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Unfortunately, even though the level of development of modern medicine is relatively high, a great number of people still suffer from life long illnesses and it often happens that their quality of life significantly decreases due to this fact. Therefore, if we consider the needs of such patients, it is important to assume the great importance of various practices applied by specialists in occupational therapy. Discussing the particular practices that healthcare providers pay an increased attention to in order to improve physical and mental condition of patients suffering from various pernicious diseases such as cancer, it is necessary to put more focus on such intervention as equipment provision.
As for the latter, it refers to a range of special tools that are successfully used by healthcare providers in rehabilitation therapy; the latter can help the ones fighting against terminal diseases to solve essential problems without becoming dependent from those who take care of them. Considering the importance of the issue stated, it was decided to search relevant and peer-reviewed sources on the topic in order to answer the following clinical question: Within the context of terminally ill adult patients, can equipment provision be regarded as the measure allowing to increase the degree of independence and improve quality of life of both patients and their carers?
Search Strategy and Outcomes
The primary goal of the given paper was to choose from a wide range of strategies and search tools in order to find a substantial number of credible academic sources providing relevant and appropriate information on the topic of equipment provision within the frame of occupational therapy and the effects that such practice may produce on adult patients and those specialists who take care of them and help them to recover in a shorter period of time.
In fact, the links between the provision of special equipment allowing patients to be independent when it comes to fulfilling the essential tasks such as cooking food and getting shower are very important as such equipment may prevent possible injuries, reduce the burden on caregivers, and make terminally ill people feel that they can still take care of themselves. Understanding that, it is necessary to pay an increased attention to the choice of search strategy because high quality of credibility of the materials to be reviewed and evaluated remains one of the key aspects allowing to solve the given problem and contribute into the field.
To begin with, it is extremely important for any researcher to define which databases containing information related to the given field can be used in order to find the best sources for the review. As for the sphere of medicine and healthcare, it is necessary to say that there are a number of databases that have been created specially for the researchers in the field among skilled professionals and graduates; nevertheless, many of them are available for the ones whose interests are somehow related to the latest discoveries in nursing and medicine.
Also, speaking about academic medical databases including full texts of articles from the most popular peer-reviewed journals that are available on the Internet nowadays, it needs to be said that many of them have been created with the help of specialists from different universities, and this is why the access to certain databases can sometimes be given only to students and lecturers from the particular university. Even though it cannot be regarded as a serious problem, there can be cases when such restrictions prevent students and independent researchers from providing more informative discussions in their papers.
In reference to the particular databases that were used during the given project aimed at providing the critical appraisal of evidence, it is necessary to state that the primary ones included Medline, the Cochrane database, and CINAHL.
Speaking about the first database included into the list, it is important to say that it contains a great number of important sources that can be used by researchers with different areas of expertise. In order to use the given database to search for the most appropriate results, I was applying different keywords and combinations of keywords in order to find the sources touching upon a few important aspects that I needed at once.
Thus, in reference to the Medline database that was the first I have used, keywords and search enquiries I was using included “occupational therapy”, occupational therapy needs”, “rehabilitation programs”, “rehabilitation equipment”. Apart from that, the search enquiries used in order to find relevant articles included “cancer rehabilitation”. Moreover, in order to find the articles touching upon one of the most important aspects related to the topic, such search enquiries as “functional rehabilitation”, “rehabilitation for patients with cancer”, “occupational therapy in palliative care”. Speaking about the references that were found with the help of the given database, it can be said that it contains a lot of articles on the topic but additional criteria should be taken into consideration in order to choose the most appropriate references.
Among other things, I paid attention to the publication date, trying to include only those sources that appeared no more than five years ago. According to the most common standards defining the requirements to papers, it is necessary to cite information from up-to-date sources in order to make a conclusion taking in to account all the facts related to the topic that have already been confirmed by modern researchers and reviewers. Therefore, start date that was used for the search was 2012 whereas end date was 2017.
As for the second and the third databases that has been used (the Cochrane database and CINAHL), it needs to be said that the number of available sources that could be used for the given review was relatively small if compared to results retrieved with the help of the first database.
The particular search enquiries that have been used included “palliative care”, “equipment prescription”, “occupational therapy”, and “rehabilitation equipment”, and a few appropriate sources were found with the help of these key words. Also, it is necessary to say that sometimes there is an opportunity to retrieve additional sources using reference lists included by the authors of the chosen articles; nevertheless, I was not using this approach to finding sources due to the fact that the majority of referenced sources were outdated as researchers were choosing sources based on their relevance, and the issue of modernity was not the most important, especially in case with reviews.
