Risk assessment of healthcare workers' exposure to physical load in relation to patient handling and movement: a feasibility study of the instrument TilThermometer.

BACKGROUND: Work-related musculoskeletal disorders are common among healthcare workers (HCWs) but might be prevented by risk assessment and further promotion of occupational safety and health. The aim of this study was to investigate if the risk assessment instrument TilThermometer can be used to identify risk profiles of physical exposure in HCWs working with patient handling and movement (PHM). Further aims were to describe HCWs' perceptions and experiences of using the TilThermometer. METHODS: This feasibility study has a mixed design methodology. In total, 54 HCWs from 17 Swedish care units participated and performed risk assessments with the TilThermometer. Data collected from the risk assessments were used to identify risk profiles of physical exposure. HCWs' experiences of using the TilThermometer were collected from activity logs and analysed qualitatively. Three questionnaires were used to assess perceived acceptability, appropriateness, and feasibility of the risk assessment, and eight study specific questions were used for perceived usefulness. RESULTS: The TilThermometer was used at the care units by assessing each care recipient, and when compiling the data at a group level, a summarized risk profile for the care unit could be provided. Risk for physical exposure was reported as high in two work tasks; no care unit used the high-low adjustable seat when showering care recipients sitting down, and 13% used the recommended assistive devices when putting compression stockings on. However, 99% used high-low adjustable assistive devices when caring and bathing care recipients lying down. TilThermometer was described as easy to use, enabling team reflections and providing an overview of the care units' recipients and workload, but difficulties in categorizing for mobility groups were also reported. The TilThermometer was, on a five-point scale, perceived as acceptable (mean 3.93), appropriate (mean 3.9), and feasible (mean 3.97). These scores are in line with questions evaluating usefulness. CONCLUSION: The risk assessment provided risk profiles with potential to contribute to care units' development of a safe patient handling and movement practice. The findings suggest that the TilThermometer can be used to assess risks for physical exposure in relation to patient handling and movement in care units at hospital and nursing homes.

Social Insurance Literacy Among the Sick-listed-A Study of Clients' Comprehension and Self-Rated System Comprehensibility of the Sickness Insurance System.

INTRODUCTION: Sickness insurance systems and their processes have been studied in terms of transparency, comprehensibility and fairness, highlighting the importance of just procedures that make sense to clients. Related research demonstrates differences between groups of clients, pointing towards a social gradient. The concept of social insurance literacy and the Social Insurance Literacy Questionnaire (SILQ) was recently developed and serves as a measure for client's ability to obtain, understand and act on information in a sickness insurance system, relating to the comprehensibility of the information that the system provides. OBJECTIVE: The purpose of this study was to investigate social insurance literacy among clients on sick leave and its associations with perceived justice, being granted sickness benefits and background factors. METHODS: This was a questionnaire study with clients on sick leave in Sweden. In the selection process 3993 clients were invited, of which 1173 recently had their sickness benefits withdrawn. Those who answered the SILQ (n = 1152) also answered a perceived justice measure and accepted sharing register data from the Swedish Social Insurance Agency. Data were analyzed through regression analysis. RESULTS: The findings demonstrate that clients' perceptions of system comprehensibility and the status of their sick leave case was significantly associated with perceived justice, and being granted sickness benefits, while their individual abilities to obtain, understand, and act on information had lesser influence. CONCLUSIONS: The system's ability to provide understandable information seems more important than clients' abilities to comprehend it. From a client perspective, a just system seems to be related to their experiences of the sick leave process (i,e., whether they had an ongoing or closed case) rather than their skills to obtain the correct information.

Exploring return to work barriers through the lens of model of human occupation. The NOW WHAT project.

