School of Occupational Therapy

Touro University Nevada

OCCT 643 Systematic Reviews in Occupational Therapy

Critically Appraised Topic Project

EVIDENCE TABLE WORKSHEET

Name: Galileo Basilio & Tonya DeDera
Date: 9/11/2015
Focus Question: Do older adults who engage in therapeutic exercise improve overall performance in ADL/IADL or quality of life.
Rationale for inclusion/exclusion criteria applied to determine which articles should be included in the evidence table:

Inclusion- Full text publication, Randomized control trial, English language, 2005- Current year, Exercise as an intervention, 65 y/o +
Exclusion- Language other than English, Articles before 2005, under 65 y/o, Abstracts
Rationale- Defining inclusion and exclusion criteria increases the likelihood of producing reliable and valid results. Year was set at 2005 or higher to ensure
relevancy and provide the most up-to-date information related to our topic.

Author/
Year

Study
Objectives

Level/Design/
Subjects

Intervention and
Outcome Measures

Results

Study Limitations

Implications for OT

Brovold, T.,
Skelton, D. A.,
& Bergland, A.
(2013)

To compare highintensity aerobic

interval exercise
with a homebased exercise in
older adults upon
discharge from
the hospital.

Level 1
Design: RCT
(single control trial)
Subjects: Older
adults, who age ranged
from 70-92 y/o with
decreased activity
tolerance and
endurance.

Intervention
Compared control group
receiving high-intensity
aerobic interval exercise
(HIA) to treatment group
receiving home-based exercise
(HBE).
Outcome Measures
Health-related quality of life
based (HRQOL) on the
impact of physical
fitness/activity level (increase
or decline).

The effects of the

HIA program
significantly
improved the HIA
groups physical
fitness promoting a
better quality of life.

Limited
generalizability due
to representation of
the group studied
Limited to
participants being
perceived as being
fit and engaged
HIA program might
have been too
challenging

Clinical & communitybased practice of OT:

Home health OTs can
implement an exercise
therapy treatment to
increases HRQOL and
physical fitness.

* HIE group(n = 59) or

HB (n = 56

Program Development:
Prior to discharge, physical
deficits can be identified
best within the natural
context of the home.

Societal Needs:
Need for therapeutic
exercise is warranted as the
elderly population values
aging in place.
Healthcare Delivery &
Policy:
Therapeutic exercise
interventions were
implemented prior to
discharge to decrease
future cost related to health
issues and increase
performance skills.
Education & training of
OT Students:
Students should be taught
the significance and
benefits of therapeutic
exercise on the elderly
population.

Dechamps, A.,
Diolez, P.,
Thiaudiere, E.,
Tulon, A.,
Onifade, C.,
Vuong, T., . . .
BourdelMarchasson, I.
(2010)

To determine the
clinical
effectiveness of
adapted Tai chi
(AT) & cognition
interventions to
improve healthrelated quality of
life (HRQOL) and

Level 1
Design: RCT
Subjects: Older adults,
60 y/o, who are highly
deconditioned, but
cognition is intact.
* Subjects were divided
into: N=51 (Tai chi),

Intervention
2 groups: AT group was based
on a movement-based
approach that included light to
moderate intensity. Control
group continued with usual
care throughout the process.
Outcome Measures

The control group

experienced a decline
in ADLs
over the 12-month
period compared with
the adapted tai-chi
group. The
components of ADL
(ability to walk,

The AT group
were less disabled
than those in the
control group.

Refinement, revision, &

advancement:
Future research should
address more occupationbased interventions as the
current interventions did
not yield high significance.
Clinical & communitybased practice of OT:
Occupation-based exercise
programs offered high
benefits for the prevention
of health related quality of
life and showed high
adaptability across
different OTs settings.

Faber, M. J.,
Bosscher, R.
J., Chin, A. P.
M. J., & van
Wieringen, P.
C. (2006)

to compare both
N=49 (CA) N=60
groups with a
(routine care)
routine care group.

ADL levels, as well as quality

of life (QOL) based on the
impact of therapeutic exercise
(AT) and routine care

continence, and
nutrition) were
maintained better in
the intervention
groups than in the
control.

