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Rodriguez-Bailon M, Vidaña-Moya L, Fernández-Solano AJ, Grau-Carrion S, Merchán-Baeza JA. Effectiveness of an occupational self-analysis intervention through a mobile application ( OcupApp) in people with anxiety or depression: a randomised controlled trial protocol. Disabil Rehabil Assist Technol 2024:1-10. [PMID: 38571461 DOI: 10.1080/17483107.2024.2327520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 03/01/2024] [Indexed: 04/05/2024]
Abstract
The main objective of this protocol is to understand the effectiveness of the use of a mobile application (OcupApp) to generate a personal self-analysis about meaningful activities in a population of adults aged between 50 and 70 years with low or moderate depression/anxiety. A randomised study will be carried out comparing the effects of the use of the OcupApp application with a control intervention on health-related quality of life, mental health, frequency of participation on meaningful activities, and perceived occupational balance. This is the first study to use occupational self-analysis in m-health to improve occupational balance, mental health, frequency of participation in meaningful activities and health-related quality of life. The app was co-created with a population whose characteristics are similar to those of the target users, and it was tested in both the intervention itself and the presentation, thus it is expected to be effective. Trial Registration Number: Clinical Trial B1-2020_25.
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Affiliation(s)
- María Rodriguez-Bailon
- Department of Physiotherapy (Occupational Therapy). Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Laura Vidaña-Moya
- Research Group Occare, Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa (EUIT), Universitat Autònoma de Barcelona, Terrassa, Spain
| | - Ana Judit Fernández-Solano
- Department of Occupational Therapy, Faculty of Physiotherapy, Podiatry and Occupational Therapy, UCAM Universidad Católica de Murcia, Spain
| | - Sergi Grau-Carrion
- Digital Care Research Group, Faculty of Science, Technology and Engineering, Centre of Health and Social care Research, University of Vic-Central University of Catalonia, (UVIC-UCC), Barcelona, Spain
| | - José Antonio Merchán-Baeza
- Department of Social Sciences and Welfare. Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Science and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), Barcelona, Spain
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Slade E, Rennick-Egglestone S, Ng F, Kotera Y, Llewellyn-Beardsley J, Newby C, Glover T, Keppens J, Slade M. The Implementation of Recommender Systems for Mental Health Recovery Narratives: Evaluation of Use and Performance. JMIR Ment Health 2024; 11:e45754. [PMID: 38551630 PMCID: PMC11015364 DOI: 10.2196/45754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 09/11/2023] [Accepted: 02/15/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Recommender systems help narrow down a large range of items to a smaller, personalized set. NarraGive is a first-in-field hybrid recommender system for mental health recovery narratives, recommending narratives based on their content and narrator characteristics (using content-based filtering) and on narratives beneficially impacting other similar users (using collaborative filtering). NarraGive is integrated into the Narrative Experiences Online (NEON) intervention, a web application providing access to the NEON Collection of recovery narratives. OBJECTIVE This study aims to analyze the 3 recommender system algorithms used in NarraGive to inform future interventions using recommender systems for lived experience narratives. METHODS Using a recently published framework for evaluating recommender systems to structure the analysis, we compared the content-based filtering algorithm and collaborative filtering algorithms by evaluating the accuracy (how close the predicted ratings are to the true ratings), precision (the proportion of the recommended narratives that are relevant), diversity (how diverse the recommended narratives are), coverage (the proportion of all available narratives that can be recommended), and unfairness (whether the algorithms produce less accurate predictions for disadvantaged participants) across gender and ethnicity. We used data from all participants in 2 parallel-group, waitlist control clinical trials of the NEON intervention (NEON trial: N=739; NEON for other [eg, nonpsychosis] mental health problems [NEON-O] trial: N=1023). Both trials included people with self-reported mental health problems who had and had not used statutory mental health services. In addition, NEON trial participants had experienced self-reported psychosis in the previous 5 years. Our evaluation used a database of Likert-scale narrative ratings provided by trial participants in response to validated narrative feedback questions. RESULTS Participants from the NEON and NEON-O trials provided 2288 and 1896 narrative ratings, respectively. Each rated narrative had a median of 3 ratings and 2 ratings, respectively. For the NEON trial, the content-based filtering algorithm performed better for coverage; the collaborative filtering algorithms performed better for accuracy, diversity, and unfairness across both gender and ethnicity; and neither algorithm performed better for precision. For the NEON-O trial, the content-based filtering algorithm did not perform better on any metric; the collaborative filtering algorithms performed better on accuracy and unfairness across both gender and ethnicity; and neither algorithm performed better for precision, diversity, or coverage. CONCLUSIONS Clinical population may be associated with recommender system performance. Recommender systems are susceptible to a wide range of undesirable biases. Approaches to mitigating these include providing enough initial data for the recommender system (to prevent overfitting), ensuring that items can be accessed outside the recommender system (to prevent a feedback loop between accessed items and recommended items), and encouraging participants to provide feedback on every narrative they interact with (to prevent participants from only providing feedback when they have strong opinions).
