Intensive client-centred occupational therapy in the home improves older adults’ occupational performance. Results from a Danish randomized controlled trial

Figures & data

Table 1. Details concerning the received rehabilitative services in the trial period.

	ICC-OT group n = 59 at baseline, n = 46 at 3 months	Usual-Practice group n = 60 at baseline, n = 53 at 3 months
ICC-OT from baseline to 3 months	52 participants had, on average, a total of 11 hours over 15 sessions
OT delivered as part of usual practice from baseline to 3 months		14 participants had, on average, a total of 3.1 hours
Physiotherapy from baseline to 3 months	9 participants had, on average, a total of 5.4 hours	5 participants had, on average, a total of 6.6 hours
ADs^a from baseline to 3 months	24 participants had 39 ADs in all	9 participants had 15 ADs in all
OT delivered as part of usual practice from 3 months to 6 months	3 participants had, on average, a total of 0.8 hours	3 participants had, on average, a total of 3.6 hours
Physiotherapy from 3 months to 6 months	12 participants had, on average, a total of 5.4 hours	6 participants had, on average, a total of 7 hours
ADs^a from 3 months to 6 months	8 participants had 16 ADs in all	10 participants had 15 ADs in all

^a Assistive devices and minor home modifications. ICC-OT: Intensive Client-Centred Occupational Therapy.

Figure 1. Characteristics of the ICC-OT intervention.

Figure 2. Participant flow.

Table 2. Demographics and baseline measurements for both groups.

Mean (SD) when not otherwise reported	ICC-OT group n = 59	Usual-Practicegroup n = 60
Age	78.4 (9.4)	76.8 (6.8)
Women, n (% )	45 (76 %)	41 (68 %)
Living alone, n (%)	49 (83 %)	48 (80 %)
1 diagnosis, n (%)	20 (34 %)	18 (30 %)
2 diagnoses, n (%)	28 (47 %)	33 (55 %)
≥3 diagnoses, n (%)	11 (19 %)	9 (15 %)
Personal care or practical help, n (%)	46 (78 %)	49 (82 %)
Meal delivery, n (%)	16 (27 %)	12 (20 %)
COPM performance	3.36 (1.13)	3.41 (1.24)
COPM satisfaction	3.74 (1.55)	3.38 (1.43)
AMPS motor	0.57 (0.64)	0.73 (0.63)
AMPS process	0.62 (0.35)	0.71 (0.34)
SF-36 General health score^#	44.95 (19.94)	41.63 (19.11)
SF-36 PCS (physical)	29.00 (9.71)	28.96 (9.15)
SF-36 MCS (mental)	50.43 (11.82)	46.26 (12.70)

COPM: Canadian Occupational Performance Measure; AMPS: Assessment of Motor and Process Skills; SF-36: Short Form 36 Health Survey.

# Standardised score, range 0–100, better score denotes better general health. PCS: physical component summary; MCS: mental component summary; ICC-OT: Intensive Client Centred Occupational Therapy.

Table 3. Occupational performance and health related quality of life. Within-group changes and between group differences in change.

	ICC-OT group		Usual-Practice group		Between group differences
Assessment^a	Change from baseline to3 months^b (SD) n = 46 COPM n = 36 AMPS n = 46 SF-36	Change from baseline to 6 months^b (SD) n = 44 COPM n = 35 AMPS n = 43 SF-36	Change from baseline to 3 months^b (SD) n = 52 COPM n = 44 AMPS n = 50 SF-36	Change from baseline to 6 months^b (SD) n = 49 COPM n = 38 AMPS n = 49 SF-36	Difference in change from baseline to 3 months^c (95%CI)	Difference in change from baseline to 6 months^c (95%CI)
Primary outcome
COPM Performance Range 1;10	1.87*** (SD 1.84)	1.42*** (SD 1.91)	0.61* (SD 1.94)	0.44 (SD 1.55)	Primary hypothesis 1.26 (0.50 to 2.02) p = 0.001***	Secondary hypothesis 6 0.98 (0.27 to 1.70) p = 0.008**
Secondary outcomes
COPM Satisfaction Range 1;10	1.83*** (SD 2.06)	2.08*** (SD 2.11)	1.12*** (SD 1.97)	0.99*** (SD 1.82)	Secondary hypothesis 1 0.71 (−0.09 to 1.52) p = 0.08	Secondary hypothesis 7 1.09 (0.28 to 1.90) p = 0.009**
AMPS Motor Range −3;4	0.33* (SD 0.82)	0.44*** (SD 0.68)	0.28* (SD 0.74)	−0.00 (SD 0.62)	Secondary hypothesis 2 0.05 (−0.30 to 0.39) p = 0.79	Secondary hypothesis 8 0.44 (0.14 to 0.74) p = 0.005**
AMPS Process Range −4;3	0.17 (SD 0.53)	0.17* (SD 0.49)	0.07 (SD 0.51)	−0.02 (SD 0.42)	Secondary hypothesis 3 0.11 (−0.13 to 0.34) p = 0.37	Secondary hypothesis 9 0.19 (−0.02 to 0.40) p = 0.08
SF-36 PCS Range 0;100	−0.47 (SD 7.30)	−2.14 (SD 7.5)	−0.48 (SD 7.09)	−0.96 (SD 8.63)	Secondary hypothesis 4 0.01 (−2.90 to 2.93) p = 0.99	Secondary hypothesis 10 −1.19 (−4.56 to 2.19) p = 0.49
SF-36 MCS Range 0;100	3.24 (SD 12.56)	3.28 (SD 11.91)	1.47 (SD 10.82)	2.83 (SD 13.03)	Secondary hypothesis 5 1.77 (−6.52 to 2.97) p = 0.46	Secondary hypothesis 11 0.45 (−4.75 to 5.65) p = 0.86

