Occupational therapy interventions for adults with severe mental illness: a scoping review

May combine two claims.

In all included articles, an occupational therapist formed part of the professional team, mainly as part of a multidisciplinary team (n=18) and secondarily alone (n=17).

“In all the articles included, an occupational therapist formed part of the professional team, mainly as part of a multidisciplinary team composed of psychologists, nurses, dieticians, physicians, sports therapists, psychiatrics, physiotherapists, informal caregivers, pharmacists or social workers (n=18),20 23 24 26–33 36 37 43 47 50 54 and secondarily alone (n=17).”

May combine two claims.

Psychosocial intervention was the most investigated OT intervention in SMI, followed by psychoeducational, cognitive and exercise interventions.

“The most used OT intervention was psychosocial intervention.”

• Also stated in: § Conclusion · plain

  “Psychosocial intervention was the most investigated OT intervention in SMI, followed by psychoeducational, cognitive and exercise interventions.”

• Also stated in: § OT interventions in SMI · plain

  “Psychosocial intervention was the most used OT intervention in the included studies (n=14).”

The quote only partly states this claim.

The OT interventions in SMI are usually group 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.”

The quote only partly states this claim.

The OT interventions in SMI usually involve 60 min sessions.

“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.”

May combine two claims.

Psychosocial interventions resulted in improvements in the symptoms, occupational balance and sociooccupational reintegration of the patients.

“Psychosocial interventions resulted in improvements in the symptoms, occupational balance and sociooccupational reintegration of the patients.”

May combine two claims.

Exercise interventions improved well-being, alertness and depression symptoms.

“Exercise interventions improved well-being, alertness and depression symptoms.”

May combine two claims.

Mood, that is, depression, was the second main health result assessed in the included studies, followed by executive.

“we expected to find social skills as the second main health result assessed in the included studies but, instead, it was mood, that is to say, depression, followed by executive.”

May combine two claims.

Cognitive interventions led to improvements in memory and executive functions and consequently in SMI patients' functionality and participation.

“Cognitive interventions led to improvements in memory and executive functions and consequently in SMI patients’ functionality and participation.”

May combine two claims.

A typical OT programme intervention in SMI can include group intervention 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 between 3 and 6 months.

“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 between 3 and 6 months.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Mood assessment was generally performed on articles retrieved from the ProQuest psychology database.

“Interestingly, mood assessment was generally performed on articles retrieved from the ProQuest psychology database (information not shown).”

May combine two claims.

In this review, the intervention was led exclusively by an occupational therapist in seventeen articles, nine of which were psychosocial interventions, and four psychoeducational interventions.

“In fact, in this review, the intervention was led exclusively by an occupational therapist in seventeen articles, nine of which were psychosocial interventions,32 34 40–42 45 46 49 52 and four psychoeducational interventions.25 39 44 51”

• cites 32 34 40–42 45 46 49 52Not checked yet

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• cites 25 39 44 51Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Two reviewers screened and selected the articles independently.

“Two reviewers screened and selected the articles independently.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The study screening was peer-reviewed.

“The study screening was peer-reviewed.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A data charting model and item definitions were drafted a priori by all authors.

“A data charting model and item definitions were drafted a priori by all authors.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Cognitive or exercise interventions are probably performed more frequently by other professionals such as psychologist or physicians.

“Cognitive or exercise interventions, on the other hand, are probably performed more frequently by other professionals such as psychologist or physicians.”

May combine two claims.

These other interventions are usually aimed at helping people with SMI to find and maintain competitive employment as well as promote recovery and overcome barriers to participation in their jobs.

“These interventions are usually aimed at helping people with SMI to find and maintain competitive employment as well as promote recovery and overcome barriers to participation in their jobs.62 64”

• cites [62] Roeg, 2020, iPS in supported housing: fidelity and employment outcomes over a 4 year period, Front Psychiatry sourceNot checked yet

  Not checked in the free run.

• cites [64] Akasyah, 2020, Vocational rehabilitation based recovery of patients with mental disorders (ODGJ), Sjik sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The recent increase in publications related to SMI over recent years may show that although recent evidence regarding OT interventions in mental health is limited, there has been an increasing number of publications.

“These results may show that although recent evidence regarding OT interventions in a mental health setting is limited, there has been an increasing number of publications related to SMI over recent years.”

