| 1. |
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| 2. |
- Bergstrom, Aileen, et al.
(författare)
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Association between satisfaction and participation in everyday occupations after stroke
- 2017
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 24:5, s. 339-348
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Tidskriftsartikel (refereegranskat)abstract
- Background: Within occupational therapy, it is assumed that individuals are satisfied when participating in everyday occupations that they want to do. However, there is little empirical evidence to show this. Aims: The aim of this study is to explore and describe the relation between satisfaction and participation in everyday occupations in a Swedish cohort, 5 years post stroke. Methods: Sixty-nine persons responded to the Occupational Gaps Questionnaire (OGQ). The questionnaire measures subjective restrictions in participation, i.e. the discrepancy between doing and wanting to do 30 different occupations in everyday life, and satisfaction per activity. Results were analysed with McNemar/chi-square. Results: Seventy percent of the persons perceived participation restrictions. Individuals that did not perceive restrictions in their participation had a significantly higher level of satisfaction (p=.002) compared to those that had restrictions. Participants that performed activities that they wanted to do report between 79 and 100% satisfaction per activity. Conclusion: In this cohort, there was a significant association between satisfaction and participating in everyday occupations one wants to do, showing that satisfaction is an important aspect of participation and substantiates a basic assumption within occupational therapy. The complexity of measuring satisfaction and participation in everyday occupations is discussed.
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| 3. |
- Bergstrom, Aileen L., et al.
(författare)
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Perceived occupational gaps one year after stroke : An explorative study
- 2012
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Ingår i: Journal of Rehabilitation Medicine. - Uppsala : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 44:1, s. 36-42
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore and describe factors associated with occupational gaps and to identify factors at 3 months that predict occupational gaps one year post-stroke. A gap, a restriction in participation, is considered to be present when there is a discrepancy between what the individual wants to do and what they actually do in everyday life. Design: Prospective longitudinal study. Subjects: Two hundred persons with stroke. Methods: Data from the Occupational Gaps Questionnaire, one year post-stroke, was used as the dependent variable in 3- and 12-month regression analyses. Domains of the Stroke Impact Scale, global life satisfaction, demographic and medical factors were used as independent variables. Results: At 3 months, activities of daily living abilities, social participation and not being born in Sweden predicted occupational gaps at 12 months. Stroke severity and not being born in Sweden and 3 factors at 12 months: social participation, self-rated recovery, and global life satisfaction were associated with occupational gaps. Conclusion: Activities of daily living ability at 3 months predicted occupational gaps after stroke. Thus, it is possible to identify early on, and provide interventions for, those that risk participation restrictions. Not being born in the country might be an indicator of a risk for participation restrictions.
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| 4. |
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| 5. |
- Bergström, Aileen L., et al.
(författare)
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Combined life satisfaction of persons with stroke and their caregivers : associations with caregiver burden and the impact of stroke
- 2011
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Ingår i: Health and Quality of Life Outcomes. - : Springer Science and Business Media LLC. - 1477-7525. ; 9, s. 1-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Little is known about the life satisfaction of the person with stroke combined with their caregiver, i.e. the dyad, despite the fact that life satisfaction is an important rehabilitation outcome. The aim of this study was to describe the dyads combined life satisfaction and to understand this in relationship to the perceived impact of stroke in everyday life and caregiver burden. Methods: In this cross-sectional study, the life satisfaction of persons and their informal caregivers was measured in 81 dyads one year post stroke. Their global life satisfaction, measured with LiSat-11, was combined to a dyad score and the dyads were then categorized as satisfied, dissatisfied or discordant. The groups were compared and analyzed regarding levels of caregiver burden, measured with the Caregiver Burden scale, and the perceived impact of stroke in everyday life, measured with the Stroke Impact Scale (SIS). Results: The satisfied dyads comprised 40%, dissatisfied 26% and those that were discordant 34%. The satisfied dyads reported a significantly lower impact of the stroke in everyday life compared with the dyads that were not satisfied. As expected, dyads that were not satisfied reported a significantly greater caregiver burden compared with the satisfied dyads. The discordant group was further broken down into a group of dissatisfied and satisfied caregivers. The caregivers that were not satisfied in the discordant group perceived a significantly greater level of caregiver burden compared with the satisfied group. Even caregivers who were satisfied with life but whose care recipients were not satisfied reported caregiver burden. Conclusions: Measuring combined life satisfaction provides a unique focus and appears to be a feasible way of attaining the dyads' perspective. The findings suggest that those dyads with a discordant life satisfaction could be vulnerable because of the caregivers' reported caregiver burden. These findings support the importance of a dyadic perspective and add to the understanding of the reciprocal influences between the caregiver and recipient. This knowledge has clinical implications and contributes to the identification of possible vulnerable dyads in need of tailored support.
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| 6. |
- Bergström, Aileen L., et al.
(författare)
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Complex negotiations : The lived experience of enacting agency after a stroke
- 2015
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 22:1, s. 43-53
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This qualitative, longitudinal, descriptive study aimed to understand the lived experience of enacting agency, and to describe the phenomenon of agency and the meaning structure of the phenomenon during the year after a stroke. Agency is defined as making things happen in everyday life through one's actions. Methods: This study followed six persons (three men and three women, ages 63 to 89), interviewed on four separate occasions. Interview data were analysed using the Empirical Phenomenological Psychological method. Results: The main findings showed that the participants experienced enacting agency in their everyday lives after stroke as negotiating different characteristics over a span of time, a range of difficulty, and in a number of activities, making these negotiations complex. The four characteristics described how the participants made things happen in their everyday lives through managing their disrupted bodies, taking into account their past and envisioning their futures, dealing with the world outside themselves, and negotiating through internal dialogues. Conclusions: This empirical evidence regarding negotiations challenges traditional definitions of agency and a new definition of agency is proposed. Understanding clients' complex negotiations and offering innovative solutions to train in real-life situations may help in the process of enabling occupations after a stroke.
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| 7. |
- Bergström, Aileen L., et al.
(författare)
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Participation in everyday life and life satisfaction in persons with stroke and their caregivers 3–6 months after onset
- 2015
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 47:6, s. 508-515
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore and describe persons with stroke and their caregivers' restrictions in participation in everyday occupations, i.e. occupational gaps, 3-6 months post-stroke, in relation to life satisfaction, combined life satisfaction, caregiver burden, perceived impact of stroke, and activities of daily living. Design: Cross-sectional study. Subjects: Persons with stroke and their caregivers (105 dyads). Methods: The Occupational Gaps Questionnaire, Life Satisfaction Checklist, Caregiver Burden Scale, Stroke Impact Scale and Barthel Index were used. Correlations were analysed with Spearman's rank, and regression analyses used life satisfaction as the dependent variable. Results: At least one person in 86% of the dyads perceived restrictions in participation, with the most common gap in travelling for pleasure. Correlations were low between the numbers of occupational gaps and life satisfaction (R=-0.33, R=-0.31); however, life satisfaction accounted for occupational gaps both for persons with stroke and for caregivers. A greater number of occupational gaps were perceived in the dyads with combined low levels of life satisfaction compared with those with combined high levels of life satisfaction. Conclusion: Participation in everyday occupations is related to life satisfaction even for caregivers of persons with stroke. The results of this study add to our knowledge about the stroke-caregiver dyad and will help to inform family-centred approaches within stroke rehabilitation.
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| 8. |
- Bertilsson, Ann-Sofie, et al.
(författare)
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A client-centred ADL intervention: three-month follow-up of a randomized controlled trial
- 2014
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 21, s. 377-391
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim was to study a client-centred activities of daily living (ADL) intervention (CADL) compared with the usualADL intervention (UADL) in people with stroke regarding: independence in ADL, perceived participation, life satisfaction,use of home-help service, and satisfaction with training and, in their significant others, regarding: caregiver burden, lifesatisfaction, and informal care. Methods: In this multicentre study, 16 rehabilitation units were randomly assigned to deliverCADL or UADL. The occupational therapists who provided the CADL were specifically trained. Eligible for inclusion werepeople with stroke treated in a stroke unit £3 months after stroke, dependent in ‡two ADL, not diagnosed with dementia, andable to understand instructions. Data were collected at inclusion and three months thereafter. To detect a significant differencebetween the groups in the Stroke Impact Scale (SIS) domain “participation”, 280 participants were required. Intention-totreatanalysis was applied. Results: At three months, there was no difference in the outcomes between the CADL group(n = 129) and the UADL group (n = 151), or their significant others (n = 87/n = 93) except in the SIS domain “emotion” infavour of CADL (p = 0.04). Conclusion: The CADL does not appear to bring about short-term differences in outcomes andlonger follow-ups are required.
