Meaningful Activities and Recovery (MA&R): the effect of a novel rehabilitation intervention among persons with psychiatric disabilities on activity engagement-study protocol for a randomized controlled trial

A systematic review of occupation- and activity-based health management interventions for adult patients with severe mental disorders

BACKGROUND

Considering the negative effects of severe mental disorders (SMDs) on the patient's social and occupational functioning and general health, besides accumulating evidence on the effectiveness of occupation- and activity-based health management interventions for these patients and the novelty of research on this topic, it is important to review, evaluate, and categorize relevant studies. The present study aimed to systematically review occupation- and activity-based health management interventions for adult patients with SMDs.

MATERIALS AND METHODS

The present study is a systematic review. We conducted a literature search in Medline, OTseeker, Cochrane Library, Embase, CINAHL, PubMed, PsycINFO, ISI Web of Science, MagIran, ISC, and SID databases from 2000 until October 2021. The study population consisted of patients clinically diagnosed with SMDs (e.g., schizophrenia, bipolar disorder, and major depression). After the literature search, we investigated the screening, quality, and inclusion and exclusion criteria of the articles. In the primary search, we extracted 238 relevant articles, and after appraising their titles and abstracts, we identified 55 relevant articles. After reviewing the full text of the articles and removing duplicates, 17 articles met the inclusion criteria of this study, while we excluded two articles from the quality assessment. Finally, we reviewed 15 studies. The outcomes included all positive and negative treatment effects and outcomes of the interventions.

RESULTS

According to the results, there were multiple occupation- and activity-based interventions for patients with SMDs, which could directly or indirectly improve their general functioning and health management.

CONCLUSION

The reviewed studies had numerous blind spots and limitations, such as common shortcomings of randomized clinical trials, lack of long follow-ups, and ambiguity or dispersion of intervention protocols. Besides addressing these limitations, we also discussed research proposals in this study.

Meaningful Activities and Recovery (MA&R): a co-led peer occupational therapy intervention for people with psychiatric disabilities. Results from a randomized controlled trial

BACKGROUND

Activity and participation are critical to health and wellbeing. Limited evidence exists on how to support people with mental illness in participating in everyday activities.

AIM

To investigate the effectiveness of Meaningful Activities and Recovery (MA&R), a co-led peer occupational therapy intervention focusing on activity engagement, functioning, quality of life, and personal recovery.

METHODS

In a statistician blinded, multicenter RCT including 139 participants from seven community and municipal mental health services in Denmark, participants were randomly assigned to 1) MA&R and standard mental health care or 2) standard mental health care. The MA&R intervention lasted 8 months and consisted of 11 group sessions, 11 individual sessions, and support to engage in activities. The primary outcome, activity engagement, was measured using Profile of Occupational Engagement in People with Severe Mental Illness (POES-S). Outcomes were measured at baseline and post-intervention follow-up.

RESULTS

Meaningful Activities and Recovery was delivered with high fidelity and 83% completed the intervention. It did not demonstrate superiority to standard mental health care, as intention-to treat analysis revealed no significant differences between the groups in activity engagement or any of the secondary outcomes.

CONCLUSION

We did not find positive effects of MA&R, possibly because of COVID-19 and related restrictions. Fidelity assessments and adherence rates suggest that MA&R is feasible and acceptable. However, future studies should focus on refining the intervention before investigating its effectiveness.

TRIAL REGISTRATION

The trial was registered 24/05/2019 at ClinicalTrials.gov NCT03963245.

Occupational value outcomes among people with mental health issues participating in activity-based interventions - The importance of internal and external factors

BACKGROUND

Perceived occupational value is an important treatment outcome but is still relatively unexplored as a phenomenon.

AIM

To evaluate whether the Balancing Everyday Life (BEL) intervention for people with mental health issues was effective compared to Standard Occupational Therapy (SOT) regarding improvement on three dimensions of occupational value (concrete, socio-symbolic and self-reward), and how internal factors (self-esteem and self-mastery) and external factors (sociodemographics) were related to occupational value.

METHODS

The study was a cluster RCT (n = 226) and used self-report questionnaires on three occasions (baseline = T1, completed intervention = T2, six-month follow-up = T3).

