Impact of Occupation-Based Groups on Occupational Performance and Satisfaction Outcomes: Pilot Study

Abstract

Occupation-based groups can be used to improve occupational performance outcomes in the inpatient rehabilitation setting. It remains unclear whether they offer comparable outcomes to occupation-based interventions delivered individually. This study aims to pilot an occupation-based group intervention and compare occupational performance, satisfaction, and goal attainment outcomes with usual care. Twenty-one participants (15 women, 6 men, aged 34–85) were allocated to control (n = 11) and intervention (n = 10) groups. The control group received usual care (individual occupation-based interventions), while the intervention group received usual care plus an occupation-based group intervention. The method used a pilot quasi-experimental pre- to post-intervention design with a nonequivalent control group. The primary outcome measures were the Canadian Occupational Performance Measure (COPM) and the Goal Attainment Scale (GAS). No significant between-group differences were found; both groups reported statistically significant improvements with medium to large effect sizes. Pilot data suggests that occupation-based groups offered comparable outcomes to individual treatment; a larger sample size is required to draw conclusions on their impact. Australian New Zealand Clinical Trials Registry (https://uat.anzctr.org.au/Default.aspx) was accessed on November 20, 2023. Registration number: ACTRN12623001196639.

Plain Language Summary

Do People Improve in their Everyday Activities in Hospital Rehabilitation When Practicing in a Group with Others?

When in hospital for rehabilitation, people may practice some of their everyday activities with their occupational therapist. For example, they might practice preparing a meal, doing their laundry, or washing dishes. We wanted to know if practicing in a group with others had the same effect as practicing these everyday activities with just their occupational therapist.

This research took place in a rehabilitation hospital in metropolitan Australia. Patients were aged 34 to 85 years and had a range of health conditions, which required an admission to a rehabilitation hospital to support their recovery and return home. Results from this study suggest that regardless of how this practice occurred (individual or group-based), patients improved their ability to perform their everyday activities. This study included a small number of participants (21 in total). Further studies with larger numbers of patients would be required to have greater confidence in the results observed. This study contributes to the growing evidence for practicing daily activities in a group with others.

Introduction

Occupational therapists in the inpatient rehabilitation setting support patient recovery with their unique contribution to rehabilitation focusing on a person’s valued occupations (Gillen, 2024; Spalding et al., 2022b). Occupations refer to the everyday activities that people engage in “to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to, and are expected to do” (World Federation of Occupational Therapists, 2024, para. 1) with the meaning and purpose dependent on the context of the individual, family, or community engaged in the occupation (Johnson & Anvarizadeh, 2024). Occupational therapists understand and recognize the impact that occupational issues can have on a person’s health-related outcomes (Kielhofner, 2009). Occupation-based practice has been recognized as a core approach to occupational therapy, using occupation as the basis for assessment, intervention, and evaluation (Fisher, 2013; Kielhofner, 2009). Occupation-based interventions use engagement in an intended occupation as a therapeutic agent of change (Fisher, 2013) and are the focus of this research.

A recent systematic review (Wall, Isbel, et al., 2024a) of occupation-based interventions in the hospital setting found good evidence to support the use of occupation-based interventions to improve occupational performance and participation outcomes in inpatient rehabilitation. It remained unclear, however, whether occupation-based interventions were more effective than any control or alternative intervention for improving these outcomes (Wall, Isbel, et al., 2024a). Qualitative findings in this review also reflected a positive impact of occupation-based interventions on patient outcomes and the patient experience (Wall, Isbel, et al., 2024a). The review included occupation-based interventions delivered both individually and, in a group, recommending further research to determine whether occupation-based interventions delivered in a group offer comparable outcomes to occupation-based interventions delivered individually (Wall, Isbel, et al., 2024a).

There is growing research to support the use of occupation-based groups in inpatient rehabilitation. Occupation-based groups offer distinct economic advantages by enabling more patients to be seen at once and creating an opportunity for increased intensity of therapy (Spalding et al., 2022b). Spalding et al. (2022a) explored the impact of an occupation-based group intervention targeting instrumental activities of daily living (IADLs) in a general inpatient rehabilitation ward. Outcomes were measured pre and post-intervention, at 30-day follow-up and 90-day follow-up. Results indicated statistically significant improvement in occupational performance, satisfaction, and self-efficacy post-intervention that was maintained at 90-day follow-up (Spalding et al., 2022a). This study was limited by its small sample size and nonrandomized design, making it difficult to draw conclusions regarding the impact of the intervention.

