***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To evaluate the cost-effectiveness of a 9-month preventive occupational therapy ( OT ) program in the Well-Elderly Study : a r and omized trial in independent-living older adults that found significant health , function , and quality of life benefits attributable to preventive OT . DESIGN A r and omized trial . SETTING Two government-subsidized apartment complexes . PARTICIPANTS One hundred sixty-three culturally diverse volunteers aged 60 and older . INTERVENTION An OT group , a social activity group ( active control ) , and a nontreatment group ( passive control ) . MEASUREMENTS Use of healthcare services was determined by telephone interview during and after the treatment phase . A conversion algorithm was applied to the R AND 36-item Short Form Health Survey to derive a preference-based health-related quality of life index , quality -adjusted life years ( QALYs ) , and the incremental cost-effectiveness ratio for preventive OT relative to the combined control group . RESULTS Costs for the 9-month OT program averaged $ 548 per subject . Postintervention healthcare costs were lower for the OT group ( $ 967 ) than for the active control group ( $ 1,726 ) , the passive control group ( $ 3,334 ) , or a combination of the control groups ( $ 2,593 ) . The quality of life index showed a 4.5 % QALY differential ( OT vs combined control ) , P < .001 . The cost per QALY estimates for the OT group was $ 10,666 ( 95 % confidence interval = $ 6,747-$25,430 ) . For the passive and active control groups , the corresponding costs per QALY were $ 13,784 and $ 7,820 , respectively . CONCLUSION In this study , preventive OT demonstrated cost-effectiveness in conjunction with a trend toward decreased medical expenditures Background : multifactorial falls prevention programmes for older people have been proved to reduce falls . However , evidence of their cost-effectiveness is mixed . Design : economic evaluation alongside pragmatic r and omised controlled trial . Intervention : r and omised trial of 364 people aged ≥70 , living in the community , recruited via GP and identified as high risk of falling . Both arms received a falls prevention information leaflet . The intervention arm were also offered a ( day hospital ) multidisciplinary falls prevention programme , including physiotherapy , occupational therapy , nurse , medical review and referral to other specialists . Measurements : self-reported falls , as collected in 12 monthly diaries . Levels of health re source use associated with the falls prevention programme , screening ( both attributed to intervention arm only ) and other health-care contacts were monitored . Mean NHS costs and falls per person per year were estimated for both arms , along with the incremental cost-effectiveness ratio ( ICER ) and cost effectiveness acceptability curve . Results : in the base-case analysis , the mean falls programme cost was £ 349 per person . This , coupled with higher screening and other health-care costs , result ed in a mean incremental cost of £ 578 for the intervention arm . The mean falls rate was lower in the intervention arm ( 2.07 per person/year ) , compared with the control arm ( 2.24 ) . The estimated ICER was £ 3,320 per fall averted . Conclusions : the estimated ICER was £ 3,320 per fall averted . Future research should focus on adherence to the intervention and an assessment of impact on quality of life OBJECTIVES Falls and fall injuries are common-potentially preventable-causes of morbidity , functional decline , and increased health-care use among elderly persons . The current analyses , performed on data obtained as part of a r and omized controlled trial conducted within a health maintenance organization , describe the costs of a multifactorial , targeted prevention program for falls , present total net health-care costs , estimate the cost per fall prevented , and describe acute fall-related health-care costs . METHODS The 301 participants were at least 70 years of age and possessed at least one of eight targeted risk factors for falling . The 153 participants r and omized to the  targeted intervention ( TI ) group received a combination of medication adjustment , behavioral recommendations , and exercises as determined by their baseline assessment . The 148 participants r and omized to the usual care ( UC ) group received a series of home visits by a social work student . RESULTS The mean intervention cost per TI participant was $ 925 ( range $ 588 to $ 1,346 ) . Total mean health-care costs were approximately $ 2,000 less in the TI than UC group , whereas median costs were approximately $ 1,100 higher in the TI than UC group . The TI strategy was unequivocally cost effective when mean costs were used because the intervention was associated with both lowered total health-care costs and fewer total and medical care falls . In sensitivity analyses , the cost-effectiveness of the TI strategy appeared robust to widely differing assumptions about total health-care costs ( 25th to 75th percentile of the actual distribution ) and intervention costs ( minimum to maximum costs ) . In subgroup analyses , the TI strategy showed its strongest effect among individuals at high risk of falling , defined as possession of at least four of the eight targeted risk factors . CONCLUSIONS Consideration should be given toward incorporating and reimbursing the cost of fall-prevention programs within the usual health care of community-living elderly persons , particularly for those persons at high risk for falling OBJECTIVE To determine the effectiveness of community based occupational therapy on daily functioning of patients with dementia and the sense of competence of their care givers . DESIGN Single blind r and omised controlled trial . Assessors were blinded for treatment allocation . SETTING Memory clinic and day clinic of a geriatrics department and participants ' homes . PARTICIPANTS 135 patients aged > or = 65 with mild to moderate dementia living in the community and their primary care givers . INTERVENTIONS 10 sessions of occupational therapy over five weeks , including cognitive and behavioural interventions , to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision . MAIN OUTCOME MEASURES Patients ' daily functioning assessed with the assessment of motor and process skills ( AMPS ) and the performance scale of the interview of deterioration in daily activities in dementia ( IDDD ) . Care giver burden assessed with the sense of competence question naire ( SCQ ) . Participants were evaluated at baseline , six weeks , and three months . RESULTS Scores improved significantly relative to baseline in patients and care givers in the intervention group compared with the controls ( differences were 1.5 ( 95 % confidence interval 1.3 to 1.7 ) for the process scale ; -11.7 ( -13.6 to -9.7 ) for the performance scale ; and ( 11.0 ; 9.2 to 12.8 ) for the competence scale ) . This improvement was still significant at three months . The number needed to treat to reach a clinical ly relevant improvement in motor and process skills score was 1.3 ( 1.2 to 1.4 ) at six weeks . Effect sizes were 2.5 , 2.3 , and 1.2 , respectively , at six weeks and 2.7 , 2.4 , and 0.8 , respectively , at 12 weeks . CONCLUSIONS Occupational therapy improved patients '  daily functioning and reduced the burden on the care giver , despite the patients ' limited learning ability . Effects were still present at 12 weeks , which justifies implementation of this intervention . TRIAL REGISTRATION Clinical Trials NCT00295152 [ Clinical Trials.gov ] Objective To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint . Design Cost effectiveness study alongside a single blind r and omised controlled trial . Setting Memory clinic , day clinic of a geriatrics department , and participants ’ homes . Patients 135 patients aged ≥65 with mild to moderate dementia living in the community and their primary care givers . Intervention 10 sessions of occupational therapy over five weeks , including cognitive and behavioural interventions , to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision . Main outcome measures Incremental cost effectiveness ratio expressed as the difference in mean total care costs per successful treatment ( that is , a combined patient and care giver outcome measure of clinical ly relevant improvement on process , performance , and competence scales ) at three months after r and omisation . Bootstrap methods used to determine confidence intervals for these measures . Results The intervention cost € 1183 ( £ 848 , $ 1738 ) ( 95 % confidence interval € 1128 ( £ 808 , $ 1657 ) to € 1239 ( £ 888 , $ 1820 ) ) per patient and primary care giver unit at three months . Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were € 1748 ( £ 1279 , $ 2621 ) lower in the intervention group , with the main cost savings in informal care . There was a significant difference in proportions of successful treatments of 36 % at three months . The number needed to treat for successful treatment at three months was 2.8 ( 2.7 to 2.9 ) . Conclusions Community occupational therapy intervention for patients with dementia and their care givers is successful and cost effective , especially in terms of informal care giving Background Major depressive disorder is among the medical conditions with the highest negative impact on work outcome . However , little is known regarding evidence -based interventions targeting the improvement of work outcomes in depressed employees . In this paper , the design of a r and omized controlled trial is presented in order to evaluate the effectiveness of adjuvant occupational therapy in employees with depression . This occupational intervention is based on an earlier intervention , which was design ed and proven effective by our research group , and is the only intervention to date that specifically targets work outcome in depressed employees . Methods / Design In a two-arm r and omized controlled trial , a total of 117 participants are r and omized to either ' care as usual ' or ' care as usual ' with the addition of occupational therapy . Patients included in the study are employees who are absent from work due to depression for at least 25 % of their contract hours , and who have a possibility of returning to their own or a new job .  