A client-centred ADL intervention: three-month follow-up of a randomized controlled trial

Abstract

ObjectiveThe aim was to study a client-centred activities of daily living (ADL) intervention (CADL) compared with the usual ADL intervention (UADL) in people with stroke regarding: independence in ADL, perceived participation, life satisfaction, use of home-help service, and satisfaction with training and, in their significant others, regarding: caregiver burden, life satisfaction, and informal care.MethodsIn this multicentre study, 16 rehabilitation units were randomly assigned to deliver CADL or UADL. The occupational therapists who provided the CADL were specifically trained. Eligible for inclusion were people with stroke treated in a stroke unit ≤3 months after stroke, dependent in ≥two ADL, not diagnosed with dementia, and able to understand instructions. Data were collected at inclusion and three months thereafter. To detect a significant difference between the groups in the Stroke Impact Scale (SIS) domain “participation”, 280 participants were required. Intention-to-treat analysis was applied.ResultsAt three months, there was no difference in the outcomes between the CADL group (n = 129) and the UADL group (n = 151), or their significant others (n = 87/n = 93) except in the SIS domain “emotion” in favour of CADL (p = 0.04).ConclusionThe CADL does not appear to bring about short-term differences in outcomes and longer follow-ups are required.

The caregiving phenomenon and caregiver participation in dementia

“…In recent years, there has been ongoing work to increase and develop patient participation within the Swedish healthcare system . However, most user‐centred interventions require a reasonably good cognitive level and an ability to understand instructions, making participation difficult in dementia. Different levels of patient participation can be considered: low participation appears in collective forms of participation, for example in registry research.…”

Training in client-centeredness enhances occupational therapist documentation on goal setting and client participation in goal setting in the medical records of people with stroke

“…Independent variables were drawn from the data collection, described in detail elsewhere, 11,12 of the randomized controlled trial: client socio-demographic data (age, education, gender, marital status), client disease related factors (the Frenchay Activity Index, 23 stroke severity); and healthcare setting, (inpatient versus outpatient rehabilitation, and county council). Client-provider interaction has been linked to client characteristics and clinical settings 24,25 and it was hypothesized that these factors could influence the documentation.…”

“…This study was performed in the context of a cluster randomized controlled trial 11,12,16 in which no significant difference in outcomes between a client-centred activities of daily living (ADL) intervention and usual ADL interventions was found. The aim of the present study was to compare client-centeredness as it was documented by the occupational therapists in the units randomized to the intervention clusters with documentation by occupational therapists in the control clusters.…”

Complex negotiations: The lived experience of enacting agency after a stroke

“…All participants in the present study were part of a larger multi-centre study in Central Sweden (Life After Stroke-II) (28). The participants were recruited between October 2009 and September 2011 while they were receiving rehabilitation services after their stroke.…”