Occupational Therapy Interventions Supporting SocialParticipation and Leisure Engagement for Community-Dwelling Older Adults: A Systematic Review

Stacy Smallfield, Whitney Lucas Molitor

Stacy Smallfield, DrOT, OTR/L, BCG, FAOTA, is

Associate Professor of Occupational Therapy and

Medicine and Assistant Director, Occupational Therapy

Entry-Level Professional Programs, Washington

University School of Medicine, St. Louis, MO;

stacy.smallfield@wustl.edu

Whitney Lucas Molitor, OTD, OTR/L, BCG, is

Assistant Professor, Department of Occupational Therapy,

University of South Dakota, Vermillion.

This systematic review examines the evidence for the effectiveness of interventions within the scope of oc-

cupational therapy that address leisure engagement and social participation among community-dwelling

older adults. Eleven Level I, 1 Level II, 1 Level III, and 1 Level IV studies met inclusion criteria. Included

articles addressed two themes: interventions supporting social participation and interventions supporting

leisure engagement. Strong evidence supports leisure education interventions to enhance leisure engage-

ment, and moderate evidence supports chronic disease self-management programs to support leisure en-

gagement. Mixed evidence exists for community-based group interventions and electronic gaming to support

social participation. Routine use of leisure education and chronic disease self-management programs to

enhance leisure engagement and selective use of community-based groups and electronic gaming to support

social participation are recommended.

Smallfield, S., & Lucas Molitor, W. (2018). Occupational therapy interventions supporting social participation and leisure

engagement for community-dwelling older adults: A systematic review. American Journal of Occupational Therapy,

72, 7204190020. https://doi.org/10.5014/ajot.2018.030627

Within 30 yr, the population of older adults residing in the United States is

expected to reach nearly 84 million (Ortman, Velkoff, & Hogan, 2014).

Researchers estimate that 35% of U.S. adults over age 45 are lonely (Wilson &

Moulton, 2010). As a population, older adults may experience greater social

isolation because they are more likely to live alone, have a chronic illness, lose a

significant other, experience transportation or mobility difficulties, have low

income, and experience declines in muscle strength (Kharicha et al., 2007;

Nicholson, 2009; Wilson & Moulton, 2010).

Older adults who experience loneliness or social isolation have an increased

risk of other physical and mental health issues, such as disease, falls, depression,

poor nutrition, rehospitalization, cognitive decline, heavy alcohol consumption,

high systolic blood pressure, infection, and mortality (Coyle & Dugan, 2012;

Lillyman & Land, 2007; Nicholson, 2009; Wilson & Moulton, 2010).

Loneliness and social isolation can undermine well-being by leading to feelings

of stress and can influence physical, emotional, and psychological health (Coyle

& Dugan, 2012; Shankar, McMunn, Banks, & Steptoe, 2011; Wilson &

Moulton, 2010). Because health and wellness risks are associated with social

isolation and loneliness in older adults, mitigating these health risks may im-

prove not only mental health but also physical health and quality of life (QOL)

in this population.

Maintaining social participation and leisure engagement throughout the

lifespan is important for enhanced well-being and health (Chang, Wray, & Lin,

2014; Doble & Santha, 2008). Because leisure pursuits often stem from en-

gagement in meaningful occupations identified earlier in life, ensuring that

7204190020p1 July/August 2018, Volume 72, Number 4

clients maintain this participation while considering new

interests is important (Agahi, Ahacic, & Parker, 2006).

Social and leisure interests are often interrelated, leading

to improvements in both areas even when addressing only

one. Leisure participation has been shown to decrease

stress, improve psychosocial well-being, and provide

meaning in daily occupations (Carruthers & Hood,

2004). Similarly, enhanced social participation and a

strong social network have positive implications for en-

gagement in leisure and enrichment in life (Carruthers &

Hood, 2004). Embracing the use of occupation-based

interventions aimed at health promotion through social-

ization can decrease health disparities, improve overall

health, and enhance QOL (American Occupational Ther-

apy Association [AOTA], 2013, 2014).

Participation in social and leisure activities is critical

to health and well-being (Chang et al., 2014; Doble &

Santha, 2008). Older adults, who naturally experience

many losses during older adulthood, may benefit from

interventions designed to promote engagement in social

and leisure activities. Encouraging active participation in

social and leisure activities that require cognitive, physi-

cal, intellectual, or social skills has been shown to decrease

cognitive decline and promote physical health (Karp

et al., 2006; Wang, Karp, Winblad, & Fratiglioni, 2002).

The purpose of this systematic review was to identify and

examine the evidence supporting the role of occupational

therapy in promoting social participation and leisure

engagement for community-dwelling older adults.

Method

This systematic review was one of six reviews on pro-

ductive aging supported by the AOTA Evidence-Based

Practice (EBP) Project. The method for the reviews was

specified in advance and documented in a protocol for

review authors.

Search Strategy

Search terms for the review were developed by the

methodology consultant to the EBP Project and AOTA

staff, in consultation with the review authors for each

question, and by an advisory group consisting of expert

occupational therapy practitioners and researchers in the

area of aging. The search terms were developed not only to

capture pertinent records but also to ensure that the terms

relevant to the specific thesaurus of each database were

included. Supplemental Table 1 (available online at

http://otjournal.net; navigate to this article, and click on

“Supplemental”) lists the search terms related to the

population (community-dwelling older adults), inter-

ventions, and study designs included in this systematic

review.

A medical research librarian with experience in

completing systematic review searches conducted the

search and confirmed and improved the search strategies in

the following databases: Cochrane Database of Systematic

Reviews, CINAHL, Medline, OTseeker, and PsycINFO.

The methodology consultant for the EBP Project did the

first review of the search results (citations), eliminating all

records not relevant to the review scope. The review au-

thors examined reference lists in the articles for potential

studies and hand searched selected journals to ensure all

appropriate articles were included.

Eligibility Criteria

Several inclusion and exclusion criteria provided the

structure for the quality, type, and years of publication of

the literature incorporated into the review. This review

included peer-reviewed scientific literature published in

English between 1995 and 2015. The intervention ap-

proaches examined were within the scope of practice of

occupational therapy for older adults with an average age

³65 living in the community, a retirement home, or an

assisted living facility or in a rehabilitation, subacute, or

hospital setting if they were being discharged to home.

Studies were also included if participants were older

adults with diabetes, arthritis, cardiac disease, or other

chronic conditions, including mild cognitive impairment

and mild Alzheimer’s disease.

The review excluded data from presentations, confer-

ence proceedings, non–peer-reviewed research literature,

dissertations, and theses. Studies were excluded if the aver-

age age of participants was <65 or if participants were living

in a skilled nursing facility or were in the hospital but not

being discharged to home. Additionally, studies were ex-

cluded if they were in an AOTA Practice Guideline and

included participants with acute or chronic conditions, such

as stroke or moderate or severe Alzheimer’s disease. Studies

without outcomes related to social participation or leisure

engagement were also excluded from this review.

