Eva Månsson Lexell

Autonomy and Housing Accessibility Among Powered Mobility Device Users.

OBJECTIVEnTo describe environmental barriers, accessibility problems, and powered mobility device (PMD) users autonomy indoors and outdoors; to determine the home environmental barriers that generated the most housing accessibility problems indoors, at entrances, and in the close exterior surroundings; and to examine personal factors and environmental components and their association with indoor and outdoor autonomy.nnnMETHODnThis cross-sectional study was based on data collected from a sample of 48 PMD users with a spinal cord injury (SCI) using the Impact of Participation and Autonomy and the Housing Enabler instruments. Descriptive statistics and logistic regression were used.nnnRESULTSnMore years living with SCI predicted less restriction in autonomy indoors, whereas more functional limitations and accessibility problems related to entrance doors predicted more restriction in autonomy outdoors.nnnCONCLUSIONnTo enable optimized PMD use, practitioners must pay attention to the relationship between client autonomy and housing accessibility problems.

The complexity of daily occupations in multiple sclerosis.

The aims of this study were to describe which self-care, productivity, and leisure occupations individuals with multiple sclerosis (MS) perceive as difficult to perform on admission to rehabilitation and the individuals’ own perception of the importance of, performance of, and satisfaction with these occupations. Whether the reported self-care, productivity, and leisure occupations were related to sex, age, disease severity, and living arrangements was also investigated. Forty-seven men and women (mean age 49.4 years) were assessed with the Canadian Occupational Performance Measure (COPM) on admission to rehabilitation. The individuals reported 366 occupations (median 8, range 3–15), which were categorized as self-care (51%), productivity (30%), and leisure (19%). Three COPM subcategories—household management (26%), personal care (21%), and functional mobility (20%)—accounted for two-thirds of the reported occupations. All prioritized occupations (n=238; (median 5, range 2–7) had high ratings for importance and the ratings for performance and satisfaction were generally low. Men reported significantly more occupations related to self-care than women, but no significant difference between the sexes could be found for productivity and leisure. No significant differences between the occupational areas were found when age, disease severity, or/and living arrangements were included in the analysis. In conclusion, individuals with MS perceive difficulties with occupations related to all aspects of daily life. This underscores the need to use assessment tools that capture the complexity of daily occupations.

Men's and women's perspectives on using a powered mobility device: benefits and societal challenges.

Abstract Objective: To describe how men and women experience their use of powered wheelchairs (PW) and powered scooters (PS) in everyday occupations, in the home and in society at large. Methods: A qualitative research approach with focus-group methodology was used. Four focus groups were created, with men and women as well as PW and PS users in different groups. Applying a descriptive approach, data were analysed according to the principles described by Krueger. Findings: Three categories emerged and revealed that even though use of PW and PS increased independence and enabled everyday occupations, participants struggled to be independent powered mobility device (PMD) users. They experienced many accessibility problems in dwellings and in society, described similarly by users of PW and PS. Men and women experienced their use of (PMD) differently, especially in relation to the service delivery process. Conclusions: The study contributes with new knowledge on accessibility for PW and PS users and related service delivery processes, stating that gender differences regarding provision and training must be taken into account. Occupational therapists can contribute to an enhanced understanding of PMD users’ challenges in person–environment–occupation transactions in the home and society, and thereby promote occupational justice for PMD users.

Occupational adaptation in people with Multiple Sclerosis.

The aim of this study was to gain an enhanced understanding of how people with multiple sclerosis experience their occupational adaptation. Ten people with multiple sclerosis were interviewed and the constant comparative method was used to analyze the data. Their occupational adaptation was experienced as a constant struggle and non-linear, and served as the means of achieving either a desired self or a desired family life. Adaptations of occupations differed according to the evolving goals of the participants. The findings showed that the participants often selected occupational adaptations to meet their family needs over their own. These findings can help professionals to establish where their clients with multiple sclerosis are in the adaptation process and offer appropriate client-centered interventions.

