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  • 1.
    Appelros, Peter
    et al.
    Örebro University, Department of Clinical Medicine.
    Nydevik, Ingegerd
    Terént, Andreas
    Living setting and utilisation of ADL assistance one year after a stroke with special reference to gender differences2006In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, no 1, p. 43-49Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To examine living setting and need for ADL assistance before and one year after a first-ever stroke with special focus on gender differences. METHODS: One-year survivors from a population-based stroke study (n = 377) were studied with regard to place of living, need for ADL assistance and who provided the help. Stroke severity, cognitive impairment, post-stroke depression as well as risk factors were evaluated. RESULTS: Before the stroke 48 patients (13%) lived in special housing (service flats or nursing homes), and one year after the stroke, 50 of the survivors (20%) lived in such accommodations. Before the stroke, 80 (21%) of the patients needed help with their personal ADL, while 90 (36%) needed help after one year. The increased need was fulfilled by relatives. Female spouses more often helped their male counterparts, and they tended to accept a heavier burden. Age, living alone, stroke severity, cognitive impairment, pre-stroke ADL dependency and depression were predictors for special housing. CONCLUSIONS: In a time when more and more stroke survivors are cared for at home, it is important to pay attention to the situation of the caregivers. Female caregivers seem to be in an especially exposed position by accepting a heavier burden.

  • 2.
    Arnell, Susann
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center, Örebro University, Örebro, Sweden; The Swedish Institute for Disability Research (SIDR), Örebro University, Örebro, Sweden.
    Jerlinder, Kajsa
    The Swedish Institute for Disability Research (SIDR), Örebro University, Örebro, Sweden; Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
    Geidne, Susanna
    Örebro University, School of Health Sciences.
    Lundqvist, Lars-Olov
    Örebro University, School of Health Sciences. University Health Care Research Center, Örebro University, Örebro, Sweden; The Swedish Institute for Disability Research (SIDR), Örebro University, Örebro, Sweden.
    Experiences of stakeholder collaboration when promoting participation in physical activity among adolescents with autism spectrum disorder2022In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 44, no 9, p. 1728-1736Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Various stakeholders contribute to the development of healthy physical activity habits in adolescents with autism spectrum disorder (ASD). Parents and stakeholders seek collaborative actions but little is still known about such efforts. The purpose of this study was thus to explore how professionals from different services experience stakeholder collaboration when promoting participation in physical activity for these adolescents.

    METHOD: Five focus group discussions were held with 17 professionals from education, health care, community, and sports organizations, engaged in the promotion of physical activity in adolescents with ASD. The data were analyzed with qualitative content analysis.

    RESULTS: . The professionals though experienced that this collaboration was hampered by the low priority given to physical activity issues within different organizations, by limited resources, lack of knowledge, and unclear roles.

    CONCLUSIONS: Notwithstanding the professionals' different roles, all agreed that physical activity issues need to be prioritized and that each stakeholder needs to acknowledge the shared responsibility of collaboration. However, more clear routines for collaboration that include joined efforts but also highlight the organization-specific responsibilities might enhance the collaborative efforts.

    • In-depth understanding of both the adolescents' needs and the environments in which physical activity is promoted is required if participation in physical activity among adolescents with ASD is to be enhanced.
    • Families and professionals within different organizations need to be supported to collaborate when mapping and meeting the adolescents' physical activity needs.
    • Issues regarding developing physical activity habits need to be prioritized.
    • Professionals, such as education, health, and community professionals who are important for the promotion of healthy physical activity habits need to be included in multi-stakeholder meetings.
  • 3.
    Arvidsson, Patrik
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Research & Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden.
    Granlund, Mats
    Swedish Institute for Disability Research, Örebro University, Örebro , Sweden; Swedish Institute for Disability Research, Örebro University, Örebro , Sweden.
    Thyberg, Ingrid
    Department of Clinical and Experimental Medicine, Faculty of Rheumatology, Linköping University, Linköping, Sweden.
    Thyberg, Mikael
    Swedish Institute for Disability Research, Örebro University, Örebro, Sweden; Department of Medical and Health Sciences, Faculty of Rehabilitation Medicine, Linköping University, Linköping, Sweden.
    Important aspects of participation and participation restrictions in people with a mild intellectual disability2014In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 36, no 15, p. 1264-1272Article in journal (Refereed)
    Abstract [en]

    Purpose: This study explored a possibility to assess the concepts of participation and participation restrictions in the International Classification of Functioning, Disability and Health (ICF) by combining self-ratings of the perceived importance with the actual performance of different everyday activities in people with a mild intellectual disability.

    Method: Structured interviews regarding 68 items from the ICF activity/participation domain were conducted (n = 69). The items were ranked by perceived importance, performance and by combined measures. Furthermore, the measures were related to a single question about subjective general well-being.

    Results: Rankings of performance highlighted about the same items as "important participation", while rankings of low performance addressed quite different items compared with "important participation restriction". Significant correlations were found between subjective general well-being and high performance (r = 0.56), high performance/high importance (important participation) (r = 0.56), low performance (r = -0.56) and low performance/high importance (important participation restriction; r -0.55).

    Conclusions: The results support the clinical relevance of the ICF and the studied selection of 68 items. Although performance only may sometimes be a relevant aspect, knowledge about the relationship between the perceived importance and the actual performance is essential for clinical interventions and for research aiming to understand specific needs regarding participation.

  • 4.
    Björck-Åkesson, E
    et al.
    School of Education and Communication, Jönköping University, Jönköping, Sweden.
    Wilder, J
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Granlund, M
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Pless, M
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Simeonsson, R
    School of Education and Communication, Jönköping University, Jönköping, Sweden.
    Adolfsson, M
    School of Education and Communication, Jönköping University, Jönköping, Sweden.
    Almqvist, L
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Augustine, L
    Swedish Institute of Public Health, Östersund, Sweden.
    Klang, N
    Academy for Education, Communication and Culture, Mälardalen University, Västerås, Sweden.
    Lillvist, Anne
    Academy for Education, Communication and Culture, Mälardalen University, Västerås, Sweden.
    The International Classification of Functioning, Disability and Health and the version for children and youth as a tool in child habilitation/early childhood intervention - feasibility and usefulness as a common language and frame of reference for practice2010In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no S1, p. S125-S138Article in journal (Refereed)
    Abstract [en]

    Early childhood intervention and habilitation services for children with disabilities operate on an interdisciplinary basis. It requires a common language between professionals, and a shared framework for intervention goals and intervention implementation. The International Classification of Functioning, Disability and Health (ICF) and the version for children and youth (ICF-CY) may serve as this common framework and language. This overview of studies implemented by our research group is based on three research questions: Do the ICF-CY conceptual model have a valid content and is it logically coherent when investigated empirically? Is the ICF-CY classification useful for documenting child characteristics in services? What difficulties and benefits are related to using ICF-CY model as a basis for intervention when it is implemented in services? A series of studies, undertaken by the CHILD researchers are analysed. The analysis is based on data sets from published studies or master theses. Results and conclusion show that the ICF-CY has a useful content and is logically coherent on model level. Professionals find it useful for documenting children's body functions and activities. Guidelines for separating activity and participation are needed. ICF-CY is a complex classification, implementing it in services is a long-term project.

