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Granbom, M., Szanton, S., Gitlin, L. N., Paulsson, U. & Zingmark, M. (2019). Ageing in the right place: a prototype of a web-based housing counselling intervention for later life. Scandinavian Journal of Occupational Therapy
Open this publication in new window or tab >>Ageing in the right place: a prototype of a web-based housing counselling intervention for later life
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2019 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Despite a strong desire among most older adults to age in place, there are few widely available services to support planning and preparing for one's future housing needs. Objective: To develop a prototype of a web-based housing counselling intervention for use in later life, by employing a user-centred design. Material and Methods: As the first step in intervention development, we employed a development process based on research circle methodology. Nine older adults participated in three sessions. Findings from literature reviews, a meeting with a technology and design panel (n = 6) and interviews with representatives of nonprofit organizations, companies, and municipalities (n = 7) served as discussion points. Result: An on-paper prototype was derived, composed of the THINK, LEARN and ACT module reflecting different stages of the decision-making process. Each module addressed preferences, health, home and social and financial resources. Key design features and theoretical underpinnings were included.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2019
Keywords
Relocation, home modifications, decision-making, housing preferences, community-living, assisted ving facilities, nursing home, user-centred, research circle methodology
National Category
Design
Identifiers
urn:nbn:se:umu:diva-162332 (URN)10.1080/11038128.2019.1634756 (DOI)000478533900001 ()31305191 (PubMedID)
Available from: 2019-08-27 Created: 2019-08-27 Last updated: 2019-08-27
Zingmark, M., Evertsson, B. & Haak, M. (2019). Characteristics of occupational therapy and physiotherapy within the context of reablement in Swedish municipalities: A national survey. Health & Social Care in the Community
Open this publication in new window or tab >>Characteristics of occupational therapy and physiotherapy within the context of reablement in Swedish municipalities: A national survey
2019 (English)In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524Article in journal (Refereed) Epub ahead of print
Abstract [en]

Reablement is a multidisciplinary, home-based intervention implemented for people at risk of functional decline and losing independence aiming to optimise functioning and independence in activities of daily living. There is limited knowledge about what characterises the intervention and the role of different professionals. The purpose of this study was to explore the characteristics and differences of occupational therapy and physiotherapy interventions in terms of focus, content and duration within the context of reablement in Swedish municipalities. Web-based surveys were used to collect data from 43 municipalities representing 25% of the population in Sweden. Data on intervention characteristics were reported for all cases receiving occupational therapy (n = 1,395) and physiotherapy (n = 1,006) over a 15-week period. Data were presented descriptively, and differences between occupational therapy and physiotherapy were analysed using Chi-square tests. The results indicated that reablement in Sweden was implemented for adults in all ages (19-103 years, median 81.0 years); 72% had home help. For both professions, a baseline assessment was made in fewer than half of all cases. There were significant differences between occupational therapists and physiotherapists regarding the focus and content as well as the number of contacts and duration of the intervention. For occupational therapists, walking indoors and self-care were the largest focus areas, whereas for physiotherapists walking indoors and body function were the largest focus areas. For most cases, the intervention was completed within five sessions over a 6-week period. This study provides the first picture of occupational therapy and physiotherapy within Swedish reablement contexts. In relation to the results, the focus of interventions, how assessments are made and how the intervention is implemented over time are issues that can be further elaborated.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
assessment, healthy ageing, home care, home-dwelling, intervention design, occupation-focus, restorative care
National Category
Occupational Therapy
Identifiers
urn:nbn:se:umu:diva-167090 (URN)10.1111/hsc.12934 (DOI)000504256600001 ()31876081 (PubMedID)
Available from: 2020-01-09 Created: 2020-01-09 Last updated: 2020-01-09
Zingmark, M., Norström, F., Lindholm, L., Dahlin-Ivanoff, S. & Gustafsson, S. (2019). Modelling long-term cost-effectiveness of health promotion for community-dwelling older people. European Journal of Ageing, 16(4), 395-404
Open this publication in new window or tab >>Modelling long-term cost-effectiveness of health promotion for community-dwelling older people
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2019 (English)In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 16, no 4, p. 395-404Article in journal (Refereed) Published
Abstract [en]

