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School of Occupational Therapy

Touro University Nevada

OCCT 643 Systematic Reviews in Occupational Therapy

Critically Appraised Topic Project

EVIDENCE TABLE
Name: Kristin Caroza and Leslie Ramos

Date: 9/16/15

Focus Question: What is the effectiveness of lifestyle interventions including self-management and mindfulness on perceived quality of life among adults with
or at risk for type 2 diabetes?

Rationale for inclusion/exclusion criteria applied to determine which articles should be included in the evidence table:
The articles that met the inclusion criteria were Level I or II articles, written in English, published within 10 years, full length articles published in peer-reviewed
journals, and answered the P, I, and O of the focused question. Articles that were excluded from the review were categorized as a Level III, IV, or V, nonEnglish, dissertation or masters thesis, and published before 2005. The inclusion and exclusion criteria provided the most current and highest level of evidence
for the systematic review.

Author/
Year
Cezaretto,
SiqueiraCatania, de
Barros,
Salvador &
Ferreira
(2012)

Study Objectives

Level/Design/ Subjects

To evaluate whether
an interdisciplinary
intervention
program on lifestyle
results in better
quality of life (QoL)
and lower
frequencies of
depression and
binge eating
disorder (BED) in
individuals at risk
for type 2 diabetes
mellitus.

Level I
Randomized Control
Trial (RCT)
Subjects:
177 individuals seen by
the public health system
of the Sao Paulo city of
Brazil between the ages
of 18 to 79. The
sample consist of a high
risk for type 2 DM
which was defined as
the presence of a
prediabetic condition or
the metabolic syndrome

Intervention and
Outcome Measures
Intervention:
The traditional
intervention (control)
consisted of 3 medical
visits during 9 months
and received written
guidelines on changes in
diet and physical activity
based on the primary care
model advocated at the
Brazilian public health
system.
The intensive
intervention
(interdisciplinary) group
consisted of medical

Results

Study Limitations

Implications for OT

Only individuals
submitted to
intensive
interventions (II)
had blood pressure
and plasma glucose
levels reduced.
Frequencies of
depression reduced
in both intervention
but of BED only in
II. Increment in the
scores of SF-36
domains were
greater in the II than
in the traditional
intervention (TI).

The level of
adherence from the
remaining sample
achieved 70% of
the attendance to
the group sessions.
Due to the nature of
a longitudinal
study, the
participants may
not adhere to a
strict diet and
physical exercise
required for their
intervention group
after a 9 month
follow up.

The clinical and


community-based practice
of OT:
IDT provides a wellrounded intervention to help
individuals develop the
knowledge and skills
needed to decrease their risk
for developing diabetes and
increase their quality of life.
Program development:
A program that incorporates
an IDT can include OTs to
provide individuals with a
client centered approach to
incorporate a lifestyle

without DM.

visits, an individual
appointment with a
dietitian, and attended a 2
hour group sessions for
up to 17 participants led
by the IDT (frequency
fading from 4
session/mo. to 1-2
session/mo.).
Outcome Measures
- International Physical
Activity Questionnaire
- Nutrition Data System
for Research
- Medical Outcome
Study 36-Item ShortForm Health Survey
(SF-36)
- PRIME-MD & Beck
Depression Inventory
(BDI)

Changes in the SF36 correlated with


decrease in
anthropometry,
blood pressure and
glucose levels,
depression, and
BED scores. Male
gender was
independently
associated with nonadherence to the II.
P-values:
II - Physical
component <0.05
& Mental
component <0.001
TI
Physical component
0.14 & Mental
component 0.02

intervention by addressing
all factors of the individual.
Societal needs:
A strong IDT may improve
the effectiveness of
implementing a lifestyle
program to provide
individuals with the best
knowledge from each
discipline. OTs are experts
in participation in daily life
activities and have the
potential to support an
individuals transition
towards a healthier lifestyle
long term.
Healthcare delivery and
health policy:
Unfortunately, healthcare
delivery is given once an
individual is already
diagnosed with diabetes.
OTs can take part in the
process of prevention to
minimize cost of frequent
hospital admissions from
complications of diabetes.
Education and training of
OT students:
The importance of
educating future OTs about
lifestyle interventions for
individuals with diabetes
can greatly improve their
health and quality of life. In
addition, understanding the
diagnosis of diabetes itself
can help OTs develop an
individualized lifestyle
modification to prevent the
onset of diabetes.

