Implementing an action over inertia group program in community residential rehabilitation services: group participant and facilitator perspectives

May combine two claims.

A sense of "stuckness," time for activities and life events could disrupt participants' "getting me going."

“whereas a sense of “stuckness,” time for activities and life events could disrupt “getting me going.””

May combine two claims.

The AOI facilitators described inertia as pervasive in its nature and holding sway over the overall culture within the CCUs, translating into environments of low expectation and limited activity participation.

“They also described it as pervasive in its nature and holding sway over the overall culture within the CCUs, translating into environments of low expectation and limited activity participation.”

May combine two claims.

There seemed to be a shared understanding that being active and involved in meaningful activities is an important part of recovery and is not just something that you do separate to having a mental illness.

“There seemed to be a shared understanding that being active and involved in meaningful activities—that it is an important part of recovery and is not just something that you do separate to having a mental illness.”

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

Sam described how the group seemed to generate its own energy, having a positive flow on effect on the motivation of individuals, with motivation levels increasing especially with quick activity changes.

“She also described how the group seemed to generate its own energy, having a positive flow on effect on the motivation of individuals: “in a group setting you could see motivation levels really increase, especially with quick activity changes.””

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

Sam noted that participants gave more detailed responses when able to share in a group, could bounce off ideas and relate to one another.

“Sam further noted the benefits of the AOI group format, noting that participants gave “more detailed responses when able to share in a group, could bounce off ideas and relate to one another.””

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

Sarah highlighted that being part of the group was evidence of change for one AOI participant who would just do the very bare minimum.

“For example, as Sarah highlighted, being part of the group was evidence of change for one AOI participant: “We had someone who would just do the very bare minimum, but for him to be in the group was the biggest achievement.””

May combine two claims.

AOI participants described many ways in which the AOI group impacted on their lives, helped get them going, and enabled their engagement in what mattered to them.

“Despite the many challenges in getting themselves going, AOI participants described noticing many ways in which the AOI group impacted on their lives, helped get them going, and enabled their engagement in what mattered to them.”

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

James described how he has learnt to think about recovery, drawing connections between what he does and how he feels.

“James too described how he has learnt to think about recovery, drawing connections between what he does and how he feels”

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

Snoopy reflected that, by the end of the AOI group, it opened people's eyes to what they were doing with their time, and the role of activity in recovering.

“Further, Snoopy reflected that, by the end of the AOI group, it “opened people's eyes to what they were doing with their time,” and the role of activity in recovering:”

May combine two claims.

Doing and talking about activities together supported participants' sense of recovering, as did participating in activities that created a sense of belonging and contributing in the social world.

“In addition, while being in the AOI group, doing and talking about activities together supported participants' sense of recovering, so did participating in activities that created a sense of belonging and contributing in the social world:”

May combine two claims.

Small changes and achievements were noticed and celebrated, with an awareness of the degree of challenge involved in getting going for some, if not all group participants.

“Small changes and achievements were noticed and celebrated, with an awareness of the degree of challenge involved in getting going for some, if not all group participants.”

May combine two claims.

While the AOI facilitators recognized the disabling nature of inertia, they found it was not immediately obvious to the AOI participants.

“While the AOI facilitators recognized the disabling nature of inertia, they also found it was not immediately obvious to the AOI participants.”

May combine two claims.

Similarly to AOI group participants, the facilitators spoke about the stuckness and difficulty in getting people going and acknowledged the challenges that AOI participants experienced, while also describing the groups as supportive and encouraging toward each member.

“Similarly to AOI group participants, the facilitators spoke about the “stuckness” and difficulty in “getting people going” and acknowledged the challenges that AOI participants experienced, while also describing the groups as supportive and encouraging toward each member.”

May combine two claims.

From the facilitators' perspectives, the challenge of getting people going stemmed from a range of factors, including perceived low service expectations of residents' active participation and skill development, as well as the challenges of inertia or stuckness on the part of residents.

“From their perspectives, this stemmed from a range of factors, including perceived low service expectations of residents' active participation and skill development, as well as the challenges of inertia or stuckness on the part of residents.”

Classified as probably not a substantial claim.

The AOI facilitators believed that AOI held potential value as a structured way to address these challenges within the CCU context.

“As a consequence, the AOI facilitators believed that AOI held potential value as a structured way to address these challenges within the CCU context.”

