Umeå University's logo

Purpose: Individuals with traumatic brachial plexus injuries (TBPI) may experience lifelong physical and psychosocial consequences. With or without surgical treatment, the rehabilitation is considered important. Physiotherapists and occupational therapists face challenges due to the scarcity of evidence-based rehabilitation protocols after TBPI. There is limited knowledge about patients’ experiences with rehabilitation. This study aims to explore and describe patients’ experiences of rehabilitation after a TBPI.

Method: Transcripts from five focus groups with 21 participants after TBPI and rehabilitation were coded and analysed with a qualitative content analysis. The discussion guide contained questions regarding experience of rehabilitation.

Results: The analysis revealed one overarching theme: “A fight on your own”, and three themes that include 1) Lack of tailored rehabilitation in a life-changing situation, 2) Crucial prerequisites for engagement in rehabilitation, and 3) Life will never be the same. The results highlighted the importance of healthcare professionals engaging with patients and advocates for comprehensive, person-centred rehabilitation programs across healthcare levels. Furthermore, participants value peer interaction, psychosocial support and up-to-date technology.

Conclusion: Patients struggle to access person-centred rehabilitation from engaged and knowledgeable occupational and physiotherapists. Addressing both psychosocial and physical aspects and daily activities is crucial.

Forming therapeutic relationships is considered important within psychiatric and mental health nursing. One way of achieving this is through social interaction when engaging in joint activities. However, introducing and using nursing interventions based on joint activities in psychiatric inpatient care has proven challenging. Since staff motivation is important, researching the meaning of engaging in joint activities from the nursing professional's point of view can provide information that is relevant in this area. This study aims to illuminate the meaning of participating in joint activities with patients as narrated by nursing professionals in psychiatric inpatient care. Narrative interviews with 14 nursing professionals with experience from psychiatric inpatient care were conducted. Data were analysed using phenomenological hermeneutics and reported following the consolidated criteria for reporting qualitative research (COREQ) guidelines. Results illuminate that engaging in joint activities means being open to a process of learning. Four themes contributed to this understanding: Struggling with uncertainty, discovering aspects of the other, unfolding paths to self-fulfilment and sharing personhood. Being open to a process of learning means being willing to face uncertainty when engaging in activities as well as being open to learning about oneself as well as the other. Through openness to this process of learning, a sharing of personhood can be achieved, where the nursing professional and the patient approach becoming two persons. Illuminating the meaning of joint activities from the nursing professionals' perspective may provide valuable insights related to introducing and using interventions focusing on joint activities.

Background: There is limited experience in combining interdisciplinary rehabilitation for persons with dementia and caregiver support.

Aim: To explore how informal caregivers perceive participation in a person-centred, multidimensional, interdisciplinary rehabilitation programme targeting community-dwelling older adults with dementia and their informal caregivers, and how the programme has influenced their everyday life.

Material and Methods: Fourteen informal caregivers, aged 45–84 years, participated in a qualitative interview following a randomised controlled pilot study. Transcribed interviews were analysed using qualitative content analysis.

Results: The analysis resulted in seven categories and three themes: feelingchallenged and boostedto face an uncertain future, perceiving supportive activities as sources ofbothjoy and frustration in everyday life and finding relief in recognising their relative’s former self.

Conclusions and Significance: Combining interdisciplinary rehabilitation for adults with dementia with education and support for caregivers was perceived as viable and valuable for the informal caregivers. They felt strengthened by the rehabilitation and better prepared for their uncertain future. However, participation also challenged everyday routines, but the benefits appeared to outweigh the strain.

Background and purpose: Loneliness is a complex public health issue that can lead to increased morbidity, with higher prevalence among older adults. Social prescribing may be one way to ease loneliness. This study aims to explore stakeholders’ perceptions of prerequisites for implementing a social prescribing program in a Swedish context.

Method: Reflexive thematic analysis was used to analyse individual semi-structured interviews with eleven stakeholders whose experience were considered relevant for implementing a social prescribing program in the Swedish context. They were selected to provide diverse perspectives related to organisation, position, and geography.

Results: From the analysis three themes were constructed; Where to implement–Necessity to bridge organisational gaps, How to implement–Balancing professional expectations, and For whom to implement–Addressing those with ‘real’ needs. These themes highlight the perceived prerequisites, including barriers and facilitators, for successful implementation of social prescribing.

