Höhl Werner, Moll Sandra, Pfeiffer Andreas
aDepartment of Psychiatry and Psychotherapy, LVR-Klinikum Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany bSchool of Rehabilitation Science, Institute for Applied Health Science, McMaster University, Hamilton, Ontario, Canada.
Curr Opin Psychiatry. 2017 Jul;30(4):300-305. doi: 10.1097/YCO.0000000000000339.
Life expectancy of people with severe mental illness is considerably shortened and their risk for cardiovascular and metabolic disorders is increased. They spend more time in solitary and less time in structured activities than the general population.Engagement in healthy patterns of activity, including active, meaningful participation in the community can, therefore, be critical to recovery from severe mental illness. Occupational therapy is a profession that focuses on time use, activity patterns and occupational engagement, and the links to health and well-being. In this study, we review research evidence regarding approaches to occupational engagement, including behavioural activation, time use, and activity promotion. We also will review studies that specifically evaluate the impact of occupational therapy interventions.
There is a growing body of evidence regarding the value of interventions addressing occupational engagement of individuals with severe mental illness, including a range of activation strategies and approaches. There is a need, however, for documentation of theoretically informed approaches that are supported by fidelity measures to ensure standardization.
Larger-scale studies are needed, including consistent outcome measures to document engagement and changes in activity patterns as well as health-related outcomes. High-quality randomized clinical trials are important to establish effectiveness. As occupational therapy interventions are complex and embedded within a range of multidisciplinary approaches, new models of pragmatic trials within the naturalistic context of psychiatric rehabilitation are also needed.
严重精神疾病患者的预期寿命显著缩短，患心血管和代谢紊乱疾病的风险增加。与普通人群相比，他们独处的时间更多，参与有组织活动的时间更少。因此，参与健康的活动模式，包括积极、有意义地参与社区活动，对于从严重精神疾病中康复至关重要。职业治疗是一门专注于时间利用、活动模式和职业参与以及与健康和幸福之间联系的专业。在本研究中，我们回顾了关于职业参与方法的研究证据，包括行为激活、时间利用和活动促进。我们还将回顾专门评估职业治疗干预效果的研究。
关于针对严重精神疾病患者职业参与的干预措施的价值，有越来越多的证据，包括一系列激活策略和方法。然而，需要记录有理论依据且有保真度测量支持以确保标准化的方法。
需要开展更大规模的研究，包括采用一致的结局测量方法来记录参与情况、活动模式的变化以及与健康相关的结局。高质量的随机临床试验对于确定有效性很重要。由于职业治疗干预措施复杂且融入了一系列多学科方法，因此还需要在精神康复自然环境下的实用试验新模型。
