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1.
  • Assander, Susanne, et al. (author)
  • ASSIST : a reablement program for older adults in Sweden - a feasibility study
  • 2022
  • In: BMC Geriatrics. - : Springer Nature. - 1471-2318. ; 22:1
  • Journal article (peer-reviewed)abstract
    • Background Western countries emphasise the provision of assistive home care by implementing reablement services. Reablement services are offered to a limited degree in Sweden, and systematic research regarding outcomes and how reablement can be tailored to maximize benefits for older adults has been lacking. This study aimed to evaluate the feasibility of a novel reablement program (ASSIST 1.0) regarding study design and outcome measures, as well as fidelity, adherence, and acceptability of the program in a Swedish context. Method A non-randomised, quasi-experimental, mixed-method, pre/post-test design was applied with an intervention group receiving ASSIST 1.0 (n = 7) and a control group receiving regular home care (n = 10). ASSIST 1.0 was developed to empower older adults to increase their perceived performance and satisfaction of performing activities in everyday life as well as increase their perceived health, self-efficacy, and well-being. ASSIST 1.0 was founded on the concept of reablement and included three components: i) goal setting with The Canadian Occupational Performance Measure (COPM), ii) provided support to home care staff to enhance their provision of reablement, and iii) explored the incorporation and use of an information- and communication technology (ICT) to facilitate information transfer. Results Using COPM for goal setting with older adults and providing support to the staff via workshops were valuable components in the delivery of ASSIST 1.0. The ICT product encountered several challenges and could not be evaluated. COPM and EQ-5D were deemed the most important instruments. Organisational and political barriers affected the feasibility. Although, the fidelity and adherence were complied the staff perceived the program to be acceptable. Conclusion The ASSIST 1.0 program was feasible in regard of study design, delivering the intervention, and evaluating instruments that detected a change. A logical progression would be to conduct a full-scale trial. In addition, a usability study to evaluate the technological component is also recommended. With minor improvements, the ASSIST 1.0 program has the potential to contribute to the development of a home care organisation that could enhance older adults possibility to age in place at home.
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2.
  • Assander, Susanne, et al. (author)
  • Individual and organisational factors in the psychosocial work environment are associated with home care staffs' job strain : a Swedish cross-sectional study
  • 2022
  • In: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 22:1
  • Journal article (peer-reviewed)abstract
    • BackgroundHome care staff (HCS) provide essential service to enable older adults to age in place. However, unreasonable demands in the work environment to deliver a safe, effective service with high quality has a negative impact on the individual employee’s well-being and the care provided to the older adults. The psychosocial work environment is associated with employees' well-being, although, knowledge regarding which individual and organisational factors that contribute to job strain for HCS is limited. These factors need to be identified to develop targeted interventions and create sustainable work situations for HCS. This study aimed to explore how HCS's perceived job strain is associated with, and to what extent can be explained by, individual and organisational factors of the psychosocial work environment and psychosomatic health.MethodAn explorative cross-sectional questionnaire survey design was used in a large Swedish county. Five home care agencies with a total of 481 HCS were asked to respond to a questionnaire regarding their perceived level of job strain (Strain in Dementia Care Scale), psychosocial work environment (QPSNordic34+), and psychosomatic health (Satisfaction with Work Questionnaire). Multiple linear regression (MLR) analyses were conducted to explore the association between job strain and individual and organisational factors.ResultsIn total, 226 (46%) HCS responded to the questionnaire. Both individual and organisational factors were significant predictors of job strain and explained a variance ranging between 39 to 51% (p = 0.001). The organisational factor job demand and the individual factor feeling worried and restless was most frequently represented in these MRL models. A higher job strain was also associated with adverse outcomes regarding leadership, organisational culture and climate, and control at work.ConclusionThis study indicates that there is an intertwined complexity of individual and organisational factors that are associated with the HC's perception of job strain. Implementation of new multidimensional work strategies, such as a reablement approach, could support the development of efficient strategies for HCS and reduce the level of job strain. Policy changes for the provision of home care are also needed to support the development of a sustainable and healthy psychosocial work environment.
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3.
  • Heiwe, Susanne, et al. (author)
  • Evidence-based practice : attitudes, knowledge and behaviour among allied health care professionals
  • 2011
  • In: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 23:2, s. 198-209
  • Journal article (peer-reviewed)abstract
    • Objective: To explore dieticians', occupational therapists' and physical therapists' attitudes, beliefs, knowledge and behaviour concerning evidence-based practice within a university hospital setting. Design: Cross-sectional survey. Setting. University hospital. Participants: All dieticians, occupational therapists and physical therapists employed at a Swedish university hospital (n = 306) of whom 227 (74%) responded. Main Outcome Measures: Attitudes towards, perceived benefits and limitations of evidence-based practice, use and understanding of clinical practice guidelines, availability of resources to access information and skills in using these resources. Results: Findings showed positive attitudes towards evidence-based practice and the use of evidence to support clinical decision-making. It was seen as necessary. Literature and research findings were perceived as useful in clinical practice. The majority indicated having the necessary skills to be able to interpret and understand the evidence, and that clinical practice guidelines were available and used. Evidence-based practice was not perceived as taking into account the patient preferences. Lack of time was perceived as the major barrier to evidence-based practice. Conclusions: The prerequisites for evidence-based practice were assessed as good, but ways to make evidence-based practice time efficient, easy to access and relevant to clinical practice need to be continuously supported at the management level, so that research evidence becomes linked to work-flow in a way that does not adversely affect productivity and the flow of patients. © The Author 2011. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.
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4.
  • Andreassen, Maria, 1966- (author)
  • Digital support for people with cognitive impairment : An intervention to increase the occupational performance in everyday life
  • 2021
  • Doctoral thesis (other academic/artistic)abstract
    • Introduction: Senior people with cognitive impairment may experience an inability to manage everyday life due to difficulties related to time management, and planning and structuring everyday life. These difficulties can affect people negatively, for example not remembering to carry out future planned activities. Interventions that compensate for lost cognitive ability often include using assistive technology for cognition (ATC). By investigating the feasibility and potential effects of an intervention with the interactive digital calendar with active reminders, RemindMe, knowledge can be generated about aspects of learning to use and using digital support. Further, knowledge can also be generated about occupations in everyday life that people need to receive reminders for, both during the rehabilitation period and two years after the rehabilitation period. This knowledge can support building evidence-based interventions in rehabilitation for people with cognitive impairment using digital technology. Aim: The overall aim of this thesis was to study an interactive digital calendar with mobile phone reminders (RemindMe) for people with cognitive impairment, as support to increase the occupational performance in everyday life. Methods: This thesis includes four studies, using both qualitative and quantitative data collection methods. Study I was a focus group interview, exploring twenty senior people aged between 66 and 85 and their experiences of learning to use and using RemindMe in everyday life. The seniors had used RemindMe for six weeks and had received weekly support calls from a research assistant during the study period. After six weeks, the participants took part in focus group interviews. Four focus group interviews were conducted, analysed with content analyses. The use of RemindMe and feasibility aspects were also investigated in study II with a mixed-methods design. Eight patients with cognitive impairment, aged between 26–68, and seven occupational therapists participated. The occupational therapists were experienced in occupational therapy and were working at three different outpatient rehabilitation clinics in southeast Sweden. They had a median of 20 years of experience (range of 2–25 years). The patients received an introduction to using RemindMe, as well as weekly support calls from occupational therapists or a research assistant for eight weeks. Quantitative data was collected using the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 (QUEST 2.0). The frequency of and the actual use of RemindMe was generated by RemindMe. Qualitative data was collected via face-to-face interviews with occupational therapists, via field notes from the weekly support conversations, and during the assessments with patients with cognitive impairment. Analyses were conducted using descriptive statistics and directive deductive content analyses. Study III investigated the intervention with RemindMe, addressing plausible outcome measures by investigating changes in outcomes, impact on occupational performance, independence, health-related quality of life, and the psychosocial impact of support used for people with cognitive impairment. The design was a pilot randomized controlled trial with fifteen patients, with cognitive impairment, aged between 26–79, randomized to either an intervention group or a control group. The intervention group consisted of eight patients and the control group of seven patients. The outcome measures were assessed using the Canadian Occupational Performance Measure (COPM), the Functional Independence Measure (FIM), the EuroQol 5-Dimension Visual Analog Scale (EQ-5D-VAS), and the Psychosocial Impact of Assistive Devices Scale (PIADS). Study III was registered at ClinicalTrails.gov, identifier: NCT04470219. Study IV explored seven patients, aged between 51–71, experiences of strategies and support used to establish a new everyday life and their experience of support for time management and planning and structuring everyday life due to cognitive impairment. The study was a qualitative, semi-structured, face-to-face interview. The interviews were analysed with inductive content analysis. Results: The results of this thesis address learning to use and using assistive technology for cognition (ATC) in everyday life and outcomes from using RemindMe. The participants were accustomed to using calendars. However, there were differences in terms of whether they preferred to use “low tech” calendars (such as paper calendars), or “high tech” calendars (for example, digital calendars with reminders), or whether a combination of “low and high tech” was preferred (Studies I and IV). Other support strategies were also described, for example, the conscious use of objects as reminders in the home environment or everyday life routines (Study IV). Participants were positive towards the use of digital technology, especially mobile phones/smartphones that they easily can carry with them (Studies I and IV). Participants also described the advantage of using digital technology with active reminders and audio prompts, signalling, and telling them when to do something. This was described as the reminder “talks to me” (Study I). The actual use of RemindMe showed that reminders were for example used for taking medication, do exercises, or meeting family or friends (Study II). Occupational therapists in Study II described that their patients benefited from using reminders and that patients have to be active in their everyday life and perceive a need for reminders. The outcomes from measurements of occupational performance (COPM) indicate that patients in the intervention group increased their occupational performance and their satisfaction with their performance compared with the control group. The intervention group also increased their independence (FIM) in the communication and social and intellectual abilities subscales (Study III). Conclusions: The results indicate the importance of choosing a reminder that is suited to the patient’s needs, and this reminder can be either “low tech” or “high tech”. The important thing is that the reminder matches the patient’s needs. The result also indicates that for people with cognitive impairment to make full use of the reminder in everyday life, support with learning to use and using the device for a longer period is needed. Participants (Studies II, III, and IV) described scheduling and receiving active reminders as important for achieving a feeling of comfort and security. Another technique was to find habits and routines or objects to support time management and planning and structuring everyday life. Having a sense of comfort and security involved being in control of everyday life. It can be understood as people talking about being fully involved in their life situations, and in that sense as experiencing participation. However, this was s not investigated in the present studies. Two years after the rehabilitation period, digital or paper calendars were used to establish a new everyday life. Active reminders were trusted and resulted in a feeling of comfort and security as well as a sense of control and independence in everyday life.  
