Kirsten Schultz Petersen

Systematic Literature Review on ICF From 2001 to 2013 in the Nordic Countries Focusing on Clinical and Rehabilitation Context.

We present a systematic review on International Classification of Functioning, Disability and Health (ICF) used in the Nordic countries from 2001 through 2013, describing and quantifying the development in utilization of ICF, and describe the extent to which the different components of the ICF have been used. A search was conducted in EMBASE, MEDLINE and PsycInfo. Papers from Nordic countries were included if ICF was mentioned in title or abstract. Papers were assigned to one of eight categories covering the wide rehabilitation area; furthermore, area of focus was assigned. Use of ICF components and intervention were coded in papers categorized as “clinical and/or rehabilitation contexts” or “non-clinical contexts”. One hundred seventy papers were included, of these 99 papers were from the categories “clinical and/or rehabilitation contexts” or “non-clinical contexts”. Forty-two percent of the 170 included papers were published in the period 2011 - 2013. There was an increase in ICF-relevant papers from 2001 to 2013, especially in the categories “clinical and/or rehabilitation contexts” and “non-clinical contexts”. The most represented focus areas were neurology, musculoskeletal, and work-related areas. All five or at least four ICF components were mentioned in the results or discussions in most papers, and activity was most frequently mentioned.

Recovery from mental illness: a service user perspective on facilitators and barriers.

Mental health services strive to implement a recovery-oriented approach to rehabilitation. Little is known about service users’ perception of the recovery approach. The aim is to explore the service user’s perspectives on facilitators and barriers associated with recovery. Twelve residents living in supported housing services are interviewed. The analysis is guided by a phenomenological-hermeneutic approach and the interpretation involves theories from critical theory, sociology, and learning. Learning, social relations, and willpower are identified as having an impact on recovery. Stigmatization and social barriers occurred. Social relations to peer residents and staff were reported as potentially having a positive and negative impact on recovery. Studies have explored the user’s perspectives on recovery but this study contributes with knowledge on how recovery-oriented services have an impact on recovery.

What are the short-term and long-term effects of occupation-focused and occupation-based occupational therapy in the home on older adults’ occupational performance? A systematic review

Abstract Background: There is a lack of evidence-based knowledge about the effectiveness of home-based OT for older adults aimed at improving occupational performance by practicing activities and tasks. Aim: This review synthesizes and discusses evidence for the effectiveness of occupation-focused and occupation-based OT for older adults at home. Material and methods: Peer-reviewed quantitative papers were included. Participants: ≥ 60-year-old adults with functional limitations. Intervention: OT aiming at improving occupational performance, primarily through the practice of activities and tasks. Outcome: Occupational performance. Context: Home. Three reviewers critically appraised 13 of 995 detected papers. Extracted data were presented and summarized descriptively. Results: Eight high-quality papers showed that occupation-focused and occupation-based OT using cognitive, behavioral and environmental strategies may significantly improve occupational performance in older, home-dwelling adults with physical health problems. Maintaining achieved improvements was a consistent challenge. Conclusions and significance: Evidence suggests that older adults’ occupational performance can be significantly improved through low-intensity occupation-focused and occupation-based intervention. It is recommended to develop and test high-intensity OT programs and maintenance programs.

Betwixt and between: workplace perspectives on work reintegration in the eldercare sector in Denmark

Abstract Purpose: Contemporary return-to-work (RTW) policies in Denmark and other welfare nations recommend employees on long-term sick leave, due to physical or mental health problems, to RTW gradually. Factors that influence the process of work reintegration (WR) is well documented, however, co-workers experiences of this process are a rather new research topic. Moreover, in the context of the present research, no studies have so far explored the workplace as an arena for social interaction. The aim of this study was to explore co-workers’ experiences of the reintegration process and how these experiences are related to social positions at the workplace. Methods: Ethnographic fieldwork was conducted at two nursing homes that were in a process WR after long-term sick leave. The data consist of field notes, policy documents, individual interviews, and focus group interviews. Data were organized by use of NVivo. A theoretical framework was adopted which enabled us to approach and interpret the reintegration process as one that changed the social position of the returning employee. Results: The dataset demonstrates how the returnee is in a state of being betwixt and between the social positions of a co-worker and a non-co-worker. This is illustrated in three cases which show that this state prevents the returnee from taking on the role as a co-worker, excludes the returnee from the workplace, and creates uncertainty for all workplace actors. Conclusion: The study highlighted that WR creates a social position for the returnee that complicates the working routine and causes uncertainty in social interactions. Implications for Rehabilitation Work reintegration (WR) after long-term sick leave is commonly characterized by reduced working hours and modified working tasks. The WR process influences the whole work place including co-workers’ everyday working life and complicates work situations where work tasks and roles are negotiated between the returning worker and co-workers. Future WR policies and guidelines could benefit from integrating co-workers’ perspective to ensure that the returning worker is not socially excluded as well as ensuring that co-workers are not overburdened in the process.

