Abstract
BackgroundEngagement 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.MethodsWe 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.DiscussionThis 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 registrationClinicalTrials.gov NCT03963245. Registered on 29 May 2019
Highlights
This paper introduces a new rehabilitation intervention named Meaningful Activities and Recovery (MA&R) and presents a study protocol for a multicentre, two-arm parallel randomized controlled trial (RCT) to compare the effect of two interventions: (1) MA&R in addition to standard mental healthcare and (2) standard mental healthcare
The primary objective of this RCT is to determine whether MA&R in addition to standard mental healthcare is more effective than standard mental healthcare alone regarding activity engagement (POES-S) [38, 39] in a sample of individuals living with psychiatric disabilities
The second objective of this study is to evaluate whether MA&R in addition to standard mental healthcare is more effective than standard mental healthcare alone regarding outcomes related to activity engagement, e.g. functioning, personal recovery and quality of life [40,41,42]
Summary
Introduction to MA&R IOne-to-one session▪ Learn about the structure and content in MA&R I ▪ Exchange mutual expectations of the course ▪ Talk about learning styles FlowGroup session One-to-one session▪ Emphasis on the main message in MA&R: what you do in daily life matters ▪ Learning about health and flow theory ▪ Identify activities associated with the experience of flow and/or wellbeingActivity patterns in daily life▪ Learning about activities and activity patterns ▪ Mapping own activities ▪ Identifying activities, routines, habits or contexts that influence well-being Recovery▪ Learning about recovery and how meaningful activities and day-to-day actions matter in the recovery process ▪ Learning about recovery and how it may unfold in daily life ▪ Abolish taboos and promote hopeTelling personal stories through Group session an activity perspective▪ Preparing narratives at the group session ▪ Identify values, interests and personal resources through storytelling ▪ To tell one’s story in a safe forum, and to help each other explore personal resources and unique features. Persons with psychiatric disabilities may reduce their engagement in meaningful activities to various degrees with possible fluctuations over time. Qualitative studies [7,8,9,10,11,12,13,14] in persons living with psychiatric disabilities have found that activity engagement is often reduced [7,8,9, 13, 14]. Simple activities, such as getting out of bed or leaving the house, can be arduous or sometimes impossible [8, 13, 14]. Lack of activity engagement seems to be a key dysfunction related to psychiatric disability
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