In relation to the particular features that have been considered to define which search results can be used in order to answer the research question, it was necessary to pay attention to a range of characteristics including relevance to the three-part question identified, the overall quality of the sources found, and their academic novelty. Based on the given requirements, fifteen articles were chosen for the review.
In the end, there were a great number of articles found with the help of three databases. Among the articles chosen for the review, there are thirteen retrieved from the Medline database, one from the Cochrane database, and one found with the help of CINAHL. The most important data retrieved from the chosen articles is included in the table below together with the essential information concerning the article.
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Critical Appraisal of Evidence
During the next stage of preparation of the given paper, it was necessary to evaluate the evidence presented in the chosen articles that were supposed to meet the requirements making them relevant for the present research. Fulfilling the given task, any researcher is required to take into account two key moments that may have a significant impact on the outcomes of the review and define practical usefulness of the review conducted. To begin with, it is extremely important to analyse all essential parts of the source giving the high priority to conclusion as the way that it corresponds to the research question that the review is supposed to answer defines its general relevance.
Apart from that, paying attention to certain details reported in different parts of the chosen studies, reviewers can decide whether the study possesses internal validity because all the papers chosen should be methodologically sound to answer the primary research question correctly. Assessment of validity remains very important as it helps to identify the sources of an inappropriate quality to exclude them. The table below illustrates the main findings used for the given review.
|Author, date, and country:||Patient group:||Study type (level of evidence):||Outcomes:||Key results:||Weaknesses of the study:|
|Baxter, Newman, Longpré, & Polo, 2017, the United States.||Patients in need of high-quality occupational services; adult cancer survivors.||The given paper presents a comparative study (therefore, it possesses the evidence of the third level).||Having outlined the most important problems that people in need of occupational therapy may have, the authors concluded that there are numerous gaps associated with occupational therapy related to reduced social participation of cancer survivors and lack of access to high-quality services.||Based on statements made by the researchers, self-management remains one of the most important practices encouraging functional rehabilitation and, therefore, reducing the burden of caring for terminally ill patients. Patients with cancer have a lot of specific needs, and reimbursement of the ability to fully participate in usual activities (with the help of special equipment as well) can be listed among their primary goals.||In reference to the weaknesses of the given study, it needs to be said that the discussed paper does not include controversial information presented by different authors; therefore, it may seem that the sources have been chosen based only on the opinions supported by the authors.|
|Kollontaj et al., 2015, Poland||The group of patients studied by the authors of the given article includes the ones having disabilities. Patients studied living in Lublin region were disabled due to different reasons.||The given paper presents a non-randomised mixed-methods study involving survey (the third level of evidence).||As for the outcomes of the study, it was stated that the majority of participants having disabilities caused both by traumas or previous diseases reported an increased need of special rehabilitation equipment and the results did not significantly differ by age and gender.||According to the data retrieved with the help of the survey, the minority of the participants (primarily those evaluating their health condition as good) had no need of special rehabilitation equipment. Nevertheless, the great number of people mentioned the need of rehabilitation products such as wheelchairs and other technical aids. In general, those with unmet needs wanted to be provided with equipment to improve their quality of life.||Among the weaknesses, it is necessary to consider that it could be important to divide participants into subgroups based on the reasons of their disabilities to single out particular problems peculiar to each group.|
|Ng et al., 2017, the United States||Patients who acted as participants of the given research are patients suffering from cancer who were undergoing cancer rehabilitation in 2014-2015.||The type of the given research is a non-randomised prospective study, therefore, it presents evidence of the third level.||Having analysed the assumptions of cancer patients related to health outcomes of the rehabilitation program, the researchers were able to define spheres that were positively evaluated and ones that needed improvement; therefore, practical usability of the research is obvious.||With the help of the survey, the authors managed to find out that the majority of patients (more than 90 %) supposed that rehabilitation had helped them to improve their physical function and become more independent. The intervention included both the use of rehabilitation medications and special equipment helping patients to improve motor skills.||As for weaknesses, the authors assume that there could have been bias in patients positively evaluating the program even though anonymity was guaranteed to all the participants of the survey.|
|Bentley, Hussain, Maddocks, & Wilcock, 2013, the United States||The participants are patients who have been diagnosed with thoracic cancer recently.||The given research is a quantitative non-randomised study (the third level of evidence).||Almost a half of surveyed participants needed a range of occupational interventions to be used due to their high stress levels.||Equipment provision was included into the list of the most important rehabilitation measures. 97% of participants regarded equipment provision as a measure that was extremely helpful.||No significant weaknesses.|
