Effectiveness of an individualised occupational therapy intervention programme (ABLE) using adaptational strategies on activities of daily living among persons with chronic conditions: A randomised controlled trial (RCT)

Abstract

Objective Compare the effectiveness of a problem-solving, individualised, home-based occupational therapy intervention (ABLE 2.0), to usual occupational therapy, on activities of daily living (ADL) ability in persons with chronic conditions. Design A single-centre, double-blinded, randomised controlled trial with 10- and 26-week follow-up. Setting A Danish municipality. Subjects Persons with chronic conditions experiencing problems performing ADL tasks ( n = 80). Interventions ABLE 2.0 was compared with usual occupational therapy. Main measures Coprimary outcomes were self-reported ADL ability (ADL-Interview Performance) and observed ADL motor ability (Assessment of Motor and Process Skills) at Week 10. Secondary outcomes were self-reported ADL ability (ADL-Interview Performance) and observed ADL motor ability (Assessment of Motor and Process Skills) at Week 26, and perceived satisfaction with ADL ability (ADL-Interview Satisfaction) and observed ADL process ability (Assessment of Motor and Process Skills) at Weeks 10 and 26. Results In total, 78 persons were randomly assigned: 40 to usual occupational therapy and 38 to ABLE 2.0. No statistically significant nor clinically relevant difference between group mean changes in primary outcomes was identified from baseline to Week 10 (ADL-Interview Performance [−0.16; 95% CI: −0.38 to 0.06] and Assessment of Motor and Process Skills ADL motor ability [−0.1; 95% CI: −0.3 to 0.1]). At Week 26, a statistically significant and clinically relevant difference was found in Assessment of Motor and Process Skills ADL motor ability (LS mean change: −0.3; 95% CI: −0.5 to −0.1) between groups. Conclusion ABLE 2.0 was effective in improving observed ADL motor ability at 26 weeks.

Qualitative realist evaluation of an occupational therapy intervention programme (ABLE), addressing ability to perform activities of daily living among persons with chronic conditions

“…Thus, the assumptions on the impact of the systematic approach in ABLE 2.0 was overall confirmed and it stands out that contextual factors supporting coherence between the different parts of the programme, and the logic order of the sessions in ABLE 2.0, were of particular importance. This is in line with the results of the ABLE 2.0 RCT [ 44 ], suggesting that the systematic approach by means of the OTIPM [ 45 ] seemed to be beneficial in enhancing ADL ability in people with chronic conditions. Hence, ABLE 2.0 should be delivered by trained, skilled, and engaged OTs, being capable of explaining the purpose, using the prescribed tools, and actively involve clients in the problem-solving process.…”

“…However, ABLE 2.0 is unique in outlining how the underpinning occupational therapy theories, conceptual practice models and instruments are applied and how the content interdependently work together to provide a coherent client-centred individualised occupational therapy process. This is supported by the results of the ABLE 2.0 RCT, showing that ABLE 2.0, compared with usual occupational therapy, was effective in terms of obtaining sustainable changes in observed ADL motor ability at 26 weeks [ 44 ]. The present realist evaluation revealed that the mechanisms that were triggered were; active involvement of the client in the problem-solving process, a collaborative working relationship, mutual confidence between the OT and the client, and a consultative process applying an adaptational approach.…”

“…Moreover, the previous pilot study [ 27 ] confirmed these findings with overall high scores on the impact of session 1 in clarifying focus for intervention and establishment of a good basis for further cooperation. Previous research also support the combined use of ADL evaluations based on both self-report and observation when evaluating the ADL ability among persons with chronic conditions [ 3 , 4 , 44 , 56 , 57 ]. More specifically, that self-report and observation provide distinct but related information about ADL ability as self-report represents the insider’s perspective (client perspective), and observation represents the outsider’s perspective (OT perspective).…”

“…OTs ( n = 3) were recruited provided they had delivered ABLE 2.0 in the RCT [ 39 , 44 ], had ≥2 years of experience working with the study target group, were calibrated AMPS raters, and were trained in delivering ABLE 2.0 by attending a three-and-a-half-day course prior to the RCT. The course consisted of introduction to ABLE 2.0 and the underlying theories and models, practicing the use of instruments in the programme, and training delivery of ABLE sessions.…”