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  • 1.
    Elf, Marie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Klockar, Erika
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Kylén, Maya
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Department of Health Sciences, Lund University, Lund.
    von Koch, Lena
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm; Theme Neuro Karolinska University Hospital, Stockholm.
    Ytterberg, Charlotte
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm.
    Wallin, Lars
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Finch, Tracy
    Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
    Gustavsson, Catharina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Center for Clinical Research Dalarna, Uppsala University, Falun; Department of Public Health and Caring Sciences, Uppsala University, Uppsala.
    Jones, Fiona
    Faculty of Health and Social Care Sciences, Kingston University and St George's, University of London, London, United Kingdom.
    Tailoring and Evaluating an Intervention to Support Self-management After Stroke: Protocol for a Multi-case, Mixed Methods Comparison Study2022Inngår i: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 11, nr 5, artikkel-id e37672Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Self-management programs are recognized as a valuable approach to supporting people with long-term conditions, such as stroke, in managing their daily lives. Bridges Self-Management (Bridges) focuses on how practitioners interact and support patients' confidence, skills, and knowledge, and it is an example of a complex intervention. Bridges has been developed and used across multiple health care pathways in the United Kingdom and is theoretically informed by social cognition theory and self-efficacy principles. Evidence shows that self-management programs based on the construct of self-efficacy can be effective. There is still much to learn about how health care services or pathways should implement support for self-management in a sustainable way and whether this implementation process is different depending on the context or culture of the team or service provided.

    OBJECTIVE: The aim of this study is to tailor and evaluate an intervention (Bridges) to support self-management after stroke in a Swedish context.

    METHODS: We will use a pretest-posttest design with a case study approach to evaluate the feasibility and implementation of self-management support in two stroke settings. This project includes a complex intervention and depends on the actions of individuals, different contexts, and the adaptation of behavior over time. A mixed methods approach was chosen to understand both outcomes and mechanisms of impact. Data collection will comprise outcome measurements and assessment tools as well as qualitative interviews. Data will be collected concurrently and integrated into a mixed methods design.

    RESULTS: Recruitment and data collection for the first site of the project ran from September 1, 2021, to January 17, 2022. The intervention at the first site was conducted from November 1, 2021, to March 5, 2022. The evaluation will start after the implementation phase. The second site has been recruited, and the baseline data collection will start in spring 2022. The intervention will start in early autumn 2022. Data collection will be completed by the end of 2022.

    CONCLUSIONS: This study represents a unique, highly relevant, and innovative opportunity to maximize knowledge and minimize practice gaps in rehabilitation stroke care. The study will produce robust data on the intervention and in-depth data on the contextual factors and mechanisms related to the feasibility of the intervention and for whom it is feasible. Bridges has been used in the United Kingdom for more than 10 years, and this study will explore its contextualization and implementation within a Swedish stroke environment. The evaluation will study results at the patient, staff, and organizational levels and provide recommendations for the adoption and refinement of future efforts to support self-management.

    Fulltekst (pdf)
    fulltext
  • 2.
    Elf, Marie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Kylén, Maya
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University.
    The Home as a Place for Rehabilitation After Stroke: Emerging Empirical Findings2023Inngår i: (Re)designing the Continuum of Care for Older Adults: The Future of Long-Term Care Settings, Springer International Publishing , 2023, s. 37-51Kapittel i bok, del av antologi (Fagfellevurdert)
    Abstract [en]

