Discharge of frail older people from acute hospitals across Europe.

Over the last few years the number of elderly patients in acute hospitals throughout Europe has risen dramatically. The pressure on hospital beds leads to earlier discharge and the task of sending patients home from hospitals is becoming more complex. The provision of health and social services is organized in different ways all over Europe. Therefore, it would be of interest to know more about how different kinds of systems support the professional carers in their effort to satisfy the needs which older people and their significant others experience in the discharge process. A pilot study was set up mainly to provide information on what kinds of problems are inherent in a multicentre, interprofessional research project involving a large number of countries. The findings serve as an important knowledge base in a future project. Experiences from the pilot study and the benefits of it are presented.

Assessing health care needs: the actual state of self-perceived activity limitation and participation restrictions due to pain in a nationwide Swedish population.

Needs assessment may be helpful in establishing health care priorities, especially when community financial resources are reduced and the need and demand for health services are increasing. As the starting point of empirical studies concerning needs assessment of rehabilitation and occupational therapy, this study aimed to establish the prevalence of self-perceived activity limitation and/or participation restrictions due to long-term or recurrent pain. The study sample (n = 10000) was taken at random from the Swedish population aged 18-58 years. After three reminders, the response rate to a postal questionnaire was 77.1%, by mail or to a telephone answering machine. The main results indicated prevalence frequencies of 26%, showing the actual state of self-perceived activity limitation and/or participation restrictions due to long-term and/or recurrent pain. Differences were found between genders, among almost all age-classes and between persons who had pain currently and those who had had pain previously. Suggested indicators from the study result were women born between 1940 and 1949 with long-term pain and previous pain.

The actual state of the effects, treatment and incidence of disabling pain in a gender perspective-- a Swedish study.

PURPOSE: The purpose of the study was to elicit the actual state of self-perceived experience of long-term and/or recurrent pain and its effects as reported by women and men with disabilities due to pain, in order to determine criteria for assessing the need for measures in rehabilitation/occupational therapy. METHODS: The study used a comparative design with a sample randomized from the Swedish population aged 18-58 years (n = 10,000). The inclusion criterion was that the respondents had or had had pain causing activity limitation or restricting participation in daily life. A special questionnaire including items concerning demography, pain, coping, occupations in daily life, work, treatments, care institutions and hospital/care staff visited, was posted to 1,849 persons and was answered by 1,448 respondents (study group n = 1,305, control group n= 117). RESULTS: Gender differences were found in the overall prevalence of pain, women reporting more frequent episodes of pain than men did. Differences were also found in pain variables, in daily occupations, days of sick-leave and work variables. Women completed more varied treatment than men. The incidence rate of long-term/recurrent pain in the population studied was 0.07. CONCLUSIONS: As a conclusion from this study, three essential components are suggested for use when assessing the need for rehabilitation/occupational therapy: (1) shoulder/arm or lower back pain of aching, tensed and/or searing character, particularly among women; (2) emotional/affective pain effects causing restlessness and depression, particularly among women; and (3) limitations in daily occupations assessed by FSQ and the demand/control/support model with results falling within the warning zones plus long sick-leave periods.

A needs assessment for referral to occupational therapy. Nurses' judgment in acute cancer care.

As a step toward developing criteria for referral to occupational therapy, the study set out to assess patients' needs of occupational therapy in an acute cancer care hospital. A 31-item Needs Assessment Questionnaire was produced. It was intended to reflect interventions/ measures of occupational therapy. Seventeen questions eliciting information on occupational therapy gave a factor with an alpha coefficient of 0.92. Four single questions on occupational therapy did not form a factor. Six questions about the disease had an alpha coefficient of 0.83, whereas four about rehabilitation prognoses formed a factor with an alpha coefficient of 0.57. The questionnaire was completed by 40 day-shift primary-care nurses acting as key informants. Their answers concerned a total of 88 of their patients. Twenty-six percent of the patients had been recommended for or referred to occupational therapy, whereas many whom the nurses judged to need this (47%) had not been referred (p = 0.01 chi-squared test, 10.59 McNemar test). Hence, no logical pattern of referral was found, and this seems to highlight both the absence of and the need for clear referral criteria.

