Make My Day: primary prevention of stroke using engaging everyday activities as a mediator of sustainable health - a randomised controlled trial and process evaluation protocol.

INTRODUCTION: The individual, societal and economic benefits of stroke prevention are high. Even though most risk factors can be reduced by changes to lifestyle habits, maintaining new and healthy activity patterns has been shown to be challenging.The aim of the study is to evaluate the impact of an interdisciplinary team-based, mHealth-supported prevention intervention on persons at risk for stroke. The intervention is mediated by engaging everyday activities that promote health. An additional aim is to describe a process evaluation that serves to increase knowledge about how the programme leads to potential change by studying the implementation process and mechanisms of impact. METHODS AND ANALYSIS: The study will be a randomised controlled trial including 104 persons at risk for stroke. Persons at risk of stroke (n=52) will be randomised to an mHealth-supported stroke prevention programme. Controls will have ordinary primary healthcare (PHC) services. The 10-week programme will be conducted at PHC clinics, combining group meetings and online resources to support self-management of lifestyle change using engaging everyday activities as a mediator. Primary outcomes are stroke risk, lifestyle habits and participation in health-promoting activities. Assessments will be performed at baseline and at follow-up (11 weeks and 12 months). The effects of the programme will be analysed using inferential statistics. Implementation will be analysed using qualitative and quantitative methods. ETHICS AND DISSEMINATION: The study has been approved by the Swedish Ethical Review Authority. Study results will be disseminated in peer-reviewed journals and at regional and international conferences targeting mixed audiences. TRIAL REGISTRATION NUMBER: NCT05279508.

The Feasibility of Make My Day-A Randomized Controlled Pilot Trial of a Stroke Prevention Program in Primary Healthcare.

Incorporating and sustaining engaging everyday activities (EEAs) in everyday life holds potential for improving health and wellbeing; thus, there is reason to explore EEAs as a behavioral change technique in stroke prevention. The aim of this study was to evaluate the feasibility of the stroke prevention program Make My Day (MMD) for people with moderate-to-high risk for stroke in a primary healthcare setting, where EEAs are utilized to promote healthy activity patterns. A randomized controlled pilot trial was designed to evaluate the feasibility of MMD. Twenty-nine persons at risk for stroke were recruited and randomized into either an intervention group (n = 14) receiving MMD or a control group (n = 15) receiving brief health advice and support with goal setting. The results suggest that MMD is feasible, with timely recruitment, overall high response rates and study completion, and sensitivity to change in key outcome measures. Moreover, the results demonstrate that the application of EEAs can be useful for promoting behavioral change in stroke prevention. Recommendations for improvements for a full-scale trial include recruiting a relevant sample, using reliability- and validity-tested outcome measures, and implementing strategies to limit missing data.

Occupational therapy gender imbalance; revisiting a lingering issue.

BACKGROUND: Recently, it has been suggested that gender disparity in Occupational Therapy has to do with segregated gendered job norms that position female dominated professions as a 'step down' for many males. Interestingly, this suggestion was not underpinned by experiences of males in the profession. AIMS AND METHODS: Thirteen male Occupational Therapists with a variety of backgrounds were invited to this Round Table research, focussing on the broader issue of the existing gender imbalance in Occupational Therapy. RESULTS: Two themes emerged: 'The core values of the profession', and 'Broadening the scope of the profession'; none of them suggesting that male/female imbalance was necessarily the most pressing issue. CONCLUSIONS: A gender-unrelated approach to everyday problem-solving was put forward to achieve increased diversity in Occupational Therapists' backgrounds, better reflecting the people they serve. By broadening the scope and the way the profession is presented, and encouraging innovative and more entrepreneurially driven approaches, diversity in the workforce could be further facilitated. These findings are discussed within the context of 'The mutual constitution of cultures and selves' model. SIGNIFICANCE: Diversity in the Occupational therapy workforce could be further facilitated with a shift in focus away from the male/female perspective to an intersectional approach.

Incorporating new ways of doing by learning from everyday experiences and interactions using a multifactorial mHealth app.

