title: Are occupational therapists more effective than social workers when assessing frail older people? Results of CAMELOT, a randomised controlled trial.
abstract: OBJECTIVE
  To compare the effectiveness of occupational therapist-led assessments of older people on dependency and service costs with that of social worker-led assessments.
  
  
  METHODS
  Pragmatic community-based randomised controlled trial over 2 years 4 months.
  
  
  METHODS
  Cambridgeshire, UK.
  
  
  METHODS
  321 older people aged 65 and over living in their own homes and 113 carers.
  
  
  METHODS
  participants were randomised to two groups, to receive either occupational therapist-led or social worker-led assessment.
  
  
  METHODS
  Primary outcome was dependency (Community Dependency Index). Secondary outcomes included quality of life scores (EQ-5D) and psychological outlook (Perceived Stress Scale (PSS)). Outcome measures for carers included Carer Assessment of Difficulty Index (CADI), PSS and EQ-5D, collected at baseline, 4 and 8 months. Resource use data were collected from professional practice records, participants and carers at final follow-up.
  
  
  RESULTS
  264 (82%) of the randomised participants completed the study. No between-group statistically significant differences were found, except that carers in the occupational therapist arm had significantly better EQ-5D scores at the 8 month follow-up (thermometer P = 0.03) and in the social worker arm better CADI scores on stress (P = 0.047) and amount of caring (P = 0.049).
  
  
  CONCLUSIONS
  There was no clear difference in patient-centred effectiveness measures between occupational therapists and social workers in assessing frail older people and their carers in the community. More extensive use of primary care health services by occupational therapists may have contributed to the differences in EQ-5D scores for carers. Delays in making occupational therapy assessments and in completing recommended housing adaptations may have contributed to these negative findings.
authors.affiliation: School of Allied Health Professions, University of East Anglia, Norwich NR4 7TJ, UK. s.e.stewart@uea.ac.uk
authors.forename: Sandra
authors.initials: S
authors.lastname: Stewart
authors.forename: Ian
authors.initials: I
authors.lastname: Harvey
authors.forename: Fiona
authors.initials: F
authors.lastname: Poland
authors.forename: Walter
authors.initials: W
authors.lastname: Lloyd-Smith
authors.forename: Miranda
authors.initials: M
authors.lastname: Mugford
authors.forename: Chris
authors.initials: C
authors.lastname: Flood
mesh_terms: D000368:Aged; D017028:Caregivers / Q000523:psychology; D003858:Dependency, Psychological; D016330:Frail Elderly / Q000523:psychology; D015577:Geriatric Assessment; D006801:Humans; D009788:Occupational Therapy; D011788:Quality of Life; D012947:Social Work; D013315:Stress, Psychological / Q000175:diagnosis