Occupational therapy in accident and emergency departments: a randomized controlled trial

The National Service Framework for Older People published in 2001 requires action to improve the discharge process of older people from hospital. Currently, many older people released from accident and emergency departments are unable to perform basic activities of daily living. This could delay recovery and increase demand for emergency primary care services.

To evaluate the potential for an occupational therapist in an accident and emergency department to reduce unmet functional needs after releasing patients aged 75 years or more with a primary diagnosis of limb, rib or back trauma.

A randomized controlled trial was employed, with the intervention group receiving an occupational therapy assessment and given, or arrangements made, for appropriate treatments and equipment before release. Controls received routine care. All patients were reassessed at home, 7 days later.

Of 72 patients, 39 were recruited with 19 randomized to the intervention group and 20 to the control group. The median age was 81 years (75-92 years) and 31 (79%) were female. At baseline, 20 (51.2%) patients had problems in performing one or more of four basic activities assessed. At the follow-up assessment, in the intervention group the proportion of patients having no problems with these activities increased by 54% over and above the change in the control group, compared with that at baseline (P < 0.001). No effect on anxiety or demand for primary care was observed.

In our local hospital, over 50% of older patients with limb, rib or back trauma would have left the accident and emergency department unable to perform basic activities of daily living. This might be overcome by employing occupational therapists to assess and meet the functional needs of these patients before sending them home. These results need confirming in a larger study.