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Widehammar, C., Pettersson, I., Janeslätt, G. & Hermansson, L. (2018). The influence of environment: experiences of users of myoelectric arm prosthesis - a qualitative study. Prosthetics and orthotics international, 42(1), 28-36
Open this publication in new window or tab >>The influence of environment: experiences of users of myoelectric arm prosthesis - a qualitative study
2018 (English)In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 42, no 1, p. 28-36Article in journal (Refereed) Published
Abstract [en]

Background: Prostheses are used to varying degrees; however, little is known about how environmental aspects influence this use.

Objectives: To describe users" experiences of how environmental factors influence their use of a myoelectric arm prosthesis.

Study design: Qualitative and descriptive.

Methods: A total of 13 patients previously provided with a myoelectric prosthetic hand participated. Their age, sex, deficiency level, etiology, current prosthesis use, and experience varied. Semi-structured interviews were audiotaped, transcribed, and analyzed through inductive content analysis.

Results: Four categories were created from the data: "Prosthesis function," "Other people's attitudes," "Support from family and healthcare," and "Individual's attitude and strategies." The overarching theme, "Various degrees of embodiment lead to different experiences of environmental barriers and facilitators," emerged from differences in individual responses depending on whether the individual was a daily or a non-daily prosthesis user. Environmental facilitators such as support from family and healthcare and good function and fit of the prosthesis seemed to help the embodiment of the prosthesis, leading to daily use. This embodiment seemed to reduce the influence of environmental barriers, for example, climate, attitudes, and technical shortcomings.

Conclusion: Embodiment of prostheses seems to reduce the impact of environmental barriers. Support and training may facilitate the embodiment of myoelectric prosthesis use.

Clinical relevance: For successful prosthetic rehabilitation, environmental factors such as support and information to the patient and their social network about the benefits of prosthesis use are important. Local access to training in myoelectric control gives more people the opportunity to adapt to prosthesis use and experience less environmental barriers.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Upper limb prosthetics; prosthetics; rehabilitation of prostheses users; rehabilitation; qualitative methods; rehabilitation; environment; amputation; upper extremity deformities; congenital
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-59041 (URN)10.1177/0309364617704801 (DOI)000424669100005 ()28470129 (PubMedID)
Note

Funding Agencies:

Uppsala-Örebro Regional Research Council  

Research committee of Örebro County Council, Sweden 

Available from: 2017-08-02 Created: 2017-08-02 Last updated: 2018-08-16Bibliographically approved
Hagberg, L., Hermansson, L. M., Fredriksson, C. & Pettersson, I. (2017). Cost-effectiveness of powered mobility devices for elderly people with disability. Disability and Rehabilitation: Assistive Technology, 12(2), 115-120
Open this publication in new window or tab >>Cost-effectiveness of powered mobility devices for elderly people with disability
2017 (English)In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 12, no 2, p. 115-120Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to analyse the cost-effectiveness of prescribing powered mobility devices (PMDs) to elderly users.

Methods: Forty-five persons participated in the preand post-intervention study with a follow-up at four months. All participants were prescribed a scooter model and were offered individual support to get started using the PMD. In the analysis, the use of the PMD was compared to the situation prior to its use. The cost-utility analysis takes a societal perspective and considers costs, savings and quality of life (QoL) using answers to the EQ-5D questionnaire.

Results: Costs for the first year with the PMD were 1395 USD and then 592 USD per subsequent year. There was a significant decrease in transportation costs and in relatives' time use, but the increase in QoL of 0.041 was not significant. Costs per gained quality adjusted life year (QALY) were 12 400-14 700 USD/QALY if the value of time saved not was considered and 600-2900 USD/QALY when an hour was valued at 3.6 USD.

Conclusion: Prescription of PMDs to elderly users might be cost-effective. However, there are shortcomings in measuring QALY gains from the use of a PMD, and it is unclear how time savings among relatives should be valued.

Implications for Rehabilitation

  • Prescription of powered mobility devices for the elderly with disability seems to be cost effective and should be a standard intervention.

