Implementation and outcomes of a novel occupational therapy service in a nursing home.
Brie Bobinskas, Alice Pashley, Helen Holloway and 5 others
Residents in a nursing home who received individualised occupational therapy over up to 36 weeks reported clinically meaningful gains in both performance and satisfaction with their chosen activities, with median improvements of 2 and 2.3 points on a 1-to-10 scale.
Key findings
1Of the residents who completed the COPM, 18 showed increased performance scores (12 of whom met the 2-point threshold for a meaningful change) and 20 showed increased satisfaction scores (12 meeting the same threshold), with median gains of 2 and 2.3 points respectively on a 1-to-10 scale.
2The most common interventions were activity and cognitive engagement (18 residents, 67%), equipment selection (15, 56%), family consultation (15, 56%), and environmental modification (14, 52%).
3Occupational therapy provided 29,535 minutes of care (17,310 minutes, or 59%, face-to-face), with a median of 895 minutes per resident across 612 service occasions; residents received a median of 3.9 minutes per day including allied health assistant-delivered sessions.
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How it was doneWhat they foundWhat it means for OTs
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What it does not show
Single nursing home in one city; the authors note this limits generalisability to other settings. No control group and no randomisation: residents were assessed and treated in their own home, so improvements could reflect regression to the mean, the novelty of receiving structured attention, or the combined effect of the other five allied health disciplines in the trial. Small sample: 27 residents received OT interventions and 25 had paired COPM data. The two delivering OTs were highly experienced (17 and 31 years), which the authors acknowledge may have influenced outcomes and makes the model harder to replicate with less-experienced staff. Residents were recommended one or more of six allied health interventions and opted into assessments; the COPM improvement cannot be attributed to OT alone when physiotherapy, dietetics, speech pathology, pharmacy, and optometry were also available in the same trial.
Declared interests
Funded by the Medical Research Future Fund. Two authors (Stephen Isbel, Claire Pearce) hold editorial positions (Associate Editor and Editorial Board member) in the Australian Occupational Therapy Journal, the journal in which this paper is published.
The easy way to misread this
Do not read the 2-point median COPM gain as proof that occupational therapy caused the improvement. There was no control group, the design was non-randomised and pre-post, and residents in this trial were also eligible for and may have received physiotherapy, dietetics, speech pathology, pharmacy, and optometry services. The observed change could reflect regression to the mean, the novelty of receiving any structured individual attention in a setting where residents described their days as 'boring,' or the combined effect of multiple disciplines acting on the same person at the same time.
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