Kanaya,
SantoyoOlsson,
Gregorich,
Grossman,
Moore &
Stewart
(2012)

To determine the
efficacy of utilizing
a community based
lifestyle intervention
program to lower
diabetes risk factors
among adults with a
lower
socioeconomic
status (SES).

Level I
RCT
Subjects:
238 community
dwelling adults within a
low-income
neighborhood in
Northern California.
Participants are at risk
for diabetes.

Intervention:
Participants completed
the Live Well, Be Well
lifestyle program in
which health counselors
provided training on diet
modification and
physical activity through
telephone based
counseling, in-person
sessions, and group
workshops.
Outcome Measures
- Blood test: fasting
serum glucose, insulin
levels, and cholesterol.
- Weight
- Waist circumference
- Blood pressure
- Modified Block Food
Frequency
Questionnaire
- CHAMPS
questionnaire &
Sleeping Problems
Index
- Psychological Distress
II
- Psychological Wellbeing Index
- Perceived Stress Scale.

Individuals in the
intervention group
had a significant
difference in weight
loss as well as diet
and reported to eat
more fruits and
vegetables than the
control group at 6
months (p=.02) and
at 12 months
(P=.04). However,
there was no
significant group
difference in the
total calories,
dietary fiber, or
physical activity.
The intervention
group had a better
psychological wellbeing and quality of
life than the control
group at 6 months
(p= .05) and 12
months (p=.05) as it
had a greater
improvement in
self-rated health and
significant decrease
of sleep problems.
However, there
were no significant
differences between
groups in perceived
stress or
psychological stress.

Study was not able


to recruit an equal
amount of men
(27%) and women
(73%).

Refinement, revision, and


advancement of factual
knowledge or theory
The study would benefit
from weekly follow ups to
increase adherence to a 9
month program.
The clinical and
communitybased practice of OT:
Explores the efficacy for
community based treatment
among individuals with a
lower SES.
Program development:
Explores interventions that
are more cost effective
methods for treatment
compared to those that are
more medically based.
Societal needs:
This would help address the
development of social
justice services within OT
by helping individuals in a
lower SES have a feasible
access to treatment for
diabetes.
Healthcare delivery and
policy:
Provides evidence toward
efficacy in community
based programs. A new
healthcare delivery method
that helps provide more
access to diabetes treatment
among individuals with a
low SES.
Education and training of
OT students:
Helps students be cognizant
of different cultures in

providing effective and


client-centered care.

Khunti, K.,
Gray, L. J.,
Skinner, T.,
Carey, M.
E., Realf,
K.,
Dallosso,
H., & ...
Davies, M.
J. (2012)

To evaluate the
effectiveness of a
structured group
education program
on biomedical,
psychosocial, and
lifestyle measures in
people with newly
diagnosed type 2
diabetes.

Level I
Cluster RCT
Subjects:
824 individuals
participated in the study
including 387 in the
control group and 437
in the intervention
group. The study was
carried out in 13 sites in
primary care, involving
17 primary care
organizations across
England and Scotland.
Participants were
referred within four
weeks of diagnosis to
the intervention arm.

Intervention:
The control group
received current routine
care in the UK providing
unstructured education
on diabetes. The
intervention group
received a structured
group education program
based on a series of
psychological theories of
learning. The program
consist of a written
curriculum focused on
lifestyle factors such as
food choices, physical
activity and
cardiovascular risk
factors. The program is
made to be deliverable in
a community setting and
can be integrated in
routine care. It takes six
hours long and can be
delivered in one day or
two half days facilitated
by two educators.
Registered healthcare
professionals received
formal training to deliver
the program.
Outcome Measures:
- Hemoglobin A1c levels
- Blood pressure

Hemoglobin A1c
levels at 12 months
had decrease by
1.49% in the
intervention group
compared with
1.21% in the control
group. The
intervention group
showed greater
weight loss
compared with the
control group (P=
0.025). The
intervention group
showed significant
greater changes in
illness belief scores
(P=0.001) indicating
greater understating
of diabetes. A
positive association
was found between
changes in
perceived personal
responsibly and
weight loss at 12
months (p=0.008).
The groups did not
differ significantly
in any of the scores
for the six
dimensions of
quality of life.

