Occupational Therapy Interventions for Chronic Diseases a Scoping Review
Occupational therapy interventions for adults with severe mental illness: a scoping review
Abstruse
Objective To place the occupational therapy (OT) interventions in adults with severe mental affliction (SMI) most investigated in intervention studies and to draw their characteristics.
Design Scoping review.
Data sources On 17 January 2020, we searched the following electronic databases: MEDLINE, Scopus, Web of Science and EMBASE. We also performed a manual search of TESEO doctoral thesis database and of the journals indexed in the start quartile of OT co-ordinate to the SCImago Journal Rank. We updated our search on ten March 2021, performing a complementary search on ProQuest database and repeating the search in all sources. The terms included in the search strategy were: schizophrenia, schizotypal personality, delusional, schizoaffective, psychotic, bipolar, major low, obsessive–compulsive, severe mental, OT and intervention.
Study selection The report screening was peer-reviewed. Inclusion criteria were: (i) OT intervention studies in SMI: experimental, randomised, non-randomised and airplane pilot/exploratory studies; (2) adult population with SMI: schizophrenia, schizotypal personality disorder, delusional disorder, obsessive–compulsive disorder, schizoaffective disorder, psychotic disorder, bipolar disorder, major depressive disorder; (3) OT identified as a subject area involved in the intervention; (four) English language or Spanish language and (v) studies with total text available.
Results 30-five studies met the inclusion criteria. OT interventions were classified in psychosocial, psychoeducational, cognitive and exercise interventions. The most used OT intervention was psychosocial intervention.
Conclusion Psychosocial intervention was the most investigated OT intervention in SMI, followed by psychoeducational, cerebral and exercise interventions. These interventions are usually group interventions in patients with schizophrenia, performed by a multidisciplinary team (in which an occupational therapist collaborates), with 2–3 weekly 60 min sessions and a duration of 3–6 months.
- mental health
- schizophrenia & psychotic disorders
- psychiatry
Data availability argument
All information relevant to the study are included in the article or uploaded as online supplemental information. No boosted data available, all data relevant to the study are included in the article.
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- mental health
- schizophrenia & psychotic disorders
- psychiatry
Strengths and limitations of this study
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There is little evidence regarding occupational therapy intervention in severe mental illness.
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We gave a detailed description of four types of occupational therapy intervention in severe mental affliction.
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We conducted a peer-reviewed database search to ensure comprehensiveness.
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We did non appraise the quality of the studies included.
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We did not include studies on addiction, feet or eating disorders.
Introduction
Mental disorders stand for a major upshot, constituting the nigh frequent crusade of affliction burden in Europe.1 In Kingdom of spain, it is estimated that at least nine% of the population is affected past a mental disorder, apart from those acquired by substance corruption; and slightly more than 15% volition suffer from one throughout their lives.ii Astringent mental illnesses (SMIs) are the nearly limiting mental disorders, and those with these conditions, according to the National Institute of Mental Health of the The states, are divers as 'a group of heterogeneous people, who suffer from serious psychiatric disorders that present with long-lasting mental disorders, which carry a variable degree of disability and social dysfunction, and which must exist cared for through various social and health resources of the psychiatric and social intendance network'.3
The disorders that are included in SMI are schizophrenia, schizotypal personality disorder, delusional disorder, schizoaffective disorder, psychotic disorder, bipolar disorder, major depressive disorder and obsessive–compulsive disorder.iv Amid the most frequent limitations that people with SMI experience is a lower participation in good for you activity patterns, including active and pregnant participation in the community, unemployment, self-care and sleep disturbances.5 six
Treatment for people with SMI requires, therefore, the integration of unlike levels of intendance and different interventions that include, in improver to pharmacological treatment, rehabilitation and social support programmes that allow them to participate in the community in a more independent and integrated manner.7 I of these not-pharmacological interventions is occupational therapy (OT), which tin back up recovery as a significant handling component of these patients through meaningful activities, influencing aspects such as autonomy in activities of daily living (ADL), quality of life and personal well-beingness.eight–x In fact, a recent scoping review showed that different factors such every bit employment, may influence the recovery procedure of people with SMI.11 OT through vocational rehabilitation such as supported employment intervention could improve SMI patients' social functioning and hospitalisation, although not all SMI patients are motivated to work.12
Although scientific evidence regarding the OT interventions in patients with SMI is scarce, some studies suggest that these interventions have a beneficial issue. Arbesman and Logsdon13 carried out a systematic review in which they described a greater involvement in education and employment of people with SMI who were intervened with OT focused on social participation. Similarly, Conn et al14 showed OT to be a primal intervention for weight loss in people with SMI, improving their motivation and helping them to learn healthy lifestyles.
