Biomedical subjects

Susanne Iwarsson

Publications and source records attributed to Susanne Iwarsson.

At least 19 recordsLinked to original sources

PubMed2006

The complexity of daily occupations in multiple sclerosis.

The aims of this study were to describe which self-care, productivity, and leisure occupations individuals with multiple sclerosis (MS) perceive as difficult to perform on admission to rehabilitation and the individuals' own perception of the importance of, performance of, and satisfaction with these occupations. Whether the reported self-care, productivity, and leisure occupations were related to sex, age, disease severity, and living arrangements was also investigated. Forty-seven men and women (mean age 49.4 years) were assessed with the Canadian Occupational Performance Measure (COPM) on admission to rehabilitation. The individuals reported 366 occupations (median 8, range 3-15), which were categorized as self-care (51%), productivity (30%), and leisure (19%). Three COPM subcategories--household management (26%), personal care (21%), and functional mobility (20%)--accounted for two-thirds of the reported occupations. All prioritized occupations (n = 238; (median 5, range 2-7) had high ratings for importance and the ratings for performance and satisfaction were generally low. Men reported significantly more occupations related to self-care than women, but no significant difference between the sexes could be found for productivity and leisure. No significant differences between the occupational areas were found when age, disease severity, or/and living arrangements were included in the analysis. In conclusion, individuals with MS perceive difficulties with occupations related to all aspects of daily life. This underscores the need to use assessment tools that capture the complexity of daily occupations.

Activities of Daily Living↗

PubMed2006

Occupational therapy research on assistive technology and physical environmental issues: a literature review.

BACKGROUND: To determine future directions for research in the area of assistive technology and physical environmental issues, it is important to have an understanding of prior research. PURPOSE: This literature review examined how assistive technology and physical environmental issues have been studied in the research published in international peer-reviewed occupational therapy journals. METHOD: Five recent volumes of nine journals were manually searched utilizing specific criteria. The publications were classified according to their perspective, application of the Person-Environment-Occupation (PEO) model, and the research design. RESULTS: Both research fields demonstrated use of different research methods and they displayed equal needs with regard to improved research methodologies. PRACTICE IMPLICATIONS: There are a lack of studies involving all three PEO components indicating a lack of research in occupational performance issues. Further research on occupational performance is important for developing occupational therapy practice in the area of assistive technology and physical environmental issues. Furthermore, study designs reflecting the societal level in all three PEO components are required. Finally, there is a strong need for conceptual and theoretical development in both fields.

Environment↗

PubMed2005

Changes in accessibility and usability in housing: an exploration of the housing adaptation process.

The purpose of a housing adaptation is to enhance daily activities and to improve housing accessibility and usability by removing physical barriers in the home. The aim of this study was to investigate longitudinal changes in housing accessibility among clients receiving grants for housing adaptations. Baseline assessments were administered one month before the housing adaptation, with the first follow-up after two to three months, and the second follow-up after eight to nine months. The Housing Enabler and the Usability in My Home instruments were used to collect data from 131 consecutively enrolled clients living in general housing. Accessibility and usability improved significantly, the number of physical environmental barriers decreased and dependence on mobility devices increased, but at different times along the process. The results indicate the complexity of the housing adaptation process and the need to consider person-environment interactions over time. The methodology seems useful for quality development of assessment, intervention and evaluation processes in housing adaptations performed by occupational therapists.

Activities of Daily Living↗

PubMed2005

Assistive devices among very old people in five European countries.

The aim of this study was to investigate the use and need of assistive devices (ADs) in a cross-national European sample of very old persons, focusing on national similarities and differences as well as similarities and differences according to age and level of health status. Data from the ENABLE-AGE research project were utilized involving very old persons in Sweden, Germany, Latvia, Hungary, and the United Kingdom (UK). Personal interviews with single-living old persons were conducted (n = 1918). Of the total sample 65% reported that they had and used one or more ADs, and 24% reported unfilled need. The most commonly used ADs were devices for communication, followed by devices for mobility. Participants in Hungary and Latvia used a lower total number of ADs. Comparisons among sub-groups according to age between the Western and the Eastern European national samples showed significant differences. The result can to some extent be explained by different welfare systems and presumably differences in knowledge and awareness of ADs, and further research is called for. However, the result can serve as input for future planning and development of information, services, and community-based occupational therapy, to improve healthcare and social services for older people.