To determine
the effects of
moderate
intensity
group-exercise
programs on

Intervention
Compared control groups
were asked not to change
their usual patterns of
activities to intervention
groups that followed a

Overall, the
Participants in
both exercise
groups showed a
small, but
significant

Level 1
Design: RCT
(single-blind)
Subjects: Older
adults, 85 y/o who
are frail or pre-fail

Program Development:
Demonstrated how
occupation-based
interventions can improve
health and wellness in
older adults.
Societal Needs:
Need for occupation- based
interventions can lead to
increased QOL and
improved skill levels in
ADLs.
Healthcare Delivery &
Policy:
Use of occupation-based
interventions can reduce
future cost related to
reoccurring health issues
and improve QOL.
Education & training of
OT Students:
All students should be
exposed to occupationbased interventions as
studies have indicated
improved QOL in older
adults
Refinement, Revision, &
Advancement:
Further research is needed
to investigate alternative
forms of therapeutic
exercise.

Clinicians
perception of the
patients
cognitive abilities
Medical
screenings

Clinical and
community-based
practice of OT:
OTs working with
older adults who have
decreased health can

functional
performance,
and disability
in older adults;
and to
investigate the
influence of
frailty on these
effects.

* 2 groups:
Intervention group
and control
consisting of
N=208

20-week exercise
program with one
meeting a week during
the first . The first
exercise program,
functional walking (FW)
and the second, in
balance (IB),exercises
were inspired by the
principles of Tai Chi.
Outcome Measures
Functional mobility
(improvement or decline)
overtime while engaged
in functional walking &
Tai chi (balance).

improvement in
their performance
oriented mobility
assessment
(POMA) and
physical
performance
scores. In the FW
group, this held
true for the
GARS score as
well. Post hoc
analyses revealed
that only the prefrail participants
improved their
POMA and
physical
performance
scores.

were
completed in
the same
manner
No specific
assessment
was utilized to
exclude the
individuals

increase occupational
performance within
functional mobility by
increasing occupationbased interventions.
Program
Development
Occupational
performance should be
identified through the
use of a clientcentered approach and
focus less on
performance skills.
Societal Needs
Functional mobility
decreases as elderly
age and impedes
independence levels
Healthcare Delivery
& Policy
Implementing a clientcentered intervention
would increase
significance levels, as
well as, occupational
performance of the
participants.
Education & training
of OT Students
Students should be
taught to implement a
client-centered,

occupation-based
approach, as this will
yield higher
significance within
this study.
Refinement, Revision,
and Advancement
Future studies should
broaden their areas of
focus to include other
domains than just
performance skills to
achieve an accurate
illustration of
functional
performance.
Foley, A.,
Hillier, S., &
Barnard, R.
(2011).

To determine
Level 1
whether high Design: RCT
intensity,
Subjects: Older adults,
progressive gym60 y/o + who suffered
based exercise
from musculoskeletal
performed once a
impairments, disability
week is as
or reduced functional
effective as twice
mobility.
a week.
* N=36 (1x week
Investigate
group), N=34 (2x week
whether highgroup), N=36 (control
intensity gymgroup-usual care)
based exercises
are sufficient
enough to
maintain strength,
physical function,
balance, and

Intervention
Three groups: control group
did not receive exercise,
whereas one group exercised
1x a week and the other 2x a
week.
Outcome measures
Examine the impact of highintensity, gym-based exercise
and its correlation to
frequency levels. Older adults
demonstrated higher
preference to one time a week
exercise program.

Control group
decreased
comparison to the
intervention groups.
1x week vs. Control
changes in 1-RM hip
extension strength
was significant and in
favor of the once-aweek group (Z=2.05,
p=0.04).
2x week vs. Control:
maximum gait speed
(Z=3.17, p=0.002)
had a significant
effect in favor of the
twice-a-week group.

Limitations: no
limitations were
identified with this
study; however, a
larger population
would increase
generalizability
within the study.

Clinical and communitybased practice of OT

Older adults were more
compliant with 1x week
exercise program than any
other therapeutic exercise.
Program development
Programs should be
flexible and meet the
participants physical
abilities via the just right
challenge in order to
provide a deeper
understanding of the
population.
Societal needs:

quality of life post

discharge.

