Patient Experiences of Participating in Mind–Body Interventions in an Outpatient Rehabilitation Setting

PURPOSE: The purpose of this study was to explore patient experiences of mind–body interventions (MBIs) implemented in outpatient rehabilitation to inform best practices. There is a need for efficient, effective, evidence-based interventions that maximize therapist–client time in rehabilitation and support the holistic nature of occupational therapy. MBIs are being widely adopted across health care (Goyal et al., 2014) and may be appropriate for occupational therapy because they can assist patients in improving quality of life, altering experiences of pain, and returning to function (Hardison & Roll, 2016). Specifically, meditative body scans can increase interoceptive awareness and focus (Kok & Singer, 2017), and visual biofeedback can increase body awareness and help patients properly perform exercises (Giggins et al., 2013). Given the potential benefits of these MBIs as part of a holistic occupational therapy approach, understanding patients’ experience is a necessary step to support best practice.

METHOD: A multimethod, randomized, crossover design was used to explore potential benefits of integrating two MBIs, audio-recorded body scan meditation and visual biofeedback using sonography, into standard care (SC) compared with SC alone. Participants were 21 English-speaking adults with upper extremity musculoskeletal injuries receiving at least 2 visits per week of occupational therapy in an outpatient clinic because of functional limitations and pain (i.e., >4/10). Patients with bilateral injuries or cognitive deficits were excluded.

Patients completed four 60-min sessions sequenced as SC only, MBI–SC, SC only, MBI–SC. All patients experienced both 20-min MBIs—one per MBI–SC session—in a randomized order. Semistructured follow-up interviews with eight participants were conducted within 2 wk of completing the four sessions. Interviewed participants were asked to describe their experiences with each MBI, followed by structured questions exploring acceptability and potential benefits. Interviews lasted up to 60 min and were audio recorded and transcribed for analysis.

A qualitative descriptive analysis was conducted to identify emergent themes regarding patient experiences of each MBI, as well as overarching themes across both MBIs. Transcripts were also evaluated for patient acceptability to inform practice. Using an iterative process, investigators held multiple consensus meetings to synthesize findings.

RESULTS: Four themes relative to participants’ experience with MBIs emerged. Themes identified with visual sonographic biofeedback were conscious embodiment of one’s disorder and verification of recovery. The body scan meditation resulted in promotion of self-efficacy through symptom management. Engagement in therapy, specifically as it related to participation and partnership with the therapist, was a theme across both MBIs. All participants reported that at least one MBI would be acceptable and identified multiple recommendations for integration into practice.

CONCLUSION: MBIs may be a viable method to assist patients in improving awareness, embodiment, self-efficacy, and engagement in their recovery process. Occupational therapy practitioners may find that integrating MBIs into practice could lead to more efficient and efficacious care.

IMPACT STATEMENT: Integrative and holistic techniques are being widely adopted across health care. Given the acceptability of and positive patient experiences with MBIs, occupational therapy clinicians should explore these techniques as part of holistic care. More rigorous research such as in-depth narrative, phenomenological studies and large quantitative efficacy trials is needed to further understand how MBIs aid patient engagement in therapy and improve outcomes.

References

Giggins, O. M., Persson, U. M., & Caulfield, B. (2013). Biofeedback in rehabilitation. Journal of NeuroEngineering and Rehabilitation, 10, 60. https://doi.org/10.1186/1743-0003-10-60

Goyal, M., Singh, S., Sibinga, E. M. S., Gould, N. F., Rowland-Seymour, A., Sharma, R., . . . Haythornthwaite, J. A. (2014). Meditation programs for psychological stress and well-being: A systematic review and meta-analysis. JAMA Internal Medicine, 174, 357–368. https://doi.org/10.1001/jamainternmed.2013.13018

Hardison, M. E., & Roll, S. C. (2016). Mindfulness interventions in physical rehabilitation: A scoping review. American Journal of Occupational Therapy, 70, 7003290030. https://doi.org/10.5014/ajot.2016.018069

Kok, B. E., & Singer, T. (2017). Phenomenological fingerprints of four meditations: Differential state changes in affect, mind-wandering, meta-cognition, and interoception before and after daily practice across 9 months of training. Mindfulness, 8, 218–231. https://doi.org/10.1007/s12671-016-0594-9