A127 Occupational Therapy at Home in Denmark

1. Tove Lise Nielsen, Mhsc, Ot (Reg), Ph.D. Student
Kirsten Schultz Petersen, Helene Polatajko
Niels Trolle Andersen, Claus Vinther Nielsen
Client-centred occupational therapy
in the homes of older adults
improves their occupational performance
Results from a randomised controlled trial

2. Older adults’ activity and participation
Health condition
Body function
And structure
ParticipationActivity
Environmental
factors
Personal
factors
Cells
Organs
Musculosceletal
system
Disease
Trauma
Physical
Attitudinal
Social
environment
Home help
Rehabilitation
Self-care
Productivity
Leisure
Life style
Motivation
Coping
Social
participation
Mobility

3. OCCUPATIONS
Groups of activities and tasks of everyday life
Given value and meaning by individuals and a culture
Everything people do to occupy themselves
within the areas of
self-care, productivity, and leisure
Have a therapeutic potential

4. CLIENT-CENTRED OCCUPATIONAL
THERAPY
Co-operation
Partnership
Empowerment
Client’s goals
Listening, respecting clients’ values, meeting clients’
needs

5. Two ways to go
- in a Danish municipality
Client-centred
occupational therapy
Home-care
reablement
Occupational
therapists:
”Will home-
care
reablement
erode older
adults’ access
to valued
occupations?”

6. Study aim – hypothesis:
Home-based, Intensive Client-Centred
Occupational Therapy
ICC-OT
Is more effective than usual care in improving older
adults’ occupational performance and satisfaction

7. Design and participants
An assessor-blinded randomised controlled superiority trial
participants: 119 home-dwelling older adults
Mean age 78 years
72 % women, 28 % men
87 % were receiving home-care
Danish speaking
Exclusion: Former home rehabilitation
Predefined severe diagnoses
Severe pain
Drug or alcohol abuse

8. Intervention group: ICC-OT
Aim Improved occupational performance
Focus Decided by the older adult, based on COPM
interview
Approach Occupation-based individual therapy
+ Usual access to home-care, meal service,
assistive devices, physiotherapy
Amount, OT 11 weeks, twice a week, max. 22 visits

9. Control group: usual practice
Aim Compensation (ADL, cleaning, cooking), minimised
need for home help
Focus Decided by the municipality’s home-care policy
Approach Acces to home-care, meal service, assistive
devices,
physiotherapy
Acces to 3 weeks of home-care reablement

10. Schedule
Time frame: (figure)
-
T1
0 T1 T3
3
months
T6
6
months
ENROLMENT X
RANDOM ALLOCATION X
INTERVENTIONS
Intervention group: ICC-OT X X
Intervention group: usual
practice
X X
Control group: usual practice X X

11. Assessment of occupational performance,
at baseline, 3 and 6 months
Canadian Occupational Performance Measure Assessment of Motor and
Process Skills

12. Details: intensity of ICC-OT
88 % of the ICC-OT group received the intervention and
had
mean 15 visits / 11 hours with the occupational therapist

13. Details: types of activities and tasks
trained in the ICC-OT group
Self-
care
32%
Productivit
Leisure
29%

14. COPM performance, preliminary results
Baseline – 3 months (figure)
Usual-practice improved 0.61
points*
ICC-OT improved 1.87 points***
Difference 1.26 points. T-test p
0.001
Baseline – 6 months
Usual-practice improvement lost
ICC-OT most improvement
maintained***

15. Secondary outcomes, preliminary results
3 months, both groups:
Improved satisfaction with occupational performance (COPM)
Improved quality of performance (AMPS motor scale)
6 months, the ICC-OT group
Further improved their scores, between-group differences highly
significant

16. Take-home messages
ICC-OT effectively improves older adults’
occupational performance and satisfaction
Effects persist 3 months after discharge
Use these results
to plan intensive occupational therapy interventions and home-
care reablement
with more focus on clients’ priorities

17. Thank-you for listening
And my warm thanks to:
Citizens, occupational therapists, home-care officers and
consultants in the municipality of Randers
The Tryg Foundation
The Danish Association of Occupational Therapists
VIA University College, Aarhus University and DEFACTUM