British Journal of Occupational Therapy

Occupational therapy (OT) has a rich history of integrating physical and mental health care services, however, there is a limited evidence base regarding the effectiveness of OT interventions for mental health disorders in primary care.

A comprehensive systematic review was conducted from database inception through 31 January 2021. Eligible studies had to include: (1) an intervention that involved an occupational therapist in design and/or implementation; (2) a quantitative outcome assessing symptoms related to a mental health disorder; (3) a comparison group; and (4) primary care or community dwelling patients and/or primary care clinical settings.

The researchers identified five studies and there was heterogeneity in the OT interventions. There were no significant differences between intervention and control groups in depression symptoms at different time intervals. Several trials employed interventions that involved interprofessional team members, including OTs, to provide training in specific strategies that promoted functioning. Other studies utilized only OTs within the intervention arm. OT interventions demonstrated no significant difference in anxiety in one study, however, another indicated a reduction in symptoms. The overall risk of bias was considered low in three studies and unclear in two studies.

There is limited evidence demonstrating the impact of OT interventions in primary care settings on quantitative outcomes measuring symptoms related to a mental health disorder. Given the heterogeneity of interventions and variation in reported findings, there is need for further pragmatic trials in this area.

The development of professional attitude evolves over time and contributes to the formation of professional identity. This study tracked formation of professional identity by comparing professional attitudes of three cohorts: new graduates, final-year, and first-year students of occupational therapy.

The online survey, including a 5-point Likert scale 17-item questionnaire and one qualitative inquiry using an incomplete statement, revealed the perception and future career prospects of 144 novice practitioners and students of occupational therapy. Written statements were compared to each other to provide insight about the participants’ perspectives during the three time periods.

One-way ANOVA indicated that there were significant differences in professional attitudes among the three cohorts (F (2, 141) = 14.32, p < 0.0001), demonstrating a downward trend in professional identity formation. The comparison analysis of statements confirmed the quantitative results and highlighted an issue of negative professional identity through indicating great concerns over the future career prospects.

Despite increased awareness of occupational therapy over time, these participants seemed to have had trouble developing a sound sense of professional identity. Possible sources and solutions for this issue were discussed, to better facilitate a clear sense of professional identity in occupational therapy students and practitioners.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a poorly understood, highly stigmatised health condition that has widespread impacts on the individual. Currently, there is limited understanding of the ME/CFS experience from an occupational perspective within Australia. This study aimed to explore the lived experience of ME/CFS and subsequent disruption to occupational participation for adults living in Australia.

Using descriptive case study design, five participants with ME/CFS in Australia completed semi-structured interviews. Reflexive thematic analysis was used to analyse the qualitative data.

Themes identified were organised using the Person-Environment-Occupation model. Participants reported systemic changes to previous levels of physical, cognitive and affective functioning, resulting in significant occupational disruption and poor well-being. Occupational prioritisation was followed by a loss of occupations starting with leisure, then productivity and eventually self-care. Environmental barriers to participation included stigma and misunderstanding of ME/CFS, financial hardship, lack of appropriate health services and strains on personal support networks and relationships.

Changes to occupational performance following the onset of ME/CFS caused significant occupational disruption and resulted in limited participation which narrowed over time. There is a clear role for occupational therapy to intervene early to prevent significant negative impacts on occupational participation for people with ME/CFS.

Children encounter several types of sensory input from their daily living environments and take in and process this information using their sensory systems. Few studies have considered the impact of children’s sensory preferences on their activity participation. This study investigated the relationship between children’s sensory processing factors and the daily activities they chose to participate in.

Twenty-three parents of typically developing school-aged children completed the Sensory Processing Measure Home Form and Children Participation Questionnaire-School. Spearman correlations were conducted between sensory preferences and participation, as measured by frequency, intensity, independence level, children’s enjoyment and parental satisfaction. Regression models were also completed between each of the participation measures and sensory processing factors.

Sensory processing accounted for 69.8% (p = 0.001) of participation diversity’s total variance with unique contributions made by body awareness (proprioception) and planning and ideas (p = 0.040); 45.9% (p = 0.024) of participation intensity’s variance with touch made a unique contribution (p = 0.030) and 42.4% (p = 0.034) of participation independence’s variance with body awareness (proprioception) made a unique contribution (p = 0.038).

