Meaningful Activities and Recovery (MA&R): a co-led peer occupational therapy intervention for people with psychiatric disabilities. Results from a randomized controlled trial.

BACKGROUND: Activity and participation are critical to health and wellbeing. Limited evidence exists on how to support people with mental illness in participating in everyday activities. AIM: To investigate the effectiveness of Meaningful Activities and Recovery (MA&R), a co-led peer occupational therapy intervention focusing on activity engagement, functioning, quality of life, and personal recovery. METHODS: In a statistician blinded, multicenter RCT including 139 participants from seven community and municipal mental health services in Denmark, participants were randomly assigned to 1) MA&R and standard mental health care or 2) standard mental health care. The MA&R intervention lasted 8 months and consisted of 11 group sessions, 11 individual sessions, and support to engage in activities. The primary outcome, activity engagement, was measured using Profile of Occupational Engagement in People with Severe Mental Illness (POES-S). Outcomes were measured at baseline and post-intervention follow-up. RESULTS: Meaningful Activities and Recovery was delivered with high fidelity and 83% completed the intervention. It did not demonstrate superiority to standard mental health care, as intention-to treat analysis revealed no significant differences between the groups in activity engagement or any of the secondary outcomes. CONCLUSION: We did not find positive effects of MA&R, possibly because of COVID-19 and related restrictions. Fidelity assessments and adherence rates suggest that MA&R is feasible and acceptable. However, future studies should focus on refining the intervention before investigating its effectiveness. TRIAL REGISTRATION: The trial was registered 24/05/2019 at ClinicalTrials.gov NCT03963245.

"Moving on to an Open World": A Study of Participants' Experience in Meaningful Activities and Recovery (MA&R).

Background: Meaningful activities and Recovery (MA&R) is a peer coled occupational therapy intervention, to support occupational engagement among persons with psychiatric disabilities. Aim: To investigate participants' perspectives on how MA&R influenced occupational engagement and recovery processes. Material and Methods. A qualitative study with a phenomenological-hermeneutic design. Individual semistructured interviews were conducted with three women and ten men who had participated in MA&R. Participants were recruited from community mental health centres and municipality mental health services in two Danish municipalities. Analysis strategy was based on Malterud's Systematic Text Condensation. Results: MA&R was perceived as a practical approach to recovery, by providing an opportunity for reorientation, meaning, making in mundane activities, and a new outlook on everyday life. Participating in MA&R challenged a black and white approach to activities, put emphasis on "the little things", and enhanced curiosity, presence, and joy in occupational engagement. Conclusion: MA&R supported participants in developing a new "lens" on meaningful activities. The lens enhanced occupational engagement and made it possible to live according to personal preference. Results can inform further development and delivery of recovery-oriented occupational therapy interventions and add to the understandings of how occupational engagement and recovery are intertwined and manifested through everyday experiences. Thus, occupational engagement is an important target for recovery-oriented interventions. Occupational therapists and peer-workers coleading such interventions is feasible and makes good sense to the participants.

The missing link-participants' perspectives on transfer from psychosocial interventional contexts to everyday community life: a qualitative synthesis of interventional studies.

BACKGROUND: The aim of this study was to illuminate participants' experiences with transfer in (1) Illness Management and Recovery (IMR); and (2) two programs based on peer support: Turning Points, and Learn to Tackle Anxiety and Depression (LTAD); and whether peer support within these programs influenced the process of transfer beyond the interventional context. Furthermore, we investigated participants' experiences with a community-based intervention [Individual Placement and Support (IPS)] to explore perspectives on mechanisms that may eliminate challenges in the transfer process. METHODS: The study was based on semi-structured interviews with participants with mental illness, from four different psychosocial interventions with and without peer support and across interventional settings. The material partly consists of secondary analyses of existing data sets of anonymised, transcribed interviews investigating participants' experience from two psychosocial interventions: Illness Management and Recovery (n = 15), and Individual Placement and Support (n = 12). Additionally, we conducted semi-structured interviews with persons who had participated in one of two peer-led programs: Turning Points and Learn How to Tackle Anxiety and Depression (n = 12). The analysis was guided by a hermeneutic-phenomenological approach to illuminate transfer processes and was based on the template method described by Nigel King. RESULTS: Applying a transfer perspective on rehabilitation interventions identified everyday life situations where capacities learned during the interventions were utilized and conditions were highlighted that promoted or hindered transfer. Experiential knowledge and peer-exchange made transferal pathways between the interventional context and everyday life. Illness intrusiveness and uncertainty, together with environmental obstacles, generated transferal gaps. Individualized support could partly address these gaps. CONCLUSION: Findings from this qualitative study illuminate how peer-support in group-based rehabilitation interventions increased social functioning and developed better self-care strategies that can be transferred to daily life. Interventions situated in mental health settings, e.g. outpatient clinics, had limited impact on participation in broader community life. Advancing rehabilitation services in mental health may benefit from tailoring services to address illness fluctuation and combining group sessions with individualized support together with acknowledging and overcoming environmental obstacles.

Meaningful Activities and Recovery (MA&R): the effect of a novel rehabilitation intervention among persons with psychiatric disabilities on activity engagement-study protocol for a randomized controlled trial.

BACKGROUND: Engagement in activities meaningful to the individual may support the process of recovery in those with mental illness. Persons with psychiatric disabilities may reduce their engagement in meaningful activities to various degrees with possible fluctuations over time. We hypothesized that activity engagement can be altered when opportunities and support are offered at an individual and a group peer-based level. Evidence is lacking regarding mental health interventions that enable engagement in meaningful activities, and powered effect studies are warranted. METHODS: We propose an 8-month combined individual and group peer-based intervention, Meaningful Activities and Recovery (MA&R), and a study protocol for a multicentre two-armed parallel randomized controlled trial (RCT). The trial investigates the effects of MA&R in community mental health centres in Copenhagen and municipality services in Denmark. The trial will comprise 128 participants with psychiatric disabilities who will be randomized to one of two groups: (1) MA&R in addition to standard mental healthcare or (2) standard mental healthcare alone. The primary outcome is self-reported activity engagement, measured by Profiles of Engagement in People with Severe Mental Illness. Secondary outcomes are recovery, functioning and quality of life. Data will be collected at baseline and at follow-up at the end of the intervention. DISCUSSION: This study adds new knowledge to a field with limited evidence, i.e. the clinical effectiveness of rehabilitation interventions among people with psychiatric disabilities, directly targeting activity engagement. The pragmatic design, regarding in- and exclusion criteria and settings, may allow assessment of the intervention's effect under real-life conditions. The randomization, adequate power and fidelity monitoring allow testing of the intervention's efficacy. The multicentre study design increases the potential for implementation in various mental health settings if the findings are positive. As the nature of the intervention does not permit blinding of the participants or staff, it may increase the risk of expectancy and performance bias. This must be considered when interpreting the findings. TRIAL REGISTRATION: ClinicalTrials.gov NCT03963245 . Registered on 29 May 2019.