CENTENNIAL TOPICS
Clinical Effectiveness of Occupational Therapy in Mental
Health: A Meta-Analysis
Moses N. Ikiugu, PhD, OTR/L, is Professor and
Director of Research, Department of Occupational Therapy,
University of South Dakota, Vermillion; moses.
ikiugu@usd.edu
Ranelle M. Nissen, PhD, OTR/L, is Assistant
Professor and Academic Fieldwork Coordinator,
Department of Occupational Therapy, University of South
Dakota, Vermillion.
Cali Bellar, OTD, was Student, Department of
Occupational Therapy, University of South Dakota,
Vermillion, at the time of the study.
Alexya Maassen, OTD, is Occupational Therapist,
Reliant Rehabilitation, Hull, IA. At the time of the study,
she was Student, Department of Occupational Therapy,
University of South Dakota, Vermillion.
Katlin Van Peursem, OTD, is Occupational Therapist,
Sanford Health, Sheldon, IA. At the time of the study,
she was Student, Department of Occupational Therapy,
University of South Dakota, Vermillion.
The American Journal of Occupational Therapy
Downloaded from http://research.aota.org/ajot/article-pdf/71/5/7105100020p1/68761/7105100020p1.pdf by New England Inst of Technology Library, Sarah Martin on 01 August 2023
Moses N. Ikiugu, Ranelle M. Nissen, Cali Bellar, Alexya Maassen,
Katlin Van Peursem
OBJECTIVE. The purpose of this study was to estimate the effectiveness of theory-based occupational
therapy interventions in improving occupational performance and well-being among people with a mental
health diagnosis.
METHOD. The meta-analysis included 11 randomized controlled trials with a total of 520 adult participants
with a mental health diagnosis. Outcomes were occupational performance, well-being, or both. We conducted
meta-analyses using Comprehensive Meta-Analysis software (Version 3.0) with occupational performance
and well-being as the dependent variables.
RESULTS. Results indicated a medium effect of intervention on improving occupational performance
(mean Hedge’s g 5 0.50, Z 5 4.05, p < .001) and a small effect on well-being (mean Hedge’s g 5
0.46, Z 5 4.96, p < .001).
CONCLUSION. Theory-based occupational therapy interventions may be effective in improving occupa-
tional performance and well-being among people with a mental health diagnosis and should be an integral
part of rehabilitation services in mental health.
Ikiugu, M. N., Nissen, R. M., Bellar, C., Maassen, A., & Van Peursem, K. (2017). Centennial Topics—Clinical effectiveness
of occupational therapy in mental health: A meta-analysis. American Journal of Occupational Therapy, 71,
7105100020. https://doi.org/10.5014/ajot.2017.024588
O
ccupational therapy was founded on the principles of humanistic philosophy
that emphasize reintegration of people with mental and physical health
challenges into the mainstream of life through participation in daily occupations
(Cole & Tufano, 2008). Over time, as the medical model became prominent
in health care, practitioners focused more on physical disabilities, eventually
leading to a decline in the presence of occupational therapy in mental health
(Creek, 2014; D’Amico, Jaffe, & Gibson, 2010). In recent years, the American
Occupational Therapy Association (AOTA) has been pushing for the profession
to reestablish its presence in mental health (AOTA, 2016; Gutman, 2011).
To achieve this objective, occupational therapists need to demonstrate that
their interventions require specialized skills that are based on research-supported
theoretical principles. Such skills can be demonstrated through competent ap-
plication of the theoretical principles undergirding interventions, as articulated in
the profession’s theoretical conceptual practice models. Therefore, occupational
Note. Each issue of the 2017 volume of the American Journal of Occupational Therapy features a special Centennial
Topics section containing several articles related to a specific theme; for this issue, the theme is occupational
therapy’s role in mental health. The goal is to help occupational therapy professionals take stock of how far the
profession has come and spark interest in the many exciting paths for the future. For more information, see the
editorial in the January/February issue, https://doi.org/10.5014/ajot.2017.711004.
7105100020p1
therapy practitioners in mental health need to demonstrate
that their interventions are clearly based on (1) the princi-
ples of the profession’s theoretical conceptual practice
models (Hinojosa, 2013; Ikiugu & Smallfield, 2015), (2)
sound research evidence (Gutman, 2011), and (3) occupa-
tions that are meaningful to the client (Schell & Gillen,
2014).
Although the profession’s theoretical principles guide
clinical decision making, no consensus exists regarding
the definition of a theoretical conceptual practice model.
