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Aims and Objectives: This study aimed to explore stroke rehabilitation staff's experiences, challenges and adaptations in their work during the first two waves of the COVID-19 pandemic in Sweden.

Methods: A web survey was conducted from September to December 2020 with staff involved in stroke rehabilitation. It covered participant characteristics, experiences, COVID-19 management, patient safety, organisation, information allocation and information and communication technologies (ICT). Quantitative data was presented with descriptive statistics. Free-text responses were used to illuminate the findings.

Results: Three hundred and forty stroke rehabilitation staff answered the survey. No stroke rehabilitation organisation was closed entirely, but services had been paused or altered in several regions. Adaptations included prioritising patients with COVID-19 and thereby reducing the capacity to supply rehabilitation for stroke survivors. The participants experienced a shortage of personal protective equipment (PPE) and patient safety had been compromised. The pandemic restricted opportunities to provide ordinary rehabilitation, often resulting in ethical dilemmas and stress. The rapid transition to using ICT was primarily experienced positively.

Conclusions: Staff reported working under complex, constantly changing and stressful conditions during the first two waves of the COVID-19 pandemic. Disruptions in ordinary practice led to compromised patient safety and increased stress among staff, intensified by limited access to PPE. Ethical guidelines, as well as regular debriefing protocols, should be put in place to prevent adverse health outcomes among staff and to prepare healthcare systems for future crises and disruptions. ICT offers a potential pathway for more flexible and accessible care in the future.

Background: The main aim of this study is to investigate the connection between a high workload and health-related quality of life among in-home care workers in northern Sweden during the COVID-19 pandemic. We also investigate whether social support and control at work can prevent poor health due to high workload.

Methods: A cross-sectional survey was conducted during the pandemic, with 629 (response rate 33 per cent) of an estimated 1,900 in-home care workers responding. Results were compared with a nearly identical survey conducted prior to the pandemic in which 1,154 (response rate 58 per cent) of an estimated 2000 in-home care workers responded. Psychosocial factors were measured using QPSNordic and health-related quality of life using EuroQol 5 Dimensions (EQ-5D). EQ-5D responses were translated into quality-adjusted life year (QALY) scores. Propensity scores were used with absolute risk differences.

Results: During the pandemic, staff with high workload had a statistically significantly (6.2%) lower QALY score (confidence interval 2.2%–10.3%) compared to staff with a normal workload. This was also the case for the usual activities and the anxiety/depression dimensions of EQ-5D. These risk differences were greater, but not statistically significant, during the pandemic than before. The combination of a normal workload and a high degree of control over one’s work appeared to protect against a low QALY score, while social support at work did not seem to be protective.

Conclusions: High workload is related to poorer health-related quality of life. This is mainly attributable to anxiety/depression. In-home care organisations need to manage workload better to prevent poor health among staff during strained situations such as a pandemic. The results of our study indicate that in-home care organisations should increase their readiness to promote opportunities for staff to maintain a high degree of control over their work, in order to counteract variations in workload that ultimately appear to have a negative impact on HRQoL.

Access to outdoor leisure activities is central to supporting active and healthy ageing. To address the lack of research on services supporting continued engagement, this study examines how public, voluntary and private sectors provide outdoor recreation services for older adults. This study uses a qualitative research design to draw on interviews, a workshop, and field observations conducted in a Swedish municipality. Grounded in the capability approach and theories of active ageing, the study contributes to a better understanding of how opportunities for participation in outdoor recreation are shaped by service provision and structural conditions. This study identifies positive examples of outdoor recreation services but also gaps, characterised by the level of challenge in the activities that stakeholders in different sectors provide. Whereas activities provided by public senior centres were conducted in accessible terrain and inclusive for people with functional limitations, opportunities for slightly more challenging activities were lacking. Activities provided by voluntary organisations offered opportunities for more challenge, with the risk of exclusion for those with mobility limitations. The private sector, despite interest, did not actively provide outdoor recreation for older adults due to demand uncertainties. A structural barrier across all sectors was limited access to transport. This study contributes to the literature by identifying the need for tiered outdoor recreation programs, improved transport solutions, and cross-sector collaboration. While situated in a Swedish context, the findings offer conceptual and practical relevance for broader efforts to provide diversity in outdoor recreation services that support active ageing for different groups. A more coordinated, inclusive approach through policy and resource allocation across sectors is essential to support outdoor engagement in ageing populations.

BACKGROUND: Research is limited on registered healthcare professionals (RHCP) usage of research and evidence-based practice (EBP) in Swedish municipal primary healthcare work.

AIM/OBJECTIVES: The aim of this study was to increase the understanding of experiences, attitudes, and conditions of usage of research and implementation of EBP among RHCPs in a Swedish municipality setting. Further, the study aimed to explore whether those attitudes and conditions were associated with RHCP basing their work on research.

