Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
This systematic review examined interventions for anxiety and depressive symptoms among inpatient physical rehabilitation patients. Results were framed by intervention type, context, and concentration of current literature among patient groups. Setting specific analyses does not seem to be common, because patient groups are often considered regardless of therapeutic setting and therefore regardless of recovery stage. Setting-specific information can aid resource development and literature navigation.
Primary Author and Speaker: Janell Pisegna
Additional Authors and Speakers: Sarah E. Anderson
Contributing Authors: Jessica L. Krok-Schoen
PURPOSE: The presence of anxiety and depressive symptoms across physical inpatient rehabilitation (IPR) patient groups is well documented in the literature (Shah, Evans, & King, 2000; Hart et al., 2016; Mitchell et al., 2017). Research indicates that patients report frustration with a lack of patient-centered mental health care and that physical recovery is often prioritized at the expense of mental recovery (Simpson et al., 2018). The occupational therapy (OT) profession is uniquely qualified to address both physical and mental sequelae of injury. Through an examination of the literature surrounding current practice in this setting, the purpose of this systematic review was to identify effective treatments and areas for future investigation to improve mental health and functioning among physical IPR patients. This review sought to: 1) determine what interventions could be utilized by OTs to address anxiety and depressive symptoms within physical IPR, and 2) determine the effectiveness of these interventions for reducing the impact of adverse anxiety and depressive symptoms on daily functioning.
DESIGN: This systematic review is in progress. Peer-reviewed quantitative and mixed methods articles were considered for review if they were published in the English language, included interventions within the OT scope of practice, with anxiety and/or depressive symptom outcome measures used, and delivered in the physical IPR setting among adults.
METHODS: A university health sciences librarian assisted in the development of the search strategy (development of MeSH terms and keywords for nine databases). The review protocol was developed and registered with PROSPERO. Two reviewers completed an independent title and abstract screening, with disagreements resolved by consensus and third reviewer decision. The same process was repeated for full-text review. Covidence software was used for article management.
RESULTS: The initial search yielded 7,477 articles. Title and abstract screening resulted in 664 articles for consideration for full text review, with a 92.1% rater agreement. Preliminary results provide information on 3 broad categories: 1) type of interventions (behavioral and cognitive behavior therapy, goal-setting, music therapy, relaxation training, virtual reality, gardening, cooking, yoga, and exercise) 2) context of therapy (more intense, higher frequency rehabilitation and multidisciplinary representation supports better mental health) 3) concentration of current literature among IPR patient populations (stroke being the most commonly represented diagnosis).
CONCLUSION: Addressing mental health needs within physical IPR populations seems to be an emerging, necessary, and clinician valued area of research. The search yielded a heterogeneity of terminology to describe settings and highlighted that often anxiety/depressive symptoms are secondary outcomes. Setting specific analyses do not seem to be common, as diagnostic groups are often considered regardless of therapeutic setting, and therefore regardless of stage of recovery. This review postulates that setting specific information can be invaluable and inform the development of toolkits specific to therapy settings, as well as highlight gaps in the literature for future investigation.
IMPACT STATEMENT: OTs report feeling underprepared to address mental illness within primary physical IPR patient populations, and physical IPR patients report dissatisfaction with patient-centered mental healthcare. This review will expand knowledge on how OTs can better serve the mental health of patients in the IPR setting and expand the knowledge around evidence-based mental health treatments in the IPR setting.
References
Shah, D. C., Evans, M., & King, D. (2000). Prevalence of mental illness in a rehabilitation unit for older adults. Postgraduate Medical Journal, 76(893), 153-156. https://doi.org/10.1136/pmj.76.893.153
Hart, T., Fann, J. R., Chervoneva, I., Juengst, S. B., Rosenthal, J. A., Krellman, J. W., . . . Kroenke, K. (2016). Prevalence, risk factors, and correlates of anxiety at 1 year after moderate to severe traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 97(5), 701-707. https://doi.org/10.1016/j.apmr.2015.08.436
Mitchell, A. J., Sheth, B., Gill, J., Yadegarfar, M., Stubbs, B., Yadegarfar, M., & Meader, N. (2017). Prevalence and predictors of post-stroke mood disorders: A meta-analysis and meta-regression of depression, anxiety and adjustment disorder. General Hospital Psychiatry, 47, 48-60. https://doi.org/10.1016/j.genhosppsych.2017.04.001
Simpson, E. K., Ramirez, N. M., Branstetter, B., Reed, A., & Lines, E. (2018). Occupational Therapy Practitioners’ Perspectives of Mental Health Practices With Clients in Stroke Rehabilitation. OTJR: Occupation, Participation and Health, 38(3), 181-189. https://doi.org/10.1177/1539449218759627
