***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES The provision of options in the occupational form that encourages meaningful choices and subsequent purpose ful occupational performances is a basic premise of occupational therapy . This study examines the preferences of elderly nursing home residents when presented with an occupationally embedded exercise versus a rote exercise and addresses the method ological problems identified in similar past research . METHODS Fifty-two elderly nursing home residents were presented with a choice between an occupationally embedded exercise that involved unilateral dunking of a small , spongy ball into a basketball hoop and a rote exercise that involved moving the arm above the head in a simulation of the dunking exercise . Both exercises required flexion of the shoulder joint . R and om assignment of the 52 subjects into one of four groups controlled for the order of the presentation of the exercises and the order of the choice statements . RESULTS Sixty-nine percent of the subjects chose the occupationally embedded exercise . Analysis with the significance of a proportion statistic revealed a statistically significant difference ( z = 2.77 ; p ( one-tailed ) = .003 ) . CONCLUSION Results were consistent with the hypothesis that elderly nursing home residents would tend to choose the occupationally embedded exercise . To further confirm this basic premise of occupational therapy , future studies that investigate therapeutic patterns of movement embedded in common occupations are recommended Objective Tailoring stroke information and providing reinforcement opportunities are two strategies proposed to enhance the effectiveness of education . This study aim ed to evaluate the effects of an education package which utilised both strategies on the knowledge , health and psychosocial outcomes of stroke patients and carers . Design Multisite , r and omised trial comparing usual care with an education and support package . Setting Two acute stroke units . Participants Patients and their carers ( N=138 ) were r and omised ( control n=67 , intervention n=71 ) of which data for 119 participants ( control n=59 , intervention n=60 ) were analysed . Intervention The package consisted of a computer-generated , tailored written information booklet and verbal reinforcement provided prior to , and for 3 months following , discharge . Outcome measures Outcome measures were administered prior to hospital discharge and at 3-month follow-up by blinded assessors . The primary outcome was stroke knowledge ( score range : 0–25 ) . Secondary outcomes were : self-efficacy ( 1–10 ) , anxiety and depression ( 0–21 ) , ratings of importance of information ( 1–10 ) , feelings of being informed ( 1–10 ) , satisfaction with information ( 1–10 ) , caregiver burden ( carers ) ( 0–13 ) and quality of life ( patients ) ( 1–5 ) . Results Intervention group participants reported better : self-efficacy for accessing stroke information ( adjusted mean difference ( MD ) of 1.0 , 95 % CI 0.3 to 1.7 , p=0.004 ) ; feeling informed ( MD 0.9 , 95 % CI 0.2 to 1.6 , p=0.008 ) ; and satisfaction with medical ( MD 2.0 , 95 % CI 1.1 to 2.8 , p<0.001 ) ; practical ( MD 1.1 , 95 % CI 0.3 to 1.9 , p=0.008 ) , services and benefits ( MD 0.9 , 95 % CI 0.1 to 1.8 , p=0.036 ) and secondary prevention information ( MD 1.7 , 95 % CI 0.9 to 2.5 , p<0.001 ) . There was no significant effect on other outcomes . Conclusions Intervention group participants had improved self-efficacy for accessing stroke information and satisfaction with information , but other outcomes were not significantly affected . Evaluation of a more intensive intervention in a trial with a larger sample size is required to establish the value of an educational intervention that uses tailoring and reinforcement strategies . BACKGROUND Functional difficulty is associated with increased frailty and poor life quality , with the oldest old , women , African Americans , and less educated persons at greatest risk of disablement . This study examines whether these at-risk groups benefit differentially from an in-home intervention previously found to effectively reduce functional difficulties . METHODS Three hundred nineteen community-living , functionally vulnerable adults 70 years old or older were r and omized  to usual care or an intervention involving occupational and physical therapy home instruction in problem solving , device use , energy conservation , safety , fall recovery , balance , and muscle strengthening . Outcome measures at 6 and 12 months included difficulty level in ambulation , instrumental ( IADLs ) and activities of daily living ( ADLs ) , self-efficacy , and fear of falling . RESULTS At 6 months , for ADLs , individuals > or = 80 years ( p = .022 ) , women ( p = .036 ) , and less educated persons ( p = .028 ) improved compared to their control group counterparts . For mobility , women ( p = .048 ) and the oldest participants ( p = .001 ) improved relative to their counterparts . For self-efficacy , women ( p = .036 ) benefited more than men . For fear of falling , less educated persons improved more than their counterparts ( p = .001 ) . A similar pattern was found at 12 months . For IADLs , whites improved more than non-whites at 12 months . CONCLUSIONS Treatment benefits varied by specific participant characteristics , with individuals at greatest disability risk being most responsive to the intervention . Both white and minority participants benefited similarly except in IADL functioning . Future research should control for participant characteristics , identify underlying mechanisms for variation in treatment effects , and tailor treatment to patient characteristics and desired outcomes Abstract Objective To evaluate an occupational therapy intervention to improve outdoor mobility after stroke . Design R and omised controlled trial . Setting General practice registers , social services departments , a primary care rehabilitation service , and a geriatric day hospital . Participants 168 community dwelling people with a clinical diagnosis of stroke in previous 36 months : 86 were allocated to the intervention group and 82 to the control group . Interventions Leaflets describing local transport services for disabled people ( control group ) and leaflets with assessment and up to seven intervention sessions by an occupational therapist ( intervention group ) . Main outcome measures Responses to postal question naires at four and 10 months : primary outcome measure was response to whether participant got out of the house as much as he or she would like , and secondary outcome measures were response to how many journeys outdoors had been made in the past month and scores on the Nottingham extended activities of daily living scale , Nottingham leisure question naire , and general health question naire . Results Participants in the treatment group were more likely to get out of the house as often as they wanted at both four months ( relative risk 1.72 , 95 % confidence interval 1.25 to 2.37 ) and 10 months ( 1.74 , 1.24 to 2.44 ) . The treatment group reported more journeys outdoors in the month before assessment at both four months ( median 37 in intervention group , 14 in control group : P < 0.01 ) and 10 months ( median 42 in intervention group , 14 in control group : P < 0.01 ) . At four months the mobility scores on the Nottingham extended activities of daily living scale were significantly higher in the intervention group , but there were no significant differences in the other secondary outcomes . No significant differences were observed in these measures at 10 months . Conclusion A targeted occupational therapy intervention at home increases outdoor mobility in people after stroke OBJECTIVES To test the efficacy of a multicomponent intervention to reduce functional difficulties , fear of falling , and home hazards and enhance self-efficacy and adaptive coping in older adults with chronic conditions . DESIGN A prospect i ve , two-group , r and omized trial . Participants were r and omized to a treatment group or no-treatment group . SETTING Urban community-living older people . PARTICIPANTS Three hundred nineteen community-living adults aged 70 and older who reported difficulty with one or more activities of daily living . INTERVENTION Occupational and physical therapy sessions involving home modifications and training in their use ; instruction in strategies of problem-solving , energy conservation , safe performance , and fall recovery techniques ; and balance and muscle strength training . MEASUREMENTS Outcome measures included self-rated functional difficulties with ambulation , instrumental activities of daily living , activities of daily living , fear of falling , confidence performing daily tasks , and use of adaptive strategies . Observations of home hazards were also conducted . RESULTS At 6 months , intervention participants had less difficulty than controls with instrumental activities of daily living ( P=.04 , 95 % confidence interval (CI)=-0.28 - 0.00 ) and activities of daily living ( P=.03 , 95 % CI=-0.24 to -0.01 ) , with largest reductions in bathing ( P=.02 , 95 % CI=-0.52 to -0.06 ) and toileting ( P=.049 , 95 % CI=-0.35 - 0.00 ) . They also had greater self-efficacy ( P=.03 , 95 % CI=0.02 - 0.27 ) , less fear of falling ( P=.001 , 95 % CI=0.26 - 0.96 ) , fewer home hazards ( P=.05 , 95 % CI=-3.06 - 0.00 ) , and greater use of adaptive strategies ( P=.009 , 95 % CI=0.03 - 0.22 ) . Benefits were sustained at 12 months for most outcomes . CONCLUSION A multicomponent intervention targeting modifiable environmental and behavioral factors results in life quality improvements in community-dwelling older people who had functional difficulties , with most benefits retained over a year UNLABELLED Long term diabetes self-management behaviors , and strict glycemic control are difficult to achieve in