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  • 1.
    Ahlin, Karin
    et al.
    Computer and System Sciences, Mid Sweden University Östersund, Sweden.
    Zingmark, Magnus
    Health and Social Care Administration, Östersunds City, Sweden.
    Persson Slumpi, Thomas
    Computer and System Sciences, Mid Sweden University Östersund, Sweden.
    A transition towards digital home visits in social care and home health care during the corona pandemic2021In: Global health 2021: the tenth international conference on global health challenges / [ed] Manuela Popescu; Ah Choo Koo; Karin Ahlin, International Academy, Research and Industry Association (IARIA), 2021, p. 1-7Conference paper (Refereed)
    Abstract [en]

    During the pandemic, physical meetings were supposed to decrease as much as possible to avoid the virus to spread. Before the pandemic, the physical meeting favoured social care and home health care in Sweden. One solution was to digitize as many of these meetings as possible. Therefore, we investigated this transition in a web survey, including questions with predetermined and open-ended answers. The web-survey was sent to co-workers in home health care and social care in a middle-seized municipality in Sweden. The results showed that not all meetings could be transformed, like meetings with citizens with hearing or cognitive impairments. Challenges related to the transformation were instability in technical equipment, the professionals’ and citizens’ knowledge of handling technical equipment, and access to technical equipment support. Despite this did the co-workers digitize meetings whenever possible, adding operational and problem-solving attitude to the transformation. Due to this study’s limitation, like respondents from one municipality and the pandemic’s length, we intend to investigate further and understand the development of the transformation and how knowledge in the area increases.

  • 2.
    Bajraktari, Saranda
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Hörling, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Pettersson, Beatrice
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Self-managed fall preventive exercise intervention with an mHealth application: self-reported health outcomes over one yearManuscript (preprint) (Other academic)
  • 3.
    Bajraktari, Saranda
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Pettersson, Beatrice
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Cost-effectiveness analysis of the digital fall preventive intervention Safe Step among community dwelling older people aged 70 and overManuscript (preprint) (Other academic)
  • 4.
    Bajraktari, Saranda
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden.
    Health-promoting and preventive interventions for community-dwelling older people published from inception to 2019: a scoping review to guide decision making in a Swedish municipality context2020In: Archives of Public Health, ISSN 0778-7367, E-ISSN 2049-3258, Vol. 78, no 1, article id 97Article, review/survey (Refereed)
    Abstract [en]

    Background: Despite the promising evidence of health-promoting and preventive interventions for maintaining health among older people, not all interventions can be implemented due to limited resources. Due to the variation of content in the interventions and the breadth of outcomes used to evaluate effects in such interventions, comparisons are difficult and the choice of which interventions to implement is challenging. Therefore, more information, beyond effects, is needed to guide decision-makers. The aim of this review was to investigate, to what degree factors important for decision-making have been reported in the existing health-promoting and preventive interventions literature for community-dwelling older people in the Nordic countries.

    Methods: This review was guided by the PRISMA-ScR checklist (Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews), the methodological steps for scoping reviews described in the Arksey and O ' Malley's framework, and the Medical Research Council's (MRC) guidance on complex interventions. Eligible studies for inclusion were randomised controlled trials (RCTs) concerning health promotion or primary prevention for community-dwelling older people implemented in the Nordic countries. Additionally, all included RCTs were searched for related papers that were reporting on additional factors. Eligible studies were searched in seven databases: PubMed, SCOPUS, CINAHL, Academic Search Elite, PsycINFO, SocINDEX, and SPORTDiscus.

    Results: Eighty-two studies met the inclusion criteria (twenty-seven unique studies and fifty-five related studies). Twelve studies focused on fall prevention, eleven had a health-promoting approach, and four studies focused on preventing disability. All interventions, besides one, reported positive effects on at least one health outcome. Three studies reported data on cost-effectiveness, three on experiences of participants and two conducted feasibility studies. Only one intervention, reported information on all seven factors.

    Conclusions: All identified studies on health-promoting and preventive interventions for older people evaluated in the Nordic countries report positive effects although the magnitude of effects and number of follow-ups differed substantially. Overall, there was a general lack of studies on feasibility, cost-effectiveness, and experiences of participants, thus, limiting the basis for decision making. Considering all reported factors, promising candidates to be recommended for implementation in a Nordic municipality context are 'Senior meetings', 'preventive home visits' and 'exercise interventions' on its own or combined with other components.

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  • 5.
    Bajraktari, Saranda
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden.
    Pettersson, Beatrice
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Reaching older people with a digital fall prevention intervention in a Swedish municipality context: an observational study2022In: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, article id 857652Article in journal (Refereed)
    Abstract [en]

    Background: There is robust evidence that falls in old age can be prevented by exercise programs that include balance training, functional exercises, and strength training. For the interventions to have a population health impact, outreach to the population of focus with suitable interventions is needed. While digital interventions are promising there is limited knowledge on the characteristics of who is reached. The aim of this study was to describe the recruitment process, estimate reach rate at the population level and to describe participants characteristics and representativeness in a digital fall prevention intervention study.

    Methods: In a municipality-based observational study, reach of a digital fall prevention intervention was evaluated. The intervention included a digital exercise programme (Safe Step) and optional supportive strategies, complemented with a range of recruitment strategies to optimize reach. Recruitment during a period of 6 months was open to people 70 years or older who had experienced a fall or a decline in balance the past year. Reach was based on data from the baseline questionnaire including health and demographic characteristics of participants. Representativeness was estimated by comparing participants to a sample of older people from the Swedish National Public Health Survey.

    Results: The recruitment rate was 4.7% (n = 173) in relation to the estimated population of focus (n = 3,706). Most participants signed up within the first month of the intervention (n = 131). The intervention attracted primarily women, older people with high education, individuals who used the internet or digital applications almost every day and those perceiving their balance as fair or poor. Safe step participants lived more commonly alone and had higher education and better walking ability in comparison to the Swedish National Public Health Survey.

    Conclusions: With a range of recruitment strategies most participants were recruited to a digital fall intervention during the first month. The intervention attracted primarily highly educated women who frequently used the internet or smart technologies. In addition to digital fall prevention interventions, a higher diversity of intervention types (digital and non-digital) is more likely to reach a larger group of older people with different needs.

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  • 6.
    Brodén, Karin
    et al.
    Service Research Centre, Karlstad University, Karlstad, Sweden.
    Snyder, Kristen
    Quality Management, Mid Sweden University, Östersund, Sweden.
    Sörensen, Helle
    Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden.
    Zingmark, Magnus
    Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden.
    Determining value in welfare-technology: the need for a multi-perspective framework2023In: International Journal of Health Economics and Policy, ISSN 2578-9295, Vol. 8, no 4, p. 76-88Article in journal (Refereed)
    Abstract [en]

    Background: Stakeholders in health and social care are implementing digital solutions to facilitate person-centred care for citizens. One problem is choosing which digital solution to implement. Ordinary cost-benefit analysis implicates the measurable parts of the value, leaving the immeasurable without any trace in an analysis.

