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| 2. |
- Guidetti, Susanne, et al.
(author)
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F@ce: a team-based, person-centred intervention for rehabilitation after stroke supported by information and communication technology : a feasibility study
- 2020
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In: BMC Neurology. - : BioMed Central (BMC). - 1471-2377. ; 20:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: Globally, there is a growing use of Information and Communication Technology (ICT), including mobile phones, tablets and computers, which are being integrated into people's daily activities. An ICT-based intervention called F@ce was developed in order to provide a structure for the process in stroke rehabilitation and facilitate change by integrating a global problem-solving strategy using SMS alerts. The aim of the study was to evaluate the feasibility of i) F@ce within in-patient and primary care rehabilitation after stroke, ii) the study design and outcome measures used, and iii) the fidelity, adherence and acceptability of the intervention.METHODS: Three teams comprising occupational therapists and physiotherapists who work in neurological rehabilitation participated in a preparatory workshop on F@ce and then enrolled 10 persons with stroke to participate in the intervention. Goals were set using the Canadian Occupational Performance Measure (COPM) and the participants with stroke rated their performance and satisfaction with the activities associated with the three goals every day for 8 weeks. Data were collected at inclusion, at four and 8 weeks, using the COPM, Stroke Impact Scale, Frenchay Activities Index, Life Satisfaction Checklist, Self-Efficacy Scale, Hospital Anxiety and Depression Scale, Fatigue Severity Scale, follow-up survey, daily ratings on the web platform and logbooks.RESULTS: All of the participants showed increased scores in the primary outcome (COPM) and a clinically meaningful improvement of ≥2 points was found in four participants regarding performance and in six participants regarding satisfaction. Overall fidelity to the components of F@ce was good. The response rates to the F@ce web platform were 44-100% (mean 78%). All of the participants stated that F@ce had supported their rehabilitation.CONCLUSION: The results indicate that the most beneficial part of F@ce was the person-centred, goal-setting process and SMS alerts. All participants were satisfied with F@ce and highlighted the benefits of receiving daily alerts about their goals. This encouraged them to be more active. The only downside mentioned was that they felt under an obligation to practice, although this was described as "a positive obligation".
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| 3. |
- Gustavsson, Martha, et al.
(author)
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Everyday doings in a nursing home - described by residents and staff
- 2015
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In: Scandinavian Journal of Occupational Therapy. - : TAYLOR and FRANCIS LTD. - 1103-8128 .- 1651-2014. ; 22:6, s. 435-441
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Journal article (peer-reviewed)abstract
- Objective: For many groups of elderly people it is important to be active, which can be hindered by disabilities that come with age. Research has progressed in this area but mostly concerns the elderly living at home. The aim of this study was to examine how residents and staff at a nursing home described the residents everyday doings. Methods: A nursing home was selected in which 15 of the residents and six of the staff were interviewed about the residents activities during an ordinary day and week. Results: The material was analysed using qualitative content analysis in which two categories emerged: shared doings and individual doings. The shared doings were important for supporting the residents in their social and physical activities, but participation in these was often hampered by reduced functions. The individual doings, where the residents own interests can be promoted, were also hampered by their disabilities. Being able to be active and having something to do were emphasized, either continuing with previous activities or participating in shared activities at the nursing home. Conclusions: Receiving care and being forced to adjust to the context at the nursing home had a significant impact on the residents daily doings. Most of the residents needed help to be able to continue performing their activities or to find new ones. The social environment consisting of other residents and staff also influenced the residents activities.
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| 4. |
- Gustavsson, Martha, 1980-, et al.
