Bakgrund: Smärta vid Reumatoid artrit (RA) ärett välkänt symtom som orsakar lidande ochaktivitetsbegränsning. Traditionellt mäts smärtainom reumatologin som smärtintensitet på enVisuell Analog Skala (VAS). Kunskapen kring hurpatienter med RA upplever smärta och dess konsekvenser är begränsad. Patientens egenbeskrivning behövs som underlag för behandlingsplanering och för att utveckla nya metoderför att beskriva problematiken.Syfte: Syftet med studien är att beskriva smärtavid RA ur ett patientperspektiv med fokus på hursmärtan påverkar dagliga aktiviteter.Metod: Patienter med diagnostiserad RA i syd-östra Sverige identifierades via Svenska Reumatologiregistret. Urvalet baserades på minst 5 årssjukdomsduration och minst 40 mm smärtintensitet på VAS vid de två senaste besöken på reumatologklinik. Sammanlagt 33 patienter, 7 män och26 kvinnor, deltog i sju fokusgrupper. Gruppernaformades utifrån kön och ålder. Intervjuguideninnehöll frågor som: Hur beskriver patienter medRA sin smärta? Vad påverkar smärtan? Vilkakonsekvenser har smärtan för aktivitetsutförande,aktivitetsbalans och undvikande av aktivitet? Enkvalitativ innehållsanalys görs.Resultat/förväntat resultat: Analyser hittills visar patienternas frustration över att inteklara det man vill eller behöver göra, beroendeav andra, minskade möjligheter till delaktigheti sociala sammanhang. Och närståendes betydelse. Analyserna visar att smärtan är relaterad till Göteborg6-8 april 201134trötthet, stress och sinnesstämning och att arbeteeller andra aktiviteter medverkar till att glömmabort smärtan och uppehålla förmåga. Analysenslutförs under hösten.Konklusion: Denna studie förväntas genererany angelägen kunskap om och förståelse försmärta.

Introduction The aim of this study was to explore how women of working age who have had a mild stroke resulting in cognitive impairment experience and manage their everyday lives. Method Data were collected using semi-structured interviews. The participants consisted of 10 women of working age who had sustained cognitive impairment after a mild stroke. The interviews were analysed using qualitative content analysis. Results Three main categories appeared: The everyday is affected by the symptoms, Living strategies, and The social environment effects and changes. Participants feel insecure about their abilities and capabilities, experience anxiety and fear in relation to work, and find it hard to live up to demands and expectations. They are required to plan their daily activities in a new way and to prioritise chores that benefit the family, rather than follow their own interests and social activities. In order to cope with everyday life, they need to allocate chores to other family members. Conclusions The constant impact of fatigue and cognitive impairments affects everyday life. The women said that they had to learn to continuously manage their limitations through their experience of everyday life, something that can be facilitated with occupational therapy.

Vad handlar boken om?

Den här boken är en lättläst version och handlar om hur unga med IF i Sverige använder internet. IF betyder intellektuell funktionsnedsättning eller utvecklingsstörning. Kunskapen i boken kommer från forskning. Jag som har forskat heter Kristin Alfredsson Ågren. Jag har också haft två handledare som har hjälpt mig med forskningen.

Sammanfattning: Unga med IF använder internet ganska mycket

 Vår forskning visar att unga med IF använder internet ganska mycket. Men andra ungdomar använder internet mer. Många unga med IF spelar spel på internet. De använder oftast mobil eller surfplatta. Föräldrar till unga med IF är inte så oroliga för att det kan finnas risker med internet.

Många behöver mer stöd för att delta på internet

Många unga med IF tycker ändå det är svårt att till exempel använda dator. De kan också ha svårt att hitta information på internet. De flesta unga med IF behöver stöd för att använda internet. Ungdomar, föräldrar och personal kan tillsammans skapa nya stöd som gör det enklare att använda internet. Internet måste bli mer tillgängligt och information måste bli enklare att förstå. Då kan ungdomar med IF bli mer delaktiga i samhället.

Background: Internet use is an integral part of everyday life in contemporary society, especially among young people. It is used to perform activities in everyday life by an increasing proportion of the population. However, knowledge about access to and use of the internet by adolescents and young adults with intellectual disabilities (ID) is scarce. More knowledge is needed about digital competencies and digital participation in their everyday lives.

Aim: The overall aim of this thesis was to explore and describe internet access and use, and digital participation in everyday life among adolescents and young adults with intellectual disabilities.

Designs and Methods: The thesis is based on results from three studies. In study I, the focus was on access to and use of the internet in the everyday settings of school/work, at home or during free time. Data was collected through observations, conversations, and follow-up interviews with 15 participants with ID, aged 13–24 years. The data was analysed using qualitative content analysis. In studies II and III, the design was cross-sectional and comparative, using national surveys on media and internet use from the Swedish Media Council, from which comparative data from reference groups could be gained. In study II, the national survey of adolescents on internet access and use was cognitively adapted for adolescents with intellectual disabilities, aged 13–20 years, in several steps. This made it accessible to a total selection of pupils from all the special schools in four diverse municipalities in two different regions of Sweden. In study III, the national survey of parents about opportunities and risks of internet use by their adolescents was used. The surveys were sent to a sample of n=318 adolescents with ID and their caregivers/parents. The responses were higher for the adolescents (n=114) than for the parents (n=99), and the response rate of the adolescents with ID was equivalent as that of the reference group, at 36% and 38% respectively. In study II, chi-square tests were used and, when necessary, Fisher’s exact test to analyse the data. In study III, analyses were carried out using Fisher’s exact test and logistic regression to control for confounding factors.

Results: This thesis show that access to internet-enabled devices is lower for adolescents with ID than for the general population, except for tablets (study II). All internet activities, except playing games, are performed by fewer adolescents with ID compared to the reference group (study II) and the time spent on the internet activities is less (study III). Both environmental challenges and personal abilities present difficulties in internet access and use (study I) and affect digital participation for adolescents and young adults with ID. Furthermore, a significantly higher proportion of parents of adolescents with ID perceive opportunities associated with internet use and playing games, and a lower proportion perceive risks with negative consequences, or have concerns about online risks, compared with the reference group (study III). Significantly more parents of adolescents with ID state that their adolescent never uses smartphones or social media compared with the reference group. Strategies used to handle the digital environment and take part in internet activities were found and described, such as getting support from others, reducing the number of internet-enabled devices used and personalising them. Gaining access to internet content and performing internet activities was facilitated by picture-, word- and voice-based strategies, which were used by adolescents and young adults with both mild and moderate ID (study I).

Conclusions: The conclusions are that the results show a lag in internet access and use and in digital participation by adolescents and young adults with ID. Adolescents and young adults with ID were accessing and using the internet in similar ways to the reference group, but to a lesser extent. The impact of the participants’ environment, together with their lack of certain abilities, make the development of digital competencies difficult for them. The result that parents of adolescents with ID perceive more opportunities and fewer risks associated with the internet provides new knowledge to support positive risk-taking in internet use and enable digital participation by adolescents and young adults with ID. Support can be developed in collaboration between the adolescent/young adult, their parents and teachers, and staff in community-based services and should involve physical, social and digital environmental adaptations. These can enable the development of digital competencies and minimise the lag in digital participation in everyday life, which is needed for participation in today’s digitalised society.

Background: The aim is to explore and describe access to the internet and how it is used among adolescents and young adults with mild and moderate intellectual disabilities in their everyday settings. Method: Data were collected through observations of and interviews with 15 participants with intellectual disabilities, aged 13-25, on access and use of the internet in school or work and at home or in their free time. A qualitative content analysis was used. Results: Main findings were categorised into: Access to the internet in different settings, Challenges when using the internet and Strategies to handle the digital environment and take part in internet activities.Conclusions: This study revealed that participants had access to internet connections and to a high number of internet-enabled devices. Participants use the internet through strategies when doing internet activities, for example using pictures and reducing the number of internet-enabled devices used in their everyday settings.

Background: Today everyday life depends on having access to, understand and use internet inorder to participate and take part in societal resources. This understanding can be complex forpersons with intellectual disabilities (ID) due to their cognitive impairments. It is even statedthat internet-use can be yet another part of daily life activities they are excluded from. Internet-use is claimed to involve risks, but also benefits for persons with ID, but there is a shortage inempirical studies with the target group ́s own opinion regarding this. Broader knowledge isacquired of internet-use in everyday life for adolescents with ID, as a precondition toparticipation. 