    Results: We used design thinking to design a framework that implicates what to add as valuable factors on individual, organisational, and governmental levels. The design is based on empirical material from workshops and literature reviews on systems thinking, quality management, and value factors. The valuable factors at an individual level could include independence, autonomy, and empowerment, and the factors at the organisational level accessibility, competence, and independence. On a central level, the factors are related to person-centred care and its value proposals, such as autonomy and independence.

    Conclusions: While conducting a cost-benefit analysis, focusing on a standard definition of the value concept is essential. The designed framework needs to be dynamic due to the broad range of welfare technology. The created rubrics cube model, including strategic, organisational-operational and individual levels, should be used by decision-making groups as a flexible foundation. Forthcoming research will test this framework, including the proposed scale for measurement and focusing on welfare technology for older citizens.

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  • 7.
    Elf, Marie
    et al.
    School of Health and Welfare, Dalarna University, Falun, Sweden.
    Rasoal, Dara
    School of Health and Welfare, Dalarna University, Falun, Sweden.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Health Sciences, Lund University, Lund, Sweden; Health and Social Care Administration, Östersund, Sweden.
    Kylén, Maya
    School of Health and Welfare, Dalarna University, Falun, Sweden; Department of Health Sciences, Lund University, Lund, Sweden.
    The importance of context: a qualitative study exploring healthcare practitioners' experiences of working with patients at home after a stroke2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 733Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Stroke significantly impacts individuals, leading to the need for long-lasting rehabilitation and adaptation to environmental demands. Rehabilitation after stroke is increasingly performed in patients' homes, and it is argued that rehabilitation in this context is more person-centred and positively impacts client outcomes. However, the role of environmental factors in this process is largely unknown. The aim of this study was to explore how multidisciplinary healthcare practitioners working with rehabilitation in the home after stroke consider possibilities and challenges in the environment and how environmental factors are documented in patients' records.

    METHODS: Eight multidisciplinary healthcare practitioners working with home-based rehabilitation after stroke participated in two semistructured focus group sessions. Thematic analysis was used to analyse the transcripts of recorded focus group discussions. Data were also collected from patient history records (N = 14) to identify interventions to increase patients' opportunities to participate in activities inside and outside the home. These records were analysed using life-space mobility as a conceptual framework.

    RESULTS: The analysis generated four overarching themes concerning possibilities and challenges in the environment: (1) the image of rehabilitation conflicts with place, (2) the person in the home reveals individual needs and capabilities, (3) environmental characteristics influence the rehabilitation practice, and (4) the person is integrated within a social context. The patient record analysis showed that most patients were discharged from hospital to home within four days. Assessments at the hospital mainly focused on basic activities of daily living, such as the patient's self-care and walking ability. Also at home, the assessments and actions primarily focused on basic activities with little focus on participation in meaningful activities performed in different life situations outside the home.

    CONCLUSIONS: Our research suggests that one way to improve practice is to include the environment in the rehabilitation and consider the person´s life space. Interventions should focus on supporting out-of-home mobility and activities as part of person-centred stroke rehabilitation. This must be supported by clear documentation in the patient records to strengthen clinical practice as well as the communication between stakeholders.

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  • 8.
    Eliassen, Marianne
    et al.
    Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.
    Sørensen, Bodil A.
    Department of Research, Development and Innovation, Municipality of Vestvågøy, Postboks 203, Leknes, Norway.
    Hartviksen, Trude A.
    Department of Health and Care Sciences, UiT, The Arctic University of Norway, Postboks 203, Leknes, Municipality of Vestvågøy, Norway.
    Holm, Solrun
    Department of Research, Development and Innovation, Municipality of Vestvågøy, Postboks 203, Leknes, Norway.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Health and Social Care administration, Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden.
    Emplacing reablement co-creating an outdoor recreation model in the rural Arctic2023In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 82, no 1, article id 2273013Article in journal (Refereed)
    Abstract [en]

    Reablement aims to enable older persons with functional decline to re-engage in meaningful activities. The benefits of engagement in outdoor activities are significant; however, reablement services primarily target function in indoor environments whereas descriptions of outdoor activities are sparse. The aim of this study was to create a model that integrates outdoor recreation into reablement. We therefore elaborated on an experienced based co-design methodology to create a model that integrates outdoor recreation for older persons in reablement in an Arctic, rural context in northern Norway. Stakeholders (N = 35), including reablement participants, participated in workshops, focus groups, and individual interviews. Based on the results, we co-created a person-centred model for outdoor recreation in reablement, including an assessment tool that can guide reablement staff in goal-setting practices. Accordingly, we argue that cherished locations holds significant meaning in the lives of older people and warrant recognition in reablement programmes. There is a need to evaluate the effects and feasibility of the model and the possibility for its implementation in other health care settings.

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  • 9.
    Fjellstrom, S.
    et al.
    Department of Health Sciences, The Swedish Winter Sport Research Centre, Mid Sweden University, Östersund, Sweden.
    Hansen, E.
    Department of Health Sciences, The Swedish Winter Sport Research Centre, Mid Sweden University, Östersund, Sweden; The Faculty of Education and Arts, Nord University, Bodø, Norway.
    Hölttä, J.
    Department of Health Sciences, The Swedish Winter Sport Research Centre, Mid Sweden University, Östersund, Sweden.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden; Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
    Nordström, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Health Sciences, The Swedish Winter Sport Research Centre, Mid Sweden University, Östersund, Sweden; School of Sports Science, UiT The Arctic University of Norway, Tromsø, Norway.
    Lund Ohlsson, M.
    Department of Health Sciences, The Swedish Winter Sport Research Centre, Mid Sweden University, Östersund, Sweden.
    Web-based training intervention to increase physical activity level and improve health for adults with intellectual disability2022In: Journal of Intellectual Disability Research, ISSN 0964-2633, E-ISSN 1365-2788, Vol. 66, no 12, p. 967-977Article in journal (Refereed)
    Abstract [en]

    Background: Individuals with intellectual disability (ID) are less physically active, have a higher body mass index (BMI) and are at greater risk for cardiovascular diseases (CVDs) than people without ID. The purpose of the study was to explore the effectiveness of a web-based training programme, consisting of 150 min of activity per week, on the health of people with ID.

    Method: Participants with ID living in supported accommodation (n = 28, 48% female, age = 36.4 ± 9.56 years) participated in a web-based training programme, consisting of a combination of exercises (endurance, strength balance and flexibility) of moderate intensity, 50 min, three times per week for 12 weeks. The body composition and waist circumference (WC) were measured, and questionnaires were used to assess enjoyment, quality of life (QoL) and physical activity (PA) level. Descriptive statistics and pairwise comparison pre and post intervention were carried out.