(author)
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Experiences of using information and communication technology within the first year after stroke – a grounded theory study
- 2018
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In: Disability and Rehabilitation. - Abingdon, Oxfordshire, United Kingdom : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 40:5, s. 561-568
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Journal article (peer-reviewed)abstract
- Purpose: The purpose of this study was to identify how people 6–12 months after stroke were using and integrating information and communication technology (ICT) in their everyday lives.Method: To capture the participants’ experiences, one focus group and 14 individual interviews were carried out in Sweden and Denmark regarding the use of ICT in everyday life. The participants comprised 11 men and seven women aged 41–79 years. A grounded theory approach was used throughout the study and a constant comparative method was used in the analysis.Results: Five categories were identified from the analysis of the interviews with the participants: 1) Using the mobile phone to feel safe, 2) Staying connected with others, 3) Recreating everyday life, 4) A tool for managing everyday life, and 5) Overcoming obstacles for using ICT. From these categories one core category emerged: The drive to integrate ICT in everyday life after stroke.Conclusions: People with stroke had a strong drive to integrate ICT in order to manage and bring meaning to their everyday lives, although sometimes they needed support and adaptations. It is not only possible but also necessary to start using ICT in rehabilitation in order to support people’s recovery and promote participation in everyday life after stroke.Implications for rehabilitation People with stroke have a strong drive for using information and communication technology in their everyday lives, although support and adaptations are needed.The recovery process of people with stroke could benefit from the use of ICT in the rehabilitation and ICT could possibly contribute to independence and promote participation in everyday life.Knowledge from this study can be used in the development of an ICT-based stroke rehabilitation model.
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| 5. |
- Gustavsson, Martha, 1980-, et al.
(author)
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Exploring future possibilities of using information and communication technology in multidisciplinary rehabilitation after stroke – a grounded theory study
- 2020
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In: Scandinavian Journal of Occupational Therapy. - London, United Kingdom : Informa Healthcare. - 1103-8128 .- 1651-2014. ; 27:3, s. 223-230
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Journal article (peer-reviewed)abstract
- Background: Using Information and Communication Technology (ICT) could increase the intensity of rehabilitation, the level of patient activity and participation in everyday life after stroke and is in line with having a person-centred approach.Aim: To explore how healthcare professionals use and could potentially use ICT to enable a person-centred rehabilitation process after stroke.Methods: Six individual and two focus group interviews were conducted with a group of healthcare professionals working within rehabilitation after stroke. A grounded theory approach was used to collect and analyze the data.Results: The professionals described their current use of ICT as well as their vision of how ICT could be incorporated as a tool in rehabilitation for sharing in four categories: (1) Sharing of information, (2) Collaborating from a distance, (3) Having transparency in the documentation and (4) Supporting patients’ use of ICT.Conclusion: Professionals state that using ICT solutions in rehabilitation after stroke could increase sharing between professionals and their patients and increase patient participation in the rehabilitation process.Significance: This study highlights the importance of developing ICT that healthcare professionals could use along with a person-centred approach. The results will be used to develop an ICT-supported multidisciplinary intervention for rehabilitation after stroke.
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| 6. |
- Gustavsson, Martha, et al.
(author)
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Factors affecting outcome in participation one year after stroke : a secondary analysis of a randomized controlled trial
- 2019
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In: Journal of Rehabilitation Medicine. - Uppsala, Sweden : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 51:3, s. 160-166
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Journal article (peer-reviewed)abstract
- Objective:To explore the importance of client characteristics (age, sex, stroke severity and participation before stroke), rehabilitation context (in-patient or client's home) and approach (enhanced client-centeredness or not) on participation in everyday life after stroke.Methods:A secondary analysis of data on 237 participants from a previous randomized controlled trial evaluating an enhanced client-centred intervention after stroke. Plausible associations between client characteristics, context and rehabilitation approach, and a positive outcome regarding participation were explored. Three different outcome measures for participation were used: Stroke Impact Scale 3.0, domain participation; Frenchay Activities Index; and Occupational Gaps Questionnaire.Results:For all participants there was a significant association between mild stroke and a positive outcome using the Frenchay Activities Index. Among participants who had not received the enhanced client-centred approach, there was a significant association between mild stroke and a positive outcome using the Stroke Impact Scale. The context of rehabilitation, i.e. receiving home rehabilitation, was also associated with a positive outcome in the Frenchay Activities Index for the control group.Conclusion:In order to increase participation in everyday life for people after stroke it appears to be important to use an enhanced client-centred approach, particularly when working within in-patient rehabilitation and with people with moderate or severe stroke.