AOTA uses standards of evidence modeled on those

developed in evidence-based medicine (Sackett, Rosenberg,

Gray, Haynes, & Richardson, 1996). Records included in

the review were rated as follows:

• Level I—meta-analyses, systematic reviews, and ran-

domized controlled trials (RCTs)

• Level II—two-group nonrandomized studies (e.g., co-

hort, case-control)

• Level III—one-group nonrandomized studies (e.g.,

before and after, pretest–posttest)

The American Journal of Occupational Therapy 7204190020p2

• Level IV—descriptive studies (single-subject design, case

series)

• Level V—case reports and expert opinions that include

narrative literature reviews and consensus statements.

Studies included in this review provide Level I, II,

or III evidence. Level IV evidence was included only

when higher levels of evidence in a given theme were not

available. No Level V evidence was included in the

review.

Data Extraction

The review authors worked collaboratively to evaluate all

articles throughout the entire review process. The authors

conducted the initial review individually. Collaborative

discussion was used to reach a consensus on all articles and

to resolve any disagreement. Each article included in the

review was summarized in an evidence table (Supplemental

Table 2, online). The studies were categorized into themes

and subthemes. The AOTA EBP Project methodology

consultant reviewed the evidence table for quality control.

Risk of Bias

Each article was individually assessed for risk of selection

bias, performance bias, detection bias, attrition bias, and

reporting bias on a scale of low, high, or unclear, as de-

scribed in the Cochrane risk of bias guideless (Higgins,

Altman, & Sterne, 2011). During the rating process, both

authors worked collaboratively to reach consensus in each

category of bias. Supplemental Table 3 (online) displays

the risk of bias for all studies included in this review.

Analysis

Each theme was analyzed for strength of evidence to assist

in determining final recommendations for occupational

therapy education, research, and practice. Analysis of

study design, findings, and risk of bias determined

strength of evidence designations. Number of studies and

the strength of evidence they provided were determined in

accordance with the U.S. Preventive Services Task Force

(2014) recommendations, as follows:

• Strong evidence indicates consistent results from well-

conducted studies, usually at least two RCTs.

• Moderate evidence indicates one RCT or two or more

studies with lower levels of evidence. Some inconsis-

tency of findings across individual well-conducted stud-

ies could preclude a classification of strong evidence and

result in a designation of moderate evidence.

• Limited evidence indicates few studies, flaws in the

available studies, and some inconsistency in findings

across individual studies.

• Mixed evidence indicates that the findings were incon-sistent across studies in a given category.

• Insufficient evidence indicates that the number and

quality of studies are too limited to make any clear

recommendation.

Results

Figure 1 is a flow diagram of record selection. The review

team identified 14 articles for inclusion in the final

qualitative synthesis. The articles addressed two themes: (1)

interventions supporting social participation (7 studies) and

(2) interventions supporting leisure engagement (7 studies).

For the theme of social participation, 5 Level I studies,

1 Level II study, and 1 Level III study were identified. For

the theme of leisure engagement, 5 Level I studies reported

in 6 articles and 1 Level IV study were identified.

Outcome Measures

Outcome measures used in the studies were varied. For the

theme of social participation, measurement tools included

primarily self-report measures of social and activity par-

ticipation, health (e.g., SF–12 and SF–36; RAND, 1994–

2018), loneliness (UCLA Loneliness Scale; Russell, 1996),

and depression (Geriatric Depression Scale; Yesavage et al.,

1982–1983). For the theme of leisure engagement, outcome

measures included self-reports of frequency of activity

participation, performance of occupations including lei-

sure activities, leisure competence and engagement, and

life satisfaction.

Interventions Addressing Social Participation

Seven articles included in this review addressed the effec-

tiveness of interventions within the scope of occupational

therapy to promote social participation in community-

dwelling older adults. Five articles provided Level I evidence

(Creswell et al., 2012; Dickens et al., 2011; Kahlbaugh,

Sperandio, Carlson, & Hauselt, 2011; Ollonqvist et al.,

2008; Routasalo, Tilvis, Kautiainen, & Pitkala, 2009),

1 article provided Level II evidence (Bell et al., 2011), and

1 article provided Level III evidence (Matuska, Giles-Heinz,

Flinn, Neighbor, & Bass-Haugen, 2003). Three main in-

tervention approaches—community-based group interven-

tions, community mentoring, and electronic gaming—were

identified.

Community-Based Group Interventions. Four studies

used a community-based group model of intervention

either as part of a multicomponent intervention or as a

single-component intervention (Creswell et al., 2012;

Matuska et al., 2003; Ollonqvist et al., 2008; Routasalo

et al., 2009). Group sessions were usually held weekly,

7204190020p3 July/August 2018, Volume 72, Number 4

and programs lasted from 8 wk to 6 mo. In a Level III

study, Matuska et al. (2003) found that group sessions

run by occupational therapists resulted in increased social

and community participation and significant differences

in posttest scores on social functioning. However, in a

Level I study, Routasalo et al. (2009) studied the effect of

3-mo psychosocial groups on the outcomes of loneliness

and social networking. Participants were assigned on the

basis of interest to one of three weekly groups: art or

other creative activities, group exercise and discussions,

or therapeutic writing and group therapy. Intervention

participants reported significant increases in number of

new friends but nonsignificant differences in loneliness or

social networking compared with control participants.

Creswell et al. (2012, Level I) studied an 8-wk stress

reduction program and found a significant decline in

loneliness. Finally, Ollonqvist et al. (2008, Level I) ex-

amined the effectiveness of intensive multidisciplinary

group rehabilitation for frail older adults but found no

significant difference between groups on the outcome of

loneliness. In combination, the 3 Level I studies and 1

Level III study provide mixed evidence for the use of

community-based group interventions to improve social

participation among community-dwelling older adults.

Community Mentoring. One study used a community

mentoring model of intervention (Dickens et al., 2011,

Level I). Older adults received up to 12 wk of mentoring

in self-confidence and engagement in personally mean-

ingful social activities. However, no improvements in the

outcomes of social activity or social support resulted from

the mentoring relationships. Thus, this study provides

moderate evidence against the use of a community

mentorship approach to promote social activity and

support.

Iden

tific

atio

nSc

reen

ing

Elig

ibili

tyIn

clud

ed

Records identified throughdatabase search

(N = 1,895)

Additional records identifiedthrough hand searching

(n = 265)

Records screened(n = 1,868)

Records excluded(n = 288)

Records included in systematicreview

(n = 14)

Full-text records assessed foreligibility(n = 302)

Records after duplicatesremoved

(n = 1,603)

Social participation (n = 7) Leisure engagement (n = 7)

Figure 1. Flow diagram for studies included in the systematic review.Figure format from “Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement,” by D. Moher, A. Liberati, J. Tetzlaff, & D. G.Altman; PRISMA Group, 2009, PLoS Med, 6(6), e1000097. https://doi.org/10.1371/journal.pmed.1000097

The American Journal of Occupational Therapy 7204190020p4

Electronic Gaming. Two studies used an electronic

gaming intervention to address social participation (Bell

et al., 2011; Kahlbaugh et al., 2011). In a small Level I

study, Kahlbaugh et al. (2011) examined the use of a

Nintendo Wii game with another person once per week

for 10 wk. This intervention decreased social isolation

and loneliness for the intervention group compared with

the control group, who watched television with another

person. In a Level II study, Bell et al. (2011) investigated

the effect of Nintendo Wii games with and without fall

prevention education over an 8-wk period on the out-

comes of social relationships and social support. They

found no significant differences between the intervention

and control groups. Therefore, these studies provide

mixed evidence for the use of electronic gaming to pro-

mote social participation.

