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1.	Ahlin, Karin, 1963-, et al. (författare) A Transition Towards Digital Home Visits in Social Care and Home Health Care During the Corona Pandemic 2021 Ingår i: GLOBAL HEALTH 2021, The Tenth International Conference on Global Health Challenges. - : International Academy, Research and Industry Association (IARIA). - 9781612088921 Konferensbidrag (refereegranskat)abstract During the pandemic, physical meetings were supposed to decrease as much as possible to avoid the virus to spread. Before the pandemic, the physical meeting favoured social care and home health care in Sweden. One solution was to digitize as many of these meetings as possible. Therefore, we investigated this transition in a web survey, including questions with predetermined and open-ended answers. The web-survey was sent to co-workers in home health care and social care in a middle-seized municipality in Sweden. The results showed that not all meetings could be transformed, like meetings with citizens with hearing or cognitive impairments. Challenges related to the transformation were instability in technical equipment, the professionals’ and citizens’ knowledge of handling technical equipment, and access to technical equipment support. Despite this did the co-workers digitize meetings whenever possible, adding operational and problem-solving attitude to the transformation. Due to this study’s limitation, like respondents from one municipality and the pandemic’s length, we intend to investigate further and understand the development of the transformation and how knowledge in the area increases.
2.	Ankre, Rosemarie, 1975-, et al. (författare) Tillgängliga och inkluderande naturmiljöer i Östersunds kommun - med fokus på äldre vuxna och personer med fysiska funktionsnedsättningar : Sammanfattning av ett samverkansprojekt mellan Mittuniversitetet och Östersunds kommun 2019–2022 2022 Rapport (populärvet., debatt m.m.)
3.	Bajraktari, Saranda, et al. (författare) Cost-effectiveness analysis of the digital fall preventive intervention Safe Step among community dwelling older people aged 70 and over Annan publikation (övrigt vetenskapligt/konstnärligt)
4.	Bajraktari, Saranda, et al. (författare) Health-promoting and preventive interventions for community-dwelling older people published from inception to 2019 : a scoping review to guide decision making in a Swedish municipality context 2020 Ingår i: Archives of Public Health. - : BioMed Central (BMC). - 0778-7367 .- 2049-3258. ; 78:1 Forskningsöversikt (refereegranskat)abstract Background: Despite the promising evidence of health-promoting and preventive interventions for maintaining health among older people, not all interventions can be implemented due to limited resources. Due to the variation of content in the interventions and the breadth of outcomes used to evaluate effects in such interventions, comparisons are difficult and the choice of which interventions to implement is challenging. Therefore, more information, beyond effects, is needed to guide decision-makers. The aim of this review was to investigate, to what degree factors important for decision-making have been reported in the existing health-promoting and preventive interventions literature for community-dwelling older people in the Nordic countries.Methods: This review was guided by the PRISMA-ScR checklist (Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews), the methodological steps for scoping reviews described in the Arksey and O ' Malley's framework, and the Medical Research Council's (MRC) guidance on complex interventions. Eligible studies for inclusion were randomised controlled trials (RCTs) concerning health promotion or primary prevention for community-dwelling older people implemented in the Nordic countries. Additionally, all included RCTs were searched for related papers that were reporting on additional factors. Eligible studies were searched in seven databases: PubMed, SCOPUS, CINAHL, Academic Search Elite, PsycINFO, SocINDEX, and SPORTDiscus.Results: Eighty-two studies met the inclusion criteria (twenty-seven unique studies and fifty-five related studies). Twelve studies focused on fall prevention, eleven had a health-promoting approach, and four studies focused on preventing disability. All interventions, besides one, reported positive effects on at least one health outcome. Three studies reported data on cost-effectiveness, three on experiences of participants and two conducted feasibility studies. Only one intervention, reported information on all seven factors.Conclusions: All identified studies on health-promoting and preventive interventions for older people evaluated in the Nordic countries report positive effects although the magnitude of effects and number of follow-ups differed substantially. Overall, there was a general lack of studies on feasibility, cost-effectiveness, and experiences of participants, thus, limiting the basis for decision making. Considering all reported factors, promising candidates to be recommended for implementation in a Nordic municipality context are 'Senior meetings', 'preventive home visits' and 'exercise interventions' on its own or combined with other components.
5.	Bajraktari, Saranda, 1989- (författare) Health promotion and fall prevention for older people : impact, relevance and economic justification for decision making in a municipality context 2023 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Background: The proportion of older people is increasing and calls for a shift towards proactive approaches to support healthy ageing. The evidence base on health-promoting and preventive interventions (HPP) is promising in terms of maintaining health in older people, but for such interventions to have an impact on population health, translation of evidence to practice is crucial. To facilitate this process, factors relevant for decision makers are important to consider. One specific public health challenge is fall-related injuries in older people which cause the highest number of injury-related deaths, have many consequences for the individual (physical and psychological) as well as wide-ranging societal costs. Translation of evidence to practice faces challenges with regards to reach, limiting the public health impact of such interventions. Digital interventions have the potential to increase reach and thereby contribute as an innovative proactive approach. The aim with this thesis was twofold. First, to review the scientific literature in the field of health promotion and prevention conducted in Nordic Countries and targeting community-dwelling older people. Secondly, to evaluate reach, self-reported health outcomes and cost-effectiveness of the Safe Step digital fall preventive exercise intervention in an observational study in the municipality of Östersund-Sweden.Methods: In paper I, a scoping review design was applied to review and summarise a broad field of research focusing on seven factors important for decision-makers such as: context, population, content, feasibility aspects, experiences of participants, intervention effects, and cost-effectiveness. In Paper II, data related to reach including recruitment rate, and participant characteristics (based on self-reported health outcomes and socioeconomic status) were collected. The sample was compared with a representative sample of older people for the purpose of exploring representativeness. In paper III, self-reported health outcomes in relation to balance, leg strength, fear of falling and health-related quality of life were evaluated over the course of the one-year intervention and in relation to exercise time, reported in quarterly questionnaires. In paper IV, the cost effectiveness of the Safe Step intervention was modelled in a Markov model with five states over 12 years to evaluate the potential cost-effectiveness of the intervention in community-dwelling older people at risk of falling.Results: Paper I showed that all included studies, except one, reported a positive effect in at least one health outcome measured. Most studies did not report on cost-effectiveness, feasibility, or experiences of participants. Based on the summarised evidence, senior meetings, preventive home visits and various forms of fall preventive exercise interventions emerged as most recommendable for implementation. Results from paper II showed that the majority of participants had a better health status, were women, and were more commonly using technology in comparison to a sample population. Paper III showed that participants in the intervention self-reported positive changes in balance and leg strength at different follow-ups. Balance and leg strength indicated a small but positive association with self-reported exercise activity. Paper IV showed the potential of Safe Step being a cost-saving intervention with better health outcomes and lower costs compared to no intervention alternative. Assuming a lower estimated intervention effect and higher recruitment costs still indicated that Safe Step was cost effective.Conclusion: This thesis provides evidence to support proactive approaches in healthy ageing and recommends increased efforts in research regarding translation of such interventions to practice as to maximize impact on a population level. The Safe Step intervention shows promise in being used independently in community-dwelling older people with good overall health and familiarity with internet and digital technologies. The majority reached were women with higher education, which infers a need for other non-digital interventions or additional support to increase reach in the general population of older people at risk for falling. Preliminary effectiveness results imply that Safe Step can lead to self-rated changes in known fall-risk factors although participants reported exercise time was lower than the recommended levels. Safe Step indicates also to be a cost-effective intervention even with conservative estimates of intervention effects and higher costs.
