Diary-based survey of lifestyle habits in everyday activities and support for the process of change - a utility study.

BACKGROUND: The need to support a healthy lifestyle among the population has become increasingly apparent in recent years. The National Board of Health and Welfare in Sweden has published national guidelines regarding unhealthy lifestyle habits since 2011. An instrument based on the practical and theoretical foundations of occupational therapy was developed to support the profession's unique contribution to implementing these guidelines. AIMS: The aim was to examine the utility of the instrument by investigating its implementation potential and clinical relevance. MATERIAL AND METHOD: Sixteen occupational therapists used the instrument in practice together with 60 clients. Afterwards, they completed a questionnaire covering questions of utility. RESULT: The instrument demonstrated mostly positive dimensions of utility. The results show that the instrument seems to have a high implementation potential and is clinically relevant. It seems, for example, to support implementation of the national guidelines and to capture how a person's lifestyle habits are expressed in everyday occupations. The instrument further seems to promote people's participation in treatment. CONCLUSION: The instrument 'Diary-based survey of lifestyle habits in everyday activities and support for the process of change' seems promising in terms of utility. However, the scientific merit of the instrument will need to be further established.

Patient and public involvement in oesophageal cancer survivorship research.

BACKGROUND: Good clinical research is often conducted in close collaboration between patients, the public, and researchers. Few studies have reported the development of patient and public involvement (PPI) in research outside the United States and the United Kingdom, and for patients with more aggressive cancers. The study aimed to describe and evaluate the development of PPI in oesophageal cancer survivorship research in Sweden by the use of a framework to support the process. METHODS: Oesophageal cancer survivors were recruited to a PPI research collaboration at Karolinska Institutet, Sweden. The development process was supported by the use of a framework for PPI, 'Patient and service user engagement in research'. Insights, benefits, and challenges of the process were described and discussed among the collaborators. RESULTS: The collaboration resulted in joint publications with a more patient- and family-focussed perspective. It also contributed to the development of information folders about survivorship after oesophageal cancer surgery and national conference arrangements for patients, their families, healthcare workers, and researchers. Since the PPI contributors were represented in patient organisations and care programmes, the dissemination of research results increased. Their contributions were highly valued by the researchers, but also revealed some challenges. The use of a structured framework contributed to support and facilitated the process of establishing PPI in research collaboration. CONCLUSIONS: A genuine interest in establishing PPI in research and an understanding and respect for the patients' expertise in providing a unique inside perspective was imperative for a successful collaboration. Research focus should not only be on mortality and reductions in daily life, but also on positive outcomes. Using a framework supports development and avoids pitfalls of PPI collaboration. PATIENT AND PUBLIC CONTRIBUTION: Patient partners were equal collaborators in all aspects of the study.

Severe reflux, sleep disturbances, and health-related quality of life after esophageal cancer surgery.

PURPOSE: Esophagectomy for cancer is an extensive procedure often followed by severe complications. This study investigated whether patients with severe symptoms of reflux are more likely to have sleep disturbances and reduced health-related quality of life (HRQL) after esophagectomy. METHODS: This Swedish nationwide prospective cohort study encompassed all patients who had undergone esophagectomy for cancer between 2013 and 2018. One year after surgery, the patients responded to three questionnaires on reflux (EORTC QLQOG25), sleep disturbances (KSQ), and HRQL (EORTC QLQ-C30). Multivariable logistic regression provided odds ratios (OR) with 95% confidence intervals (CI) for sleep disturbance/reduced HRQL between patients with and without reflux, adjusted for potential confounders. RESULTS: Among 241 esophagectomy patients, 66 (27%) reported severe reflux. Patients with reflux had an increased risk of sleep disturbances (OR 2.3, 95% CI: 1.3-4.3) compared to patients without reflux. More specifically, these patients were more likely to suffer from poor sleep quality (OR 4.9, 95% CI: 1.9-12.4). Patients with reflux and sleep disturbances reported reductions in global quality of life, role function, emotional function, social function, and more symptoms in all scales, except for dyspnea. CONCLUSIONS: This study suggests that patients with severe symptoms of reflux after esophagectomy have an increased risk of sleep disturbances and poor sleep quality, which in turn are associated with reduced HRQL. IMPLICATIONS FOR CANCER SURVIVORS: Alleviating reflux after oesophageal cancer surgery is important, since this common symptom might reduce HRQL and well-being.

