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Slenders JPL, de Graaf JA, Post MWM, van Heugten CM, Van den Berg-Vos RM, Kwa VIH, Visser-Meily JMA. Participation in daily life activities at two months after stroke predicts long-term health-related quality of life. Top Stroke Rehabil 2024; 31:11-20. [PMID: 37056169 DOI: 10.1080/10749357.2023.2202017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/09/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND After stroke, many patients experience problems with participation in daily activities. Improving participation is the main goal in stroke rehabilitation. However, the longitudinal relationship between participation and health-related quality of life (HRQoL) remains unclear. OBJECTIVES This study aimed to examine (1) the predictive value of participation at two months on long-term HRQoL and (2) the longitudinal relationship between participation and HRQoL. METHODS In this multicenter, prospective cohort study, patients were assessed at two and 12 months after stroke. Participation was measured with the Restriction subscale of the Utrecht Scale for Evaluation of Rehabilitation - Participation. HRQoL was assessed with the three-level version of the EuroQoL five dimensions questionnaire index score. RESULTS This study included 291 patients. Mean age was 66.6 ± 12.4 years, 64.3% were male and mean National Institutes of Health Stroke Scale (NIHSS) was 2.5 ± 2.9. Multivariable linear regression, adjusted for demographic characteristics, stroke characteristics, physical and cognitive impairment, showed that a higher level of participation at two months correlated with a higher HRQoL at one year (B = .004; 95% CI =.002-.005). Patients whose participation improved had a greater increase in HRQoL, compared to patients without improvement (0.080 ± .21 versus -.054 ± .21; p < .001). CONCLUSIONS The level of participation at two months post-stroke predicts HRQoL at one year. Improvement in participation during the first year after stroke is associated with improvement in HRQoL. We recommend including the assessment of participation in daily activities at follow-up visits.
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Affiliation(s)
| | - Joris A de Graaf
- Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Caroline M van Heugten
- School for Mental Health & Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, Netherlands
| | - Renske M Van den Berg-Vos
- Department of Neurology, OLVG, Amsterdam, Netherlands
- Department of Neurology, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
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2
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Kim JR, Park S, Lee CD. Relationship Between Resilience, Community Participation, and Successful Aging Among Older Adults in South Korea: Mediating Role of Community Participation. J Appl Gerontol 2023; 42:2233-2241. [PMID: 37522401 DOI: 10.1177/07334648231183772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
A high level of resilience is positively related to successful aging. However, interventions to increase resilience in older adults are not yet available. This study aimed to examine the mediating role of community participation in the relationship between resilience and successful aging. Data from 284 individuals aged 60 years and above were analyzed in this cross-sectional study. The pathways among resilience, community participation, and successful aging were statistically significant after controlling for sociodemographic characteristics, depression, disability, and chronic disease. The analysis revealed a partial mediating effect of community participation (unstandardized estimate = .01, p < .01), explaining 16.4% of the total effect of resilience on successful aging. Promoting community participation may be beneficial for enhancing successful aging in community-dwelling older adults. Further studies to examine the causal relationship between community participation and successful aging and to develop community services are recommended to use community resources as means to support successful aging.
