Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
By
Brianna Teigen
Erica Leighty
Duluth, MN.
May 2014
__________________________________________ ____5-29-2014___________
____________________________________________ ____5-29-2014___________
In the unlikely event that the author did not send a complete manuscript
and there are missing pages, these will be noted. Also, if material had to be removed,
a note will indicate the deletion.
UMI 1585277
Published by ProQuest LLC (2015). Copyright in the Dissertation held by the Author.
Microform Edition © ProQuest LLC.
All rights reserved. This work is protected against
unauthorized copying under Title 17, United States Code
ProQuest LLC.
789 East Eisenhower Parkway
P.O. Box 1346
Ann Arbor, MI 48106 - 1346
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS ii
Abstract
The object of this systematic literature review was to determine the effects of occupation-
based interventions on activity limitations and participation performance for adults with
schizophrenia. This review was compiled from reviewing six quantitative studies, all of
which were randomized controlled trials. Two independent reviewers searched and
screened databases to locate and select articles based on set inclusion and exclusion
criteria. Each article was reviewed independently, and discussed together, with a third
party available to resolve any differences of opinions. Two of the five studies reviewed
showed that occupation-based treatment had statistically significant improvements
compared a control group’s treatment. Two studies did not find a significant difference
between the performance of control and experimental groups. One study showed the
control group was more effective than the experimental group. The results of this review
have determined that there are mixed findings that suggest high variation in what
occupation-based treatment consists of for clients with schizophrenia. Further research is
needed to gain a better understanding of effective occupation-based treatment
interventions for adults with schizophrenia.
Table of Contents
Page
Abstract ii
Introduction 1
Background 1
Literature Review 4
Method 6
Results 7
Discussion 11
Conclusion 14
References 15
Appendix 18
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 1
Introduction
There are several interventions that mental health professionals, including occupational
therapists, use when treating clients who have schizophrenia, but the best form of
treatment has not yet been established. More research is needed to establish a basis of
Background
affected may hear voices and believe people are reading their minds (“What is
Schizophrenia?,” 2013). It is difficult to identify specific traits found in all people with
schizophrenia because there is much disagreement about the defining features of this
disorder (Brown & Stoffel, 2011). According to the Diagnostic and Statistical Manual of
Mental Disorders, for an individual to be diagnosed with schizophrenia they must exhibit
two of the following symptoms for at least one month: delusions, hallucinations,
& Stoffel, 2011). Schizophrenia is a complex disorder that has both positive and negative
thinking and disorganized behavior” (Brown & Stoffel, 2011, p.179). Negative
symptoms are “the absence of typical function, such as flat affect, social withdrawal, and
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 2
difficulty initiating activity” (Brown & Stoffel, 2011, p.179). People with schizophrenia
are typically unable to sort through all of the sensory stimuli in their environment and
may have enhanced perceptions of colors, sounds, and sights (Brown & Stoffel, 2011).
Schizophrenia is most prevalent in the age group of 15-35 year-olds and is currently
Schizophrenia impacts each person differently, but some common limitations include:
grooming, dressing, and other self-care skills, care for others, home management, and
complex tasks, such as instrumental activities of daily living (IADL) compared to basic
Mental health and mental illness are terms commonly used and recognized by
healthcare providers as they are becoming more prevalent in our modern society. Mental
mood, or behavior (or some combination thereof) associated with distress and/or
predicted to become the leading cause of disability, especially depression (Mental Health,
9/8/13).
work skills, and home management skills; as well as rehabilitation services of physical
There is clear evidence that biological treatments are the most effective when they are
skills training. Family psychoeducation works with the family and a counselor to provide
information about mental illness and teach interaction skills that reduce stress within the
family (Bonder, 2010). Occupational therapists may work with a wide range of severities
and types of schizophrenia and their associated symptoms, therefore multiple treatment
options are utilized. The occupational therapist’s role is to determine the best
Evaluating and discussing a client’s current activities and their limitations, as well as the
client’s view of their own participation and restrictions are important aspects of the
having difficulties executing those activities demonstrates activity limitations. The ICF
overview, 10/23/13). Interventions do not typically target schizophrenia, but rather are
intended for treating serious mental illnesses. All treatment options, such as skills
Literature Review
that were filtered to identify specific articles to meet the criteria of this systematic review.
