A qualitative research synthesis examining the effectiveness of interventions used by occupational therapists in mental health

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

In one instance, rather than sustaining engagement, the client chose to do predictable technical activities in the creative activity group.

“In this instance, rather than sustaining engagement, the client chose to do predictable technical activities, which followed a pattern or set of instructions, in the creative activity group.”

May combine two claims.

Engaging in meaningful occupation supported participants to regain a sense of control and feel empowered to make choices, to accept responsibility for feeling better whilst dealing with the fear of scrutiny.

“Engaging in meaningful occupation supported participants to regain a sense of control and feel empowered to make choices, to accept responsibility for feeling better whilst dealing with the fear of scrutiny.”

May combine two claims.

Two forms of professional artistry were evident: interaction and legitimacy, and pragmatism and reflection.

“Two forms of professional artistry were evident: 1. Interaction and legitimacy 2. Pragmatism and reflection”

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

Professional artistry related to therapists' abilities to recognize the subtleties and nuances required within effective communication, and their skill in demonstrating a tailored, considered response to clients.

“Such artistry related to therapists' abilities to recognize the subtleties and nuances required within effective communication, and their skill in demonstrating a tailored, considered response to clients.”

May combine two claims.

A therapist's approach in building rapport and establishing the client's occupational history, whilst a positive experience for one, could have potentially damaging consequences on the therapeutic relationship for another.

“For example, it was evident that a therapist's approach in building rapport and establishing the client's occupational history, whilst a positive experience for one, could have potentially damaging consequences on the therapeutic relationship for another”

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

Eleven papers focused on service user perspectives, and eleven included studies of service users', carers', and occupational therapists' perspectives.

“Eleven papers focused on service user perspectives, and eleven included studies of service users', carers', and occupational therapists' perspectives.”

May combine two claims.

Therapists saw themselves as 'seeing differently' from other multi-disciplinary team colleagues, and this was viewed by therapists as contributing to the effectiveness of therapy.

“It was also notable that therapists saw themselves as 'seeing differently' from other multi-disciplinary team (MDT) colleagues, this in itself was viewed by therapists as contributing to the effectiveness of therapy”

May combine two claims.

The use of occupational interventions that provide space for healing, self-rediscovery, identity formation, and community participation were valued more than short, psychological-based interventions focused on case management and the assessment of mental stability, which were seen as superficial in scope.

“The use of occupational interventions that provide space for healing, self-rediscovery, identity formation, and community participation, were valued more than short, psychological-based interventions focused on case management and the assessment of mental stability, which were seen as superficial in scope.”

May combine two claims.

Effectiveness was substantiated by sound therapeutic reasoning and good reflective skills.

“Effectiveness was substantiated by sound therapeutic reasoning and good reflective skills.”

May combine two claims.

Therapists' awareness of client capacity and self-belief, appreciation of the wider socio-cultural context, discussion of occupational gains, and working with resistance were all part of therapists' effectiveness in supporting clients to envision and achieve a valued future.

“Therapists' awareness of client capacity and self-belief, appreciation of the wider socio-cultural context, discussion of occupational gains, and working with resistance, were all seen to be part of therapists' effectiveness in supporting clients to envision and achieve a valued future.”

May combine two claims.

Occupation-focused interventions promoted reflection, creativity, exploration, challenge, personal meaning, skill development, and feelings of self-confidence (or not).

“The effectiveness of the occupationfocused intervention promoted reflection, creativity, exploration and challenge, and personal meaning; it also promoted skill development and feelings of self-confidence (or not) as illustrated by the following client comment:”

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

Professional artistry included therapists' skill in responding appropriately to client need with legitimacy, and how professional and personal perspectives also become privileged.

“Professional artistry included therapists' skill in responding appropriately to client need with legitimacy, and how professional and personal perspectives also become privileged.”

May combine two claims.

Mental health services appear to value short, psychological-based interventions, care co-ordination, and care planning.

“Mental health services appear to value short, psychological-based interventions, care co-ordination, and care planning, whereas the studies provided examples of client-valued occupations that included creative activities, community-focused integration, vocational and home support, and group work, which provided opportunity and space for healing, self-rediscovery, identity formation, participation,”

May combine two claims.

Professional artistry embraced not only therapists' skills and awareness of their occupational approaches and communication with clients, but equally their demeanour and ability to read and use non-verbal communication in a spontaneous way.

“Thus, professional artistry embraced not only therapists' skills and awareness of their occupational approaches and communication with clients, but equally their demeanour and ability to read and use non-verbal communication in a spontaneous way.”

May combine two claims.

Clients were not always able to envision new horizons at first and were more focused on the stage of 'being', making sense of oneself in relation to selfhood and spirituality.

