The impact of a soft robotic glove on activity performance and body function for brachial plexus birth injury patients-A longitudinal case series.

BACKGROUND: A brachial plexus birth injury (BPBI) can cause reduced ability to use the arm and hand in daily activities due to reduced grip strength and endurance. A soft robotic glove can increase the number of activities performed and improve activity performance for patients with neurological disease. The use of a soft robotic glove for patients with BPBI has not been studied. PURPOSE: To investigate if a soft robotic glove can improve activity performance and body function for patients with BPBI. STUDY DESIGN: Longitudinal Case Series. METHODS: A convenience sample of patients with BPBI, treated by the Brachial plexus injury service in Umeå, Sweden were studied. Eight patients used a soft robotic glove, (Carbonhand®), at home for three months. Data on activity performance and satisfaction with activity performance, active range of motion and strength were collected at baseline, and at three and four months. A patient evaluation form was filled out at three months, all patients kept a diary for three out of 12 weeks. RESULTS: Six out of eight patients wanted to continue using the device and improved their self-perception of activity performance and satisfaction with the performance due to a more secure grip, compared to when not using the device. All patients had improved maximum strength and endurance in elbow flexion at three months. The device was useful as an assisting device and as a training tool. CONCLUSION: A soft robotic glove (Carbonhand) may improve activity performance and perceived satisfaction and increase the number of activities that a person with BPBI can perform in everyday life. It is possible to increase strength in elbow flexion after using such a device. Due to this limited material, more research is needed.

Work Potential and Work Performance during the First Try-Out of the Person-Centred Return to Work Rehabilitation Programme ReWork-Stroke: A Case Study.

BACKGROUND: This case study explores changes in work potential and work performance for ten people who worked before their stroke while participating in the ReWork-Stroke programme. It describes measures performed by the occupational therapists to enhance work potential and work performance and the participants' level of work re-entry nine months after the start of their work trial. METHODS: Ten people who had experienced a mild or moderate stroke participated. Changes were assessed using the Worker Role Interview and the Assessment of Work Performance. Logbooks relating to work potential and work performance were analysed using content analysis. RESULTS: The participants' work potential was in general supportive to returning to work at baseline and remained so at the three-month follow-up. Most changes occurred in the environmental factors regarding the participants' belief that adaptations at the workplace would make re-entry possible. Changes concerning work performance were predominately in a positive direction. Seven of the participants returned to paid work. CONCLUSION: The ReWork-Stroke programme seems promising for promoting changes in work potential, work performance, and return to paid work. However, further studies are needed to evaluate changes in work potential and work performance and the programme's effectiveness for increasing work re-entry for people who have had stroke.

Collaboration in work ability assessment for sick-listed persons in primary healthcare.

BACKGROUND: General practitioners (GPs) have expressed difficulties in issuing sickness certificates and problems may arise if this work is not performed in an adequate manner. There is scant knowledge about how collaboration with other professions could be organized to enhance this work. OBJECTIVE: Evaluate the feasibility of occupational therapists (OTs) performing supplementary assessments for persons on sick leave. METHODS: Four healthcare centres (HCs) tested a working approach intervention where sick-listed patients were offered a complementary occupational therapy assessment. The OT assessments were intended to provide useful information for GP issued extended sickness certificates. Data on sick leave, sickness certificates and patient questionnaires were collected at different HCs. Interviews were conducted with GPs and OTs and the Consolidated Framework for Implementation Research was used to analyse the intervention's implementation. RESULTS: No major differences in the sickness certificate quality was found. Available data on sick leave increased for all HCs during the project. Not all GPs used the OT assessments, which indicates that the implementation of the intervention was insufficient. CONCLUSION: Testing a new working approach in primary healthcare requires an implementation strategy. To improve sickness certification quality, this work needs to be prioritized as an important healthcare task.

Quality in sickness certificates in a Swedish social security system perspective.