    Health care is moving toward integrated services where care and rehabilitation are provided at home rather than in institutions. This, together with the requirement that care must be person-centered, has proven to be a considerable challenge. Older adults living with complex health conditions such as stroke are vulnerable to change when their responsibility for care and rehabilitation becomes extensive. Health care tends to be governed by quick fixes rather than taking people’s own goals, resources, and life situations. Factors in the environment that can affect a person’s health and social, emotional, and physical aspects of daily life are crucial to consider in person-centered care. Nevertheless, the environment is often neglected in both research and clinical practice. This chapter addresses findings within the REARCH (Rehabilitation and Architecture) project. The project was initiated in response to Swedish law in 2018, making it more common for older adults with stroke to be rehabilitated at home rather than in a hospital. The purpose was to explore environmental factors to fulfill person-centered rehabilitation. The results are based on qualitative and quantitative data collected from patients and interdisciplinary care staff. We describe the challenges for people with stroke during rehabilitation and how their possibilities to engage in everyday life in their homes and immediate surroundings are influenced by environmental factors. Our contribution will improve the understanding of how environmental factors relate to everyday life and recovery at home. The discussion aims to guide evidence-based care models for rehabilitation at home. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.

  • 3.
    Elf, Marie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Lipson-Smith, Ruby
    University of Melbourne, VIC, Australia, AU; Western Sydney University, Westmead, NSW Australia, AU.
    Kylén, Maya
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University, Lund.
    Saa, Juan Pablo
    University of Melbourne, VIC, Australia, AU; La Trobe University, Bundoora, Melbourne, VIC, Australia, AU.
    Sturge, Jodi
    University of Twente, The Netherlands, NL.
    Miedema, Elke
    InHolland University of Applied Science, Domain Technology, Design and Computation, Division of Built Environment, The Netherlands, NL.
    Nordin, Susanna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Bernhardt, Julie
    University of Melbourne, VIC, Australia, AU.
    Anåker, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    A Systematic Review of Research Gaps in the Built Environment of Inpatient Healthcare Settings2024Inngår i: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, artikkel-id 19375867241251830Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: This study utilized the evidence-gap map method and critically examined the scope, methodologies, and focus of the studies that investigated the influence of the built environment on inpatient healthcare settings over a decade (2010-2021).

    METHODS: We conducted a systematic review per the preferred reporting items for systematic reviews and meta-analyses guidelines and surveyed 406 articles, primarily from North America and Europe.

    RESULTS: Our findings revealed a dominant focus on architectural features (73%), such as room design and ward layout. Comparatively, there was less emphasis on interior-, ambient-, social-, and nature-related features. Most previous studies explored multiple environmental features, which indicated the intricacy of this field. Research outcomes were diverse, with person-centered care (PCC) being the most frequently investigated, followed by safe care, emotional well-being, activity, and behavior. Furthermore, research methods varied considerably based on the study's outcomes and features. Clinical outcomes and safe care favored quantitative methods, activity and behavior favored mixed methods, and PCC favored qualitative research.

    CONCLUSION: This review provides an in-depth overview of the existing studies on healthcare design research and sheds light on the current trends and methodological choices. The insights garnered can guide future research, policy-making, and the development of healthcare facilities.

  • 4.
    Elf, Marie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Rasoal, Dara
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Zingmark, Magnus
    Kylén, Maya
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University.
    The importance of context: a qualitative study exploring healthcare practitioners’ experiences of working with patients at home after a stroke2023Inngår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, nr 1, artikkel-id 733Artikkel i tidsskrift (Fagfellevurdert)
    Fulltekst (pdf)
    fulltext
  • 5.
    Elf, Marie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Rasoal, Dara
    Lund University.
    Zingmark, Magnus
    Lund University; Health and Social Care Administration, Östersund; Umeå University.
    Kylén, Maya
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University.
    The importance of context-a qualitative study exploring healthcare practitioners' experiences of working with patients at home after a stroke2023Inngår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, nr 1, artikkel-id 733Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    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.

    Fulltekst (pdf)
    fulltext
  • 6.
    Elf, Marie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Slaug, Björn
    Lund University.
    Ytterberg, Charlotte
    Karolinska Institutet, Huddinge; Karolinska University Hospital, Stockholm.
    Heylighen, Ann
    KU Leuven, Belgium.
    Kylén, Maya
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University, Sweden.
    Housing Accessibility at Home and Rehabilitation Outcomes After a Stroke: An Explorative Study2023Inngår i: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 6, nr 4, s. 172-186Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: To explore if aspects of the physical home environment are related to rehabilitation outcomes among community-living persons poststroke.