The group rehabilitation helped me adjust to a new life: Experiences shared by persons with an acquired brain injury.

Primary objective: The aim of this study was to describe how persons with acquired brain injury experience an out-patient group rehabilitation programme and how the programme had contributed to their everyday lives. Design and method: Qualitative interviews with 11 men and women with an acquired brain injury who had participated in an out-patient group rehabilitation programme were performed. Data was analysed with qualitative content analysis. Findings: The findings formed the theme ‘The group rehabilitation helped me adjust to a new life’ that revealed experiences related to the content and outcome of the programme, as well as the process they went through during the programme. The participants described how the rehabilitation gave them the tools they needed to change their everyday lives, especially in relation to improved knowledge and learning new routines and habits. They perceived their rehabilitation as a long-term, individual, but also collaborative process, where professionals as well as family and friends had crucial roles. Conclusion: Learning how persons with acquired brain injury experience participation in a group rehabilitation programme can help to unravel parts of the ‘black box of rehabilitation’ and can support professionals to better understand the effective components of such programmes.

Long-Term Predictors of Social and Leisure Activity 10 Years after Stroke.

Background Restrictions in social and leisure activity can have negative consequences for the health and well-being of stroke survivors. To support the growing number of people who are ageing with stroke, knowledge is needed about factors that influence such activity in a long-term perspective. Aim To identify long-term predictors of the frequency of social and leisure activities 10 years after stroke. Method 145 stroke survivors in Sweden were followed-up at16 months and 10 years after a first-ever stroke. Data representing body functions, activities & participation, environmental factors and personal factors at 16 months after stroke, were used in multiple linear regression analyses to identify predictors of the activity frequency after 10 years, as assessed by the ‘Community, social and civic life’ sub-domain of the Frenchay Activities Index (FAI-CSC). Results At the 10-year follow-up the frequency of social and leisure activities varied considerably among the participants, with FAI-CSC scores spanning the entire score range 0–9 (mean/median 4.9/5.0). Several factors at 16 months post stroke were independently related to the long-term activity frequency. The final regression model included four significant explanatory variables. Driving a car (B = 0.999), ability to walk a few hundred meters (B = 1.698) and extent of social network (B = 1.235) had a positive effect on activity frequency, whereas an age ≥ 75 years had a negative effect (B = -1.657). This model explained 36.9% of the variance in the FAI-CSC (p<0.001). Conclusion Stroke survivors who drive a car, have the ability to walk a few hundred meters and have a wide social network at 16 months after a first-ever stroke are more likely to have a high frequency of social and leisure activities after 10 years, indicating that supporting outdoor mobility and social anchorage of stroke survivors during rehabilitation is important to counteract long-term inactivity.

Occupations that People with Late Effects of Polio Perceive Difficult to Perform

The aims of this study were to describe which occupations that people with late effects of polio perceive difficult to perform, which occupational area the occupations were related to and their level of complexity. The aims were also to describe their own perception of the importance, performance and satisfaction with these occupations. Sixty-two participants (mean age 61u2009years) were assessed with the Canadian Occupational Performance Measure. A total of 431 occupations were reported (43% self-care, 32% productivity and 25% leisure). Two subcategories, household management (27 %) and functional mobility (23 %), represented half of all the reported occupations. Ratings for prioritized occupations (Nu2009=u2009300) were high for importance and generally low for performance and satisfaction. A wide variety of occupations were reported, related to both occupational areas and different levels of complexity within an occupational area. The results underscore the importance of using assessment tools that can capture both the variety and complexity of occupations. By obtaining more detailed information about occupations that people with late effects of polio perceive difficult to perform, this will enable occupational therapists to offer targeted interventions that can facilitate engagement in meaningful and purposeful occupations. A larger and more heterogeneous sample may enable the results to be generalized to more people with late effects of polio. Future studies should focus on methods that can facilitate engagement in meaningful and purposeful occupations for people with late effects of polio.

