Psychometric properties of the arabic version of occupational value with pre-defined ítems

BACKGROUND

Perceived occupational value is closely linked with well-being and there is need worldwide for assessment tools that target this phenomenon. The Occupational Value with pre-defined items (OVal-pd), measuring three dimensions of occupational value; concrete, socio-symbolic and self-rewarding, was designed for that purpose.

AIM

To pilot an Arabic version of OVal-pd and evaluate its psychometric properties in terms of content validity, factor structure, homogeneity, construct validity, test-retest stability, floor and ceiling effects, and measurement error.

METHODS

Snowball sampling was used to recruit Arabic-speaking persons living in Sweden (n = 55). They completed the OVal-pd and questionnaires addressing background factors, content validity and feasibility. Confirmatory factor analysis, Spearman's rank correlation, Cronbach's α, intraclass correlation coefficients, and minimum detectable change were calculated.

RESULTS

A 22-item version of the Arabic OVal-pd was found to have acceptable content validity and feasibility and the proposed three occupational value dimensions were confirmed. Good properties in terms of construct validity, internal consistency and test-retest stability were also established. No floor or ceiling effects were observed.

CONCLUSION

The Arabic OVal-pd showed good validity and reliability on various psychometric aspects.

SIGNIFICANCE

In today's multicultural societies, the Arabic OVal-pd can be an important tool for occupational therapists working with Arabic-speaking clients.

Worker role perceptions and work participation among people with mental health issues taking part in interventions focusing on everyday life

BACKGROUND

Knowing whether interventions addressing everyday life as a whole can affect work readiness for people with severe mental health issues would be important for how to develop support.

OBJECTIVE

To compare two groups of people with mental health problems, receiving either of two types of 16-week activity-based interventions, Balancing Everyday Life (BEL) or Care as Usual (CAU), regarding work readiness in terms of perceived worker role and satisfaction with recent work experience. Changes from baseline (T1) to completed intervention (T2) and a six-month follow-up (T3) and variables of potential importance to changes were also explored.

METHODS

This cluster RCT recruited participants for BEL (n = 133) and CAU (n = 93) from specialized and community-based psychiatry. Questionnaires addressing work readiness and potentially influencing variables (sociodemographic, clinical, type of intervention, work experience, non-work activity factors, social interaction and self-esteem) were used. Mixed model regression analyses were employed.

RESULTS

Positive changes occurred for both groups in one worker role aspect (resources for a future worker role) and in satisfaction with recent work participation. Satisfaction with non-work everyday activities, having valued activities, and self-esteem were important for change in the work readiness variables, whereas intervention type, age, sex or general activity level were not.

CONCLUSION

Both interventions yielded equally positive work readiness outcomes. Support that emphasizes engagement in satisfying and valued everyday activities and boosts self-esteem would be a potential way to help people with mental health issues develop work readiness in terms of the worker role and satisfaction with work participation.

Outcomes of the Tree Theme Method versus regular occupational therapy: A longitudinal follow-up

INTRODUCTION

Depression and anxiety disorders affect individuals' everyday lives, and treatments that can help them to perform everyday occupations are needed. Occupational therapy for this group has been evaluated from a short-term perspective but not from a long-term perspective; further research is thus warranted. The aim of the study was to investigate the longitudinal outcomes of the Tree Theme Method (TTM) compared with care as usual, provided by occupational therapists, in terms of everyday occupations, psychological symptoms, and health-related aspects.

METHODS

This randomised controlled trial comprised a follow-up 3 and 12 months after an intervention. A total of 118 participants (19-64 years) with depression or anxiety disorders and problems with everyday occupations completed the base line questionnaires, 100 completed the follow-up at 3 months, and 84 completed the follow-up at 12 months. Imputations of missing data were performed using the last observation, and parametric analysis was used.

RESULTS

Both groups showed significant improvements (P value ≤ 0.01) in everyday occupations, psychological symptoms and health-related aspects after 3 and 12 months. No significant differences were found between the groups.

CONCLUSION

This study contributes with knowledge about the outcomes of occupational therapy for clients living with depression and anxiety disorders. Both TTM and care as usual lead to significant improvements over time concerning everyday occupations, psychological symptoms, and health-related aspects. The fact that both occupational therapy methods were associated with improvements for clients with depression and anxiety supports client-centredness in enabling an occupational therapist to choose the method best suited for the individual.

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.

Quality of life among people with psychiatric disabilities attending community-based day centres or Clubhouses

BACKGROUND

People with psychiatric disability have been found to have a poorer quality of life (QOL) compared to the general population, and QOL is an important outcome from psychosocial rehabilitation.