    BACKGROUND: Research demonstrates that healthcare environments are important for high-quality care and that the design of the physical environment is associated with improved rehabilitation outcomes. However, relevant research focusing on outpatient care settings, such as the home, is sparse.

    METHODS: In this cross-sectional study, data on rehabilitation outcomes, physical environmental barriers, and housing accessibility problems were collected during home visits of participants (N = 34), 3 months poststroke. Data were analyzed with descriptive statistics and correlation analysis.

    RESULTS: Few participants had adapted their homes, and the relevance of the physical environment was not always discussed with the patient during discharge from the hospital. Accessibility problems were associated with suboptimal rehabilitation outcomes such as worse perceived health and recovery after stroke. Activities most restricted by barriers in the home concerned hand and arm use. Participants who reported one or more falls at home tended to live in houses with more accessibility problems. Perceived supportive home environments were associated with more accessible dwellings.

    CONCLUSIONS: Many face problems adapting their home environments poststroke, and our findings highlight unmet needs that should be considered in the rehabilitation practice. These findings could be used by architectural planners and health practitioners for more effective housing planning and inclusive environments.

    Fulltekst (pdf)
    fulltext
  • 7.
    Klockar, Erika
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Kylén, Maya
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University.
    Gustavsson, Catharina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Center for Clinical Research Dalarna - Uppsala University, Falun; Uppsala University.
    Finch, Tracy
    Northumbria University, Newcastle upon Tyne, UK..
    Jones, Fiona
    Kingston University and St George's, University of London, London, UK..
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Self-management from the perspective of people with stroke – An interview study2023Inngår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 112, artikkel-id 107740Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Self-management support can improve quality of life, mood, self-efficacy, and physical function following a stroke. Knowledge of how people with stroke understand and experience self-management in different contexts is crucial to developing effective self-management support. This study explored how people with stroke understand and practice self-management during the post-acute phase. Method: A descriptive study using qualitative content analysis to explore data from semistructured interviews Results: Eighteen participants were interviewed. Most participants interpreted self-management as ‘taking care of their business’ and ‘being independent”. However, they encountered difficulties performing daily activities, for which they felt unprepared. Although interest in implementing self-management support increases, participants did not report receiving specific advice from healthcare professionals. Conclusion: People continue to feel unprepared to manage everyday activities after hospital discharge and must largely work things out for themselves. There is an overlooked opportunity to start the process of self-management support earlier in the stroke pathway, with healthcare professionals and people with stroke combining their skills, ideas and expertise. This would enable confidence to self-management to flourish rather than decrease during the transition from hospital to home. Practical implications: Individual tailored self-management support could help people with stroke more successfully manage their daily lives post-stroke. © 2023 The Authors

    Fulltekst (pdf)
    fulltext
  • 8.
    Klockar, Erika
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Kylén, Maya
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University, Lund.
    McCarthy, Linnea
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Koch, Lena von
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm.
    Gustavsson, Catharina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap. Center for Clinical Research Dalarna, Falun; Uppsala University, Uppsala.
    Jones, Fiona
    Faculty of Health and Social Care Sciences, Kingston University & St George's, University of London, London, UK, GB.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    The Swedish Stroke Self-Efficacy Questionnaire: translation and cross-cultural adaptation2024Inngår i: Journal of Patient-Reported Outcomes, E-ISSN 2509-8020, Vol. 8, artikkel-id 55Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To translate and cross-culturally adapt the Stroke Self-Efficacy Questionnaire (SSEQ) from English to Swedish and to evaluate psychometric properties of the questionnaire.

    METHODS: A cross-sectional study design, where the translation followed a process including initial translation, synthesis, backward translation, expert committee, and pretest. Content validity was assessed using Content validity index (CVI). Psychometric assessments included floor-ceiling effects and internal consistency.