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| 9. |
- Bertilsson, Ann Sofie, et al.
(författare)
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A cluster randomized controlled trial of a client-centred, activities of daily living intervention for people with stroke : One year follow-up of caregivers
- 2016
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 30:8, s. 765-775
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Compare caregiver burden, provision of informal care, participation in everyday occupations and life satisfaction of caregivers to people with stroke, who either had received a client-centred, activities of daily living intervention or usual activities of daily living interventions. Design: A multicentre cluster randomized controlled trial in which 16 rehabilitation units were randomly assigned to deliver a client-centred, activities of daily living intervention or usual activities of daily living interventions. Caregiver outcomes were compared cross-sectionally at 12 months and changes in outcomes between three and 12 months after people with stroke were included in the study. Setting: Inpatient and outpatient rehabilitation. Participants: Caregivers of people with stroke enrolled in the trial. Intervention: A client-centred, activities of daily living intervention aiming to increase agency in daily activities and participation in everyday life for people after stroke. Main measures: Caregiver Burden Scale, Occupational Gaps Questionnaire, LiSat-11. Results: There were no differences in outcomes between caregivers in the client-centred, activities of daily living (n = 88) and the usual activities of daily living (n = 95) group at 12 months. The caregiver burden score was 42.7 vs. 41.8, p = 0.75, mean occupational gaps were 3.5 vs. 4.0, p = 0.52 and satisfaction with life was 53% vs. 50%, p = 0.87. There were no differences in changes between three and 12 months. However, within groups there were significant differences in caregiver burden, factor general strain, for caregivers in the client-centred, activities of daily living group, and in provision of informal care for the usual activities of daily living group. Conclusion: The client-centred intervention did not bring about any difference between caregiver-groups, but within groups some difference was found for caregiver burden and informal care.
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| 10. |
- Bertilsson, Ann-Sofie, et al.
(författare)
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Client-centred ADL intervention after stroke : Significant others' experiences
- 2015
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 22:5, s. 377-386
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Tidskriftsartikel (refereegranskat)abstract
- Background: Client-centredness is a prominent contemporary concept in rehabilitation. However, there is a lack of knowledge on if and how a client-centred rehabilitation approach is incorporated in the everyday life of significant others of people who receive such rehabilitation. Objective: Explore and describe if and how a client-centred ADL intervention (CADL) was integrated in the everyday lives of significant others of people with stroke. Materials and methods: Qualitative longitudinal design, with a grounded theory approach. Seven significant others, who cohabited with persons receiving a CADL intervention, were interviewed during the first year. Findings: One core category was identified: "Taking responsibility and achieving balance with respect to self-esteem in order to get on with everyday life". The integration of the CADL was a process. A key aspect was that as the person with stroke acted upon his/her own desired activity goals the significant others were encouraged to act on their own needs. Conclusions: Enablement is important also for the significant others of people with stroke. One way of enabling significant others to maintain an active lifestyle and find respite in everyday life might be to enable people with stroke to formulate and act upon their desired activity goals.
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| 11. |
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| 12. |
- Erikson, Anette, et al.
(författare)
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LIVING WITH THE LONG-TERM CONSEQUENCES 11-13 YEARS AFTER STROKE : A PHENOMENOLOGICAL STUDY
- 2016
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 48:10, s. 847-852
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To follow up an original research project of persons 11-13 years after stroke, in order to describe and understand the impact of stroke on everyday life experienced during these years. Design: Eleven persons who had had a stroke were interviewed 11-13 years after the original research project. Data were collected and analysed using the empirical phenomenological psychological method. Results: Three main characteristics were identified from analysis of participants' experiences during the years after stroke: (i) going through the loss of the previous life; (ii) struggling to reclaim the former existence; (iii) finding meaning in a new and different world. Conclusion: This study provides an understanding of the complexity of the lost connection between body and world occurring for a long time after stroke. This understanding provides support for the need for long-term and intermittent support and guidance to enable the re-creation of meaning and participation in everyday life in order to find a new self-identity after stroke, especially among persons with residual cognitive impairment.
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| 13. |
- Erikson, Anette, et al.
(författare)
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The lived experience of memory impairment in daily occupation after acquired brain injury
- 2007
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Ingår i: OTJR (Thorofare, N.J.). - : SAGE Publications. - 1539-4492 .- 1938-2383. ; 27:3, s. 84-94
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to identify what characterized the lived experience of memory impairment in daily occupations during the first year after acquired brain injury. Four participants were interviewed on four occasions during the year after the brain injury. The data were collected and analyzed using the Empirical Phenomenological Psychological method. The findings revealed four main characteristics that described the individual's experiences during the year of rehabilitation: a chaotic life-world, struggling for coherent doing in new contexts, conscious strategies in new contexts, and achieving new habits. After the brain injury, the life-world changed from a taken-for-granted existence to a chaotic world that was difficult to understand. The routine performance of daily activities and the habit patterns had broken down, so it was mostly the familiar activities that were already integrated in the ""habit-body"" that enabled coherent doings in everyday life during the year. The findings contribute to an understanding of how to use familiar and meaningful occupations as a therapeutic medium in the rehabilitation of clients with memory impairment following acquired brain injury.
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| 14. |
- Eriksson, Gunilla, et al.
(författare)
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A cross-diagnostic validation of an instrument measuring participation in everyday occupations : The Occupational Gaps Questionnaire (OGQ)
- 2013
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 20:2, s. 152-160
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to validate the Occupational Gaps Questionnaire (OGQ) when used in samples of people with acquired brain injuries (ABI), stroke, stress-related disorders, concussion, and persons receiving rehabilitation after ABI to investigate whether the OGQ could be used as a generic scale. A total of 601 individuals answered the OGQ at various time points after illness/injury. A Rasch analysis was performed on the data to evaluate evidence of internal scale validity and person response validity, and the capability of the OGQ to separate people into different levels of participation in everyday occupations. The results provided evidence that the OGQ is a valid measure across different diagnostic groups. A generic version of the OGQ can separate at least two levels of perceived occupational gaps and is therefore recommended as a screening tool to be used by occupational therapists working with different diagnostic groups.
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| 15. |
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| 16. |
- Eriksson, Gunilla, et al.
(författare)
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Occupational gaps in everyday life 1-4 years after aquired brain injury
- 2006
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 38:3, s. 159-65
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore adaptation, by examining the occupational gaps occurring between what individuals want to do and what they actually do in terms of their everyday activities before and after brain injury. In addition, the relationships between occupational gaps and impairment/activity limitations and the time lapse since the brain injury were explored. Design: A cross-sectional study. Subjects: A total of 187 persons, affected by traumatic brain injury or subarachnoid haemorrhage 1–4 years previously. Methods: A postal questionnaire encompassing questions concerning gaps in the performance of activities in everyday life before and after the brain injury and perceived impairment/activity limitations. Results: The numbers of occupational gaps increased after the injury, with the number of gaps having increased from 46% to 71%. The number of occupational gaps was significantly related to executive impairment/activity limitations, and motor impairment/activity limitations and other somatic impairments, such as headache, also had an impact. The time lapse since the brain injury had no significant effect on the number of occupational gaps. Conclusion: The results suggests that there is a need for adaptation in everyday activities, even several years after a brain injury, which indicates that follow-up and access to individualized rehabilitation interventions in the long-term are required.
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| 17. |
- Eriksson, Gunilla, et al.