An exercise program that

grades and uses the just
right challenge to promote
independence and quality
of life in older adults.
Healthcare delivery and
policy
Understanding the most
suitable exercise program
and implementing it within
the intervention will create
increased levels of
independence within the
elderly population.
Education and training of
OT students
Students should be taught
the significance of
therapeutic exercise, in
relation to frequency and
duration.

Greenspan, A. I.,
Wolf, S. L.,
Kelley, M. E., &
O'Grady, M.
(2007).

To determine
Level 1
whether intense
Design: RCT (singleTai-Chi (TC)
blind)
exercise could
Subjects: Older
improve perceived
adults, 85 y/o who are
health status and
frail.
self-rated health
* 2 groups: TC: N=
(SRH) more than
148; WE: N= 143
wellness

Intervention
Compared control group
receiving a WE program for
one hour per week and
consisted of instruction on fall
prevention, exercise and
balance, diet and nutrition, and
pharmacological management
to an experimental group

Overall, the TC
participants reported
significant
improvements in the
physical dimension
and ambulation
categories and
borderline significant
improvements in the

Limited
generalizability due
to representation of
the group studied
Definition of older
adult (too broad)
Exercise changes
throughout the
intervention were

Refinement, revision, and

advancement
Future studies should
incorporate more
occupation-based activities
to promote generalizability
of performance skills.
Clinical and communitybased practice of OT
Occupation-based
intervention such as Taichi showed improvements
in both physical abilities
and ambulation skills.
Program Development

education (WE)
for older adults.

receiving TC intervention that

consists of slow, rhythmic
movements that emphasize
trunk rotation, weight shifting,
coordination, LE stance (6
exercises utilized). TC
intervention consisted of 2
sessions per week at
increasing durations starting at
60 minutes of contact time and
progressing to 90 minutes over
the course of 48 weeks.
Outcome measures
Functional
ambulation/Physical
performance (improvement or
decline) overtime while
engaged in TC or WE.

body care and

movement category
of the Sickness
Impact Profile (SIP).
Self-rated health
(SRH) did not change
for either group.

not able to be
monitored.

Using the fundamental

skills learned during TaiChi can be transferred to
other occupational domains
to improve health and
wellness.
Societal needs
Occupational performance
decreases with age thus
education programs need
to be more prevalent in this
population.
Healthcare delivery &
policy
Health and wellness
education could alleviate
difficulties with
performance skills and
allow older adults to age in
place and reduce
healthcare costs
Education & training of
OT Students
Student should taught the
importance educating the
clients on health-related
issues to increase
functional performance
skills.
Refinement, revision, and
advancement of factual
knowledge
The researchers can further
enhance this study by
increasing the sample size

Littbrand, H.,
Rosendahl, E.,
Lindelof, N.,
Lundin-Olsson,
L., Gustafson,
Y., & Nyberg, L.
(2006).

To evaluate the
effectiveness of
high-intensity
functional weightbearing (WB)
exercise program
among elderly
adults who are
dependent on
ADLs and are
living in a
residential care
facility.

Level 1
Design: RCT
Subjects: Older
adults, 65 y/o+.
* 91 participants (47=
with Dementia) and
(44= elderly without
impairments)

Intervention
A high-intensity functional
WB exercise program was
performed in groups of 3 to 7
participants who were
supervised by physical
therapists. There were 29
exercise sessions over 13
weeks. Attendance, intensity
of lower-limb strength and
balance exercises, and
occurrence and seriousness of
adverse events were the
outcome variables in
evaluating the applicability of
the program.
Outcome measures
Increased changes in
performance level impacted by
high-intensity exercise
(balance, strength) affecting
application use.

The effect of a highintensity WB

exercise program
showed statistical
significance. Further
research is warranted
to determine whether
the results of
attendance, intensity,
and adverse events
obtained in the study
can be replicated or
improve the overall
outcome.

Small sample size

Limited
generalizability due
to representation of
the group studied

and accurately defining the

older adult population.
Clinical and communitybased practice of OT:
A high-intensity functional
WB exercise program is
applicable for all use
among older people who
are dependent in ADLs
living in residential
facility.
Program development
Programs should be
flexible and meet the
participants physical
abilities via the just right
challenge in order to
provide a deeper
understanding of the
population.
Societal needs
Implementing the
performance skills learned
within high-intensity
exercise programs can
transferred over to
meaningful occupations.
Healthcare delivery &
policy
Incorporate a multifacetted occupationalbased exercised program in
concert with an
intervention treatment plan
instead of just a highintensity exercise program.