Background: Digital health innovations can support the prevention and management of risk factors for cardiovascular diseases, such as stroke. However, little is known about people's everyday experiences of digitally augmented stroke-prevention programmes combining onsite group sessions including peers and healthcare professionals with interaction and support from a multifactorial mHealth app. Objective: The aim of this study was to explore how people with stroke risk experienced interaction with a multifactorial mHealth app as support in the make my day stroke-prevention programme. Methods: Repeated interviews and observations with 12 adults with moderate to high stroke risk were analysed using a constant comparative method informed by constructive grounded theory. Results: Incorporating new ways of doing into everyday life involves a process through which participants learn from both being and doing in different environments (e.g., digital, physical and social). Digital self-monitoring combined with seemingly trivial everyday experiences played central roles in the process of increasing awareness of health and stroke risks, and providing tools to support increased self-reflection on everyday behaviours. Adoption of positive health behaviours in everyday life was supported or hindered by how easy to use and personally relevant the mHealth app was perceived to be. Conclusions: An experience-based group programme together with a personally relevant multifactorial mHealth app can be supportive in stroke prevention to increase general health literacy and stroke risk literacy, and promote the incorporation of new ways of doing in everyday life. Routines of doing digital self-monitoring and health-promoting activities were however strongly influenced by different environments in which choices are presented. It is therefore important to explore how both self-monitoring and health-promoting activities can be incorporated into everyday routines for different individuals. Research should also explore how personally relevant mHealth can be developed and integrated into prevention practices in primary healthcare.

Stakeholders' Expectations of Return-to-Work After Spinal Cord Injury: A 1-Year Follow-Up.

Understanding the process of return-to-work is key to supporting people's social participation and health after a disability. This phenomenographic study aimed to explore the expectations and ways of understanding return-to-work from the perspectives of three stakeholder types: three workers with spinal cord injuries, their employers, and an occupational therapist coordinator. Participants were interviewed twice, at 6 and 12 months, after having participated in a research-based return-to-work intervention in Sweden. A phenomenographic approach was used to analyze the data. The findings highlight how stakeholders' different expectations prevented them from openly discussing more flexible arrangements to make return-to-work viable and sustainable. The study contributes to occupational therapy practice by raising awareness of the challenges of work reintegration. It also adds to the body of knowledge in occupational science by illuminating how normative social expectations and policy concerning work/productivity influence the return-to-work process.

Return to work among workers recovering from severe COVID-19 in Slovenia: a focus group study.

PURPOSE: For working age adults, return to work (RTW) after severe COVID-19 can be an essential component of rehabilitation. We explored the expectations and experiences related to RTW in a group of workers recovering from severe COVID-19 in Slovenia. MATERIALS AND METHODS: Four focus groups were conducted between May 2021 and August 2021. Fifteen men and three women, aged between 39 and 65 years, participated. We analysed data using reflexive thematic analysis. RESULTS: Four main themes were developed in the analysis, pertaining to (1) work identity, (2) challenges to work re-entry, (3) personal strengths and support systems, and (4) possible adaptations at work. The disruption of work triggered sentiments about its role in identity. Workers' personal agency and self-advocacy helped participants cope with various barriers that were beyond their control, such as physical limitations and lack of systematic routines to address RTW. Workers recovering from severe COVID-19 were at risk of developing negative expectations regarding their work re-entry. CONCLUSIONS: RTW after severe COVID-19 involves different personal, organizational and systemic dimensions that need to be considered and carefully aligned. Due to the individuality of the process, the worker should be involved as a key partner in the RTW process.IMPLICATIONS FOR REHABILITATIONLack of clinical pathways can negatively impact return to work (RTW) after severe COVID-19.RTW processes should start early but timely and include individual follow up.Patients expect the interdisciplinary team of experts to work together and involve them in all phases of decision-making regarding their rehabilitation and RTW process.Positive expectations regarding work re-entry are essential for the RTW process.

Return to work after COVID-19: Experiences and expectations from the first wave of COVID-19 in Stockholm.

