Assessment
Baseline
Post-intervention
Follow-up
Awareness questionnaire (AQ) a
Therapist rating
43
50
53
Participant rating
64
51
64
Discrepancy rating
21
1
11
Depression, anxiety and stress scale (DASS-21) b
Depression
2
1
0
Anxiety
2
0
2
Stress
1
2
0
c.
Internal and external environmental circumstances: As Linda was an inpatient, the intervention had to be conducted within the hospital environment not in a real-life environment. The occupational therapy kitchen was utilized to simulate a naturalistic environment for meal preparation. To increase the client-centeredness and meaningfulness of the activity, the therapist asked Linda to choose a meal from three options. She chose to prepare spaghetti bolognaise for dinner.
d.
Reasons for seeking occupational therapy consultation: Linda received occupational therapy as part of her multidisciplinary rehabilitation. She was invited and agreed to be involved in a clinical trial evaluating the effectiveness of feedback interventions (Schmidt et al. 2013). Linda was randomly allocated to the group that received a combination of video and verbal feedback.
e.
Occupational needs: Linda had goals to return home, be independent with daily tasks such as her self-care routine, prepare breakfast and lunch, and return to her recreation and leisure activities.
Questions Regarding Occupational Therapy Interventions
1.
What metacognitive techniques could the therapist use before, during, and after engagement in occupational performance to improve outcomes?
2.
What is the role of the OT in the intervention?
3.
How would you know if the intervention was effective?
4.
What alternative occupational therapy interventions are available?
Summary of the Results
The first step in the occupation-based metacognitive intervention involved Linda and her therapist establishing the steps and sequence of the task. A checklist of the steps was developed to provide a rating scale for self-evaluation. Linda then prepared the meal. The therapist provided appropriately timed prompts and feedback , using the “pause, prompt, praise” technique and videotaped Linda’s performance.
After each meal preparation session, Linda and the therapist independently rated her performance using the checklist they had developed. Then, Linda and the therapist watched the video of the meal preparation together. During the viewing, they identified errors or aspects of performance that could be improved on, effective use of compensatory strategies, and other areas of strength. They also discussed discrepancies in their ratings on the checklist.
Linda prepared the same meal and received feedback on four occasions over a 2-week period. The first time Linda made 34 errors that were corrected by the therapist. Errors included impaired judgment of when food was cooked, becoming distracted, inappropriate sequencing of steps, and impulsivity throughout the task. She took 40 min to prepare the meal and did not attempt to use any compensatory strategies. In subsequent sessions, the number of errors reduced to six errors during the last session (Fig. 30.1). She independently initiated effective strategies, which included marking which steps were completed, pausing prior to completing a step, and using self-talk. Her time use was more efficient, taking 25 min.
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