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A Pilot Study of a Home-based Occupational Therapy Intervention for Older Adults With Cancer
Research Posters provided the opportunity for people with ABI and their families to have their voice heard Key Words: Advocacy, brain injury, campaign Disclosures: None disclosed. Research Poster 932 A Pilot Study of a Home-based Occupational Therapy Intervention for Older Adults With Cancer Kathleen Lyons (Dartmouth College) Research Objectives: To evaluate the feasibility of enrolling and retaining participants into a pilot study of an occupational therapy (OT) intervention for older adults with cancer. Design: Sixteen-week randomized controlled trial (RCT) comparing the OT intervention to usual care. Setting: Participants were recruited from a National Cancer Institutedesignated Comprehensive Cancer Center. Outcome assessments were conducted by telephone. The intervention occurred in participants’ homes. Participants: Participants were eligible for the pilot study if they were (1) over the age of 64; (2) experiencing disability as indicated by a score of > 3 on the Vulnerable Elders Survey (Saliba et al., 2001) or answering “yes” to the question: “Do health problems interfere with your ability to carry out your social or day-to-day activities?”; and (3) diagnosed with any solid or hematological cancer. Twenty-one men (36%) and 38 women (64%) enrolled in the RCT (mean age Z 73, sd Z 6.5). Of them, 30 (51%) had metastatic disease. Interventions: Participants randomized to the intervention met with an occupational therapist for six weekly, 1-hour home visits. They learned to use an activity planning structure to set weekly goals to maximize engagement in personally-selected activities to promote health and well-being. Main Outcome Measure(s): Feasibility was evaluated by calculating retention rates for the study and the intervention procedures. Results: Over 23 months, 59 participants enrolled in the RCT. Of the 29 assigned to usual care, 2 withdrew, 1 died, and 26 (90%) completed all study assessments. Of the 30 participants randomized to the intervention group, 27 (90%) completed the intervention. Twenty-six (87%) completed the second assessment, and 24 (80%) completed the final assessment. Conclusions: The pilot study procedures were feasible and a full scale RCT to evaluate efficacy is warranted. Key Words: Pilot projects, Occupational therapy, Feasibility studies Disclosures: None disclosed. Research Poster 935 Tinnitus, Depression, Anxiety, and Suicide: A Retrospective Analysis Erin Martz (VA Portland Healthcare System), Chennettee Jelleberg, Deborah D. Dougherty, Charles Wolters, Aaron Schneiderman Research Objectives: The purpose of this project is to investigate whether there is an association between a tinnitus diagnosis and suicide and whether depression and anxiety mediate the association. Design: This was a retrospective analysis of existing data. The two datasets that were used to create the dataset for analysis were: 1) a dataset that was created using a roster file from the Department of Defense’s (DoD) Defense Manpower Data Center (DMDC) and selecting the OEF/OIF/OND Veteran cohort who were eligible for VA health-care; and 2) a dataset that was created using the National Death Index (NDI) files produced by the National Center for Health Statistics (NCHS) and identifying Veterans who were deceased as of December 2011. Setting: The study setting included inpatient and outpatient encounter records for Veterans who accessed the VA healthcare system from January 1, 2002 to December 31, 2011. Participants: The final dataset for secondary data analysis included 769,934 OEF/OIF/OND Veterans who received VA care January 2002 to December 2011.
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e19 Interventions: N/A. Main Outcome Measure(s): Suicide, anxiety, and depression. Results: Of 769,934 OEF/OIF/OND Veterans receiving VA care January 2002 to December 2011, 15% (n Z116,358) were diagnosed with tinnitus. When further aggregated by anxiety and depression, 21% of OEF/OIF/ OND Veterans diagnosed with tinnitus were also diagnosed with depression, another 8% with anxiety and another 17% with both depression and anxiety. Fifty-four percent were identified as having tinnitus and not depression or anxiety. There were 131.6 deaths per 100,000 person-years among Veterans diagnosed with tinnitus. Within this group, other external causes of death accounted for the highest death rate (60.0 per 100,000 person-years), followed by natural causes and suicide (44.7 and 26.9 per 100,000 person-years, respectively). The differences in mortality among the tinnitus subgroups were further analyzed using a logistic regression model. Among Veterans diagnosed with tinnitus and depression and/or anxiety, there was no significant difference in the likelihood of dying compared to Veterans with no tinnitus diagnosis. However, the odds of dying among Veterans diagnosed with tinnitus only were half that compared to Veterans not diagnosed with tinnitus (ORZ0.5; 95% CIZ0.43-0.57). Specifically, Veterans diagnosed with tinnitus were 60% less likely to die of suicide (ORZ0.4; 95% CIZ0.30-0.60) and half as likely to die of other external causes (ORZ0.5; 95% CIZ0.38-0.62) compared to Veterans with no tinnitus diagnosis. There was a 40% greater likelihood of dying if a Veteran was diagnosed with a co-occurring condition compared to those with no co-occurring condition. When aggregated by cause of death, Veterans with a co-occurring condition 2.5 times as likely to die of natural causes compared to Veterans with no co-occurring condition. Conclusions: Experiencing mental-health symptoms in the context of tinnitus increases the risk of suicide. Yet, after controlling for several factors, the risk of suicide is lower in the group with tinnitus than the group that did not report a tinnitus diagnosis. This finding mirrors that which was noted by