RESULTS

No differences between the groups were seen in occupational value change scores. Within-group analyses (T1-T3) indicated a change in the BEL group on concrete value and self-reward value. No change was indicated in the SOT group. Associations showed that self-esteem and self-mastery were correlated with all three aspects of occupational value. Having children was negative for experiencing occupational value, whereas having a friend was positive. None of the correlates could predict changes in occupational value.

CONCLUSION

Self-related factors appeared to be integral in occupational value.

SIGNIFICANCE

Since occupational value is essential for a meaningful life, therapists should consider such factors and peer support when supporting people with mental health issues.

Eating disorders: When food "Eats" time

The presence of a physical or mental health issue, such as an eating disorder (ED), impacts daily activities, also known as occupations. For example, an overinvestment in body shape and weight undoubtedly can lead to an underinvestment in other, more meaningful occupations. To address ED-related perceptual disturbances, a detailed log of daily time use can pinpoint food-related occupational imbalances. This study aims to characterize the daily occupations associated with EDs. The first specific objective (SO.1) is to categorize and quantify the temporal organization of a typical day's occupations as self-reported by individuals with an ED. The second specific objective (SO.2) is to compare daily occupational time use among people with different ED types. This retrospective study based on time-use research principles was conducted by analyzing data from an anonymized secondary dataset (Loricorps's Databank). Data were collected between 2016 and 2020, from 106 participants, with descriptive analysis completed to determine the average daily time use for each occupation. A series of one-way analyses of variance (ANOVAs) were performed to compare perceived time use in each occupation for participants with different types of EDs. The outcomes show a marked underinvestment in leisure categories compared to the general population. In addition, personal care and productivity can represent the blind dysfunctional occupations (SO.1). Moreover, compared to those with binge eating disorder (BED), individuals with anorexia nervosa (AN) are significantly more invested in occupations that focus explicitly on perceptual disturbances, such as personal care (SO.2). The highlight of this study is the distinction between marked versus blind dysfunctional occupation, which offers specific avenues for clinical intervention.

Implementing an occupational therapy specific mental health intervention in a multi-professional context - the case of Balancing Everyday Life (BEL)

BACKGROUND

The occupation-based intervention Balancing Everyday Life (BEL) was found effective under controlled conditions but should also be studied in a natural clinical practice context.

AIM

The aim was to study the implementation process of BEL when provided in a multi-professional mental health team. The focus was particularly on how BEL was received and functioned.

METHODS

This qualitative study was based on manifest content analysis and used semi-structured telephone interviews with 13 occupational therapists and three managers.

RESULTS

Three themes were identified: '1 - Conditions and opportunities in the setting', '2 - Putting the BEL intervention into practice' and '3 - Experiences of practicing BEL'. BEL was a welcomed alternative, as stated by managers and occupational therapists. The team helped to recruit BEL participants, but the occupational therapists had to give rigorous information to team members and prospective participants for this to work. The social, physical and political contexts were essential for the implementation.

CONCLUSIONS

Successful implementation of an occupational therapy-specific intervention such as BEL requires a reasonable match between existing team policies and the underpinnings of the intervention. It is crucial to repeat information to all stakeholders and make the intervention a matter of urgency for the whole team.

Validity and reliability of the Turkish Occupational Balance Questionnaire (OBQ11-T) in mental health

BACKGROUND

People with psychiatric disabilities often find it difficult to maintain a satisfactory occupational balance.

AIMS/OBJECTIVES

This study aimed to investigate the validity and reliability of the Turkish version of the Occupational Balance Questionnaire (OBQ11-T) in mental health.

MATERIAL AND METHODS

OBQ11-T was applied to 149 people for construct validity analysis and to 61 of them for reliability analysis. Validity was determined using factor analyses. The reliability of the OBQ between the first and second evaluations was assessed using the intraclass correlation coefficient (ICC) for each item and the total OBQ11-T score. Internal consistency was assessed using Cronbach's alpha.

RESULTS

The results of factor analysis revealed one factor that explains 35.94% of the total variance in the model. OBQ11-T item 1 had the lowest and OBQ11-T item 4 had the highest factor loadings. The model fits the data according to the indices of relative fit (RMSEA = 0.087, CMIN/DF = 2.129, CFI = 0.901). There was an excellent correlation between test and retest OBQ11-T total scores (ICC = 0.905). All items of the OBQ11-T showed good reliability. Cronbach's alpha for the OBQ11-T total score was 0.839, indicating acceptable internal consistency.

