Acceptability of two mobile applications to support cross-sectoral, person-centred and empowering stroke rehabilitation - a process evaluation.

AIM: To evaluate the acceptability of two co-designed mobile applications Mit Sygehus [a knowledge-based solution] and Genoptræn.dk [a self-training solution] to support a cross-sectoral, person-centred and empowering stroke rehabilitation. SETTING: The applications were implemented and tested throughout two stroke rehabilitation trajectories in Southern Denmark, comprising two acute, two sub-acute and two municipal stroke rehabilitation settings. METHODS, PARTICIPANTS AND ANALYSIS: A process evaluation focusing on acceptability was conducted. Individual and dyadic interviews were performed with ten stroke survivors (three women and seven men, aged 50-84) with moderate stroke and seven significant others (five women and two men, aged 50-78) post-rehabilitation. A constructivist Grounded Theory analysis was used to explore what, why, when, and how the apps worked or did not work throughout the stroke rehabilitation trajectory and if adaptions were needed. RESULTS: Participants found that Mit Sygehus provided adequate and sufficient knowledge and was easy to use, however, acceptability of Mit Sygehus declined throughout the rehabilitation process. Also, knowledge on 'return-to-work' and 're-gaining driver's license/permission to drive' needed to be developed. The content in Genoptræn.dk was perceived as acceptable, through content being person-centred, motivating and meaningful. Genoptræn.dk furthermore, supported the transfer between rehabilitation settings, provided a sense of progress throughout the rehabilitation process, facilitated positive habits regarding self-training, and relieved the burden on significant others. Genoptræn.dk was perceived most acceptable in the sub-acute rehabilitation setting and declined when rehabilitation continued in the municipal setting. CONCLUSION: Stroke survivors and their significant others found Mit Sygehus and Genoptræn.dk acceptable to support cross-sectoral, person-centred and empowering stroke rehabilitation, however acceptability declined throughout the rehabilitation process. Further investigations are required to determine how cognitive rehabilitation can play a greater role in app-supported stroke rehabilitation and how the need for more long-term follow-up can be supported.

By using process evaluation, the user acceptability of newly developed and complex interventions can be evaluated.ICT and app-based solutions can support cross-sectoral person-centred and empowering stroke rehabilitation.Therapists play an important role in implementing and supporting stroke survivors using app-based solutions to support person-centred and empowering stroke rehabilitation.

Measurement properties of performance-based instruments for assessing mental function during activity and participation in persons with stroke: A systematic review.

BACKGROUND: Various performance-based instruments exist to assess mental function after stroke and users have to select one for research or clinical practice. OBJECTIVES: To evaluate the measurement properties of performance-based instruments to assess (any aspect of) mental function during activity and participation in persons after stroke. MATERIAL AND METHODS: We searched in five electronic databases. COSMIN methodology was used to conduct the review. The strength of evidence was assessed using a modified GRADE approach. RESULTS: Fifty articles were included reporting on 20 instruments assessing (1) multiple mental functions including ≥ four subdomains (2) attention, memory and executive functions, or single subdomains (3) executive functions, (4) perception, and (5) mental function of language. Highest quality evidence for sufficient results was found for some measurement properties in seven instruments. These instruments included: FIM + FAM, MPAI-4 and EFPT, MET, CBS/KF-NAP, BIT and the Scenario Test. CONCLUSIONS: Further studies of high methodological quality are needed that evaluate the measurement properties of instruments to allow clinicians and researchers to select the most suitable performance-based measures for purpose. SIGNIFICANCE: Results may be used to select the most suitable performance-based instrument to measure mental function during activity and participation in persons with stroke. TRIAL REGISTRATION NUMBER: PROSPERO CRD42018086744.

Using experience-based co-design to develop mobile/tablet applications to support a person-centred and empowering stroke rehabilitation.