In this study, we adopted Kielhofner’s (2009) definition
of a theoretical conceptual practice model as consisting of a
“solid grounding in practice, theory that clearly addresses
a unique practice circumstance or challenge and devel-
opment of specific practice resources” (p. 62). Some
scholars in the profession (see, e.g., Cole & Tufano,
2008) have distinguished between the terms theoretical
conceptual practice models and frames of reference. How-
ever, Kielhofner (2009) made no such distinction. Others
have relied on the Occupational Therapy Practice Frame-
work: Domain and Process (3rd ed.; AOTA, 2014) to
guide eclectic theoretical considerations during evalua-
tions and interventions aimed at improving occupational
performance through occupation-based practices. The
purpose of our meta-analysis was to answer the following
question: What is the overall effect of occupational
therapy interventions that are based on the profession’s
theoretical conceptual practice models in improving oc-
cupational performance and well-being among adults
with a mental health diagnosis?
Method
Research Design
This study was conducted using a meta-analytic design
(Borenstein, Hedges, Higgins, & Rothstein, 2009; Portney
& Watkins, 2009). This design was best suited for ap-
plying rigorous statistical procedures to estimate the ef-
fectiveness of theory-based occupational therapy interventions
in improving occupational performance and well-being
among clients with mental health conditions.
Definition of Variables
The dependent variables in our analysis were occupational
performance and well-being. Occupational performance
was defined as the outcome of a dynamic transaction
among the client, environmental context, and occupa-
tion, manifesting in participation in areas of occupation
(activities of daily living, instrumental activities of daily
living [IADLs], rest and sleep, education, work, play,
7105100020p2
leisure, social participation) as defined in the Framework.
Well-being was defined as “the total universe of human life
domains, including physical, mental, and social aspects”
(World Health Organization, 2006, p. 211). Mental
health symptoms such as anhedonia, hallucinations, and
delusions were some of the indicators of compromised
well-being.
Study Sample
Downloaded from http://research.aota.org/ajot/article-pdf/71/5/7105100020p1/68761/7105100020p1.pdf by New England Inst of Technology Library, Sarah Martin on 01 August 2023
Studies included in this meta-analysis were those in
which (1) participants were adults (age 18 yr or older); (2)
participants had a mental health diagnosis; (3) a randomized
controlled trial (RCT) design was used; (4) well-being,
occupational performance, or both were the dependent
variables; (5) parametric statistics (e.g., t tests in post hoc
pairwise comparisons) were used to analyze data; (6) the
language of publication was English; (7) the date of pub-
lication was between 1995 and June 2016; and (8) a simple
majority of the 25 criteria in the Consolidated Standards of
Reporting Trials (CONSORT; Schulz, Altman, & Moher,
2010) checklist was attained.
Instruments
Data Extraction Protocol. We developed a data extrac-
tion protocol based on the Preferred Reporting Items for
Systematic Reviews and Meta-Analysis (PRISMA; Moher,
Liberati, Tetzlaff, & Altman, 2009) guidelines and the
Cochrane Handbook for Systematic Reviews of Interventions
(Cochrane Collaboration, 2011) to ensure thoroughness
and consistency of the systematic review process (Shamseer
et al., 2015). The protocol consisted of the following
fields: citation, study design, sample characteristics, oc-
cupational therapy intervention (independent variable),
theoretical conceptual practice model that was the source
of the intervention guidelines, duration of the inter-
vention, dependent variable or variables, experimental
and control group means and standard deviations on the
dependent variable or variables, post hoc pairwise com-
parison t values, and p values (Higgins & Deeks, 2011).
Theoretical Conceptual Practice Model Identification
Criteria. Few researchers identified the theoretical con-
ceptual practice model principles that guided the in-
tervention strategies that they investigated. Therefore, we
used a framework developed by Ikiugu and Nissen (2016)
to determine the theoretical model on which the inter-
ventions were likely based, consistent with Kielhofner’s
(2009) definition of a theoretical conceptual practice
model, as explained earlier. The framework consisted of
key constructs for each of the models that Ikiugu and
Nissen found are commonly used by occupational ther-
apy practitioners in mental health.
September/October 2017, Volume 71, Number 5
 We used these constructs as the criteria for deter-
mining which theoretical conceptual practice model was
the source of the intervention strategies in the research
studies that we reviewed. For example, two key constructs
in the Canadian Model of Occupational Performance and
Engagement (CMOP–E) are (1) facilitation of client au-
tonomy by encouraging free choice of occupation and
(2) empathic sharing of the experienced occupational
performance. Therefore, because Buchain, Vizzotto,
Henna Neto, and Elkis (2003) investigated interventions
that included “free choice of activities” used in therapy and
developing “a common activity, as a whole” during group
sessions, thus “enabling richer and more varied exchanges
between” clients and “between them and the therapist” (p.
27), we concluded that these strategies were likely derived
from the CMOP–E.
