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AbstractThe aim of this study was to explore community-working occupational therapists’ involvement in research and development projects. A cross-sectional survey of occupational therapists working in community-based services in Norway (n = 617) was conducted. In all, 117 of the 617 participants responded that they were involved in research and development projects. Greater likelihood of participation in research and development work were found for occupational therapists who had completed further education. Current and prioritized research topics were professional development and the development of interprofessional and professional service designs for occupational therapy. Service and quality development, rehabilitation and technology were areas where more knowledge was considered needed. To increase the growth and success of occupational therapy research and development, it is important that more occupational therapists in the municipality continue to complete further education. High-quality occupational therapy practice should be based on research and development projects in the municipalities. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of a dialogue-based intervention on psychosocial well-being 6 months after stroke., Design: Multicentre, prospective, randomized controlled trial., Subjects: Adults (aged ≥ 18 years) who had their first or recurrent stroke within the last month, were medically stable, had sufficient cognitive functioning to participate and understood and spoke Norwegian., Methods: A total of 322 participants were randomly assigned to the intervention (n = 166) or control (n = 156) group. Participants in the intervention group received up to 8 individual sessions aimed at supporting the coping and life skills of stroke survivors in addition to usual care. The primary outcome was the proportion of participants with normal mood measured by the General Health Questionnaire-28 (GHQ-28). The secondary outcomes included health-related quality of life (Stroke and Aphasia Quality of Life Scale; SAQOL-39g), depression (Yale-Brown single-item questionnaire; Yale) and sense of coherence (SOC-13)., Results: After controlling for the baseline values, no significant benefit was found in the intervention group over the control group (odds ratio (OR): 0.898: 95% confidence interval (95% CI): 0.54-1.50, p = 0.680) 6 months post-stroke., Conclusion: Psychosocial well-being improved during the first 6 months after stroke in both arms of the trial, but no statistically significant benefit of the dialogue-based intervention was found compared with usual care.

Background: Several studies have documented the variety of post-stroke psychosocial challenges, which are complex, multifaceted, and affect a patient's rehabilitation and recovery. Due to the consequences of these challenges, psychosocial well-being should be considered an important outcome of the stroke rehabilitation. Thus, a valid and reliable instrument that is appropriate for the stroke population is required. The factor structure of the Norwegian version of GHQ-28 has not previously been examined when applied to a stroke population. The purpose of this study was to explore the psychometric properties of the GHQ-28 when applied in the stroke population included in the randomized controlled trial; "Psychosocial well-being following stroke", by evaluating the internal consistency, exploring the factor structure, construct validity and measurement invariance., Methods: Data were obtained from 322 individuals with a stroke onset within the past month. The Kaiser-Meyer-Olkin (KMO) test was used to test the sampling adequacy for exploratory factor analysis, and the Bartlett's test of sphericity was used to test equal variances. Internal consistency was analysed using Cronbach's alpha. The factor structure of the GHQ-28 was evaluated by exploratory factor analysis (EFA), and a confirmatory factor analysis (CFA) was used to determine the goodness of fit to the original structure of the outcome measurement. Measurement invariance for two time points was evaluated by configural, metric and scalar invariance., Results: The results from the EFA supported the four-factor dimensionality, but some of the items were loaded on different factors compared to those of the original structure. The differences resulted in a reduced goodness of fit in the CFA. Measurement invariance at two time points was confirmed., Conclusions: The change in mean score from one to six months on the GHQ-28 and the factor composition are assumed to be affected by characteristics in the stroke population. The results, when applying the GHQ-28 in a stroke population, and sub-factor analysis based on the original factor structure should be interpreted with caution., Trial Registration: ClinicalTrials.gov, NCT02338869 , registered 10/04/2014.

