Table 1 Summary of methods for systematic review

Review questions

1. To identify and characterise studies of interventions to improve occupational performance for adults with psychosis

2. To characterise the theory base, level of standardisation and treatment fidelity for identified interventions

Population

Participants aged between 18 and 65 with a diagnosis of schizophrenia or schizoaffective disorder (or at least 70% of sample) living in the community.

Intervention

Studies of interventions which primarily aim to improve occupational performance, excluding vocational occupations.

Outcomes

The primary outcome is occupational performance

Types of studies

Randomised controlled trials, quasi-experimental studies, observational studies, and qualitative studies.

Data sources

Three data sources were used: online databases, internet search and a hand search. Online database searches were carried out in January 2011. The online databases searched were CINAHL, PsycINFO, MEDLINE, ASSIA and Embase databases, the Cochrane Library, OTCATS (Occupational Therapy Critically Appraised Topics), OTseeker, and online databases of unpublished PhD and Masters’ theses available from the College of Occupational Therapy and the Institute of Psychiatry. The internet search using Google was carried out using the same search terms that were used in databases, to identify grey literature and conference proceedings relating to psychosis and occupational performance.

The table of contents of the following publications were also hand searched: Schizophrenia Bulletin, Schizophrenia Research, Psychiatric Services, British Journal of Occupational Therapy, Occupational Therapy in Mental Health and Occupational Therapy Journal of Rehabilitation.

Search terms

Population: Schizophrenia OR Psychotic disorders OR Affective disorders, Psychotic OR Severe and enduring mental health AND community

Intervention: Leisure activities OR functional status OR community integration OR self-care OR activities of daily living OR skill acquisition OR skill retention OR meal preparation OR occupational performance OR occupation* AND performance OR participation OR engagement OR functioning OR impairment or adaptation

Design: (Intervention AND (study OR evaluation)) OR Pilot study OR Randomised Controlled Trial

Outcome: Change in occupational performance OR skill acquisition

Search strategy

A search using variations of the above terms appropriate to the terms used in the databases was carried out in online databases and mapped and unmapped against indexed subject heading where this option exists. The search strategy was restricted to studies published since 1995 until January 2011 and English language only.

Study selection

Abstracts of identified papers were assessed for eligibility. For studies not excluded on abstract, the full paper was obtained and assessed in more detail against the inclusion and exclusion criteria. A second rater was used to independently assess the eligibility of a random selection of 20% of full papers, to estimate concordance on inclusion.

Quality assessment

Appraisal of quantitative methodologies was carried out using the Quality Assessment tool for quantitative studies [43]. A cut-off score was not used as an inclusion criterion.

Data analysis

Narrative synthesis was used to integrate the results of studies included in the review, as the studies were clinically diverse, used a range of outcome measurement tools and were shown to have a range of comparisons. The narrative synthesis used in this study consisted of three stages as described by Roberts [44].