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BackgroundTraumatic injuries, defined as physical injuries with sudden onset, are a major public health problem worldwide. There is a paucity of knowledge regarding rehabilitation needs and service provision for patients with moderate and major trauma, even if rehabilitation research on a spectrum of specific injuries is available. ObjectiveThis study aims to describe the prevalence of rehabilitation needs, the provided services, and functional outcomes across all age groups, levels of injury severity, and geographical regions in the first year after trauma. Direct and indirect costs of rehabilitation provision will also be assessed. The overarching aim is to better understand where to target future efforts. MethodsThis is a population-based prospective follow-up study. It encompasses patients of all ages with moderate and severe acute traumatic injury (New Injury Severity Score >9) admitted to the regional trauma centers in southeastern and northern Norway over a 1-year period (2020). Sociodemographic and injury data will be collected. Upon hospital discharge, rehabilitation physicians estimate rehabilitation needs. Rehabilitation needs are assessed by the Rehabilitation Complexity Scale Extended–Trauma (RCS E–Trauma; specialized inpatient rehabilitation), Needs and Provision Complexity Scale (NPCS; community-based rehabilitation and health care service delivery), and Family Needs Questionnaire–Pediatric Version (FNQ-P). Patients, family caregivers, or both will complete questionnaires at 6- and 12-month follow-ups, which are supplemented by telephone interviews. Data on functioning and disability, mental health, health-related quality of life measured by the EuroQol Questionnaire (EQ-5D), and needs and provision of rehabilitation and health care services are collected by validated outcome measures. Unmet needs are represented by the discrepancies between the estimates of the RCS E–Trauma and NPCS at the time of a patient’s discharge and the rehabilitation services the patient has actually received. Formal service provision (including admission to inpatient- or outpatient-based rehabilitation), informal care, and associated costs will be collected. ResultsThe project was funded in December 2018 and approved by the Regional Committee for Medical and Health Research Ethics in October 2019. Inclusion of patients began at Oslo University Hospital on January 1, 2020, and at the University Hospital of North Norway on February 1, 2020. As of February 2021, we have enrolled 612 patients, and for 286 patients the 6-month follow-up has been completed. Papers will be drafted for publication throughout 2021 and 2022. ConclusionsThis study will improve our understanding of existing service provision, the gaps between needs and services, and the associated costs for treating patients with moderate and major trauma. This may guide the improvement of rehabilitation and health care resource planning and allocation. International Registered Report Identifier (IRRID)DERR1-10.2196/25980

In this article, we present findings from a qualitative study examining how young women experience being long‐term bedridden with myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS), during childhood and adolescence. The aim is to explore how young women who fell ill with ME/CFS during childhood and adolescence look back on their lived experience of being long‐term bedridden from the vantage point of being fully or partially recovered. Informed by a phenomenological theoretical perspective, the researchers applied a narrative methodological approach involving the analysis of interviews with 13 women, aged 16–29 years at the time of the interview. Attention was particularly paid to how participants structured their narratives and to the events (telling moments) they identified as important. Four major storylines were developed: Ambivalent responses to the presence of others; A body on the edge of life; An eternity in the dark; and Recasting painful memories of being bedridden and alone. Based on our findings, we argue that the experience of being long‐term bedridden with ME/CFS during childhood and adolescence can be understood and communicated as a plot in which individuals find themselves pushed to the extreme limit of suffering and loneliness. [ABSTRACT FROM AUTHOR]

