Self-initiated management strategies in digitalized work and everyday life - experiences of people with cognitive difficulties due to neurological disorders.

Background: Digitalized work life can increase cognitive demands and influence people's everyday life. This can be challenging for people with cognitive difficulties, yet there is scarce knowledge of how they manage these. It is essential to learn how self-initiated management strategies can be a resource to support sustainable work and everyday life.Aim: To describe how people with cognitive difficulties due to neurological disorders experience their use of self-initiated strategies to manage digitalized work and other activities of everyday life.Material and Methods: Eleven employees in digital work with cognitive difficulties and neurological disorders participated in qualitative interviews supported by a dialogue support tool. Data were analyzed using content analysis.Results: A complexity of strategies was used to manage digital work and other activities. Based on how strategies were applied, three different profiles were found. These reflected efforts to manage situations in everyday life and how these influenced strategies applied and their importance.Conclusion: This knowledge can support people with cognitive difficulties and professionals to become aware of the potential of strategies and acknowledge a person's own management resources. Reflections on how to manage situations can give perspectives on prevention or vocational rehabilitation to facilitate a sustainable work life.

Accessing public space in the digital society: relationship between the use of everyday technology and places visited outside the home after acquired brain injury.

PURPOSE: In the digital society, people need to make use of a range of everyday technology (ET) when engaging in activities in various places outside home. The aim of this study was to describe and compare the use of ET and places visited outside the home and, also, to describe the relationship between them in people with different severity of disability after acquired brain injury (ABI). MATERIALS AND METHODS: Instruments addressing ET use, places visited outside the home and severity of disability were used to assess 74 individuals with ABI. Relationships were analyzed statistically. RESULTS: A significantly higher use of personal ET related to public space and public space ET, a higher ability to use ET and more places visited outside the home was found in those with good recovery (GR) compared to those with moderate disability/severe disability (MD/SD). The use of ET was significantly correlated with places visited in the total sample and in those with MD/SD, but for those with GR, no significant correlations were found. CONCLUSIONS: To facilitate participation after ABI, the relationship between the use of ET and places visited outside the home needs to be assessed in rehabilitation.Implications for rehabilitationDigitalization has increased the need of everyday technology (ET) when visiting various places in society.The use of ET was positively significantly correlated with the total number of places visited outside the home in the sample of people with acquired brain injury (ABI).Those with severe or moderate disability after their ABI used significantly fewer ET and visited fewer places compared to those with good recovery.Evaluation of the use of ET and places visited outside the home is important in rehabilitation to support participation after ABI.

Perceived occupational value in people with acquired brain injury.

BACKGROUND: It is well known that engagement in occupations becomes restricted after acquired brain injury (ABI), but little is known about how this influences occupational values and occupational balance. AIM: To describe the extent to which persons with ABI perceived occupational value; to explore whether occupational value and occupational balance were associated with life satisfaction, and to explore how occupational value, occupational balance, the severity of disability, fatigue and sociodemographic characteristics influenced life satisfaction. MATERIALS AND METHODS: A cross-sectional study was undertaken with 75 participants of working age with ABI who responded to questionnaires on occupational value, occupational balance, and life satisfaction. Additionally, instruments covering fatigue and severity of disability were administered. Data were analyzed by means of comparisons, correlations and logistic regression. RESULTS: A high perceived occupational value and a high perceived occupational balance were significantly associated with satisfaction with life as a whole, psychological health and somatic health. The logistic regression showed that occupational value, occupational balance and severity of disability significantly impacted satisfaction with life as a whole.Conclusions and significance: Occupational value and occupational balance together with severity of disability, are important areas of focus in the later phase of rehabilitation after ABI to promote satisfaction with life as a whole.

Patterns of participation: Facilitating and hindering aspects related to places for activities outside the home after stroke.

