Mobility device use in people with Parkinson's disease: A 3-year follow-up study.

OBJECTIVES: This study aimed to investigate how the use and perceived unmet need of mobility devices (MD) in people with Parkinson's disease (PD) evolve over a 3-year period. METHODS: The study reports baseline assessments (n = 255) and comparisons for participants with complete data at baseline and the 3-year follow-up (n = 165). Structured questions addressed the use and perceived unmet need of various MDs indoor and outdoor (eg, canes, wheeled walkers, and manual and powered wheelchairs). McNemar tests were used to investigate differences over time. RESULTS: In the total sample at baseline, 30% and 52% of the participants reported using MDs indoors and outdoors, respectively. Among those with complete data also at the 3-year follow-up, the proportion of participants using MDs increased significantly (P < .001) from 22% to 40% for indoors and from 48% to 66% for outdoors, with transition of MD toward more assistive potential (ie, wheeled walker and manual wheelchair). Wheeled walkers were the most commonly used MD indoors as well as outdoors on both occasions. Among the users of multiple MDs, the most common combination was cane and wheeled walker on both occasions. The proportion of participants who reported a perceived unmet need of MDs was 5% at baseline, whereas it was 21%, 3 years later. CONCLUSIONS: The use and perceived unmet need of MDs in people with PD increase over time. There is a need for addressing MDs at clinical follow-ups of people with PD, with continuous attention in primary health care and municipality contexts.

Secondary prevention and lifestyle indices after stroke in a long-term perspective.

OBJECTIVES: To describe the long-term perspective regarding prevalence of risk factors, secondary stroke prevention, and lifestyle indices after stroke. METHODS: From a population-based one-year cohort (n = 416), we performed an observational study of 145 survivors at 16 months and 10 years after stroke (age 27-97 years) regarding secondary prevention including reaching acceptable treatment goals; nutritional status with focus on underweight; and the lifestyle indices: living situation, level of dependence, and self-assessed health condition. RESULTS: Ten years after stroke, 50% of the subjects with hypertension diagnosis and 55% of those without hypertension diagnosis were within the blood pressure goal <140/90 compared with 32% (P = .008) and 37% (N.S.) at 16 months. Acceptable HbA1c levels among subjects with diabetes mellitus diagnosis increased from 35% to 45% (N.S.). Among those without diabetes diagnosis, satisfactory HbA1c levels decreased from 98% to 79% (P < .001). Underweight increased from 9% to 17% (P = .019). Among patients with cerebral infarction, the prevalence of atrial fibrillation increased from 22% to 29% (P = .004), and treatment with oral anticoagulants from 75% to 78% (N.S.). Acceptable LDL cholesterol levels increased from 59% to 80% (P = .033) among subjects on lipid lowering treatment, and from 18% to 40% among untreated (P = .010). At 10 years, 90% still lived in their own home. Health condition was reported as good/very good/excellent by 65%. Age, female sex, and living situation were associated with intensity of secondary prevention measures and underweight. CONCLUSIONS: The proportion of individuals within treatment goals improved over time, but secondary prevention still needed additional consideration 10 years after stroke.

Housing accessibility problems for people with Parkinson's disease.

OBJECTIVES: Promoting accessible housing for all citizens is high on the political agenda. Knowledge is, however, limited regarding housing accessibility problems for people with Parkinson's disease (PD). The objectives were to investigate housing accessibility problems among people with PD at different stages of disease severity and to analyze the potential impact of improved functional ability on accessibility problems. MATERIALS AND METHODS: The study included 253 participants with PD (61% men; mean age 70 years). Disease severity was assessed by the Hoehn and Yahr (HY) I-V stages: HY I, n=50; II, n=73, III, n=66; IV-V, n=64. Using the Housing Enabler (HE) instrument, accessibility problems were investigated by combining assessments of the person's functional capacity with assessments of physical barriers in the housing environment into a person-environment fit measure (HE-score). To analyze potential impact of improved functional ability on housing accessibility problems, data simulation was applied. RESULTS: HE-scores differed significantly (P<.001) in relation to HY stages. Overall balance problems explained 22% and walking devices 17% of the HE-scores, whereas environmental barriers contributed to a lesser extent. The environmental barriers generating the most HE-scores were "no grab bar at shower/bath/toilet" and "wall-mounted cupboards and shelves placed high". A simulation of improved balance significantly (P<.001) lowered the HE-scores in all HY stages. CONCLUSIONS: The results suggest that actions targeting balance problems and dependence on walking devices have the greatest potential for reducing housing accessibility problems for people with PD. The study also details environmental barriers that need specific attention when providing housing adaptation services.

