Academic journal article British Journal of Occupational Therapy

A Qualitative Research Synthesis Examining the Effectiveness of Interventions Used by Occupational Therapists in Mental Health

Academic journal article British Journal of Occupational Therapy

A Qualitative Research Synthesis Examining the Effectiveness of Interventions Used by Occupational Therapists in Mental Health

Article excerpt

Introduction

Occupational therapy as a profession is experiencing an increasing need to demonstrate its contribution and perceived effectiveness across practice settings by examining clients' and carers' views (Bannigan et al 2008). Alongside client perspectives, the commissioning consortia need to be convinced that occupational therapy services are valued, otherwise the profession is at risk of losing its funding to outside providers. In the United Kingdom (UK) this situation is becoming critical as health care moves towards Payment by Results and Cluster/Pathway-based commissioning (Department of Health [DH] 2010a, DH 2010b). Identifying existing practice and the effectiveness of occupational therapy in mental health is therefore crucial.

This research article presents the first qualitative research synthesis (QRS) undertaken to identify the types of interventions used by occupational therapists internationally, from the perspective of clients, carers, and occupational therapists, respectively. Detail is included on how the synthesis process was conducted. The main findings are discussed in relation to four themed areas and recommendations for practice, policy, and the commissioning of occupational therapy services are suggested.

Context

There have been a number of systematic reviews bringing together the evidence of the therapeutic effectiveness of occupational therapy in mental health in relation to specific practice areas. For example, falls prevention with people with Alzheimer's disease and related dementias (Jensen and Padilla 2011) and interventions focusing on participation and performance in occupations related to both paid and unpaid employment, as well as education for people with serious mental illness (Arbesman and Logsdon 2011). Such studies are valuable in reviewing the existing evidence about specific occupational interventions to inform future practice and research. However, as highlighted by Bullock and Bannigan's (2011) systematic review of activity-based group work in community mental health, when robust evidence is lacking, there are limitations as to what such reviews can contribute to the field. It is also worth noting that the aforementioned reviews generally excluded qualitative studies, as they were not able to address questions of effectiveness.

The challenge in reporting therapeutic effectiveness is to find ways to demonstrate not only clear links between the intervention used and its effect upon function, but also how interventions enable individuals to enjoy improved quality of life and overcome obstacles to participation (American Occupational Therapy Association [AOTA] 2007). In measuring effectiveness, baseline and discharge comparisons with reliance on pre- and post-testing are recognized as valuable forms of evidence for the profession. However, other research is being conducted that also examines therapeutic effectiveness, but from studies which examine the complexity of factors that influence occupational therapy interventions (Robertson and Colborn 2000). This research article argues that such evidence can be accessed through the more personalized perspectives that qualitative forms of research examine and report upon (Savin-Baden and Major 2013). Further, as the purpose of occupational therapy intervention is to enable occupation, judgements about the effectiveness of the service should be based on the degree to which clients consider the purpose achieved (College of Occupational Therapists [COT] 2006, Whitley 2005).

As Hocking (2007) argued, the profession needs to promote its use of occupation more effectively. What are required are robust bodies of evidence, built up through both larger (quantitative) and smaller-scale (qualitative) studies that seek to confirm, challenge, or redefine other studies, so that a more integrated picture of occupational therapy's practice and effects in mental health can emerge. The challenge of utilizing the growing number of mixed methods studies as robust forms of evidence is noted here. …

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