Ewa Wressle

The rehabilitation process for the geriatric stroke patient- an exploratory study of goal setting and interventions

PURPOSE The aim was to describe and analyse the rehabilitation process of the geriatric stroke patient from two perspectives; the treatment goals expressed by the staff and the patient and the treatment interventions chosen by the physiotherapist and occupational therapist. A secondary aim was to test whether the process, treatment goals and interventions could be classified according to the International Classification of Impairments, Disabilities and Handicaps (ICIDH). METHOD Qualitative interviews were performed with patients and personnel; diaries were used to register treatment interventions. The 30 interviews were categorized according to the goals expressed by physiotherapists, occupational therapists, physicians and patients. The diaries (n = 22) were analysed to describe how treatment interventions were connected in time, at what levels (impairment, disability and handicap) the interventions were directed, and finally, whether certain decisions were made in order to change the rehabilitation process. RESULTS The patients talked more about attaining their pre-stroke status than about their goals. The therapists set goals according to functional level, whereas the doctors expressed themselves in general terms. Three patterns of rehabilitation processes were found: one with clearly identified decision points, one with a set programme which was not changed through the process, and one where the goal was changed according to changes in medical status. CONCLUSIONS The patient does not participate in the goal-setting process, and the vaguely expressed goals are not measurable. The rehabilitation process and reason for discharge demonstrate different patterns. Treatment interventions, if related to the ICIDH, give a clear picture of the process, though certain interventions do not fit in the classification.

Responsiveness of the Swedish Version of the Canadian Occupational Performance Measure

In a client-centred approach, clients and therapists work together to define the occupational performance problem, the focus of and need for intervention and the preferred outcomes. Application of specific theories or techniques to involve clients in goal-setting may influence the therapist to use a client participation approach. The Canadian Occupational Performance Measure (COPM) presents a structure for formulating the treatment goals identified by the client in co-operation with the therapist. The aim of this study was to test the responsiveness of the Swedish version of the COPM. After translation into Swedish, the COPM was introduced to 21 occupational therapists who performed data collection. A sample of 108 clients within geriatric, neurologic and orthopaedic rehabilitation identified 418 problems at initial scoring and reassessment. Inclusion criteria for patients were the need for rehabilitation interventions and the ability to communicate well enough in an interview. The results indicate that t...

User satisfaction with mobility assistive devices: An important element in the rehabilitation process

Background. An assistive device often means an evident change in a persons ability, more easy to notice than the effects of most of other types of physiotherapy or occupational therapy intervention. In spite of this, there is very little evidence in this area. Purpose. The objective was to follow-up user satisfaction with and the use and usefulness of rollators and manual wheelchairs. The objective was also to determine any difference in satisfaction between users of the two different types of mobility assistive products. Methods. A random sample of 262 users participated in the study, 175 rollator users and 87 wheelchair users. The Quebec User Evaluation of Satisfaction with Assistive Technology—QUEST 2.0 and an additional questionnaire were used for data collection. Results. Overall satisfaction with both types of device was high and most clients reported use of their device on a daily basis. There was a difference in how the users estimated the usefulness and other characteristics as well as some service aspects related to prescription and use of the two types of device. Most users reported not having had any follow-up; however, most users had not experienced any need for one. Conclusions. A standardized follow-up will give rehabilitation professionals continuous and valuable information about the effect of and satisfaction with assistive devices.

User Satisfaction with Mobility Assistive Devices

In Sweden, the most common assistive devices are related to mobility. A study was undertaken to evaluate users’ opinions on prescription of mobility devices and their satisfaction with devices and services using a cross-sectional design. A random sample of adult users of mobility assistive devices living in three county councils of Sweden was selected. A postal package comprising a questionnaire and QUEST 2.0 was sent out to 400 users of manual wheelchairs, powered wheelchairs, or walkers. Included in the analysis were 208 questionnaires, a response rate of 52%. Most devices were used on a daily basis and satisfaction with the device was high. Satisfaction with the service was scored lower than satisfaction with the device. Follow-up was the single item with the lowest mean score, and 69% of the users reported that they had not received any follow-up. A positive effect especially on users’ ability to be active, transport oneself, feel secure, and to take part in social activities was found. Owing to the low response rate the results have to be interpreted with caution. However, follow-up seems to be an area that needs to be improved. The majority of users are satisfied with the device but not with service.

Clinical utility of the Canadian Occupational Performance Measure: Swedish version

The Canadian Occupational Performance Measure (COPM) is an individualised outcome measure intended to detect change in a clients perception of occupational performance over time. The aim of this study was to test the clinical utility of the Swedish version of the COPM. Data was collected from 27 occupational therapists in six focus groups. Emerging themes included goal-setting, preparations, limitations, interactions with clients, and impact on practice. The results indicated that the COPM is helpful in the goal-setting process and in planning treatment interventions. Therapists need knowledge about the theoretical foundation of the instrument and a personal interview technique. Problems were found using the instrument with clients who had poor insight or in acute settings. The COPM facilitated feedback on improvement over time. In summary, the COPM ensures a client-centred approach, facilitates communication within the rehabilitation team, and encourages therapists in their professional role.