The majority of the current literature relating to occupational therapy and schizophrenia
showing effects of interventions. Much of these articles are based on case studies,
professionals.
cognition and role performance for those diagnosed with schizophrenia. Cognitive
may require similar kinds of therapeutic attention” (2008, p. 62). Occupational therapy
practice involving mental health clients has been focusing on role performance with an
emphasis on social skills and interpersonal skills. When working in a specific practice
area, it is common to focus on the client’s body structure and functional impairments; it is
best if the foci are combined to treat the whole client, not just the disorder (Falk-Kessler
& Bear-Lehm, 2008). A review of several articles found a “deprivation” in the ability to
complete occupations that create meaningful life experiences for those with
A review of literature from early 1990 until late 2008 showed several studies
through the use of diaries, experience samples, and qualitative methods. This shows a
gap in the literature of studies that are being done experimentally and quantitatively.
Cognition, motor functioning, and hand functioning were mentioned in several articles,
but the impact on role performance, daily occupations, and vocational performance were
not discussed.
There are several studies that have experimentally investigated the effects of
between five and ten articles that were systematically reviewed. Of the articles found,
five of them are randomized controlled trials (Cook, Chambers & Coleman, 2009;
Buchain, Vizzotto, Neto, & Elkis, 2003; Hoshii et al., 2013; Liberman, Wallace,
Hashimoto, 2011) and one is a quasi-experimental design (Katz & Keren, 2011).
interventions on the activity limitations and participation restrictions for clients with
summarized for this systematic review will help guide occupational therapists when
determining the best intervention for their clients who have schizophrenia.
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 6
The research question for this systematic literature review will be: What are the
Method
Search Strategies
In order to acquire articles, the databases that were searched include PubMed,
Medline, CINAHL, and ProQuest. Reference lists from literature gathered were also
searched for potential articles. The following key terms were used: (Schizophrenia OR
and participation). Using the inclusion and exclusion criteria, both authors independently
discuss areas of difference. Each reviewer completed hand searching of journals to locate
reviews of direct relevance to this research question. The articles included in the review
had the following characteristics: studies with occupation-based interventions that are
thoughtfully and therapeutically designed to meet the goals of the client, such as daily
living skills and social skills training, and/or crafts; studies with outcomes that address
activity and participation dimensions of the ICF definitions; studies with levels one
Hierarchy (Trombly, Tickle-Degnen, Baker, Murphy, & Ma, 1999) (See Table 1); studies
that have been published within the last 15 years; studies with participants in the adult
Procedure
(Lieberman & Sheer, 2002). This methodology was chosen because of the emphasis the
AOTA is placing on evidence-based practice. AOTA has determined that this will be the
with the occupational therapy profession. The “AOTA Evidence-Based Practice Project”
criterion categorizes research articles into specific levels of evidence (I-V) according to
research design, sample size (A= n>20 per condition; B= n<20 per condition), and
internal and external validity. A summary of findings from each article has been
compiled into an evidence-based table (See Table 2). The internal validity of each article
was determined by using the Internal Validity Form produced by Concordia University
Results
Study Characteristics
There were 11 articles considered for this systematic review. Five of the articles
were excluded (see Table 4), resulting in a total of six articles that were included. All of
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 8
the critically appraised articles were Level I studies. Five articles were randomized
controlled trials and one was a randomized quasi-experimental study design. Internal
validity ratings were based on a scale from 1-12 with 1- 4 being weak, 5-9 being
moderate, and 10-12 being strong. Critical appraisal showed that five articles had
moderate internal validity (Buchain, et al., 2003; Cook, Chambers, Coleman, et al., 2009;
Hoshii, et al., 2013; Liberman, et al., 1998; Tatsumi, et al., 2012) and one was rated as
strong internal validity rating (Katz & Keren, 2011). Common threats to internal validity
There was high variability across the six studies in terms of the interventions.
