Intervention characteristics.

Two studies [22,23] included immigrants or migrants and all interventions were delivered face-to-face by OTs or PTs. Gupta (2012) [22] described an OT service delivery model and used a mixed-methods program evaluation. The OT-based program was delivered to new immigrants alongside their English Language Learner classes. Program modules addressed cultural transition, self-efficacy and wellbeing, cultural beliefs about time and time use; stress and impact in health; and workplace norms, stress, and injury. They instructed participants on new ways of performing daily activities, initiating community integration, and navigating the complexities of their new society. Using a combination of qualitative and quantitative analyses, they assessed the program’s effectiveness on self-efficacy, routines and schedules, time management, stress, sleep, injury, and overall health. Thulstrup and colleagues (2021) [23] described the feasibility and effects of a twelve-week, twice weekly, PT intervention for immigrant women in Denmark using a pre-post study design. The exercises were individualized to preferences of the women, and consisted of endurance, strength, coordination, balance, and resistance exercises. There were two program locations, each offering privacy through closed curtains, locked doors, and no video surveillance, which allowed the women to remove clothing and/or headscarves as needed.

Needs of the population.

The women in the study by Thulstrup and colleagues (2021) reported needing assistance with planning exercises, exercise variability, a safe space for women to remove head coverings, and quiet music to hear instructions from the instructor. Their expectations specifically for the program included pain reduction, weight loss, and general wellbeing [23].

Effects on health outcomes.

Gupta (2012) identified that motivation for self-improvement, group discussions and educational materials were facilitators to delivery [22]. Conversely, Thulstrup et al (2021) found that the PTs’ explanation of theoretical underpinnings behind the exercises was a barrier to engagement [23]. Collectively, there were no significant changes in body mass index, fat percentage, walking performance, lower-body strength, or quality of life as a result of the PT intervention [23]. However, they also noted 60% of women had improved walking performance and BMI, and 50% of women had improved lower-body strength [23]. Qualitatively, the participants in the OT intervention reported improvements in stress, sleep, injury, overall health, healthy food choices, physical activity participation and awareness of work-related injuries [22].

Intervention characteristics.

Only one study [17] reported on a refugee population in Denmark. In this study, PTs delivered basic body awareness training (BBAT) in a hospital once weekly for one hour, over thirteen weeks. Participants also received usual care involving pharmacological treatment, psychoeducation, and cognitive behavioral therapy, which were delivered by other healthcare professionals.

Needs of the population.

The qualitative interviews identified several needs for service delivery. Participants placed importance on the PTs being gentle, calm, empathetic, and catering to individual needs. Moreover, the PTs’ ongoing involvement with demonstrations helped participants learn about the movements. Finally, participants emphasized that contact with another person was essential for treatment [17].

Barriers and facilitators to implementation.

In some cases, there were language barriers or cultural differences, which presented as a barrier to delivery, while regularity with the program was a facilitator [17].

Effects on health outcomes.

Participants expressed that BBAT relieved pain and muscular tension, positively affected emotional state, and made it easier to sleep. Participants reported BBAT as being helpful when coping with stress and developing positive relationship with themselves and others [17].

Intervention characteristics.

Three primary studies [24–26] examined the impacts of OT interventions twenty-four weeks to twelve months in duration. All of the interventions were provided face-to-face and in group settings, with two of the studies [25,26] also having an individualized component. Across the interventions [24–26], the OTs mainly facilitated education sessions, which included various topics such as safety planning; drug and alcohol awareness; safe sex practices; assertiveness and advocacy skill training; anger management; stress management; boundary establishment and limit setting; vocational and educational skill training; money management; housing application; leisure exploration (e.g., relaxation, crafts, gardening); hygiene; medication routine; and nutrition and exercise. The OTs also provided handouts and led group discussions to educate the community on peer-recovery communities, and visited group meetings to observe patterns of interaction, and to provide ongoing support, guidance, and encouragement to participants [24]. In the systematic and scoping reviews [20,21], there were a broad range of interventions. The systematic review [21] included seven studies which examined the effectiveness of OT programs or identified the occupational needs of people experiencing homelessness, while the scoping review included 178 studies that described current and potential occupation-based practices. For details regarding the specifics of those interventions, we refer readers to the respective reviews [20,21].

