Therapeutic Recreation Research Articles

The role of therapeutic recreation in long-term care culture change: a comparative case study from Alberta, Canada

ABSTRACT Historically, long-term care (LTC) homes have operated under a biomedical model, with a fairly institutional atmosphere. The culture change movement has challenged this approach, advocating for person-centred care and more homelike environments. We conducted a multi-site comparative case study at three rural LTC homes to examine the role therapeutic recreation (TR) services play in contributing to culture change and in creating a homelike environment in LTC. Three factors emerged that enabled TR staff to actively contribute to LTC culture change: 1) prioritizing the value of leisure experiences for improved quality of life, 2) being valued, supported, and empowered by management, and 3) being welcomed as essential and collaborative members of the care team. We discuss the implications of these findings and conclude with several recommendations for how LTC homes can better utilize TR services to improve quality of life and advance the aims of the culture change movement.

Impact of social determinants of health on rehabilitation service use and outcomes in adults in the USA: a scoping review protocol

IntroductionMany Americans fail to receive equitable access to or positive outcomes from rehabilitation services. These disparities result from broader societal inequities that disproportionately affect certain groups of people due to...

Using Virtual Reality Recreation Therapy to Enhance Social Interaction and Well-Being in Homebound Seniors

In view of Singapore’s rapidly ageing population, this study is an exploratory pilot designed to assess the feasibility and potential impact of virtual reality recreation therapy (VRRT) on homebound seniors. A tri-party research partnership was formed between the Singapore University of Social Sciences (SUSS), NTUC Health Home Care, and Vue Reality Labs. The aim was to explore the benefits of VR recreation therapy for homebound seniors, contributing to the goal of ‘aging in place’. Over two years, a 52-week VR curriculum was developed, featuring social, travel, and cultural topics tailored to the seniors. Five care associates from NTUC Health Home Care received facilitator training by Vue Reality Labs. A total of 71 homebound senior participants aged 50 to 102 engaged in over 1600 session hours during the 52-week trial; 62% had varying levels of dementia. A mixed-methods approach was adopted to explore the general impact and feasibility of VR recreation therapy, incorporating quantitative data on participants’ emotional, social, and cognitive conditions and qualitative data from facilitator interviews. The findings revealed that most senior participants enjoyed the VR sessions, perceiving them to positively impact their overall health and well-being. Caregivers reported improvements in cognitive, social, and emotional functioning of the participants. The positive effects extended to caregivers and facilitators, with renewed relationships and enhanced skills, respectively. The insights and observations gathered from this pilot study will serve as a foundation for designing a more robust study for deploying the VR recreation therapy programme in senior care.

Do Therapeutic Recreation Mental Health Clinical Placements Provide Educational Experiences to Pre-Registration Student Nurses?: A Mixed Methods Systematic Review.

Clinical placements are a critical component in any pre-registration student nurse's skill development and play an influential role in career specialisation upon registration. However, students are reporting to feel anxious and under prepared attending clinical placements, especially within mental health settings. Such a concern was highlighted in the Australian Government's Productivity Commission into Mental Health (2020). With recommendations for clinical placements to occur in therapeutic recreation environments, allowing increased interactions between students and individuals with a lived experience. Hence, this mixed methods systematic review aims to explore the experiences of pre-registration student nurses completing their mental health clinical placement within a therapeutic recreation environment. Six databases were searched for the review; CINHAL, Medline, PsycINFO, Web of Science, Scopus and the ProQuest Dissertation and Theses database, yielding 10 214 articles. Data were imported to COVIDENCE for management and screening processes. Risk of bias was undertaken by two authors utilising the Joanna Briggs Institute's Critical Appraisal Checklist for qualitative and quasi-experimental studies and McGill's Mixed Methods Appraisal Tool 2018 Version for mixed methods studies. Data were extracted manually for the 13 included articles which met the review inclusion criteria. Following a thematic analysis of the extracted data, three themes emerged: an optimal learning environment, impact on stigmatising beliefs and influence on future career. Findings identified that therapeutic recreation environments pose numerous education benefits for pre-registration student nurses. It is apparent through an immersive mental health clinical placement; student nurses are able to increase their mental health understanding through the lens of those with lived experiences. Such environments challenge stigmatising beliefs held by students prior to clinical placements and can lead to an increased desire to pursue a career within the mental health speciality. This review offers an insight into the many benefits for pre-registration student nurses who complete their mental health clinical placements in therapeutic recreation environments, including reduced stigmatising beliefs, increased mental health knowledge and improved clinical confidence. Trial Registration: PROSPERO: CRD42023476280.