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| 7. |
- Gustavsson, Martha
(author)
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Participation in everyday life after stroke : development and evaluation of F@ce – a team-based, person-centred rehabilitation intervention supported by information and communication technology
- 2019
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Doctoral thesis (other academic/artistic)abstract
- AIM: The general aim of this thesis was to generate knowledge about how Information and Communication technology (ICT) could be used in the rehabilitation process after stroke in order to develop and evaluate the feasibility of F@ce- a person-centred, team-based intervention, supported by ICT, to enable performance of daily activities and participation in everyday life for people after stroke. METHODS: Studies I and II were qualitative grounded theory studies that were performed to generate knowledge on people after stroke and health care professionals working with rehabilitation after stroke, regarding the experiences of using ICT. The third study was a secondary analysis of a previously performed randomised controlled trial, evaluating a client-centred activities of daily living (CADL) intervention, to analyse factors of importance for a positive outcome in participation after stroke. The knowledge generated in studies I-III combined with previous research was used to develop F@ce, a team-based, person-centred intervention for rehabilitation after stroke, that was supported by ICT. Study IV was an evaluation of the feasibility of using F@ce, and the study design, in terms of the recruitment process, outcome measures used, fidelity, adherence, acceptability and potential harms. RESULTS: People after stroke in study I described their drive to integrate ICT in their everyday lives after stroke. They used their mobile phones to feel safe, to stay connected to friends and family, and to improve physical and cognitive functions. They also used their computer for social networks, to manage daily occupations such as paying bills, online shopping and searching for information. The healthcare professionals in study II did not use ICT to any greater extent outside their office, however, they had a vision that ICT could be used as a platform for sharing information and collaboration within the rehabilitation process. The results from study III showed that within the control group (receiving usual ADL interventions) those with mild stroke and home-based rehabilitation had a better outcome in perceived participation compared to the intervention group, however, in the intervention group the difference between stroke severity and context of rehabilitation were not significant. This would indicate that the CADL intervention were specifically useful for those with moderate to severe stroke and those receiving rehabilitation at an in-patient unit. The feasibility testing of the newly developed F@ce intervention in study IV showed that it was feasible to use, and that the fidelity, adherence and acceptability of the intervention were good. The participants had positive outcomes in performance (n=4) and satisfaction with the performance (n=6) of daily activities according to Canadian Occupational Performance measure (COPM) and several participants had clinically significant improvements in different domains in the Stroke Impact Scale (SIS). CONCLUSION: The studies within this thesis enabled the development and evaluation of a new rehabilitation intervention, F@ce, using ICT which is relevant in this time, with the rapid digitalization in the society, healthcare and rehabilitation. The knowledge from the previously developed CADL study, along with the experiences of people after stroke and healthcare professionals’ use of ICT, and the modelling of F@ce together with stakeholders created a strong foundation for the new intervention. Using a team-based, person-centred intervention with the support of ICT seemed to enable people to perform daily activities and thus increase their participation in everyday life.
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| 8. |
- Gustavsson, Martha, et al.
(author)
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Virtual reality gaming in rehabilitation after stroke - user experiences and perceptions
- 2022
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In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 44:22, s. 6759-6765
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Journal article (peer-reviewed)abstract
- Purpose The present study explored participants' experiences with and perceptions of using fully immersive head-mounted virtual reality (VR) gaming as rehabilitation after stroke. Methods Four men and three women (median age 64 years) with chronic stroke and varying motor impairment (mild to severe) were interviewed after 10 weeks of VR training on the commercial HTC Vive system, focusing on the upper extremities. Inductive qualitative thematic analysis was performed. Results The analysis revealed three main themes: playing the game, benefits and effects, and personalizing the game. Playing the game encompasses both the feeling of being immersed in the game and descriptions of the gaming being motivating and fun. Benefits and effects describe the participants' expectations of potential benefits, the importance of getting feed-back, and the impact in daily life. Personalizing the game includes finding the right game and level, and the participants' need for support to achieve full use of the training. Conclusions Participants with chronic stroke described the fully immersive VR gaming intervention as a fun and motivating way to improve their functioning in everyday life. Qualitative studies are needed to explore how people with stroke perceive VR gaming when it is implemented in real clinical environments.Clinical implications VR gaming was perceived as a positive and motivating rehabilitation after stroke. Getting feedback and perceiving benefits are essential parts of VR rehabilitation. Commercial fully immersive VR-games might be an option for stroke rehabilitation when the game can be personalized and support is available.