other researchers who acknowledged that the association between tinnitus and suicide is a complex one (Jacobson & McCaslin, 2001; Langguth et al., 2011; Lewis, 2002; Nondahl et al., 2011). Key Words: Tinnitus, Suicide, Mental health Disclosures: None disclosed. Research Poster 936 Pedi-ICARE Training Improves Walking and Endurance of Child With Cerebral Palsy Judith Burnfield (Madonna Rehabilitation Hospital), Sonya L. Irons, Guilherme M. Cesar, Thad W. Buster, Ruchika Khot, Carl A. Nelson Research Objectives: To evaluate impact of 24-session motor-assisted elliptical (ICARE) intervention on walking and fitness of child with cerebral palsy (CP). Children with CP sometimes have difficulty walking and engaging in physical/play activities with friends and family. ICARE (used in rehabilitation, fitness, and home settings for adults) was modified to enable children as young as three years to use (Pedi-ICARE). Step length adjusts as short as 8”. Customized physical motor-assistance enables children to train at speeds up to 65 revolutions/minute (RPM). Integrated body weight support and electronically height adjustable seat ease access/ use by children with weakness, endurance, and balance deficits. Design: Case study. Setting: Research. Participants: 12-year-old with medical history including spastic diplegic CP, hydrocephalus (ventriculoperitoneal shunting 2004), bilateral hamstring tendon lengthening (2008), asthma (managed by medications), and repeated pneumonia participated. Used bilateral AFOs to ambulate and wheelchair for longer distances. No therapy during research study. Study approved by Institutional Review Board. Interventions: Motor-assisted elliptical training parameters (i.e., speed, motor assistance, body weight support, and total training time) manipulated across 24 sessions (2-3 days/week) to progressively challenge walking and fitness.
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e19 Interventions: N/A. Main Outcome Measure(s): Suicide, anxiety, and depression. Results: Of 769,934 OEF/OIF/OND Veterans receiving VA care January 2002 to December 2011, 15% (n Z116,358) were diagnosed with tinnitus. When further aggregated by anxiety and depression, 21% of OEF/OIF/ OND Veterans diagnosed with tinnitus were also diagnosed with depression, another 8% with anxiety and another 17% with both depression and anxiety. Fifty-four percent were identified as having tinnitus and not depression or anxiety. There were 131.6 deaths per 100,000 person-years among Veterans diagnosed with tinnitus. Within this group, other external causes of death accounted for the highest death rate (60.0 per 100,000 person-years), followed by natural causes and suicide (44.7 and 26.9 per 100,000 person-years, respectively). The differences in mortality among the tinnitus subgroups were further analyzed using a logistic regression model. Among Veterans diagnosed with tinnitus and depression and/or anxiety, there was no significant difference in the likelihood of dying compared to Veterans with no tinnitus diagnosis. However, the odds of dying among Veterans diagnosed with tinnitus only were half that compared to Veterans not diagnosed with tinnitus (ORZ0.5; 95% CIZ0.43-0.57). Specifically, Veterans diagnosed with tinnitus were 60% less likely to die of suicide (ORZ0.4; 95% CIZ0.30-0.60) and half as likely to die of other external causes (ORZ0.5; 95% CIZ0.38-0.62) compared to Veterans with no tinnitus diagnosis. There was a 40% greater likelihood of dying if a Veteran was diagnosed with a co-occurring condition compared to those with no co-occurring condition. When aggregated by cause of death, Veterans with a co-occurring condition 2.5 times as likely to die of natural causes compared to Veterans with no co-occurring condition. Conclusions: Experiencing mental-health symptoms in the context of tinnitus increases the risk of suicide. Yet, after controlling for several factors, the risk of suicide is lower in the group with tinnitus than the group that did not report a tinnitus diagnosis. This finding mirrors that which was noted by other researchers who acknowledged that the association between tinnitus and suicide is a complex one (Jacobson & McCaslin, 2001; Langguth et al., 2011; Lewis, 2002; Nondahl et al., 2011). Key Words: Tinnitus, Suicide, Mental health Disclosures: None disclosed. Research Poster 936 Pedi-ICARE Training Improves Walking and Endurance of Child With Cerebral Palsy Judith Burnfield (Madonna Rehabilitation Hospital), Sonya L. Irons, Guilherme M. Cesar, Thad W. Buster, Ruchika Khot, Carl A. Nelson Research Objectives: To evaluate impact of 24-session motor-assisted elliptical (ICARE) intervention on walking and fitness of child with cerebral palsy (CP). Children with CP sometimes have difficulty walking and engaging in physical/play activities with friends and family. ICARE (used in rehabilitation, fitness, and home settings for adults) was modified to enable children as young as three years to use (Pedi-ICARE). Step length adjusts as short as 8”. Customized physical motor-assistance enables children to train at speeds up to 65 revolutions/minute (RPM). Integrated body weight support and electronically height adjustable seat ease access/ use by children with weakness, endurance, and balance deficits. Design: Case study. Setting: Research. Participants: 12-year-old with medical history including spastic diplegic CP, hydrocephalus (ventriculoperitoneal shunting 2004), bilateral hamstring tendon lengthening (2008), asthma (managed by medications), and repeated pneumonia participated. Used bilateral AFOs to ambulate and wheelchair for longer distances. No therapy during research study. Study approved by Institutional Review Board. Interventions: Motor-assisted elliptical training parameters (i.e., speed, motor assistance, body weight support, and total training time) manipulated across 24 sessions (2-3 days/week) to progressively challenge walking and fitness.