  • In economic evaluations of powered mobility devices and other assistive devices, the commonly used analyses methods are not always appropriate and therefore need to be adjusted.

Place, publisher, year, edition, pages
Taylor & Francis, 2017
Keywords
Assistive devices; cost-utility analysis; QALY
National Category
Occupational Therapy
Research subject
Nursing Science w. Occupational Therapy Focus
Identifiers
urn:nbn:se:oru:diva-40113 (URN)10.3109/17483107.2014.1002540 (DOI)000396533100002 ()25634493 (PubMedID)2-s2.0-84938500069 (Scopus ID)
Note

Funding Agencies:

Swedish Institute of Assistive Technology

Promobilia Foundation, Sweden

Available from: 2015-01-02 Created: 2015-01-02 Last updated: 2017-12-05Bibliographically approved
Adolfsson, P., Lindstedt, H., Pettersson, I., Norling Hermansson, L. & Janeslätt, G. (2016). Perception of the influence of environmental factors in the use of electronic planning devices in adults with cognitive disabilities. Disability and Rehabilitation: Assistive Technology, 11(6), 493-500
Open this publication in new window or tab >>Perception of the influence of environmental factors in the use of electronic planning devices in adults with cognitive disabilities
Show others...
2016 (English)In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 11, no 6, p. 493-500Article in journal (Refereed) Published
Abstract [en]

Background: Adults with cognitive disabilities often have difficulties in dealing with the complexity of everyday life. With cognitive assistive technology (e.g. electronic planning devices [EPDs] and individual support), they can bring order to their often chaotic life. Assumptions are that environmental factors influence with non-use of EPDs.

Objective: To explore how adults with cognitive disabilities perceive the influence of environmental factors in the use of EPDs.

Methods: A reference group with experience of use of EPDs assisted the researchers. Twelve adults with cognitive disabilities and experience of using EPDs participated. An interview guide was implemented covering environmental factors according to the International Classification of Functioning, Disability and Health. Qualitative content analysis was applied in the analyses.

Results: Five categories and two themes emerged, which were integrated into a model of facilitating factors influencing the use of EPDs. Measures to prevent or eliminate negative influences of the device use are important to be taken.

Conclusions: Professionals need more knowledge about EPDs, while users need individual adaption of the EPDs. EPDs need to be user-friendly, manageable and work in any seasons.

Place, publisher, year, edition, pages
Taylor & Francis, 2016
Keywords
Cognitive assistive technology, ICF, occupational therapy, qualitative content analysis
National Category
Occupational Therapy
Identifiers
urn:nbn:se:oru:diva-40115 (URN)10.3109/17483107.2014.989418 (DOI)000386459700007 ()25434402 (PubMedID)2-s2.0-84977560566 (Scopus ID)
Available from: 2015-01-02 Created: 2015-01-02 Last updated: 2017-12-05Bibliographically approved
Pettersson, I., Hagberg, L., Fredriksson, C. & Hermansson, L. M. (2016). The effect of powered scooters on activity, participation and quality of life in elderly users. Disability and Rehabilitation: Assistive Technology, 11(7), 558-563
Open this publication in new window or tab >>The effect of powered scooters on activity, participation and quality of life in elderly users
2016 (English)In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 11, no 7, p. 558-563Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim was to explore the effect of using a powered mobility device (PMD) on older peoples’ activity, participation and quality of life (QoL).

Method: A pre- and post-intervention design with outcome measures for activity, participation (Individually Prioritized Problem Assessment, IPPA; World Health Organization Disability Assessment Schedule, WHODAS 2.0) and QoL (SF-36) were used. T-test was used to analyse the data. The magnitude of the effects was measured by Cohen’s criteria for effect sizes (d).

Results: The sample consisted of 45 individuals (36 men) aged 66–88 years referred for prescription of a PMD. All were prescribed a powered scooter (PS). A statistically significant improvement with a large effect on IPPA in the ICF domains of Self-care (d¼2.47), Domestic life (d¼2.40), Interpersonal interactions and relationships (d¼2.08), and Community, social, and civic life (d¼2.36) was found. Medium-sized improvement on the WHODAS 2.0 domain of Participation and small improvements in the SF-36 domains of Physical Health and Role-Physical were also found.