    Results: A total of 22 out of 28 participants completed the 12-week training intervention with 83% mean attendance of training sessions. The intensity of the PA level increased and a decrease in fat mass of 1.9 ± 2.4 kg, P < 0.001 and WC of 3 ± 5 cm, P = 0.009 were observed. Enjoyment of training sessions was 3.9 out of 5, and no differences in QoL were found.

    Conclusion: A web-based training programme is an effective tool for improving health parameters of people with ID and offers a new way for caregivers to enhance the PA for the target group.

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  • 10. Granbom, Marianne
    et al.
    Szanton, Sarah
    Gitlin, Laura N.
    Paulsson, Ulrika
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ageing in the right place: a prototype of a web-based housing counselling intervention for later life2020In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 27, no 4, p. 289-297Article in journal (Refereed)
    Abstract [en]

    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.

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  • 11.
    Hultqvist, Sara
    et al.
    Department of Health Sciences, Lund University, Lund, Sweden; Department of Social Work, Linnaeus University, Växjö, Sweden.
    Ekstam, Lisa
    Department of Health Sciences, Lund University, Lund, Swede.
    Andersson, Janicke
    Department of Social Work, Halmstad University, Halmstad, Sweden.
    Nilsson, Maria H.
    Department of Health Sciences, Lund University, Lund, Sweden; Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden.
    Overton, Marieclaire
    Division of Geriatric Medicine, Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden.
    Zingmark, Magnus
    Department of Health Sciences, Lund University, Lund, Sweden; Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden.
    Iwarsson, Susanne
    Department of Health Sciences, Lund University, Lund, Sweden.
    Conditions for uptake of evidence-based knowledge in municipal care for older people in Sweden: a developmental evaluation2022In: BMC Research Notes, E-ISSN 1756-0500, Vol. 15, no 1, article id 243Article in journal (Refereed)
    Abstract [en]

    Objective: The objective of this paper is to describe the initial phase of a long-term collaboration initiative between a municipality and the Faculty of Medicine at a university in Sweden. The overall ambition of the collaboration is to strengthen the quality of care for older people. The concrete goal is to equip academically trained registered health care professionals (HCP) with tools for transferring evidence-based knowledge into practice. As municipal healthcare for older people is mainly carried out by staff lacking academic education, reg. HCP are key actors to bring in and consolidate an evidence-based approach in this setting. Developmental evaluation (DE) has been used to evaluate four separate activities in the initial phase. The activities where sequenced in a cumulative design to provide knowledge for further development of adequate tools.

    Results: The cumulative design originally planned did not fit the internal logic of the municipality. Therefore, workflow and pace adjustments were made to proceed towards the joint ambition; the creation of fruitful conditions for the uptake of evidence-based knowledge. Long-term collaboration between academia and organizations outside academia demands a sensitive and flexible research approach, recognizing that collaboration implies mutuality and restricts the sovereignty of academia in designing research.

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  • 12.
    Johanson, Suzanne
    et al.
    Department of Health Sciences, Lund University, Lund, Sweden; Department of Health Sciences/Centre for Evidence Based Psychosocial Interventions (CEPI), Lund University, Lund, Sweden.
    Gregersen Oestergaard, Lisa
    DEFACTUM Central Denmark Region, Aarhus, Denmark; Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark.
    Bejerholm, Ulrika
    Department of Health Sciences, Lund University, Lund, Sweden; Department of Health Sciences/Centre for Evidence Based Psychosocial Interventions (CEPI), Lund University, Lund, Sweden.
    Nygren, Carita
    Swedish Association of Occupational Therapists, Nacka, Sweden.
    van Tulder, Maurits
    Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark; Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences Research Institute, Vrije University, Amsterdam, Netherlands.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Health Sciences, Lund University, Lund, Sweden; Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden.
    Cost-effectiveness of occupational therapy return-to-work interventions for people with mental health disorders: a systematic review2023In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 30, no 8, p. 1339-1356Article, review/survey (Refereed)
    Abstract [en]

    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.

  • 13.
    Kylén, Maya
    et al.
    Lund University, Lund, Skåne Län, Sweden.
    Slaug, Björn
    Lund University, Lund, Skåne Län, Sweden.
    Iwarsson, Susanne
    Lund University, Lund, Skåne Län, Sweden.
    Dahlgren, David
    Lund University, Lund, Skåne Län, Sweden.
    Bjork, Jonas
    Lund University, Lund, Skåne Län, Sweden.
    Zingmark, Magnus
    Lund University, Lund, Skåne Län, Sweden.
    Housing attribute preferences when considering relocation in older age2023In: Innovation in Aging, E-ISSN 2399-5300, Vol. 7, no Supplement_1, p. 223-223Article in journal (Refereed)
  • 14.
    Liljestrand, Caroline
    et al.
    Rehabilitation Unit, Social Care Division, Municipality of Nyköping, Sweden.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Health and Social Care Administration, Municipality of Östersund, Sweden; Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
    Use of information and communication technology in occupational therapy for older adults2024In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 31, no 1, article id 2271035Article in journal (Refereed)
    Abstract [en]

    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.

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  • 15.
    Norberg, Eva-Britt
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy.
    Biberg, Elisabeth
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Occupational Therapy.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden.
    Exploring reach and experiences of participation in health-promoting senior meetings in a municipality context2021In: Journal of Public Health, ISSN 2198-1833, E-ISSN 1613-2238, Vol. 29, p. 641-651Article in journal (Refereed)
    Abstract [en]

    Aim: To explore reach and experiences of participants during implementation of health-promoting meetings of seniors in a Swedish municipality context.

    Subjects and methods: A mixed-methods approach was used, including older people who were recruited consecutively and invited to participate as they applied for health care and/or home help services in the municipality. Inclusion criterion was allocation of “early” home-care services, e.g., meals on wheels, safety alarms. Health-care services were limited to persons applying for an outside walker. The intervention was multi-professional, e.g., occupational therapy and physiotherapy. Each session included a mix of short lectures and group discussions about, for example, the importance of engagement in meaningful activity, social contacts, and physical activity. Recruitment procedures were modified during the trial in order to enhance reach. The data collection included information on the flow of participants during recruitment and participation in the intervention, field notes covering the experience of implementing the intervention, a survey covering adherence to recruitment procedures, and qualitative interviews exploring the experience of participants.

    Results: Senior meetings were experienced as positive and strengthened the participants in dealing with health-related concerns. The identification of potential participants and recruitment were challenging, but as recruitment procedures were modified, a higher proportion of potential participants were reached. In all, there were 29 participants over the study period.