  • 5.
    Björck-Åkesson, Eva
    et al.
    School of Education and Communication, Jönköping University, Jönköping, Sweden.
    Wilder, Jenny
    School of Health Sciences, Jönköping University, Jönköping, Sweden .
    Granlund, Mats
    School of Health Sciences, Jönköping University, Jönköping, Sweden .
    Pless, Mia
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden .
    Simeonsson, Rune
    School of Education and Communication, Jönköping University, Jönköping, Sweden.
    Adolfsson, Margareta
    School of Education and Communication, Jönköping University, Jönköping, Sweden.
    Almqvist, Lena
    Swedish Institute of Public Health, Östersund, Sweden.
    Klang, Nina
    Academy for Education, Communication and Culture, Mälardalen University, Västerås, Sweden.
    Lillvist, Anne
    Academy for Education, Communication and Culture, Mälardalen University, Västerås, Sweden.
    The International Classification of Functioning, Disability and Health and the version for children and youth as a tool in child habilitation/early childhood intervention: Feasibility and usefulness as a common language and frame of reference for practice2010In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no SUPPL. 1, p. 125-138Article in journal (Refereed)
    Abstract [en]

    Early childhood intervention and habilitation services for children with disabilities operate on an interdisciplinary basis. It requires a common language between professionals, and a shared framework for intervention goals and intervention implementation. The International Classification of Functioning, Disability and Health (ICF) and the version for children and youth (ICF-CY) may serve as this common framework and language. This overview of studies implemented by our research group is based on three research questions: Do the ICF-CY conceptual model have a valid content and is it logically coherent when investigated empirically? Is the ICF-CY classification useful for documenting child characteristics in services? What difficulties and benefits are related to using ICF-CY model as a basis for intervention when it is implemented in services? A series of studies, undertaken by the CHILD researchers are analysed. The analysis is based on data sets from published studies or master theses. Results and conclusion show that the ICF-CY has a useful content and is logically coherent on model level. Professionals find it useful for documenting children's body functions and activities. Guidelines for separating activity and participation are needed. ICF-CY is a complex classification, implementing it in services is a long-term project

  • 6.
    Boström, Katrin
    et al.
    Örebro University, Department of Nursing and Caring Sciences.
    Ahlström, Gerd
    Örebro University, Department of Nursing and Caring Sciences.
    Living with a chronic deteriorating disease: the trajectory with muscular dystrophy over ten years2004In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 26, no 23, p. 1388-1398Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of the study was to elucidate experiences of living with muscular dystrophy in terms of consequences for activity over 10 years. Methods: The study population was identified in a prevalence study in a county of Sweden. Forty-six persons of this cohort with MD were interviewed. A qualitative research approach was chosen. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) was used for categorization. Results: Nearly all the subjects experienced a deterioration of physical capacity. Most obvious were the restrictions on mobility and increased fatigue and feebleness. The persons described psychosocial consequences of the muscular dystrophy as well as stigma when the disability had become more obvious. In spite of reported distress several persons experienced better psychological adaptation over time. The image of the future was often dark but several focus on today and avoid thoughts about the future. ICF showed some limitation with regard to temporal aspects, emotions and the subjective perspective. Conclusions: The knowledge of the trajectory with MD is important in order to offer the best possible treatment and support. Repeated assessment by ICF can serve as a valuable source of such knowledge, and a development of the classification would increase its usefulness in future analysis of functioning and disability.

  • 7.
    Busch, Hillevi
    et al.
    Public Health Agency of Sweden, Stockholm, Sweden.
    Björk Brämberg, Elisabeth
    Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Hagberg, Jan
    Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Jensen, Irene
    Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    The effects of multimodal rehabilitation on pain-related sickness absence: an observational study2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, no 14, p. 1646-1653Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of the current study was to examine the effects on sickness absence of multimodal rehabilitation delivered within the framework of a national implementation of evidence based rehabilitation, the rehabilitation guarantee for nonspecific musculoskeletal pain.

    Method: This was an observational matched controlled study of all persons receiving multimodal rehabilitation from the last quarter of 2009 until the end of 2010. The matching was based on age, sex, sickness absence the quarter before intervention start and pain-related diagnosis. The participants were followed by register data for 6 or 12 months. The matched controls received rehabilitation in accordance with treatment-as-usual.

    Results: Of the participants, 54% (N = 3636) were on registered sickness absence at baseline and the quarter before rehabilitation. The average difference in number of days of sickness absence between the participants who received multimodal rehabilitation and the matched controls was to the advantage of the matched controls, 14.7 days (CI 11.7; 17.7, p ≤ 0.001) at 6-month follow-up and 9.5 days (CI 6.7; 12.3, p ≤ 0.001) at 12-month follow-up. A significant difference in newly granted disability pensions was found in favor of the intervention.

    Conclusions: When implemented nationwide, multimodal rehabilitation appears not to reduce sickness absence compared to treatment-as-usual.

    Implications for Rehabilitation

    • A nationwide implementation of multimodal rehabilitation was not effective in reducing sickness absence compared to treatment-as-usual for persons with nonspecific musculoskeletal pain.

    • Multimodal rehabilitation was effective in reducing the risk of future disability pension for persons with nonspecific musculoskeletal pain compared to treatment-as-usual.

    • To be effective in reducing sick leave multimodal rehabilitation must be started within 60 days of sick leave.

    • The evidence for positive effect of multimodal rehabilitation is mainly for sick listed patients. Prevention of sick leave for persons not being on sick leave should not be extrapolated from evidence for multimodal rehabilitation.

  • 8.
    Carling, Anna
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Centre; Department of Physiotherapy.
    Nilsagård, Ylva
    Health Care Management, Region Örebro County, Örebro, Sweden.
    Forsberg, Anette
    Örebro University, School of Medical Sciences.
    Making it work: experience of living with a person who falls due to multiple sclerosis2020In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 42, no 7, p. 940-947Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this study was to describe how everyday life is experienced by next of kin sharing residence with a person who falls due to multiple sclerosis (MS).

    METHODS: Twenty face-to-face interviews were analysed using a qualitative content analysis.

    RESULTS: The overall theme "Making it work" represents the next of kin's struggle to make life work. It comprises three themes: "Taking responsibility", "Making adjustments", and "Standing aside for someone else". The two first themes reflect what relatives do to make the situation work, and the last theme represents what they give up.

    CONCLUSION: Next of kin who share residence and everyday life with a person with MS are affected by that person's occasional falls. They often take on the responsibility of preventing such falls and adapt their lives practically and emotionally. However, adaptation is neither always enough or always possible. In these cases, relatives often deprioritize their own needs and free time to make everyday life in the home work.

    Implications for rehabilitation

    • By highlighting that next of kin also are affected by the falls of their cohabiting person with multiple sclerosis enhances the importance of fall prevention activities that should include the next of kin.
    • Next of kin to people who occasionally fall due to multiple sclerosis can be in need of both practical and emotional support from the health care system.
    • Enhanced information from the health care system can empower and help them to take care of themselves while managing to live with, care for, and protect the person with multiple sclerosis from falls.
  • 9.
    Carlsson, Per-Inge
    et al.
    Department of otorhioloaryngology, Central hospital, Karlstad, Sweden; Audiological Research Center, Örebro University Hospital, Örebro, Sweden.
    Hjaldahl, Jennie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Audiological Research Center, Örebro university hospital, Örebro, Sweden.
    Magnuson, Anders
    Clinical epidemiology and biostatistics unit, Örebro university hospital, Örebro, Sweden.
    Ternevall, Elisabeth
    Department of audiology, Karolinska University hospital, Stockholm, Sweden.
    Edén, Margareta
    Department of hearing impairment and deafness, Mölndal hospital, Göteborg, Sweden.
    Skagerstrand, Åsa
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Audiological Research Center, Örebro university hospital, Örebro, Sweden.
    Jönsson, Radi
    Department of Otorhinolaryngology, Sahlgrenska university Hospital, Göteborg, Sweden.
    Severe to profound hearing impairment: quality of life, psychosocial consequences and audiological rehabilitation2014In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 20, p. 1849-1856Article in journal (Refereed)
    Abstract [en]

    Purpose: To study the quality of life (QoL) and psychosocial consequences in terms of sick leave and audiological rehabilitation given to patients with severe to profound hearing impairment.

    Method: A retrospective study of data on 2319 patients with severe to profound hearing impairment in The Swedish Quality Register of Otorhinolaryngology, followed by a posted questionnaire including The Hospital Anxiety and Depression Scale (HADS). 

    Results: The results indicate greater levels of anxiety and depression among patients with severe or profound hearing impairment than in the general population, and annoying tinnitus and vertigo had strong negative effects on QoL. The proportion of sick leave differed between the studied dimensions in the study. The proportion of patients who received extended audiological rehabilitation was 38% in the present study. 

    Conclusions: Treatment focused on anxiety, depression, tinnitus and vertigo must be given early in the rehabilitation process in patients with severe or profound hearing impairment. Because sick leave differs greatly within this group of patients, collaboration with the regional Social Insurance Agency is crucial part of the rehabilitation. The study also shows that presently, only a small proportion of patients in Sweden with severe to profound hearing impairment receive extended audiological rehabilitation. Implications for Rehabilitation

    • Greater levels of anxiety and depression have been found among patients with severe or profound hearing impairment than in the general population, and annoying tinnitus and vertigo have strong negative effects on QoL in this group of patients.

