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Background An intervention that contains several interacting components can be defined as a complex intervention. This intervention was developed in accordance with the Medical Research Council (MRC) guidance for complex interventions. Aim To describe the development, theoretical framework, and content of a client-centred activities in daily living intervention (CADL) for people with stroke. Material and methods Different steps were used; identifying the evidence base, identifying/developing theory and the modelling process and outcomes in the development of the CADL. The remodelling of the process and content of the intervention that emerged are defined. Results Findings from a series of qualitative studies of people with stroke demonstrated the need to develop an ADL intervention based on the clients’ lived experiences. The theoretical framework is based on empirical research, theories about human occupation and client-centredness. The CADL is applying an occupational and phenomenological perspective in order to enable agency in daily activities and participation in everyday life among persons with stroke. Conclusions and significance The article can be used as an example of how to present the development and theoretical framework of a new complex intervention in occupational therapy.

Within occupational therapy, it is assumed that individuals are satisfied when participating in everyday occupations that they want to do. However, there is little empirical evidence to show this.The aim of this study is to explore and describe the relation between satisfaction and participation in everyday occupations in a Swedish cohort, 5 years post stroke.Sixty-nine persons responded to the Occupational Gaps Questionnaire (OGQ). The questionnaire measures subjective restrictions in participation, i.e. the discrepancy between doing and wanting to do 30 different occupations in everyday life, and satisfaction per activity. Results were analysed with McNemar/chi-square.Seventy percent of the persons perceived participation restrictions. Individuals that did not perceive restrictions in their participation had a significantly higher level of satisfaction (p = .002) compared to those that had restrictions. Participants that performed activities that they wanted to do report between 79 and 100% satisfaction per activity.In this cohort, there was a significant association between satisfaction and participating in everyday occupations one wants to do, showing that satisfaction is an important aspect of participation and substantiates a basic assumption within occupational therapy. The complexity of measuring satisfaction and participation in everyday occupations is discussed.

Background: This qualitative study was conducted in the context of a client-centred activities of daily living (CADL) intervention aiming to enable agency in daily activities and participation in everyday life after stroke. The intervention was based on the principles of client-centred occupational therapy and then further developed based on empirical research findings. Objective: To identify what from the clients’ perspective characterises the lived experience and meaning of participating in a CADL intervention after stroke. Methods: The study included 10 persons with stroke who received the intervention and who were able to communicate their experience of participating. Data were collected through two interviews, after the initiation and after the end of the intervention. The analysis was performed using an empirical phenomenological psychological method. Results: The overall characteristic of the meaning of participating in the intervention was transparency, which was expressed in the participants’ experiences of being able to see and follow their own rehabilitation process. An awareness and understanding of their own situation enabled the participants to be actively involved in their rehabilitation. Conclusion: The intervention contributed to transparency, which appeared to enable and support the client’s sense of ownership of daily activities and rehabilitation after stroke. Implications for rehabiliation A client-centred activities of daily living intervention seems to contribute to transparency, where persons with stroke can discover and understand their new ability and situation after stroke. A client-centred rehabilitation situation seems to enable clients to actively engage in their own rehabilitation process. Inviting clients to participate in goal-setting seems to be important in order to create the experience of transparency. Creating continuity in the therapeutic alliance seems to be important in order for the clients to feel trust and experience agency in everyday life.

Background By screening and modifying risk factors, stroke incidence can be reduced. Clinical guidelines states that primary prevention of stroke is a responsibility and task of primary health care, but research shows that this not always the case. The aim of the study was to explore and describe what characterizes GPs’ reasoning around risk screening and primary prevention among persons at risk for stroke in primary health care. Methods A qualitative design based in a grounded theory approach was chosen in order to investigate this unexplored research area. Data collection was done using focus group interviews and data was analysed using a constant comparative method. Twenty-two GPs were interviewed in four focus groups. Results Findings showed that GPs perceived difficulties in prioritizing patients with an unhealthy lifestyle and described a lack of systematicity in their procedures, which complicated their clinical decisions concerning patients with stroke risk factors. The results showed a lack of systematic risk screening methods. Time constraints and the reimbursement system were described as hindering the preventive work. Conclusion There is a need for a more proactive, transparent and systematic approach in the distribution of GPs’ time and reimbursement of prevention in primary health care. The findings suggest, by developing new methods and approaches such as digital clinical decision-making tools and by implementing inter-professional team-work, the quality of the primary prevention of stroke could be improved. Electronic supplementary material The online version of this article (10.1186/s12875-018-0883-6) contains supplementary material, which is available to authorized users.

This study was conducted in the context of a randomized controlled trial where occupational therapists (OTs) in collaboration with researchers implemented a client-centred activity of daily living intervention (CADL) for persons with stroke.The aim was to identify and describe over time the OTs' experiences regarding the collaboration with the researcher in their role as implementers of a new complex intervention.Focus group interviews were conducted with 33 OTs, two, six and 12 months after they had participated in a five-day workshop. The interviews were analysed using a grounded theory approach.Three categories were identified: (1) Including in the scientific world, (2) Involving as an implementer of science and (3) Integrating in a partnership. One core category emerged: The implementation of client-centred intervention enabled the fusion of practice and science. An increased experience of using CADL and support from the researchers changed the OTs' attitudes towards engaging in research from being an outsider to the scientific world to being included and then becoming a part of the research as an implementer of science.To create a context built on a collaborative partnership between practitioners and researchers enabled the fusion of practice and science.