Interventions for Leisure Engagement

Five Level I studies reported in six articles (Chang, 2014;

Garvey, Connolly, Boland, & Smith, 2015; Janssen,

2004; Searle, Mahon, Iso-Ahola, Sdrolias, & Van Dyck,

1995, 1998; Zingmark, Fisher, Rocklov, & Nilsson, 2014)

and 1 Level IV study (Schweitzer, Mann, Nochajski, &

Tomita, 1999) provide evidence for the role of occupational

therapy in supporting leisure engagement of community-

dwelling older adults. Three intervention types—leisure

education, self-management of chronic disease, and assis-

tive devices—were identified.

Leisure Education. Four Level I studies reported in five

articles used leisure education as the intervention (Chang,

2014; Janssen, 2004; Searle et al., 1995, 1998; Zingmark

et al., 2014). Janssen (2004) examined a 6-wk group

educational program that focused on leisure appreciation,

awareness, self-determination, and decision making re-

lated to leisure choices and found significant increases on

leisure domains of QOL compared with control partici-

pants. In a small RCT, Searle et al. (1995, 1998) ex-

amined a modified form of a community reintegration

program that included 12 individualized sessions con-

sisting of discussion, paper-and-pencil tasks, role-playing,

and recreational activities over approximately 17 wk. This

leisure education program led to significant increases in

perceived leisure control, leisure competence, and leisure

boredom compared with a control group (Searle et al.,

1995) that were maintained at follow-up (Searle et al.,

1998). However, immediate between-group differences

in life satisfaction were not maintained at follow-up.

Building on the work of Searle et al. (1995, 1998),

Chang (2014) investigated the effect of a similar 12-wk

leisure education program addressing leisure competence

(e.g., perceptions, capacity, behaviors) delivered 2·/wkfor 3 mo on the outcomes of leisure competence and

capacity and found improved competence among the

intervention group compared with the control group.

Finally, Zingmark et al. (2014) used a four-arm RCT to

compare one-to-one, client-centered intervention focused

on occupational engagement with a group activity in-

tervention, a discussion group intervention, and no in-

tervention. All groups declined in participation over time;

however, leisure participation declined slightly less among

intervention group participants, with the one-to-one in-

tervention group showing the highest rate of continued

leisure engagement. In general, although the dosage and

content of the programs varied, strong evidence supports

use of leisure education programs in occupational therapy

interventions targeting engagement in leisure activities for

community-dwelling older adults.

Self-Management of Chronic Disease. Garvey et al.

(2015, Level I) reported on the use of a 6-wk chronic

disease self-management program to enhance leisure

participation among older adults with multiple chronic

conditions. Goal setting, self-management of chronic

conditions, and peer support were introduced in weekly

meetings that had an occupational therapy emphasis.

This intervention led to an increase in activity frequency

compared with a control group and improved self-

perception of activity performance and satisfaction. This

study provides moderate evidence supporting the use of

chronic disease self-management programs to address the

outcome of leisure activity engagement.

Assistive Devices. One Level IV study examined

assistive device use in relation to leisure participation

among community-dwelling older adults with physi-

cal disabilities that limited home-based leisure activities

(Schweitzer et al., 1999). Participants’ home setup, assis-

tive device use, and barriers to leisure participation were

reviewed in structured interviews. Then, an appropriate

assistive device was provided to each participant to en-

courage participation in a personally meaningful leisure

activity. Provision of assistive devices led to an increased

likelihood of attempting leisure pursuits. Because only one

low-level study addressed this subtheme, insufficient evi-

dence supports the use of assistive devices to increase

home-based leisure engagement for community-dwelling

older adults.

Discussion

This systematic review examined the effectiveness of in-

terventions within the scope of occupational therapy to

promote leisure engagement and social participation

7204190020p5 July/August 2018, Volume 72, Number 4

among community-dwelling older adults. Results provide

strong evidence for the use of leisure education programs

and moderate evidence for the use of chronic disease self-

management programs to enhance leisure engagement of

community-dwelling older adults with chronic health

conditions. These interventions should be offered rou-

tinely to clients in this population who present with de-

creased participation in leisure activities. Additionally,

mixed evidence was found for community-based group

interventions and electronic gaming interventions to

improve social participation outcomes; therefore, occu-

pational therapy practitioners should consider these in-

terventions on a case-by-case basis.

Implications for OccupationalTherapy Education

The role of occupational therapy in community-based

practice is expected to rise to meet the challenge of caring

for the growing number of older adults in an ever-changing

health care environment (Lamb & Metzler, 2014). Pre-

paring future occupational therapy practitioners to meet the

needs of older adults living in the community, including

social participation and leisure engagement, should be a

focus of occupational therapy educational programs. Cur-

ricula should include the following:

• Education regarding the relationship between leisure

and social participation and physical, cognitive, and

emotional health and well-being

• Education about health conditions and contextual factors

that influence participation in social and leisure activities

• Training in the use of formal and informal assessments

of leisure and social participation

• Knowledge and skill training in the delivery of effec-

tive interventions for social and leisure participation,

including leisure education and electronic gaming.

Implications for OccupationalTherapy Research

Occupational therapy has the potential to play a significant

role in supporting social participation and leisure en-

gagement among community-dwelling older adults. Oc-

cupational therapy researchers need to continue to develop

and examine interventions for enhancing these occupa-

tions. Further research regarding interventions that im-

prove social and leisure participation will be critical to

supporting occupational therapy practitioners in this area

of practice. Recommendations for strengthening research

in this area include the following:

• Use of occupational therapy practitioners as study

interventionists

• Improvement in the consistency of interventions in-

cluded in multicomponent interventions

• Evaluation of intervention dosages (frequency and du-

ration of intervention) needed for efficacy

• Increased consistency in outcome measures used to

demonstrate intervention effectiveness

• Review of differences in leisure engagement and social

participation among older adults residing in assisted

living facilities versus those living at home.

Increased quantity and quality of evidence-based inter-

ventions that promote social participation and leisure en-

gagement will guide practitioners in providing best practice

to community-dwelling older adults.

Implications for OccupationalTherapy Practice

On the basis of the results of this review, the following

interventions are recommended as part of routine occu-

pational therapy services to community-dwelling older

adults at risk of a decline in social participation and leisure

engagement:

• Leisure education programs to enhance leisure

participation

• Chronic disease self-management programs to im-

prove leisure participation among those with chronic

conditions.