The intervention
and control groups
were well matched
for variables except
for hemoglobin
A1c level and sex.
In addition, the lack
of difference in
quality of life
between the groups
may result from a
lack of sensitivity
in the tool used.

Refinement, revision, and


advancement of factual
knowledge or theory:
Further research is needed
to explore how lifestyle
interventions would be
adjusted to be well-suited
toward different cultures.
The clinical and
community-based practice
of OT:
The study provides evidence
of a structured group
education program on
individuals newly diagnosed
with diabetes with greater
understanding and positive
health outcomes.
Program development:
After initial diagnosis of
diabetes, intervention based
on education and lifestyle
may provide individuals
with the ability to better
manage their diabetes
within the year providing
healthy habits to prevent
further complications.
Societal needs:
Special consideration should
be made for individuals
newly diagnosed with
diabetes to provide the
education and skills needed
to manage the disease.
Healthcare delivery and
health policy:
Primary care may not be
enough to provide
individuals newly diagnosed

- Body weight
- Diabetes self-care
activities questionnaire
- International physical
activity questionnaire
- Short version of the
World Health
Organizations quality
of life instrument
WHOQOL-BREF
- Illness perceptions
questionnaire
- Diabetes illness
representations
questionnaire
- Diabetes scale
- Hospital anxiety and
depression scale

Marrero,
Pan,
BarrettConnor, de
Groot,
Zhang,
Percy . . .
Rubin
(2014)

Assess if diagnosis
of type 2 diabetes
affected healthrelated quality of
life (HRQoL)
among participants
in the Diabetes
Prevention
Program/Diabetes
Prevention Program
Outcome Study and
changes with
treatment or
diabetes duration.

Level I
RCT
Subjects:
Study obtained a 3,210
participants who were
greater than or equal to
25 years of age, equal
distribution among
demographic
characteristics (age,
gender, ethnicity,
employment, income)
Exclusion criteria:
cannot have a mental
disability or medication
that relates to weight
loss

Intervention:
Comparison of three
groups. One group was
given Meformin (MET
arm), the second was
given a placebo pill, and
the third was given an
intensive lifestyle
modification program.
The lifestyle program
entailed a low-fat diet
and engagement in
physical activity up to
150 minutes per week
Outcome Measures:
- SF-36

with diabetes the necessary


education to promote a
healthy coping process of
their disease.
Education and training of
OT students:
Diabetes requires further
knowledge and
understanding to make
interventions plans that will
address the individuals
needs with a holistic
approach.

Diabetes-free
participant showed
little decline in
scores for
approximately three
years of
participation in the
study and
participants in the
ILS treatment
reported a slight
increase in scores
from baseline to one
year. However,
participants in all
the treatment groups
that remained
diabetes free show a
progressive decline
in SF-6D scores.
Scores in post

Reliance on generic
measures of
HRQoL to define
the impact of
diagnosis. In
addition, the sample
exclude mental
health issues,
depression, and
anxiety disorders.

Refinement, revision, and


advancement of factual
knowledge or theory:
Further research and followup on the group educational
program is needed to
determine the effectiveness
of the intervention after
individuals are newly
diagnosed with diabetes.
The clinical and
community-based practice
of OT:
It is important to be
cognizant of clients
expectations of outcomes of
treatment. Although
lifestyle interventions may
help treat diabetes, it may
not ultimately prevent it.
Quality of life may be
negatively affected if
clients make efforts to
control lifestyle and still be
diagnosed with type II
diabetes later on.
Program development:
Health and exercise
programs are effective in
treating the physical

diabetes diagnosis
show a more rapid
decline when
compared to the
diabetes-free
participants.

symptoms of diabetes;
however, it should be paired
with a psychosocial
treatment component to
prevent future mental health
issues and disorders.

P values:
- DM-free <.001
- Post-DM
- Lifestyle <.001
- Metformin <.001
- Placebo <.001

Societal needs:
With the rising prevalence
of diabetes, it is important to
address alternative methods
to hospital based treatment.
Lifestyle intervention is an
option to help reduce
physical symptoms but may
not improve quality of life.
Healthcare delivery and
health policy:
This article shows that only
addressing physical
symptoms of a disease may
not be enough for effective
delivery of treatment. By
showing the inefficacy of
physical treatment only
interventions, shows support
for more psychosocial
approaches in healthcare
delivery.
Education and training of
OT students:
Students will need to have a
knowledge base of diabetes
and healthy lifestyle
interventions to be
implemented. May need to
know a broad understanding
of medications most
commonly taken to treat
diabetes.
Refinement, revision, and
advancement of factual
knowledge or theory:

Oh, Bang,
Hyun, Kim,
Chu, Jeon .
. . Lee
(2010)

Determine the
effects of a lifestyle
modification
program on people
with a risk of a
metabolic disorder
including diabetes
and health related
quality of life
among middle aged
and older women in
a community in
South Korea.