Factors associated with life satisfaction in Parkinson's disease.

OBJECTIVES: To identify factors associated with life satisfaction (LS) in people with Parkinson's disease (PD), including a specific focus on those with late-stage PD. MATERIAL AND METHODS: The study included 251 persons with PD (median age 70 years; PD duration 8 years). Analyses involved the total sample and a subsample with late-stage PD, that is Hoehn and Yahr stages IV and V (n=62). LS was assessed with item 1 of the Life Satisfaction Questionnaire (LiSat-11). Simple logistic regression analyses were performed for both the total sample and for the subsample with late-stage PD. For the total sample, a multivariable logistic regression analysis was also performed. RESULTS: In the total sample, 12 of the 20 independent variables were significantly associated with LS: need of help with ADL; walking difficulties; number of non-motor symptoms (NMS); fatigue; depressive symptoms; general self-efficacy; motor symptoms; pain; PD severity; freezing episodes; gender (woman); and fluctuations. When controlling for age and gender in the multivariable logistic regression model, depressive symptoms were negatively associated with high LS and general self-efficacy was positively associated with high LS. In late-stage PD, simple logistic regression analyses (controlling for age and gender) identified the following factors as associated with LS: number of NMS, general self-efficacy, walking difficulties and fatigue. CONCLUSIONS: This study provides new knowledge on factors associated with LS in a PD sample, including those with late-stage PD. As the ultimate goal for PD care should be improvement in LS, the results have direct clinical implication.

Cognitive function in stroke survivors: A 10-year follow-up study.

OBJECTIVES: Post-stroke cognitive impairment (PSCI) has considerable impact on patients and society. However, long-term studies on PSCI are scarce and may be influenced by assessment methods and selection bias. We aimed to (i) assess the prevalence of long-term PSCI; (ii) compare two common cognitive assessment instruments; and (iii) compare cognitive function of long-term stroke survivors with non-stroke persons. METHODS: Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were administered to 10-year survivors from a population-based cohort of first-ever stroke patients included in the Lund Stroke Register, Sweden, in 2001-2002. PSCI was defined as MMSE<27 and/or MoCA<25 and severe cognitive impairment as MMSE<23. Age- and sex-matched non-stroke control subjects who had performed MMSE (but not MoCA) were recruited from the longitudinal population study "Good Ageing in Skåne." The odds of having cognitive impairment for stroke survivors compared to controls were examined with logistic regression analyses adjusting for education. RESULTS: Of 145 stroke survivors after 10 years, 127 participated. MMSE showed PSCI in 46%, whereas MoCA displayed PSCI in 61%. Among the stroke survivors with MoCA<25, 35% had MMSE≥27 (P<.001). The odds of having severe cognitive impairment defined as MMSE<23 were higher among the stroke survivors compared to 354 controls (education-adjusted; OR=2.5; P=.004). CONCLUSIONS: Post-stroke cognitive impairment was prevalent among 10-year stroke survivors, and the odds of having severe cognitive impairment were higher among the stroke survivors compared to non-stroke persons. The burden of long-term PSCI might have been underestimated previously, and MoCA may be more suitable than MMSE to detect long-term PSCI.

Psychometric properties of the General Self-Efficacy Scale in Parkinson's disease.

OBJECTIVE: This study aimed to investigate the psychometric properties of the General Self-Efficacy Scale (GSE) in people with Parkinson's disease (PD). More specifically, we investigated data completeness, scaling assumptions, targeting, reliability, and construct validity. MATERIALS AND METHODS: This study involves data available from two different projects that included people diagnosed with PD for at least 1 year, yielding two samples (1 and 2). The combined total sample (N=346; 60% men) had a mean (SD) age and PD duration of 71 (8.9) and 9 years (6.3), respectively. Both samples received a self-administered survey by mail, which was administered twice in sample 2. Additional data (e.g., clinical assessments) were available for Sample 1. RESULTS: Total GSE scores were computable for 336 participants (97%). Corrected item-total correlations exceeded 0.4. Principal component analyses identified one component (the eigenvalue of the first component extracted was 6.9), explaining 69% of the total variance. Floor and ceiling effects were <6%. Internal consistency (coefficient alpha) was 0.95. Analyses of test-retest reliability yielded (ICC) values from 0.69 to 0.80. The highest value refers to those (n=47) with identical self-ratings of mobility (in the on condition) at both tests; the standard error of measurement was 3.1 points. Construct validity was further supported by correlations in accordance with a priori expectations. CONCLUSIONS: This study provides support for the validity and reliability of GSE scores in people with PD; the GSE can thus serve as a valuable outcome measurement in clinical practice and research.