Conclusion: A PS has significant effects on the areas of activity, participation and QoL in elderly people. These findings have implications for prescriptions of a PS to this population.

Place, publisher, year, edition, pages
Taylor & Francis, 2016
Keywords
Aged, assistive technology, ICF, mobility, limitation, powered mobility devices
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:oru:diva-40304 (URN)10.3109/17483107.2015.1027301 (DOI)000386460300003 ()25799878 (PubMedID)2-s2.0-84984620299 (Scopus ID)
Available from: 2015-01-08 Created: 2015-01-08 Last updated: 2018-07-09Bibliographically approved
Widehammar, C., Pettersson, I., Janeslätt, G. & Hermansson, L. (2016). The influence of environment: experiences of users of myoelectric arm prosthesis, a qualitative study. In: “Advances in our Understanding”: The Compendium. Paper presented at Trent International Prosthetic Symposium 2016, Glasgow, UK, September 28 - October 1, 2016 (pp. 56-56).
Open this publication in new window or tab >>The influence of environment: experiences of users of myoelectric arm prosthesis, a qualitative study
2016 (English)In: “Advances in our Understanding”: The Compendium, 2016, p. 56-56Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Aims and objectives: Myoelectric prostheses can be prescribed to people born with upper limb reduction deficiency or with acquired amputation in order to improve their function and quality of life. Despite this, prostheses are used in varying degrees. An environment with barriers, or without facilitators, will restrict the individual’s occupational performance and can also result in limitations of Quality of Life. According to the International Classification of Functioning, disability and health (ICF) the environment includes the physical, social and attitudinal environment in which people live and conduct their lives. Few studies have been made to see the impact of environmental factors on prosthesis use. In this study the ICF- model is the framework to understand the complexity of environmental factors influence on prostheses use. The aim of this study was to describe users’ experience of how environmental factors influence their use of a myoelectric prosthesis in both congenital and acquired absence of a hand.

Method: Qualitative descriptive approach. Semi-structured interviews were audiotaped, transcribed by the first author and analyzed through inductive content analysis according to Graneheim & Lundman. Investigator triangulation was used to ensure the credibility.

Subjects: Strategic selection was used to get a varied sample in terms of sex, age, deficiency level, etiology, current prosthesis use, and length of experience. Interviews were conducted with 13 adult patients, previously provided with a myoelectric prosthetic hand at the Prosthetics and Orthotics Outpatient Clinic in Örebro, Sweden. The participants were 9 males and 4 females with age ranging from 20-74 years; they had acquired (n=5) or congenital (n=8) cause of absence at trans-humeral (n=3) or trans-radial (n=10) level. Their experience from prosthesis use was ranging from 2- 30 years. At the time of data collection the participants reported different patterns of prosthesis use: daily (n= 6) or non-daily (n=7), ranging from use only at work to never.

Results: The overarching theme “Different degree of embodiment provides various experiences ofinfluence from environment” illustrates the participants’ adaptation to prosthesis, which in turn influences the ability to manage environmental barriers. Four categories emerged from the data, “The prosthesis function”, “Other peoples’ attitudes”, “Support from family and healthcare” and “Personal approach to the environment”. Environmental facilitators such as, support from family and healthcare, and, good function and fit of the prosthesis, helped to make the prosthesis an embodied experience, leading to daily use. This embodiment reduces the influence of environmental barriers, e.g. climate, attitudes, and technical shortcomings. Myoelectric prosthesis use facilitates activity and participation among daily users.

Conclusions: The embodiment of the prosthesis may reduce influence of environmental barriers and promote myoelectric prosthesis use in both congenital and acquired upper limb deficiency. The users’ experience in this study indicates that support and training can facilitate the embodiment of myoelectric prosthesis. Thus, as prescribers of prostheses it is our responsibility to give support and information to the patient and also to family, pre-school and school teachers, and local healthcare, in order to motivate and encourage prosthesis use in everyday life.