Level I
RCT
Subjects:
52 community dwelling
women over the age of
50 receiving treatment
in outpatient clinics in
South Korea. ( 21
control, 31
treatment) Participants
must be able to adhere
to the program time
commitment and must
be able to engage in
moderate levels of
exercise.

Intervention:
Participants completed a
6 month lifestyle
modification program, 3
times a week for 90
minutes. Program
consists of health
monitoring, counseling,
health education, group
exercise, and diet
training.
Outcome Measures:
- Blood pressure
- Blood glucose levels
- Cholesterol levels
- Body weight
- Waist circumference
- Health Related Quality
of Life - Medical
Outcome Study Short
form 36

Weight: Treatment
group had a
significant decrease
(p<.001). All of the
participants had
experienced changes
in their vitals during
the treatment
directly after it but
did not sustain 6
months after the
study. There was
also no statistically
significant data for
the improvement of
blood pressure,
blood glucose
levels, and
cholesterol.
HRQOL: Outcomes
were mixed.
Treatment group
experienced
significant
improvements in
general health
(P<.001), vitality
(P=.008), and
mental health
(P=.027) from
baseline. No
statistical
significance for
scores of bodily
pain, but yielded
higher scores than
the control group,
indicating that the

With only 52
participants, it may
not be large enough
to determine the
effectiveness for a
community based
treatment. Study
also required a
large time
commitment and
may not be feasible
for all studies.

Explore the efficacy of


lifestyle interventions that
are paired with psychosocial
treatment to improve both
quality of life and health
condition of individuals
with diabetes.
The clinical and
community-based practice
of OT: Provides evidence
for the efficacy of
community based treatment,
however, therapists should
be cognizant of the degree
of time commitment
available for clients. Future
implementation of physical
exercise in programs should
also be wary of physical
pain and not over-exert
clients.
Program development:
Addresses alternative
methods toward holistic
care in treating diabetes.
Long term programs may
need to be implemented
because participants were
less likely to continue
lifestyle interventions when
they were on their own and
no longer in a program.
Societal needs:
With the rise of diabetes it is
necessary to explore
lifestyle changes to promote
health and wellness.
Programs that address
lifestyle interventions in a
community level allows
treatment administration at a
larger scale.

participants of the
study experience
more pain

Healthcare delivery and


policy:
The changes in vitals that
ended did not sustain 6
months after the
intervention. This shows
the importance of following
up with clients after
treatment is over.
Education and training of
OT students:
Provided evidence toward
methods to help long term
planning within group based
interventions.

Sagarra,
Costa,
Cabr,
SolMorales &
Barrio
(2014)

To perform a cost
analysis, compared
with effectiveness
and quality of life
perceived by the
participants of DM2
prevention,
conducted entirely
within the primary
care of Spain.

Level I
RCT
Subjects:
This study collected an
initial sample from a
medical database.
2,054 individuals were
screened for eligibility
for the study (risk for
diabetes). Of the initial
group, 552 participants
passed the screening
and were placed in a
standard treatment
group and an intensive
intervention group.

Intervention:
Groups were separated
into a standard group
which only received
generalized education on
diet and cardiovascular
risk while being pre
diabetic or an intensive
group that received a
structured 6 hour group
session or individualized
session with specific
teaching material. This
intervention was then
reinforced through
telephone calls, text
messages, and letters and
interviews that were
scheduled every 6-8
weeks. The prevalence

Prevalence of
diabetes: Within the
4 year span was
statistically
significant among
the groups. The
incidence of
obtaining type 2
diabetes was
greatest among the
participants who
only received the
standardized
treatment followed
by the group and
then individualized
intensive
intervention.

One of the main


limitations in this
study is that it does
not provide any
information on the
demographics of
the participants.
Culture, gender,
and age are
contributing factors
to obtaining type 2
diabetes and
attitudes toward
quality of life. This
may contribute to
the results of this
study.

