Creative arts occupations in therapeutic practice: a review of the literature.
Abstract: The purpose of this study was to conduct a matrix method literature review of published research on the use of creative arts occupations in therapeutic practice. Peer-reviewed original research articles, published between the years 2000 and 2008, were included in the review. The research articles studied creative arts occupations as a therapeutic medium. Twenty-three articles, located through multiple electronic searches, were identified as meeting the criteria of the review.

Data analysis included quantitative analysis and qualitative analysis. The findings suggest that the use of creative arts occupations in therapeutic practice may have important qualitative value related to health and wellbeing. Six predominant outcomes were most frequently identified across the studies: enhanced perceived control, building a sense of self, expression, transforming the illness experience, gaining a sense of purpose and building social support.

The results suggest that qualitative research may well be the methodology of choice for the study of this topic and raise questions about the paucity of research in this area. Further research into the use of creative arts occupations as a therapeutic approach in occupational therapy and other health and social care disciplines is warranted.

Key words:

Creative arts occupation, literature review, matrix method.
Article Type: Report
Subject: Occupational therapy (Methods)
Medical research (Methods)
Medicine, Experimental (Methods)
Authors: Perruzza, Nadia
Kinsella, Elizabeth Anne
Pub Date: 06/01/2010
Publication: Name: British Journal of Occupational Therapy Publisher: College of Occupational Therapists Ltd. Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 College of Occupational Therapists Ltd. ISSN: 0308-0226
Issue: Date: June, 2010 Source Volume: 73 Source Issue: 6
Product: Product Code: 8000200 Medical Research; 9105220 Health Research Programs; 8000240 Epilepsy & Muscle Disease R&D NAICS Code: 54171 Research and Development in the Physical, Engineering, and Life Sciences; 92312 Administration of Public Health Programs
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 229717774
Full Text: Introduction

Creativity plays an important part in the engagement of creative arts occupations. Some believe that creativity has the power to increase self-esteem, promote a sense of purpose and belonging, empower individuals and foster autonomy and competence (Schmid 2005). There is no one core definition of creativity; however, Schmid (2005) defines creativity as:

Others have described creativity as a quality or capability that is present in different degrees in all individuals and is evident in essentially all aspects of life (Hasselkus 2002). Hasselkus (2002) contends that using creativity in everyday life may be beneficial to the health and wellbeing of individuals, and may improve physical, mental and social wellbeing. Others view creativity as a lifelong process, which can be encouraged and improved (Thompson and Blair 1998, Fisher and Specht 1999). According to Molineux (2004), humans are creative beings; there is an innate need for individuals to engage in creative arts occupations.

Occupation is anything and everything that individuals do to occupy themselves; occupation is a group of activities in everyday life, which are named, organised and given meaning by the people taking part in these occupations (Hasselkus 2002). In occupational therapy, occupations are viewed as a basic human need, which help to organise behaviour and enable the expression and management of self-identity, social identity and time management (Townsend 2002). When faced with illness, engagement in occupations can be diminished; in these times, creativity can be a valuable tool in the healing process (Hasselkus 2002). In order to meet new challenges, such as illness, creative thinking skills may become important as a means to adjust and endure (Thompson and Blair 1998).

A study by Fisher and Specht (1999), which focused on creative occupations as a leisure-based pursuit for older adults, contended that as individuals deal with a changing environment and self, the inclusion of creative occupations may be beneficial. The researchers interviewed older adults exhibiting their artwork at a senior citizens art exhibition and found that creative occupations fostered a sense of purpose, competence, self-acceptance, autonomy and health (Fisher and Specht 1999). Through engagement in creative occupations one may follow a creative process, a path of discovery that guides and enables expression, which in turn may result in positive feelings of health and wellbeing (Schmid 2005).