Background: Being engaged in activities in places outside the home after a stroke can be challenging. Knowledge about what characterize places outside the home is important to support participation.Objectives: To explore patterns of participation in places for activities outside the home after stroke and whether these patterns were associated with personal and environmental aspects.Material and methods: Sixty-three people with stroke were interviewed using the Participation in Activities and Places Outside Home (ACT-OUT) questionnaire. A two-step cluster analysis was used to identify patterns of participation and non-parametric test was used to explore potential associations to the patterns of participation.Results: Four clusters of patterns of participation, based on frequency, familiarity of the place/the way to the place and perceived distance, were identified. The patterns were significantly associated with type of place, activity domain, retained or abandoned participation, transportation and being accompanied by someone. The severity of disability was significantly associated with groups of individuals with different patterns of participation.Conclusions: Different combinations of aspects facilitated and hindered whether or not participation changed. To support people with stroke in their endeavour to retain or recapture participation, social support is important to consider in relation to transportation, activities and places outside the home.

Skill clusters of ability to manage everyday technology among people with and without cognitive impairment, dementia and acquired brain injury.

BACKGROUND: In order to develop supporting interventions for people demonstrating problems ET use, a detailed level of description of strengths and deficits is needed. AIMS: To explore clusters of specific performance skill required when using ET, and to evaluate if and in what way such clusters are associated with age, gender, diagnosis, and types of ETs managed. MATERIALS AND METHODS: A secondary analysis of 661 data records from 203 heterogeneous samples of participants using the Management of Everyday Technology Assessment (META) was used. Ward's method and a hierarchical tree cluster analysis were used to determine and define the skill clusters. RESULTS: Four distinct clusters of performance skill item profiles were found, across the 661 data records. These were then, based on each individuals' cluster profiles in managing ET, categorized into two groups. The two groups were associated with, diagnosis and type of ETs managed. CONCLUSIONS AND SIGNIFICANCE: The findings support a more dyadic person-ET approach in evaluation of ET management. The information from the skill clusters can be used to develop targeted intervention guides for occupational therapy and healthcare.

Participation after acquired brain injury: Associations with everyday technology and activities in daily life.

BACKGROUND: The development of the information society has led to increased use of everyday technology and changed the conditions for participation. Enabling participation in everyday life situations is an important rehabilitation goal after acquired brain injury (ABI). Identifying factors associated with individuals' experienced participation and problems therein is therefore essential. OBJECTIVE: This study aimed at exploring the relationship between perceived difficulty in everyday technology use, perceived ability in the activities of daily living (ADL), and perceived participation, and participation problems in persons with ABI. METHODS: Eighty-one persons with ABI participated in the study and were assessed by the Impact on Participation and Autonomy questionnaire, the Everyday Technology Use Questionnaire, and the ADL taxonomy. RESULTS: Findings showed that the combined model of difficulty in everyday technology (ET) use, ADL ability, and the interaction between them explained both participation in various domains of everyday life, and also overall level of perceived participation and the perceived problems. CONCLUSIONS: The findings underscore the importance of evaluating individuals' ability in both ET use and ADL after ABI to increase the probability of explaining these persons' participation in desired everyday life situations and, also, for rehabilitation design.

The association between perceived and observed ability to use everyday technology in people of working age with ABI.

OBJECTIVE: Everyday technology (ET), including computers and automated telephone services, is increasingly required for everyday functioning. However, people with acquired brain injury (ABI) may have difficulty with ET use. To design interventions to support ET use, further knowledge of how to assess dimensions of such use is needed. METHODS: This study investigated the relationship between the perceived difficulty of ET use (self-reported using the short version of the Everyday Technology Use Questionnaire, S-ETUQ) and observed ability to use ET (observed using the Management of Everyday Technology Assessment, META) in a sample of people with ABI (n = 81). Data were analysed using a Rasch measurement model, and person measures of perceived difficulty and observed ability to use ET were identified and correlated. Results and conclusions. The person measures had a correlation of 0.49 (p < 0.001). In groups of different severity levels after ABI, significant associations were found in the moderate (0.36) and severe (0.47) disability groups. In the good recovery group, only a non-significant correlation was found (0.21). This indicates that the S-ETUQ and the META measure different but complementary dimensions of ET use. Hence, the assessments are proposed to be used together in clinical practice to more fully understand the ability of people with ABI to use ET.

Perceived difficulty in use of everyday technology in persons with acquired brain injury of different severity: a comparison with controls.