Refinement, revision, and


advancement of factual
knowledge or theory:
More research is needed to
determine the appropriate
length and intensity of
treatment in order to sustain
healthy habits for longer
periods of time.
The clinical and
community based practice
of OT:
The most effective lifestyle
intervention for individuals
with diabetes need to be
intensive enough to make an
impact on diabetic
symptoms.
Program development:
Individuals who participate
in a lifestyle intervention
program also benefitted
from reinforcements of
lessons learned through
phone calls and letters.
Societal needs:

of diabetes and quality of


life was measured once a
year for 4 years. The
study also looked at the
cost of each type of
intervention.
Outcome Measures:
- Expense summary
- Quality-adjusted lifeyear
- Medical diagnosis from
physician

Quality of life:
maintained the same
for all of the groups
in the study until the
final visit on the
fourth year when a
significant
difference emerged
which stated that the
quality of life was
greater in the
intensive
intervention group
than in the
standardized
intervention group.

With the rising prevalence


of individuals diagnosed
with diabetes, health care
may need to determine if
preventative measures may
be more cost effective than
hospital based treatments.
Healthcare delivery and
policy:
Provides evidence in
supporting the use of group
therapy. May require new
billing protocols for future
use.
Education and training of
OT students: Students are
required to learn about the
symptoms of diabetes and
non-invasive treatment
methods.

Cost effectiveness:
the cost per
participant was 646
euros in the
standardized
intervention, 686 for
the intensive
individualized
intervention, and
752 euros in the
group format.

Toobert,
Glasgow,
Strycker,
Barrera,
Ritzwoller
& Weidner
(2007)

Determine the
effectiveness of
addressing lifestyle
behaviors among
women who are
post-menopausal
with type 2 diabetes
and its psychosocial
implications
including quality of
life.

Level I
RCT
Subjects: Sample was
collected through
recruiting postmenopausal women
receiving treatment at a
primary care
clinic. This study
excluded those who are
not able to speak
English, lived more 30
miles away from the

Intervention:
4 hour weekly for 6
months meetings targeted
implementing a
Mediterranean diet,
healthy eating classes,
physical activity, stress
management, smoking
cessation, and social
support.
Outcome Measures:
- Diabetes distress scale
- Perceived stress scale

Participants in the
intervention group
had showed
significant 12 and
24 month
improvements in all
lifestyle behaviors
except smoking
habits. Significant
improvements were
also displayed in all
of the psychosocial
measurements
including quality of
life; however, with

The intervention
was a large
commitment to
time from the
participants and
mentions that those
who were already
willing to spend the
time to participate
in the study would
already be naturally
inclined to adhere
to lifestyle changes
in comparison to
individuals who

Refinement, revision and


advancement of factual
knowledge or theory:
Explore the difference in
efficacy for lifestyle training
that was administered
through phone versus in
person.
The clinical and
community-based practice
of OT: Helping individuals
through training them in
person is effective for
reducing psychosocial
symptoms related to
diabetes. Give clients the
feeling of control over their
lives.
Program development:
It is important to be
sensitive to the time
availability for

intervention site, and


are developmentally
disabled.

- Confidence in
Overcoming
Challenges to Self-Care
- Brief Chronic illness
resources Survey
- Balanced Inventory of
Desirable Responding
- Semi-quantitative food
frequency questionnaire
- CHAMPS
questionnaire for older
adults

only a modest
improvement for
self-efficacy

dropped. Thus, the


results of the study
may be attributed to
the personalities of
the participants
who stayed in the
intervention
program instead of
the intervention
itself.

implementing lifestyle
interventions.
Social needs:
Provides evidence toward
addressing psychosocial
implications that is often
secondary to the diagnosis
of a disease.
Healthcare delivery and
policy:
Lifestyle interventions
should adhere to the
availability of clients
because this study shows
that if there is too much
time commitment,
individuals are more likely
to drop out of a program.
Education and training of
OT students:
Will require the training of
various lifestyle intervention
strategies as well as the
symptoms and health
condition of individuals
with diabetes.

