Occupational Therapy in Complex Patients: A Pilot Randomized Controlled Trial

Martina Pellegrini, Debora Formisano, Veronica Bucciarelli, Margherita Schiavi, Stefania Fugazzaro, Stefania Costi, Martina Pellegrini, Debora Formisano, Veronica Bucciarelli, Margherita Schiavi, Stefania Fugazzaro, Stefania Costi

Abstract

Introduction: To determine effect size and feasibility of experimental occupational therapy (OT) intervention in addition to standard care in a population of complex patients undergoing rehabilitation in a hospital-home-based setting.

Method: 40 complex patients admitted to the rehabilitation ward of the Local Health Authority-Research Institute of Reggio Emilia (Italy) were randomized in a parallel-group, open-label controlled trial. Experimental OT targeting occupational needs in the areas of self-care, productivity, and leisure was delivered by occupational therapists. Standard care consisted of task-oriented rehabilitation delivered by a multiprofessional team.

Results: The experimental OT intervention was completed by 75% of patients assigned to this group. The average changes in the Canadian Occupational Performance Measure (COPM) performance score significantly and clinically favored experimental OT [-3,06 (-4.50; -1.61); delta > 2 points, resp.]. Similar trends were detected for COPM satisfaction and independence in instrumental activities of daily living (ADL). At follow-up, level of social participation was higher for patients treated with experimental OT (p = 0.043) than for controls.

Conclusions: Experimental OT was feasible in complex patients in a hospital-home-based setting. It ameliorated both patients' performance and satisfaction in carrying out relevant activities and improved independence in instrumental ADL. The trial is registered with ClinicalTrials.gov NCT02677766.

Figures

Figure 1
Figure 1
CONSORT 2010 flow diagram of the study.
Figure 2
Figure 2
Distribution of relevant occupational activities chosen by participants in this study.
Figure 3
Figure 3
Proportion of patients whose gain in COPM performance score exceeded the minimal clinically important difference set for the COPM.
Figure 4
Figure 4
Proportion of patients whose gain in COPM satisfaction score exceeded the minimal clinically important difference set for the COPM.

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