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Cited by 11Occupational Therapy Practice and ResearchMental Health and Patient InvolvementPsychiatric care and mental health services

The DOI matches its Crossref record; 44 of the 44 references it cites were found in a registry or an index; none of the 19 sources its claims cite is checked for support yet.

Meaningful Activities and Recovery (MA&R): a co-led peer occupational therapy intervention for people with psychiatric disabilities. Results from a randomized controlled trial

Open access
Bjørkedal, Siv-Therese Bogevik, Bejerholm, Ulrika, Hjorthøj, Carsten, Møller, Tom, Eplov, Lene Falgaard·2023·BMC Psychiatry
DOI 10.1186/s12888-023-04875-wPMC PMC10243265
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Abstract

Background: Activity and participation are critical to health and wellbeing. Limited evidence exists on how to support people with mental illness in participating in everyday activities. Aim: To investigate the effectiveness of Meaningful Activities and Recovery (MA&R), a co-led peer occupational therapy intervention focusing on activity engagement, functioning, quality of life, and personal recovery. Methods: In a statistician blinded, multicenter RCT including 139 participants from seven community and municipal mental health services in Denmark, participants were randomly assigned to 1) MA&R and standard mental health care or 2) standard mental health care. The MA&R intervention lasted 8 months and consisted of 11 group sessions, 11 individual sessions, and support to engage in activities. The primary outcome, activity engagement, was measured using Profile of Occupational Engagement in People with Severe Mental Illness (POES-S). Outcomes were measured at baseline and post-intervention follow-up. Results: Meaningful Activities and Recovery was delivered with high fidelity and 83% completed the intervention. It did not demonstrate superiority to standard mental health care, as intention-to treat analysis revealed no significant differences between the groups in activity engagement or any of the secondary outcomes. Conclusion: We did not find positive effects of MA&R, possibly because of COVID-19 and related restrictions. Fidelity assessments and adherence rates suggest that MA&R is feasible and acceptable. However, future studies should focus on refining the intervention before investigating its effectiveness. Trial registration: The trial was registered 24/05/2019 at ClinicalTrials.gov NCT03963245.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In a multicenter, statistician-blinded RCT of 139 people with psychiatric disabilities in Denmark, the co-led peer occupational therapy intervention MA&R was not superior to standard mental health care for activity engagement or secondary outcomes. Fidelity and adherence were good, but the authors suggest COVID-19 restrictions and intervention refinements may explain the null findings.

Key findings

  • Intention-to-treat analysis found no significant between-group difference in the primary outcome, activity engagement measured by POES-S: 1.1 points, 95% CI −1.9 to 3.3, p = 0.315.
  • No significant between-group differences were found for functioning, personal recovery, or quality of life; for example, QPR personal recovery differed by 1.56 points, 95% CI −2.5 to 5.7, p = 0.46.
  • MA&R was delivered with good or optimal fidelity, and 83% completed the intervention; participants attended on average 15.4 sessions (SD 5.7), comprising 7.0 group sessions (SD 3.2) and 8.3 one-on-one sessions (SD 2.9).
  • Post hoc analysis suggested a between-group POES-S difference of 2.8 points favoring MA&R before the COVID-19 lockdown (p = 0.064), but almost no difference during lockdown (0.1 points, p = 0.94).

Methods

  • Multicenter, statistician-blinded RCT including 139 participants from seven community and municipal mental health services in Denmark; participants were randomized 1:1 to MA&R plus standard mental health care (n = 70) or standard mental health care alone (n = 69).
  • MA&R lasted 8 months and consisted of 11 group sessions, 11 individual sessions, and optional individual support to engage in activities; it was co-led by occupational therapists and peer workers.
  • Primary outcome was activity engagement measured by POES-S at baseline and post-intervention; secondary outcomes included WHODAS 2.0, QPR, and MANSA. Analysis used intention-to-treat, ANOVA, multiple multivariate imputation for missing values, and post hoc within-group, COVID-19-period, and sector-based analyses.