6.	Bajraktari, Saranda, et al. (författare) Reaching older people with a digital fall prevention intervention in a Swedish municipality context : an observational study 2022 Ingår i: Frontiers in Public Health. - : Frontiers Media S.A.. - 2296-2565. ; 10 Tidskriftsartikel (refereegranskat)abstract Background: There is robust evidence that falls in old age can be prevented by exercise programs that include balance training, functional exercises, and strength training. For the interventions to have a population health impact, outreach to the population of focus with suitable interventions is needed. While digital interventions are promising there is limited knowledge on the characteristics of who is reached. The aim of this study was to describe the recruitment process, estimate reach rate at the population level and to describe participants characteristics and representativeness in a digital fall prevention intervention study.Methods: In a municipality-based observational study, reach of a digital fall prevention intervention was evaluated. The intervention included a digital exercise programme (Safe Step) and optional supportive strategies, complemented with a range of recruitment strategies to optimize reach. Recruitment during a period of 6 months was open to people 70 years or older who had experienced a fall or a decline in balance the past year. Reach was based on data from the baseline questionnaire including health and demographic characteristics of participants. Representativeness was estimated by comparing participants to a sample of older people from the Swedish National Public Health Survey.Results: The recruitment rate was 4.7% (n = 173) in relation to the estimated population of focus (n = 3,706). Most participants signed up within the first month of the intervention (n = 131). The intervention attracted primarily women, older people with high education, individuals who used the internet or digital applications almost every day and those perceiving their balance as fair or poor. Safe step participants lived more commonly alone and had higher education and better walking ability in comparison to the Swedish National Public Health Survey.Conclusions: With a range of recruitment strategies most participants were recruited to a digital fall intervention during the first month. The intervention attracted primarily highly educated women who frequently used the internet or smart technologies. In addition to digital fall prevention interventions, a higher diversity of intervention types (digital and non-digital) is more likely to reach a larger group of older people with different needs.
7.	Bajraktari, Saranda, et al. (författare) Self-managed fall preventive exercise intervention with an mHealth application : self-reported health outcomes over one year Annan publikation (övrigt vetenskapligt/konstnärligt)
8.	Brodén, Karin, 1963-, et al. (författare) Determining Value in Welfare-Technology : The Need for a Multi-Perspective Framework 2023 Ingår i: International Journal of Health Economics and Policy. - : Science Publishing Group. - 2578-9295 .- 2578-9309. ; 8:4, s. 76-88 Tidskriftsartikel (refereegranskat)abstract Background: Stakeholders in health and social care are implementing digital solutions to facilitate person-centred care for citizens. One problem is choosing which digital solution to implement. Ordinary cost-benefit analysis implicates the measurable parts of the value, leaving the immeasurable without any trace in an analysis. Results: We used design thinking to design a framework that implicates what to add as valuable factors on individual, organisational, and governmental levels. The design is based on empirical material from workshops and literature reviews on systems thinking, quality management, and value factors. The valuable factors at an individual level could include independence, autonomy, and empowerment, and the factors at the organisational level accessibility, competence, and independence. On a central level, the factors are related to person-centred care and its value proposals, such as autonomy and independence. Conclusions: While conducting a cost-benefit analysis, focusing on a standard definition of the value concept is essential. The designed framework needs to be dynamic due to the broad range of welfare technology. The created rubrics cube model, including strategic, organisational-operational and individual levels, should be used by decision-making groups as a flexible foundation. Forthcoming research will test this framework, including the proposed scale for measurement and focusing on welfare technology for older citizens.
9.	Elf, Marie, 1962-, et al. (författare) Rehabilitation at Home With the Development of a Sustainable Model Placing the Person's Needs and Environment at Heart : Protocol for a Multimethod Project 2024 Ingår i: JMIR Research Protocols. - : JMIR Publications. - 1929-0748. ; 13 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Each year, more than 1.5 million people in Europe have a stroke, and many experience disabilities leading to activity and participation restrictions. Home-based rehabilitation is the recommended approach for stroke rehabilitation, in line with the international shift to integrated care. Despite this, rehabilitation often focuses on the person's physical functions, not the whole life situation and opportunities to live an active life. Given that rehabilitation today is often provided in the person's home, there is a need to develop new models that consider the rehabilitation process as situated in the everyday living environment of persons with stroke. This project is grounded in experiences from our ongoing research, where we study the importance of the home environment for health and participation among persons with stroke, rehabilitated at home. This research has shown unmet needs, which lead to suboptimal rehabilitation outcomes. There is a need for studies on how to use environmental resources to optimize stroke rehabilitation in the home setting.OBJECTIVE: The overarching objective of the project is to develop a new practice model for rehabilitation where the needs of the person are the starting point and where the environment is considered.METHODS: The project will be conducted in partnership with persons with stroke, significant others, health care professionals, and care managers. Results from a literature review will form the base for interviews with the stakeholders, followed by co-designing workshops aiming to create a new practice model. Focus groups will be held to refine the outcome of the workshops to a practice model.RESULTS: This 4-year project commenced in January 2023 and will continue until December 2026. The results of the literature review are, as of April 2024, currently being analyzed. The ethics application for the interviews and co-design phase was approved in October 2023 and data collection is ongoing during spring 2024. We aim to develop a practice model with stakeholders and refine it together with care managers and decision makers. The outcome is a new practice model and implementation plan, which will be achieved in autumn 2026.CONCLUSIONS: The project contributes with a prominent missing puzzle to optimize the rehabilitation process by adding a strong focus on user engagement combined with integrating different aspects of the environment. The goal is to improve quality of life and increase reintegration in society for the large group of people living with the aftermath of a stroke. By co-designing with multiple stakeholders, we expect the model to be feasible and sustainable. The knowledge from the project will also contribute to an increased awareness of the importance of the physical environment for sustainable health care. The findings will lay the foundation for future upscaling initiatives.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56996.
10.	Elf, Marie, 1962-, et al. (författare) The importance of context : a qualitative study exploring healthcare practitioners' experiences of working with patients at home after a stroke 2023 Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 23:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Stroke significantly impacts individuals, leading to the need for long-lasting rehabilitation and adaptation to environmental demands. Rehabilitation after stroke is increasingly performed in patients' homes, and it is argued that rehabilitation in this context is more person-centred and positively impacts client outcomes. However, the role of environmental factors in this process is largely unknown. The aim of this study was to explore how multidisciplinary healthcare practitioners working with rehabilitation in the home after stroke consider possibilities and challenges in the environment and how environmental factors are documented in patients' records.METHODS: Eight multidisciplinary healthcare practitioners working with home-based rehabilitation after stroke participated in two semistructured focus group sessions. Thematic analysis was used to analyse the transcripts of recorded focus group discussions. Data were also collected from patient history records (N = 14) to identify interventions to increase patients' opportunities to participate in activities inside and outside the home. These records were analysed using life-space mobility as a conceptual framework.RESULTS: The analysis generated four overarching themes concerning possibilities and challenges in the environment: (1) the image of rehabilitation conflicts with place, (2) the person in the home reveals individual needs and capabilities, (3) environmental characteristics influence the rehabilitation practice, and (4) the person is integrated within a social context. The patient record analysis showed that most patients were discharged from hospital to home within four days. Assessments at the hospital mainly focused on basic activities of daily living, such as the patient's self-care and walking ability. Also at home, the assessments and actions primarily focused on basic activities with little focus on participation in meaningful activities performed in different life situations outside the home.CONCLUSIONS: Our research suggests that one way to improve practice is to include the environment in the rehabilitation and consider the person´s life space. Interventions should focus on supporting out-of-home mobility and activities as part of person-centred stroke rehabilitation. This must be supported by clear documentation in the patient records to strengthen clinical practice as well as the communication between stakeholders.