Intensive client-centred occupational therapy in the home improves older adults’ occupational performance. Results from a Danish randomized controlled trial

Abstract Background: There is growing interest in enabling older adults’ occupational performance. We tested whether 11 weeks of intensive client-centred occupational therapy (ICC-OT) was superior to usual practice in improving the occupational performance of home-dwelling older adults. Methods: An assessor-masked randomized controlled trial among adults 60 + with chronic health issues, who received or applied for homecare services. Recruitment took place September 2012 to April 2014. All participants received practical and personal assistance and meal delivery as needed. In addition, they were randomized to receive either a maximum 22 sessions of occupation-based ICC-OT (N = 59) or to receive usual practice with a maximum three sessions of occupational therapy (N = 60). The primary outcome was self-rated occupational performance assessed with the Canadian Occupational Performance Measure (COPM). Results: No important adverse events occurred. ICC-OT was accepted by 46 participants (88%), usual practice by 60 (100%). After 3 months, the ICC-OT-group had improved 1.86 points on COPM performance; the Usual-Practice group had improved 0.61 points. The between-group difference was statistically significant (95% confidence interval 0.50 to 2.02), t-test: p = 0.001. Conclusions: ICC-OT improved older adults’ occupational performance more effectively than usual practice. This result may benefit older adults and support programmatic changes.

Work reintegration after long-term sick leave: domains of influence on co-workers’ ability to be supportive

Abstract Purpose: The purpose of the study is to identify domains of influence on co-workers’ ability to be supportive of returning worker during the work reintegration (WR) process. Methods: An ethnographic study design was chosen involving fieldwork at four different workplaces, at an emergency care service, a waste disposal company and at two nursing homes. Qualitative methods for inquiry were used including participant observation, individual- and group interviews of 30 participants. Data were coded and analysed according to a grounded theory approach. Results: Four themes were identified related to domains of influence on co-workers’ ability to be supportive of returning worker during the WR process: (1) organisation of work and level of interaction; (2) disruption of work routines, (3) relationship with returning worker and (4) attitudes towards sick leave. Conclusion: The WR process after long-term sick leave is not only influenced by the WR’s arrangements made, but also by the co-workers’ responses to the process. Work arrangements not only affect the returning worker’s ability to return-to-work (RTW) successfully, but also the co-workers’ ability to be supportive and their ability to take active part in the process. Implications for Rehabilitation The process of WR after long-term sick leave involves interaction with co-workers. Domains of influence is in the co-workers’ perspective influencing their ability to be supportive during reintegration of a returning worker. Future WR management could benefit from integrating the conditions for co-worker support. We encourage co-workers to be involved in the RTW planning, monitoring and evaluation with particular focus on how the WR arrangements are influencing their work and their ability to be supportive.

A process for translating and validating model of human occupation assessments in the danish context.

The aim of the study was to validate the Danish translation of The Assessment of Communication and Interaction Skills (ACIS) and The Occupational Self-Assessment (OSA). The validation process followed four research steps where pilot versions were tested by occupational therapists in practice, peer-reviewed, and back-translated. The result of the study was two validated assessment tools based on the Model of Human Occupation (MOHO) available for Danish occupational therapy practice, education, and research. Future studies should enlighten how to maintain the validity and reliability of assessments when translations are made into other languages.

Older adults' experiences and expectations after discharge from home-based occupational therapy

Introduction Home-based occupational therapy can improve older adults’ occupational performance, but maintaining improvements presents challenges, and service development is needed. In this study, older adults’ experiences and expectations concerning their occupational performance after discharge from home-based occupational therapy were examined and used to develop suggestions for improved practice. Method Semi-structured qualitative interviews were conducted with 11 older adults living alone or with a spouse. The interviews were analysed using inductive qualitative content analysis. Findings The older adults still strove to improve and maintain their occupational performance using various strategies; their desire for independence was strong, but some could accept a lesser degree of independence. Conclusion From the findings and existing literature, ideas were developed to improve home-based occupational therapy and support maintenance of occupational performance after discharge. These ideas include: (a) finding strategies to achieve satisfactory occupational performance that does not necessarily entail full independence, (b) increased focus on the use and transfer of problem-solving strategies, (c) acknowledging and addressing possible reluctance to use assistive devices, and (d) individually scheduled follow-up visits post occupational therapy. Future research should examine the effectiveness and applicability of these ideas.

Occupational science: An important contributor to occupational therapists' clinical reasoning

The influence of occupational science is evident in the theoretical and research-based knowledge base within occupational therapy. Moreover, studies show that contributions from occupational scienc...

Learning via participation – a user perspective on user involvement in mental health rehabilitation

Abstract The aim of the study is to gain insight into the users perspective on user involvement in mental health rehabilitation. The study was designed as a field study lasting 15 months in two supported housing schemes. An ethnographic approach by James Spradley was employed, involving participant observation, informal conversations, and individual- and group-interview. A phenomenological-hermeneutic approach inspired by Paul Ricoeurs theory on text interpretation was used, including theories of situated learning. The results of the study show that the users experienced their involvement in rehabilitation to be associated with learning processes in interaction with residents as well as professionals. Learning took place via legitimate peripheral participation, via support from and negotiations with professionals and support from peer residents. Both opportunities for and limitations for learning were experienced. The transferability of knowledge and skills to life in a community was questioned, as limi...