Research Priority: Emotional and Physiological Influences

Emotional and physiological influences on performance and participation is a research priority area across the lifespan, and in clinical, home and community settings.  There is a great need for more effective interventions to ameliorate the negative impact of these influences to improve health and well-being.

Emotional Influences

  • Mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” and must be promoted, protected, and restored in individuals and communities. 1 
  • It is estimated that about 25% of U.S. adults and 20% of U.S children have a diagnosable mental illness or disorder that affects thinking, mood and behaviors.  2
  • Mental and behavioral disorders are a leading cause of disability in the U.S. accounting for over 13.5 disability-adjusted life years (DALYs) or years lost to illness, disability, or premature death. 2 
  • The annual total U.S. direct and indirect costs of serious mental illness was over $300 billion in 2002.2
  • The current National Institute of Mental Health (NIMH) Strategic Plan for Research emphasizes the urgent need for “research that will have the greatest public health impact and continue to fuel the transformation of mental health care.” 3

Physiological Influences

  • A variety of physiological factors have been linked with function, health outcomes, and quality of life. 4
  • Fatigue and pain are common in many health conditions and contribute to limited function and quality of life. 
  • Pressure sores are associated with decreased health-related quality of life for older adults. 5 The prevalence of pressure sores in acute care facilities has been estimated at almost 15%. Pressure sores were identified as a priority area for improvement in the 2014 Impact Act. 6

Urgent Need

Emotional and physiological influences on performance and participation have been identified as  

  • a critical issue for promoting health and well-being for many conditions and populations
  • an area in which evidence-based measures and interventions are needed
  • an area that is well-suited for more involvement by researchers who bring the unique perspective of occupational therapy 


The OT Lens

The “doing of everyday activities” is supported by the function of complex and interacting body systems and positive mental health.  Impairments in body function and mental illness may contribute to disabilities and poor health-related quality of life.  

Occupational therapy knowledge of the influence of emotional and physiological factors on performance of everyday activities may support development of standard measures and effective interventions to improve function and promote health. Occupational therapy interventions focus on restoring body functions, using strategies to compensate for impairments, and modifying the environment to address the barriers that are limiting performance and participation in everyday activities. 

Current knowledge, research training, measures and interventions regarding emotional and physiological influences is inadequate for addressing the needs of people with experiencing limitations in daily activities due to these factors. AOTF is committed to the development of a scientific network and body of evidence to achieve effective and efficient advances in the area of emotional and physiological influences on performance and participation in both clinical and community settings.

Opportunity to Affect Progress

There are a few occupational therapy scientists who are building knowledge related to emotional and physiological influences on performance and participation.  However, there is not a coordinated network for occupational therapy research in this area, nor sufficient resources to train more occupational therapy researchers.  We believe a significant investment is needed to address emotional and physiological influences on performance and participation in clinical and community settings to achieve better outcomes and improve quality of life for individuals and populations.

1. World Health Organization. Strengthening Mental Health Promotion. Geneva, World Health Organization (Fact sheet no. 220), 2001. Retrieved from 


3. NIM Strategic Plan for Research (2015)

4. Wilson, I. B., & Cleary, P. D. (1995). Linking clinical variables with health-related quality of life. Jama273(1), 59-65. 

5. Gorecki, C., Brown, J. M., Nelson, E. A., Briggs, M., Schoonhoven, L., Dealey, C., ... & Nixon, J. (2009). Impact of pressure ulcers on quality of life in older patients: a systematic review. Journal of the American Geriatrics Society57(7), 1175-1183.

6. Amlung, Stephanie R., Wendy L. Miller, and Linda M. Bosley. "The 1999 national pressure ulcer prevalence survey: a benchmarking approach."Advances in skin & wound care 14, no. 6 (2001): 297-301.

7. CMS Impact Act. Centers for Disease Control and Prevention.  Basic Facts. Retrieved from