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  • Marcheschi, Elizabeth, 1980-, et al. (författare)
  • To come home after a stroke: patients' early experiences of health and recovery in their home settings
  • 2018
  • Konferensbidrag (övrigt vetenskapligt)abstract
    • Healthcare systems and services for stroke patients are increasingly performed within home settings where both, people with moderate and severe disability can receive care. However, at present little knowledge is available in regard to early stroke phases and how the interaction with the physical environment of home settings might affect rehabilitation outcomes. The aim of this work was thus, to increase our understanding in regard to the interplay between home settings and people’s rehabilitation process, a month after stroke onset. A cross-sectional interdisciplinary investigation was conducted using validated measures in face-to-face interviews and by observing the participants’ interactions with their home settings. People with stroke (N = 16) that had a mild disability, and cognitive and communicative abilities to participate in an interview of approximately 2 hours, were recruited in the study and their data was collected within 4 to 7 weeks after stroke onset. Information was collected in regard to their experience of the physical and social home environment, their attachment to place, self-efficacy and the quality of continuity of care from the hospital to the home. Moreover, data about their recovery and overall health were collected with, Stroke Impact Scale and the EQ-5D. Preliminary results suggests the existence of a relation between recovery levels, self-efficacy and the perceived quality of the physical environment of home settings. More detailed results and their implication for early rehabilitation phases of stroke patients within home settings will be discussed.
  • Westgård, Theresa, et al. (författare)
  • Comprehensive geriatric assessment pilot of a randomized control study in a Swedish acute hospital: a feasibility study.
  • 2018
  • Ingår i: Pilot and feasibility studies. - 2055-5784. ; 4
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Comprehensive geriatric assessment (CGA) represent an important component of geriatric acute hospital care for frail older people, secured by a multidisciplinary team who addresses the multiple needs of physical health, functional ability, psychological state, cognition and social status. The primary objective of the pilot study was to determine feasibility for recruitment and retention rates. Secondary objectives were to establish proof of principle that CGA has the potential to increase patient safety. Methods: The CGA pilot took place at a University hospital in Western Sweden, from March to November 2016, with data analyses in March 2017. Participants were frail people aged 75 and older, who required an acute admission to hospital. Participants were recruited and randomized in the emergency room. The intervention group received CGA, a person-centered multidisciplinary team addressing health, participation, and safety. The control group received usual care. The main objective measured the recruitment procedure and retention rates. Secondary objectives were also collected regarding services received on the ward including discharge plan, care plan meeting and hospital risk assessments including risk for falls, nutrition, decubitus ulcers, and activities of daily living status. Result: Participants were recruited from the emergency department, over 32 weeks. Thirty participants were approached and 100% (30/30) were included and randomized, and 100% (30/30) met the inclusion criteria. Sixteen participants were included in the intervention and 14 participants were included in the control. At baseline, 100% (16/16) intervention and 100% (14/14) control completed the data collection. A positive propensity towards the secondary objectives for the intervention was also evidenced, as this group received more care assessments. There was an average difference between the intervention and control in occupational therapy assessment - 0.80 [95% CI 1.06, - 0.57], occupational therapy assistive devices - 0.73 [95% CI 1.00, - 0.47], discharge planning -0.21 [95% CI 0.43, 0.00] and care planning meeting 0.36 [95% CI-1.70, -0.02]. Controlling for documented risk assessments, the intervention had for falls - 0.94 [95% CI 1.08, - 0.08], nutrition - 0.87 [95% CI 1.06, - 0.67], decubitus ulcers - 0.94 [95% CI 1.08, - 0.80], and ADL status - 0.80 [95% CI 1.04, - 0.57]. Conclusion: The CGA pilot was feasible and proof that the intervention increased safety justifies carrying forward to a large-scale study.