The "Managing Fatigue" programme for people with multiple sclerosis - acceptance and feasibility with Swedish occupational therapists.

Background: Fatigue is common among people with multiple sclerosis (MS), and significantly influences engagement in occupations. The Managing Fatigue (MF) programme is an evidence-based occupational therapy group-based intervention, utilising self-management science that provides people with tools to manage fatigue. Although the national MS-guidelines in Sweden cite this as best practice, a Swedish version is not available.Aim: To translate and investigate the feasibility of a Swedish MF programme delivered by occupational therapists working with MS clients in Sweden.Material and methods: We used a mixed-methods design. Eight recruited occupational therapists, participated in a workshop prior to delivering the MF programme. Following programme delivery, they completed a questionnaire and participated in focus group interviews.Results: Each therapist conducted one programme with 5-9 MS clients. Overall, therapists were satisfied with programme content, and delivery was followed. Minor improvements were suggested, specifically in relation to how cognitive fatigue can be managed. Therapists acknowledged challenges moving from "expert" to supporting self-management.Conclusion: The MF programme is feasible in Sweden, and its client-centred and occupation focus is consistent with therapists' scope of practice. In the future, acceptability and satisfaction from the perspectives of MS participants should be examined. Larger, more robust intervention studies evaluating effectiveness are also warranted.

Development of a Swedish Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for adult patients with attention-deficit hyperactivity disorder (ADHD).

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) in adults is a phenomenon that attracts a lot of attention in society today. Advances in research have made it clear that many conditions that make people seek medical and psychiatric care may have pervasive deficits in attention, motor control and impulsivity at their roots. Since ADHD in adults is a relatively new and very versatile concept, there is a great need for systemized classification of the ramifications of the deficit that extends into every aspect of these patients' lives. AIMS: To develop a Swedish Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for adult patients with ADHD. METHODS: A national expert survey was conducted using the Delphi technique and a formal consensus conference. Forty-two experts from different professions and organizations, including psychiatrists and physicians, psychologists, occupational therapists, a counsellor, a specialist nurse, representatives from a patient organization and representatives from the Swedish Social Insurance Agency, participated in the Delphi process and 28 participants from the expert group attended the consensus conference. RESULTS: At the formal consensus conference, 66 categories from the ICF were identified and included in the national Comprehensive Core Set for ADHD: 21 categories from the component body functions, 26 categories from the component activities and participation, and 19 categories from the component environmental factors. CONCLUSION: The Comprehensive Core Set for ADHD should be regarded as national and preliminary, and should be further tested and evaluated by experts in ADHD in clinical settings in Sweden.

The measurement properties of the Occupational Circumstances Interview and Rating Scale - Sweden (OCAIRS-S V2).

AIM: This paper reports the measurement properties of the Occupational Circumstances Assessment Interview and Rating Scale - Sweden (OCAIRS-S V2). The OCAIRS is a semi-structured interview and rating scale designed to capture, in detail, a person's occupational participation. The English version 4.0 has been translated into Swedish. The psychometric properties of the Swedish version are unknown. METHODS: Eleven Swedish occupational therapists working in mental health completed 38 OCAIRS-S (V2) assessments in addition to linking videotapes. A total of 60 clients were, therefore, entered into the analysis. Many-faceted Rasch analysis was used to analyse the data. RESULTS AND CONCLUSIONS: Results supported internal, construct, and person response validity of the OCAIRS-S (V2). Inter-rater reliability was established. The scale was shown to discriminate between people who were living in the community. In addition, the results indicate a need to explore the skill items.

The Work Environment Impact Scale - Self-Rating (WEIS-SR) evaluated in primary health care in Sweden.