Wheelchair users' experience of non-adapted and adapted clothes during sailing, quad rugby or wheel-walking.

The purpose of the present quasi-experimental post-test-design study was to compare 32 wheelchair users' (mostly para/tetraplegics) experience of wearing specially adapted clothes and non-adapted clothes for sailing, quad rugby or wheel-walking. Four existing assessment instruments were used: the Klein-Bell Activities of Daily Living Scale; a two-part Basic Information Questionnaire eliciting experience of effort, comfort and feeling of physical condition; the Experience Sampling Form for investigating the individuals' attitudes in terms of involvement and affective and activity mood states, and the Occupational Therapy Assessment of Leisure Time interview framework for collecting data about experience of leisure time. The wheelchair users all associated significantly greater comfort with use of the adapted clothes and, particularly the 'sailors', better physical condition. Overall, significantly greater involvement and more positive affect states were associated with the adapted clothes than with conventional garments, and mood state changed for the better. The wheelchair users set a higher priority upon work or leisure activities than upon independence in activities of daily living, and for this reason the Klein-Bell ratings showed great variation between the 'sailors' and the 'quad rugby players' (range 57%-93%), though these groups demonstrated more independence than the 'wheel-walkers'. The results of the study confirm the value of adapting sportswear for handicapped people. Such adaptations should also be of benefit for other activities than those studied.

Evaluation of a vocational training programme in primary health care rehabilitation: a case study.

The content and effect of a new occupational therapy programme aimed for vocational training forming part of a research project named 'the Sollentuna Rehabilitation Project' are described for four patients (of 38) with musculoskeletal pain. In the programme, occupational therapy analysis and intervention alternated. Intervention was based on the model of human occupation, the rehabilitative, the biomechanical, and occupational adaptive frames of reference. Each patient participated in a structured interview and a job analysis. The programme was evaluated on five measurement occasions using the Goal Attainment Scale, self-assessments of patterns of daily occupation using an activity log, and self-estimation of pain using the 'Symtrack' instrument. On the fifth measurement occasion two of the patients had decreased their resting time and three were performing activities formerly avoided due to pain. Two patients' degree of assessed pain had decreased. Three of the four patients had attained their individual goals of occupational therapy (T= >50). The occupational therapy programme has proved to be applicable in primary health care for patients with musculoskeletal pain.

The transfer of knowledge in occupational therapy: the case of work ability assessment.

Kunskapsöverföringen inom arbetsterapi diskuteras i marknadsföringstermer. Dessa exemplifieras med strategier som författarna föreslår för att lärare, kliniskt verksamma arbetsterapeuter och annan rehabiliteringspersonal skulle kunna förbättra sina kunskaper om arbetsförmågebedömningar och om arbetsrelsterade rehabiliteringsprogram.

Work technique training for patients with chronic pain in neck, shoulder and arm. A questionnaire pilot study after a comprehensive exercise-oriented rehabilitation program.

Syftet med denna studie var att följa upp hur patienter såg på sin arbetsmiljö och arbetsteknik samt hur föreslagna arbetsplatsanpassningar hade genomförts efter deltagande i ett multimodalt intensivträningsinriktat rehabiliteringsprogram. Programmet inkluderade en väsentlig del av individuell ergonomisk analys, individuell ergonomisk rådgivning och specifik arbeetsteknikträning på arbetsterapiavdelningen. Patienterna hade kronisk muskuloskelettal smärta i armen. Efter rehabiliteringsprogrammet skickades ett frågeformulär till 181 patienter, varav 135 patienter (109 kvinnor och 26 män) (75%) svarade. Mer än halften av patienterna rapporterade att de oftere än en gång i veckan tänkte tillbaka på den individuella ergonomiska rådgivningen som gavs i samband med att videofilmen tagen på deras arbetsplats presenterades. Deras skattningar visade på en hög medvetandegrad när det gällde att la mikropauser under arbetet (dvs atl räta upp ryggen kombinerat med muskelavslappning), att arbeta med armarna nära kroppen och att lyfta bördor nära kroppen. Hälften av patienterna hade använt sig av möjligheten att ändra arbetsställning mer än en gång per timme. Resultatet indikerar att patienterna var medvetna om sin arbetsteknik efter deltagandet i rehabiliteringsprogrammet.