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5.
  • Asaba, Eric, et al. (author)
  • Engaging occupations among persons at risk for stroke : A health paradox
  • 2022
  • In: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 29:2, s. 116-125
  • Journal article (peer-reviewed)abstract
    • Background: An occupational perspective in stroke prevention could support sustainable changes in habits and routines that could contribute to reduce modifiable risk factors. Aim: To explore engaging occupation in relation to risk for stroke by drawing on experiences from everyday life among persons with a heightened risk for stroke. Material and methods: Interviews from 14 persons with an increased risk for stroke were analysed by a constant comparative approach. Findings: The analysis resulted in the core category; the paradox of engaging occupations and health. The paradox involved aspects of engaging occupations that could provide well-being and at the same time were compromising considering stroke health. Conclusions and significance: The paradox conceptually challenges some of the core values inherent in occupational therapy regarding the relationship between engaging occupations, health and well-being. Gaining a deeper understanding of experiences of occupations and studying this in relation to health promoting or compromising characteristics of occupations, can facilitate lifestyle programs that support changes in everyday life. Moreover, programs need to be designed to offer personal relevance and to facilitate a positive balance between health compromising occupations and health promoting occupations in everyday life.
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6.
  • Bergstrom, Aileen, et al. (author)
  • Association between satisfaction and participation in everyday occupations after stroke
  • 2017
  • In: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 24:5, s. 339-348
  • Journal article (peer-reviewed)abstract
    • Background: Within occupational therapy, it is assumed that individuals are satisfied when participating in everyday occupations that they want to do. However, there is little empirical evidence to show this. Aims: The aim of this study is to explore and describe the relation between satisfaction and participation in everyday occupations in a Swedish cohort, 5 years post stroke. Methods: Sixty-nine persons responded to the Occupational Gaps Questionnaire (OGQ). The questionnaire measures subjective restrictions in participation, i.e. the discrepancy between doing and wanting to do 30 different occupations in everyday life, and satisfaction per activity. Results were analysed with McNemar/chi-square. Results: Seventy percent of the persons perceived participation restrictions. Individuals that did not perceive restrictions in their participation had a significantly higher level of satisfaction (p=.002) compared to those that had restrictions. Participants that performed activities that they wanted to do report between 79 and 100% satisfaction per activity. Conclusion: In this cohort, there was a significant association between satisfaction and participating in everyday occupations one wants to do, showing that satisfaction is an important aspect of participation and substantiates a basic assumption within occupational therapy. The complexity of measuring satisfaction and participation in everyday occupations is discussed.
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7.
  • Bergstrom, Aileen L., et al. (author)
  • Perceived occupational gaps one year after stroke : An explorative study
  • 2012
  • In: Journal of Rehabilitation Medicine. - Uppsala : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 44:1, s. 36-42
  • Journal article (peer-reviewed)abstract
    • Objective: To explore and describe factors associated with occupational gaps and to identify factors at 3 months that predict occupational gaps one year post-stroke. A gap, a restriction in participation, is considered to be present when there is a discrepancy between what the individual wants to do and what they actually do in everyday life. Design: Prospective longitudinal study. Subjects: Two hundred persons with stroke. Methods: Data from the Occupational Gaps Questionnaire, one year post-stroke, was used as the dependent variable in 3- and 12-month regression analyses. Domains of the Stroke Impact Scale, global life satisfaction, demographic and medical factors were used as independent variables. Results: At 3 months, activities of daily living abilities, social participation and not being born in Sweden predicted occupational gaps at 12 months. Stroke severity and not being born in Sweden and 3 factors at 12 months: social participation, self-rated recovery, and global life satisfaction were associated with occupational gaps. Conclusion: Activities of daily living ability at 3 months predicted occupational gaps after stroke. Thus, it is possible to identify early on, and provide interventions for, those that risk participation restrictions. Not being born in the country might be an indicator of a risk for participation restrictions.
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8.
  • Bergström, Aileen, et al. (author)
  • Phronesis: Recognising a neglected dimension of knowledge within occupational therapy research
  • 2024
  • In: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis Group. - 1103-8128 .- 1651-2014. ; 31:1
  • Journal article (peer-reviewed)abstract
    • Background: Phronesis is a way of knowing, implying wisdom, experiences, and reflections that guide our judgements. Phronesis, important for learning, is a neglected form of knowledge when applied to research.Aim: To examine how phronesis is conceptualised and practiced in three research projects.Method: Data from eight interviews with researchers involved in three research projects was generated. The interview material was analysed. A theoretical matrix of contemporary understanding of phronesis was applied to the material.Result: Examples of phronesis from three research projects in occupational therapy are presented according to categories of contemporary phronesis; acknowledging embodiment, embracing humility, using perceptiveness, and practicing reflexivity.Significance: This unique approach of analysing research projects contributes to the understanding of phronesis and its implications for research, providing valuable insights into the researchers’ praxis in their respective projectsConclusion: There is a need for a greater recognition of phronesis as a dimension of knowledge within all types of research, and within the discipline. By not recognising phronesis as a legitimate form of knowledge, the discipline perpetuates a superiority of knowledge from episteme that dominates our ways of learning about the world around us and where the type of knowledge gleaned from phronesis is consequently marginalised.
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9.
  • Bertilsson, Ann-Sofie, et al. (author)
  • A client-centred ADL intervention: three-month follow-up of a randomized controlled trial
  • 2014
  • In: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 21, s. 377-391
  • 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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10.
  • Blankvoort, Nadine, et al. (author)
  • Higher education students’ experiences of a short-term international programme : Exploring cultural competency and professional development
  • 2019
  • In: Educational research (Windsor. Print). - : Routledge. - 0013-1881 .- 1469-5847. ; 61:3, s. 356-370
  • Journal article (peer-reviewed)abstract
    • Background: Globalisation trends such as increased migration to and within European countries have led to even greater cultural diversity in European societies. Cultural diversity increases the demand of cultural competency amongst professionals entering their work field. In particular, healthcare professionals need knowledge and skills to equip them to work with clients from different cultural backgrounds. Within higher education (HE), the professional development of cultural competency should ideally feature in undergraduate education and is often promoted as a by-product of a study abroad period. However, recognising that logistical and financial barriers often exist for extended study abroad, one alternative approach could be participation, at home or abroad, in a short-term international programme set within students’ own HE institutions.Purpose: The aim of this study was to explore HE students’ experiences of participating in international ‘short-term mobility week’ programmes at three European universities.Methods: Each university involved in the research offered short-term programmes for healthcare professions students at their own institution, where both local students and students from abroad could participate. Participants were healthcare students in the programme at one of the three universities. Data were collected through focus group interviews (4–8 students per group; n = 25). The data were transcribed and then analysed qualitatively, using a content comparison method.Results: The analysis identified six categories, which reflected students’ journeys within the short-term international experiences.Conclusions: The analysis suggested that, for these students, engagement in a short-term mobility week programme provided valuable opportunities for encounters with others, which contributed to personal and professional development, greater confidence in the students’ own professional identities, as well as an increasing sense of cultural awareness.
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11.
  • Darwich, Adam S., et al. (author)
  • Investigating the Connections Between Delivery of Care, Reablement, Workload, and Organizational Factors in Home Care Services : Mixed Methods Study
  • 2023
  • In: JMIR Human Factors. - : JMIR Publications Inc.. - 2292-9495. ; 10
  • Journal article (peer-reviewed)abstract
    • Background: Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use.Objective: The objective of this study is to characterize home care system variables (elements) and their relationships (connections) relevant to home care staff workload, home care user needs and satisfaction, and the reablement approach. This is to examine the effects of improvement and interventions, such as the person-centered reablement approach, on the delivery of home care services, workload, work-related stress, home care user experience, and other organizational factors. The main focus was on Swedish home care and tax-funded universal welfare systems.Methods: The study used a mixed methods approach where a causal loop diagram was developed grounded in participatory methods with academic health care science research experts in nursing, occupational therapy, aging, and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analyzed qualitatively and through simulation methods.Results: The final causal loop diagram included elements and connections across the categories: stress, home care staff, home care user, organization, social support network of the home care user, and societal level. The model was able to qualitatively describe observed intervention outcomes from the literature. The analysis suggested elements to target for improvement and the potential impact of relevant studied interventions. For example, the elements "workload" and "distress" were important determinants of home care staff health, provision, and quality of care.Conclusions: The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of improvement in home care. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored.