There were both similarities and differences in the interventions between all
articles in duration and intensity. Three of the six articles had a duration of six months
(Buchain, et al., 2003; Hoshii, et al., 2013; Liberman, et al., 1998), one study had the
duration of 12 months (Cook, et al., 2009), one for the duration of 15 weeks (Tatsumi, et
al., 2012) and one for the duration of six to eight weeks (Katz & Keren, 2011). The
intensity among the articles varied from one hour per week for 15 weeks to 12 hours per
week for six months. The intervention groups in each study varied between two to three
groups with various numbers of participants in each. However, each study included an
occupational therapy only group or occupational therapy plus another intervention and a
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 9
control group. All of the participants had a diagnosis of schizophrenia although one
study included other psychotic diagnoses such as bipolar disorder, among several others.
Each diagnosis was documented individually giving the reader the ability to single out
the diagnosis of schizophrenia. The treatment settings were similar, having occupational
rehabilitation setting. Overall, there were a combined total of 269 participants with an
average age of 41.9 years old. There was a heterogeneous mix of gender, progression of
The outcomes measured varied with no two studies using the same outcome
Observation in Occupational Therapy (EOITO) which is derived from the Scale for
Routine Task Inventory- Expanded (RTI-E), Activity Card Sort (ACS), Reintegration to
Normal Living Index (RNL), Rehabilitation Evaluation Hall and Baker Scale (REHAB),
were more effective than the control group’s treatment (Buchain, et al., 2003; Katz &
Keren, 2011). In each of these studies, the beneficial effect of the occupation-based
treatment was statistically significant; the effect was also viewed as clinically significant
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 10
for Buchain, et al. (2003), but not Katz and Keren (2011) where the mean difference
between control and experimental groups was a rank of 7.92. In the case of these two
studies, the control groups that did not show clinical importance were an activity training
approach and medication only approach. Two of the five studies did not show a
significant difference between the occupation-based experimental group and the control
group (Cook, et al., 2009; Tatsumi, et al., 2012). Both the experimental and control
groups improved equally as a result of treatment. One of the five studies showed that the
control group’s treatment, which was a skills training group, was more effective than the
occupation-based treatment group, although the difference was not statistically significant
study compared the effects of the client choosing the activity versus the therapist
choosing the activity as its intervention; both conditions were considered occupation-
based. Results of this study showed that the client-chosen group had better engagement
and performance, although not statistically significant, in therapy outcomes than the
therapist-chosen group.
Two studies (Katz & Keren, 2011; Liberman, et al., 1998) attempted to measure
long-term effects; one at six months post intervention and one at two years post
from end of treatment to follow-up (Katz & Keren, 2011). The other showed
improvement compared to the end of treatment but it did not achieve statistical
The authors of each study did not report any negative effects. Authors did not
discuss the costs for conducting the studies or the overall benefits to the experimenters,
Discussion
Main Findings
There are two main findings that have emerged from this systematic literature
review. The first of these findings was that the majority of studies suggested that
occupation-based treatment did not outperform other modes of treatment when working
with adults who have schizophrenia. In one study, the occupation-based treatment group
performed worse than the control group (Liberman, et al., 1998) and in two studies the
occupation-based treatment group performed as well as, but no better than the control
group (Cook, et al., 2009; Tatsumi, et al., 2012). Conversely, the findings from two
studies (Katz & Keren, 2011; Buchain, et al. 2003) showed that there was a benefit of
interventions outperformed the instruction of activity specific routines and the use of only
interventions. There was not a consistent pattern of treatment times (number of sessions
and duration of treatment) that showed a relation to the results being statically significant.
None of the studies reviewed provided details of the interventions, which does not allow
Another explanation of why there was variability in findings could be due to the
intervention formulated for this study was based on researcher’s knowledge and other
resources, as there was no clear definition in the literature. This definition may have
hindered the quantity of articles that were included in this review. In addition to the
researcher’s definition not matching that of the authors’, there was a difference in what
The second main finding was the lack of evidence seen in the literature on this
topic. The number of total studies available on this topic, six, represented a low volume
the studies reviewed were from strong designs (randomized controlled trials); however,
there were not any case studies, single-subject designs, or one-group pre-post studies
done on activity limitations and participation performance for clients with schizophrenia.
adults with schizophrenia, as the articles were only pertinent to this population of
individuals. A second limitation was that articles were only considered if activity
limitation and participation restriction outcome measures met the definitions of the ICF;
the body functions and structures were not considered. In addition, positive and negative
symptoms of schizophrenia were not explored. Lastly, there were time restrictions that
impacted this review causing researchers to potentially overlook studies related to this
A strength of this study was the author’s access to a vast array of resources such
Based on the identified gaps in the literature, more case studies and single-subject
designs would be important because these study designs are intended to show whether the
towards higher levels of rigor in research. However, there were several case studies
about living with schizophrenia, but nothing directly relating the diagnosis to their daily
little evidence that occupation-based interventions are effective for adults with
researchers should state what the occupational therapy intervention protocol for their
study is, and be specific about the interventions for the control group to allow replication
of future studies.
