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  • 1.
    Broqvist, Mari
    et al.
    National Center for Priority Setting in Health Care, Division of Health Care Analysis, Departement of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Lindberg, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Ethical considerations and priority in occupational therapy2015In: International handbook of occupational therapy interventions / [ed] Ingrid Söderback, Springer, 2015, 2, p. 83-93Chapter in book (Refereed)
    Abstract [en]

    Working as an occupational therapist (OT) places great demands on professional knowledge, including the OT’s ethical awareness and the ability to weigh different norms and values against one another. National guidelines for priority setting are one set of norms; ethical professional codes compose another. In Sweden, OTs have not only a National Model for Transparent Prioritisation, valid for all areas of health care, but also a specific Code of Ethics to support their professional decision making through reflection and analysis.

  • 2.
    Eriksson, Lina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Öster, Inger
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Lindberg, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    The meaning of occupation for patients in palliative care when in hospital2016In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 14, no 5, p. 541-552Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe how patients in palliative care relate to occupation during hospitalization and to define the meaning it has for them. Eight inpatients in palliative care with various cancer diagnoses were interviewed one time. These interviews were transcribed and analyzed using qualitative content analysis. Patients experience occupations as meaningful when in hospital during the last period of their lives. They would like to be able to handle their own needs as much as possible. Staff behavior, the design of the environment, the lack of accessible occupations, and the degree to which patients can decide whether to receive or decline visits affect the possibility to make their wishes a reality. Our results also revealed that patients experience a sense of loss of their role, as well as a lack of control and participation. Our results confirm the importance of occupation and of patients having the option to and being given opportunities to take care of themselves when in palliative care. Further studies are needed to enable us to understand how organized occupations might influence patients' experience of being in a hospital during the final period of life.

  • 3.
    Fischl, Caroline
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Englund, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Nygren, Ulla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Lindberg, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    The occupational therapy programme at umeå university, revised2016In: 1st COTEC-ENOTHE Congress: Connecting: Education, Practice, Research, Policy, Galway, Ireland: COTEC , 2016Conference paper (Other academic)
  • 4.
    Fischl, Caroline
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Morin, Johanna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Norberg, Eva-Britt
    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.
    Abrahamsson, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Munkholm, Michaela
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Englund, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Lindberg, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Kontinuitet i uppgifter inom år 3 arbetsterapeutprogrammet2015In: Universitetspedagogiska konferensen 2015: gränslös kunskap / [ed] Katarina Winka, Umeå: Universitetspedagogik och lärandestöd (UPL), Umeå universitet , 2015, p. 66-66Conference paper (Other academic)
  • 5.
    Hariz, Gun-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Bergenheim, A Tommy
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Neurosurgery.
    Hariz, Marwan I
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Neurosurgery.
    Lindberg, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Assessment of ability/disability in patients treated with chronic thalamic stimulation for tremor.1998In: Movement Disorders, ISSN 0885-3185, E-ISSN 1531-8257, Vol. 13, no 1, p. 78-83Article in journal (Refereed)
    Abstract [en]

    Chronic thalamic stimulation (CTS) has a documented good effect on tremor in patients with Parkinson's disease (PD) and essential tremor (ET). This study evaluates whether the alleviation of impairment, i.e., tremor, translates into improvement of the patient's ability in performing instrumental activities of daily living (IADL). Thirteen patients were assessed with an occupational therapy tool called Assessment of Motor and Process Skills (AMPS). This observation-based scale rates the patient's motor and process skills needed to perform a given task. The evaluations were done at a mean of 13 months after surgery in the patient's home, and included assessments of IADL with the CTS activated and switched off, respectively. The results showed that most patients improved to variable degrees in their IADL ability when the thalamic stimulation was on. The improvement was more marked in patients operated on for tremor of their dominant hand. The improvement concerned mainly the skill items related to the patients' abilities of coordination, calibration, endurance, and accommodation during IADL task performance. The authors concluded that for some patients with tremor, CTS can improve independence in domestic activities of daily living.

  • 6.
    Hariz, Gun-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Lindberg, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Bergenheim, A Tommy
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Impact of thalamic deep brain stimulation on disability and health-related quality of life in patients with essential tremor2002In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 72, no 1, p. 47-52Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate the impact of thalamic deep brain stimulation (DBS) on disability and health-related quality of life in patients with essential tremor.

    METHODS: Twenty seven consecutive patients were evaluated prospectively, before surgery and at a mean of 12 months (range 6-26) after thalamic DBS. Assessment tools included the Fahn-Tolosa-Marìn tremor rating scale (TRS), activities of daily living (ADL) taxonomy, Nottingham health profile (NHP) and the visual analogue scale (VAS) for measuring impact of disease on life. Additional information on the side effects of, and expectations from surgery was obtained by interview.

