Academic journal article British Journal of Occupational Therapy

Occupation and Health: A Review of Selected Literature

Academic journal article British Journal of Occupational Therapy

Occupation and Health: A Review of Selected Literature

Article excerpt

Occupational therapy is based on the belief that people can influence the state of their health through what they do. However, there appears to be a shortage of evidence to support this belief. This paper describes a review of selected literature on the effects of occupation on health. The aims were to review how occupation and health are defined in the occupational therapy literature; to find synonyms for these two terms to enable a search for relevant literature; to review evidence for a relationship between what people do and their health; and to identify factors that mediate the relationship between occupation and health.

The review had five main findings: occupation and health are defined in a variety of ways by occupational therapists; there is a wealth of literature, representing a number of disciplines and a wide range of research, that explores the relationship between occupation and health; engaging in occupation carries both potential health benefits and risks to health; there is limited knowledge of the ways in which occupation influences health; and the impact of occupation on health is mediated by a complex range of factors. These findings have implications for occupational therapy research, practice and education.

Key words: Occupation, health.

Introduction

Occupational therapy is based on the belief 'that there is a relationship between occupation, health and wellbeing' (Law et al 1998, p81). Since the early days of the profession, practitioners and educators have been calling for more research to build an evidence base for this claim and to demonstrate that interventions to change what people do can influence their health (Beldam 1957, Serrett 1985, Schwartz 1998). However, despite an increase in the amount and quality of occupational therapy research over the past two decades, it can still be said that 'there is little evidence in the occupational therapy literature to support [our core] belief' (Law et al 1998, p81).

The policy climate within the United Kingdom (UK) at the beginning of the 21st century emphasises the importance of basing practice on the best available evidence. Indeed, national service frameworks and guidelines are directing resources towards those interventions that have been demonstrated to be effective. It is, therefore, essential for occupational therapists to find evidence for a relationship between occupation and health, and to position themselves as experts in this field of practice.

Evidence is 'facts or testimony in support of a conclusion, statement or belief' (Shorter Oxford English Dictionary 2002); however, there may be disagreement about what constitutes a fact. Some writers have stated that evidence-based occupational therapy is practice that is based on the best available research evidence (Ilott et al 2006), which implies that a fact is a sound research finding. Others take a broader view, arguing that evidence-based practice is the integration of research findings, clinical experience and the client's beliefs and values (Bury 1998, Fawcett 2007).

Research findings are, at the least, a necessary component of evidence-based practice, but there is a wide range of research and this produces different types of evidence. Some research designs are considered to produce more robust evidence than others. For example, the highest levels of evidence are generally considered to come from a systematic review of multiple, well-designed randomised controlled trials (RCTs) and from properly designed RCTs (Fawcett 2007). Lower levels of evidence are produced by other means, such as well-designed trials without randomisation, cohort studies and non-experimental studies.

Evidence for a relationship between occupation and health comes from a wide range of literature, including physical medicine, gerontology, psychology, health promotion and occupational science. This breadth of research, encompassing the different types and levels of evidence already identified, makes the task of carrying out a literature review on the topic a complex one. …

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