| 1. |
- Olofsson, Alexandra, 1978-
(författare)
-
Möjlighet till aktivitet och delaktighet utanför hemmet för personer med förvärvad hjärnskada
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Det övergripande syftet med denna avhandling var att öka kunskapen om möjlighet till aktivitet och delaktighet utanför hemmet för personer i yrkesverksam ålder med förvärvad hjärnskada (FHS).Studie I syftade till att utforska och beskriva hur personer med FHS erfar engagemang i aktiviteter utanför hemmet. Intervjuer genomfördes med åtta deltagare och data analyserades genom konstant komparativ metod. Resultatet visade att svårigheter att bearbeta intryck, fatigue, förberedelse och upplevda risker var avgörande för deras begräsningar av engagemang i aktiveter. De använde nya strategier för att möjliggöra engagemang i aktiviteter med olika konsekvenser för deras liv. Studie II syftade till att utforska och identifiera problematiska situationer relaterat till aktiviteter utanför hemmet för personer med FHS. Upprepade intervjuer och deltagande observationer genomfördes med två deltagare och genererade data som analyserades med narrativ metod. Deltagarnas berättelser speglar hur det var en ständig kamp att försöka hantera oförutsedda händelser och kontrollera olika situationer de ställdes inför när de engagerade sig i aktiviteter utanför hemmet. Vidare, hur de dragit sig tillbaka från olika platser vilket medförde att deras sociala liv begränsats och att fler aktiviteter utfördes ensam och i hemmet efter skadan. Studie III syftade till att beskriva och jämföra upplevd delaktighet på platser utanför hemmet hos personer med stroke samt relationen mellan det totalt antal platser som besöktes, funktionshindrets svårighetsgrad och sociodemografisk data. Intervjuer genomfördes med sextiotre deltagare med stroke utifrån instrumentet ACT-OUT. Data analyserades med deskriptiv statistik, icke parametriska test, ANOVA och General Linear Model (GLM). Resultatet visade att gruppen med god återhämtning besökte i genomsnitt flest antal platser följt av dem med medelsvårt och svårt funktionshinder och skillnaden mellan grupperna vara signifikant. Skillnader i besökta platser var framförallt relaterat till platser för sociala, kulturella och andliga aktiviteter samt platser för rekreation och fysisk aktivitet. Oavsett funktionhindrets svårighetsgrad önskade deltagarna besöka platser i framtiden som de förnärvarande inte besökte. Funktionshindrets svårighetsgrad och bilkörning var signifikant associerade med det totala antalet besökta platser för aktiviteter utanför hemmet. Studie IV syftade till att utforska mönster av delaktighet på platser för aktiviteter utanför hemmet och om dessa mönster var relaterade till funktionshindrets svårighetsgrad och faktorer i miljön. Intervjuer genomfördes med samma deltagare och instrument som i studie III och analyserades med deskriptiv statistik, icke parametriska test och tvåstegs klusteranalys. Av analysen framkom fem mönster av delaktighet innehållande fyra möjliggörande och hindrande aspekter; upplevt avstånd till platsen, hur frekvent platsen besöktes och hur familjär platsen samt vägen till platsen var. Resultatet visade att det endast fanns signifikanta skillnader mellan mönstren när det gällde transport till och från platsen och socialt stöd.Sammanfattningsvis bidrar denna avhandling med kunskap om de mångfacetterade ständigt föränderliga utmaningar och problematiska situationer som personer med FHS erfar vid engagemang i aktiviteter utanför hemmet. Vidare, om strategier i aktivitet som möjliggör att personer med FHS kan återuppta och/eller bibehålla aktiviteter utanför hemmet. Avhandlingen bidrar även med kunskap om samband och mönster som påverkar upplevd delaktighet på platser för aktiviteter utanför hemmet, vilket är av betydelse för att förstå relationen mellan aktiviteter och platser. För att utveckla utformningen av rehabiliteringsinsatser som stärker möjlighet till aktivitet och delaktighet efter FHS behöver såväl aktiviteter som platser utanför hemmet samt aspekter som påverkar relationer dem emellan beaktas.
|
|
| 2. |
- Riekkola, Jenni
(författare)
-
Older couples' participation in everyday life - when living in changing and shifting contexts
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to explore and develop an understanding about older couples’ participation in everyday life when living in shifting contexts. To achieve the aim, multiple perspectives were sought and a variety of qualitative methods were applied. Data were generated through interviews and observations with older couples and through focus groups with spousal caregivers, healthcare professionals, and other stakeholders and those data were analyzed through a constant comparative method, content analysis, and narrative analysis.From the perspective of spousal caregivers, the findings in study I revealed the complexity and ambiguity that influences participation in everyday life. Being in charge of everyday life was described as challenging in many ways and produced a need for recovery and own time. Interacting with social contexts and being confident with the provided social services, such as respite care, was described as complex. The partner’s wellbeing and participation had an impact on the spousal caregiver’s own participation when living in shifting contexts. The perspective of healthcare professionals related to residential respite care was captured in study II. They described a broad and multifaceted picture of participation in everyday life and how promoting participation for older couples involved building trustworthy relationships, enabling meaningful activities, and arranging a comfortable shared environment. Both of the partners in the older couples needed to be considered by the professionals. In study III, the perspectives of the older couples were explored. In order to understand how meaning and togetherness is created in older couples’ everyday life, the focus has to be on the couples’ whole situation, including their relationship. The results showed that the couples strived to continue living their lives in togetherness. Strategies used by the couples were shifting responsibilities, doing more things together than before, using residential respite care, and rearranging social interactions with family and friends. Study IV offered the perspectives of multiple stakeholders. The findings suggested that the focus has to be on older couples through maintaining abilities and creating comfort. Support is also required from both an engaged civil society and healthcare professionals that are motivated and have both competence and time. Further, social services need to work together to ensure that resources are properly available.Overall, this thesis contributes to a deeper understanding about older couples’ participation in everyday life when living in shifting contexts. The findings showed that acknowledging the couples’ relationship, seeing beyond the client and the spousal caregiver, was vital for supporting their participation. Furthermore, living in shifting contexts was multifaceted and the couples strived to continue living their lives in togetherness. The meaning that the change of life situation and context has on a couple’s participation in everyday life is important to consider when supporting aging in place. In light of demographic changes and challenges, bringing together the interests of older couples, professionals, systems of services, and civil society is vital for a sustainable future. Systems and situations that are both closely and remotely related to the older couples’ daily life need to be addressed in an ideal situation of aging in place. Knowledge from this thesis could be valuable for occupational therapists and other healthcare professionals, as well as social services that are supporting older couples to age in place. Consequently, this knowledge could be used to benefit the situations of older couples and their health and wellbeing when aging in place.