Background: Evaluation of complex interventions should include a process evaluation to give evaluators, researchers, and policy makers greater confidence in the outcomes reported from RCTs. Implementation fidelity can be part of a process evaluation and refers to the degree to which an intervention is delivered according to protocol. The aim of this implementation fidelity study was to evaluate to what extent a dialogue-based psychosocial intervention was delivered according to protocol. A modified conceptual framework for implementation fidelity was used to guide the analysis., Methods: This study has an explanatory, sequential two-phase mixed methods design. Quantitative process data were collected longitudinally along with data collection in the RCT. Qualitative process data were collected after the last data collection point of the RCT. Descriptive statistical analyses were conducted to describe the sample, the intervention trajectories, and the adherence measures. A scoring system to clarify quantitative measurement of the levels of implementation was constructed. The qualitative data sources were analyzed separately with a theory-driven content analysis using categories of adherence and potential moderating factors identified in the conceptual framework of implementation fidelity. The quantitative adherence results were extended with the results from the qualitative analysis to assess which potential moderators may have influenced implementation fidelity and in what way., Results: The results show that the core components of the intervention were delivered although the intervention trajectories were individualized. Based on the composite score of adherence, results show that 80.1% of the interventions in the RCT were implemented with high fidelity. Although it is challenging to assess the importance of each of the moderating factors in relation to the other factors and to their influence on the adherence measures, participant responsiveness, comprehensiveness of policy description, context, and recruitment appeared to be the most prominent moderating factors of implementation fidelity in this study., Conclusions: This evaluation of implementation fidelity and the discussion of what constitutes high fidelity implementation of this intervention are crucial in understanding the factors influencing the trial outcome. The study also highlights important methodological considerations for researchers planning process evaluations and studies of implementation fidelity., Trial Registration: ClinicalTrials.gov , NCT02338869; registered 10/04/2014.

Background: Stroke is a major public health threat globally. Psychosocial well-being may be affected following stroke. Depressive symptoms, anxiety, general psychological distress and social isolation are prevalent. Approximately one third report depressive symptoms and 20% report anxiety during the first months or years after the stroke. Psychosocial difficulties may impact significantly on long-term functioning and quality of life, reduce the effects of rehabilitation services and lead to higher mortality rates. The aim of the study is to evaluate the effect of a previously developed and feasibility tested dialogue-based psychosocial intervention aimed at promoting psychosocial well-being and coping following stroke among stroke survivors with and without aphasia., Methods: The study will be conducted as a multicenter, randomized, single blind controlled trial with one intervention and one control arm. It will include a total of 330 stroke survivors randomly allocated into either an intervention group (dialogue-based intervention to promote psychosocial well-being) or a control group (usual care). Participants in the intervention group will receive eight individual sessions of supported dialogues in their homes during the first six months following an acute stroke. The primary outcome measure will be psychosocial well-being measured by the General Health Questionnaire (GHQ). Secondary outcome measures will be quality of life (SAQoL), sense of coherence (SOC), and depression (Yale). Process evaluation will be conducted in a longitudinal mixed methods study by individual qualitative interviews with 15-20 participants in the intervention and control groups, focus group interviews with the intervention personnel and data collectors, and a comprehensive analysis of implementation fidelity., Discussion: The intervention described in this study protocol is based on thorough development and feasibility work, guided by the UK medical research council framework for developing and testing complex interventions. It combines classical effectiveness evaluation with a thorough process evaluation. The results from this study may inform the development of further trials aimed at promoting psychosocial well-being following stroke as well as inform the psychosocial follow up of stroke patients living at home., Trial Registration: NCT02338869 ; registered 10/04/2014 (On-going trial).