(författare)
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Relationship between occupational gaps in everyday life, depressive mood and life satisfaction after acquired brain injury
- 2009
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 41:3, s. 187-194
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the relationship between occupational gaps, depressive mood and life satisfaction in persons who have acquired a brain injury during the past 1-4 years and to test the Occupational Gaps Questionnaire. Design: A cross-sectional study. Subjects: A total of 116 persons with traumatic brain injury or subarachnoid haemorrhage acquired 1-4 years previously. Methods: A postal survey with questions on occupational gaps, focusing on the domains instrumental activities of daily living, social life, leisure and work (Occupational Gaps Questionnaire), life satisfaction (LiSat-11 checklist) and depressive mood (Hospital Anxiety and Depression Scale). Rasch analyses and principal component analyses were performed to ensure that data from the LiSat-11 and Occupational Gaps Questionnaire could be used subsequently as valid unidimensional measures in regression and correlational analyses. Results: Calibration of the Occupational Gaps Questionnaire and the LiSat-11 revealed that the items and persons demonstrated acceptable goodness-of-fit to the Rasch models respectively, supporting internal scale validity and person-response validity. In addition, principal component analyses revealed that the measures could be used as valid uni-dimensional estimations of occupational gaps and life satisfaction. There was a strong relationship between the extent of occupational gaps and perceived life satisfaction, a weaker relationship with depressive mood and a non-significant relationship with the aetiological diagnoses and life satisfaction. The factors explained 32% (occupational gaps), 6% (depressive mood), and 2% (diagnosis), respectively, of the total explained variance (40%). Conclusion: There was a strong correlation between participation in desired everyday occupations and life satisfaction 1-4 years after an acquired brain injury. This indicates that individually perceived occupational gaps, as recorded by the for tailored interventions in order to improve life satisfaction among clients with acquired brain injuries.
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| 18. |
- Eriksson, Gunilla, et al.
(författare)
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The Meaning of Occupational Gaps in Everyday Life in the First Year After Stroke
- 2010
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Ingår i: OTJR (Thorofare, N.J.). - : SAGE Publications. - 1539-4492 .- 1938-2383. ; 30:4, s. 184-192
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Tidskriftsartikel (refereegranskat)abstract
- This longitudinal study identified how occupational gaps were characterized in people's lived experiences of performing everyday occupations during the first year after stroke. Four participants were interviewed four times during the year after stroke. The data were collected and analyzed using the Empirical, Phenomenological, Psychological method. Five main characteristics were identified: (1) encountering occupational gaps in formerly taken-for-granted activities, (2) striving to narrow gaps in desired occupations, (3) recognizing oneself in doing, (4) searching for a new sense of self through doing, and (5) creating strategies to enable doing. The findings show the importance of being able to preserve some sense of self in everyday doings after a life course disruption caused by stroke. Important implications for clinical practice include sensitivity to clients' experiences during this process, enablement of experiences in occupations promoting recognition, and support of clients in recapturing desired occupations.
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| 19. |
- Eriksson, Therese, et al.
(författare)
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A comparison of perceived occupational gaps between people with stress-related ill health or musculoskeletal pain and a reference group
- 2012
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 19:5, s. 411-420
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe and compare how occupational gaps were reported in everyday occupations in a rehabilitation group of people with musculoskeletal pain or stress-related ill health and in a reference group from the Swedish population.Method: Seventy-two persons with musculoskeletal pain or stress-related ill health and 261 people from the Swedish population were included. The Occupational Gaps Questionnaire, measuring to what extent individuals perceive a discrepancy between what they want to do and what they actually do, was completed by the participants. Descriptive statistics were used to analyse the data.Results: Occupational gaps were reported more often in the rehabilitation group. Leisure activities were the gaps reported most often. The occupational repertoire seemed to decrease over time as the number of activities was decreasing, particularly leisure and work-related activities. Instrumental ADL were more desirable as the length of sick leave extended.Conclusions: Being on sick leave appears to start a process towards occupational deprivation where the areas that remain in the occupational repertoire become more important. Our study highlights the need to emphasize the whole occupational repertoire in rehabilitation and to facilitate engagement in valued activities to create a sound base for the process of returning to work.
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| 20. |
- Gahnström-Strandqvist, Kitty, et al.
(författare)
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The meaning of the working cooperative for persons with long-term mental illness : A phenomenological study
- 2003
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Ingår i: American Journal of Occupational Therapy. - : AOTA Press. - 0272-9490 .- 1943-7676. ; 57:3, s. 262-272
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this phenomenological study was to understand the meanings of the lived experiences of persons with long-term mental illness at a social working cooperative. Eighteen participants were interviewed either two or three times while participating in a working cooperative in a community psychosocial rehabilitation program. Data were analyzed and interpreted using the Empirical, Phenomenological, Psychological (EPP) method (Karlsson, 1993). The findings revealed a meaning-structure consisting of one main constituent that characterized the cooperative as a normalizing life-world. Three phases contributed to the normalization process. In the first phase the participants experienced a shift from an unsatisfying occupational context to an enriching occupational life-world. In the second phase participants had the possibility to satisfy some of their occupational and social needs. During this phase, experiences of being productive and needed, commitment to others, development of their skills, and competence in work tasks and social activities were expressed. In the third phase, the meaning of the cooperative changed for some participants, who expressed this through their readiness to leave and take a further step into the life-world outside the cooperative.
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| 21. |
- Guidetti, Susanne, et al.
(författare)
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A "client-centred activities of daily living" intervention for persons with stroke: One-year follow-up of a randomized controlled trial
- 2015
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 47, s. 605-611
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare changes regarding perceived participation,independence in activities of daily living (ADL) andlife satisfaction between 3, 6 and 12 months after inclusion ina study of a client-centred ADL intervention and usual ADLintervention after stroke.Design: A multicentre randomized controlled trial.Methods: Sixteen rehabilitation units were randomly assignedto provide client-centred ADL intervention or usualADL intervention. Eligible participants were persons ≤ 3months after stroke who had been treated in a stroke unit,were dependent in two ADL domains, had not been diagnosedwith dementia, and were able to understand instructions.Data collection was performed by blinded assessors.The primary outcome, perceived participation, was assessedwith the Stroke Impact Scale 3.0, domain 8. The secondaryoutcomes, participation, independence in ADL, and lifesatisfaction, were assessed with validated instruments. Forstatistical power, 280 participants were required. Statisticalanalyses were performed on an intention-to-treat basis.Results: There were no differences between the groups regardingchanges in perceived participation, independence inADL, or life satisfaction during the first 12 months. Therewas a trend towards a clinically meaningful positive changein perceived participation that favoured client-centred ADLintervention.Conclusion: Further research is required to understand thebenefits of client-centred interventions.
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| 22. |
- Guidetti, S., et al.
(författare)
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A feasibility study of a mobile phone supported family-centred activities of daily living (ADL) intervention, F@ce, after stroke in Uganda
- 2018
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Ingår i: International Journal of Stroke. - : Sage Publications. - 1747-4930 .- 1747-4949. ; 13:Suppl. 3, s. 25-25
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: The aim of this study was to evaluate the feasibility of: i) a mobile phone supported family-centred intervention, F@ce, ii) the study design for evaluating the effects of the intervention on the perceived impact of stroke, perceived participation in everyday life, and self-efficacy in everyday activities among persons with stroke and their families in Uganda. Methods: A pre-post design with an intervention group (IG) and a control group (CG) (n¼30). The inclusion criteria were: confirmed stroke diagnosis, access to and ability to use a mobile phone, able to express themselves in English and/or Luganda, >18 years of age, resident in Kampala and its surroundings
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| 23. |
- Guidetti, Susanne, et al.
(författare)
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Activities in Daily Living : The development of a new client-centred ADL intervention for persons with stroke
- 2022
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 29:2, s. 104-115
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAn intervention that contains several interacting components can be defined as a complex intervention. This intervention was developed in accordance with the Medical Research Council (MRC) guidance for complex interventions.AimTo describe the development, theoretical framework, and content of a client-centred activities in daily living intervention (CADL) for people with stroke.Material and methodsDifferent steps were used; identifying the evidence base, identifying/developing theory and the modelling process and outcomes in the development of the CADL. The remodelling of the process and content of the intervention that emerged are defined.ResultsFindings from a series of qualitative studies of people with stroke demonstrated the need to develop an ADL intervention based on the clients’ lived experiences. The theoretical framework is based on empirical research, theories about human occupation and client-centredness. The CADL is applying an occupational and phenomenological perspective in order to enable agency in daily activities and participation in everyday life among persons with stroke.Conclusions and significanceThe article can be used as an example of how to present the development and theoretical framework of a new complex intervention in occupational therapy.
