2015 4th International MOHO Institute

International MOHO Institute at Indianapolis, IN Oct 24-25 USA

Enjoy the wonderful meeting with OT around the world

The efficacy study of an OT program (partly based on MOHO model) aiming to enhance the quality of life for persons with depression was published recently

Chen, Y.L., Pan, A.W^*., Hsiung, P.C., Chung, L., Lai, J.S., Gau, S.S.F., & Chen, T.J. (2015). Life Adaptation Skills Training (LAST) for persons with depression: A randomized controlled study. Journal of Affective Disorders, 185, 108-114.

Abstract

Background: To investigate the efficacy of the “Life Adaptation Skills Training (LAST)” program for persons with depression.

Methods: Sixty-eight subjects with depressive disorder were recruited from psychiatric outpatient clinics in Taipei city and were randomly assigned to either an intervention group (N=33), or a control group (N=35). The intervention group received 24-sessions of the LAST program, as well as phone contact mainly related to support for a total of 24 times. The control group only received phone contact 24 times. The primary outcome measure utilized was the World Health Organization Quality of Life-BREF-Taiwan version. Secondary outcome measures included the Occupational self-assessment, the Mastery scale, the Social support questionnaire, the Beck anxiety inventory, the Beck depression inventory-II, and the Beck scale for suicide ideation. The mixed-effects linear model was applied to analyze the incremental efficacy of the LAST program, and the partial eta squared (η_p²) was used to examine the within- and between- group effect size.

Results: The subjects who participated in the LAST program showed significant incremental improvements with moderate to large between-group effect sizes on their level of anxiety (-5.45±2.34, p<0 .05="" span=""> η_p²=0.083) and level of suicidal ideation (-3.09±1.11, p<0 .01="" span=""> η_p²=0.157) when compared to the control group. The reduction of suicidal ideations had a maintenance effect for three months after the end of intervention (-3.44±1.09, p<0 .01="" between-group="" moderate="" span="" with="">effect sizes (η_p²=0.101). Both groups showed significant improvement on overall QOL, overall health, physical QOL, psychological QOL, level of anxiety, and level of depression. The within-group effect sizes achieved large effects in the intervention group (η_p²=0.328~0.544), and were larger than that of the control group.

Limitations: A small sample size in the study, a high dropout rate, lower compliance rates for the intervention group, and lacking of true control group.

Conclusions: The occupation-based LAST program, which focuses on lifestyle rearrangement and coping skills enhancement, could significantly improve the level of anxiety and suicidal ideations for persons with depression.

Graduate students from NTU OT program attended the MOHO class and shared their experiences

Undergraduate students from NTU OT visited MOHO center in May 28, 2015

Scholars from abroad visited our center in 2014

Scholars from OT of Japan and University of Illinois, Urbana Champaign visited our center

New research findings of MOHO in Taiwan

Title: The Effectiveness of Remotivation Protocol for Persons with Schizophrenia

Author: Sheng-Hui Wang

Thesis Advisor: Ay-Woan Pan

Major findings: The results from this study show that utilization of a remotivation protocol helps to increase the patient's volitional performance, increase motivation to participate in occupational performance, and improves negative symptoms.

Participants:

        *N=10

        *7 males, 3 females

        *Age: 42+ 11.52 (range: 23-56)

        *Diagnosis: Schizophrenia

        *Setting: Inpatient acute ward in a psychiatric institute

        *Ethnicity: Asian (Taiwan)

Methods: The researchers translated the English edition of the remotivation process manual into Mandarin. In order to ensure the Mandarin version of the manual was consistent with the English version, the manuscript was corrected by a senior psychiatric occupational therapist experienced in scale translation. The researchers wrote a remotivation group manual based on the principle of the Chinese version of the manual, and referred to activities and types of activities that clients of schizophrenia participated in prior to the clinical trials. The researchers then invited persons with schizophrenia to engage in this therapeutic intervention. Pre-assessment protocol had subjects filling out self-report scales, including the Occupational Self-Assessment (OSA),Beck Depression Inventory Chinese Version of the second edition (BDI-Ⅱ), the Brief Symptom Rating Scale (BSRS-50). Psychiatrists then assessed patients using the Positive and Negative Syndrome Scale (PANSS), followed by an occupational therapist who further assessed patients through the Volitional Questionnaire (VQ) and the work behavior subscale of Comprehensive Occupational Therapy Evaluation Scale (COTES).

Analysis: The data was analyzed by SPSS 20 and Excel. The sign Test and Wilcoxon Signed-Rank Test (nonparametric) and a Paired-Sample t Test (parametric) were used.

Findings: The pretest and posttest scores of subjects in each scaled score all progressed except BSRS-50. The scores of Volitional Questionnaire were statistically significant in the Sign Test, Wilcoxon Signed-Rank Test and the Paired-Sample t Test. The negative scale, total scores of the Positive and Negative Syndrome Scale were statistically significant in the Wilcoxon Signed-Rank Test and the Paired-Sample t Test. The scores of the own competence of the Occupational Self-Assessment were statistically significant in the Paired-Sample t Test.

Conclusions: In general, patients with schizophrenia display motivation problems, however, a lack of theory driven occupational therapy intervention strategies hinders them from receiving the treatment they need. Through the design of theoretical basis remotivation protocol and a manualized approach, the standardization of occupational therapy intervention to enhance evidence-based mental occupational therapy can be promoted. The results from this study show that utilization of a remotivation protocol benefits patient's volitional performance, motivation to participate in occupational performance, and negative symptoms.

Implications for future research: Larger sample size and apply to various diagnostic groups.

Wang, S.H. (2014). The Effectiveness of Remotivation Protocol for Persons with Schizophrenia. [Master Thesis of the School of Occupational Therapy, National Taiwan University, unpublished].