OBJECTIVE: To compare the perceived difficulty in use of everyday technology in persons with acquired brain injury with different levels of severity of disability with that of controls. METHODS: This comparison study recruited 2 samples of persons with acquired brain injury and controls, comprising a total of 161 participants, age range 18-64 years. The long and short versions of the Everyday Technology Use Questionnaire and the Extended Glasgow Outcome Scale were used to evaluate participants. RESULTS: Persons with acquired brain injury demonstrated lower mean levels of perceived ability in use of everyday technology than controls (F = 21.84, degrees of freedom = 1, p < 0.001). Further analysis showed a statistically significant mean difference in perceived difficulty in use of everyday technology between persons with severe disability and good recovery, between persons with severe disability and controls, and between persons with moderate disability and controls. No significant mean difference was found between persons with severe disability and moderate disability, between persons with moderate disability and good recovery, and between persons with good recovery and controls. CONCLUSION: Perceived difficulty in using everyday technology is significantly increased among persons with acquired brain injury with severe to moderate disability compared with controls. Rehabilitation services should consider the use of everyday technology in order to increase participation in everyday activities after acquired brain injury.

Ability to manage everyday technology after acquired brain injury.

PURPOSE: To investigate and describe how persons with an acquired brain injury (ABI) manage everyday technology (ET) in their daily activities and to explore whether the ability to manage ET was related to the severity of the disability. METHOD: Eighty-one persons with ABI were observed while managing ET by using the Management of Everyday Technology Assessment (META). The Glasgow Outcome Scale-Extended (GOSE) was used to assess the severity of disability after the ABI. A computer application of a Rasch measurement model was used to generate measures of the participants' ability to manage ET and the measures were compared groupwise with analysis of covariance (ANCOVA). RESULTS: The degree of severity of disability had a significant main effect on the ability to manage ET. The groups with severe and moderate disability exhibited a significantly lower ability to manage ET compared to the group with good recovery. CONCLUSION: The result indicates that the ability to manage ET in daily activities can be related to the global severity of disability after ABI. This demonstrates the importance of considering the ability to manage ET to support the performance of activities at home, at work and in society in persons with ABI.

Perceived difficulties using everyday technology after acquired brain injury: influence on activity and participation.

Using everyday technology (ET) is a prerequisite for activities and participation at home and in the community. It is well known that persons with an acquired brain injury (ABI) can have limitations in activities of daily living but our knowledge of their difficulties using ET is not known. Thirty-six persons (27 men and 9 women, mean age 44 years, age range 26-60) with an ABI (2-10 years post injury) were interviewed, using the Everyday Technology Use Questionnaire (ETUQ), about their perceived difficulties using ET and how these difficulties influenced their everyday activities and their possibilities to participate at home and in the community. A majority (78%) of the persons reported difficulties using ET. The most common difficulties were related to the use of telecommunication and computers. Despite these difficulties, a majority still used most objects and services independently. Twenty-six participants (72%) perceived that their difficulties using ET influenced their everyday activities and their possibility to participate at home and in the community. The results indicate that rehabilitation following an ABI should consider whether clients' use of ET influences their activity and participation and adopt interventions accordingly. The results also indicate that difficulties using ET need to be considered in the design of community services to prevent societal barriers.

Difficulties in using everyday technology after acquired brain injury: a qualitative analysis.

The aim of this study was to identify and describe the characteristics of the difficulties using everyday technology in persons with an aquired brain injury (ABI), and their experiences of how these difficulties influenced their life. Thirteen persons with an ABI were interviewed about their difficulties in using everyday technology and were observed in their use of technology. Data were analysed qualitatively with a constant comparative method. The results showed that the persons' experiences formed two categories: “A variety of combinations of difficulties in the use of everyday technology" and “Restrictions in life". The difficulties identified were related not only to everyday technology itself but also to the interaction between the technology, the task, the person, and the environment. These difficulties influenced their experiences of restrictions in occupational performance, personal identification, and participation in society. The results emphasize that occupational therapists who design interventions for people with an ABI need to accommodate both the technology and other interacting aspects in order to overcome difficulties in using everyday technology.

Associations between perceptions of environmental barriers and participation in persons with late effects of polio.

