Objective To investigate the effect of action observation therapy (AOT) in the rehabilitation of neurologic and musculoskeletal conditions. Data Sources Searches were completed until July 2020 from the electronic databases Allied and Complementary Medicine Database (via OVID SP), Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, EMBASE, MEDLINE, and the Physiotherapy Evidence Database. Study Selection Randomized controlled trials comparing AOT with standard care were assessed. Musculoskeletal (amputee, orthopedic) and neurologic (dementia, cerebral palsy, multiple sclerosis, Parkinson disease, stroke) conditions were included. There were no age limitations. Articles had to be available in English. Data Extraction Two reviewers independently screened titles, abstracts and full extracts of studies for eligibility and assessed the risk of bias of each study using the Cochrane Risk of Bias Tool. Data extraction included participant characteristics and intervention duration, frequency, and type. Results The effect of AOT in different outcome measures (OMs) was referenced in terms of body structures and functions, activities and participation, and environmental factors as outlined by the International Classification of Functioning, Disability, and Health (ICF). Of the 3448 articles identified, 36 articles with 1405 patients met the inclusion criteria. Seven of the 11 meta-analyses revealed a significant effect of intervention, with results presented using the mean difference and 95% CI. A best evidence synthesis was used across all OMs. Strong evidence supports the use of AOT in the rehabilitation of individuals with stroke and Parkinson disease; moderate evidence supports AOT in the rehabilitation of populations with orthopedic and multiple sclerosis diagnoses. However, moderate evidence is provided for and against the effect of AOT in persons with Parkinson disease and cerebral palsy. Conclusions This review suggests that AOT is advantageous in the rehabilitation of certain conditions in improving ICF domains. No conclusions can be drawn regarding treatment parameters because of the heterogeneity of the intervention. AOT has been considerably less explored in musculoskeletal conditions.

Purpose Diagnosis of substance use disorders and addictive behaviours are growing worldwide. It is timely to examine and collate literature on the nature of occupational therapy intervention in this field, to increase understanding of current practice and inform future directions. The purpose of this paper is to source and synthesise literature on occupational therapy interventions used in the treatment of people experiencing addiction. Design/methodology/approach Four databases were searched in August 2019. A total of 597 titles were screened, and 18 studies with varying methods met inclusion criteria. A narrative synthesis of the included literature was arranged into themes to summarise key findings. Findings Findings were grouped into three themes about occupational therapy provision to people experiencing addiction: single occupation focused intervention; skills training (including sub-themes on daily living skills and vocational skills); and establishing a community-based sober routine. Research limitations/implications Further research on this topic should focus on efficacy of treatments and build on current findings to develop more rigorous research with appropriate sample sizes to support evidence-based practice. Originality/value This study presents a synthesis of how occupational therapy interventions have been used to treat people experiencing addiction issues. Findings indicate occupational therapy appears to fit well within addiction treatment and assert that occupational therapy is most supportive when interventions go beyond the teaching of skills alone to prioritise occupational engagement and client centred practice.

A recent Alberta teacher health study indicated that teachers on long‐term disability (LTD) benefits are, for the most part, left to their own devices regarding rehabilitation. Subsequently, the authors of that study (Jevne and Zingle, 1990) recommended the development of a “psychologically and educationally sound intervention” to assist the LTD teacher in maximizing recovery. In response to this recommendation, an adaptation of single‐session therapy was developed by Talman (1990) and a pilot intervention was carried out. Thirty‐three LTD teachers, volunteered to become part of this pilot project designed to provide individualized consultation and follow‐up based on an empowerment model. The main focus of these consultations was to determine the present state of wellness and to provide new insights and expand alternatives within a caring and safe therapeutic environment. The follow‐up debriefings and evaluations indicated that most individuals experienced substantive change in many areas of wellness during the time of the study. Without assuming direct causal relationship, it would seem that this single‐session therapy approach has potential as a model of brief intervention for the “disabled” teacher.

Background Mid-portion Achilles Tendinopathy (AT) is a common musculoskeletal condition with varying rehabilitation success rates. Despite the prevalence of this condition, a considerable proportion of individuals experience persisting pain and functional deficits. Current treatment approaches bias the biomedical model which emphasises physically treating and loading the tendon. Overall, there is a lack of consideration for the central nervous system that is commonly implicated in chronic injuries. The aim of this pilot study was to explore the feasibility of combining Action Observation Therapy (AOT), a treatment technique which targets central changes and influences motor learning, with eccentric exercises in the treatment of mid-portion AT. AOT involves the observation of movements and is commonly followed by the physical performance of these same movements. Methodology This was a double-blinded randomised controlled pilot feasibility study. All participants underwent the 12-week Alfredson eccentric training protocol. The intervention group watched videos of the exercises prior to performing these exercises, whilst the control group watched nature videos before performing the same exercises. Study feasibility was the primary outcome measure, with the Victorian Institute of Sports Assessment- Achilles (VISA-A) selected as the primary clinical outcome measure. Results Thirty participants were recruited, reflecting a 75% eligibility rate and 100% of eligible participants enrolled in the study. The retention rate at week 12 was 80%. At week six the mean VISA-A score improved by 18.1 (95% CI 10.2–26.0) in the intervention group and 7.7 (95% CI 0.3–14.9) in the control group, and 75% and 33% of participants in the intervention and control group respectively exceeded the minimal clinically important difference (MCID). At week 12 the mean VISA-A score from baseline improved by 22.25 (95% CI 12.52–31.98) in the intervention group and 16.5-(95% CI 8.47–24.53) in the control group, equating to 75% and 58% in each group respectively exceeding the MCID. Conclusion The positive feasibility outcomes and exploratory data from the clinical outcome measures suggest that a larger scaled RCT is warranted to further investigate the impact of AOT in the rehabilitation of mid-portion AT. Trial registration ISRCTN58161116, first registered on the 23/12/2020.