CONCLUSIONS AND SIGNIFICANCE

The current study showed that OBQ11-T is a valid and reliable tool for measuring the self-rated occupational balance of people with mental illness.

“Moving on to an Open World”: A Study of Participants’ Experience in Meaningful Activities and Recovery (MA&R)

Background. Meaningful activities and Recovery (MA&R) is a peer coled occupational therapy intervention, to support occupational engagement among persons with psychiatric disabilities. Aim. To investigate participants’ perspectives on how MA&R influenced occupational engagement and recovery processes. Material and Methods. A qualitative study with a phenomenological-hermeneutic design. Individual semistructured interviews were conducted with three women and ten men who had participated in MA&R. Participants were recruited from community mental health centres and municipality mental health services in two Danish municipalities. Analysis strategy was based on Malterud’s Systematic Text Condensation. Results. MA&R was perceived as a practical approach to recovery, by providing an opportunity for reorientation, meaning, making in mundane activities, and a new outlook on everyday life. Participating in MA&R challenged a black and white approach to activities, put emphasis on “the little things”, and enhanced curiosity, presence, and joy in occupational engagement. Conclusion. MA&R supported participants in developing a new “lens” on meaningful activities. The lens enhanced occupational engagement and made it possible to live according to personal preference. Results can inform further development and delivery of recovery-oriented occupational therapy interventions and add to the understandings of how occupational engagement and recovery are intertwined and manifested through everyday experiences. Thus, occupational engagement is an important target for recovery-oriented interventions. Occupational therapists and peer-workers coleading such interventions is feasible and makes good sense to the participants.

The Role of Courtyards within Acute Mental Health Wards: Designing with Recovery in Mind

The role of courtyards and other outdoor spaces in the recovery of acute mental healthcare users has been gaining international appreciation and recognition. However, the physical properties and conditions necessary for therapeutic and rehabilitative engagement remain to be clearly established. This paper contributes to that knowledge by triangulating evidence from the literature, exemplar case studies of good practice and first-hand accounts of the experiences of staff and service users from four acute mental health facilities. The findings are then aligned with a well-established recovery framework (CHIMES) in light of existing landscape architecture knowledge. Within the complexity of varied mental health environments, this work establishes landscape architectural design requirements and qualities essential for recovery. Rather than adopting a prescriptive quantitative approach setting out areas, numbers of elements, etc., the proposed framework recommends a performance-based model and the creation of a cohesive network of microspaces that mesh into a design of outdoor areas. In this way, design details, materials, vegetation and the variety of spaces can be modified to suit service user population demographics and site-specific needs.

A cross-sectional study addressing the importance of work and other everyday activities for well-being among people with mental illness: does additional vulnerability matter?

BACKGROUND

Work and other everyday activities are beneficial for well-being among people with mental illness, but poor circumstances can create detrimental effects, possibly aggravated by additional vulnerabilities linked with their mental illness. This study aimed to investigate how activity factors were related to well-being and functioning among three vulnerable groups using outpatient mental health care - young people with psychosis, people with a history of substance use disorder (SUD), and immigrants with post-traumatic stress disorder (PTSD) - while controlling for vulnerability group, age and gender.

METHODS

Participants represented the three types of vulnerability (n = 46/57/39). Data collection, using self-report and interviewer-rated questionnaires, concerned aspects of everyday activity (work experiences; views of the worker role; satisfaction with everyday occupations; activity level), well-being (quality of life: life and health; quality of life: environmental aspects; recovery) and functioning (psychosocial functioning; symptom severity). Spearman correlations and General Linear Modelling were used.

RESULTS

Activity satisfaction was positive (p < 0.001) but recent work experience negative (p = 0.015) for the life and health aspect of quality of life. Activity satisfaction was positive for the environmental aspects of quality of life (p < 0.001). Resources for having a worker role (p < 0.001) and belief in having a future worker role (p = 0.007) were positively associated with better recovery. Activity level (p = 0.001) and resources for having a worker role (p = 0.004) showed positive associations with psychosocial functioning. Belief in a future worker role (p = 0.011) was related with symptom level. Women had less severe symptoms in the young group with psychosis. Regarding vulnerability group, young people with psychosis perceived better quality of life; those with a history of SUD had less severe psychiatric symptoms; and the recent immigrants with PTSD had the highest level of psychosocial functioning.

