Perceived occupational value in people with acquired brain injury

A feasibility study of the internet-based intervention "Strategies for Empowering activities in Everyday life" (SEE 1.0) applied for people with stroke

BACKGROUND

To enable people with stroke to achieve an active everyday life under altered conditions, the development of self-management programs is essential to facilitate the process of change that individuals must undergo. To improve access to self-management, internet-based solutions have been proposed. The aim of this study was to evaluate the feasibility of a novel internet-based intervention, "Strategies for Empowering activities in Everyday Life" (SEE, version 1.0), for clients with stroke.

METHODS

This feasibility study had a preposttest design without a control group and utilized a mixed-method approach. Data were collected through study-specific forms, outcome assessments, interviews, and field notes. Descriptive statistics and content analysis were subsequently applied.

RESULTS

The study involved fifteen clients and staff at clinics in a hospital-based open-care rehabilitation setting. The results indicate that SEE is feasible for clients with stroke. When adopted as expected, SEE has the potential to empower self-management and enhance engagement, balance, and values in everyday activities. The study also indicates that SEE is feasible in terms of adherent delivery of dosage, acceptability, and value, as perceived by clients, occupational therapists, and clinic managers. However, adjustments are needed in the study design, in terms of recruitment strategies, the selection of assessor-based outcome assessment, and the evaluation of adherence. Additionally, the educational program for professionals should be enhanced to better support the implementation of SEE.

CONCLUSION

After the study design, intervention, and educational program are refined, SEE can be prepared for a pilot randomized controlled trial.

TRIAL REGISTRATION

clinicaltrails.gov NCT04588116, date of registration: 8th October 2020.

Psychometric properties of the arabic version of occupational value with pre-defined ítems

BACKGROUND

Perceived occupational value is closely linked with well-being and there is need worldwide for assessment tools that target this phenomenon. The Occupational Value with pre-defined items (OVal-pd), measuring three dimensions of occupational value; concrete, socio-symbolic and self-rewarding, was designed for that purpose.

AIM

To pilot an Arabic version of OVal-pd and evaluate its psychometric properties in terms of content validity, factor structure, homogeneity, construct validity, test-retest stability, floor and ceiling effects, and measurement error.

METHODS

Snowball sampling was used to recruit Arabic-speaking persons living in Sweden (n = 55). They completed the OVal-pd and questionnaires addressing background factors, content validity and feasibility. Confirmatory factor analysis, Spearman's rank correlation, Cronbach's α, intraclass correlation coefficients, and minimum detectable change were calculated.

RESULTS

A 22-item version of the Arabic OVal-pd was found to have acceptable content validity and feasibility and the proposed three occupational value dimensions were confirmed. Good properties in terms of construct validity, internal consistency and test-retest stability were also established. No floor or ceiling effects were observed.

CONCLUSION

The Arabic OVal-pd showed good validity and reliability on various psychometric aspects.

SIGNIFICANCE

In today's multicultural societies, the Arabic OVal-pd can be an important tool for occupational therapists working with Arabic-speaking clients.

Occupational balance and stroke impact among community-dwelling stroke survivors 65 years or older: a cross-sectional study

INTRODUCTION

Occupational balance has been investigated in different populations but less in stroke survivors. Previous studies have focussed on occupational balance among stroke survivors of working age (15-64 years of age), showing they did not perceive they had occupational balance. There is, therefore, a lack of knowledge of how older stroke survivors perceive their occupational balance. The aims of this study were to describe occupational balance in community-dwelling stroke survivors 65 years or older and to investigate if there were any associations between their perceived stroke impact and occupational balance.

METHODS

A cross-sectional study was performed with 58 stroke survivors, with a median age of 75 years at stroke onset and a median time since stroke onset of 11 months. The participants were recruited from a local stroke register and answered questionnaires on occupational balance and stroke impact. Data were analysed with descriptive statistics, correlations and logistic regression.

