Improving ADL Performance and Independence in Chronic Conditions

According to the CDC, 78% of adults over 55 in the U.S. have one or more chronic conditions. The ability to perform activities of daily living (ADLs) such as transfers, dressing, and bathing along with instrumental activities of daily living (IADLs) such as shopping, cooking, and cleaning informs healthcare professionals regarding the individual’s level of independence. With chronic conditions such as COPD, chronic heart failure, stroke, and diabetes, individuals may have dyspnea, weakness, and poor aerobic capacity which in turn may lead to impaired ability to perform ADLs and IADLs.

A decline in independence with ADLs may result in disability, the need for assistance within the home, or even a change in living environment. Therapy for these individuals may be the difference between living independently in the community and the need to live in a long-term patient care setting.

Related ADL research:

• Systematic review and meta-analysis show lower muscle mass, muscle strength, and physical performance scores are predictive of ADL and IADL dependence (Wang et al., 2020).
• Interventions for chronic conditions to delay disability onset and optimize functional autonomy should target early loss activities such as bathing, dressing, and walking (Fong et al., 2019).
• A comprehensive pulmonary rehabilitation program can improve functional outcomes and ADL performance in patients with COPD (Vaes et al., 2019).
• Simple energy conservation techniques (ECT) may prevent dynamic hyperinflation occurring after common ADLs in patients with moderate to severe COPD (Silva et al., 2015).

A comprehensive interdisciplinary rehab program for patients with chronic conditions requires thorough assessment and appropriate interventions that may include: pain management, ROM, strength training, aerobic exercise, breathing exercise, energy conservation techniques, posture and positioning, balance, ADL, gait, and cognitive training along with biophysical agents and advanced technologies to achieve improved patient outcomes and independence.

Assessment: Objective tests and measures should be used during evaluation and throughout care to demonstrate progress. Assessment may include:

• Pain (VAS, Faces Pain Scale)
• ROM (goniometry)
• Strength (handheld dynamometry, 5x sit-to-stand, MMT, MRC-SS)
• Aerobic Capacity (2-Minute Step Test, 6-MWT)
• Breathing (breathing rate & pattern, spirometry)
• Posture (plumb line)
• Balance (mCTSIB, Dynamic Gait Index)
• ADL (Katz ADL, Barthel ADL Index)
• Cognition (SLUMS, MoCA)

Interventions: May include biophysical agents and advanced technologies:

• Breathing exercise
• Motorized cycling ergometry,
• Dynamic balance training,
• Electrotherapy
• Virtual reality

References:
Fong J. H. (2019). Disability incidence and functional decline among older adults with major chronic diseases. BMC geriatrics, 19(1), 323. https://doi.org/10.1186/s12877-019-1348-z
Silva, C. S., Nogueira, F. R., Porto, E. F., Gazzotti, M. R., Nascimento, O. A., Camelier, A., & Jardim, J. R. (2015). Dynamic hyperinflation during activities of daily living in COPD patients. Chronic respiratory disease, 12(3), 189–196.
https://doi.org/10.1177/1479972315576143
Vaes, A. W., Delbressine, J., Mesquita, R., Goertz, Y., Janssen, D., Nakken, N., Franssen, F., Vanfleteren, L., Wouters, E., & Spruit, M. A. (2019). Impact of pulmonary rehabilitation on activities of daily living in patients with chronic
obstructive pulmonary disease. Journal of applied physiology (Bethesda, Md. 1985), 126(3), 607–615. https://doi.org/10.1152/japplphysiol.00790.2018
Wang, D., Yao, J., Zirek, Y., Reijnierse, E. M., & Maier, A. B. (2020). Muscle mass, strength, and physical performance predicting activities of daily living: a meta-analysis. Journal of cachexia, sarcopenia and muscle, 11(1), 3–25.
https://doi.org/10.1002/jcsm.12502