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Objective: The aim of this study was to evaluate the psychometric properties of the Assessment of Awareness of Disability (AAD), applied to a sample of clients with a variety of diagnoses, using two different Rasch models. Methods: The sample consisted of 245 clients admitted to occupational therapy services in Sweden. The psychometric properties of the AAD measures were analysed and compared using both Rasch partial credit (PCM) and rating scale (RSM) models. Results: In relation to rating scale properties and person response validity, the RSM yielded better results. However, the PCM demonstrated better item goodness-of-fit statistics than the RSM, supporting the internal scale validity of the AAD. Some systematic indications of sample-dependent misfit were also found in the data. Conclusion: The results support the validity of the AAD in a sample of clients with various diagnoses, although some limitations of the tool are addressed. The outcomes also demonstrate the importance of making cautious choices when selecting a Rasch model for investigating psychometric properties, as the choice has a substantial impact on the interpretation of the findings.

Objective: To investigate longitudinal impacts of home modifications on the difficulty of performing everyday life tasks for people aging with disabilities, and to investigate whether other factors had any additional impacts on difficulty in everyday life tasks for people receiving home modifications. Methods: The sample consisted of 103 persons aging with disabilities and in need of home modifications, divided into an intervention group and a comparison group. The data were first subjected to Rasch analysis and a random coefficient model was used. Results: Participants in the intervention group reported a significantly lower level of difficulty in everyday life tasks compared with those in the comparison group. One confounding factor, number of months waiting for home modification, had an impact on difficulty in everyday life. Conclusion: Home modifications are effective in decreasing difficulty in performing everyday life tasks up to six months after the installation. Furthermore, to be effective home modifications need to be installed in a timely fashion. For each consecutive month the person waited for their home modification the difficulty of performing everyday life tasks increased. Therefore, it is important that home modifications be installed as soon as possible after the need has been identified.

The overall aim of this study was to evaluate the validity of the Assessment of Awareness of Ability (A3) in a Japanese context. The A3 (formerly known as the Assessment of Awareness of Disability, AAD) is a standardized 11-question interview used to explore the discrepancy between observed strengths and limitations in the performance of activities of daily living (ADL) according to the Assessment of Motor and Process Skills (AMPS) and the limitations described by the client. In this study, 259 matched Swedish and Japanese A3 data records were analyzed using a Rasch partial credit model (PCM). The analysis of rater consistency and items demonstrated acceptable goodness-of-fit according to the PCM, indicating rater consistency and internal scale validity. The A3 can help clients and therapists understand discrepancies between observed and self-reported performance aspects of various everyday tasks within Japanese and Swedish contexts.

Objective: To explore and describe the leisure repertoire of persons with traumatic spinal cord injury (SCI) and how the repertoire is related to interest, performance, and well-being. Design: Cross-sectional study. Setting: A total of 97 persons with traumatic SCI were recruited from the non-profit national organization, RG Active Rehabilitation in Sweden. Outcome measure: Data were collected through a two-part postal survey. The first comprised of questions investigating socio-demographic variables and injury characteristics; the second part included an interest checklist with 20 areas of leisure activities. Results: The participants were mostly interested in, performed, and experienced well-being from social and culture activities and TV/DVD/movies. The areas of leisure activities in which they had most likely experienced changes after the SCI were outdoor activities, exercise, and gardening. Sex, age, and to some extent, time since injury were related to interest, performance, well-being, and changed performance. Conclusions: The results provided an explanation and limited description of a changed leisure repertoire among persons after a traumatic SCI. The study showed that sex, age, and time since injury were more closely related to the choice of leisure activities to include in the leisure repertoire than the level of injury. This knowledge can be of importance when professionals in the field of rehabilitation are planning and implementing interventions concerning leisure activities for persons with SCI.

The general aim of this thesis was to increase knowledge about the impact of homemodifications (HMs) on aspects of everyday life tasks among older adults living withdisability. The thesis also aimed to further develop an instrument assessing ability to performeveryday life tasks and to explore and describe experiences of safety and security in everydaylife after home modifications. This thesis included four studies. In Study I the psychometric properties of the Client-Clinician Assessment Protocol (C-CAP) Part I used on older adults in need of HM wereinvestigated using Rasch rating scale model. The C-CAP Part I collects data on self-ratedindependence, difficulty and safety in everyday life tasks. In Studies II and III the C-CAPPart I was used to investigate perceived ability to perform everyday life tasks after HM, usinga pre-post test design with an intervention and a comparison group. In Study II changes ineveryday life tasks after HM were investigated using data from baseline and a two-monthfollow-up. Then in Study III a mixed methods analysis was applied, investigating perceiveddifficulty in everyday life tasks and confounding factors influencing perceived difficulty up tosix months after HM. In Study IV qualitative interviews were conducted with eight olderadults, based on a grounded theory approach focusing on safety and security in everyday lifetasks after HM. The interviews were analyzed using a comparative method in combinationwith a hermeneutic interpretation. The findings in Study I showed that the three scales in C-CAP Part I had both strengthsand limitations when used on older adults in need of HM. The difficulty scale showedacceptable internal scale validity, person response validity, and person separation reliability,whereas the independence scale did not show internal scale validity and the safety scaleshowed a low person separation reliability. In Studies II and III the results showed thatpersons receiving HM perceived their ability to perform every