AIM: To investigate and describe the process of using experience-based co-design (EBCD) to develop mobile/tablet applications to support a person-centred and empowering stroke rehabilitation. SETTING: Two cross-sectoral stroke rehabilitation settings in Denmark comprising six rehabilitation units. PARTICIPANTS: Stroke survivors (n = 23), significant others (n = 18), occupational therapists (n = 12), physiotherapists (n = 9), representative of a patient organization (n = 1), application developers (n = 3) and researchers (n = 2). METHOD: A structured, facilitated EBCD approach comprising six stages was used to co-design a service that aimed to address the priorities and needs of all relevant end-users. Data were collected by interviews, participant observations, notes on "flip sheets" and written feedback on the content in the apps and on the instruction pages. Data were analyzed descriptively and with a constructivist grounded theory analysis. RESULTS: The content in the application solutions "Mit Sygehus" and "Genoptræn.dk" were co-designed to support the needs identified by all end-users. Relevant evidence-based knowledge, person-centred exercises and guidelines using video recordings were the most important among the developed content in the applications to support person-centred and empowering stroke rehabilitation. Furthermore, easy, and seamless communication were considered important. CONCLUSIONS: EBCD facilitated the development of content in the applications to support a person-centred and empowering stroke rehabilitation. Participants experienced that their contribution was considered important and valued.

Many app-based solutions exist to support stroke rehabilitation; however, stroke survivors and significant others are seldom involved in the design of these solutions, which often reduces the uptake in clinical setting.By involving stroke survivors, significant others, therapists from diverse rehabilitation settings, patient organizations, app-designers, and researchers, we co-designed the content in two app-solutions to support a person-centred and empowering stroke rehabilitation, based on the needs and wishes of all stakeholders. Stroke survivors and significant others experienced that their voices were heard throughout the co-design process, and that their contribution was considered important and valued.

Factors influencing functioning after volar locking plate fixation of distal radius fractures: a scoping review of 148 studies.

BACKGROUND AND PURPOSE: A better understanding of factors that influence functioning may improve the identification of patients with distal radius fractures (DRFs) who need hand therapy. The purpose of this scoping review was to provide a comprehensive overview of factors that have been evaluated for their influence on hand functioning following volar plate fixation of DRFs. MATERIAL AND METHODS: 6 databases were searched from 2005 to 2021 for publications regarding surgical treatment for a DRF with a volar locking plate. Included studies evaluated demographic, perioperative, and postoperative factors within the 6 weeks post-surgery for their influence on functioning at least 3 months post-surgery. Functioning was assessed with patient-reported outcome measures. The factors were categorized into themes and mapped to the International Classification of Functioning, Disability and Health (ICF). RESULTS: 148 studies were included. 708 factors were categorized into 39 themes (e.g. pain) and mapped to the ICF components. The themes were primarily mapped to "body functions and structures" (n = 26) and rarely to "activities and participation" (n = 5). Fracture type (n = 40), age (n = 38), and sex (n = 22) were the most frequently evaluated factors. CONCLUSION: This scoping review identified an extensive number of factors evaluated within 6 weeks after surgery for their influence on functioning at least 3 months after volar plate fixation of a DRF and the existing research has primarily evaluated factors related to "body functions and structures," with limited focus on factors related to "activities and participation."

Measurement properties of performance-based instruments to assess mental function during activity and participation in persons who have survived a stroke: A systematic review protocol.