    RESULTS: Thalamic DBS improved the ability of the patients in eating, drinking, writing, home maintenance, hobbies, and participation in society. Activities of daily life requiring bimanual skills were less improved. The emotional condition of the patients was positively affected and the negative impact of the disease on life as a whole, and on social life was decreased. Seventy per cent of the patients considered that the surgical treatment met their expectations.

    CONCLUSIONS: After thalamic DBS, health-related quality of life including disability in ADL and social life were improved in patients with essential tremor.

  • 7.
    Hariz, Gun-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Lindberg, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Hariz, Marwan I
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Bergenheim, A Tommy
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Does the ADL part of the unified Parkinson's disease rating scale measure ADL? An evaluation in patients after pallidotomy and thalamic deep brain stimulation.2003In: Movement Disorders, ISSN 0885-3185, E-ISSN 1531-8257, Vol. 18, no 4, p. 373-381Article in journal (Refereed)
    Abstract [en]

    We evaluated the impact of pallidotomy and thalamic deep brain stimulation (DBS) on disability of patients with advanced Parkinson's disease and investigated whether the activities of daily living (ADL) section of the Unified Parkinson's Disease Rating Scale (UPDRS) measures disability in everyday life. Nineteen patients who had pallidotomy and 14 patients who had thalamic DBS were followed for a mean of 11 months. Evaluation tools included the UPDRS as well as a generic ADL scale, called ADL taxonomy. The 13 items belonging to the ADL part of the UPDRS were classified into two categories according to whether the items described a disability or impairment. The total scores of the UPDRS Part II (ADL) were ameliorated in both the pallidotomy and the thalamic DBS groups. When analysing separately the scores from the two categories of the ADL part of the UPDRS, i.e., disability and impairment, only patients who underwent pallidotomy showed improvement in disability-related items. These findings were confirmed when evaluating the patients with the ADL taxonomy. The ADL part of the UPDRS contains a mixture of impairment- and disability-related items. This mixture may confound results when evaluating the impact of surgery on ADL.

  • 8.
    Hariz, Gun-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Neurosurgery. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Lindberg, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Hariz, Marwan I
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Neurosurgery.
    Bergenheim, A Tommy
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Neurosurgery.
    Gender differences in disability and health-related quality of life in patients with Parkinson's disease treated with stereotactic surgery2003In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 108, no 1, p. 28-37Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    To investigate eventual differences between women and men with Parkinson's disease (PD) before and after surgery, with respect to clinical status, disability and health-related quality of life (HRQoL).

    MATERIAL AND METHODS:

    Twenty-four men and 14 women with PD received a total of 46 surgical procedures (pallidotomy, thalamotomy and deep brain stimulation of the thalamus, pallidum or subthalamic nucleus). The impact of PD on disability and other aspects of HRQoL was analysed separately in men and women before and at a mean of 11 months after surgery, using the following assessment tools: The Unified Parkinson's Disease Rating Scale (UPDRS), the ADL Taxonomy, the Nottingham Health Profile, the Life Satisfaction Questionnaire and a Visual Analogue Scale.

    RESULTS:

    At surgery, women had a significantly longer duration of disease than men (mean: 15 vs. 10 years, P < 0.01). They had a higher stage on the Hoehn and Yahr scale and worse scores on UPDRS parts II (ADL) and IV (complications), as well as on the Schwab and England scale and on the ADL Taxonomy. Following surgery, both men and women showed improvement, but women experienced greater benefit than men in ADL, in emotions, and in social life.

    CONCLUSIONS:

    Perhaps women with PD should be offered surgery more often and earlier in the course of their disease.

  • 9.
    Lindberg, Margareta
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Neurosurgery. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    On functions, abilities and quality of life after subarachnoid haemorrhage: occupational therapy aspects1995Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This investigation addresses functions/impairments, abilities/disabilities and quality of life (QoL) in a consecutive series of non-hospitalised long-term survivors (2,5-12 years) of subarachnoid heamorrhage (SAH). The investigated parameters of functions/impairments were: motor, language, perceptual and memory functions. Abilities/disabilities studied were: activities of daily living (ADL) including both personal- and instrumental ADL, working and leisure capacities. Quality of life was assessed using a double visual analogue scale. Occurrence of depression was registered using a self-rating scale.

    A questionnaire focusing motor and language impairments, personal ADL, work and leisure activities was initially mailed to 324 subjects. The vast majority answered the questionnaire. Ten hospitalised subjects could not validly report their functions and abilities and were by that reason excluded.