Clinical Implications
The clinical implication for this study is that occupation-based treatments may
benefit some adult clients with schizophrenia in ADL performance and social functioning
skills. However, because this review revealed conflicting findings from a small number
for adults with schizophrenia. Practitioners would benefit from more research, as it
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 14
effective for improving activity and participation outcomes for adults with schizophrenia.
Conclusion
for adults with schizophrenia. The main findings from this study suggest there is mixed
adults with schizophrenia. In two studies, occupation-based treatment did not outperform
other modes of treatment, while two others provided evidence that client’s activity and
participation maybe improved. The small number of studies available on this topic
reveals a lack of evidence and suggests the need for future research.
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 15
Reference
Slack Incorporated.
Brown, C., & Stoffel, V.C. (2011). Occupational therapy in mental health: A
Buchain, P. C., Vizzotto, A., Henna Neto, J. & Elkis, H. (2003). Randomized controlled
44462003000100006
Cook, S., Chambers, E., & Coleman, J. H. (2009). Occupational therapy for people with
Cope, S., & Mollinger, L. (2011). Concordia University Wisconsin Internal Validity
Falk-Kessler, J., & Bear-Lehm, J. (2008). Hand function in persons with chronic mental
10.1300/J004v19n01
Hoshii, J., Yotsumoto, K., Tatsumi, E., Tanka, C., Mori, T., & Hashimoto, T. (2013).
Katz, N., & Keren, N. (2011). Effectiveness of occupational goal intervention for clients
doi: 10.5014/ajot.2011.0011347
Liberman, R. P., Wallace, C.J., Blackwell, G., Kopelowicz, A., Vaccaro, J. V., & Mintz,
J. (1998). Skills training versus psychosocial occupational therapy for person with
359.
Lipskaya, L., Jarus, T., & Kotler, M. (2011). Influence of cognition and symptoms of
Mental Health Basics. (2011). Center for Disease Control. Retrieved April 21, 2013,
from http://www.cdc.gov/mentalhealth/basics.htm
Mental Health. (2013). The American Occupational Therapy Associated Inc. Retrieved
www.who.int/mental_health/management/schizophrenia/en/
Tatsumi, E., Yotosumoto, K., Nakamae, T., & Hashimoto, T. (2012). Effects of
http://www.cdc.gov/nchs/data/icd9/ICFoverview_FINALforWHO10Sept.pdf
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 17
Trombly, C. A., Tickle-Degnen, L., Baker, N., Murphy, S., & Ma, H. (1999). Levels of
University.
Urlic, K., & Lentin, P. (2010). Exploration of the occupations of people with
10.1111/j.1440-1630.2010.00849x
http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 18
Appendix
IV Single-subject design.
Hoshii, Compare Level I - RCT Patients received six SCG had better The small number of
Yotsumoto, therapeutic effects 59 patients with months of OT for 2 treatment outcomes participants at one
Tatsumi, T of subject-chosen schizophrenia hours once a week. and overall higher hospital limited study.
anka, activities and 30 in the SCG, 29 in SCG: completed The engagement in Authors suggest the
Mori, therapist-chosen the TCG. COPM to determine activities than the intervention time
Hashimoto activities in OT activities. Subjects TCG. period may have been
2013 for inpatients with SCG- mean age: 57.1 determined a set of too short to be
schizophrenia. activities they would effective.
TCG- mean age: 55.9 wish to complete.
TCG: no COPM,
therapist chose
activities based on
treatment
recommendations.
When a patient
completed an activity,
the next activity was
chosen following the
same pattern as the
first activity.