Notably, no study has previously compared the impact of occupation-based groups on patient outcomes compared to occupation-based interventions delivered individually (usual care). Occupation-based interventions should be patient-centered, individualized, and flexible in nature, with the content, intensity, and duration of therapy tailored to each patient and their specific occupational performance goals (Nielsen et al., 2020). There is a need for research to determine whether occupation-based interventions delivered in a group using semi-supervised practice can uphold the patient-centered nature of this intervention effectively, compared with individual-based delivery.

An occupation-based group intervention for adult inpatient rehabilitation was developed using a modified Nominal Group Technique design (Wall et al., 2024b). A panel of occupational therapists, previous rehabilitation patients, and other relevant allied health professionals generated ideas and reached a consensus on the key components for an occupation-based group intervention at the intended implementation site (Wall et al., 2024b). The result of this study was the development of an occupation-based group intervention targeting IADLs including meal preparation, laundry, and other domestic tasks. These occupations were identified and agreed upon by the panel as relevant and feasible occupations to include in the group intervention. The aim of this study was to pilot the occupation-based group intervention in adult inpatient rehabilitation and investigate its impact on occupational performance, satisfaction, and goal attainment outcomes compared to occupation-based interventions delivered individually (usual care). A process evaluation paper that will be published elsewhere (Wall et al., 2024c) reports the feasibility of implementing the intervention within adult inpatient rehabilitation at one clinical site and explores the factors that may have influenced the impact and implementation of the intervention.

Method

A pilot quasi-experimental pre- to post-design with a nonequivalent control group was selected as an appropriate design to address this study’s aim in lieu of a randomized controlled trial (RCT). Due to time, funding, and resource restrictions, an RCT design was not a pragmatic option. Quasi-experimental designs are recognized as a means of assessing intervention effectiveness where random assignment of the intervention may not be feasible because of practical, ethical, social, or logistical constraints (Handley et al., 2018). Details of this research have been reported in accordance with the Transparent Reporting of Evaluations with Non-Randomized Designs (TREND) statement (Des Jarlais et al., 2004). Ethics approval was obtained from the ACT Health Human Research Ethics Committee on June 20, 2023. ACT Reference: 2023.ETH.00071. REGIS Reference: 2023/ETH00783. Cross-institutional approval was also obtained for the University of Canberra and Griffith University. This trial was registered retrospectively with the Australian New Zealand Clinical Trials Registry on November 20, 2023 (ACTRN12623001196639).

Objectives

The objective of this study was to pilot an occupation-based group intervention in adult inpatient rehabilitation and investigate its impact on occupational performance, satisfaction, and goal attainment outcomes compared to occupation-based interventions delivered individually.

It was hypothesized that occupation-based groups offered comparable outcomes to occupation-based interventions delivered individually and the trial would be feasible to conduct.

Participants

Participants were recruited from consecutive admissions across three inpatient rehabilitation wards at the University of Canberra Hospital (geriatric rehabilitation, general rehabilitation, and neurological rehabilitation). Participants were eligible for inclusion if they met the following inclusion criteria: ≥18 years old, medically stable, planned discharge destination of home, at least one IADL-based occupational performance goal, a score of <24/30 on the Mini-Mental State Examination (MMSE) (Folstein et al., 1975), a score of <13/20 on the short-Frenchay Aphasia Screening Test (Enderby et al., 2012), the ability to participate in the intervention in a semi-supervised format, and required written, informed consent to participate in the study.

Sample Size

A statistician at the University of Canberra was consulted for support with sample estimation. A linear mixed model was used to undertake a simulation-based power analysis. For power to exceed 0.8, a sample size of 40 was required. Assuming a 20% dropout rate meant a projected sample size of 60 participants.

Assignment Method

A block assignment method with two consecutive time blocks for recruitment and assignment was used in this quasi-experimental trial. Recruitment for the control group was from July 18, 2023 to September 8, 2023. This was followed by a two-week “wash out phase,” where any participants needing to finish the control intervention and complete post-outcome measures could do so. The occupation-based group intervention was also introduced across the three inpatient rehabilitation wards during this time; no recruitment or data collection occurred. Recruitment for the intervention group was from September 26, 2023 to November 17, 2023. Refer to Figure 1 for further details.

