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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.

Objective: The fact that different neurobehavioral impairments affect daily life task performance of clients with different neurological diagnoses currently restricts between-group comparisons in rehabilitation. The purpose of this study was to determine whether a single neurobehavioral impact scale could be constructed for use with different diagnostic groups. Methods and results. Rasch analysis of 422 clients (diagnosed with CVA and dementia) demonstrated that 29 of 55 items from the A-ONE Neurobehavioral Scale could be used to construct a short-form, Common Scale. Conclusions: While the use of different and longer diagnostic-specific scales versions may be more useful clinically, the short-form, Common Scale has the potential to be used in research focusing on comparison of groups. Further research will be needed to validate the common, short version.

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

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

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

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

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

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

The aim of this study was to explore what individuals who have been on sick leave experienced as important in the process of returning to work, moving to long-term sick leave, or receiving a disability pension. Grounded Theory was used for interpreting interviews with 15 people who had been on sick leave four years previously. In the results four ideal types were crystallized which are presented in the form of vignettes. The ideal types were discussed focusing on occupational life using the Model of Human Occupation and the theories of Sense of Coherence and Status Passage. The study provided a deeper understanding of people's experiences during the process of their sick leave. Valuable predictors for re-entry into work or disability retirement were: individual mental resources; clear or unclear diagnosis; how long had been spent in the sick-leave process; and personal belief in an ability to work in the future. The interventions and support given by professionals and the social environment, the balance and sense of coherence in life, and participation in the sick leave process were also important. The idealtypes found could be helpful to professionals working in this field in deepening their understanding of the clients.

Background: With the evolution of contemporary occupations mediated by digital technologies (DTs), there is a need for occupational therapists to develop and structure knowledge on how to support older adults’ engagement in occupations and social participation in a digitalised society.

Objective: The objective of this study is to explore how tailoring to support older adults’ engagement in DT-mediated occupations could be schematised.

Material and methods: The study employed a multiple case study methodology. There were nine cases, with each case involving an older adult undergoing a collaborative process to support engagement in DT-mediated occupations. The collaborative process was initiated through questionnaires, observations, and dialogues. Meetings and tailoring strategies were documented in fieldnotes and memos on tailoring, respectively. Semi-structured interviews concluded data collection. Cross-case synthesis was used in data analysis.

Results: The result is a proposed scheme for tailoring to support older adults’ engagement in digital technology-mediated occupations, wherein strategies undertaken in the collaborative processes were synthesised and described.

Conclusion and significance: The proposed scheme for tailoring could contribute to occupational therapists’ knowledge on how to support older adults’ engagement in contemporary occupations. Testing the model in various practice settings is recommended in order to enhance occupational therapy practice.

Background: Since the beginning of the occupational therapy profession, engagement in occupation has been valued as the primary therapeutic agent as well as the goal of intervention. While there are few today who would not support this idea, occupational therapists continue to struggle with implementing their beliefs through "what we do" and "how we do it". Contributing to this problem is their failure to use terminology in a manner that clearly defines what and how occupational therapists do what they do in occupational therapy research, education, and practice. Methods: The author will, therefore, first discuss some key occupational therapy terms and propose that they represent an occupation-related taxonomy that can be used to more clearly define and describe for occupational therapists and others what they do and how they do what they do as occupational therapists. Then, with a goal of fostering critical self-reflection among occupational scientists and occupational therapy researchers, educators, and practitioners, the author will go through the stages of the occupational therapy process outlined in the Occupational Therapy Intervention Process Model (OTIPM) and demonstrate how a more precise use of this occupation-related taxonomy can facilitate maximizing the power of occupation in practice.