BACKGROUND: In Stockholm (Sweden) a substantial number of persons who were infected with SARS-CoV-2 during spring 2020, and received intensive care followed by rehabilitation due to COVID-19, were of working age. For this group, return to work (RTW) is an important part of the rehabilitation, however this is an area that thus far has received little scholarly attention. The Aim of this study was two-fold. First, to descriptively look at self-reported work ability over time using the Work Abilty Index among working age adults who recovered from severe COVID-19, and secondly, to explore experiences and expectations concerning RTW among working age adults who recovered from severe COVID-19. METHODS: Focus group interviews and qualitative thematic analyses were utilized. In addition, the study populations' self-reported work ability index was recorded over one year. FINDINGS: Qualitative analysis of data resulted in 5 themes: a) Initial experiences after discharge from in-patient rehabilitation, b) Disparate first contact with work, c) Uncertainties about own role in RTW process, d) Working situation for those who had started getting back to work, and e) A need to reprioritize expectations for work in the context of everyday life. There were no statistical differences in work ability index scores between 18 and 52 weeks after discharge from an in-patient rehabilitation unit. CONCLUSION: RTW after COVID-19 can require systematic support for several months as well as be initiated earlier in the rehabilitation process. Further research in the area is needed.

Cocreation from Emerging Opportunities: Occupational Therapists' Perspectives on Supporting Older Persons, in Japan.

Introduction: Practices of occupational therapists, particularly those supporting older persons with physical impairments, remain overly focused on remediating impairments, and implementation of occupation-centered practices remains fraught with difficulties. In Japan, this issue exists across the continuum from acute care to rehabilitation settings and into the community. This is despite the existence of international models and frameworks that place occupation at the core of the profession. Accordingly, there is a need to better understand how occupational therapists respond to the call for occupation-centered practices across the said continuum of care with this population. The aim of this study was at exploring and understanding occupational therapists' experiences of supporting the resumption of occupations among older persons with physical impairments, in Japan. Methods: Embedded in a constructivist world view, this was a qualitative focus group study. Four focus groups (two in urban areas and one each in rural and semirural areas), consisting of seven or eight occupational therapists with at least three years of relevant practice experience, convened twice to narrate and explore their support of older persons. All were participating voluntarily with confidentiality of their participation being guaranteed by the researchers. They met for a third time to verify emerging analytic results. Data were analysed using a reflective thematic analysis. Results: Identified were three themes, namely, calling forth powers of occupations, imagining client's future, and cocreating plots, which we synthesized into recurring cocreations from emerging opportunities. Discussion. Supporting the resumption of occupations among older persons with physical impairments hinges on repeated processes of identifying possibilities for occupation, followed by actions to bring these (e.g., images of clients' future) into reality. Occupations' healing properties (i.e., occupations' powers) can be used to assist clients in experiencing health and well-being. The results suggest a reframing of occupational therapy practices as recurring processes of recognizing opportunities for occupation, followed by actions whereby these possibilities are turned into reality. Occupational therapy effectiveness might be enhanced when goals and methods are repeatedly and creatively aligned with the evolving plots cocreated between the client, therapist, and stakeholders.

Photovoice Revisited: Dialogue and Action as Pivotal.

Photovoice has gained acceptance as a viable visual method to engage community members as partners in research. However, as methods associated with photovoice have developed and evolved over time, concerns have also been raised with regard to how this impacts the methodological underpinnings on which photovoice rests. The aim of this article is to explore the meaning of dialogue and action as methodologically pivotal for the relevance of photovoice as community-based participatory research; further, using an empirical case and narrative theory, we attempt to contribute to an understanding of the processes that facilitate the viability and relevance of photovoice. By unpacking the contributions of dialogue and action towards a participatory methodology, in this case photovoice, the authors illustrate and argue for aspects critical in photovoice. Drawing on these aspects provides an arena for storytelling and story making, which have not previously had an explicit part in photovoice.

Communication and engagement as potentiality in everyday life between persons with young onset dementia living in a nursing home and caregivers.

