AOTA’S EVIDENCE EXCHAGE

CRITICALLY APPRAISED PAPER (CAP) WORKSHEET

General Instructions: Please insert your responses in the boxes provided. Refer to the CAP
Guidelines for submission criteria and detailed instructions on how to fill out each section of the
worksheet.

CITATION AND DOI NUMBER (APA Format)

Hunter, E.G., Gibson, R. W., Arbes a , M., & D’Amico, M. (2017). Centennial Topics – Systematic
Review of occupational therapy and adult cancer rehabilitation: Part 1. Impact of physical
activity and symptoms management interventions. American Journal of Occupational Therapy,
71, 7102100030

CLINICAL BOTTOM LINE

Briefly discuss how the evidence can be used to inform and guide occupational therapy practice (i.e.,
within the scope of traditional or emerging practice) AND how practitioners can use the evidence
relative to the target population and practice setting. Implications need to be reported in consideration
of the strength of the evidence (i.e., type of study design, level of evidence, identified study limitations,
internal validity rating, to what population results may generalize). Character count limit: 1300

This systematic review examined the evidence for the effectiveness of OT interventions to improve the
activity and participation needs of adult cancer survivors in all areas of occupation. Strong evidence is
present to indicate that multidisciplinary rehabilitation programs are beneficial for cancer survivors
regardless of cancer type or stage of cancer. Such programs can be beneficial before, during, and after
treatment.

RESEARCH OBJECTIVE(S), DESIGN TYPE, AND LEVEL OF EVIDENCE

Character count limit: 350

This review was broken into 2 parts. The objective of this review included to search for and
assess the evidence supporting OT interventions that would improve occupational engagement.
Specifically, the researchers were looking to determine the effectiveness of cancer OT rehab
interventions that address activities of daily living (ADLs), instrumental activities of daily living,
leisure, work, social participation, and rest and sleep. The second part of this review focuses on
benefits of multidisciplinary rehabilitation and interventions that address psychosocial outcomes,
sexuality, and return to work. This is a level 1 systematic review study.

PARTICIPANT SELECTION
How were participants recruited and selected to participate? What were the inclusion and exclusion
criteria? Character count limit: 600

The search terms were related to this specific

AOTA Evidence-Based Practice Project
CAP Worksheet
Evidence Exchange
Last Updated: April 2018
1
population (adult cancer survivors), types of intervention, outcomes, and types of study design to be
included in the systematic review. The search engines used included Medline, PsycINFO, CINAHL,
and OTseeker. Included in the review were peer reviewed, OT related scientific articles on adults with
cancer published in English between 1995 and 2014. The review excluded data from presentations,
theses, conference proceedings, non peer-reviewed research literature, and dissertations. The review
also excluded studies that focused on caregivers, family members, or friends rather than cancer
survivors. Also excluded were studies of childhood cancer and interventions that required an academic
degree other than occupational therapy.

INTERVENTION(S) AND CONTROL GROUPS

List each group (i.e., Group 1, Group 2, etc.). Include brief description of the intervention. How many
participants in the group? Where did the intervention take place? Who delivered? How often? For how
long? Character count limit: 1500

A team of three reviewers (Hunter, Gibson, and D’Amico) worked together to evaluate all articles. The
synthesis consisted of reading the studies and completing a table describing each one of the studies.
Analysis of study design, outcomes, and risk of bias determined which studies were assessed as strong
or moderate evidence.

OUTCOME MEASURES
List only measures used in the study that are relevant to occupational therapy. Include the outcome
measured. Is the measure reliable? Is the measure valid? When is the measure used? Character count
limit: 600

Even though many studies discussed ADLs, returning to work, participation, and sleep as their goals,
not many of these studies measured these constructs. Rather, instruments looking at quality of life
(such as SF–12 and SF–36) and symptom control (such as breathlessness, pain, ROM, and fatigue) was
discussed. Some studies discussed these constructs generically as health, wellness, and quality of life
in their findings. Only a few studies discussed occupation-based outcomes or outcome measures such
as FIM. The FIM is a standardized assessment tool tht is both reliable and valid.

RESULTS
List key findings based on study objectives. Character count limit: 1200

There is strong evidence to support the idea that rehabilitation programs benefit survivors with many
types of cancer. Multidisciplinary rehabilitation programs improved function and participation in
patients regardless of their type of cancer, stage of cancer, or age. There is strong evidence supporting
psychosocial strategies, including cognitive–behavioral and educational interventions in reducing
anxiety in greater than 3 months post-treatment and depression from one to three months post-
treatment. There was moderate evidence indicating
AOTA Evidence-Based Practice Project
CAP Worksheet
Evidence Exchange
Last Updated: April 2018
2
that rehabilitation can be beneficial both before and after treatment. There was also moderate evidence
showing that cognitive rehabilitation improved attention and quality of life. There was moderate
evidence demonstrating that aquatic therapy and exercise were beneficial for breast cancer survivors.
There is moderate evidence that high intensity exercise helped patients minimize the decreased ability
to work after cancer and treatment.

LIMITATIONS
As applicable, identify any of the following biases and limitations:
Was there measurement bias (i.e., evaluators blind to treatment status, recall or memory bias)? Was
there intervention bias (i.e., contamination, co-intervention, timing of intervention, site of intervention,
use of different therapists to provide intervention, baseline equality)? Was this study adequately
powered (large enough to show a difference)? Were the analysis methods appropriate? Were statistics
appropriately reported (in written or table format)? Was participant dropout less than 20% in total
sample and balanced between groups? List any additional study limitations. Character count limit:
1500

Limited research has been conducted on interventions related to sexuality. Also, more research is
needed addressing occupational therapy interests such as participation and occupation based outcomes
and interventions. Although all of the research projects evaluated in this review were within the scope
of occupational therapy, there were very few that addressed the return to participation or included
occupation based interventions. There were limitations in the design and methodology of the individual
studies such as having small sample sizes, limited use of standardized assessments, short intervention
periods, and short follow up periods. Determining the effects of each individual intervention was not
always possible since many of the studies included multiple interventions.

CONCLUSIONS
State the authors’ conclusions related to the research objectives. Character count limit: 600

Occupational therapists are working with cancer survivors of all types and stages cancer to determine
occupational performance, occupation based strategies, quality of life, and patient’s participation status
in order to provide client centered interventions. More research is needed to support occupation based
interventions in this population as the interventions in this review are only part of an emerging body of
research.

CAP AUTHOR INFORMATION

List full name(s) of all participants (i.e., students, faculty advisor) and credentials.

Marina Eskandrous, OTS

CAP Worksheet adapted from “Critical Review Form--

AOTA Evidence-Based Practice Project

CAP Worksheet
Evidence Exchange
Last Updated: April 2018
3
Quantitative Studies.” Copyright  1998, by M. Law, D. Stewart, N. Pollack, L. Letts, J. Bosch, & M.
Westmorland, McMaster University. Used with permission.

For personal or educational use only. All other uses require permission from AOTA.
Contact: www.copyright.com

AOTA Evidence-Based Practice Project

CAP Worksheet
Evidence Exchange
Last Updated: April 2018
4