11.	Eliassen, Marianne, et al. (författare) Emplacing reablement co-creating an outdoor recreation model in the rural Arctic 2023 Ingår i: International Journal of Circumpolar Health. - : Taylor & Francis. - 1239-9736 .- 2242-3982. ; 82:1 Tidskriftsartikel (refereegranskat)abstract Reablement aims to enable older persons with functional decline to re-engage in meaningful activities. The benefits of engagement in outdoor activities are significant; however, reablement services primarily target function in indoor environments whereas descriptions of outdoor activities are sparse. The aim of this study was to create a model that integrates outdoor recreation into reablement. We therefore elaborated on an experienced based co-design methodology to create a model that integrates outdoor recreation for older persons in reablement in an Arctic, rural context in northern Norway. Stakeholders (N = 35), including reablement participants, participated in workshops, focus groups, and individual interviews. Based on the results, we co-created a person-centred model for outdoor recreation in reablement, including an assessment tool that can guide reablement staff in goal-setting practices. Accordingly, we argue that cherished locations holds significant meaning in the lives of older people and warrant recognition in reablement programmes. There is a need to evaluate the effects and feasibility of the model and the possibility for its implementation in other health care settings.
12.	Fjellstrom, Sanna, et al. (författare) Web-based training intervention to increase physical activity level and improve health for adults with intellectual disability 2022 Ingår i: Journal of Intellectual Disability Research. - : John Wiley & Sons. - 0964-2633 .- 1365-2788. ; 66:12, s. 967-977 Tidskriftsartikel (refereegranskat)abstract Background: Individuals with intellectual disability (ID) are less physically active, have a higher body mass index (BMI) and are at greater risk for cardiovascular diseases (CVDs) than people without ID. The purpose of the study was to explore the effectiveness of a web-based training programme, consisting of 150 min of activity per week, on the health of people with ID.Method: Participants with ID living in supported accommodation (n = 28, 48% female, age = 36.4 ± 9.56 years) participated in a web-based training programme, consisting of a combination of exercises (endurance, strength balance and flexibility) of moderate intensity, 50 min, three times per week for 12 weeks. The body composition and waist circumference (WC) were measured, and questionnaires were used to assess enjoyment, quality of life (QoL) and physical activity (PA) level. Descriptive statistics and pairwise comparison pre and post intervention were carried out.Results: A total of 22 out of 28 participants completed the 12-week training intervention with 83% mean attendance of training sessions. The intensity of the PA level increased and a decrease in fat mass of 1.9 ± 2.4 kg, P < 0.001 and WC of 3 ± 5 cm, P = 0.009 were observed. Enjoyment of training sessions was 3.9 out of 5, and no differences in QoL were found.Conclusion: A web-based training programme is an effective tool for improving health parameters of people with ID and offers a new way for caregivers to enhance the PA for the target group.
13.	Godtman Kling, Kristin, et al. (författare) Tillgängliga samhällen för jämlik hälsa hälsofrämjande aktiviteter för personer med funktionsnedsättning och äldre vuxna 2024 Ingår i: Globala utmaningar - lokala lösningar. - Östersund : Mittuniversitetet. - 9789189786752 ; , s. 144-146 Bokkapitel (övrigt vetenskapligt/konstnärligt)
14.	Granbom, Marianne, et al. (författare) Ageing in the right place–a prototype of a web-based housing counselling intervention for later life 2020 Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 27:4, s. 289-297 Tidskriftsartikel (refereegranskat)abstract Background: Despite a strong desire among most older adults to age in place, there are few widely available services to support planning and preparing for one’s future housing needs. Objective: To develop a prototype of a web-based housing counselling intervention for use in later life, by employing a user-centred design. Material and Methods: As the first step in intervention development, we employed a development process based on research circle methodology. Nine older adults participated in three sessions. Findings from literature reviews, a meeting with a technology and design panel (n = 6) and interviews with representatives of nonprofit organizations, companies, and municipalities (n = 7) served as discussion points. Result: An on-paper prototype was derived, composed of the THINK, LEARN and ACT module reflecting different stages of the decision-making process. Each module addressed preferences, health, home and social and financial resources. Key design features and theoretical underpinnings were included. Conclusion and Significance: A user-centred design process can result in services that are aligned with older adults’ preferences for obtaining housing information. Services for planning and preparing future housing needs have the potential to increase older adults´ well-being at home as well as reduce costs for care and housing provision by the municipalities.
15.	Granbom, Marianne, et al. (författare) Att bo senare delen av livet “PÅ RÄTT PLATS” – första utvecklingssteget mot en webbaserad boenderådgivning för äldre 2019 Konferensbidrag (refereegranskat)
16.	Haak, Maria, et al. (författare) Hur definieras vardagsrehabilitering? Av betydelse för arbetsterapeutiska insatser 2019 Konferensbidrag (refereegranskat)
17.	Hultqvist, Sara, 1977-, et al. (författare) Conditions for uptake of evidence-based knowledge in municipal care for older people in Sweden : a developmental evaluation 2022 Ingår i: BMC Research Notes. - London : BioMed Central. - 1756-0500. ; 15 Tidskriftsartikel (refereegranskat)abstract Objective: The objective of this paper is to describe the initial phase of a long-term collaboration initiative between a municipality and the Faculty of Medicine at a university in Sweden. The overall ambition of the collaboration is to strengthen the quality of care for older people. The concrete goal is to equip academically trained registered health care professionals (HCP) with tools for transferring evidence-based knowledge into practice. As municipal healthcare for older people is mainly carried out by staff lacking academic education, reg. HCP are key actors to bring in and consolidate an evidence-based approach in this setting. Developmental evaluation (DE) has been used to evaluate four separate activities in the initial phase. The activities where sequenced in a cumulative design to provide knowledge for further development of adequate tools.Results: The cumulative design originally planned did not fit the internal logic of the municipality. Therefore, workflow and pace adjustments were made to proceed towards the joint ambition; the creation of fruitful conditions for the uptake of evidence-based knowledge. Long-term collaboration between academia and organizations outside academia demands a sensitive and flexible research approach, recognizing that collaboration implies mutuality and restricts the sovereignty of academia in designing research.
18.	Johanson, Suzanne, et al. (författare) Cost-effectiveness of occupational therapy return-to-work interventions for people with mental health disorders : a systematic review 2023 Ingår i: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 30:8, s. 1339-1356 Forskningsöversikt (refereegranskat)abstract Background: Return-to-work (RTW) resources for persons with mental health disorders are limited and costs are typically shared by several stakeholders in society. Occupational therapists (OT) provide RTW interventions for this target group, however, increased knowledge of health, and employment effects, as well as costs are needed to better inform decision makers in their prioritisations.Aims/objectives: To identify and summarise evidence of cost-effectiveness of RTW interventions for persons with mental health disorders which OTs provide.Materials and methods: A systematic search was applied and resulted in 358 articles. After screening, nine articles met inclusion criteria and were reviewed. Quality assessment was conducted using the economic evaluation tool by Joanna Briggs Institute.Results: Supported employment, Individual Placement and Support was cost-effective in several contexts while three studies showed larger effects and higher costs. An OT intervention added to treatment for major depression was indicated to be cost-beneficial and an advanced supported employment was cost-saving. The methodological quality varied considerably between studies.Conclusions and significance: The results of the included studies are promising, however, to further strengthen the economic perspective in OT RTW interventions, the need for conducting more and methodologically robust economic evaluations is crucial in future studies.
19.	Kylén, Maya, et al. (författare) Housing attribute preferences when considering relocation in older age 2023 Ingår i: Innovation in Aging. - : Oxford University Press. - 2399-5300. ; 7:Supplement_1, s. 223-223 Tidskriftsartikel (refereegranskat)
20.	Liljestrand, Caroline, et al. (författare) Use of information and communication technology in occupational therapy for older adults 2024 Ingår i: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 31:1 Tidskriftsartikel (refereegranskat)abstract Background: Information and communication technology (ICT) provides one solution to meet increasing demands for occupational therapy for older adults.Aims/Objectives: To examine if and how municipality-based occupational therapists (OTs) include ICT in their work, and which factors are associated with use of occupational therapy at a distance.Material and Methods: Survey study including 167 OTs. Data were presented descriptively. Associations were analysed by Chi2 test and logistic regression models.Results: Forty-eight percent of OTs used ICT once a month or more. OTs belief on possibilites to use ICT is associated with replacement of physical home visits. Managers expectations and support also seem to be important factors.Conclusion: ICT solutions are frequently used by OTs in home health care and can be considered complementing rather than replacing physical home visits. More knowledge is needed on when and how ICT solutions can be used by OTs and how factors that impact the use of ICT can be managed.