Background: Since the beginning of the occupational therapy profession, engagement in occupation has been valued as the primary therapeutic agent as well as the goal of intervention. While there are few today who would not support this idea, occupational therapists continue to struggle with implementing their beliefs through "what we do" and "how we do it". Contributing to this problem is their failure to use terminology in a manner that clearly defines what and how occupational therapists do what they do in occupational therapy research, education, and practice. Methods: The author will, therefore, first discuss some key occupational therapy terms and propose that they represent an occupation-related taxonomy that can be used to more clearly define and describe for occupational therapists and others what they do and how they do what they do as occupational therapists. Then, with a goal of fostering critical self-reflection among occupational scientists and occupational therapy researchers, educators, and practitioners, the author will go through the stages of the occupational therapy process outlined in the Occupational Therapy Intervention Process Model (OTIPM) and demonstrate how a more precise use of this occupation-related taxonomy can facilitate maximizing the power of occupation in practice.

Objective: To examine the relationship among (a) quality of activities of daily living (ADL) task performance, (b) quality of social interaction, and (c) the extent of discrepancy between the person's and the occupational therapist's perspectives; and explore patterns of strengths and challenges among people with developmental disabilities (DD). Methods: Fifty-eight adults with different types of DD, living in northern Sweden, were evaluated using the Assessment of Motor and Process Skills (AMPS), the Evaluation of Social Interaction (ESI) and the Assessment of Compared Qualities -Occupational Performance (ACQ-OP) and Assessment of Compared Qualities -Social Interaction (ACQ-SI). The relationships among assessments were analysed using Pearson correlation analyses. Cluster analysis was used to group participants based on their evaluation results. Results The quality of ADL task performance and the quality of social interaction demonstrated weak to moderate positive relationships while the ACQ-OP and ACQ-SI demonstrated a strong positive relationship. The cluster analysis resulted in identifying three distinct groups that differed significantly from one another. Conclusion: The findings support the clinical use of multiple assessment tools, including observation and self-report, to evaluate different aspects of occupational performance. Comprehensive and relevant evaluation supports collaborative goal setting and intervention planning.

Background: Several factors facilitate or hinder efficacy research in occupational therapy. Strategies are needed, therefore, to support the successful implementation of trials.

Aim: To assess the feasibility of conducting a randomised controlled trial (RCT). The main feasibility objectives of this study were to assess the process, resources, management, and scientific basis of a trial RCT.

Material and methods: A total of 10 occupational therapists, between the ages of 30 and 55 (M 43.4; SD 8.3) with seven to 26 years' (M 14.3; SD 6.1) experience, participated in this study. Qualitative data collected included minutes of meetings, reports, and field notes. The data were analysed based on the principles of content analysis, using feasibility objectives as the main categories.

Results: Data analysis revealed strengths in relation to retention and inclusion criteria of participants, the study protocol, study organisation, and the competence of researchers. Weaknesses were found related to recruitment, randomisation, data collection, time for training and communication, commitment, and design.

Conclusion: The findings indicated that there are several factors which had a considerable impact on the implementation of an RCT in practice. However, it was useful to assess methods and procedures of the trial RCT as a basis to refine research plans.

Background: Despite a strong desire among most older adults to age in place, there are few widely available services to support planning and preparing for one’s future housing needs.

Objective: To develop a prototype of a web-based housing counselling intervention for use in later life, by employing a user-centred design.

Material and Methods: As the first step in intervention development, we employed a development process based on research circle methodology. Nine older adults participated in three sessions. Findings from literature reviews, a meeting with a technology and design panel (n = 6) and interviews with representatives of nonprofit organizations, companies, and municipalities (n = 7) served as discussion points.

Result: An on-paper prototype was derived, composed of the THINK, LEARN and ACT module reflecting different stages of the decision-making process. Each module addressed preferences, health, home and social and financial resources. Key design features and theoretical underpinnings were included.

Conclusion and Significance: A user-centred design process can result in services that are aligned with older adults’ preferences for obtaining housing information. Services for planning and preparing future housing needs have the potential to increase older adults´ well-being at home as well as reduce costs for care and housing provision by the municipalities.