    Conclusion: For health-promoting meetings to enable community-dwelling older people to fulfill their potential by positively affecting health outcomes, recruitment procedures for optimizing reach is a critical feature.

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  • 16.
    Nordeström, Frida
    et al.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Granbom, Marianne
    Department of Health Sciences, Lund University, Lund, Sweden.
    Iwarsson, Susanne
    Department of Health Sciences, Lund University, Lund, Sweden.
    Zingmark, Magnus
    Department of Health Sciences, Lund University, Lund, Sweden;Health and Social Care Administration, Östersund Municipality, Östersund, Sweden.
    Ageing in the right place—usability of a web-based housing counselling service2023In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 31, no 1, article id 2294777Article in journal (Refereed)
    Abstract [en]

    Introduction: Residential reasoning is a complex process that includes decisions on whether to age in place or to relocate. Ageing in the Right Place (ARP), a web-based housing counselling service was created to support older adults in this process. The study’s aim was to evaluate the usability of the ARP as regards content, design, specific functions, and self-administration as a mode of delivery and to lay the ground for further optimisation.

    Material and method: Nine women and five men (aged 66–82) completed a series of tasks using the ARP. Qualitative and quantitative usability data were collected through online interviews. Data were analysed using qualitative content analysis and descriptive statistics.

    Results: Experiences of the specific functions, content, and design of the ARP were described as mainly positive. Additions to the content and optimisation to assist in the general navigation of the website were suggested. The participants disagreed regarding the preferred mode of delivery, which indicates a need for selectable options. A system usability scale median score of 84 indicated acceptable usability.

    Conclusion: The ARP seems to have acceptable usability, which paves the way for further evaluation.

    Significance: By enabling residential reasoning, older adults are supported to make proactive choices based on informed decisions.

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  • 17.
    Norström, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden; Department of Health Sciences, Lund University, Lund, Sweden.
    Pettersson-Strömbäck, Anita
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sahlen, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Öhrling, Malin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Bölenius, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    How does the distribution of work tasks among home care personnel relate to workload and health-related quality of life?2023In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 96, no 8, p. 1167-1181Article in journal (Refereed)
    Abstract [en]

    Background: The work for Swedish home care workers is challenging with a variety of support and healthcare tasks for home care recipients. The aim of our study is to investigate how these tasks relate to workload and health-related quality of life among home care workers in Sweden. We also explore staff preferences concerning work distribution.

    Methods: A cross-sectional study was conducted in 16 municipalities in Northern Sweden. Questionnaires with validated instruments to measure workload (QPSNordic) and health-related quality of life (EQ-5D), were responded by 1154 (~ 58%) of approximately 2000 invited home care workers. EQ-5D responses were translated to a Quality-adjusted life-year (QALY) score. For 15 different work task areas, personnel provided their present and preferred allocation. Absolute risk differences were calculated with propensity score weighting.

    Results: Statistically significantly more or fewer problems differences were observed for: higher workloads were higher among those whose daily work included responding to personal alarms (8.4%), running errands outside the home (14%), rehabilitation (13%) and help with bathing (11%). Apart from rehabilitation, there were statistically significantly more (8–10%) problems with anxiety/depression for these tasks. QALY scores were lower among those whose daily work included food distribution (0.034) and higher for daily meal preparation (0.031), both explained by pain/discomfort dimension. Personnel preferred to, amongst other, spend less time responding to personal alarms, and more time providing social support.

    Conclusion: The redistribution of work tasks is likely to reduce workload and improve the health of personnel. Our study provides an understanding of how such redistribution could be undertaken.

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  • 18.
    Nyman, Anneli
    et al.
    Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden; Department of Health Sciences, Lund University, Lund, Sweden.
    Lilja, Margareta
    Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden.
    Guidetti, Susanne
    Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institute, Huddinge, Sweden; Women’s Health and Allied Health Professionals Theme, Medical Unit Occupational therapy and Physiotherapy, Karolinska University Hospital, Sweden.
    Information and communication technology in home-based rehabilitation – a discussion of possibilities and challenges2023In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 30, no 1, p. 14-20Article in journal (Refereed)
    Abstract [en]

    Background: Information and communication technology (ICT) has been proven to have effect in terms of providing alternative ways to deliver rehabilitation services. The intention with this paper is to serve as a foundation for discussions regarding the future development, design, and delivery of home-based rehabilitation, including ICT.

    Aim: To reflect on and discuss the possibilities and challenges of using ICT in home-based rehabilitation services.

    Method and material: We use experiences and results from various projects to reflect on and discuss possibilities and challenges related to the use of ICT in home-based rehabilitation.

    Findings and discussion: We exemplify how ICT present new possibilities that can increase the quality of the rehabilitation process and improve access to services. We reflect on some challenges in the use of ICT, related to non-user-friendly solutions, to the specific rehabilitation situation, and a lack of technical support. At an organisational level, readiness to use ICT can impact the extent to which new solutions are integrated into practice.

    Conclusion: We emphasise that ICT has the potential to develop and improve service delivery and contribute to increased quality and accessibility of home-based rehabilitation.

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  • 19.
    Olsson Möller, Ulrika
    et al.
    Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden; Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden; Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden.
    Ekstrand, Joakim
    Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.
    Haak, Maria
    Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.
    The content of physiotherapy and factors impacting on reablement: a national study2023In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 16, p. 3075-3088Article in journal (Refereed)
    Abstract [en]

    Purpose: Reablement is a multidisciplinary intervention aimed at promoting function and independence for people with functional decline. Detailed descriptions of various professions’ actions are needed for organization and evaluation of reablement services. This study describes physiotherapy practice in a reablement context in Swedish municipalities, focusing on the content and magnitude of interventions.

    Methods: Physiotherapists (n=108) from 34 municipalities answered a web-based survey covering the target group, content and duration of their actions, and number of contacts initiated over a 3-week period. Data were analyzed with descriptive statistics and multiple logistic regression.

    Results: Overall, 1005 cases were reported, with a mean age of 78.9 years (SD: 11.7); about 91% (n=912) were aged ≥65 and 61% (n=612) were women. About 70% were allocated to home care; 16% (n=160) of these had minor functional limitations (eg, needing safety alarms/help with domestic tasks), and 55% (n=550) had major functional limitations (eg, needing help with personal activities of daily living). The most reported actions were providing technical aids (60.8%, n=576), instructions/counseling (41.5%, n=393), walking/climbing stairs (27.6%, n=262), strength training (27.2%, n=258), and fall prevention (25.5%, n=242). Almost half of the cases included one action (n=494) and about 89% (n=890) targeted primary needs (body functions, walking indoors, self-care, or domestic life), mainly in clients with major functional limitations (odds ratio=2.96; 95% confidence interval: 1.95–4.49). About 50% (n=517) of the cases involved 1–2 contacts; about 55% (n=549) were completed within 3 weeks. Exercise was associated with ≥6 visits over ≥7 weeks. Supervision of home care staff was performed in 19.1% (n=181) of cases.

