Psychometric properties of the Satisfaction with Daily Occupations (SDO) instrument and the Manchester Short Assessment of Quality of Life (MANSA) in women with scleroderma and without known illness

Association between stressful life events and depression, anxiety, and quality of life among urban adolescents and young adults in Latin America

Background

Latin American youth have a high prevalence of mental health disorders and face major socioeconomic and public safety problems. This study assesses the association between stressful life events (SLEs) and depression, anxiety, and quality of life among adolescents and young adults from deprived neighbourhoods of Latin America.

Methods

The sample consisted of 2,402 participants, between adolescents (15-16 years) and young adults (20-24 years), from Bogotá (Colombia), Buenos Aires (Argentina), and Lima (Peru), assessed in 2021-2022 and recruited in education and community settings and social media. We evaluated the most frequent recent and distant SLEs (occurred in the previous year and more than a year ago, respectively), the relationship between SLEs and severity of depression (PHQ-8), anxiety (GAD-7), and quality of life (MANSA), and we tested for differences by gender and age group.

Results

The most common recent and distant SLEs were related to public safety issues and financial distress. Accidents and school suspensions were more frequent among men, and sexual harassment and bullying among women. Every additional reported recent SLE increased the odds of mild, moderate, and severe depression (18, 17, and 25%, respectively) and anxiety (10, 17, and 21%, respectively) symptoms. Similar trends were found with distant SLEs and depression (8, 9, and 11% for mild, moderate, and severe symptoms, respectively) and anxiety (9, 11, and 12%, respectively). Furthermore, a higher number of recent and distant SLEs were associated with lower quality of life (β = -0.05, p < 0.001, 95% CI [-0.06, -0.04] and β = -0.04, p < 0.001, 95% CI [-0.05, -0.03], respectively). The relationship between mental distress and quality of life of recent SLEs seems stronger than the one from distant SLEs, and recent SLEs may have a higher impact on adolescents' mental health compared with young adults.

Conclusion

Both recent and distant SLEs are related to mental distress and quality of life. Policies and programmes should aim to enhance public and health safety, as well as improve individual, family, and community protective factors that could mitigate the effect of SLEs on Latin American youth.

Psychometric Properties of the Spanish Version of the Satisfaction With Daily Occupations and Occupational Balance in Spanish Stroke Survivors

IMPORTANCE

Stroke survivors experience changes in participation level, satisfaction with participation, and participation balance, making it necessary to have a validated tool for their assessment.

OBJECTIVE

To evaluate the psychometric properties of the Spanish version of the Satisfaction With Daily Occupations and Occupational Balance (SDO-OB) in stroke survivors.

DESIGN

Psychometric study.

SETTING

National multicenter study (rehabilitation centers, and hospitals).

PARTICIPANTS

One hundred forty stroke survivors with and without a primary caregiver.

OUTCOMES AND MEASURES

Participants completed the SDO-OB, the five-level version of the EQ-5D (EQ-5D-5L), and the Activity Card Sort (ACS). Internal consistency, convergent validity, known-groups validity, and floor and ceiling effects were assessed. Intraobserver reliability was assessed 1 wk apart.

RESULTS

The internal consistency was acceptable; Cronbach's α = .80, 95% confidence interval (CI) [0.75, 0.85]. A moderate correlation was found between the SDO-OB summed participation level and summed participation satisfaction (ρ = .53). Both SDO-OB summed scores correlated with ACS scores (0.25 < ρ < .61). However, only summed participation satisfaction scores correlated with the emotional component of the EQ-5D-5L (ρ = .32). The SDO-OB discriminated between groups with and without a caregiver (p = .001) and had no floor or ceiling effects (<7%). Good intraclass correlation coefficients (ICCs) were obtained for summed participation level (ICC = .91; 95% CI [.85, .94]) and summed participation satisfaction (ICC = .86; 95% CI [.78, .92]). Standard error of measurement and minimum detectable change were 0.7 and 1.9 points, respectively, for summed participation level and 4.5 and 12.4, respectively, for summed participation satisfaction.

CONCLUSIONS

The Spanish version of the SDO-OB presented good psychometric properties, making it a suitable instrument to address participation level, participation satisfaction, and participation balance in stroke survivors. Plain-Language Summary: After a stroke, survivors experience changes in their participation in daily activities and how satisfied they are with them. This study examined whether a tool called Satisfaction With Daily Occupations and Occupational Balance (SDO-OB) could provide reliable information about this. We looked at 140 stroke survivors from different places in Spain to see whether they had someone caring for them, how healthy they were, and how their participation in daily activities changed after stroke. We found that the SDO-OB is helpful for understanding a stroke survivor's situation and can identify areas needing intervention and track changes caused by intervention plans.