Conclusions: The participants’ perceptions are suggesting that Sweden has several practical advantages in place for implementing social prescribing, such as robust organisations responsible for citizens’ health and well-being and a range of activities available. If organisations can collaborate by prioritizing patients’ needs and overcoming organisational divisions and responsibilities, there is potential for successfully implementing social prescribing in Sweden in the future. Nevertheless, implementation may be hampered by limited resources within health care, and challenges to evaluate program effects.

Background: A team-based, individualised rehabilitation approach may be required to meet the complex needs of people with dementia. This randomised controlled pilot trial evaluated the feasibility of a person-centred multidimensional interdisciplinary rehabilitation programme for community-dwelling older people with dementia and their informal primary caregivers.

Methods: Participants with dementia were randomised to an intervention group (n = 31, mean age (SD) 78.4 (6.0) years) or usual care (n = 30, mean age 79.0 (7.1)). The rehabilitation programme consisted of a 20-week rehabilitation period containing assessments and interventions based on each individual’s goals, and group-based physical exercise plus social interaction twice a week for 16 weeks at a rehabilitation unit. After 5 and 14 months, the interdisciplinary team followed up participants over two four-week periods. For both groups, dates of deaths and decision to move to nursing home over three years, as well as interventions for the relevant periods, were collected. Blinded assessors measured physical functions, physical activity, activities of daily living, cognitive functions, nutritional status, and neuropsychiatric symptoms at baseline and at 5, 12, 24, and 36 months.

Results: Participants in the intervention group received a mean of 70.7 (20.1) interventions during the 20-week rehabilitation period, delivered by all ten team professions. The corresponding figures for the control group were 5.8 (5.9). In the intervention group, all but one participated in rehabilitation planning, including goal setting, and attendance in the exercise and social interaction groups was 74.8%. None of the adverse events (n = 19) led to any manifest injury or disease. Cox proportional hazard regression showed a non-significant lower relative risk (HR = 0.620, 95% CI 0.27–1.44) in favour of the intervention for moving to nursing home or mortality during the 36-month follow-up period. Linear mixed-effect models showed non-significant but potentially clinically meaningful between-group differences in gait, physical activity, and neuropsychological symptoms in favour of the intervention.

Conclusions: The rehabilitation programme seems feasible among community-dwelling older people with dementia. The overall results merit proceeding to a future definitive randomised controlled trial, exploring effects and cost-effectiveness. One could consider to conduct the programme earlier in the course of dementia, adding cognitive training and a control attention activity.

Trial registration: The study protocol, ISRCTN59155421, was registered online 4/11/2015.

Background: Artificial intelligence (AI) technology is constantly and rapidly evolving and has the potential to benefit occupational therapy (OT) and OT clients. However, AI developments also pose risks and challenges, for example in relation to the ethical principles of OT. One way to support future AI technology aligned with OT ethical principles may be through human-centered AI (HCAI), an emerging branch within AI research and developments with a notable overlap of OT values and beliefs.

Objective: To explore the risks and challenges of AI technology, and how the combined expertise, skills, and knowledge of OT and HCAI can contribute to harnessing its potential and shaping its future, from the perspective of OT’s ethical values and beliefs.

Results: Opportunities for OT and HCAI collaboration related to future AI technology include ensuring a focus on 1) occupational performance and participation, while taking client-centeredness into account; 2) occupational justice and respect for diversity, and 3) transparency and respect for the privacy of occupational performance and participation data.

Conclusion and Significance: There is need for OTs to engage and ensure that AI is applied in a way that serves OT and OT clients in a meaningful and ethical way through the use of HCAI.

Background: Phronesis is a way of knowing, implying wisdom, experiences, and reflections that guide our judgements. Phronesis, important for learning, is a neglected form of knowledge when applied to research.

Aim: To examine how phronesis is conceptualised and practiced in three research projects.

Method: Data from eight interviews with researchers involved in three research projects was generated. The interview material was analysed. A theoretical matrix of contemporary understanding of phronesis was applied to the material.

Result: Examples of phronesis from three research projects in occupational therapy are presented according to categories of contemporary phronesis; acknowledging embodiment, embracing humility, using perceptiveness, and practicing reflexivity.