    • Only a small proportion of patients with severe to profound hearing impairment receive extended audiological rehabilitation today, including medical, technical and psychosocial efforts.

    • Extended audiological rehabilitation focused on anxiety, depression, tinnitus and vertigo must be given, together with technical rehabilitation, early in the rehabilitation process in patients with severe or profound hearing impairment.

  • 10.
    Elvén, Maria
    et al.
    School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden; School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Prenkert, Malin
    Örebro University, School of Health Sciences.
    Holmström, Inger K.
    School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Edelbring, Samuel
    Örebro University, School of Health Sciences.
    Reasoning about reasoning: using recall to unveil clinical reasoning in stroke rehabilitation teams2024In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    Purpose: The study objective was to investigate how health care providers in stroke teams reason about their clinical reasoning process in collaboration with the patient and next of kin.

    Materials and methods: An explorative qualitative design using stimulated recall was employed. Audio-recordings from three rehabilitation dialogs were used as prompts in interviews with the involved staff about their clinical reasoning. A thematic analysis approach was employed.

    Results: A main finding was the apparent friction between profession-centered and person-centered clinical reasoning, which was salient in the data. Five themes were identified: the importance of different perspectives for a rich picture and well-informed decisions; shared understanding in analysis and decision-making - good intentions but difficult to achieve; the health care providers' expertise directs the dialog; the context's impact on the rehabilitation dialog; and insights about missed opportunities to grasp the patient perspective and arrive at decisions.

    Conclusions: Interprofessional stroke teams consider clinical reasoning as a process valuing patient and next of kin perspectives; however, their professional expertise risks preventing individual needs from surfacing. There is a discrepancy between professionals' intentions for person-centeredness and how clinical reasoning plays out. Stimulated recall can unveil person-centered practice and enhance professionals' awareness of their clinical reasoning.

  • 11. Eriksson Westblad, Mimmi
    et al.
    Forsberg, Anette
    Örebro University, School of Health and Medical Sciences.
    Press, Rayomand
    Disability and health status in patients with chronic inflammatory demyelinating polyneuropathy2009In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 9, p. 720-725Article in journal (Refereed)
    Abstract [en]

    Purpose. Chronic inflammatory demyelinating polyneuropathy (CIDP) is a disorder affecting the peripheral nerves. The purpose of this study was to describe disability and health status in patients with CIDP in Sweden. Methods. All 22 adult patients with CIDP at the Karolinska University Hospital, Huddinge were invited to participate. Twenty-one patients performed all measures. Their mean age was 54 years. The following measures were used: vibration perception threshold (VPT); the Fatigue Severity Scale (FSS); the Berg Balance Scale; finger dexterity using the Nine-Hole Peg Test (NHPT); functional mobility using the Timed 'Up and Go' Test; health status with the SF-36 questionnaire. Results. Fifty-seven per cent of the patients had a higher thumb and ankle VPT than published normative data. The FSS showed that 38% scored over 5, indicating severe fatigue. The majority of the patients had reduced functional balance. Sixty-two per cent had a subnormal result on the NHPT. Results of the SF-36 showed lower scores than the Swedish norm on the sub-scales describing physical health. Conclusions. The majority of the patients with CIDP had disabilities and decreased physical health status. The presence of fatigue may be taken into consideration in immunomodulatory treatments and during physical rehabilitation.

  • 12.
    Forsberg, Anette
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Family Medicine Research Centre, Örebro University Hospital, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Boström, Katrin
    Department of Health and Medical Services, Örebro University Hospital, Örebro, Sweden.
    Perceptions of using videogames in rehabilitation: a dual perspective of people with multiple sclerosis and physiotherapists2014In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 4, p. 338-344Article in journal (Refereed)
    Abstract [en]

    Purpose: Our aim was to describe experiences of using Nintendo Wii Fit™ for balance exercise, from the perspectives of patients with multiple sclerosis (MS) and their physiotherapists (PT).

    Methods: Individual interviews with 15 patients with MS were conducted, recruited from a multi-centre study investigating the effects of balance exercising using Wii Fit. We also conducted a single focus group interview with nine PT involved in the study. The interviews were audio-recorded, transcribed, and analysed using content analysis.

    Results: Both patients and PT said that exercising with Wii Fit games was fun, and that it challenged the patients’ physical and cognitive capacities. The competitive content in the games provided motivation to continue playing. Patients and PT reported improved body control and, more importantly, positive effects on balance and walking in daily life. The PT regarded Wii training as an effective alternative to other balance training, but some felt unsure in how to manage the video game. The patients regarded Wii training as a possible home training solution.

    Conclusions: Patients with MS and their PT considered Wii Fit exercises to be fun, challenging, and self-motivating. Exercising with Wii games can address balance impairments in MS, and can be performed at home as well as in rehabilitation settings.Implications for Rehabilitation

    • Nintendo Wii Fit™ can be used as a fun and challenging way to perform balance exercises.

    • The competitive content embedded in the games triggers continued playing and exercising.

    • The positive effect on balance control can improve standing and walking in everyday activities.

  • 13.
    Frennert, Susanne
    et al.
    School of Chemistry, Biotechnology, and Health, KTH, Stockholm, Sweden.
    Baudin, Katarina
    School of Health Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden.
    The concept of welfare technology in Swedish municipal eldercare2021In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 43, no 9, p. 1220-1227Article in journal (Refereed)
    Abstract [en]

    Purpose:  An ageing population presents a challenge for municipal eldercare in Sweden due to difficulties recruiting staff and there being a strained economy. A strategy involving welfare technology is presented as one such solution. An important group to carry out this strategy involves those who work with welfare technology in municipal eldercare. In this paper we describe their perception of welfare technology, and the challenges and opportunities they perceive in utilizing it. 

    Methods: A self-administered online questionnaire was distributed to all Swedish municipalities and answered by 393 respondents. Analyses show that the respondents were representative of the different professions who work with welfare technology within municipal eldercare.

    Results: Welfare technology was perceived as being more reliable and safer than humans with regards to supervisions and reminders. The respondents acknowledged factors that slowed down the implementation of welfare technology in municipal eldercare organizations, such as resistance to change, lack of finances, lack of supporting evidence, lack of infrastructure, high staff turnover, difficulties with procurement and uncertainties about responsibility and laws.

    Conclusions: We found that the people who work with and make decisions about welfare technology in municipal eldercare organizations were generally very positive about the deployment and use of such technology, but there appear to be problems within municipal eldercare organizations to realize this vision. The lack of structured implementation processes and coherent evaluation models indicates inequality of the access to welfare technology and, as a result, even though Swedish eldercare is publicly funded, the availability of welfare technologies and their usage differ between municipalities.

  • 14.
    Hammer, Ann M.
    et al.
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Lindmark, Birgitta
    Dept Neurosci, Sect Physiotherapy, Uppsala Univ, Uppsala, Sweden.
    Responsiveness and validity of the Motor Activity Log in patients during the subacute phase after stroke2010In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no 14, p. 1184-1193Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate the responsiveness and cross-sectional and longitudinal validity of the Motor Activity Log (MAL) in the subacute phase after stroke.

    Method: Data were collected pre-intervention, post-intervention, and at 3-month follow-up evaluations from 30 patients with stroke participating in a randomized trial of forced use. Assessments included MAL, the Fugl-Meyer test, the 16-hole peg test, grip strength, the Action Research Arm Test, and the Motor Assessment Scale. Measurements of responsiveness were effect size, standardized response mean (SRM), and responsiveness ratio (RR). Relationships between the MAL and the other measures were determined with Spearman correlations.

    Results: The MAL is responsive to change, with effect size, SRM, and RR ›1.0 at the 3-month follow-up, and SRM and RR ›1.0 at post-intervention. Correlations at the separate test occasions between MAL and the other measures were mostly close to 0.50, which shows fair to moderate construct validity. Correlations between changes in MAL and in the other measures were weaker than cross-sectional relationships.

    Conclusions: The MAL is a responsive measure of daily hand use in patients participating in rehabilitation in the subacute phase after stroke. Correlations of construct validity indicate that daily hand use may need to be measured separately from body function and activity capacity, in line with the underlying constructs of International Classification of Functioning, Disability and Health. To strengthen our findings, they should be repeated in larger samples of patients.