|Hayashi et al., 2015, Japan.||The participants of the research included cancer patients with bone problems (average age was 63 years old).||The given article presents a comparative retrospective study (the third level of evidence).||According to the data related to the participants whose cases were discussed during professional meetings, the majority of patients having bone problems reported increased mobility due to rehabilitation procedures.||The given study highlights the importance of equipment provision (wheelchairs or exercise equipment) together with medical therapy for faster recovery.||As for weaknesses, it cannot be said that positive results achieved by healthcare specialists were due only to rehabilitation programs as medications were actively used as well.|
|Leensen et al., 2017, the Netherlands.||Adult patients (18-60 years old) who have been diagnosed with cancer recently.||The article presents a non-randomised quantitative study (the third level of evidence).||Results of the survey indicated that patients regarded almost all interventions as useful.||Among the interventions perceived as the most important, there were exercises with the use of special equipment.||Due to the fact that the research studies multidisciplinary approach in general, it may be more difficult to understand the particular role of equipment provision.|
|Timmerman et al., 2017, the Netherlands.||Adult patients with lung cancer.||The article describes a mixed methods non- randomised study (the third level of evidence).||The authors proposed a healthcare application helping cancer patients to keep track of their health condition.||According to the results, the use of the application and home based exercise program has been proven to be clinically feasible and patients’ perceptions support it as well.||The researchers had to exclude some of the older participants due to their information illiteracy.|
|Nielsen, Neergaard, Jensen, Bro, & Guldin, 2016, Denmark.||Caregivers of patients with terminal illnesses.||The article reports the results of a cohort study (the third level of evidence).||As is clear from the data reported by the participants, being a caregiver involves numerous problems such as depression.||More than 30% of participants had caregiver burden due to a great number of caregiving hours.||No significant weaknesses were found.|
|Jensen at al., 2014, Germany.||Terminally ill patients with cancer.||The quantitative non-randomised study (the third level of evidence)||Physical activity in patients with cancer leads to positive results.||The necessity to do physical exercises with the use of special equipment can help to decrease pain and other symptoms in terminally ill patients.||No significant weaknesses were found.|
|Sim, Barr, & George, 2015, Australia||Adult rehabilitation patients.||A non-randomised quasi-experimental study (the third level of evidence).||Special equipment for rehabilitation patients can be prescribed based on the photographs of patient’s house and accurate personal information.||Many specialists were able to come to an agreement concerning the most reliable ways to define the equipment necessary for the patient. As is clear from the study, the role of equipment provision in rehabilitation cannot be overestimated.||Clinical implications could have been more attention to.|
|Badger, Macleod, & Honey, 2016, Australia||Adult patients with terminal sicknesses.||A qualitative non-randomised study (the third level of evidence).||The majority of terminally ill patients see occupational therapy as a practice making them feel safe.||The participants regard practices that were used by their occupational therapists (including both medications and the use of equipment) as ones allowing them to feel comfortable.||There could be potential response bias due to the use of face-to-face interviews.|
|Zimmermann et al., 2014, Canada||Adult people with advanced cancer.||A psedorandomised quantitative study (the third level of evidence).||Palliative care has a significant impact on quality of life of cancer patients in the intervention group.||Various measures included in palliative care program have a positive effect on cancer patients’ physical condition.||All experiments were conducted at one location.|
|Umezawa, Fujimori, Matsushima, Kinoshita, & Uchitomi, 2015, Japan.||Cancer patients stopping anticancer treatment.||A non-randomised quantitative study (the third level of evidence).||A great number of patients preferred to receive palliative care due to an increased control of symptoms.||Palliative care (and all the measures including equipment provision) was considered a useful intervention allowing patients to control pain.||Possible representativeness bias.|
|Scott et al., 2013, United Kingdom.||Adult patients who have survived cancer.||A systematic review (the first level of evidence).||The majority of reviewed studied indicated the importance of physical component in rehabilitation programs and functioning improving.||A lot of studies on the topic state the significance of functioning improving that involves the use of support and exercise equipment.||Possible bias in the reviewed studies.|
|Ventura, Burney, Brooker, Fletcher, & Ricciardelli, 2014, Australia.||Adult patients receiving palliative care.||A systematic review (the first level of evidence).||According to the reviewed studies, physical needs of patients were met in the majority of cases.||Patients are positive about physical aspect of palliative care (exercising and equipment provision) but communication practices should be improved.||Possible bias in the reviewed studies.|
Synthesis of Evidence
As is clear from the studies mentioned, the evidence reported by the researchers can be used in order to answer the question; the majority of papers were aimed at studying adult patients with terminal sicknesses, and the participants were likely to list exercising and equipment provision among important practices positively influencing their health. Among other things, the importance of equipment is supported by patient values as all people suffering from terminal sicknesses would like to facilitate their everyday practices. Therefore, the information can encourage occupational therapists to implement new equipment into their work.