The effectiveness of health promotion for community-dwelling older people is well documented; however, there is a general lack of health economic evaluations. The aim of the present study was to evaluate long-term cost-effectiveness over 4 years of two health promoting interventions: senior meetings and a preventive home visit, for community-dwelling older people in relation to no intervention. We applied a Markov model including five states defined in relation to level of dependency of home help and place of residency. The model included transitions between dependency states, scores for quality of life and societal costs for each state, intervention costs and intervention effects for two formats of health promoting interventions. For each intervention and a no-intervention control group, we calculated the accumulated quality-adjusted life years (QALYs) and societal costs over 4 years. Sensitivity analyses included higher intervention costs, lower intervention effects and additional intervention costs and effects related to booster sessions. The results of all analyses indicated that health promotion implemented for community-dwelling older people in the format of senior meetings or a preventive home visit was cost-effective. Both interventions lead to QALY gains and reduce societal costs at any follow-up over 4 years, and thus, resources can be used to implement other interventions. The most important factor for the magnitude of QALY gains and cost savings was the intervention effect. Yearly booster sessions implemented for those persons who maintained their level of functioning extended the intervention effects adding additional QALYs and further reducing societal costs.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Senior meetings, Preventive home visit, QALYs, Booster session, Health economy, Multi-professional
National Category
Occupational Therapy Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Occupational therapy
Identifiers
urn:nbn:se:umu:diva-158632 (URN)10.1007/s10433-019-00505-1 (DOI)000496660800001 ()31798365 (PubMedID)2-s2.0-85062045626 (Scopus ID)
Available from: 2019-05-03 Created: 2019-05-03 Last updated: 2020-01-03Bibliographically approved
Wahlberg, M., Zingmark, M., Stenberg, G. & Munkholm, M. (2019). Rasch analysis of the EQ-5D-3L and the EQ-5D-5L in persons with back and neck pain receiving physiotherapy in a primary care context. European Journal of Physiotherapy
Open this publication in new window or tab >>Rasch analysis of the EQ-5D-3L and the EQ-5D-5L in persons with back and neck pain receiving physiotherapy in a primary care context
2019 (English)In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aim: The purpose of this study was to investigate the psychometric properties of the EQ-5D-3L and the EQ-5D-5L in patients with back and neck pain.

Materials and methods: Participants from two independent clinical survey studies was included in this study. In total 164 participants were answering either the EQ-5D-3L or the EQ-5D-5L after their visit to a physiotherapist in primary care for back and neck pain. Rasch analysis was performed to measure the psychometric properties of the two instruments.

Main findings: Overall, the EQ-5D-5L showed preliminary evidence of good psychometric properties. The items in both the EQ-5D-5L and the EQ-5D-3L showed acceptable goodness-of-fit indicating unidimensionality for both instruments measuring the concept health-related quality of life. All test persons fit the model, but the person separation reliability and person separation index were only barely acceptable for the EQ-5D-5L.

Conclusions: The results indicate that the EQ-5D-5L should be the preferred option when evaluating health-related quality of life with the EQ-5D, especially for patients with back and neck pain.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
EQ-5D, psychometric analysis, instrument development, health-related quality of life, primary health care
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-164008 (URN)10.1080/21679169.2019.1646801 (DOI)000490517900001 ()
Available from: 2019-10-12 Created: 2019-10-12 Last updated: 2019-11-05
Zingmark, M., Evertsson, B. & Haak, M. (2019). The content of reablement: Exploring occupational and physiotherapy interventions. British Journal of Occupational Therapy, 82(2), 122-126
Open this publication in new window or tab >>The content of reablement: Exploring occupational and physiotherapy interventions
2019 (English)In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 82, no 2, p. 122-126Article in journal (Refereed) Published
Abstract [en]

Statement of context: Occupational therapists and physiotherapists in a Swedish municipality answered a web-based survey about their reablement interventions.

Critical reflection on practice: There were overlapping areas as well as differences regarding the focus of occupational and physiotherapy interventions. Regarding the duration of interventions, occupational therapy was implemented over a short time span in contrast to physiotherapy, which had a longer duration. Both professions used valid and reliable instruments to a very limited extent.