PRISMA Protocol. We used the PRISMA protocol
(Liberati et al., 2009) to evaluate the risk of bias for the
studies included in the meta-analysis. The protocol requires
assessment of each study to determine whether it meets the
following criteria: concealment of randomization; no early
termination of the trial; and blinding of research partici-
pants, researchers, and data collectors. The more of these
criteria are met, the less bias is attributed to the trial.
CONSORT Checklist. The CONSORT checklist (Moher
et al., 2010) consists of 25 criteria that are used to ap-
praise RCTs for external and internal validity on the basis
of randomization status as stated in the study title;
summary of the trial design, methods, results, and con-
clusions in the abstract; statement of specific objectives or
hypotheses; list of study participant eligibility criteria;
description of the settings and locations where data were
gathered; description of how the sample size was deter-
mined; and description of the method used to generate
the random allocation sequence (Moher et al., 2011). We
read each study and indicated the page number on which
each criterion on the CONSORT checklist was addressed.
If a simple majority of the 25 criteria on the checklist were
met, we considered the study to be eligible for inclusion in
the meta-analysis.
Procedures
Search Strategies and Study Selection Criteria. Three
student coinvestigators completed a comprehensive search
of the literature between September 2015 and January
2016. The databases searched were MEDLINE, CINAHL,
PsycINFO, ClinicalKey, Social Work Abstracts, Cochrane
Library, PubMed Health, and OTseeker. We used the
following search terms in various combinations: occupational
therapy, occupational therapy interventions, mental health,
theoretical conceptual practice models, occupational performance,
The American Journal of Occupational Therapy
and well-being. The three coinvestigators read the titles and
abstracts of studies that they considered potentially rele-
vant for inclusion in the sample. References of retrieved
articles were hand searched to identify other studies that
potentially met the inclusion criteria. The investigators
selected the final sample by consensus. The two principal
investigators completed an independent search in June
2016 and identified 3 additional studies. The final sample
consisted of 11 RCTs (Figure 1 provides the details of the
Downloaded from http://research.aota.org/ajot/article-pdf/71/5/7105100020p1/68761/7105100020p1.pdf by New England Inst of Technology Library, Sarah Martin on 01 August 2023
article search and selection). The articles constituting the
sample are listed in the references and indicated by
asterisks.
Appraisal of Bias and Methodological Quality. To assess
the risk of bias and methodological quality, we eval-
uated each study using the PRISMA protocol and the
CONSORT checklist. Analysis revealed that of the 11
studies, randomization was concealed in 6, researchers
or participants were blinded in none, and data col-
lectors were blinded in 4. All 11 RCTs met a majority
of the CONSORT criteria.
Data Extraction. We read each of the articles and
extracted data using the data abstraction protocol. We
used the theoretical conceptual practice model identifi-
cation framework (Ikiugu & Nissen, 2016) to determine
the theoretical basis for each study’s experimental inde-
pendent variable.
Statistical Analysis. We entered the abstracted data into
a Comprehensive Meta-Analysis software database (Version
3; Biostat Inc., Englewood, NJ). Hedge’s g was computed as
a measure of effect size because it is less biased than
Cohen’s d (Borenstein et al., 2009). Because the reviewed
studies were conducted in disparate environments and
involved participants with a variety of mental health
conditions, variability of effect sizes was expected.
Therefore, we used a random effects model to compute
the summary effect sizes (Borenstein et al., 2009). We
tested the data for homogeneity of effect sizes using the Q
statistic. Even when the hypothesis of heterogeneity was
rejected, however (p > .10), we used the random effects
model on the basis of our previously stated rationale. To
assess articles for publication bias, we constructed a funnel
plot, followed by Duval and Tweedie’s (2000) trim-and-
fill method and Egger, Davey Smith, Schneider, and
Minder’s (1997) regression intercept test (Borenstein,
Hedges, Higgins, & Rothstein, 2004).
Results
In total, 520 people participated in the 11 studies in our
sample. Occupational performance was measured for
323 participants, and well-being was measured for 349
7105100020p3

Figure 1. Illustration of the systematic search strategy.
Note. CONSORT 5 Consolidated Standards of Reporting Trials; RCT 5 randomized controlled trial.
participants. A total of 91 outcomes (44 occupational
performance outcomes and 47 well-being outcomes) were
measured. The Behavioral/Cognitive–Behavioral (B/CB)
theoretical conceptual practice model was used to guide in-
tervention in 5 studies; CMOP–E in 3 studies; and the
Cognitive Disabilities (CD) model, unspecified client-
centered models, and a psychodynamic model in 1 study
each. The interpretation of effect sizes was as follows: d > 0.20,
small; d > 0.50, medium; and d > 0.80, large (Cohen, 1988).