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Affiliation(s)
- Emily Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Center for Infectious Disease Education and Research, Osaka University, Osaka, Japan
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Chris Newby
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Tony Glover
- DRT Software Ltd., Nottingham, United Kingdom
| | - Jeroen Keppens
- Department of Informatics, King's College London, London, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Nord University, Faculty of Nursing and Health Sciences, Namsos, Norway
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Gunnarsson AB, Hedberg AK, Håkansson C, Hedin K, Wagman P. Occupational performance problems in people with depression and anxiety. Scand J Occup Ther 2023; 30:148-158. [PMID: 33569993 DOI: 10.1080/11038128.2021.1882562] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Depression and anxiety often reduce people's ability to cope with everyday occupations. There is a lack of knowledge about such problems in people of working age with depression and anxiety. AIM To describe which problems people with depression or anxiety disorders experience when performing everyday occupations and which occupations are affected. MATERIALS AND METHODS Data based on the Canadian Occupational Performance Measure was used in this cross-sectional study. A total of 118 participants aged 18-65 years, with depression or anxiety, were recruited from primary healthcare and general mental healthcare services. The data were analysed with descriptive statistics and directed content analysis. RESULTS The participants rated a low level of occupational performance, and their satisfaction with performance even lower. They described a great number of problems with their everyday occupations. The most frequent problem areas concerned household management, socialization and personal care. Detailed descriptions of which type of problem they experienced during everyday occupations are included. CONCLUSIONS This study provides knowledge of which problems people with depression and anxiety disorders experience in everyday occupations within self-care, productivity, as well as leisure. Furthermore, they rate performance and satisfaction with performance of the five occupations they find the most important to change in everyday life.
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Affiliation(s)
- Anna Birgitta Gunnarsson
- Institute of Neuroscience and Physiology, Section for Health and Rehabilitation, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Anna-Karin Hedberg
- General Psychiatry Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carita Håkansson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Katarina Hedin
- Futurum, Region Jönköping County and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Sciences in Malmö, Family Medicine Lund University, Malmö, Sweden
| | - Petra Wagman
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Wagman P, Håkansson C, Gunnarsson AB. Occupational performance issues in a longitudinal perspective in people with depression and/or anxiety on sick leave, returning to work or working. Scand J Occup Ther 2023; 30:159-169. [PMID: 35297722 DOI: 10.1080/11038128.2022.2046847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND People with depression and anxiety disorder may experience occupational performance issues (OPIs). Further knowledge about these issues longitudinally and about potential differences between people is valuable. AIM To explore experienced OPIs longitudinally in a sample living with depression and/or anxiety disorder participating in occupational therapy and varying in terms of their work situation. MATERIAL AND METHODS The Canadian occupational performance measure (COPM) was completed by 54 participants with depression and/or anxiety at four measure-points from baseline to one-year after participation in occupational therapy. The participants constituted three groups: continuously on sick leave (SL), returned to work within a year and continuing working. Descriptive and non-parametric analysis was used. RESULTS Participants in all groups identified OPIs in all occupational areas in the COPM. All groups increased their occupational performance and satisfaction with their occupational performance in the area socialisation. Each group also made improvements in relation to other occupational areas, varying between the groups. CONCLUSIONS OPIs and improvements were identified among the participants regardless of them being on SL, returning to work or working. SIGNIFICANCE The diverse nature of OPIs and improvements in the clients indicate the relevance of occupational therapy.