AIM: In Sweden, the information in the sickness certificate is crucially important for the sick-listed person as well as for the Swedish Social Insurance Agency and the sick-listed person's employer. The certificate is used as the basis for deciding whether a person is entitled to sickness benefits. Further, it communicates information significant for the return-to-work process. The aim of the study was to evaluate the quality of sickness certificates issued in primary health care and examine if the patients' or physicians' gender influences the information in the sickness certificate. METHODS: An insurance specialist at the Swedish Social Insurance Agency assessed the quality of the stated information in a sample of 323 certificates issued by 146 different general practitioners at 29 different primary health care centres in northern Sweden. RESULTS: Thirty-four percent of the certificates did not contain sufficient information requested. The areas of the certificates in need of supplementary information were mainly the descriptions of impairment of body function and activity limitation. More certificates issued for women than certificates issued for men lacked the required information. Full-time sick leave was more often prescribed for male patients than for female. Significant differences between certificates issued for women and certificates issued for men appeared in the group of musculoskeletal diseases. No differences in quality aspects connected to physicians' gender were found. CONCLUSION: Our study indicates a need for increased knowledge about the descriptions of functioning for sick-listed persons; more cooperation between health professionals in primary health care and a better gender awareness in health care encounters.

Healthcare encounters and return to work: a qualitative study on sick-listed patients' experiences.

BACKGROUND: Sickness absence is a complex phenomenon affected by aspects other than disease. One important factor that can affect sick leave is the individual's experience of healthcare encounters. It is therefore essential to consider the quality of the encounter with health professionals and its impact on the patient's rehabilitation and return to work. AIM: The aim was to explore how sick-listed patients in Sweden perceive their contact with healthcare professionals in primary healthcare and to analyse what they view as crucial components for returning to work. METHODS: A qualitative approach was used. Data were collected by semi-structured telephonic interviews with patients who were or had been on sick leave. The transcribed interview text was analysed according to qualitative content analysis. FINDINGS: The analysis revealed two themes that highlight important areas for persons on sick leave in their healthcare encounters. The theme 'Trust in the relationship' contains categories describing the patients' feelings of participation, and of being believed, confirmed, and listened to, and also dedication on the part of healthcare providers. Healthcare encounters that were characterised by professionalism, knowledge, continuity, and a holistic approach seemed to create trust. The theme 'Structure and balance' contains the participants' views on important factors that could support the return-to-work process. All participants stated the importance of follow-up and a plan for rehabilitation. Sick leave itself can make a person passive, and participants in this study asked for support to balance activity, exercise, and work demands, which could facilitate their return to work. CONCLUSION: Healthcare professionals can facilitate sick-listed persons' rehabilitation back to work by providing a clear structure in the process and support in occupational balance. The healthcare encounters must build on a mutual trust.

Exploring perceptions of occupational competence among participants in Individual Placement and Support (IPS).

OBJECTIVE: The purpose of this study was to explore perceptions of occupational competence and occupational value among a group of clients engaged in Individual Placement and Support (IPS). METHODS: The Occupational Self-Assessment (OSA), based on the Model of Human Occupation, was used with 65 men and women with mental illness, and 45 of these completed the study. RESULTS: Rasch analyses showed that the participants perceived "Managing my finances", "Managing my basic needs", and "Doing activities I like" as the most valued occupations. Most competence was perceived in "Taking care of myself". Among the occupations where the participants perceived least competence, "Getting done what I need to do" and "Accomplishing what I set out to do" were the occupations that most stand out. Significant differences were also found between perceived competence and value in most of the occupations. CONCLUSIONS: Beyond those occupations valued as most important among the participants, it is essential also to pay attention to those in which they perceived least competence, as they are important for being able to achieve a desired occupation. Support related to perceptions of occupational competence can contribute to enabling clients in IPS to master a desired working life.

Predictors of vocational outcomes using individual placement and support for people with mental illness.