|
|
| 3. |
|
|
| 4. |
- Strandkvist, Viktor
(författare)
-
Hand grip strength and postural control among individuals with and without Chronic Obstructive Pulmonary Disease : Epidemiological and motion laboratory studies
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundChronic obstructive pulmonary disease (COPD) is estimated to affect approximately 8%–10% of all adults. The disease is considered to be a heterogenic syndrome with systemic effects, in which comorbidities including cardiovascular diseases, muscle dysfunction and fatigue are common. The majority of all individuals with COPD have mild to moderate disease (Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1-2), and only a third are identified by health care, and this under-diagnosis contributes to a lack of knowledge of COPD in the population. COPD is related to skeletal muscle dysfunction, where muscle weakness, frequently assessed with hand grip strength (HGS), is one of the components. Evidence of postural control limitations among individuals with severe or very severe COPD has been emerging during the last decade. These limitations are partly related to muscle weakness, however, research of the other underlying systems of postural control is scarce, and an increased knowledge is of importance for the prevention of falls.AimThe main objective of the thesis was to increase the population-based knowledge about muscle strength, assessed as hand grip strength, and also postural control among individuals with and without COPD. Another objective was to investigate the value of hand grip strength measurements in relation to lower limb muscle strength and postural control among community-dwelling older adults.MethodsPaper I and II are based on the population-based Obstructive Lung disease in Northern Sweden (OLIN) COPD study. All individuals with obstructive lung function impairment (n=993) and an age- and sex-matched group without (n=993) (COPD and non-COPD) were identified after re-examination of population based cohorts during 2002-04. They (n=1,986) have been invited to recurrent examinations including structured interviews and spirometry. Paper I (n=1011) and II (n=831) include data from examinations during 2009-2010 and 2014, respectively, where measurements of HGS (Paper I & II) as well as assessment of fatigue and physical activity (Paper II) were included. Paper III and IV are based on the population-based Balancing Human and Robot (BAHRT) study. Randomly selected individuals over 70 years of age were invited to participate in a study of postural control aspects, in their homes and at the 2 Human Health and Performance Lab- Movement Science, at Luleå University of Technology. The examinations included a structured interview as well as measurements of postural control and sensory and motor systems including HGS, lower limb strength, proprioception, pressure sensitivity, visual acuity, vestibular function and reaction time. Participants in Paper III consisted of communitydwelling individuals over 70 years of age (n=45). Paper IV consisted of individuals with COPD recruited from both the OLIN COPD study as well as the BAHRT-study (n=22), as well as a control group without airway obstruction from the BAHRT-study (n=34).ResultsIn Paper I, there was no differences in mean HGS between the groups with and without COPD. However, HGS was related to disease severity; HGS was lower among those with severe to very severe COPD (GOLD 3-4) compared to nonCOPD, and HGS was associated with forced expiratory volume during 1 second % of predicted value (FEV1 % predicted) in regression models. Five years later, in Paper II, mean HGS was lower in COPD compared to non-COPD. Further, individuals with COPD and clinically relevant fatigue had lower HGS than those without clinically relevant fatigue, significantly so among men and close to among women. There was no clear association between HGS and level of physical activity. In Paper III, there was a strong and valid model showing association between HGS and lower limb strength, where all tested muscle groups were significantly correlated to hand grip strength. The regression model with HGS and postural control was significant, however, the model was weak. In Paper IV, individuals with COPD had worse postural control than those without COPD, significantly so regarding mediolateral amplitude in quiet stance with eyes open on soft/unstable surface, as well as anteroposterior limits of stability. In the COPD group, mediolateral amplitude was related to eye sight and the burden of tobacco smoking assessed as pack-years. Further, muscle strength associated with anteroposterior amplitude in the limits of stability test.ConclusionsIn the population-based OLIN COPD study in 2009-2010, mean HGS was significantly lower among individuals with severe to very severe COPD (GOLD 3-4) than those without COPD. Five years later, mean HGS was lower among all individuals with COPD (GOLD 1-4) compared to those without COPD, which may indicate altered aging process in COPD. HGS was associated to fatigue among individuals with COPD, while there were no associations between HGS and physical activity. HGS is a valid tool for the estimation of lower limb muscle strength among community-dwelling older adults, however, HGS is not 3 appropriate to use as an estimation of postural control. Postural control was impaired among individuals with COPD and different postural control assessments had different demands on the sensory and motor systems. The burden of tobacco smoking and visual acuity might be important for quiet stance trials with visual input, while muscle strength might be important for the more dynamic limits of stability test. Further research regarding the longitudinal aspects of muscle weakness and postural control among individuals with COPD is needed to gain knowledge for appropriate preventive or rehabilitative interventions.
|
|