BACKGROUND: A frequent consequence of stroke is impaired mental function, which often affects the ability to perform activities and participate in life situation. In occupational therapy practice, performance-based instruments during activity and participation are often used. However, it is important to assess if the instruments used are valid, reliable and responsive. OBJECTIVE: The objective of this systematic review is to investigate measurement properties of performance-based instruments to assess mental function during activity and participation in persons who have survived stroke. MATERIAL AND METHODS: Systematic database searches of PubMed, EMBASE, CINAHL, PsycINFO, and OTseeker will be conducted. COSMIN Risk of Bias checklist will be used to evaluate methodological quality of the included articles. Measurement properties of the included studies will be rated against criteria for good measurement properties. The overall evidence of each measurement property per instrument is graded using a modified GRADE approach. RESULTS: Results will be presented in text and tables. CONCLUSIONS: Conclusion will be drawn up-on the overall evidence to give recommendations on the most suitable instrument. SIGNIFICANCE: It is expected that findings of the review will provide evidence to guide professionals in the selection of a performance-based instruments to measure mental function in practice and research. TRIAL REGISTRATION NUMBER: PROSPERO CRD42018086744.

Evidence of internal construct validity of SOC-13 total score, for use in hand therapy.

PURPOSE: The objective was to examine whether the 13-item Sense of coherence scale (SOC-13) can be reported as a unidimensional interval-scale metric, when new approaches based on the Rasch model to address local item dependency are applied, and to determine whether an interval-scale scoring can be made available. METHODS: Data were derived from two samples of patients with hand-related disorders (merged n = 915). Rasch analyses of the SOC data were conducted using item-level analysis and a testlet approach. RESULTS: Initial item-level analysis of the SOC-13 confirmed previous findings of misfit to the Rasch model. In resolving local dependency by constructing three testlets, which corresponded to the three components of the SOC construct, fit to the Rasch model (χ2(df) = 43.11 (27), p = 0.163) and unidimensionality of the SOC-13 could be established. A transformation table was successfully created to convert the SOC-13 raw ordinal score to corresponding Rasch interval-scaled values. CONCLUSIONS: The results of this study indicate that data obtained by the SOC-13 can be regarded as essentially unidimensional, and an interval-scale transformation table of the SOC-13 total scores was developed, for use in clinical practice and research on coping resources in patients with hand-related disorders.

The 13-item Sense of coherence scale (SOC-13) comprises three complexly interrelated componentsTo assess coping resources in patients with hand-related disorders, an interval-scale transformation table of the SOC-13 total scores can be used.

Validity and reliability of the Danish version of QUALIDEM.

INTRODUCTION: QUALIDEM is a dementia-specific QoL instrument that allows a proxy-based Quality of Life rating in all stages of dementia. It was originally developed in The Netherlands and has later been translated into English and German. This study endeavoured to translate, cross-culturally adapt and test important psychometric properties of a Danish version in a cross-sectional validation study with a nested test-retest design. METHOD: All items underwent forward and backward translation by bilingual academics. Persons with dementia were recruited from 28 healthcare units in a Danish municipality. The severity of dementia was determined using a pragmatic approach allowing the site team to trichotomise the disease (mild, moderate-severe and very severe) before scoring the QUALIDEM. Psychometric properties for QUALIDEM were determined for item characteristics, construct validity, internal consistency, test-retest reliability, measurement error and floor and ceiling effects. The study was approved by The Danish Data Protection Agency. RESULTS: A total of 169 persons with dementia, aged 51-103, were included. The construct validity testing showed that the overall proportion of correctly hypothesised correlations was 83%. Testing for internal consistency, Cronbach's α ranged from 0.65 to 0.85 in mild-severe dementia with three out of nine subscales having values below 0.7. For very severe dementia, Cronbach's α ranged from 0.44 to 0.81, with three out of six subscales having insufficient values. For test-retest reliability, the intra-class correlation coefficients ranged from 0.56 to 0.86. The 'scale width' method revealed a marked ceiling effect in all subscales ranging from 30.6% to 87.7%. DISCUSSION: The QUALIDEM was successfully translated and cross-culturally adapted into Danish. Most subscales show acceptable internal consistency and test-retest reliability. However, a substantial measurement error and ceiling effect was present in most subscales. CONCLUSION: With few exceptions, the subscales of the Danish version of QUALIDEM have acceptable validity and reliability. Future research should address the limitations of the ceiling effects.

