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Sandström C, Mårtensson E, Hellman T. Experiences of the Redesigning Daily Occupation programme - a qualitative study among persons with neurological diseases. Scand J Occup Ther 2024; 31:2304189. [PMID: 38242166 DOI: 10.1080/11038128.2024.2304189] [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] [Received: 10/03/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND The Redesigning Daily Occupations (ReDO) is a programme targeting persons who need to restructure activities and routines to achieve a healthier balance in everyday life. Issues that often is needed for persons with neurological diseases. AIMS/OBJECTIVES To describe how persons with neurological disease experienced the ReDo-programme and to investigate how their occupational patterns and fatigue changed during the programme. MATERIAL AND METHODS A mixed method study with a convergent parallel design including ten participants. Questionnaires and individual semi-structured interviews have been used and data analysed by descriptive statistics and thematic analysis. RESULTS The findings indicated an increased participation in everyday life after the intervention. Furthermore, the main theme showed that the intervention enabled reflections and new insight. Sub-themes included: feeling pressured to perform, being part of a group and changing occupational pattern. CONCLUSIONS Participants valued being a group; however, they experienced the intensity as being too high. The content of the intervention enabled reflections and new insights regarding their occupational pattern, which was experienced as a starting point towards behavioural changes and re-prioritisation of occupations in everyday life. SIGNIFICANCE A modified version with lower intensity and careful goal setting might be valuable for persons with neurological diseases.
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Affiliation(s)
- Carina Sandström
- Rehabilitation and Pain Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Elin Mårtensson
- Rehabilitation and Pain Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Therese Hellman
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
- Department of Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
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Kylén M, Sturge J, Lipson-Smith R, Schmidt SM, Pessah-Rasmussen H, Svensson T, de Vries L, Bernhardt J, Elf M. Built Environments to Support Rehabilitation for People With Stroke From the Hospital to the Home (B-Sure): Protocol for a Mixed Method Participatory Co-Design Study. JMIR Res Protoc 2023; 12:e52489. [PMID: 37943590 PMCID: PMC10667985 DOI: 10.2196/52489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND A global trend is to move rehabilitation closer to people's neighborhoods and homes. Still, little attention has been given to how the built environment outside the hospital setting might impact rehabilitation and recovery for stroke survivors. OBJECTIVE The overarching objective of this project is to develop conceptual models of built environments that support stroke rehabilitation and recovery outside the hospital setting. Specifically, the project will explore factors and characteristics of the built environment that support people with stroke and their families and identify innovative built environments that can be designed for local health care. The project will examine facilitators and obstacles for implementing built environmental solutions and evaluate the potential benefits, feasibility, and acceptability. METHODS The project uses a mixed methods design approach with 3 phases. In phase 1, factors and characteristics of the built environment for rehabilitation will be identified. Based on the results from phase 1, phase 2 will involve co-designing prototypes of environments to support the rehabilitation process for people with stroke. Finally, the prototypes will be evaluated in phase 3. Qualitative and quantitative methods will include a literature review, a concept mapping (CM) study, stakeholder interviews, prototype development, and testing. The project will use multidimensional scaling, hierarchical cluster analysis, descriptive statistics for quantitative data, and content analysis for qualitative data. Location analysis will rely on the location-allocation model for network problems, and the rule-based analysis will be based on geographic information systems data. RESULTS As of the submission of this protocol, ethical approval for the CM study and the interview study has been obtained. Data collection is planned to start in September 2023 and the workshops later in the same year. The scoping review is ongoing from January 2023. The CM study is ongoing and will be finalized in the spring of 2024. We expect to finish the data analysis in the second half of 2024. The project is a 3-year project and will continue until December 2025. CONCLUSIONS We aim to determine how new environments could better support a person's control over their day, environment, goals, and ultimately control over their recovery and rehabilitation activities. This "taking charge" approach would have the greatest chance of transferring the care closer to the patient's home. By co-designing with multiple stakeholders, we aim to create solutions with the potential for rapid implementation. The project's outcomes may target other people with frail health after a hospital stay or older persons in Sweden and anywhere else. The impact and social benefits include collaboration between important stakeholders to explore how new environments can support the transition to local health care, co-design, and test of new conceptual models of environments that can promote health and well-being for people post stroke. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52489.