Figure 1.

Participant Flow Diagram.

Due to time, funding, and resource restrictions recruitment blocks for the control and intervention assignment could not be extended. As many patients as possible were recruited during each recruitment time block resulting in a convenience sample size appropriate for this pilot study.

Blinding

A research assistant who was blinded to the study design and participant assignment completed all baseline and post-intervention measures. It was not possible to blind participants to the intervention they were receiving or clinicians to the intervention they were delivering.

Interventions

Both the control and intervention treatment groups received usual rehabilitative care from occupational therapists and other allied health depending on each participant’s individual needs. This may have included one-to-one occupation-based interventions targeting self-care occupations such as showering, dressing, and toileting as this was part of routine care at the study site. Self-care occupations were not included in the occupation-based group intervention piloted in this study.

For this study, control group refers to patients who received all occupation-based interventions individually as described below. Intervention group refers to patients who received occupation-based interventions individually except for domestic occupations which were group-based. For both groups, the duration and frequency of the intervention were dependent on each participant, their needs, and their progress toward goal attainment/hospital discharge. Participants continued participating in the intervention/control until they had achieved their goals or were discharged.

Intervention Group

The occupation-based groups focused on using engagement in part or whole of the intended occupation, graded task practice, feedback on performance and person, environmental, and/or occupation-related strategies to maximize independence. Group size was between two and six participants and groups were supervised by two staff members including an occupational therapist and either an allied health assistant or occupational therapy student. Meal preparation groups were delivered in therapy kitchens in each respective rehabilitation ward. Domestic task groups occurred across several therapy areas in the hospital, including the laundry, bathroom, gym, and outdoor clothesline. Groups ran for approximately one to one-and-a-half hours. Participants in this study participated in one to five group sessions.

Control Group

Usual care included individual occupation-based sessions to engage in part or whole of the intended occupation, graded task practice, feedback on performance, and person, environment, and/or occupation-related strategies to maximize independence. This was delivered by an occupational therapist, allied health assistant, and/or an occupational therapy student. Meal preparation practice occurred in therapy kitchens in each respective rehabilitation ward. Domestic tasks practice occurred across several therapy areas in the hospital including the laundry, bathroom, gym, and outdoor clothesline. Individual occupation-based intervention sessions ran for approximately 1 hour.

Efforts were made to try and minimize the seasonal effects of this study design; however, it should be noted that there were some distinct differences in study conditions for the control and intervention conditions. Due to the rotational nature of allied health staff at the implementation site, different occupational therapists delivered the control group for the first three weeks. For the remainder of the control group period and the entirety of the intervention group period, staff delivering the intervention remained the same.

Data Collection

Demographic data were collected from patient electronic records.

Canadian Occupational Performance Measure

The Canadian Occupational Performance Measure (COPM) is a standardized, client-centered, and occupation-focused measure that uses semi-structured interviews, where participants self-rate their performance and satisfaction using a 10-point scale (Law et al., 2014). The COPM has been psychometrically tested, demonstrating good test–retest reliability, adequate internal consistency, and has had content, criterion, convergent, divergent, and construct validity evaluated in various settings; these studies are listed in the COPM manual (Law et al., 2014). A range of clinically important differences have been reported for the COPM, likely impacted by the population, occupational performance goals identified, and the context in which the intervention was received (Canadian Occupational Performance Measure, n.d.). A change of ≥2 points was considered clinically significant for this study, based on previous research on similar populations and contexts (Eyssen et al., 2011; Law et al., 2014; Spalding et al., 2022a). The COPM produces two main scores out of 10: performance and satisfaction (Law et al., 2014). Scores can be generated for up to five occupational performance goals, and average scores are obtained by dividing the sum of the “performance” and “satisfaction” scores by the number of goals (Law et al., 2014). There are no parameters around re-assessment timeframes for this measure.

Goal Attainment Scale (GAS)

The GAS is a therapist-rated, evidence-based, client-centered, and criterion-referenced assessment of goal attainment (Doig et al., 2010; Kiresuk & Sherman, 1968; Krasny-Pacini et al., 2016). The GAS can be used for people with any diagnosis (Krasny-Pacini et al., 2016). Scores can be aggregated to measure the extent to which an intervention that a group of clients is receiving works to achieve their individualized goals (Krasny-Pacini et al., 2016). The GAS has been used in both clinical and research practice to assess the effectiveness of an intervention in rehabilitation (Krasny-Pacini et al., 2016), is often used in combination with the COPM (Doig et al., 2010), and has been used in previous research evaluating occupation-based interventions (Spalding et al., 2022a; Trevena-Peters et al., 2018).

