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  • 1.
    Eliasson, Ann-Christin
    et al.
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Holmefur, Marie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden.
    The influence of early modified constraint-induced movement therapy training on the longitudinal development of hand function in children with unilateral cerebral palsy2015In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 57, no 1, p. 89-94Article in journal (Refereed)
    Abstract [en]

    Aim: There is evidence that modified Constraint-Induced Movement Therapy (mCIMT) has a short-term positive effect on hand function in children with unilateral cerebral palsy (CP), but the long-term effect is unknown. The aim was to investigate whether or not a single block of mCIMT (2 hours/day during 2 months) at age 2-3 years influences the course of development of bimanual hand function at about 8 years of age.

    Methods: A convenience sample of 45 children (girls, n = 21) with unilateral CP and mean age 32 months was included (mCIMT group, n = 26; reference group, n = 19). Brain lesion characteristics were available for 32 children. The children were measured repeatedly with the Assisting Hand Assessment (AHA) for a mean period of 4 years and 6 months. Development curves were created and compared with a non-linear mixed effects model.

    Results: Children receiving mCIMT had an upper limit of development that was 8.5 AHA units higher than the reference group (p = 0.022). When controlling for brain lesion characteristics and baseline in a subgroup of 32 children, the difference was considerably smaller and no longer significant.

    Conclusion: mCIMT might have a positive impact on long-term development, but the results are inconclusive. 

  • 2.
    Gustafsson, Margareta
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Holmefur, Marie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Test-retest reliability of the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) scale2015In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 15, no 4, p. 253-257Article in journal (Refereed)
    Abstract [en]

    The Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) scale evaluates the student nurses' perception of the learning environment and supervision within the clinical placement. It has never been tested in a replication study. The aim of the present study was to evaluate the test-retest reliability of the CLES + T scale. The CLES + T scale was administered twice to a group of 42 student nurses, with a one-week interval. Test-retest reliability was determined by calculations of Intraclass Correlation Coefficients (ICCs) and weighted Kappa coefficients. Standard Error of Measurements (SEM) and Smallest Detectable Difference (SDD) determined the precision of individual scores. Bland-Altman plots were created for analyses of systematic differences between the test occasions. The results of the study showed that the stability over time was good to excellent (ICC 0.88 - 0.96) in the sub-dimensions “Supervisory relationship”, “Pedagogical atmosphere on the ward” and “Role of the nurse teacher”. Measurements of “Premises of nursing on the ward” and “Leadership style of the manager” had lower but still acceptable stability (ICC 0.70 - 0.75). No systematic differences occurred between the test occasions. This study supports the usefulness of the CLES + T scale as a reliable measure of the student nurses’ perception of the learning environment within the clinical placement at a hospital.

  • 3.
    Gustafsson, Margareta
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hagberg, Lars
    Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Holmefur, Marie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ten years follow-up of health and disability in people with acute traumatic hand injury: pain and cold sensitivity are long-standing problems2011In: Journal of Hand Surgery - British and European Volume, ISSN 0266-7681, E-ISSN 1532-2211, Vol. 36, no 7, p. 590-598Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate health and disability in people with acute traumatic hand injury 10 years after the accident. A consecutive sample of patients from the Department of Hand Surgery was followed up by means of a postal questionnaire containing the instruments EQ-5D for assessment of health and DASH for assessment of disability. Questions were added about cold sensitivity, numbness and aesthetic problems. The 97 people with various acute hand injuries had greater problems with impairments of hand function than with limitations of activities and participation in daily life. Pain was more common than among the general Swedish population. Cold sensitivity was reported by 78% and was associated with both worse impairments and greater limitations on activity and participation. Despite problems with pain and cold sensitivity, they reported good health and a low degree of disability.

  • 4.
    Hickisch, Annika
    et al.
    Örebro University, School of Health Sciences.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Swedish Translation and Reliability of the Full Outline of Unresponsiveness Score2016In: Journal of Neuroscience Nursing, ISSN 0888-0395, E-ISSN 1945-2810, Vol. 48, no 4, p. 195-205Article in journal (Refereed)
    Abstract [en]

    Background: It is important for patient safety that the patient's level of consciousness is assessed and documented in a structured and reliable manner. The Full Outline of Unresponsiveness (FOUR) score measures the level of consciousness more comprehensively than the coma scales that are commonly used in Sweden. Therefore, there was a need to translate the FOUR score into Swedish and to evaluate its use in a Swedish healthcare context.

