Trial Of Occupational Therapy Research Articles

A comparison of standard occupational therapy versus early enhanced occupation-based therapy in a medical/surgical intensive care unit: study protocol for a single site feasibility trial (EFFORT-ICU)

BackgroundAdmissions to intensive care units (ICUs) are increasing due to an ageing population, and rising incidence of cardiac and respiratory disease. With advances in medical care, more patients are surviving an initial stay in critical care; however, they can experience ongoing health and cognitive limitations that may influence return to baseline function up to a year post-admission. Recent research has focused on the introduction of early rehabilitation within the ICU to reduce long-term physical and cognitive complications. The aim of this study is to explore the feasibility and impact of providing early enhanced occupation-based therapy, including cognitive stimulation and activities of daily living, to patients in intensive care.MethodsThis study involves a single site randomised-controlled feasibility trial comparing standard occupational therapy care to an early enhanced occupation-based therapy. Thirty mechanically ventilated ICU patients will be recruited and randomly allocated to the intervention or control group. The primary outcome measure is the Functional Independence Measure (FIM), and secondary measures include the Modified Barthel Index (MBI), Montreal Cognitive Assessment (MoCA), grip strength, Hospital Anxiety and Depression Scale (HADS) and Short-Form 36 Health survey (SF-36). Measures will be collected by a blind assessor at discharge from intensive care, hospital discharge and a 90-day follow-up. Daily outcome measures including the Glasgow Coma Scale (GCS), Richmond Agitation and Sedation Scale (RASS) and Confusion Assessment Measure for intensive care units (CAM-ICU) will be taken prior to treatment. Participants in the intervention group will receive daily a maximum of up to 60-min sessions with an occupational therapist involving cognitive and functional activities such as self-care and grooming. At the follow-up, intervention group participants will be interviewed to gain user perspectives of the intervention. Feasibility data including recruitment and retention rates will be summarised descriptively. Parametric tests will compare outcomes between groups. Interview data will be thematically analysed.DiscussionThis trial will provide information about the feasibility of investigating how occupational therapy interventions in ICU influence longer term outcomes. It seeks to inform the design of a phase III multicentre trial of occupational therapy in critical care general medical intensive care units.Trial registrationAustralia New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618000374268; prospectively registered on 13 March 2018/https://www.anzctr.org.auTrial funding: Metro South Health Research Support Scheme Postgraduate Scholarship

A cluster randomised controlled trial of an occupational therapy intervention for residents with stroke living in UK care homes (OTCH): study protocol

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

What Helps and Hinders People with Psychotic Conditions Doing What They Want in Their Daily Lives

It is important for people to do what they want in their daily lives and this is embedded in concepts of recovery, rehabilitation, social inclusion and quality of life. To research what helps and hinders people with psychotic conditions to do what they want, 24 people already engaged in a trial of occupational therapy were interviewed by a service user researcher. The qualitative methods used framework analysis. The findings described what the participants appreciated about occupational therapy and how other workers sometimes delivered occupational therapy type interventions. As well as therapy, multifarious factors appeared to have an impact on people's choices and actions and these reiterated the findings from prior studies. These internal and external factors combined in complex relationships. People felt particularly vulnerable when staff behaved uncaringly and with disrespect because this replicated past traumas, stigmatisation and rejection. The participants revealed how important it was for staff to pitch their interventions right for them at the time. The study led to suggestions that occupational therapists refine their artistry in order to hone their interventions to suit the individual, follow guidance on developing therapeutic relationships and recovery-focused capabilities, enhance caring by getting support themselves and employ critical thinking to challenge organisational barriers and their profession's rhetoric.

Pilot randomised controlled trial of occupational therapy to optimise independence in Parkinson's disease: the PD OT trial

Objective:To perform a pilot trial of occupational therapy (OT) to optimise functional independence in Parkinson disease (PD) to assess accrual/withdrawal rates, acceptability, outcome measures, and inform sample-size calculation.Method:Non-demented patients with...

Multicentre Trials: Planning and Achieving TOTAL

This article provides an overview for those conducting multicentre rehabilitation trials. It aims to highlight potential problems and difficulties which may not be obvious initially. TOTAL (Trial of Occupational Therapy and Leisure) was a multicentre rehabilitation trial. The aim was to test whether a leisure-based intervention was more effective than activities of daily living (ADL) based therapy at improving the mood, leisure participation and independence in ADL of stroke patients. During the study period, 466 patients were recruited from five centres in the United Kingdom. Postal assessments were sent out at 6 and 12 months after discharge to evaluate mood, leisure independence and ADL performance. The possible difficulties in recruiting centres are presented. The problems encountered were staff shortages, insufficient numbers of patients, concern over aspects of the protocol and funding issues. Day-to-day problems in running the trial and how these may be resolved are also discussed, such as access to the trial coordinator, finance, the need for written agreements and regular communication with each centre. While the complexity of conducting a multicentre trial should not be underestimated, preparation, good planning and an awareness of potential problems makes it a feasible proposition.