Occupation-based interventions to improve occupational performance and participation in the hospital setting: a systematic review

PURPOSE

To critically review the evidence for occupation-based interventions in improving occupational performance and participation outcomes in the hospital setting.

METHODS

Five databases were searched from 2000-2022. Peer-reviewed studies of any design investigating the impact of occupation-based interventions in the hospital setting were included. Methodological quality was assessed using the appropriate tool for each study design. Following data extraction, a narrative synthesis was conducted.

RESULTS

Thirty-three studies comprising of 26 experimental, five non-experimental, and two mixed methods studies were included (n = 1646 participants). Results indicate good evidence to support occupation-based interventions to improve occupational performance and participation outcomes in inpatient rehabilitation; it is unclear whether they are more effective than any control/alternative intervention. Research in the acute and mental health hospital settings were scarcer. Understanding the benefits of occupation-based interventions was enhanced through qualitative results including improving independence and confidence to discharge home, increasing motivation for therapy, connecting with others, and peer-based learning.

CONCLUSIONS

Heterogeneity and methodological weaknesses across existing studies limits the conclusions that can be drawn on the impact of occupation-based interventions in the hospital setting. More rigorous research should be conducted with better reporting of intervention design and the use of robust measures of occupational performance.Implications For RehabilitationThe use of occupation-based interventions should be considered to improve occupational performance and participation outcomes in the hospital setting.There is good evidence to support the impact of occupation-based interventions on improving occupational performance and participation outcomes in the inpatient rehabilitation setting; evidence in the acute and mental health settings is scarcer.Occupation-based interventions are valued by both patients and clinicians for their impact on patient outcomes and the patient experience.

Occupational therapy and cooking: A scoping review and future directions

BACKGROUND

Occupational therapy (OT) has historically used cooking as an intervention and assessment approach across settings. Current practices in OT and the emergence of the multidisciplinary field of culinary medicine highlight the relationship between cooking and health.

AIMS/OBJECTIVES

To map the current literature on OT and cooking and to identify key factors that may facilitate collaboration within culinary medicine.

MATERIALS AND METHODS

We conducted a scoping review using the Joanna Briggs Institute methodology to identify primary contexts and clinical settings. Publications were analysed using framework thematic analysis to identify OT themes and roles.

RESULTS

A total of 56 studies met the criteria for inclusion. The majority of studies (n = 29, 53%) represented home/community settings and brain injury was the largest clinical group (n = 15, 27%). Primary themes related to person (n = 47, 43%), occupation (n = 30 (28%), environment (n = 19, 17%), and psychosocial wellbeing (n = 13, 12%). The primary OT role identified was that of interventionist (n = 48, 86%).

CONCLUSIONS/SIGNIFICANCE

OT's holistic practice places cooking within a larger context that can help identify and overcome the barriers to participation. Findings support multiple pathways in which OT can contribute to cooking initiatives for health promotion and potentially expand OT practice in population health.

Neural correlates of overvaluation and the effort to save possessions in a novel decision task: An exploratory fMRI study

Introduction

People exhibit a strong attachment to possessions, observed in behavioral economics through loss aversion using new items in the Endowment or IKEA effects and in clinical psychology through pathological trouble discarding domestic items in Hoarding Disorder. These fields rarely intersect, but both document a reticence to relinquish a possessed item, even at a cost, which is associated with feelings of loss but can include enhanced positive states as well.

Methods

To demonstrate the shared properties of these loss-related ownership effects, we developed the Pretzel Decorating Task (PDT), which concurrently measures overvaluation of one's own over others' items and feelings of loss associated with losing a possession, alongside enhanced positive appraisals of one's items and an effort to save them. The PDT was piloted with 31 participants who decorated pretzels and responded to their own or others' items during functional neuroimaging (fMRI). Participants observed one item per trial (self or other) and could work to save it (high or low probability loss) before learning the fate of the item (trashed or saved). Finally, participants rated items and completed hoarding tendency scales.

Results

The hypotheses were supported, as even non-clinical participants overvalued, viewed as nicer, feared losing, and worked harder to save their items over others'-a response that correlated with hoarding tendencies and motor-motivational brain activation. Our region of interest in the nucleus accumbens (NAcc) was engaged when viewing one's own items to the extent that people worked harder to save them and was more active when their items were saved when they felt emotionally attached to possessions in real life. When their items were trashed, NAcc activity negatively correlated with trouble discarding and emotional attachments to possessions. Right anterior insula was more active when working to save one's own over others' items. Extensive motor-motivational areas were engaged when working to save one's own over others' items, including cerebellum, primary motor and somatosensory regions, and retrosplenial/parahippocampal regions-even after controlling for tapping.

Discussion

Our attachments to items are emotional, continuous across typical and pathological populations, and drive us to save possessions that we value.

Food skills group value, meaning, and use with inpatients in a mental health setting

Introduction

Occupational therapists use food skills groups to support mental health recovery and engagement in meaningful occupation. Research examining participants’ experiences in these mental health groups is sparse.

