Abstract
BackgroundThe occupational therapy (OT) in care homes study (OTCH) aims to investigate the effect of a targeted course of individual OT (with task training, provision of adaptive equipment, minor environmental adaptations and staff education) for stroke survivors living in care homes, compared to usual care.Methods/DesignA cluster randomised controlled trial of United Kingdom (UK) care homes (n = 90) with residents (n = 900) who have suffered a stroke or transient ischaemic attack (TIA), and who are not receiving end-of-life care. Homes will be stratified by centre and by type of care provided and randomised (50:50) using computer generated blocked randomisation within strata to receive either the OT intervention (3 months intervention from an occupational therapist) or control (usual care). Staff training on facilitating independence and mobility and the use of adaptive equipment, will be delivered to every home, with control homes receiving this after the 12 month follow-up.Allocation will be concealed from the independent assessors, but the treating therapists, and residents will not be masked to the intervention. Measurements are taken at baseline prior to randomisation and at 3, 6 and 12 months post randomisation. The primary outcome measure is independence in self-care activities of daily living (Barthel Activities of Daily Living Index). Secondary outcome measures are mobility (Rivermead Mobility Index), mood (Geriatric Depression Scale), preference based quality of life measured from EQ-5D and costs associated with each intervention group. Quality adjusted life years (QALYs) will be derived based on the EQ-5D scores. Cost effectiveness analysis will be estimated and measured by incremental cost effectiveness ratio. Adverse events will be recorded.DiscussionThis study will be the largest cluster randomised controlled trial of OT in care homes to date and will clarify the currently inconclusive literature on the efficacy of OT for stroke and TIA survivors residing in care homes.Trial registrationISRCTN00757750
Highlights
IntroductionThe occupational therapy (OT) in care homes study (OTCH) aims to investigate the effect of a targeted course of individual OT (with task training, provision of adaptive equipment, minor environmental adaptations and staff education) for stroke survivors living in care homes, compared to usual care
The occupational therapy (OT) in care homes study (OTCH) aims to investigate the effect of a targeted course of individual OT for stroke survivors living in care homes, compared to usual care
Previous cluster randomised trials demonstrated that a relatively small level of OT may have detectable and relatively long-lasting effects on morbidity and possibly mortality in care homes residents with stroke-related disabilities [10,11]. These studies enrolled small numbers of clusters and participants and were conducted in specific areas of the United Kingdom (UK), which reduces the generalisability of the findings to residents in care homes more widely
Summary
The occupational therapy (OT) in care homes study (OTCH) aims to investigate the effect of a targeted course of individual OT (with task training, provision of adaptive equipment, minor environmental adaptations and staff education) for stroke survivors living in care homes, compared to usual care. A systematic review and meta-analysis by Legg et al [1] of nine trials (1258 participants) found that in stroke survivors, occupational therapy (OT) increased personal activities of daily living scores (i.e., standardised mean difference 0.18; 95% confidence interval 0.04 to 0.32; p = 0.01). 78% of residents in a care home have cognitive impairment, 76% need some form of assistance with ambulation and 71% are incontinent [2]. These factors might affect the capacity of care home residents to engage in OT
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