“were not always able to envision these new horizons at first, and were more focused on the stage of 'being'; of making sense of oneself, in relation to selfhood and spirituality (Watson and Fourie 2004).”

• cites Watson and Fourie 2004Not checked yet

  Not checked in the free run.

May combine two claims.

Occupational engagement validated a client's interpretation of her/himself, shaping the individual's occupational competence and occupational identity.

“Occupational engagement validated a client's interpretation of her/himself, shaping the individual's occupational competence and occupational identity.”

May combine two claims.

Sound therapeutic reasoning and good reflective skills were underpinned by professional knowledge, characterized through professional foundations, through to a more dominant medical discourse, but typically illustrated through pragmatism.

“This was underpinned by professional knowledge, characterized through professional foundations, through to a more dominant medical discourse, but typically illustrated through pragmatism.”

May combine two claims.

The 22 papers represented an international perspective in terms of country of authorship, and largely focused on adult mental health service delivery, with less data available in relation to older people and/or carers' perspectives (six papers).

“The 22 papers represented an international perspective in terms of country of authorship, and largely focused on adult mental health service delivery, with less data available in relation to older people and /or carers' perspectives (six papers).”

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

A client's choice not to engage did not fit with the therapist's preferred view that he continue to attend the programme to maintain his mental stability.

“Whilst the client's reasoning related to his idea of moving into retirement, such choices did not fit with the therapist's preferred view that he continue to attend the programme in order to maintain his mental stability.”

May combine two claims.

The studies provided examples of client-valued occupations including creative activities, community-focused integration, vocational and home support, and group work, which provided opportunity and space for healing, self-rediscovery, identity formation, participation, and acceptance in the wider community.

“the studies provided examples of client-valued occupations that included creative activities, community-focused integration, vocational and home support, and group work, which provided opportunity and space for healing, self-rediscovery, identity formation, participation, and acceptance in the wider community.”

May combine two claims.

Clients from indigenous and immigrant communities held a more collectivist worldview, whereas therapists tended to hold a more individualistic worldview, emphasizing client autonomy and responsibility.

“Clients from indigenous and immigrant communities held a more collectivist worldview, whereas therapists tended to hold a more individualistic worldview, emphasizing client autonomy and responsibility.”

May combine two claims.

Therapists were seen to use reflection as a means of professional self-regulation and for developing enhanced competency.

“Although therapists were seen to use reflection as a means of professional self-regulation and for developing enhanced competency, occupational therapists need to meet with each other on a regular basis in order that 'critical conversations' can occur, in which change and challenge can take place (Savin-Baden 2008, p53).”

• cites Savin-Baden 2008Not checked yet

  Not checked in the free run.

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

Good practice in this area is not lacking, but such practices need better reporting.

“That is not to say that good practice in this area is lacking, however it is evident such practices need better reporting.”

May combine two claims.

Therapists were particularly challenged when considering cross-cultural practices, and indigenous voices were missing.

“However, as mentioned, it was also evident that therapists were particularly challenged when considering cross-cultural practices, and that indigenous voices were missing.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Unexamined relationships and unarticulated practice can have damaging effects on the therapeutic relationship and for the profession as a whole.

“I Unexamined relationships and unarticulated practice can have damaging effects on the therapeutic relationship and for the profession as a whole.”

May combine two claims.

There was a perceived lack of risk assessment of occupations and client-centred approaches to risk assessment.

“However, there was a perceived lack of risk assessment of occupations and client-centred approaches to risk assessment.”

May combine two claims.

Inclusion enhanced recovery in a collective sense; for some clients this was experienced within a community art group, for others within a support group for people with psychosis.

“Inclusion enhanced recovery in a collective sense; for some clients this was experienced within a community art group, for others within a support group for people with psychosis.”

Classified as probably not a substantial claim.

The use of occupations that provide space for healing, self-rediscovery, identity formation, and participation in the wider community, delivered by occupational therapists, is seen to be valued by clients over short psychological-based interventions focused on case management and the assessment of mental stability, which are experienced as restricted, unhelpful, or superficial in scope.

“The use of occupations that provide space for healing, selfrediscovery, identity formation, and participation in the wider community, delivered by occupational therapists is seen to be valued by clients over short psychological-based interventions focused on case management and the assessment of mental stability, which are experienced as restricted, unhelpful, or superficial in scope.”

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

Occupational therapists sought to establish a niche for themselves, evidenced through their use of occupation.

“Rather, occupational therapists sought to establish a niche for themselves, evidenced through their use of occupation.”

May combine two claims.

The findings revealed how inauthentic, un-examined, and un-articulated practice and use of interventions in mental health can have serious consequences on clients' recovery, as well as being damaging to the profession.

