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  • 1.
    Ahlström, Stina
    et al.
    Rehabilitation Unit, Luleå Primary Health Care, Luleå, Sweden.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Occupational  performance of persons who have suffered a stroke: a follow-up study2003In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 10, no 2, p. 88-94Article in journal (Refereed)
    Abstract [en]

    The main purpose of this study was to describe the progress made in terms of occupational performance during a two-year period by persons who had suffered a stroke and had been discharged to their home after their initial hospital stay. The population of the study consisted of 49 persons, 30 men and 19 women, with a mean age of 69 years. The Assessment of Motor and Process Skills (AMPS) was used to assess their occupational performance. Of the whole population at discharge, 66% showed increased effort and 29% showed decreased efficiency and independency. The results also showed that the persons who had decreased the most in their efficiency dropped out from the study. Twenty-nine persons participated in the study for 2 years. The best ADL ability was seen in the population at 3 months after discharge. A decrease was seen at 18 months after discharge in AMPS ADL process ability and at 24 months in AMPS ADL motor ability. The results suggest that persons who have suffered a stroke and live in their homes maintain their AMPS ADL ability performance for 1.5 to 2 years. A low AMPS ADL process ability measure in persons who have suffered a stroke signifies a reduced possibility of living at home.

  • 2.
    Asplund, Kjell
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    [Perceptual impairment].1989In: Nordisk Medicin, ISSN 0029-1420, Vol. 104, no 11, p. 276-7, 304Article in journal (Other academic)
    Abstract [sv]

    After a brain injury, whether traumatic or caused by a stroke, perceptual impairments are common. They are, however, only seldom revealed by a routine physical examination. In this article, the many manifestations of perceptual impairment and tests for perceptual function are briefly presented. It appears that perceptual deficits contribute largely to reduced self-care ability in patients with brain lesions. An effective training program for perceptual deficits remains to be developed.

  • 3.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Consequences of stroke: aspects of impairments, disabilities and life satisfaction : with special emphasis on perception and on occupational therapy1987Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Perceptual and motor functions and self-care ability after stroke were assessed within two weeks (n:109; mean age 69±10) and 4-6 years (n:75;70±9) after admission to a non-intensive care stroke unit. Sixty-two of the long-term stroke survivors reported on their life satisfaction (7 items) as experienced (in retrospect) before the stroke and at the time of the investigation. Perceptual functions and actual levels of life satisfaction were registered in 60 clinically healthy subjects aged about 60 or about 80 years.

    Both early on and late after stroke the 16 items of perceptual function were clearly grouped into two factors, which neatly fitted an ecological perceptual concept. One factor characterized low-order and the other higher-order perception. Impairments of low-order perception occurred for about 10% of the patients, whether investigated early or late after stroke. No one among the reference populations had such impairments. Higher-order perceptual impairments prevailed in 60% early on and in 57% late after stroke and were often more pronounced than those occurring in the reference populations, among whom 35% of the 60 year olds and significantly more - 77% - of the 80 year olds had such impairments. Hence, perceptual impairments are common after stroke, but slight age-dependent reductions should be considered when higher-order perceptual function is assessed and treated after stroke.

    Together with motor function, which was impaired in 52% of the early and 36% of the late stroke samples, higher-order perceptual function and to a limited extent low-order perception could predict the level of self-care ability in 70% and 62% of the early and late samples, respectively.

    Whereas levels of global and of domain specific variables of life satisfaction were similar in the two reference populations, the stroke had lead to a reduction in life satisfaction for 61% of the long-term survivors. Reductions were particularly pronounced for global life satisfaction and for satisfaction with leisure and sexuality. Although significantly associated with motor impairment and self-care disability, these reductions could not be attributed only to impairments and disability.

    The findings are discussed with particular reference to assessment and treatment in occupational therapy.

  • 4.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Editorial2007In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 14, no 4, p. 203-204Article in journal (Refereed)
  • 5.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Editorial. A more global arena for occupational therapy science.2009In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 16, no 2, p. 67-67Article in journal (Refereed)
  • 6.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    International occupational therapy journal.2010In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 17, no 2, p. 99-100Article in journal (Refereed)
  • 7.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Rater calibration stability for the assessment of motor and process skills1999In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 6, no 3, p. 101-109Article in journal (Refereed)
  • 8.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Scandinavian journal of occupational therapy2011In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 18, no 2, p. 83-84Article in journal (Refereed)
  • 9.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    The publications are covering fields of great interest to our researchers and research students, as well as all clinicians2013In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 20, no 1, p. 1-1Article in journal (Refereed)
  • 10.
    Bernspång, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Fugl-Meyer, Axel R.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Motor and perceptual impairments in acute stroke patients: effects on self-care ability1987In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 18, no 6, p. 1081-1086Article in journal (Refereed)
    Abstract [en]

    The relative importance of motor, perceptual, and some cognitive functions for self-care ability was analyzed in a representative sample of 109 subjects within 2 weeks of acute stroke. Forty-nine patients (45%) were dependent or partly dependent in self-care. Profound motor dysfunction was present in 39%, low-order perceptual deficits in 10%, high-order perceptual deficits in 60%, and disorientation in time and space in 13% of the patients. There was a significant covariation between motor function and self-care ability and between low-order perception and orientation function. Low-order and high-order perception covaried only weakly. Discriminant analyses showed that the actual level of self-care proficiency could be correctly predicted in 70% of the cases by the 4 indexes of motor function, low-order perception, high-order perception, and orientation. The dominating predictor was motor function, and the next highest was high-order perception. When a program for early training is designed with the aim to alleviate long-term self-care disability after stroke, correct assessment of motor and perceptual functions in the individual stroke patient is essential.

