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Background: Everyday Life Rehabilitation (ELR) is a recovery-oriented intervention that aims at improving residents’ quality of life through engagement in meaningful everyday activities. The intervention has been demonstrated to be effective in a randomized controlled trial (ClinicalTrials.gov: NCT05056415).

Method: A cost-utility analysis (CUA) was conducted using quality-adjusted life years (QALYs) derived from ReQoL-UI as the primary outcome. Both deterministic and probabilistic sensitivity analysis was used to explore critical assumptions. A budget impact analysis was used to estimate the incremental cost of scaling up ELR in routine practice.

Results: The intervention was found to be cost-effective compared to usual care, with an estimated incremental cost-effectiveness ratio (ICER) of 133 494 SEK (12 148 EUR) per QALY. Sensitivity analysis indicated that the findings were robust. The estimated average budget impact was estimated to be 10 118 SEK (921 EUR) per resident for one year of ELR. Overall, ELR demonstrated significant clinical benefits with minimal incremental costs.

Interpretation: Throughout the analysis, we have used highly conservative estimates. Despite this, the analysis concluded that the intervention has a high probability of being cost-effective. Thus, the study provides robust evidence for the value of ELR as a scalable and economically viable intervention.

Background: Individuals with serious mental illness (SMI) living in supported accommodation often lead lonely and sedentary lives. Everyday Life Rehabilitation (ELR) is a collaborative, person-centred, activity-oriented and recovery-oriented intervention that integrates outreach rehabilitation efforts into routine practices. This intervention aims to enhance personal recovery and quality of life by promoting engagement in meaningful everyday activities within real-life contexts.

Objective: To evaluate the effectiveness of ELR on personal recovery and quality of life among residents with SMI in supported accommodation, compared with treatment-as-usual (TAU).

Methods: This was a pragmatic, parallel-group, cluster-randomised controlled trial (RCT) (NCT05056415) conducted in Sweden between August 2021 and June 2024. The RCT included 60 housing units (clusters) randomly assigned (1:1) to receive either ELR or TAU. Data were collected by independent, blinded assessors, with partial blinding of residents. The primary outcome, Recovering Quality of Life (ReQoL-20), was assessed at the individual level and analysed using a mixed-effects model and an intention-to-treat (ITT) approach by a statistician blinded to the allocation.

Findings: Participants in the intervention group showed significantly greater improvements in ReQoL scores at 6 months compared with the control group (20.1, 95% CI: 15.8 to 24.4), with a statistically significant between-group difference (p<0.001). The ITT analysis included 60 housing units with 161 participants (86 men and 72 women), of whom 90 were allocated to ELR (33 units) and 71 to TAU (27 units). The overall attrition rate was 24% in both groups, and no major adverse events were reported.

Conclusions: These findings indicate that ELR is an effective intervention with a clinically relevant impact on recovering quality of life for individuals with SMI living in supported accommodation. While these results should be interpreted within the context of the Swedish system, they contribute to the growing body of evidence supporting recovery-oriented and activity-oriented interventions in supported accommodation.

Clinical implications: Responsive, person-centred, goal-oriented activity training, grounded in collaborative alliance, represents a valid strategy for recovery-oriented interventions. While multilevel approaches must be tailored to specific contexts, the integration of occupational therapists may provide clinical benefits in supported accommodation.

Trial registration number: NCT05056415.

Rural communities have unique mental health needs and challenges which are often related to the uniqueness of the community itself. On a per-capita basis, the investment in rural mental health research is far less than that in urban communities. Added to this, rural communities are often at risk of researchers, based in large urban universities, visiting, conducting the research with minimal engagement with local stakeholders and limited understanding of the community's social-service-environmental context. Often this research leaves no visible benefit to the community with respect to increased knowledge, resources or community capacity. This commentary is based on the insights of a panel of authors from 9 countries, each with extensive experience of rural mental health research and work. And it seeks to stimulate the discourse on responsible rural mental health practice. The aim of this commentary is to provide a reference on research practice for novice and experienced researchers on rural mental health research and practice, to assist policymakers, government and funding bodies to establish appropriate standards and guidelines for rural mental health research, and support rural communities to advocate for equity of funding and sustainable research as they engage with researchers, funders and governments. The 10 standards in this declaration will help guide researchers toward research that is beneficial to rural communities and also help develop the local community's research capability, which ultimately will serve to enhance the mental health and well-being of rural communities.

