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

Abstract

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.

A systematic review on improving cognition in schizophrenia: which is the more commonly used type of training, practice or strategy learning?

“…It is important to note that these types of training are not the only modalities offered to help overcome neurocognitive or sociocognitive deficits. Occupational therapy [128], social skills training [129], as well as certain forms of metacognitive psychotherapies [130] have also been documented.…”

Clinician views of referring people with negative symptoms to outcome research: A questionnaire survey

“…In light of this, researchers might need to reconsider the inclusion criteria set out when recruiting participants into future studies of negative symptom treatments in order to keep abreast of service changes in diagnostic practice. A recent pilot study (Cook et al . 2009) recruited a sample of 44 participants when relying on a case note diagnosis of psychosis, rather than schizophrenia.…”

Psychosocial treatments for negative symptoms in schizophrenia: Current practices and future directions

“… 2 Other treatments that have assessed negative symptom outcomes but with only 1 or 2 RCTs include, art therapy (Crawford et al, 2012; Richardson, Jones, Evans, & Rowe, 2007), music therapy (Ulrich, Houtmans, & Gold, 2007), dance therapy (Rohricht & Priebe, 2006), occupational therapy (Cook, Chambers, & Coleman, 2009), vocational rehabilitation (Bio & Gattaz, 2011), and dog-assisted group integrated psychological therapy (Villalta-Gil et al, 2009). …”