PURPOSE: The purpose of this scoping review is to describe how mindfulness interventions are being used in rehabilitation settings for physical disorders, identify gaps in evidence, and illuminate implications for occupational therapy (OT) practice.

BACKGROUND: Mindfulness interventions help patients focus nonjudgmentally on the experience of the present to improve health-related outcomes. Because mindfulness interventions are compatible with the holistic approach of OT, emerging literature suggests uses for mindfulness in OT practice. However, there is limited applied research evaluating the translation of mindfulness to practice-based settings in OT, especially for physical disorders.

To determine the fit with OT practice for physical disorders, it is necessary to describe how mindfulness interventions are currently used in physical rehabilitation and identify the potential for developing OT-specific mindfulness interventions.

DESIGN: This study used a systematic review methodology for searching and identifying literature; however, due to a dearth of high-quality studies, final inclusion and interpretation used a scoping review methodology (Arksey & O’Malley, 2005). The purpose of a scoping review is to describe the breadth of literature on a topic. A scoping review is especially useful when the quantity or quality of available literature is limited or too diverse to answer questions specific to intervention efficacy (e.g., using a systematic review).

DATA ACQUISITION: A systematic search was conducted in PubMed, CINAHL, SPORTDiscus, and PsycINFO using the MeSH terms therapeutics, or rehabilitation, or alternative medicine in combination with the term mindfulness. Two independent reviewers screened each abstract for eligibility and read all eligible full texts. Final selection of an article was achieved by consensus between the reviewers, using the inclusion criteria: clinical application of a mindfulness intervention for a physical disorder, within the OT scope of practice, and provision within a rehabilitative context.

ANALYSIS: Included studies were charted on the basis of study design, intervention provider(s), targeted physical diagnosis, and type of mindfulness intervention. Each mindfulness intervention was compared qualitatively with the Occupational Therapy Practice Framework: Domain and Process (3rd ed.; American Occupational Therapy Association, 2014).

RESULTS: The search produced 1,524 original abstracts, of which 188 articles were read in full, and 16 were included. Included articles showed preliminary support for the use of mindfulness interventions for physical dysfunction most consistently to resolve pain and improve adaptation to illness. Studies were generally cohort design without control. Only two interventions used an occupational therapist as the primary intervener; however, all mindfulness interventions were consistent with the Framework (i.e., occupation/activity based, group, educational, or preparatory).

DISCUSSION: Although few articles used occupational therapists, all mindfulness interventions matched with an intervention type described in the Framework and could have been provided by an OT. Evidence indicates the utility of mindfulness interventions has potential to enhance OT interventions for musculoskeletal, neurological, and other physical disorders (e.g., urinary incontinence).

IMPACT: Mindfulness may be a useful tool for rehabilitation providers, yet the level of evidence remains low for the translation of these interventions for OT treatment of physical disorders. More research is warranted to evaluate the utility and efficacy of mindfulness interventions provided by occupational therapists.

American Occupational Therapy Association. (2014). Occupational therapy framework: Domain and process (3rd Edition). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006

Arksey, H., & O'Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8, 19–32. http://dx.doi.org/10.1080/1364557032000119616