    Objectives: The aim of this study was to translate the FOUR score into Swedish and to evaluate the reliability of the Swedish version compared with the reliability of the Glasgow Coma Scale (GCS).

    Methods: The English version of the FOUR score was translated into Swedish and evaluated in terms of interrater reliability and internal consistency on fictitious patient cases with an advanced high-fidelity patient simulator. Two nurses rated 30 patient cases with the FOUR score and the GCS. Interrater reliability for items was determined by quadratic-weighted kappa and for the total score by intraclass correlation coefficient. Internal consistency was calculated with Cronbach's alpha.

    Results: The fourth version of the Swedish translation reached consensus in the expert panel. The back-translation was approved by the author of the original FOUR score. Interrater reliability of the Swedish version of the FOUR score was excellent; the weighted kappa was 0.94-1, and intraclass correlation coefficient = .99 (95% CI [0.97, 0.99]), and these were equal to the reliability of the GCS. Cronbach's alpha showed a high degree of internal consistency for the FOUR score (α = .92 for rater A and .91 for rater B), which was slightly higher than that for the GCS.

    Conclusions: The Swedish version of the FOUR score is equivalent to the original English version and has shown excellent reliability using fictitious patient cases with an advanced patient simulator.

  • 5.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Infant hand development in unilateral cerebral palsy: filling the knowledge gap2019In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 61, no 5, p. 507-507Article in journal (Other academic)
  • 6.
    Holmefur, Marie
    et al.
    Karolinska Institutet, Institutionen för Kvinnors och Barns Hälsa, Astrid Lindgrens Barnsjukhus, Stockholm, Sweden.
    Aarts, Pauline
    Brian, Hoare
    Krumlinde-Sundholm, Lena
    Test-retest och alternate forms reliabilitet hos Assisting Hand Assessment2009Conference paper (Refereed)
  • 7.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Aarts, Pauline
    Sint Maartenskliniek Nijmegen, the Netherlands.
    Hoare, Brian
    Victorian Paediatric Rehabilitation Service, Melbourne, VIC, Australia.
    Eliasson, Ann-Christin
    Karolinska Institutet, Stockholm.
    Test-retest and alternate forms reliability of the Assisting Hand Assessment2008Conference paper (Refereed)
  • 8.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences.
    Aarts, Pauline
    Sint Maartenskliniek Nijmegen, the Netherlands.
    Hoare, Brian
    Victorian Paediatric Rehabilitation Service, Melbourne, VIC, Australia.
    Krumlinde-Sundholm, Lena
    Karolinska Institutet, Stockholm.
    Retest and alternate forms reliability of the Assisting Hand Assessment2009In: 3rd International Cerebral Palsy Conference, 2009Conference paper (Refereed)
  • 9.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences.
    Aarts, Pauline
    Hoare, Brian
    Krumlinde-Sundholm, Lena
    Test-retest and alternate forms reliability of the assisting hand assessment2009In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 41, no 11, p. 886-891Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The Assisting Hand Assessment (AHA) has earlier demonstrated excellent validity and rater reliability. This study aimed to evaluate test-retest reliability of the AHA and alternate forms reliability between Small kids vs School kids AHA and the 2 board games in School kids AHA.

    DESIGN: Test-retest and alternate forms reliability was evaluated by repeated testing with 2 weeks interval.

    SUBJECTS: Fifty-five children with unilateral cerebral palsy, age range 2 years and 3 months to 11 years and 2 months.

    METHODS: Intraclass correlation coefficients and smallest detectable difference were calculated. Common item and common person linking plots using Rasch analysis and Bland-Altman plots were created.

    RESULTS: Intraclass correlation coefficients for test-retest was 0.99. Alternate forms intraclass correlation coefficients were 0.99 between Small kids and School kids AHA and 0.98 between board games. Smallest detectable difference was 3.89 points (sum scores). Items in common item linking plots and persons in common person linking plots were within 95% confidence intervals, indicating equivalence across test forms.

    CONCLUSION: The AHA has excellent test-retest and alternate forms reliability. A change of 4 points or more between test occasions represents a significant change. Different forms of the AHA give equivalent results.