clinical practice . OBJECTIVE Asesss two different reinforcement strategies for diabetes selfcare management , psychological distress and glycemic control in a one year follow up study . METHODS 70 consecutive type 2 diabetic patients , were recruited and r and omly assigned to three study groups . Subjects in the control group ( CG ) continued with their normal treatment schedule . The second group received a reinforcement course at 6 months ( RCG ) and in the third group , patients were contacted monthly by phone ( PHCG ) to promote self-management attitudes and address problems as they arose . A battery of questions and laboratory work-up were obtained at baseline and at one year follow-up . RESULTS At one year follow-up , the three groups significantly increased their diabetes-related knowledge . Both experimental groups displayed improved treatment compliance and had better adherence to the recommended meal plan ( p=0.06 and 0.003 ) . In addition , the PHCG significantly increased ( p<0.0001 ) their adherence to pharmacological treatment . No significant differences were observed in glycemic control , prevalence of depression or diabetes related distress . CONCLUSIONS Follow-up patient reinforcement strategies improve strategic diabetes self-care management behaviors . Further studies are needed to demonstrate the positive impact of these benefits on diabetes related outcomes CONTEXT Previous studies have found that a sizeable minority of newly disabled older persons recover independent function ; however , long intervals between assessment s have led to difficulty in determining the true incidence and duration of disability , and therefore in accurately characterizing the probability and course of recovery . OBJECTIVES To determine the rate of and time to recovery of independent function in community-dwelling older persons who become newly disabled in their activities of daily living ( ADLs ) , to determine the duration of recovery , and to compare the likelihood of recovery among pertinent subgroups of older persons . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study , with monthly assessment s of  ADL function , for 754 initially nondisabled , community-dwelling persons aged 70 years or older , performed in a small urban area from March 1998 to May 2003 . MAIN OUTCOME MEASURES Demographic features , chronic conditions , cognitive function , and physical frailty were determined during comprehensive assessment s at 18-month intervals . Disability , defined as needing personal assistance with 1 or more key ADLs ( bathing , dressing , walking , and transferring ) , was assessed during monthly telephone interviews . RESULTS A total of 420 participants ( 56 % ) experienced disability during a median follow-up of 51 months . Of these participants , 399 ( 81 % ) recovered ( ie , regained independence in all 4 ADLs ) within 12 months of their initial disability episode , and a majority ( 57 % ) of these maintained independence for at least 6 months . Among participants who experienced 3 or more consecutive months of disability , a majority ( 60 % ) recovered , but only a third of these maintained independence for at least 6 months . Persons who were cognitively impaired , physically frail , or severely disabled ( ie , in 3 - 4 ADLs ) at onset were less likely to recover than those who were cognitively intact , nonfrail , or mildly disabled , respectively . Nonetheless , a majority of participants within each subgroup recovered . CONCLUSIONS Newly disabled older persons recover independent ADL function at rates far exceeding those that have been previously reported . Recovery from disability , however , is often short-lasting , suggesting that additional efforts are warranted to maintain independence in this high-risk group OBJECTIVES When ascertaining the occurrence of disability , long assessment intervals may be problematic because they do not account for the possibility of recovery or for deaths or losses to follow-up . Our objective was to compare the rates of disability obtained from single follow-up assessment s with those obtained from monthly assessment s for intervals up to 24 months . DESIGN Prospect i ve cohort study . SETTING General community . PARTICIPANTS Seven hundred fifty-four nondisabled persons , aged 70 and older , categorized into three groups according to their risk for disability ( low , intermediate , and high ) . MEASUREMENTS Participants were 
    Output:
    
RESULTS Eight high- quality papers showed that occupation-focused and occupation-based OT using cognitive , behavioral and environmental strategies may significantly improve occupational performance in older , home-dwelling adults with physical health problems .
Maintaining achieved improvements was a consistent challenge .
AND SIGNIFICANCE Evidence suggests that older adults ' occupational performance can be significantly improved through low-intensity occupation-focused and occupation-based intervention .