BACKGROUND: The challenges of returning to work after sickness absence demands a wide conceptual understanding of what hinders the employee's work participation. Thus, there is a need to know more about self-perceived barriers for Return to Work (RTW). AIM: This study aimed to investigate RTW barriers experienced by employees on long-term sick leave, through the lens of the Model of Human Occupation (MOHO). MATERIAL AND METHODS: The study was a large-scale qualitative interview study (n = 85) using semi-structured telephone interviews. Eligible participants had received sick leave benefits for between 6 months and 1.5 years. The data were analysed with quantitative and qualitative content analysis. A deductive approach using the MOHO concepts guided the analysis process. RESULTS: The study generated 941 coded meaning units describing barriers for RTW, of which we were able to code 895 within the framework of MOHO. In the person-specific concepts, performance capacity barriers were most often described (n = 303), followed by volitional barriers (n = 165) and barriers related to habituation (n = 66). Barriers related to the environmental components amounted to 361. Barriers in the occupational environment was dominant (n = 214). CONCLUSION: Experienced barriers related to both environmental components and person-specific concepts. SIGNIFICANCE: The habituational and volitional perspective on barriers can contribute to the identification and communication of performance capacity-related barriers not previously identified.

The Social Insurance Literacy Questionnaire (SILQ): Development and Psychometric Evaluation.

PURPOSE: For clients to understand social insurance decisions and processes, information from authorities needs to be comprehensible, and clients need sufficient individual abilities. These dimensions are captured by the concept social insurance literacy, which has been operationalized into a measure, the Social Insurance Literacy Questionnaire (SILQ). The aim of this study was to describe the development of the SILQ and evaluate its psychometric properties using Rasch measurement theory. METHODS: The development of the SILQ included a Delphi study and cognitive interviews. A preliminary version, divided on four scales corresponding to the domains of the concept (obtaining information, understanding information, acting on information, and system comprehensibility) was psychometrically evaluated according to Rasch measurement theory, in a survey to a stratified random sample of people on sick leave (n = 1151) sent out in the fall of 2020. RESULTS: Overall, the items in the final version of the SILQ demonstrated good fit to the Rasch model, and the response scale worked as intended. Unidimensionality was supported for all scales, but minor problems with local dependency was detected for three items. The person separation was 0.80 for the Obtain scale, 0.82 for the Understand scale, 0.68 for the Act scale, and 0.81 for the System scale. Corresponding ordinal alpha values were 0.91, 0.91, 0.86, and 0.91, respectively. CONCLUSION: This study is a first step toward exploring literacy in the social insurance field. The SILQ covers individual abilities and systems' comprehensibility, and the results show that it has acceptable psychometric properties.

Psychometric evaluation of the Finnish version of the Worker Role interview (WRI-FI).

BACKGROUND: The assessment of work ability with reliable, thoroughly tested instruments, is central to evidence-based occupational therapy practice. AIMS/OBJECTIVES: The aim of this study was to investigate the psychometric properties of the Finnish version of the WRI with a focus on construct validity and measurement precision. MATERIAL AND METHODS: Ninety-six WRI-FI assessments were performed by 19 occupational therapists in Finland. A Rasch analysis was conducted to evaluate the psychometric properties. RESULTS: The WRI-FI presented an overall fit to the Rasch model, with good targeting and separation among persons. The four-point rating scale structure was supported by the Rasch analysis, except for one item with disordered thresholds. The WRI-FI indicated stable measurement properties across gender. Seven of the 96 persons showed misfit, which slightly exceeds the criteria of 5%. CONCLUSIONS: The findings from this first psychometric evaluation of the WRI-FI provided evidence of construct validity and support for measurement precision. The hierarchy among items corresponded with previous studies. The WRI-FI can offer occupational therapy practitioners a valid tool to evaluate psychosocial and environmental perspectives of persons' work ability.

Evaluation of the implementation and effectiveness of a multifactorial intervention strategy for safe patient handling and movement in the healthcare sector: a study protocol of a cluster randomised controlled trial.