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| 24. |
- Guidetti, S., et al.
(författare)
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Development and evaluation of the effect and feasibility of a person-centred multidisciplinary intervention for rehabilitation after stroke
- 2018
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Ingår i: International Journal of Stroke. - : Sage Publications. - 1747-4930 .- 1747-4949. ; 13:Suppl. 3, s. 62-62
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: The aim of this study was to evaluate the feasibility of using a person-centred ICT based intervention (F@CE) within multidisciplinary teams to increase the clients’ participation in everyday life after stroke in terms of study design and outcomes. The F@CE intervention was developed in collaboration with web developers and future users based on the Medical Research Council guidelines. A web-platform was created to provide a structure for the rehabilitation process and facilitate change by integrating a global problem solving strategy with SMS-reminders. Methods: 3 teams consisting of occupational therapists and physiotherapists working in neurological rehabilitation took part in 3 workshops including lectures, discussions and practical exercises. The participating teams then enrolled 10 clients with stroke that participated in the intervention. Goals were set using COPM and the clients scored their 3 goals each day during 8 weeks. Data was collected at inclusion, at 4 and 8 weeks using COPM, SIS, Self-Efficacy, LISAT-11, follow-up survey, daily ratings in the web-platform and by logbooks. Results: Response rates were 44–100% (mean 78%). Improvement was shown by COPM on both performance and satisfaction. In SIS 3.0 the items strength and ADL were those were the largest proportion of participants had improved at follow-up were strength and ADL/IADL (80 %) followed by memory, communication and mobility (70 %). Conclusion: All were satisfied with F@CE and the benefits of daily reminders of the goals which encouraged them to be more active. The only downside described was that they felt obligated to practice, although described as “a positive must”.
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| 25. |
- Guidetti, Susanne, et al.
(författare)
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F@ce: a team-based, person-centred intervention for rehabilitation after stroke supported by information and communication technology : a feasibility study
- 2020
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Ingår i: BMC Neurology. - : BioMed Central (BMC). - 1471-2377. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Globally, there is a growing use of Information and Communication Technology (ICT), including mobile phones, tablets and computers, which are being integrated into people's daily activities. An ICT-based intervention called F@ce was developed in order to provide a structure for the process in stroke rehabilitation and facilitate change by integrating a global problem-solving strategy using SMS alerts. The aim of the study was to evaluate the feasibility of i) F@ce within in-patient and primary care rehabilitation after stroke, ii) the study design and outcome measures used, and iii) the fidelity, adherence and acceptability of the intervention.METHODS: Three teams comprising occupational therapists and physiotherapists who work in neurological rehabilitation participated in a preparatory workshop on F@ce and then enrolled 10 persons with stroke to participate in the intervention. Goals were set using the Canadian Occupational Performance Measure (COPM) and the participants with stroke rated their performance and satisfaction with the activities associated with the three goals every day for 8 weeks. Data were collected at inclusion, at four and 8 weeks, using the COPM, Stroke Impact Scale, Frenchay Activities Index, Life Satisfaction Checklist, Self-Efficacy Scale, Hospital Anxiety and Depression Scale, Fatigue Severity Scale, follow-up survey, daily ratings on the web platform and logbooks.RESULTS: All of the participants showed increased scores in the primary outcome (COPM) and a clinically meaningful improvement of ≥2 points was found in four participants regarding performance and in six participants regarding satisfaction. Overall fidelity to the components of F@ce was good. The response rates to the F@ce web platform were 44-100% (mean 78%). All of the participants stated that F@ce had supported their rehabilitation.CONCLUSION: The results indicate that the most beneficial part of F@ce was the person-centred, goal-setting process and SMS alerts. All participants were satisfied with F@ce and highlighted the benefits of receiving daily alerts about their goals. This encouraged them to be more active. The only downside mentioned was that they felt under an obligation to practice, although this was described as "a positive obligation".
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| 26. |
- Gustavsson, Martha, 1980-, et al.
(författare)
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Experiences of using information and communication technology within the first year after stroke – a grounded theory study
- 2018
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Ingår i: Disability and Rehabilitation. - Abingdon, Oxfordshire, United Kingdom : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 40:5, s. 561-568
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this study was to identify how people 6–12 months after stroke were using and integrating information and communication technology (ICT) in their everyday lives.Method: To capture the participants’ experiences, one focus group and 14 individual interviews were carried out in Sweden and Denmark regarding the use of ICT in everyday life. The participants comprised 11 men and seven women aged 41–79 years. A grounded theory approach was used throughout the study and a constant comparative method was used in the analysis.Results: Five categories were identified from the analysis of the interviews with the participants: 1) Using the mobile phone to feel safe, 2) Staying connected with others, 3) Recreating everyday life, 4) A tool for managing everyday life, and 5) Overcoming obstacles for using ICT. From these categories one core category emerged: The drive to integrate ICT in everyday life after stroke.Conclusions: People with stroke had a strong drive to integrate ICT in order to manage and bring meaning to their everyday lives, although sometimes they needed support and adaptations. It is not only possible but also necessary to start using ICT in rehabilitation in order to support people’s recovery and promote participation in everyday life after stroke.Implications for rehabilitation People with stroke have a strong drive for using information and communication technology in their everyday lives, although support and adaptations are needed.The recovery process of people with stroke could benefit from the use of ICT in the rehabilitation and ICT could possibly contribute to independence and promote participation in everyday life.Knowledge from this study can be used in the development of an ICT-based stroke rehabilitation model.
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| 27. |
- Hellman, Therese, et al.
(författare)
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Connecting rehabilitation and everyday life - the lived experiences among women with stress-related ill health
- 2013
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 35:21, s. 1790-1797
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim was to describe and understand how connecting rehabilitation experiences and everyday life was characterised in the lived experiences during the rehabilitation in women with stress-related ill health. Method: Five women were interviewed on three occasions during a rehabilitation programme and once 3 months later. Data were analysed using the Empirical, Phenomenological and Psychological method. Results: The participants experienced connections between their rehabilitation and their previous, present and future everyday life influencing both rehabilitation and everyday life in a back-and-forth process. These connections were experienced in mind or in doing, mostly targeting the private arena in everyday life. Connecting rehabilitation experiences to their working situations was more challenging and feelings of frustration and being left alone were experienced. Conclusions: Although the participants described constructive connections between rehabilitation experiences and the private arena in everyday life, they mostly failed to experience connections that facilitated a positive return to work. Recommended support in the return to work process in rehabilitation comprises the provision of practical work-related activities during rehabilitation; being supportive in a constructive dialogue between the participant and the workplace, and continuing this support in follow-ups after the actual rehabilitation period. Implications for Rehabilitation Rehabilitation for persons with stress-related ill health needs to focus on the private arena as well as the work situation in everyday life. Creative activities may enable experiences that inspire connections in mind and connections targeting the private arena in everyday life. The work situation needs to be thoroughly discussed during rehabilitation for enabling the participants to experience a support in the return to work process. Rehabilitation including practical work-related activities, support in a constructive dialogue between the participant and the manager at the workplace, and continued support in follow-ups targeting the workplace might be beneficial for successfully return to work.
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| 28. |
- Johansson, Ulla, et al.
(författare)
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The meaning of work after acquired brain injury
- 2006
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Ingår i: American Journal of Occupational Therapy. - : AOTA Press. - 0272-9490. ; 60:1, s. 60-69
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Research in the field of brain injury rehabilitation has tended to regard return to work as a measure of outcome. Researchers have not paid particular attention to the experiences of people living with a brain injury. The aim of the phenomenological study reported here was to identify and describe what characterizes the meaning of work to those with acquired brain injury. METHODS: Ten participants of working age were interviewed about the meaning of work 1-5 years after being inflicted with a brain injury. Data were analyzed and interpreted using the Empirical Phenomenological Psychological method. RESULTS: The findings revealed a meaning structure consisting of four main characteristics. Work was no longer experienced as the primary event in life and the social dimension had become more important. The perceived competence and work identity were threatened after the injury. A common theme across all interviews was the struggle to return to a state of normality, and working was considered to be evidence of success. CONCLUSION: The findings described the altered meaning of work 1-5 years after brain injury. This knowledge should lead to an increased understanding among occupational therapists engaged in work rehabilitation after brain injury and can serve as a basis for individualized intervention strategies.
