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J Crit Care. 2017 Feb;37:85-90. doi: 10.1016/j.jcrc.2016.09.002. Epub 2016 Sep 10.

Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit: A pilot randomized clinical trial.

Author information

1
Escuela de Terapia Ocupacional, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago Centro, Chile; Departamento de Terapia Ocupacional y Ciencia de la Ocupación, Universidad de Chile, Independencia, Chile. Electronic address: alvarezevelyna@gmail.com.
2
Servicio Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Independencia, Chile. Electronic address: maricel.garrido.m@gmail.com.
3
Unidad de Pacientes Críticos, Departamento de Medicina Interna Norte, Hospital Clínico Universidad de Chile, Independencia, Chile. Electronic address: edotobar@gmail.com.
4
Escuela de Terapia Ocupacional, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago Centro, Chile; Servicio Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Independencia, Chile. Electronic address: prietostephanie@gmail.com.
5
Servicio Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Independencia, Chile. Electronic address: sebastian.vergara.ruiz@gmail.com.
6
Departamento de Terapia Ocupacional y Ciencia de la Ocupación, Universidad de Chile, Independencia, Chile; Servicio Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Independencia, Chile. Electronic address: constanza.briceno.ribot@gmail.com.
7
Servicio Medicina Interna, Departamento de Medicina, Hospital Clínico Universidad de Chile, Independencia, Chile. Electronic address: fgonzalezandrade@gmail.com.

Abstract

PURPOSE:

Delirium has negative consequences such as increased mortality, hospital expenses and decreased cognitive and functional status. This research aims to determine the impact of occupational therapy intervention in duration, incidence and severity of delirium in elderly patients in the intensive care unit; secondary outcome was to assess functionality at hospital discharge.

METHODS:

This is a pilot randomized clinical trial of patients without mechanical ventilation for 60 years. Patients were assigned to a control group that received standard strategies of prevention (n=70) or to an experimental group that received standard strategies plus occupational therapy twice a day for 5 days (n=70). Delirium was valued with Confusion Assessment Method and Delirium Rating Scale, and functional outcomes at discharge with Functional Independence Measure, Hand Dynamometer, and Mini-Mental State Examination.

RESULTS:

A total of 140 participants were recruited. The experimental group had lower duration (risk incidence ratios, 0.15 [P=.000; 95% confidence interval, 0.12-0.19] vs 6.6 [P=.000, 95% confidence interval, 5.23-8.3]) and incidence of delirium (3% vs 20%, P=.001), and had higher scores in Motor Functional Independence Measure (59 vs 40 points, P<.0001), cognitive state (MMSE: 28 vs 26 points, P<.05), and grip strength in the dominant hand (26 vs 18 kg, P<.05), compared with the control group.

CONCLUSIONS:

Occupational therapy is effective in decreasing duration and incidence of delirium in nonventilated elderly patients in the intensive care unit and improved functionality at discharge.

KEYWORDS:

Delirium; Elderly; Functional Outcomes; Intensive Care Units; Occupational Therapy

PMID:
27660922
DOI:
10.1016/j.jcrc.2016.09.002
[Indexed for MEDLINE]

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