Following completion of the COPM, any IADL-based goals identified were then applied to the GAS. The GAS was used to break these down into five possible scenarios: much less than expected (−2), somewhat less than expected (−1), expected (0), somewhat more than expected (1), and much more than expected (2) (Kiresuk & Sherman, 1968). The GAS total score has an M of 50 and a SD of 10 which is calculated using a formula described by Kiresuk and Sherman (1968). GAS scores of 50 indicate expected levels of goal attainment, scores above 50 indicate higher than expected, and scores less than 50 indicate lower than expected (Doig et al., 2010). There are no parameters around re-assessment timeframes for this measure.

Secondary outcomes included changes in the use of IADL-based services on discharge (i.e., meal preparation or domestic assistance) and any changes to living arrangements on discharge.

Procedure

Patients with IADL-based occupational performance goals, including breakfast preparation, lunch preparation, and domestic tasks, were identified as potential participants by the treating occupational therapist. The occupational therapist briefly introduced the study and obtained initial consent for the primary investigator to make contact. All potential participants were informed of the study’s risks and benefits and were explained that participation was voluntary and their identity would not be disclosed; participants chose their own pseudonyms, and all data were stored in a password-protected folder. Demographic data and outcome measures were collected by a research assistant blinded to research design and participant assignment prior to intervention commencement. The research assistant collected post-intervention outcome measures at completion of the program or at discharge (whichever occurred first).

Data Analysis

All data were analyzed using IBM SPSS Statistics (Version 27). Results were considered statistically significant where α ≤ 0.05. Demographic data were summarized descriptively using frequencies and measures of central tendency. Baseline equivalence was determined using Wilcoxon Signed Ranks Tests for continuous data and Fisher’s Exact Test for categorical data. Assumptions for normality were tested and met by COPM performance but not COPM satisfaction and GAS. Correlational analysis explored relationships with demographic factors to guide the inclusion of covariates in the analysis. No significant correlations were identified. A Linear Mixed Model Analysis explored between-group and within-group comparisons for COPM performance and satisfaction, and GAS scores. This study assigned groups of individuals to each study condition; therefore, the analyses were performed at the group level.

Results

Participant Flow

The flow of participants through each stage of this research is described in Figure 1.

Baseline Data

Participant demographic and baseline data are presented in Table 1. Twenty-one participants participated in the study and completed post-outcome measures. Eleven of these were allocated to the control group and 10 were allocated to the intervention group.

Table 1.

Participant Demographics.

Demographic characteristic	Control group (n = 11)	Intervention group (n = 10)	Total (n = 21)
Age, mean (SD)	65.91 (16.93)	63.00 (12.99)	64.52 (14.89)
Gender, N (%)
Female	8 (73)	7 (70)	15 (71)
Male	3 (27)	3 (30)	6 (29)
Diagnosis, N (%)
Non-neurological
Orthopedic condition	3 (27)	4 (40)	7 (33)
Lower limb amputation	1 (9)	2 (20)	3 (14)
COVID-19	0 (0)	1 (10)	1 (5)
General surgical	1 (9)	0 (0)	1 (5)
Neurological
FND	1 (9)	0 (0)	1 (5)
Other neurological	2 (18)	1 (10)	3 (14)
Stroke	3 (27)	2 (20)	5 (24)
Services before admission, N (%)
Yes	3 (27)	1 (10)	4 (19)
No	8 (73)	9 (90)	17 (81)
Living arrangement before admission, N (%)
Alone	6 (55)	1 (10)	7 (33)
Spouse	4 (36)	7 (70)	11 (52)
Family	0 (0)	2 (20)	2 (10)
Other	1 (9)	0 (0)	1 (5)
MMSE, M (SD)	28.27 (1.84)	29.00 (1.83)	28.62 (1.82)
Short-FAST, M (SD)	19.27 (0.65)	19.40 (0.70)	19.33 (0.66)

Note. COVID-19: Coronavirus disease, FND: functional neurological disorder, MMSE: Mini-Mental State Examination, Short-FAST: Short Frenchay Aphasia Screening Test.

