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BACKGROUND: Stroke significantly impacts individuals, leading to the need for long-lasting rehabilitation and adaptation to environmental demands. Rehabilitation after stroke is increasingly performed in patients' homes, and it is argued that rehabilitation in this context is more person-centred and positively impacts client outcomes. However, the role of environmental factors in this process is largely unknown. The aim of this study was to explore how multidisciplinary healthcare practitioners working with rehabilitation in the home after stroke consider possibilities and challenges in the environment and how environmental factors are documented in patients' records.

METHODS: Eight multidisciplinary healthcare practitioners working with home-based rehabilitation after stroke participated in two semistructured focus group sessions. Thematic analysis was used to analyse the transcripts of recorded focus group discussions. Data were also collected from patient history records (N = 14) to identify interventions to increase patients' opportunities to participate in activities inside and outside the home. These records were analysed using life-space mobility as a conceptual framework.

RESULTS: The analysis generated four overarching themes concerning possibilities and challenges in the environment: (1) the image of rehabilitation conflicts with place, (2) the person in the home reveals individual needs and capabilities, (3) environmental characteristics influence the rehabilitation practice, and (4) the person is integrated within a social context. The patient record analysis showed that most patients were discharged from hospital to home within four days. Assessments at the hospital mainly focused on basic activities of daily living, such as the patient's self-care and walking ability. Also at home, the assessments and actions primarily focused on basic activities with little focus on participation in meaningful activities performed in different life situations outside the home.

CONCLUSIONS: Our research suggests that one way to improve practice is to include the environment in the rehabilitation and consider the person´s life space. Interventions should focus on supporting out-of-home mobility and activities as part of person-centred stroke rehabilitation. This must be supported by clear documentation in the patient records to strengthen clinical practice as well as the communication between stakeholders.

Background

Art therapy could benefit couples.

Aims

This article explores art therapy used by couples in relational crisis from a professional perspective.MethodsSeven art therapists working in family counselling participated in the qualitative study.ResultsThe results showed that, through non-verbal communication, art making facilitated clarification of situations, handling non-talkable concerns, and added playfulness to the relationship. Three crucial dimensions were identified in the family counselling context: (1) outer frames, i.e. room and material; (2) some special conditions, i.e. that they trusted each other and both wanted to repair their relationship, and the therapist’s ability to assess this; and (3) art work techniques that all couples could master.

Conclusions

Art therapy could benefit couples in relational crisis, given appropriate prerequisites were ensured. Implications for practice: suitable rooms and appropriate materials have to be arranged if the social services want to offer couples in relational crisis art therapy as a tool in their work to reduce marital distress and prevent separations.

Plain-language summary

This study explores art therapy used by couples in relational crisis, from the viewpoint of art therapists. Seven art therapists were interviewed. The results showed art therapy could benefit couples in relational crises. Couples could understand each other better and they could get in touch with positive sides of the relationship. Three factors were experienced as important when using art therapy with couples in relational crisis: (1) to have access to an appropriate art therapy room and sufficient art therapy materials, (2) that the persons in the couple wanted to repair their relationship and that they trusted each other, and (3) that art therapists use easy art therapy techniques that all couples could master. Limitations, research recommendations and clinical implications are discussed.

Small-scale enterprises are less often covered by occupational health services and have insufficient awareness about health and risks in the work environment. This study investigated how Swedish entrepreneurs in small-scale enterprises use occupational health services. The study used a questionnaire sent in two waves, 5 years apart. At baseline, 496 entrepreneurs responded, and 251 participated 5 years later. The questionnaire included items about affiliation with and use of occupational health services, physical and psychosocial work environments, work environment management, sources of work environment information, and membership in professional networks. Only 3% of entrepreneurs without employees and 19% of entrepreneurs with employees were affiliated with an occupational health service. Entrepreneurs affiliated with occupational health services were more active in work environment management and gathering information about the work environment. The occupational health services most used were health examinations, health care, and ergonomic risk assessments. Affiliation with occupational health services was 6% at both measurements, 4% at baseline, and 10% 5 years later.

Background: Many people who suffer an acquired brain injury (ABI) are of working age. There are benefits, for the patient, the workplace, and society, to finding factors that facilitate successful return to work (RTW).