Background: A considerable proportion of patients with mild to moderate traumatic brain injury (TBI) experience long-lasting somatic, cognitive, and emotional symptoms that may hamper their capacity to return to work (RTW). Although several studies have described medical, psychological, and work-related factors that predict RTW after TBI, well-controlled intervention studies regarding RTW are scarce. Furthermore, there has traditionally been weak collaboration among health-related rehabilitation services, the labor and welfare sector, and workplaces., Methods/design: This study protocol describes an innovative randomized controlled trial in which we will explore the effect of combining manualized cognitive rehabilitation (Compensatory Cognitive Training [CCT]) and supported employment (SE) on RTW and related outcomes for patients with mild to moderate TBI in real-life competitive work settings. The study will be carried out in the southeastern region of Norway and thereby be performed within the Norwegian welfare system. Patients aged 18-60 years with mild to moderate TBI who are employed in a minimum 50% position at the time of injury and sick-listed 50% or more for postconcussive symptoms 2 months postinjury will be included in the study. A comprehensive assessment of neurocognitive function, self-reported symptoms, emotional distress, coping style, and quality of life will be performed at baseline, immediately after CCT (3 months after inclusion), following the end of SE (6 months after inclusion), and 12 months following study inclusion. The primary outcome measures are the proportion of participants who have returned to work at 12-month follow-up and length of time until RTW, in addition to work stability as well as work productivity over the first year following the intervention. Secondary outcomes include changes in self-reported symptoms, emotional and cognitive function, and quality of life. Additionally, a qualitative RTW process evaluation focused on organizational challenges at the workplace will be performed., Discussion: The proposed study will combine cognitive and vocational rehabilitation and explore the efficacy of increased cross-sectoral collaboration between specialized health care services and the labor and welfare system. If the intervention proves effective, the project will describe the cost-effectiveness and utility of the program and thereby provide important information for policy makers. In addition, knowledge about the RTW process for persons with TBI and their workplaces will be provided., Trial Registration: ClinicalTrials.gov, NCT03092713 . Registered on 10 March 2017.

Objective: To evaluate the effectiveness of a group-based self-management program for people with chronic fatigue syndrome., Design: A randomized controlled trial., Setting: Four mid-sized towns in southern Norway and two suburbs of Oslo., Subjects: A total of 137 adults with chronic fatigue syndrome., Intervention: A self-management program including eight biweekly meetings of 2.5 hours duration. The control group received usual care., Main Measures: Primary outcome measure: Medical Outcomes Study-Short Form-36 physical functioning subscale., Secondary Outcome Measures: Fatigue severity scale, self-efficacy scale, physical and mental component summary of the Short Form-36, and the illness cognition questionnaire (acceptance subscale). Assessments were performed at baseline, and at six-month and one-year follow-ups., Results: At the six-month follow-up, a significant difference between the two groups was found concerning fatigue severity ( p = 0.039) in favor of the control group, and concerning self-efficacy in favor of the intervention group ( p = 0.039). These significant differences were not sustained at the one-year follow-up. No significant differences were found between the groups concerning physical functioning, acceptance, and health status at any of the measure points. The drop-out rate was 13.9% and the median number of sessions attended was seven (out of eight)., Conclusions: The evaluated self-management program did not have any sustained effect, as compared with receiving usual care.

Background: After severe traumatic brain injury (TBI) it is recommended that patients in need of rehabilitation be transferred directly from acute care to specialized rehabilitation. However, recent European cohort studies found a variety of care pathways and delays in admission to rehabilitation after severe TBI., Aim: To study the pathways within rehabilitation services in a Norwegian national cohort with severe TBI and the association to functional independence 12 months post-injury., Design: Observational prospective multicenter study., Setting: Regional trauma centers., Population: A total of 163 adults, age 16-85 years, with severe TBI., Methods: The main variables were transfer between acute care and rehabilitation, type of rehabilitation services and functional independence., Results: 75% of the patients had specialized TBI rehabilitation, 11% non-specialized and 14% no in-patient rehabilitation. In total, 48% were transferred directly to specialized rehabilitation from acute units in regional trauma centers. There were no differences in injury severity between patients transferred directly and non-directly, but the direct-transfer patients were younger. At 12 months post-injury, 71% were functionally independent and 90% lived in their home. Younger age, fewer days of ventilation and shorter post-traumatic amnesia were associated with independence. Among patients treated with specialized rehabilitation, direct transfer to rehabilitation was associated with functional independence (OR=4.3, P<0.01)., Conclusions: A direct clinical pathway including specialized rehabilitation in dedicated units was associated with functional independence., Clinical Rehabilitation Impact: Direct pathways from acute care to sub-acute specialized rehabilitation might prove beneficial to functional status.