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12.
  • Ekerstad, Niklas, et al. (author)
  • Clinical frailty scale – skörhet är ett sätt att skatta biologisk ålder
  • 2022
  • In: Lakartidningen. - 0023-7205. ; 119, s. 1-5
  • Research review (peer-reviewed)abstract
    • The term frailty denotes a multi-dimensional syndrome characterised by reduced physiological reserves and increased vulnerability. Frailty may be used as a marker of biological age, distinct from chronological age. There are several instruments for frailty assessment. The Clinical Frailty Scale (CFS) is probably the most commonly used in the acute care context. It is a 9-level scale, derived from the accumulated deficit model of frailty, which combines comorbidity, disability, and cognitive impairment. The CFS assessment is fast and easy to implement in daily clinical practice. The CFS is relevant for risk stratification, and may also be used as a screening instrument to identify frail patients suitable for further geriatric evaluation, i.e. a comprehensive geriatric assessment (CGA). By providing information on long-term prognosis, it may improve informed decision-making on an individual basis.
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13.
  • Ekerstad, Niklas, 1969-, et al. (author)
  • Clinical frailty scale – skörhet ärett sätt att skatta biologisk ålder : [Clinical Frailty Scale - a proxy estimate of biological age]
  • 2022
  • In: Läkartidningen. - : Sveriges Läkarforbund. - 0023-7205 .- 1652-7518. ; 119
  • Research review (peer-reviewed)abstract
    • The term frailty denotes a multi-dimensional syndrome characterised by reduced physiological reserves and increased vulnerability. Frailty may be used as a marker of biological age, distinct from chronological age. There are several instruments for frailty assessment. The Clinical Frailty Scale (CFS) is probably the most commonly used in the acute care context. It is a 9-level scale, derived from the accumulated deficit model of frailty, which combines comorbidity, disability, and cognitive impairment. The CFS assessment is fast and easy to implement in daily clinical practice. The CFS is relevant for risk stratification, and may also be used as a screening instrument to identify frail patients suitable for further geriatric evaluation, i.e. a comprehensive geriatric assessment (CGA). By providing information on long-term prognosis, it may improve informed decision-making on an individual basis.
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14.
  • Ekstam, Lisa, et al. (author)
  • The combined perceptions of people with stroke and their carers regarding rehabilitation needs 1 year after stroke : a mixed methods study
  • 2015
  • In: BMJ Open. - : BMJ. - 2044-6055. ; 5:2
  • Journal article (peer-reviewed)abstract
    • Objectives: The aim of the study was to explore the associations between the dyad's (person with stroke and informal caregiver) perception of the person with stroke's rehabilitation needs and stroke severity, personal factors (gender, age, sense of coherence), the use of rehabilitation services, amount of informal care and caregiver burden. Further, the aim was to explore the personal experience of everyday life changes among persons with stroke and their caregivers and their strategies for handling these 1 year after stroke. Design: A mixed methods design was used combining quantitative and qualitative data and analyses. Setting: Data were mainly collected in the participants' homes. Outcome measures: Data were collected through established instruments and open-ended interviews. The dyad's perceptions of the person with stroke's rehabilitation needs were assessed by the persons with stroke and their informal caregivers using a questionnaire based on Ware's taxonomy. The results were combined and classified into three groups: met, discordant (ie, not in agreement) and unmet rehabilitation needs. To assess sense of coherence (SOC) in persons with stroke, the SOC-scale was used. Caregiver burden was assessed using the Caregiver Burden Scale. Data on the use of rehabilitation services were obtained from the computerised register at the Stockholm County Council. Participants: 86 persons with stroke (mean age 73 years, 38% women) and their caregivers (mean age 65 years, 40% women). Results: Fifty-two per cent of the dyads perceived that the person with stroke's need for rehabilitation was met 12 months after stroke. Met rehabilitation needs were associated with less severe stroke, more coping strategies for solving problems in everyday activities and less caregiver burden. Conclusions: Rehabilitation interventions need to focus on supporting the dyads' process of psychological and social adaptation after stroke. Future studies need to explore and evaluate the effects of using a dyadic perspective throughout rehabilitation.
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15.
  • Erikson, Anette, et al. (author)
  • In search of self after stroke: a longitudinal qualitative study in the context of client-centred rehabilitation
  • 2023
  • In: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 18:1
  • Journal article (peer-reviewed)abstract
    • PurposeThe aim was to illuminate the experiences of stroke survivors returning to everyday life in the year following stroke, in the context of client-centred rehabilitation.MethodsFour men who participated in a client-centred rehabilitation program were followed during the first year after stroke. Semi-structured interviews were conducted, allbut the first in the participants’ home. The data were analysed using a grounded theory approach.ResultsThe results revealed a process with the overarching core category; The “new” self becomes reality through challenging everyday experiences, and five main categories driving the process: 1) Striving for structure in a “new” chaotic world, 2) Homecoming an ambiguous experience, 3) Reaching the “new” self through reflections of self-understanding, 4) Socialising in new circumstances, and 5) Realising a new reality.ConclusionsWhile in hospital, stroke survivors can have unrealistic expectations. When at home they can begin to realise their actual capacity . To find a “new” self after a stroke can involve time-consuming and taxing processes of reflections of self-understanding. Engagement in self-selected meaningful and valued activities can support stroke survivors’ reconstruction of the “new” self but not all stroke survivors may succeed in finding their “new” self during the first year after stroke.
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16.
  • Eriksson, Christina, et al. (author)
  • Occupational therapists' perceptions of implementing a client-centered intervention in close collaboration with researchers : A mixed methods study
  • 2020
  • In: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 27:2, s. 142-153
  • Journal article (peer-reviewed)abstract
    • Background: Integration of research-based knowledge in health care is challenging. Occupational therapists (OTs) need to implement new research-based interventions in clinical practice. Therefore it is crucial to recognize and understand the factors of specific barriers and facilitators affecting the implementation process. Aim: To identify the key factors important for OTs during the implementation process of a complex intervention.Materials and methods: A cross-sectional study with a combination of qualitative and quantitative data in a mixed method design. Forty-one OTs and 23 managers from three county councils in Sweden, responded to a questionnaire one year after the OTs participation in a workshop to prepare for implementation of a client-centered activity of daily living intervention for persons with stroke.Results: Over 70% of the OTs benefitted from reading and discussing articles in the workshop; 60% had faith in the intervention; 69% reported usability of the intervention. High level of support from managers was reported, but less from team members. The therapists' interaction, perceptions of own efforts and contextual influence affected the implementation process.Conclusion: The workshop context with facilitation and access to evidence, supportive organizations and teams, sufficient interaction with researchers and satisfying self-image were successful key factors when involved in research.
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17.
  • Eriksson, Gunilla, et al. (author)
  • Handling fatigue in everyday activities at five years after stroke : A long and demanding process
  • 2023
  • In: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis Group. - 1103-8128 .- 1651-2014. ; 30:2, s. 228-238
  • Journal article (peer-reviewed)abstract
    • Background Fatigue is common and can be challenging after stroke. Aim To explore how post-stroke fatigue (PSF) was experienced and handled among people with stroke in their performance of everyday activities and in participation in social activities five years after stroke. Methods Nine persons who perceived PSF one year after stroke onset were interviewed five years later. The interviews were analysed using qualitative content analysis. Results Most participants experienced PSF even five years after stroke and reported longstanding difficulties in everyday activities. Handling fatigue-a long slow process with invisible adjustments in everyday life emerged as the theme. By implementing new strategies in everyday life their PSF lessened over time. Understanding among significant others as to how PSF appears and providing information about PSF early after stroke was perceived important. Conclusion This study adds new knowledge regarding experiences of PSF and long-term support needs. Even if PSF still was reported the participants experienced improvements in everyday life through the application of new strategies. Information about PSF and strategies for managing everyday life should be provided during rehabilitation. Significance This study is one out of only a few focussing on long-term PSF and adjustment to its consequences in everyday life.
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18.
  • Eriksson, Gunilla, et al. (author)
  • Occupational gaps in everyday life one year after stroke : association with life satisfaction and impact of stroke
  • 2012
  • In: Topics in Stroke Rehabilitation. - Birmingham, USA : Thomas Land Publishers Inc. - 1074-9357 .- 1945-5119. ; 19:3, s. 244-255
  • Journal article (peer-reviewed)abstract
    • Purpose: To examine the presence, frequency, and distribution of occupational gaps and to explore whether there are associations between occupational gaps and life satisfaction, self-rated recovery, and functioning and participation in activities of daily living (ADLs) 1 year after stroke.Method: Data were collected at onset and at 12 months after stroke from 161 patients admitted to a stroke unit in central Sweden by using Occupational Gaps Questionnaire, LiSat-11, Stroke Impact Scale, Katz ADL Index, and Barthel Index. Spearman rank correlation and Mann Whitney U test were used in the analyses.Results: Occupational gaps were reported by 87% of the participants. The number of occupational gaps was moderately associated with participation and self-rated recovery. There was a significant difference in the number of occupational gaps between the participants who were independent in ADLs and those who were not, both at baseline and at 12 months after stroke. There was, however, no significant association between occupational gaps and life satisfaction.Conclusions: Occupational gaps 1 year after stroke are very common, particularly among individuals experiencing difficulties in ADLs. Increased efforts are vital to enable individuals to do the activities that are important to them, irrespective of whether these are instrumental ADLs or leisure or social activities. Occupational gaps could be reduced by developing rehabilitation interventions that enable desired activities in different contexts that are crucial for individual patients.