21.	Norberg, Eva-Britt, 1956-, et al. (författare) Exploring reach and experiences of participation in health-promoting senior meetings in a municipality context 2021 Ingår i: Journal of Public Health. - : Springer. - 2198-1833 .- 1613-2238. ; 29, s. 641-651 Tidskriftsartikel (refereegranskat)abstract Aim: To explore reach and experiences of participants during implementation of health-promoting meetings of seniors in a Swedish municipality context.Subjects and methods: A mixed-methods approach was used, including older people who were recruited consecutively and invited to participate as they applied for health care and/or home help services in the municipality. Inclusion criterion was allocation of “early” home-care services, e.g., meals on wheels, safety alarms. Health-care services were limited to persons applying for an outside walker. The intervention was multi-professional, e.g., occupational therapy and physiotherapy. Each session included a mix of short lectures and group discussions about, for example, the importance of engagement in meaningful activity, social contacts, and physical activity. Recruitment procedures were modified during the trial in order to enhance reach. The data collection included information on the flow of participants during recruitment and participation in the intervention, field notes covering the experience of implementing the intervention, a survey covering adherence to recruitment procedures, and qualitative interviews exploring the experience of participants.Results: Senior meetings were experienced as positive and strengthened the participants in dealing with health-related concerns. The identification of potential participants and recruitment were challenging, but as recruitment procedures were modified, a higher proportion of potential participants were reached. In all, there were 29 participants over the study period.Conclusion: For health-promoting meetings to enable community-dwelling older people to fulfill their potential by positively affecting health outcomes, recruitment procedures for optimizing reach is a critical feature.
22.	Nordeström, Frida, et al. (författare) Ageing in the right place : usability of a web-based housing counselling service 2023 Ingår i: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1651-2014 .- 1103-8128. ; 31:1 Tidskriftsartikel (refereegranskat)abstract Residential reasoning is a complex process that includes decisions on whether to age in place or to relocate. Ageing in the Right Place (ARP), a web-based housing counselling service was created to support older adults in this process. The study’s aim was to evaluate the usability of the ARP as regards content, design, specific functions, and self-administration as a mode of delivery and to lay the ground for further optimisation.
23.	Nordeström, Frida, et al. (författare) Translation and Psychometric Evaluation of the University of Jyvaskyla Active Aging Scale (UJACAS) for Use in Sweden Ingår i: Journal of Cross-Cultural Gerontology. - 0169-3816. Tidskriftsartikel (refereegranskat)abstract The objectives were to translate the University of Jyvaskyla Active Aging Scale (UJACAS) to Swedish, to establish semantic equivalence and evaluate psychometric properties for use among persons 55 years and older in Sweden. The UJACAS contains 17 items to be self-assessed regarding goals, abilities, opportunity, and activity. Psychometric properties content validity, data quality including floor and ceiling effects, test-retest reliability, internal consistency, and construct validity were evaluated with different samples in three phases, using state-of-the-art statistics. After translating and establishing semantic equivalence, content validity was assessed as high. With ICC=0.88 (95% CI 0.80–0.93) test-retest reliability was moderate. Internal consistency was high (Cronbach alpha=0.84–0.91), and 84% of the questions reached the cut-off value of 0.3 for corrected item-total correlation. Construct validity hypotheses were confirmed. Results indicate that the UJACAS is reliable and valid for use among persons 55 and older in Sweden.
24.	Norström, Fredrik, et al. (författare) How does the distribution of work tasks among home care personnel relate to workload and health-related quality of life? 2023 Ingår i: International Archives of Occupational and Environmental Health. - : Springer. - 0340-0131 .- 1432-1246. ; 96:8, s. 1167-1181 Tidskriftsartikel (refereegranskat)abstract Background: The work for Swedish home care workers is challenging with a variety of support and healthcare tasks for home care recipients. The aim of our study is to investigate how these tasks relate to workload and health-related quality of life among home care workers in Sweden. We also explore staff preferences concerning work distribution.Methods: A cross-sectional study was conducted in 16 municipalities in Northern Sweden. Questionnaires with validated instruments to measure workload (QPSNordic) and health-related quality of life (EQ-5D), were responded by 1154 (~ 58%) of approximately 2000 invited home care workers. EQ-5D responses were translated to a Quality-adjusted life-year (QALY) score. For 15 different work task areas, personnel provided their present and preferred allocation. Absolute risk differences were calculated with propensity score weighting.Results: Statistically significantly more or fewer problems differences were observed for: higher workloads were higher among those whose daily work included responding to personal alarms (8.4%), running errands outside the home (14%), rehabilitation (13%) and help with bathing (11%). Apart from rehabilitation, there were statistically significantly more (8–10%) problems with anxiety/depression for these tasks. QALY scores were lower among those whose daily work included food distribution (0.034) and higher for daily meal preparation (0.031), both explained by pain/discomfort dimension. Personnel preferred to, amongst other, spend less time responding to personal alarms, and more time providing social support.Conclusion: The redistribution of work tasks is likely to reduce workload and improve the health of personnel. Our study provides an understanding of how such redistribution could be undertaken.
25.	Nyman, Anneli, et al. (författare) Information and communication technology in home-based rehabilitation – a discussion of possibilities and challenges 2023 Ingår i: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 30:1, s. 14-20 Tidskriftsartikel (refereegranskat)abstract Background: Information and communication technology (ICT) has been proven to have effect in terms of providing alternative ways to deliver rehabilitation services. The intention with this paper is to serve as a foundation for discussions regarding the future development, design, and delivery of home-based rehabilitation, including ICT.Aim: To reflect on and discuss the possibilities and challenges of using ICT in home-based rehabilitation services.Method and material: We use experiences and results from various projects to reflect on and discuss possibilities and challenges related to the use of ICT in home-based rehabilitation.Findings and discussion: We exemplify how ICT present new possibilities that can increase the quality of the rehabilitation process and improve access to services. We reflect on some challenges in the use of ICT, related to non-user-friendly solutions, to the specific rehabilitation situation, and a lack of technical support. At an organisational level, readiness to use ICT can impact the extent to which new solutions are integrated into practice.Conclusion: We emphasise that ICT has the potential to develop and improve service delivery and contribute to increased quality and accessibility of home-based rehabilitation.
26.	Olsson Möller, Ulrika, et al. (författare) The Content of Physiotherapy and Factors Impacting on Reablement : A National Study 2023 Ingår i: Journal of Multidisciplinary Healthcare. - : Dove Medical Press Ltd.. - 1178-2390. ; 16, s. 3075-3088 Tidskriftsartikel (refereegranskat)abstract Purpose : Reablement is a multidisciplinary intervention aimed at promoting function and independence for people with functional decline. Detailed descriptions of various professions’ actions are needed for organization and evaluation of reablement services. This study describes physiotherapy practice in a reablement context in Swedish municipalities, focusing on the content and magnitude of interventions. Methods : Physiotherapists (n=108) from 34 municipalities answered a web-based survey covering the target group, content and duration of their actions, and number of contacts initiated over a 3-week period. Data were analyzed with descriptive statistics and multiple logistic regression. Results : Overall, 1005 cases were reported, with a mean age of 78.9 years (SD: 11.7); about 91% (n=912) were aged ≥65 and 61% (n=612) were women. About 70% were allocated to home care; 16% (n=160) of these had minor functional limitations (eg, needing safety alarms/help with domestic tasks), and 55% (n=550) had major functional limitations (eg, needing help with personal activities of daily living). The most reported actions were providing technical aids (60.8%, n=576), instructions/counseling (41.5%, n=393), walking/climbing stairs (27.6%, n=262), strength training (27.2%, n=258), and fall prevention (25.5%, n=242). Almost half of the cases included one action (n=494) and about 89% (n=890) targeted primary needs (body functions, walking indoors, self-care, or domestic life), mainly in clients with major functional limitations (odds ratio=2.96; 95% confidence interval: 1.95–4.49). About 50% (n=517) of the cases involved 1–2 contacts; about 55% (n=549) were completed within 3 weeks. Exercise was associated with ≥6 visits over ≥7 weeks. Supervision of home care staff was performed in 19.1% (n=181) of cases. Conclusion: Reablement physiotherapy mostly comprises a few actions over a relatively short period. Whether this is a conscious strategy based on the purpose of home-based physiotherapy or clients’ needs and wishes, or conversely an expression of limited resources, remains to be investigated.