  • 15.
    Ibragimova, Nina
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lillvist, Anne
    Department of Caring and Public Health Sciences, Mälardalen University, Sweden.
    Pless, Mia
    Department of Caring and Public Health Sciences, Mälardalen University, Sweden.
    Granlund, Mats
    Department of Caring and Public Health Sciences, Mälardalen University, Sweden.
    The utility of ICF for describing interaction in non-speaking children with disabilities: caregiver ratings and perceptions2007In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 29, no 22, p. 1689-1700Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of the study is to explore the utility of the International Classification of Functioning, Disability and Health (ICF) when assessing caregivers' perceptions of interaction and factors related to interaction in non-speaking children with disability.

    METHOD: A questionnaire with focus on interaction and related factors was constructed by linking questions in existing instruments to ICF and was completed by 208 professionals and parents of 195 non-speaking children with disabilities in Russia. Caregivers' descriptions of interaction in open-ended questions were qualitatively analysed and compared to selected caregivers' ratings of children's functioning and environment in the questionnaire based on ICF.

    RESULTS: In the open-ended questions about interaction the caregivers described modes of communication children used, situations in which interactions took place, positive and negative aspects of interactions. Thirty eight respondents described interaction with children negatively, 66 neutrally, and 76 positively. Statistical analyses revealed significant differences among the three groups of respondents concerning their ratings of children's functioning and environment in the ICF-based questionnaire.

    CONCLUSIONS: The ICF-related items in the questionnaire corresponded to caregivers' perceptions of interaction, which shows their relevance for the description of interactions. ICF is feasible in describing of interaction and interaction-related factors in non-speaking children with disabilities in Russia.

  • 16.
    Johansson, Ann-Christin
    et al.
    Clin Res Ctr, Dept Orthopaed Surg, Cent Hosp, Uppsala Univ, Västerås, Sweden.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Rosenblad, Andreas
    Clin Res Ctr, Dept Orthopaed Surg, Cent Hosp, Uppsala Univ, Västerås, Sweden.
    Bergkvist, Leif
    Clin Res Ctr, Dept Orthopaed Surg, Cent Hosp, Uppsala Univ, Västerås, Sweden.
    Nilsson, Olle
    Dept Orthopaed, Univ Uppsala Hosp, Uppsala, Sweden.
    A prospective study of cognitive behavioural factors as predictors of pain, disability and quality of life one year after lumbar disc surgery2010In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no 7, p. 521-529Article in journal (Refereed)
    Abstract [en]

    Purpose: The primary aim of this study was to analyse the predictive value of cognitive and behavioural factors, in relation to pain, disability and quality of life (QoL) one year after lumbar disc surgery.

    Method: The study design was prospective. Fifty-nine patients scheduled for first time lumbar disc surgery were included. Pain, disability, QoL, coping, fear avoidance beliefs, expected outcome and sick leave were assessed preoperatively and 12 months after surgery. Multiple backward stepwise logistic regression analyses were performed to study the contribution of the preoperatively measured independent behavioural/cognitive factors (coping, fear avoidance beliefs and assessed chance to return to work within 3 months) to the dependent variables pain, disability and quality of life at 12 months after surgery.

    Results: Low expectations on work return within 3 months after surgery was significantly predictive for residual leg pain, odds ratio (OR)¼8.2, back pain, OR¼9.7, disability, OR¼13.8 and sick leave, OR¼19.5. Low QoL, was best predicted by preoperatively high scores on fear avoidance beliefs OR¼6.6 and being a woman OR¼6.0. The regression model explained 26–40% of the variance in pain, disability, QoL and sick leave.

    Conclusions: Eliciting patients’ expectations on work return after surgery could contribute to early identification of those who run the risk of developing long-term disability and sick-leave.

  • 17.
    Karlsson, Elin
    et al.
    Örebro University, School of Health Sciences. Swedish Institute of Disability Research (SIDR).
    Gustafsson, Johanna
    Örebro University, School of Health Sciences. Swedish Institute of Disability Research (SIDR).
    Validation of the international classification of functioning, disability and health (ICF) core sets from 2001 to 2019: a scoping review2022In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 44, no 14, p. 3736-3748Article, review/survey (Refereed)
    Abstract [en]

    Objective: To investigate and summarize the literature on the validation of International classification of functioning, disability and health (ICF) core sets from 2001 to 2019 and explore what research methods have been used when validating ICF core sets.

    Methods: The current study is a scoping review using a structured literature search.

    Results: In total, 66 scientific articles were included, of which 23 ICF core sets were validated. Most validation studies were conducted in Europe using a qualitative methodology and were validated from the perspective of patients. Analysis methods differed considerably between the studies, and most ICF core sets were validated only once for a single target population or from a single perspective. The comprehensive core sets were validated more often than the brief core sets, and core sets for stroke and low back pain were validated most often.

    Conclusion: The results of the current study show that only 66% of the existing ICF core sets are validated. Many of the validation studies are conducted in a European context and from a single perspective. More validation studies of ICF core sets from the perspective of both patients and professionals are needed.

  • 18.
    Lidström-Holmqvist, Kajsa
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center .
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Arvidsson, Patrik
    CHILD, Swedish Institute for Disability Research, Jönköping University, Sweden; Centre for Research & Development, Region Gävleborg, Uppsala University, Sweden.
    Test-retest reliability of the Swedish version of the Weekly Calendar Planning Activity: a performance-based test of executive functioning2020In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 42, no 18, p. 2647-2652Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The Weekly Calendar Planning Activity is a performance test aiming to examine how subtle problems with executive functioning influence the performance of multi-step activities in daily life. The purpose of this study was to explore the Swedish version of the Weekly Calendar Planning Activity, regarding test-retest reliability and possible learning effects.

    MATERIAL AND METHODS: Twenty-four adults with psychiatric, neurodevelopmental or mild intellectual disorders and with difficulties in executive functioning performed the test on three separate occasions, with two weeks apart. Test-retest reliability was determined using intraclass correlation coefficients. Possible learning effects were evaluated. The smallest detectable change was calculated to determine the precision of individual scores.

    RESULTS AND CONCLUSION: The intraclass correlation coefficients between the first two test occasions were weak (0.42-0.66), but were acceptable to excellent (0.65-0.91) between test occasions 2 and 3. There was a considerable amount of random variation in the results, but little systematic variation, indicating no or possibly a small learning effect in the total number of accurately recorded appointments. This variation indicates a need to use two consecutive baseline measurements when the Swedish version of the Weelky Calendar Planning Acitivity is used as an outcome measure. Together, our results suggest that the Swedish version of the Weelky Calendar Planning Acitivity is a useful performance-based measure of how subtle problems in executive functioning affects activity performance.

    Implications for rehabilitation:

    • Executive functioning is crucial for managing daily life, and ecologically valid tests are needed to measure such functioning.
    • The Weekly Calendar Planning Activity is a new performance-based test using a task that is relevant to daily life.
    • The outcomes obtained in the Weekly Calendar Planning Activity are highly useful in clinical practice.
    • The day-to-day variation in the Weekly Calendar Planning Activity results warrants the need for two consecutive baseline measurements when it is used to measure change.
  • 19.
    Medin, Jörgen
    et al.
    Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.
    Larson [Windahl], Jenny
    Karolinska Institutet, Stockholm, Sweden.
    von Arbin, Magnus
    Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.
    Wredling, Regina
    Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden; Sophiahemmet University College, Stockholm, Sweden.
    Tham, Kerstin
    Karolinska Institutet, Stockholm, Sweden.
    Elderly persons' experience and management of eating situations 6 months after stroke.2010In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no 16, p. 1346-1353Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore the experience and management of eating situations among persons affected by stroke, 6 months after stroke onset.

    Method: A qualitative constant comparative approach, influenced by principles of grounded theory, was used to analyse the interviews. Thirteen participants were interviewed in the home setting 6 months after the stroke.

    Results: Experiences and desire to master eating situations varied, and was related to values and previous habits. Eating difficulties were experienced as disgusting, uncomfortable, strenuous, or unproblematic and not implying shame. Getting help from others could be experienced as embarrassing and undesirable. In particular, eating could be more difficult when eating in company of unfamiliar people. The participants found new ways of mastering eating situations. Some had regained former routines.