Currently, SMI found a significant wellness problem that imposes daily limitations on those who suffer from them. In the field of OT, although there are various interventions to increase the autonomy of people with SMI and subtract their everyday restrictions, these interventions are very diverse and supported by piffling scientific show. In this sense, this scoping review is necessary to provide a detailed summary of the dissimilar OT interventions in SMI to facilitate the elaboration of evidence-based intervention programmes. Thus, we seek to respond the following research question: Which OT interventions in adults with SMI have been most investigated in intervention studies and how they are? The objective of this review was to identify the OT interventions in adults with SMI well-nigh investigated in intervention studies and to draw their characteristics.
Methodology
We performed a peer scoping review whose content was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for Scoping Reviews.15 In addition, it was conducted following the indications of the Cochrane Manual16 and previously developed guidelines.17 18 Specifically, nosotros used the Cochrane Manual to elaborate the results section and the master tables of this scoping review. We consulted the 'iii.4.1 Clarification of studies' department of affiliate iii to know how to present the principal characteristics of the included studies, and the '3.4.3 Effects of interventions' section of chapter 3 to know how to present the characteristics of the OT interventions in SMI described in the included studies, fairly. As the Cochrane Manual recommendations are specific to systematic reviews, we contrasted these recommendations with those indicated in other specific scoping reviews guidelines/frameworks.17 18 We did not prepare a typhoon or publish a protocol for this scoping review.
Search strategy and review criteria
On 17 January 2020, we consulted the databases MEDLINE (PubMed), Scopus, Web of Science and EMBASE. These databases are widely used in review studies and the majority of them are included in the optimal database combination search19 which guarantee an acceptable and efficient coverage of the scientific literature. This was supplemented by transmission searching of journals indexed in the first quartile of OT according to the SCImago Journal Rank in 2018: American Journal of Occupational Therapy, Periodical of Occupational Rehabilitation and Occupational Therapy Journal of Enquiry. We excluded the Journal of Physical and Occupational Therapy in Pediatrics (POTP) as it belongs to the paediatric customs, a criterion for exclusion from this review. In addition, gray literature was hand searched in TESEO which is a Spanish doctoral thesis database. Nosotros used the same search strategy in all databases and journals consulted, using all the disorders included in SMI, 'OT', and 'intervention' as search terms, with Boolean operators 'OR' and 'AND' (table ane).
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Table ane
Database and search strategies
In social club to update and complement our search procedure, we consulted the Psychology Database from ProQuest on 10 March 2021. This database provides abstracts and articles from central Psychology journals, many of which are indexed in PsycINFO. In addition, we reran our search strategy in all databases and journals to identify articles published from January 2020 to March 2021.
The inclusion criteria in this review were: (one) OT intervention studies in SMI: experimental, randomised, not-randomised and pilot/exploratory studies; (ii) adult population with SMI: schizophrenia, schizotypal personality disorder, delusional disorder, obsessive–compulsive disorder, schizoaffective disorder, psychotic disorder, bipolar disorder, major depressive disorder; (3) OT identified equally a discipline involved in the intervention; (iv) English language or Castilian language and (5) studies with total text available. Those studies that did not meet the established inclusion criteria were excluded.
Written report selection, data extraction and synthesis
We downloaded all titles and abstracts retrieved from all searches using Microsoft Excel. Two reviewers screened and selected the articles independently. Ane of them (MR-K) identified and removed duplicate records, and and so two review authors (L-MC-G and MR-M) independently examined titles and abstracts and removed any irrelevant papers. Finally, L-MC-G and MR-Thou examined the total texts for written report compliance with review eligibility criteria. A tertiary review author (MGdIH) resolved discrepancies betwixt these authors regarding written report inclusion. We did not critically assess the quality of the included studies because information technology is non required in scoping review15 17 18 and too because our objective was not to evaluate the efficacy or effectiveness of the OT interventions in SMI. However, the main limitations constitute in each included written report are described in online supplemental table 1 and discussed in the results section.