To follow up an original research project of persons 11-13 years after stroke, in order to describe and understand the impact of stroke on everyday life experienced during these years. Eleven persons who had had a stroke were interviewed 11-13 years after the original research project. Data were collected and analysed using the empirical phenomenological psychological method. Three main characteristics were identified from analysis of participants' experiences during the years after stroke: () going through the loss of the previous life; () struggling to reclaim the former existence; () finding meaning in a "new" and different world. This study provides an understanding of the complexity of the lost connection between body and world occurring for a long time after stroke. This understanding provides support for the need for long-term and intermittent support and guidance to enable the re-creation of meaning and participation in everyday life in order to find a "new" self-identity after stroke, especially among persons with residual cognitive impairment.

Objective: The aim of the present study was to compare client-centeredness as it was documented by the occupational therapists in the units randomized to the intervention clusters with documentation by occupational therapists in the control clusters. Design: Comparison of medical records. Setting: The study is conducted in a context of a randomized controlled trial in Sweden, with 16 post-stroke rehabilitation units cluster randomized to intervention or control group. Subjects: Occupational therapist documentation in medical records of 279 clients with stroke. Main measures: The medical records were reviewed for their level of client-centeredness using a protocol developed from the Stewart et al model. The occupational therapists in the intervention groups participated in a workshop training to enhance their client-centeredness. Results: Occupational therapists with training in client-centeredness documented significantly more on goal setting (OR = 4.1; 95% CI, 1.87-8.81), on client participation in goal setting (OR=11.34; 95% CI, 5.97-21.57), on how the goals could be reached (OR=2.8; 95% CI, 1.7-4.62), on client participation in how goals could be reached (OR=4.56; 95% CI, 2.73-7.64), on the follow-up on goals (OR=5.77; 95% CI, 2.78-11-98) and on client participation in follow-up on goals (OR=7.44, 95% CI, 4.33-12.8). This association remained after adjustment for healthcare setting, client socio-demographic variables, and stroke severity. Conclusion: Documentation of goal setting and client participation in goal setting can be influenced by training.

Background There is a lack of evidence-based health services to reduce the impact of stroke in low-income countries at a personal, family or community level. The aim was to evaluate the feasibility of: i) a mobile phone supported family-centred intervention (F@ce™), and ii) the study design for evaluating the effects of the intervention on the perceived impact of stroke; perceived participation in everyday life; and self-efficacy in everyday activities amongst persons with stroke and their families in Uganda. Methods The study comprised a pre-post design with an intervention group (IG) receiving the F@ce™ and a control group (CG). The inclusion criteria’s were: a) confirmed stroke diagnosis, b) access to and ability to use a mobile phone, c) ability to communicate in English and/or Luganda, d) > 18 years, e) residents in Kampala, and f) a Modified Rankin Scale level 2 to 4. The aim of the F@ceTM was to increase functioning in daily activities for persons living with the consequences of stroke, and participation in everyday life for persons with stroke and their families. The F@ce™ was an eight-week family-centred intervention, which entailed goal setting and problem-solving strategies, daily reminders and self-rated follow-ups of performance by short message service (SMS). Data were collected in the participants’ home environment at baseline and after eight weeks. Data on acceptability of the F@ce™ and study procedures were collected by log-books and the responses of the SMS follow ups on the server. The primary outcomes were performance and satisfaction of valued daily activities in everyday life using the Canadian Occupational Performance Measure (COPM), self-efficacy in performance of activities in daily life. Results The IG comprised n = 13 and the CG n = 15. There were differences between the IG and CG in changes between baseline and follow-up in the primary outcomes COPM (performance component) and self-efficacy in favour of F@ce™. Overall with minor modifications the intervention and the study design were feasible for all participants involved. Conclusion The results support the need for further research to rigorously evaluate the effects of F@ce™ since the intervention appears to be feasible for persons with stroke and their family members. Electronic supplementary material The online version of this article (10.1186/s12992-018-0400-7) contains supplementary material, which is available to authorized users.

ObjectiveThe objective of the study was to compare the total use of healthcare services in the course of the first year after a stroke between participants who, after the acute care, had received occupational therapy as a client-centred activities of daily living (ADL) intervention (CADL) and participants who had received usual ADL intervention (UADL).DesignA secondary analysis of a multicentre cluster-randomised controlled trial (RCT).SettingPrimary and secondary care in Sweden.ParticipantsParticipants were included if they: (1) had received CADL or UADL in the RCT, either as inpatients in geriatric rehabilitation units or in their own homes, and (2) data could be retrieved about their use of healthcare services provided by the county council from computerised registers.InterventionsCADL or UADL.Outcome measuresInpatient and outpatient healthcare in the course of the first year after stroke.ResultsParticipants from 7 of the 16 units included in the RCT met the criteria. Participants in the CADL group (n=26) who received geriatric inpatient rehabilitation had a shorter length of hospital stay (p=0.03) than participants in the UADL group (n=46), and the CADL group with home rehabilitation (n=13) had fewer outpatient contacts (p=0.01) compared with the UADL group (n=25). Multiple regression analyses showed that in four of the models, a higher age was associated with a lower use of healthcare services. The use of healthcare services was also associated (some of the models) with dependence in ADL, stroke severity and type of rehabilitation received, CADL or UADL.ConclusionsThe provision of client-centred occupational therapy after stroke did not appear to increase the use of healthcare services during the first year after stroke.rrrrrTrial registration numberNCT01417585.

Client-centredness is a prominent contemporary concept in rehabilitation. However, there is a lack of knowledge on if and how a client-centred rehabilitation approach is incorporated in the everyday life of significant others of people who receive such rehabilitation.Explore and describe if and how a client-centred ADL intervention (CADL) was integrated in the everyday lives of significant others of people with stroke.Qualitative longitudinal design, with a grounded theory approach. Seven significant others, who cohabited with persons receiving a CADL intervention, were interviewed during the first year.One core category was identified: "Taking responsibility and achieving balance with respect to self-esteem in order to get on with everyday life". The integration of the CADL was a process. A key aspect was that as the person with stroke acted upon his/her own desired activity goals the significant others were encouraged to act on their own needs.Enablement is important also for the significant others of people with stroke. One way of enabling significant others to maintain an active lifestyle and find respite in everyday life might be to enable people with stroke to formulate and act upon their desired activity goals.

