seek to improve health care quality and stem rising costs by rewarding efficiency and efficacy of outcomes. These initiatives coupled with stricter care requirements have led to renewed interest in EPAs as interventions that assist in managing difficult-to-treat conditions.

DESIGN: In this retrospective cohort study, we analyzed the electronic medical records (EMR) of clients with multiple conditions treated with EPAs in postacute care (PAC) settings. Deidentified data were collected electronically from the EMR system of participating PAC sites. A case report form was developed prior to the start of the study to capture variables necessary to meet study objectives. A systematic review was also performed to pool our study with previous cohort studies identified from MEDLINE. Information extracted included general data (author, journal, publication date), study design and setting, baseline client characteristics, and functional outcomes.

PARTICIPANTS: Data from clients receiving traditional OT + EPAs within PAC locations between January 1, 2010, and July 31, 2015, were extracted and accessed. The baseline period included data from the initial plan of care prior to EPA treatment initiation. The date of the first treatment was deemed the index date. The follow-up period was the therapy discharge report. Control group participants were age-matched clients managed by OT without EPAs.

METHOD: Data were acquired from a research data warehouse containing EMR and cost-related data providing access to the health records of over 1,200,000 clients having in excess of 60 million encounters. The main outcome measure was functional performance using the Occupational Therapy Rehabilitation Outcome Measure. The secondary outcome was length of therapy stay (LOS) and health care resource utilization (labor and supplies).

Based on data type, Pearson or Spearman rank correlations were used to measure relationships. Unpaired t test, chi-square, and analysis of variance were used to measure difference in demographics and outcomes. Common criteria for evaluating correlation coefficients were used to assess the strength of the relationship between the target and reference tests (.00 to .25 = little or none, .25 to .50 = fair, .50 to .75 = moderate to good, .75 to 1.00 = good to excellent).

RESULTS: Compared with the control group, there was a significant within-group difference in pretest and posttest functional performance scores and LOS (p < .001).

CONCLUSION: Chronic conditions causing functional disability can lead to reduced quality of life for adults across the postacute care continuum. Traditional OT with adjunctive EPAs can improve functional performance. OT can maximize wellness of older adults by using evidence-based practice interventions such as EPAs. Research reveals that the use of EPAs as an adjunct to traditional OT interventions can significantly improve performance in occupation for a variety of chronic conditions. In the domain of OT, EPAs promote a physiological response to the body functions aspect of client factors influencing performance in occupation. This study was able to demonstrate how the use of EPAs can improve performance in occupations including activities of daily living, rest and sleep, leisure, and social participation.

IMPACT STATEMENT: Occupation-based interventions plus EPAs can enhance functional outcomes while containing costs. Research demonstrates that EPAs can significantly improve client factors and performance skills necessary for obtaining wellness in human occupations of older adults.

References

Gerovasili, V., Stefanidis, K., Vitzilaios, K., Karatzanos, E., Politis, P., Koroneos, A., . . . & Nanas, S. (2009). Electrical muscle stimulation preserves the muscle mass of critically ill patients: A randomized study. Critical Care, 13, R161. http://dx.doi.org/10.1186/cc8123

Luijpen, M. W., Swaab, D. F., Sergeant, J. A., & Scherder, E. J. (2004). Effects of transcutaneous electrical nerve stimulation (TENS) on self-efficacy and mood in elderly with mild cognitive impairment. Neurorehabilitation and Neural Repair, 18, 166–175. http://dx.doi.org/10.1177/0888439004268785

Pieber, K., Herceg, M., & Paternostro-Sluga, T. (2010). Electrotherapy for the treatment of painful diabetic peripheral neuropathy: A review. Journal of Rehabilitation Medicine, 42, 289–295. http://dx.doi.org/10.2340/16501977-0554