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19.
  • Eriksson, Gunilla, et al. (author)
  • Study protocol of a non-randomised controlled trial evaluating the effectiveness of the F@ce 2.0 programme : a person-centred, ICT-supported and interdisciplinary rehabilitation intervention after stroke
  • 2022
  • In: BMJ Open. - : NLM (Medline). - 2044-6055. ; 12:8
  • Journal article (peer-reviewed)abstract
    • INTRODUCTION: Knowledge is missing on use of information and communication technology (ICT), for example, mobile phones/tablets in rehabilitation after stroke. F@ce 2.0 is a person-centred, interdisciplinary intervention supported by ICT. The components of F@ce 2.0 intend to increase performance in daily activities and participation in everyday life for patients with stroke and their significant others. Based on previous feasibility studies, a full-scale evaluation is planned in Sweden. The aim is to implement and evaluate F@ce 2.0, regarding performance of daily activities and participation in everyday life, in comparison with ordinary rehabilitation among persons who have had stroke and significant others. Second, to increase knowledge about how the programme leads to a potential change by studying the implementation process and mechanisms of impact. METHODS AND ANALYSIS: Twelve rehabilitation teams (intervention n=7; control n=5) will recruit patients (n=160) who receive rehabilitation at home after stroke and their significant others. F@ce 2.0 is an 8-week intervention where patients, together with the team, formulate three activity goals regarding what they need and want to do in daily lives. The patients will receive short messages service (SMS) each morning reminding about goals, and in the evening to rate their performance during the day. Primary outcomes for patients: self-efficacy measured by the Self-Efficacy Scale; perceived performance in daily activities measured by the Canadian Occupational Performance Measure. Significant others: perceived caregiver burden measured by Caregiver Burden Scale. Qualitative interviews with team members delivering, patients receiving intervention and significant others will explore experiences of F@ce 2.0. A process evaluation applying a case-study design using mixed methods will be conducted. ETHICS AND DISSEMINATION: Approved by the Swedish Ethical Review Authority, Stockholm. Knowledge will be created for using ICT for rehabilitation of people after stroke in self-selected activities. Dissemination will include peer-reviewed publications, presentations at conferences, and information to stakeholders. TRIAL REGISTRATION NUMBER DETAILS: NCT04351178 . © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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20.
  • Eriksson, Gunilla, et al. (author)
  • The everyday life situation of caregivers to family members who have had a stroke and received the rehabilitation intervention F@ce in Uganda
  • 2021
  • In: Archives of Public Health. - : BioMed Central (BMC). - 0778-7367 .- 2049-3258. ; 79
  • Journal article (peer-reviewed)abstract
    • Background: Stroke is increasing in Africa and consequences such as limitations in the performance of activities in everyday life persist a long time. A family member might need to care for and assist the person who has had a stroke. The life situation of these caregivers thereby changes, which could lead to increased workload and new responsibilities in caring for which they lack but request knowledge. During the F@ce rehabilitation program, the caregivers received counseling, which is uncommon in the African context. The aim of the study was twofold; (1) to investigate the perceived caregiver burden and life satisfaction and, (2) to explore and describe the life situation for caregivers to persons that have had a stroke and received the mobile phone supported rehabilitation F@ce in urban areas in Uganda.Method: A mixed method design was used. Twelve caregivers took part in a semi-structured interview regarding their everyday life situation and responded to questionnaires on caregiver burden and life satisfaction. Latent qualitative content analysis was used to analyse the interviews.Results: Five categories were identified in the caregivers' experiences of their life situation: Feels obligated but is just a natural commitment; a tightly scheduled everyday life; being the supporting relative; the caregivers approach as rehabilitators; and being supported by the rehabilitation intervention. The caregivers rated relatively high on the Caregiver Burden Scale and two thirds of the sample rated their satisfaction with life as a whole as dissatisfying. Further ratings on the Life Satisfaction checklist revealed that the financial, vocational, leisure and family situations were dissatisfying.Conclusions: Even if it was viewed as a natural commitment to be a caregiver when a family member had had a stroke, the life situation changed substantially for those who took on the caregiving role. Caregiving responsibilities were challenging as well as a heavy workload and a strained financial situation as many were giving up on jobs. The participants felt burdened and rated a low life satisfaction. The F@ce intervention was, however, expressed as valued and involved support and advice in their caregiving situation as well as information on stroke which relieved stress among them.
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21.
  • Fallahpour, Mandana, et al. (author)
  • Changes in perceived impact of stroke on everyday life over five years in a rehabilitation sample that received an activity of daily living intervention : A follow-up study
  • 2022
  • In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 54
  • Journal article (peer-reviewed)abstract
    • Objective: To compare changes in the perceived impact of stroke on everyday life over time in a rehabilitation sample that received a client-centred activities of daily living (CADL) intervention or usual ADL (UADL) intervention.Design: Longitudinal follow-up of a randomized controlled trial.Methods: A total of 145 persons with stroke were assigned into CADL or UADL. Groups were assessed using the Stroke Impact Scale (SIS) at 3 months, 12 months and 5 years post-intervention. Changes in SIS domain scores over time were compared within and between groups.Results: Changes in the impact of stroke over time were not related to which intervention the groups received. There were no significant differences in the SIS domains or stroke recovery between groups at the 3-month, 12-month and 5-year follow-ups. Despite an increased impact of stroke over time in some domains in both groups, both groups perceived a decreased impact of stroke in the Participation domain at 12 months. Perceived participation was sustained at the same level at 12 months as at 5 years in both groups.Conclusion: These findings stress the importance of access to follow-up rehabilitation interventions 1-year post-stroke to enable participation in daily activities. Such follow-up and enablement would support the use of self-management strategies in the performance of persons’ valued activities, which might be difficult to perform, due to, for example, impact on hand function or mobility. The results of this study emphasize the importance of prioritizing participation in activities that are meaningful from a personal perspective.Lay abstractIn this study, perceived impact of stroke on everyday life over time was compared among 145 persons with stroke who received the client-centred or usual activities of daily living intervention. They were followed up at 3, 12 months and 5-years post-stroke. No differences were found in the impact of stroke over time between groups. Despite increased impact of stroke (indicating more problems) over time in some areas, the groups perceived decreased impact of stroke (less problems) in their participation at 12 months. Perceived participation was sustained at the same level at 12 months as at 5 years in both groups. Findings stress the importance of access to follow-up rehabilitation interventions one-year post-stroke to enable participation in daily activities, and to support the use of self-management strategies to facilitate participation in valued and meaningful activities that might be difficult due to person’s functional limitations.
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22.
  • Fors, Uno, et al. (author)
  • User evaluation of a novel SMS-based reminder system for supporting post-stroke rehabilitation
  • 2019
  • In: BMC Medical Informatics and Decision Making. - : Springer Science and Business Media LLC. - 1472-6947. ; 19
  • Journal article (peer-reviewed)abstract
    • Background: According to WHO stroke is a growing societal challenge and the third leading cause of global disease-burden estimated using disability-adjusted life years. Rehabilitation after stroke is an area of mutual interest for health care in many countries. Within the health care sector there is a growing emphasis on ICT services to provide clients with easier access to information, self-evaluation, and self-management. ICT-supported care programs possible to use in clients' home environments are also recommended when there are long distances to the health care specialists. The aim of this study was to evaluate the technical usability of a SMS-based reminder system as well as user opinions when using such a system to assist clients to remember to perform daily rehabilitation activities, to rate their performance and to allow Occupational therapists (OT's) to track and follow-up clients' results over time. Methods: Fifteen persons with stroke were invited to participate in the study and volunteered to receive daily SMS-based reminders regarding three activities to perform on a daily basis as well as answer daily SMS-based questions about their success rate during eight weeks. Clients, a number of family members, as well as OTs were interviewed to evaluate their opinions of using the reminder system. Results: All clients were positive to the reminder system and felt that it helped them to regain their abilities. Their OTs agreed that the reminder and follow-up system was of benefit in the rehabilitation process. However, some technical and other issues were limiting the use of the system for some clients. The issues were mostly linked to the fact that the SMS system was based on a Swedish phone number, so that all messages needed to be sent internationally. Conclusion: In conclusion, it seems that this type of SMS-based reminder systems could be of good use in the rehabilitation process after stroke, even in low income counties where few clients have access to Internet or smart phones, and where access to healthcare services is limited. However, since the results are based on clients', OTs' and family members' expressed beliefs, we suggest that future research objectively investigate the intervention's beneficial effects on the clients' physical and cognitive health.
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23.