OBJECTIVE: To compare changes regarding perceived participation, independence in activities of daily living (ADL) and life satisfaction between 3, 6 and 12 months after inclusion in a study of a client-centred ADL intervention and usual ADL intervention after stroke.DESIGN: A multicentre randomized controlled trial.METHODS: Sixteen rehabilitation units were randomly assigned to provide client-centred ADL intervention or usual ADL intervention. Eligible participants were persons ≤ 3 months after stroke who had been treated in a stroke unit, were dependent in two ADL domains, had not been diagnosed with dementia, and were able to understand instructions. Data collection was performed by blinded assessors. The primary outcome, perceived participation, was assessed with the Stroke Impact Scale 3.0, domain 8. The secondary outcomes, participation, independence in ADL, and life satisfaction, were assessed with validated instruments. For statistical power, 280 participants were required. Statistical analyses were performed on an intention-to-treat basis.RESULTS: There were no differences between the groups regarding changes in perceived participation, independence in ADL, or life satisfaction during the first 12 months. There was a trend towards a clinically meaningful positive change in perceived participation that favoured client-centred ADL intervention.CONCLUSION: Further research is required to understand the benefits of client-centred interventions.

This qualitative, longitudinal, descriptive study aimed to understand the lived experience of enacting agency, and to describe the phenomenon of agency and the meaning structure of the phenomenon during the year after a stroke. Agency is defined as making things happen in everyday life through one's actions.This study followed six persons (three men and three women, ages 63 to 89), interviewed on four separate occasions. Interview data were analysed using the Empirical Phenomenological Psychological method.The main findings showed that the participants experienced enacting agency in their everyday lives after stroke as negotiating different characteristics over a span of time, a range of difficulty, and in a number of activities, making these negotiations complex. The four characteristics described how the participants made things happen in their everyday lives through managing their disrupted bodies, taking into account their past and envisioning their futures, dealing with the world outside themselves, and negotiating through internal dialogues.This empirical evidence regarding negotiations challenges traditional definitions of agency and a new definition of agency is proposed. Understanding clients' complex negotiations and offering innovative solutions to train in real-life situations may help in the process of enabling occupations after a stroke.

Objective The aim was to study a client-centred activities of daily living (ADL) intervention (CADL) compared with the usual ADL intervention (UADL) in people with stroke regarding: independence in ADL, perceived participation, life satisfaction, use of home-help service, and satisfaction with training and, in their significant others, regarding: caregiver burden, life satisfaction, and informal care. Methods In this multicentre study, 16 rehabilitation units were randomly assigned to deliver CADL or UADL. The occupational therapists who provided the CADL were specifically trained. Eligible for inclusion were people with stroke treated in a stroke unit ≤3 months after stroke, dependent in ≥two ADL, not diagnosed with dementia, and able to understand instructions. Data were collected at inclusion and three months thereafter. To detect a significant difference between the groups in the Stroke Impact Scale (SIS) domain “participation”, 280 participants were required. Intention-to-treat analysis was applied. Results At three months, there was no difference in the outcomes between the CADL group (n = 129) and the UADL group (n = 151), or their significant others (n = 87/n = 93) except in the SIS domain “emotion” in favour of CADL (p = 0.04). Conclusion The CADL does not appear to bring about short-term differences in outcomes and longer follow-ups are required.

Purpose: The purpose of this study was to identify how people 6–12 months after stroke were using and integrating information and communication technology (ICT) in their everyday lives. Method: To capture the participants’ experiences, one focus group and 14 individual interviews were carried out in Sweden and Denmark regarding the use of ICT in everyday life. The participants comprised 11 men and seven women aged 41–79 years. A grounded theory approach was used throughout the study and a constant comparative method was used in the analysis. Results: Five categories were identified from the analysis of the interviews with the participants: 1) Using the mobile phone to feel safe, 2) Staying connected with others, 3) Recreating everyday life, 4) A tool for managing everyday life, and 5) Overcoming obstacles for using ICT. From these categories one core category emerged: The drive to integrate ICT in everyday life after stroke. Conclusions: People with stroke had a strong drive to integrate ICT in order to manage and bring meaning to their everyday lives, although sometimes they needed support and adaptations. It is not only possible but also necessary to start using ICT in rehabilitation in order to support people’s recovery and promote participation in everyday life after stroke. Implications for rehabilitation People with stroke have a strong drive for using information and communication technology in their everyday lives, although support and adaptations are needed.The recovery process of people with stroke could benefit from the use of ICT in the rehabilitation and ICT could possibly contribute to independence and promote participation in everyday life.Knowledge from this study can be used in the development of an ICT-based stroke rehabilitation model.

Objective: To describe and understand the lived experience and to identify what characterizes the phenomenon of participation in everyday occupations after stroke, in Tehran, Iran. Methods: Eight individuals with stroke, who had previously been admitted to a neurological hospital ward in Tehran, were interviewed in-depth on one occasion. Data were collected and analysed using the Empirical, Phenomenological, Psychological method. Results: The findings identified 3 main characteristics of the phenomenon of participation in everyday occupations as being: (i) I cannot do activities as before; (ii) I am not the same person – discovery of a different self; (iii) I am not living my life. Conclusion: Enabling participation after stroke within a client-centred paradigm in this socio-cultural context requires consideration of the essential meaning of this concept as characterized by the dynamic process between the characteristics of “doing”, “identity”, and “living life”. The study highlights how the provision of efficient rehabilitation services in this Eastern context requires attention to both “doing” and to “identity” in rehabilitation interventions, in order to enable individuals to adapt to their new lives after stroke and to “live their lives”.