Background: The World Health Organization (WHO) suggests using the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework for disability outcomes and the modified Rankin Scale (mRS) as an outcome measure in stroke., Aim: The aim of this study was to analyze the content of the mRS and the mRS-Systematic Interview (mRS-SI) by linking the scales to the ICF and to explore the association between the mRS and the ICF Core Set for stroke., Design: Analysis of mRS and mRS-SI using ICF linking rules, as well as quantitative analysis using cross-sectional data., Setting: In- and outpatient settings, community dwelling individuals after stroke., Methods: Both scales were independently linked to the ICF and correlations between the mRS scores and the sum of problems in functioning, deriving from 266 stroke patients, were assessed under the components of the ICF Core Set for Stroke, the domains of 'Activities and Participation' and 15 second level categories linked to the mRS., Results: Twelve meaningful concepts in the mRS and 40 meaningful concepts in the mRS-SI were identified and linked to different ICF categories, covering 9% and 32% of the ICF Core Set for stroke respectively. The strongest association of the mRS scores was with the number of problems in 'Activities and Participation', especially with the 'Self-care', 'Mobility' and 'Domestic life' domains, as well as with single categories of 'Moving around using equipment', 'Changing basic body position', 'Walking' and 'Carrying out daily routine'., Conclusions: The content of the mRS and the mRS-SI can be linked to the ICF framework. But the content may not be related to a specific outcome that would be in accordance with the disability terminology suggested by the World Health Organization., Clinical Rehabilitation Impact: In order to follow the ICF model, interpretation of mRS rating requires caution.

The aims of the study were to examine whether self-reported physical health changes over the first 5 years after traumatic brain injury (TBI), and whether the trajectories of physical health over that time period could be predicted by demographic and injury-related variables. A longitudinal cohort study was conducted with 97 individuals with moderate-to-severe TBI who had been admitted to a Trauma Referral Centre in 2005/2007. Patients were followed up at 1, 2 and 5 years post-injury. Physical health-related quality of life (HRQL) (i.e., physical health) was measured by four subscales of the Medical Outcomes 36-Item Short Form Health Survey (SF-36): Physical Functioning, Role-Physical, Bodily Pain and General Health. Only the Physical Functioning domain showed statistically significant improvements across time. Women had lower scores on Role-Physical, Bodily Pain (more pain) and General Health. Unemployment prior to injury and having been in a "blue collar" physical job was associated with lower Physical Functioning and General Health, while greater TBI severity was associated with lower Physical Functioning, but better Role-Physical. Bodily Pain, Role-Physical and General Health remained fairly stable over time, despite the improvement in Physical Functioning. There were a number of significant injury-related and demographic predictors across the four trajectories of physical health. A better understanding of factors influencing these domains over the first 5 years after TBI and effective pain reducing rehabilitation strategies are needed.

The aim of this qualitative study was to explore young and midlife stroke survivors' experiences with the health services and to identify long-term follow-up needs. Sixteen participants from two cohorts were interviewed in-depth. The interviews were analyzed applying a hermeneutic-phenomenological analysis. The participants struggled to gain access to follow-up health services. They felt that whether they were systematically followed up was more coincidental than planned. Young and midlife stroke survivors thus appear vulnerable to falling outside the follow-up system. Those participants who received some follow-up care perceived it as untailored to their specific needs. To be considered supportive, the follow-up programs must be in line with their long-term needs, take into account their particular challenges as young and midlife stroke survivors, and be planned in close collaboration with the individual patient. To secure systematic and follow-up health services tailored to the individual, knowledgeable and committed healthcare professionals should play a prominent role within the community health services.