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Affiliation(s)
- Maya Kylén
- Department of Health Sciences, Lund University, Lund, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Jodi Sturge
- Department of Design, Production and Management, Faculty of Engineering Technology, University of Twente, Twente, Netherlands
| | - Ruby Lipson-Smith
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, Australia
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | | | - Hélène Pessah-Rasmussen
- Department of Neurology, Rehabilitation Medicine, Memory Clinic and Geriatrics, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Tony Svensson
- School of Information and Engineering, Dalarna University, Borlänge, Sweden
| | - Laila de Vries
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Julie Bernhardt
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Sweden
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Simpson DB, Jose K, English C, Gall SL, Breslin M, Callisaya ML. "Factors influencing sedentary time and physical activity early after stroke: a qualitative study". Disabil Rehabil 2021; 44:3501-3509. [PMID: 33399023 DOI: 10.1080/09638288.2020.1867656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE We aimed to understand from the perspective of stroke survivors and their carers (1) factors contributing to sedentary time and physical activity during inpatient rehabilitation and the transition home, and (2) actual and perceived opportunities to reduce sedentary time and increase physical activity. MATERIAL AND METHODS Qualitative study with 7 stroke survivor/carer dyads and 8 stroke survivors. Semi-structured interviews were conducted 2-4 weeks after hospital discharge, audio recorded and transcribed prior to thematic analysis. RESULTS Stroke survivors were mean age 69 [SD15] years (53% male). Carers were mean age 62 [SD15] years (86% were female). Five themes were identified: (1) Education and guidance about physical activity and sedentary behaviour after stroke is important to build understanding of recovery and secondary prevention, (2) Stroke survivors need clear communication about safety and risk, (3) Return to life participation supports motivation for and engagement in physical activity, 4) Social and professional influences and 5) Opportunities to be physically active. CONCLUSION Stroke survivors and their carers need a clearer understanding of the role of physical activity and risks of sedentary time during stroke recovery. Physical activity enablers included consistent communication, building confidence and skills to self-manage activity before discharge.Implications for RehabilitationInpatient rehabilitation and early after discharge may be an important time-point to support stroke survivors to establish long term physical activity behaviours before contact with healthcare professionals reduces.To reduce sedentary behaviour, people need to understand the health benefits of breaking up sedentary time and people who need physical support to stand up will need greater support from health professionals.Being able to imagine a future post-stroke self is important motivation to get up and move. Rehabilitation should help develop a person's vision of their post-stroke self.Managing potential risks in hospital without overly restricting physical activity is important and requires consistent communication from the multi-disciplinary team.Building a person's confidence and skills to self-manage physical activity in the community prior to discharge home may be another key enabler for activity.
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Affiliation(s)
- Dawn B Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Kim Jose
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Institute for the Study of Social Change, University of Tasmania, Hobart, Australia
| | - Coralie English
- School of Health Sciences, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle Priority Research Centre for Stroke and Brain Injury, Newcastle, Australia
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
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Hughes JG, Sharma R, Brough N, Majumdar A, Fisher P. ‘The care that you give to yourself’: A qualitative study exploring patients' perceptions of self-care. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dosanjh M, Alty J, Martin C, Latchford G, Graham CD. What is it like to live with a functional movement disorder? An interpretative phenomenological analysis of illness experiences from symptom onset to post-diagnosis. Br J Health Psychol 2020; 26:325-342. [PMID: 33058369 DOI: 10.1111/bjhp.12478] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/25/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES With few empirically supported treatments, functional movement disorders (FMD) can be challenging to manage. To enable service providers to better support people with FMD, this study sought to understand the lived experience of FMD: to gain insight into how individuals make sense of their experience from symptom onset through medical evaluation and diagnosis to post-diagnostic adaptation. DESIGN An interpretative phenomenological analysis (IPA) of patient accounts of living with FMD. METHODS Eight participants were recruited from a UK teaching hospital adult neurology service: seven females, varying in age (20s-70s), FMD symptom type (tremor, dystonia, and tics), and time to diagnosis (10 - 192 months). Semi-structured interviews facilitated participant accounts of key events. Interviews lasted 75-125 minutes and were transcribed verbatim. RESULTS Three super-ordinate themes were apparent. The first covered the experiences of onset ('Something is wrong with me'), including loss of control - with the affected body part often described as a separate entity - threats to identity and disturbance in relationships. 'At last! What now?' outlined the bittersweet experience of diagnosis and of treatments. Third, 'Living my life with it' incorporated ongoing experiences of coping with symptoms. While some continued to struggle with the emotional impact of symptoms, others developed a compassionate relationship with their self and maintained satisfying activities. CONCLUSIONS FMD has a significant impact on patients' relationships with themselves and others, which in turn affects well-being. These findings suggest some nuanced additions to interventions (diagnosis, psychotherapy, physiotherapy, public education.).