  • 11.
    Bernspång, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fischl, Caroline
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Sawert, Bertil
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Från kulturell nyfikenhet till samarbete2015In: Universitetspedagogiska konferensen 2015: Gränslös kunskap, Umeå: Umeå universitet , 2015, p. 65-Conference paper (Other academic)
  • 12.
    Bernspång, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fisher, Anne G.
    Department of Occupational Therapy, College of Applied Human Sciences, Colorado State University.
    Differences between persons with right or left cerebral vascular accident on the Assessment of Motor and Process Skills1995In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 76, no 12, p. 1144-1151Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Persons with right and left cerebral vascular accident (RCVA and LCVA) differ in terms of discrete impairments, but there is limited information with regard to how such impairments translate into differences in disability. The following hypotheses were tested: (1) persons with stroke have lower instrumental or domestic activities of daily living (IADL) ability than do matched nondisabled controls, (2) persons with RCVA do not differ from persons with LCVA in IADL ability, and (3) persons with RCVA and LCVA differ in specific motor and process skills that affect IADL performance.

    DESIGN: Descriptive comparison.

    SETTING: Subjects were tested in settings where rehabilitation services were received (home or clinic).

    SUBJECTS: 71 persons with RCVA, 76 persons with LCVA, and 83 community-living nondisabled individuals drawn from the Assessment of Motor and Process Skills (AMPS) database, matched for age, gender, and number of tasks performed.

    MAIN OUTCOME MEASURE: AMPS, designed to measure type and severity of impairments manifested in the context of IADL performance. The AMPS was administered to all subjects in accordance with standardized testing procedures.

    RESULTS: The two stroke groups did not differ significantly in IADL ability, but both stroke groups had significantly lower IADL performance than did the nondisabled subjects. On the AMPS motor scale, persons with RCVA demonstrated greater impairment in pacing, transporting, and coordinating two body parts. Persons with LCVA demonstrated greater impairments in calibrating movements. No differences were found between the two groups in AMPS process skills.

    CONCLUSIONS: Persons with RCVA and LCVA have hemisphere-specific differences in motor impairments, but do not differ significantly in IADL ability.

  • 13.
    Bernspång, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fugl-Meyer, Axel R.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Viitanen, Matti
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Perceptual function in the elderly and after stroke1988In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 2, no 2, p. 75-79Article in journal (Refereed)
    Abstract [en]

    Perceptual function was assessed in 60 clinically healthy subjects aged about 60 (n=34) and 80 (n=26), and in stroke survivors who were assessed either early (n=109) or four to six years (n=75) after the stroke. Using two indices, one characterising low-order perception and the other higher-order perception, the clinically healthy subjects invariably had no impairment in the low-order index. Slight impairments occurred in 35% of 60-year-old and 77% of 80-year-old healthy subjects. Considerably more pronounced disturbances occurred in the stroke victims, among whom about 60% had impairment or higher-order perceptual function and about 10% had low-order perceptual deficits. Thus as higher-order perception is age dependent, it appears that in rehabilitation of stroke allowance should be made for predictable signs of advancing age.

  • 14.
    Bernspång, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Nilsson, Ingeborg
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Aktivitetsengagemang under åldrandet2012In: Det goda åldrandet / [ed] Astrid Norberg, Berit Lundman, Regina Santamäki Fischer, Lund: Studentlitteratur AB, 2012, 1, p. 217-236Chapter in book (Other academic)
  • 15. Eriksson, G.
    et al.
    Hellman, T.
    Nilsson, A. O.
    Johansson, U.
    Ekbladh, E.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    The return to work process after stroke changes over time while participating in a newly designed person-centred rehabilitation programme2018In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 13, p. 31-31Article in journal (Other academic)
  • 16.
    Hemmingsson, Helena
    et al.
    Karolinska institutet, Stockholm, Sweden.
    Kottorp, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Validity of the School Setting Interview: An assessment of the student-environment fit2004In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 11, no 4, p. 171-178Article in journal (Refereed)
    Abstract [en]

    The School Setting Interview (SSI) is an internationally used client-centred interview assessment that specifically investigates the student–environment fit for students with physical disabilities. In this study the Rasch measurement model was used to examine validity of the SSI; specifically, whether or not the SSI measures a unidimensional construct. Data for analysis included SSI assessments of 87 Swedish students with physical disabilities aged between 8 and 19 years of age. The results of the Rasch analysis revealed that all items had acceptable infit MnSq and z values supporting evidence of construct validity of the SSI. The established order of the difficulty of the items was also shown to be in acceptable congruence with the theoretical basis for item development. In addition, the analysis revealed aspects of the SSI that need improvements, such as the need for more challenging items and refinements of the manual. Further investigations of validity in different cultural contexts are recommended.

