Effect of adding individualized occupational therapy to standard care on rehospitalization of patients with schizophrenia: A 2‐year prospective cohort study

Abstract

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.

Cost-Effectiveness of Individualized Occupational Therapy for Schizophrenia: Results from a Two-Year Randomized Controlled Trial

“…functioning using the Global Assessment of Functioning (GAF) [9], psychiatric symptoms using the Positive and Negative Syndrome Scale (PANSS) [10], and treatment satisfaction using the Client Satisfaction Questionnaire (CSQ-8) [11,12] among patients with schizophrenia. Furthermore, we utilized a multicenter 2-year prospective cohort study to evaluate the impact of the type of occupational therapy (GOT + IOT or GOT alone) that patients received on their subsequent rehospitalizations [3]. Findings of these studies demonstrated that adding IOT to GOT resulted in significant improvements in cognition and intrinsic motivation [2] and could prolong the time to rehospitalization and reduce the risk of rehospitalization in comparison to GOT alone, in addition to supporting good cognition at discharge and favorable medication adherence [3].…”

“…Furthermore, we utilized a multicenter 2-year prospective cohort study to evaluate the impact of the type of occupational therapy (GOT + IOT or GOT alone) that patients received on their subsequent rehospitalizations [3]. Findings of these studies demonstrated that adding IOT to GOT resulted in significant improvements in cognition and intrinsic motivation [2] and could prolong the time to rehospitalization and reduce the risk of rehospitalization in comparison to GOT alone, in addition to supporting good cognition at discharge and favorable medication adherence [3]. Details of the IOT study have been published [1][2][3].…”

“…However, the cost-effectiveness of adding IOT to standard care has been not examined. This study evaluated costeffectiveness from the perspective of the health care system using our previous study data [2,3] for GOT + IOT and GOT alone during a 2-year follow-up.…”

“…Eligibility criteria for this study and patient disposition have already been reported [2,3]. Of 260 patients who were assessed for eligibility, 136 patients with schizophrenia or schizoaffective disorder (DSM-5) who were recently hospitalized in a psychiatric hospital met the criteria for the previous study and, of these, 68 were randomly assigned to each of the GOT + IOT and GOT alone groups [2].…”

“…The individualized occupational therapy (IOT) program was developed to facilitate proactive participation in treatment and improve outcomes for patients with schizophrenia [1][2][3]. To evaluate the effect of adding IOT to group occupational therapy (GOT) as standard care, we conducted a multicenter, single-blind, randomized controlled trial, in which we assessed cognition using the Brief Assessment of Cognition in Schizophrenia (BACS) [4,5] and the Schizophrenia Cognition Rating Scale (SCoRS) [6,7], intrinsic motivation using the Intrinsic Motivation Inventory (IMI) [8], social…”