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The significance of assistive devices in the daily life of persons with stroke and their spouses
Örebro University, Department of Health Sciences.ORCID iD: 0000-0002-3437-0590
2006 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Betydelsen av hjälpmedel i vardagslivet för personer med stroke och deras närstående (Swedish)
Abstract [en]

The overall aim of this research project was to explore and describe the significance of assistive devices in daily life. The project involves two qualitative and two quantitative studies. Three of these studies were from the perspective of persons with stroke and one from the perspective of spouses of persons with stroke.

A hermeneutic phenomenological lifeworld approach was used in the qualitative studies and data was obtained through conversational interviews with the two study groups, 22 persons with stroke and 12 spouses of persons with stroke, after the devices had been used for about a year.

The results indicated that the lived experiences of assistive devices in respect of the different lifeworld existentials (lived body, lived space, lived time, lived human relation) are closely interconnected in both study groups. The lived body existential included aspects of habits, feelings and the incorporation, figuratively speaking, of the devices into their own bodies. Lived space concerned the gradual development of a new view of the environment and the devices’ role as a prerequisite for being able to live at home. The devices brought about a changed relation to lived time with respect to the temporal perspectives of past, present and future. To be able to take control of one’s own time was an important experience that the devices facilitated. Assistive devices were an integral part of the lived human relation between the couples in the study groups, as well as between the disabled persons/spouses and other people, including the health-care professionals. The devices contributed either to the maintenance or the change of social roles, but they sometimes also gave rise to the experience of being stigmatised. The results in the case of both study groups showed that the use of different devices is complex and often contradictory, especially when it comes to persons with stroke. Overall the persons’ experiences of the advantages of the devices overshadowed their experiences of the disadvantages.

The quantitative studies included a pre- and post-assessment design. Thirty-two persons with disabilities after stroke were included. The impact of an outdoor powered wheelchair on activity and participation (IPPA, WHODAS II) and quality of life (PIADS, EQ-5D) was measured. Statistical analysis with mainly non-parametric tests was used to determine significant within-group and between-group changes after intervention. The conceptual framework ICF was used in one of the quantitative studies when classifying the participants’ stated problems.

The results showed that the outdoor powered wheelchair is an essential device for persons with disabilities after stroke with regard to overcoming activity limitation and participation restrictions in everyday life. Furthermore it mostly has a positive impact on such users’ quality of life. However, it is also important to highlight the negative experiences of a few with regard to the use of powered wheelchairs. In sum, these results will enable prescribers to better understand the individual experiences of using assistive devices and the individuals’ and the families’ need for support in connection with the prescription of assistive devices, the particular example being powered wheelchairs.

Place, publisher, year, edition, pages
Örebro: Örebro universitetsbibliotek , 2006. , 95 p.
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 8
Keyword [en]
stroke, spouse, next of kin, assistive devices, assistive technology, powered wheelchair, lifeworld, phenomenology, lived experience, activity, participation, quality of life, outcome, ICF, IPPA, WHODAS II, PIADS, Euroqol-5D, occupational therapy
National Category
Nursing Occupational Therapy
Research subject
Nursing Science w. Occupational Therapy Focus
Identifiers
URN: urn:nbn:se:oru:diva-460ISBN: 91-7668-485-7 (print)OAI: oai:DiVA.org:oru-460DiVA: diva2:136830
Public defence
2006-06-02, Hörsal P 2, Prismahuset, Örebro universitet, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2006-05-11 Created: 2006-05-11 Last updated: 2015-05-04Bibliographically approved
List of papers
1. Lifeworld perspectives utilizing assistive devices: individuals, lived experience following a stroke
Open this publication in new window or tab >>Lifeworld perspectives utilizing assistive devices: individuals, lived experience following a stroke
2007 (English)In: Canadian Journal of Occupational Therapy / Revue Canadienne d`Ergotèrapie, ISSN 0008-4174, Vol. 74, no 1, 15-26 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In lifeworld research, the individual's experience of meaning is of primary importance.PURPOSE: This paper explores how individuals post stroke who have a disability, described their personal meaning and lived experiences associated with the use of assistive devices.METHODS: A hermeneutic-phenomenological research approach was used. A conversational interview was conducted with 22 post-stroke individuals regarding their daily experiences utilizing assistive devices.RESULTS: The results showed a dual experience regarding the use of assistive devices, which is often complex and contradictory. The devices were viewed as a prerequisite for well-being and independence but at the same time, the devices gave rise to negative feelings because of the restrictions implied by their use. These dual experiences were explored in relation to the lived body, space, relations to others, and time.PRACTICE IMPLICATIONS: The results of this study will facilitate occupational therapists understanding of an individual's experiences utilizing assistive devices and their need for support with this process.