Significance: This unique approach of analysing research projects contributes to the understanding of phronesis and its implications for research, providing valuable insights into the researchers’ praxis in their respective projects

Conclusion: There is a need for a greater recognition of phronesis as a dimension of knowledge within all types of research, and within the discipline. By not recognising phronesis as a legitimate form of knowledge, the discipline perpetuates a superiority of knowledge from episteme that dominates our ways of learning about the world around us and where the type of knowledge gleaned from phronesis is consequently marginalised.

Health-promoting digital agents, taking on the role of an assistant, coach or companion, are expected to have knowledge about a person's medical and health aspects, yet they typically lack knowledge about the person's activities. These activities may vary daily or weekly and are contextually situated, posing challenges for the human-Agent interaction. This pilot study aimed to explore the experiences and behaviors of older adults when interacting with an initially unknowledgeable digital agent that queries them about an activity that they are simultaneously engaged in. Five older adults participated in a scenario involving preparing coffee followed by having coffee with a guest. While performing these activities, participants educated the smartwatch-embedded agent, named Virtual Occupational Therapist (VOT), about their activity performance by answering a set of activity-ontology based questions posed by the VOT. Participants' interactions with the VOT were observed, followed by a semi-structured interview focusing on their experience with the VOT. Collected data were analyzed using an activity-Theoretical framework. Results revealed participants exhibited agency and autonomy, deciding whether to adapt to the VOT's actions in three phases: Adjustment to the VOT, partial adjustment, and the exercise of agency by putting the VOT to sleep after the social conditions and activity changed. Results imply that the VOT should incorporate the ability to distinguish when humans collaborate as expected by the VOT and when they choose not to comply and instead act according to their own agenda. Future research focuses on how collaboration evolves and how the VOT needs to adapt in the process.

Background: The World Health Organization claims that rehabilitation is important to meet the needs of persons with dementia. Rehabilitation programmes, however, are not routinely available. Person-centred, multidimensional, and interdisciplinary rehabilitation can increase the opportunities for older adults with dementia and their informal primary caregivers to continue to live an active life and participate in society. To our knowledge, staff team experiences of such rehabilitation programmes, involving older adults with dementia and their informal caregivers has not been previously explored.

Methods: The aim of this qualitative focus group study was to explore the experiences of a comprehensive staff team providing person-centred multidimensional, interdisciplinary rehabilitation to community-dwelling older adults with dementia, including education and support for informal primary caregivers. The 13 staff team members comprised 10 professions who, during a 16-week intervention period, provided individualised interventions while involving the rehabilitation participants. After the rehabilitation period the staff team members were divided in two focus groups who met on three occasions each (in total six focus groups) and discussed their experiences. The Grounded Theory method was used for data collection and analysis.

Results: The analysis resulted in four categories: Achieving involvement in rehabilitation is challenging, Considering various realities by acting as a link, Offering time and continuity create added value, and Creating a holistic view through knowledge exchange, and the core category: Refining a co-creative process towards making a difference. The core category resembles the collaboration that the staff had within their teams, which included participants with dementia and caregivers, and with the goal that the intervention should make a difference for the participants. This was conducted with flexibility in a collaborative and creative process.

Conclusions: The staff team perceived that by working in comprehensive teams they could provide individualised rehabilitation in creative collaboration with the participants through interaction, knowledge exchange, time and continuity, coordination and flexibility, and a holistic view. Challenges to overcome were the involvement of the person with dementia in goal setting and the mediating role of the staff team members. The staff pointed out that by refinement they could achieve well-functioning, competence-enhancing and timesaving teamwork.

Quality of care is determined not only by political decisions but also by how those policies are understood and managed by professionals when put into action. Home care services, the most common form of elder care in Sweden today, should include social support, which is very important for health and wellbeing. And yet, support for social participation seems to be lacking. Understanding prevalent social constructs and their possible impacts on focus and content of social practice in home care could reveal ways to address social support in home care. Therefore, this article highlights how professionals in home care provision talk about older home care recipients' loneliness and social needs, and how these repertoires are related to professionals' opportunities and obligations to support those social needs. The study included 22 persons from different professions in home care provision, from two municipalities in northern Sweden. Nine individual interviews and four group interviews were conducted, recorded, transcribed, and analyzed using a discourse psychology approach. The results show two interpretative repertoires in which notions of otherness and likeness guided definitions and support regarding loneliness, social needs, and social support. This study reveals assumptions that underpin and structure the practices of home care. As the interpretative repertoires provided differing and partly opposing views on how to provide social support and combat loneliness, it seems important to also address the broader issues of professional identities and how loneliness is defined and approached.