Background: The concept of an occupational pattern in occupational therapy and occupational science has evolved with varying definitions, ranging from activity patterns to patterns of daily occupation.AimsThis study aimed to explore the concept of occupational pattern, develop an updated definition of the concept, and theoretically validate the concept’s definition.

Method: Walker and Avant’s concept analysis method was used, where both theoretical frameworks and peer-reviewed scientific literature were searched and synthesized to clarify and define the concept. Furthermore, seven occupational therapists theoretically validated the concept.

Findings: The analysis included forty-nine references from various research contexts and theoretical perspectives. The synthesis yielded a conceptualization of the concept of occupational pattern, outlining it into three overarching categories: ‘content in an individual’s occupational pattern’, ‘designing an occupational pattern’, and ‘balancing the occupational pattern’.

Implications: An updated operational definition of the multifaceted concept of an occupational pattern now exists, with practical implications for enhancing the education of occupational therapy students and guiding the utilization of the concept. Moreover, it holds significance for instrument development and outcome measurement in research; especially in lifestyle intervention studies within the field of occupational therapy.

Background: The police profession is a high-strain and high-risk profession, sometimes resulting in poor physical, mental and social health. This systematic review aims to identify and describe crucial areas for a healthy and sustainable lifestyle among patrolling police officers in Europe, an area not previously studied.

Methods: The review was conducted according to the PRISMA guidelines. A protocol was published and registered with PROSPERO beforehand. Searches were carried out in eight databases. Two independent authors screened articles and critically appraised the included studies. A narrative synthesis was conducted to analyse the results. The review’s total body of evidence was assessed with GRADE-CERQaul.

Results: A total of 16 articles were located, representing 13 studies. Barriers and resources for a healthy and sustainable lifestyle were linked to a theoretical framework of life balance. Subsequently, a linkage model was created to explain different aspects of patrolling police officers’ life balance and its relation to health (physical, social and mental).

Conclusions: Several crucial areas for a healthy and sustainable lifestyle were found and described, indicating that patrolling officers’ working life affects their possibilities of living a balanced lifestyle, which might disturb different aspects of health, depending on which aspect is compromised.

Background: Patrolling police officers engage in different mentally, socially, and physically challenging life contexts which may affect their life and health. The aim of this scoping review is twofold, to explore life contexts of patrolling officers in the European Union, and to investigate how their lives and health are affected by environmental characteristics within these contexts.

Methods: The scoping review followed Arksey and O’Malley’s methodology and included a critical appraisal. The environmental model within Kielhofner’s Model of Human Occupation was used in the thematic analysis. The review was reported following PRISMA-ScR.

Results: In the 16 included studies, two contexts (where environments interact with persons on different levels) were discovered: the global and the immediate context. No local contexts were found. Primarily, research on the social, and occupational environments, including qualities identified in these environments were found. However, some environmental characteristics within patrolling officers’ physical environments were also discovered.

Discussion: This review contributes to the emerging research area of police officers’ life contexts, by mapping contexts and environments affecting their life and health. However, to get a deeper understanding of how officers are affected by their environments, interviewing them regarding how their different contexts affect their everyday living, would be important.

Introduction: The police officer occupation is a high-risk profession, with significantly more traumatic and stressful events than other occupations. Key factors for the health of police officers have been found to be related to intra-interpersonal, occupational, and organizational factors. However, the mechanisms underlying why is inconclusive. This protocol therefore intends to explain the approach for conducting both a scoping review, and systematic review. The overall aim of the reviews is to investigate patrolling police officers' life contexts with the intention to identify barriers and resources that affect their lifestyle and health.

Methods: The protocol is reported according to the PRISMA-P guidelines, with PROSPERO number: CRD42020190583. Searches will be carried out in SCOPUS, Web of Science, PubMed, OpenGrey, and EBSCO (Academic Search Premiere, APA PsychINFO, CINAHL, SocINDEX). Two independent raters will screen articles and conduct the critical appraisal. Analyses include Arksey and O'Malley's methodology for the scoping review, and a narrative synthesis for the systematic review, including critically appraising the total body of evidence in the systematic review.

