Johnny Rider, MS, OTR/L, CEAS, CPAM, is an assistant professor at Touro University Nevada. He is an advocate for emerging practice areas and the powerful role occupational therapy can play in chronic disease management. Alex Chevez and Anai Guardado are 2nd year students in the Master of Science in Occupational Therapy program at Touro University Nevada with a passion for advocacy.
Chronic diseases in the United States have become a growing epidemic. Chronic diseases are also the leading cause of growing healthcare spending, disability, and even death (Basu et al., 2015). $3.3 trillion is spent on annual health care costs for chronic disease management (CDC, 2018). Currently, there is an enhanced focus on the utilization of interprofessional teams to address the needs of the more than 133 million Americans with one or more chronic conditions.
Percentage of Adults with Two or More Chronic Conditions (CDC, 2018)
Does occupational therapy have a role within this interprofessional team addressing chronic disease management? Absolutely! Occupational therapists are primed to address client factors and performance skills and patterns influencing and being influenced by chronic disease. There is a growing body of evidence supporting the role of occupational therapy in chronic disease management.
-Pyatak et al. (2017) tested the effectiveness of the Resilient, Empowered, Active Living with Diabetes (REAL) program, an occupational therapy intervention that focused on lifestyle-related activities and habits on young adults with diabetes. The study found that the participants improved their blood glucose levels and habits for checking blood glucose (Pyatak et al., 2017).
-Maekura et al. (2015) found that personalized pulmonary rehabilitation, including occupational therapy, improves the prognosis and quality of life of patients with advanced COPD.
-Siegal et al. (2017) found strong evidence to support the use of occupational therapy interventions to improve function, pain, fatigue, depression, self-efficacy, and general disease symptoms in people with Rheumatoid Arthritis.
– Pergolotti et al. (2016) found that occupational therapy interventions for individuals with cancer can increase functional status, decrease the risk of falling, and improve quality of life, participation in one’s life roles, pain control, and overall mental health.
-Mariotti (2011) demonstrated that occupational therapy interventions for individuals with chronic kidney disease significantly improve mental health status and pain level.
Occupational therapy interventions for clients with chronic health conditions may include but are not limited to the following:
- Addressing performance deficits in daily ADL/IADL’s resulting from specific chronic conditions, to sustain or improve current status in these areas.
- Teaching strategies to incorporate energy conservation and activity modification techniques into daily activities to cope with physical demands and reduce fatigue.
- Individualizing adaptations to effectively perform health management tasks, such as medication management.
- Teaching and incorporating health management tasks into existing habits so they become part of the daily routine.
- Developing coping strategies, behaviors, habits, routines, and lifestyle adaptations to support physical and psychosocial health and well-being.
- Teaching safe ways to incorporate physical activity into daily routines and strategies to improve rest and sleep participation. (AOTA, 2015)
Unfortunately, even though this evidence exists in academic journals, the benefits of occupational therapy have not been disseminated to the public effectively. Currently, many healthcare providers and clients are unaware of what occupational therapy contributes to chronic disease management. Where do people go to for help in managing their chronic conditions? You guessed it. Online. 70% of Americans turn to the internet for information regarding their health (Pew Research Center, 2014). Most people search online for resources, treatment, providers, and guidance, when dealing with healthcare concerns, especially chronic conditions requiring constant management.
This finding led us to investigate our state association websites. We searched online associations for various chronic diseases, such as diabetes, chronic obstructive pulmonary disorder, cancer, heart disease, etc., to see what consumers would learn about the role of occupational therapy in chronic disease management when searching online. Unfortunately, not one website referenced occupational therapy, even though many of them had headings such as “related service providers” or “interdisciplinary healthcare team.” We decided to broaden our search to national organizations, such as the Americans with Diabetes Association website, which is visited daily by thousands of people looking for help. We found no mention of occupational therapy. Occupational therapists were not even listed under the “other specialists” in the healthcare team, despite current evidence.
We decided to change this. Listed below are some of the ways we chose to advocate for the occupational therapy profession that were successful:
- Contacted community, state, and national associations about the role of occupational therapy in chronic disease management and asked them to list our profession on their website
- Handed out fact-sheets to interdisciplinary health professionals (e.g., doctors, nurses, physical therapists, psychologists, and psychiatric caseworkers) about the role of occupational therapy with chronic disease management
- Provided a campus presentation about the role of occupational therapists in chronic disease management to other health discipline students (e.g., PT, PA, DO, FNP)
- Wrote an article for the local newspaper entitled, “More about living, less about work,” explaining what occupational therapy is and how we assist individuals with chronic conditions
- Participated in an interdisciplinary health fair providing fall prevention screenings and educating on the role of occupational therapy
As of February 27, 2019, if you go to the Americans with Diabetes Association website, you will see under “other specialists” a link to the AOTA website and inclusion of occupational therapy.
