Randomized controlled trial of occupational therapy in patients with treatment-resistant schizophrenia

Buchain, Patrícia Cardoso; Vizzotto, Adriana Dias Barbosa; Neto, Jorge Henna; Elkis, Hélio

doi:10.1590/s1516-44462003000100006

Cited by 70 publications

(58 citation statements)

References 5 publications

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“…A further weakness of this study is that it did not have an active control group. (19) The effectiveness of occupational therapy as an established mental health intervention has not been conclusively or systematically evaluated using controlled studies in any country.…”

Section: Introductionmentioning

confidence: 99%

Occupational therapy for people with psychotic conditions in community settings: a pilot randomized controlled trial

2009

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Objectives: To investigate the effectiveness of a long established intervention, occupational therapy for people with psychotic conditions, and to inform future research designs.Design: A pilot randomized controlled trial.Setting: Two community mental health teams in a UK city.Participants: Forty-four adults with schizophrenia or other psychotic conditions, eligible for enhanced care and having functional problems.Interventions: Twelve months of individualised occupational therapy (OT) in community settings, as an adjunct to usual care and compared to treatment as usual (TAU). A two to one randomisation ratio was used to enable more people to receive OT. Results: Both groups' scores on SFS and SANS showed significant improvement over 12 months. For SFS, the OT group scores were: mean difference = 2.33, CI: 0.39 to 4.27, t = 1.525, P= 0.020 and the TAU group were: mean difference = 6.17, CI: 1.04 to 11.29, t = 2.65, P = 0.023. For SANS, OT group scores were: mean difference = -16.25, CI: -22.94 to -9.56, t = -4.99, P <0.001 and the TAU group: mean difference = -17.36, CI: -29.78 to -4.94, t = -3.12, P = 0.011. There were no differences between the two groups on any of the outcome measures. After 12 months the OT group showed clinically significant improvements that were not apparent in the control group. The OT group showed clinical improvement in 4 subscales of the SFS: relationships, independence performance, independence competence, and recreation. Out of 30 people receiving OT those with a clinical level of negative symptoms reduced from 18 (64%) to 13 (46%) P = 0.055.

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Section: Introductionmentioning

confidence: 99%

Occupational therapy for people with psychotic conditions in community settings: a pilot randomized controlled trial

2009

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“…24), despite recruitment exceeding the original estimate of 90 units (133 units were recruited). The analysis of the phase 1 quantitative data is complete, and a paper presenting the findings has been published in the British Journal of Psychiatry.…”

Section: Summary Of Progress and Outputsmentioning

confidence: 81%

“…19 It has long been known that facilitating service users' activity reduces negative symptoms, 20,21 and there is some evidence that this may also lead to improvements in social function through the promotion of motivation and daytime structure. [22][23][24] Nevertheless, there is evidence that the level of activity of users of acute inpatient services is alarmingly low: in one survey in a London trust, service users spent < 17 minutes per day in an activity other than sleeping, eating or watching television. 25 There are, however, very limited published data on the number and types of activities undertaken in inpatient rehabilitation services.…”

Section: Objectivementioning

confidence: 99%

“…Objective 2 was addressed by phase 2 of the programme, the development of a staff training intervention to enhance service users' activities: the 'GetREAL' intervention (project months [18][19][20][21][22][23][24].…”

Section: Aims and Objectives Of The Real Research Programmementioning

confidence: 99%

“…Self-care is the sum of scores for items 10,12,13,14,15,16,23,24,26,30 (possible range 10 to 40) Non-turbulence is the sum of scores for items 5,6,25,27,28,29,32,34,35,36,37,38 The subscales will not be analysed in this study.…”

Section: Primary Outcomes Appendix 11mentioning

confidence: 99%

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The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