Aim: This study aims to explore and describe internet-use and doing internet activities at homeand at school among adolescents with mild and moderate intellectual disabilities. Method: The study has a qualitative inductive design using observations and interviews in thetwo settings; at home and at school. Participants are six adolescents with mild and moderate ID,from special schools in the middle-region of Sweden, between the ages 13-20, that use internetto some extent. Data was collected at 2 occasions/participant for about 2hours/participant/setting. The analysis was done using a qualitative content analysis.

Result: Preliminary results show that adolescents with mild and moderate ID use internet both athome and in school, to a greater extent than was expected, but the doings of internet-activitiesvaries in the different settings. Both facilitating and hindering aspects are described by theparticipants. Pictures on the internet seem to be of support when using and navigating theinternet.

Conclusion: Deeper knowledge regarding internet-use from the target groups own perspectivehas been gained. The results can be used in the different occupational settings and in furtherresearch to survey internet use and participation in internet-activities

Introduction

The structures of social and health care are changing, and public health related problems in Western Europe are increasing, such as an increased elderly population, obesity and mental health problems in young people. In order to meet the need of the clients in occupational therapy practice we have to look into new ways to approach the changing times. A way to support the students’ preparedness for action in the field is to encourage the use of an entrepreneurial mindset through different learning methods. An entrepreneurial mindset is defined as “a way to see the possibilities and make something out of them”.

Objectives

To describe learning methods to raise awareness and promote an entrepreneurialmind-set among OT students and teachers.Description/ReportThe learning methods for the students varies from working with a specific design problem in groups, discussing literature about entrepreneurship in seminars and get supervision from Innovation office. To enhance the teachers awareness about entrepreneurial mind-set workshops about how to find new non-traditional fieldwork placements in a creative way was conducted.

Results/Discussion

Our experiences of how the entrepreneurial mind-set can be encouraged are that entrepreneurship can be looked upon in different ways and should be seen close to the reality that one work in. Follow-up from workshops with teachersas well evaluations from the students about the entrepreneurial mind set will be presented. Primary results show that students feel more prepared for a new and creative way of thinking and that teachers have more entrepreneurial mind-set than they think in the beginning.

Conclusion

An increased entrepreneurial mindset can be learned/trained and used as a way of dealing with the future challengesin the health care sector for occupational therapists.

Bakgrund: Strukturerna för den offentliga sektorn och hälso- och sjukvården förändras ständigt, och folkhälsorelaterade problem ökar. Exempel på detta är en ökad andel äldre i befolkningen, eller fetma och psykisk ohälsa hos unga människor. För att möta dessa förändringar och behoven hos klienter i arbetsterapeutisk verksamhet måste nya förhållningssätt användas. Ett sätt att under utbildningen utveckla studenters handlingsberedskap inför framtida insatser kan vara att medvetandegöra och främja ett entreprenöriellt förhållningssättgenom olika lärmoment. Entreprenöriellt förhållningssätt definieras som"ett sätt att se möjligheterna och göra något av dem".

Syfte: Syftet är att beskriva och utvärdera lärmoment för att främja entreprenöriellt förhållningssätt hos studenter på Arbetsterapeutprogrammet.

Metod: Två huvudsakliga lärmoment användes för studenterna, och uppföljande utvärderingar genomfördes via enkät med öppna och slutna frågor. Utöver detta anordnades workshop för lärare, som följdes av utvärdering.

Resultat/preliminärt resultat: Lärmomenten för studenter innebar att arbeta i projektform i gruppmed ett aktivitetsproblem för en specifik målgrupp utifrån Design för alla under handledning. Uppföljande seminarium utifrån specifik litteratur genomfördes. Studenternas utvärdering visar vikten av att ha lärmoment om design och entreprenörskap i utbildningen. Många studenteruppgav att de kunde använda denna kunskap i arbetsterapeutisk verksamhet. Workshop genomfördes med lärare där begrepp inom entreprenörskap diskuterades och kreativa sätt att utveckla lärmoment för studenter inom detta lyftes. I utvärderingen uppgav merparten av lärarna entreprenöriellt förhållningssätt som viktigt inom utbildningen.

Slutsats: Vikten av lärares förståelse för entreprenöriellt förhållningssätt identifierades. Entreprenöriellt förhållningssätt kan främjas genom att kombinera fler lärmoment för studenter. Genom detta kan studenter utveckla handlingsberedskap gällande utmaningar i ett föränderligt samhälle.

IRM är utvecklad av professor Renée Taylor, som är doktor i klinisk psykologi och professor i arbetsterapi vid University of Illinois i Chicago. Modellen beskrivs i hennes bok från 2008 The Intentional Relationship – Occupational Therapy and Use of Self. Syftet med modellen är att erbjuda en specifik begreppsapparat för ett medvetet användande av sig själv som arbetsterapeut och den behandlar händelser som förekommer i relationer mellan personer i en interventionsprocess. Dessa händelser påverkar såväl aktivitetsengagemang som utfall av intervention.

Introduction: Internet is an integral part of everyday life today. In Sweden 98% of adolescents are reported using internet. However, adolescents with intellectual disabilities are often excluded in national surveys, since questions are not adapted for the target group. Statistics remain therefore limited regarding internet-use among adolescents with intellectual disabilities. Objectives: To investigate and describe internet-use among adolescents with intellectual disabilities through an adapted version of a nationwide survey in Sweden. Method: A cross-sectional study was conducted using an adapted version of a survey from the Swedish Media Council on media-use among adolescents. Cognitive adaptations were included and it was accessible through the web and in paper. The sample was drawn from three municipalities using a total-selection of pupils in secondary- and upper secondary special schools. 265 surveys were sent out and the response rate was approximately 32%. Data was analyzed through descriptive statistics. Results: The result gives demographic data on the participants and descriptive statistics on the access to devices for internet-connection. Further, data are provided on activities done in leisure time and whether internet is used or not, together with perceptions of doings on internet from the participants. Conclusion: Stepwise adaptations of the survey with different levels of cognitive support enabled the participation of adolescents with intellectual disabilities and the result gives increased knowledge of internet-use among adolescents with intellectual disabilities. Finally, future comparative analysis are possible due to the national survey being used implying the voices of adolescents with intellectual disabilities being heard.

Work has a great influence on most of individuals in society. It influences both identity as well as the structure of the day. Unemployed people are often affected in a negative way through economic and psychological problems. In order to help people with reduced work capacity back to the labour market and decrease unemployment, the Labour Market Board works with vocational rehabilitation. The aim of this study is to investigate experiences of vocational rehabilitation within the Labour Market Board among unemployed people. A qualitative method was used by which interviews were made with 11 unemployed persons who participated in an investigation as a part of vocational rehabilitation within the Labour Market Board. The result shows both positive and negative experiences of the investigation period. The identified experiences were sorted into code groups: Support, Insight, Confidence in the investigation and result, Belief in the future, Motivation, and Participation. Both the actions of the personnel and the presence of the group members influenced the experiences. The support given by the personnel and how it is experienced is of great importance for the future of the unemployed. When the investigation was pursued during a short period of time, there was a lack of confidence in the investigation and result. A suggestions for future studies is to design a questionnaire that can be used in a larger study including a large number of individuals who are participating in vocational rehabilitation within the Labour Market Board.

Bakgrund/Syfte*

Inom WHO pågår ett utvecklingsarbete av en ny klassifikation av åtgärder ”International Classification of Health Interventions” (ICHI), som kompletterar ICF och ICD. WHO har pågående tester av ICHI. Socialstyrelsen och nordiska klassifikationscentret har genomfört ett antal tester bland annat omfattande arbetsterapiåtgärder inom psykiatrin. Åtgärder dokumenteras med Klassifikation av vårdåtgärder (KVÅ) inom hälso- och sjukvård i Sverige.

Syfte var att mappa ett antal KVÅ-åtgärder som tillämpas inom psykiatrisk arbetsterapi till ICHI.