The association between the home environment and physical activity in community-dwelling older adults.

UNLABELLED: Physical activity (PA) decreases with increasing age despite the fact that PA exerts beneficial effects on many age-related diseases and conditions. Consequently, there is an interest in modifiable factors that may influence PA among older persons. The purpose of this study was to examine the association between PA and the home environment in well-functioning older community-dwelling persons. METHOD: This study used a person-environment (P-E) fit perspective to the home environment, operationalized by means of assessment of functional limitations in 81 community-dwelling persons (median age 79 years) as well as environmental barriers in their home environments and the nearby exterior surroundings. The interaction between functional limitations and environmental barriers generated a score expressing the magnitude of P-E fit problems in their home environment. PA was rated with a questionnaire covering household-related and recreational activities. RESULTS: We found a significant association between PA and the magnitude of P-E fit problems that explained 3.9 % of the variance of PA. The number of environmental barriers per se was not significantly associated with PA, while functional limitations explained 6.8 % of the variance of PA. CONCLUSION: In well-functioning older persons living in the community environmental aspects of housing demonstrated a weak association with PA.

Attitudes related to technology for active and healthy aging in a national multigenerational survey.

Research is needed to understand attitudes toward and adoption of the broad range of technologies available to support active and healthy aging in different generations. The present article gives an overview of the GenerationTech survey and sample, and describes attitudes and acceptance related to technology in general and as a means to support active and healthy aging. A national survey was conducted with a random sample (n = 2,121) including men and women from three generations (30-39, 50-59 and 70-79-year-olds) in Sweden. The generations shared some attitudes toward and acceptance of technologies for active and healthy aging. However, what kind of technologies are preferred to support active and healthy aging and the reasons for using certain technologies differed by generation. The findings could help guide the development and implementation of technologies for active and healthy aging throughout the aging process.

The multiple meaning of home as experienced by very old Swedish people.

The aim of this study was to explore aspects of the meaning of home as experienced by very old single-living people in Sweden. A grounded theory approach was used, and interviews were conducted with 40 men and women aged 80-89. The findings indicate that home has a central place in the lives of very old people because it is where they live and spend so much time. The significance of the home is based on the fact that it means so many different things to the participants. The theme comprises two key categories: home means security and home means freedom. Each of these has three sub-categories. In home means security, these are: living in a familiar neighborhood, everything functions, and having memories to live on. Home means freedom comprises a place for reflection, a social meeting-point, and leaving your own mark. Home is part of the environment and influences the meaning and selection of activities that very old people decide to engage in. When occupational therapists prescribe assistive devices or recommend changes in the home environment, they must be very well aware of and reflect on what home means to their clients and base their measures on that.

Quality of life in the elderly population: an example exploring interrelationships among subjective well-being, ADL dependence, and housing accessibility.

During recent decades, research on quality of life has gained increasing interest. In gerontology, the assessment of objective as well as subjective dimensions is recommendable, and the most innovative research will involve the study of the interrelationships of several components. In empirical research objective environmental factors have rarely been explored. The aim of this study was to explore the interrelationships among subjective well-being, dependence in activities of daily living (ADL), and objective housing accessibility in the elderly population in ordinary housing. A random sample of 133 subjects aged 75-84 was multi-dimensionally assessed. The Gothenburg Quality of Life Instrument, a revised version of the ADL Staircase and the Enabler were administered at home-visits. Most of the subjects rated their general well-being as high. One-third were independent in ADL, and 1/5 did not have any objective housing accessibility problems. Different aspects of physical well-being covaried significantly with ADL dependence, but even more strongly with objective housing accessibility. Theoretically, the results relate to the Lawton model of 'The Good Life'. In conclusion, inaccessible housing represents a potential health problem, since it threatens the independence and subjective well-being of elderly people. The results presented in this study provided increased knowledge of importance for geriatric rehabilitation and society planning to meet the needs of senior citizens.

Development of multi-disciplinary team I-ADL assessment in community health care: an interrater reliability study of the measure of instrumental daily activity.