OBJECTIVE: People with disabilities find it harder to enter the labour market than people without disabilities and those with a mental illness are, in relation to people with other disabilities, employed at an essentially lower extent. Many are effectively helped by the vocational rehabilitation model Individual Placement and Support (IPS), but there are still many individuals left in undesired unemployment. This study investigates potential predictors of the vocational outcomes of a one-year follow up of IPS in the north of Sweden. PARTICIPANTS: The participants were 65 men and women, mostly younger than 30 years of age diagnosed with a mental illness (predominantly with a diagnosis of anxiety and/or depression). METHODS: Baseline data related to sociodemographic and clinical characteristics of the client, the client's own perceptions of every day living and participation, self-esteem and quality of life, as well as the quantity of employment support, were investigated using analyses of logistic regression. RESULTS: Of three identified potential predictors, only psychiatric symptoms remained significant in the multivariate logistic regression analyses. A lower level of symptoms increased the odds with 5.5 for gaining employment during one year. CONCLUSIONS: Careful investigation of how psychiatric symptoms influence clients' occupational performance is of importance. By understanding essential aspects of the relationships between the clients' individual characteristics, the rehabilitation context and the vocational outcomes, more appropriate and effective interventions may be offered to the individual client.

Work ability as obscure, complex and unique: views of Swedish occupational therapists and physicians.

UNLABELLED: The concept of work ability is not clearly defined although it has a central place in vocational rehabilitation. Several health professions are involved in assessing work ability, physicians and occupational therapists are two of these. OBJECTIVE: The purpose of this study was to explore occupational therapist and physician views about work ability and experiences in assessing work ability. PARTICIPANTS: Fourteen physicians and 23 occupational therapists participated in seven focus group discussions that were audio taped and transcribed verbatim. METHODS: Qualitative content analysis was used. Each author performed an individual preliminary analysis. These analyses were later discussed and refined in the research team and a workshop. The final categorization resulted in one theme, four categories and 13 sub-categories. RESULTS: The overall theme expressed work ability as an obscure, complex and unique concept. The four categories illustrate the affecting factors and confirm the complex structure of work ability: the person, the context of life, the work, and the society. Physicians expressed greater difficulty in assessing work ability than occupational therapists did, because they have fewer instruments to access this concept. CONCLUSIONS: Assessment of work ability requires team cooperation with several different professionals. Cooperation could increase accuracy in issuing sickness certification and strengthens the ability of identifying individual requirements for rehabilitation.

Meeting the needs of elderly with bathing disability.

BACKGROUND/AIMS: Difficulties with bathing are frequent among older people and are associated with an increasing need for societal support. As loss of independence has a negative impact on health and wellbeing, it is important to study interventions that can provide the required support for people to be able to remain independent. Occupational therapy interventions can improve clients' abilities enabling them to bathe themselves, thus reducing the need for other, more long-term societal support from, e.g. a home help. In this study, two groups of elderly people with difficulties in bathing were compared; the clients in the intervention group were engaged in occupational therapy. METHODS: A quasi-experimental non-equivalent control group design was used, in which participants with reported difficulties in bathing were recruited consecutively from two municipalities. The clients in the intervention group routinely received occupational therapy, whereas clients in the control group received assistance from a home help for bathing. Activities of daily living, quality of life and home-help allocation were assessed at the baseline and after 15 weeks. RESULTS: Clients in the intervention group received less than three home visits on average, with majority of interventions consisting of graded activity and the use of an encouraging approach. Seventy per cent of the interventions were adaptive. Activities of daily living and quality of life of both groups improved, but the differences of being allocated a home help were significant. CONCLUSION: Occupational therapy interventions seem beneficial in terms of supporting older people in becoming independent of home help in bathing but the results must be interpreted with caution as there were differences at baseline between the groups.

Perceived participation and problems in participation are determinants of life satisfaction in people with spinal cord injury.

