Hospital discharge among frail elderly people: a pilot study in Sweden.

A conceptual framework for the hospital discharge process was designed. It was intended to measure frail elderly people's experience of their quality of care in terms of satisfaction and trustworthiness during their hospital discharge and their experience at home. The present pilot study aimed at evaluating the viability of an occupational therapy clinical tool. Nine frail elderly Swedish individuals reported the quality of their care as mostly satisfactory and trustworthy, according to their responses to the Discharged Patients' Enquiry Questionnaire (DPEQ). However, the participants were not satisfied with the non-continuity among the home-helpers, the lack of rehabilitation services and the non-availability of professional help, for example occupational therapy for increasing social contacts. The participant's responses indicated that occupational therapy interventions, that is, assessment of home environment (n = 6), improvement of housing accessibility (n = 3) and prescription of assistive devices (n = 4), contributed to their ability to live at home. The results are limited owing to the small number of participants. Future investigations of the care that patients discharged from hospitals receive are recommended to explore supplementary assessments of spouses' care burden and participants' quality of life, and the psychometric functions of the conceptual framework. In summary, the conceptual framework described may be a viable tool for evaluating the discharge process among frail elderly people discharged from hospitals to their homes.

Horticultural therapy: the 'healing garden'and gardening in rehabilitation measures at Danderyd Hospital Rehabilitation Clinic, Sweden.

OBJECTIVES: Objectives were to review the literature on horticultural therapy and describe the Danderyd Hospital Horticultural Therapy Garden and its associated horticultural therapy programme. DESIGN: The literature review is based on the search words 'gardening', 'healing garden' and 'horticultural therapy'. The description is based on the second author's personal knowledge and popular-scientific articles initiated by her. The material has been integrated with acknowledged occupational therapy literature. SETTING: The setting was the Danderyd Hospital Rehabilitation Clinic, Sweden, Horticultural Therapy Garden. PARTICIPANTS: Forty-six patients with brain damage participated in group horticultural therapy. RESULTS: Horticulture therapy included the following forms: imagining nature, viewing nature, visiting a hospital healing garden and, most important, actual gardening. It was expected to influence healing, alleviate stress, increase well-being and promote participation in social life and re-employment for people with mental or physical illness. The Horticultural Therapy Garden was described regarding the design of the outdoor environment, adaptations of garden tools, cultivation methods and plant material. This therapy programme for mediating mental healing, recreation, social interaction, sensory stimulation, cognitive re-organization and training of sensory motor function is outlined and pre-vocational skills and the teaching of ergonomical body positions are assessed. CONCLUSION: This study gives a broad historic survey and a systematic description of horticultural therapy with emphasis on its use in rehabilitation following brain damage. Horticulture therapy mediates emotional, cognitive and/or sensory motor functional improvement, increased social participation, health, well-being and life satisfaction. However, the effectiveness, especially of the interacting and acting forms, needs investigation.

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.

The meaning and form of occupational therapy as experienced by women with psychoses. A phenomenological study.

The meaning and form of occupational therapy as experienced by women with psychoses: a phenomenological study The aim of this study was to illuminate the experiences of occupational therapy interventions in individuals with psychoses. Repeated tape-recorded narrative interviews were conducted with six women participating in occupational therapy immediately after an intervention. The subsequent analyses followed a phenomenological approach. Key constituents integrated in two structures, are the main findings. The meaning of occupational therapy as expressed in the key constituents relief, self-knowledge, belief in the future, capability, resistance and satisfaction formed one structure. The form of occupational therapy as expressed in the key constituents time, environment, guidance, voluntariness and collaboration represented the other structure. These findings confirm and give empirical support to beliefs and assumptions expressed in occupational therapy literature. The results form a conceptual base for developing an evaluative assessment instrument for individuals with psychoses participating in occupational therapy.

The sense-of-coherence and the capability of performing daily occupations in persons with chronic pain.

OBJECTIVES: It may be helpful for occupational therapists who promote enabling occupations among persons with chronic pain, to understand the relationship between the persons feelings of meaningfulness, comprehensibility and manageability in life and their capability to perform daily occupations. AIM: The aim of this study was to describe and investigate how these concepts of person and occupational performance of 27 daily occupations in terms of "effort", "inconvenience", "avoidance", "give up", "frequency" and "satisfaction" were related to each other. DESIGN: A prospective correlative study was conducted. METHOD: A consecutive series of eighty-four patients with chronic pain completed a structured interview and responded to the self-assessment instruments Sense-of-Coherence Scale (SOC-13) and Capability of Performing Daily Occupations (CPDO). RESULTS: Weak but significant correlation (p < 0.05) were found between the SOC-13 sub-scale "manageability" and the specific occupations "physical exercise / training" (r = - 0.24), "climb stairs" (r = - 0.27) "social activity" (r= - 0.25) and "wash the laundry" (r = - 0.30), as well as between the SOC-13 sub-scale "meaningfulness" and the CPDO occupations "grocery shopping" (r = -0.22), "performing meals" (r = - 0.24), and "wash the laundry" (r = - 0.31) and the CPDO question "frequency of performing occupations" r = -0.22). The participants' mean value (mean = 58) of SOC-13 was below the other populations represented in a literature review. The mean values for CPDO (3.4-4.3) (optimal score is zero) showed that the participants perceived themselves having activity limitations concerning performance of daily occupations, and the performance area of work productive activities were experienced as more disabling. The degree to which the participants perceived themselves having a strong sense of coherence or being disabled by pain varied greatly both for the results of SOC-13 ( range 32-90 points) and CPDO (range 1.1-7.8 points). CONCLUSION: The expected significant relationship between a person's sense of coherence and the performance of daily occupations was partly verified with weak significant correlations. In clinical practice the assessment instruments are suggested to be of value in rehabilitation clinics for occupational therapists who work with people with chronic pain.

