Intervention Strategies Used by Occupational Therapy Practitioners Working in Mental Health and Their Theoretical Basis

PURPOSE: The aim of our study was to conduct a meta-analysis to determine the overall effectiveness of theory-based occupational therapy interventions in improving occupational performance and a sense of well-being among individuals with mental health disorders.

METHOD: Eight databases were searched for articles in which research findings pertained to the extent to which occupational therapy interventions for adults diagnosed with serious mental illness improved their occupational performance and/or well-being. When not stated explicitly by the researchers, the theoretical basis of interventions (dependent variables) investigated in the identified studies was determined based on the definition of theoretical conceptual practice models by Kielhofner (2009) and criteria developed by Ikiugu and Nissen (2016).

Two meta-analyses were conducted, one with occupational performance and the other with well-being as the dependent variable. Nine randomized controlled trials matched the inclusion criteria and were included in the meta-analyses. The analyses were conducted on Comprehensive Meta-Analysis software (Biostat, Englewood, NJ; Borenstein, Hedges, & Higgins, 2009) using a random effects model and Hedge’s g as a coefficient of effect size.

RESULTS: There was a small effect of intervention on occupational performance (M g = .20, Z = 3.08, p < .002) and a medium effect on well-being (M g = .66, Z = 3.92, p < .001) according to Cohen’s (1988) criteria for interpreting effect sizes. The theoretical models most frequently used as a source of strategies for interventions in the studies in our sample were behavioral or cognitive–behavioral, the Model of Human Occupation, and the Canadian Model of Occupational Performance and Engagement. Chi-square analysis indicated that none of the 10 theoretical conceptual practice models that were the basis of the interventions was more prevalently investigated in the reviewed studies, χ²(5, N = 10) = 2.0, p = .85.

CONCLUSION: Theory-based occupational therapy interventions are effective in improving occupational performance and sense of well-being among individuals with serious mental illness. More meta-analysis needs to be conducted in order to have a more complete picture of the effect of theory-based occupational therapy interventions in mental health. However, available evidence suggests that when occupational therapy practitioners use theoretical principles to guide planning of interventions in mental health, therapy is effective in improving both occupational performance and sense of well-being among clients. However, occupational therapy practitioners need to document the theories that they are using to guide intervention clearly, and researchers need to identify the theoretical basis of the interventions that they are investigating.

References

Borenstein, M., Hedges, L. V., & Higgins, J. P., & Rothstein, H. R. (2009). Introduction to meta-analysis. West Sussex, England: Wiley.

Cohen, J. (1988). Statistical power analysis for behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.

Ikiugu, M. N., & Nissen, R. M. (2016). Intervention strategies used by occupational therapists working in mental health and their theoretical basis. Occupational Therapy in Mental Health, 32, 109–129. https://doi.org/10.1080/0164212X.2015.1127192

Kielhofner, G. (2009). Conceptual foundations of occupational therapy practice (4th ed.). Philadelphia: F. A. Davis.