What, Why, How - Creative Activities in Occupational Therapy Practice in Sweden.

Creative activities have historically been used in occupational therapy, and although their usage has declined in recent decades, they are still used in Swedish practice. The aim of this study was to better understand how occupational therapists use creative activities in practice. A web-based survey was sent to 520 occupational therapists, of which 304 (58.5%) responded. The main reason identified for using creative activities was to strengthen the client's occupational performance, well-being and self-esteem. The expected outcomes of applying creative activities were to support the client in self-expression and experiencing joy and desire. More than half of the occupational therapist respondents did not use creative activities to the extent they desired. Creative activities in occupational therapy are still used as a vital treatment to strengthen the clients' occupational performance abilities. The survey has looked at only a professional perspective on effectiveness of applying creative activities in occupational therapy. More research is needed to evaluate how occupational therapists internationally apply creative activities. There is also a need to gain information from the client's perspective on the therapeutic value of creative activities. Copyright © 2016 John Wiley & Sons, Ltd.

Using a Robotic Cat in Dementia Care: A Pilot Study.

The current study aimed to explore (a) reactions of individuals with dementia to an interactive robotic cat and their relatives' and professional caregivers' experiences, and (b) to measure usability in developing the care/treatment of individuals with dementia using interactive robotic pets. An intervention design in a pilot study using mixed methods was conducted in two stages: a quantitative single-case study (n = 4) and a qualitative interview study (n = 14). Results indicated less agitated behavior and better quality of life for individuals with dementia. Interviews showed positive effects by providing increased interaction, communication, stimulation, relaxation, peace, and comfort to individuals with dementia. The tested interactive robotic cat was also considered easy to use. There is an increased need for alternative/complementary forms of care to meet an increasing number of individuals with dementia. For some individuals with dementia, an interactive robot, such as a robotic cat, can increase well-being and quality of life.

Development of an Interview Guide Identifying the Rehabilitation Needs of Women from the Middle East Living with Chronic Pain.

The purpose of this study was to develop an interview guide for use by primary healthcare professionals to support them in identifying the rehabilitation needs of forced resettled women from the Middle East living with chronic pain. Previous findings together with the existing literature were used as the basis for developing the interview guide in three steps: item generation, cognitive interviews, and a pilot study. The study resulted in a 16-item interview guide focusing on patients' concerns and expectations, with consideration of pre-migration, migration, and post-migration factors that might affect their health. With the help of the guide, patients were also invited to identify difficulties in their daily activities and to take part in setting goals and planning their rehabilitation. The current interview guide provides professional guidance to caretakers, taking a person-centered participative point of departure when meeting and planning care, for and together, with representatives from dispersed ethnic populations in Sweden. It can be used together with the patient by all staff members working in primary healthcare, with the aim of contributing to continuity of care and multi-professional collaboration.

Rehabilitation of women from the Middle East living with chronic pain--perceptions from health care professionals.

Meeting patients from other countries constitutes a challenge for health care. The purpose of this study was to increase knowledge about tacit understandings of treatment in practice by determining the perceptions of chronic pain and rehabilitation directed to resettled women from the Middle East, from a variety of health care professionals within primary care. Based on the results, we find a need to support and increase knowledge among health care professionals to involve the patient and consider her beliefs, expectations, background, current life situation, and spirituality, and to involve family in rehabilitation.

Struggling for sense of control: everyday life with chronic pain for women of the Iraqi diaspora in Sweden.

BACKGROUND: As dispersed ethnic populations in Swedish society expand, the healthcare system need to adapt rehabilitation services according to their needs. The experiences of trauma and forced resettlement have a continuing impact on health and musculoskeletal pain, as well as the intersecting structures that prerequisite the possibilities in the new country. To understand the specific needs of women from the Iraqi diaspora in Sweden, there is a need to elucidate the effects of pain on their everyday life. AIMS: To elucidate everyday life with chronic pain from the perspective of women from the Iraqi diaspora in Sweden. METHODS: Qualitative interview study according to Glaser's grounded theory. RESULTS: The results from 11 interviews suggest that pain was associated with dependency on society as well as on family. It resulted in a struggle for sense of control, framed by faith in God, influenced by the healthcare system, and with support from family. The women's testimony of lack of continuity of care, resulting in recollection of lived traumas in every visit, is a vital sign of the unconscious power relations within health care and how representatives from health care, instead of being the ones who help the women forward, become the ones who hold them back. CONCLUSIONS: The results show the importance of challenging the normative assumptions embedded in health care and treatment for patients with chronic pain and of including the voice of "others".

A school-based intervention associated with improvements in cardiometabolic risk profiles in young people with intellectual disabilities.