Discussion: The purpose of the reviews is to understand patrolling police officers' life contexts, and support future development of an assessment that measures patrolling police officers' life balance from a contextual viewpoint.

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.

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.

Background: Meaningful everyday occupations are important for mental health and recovery and are provided by both community-based day centres (DCs) and clubhouses. It is unknown, however, if any of the two has more recovery-promoting features. Objective: This nine-month longitudinal study compared DC and clubhouses, concerning the users' perceptions of unit and programme characteristics, and aspects of everyday occupations in terms of engagement and satisfaction. Stability over time in these respects, as well as motivation for participation and relationships with occupational engagement and satisfaction, were explored. Methods: Participants from 10 DCs (n = 128) and 5 clubhouses (n = 57) completed self-report instruments. Results: DC attendees rated lower levels on two organizational factors; choice and ability to influence decisions, and the unit's social network. Motivation showed to be an important factor for perceived occupational engagement, which did not differ between the two groups. DC attendees were more satisfied with their everyday occupations at baseline, but that factor increased more in the clubhouse group and there was no group difference at follow-up. The unit and programme characteristics and occupational engagement showed stability over time. Discussion: Clubhouses seemed more advantageous and DC services may consider developing users' opportunities for choice and decision-making, and peer support.

Background: Return-to-work (RTW) resources for persons with mental health disorders are limited and costs are typically shared by several stakeholders in society. Occupational therapists (OT) provide RTW interventions for this target group, however, increased knowledge of health, and employment effects, as well as costs are needed to better inform decision makers in their prioritisations.

Aims/objectives: To identify and summarise evidence of cost-effectiveness of RTW interventions for persons with mental health disorders which OTs provide.

Materials and methods: A systematic search was applied and resulted in 358 articles. After screening, nine articles met inclusion criteria and were reviewed. Quality assessment was conducted using the economic evaluation tool by Joanna Briggs Institute.

Results: Supported employment, Individual Placement and Support was cost-effective in several contexts while three studies showed larger effects and higher costs. An OT intervention added to treatment for major depression was indicated to be cost-beneficial and an advanced supported employment was cost-saving. The methodological quality varied considerably between studies.

Conclusions and significance: The results of the included studies are promising, however, to further strengthen the economic perspective in OT RTW interventions, the need for conducting more and methodologically robust economic evaluations is crucial in future studies.

Patients with stroke or traumatic injury often suffer from eating disorders. This study describes relatives' experiences of their next of kin's eating and swallowing disorders. A strategic sample was obtained, and nine informants were interviewed. Using a constant comparative approach for data analysis, three themes emerged: provider for health and well-being, sensitive attitudes about the next of kin's changed appearance, and adaptation to the new situation. The informants' roles included qualities of caring and concern, Food preparation was crucial, with more time spent on cooking than previously. Combined with circumstantial eating, it dominated the working hours. The informants expressed emotional reactions to eating behaviour. In particular the loss of good, proper eating and affinity during meals left them feeling sad. Strategies such as dinner arrangements and shared responsibility guided the informants in adapting to a new situation. In clinical practice it is important to support informal caregivers, to provide adequate information, and to share responsibility. In occupational therapy one intervention could be to help clients find a balance in activities of work, leisure, and rest.

Background: The Individual Enabling and Support (IES) model is an adapted, supported employment program developed to meet motivational, cognitive and time-use needs of people with affective disorders. Vocational programs for this target group have been developed but more knowledge is needed about the important characteristics and perceived usefulness of the programs. The aim of this study was to illustrate the IES model and process from multiple perspectives.