The following interventions should be offered selec-

tively on the basis of individual client characteristics and

intervention context:

• Community-based group interventions to support so-

cial participation

• Electronic gaming to enhance social participation.

The following intervention requires further research:

• Assistive devices to promote home-based leisure par-

ticipation for clients with physical disabilities.

Limitations

Although a growing body of literature supports inter-

ventions within the scope of occupational therapy practice

to promote social participation and leisure engagement in

community-dwelling older adults, the available research

has several limitations. First, the majority of outcome

measures used to collect information on social partici-

pation and leisure engagement were self-report measures,

which introduce recall bias. Second, interventions, in-

tervention dosages, and outcome tools varied across studies,

limiting the extent to which the data could be synthesized.

The American Journal of Occupational Therapy 7204190020p6

Third, several included RCTs had small sample sizes. Last,

several subthemes did not have enough studies to provide

sufficient evidence. Finally, although the interventions de-

scribed were within the scope of occupational therapy

practice, in the majority of studies, the interventionists were

not occupational therapy practitioners. Future research

addressing these gaps will strengthen the evidence sup-

porting interventions in this area of practice.

Conclusion

Older adults may experience increased social isolation

because of the natural losses that occur in this phase of life.

Those who experience loneliness and social isolation have

an increased risk of other physical and mental health is-

sues. Interventions that support social participation and

leisure engagement may mitigate social isolation and

loneliness and improve well-being. Strong evidence sup-

ports leisure education programs and moderate evidence

supports chronic disease self-management programs to

enhance leisure engagement. Mixed evidence exists for

community-based group programs and electronic gaming

interventions to promote social participation.

Occupational therapy practitioners know the value of

engaging in meaningful activity in all stages of life and

understand the effect of social participation and leisure

engagement on older adults’ health and well-being.

Practitioners working with community-dwelling older

adults are strongly encouraged to integrate effective in-

terventions for social and leisure occupations into routine

care for this population. s

Acknowledgments

We thank Deborah Lieberman, Marian Arbesman, and

Beth Hunter for their guidance and support on this

project. We also acknowledge Kaitlin LaPlant, who assisted

with minor editing. An earlier version of this article was

presented at the 2017 AOTA Conference & Expo in

Philadelphia.

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Lillyman, S., & Land, L. (2007). Fear of social isolation:Results of a survey of older adults in Gloucestershire.Nursing Older People, 19, 26–28. https://doi.org/10.7748/nop2007.12.19.10.26.c8245

pMatuska, K., Giles-Heinz, A., Flinn, N., Neighbor, M., &Bass-Haugen, J. (2003). Brief Report—Outcomes of apilot occupational therapy wellness program for olderadults. American Journal of Occupational Therapy, 57,220–224. https://doi.org/10.5014/ajot.57.2.220

Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G.; PRISMAGroup. (2009). Preferred Reporting Items for SystematicReviews and Meta-Analyses: The PRISMA statement. PLoSMedicine, 6(6), e1000097. https://doi.org/10.1371/journal.pmed.1000097

Nicholson, N. R., Jr. (2009). Social isolation in older adults:An evolutionary concept analysis. Journal of AdvancedNursing, 65, 1342–1352. https://doi.org/10.1111/j.1365-2648.2008.04959.x

pOllonqvist, K., Palkeinen, H., Aaltonen, T., Pohjolainen, T.,Puukka, P., Hinkka, K., & Pontinen, S. (2008). Alleviat-ing loneliness among frail older people—Findings from arandomised controlled trial. International Journal of MentalHealth Promotion, 10(2), 26–34. https://doi.org/10.1080/14623730.2008.9721760

Ortman, J. M., Velkoff, V. A., & Hogan, H. (2014). An agingnation: The older population in the United States. Retrievedfrom https://www.census.gov/content/dam/Census/library/publications/2014/demo/p25-1140.pdf

RAND. (1994–2018). 36-Item Short Form Survey (SF-36). Re-trieved from https://www.rand.org/health/surveys_tools/mos/36-item-short-form.html

pRoutasalo, P. E., Tilvis, R. S., Kautiainen, H., & Pitkala,K. H. (2009). Effects of psychosocial group rehabilitationon social functioning, loneliness and well-being of lonely,older people: Randomized controlled trial. Journal of Ad-

vanced Nursing, 65, 297–305. https://doi.org/10.1111/j.1365-2648.2008.04837.x

Russell, D. W. (1996). UCLA Loneliness Scale (Version 3):Reliability, validity, and factor structure. Journal ofPersonality Assessment, 66, 20–40. https://doi.org/10.1207/s15327752jpa6601_2

Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B.,& Richardson, W. S. (1996). Evidence based medicine:What it is and what it isn’t. BMJ, 312, 71–72. https://doi.org/10.1136/bmj.312.7023.71

pSchweitzer, J. A., Mann, W. C., Nochajski, S., & Tomita, M.(1999). Patterns of engagement in leisure activity by olderadults using assistive devices. Technology and Disability,11, 103–117.

pSearle, M. S., Mahon, M. J., Iso-Ahola, S. E., Sdrolias, H. A.,& Van Dyck, J. (1995). Enhancing a sense of indepen-dence and psychological well-being among the elderly: Afield experiment. Journal of Leisure Research, 27, 107–124.https://doi.org/10.1080/00222216.1995.11949737

pSearle, M. S., Mahon, M. J., Iso-Ahola, S. E., Sdrolias, H. A.,& Van Dyck, J. (1998). Examining the long term effectsof leisure education on a sense of independence and psy-chological well-being among the elderly. Journal of Lei-sure Research, 30, 331–340. https://doi.org/10.1080/00222216.1998.11949836

Shankar, A., McMunn, A., Banks, J., & Steptoe, A. (2011).Loneliness, social isolation, and behavioral and biologicalhealth indicators in older adults. Health Psychology, 30,377–385. https://doi.org/10.1037/a0022826

U.S. Preventive Services Task Force. (2014). Grade definitions.Retrieved from http://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions

Wang, H. X., Karp, A., Winblad, B., & Fratiglioni, L. (2002).Late-life engagement in social and leisure activities is as-sociated with a decreased risk of dementia: A longitudinalstudy from the Kungsholmen project. American Journal ofEpidemiology, 155, 1081–1087. https://doi.org/10.1093/aje/155.12.1081

Wilson, C., & Moulton, B. (2010). Loneliness among olderadults: A national survey of adults 451. Washington,DC: AARP. Retrieved from https://assets.aarp.org/rgcenter/general/loneliness_2010.pdf

Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V.,Adey, M., & Leirer, V. O. (1982–1983). Developmentand validation of a geriatric depression screening scale: Apreliminary report. Journal of Psychiatric Research, 17,37–49. https://doi.org/10.1016/0022-3956(82)90033-4

pZingmark, M., Fisher, A. G., Rocklov, J., & Nilsson, I.(2014). Occupation-focused interventions for well olderpeople: An exploratory randomized controlled trial. Scan-dinavian Journal of Occupational Therapy, 21, 447–457.https://doi.org/10.3109/11038128.2014.927919