Supplemental fabric
A data charting model and particular definitions were drafted a priori by all authors. Nosotros used Microsoft Excel to create an 'Excel data grade'. We conducted data extraction independently using the Excel information form and presented the characteristics of included studies following the Cochrane Manual,sixteen detailing author/s and year of publication, type of study, sample, OT interventions carried out, results and limitations.
We carried out a descriptive synthesis of the results. Tables and figures were used (where possible) to present the flow of study pick process and the characteristics of the included studies. In addition, as a multidisciplinary research team, we discussed the categories to classify the different types of OT interventions in SMI that are used in the included studies.
Patient and public involvement
No patients or public were involved in this review.
Results
The initial search retrieved 1217 published articles on OT intervention in SMI, which resulted in 790 afterwards removing duplicate articles. Fifty-four studies met the inclusion criteria in abstract peer review and went on to total-text review. In this initial search, we extracted information from 12 manufactures which fulfilled the inclusion criteria for this scoping review. The complementary search on ProQuest retrieved 2068 published articles and the updated search on initial databases and journals retrieved 149 published manufactures, 23 of which fulfilled the inclusion criteria. In total, nosotros extracted data from 35 published articles on OT intervention in SMI. The study selection flowchart is shown in figure one.
Below we present the results regarding the characteristics of the studies included in this scoping review (online supplemental tabular array ane) in addition to the characteristics of the OT interventions in SMI studied in the included articles (online supplemental table ii).
Supplemental material
Main characteristics of included studies
The master characteristics of included studies are summarised in online supplemental tabular array 1. 15 of the studies were carried out in Asia, xi in Europe, 6 in North America, ane in Due south America, 1 in Oceania and 1 in South Africa. Xv of the articles included are randomised controlled trials,20–34 10 are quasi-experimental studies,35–44 five are a non-randomised experimental study45–49 and 5 are airplane pilot studies.l–54
OT interventions in SMI
We present below the specific characteristics of the OT interventions in SMI to answer our inquiry question in detail. The specific characteristics of included studies, such as the type of intervention, the duration of the intervention, the number of sessions performed or the measurement instruments used, are shown in online supplemental table ii.
Get-go, we explored if the investigators used the same type of intervention in both the control and intervention groups (online supplemental table 2). In most studies (n=18), standard OT intervention or pharmacological treatment was performed in both the control and intervention groups.twenty 23 24 26–28 30 32 33 twoscore 42 44 47 48 50–53 Nonetheless, in the intervention group, treatment was reinforced by specific OT interventions in SMI, including: a home-based rehabilitation programme,20 a social cognition enhancement programme,23 an OT program focused on work reintegration,24 a collaborative journal,26 a computerised cerebral programme,27 an emotion regulation skills programme,28 a group programme for balance in ADL,30 individualised OT,32 dance therapy,33 training in shopping skills,40 activity-based OT,42 OT narrative medicine,44 weight loss psychiatric rehabilitation,47 metacognitive training,48 a prevocational programme,50 a plan to reconnect patients with a significant activity,51 an OT plan focused on expressive activities52 and an early OT intervention.53
In the remaining studies, both the control and intervention groups participated in a different programme (north=10),21 25 29 31 34 36 38 41 46 54 all participants received the same intervention (n=4)37 39 40 43 or participants were divided in three dissimilar study groups (north=3) (online supplemental table ii).22 45 49 In studies with both the control and intervention groups we found interventions such as an instrumental enrichment programme versus standard OT,21 a programme focused on the direction of the affliction versus traditional OT,25 a physical exercise programme versus traditional OT,29 a metacognitive program versus traditional OT,31 a habitation-visit OT programme versus a management tool for daily life performance plan,34 a recovery education program versus traditional mental health treatment,36 an aerobic trip the light fantastic program versus a manual activities programme,38 a balancing everyday life programme versus traditional OT,41 a motivational intervention