Efficacy of Theory-Based Interventions in Improving
Occupational Performance
A test of homogeneity revealed significant heterogeneity in
effect sizes in the 7 studies in which occupational per-
formance was measured, Q(6) 5 37.57, p < .001. Analysis
for moderators indicated that much of the variability
could be attributed to 1 outlier study (N 5 42) in which
intervention was based on unspecified client-centered
theory. The intervention had a small effect favoring the
control group (Hedge’s g 5 20.06, 95% confidence
interval [CI] [20.20, 20.07], Z 5 20.91, p 5 .36).
When the study was removed from analysis, heteroge-
neity was reduced, Q(5) 5 10.05, p 5 .07. A p > .10 is
7105100020p4
Downloaded from http://research.aota.org/ajot/article-pdf/71/5/7105100020p1/68761/7105100020p1.pdf by New England Inst of Technology Library, Sarah Martin on 01 August 2023
recommended for the Q test to reject the heterogeneity
hypothesis (Kim, Yoo, Jung, Park, & Park, 2012).
However, Higgins (2008) argued that “any amount of
heterogeneity is acceptable, providing both that the pre-
defined eligibility criteria for the meta-analysis are sound
and that the data are correct” (p. 1158).
Because heterogeneity in this case was not substantial
(p > .05), our meta-analysis inclusion criteria were sound,
and great care was taken to ensure data accuracy, we judged
that we could combine the remaining 6 studies in the meta-
analysis. The effect of intervention on occupational per-
formance was medium (Hedge’s g 5 0.50, 95% CI [0.26,
0.74], Z 5 4.05, p < .001; see Supplemental Table 1,
available online with this article at https://ajot.aota.org). The
funnel plot indicated no publication bias (fail-safe N 5 51
studies; Egger’s regression intercept 5 0.56, p 5 .40,
one-tailed). This finding was confirmed using Duval and
Tweedie’s (2000) trim-and-fill procedure (Figure 2).
Efficacy of Theory-Based Interventions in
Improving Well-Being
A test of homogeneity revealed significant heterogeneity in
the effect sizes among the 7 studies in which well-being
September/October 2017, Volume 71, Number 5

Figure 2. Standardized mean differences plotted against standard error of the differences.
Note. No publication bias was evident in this meta-analysis (fail-safe N 5 51, Egger’s regression intercept 5 0.56, p 5 .40). Std. diff 5 standardized difference;
Std err 5 standard error.
was measured, Q(6) 5 537.26, p < .001. Analysis for
moderators revealed that much of the variability could be
attributed to 2 outlier studies (N 5 102) in which un-
specified client-centered theory and the psychodynamic
model were used to guide intervention strategies. A small
effect of intervention was found, based on unspecified
client-centered principles, on well-being that favored the con-
trol group (Hedge’s g 5 20.40, 95% CI [20.56, 20.23],
Z 5 24.65, p < .001). The effect of intervention based
on the psychodynamic model (N 5 60) was very large
(Hedge’s g 5 3.46, 95% CI [3.18, 3.75], Z 5 23.85, p <
.001). Removal of the 2 studies reduced heterogeneity to
acceptable levels, Q(4) 5 7.73, p 5 .10. Subsequent anal-
ysis indicated that there was a small effect of intervention on
well-being among study participants (Hedge’s g 5 0.46,
95% CI [0.28, 0.65], Z 5 4.96, p < .001; Table 1).
The funnel plot revealed that there was a significant
publication bias (fail-safe N 5 64 studies, Egger’s regression
intercept 5 3.35, p 5 .01, one-tailed). Duval and Tweedie’s
(2000) procedure revealed that the bias was corrected by
trimming and imputing 2 studies, leading to an adjusted
Hedge’s g of 0.37 (95% CI [0.16, 0.57]; Figure 3).
The imputed studies seemed to correspond to the 2
that were removed to address the problem of heterogeneity.
When the 2 studies were added back into the analysis, the
summary effect was still small (Hedge’s g 5 0.49). However,
the publication bias was corrected (fail-safe N 5 320
studies, Egger’s regression intercept 5 12.01, p 5 .15).
Discussion
The purpose of this meta-analysis was to estimate the
effectiveness of occupational therapy interventions based
The American Journal of Occupational Therapy
Downloaded from http://research.aota.org/ajot/article-pdf/71/5/7105100020p1/68761/7105100020p1.pdf by New England Inst of Technology Library, Sarah Martin on 01 August 2023
on the profession’s theoretical conceptual practice models
in improving occupational performance and well-being
among people with mental health challenges. There
was indication of a medium effect of interventions in
improving occupational performance among treated
participants. This finding was consistent with previous
research indicating that occupational therapy interven-
tions were effective in improving performance of occu-
pations such as work, parenting, home management and
maintenance, and social participation among people with
serious mental illness (Arbesman & Logsdon, 2011;
Gutman, Kerner, Zombek, Dulek, & Ramsey, 2009;
Gutman et al., 2007; Oka et al., 2004). In addition,
training clients in social skills, life skills, IADLs, and
neurocognitive interventions, coupled with vocational,
social, and IADL training, has been found to be effective
in enhancing executive functioning and healthy routines
among people with mental health disorders (Anzai et al.,
2002; Katz & Keren, 2011; Zielinski Grimm et al.,
2009).
