Cluster Randomized Pilot Controlled Trial of an Occupational Therapy Intervention for Residents With Stroke in UK Care Homes

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Abstract
Background and Purpose— A pilot evaluation of an occupational therapy intervention to improve self-care independence for residents with stroke-related disability living in care homes was the basis of this study. Methods— A cluster randomized controlled trial with care home as the unit of randomization was undertaken in Oxfordshire, UK. Twelve homes (118 residents) were randomly allocated to either intervention (6 homes, 63 residents) or control (6 homes, 55 residents). Occupational therapy was provided to individuals but included carer education. The control group received usual care. Assessments were made at baseline, postintervention (3 months) and at 6-months to estimate change using the Barthel Activity of Daily Living Index (BI) scores, “poor global outcome”, (defined as deterioration in BI score, or death) and the Rivermead Mobility Index. Results— At 3 months BI score in survivors had increased by 0.6 (SD 3.9) in the intervention group and decreased by 0.9 (2.2) in the control group; a difference of 1.5 (95% CI allowing for cluster design, −0.5 to 3.5). At 6 months the difference was 1.9 (−0.7 to 4.4). Global poor outcome was less common in the intervention group. At 3 months, 20/63 (32%) were worse/dead in the intervention group compared with 31/55 (56%) in the control group, difference −25% (−51% to 1%). At 6 months the difference was similar, −26% (−48% to −3%). Between-group changes in Rivermead Mobility Index scores were not significantly different. Conclusion— Residents who received an occupational therapy intervention were less likely to deteriorate in their ability to perform activities of daily living.