INTRODUCTION: Healthcare workers with physically demanding work tasks, such as patient handling and movement (PHM), are at high risk of musculoskeletal disorders. To facilitate safe PHM and prevent musculoskeletal disorders, a combination of workplace interventions, including risk assessments, is needed. The aim of this study is to implement and evaluate a multifactorial intervention strategy for safe PHM and compare it with a single intervention strategy. METHODS AND ANALYSIS: This cluster randomised controlled trial will compare a multifactorial intervention strategy with a single intervention strategy for safe PHM in workplaces in the Swedish regional and municipal healthcare systems. At least twelve healthcare units will be recruited. Care units belonging to arm A will receive: (1) guidelines for PHM, (2) training modules, (3) risk assessment with TilThermometer, (4) risk assessment with Downtown Fall Risk Index and (5) work environment mapping. Care units belonging to Arm B will receive interventions (1) and (5). The two strategies will be evaluated with regards to (1) the primary outcome of the applied strategies' intervention effectiveness (safety climate in relation to aspects of PHM) and (2) the primary implementation outcome (acceptability, appropriateness and feasibility). This study will also explore the implementation process and intervention fidelity, examine the influence of contextual factors and investigate participants' experiences of working with strategies for safe PHM. A mix of quantitative and qualitative methods will be used. The data collection is based on questionnaires, interviews and field notes of contextual factors. ETHICS AND DISSEMINATION: The study is approved by the Swedish national ethical board (Dnr 2021-00578). Study results will be published in peer-reviewed journals, presented at conferences and distributed on social media. A lay summary and dissemination strategy will be codesigned with a reference group and participating healthcare units. TRIAL REGISTRATION NUMBER: NCT05276180.

Feasibility of a new homebased ballistocardiographic tool for sleep-assessment in a real-life context among workers.

BACKGROUND: There is a need for simple and suitable tools for assessing sleep in a natural home environment. OBJECTIVES: This study explores the feasibility in terms of implementation and acceptability of a new homebased ballistocardiographic (BCG) tool for objective sleep-assessment in a real-life context. METHODS: The participants included thirty-nine workers, taking part in two seven nights' sleep-assessment periods. Objective data regarding sleep was collected with BCG. Subjective data regarding sleep was collected with a sleep diary. Implementation was analysed by determining the number of nights with usable signal quality and comparing with the total number of potential nights and by exploring associations between objective and subjective sleep data. Acceptability was analysed by categorizing the participants' experiences of how the BCG tool impacted the sleep. RESULTS: In terms of implementation, usable BCG data increased from 40% at assessment phase 1 to 70% during assessment phase 2. Moreover, in assessment phase 2, there was a significant moderate correlation between the 'time in bed' assessed by the BCG and in sleep diary by participants in the first five nights. In terms of acceptability, almost one third of the participants did not experience any impact of the BCG on the sleep. Two participants experienced a major negative impact on the sleep. CONCLUSIONS: This study indicates that the novel BCG tool could be feasible for objective assessing of sleep in workers natural home-environment in the future, but there is still a need for development of the BCG both regarding technology and implementation process.

Translation and cross-cultural adaptation of the risk assessment instrument TilThermometer for a Swedish version - patient handling in the healthcare sector.

BACKGROUND: Work-related musculoskeletal disorders are common in the healthcare sector due to exposure of physical demanding work tasks. Risk assessment is necessary to prevent injuries and promote a safety culture. The TilThermometer has proved to be useful in the Netherlands for assessing healthcare workers' physical exposure to patient handling. The aim of this study was to translate the risk assessment instrument TilThermometer from Dutch to Swedish, perform cross-cultural adaptation, and evaluate its linguistic validity to a Swedish healthcare context. METHODS: Translation and validation process was performed according to following eight steps: 1) Translation (two translators), 2) Synthesis, 3) Back-translation (two back-translators), 4) Synthesis, 5) Linguistic review (one bilingual reviewer), 6) fifteen experts in a panel review according to Delphi-method, 7) Semi-structured interviewing eleven informants, analyzed using qualitative content analysis and step 8) discussion and input from creators of the instrument. RESULTS: A new Swedish version, the TilThermometer, was provided through the translation process (steps 1-5). The linguistic validity and usefulness were confirmed thru step 6 and 7. Consensus was reached in the expert review after two rounds, comments were analyzed and grouped into five groups. The qualitative content analyses of the interviews emerged in to three categories: 1) "User-friendly and understandable instrument", 2) "Further development", and 3) "Important part of the systematic work-environment management". CONCLUSION: In this study, the cross-cultural adaption and translation performed of the Swedish version of TilThermometer assured linguistic validity. This is this first phase before further testing the psychometrics aspects, inter-rater reliability and feasibility of TilThermometer. In the second phase TilThermometer will be implemented and evaluated together with other measures in the Swedish healthcare sector.