RESULTS

The participants had a median score of 29 (min 12 to max 33), indicating a very high occupational balance, a low stroke impact, and a good recovery (median 82.5; min 0 to max 100). An association between participation and occupational balance (OR 1.13; 95% CI 1.04-1.23) was found.

CONCLUSION

The stroke survivors perceived a low stroke impact and a high occupational balance. It is possible that older community-dwelling stroke survivors, of whom many have retired, juggle less occupations leaving them with more time to engage in those occupations they want to, leading to a better occupational balance.

The Internet-Based Intervention Strategies for Empowering Activities in Everyday Life: Qualitative Study of Experiences of Clients With Stroke

BACKGROUND

There is a need to enhance access to and support for self-management of activities in everyday life after a stroke. Internet-based solutions have the potential to contribute to this development. Consequently, an internet-based intervention called Strategies for Empowering Activities in Everyday Life (SEE) was developed. The intervention aims to assist clients in developing management strategies that promote a healthy distribution and balanced engagement in various activities performed in different places and with other people. To further support the development and feasibility of this intervention, more knowledge is needed about clients' experiences during the intervention process.

OBJECTIVE

This study aims to explore and describe how clients with stroke experienced the SEE intervention process and whether participation in SEE influenced their experience of everyday life.

METHODS

Overall, 9 clients with stroke who received SEE participated in the study-4 (44%) women and 5 (56%) men aged 37 to 73 years. Qualitative interviews about experiences with SEE were conducted twice during the intervention process with each participant. The data were analyzed using the constant comparative method of grounded theory.

RESULTS

The participants' experiences with the intervention process of SEE formed the core category, conceptualized as The relevance of and readiness for entering a change process in activities of everyday life differ among clients, constituting of two main categories: (1) an eye-opener providing agency for a change process and (2) never beginning a change process in activities in everyday life. The results showed that the relevance of and readiness for SEE differed between the participants. The experiences of 78% (7/9) of the participants reflected that the intervention process provided them with an agency to drive their own change process for activities in everyday life to promote health. Overall, 22% (2/9) of the participants refrained from entering a change process during SEE as they did not recognize any need for changes in their activities. When SEE was relevant and adopted as expected, the participants described it as an eye-opener for how they can alter their health based on how they distribute and spend their time on various activities.

CONCLUSIONS

SEE has the potential to support clients' development of self-management and to take an active role in influencing their engagement in activities in everyday life and health. This study identified necessary improvements in the educational program for professionals to enhance delivery and strengthen the therapeutic mechanisms of SEE for future research. To effectively implement internet-based interventions such as SEE, it is crucial to identify clients who express a need for self-management in activities and are ready to invest the effort required to adopt a change process. Furthermore, it is indicated that participants' self-analysis of their everyday activities empowers them to adopt new self-management strategies, which can also benefit other interventions.

Developing and testing the feasibility of a new internet-based intervention-A case study of people with stroke and occupational therapists

INTRODUCTION

Internet-based interventions are called for within rehabilitation to meet the limited access to support for self-management after stroke. Therefore, a new intervention program, "Strategies for Empowering activities in Everyday life" (SEE) was developed. The aim of this study was to explore and describe how clients with stroke and their occupational therapists experienced the SEE intervention process and whether SEE has the potential to promote an active everyday life.

METHODS

A qualitative descriptive case study was designed. Four people with stroke (two of each sex, mean age 66,5 years) and their two occupational therapists (one of each sex) were included. A mix of data collection methods as interviews, assessments, registration forms and fieldnotes was used to uncover the participants' experiences and potential changes. Data were analysed with pattern matching.

FINDINGS

The analysed data formed three categories: "Not being able to take on the internet-based intervention", "Being facilitated in the change process of everyday life through the internet-based intervention", and "Providing a new internet-based intervention is a transition from ordinary practice". These categories included two to four subcategories that reflected aspects of SEE feasibility and acceptability with a focus on content and delivery.

CONCLUSION

The first test of the intervention indicates that the content and delivery of SEE can be feasible and acceptable both for clients and occupational therapists. The findings suggest that SEE has the potential to support clients' self-reflections and their adoption of strategies that influence engagement in daily activities and satisfaction with life in various ways. Further research with large-scale studies is needed.