Prospering without processing: therapeutic recreation without a therapist

ABSTRACT This critical essay seeks to liberate the concept of ‘therapeutic’ from recreation therapy/therapeutic recreation (RT/TR) for the broader field of leisure studies, as well as to demonstrate that ‘processing’ often happens for individuals in any recreation activity, without the direction of an expert or professional therapist. The two main issues addressed in this essay are what makes a recreation activity ‘therapeutic,’ and whether it is necessary to have a recreation therapist help the recreationist or client ‘process’ what transpires and its broader value to their life.

A Systematic Review and Critique of Recreational Therapy-Specific Literature Regarding Substance Use Disorders

Just over four out of 10 Certified Therapeutic Recreation Specialists (CTRS®s) identify that they work with people who have substance use disorder (SUD); however, there are few SUD-specific recreational therapy (RT) resources available to guide practice with this population. A systematic review and critique of SUD-specific RT literature was conducted to examine the basis for the current state of practice of RT within SUD treatment. Peer-reviewed journal articles from 1981-2021 and current RT textbooks and manuals from four publishers were reviewed to highlight the existing evidence base for SUD-specific RT practice, and critiqued for shortcomings. Gaps and needs in research are discussed, as well as recommendations for the development of SUD-specific evidence-based practices in RT.

How Recreational Therapists with a Disability Perceive Their Current Workplace: Perception of Climate of Inclusion, Self-Advocacy, and Occupational Self-Efficacy

High perceived levels of climate of inclusion, occupation-al self-efficacy, and self-advocacy skills in employees are beneficial to employers. Yet, it is unclear how recreational therapists with disabilities perceive their workplace's cli-mate of inclusion as well as their own self-advocacy skills and occupational self-efficacy. Therefore, the purpose of this study was two-fold: (a) to investigate the extent to which Certified Therapeutic Recreation Specialists (CTRSs) with a disabling condition perceive climate of inclusion, self-advocacy, and occupational self-advocacy in their current workplace; and (b) to explore if there are associations between climate of inclusion, self-advocacy, and occupational self-efficacy in the workplace. A con-venience sample of 77 CTRSs who identified as having a disability participated in this study. Results indicated that participants were neutral regarding the climate of inclusion at their current workplaces, are confident with their self-advocacy skills at work, and perceive their occupational self-efficacy levels to be fairly high. There are also positive associations between the three concepts of climate of inclusion, self-advocacy, and occupational self-efficacy. Future research is needed to better understand the neu-trality recreational therapists with disabilities perceive of their workplace as well as to conduct more robust studies.

Implementing Positive Education about Aging and Contact Experiences (PEACE) Model into an Undergraduate Therapeutic Recreation Course

Studying aging is vital for therapeutic recreation students due to several compelling factors, like an increasing ag-ing population, prevalence of ageism in society, and ris-ing numbers of recreational therapists providing services to older adults. In addition to educating students about the aging process, faculty members have the opportunity to develop innovative approaches within the therapeu-tic recreation curriculum to highlight how older adults contribute positively to society. Additionally, recreational therapists involved in developing intergenerational pro-grams have a unique opportunity to facilitate positive connections between younger and older adults. This manuscript aimed to present how the Positive Education about Aging and Contact Experiences (PEACE) model was infused into an undergraduate therapeutic recre-ation course about aging and used to help design and im-plement two intergenerational service-learning projects.

