Occupational therapy compared with social work assessment for older people. An economic evaluation alongside the CAMELOT randomised controlled trial (original) (raw)
Related papers
Age and Ageing, 2005
Objectives: to compare the effectiveness of occupational therapist-led assessments of older people on dependency and service costs with that of social worker-led assessments. Design: pragmatic community-based randomised controlled trial over 2 years 4 months. Setting: Cambridgeshire, UK. Participants: 321 older people aged 65 and over living in their own homes and 113 carers. Intervention: participants were randomised to two groups, to receive either occupational therapist-led or social worker-led assessment. Outcome measures: primary outcome was dependency (Community Dependency Index). Secondary outcomes included quality of life scores (EQ-5D) and psychological outlook (Perceived Stress Scale (PSS)). Outcome measures for carers included Carer Assessment of Difficulty Index (CADI), PSS and EQ-5D, collected at baseline, 4 and 8 months. Resource use data were collected from professional practice records, participants and carers at final follow-up. Results: 264 (82%) of the randomised participants completed the study. No between-group statistically significant differences were found, except that carers in the occupational therapist arm had significantly better EQ-5D scores at the 8 month follow-up (thermometer P = 0.03) and in the social worker arm better CADI scores on stress (P = 0.047) and amount of caring (P = 0.049). Conclusions: there was no clear difference in patient-centred effectiveness measures between occupational therapists and social workers in assessing frail older people and their carers in the community. More extensive use of primary care health services by occupational therapists may have contributed to the differences in EQ-5D scores for carers. Delays in making occupational therapy assessments and in completing recommended housing adaptations may have contributed to these negative findings.
Australian and New Zealand Journal of Public Health, 1996
The main objective of this study was to see if older people could maintain their quality of life and independence after their homes had been modified and they were using community services as recommended by an occupational therapist. There were 167 study participants aged 69 to 94 years from the Northern Sydney Area. After being assessed at home by an occupational therapist, 105 were randomly allocated to one of two groups, to either have or not have the occupational therapist's recommendations carried out. They were assessed again after six months. A third group did not require any intervention. This group was followed up by telephone and postal questionnaire at six months. The main outcome measures used were the Sickness Impact Profile, the Philadelphia Geriatric Center Morale Scale, the Life Satisfaction Index, assessment of Activities of Daily Living, the Health Assessment Questionnaire and change in residence. After six months there were no difference in outcomes among the three groups. Most study participants remained at a satisfactory level on each measure. Three people had died. One had moved to hostel care and one had moved to a nursing home. A further 14 from the group having no intervention had withdrawn from the study. A secondary objective of this study was to indicate the responsiveness of these outcome measures to change in the short term (over six months) in an elderly population. Twelve-month assessments are in progress and may indicate what to expect from these outcome measures in the medium term.
Cost-Effectiveness of Preventive Occupational Therapy for Independent-Living Older Adults
Journal of the American Geriatrics Society, 2002
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The health intervention examined in the study was preventive occupational therapy (OT) to obtain successful ageing, such as improvements in health, function, and quality of life. The intervention consisted of weekly sessions involving 8 to 10 participants, who were helped to a better appreciation of the importance of meaningful activity in their lives through didactic teaching and direct experience with a broad range of activities. The central theme of the OT programme was health through occupation, defined as regularly performed activities such as grooming, exercising, and shopping. Participants were followed by registered occupational therapists trained in working with the elderly. Type of intervention Other: occupational therapy. Economic study type Cost-utility analysis. Study population The study population comprised independent-living elderly people, aged 60 years or older. Subjects were excluded if they were unable to live independently or if they exhibited marked dementia. Setting The setting was community. The economic study was conducted in two federally subsidised apartment complexes for older adults California, USA. Dates to which data relate No dates were reported. The price year was 1995. Source of effectiveness data The source of the effectiveness evidence was a single study, the results of which were published in a separate paper. Link between effectiveness and cost data The costing was performed prospectively on the same patient sample as that used in the effectiveness study. Study sample Power calculations were performed in the original study: assuming a 20% attrition of subjects over 9 months and conducting testing of hypotheses at the 0.05 level (1-tailed), a projected sample size of 360 (with a 2:1 allocation ratio) gave 80% power in detecting a moderate population effect size (greater than or equal to 0.3) attributable to the OT treatment. Methods of enrolment included staffed recruitment tables placed in facility lobbies and at on-site functions
2018
Objective:To compare the cost effectiveness of two occupational therapy–led discharge planning interventions from the HOME trial.Design:An economic evaluation was conducted within the superiority randomized HOME trial to assess the difference in costs and health-related outcomes associated with the enhanced program and the in-hospital consultation. Total costs of health and community service utilization were used to calculate incremental cost-effectiveness ratios, activities of daily living and quality-adjusted life years.Setting:Medical and acute care wards of Australian hospitals (<i>n</i>=5).Subjects:A total of 400 people ≥ 70 years of age.Interventions:Participants were randomized to either (1) an enhanced program (HOME), involving pre/post discharge visits and two follow-up phone calls, or (2) an in-hospital consultation using the home and community environment assessment and the Lawton Instrumental Activities of Daily Living assessment.Main measures:Nottingham Exte...