Method

Researchers used a convergent parallel mixed methods design. Following participation in an inpatient food skills group, 60 participants completed a questionnaire, and 20 also participated in a semi-structured interview. The questionnaire data was analysed using descriptive and correlational statistics. The interview data was analysed using thematic analysis. Triangulation was used to combine and interpret findings from the different methods to gain a more complete understanding of the participants’ experiences.

Findings

Participants strongly agreed/agreed that they enjoyed participating, felt having the opportunity to participate was important to their recovery, and after discharge would use the skills they had learnt. Age, sex, and level of education were associated with some of the questionnaire responses. Three main themes emerged from the interview data: importance of engaging/doing, connections with food, and being involved in a group process.

Conclusion

Individuals who participated in the food skills group valued having the opportunity to build skills and engage in meaningful activities with others while in hospital. They identified the food skills group as important to their recovery.

Cognitive work hardening for return to work following depression: An intervention study: Le réentraînement cognitif au travail pour favoriser le retour au travail à la suite d'une dépression : étude d'intervention

BACKGROUND

Work absences due to depression are prevalent; however, few interventions exist to address the return-to-work challenges following a depressive episode.

PURPOSE

This mixed-methods study aimed to (a) evaluate the effectiveness of cognitive work hardening in preparing people with depression to return to work and (b) identify key elements of the intervention.

METHOD

A single group ( n = 21) pretest-posttest study design was used incorporating self-report measures (Work Ability Index, Multidimensional Assessment of Fatigue, Beck Depression Inventory II) with interviews at intervention completion and at 3-month follow-up. Descriptive statistics, paired-samples t test, and content analysis were used to analyze the data.

FINDINGS

Work ability, fatigue, and depression severity significantly improved postintervention. Participants identified structure, work simulations, realism of simulated work environment, support, and education as key intervention elements.

IMPLICATIONS

Findings underscore an occupationally focused return-to-work intervention for people recovering from depression with potential for wider adoption and future research.

Psychosocial Benefits of Cooking Interventions: A Systematic Review

OBJECTIVES

Cooking interventions are used in therapeutic and rehabilitative settings; however, little is known about the influence of these interventions on psychosocial outcomes. This systematic review examines the research evidence regarding the influence of cooking interventions on psychosocial outcomes.

METHODS

A systematic review of the literature examined peer-reviewed research using Embase, PubMed, CINALH Plus, and PsychInfo with the following search terms: cooking, culinary, baking, food preparation, cookery, occupational therapy, mental health, mood, psychosocial, affect, confidence, self-confidence, self-esteem, socialization, and rehabilitation. Inclusion criteria were the following: adults, English, influence of cooking interventions on psychosocial outcomes. PRISMA guidelines were used.

RESULTS

The search yielded 377 articles; and 11 ultimately met inclusion criteria and were reviewed. Generally, the quality of the research was weak due to nonrandomization, unvalidated research tools, and small sample sizes. However, inpatient and community-based cooking interventions yielded positive influences on socialization, self-esteem, quality of life, and affect.

CONCLUSIONS

Finding benefits to cooking that extend beyond nutritional may be helpful in increasing motivation and frequency of cooking. This review suggests that cooking interventions may positively influence psychosocial outcomes, although this evidence is preliminary and limited. Further qualitative and rigorous quantitative research are needed to identify mechanisms by which cooking interventions may improve psychosocial outcomes.

Collaborative research exploring mental health service user perspectives on acute inpatient occupational therapy

Introduction

User perspectives are important for understanding why people engage with occupational therapy during an admission for acute mental health issues, and can be used to inform service provision and development.

Method

Twenty-two recent and current inpatients participated in six semi-structured individual interviews and three focus groups. Data from the two methods were initially subject to separate thematic analysis. Then a further stage of constant comparative analysis, of both data sets, generated the findings presented here.

Findings

Three themes were identified: (1) ‘A tiny sort of world’ expressed experiences of being restricted; (2) ‘Relief’ indicated how occupational therapy offered relief from the ward and experiences of mental ill-health; and (3) ‘Something to do’ suggested specific purposes for engaging in occupation. These themes indicate how service users experience and value occupational therapy for different reasons at different times. The approach of occupational therapists to service users, valuing them as occupational beings, is a key aspect of their experience.

Conclusion

The profession is challenged to design flexible opportunities for occupational engagement which simultaneously provide relief and distraction, address diverse occupational needs, and are feasible within the resource restrictions of acute mental health services.

An Occupational Perspective of the Recovery Journey in Mental Health

Background:

The philosophy of occupational therapy and that of recovery are markedly similar; however, there is limited research linking occupation to recovery in mental health. Aim: This study aimed to explore the relationship between recovery and occupation in consumers with mental health problems.

Method:

A qualitative method in the form of narratives was chosen in exploring the uniquely subjective experiences of mental health, occupation and recovery. Five members of a mental health support group (GROW) were engaged in semi-structured interviews, whereby individual narratives were analysed through comparative methods to identify categories and themes.