Swedish use and validation of Valpar work samples for patients with musculoskeletal neck and shoulder pain.

I studien beskrivs vad e bedömning av arbetskapacitet (BAK) innehåller Vid en bedömning av arbetskapacitet jämförs kraven för att utföra ett specifikt arbete, definierat i "The dictionary of Occupational Titles" (DOT), och patientens förmåga att utföra ett arbote vilket definieras med hjälp av sju variabler. Allmän utbildnings nivä. Speciella yrkesförberedelser. Anlag, Intresseområden, Personlig läggning. Fysiska drav och Miljöpåverkan. En bedömning av arbetskapaciteten kan ske antingen genom att observera patienten under arbete påarbetsplatsen eller under simulerat arbete tex genom att använda Valpar systemets arbetsprover.Vid Rehabiliteringsmedicinska kliniken, Karolinska Sjukhuset har tvä av de standardiserade arbetsprovema använts. VCWS 8 "Simulerad moontering" och VCWS 9 "Simulerade rorelser for hela kroppen" for att förbättra bedömningen av patientens arbetskapacitet. VCWS 8 mäter "en persons förmaga att utföra ett monteringsarbete som kräver repetetiva fysiska manipulationer" och VCWS 9 mäter "en persons formåga att röra på bålen, nacken, armarna, händerna och fingrama när de relaterar till funktionellt utförande av ett arbete". Valideringen av arbetsprovema för Svensk anvandning gjordes på en grupp patienter (n = 97) med muskuloskelettal nack- och skulder smärta som deltog i ett rehabiliteringsprogram. VCWS 9 utfördes av åttiofem patienter och VCWS 9 av sextionic patienter.Medelvärdet for patienterna som slutförde VCWS 8 var 83.1% av industriell standard nivå (mätt enligt MTM-Method-Time-Measurement) där den lä gsta gränsen är 87.5% för ett godkännt utförende. Detta innebär att de "inte moter" kraven för detta specifika arbete. I motsats till detta sä nädde patientema som utförde VCWS 9 ett medelvärde pä 108.6% vilket overstiger kravet (87.5%) för industriell standard. Det oväntade resultatet kan kanske förklaras av att patienternas intresseområden vad gäller arbetsfalt endast sammanfoll med iintresseområdena för VCWS 8 och yeWS 9 i 32% av fallen. En retrospective jämförelse mellan att vara sjukskriven eller inte vara sjukskriven och deras förmåga att utföra ett arbetsprov och uppnå minimi kravet for industriell standard visade inte på något samband. Mänga faktorer kan ha påverkat resultatet som tex patientens motivation, andra psyko-sociala omstandigheter och arbetsterapeutemas beslut att endast använda sig av två stycken av ett flertal arbetsprov.Konklusiionen ar att en bedörning av patientens arbetskapacitet skall utföras prospektivt och bör ta i beräknng de krav arbetet ställer enligt DOT och därefter bör rätt arbetsprov väijas för den individuella patienten. Sker detta på ett riktigt sätt så år Valpars arbetsprover valida och till stor hjälp vid en medicinsk bedomning och för beslut när det gäller fortsatt sjukskrivning eller vid yrkesrådgivning.

A study of activity in the home environment among individuals with disability following a stroke.