Psychometric properties of the Swedish version of the General Self-Efficacy Scale in stroke survivors

The aim of this study was to assess the psychometric properties of a Swedish version of the General Self-Efficacy Scale (GSE) in stroke survivors. The GSE was administered by the same assessor on two occasions 3 weeks apart with 34 stroke survivors (21 men, 13 women; mean age=68.1 years) 6–10 months after stroke. Psychometric properties including targeting and scaling assumptions, and several reliability indices, were calculated. The mean score was well above the midpoint of the scale and the total scores spanned almost the entire scale range. Floor and ceiling effects were within the limits of 15–20% for total scores (0 and 8.8%, respectively), but not for each item individually. Total skewness was estimated at −1.02 and skewness for individual items was estimated as −1.55 to −0.33. The corrected item–total correlations were all above 0.3, except for one item. Cronbach’s &agr; was high (0.92) and the test–retest reliability was acceptable (intraclass correlation coefficient2,1=0.82). The mean difference (đ) was −0.68 (NS). The SEM was 2.97 (SEM%; 9.40). In conclusion, although targeting in relation to skewness and ceiling effects was observed in some items, the GSE was reliable for use in mobile stroke survivors 6–10 months after stroke.

Facilitators for traveling with local public transport among people with mild cognitive limitations after stroke

Abstract Introduction: Previous research of how people with stroke manage public transport has mainly focused on barriers due to physical limitations whereas the influence of cognitive limitations is scarce. There is also a lack of knowledge of facilitators that can help to overcome these barriers. The aim of this study was to describe facilitators for travelling with public transport, e.g. local buses, among people with mild cognitive limitations after stroke. Methods: A multiple case study research design was used, where quantitative and qualitative data were utilized, and analysed according to a mixed methods design. Findings: The case descriptions reveal how people with mild cognitive limitations after stroke manage their trips but constantly have to be prepared to solve problems to unexpected events. Personal characteristics and other individual strategies together with support and solutions from society were important facilitators for travelling with bus. Discussion: This study takes a new approach by specifically describing facilitators for travelling with public transport among people with mild cognitive limitations after stroke. To facilitate participation in society for this particular traveller group, occupational therapists have an important role when new technology and interventions that target bus travels, and other modes of transport are developed.

The rehabilitation plan can support clients' active engagement and facilitate the process of change - experiences from people with late effects of polio participating in a rehabilitation programme

Abstract Purpose: To explore how the rehabilitation plan influences the rehabilitation process and its outcome in people with late effects of polio participating in an individualised goal-oriented interdisciplinary rehabilitation programme. Methods: Four women and two men with late effects of polio were interviewed before rehabilitation, at discharge, and at follow-up. Data were analysed according to the constant comparative method of grounded theory. Findings: The participants’ experiences formed one core category: “The same starting point but different rehabilitation processes”. Before rehabilitation, all participants experienced a similar starting point: Naïve understanding of rehabilitation. During rehabilitation, two separate processes followed. Four participants experienced their rehabilitation as being a mutually shared process that led to a process of change. They were actively engaged, using the rehabilitation plan, and working towards goals targeting a broad perspective of daily activities. The remaining two participants experienced their rehabilitation as a staff-directed process, with limited use of the rehabilitation plan, focusing on goals mainly related to body functions and self-care, not leading to any substantial changes. Conclusion: When clients experience that they develop a mutually shared rehabilitation process, based on a rehabilitation plan, they became more engaged in their rehabilitation and gained a better understanding of their participation during the process. Knowledge of the differences in how clients use the rehabilitation plan during the rehabilitation process can support their active engagement during rehabilitation. This, in turn, can promote a more holistic view among clients and professionals during the rehabilitation for people with late effects of polio. Implications for Rehabilitation Clients who experience a rehabilitation that is mutually shared with professionals, have a better understanding of their engagement during the rehabilitation process. When clients and professionals use the rehabilitation plan as a mutual tool, clients become more actively engaged in their rehabilitation process. A structured rehabilitation plan can serve as a map, and support clients’ process of change during the rehabilitation process, also after the rehabilitation period is completed.