Killaspy

King

Holloway

et al. 2017

Programme Grants Appl Res

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BackgroundThe REAL (Rehabilitation Effectiveness for Activities for Life) research programme, funded by the National Institute for Heath Research (NIHR) from 2009 to 2015, investigated NHS mental health rehabiliation services across England. The users of these services are people with longer-term, complex mental health problems, such as schizophrenia, who have additional problems that complicate recovery. Although only around 10% of people with severe mental illness require inpatient rehabilitation, because of the severity and complexity of their problems they cost 25–50% of the total mental health budget. Despite this, there has been little research to help clinicians and commissioners to plan and deliver effective treatments and services. This research aimed to address this gap.MethodsThe programme had four phases. (1) A national survey, using quantitative and qualitative methods, was used to provide a detailed understanding of the scope and quality of NHS mental health rehabilitation services in England and the characteristics of those who use them. (2) We developed a training intervention for staff of NHS inpatient mental health rehabilitation units to facilitate service users’ activities. (3) The clinical effectiveness and cost-effectiveness of the staff training programme was evaluated through a cluster randomised controlled trial involving 40 units that scored below average on our quality assessment tool in the national survey. A qualitative process evaluation and a realistic evaluation were carried out to inform our findings further. (4) A naturalistic cohort study was carried out involving 349 service users of 50 units that scored above average on our quality assessment tool in the national survey, who were followed up over 12 months. Factors associated with better clinical outcomes were investigated through exploratory analyses.ResultsMost NHS trusts provided inpatient mental health rehabilitation services. The quality of care provided was higher than that in similar facilities across Europe and was positively associated with service users’ autonomy. Our cluster trial did not find our staff training intervention to be clinically effective [coefficient 1.44, 95% confidence interval (CI) –1.35 to 4.24]; staff appeared to revert to previous practices once the training team left the unit. Our realistic review suggested that greater supervision and senior staff support could help to address this. Over half of the service users in our cohort study were successfully discharged from hospital over 12 months. Factors associated with this were service users’ activity levels [odds ratio (OR) 1.03, 95% CI 1.01 to 1.05] and social skills (OR 1.13, 95% CI 1.04 to 1.24), and the ‘recovery’ orientation of the unit (OR 1.04, 95% CI 1.00 to 1.08), which includes collaborative care planning with service users and holding hope for their progress. Quality of care was not associated with costs of care. A relatively small investment (£67 per service user per month) was required to achieve the improvement in everyday functioning that we found in our cohort study.ConclusionsPeople who require inpatient mental health rehabilitation are a ‘low-volume, high-needs’ group. Despite this, these services are able to successfully discharge most to the community within 18 months. Our results suggest that this may be facilitated by recovery-orientated practice that promotes service users’ activities and social skills. Further research is needed to identify effective interventions that enhance such practice to deliver these outcomes. Our research provides evidence that NHS inpatient mental health rehabilitation services deliver high-quality care that successfully supports service users with complex needs in their recovery.Main limitationOur programme included only NHS, non-secure, inpatient mental health rehabilitation services.Trial registrationCurrent Controlled Trials ISRCTN25898179.FundingThe NIHR Programme Grants for Applied Research programme.

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Supported employment for adults with severe mental illness

Kinoshita

Furukawa

Kinoshita³

et al. 2013

Cochrane Database of Systematic Reviews

165

178

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This is the protocol for a review and there is no abstract. The objectives are as follows: 1. To review the effectiveness of supported employment compared to other approached to vocational rehabilitation and treatment as usual. 2. Secondary objectives are to establish how far: a. fidelity to the IPS model affects the effectiveness of supported employment, b. the effectiveness of supported employment can be augmented by the addition of other interventions.

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Randomized controlled trial of occupational therapy in patients with treatment-resistant schizophrenia

Abstract: In patients with TRS the combination of OT and clozapine showed to be more effective than the use of clozapine alone. OT may represent an additional therapeutic option for patients with TRS.

Cited by 70 publications

References 5 publications

Occupational therapy for people with psychotic conditions in community settings: a pilot randomized controlled trial

Occupational therapy for people with psychotic conditions in community settings: a pilot randomized controlled trial

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

Supported employment for adults with severe mental illness

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