    Conclusions: Old values and habits and/or involvement of other people were the basis of mastering eating situations. New ways of mastering were found, some accepted, and got used to the new situation. Some regained former routines. This knowledge could contribute to health care personnel's awareness of each patient's individual values and previous habits during the rehabilitation process. A dialogue is needed with the person suffering from eating difficulties after stroke, to help create the best possible individual conditions for mastering eating situations.

  • 20.
    Mäki-Torkko, Elina Margareetta
    et al.
    Örebro University Hospital. Department of Clinical and Experimental Medicine/Technical Audiology, Linköping University, Linköping, Sweden; Department of ENT-Head Neck Surgery, County Council of Östergötland, Linköping, Sweden; Linnaeus Centre HEAD, Linköping University, Linköping, Sweden.
    Vestergren, Sara
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Harder, Henrik
    Department of ENT-Head Neck Surgery, County Council of Östergötland, Linköping, Sweden.
    Lyxell, Björn
    Linnaeus Centre HEAD, Linköping University, Linköping, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    From isolation and dependence to autonomy - expectations before and experiences after cochlear implantation in adult cochlear implant users and their significant others2015In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 6, p. 541-547Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of the study was to examine pre-operative expectations and the postoperative experiences related to cochlear implants (CI) in CI-users and their significant others.

    Methods: A questionnaire was used and the responses were analysed by means of The Qualitative Content Analysis. All adults implanted between 1992 and 2010, who had had their implants for a minimum of 12 months (n = 120) were contacted. Response rate was high (90.8%), and all-inclusive answers were received from 101 CI-users (84.2%).

    Results: The overall sense of increased well-being and life satisfaction was described as having lived in two different worlds, one with the auditory stimulation and one without. In the overall sense of increased well-being and satisfaction three interwoven subcategories, alienation - normality, fear - autonomy, and living a social life emerged. When CI-users and their significant others recalled the time prior to receiving the CI, a sense of fear was present with origins in the concern for the respondents' (CI-users) ability to cope and care independently in society. Conversely, after the implantation both parties emphasized the notion of a distinct transformation within the CI-user towards autonomy. Communication was highlighted as a large part of living social life.

    Conclusion: The CI increases well-being and satisfaction for both CI-users and their significant others, which is especially evident regarding enhanced autonomy, normality and living social life.

  • 21.
    Möller, Kerstin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Eriksson, Kristina
    Sadeghi, André M.
    Möller, Claes
    Örebro University, School of Health and Medical Sciences.
    Danermark, Berth
    Örebro University, School of Health and Medical Sciences.
    Long-term ophthalmic health care in Usher syndrome type I from an ICF perspective2009In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 15, p. 1283-1292Article in journal (Refereed)
    Abstract [en]

     

    PURPOSE: The aim was to explore ophthalmic health care in female patients with Usher Syndrome type I (USH I) over 20 years and to evaluate the relationship between the ophthalmic health care and the health state of the patients from a health perspective. METHODS: A retrospective study of records from ophthalmology departments (OD) and low vision clinics (LVC) from 1985 to 2004. Assessment of the reports was performed based on the International Classification of Functioning, Disability and Health (ICF). Findings were analysed by manifest content analysis with ICF as a framework and using four themes: health care system, procedure examinations, patient's functioning and disability and procedure actions. RESULTS: The records of nine female patients (aged 25-39 years, 1985) with USH I were selected from the national database of USH. A great number of notes were collected (OD 344 and LVC 566). Procedure examinations were exclusively oriented towards body structure and function. All patients showed aggravated visual impairment over and above the hearing and vestibular impairment. Procedure actions were oriented towards environmental factors. No correlation was found between procedures performed and patient's experience of disability. CONCLUSIONS: The high degree of resource allocation was not correlated to the patients' impairment. The study indicates that the ophthalmic health care was characterised by inefficiency. This conclusion is very serious because patients very likely face severe disability and emotional difficulties. ICF is ought to be incorporated in ophthalmic health care strategy to improve the health care.

  • 22.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health and Medical Sciences.
    Denison, Eva
    Gunnarsson, Lars-Gunnar
    Boström, Katrin
    Factors perceived as being related to accidental falls by persons with multiple sclerosis2009In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 16, p. 1301-1310Article in journal (Refereed)
    Abstract [en]

    Purpose. This study explores and describes factors that persons with multiple sclerosis (MS) perceive as being related to accidental falls. Method. A qualitative content analysis with primarily deductive approach was conducted using the International Classification of Functioning, Disability and Health. Twelve persons with MS, and identified as fallers, were interviewed. Results. Factors perceived to cause accidental falls that had not previously been targeted in MS populations in relation to falls were identified as divided attention, reduced muscular endurance, fatigue and heat sensitivity. Previously reported risk factors such as changed gait pattern, limited walking ability, impaired proprioception, vision and spasticity were supported. Activities involving walking, recreation and leisure, maintaining and changing body position, lifting or carrying, taking care of the home, washing the body, moving around, preparing meals and housekeeping were limited and considered to be risk activities. Supportive persons and assistive device reduced falls, and unsuitable physical environments and climate conditions induced falls. Several preventative strategies were described as partially compensating for the impairments, limitations and restrictions. Conclusions. Investigating accidental falls using the perspective of the patient gave important information about variables not earlier targeted in MS research.

  • 23.
    Nilsagård, Ylva
    et al.
    Centre for Health Care Sciences, Örebro, Sweden.
    Forsberg, Anette
    Family Medicine Research Centre, Örebro, Sweden.
    Psychometric properties of the Activities-Specific Balance Confidence Scale in persons 0-14 days and 3 months post stroke2012In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 14, p. 1186-1191Article in journal (Refereed)
    Abstract [en]

    Purpose: To test the internal consistency and validity of a Swedish translation of the Activities-specific Balance Confidence Scale (ABC) 0-14 days and 3 months post stroke.

    Method: 37 persons were tested at 0-14 days (median 5 days) post stroke and 31 were retested 3 months later (median 87 days). In addition to the ABC, the Functional Ambulation Categories, modified Rivermead Mobility Index, timed up and go test, 10-meter timed walk, SF-36 and the 12-item Walking Scale were used.

    Results: The internal consistency was high at α = 0.94 to 0.97. Kendall correlation-τ coefficients were moderate and varied somewhat depending on time poststroke. At 0-14 days post stroke the highest correlation was found between the ABC and the 12-item Walking Scale (-0.55, p < 0.01). At 3 months poststroke, the correlations with the Functional Ambulation Categories was 0.49 (p < 0.01), timed up and go test -0.43 (p < 0.01), 10-meter timed walk -0.41 (p < 0.01), and modified Rivermead Mobility Index 0.46 (p < 0.01). Divergent validity was established by the non-significant correlation (0.12) between the ABC and SF-36 mental component summary.

    Conclusions: The Swedish version of ABC has high internal consistency and is valid for measuring balance confidence in the acute and sub acute phases of stroke

  • 24.
    Nilsing Strid, Emma
    et al.
    Division of Physiotherapy, Linköpings University, Linköping, Sweden.
    Söderberg, Elsy
    Linköpings University, Linköping, Sweden.
    Öberg, Birgitta
    Linköpings University, Linköping, Sweden.
    Sickness certificates: what information do they provide about rehabilitation?2014In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 36, no 15, p. 1299-1304Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate whether patients are prescribed rehabilitation early in a new sick leave period, and whether this prescription is associated with age, sex, diagnosis, description of functioning, and affiliation of certifying physician.

    Methods: A cross-sectional study using data from sickness certificates issued during a total sick leave period, collected consecutively during 2 weeks in 2007 in Östergötland County, Sweden. Rehabilitation prescribed in the first certificate or within 28 days after the start of sick leave was defined as early rehabilitation.

    Results: Musculoskeletal diseases (MSD) were the largest diagnostic group, followed by mental disorders (MD). The mean certified duration of sick leave was 94 days (SD 139), longest for MD patients. Early rehabilitation was prescribed in 27% of all certificates and in 45% of certificates for MSD and MD diagnoses. Logistic regression analysis indicated that prescription of early rehabilitation was associated with certificates issued for MSD and MD, youngest patients, and certificates issued by primary health care physicians. The final model explained 29% of variation in the prescription of early rehabilitation.