AIMS

This study aimed at comparing users of two approaches to psychosocial rehabilitation in Sweden, community-based mental health day centres (DCs) and clubhouses, regarding QOL. A further aim was to investigate predictors of QOL.

METHODS

People regularly attending DCs (n = 128) or clubhouses (n = 57) completed questionnaires at baseline and a 9-month follow-up about socio-demographics, QOL, self-esteem, social network, satisfaction with daily occupations, satisfaction with services and the unit's organisation.

RESULTS

Quality of life remained stable over time in both groups. QOL at follow-up was associated with baseline self-esteem, social network, satisfaction with daily occupations and QOL at baseline. The strongest indicator of a higher QOL at follow-up was attending a clubhouse programme followed by having scored high on QOL at baseline.

CONCLUSION

Both approaches were suited for supporting their users in maintaining QOL. Visiting clubhouses seems, however, advantageous for QOL in a longer-term perspective. Although this study contributed some new knowledge, research should further address which circumstances are associated with maintaining stability in QOL.

Treatment of depression and/or anxiety - outcomes of a randomised controlled trial of the tree theme method® versus regular occupational therapy

BACKGROUND

Depression and anxiety disorders are a major concern in western countries, and because these often have a negative affect on everyday life interventions based on activities in everyday life are needed. The Tree Theme Method® (TTM) is a client-centred occupational therapy intervention designed to increase the ability to cope with, and to enhance satisfaction with, everyday life, both at home and at work. The aim of this study was to compare the short term outcomes of the TTM intervention with regular occupational therapy treatment for people with depression and/or anxiety disorders.

METHODS

This randomised controlled trial included patients from three counties in Sweden. Men and women with depression and/or anxiety disorders, ages 18 to 65, were randomised to either TTM or regular occupational therapy. Assessment data were collected at baseline and the follow-up directly after completing the intervention. Non-parametric and parametric statistical methods were used.

RESULTS

The questionnaires were answered by 118 patients at baseline and by 107 patients after completing the intervention. No significant differences in short term outcomes were found between the groups. Both groups showed positive significant outcomes regarding almost all aspects of activities in everyday life, psychological symptoms, and health-related and intervention-related aspects.

CONCLUSIONS

Despite the lack of differences between the groups, the positive outcomes regarding activities in everyday life, psychological symptoms, and health-related aspects after completing the intervention indicates the need for further research on the long-term perspective of TTM compared to regular occupational therapy.

TRIAL REGISTRATION

Clinical Trials.gov: NCT01980381 ; registered November 2013.

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.

Measuring Opportunities for Engaging in Meaningful Home-Based Activities in Housing Services for People With Psychiatric Disabilities: Development of the Perceived Meaning of Activity in Housing (PMA-H)

There is a scarcity of instruments for assessing opportunities for residents with psychiatric disabilities to engage in meaningful home-based activities. We thus developed the Perceived Meaning of Activity in Housing (PMA-H), containing four subscales (activity opportunities, social interaction, developing as a person, and organization and planning). The aim of the study was to investigate the content validity, utility, internal consistency and concurrent and criterion validity of the PMA-H, as well as possible floor and ceiling effects. One hundred and fifty-five residents in supported housing (SH) and 111 in ordinary housing with support (OHS) completed the PMA-H. The SH group also competed the Community-Oriented Programs Environment Scale (COPES). A majority of the participants found the content of the PMA-H relevant, easy to complete, and the time for completion as reasonable. Internal consistency varied between 0.85 and 0.92 for the subscales. Logical associations with COPES indicated construct validity. The subscales social interaction and developing as a person could discriminate between the SH and OHS groups, whereas activity opportunities could not. No floor or ceiling effects were found. This study indicated adequate initial psychometric properties of the PMA-H. It can thus be used in housing settings to assess the residents’ perceived opportunities for meaningful activity in the housing context.

Assessing the quality of life in patients with multiple sclerosis in Kuwait: a cross sectional study

The main objective of this paper was to assess the level and the determinants of quality of life (QOL) amongst patients with multiple sclerosis (MS). A cross-sectional study was conducted among a convenience sample of 200 adult MS patients. Inclusion criteria were: MS diagnosis for at least one year, and aged 21+ years. However, exclusion criteria were: having other neurological diseases, serious cardiovascular, orthopedic or other disability precluding participation. Self-administered questionnaire employed MSQOL-54 with two outcomes: Physical Health Composite (PHC) and mental health composite (MHC). Satisfaction with Daily Occupation scale was adopted through face to face interviews. The median of PHC and MHC scores were 48.9/100, and 53.4/100 respectively. Multivariate analysis revealed that unemployment was a determinant of poor PHC, while low monthly income was a predictor of poor MHC. Additionally, low endurance and sensory problems were associated with poor PHC, and MHC, while motor problems were allied with only poor PHC. Patient's satisfaction level with performing activities of daily living was positively associated with PHC and MHC. Assessment of QOL is suggested to be comprised in medical settings.

