This qualitative study systematically examined occupational therapists’ use of a model of human occupation intervention, the Remotivation Process, for individuals with dementia.
Method
An international sample of therapists participated in an on-line survey and in-depth interviews, resulting in 33 respondents and eight participants, respectively. The survey gathered general information regarding therapists’ use of the Remotivation Process with persons experiencing dementia, and was used to recruit interview participants. Interviews were conducted using SKYPE or telephone, and were audio-recorded and transcribed. Descriptive statistics were derived from the survey results, and van Manen’s phenomenological approach was used to describe therapists’ experiences using the intervention.
Results
Use of the Remotivation Process for this population was most common among mid-career therapists, and a majority of respondents had been using the intervention less than two years. Three themes identified from the interviews were: (1) Therapist beliefs: Commitment to the Remotivation process; (2) Does it work? Evaluating success; (3) It's more than me: External factors.
Conclusion
Survey and interview data revealed that use of the Remotivation Process intervention for persons experiencing dementia is fairly complex yet clinically applicable. Therapists’ experiences of using the Remotivation Process underscored the importance of therapist volition and clinical reasoning in achieving desired outcomes.
American Occupational TherapyAssociation (2010) Standards of practice for occupational therapy. American Journal of Occupational Therapy64(Suppl.): S106–S111.
2.
American Psychiatric Association Work Group on Alzheimer’s Disease and OtherDementias (2007) American psychiatric association practice guideline for the treatment of patients with Alzheimer’s disease and other dementias, 2nd ed. American Journal of Psychiatry164(12): 5–56.
3.
AndersenCKWittrup-JensenKULolkA, et al. (2004) Ability to perform activities of daily living is the main factor affecting quality of life in patients with dementia. Health and Quality of Life Outcomes2(52): 1–7.
4.
BaldelliMVPradelliJMZucchiP, et al. (2007) Occupational therapy and dementia: The experience of an Alzheimer special care unit. Archives of Gerontology and Geriatrics44(Suppl.): 49–54.
5.
BianchettiATrabucchiM (2004) Behavioural and psychological symptoms of dementia: Clinical aspects. Neuroscience Research Communications35(3): 173–183.
6.
Cohen-MansfieldJJensenB (2008) Assessment and treatment approaches for behavioral disturbances associated with dementia in the nursing home: Self-reports of physicians’ practices. Journal of the American Medical Directors Association9(6): 406–413.
7.
CurtinMFosseyE (2007) Appraising the trustworthiness of qualitative studies: Guidelines for occupational therapists. Australian Occupational Therapy Journal54: 88–94.
8.
de las HerasCGLlerenaVKielhofnerG (2003) A User’s Manual for Remotivation Process: Progressive Intervention for Individuals with Severe Volitional Challenges, Chicago, IL: The Model of Human Occupation Clearinghouse, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago.
9.
de las HerasCGLlernaVKielhofnerG, et al. (2007) A User’s Manual for the Volitional Questionnaire, Chicago, IL: The Model of Human Occupation Clearinghouse, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago.
FrakerJKalesHCBlazekM, et al. (2014) The role of the occupational therapist in the management of neuropsychiatric symptoms of dementia in clinical settings. Occupational Therapy in Health Care28(1): 4–20.
12.
GauthierSCummingsJBallardC, et al. (2010) Management of behavioral problems in Alzheimer’s disease. International Psychogeriatics22(3): 346–372.
13.
GitlinLNWinterLBurkeJ, et al. (2008) Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: A randomized pilot study. The American Journal of Geriatric Psychiatry16(3): 229–239.
14.
GraffMJLVernooij-DassenMJMThijssenM, et al. (2006) Community based occupational therapy for patients with dementia and their caregivers: Randomized controlled trial. British Medical Journal333: 1196–1201.
15.
GraffMJLVernooij-DassenMJMThijssenM, et al. (2007) Effects of community occupational therapy on quality of life, mood, and health status in dementia patients and their caregivers: A randomized controlled trial. Journals of Gerontology Series A: Biological Sciences and Medical Sciences62(9): 1002–1009.
16.
GraneheimUHJanssonL (2006) The meaning of living with dementia and disturbing behavior as narrated by three persons admitted to a residential home. Journal of Clinical Nursing15(11): 1397–1403.
17.
HolmesC (2008) Dementia. Psychiatric Aspects of General Medicine36(9): 467–470.
18.
HyperResearch 2.8.3. (2009) Computer Software. ResearchWare, Inc., 2009. Available at: www.researchware.com (accessed 1 September 2011).
19.
KielhofnerG (2008) Model of Human Occupation: Theory and Application, 4th ed. Baltimore, MD: Lippincott Williams & Wilkins.
20.
KolanowskiAFickDFrazerC, et al. (2010) It’s about time: Use of nonpharmacological interventions in the nursing home. Journal of Nursing Scholarship42(2): 214–222.
21.
LeeSUForsythKMeltonJ, et al. (2011) Practice development efforts impact on mental health rehabilitation: Results-based health care implications. International Journal of Therapy and Rehabilitation18(11): 602–609.
22.
LeeSUTaylorRRKielhofnerG, et al. (2008) Theory use in practice: A national survey of therapists who use the model of human occupation. American Journal of Occupational Therapy62(1): 106–117.
23.
LyketsosCGCarrilloMCRyanJM, et al. (2011) Neuropsychiatric symptoms in Alzheimer’s disease. Alzheimer’s & Dementia, The Journal of the Alzheimer’s Association7(5): 532–539.
24.
MaherRL (2004) The pharmacological approach of behavioral disturbances in dementia. Journal of Pharmacy Practice17(2): 129–132.
25.
MeltonJForsythKFreethD (2010) A practice development programme to promote the use of the model of human occupation: Contexts, influential mechanisms and levels of engagement amongst occupational therapists. British Journal of Occupational Therapy73(11): 549–558.
26.
National Institute for Health and ClinicalExcellence (2012) Dementia: Supporting People with Dementia and their Careers in Health and Social Care, London: National Institute for Health and Clinical Excellence.
27.
PattonMQ (2002) Qualitative Research and Evaluation Methods, 3rd ed. Thousand Oaks, CA: SAGE.
28.
PepinGGueretteFLefebvreB, et al. (2008) Canadian therapists’ experiences while implementing the model of human occupation remotivation process. Occupational Therapy in Health Care22(2–3): 115–124.
29.
PulsfordDDuxburyJ (2006) Aggressive behaviour by people with dementia in residential care settings: A review. Journal of Psychiatric and Mental Health Nursing13(5): 611–618.
30.
RaberCTeitelmanJWattsJ, et al. (2010) A phenomenological study of volition in everyday occupations of older people with dementia. British Journal of Occupational Therapy73(11): 498–506.
31.
SchaberPLiebermanD (2010) Occupational Therapy Practice Guidelines for Adults with Alzheimer’s Disease and Related Disorders, Bethesda, MD: AOTA Press.
32.
van ManenM (1990) Researching the Lived Experience: Human Science for an Action Sensitive Pedagogy, Albany, NY: State University of New York.
33.
van Manen M (2007) Phenomenology of practice. Phenomenology and Practice 1(1): 11–30.
34.
WimoAWinbladBJonssonL (2010) The worldwide societal costs of dementia: Estimates for 2009. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association6(2): 98–103.