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Affiliation(s)
- Mandip Dosanjh
- Leeds Institute of Health Sciences, University of Leeds, UK.,Department of Clinical and Health Psychology, Leeds Teaching Hospitals NHS Trust, UK
| | - Jane Alty
- Department of Neurosciences, Leeds Teaching Hospitals NHS Trust, UK.,College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Carol Martin
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Gary Latchford
- Leeds Institute of Health Sciences, University of Leeds, UK.,Department of Clinical and Health Psychology, Leeds Teaching Hospitals NHS Trust, UK
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Kılınç S, Erdem H, Healey R, Cole J. Finding meaning and purpose: a framework for the self-management of neurological conditions. Disabil Rehabil 2020; 44:219-230. [DOI: 10.1080/09638288.2020.1764115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Stephanie Kılınç
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Hannah Erdem
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Rebecca Healey
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Joanne Cole
- Neuro Key (working title of the Tees Valley, Durham and North Yorkshire Neurological Alliance), Acklam Green Centre, Middlesbrough, UK
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Fletcher S, Kulnik ST, Demain S, Jones F. The problem with self-management: Problematising self-management and power using a Foucauldian lens in the context of stroke care and rehabilitation. PLoS One 2019; 14:e0218517. [PMID: 31216337 PMCID: PMC6584009 DOI: 10.1371/journal.pone.0218517] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 06/04/2019] [Indexed: 02/01/2023] Open
Abstract
Self-management is a concept which is now firmly established in Western healthcare policy and practice. However, the term remains somewhat ambiguous, multi-faceted and contentious. This is evident in stroke care and rehabilitation, in which a self-management approach is increasingly adopted and advocated, yet interpreted in different ways, resulting in contradictions and tensions around control, responsibility, power and discipline. This paper aims to further our understanding of tensions and contradictions in stroke self-management, by critically examining contemporary self-management practices. We use a Foucauldian theoretical lens to explore the various power dynamics in the operationalisation of self-management, in addition to the complexity of the term self-management itself. Conducting a secondary analysis of interview and focus group data from the Self-Management VOICED study, supplemented with analysis of relevant documentary evidence from policy and practice, we describe the multiple aspects of power in operation. These include rhetorical, hierarchical, personal and mutual forms of power, representing interweaving dynamics evident in the data. These aspects of power demonstrate underlying agendas and tacit and explicit understandings of self-management which exist in clinical practice. These aspects of power also give insight into the multiple identities of ‘self-management’, acting as a simultaneous repressor and liberator, directly in keeping with Foucauldian thinking. The findings are also consistent with Foucault’s notions of bodily docility, discussions around governance and biopower, and contemporary discipline. Our analysis positions self-management as a highly nuanced and complex concept, which can fluctuate in its conceptualisation depending on the structures, routines, and the individual. We encourage healthcare professionals, policymakers and commissioners in the field of self-management to reflect on these complexities, to make transparent their assumptions and to explicitly position their own practice accordingly.
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Affiliation(s)
- Simon Fletcher
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, United Kingdom
| | - Stefan Tino Kulnik
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, United Kingdom
| | - Sara Demain
- School of Health Professions, University of Plymouth, Plymouth, United Kingdom
| | - Fiona Jones
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, United Kingdom.,Bridges Self-Management Limited, London, United Kingdom
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Leviton A, Oppenheimer J, Chiujdea M, Antonetty A, Ojo OW, Garcia S, Weas S, Fleegler E, Chan E, Loddenkemper T. Characteristics of Future Models of Integrated Outpatient Care. Healthcare (Basel) 2019; 7:healthcare7020065. [PMID: 31035586 PMCID: PMC6627383 DOI: 10.3390/healthcare7020065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 01/01/2023] Open
Abstract
Replacement of fee-for-service with capitation arrangements, forces physicians and institutions to minimize health care costs, while maintaining high-quality care. In this report we described how patients and their families (or caregivers) can work with members of the medical care team to achieve these twin goals of maintaining-and perhaps improving-high-quality care and minimizing costs. We described how increased self-management enables patients and their families/caregivers to provide electronic patient-reported outcomes (i.e., symptoms, events) (ePROs), as frequently as the patient or the medical care team consider appropriate. These capabilities also allow ongoing assessments of physiological measurements/phenomena (mHealth). Remote surveillance of these communications allows longer intervals between (fewer) patient visits to the medical-care team, when this is appropriate, or earlier interventions, when it is appropriate. Systems are now available that alert medical care providers to situations when interventions might be needed.
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Affiliation(s)
- Alan Leviton
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Julia Oppenheimer
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Madeline Chiujdea
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Annalee Antonetty
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Oluwafemi William Ojo
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Stephanie Garcia
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Sarah Weas
- Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Eric Fleegler
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Eugenia Chan
- Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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