The influence of contextual factors on an intervention for people with disabilities from support persons’ and health personnel's perspectives: a focus group study

IntroductionContextual factors influence interventions in healthcare and pose a particular challenge in interventions designed for people with profound intellectual and multiple disabilities (PIMD). Exploring support persons’ and health personnel’s experience of an intervention may improve our understanding of the influence of contextual factors. Such exploration is important for revealing areas and focus points for future implementations. Therefore, the aim of this study is to explore support persons’ and health personnel’s experience of contextual factors during involvement in an intervention for people with PIMD.MethodsThis focus group study includes eight groups, comprising a total of 34 support persons and health personnel, at habilitation centres at four regions in central Sweden. Data were analysed inductively using a content analysis approach.ResultsThree themes emerged from the analysis of the informants’ perspectives on the contextual factors: (1) structure and support enhances intervention feasibility; (2) an intervention’s benefit for people with PIMD increases its acceptability; and (3) being engaged and involved increases support persons’ and health personnel’s motivation. Our findings show that the implementation of an intervention for people with PIMD should focus on the recipients of the intervention in its context, forming a clear communication plan. A training programme should be provided for the recipients and providers of the intervention.DiscussionFinally, the implementation process can be facilitated by creating space for staff to contribute and by encouraging participation and ownership for everyone involved. Using a co-design strategy can enable a shared responsibility to solve the identified challenges, while contributing to the development and design of future interventions for people with disabilities

Investigating cognitive impairment, biopsychosocial barriers, and predictors of return to daily life among older stroke survivors

PurposeThe aim was to investigate the associations between cognitive impairment and biopsychosocial factors among older stroke survivors and predictors of poststroke return to daily life.Materials and methodsThis cross-sectional study involved 117 stroke survivors (61% men) with an average age of 77 years (range 65–91). The participants completed two questionnaires (Riksstroke and Short Form 36 questionnaires). The Montreal Cognitive Assessment (MoCA) was used to assess cognitive abilities. The International Classification of Functioning, Disability, and Health (ICF) framework guided the selection of biopsychosocial variables. We used Spearman’s correlation coefficient and multiple logistic regression in the analyses.ResultsThe average MoCA score was 21.7 points (range: 4–30, SD 5.6). The need for assistance from relatives and professionals, need for help with dressing and household chores, reliance on others for mobility, and reading and balance problems were correlated with more severe cognitive impairment (r = 0.20–0.33). Cognitive impairment, fatigue, and balance issues predicted an unfavorable return to daily life (odds ratio: 6.2–6.8).ConclusionThe study indicated that cognitive impairment is associated with difficulties in all ICF domains. Cognitive impairment, fatigue, and balance issues are associated with an unsuccessful return to daily life. Prioritizing these factors and screening for cognitive impairment with objective assessment tools may improve rehabilitation outcomes and enhance overall quality of life poststroke

Salivary cortisol levels and stress in adults with profound intellectual and multiple disabilities participating in the Structured Water Dance Intervention: A randomised controlled crossover trial

The Structured Water Dance Intervention (SWAN) is a dance-oriented aquatic group activity directed to give opportunities for the joy of movement, relaxation, and reduced stress. This study aimed to evaluate the effects of SWAN on salivary cortisol and stress in adults with profound intellectual and multiple disabilities (PIMD). A total of 34 adults with PIMD at four habilitation centres in Sweden completed the SWAN intervention. The intervention was administered for 40 min once a week during a 12-week period. Saliva cortisol was collected in the morning and evening at baseline one week before the intervention, thrice during the intervention period, and one week after the intervention. Moreover, in connection with the SWAN sessions, the participants’ level of stress was also assessed by the accompanying assistants. The results showed that salivary cortisol and participants stress decreased significantly, directly after the SWAN sessions compared with measures directly before sessions. The study demonstrates that adults with PIMD have diurnal salivary cortisol patterns consistent with those observed in adults without disability and that the SWAN reduces salivary cortisol levels and stress in people with PIMD; this justifies that SWAN could be considered in the choice of interventions to reduce stress in adults with PIMD. Trial registration: This study is registered 09/04/2019 on ClinicalTrials.gov (ID: NCT03908801)

Återgång i arbete efter förvärvad hjärnskada : livskvalitet, möjligheter och hinder