Van Son,
Nyklcek,
Pop, Blonk,
Erdtsieck,
Spooren . . .
Pouwer
(2013)

To determine the
effectiveness of
group mindfulness
based cognitive
therapy to reduce
emotional distress
and health related

Level I
RCT
Subjects: 139 adults
diagnosed with diabetes
receiving treatment

Intervention:
Participants completed an
8 week mindfulness
program for 2 hours each
session conducted by
clinical psychologists.
Topics discussed include

Emotional Distress:
Levels of perceived
stress over time in
comparison to the
treatment as usual
group had
significantly

There was a
significant dropout
in the study, the
study did not
investigate changes
in medication or in
overall mental

Refinement, revision, and


advancement of factual
knowledge or theory:
Compare and contrast a
lifestyle intervention
program with different time
lengths to identify the
optimal length for treatment
time.
The clinical and
community-based practice
of OT: Provides evidence
supporting the use of the
mindfulness based cognitive
therapy protocol.

quality of life
among patients with
type 2 diabetes.

from outpatient diabetes


clinics. (69 control, 70
treatment)

methods for coping with


stress and managing
thoughts. Effectiveness
on managing emotional
distress was assessed
before, during, and after
the intervention.
Outcome measures:
- Perceived stress scale
- Hospital anxiety and
depression scale
- Profile of mood
- Problem areas in
diabetes survey
- 12 short form health
survey

decreased (P<.001).
There was also a
statistically
significant but small
effect on symptoms
of anxiety (p<.001).
There was no
significant
difference between
both of the groups
when it comes to
diabetes-specific
stress.

health prior to
diabetes diagnosis.

Program development:
Important to utilized the
standardized protocol to
administer the group
mindfulness cognitive
therapy.
Societal needs:
In modern health care,
psychosocial needs are often
treated secondary to
treatment of a disease even
though it may be of equal
importance.

Quality of Life: The


MBCT group had
strongly improved
mental quality of
life as well as
physical quality of
life compared to the
treatment as usual
group.

Healthcare delivery and


policy:
Addresses the fact that
individuals with diabetes
may need to be treated for
comorbid mental health
needs. Provides efficacy
toward mindfulness based
cognitive therapy.
Education and training of
OT students:
Determines therapeutic
methods in which OTs can
contribute to the
psychosocial needs of
clients with diabetes.

Williamson
, Rejeski,
Lang, Van
Dorsten,
Fabricatore,
& the Look
AHEAD

To test the efficacy


of a weight
management
program for
improving healthrelated quality of
life (HRQOL) in

Level I
RCT
Subjects:
2082 men and 3063
women ranging from 45

Intervention
The intensive lifestyle
interventions (ILI)
consisted of the Look
AHEAD program. Goals
included: induce a mean
loss of at least 7% of

The participants in
the ILI arm
achieved
significantly greater
reduction in body
weight compared
with the DSE arm

The look AHEAD


program last for a
duration of 11
years. This study
only captures the
outcome after one
year of the

Refinement, revision, and


advancement of factual
knowledge or theory:
Explore the efficacy of
MBCT in a group setting
versus one on one.
The clinical and
community-based practice
of OT:
Lifestyle modification with
an emphasis on weight
management can be used to
improve HRQOL and

Research
Group
(2009)

overweight or
obsessed adults
diagnosed as having
type 2 diabetes
mellitus.

to 75 year of age.
Majority of participants
were white (63.1%),
followed by African
American (15.6%),
including Hispanic,
Asian American, native
American, and other.
The study did not state
if the two groups were
equally distributed
and/or similar.

initial weight and


increase participants
moderately intense
physical activity to at
least 175 minutes per
week. The first 6
months, participants
attended 1 individual and
3 group sessions per
month and were
encouraged to replace 2
meals and one snack each
day with liquid shakes
and meal bars. From
months 7-12, participants
attended 1 individual and
2 group meeting per
month and continue to
replace 1 meal per day.
The diabetes support and
education (DSE) is the
control group that
provided 3 educational
group sessions per year
(focusing each session on
one of the following:
nutrition, physical
activity, and support). No
goals were given for
weight loss or caloric
intake. Participants were
not instructed to monitor
energy intake or physical
activity. In addition, they
were not weighed at
group meetings
Outcome Measures
- SF-36
- Beck Depression
Inventory II (BDI-II)
- Self-report

(P<.001). Improved
HRQOL was
demonstrated by the
PCs and BDI-II
scores (P<.001) in
the ILI compared
with the DSE arm.
The study also
found that the
greatest HRQOL
improvement
occurred in
participants with the
lowest baseline
HRQOL levels.