Factors influencing self-perceived functioning after volar locking plate fixation of distal radius fractures: a scoping review protocol.

OBJECTIVE: The objective of this review is to give an overview of the demographic, peri-, and postoperative factors that have been assessed for influence on self-perceived functioning at least 3 months after volar locking plate fixation of a distal radius fracture. INTRODUCTION: Most patients treated with a volar locking plate for a distal radius fracture recover within months after surgery; however, a subgroup of patients experience complications and slow recovery. A variety of demographic, peri-, and postoperative factors may influence self-perceived functioning. To facilitate functioning after surgery, supervised rehabilitation can be offered by a hand therapist. In the decision-making process about which patients to offer supervised rehabilitation, demographic, peri-, and postoperative factors may provide additional information, but no updated overview of explored factors has been found. INCLUSION CRITERIA: This review will consider all studies reporting on peri- and postoperative factors identified within 6 weeks after surgery, or demographic factors assessed for influence on self-perceived functioning experienced by patients at least 3 months after volar locking plate fixation of distal radius fractures. METHODS: MEDLINE, CINAHL, Embase, Cochrane Library, PsycINFO, SPORTSdiscus, and Web of Science will be searched for eligible studies. The review will consider peer-reviewed studies published after 2005 in English and Scandinavian languages. Two reviewers will independently perform study selection and data extraction. Following a content analysis of each identified factor, the factors will be mapped to the International Classification of Functioning, Disability and Health (ICF) components by using the ICF linking rules. An overview will be depicted graphically or in tabular format for different timepoints based on assessment of the self-perceived functioning.

Use of Mobile/Tablet and Web-Based Applications to Support Rehabilitation After Stroke: A Scoping Review.

OBJECTIVE: To describe and review evidence of mobile/tablet and web-based applications to support the rehabilitation process after stroke. The secondary aim was to describe participants' stroke severity, and use of applications in relation to, respectively, the setting and phase of the rehabilitation process. METHODS: A scoping review methodology was used to identify studies, through databases such as Pub-Med, CINAHL, Embase and AMED. In addition, grey literature was searched. The studies were categorized according to Wade's model of rehabilitation. RESULTS: The literature search resulted in 12,065 records. Forty-six studies were included, in which applications were used to support: assessment (n = 16); training (n = 25); discharge from hospital (n = 2); and 2 studies were targeted at supporting discharge/education/information and training. One study targeted assessment, discharge support and goal-setting. No studies were related to the element "participation" using Wade's model of rehabilitation. Of the 46 studies, 33 studies included participants with mild to moderate stroke, and 4 studies included participants with severe stroke. In 9 studies the stroke severity was not reported. Twenty three studies included participants with chronic stroke, 16 acute and/or subacute stroke, and 5 included participants with acute and/or subacute and/or chronic stroke. In 2 studies, stroke onset was not reported. Applications were used in a rehabilitation setting (n = 21), home setting (n = 17), and both settings (n = 3). In 5 studies the setting was not reported. CONCLUSION: Most studies of applications developed to support the rehabilitation process after stroke have been explorative. They primarily include participants with mild or moderate stroke and focus on a limited aspect of the rehabilitation process, e.g. assessment or training. Future applications to support stroke rehabilitation should accommodate stroke survivors' and significant others' need for solutions, irrespective of stroke severity and throughout the entire rehabilitation process.

Enhancing engagement in meaningful occupation in a dementia town: A qualitative evaluation of MOED - The meaningful occupational engagement intervention for people with dementia.