National Category
Occupational Therapy
Research subject
Nursing Science w. Occupational Therapy Focus
Identifiers
urn:nbn:se:oru:diva-57610 (URN)
Conference
Trent International Prosthetic Symposium 2016, Glasgow, UK, September 28 - October 1, 2016
Available from: 2017-05-09 Created: 2017-05-09 Last updated: 2018-07-24Bibliographically approved
Pettersson, I., Hagberg, L., Fredriksson, C. & Hermansson, L. M. N. (2015). Effekten av en eldriven rullstol (scooter) för äldre personer. In: : . Paper presented at Arbetsterapiforum 2015, Göteborg, 15-16 april, 2015.. Stockholm
Open this publication in new window or tab >>Effekten av en eldriven rullstol (scooter) för äldre personer
2015 (Swedish)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [sv]

Bakgrund: Att kunna förflytta sig är ofta en förutsättning för att kunna delta i olika aktiviteter, en eldriven rullstol kan bidra till detta.

Syfte: Syftet var att undersöka effekten av en eldriven rullstol på äldre personers aktivitet, delaktighet och livskvalitet.

Metod: Personer > 65 år som för första gången remitterats till Centrum för hjälpmedel; ÖLL, för utprovning av eldriven rullstol för utomhusbruk inkluderades konsekutivt. Mätning gjordes före förskrivning och efter 4 månaders användning av eldriven rullstol med olika instrument för aktivitet, delaktighet (Individually Prioritized Problem Assessment, IPPA och WHO-Disability Assessment Schedule, WHODAS 2.0) och hälsorelaterad livskvalitet (SF-36). Analyser genomfördes med t-test. Cohens d användes för beräkning av effektstorlek. För att klassificera deltagarnas självskattade aktivitetsproblem (IPPA) användes Klassifikation av funktionstillstånd, funktionshinder och hälsa (ICF).

Resultat/preliminärt resultat: Fyrtiofem personer (m=78 år, 36 män, 9 kvinnor inkluderades, samtliga fick en trehjulig eldriven rullstol med manuell styrning förskriven (scooter). För hela gruppen visade resultatet en statistisk signifikant förbättring med stor effekt av scootern på personernas aktivitetsproblem (IPPA; n=164). Majoriteten av problem var inom områdena Hemliv (i huvudsak olika inköp) och Samhällsgemenskap, socialt och medborgerligt liv (rekreation och fritidsaktiviteter): För hela gruppen framkom små signifikanta förbättringar inom WHODAS 2.0 domän Delaktighet och inom SF-36 index Fysisk hälsa och delskala Fysiska roller. Vid subgruppsanalyser framkom medelstora signifikanta förbättringar för kvinnor inom domänen Delaktighet (WHODAS 2.0) och för män små förbättringar inom delskalorna Fysiska roller och Social funktion (SF-36).

Slutsats: En eldriven scooter har ett stort positivt värde för äldre personers egna prioriterade aktiviteter och en liten effekt på hälsorelaterad livskvalitet.  

Place, publisher, year, edition, pages
Stockholm: , 2015
Keywords
hjälpmedel, eldriven rullstol, äldre, ICF, aktivitet, delaktighet, livskvalitet
National Category
Occupational Therapy
Research subject
Occupational therapy
Identifiers
urn:nbn:se:oru:diva-44494 (URN)
Conference
Arbetsterapiforum 2015, Göteborg, 15-16 april, 2015.
Projects
Värdet av en eldriven rullstol: fokus på äldre användare, anhöriga och hälsoekonomi
Available from: 2015-04-28 Created: 2015-04-28 Last updated: 2019-04-11Bibliographically approved
Widehammar, C., Pettersson, I. & Hermansson, L. M. N. (2014). The influence of environment: experiences from users of myoelectric arm prostheses. In: MEC'14: Redefinig the Norm. Paper presented at MEC'14 - Redefining the Norm, Fredricton, New Brunnswick, Canada, August 19-22, 2014.. Frederiction, New Brunswick, Canada: University of New Brunswick, Fredericton, Canada
Open this publication in new window or tab >>The influence of environment: experiences from users of myoelectric arm prostheses
2014 (English)In: MEC'14: Redefinig the Norm, Frederiction, New Brunswick, Canada: University of New Brunswick, Fredericton, Canada , 2014Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Background: Myoelectric prostheses are used in varying degrees. According to the International Classification of functioning, disability and health (ICF) the environment includes the physical, social and attitudinal environment in which people live and conduct their lives. An environment with barriers, or without facilitators, will restrict the individual’s occupational performance and can result in limitations of Quality of Life. Few studies have been made to see the impact of environmental factors on prosthesis use. In this study the ICF- model is the framework to understand the complexity of environmental factors influence on prostheses use. The aim of this study was to describe the experience of how environmental factors affect the use of myoelectric arm prostheses..                        