Aim The aim of this study was to describe the experiences and meaning of using mobile phones in everyday life after stroke, among persons with stroke and their family members. Methods Qualitative semi-structured interviews were conducted among 11 persons with stroke and 9 family members 2 months to 2 years after the stroke. The interviews were analysed by using constant comparative grounded theory (GT) approach. Results Seven categories were identified from the analysis of the participants' experiences. The mobile phone: (1) as an enabler of communication and connections with other people, (2) a source of inspiration for agency, (3) structuring routine and activities in daily life, (4) as a facilitator of social and economic wellbeing of an individual or family, (5) promoter of belonging and participation in social relationships, (6) facilitator of reintegration to community living and (7) enabler of family members to feel secure. From these categories, a core category emerged: The mobile phone as a "life line" and an extension of the body enabling connection, belonging and agency to act in a complex everyday life situation. Conclusion The study gives support for the possibility of using mobile phones to facilitate change and community integration in the rehabilitation process after stroke. Implications for Rehabilitation Stroke leads to decreased functioning in everyday life due to impairments, activity limitations and participation restrictions as well caregiver burden. Mobile phones seem to be an accessible and affordable technology used in daily life of persons with stroke and family members and connects them to the needed services and social relationships. The mobile phone technology reduces resource and infrastructural challenges and increases accessibility to rehabilitation interventions. The mobile phone was an important instrument that facilitated the quality of life of persons with stroke and their family members and could increase their participation in rehabilitation interventions.

Aims and obkectives: To examine eating difficulties among stroke patients - a comparison between women and men.Background: Gender differences have been reported in studies of stroke, but the findin ...

Aim: This paper is a report of a study comparing eating difficulties among patients 3 months after stroke in relation to the acute phase.Background: There is limited knowledge of patients with eati ...

The objective of this study was to psychometrically evaluate the Persian version of the Occupational Gaps Questionnaire (OGQ-P) and LiSat-11 checklist, and to describe occupational gaps after stroke and their relation to aspects of functioning and perceived life satisfaction. A total of 102 individuals who had experienced a stroke were assessed for their occupational gaps, aspects of functioning, and life satisfaction. Psychometric analyses of the Persian versions of the OGQ and LiSat-11 were completed and the measures were applied for using univariate and multivariate analyses. The results provided evidence of internal scale validity, person response validity, and sensitivity for the instruments. The participants perceived the most common occupational gaps in “helping and supporting others.” Furthermore, perceived physical function including activities of daily living ability, motor function, and perceived life satisfaction were the most influential variables for the prediction of occupational gaps. It is essential to address the occupations such as “helping and supporting others” that are important from an individual perspective but overlooked in rehabilitation. A combination of physical function, motor function, and life satisfaction can predict occupational gaps after stroke.

THE study's rationale: Eating difficulties are common after stroke. However, to better meet individuals' needs, in terms of care, support and rehabilitation after stroke, it was considered importan ...

Actions link meaning to particular places over time. This study examined how familiar places, in turn, inspired or influenced actions in the rehabilitation process for individuals who had experienced stroke. The aim of this study was to describe the meanings of actions in different places during 1 year of rehabilitation after stroke. The interview data were longitudinal and collected on four occasions during the first year after stroke (e.g., at 1, 3, 6, and 12 months). Seven categories emerged from the data analysis using a constant comparative method: (1) workplace in mind, (2) experiences at home enabling reflection, (3) rehabilitation setting creates uncertainty, (4) retrieving inspiration from familiar places, (5) matching the complexity of tasks across places, (6) understanding the reality by confrontation, and (7) on the way to place integration. From these themes, a core or overarching theme emerged: the desire for place integration inspires engagement in rehabilitation. The central finding in this study revealed a strong relationship between the desire to be reintegrated into familiar places, such as work and home, and motivation to engage in rehabilitation. Further, this desire for place integration was a constant driving force over the year that motivated the participants to find activities on their own that matched the task demands at their workplaces.

The aim of the study was to evaluate the effect of client-centred, self-care intervention (CCSCI) on (i) activities of daily living (ADL) and life satisfaction in persons with stroke, (ii) caregiver burden, use of informal care and home-help services, and (iii) the feasibility of the study design.Randomized controlled trial, a pilot study of an intervention group (IG) receiving CCSCI or a control group (CG) receiving ordinary training.Forty persons with stroke (IG n = 19, CG n = 21) were included: non-demented, able to follow instructions, dependent regarding self-care and referred for rehabilitation, and their significant others (IG n = 8, CG n = 8).Data were collected at baseline and three months later using established instruments regarding ADL, life satisfaction, caregiver burden, and use of health services from medical records, the county register, and by interviews.There were no differences in ADL, life satisfaction, caregiver burden, or use of services at three months. Both groups improved significantly and clinically important improvements were achieved by 86% in IG and 63% in CG.The CCSCI appears promising for the recapturing of self-care after stroke and a large randomized controlled trial is warranted, in which the present design and methods with some modification will be feasible.

To explore the experience and management of eating situations among persons affected by stroke, 6 months after stroke onset.A qualitative constant comparative approach, influenced by principles of grounded theory, was used to analyse the interviews. Thirteen participants were interviewed in the home setting 6 months after the stroke.Experiences and desire to master eating situations varied, and was related to values and previous habits. Eating difficulties were experienced as disgusting, uncomfortable, strenuous, or unproblematic and not implying shame. Getting help from others could be experienced as embarrassing and undesirable. In particular, eating could be more difficult when eating in company of unfamiliar people. The participants found new ways of mastering eating situations. Some had regained former routines.Old values and habits and/or involvement of other people were the basis of mastering eating situations. New ways of mastering were found, some accepted, and got used to the new situation. Some regained former routines. This knowledge could contribute to health care personnel's awareness of each patient's individual values and previous habits during the rehabilitation process. A dialogue is needed with the person suffering from eating difficulties after stroke, to help create the best possible individual conditions for mastering eating situations.