Drawing on the World Health Organisation's definition, health is described as 'A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity' (Schmid 2005, p6). Health can be influenced by what individuals do in their everyday life; it may be dependent on people engaging in meaningful occupation (Townsend 2002). As people move through their lives, situations that hinder their ability to engage in meaningful occupation may arise and these periods may require new patterns of occupation; it is in these times that creative occupations may offer an alternative means of engaging in a meaningful occupation and may contribute to health and wellbeing (Vrkljan and Miller-Polgar 2001). Law et al (1998) stated that health is a positive concept, emphasising social and personal resources, as well as physical capacity.

Wellbeing is seen as an important aspect of health and can be described as feelings of happiness, pleasure, health and comfort and a balance in all aspects of one's life (Law et al 1998, Wilcock et al 1998). An exploratory survey by Wilcock et al (1998) aimed to describe the meanings, perceptions and feelings that people possessed regarding wellbeing and how these factored into participation in everyday occupation. Participants between the ages of 13 and 66 years completed a questionnaire that incorporated demographic questions, as well as open-ended questions about participants' experiences of wellbeing. The results indicated that wellbeing was seen differently in all people yet commonly encompassed feelings of happiness, self-esteem, self-respect and confidence. In addition, fulfilment, purpose and satisfaction were identified as rewards of engagement in occupation.

Withdrawal, disruption or changes in an individual's ability to engage in a chosen meaningful occupation may have a significant impact on an individual's perceived health and wellbeing (Vrkljan and Miller-Polgar 2001). As Vrkljan and Miller-Polgar (2001) point out, the meaning that is attributed to the occupation an individual chooses to engage in may change. The arrival of impairment or illness can lead to a diminished awareness of self as competent, which may lead a person to feel hopeless and worthless (Hammell 2004).

Becoming aware of the value of creative occupations and making these a part of everyday life and occupations can be a positive way of making the best out of negative disruptions in life (Schmid 2005). A number of authors contend that using creative occupations can have a beneficial effect on an individual's health and wellbeing (Hasselkus 2002, Reynolds 2003, Schmid 2005). The ability to participate in creative occupation is a major feature of human beings and engagement in these occupations may have a beneficial effect on health and wellbeing (Molineux 2004).

Despite the proposed link between creativity and health and wellbeing, it continues to prove difficult to obtain research support for the application of creative occupations in therapeutic practice (Thompson and Blair 1998). This may be one of the main reasons for the apparent decline in the therapeutic use of creative occupations by health care professionals (Thompson and Blair 1998). This decline is the motivation for this literature review. Although it is recognised that any occupation may invoke creativity or possess creative dimensions, the focus of this study is particularly on the value of the creative arts as a means of creative occupation. Creative arts occupations include any arts-based occupation that evokes a creative process in an individual, such as painting, drawing, creative writing, music, textile arts and crafts. The purpose of this study is to review the available research published between the years 2000 and 2008, on the perceived outcomes of creative arts occupations with respect to health and wellbeing.

Research design

This literature review followed the matrix method, guidelines set out by Garrard (1999). The matrix method is a framework used to review literature on a specific topic and consists of four sections: a paper trail, a documents section, a review matrix and a synthesis section. The paper trail is a record kept by the researcher in order to keep track of the search process: in this study, electronic database searches were saved and records of the search name and password were kept for easy retrieval. The documents section consists of a printout of all articles included in the study and is intended to organise the documents in the review. The review matrix is a table used to abstract the literature, according to the following categories: reference, year, purpose, methods, methodology, participants and findings. The final part of the matrix method is the synthesis; this section is a review of the literature based on the information in the review matrix.

Method

Locating and selecting studies

The purpose of the study was to contribute to the occupational therapy literature rather than the broader literature on this topic and this purpose guided decisions regarding the parameters of the review. With a consideration of occupation as a key construct in the work of occupational therapists, the researchers intentionally chose to search for studies that used the language of occupation. The years 2000-2008 were chosen, with the assumption that 8 years would offer a sufficient timeframe to gain insight into current research on the use of creative arts occupations.

