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The effect on subjective quality of life of occupational therapy based on adjusting the challenge-skill balance: a
Ippei Yoshida1,2, Kazuki Hirao3, Ryuji Kobayashi1
1Department of Occupational Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan.
Objective:
To verify the effect of adjusting the challenge-skill balance with respect to rehabilitation process.
Design:
A single-blind, two-arm, parallel-group, randomized controlled trial.
Setting:
Recovery rehabilitation unit of Harue Hospital, Japan.
Subjects:
The trial included 72 clients (mean (SD): age, 74.64 (9.51) years; Functional Independence Measure score, 98.26 (15.27)) with cerebral or spinal disease or musculoskeletal disease.
Interventions:
Clients were randomly divided into two groups: the experimental group, who received occupational therapy with adjustment of the challenge-skill balance, and the control group who received conventional occupational therapy. Time from admission to discharge was considered the implementation period; the final evaluation was conducted at three months after discharge.
Main Measures:
The primary outcome was subjective quality of life (Ikigai-9). Secondary outcomes were the health-related quality of life (EuroQol-5 Dimensions, Five Levels (EQ-5D-5L)), the Flow State Scale for Occupational Tasks, and the Functional Independence Measure. A cost-effectiveness analysis was conducted using total cost and quality-adjusted life-year based on the EQ-5D-5L.
Results:
Significant differences were observed between the experimental and control groups with respect to the Ikigai-9 score (P = 0.008) and EQ-5D-5L (P = 0.038), and the effect sizes were 0.76 (95% confidence interval [CI]: 0.27-1.24) and 0.62 (95% CI: 0.14-1.10), respectively. No significant between-group differences in other outcomes were observed, for example, the Functional Independence Measure score improved in both experimental and control groups (119.80 (5.50) and 118.84 (6.97), respectively. The incremental cost-effectiveness ratio was US$5518.38.
Conclusions:
Adjusting the challenge-skill balance may be a useful approach to improve the participant's subjective quality of life in the rehabilitation process.
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