Exploring Occupational Therapy Interventions For People with Multiple Sclerosis Within Instrumental Activities of Daily Living

Introduction

Multiple Sclerosis (MS) is an unpredictable progressive neurological condition that has a profound impact on the ability of people to engage and participation in occupations from onset which often occurs in early adulthood. At this stage of life Instrumental Activities of Daily Living (IADL), based in domestic and community contexts, constitute a complex and demanding group of occupations that contribute to occupational identity. Occupational therapy interventions have a complex role in enabling people with MS to engage and participate in purposeful and meaningful occupations such as IADL. Adopting a person-centred theoretical lens, the study reported in this thesis explored the experiences and perceptions of IADL and the occupational therapy interventions of five people with multiple sclerosis in the practice context of a community neurology team.

Methods

The research design consisted of a multiple case study incorporating mixed methods to collect predominantly qualitative data. A novel methodological approach adopted a world view influenced by pragmatism and critical realism. The Assessment of Motor and Process Skills (AMPS) providing case attributes that measured occupational performance in IADL. Semi-structured interviews were then conducted with the people with MS, their carers, occupational therapist, and other healthcare professionals. A questionnaire was also administered to the occupational therapists. The framework approach was applied to analyse the data systematically and robustly. Computer assisted qualitative data analysis software (NVivo) was used to manage data. Presentation of the framework analysis was supplemented by case summaries illuminating the narratives of the five people with MS.

Findings

Four core concepts were identified. The Person Living with MS represented the understanding of the impact of MS on occupational performance in IADL. The Occupations core concept demonstrated the variety of IADL participation and linkage to other groups of occupations. Occupational Therapy Interventions for People with MS revealed professional reasoning and featured fatigue management strategies, environmental interventions, and psychological interventions. The social context of Inter-relationships with other significant people and the MDT to support and enhance occupational performance was also identified. Development of a therapeutic partnership, that listens to and respects the diagnostic narrative of the person with MS, enables personalised interventions to support and empower participation in IADL and other occupations. The contemporary MS person-centred occupational therapy (MS-PcOT) practice model was constructed as a synthesis of the findings.

Conclusion

Occupational therapy interventions have a multi-faceted role in enabling people with MS to participate in occupations they want, need, and expect to do. The findings contribute new knowledge of professional reasoning in occupational therapy practice for people with MS. The findings also contribute to the understanding of experiences and perception of occupations in the domestic lives of people with MS. The MS-PcOT practice model is a person-centred and occupation based guide for occupational therapy practice. The model incorporates integrated and coordinated interdisciplinary practice to support people with MS in their daily occupations and maintain health and well-being.