Baseline Equivalence

There were no statistically significant between-group differences for any baseline demographics (p > .05).

Outcomes

Participants across treatment groups identified a total of 51 IADL goals (control group = 22 goals, intervention group = 29 goals). The most common IADL goal for each group was meal preparation; 50% of IADL goals related to meal preparation for the control group and 34% of IADL goals related to meal preparation for the intervention group. Other goals included cleaning, doing the dishes, laundry tasks, and bed-making. Refer to Supplemental Table 1 for tabulated data regarding the frequency of IADL goals for treatment groups.

The frequency of training for participants in the control group ranged from one to five sessions with a mean of 2.4 sessions and a median of two sessions. The frequency of training ranged from one session to 11 sessions with a mean of 4.4 sessions for the intervention group and a median of 3.5 sessions. An average length of stay in inpatient rehabilitation was 38.82 days (median 35 days, range 14–62 days) for the control group and 39.40 days (median 32.5 days, range 17–72 days) for the intervention group.

Primary Outcome Measures

Measures of central tendency for the primary outcome measures at the two data collection points are outlined in Table 2. Mixed model analysis found a significant change over time for all participants on COPM performance (F = 83.77, p ≤ .001), COPM satisfaction (F = 59.60, p ≤ .001), and GAS (F = 101.80, p ≤ .001) scores (Table 3). There were no significant differences between the groups for COPM performance (F = 1.52, p = .23), COPM satisfaction (F = 3.16, p = .09), or GAS (F = 3.35, p = .08) (Table 3). There were no significant time by group effects for COPM performance (F = 1.65, p = .21), satisfaction (F = .46, p = .51), or GAS (F = 1.02, p = .33) (Table 3). Table 3 reports the estimates of the fixed effects.

Table 2.

Measures of Central Tendency for COPM Performance, Satisfaction, and GAS.

Measure	Control group (n = 11)		Intervention group (n = 10)
	T1	T2	T1	T2
	Mdn (IQR)	Mdn (IQR)	Mdn (IQR)	Mdn (IQR)
COPM performance	3.20 (4.20)	6.80 (2.60)	3.30 (2.55)	5.60 (2.85)
COPM satisfaction	3.00 (4.20)	7.40 (3.00)	2.90 (1.70)	6.30 (3.60)
GAS T	31.70 (8.60)	68.30 (13.80)	29.80 (14.42)	56.85 (29.50)

Note. COPM: Canadian Occupational Performance Measure, GAS: Goal Attainment Scale, IQR: interquartile range, Mdn: median.

Table 3.

Linear Mixed Model Analysis Fixed Effects.

Measure	Fixed effect	Estimate	t	p	95% confidence interval
					Lower	Upper
COPM performance	Group	1.30 (control)	1.57	.13	−.431	3.03
	Time	−2.48	−5.4	<.001	−3.44	−1.53
	Group × Time	−.81	−1.29	.21	−2.13	.509
COPM satisfaction	Group	1.68 (control)	1.95	.07	−.127	3.49
	Time	−2.92	−.49	<.001	−4.18	−1.66
	Group × Time	−.56	−.68	.51	−2.30	1.17
GAS	Group	9.19 (control)	1.68	.11	−2.28	20.67
	Time	−24.13	−6.28	<.001	−32.18	−16.08
	Group × Time	−5.37	−1.01	.33	−16.49	5.75

Note. COPM: Canadian Occupational Performance Measure, GAS: Goal Attainment Scale.

Change scores for the COPM were ≥2 points for performance and satisfaction scores in both the control and intervention groups and are considered clinically significant (Eyssen et al., 2011; Law et al., 2014). Furthermore, 82% of participants equaled or exceeded the clinically significant difference for changes in COPM performance in the control group, and 50% equaled or exceeded this in the intervention group. For changes in COPM satisfaction outcomes, 73% of participants equaled or exceeded the clinically significant difference in the control group, and 90% equaled or exceeded this in the intervention group. GAS scores were considered clinically significant where GAS T > 50 post-intervention (Doig et al., 2010). For GAS T scores, 91% of participants in the control group exceeded this and 60% exceeded this in the intervention group.