  • 10.
    Holmefur, Marie
    et al.
    Örebro University, School of Health Sciences.
    Eliasson, Ann-Christin
    Institutionen för kvinnors och barns hälsa, Karolinska Institutet, Stockholm, Sverige.
    Kan baby CIMT-träning vid 2-3 års ålder ge en bättre framtida utveckling av handfunktion hos barn med unilateral CP?2015Conference paper (Refereed)
  • 11.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Eliasson, Ann-Christin
    Karolinska Institutet, Stockholm, Sweden.
    The influence of early CIMT training on longitudinal development of hand function in children with unilateral cerebral palsy2013In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 55, no s2, p. 18-18Article in journal (Refereed)
    Abstract [en]

    Introduction: There is evidence that Constraint-Induced Movement Therapy (CIMT) has a short-term positive effect on hand function in children with unilateral cerebral palsy (CP). Secondary analysis from previous study of development of hand function was performed with the aim to investigate whether one period of CIMT (at age 2–3y) influences the course of development or not.

    Participants and Methods: A convenience sample of 45 children with unilateral CP was included at mean age 32 months (CIMT-group, n=24, non-CIMT group n=21) and mean age at start of intervention was 28.2 months. The children were measured repeatedly, at least once a year with the Assisting Hand Assessment (AHA) for a mean period of 4 years and 6 months. A non-linear mixed effects model was used to create and compare development curves for the CIMT and non-CIMT groups.

    Results: Children who had CIMT had an upper limit of development that was 8,1 AHA-units higher than the children who had not have CIMT (p=0.028). Also when controlling for brain lesion characteristics there was a difference in limit of development in favour of the CIMTgroup, although not significant. Children with lower AHA-score at 18 months had seemed to gain more from CIMT than children with a higher AHA-score.

    Conclusion: This study shows that one period of CIMT at age 2–3 years in children with unilateral CP is associated with better development of hand function regardless of brain lesion characteristics. This is the first study describing long-term effects of CIMT.

  • 12.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kits, Annika
    Karolinska sjukhuset, Stockholm, Sweden.
    Bergström, Jakob
    Karolinska Institutet, Stockholm, Sweden.
    Krumlinde-Sundholm, Lena
    Karolinska Institutet, Stockholm, Sweden.
    Flodmark, Olof
    Karolinska Institutet, Stockholm, Sweden.
    Forssberg, Hans
    Karolinska Institutet, Stockholm, Sweden.
    Eliasson, Ann-Christin
    Karolinska Institutet, Stockholm, Sweden.
    Factors that predict and correlate with development of hand function in children with unilateral cerebral palsy2012In: 9th COTEC Congress of Occupational Therapy, 2012Conference paper (Refereed)
    Abstract [en]

    Earlier studies of development of hand function showed large variation between individuals in course of development.

    Aim: To identify factors that predict or correlate with development of hand function in children with unilateral cerebral palsy (CP).

    Methods: Forty-five children with unilateral CP (inclusion age 18-64 months) were measured repeatedly with the Assisting Hand Assessment over on average 4,5 years. Data was collected on brain lesion (n=27), learning ability, sensibility in affected hand etc. A non-linear mixed models analysis was used.

    Results: Type, extent and location of brain lesion could predict development of hand function. Decreased learning ability was a predictor of slower development of hand function. Poor sensibility in the affected hand correlated with slower development and a lower ability level compared to children with good sensibility.

    Conclusion: Development of hand function can be predicted by brain lesion and is correlated to learning ability and sensibility in the affected hand.

  • 13.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kits, Annika
    Karolinska University Hospital, Stockholm, Sweden.
    Bergström, Jakob
    Karolinska Institutet, Stockholm, Sweden.
    Krumlinde-Sundholm, Lena
    Karolinska Institutet, Stockholm, Sweden.
    Flodmark, Olof
    Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    Forssberg, Hans
    Karolinska Institutet, Stockholm, Sweden.
    Eliasson, Ann-Christin
    Karolinska Institutet, Stockholm, Sweden.
    Neuroradiology can predict the development of hand function in children with unilateral cerebral palsy2013In: Neurorehabilitation and Neural Repair, ISSN 1545-9683, E-ISSN 1552-6844, Vol. 27, no 1, p. 72-78Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Much variation is found in the development of hand function in children with unilateral cerebral palsy (CP).

    OBJECTIVE: To explore how anatomic brain abnormalities can be used to predict the development of hand function.

