Occupational therapy holds potential to provide clinical benefits to dementia patients

A French observational study in real life showed that dementia patients benefiting from occupational therapy sessions report relevant clinical benefits over the intervention period, according to a research study published in the Journal of Alzheimer's Disease this month. The research suggested the influence of occupational therapy on reducing behavioral troubles, caregivers' burden and amount of informal care over the intervention period and a stabilization over the 3-months period thereafter.

France put a massive effort for improving dementia care through a national Alzheimer plan in 2008 and this effort was confirmed by the next government (Neurodegenerative Diseases Plan 2014-2019). Some new care models and interventions have been implemented such as integrated care, case management or occupational therapy. Occupational therapy has been spread nationwide through specialized Alzheimer team intervening at home with medical prescription. Even if efficacy of occupational therapy has been demonstrated in some clinical trials, its efficacy under routine care conditions was unknown and deserved to be investigated.

The research was conducted on a network of 16 specialized Alzheimer team in Aquitaine, South West of France and was supported by the regional agency of Health (Agence Régionale de la Santé d'Aquitaine). Titled "Benefits of Occupational Therapy in Dementia Patients: Findings from a Real-World Observational Study," the study included 421 dementia patient who had been referred to occupational therapy by their general practionner or memory clinics and who had been followed up to 6 months. Research studied the clinical evolution of patients between inclusion and 3 month follow-up (end of the 15 home sessions) and between 3 and 6-month follow-up (no session planned over this timeframe).

The study's results indicate that behavioral troubles, caregivers' burden, amount of informal care provided by caregivers and patients' quality of life were significantly reduced over the 3-month intervention period and remained stable thereafter. Cognitive performances remained stable over the 6-month study period and functional performances remained stable over the 3-month intervention period but were significantly reduced thereafter. Moreover, patients who had been diagnosed more recently and those with milder cognitive deficits may gain more benefits from occupational therapy in terms of functional decline or caregivers' burden decline. These findings suggest that occupational therapy should target early dementia stages in order to optimize its potential clinical benefits.

In many Western countries, recent national guidelines have aimed at improving home dementia care. This study highlights the potential occupational therapy in terms of patients' and their caregivers' well-being. The findings also opens a new field of research on occupational therapy. Indeed, occupational therapy has been conceptualized as a short-term home intervention, but long-term benefits and consequences of disruption are unknown. "Future studies should explore more in detail which sub-groups of patients could gain more benefits from OT as well as its long-term clinical effects notably on global care quality and users' satisfaction" stated Clément Pimouguet.

Moreover, strategies aiming to improve initial benefits of occupational therapy should be promoted. The French research team will conduct a randomized trial that aim to compare the maintenance of occupational therapy over an additional 4-month period and usual occupation therapy as recommended.