This paper describes a development process concerning the active involvement of staff of different professions in developing and implementing methods for assessment of activities of daily living (ADL) in home-based geriatric rehabilitation. Although a variety of established ADL instruments exist, at the time for this study no I-ADL (Instrumental Activities of Daily Living) instrument suitable for communication among staff members of different professions was available. The specific aim was to test a new I-ADL instrument for interrater reliability. The developmental process resulting in the Measure of Instrumental Daily Activity (MIDA) is described. The instrument comprises 12 I-ADL items, defined on the basis of practical home rehabilitation experience. The study involved 36 clients with impairments, aged 65+ years. Multi-disciplinary interrater reliability was tested by 67 parallel independent assessments during a 3-month period, performed by pairs of raters of different professions. Overall agreement was very good (mean weighted kappa=0.89). The MIDA fulfils the basic requirements necessary for valid I-ADL assessment of elderly clients in community health care. An important quality is the active involvement of all staff in the assessment procedure, facilitating and stimulating the implementation of a general rehabilitative attitude in everyday practice.

Accessibility, usability and universal design--positioning and definition of concepts describing person-environment relationships.

PURPOSE: The aim of this paper is to position, define and discuss three concepts crucial for research and practice concerning person-environment relationships, viz. accessibility, usability and universal design. METHODS: Literature review, synthesized with the authors' research and practice experiences. RESULTS: The authors suggest an instrumental, three-step definition to accessibility, highlighting that accessibility comprises a personal as well as a environmental component, and that accessibility must be analysed by an integration of both. Suggesting the introduction of an activity component, accessibility should partly be replaced by the more complex term usability. Universal design is highlighted as a more process-oriented but less stigmatizing concept. CONCLUSION: This paper contributes to the positioning and definition of concepts describing person-environment relationships. The definitions suggested challenge current terminology, but can support in developing more efficient research and practice strategies. In order to develop theory for application to societal planning issues, the definition of concepts is a necessary step.

Satisfaction with rollators among community-living users: a follow-up study.

PURPOSE: Rollators are used in order to make mobility possible for people with restricted walking ability. The use of rollators is increasing, but little is known about outcomes. The aim of this study was to investigate users' satisfaction with rollators. METHOD: A follow-up study was carried out in seven Danish municipalities. One month after they got their device, 89 users of rollators were interviewed by means of the QUEST 1.0. Three months after the first interview a second interview took place and data from the 64 users available for follow-up were analysed. RESULTS: The users were satisfied with their rollators, and the frequency of use was high. However, many of the users were frail, and some of them were not fully satisfied in all respects. Women especially, users living alone and first time users were likely to be dissatisfied. The main problem identified was handling the rollator, and for several users the physical environment caused accessibility problems. CONCLUSIONS: Rollators are valuable for the users and a relevant societal intervention. However, a better match between person and technology, enhanced user training and follow-up can improve the outcome of the intervention. Furthermore, better rollator design is called for, and buses and the outdoor environment need to be made more accessible.

Hand function tests and questions on hand symptoms as related to the Stockholm workshop scales for diagnosis of hand-arm vibration syndrome.

The severity of hand-arm vibration syndrome (HAVS) is usually graded according to the Stockholm workshop scales. Although the Stockholm workshop scales are regarded the gold standard for assessing the severity of HAVS, they are based primarily on subjective symptoms. The aim of the present study was to explore the agreement between Stockholm workshop scales and the outcome from ten well-defined clinical tests commonly used in hand rehabilitation for assessment of hand function. One hundred and eleven vibration-exposed workers participated in the study. Ten objective tests of hand function and four questions on subjective hand symptoms were included. The results indicated that, out of these tests, perception of vibration, perception of touch/pressure and dexterity showed a moderate agreement with Stockholm workshop scales. Among specific questions on hand symptoms, cold intolerance and pain showed a high agreement with Stockholm workshop scales. It is concluded that defined objective tests combined with directed questions on specific hand symptoms, together with the Stockholm workshop scales, may be helpful for diagnosing HAVS.

Occupation and survival: a 25-year follow-up study of an aging population.

