Stroke patients think about goals very differently from health professionals. Individual patients have diverse ideas about goals within the context of the uncertainty of stroke, their life as a whole and recovery after formal rehabilitation is completed. To meet these diverse needs, health professionals need to communicate fully with patients to gain an understanding of their experiences of stroke and wider views on goals.
While a range of literature has explored the meaning of occupation, the lived experience of occupation has been relatively neglected. In this hermeneutic phenomenological study 12 New Zealand adults who had experienced a disruption to their occupations were interviewed, on the assumption that disruption reveals things that are usually overlooked. The data were analysed by identifying key themes and engaging in a hermeneutic process informed by the philosophies of Heidegger and Gadamer. The findings suggest that the meaning of occupation is complex and tends to remain hidden. Three facets of meaning that work in unison, each interconnected with the other, emerged from analysis; the Call, Being-with and Possibilities. The findings of this study are considered in relation to selected literature, to build on current understandings of the meaning of the occupation. While the study is acknowledged to have limitations in terms of sampling, the findings do have implications for occupational science which include building on knowledge of the meaning of occupation and considering occupation from a context wider than that of the individual.
A cluster randomized design is not a practical means of avoiding contamination effects in studies of inpatient rehabilitation goal-setting. Other techniques for coping with contamination effects are necessary.
Occupational therapy's theories would benefit from an evidence base that includes meaning, which in turn would lead to authentic occupational therapy practice.
ObjectivesTo evaluate the effectiveness of vocational interventions to help people living with mild to moderate mental health conditions gain paid work.MethodsSystematic review of international, peer-reviewed literature. Development of the prepublished protocol and search strategy was done in consultation with stakeholder reference groups consisting of people with lived experience of long-term conditions, advocates and clinicians. We searched academic databases MEDLINE, EMBASE, PsychINFO, AMED, CINAHL, Proquest Dissertations and Theses database, and Business Source Complete for controlled trials comparing a specific vocational intervention against a control intervention or usual care, published between 1 January 2004 and 1 August 2019. Two authors independently screened search results, extracted data and appraised studies using the Cochrane risk of bias tool.ResultsEleven studies met inclusion criteria. Seven studies investigated Individual Placement and Support (IPS) modified for people who were not in intensive mental health treatment services. These studies occurred settings such as community vocational rehabilitation services, a housing programme and community mental health services. The studies provided very low quality evidence that people who receive IPS-style vocational rehabilitation are more likely to gain competitive employment than people who receive usual care (risk ratio 1.70, 95% CI 1.23 to 2.34, seven studies, 1611 participants). The remaining four studies considered cognitive behavioural therapy or specific vocational rehabilitation interventions designed to fit a unique context. There was insufficient evidence from these studies to draw conclusions regarding the effectiveness of non-IPS forms of vocational rehabilitation for people with mild to moderate mental health conditions.DiscussionThe meta-analysis showed a clear intervention effect but low precision, and more high-quality studies are needed in this field. There is currently very low quality evidence that IPS-style intervention results in more participants in competitive employment compared with ‘usual care’ control groups in populations with mild to moderate mental health conditions.
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