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

John had been working on achieving goals since participation in group and was back at school completing an adult literacy, computer and spelling course as a result.

“This was illustrated by John, who had been “working on achieving goals since participation in group,” and was back at school completing an adult literacy, computer and spelling course as a result.”

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

Jess described it was rewarding to see some participants and the changes they made during the eight week period.

“Further, as Jess described, it was “rewarding to see some of participants, and the changes they made during the eight week period.””

May combine two claims.

For James, participation in AOI increased his awareness of what he could be doing and helped him to make changes.

“Further, for James, participation in AOI increased his awareness of what he could be doing, and helped him to make changes:”

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

Josh highlighted the importance of other CCU staff also noticing subtle changes in a participant's engagement in activities and interactions with others.

“Josh too highlighted the importance of other CCU staff also noticing subtle changes in a participant's engagement in activities and interactions with others.”

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

Shandy described how using the daily activity chart informed her about both what she was doing and how her activities were impacting her.

“Shandy also described how using the daily activity chart informed her about both what she was doing and how her activities were impacting her: “it was good doing that.””

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

Josh noted that a lot of clients don't do worksheet-based activities day to day, creating an unexpected opportunity for practice reading and completing forms that turned out to be a real positive.

“For instance, having described initial reluctance to use worksheet-based activities during AOI groups, Josh noted: “A lot of clients don't do that day to day at all,” creating an unexpected opportunity for practice reading and completing forms that “turned out to be a real positive.””

May combine two claims.

Sam found that revisiting the ideas regularly in the groups facilitated AOI group participants to understand more fully, and to make connections with their own lives and daily routines.

“For instance, Sam found that revisiting the ideas regularly in the groups facilitated AOI group participants to understand more fully, and to make connections with their own lives and daily routines.”

May combine two claims.

Following completion of the AOI groups, participants identified activities that were personally meaningful to them and developed ways of participating in them.

“Following completion of the AOI groups, participants identified activities that were personally meaningful to them, and how they had developed ways of participating in them.”

May combine two claims.

AOI group participants described factors that prevented or got in the way of getting going, including being out of the habit of routine activity or engaging in mainly passive activities, difficulties finding time amidst competing demands, life events that disrupted participation, the impacts of medications, and the paralyzing nature of feeling stuck.

“These factors varied between them and over time, and included: being out of the habit of routine activity or engaging in mainly passive activities; difficulties finding time amidst competing demands; life events that disrupted participation; the impacts of medications; and the paralyzing nature of feeling stuck.”

May combine two claims.

Running AOI groups challenged facilitators' own ideas about CCU residents having skill deficits assumed either to be cognitive or symptom-related in nature, and provided opportunities to reframe some of them as consequences of lack of opportunity to perform, practice and develop skills.

“Running AOI groups also challenged facilitators' own ideas about CCU residents having skill deficits assumed either to be cognitive or symptom-related in nature, and providing opportunities to reframe some of them as consequences of lack of opportunity to perform, practice and develop skills.”

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

Shandy valued talking about recovery and what being healthy meant to her during the AOI group, noting it helped to motivate her.

“while Shandy valued talking about recovery and what being healthy meant to her during the AOI group, noting it helped to “motivate me””

May combine two claims.

For facilitators, facilitating change involved recognizing inertia as a challenge, getting people going, and looking at how the AOI intervention works to impact inertia.

“For the facilitators, facilitating change involved recognizing inertia as a challenge; getting people going; and looking at how AOI intervention works to impact inertia.”

May combine two claims.

Of central importance to getting themselves going, AOI participants identified recognizing the value of meaningful activities and how doing things brings a sense of hope and recovery.

“Of central importance to getting themselves going, AOI participants identified: recognizing the value of meaningful activities; and how doing things brings a sense of hope and recovery.”

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

Sam described how peers listening to and learning the benefits gained from being more active from each other was motivating, and led to offers of support.

“For instance, Sam described how peers listening to and learning the benefits gained from being more active from each other was motivating, and led to offers of support: “one group member offered to assist someone else because that was a strength of theirs.””

May combine two claims.

While the group format facilitated knowledge and understanding of barriers to activity participation, the facilitators had the sense that this alone was insufficient to facilitate lasting change.

“So, while the group format facilitated knowledge and understanding of barriers to activity participation, the facilitators had the sense that this alone was insufficient to facilitate lasting change.”