Purpose: To explore the recovery narratives of 13 young women who had fallen ill with severe Myalgic Encephalomyelitis (ME), also known as Chronic Fatigue Syndrome (CFS), during childhood and adolescence, with the focus on what they had to say about their past experiences from the perspective of the present. Method: A qualitative narrative approach, informed by a phenomenological theoretical perspective, was adopted to explore what the women found significant and meaningful in their recovery process. Data analysis of in-depth narrative interviews was performed which are presented to readers through the stories of two particular participants. Results: The first story describes how one participant made a recovery by testing her body's tolerance and working to create a more confident self. The second story describes a complex exploration of possibilities for action in recovery, along with a struggle to make sense of setbacks and hold on to what has been gained. Conclusion: Recovering from ME/CFS emerges as an inter-personal, contextual, fragile and nonlinear process of homecoming, based on gradually rising bodily based self-knowledge. Illness slowly fades away into the background, and there is the prospect of a healthier tomorrow. [ABSTRACT FROM AUTHOR]

The aim of this study was to elicit participants' experiences with a multidisciplinary patient education programme and their views regarding the usefulness of the programme. Focus group interviews were conducted with 10 participants immediately and nine months following participation in the programme and analysed using thematic analysis. Initially, the participants experienced confusion and insecurity regarding coping with the illness. Participation in the programme appeared to promote understanding, acceptance and coping through gaining greater knowledge, learning coping strategies and exchanging experiences, as well as receiving understanding and acceptance. Thus, the programme was experienced to be a beneficial intervention. However, the participants expressed a need for more guidance or follow-up to maintain the practice of coping strategies for better coping with their illness.

Thirteen women (16–30 years) storied their experiences about the process of falling severely ill with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome during childhood and adolescence. We performed a narrative analysis informed by phenomenology which yielded three central themes: The active and meaningful life I used to live; gradually developing unhomeliness and feeling pushed toward the edge; and left abandoned on the sidelines. Out of the incomprehensible and unpredictable emerges an understanding of the scale of their ordeal, along with advice that may have made it worse. This portrays a gradual developing uncertain, unhomely life situation with no outlooks for future recovery. [ABSTRACT FROM AUTHOR]

Background: Individuals who have sustained mild traumatic brain injury (mTBI) with a protracted course of recovery may experience long-lasting somatic, cognitive, and emotional symptoms affecting activities of daily living. There is limited knowledge regarding individuals' lived experiences with treatments and advice provided. Purpose: To explore how individuals with mTBI describe and make sense of their injury, recovery process, and their experiences with various treatment approaches. Methods: Eight participants with mTBI were recruited from the intervention group in an ongoing randomized controlled trial regarding return-to-work. They were interviewed once after treatment delivery using a qualitative hermeneutical approach. Thematic analysis was applied, and findings are discussed in light of a salutogenic theory. Results: Participants expressed uncertainty regarding conflicting advice they received in the early phase of recovery. Three main themes were developed: (1) "Ambiguity and hope"; (2) "Uncertainty concerning activity and rest"; and (3) "To become the person I used to be vs. to become a new version of myself." Conclusion: The findings showed that the participants experienced both uncertainty and hope for further recovery. The recovery process is challenged by the variability of TBI symptoms that affects participation in everyday life, as well as the conflicting advice received by the participants. [ABSTRACT FROM AUTHOR]