Consensus on Feedback Statements That Create Responsibility Among People With Parkinson's Disease: A Delphi Study

IMPORTANCE

Sense of agency is associated with a sense of responsibility, which is essential to performing goal-directed occupations.

OBJECTIVE

To reach consensus on a set of extrinsic feedback statements that have the potential to create a sense of responsibility among patients with neurological disorders in the course of performing daily or social occupations.

DESIGN

Anonymous Delphi study with two rounds with international experts and one round with Irani patients with Parkinson's disease (PD).

SETTING

Electronic survey.

PARTICIPANTS

One hundred experts and 73 patients with idiopathic PD.

OUTCOMES AND MEASURES

Experts and patients anonymously rated (5 = strongly agree/very effective, 4 = agree/effective, 3 = neither agree nor disagree/uncertain, 2 = disagree/ineffective, 1 = strongly disagree/very ineffective) their level of agreement with each survey statement and the effectiveness of each statement in creating a sense of responsibility in the course of performing daily or social occupations. Consensus was set as an interquartile range of ≤1 and ≥70% agreement in two adjacent categories of a Likert scale.

RESULTS

In the experts' first round, consensus was reached on the level of agreement and effectiveness of 18 statements. In the second round, final consensus was achieved on all statements. In the one patient round, patients reached consensus on all statements. Finally, 34 statements were rated as 4 or 5 in terms of agreement and effectiveness, based on the opinions of experts and patients.

CONCLUSIONS AND RELEVANCE

This study has produced a collection of feedback statements that might be useful in occupation-based interventions. What This Article Adds: Extrinsic responsibility feedback delivered while administering occupation-based interventions may increase volition, motivation, and engagement.

Validity and Reliability of the Occupational Balance Questionnaire (OBQ11) in a U.S. Sample of Adults With Type 1 Diabetes

IMPORTANCE

Although occupational balance (OB) is a construct of importance to occupational therapy, existing OB assessments have not been validated in clinical populations.

OBJECTIVE

To examine the validity and reliability of the 11-item version of the Occupational Balance Questionnaire (OBQ11) in U.S. adults with Type 1 diabetes.

DESIGN

Data were analyzed from adults with Type 1 diabetes enrolled in a larger longitudinal study examining the relationships among blood glucose, emotion, and functioning. Dimensionality of the OBQ11 was assessed with item response theory (IRT); convergent validity was tested by examining whether associations between the OBQ11 and other constructs were consistent with a priori hypotheses.

SETTING

Three outpatient clinical sites in the United States.

PARTICIPANTS

Data from 208 U.S. adults with Type 1 diabetes were included in the analyses (42% Latino, 29% White, 14% African American, 7% multiethnic, and 8% other).

OUTCOMES AND MEASURES

Assessments administered include the OBQ11, Patient Health Questionnaire (depression), and Diabetes Self-Management Questionnaire.

RESULTS

Overall, results from IRT models and correlational tests supported the reliability and validity of the OBQ11. For instance, higher scores on the OBQ11 were significantly associated with better self-ratings of diabetes management behaviors (r = .28, p < .001), lower depression symptoms (r = -.53, p < .001), and greater positive affect (r = .32, p < .001). A single-factor generalized partial credit model fit the OBQ11 acceptably well, supporting its unidimensionality.

CONCLUSIONS AND RELEVANCE

The OBQ11 may be a reliable and valid measure of OB appropriate for use in clinical populations such as adults with diabetes. What This Article Adds: OB is not often formally assessed by occupational therapists in the United States, even though the contributions of OB to health and well-being are core components of the philosophy of occupational therapy. The current evidence supports the validity of the OBQ11 in a clinical population of adults with Type 1 diabetes and demonstrates significant associations between OB and health management behaviors. Study results may encourage greater consideration and assessment of OB in occupational therapy clinical practice in the United States.