Limitations

  • The paper states that participants and staff could not be blinded to allocation, increasing risk of expectation and collateral intervention bias; outcome measures were self-report and thus more prone to bias.
  • The paper states outcomes were measured only twice, which was insufficient to distinguish effects of MA&R components, and the trial was partly conducted during COVID-19, limiting external validity to “normal conditions.”
  • The paper states it did not obtain specific data on participants’ standard mental health care service use beyond psychiatric and somatic inpatient admissions, leaving the comparator and treatment–control contrast unclear; post hoc subgroup analyses also lacked statistical power.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12888-023-04875-w

Cites

44 of 44 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 19 cited sources checked · 0 supported · 0 flagged

  • Findingreasoning

    The utilization of individual support was much lower than anticipated when designing MA&R.

    “Thus, the utilization of individual support was much lower than we anticipated when designing MA&R.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Among subsets of participants completing post-intervention follow-up before the COVID-19 lockdown, there was a between-group difference of 2.8 points favoring the intervention group (p = 0.064).

    “When comparing the subsets of participants completing post-intervention follow-up, before and after the COVID-19 lockdown, we found a between-group difference of 2.8-points favoring the intervention group (p = 0.064) before the COVID lockdown, and almost no difference during lockdown (Table 4).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Intention-to-treat analysis showed no significant difference at post-intervention follow-up between the intervention group and the control group on the primary outcome, activity engagement (1.1, 95% CI -1.9 to 3.3, p = 0.315).

    “As shown in Table 3, intention-to-treat analysis showed no significant difference at post-intervention follow-up between the intervention group and the control group on the primary outcome, activity engagement (1.1, 95% CI: -1,9, 3,3, p = 0.315).”
    Quote in the paperSubstantial claim
  • Findingown data

    Fidelity assessments were completed for all MA&R groups, showing good or optimal fidelity to MA&R.

    “Fidelity assessments were completed for all MA&R groups, showing good or optimal fidelity to MA&R.”
    • Also stated in: § Results · plain
      “Meaningful Activities and Recovery was delivered with high fidelity”
    Quote in the paperNot a substantial claim
  • Findingown data

    Both the intervention group and the control group improved in the participation domain.

    “Both the intervention group and the control group improved in the participation domain.”
    Quote in the paperNot a substantial claim
  • It may state two separate claims as one. 26
  • Probably not a substantial claim. 28

  • It may state two separate claims as one.

    Findingown data

    MA&R did not demonstrate superiority to standard mental health care, as intention-to-treat analysis revealed no significant differences between the groups in activity engagement or any of the secondary outcomes.

    “It did not demonstrate superiority to standard mental health care, as intention-to treat analysis revealed no significant differences between the groups in activity engagement or any of the secondary outcomes.”
    • Also stated in: § Conclusion · plain
      “We did not find positive effects of MA&R”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    139 participants were enrolled and randomly allocated to MA&R plus standard mental health care (n=70) or standard mental health care alone (n=69).

    “Between September 2018 and August 2020, 139 participants were enrolled and randomly allocated to MA&R in addition to standard mental health care (n = 70) or standard mental health care alone (n = 69).”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    Post hoc analysis showed that both groups improved in activity engagement and quality of life.

    “Post hoc analysis showed that both groups improved in activity engagement and quality of life.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    The intervention and control groups did not differ at post-intervention follow-up with regard to functioning, personal recovery, or quality of life.

    “Nor did the groups differ with regard to functioning, personal recovery, or quality of life (Table 3).”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    No between-group differences were found in safety measures: psychiatric admissions, bed days, somatic admissions, or somatic bed days.

    “For safety measures, no between-group differences were found in psychiatric admissions, bed days, in somatic admissions or bed days, as shown in the supplementary table 2.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Findingreasoning

    Due to COVID-19 regulations, MA&R groups starting during COVID consisted of 4 to 5 participants, whereas MA&R groups typically included 5 to 9 participants before the lockdown.

    “Moreover, due to COVID-19 regulations, the MA&R groups starting during COVID consisted of 4 to 5 participants, whereas MA&R groups typically included 5 to 9 participants before the lockdown.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Study design and conductcitation

    The POES-S has been found to be a valid and reliable instrument for measuring activity engagement.