Our findings also indicate that occupational therapy
interventions may have a small effect in improving well-
being for people with a mental health diagnosis. This
result was consistent with the findings of a systematic
review by Gibson, D’Amico, Jaffe, and Arbesman (2011)
that occupational therapy was effective in enhancing
occupational performance and reducing mental health
symptoms, thus improving well-being. Finally, the the-
oretical principles that informed intervention strategies in
the studies constituting our sample were drawn from the
B/CB, CMOP–E, CD, Occupational Adaptation (OA),
Model of Human Occupation (MOHO), and psycho-
dynamic theoretical conceptual practice models. This
7105100020p5

Figure 3. Plot of standardized differences in means against standard errors of the differences.
Note. Std diff 5 standardized difference.
result was similar to the finding in previous studies that
the B/CB model, MOHO, and CMOP–E were the
most frequent sources of intervention strategies in mental
health practice (Ikiugu, 2012; Ikiugu & Nissen, 2016;
Lee, Taylor, & Kielhofner, 2009). However, unlike in
previous studies, the OA and psychodynamic models also
featured in our meta-analysis.
Limitations
In most cases, the researchers did not identify the theo-
retical conceptual practice models on which the inter-
ventions that they investigated were based. We often had
to use previously developed criteria (Ikiugu & Nissen,
2016) to determine the theoretical basis of interventions.
It is possible that we could have made errors in inter-
preting the interventions investigated in the studies that
constituted our study sample. Moreover, the appraisal of
bias and methodological quality of the studies in our
sample revealed a lack of reporting of preferred criteria.
Therefore, the effect sizes reported should be viewed with
these limitations in mind.
Considerations for Future Research
In future research, investigators may consider completing
content analysis of the studies that do not meet the in-
clusion criteria for meta-analysis to generate more infor-
mation about the theoretical conceptual practice models
that are generally used to guide interventions in mental
health. Such investigations may shed more light on the
theoretical reasoning used by occupational therapy cli-
nicians and researchers when they plan therapeutic in-
terventions. Moreover, in future meta-analyses it may be
7105100020p6
Downloaded from http://research.aota.org/ajot/article-pdf/71/5/7105100020p1/68761/7105100020p1.pdf by New England Inst of Technology Library, Sarah Martin on 01 August 2023
interesting to find out how diagnostic categories modulate
the effects of interventions.
Implications for Occupational
Therapy Practice
Our findings indicate that occupational therapy inter-
ventions based on the following theoretical frameworks
may be effective in improving occupational performance
and well-being among people with a mental health di-
agnosis: B/CB, MOHO, CMOP–E, psychodynamic,
CD, and OA. However, many times the researchers did
not clearly identify the occupational therapy theories
that guided their intervention strategies. One interesting
finding was that when the theoretical basis of intervention
was extremely ambiguous (unspecified client-centeredness),
the effect was very small and tended to favor the control
group. This finding further underscores the importance of
basing interventions on clear occupational therapy theo-
retical principles. Overall, the results of the study suggested
that
• Interventions based on theoretical conceptual practice
models may lead to improvement in occupational per-
formance and well-being among people with a mental
health diagnosis.
• Clear identification of specific theoretical conceptual
practice models on which interventions are based is
often lacking in the published mental health occupa-
tional therapy research.
• A clearer description of the theoretical basis of inter-
ventions (independent variables) in research may pro-
vide clinicians with stronger rationales when claiming
reimbursement for services.
September/October 2017, Volume 71, Number 5
Conclusion
The purpose of this meta-analysis was to estimate the ef-
fectiveness of occupational therapy interventions based on
the profession’s theoretical conceptual practice models in
improving occupational performance and well-being among
people with a mental health diagnosis. Our findings suggest
that occupational therapy interventions had a medium ef-
fect on improving occupational performance and a small
effect on improving well-being among people with a mental
health diagnosis. Further research should be conducted to
confirm these findings. In addition, occupational therapy
practitioners and researchers should clearly and consistently
identify and document the theoretical basis and details of
their interventions to demonstrate the profession’s unique
value in the rehabilitation of people with a mental health
diagnosis. s
Acknowledgments
The findings of this study were presented at the University of
South Dakota School of Health Sciences Research Con-
ference on April 22, 2016, and the University of South
Dakota Occupational Therapy Research Symposium on
May 4, 2016. They were also presented at the 2017 AOTA
Annual Conference & Centennial Celebration on March
30, 2017.
