Individualised home-based rehabilitation after stroke in eastern Finland--the client's perspective.

Reintegration into society is one of the main purposes of post-stroke rehabilitation. The experiences of clients returning home after a stroke have been studied before. There is, however, little knowledge about activities carried out during home-based rehabilitation interventions and about the involvement of clients in the process. This study focused on clients' experiences of a 3-month individualised, home-based rehabilitation programme supervised by a multidisciplinary team. The data were collected in 2009-2010, and it was based on interviews with 14 clients (48-83 years of age) conducted approximately 7 months after stroke. In the thematic analysis, five main topics describing the goals and functions of the home-based rehabilitation were identified as follows: (i) learning strategies for solving problems in daily activities at home and in the community; (ii) receiving exercise coaching; (iii) exploring community services and facilities; (iv) having a dialogue with professionals; and (v) engaging in activities aimed at returning to work. Implementing rehabilitation activities in the home environment seemed to enhance the participants' active involvement and their ability to evaluate themselves and to set goals for their recovery. Work was an important goal for clients of working age, but work-related tasks were not sufficiently integrated with home-based rehabilitation. A challenge for local communities is to provide health promotion and recreation services that are also suitable for persons with limited functioning.

Randomized trial on the effectiveness of long- and short-term psychotherapy on psychosocial functioning and quality of life during a 5-year follow-up.

Knowledge is incomplete on whether long-term psychotherapy is more effective than short-term therapy in treating mood and anxiety disorder, when measured by improvements in psychosocial functioning and life quality. In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorder were randomized to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP), or long-term psychodynamic psychotherapy (LPP), and followed up for 5 years from the start of treatment. The outcome measures comprised 4 questionnaires on psychosocial functioning, assessing global social functioning (Social Adjustment Scale (SAS-SR), sense of coherence (Sense of Coherence Scale (SOC)), perceived competence (Self-Performance Survey), dispositional optimism (Life Orientation Test (LOT)), and 1 questionnaire assessing quality of life (Life Situation Survey (LSS)). Short-term therapies improved psychosocial functioning and quality of life more than LPP during the first year. The only exceptions were LOT and perceived competence, which did not differ between SPP and LPP. Later in the follow-up, SOC and perceived competence showed significantly more improvement in LPP than in the short-term therapy groups. No direct differences between SFT and SPP were noted. Short-term therapy has consistently more short-term effects on psychosocial functioning and quality of life than LPP, whereas LPP has some additional long-term benefits on psychosocial functioning.

Service characteristics as predictors of parents' perceptions of child rehabilitation outcomes.

Medical rehabilitation arranged by the Social Insurance Institution of Finland is provided for children with severe disabilities. The study aimed to find out which service characteristics were associated with perceived outcomes of rehabilitation. Parents whose children had participated in rehabilitation (n = 496) responded to a mail questionnaire that included questions on service characteristics and possible outcomes. Based on factor analysis, four outcome variables were formed. Logistic regression analysis was used to identify the particular service characteristics that were associated with the perceived outcomes. The family's participation in rehabilitation planning and the child's willingness to participate in rehabilitation activities were associated with good outcomes. Having a contact person for the rehabilitation process predicted child and family empowerment outcomes. The results emphasize the significance of establishing a good partnership between the professionals and the family; of developing the contents of the rehabilitation program, so that they motivate the child, and of organizing service coordinators for each family.

Motivational orientation of people participating in vocational rehabilitation.

PURPOSE: The task of vocational rehabilitation is to support the employee's chances of continuing in working life. The study aimed to examine the motivational orientation of people participating in vocational rehabilitation and to find out what characteristics of the clients, their life situation, and their beliefs and perceptions were associated with it. METHODS: A mail questionnaire was answered by 839 rehabilitation clients who had received an affirmative rehabilitation decision under the earnings-related pension scheme 12 months earlier (response rate 67 %). Two variables depicting motivational orientation were formed, i.e., motivation for continuing in working life and motivation for participating in vocational rehabilitation. Logistic regression analyses were applied in examining the factors associated with each motivation variable. RESULTS: The results indicate that the two motivational orientations can be regarded as partly separate and partly overlapping constructs. The rehabilitation clients' motivational orientations were associated with their experiences and their perceptions on environmental factors and future possibilities, both those that precipitated the application for rehabilitation and those that are important in their current life situation and their perceived future possibilities. CONCLUSIONS: In the planning of individual rehabilitation processes there is a clear need to sort out what factors may hide behind the client's weak contextual or situational motivation. In the course of the rehabilitation process, it is important to discuss these factors in order to alleviate the clients' uncertainty towards change and enhance their motivation to participate in rehabilitation and re-think their future prospects of returning to work.

Shared agency and collaboration between the family and professionals in medical rehabilitation of children with severe disabilities.

