Effectiveness and Cost-Effectiveness of Occupation-Based Occupational Therapy Using the Aid for Decision Making in Occupation Choice (ADOC) for Older Residents: Pilot Cluster Randomized Controlled Trial.
Effectiveness and Cost-Effectiveness of Occupation-Based Occupational Therapy Using the Aid for Decision Making in Occupation Choice (ADOC) for Older Residents: Pilot Cluster Randomized Controlled Trial.
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DOI：
10.1371/journal.pone.0150374
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Yamauchi K
中科院分区：
文献类型：
--
作者：
Nagayama H;Tomori K;Ohno K;Takahashi K;Ogahara K;Sawada T;Uezu S;Nagatani R;Yamauchi K
养老院的居民大多不活跃，与工作人员互动很少，并且依赖工作人员从事日常职业。我们最近开发了一款名为“职业选择决策辅助”（ADOC）的iPad应用程序，通过从描述日常活动的插图中进行选择，促进活动中的共同决策和基于职业的目标设定。本研究旨在评估使用ADOC基于职业目标设定的干预措施是否可以专注于有意义的活动，以改善生活质量和独立的日常生活活动，比基于损伤的方法具有更高的成本效益，并评估进行大型集群随机对照试验的可行性。在这项单盲随机对照试验中，干预组（ADOC组）接受基于ADOC职业目标设置的职业治疗，干预措施侧重于有意义的职业。对照组采用基于损伤的方法，重点是恢复能力，没有目标设定工具。在两组中，每周进行两次20分钟的个性化干预会议，持续4个月。SF-36量表（SF-36）评分、SF-6D效用评分、质量调整生命年（QALY）、Barthel指数和总护理成本。我们随机化并分析了12个设施（44名参与者，18.5%的脱落率），其中6个设施分别分配到ADOC组（n = 23）和对照组（n = 21）。干预4个月后，ADOC组BI评分的变化显著更大，评分改善（P = 0.027，95%CI 0.41至6.87，群内相关系数= 0.14）。其他结局无显著差异。使用BI评分的变化计算的增量成本效益比为63.1美元。结果表明，职业治疗使用ADOC老年居民可能是有效的和成本效益。我们还发现，在职业治疗环境中进行随机对照试验是可行的。UMIN临床试验注册中心UMIN 000012994
Care-home residents are mostly inactive, have little interaction with staff, and are dependent on staff to engage in daily occupations. We recently developed an iPad application called the Aid for Decision-making in Occupation Choice (ADOC) to promote shared decision-making in activities and occupation-based goal setting by choosing from illustrations describing daily activities. This study aimed to evaluate if interventions based on occupation-based goal setting using the ADOC could focus on meaningful activities to improve quality of life and independent activities of daily living, with greater cost-effectiveness than an impairment-based approach as well as to evaluate the feasibility of conducting a large cluster, randomized controlled trial. In this single (assessor)-blind pilot cluster randomized controlled trial, the intervention group (ADOC group) received occupational therapy based on occupation-based goal setting using the ADOC, and the interventions were focused on meaningful occupations. The control group underwent an impairment-based approach focused on restoring capacities, without goal setting tools. In both groups, the 20-minute individualized intervention sessions were conducted twice a week for 4 months. Short Form-36 (SF-36) score, SF-6D utility score, quality adjusted life years (QALY), Barthel Index, and total care cost. We randomized and analyzed 12 facilities (44 participants, 18.5% drop-out rate), with 6 facilities each allocated to the ADOC (n = 23) and control (n = 21) groups. After the 4-month intervention, the ADOC group had a significantly greater change in the BI score, with improved scores (P = 0.027, 95% CI 0.41 to 6.87, intracluster correlation coefficient = 0.14). No other outcome was significantly different. The incremental cost-effectiveness ratio, calculated using the change in BI score, was $63.1. The results suggest that occupational therapy using the ADOC for older residents might be effective and cost-effective. We also found that conducting an RCT in the occupational therapy setting is feasible. UMIN Clinical Trials Registry UMIN000012994