Exploring Interactions in the Sickness Insurance System in Terms of Power and Trust.

Purpose Activation policies and efforts to reduce sick leave rates has influenced sickness insurance systems in Western countries, which has led to social security being more connected with work and attempts to expose malingering among the sickness absent. The aim of this study was to explore how power and trust are expressed by clients and stakeholders within the Swedish sickness insurance system. Methods This was a longitudinal qualitative study based on semi structured interviews and case files from 31 clients on sick leave in Sweden. Data was analyzed using a thematic analysis. Results The main theme 'Acts of power and distrust' illustrates how stakeholders' express suspicions towards each other, and how clients need to demonstrate desire and efforts to return to work which other stakeholders verified. Conclusions The clients desire to prove themselves able to contribute to society was prominent in this study and power relations need to be acknowledged, in particular between client and the SIA. Further, to preserve citizens trust in the system, the system needs to demonstrate trust also in the clients.

Social validity of work ability evaluations and official decisions within the sickness insurance system: A client perspective.

BACKGROUND: Studies of the social validity of work ability evaluations are rare, although the concept can provide valuable information about the acceptability, comprehensibility and importance of procedures. OBJECTIVE: The aim of this study was to explore clients' perceptions of social validity of work ability evaluations and the following official decisions concerning sickness benefits within the Swedish sickness insurance system. METHODS: This was a longitudinal qualitative study based on interviews with 30 clients on sick leave, analyzed through deductive content analysis. RESULTS: Clients' understanding of the evaluation was dependent on whether the specific tests were perceived as clearly related to the clients' situation and what information they received. For a fair description of their work ability, clients state that the strict structure in the evaluation is not relevant to everyone. CONCLUSION: The work ability evaluations indicate low acceptability due to lack of individual adaptation, the comprehensibility varied depending on the applicability of the evaluation and information provided, while the dimension 'importance' indicated as higher degree of social validity. The official decision about sickness benefits however was considered unrelated to the evaluation results, lacking solid arguments and sometimes contradictory to other stakeholders' recommendations indicating poor social validity.

Translation and validation of Assessment of Work Performance (AWP) into the Icelandic language and culture.

BACKGROUND: Evidence-based services in vocational rehabilitation call for valid and reliable assessments of work performance for intervention planning and safe return to work for individuals with illness or injuries. Assessments that are easy to use, culturally adapted, and in a language professionals and clients understand is important for their utility. Translation and adaption of assessments to new languages and cultures are of importance to maintain high standards of assessments and the quality of services in the vocational rehabilitation setting. OBJECTIVE: The aim of this study was to translate and adapt the Assessment of Work Performance (AWP), into the Icelandic language and culture. Furthermore, to investigate the content validity and utility of the evaluation instrument. METHODS: The study was conducted in two phases. The first phase, based on the Dual-Panel translation method, included two expert panels performing translation and cultural adaption of the original Swedish AWP. In the second phase field testing of the translated instrument was followed by an online survey among vocational rehabilitation professionals for content validation and utility. RESULTS: The results of the study showed satisfactory opinions from experienced professionals toward the content validity, translation, cultural adaption, and utility of the Icelandic version of the AWP. CONCLUSIONS: The study indicates that the Dual-Panel translation method is a valid method when translating instruments from one language and culture to another. Furthermore, the results of the study imply that the AWP can be regarded as content valid up to an acceptable degree for implementation in vocational rehabilitation services in Iceland.

Predictive validity of general work ability assessments in the context of sickness insurance.