MATERIAL AND METHODS: The study was a mixed- methods study of a convergent design with five dialogue meetings and a web-based survey. Participants were RHCP recruited from one large size municipality.

FINDINGS: Registered healthcare professionals struggled between personal and organisational conditions to use research and work according to EBP. They were torn between personal ambitions and lack of skills to use research, whereas having an advanced level education was significantly associated with basing work on research. Lack of organisational resources and support made usage of research and implementation of EBP difficult.

CONCLUSION: There is a need to strengthen the RHCP competence in using research evidence in clinical practice. Managemental support, education and clinical goals could improve the conditions for usage of research and implementation of EBP.

OBJECTIVE: To highlight experiences from a personal data incident, which occurred during recruitment for a project focused on how housing choices and relocation are related to active and healthy ageing.

RESULTS: Based on established collaboration, the researchers and representatives of housing companies planned for recruitment. Invitations to participate was distributed to persons registered with an interest in relocation. The invitation letter included information according to ethical requirements and a link to an online survey. Within a few days, the housing company was contacted by a person who had received the invitation stating that the company had not secured individual consent to the disclosure of personal data to the researchers. The company and the researchers initiated a range of immediate actions to manage the situation, including a plan for how to respond to persons who wanted their person data to be deleted, how to handle already collected data, and for the continued implementation of the recruitment process. We acknowledge that despite established collaboration based on long term commitment from all parties involved, ethical issues require constant attention. Whereas our case represents a hard-learned lesson on a sensitive ethical issue, the well-established collaboration was of paramount importance for how the situation was handled.

Background: To reduce the risk of falls, tailored interventions including exercise that simultaneously challenges cognition (motor–cognitive) are recommended. However, considerable variation in motor–cognitive approaches exist, and its use in clinical practice is less widespread. This study aimed to explore older peoples’ and physiotherapists’ perspectives on motor–cognitive exercise and their suggestions for programme development during co-creation.

Method: Community-dwelling women (n = 8) and men (n = 9), aged (mean ± SD) 74 ± 5.6 years, and 4 physiotherapists working in geriatric rehabilitation were included. Data were collected through nine workshops. The discussions were audio-recorded and analysed employing a qualitative content analysis approach. This study aligns with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Results: The analysis resulted in four themes and nine categories. The themes were: discovering the motor–cognitive concept through engagement in activity, balancing safety and challenge, navigating the complexity of individualisation, and managing motivation and compliance. The context was initially difficult to grasp. Performing practical activities led to understanding, and motor–cognitive exercises were experienced as enjoyable yet challenging to perform. Balancing safety while providing exercises that were challenging enough to make the programme effective was perceived as challenging by both older participants and physiotherapists. Regular individual follow-up during the exercise programme was considered important for promoting progression and compliance. Leader-led, group-based exercises later incorporated into daily life routines were suggested to support motivation and promote safety.

Conclusion: Incorporating motor–cognitive exercise in fall prevention exercises programmes for older people at risk of falls, may enhance enjoyment and motivation but requires consideration for safe and effective delivery. The co-creative design in this context is rare and the results may be useful for further research and for the development of fall prevention interventions.

Background: Falls among older adults are a significant public health issue due to their high incidence, severe consequences, and substantial economic impact. Exercise programs incorporating balance and functional exercises have been shown to reduce fall rates, but adherence and scaling up the interventions remain challenges. Digital technology offers a promising avenue to deliver this type of exercise, potentially improving exercise adherence and enabling self-management of exercise in the aging population.

Objective: This study aims to assess the effectiveness of the Safe Step app, a self-managed, unsupervised, home-based digital exercise program, in reducing fall rates or fall risk in community-dwelling older adults. Additional aims were to describe fall-related injuries in both the exercise and control groups, study attrition, and adherence to the Safe Step exercise program.

Methods: Community-dwelling individuals, aged 70 years or older, who had experienced falls or a decline in balance in the past year were randomized to either an exercise group using the Safe Step app combined with educational videos, or a control group receiving educational videos alone. Both interventions lasted for 1 year. Information regarding fall events was self-reported monthly through questionnaires. Exercise adherence was monitored through questionnaires every third month. Negative binomial and logistic regression estimated the incidence rate ratio of fall rate and the risk ratio (RR) of experiencing falls, respectively. Fall-related injuries, study attrition, and exercise adherence were reported descriptively. Results: In total, 1628 people were enrolled in the study, 79% were women, and the mean age was 75.8 (SD 4.4) years (range 70-94 years). The intention-to-treat analysis showed no significant difference in fall rates between the exercise and control groups after 12 months (2.21 falls per person-year in the exercise group and 2.41 in the control group; incidence rate ratio 0.92, 95% CI 0.76-1.11; P=.37). The risk of experiencing at least 1 fall was significantly lower (11%) in the exercise group compared to the control group (53% vs 59.6%; RR 0.89, 95% CI 0.80-0.99; P=.03). No differences were observed regarding the risk of 2 or more falls (34.1% in the exercise group, 37.1% in the control group; RR 0.92, 95% CI 0.79-1.06; P=.23). Injurious fall rates were similar between the exercise and control group. During the trial, 161 (20%) participants from the exercise group and 63 (8%) from the control group formally withdrew. The proportion of exercise group participants meeting the 90-minute weekly exercise goal was 12.7%, 13.4%, 8.6%, and 9.1% at 3, 6, 9, and 12 months, respectively.

