#MSBlog: Is it true? Does MSer-focused occupational therapy work?
Epub: Eyssen et al. A cluster randomised controlled trial on the efficacy of client-centred occupational therapy in multiple sclerosis: good process, poor outcome. Disabil Rehabil. 2013 Jan.
Purpose: To assess the efficacy of client-centred occupational therapy (OT) according to a MSer-centred process framework, as compared to usual care OT, in MSers.
Method: A multicentre cluster randomised controlled trial with the institution (i.e. hospital or rehabilitation centre) as the unit of randomisation was performed. A total of 269 outpatient MSers, 13 hospitals and rehabilitation centres and 29 occupational therapists participated. Primary outcomes included measures of disability, participation and autonomy. Secondary outcomes included fatigue, generic health-related quality of life, quality and evaluation of therapy, therapy compliance and therapy frequency. Measurements were taken at baseline, four months and at eight months follow-up.
Results: Primary outcome measures did not show significant differences between the two interventions. Secondary outcomes revealed significant differences in favour of the usual care OT on fatigue (physical scale and total scale) and health-related quality of life (bodily pain and vitality) at four months. After eight months only significant differences on mental health were found. Process outcomes (i.e. the information scale of therapy quality and the client-centredness of the organisation) were in favour of the MSer-centred intervention.
Conclusion: Because the MSer-centred intervention resulted in no effects on the primary outcomes and small but negative effects on the secondary functional outcomes, we should seriously reconsider the application of MSer-centred practice. Implications for Rehabilitation An increasing number of interventions claim to incorporate MSer-centred practice. MSer-centred practice is associated with improved satisfaction but the effects on functional health-related outcomes have not been fully evaluated. The findings of this study show that the process outcomes of therapy were in favour of the MSer-centred intervention, but no effects were found on the primary outcomes and negative effects on the secondary functional health outcomes. It is suggested that the implementation of MSer-centred practice should be adjusted in order to achieve optimal health outcomes.
"These results will come as a surprise to our therapists. I will need to get their take on this. It does not look good."
"Please let us know how helpful you have found OT in the last 12 months."