Implications for practice: If other areas than self-care and mobility are to be addressed within reablement there is a need to critically reflect on the focus, content and duration of reablement interventions. Valid and reliable assessments can be utilised to a greater extent to guide goal-setting, the focus of interventions and to evaluate effects.mited extent.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Reablement, assessment, intervention design, rehabilitation, home care, occupational therapy
National Category
Occupational Therapy
Identifiers
urn:nbn:se:umu:diva-162766 (URN)10.1177/0308022618792188 (DOI)000457652700007 ()
Available from: 2019-09-10 Created: 2019-09-10 Last updated: 2019-09-10Bibliographically approved
Zingmark, M., Nilsson, I., Norström, F., Sahlén, K.-G. & Lindholm, L. (2017). Cost effectiveness of an intervention focused on reducing bathing disability. European Journal of Ageing, 14(3), 233-241
Open this publication in new window or tab >>Cost effectiveness of an intervention focused on reducing bathing disability
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2017 (English)In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 14, no 3, p. 233-241Article in journal (Refereed) Published
Abstract [en]

The onset of bathing disability among older people is critical for a decline in functioning and has implications for both the individuals’ quality of life and societal costs. The aim of this study was to evaluate longterm cost effectiveness of an intervention targeting bathing disability among older people. For hypothetical cohorts of community-dwelling older people with bathing disability, transitions between states of dependency and death were modelled over 8 years including societal costs. A five-state Markov model based on states of dependency was used to evaluate Quality-adjusted life years (QALYs) and costs from a societal perspective. An intervention group was compared with a no intervention control group. The intervention focused on promoting safe and independent performance of bathing-related tasks. The intervention effect, based on previously published trials, was applied in the model as a 1.4 increased probability of recovery during the first year. Over the full follow-up period, the intervention resulted in QALY gains and reduced societal cost. After 8 years, the intervention resulted in 0.052 QALYs gained and reduced societal costs by €2410 per person. In comparison to the intervention cost, the intervention effect was a more important factor for the magnitude of QALY gains and long-term societal costs. The intervention cost had only minor impact on societal costs. The conclusion was that an intervention targeting bathing disability among older people presents a cost-effective use of resources and leads to both QALY gains and reduced societal costs over 8 years.

Keywords
Cost effectiveness, QALY, Occupational therapy intervention, Reablement
National Category
Occupational Therapy Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-100062 (URN)10.1007/s10433-016-0404-1 (DOI)000409468500003 ()
Note

Orginally published in manuscript form with title: Recovery from bathing disability among older people - modeling long term cost-effectiveness of an occupational therapy intervention

Available from: 2015-02-20 Created: 2015-02-20 Last updated: 2018-06-07Bibliographically approved
Zingmark, M., Nilsson, I., Fisher, A. G. & Lindholm, L. (2016). Occupation-focused health promotion for well older people: a cost-effectiveness analysis. British Journal of Occupational Therapy, 79(3), 153-162
Open this publication in new window or tab >>Occupation-focused health promotion for well older people: a cost-effectiveness analysis
2016 (English)In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 79, no 3, p. 153-162Article in journal (Refereed) Published
Abstract [en]

Introduction The aim of this study was to evaluate three occupational therapy interventions, focused on supporting continued engagement in occupation among older people, to determine which intervention was most cost effective, evaluated as the incremental cost/quality adjusted life year gained. Method The study was based on an exploratory randomized controlled trial. Participants were 77-82 years, single living and without home help. One hundred and seventy seven persons were randomized to an individual intervention, an activity group, a discussion group or a no intervention control group. All interventions focused on supporting the participants to maintain or improve occupational engagement. Outcomes were evaluated at baseline, three and 12 months and included general health and costs (intervention, municipality and health care). Based on linear regression models, we evaluated how outcomes had changed at each follow-up for each intervention group in relation to the control group. Results Both group interventions resulted in quality adjusted life years gained at three months. A sustained effect on quality adjusted life years gained and lower total costs indicated that the discussion group was the most cost-effective intervention. Conclusion Short-term, occupation-focused occupational therapy intervention delivered in group formats for well older people resulted in quality-adjusted life years gained. A one-session discussion group was most cost effective.