    In a follow-up investigation up to 247 long-term non-hospitalised subjects were investigated by a physician and an occupational therapist. A total of 82% had at least one impairment. The majority (73%) had memory impairment and among these subjects equal proportions (about 50%) had impairments of long- and short-term memory. Forty-five percent were perceptually impaired, while motor impairment occurred for 25% and aphasia in 10%. Only a small minority (9%) were, according to self-reports, regarded as being to some extent disabled in personal ADL. The corresponding numbers of disabled in instrumental ADL, leisure and working- capacity were 52%, 48% and 40%. Depression was found in 22% - among whom the majority had minimal or mild depression. Overall QoL was judged to be unchanged or increased in 62% and, therefore, decreased in 38%.

    As expected impairments to a significant degree caused disabilities. None of the 5 different categories of impairments were associated with mood (depressed/not depressed) and QoL (decreased/not decreased). Occurrence of depression was significantly associated with different aspects of disabilities. In contrast among a series of instrumental ADL-variables, leisure and working capacity, QoL was influenced negatively only by decreased ability to act sociably and, to a minor extent, by depressed mood.

    Judging from the extent of decreased quality of life, it appears that nearly 40% of all non-hospitalised former victims of SAH have not coped successfully with the impact of the SAH. A follow-up program aiming at optimising the coping process of SAH-victims is, therefore, outlined.

    Download full text (pdf)
    On Functions, Abilities and Quality of Life after Subarachnoid Haemorrhage
  • 10.
    Lindström, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Lindberg, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Home bittersweet home: the significance of home for occupational transformations2011In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 57, no 3, p. 284-299Article in journal (Refereed)
    Abstract [en]

    Background: The study illuminated how persons with psychiatric disabilities experienced the processes of change in a residential context.

    Material: Qualitative interviews with residents living in supported housing were conducted and analyzed using constant comparative analysis.

    Discussion: Residential conditions appear to provide a complex structure that facilitates rehabilitative interactions, in which ‘progressive tensions’ arise between opposing values, such as authentic versus artificial, and independence versus dependence, both of which are important in the process of change.

    Conclusions: A client-centred approach could be taken further if clients are engaged in productive discussions about challenging these ‘progressive tensions’. Awareness of the meaning of home also emerged as central.

  • 11.
    Lindström, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Lindberg, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Responsiveness or resistance: views of community care workers encountering a new rehabilitation modelManuscript (preprint) (Other academic)
    Abstract [en]

    The importance of engagement in meaningful occupations and participation in life situations of people with psychiatric disabilities is well known. Therefore, community care workers (CCWs) in sheltered or supported housing are a key resource in the facility context. Yet, the role and views of CCWs, in facilitating or inhibiting rehabilitative opportunities for residents, is only beginning to be understood. We offered an intervention project using the Everyday Life Rehabilitation (ELR), to integrate recovery- and occupation-oriented interventions, including collaboration between occupational therapists (OT) and CCWs, into supported or sheltered housing. As one part of the intervention project, focus group interviews were conducted with 21 CCWs involved in the intervention project. The aim was to illuminate the views of CCWs working with residents partaking the Everyday Life Rehabilitation. Qualitative content analysis revealed seven categories, with associated subcategories. These categories relate to two different disability ideologies: a stabilisation oriented, and a recovery oriented approach to rehabilitation. Related to organisational aspects, we have also identified two different tensions to change: resistance, and responsiveness to the intervention. The findings have implications for the forthcoming development of housing facilities, personnel development, and rehabilitative efforts for people with severe psychiatric disability.

  • 12.
    Lindström, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lindberg, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Stories of rediscovering agency: home-based occupational therapy for people with severe psychiatric disability2013In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 23, no 6, p. 728-740Article in journal (Other academic)
    Abstract [en]

    As part of a larger study, we offered Everyday Life Rehabilitation (ELR) as a model for integrated occupational therapy in sheltered or supported housing facilities, to enable meaningful daily occupations for people with psychiatric disabilities. Our aim of this article was to understand how participants make sense of their occupational transformations in the context of their everyday life and life history. We carried out qualitative interviews and field observations with 16 participants with psychosis-related disorders. We used narrative analysis and disclosed stories of ‘rediscovering agency’, referring to occupational and identity transformations. A parallel outcome article has shown positive results for participants, and by narrative inquiry we contribute with a deeper understanding of the meaning-making of their transformations and mechanisms of the intervention; i.e. hope, extended value of reaching goals, re-entering the majority world, and transparency of process and attunement to the individual. The findings support the use of the ELR-intervention.

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