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Affiliation(s)
- Jung-Ran Kim
- Department of Dementia Prevention and Rehabilitation, College of Human Service, Catholic Kwandong University, Gangneung, Republic of Korea
| | - Sangmi Park
- Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Chang Dae Lee
- Department of Rehabilitation Science and Technology, University of Pittsburgh, PA, USA; Human Engineering Research Laboratories, Department of Veterans Affairs Pittsburgh, Healthcare System and University of Pittsburgh, PA, USA
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3
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Kersey J, Kringle E, Setiawan IMA, Parmanto B, Skidmore ER. Pilot RCT examining feasibility and disability outcomes of a mobile health platform for strategy training in inpatient stroke rehabilitation (iADAPT). Top Stroke Rehabil 2023; 30:512-521. [PMID: 35583268 PMCID: PMC9672133 DOI: 10.1080/10749357.2022.2077522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Strategy training is an intervention that may reduce disability when delivered in inpatient rehabilitation following stroke. However, shorter lengths of stay and challenges with continuity of care following discharge results in difficulties in achieving adequate intervention dosage and carryover of training. OBJECTIVE We examined whether strategy training using a mobile health platform (iADAPT) is feasible during inpatient stroke rehabilitation and following discharge. METHODS In this RCT, participants were randomized to receive strategy training using either the iADAPT application (n = 16) or a workbook (n = 15). Participants in both groups received 7 in-person sessions during inpatient rehabilitation and 3 remote sessions following discharge. We calculated descriptive statistics to examine acceptance, attendance, and adherence, and within-group effect sizes on satisfaction and disability. RESULTS Participants in the iADAPT group attended fewer total intervention sessions (n = 5.5, workbook n = 9.0) but attempted a similar number of goals (n = 7.6, workbook n = 8.2). Both groups reported similar satisfaction with in-person intervention (Treatment Expectancy: iADAPT d = 0.60, workbook d = 0.47; Patient Provider Connection: iADAPT d = 0.18, workbook d = 0.31), but the mobile health group reported greater satisfaction with remote intervention (Treatment Expectancy: iADAPT d = -0.91, workbook d = -0.97; Patient Provider Connection: iADAPT d = 0.85, workbook d = -1.80). . CONCLUSIONS Considering these promising feasibility metrics and the benefits of mobile health, it is worth continuing to explore the efficacy of strategy training using a mobile health platform.
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Affiliation(s)
- Jessica Kersey
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emily Kringle
- Department of Medicine, University of Illinois at Chicago, College of Medicine, Chicago, IL, USA
| | - I Made Agus Setiawan
- Department of Health Information, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bambang Parmanto
- Department of Health Information, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Computer Science, Udayana University, Badung, Indonesia
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, USA
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Palumbo A, Aluru V, Battaglia J, Geller D, Turry A, Ross M, Cristian A, Balagula C, Ogedegbe G, Khatri L, Chao MV, Froemke RC, Urbanek JK, Raghavan P. Music Upper Limb Therapy-Integrated Provides a Feasible Enriched Environment and Reduces Post-stroke Depression: A Pilot Randomized Controlled Trial. Am J Phys Med Rehabil 2022; 101:937-946. [PMID: 34864768 PMCID: PMC9163211 DOI: 10.1097/phm.0000000000001938] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study's aims were to refine Music Upper Limb Therapy-Integrated (MULT-I) to create a feasible enriched environment for stroke rehabilitation and compare its biologic and behavioral effects with that of a home exercise program (HEP). DESIGN This was a randomized mixed-methods study of 30 adults with post-stroke hemiparesis. Serum brain-derived neurotrophic factor and oxytocin levels measured biologic effects, and upper limb function, disability, quality of life, and emotional well-being were assessed as behavioral outcomes. Participant experiences were explored using semistructured interviews. RESULTS MULT-I participants showed reduced depression from preintervention to postintervention as compared with HEP participants. Brain-derived neurotrophic factor levels significantly increased for MULT-I participants but decreased for HEP participants, with a significant difference between groups after excluding those with post-stroke depression. MULT-I participants additionally improved quality of life and self-perceived physical strength, mobility, activity, participation, and recovery from preintervention to postintervention. HEP participants improved upper limb function. Qualitatively, MULT-I provided psychosocial support and enjoyment, whereas HEP supported self-management of rehabilitation. CONCLUSIONS Implementation of a music-enriched environment is feasible, reduces post-stroke depression, and may enhance the neural environment for recovery via increases in brain-derived neurotrophic factor levels. Self-management of rehabilitation through an HEP may further improve upper limb function.