Adaptive Sport and Recreational Therapy: A Scoping Review to Explore Practices for the Profession

Adaptive sports provide athletes with disabilities with independent engagement while increasing their physical health and skill-building abilities. Recreational therapy prides itself as the primary discipline implementing adaptive sports for individuals with disabilities, yet efficacy needs to be determined. A scoping review was conducted using recreational therapy/therapeutic recreation online journals, and standardized checklists with predefined criteria to extract details on study design, procedures, outcomes, and study quality. Data were analyzed by three researchers using a structured, blinded review. Four themes emerged about recreational therapy services and adaptive sports: Fostering positive athlete outcomes, the importance of including both components of physical health and skill competency, social benefits for athletes, and facilitation considerations for adaptive sports within recreational therapy services. Findings warrant additional research on adaptive sports and recreational therapy services and recommendations for practice are discussed, such as establishing best practice guidelines for this specialty area.

Exploring Parent Perspectives on Autonomy Supportive Environments: A Qualitative Recreational Therapy Approach

The purpose of this study was to explore the ways par-ents provide autonomy supportive environments to their child with type 1 diabetes. Self-determination theory (SDT) is focused on interplay between extrinsic forces acting on persons and the intrinsic motive and needs of human beings. This study adopted SDT as its theoreti-cal framework, with emphasis on autonomy supportive environments. Interview questions were formulated and prepared according to components within the SDT. Between January 2023 and March 2023, seven parents consented and participated in interviews via Zoom. In-terviews followed a pre-constructed interview protocol which included 10 questions centered on the fostering of competence, relatedness, autonomy, choice provision, ra-tional provision, perspective taking, and advocacy. While it is known that parenting children with type 1 diabetes poses many challenges, our findings support giving a child autonomy to lead to more effective diabetes management. Also, findings indi-cated the importance of involvement in social groups, such as parent groups and medi-cal specialty camps. Recreational therapist (RT) professionals can measure outcomes as well as additional insight into parent perspective through camp involvement. This further supports RT using the self-determination theory within the practice of diabetes camps to improve health. Authors provide suggestions for future studies and practice implications for parental camp involvement.

Effects of Balance-Based Recreational Therapy on Postural Stability in Those Diagnosed with Parkinson’s Disease

Individuals diagnosed with Parkinson’s disease (PD) have reported increased incidence rates of falling in compari-son to undiagnosed peers. Falls in this population have been found to be related to increasing symptom intensity as well as decreases in overall quality of life. The follow-ing examines the effectiveness of balance-based Recre-ational Therapy within the community setting as part of a multidiscipline treatment team known as the Stillwater Communication, Arts, Nutrition, & Exercise program. A combination of previous data analysis from this longitudinal study have found that participants improved or main-tained their physical functioning and reported less occurrences of falling. Treatment protocol focused on strength, balance, and gait-utilizing modalities such as exercise, obstacle courses, boxing training, and tai chi. Data collection of postural stability, or static balance, occurred throughout the 8-month treatment period on a monthly ba-sis and the month 1 and month 8 mean differences were analyzed for statistical and clinical significance. Assessments revealed the successful increase and/or maintenance of overall postural stability through the 8-month treatment period. Results were not statistically significant, yet provide clinical evidence to the effectiveness of RT com-munity-based balance training for individuals diagnosed with PD. The following study builds upon previous evidence that recreational therapy can be an effective treatment option for those who have been diagnosed with PD and potentially others who are ex-periencing issues with their balance. Implications for future studies and current prac-tice are provided.

