Anne Lund

A lifestyle intervention as supplement to a physical activity programme in rehabilitation after stroke: a randomized controlled trial

Objective: To evaluate the effectiveness of lifestyle group intervention on well-being, occupation and social participation. Design: A randomized controlled trial. Setting: Senior centres in the community. Subjects: Of 204 stroke survivors screened, 99 (49%) were randomized three months after stroke whereby 86 (87%) participants (mean (SD) age 77.0 (7.1) years) completed all assessments (39 in the intervention group and 47 in the control group). Intervention: A lifestyle course in combination with physical activity (intervention group) compared with physical activity alone (control group). Both programmes were held once a week for nine months. Main outcome measure: The Short Form Questionnaire (SF-36), addressing well-being and social participation. Assessments were performed at baseline and at nine months follow-up. Results: We found no statistically significant differences between the groups at the nine months follow-up in the SF-36. Adjusted mean differences in change scores in the eight subscales of SF-36 were; ‘mental health’ (+1.8, 95% confidence interval (CI) –4.0, +7.6), ‘vitality’ (−3.0, 95% CI −9.6, +3.6), ‘bodily pain’ (+3.3, 95% CI −7.8, +14.4), ‘general health’ (−1.6, 95% CI −8.4, +5.1), ‘social functioning’ (−2.5, 95% CI −12.8, +7.8), ‘physical functioning’ (+1.0, 95% CI −6.7, +8.6), ‘role physical’ (−7.1, 95% CI −22.7, +8.4), ‘role emotional’ (+11.8, 95% CI −4.4, +28.0). Conclusions: Improvements were seen in both groups, but no statistically significant differences were found in the intervention group compared to controls. An intervention comprising regular group-based activity with peers may be sufficient in the long-term rehabilitation after stroke.

Assessment of clients with cognitive impairments: A survey of Norwegian occupational therapists in municipal practice

Abstract Background: With the Coordination Reform Act initiated in 2012, Norwegian occupational therapists in municipal practice have been given responsibilities concerning clients with cognitive impairments. With emphasis on supporting best practice, the aim was to investigate the practice of Norwegian municipal occupational therapists (OTs) in their assessment of clients with cognitive impairments. Method: An online questionnaire was used to collect data from 497 of 1367 OTs in Norwegian municipalities (RR = 36%) Results: The most frequently used methods were informal interviews (91%), observations (91%) and standardized assessments (73%). The most frequently used standardized assessments were the Clock Drawing test (60%) and the Mini Mental State Examination (MMSE 59%). The most common reasons for using standardized assessments were to get a better foundation for initiating interventions (74%), to get more reliable results (64%) and to measure the effect of interventions (47%). The most common reasons for not using standardized assessments were that they did not have competence (49%) or that they did not have access to the materials (40%). Conclusion: The results indicate that there are challenges when it comes to the methods and standardized assessments used. These findings invite further research on enabling municipal OTs to move further towards evidence-based practice.

Experiences of attending day care services designed for people with dementia – a qualitative study with individual interviews

ABSTRACT Objectives: Day care is assumed to promote independence in home-dwelling people with dementia, increase well-being and enhance social stimulation. Few studies have directly engaged people with dementia to better understand the benefits and impacts of such services. The aim of this study was to explore attendees’ experiences with day care designed for people with dementia. Method: This study had a qualitative descriptive design and included individual interviews with 17 users attending day care. The analysis was undertaken using content analyses. Results: The participants reported that day care had a positive influence on their physical functioning, cognition, well-being, and situation at home because they were provided with social stimulation, meals, and activities. Day care contributed to the maintenance of a rhythm and structure in everyday life. Furthermore, the staff contributed to making the day care a safe place to be and enhanced a sense of belonging. Conclusion: This study reveals the positive impact of day care on the daily lives of people with dementia because this service contributes to the enhancement of activities and social support, prevents isolation, and enhances practical and cognitive functioning as experienced by the users. The staff has a major impact on the experience of the participants in the day care.

