Comparison of occupation-based and impairment-based occupational therapy for subacute stroke: a randomized controlled feasibility study.
OBJECTIVE
To compare occupation-based and impairment-based approaches in occupational therapy and determine the feasibility of patient recruitment and retention.


METHODS
A multicenter, randomized, controlled pilot trial with a single blind assessor.


METHODS
Ten subacute rehabilitation units in Japan.


METHODS
Fifty-four patients with subacute stroke.


METHODS
The experimental group used the iPad application, Aid for Decision-making in Occupation Choice, to establish occupation-based goals, and evaluation and intervention were conducted mainly through real occupations. The control group was evaluated according to patients' generic abilities and activities of daily living (ADL), and the intervention mainly involved the impairment-based approach.


METHODS
Short Form-36, Functional Independence Measure, Brunnstrom recovery stages, The Client Satisfaction Questionnaire, and length of hospital stay.


RESULTS
Of the 1465 potential participants, 54 (3%) subacute stroke patients were enrolled over 16 months and 68% (n = 36) were retained to the 2-month assessment: experimental group (n = 16); control group (n = 21). Although there was no significant intergroup difference for any outcomes, the experimental group had a small effect size advantage on the Short Form-36 "General health" (d = 0.42) and "Role emotional" (d = 0.43) subscales relative to the control group. A sample of 118 subacute stroke patients per group would be required for a lager study.


CONCLUSIONS
Results suggest that the occupation-based approach has more potential to improve "General health" and "Role emotional" scores on the Short Form-36 than the impairment-based approach. Further investigation of study protocol with interventions and recruiting is needed prior to a larger trial.
Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan adoc.project@gmail.com.
Kounosuke
K
Tomori
Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan.
Hirofumi
H
Nagayama
Graduate Course in Health and Social Care, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan.
Kanta
K
Ohno
Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan.
Ryutaro
R
Nagatani
Department of Occupational Therapy, Koriyama Institute of Health Science, Koriyama, Fukushima, Japan.
Yuki
Y
Saito
Department of Occupational Therapy, Kitasato University, Sagamihara, Kanagawa, Japan.
Kayoko
K
Takahashi
IMS Itabashi Rehabilitation Hospital, Itabashi, Tokyo, Japan.
Tatsunori
T
Sawada
Department of Community-Based Rehabilitation Sciences, Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan.
Toshio
T
Higashi
D000203:Activities of Daily Living; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods*; D017060:Patient Satisfaction; D018579:Patient Selection; D010865:Pilot Projects; D016037:Single-Blind Method; D000071939:Stroke Rehabilitation
Aid for Decision-Making in Occupation Choice; Occupational therapy; activities; impairment-based; occupation-based