Home-Based Occupational Therapy and Stroke Readmissions in Medicaid Recipients.

The aim of this scoping review was to review and assess recent studies on the efficacy of home-based occupational therapy interventions for adults post-stroke. The number of efficacy studies is limited. The few studies available suggest that occupational therapy delivered in home settings may improve outcomes for stroke patients. There is also limited use of occupation-based assessments, interventions, and outcome measures in studies addressing home-based occupational therapy. Methodologies should be improved to include contexts, caregiver training, and self-efficacy. Further high-quality studies are needed on the efficacy home-based occupational therapy services.

Introduction Home-based occupational therapy can improve older adults’ occupational performance, but maintaining improvements presents challenges, and service development is needed. In this study, older adults’ experiences and expectations concerning their occupational performance after discharge from home-based occupational therapy were examined and used to develop suggestions for improved practice. Method Semi-structured qualitative interviews were conducted with 11 older adults living alone or with a spouse. The interviews were analysed using inductive qualitative content analysis. Findings The older adults still strove to improve and maintain their occupational performance using various strategies; their desire for independence was strong, but some could accept a lesser degree of independence. Conclusion From the findings and existing literature, ideas were developed to improve home-based occupational therapy and support maintenance of occupational performance after discharge. These ideas include: (a) finding strategies to achieve satisfactory occupational performance that does not necessarily entail full independence, (b) increased focus on the use and transfer of problem-solving strategies, (c) acknowledging and addressing possible reluctance to use assistive devices, and (d) individually scheduled follow-up visits post occupational therapy. Future research should examine the effectiveness and applicability of these ideas.

This study evaluated a short post-discharge home-based occupational therapy service for stroke patients, including an assessment of the patients' satisfaction with occupational performance and service provision. A single-site, blind randomised controlled trial was conducted. One hundred and thirty-eight patients were randomly allocated to either a conventional outpatient follow-up or conventional services plus 6 weeks of home-based occupational therapy. The data were collected before discharge and at 7 weeks and 6 months after discharge using the Canadian Occupational Performance Measure (COPM), the Dartmouth COOP Charts, the London Handicap Scale and a patient satisfaction questionnaire. At 7 weeks the intervention group reported significantly greater changes in performance and satisfaction on the COPM, better emotional scores (Dartmouth COOP Charts) and improved work and leisure activity scores (London Handicap Scale). No other differences in subjective health status were described. By 6 months, the intervention group was more satisfied with several aspects of service provision but no other differences in subjective health experience were reported. A 6-week post-discharge home-based occupational therapy service can improve patients' perceptions of their occupational performance and satisfaction with services but may not have a long-term effect on subjective health outcomes.

The demand for effective home-based rehabilitation is increasing with the aging global population. Occupational therapy supports older adults in maintaining and improving activity and participation; however, standardized intervention approaches, consistent outcome measures, and goal-setting frameworks are still lacking. To systematically map current home-based occupational therapy interventions aimed at enhancing activity and participation among community-dwelling older adults and identify research gaps in intervention methods, evaluations, and designs. PubMed, Web of Science, Scopus, Ichushi Web, and J-Stage were searched without time restrictions. Additional relevant studies were identified manually. Studies involving community-dwelling adults age 65 yr or older were included. Data on intervention strategies, outcome measures, and research designs were extracted and categorized by using qualitative methods. Fifty-four studies were included. Interventions ranged from activities of daily living (ADLs) and instrumental ADLs (IADLs) training and environmental modifications to structured programs such as Community Aging in Place-Advancing Better Living for Elders (CAPABLE) and Reablement. However, outcome measures were highly diverse (126 unique tools), and 16 nonstandardized assessments were identified, mostly in case reports. Although many studies showed positive effects, the diversity of study designs and limited use of remote interventions hindered generalizability and long-term evidence building. Home-based occupational therapy can positively affect older adults' activity, participation, and quality of life. However, standardized evaluation methods, integration of remote approaches, and culturally tailored intervention programs are needed to strengthen evidence and guide clinical practice. Plain-Language Summary: This review examined studies on home-based occupational therapy for older adults. Interventions often targeted activities of daily living, instrumental activities of daily living, and environmental adaptations. Most occupational therapy interventions showed benefits in everyday function and well-being. However, a lack of standardized tools and goal-setting methods, variation in study quality, and limited evidence on remote rehabilitation remain challenges.