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Affiliation(s)
- Anna Palumbo
- Rehabilitation Science Program, Department of Occupational Therapy, NYU Steinhardt School of Culture, Education, and Human Development, New York, NY 10003
- Nordoff Robbins Center for Music Therapy, NYU Steinhardt School of Culture, Education and Human Development, New York, NY 10003
| | - Viswanath Aluru
- Department of Rehabilitation Medicine, NYU Langone School of Medicine, New York, NY, 10016
- Department of Physical Medicine and Rehabilitation, Kingsbrook Jewish Medical Center, Brooklyn, NY 11203
| | - Jessica Battaglia
- Department of Physical Medicine and Rehabilitation, Kingsbrook Jewish Medical Center, Brooklyn, NY 11203
| | - Daniel Geller
- Department of Rehabilitation Medicine, NYU Langone School of Medicine, New York, NY, 10016
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY 10032
| | - Alan Turry
- Nordoff Robbins Center for Music Therapy, NYU Steinhardt School of Culture, Education and Human Development, New York, NY 10003
| | - Marc Ross
- Department of Physical Medicine and Rehabilitation, Kingsbrook Jewish Medical Center, Brooklyn, NY 11203
| | - Adrian Cristian
- Department of Physical Medicine and Rehabilitation, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176
| | - Caitlin Balagula
- Department of Rehabilitation Medicine, NYU Langone School of Medicine, New York, NY, 10016
| | - Gbenga Ogedegbe
- Department of Population Health, NYU Langone School of Medicine, New York, NY 10016
| | - Latika Khatri
- Skirball Institute, NYU Langone School of Medicine, New York, NY 10016
| | - Moses V. Chao
- Skirball Institute, NYU Langone School of Medicine, New York, NY 10016
| | - Robert C. Froemke
- Skirball Institute, NYU Langone School of Medicine, New York, NY 10016
| | - Jacek K. Urbanek
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Preeti Raghavan
- Department of Rehabilitation Medicine, NYU Langone School of Medicine, New York, NY, 10016
- Department of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
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Ravesloot C, Myers A, Greiman L, Ward B, Shinnick K, Hall J. Is the presence of home entrance steps associated with community participation of people with mobility impairments? Disabil Health J 2022; 15:101183. [PMID: 34417155 PMCID: PMC10792725 DOI: 10.1016/j.dhjo.2021.101183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/22/2021] [Accepted: 08/11/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Little is known about how home entrances are related to community participation for people with mobility impairments. OBJECTIVE This investigation explored how the need to navigate steps at the entrance of a home affects the community participation levels of people with mobility impairments. METHODS This survey study used pre-measure data collected from three different samples. Participants were adults living independently in the community aged 18-94 years old who self-reported having a mobility impairment. Measures included the Brief Community Engagement Questionnaire to examine potential differential effects on the number of non-discretionary trips people make into the community (e.g., getting groceries, medications) versus the number of discretionary activities (e.g., socializing outside the home) people reported over seven days. RESULTS People with mobility impairments were less likely to report a stepped entrance than people without MI, but when the entrance they use the most had steps they reported significantly higher exertion to use the entrance. The presence of steps had no effect on non-discretionary trips (p = .74), but was associated with 49% (p < .01) fewer discretionary activities reported by people with mobility impairment relative to those without MI. CONCLUSION Steps at the home entrance of people with mobility impairment may be an important mediating factor in their level of participation. When researchers and practitioners evaluate interventions that aim to increase community participation of people with mobility impairment, they should control for the presence of steps at their home entrance.
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Affiliation(s)
- Craig Ravesloot
- Research and Training Center on Disability in Rural Communities, University of Montana, USA.