Web-based training intervention to increase physical activity level and improve health for adults with intellectual disability

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.

Systematic review of 29 self-report instruments for assessing quality of life in older adults receiving aged care services

BACKGROUND

Quality of life (QoL) outcomes are used to monitor quality of care for older adults accessing aged care services, yet it remains unclear which QoL instruments best meet older adults', providers' and policymakers' needs. This review aimed to (1) identify QoL instruments used in aged care and describe them in terms of QoL domains measured and logistical details; (2) summarise in which aged care settings the instruments have been used and (3) discuss factors to consider in deciding on the suitability of QoL instruments for use in aged care services.

DESIGN

Systematic review.

DATA SOURCES

MEDLINE, EMBASE, PsycINFO, Cochrane Library and CINAHL from inception to 2021.

ELIGIBILITY CRITERIA

Instruments were included if they were designed for adults (>18 years), available in English, been applied in a peer-reviewed research study examining QoL outcomes in adults >65 years accessing aged care (including home/social care, residential/long-term care) and had reported psychometrics.

DATA EXTRACTION AND SYNTHESIS

Two researchers independently reviewed the measures and extracted the data. Data synthesis was performed via narrative review of eligible instruments.

RESULTS

292 articles reporting on 29 QoL instruments were included. Eight domains of QoL were addressed: physical health, mental health, emotional state, social connection, environment, autonomy and overall QoL. The period between 1990 and 2000 produced the greatest number of newly developed instruments. The EuroQoL-5 Dimensions (EQ-5D) and Short Form-series were used across multiple aged care contexts including home and residential care. More recent instruments (eg, ICEpop CAPability measure for Older people (ICECAP-O) and Adult Social Care Outcomes Toolkit (ASCOT)) tend to capture emotional sentiment towards personal circumstances and higher order care needs, in comparison with more established instruments (eg, EQ-5D) which are largely focused on health status.

CONCLUSIONS

A comprehensive list of QoL instruments and their characteristics is provided to inform instrument choice for use in research or for care quality assurance in aged care settings, depending on needs and interests of users.

Cross-Cultural Adaptation, Validation and Reliability of the Spanish Satisfaction with Daily Occupations-Occupational Balance (SDO-OB): An Evaluation Tool for People with Mental Disorders

Occupation can be defined as all activities that occupy a person's time. The Satisfaction with Daily Occupations and Occupational Balance instrument evaluates the perceived satisfaction with performance and the balance in time dedicated to different occupations. The main aim was to translate the original instrument to Spanish and examine and establish the psychometric properties. This is a quantitative, cross-sectional study conducted in two stages: translation and cultural adaptation (forward translation, expert panel, back-translation, second expert panel and pre-testing and cognitive interviewing) and collecting data to evaluate psychometric properties (homogeneity, construct validity, known-groups validity, and floor/ceiling effects). One hundred participants took part in the study, adults with a diagnosis of a mental health disorder and adults without any known health problems. The Spanish version showed known-groups validity, acceptable internal consistency, and construct validity, although the relationships with some of the indicators of discriminant validity were somewhat higher than expected. The instrument shows promise as a useful screening tool for assessing activity level and satisfaction with daily occupations among a Spanish speaking population.

Latent structure of secondary traumatic stress, its precursors, and effects on people working with refugees