Multidimensional aspects of work capability.

OBJECTIVE: Comparisons of the results of a multidimensional criterion-referenced vocational assessment (CMVA) were performed between a group of patients with chronic pain (group P; n = 86) and individuals working (group W; n = 106). The participants had experience of five job categories. METHODS: The participants' capability to work was assessed from the aspects of personal factors, background data, present work experience, personal and work environmental factors probably influencing work capacity and capacity to perform occupations. Eleven instruments comprising 407 items were used. RESULTS: The results of the comparisons suggest that group P participants' work capacity was significant decreased by how they perceived their present work experience (X^2; p < 0.001), self-assessed or observed capability to perform daily and work occupations (t; p < 0.000). Among the factors which probably influenced their work capability, group P participants significantly (t; p < 0.05) more often used confrontive, emotive, palliative and covert coping strategies and had attained work and other life values to a less extent. Moreover, group P participants perceived that they had had a significant (t; p < 0.000) higher degree of psychosocial demands and more strain incurred from the psychosocial work environment.

A criterion-referenced multidimensional job-related model prediction capability to perform occupations among persons with chronic pain.

OBJECTIVE: The purpose of this prospective study was an exploration of the construct of the criterion-referenced multidimensional job-related model (CMVA) aimed for predicting patients' with chronic pain capability to perform occupations. METHODS: The study samples were 1) participants (n=84) who at present were not performing employed work (median sick-listing period 12 months) because of chronic pain and 2) participants (n = 104) who at present were performing employed work at least 20 hours of a workweek. The participants had experiences of 40 different occupations classified into five of the occupational categories of Jist's Enhanced Dictionary of Occupational Titles. Data were collected through ten assessment instruments and a structured interview, comprising 54 variables and 465 items. Data were analyzed using multiple regression with forward entering of variables. RESULTS: The CMVA model (Adjusted R^2 0.777, F (4, 183) = 164.067; p<0.001) was able to explain 78% of the variance. CMVA contained the aspects; "the work demands-variable, the person-variable of work life values, the environment-variable of social support and the two occupational performances-variables; self-perceived capability to perform work tasks/the simulated work tasks". CONCLUSIONS: The construct of CMVA was robust suggesting that among persons with chronic pain, the predictors focusing on their capability to perform occupations are of great importance.

A study of well-being among a population of Swedish workers using a job-related criterion-referenced multidimensional vocational assessment.

OBJECTIVES: This study involved Swedish workers (n = 106) who perform jobs categorized into four occupational groups from Jist's Enhanced Dictionary of Occupational Titles (DOT) (Technical, Clerical, Service and Miscellaneous occupations) [1]. The workers capacity for work were investigated according to the Criterion Referenced Multidimensional Vocational Assessment (CMVA) comprising four aspects (described below), which were assessed in 14 different ways using 465 items. METHOD: The participants were interviewed [2], observed during performance of simulated work tasks [3], and answered mailed questionnaires [4,5,6,7,8,9,10,11,12,13,14,15]. The collected data were statistically analyzed using descriptive statistics and the tests of Cronbach's alpha coefficient, ANOVA, Chi-square, linear regression and Pearson's correlation coefficient. RESULTS: The participants' work contained different level of occupationally substantive complexity showing that the work demands were different for the four work groups. For some of the participants ill-health were detected; The workers' work skills, e.g., the demands (VALPAR work samples) [3] the jobs required of the worker was higher than 14 of the workers' capacity for work. It was remarkable that many of the workers (34%) estimated themselves in need for rehabilitative measures (Functional Status Questionnaire) [12,13]. The results suggested that there was a negative discrepancy of what the workers' valued and strived for in connection to what they had attained in their work-lives [15,16]. The psychosocial work environment influenced the worker both positively and negatively. Participants (about 17%) who are performing their usual work for at least 20 hours a week had risks for ill-health [6]. In several components of CMVA there were significant differences between male and female workers, probably showing that the female workers had a greater burden to perform all the myriad of daily occupations (Self-Assessed Capabilities to Perform Daily Occupations) [7] including salaried work.

Validation of the theory: satisfaction with time-delimited daily occupations.

OBJECTIVES: This study examines the construct validity of the theory Satisfaction with time-delimited daily occupations (STO). The outcome of STO concerns how individuals perceive their occupational health status and to what degree the individuals experience satisfaction with their performance of time-delimited daily occupations. DESIGN: The "known-groups technique" was used for discriminating the occupational health status among four groups (n = 147) of full-time workers or sick-listed participants. A mailed ActivityLog-sheet was used for recording their occupational health 24 times during 24 hours. The computerized program ActivityLog was used for data registration. The data analysis were accounted by ANOVA, Tukey's HSD test with significance level of p < 0,05 using the SPSS program. RESULTS: The occupational health status did not differ significantly among the four groups, but the number of records concerning work (p = 0,00) and care (p = 0,02) time-delimited daily occupations were significantly different. The patterns of occupational health status during the 24-hour-records were visually separated for the four groups. CONCLUSION: There is need for refining the STO theory and then for undertaking further investigations of the STO construct validity.