| 1. |
- Carlsson, Gunilla, et al.
(författare)
-
Self-reported versus professionally assessed functional limitations in community-dwelling very old individuals.
- 2012
-
Ingår i: International Journal of Rehabilitation Research. - 1473-5660. ; 35:4, s. 299-304
-
Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to examine the relationship between self-reported and professionally assessed functional limitations in community-dwelling very old individuals. In total, 306 single-living adults aged 81-90 years were included in this cross-sectional study. The main outcome measure was the presence and absence of self-reported and professionally assessed functional limitations. A significant correlation was found between the total number of self-reported and professionally assessed functional limitations in the total sample (intraclass correlation=0.65) as well as in subgroups with respect to sex, age, and depression. When item-wise differences in the two assessments were assessed, the results showed significant differences for nine of the 15 functional limitations. In general, the participants reported more functional limitations as present than the professional did. In conclusion, research on self-reported and professionally assessed functional limitations contributes toward the understanding of how different modes of data collection influence the results. In this study, functional limitations were examined on a broad basis, including physical as well as cognitive and perceptual limitations. Once the assessments of self-reporting have been refined, we will have a more nuanced picture of functional limitations, incorporating self-report as well as professional assessments.Ziel der vorliegenden Studie war die Untersuchung der Beziehung zwischen selbst und professionell beurteilten Funktionseinschränkungen bei in der Gemeinschaft lebenden Menschen hohen Alters. Insgesamt wurden 306 allein lebende Erwachsene im Alter von 81-90 Jahren in diese Querschnittsstudie eingeschlossen. Die wichtigste verwendete ergebnisorientierte Messgröße war das Vorhandensein oder Fehlen von selbst und professionell beurteilten Funktionseinschränkungen. Es bestand eine signifikante Korrelation zwischen der Gesamtanzahl der selbst und professionell beurteilten Funktionseinschränkungen in der Stichprobe insgesamt (Intraclass-Korrelation=0.65) sowie in den Subgruppen mit Bezug auf Geschlecht, Alter und Depression. Bei der Beurteilung der Unterschiede unter Berücksichtigung der einzelnen Items wiesen die Ergebnisse signifikante Unterschiede bei neun der 15 Funktionseinschränkungen auf. Im Allgemeinen berichteten die Teilnehmer von mehr vorhandenen Funktionseinschränkungen als die Experten. Abschließend kann gesagt werden, dass die Forschung im Bereich der selbst und professionell beurteilten Funktionseinschränkungen zu einem besseren Verständnis dessen beiträgt, wie verschiedene Methoden der Datenerfassung die Ergebnisse beeinflussen. Im Rahmen dieser Studie wurden Funktionseinschränkungen, darunter physischer, kognitiver und perzeptiver Art, breit angelegt beurteilt. Sobald die Beurteilungsmethoden der Selbstanzeige weiterentwickelt sind, besitzen wir ein nuancierteres Bild der Funktionseinschränkungen mit eigener und professioneller Auswertung.El objetivo de este estudio fue examinar la relación entre las limitaciones funcionales indicadas por los propios sujetos y las evaluadas por profesionales en individuos de edad avanzada pertenecientes a una comunidad. En total, 306 adultos que vivían solos y de edad comprendida entre los 81 y los 90 años participaron en este estudio transversal. Los principales resultados obtenidos se basaron en la presencia y la ausencia de limitaciones funcionales indicadas por los propios sujetos y evaluadas por profesionales. Se observó una correlación significativa entre el número total de limitaciones funcionales indicadas por los propios sujetos y las evaluadas por profesionales (correlación intraclase=0.65), así como en los subgrupos, en relación con el sexo, la edad y la depresión. Tras analizar las diferencias entre los dos tipos de evaluación con respecto a las distintas variables, los resultados difirieron significativamente en nueve de las quince limitaciones funcionales. En general, los participantes indicaron que padecían más limitaciones funcionales que los profesionales. Como conclusión, la investigación sobre las limitaciones funcionales indicadas por los propios sujetos y evaluadas por profesionales contribuye a comprender cómo las distintas formas de recopilación de datos influyen en los resultados. En este estudio, las limitaciones funcionales se examinaron de manera general, incluyendo las limitaciones físicas, además de las cognitivas y las perceptivas. Una vez que se perfeccionen las evaluaciones realizadas por los propios sujetos, se poseerá una visión más clara de las limitaciones funcionales, que podrán incorporar tanto