Metod/Tillvägagångssätt*

En lista med åtgärder inom psykiatri, som används av arbetsterapeuter från sex olika sjukhus i Sverige mappades till ICHI 2018. Mappningsregler för ICHI användes där grad av samstämmighet värderas. Även kardinalitet dvs. hur många ICHI-interventioner användes för att beskriva KVÅ-åtgärden. Resultatet bearbetades med deskriptiv statistik.

Resultat/Preliminärt resultat*

Totalt mappades 136 KVÅ-åtgärder (27 undersökande, 98 behandlande och 11 administrativa). Kardinaliteten mellan KVÅ och ICHI varierade från 1:0 till 1:28. Nio procent av KVÅ-åtgärderna kunde inte mappas till ICHI (1:0). I 37 procent var förhållandet 1:1, dvs en KVÅ-åtgärd mappades till en ICHI-intervention. I 34 procent var förhållandet 1:2 eller 1:3 och i 17 procent mellan 1:4-1:9. Fyra KVÅ-åtgärder hade förhållandet 1:14, 1:25 och 1:28. Grad av samstämmighet mellan KVÅ-åtgärd och ICHI-intervention visade att 14 procent överensstämde exakt. 67 procent av KVÅ-åtgärderna var bredare dvs. mindre specifika än ICHI-interventionerna och 18 procent av KVÅ-åtgärderna var mer specifika än ICHI-intervention.

Slutsats/Praktisk tillämpning*

ICHI har fler specifika interventioner för att dokumentera arbetsterapeuters åtgärder inom psykiatrisk verksamhet än KVÅ. Att börja tillämpa ICHI inom svenska psykiatrisk arbetsterapiverksamhet skulle öka kvalitén på dokumentationen.

Background: The PREP (Pathways and Resources for Engagement and Participation), an innovative 12-week occupational therapy intervention that focuses on changing the environment, was found effective in improving the participation of youth in specific chosen community-based activities.

Objective: To complement existing evidence, this study explored changes in overall participation patterns of youth with physical disabilities following the PREP intervention.

Methods: Guided by time-geography approach, 13 youth aged 12–17 completed a 24-hr diary using the Aday app during one typical weekday and another day during the weekend, pre- and post-intervention. Data of 50 diaries were plotted and analyzed using the VISUALTimePAcTS program.

Results: Following the PREP, youth were engaged in less digital media and more in study-related activities. Number of occurrences and time spent doing activities with friends were greater post-intervention, whereas time spent doing activities at home was quite similar, particularly during the weekdays. During the weekends, however, youth spent slightly less time at home.

Conclusions and significance: Findings provide preliminary support for the effectiveness of the PREP, extending beyond the accomplishment of specific targeted activities towards a change in the overall daily patterns of youth. Such knowledge can redirect occupational therapists’ attention to environment-focused interventions involving real-life experiences.

Interdisciplinary pain rehabilitation (IPR) is a recommended treatment for people with chronic pain. An inadequate description of the content of IPR programs makes it difficult to draw conclusions regarding their effects. The purpose of this study was to describe the perceptions and attitudes of healthcare professionals toward a content description of IPR programs for patients with chronic pain. Individual interviews with healthcare professionals (n = 11) working in IPR teams in Sweden were conducted between February and May 2019. Analysis of the interviews resulted in a theme: interdisciplinary pain rehabilitation is a complex intervention, with three categories: limitations in the description of IPR programs; lack of knowledge about IPR and chronic pain; and facilitating and hindering factors for using the content description of IPR programs. Conclusion: Healthcare professionals perceived that IPR programs could be described through a general content description. A general content description could enhance the quality of IPR programs through a better understanding of their content and a comparison of different IPR programs. Healthcare professionals also expressed the importance of a content description being a guide rather than a steering document.

Few studies have examined health-related quality of life (HRQoL) with respect to daily living and health factors for relatively healthy elderly individuals. To this end, this study examines 85-year-olds’ reported HRQoL in relation to social support, perceived health, chronic diseases, health care use and instrumental activities of daily living. Data were collected from 360 participants (55% response rate) between March 2007 and March 2008 using a postal questionnaire and a home visit interview.  HRQoL was assessed using the EQ-5D-3L. For the items in the EQ-5D-3L, more problems were related to lower HRQoL. Restricted mobility and occurrence of pain/discomfort was common.  Lower HRQoL was associated with increased risk for depression, increased use of medication, increased number of chronic diseases, and more problems with instrumental activities of daily living (IADL). Health care use and health care costs was correlated to lower HRQoL.  HRQoL is of importance to health care providers and must be considered together with IADL in the elderly population when planning interventions. These should take into account the specific needs and resources of the older individuals.

Många unga vuxna i Sverige är diagnostiserade med psykisk ohälsa vilket kan leda tillaktivitetsproblem inom en rad olika livsområden. Flertal studier finns om arbetsterapeutiskainterventioners effekt för målgruppen. Det finns fåtal studier som fångar arbetsterapeutenserfarenheter av att arbeta med unga vuxna med psykisk ohälsa. Syftet med examensarbetetvar att beskriva arbetsterapeuters erfarenheter av att arbeta med unga vuxna med psykiskohälsa. Metoden som användes var en kvalitativ intervjustudie med en semistruktureradintervjuguide. Deltagarna arbetade i olika delar av Sverige och totalt intervjuades 11arbetsterapeuter. Resultatet visade att motivation är viktigt i arbetet med unga vuxna medpsykisk ohälsa. Flertalet deltagare förespråkade gruppinterventioner som åtgärd förpatientgruppen men det fanns undantag. Resultatet visade även att arbetsterapeuterupplevde att deras insatser för unga vuxna sattes in för sent.Konklusionen är att arbetsterapeutiska insatser behöver sättas in i ett tidigare skede. Tidigareinsatser kan minska patientgruppens risk för livslång funktionsnedsättning och minskasuicidrisken. Slutsatsen är att arbetsterapeuters åtgärder kan spela en viktig roll vidvårdinsatser för unga vuxna med psykisk ohälsa men mer forskning inom området behövs.

Introduction: Senior people with cognitive impairment may experience an inability to manage everyday life due to difficulties related to time management, and planning and structuring everyday life. These difficulties can affect people negatively, for example not remembering to carry out future planned activities. Interventions that compensate for lost cognitive ability often include using assistive technology for cognition (ATC). By investigating the feasibility and potential effects of an intervention with the interactive digital calendar with active reminders, RemindMe, knowledge can be generated about aspects of learning to use and using digital support. Further, knowledge can also be generated about occupations in everyday life that people need to receive reminders for, both during the rehabilitation period and two years after the rehabilitation period. This knowledge can support building evidence-based interventions in rehabilitation for people with cognitive impairment using digital technology. 

Aim: The overall aim of this thesis was to study an interactive digital calendar with mobile phone reminders (RemindMe) for people with cognitive impairment, as support to increase the occupational performance in everyday life. 

Methods: This thesis includes four studies, using both qualitative and quantitative data collection methods. Study I was a focus group interview, exploring twenty senior people aged between 66 and 85 and their experiences of learning to use and using RemindMe in everyday life. The seniors had used RemindMe for six weeks and had received weekly support calls from a research assistant during the study period. After six weeks, the participants took part in focus group interviews. Four focus group interviews were conducted, analysed with content analyses. The use of RemindMe and feasibility aspects were also investigated in study II with a mixed-methods design. Eight patients with cognitive impairment, aged between 26–68, and seven occupational therapists participated. The occupational therapists were experienced in occupational therapy and were working at three different outpatient rehabilitation clinics in southeast Sweden. They had a median of 20 years of experience (range of 2–25 years). The patients received an introduction to using RemindMe, as well as weekly support calls from occupational therapists or a research assistant for eight weeks. Quantitative data was collected using the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 (QUEST 2.0). The frequency of and the actual use of RemindMe was generated by RemindMe. Qualitative data was collected via face-to-face interviews with occupational therapists, via field notes from the weekly support conversations, and during the assessments with patients with cognitive impairment. Analyses were conducted using descriptive statistics and directive deductive content analyses. Study III investigated the intervention with RemindMe, addressing plausible outcome measures by investigating changes in outcomes, impact on occupational performance, independence, health-related quality of life, and the psychosocial impact of support used for people with cognitive impairment. The design was a pilot randomized controlled trial with fifteen patients, with cognitive impairment, aged between 26–79, randomized to either an intervention group or a control group. The intervention group consisted of eight patients and the control group of seven patients. The outcome measures were assessed using the Canadian Occupational Performance Measure (COPM), the Functional Independence Measure (FIM), the EuroQol 5-Dimension Visual Analog Scale (EQ-5D-VAS), and the Psychosocial Impact of Assistive Devices Scale (PIADS). Study III was registered at ClinicalTrails.gov, identifier: NCT04470219. Study IV explored seven patients, aged between 51–71, experiences of strategies and support used to establish a new everyday life and their experience of support for time management and planning and structuring everyday life due to cognitive impairment. The study was a qualitative, semi-structured, face-to-face interview. The interviews were analysed with inductive content analysis. 

