Lund University, Department of Health Sciences, the Mental Health, Activity and Participation (MAP) group, Box 157, 221 00, Lund, Sweden.
Lund University, Department of Psychology, Box 213, 221 00 Lund, Sweden.
BMC Psychiatry. 2020 Oct 30;20(1):520. doi: 10.1186/s12888-020-02924-2.
Personal recovery is associated with many significant health-related factors, but studies exploring associations between activity factors and personal recovery among service users are scarce. The aims of this study were hence to; 1) investigate if various aspects of activity may mediate change in recovery while also acknowledging clinical, sociodemographic and well-being factors; 2) explore the effects of two activity-based interventions, Balancing Everyday Life (BEL) or standard occupational therapy (SOT), on personal recovery among service users.
Two-hundred-and-twenty-six service users were included in a cluster RCT, 133 from BEL units and 93 from SOT units. Participants commonly had a diagnosis of mood disorder and the mean age was 40. Instruments used targeted activity, mastery and functioning. A mixed-model regression analysis was employed.
The model tested was whether selected variables could be used to mediate the change in recovery from the start to a six-month follow-up after intervention. Participants' personal recovery increased after treatment and increased further at the follow-up. The general level of recovery was negatively related to a diagnosis of depression/anxiety, both before and after treatment, but depressed/anxious service users still increased their recovery. There were no significant relations between recovery and sex or age. The interactions between change in recovery and changes in depression/anxiety, satisfaction with activities, sex, and age were all non-significant. All possible treatment mediators included were related to change in recovery, the strongest being occupational engagement and mastery, followed by activity satisfaction and symptoms. Mediation was shown by the decrease in the effect of the time factor (from intervention start to completion) when the covariates were introduced. In all cases the time variable was still significant. When testing a model with all variables simultaneously as covariates, occupational engagement and mastery were strongly significant. There was no difference between interventions regarding recovery improvement.
The treatments were equally beneficial and were effective regardless of gender, age and diagnosis. Those who gained most from the treatment also gained in feelings of mastery and activity engagement. Activity engagement also moderated the level of recovery. To enhance recovery, interventions should facilitate meaningful activities and gaining control in life.
The study was registered with ClinicalTrials.gov . Reg. No. NCT02619318 . Retrospectively registered: December 2, 2015.
个人康复与许多重要的健康相关因素有关，但探索服务使用者的活动因素与个人康复之间的关联的研究却很少。因此，本研究的目的是：1）调查各种活动方面是否可以在考虑临床、社会人口统计学和幸福感因素的情况下调节康复的变化；2）探讨两种基于活动的干预措施，日常平衡（BEL）或标准职业治疗（SOT）对服务使用者个人康复的影响。
本研究纳入了 226 名服务使用者的一项聚类 RCT 研究，其中 133 名来自 BEL 小组，93 名来自 SOT 小组。参与者通常被诊断为情绪障碍，平均年龄为 40 岁。使用的工具针对活动、掌握和功能。采用混合模型回归分析。
模型测试的是选择的变量是否可以用于调解干预开始时到干预后六个月随访时康复的变化。参与者的个人康复在治疗后增加，并在随访时进一步增加。总体康复水平与治疗前后的抑郁/焦虑诊断呈负相关，但抑郁/焦虑的服务使用者仍能提高他们的康复水平。康复与性别或年龄之间没有显著关系。康复与抑郁/焦虑变化、活动满意度、性别和年龄之间的相互作用均无统计学意义。所有可能的治疗中介都与康复变化有关，其中最强的是职业参与和掌握，其次是活动满意度和症状。当引入协变量时，康复变化与时间因素（从干预开始到完成）之间的相互作用减少，表明存在中介作用。在所有情况下，时间变量仍然是显著的。当以协变量同时测试所有变量的模型时，职业参与和掌握具有很强的显著性。两种干预措施在改善康复方面没有差异。
治疗效果相当，且无论性别、年龄和诊断如何，都具有有效性。那些从治疗中获益最多的人也在掌握和活动参与方面获益更多。活动参与也调节了康复水平。为了提高康复水平，干预措施应促进有意义的活动并在生活中获得控制。
该研究在 ClinicalTrials.gov 注册。注册号 NCT02619318。回顾性注册：2015 年 12 月 2 日。