In Sweden, about 35–40 percent of people who acquire a brain injury can return to work. To be able to help people with acquired brain injury to return to work, it is important to know about experiences and factors that facilitate return to work and how they affect quality of life. The overall aim of this thesis is to investigate the opportunities and barriers for people with acquired brain injury to return to work, as well as the importance of returning to work for their quality of life. Four studies were conducted: two interview studies and two register studies, giving qualitative and quantitative data.The major finding in this thesis was that people with acquired brain injury who could return to work had high functioning in all levels of the biopsychosocial model. The opportunities increased if the return to work was individually adapted in all phases of the process and if the person was motivated and supported by support persons with commitment, cooperation and adaptation. Those who had a university education, got their driver’s license reinstated, had high motor function and could return towork showed the greatest increase in their quality of life.Return to work is a complex process for people with acquired brain injury that could be successful if they are motivated, can balance the internal and external demands to return to work, get individual adaptation, and receive committed support. Their quality of life also increased more if theywere able to return to work

Change in quality of life in relation to returning to work after acquired brain injury : a population-based register study

PURPOSE: This study investigated changes in quality of life (QoL) in relation to return to work among patients with acquired brain injury (ABI). METHOD: The sample consisted of 1487 patients with ABI (63% men) aged 18-66 years (mean age 52) from the WebRehab Sweden national quality register database. Only patients who worked at least 50% at admission to hospital and were on full sick leave at discharge from hospital were included. QoL was measured by the EuroQol EQ-5D questionnaire. RESULTS: Patients who returned to work perceived a larger improvement in QoL from discharge to follow-up one year after injury compared to patients who had not returned to work. This difference remained after adjustment for other factors associated with improved QoL, such as having a university education, increased Extended Glasgow Outcome Scale scores and getting one's driving licence reinstated. CONCLUSION: Return to work is an important factor for change in QoL among patients with ABI, even after adjusting for other factors related to QoL. This is consistent with the hypothesis that having employment is meaningful, increases self-esteem and fosters participation in society. Thus, helping patients with ABI return to work has a positive influence on QoL.Funding Agency:University Health Care Research Centre, Region Örebro County, Sweden</p

Hälso- och sjukvårdskuratorns funktion i rehabilitering för personer med stroke

Att stödja patienter i rehabilitering efter stroke är en viktig funktion för hälso- och sjukvårdskuratorn. I denna artikel analyseras hälso- och sjukvårdskuratorns funktion utifrån ett systemteoretiskt perspektiv med stöd av patienternas erfarenheter av resiliens och livskvalitet. Intervjuer med 19 personer med stroke sekundäranalyserades tematiskt och resulterade i fem områden av betydelse för hälso- och sjukvårdskuratorns funktion. De teman som framkom på mikronivå var: trygghet och förutsägbarhet; mening och hopp. På mesonivå: socialt och formellt stöd; samordna och informera. På makronivå: kunskapsspridning och kompetens. Den legitimerade hälso- och sjukvårdskuratorn funktioner återfinns således systemteoretiskt på alla nivåer vilket innebär att de professionellt antar en helhetssyn med fokus på individen i relation till dennes situation och kontext

Hälso- och sjukvårdskuratorns funktion i rehabilitering för personer med stroke

Att stödja patienter i rehabilitering efter stroke är en viktig funktion för hälso- och sjukvårdskuratorn. I denna artikel analyseras hälso- och sjukvårdskuratorns funktion utifrån ett systemteoretiskt perspektiv med stöd av patienternas erfarenheter av resiliens och livskvalitet. Intervjuer med 19 personer med stroke sekundäranalyserades tematiskt och resulterade i fem områden av betydelse för hälso- och sjukvårdskuratorns funktion. De teman som framkom på mikronivå var: trygghet och förutsägbarhet; mening och hopp. På mesonivå: socialt och formellt stöd; samordna och informera. På makronivå: kunskapsspridning och kompetens. Den legitimerade hälso- och sjukvårdskuratorn funktioner återfinns således systemteoretiskt på alla nivåer vilket innebär att de professionellt antar en helhetssyn med fokus på individen i relation till dennes situation och kontext.Supporting patients in rehabilitation after stroke is an important function for the health care counsellor. This article analyzes the function of the health care counsellor from a systems theory perspective, as applied to patient experiences of resilience and quality of life. Interviews with 19 people af-fected by stroke were analyzed thematically and resulted in five areas of im-portance for the health care counsellor’s function. The themes that emerged at the micro level were: security and predictability; meaning and hope; at the meso level: social and formal support; coordination and information; and at the macro level: dissemination of knowledge and competence. The regis-tered health care counsellors’ function at different levels within the system, which means that they professionally adopt a holistic view focusing on the individual in relation to the situation and context