Evaluating Outcomes of a Recovery-Oriented Occupational Therapy Programme.

Objectives

Psychiatric rehabilitation services aim to involve service users in the process of making progress towards meaningful occupation, improved social interaction and community inclusion (King, Lloyd and Meehan, 2007). OcTAVE@IMH is an outpatient psychiatric rehabilitation facility run by occupational therapists at the Institute of Mental Health (IMH) in Singapore. The model of care has been revamped in 2012, to focus on recovery and integrating patients back to community through promoting occupational participation. It offers a range of programmes such as clinical rehabilitation (eg: illness management and recovery, cognitive rehabilitation), vocational training (in retail, food and beverage as well as administrative work), creative therapies and individual occupational therapy intervention. The overall aim is to maximise service users’ work potential and improve community independence.

This retrospective study aims to evaluate programme effectiveness, as well as to identify factors that predict improvement in community independence after occupational therapy intervention.  

Methods

225 patients were enrolled in OcTAVE@IMH in the year of 2014. Outcome measurements such as Milestones of Recovery (MORS), Multnomah Community Ability Scale (MCAS), Work Behaviour Inventory (WBI), job placement and job tenure were collected as part of routine reporting. This study extracted the above data retrospectively and statistical analyses such as paired t-tests and repeated measures were conducted to determine baseline and post-intervention changes in MORS, MCAS and WBI. Multiple regression was also conducted with change in MCAS score between baseline and post intervention as dependent variable. Independent variables included age, duration of intervention, MORS change, type of intervention, baseline score,  gender, ethnicity, education and diagnoses.  

Results

Majority of the service users were diagnosed with schizophrenia (n=145). Average duration of intervention was 179 days. There were significant improvements in MORS  t(165)= 6.38, p = 0.000 and MCAS scores t(115)= 8.452, p = 0.000 from baseline to post-intervention. Such changes were not significantly different amongst the different types of occupational therapy interventions. However, improvement in recovery milestone predicted improvement in community independence (β = .638, p<0.001). There was also a statistically significant effect of time on WBI scores over the six months of vocational training, F(1.6, 33.5) = 50.97, p = .000, showing that WBI scores had significantly improved. Among those who completed vocational training and were job placed (n=46), their average job tenure was 207 days.    

Conclusions

A recovery-oriented occupational therapy programme led to significant improvement in work behaviour and community integration. Recovery also predicted improvement in community independence.