• AssumptionRests on an assumption: The AOI intervention is about both understanding and acting on barriers to change, including use of coaching to support in-vivo activity change.

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

Snoopy's words: participants were able to identify pros and cons of different occupational balance or imbalance, and they were able to review their daily time use and get a sense of what their just right balance would be.

“Hence, in Snoopy's words, participants were “able to identify pros and cons of different occupational balance or imbalance, and they were able to review their daily time use and get a sense of what their just right balance would be.””

May combine two claims.

AOI facilitators adjusted the ways in which they shared the content within groups to ensure its relevance for participants, including by turning worksheets into activities; using examples; providing one-on-one support; and asking questions that could lead to meaningful discussion.

“AOI facilitators adjusted the ways in which they shared the content within groups to ensure its relevance for participants, including by turning worksheets into activities; using examples; providing one-on-one support; and asking questions that could lead to meaningful discussion.”

• AssumptionRests on an assumption: The AOI workbook was designed for flexibly tailored use.

May combine two claims.

By the end of the AOI group intervention, the facilitators noted overall a sense of client understanding, it led to people being more motivated about activity levels, having changed their mindset, being really proud of self, and sharing and celebrating smaller steps toward the change with others in their group.

“Nevertheless, by the end of the AOI group intervention, the facilitators noted overall a “sense of client understanding … it led to people being more motivated about activity levels” [Snoopy]; having “changed their mindset” [Josh]; being “really proud of self” [Jess]; and sharing and celebrating “smaller steps toward the change” with others in their group [Sam].”

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

Learning in a group setting could also potentially be confronting, as one participant doing a lot with his time might have been challenging for other clients to hear, comparing themselves to him and maybe feeling a bit lacking, but at the same time maybe positive because they got to see a peer who was active and getting benefits.

“On the other hand, learning in a group setting could also potentially be confronting, as Snoopy reflected: > … one participant [was] doing a lot with his time and I wonder whether that was challenging for other clients to hear… comparing themselves to him and maybe feeling a bit lacking perhaps. But then at the same time, maybe that was a positive too because they got to see a peer of theirs that”

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

Sam elaborated that if done individually, the motivation and willingness to do it would not have been as high as compared to the group setting, and that there was a better response or more detailed responses when participants were able to share in a group.

“Sam also elaborated: > I think if done individually, the motivation, the willingness to do it wouldn't have been as high as compared to that group setting. … I think you got a lot better response or more detailed responses when they were able to share in a group'.”

May combine two claims.

All AOI facilitators used the AOI manual and locally-developed AOI group intervention guide, but they also recognized the need to not only familiarize themselves with the content but also to apply it with creativity and flexibility in structuring the group sessions to address the concerns and interests of participants over the course of group sessions.

“Hence, all AOI facilitators used the AOI manual (25) and locally-developed AOI group intervention guide, but they also recognized the need to not only familiarize themselves with the content but also to apply it with creativity and flexibility in structuring the group sessions to address the concerns and interests of participants over the course of group sessions.”

• cites [25] Krupa, 2010Not checked yet

  Not checked in the free run.

May combine two claims.

AOI in a group format supports participants to identify barriers to more active living, to appreciate how time-use and well-being interrelate, and to reframe and take steps to overcome inertia.

“AOI in a group format supports participants to identify barriers to more active living; to appreciate how time-use and well-being interrelate; and to reframe and take steps to overcome inertia.”

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

Benefits of activity engagement may include expressing one's own goals and values, developing skills or knowledge, improving mental and physical well-being, interacting with others, contributing in one's community, and experiencing pleasure and satisfaction.

“These benefits of activity engagement are not limited to but may include expressing one's own goals and values; developing one's skills or knowledge; improving mental and physical well-being; interacting with others; contributing in one's community; experiencing pleasure and satisfaction (25, 27).”

• cites [25] Krupa, 2010Not checked yet

  Not checked in the free run.

• cites [27] Moll, 2015, “'Do-Live-Well”: a Canadian framework for promoting occupation, health, and well-being, Can J Occup Ther. sourceNot checked yet

  Not checked in the free run.

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

An important dimension of therapeutic effectiveness is how interventions are experienced, the degree to which they are impactful, and the change processes involved from the perspectives of those accessing services.

