Occupational therapy improves social participation of complex patients discharged from hospital: results of a powered randomized controlled trial

Abstract

Purpose

To verify the effectiveness of experimental occupational therapy plus intensive standard rehabilitation compared to intensive standard rehabilitation alone on the reintegration to social activities of complex patients three months after hospital discharge.

Materials and methods

Patients with a score ≥ 9 on the Rehabilitation Complexity Scale at admission to an intensive rehabilitation ward were randomized to the control or experimental group. Both groups received intensive multidisciplinary rehabilitation aimed at recovering independence in the basic activities of daily life (ADL). The experimental group also received experimental occupational therapy services to address goals identified through the administration of the Canadian Occupational Performance Measure (COPM). Experimental occupational therapy began during the in-hospital phase and continued in the home-based setting. It consisted of teaching strategies, recommending aids, and providing personalized information regarding available community support.

Results

Ninety-two individuals with a mean age of 65 years (female 44.6%) were enrolled. The experimental group significantly improved participation measured by the Reintegration to Normal Living Index (mean changes 8.61, 95% CI: 1–16.23, p = 0.027). The performance and satisfaction scores of the COPM, both during hospitalization and after discharge, and independence in ADL also improved. No differences in mood disturbances were found.

Conclusion

Early post-discharge occupational therapy integrated with multidisciplinary rehabilitation improves the social participation of complex patients. Future research should investigate the concrete feasibility of implementing this complex intervention cost-effectively and in different contexts.

Trial registration

ClinicalTrials.gov Identifier NCT03668938 (first posted date 13/09/2018)

IMPLICATIONS FOR REHABILITATION

• Early post-discharge rehabilitation assists patients’ transition from hospital to home by improving the management of problems they encounter.

• In complex patients, occupational therapy initiated during hospitalization and extended to the early post-discharge phase improves social participation, independence in basic and instrumental daily activities, and performance and satisfaction when carrying out relevant occupational activities.

• The strong partnership between the Occupational Therapist and the patient improves compliance to treatment, enhancing the chances of success of rehabilitation interventions.

Keywords:

• Rehabilitation
• occupational therapy
• complex patients
• randomized controlled trial
• social participation
• activities of daily living
• health services for persons with disabilities

Acknowledgements

The authors thank Jacqueline M. Costa for the English language editing.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. This study was partially supported by the Italian Ministry of Health – Ricerca Corrente Annual Program 2023.