The American Journal of Occupational Therapy 7204190020p8

Supplemental Table 1. Search Terms for the Systematic Review of Interventions Supporting Social Participation and Leisure Engagementfor Community-Dwelling Older Adults

Category Key Search Terms

Population aged (80 and over), aged (includes ages 80 and over and frail elderly), aging, elderly, geriatrics, gerontology, late life, older adults,oldest old, pensioner, seniors, 651, young old

Rehabilitation information occupational therapy, rehabilitation, recreation therapy

Intervention: socialparticipation andleisure engagement

activity participation, civic engagement, civic participation, computer application, computer tablet, computer tablet technology,computer use, clubs, community service, crafts, creative aging, elder hostel, family relations, friends, friendships, games, hobbies,hobby, interpersonal relations, leisure, leisure activities, leisure exploration, leisure participation, mobile application, mobiledevice, mobile phone, neighbor relations, peer, personal support, reading, recreation, relationships, retirement, retirementplanning, retirement preparation, road scholar, senior center, senior games, senior groups, smartphone use, social activity, socialadjustment, social capital, social environment, social interaction, social isolation, socialization, socializing, social participation,social skills, social support, sports, tablet technology, third age, travel, vital aging, vitality

Study and trial designs appraisal, best practices, case control, case report, case series, clinical guidelines, clinical trial, cohort, comparative study,consensus development conferences, controlled clinical trial, critique, cross over, cross-sectional, double-blind, epidemiology,evaluation study, evidence-based, evidence synthesis, feasibility study, follow-up, health technology assessment, intervention,longitudinal, main outcome measure, meta-analysis, multicenter study, observational study, outcome and process assessment,pilot, practice guidelines, prospective, random allocation, randomized controlled trials, retrospective, sampling, scientific integrityreview, single subject design, standard of care, systematic literature review, systematic review, treatment outcome, validationstudy

This table is a product of AOTA’s Evidence-Based Practice Project and the American Journal of Occupational Therapy. Copyright © 2018 by the AmericanOccupational Therapy Association. It may be freely reproduced for personal use in clinical or educational settings as long as the source is cited. All other usesrequire written permission from the American Occupational Therapy Association. To apply, visit www.copyright.com.

Suggested citation: Smallfield, S., & Lucas Molitor, W. (2018). Occupational therapy interventions supporting social participation and leisure engagement forcommunity-dwelling older adults: A systematic review (Suppl. Table 1). American Journal of Occupational Therapy, 72, 7204190020. https://doi.org/10.5014/ajot.2018.030627

The American Journal of Occupational Therapy, July/August 2018, Volume 72, Number 4 1

Sup

plem

entalTa

ble2.Eviden

ceTa

blefortheSystematic

Reviewof

Interven

tion

sSup

portingSocialParticipa

tion

andLe

isureEn

gage

men

tforCom

mun

ity-Dwelling

Older

Adu

lts

Author/Year

Levelof

Evidence/Study

Design/Participants/Inclusion

Criteria

InterventionandControl

Groups

OutcomeMeasures

Results

Interven

tion

sforSocialParticipa

tion

Com

munity-Based

Group

Interven

tions

Cresw

ellet

al.(201

2)

https://doi.org/10.1016

/j.bb

i.2012.07

.006

LevelI

2-arm

RCT

N5

40(M

age5

65yr).

Interventiongrou

p,n5

20(M

age5

64.35yr).

Control

grou

p,n5

20(M

age5

65.16yr).

Inclusioncriteria:

English-speaking

;no

tpracticingany

mind–bo

dytherapiesmorethan

1·/wk;no

nsmoker;in

good

health

forpast

3mo;

nottaking

medications

that

affect

immune,

cardiovascular,endocrine,

orpsychiatricfunctioning

Intervention

Mindfulness-Based

StressReductionmanualized

prog

ram,consistingof

8weekly2-hr

grou

psessions

11-dayretreatin

Week6or

71

30min

ofdaily

homemindfulness

practice6days/wk

Con

trol

Waitlist

•KentuckyInventoryof

Mindfulness

Skills

•UCLA

LonelinessScale

Theinterventiongrou

pshow

edsign

ificant

declines

inlonelinesscomparedwith

the

controlgrou

p.

Matuska,Giles-Heinz,Flinn,

Neighbor,&Bass-Haugen

(200

3)

https://doi.org/10.5014

/ajot.57.2.22

0

LevelIII

1-grou

ppretest–po

sttest

N5

65(age

range5

70–92yr).

N5

39with

completepretestandpo

sttest

data

(95%

female).

Inclusioncriteria:

Age

³65yr,from

1of

3Midwestern

senior

apartm

entbu

ildings

andnearby

homes

inurban

andsubu

rban

communities

Intervention

Designing

aLife

ofWellnessprog

ram,consistingof

weekly1.5-hr

educationalclassestaught

byoccupationaltherapyprofession

alsfor6mo.

The

program

focusedon

participationin

meaningful

occupations

toimprovequ

ality

oflifeandstrategies

toremoveperson

alandenvironm

entalbarriers

toparticipation.

Weeklytopics

included

transportation,

aging,

safety,fallprevention,stress,lifestylebalance,

andcommun

ication.

Con

trol

Nocontrol

•SF–36

•Frequencyof

socialand

commun

ityparticipation

from

aprog

ram-specific

intake

form

SF–36

Vitality,SocialFun

ctioning

,and

Mental

Health

scores

improved

significantly.

Medium

effect

sizeswerefoundforSF–36

PhysicalRoleFunction,

GeneralHealth,

Vitality,SocialFunction,

Role–Em

otional,and

MentalHealth

Sum

maryscores.

Theaveragenumberof

participants

who

participated

insocialor

community

activities

increasedfrom

56%

to66

%.

Ollonq

vist

etal.(200

8)

https://doi.org/10.1080

/14

6237

30.2008.9721

760

LevelI

2-arm

RCT

N5

708(M

age5

78yr,agerange5

65–96yr).

Interventiongroup,n5

365(M

age5

78.1yr±6.6).

Control

grou

p,n5

343(M

age5

78.6

yr±6.6).

Inclusioncriteria:Age

>65yr,livingathomeinFinland,at

riskof

institutionalizationbecauseof

decreasing

functional

capacity,need

forassistance,disabilityor

frailty

Intervention

3periodsof

multiprofessionalinpatient

rehabilitation

design

edforfrailolderadults

that

includ

edinpatient

grou

pph

ysical

activity,grou

pdiscussion

son

topics

includingproblemsfacing

olderadults,self-care,

counseling,

medicalcare,socialservices

and

recreation

Con

trol

Normalroutine

•Lo

neliness

questionn

aire

•GeriatricDepression

Scale

Nosignificant

difference

betweengrou

pswas

foundin

change

inloneliness;

therewas

a0.9-fold

decrease

inlonelinessin

the

interventiongrou

panda1.1-fold

increase

inlonelinessin

thecontrolgrou

p.