Responsible development of self-learning assisted living technology for older adults with mild cognitive impairment or dementia

In this paper we present work in progress in the Assisted Living Project – responsible innovations for dignified lives at home for people with mild cognitive impairment or dementia. The project has a distinctly interdisciplinary approach and engages experts in nursing and occupational therapy, in ethics and responsible research and innovation, and in technology, in particular automation and machine learning. Our approach is to involve the end-users, their family and their care providers and develop technology responsibly together with them. The technological approach employs self-learning systems to develop solutions that provide individualised support in accordance with the user’s values, choices, and preferences. The paper presents our approach, current findings and future plans.

The conflicted practice: Municipal occupational therapists’ experiences with assessment of clients with cognitive impairments

Abstract Background: The practice of Norwegian occupational therapists (OTs) in municipal practice is a little explored area and with the Coordination Reform Act from 2012, Norwegian OTs in municipal practice have received responsibilities concerning clients with cognitive impairments. The aim of this study was to explore municipal OTs experiences with assessment of clients with cognitive impairments. Method: Fourteen individual interviews with OTs who worked with clients with cognitive impairments, were conducted. An inductive thematic analysis, using text condensation and coding, was performed. Results: The results revealed three themes; power of occupation, advantages and disadvantages of assessments used and the need for competencies within municipal services. The participants emphasized using observation in the assessment process and reflected on pros and cons of the standardized assessment tools they used. They expressed a need for competence development, although it was difficult to prioritize to do so. Conclusion: This study illustrated a conflicted practice related to choices OTs make in their practices. They valued the importance of working occupation based, however, they chose to use impairment based standardized assessments. They expressed a need to engage in professional development, but due to heavy workloads, the limited power they experienced and lack of knowledge, this was difficult.

Enjoyable company in sharing stroke experiences; - lifestyle groups after stroke

Abstract Background: Even people with mild to moderate stroke will experience changes in their abilities to perform everyday occupations. Group interventions may be appropriate in late-stage rehabilitation. The aim of this study was to explore how the participants involved themselves in person-centered lifestyle groups after stroke in Norway. Method: Semi-structured interviews were performed with six older adults with mild-to-moderate stroke who had participated in lifestyle groups over a period of nine months. The interviews were analyzed using qualitative content analysis. Results: The participants involved themselves in the lifestyle groups in a variety of ways by creating enjoyable company in sharing stroke experiences, sharing knowledgeable interest, pushing and forcing each other forward and reflecting on self-worth. Through doing group activities together, they created various ways of being, belonging and becoming, addressing development of strategies for regaining self-belief and a sense of autonomy, and for adapting to everyday life post-stroke. Conclusion: The participants were active contributors in the groups and pushed each other and themselves regarding involvement in meaningful occupations. This active participation seemed to bring the participants’ resources into focus and contrasted with the frequent negative perceptions of people post-stroke as ‘victims’.

The assisted living project: a process evaluation of implementation of sensor technology in community assisted living. A feasibility study

Abstract Introduction: The ageing population has been described as a grand societal challenge worldwide, and access to technology is one important strategy for meeting this challenge. The Assisted Living Project has a responsible research and innovation approach and includes older adults in evaluating sensor-based functions in assisted living facilities. The purpose of involving users in research is to enhance a wider dialogue about the values, methods, and purposes of the research project. Methods: We carried out a feasibility study in order to inform the development and conduct of a pilot project with eight residents. The purposes were to evaluate the process of technology installation, the feasibility of the technology, and methods for user involvement. One resident, Hilda, gave her informed consent to take part in this feasibility study. Her sensor system consisted of two magnetic sensors, six pyroelectric infrared motion sensors, one power sensor, one push button by the entrance door, and one loudspeaker. The sensors were wirelessly connected to a controller, which registered and transmitted all data to a secure server. Results: The feasibility study suggested important modifications for the pilot project, which concerned pre-configuration of the sensors, securing efficiently, rapid installation, number of visitors during the installation, preparation necessitating a site acceptance test for the wireless network and environmental prerequisites for mounting the sensors. Furthermore, this study recommends that the signals that are transmitted from the sensors to the secure server need verification. Conclusion: A feasibility study provides an opportunity to inform develop and conduct of a main trial. The MRC framework was useful for doing a process evaluation to assess feasbility and quality of implementation, clarify causal mechanisms and identify contextual factors associated with variations in outcome. Implications for rehabilitation The feasibility study was useful in order to develop sustainable technological solutions by evaluating the robustness of the technology consider challenges regarding the architectural features/requirements for mounting sensors etc. decide user needs for individual tailoring to reach a ‘person-fit’ technology User participation in a feasibility study is vital to learn about the end user’s needs and expectations regarding information, technical support, for support in daily use and follow-up. Transdisciplinary collaboration in the feasibility study is necessary to inform the main technology implementation project.