  • Guidetti, Susanne, et al. (author)
  • A "client-centred activities of daily living" intervention for persons with stroke: One-year follow-up of a randomized controlled trial
  • 2015
  • In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 47, s. 605-611
  • Journal article (peer-reviewed)abstract
    • Objective: To compare changes regarding perceived participation,independence in activities of daily living (ADL) andlife satisfaction between 3, 6 and 12 months after inclusion ina study of a client-centred ADL intervention and usual ADLintervention after stroke.Design: A multicentre randomized controlled trial.Methods: Sixteen rehabilitation units were randomly assignedto provide client-centred ADL intervention or usualADL intervention. Eligible participants were persons ≤ 3months after stroke who had been treated in a stroke unit,were dependent in two ADL domains, had not been diagnosedwith dementia, and were able to understand instructions.Data collection was performed by blinded assessors.The primary outcome, perceived participation, was assessedwith the Stroke Impact Scale 3.0, domain 8. The secondaryoutcomes, participation, independence in ADL, and lifesatisfaction, were assessed with validated instruments. Forstatistical power, 280 participants were required. Statisticalanalyses were performed on an intention-to-treat basis.Results: There were no differences between the groups regardingchanges in perceived participation, independence inADL, or life satisfaction during the first 12 months. Therewas a trend towards a clinically meaningful positive changein perceived participation that favoured client-centred ADLintervention.Conclusion: Further research is required to understand thebenefits of client-centred interventions.
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24.
  • Guidetti, Susanne, et al. (author)
  • Activities in Daily Living : The development of a new client-centred ADL intervention for persons with stroke
  • 2022
  • In: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 29:2, s. 104-115
  • Journal article (peer-reviewed)abstract
    • BackgroundAn intervention that contains several interacting components can be defined as a complex intervention. This intervention was developed in accordance with the Medical Research Council (MRC) guidance for complex interventions.AimTo describe the development, theoretical framework, and content of a client-centred activities in daily living intervention (CADL) for people with stroke.Material and methodsDifferent steps were used; identifying the evidence base, identifying/developing theory and the modelling process and outcomes in the development of the CADL. The remodelling of the process and content of the intervention that emerged are defined.ResultsFindings from a series of qualitative studies of people with stroke demonstrated the need to develop an ADL intervention based on the clients’ lived experiences. The theoretical framework is based on empirical research, theories about human occupation and client-centredness. The CADL is applying an occupational and phenomenological perspective in order to enable agency in daily activities and participation in everyday life among persons with stroke.Conclusions and significanceThe article can be used as an example of how to present the development and theoretical framework of a new complex intervention in occupational therapy.
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25.
  • Guidetti, Susanne, et al. (author)
  • Changes in the impact of stroke between 3 and 12 months post-stroke, assessed with the Stroke Impact Scale
  • 2014
  • In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 46:10, s. 963-968
  • Journal article (peer-reviewed)abstract
    • Objective: To examine data collected using the Stroke Impact Scale 3.0 (SIS) at 3 and 12 months post-stroke, and to explore any clinically meaningful changes in everyday life in relation to age, gender and stroke severity. Design: Prospective longitudinal study. Methods: A total of 204 persons were assessed using the SIS at 3 and 12 months after onset of stroke. Changes in domain scores were calculated over time and in relation to age, gender and stroke severity. Results: The Strength, Hand Function and Participation domains had the highest perceived impact at 3 and 12 months, indicating problems in everyday life. Stroke recovery was perceived to be significantly higher at 12 than at 3 months irrespective of stroke severity, age or gender. The impact on the Strength and Emotion domains was significantly lower at 12 months than at 3 months. Most clinically meaningful changes, both positive and negative ( 15 points), were seen in the Participation domain and in Stroke recovery. Few changes were associated with age, gender or stroke severity. Conclusion: Both positive and negative clinically meaningful changes related to impact of stroke were found between 3 and 12 months post-stroke. Therefore it is important to pay close attention to patients' perceptions of their everyday life situation during rehabilitation and at discharge.
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26.
  • Guidetti, Susanne, et al. (author)
  • F@ce: a team-based, person-centred intervention for rehabilitation after stroke supported by information and communication technology : a feasibility study
  • 2020
  • In: BMC Neurology. - : BioMed Central (BMC). - 1471-2377. ; 20:1
  • 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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27.
  • Guidetti, Susanne (author)
  • Recapturing self-care after stroke or spinal cord injury : exploration of experiences and evaluation of a client-centred intervention
  • 2008
  • Doctoral thesis (other academic/artistic)abstract
    • After stroke or spinal cord injury a person s lived body and life-world commonly change, and suddenly taken-for-granted occupations such as self-care become difficult to perform. This can be a great challenge to living an independent everyday life. In order to enable performance of self-care, occupational therapists commonly initiate self-care training in the early phase of rehabilitation. However there is a lack of well-defined self-care interventions evaluated in research. The general aim of this thesis was to describe the occupational therapists experiences of self-care training and the clients experiences of recapturing self-care after a stroke or a spinal cord injury as well as in close collaboration with occupational therapists to develop a new client-centred self-care intervention (CCSCI) for evaluating the effect of this intervention in a randomized control trial (RCT) pilot study. This research project comprises four studies concerning the recapturing of self-care in a rehabilitation setting during the early phase of rehabilitation (the first week to three months) after a stroke or spinal cord injury. The project used both qualitative methods (Study I-III) and quantitative methods (Study IV). Study I described what characterized the phenomenon of self-care training from 12 occupational therapists viewpoints. Study II identified the lived experiences of recapturing self-care, and Study III the meaning of context in the recapturing processes of 11 persons with stroke or spinal cord injury. Studies I-III are based on interviews and analyzed using the Empirical Phenomenological Psychological (EPP) method, aimed at describing the essence, structure and character of the studied phenomenon based on the participants lived experiences. In Pilot Study IV the aim was to evaluate the effect of CCSCI on (i) activities of daily living (ADL) and life satisfaction in persons with stroke, (ii) caregiver burden and use of informal care and home-help services, and (iii) the feasibility of the RCT study design. Forty persons with stroke were included (Intervention Group (IG) n=19, Control Group (CG) n=21), as well as their significant others (n=16). Study I identified eight therapeutic strategies used by all the occupational therapists to support their clients in taking control of their self-care and their lives again. Study II identified four main characteristics that were presented in all the participants lived experiences: a) becoming familiar with the new body, b) recapturing self-care through trying, c) reclaiming control, and d) feeling uncertainty in the continued process of recapturing self-care. Study III identified six main characteristics of the meaning of context in recapturing self-care: a) support from others, b) expectations in the air, c) extended time, d) new daily structure, e) therapeutic relationship enabling possibility, and f) gradual change in challenge. The main characteristics described in Studies II and III seemed to be prerequisites for the recapture of self-care after stroke or spinal cord injury. Study IV did not show any statistically significant differences between the two groups in outcomes at the three-month follow-up. Comparing clinically significant improvements in ADL on an individual level, 13 out of 14 (93%) participants improved in ADL in the IG, and 12 out of 19 participants (63%) in the CG. The CCSCI appears promising for the recapture of self-care. The feasibility of study design and methods were, in general, favourable for a larger RCT. In conclusion, this research project identified the lived experience and the meaning of recapturing self-care after stroke or spinal cord injury. It can increase the understanding of these phenomena among rehabilitation professionals such as occupational therapists. A well-defined and research-based self-care intervention was developed and evaluated in collaboration between the researcher and occupational therapists. The findings from Studies I-III were integrated in the new CCSCI, evaluated in Study IV. This approach of integrating qualitative studies in a new and well-defined intervention can be viewed as a model for how to implement research into practice, which has been shown to be a challenge in the area of health care.
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28.
  • Gustavsson, Martha, 1980-, et al. (author)
  • Experiences of using information and communication technology within the first year after stroke – a grounded theory study
  • 2018
  • In: Disability and Rehabilitation. - Abingdon, Oxfordshire, United Kingdom : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 40:5, s. 561-568
  • 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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29.
  • Gustavsson, Martha, 1980-, et al. (author)
  • Exploring future possibilities of using information and communication technology in multidisciplinary rehabilitation after stroke – a grounded theory study
  • 2020
  • In: Scandinavian Journal of Occupational Therapy. - London, United Kingdom : Informa Healthcare. - 1103-8128 .- 1651-2014. ; 27:3, s. 223-230
  • 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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30.
  • Gustavsson, Martha, et al. (author)
  • Factors affecting outcome in participation one year after stroke : a secondary analysis of a randomized controlled trial
  • 2019
  • In: Journal of Rehabilitation Medicine. - Uppsala, Sweden : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 51:3, s. 160-166
  • 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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31.