Optimising the development of sustainable internet-based occupational therapy interventions: Important key actions and perspectives to consider

BACKGROUND

By examining the health needs of the general population and utilising the potential of digitalisation as a driving force, new internet-based services need to be developed in occupational therapy. However, existing guidelines for the development of complex interventions provide scant information on how to develop internet-based interventions.

AIM

The aim of this paper is to share experiences and illustrate important key actions and new perspectives to consider during the innovation process of developing and designing an internet-based occupational therapy intervention.

METHOD AND MATERIALS

International guidelines for intervention development was reviewed to add important perspectives in the innovation process.

RESULTS

The illustration focuses on five key actions in the development phase to highlight new perspectives and questions important to consider when designing new internet-based occupational therapy interventions.

CONCLUSION

The new perspectives can complement existing guidelines to enhance the development of more effective and sustainable internet-based interventions.

SIGNIFICANCE

The illustration provided has potential to improve the sustainability in innovation processes of new internet-based occupational therapy interventions.

Organizational and social work environment factors, occupational balance and no or negligible stress symptoms among Swedish principals - a cross-sectional study

BACKGROUND

Few studies have assessed the mental health of principals, or studied associations with both organizational and social work environment factors and occupational balance. The purpose of the present study was therefore to investigate associations between supporting and demanding organizational and social work environment factors, occupational balance and stress symptoms in principals.

METHODS

A total of 4309 surveys (2316 from the first round, 1992 from the second round), representing 2781 Swedish principals who had responded to at least one of two surveys, were included in the present study. The surveys include questions about socio-demographic factors, occupational balance, overtime work, and supporting and demanding organizational and social work environment factors, as well as questions about personal stress and exhaustion. Generalized Estimating Equations (GEE) models were used to specify a repeated measures model with a dichotomous outcome (binary logistic regression) and multiple independent factors. Data from two surveys were combined, taking into account dependent observations due to the fact that many study subjects had participated in both surveys.

RESULTS

Associations were found between occupational balance (Q1: OR 2.52, 95% CI 2.03-3.15; Q2: OR 4.95, 95% CI 3.86-6.35; Q3: OR 9.29, 95% CI 6.99-12.34), overtime work (Once a week: OR 1.51, 95% CI 1.10-2.08; Sometimes a week: OR 1.31, 95% CI 1.03-1.66), supportive private life (OR 1.50, 95% CI 1.36-1.66), supportive colleagues at the leadership level (OR 1.24, 95% CI 1.14-1.36), supportive management (OR 1.17, 95% CI 1.07-1.28) and no or negligible stress symptoms. In addition, role demands (OR 0.72, 95% CI 0.63-0.83), having a container function (OR 0.72, 95% CI 0.64-0.82), collaboration with employees (OR 0.77, 95% CI 0.66-0.89), role conflicts (OR 0.75, 95% CI 0.66-0.89) and having a buffer function (OR 0.86, 95% CI 0.77-0.97) were associated with lower likelihood to rate no or negligible stress symptoms.

CONCLUSIONS

The occupational balance of principals is strongly associated with no or negligible stress symptoms, and thus is a promising venue for promoting well-being. Improvements should be made to several factors in the organizational and social work environments to improve principals' chances of having occupational balance, and therefore better mental health.

Occupational balance from a clinical perspective

BACKGROUND

Occupational balance is a central concept in occupational therapy and is commonly defined as an individual's perception of having the right amount and variety of occupations in daily life. This individualistic and subjective nature of occupational balance brings with it certain challenges when applied in practice. The aim of this discussion paper is to highlight the challenges associated with the lone application of individualistic occupational balance in practice situations, and propose some way forward.

METHODS

The Meleis' Theory to Practice to Theory strategy was used. Practice-based vignettes were used as a point of departure to discuss these challenges. This was followed by theorising the importance of including the others' perceptions of a person's pattern of daily occupations.

CONCLUSION

Besides a goal of increasing a person's occupational balance in clinical practice, striving towards creating a suitable pattern of daily occupations from a community perspective also seems to be a relevant goal.