Effect of Everyday Life Rehabilitation on recovering quality of life in individuals with serious mental illness in supported accommodation: a pragmatic cluster randomised controlled trial.

Abstract

BACKGROUND Individuals with serious mental illness (SMI) living in supported accommodation often lead lonely and sedentary lives. Everyday Life Rehabilitation (ELR) is a collaborative, person-centred, activity-oriented and recovery-oriented intervention that integrates outreach rehabilitation efforts into routine practices. This intervention aims to enhance personal recovery and quality of life by promoting engagement in meaningful everyday activities within real-life contexts. OBJECTIVE To evaluate the effectiveness of ELR on personal recovery and quality of life among residents with SMI in supported accommodation, compared with treatment-as-usual (TAU). METHODS This was a pragmatic, parallel-group, cluster-randomised controlled trial (RCT) (NCT05056415) conducted in Sweden between August 2021 and June 2024. The RCT included 60 housing units (clusters) randomly assigned (1:1) to receive either ELR or TAU. Data were collected by independent, blinded assessors, with partial blinding of residents. The primary outcome, Recovering Quality of Life (ReQoL-20), was assessed at the individual level and analysed using a mixed-effects model and an intention-to-treat (ITT) approach by a statistician blinded to the allocation. FINDINGS Participants in the intervention group showed significantly greater improvements in ReQoL scores at 6 months compared with the control group (20.1, 95% CI: 15.8 to 24.4), with a statistically significant between-group difference (p<0.001). The ITT analysis included 60 housing units with 161 participants (86 men and 72 women), of whom 90 were allocated to ELR (33 units) and 71 to TAU (27 units). The overall attrition rate was 24% in both groups, and no major adverse events were reported. CONCLUSIONS These findings indicate that ELR is an effective intervention with a clinically relevant impact on recovering quality of life for individuals with SMI living in supported accommodation. While these results should be interpreted within the context of the Swedish system, they contribute to the growing body of evidence supporting recovery-oriented and activity-oriented interventions in supported accommodation. CLINICAL IMPLICATIONS Responsive, person-centred, goal-oriented activity training, grounded in collaborative alliance, represents a valid strategy for recovery-oriented interventions. While multilevel approaches must be tailored to specific contexts, the integration of occupational therapists may provide clinical benefits in supported accommodation. TRIAL REGISTRATION NUMBER NCT05056415.