While many persons who sustain a mild traumatic brain injury (MTBI) can resume work shortly after their injury, some experience persisting symptoms leading to longer-term sickness absence. In-depth knowledge about how these persons experience the return to work (RTW) process is needed. To explore how persons with MTBI experience the process of returning to ordinary competitive work after a prolonged period of sickness absence. Semi-structured interviews were conducted with six persons (four women) approximately 12 months after sustaining an MTBI. Data were analysed using a stepwise-deductive inductive method. When starting work the participants experienced a crisis. They described the importance of making the actual decision to RTW. Being present at the workplace was significant. In the process of increased workload, they expressed having challenges related to time perception and capacity restrictions. The importance of being seen and valued was emphasised. When reintegrated into the workplace revaluing work tasks and priorities shaped the RTW process as well as a further professional career. The process of RTW contained the experience of unpredictability and incompatibility with own identity and performance. Working had an impact on social participation, self-worth, daily structure, as well as reconstructing occupational biography. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to (1) assess self-reported main problem areas reported by patients with traumatic brain injury (TBI) and their family members in the chronic phase, and (2) compare the self-prioritized problems with difficulties captured by questionnaires and neuropsychological screening through linking to the International Classification of Functioning, Disability and Health (ICF). Setting: Outpatient clinic at the Oslo University Hospital, Norway. Participants: In total, 120 patients with TBI were recruited, of whom, 78 had a participating family member. Eligibility criteria were a clinical TBI diagnosis with verified intracranial injury, living at home, aged 18 to 72 years, 2 years or more postinjury, and experiencing perceived TBI-related difficulties, reduced physical and mental health, or difficulties with participation in everyday life. Patients with severe psychiatric or neurological disorders or inability to participate in goal-setting processes were excluded. Design: Cross-sectional. Main Measures: Target Outcomes, that is, 3 main TBI-related problem areas reported by patients and family members, collected in a semistructured interview; standardized questionnaires of TBI-related symptoms, anxiety, depression, functioning, and health-related quality of life; neuropsychological screening battery. Results: Target Outcomes were related to cognitive, physical, emotional, and social difficulties. Target Outcomes were linked to 12 chapters and 112 distinct categories in the ICF, while standardized measures only covered 10 chapters and 28 categories. Some aspects of post-TBI adjustment were found to be insufficiently covered by the ICF classification, such as identity issues, lack of meaningful activities, and feeling lonely. Conclusion: The Target Outcomes approach is a useful assessment method in a population with chronic TBI. The standardized questionnaires capture the spectrum of problems, whereas the Target Outcomes approach captures the prioritized individual problems hindering everyday life after TBI. While the standardized measures are an irreplaceable part of the assessment, Target Outcomes ensures patient involvement and may help clinicians better tailor relevant rehabilitation efforts. [ABSTRACT FROM AUTHOR]

Stroke impacts psychosocial well-being and engagement in occupation. Psychosocial interventions reduce depression and anxiety but may not impact occupation. Knowledge of key processes and components of community psychosocial stroke interventions can inform future intervention development. To determine the essential elements common to three psychosocial interventions for stroke survivors. Concept maps were created for three community psychosocial stroke interventions based on published literature and communication with researchers who tested the intervention with stroke survivors. The concept maps were then compared to identify common elements. Ongoing communication with researchers ensured accurate representation of each respective intervention. Similarities in intervention processes and components included support for autonomy; individualized information exchange; coping, life skill development and adaptation support; competence development; and the incorporation of goals. Differences included intervention delivery (individual versus group), and the avenues in which psychosocial needs are addressed (occupation versus dialogue). Concept mapping identified similarities among the three interventions that can be best understood using self-determination theory. Clinicians may utilize findings revealed in the process to inform evidence-based psychosocial stroke interventions. Knowledge of key 'active ingredients' for psychosocial community stroke interventions, can be used to guide clinical reasoning and inform development of interventions. [ABSTRACT FROM AUTHOR]

To (1) identify interventional research topics in traumatic brain injury (TBI) rehabilitation, (2) describe potential knowledge gaps, and (3) uncover further needs for interventional TBI rehabilitation research for patients and families. We searched three databases (2006–2019) and screened 1552 non-duplicate articles. Titles and abstracts were screened for relevance, yielding 754 articles for full-text review. Of these, 425 were included, as relevant to the purpose of the scoping review. Among articles on TBI rehabilitation, the majority (71.8%) applied quantitative methodology; of these only 19.7% were randomized controlled trials. Severe TBI was described more often than mild/moderate TBI populations. Hospital vs community/home rehabilitation was 55.1% vs 37.2%; rehabilitation at workplace/school was described in only 4.5% articles, while in 7.2% the setting was undisclosed. Of 83 articles describing work/education, only 14 were in a work/school context. An additional focus in the work/education articles was activities of daily living (n = 28), cognition (n = 33) and emotions (n = 23), few targeted family or network. The main attention of interventional TBI rehabilitation studies has been on severe TBI and long-term rehabilitation. Gaps identified were rehabilitation of mild/moderate TBI populations, older populations, acute/sub-phase rehabilitation, return to work issues and studies including the family. A substantial number of interventional studies exist to guide long-term rehabilitation after traumatic brain injury with focus on daily life, physical, emotional and cognitive functioning. We recommend a stronger focus in the clinic on the following groups; people with mild/moderate traumatic brain injury, people in the acute and sub-acute phase, and older people with traumatic brain injury. Issues that target challenges returning to work should be addressed, while they are of importance to patients and families. Emphasis should be put on continuity of care and peer-support. [ABSTRACT FROM AUTHOR]