Objective: The aim was to increase knowledge of opportunities and barriers for a successful RTW in patients with ABI.

Method: Five men and five women with ABI participated. All had successfully returned to work at least 20 hours a week. Their experiences were gathered by semi-structured interviews, which were subsequently subjected to qualitative content analysis.

Results: Three themes that influenced RTW were identified: individually adapted rehabilitation; motivation for RTW; and cognitive and social abilities. An individually adapted rehabilitation was judged important because the patients were involved in their own rehabilitation and required individually adapted support from rehabilitation specialists, employers, and colleagues. A moderate level of motivation for RTW was needed. Awareness of the person's cognitive and social abilities is essential, in finding compensatory strategies and adaptations.

Conclusions: It seems that the vocational rehabilitation process is a balancing act in individualized planning and support, as a partnership with the employer needs to be developed, motivation needs to be generated, and awareness built of abilities that facilitate or hinder RTW.

PURPOSE: This study investigated changes in quality of life (QoL) in relation to return to work among patients with acquired brain injury (ABI).

METHOD: The sample consisted of 1487 patients with ABI (63% men) aged 18-66 years (mean age 52) from the WebRehab Sweden national quality register database. Only patients who worked at least 50% at admission to hospital and were on full sick leave at discharge from hospital were included. QoL was measured by the EuroQol EQ-5D questionnaire.

RESULTS: Patients who returned to work perceived a larger improvement in QoL from discharge to follow-up one year after injury compared to patients who had not returned to work. This difference remained after adjustment for other factors associated with improved QoL, such as having a university education, increased Extended Glasgow Outcome Scale scores and getting one's driving licence reinstated.

CONCLUSION: Return to work is an important factor for change in QoL among patients with ABI, even after adjusting for other factors related to QoL. This is consistent with the hypothesis that having employment is meaningful, increases self-esteem and fosters participation in society. Thus, helping patients with ABI return to work has a positive influence on QoL.

Research aim

The aim of this study was to increase our knowledge about the opportunities and barriers for successfully return to work (RTW) among individuals with acquired brain injury (ABI).

Methodology

Adults who have ABI were interviewed in regard to their experiences of the work rehabilitation process. The informants (5 females, 5 males) had participated in a work rehabilitation, had successfully RTW and had worked at least 50 % in at least a year after the injury. The interviews were transcribed, structured and analyzed by latent content analysis with a hermeneutic approach.

Findings and conclusions

Three main themes that influenced RTW after ABI were identified: (i) individually adapted rehabilitation process, (ii) motivation for RTW and (iii) cognitive abilities and inabilities.

The findings indicated that an individually adapted vocational rehabilitation (VR) process was important because the individuals with ABI involved actively in their own rehabilitation process and they required continuous support from the society, the specialists, their employers and colleagues. A moderate level of motivation for RTW was necessary to achieve the best result for RTW and it was important to achieve a balance between too high and too low motivation. Finally, a comprehensive knowledge about the cognitive abilities and inabilities of the individual after ABI helped the individuals and their employers to find compensatory strategies to handle their work tasks.

One implication of the findings was the necessity of a good support system and a good VR that functions well and lasts for a longer period. When there are obstacles in the VR process, it is important to have strategies and awareness of how to proceed further.

Consequently the support built for a person individually, with a balanced motivation, a high knowledge about the cognitive abilities and awareness of how to proceed further in the process will help to build a successful and sustainable RTW.

Idag bor många äldre personer kvar i sin bostad trots omfattande hälsoproblem i form av fysiska och kognitiva funktionsnedsättningar och långvariga sjukdomstillstånd. Miljöns utformning har potential att stödja personer med skör hälsa och således krävs fungerande boendemiljöer som är anpassade till äldre personers behov och skapar förutsättningar att leva ett gott liv. Mot denna bakgrund ville vi undersöka miljömässiga aspekter av betydelse för äldre personer och deras aktiviteter i boendemiljön. För att få en heltäckande bild av äldres boendemiljöer tillämpades olika metoder. Data har använts från SWEOLD Dalarna, en databas som fångar ett brett spektrum av levnadsvillkor för äldre personer. I SWEOLD-urvalet ingick drygt 400 personer där medelåldern var 82 år. Vidare har en mindre grupp äldre personer med hemtjänst deltagit där data har insamlats med intervjuer, observationer, aktivitetsdagböcker, frågeformulär och GPS-sändare. I den gruppen ingick 20 personer där medelåldern var 87 år. För att få ett bredare perspektiv kring äldres boendemiljöer har även hemtjänstpersonal och anhöriga till personer med hemtjänst deltagit.