Methods: Five participants were included in this multiple-case study. The material comprised interviews with participants, intervention documents, memos and interviews with employment specialists. Within and cross-case analyzes and an analytical generalization were performed.

Results: The cases illustrated different IES processes, and the theme; Enabling engagement in return to work (RTW) was formulated. Continuous support from the employment specialist and a focus on personal resources and motivation were essential to overcome low self-confidence regarding RTW. Motivational, cognitive and time-use strategies gave an opportunity to learn new behavior and coping strategies for job seeking, getting employed and working.

Conclusion: Providing a combination of these strategies integrated with supported employment could promote self-efficacy and engagement in the RTW process among people on sick leave due to an affective disorder.

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.

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

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

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

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

Background: There are no validated assessment tools for evaluating quality of schoolwork task performance of children living in German-speaking Europe (GSE).

Objective: To determine whether the international age-normative means of the School Version of the Assessment of Motor and Process Skills (School AMPS) are valid for use in GSE.

Methods: The participants were 159 typically-developing children, 3-12 years, from GSE. We examined the proportions of School AMPS measures falling within +/- 2 standard deviation (SD) of the international age-normative means, and evaluated for significant group differences (p<0.05) in mean School AMPS measures between the GSE sample and the international age-normative sample using one-sample Z tests. When significant mean differences were found, we evaluated if the differences were clinically meaningful.

Results: At least 95% of the GSE School AMPS measures fell within +/- 2 SD of the international age-normative means for the School AMPS. The only significant mean differences were for 6(p < 0.01) and 8-year-olds (p = 0.02), and only the 6-year-old school process mean difference was clinically meaningful.

Conclusions: Because the only identified clinically meaningful difference was associated with likely scoring error of one rater, the international age-normative means of the School AMPS appear to be valid for use with children in GSE.

Purpose: To explore and describe how persons with an acquired brain injury (ABI) managed the everyday technology (ET) that they needed to use in their workplace and how this use influences their opportunities to work. Methods: Nine persons with an ABI were interviewed and observed when managing ET in their workplace. The data were analysed qualitatively with a constant comparative method. Results: The main category, "The challenge of managing ET in the workplace", consisted of three categories, all of which reflected different kinds of discrepancies between the participants' ability to manage ET and the demands that ET imposes on them in work: "Struggling with ET to be able to continue to work; "Depending on strategies to cope with ET to continue in a particular profession", and "Managing ET at work but concerned about keeping up with the changes". Conclusions: The result revealed discrepancies between the abilities of the persons with ABI to manage ET in relation to the demands that technology imposed on them in their work setting. This indicated that professionals need to consider the role of ET when designing interventions supporting a person's return to work after an ABI.

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.

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.

Objective: To explore how client-centred occupational therapy intervention processes for participation in meaningful Social Internet-Based Activities (SIBAs) can be designed, and to explore the influences of participation in SIBAs on seniors' social activities and social contacts. Method: A qualitative, descriptive, multiple-case study was conducted, and an intervention was provided to the five participants, who were aged 65-85. Data were collected through assessment tools, field notes, and interviews. Results: The participants' needs and challenges related to SIBAs varied during the intervention processes. Individual-adapted support was provided for the seniors (by the occupational therapist) to managing the introduction to different SIBAs, their appearance on the internet, and the lack of privacy. The association between the seniors' participation in SIBAs and their satisfaction with these activities, as well as their social contacts, requires further exploration. Conclusions: Client-centred occupational therapy interventions can support seniors' participation in SIBAs and their self-reliance when performing these activities.