Background: Numerous studies of user involvement in research have been conducted. However, there is a lack of studies applying observational methods and addressing the concrete practice of involvement. Objective: To determine what knowledge types and competences users apply when involved in the research process through user panel meetings. Design: User panel meetings in a qualitative project in rehabilitation were sound‐recorded and transcribed verbatim. Data analysis applied an abductive approach framed by positioning theory. Setting and participants: Six rehabilitation service users and a similar number of researchers met 20 times during a six‐year project period. They discussed various issues in the research process such as interview guides, analysis and dissemination of results. Findings: The service users combined their respective knowledge and competence into six positions enacted in the panel interactions. They engaged as co‐researchers, based their contributions on their respective personal histories, represented an NGO and peers, applied their respective professional and educational backgrounds and, finally, engaged as concerned citizens. Discussion and conclusion: The findings add to the discussion of professionalization of user involvement by introducing a wider array of positions enacted than do the findings of previous studies. Researchers recruiting user panel members, as well as NGOs appointing candidates for user panels, are advised to consider a wide competence profile for possible candidates. A panel is also considered as a resource in confirming and elaborating on a study's findings. Patient and public contribution: A service user panel contributed to the study. [ABSTRACT FROM AUTHOR]

Introduction Assessment of patients' abilities in activities of daily living (ADL functions) is important in geriatric medicine, and particularly in the rehabilitation of stroke patients. The Barthel Index [1] has [...]

Community-based occupational therapy is an increasingly important domain of work for occupational therapists. In Norway, this has been emphasized by the Coordination reform (2012), which assigned municipalities increased responsibility to protect and promote the health of their inhabitants. However, even if approximately 400 positions have been established between 2012 and 2017, little is known whether they have contributed to increased and/or more equal coverage across municipalities. To explore this matter, survey data was gathered among members of the Norwegian Occupational Therapy Association during 2017. Data was analyzed statistically (descriptive, comparative and associative) with SPSS 25. Results suggest large regional variations in the establishment of new positions. Moreover, most new positions were established in medium-sized municipalities that already had (an) occupational therapist(s) in the community. Number of prior positions, as well as being in the process of merging with another municipality were the only significant predictors for the establishment of new positions during regression analysis. Findings suggest that no levelling-out of geographical distributions of OT-coverage has occurred, even if new positions might have contributed to level-out workload (number-of-patients-per-therapist). Further, we discuss implications of our findings for policy-making and recruitment of Occupational Therapists for rural positions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of a dialogue-based intervention targeting psychosocial well-being at 12 months post-stroke. Design: Multicenter, prospective, randomized, assessor-blinded, controlled trial with two parallel groups. Setting: Community. Subjects: Three-hundred and twenty-two adults (⩾18 years) with stroke within the last four weeks were randomly allocated into intervention group (n = 166) or control group (n = 156). Interventions: The intervention group received a dialogue-based intervention to promote psychosocial well-being, comprising eight individual 1–1½ hour sessions delivered during the first six months post-stroke. Main measures: The primary outcome measure was the General Health Questionnaire-28 (GHQ-28). Secondary outcome measures included the Stroke and Aphasia Quality of Life Scale-39g, the Sense of Coherence scale, and the Yale Brown single-item questionnaire. Results: The mean (SD) age of the participants was 66.8 (12.1) years in the intervention group and 65.7 (13.3) years in the control group. At 12 months post-stroke, the mean (SE) GHQ-28 score was 20.6 (0.84) in the intervention group and 19.9 (0.85) in the control group. There were no between-group differences in psychosocial well-being at 12 months post-stroke (mean difference: −0.74, 95% confidence interval (CI): −3.08, 1.60). The secondary outcomes showed no statistically significant between-group difference in health-related quality of life, sense of coherence, or depression at 12 months. Conclusion: The results of this trial did not demonstrate lower levels of emotional distress and anxiety or higher levels of health-related quality of life in the intervention group (dialogue-based intervention) as compared to the control group (usual care) at 12 months post-stroke. [ABSTRACT FROM AUTHOR]