versus traditional OT46 and a programme focused on executive functions versus a programme based on handmade activities.54 In the included studies with a unique study group in which all participants were treated, we found interventions such as indoor and outdoor practice program,37 a 'therapeutic package',39 care as usual and cognitive–behavioural therapy40 and a psychoeducation for schizophrenia programme.43 Finally, three studies included three study groups to compare ii different interventions with a control group: cerebral remediation therapy versus intensive OT versus healthy patients,22 project activeness group versus give-and-take grouping versus no treatment,45 and OT at the community mental health centre (CMHC) versus OT at CMHC+psychosocial skill training versus outpatient follow-up.49
2d, we analysed what blazon of SMI was treated in each written report and which was the function of the occupational therapist in the intervention team (online supplemental table 2). Schizophrenia was the almost frequent object of written report amongst the selected studies (due north=25),20–23 25 27 31–36 38 40 43 46 48–54 followed past schizoaffective disorder (n=10),23 25 27 31 32 34 45 50 51 53 major depression (northward=6),24 28 29 34 36 42 a wide spectrum of disorders or non-specific SMI (northward=5)thirty 37 41 44 47 and bipolar disorder (n=3).26 36 49 In all the articles included, an occupational therapist formed part of the professional person team, mainly equally function of a multidisciplinary team equanimous of psychologists, nurses, dieticians, physicians, sports therapists, psychiatrics, physiotherapists, breezy caregivers, pharmacists or social workers (north=18),20 23 24 26–33 36 37 43 47 50 54 and secondarily solitary (north=17).21 22 25 34 38–42 44–46 48 49 51–53
Tertiary, as we accept shown in online supplemental table ii and every bit described below, the articles analysed were classified into four conspicuously differentiated interventions, except ane study.53 In this written report the intervention used was conventional OT in schizophrenia and schizoaffective disorder. This intervention was led exclusively by an occupational therapist, the programme lasted 12 weeks with ii–5 weekly 30-min sessions and it included practice, craft and daily life skills activities.
Nosotros classified the included studies in the following four interventions:
Psychosocial intervention
Psychosocial intervention was the almost used OT intervention in the included studies (n=14).20 26 xxx 32 34 40–42 45 46 49 50 52 54 In full general, these interventions are performed exclusively by occupational therapists, but in five studies this intervention was performed past a multidisciplinary team made up of occupational therapists, psychologists, social workers, breezy caregivers, psychiatrists or nurses.xx 26 30 fifty 54 The master objectives of psychosocial intervention were to improve the symptoms of the disorders and occupational residual, besides as the social and work reintegration of patients with SMI. Amid the different SMI treated with this intervention, psychosocial intervention was applied mainly in schizophrenia (n=8),20 34 forty 45 46 49 52 55 schizoaffective disorder (n=four),32 34 45 fifty bipolar disorder (n=two),26 49 in a broad spectrum of disorders (north=ii)30 41 and major depressive disorder (n=2).25 34
The intervention programmes lasted between 3 and ix months, and the sessions were mainly between threescore and 90 min long, although in three articles40 42 45 the duration of the plan was notably shorter, lasting only two and 4 weeks. In turn, it should be noted that in three of the studies26 xxx 41 only 1 weekly session was practical, while the rest32 34 forty 42 45 46 49 50 52 54 varied between 2 and five sessions per week. In one of the studies the number of session was not specify.20 This intervention was generally carried out in a group (n=8),26 30 xl–42 45 50 55 only in six studies was it carried out individually.20 32 34 46 49 52
Psychoeducational intervention
Psychoeducational intervention was the second most used intervention in the studies included in this review (n=9).24 25 27 35 36 39 43 44 51 Only in four studies, the intervention was performed exclusively by an occupational therapist.25 39 44 51 The primary objectives of this intervention were to improve affliction direction, to increase social abilities such as non-exact techniques, and for the patient to larn a significant action, such as reading. The primary disorder treated in these interventions was schizophrenia, although in three studies were schizoaffective disorder,25 51 in one major depression24 and in ane a wide spectrum of disorders.44