autoevaluaciones como evaluaciones realizadas por profesionales.Cette étude avait pour objet d'examiner la relation entre les limitations fonctionnelles auto-déclarées et professionnellement évaluées chez les personnes très âgées vivant dans la collectivité. Au total, 306 adultes de 81-90 ans vivant seuls ont été inclus dans cette étude transversale. Le critère de mesure principal était la présence ou l'absence de limitations fonctionnelles auto-déclarées ou professionnellement évaluées. Une corrélation significative a été observée entre le nombre total de limitations fonctionnelles autodéclarées et professionnellement évaluées dans l'échantillon total (corrélation interclasses=0.65) ainsi que dans les sous-groupes définis par sexe, âge et dépression. Lorsque les différences sur l'ensemble d'un item entre les deux évaluations ont été évaluées, les résultats ont fait apparaître des différences significatives pour neuf des 15 limitations fonctionnelles. En général, les participants ont signalé la présence d'un plus grand nombre de limitations fonctionnelles que les professionnels. En conclusion, les recherches sur les limitations fonctionnelles autodéclarées et professionnellement évaluées contribuent à la compréhension de la manière dont les différents modes de collecte des données influent sur les résultats. Dans cette étude, les limitations fonctionnelles ont été examinées sur une base large, en incluant notamment les limitations physiques ainsi que cognitives et perceptives. Une fois les évaluations autodéclarées affinées, nous aurons une image plus nuancée des limitations fonctionnelles, qui intégrera l'auto-évaluation ainsi que les évaluations professionnelles.
|
|
| 2. |
|
|
| 3. |
- Carlsson, Gunilla, et al.
(författare)
-
Towards a screening tool for housing accessibility problems: a reduced version of the Housing Enabler.
- 2009
-
Ingår i: Journal of Applied Gerontology. - : SAGE Publications. - 1552-4523 .- 0733-4648. ; 28:1, s. 59-80
-
Tidskriftsartikel (refereegranskat)abstract
- To present a reduced version of the Housing Enabler, useful as a screening tool in practice contexts and in research, this study identifies the core items of the environmental component of the instrument, that is, the items most important in terms of the instrument's overall validity to measure accessibility problems. Utilizing cross-national data and interdisciplinary knowledge through an iterative process, a set of core items was identified. The environmental component of the reduced version comprises 61 items, compared to 188 in the original instrument. The rank correlation between the accessibility scores generated by the original and reduced versions was r ≥ .97 (p < .001). Based on comprehensive empirical research in three countries, the reduced version of the Housing Enabler is a time-efficient and valid screening instrument. It is a powerful tool for research and interventions focusing on housing accessibility problem identification.
|
|
| 4. |
- Hovbrandt, Pia, et al.
(författare)
-
Very old people’s use of the pedestrian environment: functional limitations, frequency of activity and environmental demands
- 2007
-
Ingår i: European Journal of Ageing. - : Springer Science and Business Media LLC. - 1613-9380 .- 1613-9372. ; 4:4, s. 201-211
-
Tidskriftsartikel (refereegranskat)abstract
- Due to decreased functional capacity as well as high environmental demands there is a risk of diminishing activity outside home in very old age (age 80+). In order to explore differences according to functional limitations (FL) among very old people with respect to frequency of activity, perceived health, overall perception of neighbourhood environment, and perceived problems in the pedestrian environment, data derived from a postal questionnaire survey to very old people living in an urban area in Sweden were used. This explorative study is based on the sub-sample of people aged 80+ who reported outdoor activities (n = 97). Four groups of respondents with different types of FL were identified: with no FL (n = 23), with only movement-related FL (n = 26), with only perception/cognition-related FL (n = 16), and with both movement- and perception/ cognition-related FL (n = 32). The majority of the respondents reported rather high frequency of activity outside home. When examining differences between the four groups, the analysis indicated how the complexity of FL and perceived problems in the pedestrian environment impacted on their activity performance. Persons with both movement- and perception/cognition-related FL were less satisfied with their frequency of activity, experienced their health more negatively and experienced more problems in the pedestrian environment than in the other groups. The findings from this study indicate the importance of considering combinations of FL in creating supportive environments for activity and health.
|
|
| 5. |
- Iwarsson, Susanne, et al.
