The individualized occupational therapy (IOT) program is a psychosocial program that we developed to facilitate proactive participation in treatment and improve cognitive functioning and other outcomes for inpatients with acute schizophrenia. The program consists of motivational interviewing, self-monitoring, individualized visits, handicraft activities, individualized psychoeducation, and discharge planning. This multicenter, open-labeled, blinded-endpoint, randomized controlled trial evaluated the impact of adding IOT to a group OT (GOT) program as usual for outcomes in recently hospitalized patients with schizophrenia in Japanese psychiatric hospitals setting compared with GOT alone. Patients with schizophrenia were randomly assigned to the GOT+IOT group or the GOT alone group. Among 136 randomized patients, 129 were included in the intent-to-treat population: 66 in the GOT+IOT and 63 in the GOT alone groups. Outcomes were administered at baseline and discharge or 3 months following hospitalization including the Brief Assessment of Cognition in Schizophrenia Japanese version (BACS-J), the Schizophrenia Cognition Rating Scale Japanese version, the Social Functioning Scale Japanese version, the Global Assessment of Functioning scale, the Intrinsic Motivation Inventory Japanese version (IMI-J), the Morisky Medication Adherence Scale-8 (MMAS-8), the Positive and Negative Syndrome Scale (PANSS), and the Japanese version of Client Satisfaction Questionnaire-8 (CSQ-8J). Results of linear mixed effects models indicated that the IOT+GOT showed significant improvements in verbal memory (p <0.01), working memory (p = 0.02), verbal fluency (p < 0.01), attention (p < 0.01), and composite score (p < 0.01) on the BACS-J; interest/enjoyment (p < 0.01), value/usefulness (p < 0.01), perceived choice (p < 0.01), and IMI-J total (p < 0.01) on the IMI-J; MMAS-8 score (p < 0.01) compared with the GOT alone. Patients in the GOT+IOT demonstrated significant improvements on the CSQ-8J compared with the GOT alone (p < 0.01). The present findings provide support for the feasibility in implementing an IOT program and its effectiveness for improving cognitive impairment and other outcomes in patients with schizophrenia.

Aim We examined the effect of individualized occupational therapy (IOT) compared to the usual group occupational therapy (GOT) on the rehospitalization of patients with schizophrenia. Methods A prospective cohort study included patients with schizophrenia who were discharged within 1 year from a psychiatric hospital. Time to rehospitalization by treatment group (GOT + IOT or GOT‐alone) was evaluated with Kaplan–Meier survival analysis. The impact of demographics and clinical factors associated with rehospitalization was investigated using Cox proportional hazards models. Results Of the 111 patients who met the criteria, 54 were in the GOT + IOT group and 57 in the GOT‐alone group. Over the 2 years from discharge, the overall rehospitalization rate was 51.376% (56 patients); the GOT + IOT group demonstrated a significantly lower rehospitalization rate with 16 patients rehospitalized compared to 40 patients from the GOT‐alone group. Time to rehospitalization was significantly longer for the GOT + IOT group compared to those in the GOT‐alone group (P < 0.001). The multivariate Cox proportional hazards models showed that type of occupational therapy (hazard ratio [HR] = 0.543), medication adherence (HR = 0.343), access to resident support persons (HR = 0.450), and executive function at discharge (HR = 0.740) were all significantly associated with rehospitalization. Conclusion Our results provide support for the prolonging effects of IOT in relation to rehospitalization and the reduction of rehospitalization risk compared to patients with schizophrenia who receive GOT alone, in addition to supporting good cognition at discharge and favorable medication adherence.

Objective: To evaluate the cost-effectiveness of adding individualized occupational therapy (IOT) to group occupational therapy (GOT) as standard care versus GOT alone for prevention of rehospitalization for patients with schizophrenia. Methods: Data were collected from our previous randomized controlled trial from baseline psychiatric discharge to 2-year follow-up. The effectiveness was measured as the number of patients who were not rehospitalized, and the cost outcome was defined as direct medical costs. Results: A total of 109 patients were included: 53 in GOT + IOT and 56 in GOT alone. The number of patients who avoided rehospitalization was significantly higher in the GOT + IOT (n = 37) condition compared with the GOT alone condition (n = 16) (p < .001). Adding IOT to GOT was associated with a 56.76% probability of being more effective at reducing the rehospitalization rate and a 26.93% probability of being less costly than GOT alone. GOT + IOT had high outpatient costs, but lower inpatient costs due to the lower rehospitalization rate; as a result, total medical costs were lower than for GOT alone. Conclusions: Our results demonstrate that adding IOT to GOT is likely to reduce costs and the rehospitalization rate; thus, GOT + IOT is more cost-effective than GOT alone.

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