Results: The results of this thesis address learning to use and using assistive technology for cognition (ATC) in everyday life and outcomes from using RemindMe. The participants were accustomed to using calendars. However, there were differences in terms of whether they preferred to use “low tech” calendars (such as paper calendars), or “high tech” calendars (for example, digital calendars with reminders), or whether a combination of “low and high tech” was preferred (Studies I and IV). Other support strategies were also described, for example, the conscious use of objects as reminders in the home environment or everyday life routines (Study IV). Participants were positive towards the use of digital technology, especially mobile phones/smartphones that they easily can carry with them (Studies I and IV). Participants also described the advantage of using digital technology with active reminders and audio prompts, signalling, and telling them when to do something. This was described as the reminder “talks to me” (Study I). The actual use of RemindMe showed that reminders were for example used for taking medication, do exercises, or meeting family or friends (Study II). Occupational therapists in Study II described that their patients benefited from using reminders and that patients have to be active in their everyday life and perceive a need for reminders. The outcomes from measurements of occupational performance (COPM) indicate that patients in the intervention group increased their occupational performance and their satisfaction with their performance compared with the control group. The intervention group also increased their independence (FIM) in the communication and social and intellectual abilities subscales (Study III). 

Conclusions: The results indicate the importance of choosing a reminder that is suited to the patient’s needs, and this reminder can be either “low tech” or “high tech”. The important thing is that the reminder matches the patient’s needs. The result also indicates that for people with cognitive impairment to make full use of the reminder in everyday life, support with learning to use and using the device for a longer period is needed. Participants (Studies II, III, and IV) described scheduling and receiving active reminders as important for achieving a feeling of comfort and security. Another technique was to find habits and routines or objects to support time management and planning and structuring everyday life. Having a sense of comfort and security involved being in control of everyday life. It can be understood as people talking about being fully involved in their life situations, and in that sense as experiencing participation. However, this was s not investigated in the present studies. Two years after the rehabilitation period, digital or paper calendars were used to establish a new everyday life. Active reminders were trusted and resulted in a feeling of comfort and security as well as a sense of control and independence in everyday life.  

Cognitive impairment may cause difficulties in planning and initiating daily activities, as well as remembering to do what is scheduled. This study investigates the effectiveness of an interactive web-based mobile reminder calendar that sends text messages to the users mobile phone as support in everyday life, for persons with cognitive impairment due to neurological injury/diagnoses. The study has a randomised controlled trail design with data collection at baseline and at follow-up sessions after two and four months. Data collection started in August 2016 and continues until December 2017. The interactive web-based mobile reminder calendar may give the needed support to remind the person and thus increase the ability to perform activities and to be independence in everyday life. Preliminary results will be presented regarding what effect the interactive web-based mobile reminder calendar have for the participants performance of everyday life activities as well as perceived quality of life.

Background People with cognitive impairment often need support to perform everyday-life activities. Interventions are available, but evidence-based interventions are lacking. Aim This pilot RCT aimed to investigate use of an intervention with an interactive digital calendar with mobile phone reminders (RemindMe) in relation to change in outcomes and impact on occupational performance, independence, health-related quality of life, and psychosocial impact of the support for people with cognitive impairment. Method The study design was a multi-centre parallel-group pilot RCT [ClinicalTrails.gov, identifier: NCT04470219]. Fifteen participants from primary rehabilitation centres in Sweden were recruited and randomly assigned to intervention group (n = 8) receiving the intervention with RemindMe, or control group (n = 7) receiving usual treatment by an occupational therapist. Data were collected at baseline, after two- and four months, and analysed using descriptive and non-parametric statistics. Result The Canadian Occupational Performance Measure (COPM), and the Functional Independence Measure (FIM item n-r) showed significant differences. There were no significant differences in health-related quality of life nor in the psychosocial impact of the used support. Conclusion Plausible changes in outcome measures were found in COPM and FIM (items n-r). These instruments indicate change in outcome measures and impact on occupational performance and independence.

The aim of this study is to increase evidence-based interventions by investigating the feasibility of an intervention using an interactive digital calendar with mobile phone reminders (RemindMe) as support in everyday life. Qualitative and quantitative data were collected from participating patients (n = 8) and occupational therapists (n = 7) from three rehabilitation clinics in Sweden. The intervention consisted of delivering the interactive digital calendar RemindMe, receiving an individualized introduction, a written manual, and individual weekly conversations for two months with follow-up assessments after two and four months. Feasibility areas of acceptability, demand, implementation, practicality, and integration were examined. Patients expressed their interest and intention to use RemindMe and reported a need for reminders and individualized support. By using reminders in activities in everyday life their autonomy was supported. The study also demonstrated the importance of confirming reminders and the possible role of habit-forming. Occupational therapists perceived the intervention to be useful at the rehabilitation clinics and the weekly support conversations enabled successful implementation. This study confirmed the importance of basing and tailoring the intervention to patients needs and thus being person-centered.

Background: Assessing occupational performance is commonly done by occupational therapists[OT] working in special housing in municipal elder care. Assessments should be relevant and evidence-based. Even so, we know little about how assessment of occupational performance is conducted in special housing.

Aim: The aim of this study was to identify OTs’ use and perceptions of different methods to assess occupational performance for elderly clients living in special housing.  

Method: An email questionnaire was sent to OTs working in special housing in Sweden. Data was analyzed using descriptive and parametric statistics.

Results: The findings, based on data from 660 respondents, showed that OTs regularly assessed occupational performance but did not use standardized assessment instruments or structured methods to any great extent. In general, OTs reported that they were not pleased with their ability to assess their clients; however, OTs with higher education and with responsibility for fewer clients were more pleased with their assessments and stated that they had more knowledge about assessment methods. Conclusion: To support OTs in using structured assessments of occupational performance in everyday practice, organization as well as structures in the work environment and educational development need to be taken into consideration.

AimTo investigate strategies used by professionals in pediatric rehabilitation to engage children in every step of the intervention process, including assessment, goal setting, planning and implementation of the intervention, and results evaluation.MethodsA scoping literature review was conducted, and seven databases were searched, including CINAHL and MEDLINE, ProQuest Central, PsycINFO, Social Science Premium Collection, PubMed, and Web of Science. A citation search of included articles was completed. Predetermined criteria, quality standards, and PIO framework guided the selection process. Results were presented in relation to Self-Determination Theory (SDT) and the contextual model of therapeutic change.ResultsIn total, 20 studies were included in the review. Pediatric professionals reported that therapeutic use of self and their own engagement in the intervention facilitated the establishment of a supportive relationship. Providing clear explanations about their role and therapy rationale developed positive expectations. By making the child feel successful within-session and outside-session activities, professionals enhanced child mastery. Professionals' strategies were abstractly described.ConclusionsFurther research is needed to investigate strategies that are effective in the different steps of the intervention. More observational, longitudinal studies are required to capture fluctuations in in-session engagement.

This study is a process evaluation of a trial examining the effects of an organizational intervention (Productivity Measurement and Enhancement System or ProMES) on employee stress. The aims were to explore the implementation process and fidelity to the intervention guidelines, examine the influence of contextual factors (hindrances and facilitators) and explore participants experience of working with ProMES. We used the UK Medical Research Council (MRC) guidance to guide the process evaluation. The recruitment, reach and dose delivered were satisfactory and participation high. The employees felt ProMES clarified priorities, gave control and increased participation in decision-making. However, difficulty in obtaining statistical productivity data from the central administration office (a central feature of the intervention) hindered full implementation and regular feedback meetings. Staffing shortages interfered with the implementation process, while having seven design teams and one consultant prevented all occupational groups from working simultaneously. A detailed examination of access to necessary organizational data should be undertaken before implementing ProMES. We recommend a better introduction for new employees, more work on design and packaging and giving employees more training in how to use the software program. The study contributes to our understanding of process evaluations in research into organizational stress management interventions.