Secondary Outcome Measures

The percentage of participants using IADL-based community services increased from 27% at baseline to 55% post-intervention for the control group and from 10% to 40% for the intervention group. There were no statistically significant between-group differences for the use of community services on discharge between the control and intervention groups (p > .05).

The percentage of participants living alone decreased from 55% at baseline to 45% post-intervention for the control group and remained unchanged for the intervention group. There were no statistically significant between-group differences in living arrangements on discharge between the control and intervention groups (p > .05).

Refer to Supplemental Table 2 for tabulated data regarding secondary outcome measures.

No adverse events were recorded in this study.

Discussion

There is growing evidence to support the use of occupation-based groups in inpatient rehabilitation; however, no study has compared the effectiveness of occupation-based groups to occupation-based interventions delivered individually (usual care). The objective of this study was to pilot an occupation-based group intervention in adult inpatient rehabilitation and investigate its impact on occupational performance, satisfaction, and goal attainment outcomes compared to occupation-based interventions delivered individually.

Results from this pilot study suggest that occupation-based interventions delivered either individually or in a group support goal attainment of IADLs and improve patient-perceived occupational performance and satisfaction immediately following intervention completion. This is indicated by clinically significant (≥2 points) improvements in COPM scores post-intervention and GAS T scores > 50 post-intervention for both treatment groups. There was no statistically significant difference between patient-reported outcomes for the control and intervention groups. These findings are preliminary in nature given the small sample size, and further research is necessary to confirm the impact of occupation-based groups on patient outcomes. Results from this study are consistent with recent research by Spalding, Di Tommaso, & Gustafsson (2022), who identified improved IADL performance, satisfaction, and goal achievement following an occupation-based group delivered in general inpatient rehabilitation. These results were maintained at 90-day follow-up (Spalding et al., 2022a). This study was a single-group design with no comparison or control group to compare outcomes (Spalding et al., 2022a).

It should be noted that patient recruitment for this research did not meet the target sample size. Due to the pilot design of this study, a convenience sample size was obtained. Many participants declined to participate in this research as they were unable to identify any IADL-based occupational performance goals. Anecdotal feedback from staff also suggested a potential system influence in that many patients at the time of this research accessed IADL-based community services or family assistance to support early hospital discharge due to high demand for patient turnover. In these instances, patients were referred to outpatient rehabilitation services to address IADL-based goals. Similar challenges in inpatient rehabilitation were identified by Gustafsson and Mckenna (2010), who proposed the need for further investigation into approaches to rehabilitation that facilitate equitable focus on occupations beyond self-care that are often considered “more essential” for discharge. Murray et al. (2021) identified similar organizational barriers to occupation-based practice in acute hospital settings due to the fast-paced and discharge-oriented nature of this setting. A longer recruitment period or a multisite RCT should be considered for future research to achieve an adequately powered trial.

Occupational therapists often use groups in conjunction with individual-based interventions (Higgins et al., 2015). Inpatient rehabilitation hospitals are often faced with the challenge of trying to increase the intensity of rehabilitation within a health care system that is financially restricted (Pigott et al., 2022). As a result, clinicians are required to develop innovative solutions to increase the intensity of rehabilitation with existing resources (Pigott et al., 2022). From a service delivery perspective, groups are valued for their ability to enhance time and resource efficiency in the inpatient rehabilitation setting; through being able to see more patients at once, groups also offer the potential to increase the frequency and intensity of therapy (Pigott et al., 2022; Spalding et al., 2022b). Increasing intensity of task practice has demonstrated benefits for improving functional outcomes across a range of diagnostic groups (French et al., 2016; Marston et al., 2022; Schneider et al., 2016). Delivering occupation-based interventions can be time and resource-intensive. In this study participants in the intervention group received an average of two more sessions than those allocated to the control group. Further research including cost analysis is required to determine the potential impact of occupation-based groups on resources and cost-effectiveness of service delivery.

The frequency of training sessions almost doubled when comparing the control group (average 2.4 sessions) with the intervention group (average 4.4 sessions) in this study. Participants receiving the occupation-based group intervention were able to access a higher frequency of therapy by participating in the occupation-based group intervention. This may have been attributed to the group-based nature of the intervention improving time and cost-effectiveness. Despite this increase in frequency of therapy, there was no significant difference between treatment groups across patient-reported outcomes. There are several plausible explanations for this. First, data on the intensity of task practice within sessions for both treatment groups were not recorded (i.e., number of tasks practiced within each session). While the frequency of sessions was higher in the intervention group, the intensity of task practice may not have increased. Another explanation could be patients in the intervention group required a higher frequency of therapy to achieve the same or similar outcomes to patients in the control. The patient-reported nature of outcome measures selected for this research and the challenge of goals set may have influenced this. Future studies should aim to capture data not only on the frequency of the sessions for each treatment group but also on the intensity of task practice within each session.