Purpose: People with acquired brain injury (ABI) have difficulties using everyday technology (ET) in daily tasks at home and in society. To support them in managing the demands imposed by using ET, knowledge is needed concerning their response actions to the difficulties. The aim of this study was to explore and describe what characterizes response actions to difficulties using ET, their conditions, and how they influence the experiences of tasks in daily life among people with ABI. Methods: Interviews and observations were undertaken with 13 persons with an ABI. Data were analysed qualitatively using the constant comparative method. Results: The participants' response actions were categorized as (i) deliberate and organized planning, (ii) random and inflexible repeating (iii), re-evaluating tasks, (iv) explaining difficulties related to others, and (iv) proving and protecting capability. Certain conditions were decisive for the different response actions to be applied and also for their effectiveness in enabling engagement in tasks in daily life. Each participant used several types of response actions and the same action could be applied in several situations. Conclusion: To support people with an ABI to manage the demands imposed by using ET, it is important to identify the uniqueness of each client and his or her response actions to difficulties using ET and thereafter adjust the interventions accordingly.

The purpose of this study was to describe how a group of mainly elderly disabled persons experienced their rehabilitation over a period of time focusing on their interactions with professionals, relatives and the community. Fifteen persons who had suddenly been taken ill and who had received rehabilitation were interviewed. The interview transcripts were analysed qualitatively. The results showed that the informants' experiences could be described in a form of three rehabilitation chains, each one consisting of a number of phases. First, a medical rehabilitation chain that started at the onset of the informants' disability. This chain was relatively short and reflected the informants' interactions with the professionals. A psychological rehabilitation chain that represented the informants' internal struggle towards a new meaningful life. The third was labelled a social rehabilitation chain. This chain became visible later in the rehabilitation process and reflected the informants' interactions with their relatives and their experiences of a stigmatizing society. Although rehabilitation in Sweden is claiming to apply a holistic perspective encompassing medical, psychological and social aspects, the results of the study showed that it is not perceived so by the informants in the study, who experienced rehabilitation mainly in the medical rehabilitation chain.

Background: Information and communication technology (ICT) provides one solution to meet increasing demands for occupational therapy for older adults.

Aims/Objectives: To examine if and how municipality-based occupational therapists (OTs) include ICT in their work, and which factors are associated with use of occupational therapy at a distance.

Material and Methods: Survey study including 167 OTs. Data were presented descriptively. Associations were analysed by Chi2 test and logistic regression models.

Results: Forty-eight percent of OTs used ICT once a month or more. OTs belief on possibilites to use ICT is associated with replacement of physical home visits. Managers expectations and support also seem to be important factors.

Conclusion: ICT solutions are frequently used by OTs in home health care and can be considered complementing rather than replacing physical home visits. More knowledge is needed on when and how ICT solutions can be used by OTs and how factors that impact the use of ICT can be managed.

Using everyday technology (ET) is a prerequisite for activities and participation at home and in the community. It is well known that persons with an acquired brain injury (ABI) can have limitations in activities of daily living but our knowledge of their difficulties using ET is not known. Thirty-six persons (27 men and 9 women, mean age 44 years, age range 26-60) with an ABI (2-10 years post injury) were interviewed, using the Everyday Technology Use Questionnaire (ETUQ), about their perceived difficulties using ET and how these difficulties influenced their everyday activities and their possibilities to participate at home and in the community. A majority (78%) of the persons reported difficulties using ET. The most common difficulties were related to the use of telecommunication and computers. Despite these difficulties, a majority still used most objects and services independently. Twenty-six participants (72%) perceived that their difficulties using ET influenced their everyday activities and their possibility to participate at home and in the community. The results indicate that rehabilitation following an ABI should consider whether clients' use of ET influences their activity and participation and adopt interventions accordingly. The results also indicate that difficulties using ET need to be considered in the design of community services to prevent societal barriers.

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.

The aim of this study was to identify and describe the characteristics of the difficulties using everyday technology in persons with an aquired brain injury (ABI), and their experiences of how these difficulties influenced their life. Thirteen persons with an ABI were interviewed about their difficulties in using everyday technology and were observed in their use of technology. Data were analysed qualitatively with a constant comparative method. The results showed that the persons' experiences formed two categories: "A variety of combinations of difficulties in the use of everyday technology" and "Restrictions in life". The difficulties identified were related not only to everyday technology itself but also to the interaction between the technology, the task, the person, and the environment. These difficulties influenced their experiences of restrictions in occupational performance, personal identification, and participation in society. The results emphasize that occupational therapists who design interventions for people with an ABI need to accommodate both the technology and other interacting aspects in order to overcome difficulties in using everyday technology.

