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  • 1.
    Hedman, Annicka
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc NVS, Div Occupat Therapy, Box 23 200, SE-14183 Huddinge, Sweden.
    Eriksson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine. Karolinska Inst, Dept Neurobiol Care Sci & Soc NVS, Div Occupat Therapy, Box 23 200, SE-14183 Huddinge, Sweden.
    von Koch, Lena
    Karolinska Inst, Dept Neurobiol Care Sci & Soc NVS, Div Occupat Therapy, Box 23 200, SE-14183 Huddinge, Sweden;Karolinska Univ Hosp, Neuro, Stockholm, Sweden.
    Guidetti, Susanne
    Karolinska Inst, Dept Neurobiol Care Sci & Soc NVS, Div Occupat Therapy, Box 23 200, SE-14183 Huddinge, Sweden.
    Five-year follow-up of a cluster-randomized controlled trial of a client-centred activities of daily living intervention for people with stroke2019In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 33, no 2, p. 262-276Article in journal (Refereed)
    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.

  • 2.
    Holmlund, Lisa
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Occupat Therapy, Huddinge, Sweden;Rehab Stn Stockholm, Spinalis SCI Unit, Stockholm, Sweden.
    Guidetti, Susanne
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Occupat Therapy, Huddinge, Sweden.
    Eriksson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Occupat Therapy, Huddinge, Sweden.
    Asaba, Eric
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Occupat Therapy, Huddinge, Sweden;Stockholms Sjukhem Fdn, Res Educ & Dev Unit, Stockholm, Sweden;Tokyo Metropolitan Univ, Grad Sch Human Hlth Sci, Dept Occupat Therapy, Tokyo, Japan.
    Return to work in the context of everyday life 7-11 years after spinal cord injury - a follow-up study2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, no 24, p. 2875-2883Article in journal (Refereed)
    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.

  • 3.
    Tistad, Malin
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Occupat Therapy, Huddinge, Sweden;Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden;Umea Univ, Dept Rehabil & Social Med, Physiotherapy, Umea, Sweden.
    Flink, Maria
    Karolinska Univ Hosp, Funct Area Social Work Hlth, Stockholm, Sweden;Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden.
    Ytterberg, Charlotte
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Physiotherapy, Huddinge, Sweden;Karolinska Univ Hosp, Funct Area Occupat Therapy & Physiotherapy, Stockholm, Sweden.
    Eriksson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Occupat Therapy, Huddinge, Sweden.
    Guidetti, Susanne
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Occupat Therapy, Huddinge, Sweden.
    Tham, Kerstin
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Occupat Therapy, Huddinge, Sweden;Malmo Univ, Fac Hlth & Soc, Malmo, Sweden.
    von Koch, Lena
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Occupat Therapy, Huddinge, Sweden;Karolinska Univ Hosp, Theme Neuro, Stockholm, Sweden.
    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 intervention2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 8, article id e022222Article in journal (Refereed)
    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.

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