An ethnographic approach (Fetterman DM. Ethnography Step by Step. Applied Social Research Methods Series, Vol. 17. London, New Delhi, SAGA Publication, 1990) with thematic interviews, participatory observations, the 'activity log' (Yerxa EJ, Baum S. Engagement in daily occupations and life satisfaction among people with spinal cord injuries. Occup Ther J Res 1986;(6)4;318-326), and the 'satisfaction with performance scaled questionnaire' (Yerxa EJ, Burnett-Beaulieu SE, Stocking S, Azen SP. Development of the satisfaction with performance scaled questionnaire (SPSQ). Am J Occup Ther 1988;42:215-221) were used to investigate, in their homes, the performance of occupation/activity in 15 stroke victims dependent in activities of daily living. The data were categorised according to Spradley (Participants Observation. USA, Holt, Rinehart and Winston, 1980). The study describes the activities performed by the individuals themselves, activities done for them, patterns of activity over time and the individuals' satisfaction with, and feelings about, each activity.

An activity analysis of hand grips used in housework by female rheumatoid arthritics.

In this nonexperimental study, videofilmed, self-selected housework activities of rheumatic women were analyzed. The women gripped and manipulated objects in their homes. The activities were analyzed under the headings Activity, Actions, Objects, and Grip. The films were viewed frame by frame, and the data was computerized for statistical analysis. The women performed five self-selected housework activities and eight groups of actions (n = 340). During the actions the women handled 12 groups of objects using the eight grip classes of Sollerman's grip classification. The diagonal volar grip was the most common grip (20%), and the tripoid pinch was the least common (0.29%); 34% of the actions were right-handed, 19% left-handed, and 47% bimanual. No clear grip pattern was revealed by the activity analysis.

Assessment of patients with chronic back pain using the "Functional Status Questionnaire".

Forty-eight patients with chronic back pain undergoing a rehabilitation program were assessed with the Functional Status Questionnaire (FSQ) during the first week of rehabilitation and after 6 weeks, 6 months and one year. In their first test, all the patients showed diminished functional capacity in at least one of five summary scales, indicating serious health problems and a need for rehabilitation. The test-retest correlation was k = 0.96, indicating high reliability of the questionnaire. After 6 weeks of rehabilitation the patients estimated significant improvements regarding "Satisfaction with health", "Mental health" and "Number of close friends". Some of these improvements were maintained after 6 months and one year. The "Basic ADL" and "Intermediate ADL" scales, however, showed no changes, indicating either low sensitivity or that no real changes had occurred during the rehabilitation period. The FSQ is recommended for use among patients with chronic back pain, but the tests need to be supplemented with other measurements concerning ADL capacity.

The usefulness of four methods of assessing the benefits of electrically adjustable beds in relation to their costs.

Ten picture cards, interviews, time logs, and the Klein-Bell ADL scale were useful in assessing the benefits of electrically adjustable beds to patients but not to caregivers. The mean cost per bed per year of US $346 seems, in relation to the benefits, to be a worthwhile investment for increasing patients' quality of life.

Causes of Dependence in Personal Care Three Years after StrokeA Study in the Home Environment.

Many activities of daily living (ADL) assessment instruments are available for judging the ability to perform personal care in, among others, persons suffering a stroke. However, ADL assessment instruments do not normally treat the underlying causes of failure to perform an activity.Seventeen persons with stroke were videotaped when performing personal care in their home environments about three years after the incident. The underlying causes of their failure in personal care are described in intrapersonal, interpersonal, and environmental dimensions. Interpersonal obstacles proved to be the main reasons why the persons in this study did not perform personal care.The self-reports of a 24-hour activity pattern showing the relationship between use of time for performance of personal care, sleep and rest, and other activities are presented.For the participants in this study, the Klein-Bell ADL Scale, an assessment instrument comprising 170 observation points, was judged to be valid and reliable, but some modifications are proposed.