27.	Pettersson, Beatrice, et al. (författare) Effectiveness of a self-managed digital exercise programme to prevent falls in older community-dwelling adults : study protocol for the Safe Step randomised controlled trial 2020 Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 10:5 Tidskriftsartikel (refereegranskat)abstract Introduction: Exercise interventions have a strong evidence base for falls prevention. However, exercise can be challenging to implement and often has limited reach and poor adherence. Digital technology provides opportunities for both increased access to the intervention and support over time. Further knowledge needs to be gained regarding the effectiveness of completely self-managed digital exercise interventions. The main objective of this study is to compare the effectiveness of a self-managed digital exercise programme, Safe Step, in combination with monthly educational videos with educational videos alone, on falls over 1 year in older community-dwelling adults.Methods and analysis: A two-arm parallel randomised controlled trial will be conducted with at least 1400 community-living older adults (70+ years) who experience impaired balance. Participants will be recruited throughout Sweden with enrolment through the project website. They will be randomly allocated to either the Safe Step exercise programme with additional monthly educational videos about healthy ageing and fall prevention, or the monthly education videos alone. Participants receiving the exercise intervention will be asked to exercise at home for at least 30 min, 3 times/week with support of the Safe Step application. The primary outcome will be rate of falls (fall per person year). Participants will keep a fall calendar and report falls at the end of each month through a digital questionnaire. Further assessments of secondary outcomes will be made through self-reported questionnaires and a self-test of 30 s chair stand test at baseline and 3, 6, 9 and 12 months after study start. Data will be analysed according to the intention-to-treat principle.Ethics and dissemination: Ethical approval was obtained by The Regional Ethical Review Board in Umeå (Dnr 2018/433-31). Findings will be disseminated through the project web-site, peer-reviewed journals, national and international conferences and through senior citizen organisations’ newsletters.Trial registration number: NCT03963570.
28.	Pettersson, Beatrice, et al. (författare) Recruitment strategies and reach of a digital fall-prevention intervention for community-dwelling older adults 2022 Ingår i: Digital health. - : Sage Publications. - 2055-2076. ; 8 Tidskriftsartikel (refereegranskat)abstract Background: To have an impact on the population's health, preventive interventions have to reach a large proportion of the intended population. Digital solutions show potential for providing wider access to fall preventive exercise. However, there is a lack of knowledge about how to reach the target group. The aim of this study was to describe the recruitment process used in the Safe Step randomised controlled trial and the characteristics of the participants reached.Methods: Several recruitment methods, both digital and non-digital, were adopted to reach the intended sample size. Sociodemographic parameters from the baseline questionnaire were used to describe participant characteristics. The characteristics were also compared to a representative sample of older adults in the Swedish population.Results: In total, 1628 older adults were recruited. Social media proved to be the most successful recruitment strategy, through which 76% of the participants were recruited. The participants reached had a mean age of 75.9 years, lived in both urban and rural locations, were already frequent users of the Internet and applications (smartphone/tablet) (79.9%), had higher education (71.9%), and a large proportion were women (79.4%). In comparison with the general population participants in the Safe Step study were more highly educated (p < 0.001), women in the study more frequently lived alone (p < 0.001) and men more often reported poorer self-rated health (p = 0.04). Within the study, men reported a faster deteriorating balance (p = 0.003) and more prescribed medication (p < 0.001) than women.Conclusion: Recruitment via social media is a useful strategy for reaching older adults, especially women and frequent users of the Internet, for a fully self-managed and digital fall prevention exercise intervention. This study underlines that a range of interventions must be available to attract and suit older adults with different functional statuses and digital skills.
29.	Pettersson, Cecilia, 1963-, et al. (författare) Enabling social participation for older people : The content of reablement by age, gender, and level of functioning in occupational therapists' interventions 2022 Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa Healthcare. - 1103-8128 .- 1651-2014. ; 29:6, s. 522-529 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Social participation and the ability to build and maintain social relationships is emphasized as important for older people's health and well-being.AIM: To explore if social participation is addressed and whether age, gender and level of functioning are associated with the composition of occupational therapy interventions within the context of reablement.METHOD: In this cross-sectional study, invitations to participate were sent to 60 municipalities in Sweden. 318 occupational therapists participated and described the character of initiated interventions made during 3 weeks through web-based surveys.RESULT: 1392 cases were reported in the age span of 19-103 years, 61.7% were women. A higher proportion of persons having no home care and minor functional dependency got interventions with a focus on social participation to a higher extent than persons with major functional dependency. Occupational therapists' interventions vary as related to functional limitation, age, and gender.CONCLUSION: The results indicate that the severity of functional limitation impacts the focus of the intervention whereas age and gender do not. There is a need for social participation to be more clearly addressed within the context of reablement.SIGNIFICANCE: To develop a person-centred intervention, one needs to consider aspects of age, gender, and functions.
30.	Ryan, Jean, et al. (författare) Examining the Use and Non-use of Special Transport Services in Sweden’s Large City-Regions : The Last Resort? 2022 Ingår i: Findings. - : Findings Press. - 2652-8800. Tidskriftsartikel (refereegranskat)abstract This study examines the extent of the gap between the proportions of survey respondents reporting (1) having the possibility to use and (2) using special transport services (STS) compared to the corresponding gaps for other transport modes. For persons eligible for STS, differences between those who use them and those who do not use them are explored. The frequencies with which these two groups leave the home are then compared. Those aged 65-69, those with higher self-rated health and those cohabiting were less likely to use STS, despite being eligible. Those using STS tend to leave the home less often.
31.	Slaug, Björn, et al. (författare) Meaning of home attenuates the relationship between functional limitations and active aging 2024 Ingår i: Aging Clinical and Experimental Research. - : Springer. - 1594-0667 .- 1720-8319. ; 36:1 Tidskriftsartikel (refereegranskat)abstract Background and aims: Active aging is the process through which people strive to maintain wellbeing when growing old. Addressing the lack of research on active aging in the context of housing, the aim was to describe active aging among people aged 55 and older considering relocation and investigate whether perceived housing moderates the relationship between functional limitations and active aging.Methods: We utilized cross-sectional data from a sub-sample (N = 820; mean age = 69.7; 54% women) of the Prospective RELOC-AGE. Functional limitations were reported using 10 dichotomous questions. Active aging was assessed with the University of Jyvaskyla Active Aging Scale (UJACAS; 17 items, self-rated for four perspectives). Perceived housing was self-rated with four usability questions and meaning of home (MOH; 28 items). Cross-sectional associations and interactions were analysed using linear regression models, adjusting for gender and educational level.Results: Each functional limitation decreased the active aging score by almost five points (p < 0.001). Usability did not moderate that relationship while MOH significantly attenuated the association between functional limitations and active aging (p = 0.039). Those with high MOH had two points less decrease in active aging score compared to those with low MOH.Discussion and conclusions: Having a home with more personal meaning attached to it seems to provide more ability and opportunity for meaningful activities, thus supporting active aging despite functional limitations. This sheds new light on the known association between MOH and different aspects of wellbeing in old age and has relevance for theory development, housing policies and housing counselling targeting younger older adults.