This phenomenological study explored and described the lived experience of falls self-efficacy (i.e., perceived self-efficacy in avoiding a fall during basic activities of daily living) among six individuals with multiple sclerosis and its relationship to their overall volition and occupational lives. Participants were interviewed three times over a 3-month period. All interviews were analyzed using the Empirical, Phenomenological, Psychological method. One main theme (managing fall risk as a means of supporting activity) and six subthemes were reflected in participants' lived experiences: (1) understanding personal multiple sclerosis symptoms, abilities, and fall risk; (2) accepting one's changed capacity; (3) focusing on what you can control; (4) ongoing learning by doing; (5) vigilance while doing; and (6) taking personal responsibility to reduce fall risk. The findings show how falls self-efficacy operates as part of a larger volitional process and can be used to inform the development of fall prevention programs for individuals living with multiple sclerosis.

This longitudinal study identified how occupational gaps were characterized in people's lived experiences of performing everyday occupations during the first year after stroke. Four participants were interviewed four times during the year after stroke. The data were collected and analyzed using the Empirical, Phenomenological, Psychological method. Five main characteristics were identified: (1) encountering occupational gaps in formerly taken-for-granted activities, (2) striving to narrow gaps in desired occupations, (3) recognizing oneself in doing, (4) searching for a new sense of self through doing, and (5) creating strategies to enable doing. The findings show the importance of being able to preserve some sense of self in everyday doings after a life course disruption caused by stroke. Important implications for clinical practice include sensitivity to clients' experiences during this process, enablement of experiences in occupations promoting recognition, and support of clients in recapturing desired occupations.

This study identifies the meaning of context in recapturing self-care after a stroke or spinal cord injury (SCI). Recapturing denotes the process of engaging in self-care to regain the ability to participate in self-care activities. Five people who had had a stroke and 6 people with SCI were interviewed 1–3 months after onset. The interviews were open ended and transcribed verbatim. They were analyzed by using the empirical, phenomenological, psychological method, which identified 6 main characteristics describing the role of context in recapturing self-care: (1) support from others, (2) an air of expectation, (3) extended time, (4) new daily structure, (5) therapeutic relationship as enabling possibility, and (6) gradual change in challenge. These findings showed that rehabilitation professionals play an important role in creating a context that contributes to recapturing self-care by allowing extended time, enabling patients to see possibilities, and creating expectations for them to do things on their own.

The aim of this study was to determine internal scale validity and reliability of P-Drive on-road by observing driving performance among people with neurological disorders. The study comprised a consecutive sample of 205 persons with stroke, dementia, or mild cognitive impairment who were remitted for and performed a standardized test in real traffic. Their driving abilities were evaluated with a new assessment tool, P-Drive on-road. Aspects of validity and reliability of the tool were analyzed using a Rasch rating scale model. The results indicated that the rating scale functioned as intended and a principal component analysis indicated that the items formed a unidimensional scale. Acceptable levels of person response validity were found and the scale was also able to distinguish between the abilities of the drivers with a person separation reliability of 0.90. The results indicate that P-Drive on-road is valid and reliable for producing a linear measure of driving ability in people with stroke, dementia and mild cognitive impairment, and has the potential to become a clinically useful assessment tool for on-road driving tests.

This study sought to identify the characteristics of the lived experience of recapturing self-care after a stroke or a spinal cord injury (SCI). Five people who had had a stroke and six with SCI who were in the midst of recapturing self-care (1–3 months after onset) were interviewed. All interviews were analyzed using the Empirical, Phenomenological, and Psychological method. Four main characteristics were present among all of the participants’ lived experiences: (a) becoming familiar with the new body, (b) recapturing self-care through trying, (c) reclaiming control, and (d) feeling uncertainty in the continued recapturing process. The findings indicate that a prerequisite for recapturing self-care was to get experience from doing to become familiar with the new body, which makes explicit the importance of enabling self-care in the rehabilitation process after stroke or SCI. The findings can be used in clinical practice to improve the understanding of how to better plan individualized self-care intervention.

Objective: Compare caregiver burden, provision of informal care, participation in everyday occupations and life satisfaction of caregivers to people with stroke, who either had received a client-centred, activities of daily living intervention or usual activities of daily living interventions. Design: A multicentre cluster randomized controlled trial in which 16 rehabilitation units were randomly assigned to deliver a client-centred, activities of daily living intervention or usual activities of daily living interventions. Caregiver outcomes were compared cross-sectionally at 12 months and changes in outcomes between three and 12 months after people with stroke were included in the study. Setting: Inpatient and outpatient rehabilitation. Participants: Caregivers of people with stroke enrolled in the trial. Intervention: A client-centred, activities of daily living intervention aiming to increase agency in daily activities and participation in everyday life for people after stroke. Main measures: Caregiver Burden Scale, Occupational Gaps Questionnaire, LiSat-11. Results: There were no differences in outcomes between caregivers in the client-centred, activities of daily living ( n = 88) and the usual activities of daily living ( n = 95) group at 12 months. The caregiver burden score was 42.7 vs. 41.8, p = 0.75, mean occupational gaps were 3.5 vs. 4.0, p = 0.52 and satisfaction with life was 53% vs. 50%, p = 0.87. There were no differences in changes between three and 12 months. However, within groups there were significant differences in caregiver burden, factor general strain, for caregivers in the client-centred, activities of daily living group, and in provision of informal care for the usual activities of daily living group. Conclusion: The client-centred intervention did not bring about any difference between caregiver-groups, but within groups some difference was found for caregiver burden and informal care.