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Affiliation(s)
- Petra Wagman
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Carita Håkansson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - A Birgitta Gunnarsson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Research and Development, Region Kronoberg, Växjö, Sweden
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Wagman P, Gunnarsson AB, Hjärthag F, Hedin K, Håkansson C. Quality of life, sense of coherence and occupational balance one year after an occupational therapy intervention for people with depression and anxiety disorders. Work 2023; 76:561-568. [PMID: 37066954 PMCID: PMC10657701 DOI: 10.3233/wor-220096] [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: 02/18/2022] [Accepted: 02/17/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Quality of life (QOL), sense of coherence (SOC) and occupational balance (OB) have been found to increase after rehabilitation among people living with depression and anxiety. However, these aspects have not been investigated over time in participants with different paid work situations, such as being on sick leave or not. OBJECTIVE To describe and compare the self-rated QOL, SOC and OB after participation in occupational therapy in three groups of people with depression and anxiety disorders based on their work situation during the study period: continuous sick leave, return to work and continuous work. METHODS Forty-seven women and seven men, 19-60 years old with depression and anxiety were followed over time. They completed questionnaires on QOL, SOC and OB on four occasions. Data were analyzed with non-parametric statistics. RESULTS No statistically significant differences between the groups were identified. All groups improved in at least one of the studied areas over time: the sick leave group in OB; the return-to-work group in QOL and OB; and the Work group in QOL and SOC. CONCLUSION The results indicate variations in QOL, SOC and OB between people with different work situations over time after occupational therapy. Studies with larger samples are, however, warranted.
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Affiliation(s)
- Petra Wagman
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - A. Birgitta Gunnarsson
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
- Department of Clinical Neuroscience and Rehabilitation, Gothenburg University, Gothenburg, Sweden
| | - Fredrik Hjärthag
- Faculty of Arts and Social Sciences, Karlstad University, Karlstad, Sweden
| | - Katarina Hedin
- Futurum, Region Jönköping County, Jönköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Lund, Sweden
| | - Carita Håkansson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
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Gunnarsson AB, Håkansson C, Hedin K, Wagman P. Outcomes of the Tree Theme Method versus regular occupational therapy: A longitudinal follow-up. Aust Occup Ther J 2022; 69:379-390. [PMID: 35257386 PMCID: PMC9545876 DOI: 10.1111/1440-1630.12796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- A Birgitta Gunnarsson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Carita Håkansson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Katarina Hedin
- Futurum, Region Jönköping County and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Lund, Sweden
| | - Petra Wagman
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Kang M, Smith E, Goldsmith CH, Switzer L, Rosenbaum P, Wright FV, Fehlings D. Documenting change with the Canadian Occupational Performance Measure for children with cerebral palsy. Dev Med Child Neurol 2020; 62:1154-1160. [PMID: 32491226 DOI: 10.1111/dmcn.14569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 01/26/2023]
Abstract
AIM To assess the Canadian Occupational Performance Measure's (COPM) ability to document change over 3 years in children with cerebral palsy (CP). METHOD This was a prospective study with ambulatory children with CP, aged 2 to 6 years. Caregivers set one to three COPM goals which were rescored annually over 3 years. A ceiling effect for performance goals was operationalized as a score of 8. A Wald χ2 generalized estimating equations model adjusted for age, sex, and Gross Motor Function Classification System (GMFCS) level, evaluated change over time. RESULTS In total, 124 children (47 [37.9%] females, 77 [62.1%] males; mean age 3y 11mo [SD 1y 1mo]; GMFCS level I [n=78, 62.9%], II [n=21, 16.9%], and III [n=25, 20.2%]) were set 345 COPM goals at baseline. By Year 3, 106 participants (85.5%) rescored 287 of the goals (83.2%). Performance scores increased between baseline mean (SD) 2.93 (0.56), Year 1 5.98 (0.58) with 34.8% at ceiling; Year 2 6.74 (0.60) 48.3% at ceiling; and Year 3 7.37 (0.60) 59.6% at ceiling (Wald χ2 [3]=607.18, p<0.001). Satisfaction scores increased between baseline 4.42 (0.59), Year 1 6.82 (0.60) with 48% at ceiling; Year 2 7.53 (0.60) with 62.2% at ceiling (Wald χ2 [3]=208.48, p<0.001); with no significant increase by Year 3 7.82 (0.62) with 66.9% at ceiling. INTERPRETATION COPM performance scores increased steadily over 3 years. By Year 2, a ceiling effect was seen in about half of the goals. The COPM may have utility to measure change over 3 years; periodic resetting of the descriptors of goal success are required to minimize ceiling.