How do Swedish day center attendees with psychiatric disabilities view their worker role? A structural equation modeling study

AIM

To investigate how day center attendees with psychiatric disabilities perceived their worker role and the importance of current work situation and personal factors in that respect.

METHODS

Two-hundred attendees completed the Worker Role Self-assessment and questionnaires addressing possible predictors of the worker role: current employment situation, satisfaction with that situation, and a personal factor (encompassing self-esteem, self-mastery and engagement). Structural equation modeling was used.

RESULTS

A model indicated two worker role factors; belief in a future worker role (WR1) and current capacities and routines (WR2). WR1 was positively influenced by having a job, younger age and the personal factor. Satisfaction with current work situation (usually unemployment) was negatively associated with WR1. The personal factor was single predictor of WR2. The attendees rated WR2 more positively than WR1.

CONCLUSIONS

The personal factor was crucial for both WR1 and WR2. Work-related factors were only important for WR1. The more negative rating of belief in a future worker role may be interpreted as mistrust in the services. The attendees' positive ratings of capacities indicate, however, that they had a rehabilitation potential to develop. Enhancing self-esteem, mastery and engagement may be an avenue for staff in efforts to support the attendee's worker role.

Staff ratings of occupational engagement among people with severe mental illness - psychometric properties of a screening tool in the day center context

Background

Staff who plan and organize day center activities may need to observe the attendees’ performance and progression. This led us to develop a tool for that purpose, termed General Occupational Engagement in people with Severe mental illness (GOES). The aim was to investigate its psychometric properties in terms of factor structure, internal consistency, corrected item-total correlations (CITC), convergent and discriminant validity, and test-retest stability.

Methods

Ninety-three day center attendees were assessed by the GOES and instruments addressing constructs hypothesized to be either similar to (activity level, motivation for day center attendance, perceptions of the worker role, hours spent in the day center) or divergent from the GOES (attendees’ ratings of engagement in specified occupations, self-rated health, psychosocial functioning, psychiatric symptoms). A second sample of 41 attendees were included for the test-retest analysis. Exploratory factor analysis, Cronbach’s alpha analysis, Pearson correlations and paired-samples t-tests were performed.

Results

Exploratory factor analysis indicated one factor, which was in line with the intentions of the scale. The alpha value was 0.85 and all CITC were above 0.30. The tests for convergent validity resulted in correlations ranging between 0.23 and 0.47, most of which were moderately strong and mainly confirmed the hypotheses. Discriminant validity was clearly indicated, since all correlations with the selected constructs were <0.20. GOES also showed preliminary test-retest stability (r = 0.32).

Conclusions

The GOES is ready for use in rehabilitation services and research where productive and other types of activities are of interest. It may serve as an important supplement to attendees’ self-reported occupational engagement.

Programme characteristics and everyday occupations in day centres and clubhouses in Sweden

BACKGROUND

Meaningful everyday occupations are important for mental health and recovery and are provided by both community-based day centres (DCs) and clubhouses. It is unknown, however, if any of the two has more recovery-promoting features.

OBJECTIVE

This nine-month longitudinal study compared DC and clubhouses, concerning the users' perceptions of unit and programme characteristics, and aspects of everyday occupations in terms of engagement and satisfaction. Stability over time in these respects, as well as motivation for participation and relationships with occupational engagement and satisfaction, were explored.

METHODS

Participants from 10 DCs (n = 128) and 5 clubhouses (n = 57) completed self-report instruments.

RESULTS

DC attendees rated lower levels on two organizational factors; choice and ability to influence decisions, and the unit's social network. Motivation showed to be an important factor for perceived occupational engagement, which did not differ between the two groups. DC attendees were more satisfied with their everyday occupations at baseline, but that factor increased more in the clubhouse group and there was no group difference at follow-up. The unit and programme characteristics and occupational engagement showed stability over time.

DISCUSSION

Clubhouses seemed more advantageous and DC services may consider developing users' opportunities for choice and decision-making, and peer support.

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.

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.

Social interaction among people with psychiatric disabilities--does attending a day centre matter?