Keywords
Occupational therapy, occupational engagement, activity limitations, participation restrictions, health omotion, self-rated health, quality-adjusted life years, cost effectiveness
National Category
Occupational Therapy
Identifiers
urn:nbn:se:umu:diva-119071 (URN)10.1177/0308022615609623 (DOI)000372175200004 ()
Available from: 2016-04-19 Created: 2016-04-11 Last updated: 2018-06-07Bibliographically approved
Zingmark, M. (2015). Occupation-focused and occupation-based interventions for community-dwelling older people: Intervention effects in relation to facets of occupational engagement and cost effectiveness. (Doctoral dissertation). Umeå: Umeå Universitet
Open this publication in new window or tab >>Occupation-focused and occupation-based interventions for community-dwelling older people: Intervention effects in relation to facets of occupational engagement and cost effectiveness
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

 Occupation-focused and occupation-based interventions can potentially promote occupational engagement among community-dwelling older people, but there is limited evidence to identify the most effective and cost-effective interventions. For independent-living older people, there is a lack of evidence to determine if occupation-focused and occupation-based interventions have an effect on their occupational engagement. For older people who need assistance because of bathing disabilities, there is limited evidence of the effects of occupation-focused and occupation-based interventions on their occupational engagement or for reducing or omitting their need for assistance. Finally, there is limited evidence to determine if occupation-focused and occupation-based interventions implemented for community-dwelling older people are cost effective.

Aim

The aim of this thesis was to evaluate the effects and cost effectiveness of occupation-focused and occupation-based interventions for two groups of community-dwelling older people, independent-living, community-dwelling older people and older people with bathing disabilities.

Method

Studies I and II were based on an exploratory randomized controlled trial. One hundred and seventy seven persons, 77–82 years, single living, and without need for home help were randomized to a no-intervention control group or to one of three occupational therapy interventions focused on promoting occupational engagement: an individual intervention, an activity group or a discussion group. In study I, effect sizes for leisure engagement and ability to perform activities of daily living (ADL) tasks were estimated for each intervention in relation to the control group to identify the most effective intervention at 3 and 12 months after baseline. In study II, the effects on quality adjusted life years (QALYs) and the total costs for the intervention, social services provided by the municipality and health care were used evaluate cost-effectiveness.

Study III was a quasi-experimental clinical trial and included 95 persons, 65+, who had applied for municipality-based home help with bathing. For participants in the intervention group, occupational therapists implemented occupation-focused and occupation-based interventions. No occupational therapy intervention was implemented for those in the control group, but they were allocated home help services if judged to need it based on an assessment by a municipality care manager. Evaluations of ADL ability, self-rated health and allocated home help were implemented at baseline and after 15 weeks.

Study IV involved the use of decision-modeling based on a five state Markov model that included levels of dependency in ADLs, place of residency and death. Probabilities for transitions between states in the model, QoL scores and societal costs for each state were derived from previous research. Overall, the model was based on research indicating that more severe levels of dependency reduced QALY scores and increased societal costs. Previous trials have provided evidence that an occupation-focused and occupation-based intervention implemented to reduce bathing disabilities increased the probability of independence of home help. The Markov model was used to evaluate cost-effectiveness over 8 years for an intervention compared to no intervention.

Results

The results of study I indicated that each intervention had a small positive effect on minimizing a decline in leisure engagement and/or ADL, but no intervention was clearly superior. In study II, the results indicated that the interventions delivered in a group format positively affected self-rated health. The discussion group was the most cost-effective intervention. The results of study III indicated that the intervention had no effect on ADL ability or self-rated health. There was, however, a large difference in the allocation of home help at follow up, indicating that the intervention was effective in reducing dependency on home help for bathing. The results of study IV indicated that compared to no intervention, the intervention resulted in a positive accumulation of QALYs and lower costs for every year during the entire 8 year period.