32.	Tuntland, Hanne, et al. (författare) Examining client-level outcomes and instruments in reablement 2023 Ingår i: Reablement in Long-Term Care for Older People: International Perspectives and Future Directions. - : Policy Press. ; , s. 118-136, s. 118-136 Bokkapitel (refereegranskat)
33.	Verma, Apoorv, et al. (författare) Insights into the evolution of enzymatic specificity and catalysis : from Asgard archaea to human adenylate kinases 2022 Ingår i: Science Advances. - : American Association for the Advancement of Science (AAAS). - 2375-2548. ; 8:44 Tidskriftsartikel (refereegranskat)abstract Enzymatic catalysis is critically dependent on selectivity, active site architecture, and dynamics. To contribute insights into the interplay of these properties, we established an approach with NMR, crystallography, and MD simulations focused on the ubiquitous phosphotransferase adenylate kinase (AK) isolated from Odinarchaeota (OdinAK). Odinarchaeota belongs to the Asgard archaeal phylum that is believed to be the closest known ancestor to eukaryotes. We show that OdinAK is a hyperthermophilic trimer that, contrary to other AK family members, can use all NTPs for its phosphorylation reaction. Crystallographic structures of OdinAK-NTP complexes revealed a universal NTP-binding motif, while 19F NMR experiments uncovered a conserved and rate-limiting dynamic signature. As a consequence of trimerization, the active site of OdinAK was found to be lacking a critical catalytic residue and is therefore considered to be "atypical." On the basis of discovered relationships with human monomeric homologs, our findings are discussed in terms of evolution of enzymatic substrate specificity and cold adaptation.
34.	Vikberg, Sanna, et al. (författare) Adapted internet-based training program improves exercise accessibility for people with intellectual disabilities 2021 Konferensbidrag (refereegranskat)abstract Introduction and objective Individuals with intellectual disability (ID) are less physically active than people without ID, and rarely or never reach the recommended daily dose of physical activity level. People with ID have a higher BMI than their peers and therefore a higher risk of obesity causing cardiovascular diseases. The overall objective was to determine the effectiveness on health and user experience of a 12-week, internet-based training program, customized for people with ID. Methods Participants with ID living in communal settings (n=27, 48% female, age = 36.4±9.56 years) were recruited for a training study including 50 minutes training 3 times a week in 12 weeks. Staff working with these participants (n=7, 57% female) were recruited for interviews. Questionnaires were used to evaluate enjoyment, quality of life and physical activity level, along with interviews. Body composition was measured as well as waist circumference. Results This study showed that 85% of the participants completed the web-based training. The level of physical activity (PA) increased during this period and positive changes in health outcomes were observed, for example a significant decrease in fat mass by a mean of 1.9kg ±2.4. The study also high-lighted barriers and facilitators for people with ID to use web-based training, along with perspectives and experiences on health and exercise among the staff within the supported housings. Conclusion A web-based training program is a new way to increase level of PA for people with ID. This study showed that web-based training program is an effective tool to improve health parameters, reduces hinders such as transport. Moreover, it is an easy way for staff to enhance PA in their work. This study present how web-based training was appreciated by many but not all participants ID which would probably be the same for people in general. The study was performed during the Covid-19 pandemic, which might have influenced the interest of the study in a positive manner. Individuals with ID can be difficult to reach in health care. Barriers such as transport, less knowledge in health literacy and difficulties in seeking care are examples why. A web based exercise program is one of many parameters that can help to improve health and an effective way for health care to reach this target group in a cost effective manner.
35.	Wahlberg, Martina, et al. (författare) Rasch analysis of the EQ-5D-3L and the EQ-5D-5L in persons with back and neck pain receiving physiotherapy in a primary care context 2021 Ingår i: European Journal of Physiotherapy. - : Taylor & Francis. - 2167-9169 .- 2167-9177. ; 23:2, s. 102-109 Tidskriftsartikel (refereegranskat)abstract Aim: The purpose of this study was to investigate the psychometric properties of the EQ-5D-3L and the EQ-5D-5L in patients with back and neck pain.Materials and methods: Participants from two independent clinical survey studies was included in this study. In total 164 participants were answering either the EQ-5D-3L or the EQ-5D-5L after their visit to a physiotherapist in primary care for back and neck pain. Rasch analysis was performed to measure the psychometric properties of the two instruments.Main findings: Overall, the EQ-5D-5L showed preliminary evidence of good psychometric properties. The items in both the EQ-5D-5L and the EQ-5D-3L showed acceptable goodness-of-fit indicating unidimensionality for both instruments measuring the concept health-related quality of life. All test persons fit the model, but the person separation reliability and person separation index were only barely acceptable for the EQ-5D-5L.Conclusions: The results indicate that the EQ-5D-5L should be the preferred option when evaluating health-related quality of life with the EQ-5D, especially for patients with back and neck pain.
36.	Zingmark, Magnus, et al. (författare) Ageing in the right place – the development of a web-based housing counselling intervention 2021 Konferensbidrag (refereegranskat)abstract Introduction: Despite a strong wish of most seniors to age in place, no services exist to support seniors in their residential reasoning, i.e., to plan and prepare for future housing needs. The aim of this study was to describe the first steps of development of a web-based housing counseling intervention aiming to promote active ageing.Material & Methods: A user-centered design process was applied based on the research circle methodology including iterative cycles of information gathering, data collection, and analytic meetings. Findings from literature reviews, meeting with a tech expert board (n=6) and interviews with stakeholders representing non-for-profit organizations, companies, and municipalities (n=7) served as discussion points in the research circles. Nine older adults participated in three research circles during the initial phase of developing an on-paper prototype; a fourth research circle was conducted focused on the content of a first web-based prototype.Results: The findings generated through the process of user involvement were identified as key features of the intervention and categorized into three modules: THINK, LEARN and ACT. This content allowed users at different stages of the decision-making process to access relevant information related to their present and future housing situation. The actual design of the web-based intervention, including how information relevant to the unique user’s situation was to be accessed, was identified as a critical feature to enhance usability.Conclusion: Residential reasoning is complex and a web-based housing-counselling intervention can provide older adults with the information needed to support residential reasoning and thereby potentially promote active ageing.
37.	Zingmark, Magnus, et al. (författare) Better health outcomes and reduced societal costs – both senior meetings and a preventive home visit result in cost-effective use of resources 2019 Ingår i: IAGG-ER 2019. Konferensbidrag (övrigt vetenskapligt/konstnärligt)
38.	Zingmark, Magnus, et al. (författare) Better health outcomes and reduced societal costs – both senior meetings and a preventive home visit result in cost-effective use of resources 2019 Konferensbidrag (refereegranskat)abstract Health economic evaluations provide decision makers with information whether the health effects of one intervention come at a reasonable cost in relation to a comparator. The existing evidence indicate that health promotion for community-dwelling older people result in a range of positive health outcomes, but there is a general lack of health economic evaluation. The aim was to evaluate cost-effectiveness over 4 years of two health promoting interventions: senior meetings and a preventive home visit, in relation to no intervention. The study was based on a Markov model including five states defined in relation to level of dependency. The model included transitions between dependency states, scores for quality of life and societal costs for each state, intervention costs and intervention effects for two formats of health promoting interventions. For each intervention, we calculated the accumulated quality-adjusted life years (QALYs) and societal costs over 4 years, in relation to a no-intervention control group. In addition to presenting the results in terms of the cost per quality adjusted life years we also calculated return on investment (ROI), e.g., the ratio between net economic savings and the costs for each intervention. The results indicated that both senior meetings and a preventive home visit was cost-effective resulting in QALY gains and reduced societal costs at any follow-up and a high ROI. In relation to no intervention, senior meetings resulted in 0.054 QALYs gained, 2300 € in reduced societal costs and a ROI ratio of 14; a preventive home visit resulted in 0.048 QALYs gained, 2100 € in reduced societal costs and a ROI ratio of 29. The results indicate that implementation of these intervention can promote healthy ageing and thus, resources can be used for other interventions. In health economic evaluation, a comparison of health effects e.g., QALYs gained, in relation to costs is central. In the case of net savings, as was the case in this study, ROI provide an additional perspective focusing on the magnitude of effects on costs.