Documents from these years were chosen for practical reasons in order to set boundaries on the amount of data to be included in the review. The criteria for the inclusion of articles were as follows: available in full text in the English language; peer-reviewed original research articles; published between the years 2000 and 2008; and studies that examine the perceived outcomes of creative arts occupations with respect to health and wellbeing. Creative arts occupations could be therapeutic or leisure based and could include painting, drawing, creative writing, music, textile arts and crafts. The articles adopted any methodology, population and sample characteristics. The search focused primarily on the fields of occupational therapy and occupational science; however, in light of limited available literature, articles from other disciplines located during the search were included. The articles excluded in this study were theoretical peer-reviewed articles, book reviews, letters to the editor, non-peer reviewed magazine articles, programme descriptions and newspaper articles, and articles published before 2000 or after 2008. In addition, articles that used creative arts occupations as a means to determine a variable other than health and wellness (as an example, the effect of choice on behaviour during an art programme) were excluded.

The documents were obtained through multiple electronic searches using five databases: Allied and Complementary Medicine (AMED), the Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE-OVID and Scopus (see Table 1). These databases were chosen because they index a broad range of health care disciplines, including occupational therapy and other allied health care disciplines.

The key word combinations used for the electronic searches were as follows: 'Creative Occupation', 'Creativity' AND 'Occupation', 'Art' AND 'Occupation', 'Creative Occupation' AND 'Health', 'Art' AND 'Health', 'Creativity' AND 'Health', 'Art' AND 'Occupational Therapy', 'Creativity' AND 'Occupational Therapy'. These key words were chosen based on articles obtained through searches for the background information (initial literature review). Searches were conducted until redundancy in the literature was found.

Data analysis

Using the search strategies above, 70 papers were retrieved and screened using the inclusion criteria. The articles were reviewed several times. Twenty-three articles met the inclusion criteria; 47 papers were excluded, of which 21 were conceptual papers and 26 were research papers.

The 23 articles included in the study were entered into the review matrix and the analysis stage began. Articles were first analysed and reviewed based on the categories set out in the review matrix: full citation, year, purpose, methodological design, methods, sample and findings. Of the 23 articles identified, 4 used quantitative approaches, 16 used qualitative methodologies and 3 used mixed methodologies.

As the majority of studies were qualitative in nature, a thematic analysis of common themes was undertaken. Thematic analysis was conducted using mind maps. Mind mapping is a method used to progress from individual ideas or themes to groups of major themes: through mind-mapping, a thoughtful organisation of the literature review can be accomplished (Heinrich 2001). Each paper was examined for emergent themes related to creative arts occupations and health and wellbeing. A mind map was generated for each paper in order to identify clusters of themes. The mind maps were then compared with one another and consolidated to identify common themes across studies. A theme was deemed salient if it was identified by a minimum of eight studies.

Results

Quantitative findings

Twenty-three articles were included in the literature review A number of methodologies were used in these studies, as presented in Table 2. Qualitative methodologies were found to be the most prevalent approach for studying creative arts occupations.

The articles were most frequently published in the United Kingdom, with 14 studies; 5 studies were published in the United States, 3 studies in Sweden and 1 in Australia, with none in Canada.

In terms of client groups, people living with mental illness were represented in 10 of the articles; people living with cancer were represented in 5 articles; people living with other disabilities, including arthritis and multiple sclerosis, were represented in 5 articles; and people living with kidney disease and in palliative care were each represented in 1 article. Mental illness was the disability most frequently represented; there appears to be a lack of research that examines the use of creative arts occupations with other populations.

Seventeen articles examined the experiences of individuals experiencing disability or illness, in 3 articles the views of both clients and health care professionals were represented, and 3 articles examined health professionals' views on creative arts occupations in a therapeutic environment.

Adults and older adults were the participants in 19 of the 23 studies and strictly older adults were the participants in one study Children were the participants in 1 article, mixed age groups were used in 1 article and 1 article did not mention the age group of its participants. In terms of gender, 7 articles had only female participants, 11 included males and females, and 4 did not state the gender of the participants. It is interesting to note that the majority of this research includes adult female participants; no studies were focused on a solely male population.