    “has been found to be a valid and reliable instrument for measuring activity engagement [38–40].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [38] Bejerholm U, Hansson L, Eklund M. Profiles of occupational engagement among people with schizophrenia: instrument development, content validity, inter-rater reliability, and internal consistency. Br J Occup Ther. 2006;69(2):58–68. source
    • cites [39] Bejerholm U, Eklund M. Construct validity of a newly developed instrument: profile of occupational engagement in people with schizophrenia. POES Nordic J Psychiatry. 2006;60(3):200–6. source
    • cites [40] Bejerholm U, Lundgren-Nilsson A. Rasch Analysis of the Profiles of Occupational Engagement in people with Severe mental illness (POES) instrument. Health Qual Life Outcomes. 2015;13(1):130. source

  • Probably not a substantial claim.

    Study design and conductnone given

    The analysis was based on the intention-to-treat principle.

    “The analysis was based on the “intention-to-treat” principle.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    It was not possible to blind participants or the professionals to the intervention allocation.

    “It was not possible to blind participants or the professionals to the intervention allocation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductnone given

    The trial was conducted in accordance with the Helsinki Declaration and approved by the Ethics Committee of the Capital Region, Copenhagen, Denmark and the Danish Data Protection Agency.

    “The trial was conducted in accordance with the Helsinki Declaration and approved by the Ethics Committee of the Capital Region, Copenhagen, Denmark (H-18017307) and the Danish Data Protection Agency (VD-2018–299, I-suite nr: 6543).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim.

    Premisecitation

    In an RCT, the group-based occupational therapy intervention Balancing Everyday Life (BEL) showed a small but significant effect on activity engagement.

    “In an randomized controlled trial (RCT), the group-based occupational therapy intervention Balancing Everyday Life (BEL) showed a small but significant effect on activity engagement [24].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Eklund M, Tjörnstrand C, Sandlund M, Argentzell E. Effectiveness of Balancing Everyday Life (BEL) versus standard occupational therapy for activity engagement and functioning among people with mental illness–a cluster RCT study. BMC Psychiatry. 2017;17(1):363. source

  • It may state two separate claims as one.

    Interpretationown data

    Fidelity assessments and adherence rates suggest that MA&R is feasible and acceptable.

    “Fidelity assessments and adherence rates suggest that MA&R is feasible and acceptable.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    Multiple multivariate imputation was used to handle missing values.

    “Multiple multivariate imputation was used to handle missing values.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductnone given

    Researchers were blinded to participants' allocation during data collection, analysis, and while writing the conclusion of the study.

    “Researchers were blinded to the participants’ allocation during data collection, during analysis, and while writing the conclusion of the study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    No amendments were made to the RCT methodology after the protocol paper was published.

    “No amendments were made after the paper was published.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Interpretationnone given

    COVID-19 may partly explain the low uptake of individualized support and transition of activities in the community.

    “While COVID-19 may partly explain the low uptake of individualized support and transition of activities in the community”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Interpretationreasoning

    The low use of support may also be a result of implementation failure.

    “the low use of support may also be a result of implementation failure”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Study design and conductreasoning

    The study had to include 128 participants, 64 in each group, to achieve a statistical power of 80% and a significance level of 5% and to detect a difference of 3 points corresponding to a moderate effect size on the POES-S.

    “The study had to include 128 participants, 64 in each group, to achieve a statistical power of 80% and a significance level of 5% and to detect a difference of 3 points corresponding to a moderate effect size, on the POES-S.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Eklund M, Tjörnstrand C, Sandlund M, Argentzell E. Effectiveness of Balancing Everyday Life (BEL) versus standard occupational therapy for activity engagement and functioning among people with mental illness–a cluster RCT study. BMC Psychiatry. 2017;17(1):363. source

  • Probably not a substantial claim.

    Premisecitation

    Results from a qualitative synthesis suggest that the group format may not be ideal for enabling activity engagement in the community.

    “Yet, results from a qualitative synthesis suggest that the group format may not be ideal for enabling activity engagement in the community [25].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Bjørkedal STB, Eplov LF, Møller T. The missing link-participants’ perspectives on transfer from psychosocial interventional contexts to everyday community life: a qualitative synthesis of interventional studies. BMC Psychol. 2021;9(1):1–15. source

  • It may state two separate claims as one.