  • Hedman, Annicka, et al. (author)
  • Five-year follow-up of a cluster-randomized controlled trial of a client-centred activities of daily living intervention for people with stroke
  • 2019
  • In: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 33:2, s. 262-276
  • Journal article (peer-reviewed)abstract
    • Objective: To compare five-year outcomes and changes over time of a client-centred activities of daily living (ADL) intervention versus usual ADL interventions for people with stroke and their significant others.Design: Five-year follow-up of a cluster-randomized controlled trial where a client-centred ADL intervention (n = 129) or usual ADL interventions (n = 151) were delivered to people with stroke.Setting: Multicentre study including 16 inpatient or home-based rehabilitation units.Participants: People with stroke and significant others.Intervention: The client-centred ADL intervention aimed at enabling agency in daily activities and participation in everyday life and at reducing caregiver burden.Main measures: For people with stroke, perceived participation (Stroke Impact Scale), independence in ADL, life satisfaction, and use of formal/informal care were measured. For significant others, caregiver burden, life satisfaction, and mood (Hospital Anxiety and Depression Scale) were assessed.Results: Five years post-intervention, data were collected from 145 people with stroke (intervention group: n = 71/control group: n = 74) and 75 significant others (intervention group: n = 36/control group: n = 39). For those with stroke, the Participation domain of the Stroke Impact Scale showed no group differences at year five (68.9 vs 75.4, P = 0.062) or in changes over time. At year five, the control group had better outcomes regarding Other help/supervision. Significant others in the control group were more likely to show signs of depression at year five (odds ratio = 22.3; P < 0.001).Conclusion: The client-centred ADL intervention appears to render similar long-term effects as usual ADL interventions for people with stroke, but for significant others signs of depression might be reduced.
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32.
  • Holmlund, Lisa, et al. (author)
  • Evaluating the feasibility of ReWork-SCI : a person-centred intervention for return-to-work after spinal cord injury
  • 2020
  • In: BMJ Open. - : BMJ. - 2044-6055. ; 10:8
  • Journal article (peer-reviewed)abstract
    • Objectives To evaluate the feasibility of: (1) ReWork-SCI with regard to adherence and acceptability and (2) a study design for evaluating ReWork-SCI with regard to recruitment, retention and outcome measures. Design Pre-test and post-test, single group, feasibility study. Setting Spinal cord injury (SCI) unit at a regional rehabilitation centre in Sweden. Participants Two women and five men (n=7). Eligible criteria: (1) sustained traumatic or non-traumatic SCI; (2) completed the first acute care episode in a hospital; (3) between 18 to 65 years of age; (4) assessed by a physician as approachable for participation in the intervention; (5) history of permanent or temporary employment; (6) self-reported desire to return to work; and (7) ability to communicate in English or Swedish. Intervention ReWork-SCI is a person-centred intervention for return-to-work (RTW), developed and evaluated using the Medical Research Council's guidelines. ReWork-SCI follows a person-centred, structured and coordinated intervention process led by a coordinator within a SCI rehabilitation team. Outcome measures The feasibility of ReWork-SCI and a study design was evaluated using a set of outcome measurement tools, vocational data, logbooks and semi-structured interviews. Results All eligible participants accepted enrolment and follow-up. All participants had a plan for RTW after 3 months and four participants had initiated part-time work or work trial 6 months after commencement of intervention. Adherence and acceptability were overall good. Challenges of the intervention related to the person-centred follow-up, staff shortage and rootedness in the SCI team. Conclusions ReWork-SCI was feasible and can contribute to a systematic design of an individualised plan, facilitate decision-making and build trust in the RTW process after SCI. Core features of the intervention was the systematic structure, use of a person-centred approach and dialogue with the employer. For the effectiveness of ReWork-SCI, modifications and considerations of study design are needed.
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33.
  • Holmlund, Lisa, et al. (author)
  • Return-to-work : Exploring professionals' experiences of support for persons with spinal cord injury
  • 2021
  • In: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 28:7, s. 571-581
  • Journal article (peer-reviewed)abstract
    • Purpose: To generate knowledge about how professional stakeholders organise and experience the support of the return-to-work (RTW) process for persons with spinal cord injury (SCI).Methods: Constructivist grounded theory approach. Professional stakeholders (n = 34) involved in the RTW process and representing three Swedish Regions were recruited into seven focus groups. Analysis followed initial, focussed, and theoretical coding.Findings: The core category - mediating intentions to support work and possibilities of working through social, labour market, and societal context - illustrates complexities of when and how to support a person with SCI in the RTW process, and a risk of delayed, unequal, or absent RTW processes. Analysis outlines: (1) Assessment of ability to work - uncertainty of how and when; (2) Planning RTW - divide between dynamic and rule-based perspectives; (3) Work re-entry - unequal paths towards viable solutions.Conclusions: In RTW after SCI, it is critical to acknowledge how the RTW process is situated in relation to the person and context. A possible direction - grounded in an occupational perspective - through early identification of needs and resources and coordination derived from the SCI rehabilitation setting within healthcare is suggested. This can facilitate a time-sensitive and equal RTW process.
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34.
  • Holmlund, Lisa, et al. (author)
  • Return to work in the context of everyday life 7-11 years after spinal cord injury - a follow-up study
  • 2018
  • In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 40:24, s. 2875-2883
  • Journal article (peer-reviewed)abstract
    • Purpose: The aim of this follow-up study was to explore experiences of return to work in the context of everyday life among adults 7-11 years after spinal cord injury (SCI). Methods: This study used in-depth interviews and observations in a qualitative design with eight persons who had previously been interviewed in 2008. A narrative approach was used during data gathering and analysis. Results: Return to work was experienced as something constantly needing to be negotiated in the context of everyday life. Several years after SCI expectations for work and perceptions of possibilities for meaningful work had changed. Five main themes were identified through the analysis, (1) negotiating the possibilities of working, (2) hope for future work tempered with concern, (3) education as a possible path to employment, (4) paths toward return to work in light of unmet support, and (5) unpaid occupations grounded in interest and competence. Conclusions: Persons who have no higher education or lack viable employment to return to after SCI seem to be vulnerable in return to work. Early and timely interventions tailored to the person's interests and competencies, in which the rehabilitation team has a distinct coordinating role, are thus critical in return to work.
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35.
  • Kamwesiga, Julius T, et al. (author)
  • A feasibility study of a mobile phone supported family-centred ADL intervention, F@ce™, after stroke in Uganda
  • 2018
  • In: Globalization and Health. - : BioMed Central. - 1744-8603. ; 14:1
  • Journal article (peer-reviewed)abstract
    • Background: There is a lack of evidence-based health services to reduce the impact of stroke in low-income countries at a personal, family or community level. The aim was to evaluate the feasibility of: i) a mobile phone supported family-centred intervention (F@ce™), and ii) the study design for evaluating the effects of the intervention on the perceived impact of stroke; perceived participation in everyday life; and self-efficacy in everyday activities amongst persons with stroke and their families in Uganda. Methods: The study comprised a pre-post design with an intervention group (IG) receiving the F@ce™ and a control group (CG). The inclusion criteria’s were: a) confirmed stroke diagnosis, b) access to and ability to use a mobile phone, c) ability to communicate in English and/or Luganda, d) > 18 years, e) residents in Kampala, and f) a Modified Rankin Scale level 2 to 4. The aim of the F@ceTM was to increase functioning in daily activities for persons living with the consequences of stroke, and participation in everyday life for persons with stroke and their families. The F@ce™ was an eight-week family-centred intervention, which entailed goal setting and problem-solving strategies, daily reminders and self-rated follow-ups of performance by short message service (SMS). Data were collected in the participants’ home environment at baseline and after eight weeks. Data on acceptability of the F@ce™ and study procedures were collected by log-books and the responses of the SMS follow ups on the server. The primary outcomes were performance and satisfaction of valued daily activities in everyday life using the Canadian Occupational Performance Measure (COPM), self-efficacy in performance of activities in daily life. Results: The IG comprised n = 13 and the CG n = 15. There were differences between the IG and CG in changes between baseline and follow-up in the primary outcomes COPM (performance component) and self-efficacy in favour of F@ce™. Overall with minor modifications the intervention and the study design were feasible for all participants involved. Conclusion: The results support the need for further research to rigorously evaluate the effects of F@ce™ since the intervention appears to be feasible for persons with stroke and their family members.
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36.
  • Kamwesiga, Julius T., et al. (author)
  • The impact of stroke on people living in central Uganda : A descriptive study
  • 2018
  • In: African Journal of Disability. - : AOSIS. - 2223-9170 .- 2226-7220. ; 7
  • Journal article (peer-reviewed)abstract
    • Background: Knowledge about perceived impact of stroke on everyday life as well as rehabilitation needs after stroke in Uganda is necessary to identify and develop rehabilitation interventions. Objectives: To explore and describe clinical characteristics and functioning during the acute or subacute phase and chronic phase, as well as the impact of stroke on everyday life during the chronic phase in stroke survivors in central Uganda. Method: A cross-sectional observational study was conducted on a consecutively included acute or subacute (n = 58) sample and a chronic (n = 62) sample. Face-to-face interviews were conducted to collect demographic information and clinical characteristics. The Scandinavian Stroke Scale (SSS) was used to collect clinical characteristics, assess neurological impairment and define stroke severity. The Barthel Index was used to assess the level of dependence in activities of daily living. In addition, the Stroke Impact Scale (SIS) 3.0 Uganda version was used to assess the impact of stroke in everyday life as perceived by the individuals in the chronic sample receiving rehabilitation. Results: The mean age of the acute/subacute sample was 49 years and 81% had moderate or severe stroke. The mean age of the chronic rehabilitation group was 53 years and 58% had mild stroke. Time since onset in the acute sample was between 2 days and 3 weeks, and time since onset for the chronic sample varied between 3 months and 3 years. Strength, hand function and participation were the most impacted SIS domains in the chronic sample. Conclusion: People with severe and moderate stroke were more likely to be admitted to Mulago Hospital. The mean age in the study sample was lower than that in high-income countries. Further knowledge is needed regarding the impact of stroke to develop guidelines for stroke rehabilitation interventions feasible in the Ugandan healthcare context in both rural and urban areas.