Background Long-term disability following stroke can lead to participation restrictions in complex and social everyday activities, yet information is lacking on to what extent stroke survivors return to their pre-stroke levels of participation. Objectives The objectives of this study were to investigate the level of participation in complex and social everyday activities 6 years after stroke, to compare this with pre-stroke participation and to identify predictors of returning to pre-stroke levels of participation. Method All patients admitted to Karolinska University Hospital's stroke units during a 1-year period were eligible to participate and 349 patients were recruited. Assessments were made at base-line, 3 months and 6 years using self-reported outcome measures. Participation was assessed using the Frenchay Activities Index (FAI). The 6-year score for each participant was compared to the pre-stroke score, both for the total score and for each domain (domestic chores, leisure/work and outdoor activities). Predictors of having the same or better level of participation at 6 years were identified using logistic regression. Results At 6 years, 121 participants were followed up, 166 were deceased, 44 declined to take part and 18 could not be traced. At 6 years 84% could be described as active (FAI≥15). The same level of participation or better than pre-stroke was found in 35% of participants, in 65% the level was lower. Similar predictors were identified for achieving the same or better level of participation at 6 years for FAI total and the three domains; ability to walk without aids and a lower age at stroke onset, and perceived mobility, participation and recovery at 3 months. Conclusion Six years after stroke, 35% of participants had the same or better level of participation as pre-stroke. Rehabilitation after stroke to improve walking ability and participation might improve long-term participation in complex and social everyday activities.

PURPOSE. Research in the field of brain injury rehabilitation has tended to regard return to work as a measure of outcome. Researchers have not paid particular attention to the experiences of people living with a brain injury. The aim of the phenomenological study reported here was to identify and describe what characterizes the meaning of work to those with acquired brain injury. METHODS. Ten participants of working age were interviewed about the meaning of work 1–5 years after being inflicted with a brain injury. Data were analyzed and interpreted using the Empirical Phenomenological Psychological method. RESULTS. The findings revealed a meaning structure consisting of four main characteristics. Work was no longer experienced as the primary event in life and the social dimension had become more important. The perceived competence and work identity were threatened after the injury. A common theme across all interviews was the struggle to return to a state of normality, and working was considered to be evidence of success. CONCLUSION. The findings described the altered meaning of work 1–5 years after brain injury. This knowledge should lead to an increased understanding among occupational therapists engaged in work rehabilitation after brain injury and can serve as a basis for individualized intervention strategies.

The objective of this survey was to identify couples' joint perception of their satisfaction with life as a whole when one of the persons in the couple had acquired brain injury between one and five years earlier. The focus was on the influence that functioning and disability in everyday life have on the couple's joint life satisfaction after brain injury. The sample consisted of 55 couples, and the mean age of the brain-injured persons was 51 years. Both persons in the couple answered a mailed questionnaire encompassing questions concerning perceived impairments, activity limitations, participation restrictions, and life satisfaction. The results showed that in 16 of the 55 couples both partners were satisfied with life as a whole. The joint experience of life satisfaction was significantly related to the couple's functioning in everyday life, and specifically to perceived participation in leisure time and in their social life, and in their ability to wash clothes. Important implications from this study, showing that only one-third of the couples were satisfied, are that the partners should be included to a greater extent in the rehabilitation process and the couple's perspective of what they find difficult to deal with should serve as a guide during rehabilitation.

As it develops, an ageing society has increased need of services that can promote the health and well-being of the elderly. Community-based day programmes are one kind of service intended to support elderly people with restricted function in their daily lives. There are several different forms of day programmes for the elderly in Sweden, but guidelines are vague about their aim and implementation and little is known about the persons using them. The aim of this study was to identify characteristics of the elderly people living in their own home who participated in social day centres in comparison with participants who attended a rehabilitative day centre. The focus was on perceived functioning and competence in daily life. Twelve social day centre participants and 12 rehabilitative day centre participants answered two questionnaires, the sickness impact profile (SIP) and occupational self-assessment (OSA). The results show that the majority of participants from both centres were elderly persons living alone who experienced severely restricted physical function. This demonstrates that the day centres serve the needs of a specific group of elderly people, namely, those with highly restricted functioning living on their own. A significant difference between the groups was that those who attended the social day centre perceived better psychosocial function than the group attending the rehabilitative centre. The fact that the social centre group had better psychosocial function than the other group, but yet had severely restricted physical function indicates that it is preferably the psychosocial well-being of elderly persons with restricted functioning that is possible to influence. This result implies that these centres serve as an important meeting place for elderly persons who would otherwise be isolated in their homes because of their physical restrictions. To fulfil this challenge, the day centres might need to accommodate a wider range of persons with restricted functioning.

Objective: The Baking Tray Task is a comprehensible, simple-to-perform test for use in assessing unilateral neglect. The aim of this study was to validate further its use with stroke patients. Methods: The Baking Tray Task was compared with 2 versions of the Behaviour Inattention Test and a test for personal neglect. A total of 270 patients were subjected to a 3-item version of the Behaviour Inattention Test and 40 patients were subjected to an 8-item version of the Behaviour Inattention Test, besides the Baking Tray Task and the personal neglect test. Results: The Baking Tray Task was more sensitive than the 3-item Behaviour Inattention Test, but the 8-item Behaviour Inattention Test was more sensitive than the Baking Tray Task. The best combination of any 3 tests was Baking Tray Task, Reading an article, and Figure copying; the 2 lastmentioned being a part of the 8-item Behaviour Inattention Test. Conclusion: Multi-item tests detect more cases of neglect than do single tests. However, it is tiresome for the patient to undergo a larger test battery than necessary. It is also time-consuming for the staff. Behavioural tests seem more appropriate when assessing neglect. The Baking Tray Task seems to be one of the most sensitive single tests, but its sensitivity can be further enhanced when it is used in combination with other tests.