| | - Andrew Myers
- Research and Training Center on Disability in Rural Communities, University of Montana, USA
| | - Lillie Greiman
- Research and Training Center on Disability in Rural Communities, University of Montana, USA
| | - Bryce Ward
- Research and Training Center on Disability in Rural Communities, University of Montana, USA
| | - Kelsey Shinnick
- Research and Training Center on Independent Living, The University of Kansas, USA
| | - Jean Hall
- Research and Training Center on Independent Living, The University of Kansas, USA
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van Heijningen VG, Cardol M, van Heijningen-Tousain HJM, Oosterveer DM, van Markus-Doornbosch F, Sattoe JNT, van der Holst M, Hilberink SR. Aging With Cerebral Palsy: A Photovoice Study Into Citizenship. Front Neurol 2021; 12:729509. [PMID: 34531818 PMCID: PMC8439253 DOI: 10.3389/fneur.2021.729509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Adults with cerebral palsy (CP) may experience an increasing impact of their disability on daily life and this may interfere with their citizenship. Citizenship is a layered construct. Next to formal and theoretical significations, and civil rights acts such as the UN Convention on the Rights for Persons with Disabilities (CRPD), the meaning of citizenship is formed by the person themselves. The present study aimed to gain insight into what citizenship means for adults with CP 40 years or older and what is needed to support and pursue their citizenship to improve person-centered rehabilitation which can facilitate this process. Methods: Adults with CP (>40 years) without intellectual disability were recruited from medical records of a large rehabilitation center to participate in a qualitative study using the photovoice method. Participants were asked to take photos of objects or life situations that constituted citizenship for them; these photos were then the prompts for the semi-structured interviews that were held face-to-face at their homes. Background and clinical characteristics were gathered using a short face-to-face questionnaire. Data were analyzed through inductive thematic analysis. Results: Nineteen adults participated [mean age (SD) 57.8 (9.4) years (range 44-79), six men]. From the analysis four themes emerged: (a) Meanings of citizenship; (b) Citizenship: Facilitator and barriers; (c) Paradoxes of support and participation; and (d) Future. Furthermore, next to the ability to participate in society without restrictions, sense of belonging was reported to be an important aspect of "meanings of citizenship." The physiotherapist was perceived as an important health professional to maintain physical activity and deal with the impact of aging with CP on daily activities. Complex healthcare and support services regulations and aging affected citizenship negatively. Conclusion: Middle-aged and older adults with CP view citizenship as the ability to participate and belong in society. To optimize their citizenship the challenges and individual needs must be seen and supported by person-centered rehabilitation and support services. Simplification of complex healthcare and services regulations can further improve citizenship.
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Affiliation(s)
- Vera G. van Heijningen
- Research Centre Innovations in Care, Rotterdam University of Applied Science, Rotterdam, Netherlands
| | - Mieke Cardol
- Research Centre Innovations in Care, Rotterdam University of Applied Science, Rotterdam, Netherlands
| | | | | | | | - Jane N. T. Sattoe
- Research Centre Innovations in Care, Rotterdam University of Applied Science, Rotterdam, Netherlands
| | - Menno van der Holst
- Basalt Rehabilitation, Hague/Leiden, Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands
| | - Sander R. Hilberink
- Research Centre Innovations in Care, Rotterdam University of Applied Science, Rotterdam, Netherlands
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Li Y, Zhang W, Ye M, Zhou L. Perceived participation and autonomy post-stroke and associated factors: An explorative cross-sectional study. J Adv Nurs 2020; 77:1293-1303. [PMID: 33249635 DOI: 10.1111/jan.14670] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/18/2020] [Accepted: 11/04/2020] [Indexed: 11/28/2022]
Abstract
AIMS To explore the level and associated factors of perceived participation and autonomy among stroke survivors in Shanghai, China. DESIGN Cross-sectional explorative study. METHODS From January to December 2018, 431 patients presenting at the neurology departments of three hospitals with a confirmed diagnosis of stroke were recruited. Impact on Participation and Autonomy Questionnaire, modified Rankin Scale, Self-efficacy for Managing Chronic Disease six-item Scale, Medical Coping Modes Questionnaire and Multidimensional Scale of Perceived Social Support were applied to measure their participation, physical function, self-efficacy, coping styles, and social support. RESULTS The average score of perceived participation and autonomy was 41.30 (SD 21.22); and 54.3%, 46.9%, 21.6%, and 7.7% of the participants reported poor participation in social relations, family role, autonomy indoors, and autonomy outdoors. Age, physical function, self-efficacy, friend support, and knowledge of stroke were predictors of post-stroke participation. Physical function and self-efficacy were the most relevant factors of nearly all domains of participation except autonomy outdoors, while predictors of autonomy outdoors were social support, resignation coping style, and knowledge of stroke. CONCLUSION The stroke patients experienced insufficient participation compared with previous studies in western countries. Patients' physical function and self-efficacy were particularly important and contributed to their participation, while the patient's age, perceived social support, coping styles, and knowledge of stroke also played a role in formulating participation. IMPACT The results may be used to provide nurses with a better understanding of the participation among stroke patients and assist them in promoting the post-stroke participation. Nurses should pay special attention to those with older age, worse physical function, lower self-efficacy, less support, little stroke-related knowledge, or who applied resignation coping style since those patients might experience lower participation in their daily life. It needs further studies to explore the causal effects of self-efficacy, coping styles, and social support on post-stroke participation.
