EVIDENCE REVIEW
Issue Date: July/August 2021
Published Online: June 10, 2021
Updated: June 18, 2021
Self-Management Interventions to Improve Activities of Daily Living and Rest and Sleep for Adults With Chronic Conditions: A Systematic Review
Author Affiliations
  • Stacy Smallfield, DrOT, MSOT, OTR/L, BCG, FAOTA, is Associate Program Director and Capstone Coordinator, Division of Occupational Therapy, College of Allied Health Professions, University of Nebraska Medical Center, Omaha. At the time of the study, Smallfield was Associate Professor of Occupational Therapy and Medicine and Assistant Director, Occupational Therapy Entry-Level Professional Programs, Washington University School of Medicine, St. Louis, MO; stacy.smallfield@gmail.com
  • Lea Fang, OTD, OTR/L, is Occupational Therapist, SSM Health Physical Therapy, St. Louis, MO. At the time of the study, Fang was Doctoral Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO.
  • Darby Kyler, OTD, OTR/L, is Occupational Therapist. At the time of the study, Kyler was Doctoral Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO.
Article Information
Cardiopulmonary Conditions / Complementary/Alternative Approaches / Evidence-Based Practice / Musculoskeletal Impairments / Special Section: Evidence Review
EVIDENCE REVIEW   |   June 10, 2021
Self-Management Interventions to Improve Activities of Daily Living and Rest and Sleep for Adults With Chronic Conditions: A Systematic Review
American Journal of Occupational Therapy, June 2021, Vol. 75, 7504190010. https://doi.org/10.5014/ajot.2021.046946
American Journal of Occupational Therapy, June 2021, Vol. 75, 7504190010. https://doi.org/10.5014/ajot.2021.046946
Abstract

Importance: Chronic conditions often cause functional impairments in activities of daily living (ADLs) and rest and sleep, leading to decreased independence and self-efficacy.

Objective: To aid occupational therapy practitioners in making informed decisions regarding self-management interventions to improve ADLs and rest and sleep for community-dwelling adults with chronic conditions.

Data Sources: We identified literature published from 1995 to 2019 through searches of the Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, CINAHL, and OTseeker.

Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to abstract and assess data quality and validity. The review followed American Occupational Therapy Association Evidence-Based Practice Project methodology. Studies addressing self-management interventions for community-dwelling adults ages 18 and older with chronic cardiovascular disease, Type 2 diabetes, heart disease, hypertension, chronic respiratory problems, or kidney disease were included.

Findings: Fifteen articles met inclusion criteria and were categorized into ADLs and sleep. Strong evidence supports education to improve diabetic foot self-care. Low evidence addresses exercise and education to improve ADLs for people with heart disease and chronic obstructive pulmonary disease. Moderate evidence supports mind–body self-care education to enhance sleep.

Conclusions and Relevance: Occupational therapy practitioners working with adults with diabetes are encouraged to routinely offer education that includes discussion of risk factors and daily foot inspections and hygiene. When addressing sleep, education that addresses sleep hygiene, nutrition, relaxation techniques, and physical activity should routinely be provided to adults with chronic conditions. Further research is needed to understand the dosage needed.

What This Article Adds: This systematic review supports the role of occupational therapy in providing self-management interventions to address ADLs and sleep for adults with diabetes and other chronic conditions.