    RESULTS: Language and cultural congruence were achieved, and content validity index scores were high (0.923-1). The psychometric evaluations provided acceptable outcomes concerning internal consistency, with Cronbach's alpha scores for the total scale (0.902), the activities subscale (0.861) and the self-management subscale (0.818) respectively. Ceiling effects were evident, but no floor effects.

    CONCLUSION: This study found the Swedish version of the SSEQ promising as a tool for assessment of self-efficacy in a Swedish stroke care setting, although further psychometric assessments are recommended in future studies.

    Fulltekst (pdf)
    fulltext
  • 9.
    Kylén, Maya
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University.
    Schön, Ulla-Karin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Socialt arbete. Stockholm University.
    Pessah-Rasmussen, Hélène
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Patient Participation and the Environment: A Scoping Review of Instruments2022Inngår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, nr 4, artikkel-id 2003Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Patient participation and the environment are critical factors in achieving qualitative healthcare. We conducted a systematic scoping review using Arksey and O’Malley’s framework to identify instruments intended to measure patient participation. We assessed those instruments’ characteristics, which areas of the healthcare continuum they target, and whether environmental factors are considered. Instruments were considered eligible if they represented the patient perspective and measured patient participation in healthcare. The search was limited to articles written in English and published in the last 10 years. We extracted concepts (i.e., patient empowerment, patient participation, and patient-centeredness) based on the framework developed by Castro et al. and outcomes of significance regarding the review questions and specific objectives. The search was conducted in PsycINFO, CINHAL/EBSCO, and PubMed in September 2019 and July 2020. Of 4802 potential titles, 67 studies reported on a total of 45 instruments that met the inclusion criteria for this review. The concept of patient participation was represented most often in these studies. Although some considered the social environment, no instrument was found to incorporate and address the physical environment. Thirteen instruments were generic and the remaining instruments were intended for specific diagnoses or healthcare contexts. Our work is the first to study instruments from this perspective, and we conclude that there is a lack of instruments that measure aspects of the social and physical environment coherently as part of patient participation. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

    Fulltekst (pdf)
    fulltext
  • 10.
    Kylén, Maya
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University, Lund.
    Sturge, Jodi
    University of Twente, Twente, Netherlands.
    Lipson-Smith, Ruby
    Western Sydney University, Westmead, Australia; The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.
    Schmidt, Steven M
    Lund University, Lund.
    Pessah-Rasmussen, Hélène
    Skåne University Hospital, Malmö; Lund University, Lund.
    Svensson, Tony
    Högskolan Dalarna, Institutionen för information och teknik, Byggteknik.
    de Vries, Laila
    Högskolan Dalarna, Institutionen för hälsa och välfärd.
    Bernhardt, Julie
    The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Built Environments to Support Rehabilitation for People With Stroke From the Hospital to the Home (B-Sure): Protocol for a Mixed Method Participatory Co-Design Study2023Inngår i: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 12, artikkel-id e52489Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: A global trend is to move rehabilitation closer to people's neighborhoods and homes. Still, little attention has been given to how the built environment outside the hospital setting might impact rehabilitation and recovery for stroke survivors.

    OBJECTIVE: The overarching objective of this project is to develop conceptual models of built environments that support stroke rehabilitation and recovery outside the hospital setting. Specifically, the project will explore factors and characteristics of the built environment that support people with stroke and their families and identify innovative built environments that can be designed for local health care. The project will examine facilitators and obstacles for implementing built environmental solutions and evaluate the potential benefits, feasibility, and acceptability.

    METHODS: The project uses a mixed methods design approach with 3 phases. In phase 1, factors and characteristics of the built environment for rehabilitation will be identified. Based on the results from phase 1, phase 2 will involve co-designing prototypes of environments to support the rehabilitation process for people with stroke. Finally, the prototypes will be evaluated in phase 3. Qualitative and quantitative methods will include a literature review, a concept mapping (CM) study, stakeholder interviews, prototype development, and testing. The project will use multidimensional scaling, hierarchical cluster analysis, descriptive statistics for quantitative data, and content analysis for qualitative data. Location analysis will rely on the location-allocation model for network problems, and the rule-based analysis will be based on geographic information systems data.