Occupational therapy was represented in 8 of the articles, 4 represented nursing practice, 6 articles were in the fields of psychotherapy, psychology or psychiatry, 1 article was in general rehabilitation, 1 was conducted in the discipline of art therapy and 3 articles represented unknown professions.

In 12 of the studies, the researchers studied a variety of creative arts occupations, including crafts, painting and drawing. Four articles used strictly textile/needlecraft activities, 4 articles did not describe which creative arts occupations were used and 2 articles used music therapy.

The publication years of the studies are presented in Table 3; most of the research articles were published in 2007. It is noteworthy that the one randomised controlled trial study did not show significant results. In the other experimental and qualitative research, however, a number of positive themes emerged.

The results indicate a need for further research across a broad range of ages, genders and disabilities. In addition, different study designs may be used in order to determine the best means of conducting research on this topic. A question is raised with respect to which research designs are best suited to the study of the therapeutic potential of creative arts occupations.

Qualitative findings

Most of the research adopted a qualitative approach and identified qualitative outcomes based on participants' experiences with creative arts occupations. In the qualitative analysis, 16 qualitative studies were included as well as 3 mixed methodology studies, for a total of 19 studies. Six predominant themes were identified as the outcomes of using creative arts occupations most frequently represented across studies. These were (a) enhanced perceived control, (b) building a sense of self, (c) expression, (d) transforming the illness experience, (e) gaining a sense of purpose and (f) building social support.

Enhanced perceived control

An improved sense of choice and control in participants' lives was a frequently identified outcome. In a study by Reynolds (2002), interviews were carried out with 35 women, aged 29-75 years, who all had long-term health problems and saw textile arts as a way of coping with their illness. From these interviews it was noted that a sense of powerlessness was commonly reported by individuals who experience illness, yet by increasing one's sense of control over negative emotions, through engagement in textile arts, improved psychological states were identified.

Similarly, Lloyd et al (2007) studied the ways in which involvement in an arts programme contributed to the recovery process of individuals who were faced with mental illness. They found that participants experienced a sense of control through engagement in artwork. By using creative arts occupations to express feelings and moods, participants were empowered to decide what feelings and emotions they would express and how much of that emotion. The participants had the ability to choose what they wanted to express and how much they wanted to express, and to express feelings and emotions directly or through the use of symbolism. This sense of control and choice carried over into other aspects of their lives, resulting in an increased perception of control and independence and the ability to take risks and to deal with the consequences of these risks.

Griffiths (2008) explored the clinical use of creative arts activities as a treatment medium by occupational therapists working with people living with mental illness. Through a grounded theory study, which employed methods of observation and interviews with clients and occupational therapists, they theorised that the capacity to control the choice of creative arts occupation was an important factor. The creative occupations were seen to empower individuals by facilitating mastery over their surroundings, while choice allowed participants to work comfortably and to control the pace and challenge of their occupations. Reynolds and Prior (2006) conducted interviews to gain an understanding of how participation in arts for women with cancer helps them to live more positive lives. By engaging in creative arts occupations, the participants in this study indicated that feelings of achievement came about through the sense of autonomy and control experienced in art making.

Daykin et al (2007) undertook a survey of 80 clients at cancer care organisations to develop a grounded theory about the role that music and music therapy play in cancer care. The researchers found that the participants in their study expressed feelings of power, freedom and release when describing their experience with creative arts occupations. In summary, an enhanced sense of perceived control was a frequent outcome identified through an analysis of the research considered in this review.