    METHODS: A total of 32 children with unilateral CP (16 boys and 16 girls) were evaluated at least once a year by the Assisting Hand Assessment (AHA). The data collection covered an age range from 18 months to 8 years (mean time in study, 4 years and 6 months). Computerized tomography or magnetic resonance imaging of the brain were assessed for patterns of brain damage, including the location of gray and extent of white-matter damage. The children were divided into groups according to lesion characteristics, and a series of univariate models were analyzed with a nonlinear mixed-effects model. The rate and maximum limit of development were calculated.

    RESULTS: The highest predictive power of better development of hand function was the absence of a concurrent lesion to the basal ganglia and thalamus, independent of the basic type of brain lesion. This model predicted both the rate of increasing ability and hand function at age 8 years. Hand function was also predicted by the basic pattern of damage and by the extent of white-matter damage. The presence of unilateral or bilateral damage had no predictive value.

    CONCLUSIONS: Neuroradiological findings can be used to make a crude prediction of the future development of the use of the affected hand in young children with unilateral CP.

  • 14.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Krumlinde Sundholm, Lena
    Karolinska Institutet, Stockholm, Sweden.
    Psychometric properties of the revised Assisting Hand Assessment version 5.02014In: 16th International Congress of the World Federation of Occupational Therapists, 2014Conference paper (Refereed)
  • 15.
    Holmefur, Marie
    et al.
    Örebro University, School of Health Sciences.
    Krumlinde Sundholm, Lena
    Bergström, Jakob
    Hanna, Steven
    Kits, Annika
    Eliasson, Ann-Christin
    Assisting Hand Assessment: continued development, psychometrics and longitudinal use2011Conference paper (Refereed)
  • 16.
    Holmefur, Marie
    et al.
    Örebro University, School of Health Sciences.
    Krumlinde-Sundholm, Lena
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Psychometric properties of a revised version of the Assisting Hand Assessment (Kids-AHA 5.0)2016In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 58, no 6, p. 618-624Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to scrutinize the Assisting Hand Assessment (AHA) version 4.4 for possible improvements and to evaluate the psychometric properties regarding internal scale validity and aspects of reliability of a revised version of the AHA.

    Method: In collaboration with experts, scoring criteria were changed for four items, and one fully new item was constructed. Twenty-two original, one new, and four revised items were scored for 164 assessments of children with unilateral cerebral palsy aged 18 months to 12 years. Rasch measurement analysis was used to evaluate internal scale validity by exploring rating-scale functioning, item and person goodness-of-fit, and principal component analysis. Targeting and scale reliability were also evaluated.

    Results: After removal of misfitting items, a 20-item scale showed satisfactory goodnessof- fit. Unidimensionality was confirmed by principal component analysis. The rating scale functioned well for the 20 items, and the item difficulty was well suited to the ability level of the sample. The person reliability coefficient was 0.98, indicating high separation ability of the scale. A conversion table of AHA scores between the previous version (4.4) and the new version (5.0) was constructed.

    Interpretation: The new, 20-item version of the Kids-AHA (version 5.0), demonstrated excellent internal scale validity, suggesting improved responsiveness to changes and shortened scoring time. For comparison of scores from version 4.4 to 5.0, a transformation table is presented.

  • 17.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Krumlinde-Sundholm, Lena
    Karolinska Institutet, Stockholm, Sweden.
    Psychometric properties of the revised Assisting Hand Assessment version 5.02012In: 4th International Cerebral Palsy Conference, Pisa, Italy, 2012Conference paper (Refereed)
  • 18.
    Holmefur, Marie
    et al.
    Örebro Läns Landsting, Örebro, Sweden.
    Krumlinde-Sundholm, Lena
    Psykometriska egenskaper hos den reviderade versionen av Assisting Hand Assessment (AHA)2013Conference paper (Refereed)
  • 19.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences. Department of Women and Child Health, Karolinska Institutet, Stockholm.
    Krumlinde-Sundholm, Lena
    Karolinska Institutet,Stockholm.
    Bergström, Jakob
    Karolinska Institutet, Stockholm.
    Eliasson, Ann-Christin
    Karolinska Institutet, Stockholm.
    Longitudinal development of hand function in children with unilateral cerebral palsy2009In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 51, no s5Article in journal (Refereed)
    Abstract [en]

    Background/Objectives: Studies of longitudinal development of hand function in children with unilateral cerebral palsy (CP) are sparse. For children with unilateral CP the ability to use the affected hand as an effective assist to the dominant hand in bimanual tasks may be the most important aspect of hand function in daily life. This ability can be assessed with the assisting hand assessment (AHA). The aim of this study was to describe how the usefulness of the hemiplegic hand develops in children with unilateral CP between 18 months and 8 years of age.