    Conclusion: There is a modest prescription of early rehabilitation in sickness certificates, based on younger age and MSD or MD diagnosis. This indicates that patients’ rehabilitation needs may not have been identified.

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    Sickness certificates: what information do they provide about rehabilitation
  • 25.
    Norderyd, Johanna
    et al.
    National Oral Disability Centre, The Institute for Postgraduate Dental Education, Jönköping, Sweden; CHILD, Swedish Institute for Disability Research, School of Health Sciences, Jönköping, Sweden.
    Lillvist, Anne
    School of Education, Culture and Communication, Mälardalen University, Västerås, Sweden.
    Klingberg, Gunilla
    Departement of Pediatric Dentistry, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Faulks, Denise
    CHU Clermont-Ferrand, Service d’Odontologie, Clermont-Ferrand, France; Clermont Universite ́, Universite ́d’Auvergne, Centre de Recherche en Odontologie Clinique, Clermont-Ferrand, France.
    Granlund, Mats
    CHILD, Swedish Institute for Disability Research, School of Health Sciences, Jönköping, Sweden.
    Oral health, medical diagnoses, and functioning profiles in children with disabilities receiving paediatric specialist dental care – a study using the ICF-CY2015In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 16-17, p. 1431-1438Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe 0-16-year-old children with disabilities receiving paediatric specialist dental care from a biopsychosocial perspective, with focus on relationship between oral health, medical diagnosis, and functioning.

    Method: A questionnaire with an International Classification of Functioning, Disability and Health - Children and Youth version (ICF-CY) Checklist for Oral Health was completed using structured interview, direct observation, and information from dental records. Descriptive data analysis was performed together with principle component analysis to calculate factors of functioning used in cluster analysis in order to present functioning profiles.

    Results: Ninety-nine children with at least one major medical diagnosis were included. Twenty had previous caries experience. Two factors of functioning were calculated, labelled "Physical ability" and "Intellectual ability, communication, and behaviour". Based on functioning profiles three clusters were determined. There were no statistically significant differences in caries experience between medical diagnoses or clusters.

    Conclusion: It was possible to identify profiles of functioning in children with disabilities receiving specialist dental care. Despite complex disabilities, the children had good oral health. Neither medical diagnosis nor functioning was found to have a clear relationship with oral health. To understand the environmental context leading to high-quality oral health, further studies of dental management in relation to medical and oral diagnoses and child functioning are needed.

  • 26.
    Pettersson, Cecilia
    et al.
    Department of Health Sciences, Health Sciences Center, Lund, Sweden.
    Löfqvist, Charlotte
    Department of Health Sciences, Health Sciences Center, Lund, Sweden.
    Fänge, Agneta Malmgren
    Department of Health Sciences, Health Sciences Center, Lund, Sweden.
    Clients' experiences of housing adaptations: a longitudinal mixed-methods study2012In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 20, p. 1706-1715Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To explore clients' experience of the housing adaptations (HAs) over time in relation to housing and health.

    METHOD: A multiple longitudinal case study, employing an embedded mixed-method design was used. Four participants were included and data from semi-structured interviews were combined with data from structured survey assessments.

    RESULTS: HA made it possible to maintain valuable roles and activities, to continue to live in the participants' own homes and to take part in the society. The participants strived for autonomy and control, and in order to do so they needed different kinds of support, in terms of HA and mobility devices as well as support from professionals. HA also challenged the participants' routines and habits, as well as their perception about how an appealing HA aesthetically. Thus, the decision to apply for a HA was not always straightforward. Instead, the participants were constantly engaged in negotiations with themselves, concerning benefits and drawbacks of different decisions.

    CONCLUSIONS: HAs involve complex person-environment-activity (P-E-A) transactions, and enhance clients' activity and independence in spite of functional decline. The knowledge generated is important in order to improve individual HA, as well as improving the efficiency and effectiveness of the intervention.

  • 27.
    Rinde, Elisabeth Rønning
    et al.
    Division of Habilitation, Telemark Hospital Trust, Skien, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway.
    Anderzen-Carlsson, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre.
    Jahnsen, Reidun Birgitta
    Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway; Research Center for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway.
    Andersen, Randi Dovland
    Research Center for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Research, Telemark Hospital Trust, Skien, Norway.
    "I have to obey my pain": children's experiences of pain burden in cerebral palsy2024In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 46, no 6, p. 1112-1120Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To explore pain experiences of children with cerebral palsy, and how it influences their everyday life.

    METHOD: Fourteen children with CP between eight and seventeen years old were included, using a purposeful sampling strategy. They had different experiences of pain, and different degrees of physical and cognitive impairments. Sixteen individual semi-structured interviews were carried out, and analyzed using inductive thematic analysis.

    RESULTS: Data analysis resulted in the main theme "I have to obey my pain" and four themes were identified. Experiences regarding pain varied ("My pain is mine alone"). Both pain itself and the use of cognitive strategies to cope with pain involved a mental struggle ("Pain brings me down"). The children had to make adjustments to manage their pain ("I want to participate, but I have to rest"). The most important help was to be understood, but adults also provided valuable help with interventions like stretching, medication and adjustment of activity levels ("Others can help me").

    CONCLUSION: Pain was a determining feature in the lives of these children with CP. The wide variety of experiences and challenges emphasized the need for tailored management strategies developed together with each child and their parents.

    IMPLICATIONS FOR REHABILITATION

    • Children with cerebral palsy had varied experiences of pain, and health professionals need to tailor their pain management approaches to the individual child.
    • Health services should offer pain education to expand children's repertoire of pain management strategies.
    • When a child's pain influences their daily activities, health services must ensure that the school is informed of the child's situation, and able to make necessary adjustments.
    • Health professionals should strive to include children's own descriptions whenever possible to make sure children feel heard and believed.
    • Even children with communicative and cognitive impairments were able to self-report when necessary adjustments in the communication situation were made.
  • 28.
    Rinde, Elisabeth Rønning
    et al.
    Division of Habilitation, Telemark Hospital Trust, Skien, Norway; Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Department of Public Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
    Anderzen-Carlsson, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.
    Jahnsen, Reidun Birgitta
    Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Department of Public Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; NorCP, Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway.
    Andersen, Randi Dovland
    Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Department of Public Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Research, Telemark Hospital Trust, Skien, Norway.
    "Pain is one piece of a complex jigsaw puzzle": experiences of raising a child with cerebral palsy who has pain2023In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore experiences of parenting a child with CP and pain.

    Method: Fourteen mothers and one father of children (9-16) with CP were included. All children had pain regularly, but the frequency and intensity of their pain experiences varied. Their motor function varied from GMFCS level I to V. Cognitive abilities varied from normal to moderate cognitive deficits. All children could express themselves verbally. Semi structured individual interviews were carried out, and results were developed using inductive thematic analysis.

    Results: The analysis resulted in the main theme "My child's pain is just one piece of a complex jigsaw puzzle". The main theme was developed by four mutually exclusive, but related themes: "My child's struggle burdens me", "Pain and CP direct our everyday life", "I want to be in control, but cannot always be" and "We are the only ones who understand the complexity".Conclusion: Parents of children with CP experience pain as one aspect of a bigger picture. They need help and support to cope with their child's pain, and professional helpers need to address the complexity pain is a part of.

    IMPLICATIONS FOR REHABILITATION: Parents of children with cerebral palsy (CP) experience their child's pain as one piece in a jigsaw puzzle, and counseling needs to address the complexity rather than the separate parts of the picture.Health professionals should support parents in evaluation and management of their child's pain, as a feeling of competence in pain management is important to reduce parental stress.Health professionals should inform themselves about the life situation of parents whose child with CP has pain, and encourage them to seek practical support and apply for relevant support schemes that can make their everyday life easier.Parents of children with CP should be encouraged to take part in a diagnosis-specific support group, where they can meet with others in a similar situation, in order to reduce their feeling of being alone with their challenges.

  • 29.
    Sjöberg, Lis
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Paediatrics, Limb Deficiency and Arm Prosthesis Centre, Örebro University Hospital, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro University, Örebro, Sweden.
    Fredriksson, Carin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Life situation of adults with congenital limb reduction deficiency in Sweden2014In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 18, p. 1562-1571Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe the current life situation of adults with congenital limb reduction deficiencies (CLRD), living in Sweden, regarding their main daily occupation, leisure activities and self-reported general health.