Building a sense of self

Throughout the studies, creative arts occupations were seen to contribute to participants' evolving sense of self. In a narrative study undertaken by Reynolds (2000), the participants' views about the personal meanings of engaging in self-chosen needlecraft activities and the part they played in the self-management of depression were examined. This study found that participation in textile arts contributed to building a healthy self-image in the face of depression. Needlework occupations afforded participants with evidence of mastery and competence and a record of their achievements. Confidence was built through the admiration and acknowledgement of others (Reynolds 2000). In a study by Odell-Miller et al (2006), a randomised controlled trial investigated art therapies as a treatment modality for individuals with continuing mental health problems. In this study, the participants valued art therapy as a way to increase self-confidence and to gain a sense of achievement. One participant expressed this as follows: 'You're actually taking part in something, and achieving something' (p130).

As part of a national study to evaluate the influence of participatory arts provision for people who have mental illness, Spandler et al (2007) explored how the arts may help to facilitate recovery in people with mental illness. This study comprised different strands of research, including a survey, a follow-up survey using standardised outcomes measures and a series of qualitative case studies. The participants in the study indicated that the arts gave them the chance to rediscover the self they knew prior to illness or to build a new identity, seeing themselves as people capable of achievement. Similarly, in a narrative study by Reynolds (2000), one participant described this sense of a capable self: 'If I'm tense or stressed, a few hours of stitching gives me back a feeling of confidence in myself when I see what I can achieve' (p111).

In a grounded theory study by la Cour et al (2007), interviews were conducted with older people dealing with a life-threatening illness and with occupational therapists who were participating in creative workshops using crafts at a nursing home. The findings of this study suggest that creative arts occupations can expand the experience of self as an active person when faced with a life-threatening illness. From the qualitative analysis of these studies, a consistently reported outcome was that creative arts occupations have the potential to contribute to an enhanced sense of self.

Expression

Creative arts were frequently depicted as offering opportunities for non-verbal self-expression. Reynolds (2002) found that people living with a chronic illness used art as a means of expressing feelings about their illness experience. Some participants were unable to express their feelings verbally, owing to the complexity of these feelings, and art provided an alternative vehicle through which they could express themselves more fully. Reynolds and Prior (2003) quoted one participant as stating: 'When I look back now, I did the most gruesome scary drawings ... Obviously that was how I was feeling inside' (p788).

In a study by Lloyd et al (2007), individuals living with mental illness depicted art as a preferred way of expressing thoughts and emotions for the majority of participants. The participants were not only able to reflect their illness in their artwork but also able to express their hopes and dreams. The participants with mood disorders indicated that expressing their feelings, thoughts and emotions was beneficial to their ability to overcome suicidal ideation and fears. Similarly, in a narrative discourse analysis conducted by Stickley et al (2007), the participants, who had attended arts workshops organised by mental health service providers, indicated that they were able to incorporate an understanding of themselves and their thoughts by making it solid and real through the artwork they produced.

Transforming the illness experience

Creative arts occupations were frequently depicted as a means of coming to terms with an illness and as a way to transform negative emotions and events into more positive interpretations. In addition, creative arts were seen as a way to turn negative thinking about the illness experience toward more generative aspects of life experience. Reynolds and Prior (2006) found that participants described being so immersed in their artwork that it helped them to diminish disturbing thoughts and feelings about their illness for the period of time in which they were involved. This notion of deep immersion in artwork is similar to the notion of 'flow' (Csikszentimihalyi 1997), highlighted in Griffiths' (2008) study which notes the ways in which engagement in creative activities contributes to a sense of 'flow' that transforms the illness experience. Reynolds (2000) found that planning for the artwork also helped to draw participants' attention away from negative thoughts about illness.

In the study by la Cour et al (2007), engagement in creative arts occupations during a life-threatening illness appeared to facilitate an alternative way of dealing with the illness and its consequences, one that transformed the illness experience into an experience that was part of a larger life picture. They found that participating in creative occupations promoted a positive and healthy focal point and facilitated the coexistence of negative aspects of people's lives, with the more generative dimensions revealed through creative occupations.