To investigate the Level I- RCT Patients received 12 Neither group’s SFS A limitation to this
effectiveness of months of OT. scores improved study was that it did
OT for people 44 participants with Participants in both significantly after the not target the
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 21
with psychotic psychotic disorders, the OTG and the TAU 12 months of participant’s cognitive
conditions and to 30 in the OTG, 14 in group were both given treatment. function. It was also
Cook, inform future the TAU. the SFS at baseline, 6 limited to a particular
Chamber, research designs. months, 9 months and local population with
Coleman, 12 months. unspecified ethnicity
2009 Mean age- 39 years which makes
old. generalizing this study
restricted.
To investigate if Level I: RCT Two groups were From baseline to Small sample size and
OT is effective compared, the EG Month 6, the EG the number of
Buchain, when added to a 26 participants total. received group improved with a withdrawals from the
Vizzotto, psychopharmacol 12 in the CG and 14 in psychopharmacologic Magnitude of the study.
Neto, Elkis, ogical treatment in the EG. al treatment (with effect (d) = -1.22
2013 treatment clozapine) plus meaning it is of a
Diagnosis:
resistance sessions of OT. The large clinical
schizophrenia
schizophrenia. CG received only importance and a
CG- mean age: 36.6 clozapine. The EOITO significance (p)= 0.02
was given to statistically
EG- mean age: 33.7 participants 7 times significant. The CG’s
throughout the study. EIOTO scores
improved from
baseline to 6 months
but were not
statistically
significant.
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 22
Katz & The Level I Participants had a The IADL section of Small sample size
Keren effectiveness of Quasi- total of 18 the RTI showed and large dropout
2011 OGI in clients experimental, individual significant differences rate of those who
with pre/post test treatment sessions met the inclusion
from baseline to end
schizophrenia over 6-8 weeks. criteria. Person
was compared 18 total participants Pretest was given, of treatment for the who administered
to FEP and an 6 - OGI as well as a post- OGI group. The ACS assessments wasn’t
ATA (CG). 6 - FEP treatment test and a had significant completely blinded
6 – ATA 6-month follow-up differences from to treatment effects.
test. baseline to end of There may have
Diagnosis: Outcome measures: been significant
treatment for the OGI
schizophrenia or RTI, ACS, and improvements had
and ATA groups.
schizoaffective RNL. the treatment time
However, there was been longer.
disorder
no significant change
Mean age: 30 in any measures from
the time of ending
treatment to 6-month
follow-up.
Tatsumi, To determine Level 1: RCT Patients in the OTG The total Rehab score General of this
Yotsumoto, whether OT did cooking did not significantly study was limited
Nakame, can improve 38 participants activities while change from baseline because the inter-
Hashimoto, the were divided into patients in the CG group comparisons
to post intervention
(2011) interpersonal either the OTG did not. The showed no
relationships (EG) or the CG. patients were for either intervention significant
and negative n=19 in EG and evaluated twice: group. difference. Another
symptoms of n=19 in the CG. once before the limitation was the
hospitalized Diagnosis: intervention and small sample size.
chronic schizophrenia once after the
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 23
Lieberman, D. & Scheer, J. (2002). AOTA’s evidence-based literature review project: An overview. American Journal of
Occupational Therapy, 56(3), 344-359.
RCT = Randomized Control Trial; SCG = Subject Chosen Group; TCG = Therapist Chosen Group; COPM = Canadian Occupational
Performance Measure; EG = Experimental Group; CG = Control Group; OGI = Occupational Goal Intervention; FEP = Frontal
Executive Program; ATA = Activity Training Approach; RTI = Routine Task Inventory; ACS = Activity Card Sort; RNL =
Reintegration to Normal Living Index; BRPS = Brief Psychiatric Rating Scale; SANS = Scale for Negative Symptoms; Rehab =
Rehabilitation Evaluation Hall and Baker; POMS = Profile of Mood States; SSTG = Social Skills Training Group; ILSS =
Independent Living Skills Survey; GAS = Global Assessment Scale; SAS = Social Activities Scale; OTG = Occupational Therapy
Group; TAU = Treatment as usual; EIOTO = Scale of Interaction Observation in Occupational Therapy; OT = Occupational Therapy
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 25
Participants 1. Sample selection: did investigators clearly specify inclusion/exclusion criteria to minimize sample heterogeneity? In
studies with a control group, this bias should affect both groups equally.