The study aims to examine the latent structure of secondary traumatic stress (STS), its precursors, and the psychological effects of it on the population of service providers working with refugees passing through the Balkan route. A total of 270 service providers (57% female) of different professional backgrounds working directly with refugees took part in the study. Participants were assessed for STS using the Secondary Traumatic Stress Scale, the extent of secondary exposure to trauma (i.e., clients’ traumatic experiences from the countries of origin and travel that were communicated to them directly), depression, anxiety, and quality of life. Comparisons of several confirmatory factor analyses following prominent PTSD conceptualizations showed that the model with three relatively distinct but highly correlated factors–intrusion, avoidance, and the blend of negative alterations in cognitions, mood, and reactivity (NACMR), had the best fit. STS has been shown to be positively correlated both with the amount of different traumatic experiences that were communicated to them as well as with the specific content of those experiences. Path analysis showed that the amount of secondary exposure to the clients’ traumatic experiences during travel, but not in the country of origin, had exclusive relationships with all three factors of STS. NACMR demonstrated direct effects on anxiety and depression symptoms, while intrusions exhibited a direct effect on anxiety-related symptomatology only. The avoidance factor did not have any independent direct effects on anxiety or depression. Finally, the effects of STS factors on quality of life were fully mediated by an increase of depression-related symptomatology. Results provide evidence on the latent structure of the STS which partially deviates from the prominent models of PTSD thus questioning the isomorphism of two constructs on the empirical level. Additionally, findings provide insights on the cascade of events that make professionals working with traumatized people especially vulnerable to STS and broader psychological distress.

Tailoring cognitive behavioural therapy to subtypes of voice-hearing using a novel tabletised manual: a feasibility study

BACKGROUND

Cognitive behavioural therapy for psychosis (CBTp) is a recommended treatment for psychotic experiences, but its effectiveness has been questioned. One way of addressing this may be to tailor therapy materials to the phenomenology of specific psychotic experiences.

AIM

In this study, we investigated the acceptability of a novel treatment manual for subtypes of 'voice-hearing' experiences (i.e. auditory verbal hallucinations). An uncontrolled, single-arm design was used to assess feasibility and acceptability of using the manual in routine care for people with frequent voice-hearing experiences.

METHOD

The manual was delivered on a smart tablet and incorporated recent research evidence and theory into its psychoeducation materials. In total, 24 participants completed a baseline assessment; 19 started treatment, 15 completed treatment and 12 participants completed a follow-up assessment (after 10 sessions of using the manual).

RESULTS

Satisfaction with therapy scores and acceptability ratings were high, while completion rates suggested that the manual may be more appropriate for help with participants from Early Intervention in Psychosis services rather than Community Mental Health Teams.

CONCLUSION

Within-group changes in symptom scores suggested that overall symptom severity of hallucinations - but not other psychosis features, or beliefs about voices - are likely to be the most appropriate primary outcome for further evaluation in a full randomised controlled trial.

Everyday Occupations and Other Factors in Relation to Mental Well-Being among Persons with Advanced Parkinson's Disease

This cross-sectional study investigated performed activities and the level of satisfaction with everyday occupations among people (n = 67) with advanced Parkinson's disease (PD), and how these factors and experiences of social relationships were related to mental well-being. Managing one's hygiene and physical exercises were activities that the majority still performed, whereas few were engaged in work or other productive occupations. Perceived health problems and satisfaction with everyday occupations were important factors for mental well-being since satisfaction with everyday occupations may be an important focus for occupational therapists and other health professionals when supporting mental well-being among persons with advanced PD.

Satisfaction with Daily Occupations for Elderly People (SDO-E)-Adaptation and Psychometric Testing

Satisfaction with everyday occupations has been shown to be important for health and well-being in various populations. Research into satisfaction with everyday occupations among elderly persons is, however, lacking. The aim was to investigate the psychometric properties of an adapted test version of the Satisfaction with Daily Occupations instrument (SDO) for elderly people, called SDO-E. Five hospital-based occupational therapists working with elderly people evaluated the content validity and usability of the SDO-E. The elderly participants consisted of 50 people from outside of the health services and 42 inpatients at an internal medicine clinic. They completed the SDO-E and rated their perceived health, activity level, and general satisfaction with daily occupations. The SDO-E showed fair content validity and utility, acceptable internal consistency, good preliminary construct validity and relevant known-groups validity. The SDO-E thus appears to be a useful screening tool for assessing activity level and satisfaction with daily occupations among elderly people, and a complement to other self-report instruments concerning factors connected with health and well-being. Future research should further explore the content validity of the SDO-E, particularly the views of the elderly themselves, and investigate the SDO-E in terms of sensitivity to change.