    Interpretationown data

    MA&R was not superior to standard mental health care in improving activity engagement, personal recovery, functioning, or quality of life.

    “Findings from the trial did not confirm our study hypothesis, as MA&R was not superior to standard mental health care in improving activity engagement, personal recovery, functioning or quality of life.”
    • Also stated in: § Conclusion · plain
      “The trial did not provide evidence that MA&R, a co-led peer occupational therapy intervention, is superior to standard mental health care delivered in the CMCHs, ASSCs or rehabilitation teams in terms of promoting activity engagement, personal recovery, functioning or quality of life.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Conceptual practice models exist within occupational therapy literature that could have guided MA&R providers in providing support to enable activity engagement.

    “Within occupational therapy literature, conceptual practice models exist [46–48] that could have guided the MA&R providers in providing support to enable activity engagement.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [46] Taylor RR. The intentional relationship: Occupational therapy and use of self. Philadelphia: FA Davis; 2020.
    • cites [47] Bjørkedal STB, Torsting AMB, Møller T. Rewarding yet demanding: client perspectives on enabling occupations during early stages of recovery from schizophrenia. Scand J Occup Ther. 2016;23(2):97–106. source
    • cites [48] Rebeiro KL. Enabling occupation: the importance of an affirming environment. Can J Occup Ther. 2001;68(2):80–9. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductown data

    On average, participants in MA&R attended 15.4 sessions (SD 5.7), corresponding to a mean of 7.0 group sessions and 8.3 one-on-one sessions.

    “On average, participants in MA&R attended 15,4 sessions (SD: 5,7), corresponding to a mean of 7,0 (SD 3,2) group sessions and 8,3 (SD 2,9) one-on-one sessions; 14 (20%) participants attended 0–10 sessions, 33 (49%) attended 11–19 sessions, and 20 (29%) attended 20–22 sessions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may state two separate claims as one.

    Study design and conductreasoning

    The allocation sequence was stratified by sex, used varying block sizes, and was generated by a staff member external to the research team and stored away from the research team during the study period.

    “The allocation sequence was stratified by sex and used varying block sizes. To keep it unknown, the sequence was generated by a staff member external to the research team and stored away from the research team during the study period.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Premisenone given

    MA&R offered individual support, but this component of the intervention was optional.

    “Instead, MA&R offered individual support, but this component of the intervention was optional.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Study design and conductown data

    At post-intervention follow-up, 113 participants completed questionnaires providing data on at least the primary outcome, and 26 participants were lost to follow-up.

    “At post-intervention follow-up, 113 participants completed questionnaires providing data on at least the primary outcome (Questionnaires completed by participants at follow up: POES-S: n = 113, QPR: n = 113, WHODAS.2.0 12: n = 108, MANSA: n = 103, EuroQOL: n = 111); 26 participants were lost to follow-up.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Study design and conductown data

    No significant differences were found between responders and non-responders in age, sex, educational level, functioning measured using MINI ICF-APP or any of the baseline measures.

    “No significant differences were found between responders and non-responders in age, sex, educational level, functioning measured using MINI ICF-APP or any of the baseline measures.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Interpretationnone given

    The trial was partly conducted during the COVID-19 pandemic, and the results may be unique to this context, thus limiting the study's external validity when generalizing the findings to normal conditions.

    “The trial was partly conducted during the COVID-19 pandemic, and the results may be unique to this context, thus limiting the study`s external validity when generalizing the findings to “normal conditions”.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Interpretationreasoning

    As this RCT was a multicenter trial, between-group comparisons may have been blurred by differences in standard mental health care across sites.

    “As this RCT was a multicenter trial, between-group comparisons may have been blurred by differences in standard mental health care across sites.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim.

    Study design and conductnone given

    Analysis was based on intention-to-treat analysis.

    “analysis was based on intention-to-treat analysis”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Study design and conductnone given

    Randomization was conducted with adequate allocation concealment.