  • Björkdahl, Ann, 1959-, et al. (författare)
  • Decline in cognitive function due to diffuse axonal injury does not necessarily imply a corresponding decline in ability to perform activities
  • 2016
  • Ingår i: Disability and Rehabilitation. - 0963-8288 .- 1464-5165. ; 38:10, s. 1006-1015
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>Purpose<em>:</em></strong> The study explored the direction of change (decline vs. improvement) after diffuse axonal injury (DAI) in the domains of the ICF: body structure, body function, and activity.</p><p><strong>Methods</strong>: Thirteen patients with DAI were assessed by using diffusion tensor imaging (DTI) to measure body structure, the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) to measure body function, and the Assessment of Motor and Process Skills (AMPS) to measure activity. The DTI, BNIS, and AMPS were applied at the acute phase (A1), and at 6 and 12 months post-injury (A2 and A3). Visual and statistical analyses were conducted to explore time-dependent changes in the ICF domains.</p><p><strong>Results<em>:</em></strong> Improvements were observed for most patients in all ICF domains from injury until six months. Thereafter, the results diverged, with half of the subjects showing a decline in DTI and BNIS scores between A2–A3, and all but one of the patients exhibiting identical or better A2–A3 AMPS process skill scores.</p><p><strong>Conclusions<em>: </em></strong>From 6 to 12 months post-injury, some patients underwent an ongoing degenerative process, causing a decline in cognitive function. The same decline was not observed in the activity measure, which might be explained by the use of compensatory strategies.</p><ul><li>Implications for rehabilitation</li><li><p>In rehabilitation it is essential to be aware that in some cases with TBI, an ongoing degenerative process in the white matter can be expected, causing an adverse late effect on cognitive function.</p></li><li><p>The cognitive decline, caused by DAI, does not necessarily mean a concurrent decrease in activity performance, possibly explained by the use of compensatory strategies. This suggests that, after the post-acute phase, rehabilitation offering strategy training may be beneficial to enhance every-day functioning.</p></li><li><p>Strategy use requires awareness, which imply the need to assess level of awareness in order to guide rehabilitation.</p></li></ul>
  • Cruice, Madeline, et al. (författare)
  • Reporting Interventions in Communication Partner Training : A Critical Review and Narrative Synthesis of the Literature
  • 2018
  • Ingår i: Aphasiology. - 0268-7038 .- 1464-5041. ; 32:10, s. 1135-1166
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: Communication partner training (CPT) is an umbrella term for a complex behavioural intervention for communications partners (CPs) of people with aphasia (PWA) and possibly PWA themselves, with many interacting components, deployed in flexible ways. Recent systematic reviews (Simmons-Mackie, Raymer, Armstrong, Holland, &amp; Cherney, 2010; Simmons-Mackie, Raymer, &amp; Cherney, 2016) have highlighted the effectiveness of CPT in addressing the skills of conversation partners and the communicative participation of people with aphasia but have suggested that CPT has been variably delivered, with no clear picture of what the essential elements of CPT are and how CPT is expected to achieve its results through hypothesised mechanisms of change (Coster, 2013).</p><p>Aim: This paper aims broadly to consider specification of CPT and describes how CPT has been conducted overall and in relation to treatment recipients. Recommendations for CPT and areas for future research are considered.</p><p>Methods &amp; Procedures: A critical review and narrative synthesis was carried out through: (i) the systematic application of the 12-item TIDieR checklist (Hoffmann et al., 2014) to the 56 studies appraised in the Simmons-Mackie et al. (2010, 2016)) reviews, providing a quantitative overview of the completeness of CPT intervention reporting; and (ii) a qualitative synthesis of the reviewed CPT literature according to TIDieR items.</p><p>Outcomes &amp; Results: Half of the TIDieR checklist items were reported by 71% or more of the studies, and the rest of the items were reported by 0–63% of studies. TIDieR items relating to the treatment (goal, rationale or theory of essential elements, materials and procedures) and provision (provider, mode, timing, dose) were more frequently reported; however, the level of detail provided was often inadequate or incomplete. The interventions were insufficiently specified to enable replication for most of the studies considered. The most infrequently reported items were: name, location, intervention tailoring and modification, and planned and actual intervention adherence/fidelity.