Background: Sexual health needs are insufficiently met for persons living with rheumatological diseases and it is necessary to create better ways to meet these needs.Objective: To co-create a working model to improve sexual health for persons living with rheumatological diseases, that can be used by rheumatological teams in regular rheumatology practice.Design: This study applied a co-creation design with three key features: 1) it took a systems perspective with emergent multiple interactive entities; 2) the research process was viewed as a creative endeavour with strong links to design, while human imagination and the individual experience of patient and staff were at the core of the creative design effort; 3) the process of the co-creative efforts was as important as the generated product.Results: A model defining the role of the patient, the professionals, and the team in optimizing sexual health for persons living with rheumatological diseases was co-created. The model can be seen as a practice guideline, which includes the support needed from and to each participant in the process of promoting sexual health, while being within the professional scope of the professionals’ knowledge and capacity, and in line with the needs of the persons living with rheumatological diseases.Discussion and Conclusions: The co-creative work process identified crucial factors in promoting sexual health, resulting in a useful model for patients, professionals and teams. Co-creation was experienced to be a useful research design to improve rheumatological care, through valuing and using the competence of all research members equally.

BackgroundLimited time management skills cause problems in daily life for people with mild intellectual disability (ID) and "Lets Get Organized" (LGO) is a promising manual-based occupational therapy group intervention aiming to support management skills.Aims/ObjectivesTo evaluate the applicability of the Swedish version of LGO-S by i) exploring enhancements in time management skills, satisfaction with daily occupations, and aspects of executive functioning in people with time-management difficulties and mild ID, and ii) describing clinical experiences of using the LGO-S for people with mild ID.Material and methodsTwenty-one adults with mild ID were included. Data were collected pre-/post-intervention and at 3- and 12-month follow-ups with: Swedish version of Assessment of Time Management Skills (ATMS-S), Satisfaction with Daily Occupation (SDO-13), and Weekly Calendar Planning Activity (WCPA-SE). There were few follow-up participants (n = 6-9).ResultsSignificant change in time management skills that maintained at 12-months follow-ups. Significant increase in regulation of emotions at 12-month follow-up. Results at 12-months follow-up indicated sustainability in outcomes as measured by ATMS-S. A non-significant positive trend was observed in other outcomes between pre- and post-intervention.Conclusions and significanceLGO-S seems applicable for improving skills in time management, organisation and planning also for people with mild ID.

BACKGROUND: Disabilities can hinder children's and youths' participation (frequency of attendance and engagement) and independence in everyday life.

AIMS: To identify factors that predict levels of participation and independence in everyday activities in Swedish children and youths with disabilities.

MATERIAL AND METHODS: This cross-sectional study, including 131 participants, utilised instruments about child and environmental factors. LASSO regression analyses were conducted to identify predictors of participation and independence.

RESULTS: An item screening for comprehension difficulties was the strongest predictor of attendance, engagement, and independence in daily activities. Other influential child factors included the presence of seizures, speech abilities, age, pain levels, and motor functions. None of the studied environmental factors were retained as predictors in the models.

CONCLUSIONS: Difficulties in intellectual functioning need to be evaluated and considered in planning interventions to improve participation and independence. Likewise, multifaceted nature of challenges found in this study underscores the need for diversity of interventions tailored for individual needs.

SIGNIFICANCE: The result underscores the critical role of comprehension and intellectual functioning in predicting and enhancing participation and independence in children and youths with disabilities, advocating for comprehensive assessments and sustained support.

Regular physical activity (PA) and limited sedentary time (SED) are highly recommended in international guidelines for patients after a myocardial infarction (MI). Data on PA and SED are often self-reported in clinical practice and, hence, reliable and valid questionnaires are crucial. This study aimed to assess the test-retest reliability, criterion validity and agreement of two PA and one SED questionnaire commonly used in clinical practice, developed by the Swedish National Board of Health and Welfare (BHW) and the Swedish national quality register SWEDEHEART. Data from 57 patients (mean age 66 ± 9.2 years, 42 males) was included in this multi-centre study. The patients answered three questionnaires on PA and SED at seven-day intervals and wore an accelerometer for seven days. Test-retest reliability, criterion validity and agreement were assessed using Spearman's rho and linearly weighted kappa. Test-retest reliability was moderate for three of the six-sub questions (k = 0.43-0.54) within the PA questionnaires. For criterion validity, the correlation was fair within three of the six sub-questions (r = 0.41-0.50) within the PA questionnaires. The SED questionnaire had low agreement (k = 0.12) and criterion validity (r = 0.30). The studied questionnaires for PA could be used in clinical practice as a screening tool and/or to evaluate the level of PA in patients with an MI. Future research is recommended to develop and/or evaluate SED questionnaires in patients with an MI.

This article presents the findings from a qualitative research project exploring eight women’s experiences of living with rheumatoid arthritis (RA). Through semistructured interviews, the women provided insights into the physical, emotional, and social impacts of RA and the “work” involved in negotiating its influence in the everyday life. In narrating their experiences of adapting to RA, the women express a common desire for “normalcy,” to return to a time and space before the disruption of RA. The women’s accounts also emphasized the interrelatedness between bodily experience and constructions of self, highlighting the corporeal nature of RA and the constant shaping and reshaping of personal meanings and values.

Purpose – Mobility is an important aspect of well-being, activity and participation. Retiring from paid work is a transition in later life when people need to adjust to a new daily structure and fill the day with activities other than work. Life-course transitions influence demands for mobility and choice of travel mode as people adapt to new circumstances and learning processes. The purpose of this paper is to explore how mobility strategies develop during the first years of retirement.

Design/methodology/approach – A qualitative analysis based on initial interviews with a total of 27 retired people during their first year of retirement and again, about three years later.

Findings – Important changes during the first years of retirement included illness or a decline in physical health. Mobility had become a means of achieving certain goals after an illness, such as learning to walk, being able to drive or enjoying the time that was left. While some enjoyed not having commitments, others experienced difficulties in filling the day. The results indicate four dimensions of mobility: means of carrying out activities which are needed and desired; resources for creating activities; a leisure activity in itself; and subordinate to staying at home.

Originality/value – Gives a deeper understanding of the mobility challenges people ultimately face in later life, and how these are managed, which is important for transport planning and public health policy aimed at improving mobility, activity participation and well-being in later life.

Introduction: The treatment of rheumatoid arthritis (RA) has evolved over recent decades. Today, many previous limitations related to, for example, joint damage have become rare, and persons with RA can often continue to work and engage in different aspects of everyday life. Nonetheless, persons with RA still report restrictions in everyday life, as they can be negatively impacted by symptoms like pain, stiffness and fatigue. As these symptoms might be invisible to others, the significant others of persons with RA can find it difficult to comprehend the effect of the disease. As a consequence, both the person with RA and the significant other may be affected, despite today’s effective treatment.

As participation is a central concept within healthcare, it is also a prominent factor within rehabilitation and its goals. Despite access to contemporary treatment during the whole disease course, persons with RA still report participation restrictions. Since RA is a chronic disease, these remaining restrictions are of particular interest from a longitudinal perspective. However, support from the social environment, such as significant others, has the possibility to positively influence participation in everyday life. Therefore, it is essential to explore the influence of significant others and their support with the goal of enhanced participation in the everyday life of persons with RA, from a longitudinal perspective.

Aim: The general aim of this thesis is to explore participation in the everyday life of persons with RA over a decade, and in relation to this investigate the influence of significant others and their support.

Methods: This thesis consists of four studies that used different methodological approaches: qualitative, quantitative and mixed methods.

Study I was a qualitative study where 59 persons with RA participated in semi-structured interviews approximately three years after diagnosis. Questions covered experiences in everyday life and participation. The material was analysed through content analysis.