    “randomization was conducted with adequate allocation concealment”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Study design and conductnone given

    MA&R was delivered with good and optimal fidelity.

    “MA&R was delivered with good and optimal fidelity”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may state two separate claims as one.

    Interpretationcitation

    Although the IPS intervention is useful for enabling participation in work and education, it may not be applicable in other areas of everyday life.

    “Although the IPS intervention is useful for enabling participation in work and education, it may not be applicable in other areas of everyday life.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Bjørkedal STB, Eplov LF, Møller T. The missing link-participants’ perspectives on transfer from psychosocial interventional contexts to everyday community life: a qualitative synthesis of interventional studies. BMC Psychol. 2021;9(1):1–15. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.

    Study design and conductnone given

    The outcome measures consisted of self-report instruments, which are more prone to bias than assessor-rated or objective measures.

    “the outcome measures consisted of self-report instruments, which are more prone to bias than assessor-rated or objective measures”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    Blinding of researchers was obtained during analysis and while writing the conclusion.

    “blinding of researchers was obtained during analysis and while writing the conclusion”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Study design and conductown data

    In this study, standard mental health was broadly defined, and we do not have information about what type of care participants received.

    “In this study, standard mental health was broadly defined, and we do not have information about what type of care participants received.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Interpretationreasoning

    COVID-19 may also have affected overall intervention delivery and the intended impact of the intervention, as restrictions impaired some key change mechanisms.

    “COVID-19 may also have affected overall intervention delivery and the intended impact of the intervention, as the restrictions impaired some of our key change mechanisms, for instance limiting the range of available meaningful activities or reducing access to peer support because of social distancing.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.

    Interpretationnone given

    The lockdown might have affected intervention delivery and impeded its potential impacts.

    “The lockdown might have affected intervention delivery, and impeded its potential impacts, therefore, we recommend that MA&R is re-evaluated under “normal conditions”.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Interpretationown data

    Post hoc analysis suggested that MA&R may have been better than standard mental health services before, but not during, the lockdown.

    “Post hoc analysis suggested that MA&R may have been better than standard mental health services before, but not during, the lockdown, but it is important to keep in mind that these subgroup analyses lack statistical power and are not based on enough participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Interpretationreasoning

    This lack of information leads to a lack of clarity, for example concerning the comparator and the treatment-control contrast.

    “This lack of information leads to a lack of clarity, for example concerning the comparator and the treatment–control contrast [50, 51].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [50] Zuidgeest MG, Welsing PM, van Thiel GJ, Ciaglia A, Alfonso-Cristancho R, Eckert L, et al. Series: Pragmatic trials and real world evidence: Paper 5. Usual care and real life comparators. J Clin Epidemiol. 2017;90:92–8. source
    • cites [51] Jacob RT, Doolittle F, Kemple J, Somers MA. A framework for learning from null results. Educ Res. 2019;48(9):580–9. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    All outcomes are reported.

    “all outcomes are reported”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Study design and conductnone given

    The subgroup analyses lack statistical power and are not based on enough participants.

    “these subgroup analyses lack statistical power and are not based on enough participants”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    There were relatively low attrition rates.

    “relatively low attrition rates”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    The trial reached the intended number of participants.

    “the trial reached the intended number of participants”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Interpretationreasoning

    MA&R is a complex intervention with multiple interacting components, and two measurement time points were not sufficient to show whether some modes or components, such as the high intensity mode in MA&R I versus the low intensity mode in MA&R II, were more effective than others.

    “MA&R is a complex intervention with multiple interacting components, and two measurement time points were not sufficient to show whether some modes or components, such as the high intensity mode in MA&R I vs. the low intensity mode in MA&R II, were more effective than others.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    A sample size calculation was performed prior to recruitment.

    “a sample size calculation was performed prior to recruitment”
    Quote in the paperNot a substantial claim
45 of 45

  • The paper relies on this without support.

    COVID-19 restrictions affected the interventional context by restricting opportunities for engaging in activities.

    “The COVID-19 restrictions affected the interventional context, namely by restricting opportunities for engaging in activities.”

  • The paper relies on this without support.