Implementation of medical rehabilitation for children with severe disabilities, arranged by the Social Insurance Institution of Finland, is based on collaboration of the family with several professionals and organizations providing the necessary services. Therefore, it sets special challenges for service provision. Parents' experiences of shared agency and participation during children's rehabilitation process were analyzed in relation to the following research questions: what factors, describing the planning and implementation of rehabilitation, were associated with (a) the parents' satisfaction with planning, (b) the correspondence between the plans and the needs of the child, and (c) the correspondence between the received rehabilitation and the needs and wishes of the child and the parents. A questionnaire survey for the children's parents (n=496) included items on rehabilitation planning and implementation of services. The results were analyzed using cross-tabulations and logistic regression analyses. Taking into account of the parents' and children's preferences in rehabilitation and active participation of the rehabilitation counselor and the therapist were positively associated with parents' satisfaction with planning and the correspondence between the plan and the needs. The rehabilitation process was considered as more successful if the information received was sufficient, the parents were heard in all phases of the process, and the child was motivated to participate. Several stakeholders have responsibilities in medical rehabilitation for individuals with severe disabilities. Parents' experience of good rehabilitation planning in healthcare requires shared agency; that is, rehabilitation professionals listening to the family's preferences in decision making. Parents' experience with a successful rehabilitation process is dependent on information sharing, becoming heard, and collaboration in all phases of the process.

Effectiveness of short-term and long-term psychotherapy on work ability and functional capacity--a randomized clinical trial on depressive and anxiety disorders.

BACKGROUND: Insufficient evidence exists about the effect of different therapies on work ability for patients with psychiatric disorders. The present study compares improvements in work ability in two short-term therapies and one long-term therapy. METHODS: In the Helsinki Psychotherapy Study, 326 outpatients with depressive or anxiety disorder were randomly assigned to long-term and short-term psychodynamic psychotherapy, and solution-focused therapy. The patients were followed for 3 years from the start of treatment. Primary outcome measures were the Work Ability Index (WAI), the Work-subscale (SAS-Work) of the Social Adjustment Scale (SAS-SR), Perceived Psychological Functioning Scale, the prevalence of patients employed or studying, and the number of sick-leave days. RESULTS: Work ability was statistically significantly improved according to WAI (15%), SAS-Work (17%), and Perceived Psychological Functioning Scale (21%) during the 3-year follow-up. No differences in the work ability scores were found between two short-term therapies. The short-term therapies showed 4-11% more improved work ability scores than long-term therapy at the 7 month follow-up point. During the second year of follow-up, no significant differences were found between therapies. After 3 years of follow-up, long-term therapy was more effective than the short-term therapies with 5-12% more improved scores. No differences in the prevalence of individuals employed or studying or in the number of sick-leave days were found between therapies during follow-up. CONCLUSIONS: Short-term therapies give benefits more quickly than long-term therapy on work ability but in the long run long-term therapy is more effective than short-term therapies. More research is needed to confirm these findings.

Occupational Functioning Scale (OFS)--an instrument for assessment of work ability in psychiatric disorders.

The aim was to present the content of the newly developed observer rating scale of work ability--The Occupational Functioning Scale (OFS)--and its basic psychometric properties. Psychiatric disorders cause functional impairment in several domains, including occupational functioning. The assessment of work-related functioning is often neglected in psychiatric research, partly due to a lack of reliable and valid instruments. The validity of OFS was evaluated by comparing it with other work ability measures (SAS-work, Work Ability Index, sickness absence) and to non-work-ability related measures [Inventory of Interpersonal Problems (IIP), Symptom Check List - General Symptomatic Index (SCL-90-GSI)] in 150 patients with depressive or anxiety disorders. Reliability was determined by 39 videotaped interviews rated by four judges. OFS showed excellent inter-rater reliability (intraclass correlation = 0.91) and good criterion validity by being more strongly related to other scales of occupational functioning (mid R:rmid R: = 0.39-0.47) than to measures of general distress (SCL-90-GSI) and interpersonal problems (IIP)(mid R:rmid R: = 0.26 and 0.12). OFS is a simple, reliable and clinically meaningful instrument for assessment of work ability in depressive and anxiety disorders.

Health locus of control beliefs and psychological distress as predictors for treatment outcome in low-back pain patients: results of a 3-month follow-up of a controlled intervention study.

Association of health locus of control beliefs (HLC) and psychological distress (GHQ-12) with short-term outcome of low-back pain (LBP) rehabilitation was studied in patients with chronic or recurrent LBP (n = 459; aged 35-54 years; 63% men). These patients were randomly assigned to 3 study groups, namely the inpatient, the outpatient and the control group. The results showed a significant decrease in disability due to LBP in the 2 treated groups; in addition, the accomplishment and frequency of back exercises was significantly better in the treated groups. HLC beliefs were associated with a successful outcome; those patients with stronger internal beliefs had gained more from the treatment, had learned their exercises better and had done the exercises more frequently during the follow-up period. Symptoms of psychological distress were significantly associated with poorer accomplishment of back exercises.

Symptoms of psychological distress and treatment effects with low-back pain patients.

The aim of the study was to investigate the relationship between psychological distress, the severity of low-back pain and the response of 54-63-year-old male in- and outpatients to low-back treatment. The correlation between the index of psychological distress and the back pain index was statistically significant, but relatively low. In the outpatient group (n = 63) those with fewer symptoms of distress and those not employed benefited significantly more from the treatment. In the inpatient group (n = 88), such clear differences were not found. The effects of treatment for low-back pain were relatively short-lived in both groups, whilst the number of inpatients reporting a large variety of positive effects after the treatment was greater. Differences between the two types of treatment are discussed.