OBJECTIVE: In this retrospective study of an elderly population cohort living in a defined Swedish rural area, the relationship between occupation and survival as a measure of objective health was investigated. The cohort has been followed for 25 years. METHOD: On the basis of the baseline socioeconomic interview from assessments performed when the participants were 67 years of age, an index of active participation in daily occupation was devised. The index was used to investigate the covariation between generic everyday occupation and long-time survival. RESULTS: For the female participants, Kaplan-Meier curves demonstrated differences in survival between the "less active" and "more active," and Cox regression survival analyses resulted in a significant covariance between occupation and survival. For the male participants, no such differences were found. CONCLUSION: The significant results for the women implied support for the core assumption of occupational therapy that a relationship exists between occupation and health. The lack of differences in survival among more active and less active men demonstrates the complexity of studying occupation.

Physical housing environment: development of a self-assessment instrument.

The aims of this study were to construct and develop a self-administered assessment instrument, useful for studying clients' own perception of accessibility and usability in their housing environment, and to test the instrument for reliability. It was developed for use in combination with an objective, norm-based assessment of the physical housing environment, the Enabler instrument. The instrument developed in this study contains 31 questions about different aspects of the physical housing environment. Answers are given on a 7-point rating scale. Content validity was established by the use of an expert panel and pilot testing, followed by a test-retest study. Internal consistency of the instrument was good (Cronbach's alpha 0.96), and very good to moderate agreement between the two ratings was found on all items (mean weighted kappa, Kw 0.71) indicating good reliability. However, the removal of three items from the standardized part of the instrument is suggested. The instrument has a client-centred approach and is a valid and reliable tool, useful for occupational therapy practice and research.

Methodologic support in habilitation and rehabilitation: communicative action between practice and science.

This study evaluated the early phase of development of a model for quality improvement of habilitation and rehabilitation project processes. The focus of the methodologic support in habilitation and rehabilitation model was on cooperation between practice contexts and science. Habermas' theory about communicative action was a theoretical frame of reference. Three project coordinators and ten project leaders were interviewed. The results revealed different attitudes towards methodologic support activities, demonstrating the importance of acknowledging cognitive and social functions, the process of legitimization, different approaches of practice versus science, and problems regarding information and communication. The model was shown to be important in bridging the gap between practice and science. To support reflective and emancipatory cognitive learning, more efforts to foster communicative action are called for, and more attention must be paid to the importance different missions and organizational structures have for the development of the dialog between practitioners and researchers.

Mobility and mobility-related participation outcomes of powered wheelchair and scooter interventions after 4-months and 1-year use.

PURPOSE: The aim was to investigate outcomes of powered wheelchair and scooter interventions after 4-months and 1-year use regarding need for assistance when moving around, frequency of mobility-related participation, easiness/difficulty in mobility during participation, and number of participation aspects performed in everyday life. METHOD: The study was a prospective cohort study, using an instrument focusing on mobility-related participation outcomes of mobility device interventions (NOMO 1.0), at baseline, after 4-months and 1-year use. RESULTS: The results show that the outcomes in terms of participation frequency and easiness in mobility occur in a short time perspective, and that the effects remained stable at 1-year follow-up. The frequency of going for a walk increased most prominently (26%). Even though the majority of the participation aspects were not performed, more often they became easier to perform: 56-91% found that shopping, walking and visiting family/friends were easier. Moreover, independence outdoors and indoors increased. CONCLUSIONS: This small study provides knowledge about the outcomes of powered wheelchairs and scooters in terms of mobility and mobility-related participation in real-life situations. The study supports results from former studies, but even so, larger studies are required in order to provide evidence for the effectiveness of powered wheelchairs and scooters. [Box: see text].

Environmental influences on the cumulative structure of instrumental ADL: an example in osteoporosis patients in a Swedish rural district.

INTRODUCTION: The ADL Staircase is a hierarchical instrument for the assessment of dependence/independence in personal and instrumental activities of daily living (P-ADL and I-ADL). Previous results indicated that environmental factors might affect assessment results, and revisions for use in rural areas have been tested with a gerontological population sample. OBJECTIVE: To investigate further the cumulative structure of I-ADL in osteoporosis patients in a Swedish rural district. METHOD: Patients were interviewed consecutively concerning their pre-injury dependence in P-ADL and I-ADL, using a revised version of the ADL Staircase (n = 276). RESULTS: In contrast to results from urban areas, 'transportation' was the activity generating the most dependence among the respondents. In addition, different gender-specific cumulative orders among I-ADL were demonstrated. Guttman's scaling analysis confirmed the cumulativity of the revised scale (C of R = 0.94/0.97, C of S = 0.77/0.88). CONCLUSION: Environmental factors influence the validity of instruments as well as the prevalence of disability.