Needs of the population.

The systematic review by Thomas et al (2011) [21] identified money management, coping skills, employment and education, and leisure activities were important and common needs of people experiencing homelessness in the included studies, which align with the findings by Gutman et al (2004). Similarly, the scoping review found employment and education interventions, physical rehabilitation services, and child and family services were critical needs for people experiencing homelessness. Gutman et al (2004) also found interventions should be client-centred, and that leisure exploration exercises, knowledge of available resources, and developing assertiveness and advocacy skills were valuable. Participants in the intervention by Boisvert et al (2008) reported needing trust, respect, honesty, openness, helpfulness, leadership, integrity, willingness, and sobriety in their program.

Barriers and facilitators to implementation.

In the scoping review by Roy et al (2017) [20], past negative experiences with service providers were identified as barriers to delivery, but that building rapport and sensitivity to traumatic experiences were facilitators. There were two main barriers to service delivery among the individual studies. Chapleau et al (2012) [26] found case managers felt OT referrals were not necessary once they were satisfied with their clients’ improvement. Gutman et al (2007) [25] identified that vulnerable populations are often not allocated the most appropriate services due to non-disclosure by the clients, which may present as a barrier to delivery. Gutman et al (2007) [25] also noted therapist support was helpful for safety planning. Similarly, Boisvert et al (2008) [24] also found that encouragement and a sense of support or community was a facilitator for client retention.

Effects on health outcomes.

Roy et al (2017) also found reductions in trauma symptoms and increases in physical health among sports-based community building initiatives [20]. Among individual studies, there were no long-term differences in goal attainment [26], while shorter-term improvements in goal attainment were observed [24–26]. There was also improvements in social support and quality of life as a result of interventions [24]. Chapleau et al (2015) reported lower variance from ideal housing status over the twelve-month period compared to the control group. Boisvert et al (2008) [24] reported varying effects on health outcomes, and reduced risk of drug or alcohol relapse.

Intervention characteristics.

The three interventions [27,29,30] occurred once or twice per week for one to two hours, over six to twelve weeks, delivered face to face by OTs in group settings, and mainly involved education sessions. Barnes et al (2008) implemented a lifestyle redesign program consisting of twelve educational modules involving: occupations, stress management, relationship, energy conservation and time management, exercise, joint protection, transportation/low-cost activities, nutrition, and spirituality/aging [27]. Ciro and Smith (2015) engaged in group education sessions that included: (1) didactic lessons on the benefits of meaningful activities; (2) exploring individually meaningful activities targeting physical, cognitive, and mental health; and (3) problem-solving environmental barriers that hinder participation in meaningful activities [29]. Towfighi et al (2020) reported on OTs implementing individualized nutrition, physical activity, and self-management action plans with participants after creating short term goals. Participants engaged in OT-led group sessions including didactic presentations of lifestyle practice, problem-solving strategies targeting barriers to identified goals, and engaged in group exercise and grocery purchasing activities [30].

The two studies about service delivery models were a prospective cohort study [28] and a systematic review [19]. The prospective cohort study followed individuals involved in a group and individual lifestyle modification program in a community health centre and over the phone for two years, led by a multidisciplinary team of PTs, physicians, nutritionists and health coaches in the United States. The systematic review by Rahmati and colleagues (2023) examined the effectiveness of a Community Aging in Place-Advancing Better Living for Elders (CAPABLE) program in seven studies. The CAPABLE program involved ten in-home sessions over six months and used psychosocial, behavioural, and biological factors that can impact overall health. Specifically, referenced program included an assessment, education, and a barrier to function identification process. OTs were involved in six sessions, while nurses were involved in four sessions. A program ‘handyman’ helped make home modifications based on the assessment findings and OTs recommendations [38]. In the systematic review, the included studies using the CAPABLE programs highlighted several hazard complaints of lower income individuals such as a lack of adaptive equipment, tripping hazards, clutter, and lighting [19].

