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Gustavsson, M., Guidetti, S., Eriksson, G., von Koch, L. & Ytterberg, C. (2019). Factors affecting outcome in participation one year after stroke: a secondary analysis of a randomized controlled trial. Journal of Rehabilitation Medicine, 51(3), 160-166
Open this publication in new window or tab >>Factors affecting outcome in participation one year after stroke: a secondary analysis of a randomized controlled trial
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2019 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 51, no 3, p. 160-166Article in journal (Refereed) Published
Abstract [en]

Objective:

To explore the importance of client characteristics (age, sex, stroke severity and participation before stroke), rehabilitation context (in-patient or client's home) and approach (enhanced client-centeredness or not) on participation in everyday life after stroke.

Methods:

A secondary analysis of data on 237 participants from a previous randomized controlled trial evaluating an enhanced client-centred intervention after stroke. Plausible associations between client characteristics, context and rehabilitation approach, and a positive outcome regarding participation were explored. Three different outcome measures for participation were used: Stroke Impact Scale 3.0, domain participation; Frenchay Activities Index; and Occupational Gaps Questionnaire.

Results:

For all participants there was a significant association between mild stroke and a positive outcome using the Frenchay Activities Index. Among participants who had not received the enhanced client-centred approach, there was a significant association between mild stroke and a positive outcome using the Stroke Impact Scale. The context of rehabilitation, i.e. receiving home rehabilitation, was also associated with a positive outcome in the Frenchay Activities Index for the control group.

Conclusion:

In order to increase participation in everyday life for people after stroke it appears to be important to use an enhanced client-centred approach, particularly when working within in-patient rehabilitation and with people with moderate or severe stroke.

Keywords
stroke rehabilitation, activities of daily living, occupational therapy, brain injury, logistic regression, client-centredness
National Category
Occupational Therapy
Identifiers
urn:nbn:se:uu:diva-379932 (URN)10.2340/16501977-2523 (DOI)000460419000002 ()30815706 (PubMedID)
Funder
Swedish Research CouncilForte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2019-03-27 Created: 2019-03-27 Last updated: 2019-03-27Bibliographically approved
Hedman, A., Eriksson, G., von Koch, L. & Guidetti, S. (2019). Five-year follow-up of a cluster-randomized controlled trial of a client-centred activities of daily living intervention for people with stroke. Clinical Rehabilitation, 33(2), 262-276
Open this publication in new window or tab >>Five-year follow-up of a cluster-randomized controlled trial of a client-centred activities of daily living intervention for people with stroke
2019 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 33, no 2, p. 262-276Article in journal (Refereed) Published
Abstract [en]

Objective: To compare five-year outcomes and changes over time of a client-centred activities of daily living (ADL) intervention versus usual ADL interventions for people with stroke and their significant others.

Design: Five-year follow-up of a cluster-randomized controlled trial where a client-centred ADL intervention (n = 129) or usual ADL interventions (n = 151) were delivered to people with stroke.

Setting: Multicentre study including 16 inpatient or home-based rehabilitation units.

Participants: People with stroke and significant others.

Intervention: The client-centred ADL intervention aimed at enabling agency in daily activities and participation in everyday life and at reducing caregiver burden.

Main measures: For people with stroke, perceived participation (Stroke Impact Scale), independence in ADL, life satisfaction, and use of formal/informal care were measured. For significant others, caregiver burden, life satisfaction, and mood (Hospital Anxiety and Depression Scale) were assessed.

Results: Five years post-intervention, data were collected from 145 people with stroke (intervention group: n = 71/control group: n = 74) and 75 significant others (intervention group: n = 36/control group: n = 39). For those with stroke, the Participation domain of the Stroke Impact Scale showed no group differences at year five (68.9 vs 75.4, P = 0.062) or in changes over time. At year five, the control group had better outcomes regarding Other help/supervision. Significant others in the control group were more likely to show signs of depression at year five (odds ratio = 22.3; P < 0.001).

Conclusion: The client-centred ADL intervention appears to render similar long-term effects as usual ADL interventions for people with stroke, but for significant others signs of depression might be reduced.