OBJECTIVE: To develop a self-report alternative to the Work Environment Impact Scale (WEIS). PARTICIPANTS: First the novel instrument was used and evaluated by ten occupational therapists and 45~clients in primary health care. Then the instrument was used by 26~clients who participated in a rehabilitation programme in another primary health care district. METHODS: The instrument was investigated in two steps. First content validity and utility were investigated through a questionnaire addressed to occupational therapists and their clients respectively. The response distribution was calculated by frequencies. Internal consistency was investigated. In the second step, a revised version of the instrument was investigated for test-retest reliability and internal consistency. The test-retest reliability was calculated by weighted kappa. The internal consistency of the WEIS-SR was calculated by means of Cronbach's alpha. RESULTS: In step one the content validity was good to moderately good, the utility was good, and the internal consistency was satisfactory (0.72). In step two the internal consistency was good (0.88/0.89) and the test-retest reliability was mostly good to moderate (0.35-0.78, median 0.61). CONCLUSIONS: The instrument will be further investigated in other populations and take into consideration additional psychometric properties such as sensitivity to change, predictive validity, and concurrent validity.

Utilization of an ICF-based assessment from occupational therapists' perspectives.

The International Classification of Functioning, Disability and Health (ICF) is intended to provide a framework for practitioners. A client-centred ICF-based assessment (ICF-A) was developed to be used by occupational therapists in problem identification. The aim was to evaluate the ICF-based assessment (ICF-A) focusing on the examination of its utility on the basis of occupational therapists' perspectives regarding clinical relevance and potential for implementation. Eleven occupational therapists, most of whom worked in hospitals, performed in total 99 ICF-A based assessments and completed three self-reported questionnaires related to the utility of the ICF-A, resulting in a total of 121 questionnaires. Data were analysed using descriptive statistics and directed content analysis. The results from this initial testing of ICF-A showed that its clinical relevance was considered low since ICF-A included too many categories. In addition, the time needed to perform the assessments decreased during the 10 assessment occasions. Furthermore, concerning its implementation potential, the client-centred approach in the ICF-A was rated as weak. The target group did not benefit from using ICF-A in a hospital context. Hence, an investigation of its utility among occupational therapists in community and primary care will be the next step in the development of the ICF-A.

The myth of participation in occupational therapy: reconceptualizing a client-centred approach.

Participation is often the comprehensive objective of treatment but also an indication of the extent to which the process of occupational therapy is client-centred. The purpose of this study was to explore levels of participation during occupational therapy among clients in the area of mental health from the occupational therapists' perspectives. Additionally the authors sought to identify factors that might hinder client participation. Postal questionnaires were sent out to 670 Swedish occupational therapists working with persons with mental illness and learning disabilities. The questionnaire required therapists to rate clients' levels of participation during occupational therapy. Findings indicated that the most common level of participation for the clients was interdependent, meaning that problems, goals, and plans were identified jointly and collaboratively with the occupational therapist. However, more than 20% of the clients were described as being dependent. Almost 90% of the occupational therapists rated client participation in therapy to be very important and nearly 70% claimed that client participation in general needed to be increased. Occupational therapists rated the primary barriers to participation as being clients' inability to participate and organizational and financial problems. Implications of these findings for education in client-centred practice approaches are discussed.

Perceptions of the work environment among people with experience of long term sick leave.

PURPOSE: The aims were to describe and analyze how people with experience of long term sick leave perceive that factors in their work environment support or interfere with work performance, satisfaction, and well-being. METHOD: The 53 participants were interviewed with the Work Environment Impact Scale (WEIS). The WEIS ratings and belonging notes were analyzed by descriptive statistics and qualitative analysis respectively. Differences in WEIS ratings between; women and men; participants with somatic and mental diseases; and participants working and on full-time sick leave were tested. RESULTS: The most supportive factors concerned social interactions at work, and the value and meaning of work. The factors perceived as most interfering concerned work demands and rewards. The social relations at work were perceived as more supportive by the working group than by those on full-time sick leave. The participants with somatic diseases perceived physical work factors as more interfering than did participants with mental diseases, who in turn perceived the value and meaning of work as more interfering. CONCLUSION: Knowledge about the interaction between the worker and the work environment could reveal useful information about the complex phenomenon of reducing sick leave. The WEIS seems useful in providing information about how alterations and accommodations in the work environment could support individual workers.

Return to work: the predictive value of the Worker Role Interview (WRI) over two years.