“Yet, an important dimension of therapeutic effectiveness is how interventions are experienced, the degree to which they are impactful and the change processes involved from the perspectives of those accessing services (24, 31).”

• cites [24] Wimpenny, 2014, A qualitative research synthesis examining the effectiveness of interventions used by occupational therapists in mental health, Br J Occup Ther. sourceNot checked yet

  Not checked in the free run.

• cites [31] Lund, 2019, Breaking a cycle of perceived failure: the process of making changes toward a more balanced lifestyle, Aust Occup Ther J. sourceNot checked yet

  Not checked in the free run.

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

Local adaptation of the AOI workbook for group format, development of the research protocols, and development of the interview questions each involved extensive consultation with occupational therapists, the Consumer Advisory Group, and senior management of the mental health services.

“Local adaptation of the AOI workbook (25) for use in a group format, development of the research protocols and the interview questions each involved extensive consultation with these occupational therapists, the Consumer Advisory Group, and senior management of the mental health services.”

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

Reflective journaling by the first author was used during data collection and analysis to trace assumptions, decision-making processes and experiences.

“In addition, reflective journaling by the first author was used during data collection and analysis processes to trace assumptions, decision-making processes and experiences, as well as peer supervision with the other authors, both of whom are experienced occupational therapy researchers.”

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

Peer supervision with the other authors, both experienced occupational therapy researchers, was used as a trustworthiness strategy.

“as well as peer supervision with the other authors, both of whom are experienced occupational therapy researchers.”

May combine two claims.

Qualitative case study research methodology is well-suited to describing and understanding specific programs or interventions within their naturalistic settings and is useful for exploring processes involved in program implementation that can be difficult to study experimentally.

“Qualitative case study research methodology was chosen since it is well-suited to describing and understanding specific programs or interventions within their “real world” or naturalistic settings; and is useful for exploring processes involved in program implementation that can be difficult to study experimentally (32–34).”

• cites [32] Crowe, 2011, The case study approach, BMC Med Res Methodol sourceNot checked yet

  Not checked in the free run.

• cites [33] Anthony, 2009, Qualitative case study methodology in nursing research: an integrative review, J Adv Nurs. sourceNot checked yet

  Not checked in the free run.

• cites [34] Lincoln, 1985 sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

AOI takes the view that struggles with living with mental illness need not prevent an individual from engaging in personally meaningful activities associated with recovery, health and well-being benefits.

“This approach acknowledges that living with mental illness is challenging, but also takes the view that these struggles need not prevent an individual from engaging in personally meaningful activities associated with recovery, health and well-being benefits (25).”

• cites [25] Krupa, 2010Not checked yet

  Not checked in the free run.

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

Improved activity engagement and activity levels were demonstrated in a recent randomized controlled trial comparing BEL with usual care.

“Improved activity engagement and activity levels were demonstrated in a recent randomized controlled trial comparing BEL with usual care (20).”

• cites [20] Eklund, 2017, Effectiveness of balancing everyday life (BEL) vs. standard occupational therapy for activity engagement and functioning among people with mental illness—a cluster RCT study, BMC Psychiatry sourceNot checked yet

  Not checked in the free run.

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

Edgelow and Krupa reported that individuals receiving the AOI intervention made positive changes in how much time was spent in activities other than sleep.

“Based on a small-scale prospective randomized controlled pilot study to investigate the use of AOI with individuals with SMI receiving assertive community treatment, Edgelow and Krupa (28) reported that individuals receiving the AOI intervention made positive changes in how much time was spent in activities other than sleep.”

• cites [28] Edgelow, 2011, Randomized controlled pilot study of an occupational time-use intervention for people with serious mental illness, Am J Occup Ther. sourceNot checked yet

  Not checked in the free run.

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

The second author independently reviewed and coded some transcripts, and emerging categories and themes were developed through discussion between the three authors.

“The second author independently reviewed and coded some transcripts; emerging categories and themes were then developed through discussion between the three authors.”

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

Edgelow and Krupa reported that participants commented positively on their experience of AOI and changes made in their daily lives.

“Participants also commented positively on their experience of AOI and changes made in their daily lives.”

• cites [28] Edgelow, 2011, Randomized controlled pilot study of an occupational time-use intervention for people with serious mental illness, Am J Occup Ther. sourceNot checked yet

  Not checked in the free run.