Temperament, Character, and Self-Esteem in Relation to Occupational Performance in Individuals with Schizophrenia

Occupational therapy researchers have tried to clarify the links between occupation and state-like characteristics, such as people's experienced health, disability, and quality of life. However, to fully examine the spectrum of potential influences on occupation, trait-like features should also be investigated. This study focused on personality and self-related factors, in terms of temperament, character, and self-esteem, and how these influenced certain facets of daily occupation (activity level, occupational engagement, and satisfaction with daily occupations) in 72 adults with schizophrenia. Trait properties were associated with different facets of daily occupation. Self-esteem and the temperament dimension “persistence” explained most of the variance in both activity level and occupational engagement, whereas the character dimension “self-directedness” accounted for most of the variance in satisfaction with daily occupations. Thus, both the character and self aspects, regarded as influenced by social learning and developing over time, and the temperament dimensions, regarded as innate traits that are stable over time, exhibited such relationships. The findings highlight the role of people's trait-like properties in relation to their capacity for occupational performance, an area that has been addressed in theoretical discussions but needs to be further explored in empirical studies. If the findings of this study can be replicated in future studies, the effect of personality on occupational performance should be carefully considered in occupational therapy practice.

Relationships between Occupational Factors and Health and Well-Being in Individuals with Persistent Mental Illness Living in the Community

Purpose. This study identified relationships between occupational factors and health and well-being among individuals with persistent mental illness. Methods. There were 103 subjects assessed in regards to time spent in different occupations, activity level, satisfaction with daily occupations, and experienced occupational value. The health-related variables were self-rated health, quality of life, self-esteem, sense of coherence, self-mastery, psychosocial functioning, and psychiatric symptoms. Results. Subjective perceptions of occupational performance were consistently related to both self-rated and interviewer-rated aspects of health and functioning. While variables pertaining to actual doing showed weak or no associations with self-rated health-related variables, they exhibited moderate relationships to interviewer-rated health and functioning. Implications. The health-promoting ingredients in occupations were determined by the way occupations were perceived, rather than the doing per se. The findings indicate that perceived meaning and satisfaction ought to be prioritized when setting goals in occupational therapy practice, and, besides, that existing occupational therapy theory needs to be updated.

Quality of life in systemic sclerosis

Systemic sclerosis (SSc) is a chronic multi-system autoimmune disease associated with disability and reduced quality of life. There is no effective treatment or cure to SSc, so it is important improve global health of these patients and reduce morbidity and mortality associated with SSc. It was made a literature review about quality of life in patients with SSc, regarding the several factors that should be considered and evaluated when attending to SSc patients. It was also considered the validated scales and questionnaires used to measure outcomes in patients with SSc. We concluded that it is important to have an interdisciplinary approach to SSc patients considering the patient's cognitive representations of the disease and what they value most like mobility and hand function, pain, fatigue, sleep, depression and body image.

The Satisfaction with Daily Occupations (SDO-13) Scale: Psychometric Properties among Clients in Primary Care in Sweden

This article describes the results to expand and develop the use of the Satisfaction with Daily Occupations (SDO-13) Scale. Data were collected in primary care before (I) and after intervention (II) among clients with stress-related disorders and musculoskeletal pain. The Cronbach's alpha values of the SDO-13 Scale were 0.80 and 0.88. Convergent validity was assessed against global occupational satisfaction and general health, resulting in rs = -0.65 (p < 0.001) and rs = -0.46 (p < 0.001). The SDO-13 Scale could not discriminate between the primary care sample and a psychiatric sample (p = 0.15), whereas number of current occupations could (p < 0.001). The SDO-13 was not sensitive to change (p = 0.92). Future studies need to explore criterion and construct validity based on more dissimilar samples and more standardized interventions. Applications of these results to practice are discussed.

The psychometric properties of the Arabic version of the Satisfaction with Daily Occupations

Introduction

There is a shortage of tools designed for use by occupational therapy practice in Arabic-speaking countries. The purpose of this study was to translate and cross-culturally adapt the original Satisfaction with Daily Occupations tool to Arabic and assess the psychometric properties of the adapted tool.

Method

A cross-cultural adaptation process was performed. Face, content, and criterion validity were examined, as well as internal consistency and test–retest reliability. The study included 147 healthy adults and 73 patients with cerebrovascular accident. They were purposefully selected from two countries (Kuwait and Jordan).

Results

The adapted tool comprised six domains and a total of 14 items. Face and content validity were established through prolonged content analysis. Criterion validity was indicated by significant differences between the healthy and the cerebrovascular accident group in all areas of the Satisfaction Daily Occupations scale ( p < 0.001). Satisfactory overall internal consistency (α = 0.77) and good test–retest reliability for the total satisfaction score for the healthy (inter-class correlation coefficient (ICC) = 0.984) and the cerebrovascular accident group (inter-class correlation coefficient (ICC) = 0.933) were found.