INTRODUCTION: Engagement in meaningful everyday life occupations is linked to well-being. However, people with dementia are often deprived of engagement. As a response, a Danish Dementia Town was established with the intention of transforming care services to improve opportunities for meaningful engagement. The evidence-based The meaningful occupational engagement intervention for people with dementia (MOED) intervention was developed and implemented in dementia town to enhance meaningful occupational engagement. The purpose of this paper is to evaluate the content, impact and implementation process of MOED. METHOD: To evaluate MOED, we applied a program theory-based qualitative approach, building on participant observations and informal conversations with people with dementia (n = 7) and staff (n = 9). Data were analysed from a hermeneutic approach to gain an in-depth understanding of how MOED influenced meaningful occupational engagement and to evaluate the implementation process. FINDINGS: The main theme 'Engagement in meaningful occupations - a conditional and fragile process' emerged along with three subthemes: 'Creating an everyday space of meaning: Conditions of the intervention', 'Occupational engagement as an opportunity to blossom: Impact of the intervention' and 'Professional identity, culture and reflections: Contextual barriers to changes to working practice'. Together, the subthemes illustrate how engagement in meaningful occupations arose. However, opportunities to engage in meaningful occupations were fragile, as they depended on various factors within the context. CONCLUSION: Engagement in meaningful occupations emerged when MOED was applied in accordance with the program theory, as it seemed to create spaces where people with dementia could engage in meaningful occupations and they could blossom over time. However, MOED was only partially implemented in accordance with the developed program theory, as several contextual barriers influenced the sustainability of the intervention. MOED showed potential to support improvement in dementia care activity programmes to enhance opportunities to engage in meaningful occupations in everyday life for people living with dementia.

Danish translation and validation of the Occupational Balance Questionnaire.

BACKGROUND: Occupational balance is a key concept in occupational science and occupational therapy. However, it is not well operationalized and instruments to evaluate occupational balance are scarce. AIM: To translate and validate a Danish version of the 10-item Occupational Balance Questionnaire (OB-Quest). MATERIAL AND METHODS: Translation was conducted using the dual-panel approach. Thereafter, data from 262 healthy Danish students were analyzed regarding fit to the Rasch model. RESULTS: The translation of the questionnaire to Danish required only minor cultural adaptations. Ninety percent of the participants were female. The mean age (±SD) was 26.10 (7.05) years. The reliability (person separation index) was questionable (0.63), and the scale showed multidimensionality. Two items (1 and 9) showed misfit to the Rasch model. Differential item function by gender was detected in one item (item 4). After deleting items 1 and 9 and splitting item 4 into two gender-specific items, the new 9-item scale showed good overall and individual item fit. However, reliability remained low (0.59) and some elements of the latent variable (occupational balance) were not sufficiently represented. CONCLUSIONS AND SIGNIFICANCE: Further development and testing of the Danish OB-Quest is needed before implementation in clinical practice or research involving healthy subjects.

Danish translation, adaptation and validation of the ABILHAND-Kids questionnaire for children with cerebral palsy.

PURPOSE: To translate and cross-culturally adapt the ABILHAND-Kids questionnaire into Danish and assess its psychometric properties in children with cerebral palsy (CP). MATERIALS AND METHODS: A Danish version of the parent-reported ABILHAND-Kids questionnaire was created through a standardized translation process. Dimensionality (confirmatory factor analysis), reliability, smallest detectable change, floor and ceiling effects, and Rasch analysis were carried out. RESULTS: One-hundred-and-fifty children diagnosed with CP were included. No parent had difficulty completing the ABILHAND-Kids (DK). Psychometric testing demonstrated a unidimensional scale, excellent test-retest reliability (ICC2.1A = 0.97) and internal consistency (α = 0.96). A smallest detectable change of 5.15 points was considered acceptable. One item showed Differential Item Functioning, four pairs of items showed signs of local dependence and one item had disordered thresholds. Nevertheless, analyses did not lead to the removal of any items. Item thresholds covered most levels of person abilities. Lastly, 24.7% scored within measurement error at the ceiling of the scale, indicating that it was not possible to measure further improvement. CONCLUSION: ABILHAND-Kids (DK) seems to be a valid, reliable and comprehensive measurement scale to assess manual ability in children with CP. It can be used in goal setting and to inform future interventions and rehabilitation evaluation.IMPLICATIONS FOR REHABILITATIONImpaired hand function leads to limited participation in activities of everyday life in children with cerebral palsy.Adequate outcome measures of hand function are crucial for the planning and evaluation of interventions.The Danish version of ABILHAND-Kids is a valid and reliable measure of manual ability in children with cerebral palsy, and it can be used in clinical practice and for research purposes.