Några av resultaten visade att boendemiljön kunde relateras till en känsla av gemenskap, trygghet och tillhörighet. Äldre personer hade rutiner i vardagen i form av aktiviteter i och utanför bostaden och det var av central betydelse att känna sig självständig i det dagliga livet trots hälsoproblem och försämrad funktionsförmåga. Miljöhinder förekom i samtliga bostäder både utomhus, vid entréer och inomhus, något som kunde begränsa äldre personers mobilitet och delaktighet. Av resultaten framkom även könsskillnader där kvinnor i jämförelse med män uppgav sämre mobilitet, använde hjälpmedel i större utsträckning och upplevde fler tillgänglighetshinder. Sammantaget framkom att boendemiljöns utformning har stor påverkan på äldre i deras vardag, inte minst vad gäller förutsättningar för socialt umgänge där bostadens inomhusmiljö, utomhusmiljö och närliggande omgivning måste vara tillgänglig och användbar.

This study investigated associations between time processing ability (TPA), daily time management (DTM), and dementia severity. Persons with dementia (PwDs) (n = 53) and their significant others (n = 49) participated in this cross-sectional study. Bivariate analyses were used to investigate associations between TPA and DTM and the dementia severity. Linear regression models were used to further predict the contribution of the subtests in the Mini Mental State Examination (MMSE) for TPA results. The results showed significant correlations between TPA and dementia severity, where visuospatial functions were the most highly correlated. TPA also showed a significant correlation to proxy-rated DTM. In addition, proxy-rated DTM was significantly correlated with dementia severity and PwDs’ own self-ratings of their DTM. Knowledge of the association between TPA, dementia severity, and visuospatial functions can enable early detection of TPA impairments. For a comprehensive assessment of TPA and DTM, objective measures should be used in combination with self-ratings and proxy-ratings. The findings can be used in clinical research and healthcare settings to develop methods to compensate for impaired TPA and support DTM in PwDs. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

BACKGROUND: Persons with dementia encounter time-related problems and significant others often need to provide support in daily time management and use of time assistive technology (AT). Further research has been requested on how time AT for persons with dementia affects the situation of significant others. Moreover, there are a few previous qualitative studies on the experiences of time AT by persons with dementia. This study explores the experiences of persons with dementia and significant others in daily time management and their perceptions on how time AT affects everyday life.

METHOD: Semi-structured interviews with persons with mild to moderate dementia (n = 6) and significant others (n = 9) were conducted three months after receiving prescribed time AT. Interviews were analysed using qualitative content analysis.

RESULTS: A main category "Support by significant others is always part of daily time management", and three categories "Facing new challenges", "Using strategies to handle changes", and "Time assistive technology in daily life" illustrated that significant others provided support for daily time management in all phases of dementia. This support was often embedded in other kinds of support for emerging challenges. Support in time management was needed from an early stage in dementia, and responsibility for time management was gradually transferred to significant others. Time AT could support time orientation and were important for sharing the time management conducted by others but did not enable independent time management.

CONCLUSIONS: Time-related assessments and interventions should be offered at an early stage of dementia to increase the possibility of maintaining daily time management skills. Using time AT to communicate time might increase agency and participation in daily occupations for persons with dementia. Given the central role of significant others for daily time management, the society needs to adequately support persons with dementia lacking support from significant others.