In Study II, longitudinal data from 274 persons with RA were analysed regarding disease activity (assessed by DAS28), grip force (assessed by Grippit), pain intensity (VAS mm) and activity limitations (assessed by HAQ). The data were collected at inclusion, year one and year two after diagnosis. Data related to sickness absence were also obtained, as well as self-assessed perceptions of experienced support. Through regression analyses, associations between disease-related variables and sickness absence were investigated, with support as a moderator.

The data in Study III comprise semi-structured individual interviews with 16 persons with RA and their significant others, conducted approximately a decade after diagnosis. The interview guide was developed with Study I in mind and included similar topics, with the addition of support. This material was analysed using dyadic analysis, where a person with RA and the significant other comprised a dyad.

Finally, in Study IV, a convergent mixed methods approach was used. Longitudinal data regarding disease-related variables (same as Study II) were collected during the first decade after diagnosis and analysed through linear mixed models. The qualitative material consisted of individual interviews conducted three and ten years after diagnosis and analysed by directed content analysis. The quantitative and qualitative results were integrated in accordance with the chosen method.

Results: Significant others of persons with RA could encompass both facilitators and hinders to participation in the everyday life of persons with RA. Through the provision of support and helpful attitudes towards needed adaptations, they had a positive influence on participation in the everyday life of persons with RA. This was a continuous process since the persons with RA were still affected by the disease a decade after diagnosis, and adaptations by the significant others might also still be needed.

Experiences of RA were found to differ between men and women over the first decade after diagnosis. Moreover, through a mixed methods design, discrepancies were found between the persons’ own descriptions in interviews and the quantitative results. For instance, women expressed issues related to grip force and disease activity in the interviews, but these issues were not detected in the same way in the quantitative results. These discrepancies were additionally not seen in men; however, both men and women still showed signs of disability a decade after RA diagnosis. Nevertheless, over time, the persons with RA and their significant others had learned to live with the disease and there was a sense of togetherness in everyday life with RA. Namely, they approached the disease together as a unit.

Support was identified as a positive aspect that facilitated everyday life. It entailed both the support between the person with RA and the significant other, as well as the support from others outside of the dyad. Support could also come in different forms. For example, the person with RA could receive emotional support from a significant other, or healthcare professionals (HCPs) could provide informational support to either or both of the parties. In connection to the latter, a continuous need for knowledge was identified in both the persons with RA and the significant others. Support from significant others also proved to have an impact on work life specifically, as more perceived support was associated with an increased risk of sickness absence.

Conclusively, significant others and their support can influence participation in the everyday life of persons with RA, and this influence can be facilitated through positive attitudes and different types of support during the first decade after diagnosis.

Conclusions: Significant others are essential providers of support as facilitators for participation in the everyday life of persons with RA, including many years after diagnosis. However, they must also be attentive towards the further need for adaptations and possible emotional burden in the persons with RA. It is also important for significant others to find a balance between overprotecting and contributing to independence.

The significant others in their turn might need support in understanding the impact of the disease. In this case, HCPs should be providers of support to both persons with RA and their significant others and consult with both of them as a unit in the rehabilitation process. This also exemplifies the need for support from outside the dyads of persons with RA and their significant others.

Support is requested both at an early stage and throughout the disease course. Different types of support from significant others can therefore preferably be part of the rehabilitation process as a way to enhance participation in the everyday life of persons with RA.

Background Support from significant others is important for participation in everyday life for persons with rheumatoid arthritis (RA). Meanwhile, significant others also experience limitations. Aims To explore how support is expressed by persons with RA and significant others, and how support relates to participation in everyday life of persons with RA. Material and methods Sixteen persons with RA and their significant others participated in individual semi-structured interviews. The material was analyzed using dyadic analysis. Results Persons with RA and significant others reported that RA and support had become natural parts of everyday life, especially emotional support. The reciprocal dynamics of support were also expressed as imperative. Also, support from people outside of the dyads and well-functioning communication facilitated everyday life. Conclusions Significant others and the support they give are prominent factors and facilitators in everyday life of persons with RA. Concurrently, the support persons with RA provide is important, along with support from outside of the dyads. Significance The results indicate that the interaction between persons with RA and the social environment is central to gain insight into how support should be provided for optimal participation in everyday life. Significant others can preferably be more involved in the rehabilitation process.

Purpose: To describe the meaning of significant others in relation to participation in everyday life of persons with early diagnosed rheumatoid arthritis (RA). Materials and methods: Fifty-nine persons participated in this interview study. Inclusion criteria were three years experience of diagnosis and being of working age. Semi-structured interviews were conducted using critical incident technique (CIT), and the material was analysed using content analysis. Results: Four categories were revealed: (1) My early RA causes activity adaptations for us all, referring to the person and significant others modifying activities. (2) Making the significant others balance between shortfalls and participation, where the participants distinguished between needing help and feeling involved in activities. (3) Physical interactions with significant others, referring to both the problematic and manageable impact RA could have on body contact. (4) Emotions in relation to activities with others, where participants described feelings of failing others, and anxiety about future activities. Conclusions: For persons with early diagnosed RA, significant others can be both hindering and facilitating for participation in everyday life. As a clinical implication, it is valuable to identify how significant others can be involved in the rehabilitation process, to enhance participation in everyday life early in the disease process.

Introduction: An internet-based cognitive behavioral therapy (ICBT) offers a way to increase access to evidence-based tinnitus care. To increase the accessibility of this intervention, the materials were translated into Spanish to reach Spanish as well as English speakers. A clinical trial indicated favorable outcomes of ICBT for tinnitus for the population of the United States. In view of later dissemination, a way to increase the applicability of this intervention is required. Such understanding is best obtained by considering the perspectives and experiences of participants of an intervention. This study aimed to identify the processes that could facilitate or hinder the clinical implementation of ICBT in the United States.Methods: This study evaluated the processes regarding enrolment, allocation, intervention delivery, the outcomes obtained, and the trial implementation. The study sample consisted of 158 participants who were randomly assigned to the experimental and control group.Results: Although the recruitment was sufficient for English speakers, recruiting the Spanish participants and participants belonging to ethnic minority groups was difficult despite using a wide range of recruitment strategies. The allocation processes were effective in successfully randomizing the groups. The intervention was delivered as planned, but not all the participants chose to engage with the materials provided. Compliance for completing the outcome measures was low. The personal and intervention factors were identified as barriers for the implementation whereas the facilitators included the support received, being empowering, the accessibility of the intervention, and its structure.Conclusion: An understanding regarding the factors contributing to the outcomes obtained, the barriers and facilitators of the results, engagement, and compliance were obtained. These insights will be helpful in preparing for the future dissemination of such interventions.

Objective: This study aimed to explore participants experiences after undertaking an Internet-based cognitive behavioural therapy intervention (ICBT) for tinnitus. Design: Semi-structured telephone interviews were conducted 6-8 months after participants undertook the ICBT intervention. Qualitative thematic analysis was used to interpret the interview data. Study sample: A purposeful sampling strategy was used to identify a diverse range of participants. Semi-structured interviews were carried out with 15 participants. The mean age was 58.5 years, 7 men and 8 women participated. Results: The analysis generated the following main themes: (1) expectations and motivation for doing the intervention, (2) experiences of the intervention, (3) intervention engagement and (4) intervention effects. Most participants expectations were hopeful that the intervention would lessen the impact of their tinnitus. Aspects of the intervention that were beneficial, as well as difficult, were identified together with the impact they had on engagement. Intervention effects were evident on both tinnitus and activities of daily life. Conclusions: The benefits described by participants indicate the potential of ICBT as an alternate form of intervention delivery. The difficulties that hampered engagement need to be addressed to enhance the application and to optimise the clinical acceptability of ICBT for tinnitus.

