title: Outcomes of a vocational program for persons with AIDS. Randomised controlled trial of an occupational therapy intervention to increase outdoor mobility after stroke The long-term outcomes from a randomized controlled trial of an educational–behavioural joint protection programme for people with rheumatoid arthritis Effects of Functional Restoration Versus 3 Hours per Week Physical Therapy: A Randomized Controlled Study Occupational therapy compared with social work assessment for older people. An economic evaluation alongside the CAMELOT randomised controlled trial. A randomised controlled trial of occupational therapy for people with early rheumatoid arthritis. Reliability of the Canadian Occupational Performance Measure in patients with ankylosing spondylitis. The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial. Maintenance of effects of the home environmental skill-building program for family caregivers and individuals with Alzheimer's disease and related disorders. Is a day hospital rehabilitation programme associated with reduction of handicap in stroke patients? Evaluation of changes in occupational performance among patients in a pain management program. Occupational Therapy and Pulmonary Rehabilitation of Disabled COPD Patients Early individualized postoperative occupational therapy training in 100 patients improves ADL after hip fractureA randomized trial
abstract: Advances in medical treatment combined with changes in the demographics of persons who are becoming infected with autoimmune deficiency syndrome ( AIDS ) have transformed this illness from a rapidly progressing to a chronically disabling condition in a short period of time . This paper describes the development , implementation , and outcomes of a program of vocational services for persons with AIDS . This program was studied using a single group design , in which participatory action research strategies were used to investigate and improve the program as it unfolded . In addition to examining the overall outcomes of services , the study aim ed to discover which components were most helpful to participants and which participants were most likely to benefit from the program . Of 129 participants of who initially enrolled , 39 dropped out before finishing the program . Sixty of the 90 participants who completed the program achieved employment , returned to school , or began a volunteer position or internship . Consequently , the overall success rate was 46.5 % and the success rate for program completers was 66.7 % . The occupational narrative , which participants told in their initial assessment interview , was closely associated with both program completion and successful outcomes . This association adds support to the importance of narrative for underst and ing participants and predicting future behavior , as well as for the therapy process Abstract Objective To evaluate an occupational therapy intervention to improve outdoor mobility after stroke . Design R and omised controlled trial . Setting General practice registers , social services departments , a primary care rehabilitation service , and a geriatric day hospital . Participants 168 community dwelling people with a clinical diagnosis of stroke in previous 36 months : 86 were allocated to the intervention group and 82 to the control group . Interventions Leaflets describing local transport services for disabled people ( control group ) and leaflets with assessment and up to seven intervention sessions by an occupational therapist ( intervention group ) . Main outcome measures Responses to postal question naires at four and 10 months : primary outcome measure was response to whether participant got out of the house as much as he or she would like , and secondary outcome measures were response to how many journeys outdoors had been made in the past month and scores on the Nottingham extended activities of daily living scale , Nottingham leisure question naire , and general health question naire . Results Participants in the treatment group were more likely to get out of the house as often as they wanted at both four months ( relative risk 1.72 , 95 % confidence interval 1.25 to 2.37 ) and 10 months ( 1.74 , 1.24 to 2.44 ) . The treatment group reported more journeys outdoors in the month before assessment at both four months ( median 37 in intervention group , 14 in control group : P < 0.01 ) and 10 months ( median 42 in intervention group , 14 in control group : P < 0.01 ) . At four months the mobility scores on the Nottingham extended activities of daily living scale were significantly higher in the intervention group , but there were no significant differences in the other secondary outcomes . No significant differences were observed in these measures at 10 months . Conclusion A targeted occupational therapy intervention