'I know his needs better than my own' - carers' support needs when caring for a person with dementia.

BACKGROUND: Caring for a person with dementia predisposes informal carers (carers) to mental and physical disability. Carers tend to focus on the needs of the person with dementia and have difficulties expressing their own needs for support. No instrument has yet been developed to directly assess carers' support needs. The aim of this study is to clarify the main categories of carers' support needs to inform future development of an instrument to assess carers' support needs. METHODS: A qualitative approach combining focus group interviews with carers and professionals and individual interviews were used. RESULTS: Carers' support needs were categorised into four areas: (i) daily life when caring for a person with dementia, (ii) focus on themselves, (iii) maintain own well-being, and (iv) communicate and interact with surroundings. DISCUSSION: Carers have support needs in common regardless of the relation to the person with dementia. Carers tend to focus on the needs of the person with dementia, thus not knowing their own needs. The four main categories clarified in this study may inform the foundation of developing an instrument to facilitate dialogue between carers and professionals with the purpose of assessing carers' support needs.

Client-centred practice in Scandinavian contexts: A critical discourse analysis.

Background: The concept of client-centred practice is an essential element of occupational therapy (OT), but there is a lack of a clear and shared definition of the concept in Scandinavia (Norway, Sweden and Denmark). This may complicate the articulation, discussion, development and implementation of client-centredness in OT practices.Aim: The purpose of this study was to investigate and discuss current understandings of client-centred practice in Scandinavian contexts.Material and method: The study was based on a social constructivist research approach in which Fairclough's critical discourse analysis was applied. The analysis was based on six documents published in Scandinavian OT journals and four documents published in Scandinavian Journal of OT.Results: In Scandinavian contexts, the concept of client-centred practice was articulated in three overall discourses: a client, collaborative and practice discourse. The practice discourse was the most prominent and the source of the other discourses.Conclusions and significance: Occupational therapists (OTs) in the Scandinavian countries have conceptual understandings of client-centred practice that potentially provide the basis for knowledge sharing and collaboration between OT communities. However, the study also found that client-centred practice may not yet be firmly established in all OT practices in Scandinavia.

Development and field-testing of the Dementia Carer Assessment of Support Needs Tool (DeCANT).

OBJECTIVES: Caring for a person with dementia is associated with poor mental, physical, and social health, which makes it important to consider how carers are best supported in their caring role to preserve both their and the person with dementia's well-being. At present, a robust instrument to assess carers' support needs does not exist. This study aimed to develop a self-reported questionnaire to assess the support needs of carers of people with dementia. The objectives were to: (1) generate items, (2) pilot test, and (3) field-test the questionnaire. DESIGN: Development and field-testing of a new questionnaire. SETTINGS: Primary and secondary health and social care of informal carers and people with dementia in nine municipalities and one dementia clinic in a hospital in Denmark. PARTICIPANTS: Eight experts, 12 carers, and 7 digital users participated in pilot testing. 301 carers participated in field-testing. MEASUREMENTS: Items for inclusion were generated based on interviews and literature review. An iterative process of data collection was applied to establish face and content validity of the Dementia Carer Assessment of Support Needs Tool (DeCANT) using Content Validity Index among experts and cognitive interviews with carers. Field-testing of DeCANT among carers included using the 12-item Short Form Health Survey, the Barthel-20 Index, and the Neuropsychiatric Inventory. RESULTS: Initially, an item pool of 63 items was generated, and pilot testing reduced this to 42 items. Subsequent field-testing resulted in a 25-item version of DeCANT, and confirmatory factor analysis of three hypothesized models demonstrated a marginally better fit to a four-factor model with fit indices of: χ2 = 775.170 (p < 0.001), root mean square error of approximation = 0.073, Comparative Fit Index = 0.946, the Tucker-Lewis Index = 0.938, and weighted root mean residual (WRMR) = 1.265. CONCLUSIONS: DeCANT is a 25-item carer-reported questionnaire that can be used to help identify their support needs when caring for a person with dementia to enable supportive interventions and improve carers' health and well-being.