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

Edgelow and Krupa recommended further research to investigate AOI implementation in different settings and formats.

“While their study indicated that AOI is relevant and useful, Edgelow and Krupa recommended further research investigate its implementation in different settings and formats.”

• cites [28] Edgelow, 2011, Randomized controlled pilot study of an occupational time-use intervention for people with serious mental illness, Am J Occup Ther. sourceNot checked yet

  Not checked in the free run.

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

Qualitative case study research should have pre-defined boundaries that may address time, place and individuals, defining what is and is not studied.

“Qualitative case study research should also have pre-defined boundaries that may address time, place and individuals, defining what is and is not studied (32, 35).”

• cites [32] Crowe, 2011, The case study approach, BMC Med Res Methodol sourceNot checked yet

  Not checked in the free run.

• cites [35] Sangster-Gormley, 2013, How case-study research can help to explain implementation of the nurse practitioner role, Nurse Res sourceNot checked yet

  Not checked in the free run.

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

Balancing Everyday Life (BEL) is an evidence-informed 12-session group-based and lifestyle redesign intervention for people using community mental health services, developed in Sweden.

“In comparison, BEL is an evidence-informed 12 session group-based and lifestyle redesign intervention for people using community mental health services developed in Sweden.”

• cites [20] Eklund, 2017, Effectiveness of balancing everyday life (BEL) vs. standard occupational therapy for activity engagement and functioning among people with mental illness—a cluster RCT study, BMC Psychiatry sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Action Over Inertia (AOI) is a flexible workbook-based, time-use intervention for use in collaboration with people experiencing challenges of everyday living with severe mental illness.

“Developed by occupational therapists in Canada, Action Over Inertia (AOI) is a flexible workbook-based, time-use intervention for use in collaboration with people experiencing challenges of everyday living with severe mental illness (25, 26).”

• cites [25] Krupa, 2010Not checked yet

  Not checked in the free run.

• cites [26] Chen, 2015, Temporal adaptation for individuals living with serious mental illness in the community sourceNot checked yet

  Not checked in the free run.

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

Group leaders' and participants' perspectives of the BEL intervention have been reported, suggesting the value of joining with others and group support to bring about meaningful activity changes in daily life.

“Group leaders' and participants' perspectives of the BEL intervention have also been reported, suggesting the value of joining with others and group support to bring about meaningful activity changes in daily life (29, 30).”

• cites [29] Lund, 2019, Joining, belonging, and re-valuing: a process of meaning-making through group participation in a mental health lifestyle intervention, Scand J Occup Ther sourceNot checked yet

  Not checked in the free run.

• cites [30] Lund, 2020, Group leader and participant perceptions of balancing everyday life, a group-based lifestyle intervention for mental health service users, Scand J Occup Ther. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S4 (based).

This is the first known attempt to explore the use of Action Over Inertia (AOI) in Australian community residential mental health rehabilitation services.

“This is the first known attempt to explore the use of one such approach, Action Over Inertia (AOI), in Australian community residential mental health rehabilitation services.”

May combine two claims.

In turn, this process created possibilities for staff to reframe previous low expectations as a lack of opportunity to perform, practice and develop skills, so that barriers to activity participation might be viewed as more complex than previously understood, and not solely about negative symptoms or cognitive difficulties.

“In turn, this process created possibilities for staff to reframe previous low expectations as a lack of opportunity to perform, practice and develop skills, so that barriers to activity participation might be viewed as more complex than previously understood, and not solely about negative symptoms or cognitive difficulties.”

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

In this context, the competing perspectives of clinical and personal recovery perspectives may contribute to underlying low expectations or pessimism about CCUs residents' potential for recovery.

“In this context, the competing perspectives of clinical and personal recovery perspectives may contribute to underlying low expectations or pessimism about CCUs residents' potential for recovery.”

May combine two claims.

The doing within the group was critical in cementing ideas and supporting participants to try them out and see that change was possible.

“The “doing” within the group was critical in cementing ideas and supporting participants to try them out and see that change was possible.”

May combine two claims.

Involvement in self-chosen, personally and culturally meaningful activities is a recognized contributing factor in recovery and well-being, so that the further development of effective approaches to individualized support for engagement in meaningful and healthy activity patterns is important.

