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, Ϫ0.5 to 3.5). At 6 months the difference was 1.9 (Ϫ0.7 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 Ϫ25% (Ϫ51% to 1%). At 6 months the difference was similar, Ϫ26% (Ϫ48% to Ϫ3%). 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.

Immobility, inactivity and the lack of social interaction are associated with poor physical and mental health. The main aim of this study was to examine the type and frequency of activities and social interactions with took place in a care home for older people. Residents within the communal area of a care home were observed over a period of 16 hours at 10-minute intervals by two psychologists. Residents' positions, activities and interactions were recorded. The majority of observations (97%) found residents sitting and not engaged in activity (60.7%). Only 10.7% of observations involved social interaction of residents either with each other or with a carer. The results demonstrate a very low level of daily activity and interaction in the care home setting. The risks of immobility and inactivity related complications such as pressure sores, muscle weakness, depression and anxiety are high.