Referral prioritisation is commonly used in home-based occupational therapy to minimise the negative impacts of waiting, but this practice is not standardised. This may lead to inequities in access to care, especially for clients considered as low priority, who tend to bear the brunt of lengthy waiting lists. This cross-sectional study aimed to describe waiting list management practices targeting low-priority clients in home-based occupational therapy in the province of Quebec, Canada, and to investigate the association between these practices and the length of the waiting list. A structured telephone interview was conducted in 2012-2013 with the person who manages the occupational therapy waiting list in 55 home care programmes across Quebec. Questions pertained to strategies aimed at servicing low-priority clients, the date of the oldest referral and the number of clients waiting. Results were analysed using descriptive statistics and non-parametric tests. The median wait time for the oldest referral was 18 months (range: 2-108 months). A variety of strategies were used to service low-priority clients. Programmes that used no strategies to service low-priority clients (n = 16) had longer wait times (P < 0.0001) and a greater number of people on the waiting list (P = 0.006) compared with programmes that applied a maximum wait time target (n = 12). In conclusion, diverse strategies exist to allocate services to low-priority clients in home-based occupational therapy programmes. However, in programmes where none of these strategies are used, low-priority clients may be denied access to services indefinitely.

Objective : This study aims to analyze the experiences, environmental constraints, and responses of clients and families in providing home-based occupational therapy services, to offer practical evidence for improving client-centered care and strengthening the rehabilitation system. Methods: Four occupational therapists were recruited for focus group interviews in July and August 2024 to provide foundational data on home-based occupational therapy services. The study followed six stages: expert selection, preparation, interviews, transcription, analysis, and result derivation. Results: Based on the interview recordings and transcriptions, results were derived for four main topics: experiences and effects of providing occupational therapy, advantages and disadvantages of the service, relationship building with clients, and areas for improvement and necessary support. Conclusion: In home-based occupational therapy rehabilitation services, a client-centered approach and training in real-life environments yield positive effects. However, to address drawbacks such as the lack of therapeutic tools and difficulties in scheduling, increasing treatment sessions, formal recognition of fees, and policy support are necessary.

IntroductionGiven the promising advantages of upper extremity home-based programmes in children with cerebral palsy (CP), a systematic review of the available literature on this topic is warranted. The purpose of...

This study investigated the situations and satisfaction of home-based occupational therapy service for children under eighteen residing in Suncheon and Gwangyang. Arithmetic statistics were conducted by dividing the general facts of home-based occupational therapy service, the kinds of service used in home-based therapy, the satisfaction of home-based occupational therapy service, facts helpful for children, and facts helpful for parents or home. As a result, the most common source of home-based occupational therapy information was the association for children with disabilities and its satisfaction was high. This study will provide basic materials to build up systematic, stable, and continuous rehabilitation therapy support projects by the government.

Background/aims: Prioritising referrals on waiting lists is common practice in rehabilitation. However, little is known about the exact criteria that are used in home-based occupational therapy to determine the level of urgency. This study aimed to identify prioritisation criteria in home-based occupational therapy services in Quebec, Canada, and to describe how they are used in practice. Methods: A mail and telephone survey of 55 home care programmes across Quebec was conducted. Participants provided information about occupational therapy wait times, and referral prioritisation tools and practices. A detailed quantitative content analysis compared the content of all referral prioritisation tools. Results: This study identified 48 main categories of referral prioritisation criteria, but only nine of them were present in the majority of tools. Wait times vary greatly between priority levels, with a median of 2 days for urgent referrals and 20 months for low-priority referrals. In general, problems related to safety and remaining at home are considered more urgent than problems related to independence, quality of life, and activities outside the home. Conclusions: These findings highlight the need for more consistent and evidence-based prioritisation criteria for occupational therapy in home care in order to facilitate equitable access to these services.