Participants 2. Attrition (participant drop out): is participant drop out less than 20% in total sample and balanced between groups? If
drop out is greater than 20% and unbalanced between groups, attrition may be a concern. Consider reasons for attrition if
reported by researchers.
Participants 3. Attentional bias (Hawthorne effect): was participant behavior unaltered by experimenter expectations or attention? This
bias should affect both groups equally assuming the control or placebo group gets equal attention.
Participants 4. Baseline equality: Were groups equal on important participant characteristics (e.g. age, gender, severity of disability) and
outcome measures (dependent variables) at study outset? If not, were differences dealt with appropriately in data analysis?
Participants 5. Maturation or spontaneous recovery: there is no evidence that patients got better because of maturing (children) or
natural healing (adults in acute phase of recovery) between pre and post testing? Not a significant concern in studies where
data collection is completed in a short time (single session) or if there is a control group.
Outcome 6. Psychometrics of dependent variables: Were the outcome measures valid and reliable for measuring the outcomes of
Measures interest? In studies with a control group, this bias should affect both groups equally.
Outcome 7. Instrumentation bias: were the investigators careful to record information accurately and with calibrated instruments? In
Measures studies with a control group, this bias should affect both groups equally.
Outcome 8. Blinding: Evaluator bias: was the outcome assessor unaware of group assignment (treatment or control)? Investigator
Measures bias: If possible, was the person providing the intervention blinded to group assignment?
Outcome 9. Testing effects: the outcomes of interest were measured such that learning or fatigue were not likely to account for
Measures changes? Did investigators take care to measure at the same time of day at pre and post-testing? For studies where all
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 26
participants experience multiple conditions, was the order of the conditions randomized (counterbalanced)? If order effects
are not relevant based on the research design, ok to say “yes”. In studies with a control group, this bias should affect both
groups equally.
Research 10. Data Analysis: Was the correct statistical analysis used for the data?
Methods
Research 11. Was there adherence to the intervention? Did investigators keep track of and report compliance to treatment? In studies
Methods with a control group, this bias should affect both groups equally.
Research 12. Co-intervention: participants did not begin or stop an activity/treatment in addition to their assigned intervention.
Methods Participants assigned to control group did not begin treatment of interest (contamination). In studies with a control group,
this bias should affect both groups equally.
Total
Note. Cope, S., & Mollinger, L. (2011). Concordia University Wisconsin Internal Validity Rating Form: Unpublished
Manuscript. Concordia University Wisconsin.
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 27
Bejerholm, U. (2010). Relationships between occupational engagement and status of and satisfaction with There was no
sociodemographic factors in a group of people with schizophrenia. Scandinavian Journal of Occupational Therapy, intervention used
16, 244-254. doi: 10.3109/11038120903254232 and was qualitative
study.
Foruzandeh, N., & Parvin, N. (2013). Occupational therapy for inpatients with chronic schizophrenia: A pilot randomized Results only
control trial. Japan Journal of Nursing Science, 10, 136-141. doi: 10.1111/j.1742-7924.2012.00211.x measured positive
and negative
symptoms, not
activity and
participation.
Katz, N., Fleming, J., Keren, N., Lightbody, S., & Maeir, A. H. (2002). Unawareness and/or denial of disability: Study was all case
Implications for occupational therapy intervention. Canadian Journal of Occupational Therapy, 69, 281-292. studies and surveys,
no experimental
study completed.
Lipskaya, L., Jarus, T., & Kotler, M. (2011). Influence of cognition and symptoms of schizophrenia on IADL performance. Study was a
Scandinavian Journal of Occupational Therapy, 18, 180-187. doi: 10.3109/11038128.2010.490879 paper/pencil survey
with no
THE IMPACT OF OCCUPATION- BASED INTERVENTIONS 28
intervention
measuring activity
and participation.
Morimoto, T., Matsuyama, K., Takeda, S. I., Murakami, R., & Ikeda, N. (2012). Influence of self-efficacy on the There was no
interpersonal behavior of schizophrenia patients undergoing rehabilitation in psychiatric day-care services. treatment, only
Psychiatry and Clinical Neurosciences, 66, 203-209. doi: 10.1111/j.1440-1819.2012.02332.x evaluations of
cognition, mental
stability, and
interpersonal skills
and behavior.