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| 9. |
- Kesthely, Martha, 1945-
(author)
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Jag vill att ni hämtar min mamma... : Villkor för familjearbete för ungdomar inom institutionsvården.
- 2006
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Doctoral thesis (other academic/artistic)abstract
- This thesis is about a special type of institutional treatment called family-work. It can be described as different ways to involve the families of the youth in their treatment programme. The locus of the study are special treatment homes which provide treatment for youth with serious social and behavioural problems. The study concerns three units at three institutions. The thesis has a qualitative and interpretative approach with using of observations, field studies, combined with interviews and field notes. The study focuses at the pre-conditions for the local "family projects" run by the care workers. With "project" means a process where different actions take place. The Theory of Action concept facilitates the understanding of these types of process and the importance of the internal(subjective) and external(objective) conditions in proportion to the space of action. Several local conditions influenced the pre-requisites for the staff to be able to carry out a "family project" and decide how to realize an intention. Important conditions were commissions given by the social services and the treatment focus at the units. The units are functioned as kinds of overall social "project contexts" with four basic characteristics: the treatment focus and structure, the professionalism and the organisation of the work. The conclusion from the study is that none of the "project contexts" at the three units provided good pre-requisites for family-work. "Family projects", realised by care workers were however professional and seem to have helped both the parents and the young persons, but "the project" were, in total, relatively few. It appeared that a successfully completed "family project" is the last step in a long process in which many different conditions contribute to the destiny of the "project". A clear family focused structured treatment at a unit can provide the employees with good conditions for realising the opportunities they see for working with families.
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| 10. |
- Kjörk, Emma, et al.
(author)
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Stroke-related health problems and associated actions identified with the post-stroke checklist among nursing home residents
- 2022
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In: BMC Cardiovascular Disorders. - London, United Kingdom : Springer Science and Business Media LLC. - 1471-2261. ; 22:1
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Journal article (peer-reviewed)abstract
- Background Little is known about the needs of permanent nursing home residents after a stroke; comprehensive descriptions of needs are rare. The Post-Stroke Checklist facilitates the identification of health problems. The study aimed to use the Post-Stroke Checklist to identify the extent of health problems, and how they were addressed, in nursing home residents that experienced strokes in Sweden. We also investigated the feasibility of the Checklist in a nursing home context. Methods This is a cross-sectional explorative study. Twenty nursing homes in two regions of Sweden participated. We included residents that had experienced a stroke within approximately 3 years and the responsible staff members were approached. Questionnaires were completed during face-to-face meetings with staff members (n = 45) knowledgeable about the residents. Data collection included the Post-Stroke Checklist, Barthel Index, modified Rankin Scale, resident and staff characteristics, and a satisfaction-questionnaire completed by staff. Results At the included nursing homes 1061 residents, 22% (n = 239) had a history of stroke, and 6% (n = 65) had experienced strokes during the last 3.5 years. Forty-nine residents were included (41% men, median age, 86 years, range 59-97). Among the health problems identified with the Checklist, activities of daily living (82%) were most common, and spasticity (41%) and pain (29%) were least common. Residents had extensive care needs, with a median of six health problems per resident. The total number of health problems addressed by previous actions i.e., referrals, as suggested in the Checklist, was 124, when recalled by staff. The median Barthel index score was 35. Lack of follow-up after stroke (e.g., by using a checklist) was reported in 17/20 nursing homes. The staff were satisfied with the Post-Stroke Checklist. Conclusions We found that more than 1/5 of residents had experienced a stroke; thus, the Post-Stroke Checklist was a useful tool in nursing homes. Half of the residents had more than six health problems, identified with the Post-Stroke Checklist. Extensive needs, combined with a lack of follow-up, indicated a risk of insufficient care. These findings suggested that nursing home routines could be improved with the Post-Stroke Checklist. Trial registration The project is registered in Research web, project number: 256021.
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