The intervention programmes lasted between iii and 9 months, and the sessions were mainly between fifty and 90 min long, although in one article the duration of the session was 120 min24 and in other ii manufactures the duration of the sessions was not specify.43 51 In two articles the duration of the programme was notably shorter, lasting only 225 and 4 weeks,43 while in one commodity the duration of the programme was notably longer, lasting 12 months.36 In 4 of the studies33 43 44 51 only 1 weekly session was applied, while the rest24 25 27 36 39 varied between ii and five sessions per calendar week. This intervention was generally carried out in a grouping (n=seven),24 27 35 36 39 43 44 only in two studies was it carried out individually.25 51
Cognitive intervention
Cognitive intervention was the tertiary about used intervention in the studies included in this review (n=7).21–23 28 31 38 48 In four manufactures the intervention was carried out exclusively by an occupational therapist.21 22 38 48 The master objective of cognitive intervention was to meliorate cognitive functions and processing strategies. The chief disorder treated with these interventions was schizophrenia, although in one study was it major depression.28
The duration of the intervention programmes was from 1 to three months, although in 1 of the studies the duration was 6 months.23 The sessions lasted between 45–60 min, but in one study26 they lasted for up to two hours, in other they lasted ninety minutes,23 and in other the duration of the intervention plan was non specify.31 In general, in all the interventions, the sessions were carried out 2–5 times a week, except in one study31 where only 1 weekly session was applied. This intervention was generally carried out in a group (north=5),23 28 31 38 48 only in two studies was it carried out individually.21 22
Practice intervention
Less frequently, an do intervention was used (n=four).29 33 37 47 In all of these studies the intervention was carried out exclusively by a multidisciplinary team fabricated upward of occupational therapists, sport therapists, physicians, sport psychologists, psychiatrics or dieticians. The main objectives of exercise interventions were to compensate cognitive impairment mutual in psychiatric disabilities, to increase the knowledge and understanding of rules and to strengthen participants' ability to work every bit part of a team. In two studies the SMI treated was non specify,37 47 in one schizophrenia was treated,33 and in ane major low was treated.29
The duration of the intervention programmes was 3 months,37 47 although in one of the studies the duration was 2 months,33 and in another the duration was only 1 month.29 The sessions lasted 30,29 40–50,33 6037 and 120 min.47 In general, the sessions were carried out 2–3 times a week, except in i study47 where merely 1 weekly session was applied. This intervention was carried out in a group in all four studies.29 33 37 47
Finally, we explored the measurement instruments used to assess the outcome of the interventions performed in each study to facilitate the elaboration of evidence-based intervention programmes. As we have shown in online supplemental table 2, different questionnaires and scales were used. Among the included studies, the use of measuring instruments on the symptoms of the illness, mood and executive functions stands out.
Symptoms of the disease
Ten studies used Positive and Negative Symptoms Scale (PANSS) to assess the symptoms of the disease,27 28 31–33 43 48–50 54 ane used Andreasen's scale for assessment of negative symptoms and Andreasen's scale for assessment of positive symptoms,52 and one used The Young Mania Rating Calibration to asses maniac symptoms.26
Mood
To assess mood, that is, low, authors used several measurement instruments and scales, such as the Montgomery Asberg Depression rating scale, the Calgary Depression Scale for Schizophrenia, the Cursory Psychiatric Rating Scale, the Beck Depression Inventory or the Hamilton Depression Rating Scale.24 26–29 31 36 53
Executive office
In add-on, investigators used a diverseness of measurement instruments to assess executive functions, including the Trail Making Test Parts A and B, the Brief Assessment of Cognition in Schizophrenia, the Behavioural Cess of the Dysexecutive Syndrome, the N-Dorsum Task and the Executive Part Performance Test.twenty 22 32 38 forty 50 54
Other outcomes
To a bottom extent, other questionnaires were used to evaluate memory20–22 27 29 38 45 50 such as Wechsler Developed Intelligence Scale, the General Bent Test Battery, Rey Auditory Verbal Learning Exam, the Rey'southward Complex Effigy or Mini-mental state examination; psychosocial functioning21 30 32 34 39 49 such every bit the Global Assessment of Functioning, the Personal and Social Functioning or the Social Performance Scale and quality of life25 27 30 34 39 41 42 such as the 36-Item Short-Class Wellness Survey (SF-36) questionnaire, the General Health Questionnaire and the Manchester Brusk Assessment of Quality of Life.