(författare)
-
Occupational therapy targeting physical environmental barriers in buildings with public facilities
- 2004
-
Ingår i: British Journal of Occupational Therapy. - 1477-6006. ; 67:1, s. 29-38
-
Tidskriftsartikel (refereegranskat)abstract
- The main aim of this study was to evaluate an occupational therapy based intervention aimed at increasing the accessibility to buildings with public facilities in a Swedish town centre, which targeted physical environmental barriers. The intervention was occupational therapy advice based on the environmental assessments of each facility, given to the facility owners in order to ease the removal of environmental barriers. Another aim was to elucidate the attitudes towards and the practical obstacles to the implementation of accessibility measures among public facility owners. Systematic on-site observations of environmental barriers were administered in five buildings with different facilities, at baseline and at follow-up 18 months later, and were complemented by semi-structured interviews with the facility owners at follow-up. At baseline, environmental barriers were found in all five facilities, such as at entrances, and at follow-up only minor improvements were identified. Two of the facility owners had made use of the occupational therapy advice, but the results also revealed scarce knowledge of or negative attitudes towards accessibility measures. Much remains to be done when it comes to attitudes towards the inclusion of people with disabilities. Active occupational therapy, as described in this study, can influence the situation only to a limited extent. Nevertheless, the results demonstrate that there is knowledge to be gained through this kind of approach.
|
|
| 6. |
- Iwarsson, Susanne, et al.
(författare)
-
Person--environment fit predicts falls in older adults better than the consideration of environmental hazards only.
- 2009
-
Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 1477-0873 .- 0269-2155. ; 23:6, s. 558-567
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To test the hypotheses that the empirical consideration of objective person-environment fit in the home environment is a stronger predictor of indoor falls among older adults than the assessment of environmental barriers only, and that perceived aspects of home play a role as predictors for falls.Design: Survey study with data collection at home visits, followed up by self-reports about falls at home visits one year later.Setting: Urban districts in Sweden, Germany, Latvia.Participants: Eight hundred and thirty-four single-living, older adults (75-89 years), in ordinary housing.Measurements: An assessment of objective person-environment fit in the home environment (housing enabler), a self-rating of the perceived home environment (usability in my home) and retrospective self-reports on indoor falls.Results: The participants reporting falls tended to be frailer than the non-fallers. The number of environmental barriers in the home was similar for the fallers and non-fallers; the magnitude of person-environment fit problems was higher among the fallers. The person-environment fit problem variable was a stronger fall predictor (odds ratio (OR) = 1.025; P=0.037) than number of environmental barriers (n.s.), even after controlling for confounders. Fallers also experienced lower usability of their home.Conclusion: The results suggest that much of the inconclusiveness of the data in the relationship between environmental hazards and falls in the previous falls literature could be due to the neglect of person-environment fit assessment. The effectiveness of environmental interventions based on the notion of person-environment fit compared with traditional home hazard checklists remains to be tested.
|
|
| 7. |
- Iwarsson, Susanne, et al.
(författare)
-
Travel Chain Enabler: Development of a pilot instrument for assessment of urban public bus transportation accessibility.