    Method: A cross-sectional survey was conducted using a study-specific questionnaire, sent by post. A hundred and seventeen persons with different extent, forms, and levels of CLRD (mean age 33 years) responded to the questionnaire.

    Results: Work or study was the main occupation for 86 % of the participants and 50 % had completed a college or university education. Seven per cent were unemployed and three per cent were on sick leave. The participants were highly involved in social and physical activities during leisure time. The majority reported good or very good general health.

    Conclusion: This study is the first investigation of the life situation of adults with CLRD described with a perspective from Swedish society. The participants were educated and worked to a great extent, which corresponds well to the Swedish population as a whole. Further research is needed especially with a focus on the internal perspective of life situation, different aspects of work capacity, occurences of strain injuries and the benefit of assistive devices among adults with CLRD.

  • 30.
    Tofiq, avin
    et al.
    Örebro University, School of Medical Sciences. Department of Neurology and Rehabilitation, School of Medicine, Örebro University, Sweden.
    Eriksson Crommert, Martin
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Zakrisson, Ann-Britt
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    von Euler, Mia
    Örebro University, School of Medical Sciences. Department of Neurology and Rehabilitation, School of Medicine, Örebro University, Sweden.
    Nilsing Strid, Emma
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Physical functioning post-COVID-19 and the recovery process: a mixed methods study2024In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 46, no 8, p. 1570-1579Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To describe physical functioning after severe COVID-19-infection.

    MATERIALS AND METHOD: An explanatory sequential mixed method design was used. Thirty-nine participants performed tests and answered questionnaires measuring physical functioning six months after hospitalisation due to COVID-19. Thirty of these participants participated in semi-structured interviews with questions regarding how they perceived their physical functioning and recovery from COVID-19 at 12 months post-hospitalisation.

    RESULTS: At six months, physical functioning measured via chair stand test and hip-worn accelerometers was lower than normal reference values. There was a reduction in breathing muscle strength. Participants estimated their functional status during different activities as lower compared to those before COVID-19-infection, measured with a patient-specific functional scale. At one year after infection, there were descriptions of a rough recovery process and remaining symptoms.

    CONCLUSION: Patients recovering from severe COVID-19 seem to have reduced physical functioning and activity levels, and they perceive their recovery to be slow and difficult. They experienced a lack of clinical support and contradictory advice regarding rehabilitation. Coaching in returning to physical functioning after the infection needs to be better co-ordinated and there is a need for guidelines for health professionals to avoid patients receiving contradictory advice.

  • 31.
    Torbjörnsson, Eva
    et al.
    Department of Clinical Science and Education, Karolinska Institutet, Department of Surgery, Södersjukhuset, Stockholm, Sweden.
    Ottosson, Carin
    Department of Clinical Science and Education, Wound Centre, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    Boström, Lennart
    Department of Clinical Science and Education, Karolinska Institutet, Department of Surgery, Södersjukhuset, Stockholm, Sweden.
    Blomgren, Lena
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiovascular and Vascular Surgery.
    Malmstedt, Jonas
    Department of Clinical Science and Education, Karolinska Institutet, Department of Surgery, Södersjukhuset, Stockholm, Sweden.
    Fagerdahl, Ann-Mari
    Department of Clinical Science and Education, Wound Centre, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    Health-related quality of life and prosthesis use among patients amputated due to peripheral arterial disease: a one-year follow-up2022In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 44, no 10, p. 2149-2157Article in journal (Refereed)
    Abstract [en]

    Purpose: A major amputation affects the patients' independence, well-being and HRQoL. However, prosthesis use and the impact on the patient's HRQoL are scarcely described. The aim was to compare HRQoL between walker and non-walker amputees. Secondary aim was to evaluate prosthesis use and habits.

    Method: Ninety-eight patients with a major amputation due to peripheral arterial disease were included during 2014-2018. They were interviewed using EQ-5D-3L (HRQoL), Stanmore Harold Wood mobility grade (prosthesis use) and Houghton scale (prosthesis habits).

    Results: Seventy-three patients completed the one-year follow-up, out of them 56 got a prosthesis. Twenty-three used it to walk both inside and outside. EQ-5D-3L at follow-up was increased in all patients in comparison to baseline (0.16 versus 0.59,p< 0.001). Patients walking with prosthesis had the largest improvement (0.12 versus 0.78,p< 0.001). A sub-analysis aiming to study the importance of independent movement showed an improved HRQoL at follow-up among those classified as prosthesis-user (p<0.001) and walker (p<0.001), but not among non-prosthesis users (p= 0.245).

    Conclusion: Learning how to use, not exclusively to walk with, a prosthesis after an amputation is important for the patients' HRQoL. At follow-up, patients using their prosthesis to walk or to move to a wheelchair, showed an improved HRQoL compared to baseline.

  • 32.
    Turunen-Taheri, Satu
    et al.
    Department of CLINTEC, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Audiology and Neurotology, Karolinska University Hospital, Stockholm, Sweden.
    Carlsson, Per-Inge
    Department of Otorhinolaryngology, Central Hospital, Karlstad, Sweden; Audiological Research Center, Örebro University Hospital, Örebro, Sweden.
    Johnson, Ann-Christin
    Department of CLINTEC, Division of Audiology, Karolinska Institutet, Huddinge, Sweden.
    Hellström, Sten
    Department of CLINTEC, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Audiology and Neurotology, Karolinska University Hospital, Stockholm, Sweden.
    Severe-to-profound hearing impairment: demographic data, gender differences and benefits of audiological rehabilitation2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 41, no 23, p. 2766-2774Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this study was to identify and report demographic data of patients with severe-to-profound hearing loss, assess participation in audiological rehabilitation and analyze the benefits of various rehabilitation methods.

    Materials and methods: Data on 4286 patients with severe-to-profound hearing impairments registered in the Swedish Quality Register of Otorhinolaryngology over a period from 2006?2015 were studied. Demographic data, gender differences, audiological rehabilitation and benefits of the rehabilitation were analyzed.

    Results: Group rehabilitation and visits to a hearing rehabilitation educator provided the most benefits in audiological rehabilitation. Only 40.5% of the patients received extended audiological rehabilitation, of which 54.5% were women. A total of 9.5% of patients participated in group rehabilitation, with 59.5% being women. Women also visited technicians, welfare officers, hearing rehabilitation educators, psychologists and physicians and received communication rehabilitation in a group and fit with cochlea implants significantly more often than did men.

    Conclusions: The study emphasizes the importance of being given the opportunity to participate in group rehabilitation and meet a hearing rehabilitation educator to experience the benefits of hearing rehabilitation. There is a need to offer extended audiological rehabilitation, especially in terms of gender differences, to provide the same impact for women and men.

  • 33.
    Westman, Anders
    et al.
    Örebro University, Department of Clinical Medicine.
    Linton, Steven J.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Theorell, Töres
    Stressforskninginsinstitutet, Stockholms universitet.
    Öhrvik, John
    Inst för medicin, Enh för kardiologi, Karolinska institutet, Stockholm.
    Wahlén, Petra
    Centre for Clinical Research,Uppsala University-Västerås Hospital.
    Leppert, Jerzy
    Quality of life and maintenance of improvements after early multimodal rehabilitation: a 5-year follow-up2006In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, no 7, p. 437-446Article in journal (Refereed)
    Abstract [en]

    Purpose. There is a paucity of long-term evaluations on rehabilitation of musculoskeletal disorders, e.g., neck, shoulder or back pain. The aim of this study was to assess quality of life and the effect of early multimodal rehabilitation on 91 patients with musculoskeletal pain and disability at a 5-year follow-up.

    Method. The follow-up assessment, which included questions on pain, function, quality of life, perceived health, sick leave and psychosomatic symptoms, was performed 5 years after the assessment of baseline status.

    Results. Improvements in pain, perceived health and psychosomatic symptoms were maintained at the 5-year follow-up. In addition, improvements in function, quality of life, and level of acceptable pain were significant in comparison to baseline. At the time of the baseline assessment all patients were on sick leave (13% were on partial sick leave). At the 5-year follow-up, 58% of the patients were at work part or full time. The results show that those working differed significantly from those not working at the 5-year follow-up on almost all variables, indicating that those working enjoy better health. The most salient prognostic factors for return to work were perceived health and educational level at the time of the baseline evaluation.