Needs of the population.

Participants in the study by Ciro and Smith (2015) [29] expressed a desire to participate in meaningful activities such as socialization, and preferred information on chronic disease management.

Barriers and facilitators to implementation.

Across the studies, participants identified the following as environmental barriers to engaging in meaningful activities: intervention components not aligning with personal interests, low income, lack of awareness of available opportunities, lack of accessible transportation, functional limitations [29]. The studies also mentioned time-constraints and competing priorities as main reasons for attrition from interventions [28,30], and those with limited education and/or were immigrants cited cultural, financial, and education as barriers [28]. The studies also identified that availability of desired activities [29], group settings [30], and use of incentives [30] were facilitators to ongoing participation.

Effects on health outcomes.

There were no quantitative changes in any health outcomes for the intervention studies, but one study reported increased life satisfaction through developing better social skills, increased knowledge of nutrition, and improved interpersonal skills [27]. Another study reported increases in meaningful participation in activities [29]. For the service delivery models, the program by Gilstrap et al (2013) yielded several health benefits and behaviours such as reduction of metabolic syndrome prevalence, lower rates of hypertension, increases in HDL cholesterol and lower glycated hemoglobin, anxiety and depression levels [28]. The review by Rahmati et al (2023) [19] also found the CAPABLE programs led to reductions in home safety hazards because of the service, as well as improvement in ADLs, IADLs, depression, falls efficacy, pain, and quality of life.

Intervention characteristics.

Three studies [31–33], two single group pre-post studies [31,32] and one case series [33], used PT interventions to improve health outcomes for people who have experienced trauma or torture. Two studies [31,32] used body awareness therapy administered face-to-face by PTs once per week for fourteen to eighteen weeks. The intervention by Stade and colleagues (2015) focused on relaxation and free movement [32], while the body awareness therapy provided by Palic et al (2009) was in conjunction with coping education and psychological therapy using cognitive behavioural theory [31]. The psychological therapy specifically involved methods to treat panic attacks, trauma hierarchies, in vitro exposure (through memory), breathing exercises, and anxiety/fear coping strategies. Trauma therapy was also employed in this study using principles of stabilization, coming to terms with trauma, and integration of traumatic memories and grieving using Herman’s model. In the case study by Dibaj et al (2017) [33], participants received 20 sessions of Narrative Exposure Therapy (NET) which consisted of the participants identifying and labelling traumatic experiences in their lives during the first session. In subsequent sessions, participants and therapists read the life narratives and applied prolonged exposure therapy applied for traumatic memories. Participants also received ten individualized PT sessions lasting one hour each.

Needs of the population.

Stade et al (2015) [32] identified rehabilitation needs that may be culturally specific. They found that Arabic women in their study would feel uncomfortable in mixed-gender sessions and a need for an interpreter during the intervention period. Dibaj et al (2017) [33] found a need for family support during the program and assistance with current stressors.

Barriers and facilitators to implementation.

Participants and therapists in the case series identified lack of motivation, low physical functioning, and concomitant conditions (e.g., pain) that lead to social isolation as barriers to benefitting from the intervention [33]. Participants in the study by Stade and colleagues (2015) identified physical disability, social anxiety with group therapy, lack of accessible transportation, and memory impairment leading to transport difficulties as being barriers to program participation [32].

Effects on health outcomes.

Stade et al (2015) [32] identified statistically significant improvements in several health outcomes such as body awareness, somatization symptoms, self-reported disability post intervention. The interventions by Palic et al (2009) [31] resulted in reductions in post-traumatic stress disorder (PTSD) symptoms and other psychiatric symptoms, but no changes in cognitive function. In the case series by Dibaj et al (2017) [33], 50% of participants did not meet the clinical criteria for PTSD diagnosis by three months, and two participants achieved a clinically significant decrease in PTSD symptoms. Moreover, some participants were no longer diagnosed with depression at follow-up, or achieved clinically significant reductions in depressive symptoms or pain intensity.