Objectives: To describe trajectories of self-reported functional competency up to 10 years following traumatic brain injury (TBI) and identify their predictors from baseline socio-demographic and injury severity characteristics. Design and methods: Data from 94 participants from a longitudinal cohort of patients with moderate-to-severe TBI were analyzed. Socio-demographic and injury severity data were recorded at baseline. Participants completed the Patient Competency Rating Scale (PCRS) at 1, 2, 5, and 10 years. Hierarchical linear modeling was used to examine PCRS trajectories over time and assess baseline predictors. Results: There was no significant change in average PCRS scores across the follow-up time points in the full sample. Emotional and cognitive competencies had the lowest mean scores. Gender, employment, and the interaction term between gender and time were significant predictors of PCRS trajectories. Females and those who were unemployed at the time of injury showed lower trajectories of self-reported competency. Conclusion: Self-reported competency remained stable from one-year post-injury for men only. Lower mean scores in the domains of emotional and cognitive competencies suggest a need for continued rehabilitation focus in the chronic phase after TBI. Special attention to women and individuals who are unemployed at the time of injury may be warranted. [ABSTRACT FROM AUTHOR]

Background: Ongoing changes in healthcare delivery systems in Norway increasingly require community-based services, and the changes will likely affect the working conditions and opportunities for occupational therapists. Aim: To characterize occupational therapy in community-based practice in Norway. Material and methods: A cross-sectional, descriptive survey design was applied using a questionnaire related to personal and organizational characteristics. Participants (n = 561) were recruited among community-working occupational therapists in Norway registered as members of Ergoterapeutene. Data were analyzed with descriptive statistics. Results: The majority of the participants was female and had an average of 16.5 years of professional experience. They reported to spend about half of their working hours on direct work with clients. For many, work with assistive technology was a main task, accounting for approximately half their working hours. Only a small proportion worked in municipalities that had merged with others, but for a larger proportion (27%) a merger had been decided and was in preparation. Conclusion: This study established some basic information regarding Norwegian community-based occupational therapy and the municipalities where occupational therapists work. Significance: With this study serving as a baseline, we may be able to track how changes will affect community-based occupational therapy practice in the near future. [ABSTRACT FROM AUTHOR]

Background: Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a relatively common disabling illness in adolescents that may limit participation in daily life. Aim: This study explored interactions between the illness experiences of adolescents with CFS/ME, their occupational lives and expectations for the future. Methods: Seven adolescents with CFS/ME were interviewed. The interviews were analyzed using thematic analysis. Results: Three themes were developed. 'Being ruled by an unfamiliar and inexplicable body', which illustrated that altered and strange bodies seemed to separate and disrupt the participants from their former occupational lives. 'On the sideline of life with peers', which demonstrated that the informants spent time at home, doing undemanding activities instead of participating in activities with peers. 'A coherent connection between present and future life', which was reflected by how the participants eventually accepted their situation and rebuilt a meaningful occupational life and value of self. Conclusion: CFS/ME made the body unfamiliar and disconnected informants from participating in their usual daily occupations. A coherent interaction between body, occupational life and social self was achieved by taking their new body into account and adjusting their occupations accordingly. This practice enabled the participants to hope for a better future life. [ABSTRACT FROM AUTHOR]