In recent years, public reporting, targeted financial penalties, and incentives to develop alternative payment models that include the assumption of financial risk have compelled hospitals to focus on reducing readmission rates for high-cost conditions such as heart failure (HF). When older patients with multiple medical conditions including HF are discharged from the hospital, they are vulnerable to adverse events, which may result in recurrent hospitalization (the post-hospital syndrome).1 In theory, providing home health nursing and therapy could promote recovery in vulnerable HF patients with post-hospital syndrome and potentially reduce readmissions. Within the United States, home health care (HHC) referrals after acute care hospitalization increased by 65% to 3.7 million between 2001 and 2012.2,3 Patients discharged from US hospitals with a primary diagnosis of HF had the highest number of HHC referrals during this time, with ≈200 000 post-acute HHC referrals in 2012.2 In addition, HHC surpassed skilled nursing facilities as the most frequently used post-acute care among Medicare beneficiaries with HF in 2012 (unpublished HCUPnet data). Such an increase in HHC use for patients with HF is likely related to multiple factors, including decreasing length of stay for patients with HF4 and more recent pressures to improve readmission rates for HF after adoption of the Affordable Care Act in 2010, which included the Hospital Readmissions Reduction Program that was implemented in 2012.5,6 Despite substantial growth in post-acute HHC referrals for patients with HF,2 it is unclear whether HHC delivered in real-world settings consistently provides high-value care. Understanding the characteristics of effective post-acute HHC for patients with HF will inform best practices, optimal outcomes for cost, and ultimately high-value care. Because most patients referred for skilled HHC are Medicare beneficiaries, Medicare eligibility and payment policies have important implications for HHC. Patients who …

A problem for occupational therapists involved in home-based rehabilitation is the dichotomy between traditional functional status measures, which are commonly reported by therapists to have insufficient flexibility and poor clinical sensitivity, and individualized methods (which do not allow inter-patient comparison for program evaluation). This study used Goal Attainment Scaling (GAS) to evaluate both individual and program change. The study demonstrates that GAS was a simple, clinically meaningful measure of change which evaluated patient-centered outcomes and program effects concurrently. In addition, this measure was applied to a traditionally challenging service, that of a home-based rehabilitation program.Goal Attainment Scaling was demonstrated to be useful as an outcome measure for patients with multiple, complex rehabilitation needs, such as those served by a home-based rehabilitation occupational therapy service. It was able to accurately detect meaningful change (necessary for demonstrating clinically significant improvement at the level of the individual patient), be administered in a time-effective manner, and also allow the clinician to evaluate program effectiveness.

Emotion-related school attendance challenges (ER-SAC) refer to school attendance difficulties rooted in emotional issues. This report examined the support process and outcomes of home-based occupational therapy in two junior high school students experiencing long-term absenteeism and social withdrawal. Both students exhibited emotional difficulties, including anxiety, interpersonal tension, and impulsivity, that disrupted daily routines, impaired self-care, and led to social avoidance. Occupational therapists initiated home visits by building trust, then gradually introduced strategies to restructure daily routines, verbalize emotions, enhance self-understanding, and set interest-based goals. Both cases demonstrated improvements in interpersonal relationships, leisure activities, and coping skills. In Case 1, vocational exploration and growing introspection fostered future aspirations. In Case 2, reduced impulsivity and mistrust improved social skills, enabling desired participation in club and sports activities. Both students progressed from "blockage and isolation" to "social connection and active participation". Home-based occupational therapy appears effective for life restructuring and social reintegration in students with ER-SAC. The support model offers practical guidance for similar student cases, emphasizing the need for flexible, individualized plans considering emotional, cognitive, and social characteristics over uniform interventions.