CONCLUSION

Work experience may not be conducive to well-being in itself; it is satisfaction with work and other activities that matters, and worker and employer expectations need alignment. No vulnerability group seemed consistently more disadvantaged regarding well-being and functioning, but the fact that differences existed is vital to acknowledge in activity-based rehabilitation. Inquiring about meaningful activities and providing opportunities for executing them would be a fruitful way of support.

A journey of living well: a participatory photovoice study exploring recovery and everyday activities with people experiencing mental illness

BACKGROUND AND AIM

Engagement in everyday activities has been identified as an important element in personal recovery from the experience of mental illness and a key priority for service-users. This study explored the role of everyday activities in recovery.

METHOD

This study used a photovoice participatory research. Twenty-one participants experiencing mental illness were recruited from a community-managed mental health service in Melbourne, Australia. Data collection included individual interviews and photovoice courses. The courses included group discussions and required participants to take photographs about their everyday activities that support recovery. A lived experience co-facilitator contributed to development and delivery of the course. The interviews and group discussions were transcribed verbatim and analysed using constant comparative methods.

RESULTS

Recovery as a "journey of living well" was identified as the central theme that encompasses three interlinked categories: (1) living a life on hold; (2) choosing to recover; and (3) learning and navigating strategies.

CONCLUSIONS

The findings suggest that recovery involves a range of experiences embedded in people's everyday lives. Recovery-oriented practice should provide opportunities for engagement in meaningful activities, to help consumers identify their potential and strategies to live well, and to adopt co-production at all levels.

Supported Employment, Participation at Work, and Peer Support: A Qualitative, Participatory Case Study Report of the Geesthacht Model

Background: For people who have experienced mental health crises or psychosocial disabilities, it is considerably more difficult to receive support to participate in work on an equal basis with others. In the town of Geesthacht, in Northern Germany, an integrative care network was implemented that allows for acute psychiatric treatment as well as participation in work and activities. This paper aims to explore the principles, advantages, and challenges of this innovative project. Methodology: Within the context of a participatory and collaborative process evaluation of a prospective controlled cohort study (PsychCare), researchers with and without experiential expertise conducted expert interviews and focus groups to evaluate the experiences of 37 employees, with and without lived experience, from various institutions associated with this care network. The data was analyzed using qualitative content analysis. Results: It was the change from financial compensation paid on a daily basis to a global treatment budget that allowed for a significant reduction of hospital beds in Geesthacht and freed up resources to implement a complex care network. Since then, various possibilities for participation, work, and activities for former service users, some of which are compensated financially, have been made available. These developments now allow for a less bureaucratic and often smooth transition from being a service user to involvement in participatory activities in the role of a peer, which is frequently perceived to be empowering and beneficial by participants with lived experience. At the same time, this care model has led to multiple role conflicts and different challenges for all parties involved. Conclusion: This innovative project in Geesthacht demonstrates the multifaceted potential of a global treatment budget system in the field of mental health care. To address certain downsides of the Geesthacht model, further development is necessary.

Meaningful activities during COVID-19 lockdown and association with mental health in Belgian adults

BACKGROUND

The spread of COVID-19 has affected people's daily lives, and the lockdown may have led to a disruption of daily activities and a decrease of people's mental health.

AIM

To identify correlates of adults' mental health during the COVID-19 lockdown in Belgium and to assess the role of meaningful activities in particular.

METHODS

A cross-sectional web survey for assessing mental health (General Health Questionnaire), resilience (Connor-Davidson Resilience Scale), meaning in activities (Engagement in Meaningful Activities Survey), and demographics was conducted during the first Belgian lockdown between April 24 and May 4, 2020. The lockdown consisted of closing schools, non-essential shops, and recreational settings, employees worked from home or were technically unemployed, and it was forbidden to undertake social activities. Every adult who had access to the internet and lived in Belgium could participate in the survey; respondents were recruited online through social media and e-mails. Hierarchical linear regression was used to identify key correlates.

RESULTS

Participants (N = 1781) reported low mental health (M = 14.85/36). In total, 42.4% of the variance in mental health could be explained by variables such as gender, having children, living space, marital status, health condition, and resilience (β = -.33). Loss of meaningful activities was strongly related to mental health (β = -.36) and explained 9% incremental variance (R2 change = .092, p < .001) above control variables.

CONCLUSIONS

The extent of performing meaningful activities during the COVID-19 lockdown in Belgium was positively related to adults' mental health. Insights from this study can be taken into account during future lockdown measures in case of pandemics.