This study evaluates a multifactorial school-based intervention with the aim of decreasing cardiometabolic risk factors by means of a healthy lifestyle, primarily with daily physical activity and healthy food during school hours, at an upper secondary school for students with intellectual disabilities. The outcome is measured in terms of cardiometabolic risk factors and cardiovascular fitness, both known to increase the risk of future cardiovascular disease, type 2 diabetes and cancer. Two years of intervention resulted in a positive trend in several measured cardiometabolic risk factors, with no increase in fat mass. Cardiovascular fitness levels were unchanged. We conclude that a healthy school environment can contribute to a deceleration of both fat mass gain and loss of cardiovascular fitness.

Use of creative activities in occupational therapy practice in Sweden.

The aim of this study was to describe the prevalence of creative activities in occupational therapy in Sweden and how often Swedish occupational therapists use creative activities as a means of intervention. A web-mail survey was sent to 2975 Swedish occupational therapists working in health care at regional, county council or primary health care level, and those working in vocational rehabilitation. A total of 1867 (63%) answered the questionnaire and showed that 44% did use creative activities as a means of intervention and most often by practitioners working in psychiatric health care. The most commonly used form of creative activity was arts and crafts followed by gardening. This web-mail survey was based on a limited amount of items regarding creative activities. Further research should focus on in-depth inquiries about how occupational therapists and their patients perceive the use of creative activities as a means of treatment in occupational therapy.

The magnitude of reciprocity in chronic pain management: experiences of dispersed ethnic populations of Muslim women.

Dispersed ethnic populations believe their health to be worse than the ethnic majority group in Sweden. Most studies in rehabilitation exclude dispersed ethnic populations who can not read or speak the national language although this group seems to be in need of rehabilitation to a larger extent than privileged majority groups. The aim of the study was to examine the experience of living with musculoskeletal pain and experience of health care among dispersed ethnic populations of Muslim women. The method used was inspired by Grounded Theory in this study. Interviews were made with five first-generation Muslim immigrant women who had come to Sweden via Iraq as refugees. Two interviews were performed with interpreters. A preliminary core category 'The magnitude of reciprocity' based on three categories emerged from the analysis: (1) Impact of pain, (2) Managing pain and (3) Facing health care. Chronic pain limited the informants physically and emotionally, as well as impacting on their everyday life. Informants managed their pain primarily through medicine and physical activity, which gave at least temporary relief. Health care providers were perceived as doing their best but experiences of bad meetings were also witnessed. The factors important in achieving a good meeting in this study appeared to be; time, dialogue, honesty and understanding. Communication skills, feelings of being taken seriously and a sense of security were additional factors. Not being properly examined, or offered optimal treatment, not being believed or understood, were all seen as signs of dismissal within health care. The limitations of this study are primarily concerned with language difficulties resulting in various shortcomings. Reciprocal recognition and support connected to the specific life experiences of women that come with forced resettlement from the Muslim world to the European diaspora is a vital part of a holistic approach to pain management.

Occupation as described by academically skilled occupational therapists in Sweden: a Delphi study.

The aim of this study was to continue the process of exploring and understanding the concept of occupation in a Swedish occupational therapy context and from an expert perspective. Thirteen eligible occupational therapists active in Sweden, all academically skilled and who had published articles concerning the concept of occupation or activity, were invited to take part in the study. Eight were willing to participate representing different parts of Sweden. A three-round Delphi study was conducted in which the participants reflected on 46 statements derived from a core category and five categories concerning the concept of occupation, extracted from previous studies in this project. The participants gave 124 comments on 44 of the 46 statements. Results revealed new statements, mainly concerning the intentional aspect of occupation and occupation in a structural hierarchy. Comments also contributed with rephrased statements promoting clarity. A total of 54 statements were then ranked on a four-point Likert scale of which 47 reached consensus among participants. Seven statements were not supported to a level of consensus. Four of them dealt with how and if values and individual judgements influence what are viewed as occupations. To continue the developing process, studies in occupational therapy praxis have to be performed.

Maintaining professional confidence--monitoring work with obese schoolchildren with support of an action plan.

School nurses meet obese children in their everyday work. Although school nurses acknowledge the importance of getting hold of school children's obesity, they seem to lack strategies enabling them to handle the delicacy of the problem. The aim of this study was to describe how school nurses perceive their work with obese children with support of an action plan. Qualitative in-depth interviews were performed with six school nurses working in a municipality, where an action plan for the work with obese school-age children had been implemented. The transcribed data was analysed by a manifest content analysis. The results showed that the informants perceived having a key role in the obesity work, which they experienced as meaningful, but full of pitfalls. They found themselves suitable for the task, but perceived lacking deeper knowledge about specific modes of work such as motivational conversation. As the task was considered delicate, there were great demands for guidelines, education and cooperation. The action plan served as support for maintaining professional confidence throughout the process, but there was room for improvements.

Aspects of health, physical/leisure activities, work and socio-demographics associated with pet ownership in Sweden.