BACKGROUND

Engaging in social interaction has, for people with psychiatric disabilities, been shown to enhance well-being and the experience of meaning and to generally prevent the worsening of mental illness.

AIM

The aim of the study was to investigate how day centre attendees differed from non-attendees regarding different aspects of social interaction and to investigate how occupational factors, including day centre attendance, and previously known predictors were related to social interaction in the study sample as a whole.

METHODS

A total of 93 day centre attendees and 82 non-attendees with psychiatric disabilities were examined regarding social interaction, subjective perception of occupation, activity level, sense of self-mastery and socio-demographic and clinical variables. Data were analysed with non-parametric statistics, mainly logistic regression.

RESULTS

Social support was mainly provided by informal caregivers such as family members. The day centre attendees had more social relations but did not experience better quality or closeness in their relationships than non-attendees. Important factors for social interaction were subjective perceptions of daily occupation, being married/cohabiting, self-mastery and severity of psychiatric symptoms.

CONCLUSION

Alternative ways of enhancing social interactions in the community is needed, targeting the group's feeling of satisfaction and value in daily life together with self-mastery.

Women's perceptions of everyday occupations: outcomes of the Redesigning Daily Occupations (ReDO) programme

AIMS

The aim was to (i) assess the outcomes of the 16-week Redesigning Daily Occupations (ReDO) programme for women on sick leave due to stress-related disorders, in terms of occupational value, satisfaction with everyday occupations, and participation level; (ii) investigate the relationships between those outcomes and return-to-work rate.

METHODS

A total of 42 women receiving ReDO and 42 receiving care as usual (CAU) were included in a matched-control study with measurements before and after the rehabilitation. Seventy-eight participated on both occasions. They completed self-report questionnaires regarding the aforementioned outcomes. Return-to-work data were obtained from the registers of the Social Insurance Offices.

RESULTS

Increases in concrete, symbolic, and self-reward values were found in both groups, but no statistically significant difference between the groups was demonstrated. The ReDO group improved more than the CAU group, however, on satisfaction with everyday occupations and participation level. Occupational value, but not satisfaction with everyday occupations, was related to return to work.

CONCLUSIONS

Everyday occupations were shown to be relevant outcomes after work rehabilitation. They could play an important role in future development of profession-specific evidence of occupational therapy. Further support was obtained for viewing occupational value and satisfaction with everyday occupations as theoretically distinct phenomena.

Effectiveness of an intervention to improve day centre services for people with psychiatric disabilities

Background/aim

Day centres for people with psychiatric disabilities need to be evaluated for effectiveness in order to provide the best possible support. This study aimed at investigating the effectiveness of a tailor-made intervention to improve day centre services for people with psychiatric disabilities.

Methods

The intervention was devised to bridge identified gaps in the services and lasted for 14 months. Eight centres were allotted to the intervention (55 attendees) or comparison condition (51 attendees). Fidelity to the intervention and major events in the day centres were assessed. The outcomes were degree of meaningfulness found in the day centre occupations, satisfaction with the rehabilitation received, satisfaction with everyday occupations and quality of life.

Results

The fidelity to the intervention was good, but more positive events, such as new occupational opportunities, had taken place in the comparison units. No differences were identified between the intervention and the comparison group regarding changes from baseline to the 14-month follow-up in perceived meaningfulness among day centre occupations, satisfaction with everyday occupations or quality of life.

Conclusions

The intervention seemed ineffective, but the positive events in the comparison group resembled the measures included in the tailor-made interventions. This first intervention study in the day centre context has hopefully helped to generate hypotheses and methods for future research.

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.

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.

Dealing with Real-Life Challenges: Outcome of a Home-Based Occupational Therapy Intervention for People with Severe Psychiatric Disability

The authors offered home-based occupational therapy integrated into supported or sheltered housing to help individuals with severe psychiatric disability identify their specific needs of engagement in meaningful daily occupations. This study aimed to evaluate the client outcomes in activities of daily living (ADL) ability and health factors following their participation in occupation-centered interventions in home and community settings. Seventeen participants (7 women) between the ages of 27 and 66 years participated in the intervention project based on the Everyday Life Rehabilitation (ELR). The following instruments were administered before and after the intervention and at a 6-month follow-up: Goal Attainment Scaling, Assessment of Motor and Process Skills, Assessment of Social Interaction, Satisfaction with Daily Occupations, ADL-taxonomy with an effort-scale, and the Symptom Check List-90. Pretest, posttest, and follow-up differences in test scores on goal attainment, occupation, and health-related factors indicate that important progress was made. These findings support the use of the ELR intervention and suggest that larger randomized clinical trials are needed.

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.