“Involvement in self-chosen, personally and culturally meaningful activities is a recognized contributing factor in recovery and well-being (11, 27), so that the further development of effective approaches to individualized support for engagement in meaningful and healthy activity patterns is important (21).”

• cites [11] Doroud, 2015, Recovery as an occupational journey: a scoping review exploring the links between occupational engagement and recovery for people experiencing mental health issues, Aus Occup Ther J sourceNot checked yet

  Not checked in the free run.

• cites [27] Moll, 2015, “'Do-Live-Well”: a Canadian framework for promoting occupation, health, and well-being, Can J Occup Ther. sourceNot checked yet

  Not checked in the free run.

• cites [21] Höhl, 2017, Occupational therapy interventions in the treatment of people with severe mental illness, Curr Opin Psychiatry sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Given the present study indicates Action Over Inertia groups can facilitate greater understanding of inertia and activity engagement as experienced by consumers, this suggests further collaborative development and co-facilitation of AOI groups with peer support workers offers promise for strengthening their contribution to recovery focused practice in CCU settings.

“Given the present study indicates Action Over Inertia groups can facilitate greater understanding of inertia and activity engagement as experienced by consumers, this suggests further collaborative development and co-facilitation of AOI groups with peer support workers offers promise for strengthening their contribution to recovery focused practice in CCU settings.”

Classified as probably not a substantial claim.

Action Over Inertia (AOI) is designed to support people with enduring mental illness in making change to disrupted or restricted activity patterns that limit their opportunities for health and well-being benefits.

“Action Over Inertia (AOI) is designed to support people with enduring mental illness in making change to disrupted or restricted activity patterns that limit their opportunities for health and well-being benefits (25).”

• cites [25] Krupa, 2010Not checked yet

  Not checked in the free run.

May combine two claims.

This improved sense of capability in turn led to doing more, and feeling more capable and less stuck.

“This improved sense of capability in turn led to doing more, and feeling more capable and less “stuck.””

May combine two claims.

Imagining change as possible aligns with both instilling hope and the recovery process.

“Imagining change as possible aligns with both instilling hope and the recovery process (4, 9, 42).”

• cites [4] Slade, 2014, Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems, World Psychiatry sourceNot checked yet

  Not checked in the free run.

• cites [9] Oades, 2017, Collaborative recovery model: from mental health recovery to wellbeing sourceNot checked yet

  Not checked in the free run.

• cites [42] Davidson, 2003Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

This present study is also novel in describing the use and value of AOI as a group intervention.

“This present study is also novel in describing the use and value of AOI as a group intervention.”

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

The issue of inertia is itself not new; issues with energy and drive have long been associated with schizophrenia.

“The issue of “inertia” is itself not new, issues with energy and drive have long been associated with schizophrenia (40).”

• cites [40] Switaj, 2012, Disability and schizophrenia: a systematic review of experienced psychosocial difficulties, BMC Psychiatry sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Action Over Inertia is neither prescriptive, nor primarily education focused, recognizing that enhanced knowledge about connections between activity patterns and well-being and about barriers to change, while useful, is not sufficient to enable lasting change in activity patterns, as participants in this study also indicated.

“Thus, Action Over Inertia is neither prescriptive, nor primarily education focused, recognizing that enhanced knowledge about connections between activity patterns and well-being and about barriers to change, while useful, is not sufficient to enable lasting change in activity patterns, as participants in this study also indicated.”

• AssumptionRests on an assumption: The factors that disrupt activity patterns and restrict engagement in meaningful activities are multiple and intersecting.

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

This qualitative case study research is the first known to report the use of Action Over Inertia (AOI) within community residential rehabilitation services for people with enduring mental illnesses in Australia.

“This qualitative case study research is the first known to report the use of Action Over Inertia (AOI) within community residential rehabilitation services for people with enduring mental illnesses in Australia.”

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

Others have identified the ways in which not only cognitive intrusions and disruptions, but also failed efforts to make sense of experiences and overcome difficulties can spiral into a diminished sense of agency and capability, withdrawal and demoralization.

“Others too have identified the ways in which not only cognitive intrusions and disruptions, but also failed efforts to make sense of experiences and overcome difficulties can spiral into a diminished sense of agency and capability, withdrawal and demoralization (42, 43).”

• cites [42] Davidson, 2003Not checked yet

  Not checked in the free run.