    Conclusion: Reablement physiotherapy mostly comprises a few actions over a relatively short period. Whether this is a conscious strategy based on the purpose of home-based physiotherapy or clients’ needs and wishes, or conversely an expression of limited resources, remains to be investigated.

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  • 20.
    Pettersson, Beatrice
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Bajraktari, Saranda
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Skelton, Dawn
    School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Recruitment strategies and reach of a digital fall-prevention intervention for community-dwelling older adults2022In: Digital health, Vol. 8, article id 20552076221126050Article in journal (Refereed)
    Abstract [en]

    Background: To have an impact on the population's health, preventive interventions have to reach a large proportion of the intended population. Digital solutions show potential for providing wider access to fall preventive exercise. However, there is a lack of knowledge about how to reach the target group. The aim of this study was to describe the recruitment process used in the Safe Step randomised controlled trial and the characteristics of the participants reached.

    Methods: Several recruitment methods, both digital and non-digital, were adopted to reach the intended sample size. Sociodemographic parameters from the baseline questionnaire were used to describe participant characteristics. The characteristics were also compared to a representative sample of older adults in the Swedish population.

    Results: In total, 1628 older adults were recruited. Social media proved to be the most successful recruitment strategy, through which 76% of the participants were recruited. The participants reached had a mean age of 75.9 years, lived in both urban and rural locations, were already frequent users of the Internet and applications (smartphone/tablet) (79.9%), had higher education (71.9%), and a large proportion were women (79.4%). In comparison with the general population participants in the Safe Step study were more highly educated (p < 0.001), women in the study more frequently lived alone (p < 0.001) and men more often reported poorer self-rated health (p = 0.04). Within the study, men reported a faster deteriorating balance (p = 0.003) and more prescribed medication (p < 0.001) than women.

    Conclusion: Recruitment via social media is a useful strategy for reaching older adults, especially women and frequent users of the Internet, for a fully self-managed and digital fall prevention exercise intervention. This study underlines that a range of interventions must be available to attract and suit older adults with different functional statuses and digital skills.

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  • 21.
    Pettersson, Beatrice
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Skelton, Dawn A.
    School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
    Liv, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Effectiveness of a self-managed digital exercise programme to prevent falls in older community-dwelling adults: study protocol for the Safe Step randomised controlled trial2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 5, article id e036194Article in journal (Refereed)
    Abstract [en]

    Introduction: Exercise interventions have a strong evidence base for falls prevention. However, exercise can be challenging to implement and often has limited reach and poor adherence. Digital technology provides opportunities for both increased access to the intervention and support over time. Further knowledge needs to be gained regarding the effectiveness of completely self-managed digital exercise interventions. The main objective of this study is to compare the effectiveness of a self-managed digital exercise programme, Safe Step, in combination with monthly educational videos with educational videos alone, on falls over 1 year in older community-dwelling adults.

    Methods and analysis: A two-arm parallel randomised controlled trial will be conducted with at least 1400 community-living older adults (70+ years) who experience impaired balance. Participants will be recruited throughout Sweden with enrolment through the project website. They will be randomly allocated to either the Safe Step exercise programme with additional monthly educational videos about healthy ageing and fall prevention, or the monthly education videos alone. Participants receiving the exercise intervention will be asked to exercise at home for at least 30 min, 3 times/week with support of the Safe Step application. The primary outcome will be rate of falls (fall per person year). Participants will keep a fall calendar and report falls at the end of each month through a digital questionnaire. Further assessments of secondary outcomes will be made through self-reported questionnaires and a self-test of 30 s chair stand test at baseline and 3, 6, 9 and 12 months after study start. Data will be analysed according to the intention-to-treat principle.

    Ethics and dissemination: Ethical approval was obtained by The Regional Ethical Review Board in Umeå (Dnr 2018/433-31). Findings will be disseminated through the project web-site, peer-reviewed journals, national and international conferences and through senior citizen organisations’ newsletters.

    Trial registration number: NCT03963570.

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  • 22.
    Pettersson, Cecilia
    et al.
    School of Health Sciences, Örebro University, Örebro, Sweden.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden.
    Haak, Maria
    Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden; Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden.
    Enabling social participation for older people: the content of reablement by age, gender, and level of functioning in occupational therapists’ interventions2022In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 29, no 6, p. 522-529Article in journal (Refereed)
    Abstract [en]

    Background: Social participation and the ability to build and maintain social relationships is emphasized as important for older people’s health and well-being.

    Aim: To explore if social participation is addressed and whether age, gender and level of functioning are associated with the composition of occupational therapy interventions within the context of reablement.

    Method: In this cross-sectional study, invitations to participate were sent to 60 municipalities in Sweden. 318 occupational therapists participated and described the character of initiated interventions made during 3 weeks through web-based surveys.

    Result: 1392 cases were reported in the age span of 19–103 years, 61.7% were women. A higher proportion of persons having no home care and minor functional dependency got interventions with a focus on social participation to a higher extent than persons with major functional dependency. Occupational therapists’ interventions vary as related to functional limitation, age, and gender.

    Conclusion: The results indicate that the severity of functional limitation impacts the focus of the intervention whereas age and gender do not. There is a need for social participation to be more clearly addressed within the context of reablement.

    Significance: To develop a person-centred intervention, one needs to consider aspects of age, gender, and functions.

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  • 23.
    Ryan, Jean
    et al.
    K2 – The Swedish Knowledge Centre for Public Transport,;Lund University;Lund University.
    Zingmark, Magnus
    Lund University, Municipality of Östersund.
    Examining the use and non-use of special transport services in Sweden’s large city-regions: the last resort?2022In: Findings, E-ISSN 2652-8800Article in journal (Refereed)
    Abstract [en]

    This study examines the extent of the gap between the proportions of surveyrespondents reporting (1) having the possibility to use and (2) using specialtransport services (STS) compared to the corresponding gaps for other transportmodes. For persons eligible for STS, differences between those who use them andthose who do not use them are explored. The frequencies with which these twogroups leave the home are then compared. Those aged 65-69, those with higherself-rated health and those cohabiting were less likely to use STS, despite beingeligible. Those using STS tend to leave the home less often. 