at home increases outdoor mobility in people after stroke Objective : To evaluate the long-term effects of joint protection on health status of people with early rheumatoid arthritis ( RA ) . Design : A four-year follow-up of a r and omized , controlled , assessor-blinded trial was conducted . Setting : Two rheumatology outpatient departments . Participants : People with rheumatoid arthritis less than five years since diagnosis . Interventions : Two 8-hour interventions were originally compared : a st and ard arthritis education programme , including 21/2 hours of joint protection based on typical UK occupational therapy practice ( plus 51/2 hours on RA , exercise , pain management , diet and foot care ) ; and a joint protection programme , using educational-behavioural training . Main measures : Adherence to joint protection , pain , h and pain on activity , Arthritis Impact Measurement Scales 2 and Arthritis Self-efficacy were recorded at 0 and 4 years . Results : Sixty-five people attended the joint protection and 62 the st and ard programmes . Groups at entry were similar in age ( 51 years ; 49 years ) , disease duration ( 21 months : 17.5 months ) and use of nonsteroidal anti-inflammatory and disease-modifying drugs . At four years , the joint protection group continued to have significantly better : joint protection adherence ( p=0.001 ) ; early morning stiffness ( p=0.01 ) ; AIMS 2 activities of daily living ( ADL ) scores ( p=0.04 ) compared with the st and ard group . The joint protection group also had significantly fewer h and deformities : metacarpophalangeal ( MCP ) ( p=0.02 ) and wrist joints ( p=0.04 ) . Conclusion : Attending an educational = behavioural joint protection programme significantly improves joint protection adherence and maintains functional ability long term . This approach is more effective than st and ard methods of training and should be more widely adopted Study Design . R and omized parallel-group comparative trial with a 6-month follow-up period . Objective . To compare , in chronic low back pain patients , the effectiveness of a functional restoration program , including intensive physical training , occupational therapy , and psychological support to an active individual therapy consisting of 3 hours physical therapy per week during 5 weeks . Summary of Background Data . Controlled studies conducted in the United States showed a benefit of functional restoration in patients with low back pain , especially on return to work . R and omized Canadian and European trials had less favorable results . In France , there has been up to now no r and omized study . Controlled studies suggested a positive effect of functional restoration programs . Methods . Eighty-six patients with low back pain were r and omized to either the functional restoration ( 44 patients ) or the active individual therapy ( 42 patients ) program . One person in each group never started the program . Two patients did not complete the functional restoration program , and one was lost to follow-up at 6 months . The mean number of sick-leave days in the 2 previous years was 6 months . Results . After adjustment on the variable ≪ workplace enrolled in an ergonomic program ≫ , the mean number of sick-leave days was significantly lower in the functional restoration group . Physical criteria and treatment appreciation were also better . There was no significant difference in the intensity of pain , the quality of life and functional indexes , the psychological characteristics , the number of contacts with the medical system , and the drug intake . Conclusions . This study demonstrates the effectiveness of a functional restoration program on important outcome measures , such as sick leave , in a country that has a social system that protects people facing difficultiesat work OBJECTIVES To compare costs and outcome of occupational therapy-led assessment with social worker-led assessment of older people , in terms of their independence and quality of life . DESIGN Cost-effectiveness analysis alongside a r and omised controlled trial . The analysis took viewpoints of health services and patients . The primary outcome measure for cost-effectiveness was dependency using the Community Dependency Index ( CDI ) . Secondary outcomes included utility scores based on the EuroQoL ( EQ-5D ) . Re source use was measured for each patient , from clinical records and from patient carer interviews at 8 months . Unit costs of health and social care re sources were derived from local sources and national data sets . Cost-effectiveness was analysed using cost-effectiveness acceptability curves . RESULTS There were no differences between the two arms of the trial in terms of cost-effectiveness . There is an apparent increase in mean cost per case for the occupational therapy arm but this is