title: Effectiveness and Cost-Effectiveness of Occupation-Based Occupational Therapy Using the Aid for Decision Making in Occupation Choice (ADOC) for Older Residents: Pilot Cluster Randomized Controlled Trial.
abstract: BACKGROUND
  Care-home residents are mostly inactive, have little interaction with staff, and are dependent on staff to engage in daily occupations. We recently developed an iPad application called the Aid for Decision-making in Occupation Choice (ADOC) to promote shared decision-making in activities and occupation-based goal setting by choosing from illustrations describing daily activities. This study aimed to evaluate if interventions based on occupation-based goal setting using the ADOC could focus on meaningful activities to improve quality of life and independent activities of daily living, with greater cost-effectiveness than an impairment-based approach as well as to evaluate the feasibility of conducting a large cluster, randomized controlled trial.
  
  
  METHODS
  In this single (assessor)-blind pilot cluster randomized controlled trial, the intervention group (ADOC group) received occupational therapy based on occupation-based goal setting using the ADOC, and the interventions were focused on meaningful occupations. The control group underwent an impairment-based approach focused on restoring capacities, without goal setting tools. In both groups, the 20-minute individualized intervention sessions were conducted twice a week for 4 months.
  
  
  METHODS
  Short Form-36 (SF-36) score, SF-6D utility score, quality adjusted life years (QALY), Barthel Index, and total care cost.
  
  
  RESULTS
  We randomized and analyzed 12 facilities (44 participants, 18.5% drop-out rate), with 6 facilities each allocated to the ADOC (n = 23) and control (n = 21) groups. After the 4-month intervention, the ADOC group had a significantly greater change in the BI score, with improved scores (P = 0.027, 95% CI 0.41 to 6.87, intracluster correlation coefficient = 0.14). No other outcome was significantly different. The incremental cost-effectiveness ratio, calculated using the change in BI score, was $63.1.
  
  
  CONCLUSIONS
  The results suggest that occupational therapy using the ADOC for older residents might be effective and cost-effective. We also found that conducting an RCT in the occupational therapy setting is feasible.
  
  
  BACKGROUND
  UMIN Clinical Trials Registry UMIN000012994.
authors.affiliation: Department of Occupational Therapy, Kanagawa University of Human Services, Kanagawa, Japan.|Graduate School of Health Management, Keio University, Kanagawa, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nagayama
authors.affiliation: Department of Occupational Therapy, Kanagawa University of Human Services, Kanagawa, Japan.
authors.forename: Kounosuke
authors.initials: K
authors.lastname: Tomori
authors.affiliation: Graduate Course of Health and Social, Kanagawa University of Human Services, Kanagawa, Japan.
authors.forename: Kanta
authors.initials: K
authors.lastname: Ohno
authors.affiliation: School of Allied Health, Department of Occupational Therapy, Kitasato University, Kanagawa, Japan.
authors.forename: Kayoko
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Occupational Therapy, Kanagawa University of Human Services, Kanagawa, Japan.
authors.forename: Kakuya
authors.initials: K
authors.lastname: Ogahara
authors.affiliation: IMS Itabashi Rehabilitation Hospital, Tokyo, Japan.
authors.forename: Tatsunori
authors.initials: T
authors.lastname: Sawada
authors.affiliation: Naha City Ajya Complex Welfare Facility, Okinawa, Japan.
authors.forename: Sei
authors.initials: S
authors.lastname: Uezu
authors.affiliation: Department of Occupational Therapy, Kanagawa University of Human Services, Kanagawa, Japan.
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Nagatani
authors.affiliation: Graduate School of Health Management, Keio University, Kanagawa, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Yamauchi
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000369:Aged, 80 and over; D002755:Choice Behavior / Q000502:physiology; D003362:Cost-Benefit Analysis / Q000191:economics*; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D009788:Occupational Therapy / Q000191:economics*; D009790:Occupations / Q000191:economics*; D017063:Outcome Assessment, Health Care / Q000191:economics; D010865:Pilot Projects; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology; D019057:Quality-Adjusted Life Years; D016037:Single-Blind Method