AIMS: The aim of the work presented here was to explore differences between pet owners and non-pet-owners concerning aspects of health, physical/leisure activities, work and socio-demographics. METHODS: The study was based on nationally representative data from the Swedish population (n = 43,589). Associations between pet ownership and background variables were investigated using logistic regression analysis. RESULTS: A total of 39,995 respondents were included in the analysis (non-pet-owners = 25,006; pet owners = 14,989). Pet ownership was associated with both positive and negative aspects of health, physical/leisure activities and socio-demographics. Pet owners had better general health but suffered more from mental health problems than non-pet-owners. Their leisure activities involved a greater interest in nature life and/or gardening than those of non-pet-owners. The logistic regression analysis showed that people who were self-employed, in the age range 35 to 49, of female sex, and suffering from pain in the head, neck and shoulders were more likely to own a pet than others. People physically active at a level sufficient to have a positive effect on their health more often owned a pet than people who were less active. CONCLUSIONS: Pet owners differ from non-pet-owners in aspects of socio-demographics, health, physical/leisure activities and work situation. This study, based on a general regional population in Sweden, showed differences of both a positive and a negative kind between non-pet-owners and pet owners concerning aspects of health, physical and leisure activities, and work situation.

Indicators of need for occupational therapy in patients with chronic pain: occupational therapists' focus groups.

This study explores occupational therapists' (OT) perceptions of indicators for occupational therapy interventions among patients with chronic pain. An exploratory design was applied to six focus groups of OTs (n = 25) for data collection. Analysis was performed using content analysis through identification of meaning units, codes, categories and themes. Limitations of occupational performance was a major theme that included participant restrictions caused by physical, emotional and environmental barriers. Five subthemes of need were identified: 1) pain behaviour that prevented engagement in activities; 2) lack of knowledge about pain mechanisms and strategies to deal with pain; 3) occupational imbalance in work, leisure and home; 4) emotional stress and depression due to pain; and 5) physical or environmental strain resulting in limitations in occupational performance. Because of the variety and the diverse trends of approaches towards interventions for patients with chronic pain that exist in different cultures and settings, this study should be replicated in other contexts to increase the transferability of the findings.

Exploring indicators for pain rehabilitation: a Delphi study using a multidisciplinary expert panel.

OBJECTIVE: Lack of referral guidelines can cause delayed or even non-existent rehabilitation for chronic pain patients. Indicators signalling the need for interventions could counteract this delay for pain rehabilitation and thereby prevent deteriorating patient health. This study aimed to explore the indicators of need for pain rehabilitation using a multidisciplinary expert panel working with pain rehabilitation. METHODS: A three-round Delphi study was conducted with a multidisciplinary expert panel (n = 23), each representing one pain rehabilitation unit in Sweden. The expert panel produced indicators, which were then ranked using a four-point Likert scale. RESULTS: Twenty multi-faceted indicators for pain rehabilitation were identified. A major part concerned patient problems with activity level, catastrophizing, coping, existential problems, fear avoidance, high pain rating, medication, mental health, motivation, no pain relief, pain spread/increase, psychosocial problems combined with activity problems, psychosocial problems, recovery, and reduced physical function. Furthermore, indicators concerned demographic factors, sick leave, situation in primary health care and work. Finally, tacit knowledge was pointed out as an indicator. The results support previous research but also bring out less quantifiable indicators, such as relying on tacit knowledge while assessing a patient's need for rehabilitation. CONCLUSION: The indicators for pain rehabilitation were comprehensive, pointing out that needs assessment is complex. Despite reaching consensus on 19 out of 20 indicators, further research is needed to deepen knowledge in this area and to secure a fair assessment of a patient's need for pain rehabilitation.

High prevalence of cardio-metabolic risk factors among adolescents with intellectual disability.

UNLABELLED: Adults with intellectual disabilities (IDs) have poor lifestyle-related health compared with the general population. Our aim was to study whether such differences are present already in adolescents. AIM: To compare the prevalence and severity of cardio-metabolic risk factors and cardio-vascular fitness in adolescents with and without IDs. METHODS: Intellectual disability (ID) students (n = 66) and non-intellectual disability (non-ID) students from practical (non-ID-p) (n = 34) and theoretical (non-ID-t) (n = 56) programmes were recruited from three upper secondary schools. Anthropometric data, blood pressure, body composition, fasting-insulin, fasting-glucose, fasting-lipids and cardio-vascular fitness were measured. RESULTS: Participants with and without ID differed significantly in the prevalence of cardio-metabolic risk factors with participants with ID having a higher percentage of total fat mass, wider waist circumferences (WCs), lower levels of fat-free mass (FFM), lower bone mineral density (BMD) and higher insulin and homeostasis model assessment of insulin resistance (HOMA) levels and poorer cardio-vascular fitness. The healthiest levels were found in the non-ID-t group compared to the group with ID and the group with non-ID-p in between. CONCLUSION: The prevalence of cardio-metabolic risk factors and poor cardio-vascular fitness was found to be high in this young population with intellectual disabilities. Measures should be taken to improve the health messages directed towards children and adolescents with intellectual disabilities.

