Priority 16 from the Occupational Therapy PSP

UNCERTAINTY: What is the value of occupation as an intervention and how does effectiveness vary with the way it is used? (e.g. 'occupation-focused' interventions based on understanding a person, their environment and the meaningful occupations in their life, or 'occupation-based' interventions in which doing a meaningful occupation forms the focus) (JLA PSP Priority 16)
Overall ranking 16
JLA question ID 0100/16
Explanatory note "Occupation" is a term that refers to the practical and purposeful activities that allow people to live independently and have a sense of identity. They are the meaningful things that people need, want or have to do, and therefore vary from person to person.
The way occupational therapists use occupations within their interventions can vary. For example, an intervention might be 'occupation-focused' and aim to support a person to resume a meaningful occupation (such as returning to and participating in parkrun after a myocardial infarction, or heart attack). Alternatively, an intervention might be 'occupational based' in which case an activity that is already meaningful to an individual might be used to help achieve specific goals (such as running with a local club to to help managing depression).
This question aims to explore whether there is value in using occupation as a focus for interventions, and how the effectiveness of interventions may vary depending on whether an occupation focused or occupation based perspective is taken. 

There is some evidence addressing this area, but varied in nature and quality. This question has partially been addressed in the evidence base.
Maclean, F. and J. Breckenridge (2015). "Use of occupation-focused language by occupational therapists in physical health care settings when considering older people and alcohol use." British Journal of Occupational Therapy 78(11): 713-717.
Newman, R., et al. (2019). "Feasibility, acceptability and potential effectiveness of an occupation-focused cognitive self-management program for breast cancer survivors." British Journal of Occupational Therapy 82(10): 604-611.
Nielsen, K. T., et al. (2019). "Lessons learned about occupation-focused and occupation-based interventions: A synthesis using group concept mapping methodology." Scandinavian Journal of Occupational Therapy: 1-12.
Nielsen, T. L., et al. (2017). "What are the short-term and long-term effects of occupation-focused and occupation-based occupational therapy in the home on older adults' occupational performance? A systematic review." Scandinavian Journal of Occupational Therapy 24(4): 235-248.
Orban, K., et al. (2014). "Effect of an occupation-focused family intervention on change in parents' time use and children's body mass index." The American Journal Of Occupational Therapy: Official Publication Of The American Occupational Therapy Association 68(6): e217-e226.
Pereira, R. B. (2017). "Towards inclusive occupational therapy: Introducing the CORE approach for inclusive and occupation-focused practice." Australian Occupational Therapy Journal 64(6): 429-435.
Swan, J., et al. (2018). "Meaningful occupation with iPads: Experiences of residents and staff in an older person’s mental health setting." British Journal of Occupational Therapy 81(11): 649-656.
Zingmark, M., et al. (2014). "Occupation-focused interventions for well older people: an exploratory randomized controlled trial." Scandinavian Journal of Occupational Therapy 21(6): 447-457.
Zingmark, M., et al. (2016). "Occupation-focused health promotion for well older people — A cost-effectiveness analysis." British Journal of Occupational Therapy 79(3): 153-162.

Health Research Classification System category Generic Health Relevance
Extra information provided by this PSP
Original uncertainty examples Are occupationally-based interventions as or more effective than occupationally focused interventions?  ~ Intervention processes to support people with a personality disorder in older age via meaningful occupation.  ~ What occupation-based interventions are effective?  ~ How occupational therapists promote participation in occupation.  ~ Does occupation-focused or occupation-based practice result in greater occupational participation compared to generic practice? ~ Why can occupation take centre stage in eating disorder recovery?
Submitted by Occupational therapists, Services Users, Carers, Students, Other
PSP information
PSP unique ID 0100
PSP name Occupational Therapy
Total number of uncertainties identified by this PSP. 66  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 27 July 2020