This observational cohort study explored objective neurocognitive deficits in COVID-19 patients five months after discharge, and any associations with demographic factors and disease severity indicators. Medical notes of all COVID-19 patients admitted to hospital in Region ostergotland, Sweden, March-May 2020, were reviewed. After applying exclusion criteria, 433 patients were screened by telephone. Of these, 185 patients reported persistent and concerning post-COVID-19 problems, including but not restricted to cognitive functions, and were invited to a clinical evaluation. The Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and Colour-Word Interference Test (CWIT) were used to assess immediate memory, visuo-spatial function, language, attention, delayed memory, and executive function. A total of 133 patients had valid test performances. Mean RBANS Global Cognition Score was 83.4, with 37% scoring below cut-off (1.5 SD). Deficits in Attention and Memory indices were most common, each affecting approximately 30% of the patients. After adjustment for sex, language, level of education and premorbid function, neurocognitive performance was positively associated with length of hospital stay, but not with the disease severity indicators WHO CPS and CRP. Findings support that comprehensive neuropsychological assessment should be performed when patients report post-COVID-19 symptoms that affect daily life.

Ohälsosamma levnadsvanor är ett problem bland patienter som vårdas inom den rättspsykiatriska slutenvården. Patienter med psykisk ohälsa har en sårbarhet och löper större risk att drabbas av livsstilsrelaterade sjukdomar och för tidig död. Syftet är att beskriva hur personalen inom rättspsykiatrisk slutenvård upplever patienternas förutsättningar till att skapa hälsofrämjande levnadsvanor. Studien omfattar kvalitativ studiedesign där åtta personer som arbetar inom rättspsykiatrisk slutenvård intervjuades. I resultatet framkommer det att begränsningen av valet och möjligheten att engagera sig i aktiviteter inverkar negativt på en persons hälsa. Patienterna på kliniken har olika förutsättningar till delaktighet i aktivitet. Resultatet visar att patienternas tidigare vanemönster har inverkan på vilka levnadsvanor patienten har inom slutenvården. Personer med psykisk ohälsa stöter på många hinder i att skapa hälsofrämjande levnadsvanor då de beskrivs ha bristande insikt över vilka konsekvenser deras handlade får i relation till deras hälsa Patientgruppen framställs som rädda för livet utanför den rättspsykiatriska slutenvården och beskrivs trygga i det hospitaliserade klimatet. Detta resulterar i att många vill och blir kvar. Arbetsterapeutens kunskap kring vanor och roller är betydande vid förändring av patienternas levnadsvanor och arbetsterapeutiska insatser kan riktas mot att främja återgång i samhällslivet. Omfattningen forskning inom ämnet är bristande och det behövs mer kunskap om hur rättspsykiatriska kliniker kan arbeta för att främja hälsa och välmående för målgruppen.

OBJECTIVE: The objective was to create a linguistically and culturally validated Swedish version of the Valued Life Activities scale. The aim was also to describe its content and concurrent validity and its internal consistency in persons with rheumatoid arthritis.

METHODS: The Valued Life Activities scale was translated to Swedish and culturally adapted. In order to describe the content validity, both the Swedish and original Valued Life Activities scale were linked to the International Classification of Functioning, Disability and Health. The concurrent validity and internal consistency were evaluated in 737 patients with rheumatoid arthritis. To establish concurrent validity, the scale was correlated to disease activity, activity limitations, and life satisfaction. Internal consistency was assessed with Cronbach's alpha.

RESULTS: The equivalence of meaning between the Swedish and the original Valued Life Activities scale was ensured by harmonization review. Content validity was high when linked to the International Classification of Functioning, Disability and Health. Concurrent validity showed a strong correlation with the activity limitations (r = 0.87), moderate with life satisfaction (r = -0.61), and weak with disease activity (r = 0.38). Internal consistency was excellent (Cronbach's alpha = 0.97).

CONCLUSIONS: The Swedish Valued Life Activities scale has been tested in a large and well-characterized sample and found to be a linguistically valid and culturally adapted self-reported measure of participation. Content validity of the Valued Life Activities scale was excellent, concurrent validity strong, and the internal consistency excellent. Since both individual preferences and International Classification of Functioning, Disability and Health concepts of disability are taken into account, the Swedish Valued Life Activities scale appears to be a promising new scale addressing important aspects of participation.

Immigrant women suffer more from bad health than Swedish people and immigrant men. To develop and maintain physical health, mental health and satisfaction in life, participation in meaningful occupations is important. Further, participation and influence in the society is an essential condition for health. Many occupational therapists have difficulty in treating patients with another cultural backgrounds, due to lack of knowledge. Further, several assessments that occupational therapists use are not adapted to different cultures. The aim of the study was to investigate how women from Iran participate in Swedish society. More specifically, the aim was to investigate what occupations the women fill their everday life with, and whetter they were satisfied with their occupations. An occupational diary was used to collect data. To name the occupations, ICF was used as inspiration. The result showed that most women in general were satisfied with their everday life. The occupations most frequently performed by the women during the day were, “applied knowledge” and “exercise”. The result also implied that the women performed most of the occupations alone or with family. “Recreation outside home” and “work and occupy” were occupations that were done in most cases together with a friend or another person not related to the family.

The overall aim of this thesis was to describe and explore the experiences of support in school of adolescents and young adults with neuropsychiatric disabilities. Furthermore, the aim was to explore support that influences the occupational transition to upper secondary school, further education and work. The two first studies investigated computer use in educational activities and during leisure activities by adolescents with attention deficit hyperactivity disorder (ADHD). Study II also aimed to explore how traditional leisure activities and Internet activities interrelate among adolescents with ADHD. In Studies I and II data was collected using a questionnaire focusing on information and communication technology (ICT) use in school and leisure. Adolescents with ADHD (n = 102) aged 12-18 years were compared with adolescents with physical disabilities (Study I) and adolescents from the general population (Studies I and II). In Study III the aim was to describe the experiences of support at school among young adults with AS and ADHD, and to explore what support they, in retrospect, described as influencing learning. Study IV aimed to describe the occupational transition process to upper secondary school, further education and/or work and to explore what support influenced the process from the perspectives of young adults with AS or ADHD. Studies III (n=13) and IV (n=15) used qualitative semi-structured interviews with young adults with AS or ADHD, aged 18-30 years and were analysed using hermeneutics according to Gadamer.

The findings of Study I showed that students with ADHD reported significantly less frequent use of computers for almost all educational activities compared with students with physical disabilities and students from the general population. They reported low satisfaction with computer use in school and a desire to use computers more often and for more activities in school compared with students with physical disabilities. Study II showed that Internet activities among adolescents with ADHD during leisure, tended to focus on online games. Furthermore, analysis demonstrated that Internet activities were broadening leisure activities among adolescents with ADHD, rather than being a substitute for traditional leisure activities. Study III found that young adults with AS or ADHD experienced difficulties at school that included academic, social, and emotional aspects, all of which influenced learning. Support addressing difficulties with academic performance was described as insufficient and only occasionally provided in school. In conclusion, support for learning among students with AS or ADHD needs to combine academic and psychosicial support. The findings of Study IV identified three different pathways following compulsory school. Support influencing the occupational transition process included: occupational transition preparation in compulsory school, practical work experience in a safe environment, and support beyond the workplace. Support from community-based day centres was described both as an important step towards work in the regular labour market, as well as being too far away from the regular labour market.

In conclusion, this thesis revealed that support in school among students with AS or ADHD needs to combine academic and psychosocial support. Despite being regarded as facilitating learning, individuals with ADHD or AS reported limited computer and Internet use in school. Based on the results it is suggested that Internet activities may provide adolescents with neuropsychiatric disabilities with new opportunities for social interaction and educational activities. On the basis of the results it is suggested that the occupational transition process should be viewed as a longitudinal one, starting in compulsory school and continuing on until young adults obtain and are able to remain in work or further education. This thesis revealed that extended transition planning, inter-service collaboration and support from communitybased day centres were aspects of the environment that influenced the occupational transition process.

Introduction: One type of support in school that holds promise for students with attention deficit hyperactivity disorder (ADHD) is the use of information and communication technology (ICT) such as computers and Internet. Computer use in educational activities may be one promising tool to support academic performance of students with ADHD experiencing difficulties in school. However, students with ADHD may be overlooked regarding available support compared with students with physical disabilities.Objectives: The aim of this study was to investigate computer use in educational activities by students with attention deficit hyperactivity disorder (ADHD) in comparison with that of students with physical disabilities and students from the general population.Methods: The design of the study was cross-sectional with group comparison. Students with a primary diagnosis of ADHD and related disorders were recruited from habilitation centres (HCs). Students with ADHD (n=102) were pairmatched in terms of age and sex with students with physical disabilities and students from the general population (n = 940) were used as a reference group.Results: Students with ADHD reported significantly less frequent use of computers for almost all educational activities compared with students with physical disabilities and students from the general population. Students with ADHD reported low satisfaction with computer use in school. In addition, students with ADHD reported a desire to use computers more often and for more activities in school compared with students with physical disabilities. Conclusion: From an equality perspective, it is essential to enable students with ADHD to use computers in educational activities. Contribution to the practice/evidence base of occupational therapy: Focusing on promoting computer use in educational activities in school for students with physical disabilities as well as students with ADHD is an emerging field in occupational therapy.