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  • 24.
    Slaug, Bjorn
    et al.
    Lund University, Lund, Skåne Län, Sweden.
    Zingmark, Magnus
    Lund University, Lund, Skåne Län, Sweden.
    Iwarsson, Susanne
    Lund University, Lund, Skåne Län, Sweden.
    Associations between life space mobility and aspects of housing and service infrastructure2022In: Innovation in Aging, E-ISSN 2399-5300, Vol. 6, no Supplement_1, p. 314-314Article in journal (Refereed)
  • 25.
    Wahlberg, Martina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden.
    Stenberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Munkholm, Michaela
    Rasch analysis of the EQ-5D-3L and the EQ-5D-5L in persons with back and neck pain receiving physiotherapy in a primary care context2021In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 23, no 2, p. 102-109Article in journal (Refereed)
    Abstract [en]

    Aim: The purpose of this study was to investigate the psychometric properties of the EQ-5D-3L and the EQ-5D-5L in patients with back and neck pain.

    Materials and methods: Participants from two independent clinical survey studies was included in this study. In total 164 participants were answering either the EQ-5D-3L or the EQ-5D-5L after their visit to a physiotherapist in primary care for back and neck pain. Rasch analysis was performed to measure the psychometric properties of the two instruments.

    Main findings: Overall, the EQ-5D-5L showed preliminary evidence of good psychometric properties. The items in both the EQ-5D-5L and the EQ-5D-3L showed acceptable goodness-of-fit indicating unidimensionality for both instruments measuring the concept health-related quality of life. All test persons fit the model, but the person separation reliability and person separation index were only barely acceptable for the EQ-5D-5L.

    Conclusions: The results indicate that the EQ-5D-5L should be the preferred option when evaluating health-related quality of life with the EQ-5D, especially for patients with back and neck pain.

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  • 26.
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Occupation-focused and occupation-based interventions for community-dwelling older people: Intervention effects in relation to facets of occupational engagement and cost effectiveness2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

     Occupation-focused and occupation-based interventions can potentially promote occupational engagement among community-dwelling older people, but there is limited evidence to identify the most effective and cost-effective interventions. For independent-living older people, there is a lack of evidence to determine if occupation-focused and occupation-based interventions have an effect on their occupational engagement. For older people who need assistance because of bathing disabilities, there is limited evidence of the effects of occupation-focused and occupation-based interventions on their occupational engagement or for reducing or omitting their need for assistance. Finally, there is limited evidence to determine if occupation-focused and occupation-based interventions implemented for community-dwelling older people are cost effective.

    Aim

    The aim of this thesis was to evaluate the effects and cost effectiveness of occupation-focused and occupation-based interventions for two groups of community-dwelling older people, independent-living, community-dwelling older people and older people with bathing disabilities.

    Method

    Studies I and II were based on an exploratory randomized controlled trial. One hundred and seventy seven persons, 77–82 years, single living, and without need for home help were randomized to a no-intervention control group or to one of three occupational therapy interventions focused on promoting occupational engagement: an individual intervention, an activity group or a discussion group. In study I, effect sizes for leisure engagement and ability to perform activities of daily living (ADL) tasks were estimated for each intervention in relation to the control group to identify the most effective intervention at 3 and 12 months after baseline. In study II, the effects on quality adjusted life years (QALYs) and the total costs for the intervention, social services provided by the municipality and health care were used evaluate cost-effectiveness.

    Study III was a quasi-experimental clinical trial and included 95 persons, 65+, who had applied for municipality-based home help with bathing. For participants in the intervention group, occupational therapists implemented occupation-focused and occupation-based interventions. No occupational therapy intervention was implemented for those in the control group, but they were allocated home help services if judged to need it based on an assessment by a municipality care manager. Evaluations of ADL ability, self-rated health and allocated home help were implemented at baseline and after 15 weeks.

    Study IV involved the use of decision-modeling based on a five state Markov model that included levels of dependency in ADLs, place of residency and death. Probabilities for transitions between states in the model, QoL scores and societal costs for each state were derived from previous research. Overall, the model was based on research indicating that more severe levels of dependency reduced QALY scores and increased societal costs. Previous trials have provided evidence that an occupation-focused and occupation-based intervention implemented to reduce bathing disabilities increased the probability of independence of home help. The Markov model was used to evaluate cost-effectiveness over 8 years for an intervention compared to no intervention.

    Results

    The results of study I indicated that each intervention had a small positive effect on minimizing a decline in leisure engagement and/or ADL, but no intervention was clearly superior. In study II, the results indicated that the interventions delivered in a group format positively affected self-rated health. The discussion group was the most cost-effective intervention. The results of study III indicated that the intervention had no effect on ADL ability or self-rated health. There was, however, a large difference in the allocation of home help at follow up, indicating that the intervention was effective in reducing dependency on home help for bathing. The results of study IV indicated that compared to no intervention, the intervention resulted in a positive accumulation of QALYs and lower costs for every year during the entire 8 year period.

    Conclusion

    This thesis provides evidence to support the implementation of occupation-focused and occupation-based interventions for independent-living, community-dwelling older people in order to reduce their decline in occupational engagement and improve their self-rated health; the interventions also have the potential to be cost effective. This thesis also provides evidence that an occupation-focused and occupation-based intervention implemented for older people with bathing disabilities was effective in promoting independence from home help for bathing. Finally, an occupation-focused and occupation-based intervention that increased the probability of being independent of home help for bathing had a positive impact on the long term accumulation of QALYs and reduced societal costs and, therefore, can be considered very cost effective.

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  • 27.
    Zingmark, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden; Department of Health Sciences, Lund University, Lund, Sweden.
    Ankre, Rosemarie
    Department of Economics, Geography, Law and Tourism, Mid Sweden University, Östersund, Sweden; European Tourism Research Institute (ETOUR), Mid Sweden University, Östersund, Sweden.
    Wall-Reinius, Sandra
    Department of Economics, Geography, Law and Tourism, Mid Sweden University, Östersund, Sweden; European Tourism Research Institute (ETOUR), Mid Sweden University, Östersund, Sweden.
    Promoting outdoor recreation among older adults in Sweden – a theoretical and empirical foundation for the development of an intervention2021In: Archives of Public Health, ISSN 0778-7367, E-ISSN 2049-3258, Vol. 79, no 1, article id 232Article in journal (Refereed)
    Abstract [en]

    Background: Disengagement from outdoor recreation may diminish the positive benefits on health and well-being in old age. The purpose of this study is to present a contextual, theoretical, and empirical rationale for an intervention, aiming to promote continued engagement in outdoor recreation for older adults in a Swedish context.

    Methods: The paper includes a contextualization of outdoor recreation in Sweden, a presentation of evidence on health benefits related to engagement in outdoor recreation, together with theoretical frameworks that may guide future intervention designs. To add empirical knowledge, a mixed methods approach was applied, including an empirical data collection based on a quantitative survey (n = 266) and individual semi-structured interviews with older adults (n = 12). Survey data were presented with descriptive statistics. Associations between disengagement from previously performed activities and age and gender was analyzed with Chi2 tests. Transcripts and handwritten notes from the interviews were analyzed qualitatively to identify key themes, as well as patterns and disparities among respondents.