This scoping review aims to identify the outcome measures used in intervention studies for mid‐portion Achilles Tendinopathy (AT), classify these measures within The International Classification of Functioning, Disability and Health (ICF) framework, and summarize reported psychometric properties. A literature search was performed on multiple databases. Randomized controlled trials of intervention studies for mid‐portion AT published between 2005‐2020 in English were included. No age or gender limitations were set. A total of 94 different outcomes measures were used within the 38 included studies. A lack of consistency is seen in the selection of outcome measures, with over two‐thirds of the measures being used once. The Victorian Institute of Sports Assessment‐Achilles Questionnaire (VISA‐A) was the most frequently implemented measure (25 studies), followed by the Visual Analog Scale (VAS) for pain (19 studies). A total of 59 outcome measures were coded within the ICF framework; Body Structures and Functions, and Activity and Participation ICF domains are well represented, however, personal factors, patient perceptions, and satisfaction levels could not be coded. Under‐reporting of psychometric properties was found, with properties reported for 12 measures only. This review highlights the need for a core standard of outcome measures for rehabilitating persons with mid‐portion AT.

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Background Quantitative research has dominated the field of Achilles Tendinopathy. The use of qualitative research allows in-depth exploration of participants’ perspectives, offering great insight in the evaluation of a trial’s processes, particularly when exploring a novel intervention such as Action Observation Therapy combined with eccentric exercises which has not been previously researched. This study aimed to qualitatively explore participants’ experiences of partaking in a telehealth study including the acceptability of the intervention, motivators for participation, and perspectives on the trial processes. Method A thematic analysis as guided by Braun and Clarke was used to analyse the semi-structured interviews conducted on a purposive sample of participants with mid-portion Achilles Tendinopathy who recently completed a pilot feasibility study. The study adhered to the criteria for reporting qualitative research guidelines (COREQ). Results/Discussion Sixteen participants were interviewed. The five themes identified were: (i) The impact of Achilles Tendinopathy is commonly not prioritised with ‘The acceptance and minimisation of pain’ as a sub-theme (ii) Therapeutic alliance has the greatest impact on support (iii) Factors which influenced adherence (iv) Action Observation Therapy is valued and recommended (v) Recommendations for future interventions. Conclusion This study provides insightful recommendations around; exploring the use of Action Observation Therapy in Achilles Tendinopathy, the relative importance of therapeutic alliance rather than mode of therapy delivery, and that sufferers of Achilles Tendinopathy may not prioritise health seeking for this condition.

Background Mid-portion Achilles tendinopathy (AT) is a common overuse injury which can be difficult to successfully rehabilitate. Whilst peripherally directed treatment approaches that strengthen the Achilles tendon complex can be efficacious for some individuals, others will continue to experience long-standing pain and functional deficits. Expanding our rehabilitation approach beyond the tendon mechanical properties to include techniques which target the central neurophysiological changes which can occur in chronic injuries, including mid-portion AT, may improve our rehabilitation outcomes. Action observation therapy (AOT) is one such technique which targets central changes and can enhance motor learning. To our knowledge, there is currently no available information on the combined effect of AOT and eccentric exercises in the rehabilitation of mid-portion AT, nor understanding of the feasibility of conducting randomised controlled trials that investigate this combined centrally and peripherally directed treatment approach. This protocol outlines the design of a remotely conducted parallel-group randomised controlled trial comparing the efficacy of combined AOT and eccentric loading exercises versus eccentric loading exercises alone for mid-portion AT. Methods Participants recruited throughout Ireland with mid-portion AT will be randomly assigned to one of the following groups: (i) The AOT group will observe videos of the eccentric exercises prior to the physical performance of the eccentric exercises. (ii) The control group will observe videos of landscapes prior to the performance of the eccentric exercises. This is a 12-week daily intervention as per the Alfredson loading protocol and outcome measures will be assessed at baseline, week 6 and week 12. Primary feasibility outcomes will include data on numbers of eligible participants, recruitment and retention rates, along with exercise compliance and acceptability of treatment. The primary clinical outcome measure will be the Victorian Institution Symptom Assessment-Achilles Questionnaire (VISA-A) assessing disability. Secondary clinical outcomes will address the remaining core domains as outlined by the International Scientific Tendinopathy Symposium consensus (ICON group) including pain, participation, functional, physical function capacity, quality of life and psychological factors. Widespread bodily pain and centralised pain features and patient satisfaction levels will also be evaluated. Discussion This study will provide scientific direction for future randomised controlled trials exploring the effect of AOT and eccentric exercises in the treatment of mid-portion AT on pain, centralised pain features, motor and non-motor functions, quality of life and patient satisfaction levels. The feasibility of the conducting a study remotely from participant screening to final follow-up assessment will also be provided. Trial registration ISRCTN58161116