Aged↗

PubMed2005

Cross-national and multi-professional inter-rater reliability of the Housing Enabler.

In order to render reliable assessment of housing accessibility in a cross-national context possible, the objective of this study was to investigate multi-professional, cross-national inter-rater reliability of the ENABLE-AGE project-specific version of the Housing Enabler instrument. The data collection was performed with elderly persons in ordinary housing in five European countries. After participation in rater training courses, 26 raters representing different nationalities and professions performed data collection in independent pairs of raters, n = 64. Inter-rater reliability was calculated by means of percentage agreement as well as Cohen's kappa. The results demonstrated moderate to good overall inter-rater reliability of the project-specific version of the Housing Enabler instrument. The mean agreement for the personal component part of the instrument was 91%. For 13 of the 15 items in this part kappa values could be defined, kappa = 0.43, indicating moderate agreement. In the environmental component part the mean agreement for all 188 items was 85%, while kappa = 0.50, indicating moderate agreement. Given the complexity of the instrument and the number of different professions and countries involved, we consider the Housing Enabler as useful for cross-national research targeting housing accessibility, even if the agreement levels reached were moderate. However, the moderate agreement levels pinpoint the importance of rater training.

Aged↗

PubMed2005

ADL dependence and perceived health among elderly deaf sign-language users: a comparison with a matched group of elderly hearing people.

The main purpose of the study was to investigate dependence in ADL and perceived health among elderly deaf sign-language users and to compare these findings with data from a matched hearing elderly population sample. Data on the deaf population were collected through assessments and structured interviews in sign language. Data on the hearing population were retrieved from the Swedish National Study and Ageing and Care (SNAC), while only a few variables from the questionnaire were used in the present study. Each deaf individual was matched by three hearing persons. Matching was performed according to gender, age, and living situation. The main finding is that elderly deaf sign-language users are more dependent in ADL but simultaneously report better health than their hearing counterparts. The differences in ADL dependence can be explained by factors linked to the communication problems experienced by deaf sign-language users, but also by cultural factors. The better health reported by the deaf sample may be attributed to adaptive mechanisms that deaf sign-language users have been claimed to develop. This research provides new information on a vulnerable group of elderly people, i.e. deaf sign-language users, that has previously been given little scientific attention.

Activities of Daily Living↗

PubMed2005

Quality of life after stroke: well-being, life satisfaction, and subjective aspects of work.

Stroke incidence in those of working age has been reported to be increasing significantly, implying strong incentives for research concerning working ability after stroke. This study focused on differences in subjective aspects of work and dimensions of quality of life after having experienced stroke. Sixty-five persons answered a postal questionnaire. The median age at the time of the stroke was 54 years, (Q3 -Q1 = 8 years). "Financial aspects" and "intrinsic aspects" of work were rated as the most important by 37% and 36% of the respondents, respectively. Fewer respondents ranked "social aspects" as most important. In total, 23 persons had returned to work, but no difference in the ratings of the most important aspects of work between those who had returned to work and those who had not was found. Persons who rated "intrinsic aspects" of work as the most important were more satisfied with the subjective dimensions of quality of life "vocational situation" (p = 0.020) and "work" (p = 0.015) than the others. In conclusion, subjective aspects of work need to be explored and discussed thoroughly in rehabilitation of younger stroke patients.

Employment↗

PubMed2005

Short hospital stay augmented with education and home-based rehabilitation improves function and quality of life after hip replacement: randomized study of 50 patients with 6 months of follow-up.