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| 29. |
- Kamwesiga, Julius T, et al.
(författare)
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A feasibility study of a mobile phone supported family-centred ADL intervention, F@ce™, after stroke in Uganda
- 2018
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Ingår i: Globalization and Health. - : BioMed Central. - 1744-8603. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a lack of evidence-based health services to reduce the impact of stroke in low-income countries at a personal, family or community level. The aim was to evaluate the feasibility of: i) a mobile phone supported family-centred intervention (F@ce™), and ii) the study design for evaluating the effects of the intervention on the perceived impact of stroke; perceived participation in everyday life; and self-efficacy in everyday activities amongst persons with stroke and their families in Uganda. Methods: The study comprised a pre-post design with an intervention group (IG) receiving the F@ce™ and a control group (CG). The inclusion criteria’s were: a) confirmed stroke diagnosis, b) access to and ability to use a mobile phone, c) ability to communicate in English and/or Luganda, d) > 18 years, e) residents in Kampala, and f) a Modified Rankin Scale level 2 to 4. The aim of the F@ceTM was to increase functioning in daily activities for persons living with the consequences of stroke, and participation in everyday life for persons with stroke and their families. The F@ce™ was an eight-week family-centred intervention, which entailed goal setting and problem-solving strategies, daily reminders and self-rated follow-ups of performance by short message service (SMS). Data were collected in the participants’ home environment at baseline and after eight weeks. Data on acceptability of the F@ce™ and study procedures were collected by log-books and the responses of the SMS follow ups on the server. The primary outcomes were performance and satisfaction of valued daily activities in everyday life using the Canadian Occupational Performance Measure (COPM), self-efficacy in performance of activities in daily life. Results: The IG comprised n = 13 and the CG n = 15. There were differences between the IG and CG in changes between baseline and follow-up in the primary outcomes COPM (performance component) and self-efficacy in favour of F@ce™. Overall with minor modifications the intervention and the study design were feasible for all participants involved. Conclusion: The results support the need for further research to rigorously evaluate the effects of F@ce™ since the intervention appears to be feasible for persons with stroke and their family members.
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| 30. |
- Medin, Jörgen, et al.
(författare)
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Eating difficulties among patients 3 months after stroke in relation to the acute phase
- 2012
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Ingår i: Journal of Advanced Nursing. - Malden, USA : Wiley-Blackwell. - 0309-2402 .- 1365-2648. ; 68:3, s. 580-9
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This paper is a report of a study comparing eating difficulties among patients 3 months after stroke in relation to the acute phase.Background: There is limited knowledge of patients with eating problems early after stroke, hence the progress of eating abilities needs to be further explored.Method: From March 2007 to June 2008 36 stroke patients with 2-7 eating difficulties or problems with reduced alertness or swallowing in the acute phase were included. Eating difficulties were detected using a structured protocol of observation of meals. In addition, stroke severity (National Institute of Health Stroke Scale), functional status (Barthel Index), unilateral neglect (Line Bisection test and Letter Cancellation test), psychological well-being (The Well-being Questionnaire-12), nutritional status (Mini Nutritional Assessment) and oral status (Revised Oral Assessment Guide) were assessed.Results: There were 36 participants (58% female) with a median age of 74·5 years. The proportion of eating difficulties decreased significantly from the acute phase to the 3-month follow-up in 'sitting position', 'managing food on the plate' and 'manipulating food in the mouth' and increased regarding inadequate food consumption. Improvements were shown at 3 months in stroke severity, functional status, nutritional status and neglect. Oral status and psychological well-being remained unchanged.CONCLUSION: The majority of eating problems persisted 3 months after stroke despite a marked improvement in most of the physical functions. The unchanged psychological well-being and sustained problems with food consumption indicate that factors other than physical function should be taken into account regarding eating difficulties poststroke.
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| 31. |
- Medin, Jörgen, et al.
(författare)
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Eating difficulties among stroke patients in the acute state : a descriptive, cross-sectional, comparative study
- 2011
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Ingår i: Journal of Clinical Nursing. - Malden, USA : Wiley-Blackwell. - 0962-1067 .- 1365-2702. ; 20:17-18, s. 2563-2572
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Tidskriftsartikel (refereegranskat)abstract
- Aims and obkectives: To examine eating difficulties among stroke patients - a comparison between women and men.Background: Gender differences have been reported in studies of stroke, but the findings are inconclusive and few of these studies have specifically focused on gender differences in eating difficulties.Design: This study was a descriptive, cross-sectional, comparative study.Method: Patients with stroke were recruited at a general hospital in Sweden. To detect eating difficulties, individual observations of the patients were made during one meal using a structured observation protocol. Assessment also included measurements of nutritional and oral status, degree of independence, stroke severity, neglect and well-being.Results: One hundred and four patients (53·8% women) were included in the study. The proportion of stroke patients with one or more eating difficulties was 81·7%. The most common eating difficulties were 'managing food on the plate' (66·3%), 'food consumption' (54·8%) and 'sitting position' (45·2%). Women had lower 'food consumption', more severe stroke (p = 0·003), worse functional status (p = 0·001) and lower quality of life (QoL) (p=0·038) than men. More women than men were malnourished and living alone. After adjustment for functional status and motor arm, the odds ratio of having difficulties with food consumption was four times higher among women than men (1·7-9·4, confidence interval 95%).Conclusions: More women than men with stroke suffered from inadequate food consumption. The women had more severe strokes, experienced poorer QoL and showed lower functional status than the men. In the rehabilitation process of women with stroke, these factors should be taken into consideration.Relevance ti clinical practice: Structured observation of meals, including assessment of food consumption, might be necessary in acute stroke care to detect patients, especially women, who might need closer supervision and nutritional intervention.
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| 32. |
- Medin, Jörgen, et al.
(författare)
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Elderly persons' experience and management of eating situations 6 months after stroke.
- 2010
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Ingår i: Disability and Rehabilitation. - Oxon, United Kingdom : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 32:16, s. 1346-1353
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To explore the experience and management of eating situations among persons affected by stroke, 6 months after stroke onset.Method: A qualitative constant comparative approach, influenced by principles of grounded theory, was used to analyse the interviews. Thirteen participants were interviewed in the home setting 6 months after the stroke.Results: Experiences and desire to master eating situations varied, and was related to values and previous habits. Eating difficulties were experienced as disgusting, uncomfortable, strenuous, or unproblematic and not implying shame. Getting help from others could be experienced as embarrassing and undesirable. In particular, eating could be more difficult when eating in company of unfamiliar people. The participants found new ways of mastering eating situations. Some had regained former routines.Conclusions: Old values and habits and/or involvement of other people were the basis of mastering eating situations. New ways of mastering were found, some accepted, and got used to the new situation. Some regained former routines. This knowledge could contribute to health care personnel's awareness of each patient's individual values and previous habits during the rehabilitation process. A dialogue is needed with the person suffering from eating difficulties after stroke, to help create the best possible individual conditions for mastering eating situations.
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| 33. |
- Medin, Jörgen, et al.