OBJECTIVE: The activity ability assessment is a Swedish method for assessing general work ability, based on self-reports combined with an examination by specially trained physicians, and, if needed, extended assessments by occupational therapists, physiotherapists and/or psychologists. The aim of this study was to analyse the predictive validity of the activity ability assessment in relation to future sick leave. DESIGN: Analysis of assessments in 300 case files, in relation to register data on sick leave. SUBJECTS: People on sick leave (n =300, 32% men, 68% women; mean age 48 years; assessment at mean sick leave day 249). METHODS: Univariate and multivariate statistics. RESULTS: Self-rated work ability was the only factor with predictive value related to future sick leave. Physicians' evaluations lacked predictive value, except where the person had a limitation in vision, hearing or speech that was predictive of future decisions by the Social Insurance Agency. No sex differences were identified. CONCLUSION: The predictive value of the activity ability assessment for future sick leave is limited, and self-rated work ability is more accurate compared with an extensive insurance medical assessment. Self-rated work ability may be more holistic compared with insurance medicine assessments, which may be overly focused on individual factors. A practical implication of this is that the inclusion of contextual factors in assessment procedures needs to be improved.

Social insurance literacy: a scoping review on how to define and measure it.

PURPOSE: Sickness insurance and workers' compensation systems decide on peoples' eligibility for benefits, and are commonly based on medical certificates and assessments of work ability. Systems differ in the extent to which they preserve clients' dignity and right to fair assessments. In this article, we define a new concept for studying interactions between individuals and systems: social insurance literacy, which concerns how well people understand the different procedures and regulations in social insurance systems, and how well systems communicate with clients in order to help them understand the system. METHODS: The concept was defined through a scoping literature review of related concepts, a conceptual re-analysis in relation to the social insurance field, and a following workshop. RESULTS: Five related concepts were reviewed for definitions and operationalizations: health literacy, financial/economic literacy, legal capability/ability, social security literacy, and insurance literacy. CONCLUSIONS: Social insurance literacy is defined as the extent to which individuals can obtain, understand and act on information in a social insurance system, related to the comprehensibility of the information provided by the system. This definition is rooted in theories from sociology, social medicine and public health. In the next step, a measure for the concept will be developed based on this review.Implications for rehabilitationSocial insurance literacy is a new concept that is based on theories in sociology, social medicine and public health.It provides conceptual orientation for analyzing factors that may influence different outcomes of peoples' contacts with social insurance systems.The concept is of relevance for rehabilitation professionals since it focuses on how interactions between individuals and systems can influence the rehabilitation process.The study will in the next step develop a measure of social insurance literacy which will have practical applications for rehabilitation professionals.

Is a structured work task application for the assessment of work performance in a constructed environment, useful for patients with attention deficits?

BACKGROUND: The purpose of our study was to develop a Structured Work Task application for the Assessment of Work Performance for patients with attention deficits. MATERIAL AND METHODS: We developed a computer-based registration task titled the Attention-demanding Registration Task. It had a structured administrative procedure with additional scoring regarding time and accuracy, also linked to the original scoring of the Assessment of Work Performance. We evaluated the Attention-demanding Registration Task for content validity. Furthermore, we investigated it concerning sensitivity and specificity in patients with attention deficits due to acquired brain injury (n = 65) against a comparison group of healthy people (n = 47). RESULTS: Our investigation on content validity using the Assessment of Work Characteristics confirmed that the Attention-demanding Registration Task sets high demands on process skills, especially on energy, temporal organization, and adaptation. The Attention-demanding Registration Task showed high sensitivity and specificity in differing between patients with attention deficits and a healthy working group; nine out of ten participants were placed in the correct group. CONCLUSIONS: To assess work performance, the use of a Structured Work Task application, the Attention-demanding Registration Task, linked with the Assessment of Work Performance, proved to be sensitive to attention deficits.Implications for rehabilitationA Structured Work Task application for the Assessment of Work Performance was developed for use in people with attention deficits and showing a high degree of sensitivity and specificity.Linking performance time and accuracy to the Assessment of Work Performance scoring and providing a guide for linking task performance to the Assessment of Work Performance skills in addition to the usual observations performed, may increase scoring accuracy.Reference data for a comparison group of healthy subjects are provided.The use of the Attention demanding Registration Task, while using the Assessment of Work Performance within clinical practice ensures a more accurate description of process skills in performance.

