School of Occupational Therapy, Faculty of Medicine, The Hebrew University, Jerusalem 9124001, Israel.
School of Rehabilitation Therapy, Queen's University, Kingston, ON K7L 3N6, Canada.
Int J Environ Res Public Health. 2023 Jan 24;20(3):2141. doi: 10.3390/ijerph20032141.
Evidence-based practice is critical but challenging in mental health. Rigorous research-proven interventions often do not yield expected results in the clinical practice. This study aimed to explore factors contributing to the effectiveness of Occupational Connections (OC)-an intervention for promotion of engagement in meaningful occupations in serious mental illness (SMI)-based on case series study of three quasi-experimental studies. The studies focused on people with SMI, admitted to intensive mental health services participated in the OC, as well as on a control condition group. Similar evaluation procedures throughout these studies addressed primary outcomes of participation dimensions and recovery orientation, as well as secondary outcomes of functional capacity, cognition, and symptom severity. Patterns of changes in outcome measures varied between the three studies as to direction and extension. In the OC groups, 29-60% of the outcome measurements were changed, in comparison to 29-43% of measurements in the control groups. The secondary outcomes were consistently improved in the OC (18-100% of measurements) in comparison to the control (18-67%). The analysis of the studies revealed that clinical effectiveness of participation-oriented intervention varied dependent on interplay between the clinical context, clinician actions, served persons' characteristics, and evidence-building process. These factors should be considered to maximize research benefits for practice.
循证实践在心理健康领域至关重要，但也极具挑战性。经过严格研究验证的干预措施在临床实践中往往无法产生预期的效果。本研究旨在通过对三项准实验研究的案例系列研究，探讨影响职业联系（OC）干预措施有效性的因素。OC 干预措施旨在促进严重精神疾病（SMI）患者参与有意义的职业活动。研究对象为入住强化精神卫生服务的 SMI 患者，以及对照组。这些研究采用相似的评估程序，评估参与维度和康复倾向的主要结果，以及功能能力、认知和症状严重程度的次要结果。这三项研究中，各项结果测量的变化模式在方向和程度上存在差异。OC 组中，29%-60%的测量结果发生了变化，而对照组中则为 29%-43%。OC 组的次要结果（18%-100%的测量结果）始终得到改善，而对照组则为 18%-67%。研究分析表明，以参与为导向的干预措施的临床效果取决于临床环境、临床医生的行动、服务对象的特点和证据建立过程之间的相互作用。这些因素应加以考虑，以最大限度地提高研究对实践的效益。