Worker Role Interview (WRI) is an assessment tool designed to identify psychosocial and environmental factors which influence a person's ability to return to work. The purpose of this study was to investigate if the Worker Role Interview (WRI) can predict return to work over a period of two years. Fifty three long-term sick-listed people were interviewed and rated with the WRI. Differences in ratings and the ability of WRI to correctly predict whether these people would fall into the working or non-working groups at 6, 12 and 24 month follow-ups were tested by Mann-Whitney test and logistic regression respectively. Eight of 17 items in WRI were rated differently between the groups at one or more of the follow-ups. The regression models based on the WRI ratings had an overall correct prediction rate ranging from 81% to 96%. 'Expectation of job success' which concerns the person's belief in abilities in relation to return to work emerged as an important predictive factor for return to work in all statistical analyses. The WRI assessment contains items that could predict return to work. This implies that the WRI could be a useful tool in vocational rehabilitation for identifying individual rehabilitation needs.

Psychometric properties of the Worker Role Self-assessment instrument used to evaluate unemployed people in Sweden.

The aim was to determine the psychometric properties of the new Worker Role Self-assessment (WRS) instrument. The content validity, utility, test-retest reliability, sensitivity to change, and predictive validity of the WRS were investigated in two subject samples, which were selected at work and pain rehabilitation clinics, respectively. One of these groups consisted of 23 clients and four occupational therapists, and the other comprised 83 clients. All clients in both samples were unemployed. The results showed that both the clients and the occupational therapists perceived the content validity and the utility of the WRS as good. The test-retest reliability showed mostly good to moderate agreement, and the internal consistency was satisfactory. One of the items showed predictive validity for work capacity, and the same item was sensitive to change. However, a ceiling effect reduced the utility and the sensitivity to change. Our findings indicate that the WRS is promising as a tool that clinicians can use to evaluate the capacity for return to work and for planning interventions, although some revisions are needed to counteract the ceiling effect.

Doing everyday life--experiences of the oldest old.

The purpose of this article is to explore how a group of elderly people, living and managing on their own, describe and experience their everyday doings. Interviews and observations were conducted with 18 community-living people aged 85 and above. The experiences of 'Doing everyday life' are described in five overarching themes: 'Experiencing being old', 'Doings in everyday life', 'Patterns of the day', 'Altered doings', and 'The importance of time'. What is done during an ordinary day does not differ much from earlier in life, but how the doings are performed has changed. Being occupied and staying healthy and sound in mind was stressed as important in old age and even if reduced energy and functional constraints limited the doings, a strong volition to manage independently was expressed. The participants perceived society as regarding the elderly as useless and worthless. Knowledge emanating from the very old themselves is vital to diversify the image of elderly people and to offer interventions and support adapted to their needs and desires.

A review of research with elderly people as respondents reported in occupational therapy journals.

The aim of this article is to review research presented in occupational therapy journals with the elderly as respondents. With an increasing number of elderly people in society research including the elderly should play a vital role within occupational therapy especially since emphasis on subjective experience is an important factor in the core constructs of occupation. Through a review of six occupational therapy journals, covering the period 2001--2006, it was discovered that 15% of the total number of articles included the elderly as respondents. The published articles with the elderly as respondents were mainly quantitative with the most frequent subject being instrument developing and testing. Most studies had a population group of mixed ages, making it hard to draw conclusions concerning the elderly population. The conclusion is that more research of a qualitative nature reflecting the subjective perspectives of the elderly is needed, especially regarding the oldest age group since this is the fastest growing and there is still limited knowledge regarding their perspective on matters concerning their everyday lives and their doings. Technological developments are implied to benefit elderly people but more research and discussion is needed on how this will affect both the elderly and occupational therapy theory and practice.

Activity and participation in psychiatric institutional care.

National action plans emphasize the importance of strengthening the role of patients in health and medical care. Patients should feel that they can participate and that they are seen as a resource. In occupational therapy, the client-centred approach has developed, whereby it is key to enable patients to participate in their treatment. The International Classification of Functioning Disability and Health (ICF) has inspired this study, in which concepts such as activity and participation are central. The purpose of the study was to describe how patients in psychiatric institutional care conceive their opportunities to be active, and how they participate in their own treatment. Questionnaires were sent to patients who had received care during a six-month period. Ten patients were then selected for interview. The study shows that younger patients and patients who were treated involuntarily were generally more dissatisfied than other patients. The patients' perceptions of their environment were influenced by the values in the ward. Topics such as atmosphere in the ward, reception, continuity, and support were presented. Important factors related to activity and participation were: agreement concerning the treatment plan, discussions about expectations, creating conditions for engagement in activities, and providing the patients with opportunities to take responsibility for themselves.