Stroke patients' well-being is threatened after stroke. A psychosocial intervention was developed for Norwegian stroke patients living in the community. Eight individual sessions between people with stroke and a trained health care professional were conducted 1 to 6 months post-stroke with one group of participants and 6 to 12 months post-stroke with another group. Subsequently, 19 of these stroke patients were interviewed to gain an in-depth understanding of their lived experience of the influence of the intervention on their adjustment process. Interview texts were analyzed using Ricoeur's interpretation theory. Two participants did not personally find the intervention useful. The remaining participants greatly appreciated dialogues with the empathetic intervention personnel, feeling free to discuss their fears and worries. The intervention raised these participants' awareness of their needs and resources. They were guided to resume their everyday life and adopt a future-oriented attitude. The intervention facilitated their meaning-making endeavors and post-stroke adjustment. [ABSTRACT FROM AUTHOR]

Background: Profound changes in municipal health services, are calling for new models for community-based occupational therapy services. Objective: The aim of the study is to explore how Norwegian occupational therapists position themselves in relation to the tasks delivered. Method: Focus group interviews were conducted with ten community-based occupational therapists. Systematic text condensation was then used in the data analysis. Results: Norwegian occupational therapists description of professional practices can be constructed into four ideal types; being 'the all-rounder', 'the provider of assistive device', 'the fire extinguisher', or 'the innovator'. The ideal types can help us understand more of the content and dilemmas that community-based occupational therapists encountered in their daily practice, and the priorities they make during these encounters. Conclusions and Significance: Community-based occupational therapists positioned themselves in different ways, and some of these positions were considered to be more favourable than others. The therapists struggled between 'traditional' occupational therapy tasks and new ways of delivering occupational therapy services. The study reveals similarities and differences between rural and urban occupational therapy practice. The ideal types can help community-based therapists to reflect on their own practice and empower them to be more in keeping with the OT's objectives and preferences. [ABSTRACT FROM AUTHOR]

As enrollment numbers grow in occupational therapy academic programs in Norway, the need for more fieldwork placements and supervisors increases. More knowledge about factors of importance for occupational therapists' decisions to take on the role of fieldwork supervisor may promote easier access to supervisors who are ready for the task, and it may assist in addressing the barriers for those who are not. We recruited a sample of 561 community-working occupational therapists for an electronic survey conducted in 2017. Quantitative survey responses were obtained and used in the current study. The differences between supervisors and non-supervisors were examined with independent ttests and Chi Square tests. To assess factors associated with serving as a supervisor, a multivariate logistic regression analysis was conducted. One hundred fifty-six participants (27.8%) had served as a fieldwork supervisor during the preceding year. The adjusted analysis showed that having a job physically located together with other occupational therapists was significantly associated with increased odds for serving as supervisor (OR:1.79, 95% CI:1.17-2.74, p < 0.01). A minority of the participants had supervised occupational therapy students during the preceding year, suggesting that community-based services are an under-used arena for occupational therapy students' fieldwork. In a long-term perspective, providing social and organizational support for occupational therapists who might take on student supervision may increase their willingness and opportunity to do so. [ABSTRACT FROM AUTHOR]

A cross-sectional descriptive survey was conducted (n = 561). Almost half of the participants took part in research and development projects. Being involved in research and development was associated with lower age, having further education, and higher levels of work experience. The current and prioritized research topics were reablement and assistive technology. The study implies that community-working occupational therapists are largely involved in research and development, or eager to become involved. [ABSTRACT FROM AUTHOR]

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’. [ABSTRACT FROM PUBLISHER]