References
American Occupational Therapy Association. (2014). Occu-
pational therapy practice framework: Domain and pro-
cess (3rd ed.). American Journal of Occupational Therapy,
68(Suppl.1), S1–S48. https://doi.org/10.5014/ajot.2014.
682006
American Occupational Therapy Association. (2016). Occupa-
tional therapy’s distinct value: Mental health promotion, pre-
vention, and intervention across the lifespan. Retrieved from
https://www.aota.org/-/media/Corporate/Files/Practice/
MentalHealth/Distinct-Value-Mental-Health.pdf
Anzai, N., Yoneda, S., Kumagai, N., Nakamura, Y., Ikebuchi, E.,
& Liberman, R. P. (2002). Training persons with schizo-
phrenia in illness self-management: A randomized controlled
trial in Japan. Psychiatric Services, 53, 545–547. https://doi.
org/10.1176/appi.ps.53.5.545
Arbesman, M., & Logsdon, D. W. (2011). Occupational therapy
interventions for employment and education for adults with
serious mental illness: A systematic review. American Journal
of Occupational Therapy, 65, 238–246. https://doi.org/
10.5014/ajot.2011.001289
pBickes, M. B., Deloache, S. N., Dicer, J. R., & Miller, S. C.
(2001). Effectiveness of experiential and verbal occupa-
tional therapy groups in a community mental health set-
ting. Occupational Therapy in Mental Health, 17, 51–72.
https://doi.org/10.1300/J004v17n01_04
p
Indicates studies included in the meta-analysis.
The American Journal of Occupational Therapy
Borenstein, M., Hedges, L., Higgins, J., & Rothstein, H.
(2004). Comprehensive Meta-Analysis (Version 2) [Com-
puter software]. Englewood, NJ: Biostat.
Borenstein, M., Hedges, L. V., Higgins, J. P., & Rothstein,
H. R. (2009). Introduction to meta-analysis. Chichester,
England: Wiley. https://doi.org/10.1002/9780470743386
pBuchain, P. C., Vizzotto, A. D., Henna Neto, J., & Elkis, H.
(2003). Randomized controlled trial of occupational ther-
apy in patients with treatment-resistant schizophrenia. Re-
vista Brasileira de Psiquiatria, 25, 26–30. https://doi.org/
Downloaded from http://research.aota.org/ajot/article-pdf/71/5/7105100020p1/68761/7105100020p1.pdf by New England Inst of Technology Library, Sarah Martin on 01 August 2023
10.1590/S1516-44462003000100006
pChan, S. H., Lee, S. W., & Chan, I. W. (2007). TRIP: A
psycho-educational programme in Hong Kong for people
with schizophrenia. Occupational Therapy International,
14, 86–98. https://doi.org/10.1002/oti.226
pChapleau, A., Seroczynski, A. D., Meyers, S., Lamb, K., &
Buchino, S. (2012). The effectiveness of a consultation
model in community mental health. Occupational Therapy
in Mental Health, 28, 379–395. https://doi.org/10.1080/
0164212X.2012.708609
pChen, Y., Pan, A., Hsiung, P., & Chung, L. (2015). Quality
of life enhancement programme for individuals with
mood disorder: A randomized controlled pilot study.
Hong Kong Journal of Occupational Therapy, 25, 23–31.
https://doi.org/10.1016/j.hkjot.2015.04.001
Cochrane Collaboration. (2011). Cochrane handbook for system-
atic reviews of interventions. London: Author. Retrieved
from http://handbook.cochrane.org/
Cohen, J. (1988). Statistical power analysis for the behavioral
sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
Cole, M. B., & Tufano, R. (2008). Applied theories in occupa-
tional therapy: A practical approach. Thorofare, NJ: Slack.
pCook, S., Chambers, E., & Coleman, J. H. (2009). Occupa-
tional therapy for people with psychotic conditions in
community settings: A pilot randomized controlled trial.
Clinical Rehabilitation, 23, 40–52. https://doi.org/10.1177/
0269215508098898
Creek, J. (2014). The knowledge base of occupational therapy.
In W. Bryant, J. Fieldhouse, & K. Bannigan (Eds.), Creek’s
occupational therapy and mental health (5th ed., pp. 27–47).
Edinburgh, Scotland: Churchill Livingstone Elsevier.