not statistically significant ( mean difference in cost per case 542 pounds , 95 % CI 434 - 1,519 pounds ) . Mean total costs of care per participant were 4,379 pounds and 3,837 pounds for the occupational therapy and social work arms , respectively . At best the intervention would improve outcomes at a cost of 14,000 pounds per quality -adjusted life year ( QALY ) . The probability of such an outcome was < 50 % . CONCLUSIONS From a policy perspective , the lack of difference in clinical and cost-effectiveness means that either a social work or an occupational therapy service is successful in making care assessment s that enable an older person to remain in their own home BACKGROUND Occupational therapy ( OT ) aims at improving performance of daily living tasks , facilitating successful adjustments in lifestyle , and preventing losses of function . OBJECTIVE To evaluate the effects of a pragmatic , comprehensive OT programme on self management and health status of people with early rheumatoid arthritis ( RA ) ( < 2.5 years ) . METHODS A r and omised , controlled " assessor blinded " trial was conducted with assessment s made at entry , 6 , 12 , and 24 months . Main outcomes were AIMS 2 : physical function ( PF ) , pain visual analogue scale ( VAS ) , and Arthritis Self-Efficacy Scale ( ASES ) . RESULTS Groups had similar disease duration ( 9 months OT ( n = 162 ) v 10 months control ( n = 164 ) ) . The OT group received 7.57 ( SD 3.04 ) hours of therapy . Self management significantly increased in the OT group . Otherwise , there were no significant differences in any outcome measures , or between groups , by ACR functional class : AIMS 2 : PF ( F = 0.04 ; p = 0.96 ) ; pain VAS ( F = 0.29 ; p = 0.74 ) ; total ASES score ( F = 0.93 ; p = 0.39 ) . CONCLUSIONS OT improved self management but not health status in early RA . Functional ability remains reasonably good for many in the first five years , so preventive benefits of self management may not yet be apparent and longer follow up is needed . Although many considered the education and therapy useful , insufficient numbers in the OT group used self management sufficiently to make a difference . Behavioural approaches can improve adherence and , potentially , the long term benefits . Future research should evaluate OT as a complex intervention and develop programmes from a theoretical and evidence base OBJECTIVE The Canadian Occupational Performance Measure ( COPM ) is a client-centered measure , design ed to detect changes in occupational performance over time . The main aim of our study was to examine the test-retest reliability of the Norwegian version of the COPM in patients with ankylosing spondylitis ( AS ) in 3 different retest modes of data collection . METHODS A total of 119 patients with AS completed the baseline COPM interview before r and omization into one of 3 modes of retest data collection performed 2 weeks later : by personal interview , telephone interview , or mailed question naire . Scores were computed for Performance and Satisfaction , and the 2 sets of scores were examined for reliability by intraclass correlations ( ICC ) , and by the Bl and -Altman procedure for calculation of smallest detectable difference ( SDD ) . RESULTS The ICC coefficients for Performance and Satisfaction were as follows : 0.92 and 0.93 ( rescoring by personal interview ) , 0.73 and 0.73 ( rescoring by telephone interview ) , and 0.90 and 0.90 ( rescoring by mail ) . SDD for the Performance and Satisfaction scores were 1.47 and 1.80 , respectively , for rescoring by personal interview ; 3.14 and 4.00 for rescoring by telephone interview ; and 2.20 and 2.41 for rescoring by mailed survey . CONCLUSION The results confirm that the COPM is a reliable instrument for use in clinical practice in patients with AS , and may serve as an instrument to promote a patient-centered approach in the planning and evaluation of rehabilitation programs . Mailed question naires may replace personal interview in followup examinations , while rescoring by telephone interview is less reliable OBJECTIVES To test whether Stepping On , a multifaceted community-based program using a small-group learning environment , is effective in reducing  falls in at-risk people living at home . DESIGN A r and omized trial with subjects followed for 14 months . SETTING The interventions were conducted in community venues , with a follow-up home visit . PARTICIPANTS Three hundred ten community residents aged 70 and older who had had a fall in the previous 12 months or were concerned about falling . INTERVENTION The Stepping On program aims to improve fall self-efficacy , encourage behavioral change , and reduce falls . Key aspects of the program are improving lower-limb balance and strength , improving home and community environmental and behavioral safety , encouraging regular visual screening , making adaptations to low vision , and encouraging medication review . Two-hour sessions were conducted weekly for 7 weeks , with a follow-up occupational therapy home visit . MEASUREMENTS The primary outcome measure was falls , ascertained using a monthly calendar mailed by each participant . RESULTS The intervention group experienced a 31 % reduction in falls ( relative risk (RR)=0.69 , 95 % confidence interval (CI)=0.50 - 0.96 ; P=.025 ) . This was a clinical ly meaningful result demonstrating that the Stepping On program was effective for community-residing elderly people . Secondary analysis of subgroups showed that it was particularly effective for men ( n=80 ; RR=0.32 , 95 % CI=0.17 - 0.59 ) . CONCLUSION The results of this study renew attention to the idea that cognitive-behavioral learning in a small-group environment can reduce falls .  Stepping On offers a successful fall-prevention option BACKGROUND Few studies evaluate whether short-term intervention effects are maintained over time for families caring for persons with dementia . This article examines whether treatment effects found at 6 months following active treatment were sustained at 12 months for 127 family caregivers who participated in an occupational therapy intervention tested as part of the National Institutes of Health Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) initiative . METHODS A r and omized two-group design was implemented with three assessment points : baseline , 6 months , and 12 months . Caregivers were r and omly assigned to a usual care control group or intervention that consisted of six occupational therapy sessions to help families modify the environment to support daily function of the person with dementia and reduce caregiver burden . Following 6-month active treatment , a maintenance phase consisted of one home and three brief telephone sessions to reinforce strategy use and obtain closure . Non-inferiority statistical analysis was used to evaluate whether intervention caregivers maintained treatment benefits from 6 to 12 months in comparison to controls . RESULTS For the sample of 127 at 6 months , caregivers in intervention reported improved skills ( p = .028 ) , less need for help providing assistance ( p = .043 ) , and fewer behavioral occurrences ( p = .019 ) compared to caregivers in control . At 12 months , caregiver affect improved ( p = .033 ) , and there was a trend for maintenance of skills and reduced behavioral occurrences , but not for other outcome measures . CONCLUSION An in-home skills training program helps sustain caregiver affect for those enrolled for more than 1 year . More frequent professional contact and ongoing skills training may be necessary to maintain other clinical ly important outcomes such as reduced upset with behaviors Objective : ( 1 ) To assess whether a rehabilitation day hospital programme is associated with a reduced h and icap level of stroke patients . ( 2 ) To estimate the relationship between the London H and icap Scale ( LHS ) and other outcome measures . ( 3 ) To examine the effect of demographic parameters ( age , gender , family status , education ) on LHS scores . Design : A prospect i ve longitudinal survey . Setting : An urban geriatric rehabilitation day hospital . Subjects : Two hundred and seven elderly stroke patients admitted between December 1999 and February 2001 . Main outcome measures :  London H and icap Scale ( LHS ) , Functional Independent Measure ( FIM ) , Nottingham Extended ADL Index , timed get up and go test . Results : LHS scores at discharge changed significantly ( p < 0.008 ) for mobility , physical independence and occupation . The overall change in LHS score was 2.3 points ( 20 % ) ; effect size 0.43 . A significant relationship was found between discharge score of LHS and admission score of FIM , Nottingham Index , timed get up and go and age . Multiple linear regressions did not identify a good predictor for the discharge score of LHS . Higher education was associated with higher LHS scores on admission ( p= 0.016 ) but with less success in correcting h and icap ( p= 0.046 ) . Conclusions : A day hospital programme is associated with reduced level of h and icap in stroke patients . The LHS is a useful and simple scale for measuring change in these patients . LHS in stroke patients correlates with other outcome measures , yet they can not be used interchangeably . A significant relationship between education and level of h and icap exists OBJECTIVES The aims of this study were to evaluate changes in occupational performance among chronic pain patients after a pain management program  and to explore relationships between these changes and demographic and clinical factors , psychosocial functioning and psychological well-being . SUBJECTS 188 consecutive patients were included . METHODS Changes were registered by using Canadian Occupational Performance Measure , Multidimensional Pain Inventory and Psychological General Well-Being Index . RESULTS There were statistically significant positive changes in occupational performance .  