The purpose was to explore, describe and compare the characteristics of physiotherapy sessions with patients after stroke from two perspectives: the patients' and the physiotherapists', in relation to observed behaviour.A qualitative, descriptive, comparative approach was used. Nine patients and 10 physiotherapists participated. Data from observations and semi-structured interviews were used.Six themes were identified: setting and attaining goals, focusing on motor activity, finding the optimal training strategy, facilitating active patient involvement, making use of environmental factors and adjusting to the structural reorganization of the rehabilitation services. The physiotherapists and the patients made similar descriptions in some of the themes but differed in some. The physiotherapists expressed what they perceived to be their lack of scientific knowledge, while the patients trusted their physiotherapists' competence. The physiotherapists wanted to take the patients' personal experiences into account in the sessions, which was not obvious to the patients.Differences in physiotherapists' and patients' descriptions of characteristics of physiotherapy sessions have to be taken into consideration in the rehabilitation of stroke patients. In order to empower the patient to take a more active part in the rehabilitation process, there is a need to explore how to incorporate the patients' personal experiences and knowledge into the rehabilitation process.

The purpose of this study was to evaluate evidence on the validity of a newly developed assessment tool, P-Drive (Performance Analysis of Driving Ability) intended to measure driving ability in a simulator. P-Drive was made available to a sample of 31 brain-damaged participants. P-Drive consists of 21 items relating to observable driving actions, each of which is scored on a 4-point criterion-referenced rating scale. A Rasch measurement model was used to evaluate whether P-Drive was a valid tool. The results indicated that P-Drive represented one single construct. All the items showed acceptable goodness-of-fit, indicating overall internal scale validity. The hierarchical order of the items in P-Drive was in agreement with the theories concerning driving ability after acquired brain injury, providing further evidence of validity. The participants also demonstrated acceptable levels of goodness-of-fit, indicating person response validity. The study indicates that the results for different aspects of the va...

This study examines how persons with visuospatial agnosia following stroke experience their interaction with the physical environment in everyday occupations. Eight clients with cerebrovascular les...

OBJECTIVE. The purpose of this study was to gain an understanding of social environmental influences on occupational experience and performance over the course of rehabilitation of four persons with unilateral neglect. METHODS. The Phenomenological Psychological Method (Karlsson, 1993) was used to gather and analyze qualitative data on four women over a 4-month period. Four women were interviewed five to seven times each and observed during their rehabilitation process. Analysis focused on how these persons with unilateral neglect experienced and responded to their interactions with others in their everyday lives. FINDINGS. As perceived by the study participants, rehabilitation professionals and relatives demonstrated a sequence of strategies for dealing with and helping the women perform despite their unilateral neglect. The sequence of strategies reflects the changing experience of neglect over time. The strategies used by professionals and family members during the rehabilitation process enabled these women to reclaim and occupy the neglected half of the world. Moreover, the women with neglect learned to incorporate others as extensions of their bodies in order to compensate for their ongoing inability to directly experience the left half of the world. CONCLUSION. The results suggest that it is important for others (e.g., therapists, nurses, or relatives) to understand the client’s changing experience of neglect and adjust their support and collaboration accordingly. Occupational therapy intervention for persons with neglect could potentially become more effective by systematically incorporating the kinds of strategies identified in this study. Moreover, therapists could consult with others to increase their understanding and effectiveness in interacting with persons who have unilateral neglect.

This study examined the phenomenon ?what are occupational therapists doing when they feel competent?. Data were provided by eleven occupational therapists who narrated clinical cases in which they had felt themselves to be competent. The empirical phenomenological psychological (EPP) method was used to analyse and interpret the data. The result revealed that on a general level the experience of feeling competent as an occupational therapist derived from achieving results in the rehabilitation project that were satisfying for both participants (the therapist and the client). The strategies for accomplishing this were related to the empathic competence of the therapists. This competence involved interpreting clinical situations as well as understanding the relationship between motive, meaning, decision and time. Further it involved bringing objects, in the form of adaptations, technical aids, structures, simplifications or compensations, into the clinical situation. These abilities together had a great impa...

To compare the effects of a video procedure and a conventional verbal procedure in giving patients feedback on their neglect behavior in a practical task.Subjects in group A were trained with a video feedback procedure and subjects in group B with a conventional, verbal procedure. Three hours after the procedures, the subjects were tested with four different neglect tests to evaluate the effects of training.A consecutive series of 14 right-brain-damaged patients with moderate to severe unilateral neglect (UN): 7 patients in group A and 7 in group B.Subjects in group A were given the opportunity to see their performances on video, directly after the performance of the "Baking Tray Task" (BTT). They could see their neglected left side on the right side of the TV monitor. Subjects in group B were given verbal and visual guidance to see their results in the BTT.Line Cancellation Task, Figure Copying Task, Line Bisection, and BTT before and after procedures.The video feedback group improved significantly in the BTT, as tested 3 hours after training (p.02). Conventional training had no effect on the BTT or on the other neglect measures. In the video feedback group, no generalization effects from the videotaped BTT on other neglect tests were observed.Video feedback seems to be a useful technique in the rehabilitation of patients with unilateral neglect.

The purpose of this study was to explore and describe the motivation for training, in four persons with unilateral neglect, who participated in an intervention study aiming to improve sustained attention. Data about the participantsÆ motivation was collected through observations and semi-structured interviews based on the terms used in the volitional subsystem in The Model of Human Occupation. Findings show that the four personsÆ awareness of their own disabilities influenced their motivation toward training and that they sometimes overvalued their own capacities, especially concerning activities they had not practiced since before the stroke. This report concludes with a discussion on the implications of the study on occupational therapy practice.