    RESULTS: As of the submission of this protocol, ethical approval for the CM study and the interview study has been obtained. Data collection is planned to start in September 2023 and the workshops later in the same year. The scoping review is ongoing from January 2023. The CM study is ongoing and will be finalized in the spring of 2024. We expect to finish the data analysis in the second half of 2024. The project is a 3-year project and will continue until December 2025.

    CONCLUSIONS: We aim to determine how new environments could better support a person's control over their day, environment, goals, and ultimately control over their recovery and rehabilitation activities. This "taking charge" approach would have the greatest chance of transferring the care closer to the patient's home. By co-designing with multiple stakeholders, we aim to create solutions with the potential for rapid implementation. The project's outcomes may target other people with frail health after a hospital stay or older persons in Sweden and anywhere else. The impact and social benefits include collaboration between important stakeholders to explore how new environments can support the transition to local health care, co-design, and test of new conceptual models of environments that can promote health and well-being for people post stroke.

    INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52489.

    Fulltekst (pdf)
    fulltext
  • 11.
    Kylén, Maya
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Von Koch, Lena
    Pessah-Rasmussen, Hélène
    Marcheschi, Elizabeth
    Ytterberg, Charlotte
    Heylighen, Ann
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Chalmers University.
    The importance of the built environment in person-centred rehabilitation at home: study protocol2019Inngår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, nr 13, artikkel-id E2409Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Health services will change dramatically as the prevalence of home healthcare increases. Only technologically advanced acute care will be performed in hospitals. This-along with the increased healthcare needs of people with long-term conditions such as stroke and the rising demand for services to be more person-centred-will place pressure on healthcare to consider quality across the continuum of care. Research indicates that planned discharge tailored to individual needs can reduce adverse events and promote competence in self-management. However, the environmental factors that may play a role in a patient's recovery process remain unexplored. This paper presents a protocol with the purpose to explore factors in the built environment that can facilitate/hinder a person-centred rehabilitation process in the home. The project uses a convergent parallel mixed-methods design, with ICF (International Classification of Functioning, Disability and Health) and person-environment theories as conceptual frameworks. Data will be collected during home visits 3 months after stroke onset. Medical records, questionnaires, interviews and observations will be used. Workshops will be held to identify what experts and users (patients, significant others, staff) consider important in the built environment. Data will be used to synthesise the contexts, mechanisms and outcomes that are important to support the rehabilitation process at home.

    Fulltekst (pdf)
    fulltext
  • 12.
    Kylén, Maya
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    von Koch, Lena
    Pessah-Rasmussen, Hélène
    Ytterberg, Charlotte
    Heylighen, Ann
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    The importance of the built environment in person-centred stroke rehabilitation at home2019Inngår i: The importance of the built environment in person-centred stroke rehabilitation at home, 2019Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Introduction: Health services will change dramatically as the prevalence of home healthcare increases. Only technologically advanced stroke acute care will be performed in hospitals. This, along with the rising demand for services to be more person-centred will place pressure on healthcare to consider quality across the continuum of care. Research indicates that planned discharge tailored to individual needs can reduce adverse events and promote competence in self-management. However, the environmental factors that may play a role in a patient’s recovery process remain unexplored. In this presentation, experiences and emerging findings from a research project targeting such issues will be presented. The purpose is to explore factors in the built environment that can facilitate/hinder a person-centred rehabilitation process in the home. Methods: The study uses a mixed methods design, with the ICF and person-environment theories as conceptual frameworks. Qualitative and quantitative data are currently collected from medical records and during home visits three months after stroke by use of questionnaires, interviews and observations. Workshops will be held to identify what experts and users (patients, significant others, staff) consider important in the built environment. Results: Emerging findings concerning the contexts and mechanisms that are important to support the rehabilitation process at home will be presented. Conclusions: Providing scientific knowledge that support patients’ recovery process in the home poses challenges for research that requires multidisciplinary knowledge. By bringing together international experts committed to improve care models and design, we will contribute to this under researched field and build capacity for the future.