Recruitment and retention of participants in randomized controlled trials (RCTs) drawn from the older population is challenging, and studies have shown that poor recruitment and retention may lead to biased samples and results. Several strategies to improve the participation of older adults in research are outlined in the literature. The objective was to identify factors associated with participation in an RCT aiming at preventing depressive symptoms and social isolation in a later phase following a stroke, in an older population living in their homes. Strategies to improve participation were applied in the RCT "Lifestyle intervention for older adults in rehabilitation after stroke: development, implementation and evaluation". Quantitative data collected on participants (n=99) and non-participants (n=56) in the trial were compared using statistical analyses. The findings are in line with earlier studies in that the participants were younger (p=0.01) and received less help in the home (p=0.01) than did non-participants. The results differ from earlier studies in that participants had a higher rate of depressive symptoms (participation rate was 57% with HAD depression scale score 0-2, 61% with score 3-4, 62% with score 5-6 and 79% with a score 7 or above). The findings also illustrate a poorer health-related quality of life among the participants in the role physical domain on Short Form-36 (p=0.01). The results indicate that the use of targeted strategies to enhance participation may lead to a less biased sample as well as the inclusion of more subjects who seem to meet the aims of the intervention., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: The aim of this study was to explore by Rasch analysis whether the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set might represent a future clinical tool for measuring functioning of patients with low back pain. Material and methodsThe Comprehensive ICF Core Set for low back pain was scored by health professionals for 118 patients with low back pain. Qualifier levels, invariance, construct validity and ordering of the categories in the components of Body function, Body structure, Activities and participation and Environmental factors were explored by Rasch analysis., Results: The number of qualifier levels had to be reduced. Categories within Body functions and within Environmental factors reflected a single underlying construct. The categories within the component of Activities and Participation did not meet the requirements of a single underlying construct in the present population. Few categories covered the problems reported by patients with a relatively high level of function., Conclusion: Rasch analysis indicated that the Comprehensive ICF Core Set for low back pain may be used with some modification of categories as a common tool for assessing problems within the components Body functions, and Activity and Participation. However, detecting ICF categories that reflect the higher functional levels in patients with low back pain, and revision of the qualifier levels may be necessary.

Background: International Classification of function, disability and health (ICF) is a globally accepted framework and classification system. ICF core sets for chronic health conditions have been developed to promote implementation of ICF in clinical practice. A preliminary core set for low back pain, with 78 categories, has been developed and proposed for international validation., Material and Method: Health professionals used ICF core sets to rate patient problems within the 78 categories. The categories from the components of body functions- and structure, activity, and participation and environmental factors were scored using qualifiers. Time consumption and usefulness of the ICF Core Set were also rated., Results: The patients (n = 118) had problems in all 78 categories with a frequency from 5 to 95 %., Results: The patients (n = 118) had problems in all 78 categories with a frequency from 5 to 95 %. B265 TOUCH SENSATION was the only category reported to be missing in the core set. Environmental factors were frequently scored as facilitators, but also as barriers. Discrepancies were discovered between terms in ICF and those most commonly used in the clinical setting. Health professionals' experience of usefulness varied. Mean time consumption for scoring was 48 min (SD 25 min), Interpretation: The ICF Core Set for low back pain can be used clinically and seems to broaden the perspective of participation and environmental factors. Knowledge of ICF and training in use of the Core Set is needed before clinical implementation.

The definition of rehabilitation is debated, but the true sense of the word is "reinstatement in dignity." There is often a need for rehabilitation after diseases and injuries. Rehabilitation is founded on the individual's right to participate in society and to have equal opportunities in general, and can be considered both in a medical and a sociological perspective. WHO has developed "International Classification of Functioning, disability and health"-ICF. ICF reflects an understanding of function and disability in a bio-psychosocial model. The issues discussed in this article will be limited to rehabilitation within the Norwegian healthcare system. Rehabilitation is based on the individual's loss of function, irrespective of the injury or disease, and should focus on resources. Its main issue is the subject's own goals and wishes with respect to quality of life and total life situation. Many groups that have, or are in danger of acquiring reduced function are in need of rehabilitation, if this can prevent or reduce loss of function or participation. The measures taken can be directed over a wide spectrum, directed towards function and activity, and often with participation in a variety of life aspects as the main goal. Rehabilitation is presented with many challenges caused by the general development in society, including implementation of the medical and technological development and demand of scientific documentation.

Background: Cognitive symptoms are common after stroke, but doctors' knowledge about such symptoms seems sparse., Methods: We review the literature and present our own clinical experience on selected cognitive losses after stroke., Results and Interpretation: The most common non-linguistic cognitive symptoms are neglect (hemi-inattention), visuospatial problems (difficulties in putting elements together or to perform spatial tasks), and apraxia (difficulties in performing voluntary, purposeful tasks due to mistakes in the choice and order of motor elements). More than half of patients suffer from such symptoms in the acute phase of stroke and approximately one in four has long-lasting problems. Knowledge about these symptoms is essential for effective rehabilitation, good information to the patient and his caregivers, and for prognostic purposes. Full evaluation of cognitive losses requires a neuropsychological examination, but thorough observation of the patient combined with simple pen-and-paper tests can be very helpful.