PURPOSE: To determine the relationships between perceived participation and problems in participation, and life satisfaction in people with spinal cord injury (SCI). METHOD: A total of 157 men and women with SCI completed the Swedish versions of the Impact on Participation and Autonomy Questionnaire (IPA) and the Life Satisfaction Questionnaire (LiSat-9). RESULTS: The respondents' perceived participation in the five domains of the IPA was significantly correlated with their satisfaction with life as a whole (P < 0.01) and in most of the eight other domains of life satisfaction (P < 0.05 to P < 0.01) in the LiSat-9. The respondents' life satisfaction decreased gradually with increasing frequency of severe problems in participation and significant differences within groups of increasingly severe problems were found. The level of life satisfaction in respondents that perceived no severe problems with participation was similar to those of a normal population. CONCLUSIONS: Perceived participation and problems in participation are determinants of life satisfaction in people with SCI. The results emphasize the importance to focus on severe problems with participation in order to optimize life satisfaction during the rehabilitation after SCI.

Participation in everyday occupations in a late phase of recovery after brain injury.

The aim of this study was to describe to what extent individuals of working age, in a late phase after an acquired brain injury, participate in everyday occupations related to home maintenance, work, and leisure. The aim was also to evaluate if participation in different occupations influences their life satisfaction. A sample of 157 people consecutively admitted to a rehabilitation clinic between June 1995 and December 2000 answered a mailed questionnaire. The subjects who were of working age had had a brain injury on average 6 years before this study. The perceived participation was reported using the Reintegration to Normal Living Index (RNL) and life satisfaction according to an expanded version of the LiSat 11. This study showed that in this late phase of recovery after brain injury the subjects still experienced many restrictions in participation in everyday occupations. The area with the lowest reported participation was work activity while most comfort with the situation was reported for self-care. The RNL subscales showed a significant connection with satisfaction with life as a whole. Furthermore an interaction was found between the two subscales "Daily living" and "Perception of self". This study showed restrictions in participation in the community even several years after brain injury, which underlines the need for rehabilitation services long after injury.

Impact on participation and autonomy questionnaire: internal scale validity of the Swedish version for use in people with spinal cord injury.

OBJECTIVE: To evaluate aspects of internal scale validity and reliability of the Swedish version of the Impact on Participation and Autonomy questionnaire (IPA-S) for use in people with spinal cord injury. SUBJECTS: A total of 161 persons with spinal cord injury. METHOD: IPA-S psychometric properties were evaluated using Rasch rating scale analysis. RESULTS: The results show that the IPA-S has 27 items for perceived participation and 6 items for perceived problems with participation, indicating 2 underlying unidimensional constructs for use in people with spinal cord injury, after removal of misfitting items. The established hierarchical order of the item calibration values in both scales appeared logical and the distances between the items, with a few exceptions in the problem scale, were appropriate. Both scales demonstrated good separation reliability. The range of item calibration values in both scales did not fully cover the range of measures of persons' perceived participation and problems thereof. CONCLUSION: The psychometric properties of IPA-S are promising and indicate that IPA-S has potential to be developed further.

Assessment of capacity for myoelectric control: a new Rasch-built measure of prosthetic hand control.

OBJECTIVE: To report the results from a Rasch rating scale analysis of the Assessment of Capacity for Myoelectric Control (ACMC) implemented to evaluate internal scale validity, person response validity, separation reliability, targeting and responsiveness of the measures over time. DESIGN: Longitudinal data (18 months) from a prospective study of development of capacity for myoelectric control in children and adults were used for the analysis. PATIENTS: A consecutive sample of 75 subjects (43 males, 32 females) with upper limb reduction deficiency or amputation and myoelectric prosthetic hands referred for occupational therapy from September 2000 to March 2002. Participants' ages ranged from 2 to 57 years. METHODS: Outcome measure was the ACMC. Occupational therapists completed 210 assessments at an arm prosthesis centre in Sweden. A two-faceted rating scale analysis of the data was performed. RESULTS: All 30 ACMC items and 96.2% of participants demonstrated goodness-of-fit to the rating scale model for the ACMC. Separation and SE values suggested adequate reliability of the item and person estimates. CONCLUSION: The items demonstrated internal scale validity and the participants demonstrated person response validity. The ACMC was well targeted and sensitive enough to detect expected change in ability.