Effect of Adjusting the Challenge-Skill Balance for Occupational Therapy in a Recovery Rehabilitation Unit: A Pilot Study

Abstract

The primary goal of occupational therapy is to enable people to participate in normal everyday activities. To understand and support a client's desired activities, it is necessary to share the meaning of occupation between the therapist and client. One concept that has been used to capture the psychological state for an activity is flow. Therefore, we devised a process of adjusting the challenge-skill balance for occupational therapy based on flow theory.

In this pilot study, we aimed to verify whether adjusting the challenge-skill balance for occupational therapy improved subjective quality of life in a recovery rehabilitation unit. To inform the future design of randomized controlled trials, we therefore compared standard occupational therapy with this new approach. Both interventions took place from recovery rehabilitation unit entry to discharge, and outcomes (continuous variables) were analyzed using a Bayesian approach explored with generalized linear mixed modeling.

Among a total of 22 patients, those receiving the new approach showed a significant improvement in Ikigai-9 (quality of life) compared with those receiving standard occupational therapy. The mean improvement was 4.44 ± 2.17 with a 95% credible interval of 0.104-8.713. The dependence factor, effective sample size, and autocorrelation time were 3.769, 8093, and 6.18, respectively. We conclude that adjusting the challenge-skill balance during occupational therapy could improve a client's subjective quality of life.