“The findings revealed how inauthentic, un-examined, and un-articulated practice and use of interventions in mental health can have serious consequences on clients' recovery, as well as being damaging to the profession.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Therapists' means of measuring their therapeutic effectiveness requires better reporting upon.

“I Therapists' means of measuring their therapeutic effectiveness requires better reporting upon.”

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

QRS provides integrated forms of knowledge and a means of making connections between existing studies, thereby providing ways to advance professional knowledge through examination of qualitative evidence that is both broad and deep.

“QRS provides integrated forms of knowledge and a means of making connections between existing studies, thereby providing ways to advance professional knowledge through examination of qualitative evidence that is both broad and deep.”

• cites Sandelowski and Barroso 2007Not checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

The challenge in reporting therapeutic effectiveness is to find ways to demonstrate not only clear links between the intervention used and its effect upon function, but also how interventions enable individuals to enjoy improved quality of life and overcome obstacles to participation.

“The challenge in reporting therapeutic effectiveness is to find ways to demonstrate not only clear links between the intervention used and its effect upon function, but also how interventions enable individuals to enjoy improved quality of life and overcome obstacles to participation (American Occupational Therapy Association [AOTA] 2007).”

• cites American Occupational Therapy Association [AOTA] 2007Not checked yet

  Not checked in the free run.

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

QRS provides researcher knowledge about quality issues when conducting qualitative research, since only studies of accepted calibre are included.

“Furthermore, QRS provides researcher knowledge about quality issues when conducting qualitative research, since only studies of accepted calibre are included.”

Classified as probably not a substantial claim.

Twenty-two articles that rated 2 or 3 in at least five of the seven categories identified in Table 2 were selected for analysis and interpretation.

“Twenty-two articles, that rated 2 or 3 in at least five of the seven categories identified in Table 2, were selected for analysis and interpretation.”

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

In the United Kingdom, the situation is becoming critical as health care moves towards Payment by Results and Cluster/Pathway-based commissioning.

“In the United Kingdom (UK) this situation is becoming critical as health care moves towards Payment by Results and Cluster/Pathway-based commissioning (Department of Health [DH] 2010a, DH 2010b).”

• cites Department of Health [DH] 2010aNot checked yet

  Not checked in the free run.

• cites DH 2010bNot checked yet

  Not checked in the free run.

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

New horizons captures the challenge of balancing user-led choice (client stance) with promoting user-led growth (therapist stance), and the mismatch of interpretations that can occur between therapists and clients about what moving on means.

“New horizons is thus important in capturing the challenge of balancing user-led choice (client stance) with promoting user-led growth (therapist stance), and the mismatch of interpretations which can occur between therapists and clients about what moving on means.”

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

Identifying existing practice and the effectiveness of occupational therapy in mental health is crucial.

“Identifying existing practice and the effectiveness of occupational therapy in mental health is therefore crucial.”

• AssumptionRests on an assumption: The commissioning consortia need to be convinced that occupational therapy services are valued, otherwise the profession is at risk of losing its funding to outside providers.

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

Robust bodies of evidence are required, built up through both larger quantitative and smaller-scale qualitative studies that seek to confirm, challenge, or redefine other studies, so that a more integrated picture of occupational therapy's practice and effects in mental health can emerge.

“What are required are robust bodies of evidence, built up through both larger (quantitative) and smaller-scale (qualitative) studies that seek to confirm, challenge, or redefine other studies, so that a more integrated picture of occupational therapy's practice and effects in mental health can emerge.”

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

As the purpose of occupational therapy intervention is to enable occupation, judgements about the effectiveness of the service should be based on the degree to which clients consider the purpose achieved.

“Further, as the purpose of occupational therapy intervention is to enable occupation, judgements about the effectiveness of the service should be based on the degree to which clients consider the purpose achieved (College of Occupational Therapists [COT] 2006, Whitley 2005).”

• cites College of Occupational Therapists [COT] 2006Not checked yet

  Not checked in the free run.

• cites Whitley 2005Not checked yet

  Not checked in the free run.

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

The process of quality checking was overseen by the team expert, and no major disagreements were noted.

“This process was overseen by the team expert; no major disagreements were noted.”

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

Other research is being conducted that examines therapeutic effectiveness from studies which examine the complexity of factors that influence occupational therapy interventions.

“However, other research is being conducted that also examines therapeutic effectiveness, but from studies which examine the complexity of factors that influence occupational therapy interventions (Robertson and Colborn 2000).”

• cites Robertson and Colborn 2000Not checked yet

  Not checked in the free run.

May combine two claims.

The aforementioned systematic reviews generally excluded qualitative studies, as they were not able to address questions of effectiveness.

“It is also worth noting that the aforementioned reviews generally excluded qualitative studies, as they were not able to address questions of effectiveness.”

