Ulla Sonn

Achieving balance in everyday life: Insights from women with stress-related disorders.

Abstract There is growing interest in developing a conceptual understanding of the experience of balance in everyday life, from an occupational perspective. The purpose of this study was to gain insights about balance in the everyday lives of women with stress‐related disorders. Data were gathered from 19 women who were past the first phase of recovery from a stress‐related disorder and participated in one of five focus groups. Analysis revealed that the participants experienced a continuum between imbalance and balance in everyday life. The themes that emerged were image of occupational self, strategies to manage and control everyday life, occupational repertoire, and occupational experience. Balance in everyday life was achieved through a dynamic interaction between these themes, which the women characterised as respecting their own values, needs, and resources; having strategies to manage and control everyday life; having a harmonious occupational repertoire; and engaging in personally meaningful occupation. Engagement in personally meaningful occupation appears to be a mechanism that enables people to achieve balance in everyday life by enabling them to develop a successful occupational self‐image, manageability, control, and a harmonious occupational repertoire. Well‐being seems to be the outcome of balance in everyday life, and lack of balance is experienced as overload.

The ADL Taxonomy - from Individual Categorical Data to Ordinal Categorical Data

The ADL taxonomy comprises 12 defined activities organized into actions from the easiest to the more demanding ones. The purpose of the study was to determine whether the actions in the activities have an ordered, categorical structure, and to compare the distribution of individuals at the levels within each activity in three different samples. Data were collected by occupational therapists from the following three samples: (i) persons 65 years or older with home help (n=684); (ii) patients from different fields of occupational therapy (n=373); and (iii) patients with stroke (n=226). This study shows that there is an ordered, categorical structure within each activity defined in the ADL-taxonomy. The median proportion error of scales was 4%. Some of the activities/actions were redefined and one action was excluded because of the concentration of errors. People living in their own homes had a significantly higher level of ability in all activities compared to the other groups. The ADL taxonomy can be used ...

Domestic activities and walking in the elderly: Evaluation from a 30- hour heart rate recording

The physical activity pattern among 43 subjects (25 women, 18 men) from the Intervention Study of Elderly in Gothenburg (IVEG) has been evaluated by means of heart rate monitoring, rating of perceived exertion and recording activities over a 30-hour period. These subjects had previously been interviewed about their activity pattern, including the duration of their daily walks. In 91% of the participants the average heart rate was below 100 beats/min during walking. Considerable individual variations were noted in the duration of domestic activities and of walks. Using heart rate levels equal to or above the average heart rate during walking as a criterion, it was found that 68% of the women, but only 17% of the men, spent more time on domestic activities than on walking. Nonetheless, it is suggested that in addition to walking, domestic activities, owing to their duration, are important in maintaining physical fitness in the elderly, especially among women. This should be taken into account when physical activity is being classified (to avoid bias in favour of men). A modified version of a previously published six-grade scale for the classification of physical activity has been suggested. (Aging 2:191–198,1990)

Towards an ADL taxonomy for occupational therapists

Abstract One of the main concepts in occupational therapy is human occupation. In occupational therapy there is a need for a common conceptual framework to assess and describe the ability of patients to perform occupational activities of daily living. The aim of this report was to develop a taxonomy concerning the activities of daily living (ADL). In the taxonomy, occupation has been defined and related to common concepts of disability. Ordinary ADL terms have been categorized into three levels: occupational forms, activities and actions. Different actions are components of and subordinated to superior activities. Experience shows that the ADL taxonomy contributes to a valid (content and construct) assessment of ADL, a common language for OTs and to a clearer picture of the patient’s performance in daily life activities.

Long-term evaluation of a health education programme for elderly persons with visual impairment. A randomized study

In order to implement evidence-based practice, a randomized study was set up to evaluate the ADL- based Health Education Programme ‘Discovering new ways’ for elderly persons with age-related macular degeneration. Purpose: To investigate the impact of this program on perceived security in the performance of daily activities 28 months after the intervention. Method: Two-hundred and twenty-nine persons randomized to either the Health Education programme or an Individual Intervention Programme participated in the study. At the 28-month follow-up there was a dropout of 98 persons and the results are based on 62 persons participating in the Health Education Programme and 69 persons in the Individual Intervention Programme. Results: There were statistically significant differences in perceived security between the groups in 15 out of 28 daily activities. Furthermore, the Health Education Group showed a significant tendency towards an improved level of security while the Individual Intervention Group tended to deteriorate. Conclusions: The findings provide strong support for the long-term effect of the programme and for the implementation of evidence-based practice. The study corroborates the effectiveness of the Health Education Programme in enhancing security and hindering a progressive decline in perceived security in daily activities.