    Results: Outdoor recreation was rated as important/very important by 90% of respondents of the survey. The interviews highlighted that engagement in outdoor recreation aided respondents to keep fit but had also relevance in terms of identity, experiences, and daily routines. Outdoor recreation close to the place of residence was most common and walking was the most frequently reported activity. While 80% considered their health to be good/very good, disability and long-term diseases were common and during the previous year, more than half of all respondents had disengaged from activities previously performed. Reasons for disengagement were mainly related to health decline or that activities were too demanding but also due to social loss. The interviews indicated that continued engagement was important but challenging, and that disengagement could be considered as a loss or accepted due to changing circumstances.

    Conclusions: In the design of an intervention aiming to promote engagement in outdoor recreation for older adults, the following features are proposed to be considered: person-centeredness, promoting functioning, addressing self-ageism, providing environmental support, promoting subjective mobility needs and adaptation to find new ways to engage in outdoor recreation.

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  • 28.
    Zingmark, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy. Community Care Administration, Municipality of Östersund, Östersund.
    Bernspång, Birgitta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Meeting the needs of elderly with bathing disability2011In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 58, no 3, p. 164-71Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/AIMS: Difficulties with bathing are frequent among older people and are associated with an increasing need for societal support. As loss of independence has a negative impact on health and wellbeing, it is important to study interventions that can provide the required support for people to be able to remain independent. Occupational therapy interventions can improve clients' abilities enabling them to bathe themselves, thus reducing the need for other, more long-term societal support from, e.g. a home help. In this study, two groups of elderly people with difficulties in bathing were compared; the clients in the intervention group were engaged in occupational therapy.

    METHODS: A quasi-experimental non-equivalent control group design was used, in which participants with reported difficulties in bathing were recruited consecutively from two municipalities. The clients in the intervention group routinely received occupational therapy, whereas clients in the control group received assistance from a home help for bathing. Activities of daily living, quality of life and home-help allocation were assessed at the baseline and after 15 weeks.

    RESULTS: Clients in the intervention group received less than three home visits on average, with majority of interventions consisting of graded activity and the use of an encouraging approach. Seventy per cent of the interventions were adaptive. Activities of daily living and quality of life of both groups improved, but the differences of being allocated a home help were significant.

    CONCLUSION: Occupational therapy interventions seem beneficial in terms of supporting older people in becoming independent of home help in bathing but the results must be interpreted with caution as there were differences at baseline between the groups.

  • 29.
    Zingmark, Magnus
    et al.
    Department of Health Sciences, Lund University, Lund, Sweden.
    Björk, Jonas
    Granbom, Marianne
    Gefenaite, Giedre
    Nordeström, Frida
    Schmidt, Steven M
    Rantanen, Taina
    Slaug, Björn
    Iwarsson, Susanne
    Exploring associations of housing, relocation, and active and healthy aging in Sweden: protocol for a prospective longitudinal mixed methods study2021In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 10, no 9, article id e31137Article in journal (Refereed)
    Abstract [en]

    Background:While housing and neighborhood features have the potential to impact opportunities for active aging, there is a lack of knowledge related to how older people reason regarding their housing situation and how housing and fulfillment of relocation are associated with active and healthy aging.

    Objective:The objectives of Prospective RELOC-AGE are to study housing choices and relocation and explore effects on active and healthy aging among men and women aged 55 years and older in Sweden considering relocation.

    Methods: The estimated sample (2800) will include people aged 55 years and older being listed for relocation at either of two housing companies: a local public housing company in Southern Sweden and a national condominium provider. Prospective RELOC-AGE has a 2-level longitudinal mixed methods design and includes quantitative surveys (implemented by a professional survey company) and a telephone interview for baseline data collection in 2021, with follow-ups with the same procedures in 2022 and 2023. The survey and interviews include questions related to present housing and neighborhood, relocation plans and expectations, a range of perspectives on active and healthy aging, and demographics. Linking to national registers will provide additional data on home help and health care use, objective housing, and neighborhood characteristics. To explore what housing attributes older adults considering relocation find important and to what extent when making their decisions on housing, we will develop a discrete choice experiment to be implemented with a subsample of participants. Further, a grounded theory approach will be applied to collect in-depth interview data from participants who have moved to another dwelling, within 6 months of the move. A follow-up interview 12 months later will focus on participants’ deepened experience over time in terms of fulfilled expectations and relocation experiences.

    Results: As of submission of this protocol (June 2021), recruitment has commenced with approximately 960 respondents to the survey and ongoing telephone interviews. We anticipate recruitment and data collection based on surveys and interviews to continue during 2021.

    Conclusions: Prospective RELOC-AGE has the capacity to generate new policy-relevant knowledge on associations of housing, relocation, and active and healthy aging. Such knowledge is relevant for the development of proactive approaches to housing in old age on the individual, group, and societal levels.

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  • 30.
    Zingmark, Magnus
    et al.
    Lund University, Lund, Sweden.
    Björk, Jonas
    Lund University, Lund, Sweden.
    Granbom, Marianne
    Lund University, Lund, Sweden.
    Slaug, Björn
    Lund University, Lund, Sweden.
    Iwarsson, Susanne
    Lund University, Lund, Sweden.
    Prospective RELOC-AGE: Baseline data from a longitudinal mixed-methods study exploring associations of housing, relocation and active ageing in Sweden2022In: 2673-9259, Vol. 3, no 3, p. 388-389Article in journal (Refereed)
    Abstract [en]

    Introduction: To inform the design of policies and societal support related to housing, knowledge is needed about how housing and relocation are associated with active ageing and health outcomes. The objectives of Prospective RELOC-AGE are to study housing choices and relocation and explore effects on active ageing among men and women aged 55+ in Sweden considering relocation. Material and Methods: Recruitment included people aged 55+ listed with an interest for relocation at either of three housing companies. A two-level longitudinal mixed-methods design included a survey and a telephone interview for the baseline data collection. The questions related to present housing and neighbourhood, relocation plans and expectations, a range of perspectives on active and healthy ageing, and demographics. Exploratory and inferential statistics are applied to investigate how personal and neighbourhood-level characteristics are associated with active ageing and health outcomes such as life-space mobility and self-rated health.

    Results: The sample (n = 1966) included 56% women, mean age 70 years. Preliminary analyses indicated that 83% rated their health has good or better, 53% lived in apartments. Several reasons for signing up with an interest for relocation were reported. Further analyses will broaden the scope of baseline sample characteristics, and associations with active ageing, life-space mobility and self-rated health will be explored.

    Conclusions: Prospective RELOC-AGE has the capacity to generate new policy-relevant knowledge on associations of housing, relocation and active ageing relevant for the development of proactive approaches to housing in old age on the individual, group as well as societal levels.