Health-related factors associated with hospitalization for old people: comparisons of elderly aged 85 in a population cohort study.

The aim of this population-based study was to (1) describe living conditions and actual health care utilization among 85 year olds; (2) determine factors that affect hospital admissions in this age. The study was conducted on 85-year-old residents in Linköping municipality, Sweden. The data collected included medical records, health care utilization during the preceding 12 months and a postal questionnaire on assistance, assistive technology, functional impairment, feelings of loneliness, worries and health-related quality of life measured by the EQ-5D. Out of 650 eligible individuals, 496 (78% of those alive) participated. Despite the prevalence of multi-morbidity (68%) and mental discomfort, the majority managed self-care (85%), usual activities (74%) and had high (>60/100) self-rated health evaluated by a visual analog scale (VAS). The non-hospitalized group reported a better health status than the hospitalized group in terms of medical aspects, living conditions and subjective estimation. Factors associated with in-patient care were an increased number of general practitioner visits, more assistive technology, community assistance, multimorbidity and/or diagnosed congestive heart failure and arrhythmia.

Health Consequences Associated with Being Overweight or Obese: A Swedish Population-Based Study of 85-Year-Olds

To determine whether being overweight or obese is associated with significant health outcomes in an 85‐year‐old population.

Hearing difficulties, uptake, and outcomes of hearing aids in people 85 years of age

Abstract Objective: The aim of this study was to investigate self-reported hearing difficulties, uptake, and hearing-aid outcomes and their relationships to demographic, cognitive, psychosocial, and health variables in 85 year olds. Design and study sample: Three hundred and forty-six elderly adults participated in a survey that included questionnaires and home visits. Fifty-five percent of participants admitted to having hearing difficulties, and 59% of these owned hearing aids. The participants’ most frequently cited reason for not acquiring hearing aids was that they did not think their hearing problem was perceived as severe enough. Participants with hearing difficulties who did not own hearing aids showed worse general and mental health. Many of the elderly participants were successful in their rehabilitation, and their hearing-aid outcomes were similar to those of a younger group, with the exception of a greater proportion of non-users among the elderly. Conclusion: Many older people with self-reported hearing difficulties do not acquire hearing aids, despite this studys findings that older people are likely to have success with hearing rehabilitation. It is important to make greater efforts to try to increase elderly adults’ awareness of hearing loss and the benefits of hearing rehabilitation.

Powered wheelchairs and scooters for outdoor mobility: a pilot study on costs and benefits

Abstract Purpose: This study evaluates the effect of electric powered wheelchairs/scooters (PWC/S) on occupational performance, social participation, health and life satisfaction. In addition, this study estimates the costs and benefits of PWC/S and describes users’ experiences with the delivery process. Methods: This prospective study has a before-and-after design. Postal questionnaires were sent to 24 first-time PWC/S users before delivery of the PWC/S and 4 months after delivery. The participants used their PWC/S for outdoor mobility. Results: PWC/S improved the users’ daily lives, their ability to engage in mobility-related activities and their social participation. For a majority of the users, estimated independence, feelings of safety and self-esteem increased although overall health and life satisfaction were not significantly affected. All users thought that the therapist had considered their needs during the providing process. Most participants (73%) were satisfied with their device at follow-up. For the 12 users who reported no change in health status between measures, the mean societal savings based on calculated costs for assistance was €6227 per person per year. Conclusions: PWC/S seems to improve occupational performance, social participation and life satisfaction for users. Moreover, these improvements seem to have an economic advantage for both users and society. Implications for Rehabilitation The use of a PWC/S has been shown to positively affect a person’s independence in daily activities which in turn increases the sense of self-esteem and security. Facilitating mobility is cost-effective both from a societal as well as from anindividual perspective and should be a key intervention in rehabilitation.

Cognition, daily living, and health-related quality of life in 85-year-olds in Sweden

ABSTRACT This study investigates how cognition influences activities of daily living and health-related quality of life in 85-year-olds in Sweden (n = 373). Data collection included a postal questionnaire comprising demographics and health-related quality of life measured by the EQ-5D. The ability to perform personal activities of daily living (PADL) was assessed during a home visit that included administering the Mini Mental State Examination (MMSE). Cognitive impairment was shown in 108 individuals (29%). The majority were independent with respect to PADL. A larger number of participants with cognitive impairment reported that they needed assistance in instrumental activities of daily living (IADL) compared to the group without cognitive impairment. Impaired cognition was significantly related to problems with IADL. Significant but low correlations were found between cognition and health-related quality of life – higher ratings on perceived quality of life correlated with higher results on the MMSE.