</p><p>Conclusion: For a better understanding of an intervention, it is necessary to identify and describe potentially central elements and perhaps especially in complex interventions as CPT, where it is likely also more difficult. Whilst the reviewed CPT studies are on average reporting on slightly more than half of the TIDieR items, they are overall insufficiently detailed. Some items appear easier to report on, whereas other items have not been attended to, are too complex in nature to give a full report on, or simply have not been relevant for the individual study to include.</p>
  • Germundsson, Per, 1956-, et al. (författare)
  • Vocational rehabilitation, interagency collaboration and social representations
  • 2012
  • Ingår i: Work : A journal of Prevention, Assessment and rehabilitation. - Amsterdam, Netherlands : IOS Press. - 1051-9815 .- 1875-9270. ; 42:4, s. 507-517
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>Objective:</strong> The aim of this study is to describe and analyse two important dimensions of vocational rehabilitation for disadvantaged groups and persons with disabilities: interagency collaboration and social representations.</p><p><strong>Participants:</strong> Four focus group discussions were conducted. The participants were 20 officials of various agencies who had taken part in collaboration projects in vocational rehabilitation.</p><p><strong>Methods:</strong> Qualitative content analysis was used for the analysis. The material was categorised and central themes identified.</p><p><strong>Results:</strong> Three themes emerged: 'Collaboration Process', 'Other Agencies' and 'Object for Collaboration'. The results indicate that interagency collaboration is very important in vocational rehabilitation, but that there are a number of obstacles to smooth collaboration. The professionals of the different agencies shared social representations to a great extent. Working with people with psychiatric disorders is especially challenging, and conflicts tended to arise between the projects and the home organisations.</p><p><strong>Conclusions:</strong> Recognition of others' knowledge and respectfulness toward other professions facilitated vocational rehabilitation and the interagency collaboration process. The agencies' lack of flexibility increased the risk of conflicts as attempts were made to integrate the new working methods developed within the projects into the ordinary activities of the agencies.</p>
  • Haggman-Henrikson, Birgitta, et al. (författare)
  • Temporomandibular Disorder Pain After Whiplash Trauma: A Systematic Review
  • 2013
  • Ingår i: Journal of Orofacial Pain. - Quintessence Publishing. - 1064-6655. ; 27:3, s. 217-226
  • Forskningsöversikt (refereegranskat)abstract
    • Aims: To assess, by systematic review of the literature, (1) the prevalence and incidence of temporomandibular disorder (TMD) pain after whiplash trauma, and (2) whether treatment modalities commonly used for TMD are equally effective in patients with solely TMD pain and those with TMD/whiplash-associated disorders (WAD) pain. Methods: A systematic literature search of the PubMed, Cochrane Library, and Bandolier databases was conducted from January 1966 through October 2012. The systematic search identified 125 articles. After an initial screening of abstracts, 45 articles were reviewed in full text. Two investigators evaluated the methodological quality of each identified study. Results: Eight studies on prevalence/incidence of TMD pain in WAD and four studies on interventions in TMD pain and WAD met the inclusion criteria. The reported median prevalence of TMD pain after whiplash trauma was 23% (range 2.4% to 52%) and the incidence ranged from 4% to 34%. For healthy controls, the reported median prevalence was 3% (range 2.5% to 8%) and the incidence ranged from 4.7% to 7%. For patients with a combination of TMD pain and WAD, treatment modalities conventionally used for TMD, such as jaw exercises and occlusal splints, had less of an effect (median improvement rate of 48%, range 13% to 68%) compared to TMD patients without a whiplash injury (75%, range 51% to 91%). Conclusion: There is some evidence that prevalence and incidence of TMD pain is increased after whiplash trauma. The poorer treatment outcome suggests that TMD pain after whiplash trauma has a different pathophysiology compared to TMD pain localized to the facial region.