Approaches to engaging people with dementia in meaningful occupations in institutional settings: A scoping review.

BACKGROUND: People with dementia in institutional settings lack engagement in meaningful occupations, which may cause decreased quality of life. Although many researchers and professionals have proposed approaches to engage people with dementia in these occupations, an overview seems to be missing. AIM: This scoping review provides an overview by categorizing and describing the characteristics of the approaches. MATERIAL AND METHOD: A thorough literature search in nine databases identified the studies on approaches. We included 54 studies, and extracted bibliometric data. A content analysis revealed the characteristics of the approaches. RESULTS: Four categories of approaches were uncovered. First, the literature defined the concept of meaningful occupation in various ways. Second, a category of approaches provided theoretical knowledge of meaningful occupations. The third category focussed on specific themes, such as certain methods. The final described comprehensive multilevel approaches. CONCLUSION: This review contributes to knowledge of the diversity of approaches to engage people with dementia in meaningful occupation within institutional settings. SIGNIFICANCE: We suggest that occupational therapy researchers and practitioners consider how the concept of meaningful occupation is embedded in the theoretical landscape. Furthermore, activity programming requires reflexive decision-making at the policy and practice level, as engagement in meaningful occupations is complex.

Physiotherapists' and occupational therapists' perspectives on information and communication technology in stroke rehabilitation.

AIM: The aim of this study was to explore the current and potential use of information and communication technology (ICT) to enhance coherent person-centred rehabilitation after stroke, from the perspectives of physiotherapists and occupational therapists. METHOD: Five occupational therapists and four physiotherapists from different phases of the Danish stroke rehabilitation process were included and two focus group interviews were carried out. A grounded theory approach was used throughout the study and a constant comparative method was used in the analysis. RESULTS: Three subcategories were identified from the analysis of interviews with participants: 1) ICT and apps as meaningful and supportive in the rehabilitation process, 2) ICT as a tool in communication and documentation and 3) Barriers to the integration of ICT and apps in the rehabilitation process. From these categories one core category emerged: The potential of a personalized app solution to facilitate coherent person-centred rehabilitation. CONCLUSION: ICT was perceived as important to integrate in stroke rehabilitation both for assessment, training and to compensate for remaining deficits. The development of a personalized app solution could accommodate stroke survivors' and significant others' need for insight into and overview over the rehabilitation process as well as access to relevant information, which would thereby empower them. Furthermore, a personalized app solution could also facilitate follow-up after discharge and was perceived to ease the communication and documentation within and between sectors, as well as communication with both stroke survivors and significant others.

An occupation-based intervention in patients with hand-related disorders grouped using the sense of coherence scale-A randomized controlled trial.