Healing Hives: Exploring the Effects of Beekeeping on Veteran Mental Health and Quality of Life

Veterans experience higher risks of suicide and mental health disorders due to the traumas of military service, disabilities, and the difficulties of reassimilation into civilian life. Therapeutic interventions using human-animal interactions have shown promising results in reducing many risk factors affecting veterans’ quality of life. This quality improvement project sought to consider if veterans participating in a recreational therapy program focused on beekeeping and administered by the Department of Veteran Affairs would experience quality of life improvements using a standardized EQ-5D-5L assessment. Our results indicate significant changes in mobility, anxiety/depression, and overall health for veterans participating in beekeeping as a recreational therapy. Implications for practice and future research are presented.

Affective Experiences of Older Adults Enrolled in a Multi-Component Health Promotion Program: A Focu-Group Study

The purpose of this qualitative study using focus groups was to explore the affective experiences of older adults enrolled in Bingocize®, a health promotion program that combines bingo and exercise after program facili-tators received a supplemental training developed by a recreational therapist titled, FUNctional Movement. The training emphasized participant enjoyment and autono-my support utilizing The Self-Determination Enjoyment Enhancement Service Delivery Model. Focus groups, comprised of 17 participants across three sessions, re-vealed that while the supplemental training may have improved engagement, many were unaware of the fall prevention components of Bingocize®. Focus group themes included autonomy sup-port, enjoyment, future desired activities, and barriers to physical activity. This may highlight a need to explicitly incorporate fall prevention and functional movement into Bingocize® training for facilitators. Additionally, integrating health education topics like sexual health and incontinence into Bingocize® could address participant needs and enhance program offerings. These findings may provide insights for refining Bin-gocize® training, aligning it more closely with participant expectations through a rec-reational therapy approach to physical activity in long-term care settings. The authors provide practice recommendations.

Introduction to Adaptive Sports: An Intervention Protocol for Youth

Certified therapeutic recreation specialists (CTRS®s) within pediatric rehabilitation inpatient (PR-I) units use a variety of treatment modalities. One such modality is adaptive sports. Positive emotions that can be generated when participating in an adaptive sports activity include enjoyment and gratification. CTRSs are able to provide youth in the PR-I unit with a unique experience that teaches them about adaptive sports while introducing a potential new leisure pursuit. Thus, the Introduction to Adaptive Sports program was developed with the intent of documenting youths' knowledge related to adaptive sports following brief exposure, their enjoyment of ac-tivities associated with four different adaptive sports, and their interest in future participation. The youth involved in the piloting of this protocol were asked to complete a Knowledge and Future Participation Quiz as well as an Enjoyment Scale to measure their level of knowledge about each adaptive sport presented, how much they enjoyed participating in each ses-sion, and if they would be interested in future participation. The results showed that the youth demonstrated strong knowledge about each adaptive sport (average scores of 5.06 out of 6). The scores on the Enjoyment Scale indicated that youth on the PR-I unit enjoyed the adaptive sports sessions (average scores of 8.38 out of 10). Addition-ally, participant responses indicated 78.13% overall interest in future participation in the four presented adaptive sports. Though the preliminary results from the trial of this protocol are encouraging, recommendations for revision and future study by CTRS professionals on PR-I units are included.

Effects of Preferred Music on Older Adults with Dementia: An Observational Study

Dementia is becoming more prevalent as the population of adults over the age of 65 increases. With an increase in this disease comes a need for interventions, as dementia is incurable, nonpharmacological interventions are es-sential to reduce associated behaviors associated with de-mentia. This single subject A-B experimental design took place in the upper midwestern United States with indi-viduals diagnosed with dementia who had documented moderate-to-severe cognitive impairment and demon-strated dementia-related behaviors. Demographic and personalized treatment data were collected through chart reviews and interviews with staff and participants before starting baseline observations. The lead investigator con-ducted A-phase baseline behavioral observations using time sampling for five consecutive days followed by B-phase experimental behavioral observations using time sampling for five consecutive days. The data suggested that preferred music can impact dementia-related behaviors and has the potential to improve quality of life. Implications for recreational therapy practice are included.