OBJECTIVES: To explore communication and engagement in everyday situations between persons with young-onset dementia (YOD) living in a nursing home (NH) and the caregivers. METHODS: The study draws on ethnographic methods aligned with participatory design. Three residents with YOD living in a NH and eight staff members were recruited. A narrative approach was used for data collection and analysis. FINDINGS: Three narrative vignettes were developed representing everyday situations in which communication and engagement was enacted among residents and caregiver staff: (a) waiting for something to happen, (b) tensions about everyday communication, and (c) negotiating a combined living + working environment. The findings stress a paradoxical tension rooted in the NH as residence and workplace as well as place of calm and place of boredom. The everyday situations are interpreted differently from the perspective of the residents and staff. CONCLUSION: The identified paradox of planned and spontaneous situations influences communication and engagement in everyday life, and the potentiality for active engagement embedded in contexts of units for residents with YOD. The degree to which everyday activities and encounters are redefined and renegotiated is an important part of caregiving practices in NH settings for residents with YOD.

Engaging occupations among persons at risk for stroke: A health paradox.

BACKGROUND: An occupational perspective in stroke prevention could support sustainable changes in habits and routines that could contribute to reduce modifiable risk factors. AIM: To explore engaging occupation in relation to risk for stroke by drawing on experiences from everyday life among persons with a heightened risk for stroke. MATERIAL AND METHODS: Interviews from 14 persons with an increased risk for stroke were analysed by a constant comparative approach. FINDINGS: The analysis resulted in the core category; the paradox of engaging occupations and health. The paradox involved aspects of engaging occupations that could provide well-being and at the same time were compromising considering stroke health. CONCLUSIONS AND SIGNIFICANCE: The paradox conceptually challenges some of the core values inherent in occupational therapy regarding the relationship between engaging occupations, health and well-being. Gaining a deeper understanding of experiences of occupations and studying this in relation to health promoting or compromising characteristics of occupations, can facilitate lifestyle programs that support changes in everyday life. Moreover, programs need to be designed to offer personal relevance and to facilitate a positive balance between health compromising occupations and health promoting occupations in everyday life.

'Weaving lifestyle habits': Complex pathways to health for persons at risk for stroke.

BACKGROUND: It is important to understand how healthy lifestyle habits can be developed as they are essential in cardiovascular disease (CVD) prevention. There is limited knowledge regarding whether, and how, engaging occupations (things that people do and occupy themselves with) can promote and help sustain healthy lifestyle habits for persons at risk for CVDs, including stroke. AIM: The aim was to develop knowledge of how engaging in occupations can contribute to changes in lifestyle habits among persons at risk for stroke. METHODS: Six adults presenting with stroke risk factors were interviewed on several occasions after participating in an occupation-focused stroke prevention programme. Grounded theory was utilised, and constant comparative methods guided the analysis. FINDINGS: Changing lifestyle habits was perceived as a complex process, much like weaving a fabric with many parallel and interlacing threads. Literacy of both health and occupations and participation in engaging occupations were important facilitators for promoting healthy lifestyle habits, yet engagement in health-promoting occupations was described as conditioned behaviour. CONCLUSIONS: CVD prevention programmes can benefit from incorporating engaging occupations to promote healthy lifestyle habits and literacy of health and occupations. However, contextual factors conditioning health and occupations should be considered when developing and implementing sustainable interventions.

Experiences and motives of retirement-aged workers during the first wave of COVID-19 in Slovenia: "This was the first time in 40 years that I really saw spring".

Choosing to continue working after retirement eligibility can attract both negative and positive sentiments from the general public. Studies examining the motivations of older workers have so far been conducted in times of relative social and economic stability. However, little is known about what it means for older workers to work during a lockdown or pandemic situation. The present longitudinal study aimed to explore experiences of retirement-aged workers in Slovenia in relation to their motives for prolonged work activity amid the COVID-19 pandemic, using the theory of gerotranscendence as a theoretical framework. Nine workers were interviewed before and after the start of the pandemic. The qualitative analysis was based on 18 interviews and observations, juxtaposing two analytical methods in order to illustrate common themes across the data as well as tensions in specific situations within a narrative context. Four main themes are presented: Unchanged plans, Motive developments, Psychological preparation for retirement and Views of society. In addition, a narrative analysis is presented with a focus on self-transcending elements in some of the participants' narratives. The findings suggest that during a pandemic, older workers' individual experiences might be constructed more positively compared to other groups, especially if they develop agentic identity and pursue meaningful activities. We discuss an innovative approach to gerotranscendence, complementing this theory with concepts from occupational science to develop a clearer distinction from the now dated disengagement theory and examine the life trajectories of older workers in novel situations such as a pandemic.