• cites Bullock and Bannigan's (2011)Not checked yet

  Not checked in the free run.

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

Studies rejected included those that were not methodologically positioned, or where the description provided of the methodology and methods used were thin, absent, or where thick description was lacking.

“Studies rejected included those that were not methodologically positioned, or where the description provided of the methodology and methods used were thin, absent, or where thick description was lacking.”

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

Professional artistry accounted for the range of often competing, complex issues and discourses that therapists need to manage in an artful way.

“Professional artistry accounted for the range of often competing, complex issues and discourses, which therapists need to manage in an artful way.”

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

Two papers from each set were critiqued by both the first and third authors as a means of ensuring quality in one another's approach.

“Two papers from each set were critiqued by both the first and third authors as a means of ensuring quality in one another's approach.”

Probably not a substantial claim: may not pass S1 (asserted), S2 (checkable), S3 (load-bearing).

The profession needs to promote its use of occupation more effectively.

“As Hocking (2007) argued, the profession needs to promote its use of occupation more effectively.”

• cites Hocking (2007)Not checked yet

  Not checked in the free run.

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

Eisner (1985) uses the term 'professional practice connoisseur' to describe the art of developing a critical appreciation for practice, manifested through therapeutic reasoning.

“(1985) uses the term 'professional practice connoisseur' to describe the art of developing a critical appreciation for practice, manifested through therapeutic reasoning.”

• cites Eisner 1985Not checked yet

  Not checked in the free run.

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

Barnard (1968) has written of 'non-logical processes' that we cannot express in words as a process of reasoning, but evidence rather by a judgment, decision, or action.

“Barnard (1968) has written of 'non-logical processes' that we cannot express in words as a process of reasoning, but evidence rather by a judgment, decision, or action.”

• cites Barnard (1968)Not checked yet

  Not checked in the free run.

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

Such connoisseurship extends to therapists' examination of their intrapersonal skills and means of exerting control, and how this is seen to influence clients' sense of agency and willingness to engage in therapy.

“Such connoisseurship extends to therapists' examination of their intrapersonal skills and means of exerting control, and how this is seen to influence clients' sense of agency and willingness to engage in therapy.”

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

Occupational therapists have a valuable contribution to make to client recovery, in their ability to respond to the diverse and complex needs of people accessing mental health services effectively, rather than just adequately.

“In relation to their skill mix, occupational therapists have a valuable contribution to make to client recovery, in their ability to respond to the diverse and complex needs of people accessing mental health services effectively, rather than just adequately.”

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

Further meetings with the steering groups provided invaluable support in ensuring that there was congruence across the themes.

“Further meetings with the steering groups provided invaluable support in ensuring that there was congruence across the themes.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

The effective use of professional supervision and caseload management has relevance for formulating disciplinary positions, and by formalizing the use of space for professional learning, over time, practice repertoires can be confronted and developed.

“The effective use of professional supervision and caseload management has relevance for formulating disciplinary positions, and by formalizing the use of space for professional learning, over time, practice repertoires can be confronted and developed.”

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

Frequent research team meetings occurred throughout the synthesis process so that individual interpretations could be explored, qualified, and combined.

“Frequent research team meetings occurred throughout the synthesis process so that individual interpretations could be explored, qualified, and combined.”

Classified as probably not a substantial claim.

The synthesis provides evidence of the perceived contribution and value of occupational therapy to clients' recovery and quality of life.

“The synthesis provides evidence of the perceived contribution and value of occupational therapy to clients' recovery and quality of life.”

Classified as probably not a substantial claim.

The level of effectiveness of an identified intervention was more reflective of the skill and judgement of the therapist in their 'caring, artistry and critical thinking'.

“Whilst choice in occupation was seen to be most effective when negotiated with clients, the level of effectiveness of an identified intervention was more reflective of the skill and judgement of the therapist in their 'caring, artistry and critical thinking' (Cook and Chambers 2009, p247).”

• cites Cook and Chambers 2009Not checked yet

  Not checked in the free run.

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

Professional artistry, including use of well-paced occupation and considering the client's stage of recovery, demonstrates the value of the profession to clients accessing mental health services.

“I Professional artistry, including use of well-paced occupation and considering the client's stage of recovery, demonstrates the value of the profession to clients accessing mental health services.”

Classified as probably not a substantial claim.

The synthesis has provided a bank of evidence to inform the commissioning of services about the effectiveness of interventions delivered by occupational therapists, as indicated by client and carer perspectives.

“The synthesis has provided a bank of evidence to inform the commissioning of services about the effectiveness of interventions delivered by occupational therapists, as indicated by client and carer perspectives.”

• AssumptionRests on an assumption: The perspectives of clients and carers are a valid basis for evaluating the effectiveness of occupational therapy interventions.