Conclusions: Access to a self-managed unsupervised digital exercise program can be an effective component of a primary fall prevention strategy for community-dwelling older adults. Further research is needed to explore the mediating factors that influence the outcomes and develop strategies that enhance adherence for optimal impact in this population.

OBJECTIVES: Most patients with chronic pain are identified and managed in primary care (PC). Chronic pain management is challenging, which is manifested by increased healthcare utilization (HCU) in this patient group. The interdisciplinary pain rehabilitation program (IPRP) is the gold standard treatment for patients with chronic pain but is scarcely used in PC. The aim of this study was to evaluate the HCU of patients with chronic pain in PC 1 year before and 1 year after an IPRP by examining the distribution of costs and resources.

METHODS: This retrospective cohort study combined data from a national pain registry and HCU data from regional administrative registries, including 146 patients who participated in an IPRP in PC. The outcome measure was the number of outpatient healthcare contacts. Costs and the distribution of resources were compared across the two measurement intervals using paired t-tests. HCU costs were described from a healthcare provider perspective.

RESULTS: HCU decreased by 16% in the year following IPRP compared to the year before. Costs for outpatient visits dropped by 12% or €434 per participant. Visits to physiotherapists and general practitioners decreased the most, by 31% (p = 0.048) and 23% (p < 0.001) respectively. Visits to nurses, occupational therapists, and psychologists/social workers in turn increased marginally (6%, 5% vs 10%).

CONCLUSIONS: IPRP in PC may lead to reduced HCU, freed resources, and streamlined chronic pain management. The study offers valuable insights into expected changes in HCU for chronic pain patients after an IPRP and how these changes may impact daily activities at the PC center.

Background: The in‑home work environment is the main work environment for home care workers, but it has only been sparsely studied. Our aim was to investigate the in‑home work environment for home care workers by exploring challenges that arise regardless of a pandemic and by investigating Covid‑19–specific challenges.

Methods: Two cross‑sectional studies were conducted, one before (2017) and one during the pandemic (2021/2022) in three Swedish regions (Jämtland/Härjedalen, Västerbotten and Västernorrland), in which 1,154 (58%) out of 2,000 and 629 (33%) of 1,900 invited home care workers participated, respectively. Participants responded to a question‑naire asking about 10 problems associated with the in‑home work environment as well as Covid‑19–related chal‑lenges. Comparisons were conducted between regions and between study years using univariable analyses.

Results: Daily problems with the in‑home work environment were common before the pandemic, and they increased statistically significantly during the pandemic for, among other things, non‑ergonomic beds (29% vs. 37%), impractical bathrooms (40% vs. 50%), indoor smoking (24% vs. 31%), and pets (19% vs. 25%). There were major con‑cerns about the risk of getting infected with Covid‑19 for both staff (42%) and the home care recipients (50%). There were statistically significant differences between regions, e.g. many problems were more common in the Västerbotten region than in the other two regions during the pandemic, while challenges with protective equipment was most common in the Västernorrland region.

Conclusions: In‑home work environment problems are common for home care workers and worsen in a more strained situation. Efforts are needed to strengthen the work environment for home care workers.

The objectives of this study were to explore active aging among people listed with an interest in relocation, and the relationships between active aging and aspects of perceived home. Using cross-sectional data from the 2022 RELOC-AGE project (N = 1,509, mean age = 70 years), linear regression analysis was conducted. Women and individuals with higher self-rated health and education reported higher levels of active aging. After adjusting for confounders, Housing Satisfaction (decrease in Housing satisfaction led to lower active aging scores (beta = -17.8, 95% CI [-28.6, -7.0] for neither satisfied nor dissatisfied), and Meaning of home relationship (beta = 4.6, 95% CI [3.4, 5.8]), was positively associated with active aging, "Housing-Related Control Beliefs" showed a significant negative relationship (beta = -14.6, 95% CI [-17.1, -12.1]). These findings are significant for promoting health and well-being among older adults. They add knowledge about home as a key factor for active aging and could be valuable for policymakers, housing authorities, and healthcare and social services staff involved in aging and housing issues.