Conclusions

The Satisfaction with Daily Occupations-Arabic version is a valid and reliable tool for use with Arabic-speaking occupational therapy clients. This study has several implications for occupational therapy education, practice, and research in the Arab world.

Exploring quality of life as an intervention outcome among women with stress-related disorders participating in work rehabilitation

Background

Findings from quality of life studies are often inconclusive for reasons such as: i) estimates may address different aspects of quality of life and thus produce different outcomes; ii) quality of life is largely determined by self-factors; and iii) people with a long-term condition rate their quality of life better than those who have had their condition for a short duration. This makes quality of life a complex phenomenon to measure.

Aims

The above explanations served as hypotheses for this methodologically oriented paper, based on a longitudinal study on women with stress-related disorders receiving work rehabilitation.

Methods

Eighty-four women participating in a lifestyle intervention or care as usual were compared. Self-ratings of “general quality of life” and a summarized “satisfaction with different life domains” index (according to Manchester Short Assessment of Quality of Life) and two self-factors (self-esteem and self-mastery) were administered at admission and a 6-month follow-up. Participant age and amount of months on sick leave prior to rehabilitation were used as two proxies of duration of the condition.

Results

General quality of life distinguished between the groups, whereas satisfaction with life domains did not. Self-esteem and self-mastery were related to both quality of life aspects. Age was related to both estimates of quality of life, whereas duration of sick leave was unrelated to both.

Conclusion

General quality of life and satisfaction with life domains produced different results. Outcome studies should apply more than one operationalization of quality of life and self-factors should be considered as important determinants of quality of life. Duration of the condition needs to be acknowledged as well when interpreting levels of quality of life, although the current study could not present any clear-cut findings in this respect.

Psychometric properties and factor structure of the 13-item satisfaction with daily occupations scale when used with people with mental health problems

Background

In mental health care practice and research it is increasingly recognized that clients’ subjective perceptions of everyday occupations, such as satisfaction, are important in recovery from mental illness. Instruments thus need to be developed to assess satisfaction with everyday occupations. The aim of the present study was to assess psychometric properties of the 13-item Satisfaction with Daily Occupation (SDO-13) when used with people with mental health problems, including its internal consistency, factor structure, construct validity and whether the scale produced ceiling or floor effects. An additional question concerned if the factor structure varied whether the participants were, or were not, presently engaged in the activity they rated.

Methods

The interview-based SDO-13 includes items pertaining to work/studies, leisure, home maintenance, and self-care occupations. Whether the person currently performs an occupation or not, he/she is asked to indicate his/her satisfaction with that occupation. The SDO-13 was completed with 184 persons with mental illness. Residual variables were created to remove the variation linked with currently performing the targeted occupation or not and to assess the factor structure of the SDO-13. The indicators of general satisfaction with daily occupations, self-esteem and global functioning were used to assess construct validity. The statistical methods included tests of homogeneity, confirmatory factor analysis and Pearson correlations.

Results

The internal consistency was satisfactory at 0.79. A three-factor solution indicated that the construct behind the SDO-13 was composed of three facets; Taking care of oneself and the home, Work and studies, and Leisure and relaxation. The same factor structure was valid for both original scores and the residuals. An expected pattern of correlations with the indicators was mainly found, suggesting basic construct validity. No ceiling or floor effects were found.

Conclusions

Taken together, the findings suggest the SDO-13 is a reliable and robust instrument that may be used to get an overview of the satisfaction people living with mental illness derive from their daily occupations.

Psychometric evaluation of the Danish version of Satisfaction with Daily Occupations (SDO)

AIMS

The Satisfaction with Daily Occupations (SDO) scale assesses satisfaction within the domains of work, leisure, domestic tasks, and self-care. The aim was to investigate the psychometric properties of the Danish version of the SDO when used with asylum seekers.

METHODS

The participants were 93 Danes without known ill health and 43 asylum seekers. They completed the SDO and rated their perceived health, activity level, and general satisfaction with daily occupations. Translation into Danish and back-translation into Swedish was made by professional interpreters.

RESULTS

Internal consistency was α = 0.75 for the Danish sample and α = 0.79 for the asylum seekers. The SDO distinguished between asylum seekers and the Danish sample, suggesting criterion validity. Concurrent validity, analysed against general satisfaction with daily occupations, was indicated for both samples. Discriminant validity was indicated against self-rated health for both samples and against activity level for the Danish sample. There was, however, a correlation of 0.65 between the SDO satisfaction score and activity level for the asylum seekers.

