Results from a Danish randomised controlled trial. Nielsen TL, Andersen NT, Petersen KS, Polatajko H, Nielsen CV
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1 Intensive client-centred occupational therapy in the home improves older adults occupational performance and is still effective 6 months after baseline Results from a Danish randomised controlled trial Nielsen TL, Andersen NT, Petersen KS, Polatajko H, Nielsen CV 1
2 Disposition Background Aim and main hypothesis Methods Results Strengths and limitations Implications for practice and research
3 Background Older adults impaired occupational performance Rehabilitative and compensatory services Lack of evidence concerning home-based, client-centred and occupation-based occupational therapy for older adults with various chronic health issues
4 Aim and primary hypothesis Aim To compare the effect of 11 weeks of home-based, client-centred and occupation-based occupational therapy for older adults to the effect of the usual practice of a Danish municipality Primary hypothesis The intervention will improve the participants self-reported occupational performance more than the usual practice
5 A Randomised controlled trial was performed 119 older adults were included Home-dwelling women and men ( 72%, 28%) Age 60+ (mean 78 years) Danish speaking Excluded were older adults who had Previously received home rehabilitation Predefined severe diseases Severe pain Drug or alcohol abuse
6 Randomisation to two groups 119 participants 59 ICC-OT + some usual practice 60 Usual practice
7 Usual practice, both groups Personal care and practical help Meal delivery Assistive devices and home modifications Physiotherapy 7
8 Occupational therapy, ICC-OT Aim Improved occupational performance Approach Home-based, client-centred, occupation-based occupational therapy Intensity 11 weeks, twice a week, max. 22 visits by an occupational therapist 8
9 Some in the Usual Practice group had occupational therapy Aim Minimised need for home help Appropach Home-care reablement Practicing activities to which the older adult needed home help Intensity, occupational therapy Max 3 weeks, max 3 visits by an occupational therapist 9
10 Assessment of occupational performance at baseline, 3, and 6 months COPM AMPS 10
11 Self-reported occupational performance (COPM) Main result, baseline to 3 months The ICC-OT group Improvement 1.87 points The usual-practice group Improvement 0.61 points Difference in improvement 1.26 points (95%CI 0.5 to 2.02) p
12 Self-reported occupational performance (COPM) Secondary result, baseline to 6 months Usual Practice mean performance baseline ICC-OT mean performance 6 months The ICC-OT group Improvement 1.42 points The usual-practice group Improvement 0.44 points Difference in improvement 0.98 points (95%CI 0.27 to 1.70) p
13 To sum up.. 3 months after baseline, ICC-OT had effectively improved occupational performance (COPM) 6 months after baseline, ICC-OT had effectively improved occupational performance (COPM) performance satisfaction (COPM) quality of occupational performance (AMPS) Concerning occupational performance (COPM) modest effect sizes and smaller effect at 6 months 13
14 Strengths Study design Skilled professionals Validated assessments Limitations No long term follow-up All born and raised in Denmark
15 Implications for practice and research Consider offering home-based ICC-OT to older adults with mainly physical health issues Focus on how to further improve the effectiveness of ICC-OT Test the long-term effectiveness of ICC-OT Test the effectiveness of ICC-OT in different populations and health systems
16 THANK-YOU FOR LISTENING And thank-you to Citizens from Randers Occupational therapists and other professionals involved in the study DEFACTUM, Central Denmark Region VIA University College Health, Aarhus University The municipality of Randers The Tryg Foundation The Danish Association of Occupational Therapists The Lundbeck Foundation 16
17 Sæt artiklen ind her Nielsen TL, Andersen NT, Petersen KS, Polatajko H, Nielsen CV. Intensive client-centred occupational therapy in the home improves older adults occupational performance. Results from a Danish randomized controlled trial. Scan J Occup Ther. DOI: / Published online: 12 Jan
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