BACKGROUND: Because of current cost restrictions, we studied the effect of a shorter hospital stay on function, pain and quality of life (QOL) after total hip replacement (THR). PATIENTS AND METHODS: 50 patients from two hospitals were randomized into a study group (SG) of 27 patients receiving preoperative and postoperative education programs, as well as home visits from an outpatient team, and a control group (CG) of 23 patients receiving "conventional" rehabilitation often augmented by a stay at a rehabilitation center. RESULTS: Mean hospital stay was shorter for the SG than for the CG (6.4 days and 10 days, respectively; p < 0.001). During the 6-month study period, there were 9 non-fatal complications in the SG and 12 in the CG (p = 0.3). The difference in Oxford Hip Score between the groups was not statistically significant before the operation, but was better for the SG at 2 months (p = 0.03) and this difference remained more or less constant throughout the study. The overall score from the Nottingham Health Profile indicated a better QOL in the SG. INTERPRETATION: Our preoperative education program, followed by postoperative home-based rehabilitation, appears to be safer and more effective in improving function and QOL after THR than conventional treatment.

Adult↗

PubMed2005

A long-term perspective on person-environment fit and ADL dependence among older Swedish adults.

PURPOSE: This study described person-environment (P-E) fit and activities of daily living (ADLs) among older adults, and it explored the relationship between P-E fit and ADL dependence, testing Lawton's docility hypothesis at two points in time. DESIGN AND METHODS: From a random sample of individuals aged 75-84 living in a Swedish municipality, 72 persons were available for baseline and follow-up interviews over a 6-year period. Interviews and observations were used for data collection at home visits. RESULTS: P-E fit problems as well as ADL dependence increased from baseline to follow-up. Functional limitations and dependence on mobility devices increased; few changes were found concerning environmental barriers. At follow-up, ADL dependence and P-E fit correlated significantly in the frailest subsample. IMPLICATIONS: In advanced age, P-E fit problems in housing are related to ADL dependence. The increase of P-E fit problems mostly results from functional decline, although to some extent it is from environmental changes as well. The methodology used demonstrates the potential to increase our understanding of how the main components of Lawton's model change and interact over time.

Activities of Daily Living↗

PubMed2004

Older people's use of powered wheelchairs for activity and participation.

OBJECTIVE: The aims of this study were to investigate outcomes of older people's use of powered wheelchairs and risk factors for negative outcomes. DESIGN: The study was a cross-sectional interview-study including 111 powered wheelchair users over 65 years of age. RESULTS: All participants used their powered wheelchair in the summer; nearly all users regarded it as important and found that it gave them independence. The wheelchair made activity and participation possible for the users. The most frequent activity in the summer was going for a ride, and in the winter it was shopping. However, some could not use the wheelchair for visits, and supplementary travel modes are called for. Users who could not walk at all or who could not transfer without assistance were more likely not to be able to carry out prioritized activities. Furthermore, other risk factors for negative outcomes and need for further research were identified. CONCLUSION: The use of powered wheelchairs is a relevant societal intervention in relation to older people with limited walking ability in order to make activity and participation possible. It is likely that a larger proportion of older people could benefit from this intervention, in particular if current practices are improved taking activity and participation outcomes into consideration.

Aged↗

PubMed2004

Alternative data treatment principles for categorical ADL data.

Scaling methodology represents a problem in assessments of activities of daily living (ADL) and little is known about how the results of these assessments are affected by data treatment principles and statistical methods. The aims of this paper are to: (i) describe alternative ways of transforming a response pattern on ADL into a single number; and (ii) to present and compare different ways of analysing both changes in ADL capacity from one occasion to another and also differences in ADL between one group and another. Three datasets based on assessments with the ADL Staircase were used. Four different data treatment principles were described and the development of a novel principle to transform response patterns into ranks was put forward. Thereafter, different paired-data cases and two-sample cases were analysed, using different statistical standard methods to explore possible variations in results. The results demonstrated a few marked differences among P values, no matter which data treatment principle or statistical method was used. That is, different principles and methods yield similar results in terms of P values, although there are important differences as regards selection bias. Principles and methods respecting the ordinal character of ADL data encourage the use of non-parametric methods and the novel rank principle presented here is a useful alternative.