Video feedback in occupational therapy: its effects in patients with neglect syndrome.

The use of video feedback in occupational therapy was evaluated in four patients with right hemisphere stroke and hemineglect. The study followed a single-case research experimental pretest, posttest, and follow-up (A1, B, A2, A3) design. Phases A1 and A2 included four observation times and phase A3 three, with 12 weeks for each patient. Three household tasks were assessed, and the patients' neglect behavior while performing these was videorecorded. One paper-and-pencil task using a modified Albert's test was also used, but not filmed. In the intervention program, the patients watched the film, which was stopped by the occupational therapist where the neglect behavior was significant. Through dialogue, the patients were led to perceive and interpret their neglect behavior, and strategies for relearning and remediation were recommended. The program seems to be effective for remediation and relearning a functional way of working.

Medical and social factors affecting behaviour patterns in patients with acquired brain damage: a study of patients living at home three years after the incident.

This study aimed to describe the consequence of stroke or brain trauma 3 years after the incident for individuals living at home, and how patterns of behaviour were influenced by determinants. One hundred and eighty-eight individuals in three age groups answered a questionnaire. Answers were classified according to WHO's ICIDH, and 11 areas of behaviour were distinguished. Diagnoses and locations of lesions were noted from medical records. Impairment and disability increased with increasing age at the time of the incident. Individuals working before but not after the incident indicated decreased life satisfaction and changed intellectual function, personal care, and domestic/housework/gardening activities, and inability to organize their time. Those who had resumed work but at different tasks indicated changed emotional and sensorimotor function and content in leisure activities. The influence of the localization and lateralization of the lesion is also discussed.

A leisure-time frame of reference based on a literature analysis.

The aims of this study were, through literature analyses, to identify the concept 'leisure time,' to design a model of leisure time and to study the empirical methods used in research literature on leisure time. The data for this article consisted of occupational therapy literature including 48 articles found through a search of the MEDLINE and PsychLIT databases for the period 1975-1989. The methods used for identifying and coding these data based on a set of questions presented by Guba and Lincoln (1985). For discovering the empirical methods used in the material, the work of Ostrow and Caplan (1985) was followed. The data analysis led to the development of a frame of reference of leisure time as used in occupational therapy literature. This model consists of the following dimensions: time, intrinsic motivation, free choice of activity, capability, structure of social and culture environment, leisure-time activity engaged in, goals, pleasure for pleasure's sake, diversion, recreation, relaxation, self-fulfillment, influence on individual, leisure role, leisure behavior, and satisfied harmonious person.

Impairment/function and disability/activity 3 years after cerebrovascular incident or brain trauma: a rehabilitation and occupational therapy view.

A consecutive series of 195 individuals who had had a stroke or brain trauma in 1986 responded in 1989 to a questionnaire about the consequences of the incident for occupational performance. The questionnaire contained 86 questions organized to correspond to the WHO International Classification of Impairments, Disabilities and Handicaps (ICIDH). The questions were distributed over 11 areas of occupational performance: work, leisure activities/social role, life satisfaction, sensori-motor, perceptual, intellectual, emotional function, sleep, personal care, domestic/housework/gardening, and temporal adaptation. None of the individuals considered they had attained the same level of occupational performance in all 11 areas as before the incident. Eight patterns of occupational performance were identified: 35% considered that they performed personal care at the same level and had the same temporal adaptation as before the incident, and that they had minimal impairment/disability in the other areas of occupational performance; 27% thought that they had a considerable degree of disability in all areas of occupational performance except for temporal adaptation; 8% thought that they had imbalance in temporal adaptation and severe performance difficulties in all 11 areas of occupational performance; 4% were dissatisfied with their life situation, and had a changed family role, did not practise the leisure activities they wanted, and had severe sleep problems; and for 9% the levels of performance varied a great deal and depended on the particular area of performance. The consequences of stroke or brain trauma for function and activity 3 years afterwards are considerable.