  • 17. Hermansson, Liselotte M
    et al.
    Fisher, Anne G.
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Occupational Therapy.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Occupational Therapy.
    Eliasson, Ann-Christin
    Assessment of capacity for myoelectric control: A new Rasch-built measure of prosthetic hand control2005In: Journal of Rehabilitation Medicine, ISSN 1650-1977, Vol. 37, no 3, p. 166-71Article in journal (Refereed)
  • 18.
    Johansson, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Life satisfaction related to work re-entry after brain injury: A longitudinal study2003In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 17, no 11, p. 991-1002Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study was to assess the subjective life satisfaction after brain injury and its relation to work re-entry. METHOD: The research design was a longitudinal study. Thirty-six individuals answered a questionnaire at 3 and 6 years after admittance to a rehabilitation programme. The questionnaire addressed work status, job satisfaction, subjective symptoms of illness and life satisfaction. RESULTS: The reported life satisfaction both for life as a whole and for different domains of life was low. No significant difference between follow-ups was found for satisfaction with life as a whole. For the domain IADL activities, the subjects reported a statistically significant lower satisfaction at the second follow-up than at the first. No correlation between work status and subjective satisfaction with life as a whole was found in this population. At the second follow-up, significantly more people were satisfied with IADL in the group that had returned to work. CONCLUSIONS: The results from this study indicate that brain injury has a lasting effect on a person's life also many years after onset. The decreasing satisfaction with the ability to perform IADL-activities in along-term perspective should give implications for clinical practice. More research in this area is needed.

  • 19.
    Johansson, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Predicting return to work after brain injury using occupational therapy assessments2001In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 23, no 11, p. 474-480Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to evaluate the value of occupational therapy assessments used in an outreach rehabilitation programme to predict return to work after brain injury. The assessments represent the ICIDH-2 levels of body function and activity. Method: Fifty-six persons in a late phase after brain injury who had been admitted to the rehabilitation programme during 2 years were followed up according to work status. The follow up was made at a minimum of 2 years after injury. Demographic data and scores from the occupational therapy assessments were compared for the two groups who were back to work or studies (BTW) and not back to work or studies (NBTW). Results: Assessments of memory, visual perception and apraxia separated between the two groups BTW and NBTW. Logistic regression showed that memory score in combination with data on PADL made up the best predictive model. In a subgroup with 21 persons where data on IADL were added to memory and PADL the predictive value was even stronger. Conclusions: In this study we found that occupational therapy assessments were valuable in predicting failure to return to work or studies after brain injury.

  • 20.
    Johansson, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Högberg, Hans
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Participation in everyday occupations in a late phase of recovery after brain injury.2007In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 14, no 2, p. 116-125Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe to what extent individuals of working age, in a late phase after an acquired brain injury, participate in everyday occupations related to home maintenance, work, and leisure. The aim was also to evaluate if participation in different occupations influences their life satisfaction. A sample of 157 people consecutively admitted to a rehabilitation clinic between June 1995 and December 2000 answered a mailed questionnaire. The subjects who were of working age had had a brain injury on average 6 years before this study. The perceived participation was reported using the Reintegration to Normal Living Index (RNL) and life satisfaction according to an expanded version of the LiSat 11. This study showed that in this late phase of recovery after brain injury the subjects still experienced many restrictions in participation in everyday occupations. The area with the lowest reported participation was work activity while most comfort with the situation was reported for self-care. The RNL subscales showed a significant connection with satisfaction with life as a whole. Furthermore an interaction was found between the two subscales "Daily living" and "Perception of self". This study showed restrictions in participation in the community even several years after brain injury, which underlines the need for rehabilitation services long after injury.

  • 21.
    Josephsson, Staffan
    et al.
    Karolinska institutet.
    Bäckman, Lars
    Karolinska institutet.
    Borell, Lena
    Karolinska institutet.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Nygård, Louise
    Karolinska institutet.
    Rönnberg, Lisa
    Karolinska Institutet.
    Supporting everyday activities in Dementia: an intervention study1993In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 8, no 5, p. 395-400Article in journal (Refereed)
    Abstract [en]

    The efficacy of an intervention programme designed to support performance in activities of daily living was investigated in four patients with dementia at different levels of severity of impairment. Important features of the programme included that (a) task conditions should be highly supportive, (b) the importance of episodic and semantic memory skills for successful performance should be minimized, (c) an acceptable performance level should be possible to achieve using skills that are relatively well preserved in the disease, and (d) factors related to patients' motivation and habits should be taken into account. Performance gains were evaluated using the Assessment of Motor and Process Skills instrument. Results showed intervention-related gains in three patients. One of these patients maintained performance gains when environmental guidance (eg signs) was withdrawn, whereas the other two required environmental guidance in order to exhibit gains. The overall pattern of results suggests that this form of intervention related to everyday functioning in dementia is worthy of further empirical attention.

  • 22.
    Kottorp, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fisher, Anne G.
    Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado.
    Activities of daily living in persons with intellectual disability: Strengths and limitations in specific motor and process skills2003In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 50, no 4, p. 195-204Article in journal (Refereed)
    Abstract [en]

    As there is a wide range of abilities among clients with intellectual disability, occupational therapists should use assessments of activities of daily living that specify clients’ strengths and limitations to guide and target interventions. The aim of the present study was to examine if activities of daily living performance skills differ between adults with mild and moderate intellectual disability. Three hundred and forty-eight participants with either mild intellectual disability (n = 178) or moderate intellectual disability (n = 170) were assessed using the Assessment of Motor and Process Skills to examine the quality of their activities of daily living skills. The overall activities of daily living motor and activities of daily living process hierarchies of skill item difficulties remained stable between groups. Although participants with moderate intellectual disability had more difficulty overall with activities of daily living motor and activities of daily living process skills, they were able to carry out some of these activities equally as well as participants with mild intellectual disability. The findings are discussed in relation to the planning of specific interventions to improve the ability of clients with intellectual disability to carry out activities of daily living.