Main results of included studies
We summarised the principal results of OT interventions in SMI in online supplemental table ane. In general, intervention groups obtained improve results than command groups in all the studies, although in five of the studies included both intervention and control groups presented better results after intervention.24 27 34 35 37 twoscore 43 Authors showed that the interventions carried out in their studies resulted in significant improvements in aspects such as participation and social functioning (northward=19),xx 21 23–25 xxx 32–34 39 40 42 44–46 48 49 51 54 cognitive functioning (north=11),21 22 29 31 32 35 36 40 47 50 53 that is, executive function and retention; general symptoms (n=8)27–30 33 49 fifty 52 and well-being (northward=5),28 36 37 43 47 although, in 3 studies, these improvements were no longer presented during follow-upwardly.24 30 36 In fact, it should exist noted that in only three of the included studies,26 38 41 the improvements found were not statistically significant.
Primary limitations reported in included studies
All the studies reported limitations (online supplemental table one). Well-nigh of the studies included in this review take a modest sample size (north=22),20 22–25 29 31 33 37–40 44 45 47 49–54 take not evaluated the long-term effects of the intervention (n=11),20 24 32 33 35 39 42 45 49 51 53 are non-blinding studies (n=x),26 27 thirty 32 34 38 40 42 49 53 have results which are non generalisable (north=7),22 33 37 40 42 47 53 accept a lack of randomisation (n=five)36 38 47 48 50 or they do non take a comparison group (n=6).33 35 37 39 43 50
Discussion
The nowadays scoping review aimed to identify the about investigated OT interventions in adults with SMI in intervention studies and to describe their characteristics. We explored the scientific show bachelor in this regard in several databases and journals, in which nosotros institute 35 articles with different types of interventions in which occupational therapists collaborated. We found four articulate types of OT intervention in SMI: psychosocial, psychoeducational, cerebral and practise interventions. The manufactures included in this review provide insight into the current characteristics of OT interventions in people with SMI and could provide occupational therapists with new ideas and perspectives for the implementation, development and evaluation of their interventions.
In this review, more than half (lx%) of the selected articles were published in the terminal decade. These results may show that although recent evidence regarding OT interventions in a mental wellness setting is express, at that place has been an increasing number of publications related to SMI over recent years. Moreover, the oldest articles included in this review are from the year 199920 45 which appears to show that OT is non a relatively new healthcare subject area, only that scientific research in the field of OT has been carried out for several years. This inquiry started very early, in fact The Globe Federation of Occupational Therapists meetings began in 1951,55 and in some countries, similar Espana, the first health section including an OT service was set in 1969.56
In general, the included manufactures showed that OT intervention had beneficial results in several SMI patients' health outcomes such as noesis, social skills or mood. These positive results could be the consequence of publication bias or the consequence of the study limitations such every bit pocket-size sample size, lack of randomisation or non-blinded researchers, which could compromise their validity. However, the significance of the associations establish in the included articles should not be influenced by these limitations. In fact, some reviews have pointed out the effectiveness of OT interventions in SMI aimed at facilitating work,13 community integration57 or weight loss.58 Moreover, OT has been identified as a non-pharmacological approach that tin be an important adjunct to other psychiatric treatments.8
In this review, the most widely described OT intervention in SMI amidst the included studies was the psychosocial intervention followed by psychoeducational, cognitive and exercise intervention. 1 reason could be that psychosocial impairments should rather be seen as a consequence of chronic mental disease.59 Their improvement and a patient's greater power to participate socially are the central treatment goals. How well this can exist accomplished and through which intervention must be investigated in scientific studies. Another reason could exist the fact that we only included those articles where occupational therapists were one of the professionals who performed the interventions in SMI. In this sense, OT is a discipline that rehabilitates the patient through the utilize of occupation and meaningful activities so that they tin acquire the greatest level of autonomy and daily life functioning.lx Thus, it is possible that occupational therapists use psychosocial and psychoeducational interventions more frequently than other professionals, since social limitations are non but one of the most relevant symptoms of SMI but are also closely related to an impairment in daily life performance.61 Cognitive or exercise interventions, on the other hand, are probably performed more than frequently by other professionals such as psychologist or physicians. In fact, in this review, the intervention was led exclusively by an occupational therapist in seventeen manufactures, nine of which were psychosocial interventions,32 34 40–42 45 46 49 52 and four psychoeducational interventions.25 39 44 51
Psychosocial, psychoeducational, cognitive and do interventions were the main interventions that nosotros institute based on our search strategy and inclusion criteria. However, there are other interventions that can exist used in SMI from OT such every bit vocational, individual placement and support (IPS) and identify beginning then railroad train interventions.62 63 These interventions are usually aimed at helping people with SMI to find and maintain competitive employment also as promote recovery and overcome barriers to participation in their jobs .62 64 An explanation for the non-inclusion of these types of interventions may be the fact that we only included those articles in which the occupational therapist was involved in the intervention and this was clearly specified. It would be interesting to conduct more review studies that specifically address this type of interventions.