Aim: The purpose of this study was to use a variety of methods to evaluate and cross-validate the reliability estimates of the quality of schoolwork performance measures in the School Version of the Assessment of Motor and Process Skills (School AMPS)(1).

Methods: Split-half reliability was estimated based on School AMPS data from 6 194 students who had performed at least two school AMPS tasks. Two different split-half methods were used: splitting the School AMPS items vertically and splitting them horizontally. The Rasch equivalent of Cronbach’s alpha for the full School AMPS evaluation and standard error of measurement (SEm) were also considered.

Results: All three methods yielded high reliability coefficient estimates (r ≤ 0.70) and overall SEm was low.

Conclusions: From a practice perspective, the results of this study are of clinical importance as they provide evidence that occupational therapists can have confidence in the consistency of the School AMPS measures when they are used in the process of making decisions about individual students, planning interventions, and later performing followup evaluations to measure the outcome.

Rationale: As support in leading a meaningful and active life, a person with mental illness is often given the opportunity to attend a day centre. However, few studies have investigated the meaningfulness perceived by the person visiting a day centre. For such a purpose, a self-report instrument was developed.

Aims: To explore whether perceived meaningfulness, as expressed in the recently developed instrument Evaluation of Perceived Meaning in Day Centers (EPM-DC), could be viewed as one dimension and also to investigate the psychometric properties of this instrument.

Methods: Persons with mental illness attending five day centres in Sweden participated and completed the questionnaire. The data were analysed by Rasch analysis.

Major findings: The study showed that the concept captured in the instrument could be viewed as unidimensional and the result gave preliminary evidence for sound psychometric properties.

Principal conclusion: The results indicate promising signs of validity and reliability, but the suitability of self-reporting may be questioned.

Aim. To determine whether the Modified NPS Interest Checklist (MNPS) could be developed as a tool with linear measures of four dimensions of leisure: Interest, Performance, Motivation, and Well-being.

Methods. A cross-sectional descriptive study including 156 volunteers born between 1904 and 1917 and living in urban or rural northern Sweden. Each participant was individually interviewed at her/his place of residence. Subsequent data were subjected to a series of Rasch analyses using FACETS.

Major findings. The items and persons demonstrated acceptable goodness-of-fit across all four dimensions in the MNPS checklist. The Rasch equivalent of Cronbach's alpha was 0.98 for items, and ranged from 0.66 to 0.75 for persons.

Principal conclusion. The MNPS shows evidence for acceptable internal scale validity, person response validity, and scale reliability. This study provides initial evidence that the MNPS is a valid tool for measuring leisure among the oldest old. While this study provides the first psychometric examination of an assessment designed to evaluate different dimensions of leisure, more research is needed to further assess validity and reliability of this tool with the elderly and with other groups.

This study describes how elderly people, temporarily living in a pre-discharge community rehabilitation centre, may experience participation in an in-patient occupational therapy programme built around group activities. The group activity programme was comprised of five sessions, each focusing on a theme chosen to encourage reflection and mutual sharing of experiences and support. Data were collected through interviews with each of the three participants immediately after each of the five group sessions. The resultant 15 interviews were analysed by adopting a Grounded Theory approach. The results show that the ways in which the participants experienced participating in the group activity programme can be described from two distinct core categories: experiences of activation and experiences of transformation . The category of activation emerged from their experiences of a creative force whilst engaged in performing the activities and from their discovery that the group was a good place for learning . Engagement in the group activities also seemed to bring about a transformation in the participants in that their experiences triggered reflection and adaptation , which contributed to a change in attitude and a personal synthesis where their new discoveries were internalized. The study shows the potential a group activity programme in occupational therapy has in triggering an adaptational and reflective process within elderly people facing discharge from hospital. Hence, group activity interventions in occupational therapy are suggested as one possible way to support the elderly person in the discharge process from hospital to the home.