May combine two claims.

Other OT interventions for SMI include vocational, individual placement and support (IPS), and place first then train interventions.

“However, there are other interventions that can be used in SMI from OT such as vocational, individual placement and support (IPS) and place first then train interventions.62 63”

• cites [62] Roeg, 2020, iPS in supported housing: fidelity and employment outcomes over a 4 year period, Front Psychiatry sourceNot checked yet

  Not checked in the free run.

• cites [63] Prior, 2020, An enhanced individual placement and support (iPS) intervention based on the model of human occupation (MOHO); a prospective cohort study, BMC Psychiatry sourceNot checked yet

  Not checked in the free run.

May combine two claims.

It is possible that occupational therapists use psychosocial and psychoeducational interventions more frequently than other professionals, since social limitations are not only one of the most relevant symptoms of SMI but are also closely related to an impairment in daily life functioning.

“Thus, it is possible that occupational therapists use psychosocial and psychoeducational interventions more frequently than other professionals, since social limitations are not only one of the most relevant symptoms of SMI but are also closely related to an impairment in daily life functioning.61”

• cites [61] sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The positive results of OT interventions in the included articles could be due to publication bias or study limitations such as small sample size, lack of randomisation or non-blinded researchers, which could compromise their validity.

“These positive results could be the consequence of publication bias or the consequence of the study limitations such as small sample size, lack of randomisation or non-blinded researchers, which could compromise their validity.”

May combine two claims.

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.

“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”

• cites [12] sourceNot checked yet

  Not checked in the free run.

May combine two claims.

People with SMI often experience stigma which can produce consequences that can be related to low mood, such as burden, feelings of embarrassment or shame and poor quality of life.

“people with SMI often experience stigma which can produce consequences that can be related to low mood, such as burden, feelings of embarrassment or shame and poor quality of life.76”

• cites [76] Javed, 2021, Reducing the stigma of mental health disorders with a focus on low- and middle-income countries, Asian J Psychiatr sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Similar results were found in recent published studies and a relationship was found between exercise interventions and healthy lifestyles acquisition.

“Similar results were found in recent published studies72–74 and additionally, was found a relationship between exercise interventions and healthy lifestyles acquisition74”

• cites [72] Ng, 2020, Activity participation and perceived health status in patients with severe mental illness: a prospective study, East Asian Arch Psychiatry sourceNot checked yet

  Not checked in the free run.

• cites [73] Ringen, 2018, Using motivational techniques to reduce cardiometabolic risk factors in long term psychiatric inpatients: a naturalistic interventional study, BMC Psychiatry sourceNot checked yet

  Not checked in the free run.

• cites [74] Korman, 2020, Feasibility and acceptability of a student-led lifestyle (diet and exercise) intervention within a residential rehabilitation setting for people with severe mental illness, go heart (group occupation, health, exercise and rehabilitation treatment), Front Psychiatry sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

These characteristics may be influenced by the regulations/policy of each centre.

“so these characteristics may be influenced by the regulations/policy of each centre.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The categories to classify OT interventions were discussed by a multidisciplinary research team.

“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.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Data extraction was conducted independently using the Excel data form.

“We conducted data extraction independently using the Excel data form and presented the characteristics of included studies following the Cochrane Manual,16”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The review was conducted following the Cochrane Manual and previously developed guidelines.

“In addition, it was conducted following the indications of the Cochrane Manual16 and previously developed guidelines.17 18”

• cites [16] Higgins J , Green S . Cochrane Handbook for systematic reviews of interventions. The Cochrane collaboration, 2011. Available: http://handbook.cochrane.org/ [Accessed 16 February 2020].Not checked yet

  Not checked in the free run.

• cites [17] sourceNot checked yet

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• cites [18] sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The review did not include studies using IPS, vocational or place first then train interventions, which may lead to an incomplete overview of current OT interventions in SMI.

“we have not included studies in which IPS, vocational or first place then train interventions were used, which may lead to an incomplete overview of current OT interventions in SMI.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The oldest articles from 1999 appear to show that OT is not a relatively new healthcare discipline, but scientific research in OT has been carried out for several years.