Conclusion

This thesis provides evidence to support the implementation of occupation-focused and occupation-based interventions for independent-living, community-dwelling older people in order to reduce their decline in occupational engagement and improve their self-rated health; the interventions also have the potential to be cost effective. This thesis also provides evidence that an occupation-focused and occupation-based intervention implemented for older people with bathing disabilities was effective in promoting independence from home help for bathing. Finally, an occupation-focused and occupation-based intervention that increased the probability of being independent of home help for bathing had a positive impact on the long term accumulation of QALYs and reduced societal costs and, therefore, can be considered very cost effective.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2015. p. 99
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1699
Keywords
Activities of daily living, Bathing disabilities, Cost effectiveness, Effect size, Health promotion, Occupational therapy, Leisure engagement, Reablement, Self-rated health, Successful aging, QALY
National Category
Occupational Therapy
Identifiers
urn:nbn:se:umu:diva-100064 (URN)978-91-7601-218-5 (ISBN)
Public defence
2015-03-23, Aulan, Vårdvetarhuset, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-02-25 Created: 2015-02-20 Last updated: 2018-06-07Bibliographically approved
Zingmark, M., Fisher, A. G., Rocklöv, J. & Nilsson, I. (2014). Occupation-focused interventions for well older people: an exploratory randomized controlled trial. Scandinavian Journal of Occupational Therapy, 21(6), 447-457
Open this publication in new window or tab >>Occupation-focused interventions for well older people: an exploratory randomized controlled trial
2014 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 21, no 6, p. 447-457Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this exploratory randomised controlled trial (RCT) was to evaluate three different occupation-focused interventions for well older people by estimating effect sizes for leisure engagement and ability in activities of daily living (ADL) and thereby identifying the most effective interventions.

Methods: One hundred and seventy seven persons, 77-82 years old, living alone and without home help, were randomized to a control group (CG), an individual intervention (IG), an activity group (AG), and a one-meeting discussion group (DG). All interventions focused on occupational engagement and how persons can cope with age-related activity restrictions in order to enhance occupational engagement. Data were collected by blinded research assistants at baseline, three, and 12 months. Ordinal outcome data were converted, using Rasch measurement methods, to linear measures of leisure engagement and ADL ability. Standardized between-group effect sizes, Cohen's d, were calculated.

Results: While all groups showed a decline in leisure engagement and ADL over time, the IG and the DG were somewhat effective in minimizing the decline at both three and 12 months. However, the effect sizes were small.

Conclusions: The findings indicate that occupation-focused interventions intended to minimize a decline in leisure engagement and ADL were sufficiently promising to warrant their further research.

Place, publisher, year, edition, pages
Informa Healthcare, 2014
Keywords
leisure engagement, healthy ageing, health promotion, effect size, ADL
National Category
Occupational Therapy
Identifiers
urn:nbn:se:umu:diva-91941 (URN)10.3109/11038128.2014.927919 (DOI)000344362000006 ()25022428 (PubMedID)
Available from: 2014-08-18 Created: 2014-08-18 Last updated: 2018-06-07Bibliographically approved
Zingmark, M. & Bernspång, B. (2011). Meeting the needs of elderly with bathing disability. Australian Occupational Therapy Journal, 58(3), 164-71
Open this publication in new window or tab >>Meeting the needs of elderly with bathing disability
2011 (English)In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 58, no 3, p. 164-71Article in journal (Refereed) Published
Abstract [en]

BACKGROUND/AIMS: Difficulties with bathing are frequent among older people and are associated with an increasing need for societal support. As loss of independence has a negative impact on health and wellbeing, it is important to study interventions that can provide the required support for people to be able to remain independent. Occupational therapy interventions can improve clients' abilities enabling them to bathe themselves, thus reducing the need for other, more long-term societal support from, e.g. a home help. In this study, two groups of elderly people with difficulties in bathing were compared; the clients in the intervention group were engaged in occupational therapy.

METHODS: A quasi-experimental non-equivalent control group design was used, in which participants with reported difficulties in bathing were recruited consecutively from two municipalities. The clients in the intervention group routinely received occupational therapy, whereas clients in the control group received assistance from a home help for bathing. Activities of daily living, quality of life and home-help allocation were assessed at the baseline and after 15 weeks.

RESULTS: Clients in the intervention group received less than three home visits on average, with majority of interventions consisting of graded activity and the use of an encouraging approach. Seventy per cent of the interventions were adaptive. Activities of daily living and quality of life of both groups improved, but the differences of being allocated a home help were significant.

CONCLUSION: Occupational therapy interventions seem beneficial in terms of supporting older people in becoming independent of home help in bathing but the results must be interpreted with caution as there were differences at baseline between the groups.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2011
Keywords
activities of daily living, bathing, home care, quality of life
National Category
Occupational Therapy
Identifiers
urn:nbn:se:umu:diva-81614 (URN)10.1111/j.1440-1630.2010.00904.x (DOI)21599681 (PubMedID)
Available from: 2013-10-18 Created: 2013-10-18 Last updated: 2018-06-08Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1087-8656

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