  • 23.
    Kottorp, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fisher, Anne G.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Occupational Therapy, Colorado State University. Fort Collins, Colorado.
    Validity of a performance assessment of activities of daily living for people with developmental disabilities2003In: Journal of Intellectual Disability Research, ISSN 0964-2633, E-ISSN 1365-2788, Vol. 47, no 8, p. 597-605Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Since clients with different types of developmental disabilities often experience difficulties in activities of daily living (ADL), it is critical that assessments of ADL are evaluated in order to ensure that one can make valid judgements based on the results of the appraisal. The purpose of the present study was to evaluate the validity of a specific performance assessment instrument, the Assessment of Motor and Process Skills (AMPS), when used by occupational therapists with clients with developmental disabilities. Unlike global ADL assessments, the AMPS is used not only to evaluate the level of ADL dependence, but also to estimate the quality of each specific action performed when a person is performing ADL tasks.

    METHODS: Data were gathered from 1724 participants with different developmental disabilities, including intellectual disability (ID), cerebral palsy and spina bifida. Many-Facet Rasch (MFR) analysis was used to examine person-response validity, and task and item scale validity.

    RESULTS: Goodness-of-fit statistics showed that the tasks and items had acceptable scale validity. The participants had acceptable person-response validity on the ADL motor scale, but had slightly lower than expected levels of person-response validity on the ADL process scale. The results indicate that clients with more severe forms of ID may have a higher proportion of different performance profiles in ADL than is expected by the MFR model of the AMPS. Since the proportion of participants who did not meet the criteria was only 3% lower than expected and in accordance with other studies, the difference may not be clinically meaningful. Otherwise, the results indicated that the AMPS is a valid tool when used with clients with developmental disabilities.

    CONCLUSIONS: Further research is needed to evaluate the use of the AMPS in clinical assessment and intervention planning for this group of clients.

  • 24.
    Kottorp, Anders
    et al.
    Department of Handicaps, University Hospital, Umeå, Sweden .
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fisher, Anne G.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Occupational Therapy, Colorado State University. Fort Collins, Colorado.
    Bryze, Kim A.
    University of Ilinois at Chicago, Hospital and Clinics, Chicago, Illinois, USA.
    IADL Ability Measured with the AMPS: relation to two Classification Systems of Mental Retardation1995In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 2, no 3/4, p. 121-128Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to examine the relationship between the Assessment of Motor and Process Skills (AMPS) and two types of assessment of level of mental retardation. The subjects were 22 adults from the United States and 39 adults from Sweden, all diagnosed with mental retardation. The subjects in each group were divided into three subgroups according to their level of mental retardation. The level of mental retardation was determined according to established criteria used in each country. They were then assessed using the AMPS to evaluate motor and process (organizational and adaptive) skills necessary for competent IADL task performance. The results showed that different methods of determining the level of mental retardation showed patterns similar to motor and process skills. The correlations were strongest between the Swedish method of assessing level of mental retardation and the AMPS. The correlations were stronger between level of mental retardation and process skills in both the Swedish and US groups. The results indicate a relationship between level of mental retardation and IADL ability, despite differences in assessments of level of mental retardation. The study recommends the use of the AMPS as a valid and sensitive instrument of IADL ability in the development of intervention strategies in occupational therapy for persons with mental retardation. Further studies with the AMPS are suggested in order to evaluate IADL skills in this population.

  • 25.
    Kottorp, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Hällgren, Monica
    Disability Services, Lycksele, Sweden.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fisher, Anne G.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Occupational Therapy, Colorado State University, Fort Collins, United States.
    Client-Centred Occupational Therapy for Persons with Mental Retardation: Implementation of an Intervention Programme in Activities of Daily Living Tasks2003In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 10, no 2, p. 51-60Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to implement a single-case design to evaluate the outcomes of a specified occupational therapy intervention programme. The intervention programme was based on a client-centred top-down approach and followed the Occupational Therapy Intervention Process Model. The interventions included both restorative and adaptive strategies to improve performance of the activities of daily living (ADL) tasks the participants defined as relevant and meaningful. Three women with moderate mental retardation living alone in apartments with support from professionals were included in the study. The Assessment of Motor and Process Skills was used to evaluate for changes in ADL motor and ADL process ability. The Assessment of Awareness of Disability was used to evaluate changes in the client’s awareness of disability. The results showed improvements for all participants but patterns of changes were different between the participants and the outcome variables. ADL process ability was the only outcome variable that improved in all participants. The results are discussed in relation to the design used for evaluating intervention efficacy. Future improvements in the process of evaluating occupational therapy interventions are suggested.

  • 26.
    Larsson Lund, Maria
    et al.
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation.
    Fisher, Anne
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation.
    Lexell, Jan
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation.
    Impact on participation and autonomy questionnaire: Internal scale validity of the Swedish version for use in people with spinal cord injury.2007In: Journal of Rehabilitation Medicine, ISSN 1650-1977, Vol. 39, no 2, p. 156-62Article in journal (Refereed)
  • 27.
    Larsson Lund, Maria
    et al.
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation.
    Nordlund, Anders
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation.
    Lexell, Jan
    Perceived participation and problems in participation are determinants of life satisfaction in people with spinal cord injury.2007In: Disability and Rehabilitation, ISSN 0963-8288, Vol. 29, no 18, p. 1417-22Article in journal (Refereed)
  • 28.
    Larsson Lund, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Nordlund, Anders
    Nygård, Louise
    Lexell, Jan
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Perceptions of participation and predictors of perceived problems with participation in persons with spinal cord injury2005In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 37, no 1, p. 3-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe how persons with spinal cord injury perceived their participation in life situations and to determine the relationship between their participation and perceived problems therewith. The purpose was also to evaluate the influence of age, sex, level of injury, time since injury, marital status and access to social support on perceived problems with participation. DESIGN: Cross-sectional. SUBJECTS: One hundred sixty-one persons with spinal cord injury. METHODS: A postal questionnaire including socio-demographic characteristics and a Swedish version of the Impact on Participation and Autonomy questionnaire. RESULTS: A majority of the respondents perceived their participation as sufficient in most activities addressed. Still, a majority of the respondents perceived one or more severe problems with their participation. Access to social support was the most influencing variable in predicting perceived severe problems with participation as compared with certain personal and health-related factors. CONCLUSION: The results suggest that it is important to consider access to social support along with other factors in the person-environment interaction and their influence on severe problems with participation in enhancing clients' participation in rehabilitation.

