Participation in everyday occupations among persons with stroke in Iran: An exploration of perceived participation, associated factors and lived experience

The general aim of this thesis was to explore and describe perceived participation in everyday occupations, and the factors associated with participation among persons with stroke in a sample from Iran. Furthermore, the aim was to describe and understand the lived experience of participation in everyday occupations following stroke. This thesis was based on four studies. The first three studies were performed using quantitative methods and the last study used a qualitative method. In Study I the focus was on producing the Persian version of the Impact on Participation and Autonomy (IPA) questionnaire and the psychometric evaluation of the translated version to be used for persons with stroke. In Study II perceived participation and autonomy was described among persons with stroke, and different aspects of functioning and contextual factors associated with participation after stroke were explored and identified in the sample. In Study III the Persian translated version of the Occupational Gaps Questionnaire (OGQ) and the LiSat-11 checklist were produced and psychometrically evaluated to use for persons with stroke. Moreover, this study focused on describing occupational gaps after stroke and exploring their relation to different aspects of functioning and perceived life satisfaction. In Study IV the lived experience of participation in everyday occupations was explored among persons with stroke using the phenomenological approach. The findings of Study I demonstrated that participation can be measured as two different but related dimensions, performance-based participation and social-based participation. The findings of Study II showed that most participation restrictions were perceived in autonomy outdoors activities. It also identified physical function, mood state, and access to caregiving services as the most influential variables associated with dimensions of participation. The findings of Study III supported the psychometric properties of the Persian versions of the OGQ and the LiSat-11, and found “helping and supporting others” and instrumental activities of daily living to be the most common occupations in which individuals perceived gaps in participation. This study also identified the combination of three factors of physical function (including ADL ability), motor function and perceived life satisfaction as being the most influential factors associated with occupational gaps after stroke. The findings of Study IV showed that in order for individuals to adapt to their new life after stroke and be able to live their life, both doing and identity should be addressed in rehabilitation as the aspects defining the phenomenon of participation. In conclusion, this thesis contributes by generating new knowledge regarding the definition of the concept of participation. The findings highlight the importance of both dimensions in the facilitation of adaptation and participation in everyday occupations. Moreover, this thesis emphasises the importance of providing culturally sensitive rehabilitation based on the individuals’ needs and consistent with the sociocultural context when planning appropriate rehabilitation interventions. As a first exploration of participation in everyday occupations after stroke in an Iranian context, this thesis provides instruments for measuring participation and life satisfaction for use in clinical practice and research within rehabilitation in Iran

Perceived difficulty in use of everyday technology in persons with acquired brain injury of different severity : a comparison with controls

Objective: To compare the perceived difficulty in use of everyday technology in persons with acquired brain injury with different levels of severity of disability with that of controls. Methods: This comparison study recruited 2 samples of persons with acquired brain injury and controls, comprising a total of 161 participants, age range 18-64 years. The long and short versions of the Everyday Technology Use Questionnaire and the Extended Glasgow Outcome Scale were used to evaluate participants. Results: Persons with acquired brain injury demonstrated lower mean levels of perceived ability in use of everyday technology than controls (F = 21.84, degrees of freedom = 1, p < 0.001). Further analysis showed a statistically significant mean difference in perceived difficulty in use of everyday technology between persons with severe disability and good recovery, between persons with severe disability and controls, and between persons with moderate disability and controls. No significant mean difference was found between persons with severe disability and moderate disability, between persons with moderate disability and good recovery, and between persons with good recovery and controls. Conclusion: Perceived difficulty in using everyday technology is significantly increased among persons with acquired brain injury with severe to moderate disability compared with controls. Rehabilitation services should consider the use of everyday technology in order to increase participation in everyday activities after acquired brain injury

A Review on Occupational Therapy in Iran

This article is a review on occupational therapy in Iran. Occupational therapy started in the Rehabilitation faculty of Iran Medical University as a BS degree in 1973. About 2000 students were graduated in occupational therapy and are active in different parts of the country. They assist disabled individuals to achieve maximal independence. In this article a summary of the history and educational structure of occupational therapy and job opportunities of graduates of this speciality in Iran is given