The aim of this pilot study was to assess the association between perceived environmental barriers and perceived participation in everyday life situations encountered by people with late effects of polio. A sample of 45 persons with clinically verified late effects of polio answered the Swedish versions of the Impact on Participation and Autonomy Questionnaire (IPA-S) and the Craig Hospital Inventory of Environmental Factors (CHIEF-S). The relationships between the perceived occurrence of a broad range of environmental barriers and perception of participation in life situations and problems with participation were explored. The majority of the respondents perceived that they encountered environmental barriers, but their occurrence was generally infrequent and their magnitude tended to be low. The barriers identified in the physical/structural subscale were generally most strongly related to problems with participation, compared with the four other environmental subscales. A high frequency of never encountering environmental barriers in the three subscales physical/structural, work and education, and policies in CHIEF-S were significantly related to more reports of good participation in IPA-S. These associations indicate that the participation of those with late effects of polio is influenced by their perception of the barriers they encounter. Further studies of these concepts can provide a greater understanding of disabilities and help us to promote participation in life situations for people with late effects of polio.

Relationship between participation in life situations and life satisfaction in persons with late effects of polio.

PURPOSE: To assess the relationship between participation and problems with participation in life situations, and life satisfaction in persons with late effects of polio. METHODS: One hundred fifty-eight persons with late effects of polio responded to a postal questionnaire including the Swedish versions of the Impact on Participation and Autonomy Questionnaire (IPA-S) and Life Satisfaction Questionnaire (LiSat-11). RESULTS: The persons' perceived participation in the five domains of participation in the IPA-S was significantly correlated with their satisfaction with life as a whole and with most of the 10 domains of life satisfaction. Significant differences in satisfaction with life as a whole and with eight of the 10 domains in LiSat-11 were found between groups of increasing severe problems with participation. Greater number of reports of severe problems with participation corresponded with gradually decreased satisfaction with life as a whole and with satisfaction in the eight domains in LiSat-11. CONCLUSIONS: Perceived participation and problems with participation in life situations are determinants of life satisfaction in persons with late effects of polio. This implies that addressing participation and problems with participation in the rehabilitation of persons with late effects of polio may lead to an enhanced life satisfaction.

Constantly changing lives: experiences of people with multiple sclerosis.

The purpose of this study was to gain an enhanced understanding of how people with multiple sclerosis (MS) experience their engagement in occupations. We interviewed 10 people and then analyzed the data gathered using the constant comparative method of grounded theory. The findings encompassed the core category "essentials of a constantly changing life", showing that along a continuum of change, the participants experienced a decreasing engagement in occupations that forced them to continuously struggle to maintain engagement. This struggle changed them and required them to construct a different life than before. Our findings suggest that professionals working in MS rehabilitation need to broaden their repertoire of interventions relevant to conditions in clients' social environment, with the intention of influencing those occupations that are individually most meaningful. Occupational therapists should focus on the client's engagement in occupations and its consequences for the client's life and self-identity.

Perceived participation in life situations in persons with late effects of polio.

OBJECTIVE: To investigate how persons with late effects of polio perceive their participation and problems with participation in life situations and to determine the association between perceived problems with participation and sex, age, marital status, use of mobility aids and access to instrumental support. DESIGN: Cross-sectional. SUBJECTS: A total of 160 persons with prior polio 6-30 months after an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme. METHODS: All subjects answered the Swedish version of the Impact on Participation and Autonomy Questionnaire. RESULTS: A majority of the respondents perceived their participation as sufficient in most activities and 65% of the respondents perceived no severe problems with participation. The remaining 35% perceived 1-6 severe problems with participation. All 5 domains of participation were positively correlated with the 9 items for problem experience. Most restrictions in participation were reported in the domains of Family role, Autonomy outdoors, and Work and education. Insufficient instrumental support was most strongly associated with the perception of severe problems with participation. CONCLUSION: Rehabilitation programmes for persons with late effects of polio need to focus on areas of participation that are perceived as a problem by these persons and to promote access to a supportive environment to enhance their participation.

The complexity of participation in daily life: a qualitative study of the experiences of persons with acquired brain injury.