  • 29.
    Lindström, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Hariz, Gun-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Dealing with real-life challenges: outcome of a home-based occupational therapy intervention for people with severe psychiatric disability2012In: OTJR (Thorofare, N.J.), ISSN 1539-4492, E-ISSN 1938-2383, Vol. 32, no 2, p. 5-13Article in journal (Refereed)
    Abstract [en]

    the authors offered home-based occupational therapy integrated into supported or sheltered housing to help individuals with severe psychiatric disability identify their specific needs of engagement in meaningful occupation. This study aimed to evaluate the client outcomes in activities of daily living (ADL) ability and health factors following their participation in occupation-centered interventions in home and community settings. Seventeen participants (7 women) between the ages of 27 to 66 years, living in sheltered or supported housing participated in the intervention project based on the Everyday Life Rehabilitation (ELR). The following instruments were administered before and after the intervention and at a six-month follow-up: Goal Attainment Scaling, Assessment of Motor and Process Skills, Assessment of Social Interaction, Satisfaction with Daily Occupations, ADL-taxonomy with an effort-scale, and the Symptom Check List-90. Pretest, posttest, and follow-up differences in test scores on goal attainment, occupation, and health-related factors indicate that important progress was made.  These findings support the use of the intervention and suggest that larger randomized clinical trials are needed.

  • 30.
    Nilsson, Ingeborg
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Aktivitetsengagmang under åldrandet2012In: Det goda åldrandet / [ed] Santamäki Fisher, R., Lundman, B., Norberg, A., Lund: Studentlitteratur, 2012, 1, p. 217-232Chapter in book (Other academic)
  • 31.
    Nilsson, Ingeborg
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fisher, Anne G
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Löfgren, Britta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Occupational engagement and life satisfaction in the oldest old: the Umeå 85+ study2007In: OTJR (Thorofare, N.J.), ISSN 1539-4492, E-ISSN 1938-2383, Vol. 27, no 4, p. 131-139Article in journal (Refereed)
    Abstract [en]

    This study was designed to evaluate whether the level of occupational engagement is relatedto life satisfaction among the oldest-old. The study was performed as part of a cross-sectionalstudy of individuals 85 years and older in northern Sweden. The results revealed significantcorrelations between life satisfaction and engagement in both leisure and activities of daily living,and the effect sizes were interpreted as medium. This study adds some support to earlierfindings that a higher level of task performance is related to a higher level of life satisfaction.The results also give some clinical evidence to support a client-centered approach that includesconsideration of leisure tasks a person is motivated to perform.

  • 32.
    Nilsson, Ingeborg
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Löfgren, Britta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fisher, Anne G
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Focus on leisure repertoire in the oldest old: the Umeå 85+ study2006In: Journal of Applied Gerontology, ISSN 0733-4648, E-ISSN 1552-4523, Vol. 25, no 5, p. 391-405Article in journal (Refereed)
    Abstract [en]

    This study elucidates the oldest olds’ leisure repertoire and how this repertoire varies due to gender, where they live, and cognitive status. A validated 20-item leisure interest checklist with four subscales was used to measure leisure participation and investigate the leisure repertoire among participants. The oldest old were most likely to be interested in, perform, be motivated for, and perceive well-being from social activities, cultural activities, and TV/video/movies. The respondents were least likely to be interested in, perform, be motivated for, and perceive well-being from equipment sports and ball games. Some gender, geographic differences, and differences in cognitive status were found. The oldest old were more likely to endorse the same activities across all subscales of the checklist, but the linear magnitude varied across sub-scales. The relationships between performance and the other subscales suggested that a sense of engagement or participation is related to actual performance.

  • 33.
    Nygren, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Processes towards employment among persons with psychiatric disabilities: a study of two individual placement and support programmes in Sweden2016In: Scandinavian Journal of Disability Research, ISSN 1501-7419, E-ISSN 1745-3011, Vol. 18, no 1, p. 32-51Article in journal (Refereed)
    Abstract [en]

    Individual placement and support (IPS) has been found to be an effective intervention for rehabilitation to work in the field of mental health. Being as the principles used in IPS reflect core values in the concept of personal recovery, several other outcomes than just the percentage of clients gaining employment are of interest. The purpose of the study was to describe a number of unique processes and analyze these with a special concern for circumstances perceived as important for the individual IPS process. A collective instrumental case-study design was used and five cases were included. Data from three different sources were collected, both quantitative and qualitative. The findings illustrate how a relationship characterized by curiosity, interest and engagement in the individual client, positive risk-taking and time for reflected experiences resulted in processes of change. It was concluded that providing IPS is a type of specialized relationship-based work that includes advanced problem solving.