Keywords
Stroke rehabilitation, rehabilitation, occupational therapy, follow-up studies, evaluation studies, longitudinal studies, caregivers
National Category
Occupational Therapy
Identifiers
urn:nbn:se:uu:diva-377337 (URN)10.1177/0269215518809791 (DOI)000456887100012 ()30409049 (PubMedID)
Funder
Swedish Research Council
Available from: 2019-02-25 Created: 2019-02-25 Last updated: 2019-02-25Bibliographically approved
Fors, U., Kamwesiga, J. T., Eriksson, G., von Koch, L. & Guidetti, S. (2019). User evaluation of a novel SMS-based reminder system for supporting post-stroke rehabilitation. BMC Medical Informatics and Decision Making, 19, Article ID 122.
Open this publication in new window or tab >>User evaluation of a novel SMS-based reminder system for supporting post-stroke rehabilitation
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2019 (English)In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 19, article id 122Article in journal (Refereed) Published
Abstract [en]

Background: According to WHO stroke is a growing societal challenge and the third leading cause of global disease-burden estimated using disability-adjusted life years. Rehabilitation after stroke is an area of mutual interest for health care in many countries. Within the health care sector there is a growing emphasis on ICT services to provide clients with easier access to information, self-evaluation, and self-management. ICT-supported care programs possible to use in clients' home environments are also recommended when there are long distances to the health care specialists. The aim of this study was to evaluate the technical usability of a SMS-based reminder system as well as user opinions when using such a system to assist clients to remember to perform daily rehabilitation activities, to rate their performance and to allow Occupational therapists (OT's) to track and follow-up clients' results over time.

Methods: Fifteen persons with stroke were invited to participate in the study and volunteered to receive daily SMS-based reminders regarding three activities to perform on a daily basis as well as answer daily SMS-based questions about their success rate during eight weeks. Clients, a number of family members, as well as OTs were interviewed to evaluate their opinions of using the reminder system.

Results: All clients were positive to the reminder system and felt that it helped them to regain their abilities. Their OTs agreed that the reminder and follow-up system was of benefit in the rehabilitation process. However, some technical and other issues were limiting the use of the system for some clients. The issues were mostly linked to the fact that the SMS system was based on a Swedish phone number, so that all messages needed to be sent internationally.

Conclusion: In conclusion, it seems that this type of SMS-based reminder systems could be of good use in the rehabilitation process after stroke, even in low income counties where few clients have access to Internet or smart phones, and where access to healthcare services is limited. However, since the results are based on clients', OTs' and family members' expressed beliefs, we suggest that future research objectively investigate the intervention's beneficial effects on the clients' physical and cognitive health.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Stroke, Rehabilitation, Client-centred, Feedback, Occupational therapy, SMS-reminders, Africa
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-391018 (URN)10.1186/s12911-019-0847-3 (DOI)000474206000001 ()31269946 (PubMedID)
Funder
Swedish Research Council, 2014-28-63
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-08-20Bibliographically approved
Terio, M., Eriksson, G., Kamwesiga, J. T. & Guidetti, S. (2019). What's in it for me?: A process evaluation of the implementation of a mobile phone-supported intervention after stroke in Uganda. BMC Public Health, 19, Article ID 562.
Open this publication in new window or tab >>What's in it for me?: A process evaluation of the implementation of a mobile phone-supported intervention after stroke in Uganda
2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 562Article in journal (Refereed) Published
Abstract [en]

Background

The prevalence of stroke in Uganda is increasing. In stroke rehabilitation, information and communication technology has been shown to have potential in improving service delivery in high-income countries but there is limited knowledge of its use and impact in low-income countries.The aim of the study was to evaluate the implementation process of a mobile phone-supported family-centred rehabilitation intervention and to gain knowledge on the mechanisms of impact as well as the contextual factors that might have affected the implementation process and its outcome.

Method

This was a single-case study design using the integrated Promoting Action on Research Implementation in Health Services framework and the Medical Research Council guidance as frameworks. Quantitative process data was derived from 14 log books used by occupational therapists during the implementation. Qualitative semi-structured interviews were conducted with 12 implementers in different professions, 12months into the implementation, in order to obtain the primary data. Secondary data was derived from six semi-structured interviews conducted directly after pre-intervention workshops and 6 months later. The framework method was used in the data analysis.