Intervention characteristics.

Only one study [34] involved veterans who were hard-to-reach. Using a retrospective cohort design, PTs in the study delivered approximately fifteen virtual (74%) and face-to-face (26%) rehabilitation sessions over 100 days (approximately once per week) to veterans living in rural areas of the United States. The combination of in-person rehabilitation and telerehabilitation services included occupational, physical, and recreational therapies, psychological and nursing care from the patient’s home. Types of physical therapy provided included a general strengthening program, a lumbar and scapular stabilization program.

Effects on health outcomes.

While no specific needs, barriers or facilitators were highlighted, the program resulted in improved physical and cognitive function, health-related quality of life, functional independence, and participants were satisfied with the program.

Intervention characteristics.

The PTs in the RCT by Carr et al (2005) [18] delivered a one-hour physical fitness class (termed ‘Back to Fitness’) twice weekly for four weeks involving aerobic, resistance and flexibility exercises, in addition to relaxation techniques using a cognitive-behavioural approach. The control group received individualized therapy of variable frequency and duration according to the patients’ needs, at the discretion of the PT. In contrast, the intervention reported by Cook et al (2003) [36] provided individualized OT, expanded general practitioner services, and care management for up to twelve months in a primary care setting. The OT had many roles including assessments, treatment planning, activity selection (e.g., personal hygiene, budgeting, adult literacy), and skill development. Participants also received a psychological intervention which included supportive counselling and anxiety management. Finally, Morita and colleagues (2009) conducted a prospective survey of a rehabilitation service over nearly seven years, implemented in a rehabilitation-deficient area in Japan [35]. A multidisciplinary team of PTs, nurses, care managers and social workers provided home-visit rehabilitation to improve physical function, mobility, and housing environmental modifications.

Barriers and facilitators to implementation.

Cook et al (2003) [36] identified there was a high annual cost for the program due to continuation of referral and therapy, representing a potential barrier for individuals. There were no other needs, barriers and facilitators highlighted for clients in rehabilitation deficient areas.

Effects on health outcomes.

The RCT by Carr et al (2005) [18] found no significant differences in change scores between groups for quality of life, disability, and pain self-efficacy. However, the OT intervention by Cook et al (2003) resulted in greater social functioning and improvements in psychiatric symptoms including anxiety, depressed mood, incongruity, overactivity, and pressure of speech (i.e., symptoms of affect); incoherence or irrelevance (i.e., symptoms of schizophrenia). Moreover, there were significant improvements in most domains of the Health of the Nation Outcome Scale, except for the physical illness and disability, and non-accidental self-injury domains [36]. Finally, over a mean intervention period of approximately twelve months, Morita et al (2009) observed significant improvements in ADL disability compared to a reference group of people who did not receive rehabilitation [35].

Intervention characteristics.

Only one study [37] focused on individuals with drug or alcohol use disorders using a qualitative case series design. Ussher et al (2000) assessed the effectiveness of an OT-delivered physical activity intervention in a community-based alcohol service, with support from an exercise professional. The 6-week, face-to-face, group-based program aimed to promote independence, integration, education, and health among clients. Specifically, it involved twenty-five minutes exercise counselling, fifty minutes supervised exercise, fifteen minutes client feedback. Exercise counselling involved cognitive-behavioural techniques to promote exercise adherence. The intervention used goal setting, self-monitoring, decision-making, and relapse prevention techniques. Discussion topics included the role of exercise and lifestyle PA, importance of fitness for ADLs, associations between social PA and heavy social drinking, and motivation to a PA program.

Effects on health outcomes.

Ussher et al (2000) [37] found attending exercise classes resulted in reduced attendance due to problems at home or poor health. However, they also found a tailored home exercise program and support early in the program provided motivation to exercise. Increased confidence, positive conversations around exercise instead of drinking, and group discussions were also recognized facilitators. Although there were mixed attendance rates for the program, more than 50% of goal attainment was reported in 9 of 15 participant goals. There were general improvements in health and motivation, and positive attitudes towards the program.