Gaining a sense of purpose

Gaining a sense of purpose through involvement in creative arts was another major theme identified in the analysis. In the case study by Spandler et al (2007), the participants described gaining a sense of purpose and meaning in their lives, not only with respect to their artwork but in all aspects of their lives. In a study by Griffiths (2008), the participants indicated that the creative arts in which they were involved provided reasons for them to get out of bed in the morning or to get out of their house. The participants in the study by Lloyd et al (2007) valued the sense of being useful and needed by their peers in the art group. Similarly, la Cour et al (2007) reported that through participation in creative arts occupations, such as pottery, woodworking, gardening and painting, people were able to recognise their capacities and potential. Stickley et al (2007) reported that creative arts occupations, including visual arts, writing, poetry, music and lyrics, gave people a sense of purpose through ownership of their projects and a distinctive relationship with their artistic skill. Phenomenological research, conducted by Reynolds and Prior (2003), which explored the meanings of art for women living with a disabling chronic illness, revealed that art may provide a way to fill an occupational void with a satisfying occupation, thus leading to the re-evaluation of lifestyle and purpose. The researchers suggested that building a sense of purpose and filling occupational voids may lead to a more positive outlook on the future.

Building social support

The social aspect of engaging in creative occupations was very important to many participants across the studies. One study described how social identity may be a central aspect of confidence, positive self-image and fulfilment (Stickley et al 2007). Lloyd et al (2007) found that participants developed a sense that they could not only influence their own lives but also contribute to society and influence others.

In a narrative study by Reynolds (2000), participants described shared interests in crafts as contributing to the development and maintenance of friendships. A significant theme that emerged in the research was the sense of having a safe and supportive environment where individuals engaged collectively in creative occupations. Griffiths (2008) identified features of this environment as acceptance, achievable expectations with no consequences if things go wrong, predictability and protection. Griffiths (2008) suggested that an emotionally and physically safe and supportive environment is an important aspect of healing and recovery when faced with illness.

In research conducted by la Cour et al (2005), participants described a generous receptive environment as one that is characterised by freedom and support. These two aspects were seen as the main reason for enabling engagement in creative arts occupations and, at the same time, contributed to participants' capacity to build their network of social supports.

Discussion

This analysis of qualitative studies reveals six emergent themes with respect to perceived outcomes of creative arts occupations in terms of health and wellbeing. These outcomes--enhanced perceived control, building a sense of self, expression, transforming the illness experience, gaining a sense of purpose and building social support--indicate important implications for therapeutic practice and offer practical insights for occupational therapists who integrate creative arts occupations in their practices.

The findings are of interest given the historical roots of the profession and recognition that, since the early days, creative arts occupations have played a central role in the theory and practice of occupational therapists (Friedland 2003). From the inception of the profession until about the 1960s, occupational arts and crafts were the main tools of occupational therapy practice (Friedland 2003, Schmid 2004). Nonetheless, creative arts occupations have largely lost their place in occupational therapy practice and research (Schmid 2004) and many therapists and other professions, particularly in the North American context, still choose to dismiss this form of therapy (Friedland 2003). Friedland (2003) argued that the growth of the occupational therapy profession has led it towards increasingly biomedically oriented approaches, moving the profession away from its historical belief and value of creative art as a medium for therapeutic practice and occupational engagement.

From the literature reviewed, the United Kingdom appears to have contributed the most research on the use of creative arts occupations. Given a rise in the recognition of the importance of creativity (Schmid 2005) and creative occupation (Reynolds 2000, Molineux 2004) for health and wellbeing (Wilcock et al 1998), and the lack of substantive research on this subject, the authors contend that it is time that occupational therapy researchers around the world reinvigorate attention to a domain of historical importance in the occupational therapy profession: the use of creative arts occupations and the implications for health and wellbeing.

