[185] REHABILITATION EFFECTS OF PAY, ACTIVITY, AND SUPPORT INTENSITY ON SCHIZOPHRENIA
Morris Bell, PhD
VA Medical Center West Haven, CT 06516; email:
bryson.gary_j@west-haven.va.gov
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Project #D828-2RA)
PURPOSE--This research investigates the benefits of productive activity in the rehabilitation of patients with schizophrenia, seeking answers to the key questions: 1) does pay increase participation in work activity? 2) do higher intensity services yield better clinical outcomes than standard services? 3) Is greater productivity associated with better clinical outcomes? and 4) is performance on psychological and neuropsychological measures a useful predictor of rehabilitation outcomes?
METHODOLOGY--We are recruiting 120 subjects, stratified by prior work function, with DSM III-R confirmed diagnoses of schizophrenia and schizoaffective disorder from the general psychiatric service, and assigning them randomly to one of two levels of pay: $3.40 per/hr up to 20 hrs weekly or no remuneration; and one of two levels of support: standard or high. High support subjects have access to a job coach, attend weekly group meetings where vocational issues are addressed and are provided biweekly work performance feedback. All subjects are offered 6-mo work placements. Research staff perform biweekly evaluations of job performance using the Work Behavior Inventory (WBI), symptom levels using the Positive and Negative Syndrome Scale (PANSS), and quality of life (QOL). Subjects are evaluated at baseline, 5 mo, 1 yr and follow-up on demographic, neuro-behavioral, and productivity variables.
PROGRESS--To date, we have had over 130 referrals of whom 121 have completed all intake procedures and have been randomized into the study. This completes the planned sample (N=120). Currently, 73 have been assigned to the pay condition, and 48 to the no-pay condition. 60 have been assigned to the standard support condition, and 61 to the high support condition. Of the 121 subjects who have completed intake procedures, 97 have elected to continue to participate following randomization. As a group, these subjects have worked 21,618.75 hours. We have, to date, performed 767 WBIs on this group.
At the time of this writing, we had conducted 160 weekly high support meetings. Attendance for group meetings has been excellent (87 percent) and there has been surprisingly lively participation on the part of even the most withdrawn and symptomatic subjects. Also, we have conducted 849 weekly PANSS interviews, 441 QOL interviews, 717 group questionnaires, and 314 Job Satisfaction Inventories. In total, we have conducted 2,321 weekly assessments.
Follow-up data continue to be gathered. Most subjects (116 out of 121 subjects or 96 percent) have completed their 5-mo follow-up procedures. Of those not completing it, two have died and three have refused. Reevaluation of baseline measures for all subjects at 1 year is concurrently being conducted: 97 out of 112 subjects (87 percent) who have reached 1 year since intake have completed that battery.
RESULTS--With 98 percent of the total sample intake and follow up data collected, we have begun to analyze data regarding the primary hypotheses, finding that subjects in the high support condition work approximately 12.5 percent more hours than those in the standard condition, though they are no more likely to start work than standard-support participants. At this time there is no evidence that higher levels of support are related to better clinical outcomes.
Data indicate that 97 percent of participants in the pay condition had at least 1 week of work, while only 54 percent of the no-pay participants did. Also, the pay participants worked significantly more hours (259) than did the no-pay group participants (56). Preliminary results on the relationship of productivity with clinical variables has indicated that hours worked and weeks worked are associated with clinical improvement. We hope to complete analysis of the final data set in regard to the central hypotheses in the coming year.
[186] EFFECTS OF WORK ACTIVITY AND COGNITIVE REHABILITATION ON SCHIZOPHRENIA: A MATCHING STUDY
Morris Bell, PhD
VA Medical Center West Haven, CT 06516; email:
bryson.gary_j@west-haven.va.gov
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Project #D2128-RA)
PURPOSE--This research investigates the benefits of productive activity and cognitive rehabilitation for patients with schizophrenia, seeking to answer the key questions: 1) Does cognitive rehabilitation plus work activity produce better outcomes than work activity alone? 2) Is cognitive rehabilitation more helpful for subjects with moderate or greater cognitive impairment than for subjects without such impairment? 3) Can a broader range of subjects with schizophrenia be served by adding cognitive rehabilitation to work activity (i.e., does cognitive rehabilitation reduce the dropout rate and increase participation in work activity for cognitively impaired subjects)? 4) What features of cognitive rehabilitation (e.g., participation, initial performance, learning curve, or final performance) are most important for clinical and rehabilitation outcomes?
METHODOLOGY--We are inviting the participation of 120 patients, stratified by prior work function, with DSM IV confirmed diagnoses of schizophrenia and schizoaffective disorder from the general psychiatric service and assigning them randomly to one of two types of rehabilitation services: 1) Work Services Only (WSO) includes compensated work ($3.40 per/hour) for up to 20 hours weekly, access to a job coach, attendance at a weekly group where vocational issues are addressed, and biweekly work performance feedback. 2) Work Services augmented with Cognitive Training (WSCT), includes the above work service plus 3 or more hrs per week of computer-based cognitive training, work feedback focussing on the impact of cognitive deficits on work performance, and a communication skills group. All subjects are offered 6-mo work placements. Research staff evaluate job performance using the Work Behavior Inventory (WBI), symptom levels using the Positive and Negative Syndrome Scale (PANSS), and quality of life (QOL). Subjects are evaluated at baseline, 5-mo, 1 yr, and follow-up on demographic, neuro-behavioral and productivity variables.
PROGRESS--This project commenced in January 1998. Start-up included training new staff, developing neuropsychological and cognitive training procedures, and creating new links with referral sources. Since start-up, we have had 30 referrals, 24 of whom have completed all intake procedures and have been randomized into the study. This rate places us within the projected participant flow for the 120 participants over 3 years. Currently, 8 have been assigned to WSCT and 16 to WSO. Of those who have completed intake procedures, all have elected to continue to participate following randomization and have been successfully placed in work sites. At the time of this writing, 26 worker support groups had been conducted. Attendance for group meetings has been very good (84 percent) and there has been surprisingly lively participation on the part of even the most withdrawn and symptomatic subjects. Also, we have conducted 91 biweekly PANSS interviews, 44 QOL interviews, 152 group questionnaires, and 40 Job Satisfaction Inventories. In total, we have conducted 175 weekly assessments.
RESULTS--With 20 percent of intake information and 3 percent of follow up data collected, we have not begun to analyze any of the data.
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