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Occupational therapy interventions for recovery

Reviewed by Dr Katrina Bannigan, Director of RCOMH.

This systematic review is one of three published in the special issue on the effectiveness of occupational therapy services in mental health practice published by the American Journal of Occupational Therapy. The editor’s motivation in compiling the special issue was an attempt to build the evidence supporting the occupational therapy profession’s contribution to mental health practice.

The publication of this paper is timely in that it focuses on the contribution of occupation- and activity based interventions, and interventions addressing performance skills and performance patterns; aspects of the environment; and context, activity demands, and client factors, in terms of recovery for people with serious mental illness in community settings. Serious mental illness was defined as the group of people who experience schizophrenia, major depression, bipolar disorder, and schizoaffective disorder. Gibson et al (2011) contest that “…community integration is the tangible manifestation of the personal recovery experience because it can be viewed by others and it allows for concrete measurement. The acquisition and maintenance of normative life roles serve as an additional manifestation of the personal recovery experience.” (p248). However, there was not an a priori agreed measure, which is usually expected in systematic reviews, but the studies were integrated in narrative review rather than a meta analysis so the issue of heterogeneity was not an issue. Gibson et al (2011) observe “Evidence can be found indirectly, however, by examining the components of recovery” (p253). This is indicative of the fact that the evidence of effectiveness of interventions to improve recovery and more research in the area of recovery is limited. Gibson et al (2011) make two very important points namely,

  1. “This type of research is best achieved through the development of a cooperative network of academic, clinical, and professional staff to develop, design, and see grant funding for multisite efficacy studies” (p254), and
  2. “…it is important that mental health curricula incorporate the most up-to-date information on best practice” (p254).

Some observations in passing

  • The search terms were shaped by a Patient Intervention Comparison and Outcome (PICO) question. Therefore it should be a useful worked example, for students at undergraduate and postgraduate levels, of how the research question is used to shape a search strategy.
  • Two Masters students contributed to this work as part of their degree. This is an example of how students can use their studies positively to make a valuable contribution to the evidence base.  To grow the evidence base postgraduate students are encouraged strongly to engage with faculty members to see how they can contribute research programmes that will contribute to developing the evidence for occupation and mental health.
  • The data extraction table is published as a supplemental table (available from the web) which is a bit frustrating when reading the hard copy. More journals are doing this now because of the constraints on space in hard copy.

If you would like to read this article the full reference is

Gibson RW, D’Amico M, Jaffe L, Arbesman M (2011) Occupational therapy interventions for recovery in the areas of community integration and normative life roles for adults with serious mental illness: a systematic review. The American Journal of Occupational Therapy, 65(3), 247-256. Doi:10.5014/ajot.2011.001297