- 2000
-
Ingår i: Technology and Disability. - 1878-643X. ; 12, s. 3-12
-
Tidskriftsartikel (refereegranskat)abstract
- Among the issues relating to the needs of citizens with reduced functional capacity, accessibility problems throughout society are gaining interest. The focus of this paper is on methodology for assessment of urban public bus transport accessibility. The aims are to describe the development of a pilot version of a new instrument, the Travel Chain Enabler, and to identify problems to target for further research. Based on the previously developed Housing Enabler instrument and a literature review, the development of a pilot instrument was initiated. In several steps, three different raters recorded accessibility on site while traveling by public bus transport in a Swedish city. The results showed the relevance of the assessment approach, but definition problems, difficulties as regards reliable measurements, and/or paucity of administration instructions were demonstrated in 32% inter-rater reliability analysis indicated moderate agreement. The detailed specification of the different kinds of problems and assessment difficulties is of the outermost importance for further research in the field. With current results as a new point of departure, major methodological challenges will be more constructively dealt with.
|
|
| 8. |
- Slaug, Björn, et al.
(författare)
-
Defining Profiles of Functional Limitations in Groups of Older Persons: How and Why?
- 2011
-
Ingår i: Journal of Aging and Health. - : SAGE Publications. - 1552-6887 .- 0898-2643. ; 23:3, s. 578-604
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Addressing the complexity of multiple health problems in the older population, the objective was to identify combinations of functional limitations for use in simulation analysis, to enable predictions of the potentially most severe person-environment fit (i.e., accessibility) problems among groups of older persons. METHOD: Utilizing data from 1,542 persons aged 75 to 89 years and applying Configuration Frequency Analysis, we tested which combinations of functional limitations that occurred more or less often than expected. Significant combinations were defined as type profiles and used in simulated accessibility analyses. RESULTS: Eleven combinations occurred more often and eight less often than expected (p < .05). Simulations with ten type profiles predicted varied patterns of accessibility problems. CONCLUSION: The use of type profiles has potential to contribute to the knowledge of combinations of functional limitations among groups of older persons. Variation in predicted accessibility problems for different type profiles helps identifying priorities in societal planning.
|
|
| 9. |
- Slaug, Björn, et al.
(författare)
-
Typology of person-environment fit constellations: a platform addressing accessibility problems in the built environment for people with functional limitations.
- 2015
-
Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 15
-
Tidskriftsartikel (refereegranskat)abstract
- Making the built environment accessible for all regardless of functional capacity is an important goal for public health efforts. Considerable impediments to achieving this goal suggest the need for valid measurements of acccessibility and for greater attention to the complexity of person-environment fit issues. To address these needs, this study aimed to provide a methodological platform, useful for further research and instrument development within accessibility research. This was accomplished by the construction of a typology of problematic person-environment fit constellations, utilizing an existing methodology developed to assess and analyze accessibility problems in the built environment.
|
|
| 10. |
- Slaug, Björn, et al.
(författare)
-
Unfolding the phenomenon of interrater agreement: a multicomponent approach for in-depth examination was proposed.
- 2012
-
Ingår i: Journal of Clinical Epidemiology. - : Elsevier BV. - 1878-5921 .- 0895-4356. ; 65:9, s. 1016-1025
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The overall objective was to unfold the phenomenon of interrater agreement: to identify potential sources of variation in agreement data and to explore how they can be statistically accounted for. The ultimate aim was to propose recommendations for in-depth examination of agreement to improve the reliability of assessment instruments. STUDY DESIGN AND SETTING: Using a sample where 10 rater pairs had assessed the presence/absence of 188 environmental barriers by a systematic rating form, a raters×items data set was generated (N=1,880). In addition to common agreement indices, relative shares of agreement variation were calculated. Multilevel regression analysis was carried out, using rater and item characteristics as predictors of agreement variation. RESULTS: Following a conceptual decomposition, the agreement variation was statistically disentangled into relative shares. The raters accounted for 6-11%, the items for 32-33%, and the residual for 57-60% of the variation. Multilevel regression analysis showed barrier prevalence and raters' familiarity with using standardized instruments to have the strongest impact on agreement. CONCLUSION: Supported by a conceptual analysis, we propose an approach of in-depth examination of agreement variation, as a strategy for increasing the level of interrater agreement. By identifying and limiting the most important sources of disagreement, instrument reliability can be improved ultimately.
|
|