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Affiliation(s)
- Mani Kang
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Emma Smith
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Charles H Goldsmith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Health Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lauren Switzer
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Peter Rosenbaum
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Paediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Frances Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Darcy Fehlings
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Wagman P, Hjärthag F, Håkansson C, Hedin K, Gunnarsson AB. Factors associated with higher occupational balance in people with anxiety and/or depression who require occupational therapy treatment. Scand J Occup Ther 2019; 28:426-432. [PMID: 31838931 DOI: 10.1080/11038128.2019.1693626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Anxiety and depressive disorders are associated with problems with everyday occupations, including difficulties achieving occupational balance. The aim of this cross-sectional study was to describe occupational balance in people suffering from anxiety and/or depression and the factors that are associated with better self-rated occupational balance. MATERIAL One hundred and eighteen participants were recruited from outpatient mental health care and primary health care. The participants were 18-65 years, had a diagnosis of anxiety and/or depression, and had problems in everyday occupations. They answered questionnaires on occupational balance, psychological symptoms, quality of life and everyday occupations. RESULTS A generally low rating of occupational balance was found; however, the scores differed depending on the participants' degree of anxiety and depression, their quality of life, their occupational performance and satisfaction with their occupational performance. Logistic regression analyses revealed that high quality of life, high satisfaction with occupational performance and low level of depression were associated to occupational balance. CONCLUSION The results indicate that enhanced satisfaction with life and with performance of everyday occupations are relevant factors for achieving occupational balance in clients diagnosed with anxiety and/or depression. SIGNIFICANCE The results will be valuable for professionals working to support their clients in enhancing their occupational balance.
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Affiliation(s)
- Petra Wagman
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Fredrik Hjärthag
- Faculty of Arts and Social Sciences, Karlstad University, Karlstad, Sweden
| | - Carita Håkansson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Katarina Hedin
- Futurum, Region Jönköping County and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden
| | - A Birgitta Gunnarsson
- Department of Research and Development, Kronoberg County Council, Växjö, Sweden.,Department of Clinical Neuroscience and Rehabilitation, Gothenburg University, Gothenburg, Sweden
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Birgitta Gunnarsson A, Wagman P, Hedin K, Håkansson C. Treatment of depression and/or anxiety - outcomes of a randomised controlled trial of the tree theme method® versus regular occupational therapy. BMC Psychol 2018; 6:25. [PMID: 29792226 PMCID: PMC5967043 DOI: 10.1186/s40359-018-0237-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/16/2018] [Indexed: 01/18/2023] Open
Abstract
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.
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Affiliation(s)
- A Birgitta Gunnarsson
- Department of Research and Development, Region Kronoberg, PO Box 1223, SE-351 12, Växjö, Sweden. .,Department of Clinical Neuroscience and Rehabilitation, University of Gothenburg, Gothenburg, Sweden.
| | - Petra Wagman
- School of Health and Welfare, Department of Rehabilitation, Jönköping University, Jönköping, Sweden
| | - Katarina Hedin
- Futurum, Region Jönköping County and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Sciences in Malmö, Family Medicine Lund University, Lund, Sweden
| | - Carita Håkansson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
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