CONCLUSION

The SDO exhibited satisfactory internal consistency and criterion and concurrent validity. The findings regarding discriminant validity were somewhat inconclusive. The Danish SDO may be regarded as psychometrically sound but further psychometric testing is needed.

The validity of occupational performance assessments: a validity generalization meta-analysis

The purpose of this meta-analysis was to determine sample weighted mean validity effect sizes for occupational performance assessments, and their generalizability from research to clinical settings. The bare-bones Validity Generalization (VG) guidelines developed by Hunter and Schmidt ( 2004 ) augmented by Maximum Likelihood (ML) procedures were used to complete the meta-analysis. The sample consisted of 27 studies in which convergent, divergent, and predictive validity estimates of occupational performance assessments were investigated. The mean coefficients of assessments validated in the studies constituting the sample for this meta-analysis ranged from medium to large. Further meta-analysis with complete dis-attenuation of observed mean validity coefficients is indicated.

Psychometric testing of a self-report measure of engagement in productive occupations

BACKGROUND

Occupational therapists working with clients in productive occupations explicitly or implicitly assess their clients' occupational engagement.

PURPOSE

To investigate the psychometric properties of the Profiles of Occupational Engagement in People with Severe Mental Illness: Productive Occupations (POES-P) in terms of internal consistency, initial construct validation, and floor and ceiling effects.

METHOD

Participants (n = 93) from six day centres completed the data collection. Correlations between the POES-P and instruments measuring similar and dissimilar attributes, such as satisfaction, psychosocial functioning, and unmet needs, were studied.

FINDINGS

A moderate relationship was found between the POES-P and occupational satisfaction (r(s) = 0.43) and a weak one with psychosocial functioning (r(s) = 0.22). The association with researcher-assessed participant engagement was slightly higher (r(s) = 0.37), and the relationship with unmet needs was nonsignificant (r(s) = -0.15). Internal consistency of the POES-P (alpha = 0.85) was good, but the distribution of responses indicated a ceiling effect.

IMPLICATIONS

The POES-P seems promising for assessing engagement in work-like occupations but would benefit from further development.

Outcome and clinical changes in patients 3, 6, 12 months after a severe or major hand injury--can sense of coherence be an indicator for rehabilitation focus?

Background

Our objective was to explore outcome and clinical changes in hand function, satisfaction in daily occupations, sleep disturbances, health and quality of life in consecutive patients after a severe or major hand injury. Our objective was also to investigate possible differences between groups according to severity of injury, presence of peripheral nerve injury and the patients' sense of coherence.

Methods

A postal questionnaire, including demographic data, disabilities of the arm, shoulder and hand (DASH), QoL (SF-36), EuroQol (EQ-5D VAS), hand function (VAS), satisfaction in daily occupation (SDO), was sent out 3, 6 and 12 months after injury to 45 consecutive patients with a severe or major hand injury. Sense of coherence (SOC) was evaluated at 6 months. For the descriptive study, non-parametric tests were used since almost all results were measured with ordinal scales, the study sample was small, and most variables not normally distributed.

Results

Almost all self-assessed aspects of hand function, satisfaction in daily occupations, health (DASH), and physical QoL (SF-36) improved statistically for the whole group over time. Large clinical improvement was seen for physical QoL and health, while a low or no improvement was observed for mental QoL, and cold sensitivity. Few differences were found between participants with a severe or major of hand injury or with or without a major nerve injury. No significant differences in demographic data were observed between participants with high or low SOC, but participants with low SOC showed significantly lower satisfaction in daily occupations, higher DASH scores, lower mental QoL, more sleep disturbances, and bodily pain. Correlation was found between SOC, and QoL, health and satisfaction in daily occupations.

Conclusions

SOC had a significant influence on patients with a severe or major traumatic hand injury. Patients with lower SOC would probably benefit from extra support and help to master their daily life, indicating that sense of coherence is an indicator for future rehabilitation focus.

Belonging and doing: important factors for satisfaction with sexual relations as perceived by people with persistent mental illness

BACKGROUND

It is increasingly acknowledged that satisfaction with sexual relations forms an important aspect of people's lives, but little is known of factors associated with this phenomenon among people with mental illness.