    This is the first trial to evaluate the effectiveness of a co-led peer occupational therapy intervention combining group sessions with individual sessions and the option of individual support.

    “To our knowledge, this is the first trial to evaluate the effectiveness of a co-led peer occupational therapy intervention combining group sessions with individual sessions and the option of individual support.”

  • The paper relies on this without support.

    Peer support and occupational therapy were part of standard mental health care in several sites and therefore available to the control group.

    “For instance, peer support and occupational therapy were part of standard mental health care in several sites and therefore available to the control group, too.”

  • The paper relies on this without support.

    Little is known about how people with psychiatric disabilities experience support to enable participation in a broader spectrum of daily activities relating to the household, social life, hobbies, and interests.

    “However, little is known about how people with psychiatric disabilities experience support to enable participation in a broader spectrum of daily activities relating to the household, social life, hobbies, and interests, etc.”

  • The paper relies on this without support.

    Some core components of MA&R were also available in standard mental health care.

    “since some of the core components in MA&R were also available in standard mental health care”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Bjorkedal et al. found no significant improvements in activity engagement in the MA&R group compared to those receiving standard occupational therapy services.

    “No significant improvements in activity engagement were found in the MA&R group compared to those receiving standard occupational therapy services, possibly due to similarities between MA&R and the standard service.”

    From Contributions of a time use perspective in community mental health practice: a scoping review (2024) · cites this paper as [57]

    The Results table reports no significant between-group difference in activity engagement (p = 0.3), and the Discussion says MA&R was not superior. The comparator was standard mental health care, not specifically standard occupational therapy services. The Discussion suggests overlapping services as a possible explanation, noting that occupational therapy was available to controls at several sites. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • MA&R alcohol or substance abuse percentage is understated

    Minor

    Five of 70 MA&R participants is 7.14%, not the reported 0.7%.

    Reported 0.7 · recomputed 7.142857

  • Control-group alcohol or substance abuse percentage is understated

    Minor

    Three of 69 control participants is 4.35%, not the reported 0.4%.

    Reported 0.4 · recomputed 4.347826

  • Primary-outcome confidence interval differs between text and table

    Minor

    The results text gives −1.9 as the lower confidence limit for the between-group activity-engagement difference; Table 3 gives −1.0 for the same estimate.

  • EuroQol instrument version differs between outcome table and results

    Minor

    Table 1 identifies the EuroQol measure as EQ-5D-3L, whereas Table 3 labels the reported outcome EQ-5D-5L.

4 of 4

Citations

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Organization WH. International classification of functioning, disability and health: ICF. Geneva: World Health Organization; 2001.
  2. Van Buuren S, Groothuis-Oudshoorn K. mice: multivariate imputation by chained equations in R. J Stat Softw. 2011;45(1):1–67.

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Metadata

Authors
Bjørkedal, S.-T. B., Bejerholm, U., Hjorthøj, C., Møller, T., & Eplov, L. F.
Affiliations
  • Gentofte Hospital (DK)
  • Lund University (SE)
  • University of Copenhagen (DK)
Corresponding author
Bjørkedal, Siv-Therese Bogevik
ORCID
Venue
BMC Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2023-06-06
Volume
23
Issue
1
Pages
406-406
ISSN
1471-244X (ISSN-L)
DOI
10.1186/s12888-023-04875-w
PMC
PMC10243265
OpenAlex
W4379536654
Semantic Scholar
14c0787fcc2bc45b8feec38d58282f8c9207fd9f
Cited by
11
References
44
Citations by year
2026: 3 · 2025: 2 · 2024: 6
FWCI
5.48
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Lund University Publications (Lund University) (submittedVersion)
Funders
  • TrygFonden (ID number 112526)
  • Ergoterapeutforeningen (FF-117-R45- A1271)
  • Mental Health Services in the Capital Region of Denmark (No number provider)
Topics
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Therapy Practice and Research
  • Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords
psychiatric disability, severe mental illness, activity engagement, personal recovery, quality of life, intervention fidelity, intervention adherence, COVID-19 restrictions, community mental health services
MeSH terms
COVID-19, Mental Disorders, Humans, Occupational Therapy, Quality of Life, Treatment Outcome

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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