Activities of Daily Living↗

PubMed2004

Statistical assessment of changes in ADL dependence: three-graded versus dichotomised scaling.

The aim of this study was to investigate how dichotomising three-graded ADL Staircase data affects the possibility of detecting changes in ADL dependence between different assessment occasions. An authentic two-occasion data set was used as a basis for a simulation experiment. In all, we used four different data treatment principles, all utilising the matched pairing of the data. The first principle utilised a sum score technique, and the second within-person comparisons by means of item-by-item analysis of improvement or deterioration. The third principle used ADL ranks, a novel approach, while the fourth used within-item ranks. Independently of the data treatment principle used, the statistical power of all tests was reduced by 13-24% after dichotomisation, compared to when the three-graded scale was utilised. The results indicate that dichotomising ADL Staircase data results in information loss, and hence in reduced ability to detect changes. The need to consider the purpose of the ADL assessment before reducing the number of scale steps is highlighted. The knowledge generated in this study is useful for practitioners and researchers, aiming at evaluating rehabilitation interventions.

Activities of Daily Living↗

PubMed2003

Accessibility and usability in housing: construct validity and implications for research and practice.

PURPOSE: The aim of this study was to validate the conceptual definitions of accessibility and usability, and to explore differences between objective accessibility assessments and subjective ratings of usability in different client groups. METHOD: The Housing Enabler and the Usability in My Home instruments were used for 131 persons above 18 years of age, living in ordinary housing and receiving a housing adaptation grant. Covariation between accessibility in four different housing sections and three different usability aspects were explored, for the total sample and for six sub-samples reflecting person-environment-activity transactions or demographic factors. RESULTS: Significant correlations were found in the total sample, among clients aged 75-84, women, clients living alone, as well as among clients with high dependence in personal and instrumental ADL and in outdoor activities. Subjective usability evaluations of activity aspects and physical environmental aspects were correlated to accessibility indoors and outdoors, while personal and social aspects of usability were correlated to outdoor accessibility. CONCLUSIONS: Accessibility and usability are concluded to be different but related concepts. The results indicate that e.g. age, civil status and ADL dependence affect how clients assess aspects of their housing situation. For efficient planning and evaluation of housing adaptations, assessment of housing accessibility, usability, and dependence in ADL is recommended.

Activities of Daily Living↗

PubMed2003

Indicators for return to work after stroke and the importance of work for subjective well-being and life satisfaction.

OBJECTIVES: This study focuses on the continuation of gainful employment after experiencing stroke, addressing factors indicative of readiness for return to work, subjective well-being and life satisfaction. METHODS: The target group comprised 120 patients, studied by means of medical records and postal questionnaires. RESULTS: A total of 41% had returned to work, although there were changes concerning employers, assignments and working hours. Individuals who had returned to work reported a significantly higher level in subjective well-being and life satisfaction. Being able to walk meant the greatest chance of returning to work (odds ratio = 3.98) followed by white-collar worker (odds ratio = 2.99) and having preserved cognitive capacity (odds ratio = 2.64). CONCLUSION: Returning to work after stroke is a major factor for high subjective well-being and life satisfaction. Three factors indicative of readiness for return to work were identified, providing implications for more efficient vocational rehabilitation programmes.

Adult↗

PubMed2002

Accessibility to the public environment as perceived by teenagers with functional limitations in a south Swedish town centre.

