title: Home- and Community-Based Occupational Therapy Improves Functioning in Frail Older People: A Systematic Review.
abstract: OBJECTIVE
  The objective is to assess the effectiveness of occupational therapy to improve performance in daily living activities in community-dwelling physically frail older people.
  
  
  METHODS
  We conducted a systematic review and meta-analysis. We included randomized controlled trials reporting on occupational therapy as intervention, or as part of a multidisciplinary approach. This systematic review was carried out in accordance with the Cochrane methods of systematic reviews of interventions.
  
  
  METHODS
  Meta-analyses were performed to pool results across studies using the standardized mean difference. The primary outcome measures were mobility, functioning in daily living activities, and social participation. Secondary outcome measures were fear of falling, cognition, disability, and number of falling persons.
  
  
  RESULTS
  Nine studies met the inclusion criteria. Overall, the studies were of reasonable quality with low risk of bias. There was a significant increase in all primary outcomes. The pooled result for functioning in daily living activities was a standardized mean difference of -0.30 (95% CI -0.50 to -0.11; P = .002), for social participation -0.44 (95% CI -0.69, -0.19; P = .0007) and for mobility -0.45 (95% CI -0.78 to -0.12; P = .007). All secondary outcomes showed positive trends, with fear of falling being significant. No adverse effects of occupational therapy were found.
  
  
  CONCLUSIONS
  There is strong evidence that occupational therapy improves functioning in community-dwelling physically frail older people.
authors.affiliation: Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.|CEBAM Belgian Centre for Evidence-based Medicine vzw, Leuven, Belgium.|Department of Occupational Therapy, University College Artevelde, Ghent, Belgium.
authors.forename: Leen
authors.initials: L
authors.lastname: De Coninck
authors.affiliation: CEBAM Belgian Centre for Evidence-based Medicine vzw, Leuven, Belgium.
authors.forename: Geertruida E
authors.initials: GE
authors.lastname: Bekkering
authors.affiliation: Department of Occupational Therapy, University College Artevelde, Ghent, Belgium.
authors.forename: Leen
authors.initials: L
authors.lastname: Bouckaert
authors.affiliation: LUCAS Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium.
authors.forename: Anja
authors.initials: A
authors.lastname: Declercq
authors.affiliation: Scientific Institute for Quality of Health Care and Department of Rehabilitation, Donders Center for Cognition, Brain and Behavior, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Maud J L
authors.initials: MJL
authors.lastname: Graff
authors.affiliation: Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.|CEBAM Belgian Centre for Evidence-based Medicine vzw, Leuven, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: Aertgeerts
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D016330:Frail Elderly; D006699:Home Care Services; D006801:Humans; D057187:Independent Living; D009788:Occupational Therapy / Q000379:methods*; D011320:Primary Health Care; D058992:Social Participation / Q000523:psychology
keywords: frail older people; functionality; occupational therapy; primary care; social participation