Several other studies have investigated the impact of occupation-based groups from both clinician and patient perspectives demonstrating a generally positive impact. Benefits such as developing relationships with co-participants through shared experiences, improved motivation for therapy, peer-based learning, and enhanced self-efficacy for discharge have all been reported in recent literature (Patterson et al., 2017, 2019; Spalding, Di Tommaso, & Gustafsson, 2022). It should be noted that studies conducted by Patterson et al. (2017, 2019) included both occupation-based and occupation-focused groups. It is important when evaluating the impact of health care interventions to consider the perceptions and experiences of patients as consumers of health care as well as clinicians responsible for delivering the intervention. Understanding these perspectives and experiences can assist in determining whether the intervention is meeting the needs of that practice setting and can lead to improved uptake and sustainability (Klaic et al., 2022). Patient and clinician perceptions and experiences of the occupation-based group intervention were explored as part of the process evaluation which will be published elsewhere (Wall et al., 2024c).

This research contributes to the growing body of evidence on occupation-based groups in inpatient rehabilitation. Pilot data suggests that delivering occupation-based interventions in a semi-supervised format did not compromise patient outcomes however this study was not adequately powered and further research is required to confirm these results.

Limitations

There are several limitations to this research and as such results should be interpreted with caution. This study was underpowered, used a heterogeneous sample, and had a nonrandomized design. Due to time constraints for this research, the recruitment period was unable to be extended and as such, the total number of participants was below the target sample size. Based on this small sample size, the results of this study should be interpreted with caution as it is unclear whether other confounding variables may have impacted the results. In addition, due to the nature and demands of the workforce delivering the intervention, it was not possible to control for variables such as therapist experience and this may also have influenced the results. This may also be viewed as a strength of this study as controlling for confounding variables such as therapist experience would not be reflective of real-world clinical practice.

It is worth noting the distribution of participants with neurological and non-neurological conditions across treatment groups (Table 1). The control group included six participants with neurological conditions and the intervention group included three. While this baseline difference was not statistically significant, it may still be considered clinically significant as neurological and non-neurological rehabilitation progress and recovery can vary significantly. Future large-scale clinical trials should consider subgroup analyses for neurological and non-neurological conditions. Patients with significant cognitive and/or communication deficits were also excluded from this study and further research is required to determine the suitability and impact of the occupation-based groups for more vulnerable patient groups such as those with severe cognitive and/or communication deficits.

This study did not include a follow-up period for outcome measures and outcomes were only reflective of patient-perceived goal attainment, performance, and satisfaction with their chosen IADLs when completed in the hospital environment. It is unclear whether these outcomes were maintained for patients when they returned home, faced with an additional person, occupation, and environmental factors that may have impacted these outcomes. Future large-scale clinical trials should include a follow-up period.

Conclusion

In this pilot study, occupation-based groups offered comparable outcomes to occupation-based interventions delivered individually in adult inpatient rehabilitation. Pilot data suggests occupation-based interventions (irrespective of whether they are delivered individually or in a group) can be used to improve patient-perceived goal attainment, occupational performance, and satisfaction outcomes in inpatient rehabilitation. Furthermore, more rigorous research is required to confirm the impact of occupation-based groups compared to occupation-based interventions delivered individually. Future research should aim to recruit a larger number of participants, use a more homogeneous sample, and consider the use of more robust measures of occupational performance.

Supplemental Material

sj-docx-1-otj-10.1177_15394492241300606 – Supplemental material for Impact of Occupation-Based Groups on Occupational Performance and Satisfaction Outcomes: Pilot Study

Supplemental material, sj-docx-1-otj-10.1177_15394492241300606 for Impact of Occupation-Based Groups on Occupational Performance and Satisfaction Outcomes: Pilot Study by Gemma Wall, Louise Gustafsson, Claire Pearce and Stephen Isbel in OTJR: Occupational Therapy Journal of Research