Communication characteristics between clients and stakeholders within the Swedish sickness insurance system - a document analysis of granted and withdrawn sickness benefit claims.

Purpose: The purpose of this study was to investigate how communication within the Swedish sickness insurance system differs between cases of sick leave and how this may affect clients' cases.Materials and methods: This was a document study using 30 client files from the Swedish Social Insurance Agency (SIA). The clients included had been on a work ability evaluation during their sick leave spell and were aged 32-64 years. The material was analyzed using qualitative document analysis.Results: The results show different approaches to communication, characterized by emotional argumentation, matter-of-fact driven argumentation and information exchange, which have diverse success in affecting official decisions. Arguments characterized by emotions such as frustration or desperation are to a larger extent neglected by the authorities compared to those characterized by a matter-of-fact driven approach and referring to regulations and medical certificates.Conclusion: There are differences regarding how clients and stakeholders communicate the clients' needs and pre-requisites, and how this affects official decisions. Further research must be carried out in order to establish social insurance literacy, initially for individuals on sick leave within the sickness insurance system, and whether there are differences between diverse groups that could lead to injustices.Implications for rehabilitationWithin a social insurance context, professionals need to provide clients with adequate and individually adapted information in order for procedures to be perceived as comprehensible and manageable by the clients.The support from stakeholders such as the treating physician and/or employer can affect clients' sick-leave process.Clients' treating medical professionals can contribute to ensuring that clients rights are met by communicating the clients' needs to other stakeholders in a formal way.

Fair or square? Experiences of introducing a new method for assessing general work ability in a sickness insurance context.

PURPOSE: To study social validity and perceived fairness of a new method for assessing general work ability in a sickness insurance context. Assessments are based on self-reports, combined with examinations by physicians, and, if needed, occupational therapists, physiotherapists and/or psychologists. MATERIALS AND METHODS: Interviews with 36 insurance officials, 10 physicians, and 36 sick-listed persons, which were analysed through a qualitative content analysis. RESULTS: Insurance officials and physicians considered the method useful and that it facilitated benefit decisions. The experiences of persons who had undergone the assessment differed, where the dialog with insurance officials seemed to have had an influence on experiences of the assessment and the decisions it led to. CONCLUSIONS: The perceived fairness and social validity of the assessment depended on how it was carried out; organisational conditions and priorities; communication skills; and decision outcomes. Professionals have an important pedagogical task in explaining the purpose and procedure of the assessment in order for the sick-listed to perceive it as fair rather than square, i.e., too standardised and not considering individual conditions. If the assessment could be used also for rehabilitative purposes, it could possibly be perceived as more acceptable also in cases where it leads to denied benefits. Implications for rehabilitation The perceived fairness of work ability assessments is dependent on procedures for the assessment, communication with the person, and the outcome. What is considered fair differs between assessing professionals and persons being assessed. Professionals may influence the perceptions of fairness through their way of communication. Assessments need to be coupled with rehabilitation measures in order to perceived as relevant and acceptable.

Initial evaluation of psychometric properties of a structured work task application for the Assessment of Work Performance in a constructed environment.

PURPOSE: The Swedish Social Insurance Administration has developed a new assessment tool for sickness insurance. This study is a part of the initial evaluation of the application, called the Assessment of Work Performance, Structured Activities, and focuses on evaluation of the psychometric properties of social validity, content validity, and utility. MATERIALS AND METHODS: This was a qualitative study using semi-structured telephone interviews with occupational therapists. A convenience sample was used and participants who fulfilled inclusion criteria (n = 15) were interviewed. Data were analyzed using content analysis with a directed approach. RESULTS: The results indicate that the application provides valuable information and that it is socially valid. Assessors found work tasks suitable for a diverse group of clients and reported that clients accepted the assessments. Improvements were suggested, for example, expanding the application with more work tasks. CONCLUSION: The instrument has benefits; however, further development is desired. The use of a constructed environment in assessments may be a necessary option to supplement a real environment. But depending on organizational factors such as time and other resources, the participants had different opportunities to do so. Further evaluations regarding ecological validity are essential to ensure that assessments are fair and realistic when using constructed environments. Implications for rehabilitation This study indicates that assessment in a constructed environment can provide a secure and protected context for clients being assessed. Psychometric evaluations are a never-ending process and this assessment instrument needs further development. However, this initial evaluation provides guidance in development of the instrument but also what studies to give priority to. It is important to evaluate social validity in order to ensure that clients and assessors perceive assessment methods fair and meaningful. In this study, participants found the work tasks appropriate and usable when assessing their clients but client's perspective must also be included in following studies. This assessment instrument is the only activity-based assessment instrument within the Swedish Social Security Insurance. Psychometric evaluations are important since it affects so many individuals in Sweden.