No.

offriendsdecreasedin

both

groups

throughout

thestudy;

poor

subjectivehealth

anddepressive

moodweremoreprevalentin

thecontrolgroup.

Theph

ysicalrehabilitationprog

ram

may

have

redu

cedem

otionalloneliness.

(Con

tinued)

The American Journal of Occupational Therapy, July/August 2018, Volume 72, Number 4 2

Sup

plem

entalTa

ble2.

Eviden

ceTa

blefortheSystematic

Reviewof

Interven

tion

sSup

portingSocialParticipa

tion

andLe

isureEn

gage

men

tforCom

mun

ity-Dwelling

Older

Adu

lts(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants/Inclusion

Criteria

InterventionandControl

Groups

OutcomeMeasures

Results

Routasalo,Tilvis,Kautiainen,

&Pitkala(200

9)

https://doi.org/10.1111

/j.136

5-26

48.200

8.0483

7.x

LevelI

2-arm

RCT

N5

235.

Interventiongrou

p,n5

117(M

age5

80yr).

Control

grou

p,n5

118(M

age5

80yr).

Inclusioncriteria:

Age

³75yr,subjectivefeelings

ofloneliness,

willingnessto

participate,

community

dwellingin

6commun

ities

inFinland

Intervention

Psychosocialgrouprehabilitation1·

/wkfor3mo.

Groupsconsistedof

7–8participants

andwere

closed

tonewmem

bers.Group

meetings

weregoal

oriented,activities

includ

edartandinspiring

activities,groupexercise

anddiscussions,

ortherapeutic

writingandgrouptherapyaccordingto

participantinterest.

Con

trol

Usualcare

•UCLA

LonelinessScale

•Lu

bben’sSocial

NetworkScale

•Psychologicalwell-

beingchartedusinga

6-dimensional

questionn

aire

Asign

ificantlylarger

prop

ortionof

the

interventiongrou

phadfoun

dnewfriend

sdu

ring

thefollow-upyear.40

%of

the

interventiongrou

pcontinuedtheirgrou

pmeetings

for1yr.

Nodifferencesbetweengrou

pswerefoun

din

lonelinessor

socialnetworks.

Theinterventiongrou

pshow

edsign

ificant

improvem

entin

psychologicalwell-being

scorecomparedwith

thecontrol

grou

p.Com

munityMen

toring

Dickens

etal.(2011)

https://doi.org/10.1186

/1471-

2458

-11-218

LevelI

2-arm

RCT

N5

395.

Interventiongrou

p,n5

200(M

age5

71.8

yr±12

.2).

Control

grou

p,n5

195(M

age5

69.8

yr±11

.6).

Inclusioncriteria:Age³5

0yr,so

cially

isolatedorat

risk

forso

cialisolation,provided

inform

edco

nsent,

completedquestionnaire

withoutassistan

ce,

communitydwellin

gin

United

Kingdom

Intervention

Com

munity-based

mentoring

serviceincluding³1

2wk

ofmentoring

inself-confidenceandengagementin

personally

meaningfulsocialactivities

Con

trol

Usualcare

•SF–12

MentalHealth

andPhysicalHealth

Com

ponent

scores

•Eu

roQol

5Dimension

s•GeriatricDepression

Scale

•Socialactivity

•Socialsupp

ortand

morbidities

Nosign

ificant

differencesbetweengrou

pswerefound;

mentoring

didno

treduce

social

isolationin

olderadults.

Electronic

Gam

ing

Bellet

al.(201

1)

https://doi.org/10.3109

/02

7031

81.2011.5593

07

LevelII

Mixed

methods,3-grouppretest–posttest

N5

21(age

range5

60–94yr).

InterventionGroup

1,n5

8(age

rang

e5

60–89yr).

InterventionGroup

2,n5

6(age

rang

e5

60–9

01yr).

Control

grou

p,n5

7(age

rang

e5

80–901

yr).

Inclusioncriteria:

Age

³60yr,physicallycapableof

participating,

nosignificant

visualor

cognitive

impairment,independenttransportationto

sessions,

nocurrentinjuries,n

ocurrentparticipationinNintendo

Wiiexercisesor

fallpreventionprog

ram

Intervention

Group

1:NintendoWiibo

wling1

fallprevention

education,

8wk

Group

2:NintendoWiibo

wlingon

ly,8wk

Con

trol

NoNintendoWiigameor

fallpreventioneducation

•SPAsocialrelationships

andsocialsupp

ortitems

•Other

outcom

esno

tin

scopeof

thisreview

Nosignificant

differencesinSPAscores

were

foundexcept

for3isolated

itemsthat

the

researchersreported

werelikelyattributable

tochance.

(Con

tinued)

The American Journal of Occupational Therapy, July/August 2018, Volume 72, Number 4 3

Sup

plem

entalTa

ble2.

Eviden

ceTa

blefortheSystematic

Reviewof

Interven

tion

sSup

portingSocialParticipa

tion

andLe

isureEn

gage

men

tforCom

mun

ity-Dwelling

Older

Adu

lts(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants/Inclusion

Criteria

InterventionandControl

Groups

OutcomeMeasures

Results

Kahlbaugh,Sperandio,

Carlson

,&Hauselt(201

1)

https://doi.org/10.1080

/01

9247

88.2011.6252

18

LevelI

3-arm

RCT

N5

35(M

age5

82yr±9.8).

InterventionGroup

1,n5

16.

Interventiongrou

p2,

n5

12.

Control

grou

p,n5

7.

Inclusioncriteria:

Residents

ofan

independentliving

apartm

entbu

ildingin

Con

necticut

Intervention

Group

1:Wiigameof

choice

(allchosebo

wling)

played

with

research

assistant,1hr/wkfor10

wk

Group

2:WatchingTV

with

research

assistant,

1hr/wkfor10

wk

Con

trol

Noactivity

orresearch

assistantvisit

•WeeklyPhysicalActivity

scale(m

odified)

•UCLA

LonelinessScale

•Positive

andNegative

AffectScale

•Life

SatisfactionScale

•SF–36

Therewas

asignificant

difference

inmoo

dandlonelinessbetweeninterventiongrou

psat

posttest,with

theparticipants

intheWii

grou

phaving

lower

lonelinessandhigh

erpo

sitivemoo

dat

posttest

than

television

grou

pparticipants.

Nosign

ificant

differencesbetweengrou

pswerefoundon

measuresof

lifesatisfaction

andph

ysicalactivity.

Intervention

sforLe

isureEn

gage

ment

LeisureEd

ucation

Chang

(201

4)

https://doi.org/10.1080

/13

6078

63.2013.8783

06

LevelI

2-arm

RCT

N5

60.

Interventiongrou

p,n5

30(M

age5

70.83yr).

Control

grou

p,n5

30(M

age5

70.76yr).