The occupational intervention consists of six individual sessions , eight group sessions and a work-place visit over a 16-week period . By increasing exposure to the working environment , and by stimulating communication between employer and employee , the occupational intervention aims to enhance self-efficacy and the acquisition of more adaptive coping strategies . Assessment s take place at baseline , and at 6 , 12 , and 18-month follow-ups . Primary outcome measure is work participation ( hours of absenteeism and time until work resumption ) . Secondary outcome measures are work functioning , symptomatology , health-related quality of life , and neurocognitive functioning . In addition , cost-effectiveness is evaluated from a societal perspective . Finally , mechanisms of change ( intermediate outcomes ) and potential patient-treatment matching variables are investigated . Discussion This study hopes to provide valuable knowledge regarding an intervention to treat depression , one of the most common and debilitating diseases of our time . If our intervention is proven ( cost- ) effective , the personal , economic , and health benefits for both patients and employers are far-reaching . Trial registration The effectiveness and cost of day hospital care in rehabilitation were studied in a r and omised controlled trial in 120 elderly patients who were assessed at referral and six weeks and five months later in activities of daily living skills and mood .  Day hospital patients were compared with a control group , who were managed as they would have been before the availability of day hospital care . Day hospital patients showed a significant improvement in performance of activities of daily living at six weeks but not at five months ; however , they had a sustained improvement in mood . The cost of day hospital rehabilitation  was one third greater than that of rehabilitation by alternative means . In its current form the geriatric day hospital is not a cheap alternative to other means of rehabilitation . Expensive components of the day hospital should be critically re-examined and renewed emphasis placed on sufficient inpatient beds , domiciliary services , and day care centres Background Annually , about 30 % of the persons of 65 years and older falls at least once and 15 % falls at least twice . Falls often result in serious injuries , such as fractures . Therefore , the prevention of accidental falls is necessary . The aim is to describe the design of a study that evaluates the efficacy and cost-effectiveness of a multidisciplinary assessment and treatment of multiple fall risk factors in independently living older persons with a high risk of falling . Methods / Design The study is design ed as a r and omised controlled trial ( RCT ) with an economic evaluation . Independently living persons of 65 years and older who recently experienced a fall are interviewed in their homes and screened for risk of recurrent falling using a vali date d fall risk profile . Persons at low risk of recurrent falling are excluded from the RCT . Persons who have a high risk of recurrent falling are blindly r and omised into an intervention ( n = 100 ) or usual care ( n = 100 ) group . The intervention consists of a multidisciplinary assessment and treatment of multifactorial fall risk factors . The transmural multidisciplinary appraoch entails close cooperation between geriatrician , primary care physician , physical therapist and occupational therapist and can be extended with other specialists if relevant . A fall calendar is used to record falls during one year of follow-up . Primary outcomes are time to first and second falls . Three , six and twelve months after the home visit , question naires for economic evaluation are completed . After one year , during a second home visit , the secondary outcome measures are reassessed and the adherence to the interventions is evaluated . Data will be analysed according to the intention-to-treat principle and also an on-treatment analysis 
    Output:
    
These studies found that occupational therapy for older people was clinical ly effective and cost-effective in comparison with st and ard care or other therapies .
With reference to their clinical implication , these intervention studies ( using a client-centred approach ) suggested potentially cost-effective means to motivate clients to maintain their own health .