In the end, it can be stated that equipment provision in adults with terminal sicknesses is a measure increasing their degree of independence and improving their quality of life (and, possibly, lives of their carers as well).
Badger, S., Macleod, R., & Honey, A. (2016). “It’s not about treatment, it’s how to improve your life”: The lived experience of occupational therapy in palliative care. Palliative and Supportive Care, 14(03), 225-231.
Baxter, M. F., Newman, R., Longpré, S. M., & Polo, K. M. (2017). Occupational therapy’s role in cancer survivorship as a chronic condition. American Journal of Occupational Therapy, 71(3).
Bentley, R., Hussain, A., Maddocks, M., & Wilcock, A. (2013). Occupational therapy needs of patients with thoracic cancer at the time of diagnosis: Findings of a dedicated rehabilitation service. Supportive Care in Cancer, 21(6), 1519-1524.
Hayashi, Y., Nagaoka, M., Takagi, T., Kitahara, E., Hatori, K., Terakado, A., & Izawa, N. (2015). Effectiveness of interdisciplinary team conference to manage skeletal related events in rehabilitation for patients with cancer. Juntendo Medical Journal, 61(4), 426-436.
Jensen, W., Bialy, L., Ketels, G., Baumann, F. T., Bokemeyer, C., & Oechsle, K. (2014). Physical exercise and therapy in terminally ill cancer patients: A retrospective feasibility analysis. Supportive Care in Cancer, 22(5), 1261-1268.
Kollontaj, B., Gorczyca, R., Kollontaj, W., Jedrych, M., Sobieszczanska, A., Sobieszczanski, J., & Karwat, I. D. (2015). Meeting needs for rehabilitation equipment and home adjustments among the disabled in their life environment. Annals of Agricultural and Environmental Medicine, 22(3), 504-512.
Leensen, M. C. J., Groeneveld, I. F., Rejda, T., Groenenboom, P., Berkel, S., Brandon, T.,… Frings‐Dresen, M. H. W. (2017). Feasibility of a multidisciplinary intervention to help cancer patients return to work. European Journal of Cancer Care, 1(1), 2-16.
Ng, A. H., Gupta, E., Fontillas, R. C., Bansal, S., Williams, J. L., Park, M.,… Bruera, E. (2017). Patient reported usefulness of acute cancer rehabilitation. PM&R. Web.
Nielsen, M. K., Neergaard, M. A., Jensen, A. B., Bro, F., & Guldin, M. B. (2016). Psychological distress, health, and socio-economic factors in caregivers of terminally ill patients: a nationwide population-based cohort study. Supportive Care in Cancer, 24(7), 3057-3067.
Scott, D. A., Mills, M., Black, A., Cantwell, M., Campbell, A., Cardwell, C. R.,… Donnelly, M. (2013). Multidimensional rehabilitation programmes for adult cancer survivors. Cochrane Database Syst Rev, 3, 1-50.
Sim, S., Barr, C. J., & George, S. (2015). Comparison of equipment prescriptions in the toilet/bathroom by occupational therapists using home visits and digital photos, for patients in rehabilitation. Australian Occupational Therapy Journal, 62(2), 132-140.
Timmerman, J. G., Dekker-van Weering, M. G. H., Stuiver, M. M., Groen, W. G., Wouters, M. W. J. M., Tönis, T. M.,… Vollenbroek-Hutten, M. M. R. (2017). Ambulant monitoring and web-accessible home-based exercise program during outpatient follow-up for resected lung cancer survivors: Actual use and feasibility in clinical practice. Journal of Cancer Survivorship, 1, 1-12.
Umezawa, S., Fujimori, M., Matsushima, E., Kinoshita, H., & Uchitomi, Y. (2015). Preferences of advanced cancer patients for communication on anticancer treatment cessation and the transition to palliative care. Cancer, 121(23), 4240-4249.
Ventura, A. D., Burney, S., Brooker, J., Fletcher, J., & Ricciardelli, L. (2014). Home-based palliative care: A systematic literature review of the self-reported unmet needs of patients and carers. Palliative Medicine, 28(5), 391-402.
Zimmermann, C., Swami, N., Krzyzanowska, M., Hannon, B., Leighl, N., Oza, A.,… Donner, A. (2014). Early palliative care for patients with advanced cancer: A cluster-randomised controlled trial. The Lancet, 383(9930), 1721-1730.