Method: A qualitative descriptive approach was used and interviews were conducted with 13 adult prosthesis users at the Prosthetics and Orthotics Outpatient Clinic in Örebro, Sweden. The participants were 9 males and 4 females with age ranging from 20-74 years ; they had acquired (n=5) or congenital (n=8) cause of absence at trans humeral (n=3 ) or trans radial (n=10 ) level. Their experience from prosthesis use was ranging from 2- 30 years. Qualitative content analysis with an inductive approach was used for data analysis.        

Results: Participants’ experiences of prosthesis use and how environmental factors affect them could be divided into seven categories: Various adaptations to the environment; Other peoples attitudes affect use; Support promotes use; Technical shortcomings affect use; Climate affects comfort and function; Ignorance and legislation complicates; Different approach to usability. Two themes occurred in all the categories and gave an overall perspective of what the participants believe have an important impact on prosthesis use: The prosthesis is/is not a part of my body; and, It is important to be like everyone else. A model was created to clarify the relation between environmental factors and prosthesis use/non-use. It illustrates how a persons coping strategy interacts with all the different environmental factors it is exposed to and how this leads to usability in different degrees. The prosthesis use can be a barrier or a facilitator for activity, participation and body structure.  

Conclusions: Embodiment of prosthesis reduces environmental barriers and facilitates future use in both congenital and acquired upper limb amputees. Support to the persons and their family in prosthetic use, access to prosthesis training close to home, and considerations taken to the prosthesis appearance and function will facilitate future prosthesis use.