D’Amico, M., Jaffe, L., & Gibson, R. W. (2010). Centennial
Vision—Mental health evidence in the American Journal
of Occupational Therapy. American Journal of Occupa-
tional Therapy, 64, 660–669. https://doi.org/10.5014/
ajot.2010.09180
Duval, S., & Tweedie, R. (2000). Trim and fill: A simple
funnel-plot-based method of testing and adjusting for pub-
lication bias in meta-analysis. Biometrics, 56, 455–463.
https://doi.org/10.1111/j.0006-341X.2000.00455.x
pEdgelow, M., & Krupa, T. (2011). Randomized controlled
pilot study of an occupational time-use intervention for
people with serious mental illness. American Journal of
Occupational Therapy, 65, 267–276. https://doi.org/10.5014/
ajot.2011.001313
Egger, M., Davey Smith, G., Schneider, M., & Minder, C.
(1997). Bias in meta-analysis detected by a simple, graph-
ical test. BMJ, 315, 629–634. https://doi.org/10.1136/
bmj.315.7109.629
7105100020p7
pForuzandeh, N., & Parvin, N. (2013). Occupational therapy
for inpatients with chronic schizophrenia: A pilot randomized
controlled trial. Japan Journal of Nursing Science, 10, 136–141.
https://doi.org/10.1111/j.1742-7924.2012.00211.x
Gibson, R. W., D’Amico, M., Jaffe, L., & Arbesman, M.
(2011). Occupational therapy interventions for recovery
in the areas of community integration and normative life
roles for adults with serious mental illness: A systematic
review. American Journal of Occupational Therapy, 65,
247–256. https://doi.org/10.5014/ajot.2011.001297
pGitlin, L. N., Winter, L., Burke, J., Chernett, N., Dennis,
M. P., & Hauck, W. W. (2008). Tailored activities to
manage neuropsychiatric behaviors in persons with
dementia and reduce caregiver burden: A random-
ized pilot study. American Journal of Geriatric Psychi-
atry, 16, 229–239. https://doi.org/10.1097/01.JGP.
0000300629.35408.94
Gutman, S. A. (2011). From the Desk of the Editor—Special
issue: Effectiveness of occupational therapy services in
mental health practice. American Journal of Occupational
Therapy, 65, 235–237. https://doi.org/10.5014/ajot.2011.
001339
Gutman, S. A., Kerner, R., Zombek, I., Dulek, J., & Ramsey,
C. A. (2009). Supported education for adults with psychi-
atric disabilities: Effectiveness of an occupational therapy
program. American Journal of Occupational Therapy, 63,
245–254. https://doi.org/10.5014/ajot.63.3.245
Gutman, S., Schindler, V., Furphy, K., Klein, K., Lisak, J., &
Durham, D. (2007). The effectiveness of a supported ed-
ucation program for adults with psychiatric disabilities: The
Bridge Program. Occupational Therapy in Mental Health, 23,
21–38. https://doi.org/10.1300/J004v23n01_02
Higgins, J. P. (2008). Commentary: Heterogeneity in meta-
analysis should be expected and appropriately quantified.
International Journal of Epidemiology, 37, 1158–1160.
https://doi.org/10.1093/ije/dyn204
Higgins, J., & Deeks, J. (2011). Selecting studies and collecting
data. In J. Higgins & S. Green (Eds.), Cochrane handbook
for systematic reviews of interventions (Version 5.1.0.). Re-
trieved from http://handbook.cochrane.org/.
Hinojosa, J. (2013). The evidence-based paradox. American
Journal of Occupational Therapy, 67, e18–e23. https://
doi.org/10.5014/ajot.2013.005587
Ikiugu, M. N. (2012). Use of theoretical conceptual prac-
tice models by occupational therapists in the US:
A pilot survey. International Journal of Therapy and
Rehabilitation, 19, 629–639. https://doi.org/10.12968/
ijtr.2012.19.11.629
Ikiugu, M. N., & Nissen, R. M. (2016). Intervention strategies
used by occupational therapists working in mental health
and their theoretical basis. Occupational Therapy in Mental
Health, 32, 109–129. https://doi.org/10.1080/0164212X.
2015.1127192
Ikiugu, M. N., & Smallfield, S. (2015). Instructing occupa-
tional therapy students in use of theory to guide practice.
Occupational Therapy in Health Care, 29, 165–177.
https://doi.org/10.3109/07380577.2015.1017787
Katz, N., & Keren, N. (2011). Effectiveness of occupational
goal intervention for clients with schizophrenia. American
7105100020p8
Journal of Occupational Therapy, 65, 287–296. https://doi.
org/10.5014/ajot.2011.001347
Kielhofner, G. (2009). Conceptual foundations of occupational
therapy practice. Philadelphia: F. A. Davis.
