Predictors of cognitive and functional changes following individualised occupational therapy for schizophrenia: data from the IOT study

Background It remains unclear which patient and treatment characteristics are associated with greater cognitive and functional gains from individualised occupational therapy (IOT) in schizophrenia. Aims To explore predictors of changes in cognition and functioning and their maintenance among patients with schizophrenia who received IOT. Method This secondary analysis used data from a randomised controlled trial and its follow-up. Participants allocated to the group occupational therapy plus IOT arm who received IOT during their hospital stay and had available outcome data were included ( n = 34; with follow-up data available for 32 participants). Changes in cognition (Brief Assessment of Cognition in Schizophrenia) and functioning (modified Global Assessment of Functioning – social functioning subscale) were examined. Linear mixed-effects models were used to evaluate patient- and treatment-related predictors of change and maintenance. Results Greater improvement in cognition was associated with lower baseline cognition ( β = −0.40, p = 0.003). Maintenance of cognitive improvement was associated with fewer prior hospital stays ( β = −0.21, p = 0.031) and better post-treatment quality of life ( β = 5.61, p < 0.001). Greater improvement in functioning was associated with lower baseline functioning ( β = −0.50, p < 0.001) and fewer physical comorbidities ( β = −8.43, p = 0.004), whereas maintenance of functional improvement was associated with better post-treatment cognition ( β = 2.27, p = 0.014) and greater engagement in self-monitoring ( β = 0.27, p = 0.026). Conclusions Both patient characteristics and engagement in specific IOT components were associated with variability in changes in outcomes and their maintenance. These findings may inform more personalised occupational therapy strategies for schizophrenia.