The Validity of the Norwegian Version of the Cognitive Function Instrument

Background/Aims: A timely diagnosis of dementia is important, and the Cognitive Function Instrument (CFI) is a newly developed instrument to screen for cognitive decline. The aim of this study was to evaluate the validity and internal consistency of the Norwegian version of the CFI. Methods: We included 265 participants with dementia, mild cognitive impairment (MCI), subjective cognitive impairment (SCI), and a reference group without subjective or assessed cognitive decline. The participants and their relatives answered the self- and proxy-rated versions of the CFI. Results: The Norwegian CFI had power to discriminate between people with dementia and with MCI, SCI, and the reference group. The proxy version had better power than the self-rated version in our participants (area under the curve [AUC] proxy-rated varying from 0.79 to 0.99, AUC self-rated varying from 0.56 to 0.85). Conclusion: The Norwegian CFI was found to be a useful, valid, and robust instrument.

Usability and acceptability of technology for community-dwelling older adults with mild cognitive impairment and dementia: a systematic literature review

Background The objective of this review was to obtain an overview of the technologies that have been explored with older adults with mild cognitive impairment and dementia (MCI/D), current knowledge on the usability and acceptability of such technologies, and how people with MCI/D and their family carers (FCs) were involved in these studies. Materials and methods Primary studies published between 2007 and 2017 that explored the use of technologies for community-dwelling people with MCI/D were identified through five databases: MEDLINE, PsycINFO, Embase, AMED, and CINAHL. Twenty-nine out of 359 papers met the criteria for eligibility. We used the Mixed Methods Appraisal Tool for quality assessment. Results A wide range of technologies was presented in the 29 studies, sorted into four domains: 1) safe walking indoors and outdoors; 2) safe living; 3) independent living; and 4) entertainment and social communication. The current state of knowledge regarding usability and acceptability reveals that even if researchers are aware of these concepts and intend to measure usability and acceptability, they seem difficult to assess. Terms such as “user friendliness” and “acceptance” were used frequently. User participation in the 29 studies was high. Persons with MCI/D, FCs, and staff/other older adults were involved in focus groups, workshops, and interviews as part of the preimplementation process. Conclusion Research regarding technologies to support people with MCI/D seems optimistic, and a wide range of technologies has been evaluated in homes with people with MCI/D and their FCs. A major finding was the importance of including people with MCI/D and their FCs in research, in order to learn about required design features to enhance usability and acceptability. Surprisingly, very few studies reported on the consequences of technology use with regard to quality of life, occupational performance, or human dignity.

Grade correspondence between internal and external examiners of occupational therapy students’ bachelor theses

Students’ grades are increasingly important in defining their future employability, and therefore, securing a fair assessment of students’ theses is important. This study aimed to assess the level of grade correspondence between internal and external examiners of occupational therapy students’ bachelor theses, and to evaluate the overall level of grades initially set by examiners in the two groups. The grades initially suggested for 67 bachelor theses were analyzed. Absolute agreement between internal and external examiners was estimated as the proportion of theses on which the examiners suggested identical grades (percentage agreement), and consistency in agreement was estimated by the intraclass correlation coefficient (ICC). There was absolute agreement between the internal and the external examiners in 33 of the 67 cases (49.3 %), and also consistency in agreement was high (ICC = 0.81, 95 % CI [0.68, 0.88], p < 0.001). The results from this study demonstrate a high level of agreement between internal and external examiners of occupational therapy students’ bachelor theses. However, internal examiners as a group are more prone to give high grades compared to external examiners, and this may support the continued use of two examiners to ensure quality in grading.