Results

In 11 out of 14 cases, the clients were compliant with the intervention. Yet, challenges such as technical problems were reported. The target of conducting 16 phone calls for each client was achieved to 74%. Eight categories emerged from the qualitative analysis of the interviews including: 1) perceptions on facilitation, 2) using scientific and experience-based knowledge, 3) tailoring the intervention, 4) supportive working culture, 5) barriers to the service delivery, 6) implementers' interaction with the intervention, 7) perceptions on motivations and values, and 8) improving the model and enabling sustainability. Mechanisms contributing to the implementation of the intervention included engaged facilitators and motivated participants. Challenges in the client recruitment and poor information dissemination were some of the mechanisms impeding the implementation.

Conclusions

The intervention was partially delivered in accordance with the logic model for the project, where the implementation process was influenced by several barriers in the context such as technical setbacks. However, there were also several mediators in the process driving the project forward, including strong facilitation and motivated participants.

Keywords
Stroke, Africa, ICT, Low-income, Occupational therapy, Process evaluation, SMS, Tele-rehabilitation, Tele medicine
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Occupational Therapy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-387283 (URN)10.1186/s12889-019-6849-3 (DOI)000468070900002 ()31088411 (PubMedID)
Funder
Swedish Research Council, 2014-28-63
Available from: 2019-06-24 Created: 2019-06-24 Last updated: 2019-06-24Bibliographically approved
Kamwesiga, J. T., Eriksson, G., Tham, K., Fors, U., Ndiwalana, A., von Koch, L. & Guidetti, S. (2018). A feasibility study of a mobile phone supported family-centred ADL intervention, F@ce (TM), after stroke in Uganda. Globalization and Health, 14, Article ID 82.
Open this publication in new window or tab >>A feasibility study of a mobile phone supported family-centred ADL intervention, F@ce (TM), after stroke in Uganda
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2018 (English)In: Globalization and Health, ISSN 1744-8603, E-ISSN 1744-8603, Vol. 14, article id 82Article in journal (Refereed) Published
Abstract [en]

Background: There is a lack of evidence-based health services to reduce the impact of stroke in low-income countries at a personal, family or community level. The aim was to evaluate the feasibility of: i) a mobile phone supported family-centred intervention (F@ce (TM)), and ii) the study design for evaluating the effects of the intervention on the perceived impact of stroke; perceived participation in everyday life; and self-efficacy in everyday activities amongst persons with stroke and their families in Uganda. Methods: The study comprised a pre-post design with an intervention group (IG) receiving the F@ce (TM) and a control group (CG). The inclusion criteria's were: a) confirmed stroke diagnosis, b) access to and ability to use a mobile phone, c) ability to communicate in English and/or Luganda, d) > 18 years, e) residents in Kampala, and f) a Modified Rankin Scale level 2 to 4. The aimof the F@ce (TM) was to increase functioning in daily activities for persons living with the consequences of stroke, and participation in everyday life for persons with stroke and their families. The F@ce (TM) was an eight-week family-centred intervention, which entailed goal setting and problem-solving strategies, daily reminders and self-rated follow-ups of performance by short message service (SMS). Data were collected in the participants' home environment at baseline and after eight weeks. Data on acceptability of the F@ce (TM) and study procedures were collected by log-books and the responses of the SMS follow ups on the server. The primary outcomes were performance and satisfaction of valued daily activities in everyday life using the Canadian Occupational Performance Measure (COPM), self-efficacy in performance of activities in daily life. Results: The IG comprised n = 13 and the CG n = 15. There were differences between the IG and CG in changes between baseline and follow-up in the primary outcomes COPM (performance component) and self-efficacy in favour of F@ce (TM). Overall with minor modifications the intervention and the study design were feasible for all participants involved. Conclusion: The results support the need for further research to rigorously evaluate the effects of F@ceT (TM) since the intervention appears to be feasible for persons with stroke and their family members.