AIM

This study aimed to investigate how demographic, social, clinical, and health-related factors were related to satisfaction with sexual relations.

METHODS

Patients with persistent mental illness (N = 103), recruited from an outpatient unit, were assessed regarding the target variables.

RESULTS

No clinical variable, and only one demographic factor, namely being a cohabitant, was found to be important to satisfaction with sexual relations. Several social factors, pertaining to how everyday occupations were valued and how the social network was perceived, were shown to be of importance. General quality of life, but not self-rated health or interviewer-assessed psychopathology, was also important for satisfaction with sexual relations. A multivariate analysis showed that the most significant factor for satisfaction with sexual relations was how everyday activities were valued, and being a cohabitant explained some additional variation.

CONCLUSION

Previous research indicates that the mental health care services largely neglect sexual problems among people with mental illness, and the findings may provide additional knowledge that may be used in the support of this target group.

Pain, fatigue and hand function closely correlated to work ability and employment status in systemic sclerosis

OBJECTIVE

To identify factors, individual and work related, influencing work ability, and to assess the association between work ability and employment status, activities of daily life (ADLs) and quality of life in patients with SSc.

METHODS

Fifty-seven consecutive patients (53 females/4 males) with SSc (47 lcSSc/10 dcSSc) were included. Median age was 58 [interquartile range (IQR) 47-62] years and disease duration 14 (9-19) years. The patients were assessed for socio-demographic characteristics, disease parameters, symptoms, work ability, empowerment and adaptations in a workplace, social support, ADLs and quality of life.

RESULTS

Work ability, assessed with the Work Ability Index (WAI) could be evaluated in 48 of 57 patients. The correlation between employment status and WAI was good (r(s) = 0.79, P < 0.001). Thirteen patients had good or excellent WAI, 15 had less good and 20 had poor WAI. There were no significant differences between subgroups of WAI and socio-demographic characteristics, disease duration or degree of skin and lung involvement. However, patients with good WAI expressed milder perceived symptoms (pain, fatigue and impaired hand function; P < 0.001). Patients with better WAI had better competence (P < 0.001), better possibility of adaptations at work (P < 0.01) and impact at work (P < 0.01) than those with poorer WAI.

CONCLUSIONS

In SSc, pain, fatigue and impaired hand function have a dominant impact on the WAI. Employment interventions should include support in job adaptations as well as self-management strategies to help patients deal with pain and fatigue and to enhance the confidence to perform their work.

Daily occupations – performance, satisfaction and time use, and relations with well-being in women with limited systemic sclerosis

PURPOSE

To describe activity level, operationalized as ADL capacity and performance of occupations, and occupational balance, operationalized as time use and satisfaction with occupations, in women with limited systemic sclerosis, and to investigate the relationship between these occupational factors and disease characteristics, demographic variables and wellbeing.

METHOD

Forty-four women of working age and with long-standing limited systemic sclerosis were assessed regarding occupational factors, clinical variables, sociodemographic characteristics and well-being.

RESULTS

The women exhibited a generally high activity level and were satisfied with their daily occupations. More time spent working was related to spending less time on household chores, greater satisfaction with occupations in general and greater well-being. Symptoms such as breathlessness, fatigue and pain, influenced ADL capacity and satisfaction with occupations negatively.

CONCLUSIONS

Work seems to be an important factor for satisfaction with occupations and well-being. This emphasizes the importance of investigating risk factors for work disability in people with systemic sclerosis, and of developing strategies for people with a work disability to enable them to maintain routines and a structured day. The findings also demonstrate the importance of reinforcing performance in satisfying occupations in order to maintain a feeling of well-being.

Lower gastrointestinal symptoms and quality of life in patients with systemic sclerosis: a population-based study

OBJECTIVE

To investigate the frequency and nature of bowel symptoms in a population-based cohort of patients with systemic sclerosis (SSc), compared with healthy controls, and to relate these symptoms to health-related quality of life (HR-QOL).

METHOD

Seventy-nine SSc patients and 158 matched controls answered a validated questionnaire on gastrointestinal (GI) symptoms and Medical Outcomes Study Short Form Health Survey (SF-36). Modified Miller Score, a composite score measuring faecal incontinence, was computed.

