Anna-Liisa Salminen

Effects of lower limb prosthesis on activity, participation, and quality of life: a systematic review

Background: Effects presented on the use of assistive devices such as prosthesis are often based on laboratory findings (i.e. efficacy). Objectives: To summarise and evaluate findings from studies on effectiveness of lower limb prostheses for adults in real life contexts, primarily in terms of activity, participation, and quality of life (QoL) and secondarily in terms of user satisfaction, use/non-use, and/or cost-effectiveness. Study Design: Systematic review. Methods: We included controlled studies and non-controlled follow-up studies including both baseline and follow-up data. Using 14 different databases supplemented with manual searches, we searched for studies published from 1998 until June 2009. Results: Out of an initial 818 identified publications, eight met the inclusion criteria. Four studies reported on the effectiveness of a microprocessor-controlled knee (MP-knee) compared to a non-microprocessor-controlled knee (NMP-knee). Results were inconsistent except for quality of life and use/non-use, where the authors reported an improvement with the MP-knee compared to the NMP-knee. The remaining four studies included a diversity of prosthetic intervention measures and types of endpoints. Conclusions: Overall, there was an inconsistency in results and study quality. This review highlights the need for high-quality research studies that reflect the effectiveness of different prosthesis interventions in terms of users’ daily living and QoL. Clinical relevance Clinical guidelines are important to every practitioner. Information on expected effectiveness from assistive devices should be well founded and contain both facts about the device quality and its contribution to users’ daily lives. Thus, studies based on users’ experiences from prosthetic use in everyday life activities are of great importance.

Quality of evidence of assistive technology interventions for people with disability: An overview of systematic reviews

This overview summarizes the available evidence from systematic reviews of outcomes studies on various assistive technologies (AT) for persons with disabilities. Systematic reviews published betwee ...

Rehabilitation planning for children and adolescents with cerebral palsy

OBJECTIVE To explore the types of procedures and practices in rehabilitation planning for children with cerebral palsy and how multidisciplinary team members experience them. DESIGN, SUBJECTS, AND SETTING A qualitative research approach was used. Participants were members of multidisciplinary teams in neuropediatric wards at five university hospitals. METHODS In order to explore the rehabilitation planning procedure within multidisciplinary teams, focus group interviews were conducted. The interviews were tape recorded and transcribed. Three content areas guided the interviews: goal setting, the different transition phases, and the use of the international classification of functioning, disability and health, child and youth version (ICF-CY). Qualitative content analysis was used to analyze the results. RESULTS Three themes arose from the focus group discussions; challenging goal setting, transition without routines, and ICF-CY not in use. A family-centered service model had been adopted, but there was no clear procedure in the collaboration with parents. Goal setting was found to be challenging and the concern arose of how to integrate goals into the childs everyday life. There was a lack of systematic planning of the different transition phases. There was also a general variation in the rehabilitation planning procedures due to local and regional differences in practice. The ICF-CY was familiar, but not in formal use in clinical practice. CONCLUSION There is a need to enhance the procedures and to systematize coordination of services in the rehabilitation process. The ICF-CY framework might help to optimize collaborative goal setting and to structure both procedures and documentation of the rehabilitation plans and goals.

The activities and participation categories of the ICF Core Sets for multiple sclerosis from the patient perspective

Purpose: To validate the activities and participation components of The International Classification of Functioning, Disability and Health (ICF). Methods: In this cross-sectional study, 113 Finnish community-dwelling persons with MS were assessed using a semi-structured interview provided by the Canadian Occupational Performance Measure (COPM) to capture participants’ self-perceived problems in everyday activities and participation. Problems were linked to the ICF categories. Results: Participants identified 527 of the most important occupational performance problems. They covered all chapters of the ICF Activities and Participation components. Forty-one categories out of a total 53 ICF activities and participation categories of the Comprehensive ICF Core Set and four out of five categories of the Brief ICF Core Set were reported on by the participants. The most common category in this sample, ‘d920 Recreation and leisure’ (145 problems/27.5%), is not included in the Brief ICF Core Set. Conclusions: Most, but not all, ICF activities and participation categories of the ICF Core Sets for MS could be confirmed from the perspective of persons with MS. It is worth considering to add category ‘d920 Recreation and leisure’ to the Brief ICF Core Set. Implications for Rehabilitation The perceived problems of persons with MS support current versions of the ICF Core Sets for MS. The subjective experiences of prioritized problems encountered in everyday life vary considerably among community-dwelling persons with MS. Persons with MS often experience problems with recreation and leisure activities. Experiences of patient about recreation and leisure activities should be asked more systematically during rehabilitation process and the role of recreation and leisure should be considered when further developing the Brief ICF Core Sets for MS.

Young persons with visual impairment: Challenges of participation

Abstract Objective: To describe the challenges to activity and participation faced by young people with visual impairment within the framework of the International Classification of Functioning (ICF). Methods: 14 young persons (aged 16–22 years) with visual impairment and their parents (n = 22) participated in the study. The Canadian Occupational Performance Measure (COPM) was used to describe challenges of participation as perceived by the young persons themselves. Individual interviews with the young persons and their parents were used to investigate in more depth the challenges the young persons face with regard to participation. Results: Young persons with visual impairment face challenges to participation most frequently with regard to mobility, domestic life, interpersonal interaction and relationships, major life areas, and leisure activities. The environment in which they live has a central role as a barrier or facilitator of participation. Conclusions: The challenges related to activities and participation that young persons with visual impairment face are diverse. It is important that these challenges are assessed individually and with the help of subjective measures. Serving as a broad framework for classifying the data, the ICF proved to be a useful tool, but used strictly at category level it may limit the coding of data and narrow interpretation.