    Conclusions. These results show that treatment improved quality of life and the effects were basically maintained at 5 years. Work capacity as reflected in return to work increased greatly (81%) at a 1-year follow-up and was substantial (58%) at the 5-year follow-up. Moreover, perceived health and educational levels were important prognostic factors. Finally, the fact that patients working reported better health underscores the probable importance of return to work. Our results imply that it may be feasible to obtain long-term benefits from such a primary care-based intervention.

  • 34.
    Westman, Anders
    et al.
    Örebro University, Department of Clinical Medicine. Psychosomat Med Clin, Västmanlands sjukhus, Västerås, Sweden.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Öhrvik, John
    Cent Hosp, Clin Res Ctr, Uppsala Univ, Västerås, Sweden.
    Wahlén, Petra
    Cent Hosp, Clin Res Ctr, Uppsala Univ, Västerås, Sweden.
    Theorell, Töres
    Stress Res Inst, Stockholm Univ, Stockholm, Sweden.
    Leppert, Jerzy
    Cent Hosp, Clin Res Ctr, Uppsala Univ, Västerås, Sweden.
    Controlled 3-year follow-up of a multidisciplinary pain rehabilitation program in primary health care2010In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no 4, p. 307-316Article in journal (Refereed)
    Abstract [en]

    Purpose: The high prevalence of musculoskeletal pain generates significant costs for primary health care and the whole of society. The development of appropriate interventions is therefore necessary. The aim of this effectiveness study was to assess the long-term effects of a primary health care multidisciplinary rehabilitation program in Sweden.

    Methods: An experimental group comprising 89 patients from two primary health care units received individualised treatment interventions after a multidisciplinary investigation. A control group of 69 patients with the same inclusion criteria from four other primary health care units were treated according to routine. All participants completed questionnaires measuring pain, sick leave, quality of life, health care utilisation, drug consumption and psychosocial factors at baseline and at 3-year follow-up.

    Results: After 3 years, utilisation of primary health care was significantly lower in the experimental group and work capacity was slightly but not significantly higher. The control group showed a trend of having a higher risk of high consumption after 3 years compared to the intervention group. There was no significant difference between the two groups concerning remaining variables such as function, catastrophising and pain.

    Conclusion: Both groups demonstrated considerable improvement over the course of 3 years. The experimental group had lower health care utilisation and a reduced risk of using large amounts of medication at the 3-year follow-up, indicating that compared with participants in the control group they were coping in a better way with pain.

  • 35.
    Witte, Ingrid
    et al.
    Örebro University, School of Health Sciences.
    Strandberg, Thomas
    Örebro University, School of Behavioural, Social and Legal Sciences.
    Gustafsson, Johanna
    Örebro University, School of Health Sciences. Centre for the Study of Professions, Oslo Metropolitan University, Oslo, Norway.
    Social representations of gender and their influence in Supported Employment: employment specialists' experiences in Sweden2023In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, p. 1-15Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Gender differences have been found in the outcomes of vocational rehabilitation (VR) and in Supported Employment (SE), therefore, the purpose of this study was to explore employment specialists' (ES) social representations of gender in relation to work and VR and how these social representations influence the ES's work in the VR process according to SE.

    METHODS: The qualitative method of focus group discussions was employed. Ten focus groups were held with 39 ESs from four categories of SE organizations in Sweden. Topic analysis was applied to the transcribed material from the focus groups.

    RESULTS: Five themes with different social representations about gender and disability in relation to VR and working life formed in the analysis: (1) differences in personal and health factors among VR-participants, (2) gender norms in society influencing VR, (3) energy-intensive environmental issues influencing VR, (4) gender-specific interactions in VR, and (5) gendered paths in the welfare system.

    CONCLUSION: Social representations of higher strains on women with disabilities compared to men with disabilities both in private and working life, which reflect the lived experiences of the ESs, is a possible explanation for gender differences in VR and working life for persons with disabilities.

    IMPLICATIONS FOR REHABILITATION: Gender differences in the outcomes of vocational rehabilitation (VR) interventions have been noticed worldwide. In this study, pervasive social representations about gender and disability in relation to VR were found, but also unconsciousness about gender among VR professionals. Therefore, awareness of gender is necessary in VR.Individualized and person-centered approaches to VR like Supported Employment, although considered best practice, might hide structures like gender, which could lead to reproducing discriminating processes and therefore not achieving gender equality in VR. Therefore, knowledge of discrimination is important in VR.Gender-sensitivity in vocational rehabilitation models with a person-centered and individualized approach is needed and there might also be a need to systematically tailor vocational rehabilitation models to reach gender equality in the outcomes of the interventions. Therefore, gender equality indicators are needed for VR models, to evaluate model effectiveness from a gender perspective.

  • 36.
    Wittig, P.G.
    et al.
    Wood's Homes Adolescent Treat. Ctr., Calgary, Alta., Canada.
    Tilton-Weaver, Lauree
    University of Nebraska at Omaha, Omaha, NE, United States.
    Patry, B.N.
    University of Victoria, Victoria, BC, Canada.
    Mateer, C.A.
    University of Victoria, Victoria, BC, Canada.
    Variables related to job satisfaction among professional care providers working in brain injury rehabilitation2003In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 25, no 2, p. 97-106Article in journal (Refereed)
    Abstract [en]

    Purpose: To examine variables that contribute to work satisfaction among rehabilitation professionals involved in brain injury rehabilitation.

    Method: One hundred and thirty-three respondents completed a job satisfaction questionnaire and qualitative questions regarding sources of stress and satisfaction in working with individuals with acquired brain injury (ABI).

    Results: Factor analysis yielded four factors relating to intrinsic satisfaction, perceived importance to the organization, organizational support and training support. Although intrinsic satisfaction was significantly related to the three other factors, it was best predicted by training support, particularly training that addressed the management of intrusive and/or aggressive behaviours. Qualitative correlates of both work stress and satisfaction were also identified with respect to personal issues, client-related issues, and organizationally-related issues.

    Conclusions: Satisfaction with work in ABI rehabilitation is derived from multiple sources, but it appears to be largely dependent on feeling important to, and valued by, the organization and on the level of support and training provided in the workplace.

  • 37.
    Öhrvall, Ann-Marie
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Krumlinde-Sundholm, Lena
    Karolinska Institutet, Stockholm, Sweden.
    Eliasson, Ann-Christin
    Karolinska Institutet, Stockholm, Sweden.
    Exploration of the Relationship Between the Manual Ability Classification System and Hand-Function Measures of Capacity and Performance2013In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 35, no 11, p. 913-8Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To further investigate the construct of Manual Ability Classification System (MACS) by evaluating the relationship between children's designated MACS levels and their outcomes on two different tests of hand function, measuring capacity and performance, respectively. Another aim was to use the International Classification of Functioning, Disability and Health-Child and Youth version (ICF-CY) as a framework to explore the uniqueness of the assessments.

    METHOD: Ninety-one children with cerebral palsy in MACS levels I-V, aged 5-17 years (mean 9.8, SD 3.0) participated. Data were collected using MACS, ABILHAND-Kids and Box and Block Test.

    RESULTS: A strong association between MACS and ABILHAND-Kids (rs = -0.88, p < 0.05) and MACS and Box and Block Test (rs = -0.81, p < 0.05) was demonstrated. Children's performance differed significantly between the different MACS levels (ABILHAND-Kids F (4:86) = 103.86, p < 0.001, Box and Block Test F (4:86) = 59.18, p < 0.001). The content comparison with ICF-CY, as a frame of reference, showed that these instruments capture fine hand use in the activity and participation component. The linking of the instruments to various ICF-CY categories demonstrated conceptual differences between the instruments. MACS had the broadest representation of ICF-CY domains.

    CONCLUSIONS: This study strengthens the construct, and thereby the validity, of MACS as a classification of children's hand function, expressed by the handling of objects in everyday activities in their daily environments.

    IMPLICATIONS FOR REHABILITATION: • This study has strengthened the evidence of Manual Ability Classification System (MACS) as being a valid and useful classification of children's hand function. • The various MACS levels describe different degrees of hand-function impairment. • MACS give a broad description of children's manual ability in a variety of daily life domains.

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