Occupational therapy for people with psychotic conditions in community settings: a pilot randomized controlled trial

Objectives: To investigate the effectiveness of a long established intervention, occupational therapy for people with psychotic conditions, and to inform future research designs.

Design: A pilot randomized controlled trial.

Setting: Two community mental health teams in a UK city.

Participants: Forty-four adults with schizophrenia or other psychotic conditions, and functional problems.

Interventions: Twelve months of individualized occupational therapy in community settings, as an adjunct to usual care and compared to treatment as usual. A two to one randomization ratio was used in favour of occupational therapy.

Outcome measures: Social Functioning Scale, Scale for the Assessment of Negative Symptoms and employment.

Results: Both groups' scores on Social Functioning Scale and Scale for the Assessment of Negative Symptoms showed significant improvement over 12 months. The Social Functioning Scale overall mean difference for occupational therapy was 2.33, P=0.020 and for treatment as usual was 6.17, P=0.023. The Scale for the Assessment of Negative Symptoms total mean difference for occupational therapy was -16.25, P<0.001 and for treatment as usual was -17.36, P= 0.011. There were no differences between the two groups on any of the outcome measures. After 12 months the occupational therapy group showed clinically significant improvements that were not apparent in the control group. These were in four subscales of the Social Functioning Scale: relationships, independence performance, independence competence and recreation. Out of 30 people receiving occupational therapy those with a clinical level of negative symptoms reduced from 18 (64%) to 13 (46%), P=0.055.

Conclusion: This pilot study suggested that individualized occupational therapy may contribute to recovery but more focus is recommended on people's cognitive abilities and employment.