Date Presented 04/22/2023
Our systematic review examines interventions to decrease functional limitations and disability among people with multiple chronic conditions. We discuss behavior change techniques used in the research and relate them to OT practice.
Primary Author and Speaker: Tara C. Klinedinst
Contributing Authors: Jennie Dorris, Rose Turner, Carrie Ciro, Juleen Rodakowski
PURPOSE: Adults with multiple chronic conditions (MCC) have an increased risk for functional limitation and disability (Fabbri et al., 2015), yet little is known about how interventions for this population improve these outcomes. Previous self-management research supports that behavior change interventions are enhanced when participants identify their own goals for treatment (Boland, et al., 2018). Therefore, we sought to synthesize current evidence-based interventions for adults with MCC that address functional limitations and disability, with focus on interventions with participant-generated goal setting.
METHOD: We performed a systematic review of randomized controlled trials of home and community-based interventions that used participant-generated goals to decrease functional limitations and disability in adults (aged 45+) with MCC. We used the Taxonomy of Behavior Change Techniques (BCT) to code active ingredients of the interventions and calculated Cohen’s d effect sizes.
RESULTS: The search strategy produced 19,034 articles; 8 articles were included in the final synthesis. All were complex interventions using at least 1 BCT (mean = 4.5). Aside from ‘goal setting’, the most common BCTs were 'instruction on how to perform a behavior' and ‘social support’. Five studies included care coordination/information sharing among providers. Influence of the interventions on disability in daily activity and physical function resulted in a range of effects; effect sizes ranged from -.10–.83.
CONCLUSION: Using participant-generated goals was common among all interventions; occupational therapists are well-equipped to help adults with MCC develop goals that improve disability in daily activity and physical function. Due to the limited number of articles and heterogeneity of interventions, anticipated effects are not known. Impact statement: This research synthesizes the state of the science in care for adults with MCC, and highlights relationships to occupational therapy practice, including gaps in service provision.
References
Fabbri, E., Zoli, M., Gonzalez-Freire, M., Salive, M. E., Studenski, S. A., & Ferrucci, L. (2015). Aging and multimorbidity: new tasks, priorities, and frontiers for integrated gerontological and clinical research. Journal of the American Medical Directors Association, 16(8), 640-647.
Boland, L., Bennett, K., & Connolly, D. (2018). Self-management interventions for cancer survivors: a systematic review. Supportive Care in Cancer, 26(5), 1585-1595. https://doi.org/10.1007/s00520-017-3999-7