Scandinavian journal of occupational therapy, 2018
There is growing interest in enabling older adults' occupational performance. We tested whether 11 weeks of intensive client-centred occupational therapy (ICC-OT) was superior to usual practice in improving the occupational performance of home-dwelling older adults. An assessor-masked randomized controlled trial among adults 60 + with chronic health issues, who received or applied for homecare services. Recruitment took place September 2012 to April 2014. All participants received practical and personal assistance and meal delivery as needed. In addition, they were randomized to receive either a maximum 22 sessions of occupation-based ICC-OT (N = 59) or to receive usual practice with a maximum three sessions of occupational therapy (N = 60). The primary outcome was self-rated occupational performance assessed with the Canadian Occupational Performance Measure (COPM). No important adverse events occurred. ICC-OT was accepted by 46 participants (88%), usual practice by 60 (100%). ...
Trials, 2016
A community-based occupational therapy intervention for people with mild to moderate dementia and their family carers (Community Occupational Therapy in Dementia (COTiD)) was found clinically and cost effective in the Netherlands but not in Germany. This highlights the need to adapt and implement complex interventions to specific national contexts. The current trial aims to evaluate the United Kingdom-adapted occupational therapy intervention for people with mild to moderate dementia and their family carers living in the community (COTiD-UK) compared with treatment as usual. This study is a multi-centre, parallel-group, pragmatic randomised trial with internal pilot. We aim to allocate 480 pairs, with each pair comprising a person with mild to moderate dementia and a family carer, who provides at least 4 hours of practical support per week, at random between COTiD-UK and treatment as usual. We shall assess participants at baseline, 12 and 26 weeks, and by telephone at 52 and 78 week...
BMC Geriatrics, 2012
Background Decreased functional ability is common in older adults after hospitalisation. Lower levels of functional ability increase the risk of hospital readmission and nursing care facility admission. Discharge planning across the hospital and community interface is suggested to increase functional ability and decrease hospital length of stay and hospital readmission. However evidence is limited and the benefits of occupational therapists providing this service has not been investigated. This randomised trial will investigate the clinical effectiveness of a discharge planning program in reducing functional difficulties of older adults post-discharge. This trial will also examine the cost of the intervention and cost effectiveness when compared to in-hospital discharge planning. Methods/design 400 participants admitted to participating hospitals will be recruited. Participants will be 70 years of age and over, have no significant cognitive impairment and be independently mobile at ...
Economic evaluation of a geriatric rehabilitation programme: A randomized controlled trial
Journal of Rehabilitation Medicine, 2010
Objective: Cost-effectiveness of a geriatric rehabilitation programme. Design: Economic evaluation alongside a randomized controlled trial. Methods: A total of 741 subjects with progressively decreasing functional ability and unspecific morbidity were randomly assigned to either an inpatient rehabilitation programme (intervention group) or standard care (control group). The difference between the mean cost per person for 12 months' care in the rehabilitation and control groups (incremental cost) and the ratio between incremental cost and effectiveness were calculated. Clinical outcomes were functional ability (Functional Independence Measure (FIM TM )) and healthrelated quality of life (15D score). Results: The FIM TM score decreased by 3.41 (standard deviation 6.7) points in intervention group and 4.35 (standard deviation 8.0) in control group (p = 0.0987). The decrease in the 15D was equal in both groups. The mean incremental cost of adding rehabilitation to standard care was 3111 euros per person. The incremental cost-effectiveness ratio for FIM TM did not show any clinically significant change, and the rehabilitation was more costly than standard care. A cost-effectiveness acceptability curve suggests that if decision-makers were willing to pay 4000 euros for a 1-point improvement in FIM TM , the rehabilitation would be cost-effective with 70% certainty. Conclusion: The rehabilitation programme was not costeffective compared with standard care, and further development of outpatient protocols may be advisable.
Occupational therapy for independent-living older adults. A randomized controlled trial
JAMA: The Journal of the American Medical Association, 1997
O b j e c t i v e. \ p = m-\ T o evaluate the effectiveness of preventive occupational therapy (OT) services specifically tailored for multiethnic, independent-living older adults. De s i g n. \ p = m-\ A randomized controlled trial. Set t i ng. \ p=m-\ Two government subsidized apartment complexes for independentliving older adults. S u b j e c t s. \ p = m-\ A total of 361 culturally diverse volunteers aged 60 years or older. I n t e r v e n t i o n. \ p = m-\ A n OT group, a social activity control group, and a nontreatment control group. The period of treatment was 9 months. Main Outcome M e a s u r e s. \ p = m-\ A battery of self-administered questionnaires designed to measure physical and social function, self-rated health, life satisfaction, and depressive symptoms.
British Journal of Occupational Therapy, 2017
Introduction Re-ablement services are in a period of strong development, but the terms and definitions used remain unclear, and the scientific evidence is still weak. The aim of this systematic review was to obtain an overview of the scientific literature in this evolving research area, and investigate whether there is scientific evidence for positive effects of re-ablement services for older community-living people. Method The systematic literature search was conducted in the databases CINAHL, PubMed and Svemed+(Swemed) and covered the years 2000–2014. Owing to the heterogeneity in the included studies, a narrative synthesis was performed. Results Eight original publications were found eligible and included in the systematic review. When addressed, terms and definitions varied among the papers. Effects such as less use of home care, higher likelihood to live at home, improved activities of daily living (ADL) skills, quality of life and physical health, increased physical activity a...