Based on the synthesis of information on the characteristics of the interventions carried out in the manufactures included, we could say that a 'typical' OT program intervention in SMI can include the post-obit characteristics: group intervention in patients with schizophrenia, performed by a multidisciplinary team (in which an occupational therapist collaborates), with 2–iii weekly 60 min sessions, and a duration of between three and 6 months. None of the articles contained an explanation every bit to why they chose these characteristics for their intervention programmes, but nearly of the articles mentioned that the interventions were carried out in private mental wellness centres, then these characteristics may exist influenced past the regulations/policy of each centre. SMI symptomatology, that is, social difficulties, represents some other possible factor that may influence the characteristics of the interventions; carrying out a grouping intervention could favour the patient's opportunities for peer contact and emotional, practical and peer support, within a safe environment for them.65
In general, regardless of the type of intervention performed in each study, the results of the articles included in this review showed positive effects of OT interventions. Psychosocial interventions resulted in improvements in the symptoms, occupational residue and sociooccupational reintegration of the patients. Other studies supported these improvements, particularly of psychosocial interventions based on action and lifestyle, and those focused on vocational and occupational rehabilitation.66–68 Psychoeducational intervention showed favourable results in these people's self-perceived health and social participation. Similarly showed Doroud et al69 and Petersen et al,seventy who pointed out that participating in meaningful activities is experienced equally a break from the discomfort acquired by symptoms and as a means to rediscover forgotten resources and reconnect with daily life. Cognitive interventions led to improvements in memory and executive functions and consequently in SMI patients' functionality and participation. These results are in line with those found by Wykes et al71 which showed that an intervention based on cognitive remediation could reduce cerebral deficits, achieving a brusque-term impact on social functioning. Exercise interventions improved well-existence, alertness and depression symptoms. Similar results were institute in recent published studies72–74 and additionally, was found a relationship between exercise interventions and healthy lifestyles acquisition74
The measurement instruments used in the included articles to assess these outcomes varied widely between studies. Therefore, providing a synthesis of the information regarding this characteristic of the OT intervention in SMI was practically impossible for us. In general terms, PANSS was the most widely used scale among the included studies. This is consequent with the rest of the results of this scoping review if we consider that it is a specific instrument widely used to assess the presence of symptoms in schizophrenia,75 which is this the most studied type of SMI in this scoping review. Moreover, this was non the only exam used to assess the illness symptoms, which were the chief health consequence assessed among the included studies. Because that psychosocial intervention was the most used intervention, nosotros expected to find social skills as the 2d main wellness result assessed in the included studies only, instead, it was mood, that is to say, depression, followed by executive. Interestingly, mood cess was generally performed on articles retrieved from the ProQuest psychology database (information not shown). We found that mood was i of the most studied outcomes in the included studies, and it may exist partly explained past the fact that people with SMI often experience stigma which tin produce consequences that tin can exist related to depression mood, such as burden, feelings of embarrassment or shame and poor quality of life .76 In addition, people with SMI oft nowadays other chronic conditions that coexist with the SMI,77 which tin too exist related to mood impairment.
We highlight the implications of this review for the practice of OT and like professionals. This scoping review provides occupational therapists with tools that facilitate the development of OT intervention sessions in SMI by knowing in accelerate some characteristics of these iv types of intervention: psychosocial, psychoeducational, cognitive and exercise. Somehow, this updated summary of the scientific evidence that exists on SMI interventions could exist useful for occupational therapists to perform evidence-based OT, although the information presented in this review should be interpreted with caution because we did not assess the quality of the included studies.