The evolving theory of occupational justice links the concept to social justice and to concerns for a justice of difference: a justice that recognizes occupational rights to inclusive participation in everyday occupations for all persons in society, regardless of age, ability, gender, social class, or other differences. The purpose of this descriptive paper is to inspire and empower health professionals to build a theoretical bridge to practice with an occupational justice lens. Using illustrations from a study of leisure and the use of everyday technology in the lives of very old people in Northern Sweden, the authors argue that an occupational justice lens may inspire and empower health professionals to engage in critical dialogue on occupational justice; use global thinking about occupation, health, justice, and the environment; and combine population and individualized approaches. The authors propose that taking these initiatives to bridge theory and practice will energize health professionals to enable inclusive participation in everyday occupations in diverse contexts.

The evolving theory of occupational justice links the concept to social justice and to concerns for a justice of difference: a justice that recognizes occupational rights to inclusive participation in everyday occupations for all persons in society, regardless of age, ability, gender, social class, or other differences. The purpose of this descriptive paper is to inspire and empower health professionals to build a theoretical bridge to practice with an occupational justice lens. Using illustrations from a study of leisure and the use of everyday technology in the lives of very old people in Northern Sweden, the authors argue that an occupational justice lens may inspire and empower health professionals to engage in critical dialogue on occupational justice; use global thinking about occupation, health, justice, and the environment; and combine population and individualized approaches. The authors propose that taking these initiatives to bridge theory and practice will energize health professionals to enable inclusive participation in everyday occupations in diverse contexts.

Aim:

The aim of this study was to describe experiences of limitations in occupational performance and strategies for managing daily activities among the elderly with chronic heart failure (CHF).

Methods:

Ten participants from primary healthcare with a confirmed diagnosis of CHF were interviewed. The interviews were analysed using qualitative content analysis.

Results: The first theme, "Redefining an active life, aware of one's impaired body", was based on four sub-themes: realizing one's limited activity ability; striving to preserve an active life; focusing on meaningful activities; and changing vs. not changing habits and roles. The second theme, "Planning activities and balancing the degree of effort", was based on three sub-themes: limiting, organizing, and rationalizing activities; adjusting activities to today's ability; and using technology and adapting the environment.

Conclusions:

Elderly people with CHF are struggling with an ongoing process of occupational adaptation due to periodical physical decline and fluctuating day-to-day ability. This highlights a need for information on strategies from a holistic perspective and client-centred occupational therapy interventions.

AIM: The purpose of this study was to describe clients and occupational therapists (OTs) experiences of a home-based programme focusing energy conservation strategies (ECS) for clients with chronic heart failure (CHF).

METHODS: The programme, based on occupational therapy intervention process model (OTIPM), was led by two OTs in primary health care. Five clients' self-reported activities of daily living (ADL), fatigue, depression, goal achievements and use of ECS. Furthermore, both clients and OTs were individually interviewed.

RESULTS: The clients reported mild depression, severe fatigue and both increased and decreased independence in ADL. Most goals were achieved, and multiple ECS were used. Clients perceived that they worked collaboratively with the OTs and gained professional support to enhance daily activities. The OTs experienced knowledge and structure and found benefits from the programme, but doubted the possibility of using it in clinical practice.

CONCLUSIONS: This study, despite having few participants, indicates that both the OTs and the clients experienced that the specialized programme gave structure to the OTs work, provided knowledge about CHF and valuable energy conservation strategies. The programme supported the OTs in working in a more comprehensive client-centred way. However, its feasibility needs to be further evaluated.