Eyssen IC, Steultjens MP, de Groot V, Steultjens EM, Knol DL, Polman CH, et al. A cluster randomised controlled trial on the efficacy of client-centred occupational therapy in multiple sclerosis: Good process, poor outcome. Disability & Rehabilitation. 2013;35:1636-1646
比較Client-centered OT與usual OT對於MS病人的perceived disability、function outcome與perceived client-centredness。研究結果發現：Client-centered OT僅利於病人的perceived client-centredness；然而對於perceived impact與functional outcome之成效皆與usual OT無異，甚至部份function outcome傾向usual OT具教佳的療效…
我覺得關於perceived client-centredness之結果很符合我們的預期，但主觀 (perceived disability)與客觀 (function outcome)功能評估結果卻不然。可能原因為：此篇client-centered OT與usual OT之protocol差異僅在於：client-centered OT增加了與病人共同討論、擬訂治療目標/計畫的過程 (OTs in the experimental group focused on enabling patients to choose, organize and perform activities the patients found useful and meaningful in their environment.)；而usual care OT則不著重於此討論的過程 (OTs in the control group were focused on providing therapy for the patient.)。但實際的介入手法、活動內容可能差異不大，這可能造成兩種介入模式之function outcome無顯著差異。
我們原預期client-centered OT具較佳的治療成效之主因為：中介變項－「治療參與度」。我們假設client-centered OT組之治療參與度較好，因此可能具較佳的預後。由本篇無法瞭解兩組個案之治療參與度的差異，或許治療參與度為較佳的outcome measure，較能反映出療效之差異。（與client-centered approach之關係較近）
很有趣，您有看法嗎?
回覆刪除作者已經移除這則留言。
回覆刪除至少還有一點: client-centered 個案所設定的目標，可行嗎? 實際嗎? if not, 我想效果不良的。
回覆刪除雖說 client-centered，還必須醫病雙方達成合理可行的治療目標，不是個案說了算。