A goal for rehabilitation after stroke is to regain the ability to manage activities of daily living (ADL). The Swedish health care legislation recognizes that individuals bring unique sets of needs and preferences to encounters with the health care system, which should impact the services delivered. Consequently rehabilitation needs to be designed to meet each individual’s concern i.e., be client-centered. This implies interventions tailored to the client’s ability and perceived needs, services that take the client’s unique life-world experiences as the point of departure for goals and collaboration during the rehabilitation. However, studies on such services are scarce. Thus the aim was to compare a client-centered ADL intervention (CADL) to usual ADL training (UADL) regarding perceived participation, independence in ADL and life satisfaction at 3 months after inclusion. Methods: Sixteen rehabilitation units in Stockholm, Uppsala and Gävleborg, Sweden were randomly assigned to deliver either CADL or UADL to people in need of ADL rehabilitation after stroke. The occupational therapists (OT) who delivered the CADL were specifically trained. At 3 months perceived participation was assessed with the Stroke impact scale (SIS) and the Occupational Gaps questionnaire (OGQ), self-reported dependence in ADL with the Barthel Index (BI) and the Katz Extended ADL Index (KE), and life satisfaction with the LiSat-11. Number of contacts with an OT was collected in the clients’ medical records. Intention-to-treat analysis was applied. The significance level was set to 0.05. ClinicalTrials.gov identifier: NCT01417585 . Results: Two hundred and eighty persons with stroke were included (CADL n=126, UADL n=154). The mean number of OT sessions in the CADL was 19 and 14 in the UADL group. There were no differences regarding SIS (p=0.64), OGQ (p=0.15), BI (p=0.06), KE (p=0.78) or in LiSat-11 (p=0.77). Conclusion: Albeit people with stroke who receive CADL tend to be more independent in ADL at 3 months it is likely that differences in perceived participation and life satisfaction will not be present until later. Thus there is a need to evaluate such services in the long term, their impact on significant others and qualitative studies of the clients’ experiences.

BACKGROUND AND OBJECTIVE: To a large extent, people who have suffered a stroke report unmet needs for rehabilitation. The purpose of this study was to explore aspects of rehabilitation provision that potentially contribute to self-reported met needs for rehabilitation 12 months after stroke with consideration also to severity of stroke.METHODS: The participants (n = 173) received care at the stroke units at the Karolinska University Hospital, Sweden. Using a questionnaire, the dependent variable, self-reported met needs for rehabilitation, was collected at 12 months after stroke. The independent variables were four aspects of rehabilitation provision based on data retrieved from registers and structured according to four aspects: amount of rehabilitation, service level (day care rehabilitation, primary care rehabilitation and home-based rehabilitation), operator level (physiotherapist, occupational therapist, speech therapist) and time after stroke onset. Multivariate logistic regression analyses regarding the aspects of rehabilitation were performed for the participants who were divided into three groups based on stroke severity at onset.RESULTS: Participants with moderate/severe stroke who had seen a physiotherapist at least once during each of the 1st, 2nd and 3rd-4th quarters of the first year (OR 8.36, CI 1.40-49.88 P = 0.020) were more likely to report met rehabilitation needs.CONCLUSION: For people with moderate/severe stroke, continuity in rehabilitation (preferably physiotherapy) during the first year after stroke seems to be associated with self-reported met needs for rehabilitation.

This paper describes a new neglect test, where patients are asked to spread out 16 cubes as evenly as possible over a 75 × 100 cm board "as if they were buns on a baking tray". A consecutive series of 52 brain-damaged patients and 30 control subjects were examined with the new test as well as with several commonly used neglect tests. The baking tray task proved to be a quick and yet sensitive test, suitable for screening purposes and longitudinal studies.

The purpose of this study was to explore and describe the motivation for training, in four persons with unilateral neglect, who participated in an intervention study aiming to improve sustained attention. Data about the participantsAE motivation was collected through observations and semi-structured interviews based on the terms used in the volitional subsystem in The Model of Human Occupation. Findings show that the four personsAE awareness of their own disabilities influenced their motivation toward training and that they sometimes overvalued their own capacities, especially concerning activities they had not practiced since before the stroke. This report concludes with a discussion on the implications of the study on occupational therapy practice.

The aim of this study was to validate the Occupational Gaps Questionnaire (OGQ) when used in samples of people with acquired brain injuries (ABI), stroke, stress-related disorders, concussion, and persons receiving rehabilitation after ABI to investigate whether the OGQ could be used as a generic scale. A total of 601 individuals answered the OGQ at various time points after illness/injury. A Rasch analysis was performed on the data to evaluate evidence of internal scale validity and person response validity, and the capability of the OGQ to separate people into different levels of participation in everyday occupations. The results provided evidence that the OGQ is a valid measure across different diagnostic groups. A generic version of the OGQ can separate at least two levels of perceived occupational gaps and is therefore recommended as a screening tool to be used by occupational therapists working with different diagnostic groups.

The aim of this study was to describe occupational therapists' expectations and experiences of integrating a new intervention programme within an RCT pilot study, in collaboration with a researcher.Six occupational therapists participated in a five-day training course (during a one-month period) including lectures, reading articles, and discussions. The data were collected through interviews and written reflections, analysed by a qualitative constant comparative approach.The findings displayed a process of change, primarily in the participants' way of integrating research in their clinical practice. Three main categories were identified as: hope of taking part in a research project, confirmation of anchoring, and experience of scepticism. These categories constituted the core category "The occupational therapist's process of integrating research in a clinical context with the prerequisite being a dialogue and a sharing of responsibility and authority between researcher and occupational therapist". A tentative model was formulated which described how the various categories were related to one another as well as how change occurred over time in the context in which the study was carried out.One conclusion is the importance of providing opportunities for creating dialogues among researcher and practitioners to narrowing the gap between research and "everyday practice of occupational therapy".