39.	Zingmark, Magnus, et al. (författare) Challenges related to self-assessment of active ageing during the Covid-19 pandemic in Sweden 2022 Ingår i: BMC Research Notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 15:1 Tidskriftsartikel (refereegranskat)abstract Objective: The aim is to describe and reflect upon potentially pandemic-related impact on self-assessments of active ageing. As part of the baseline data collection in the Prospective RELOC-AGE (ClinicalTrials.gov NCT04765696) study, telephone interviews, including the University of Jyvaskyla Active Aging Scale (UJACAS) were conducted with 820 people 55 years or older listed with an interest of relocation at three housing companies in Sweden. Field notes alongside the interviews focused on two topics: (1) how respondents reasoned and replied to the questions included in the UJACAS; (2) whether there were specific items that seemed to be affected by the pandemic. Results: For four items (Participating in events, Exercising, Maintaining friendships, Getting to know new people), recurrent comments indicated that respondents had been affected by the pandemic situation regarding one or more of the facets in UJACAS: will to act, ability to act, opportunity to act, or frequency or extent of doing the activity. Opportunities to act was most frequently commented on as a factor affected by restricted participation in activities. As Prospective RELOC-AGE is a longitudinal study focused on associations between housing, relocation and active ageing, it is imperative to consider the potential pandemic-related impact on baseline data in future analyses. ¤¤¤¤¤
40.	Zingmark, Magnus, et al. (författare) Characteristics of occupational therapy and physiotherapy within the context of reablement in Swedish municipalities : A national survey 2020 Ingår i: Health & Social Care in the Community. - : John Wiley & Sons. - 0966-0410 .- 1365-2524. ; 28:3, s. 1010-1019 Tidskriftsartikel (refereegranskat)abstract Reablement is a multidisciplinary, home-based intervention implemented for people at risk of functional decline and losing independence aiming to optimise functioning and independence in activities of daily living. There is limited knowledge about what characterises the intervention and the role of different professionals. The purpose of this study was to explore the characteristics and differences of occupational therapy and physiotherapy interventions in terms of focus, content and duration within the context of reablement in Swedish municipalities. Web-based surveys were used to collect data from 43 municipalities representing 25% of the population in Sweden. Data on intervention characteristics were reported for all cases receiving occupational therapy (n = 1,395) and physiotherapy (n = 1,006) over a 15-week period. Data were presented descriptively, and differences between occupational therapy and physiotherapy were analysed using Chi-square tests. The results indicated that reablement in Sweden was implemented for adults in all ages (19-103 years, median 81.0 years); 72% had home help. For both professions, a baseline assessment was made in fewer than half of all cases. There were significant differences between occupational therapists and physiotherapists regarding the focus and content as well as the number of contacts and duration of the intervention. For occupational therapists, walking indoors and self-care were the largest focus areas, whereas for physiotherapists walking indoors and body function were the largest focus areas. For most cases, the intervention was completed within five sessions over a 6-week period. This study provides the first picture of occupational therapy and physiotherapy within Swedish reablement contexts. In relation to the results, the focus of interventions, how assessments are made and how the intervention is implemented over time are issues that can be further elaborated.
41.	Zingmark, Magnus, et al. (författare) Cost effectiveness of an intervention focused on reducing bathing disability 2017 Ingår i: European Journal of Ageing. - : Springer Science and Business Media LLC. - 1613-9372 .- 1613-9380. ; 14:3, s. 233-241 Tidskriftsartikel (refereegranskat)abstract The onset of bathing disability among older people is critical for a decline in functioning and has implications for both the individuals’ quality of life and societal costs. The aim of this study was to evaluate longterm cost effectiveness of an intervention targeting bathing disability among older people. For hypothetical cohorts of community-dwelling older people with bathing disability, transitions between states of dependency and death were modelled over 8 years including societal costs. A five-state Markov model based on states of dependency was used to evaluate Quality-adjusted life years (QALYs) and costs from a societal perspective. An intervention group was compared with a no intervention control group. The intervention focused on promoting safe and independent performance of bathing-related tasks. The intervention effect, based on previously published trials, was applied in the model as a 1.4 increased probability of recovery during the first year. Over the full follow-up period, the intervention resulted in QALY gains and reduced societal cost. After 8 years, the intervention resulted in 0.052 QALYs gained and reduced societal costs by €2410 per person. In comparison to the intervention cost, the intervention effect was a more important factor for the magnitude of QALY gains and long-term societal costs. The intervention cost had only minor impact on societal costs. The conclusion was that an intervention targeting bathing disability among older people presents a cost-effective use of resources and leads to both QALY gains and reduced societal costs over 8 years.
42.	Zingmark, Magnus, et al. (författare) ”Det är väldigt viktigt att komma ut för både kropp och själ” – Äldre personers utomhusvistelse och tillgänglighet till Östersunds naturområden 2021 Konferensbidrag (övrigt vetenskapligt/konstnärligt)
43.	Zingmark, Magnus, et al. (författare) Exploring associations of housing, relocation, and active and healthy aging in sweden : Protocol for a prospective longitudinal mixed methods study 2021 Ingår i: JMIR Research Protocols. - : JMIR Publications Inc.. - 1929-0748. ; 10:9 Tidskriftsartikel (refereegranskat)abstract Background: While housing and neighborhood features have the potential to impact opportunities for active aging, there is a lack of knowledge related to how older people reason regarding their housing situation and how housing and fulfillment of relocation are associated with active and healthy aging. Objective: The objectives of Prospective RELOC-AGE are to study housing choices and relocation and explore effects on active and healthy aging among men and women aged 55 years and older in Sweden considering relocation. Methods: The estimated sample (2800) will include people aged 55 years and older being listed for relocation at either of two housing companies: a local public housing company in Southern Sweden and a national condominium provider. Prospective RELOC-AGE has a 2-level longitudinal mixed methods design and includes quantitative surveys (implemented by a professional survey company) and a telephone interview for baseline data collection in 2021, with follow-ups with the same procedures in 2022 and 2023. The survey and interviews include questions related to present housing and neighborhood, relocation plans and expectations, a range of perspectives on active and healthy aging, and demographics. Linking to national registers will provide additional data on home help and health care use, objective housing, and neighborhood characteristics. To explore what housing attributes older adults considering relocation find important and to what extent when making their decisions on housing, we will develop a discrete choice experiment to be implemented with a subsample of participants. Further, a grounded theory approach will be applied to collect in-depth interview data from participants who have moved to another dwelling, within 6 months of the move. A follow-up interview 12 months later will focus on participants' deepened experience over time in terms of fulfilled expectations and relocation experiences. Results: As of submission of this protocol (June 2021), recruitment has commenced with approximately 960 respondents to the survey and ongoing telephone interviews. We anticipate recruitment and data collection based on surveys and interviews to continue during 2021. Conclusions: Prospective RELOC-AGE has the capacity to generate new policy-relevant knowledge on associations of housing, relocation, and active and healthy aging. Such knowledge is relevant for the development of proactive approaches to housing in old age on the individual, group, and societal levels.
44.	Zingmark, Magnus, et al. (författare) Feasibility of a reablement-program in a Swedish municipality 2023 Ingår i: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 30:1, s. 53-64 Tidskriftsartikel (refereegranskat)abstract Background: While occupational therapists (OT) and physiotherapists (PT) have a central role in reablement, no structured approach for these professions has been described in Sweden.Aims/Objectives: The aim was to explore the feasibility of a reablement program developed to guide OTs and PTs in a Swedish municipality context.Material and methods: Eligible participants were OTs and PTs working with reablement. Feasibility was evaluated in terms of how OTs (n = 16) and PTs (n = 15) experienced the application of the program. Data were collected through web surveys during a pilot study over four months.Results: The program was implemented for 62 clients. Baseline assessments were conducted in 97% of all cases and follow-ups in 77%. The average duration of the program was 8 weeks and includeed 5 home visits and 3 contacts by phone. In 15 cases, a new goal was identified after follow-up. Collaboration was included with other professionals and relatives in 89% and 35% of the cases, respectively. The program was categorized as feasible to some extent in 34 cases and not feasible in 21 cases.Conclusions and significance: The program was feasible to some extent. To enhance feasibility, flexibility may be needed in order to tailor assessments according to the client’s health status.
