Article

PURPOSE: To assess the efficacy of client-centred occupational therapy (OT)
according to a client-centred process framework, as compared to usual care OT, in
patients with multiple sclerosis (MS). METHOD: A multicentre cluster randomised
controlled trial with the institution (i.e. hospital or rehabilitation centre) as
the unit of randomisation was performed. A total of 269 outpatients with MS, 13
hospitals and rehabilitation centres and 29 occupational therapists participated.
Primary outcomes included measures of disability, participation and autonomy.
Secondary outcomes included fatigue, generic health-related quality of life,
quality and evaluation of therapy, therapy compliance and therapy frequency.
Measurements were taken at baseline, four months and at eight months follow-up.
RESULTS: Primary outcome measures did not show significant differences between
the two interventions. Secondary outcomes revealed significant differences in
favour of the usual care OT on fatigue (physical scale and total scale) and
health-related quality of life (bodily pain and vitality) at four months. After
eight months only significant differences on mental health were found. Process
outcomes (i.e. the information scale of therapy quality and the
client-centredness of the organisation) were in favour of the client-centred
intervention. CONCLUSION: Because the client-centred intervention resulted in no
effects on the primary outcomes and small but negative effects on the secondary
functional outcomes, we should seriously reconsider the application of
client-centred practice. IMPLICATIONS FOR REHABILITATION: An increasing number of
interventions claim to incorporate client-centred practice. Client-centred
practice is associated with improved satisfaction but the effects on functional
health-related outcomes have not been fully evaluated. The findings of this study
show that the process outcomes of therapy were in favour of the client-centred
intervention, but no effects were found on the primary outcomes and negative
effects on the secondary functional health outcomes. It is suggested that the
implementation of client-centred practice should be adjusted in order to achieve
optimal health outcomes.

Langue : ANGLAIS