(författare)
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Striving for control in eating situations after stroke
- 2010
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Ingår i: Scandinavian Journal of Caring Sciences. - Malden, USA : Wiley-Blackwell. - 0283-9318 .- 1471-6712. ; 24:4, s. 772-80
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Tidskriftsartikel (refereegranskat)abstract
- THE study's rationale: Eating difficulties are common after stroke. However, to better meet individuals' needs, in terms of care, support and rehabilitation after stroke, it was considered important to know more about how patients with stroke experience their eating difficulties while in process of regaining their ability.Aims and objectives: The aim of this study was to explore the experience of eating difficulties among patients with stroke 3 months after stroke onset.Methodological design and justification: A qualitative interpretive descriptive approach was used. The analysis was based on constant comparative approach, using the principles of grounded theory.Research methods: The study included 14 participants with stroke and eating difficulties. A semi-structured interview guide with open-ended questions and probes was used. The interview guide was gradually modified during the data collection process. The interviews were digital audio recorded and fully transcribed. Memos were documented simultaneously with the analysis. Instruments: A structured observation of a meal verified eating difficulties, and semi-structured interviews were conducted.Results 'Striving for control' emerged as a tentative core category. The participants related their striving for control to 'eating safely', and 'eating properly'; they also had to analyse the consequences of their eating difficulties, being careful when eating, and/or avoiding activities. Some also felt a need of help from others. Those others could remind and provide advice in this matter.Conclusion: This study highlights the complexity of having eating difficulties after stroke. Aspects related to the participants' striving for control are based on different strategies to eat safely and properly. Nurses can use this knowledge to support patients in their strive for control by observing them in eating situations. In addition, nurses can also ask them to describe and make explicit the experience of eating situations after stroke.
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| 34. |
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| 35. |
- Patomella, Ann-Helen, et al.
(författare)
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General practitioners' reasoning on risk screening and primary prevention of stroke : a focus group study
- 2018
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Ingår i: BMC Family Practice. - : BioMed Central (BMC). - 1471-2296. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundBy screening and modifying risk factors, stroke incidence can be reduced. Clinical guidelines states that primary prevention of stroke is a responsibility and task of primary health care, but research shows that this not always the case. The aim of the study was to explore and describe what characterizes GPs' reasoning around risk screening and primary prevention among persons at risk for stroke in primary health care.MethodsA qualitative design based in a grounded theory approach was chosen in order to investigate this unexplored research area. Data collection was done using focus group interviews and data was analysed using a constant comparative method. Twenty-two GPs were interviewed in four focus groups.ResultsFindings showed that GPs perceived difficulties in prioritizing patients with an unhealthy lifestyle and described a lack of systematicity in their procedures, which complicated their clinical decisions concerning patients with stroke risk factors. The results showed a lack of systematic risk screening methods. Time constraints and the reimbursement system were described as hindering the preventive work.ConclusionThere is a need for a more proactive, transparent and systematic approach in the distribution of GPs' time and reimbursement of prevention in primary health care. The findings suggest, by developing new methods and approaches such as digital clinical decision-making tools and by implementing inter-professional team-work, the quality of the primary prevention of stroke could be improved.
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| 36. |
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| 37. |
- Ranner, Maria, et al.
(författare)
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Client-centred ADL intervention after stroke : Occupational therapists’ experiences
- 2016
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 23:2, s. 81-90
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Forskningsöversikt (refereegranskat)abstract
- Background: This study was conducted in the context of a randomized controlled trial evaluatingthe effect of a client-centred activities in daily living intervention (CADL). The aim of the CADL wasto enable agency in daily activities and participation in everyday life among persons with stroke.Objective: This qualitative, longitudinal study aimed to describe how occupational therapists (OTs)applied the CADL in their clinical practice by studying their experiences and reflections concerningtheir interaction with the clients with stroke. Methods: Six OTs who conducted the CADL werefollowed through interviews and observations on four separate occasions over one year. Data wereanalysed using a grounded theory approach. Results: Sharing was the core category showing howthe OTs helped their clients to achieve agency in daily activities. Through sharing the situation theOTs strove to obtain an empathetic understanding of the clients’ lived experience throughout thewhole intervention process in order to enable the clients’ ownership of their daily activities.Conclusion: The continuity of sharing seems to be the key for a gradual increase in agency. Theapproach of sharing should preferably be applied by all members of the interprofessional team,including the client and significant others.
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| 38. |
- Ranner, Maria, et al.
(författare)
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Experiences of participating in a client-centred ADL intervention after stroke.
- 2019
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Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 41:25, s. 3025-3033
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Tidskriftsartikel (refereegranskat)abstract
- Background: This qualitative study was conducted in the context of a client-centred activities of daily living (CADL) intervention aiming to enable agency in daily activities and participation in everyday life after stroke. The intervention was based on the principles of client-centred occupational therapy and then further developed based on empirical research findings. Objective: To identify what from the clients’ perspective characterises the lived experience and meaning of participating in a CADL intervention after stroke. Methods: The study included 10 persons with stroke who received the intervention and who were able to communicate their experience of participating. Data were collected through two interviews, after the initiation and after the end of the intervention. The analysis was performed using an empirical phenomenological psychological method. Results: The overall characteristic of the meaning of participating in the intervention was transparency, which was expressed in the participants’ experiences of being able to see and follow their own rehabilitation process. An awareness and understanding of their own situation enabled the participants to be actively involved in their rehabilitation. Conclusion: The intervention contributed to transparency, which appeared to enable and support the client’s sense of ownership of daily activities and rehabilitation after stroke. Implications for rehabiliation A client-centred activities of daily living intervention seems to contribute to transparency, where persons with stroke can discover and understand their new ability and situation after stroke. A client-centred rehabilitation situation seems to enable clients to actively engage in their own rehabilitation process. Inviting clients to participate in goal-setting seems to be important in order to create the experience of transparency. Creating continuity in the therapeutic alliance seems to be important in order for the clients to feel trust and experience agency in everyday life.
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| 39. |
- Tham, Kerstin, et al.
(författare)
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Development of the Assessment of Awareness of disabilities
- 1999
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 6:4, s. 184-190
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Tidskriftsartikel (refereegranskat)abstract
- It is common for clients with stroke to lack awareness of their disabilities, which is an obstacle in the rehabilitation process. The aim of this article is to describe how Rasch measurement methods were used to develop a new Assessment of Awareness of Disability (AAD) and to present a preliminary evaluation of the instrument. Awareness of disability was defined as no discrepancy between the client’s actual disability (measured by the Assessment of Motor and Process Skills, AMPS) and the client’s perceived and verbally described disability in a specific ADL task. AAD consists of an interview guide that includes seven questions (items) that are asked directly after the performance of the AMPS task. The AAD was administered to a target sample of 12 clients with stroke. Four clients were each tested 10 times and 8 clients were each tested once. A Rasch measurement model was used to analyse the AAD data from 48 test sessions. The results indicated that AAD measures a single construct and that it discriminates among clients with different levels of awareness of disability. While the results of this pilot study are promising, the validity and reliability of the AAD need to be further examined on a larger and more varied group of clients.
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| 40. |
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| 41. |
- Tham, Kerstin, et al.
(författare)
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The discovery of disability: A phenomenological study of unilateral neglect
- 2000
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Ingår i: American Journal of Occupational Therapy. - : AOTA Press. - 0272-9490 .- 1943-7676. ; 54:4, s. 398-406
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Clients with right brain damage and unilateral neglect often lack awareness of their disabilities. This study examined how 4 participants with neglect experienced, discovered, and handled their disabilities in the context of their everyday life. Method. The 4 participants were interviewed five to seven times during their rehabilitation process. The data were collected and analyzed using the EPP (empirical, phenomenological, psychological) method. Findings. Findings revealed seven features that described a discovery process for the 4 participants. During this process, each participant began to discover and understand the consequences of her unilateral neglect in the performance of everyday tasks. This increased understanding was a prerequisite to being able to use compensatory strategies. Conclusion. By experiencing meaniongful occupational situations, the participants gradually discovered and began to compensate for their disabilities in everyday life.