Patients with sickness compensation had significantly higher changes in occupational performance than those without sickness compensation . The patients with a profile group as interpersonally distressed had statistically significant higher change scores on occupational performance than the adaptive coper group . Furthermore , increases in changes on general activity level , general health , and vitality and decreases in pain severity were associated with positive changes on perceived occupational performance and performance satisfaction . CONCLUSION Changes in occupational performance , psychological well-being and psychosocial functioning seem all to be of relevance in the evaluation of pain management programs . Psychosocial profiles and sickness compensation has relevance for directions on changes in occupational performance , whereas other demographic and clinical factors do not Background : Occupational therapy ( OT ) has been defined as a task of rehabilitation for disabled patients , giving them maximal function and independence to sustain specific activities of daily living . Objectives : To evaluate the effectiveness of OT as an adjunctive measuring during pulmonary rehabilitation ( PR ) of hospitalized COPD patients . Methods : A prospect i ve clinical trial with parallel groups was undertaken in severely disabled COPD patients ( n = 71 , age 73 ± 5 years ) . They were assigned to either OT+PR ( n = 47 , FEV1 46 ± 21%pred . ) or PR ( n = 24 , FEV1 44 ± 12%pred . ) . PR consisted of eighteen 3-hour daily sessions , whilst OT ( domestic activities ) was added 3 times a week up to nine 1-hour sessions  . Six-min walk ( 6MWD ) with evaluation of BORG dyspnea ( D ) and leg fatigue ( F ) scores at end of effort , breathlessness sensation ( B ) by means of the MRC scale as well as the number of functions lost in the Basic Activity of Daily Living ( BADL ) categories were assessed as outcomes before ( T₀ ) and after ( T1 ) rehabilitation . Results : 6MWD ( from 165 ± 63 to 233 ± 66 and from 187 ± 52 to 234 ± 65 m in the OT+PR and PR groups , respectively ) , D ( from 4.9 ± 2.1 to 3.2 ± 1.6 and from 5.3 ± 2.1 to 3.4 ± 2.1 ) , F ( from 6.1 ± 0.5 to 4.5 ± 1.7 and from 5.9 ± 0.8 to 4.3 ± 0.8 ) and B ( from 4.3 ± 0.9 to 3.0 ± 0.9 and from 4.2 ± 1.0 to 3.2 ± 0.8 ) had similarly improved ( p < 0.01 ) in both groups at T1 . The percentage distribution of patients across the BADL categories significantly changed ( p = 0.004 ) in OT+PR ( from 17 to 61 % , from 70 to 34 % and from 23 to 5 % in categories A , B and C , respectively ) but not in the PR group . Conclusions : The addition of OT to comprehensive PR is able to specifically improve the outcome of severely disabled COPD in patients Background It is not clear whether occupational therapy is of value for hip fracture patients . Patients and methods In a r and omized trial we studied the effects of an early , individualized , postoperative occupational training ( OT ) program on the ability of hip fracture patients to perform ADL and IADL . Secondary endpoints were self-reported fear of pain and pain when performing ADL and IADL . The need for technical aids and /or home adaptations was also investigated . 100 eligible patients ( aged ≥65 years , with independent residence ) were r and omized 50:50 to an OT or control group ( conventional care ) . During their hospital stay , members of the OT group received individual daily training which included the use of technical aids . Before discharge , the occupational therapist paid a home visit together with the patient . All patients were assessed 2–4 days after surgery , at discharge and after 2 months , using the Klein-Bell ADL scale and a modified version of the Disability Rating Index . Results At discharge , the OT group had better ability to dress , to take care of personal hygiene and bathing activities independently , and to make toilet visits . Age , sex , type of fracture or length of stay at the hospital made no significant contribution to explaining the better ADL ability on discharge . After 2 months , all patients had regained their ADL and IADL abilities . Half of the patients required technical aids and adaptations in their homes . Interpretation Individualized OT-training speed up the ability of patients to perform ADL , thus enhancing the likelihood of patients returning to independent living and reducing the need for postoperative care at home
target: Relative importance of rehabilitation therapy characteristics on functional outcomes for persons with stroke .
background: nan