Psychometric properties of the Worker Role Interview.

OBJECTIVES: This study examined the psychometric properties of the rating scale of the Worker Role Interview (WRI). The study also asked whether the scale's items formed a valid measure of the construct, psychosocial capacity for work, and whether they were targeted to and could effectively discriminate between persons at different levels of psychosocial ability for work. METHOD OF STUDY: Data were collected from 21 raters on 440 participants from the United States, Sweden and Iceland. A many-faceted Rasch model was used to analyze the data. RESULTS: Most items of the scale worked effectively to measure the underlying construct for which the WRI was designed. In addition, the items were ordered from least to more of the underlying construct as expected. The scale validly measured 90.23% of the participants, who varied by nationality, culture, age and diagnostic status. The scale's items distinguished participants into approximately three different strata and were appropriately targeted to the participants. Seventeen of the 21 raters used scale in a valid manner. CONCLUSIONS: The WRI scale and items are valid across ages, diagnoses, and culture and effectively measure a wide range of persons.

Clinical perspective on the Swedish version of the Assessment of Communication and Interaction Skills: stability of assessments.

The purpose of the present study was to investigate whether ratings according to the Assessment of Communication and Interaction Skills, Swedish version (ACIS-S) are related to the settings in which the skills are assessed, and whether the client's comprehension of the setting is related to the ACIS-S rating scores. The ACIS-S is an observation rating scale applied immediately after each of two to six different social sessions that the client takes part in. The selection of settings relies on the client's judgement of them as being meaningful. In total, nine occupational therapists and 16 clients participated in the study. A total of 71 ratings were made in a mean of 4.4 settings per client. The results indicate that the client's rated comprehension of the settings is not significantly related, in general, to the ACIS-S rating scores given by the occupational therapist. However, the clients ACIS-S scores may vary a lot over settings. In the present study, 13- of the 20-items showed ratings of both the existence and the absence of problems in the same skill -- but in different settings -- in half or more of the client group. This may rise questions for the practitioners how to implement the ACIS-S in clinical practice, for example, how many and which kind of settings and how many times? Further research in the field is recommended.

Psychiatric occupational therapy service--quality assurance.

During the last few decades, quality assurance has been a central issue in the societies, both in, for example the industrial area and in healthcare. It is a tool to measure the outcomes of product or service provided. A review of the literature during the last 17 years with respect to quality assurance work in psychiatric occupational therapy indicates that few articles have been published in the area and that their scientific quality is questionable. The studies show many methodological shortcomings, which result in difficulty drawing any conclusion from the studies. The number of publications is also decreasing. Furthermore, a survey to investigate quality assurance work in psychiatric occupational therapy service shows that the occupational therapists do not work with quality assurance methods to a great extent. The methods they use most are interviews with patients and patient questionnaire. Both these methods require documentation in order to offer the patient a suitable service. Quality assurance work will be difficult to implement if no documentation is available. Documentation is central to communicating with other professions and with the client. This study points out that occupational therapists need to improve practice as well as research concerning quality assurance in order to ensure that they offer the patient a high-quality service.

The worker role interview--preliminary data on the predictive validity of return to work of clients after an insurance medicine investigation.

The aim was to investigate the predictive validity of the Worker Role Interview (WRI) for return to work at a 2-year follow-up of clients who attended an insurance medicine investigation center. The WRI identifies psychosocial and environmental factors that influence a person's abilities to return to work. Forty-eight of 202 consecutively selected clients constituted the study group. The Mann-Whitney U test was used to test the statistically significant differences in WRI ratings between those who were working (n = 6) and those who were not (n = 42) 2 years after their investigations. Five of the 17 items in WRI had a tentative predictive validity of return to work. The content area "personal causation" in WRI, had the best predictive validity. The results emphasize the importance of considering the unique individual's beliefs and expectations of his/her effectiveness at work when assessing clients' work ability and planning for further rehabilitation.