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| 42. |
- Tham, Kerstin
(författare)
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Unilateral neglect : aspects of rehabilitation from an occupational therapy perspective
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Unilateral neglect (UN) refers to an inability to orient the attention to stimuli in the contralesional hemispace. This may severely impair the performance of everyday tasks. UN is most common and severe after right brain damage. The general aim of this dissertation was to explore some aspects of importance for the rehabilitation of patients with UN and to develop and evaluate strategies for assessment and intervention. In study I, we developed a new type of neglect assessment, the Baking Tray Task (BTT), presented normative data and compared the BTT with standard neglect tests in a consecutive series of 52 brain-damaged patients. BTT seems to be a sensitive method for identifying extrapersonal neglect. The study also verified the importance of using several different types of tasks in the assessment of UN. Study II evaluated a training strategy based on the assumption that patients with persistent UN also have impaired sustained attention, which interferes with their ability to learn and to use strategies to compensate for their UN. In this experimental case study, all the eight patients improved in both sustained attention and UN. The aim of study III was to explore the motivation for training in four patients with UN. A qualitative approach was used. The findings suggest that motivation is a complex phenomenon, which is closely related to awareness of disabilities. In study IV, we examined if video feedback is a useful tool to give patients feedback on their neglect behaviour during task performance. Video technique allows the patients to see the left side of the task on the right side of the TV monitor. Video feedback seems to be a useful method for helping patients to become more aware of their disabilities related to UN. In study V, an attempt was made to train awareness of disabilities in everyday tasks. The assumption was that many patients with UN are unaware of their disabilities, which interferes with their engagement in learning compensatory strategies in everyday tasks. We found that training seems to improve not only awareness of disabilities, but also UN and ADL ability. In the phenomenological study VI, four patients with UN described how they experienced and discovered their disabilities and how they learned to handle them in everyday life. The study describes the features of a discovery process. Patients needed to experience their disabilities in the context of everyday life to become more aware of them and to learn how to use compensatory strategies.
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| 43. |
- Tistad, Malin, et al.
(författare)
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Different perspectives on disability three months after stroke : a mixed methods approach
- 2011
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Ingår i: 16th Nordic Congress on Cerebrovascular Diseases. - Tallinn, Estland.
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Konferensbidrag (refereegranskat)abstract
- Abstract Background A substantial number of people who have suffered a stroke perceive unmet needs for rehabilitation and other health care services. Disability is one of the phenomena underlying people’s need for health care services and disability/problems can be viewed both from the perspective of people with stroke (felt problems), and from the perspective of health professionals (assessed problems). Objective The aim was to describe the felt problems three months after stroke and to explore the concurrence between the felt problems and the assessed problems. Method The patients (n=203) received care in the stroke units at Karolinska University Hospital, Sweden. Felt problems, collected by posing an open question, were categorized. Results from three established assessment tools: Katz Extended Index of ADL (KE); Barthel Index (BI) and Stroke Impact Scale (SIS) represented assessed problems. Items/domains in the assessment tools that corresponded to the categories of felt problems were identified and comparisons between the felt problems and the assessed problems performed. Result Fatigue was the category with the largest number of felt problems (n=58, 28%). Fourteen out of the 28 categories of felt problems, had corresponding items/domains in the KE/ BI and the SIS. The KE/BI failed to identify 16-57% of the felt problems whereas the SIS failed to identify 0-33%. Conclusion There was a substantial lack of concurrence between felt and assessed problems. The results indicate that the use of standardized instruments has to be complemented by open questions and dialogue if the health care services are to be based on the problems experienced by the patients.
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| 44. |
- Tistad, Malin, et al.
(författare)
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Different perspectives on disability three months after stroke : a mixed methods approach
- 2011
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Ingår i: 20th European Stroke Conference. - Hamburg, Tyskland.
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Konferensbidrag (refereegranskat)abstract
- Abstract Background People who have suffered a stroke perceive to a large extent unmet needs of rehabilitation. Needs of health care services can be viewed from the perspective of the phenomena underlying the need i.e. the disability/problems and also from the perspective of the people with stroke as well as the health professionals. The aim was to describe disability/problems from the perspective of the people with stroke, represented by felt problems, reported by patients three months after stroke and to examine if there were differences between men and women. A further aim was to explore the concurrence between the perspective of the people with stroke (felt problems) and the perspective of the health professionals (assessed problems). Methods The patients (n=203) received care at the stroke units at Karolinska University Hospital, Sweden. Felt problems, collected using an open question, were categorized. Results from three established assessment tools: Katz Extended Index of ADL (KE); Barthel Index (BI) and Stroke Impact Scale (SIS) represented assessed problems. Items/domains in the assessment tools that corresponded to the categories with felt problems were identified and comparisons performed. Results Fatigue was the category in which the largest number of patients reported felt problems (n=58, 28%). More women than men had felt problems in the category Acquisition, meals and housework (p=0.01) whereas more men had felt problems in the categories Employment (p=0.02) and Driving (p=0.009). Fourteen out of the 28 categories of felt problems had corresponding items/domains in the KE/ BI and the SIS. The KE/BI failed to capture 16-57 % of the felt problems whereas the SIS failed to capture 0-33 %. Conclusion There was a substantial lack of concurrence between felt and assessed problems indicating that the use of assessment tools has to be complemented with open questions if health services are to address the problems experienced by the patients.
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| 45. |
- Tistad, Malin, et al.
(författare)
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Poor concurrence between disability as described by patients and established assessments tools three months after stroke
- 2011
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Ingår i: Conference on Advances in Health Care Science Research. - Stockholm.
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Konferensbidrag (refereegranskat)abstract
- A substantial number of people who have suffered a stroke perceive unmet needs for rehabilitation and other health care services. Disability is one of the phenomena underlying people’s need for health care services and disability/problems can be viewed both from the perspective of people with stroke (felt problems), and from the perspective of health professionals (assessed problems). The aims were to describe the felt problems three months after stroke and to explore the concurrence between the felt problems and the assessed problems. The patients (n=203) received care in the stroke units at Karolinska University Hospital, Sweden. Felt problems, collected by posing an open question, were categorized. Results from three established assessment tools: Katz Extended Index of ADL (KE); Barthel Index (BI) and Stroke Impact Scale (SIS) represented assessed problems. Items/domains in the assessment tools that corresponded to the categories of felt problems were identified and comparisons the felt problems and the assessed problems performed. Fatigue was the category with the largest number of felt problems (n=58, 28%). Fourteen out of the 28 categories of felt problems, had corresponding items/domains in the KE/ BI and the SIS. The KE/BI failed to identify 16-57% of the felt problems whereas the SIS failed to identify 0-33%. There was a substantial lack of concurrence between felt and assessed problems. The results indicate that the use of standardized instruments has to be complemented by open questions and dialogue if the health care services are to be based on the problems experienced by the patients.
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| 46. |
- Tistad, Malin, et al.
(författare)
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Poor concurrence between disability as described by patients and established assessments tools three months after stroke : a mixed methods approach
- 2012
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Ingår i: Journal of the Neurological Sciences. - : Elsevier BV. - 0022-510X .- 1878-5883. ; 313:1-2, s. 160-166
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Tidskriftsartikel (refereegranskat)abstract
- Background. Disability/problems, one phenomenon underlying people's need for health care services, can be viewed both from the perspectives of people with stroke (felt problems), and the health professionals (assessed problems). Objective The aim was to describe felt problems three months after stroke and to explore the concurrence between felt problems and assessed problems.Method. The patients (n = 203) received care in the stroke units at Karolinska University Hospital, Sweden. Felt problems, drawn from an open question, were categorized. Results from established assessment tools: Katz Extended Index of ADL (KI); Barthel Index (BI) and Stroke Impact Scale (SIS) represented assessed problems. Items/domains in the assessment tools that corresponded to the categories of felt problems were identified and comparisons performed.Result. The category Fatigue had the largest number of felt problems (n = 58, 28%). Fourteen out of the 24 categories of felt problems had corresponding items/domains in the assessment tools. KE/BI failed to identify 16–57% and SIS 0–33% of the felt problems.Conclusion. There was a substantial lack of concurrence between felt and assessed problems. The results indicate that the use of standardized instruments should be complemented by a dialog if health services are to be based on problems experienced by the patients.
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| 47. |
- Tistad, Malin, et al.
