Does intensive occupational therapy improve functional outcomes in a large cohort of hospitalised elderly patients?

Ms Celia Marston1, Dr Digsu Koye1,2, Ms Rose Goonan1, Professor Andrea Maier1,2, Dr Esmee Reijnierse2, Dr Marlena Klaic1,2

1Royal Melbourne Hospital, Melbourne, Australia, 2University of Melbourne, Melbourne, Australia

Background: Understanding the amount of rehabilitation interventions required for older people to achieve desired results is critical from patient, clinician and organisational perspective. It is not known how much occupational therapy is needed to produce functional gains.

Objective: To explore the association between intensity of occupational therapy interventions and functional outcomes in a cohort of elderly patients admitted for an episode of rehabilitation

Design: Prospective cohort study of geriatric rehabilitation inpatients was conducted. Outcomes were measured at admission, discharge and 3-months post discharge using Katz Index of Activities of Daily Living and the Lawton and Brody scale of Instrumental Activities of Daily Living. Intensity of occupational therapy interventions were measured as high (>30 minutes) vs low (<30 minutes). Data were analysed using binary logistic regression models adjusted for age, sex, severity of function at baseline, frailty and cognitive impairment

Results: A total of 693 patients were included. Patients who received high intensity occupational therapy were two and three times more likely to have clinically relevant functional improvements. for both Katz (OR = 1.87, 95% CI [1.24, 2.83]) and Lawton (OR = 3.00, 95% CI [1.96, 4.61]). These improvements did not significantly change 3-months following discharge.

Conclusion: Higher intensity occupational therapy is associated with functional improvements for geriatric rehabilitation patients irrespective of their baseline impairments; and can be maintained after discharge. This suggests that traditional delivery of “slow” and lower intensity interventions may not be adequate to achieve patient and health service outcomes.


Celia has worked as an occupational therapist for 20 years, specialising in oncology and palliative care. She holds two roles as Research Lead at Royal Melbourne Hospital and Clinical Lead at Peter Mac Cancer Centre. She is a PhD Candidate at the University of Technology Sydney – examining care transitions  interventions at end of life. Research interests include improving allied health clinical trial activity in oncology and palliative care, and examining impact of rehabilitation interventions on this population.

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