Adjusting Challenge-Skill Balance to Improve Quality of Life in Older Adults: A Randomized Controlled Trial

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We sought to investigate whether occupational therapy that includes adjusting the challenge-skill balance improves health-related quality of life (HRQOL) for older adults in comparison with standard occupational therapy.


In this single-blind, randomized controlled trial, 56 older adults were assigned to two groups that received 10 sessions of occupational therapy with and without adjustment of challenge-skill balance. The primary outcome was change in HRQOL after 10 sessions of occupational therapy.


Significant differences were observed in HRQOL using the EuroQol-5 Dimension score (p = .022, d = 0.76) and the eight-item Short-Form Health Survey scores for general health (p = .001, d = 0.99) and in flow experience using the Flow State Scale for Occupational Tasks (p = .008, d = 0.82).


Assessment and adjustment of the challenge-skill balance of activities may effectively improve older adults' HRQOL.

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