Aim: The aim of the study was to examine the usability of an interactive web-based mobile reminder calendar (RemindMe) developed for supporting individuals in organizing, planning and executing activities in everyday life, from the perspectives of professionals.

Methods and material: Eleven professionals working in community services evaluated the usability of RemindMe in their clinical practice. Data were collected using semi-structured interviews and analysed with inductive qualitative analysis.

Results: The professionals perceived that RemindMe was useful, easy to use, and intuitive. There was a need among professionals for a web-based reminder calendar that requires the active acknowledgement of reminders. RemindMe's feedback system offering self-monitored information based on the user's interaction with the system supported the professionals in discussions, evaluation, and follow-up based on the needs of the persons with cognitive impairments.

Conclusion: The results indicate that RemindMe may be potentially useful to professionals who provide support to individuals with cognitive impairments. However, further research is needed to evaluate experience of using RemindMe from the perspective of individuals with cognitive impairments.

Stöd i skolan och övergång till vidare studier och arbetsliv-personer med neuropsykiatriska diagnoser

Bakgrund

Att lämna grundskolan innebär för många unga vuxna en övergång till vuxenlivet med antingen vidare studier eller arbetsliv i sikte. Det innebär nya utmaningar som de flesta unga vuxna klarar av medan personer med neuropsykiatriska funktionsnedsättningar riskerar att komma tillkorta i och med de krav som samhället ställer. Hur stödet har sett ut i grundskolan kan påverka ungdomarnas övergång till vidare studier och arbetsliv. Studier har visat att personer med neuropsykiatriska funktionsnedsättningar är en eftersatt grupp då det gäller anpassningar i skolan.

Syfte

Syftet med studien är att undersöka unga vuxnas med Asperger diagnos och ADHD erfarenheter av stödåtgärder i skolan samt vad individerna retrospektivt värderar som betydelsefullt för övergången till vidare studier och arbetsliv.

Tillvägagångssätt och analys

I studien har ett ändamålsenligt urval användas utifrån följande kriterier; personerna ska ha en neuropsykiatrisk diagnos som Asperger syndrom och Attention-Deficit Hyperactivity Disorder (ADHD) baserad på DSM-IV och/eller ICD-10 (American Psychiatric Association, 2000; World Health Organisation, 1993), vara i åldrarna 18-30 år samt vilja och förmåga att kommunicera sina erfarenheter av tidigare skoltid och övergången till vidare studier. Intervjuer har genomförts med 13 unga vuxna i åldrarna 20 till 29 år. Intervjuerna har analyserats kvalitativt.

Resultat/förväntat resultat

Analysen av intervjuerna påbörjades i augusti 2012. Preliminära resultat visar att den sociala och fysiska miljön samt pedagogiskt stöd är betydelsefullt för övergången till vidare studier och arbetsliv. Analysen pågår och vid tidpunkt för konferensen kommer resultat gällande erfarenheter av stödåtgärder i skolan samt vad individerna värderar som betydelsefullt för övergången till vidare studier eller arbetsliv att presenteras.

Slutsats

I samband med AT-forum 2013 kommer slutsatser från analysen att presenteras.

Bakgrund

Att lämna grundskolan innebär för många unga vuxna en övergång till vuxenlivet med antingen vidare studier eller arbetsliv i sikte. Det innebär nya utmaningar som de flesta unga vuxna klarar av medan personer med neuropsykiatriska funktionsnedsättningar riskerar att komma tillkorta i och med de krav som samhället ställer. Hur stödet har sett ut i grundskolan kan påverka ungdomarnas övergång till vidare studier och arbetsliv. Studier har visat att personer med neuropsykiatriska funktionsnedsättningar är en eftersatt grupp då det gäller anpassningar i skolan.

Syfte

Syftet med studien är att undersöka unga vuxnas med Asperger diagnos och ADHD erfarenheter av stödåtgärder i skolan samt vad individerna retrospektivt värderar som betydelsefullt för övergången till vidare studier och arbetsliv.

Tillvägagångssätt och analys

I studien har ett ändamålsenligt urval användas utifrån följande kriterier; personerna ska ha en neuropsykiatrisk diagnos som Asperger syndrom och Attention-Deficit Hyperactivity Disorder (ADHD) baserad på DSM-IV och/eller ICD-10 (American Psychiatric Association, 2000; World Health Organisation, 1993), vara i åldrarna 18-30 år samt vilja och förmåga att kommunicera sina erfarenheter av tidigare skoltid och övergången till vidare studier. Intervjuer har genomförts med 13 unga vuxna i åldrarna 20 till 29 år. Intervjuerna har analyserats kvalitativt.

Resultat/förväntat resultat

Analysen av intervjuerna påbörjades i augusti 2012. Preliminära resultat visar att den sociala och fysiska miljön samt pedagogiskt stöd är betydelsefullt för övergången till vidare studier och arbetsliv. Analysen pågår och vid tidpunkt för konferensen kommer resultat gällande erfarenheter av stödåtgärder i skolan samt vad individerna värderar som betydelsefullt för övergången till vidare studier eller arbetsliv att presenteras.

Slutsats

I samband med AT-forum 2013 kommer slutsatser från analysen att presenteras.

Support in school and the transition to further education and/or work – young adults with Asperger’s Disorder and ADHD

Introduction

Individuals with Asperger’s Disorder and attention deficit hyperactivity disorder (ADHD) may need support in order to participate and progress toward graduating from school; a starting point for pursuing institutes of further education, work and participation in community life.

Objectives

The aim of this study was to describe and explore young adults’ with Asperger’s Disorder syndrome and ADHD experience of support in school and what they, in retrospect describe as influencing learning.

Methods

Semi-structured interviews were conducted with a purposive sample comprising 13 young adults between the age of 20 to 29 years, diagnosed with Asperger’s Disorder and attention-Deficit Hyperactivity Disorder (ADHD) based on DSM-IV and / or ICD-10 that have completed compulsory school.  A qualitative data analysis was used. 

Results

Results show that the students in the present study stated that they did not receive adequate support during their school time in relation to their perceived difficulties with academic performance. Different aspects of support including academic accommodations, social support and emotional support are described as important for learning and participation in school.  Despite being evident in the students’ stories the support was perceived as inappropriate in relation to their individual needs and the students advocate for support affecting the students’ wellbeing.

Conclusion

The experience of support in school described by students with presented Asperger’s Disorder and ADHD are complex and require understanding of multiple aspects important for learning and participation.  

Contribution to the practice/evidence base of occupational therapy

Based on the students’ perspectives this study showed that different forms of support in school are important for learning and participation.  Therefore, occupational therapy services are essential for developing and implementing interventions in school. In addition, a collaborative approach between educators, parents and students is crucial for supporting students with Asperger’s Disorder and ADHD in school.

Aim: The aim of this study was to investigate computer use in educational activities by students with attention deficit hyperactivity disorder (ADHD) in comparison with that of students with physical disabilities and students from the general population.

Methods: The design of the study was cross-sectional with group comparison. Students with ADHD (n = 102) were pair-matched in terms of age and sex with students with physical disabilities and students from the general population (n = 940) were used as a reference group.

Results: The study showed that less than half of the students with ADHD had access to a computer in the classroom. Students with ADHD reported significantly less frequent use of computers for almost all educational activities compared with students with physical disabilities and students from the general population. Students with ADHD reported low satisfaction with computer use in school. In addition, students with ADHD reported a desire to use computers more often and for more activities in school compared with students with physical disabilities.

Conclusions: These results indicate that occupational therapists should place more emphasize on how to enable students with ADHD to use computers in educational activities in school.