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  • 13.
    Kylén, Maya
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University, Department of Health Sciences, Lund, Sweden.
    von Koch, Lena
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    Wottrich, Annica Wohlin
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Living with the aftermaths of a stroke in the era of the COVID-19 pandemic: the significance of home and close surroundings2022Inngår i: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 76, artikkel-id 102852Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Stay-at-home recommendations to reduce the spread of the COVID-19 virus have had a major impact on people's everyday lives. However, while the evidence indicates that such recommendations have caused distress, anxiety, and fear among the public, little is known about how persons living with complex health conditions, e.g., disability after stroke, have experienced and handled the situation. We interviewed fourteen participants (7 women, 7 men) aged 61-91 years living in ordinary housing during summer 2020 to explore how people who recovered after a stroke experienced their everyday lives in their homes and close surroundings during the COVID-19 pandemic recommendations. Three intertwined themes were constructed from the narrative data and the iterative thematic analysis: (1) Places within and out of reach, (2) Upholding activities-strategies and structures, and (3) Adapting to new circumstances. The findings suggest that places within reach were important to maintain activities and provide structure in daily life. The participants seemed to make use of their previous experiences of adjusting to new circumstances after stroke when adapting to living under the stay-at-home recommendations. In addition, feeling that they now shared the restrictions with all other people in society seemed to ease their situations. Access to nature and spaces in the close surroundings was essential for staying socially connected and receiving support in daily life. The significance of the home and the neighbourhood for health experiences among people who recently have had a stroke should inform rehabilitation interventions both during and after pandemics and environmental planning.

    Fulltekst (pdf)
    fulltext
  • 14.
    Kylén, Maya
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Lund University.
    Ytterberg, Charlotte
    Karolinska Institutet, Huddinge; Karolinska University Hospital, Stockholm.
    von Koch, Lena
    Karolinska Institutet, Huddinge; Karolinska University Hospital, Stockholm.
    Elf, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    How is the environment integrated into post-stroke rehabilitation?: A qualitative study among community-dwelling persons with stroke who receive home rehabilitation in Sweden2022Inngår i: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, nr 5, s. 1933-1943Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Studies have shown a need to consider environmental factors to best support the rehabilitation and recovery process after a stroke. In addition, despite intentions to increase individuals' participation in care and rehabilitation, patients and family members report weak participation. The aim of this study was to explore how the environment was integrated into rehabilitation at home from the perspective of patients after a stroke. We conducted as a qualitative study with 17 patients rehabilitated at home. Data on the participants' experiences of the rehabilitation process and their perceptions of how the environment was considered in the process were collected via interviews and analysed using qualitative content analysis. The main category that was constructed from the data was "Partial integration of person- environment dynamics in the rehabilitation", which was informed by three subcategories: (a) I recover in my home: Challenges and opportunities in the environment, (b) Following a generic approach to therapy: Limited integration of the environment, and (c) Informed more than involved. Our study showed that the environment was integrated in a limited manner. The participants were more informed about than involved in their planning of the rehabilitation. The results are important for informing the ongoing development of rehabilitation at home and person-centred care strategies. 

    Fulltekst (pdf)
    fulltext
  • 15.
    Zingmark, Magnus
    et al.
    Health and Social Care Administration, Municipality of Östersund, Sweden; Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden; Department of Health Sciences, Faculty of Medicine, Lund University, Sweden.
    Kylén, Maya
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Department of Health Sciences, Faculty of Medicine, Lund University, Sweden.
    Feasibility of a reablement-program in a Swedish municipality2023Inngår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 30, nr 1, s. 53-64Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    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.

    Fulltekst (pdf)
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