  • 34.
    Nygren, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Unique processes towards employment within an IPS-programme: illustrated by five casesManuscript (preprint) (Other academic)
    Abstract [en]

    Individual Placement and Support (IPS) is a well known intervention for rehabilitation to work in the field of psychiatric rehabilitation. The development of high fidelity IPS-programmes is of great importance for getting successful outcomes in terms of the percentage of clients competitively employed. Since the philosophy used in IPS reflects core values in the concept of personal recovery, several other outcomes would also be of interest and importance for improving the quality of IPS. The purpose was to analyse and describe a number of unique processes with special concern to situations, circumstances and events perceived as of importance for the IPS intervention. A collective instrumental case-study was used and five cases were included, three women and two men enrolled in one of two IPS programmes. Data from three different sources were collected, both quantitative and qualitative. For analysing the qualitative data, an approach of directed content analysis was used. The findings illustrate how a relation marked by curiosity, interest and engagement in the individual client, positive risk-taking and time for reflected experiences resulted in unique processes of change. It was concluded that doing IPS is a kind of pronounced relation based work which includes advanced problem solving.

  • 35.
    Nygren, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Svensson, Bengt
    Institutionen för hälsovetenskap.
    Hansson, Lars
    Institutionen för hälsovetenskap.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Predictors of vocational outcomes using individual placement and support for people with mental illnessManuscript (preprint) (Other academic)
    Abstract [en]

    Objective: People with disabilities find it harder to enter the labour market than people without disabilities and those with a mental illness are, in relation to people with other disabilities, employed at an essentially lower extent. Many are effectively helped by the vocational rehabilitation model Individual Placement and Support (IPS), but there are still many individuals left in undesired unemployment. This study investigates potential predictors of the vocational outcomes of a one-year follow up of IPS in the north of Sweden.

    Participants: The participants were 65 men and women, mostly younger than 30 years of age predominantly with a diagnosis of anxiety and/or depression.

    Methods: Baseline data related to sociodemographic and clinical characteristics of the client, the client’ own perceptions of every day living and participation, self-esteem and quality of life, as well as  the quantity of employment support, were investigated using analyses of  logistic regression.

    Results: Of three identified potential predictors, only psychiatric symptoms remained significant in the multivariate logistic regression analyses. A lower level of symptoms increased the odds with 5.5 for gaining employment during one year.

    Conclusions: Careful investigation of how psychiatric symptoms influence clients’ occupational performance is of importance. By understanding essential aspects of the relationships between the clients´ individual characteristics, the rehabilitation context and the vocational outcomes, more appropriate and effective interventions may be offered to the individual client.

  • 36.
    Nygren, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Markström, Urban
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Svensson, Bengt
    Lund Univ, Dept Hlth Sci, Lund, Sweden.
    Hansson, Lars
    Lund Univ, Dept Hlth Sci, Lund, Sweden.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Predictors of vocational outcomes using Individual Placement and Support for people with mental illness2013In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 45, no 1, p. 31-39Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: People with disabilities find it harder to enter the labour market than people without disabilities and those with a mental illness are, in relation to people with other disabilities, employed at an essentially lower extent. Many are effectively helped by the vocational rehabilitation model Individual Placement and Support (IPS), but there are still many individuals left in undesired unemployment. This study investigates potential predictors of the vocational outcomes of a one-year follow up of IPS in the north of Sweden. PARTICIPANTS: The participants were 65 men and women, mostly younger than 30 years of age diagnosed with a mental illness (predominantly with a diagnosis of anxiety and/or depression). METHODS: Baseline data related to sociodemographic and clinical characteristics of the client, the client's own perceptions of every day living and participation, self-esteem and quality of life, as well as the quantity of employment support, were investigated using analyses of logistic regression. RESULTS: Of three identified potential predictors, only psychiatric symptoms remained significant in the multivariate logistic regression analyses. A lower level of symptoms increased the odds with 5.5 for gaining employment during one year. CONCLUSIONS: Careful investigation of how psychiatric symptoms influence clients' occupational performance is of importance. By understanding essential aspects of the relationships between the clients' individual characteristics, the rehabilitation context and the vocational outcomes, more appropriate and effective interventions may be offered to the individual client.

  • 37.
    Nygren, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fisher, Anne G.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Exploring perceptions of occupational competence among participants in Individual Placement and Support (IPS)2013In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 20, no 6, p. 429-437Article in journal (Refereed)
    Abstract [en]

    Objective: The purpose of this study was to explore perceptions of occupational competence and occupational value among a group of clients engaged in Individual Placement and Support (IPS). Methods: The Occupational Self-Assessment (OSA), based on the Model of Human Occupation, was used with 65 men and women with mental illness, and 45 of these completed the study. Results: Rasch analyses showed that the participants perceived "Managing my finances", "Managing my basic needs", and "Doing activities I like" as the most valued occupations. Most competence was perceived in "Taking care of myself". Among the occupations where the participants perceived least competence, "Getting done what I need to do" and "Accomplishing what I set out to do" were the occupations that most stand out. Significant differences were also found between perceived competence and value in most of the occupations. Conclusions: Beyond those occupations valued as most important among the participants, it is essential also to pay attention to those in which they perceived least competence, as they are important for being able to achieve a desired occupation. Support related to perceptions of occupational competence can contribute to enabling clients in IPS to master a desired working life.

  • 38.
    Nygren, Ulla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fisher, Anne G
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Occupational competence among individuals with psychiatric disabilities in rehabilitation to workManuscript (preprint) (Other academic)
    Abstract [en]

    Introduction: Several qualitative studies have described the struggles persons with mental illness face in mastering their occupational challenges when participating in rehabilitation to work. The purpose of this study was to explore the pattern of perceived occupational competence and occupational values among a group of persons with psychiatric disabilities engaged in Individual Placement and Support for rehabilitation to work.

