In our
first
spotlight
on
research,
which we
hope
will
become a
regular
feature
in The
Bridge,
we are
focusing
on a
very
exciting
paper
that has
just
been
published
in
Clinical
Rehabilitation
by Sarah
Cook and
colleagues.
Simon
Hughes,
a
consultant
occupational
therapist
who is
currently
conducting
a
research
study on
occupation
and
assertive
outreach,
reflects
on this
publication…
This
paper
has been
eagerly
anticipated
since
the
publication
of
‘Occupational
therapy
defined
as a
complex
intervention’
(Creek
2003).
Creek’s
(2003)
work
laid the
pathway
for this
trial
based on
a clear
definition
of
occupational
therapy.
The
paper
reports
the
findings
from a
pilot
randomized
control
trial
conducted
in two
NHS
community
mental
health
adult
services
in a
city in
the
north of
England.
The aim
of the
study
was to
investigate
the
feasibility
of a
randomized
controlled
trial
design
to
inform a
future
fully
powered
study
within a
European
health
and
cultural
context.
The
intervention
was
twelve
months
of
occupational
therapy
delivered
in a
community
setting
and
individualised
to the
service
user as
an
adjunct
to usual
care,
this was
compared
to
treatment
as
usual.
The
results
showed
that
there
were no
differences
between
the two
groups
on any
of the
outcome
measures.
For both
groups
there
was
statistically
significant
improvement
over the
twelve
month
period
as rated
by the
Social
Functioning
Scale
and the
Scale
for the
Assessment
of
Negative
Symptoms.
Studying
the
subscales
within
the
Social
Functioning
Scale
the
occupational
therapy
group
demonstrated
clinically
significant
change
that was
not
apparent
in the
control
group;
this was
in the
areas of
relationships,
independence
performance,
independence
competence,
and
recreation.
The
authors
concluded
that
individualised
occupational
therapy
may
contribute
towards
an
individual’s
recovery
and that
further
research
is
necessary
with an
emphasis
on
individuals’
cognitive
abilities
and
employment.
The
importance
of this
study is
the
steps
forward
it takes
in the
lengthy
process
towards
being
able to
routinely
evaluate
a
complex
intervention
such as
occupational
therapy.
The
Medical
Research
Council
(2008)
guidelines
to
developing
and
evaluating
complex
interventions
confirm
this
process.
In terms
of
challenges
to the
feasibility
of the
study
key
issues
included
(a) the
context
of the
investigation
in that
occupational
therapy
is an
established,
rather
than a
novel,
intervention
and (b)
there
was
evidence
from the
parallel
qualitative
study
that
individuals
in the
treatment
as usual
group
had also
received
occupational
therapy.
(The
authors
also
generated
other
possible
explanations
of lack
of
difference
between
the two
groups).
This
pilot
study
has laid
the
groundwork
for
future
fully
powered
studies,
for
example
the
outcome
measures
that the
trials
should
be
powered
against
are
discussed.
The
paper
also
questioned
the
utility
of the
chosen
standardised
outcome
measures
to
sensitively
detect
clinically
significant
change
in an
individually
tailored
programme.
A
proposal
is put
forward
that in
future
consideration
may need
to be
given to
goal
attainment
scales.
If you
would
like to
read
Sarah’s
article
the full
reference
is:
Cook S,
Chambers
E,
Coleman
JH
(2009)
Occupational
therapy
for
people
with
psychotic
conditions
in
community
settings:
a pilot
randomized
controlled
trial.
Clinical
Rehabilitation
23
40-52.
Available
online
at
http://cre.sagepub.com/cgi/content/abstract/23/1/40
(DOI:
10.1177/0269215508098898)
References
Creek J
(2003)
Occupational
therapy
defined
as a
complex
intervention
London:
COT
The
Medical
Research
Council
(2008)
Developing
and
evaluating
complex
interventions:
new
guidance.
Available
online
at :-
http://www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC004871
Simon
Hughes
Lead for
Occupation
and
working
with
people
with
psychosis
living
in the
community
Research
Programme
(RCOMH)
Tees,
Esk
&Wear
Valley
NHS
Trust