Considerations should be made for sensory processing screening for typically developing children and the impacts this could potentially have on their daily participation.

Occupational therapists have an integral role in the treatment of people with functional neurological disorder, yet there is evidence of variable implementation of occupational therapy in community settings. This study explored the barriers and enablers to delivering community-based occupational therapy to people with functional neurological disorder in the United Kingdom.

Community-based neurological occupational therapists (n = 10) with experience in functional neurological disorder were invited to complete semi-structured qualitative interviews. The interview schedule and analysis were based on the Theoretical Domains Framework, a behavioural science tool for investigating barriers and enablers to clinical practice. Data were analysed using a combined content and framework analysis approach.

Important barriers to treatment included limited published information to guide practice, lack of professional role clarity and restricted multidisciplinary team working. Enablers included occupational therapists’ dual training in physical and mental health and focus on activity engagement. Service provision, quality and access varied across geographical locations.

Occupational therapists are uniquely placed to help people with functional neurological disorder; however, findings suggest that existing community service structures in many regions in the United Kingdom are inadequate and limit the quality of treatment that can be provided. Additional resources are required to support occupational therapy service provision in community settings.

There is recognition within the literature that the role of care-giving can have a negative impact on care-givers’ general well-being. Less is understood about the role of care-giving on an individual’s occupational participation and in turn occupational identity. Occupational therapists have a unique understanding of the interplay between occupational participation and health, though this is an area that has been under researched in relation to mental health care-givers. Therefore, the current research aims to understand how the role of care-giving for an individual with a mental illness impacts on occupational participation and identity.

A qualitative semi-structured interview the Occupational Performance and History Interview–Version 2 was utilised to understand life experiences. Six mental health care-givers were interviewed, and these interviews were transcribed for thematic analysis.

Three main themes were identified: being me, roles and responsibilities associated with care-giving and services.

The findings suggest being a mental health care-giver does have a detrimental impact on occupational participation and therefore occupational identity. As care-givers gained more experience in their role, they used occupational adaption as a positive coping mechanism that helped them achieve occupational balance. Using their unique understanding of occupational participation and occupational identity, occupational therapists are well placed to utilise their knowledge and skills to work in a systemic way supporting both the person with mental illness and their care-giver.

The issue of the health status of mothers of children with disability is one that is beginning to be addressed more fully. This study aimed to explore the process of health in mothers during caregiving of children with cerebral palsy (CP).

A qualitative research method with a grounded theory approach was used, including purposive and theoretical sampling. A constant comparative analysis method was adopted, and data were gathered from 15 mothers with CP children through interviews.

The results were grouped into six main categories: Self-neglecting of their health, facing challenges in caring their children, physical and psychosocial damages, perceiving threat of health problems from concern to action, trying to regain their health, and caring in a complex context. “Facing challenges in caring” was extracted as a core concept.

Results showed an urgent need to establish family-centered services in clinical settings and change the “way of thinking” of the health provider system.

Although play is viewed as a childhood occupation that is spontaneous, it can be limited in children with HIV/AIDS. This study explored the perspectives of caregivers from Zimbabwe on the play of children with HIV/AIDS.

A descriptive qualitative research approach was used to explore the perceptions of caregivers on play of children living with HIV/AIDS. Fifteen caregivers of children aged 4–9 years diagnosed with HIV/AIDS were purposively sampled. Two interviews were carried out with each of the caregivers. Findings were analysed thematically.

Four major themes were generated from the study: ‘Ubuntu is no more’, ‘Survival is primary (chikuru kurarama)’, ‘Play affirms that my child is still like other children’ and ‘More is required for this child’. Although issues of survival were paramount, caregivers were able to highlight the importance of play in affirming childhood, identifying the specific needs for play of children with HIV/AIDS.

Play, like all other human occupation, is contextually situated. Poverty and health status are key in shaping how families prioritise play. However, the ability to play for a child with HIV/AIDS also seems to mitigate stigma and may disrupt the ‘HIV is death’ narrative.