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- Bertilsson, Ann-Sofie, et al.
(author)
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A client-centred ADL intervention: three-month follow-up of a randomized controlled trial
- 2014
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In: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 21, s. 377-391
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Journal article (peer-reviewed)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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| 2. |
- Bertilsson, Ann Sofie, et al.
(author)
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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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In: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 30:8, s. 765-775
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Journal article (peer-reviewed)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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| 3. |
- Bertilsson, Ann-Sofie, et al.
(author)
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Client-centred ADL intervention after stroke : Significant others' experiences
- 2015
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In: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 22:5, s. 377-386
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Journal article (peer-reviewed)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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| 4. |
- Bertilsson, Ann-Sofie
(author)
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Evaluation of a client-centred ADL intervention after stroke : perspectives of occupational therapists, clients with stroke and significant others
- 2015
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Doctoral thesis (other academic/artistic)abstract
- The overall aim of this thesis is to build knowledge of a new client-centred activities of daily living (ADL) intervention (CADL), which takes the unique experiences of persons with stroke as the point of departure, and aims to enable agency in daily activities and participation in everyday life among persons with stroke. The focus of this thesis is an evaluation of CADL after stroke, from the perspectives of occupational therapists (OT), clients with stroke and their significant others. Methods: Study I uses quantitative content analysis to explore how client-centredness is documented in 280 medical records by OTs who received training intended to enhance client-centredness, compared with OTs who had not received such training. Studies II and III are based on a multicentre randomized controlled trial (RCT): Study II studies the effects of CADL compared with usual ADL (UADL), 3 months after the start of interventions on 280 people with stroke regards: independence in ADL, perceived participation, life satisfaction, use of home help service and satisfaction with training; and on the significant others of persons with stroke receiving CADL or UADL as regards caregiver burden, life satisfaction and provision of informal care. Study III compares the effects of CADL and UADL on the caregiver burden, provision of informal care, participation in everyday occupations and life satisfaction of 183 significant others up to one year after the persons with stroke were included in the study. Study IV has a grounded theory approach exploring and describing whether and if so, how CADL was integrated into everyday lives of the significant others of people with stroke who received CADL during the first year after the intervention. The findings in Study I show that OTs with client-centredness training recorded significantly more client participation in goal-setting than therapists without training. In Study II, 3 months after inclusion, there were no differences between the CADL group and UADL group in the outcomes of people with stroke or their significant others, except in the Stroke Impact Scale “Emotion” domain, which favours CADL intervention. Nor were there any differences in outcomes at 12 months between significant others in the two groups, or in changes between 3 and 12 months in Study III. For significant others in the CADL group, however, the odds were significantly lower regarding the “General strain” factor in Caregiver burden at 12 months compared to 3 months. The findings in Study IV indicate that CADL has been integrated into the everyday lives of the significant others. An overall core category “Taking responsibility and achieving balance with respect to self-esteem to get on with everyday life”, and four interrelated subcategories represent a temporal process of interactions between significant others and persons with stroke in their daily activities in which significant others adapted themselves to achieve balance in everyday life. One further key aspect is that as persons with stroke acted upon their own activity goals, their significant others were encouraged to act on their own needs. Conclusion: It is possible to increase client-centredness through training. CADL has beneficial effects on the perceived impact of stroke on emotions at 3 months after stroke, there were no other differences in effects between CADL and UADL for people with stroke or their significant others. Among the significant others in the CADL group, however, the experiences of burden seemed to decrease over time between 3 and 12 months, despite no change in informal care. Findings indicate that it was a transfer of learning from the person with stroke to the significant others, with a new shared learning. By initiating the CADL soon after the stroke, professionals involved such as OTs can support both the people with stroke and their significant others in adjusting to the new life situation. In order to tailor the interventions to meet the individual needs in everyday life, however, conducting follow-up sessions over a longer time period would be of importance.
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| 6. |
- Nowicka, Paulina, 1974-, et al.
(author)
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Systematic Development of National Guidelines for Obesity Care : the Swedish Approach
- 2024
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In: Obesity Facts. - : S. Karger. - 1662-4025 .- 1662-4033. ; 17:2, s. 183-190
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Journal article (peer-reviewed)abstract
- INTRODUCTION: With the rapid development of treatment modalities for obesity management, there is a growing need for guidelines. This was acknowledged by the Swedish National Board of Health and Welfare and in 2020 the process of producing the first national guidelines for obesity care, including both children and adults, was initiated. The main aim was to ensure equal high standard care throughout Sweden by supporting decision makers to allocate resources to the best knowledge-based care.METHODS: The standardized procedures of the National Board of Health and Welfare were applied to construct guidelines in a systematic and transparent way, including priority setting of recommendations and quality indicators to evaluate the progress of implementation. The process involved independent expert committees including professionals and patient representatives, and the guidelines were reviewed through an open public consultation.RESULTS: In total, 20 recommendations were issued encompassing a broad scope, from identification and diagnosis to multiple treatment modalities, embedded in a life course perspective from pregnancy to the elderly, as well as highlighting the need for improved knowledge and competence of health care providers.CONCLUSIONS: National guidelines for improved standard care and evidence based and efficient use of health care resources for obesity treatment can be developed in a systematic way with professionals and patient representatives.
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| 7. |
- Nowicka, Paulina, 1974-, et al.
(author)
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Systematic Development of National Guidelines for Obesity Care: The Swedish Approach
- 2024
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In: OBESITY FACTS. - : S. Karger. - 1662-4025 .- 1662-4033. ; 17:2, s. 183-190
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Journal article (peer-reviewed)abstract
- Introduction: With the rapid development of treatment modalities for obesity management, there is an increasing demand for guidance to facilitate the prioritization of interventions. In 2020, the Swedish National Board of Health and Welfare started the process of producing the first national guidelines for obesity care directed to decision makers who allocate resources to the best knowledge-based care. The main aim of this paper was to describe the systematic development of these guidelines, designed to guarantee uniformly high standards of care throughout the whole country. Methods: The standardized procedures of the National Board of Health and Welfare were applied to construct guidelines in a systematic and transparent way, including priority setting of recommendations and quality indicators to evaluate the progress of implementation. The process involved independent expert committees including professionals and patient representatives, and the guidelines were reviewed through an open public consultation. Results: National guidelines were issued in 2023, encompassing a broad scope, from identification and diagnosis to multiple treatment modalities, embedded in a life-course perspective from pregnancy to the elderly, as well as highlighting the need for improved knowledge and competence of health care providers. Conclusions: National guidelines for improved standard care and evidence-based and efficient use of health care resources for obesity treatment can be developed in a systematic way with professionals and patient representatives.
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