RESULTS

Abnormal stool consistency, bloating, a feeling of incomplete evacuation, faecal incontinence and rectal bleeding were more frequently reported by SSc patients than controls. The ability for anorectal discrimination, and deferring defecation was diminished in SSc patients. Bowel function affected general well being in 30% of patients and social life in 20%. Patients had lower SF-36 scores, that is, worse HR-QOL than controls. Modified Miller Score did not correlate to the SF-36 scores in patients, but other lower GI symptoms, especially abdominal pain and bloating, were associated with diminished HR-QOL.

CONCLUSION

Lower GI symptoms, including faecal incontinence, are more common in patients with SSc than in healthy controls and are of consequence to the individual patient's life. The lower prevalence of anorectal discrimination in the SSc patients suggests a neuronal defect in these patients. Increased awareness of these symptoms might stimulate a search for new diagnostic and therapeutic strategies.

Work status, daily activities and quality of life among people with severe mental illness

OBJECTIVE

Work is often a desired goal for people with mental illness, as expressed by both themselves and their relatives. This study investigated the importance of work status, everyday activities and objective life indices for subjective quality of life, with a special focus on quality of life domains.

METHOD

The sample consisted of 103 individuals with severe mental illness in Sweden, a majority of whom had schizophrenia. Interview-based questionnaires were used to assess quality of life (MANSA) and activity factors (SDO, OVal-pd).

RESULTS

Work status and activity in terms of actual doing were of some, but minor, importance to subjective quality of life domains, whereas satisfying and valuable activities were consistently associated with most quality of life domains.

CONCLUSION

Although no causal relationship could be established, the findings indicate that open-market work might not be decisive for subjective quality of life, but that satisfying and meaningful everyday activities could contribute to a better life quality for those who have a severe and lasting mental illness.

Content Validity, Clinical Utility, Sensitivity to Change and Discriminant Ability of the Swedish Satisfaction with Daily Occupations (SDO) Instrument: A Screening Tool for People with Mental Disorders

A screening tool for assessing satisfaction with daily occupations among people with mental illness has been devised — the Swedish version of the Satisfaction with Daily Occupations (SDO) instrument — comprising a satisfaction scale and an activity level scale. The aim was to investigate the SDO for content validity, clinical utility, sensitivity to change and discriminant ability.

Nine occupational therapists evaluated the content validity of the SDO. Sensitivity to change was assessed on a sample of 36 clients in psychosocial occupational therapy. Discriminant ability was evaluated by comparing four samples: (1) 103 clients with a diagnosis of severe mental illness, (2) 55 clients attending an outpatient mental health clinic, (3) 36 women with a diagnosis of systemic sclerosis and (4) 40 healthy women.

The SDO rendered positive ratings regarding content validity, but some rewording of items was indicated as well as clearer instructions. Both the satisfaction scale and the activity level scale were found to be responsive to change. Discriminant ability was shown in that, in particular, the activity level score distinguished the mentally ill participants from the other samples.

The SDO was shown to reflect the targeted phenomenon satisfactorily and to be sensitive enough to detect change following an occupational therapy intervention. However, so far only the Swedish version of the SDO has been studied, but an English version is available whose cross-cultural validity should be examined.

Working ability in relation to disease severity, everyday occupations and well-being in women with limited systemic sclerosis

OBJECTIVE

To investigate how women with SSc and varying degrees of working ability differed regarding disease severity, everyday occupations and well-being. Working ability was operationalized according to the degree of sick leave.

METHODS

Forty-four women of working age with lcSSc were assessed regarding sociodemographic characteristics, disease severity including organ manifestation, perceived physical symptoms, hand function, and satisfaction with everyday occupations, self-rated health and well-being.

RESULTS

The subjects formed three groups with regard to reduction in working capacity. Twenty-one women (48%) had no sick leave, 15 women (34%) were on partial sick leave and eight women (18%) were temporarily on full-time sick leave or had a full disability pension. There were no statistically significant differences concerning sociodemographics between the groups. Women without sick leave had less physically demanding jobs (P = 0.026), and the hypothesis that working ability reflects lower disease severity was confirmed regarding dexterity grip force and perceived fatigue and breathlessness (P < 0.05). Greater working ability was associated with better capacity to perform activities of daily life (P < 0.01), greater satisfaction with occupations (P < 0.01), better well-being (P < 0.001) and better health (P < 0.001).

CONCLUSIONS

Fifty per cent of the women were restricted in their working ability; the lower the working ability, the lower their perceived well-being. This emphasizes the need for further research into the factors that promote working ability and the development of suitable methods to improve working ability.