    Method: The instrument Occupational Self Assessment (OSA), based on the Model of Human Occupation, was used with 65 men and women, mostly younger than 30 years of age and with a mental illness. The ordinal raw scores from three evaluations (baseline, 12 months, 24 months) were analysed using Rasch measurement.  

    Findings: In general, it was easier for the participants to value occupational behaviours as important than to perceive them as being well performed. Among the most valued occupational behaviours, Managing my finances, Managing my basic needs and Doing activities I like, we found clinically meaningful significant gaps between competence and value.

    Conclusion: Beyond those occupational behaviours valued as most important among the participants, it is also essential to pay attention to the behaviours they perceived as most difficult to perform well, as they can be important competencies for being able to achieve desired occupation.

  • 39.
    Nygård, L
    et al.
    Karolinska Institutet.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fisher, A G
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Winblad, B
    Karolinska institutet.
    Comparing motor and process ability of persons with suspected dementia in home and clinic settings1994In: American Journal of Occupational Therapy, ISSN 0272-9490, E-ISSN 1943-7676, Vol. 48, no 8, p. 689-96Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Evaluating functional level of persons with diagnosed or suspected dementia is an important part of occupational therapy. The importance of the environment is often highlighted. We investigated the ability of clients with suspected dementia to perform instrumental activities of daily living (IADLs) in the clinic versus in their homes.

    METHOD: We used the Assessment of Motor and Process Skills (AMPS) to measure the motor and process skill ability of 19 clients with suspected dementia.

    RESULTS: Using two-tailed paired t-tests, we found no overall difference in IADL motor or process performance between the clinic and home setting. However, of the 19 clients, 6 had motor ability measures, whereas 5 had process ability measures that differed significantly between the two settings.

    CONCLUSION: The results suggest that if we want to know how a person with suspected dementia performs in IADLs in a specific environment we should test him or her in that environment.

  • 40.
    Nygård, Louise
    et al.
    Karolinska Institutet.
    Amberla, Kaarina
    Karolinska Institutet.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Almqvist, Ove
    Karolinska Institutet.
    Winblad, Bengt
    Karolinska Institutet.
    The Relationship Between Cognition and Daily Activities in Cases of Mild Alzheimer's Disease1998In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 5, no 4, p. 160-166Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate the relationship between cognitive functions, assessed by neuropsychological tests, and instrumental activities of daily living (IADL) ability, assessed by the Assessment of Motor and Process Skills (AMPS) in persons with mild Alzheimer's disease. Fifty-two participants were included in the study. We found significant relationships between the AMPS IADL process ability and Factors 1 (perceptual speed, visuoconstructive ability) and 4 (secondary memory). The AMPS IADL motor ability showed a significant relationship to Factors 1 and 3 (logical memory). The cognitive factors explained 24 26% of the variability in AMPS IADL ability. The results indicate that cognitive functions had a significant impact on IADL ability in this population. However, as 74–76% of the variability in the IADL ability was left unaccounted for by the cognitive functions, it is important to assess both cognitive functions and IADL ability when investigating persons with mild dementia. Further study of the complex interaction between a variety of influencing factors is needed to better understand the consequences of dementia on everyday life functioning.

  • 41.
    Sturesson, Marine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Edlund, Curt
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Falkdal, Annie H.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy. Swedish Association of Local Authorities and Regions, Stockholm, Sweden.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Healthcare encounters and return to work: a qualitative study on sick-listed patients' experiences2014In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 15, no 4, p. 464-475Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sickness absence is a complex phenomenon affected by aspects other than disease. One important factor that can affect sick leave is the individual's experience of healthcare encounters. It is therefore essential to consider the quality of the encounter with health professionals and its impact on the patient's rehabilitation and return to work.

    AIM: The aim was to explore how sick-listed patients in Sweden perceive their contact with healthcare professionals in primary healthcare and to analyse what they view as crucial components for returning to work.

    METHODS: A qualitative approach was used. Data were collected by semi-structured telephonic interviews with patients who were or had been on sick leave. The transcribed interview text was analysed according to qualitative content analysis.

    FINDINGS: The analysis revealed two themes that highlight important areas for persons on sick leave in their healthcare encounters. The theme 'Trust in the relationship' contains categories describing the patients' feelings of participation, and of being believed, confirmed, and listened to, and also dedication on the part of healthcare providers. Healthcare encounters that were characterised by professionalism, knowledge, continuity, and a holistic approach seemed to create trust. The theme 'Structure and balance' contains the participants' views on important factors that could support the return-to-work process. All participants stated the importance of follow-up and a plan for rehabilitation. Sick leave itself can make a person passive, and participants in this study asked for support to balance activity, exercise, and work demands, which could facilitate their return to work.

    CONCLUSION: Healthcare professionals can facilitate sick-listed persons' rehabilitation back to work by providing a clear structure in the process and support in occupational balance. The healthcare encounters must build on a mutual trust.