OBJECTIVE: To describe and enhance the understanding of how adults with acquired brain injury experience participation in daily life. PATIENTS AND METHODS: Qualitative interviews with 11 persons of working age with acquired brain injuries were analysed using qualitative content analysis. RESULTS: The informants' experiences formed 5 categories: "Performing tasks"; "Making decisions and exerting influence"; "Being engaged in meaningful activities"; "Doing things for others"; and "Belonging". The categories that needed to be present for the informants to experience a feeling of participation varied according to their individual daily life situations. In addition, their experiences showed that a variety of conditions, related to each of the 5 categories, influenced their participation. Individuals adopted a variety of strategies to enhance their experience of participation. CONCLUSION: The meaning of participation and the conditions and strategies influencing participation are complex. Many of the categories identified for participation can be understood only through subjective experience and cannot be captured by professionals' observation of the performance of activities. These results emphasize the importance of considering clients' unique experiences of participation when designing individually tailored rehabilitation programmes intended to enhance participation.

Perceived participation and problems in participation are determinants of life satisfaction in people with spinal cord injury.

PURPOSE: To determine the relationships between perceived participation and problems in participation, and life satisfaction in people with spinal cord injury (SCI). METHOD: A total of 157 men and women with SCI completed the Swedish versions of the Impact on Participation and Autonomy Questionnaire (IPA) and the Life Satisfaction Questionnaire (LiSat-9). RESULTS: The respondents' perceived participation in the five domains of the IPA was significantly correlated with their satisfaction with life as a whole (P < 0.01) and in most of the eight other domains of life satisfaction (P < 0.05 to P < 0.01) in the LiSat-9. The respondents' life satisfaction decreased gradually with increasing frequency of severe problems in participation and significant differences within groups of increasingly severe problems were found. The level of life satisfaction in respondents that perceived no severe problems with participation was similar to those of a normal population. CONCLUSIONS: Perceived participation and problems in participation are determinants of life satisfaction in people with SCI. The results emphasize the importance to focus on severe problems with participation in order to optimize life satisfaction during the rehabilitation after SCI.

Impact on participation and autonomy questionnaire: internal scale validity of the Swedish version for use in people with spinal cord injury.

OBJECTIVE: To evaluate aspects of internal scale validity and reliability of the Swedish version of the Impact on Participation and Autonomy questionnaire (IPA-S) for use in people with spinal cord injury. SUBJECTS: A total of 161 persons with spinal cord injury. METHOD: IPA-S psychometric properties were evaluated using Rasch rating scale analysis. RESULTS: The results show that the IPA-S has 27 items for perceived participation and 6 items for perceived problems with participation, indicating 2 underlying unidimensional constructs for use in people with spinal cord injury, after removal of misfitting items. The established hierarchical order of the item calibration values in both scales appeared logical and the distances between the items, with a few exceptions in the problem scale, were appropriate. Both scales demonstrated good separation reliability. The range of item calibration values in both scales did not fully cover the range of measures of persons' perceived participation and problems thereof. CONCLUSION: The psychometric properties of IPA-S are promising and indicate that IPA-S has potential to be developed further.

Influences of the social environment on engagement in occupations: the experience of persons with rheumatoid arthritis.

The aim of this explorative study was to describe and enhance the understanding of how persons with rheumatoid arthritis (RA) experience the influence of the social environment on their engagement in occupations. Nine persons were interviewed and the data obtained were analysed using a comparative method. The findings revealed that other persons in the social environment influenced informants' experiences of engaging in occupations in two ways, which formed the categories: "Constructive collaboration" and "Insufficient collaboration". These categories had certain properties related to the actions the others undertook to assist the informants during their collaboration. These assisting actions influenced the informants' possibilities to engage in occupations, and also their experience of engagement. The findings also showed that the "Conditions for collaboration" varied and influenced their collaboration, which thereby constituted a third category. The findings may contribute to a deeper understanding of how other persons can facilitate and restrict meaningful occupational experiences. This provides knowledge that can be used by occupational therapists when empowering their clients and those close to them to reflect on their actions and the consequences of these actions to enhance occupational engagement.