  • Miyasaka, Hiroyuki, et al. (författare)
  • The quantification of task-difficulty of upper limb motor function skill based on Rasch analysis
  • 2020
  • Ingår i: Topics in Stroke Rehabilitation. - Taylor & Francis. - 1074-9357 .- 1945-5119. ; 27:1, s. 49-56
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: The degree of difficulty of skills of paretic upper limbs in daily life has not been investigated. Objective: To determine the internal validity and level of difficulty of items of the Functional Skills Measure After Paralysis (FSMAP), which can be used to evaluate the functional skills of daily living for stroke patients. Method: A total of 105 first-stroke patients were assessed using the FSMAP. The evaluation system consists of 65 items in 15 categories. We examined the internal validity and level of difficulty of these items using Rasch analysis. In this study, an item with either infit or outfit of &gt;= 1.5 was defined as underfit. Results: Rasch analysis showed that 8 items were underfit. The highest infit and outfit logits were 2.47 for "Trouser donning/doffing" and 8.44 for "Paper manipulation". "Shirt donning/doffing" was the easiest item and "Coin manipulation" was the most difficult, with difficulty logits of -35.8 and 41.5, respectively. Conclusion: The therapist can confirm items that the patient can or cannot perform. By understanding the level of difficulty of each item, the most appropriate functional skill to focus on acquiring next can be identified.</p>
  • Ottenvall Hammar, Isabelle, 1984-, et al. (författare)
  • From Intervention Trial to Full-scale Implementation Research: Positive Tendencies for Frailty and Self-rated Health in Frail Older People.
  • 2018
  • Ingår i: International Journal of Geriatrics and Gerontology. - 2577-0748. ; 2018:2
  • Tidskriftsartikel (refereegranskat)abstract
    • A continuum of care for frail older people was created to link the chain between the hospital, and discharge to the person’s home. Despite earlier positive findings, it remains unclear if the benefits are sustainable in a real-life context. The present longitudinal study aimed at evaluate the effects of the implementation of a full-scale process program for frail older people in a real-life context regarding levels of frailty, self-rated health and activities of daily living up to one year later. The sample consisted of a total of 143 frail people aged 75 years and older, divided in the two groups: 77 participants from the full-scale process program and 66 historical controls. The findings showed that at the six months follow-up, the participants partaking in the full-scale process program had a significantly higher odds of displaying decreased frailty (p=0.015), and at twelve months, this sample had a significant lower likelihood of reporting decreased self-rated health (p=0.023). Thus, the findings showed positive results on frailty level and self-rated health when implementing the intervention in real life, indicating that a person-centred, multi-professional team with a case manager is beneficial for frail older people.
  • Palsdottir, Anna Maria, et al. (författare)
  • The Journey of Recovery and Empowerment Embraced by Nature - Clients' Perspectives on Nature-Based Rehabilitation in Relation to the Role of the Natural Environment
  • 2014
  • Ingår i: International journal of environmental research and public health. - MDPI. - 1661-7827 .- 1660-4601. ; 11, s. 7094-7115
  • Tidskriftsartikel (refereegranskat)abstract
    • This paper presents findings from real life situations, a longitudinal single case study on the role of natural environments in nature-based rehabilitation (NBR) for individuals with stress-related mental disorders, at the Alnarp Rehabilitation Garden in Sweden. A sample of 43 former clients voluntarily participated in semi-structured interview, and the data were analyzed according to interpretative phenomenological analysis (IPA). Three main superordinate themes were identified as the three phases of NBR-Prelude, Recuperating and Empowerment-explaining and illuminating the role of the natural environments in each phase. An explanatory model of NBR in this context is presented including the three phases of NBR, IRP supportive occupations and a pyramid of supporting environments. A new component of supportive environments was identified and herby named, Social quietness, an important component facilitating personal and intimate engagement with the natural environments.
  • Benkel, Inger, et al. (författare)
  • Palliativ vård
  • 2016
  • Bok (övrigt vetenskapligt)
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