Place, publisher, year, edition, pages
BMC, 2018
Keywords
Tele health, Africa, ICT, Low-income, Occupational therapy, SMS, Telerehabilitation, Tele medicine, Stroke rehabilitation, Participation
National Category
Occupational Therapy
Identifiers
urn:nbn:se:uu:diva-362679 (URN)10.1186/s12992-018-0400-7 (DOI)000442007000001 ()30111333 (PubMedID)
Funder
Swedish Research Council, 2014-28-63
Available from: 2018-11-13 Created: 2018-11-13 Last updated: 2018-11-13Bibliographically approved
Eriksson, G., Öst Nilsson, A., Asaba, E., Johansson, U. & Hellman, T. (2018). Being a co-worker or a manager of a colleague returning to work after stroke: a challenge facilitated by cooperation and flexibility. International Journal of Stroke, 13, 31-31
Open this publication in new window or tab >>Being a co-worker or a manager of a colleague returning to work after stroke: a challenge facilitated by cooperation and flexibility
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2018 (English)In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 13, p. 31-31Article in journal, Meeting abstract (Other academic) Published
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-373078 (URN)000452504600118 ()
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-01-11Bibliographically approved
Tistad, M., Flink, M., Ytterberg, C., Eriksson, G., Guidetti, S., Tham, K. & von Koch, L. (2018). Resource use of healthcare services 1 year after stroke: a secondary analysis of a cluster-randomised controlled trial of a client-centred activities of daily living intervention. BMJ Open, 8(8), Article ID e022222.
Open this publication in new window or tab >>Resource use of healthcare services 1 year after stroke: a secondary analysis of a cluster-randomised controlled trial of a client-centred activities of daily living intervention
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 8, article id e022222Article in journal (Refereed) Published
Abstract [en]

Objective: The objective of the study was to compare the total use of healthcare services in the course of the first year after a stroke between participants who, after the acute care, had received occupational therapy as a client-centred activities of daily living (ADL) intervention (CADL) and participants who had received usual ADL intervention (UADL).

Design: A secondary analysis of a multicentre cluster-randomised controlled trial (RCT).

Setting: Primary and secondary care in Sweden.

Participants: Participants were included if they: (1) had received CADL or UADL in the RCT, either as inpatients in geriatric rehabilitation units or in their own homes, and (2) data could be retrieved about their use of healthcare services provided by the county council from computerised registers.

Interventions: CADL or UADL.

Outcome measures: Inpatient and outpatient healthcare in the course of the first year after stroke.

Results: Participants from 7 of the 16 units included in the RCT met the criteria. Participants in the CADL group (n=26) who received geriatric inpatient rehabilitation had a shorter length of hospital stay (p=0.03) than participants in the UADL group (n=46), and the CADL group with home rehabilitation (n=13) had fewer outpatient contacts (p=0.01) compared with the UADL group (n=25). Multiple regression analyses showed that in four of the models, a higher age was associated with a lower use of healthcare services. The use of healthcare services was also associated (some of the models) with dependence in ADL, stroke severity and type of rehabilitation received, CADL or UADL.

Conclusions: The provision of client-centred occupational therapy after stroke did not appear to increase the use of healthcare services during the first year after stroke. Trial registration number NCT01417585.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2018
Keywords
health care services, resource utilisation
National Category
Occupational Therapy
Identifiers
urn:nbn:se:uu:diva-368768 (URN)10.1136/bmjopen-2018-022222 (DOI)000446470200137 ()30082359 (PubMedID)
Funder
Swedish Research Council, 2010-2943Stockholm County Council, 20080156Stockholm County Council, 20100107
Available from: 2018-12-10 Created: 2018-12-10 Last updated: 2018-12-10Bibliographically approved
Holmlund, L., Guidetti, S., Eriksson, G. & Asaba, E. (2018). Return to work in the context of everyday life 7-11 years after spinal cord injury - a follow-up study. Disability and Rehabilitation, 40(24), 2875-2883
Open this publication in new window or tab >>Return to work in the context of everyday life 7-11 years after spinal cord injury - a follow-up study
2018 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, no 24, p. 2875-2883Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this follow-up study was to explore experiences of return to work in the context of everyday life among adults 7-11 years after spinal cord injury (SCI). Methods: This study used in-depth interviews and observations in a qualitative design with eight persons who had previously been interviewed in 2008. A narrative approach was used during data gathering and analysis. Results: Return to work was experienced as something constantly needing to be negotiated in the context of everyday life. Several years after SCI expectations for work and perceptions of possibilities for meaningful work had changed. Five main themes were identified through the analysis, (1) negotiating the possibilities of working, (2) hope for future work tempered with concern, (3) education as a possible path to employment, (4) paths toward return to work in light of unmet support, and (5) unpaid occupations grounded in interest and competence. Conclusions: Persons who have no higher education or lack viable employment to return to after SCI seem to be vulnerable in return to work. Early and timely interventions tailored to the person's interests and competencies, in which the rehabilitation team has a distinct coordinating role, are thus critical in return to work.