Changes in perceived impact of stroke on everyday life over five years in a rehabilitation sample that received an activity of daily living intervention : A follow-up study

Objective: To compare changes in the perceived impact of stroke on everyday life over time in a rehabilitation sample that received a client-centred activities of daily living (CADL) intervention or usual ADL (UADL) intervention. Design: Longitudinal follow-up of a randomized controlled trial. Methods: A total of 145 persons with stroke were assigned into CADL or UADL. Groups were assessed using the Stroke Impact Scale (SIS) at 3 months, 12 months and 5 years post-intervention. Changes in SIS domain scores over time were compared within and between groups. Results: Changes in the impact of stroke over time were not related to which intervention the groups received. There were no significant differences in the SIS domains or stroke recovery between groups at the 3-month, 12-month and 5-year follow-ups. Despite an increased impact of stroke over time in some domains in both groups, both groups perceived a decreased impact of stroke in the Participation domain at 12 months. Perceived participation was sustained at the same level at 12 months as at 5 years in both groups. Conclusion: These findings stress the importance of access to follow-up rehabilitation interventions 1-year post-stroke to enable participation in daily activities. Such follow-up and enablement would support the use of self-management strategies in the performance of persons’ valued activities, which might be difficult to perform, due to, for example, impact on hand function or mobility. The results of this study emphasize the importance of prioritizing participation in activities that are meaningful from a personal perspective. Lay abstract In this study, perceived impact of stroke on everyday life over time was compared among 145 persons with stroke who received the client-centred or usual activities of daily living intervention. They were followed up at 3, 12 months and 5-years post-stroke. No differences were found in the impact of stroke over time between groups. Despite increased impact of stroke (indicating more problems) over time in some areas, the groups perceived decreased impact of stroke (less problems) in their participation at 12 months. Perceived participation was sustained at the same level at 12 months as at 5 years in both groups. Findings stress the importance of access to follow-up rehabilitation interventions one-year post-stroke to enable participation in daily activities, and to support the use of self-management strategies to facilitate participation in valued and meaningful activities that might be difficult due to person’s functional limitations

Communication and engagement as potentiality in everyday life between persons with young onset dementia living in a nursing home and caregivers

Objectives To explore communication and engagement in everyday situations between persons with young-onset dementia (YOD) living in a nursing home (NH) and the caregivers. Methods The study draws on ethnographic methods aligned with participatory design. Three residents with YOD living in a NH and eight staff members were recruited. A narrative approach was used for data collection and analysis. Findings Three narrative vignettes were developed representing everyday situations in which communication and engagement was enacted among residents and caregiver staff: (a) waiting for something to happen, (b) tensions about everyday communication, and (c) negotiating a combined living + working environment. The findings stress a paradoxical tension rooted in the NH as residence and workplace as well as place of calm and place of boredom. The everyday situations are interpreted differently from the perspective of the residents and staff. Conclusion The identified paradox of planned and spontaneous situations influences communication and engagement in everyday life, and the potentiality for active engagement embedded in contexts of units for residents with YOD. The degree to which everyday activities and encounters are redefined and renegotiated is an important part of caregiving practices in NH settings for residents with YOD

The sociocultural shaping of mothers’ doing, being, becoming and belonging after returning to work

The aim of this study was to explore the influence of social ideologies on the doing, being, becoming, and belonging of Western employed professional women who are new mothers, after returning to work outside the home within the first 18 months after giving birth. Although occupational science has provided valuable insights into mothering occupations, it perpetuates an individualistic focus that often neglects the complex and multifaceted societal influence on mothering. A narrative approach was used to collect and analyse data from seven Swiss women who had returned to professional level jobs after giving birth to their first child. Hitch et al.’s (2014a, 2014b) framework was employed to analyse how social ideologies influence working mothers’ doing, being, becoming, and belonging. The findings are presented through stories that illustrate the complex interplay between social norms and participants’ possibilities for doing and being as mothers and workers. Three stories are presented: ‘Balancing being a mother and work: The aspect of doing’; I don’t want to be seen as the mother only: The aspect of being a mother and belonging at work’; and ‘As a mother, you get criticised a lot: The aspect of doing and belonging to society’. This study enriches current understandings of how social ideologies pervade the context in which occupations are performed and how working mothers are influenced by them in their doing, being, becoming, and belonging