Inclusioncriteria:

Age

³65yr,no

previous

training

inleisureeducation,

literate,

nomentalhealth

cond

ition

s

Intervention

Leisureeducationprogram

addressing

leisure

competenceandcapacity,12

~2-hrsessions

2·/wk

over

3mo

Con

trol

Waitlist

•Chang’s

(201

2)leisure

competencescale:

6itemsmeasuring

older

adults’perceptionof

theirabilityto

participate

inleisureactivities

•Other

outcom

esno

tin

scopeof

thisreview

Theinterventiongrou

pshow

edsign

ificant

improvem

ents

inleisurecompetence

comparedwith

thecontrolgrou

p.

Leisureeducationprog

rammingfostered

leisurecompetence.

Janssen(2004)

LevelI

2-arm

RCT

N5

47(age

range5

62–99yr).

Interventiongrou

p,n5

23.

Control

grou

p,n5

24.

Inclusioncriteria:

Older

adults

livingin

1of

3residen

tial

retiremen

tfacilitiesin

Midwestern

United

States,

intact

cognition,interest

inparticipation

Intervention

Leisureeducationprog

ram

cond

uctedby

therapeutic

recreationspecialists

addressing

leisure

appreciation,

awareness,

self-determ

ination,

and

decision

makingregardingleisure;

1260–90min

sessions

over

6wk

Con

trol

Nointervention

Qualityof

Life

Profile:

SeniorVersion

including

3do

mains

(being,

belong

ing,

becoming)

and

severalsubd

omains

includingleisure

Significantbetween-grou

pdifferenceswere

foun

din

theleisuresubd

omain;

intervention

grou

pscores

increasedin

all6areasof

the

leisuresubd

omain,

whereas

controlgrou

pscores

remainedstable.

(Con

tinued)

The American Journal of Occupational Therapy, July/August 2018, Volume 72, Number 4 4

Sup

plem

entalTa

ble2.

Eviden

ceTa

blefortheSystematic

Reviewof

Interven

tion

sSup

portingSocialParticipa

tion

andLe

isureEn

gage

men

tforCom

mun

ity-Dwelling

Older

Adu

lts(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants/Inclusion

Criteria

InterventionandControl

Groups

OutcomeMeasures

Results

Searle,

Mahon,Iso-Ahola,

Sdrolias,

&Van

Dyck(199

5)

https://doi.org/10.1080

/00

2222

16.1995.1194

9737

LevelI

2-arm

RCT

N5

30(age

range5

651

yr).

Interventiongrou

p,n5

15.

Control

grou

p,n5

15.

Inclusioncriteria:

Com

munity-dwellingolderadults

inCanadawith

redu

cedparticipationin

afavorite

leisure

activity

Intervention

Leisureeducationusingamodified

versionof

the

Com

munity

ReintegrationProgram

consistingof

individual

weeklysessions

ledby

atherapeutic

recreationspecialistandactivities

such

asdiscu

ssion,pap

er-and-pen

ciltask

s,role-play,

andrecrea

tion,12se

ssionsoveramea

nof

17wk

Con

trol

Nointervention

•Perceived

Leisure

Control

Scale

•Perceived

Leisure

Com

petenceScale

•Life

SatisfactionIndexA

•Lo

cusof

Control

Scale

•LeisureBoredom

Scale

Significantbetween-grou

pdifferenceswere

foundin

perceivedleisurecontrol,leisure

competence,

lifesatisfaction,

andleisure

boredom.Nosign

ificant

between-grou

pdifferenceswerefoundin

locusof

control.

Searle,

Mahon,Iso-Ahola,

Sdrolias,

&Van

Dyck(199

8)

https://doi.org/10.1080

/00

2222

16.1998.1194

9836

LevelI

2-arm

RCT(follow-upof

Searleet

al.,19

95)

N5

22.

Interventiongrou

p,n5

10(M

age5

75.6

yr).

Control

grou

p,n5

12(M

age5

76.2

yr).

Inclusioncriteria:

Com

munity-dwellingolderadults

inCan

adawithreducedparticipationin

afavo

rite

leisure

activity

Intervention

Leisureeducationprogram

used

inSearleet

al.

(1995),with

noadditionalintervention

Con

trol

Nointervention

•Perceived

Leisure

Control

Scale

•Perceived

Leisure

Com

petenceScale

•Life

SatisfactionIndexA

•Lo

cusof

Control

Scale

•LeisureBoredom

Scale

Significantbetween-grou

pdifferencesin

perceivedleisurecontrol,leisurecompetence,

andleisurebo

redom

weresustainedat16

–18

wkpostintervention.

Group

differencesin

life

satisfactionwereno

longer

significant.A

sign

ificant

difference

inlocusof

controlwas

foun

dbetweengrou

psin

favorof

the

interventiongrou

p.

Zing

mark,

Fisher,Rocklo v,&

Nilsson(2014)

https://doi.org/10.3109

/11

0381

28.2014.9279

19

LevelI

4-arm

RCT

Singleblind,

4grou

ps

N5

177(age

rang

e5

77–82yr).

InterventionGroup

1,n5

41.

InterventionGroup

2,n5

49.

InterventionGroup

3,n5

41.

Control

grou

p,n5

46.

Inclusioncriteria:

Living

alon

eindependently,no

apparent

cogn

itive

orcommunicationprob

lems

Intervention

Allinterventions

werefocusedon

occupational

engagementandhealth

prom

otionandwere

delivered

byoccupationaltherapists.

Group

1:Individual

client-centered,occupation-

based

,an

dgoal-orien

tedsessionsin

participan

ts’home,

3–81.5-hrindividual

sessionsover10wk

Group2:Occupation-based

meaningful

activity,weekly1.5-hrgroupsessionsover

8wk

Group3:1lecture

withwritten

han

douts

on

occupational

engag

emen

tan

dhealthyag

ing

followed

bygroupdiscu

ssion,totalduration

of2hr

Con

trol

Nointervention

•Leisureengagement

measuredby

the

Modified

NPSInterest

Checklist

•Other

outcom

esno

tin

scopeof

thisreview

Allgroups

show

edadeclinein

leisure

participationwith

age.

Thedeclinewas

slightlyredu

cedin

thegrou

psreceivingthe

individual(Group

1)andgroupdiscussion

(Group

3)interventions,buttheeffect

size

was

small.

Theindividualintervention(Group

1)was

mosteffectiveinsupportinglong-term

leisure

engagement.

(Con

tinued)

The American Journal of Occupational Therapy, July/August 2018, Volume 72, Number 4 5

Sup

plem

entalTa

ble2.

Eviden

ceTa

blefortheSystematic

Reviewof

Interven

tion

sSup

portingSocialParticipa

tion

andLe

isureEn

gage

men

tforCom

mun

ity-Dwelling

Older

Adu

lts(con

t.)

Author/Year

Levelof

Evidence/Study

Design/Participants/Inclusion

Criteria

InterventionandControl

Groups

OutcomeMeasures

Results

Self-Manag

ementof

Chronic

Disease

Garvey,

Connolly,Boland,

&Smith

(201

5)

https://doi.org/10.1186

/s128

75-015-026

7-0

LevelI

2-arm

RCT;

feasibility

study

N5

50.

