Abstract
The individualized occupational therapy (IOT) program is a psychosocial program that we developed to facilitate proactive participation in treatment and improve cognitive functioning and other outcomes for inpatients with acute schizophrenia. The program consists of motivational interviewing, self-monitoring, individualized visits, handicraft activities, individualized psychoeducation, and discharge planning. This multicenter, open-labeled, blinded-endpoint, randomized controlled trial evaluated the impact of adding IOT to a group OT (GOT) program as usual for outcomes in recently hospitalized patients with schizophrenia in Japanese psychiatric hospitals setting compared with GOT alone. Patients with schizophrenia were randomly assigned to the GOT+IOT group or the GOT alone group. Among 136 randomized patients, 129 were included in the intent-to-treat population: 66 in the GOT+IOT and 63 in the GOT alone groups. Outcomes were administered at baseline and discharge or 3 months following hospitalization including the Brief Assessment of Cognition in Schizophrenia Japanese version (BACS-J), the Schizophrenia Cognition Rating Scale Japanese version, the Social Functioning Scale Japanese version, the Global Assessment of Functioning scale, the Intrinsic Motivation Inventory Japanese version (IMI-J), the Morisky Medication Adherence Scale-8 (MMAS-8), the Positive and Negative Syndrome Scale (PANSS), and the Japanese version of Client Satisfaction Questionnaire-8 (CSQ-8J). Results of linear mixed effects models indicated that the IOT+GOT showed significant improvements in verbal memory (p <0.01), working memory (p = 0.02), verbal fluency (p < 0.01), attention (p < 0.01), and composite score (p < 0.01) on the BACS-J; interest/enjoyment (p < 0.01), value/usefulness (p < 0.01), perceived choice (p < 0.01), and IMI-J total (p < 0.01) on the IMI-J; MMAS-8 score (p < 0.01) compared with the GOT alone. Patients in the GOT+IOT demonstrated significant improvements on the CSQ-8J compared with the GOT alone (p < 0.01). The present findings provide support for the feasibility in implementing an IOT program and its effectiveness for improving cognitive impairment and other outcomes in patients with schizophrenia.
Highlights
Psychosocial treatments designed to remediate or to bypass cognitive impairments are important to pursue to maximize outcomes for patients with schizophrenia [1,2,3,4,5,6]
Of the 260 patients who were assessed for eligibility in the study, 136 patients met criteria for study completion, 68 (50.00% of those randomized) in the group occupational therapy (OT) (GOT) + individualized OT (IOT) arm and 68 (50.00% of those randomized) in the GOT alone control arm
The final sample used for analysis consisted of 129 patients, 66 (51.16%) in the GOT + IOT group and 63 (48.84%) in the GOT alone control group
Summary
Psychosocial treatments designed to remediate or to bypass cognitive impairments are important to pursue to maximize outcomes for patients with schizophrenia [1,2,3,4,5,6]. IOT strategies are tailored to enhance cognitive functioning and prompt adaptive behaviors to maximize the functional outcomes of patients with schizophrenia It consists of a combination of effective psychosocial treatment programs that are very relevant to OT practice, including motivational interviewing, self-monitoring, individualized visits, handicraft activities, individualized psychoeducation, and discharge planning. Our finding of a previous pilot study concerning the IOT program provided preliminary support for the feasibility of IOT for helping patients with schizophrenia who were enrolled in an OT program at a Japanese psychiatric hospital setting and its beneficial effects on improving cognitive impairment and symptoms for patients with schizophrenia [18] It had several limitations, including being conducted in only one site and having selection biases because the study design was a non-randomized controlled trial where participants were assigned to.
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