Creative arts occupation is a challenging topic to study, because little research on this topic currently exists and finding the right research design appears to be a challenge. This raises important issues with respect to the appropriate research designs for advancing knowledge about creative arts occupations. Creativity and healing are in many ways internal processes, yet many research designs focus on external processes and observable measurement. Although such experimental research is undeniably important, research designs that offer avenues for examining people's perceptions and internal life world experiences also appear to be important for advancing knowledge about creative arts occupations in therapeutic practice. This finding supports the trend toward more socially oriented and qualitative research designs (Higgs et al 2007, Willis 2007) in researching health and wellbeing generally and creative arts occupations in particular. It is clear that significantly more research on the use of creative arts occupations in occupational therapy, a profession whose historical roots recognised the therapeutic potential of such occupations, is required.

The strengths of this study include the systematic approach to searching, selecting, describing and organising the literature review, the rigorous application of the matrix method of literature review, the strength of a collective analysis of qualitative research and the importance and timeliness of the topic. The limitations include the lack of available research on this subject, the need to limit databases to those relevant to occupational therapy and the need to impose a timeframe for the review that may have excluded other relevant literature. The focus on 'occupation' as a key word may have resulted in the exclusion of other relevant studies. An additional limitation of the study is related to the variability of criteria by which different qualitative researchers and different schools of qualitative research address questions of trustworthiness and the complexity of trustworthiness in qualitative research. Trustworthiness in qualitative research is frequently related to readers' perceptions of the coherence, plausibility and resonance of the findings (Thomas and Pollio 2002) and is beyond what could be examined in this review. Further relevant research beyond the scope of the parameters set for this study may be present in other fields, such as art therapy or psychotherapy, or by searching other databases such as PsycINFO, using other key words such as 'activity', 'art and health' and 'music and health'.

Conclusion

The purpose of this study was to gather, describe and analyse the available research on the use of creative arts occupations with respect to perceived outcomes on health and wellbeing. Creativity has been depicted as a healing force; Hasselkus (2002) contended that it is one of the most valuable tools to aid in the healing process. Friedland (2003) drew on an historical analysis of occupational therapy to suggest that participation in creative occupations has a healing effect. She noted that crafts are seen to be an uplifting occupation in people's lives. With this in mind, researchers as well as practitioners need to understand better the value that creative arts occupations can potentially offer in therapeutic practice.

This literature review brings to the forefront six emergent themes that reflect the documented benefits in the qualitative research literature on this subject. These preliminary qualitative outcomes highlight the value that creative arts occupations may have on health and wellbeing when individuals are faced with illness. The findings suggest that the use of creative occupations may have important value for individuals living with mental and physical disabilities and raise questions about the lack of research in this area. Further research into the use of creative arts occupations as an approach to therapy is warranted.

Acknowledgements

The authors would like to thank the School of Occupational Therapy and the Faculty of Health Sciences at the University of Western Ontario for support of this research. In addition, the second author is grateful for funding from the Social Science and Humanities Research Council of Canada, which provided support for this research and its conception.

Conflict of interest: None.

Key findings

* The findings suggest that the use of creative arts occupations in therapeutic practice may have important qualitative value related to health and wellbeing.

* Six predominant outcomes, of using creative arts occupations, were most frequently identified across the 23 studies: enhanced perceived control, building a sense of self, expression, transforming the illness experience, gaining a sense of purpose and building social support.

What the study has added

The study contributes to knowledge about the use of creative arts occupations as a therapeutic approach in occupational therapy.

Submitted: 23 December 2008.

Accepted: 22 December 2009.

DOI: 10.4276/030802210X12759925468943

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Thompson M, Blair SE (1998) Creative arts in occupational therapy: ancient history or contemporary practice? Occupational Therapy International, 5(5), 48-64.

Townsend E, ed (2002) Enabling occupation: an occupational therapy perspective. Ottawa, ON: CAOT Publications ACE.

Vrkljan B, Miller-Polgar J (2001) Meaning of occupational engagement in life-threatening illness: a qualitative pilot project. Canadian Journal of Occupational Therapy, 68(4), 237-46.

Wikstrom BM (2005) Communicating via expressive arts: the natural medium of self-expression for hospitalized children. Pediatric Nursing, 31(6), 480-85.

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Willis JW (2007) Foundations of qualitative research: interpretive and critical approaches. Thousand Oaks, NJ: Sage.