programs
implementation. It
will be important to
observe the stability
of improvement in
HRQOL for longer
study periods.

decrease depression scores


among obsessed or
overweight individuals
diagnosed with type 2
diabetes.
Program development:
OTs focus on daily
participation; therefore, it is
important to implement
strategies to develop a
healthy diet and schedule
physical exercise in an
individuals daily routine to
help manage diabetes.
Societal needs:
Due to the rise in diabetes,
maintaining a healthy
weight and diet can help
prevent the onset or
progression of the disease.
Healthcare delivery and
health policy:
Implementing a weight
management program can
help individuals with type 2
diabetes manage their
diagnosis and prevent
further complications. This
can decrease hospital
admission, therefore,
providing reducing health
care cost.
Education and training of
OT students:
Education on diabetes will
help OT students understand
how to implement lifestyle
interventions to further
improve their quality of life.

Wu, Liang,
Wang,
Chen, Jian
& Cheng
(2011)

To examine the
effectiveness of selfmanagement
intervention to
improve healthrelated quality of
life (HRQOL) and
psychosocial wellbeing for individuals
with type 2 diabetes
mellitus.

Level II
Quasi-experimental
design
Subjects:
145 participants were
recruited from an
outpatient clinic in a
municipal hospital in
Taipei. Each
participant was
screened by the
researcher to determine
if they met the
following criteria: (1)
diagnosed with type 2
diabetes, (2) 30 years
old or higher, (3) fluent
in Chinese or
Taiwanese, (4) had a
telephone in their
residence and were able
to use it effectively.
The participants were
assigned to an
intervention group (n
=72) and control group
(n=73) with similar
characteristics in age,
gender, marital status,
ethnic status, religion,
education, and other
chronic conditions.

Intervention:
Both the control group
and intervention group
received a standard
diabetic education
program in the outpatient
clinic which consisted of
a 15-20 minute nutrition
consultation with a
nutritionist and an
individual diabetic
education consultation
with a diabetic nurse
educator.
In addition to the
standard diabetic
program, the intervention
group received a selfmanagement intervention
(Self-Efficacy Enhancing
Intervention Program;
SEEIP) which included a
diabetes self-care
booklet, a DVD, four
weekly self-efficacyenhancing session that
participants had to
participate in at least
three of the four sessions,
and follow-up by
telephone.
Outcome Measures:
- Health-Related Quality
of Life (HRQOL) SF12 scale

The scores for social


support were
significantly
increased in the
intervention group
at three and six
months from
commencement of
the intervention
compared with
those of the control
group (p <0.01),
whereas healthrelated quality of
life (p<0.41) and
depression (p<0.64)
were not
significantly
different.

The research design


allowed participants
to be aware of
which group they
were placed in
which may lead to
potential bias
through selfreported data. The
sample size was
small and consisted
of participants with
only a primary
school education;
therefore, results
cannot be
generalized to more
highly educated
individuals. In
addition, the study
followed up for a
short period of
time.

Refinement, revision, and


advancement of factual
knowledge or theory:
Further research and follow
up of the look AHEAD
program is needed to
determine the long term
effects of this specific
lifestyle intervention.
The clinical and
community-based practice
of OT:
Although managing diabetes
is important, a selfmanagement program offers
individuals social support
needed to cope with the
diagnosis of diabetes.
Program development:
Learning how to accept a
diagnosis as part of an
individuals daily life is an
important step that tends to
get overlooked when
implementing a program for
individuals with diabetes.
Societal needs:
Diabetes continues to be a
prevalent disease that tends
to be pushed aside. The
importance of
acknowledging the disease
as a contributing fact of an
individuals health needs
more awareness as many
individuals are impacted.
Healthcare delivery and
health policy:
Although a selfmanagement program helps
provide individuals with
strategies and education to
cope with diabetes, the

- The Medical Outcomes


Study (MOS) Social
Support Survey (SSS)
scale
- The Center for
Epidemiology Studies
Short Depression Scale
(CES-D)

individual may need to pay


out of pocket to receive this
type of service.
Education and training of
OT students:
OT students would need
additional training to
implement a selfmanagement program to
further expand their services
for individuals diagnosed
with diabetes in addition to
basic understanding of
diabetes itself.
Refinement, revision, and
advancement of factual
knowledge or theory:
Additional research is
needed to determine the
long term effects of a selfmanagement program on
individuals with diabetes.

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