Evaluation studies of the effectiveness of home-based occupational therapy are scarce but are needed to justify the impact of occupational therapy intervention. When the intervention is for persons from diverse cultural backgrounds, additional research challenges arise. To share lessons learned in conducting home-based occupational therapy research with Canadian, and immigrant South Asian and Chinese mothers of premature infants in a large Canadian city. Lessons learned were to implement a culturally sensitive recruitment process, change the research design to include more interviews and focus groups, and be aware of the need for culturally appropriate instruments. Researchers need to be sensitized to the Western cultural values upon which most research designs and instrumentation are constructed. Involvement of a culturally diverse research team, openness to feedback, adaptability, and critical reflection on what is important to the cultural groups are among the suggestions for researchers planning home-based occupational therapy research with culturally diverse populations.

Purpose: To investigate the combined effect of transcranial direct current stimulation (tDCS) and home-based occupational therapy on activities of daily living (ADL) and grip strength, in patients with upper limb motor impairment following intracerebral hemorrhage (ICH). Methods: A double-blind randomized controlled trial with one-week follow-up. Patients received five consecutive days of occupational therapy at home, combined with either anodal (n = 8) or sham (n = 7) tDCS. The primary outcome was ADL performance, which was assessed with the Jebsen–Taylor test (JTT). Results: Both groups improved JTT over time (p < 0.01). The anodal group improved grip strength compared with the sham group from baseline to post-assessment (p = 0.025). However, this difference was attenuated at one-week follow-up. There was a non-significant tendency for greater improvement in JTT in the anodal group compared with the sham group, from baseline to post-assessment (p = 0.158). Conclusions: Five consecutive days of tDCS combined with occupational therapy provided greater improvements in grip strength compared with occupational therapy alone. tDCS is a promising add-on intervention regarding training of upper limb motor impairment. It is well tolerated by patients and can easily be applied for home-based training. Larger studies with long-term follow-up are needed to further explore possible effects of tDCS in patients with ICH.Implications for RehabilitationFive consecutive days of tDCS combined with occupational therapy provided greater improvements in grip strength compared with occupational therapy alone.tDCS is well tolerated by patients and can easily be applied for home-based rehabilitation.

A large randomized clinical trial (the Occupational Therapy in Parkinson's Disease [OTiP] study) recently demonstrated that home-based occupational therapy improves perceived performance in daily activities of people with Parkinson's disease (PD). The aim of the current study was to evaluate the cost-effectiveness of this intervention. We performed an economic evaluation over a 6-month period for both arms of the OTiP study. Participants were 191 community-dwelling PD patients and 180 primary caregivers. The intervention group (n = 124 patients) received 10 weeks of home-based occupational therapy; the control group (n = 67 patients) received usual care (no occupational therapy). Costs were assessed from a societal perspective including healthcare use, absence from work, informal care, and intervention costs. Health utilities were evaluated using EuroQol-5d. We estimated cost differences and cost utility using linear mixed models and presented the net monetary benefit at different values for willingness to pay per quality-adjusted life-year gained. In our primary analysis, we excluded informal care hours because of substantial missing data for this item. The estimated mean total costs for the intervention group compared with controls were €125 lower for patients, €29 lower for caregivers, and €122 higher for patient-caregiver pairs (differences not significant). At a value of €40,000 per quality-adjusted life-year gained (reported threshold for PD), the net monetary benefit of the intervention per patient was €305 (P = 0.74), per caregiver €866 (P = 0.01) and per patient-caregiver pair €845 (P = 0.24). In conclusion, occupational therapy did not significantly impact on total costs compared with usual care. Positive cost-effectiveness of the intervention was only significant for caregivers.