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Nadia Perruzza (1) and Elizabeth Anne Kinsella (2)

(1) Rehab First Inc., London, Ontario, Canada.

(2) University of Western Ontario, London, Ontario, Canada.

Correspondence to:

Dr Elizabeth Anne Kinsella, Assistant Professor, School of Occupational Therapy, Elborn College, University of Western Ontario, 1201 Western Road, London, Ontario, Canada N6G 1H1. Email: akinsell@uwo.ca

Reference: Perruzza N, Kinsella EA (2010) Creative arts occupations in therapeutic practice: a review of the literature. British Journal of Occupational Therapy, 73(6), 261-268.
An innate capacity to think and act in original ways, to be
   inventive, to be imaginative and to find new and original solutions
   to needs, problems and forms of expression. It can be used in all
   activities. Its processes and outcomes are meaningful to its user
   and generate positive feelings (p6).


Table 1 Electronic database searches

                                               AMED        CINAHL
                                             Number of    Number of
                                              results      results

1. 'Creative Occupation'                          2            2
2. 'Creativity' AND 'Occupation'                  7           12
3. 'Art' AND 'Occupation'                        15           24
4. 'Creative Occupation' AND 'Health'             1            0
5. 'Art' AND 'Health'                            48          298
6. 'Creativity' AND 'Health'                     22          182
7. 'Art' AND 'Occupational Therapy'              23           46
8. 'Creativity' AND 'Occupational Therapy'       12            9

                                              EMBASE       MEDLINE
                                             Number of    Number of
                                              results      results

1. 'Creative Occupation'                          0            0
2. 'Creativity' AND 'Occupation'                 20            4
3. 'Art' AND 'Occupation'                        47           17
4. 'Creative Occupation' AND 'Health'             0            0
5. 'Art' AND 'Health'                           282          317
6. 'Creativity' AND 'Health'                    331          244
7. 'Art' AND 'Occupational Therapy'              51           14
8. 'Creativity' AND 'Occupational Therapy'        9            5

                                              SCOPUS
                                             Number of
                                              results

1. 'Creative Occupation'                          0
2. 'Creativity' AND 'Occupation'                 64
3. 'Art' AND 'Occupation'                       318
4. 'Creative Occupation' AND 'Health'            21
5. 'Art' AND 'Health'                           N/A
6. 'Creativity' AND 'Health'                    N/A
7. 'Art' AND 'Occupational Therapy'             N/A
8. 'Creativity' AND 'Occupational Therapy'      N/A

Table 2. Quantitative results: methodologies

Methodology                 Studies   Authors and year

Experimental design           1       Kolin et al (2000)
Observational outcome         2       Zeltzer et al (2003)
  measures                            Ross et al (2006)
Prospective cohort            1       Hamre et al (2007)
Grounded theory               5       Reynolds (2002)
                                      Reynolds (2003)
                                      la Cour et al (2005)
                                      Daykin et al (2007)
                                      Griffiths (2008)
Phenomenolgy                  5       Reynolds and Prior (2003)
                                      Schmid (2004)
                                      Lane (2005)
                                      La Cour et al (2007)
                                      Reynolds and Lim (2007)
Generic qualitative
  research                    3       Wikstrom (2005)
                                      Reynolds and Prior (2006)
                                      Lloyd et al (2007)
Narrative inquiry             1       Reynolds (2000)
Case study                    1       Spandler et al (2007)
Narrative discourse
  analysis                    1       Stickey et al (2007)
Mixed methodologies           3       Daykin et al (2006)
--RCT and grounded theory             Odell-Miller et al (2006)
--Experimental and generic            Griffiths and Corr (2007)
  qualitative research
--Grounded theory
  and observational
  cross-sectional survey

RCT = randomised controlled trial.

Table 3. Publication years

Year           Studies

2000             2
2001             0
2002             1
2003             3
2004             1
2005             3
2006             4
2007             8
2008             1
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