Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands.
Disabil Rehabil. 2013 Sep;35(19):1636-46. doi: 10.3109/09638288.2012.748845. Epub 2013 Jan 24.
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).
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.
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.
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.
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.
根据以患者为中心的过程框架评估以患者为中心的职业治疗（OT）的疗效，与常规 OT 相比，在多发性硬化症（MS）患者中。
进行了一项多中心集群随机对照试验，以机构（即医院或康复中心）为随机单位。共有 269 名多发性硬化症门诊患者、13 家医院和康复中心以及 29 名职业治疗师参与了研究。主要结局指标包括残疾、参与和自主能力的衡量。次要结局指标包括疲劳、一般健康相关生活质量、治疗质量和评估、治疗依从性和治疗频率。在基线、4 个月和 8 个月随访时进行测量。
主要结局测量指标在两种干预措施之间没有显示出显著差异。次要结局在 4 个月时显示出有利于常规 OT 的显著差异，在疲劳（身体和总体量表）和健康相关生活质量（身体疼痛和活力）方面。8 个月后，仅在心理健康方面发现了显著差异。过程结局（即治疗质量的信息量表和组织的以患者为中心程度）有利于以患者为中心的干预。
由于以患者为中心的干预对主要结局没有影响，对次要功能结局的影响较小且为负面，我们应该认真重新考虑应用以患者为中心的实践。
越来越多的干预措施声称包含以患者为中心的实践。以患者为中心的实践与提高满意度相关，但对功能健康相关结局的影响尚未得到充分评估。本研究的结果表明，治疗的过程结局有利于以患者为中心的干预，但对主要结局没有影响，对次要功能健康结局产生了负面影响。建议调整以患者为中心的实践的实施，以达到最佳的健康结局。