  • 42.
    Sturesson, Marine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Edlund, Curt
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Falkdal, Annie Hansen
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Work ability as obscure, complex and unique: Views of Swedish occupational therapists and physicians2013In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 45, no 1, p. 117-128Article in journal (Refereed)
    Abstract [en]

    The concept of work ability is not clearly defined although it has a central place in vocational rehabilitation. Several health professions are involved in assessing work ability, physicians and occupational therapists are two of these. OBJECTIVE: The purpose of this study was to explore occupational therapist and physician views about work ability and experiences in assessing work ability. PARTICIPANTS: Fourteen physicians and 23 occupational therapists participated in seven focus group discussions that were audio taped and transcribed verbatim. METHODS: Qualitative content analysis was used. Each author performed an individual preliminary analysis. These analyses were later discussed and refined in the research team and a workshop. The final categorization resulted in one theme, four categories and 13 sub-categories. RESULTS: The overall theme expressed work ability as an obscure, complex and unique concept. The four categories illustrate the affecting factors and confirm the complex structure of work ability: the person, the context of life, the work, and the society. Physicians expressed greater difficulty in assessing work ability than occupational therapists did, because they have fewer instruments to access this concept. CONCLUSIONS: Assessment of work ability requires team cooperation with several different professionals. Cooperation could increase accuracy in issuing sickness certification and strengthens the ability of identifying individual requirements for rehabilitation.

  • 43.
    Sturesson, Marine
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Hörnqvist Bylund, Sonya
    Edlund, Curt
    Hansen Falkdal, Annie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Quality in sickness certificates in a Swedish social security system perspective2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 8, p. 841-847Article in journal (Refereed)
    Abstract [en]

    AIM: In Sweden, the information in the sickness certificate is crucially important for the sick-listed person as well as for the Swedish Social Insurance Agency and the sick-listed person's employer. The certificate is used as the basis for deciding whether a person is entitled to sickness benefits. Further, it communicates information significant for the return-to-work process. The aim of the study was to evaluate the quality of sickness certificates issued in primary health care and examine if the patients' or physicians' gender influences the information in the sickness certificate.

    METHODS: An insurance specialist at the Swedish Social Insurance Agency assessed the quality of the stated information in a sample of 323 certificates issued by 146 different general practitioners at 29 different primary health care centres in northern Sweden.

    RESULTS: Thirty-four percent of the certificates did not contain sufficient information requested. The areas of the certificates in need of supplementary information were mainly the descriptions of impairment of body function and activity limitation. More certificates issued for women than certificates issued for men lacked the required information. Full-time sick leave was more often prescribed for male patients than for female. Significant differences between certificates issued for women and certificates issued for men appeared in the group of musculoskeletal diseases. No differences in quality aspects connected to physicians' gender were found.

    CONCLUSION: Our study indicates a need for increased knowledge about the descriptions of functioning for sick-listed persons; more cooperation between health professionals in primary health care and a better gender awareness in health care encounters.

  • 44.
    Tham, Kerstin
    et al.
    Karolinska Institutet.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fisher, Anne G.
    Department of Occupational Therapy, College of Applied Human Sciences, Colorado State University, Fort Collins, Colorado, USA.
    Development of the Assessment of Awareness of disabilities1999In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 6, no 4, p. 184-190Article in journal (Refereed)
    Abstract [en]

    It is common for clients with stroke to lack awareness of their disabilities, which is an obstacle in the rehabilitation process. The aim of this article is to describe how Rasch measurement methods were used to develop a new Assessment of Awareness of Disability (AAD) and to present a preliminary evaluation of the instrument. Awareness of disability was defined as no discrepancy between the client’s actual disability (measured by the Assessment of Motor and Process Skills, AMPS) and the client’s perceived and verbally described disability in a specific ADL task. AAD consists of an interview guide that includes seven questions (items) that are asked directly after the performance of the AMPS task. The AAD was administered to a target sample of 12 clients with stroke. Four clients were each tested 10 times and 8 clients were each tested once. A Rasch measurement model was used to analyse the AAD data from 48 test sessions. The results indicated that AAD measures a single construct and that it discriminates among clients with different levels of awareness of disability. While the results of this pilot study are promising, the validity and reliability of the AAD need to be further examined on a larger and more varied group of clients.

  • 45.
    Viitanen, Matti
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Fugl-Meyer, K. S.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fugl-Meyer, Axel R
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Life satisfaction in long-term survivors after stroke1988In: Scandinavian Journal of Rehabilitation Medicine, ISSN 0036-5505, E-ISSN 1940-2228, Vol. 20, no 1, p. 17-24Article in journal (Refereed)
    Abstract [en]

    Different aspects of the quality of life before and after stroke were registered for 62 communicable, representative long-term (4-6 years) survivors, who reported the global and domain specific life satisfaction that they experienced (7 items, 6 graded-ordinal scales). Reference subjects were 60 healthy individuals in two age cohorts (60-61 years, n = 34; 79-81 years, n = 26) none of whom had been hospitalized during the last seven years prior to the investigation. The main finding is that, after the stroke, at least one aspect of the quality of life had decreased for 61% of them; this concerned global, sexual and leisure satisfaction mainly. Moreover, persisting motor impairment and ADL-disability had a negative effect on several aspects of life satisfaction. As nearly 30% of the non-impaired and the non-disabled interviewees reported decreased global life satisfaction, these changes indicate that they do not cope psychosocially with the stroke as such nor with its sequelae. In contrast, the levels of life satisfaction were similar for the 60-61 and 79-81 year-old interviewees, clinically healthy respondents, indicating stability in the quality of life that they experienced from late middle age into senectitude. For the patients, social integration estimated normatively did not covariate significantly with post-stroke satisfaction derived from social relationships.

  • 46.
    Zingmark, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy. Community Care Administration, Municipality of Östersund, Östersund.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Meeting the needs of elderly with bathing disability2011In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 58, no 3, p. 164-71Article in journal (Refereed)
    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.

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