Occupation as described by occupational therapy students in Sweden: a follow-up study.

This study is the second in a series of studies carried out in Sweden concerning the dimensions of the concept occupation. The specific aim of this study was to explore new and confirm previously found dimensions of the concept of occupation in the context of occupational therapy. Occupational therapy students, a few weeks from their completion of studies, were asked to write down spontaneously what they personally considered to be occupation. Forty-two women and three men, aged between 25 and 33 years, participated. Grounded theory with the constant comparative method was used to analyse the data. A coding scheme of 40 codes was used to compare new data with previously found data concerning the concept of occupation as described by occupational therapy students. Six new codes concerning occupation expanded the dimensions of the concept. Five of those were found within the doing and context dimensions. These codes defined occupation as something that depends on who is performing the occupation and where the occupation is performed. Thus, occupation is not a permanent state but also very much depends on subjective experience. Additional studies with experienced occupational therapists have been planned to further expand these findings and aim to give a stronger foundation to the concept of occupation built on empirical grounds.

An integrative review combined with a semantic review to explore the meaning of Swedish terms compatible with occupation, activity, doing and task.

The aims of this study were to explore the intended meaning of the terms "occupation", "activity", "doing", and "task" used in international occupational therapy literature and from this perspective explore which Swedish terms best capture these meanings. A literature review of occupational therapy-related journals was performed to gain a basic understanding of the term occupation and related terms. In addition, a semantic review was used: English and Swedish dictionaries were reviewed to explore the semantic meaning of the English terms "occupation", "activity", "doing", and "task", and the Swedish terms "aktivitet", "syssla/sysselsättning", "görande", and "uppgift". A comparison was also performed by searching for parallels between the results of the literature review, the semantic definitions of the English and Swedish terms and the comprehensive meaning of the Swedish terms aktivitet and syssla/sysselsättning. An overarching idea of the concept of occupation was found in the literature review and for the purposes of this study we have identified this as Occupation for survival. From this overarching idea, three themes were identified: The feature of occupation, Impact of occupation and Occupation an occupational therapy concept. Each theme could be subdivided into sub-themes. The Swedish term aktivitet was found to have more power, strength, and spirit connected to the synonyms found in the semantic analysis than to those connected with the Swedish term syssla/sysselsättning. According to the findings in this study we found that the term "aktivitet" is the best comparable term in Swedish to the English term "occupation".

Occupation as described by novice occupational therapy students in Sweden: the first step in a theory generative process grounded in empirical data.

A core assumption in occupational therapy is that occupation enhances health. This study is one of a series of planned studies carried out in Sweden, with the overall aim to develop a theory, based on empirical grounds, concerning the dimensions of occupation that may be useful in occupational therapy. The specific aim for this study is to examine the dimensions of occupation as generally understood among novice occupational therapy students. Grounded Theory was the chosen method. Data were collected among occupational therapy students. The students wrote down spontaneously what they considered to be included in activity. A preliminary core category "The what, why, and how of occupation" and five other categories emerged from the analysis: (1) The doing and context of occupation; (2) Motive for occupation; (3) Time and place for occupation; (4) Type of participation; and (5) Outcome of occupation. Relationships between the categories were established between the Motive for occupation and Outcome of occupation, which constitute a kind of prerequisite for occupation. The three remaining categories: The doing and context of occupation, Time and place for occupation, and Type of participation established a form for occupation. In conclusion, the study results illuminated the richness of the concept of occupation and support the core assumption in occupational therapy that occupation enhances health.

Occupational therapists' assessments of adults with long-term pain: the Swedish experience.

The purposes of this study were to describe the needs for occupational therapy among people of working age with long-term pain, and to describe treatment interventions based on these assessments. Occupational therapists working in primary health care and/or with special interest in pain management (n=109) assessed 113 people aged 18-58 years with long-term pain with the Occupational Therapy Needs Assessment--Pain (OTNA--P) questionnaire. The occupational therapists recommended treatment interventions where appropriate. The results generated categories of needs that have implications for interventions: 1) need for patient education, 2) needs due to limitations in activity performance, 3) needs due to patient's discouragement, 4) need as a result of patient's dependency and 5) needs related to work. The suggested interventions focused on increased knowledge of how to handle daily occupations, mainly categorized as education and stress management' and behavioural' interventions. Significant correlations were found between the assessed needs and the suggested interventions. The results of this study could assist in developing guidelines for practitioners working in occupational therapy pain management programmes. It is recommended that further research is done on the effectiveness of occupational therapy interventions with patients with long-term pain.