Findings:

Five categories emerged: (1) The recovery map, (2) GROW has just given me the platform, (3) You have to become active, (4) The great barriers and (5) Where am I now … I couldn't bear it if I was any better. The participants' experiences of recovery highlighted the necessity for occupational engagement in a supported environment. The benefits of occupation included feelings of social cohesion, meaning, purpose, normalisation, routine, competence, productivity, skill acquisition, routine and pleasure. These factors enabled the participants to re-establish self-concepts and subsequently promoted mental health.

Implications:

The findings may have implications for occupational therapy practice, whereby occupational therapy could facilitate a leadership role in recovery-orientated mental health services.

Promoting Mental Wellbeing through Activity in a Mental Health Hospital

Studies have indicated widespread inactivity in psychiatric wards, although the occupational therapy and mental health journals support the therapeutic benefits of participation in activity. A service evaluation was conducted to explore activity provision and identify gaps in service within a 13-ward psychiatric hospital. The results of the initial exploration were that staff and patients indicated a lack of structured and accessible activity. An activity programme was introduced offering a minimum of 17 groups weekly, including functional, leisure, art and sport groups. Six months after the introduction of the programme, 63 patients participated in one week, which was a considerable increase from 6 inpatients taking part in activity prior to the introduction of the programme. The results of a service evaluation conducted by questionnaire identified positive feedback from over 90% of patients and 100% of staff. The main recommendation was the continuous provision of an inpatient activity programme within the hospital. A further recommendation was to build closer links with community resources to enable continued participation after discharge from hospital.

Experiences of Engagement in Occupations and Assertive Outreach Services

Aim:

The purpose of this study was to describe the experience and meaning of engagement for staff and clients of assertive outreach teams.

Method:

Interpretative phenomenological analysis was selected for its flexibility and transparency. Data were collected by semi-structured interviews from a sample of five client and five staff participants (n = 10). The interviews were analysed idiographically, inductively and interrogatively.

Findings:

Four themes identified by both staff and client participants emerged: engagement as an interpersonal relationship, engagement in and through time, enabling and disabling factors and engagement in occupation. In addition, clients developed a theme around engagement as a means to self-actualisation. Staff also raised a specific theme around the role of engagement in mental health services.

Conclusion:

Staff and clients experienced engagement in broadly similar ways, but with differing emphases. Although all participants described it as both an invisible ‘means’ and a visible ‘end’, the staff related engagement only to mental health services whereas the clients experienced it in the context of both mental health services and occupations.

Relevance:

This study is relevant to all occupational therapists who work with people experiencing mental health problems.

Meal Preparation: Comparing Treatment Approaches to Increase Acquisition of Skills for Adults with Schizophrenic Disorders

This pilot study was conducted to determine whether an occupational therapy intervention using an acquisitional frame of reference with a psychoeducational component resulted in greater functional outcomes in the improvement of meal preparation for adult clients with schizophrenic disorders than an intervention framed solely by acquisition. Eight participants who met the inclusion criteria and were randomly assigned to the control group or the experimental group completed the study. Occupational performance in this area was assessed before and after treatment by administering relevant portions of the Performance Assessment of Self-Care Skills. Analysis of data suggests a significant change in one of three areas evaluated. All participants' “level of independence” improved, indicating that clients required less assistance after occupational therapy intervention; however, the findings did not indicate that the acquisition plus psychoeducation resulted in better outcomes than acquisition alone.

Activity and participation in psychiatric institutional care

National action plans emphasize the importance of strengthening the role of patients in health and medical care. Patients should feel that they can participate and that they are seen as a resource. In occupational therapy, the client-centred approach has developed, whereby it is key to enable patients to participate in their treatment. The International Classification of Functioning Disability and Health (ICF) has inspired this study, in which concepts such as activity and participation are central. The purpose of the study was to describe how patients in psychiatric institutional care conceive their opportunities to be active, and how they participate in their own treatment. Questionnaires were sent to patients who had received care during a six-month period. Ten patients were then selected for interview. The study shows that younger patients and patients who were treated involuntarily were generally more dissatisfied than other patients. The patients' perceptions of their environment were influenced by the values in the ward. Topics such as atmosphere in the ward, reception, continuity, and support were presented. Important factors related to activity and participation were: agreement concerning the treatment plan, discussions about expectations, creating conditions for engagement in activities, and providing the patients with opportunities to take responsibility for themselves.

Occupation Matters: Do Techniques and Media Matter?

The theme of the College of Occupational Therapists' annual conference this year, ‘Occupation Matters’, led two occupational therapy lecturers to reflect on the place of occupation, in the form of techniques and media, within their curriculum. Despite a strong rationale for it remaining on the curriculum, there was an awareness that this might not reflect the reality of practice. It is suggested that many occupational therapists are not using techniques and media because they lack the confidence to do so. Such a lack of confidence could therefore be addressed in the occupational therapy curriculum, using experiential learning and evidence-based practice.