Perceived difficulty in everyday technology use among persons with acquired brain injury of different severity : a comparison with controls

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Impact on Participation and Autonomy (IPA) : psychometric evaluation of the Persian version to use for persons with stroke

The aim of this study was to evaluate the psychometric properties of the Persian version of the Impact on Participation and Autonomy questionnaire (IPA-P) to use for persons with stroke. A total of 102 persons diagnosed with first-ever stroke participated in this cross-sectional study. The psychometric properties were evaluated using a Rasch rating scale model. The results showed that IPA-P could not measure perceived participation as one unidimensional construct according to the criteria, but supported two different but related constructs. Performance-based participation consisted of 19 items including three IPA domains: autonomy indoors, family role, and autonomy outdoors. Social-based participation consisted of seven items from the social relations domain. The results provided evidence of internal scale validity, person response validity, and sensitivity for each of the two constructs of IPA-P. In conclusion, the results supported the psychometric properties of two constructs of perceived participation in the Persian sample tested. However further evaluation of psychometric properties of the IPA is needed in a variety of diagnoses and in other cultural backgrounds

Dementia care education targeting job strain and organizational climate among dementia care specialists in swedish home care services

Introduction: An increasing number of older persons live at home with various limitations, such as dementia, requiring well-educated and trained home care staff to meet their complex care needs. Dementia care specialists working in home care service have reported high levels of job strain in comparison with home care staff in general. Aim: This pilot study aims to evaluate the effects of a dementia care education model targeting self-reported job strain and organizational climate, among dementia care specialists in home care service. Methods: A quasi-experimental, one-group pretest–posttest design was applied, with 12 months’ follow-up. Participants were dementia care specialists who worked in home care service (n=34 baseline; n=30 follow-up). The data were collected using the Strain in Dementia Care Scale and Creative Climate Questionnaires, administered pre- and post-intervention. The intervention applied an educational model based on previous research in dementia care and a person-centered approach. Results: The educational model was implemented in the context of home care services. Of 34 participants at baseline, only 21 responded to the questionnaires, due to a drop off of 13 participants and recruitment of 9 new participants (follow-up=30). A significantly reduced perceived job strain among the participants was detected, indicating perceiving less difficulty in “Balancing competing needs” when caring for the older persons. No significant difference was found in the self-reported creative organizational climate between the two occasions. Conclusion: The educational model could be integrated into dementia home care and it seemed to reduce job strain among dementia care specialists. Future studies are needed to evaluate the effects of the intervention using a stronger study design and a larger sample

The Effect of Client-Centered Occupational Therapy on the Self-Care Satisfaction and Performance of Older Adults With Cerebrovascular Accidents

Objectives: This study has been done in order to evaluate the effects of client-centered occupational therapy on satisfaction and self-care performance among clients with stroke. Methods & Materials: In this study, 24 clients with stroke who were referred to Rofeydeh Stroke Rehabilitation Center were selected by randomized sampling based on the inclusion criteria and randomly divided into two groups of twelve&ndash;intervention and control. Two clients from the study group refused to continue and were excluded from the study. Subsequently, the clients in the intervention group received 24 forty-five-minute sessions of client-centered occupational therapy in self-care activities. The control underwent the conventional occupational therapy. The time of each treatment session for both groups was 45 minutes. Data collection tool included a questionnaire for client demographics, the Canadian Occupational Performance Measure (COPM) and Barthel's ADL Index. Results: There was no significant difference between the two groups in satisfaction, performance and independency in self-care neither before nor after intervention. However, for each group, independent of the other, significant differences were found before and after intervention in satisfaction levels (intervention: P=0.009 control: P=0.011), performance status (intervention: P=0.028, control: P=0.007) and independency in self-care (intervention: P=0.019 control: P=0.029). Conclusion: The findings show that client-centered occupational therapy could improve satisfaction, performance and independency in self-care among clients with stroke. However, this effect was not significant enough to be observed when the two groups were compared. The only significant difference was seen when comparisons were made before and after intervention in the intervention group