Education & training of

OT Students
Student should be welldiverse on different
intervention approaches to
maximize performance
levels via therapeutic
exercise.
Refinement, revision, and
advancement of factual
knowledge
Future research can
enhance this study by
increasing the sample size
and focusing on the
attendance and intensity of
the program.
Oken, B. S.,
Zajdel, D.,
Kishiyama, S.,
Flegal, K.,
Dehen, C., Haas,
M., . . . Leyva, J.
(2006).

To determine the
effect of yoga on
cognitive
function, fatigue,
and quality of life
(QOL) in seniors.

Level 1
Design: RCT (parallel
group)
Subjects: Older adults,
65-85 y/o who are
considered healthy.
* 3 groups: exercise,
yoga and control group
consisting of 135
participants.

Intervention
Compared control group (wait
list) receiving no intervention
to intervention groups
receiving aerobic intervention,
which consisted of one class
per week along with home
exercise including walking
and yoga intervention
receiving one class per week
for 90 minutes along with
home practice.
Outcome measures
Cognitive change/physical
abilities/ QOL (improvement
or decline) based on the
utilizing yoga as the main
intervention.

Overall, there was

significant
improvements in
QOL measures.
There were also
significant
improvements in
outcome measures
specifically related to
the physical
intervention (e.g.,
one-legged standing
and seated forwardbending ability).
Furthermore,
improvement was
shown in relation to
QOL measures
related to sense of
well-being and

Small sample size

Limited
generalizability due
to not being
considered a typical
yoga class
Limited
generalizability due
to representation of
the group studied

Clinical and communitybased practice of OT:

Maintaining physical
capacity and demands of
ADLs should be of
emphasis for a better QOL.
Program development
This exercise program
should only be a
component of therapeutic
treatment as it failed to use
additional interventions
besides yoga.
Societal needs
This intervention has the
ability to illustrate a deeper
understanding of QOL
through use of

energy and fatigue

compared to controls.

complimentary alternative
medicine (CAM).
Healthcare delivery &
policy
Results of this study could
be used to inform
insurance policy makers on
the benefits of CAM within
occupational therapy.
Education & training of
OT Students
Student should have
knowledge regarding CAM
and its use within a
treatment session.

Peri, K., Kerse,

N., Robinson, E.,
Parsons, M.,
Parsons, J., &
Latham, N.
(2008).

To examine
whether repetitive
ADL improve
health status, life
satisfaction, and
mobility in older
adults who are
living in
residential care
facility.

Level 1
Design: RCT (cluster)
Subjects: Older
adults, 85 y/o who are
living in residential
facility and are frail.
* 2 groups:
Intervention and
control group
consisting of 149
participants who were
considered independent
or required minimal
assistance.

Intervention
Compared control group
receiving usual care; however,
at the end was giving physical
activity intervention group
receiving assistance from a
gerontologist while engaging
in physical function. Next, a
nurse completed health
assessment on group with
occupational therapy (OT)
assistance. Client-centered
plan created to increase
strength, balance, endurance
through BADLs (i.e. bed

The intervention
group met all goals
and demonstrated
improvement at 3
months in
comparison to control
group. There was no
difference between
the groups at 6-month
follow-up because
contamination began
to affect results.
Statistical
significance was
demonstrated for

Small sample size

Limited
generalizability due
to representation of
the group studied

Refinement, revision, and

advancement of factual
knowledge
To fully understand the
impacts of CAM, it should
be utilized within various
domains of occupation.
Clinical and communitybased practice of OT
OTs understanding of
ADLs and its relation
overall to health will lead
to a better identification of
independent levels.
Program development
This intervention could
provide a thorough
understanding of ADLs
and its implications on
valued occupations.

mobility, transfers).
Residential staff ensured
activity program was carried
out via weekly visits and
continued for following
months until 6-month
termination.

only the Satisfaction

of Life Scale and the
physical component
summary. Other areas
addressed mobility,
but no significant
finding were given.

Societal needs:
Understanding the
significance of ADLs
interventions will promote
independence within this
population.
Healthcare delivery and
policy
The use of ADLs
interventions can reduce
health care cost and
improve functional
performance.