STUDY DESIGN: A nonblinded randomized controlled trial. INTRODUCTION: Occupation-based interventions are superior to physical exercise-based interventions in patients with activity limitations. However, only a few studies have examined the effect in patients with hand-related disorders. Patients recover heterogeneously, which could be due to personal factors, such as sense of coherence (SOC). PURPOSE OF THE STUDY: To investigate the effectiveness of an occupation-based intervention for patients with hand-related disorders and whether SOC can give an indication of the expected effects. METHODS: A total of 504 patients were stratified into three SOC groups and then randomized to either an occupation-based intervention, including physical exercises (OBI) or a physical exercise-based occupation-focused intervention. The primary outcome, functioning, was measured using the Disability of the Arm, Shoulder and Hand questionnaire. Primary endpoint was at three months. Patients were followed up for a year. RESULTS: No significant difference was found in primary outcome analysis. Nevertheless, patients receiving OBI had a statistically significant and greater change in satisfaction with their occupational performance at one, two, and three months follow-up. Patients with a weak SOC had worse functioning and lower health-related quality of life than those in the other groups, at all times. CONCLUSIONS: OBI as delivered in this study was not superior to physical exercise-based occupation-focused intervention in this patient group. However, in taking a client-centered approach, we recommend that OBI be based on individual needs, given that patients had a statistically greater change in score regarding satisfaction with their occupational performance. It is evident that patients with a weaker SOC have a lower level of functioning. This knowledge should inform clinical practice.

Factors related to met needs for rehabilitation 6 years after stroke.

INTRODUCTION: Research on stroke rehabilitation mainly concerns the first year of recovery, and there is a lack of knowledge regarding long-term rehabilitation needs and associated factors. AIM: The aim was to explore the perceived needs for rehabilitation services of people six years after stroke and factors associated with having rehabilitation services needs met. METHODS: The study was a 6-year follow up of a prospective study on the rehabilitation process after stroke. Data on perceived needs for rehabilitation, personal factors, disease specific factors, and patient-reported disability were collected through face-to-face interviews in the participants' homes. Logistic regression models were created to explore associations between having rehabilitation services needs met in 11 problem areas (dependent variable) and the independent variables: involvement in decisions regarding care and treatment, sex, age, sense of coherence, self-defined level of private financing, stroke severity, frequency of social everyday activities, perceived impact of stroke, and life satisfaction. RESULTS: The 121 participants had a mean age of 63 years at stroke onset and 58% were men. In all problem areas the majority (53-88%) reported having needs met at six years after stroke, however 47% reported unmet needs regarding fatigue and 45% regarding mobility. A lower perceived impact on participation was found to be associated with having rehabilitation services needs met in seven problem areas: mobility, falls, pain, fatigue, concentration, memory, and sight. The strongest association for having needs met was found for the independent variable, involvement in care and treatment, within the three problem areas mobility, falls, and speaking. CONCLUSION: In a long-term perspective, there were several modifiable factors associated with having rehabilitation services needs met. The most prominent were perceived involvement in care and treatment, and perceived participation. These factors had a stronger association with having rehabilitation services needs met than disease specific factors six years after stroke.

Mapping empirical experiences of Tom Kitwood's framework of person-centred care for persons with dementia in institutional settings. A scoping review.

INTRODUCTION: Tom Kitwood's theoretical framework of person-centred care is extensively and internationally referred to in healthcare services. However, despite the broad use of Kitwood's approach in clinical practice, the research examining experiences with the approach has not been mapped. AIM: To map the available literature on current empirical experiences in clinical practice of Kitwood's approach to person-centred care for people with dementia, living in institutional settings in primary health care. METHODS: A total of 154 studies concerning the experiences of people with dementia and their formal caregivers' use of Kitwood's framework of person-centred care for residents living in institutional settings in primary health care were compiled from scientific databases. All three authors engaged in a systematic selection process, leading to nineteen articles being included in the review. RESULTS: The results showed an overall tendency towards positive experiences gained from applying person-centred approaches in clinical practice influenced by Kitwood's theoretical framework. Through the synthesis of data from the selected studies, six categories related to our research aim were identified 'Theoretical evaluation of Tom Kitwood's model of care', 'Models and frameworks', 'Interventions', 'Communication', 'Dementia Care Mapping' and 'Environment'. CONCLUSION: The present review included nineteen studies published from 1998 to 2016 and consisted mainly of peer-reviewed scientific articles, followed by dissertations, conference posters and nonpeer-reviewed articles. All studies were undertaken in Western countries. The vast majority of the studies considered Kitwood's theoretical framework to be beneficial and useful in practice.