Keywords
Vocational rehabilitation, work reentry, expectations, meaning, occupation, occupational science
National Category
Occupational Therapy Social Work
Identifiers
urn:nbn:se:uu:diva-371050 (URN)10.1080/09638288.2017.1362597 (DOI)000450400300004 ()28793801 (PubMedID)
Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2019-01-07Bibliographically approved
Kamwesiga, J. T., von Kock, L. K., Eriksson, G. & Guidetti, S. G. E. (2018). The impact of stroke on people living in central Uganda: A descriptive study. African Journal of Disability, 7, Article ID UNSP a438.
Open this publication in new window or tab >>The impact of stroke on people living in central Uganda: A descriptive study
2018 (English)In: African Journal of Disability, ISSN 2226-7220, Vol. 7, article id UNSP a438Article in journal (Refereed) Published
Abstract [en]

Background: Knowledge about perceived impact of stroke on everyday life as well as rehabilitation needs after stroke in Uganda is necessary to identify and develop rehabilitation interventions. Objectives: To explore and describe clinical characteristics and functioning during the acute or subacute phase and chronic phase, as well as the impact of stroke on everyday life during the chronic phase in stroke survivors in central Uganda. Method: A cross-sectional observational study was conducted on a consecutively included acute or subacute (n = 58) sample and a chronic (n = 62) sample. Face-to-face interviews were conducted to collect demographic information and clinical characteristics. The Scandinavian Stroke Scale (SSS) was used to collect clinical characteristics, assess neurological impairment and define stroke severity. The Barthel Index was used to assess the level of dependence in activities of daily living. In addition, the Stroke Impact Scale (SIS) 3.0 Uganda version was used to assess the impact of stroke in everyday life as perceived by the individuals in the chronic sample receiving rehabilitation. Results: The mean age of the acute/subacute sample was 49 years and 81% had moderate or severe stroke. The mean age of the chronic rehabilitation group was 53 years and 58% had mild stroke. Time since onset in the acute sample was between 2 days and 3 weeks, and time since onset for the chronic sample varied between 3 months and 3 years. Strength, hand function and participation were the most impacted SIS domains in the chronic sample. Conclusion: People with severe and moderate stroke were more likely to be admitted to Mulago Hospital. The mean age in the study sample was lower than that in high-income countries. Further knowledge is needed regarding the impact of stroke to develop guidelines for stroke rehabilitation interventions feasible in the Ugandan healthcare context in both rural and urban areas.

National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-373245 (URN)10.4102/ajod.v7i0.438 (DOI)000453934100001 ()30568911 (PubMedID)
Funder
Swedish Research Council, 2014-2863
Available from: 2019-01-14 Created: 2019-01-14 Last updated: 2019-01-14Bibliographically approved
Eriksson, G., Hellman, T., Nilsson, A. O., Johansson, U., Ekbladh, E. & Bernspang, B. (2018). The return to work process after stroke changes over time while participating in a newly designed person-centred rehabilitation programme. International Journal of Stroke, 13, 31-31
Open this publication in new window or tab >>The return to work process after stroke changes over time while participating in a newly designed person-centred rehabilitation programme
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2018 (English)In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 13, p. 31-31Article in journal, Meeting abstract (Other academic) Published
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-373079 (URN)000452504600120 ()
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-01-11Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5308-4821

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