Gaze-based assistive technology in daily activities in children with severe physical impairments-An intervention study.

OBJECTIVE: To establish the impact of a gaze-based assistive technology (AT) intervention on activity repertoire, autonomous use, and goal attainment in children with severe physical impairments, and to examine parents' satisfaction with the gaze-based AT and with services related to the gaze-based AT intervention. METHODS: Non-experimental multiple case study with before, after, and follow-up design. Ten children with severe physical impairments without speaking ability (aged 1-15 years) participated in gaze-based AT intervention for 9-10 months, during which period the gaze-based AT was implemented in daily activities. RESULTS: Repertoire of computer activities increased for seven children. All children had sustained usage of gaze-based AT in daily activities at follow-up, all had attained goals, and parents' satisfaction with the AT and with services was high. DISCUSSION: The gaze-based AT intervention was effective in guiding parents and teachers to continue supporting the children to perform activities with the AT after the intervention program.

Eye gaze performance for children with severe physical impairments using gaze-based assistive technology-A longitudinal study.

Gaze-based assistive technology (gaze-based AT) has the potential to provide children affected by severe physical impairments with opportunities for communication and activities. This study aimed to examine changes in eye gaze performance over time (time on task and accuracy) in children with severe physical impairments, without speaking ability, using gaze-based AT. A longitudinal study with a before and after design was conducted on 10 children (aged 1-15 years) with severe physical impairments, who were beginners to gaze-based AT at baseline. Thereafter, all children used the gaze-based AT in daily activities over the course of the study. Compass computer software was used to measure time on task and accuracy with eye selection of targets on screen, and tests were performed with the children at baseline, after 5 months, 9-11 months, and after 15-20 months. Findings showed that the children improved in time on task after 5 months and became more accurate in selecting targets after 15-20 months. This study indicates that these children with severe physical impairments, who were unable to speak, could improve in eye gaze performance. However, the children needed time to practice on a long-term basis to acquire skills needed to develop fast and accurate eye gaze performance.

Work ability in patients with polymyositis and dermatomyositis: An explorative and descriptive study.

BACKGROUND: Polymyositis (PM) and dermatomyositis (DM) are rare, chronic inflammatory diseases leading to muscle weakness and low muscle endurance. The muscle weakness may lead to restrictions in daily activities and low health-related quality of life. OBJECTIVES: This study aimed to investigate the work situation, work ability, work-related risk factors, and influence of the physical and psycho-social work environment in patients with PM and DM. METHODS: Patients with PM/DM were assessed using the Work Ability Index (WAI), and the Work Environment Impact Scale (WEIS). RESULTS: Forty-eight patients (PM n = 25 and DM n = 23) participated (women/men: 29/19) with a mean age of 54 years (range 28-67 years, SD.10) and mean disease duration of nine years (SD.9). Forty-four percent worked full-time, 31% part-time and 25% were on full-time sick leave. More than 50% self-rated work ability as "poor" or "less good". Physically strenuous work components were present "quite to very often" in 23-79% and more in patients on sick leave ≥ 2 years. For those working, the interfering factors in the work environment concerned task and time demands. Supporting factors concerned meaning of work, interactions with co-workers and others. Self-rated work ability correlated moderately-highly positive with percentage of full-time employment, work-related risk factors and opportunities and constraints in the work environment. CONCLUSIONS: Poor self-rated work ability is common in patients with PM/DM indicating a need to identify interfering risk factors and support patients to enhance work performance.