Title

Occupational therapy predischarge home visits in acute hospital care: A randomized trial

RIS ID

110057

Publication Details

Clemson, L., Lannin, N. A., Wales, K., Salkeld, G., Rubenstein, L., Gitlin, L., Barris, S., Mackenzie, L. & Cameron, I. D. (2016). Occupational therapy predischarge home visits in acute hospital care: A randomized trial. Journal of the American Geriatrics Society, 64 (10), 2019-2026.

Abstract

Objectives

To determine whether an enhanced occupational therapy discharge planning intervention that involved pre- and postdischarge home visits, goal setting, and follow-up (the HOME program) would be superior to a usual care intervention in which an occupational therapy in-hospital consultation for planning and supporting discharge to home is provided to individuals receiving acute care.

Design

Randomized controlled trial.

Setting

Acute and medical wards.

Participants

Individuals aged 70 and older (N = 400).

Measurements

Primary outcomes: activities daily living (ADLs; Nottingham Extended Activities of Daily Living) and participation in life roles and activities (Late Life Disability Index (LLDI)).

Results

Occupational therapist recommendations differed significantly between groups (P < .001) (HOME n = 892 recommendations; control n = 329 recommendations). There was no difference between groups in ADLs (Nottingham Extended Activities of Daily Living scale (NEADL): β = −0.17, 95% confidence interval (CI) = −0.99–0.66) or participation (LLDI—Frequency: β = −0.23, 95% CI = −2.05–1.59; LLDI—Limitation: β = −0.14, 95% CI = −2.86–2.58). Both groups maintained prehospital functional status at 90 days, and there was no difference between groups in the number of people with unplanned readmissions (HOME 23.5%, n = 43; control 21.9%, n = 37). When groups were combined, being male (P = .03) or having lower perceived participation because of physical problems (P = .04) resulted in higher risk of unplanned readmissions.

Conclusion

HOME discharge planning, which had a strong emphasis on task modification, well-being, and prevention strategies, implemented twice as many occupational therapy recommendations as the in-hospital only consultation, which had a greater emphasis on equipment provision, but HOME did not demonstrate greater benefit in global measures of ADLs or participation in life tasks than in-hospital consultation alone. It is not recommended that home visits be conducted routinely as part of discharge planning for acutely hospitalized medical patients. Further work should develop guidelines for quality in-hospital consultation.

Please refer to publisher version or contact your library.

Share

COinS
 

Link to publisher version (DOI)

http://dx.doi.org/10.1111/jgs.14287