• cites [43] Sutton, 2012, A phenomenological study of occupational engagement in recovery from mental illness, Can J Occup Ther. sourceNot checked yet

  Not checked in the free run.

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

While this is a small-scale study, the inclusion of data from multiple sources and across three service sites and two time-points reflects adherence to case study research methodology and enhances the authenticity of its findings.

“While this is a small-scale study, the inclusion of data from multiple sources and across three service sites and two time-points reflects adherence to case study research methodology and enhances the authenticity of its findings (33).”

• cites [33] Anthony, 2009, Qualitative case study methodology in nursing research: an integrative review, J Adv Nurs. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Findings from this study indicate that both AOI participants and facilitators gained greater awareness and understanding of this sense of stuckness, enabling the development of hope and a sense of agency, or feeling of I can do something about this on both their parts.

“Findings from this study indicate that both AOI participants and facilitators gained greater awareness and understanding of this sense of “stuckness,” enabling the development of hope and a sense of agency, or feeling of “I can do something about this” on both their parts.”

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

The need to tailor manualized and structured psychosocial interventions to participants' particular needs, aspirations and contexts is increasingly recognized as necessary to bring about health-enhancing changes in people's everyday lives, along with ensuring ongoing support.

“The need to tailor manualized and structured psychosocial interventions to participants' particular needs, aspirations and contexts is increasingly recognized as necessary to bring about health-enhancing changes in people's everyday lives, along with ensuring ongoing support (47).”

• cites [47] Ennals, 2020, Active8: promoting health beyond the absence of mental illness, Aust J Rural Health sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The findings of this study indicate AOI appears to support people to explore inertia and consider alternative ways of understanding this stuckness and the barriers to getting going, which in turn makes imagining change possible.

“Yet, the findings of this study indicate AOI appears to support people to explore “inertia” and consider alternative ways of understanding this “stuckness” and the barriers to “getting going,” which in turn makes imagining change possible.”

Classified as probably not a substantial claim.

This speaks to the interactive process between action and belief.

“This speaks to the interactive process between action and belief (31).”

• cites [31] Lund, 2019, Breaking a cycle of perceived failure: the process of making changes toward a more balanced lifestyle, Aust Occup Ther J. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S4 (based).

It is novel in its description of AOI as a group-based intervention.

“Further, it is novel in its description of AOI as a group-based intervention.”

May combine two claims.

The social dimension of this approach should also not be discounted: the group provided participants with a supportive structure for building awareness, for experimenting with making changes and reinforcing success; a counter experience to tackling and failing at large goals alone.

“The social dimension of this approach should also not be discounted: the group provided participants with a supportive structure for building awareness, for experimenting with making changes and reinforcing success; a counter experience to tackling and failing at large goals alone (31).”

• cites [31] Lund, 2019, Breaking a cycle of perceived failure: the process of making changes toward a more balanced lifestyle, Aust Occup Ther J. sourceNot checked yet

  Not checked in the free run.

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

Deegan described the despair experienced by people whose lives are characterized by inertia and the important role of supporters to instill hope of a future beyond inertia.

“Furthermore, Deegan (41) described the despair experienced by people whose lives are characterized inertia and the important role of supporters to instill hope of a future beyond inertia.”

• cites [41] Deegan, 1996, Recovery as A Journey of the Heart, Psychiatric Rehabilitation Journal. sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

A detailed description has been provided of the Action Over Inertia intervention and the Community Care Unit setting in which it was implemented, so as to allow readers to judge the applicability of the results to another setting for themselves.

“A detailed description has been provided of the Action Over Inertia intervention and the Community Care Unit setting in which it was implemented, so as to allow readers to judge the applicability of the results to another setting for themselves (48).”

• cites [48] Whitley, 2005, Qualitative research in psychiatry, Can J Psychiatry. sourceNot checked yet

  Not checked in the free run.

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

As highlighted by McKenna et al. and Muerk et al., CCUs are in a transition from a clinically-oriented rehabilitative model of care to one informed by a recovery framework.

“As highlighted by McKenna et al. (2) and Muerk et al. (46), CCUs are in a transition from a clinically-oriented rehabilitative model of care to one informed by a recovery framework.”

• cites [2] McKenna, 2016, Recovery-oriented mental health practice in a community care unit: an exploratory study, J Forensic Nurs sourceNot checked yet

  Not checked in the free run.