Engagement in Everyday Activities for Prevention of Stroke: Feasibility of an mHealth-Supported Program for People with TIA.

Most of the risk factors for stroke are modifiable, yet incorporating and sustaining healthy lifestyle habits in daily life that reduce these risk factors is a major challenge. Engaging everyday activities (EEAs) are meaningful activities that are regularly performed that have the potential to contribute to the sustainability of healthy lifestyle habits and reduce risk factors for stroke. The aims of this study were (1) to investigate the feasibility and acceptability of a digitally supported lifestyle program called "Make My Day" (MMD) for people at risk for stroke following a transient ischemic attack, and (2) to describe participants' stroke risk and lifestyle habits pre- and post-intervention. A multiple case study design using mixed methods was utilized (n = 6). Qualitative and self-reported quantitative data were gathered at baseline, post-intervention, and 12 months post-baseline. The results indicate that MMD can support lifestyle change and self-management for persons at risk for stroke following a TIA. The findings indicate a high acceptability and usability of MMD, as well as a demand for digital support provided via a mobile phone application. Self-management with digital support has the potential to increase participation in EEAs for persons at risk for stroke following a TIA.

"Suddenly we have hope that there is a future": two families' narratives when a child with spinal muscular atrophy receives a new drug.

Purpose: This study aims to explore negotiations of hope in everyday life for families where a child with spinal muscular atrophy (SMA) has received a new drug treatment.Methods: A narrative design was used, drawing on interviews and participant observations in two families with children with SMA, types 1-2, to situate family experiences of hope in everyday life. Narrative analysis was used on the data.Results: Results are presented as stories, with details about situations and contexts, to illustrate how hope was used by families to reconstruct their own family narratives.Conclusions: Hope was negotiated and struggled with in different ways by different family members, but contributed to each person's own way of dealing with the disease and outlook for the future.

Return-to-work: Exploring professionals' experiences of support for persons with spinal cord injury.

PURPOSE: To generate knowledge about how professional stakeholders organise and experience the support of the return-to-work (RTW) process for persons with spinal cord injury (SCI). METHODS: Constructivist grounded theory approach. Professional stakeholders (n = 34) involved in the RTW process and representing three Swedish Regions were recruited into seven focus groups. Analysis followed initial, focussed, and theoretical coding. FINDINGS: The core category - mediating intentions to support work and possibilities of working through social, labour market, and societal context - illustrates complexities of when and how to support a person with SCI in the RTW process, and a risk of delayed, unequal, or absent RTW processes. Analysis outlines: (1) Assessment of ability to work - uncertainty of how and when; (2) Planning RTW - divide between dynamic and rule-based perspectives; (3) Work re-entry - unequal paths towards viable solutions. CONCLUSIONS: In RTW after SCI, it is critical to acknowledge how the RTW process is situated in relation to the person and context. A possible direction - grounded in an occupational perspective - through early identification of needs and resources and coordination derived from the SCI rehabilitation setting within healthcare is suggested. This can facilitate a time-sensitive and equal RTW process.

Views on everyday life among adults with spina bifida: an exploration through photovoice.

The aim of this study was to actively integrate expertise of persons living with spina bifida, to explore conditions embedded in their everyday life. This was important because young adults with spina bifida risk not being able to fully participate in the community on equal terms and in accordance with their own preferences. Photovoice, a community-based participatory research approach, was utilized to engage participants through dialogue and photography. An exhibition was created to share results with community and stakeholders. An overarching theme that characterized the experiences of the group was, "an adaptation for us, but it works for no one". Findings are presented as: "Accessibility-a never-ending project," "Tensions of a normative view," and "Power to influence." Findings integrated everyday life metaphors photographically depicted by broken elevators, unsafe transportation, closed doors and not experiencing real opportunities of involvement. Tensions in everyday life experienced by persons living with spina bifida can inform conditions relevant and necessary to support community participation, particulary among persons living with disability.