Information and communication technology (ICT) has increased in importance and facilitates participation in several life areas throughout society. However, young adults with mild to moderate intellectual disability make less use ICT than the general population. Disability services staff play a central role in supporting and enabling service users in daily life, and their perceptions of ICT are important to their role in service provision. The aim of the study is to describe staff perceptions of the role of ICT and how it affects daily life in young adults with mild to moderate intellectual disability living in residential homes. Focus group interviews and individual interviews were conducted with staff working in residential homes in which young adults with mild to moderate intellectual disability live. All materials were transcribed verbatim and analyzed using latent content analysis. Staff perceived ICT and, more specifically, the Internet as being supportive of both daily life and social relationships of these young adults, but they also viewed ICT as posing social risks. Perceptions of and support for ICT were related to staff perceptions about what is appropriate and manageable in relation to an individual resident's functioning level. Staff members also considered the views of parents about appropriate content when providing support. Staff in residential homes for young adults with mild to moderate intellectual disability use their implicit moral judgment about the use of ICT by residents. Their enablement of and support for ICT are not primarily based on the service user's wishes or interests. This finding implies a risk that the organization of a conflict-free service provision is a higher priority than service users' participation in social life.

The Swedish Institute for Disability Research (SIDR) was founded in 2000. The SIDR graduate programmedis a leading research programmedin disability science. The scientific method at SIDR is based on an interdisciplinary approach.The aim of this study is to describe content of doctoral theses presented within SIDR, and to analyzethe occurrence of interdisciplinarywithin the theses published between 2000 and 2012. Forty-one theses were included in the study. First, the manifest data was categorized in a matrix, and second, the latent content was analyzedwithin a scheme. The scheme included seven criteria within interdisciplinary theory, namely: Is the phenomenon multi-dimensional? Does the aim reflect an interdisciplinary approach? Are the studies non-reductionist? Have multiple methods been used? Is the knowledge integrated? Are the results discussed as a whole?Do they explicitly show an interdisciplinaryknowledge?Findings show a variety of disability groups studied within SIDR, but the main disabilities are hearing impairment or deafness, and cognitive and communication difficulties. Different theoretical perspectives are used within the theses. To different extents, an interdisciplinary approach is used as an overall meta-theory.

BACKGROUND: Supported Employment (SE) has shown better results in the employment rate for persons with disabilities than other methods within vocational rehabilitation, but how SE affects the employment rate for subgroups in the interventions needs further attention.

OBJECTIVE: To examine previous research regarding the influence of intersecting statuses on the employment rate in SE for people with psychiatric, neuropsychiatric, or intellectual disabilities according to type of diagnosis, sex, race/ethnicity, age, level of education and previous work history.

METHODS: A systematic literature search was conducted in nine databases including peer-reviewed articles from 2000 to April 2021. Articles presenting the employment rate in SE interventions according to the intersecting statuses listed in the objective were included.

RESULTS: The searches identified 3777 unique records, of which 53 articles were included in data extraction. In most of the included articles, intersecting statuses did not affect the employment rate for people in the SE interventions with psychiatric disabilities. Few studies have examined neuropsychiatric and intellectual disabilities. A majority of the studies subjected to full-text analysis were excluded due to a lack of reporting of the effects of intersecting statuses on the employment rate. The studies that reported on the effects of intersecting statuses on the employment rate often had small samples and lacked statistical power.

CONCLUSIONS: Intersecting statuses do not appear to affect the employment rate for people receiving SE interventions, but systematic reviews with pooled samples need to be undertaken because of the low reporting rate and underpowered sample sizes in existing studies.

BACKGROUND: While occupational therapists (OT) and physiotherapists (PT) have a central role in reablement, no structured approach for these professions has been described in Sweden.

AIMS/OBJECTIVES: The aim was to explore the feasibility of a reablement program developed to guide OTs and PTs in a Swedish municipality context.

MATERIAL AND METHODS: Eligible participants were OTs and PTs working with reablement. Feasibility was evaluated in terms of how OTs (n = 16) and PTs (n = 15) experienced the application of the program. Data were collected through web surveys during a pilot study over four months.

RESULTS: The program was implemented for 62 clients. Baseline assessments were conducted in 97% of all cases and follow-ups in 77%. The average duration of the program was 8 weeks and includeed 5 home visits and 3 contacts by phone. In 15 cases, a new goal was identified after follow-up. Collaboration was included with other professionals and relatives in 89% and 35% of the cases, respectively. The program was categorized as feasible to some extent in 34 cases and not feasible in 21 cases.

CONCLUSIONS AND SIGNIFICANCE: The program was feasible to some extent. To enhance feasibility, flexibility may be needed in order to tailor assessments according to the client's health status.