Outcome measures
Health status change
(improvement or decline) and
mobility over time

Education and training of

OT students
All student should have a
deeper knowledge of the
benefits of ADLs to
maximize functional
performance.

Sato, D.,
Kaneda, K.,
Wakabayashi,
H., & Nomura,
T. (2009).

To compare the 2- Level 1

year effects of
Design: RCT
once and twice(longitudinal study)
weekly water
Subjects: Older
exercise at a day
adults, mean age of 79
service facility on y/o who frail and
ADL ability in the received nursing care.
frail elderly
* 2 groups:
receiving nursing
Intervention and
care for 2 years.
control group. Total of
20 participants (9 in

Intervention
Compared Group 1 receiving
water exercise for one hour
once weekly to Group 2
receiving water exercise one
hour but twice a week.
Outcome measures
ADL ability (improvement or
decline) based on the impact

The effect of water

exercise on
sustaining ADL
ability in Group 2
was significant. The
2-year water exercise
program, conducted
twice a week in a day
service facility, was
effective for
maintaining ADL

Small sample size

Limited
generalizability due
to representation of
the group studied
Limited validity
and reliability of
studied variables

Refinement, revision, and

advancement of factual
knowledge
Future studies should
include a larger, varied
sample size.
Clinical and communitybased practice of OT:
Water exercises leads to a
healthier lifestyle and has
illustrated no need for high
impact exercise.
Program development
By teaching older adults
the importance of water
therapy can lead to

Group 1 and 11 in
Group 2).

of water exercise, in regards to

frequency and intensity.

ability for transfer,

bathing transfer,
mobility
(locomotion) and
stair climbing.

generalizability within
other occupations.
Societal needs
The skills learned within
water therapy can lead to
sustainment of ADLs
through meaningful
occupations.
Healthcare delivery &
policy
The significance of the
results suggests that
current policy makers
should implement more
OTs within this scope of
practice.
Education & training of
OT Students
Therapist and students
should be educated on the
skilled techniques within
water therapy.

Teri, L.,
McCurry, S. M.,
Logsdon, R. G.,
Gibbons, L. E.,
Buchner, D. M.,
& Larson, E. B.
(2011).

To compare the
Level 1
efficacy of a
Design: RCT (single
physical activity
blind)
program using
Subjects: Older
moderate exercise
adults, with age range
in older adults in
75-84 y/o.
conjunction with a
health promotion
* SPA (n=69) HP
program. Also,
(n=73) SPA1HP (n=67)

Intervention
Compared control group
receiving routine medical care
(RMC) to intervention group
receiving Seattle Protocol for
Activity (SPA) for moderate
exercising in older adults in
conjunction with a health
promotion program (HP),

Overall, at three
months and eighteen
months self-reported
health, strength,
physical function,
and general wellbeing (Po. 05) was
significantly better

Limited
generalizability due
to utilizing only those
who were highly
educated
Participants
without chronic
illness

Refinement, revision, and

advancement of factual
knowledge
Future research should
broaden the sample size to
improve generalizability.
Clinical and communitybased practice of OT:
The study showed the need
for physical activity within
older adults to increase
functional performance and
increase independence in
the community.

examined a
combination
group of both
(SPA+HP), and
control group
consisting of
routine medical
care (RMC).

Routine Medical Care

(n=64)

combination of both (SPA +

HP).
Outcome measures
Physical
function/performance,
health behaviors, and
affects were used to assess
quality of life, well-being,
vitality, and self-perception.

than non-SPA
participants.

Participants who
were institutionalized
Participants with
severe mobility
limitations

Program development
Occupational therapist
should use a clientcentered approach to
educate on healthy
lifestyles and determine the
most effective exercise
program pertinent to the
population.
Societal needs
This article revealed
physical exercise is a
favored intervention as it is
inexpensive and easy to
implement.
Healthcare delivery &
policy
Multidisciplinary approach
is warranted to promote
best treatment outcomes.
Education & training of
OT Students
Students should be aware
of confounding variable
related to self-report
questionnaires that are
based on physical
performance.
Refinement, revision, and
advancement of factual
knowledge
Further research
broadening the population
to improve generalizability
of the study.