Introduction: Swedish healthcare has undergone significant changes since the transferral of home healthcare from a regional to municipal responsibility, and since the new 2018 law regulating discharge from hospital. This meant changes to ways of working for Occupational Therapists (OTs), as OTs play a key role in planning for discharging patients, a crucial process before patients return home, and in the transition between care givers.

Aim: The aim of this study is to illuminate how OTs experience the intra-professional collaboration during the discharge process between inpatient care and home healthcare.

Methods: Interviews were conducted with OTs (N = 12), with even distribution between inpatient care and home healthcare, in three geographical locations in Sweden. Data analysis was performed according to qualitative content analysis.

Results: A central theme ran through all categories; the multi faces of intra-professional communication are challenging, intertwined and emotional. The categories illuminate experiences in terms of important but neglected patient participation and safety, different forms of mind-set depending on setting, complex rapid communication, unpredictable paths of discharge, unclear responsibility and organisational guidelines and, impact on work health and OT emotions.

Conclusion: Intra-professional communication is complex with many aspects and perspectives of importance for collaboration to run smoothly, but also the many individuals involved in the collaboration process of discharging a patient. This situates high demands on the professionals involved to distinguish and identify necessary information to make the discharge sound and safe for patient, as well as for relatives, involved services, and manageable for OTs.

Context and purpose: Persons enduring serious mental illness (SMI) and living in supported housing facilities often receive inadequate care, which can negatively impact their health outcomes. To address these challenges, it is crucial to prioritize interventions that promote personal recovery and address the unique needs of this group. When developing effective, equitable, and relevant interventions, it is essential to consider the experiences of persons with an SMI. By incorporating their perspectives, we can enhance the understanding, and thereby, the design and implementation of activity- and recovery-oriented interventions that promote health, quality of life, and social connectedness in this vulnerable population. Thus, the aim of this study is to explore the stories of participants partaking in Everyday Life Rehabilitation and how they make sense of their engagements in everyday life activities and their recovery processes.

Methods: Applying a narrative analysis, this study explores the stories of seven individuals with an SMI residing in Swedish supported housing facilities, participating in the Everyday Life Rehabilitation (ELR) program during six months, and how they retrospectively make meaning of their engagement in everyday life activities and recovery processes.

Findings: The participants’ stories about their rehabilitation and personal recovery pathways elucidate how the inherent power of the activity, as well as the support the participants received to get started and succeed, had a significant impact on their self-identity, confidence, motivation, mattering, life prospects, and vitality. The participants valued the transparent steps along the process, weekly meetings, the signals, beliefs, and feedback communicated throughout, and the persistent, adaptive, and yet supporting approach in their personal progress.

Significance: This study underscores the need for interventions that prioritize meaningful activities and are sensitive to the complexity of the personal recovery process, especially in supported housing facilities. Future research should further explore effective strategies and mechanisms to promote personal recovery and to reduce the stigma associated with SMI.

In research and among clinicians, the focus has shifted from mainly symptom reduction and increasing functionality to a more recovery-oriented focus. Although there are instruments measuring recovery, there has been a lack of instruments sensitive enough to measure the quality of life for people with severe mental health disorders. Therefore, this study aimed to obtain a Swedish version of the Recovering Quality of Life (ReQoL) questionnaire adhering to best practice guidelines using various steps of translation, linguistic validation, and cognitive debriefing. The cognitive debriefing was conducted with seven participants, and all felt the items in the questionnaire were relevant to their health, apprehensible, and easy to complete. However, some issues were raised regarding wording and the concepts behind certain items. All feedback was considered, and some items were revised in response to criticism after continuous discussions. A Swedish version of ReQoL now exists, and although there is a need for ReQoL in different clinical research settings in Sweden, further research is required to psychometrically test the construct validity as well as reliability of the Swedish version in Sweden.

Background: Young and adult users of electric wheelchairs (EWs) describe how EWs have personal, functional, emotional, and symbolic values and are considered by some to be part of the self.

Aim: The aim of this study was to increase our understanding of how occupational identity is constructed in the daily practices of EW users.

Material and methods: Context-based, in-depth oral stories and filmed sequences of daily practice enactments of persons who have used an EW since childhood were the basis for the narrative analysis.

Findings: The findings elucidate how the informants enact and tell about their identity-development in response to daily and relational practices, and its relevance to the informant's sense of self, belonging, competence, life-prospects, conduct, and awareness of shifting values, and this was likewise demonstrated in different appearances and roles related to social recognition. A model illustrating the findings is proposed.

