title: Enhancing occupational performance using the 'LifeSkills' program: Evaluation of an occupation-based group in an inpatient rehabilitation setting
Creators: name: Spalding, Kaitlyn G
Publisher: name: Griffith University
Year: 2021
Subjects: subject: occupation-based groups
subject: hospital rehabilitation
subject: LifeSkills group
subject: daily living skills
subject: rehabilitation clinicians

description: Occupational therapists working in inpatient rehabilitation settings support people post-injury and illness to engage in meaningful occupations to achieve success. A common practice approach is using occupation-based interventions, where engaging in occupations is used as the therapeutic agent of change. There is a strong incentive in the current Australian healthcare system to develop value-based rehabilitation interventions that better enable patient independence and recovery. A current trend to maximise patient outcomes is the use of group-based interventions to enhance frequency and intensity of practise. However, limited research exists to support occupational therapists wishing to incorporate an occupation-based intervention into this group approach. Therefore, further exploration of the use of occupation-based groups in inpatient rehabilitation settings is warranted. The objective of this thesis was to investigate occupation-based groups in inpatient rehabilitation practice. This was achieved through the following aims: (1) to examine and map the range of occupation-based group programs used in hospital rehabilitation; (2) to examine the impact of the LifeSkills group in improving and maintaining instrumental activities of daily living skills, as measured by the examiner and as perceived by the participant: a) immediately post-intervention, b) at a 30-day follow-up, and c) at a 90-day follow-up; (3) to examine differences in outcomes from the LifeSkills group based on age or diagnoses; and (4) to examine the LifeSkills group through a process evaluation to determine active components and mechanisms for success. Three studies were conducted to explore the thesis aims. First, a scoping review was conducted using a recognised framework to identify 10 articles on the current length and breadth of the literature landscape for occupation-based groups. Second, a longitudinal observational cohort study recruited 31 consecutive, eligible participants of the LifeSkills group; 21 female and 9 men aged 35-91 years with varying neurological (16) and non- neurological (15) conditions. Thirty patients agreed to participate with outcomes of performance, satisfaction, and self-efficacy measured over four data points. Third, a process evaluation study was conducted alongside the cohort study with the same participants. Using a process evaluation framework, quantitative administrative data, patient outcome measures, group observations and qualitative semi-structured interviews identified essential components and mechanisms for group success.Results from the scoping review showed that there was a paucity in the literature on the use of occupation-based groups which justified the longitudinal investigation into the use of this intervention, the impact on outcomes, and key implementation factors. These longitudinal outcomes demonstrated statistically and clinically significant positive changes. The process evaluation showed that whilst patient-related barriers of pain and fatigue were identified, three main factors of facilitating the shared experience, using patient-centred tasks to offer real-world experiences, and enabling regular and meaningful opportunities to practise, could be used to enable successful group implementation and patient outcomes. Findings from this body of research offer four contributions for clinical practice; (1) occupation-based groups can enable positive outcomes; (2) taking a personalised approach to outcome measurement provides a better understanding of change; (3) key success factors for occupation-based group implementation; and (4) how such groups can deliver the unique principles of occupation-based practice in a controlled environment. This thesis was driven by the clinical-based desire to find, develop and contribute the best available research to provide quality evidence for practice. The subsequent findings support the use of an occupation-based group approach to facilitate occupation-based practice and address occupational performance outcomes. This offers promising avenues for future research opportunities, particularly justifying larger, explanatory study designs to examine intervention effects and generalisability. In the meantime, rehabilitation clinicians are enabled to consider the impacts of such an approach on patient outcomes and presents justification for incorporating it into practice.