PURPOSE: Owing to physical inaccessibility persons with mobility restrictions and other functional limitations often face problems in public environments, leading to restrictions in activity and participation. To investigate general accessibility and perceived problems of accessibility to the public environment in a town centre, as well as visiting preferences to public facilities, among teenagers with functional limitations. METHODS: An interview questionnaire specific to a south Swedish town was constructed and used with 33 Swedish teenagers with functional limitations. RESULTS: To a varying degree, all 33 teenagers commented on accessibility problems, e.g. concerning uneven surface material outdoors, steps at entrances, heavy doors and restricted space indoors. The results also indicated that teenagers with functional limitations to a high extent want to visit the same environments as other teenagers, but that it is often impossible owing to accessibility problems. Furthermore, because of accessibility problems, many of the teenagers were dependent on personal assistance. CONCLUSION: Inaccessibility results in dependence, which might affect personal development negatively, and much effort are required in order to ensure activity and societal participation. Efficient priorities in public environment accessibility matters and discussions with the actors involved require valid and reliable data on local accessibility problems.

Adolescent↗

PubMed2002

Theoretical understanding and methodological challenges in accessibility assessments, focusing the environmental component: an example from travel chains in urban public bus transport.

PURPOSE: In order to increase the theoretical understanding of the concept of accessibility, this paper reports the results from an exploration of methodological difficulties inherent in systematic accessibility assessments of single persons' travel chains in urban public bus transport. In addition, Special Transport Service (STS) travellers' perception of environmental demands in public transport are reported. METHODS: This study was designed to explore the environmental component in accessibility problems systematically. Twenty persons entitled to STS were recruited in order to travel by low-floor bus, Service Route Traffic (SRT) or STS. Two different methods were chosen. Critical incidents were collected during participant observation, and by means of a pilot instrument based on the Enabler Concept independent environmental assessments were performed. RESULTS: Not all environmental details registered during the participant observations were in agreement with the independent environmental assessment, and different reasons for the disagreements were reported. In addition, participants travelling by STS gave information about what hindered them from using conventional public transport. CONCLUSIONS: The theoretical understanding behind accessibility assessments has benefited from the methodological challenges mapped out in this study. In order to interpret accessibility, the individual perspective as well as the population perspective are necessary, which means that complementary methods are needed.

Aged↗

PubMed2002

Subjective quality of life, health, I-ADL ability and adaptation strategies in fibromyalgia.

OBJECTIVES: To describe subjective quality of life and health, self-perceived instrumental activities of daily living (I-ADL) ability and adaptation strategies, and to explore possible relationships between these variables in fibromyalgia patients. DESIGN: Two instruments were used with fibromyalgia patients: the Fibrositis Impact Questionnaire and 'Living with fibromyalgia - adaptation to chronic disease and handicap', and correlative analyses were performed. SUBJECTS: A sample of 34 patients undergoing rehabilitation (in a specific programme). RESULTS: The majority of the patients used many adaptation strategies, demonstrating some significant relationships with perceived I-ADL ability and subjective quality of life and health. Different symptoms correlated highly significantly with self-perceived ability in I-ADL. CONCLUSION: The significant relationships between adaptation strategies and I-ADL ability and health demonstrated deserve clinical awareness and further research efforts.

Activities of Daily Living↗

PubMedDate not supplied

Preferences and frequencies of visits to public facilities in old age--a pilot study in a Swedish town center.

In societies with an increasing proportion of elderly active people it is valuable to gain knowledge about what elderly people actually do and want to do in relation to activity arenas in the public environment. The main aim of this study was to investigate elderly people's preferences and frequencies of visits to public facilities in a Swedish town center. A further aim was to gather information on elderly people's subjective perception of problematic and favorable environmental conditions in public environments. The study was conducted using a previously developed questionnaire, "My visit preferences to the public environment". The sample comprised 39 persons aged 75-84 years, living in a defined geographic area. The results of this study provide an overview of the public facilities elderly people rate as important to visit. There are public facilities preferred by most elderly people but with varying frequencies of visits. The study also generated information about elderly people's subjective perceptions of problematic and favorable environmental conditions in public environments, demonstrating that more problems were perceived along walking routes in the public outdoor environment than in the public facilities per se. The results are indicative for community planning supporting elderly people's activities in the public environment, but the questionnaire used should be further validated.

Aged↗