“Occupational therapy can also play a critical role in diabetes self-management. Visit the American Occupational Therapy Association, Inc. for more information.”
(Potentially show screenshot of www.diabetes.org or provide a link to the page with OT listed)
We were able to get multiple state and national associations to include occupational therapy on their website, post AOTA fact sheets on their social media pages, and provide direct links to AOTA.org. It did not cost any money. It did not require special training. All it required was some time, passion and perseverance.
This is our profession and we know the power of engaging in occupations. We know how valuable our services can be in managing chronic diseases, as well as other areas of practice. It is our responsibility to share that power with as many people as we can. Every member of AOTA has the potential to contact associations related to their interest or area of practice and advocate for the role of occupational therapy. We encourage all of you to start with your state associations and work your way up to national and international organizations.
As part of the Centennial Vision, our profession seeks to be powerful and widely recognized. To achieve this, we must promote occupational therapy’s distinct value. Below are some practical ideas that you can do today to advocate for the occupational therapy profession:
- Contact health associations about the benefits of occupational therapy and ask them to list our services on their website and provide a link to AOTA.org
- Contact local healthcare facilities and ask them to post written materials in their buildings
- Educate healthcare professionals about occupational therapy using AOTA fact sheets
- Provide workshops on selected topics at local senior centers, libraries, community centers, etc., and explain the role of occupational therapy
- Submit to present at interdisciplinary conferences and include the unique role of occupational therapy in your presentation or poster
- Schedule a meeting with local political leaders and provide education about the field of occupational therapy
- Participate in or organize local health fairs and provide screenings along with education about the role of occupational therapy with chronic disease management
- Write an article for your local newspaper about the benefits of seeing an occupational therapist
These ideas are not an exhaustive list by any means and they are not exclusive to advocating for chronic disease management. These ideas can be tailored to your advocacy efforts for the distinct value of occupational therapy in any setting or practice. Use our ideas or come up with your own. Our goal is help you realize that everyone can advocate for our profession and you can do your part today.
References
Basu, R., Ory, M. G., Towne, S. D., Smith, M. L., Hochhalter, A. K., & Ahn, S. (2015). Cost-effectiveness of the chronic disease self-management program: Implications for community-based organizations. Frontiers in Public Health, 3(27). doi:10.3389/fpubh.2015.00027
Centers for Disease Control and Prevention. (2018). Health and economic costs of chronic diseases [Website]. Retrieved from https://www.cdc.gov/chronicdisease/about/costs/index.htm
Fox, S. & Duggan, M. (2013). Part two: Sources of health information [Website]. Retrieved from https://www.pewinternet.org/2013/11/26/part-two-sources-of-health-information/
Freid, M. V., Bernstein B. A., & Bush A. M. (2012). Multiple chronic conditions among adults aged 45 and over: Trends over the past 10 years [PDF File]. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db100.pdf
Ludman, E. J., Peterson, D., Katon, W. J., Lin, E. H., Von Korff, M., Ciechanowski, P., Young, B., & Gensichen, J. (2013). Improving confidence for self care in patients with depression and chronic illnesses. Behavioral Medicine, 39(1), 1-6. doi: 10.1080/08964289.2012.708682
Maekura, R., Hiraga, T., Miki, K., Kitada, S., Miki, M., Yoshimura, K., & Mori, M. (2015). Personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease, 10, 1787–1800. doi:10.2147/COPD.S86455
Mariotti, M., & de Carvalho, J.G. (2011). Improving quality of life in hemodialysis: Impact of an occupational therapy program. Scandinavian Journal of Occupational Therapy, 18(3), 172-179. doi:10.3109/11038128.2010.488271.
Pergolotti, M., Williams, G. R., Campbell, C., Munoz, L. A., & Muss, H. B. (2016). Occupational Therapy for Adults With Cancer: Why It Matters. The Oncologist, 21(3), 314–319. doi:10.1634/theoncologist.2015-0335
Pew Research Center. (2014). The social life of health information [Website]. Retrieved from http://www.pewresearch.org/fact-tank/2014/01/15/the-social-life-of-health-information
Pyatak, E. A., Carandang, K., Vigen, C., Blanchard, J., Sequeira, P. A., Wood, J. R., Spruijt-Metz, D., Whittemore, R., Peters, A. L. (2017). Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) study: Methodology and baseline characteristics of a randomized controlled trial evaluating an occupation-based diabetes management intervention for young adults. Contemporary Clinical Trials, 54, 8-17. doi: 10.1016/j.cct.2016.12.025
Siegel, P., Tencza, M., Apodaca, B., & Poole, J. L. (2017). Effectiveness of occupational therapy interventions for adults with rheumatoid arthritis: A systematic review. American Journal of Occupational Therapy, 71, 7101180050. https://doi.org/10.5014/ajot.2017.023176