Kim, S. Y., Yoo, E.-Y., Jung, M.-Y., Park, S.-H., & Park, J.-H.
(2012). A systematic review of the effects of occupational
therapy for persons with dementia: A meta-analysis of
randomized controlled trials. NeuroRehabilitation, 31,
107–115.
pLambert, R. A., Harvey, I., & Poland, F. (2007). A prag-
Downloaded from http://research.aota.org/ajot/article-pdf/71/5/7105100020p1/68761/7105100020p1.pdf by New England Inst of Technology Library, Sarah Martin on 01 August 2023
matic, unblinded randomised controlled trial comparing
an occupational therapy-led lifestyle approach and routine
GP care for panic disorder treatment in primary care.
Journal of Affective Disorders, 99, 63–71. https://doi.org/
10.1016/j.jad.2006.08.026
Lee, S. W., Taylor, R., & Kielhofner, G. (2009). Choice,
knowledge, and utilization of a practice theory: A national
study of occupational therapists who use the model of
human occupation. Occupational Therapy in Health Care,
23, 60–71. https://doi.org/10.1080/07380570802455540
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche,
P. C., Ioannidis, J. P., . . . Moher, D. (2009). The PRISMA
statement for reporting systematic reviews and meta-analyses
of studies that evaluate health care interventions: Explanation
and elaboration. PLoS Medicine, 6, e1000100. https://doi.
org/10.1371/journal.pmed.1000100
Moher, D., Hopewell, S., Schulz, K. F., Montori, V., Gotzsche,
P. C., Devereaux, P. J., . . . Altman, D. G. (2010). CONSORT
2010 explanation and elaboration: Updated guidelines for
reporting parallel group randomized trials. BMJ, 343,
d6131. http://dx.doi.org/10.1136/bmj.d6131
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G.; PRISMA
Group. (2009). Preferred reporting items for systematic
reviews and meta-analyses: The PRISMA statement. PLoS
Medicine, 6, e1000097. https://doi.org/10.1371/journal.
pmed.1000097
Oka, M., Otsuka, K., Yokoyama, N., Mintz, J., Hoshino, K.,
Niwa, S., & Liberman, R. P. (2004). An evaluation of a
hybrid occupational therapy and supported employment
program in Japan for persons with schizophrenia. Ameri-
can Journal of Occupational Therapy, 58, 466–475. https://
doi.org/10.5014/ajot.58.4.466
Portney, L. G., & Watkins, M. P. (2009). Foundations of
clinical research: Applications to practice (3rd ed.). Upper
Saddle River, NJ: Prentice Hall.
Schell, B. A. B., & Gillen, G. (2014). Overview of theory
guided intervention. In B. A. B. Schell, G. Gillen, M. E.
Scaffa, & E. S. Cohn (Eds.), Willard and Spackman’s oc-
cupational therapy (12th ed., pp. 745–749). Philadelphia:
Lippincott Williams & Wilkins.
Schulz, K. F., Altman, D. G., & Moher, D. (2010). CONSORT
2010 statement: Updated guidelines for parallel group rand-
omised trials. BMJ, 340, 698–702.
Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A.,
Petticrew, M., . . . Stewart, L. A.; PRISMA-P Group.
(2015). Preferred Reporting Items for Systematic Review
and Meta-Analysis Protocols (PRISMA-P) 2015: Elabora-
tion and explanation. BMJ, 349, g7647. https://doi.org/
10.1136/bmj.g7647
September/October 2017, Volume 71, Number 5
pVelligan, D. I., Bow-Thomas, C. C., Huntzinger, C., Ritch,
J., Ledbetter, N., Prihoda, T. J., & Miller, A. L. (2000).
Randomized controlled trial of the use of compensatory
strategies to enhance adaptive functioning in outpatients
with schizophrenia. American Journal of Psychiatry, 157,
1317–1328. https://doi.org/10.1176/appi.ajp.157.8.1317
World Health Organization. (2006). Constitution of the
World Health Organization (45th ed.). Retrieved from
The American Journal of Occupational Therapy
http://www.afro.who.int/index.php?option5com_docman&
task5doc_download&gid519&Itemid52111WHO2006
Zielinski Grimm, E., Sturtevant Meus, J., Brown, C., Exley,
M., Hartman, S., Hays, C., & Manner, T. (2009). Meal
preparation: Comparing treatment approaches to increase
acquisition of skills for adults with schizophrenic disorders.
OTJR: Occupation, Participation and Health, 29, 148–153.
https://doi.org/10.3928/15394492-20090914-02
Downloaded from http://research.aota.org/ajot/article-pdf/71/5/7105100020p1/68761/7105100020p1.pdf by New England Inst of Technology Library, Sarah Martin on 01 August 2023
7105100020p9