• cites [46] Muerk, 2019, Staff expectations of an Australian integrated model of residential rehabilitation for people with severe and persisting mental illness: a pragmatic grounded theory analysis, Front Psychiatry sourceNot checked yet

  Not checked in the free run.

May combine two claims.

As a consequence, AOI participants started taking small steps in making self-directed activity changes that increased their self-efficacy and confidence.

“As a consequence, AOI participants started taking small steps in making self-directed activity changes that increased their self-efficacy and confidence.”

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

Lund et al. described the power of the group for supporting change, highlighting that group participants gain value from connecting with and helping each other, the sense of belonging and the provision of mutual support in groups, as well as the content of the group.

“Similarly, Lund et al. (29) described the power of the group for supporting change, highlighting that group participants gain value from connecting with and helping each other, the sense of belonging and the provision of mutual support in groups, as well as the content of the group.”

• cites [29] Lund, 2019, Joining, belonging, and re-valuing: a process of meaning-making through group participation in a mental health lifestyle intervention, Scand J Occup Ther sourceNot checked yet

  Not checked in the free run.

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

Action Over Inertia is a workbook-based resource intended for use in collaboration with people experiencing with severe mental illness, so as to offer individualized support for engagement in activity patterns that promote recovery and well-being.

“Action Over Inertia is a workbook-based resource intended for use in collaboration with people experiencing with severe mental illness, so as to offer individualized support for engagement in activity patterns that promote recovery and well-being (25).”

• cites [25] Krupa, 2010Not checked yet

  Not checked in the free run.

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

A similar process of gaining momentum has also been described elsewhere.

“A similar process of gaining momentum has also been described elsewhere (31, 42, 45).”

• cites [31] Lund, 2019, Breaking a cycle of perceived failure: the process of making changes toward a more balanced lifestyle, Aust Occup Ther J. sourceNot checked yet

  Not checked in the free run.

• cites [42] Davidson, 2003Not checked yet

  Not checked in the free run.

• cites [45] Pépin, 2008, Canadian therapists' experiences while implementing the model of human occupation remotivation process, Occup Ther Health Care sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Collaboration with peer support workers could enhance the ongoing support available to sustain changes beyond the groups themselves so as to support experiences of inclusion and citizenship, presently the least well-developed among recovery oriented practices.

“Furthermore, collaboration with peer support workers could enhance the ongoing support available to sustain changes beyond the groups themselves so as to support experiences of inclusion and citizenship, presently the least well-developed among recovery oriented practices (4).”

• cites [4] Slade, 2014, Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems, World Psychiatry sourceNot checked yet

  Not checked in the free run.

May combine two claims.

As the group participants in this study identified, inertia or stuckness is real and difficult to overcome, but neither an intractable symptom nor insurmountable with the right support.

“Hence, as the group participants in this study identified, inertia or stuckness is real and difficult to overcome, but neither an intractable symptom nor insurmountable with the right support.”

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

The latter study by Muerk et al. explored an integrated staffing model involving peer support and clinical staff, highlighting the potential of bringing together lived experience and therapeutic perspectives to foster recovery-promoting environments within Australian CCU service settings.

“The latter study by Muerk et al. explored an integrated staffing model involving peer support and clinical staff, highlighting the potential of bringing together lived experience and therapeutic perspectives to foster recovery-promoting environments within Australian CCU service settings.”

• cites [46] Muerk, 2019, Staff expectations of an Australian integrated model of residential rehabilitation for people with severe and persisting mental illness: a pragmatic grounded theory analysis, Front Psychiatry sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The findings indicated that AOI provided Community Care Unit residents with valued support to identify barriers to more active living, to appreciate the connections between their time-use, health and well-being, to reframe inertia and take steps to overcome it.

“The findings indicated that AOI provided Community Care Unit residents with valued support to identify barriers to more active living, to appreciate the connections between their time-use, health and well-being, to reframe inertia and take steps to overcome it.”

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

Action Over Inertia offers a flexible approach that provides tools and resources to promote meaningful and healthy patterns of activity engagement as part of recovery oriented practice, the benefits of which merit further research in collaboration with adults receiving community mental health services.

“Action Over Inertia offers a flexible approach that provides tools and resources to promote meaningful and healthy patterns of activity engagement as part of recovery oriented practice, the benefits of which merit further research in collaboration with adults receiving community mental health services.”