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37.
  • Lawrence, Maggie, et al. (author)
  • Stroke secondary prevention, a non-surgical and non-pharmacological consensus definition: results of a Delphi study
  • 2019
  • In: BMC Research Notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 12:1
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: Evidence supporting lifestyle modification in vascular risk reduction is limited, drawn largely from primary prevention studies. To advance the evidence base for non-pharmacological and non-surgical stroke secondary prevention (SSP), empirical research is needed, informed by a consensus-derived definition of SSP. To date, no such definition has been published. We used Delphi methods to generate an evidence-based definition of non-pharmacological and non-surgical SSP. RESULTS: The 16 participants were members of INSsPiRE (International Network of Stroke Secondary Prevention Researchers), a multidisciplinary group of trialists, academics and clinicians. The Elicitation stage identified 49 key elements, grouped into 3 overarching domains: Risk factors, Education, and Theory before being subjected to iterative stages of elicitation, ranking, discussion, and anonymous voting. In the Action stage, following an experience-based engagement with key stakeholders, a consensus-derived definition, complementing current pharmacological and surgical SSP pathways, was finalised: Non-pharmacological and non-surgical stroke secondary prevention supports and improves long-term health and well-being in everyday life and reduces the risk of another stroke, by drawing from a spectrum of theoretically informed interventions and educational strategies. Interventions to self-manage modifiable lifestyle risk factors are contextualized and individualized to the capacities, needs, and personally meaningful priorities of individuals with stroke and their families.
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38.
  • Mälstam, Emelie, et al. (author)
  • The Feasibility of Make My Day—A Randomized Controlled Pilot Trial of a Stroke Prevention Program in Primary Healthcare
  • 2023
  • In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 20:19
  • Journal article (peer-reviewed)abstract
    • Incorporating and sustaining engaging everyday activities (EEAs) in everyday life holds potential for improving health and wellbeing; thus, there is reason to explore EEAs as a behavioral change technique in stroke prevention. The aim of this study was to evaluate the feasibility of the stroke prevention program Make My Day (MMD) for people with moderate-to-high risk for stroke in a primary healthcare setting, where EEAs are utilized to promote healthy activity patterns. A randomized controlled pilot trial was designed to evaluate the feasibility of MMD. Twenty-nine persons at risk for stroke were recruited and randomized into either an intervention group (n = 14) receiving MMD or a control group (n = 15) receiving brief health advice and support with goal setting. The results suggest that MMD is feasible, with timely recruitment, overall high response rates and study completion, and sensitivity to change in key outcome measures. Moreover, the results demonstrate that the application of EEAs can be useful for promoting behavioral change in stroke prevention. Recommendations for improvements for a full-scale trial include recruiting a relevant sample, using reliability- and validity-tested outcome measures, and implementing strategies to limit missing data.
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39.
  • Mälstam, Emelie, et al. (author)
  • 'Weaving lifestyle habits' : Complex pathways to health for persons at risk for stroke.
  • 2022
  • In: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 29:2, s. 152-164
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: It is important to understand how healthy lifestyle habits can be developed as they are essential in cardiovascular disease (CVD) prevention. There is limited knowledge regarding whether, and how, engaging occupations (things that people do and occupy themselves with) can promote and help sustain healthy lifestyle habits for persons at risk for CVDs, including stroke.AIM: The aim was to develop knowledge of how engaging in occupations can contribute to changes in lifestyle habits among persons at risk for stroke.METHODS: Six adults presenting with stroke risk factors were interviewed on several occasions after participating in an occupation-focused stroke prevention programme. Grounded theory was utilised, and constant comparative methods guided the analysis.FINDINGS: Changing lifestyle habits was perceived as a complex process, much like weaving a fabric with many parallel and interlacing threads. Literacy of both health and occupations and participation in engaging occupations were important facilitators for promoting healthy lifestyle habits, yet engagement in health-promoting occupations was described as conditioned behaviour.CONCLUSIONS: CVD prevention programmes can benefit from incorporating engaging occupations to promote healthy lifestyle habits and literacy of health and occupations. However, contextual factors conditioning health and occupations should be considered when developing and implementing sustainable interventions.
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40.
  • Nyman, Anneli, et al. (author)
  • Information and communication technology in home-based rehabilitation – a discussion of possibilities and challenges
  • 2023
  • In: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 30:1, s. 14-20
  • Journal article (peer-reviewed)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.
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41.
  • Olsson, Henrik, et al. (author)
  • Cross-cultural adaption and inter-rater reliability of the Swedish version of the updated clinical frailty scale 2.0.
  • 2023
  • In: BMC Geriatrics. - : BioMed Central (BMC). - 1471-2318. ; 23:1
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Worldwide, there is a large and growing group of older adults. Frailty is known as an important discriminatory factor for poor outcomes. The Clinical Frailty Scale (CFS) has become a frequently used frailty instrument in different clinical settings and health care sectors, and it has shown good predictive validity. The aims of this study were to describe and validate the translation and cultural adaptation of the CFS into Swedish (CFS-SWE), and to test the inter-rater reliability (IRR) for registered nurses using the CFS-SWE.METHODS: An observational study design was employed. The ISPOR principles were used for the translation, linguistic validation and cultural adaptation of the scale. To test the IRR, 12 participants were asked to rate 10 clinical case vignettes using the CFS-SWE. The IRR was assessed using intraclass correlation and Krippendorff's alpha agreement coefficient test.RESULTS: The Clinical Frailty Scale was translated and culturally adapted into Swedish and is presented in its final form. The IRR for all raters, measured by an intraclass correlation test, resulted in an absolute agreement value among the raters of 0.969 (95% CI: 0.929-0.991) and a consistency value of 0.979 (95% CI: 0.953-0.994), which indicates excellent reliability. Krippendorff's alpha agreement coefficient for all raters was 0.969 (95% CI: 0.917-0.988), indicating near-perfect agreement. The sensitivity of the reliability was examined by separately testing the IRR of the group of specialised registered nurses and non-specialised registered nurses respectively, with consistent and similar results.CONCLUSION: The Clinical Frailty Scale was translated, linguistically validated and culturally adapted into Swedish following a well-established standard technique. The IRR was excellent, judged by two established, separately used, reliability tests. The reliability test results did not differ between non-specialised and specialised registered nurses. However, the use of case vignettes might reduce the generalisability of the reliability findings to real-life settings. The CFS has the potential to be a common reference tool, especially when older adults are treated and rehabilitated in different care sectors.
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42.
  • Patomella, Ann-Helen, et al. (author)
  • Primary prevention of stroke : randomised controlled pilot trial protocol on engaging everyday activities promoting health
  • 2019
  • In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:11
  • Journal article (peer-reviewed)abstract
    • IntroductionStroke is a globally common disease that has detrimental effects on the individual and, more broadly, on society. Lifestyle change can contribute to reducing risk factors for stroke. Although a healthy lifestyle has direct benefits, sustaining and incorporating healthy activities into everyday life is a challenge. Engaging everyday activities have the potential to support lifestyle change and to promote sustainable activity patterns. Current healthcare is failing to reduce modifiable risk factors in people at risk, and in addition to current practice, there is a need for systematic and efficient non-pharmacological and non-surgical stroke-prevention strategies. The aim of the pilot study was to increase knowledge about the effects of a prevention programme and its feasibility to promote sustainable and healthy activity patterns among persons at risk of stroke.Methods and analysisThe proposed pilot study will be a two-armed randomised, assessor-blinded, parallel pilot trial. The study will include feasibility data, investigating acceptability and delivery of the intervention. Persons at risk of stroke (n=60) will be included in a mobile phone-supported prevention programme. The 10-week programme will be conducted at primary healthcare clinics, combining group meetings and online resources to support self-management of lifestyle change. Main outcomes are stroke risk, lifestyle habits and healthy activity patterns. Assessments will be performed at baseline and at follow-up (immediately following the end of the programme and at 6 and 12 months). Effects of the programme will be analysed using inferential statistics. Feasibility will be analysed using both qualitative and quantitative methods.Ethics and disseminationThe study has been approved by the Regional Ethical Review Board in Stockholm, Sweden, being granted reference numbers 2015/834-31, 2016/2203-32 and 2019/01444. Study results will be disseminated through peer-review journals and presentations to mixed audiences at regional and international conferences. Trial registration number NCT03730701.
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43.
  • Ranner, Maria, et al. (author)
  • Client-centred ADL intervention after stroke : Occupational therapists’ experiences
  • 2016
  • In: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 23:2, s. 81-90
  • Research review (peer-reviewed)abstract
    • Background: This study was conducted in the context of a randomized controlled trial evaluatingthe effect of a client-centred activities in daily living intervention (CADL). The aim of the CADL wasto enable agency in daily activities and participation in everyday life among persons with stroke.Objective: This qualitative, longitudinal study aimed to describe how occupational therapists (OTs)applied the CADL in their clinical practice by studying their experiences and reflections concerningtheir interaction with the clients with stroke. Methods: Six OTs who conducted the CADL werefollowed through interviews and observations on four separate occasions over one year. Data wereanalysed using a grounded theory approach. Results: Sharing was the core category showing howthe OTs helped their clients to achieve agency in daily activities. Through sharing the situation theOTs strove to obtain an empathetic understanding of the clients’ lived experience throughout thewhole intervention process in order to enable the clients’ ownership of their daily activities.Conclusion: The continuity of sharing seems to be the key for a gradual increase in agency. Theapproach of sharing should preferably be applied by all members of the interprofessional team,including the client and significant others.