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Affiliation(s)
- Yuxia Li
- Nursing School, Second Military Medical University, Shanghai, China
| | - Wei Zhang
- Nursing School, Second Military Medical University, Shanghai, China
| | - Mingming Ye
- Nursing School, Second Military Medical University, Shanghai, China
| | - Lanshu Zhou
- Head of Department: Clinical Nursing, Nursing School, Second Military Medical University, Shanghai, China
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Beit Yosef A, Jacobs JM, Shenkar S, Shames J, Schwartz I, Doryon Y, Naveh Y, Khalailh F, Berrous S, Gilboa Y. Activity Performance, Participation, and Quality of Life Among Adults in the Chronic Stage After Acquired Brain Injury-The Feasibility of an Occupation-Based Telerehabilitation Intervention. Front Neurol 2019; 10:1247. [PMID: 31866924 PMCID: PMC6908485 DOI: 10.3389/fneur.2019.01247] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/08/2019] [Indexed: 12/26/2022] Open
Abstract
Objective: Acquired brain injury (ABI) is a leading cause of long-term disability. This calls for effective and accessible interventions to support participation in the community over time. One promising avenue to answer this need is telerehabilitation. Prior to conducting a larger trial, the main objective of this pilot study is to explore the feasibility, acceptability, and preliminary efficacy of a metacognitive occupation-based intervention in a telerehabilitation format with adults and older adults in the chronic phase after ABI. Methods: Five community dwelling participants (ages 65–72), 6–10 months post-ABI, with scores 2–4 on the modified Rankin scale and without dementia, completed the teleintervention. The intervention included ~10 weekly videoconferencing sessions administered by an occupational therapist using the Cognitive Orientation to Daily Occupational Performance approach. Each participant defined five functional goals and three were trained and two were not trained during the intervention. Evaluations were conducted at pre, post, and 3-month follow-up. The primary outcome measures included activity performance (The Canadian Occupational Performance Measure; COPM), participation (the Mayo-Portland Adaptability Inventory-4 Participation Index; MPAI-4-P), and quality of life (QoL) (stroke impact scale; SIS). Other measures included a feedback interview, satisfaction questionnaire, field notes, and a treatment fidelity checklist. Results: The teleintervention was found to be feasible and the participants expressed a high degree of satisfaction with the intervention and the technology use. A Wilcoxon Signed-Ranks test indicated statistically significant improvements post intervention in COPM performance (z = −2.023, p = 0.043) and satisfaction (z = −2.023, p = 0.043) ratings. Additionally, clinically significant improvements (≥2 points) in both performance and satisfaction with performance were found for each participant in at least three of their five defined functional goals. Trends toward significant improvement were found in MPAI-4-P ratings post intervention (z = −1.826, p = 0.068). Furthermore, clinically significant improvements (≥15 points) post intervention were found for each participant in some subscales of the SIS. Results were partially maintained at 3-month follow-up. Conclusions: This pilot study demonstrated the feasibility of a metacognitive occupation-based telerehabilitation intervention and its potential benefits in activity performance, participation, and QoL for older adults coping with long-term disability following ABI. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03048708.
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Affiliation(s)
- Aviva Beit Yosef
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jeremy M Jacobs
- Faculty of Medicine, Department of Geriatrics and Geriatric Rehabilitation, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shira Shenkar
- Occupational Therapy Department, Maccabi Health Services, Jerusalem, Israel
| | - Jeffrey Shames
- Medical and Health Professions Division, Maccabi Health Services, Tel Aviv-Yafo, Israel
| | - Isabella Schwartz
- Faculty of Medicine, Physical Medicine and Rehabilitation Department, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yehudit Doryon
- Occupational Therapy Department, Medical and Health Professions Division, Maccabi Health Services, Tel Aviv-Yafo, Israel
| | - Yuval Naveh
- Maccabi Health Care Services Group, Occupational Therapy Department, Bayit Balev Hospital, Bat Yam, Israel
| | - Fatena Khalailh
- Occupational Therapy Department, Hadassah Medical Center, Jerusalem, Israel
| | - Shani Berrous
- Occupational Therapy Department, Maccabi Health Services, Jerusalem, Israel
| | - Yafit Gilboa
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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