Place, publisher, year, edition, pages
Frederiction, New Brunswick, Canada: University of New Brunswick, Fredericton, Canada, 2014
National Category
Medical and Health Sciences Occupational Therapy
Identifiers
urn:nbn:se:oru:diva-40575 (URN)978-1-55131-176-0 (ISBN)
Conference
MEC'14 - Redefining the Norm, Fredricton, New Brunnswick, Canada, August 19-22, 2014.
Available from: 2015-01-08 Created: 2015-01-08 Last updated: 2017-10-18Bibliographically approved
Hermansson, L. M. N., Hagberg, L., Fredriksson, C. & Pettersson, I. (2013). The impact of powered wheelchairs on activity, participation and health related quality of life in older people. In: Special Session Power mobility: User experiences and Outcomes. Paper presented at Association for the Advancement of Assistive Technology in Europe Conference, Vilamoura, Portugal, 19-22 September, 2013.. Association for the Advancement of Assistive Technology in Europe
Open this publication in new window or tab >>The impact of powered wheelchairs on activity, participation and health related quality of life in older people
2013 (English)In: Special Session Power mobility: User experiences and Outcomes, Association for the Advancement of Assistive Technology in Europe , 2013Conference paper, Oral presentation with published abstract (Refereed)
Place, publisher, year, edition, pages
Association for the Advancement of Assistive Technology in Europe, 2013
National Category
Medical and Health Sciences Occupational Therapy
Identifiers
urn:nbn:se:oru:diva-40576 (URN)
Conference
Association for the Advancement of Assistive Technology in Europe Conference, Vilamoura, Portugal, 19-22 September, 2013.
Available from: 2015-01-08 Created: 2015-01-08 Last updated: 2017-10-18Bibliographically approved
Fredriksson, C., Hermansson, L. M. N., Hagberg, L. & Pettersson, I. (2013). The value of a powered wheelchair: spouses´ perspective. In: P Encarnação et al (Ed.), Association for the Advancement of Assistive Technology in Europe Conference 2013 (AAATE 2013): . Paper presented at Association for the Advancement of Assistive Technology in Europe Conference, Vilamoura, Portugal, September 19-22, 2013. (pp. 222-225). Amsterdam, Netherlands: Elsevier
Open this publication in new window or tab >>The value of a powered wheelchair: spouses´ perspective
2013 (English)In: Association for the Advancement of Assistive Technology in Europe Conference 2013 (AAATE 2013) / [ed] P Encarnação et al, Amsterdam, Netherlands: Elsevier, 2013, p. 222-225Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Research concerning the significance of assistive technology to spouses of persons who uses technology is sparse and the impact of a powered wheelchair on spouses' activity and participation is not at all researched. Thus, the aim was to explore how spouses experience the significance of a powered wheelchair prescribed to and used by their next of kin. A descriptive design with a qualitative approach focusing on the experiences of the spouses was used. The sample comprised of 10 spouses of elderly people that have been prescribed a powered wheelchair. Semi-structured interviews were conducted with the ten spouses (nine women and one man). The participants were 65-86 years of age. The questions posed during the interview concerned: i) the significance of the powered scooter for personal everyday activities, participation and quality of life; ii) the significance of the scooter for shared activity and participation; and iii) the significance of the next of kin using a scooter, from the perspective of the spouse. Interviews were transcribed verbatim and analyzed using qualitative content analysis. The results showed that the spouses experienced that their everyday life and life situation had changed in a positive way as their next of kin received a powered wheelchair. They experienced a sense of freedom that had an impact on their own activities as well as on the activities they performed together with their next of kin. The spouses expressed that they now to a larger extent shared responsibility for different tasks in the home and also how the powered wheelchair had made it possible to spontaneously do things together again and to do things with more ease. In conclusion, the narratives of the spouses of the elderly powered wheelchair users were to a great extent positive. The powered wheelchair was of great value and brought freedom to everyday life.

Place, publisher, year, edition, pages
Amsterdam, Netherlands: Elsevier, 2013
Series
Assistive Technology Research Series, ISSN 1383-813X ; 33
Keywords
Activity, everyday life, powered wheelchair, spouse
National Category
Medical and Health Sciences Occupational Therapy
Identifiers
urn:nbn:se:oru:diva-40577 (URN)10.3233/978-1-61499-304-9-222 (DOI)2-s2.0-84889064907 (Scopus ID)9781614993032 (ISBN)
Conference
Association for the Advancement of Assistive Technology in Europe Conference, Vilamoura, Portugal, September 19-22, 2013.
Available from: 2015-01-08 Created: 2015-01-08 Last updated: 2017-10-18Bibliographically approved
Pettersson, I., Hermansson, L. M., Hagberg, L., Larsholt, G. & Fredriksson, C. (2013). Värdet av en eldriven rullstol: fokus på äldre användare och anhöriga. Sundbyberg: Hjälpmedelsinstitutet
Open this publication in new window or tab >>Värdet av en eldriven rullstol: fokus på äldre användare och anhöriga
Show others...
2013 (Swedish)Report (Other academic)
Abstract [sv]

Undersökningen som redovisas i den här rapporten har studerat värdet av en eldriven rullstol för den primära användaren och dennes anhörige. Syftet har varit att få en djupare förståelse för hur förskrivning av en eldriven rullstol till äldre personer med funktionsnedsättning påverkar vardagen för äldre anhöriga.

Place, publisher, year, edition, pages
Sundbyberg: Hjälpmedelsinstitutet, 2013
National Category
Occupational Therapy
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-27810 (URN)
Available from: 2013-03-01 Created: 2013-03-01 Last updated: 2017-10-18Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3437-0590

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