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44.
  • Ranner, Maria, et al. (author)
  • Experiences of participating in a client-centred ADL intervention after stroke.
  • 2019
  • In: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 41:25, s. 3025-3033
  • Journal article (peer-reviewed)abstract
    • Background: This qualitative study was conducted in the context of a client-centred activities of daily living (CADL) intervention aiming to enable agency in daily activities and participation in everyday life after stroke. The intervention was based on the principles of client-centred occupational therapy and then further developed based on empirical research findings. Objective: To identify what from the clients’ perspective characterises the lived experience and meaning of participating in a CADL intervention after stroke. Methods: The study included 10 persons with stroke who received the intervention and who were able to communicate their experience of participating. Data were collected through two interviews, after the initiation and after the end of the intervention. The analysis was performed using an empirical phenomenological psychological method. Results: The overall characteristic of the meaning of participating in the intervention was transparency, which was expressed in the participants’ experiences of being able to see and follow their own rehabilitation process. An awareness and understanding of their own situation enabled the participants to be actively involved in their rehabilitation. Conclusion: The intervention contributed to transparency, which appeared to enable and support the client’s sense of ownership of daily activities and rehabilitation after stroke. Implications for rehabiliation A client-centred activities of daily living intervention seems to contribute to transparency, where persons with stroke can discover and understand their new ability and situation after stroke. A client-centred rehabilitation situation seems to enable clients to actively engage in their own rehabilitation process. Inviting clients to participate in goal-setting seems to be important in order to create the experience of transparency. Creating continuity in the therapeutic alliance seems to be important in order for the clients to feel trust and experience agency in everyday life.
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45.
  • Terio, Minna, et al. (author)
  • Preventing frailty with the support of a home-monitoring and communication platform among older adults-a study protocol for a randomised-controlled pilot study in Sweden
  • 2022
  • In: Pilot and Feasibility Studies. - : BMC. - 2055-5784. ; 8:1
  • Journal article (peer-reviewed)abstract
    • Background: POSITIVE (i.e. maintaining and imPrOving the intrinSIc capaciTy Involving primary care and caregiVErs) is a new intervention program consisting of home-monitoring equipment and a communication platform to support treatment of frailty symptoms initially in primary care and prevent disability in older adults. Methods: The primary objectives are to estimate the potential efficacy of the POSITIVE system on improving frailty in at least one point in Fried's criteria and five points in Frailty Trait Scale. The secondary objectives are to (A) assess the recruitment, retention, drop-out rates, compliance with the intervention and the intervention mechanisms of impact; (B) evaluate the usability and acceptance of the POSITIVE system, and to get estimations on; (C) the potential efficacy of the intervention on improving the participants' physical performance, cognitive functions, mood, independency level in activities in daily living, the impact on quality of life and number of falls during the follow-up period; (D) the impact on the caregiver quality of life and caregiver burden; and (E) on the consumption of health care resources, participants' perception of health and level of care received, and healthcare professionals' workload and satisfaction. A randomised controlled, assessor-blinded pilot study design recruiting from a primary care centre in Stockholm Region will be conducted. Fifty older adults identified as pre-frail or frail will be randomised into a control or an intervention group. Both groups will receive a medical review, nutritional recommendations and Vivifrail physical exercise program. The intervention group will receive the POSITIVE-system including a tablet, the POSITIVE application and portable measurement devices. The participants receiving the POSITIVE program will be monitored remotely by a primary care nurse during a 6-month follow-up. Data will be collected at baseline, 3 and 6 months into the intervention though the platform, standardised assessments and surveys. A process evaluation as per Medical Research Council guidance will be conducted after the 6-month follow-up period. Discussion:The implications of the study are to provide estimations on the potential efficacy of the POSITIVE system in improving frailty among older adults and to provide relevant data to inform powered studies of potential efficacy and effectiveness, as well as to inform about the feasibility of the current study design.
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46.
  • Terio, Minna, et al. (author)
  • What's in it for me? : A process evaluation of the implementation of a mobile phone-supported intervention after stroke in Uganda
  • 2019
  • In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 19
  • Journal article (peer-reviewed)abstract
    • BackgroundThe prevalence of stroke in Uganda is increasing. In stroke rehabilitation, information and communication technology has been shown to have potential in improving service delivery in high-income countries but there is limited knowledge of its use and impact in low-income countries.The aim of the study was to evaluate the implementation process of a mobile phone-supported family-centred rehabilitation intervention and to gain knowledge on the mechanisms of impact as well as the contextual factors that might have affected the implementation process and its outcome.MethodThis was a single-case study design using the integrated Promoting Action on Research Implementation in Health Services framework and the Medical Research Council guidance as frameworks. Quantitative process data was derived from 14 log books used by occupational therapists during the implementation. Qualitative semi-structured interviews were conducted with 12 implementers in different professions, 12months into the implementation, in order to obtain the primary data. Secondary data was derived from six semi-structured interviews conducted directly after pre-intervention workshops and 6 months later. The framework method was used in the data analysis.ResultsIn 11 out of 14 cases, the clients were compliant with the intervention. Yet, challenges such as technical problems were reported. The target of conducting 16 phone calls for each client was achieved to 74%. Eight categories emerged from the qualitative analysis of the interviews including: 1) perceptions on facilitation, 2) using scientific and experience-based knowledge, 3) tailoring the intervention, 4) supportive working culture, 5) barriers to the service delivery, 6) implementers' interaction with the intervention, 7) perceptions on motivations and values, and 8) improving the model and enabling sustainability. Mechanisms contributing to the implementation of the intervention included engaged facilitators and motivated participants. Challenges in the client recruitment and poor information dissemination were some of the mechanisms impeding the implementation.ConclusionsThe intervention was partially delivered in accordance with the logic model for the project, where the implementation process was influenced by several barriers in the context such as technical setbacks. However, there were also several mediators in the process driving the project forward, including strong facilitation and motivated participants.
  •  
47.
  • Tistad, Malin, et al. (author)
  • Resource use of healthcare services 1 year after stroke : a secondary analysis of a cluster-randomised controlled trial of a client-centred activities of daily living intervention
  • 2018
  • In: BMJ Open. - : BMJ. - 2044-6055. ; 8:8
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: The objective of the study was to compare the total use of healthcare services in the course of the first year after a stroke between participants who, after the acute care, had received occupational therapy as a client-centred activities of daily living (ADL) intervention (CADL) and participants who had received usual ADL intervention (UADL).DESIGN: A secondary analysis of a multicentre cluster-randomised controlled trial (RCT).SETTING: Primary and secondary care in Sweden.PARTICIPANTS: Participants were included if they: (1) had received CADL or UADL in the RCT, either as inpatients in geriatric rehabilitation units or in their own homes, and (2) data could be retrieved about their use of healthcare services provided by the county council from computerised registers.INTERVENTIONS: CADL or UADL.OUTCOME MEASURES: Inpatient and outpatient healthcare in the course of the first year after stroke.RESULTS: Participants from 7 of the 16 units included in the RCT met the criteria. Participants in the CADL group (n=26) who received geriatric inpatient rehabilitation had a shorter length of hospital stay (p=0.03) than participants in the UADL group (n=46), and the CADL group with home rehabilitation (n=13) had fewer outpatient contacts (p=0.01) compared with the UADL group (n=25). Multiple regression analyses showed that in four of the models, a higher age was associated with a lower use of healthcare services. The use of healthcare services was also associated (some of the models) with dependence in ADL, stroke severity and type of rehabilitation received, CADL or UADL.CONCLUSIONS: The provision of client-centred occupational therapy after stroke did not appear to increase the use of healthcare services during the first year after stroke.rrrrr TRIAL REGISTRATION NUMBER: NCT01417585.
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48.
  •  
49.
  • Ytterberg, Charlotte, et al. (author)
  • Perceived impact of stroke six years after onset, and changes in impact between one and six years
  • 2017
  • In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 49:8, s. 637-643
  • Journal article (peer-reviewed)abstract
    • Objective: To examine the perceived impact of stroke between 1 and 6 years after stroke using the Stroke Impact Scale 3.0 (SIS). Design: A prospective longitudinal study.Methods: A total of 100 individuals were assessed using the SIS 3.0 at 1 and 6 years after onset of stroke and clinically meaningful changes were explored. Changes in domain scores were calculated over time in relation to age, sex and stroke severity.Results: The most impacted SIS domains after 6 years were Participation, Strength, Hand function, and Stroke recovery. Participants with moderate/severe stroke experienced a higher impact in all domains except Hand function and Stroke recovery, indicating more problems in everyday life, compared with those with mild stroke. Almost half of the participants had a clinically meaningful change in the domain Participation between 1 and 6 years. Those with moderate/severe stroke and the older age group experienced more negative clinically meaningful changes in several domains in comparison with those with mild stroke and the younger age group.Conclusion: The long-term perceived impact of stroke highlights the importance of appropriate rehabilitation interventions within several areas to reduce the long-term negative impact in everyday life.
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50.
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