Strengths and limitations
This scoping review presents some limitations that may influence the results obtained. Although a systematic peer review was used to ensure scientific rigour, the lack of abyss of the data reported, the publication bias limiting nil results intervention and selection bias are limitations for the majority of reviews. Regarding the inclusion criteria, we only included those studies published in Spanish or English and with total text bachelor, we may, therefore, not have included pregnant articles because they were published in another language, this may exist a potential source of bias. In improver, information technology was hard to establish the search strategy because the disorders included in SMI spectrum were non clearly defined in published articles. Thus, we decided to apply the WHO definition of SMI, which includes schizophrenia and related conditions, bipolar disorder and moderate and severe depression.78 This could lead to the non-inclusion of other relevant articles whose study population was other mental illnesses that could too be serious such every bit anxiety, addiction, personality disorders or eating disorders. Moreover, we only included in this review those articles where occupational therapists were one of the professionals who performed the interventions in SMI. Thus, we may non have included some manufactures in which occupational therapist was involved in the intervention but this was not conspicuously specified in the written report, which favoured the selection bias. In this sense, we accept not included studies in which IPS, vocational or kickoff place then train interventions were used, which may lead to an incomplete overview of current OT interventions in SMI. Regarding the studies included in this review, it is possible that they contained biases associated with the experimental study design, which was the only type of study included in this review. In improver, nosotros did non assess the quality of the terminal selected articles, so we could have included some articles with depression methodological quality. However, nosotros collected and presented the main limitations reported in included studies in an endeavour to provide readers with information closely related the quality of the studies. Furthermore, not all the manufactures included mensurate the same variables or use the same measurement instruments. Although our objective was non to statistically analyse the numerical results, the peachy variety of measurement instruments used made difficult to compare the results between studies and to draw conclusions. Thus, the results of this scoping review must be interpreted with circumspection.
However, this review likewise has several strengths. This is a necessary and original review, because to our cognition, in that location is no other review whose aim was to describe the OT interventions which are most often used in intervention studies. In addition, scoping reviews stands out for their power to place knowledge gaps on the discipline of written report, which provides opportunity for future research. This review highlights the post-obit knowledge gaps: (one) to our knowledge, there are no OT intervention studies in SMI in Kingdom of spain; (two) most of the studies had limitations that could compromises the validity of their results, such as: pocket-size sample size and lack of randomisation, (3) most of the included studies are supported by little show of the furnishings of long-term interventions; (4) at that place is a wide diversity of measurement instruments that differ between studies and (5) there is a depression representation of IPS, vocational and place commencement and then railroad train interventions studies in which the office of the occupational therapist was clearly specified. The results of this scoping review may provide a useful theoretical ground on which to develop new OT interventions in SMI. Especially for researchers developing interventions based on The Medical Research Council (MRC) Framework,79 who can use the results presented in this review to complete the offset stage of this framework: 'Developing complex intervention', specifically the stage ane.one 'Identifying bear witness base of operations by reviewing published literature and existing systematic reviews'. Yet, it would be necessary to supplement this data with the results of some systematic reviews, as indicated by the recommendations of the MRC framework.
In decision, the most investigated OT interventions in SMI were psychosocial, psychoeducational, cognitive and exercise interventions. These interventions are commonly group interventions in patients with schizophrenia, performed by a multidisciplinary team (in which an occupational therapist collaborates), with two–3 weekly threescore min sessions, and a duration of betwixt three and 6 months. Moreover, although there are different interventions and each ane covers different aspects, they all have a common objective: to reduce, through occupation, the limitations that SMI cause in patients, thus improving their quality of life. Although previous studies have shown beneficial effects of the interventions described in this review, further inquiry is required to conspicuously ascertain parameters such every bit optimal dose and frequency of sessions, and to understand the long-term effects of the interventions. In the case of the MRC framework, farther studies are needed to proceed with the stage 2 'Assessing feasibility and piloting methods'.
Data availability statement
All information relevant to the report are included in the commodity or uploaded as online supplemental data. No additional data available, all data relevant to the written report are included in the commodity.
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Patient consent for publication
Acknowledgments
We would like to acknowledge the English revision made by Jessica Gorlin.
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Source: https://bmjopen.bmj.com/content/11/10/e047467
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