Conclusions and significance: Contextual values and exploring experiences, such as possibilities to develop competences and roles, along with encountering social recognition, but also hindering regulations and adversities, influence the development of occupational identities. Findings in this study can contribute to increased understanding, conscious political decisions, as well as a more person-centred approach within healthcare.

This paper describes the initial phases of the design and development of the Everyday Life Rehabilitation (ELR) intervention, and it presents preliminary findings on usefulness and implementation aspects derived from an ongoing larger trial exploring the effect, cost-effectiveness, and usefulness of ELR. ELR is a model designed to meet the absence of meaningful activities and challenges with integrated, activity- and recovery-oriented rehabilitation in sheltered and supported housing facilities for persons with extensive psychiatric disabilities. The aim of the present study was to examine early experiences of implementing the ELR model from the perspectives of managers, housing staff, and occupational therapists. The paper will sum up preliminary findings based on process data included in an internal pilot prior to a full-scale pragmatic clustered RCT. Four Swedish municipalities with 19 housing facility units were involved and provided process data for the study. Thematic analysis were applied. The informants perceived the methodology to be well suited to the target group and context and to contribute to positive changes in participants' lives. The web-based training was also experienced as relevant and easily accessible to staff, as well as elements of collegial learning and feedback. However, they reported that their municipalities lacked basic conditions for making the whole concept work in such a short time. The ELR is overall perceived as useful, but experiences also make complex difficulties visible regarding integrated, coordinated rehabilitation and organizational readiness. Based on findings, a recommendation on basic prerequisites will be added to the ELR guidance for leadership and management. Clinical trial registration: [ClinicalTrials.gov, 24 September 2021], identifier [NCT05056415].

Background: People with severe psychiatric disabilities and impaired autonomy, living in sheltered or supported housing facilities, often lead sedentary, solitary lives indoors and have significantly poorer health than others in the population. Meaningful everyday activities are important for the recovery towards an enrichening, agentic, social, and hopeful everyday life. The Everyday Life Rehabilitation (ELR) model—a person-centred activity- and recovery-oriented intervention—has shown positive outcomes in feasibility studies, and thus a randomised controlled trial (RCT) is required to establish the effectiveness of ELR, along with calculations of cost-effectiveness.

Methods: The ELR-RCT is a pragmatic, two-parallel-armed cluster RCT evaluating the effect and cost-effectiveness of using ELR from two measurement points over 6 months (pre-post intervention) and in three waves over 3 years. The primary outcome is recovering quality of life (ReQoL) at 6 months, and the secondary outcome is self-perceived recovery and daily functioning (RAS-DS) at 6 months. Additionally, Goal Attainment Scaling (GAS) will be used for the intervention group. Power analysis has been conducted for primary outcome measure. The first wave will include an internal pilot, to be evaluated after 6 months, used as basis for decisions on updating the required sample size and any other need for adaptations before continuing with the full-scale RCT in the second and third wave. All municipalities within a geographic area in northern Sweden, with a minimum of one sheltered or supported housing facility for people with severe psychiatric or neuropsychiatric disability, including access to occupational therapy, will be enrolled. Participants will be block-randomised to receive ELR plus treatment as usual (TAU) or TAU alone for a control period. The control group will thereafter receive delayed ELR. Occupational therapists and housing staff will receive an educational package, manuals, and tools, as well as reflections with colleagues during the intervention period. Housing managers will receive questions for monthly follow-up and coaching with staff.

Discussion: This is a protocol for both an internal pilot and full trial of the first RCT study using the ELR intervention model in sheltered or supported housing facilities, evaluating the effects together with cost-effectiveness.

This article suggests a shift in focus from stories as verbal accounts to narrative interpretation of the every day as a resource for achieving person-centred health and social care. The aim is to explore Ricoeur's notion of narrative and action, as expressed in his arguments on a threefold mimesis process, using this as a grounding for the use of narration to achieve person-centredness in health and social care practice. This focus emerged from discussions on this matter at the IPONS conference in Gothenburg, 2021. Based on philosophical resources from Ricoeur's notions of narrative and action developed in his arguments on a threefold mimesis process, we propose a wider use of stories in health and social care practices. We suggest expanding from only focusing on verbal accounts to focusing on narrative as a human way to interpret and make sense of everyday life and circumstances and to communicate possible meanings. We discuss how such complementary focus can be a resource in getting patients involved and collaborating in their health and social care and thereby help develop person-centred practices.