Occupational Therapy Research on Assistive Technology and Physical Environmental Issues: A Literature Review

Background. To determine future directions for research in the area of assistive technology and physical environmental issues, it is important to have an understanding of prior research. Purpose. This literature review examined how assistive technology and physical environmental issues have been studied in the research published in international peer-reviewed occupational therapy journals. Method. Five recent volumes of nine journals were manually searched utilizing specific criteria. The publications were classified according to their perspective, application of the Person-Environment-Occupation (PEO) model, and the research design. Results. Both research fields demonstrated use of different research methods and they displayed equal needs with regard to improved research methodologies. Practice Implications. There are a lack of studies involving all three PEO components indicating a lack of research in occupational performance issues. Further research on occupational performance is important for developing occupational therapy practice in the area of assistive technology and physical environmental issues. Furthermore, study designs reflecting the societal level in all three PEO components are required. Finally, there is a strong need for conceptual and theoretical development in both fields.

Engagement in patterns of daily occupations and perceived health among women of working age.

The aim of the present cross-sectional study was to examine how subjective experiences of engagement in patterns of daily occupations (gainful employment, domestic work, enjoyable and recreational occupations) were associated with perceived health among women of working age. The sample (n=488) was drawn from a longitudinal cohort study of women of working age in Gothenburg, Sweden. Participants were women 38 (n=202) and 50 (n=286) years of age. They completed a questionnaire including questions about occupational experiences in relation to their patterns of daily occupations, perceived health, and socioeconomic factors. The results of the present study showed that a combination of different experience dimensions of patterns of daily occupations was associated with perceived health among women of working age, even when adjusted for socioeconomic factors and age. The results provided occupational pattern-related health indicators, i.e. manageability, personally meaningful occupations, and occupational balance. To combine these health indicators can be a way for occupational therapists to enable women to develop strategies to promote health and to prevent stress and sick leave.

Experiences of daily occupations at 99 years of age

The aim was to explore experiences of daily occupations among the oldest old. Ten 99-year-old persons were interviewed in their living environment about an ordinary day. The interviews were analysed according to the phenomenographic approach. The result showed that participants regarded themselves as competent and that they felt proud because they were involved in daily occupations. Being challenged was experienced as a way of performing difficult tasks, thus being confirmed as a capable person who performs and learns new things. The participants’ occupational patterns preserve occupational ability and continuity in life in that they have a rhythm and allow the individuals to predict and handle interruptions. Participants experienced being incapable and being restricted as a result of personal, environmental, and social hindrances. The participants adapted to and reshaped their sense of self, which has been disrupted due to the discrepancy between self, the persons ability, and the real world “outside”. Experience of daily occupation is unique, supports the sense of self, builds identities, and describes engagement and creative processes. Individual experience must be recognized as it can mean the difference between success and failure in maintaining meaningful daily occupation.

Use of assistive devices in daily activities among 85-year-olds living at home focusing especially on the visually impaired

Purpose: The purpose was to investigate the use of assistive devices in daily activities and its relation to daily activities. Method: 85-year-old persons (n = 617) were studied in a descriptive, cross-sectional population study. Results: The overall use of assistive devices was 77% in the total population of 85-year-old persons and the results show that persons who have visual impairment use more assistive devices. The most common category of assistive devices in the population was connected with bathing followed by mobility devices. The majority of the assistive device users in all groups were independent in both instrumental (I-ADL) and personal daily activities (P-ADL). There was a statistically significant higher proportion of device users who were independent in daily activities in the normal vision group compared to the visual impairment groups. There was already a significant difference in the use of assistive devices at a visual acuity level of 0.7 - 0.5 compared to participants with normal vision. Conclusion: The results show that it is imperative to provide intervention such as assistive devices in P and I-ADL earlier in the disablement process in order to slow down the progression of decline, as persons with visual impairment are at high risk of developing disability.

Cognitive function and functional ability. A cross- sectional and longitudinal study at ages 85 and 95 in a non-demented population

We studied the relationship between cognitive function and ability in daily life activities (ADL) at ages 85 (N=332) and 95 (N=63) cross- sectionally and longitudinally in representative populations of non- demented persons, in order to focus on manifestations related to healthy aging. Among the 85- year olds, 31% were independent, 42% were dependent on personal assistance in instrumental ADL (IADL) and 27% in personal ADL (PADL); the corresponding figures for the 95- year olds were 8, 40 and 52%, respectively. Regarding the relationship between cognitive function and ADL, the analysis could only be performed in the cross- sectional data. At age 85 a significant trend was found regarding nearly all cognitive tests for both men and women, indicating that subjects who were ADL- indepen- dent had better results than those dependent in IADL, and both IADL and PADL. At age 95, no such trend was found in males, but in females the trend was significant, and those dependent in ADL had poorer results in the separate cognitive tests. By combining the different cognitive tests into a compiled cognitive index, it was seen that the most ADL- dependent persons were more cognitively impaired both at ages 85 and 95, compared to persons who were ADL- independent. Not only cognitive functioning (OR 3.3), but also mobility (OR 4.9) and tiredness (OR 3.3) were independent predictors for ADL- dependence among the 85- year olds.