Place, publisher, year, edition, pages
Toronto: Canadian Association of Occupational Therapists, 2007
National Category
Social Sciences Interdisciplinary Nursing Occupational Therapy
Research subject
Nursing Science w. Occupational Therapy Focus
Identifiers
urn:nbn:se:oru:diva-3071 (URN)10.2182/cjot.06.05 (DOI)17319319 (PubMedID)
Available from: 2006-05-11 Created: 2006-05-11 Last updated: 2017-03-27Bibliographically approved
2. Lifeworld perspectives on assistive devices: lived experiences of spouses of persons with stroke
Open this publication in new window or tab >>Lifeworld perspectives on assistive devices: lived experiences of spouses of persons with stroke
2005 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 12, no 4, 159-169 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to explore how spouses of persons with a disability following stroke describe their lived experiences regarding assistive devices in everyday life. A phenomenological lifeworld approach was used and conversational interviews were conducted with 12 spouses. Their lived experiences of assistive devices were explored in relation to four lifeworld existentials intertwined in everyday life. The results showed that lived body concerns aspects of feelings, habits, and incorporation of the devices with one's own body. The devices are, from the spouses' perspective, a prerequisite for their partner with stroke living at home. Successively the devices are incorporated into the couples' homes, and they provide a new view of the environment, aspects related to lived space. The devices bring about a changed relation to lived time, related to past, present, and future. Further, lived human relation concerns changed relationships to husbands/wives with stroke, including a great responsibility due to the devices and their usage. The results also included stigmatizing aspects and a twofold relationship to health professionals regarding participation in decisions about prescribing assistive devices. Understanding the unique meaning of assistive devices from the spouses' perspective is vital for occupational therapists prescribing such devices.

Place, publisher, year, edition, pages
London: Taylor & Francis, 2005
National Category
Social Sciences Interdisciplinary Nursing Occupational Therapy
Research subject
Nursing Science w. Occupational Therapy Focus
Identifiers
urn:nbn:se:oru:diva-3072 (URN)10.1080/11038120510031789 (DOI)
Available from: 2006-05-11 Created: 2006-05-11 Last updated: 2015-05-04Bibliographically approved
3. The effect of an outdoor powered wheelchair on activity and participation in users with stroke
Open this publication in new window or tab >>The effect of an outdoor powered wheelchair on activity and participation in users with stroke
2006 (English)In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, Vol. 1, no 4, 235-243 p.Article in journal (Refereed) Published
Abstract [en]

Purpose.Persons with disabilities after stroke are often restricted in activity and participation in society because of mobility limitations. An outdoor powered wheelchair may be one among other interventions in a rehabilitation programme. The aim of this study was to describe and compare activity limitations and participation restrictions in persons with stroke from their own perspective, before and after using an outdoor powered wheelchair. Method. At baseline and follow-up two instruments were used: Individually Prioritized Problem Assessment (IPPA) and World Health Organization Disability Assessment Schedule II (WHODAS II). Results. The results indicated that the powered wheelchair has a great positive effect on activity and participation assessed with IPPA. The results also showed that most of the participants' problems could be categorised as belonging to the domain of 'Community, social and civic life' according to the International Classification of Functioning, Disability and Health (ICF), and the effect size in this domain was large (2.4) after the participants had used the wheelchair. Conclusion. An outdoor powered wheelchair is an essential device for persons with disability after stroke with regard to overcoming activity limitations and participation restrictions in everyday life.

Place, publisher, year, edition, pages
Abingdon, Oxford, UK: Taylor & Francis, 2006
National Category
Social Sciences Interdisciplinary Nursing Occupational Therapy
Research subject
Nursing Science w. Occupational Therapy Focus
Identifiers
urn:nbn:se:oru:diva-3073 (URN)10.1080/17483100600757841 (DOI)
Available from: 2006-05-11 Created: 2006-05-11 Last updated: 2015-05-04Bibliographically approved
4. The value of an outdoor powered wheelchair with regard to the quality of life of persons with stroke: a follow-up study
Open this publication in new window or tab >>The value of an outdoor powered wheelchair with regard to the quality of life of persons with stroke: a follow-up study
2007 (English)In: Assistive technology, ISSN 1040-0435, E-ISSN 1949-3614, Vol. 19, no 3, 143-153 p.Article in journal (Refereed) Published
Abstract [en]

Evaluating the use of a powered wheelchair is of importance because of the increasing number of people with disabilities who are provided with one. The aim of this study is to describe characteristics of persons with stroke using an outdoor powered wheelchair and to evaluate the impact of the wheelchair on quality of life. A further aim is to compare the impact on quality of life in respect to age, gender, different disability characteristics, and living conditions. The 32 participants with stroke were recruited consecutively from three county council areas in Sweden. A follow-up design was applied including the EuroQol-5D questionnaires at baseline before the persons were prescribed an outdoor powered wheelchair, and after the participants had used the wheelchair for 3 to 5 months, data were collected by means of the EuroQol-5D and the Psychosocial Impact of Assistive Devices Scale (PIADS). The results indicated an improved quality of life with respect to the items competence, independence, capability, quality of life, well-being, happiness, and self-esteem on the PIADS. The usual activity dimension on the EuroQol-5D showed a significant improvement after wheelchair use. The group who drove the powered wheelchair at least once a day in the summer showed a more positive score on the total PIADS and its Competence subscale than persons who drove less. Furthermore, the group with higher rankings of the importance of the powered wheelchair scored higher on psychosocial impact than did the group with lower rankings. The conclusion is that the powered wheelchair mostly has a positive impact on the quality of life of users with stroke. Service providers should be alert, however, to the possible negative impact of a powered wheelchair on quality of life and support the user.

Place, publisher, year, edition, pages
New York, NY: Demos, 2007
National Category
Social Sciences Interdisciplinary Nursing Occupational Therapy
Research subject
Nursing Science w. Occupational Therapy Focus
Identifiers
urn:nbn:se:oru:diva-3074 (URN)17937056 (PubMedID)
Available from: 2006-05-11 Created: 2006-05-11 Last updated: 2016-11-30Bibliographically approved

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