Examining the Effectiveness of a Group Occupational Therapy Program During the Early Stage of Psychiatric Hospitalization in Japan: A Randomized Controlled Trial

TL;DR

A group occupational therapy program in Japan improved motivation and community living skills for people with mental disorders during early hospitalization.

Contribution

This study introduces and evaluates a novel group-based occupational therapy program for early psychiatric hospitalization in Japan.

Findings

The intervention group showed greater improvements in interpersonal relationships and work on the LASMI compared to the control group.

Participants reported increased interest in meaningful occupations and reactivated motivation for occupational participation.

Positive effects were observed in daily living functions, though with a small sample size.

Abstract

Background: In mental health occupational therapy, occupation-focused practice is recognized as crucial for supporting clients’ quality of life and facilitating their recovery. However, evidence supporting the effectiveness of group-based, occupation-focused interventions for individuals with mental disorders during the early stages of hospitalization remains limited.

Objective: This study aimed to develop and evaluate the effectiveness of a group occupational therapy program designed to promote occupational participation among individuals with mental disorders during the early stages of hospitalization.

Methods: A multi-center, open-label, randomized controlled trial was conducted. Participants were block-randomized in a 1:1 ratio by sex into an intervention group (novel program + standard occupational therapy) or a control group (standard occupational therapy only). The developed program was designed to identify clients’ occupations, clarify challenges in daily life, enhance motivation for occupational participation, and explore strategies to address barriers to occupational performance. It was implemented once a week over four sessions. Outcomes included the Japanese version of the Intrinsic Motivation Inventory (primary outcome), the Occupational Self-Assessment Short Form, the Occupational Questionnaire (OQ), the General Self-Efficacy Scale, and the Life Assessment Scale for the Mentally Ill (LASMI), all assessed pre- and post-intervention. Program evaluation questionnaires and qualitative feedback were collected from the intervention group. Analyses used hierarchical Bayesian linear models with weakly informative priors and the NUTS algorithm to estimate time-by-group interaction effects.

Results: A total of 13 participants were analyzed (intervention group: 10, control group: 3). Posterior estimates indicated meaningful interaction effects, suggesting that the intervention group showed greater improvements in interpersonal relationships and work on the LASMI, as well as in interest in occupation on the OQ, compared to the control group. Additionally, a potential positive effect was observed for the daily living subscale of the LASMI. Qualitative feedback highlighted participants’ awareness of meaningful occupations, reactivated motivation, and transformative changes in occupational participation and interpersonal relationships.

Conclusion: The study’s findings suggest that occupation-focused group interventions may enhance motivation, specifically, interest in meaningful occupations related to occupational participation and improve community living functions during early psychiatric hospitalization. The results support the clinical value of such programs as recovery-oriented practices in acute mental health care. Further large-scale studies are required to verify reproducibility, given the small sample size.

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