Table 4

Quality of subprocesses of Community Occupational Therapy in Dementia Programme performance in 54 Alzheimer's disease patients (German completers of the experimental intervention)

SubprocessesPerformance*Main problems
Good (%)Poor
01Receiving medical information52 (96)2Received wrong phone number or no detailed medical information
02Making appointments with participants49 (91)5Participants had other appointments
03Travelling to participants46 (85)8Long travel to patient's home (some >40 km)
04Meeting the participants50 (93)4Participants forgot to cancel the date and were late or not at home
05Contacting and providing confidence50 (93)4Patient was sceptic or abrasive
06Informing about the procedure50 (93)4Patient could not understand procedure, misunderstood procedure as test for nursing home placement
07Observing the time frame42 (78)12Participants (mainly carer) had a great need to tell and talk
08Explaining clearly, responding to questions50 (93)4Patient could not understand the explanations, owing to communication deficits or mood swings
09Mastering conflicts and problematic situations39 (72)15Patient had severe mood swings or additional cognitive deficits or was not aware of deficits; carer was overstrained, abrasive or placed sole responsibility on therapist; family conflicts existed for a long time
10Interviewing patient with OPHI38 (70)16Patient was unable or hardly able to tell, had anomia or severe deficits in biographic memory or was disorientated
11Observing patient activity with Volitional Questionnaire, if OPHI not done5 (71*)2Patient not motivated to demonstrate activities; *Volitional Questionnaire not necessary in 47 cases, because OPHI was done
12Interviewing carer with Ethnographic Interview47 (87)7Carer had only little understanding of dementia or felt very burdened
13Observing activities of patient and carer43 (80)11Patient did activity incompletely, was very passive or was fraught when being observed; carer was demanding or impatient
14Setting therapy goals with patient and carer41 (76)13Participants negated need for change or could not specify goals
15Defining occupational therapy problems43 (80)11Patient had no activity limitations; participants could not understand the relevance of problems; problems were very complex or became clearer only later during intervention or were related not to dementia but to depression or physical limitations
16Educating patient in new skills and compensation capability25 (46)29Patient was not or hardly motivated in training, additional symptoms such as dyspraxia, depression, apathy, attention deficit disorder hampered the training; carer or family were not supportive
17Adapting physical environment24 (44)30Participants refused or hesitantly accepted necessary adaptations
18Adapting social environment25 (46)29Participants were reluctant to change social environment; informal social support or care services were lacking
19Training of carer's competence in instruction and interaction32 (59)22Carer could not change behaviour as being very burdened or impatient or bound in firm habits; was not willing to take responsibility or was missing sessions
20Training of carer's competence in problem solving29 (54)25Carer was not willing to undertake the responsibility of problem solving or not able to do so owing to high burden; carer would have needed more time or further support to undertake the responsibility for independent problem-solving
  • * Number of cases, in which the performance of this subprocess was rated as unproblematic (=good) or problematic (=poor).

  • OPHI, Occupational Performance History Interview.