Evaluating the feasibility of ReWork-SCI: a person-centred intervention for return-to-work after spinal cord injury.

OBJECTIVES: To evaluate the feasibility of: (1) ReWork-SCI with regard to adherence and acceptability and (2) a study design for evaluating ReWork-SCI with regard to recruitment, retention and outcome measures. DESIGN: Pre-test and post-test, single group, feasibility study. SETTING: Spinal cord injury (SCI) unit at a regional rehabilitation centre in Sweden. PARTICIPANTS: Two women and five men (n=7). Eligible criteria: (1) sustained traumatic or non-traumatic SCI; (2) completed the first acute care episode in a hospital; (3) between 18 to 65 years of age; (4) assessed by a physician as approachable for participation in the intervention; (5) history of permanent or temporary employment; (6) self-reported desire to return to work; and (7) ability to communicate in English or Swedish. INTERVENTION: ReWork-SCI is a person-centred intervention for return-to-work (RTW), developed and evaluated using the Medical Research Council's guidelines. ReWork-SCI follows a person-centred, structured and coordinated intervention process led by a coordinator within a SCI rehabilitation team. OUTCOME MEASURES: The feasibility of ReWork-SCI and a study design was evaluated using a set of outcome measurement tools, vocational data, logbooks and semi-structured interviews. RESULTS: All eligible participants accepted enrolment and follow-up. All participants had a plan for RTW after 3 months and four participants had initiated part-time work or work trial 6 months after commencement of intervention. Adherence and acceptability were overall good. Challenges of the intervention related to the person-centred follow-up, staff shortage and rootedness in the SCI team. CONCLUSIONS: ReWork-SCI was feasible and can contribute to a systematic design of an individualised plan, facilitate decision-making and build trust in the RTW process after SCI. Core features of the intervention was the systematic structure, use of a person-centred approach and dialogue with the employer. For the effectiveness of ReWork-SCI, modifications and considerations of study design are needed.

Being a co-worker or a manager of a colleague returning to work after stroke: A challenge facilitated by cooperation and flexibility.

Background: The process of return to work is complex. Knowledge is scarce regarding the experiences from co-workers and employers about this process.Aim: To explore and describe how co-workers and managers experience the return to work process involving a colleague with stroke who is participating in a person-centred rehabilitation programme focusing on return to work including a work trial.Material and methods: Seven co-workers and four managers were interviewed during the work trial of a colleague with stroke.Results: Being a co-worker or manager was related to various challenging experiences; the emotional challenge of being a supportive co-worker or manager, the challenging experience of having too much responsibility, and the challenge of being supportive despite a lack of knowledge.Conclusions: The participants placed value on having support from the coordinator for handling different challenges, but despite this they experienced difficulties in being a valuable support. The limited time of work trial and occasional lack of support from the employer were aggravating aspects.Significance: This study highlights the importance of establishing a commitment between the employer and all involved actors in the initial phase in order to create the best possibilities for a fruitful return to work process, including work trial.

The use of information and communication technology in healthcare to improve participation in everyday life: a scoping review.

Background and purpose: The increase in use of everyday information and communication technologies can lead to the need for health professionals to incorporate technology use competencies in practice. Information and communication technologies has the potential to improve participation in daily life among people with disability. The aim was to review and describe evidence of the use of information and communication technology, including mobile technology, for improving participation in everyday life. A secondary aim was to describe how study outcomes were related to participation.Materials and methods: A scoping review methodology was used to identify studies through databases as MEDLINE, CINAHL, Cochrane Library. Thereafter, the studies were screened and assessed for inclusion.Results: Eleven studies were included. The most commonly used technology were videoconferencing and the telephone. Ten of the 11 studies reported a change in participation in everyday life. Participation was mainly described as involvement in a life situation or related to activities of daily living.Conclusion: Delivering an intervention to improve participation through information and communication technology can be a valid option in rehabilitation. There is a need to measure and describe the intervention and its outcomes in relation to a definition of participation in future studies.IMPLICATIONS FOR REHABILITATIONThe use of an information and communication technology application seems to be as good as the face-to-face intervention.There is a need for defining the concept of participation related to outcome measures in future studies.