  • 31.
    Zingmark, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Head of Research and Development Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden.
    Evertsson, Bodil
    Haak, Maria
    Characteristics of occupational therapy and physiotherapy within the context of reablement in Swedish municipalities: A national survey2020In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 28, no 3, p. 1010-1019Article in journal (Refereed)
    Abstract [en]

    Reablement is a multidisciplinary, home-based intervention implemented for people at risk of functional decline and losing independence aiming to optimise functioning and independence in activities of daily living. There is limited knowledge about what characterises the intervention and the role of different professionals. The purpose of this study was to explore the characteristics and differences of occupational therapy and physiotherapy interventions in terms of focus, content and duration within the context of reablement in Swedish municipalities. Web-based surveys were used to collect data from 43 municipalities representing 25% of the population in Sweden. Data on intervention characteristics were reported for all cases receiving occupational therapy (n = 1,395) and physiotherapy (n = 1,006) over a 15-week period. Data were presented descriptively, and differences between occupational therapy and physiotherapy were analysed using Chi-square tests. The results indicated that reablement in Sweden was implemented for adults in all ages (19-103 years, median 81.0 years); 72% had home help. For both professions, a baseline assessment was made in fewer than half of all cases. There were significant differences between occupational therapists and physiotherapists regarding the focus and content as well as the number of contacts and duration of the intervention. For occupational therapists, walking indoors and self-care were the largest focus areas, whereas for physiotherapists walking indoors and body function were the largest focus areas. For most cases, the intervention was completed within five sessions over a 6-week period. This study provides the first picture of occupational therapy and physiotherapy within Swedish reablement contexts. In relation to the results, the focus of interventions, how assessments are made and how the intervention is implemented over time are issues that can be further elaborated.

  • 32.
    Zingmark, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Health and Social Care Administration, Municipality of Östersund, Sweden.
    Evertsson, Bodil
    Haak, Maria
    The content of reablement: Exploring occupational and physiotherapy interventions2019In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 82, no 2, p. 122-126Article in journal (Refereed)
    Abstract [en]

    Statement of context: Occupational therapists and physiotherapists in a Swedish municipality answered a web-based survey about their reablement interventions.

    Critical reflection on practice: There were overlapping areas as well as differences regarding the focus of occupational and physiotherapy interventions. Regarding the duration of interventions, occupational therapy was implemented over a short time span in contrast to physiotherapy, which had a longer duration. Both professions used valid and reliable instruments to a very limited extent.

    Implications for practice: If other areas than self-care and mobility are to be addressed within reablement there is a need to critically reflect on the focus, content and duration of reablement interventions. Valid and reliable assessments can be utilised to a greater extent to guide goal-setting, the focus of interventions and to evaluate effects.mited extent.

  • 33.
    Zingmark, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fisher, Anne G.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nilsson, Ingeborg
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Occupation-focused interventions for well older people: an exploratory randomized controlled trial2014In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 21, no 6, p. 447-457Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this exploratory randomised controlled trial (RCT) was to evaluate three different occupation-focused interventions for well older people by estimating effect sizes for leisure engagement and ability in activities of daily living (ADL) and thereby identifying the most effective interventions.

    Methods: One hundred and seventy seven persons, 77-82 years old, living alone and without home help, were randomized to a control group (CG), an individual intervention (IG), an activity group (AG), and a one-meeting discussion group (DG). All interventions focused on occupational engagement and how persons can cope with age-related activity restrictions in order to enhance occupational engagement. Data were collected by blinded research assistants at baseline, three, and 12 months. Ordinal outcome data were converted, using Rasch measurement methods, to linear measures of leisure engagement and ADL ability. Standardized between-group effect sizes, Cohen's d, were calculated.

    Results: While all groups showed a decline in leisure engagement and ADL over time, the IG and the DG were somewhat effective in minimizing the decline at both three and 12 months. However, the effect sizes were small.

    Conclusions: The findings indicate that occupation-focused interventions intended to minimize a decline in leisure engagement and ADL were sufficiently promising to warrant their further research.

  • 34.
    Zingmark, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Health and Social Care Administration, Municipality of Östersund, Sweden; Department of Health Sciences, Faculty of Medicine, Lund University, Sweden.
    Kylén, Maya
    Department of Health Sciences, Faculty of Medicine, Lund University, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Feasibility of a reablement-program in a Swedish municipality2023In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 30, no 1, p. 53-64Article in journal (Refereed)
    Abstract [en]

    Background: While occupational therapists (OT) and physiotherapists (PT) have a central role in reablement, no structured approach for these professions has been described in Sweden.

    Aims/Objectives: The aim was to explore the feasibility of a reablement program developed to guide OTs and PTs in a Swedish municipality context.

    Material and methods: Eligible participants were OTs and PTs working with reablement. Feasibility was evaluated in terms of how OTs (n = 16) and PTs (n = 15) experienced the application of the program. Data were collected through web surveys during a pilot study over four months.

    Results: The program was implemented for 62 clients. Baseline assessments were conducted in 97% of all cases and follow-ups in 77%. The average duration of the program was 8 weeks and includeed 5 home visits and 3 contacts by phone. In 15 cases, a new goal was identified after follow-up. Collaboration was included with other professionals and relatives in 89% and 35% of the cases, respectively. The program was categorized as feasible to some extent in 34 cases and not feasible in 21 cases.

    Conclusions and significance: The program was feasible to some extent. To enhance feasibility, flexibility may be needed in order to tailor assessments according to the client’s health status.

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  • 35.
    Zingmark, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Nilsson, Ingeborg
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fisher, Anne
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Occupation-focused health promotion for well older people: a cost-effectiveness analysis2016In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 79, no 3, p. 153-162Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim of this study was to evaluate three occupational therapy interventions, focused on supporting continued engagement in occupation among older people, to determine which intervention was most cost effective, evaluated as the incremental cost/quality adjusted life year gained.

    Method: The study was based on an exploratory randomized controlled trial. Participants were 77–82 years, single living and without home help. One hundred and seventy seven persons were randomized to an individual intervention, an activity group, a discussion group or a no intervention control group. All interventions focused on supporting the participants to maintain or improve occupational engagement. Outcomes were evaluated at baseline, three and 12 months and included general health and costs (intervention, municipality and health care). Based on linear regression models, we evaluated how outcomes had changed at each follow-up for each intervention group in relation to the control group.

    Results: Both group interventions resulted in quality adjusted life years gained at three months. A sustained effect on quality adjusted life years gained and lower total costs indicated that the discussion group was the most cost-effective intervention.

    Conclusion: Short-term, occupation-focused occupational therapy intervention delivered in group formats for well older people resulted in quality-adjusted life years gained. A one-session discussion group was most cost effective.

  • 36.
    Zingmark, Magnus
    et al.