(författare)
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Resource use of healthcare services 1 year after stroke : a secondary analysis of a cluster-randomised controlled trial of a client-centred activities of daily living intervention
- 2018
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 8:8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The objective of the study was to compare the total use of healthcare services in the course of the first year after a stroke between participants who, after the acute care, had received occupational therapy as a client-centred activities of daily living (ADL) intervention (CADL) and participants who had received usual ADL intervention (UADL).DESIGN: A secondary analysis of a multicentre cluster-randomised controlled trial (RCT).SETTING: Primary and secondary care in Sweden.PARTICIPANTS: Participants were included if they: (1) had received CADL or UADL in the RCT, either as inpatients in geriatric rehabilitation units or in their own homes, and (2) data could be retrieved about their use of healthcare services provided by the county council from computerised registers.INTERVENTIONS: CADL or UADL.OUTCOME MEASURES: Inpatient and outpatient healthcare in the course of the first year after stroke.RESULTS: Participants from 7 of the 16 units included in the RCT met the criteria. Participants in the CADL group (n=26) who received geriatric inpatient rehabilitation had a shorter length of hospital stay (p=0.03) than participants in the UADL group (n=46), and the CADL group with home rehabilitation (n=13) had fewer outpatient contacts (p=0.01) compared with the UADL group (n=25). Multiple regression analyses showed that in four of the models, a higher age was associated with a lower use of healthcare services. The use of healthcare services was also associated (some of the models) with dependence in ADL, stroke severity and type of rehabilitation received, CADL or UADL.CONCLUSIONS: The provision of client-centred occupational therapy after stroke did not appear to increase the use of healthcare services during the first year after stroke.rrrrr TRIAL REGISTRATION NUMBER: NCT01417585.
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| 48. |
- Tistad, Malin, et al.
(författare)
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Unfulfilled rehabilitation needs and dissatisfaction with care 12 months after a stroke : an explorative observational study
- 2012
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Ingår i: BMC Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: People who have suffered a stroke commonly report unfulfilled need for rehabilitation. Using a model of patient satisfaction, we examined characteristics in individuals that at 3 months after stroke predicted, or at 12 months were associated with unmet need for rehabilitation or dissatisfaction with health care services at 12 months after stroke.METHODS: The participants (n = 175) received care at the stroke units at the Karolinska University Hospital, Sweden. The dependent variables "unfulfilled needs for rehabilitation" and "dissatisfaction with care" were collected using a questionnaire. Stroke severity, domains of the Stroke Impact Scale (SIS), the Sense of Coherence scale (SOC) and socio demographic factors were used as independent variables in four logistic regression analyses.RESULTS: Unfulfilled needs for rehabilitation at 12 months were predicted by strength (SIS) (odds ratio (OR) 7.05) at three months, and associated with hand function (SIS) (OR 4.38) and poor self-rated recovery (SIS) (OR 2.46) at 12 months. Dissatisfaction with care was predicted by SOC (OR 4.18) and participation (SIS) (OR 3.78), and associated with SOC (OR 3.63) and strength (SIS) (OR 3.08).CONCLUSIONS: Thirty-three percent of the participants reported unmet needs for rehabilitation and fourteen percent were dissatisfied with the care received. In order to attend to rehabilitation needs when they arise, rehabilitation services may need to be more flexible in terms of when rehabilitation is provided. Long term services with scheduled re-assessments and with more emphasis on understanding the experiences of both the patients and their social networks might better be able to provide services that attend to patients' needs and aid peoples' reorientation; this would apply particularly to those with poor coping capacity.
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| 49. |
- Tistad, Malin, et al.
(författare)
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What aspects of rehabilitation provision contribute to self-reported met needs for rehabilitation one year after stroke - amount, place, operator or timing?
- 2013
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Ingår i: Health Expectations. - : Wiley. - 1369-6513 .- 1369-7625. ; 16:3, s. e24-35
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVE: To a large extent, people who have suffered a stroke report unmet needs for rehabilitation. The purpose of this study was to explore aspects of rehabilitation provision that potentially contribute to self-reported met needs for rehabilitation 12 months after stroke with consideration also to severity of stroke.METHODS: The participants (n = 173) received care at the stroke units at the Karolinska University Hospital, Sweden. Using a questionnaire, the dependent variable, self-reported met needs for rehabilitation, was collected at 12 months after stroke. The independent variables were four aspects of rehabilitation provision based on data retrieved from registers and structured according to four aspects: amount of rehabilitation, service level (day care rehabilitation, primary care rehabilitation and home-based rehabilitation), operator level (physiotherapist, occupational therapist, speech therapist) and time after stroke onset. Multivariate logistic regression analyses regarding the aspects of rehabilitation were performed for the participants who were divided into three groups based on stroke severity at onset.RESULTS: Participants with moderate/severe stroke who had seen a physiotherapist at least once during each of the 1st, 2nd and 3rd-4th quarters of the first year (OR 8.36, CI 1.40-49.88 P = 0.020) were more likely to report met rehabilitation needs.CONCLUSION: For people with moderate/severe stroke, continuity in rehabilitation (preferably physiotherapy) during the first year after stroke seems to be associated with self-reported met needs for rehabilitation.
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| 50. |
- Zingmark, Magnus, 1971-
(författare)
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Occupation-focused and occupation-based interventions for community-dwelling older people : Intervention effects in relation to facets of occupational engagement and cost effectiveness
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Occupation-focused and occupation-based interventions can potentially promote occupational engagement among community-dwelling older people, but there is limited evidence to identify the most effective and cost-effective interventions. For independent-living older people, there is a lack of evidence to determine if occupation-focused and occupation-based interventions have an effect on their occupational engagement. For older people who need assistance because of bathing disabilities, there is limited evidence of the effects of occupation-focused and occupation-based interventions on their occupational engagement or for reducing or omitting their need for assistance. Finally, there is limited evidence to determine if occupation-focused and occupation-based interventions implemented for community-dwelling older people are cost effective.AimThe aim of this thesis was to evaluate the effects and cost effectiveness of occupation-focused and occupation-based interventions for two groups of community-dwelling older people, independent-living, community-dwelling older people and older people with bathing disabilities.MethodStudies I and II were based on an exploratory randomized controlled trial. One hundred and seventy seven persons, 77–82 years, single living, and without need for home help were randomized to a no-intervention control group or to one of three occupational therapy interventions focused on promoting occupational engagement: an individual intervention, an activity group or a discussion group. In study I, effect sizes for leisure engagement and ability to perform activities of daily living (ADL) tasks were estimated for each intervention in relation to the control group to identify the most effective intervention at 3 and 12 months after baseline. In study II, the effects on quality adjusted life years (QALYs) and the total costs for the intervention, social services provided by the municipality and health care were used evaluate cost-effectiveness.Study III was a quasi-experimental clinical trial and included 95 persons, 65+, who had applied for municipality-based home help with bathing. For participants in the intervention group, occupational therapists implemented occupation-focused and occupation-based interventions. No occupational therapy intervention was implemented for those in the control group, but they were allocated home help services if judged to need it based on an assessment by a municipality care manager. Evaluations of ADL ability, self-rated health and allocated home help were implemented at baseline and after 15 weeks.Study IV involved the use of decision-modeling based on a five state Markov model that included levels of dependency in ADLs, place of residency and death. Probabilities for transitions between states in the model, QoL scores and societal costs for each state were derived from previous research. Overall, the model was based on research indicating that more severe levels of dependency reduced QALY scores and increased societal costs. Previous trials have provided evidence that an occupation-focused and occupation-based intervention implemented to reduce bathing disabilities increased the probability of independence of home help. The Markov model was used to evaluate cost-effectiveness over 8 years for an intervention compared to no intervention.ResultsThe results of study I indicated that each intervention had a small positive effect on minimizing a decline in leisure engagement and/or ADL, but no intervention was clearly superior. In study II, the results indicated that the interventions delivered in a group format positively affected self-rated health. The discussion group was the most cost-effective intervention. The results of study III indicated that the intervention had no effect on ADL ability or self-rated health. There was, however, a large difference in the allocation of home help at follow up, indicating that the intervention was effective in reducing dependency on home help for bathing. The results of study IV indicated that compared to no intervention, the intervention resulted in a positive accumulation of QALYs and lower costs for every year during the entire 8 year period.ConclusionThis thesis provides evidence to support the implementation of occupation-focused and occupation-based interventions for independent-living, community-dwelling older people in order to reduce their decline in occupational engagement and improve their self-rated health; the interventions also have the potential to be cost effective. This thesis also provides evidence that an occupation-focused and occupation-based intervention implemented for older people with bathing disabilities was effective in promoting independence from home help for bathing. Finally, an occupation-focused and occupation-based intervention that increased the probability of being independent of home help for bathing had a positive impact on the long term accumulation of QALYs and reduced societal costs and, therefore, can be considered very cost effective.
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