^a Range, all assessment tools: higher scores are more positive. COPM: Canadian Occupational Performance Measure; AMPS: Assessment of Motor and Process Skills; SF-36: Short Form 36 Health Survey; PCS: Physical Component Summary; MCS: Mental Component Summary; ICC-OT: Intensive Client-Centred Occupational Therapy.

^b Paired t-tests.

^c Unpaired t-tests.

*The results were statistically significant at 0.05*, at 0.01**, or at 0.001*** level.

Figure 3. COPM performance at baseline and at 3 months.

Figure 4. (a,b) Exploratory analyses of age and health status' influence on change in COPM from baseline to 3 months.

Appendix 1. Occupational performance and health related quality of life.

Mean scores and between group differences at 3 and 6 months

	ICC-OT group		Usual practice group		Between group differences (exploratory analyses)
Assessments^a	3 months COPM n = 46 AMPS n = 36 SF-36 n = 46	6 months COPM n = 44 AMPS n = 35 SF-36 n = 43	3 months COPM n = 52 AMPS n = 44 SF-36 n = 50	6 months COPM n = 49 AMPS n = 38 SF-36 n = 49	3 months Between group differences# (95%CI)	6 months Between group differences# (95%CI)
Primary end point
COPM Performance Range 1;10	5.29 (SD 1.73)	4.87 (SD 1.73)	4.08 (SD 1.63)	3.93 (SD 1.78)	Primary hypothesis 1.21 (0.54 to 1.88) p < 0.001***	Secondary hypothesis 6 0.94 (0.21 to 1.66) p = 0.012*
Secondary end points
COPM Satisfaction Range 1;10	5.61 (SD 1.75)	5.87 (SD 1.91)	4.49 (SD 2.04)	4.38 (SD 2.22)	Secondary hypothesis 1 1.13 (0.36 to 1.89) p = 0.004**	Secondary hypothesis 7 1.49 (0.63 to 2.35) p < 0.001***
AMPS Motor Range −3;4	0.88 (SD 0.67)	0.94 (SD 0.75)	1.00 (SD 0.62)	0.78 (SD 0.56)	Secondary hypothesis 2 −0.12 (−0.41 to 0.16) p = 0.39	Secondary hypothesis 8 0.17 (0.14 to 0.47) p = 0.28
AMPS Process Range −3;4	0.78 (SD 0.49)	0.82 (SD 0.51)	0.77 (SD 0.48)	0.70 SD 0.40)	Secondary hypothesis 3 0.01 (−0.21 to 0.22) p = 0.94)	Secondary hypothesis 9 0.11 (0.10 to 0.33) p = 0.29
SF-36 PCS Range 0;100	29.77 (SD 10.79)	28.94 (SD 10.32)	28.54 (SD 9.79)	28.19 (SD 10.22)	Secondary hypothesis 4 1.23 (−2.94 to 5.40)p = 0.56	Secondary hypothesis 10 −0.75 (−5.01 to 3.51) p = 0.73
SF-36 MCS Range 0;100	54.03 (SD 12.60)	54.89 (SD 11.12)	47.72 (SD 12.03)	48.61 (SD 12.07)	Secondary hypothesis 5 6.31 (1.31 to 11.30) p = 0.014*	Secondary hypothesis 11 6.27 (1.45 to 11.10) p = 0.012*

^aRanges, all assessment tools: higher scores are more positive. COPM: Canadian Occupational Performance Measure; AMPS: Assessment of Motor and Process Skills; SF-36: Short Form 36 Health Survey; PCS: Physical Component Summary; MCS: Mental Component Summary; ICC-OT: Intensive Client-Centred Occupational Therapy.

^#Unpaired t-tests. Positive differences are in favour of the ICC-OT group. *The results were statistically significant at 0.05*, at 0.01**, or at 0.001*** level.