Occupational Therapy in HomEcare Re-ablement Services (OTHERS): results of a feasibility randomised controlled trial
journal contributionposted on 23.04.2018 by Phillip J. Whitehead, Marion F. Walker, Ruth Parry, Zaid Latif, Ian D. McGeorge, Avril Drummond
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Objectives The objective of this study was to test the feasibility of conducting a randomised controlled trial (RCT) of an intervention targeted at activities of daily living (ADL), delivered by an occupational therapist, in homecare reablement. Design Feasibility parallel group RCT. Setting Single-site local authority homecare reablement service. Participants People referred for homecare reablement with ability to consent. Exclusion criteria were as follows: inability to speak English, receiving other community therapy services, needing two or more to assist transfer and receiving end-of-life care. Control ‘Usual care’ was 6 weeks of homecare reablement delivered by social care workers (no routine health professional input). Intervention A targeted ADL programme, delivered by an occupational therapist incorporating goal setting, teaching/practising techniques, equipment/adaptations and provision of advice/support. This was in addition to usual care. Outcome measures Aspects of feasibility including eligibility, recruitment, intervention delivery, attrition and suitability and sensitivity of outcome measures. Participant outcomes were personal and extended ADL, quality of life, falls and use of health and social care services. Results 30 participants were recruited, 15 to each arm, which was 60% of those eligible. Data from 22 (73%) were analysed at 6 months. Of the 15 participants, 13 (86%) received the intervention and were able to set one or more ADL goals. There were improvements from baseline in both groups, although overall improvements were greater in the occupational therapy (OT) intervention group. The biggest threat to feasibility was a change in service configuration during the trial, involving additional occupational therapy input, affecting usual care and recruitment. Conclusions Despite the service reconfiguration, it was feasible to recruit and retain participants, deliver the intervention and collect outcome data that were responsive to change. The choice of primary outcome measure remains unclear. A further powered study is feasible and warranted; however, the design will require careful consideration because of ongoing national changes in service configurations.
This article is independent research supported by the National Institute for Health Research (Doctoral Research Fellowship, DRF-2012-05-131).
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