A Systematic Review and Critique of Recreational Therapy-Specific Literature Regarding Substance Use Disorders

Just over four out of 10 Certified Therapeutic Recreation Specialists (CTRS®s) identify that they work with people who have substance use disorder (SUD); however, there are few SUD-specific recreational therapy (RT) resources available to guide practice with this population. A systematic review and critique of SUD-specific RT literature was conducted to examine the basis for the current state of practice of RT within SUD treatment. Peer-reviewed journal articles from 1981-2021 and current RT textbooks and manuals from four publishers were reviewed to highlight the existing evidence base for SUD-specific RT practice, and critiqued for shortcomings. Gaps and needs in research are discussed, as well as recommendations for the development of SUD-specific evidence-based practices in RT.

The effect of recreational therapy application on fatigue in hemodialysis patients: a randomized clinical trial

BackgroundChronic Kidney Disease (CKD) is a progressive disorder that often leads to End-Stage Renal Disease (ESRD), necessitating hemodialysis (HD) treatment. Fatigue is a prevalent and debilitating symptom among HD patients, significantly affecting their quality of life. Recreational Therapy (RT) is a therapeutic recreational service designed to maintain and restore a person’s level of performance and independence in daily activities. This study aimed to evaluate the effect of a smartphone-based recreational therapy intervention on fatigue in hemodialysis patients.MethodsThis randomized controlled trial was conducted on HD patients at a hospital in Mashhad, Iran. The intervention group received a custom-designed recreational therapy mobile application, including music, comedy, exercise, and educational content. The control group received standard care. Fatigue was assessed using the Multidimensional Fatigue Inventory (MFI-20) before and after the 30-day intervention.ResultsA total of 72 patients (36 per group) participated in the study. The intervention group demonstrated a significant reduction in overall fatigue scores and improvements across various fatigue dimensions, including general fatigue, physical fatigue, mental fatigue, reduced activity, and reduced motivation, compared to the control group (p < 0.001).ConclusionThe smartphone-based recreational therapy intervention effectively reduced fatigue in hemodialysis patients. This approach could be a valuable complementary strategy for managing fatigue in this population. Further research is needed to explore the long-term sustainability of these benefits and the intervention’s impact on other patient-reported outcomes.Trial registrationThis study was registered in the Iranian Registry of Clinical Trials (no. IRCT20220803055608N1) on 29/08/2022.

Exploring influencing factors to clinical leadership development: a qualitative study with healthcare professionals in Flemish nursing homes

BackgroundNursing homes face a critical need for competent healthcare professionals to deliver high-quality care. Focusing on clinical leadership is crucial for equipping healthcare professionals with the skills necessary to manage complex care needs, collaborate effectively within multidisciplinary teams, and improve care quality in nursing homes. Developing clinical leadership fosters professional growth and enhances healthcare professionals’ ability to tackle the challenges unique to the nursing home environment. However, the concept of clinical leadership in nursing homes remains poorly defined and investigated. This study aimed to explore and define influencing factors for the development of clinical leadership within healthcare professionals in nursing homes.MethodsA qualitative study was conducted in Flanders, Belgium, using semi-structured focus group interviews (n = 5) with healthcare professionals (n = 41), including nurse assistants, licensed practical nurses, registered nurses, occupational therapists, recreational therapists, psychologists, and gerontologists. Interviews were audio-taped, transcribed, analysed and interpretated by using a thematic analysis based on descriptive phenomenology.ResultsClinical leadership development within healthcare professionals’ hinges on four pivotal themes: (1) Cultivating an empowering working environment that fosters open feedback, encourages peer learning, and champions a stimulating learning climate. (2) Nurturing a supportive leadership style in formal leaders that exemplifies role modeling, accessibility, and a coaching approach. (3) Elevating well-developed professional identity through targeted training, experience, and a talent-oriented work approach. (4) Fostering team dynamics marked by commitment, collaboration, support, and trust.ConclusionsThe study’s findings on the influencing factors for clinical leadership development should be actively applied in nursing homes and guide the creation of targeted training programs and leadership development initiatives. Awareness of these factors are crucial to optimise and to support the development and implementation of clinical leadership in nursing homes in an attempt to reduce the workforce shortages.