45.	Zingmark, Magnus, et al. (författare) Meeting the needs of elderly with bathing disability 2011 Ingår i: Australian Occupational Therapy Journal. - : Wiley-Blackwell. - 0045-0766 .- 1440-1630. ; 58:3, s. 164-71 Tidskriftsartikel (refereegranskat)abstract BACKGROUND/AIMS: Difficulties with bathing are frequent among older people and are associated with an increasing need for societal support. As loss of independence has a negative impact on health and wellbeing, it is important to study interventions that can provide the required support for people to be able to remain independent. Occupational therapy interventions can improve clients' abilities enabling them to bathe themselves, thus reducing the need for other, more long-term societal support from, e.g. a home help. In this study, two groups of elderly people with difficulties in bathing were compared; the clients in the intervention group were engaged in occupational therapy.METHODS: A quasi-experimental non-equivalent control group design was used, in which participants with reported difficulties in bathing were recruited consecutively from two municipalities. The clients in the intervention group routinely received occupational therapy, whereas clients in the control group received assistance from a home help for bathing. Activities of daily living, quality of life and home-help allocation were assessed at the baseline and after 15 weeks.RESULTS: Clients in the intervention group received less than three home visits on average, with majority of interventions consisting of graded activity and the use of an encouraging approach. Seventy per cent of the interventions were adaptive. Activities of daily living and quality of life of both groups improved, but the differences of being allocated a home help were significant.CONCLUSION: Occupational therapy interventions seem beneficial in terms of supporting older people in becoming independent of home help in bathing but the results must be interpreted with caution as there were differences at baseline between the groups.
46.	Zingmark, Magnus, et al. (författare) Modelling long-term cost-effectiveness of health promotion for community-dwelling older people 2019 Ingår i: European Journal of Ageing. - : Springer. - 1613-9372 .- 1613-9380. ; 16:4, s. 395-404 Tidskriftsartikel (refereegranskat)abstract The effectiveness of health promotion for community-dwelling older people is well documented; however, there is a general lack of health economic evaluations. The aim of the present study was to evaluate long-term cost-effectiveness over 4 years of two health promoting interventions: senior meetings and a preventive home visit, for community-dwelling older people in relation to no intervention. We applied a Markov model including five states defined in relation to level of dependency of home help and place of residency. The model included transitions between dependency states, scores for quality of life and societal costs for each state, intervention costs and intervention effects for two formats of health promoting interventions. For each intervention and a no-intervention control group, we calculated the accumulated quality-adjusted life years (QALYs) and societal costs over 4 years. Sensitivity analyses included higher intervention costs, lower intervention effects and additional intervention costs and effects related to booster sessions. The results of all analyses indicated that health promotion implemented for community-dwelling older people in the format of senior meetings or a preventive home visit was cost-effective. Both interventions lead to QALY gains and reduce societal costs at any follow-up over 4 years, and thus, resources can be used to implement other interventions. The most important factor for the magnitude of QALY gains and cost savings was the intervention effect. Yearly booster sessions implemented for those persons who maintained their level of functioning extended the intervention effects adding additional QALYs and further reducing societal costs.
47.	Zingmark, Magnus, 1971- (författare) Occupation-focused and occupation-based interventions for community-dwelling older people : Intervention effects in relation to facets of occupational engagement and cost effectiveness 2015 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.
48.	Zingmark, Magnus, et al. (författare) Occupation-focused health promotion for well older people : a cost-effectiveness analysis 2016 Ingår i: British Journal of Occupational Therapy. - : Sage Publications. - 0308-0226 .- 1477-6006. ; 79:3, s. 153-162 Tidskriftsartikel (refereegranskat)abstract Introduction: The aim of this study was to evaluate three occupational therapy interventions, focused on supporting continued engagement in occupation among older people, to determine which intervention was most cost effective, evaluated as the incremental cost/quality adjusted life year gained.Method: The study was based on an exploratory randomized controlled trial. Participants were 77–82 years, single living and without home help. One hundred and seventy seven persons were randomized to an individual intervention, an activity group, a discussion group or a no intervention control group. All interventions focused on supporting the participants to maintain or improve occupational engagement. Outcomes were evaluated at baseline, three and 12 months and included general health and costs (intervention, municipality and health care). Based on linear regression models, we evaluated how outcomes had changed at each follow-up for each intervention group in relation to the control group.Results: Both group interventions resulted in quality adjusted life years gained at three months. A sustained effect on quality adjusted life years gained and lower total costs indicated that the discussion group was the most cost-effective intervention.Conclusion: Short-term, occupation-focused occupational therapy intervention delivered in group formats for well older people resulted in quality-adjusted life years gained. A one-session discussion group was most cost effective.
49.	Zingmark, Magnus, et al. (författare) Occupation-focused interventions for well older people : an exploratory randomized controlled trial 2014 Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa Healthcare. - 1103-8128 .- 1651-2014. ; 21:6, s. 447-457 Tidskriftsartikel (refereegranskat)abstract Objective: The aim of this exploratory randomised controlled trial (RCT) was to evaluate three different occupation-focused interventions for well older people by estimating effect sizes for leisure engagement and ability in activities of daily living (ADL) and thereby identifying the most effective interventions.Methods: One hundred and seventy seven persons, 77-82 years old, living alone and without home help, were randomized to a control group (CG), an individual intervention (IG), an activity group (AG), and a one-meeting discussion group (DG). All interventions focused on occupational engagement and how persons can cope with age-related activity restrictions in order to enhance occupational engagement. Data were collected by blinded research assistants at baseline, three, and 12 months. Ordinal outcome data were converted, using Rasch measurement methods, to linear measures of leisure engagement and ADL ability. Standardized between-group effect sizes, Cohen's d, were calculated.Results: While all groups showed a decline in leisure engagement and ADL over time, the IG and the DG were somewhat effective in minimizing the decline at both three and 12 months. However, the effect sizes were small.Conclusions: The findings indicate that occupation-focused interventions intended to minimize a decline in leisure engagement and ADL were sufficiently promising to warrant their further research.
50.	Zingmark, Magnus, et al. (författare) Promoting continued engagement in outdoor recreation among older adults in Sweden through the public sector, third sector and companies 2022 Konferensbidrag (refereegranskat)abstract Conclusions: • Older adults are at high risk for disengagement from outdoor recreation• Suggested core features to promote outdoor recreation: person-centeredness, promoting functioning, addressing self-ageism, providing environmental support, promoting subjective mobility needs, adaptation (new ways to engage)• Opportunities for sectors and private companies: potential to develop and expand services to an increasingly larger group of older people Background: The advantages of sustained health and well-being in old age may be reduced by disengagement from outdoor recreation. We present a rationale for how the public sector, the third sector and private companies can promote continued engagement in outdoor recreation.Methods: Empirical data from (i) older adults through a quantitative survey and semi-structured interviews, (ii) sector representatives and private companies through semi-structured interviews, (iii) older adults, sector representatives and private companies through a workshop. Results: Outdoor recreation was considered important to maintain physical fitness, psychological wellbeing, identity, and daily routines. More than 50 percent of survey respondents had disengaged from activities previously performed due to health decline, too demanding activities, or social loss. Continued engagement was considered important but challenging. To improve services for different needs and preferences in outdoor recreation, sector representatives and private companies highlighted: Knowledge and support on how to design accessible activities and natural environments and increased financial resources for accessibility.

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