What components of rehabilitation are helpful from the perspective of individuals with multiple sclerosis

Abstract Purpose: To investigate the helpful components of rehabilitation from the point of view of people with multiple sclerosis (MS). Methods: Sixteen focus groups were conducted for 68 adults with MS, who were 6 months through their 2-year multi-professional group-based out-patient rehabilitation programs in three regions of Finland. Data were analyzed using qualitative inductive content analysis combined with counts of the coded data. Results: Participants described 20 helpful components of rehabilitation that were clustered to themes of the rehabilitee himself/herself, structures of everyday life, information, activity, environmental interventions, social relationships and support. The most frequently described components of the seven main themes were peers, advice, physical exercise, assistive technology and home adaptations, and personal responsibility. Conclusions: The helpful components of both in-patient and out-patient rehabilitation that are of particular importance to people with MS are diverse and show the relevance of ICF in rehabilitation and the need for a comprehensive view in rehabilitation. The importance of peers and peer support should be taken into account in rehabilitation planning and related recommendations. The findings show that helpful rehabilitation for people with MS is not a set of mechanistic interventions but requires good social relationships and support. Implications for Rehabilitation Helpful components of rehabilitation for people with MS are diverse and show the need for a comprehensive and individual view in rehabilitation. Professionally guided peer support should be offered as a part of rehabilitation. Interventions related to assistive technology and home adaptations should be an obvious part of rehabilitation. It is important to support people with MS to preserve identity as an active person and to take personal responsibility in their own rehabilitation.

Reliability and validity of the COPE Index among caregivers of disabled people

AIM To study the reliability and validity of the Carers of Older People in Europe (COPE) Index among caregivers of disabled people of different ages. METHODS A cross-sectional design of Finnish caregivers (n=1117). Exploratory factor analysis (EFA) was performed separately on samples of three different age groups, and the internal consistencies of the subscales were investigated. RESULTS Three factors were identified; Cronbachs alpha was 0.83-0.86 for negative impact and 0.77-0.78 for quality of support, indicating good internal consistency. The third factor, positive value, was less consistent across the age groups (α<0.66). CONCLUSIONS The COPE Index is a valid and reliable screening tool to measure negative impact and quality of support of caregivers of disabled people. Further research is needed to develop the COPE Index to more precisely measure positive value of the caregiving process.

Feasibility and psychometric properties of the Finnish version of the measure of processes of care for adults

Objective: To assess the psychometric properties and feasibility of the Finnish translation of the measure of processes of care for adults (MPOC-A) when used in an inpatient rehabilitation setting. Design: A feasibility study. Settings: Inpatient rehabilitation settings. Subjects: A total of 858 people with severe neurological disabilities, musculoskeletal problems, and mental disorders were recruited to the study. Methods: The MPOC-A questionnaire is a self-administered questionnaire consisting of 34 items in five-factorial domains. The construct validity of the translated questionnaire was evaluated using confirmatory factor analysis. To compare the fit of the model to the fit of the independent null-model Comparative Fit Index was used. Internal consistency for the total scale and subscales was calculated using Cronbach’s alpha reliability coefficient. Results: A total of 554 people, mean age 52 years (SD = 9), participated in the study. Most of the responders had musculoskeletal problems (n = 328, 57%). The respondents rated the client-centeredness in rehabilitation service as moderate (m = 5.40, SD = 0.81). The five-factor and the one-factor model fitted the data well according to all three indices. Internal consistency showed high reliability between the one-factor and five-factor models for all except one domain (0.49–0.93). The mean for Person Infit for the people with neurological disabilities was higher than for the other two groups (m = 1.77, SD = 1.32) indicating less predictable response patterns in this group. Conclusion: The results confirm the appropriate psychometric properties of the Finnish version of the MPOC-A, especially for people with musculoskeletal problems and those with mental health disorders.

Psychometric evaluation of the Finnish version of the impact on participation and autonomy questionnaire in persons with multiple sclerosis

Abstract Objective: The objective of this study was to evaluate the psychometric properties of the impact on participation and autonomy (IPA) questionnaire. The Finnish version of IPA (IPAFin) was translated into Finnish using the protocol for linguistic validation for patient-reported outcomes instruments. Methods: A total of 194 persons with multiple sclerosis (MS) (mean age 50 years SD 9, 72% female) with moderate to severe disability participated in this study. A confirmatory factor analysis (CFA) was used to confirm the four factor structure of the IPAFin. The work and educational opportunities domain was excluded from analysis, because it was only applicable to 51 persons. Internal consistency was investigated by calculating Cronbach’s alpha. Results: CFA confirmed the construct validity of the IPA (standardized root mean square residual (SRMR) = 0.06, comparative fit index (CFI) = 0.93, Tucker–Lewis index =0.93, root mean square error of approximation (RMSEA) = 0.06), indicating a good fit to the model. There was no difference in the models for females and males. Cronbach’s alpha for the domains ranged between 0.80 and 0.91, indicating good homogeneity. Conclusions: The construct validity and reliability of the IPAFin is acceptable. IPAFin is a suitable measure of participation in persons with MS.