Implementing a new multidisciplinary, remote, dementia staff training program for Veterans affairs nursing homes

BackgroundPreventing Loss of Independence through Exercise (PLIÉ) is a group program for people living with dementia that combines movements to support daily function with present moment body awareness and social engagement that has been found to have physical, emotional, social, and cognitive benefits. The goal of this study was to develop and refine a PLIÉ remote training program for interdisciplinary Veterans Affairs (VA) nursing home staff members also known as community living center (CLC) staff.MethodsThis pre-implementation study used iterative Plan-Do-Study-Act (PDSA) cycles. The 10-week PDSA cycles occurred from June to September 2021 at 2 VA nursing home sites. Remote training was delivered via Microsoft Teams and included 1-hour live-streamed weekly didactic sessions (nursing staff with PLIÉ instructor) focused on PLIÉ principles and 1-hour weekly live-streamed experiential sessions for staff to apply PLIÉ principles with residents. We administered weekly feedback surveys to iteratively refine the training process.Results14 staff members participated (5 recreation therapists, 3 social workers, 2 registered nurses, 2 chaplains, 1 psychologist, and 1 speech pathologist). The experiential sessions were rated as most helpful overall. Key PDSA refinements included: (1) creating 10-minute video recording summaries to support learning, particularly for those unable to attend live training sessions due to clinical schedules; and (2) incorporating self-reflection and goal setting to support staff incorporation of PLIÉ principles into routine care and personal life. These refinements resulted in increased use of PLIÉ principles with the residents from 67 to 89% of the staff participants. 100% of regular attendees (11/11) rated their overall satisfaction with remote training as “very good” or “excellent.”ConclusionsIt was feasible to train interdisciplinary CLC staff participants to deliver an integrative group movement program for residents with dementia remotely. PDSA cycles supported refinement of the training process and improved uptake. A larger study of PLIÉ remote CLC staff training is needed to assess outcomes on residents and quality of care.

The effect of recreational therapy application on depression in hemodialysis patients: a randomized clinical trial.

Chronic kidney disease is a progressive disorder often leading to End-stage renal disease, necessitating hemodialysis treatment. Mild depression is prevalent among hemodialysis patients, adversely affecting their quality of life. This study aimed to evaluate the effect of a smartphone-based recreational therapy intervention on mild depression in hemodialysis patients. This randomized controlled trial was conducted at Montaserieh Hospital, Mashhad, Iran, involving 72 patients undergoing hemodialysis. Participants were randomly assigned to either the intervention group, receiving a custom-designed recreational therapy mobile app (including music, comedy, exercise, and educational content), or the control group, receiving standard care. The trial was registered with the Iranian Registry of Clinical Trials (IRCT20220803055608N1). Outcome assessors and statisticians were blinded to minimize bias. Sample size was calculated for an expected effect size of 0.90 with 80% power, resulting in 36 participants per group, adjusted for a 6% attrition rate. Depression levels were assessed using the Beck Depression Inventory-II (BDI-II) at baseline and after a 30-day intervention. A total of 72 patients (36 per group) completed the analysis. The intervention group showed a significant decrease in depression scores compared to the control group (mean BDI-II score reduction: intervention group = 10.3 ± 4.1, control group = 4.6 ± 3.8; p < 0.001). Post-intervention, 86.1% of patients in the intervention group exhibited minimal depression (BDI-II score ≤ 13), compared to 61.1% in the control group (p = 0.005). The smartphone-based recreational therapy intervention significantly reduced mild depression in hemodialysis patients. This approach can serve as a valuable complementary strategy to manage mild depression in this population. Further research is warranted to explore the long-term sustainability of these benefits and the intervention's impact on other patient-reported outcomes. This study was registered in the Iranian Registry of Clinical Trials (no. IRCT20220803055608N1) on 28/08/2022.