“Moreover, the oldest articles included in this review are from the year 199920 45 which appears to show that OT is not a relatively new healthcare discipline, but that scientific research in the field of OT has been carried out for several years.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Conn et al showed OT to be a key intervention for weight loss in people with SMI, improving motivation and helping them acquire healthy lifestyles.

“Similarly, Conn et al14 showed OT to be a key intervention for weight loss in people with SMI, improving their motivation and helping them to acquire healthy lifestyles.”

• cites [14] Conn, 2019, Occupational therapy intervention addressing weight gain and obesity in people with severe mental illness: a scoping review, Aust Occup Ther J sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The databases used are widely used in review studies and guarantee adequate and efficient coverage of the scientific literature.

“These databases are widely used in review studies and the majority of them are included in the optimal database combination search19 which guarantee an adequate and efficient coverage of the scientific literature.”

• cites [19] Bramer, 2017, Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study, Syst Rev sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

People with SMI often present other chronic conditions that coexist with the SMI, which can also be related to mood impairment.

“In addition, people with SMI often present other chronic conditions that coexist with the SMI,77 which can also be related to mood impairment.”

• cites [77] sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

A systematic peer review was used to ensure scientific rigour.

“Although a systematic peer review was used to ensure scientific rigour”

May combine two claims.

The review used the WHO definition of SMI, which includes schizophrenia and related conditions, bipolar disorder and moderate and severe depression, which could lead to non-inclusion of other relevant articles on other serious mental illnesses.

“Thus, we decided to use 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 also be serious such as anxiety, addiction, personality disorders or eating disorders.”

• cites [78] World Health Organization . Helping people with severe mental disorders live longer and healthier lives: policy brief. WHO, 2017.Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The review was reported using the PRISMA guidelines for Scoping Reviews.

“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”

• cites [15] sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

One reason for the predominance of psychosocial interventions could be that psychosocial impairments should rather be seen as a consequence of chronic mental illness.

“One reason could be that psychosocial impairments should rather be seen as a consequence of chronic mental illness.59”

• cites [59] Gühne, 2020, Psychosocial therapies in severe mental illness: update on evidence and recommendations, Curr Opin Psychiatry sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The review only included articles where occupational therapists were one of the professionals who performed the interventions in SMI, which may have excluded articles where the occupational therapist was involved but not clearly specified, favouring selection bias.

“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 not have included some articles in which occupational therapist was involved in the intervention but this was not clearly specified in the study, which favoured the selection bias.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A third review author resolved discrepancies between reviewers regarding study inclusion.

“A third review author (MGdIH) resolved discrepancies between these authors regarding study inclusion.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

No draft or published protocol was prepared for this scoping review.

“We did not prepare a draft or publish a protocol for this scoping review.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

SMI symptomatology, that is, social difficulties, represents another possible factor that may influence the characteristics of the interventions; carrying out a group intervention could favour the patient's opportunities for peer contact and emotional, practical and peer support, within a safe environment for them.

“SMI symptomatology, that is, social difficulties, represents another possible factor that may influence the characteristics of the interventions; carrying out a group intervention could favour the patient’s opportunities for peer contact and emotional, practical and peer support, within a safe environment for them.65”

• cites [65] Morant, 2021, Acute day units for mental health crises: a qualitative study of service user and staff views and experiences, BMC Psychiatry sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The review only included studies published in Spanish or English and with full text available, which may have excluded significant articles published in another language, a potential source of bias.

“we only included those studies published in Spanish or English and with full text available, we may, therefore, not have included significant articles because they were published in another language, this may be a potential source of bias.”

May combine two claims.

Not all articles included measured the same variables or used the same measurement instruments, making it difficult to compare results and draw conclusions.

“not all the articles included measure the same variables or use the same measurement instruments. Although our objective was not to statistically analyse the numerical results, the great variety of measurement instruments used made difficult to compare the results between studies and to draw conclusions.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

This is a necessary and original review, because to our knowledge, there is no other review whose aim was to describe the OT interventions which are most often used in intervention studies.

“This is a necessary and original review, because to our knowledge, there is no other review whose aim was to describe the OT interventions which are most often used in intervention studies.”

• AssumptionRests on an assumption: No other review aims to describe the OT interventions most often used in intervention studies.

Classified as probably not a substantial claim. May combine two claims.

Although there are different interventions and each one 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.

“Moreover, although there are different interventions and each one 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.”