Interventiongrou

p,n5

26(M

dnage5

65yr).

Control

grou

p,n5

24(M

dnage5

67.5

yr).

Inclusioncriteria:

Age

³18yr,multim

orbidity,³4

repeat

prescriptions

Intervention

Professionally

ledself-managem

entprogram

tomanagemultim

orbidity,includingweeklygroup

meetings,occupationaltherapyem

phasis,peer

support,goalsetting,

andafocuson

self-

managem

entof

chroniccond

itions,

over

6wk

Con

trol

Waitlist

•Frequencyof

activity

participation

•Frenchay

Activities

Index

•CanadianOccup

ational

Perform

ance

Measure

•Other

outcom

esno

tinclud

edinscop

eof

this

review

Theinterventiongrou

pshow

edsign

ificant

improvem

entin

frequencyof

activity

participationcomparedwith

thecontrol

grou

p.

Significantimprovem

ents

werefoundin

perceptions

ofactivity

performance

and

satisfaction.

Assistive

Devices

Schweitzer,Mann,

Nochajski,

&To

mita

(199

9)LevelIV

1-grouppretest–posttest

with

case

exam

ples

N5

25(M

age5

77.8

yr;20

wom

en).

Inclusioncriteria:Com

munity-dwellingolderadults,no

cogn

itive

impairmentor

significant

depression

,physicaldisabilitylim

iting

ability

tocarryouthome-

basedvalued

leisureactivities,identified

³1ho

me-

basedvalued

leisureactivity

they

would

liketo

dodespite

theimpact

oftheirdisability

Intervention

Structuredinterviewto

identifyleisureactivities

most

missed,assistivedevice

provided

tomeettheneed

ofthistask,andfollow-upcontact1moafter

interventionto

determ

ineuseof

thedevice

and

ascertaincurrentsatisfactioninperformingthetarget

leisureactivity

Con

trol

Nocontrol

•Consumer

Assessm

ent

Study

•Identified

aleisure

activity

that

participants

mostmissedbecauseof

theimpact

oftheir

disability

Involvem

entin

³1activeleisureop

tions

improved

from

80%

to96%

ofparticipants.

Whenfamily

mem

bers

orcaregivers

sanctionedactivity

involvem

entusingthe

device,participants

weremorelikelyto

attempt

andsucceedin

itsuse.

Participants’intrinsicmotivationto

develop

thehabitof

incorporatingthetarget

leisure

activity

intheirdayaffected

theirleisure

participation.

Note.M

5mean;Mdn

5median;RCT5

random

ized

controlledtrial;SF–12

512

-item

Sho

rtForm

Health

Survey;SF–36

536-item

ShortForm

Health

Survey;SPA5

SocialP

rovision

sScale;U

CLA

5University

ofCalifornia,

LosAng

eles.

Thistableisaprod

uctof

AOTA

’sEvidence-Based

PracticeProject

andtheAmerican

Journalof

OccupationalTherapy.

Copyright

©20

18by

theAmerican

Occup

ationalTh

erapyAssociation.

Itmay

befreelyreprod

uced

for

person

alusein

clinicalor

educationalsettings

aslong

asthesource

iscited.

Allotheruses

requirewritten

perm

ission

from

theAmerican

Occup

ationalTh

erapyAssociation.

Toapply,

visitwww.cop

yright.com

.

Suggested

citation:Smallfield,

S.,&LucasMolitor,W.(2018).O

ccupationalTherapy

interventions

supportingsocialparticipationandleisureengagementforcommunity-dwellingolderadults:A

system

aticreview

(Suppl.T

able2).

American

Journalof

OccupationalTherapy,

72,7204190020.https://doi.org/10.5014/ajot.2018.030627

The American Journal of Occupational Therapy, July/August 2018, Volume 72, Number 4 6

Supplemental Table 3. Risk-of-Bias Analysis for Included Studies on Interventions Supporting Social Participation and LeisureEngagement for Community-Dwelling Older Adults

Citation

Selection BiasBlinding ofParticipants

and Personnel(Performance

Bias)

Blinding of OutcomeAssessment (Detection Bias)

IncompleteOutcome Data(Attrition Bias)

SelectiveReporting(Reporting

Bias)

RandomSequenceGeneration

AllocationConcealment

Patient-ReportedOutcomes

All-Cause

Mortality

ShortTerm(2–6wk)

LongTerm

(>6 wk)

Bell et al. (2011) – ? ? 1 1 1 1 1

Chang (2014) 1 1 1 1 1 1 1 1

Creswell et al. (2012) ? ? 1 1 1 1 1 1

Dickens et al. (2011) 1 1 1 1 – 1 1 1

Garvey, Connolly, Boland, & Smith (2015) 1 1 1 1 – 1 1 1

Janssen (2004) 1 ? ? 1 ? 1 1 1

Kahlbaugh, Sperandio, Carlson,& Hauselt (2011)

? ? – 1 ? 1 1 1

Matuska, Giles-Heinz, Flinn, Neighbor,& Bass-Haugen (2003)

– ? – 1 1 – – 1

Ollonqvist et al. (2008) 1 1 1 1 ? 1 1 1

Routasalo, Tilvis, Kautiainen,& Pitkala (2009)

1 ? 1 1 ? 1 1 1

Schweitzer, Mann, Nochajski,& Tomita (1999)

? – – 1 1 1 1 1

Searle, Mahon, Iso-Ahola, Sdrolias,& Van Dyck (1995)

? ? ? 1 1 1 1 1

Searle, Mahon, Iso-Ahola, Sdrolias,& Van Dyck (1998)

? ? ? 1 ? 1 1 1

Zingmark, Fisher, Rocklov,& Nilsson (2014)

1 ? ? 1 1 1 1 1

Note. Categories for risk of bias: 1 5 low risk of bias; ? 5 unclear risk of bias; – 5 high risk of bias.

Risk-of-bias table format adapted from “Assessing Risk of Bias in Included Studies,” by J. P. T. Higgins, D. G. Altman, and J. A. C. Sterne, in Cochrane Handbookfor Systematic Reviews of Interventions (Version 5.1.0), by J. P. T. Higgins and S. Green (Eds.), 2011, London: Cochrane Collaboration. Retrieved from http://handbook-5-1.cochrane.org. Copyright © 2011 by The Cochrane Collaboration.

This table is a product of AOTA’s Evidence-Based Practice Project and the American Journal of Occupational Therapy. Copyright © 2018 by the AmericanOccupational Therapy Association. It may be freely reproduced for personal use in clinical or educational settings as long as the source is cited. All other usesrequire written permission from the American Occupational Therapy Association. To apply, visit www.copyright.com.

Suggested citation: Smallfield, S., & Lucas Molitor, W. (2018). Occupational therapy interventions supporting social participation and leisure engagement forcommunity-dwelling older adults: A systematic review (Suppl. Table 3). American Journal of Occupational Therapy, 72, 7204190020. https://doi.org/10.5014/ajot.2018.030627

The American Journal of Occupational Therapy, July/August 2018, Volume 72, Number 4 7

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