    Design: This was a study of prognosis with a prospective longitudinal cohort design. Participants and Setting: Forty-three children with unilateral cerebral palsy participated (22 male, 21 female). They were recruited at local rehabilitation centres and constituted a convenience sample. Inclusion age was 18 months–5 years 4 months (mean 2 years 8 months). Manual ability classification system (MACS) levels: I [n=7], II [n=25], III [n=11].

    Materials/Methods: The children were assessed with the AHA over a period of at least 3 years (mean 4.5 years), with 3–11 assessments per child. Children entered the study at different ages allowing evaluation of development from ages 18 months to 8 years. Estimated average motor development curves were fitted with a non-linear mixed effects model.

    Results: Individual differences in development were considerable. Children with a high AHA score at 18 months (over 40 raw scores) reached a significantly higher ability level and at a higher progression rate than the children with a low 18-month AHA score. The children with high 18-month AHA score reached 90% of their limit at average age 3 years whereas the children with a low 18-month AHA score reached 90% of their maximum level at a mean age of 7. Similarly, the maximum level of development differed between children in MACS level I–III. The rate of change was similar in levels I and II and significantly slower, in level III.

    Conclusions/Significance: This study shows that children with different ability levels all develop their way of using their hemiplegic hand during the preschool years. The AHA can be used to follow development over time and the AHA score at 18 months can be used for approximate prediction of development of assisting hand use.

  • 20.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences.
    Krumlinde-Sundholm, Lena
    Bergström, Jakob
    Eliasson, Ann-Christin
    Longitudinal development of hand function in children with unilateral cerebral palsy2010In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 52, no 4, p. 352-357Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to describe how the usefulness of the hemiplegic hand develops in children with unilateral cerebral palsy (CP) aged between 18 months and 8 years.

    METHOD: A prospective longitudinal study of 43 children (22 males, 21 females) with unilateral CP was conducted. Inclusion age was 18 months to 5 years 4 months (mean 2y 8mo [SD 1y 1mo]). Children were assessed with the Assisting Hand Assessment (AHA) 3 to 11 times per child over a mean period of 4 years 6 months. Two models were used for grouping children: by AHA score at 18 months and by Manual Ability Classification System (MACS) levels. Estimated average motor development curves were fitted with a nonlinear mixed-effects model.

    RESULTS: Children with a high AHA score (high ability level) at 18 months reached a significantly higher ability level and at a higher progression rate than children with a low 18-month AHA score. Limits of development differed between the three MACS levels.

    INTERPRETATION: Results indicate that the AHA score at 18 months can be used to discuss future development of affected hand use in bimanual tasks in children with unilateral CP.

  • 21.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences.
    Krumlinde-Sundholm, Lena
    Karolinska Institutet, Stockholm, Sweden.
    Bergström, Jakob
    Karolinska Institutet, Stockholm, sweden.
    Eliasson, Ann-Christin
    Karolinska Institutet, Stockholm, Sweden.
    Longitudinal development of hand function in children with unilateral cerebral palsy2010In: World Federation of Occupational Therapists Congress 2010, Santiago, Chile, 2010Conference paper (Refereed)
  • 22.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences.
    Krumlinde-Sundholm, Lena
    Karolinska Institutet,Stockholm, Sweden.
    Bergström, Jakob
    Karolinska Institutet, Stockholm, Sweden.
    Flodmark, Olof
    Karolinska Institutet, Stockholm, Sweden.
    Kits, Annika
    Karolinska Sjukhuset, Stockholm, Sweden.
    Eliasson, Ann-Christin
    Karolinska Institutet, Stockholm, Sweden.
    Factors associated with development of hand function in children with unilateral cerebral palsy2010In: European Academy of Childhood Disability 22th Annual Meeting 2010, Brussels, Belgium, 2010Conference paper (Refereed)
  • 23.
    Holmefur, Marie
    et al.
    Örebro University, School of Health Sciences.
    Krumlinde-Sundholm, Lena
    Bergström, Jakob
    Flodmark, Olof
    Kits, Annika
    Eliasson, Ann-Christin
    Factors associated with development of hand function in children with unilateral Cerebral Palsy2010Conference paper (Refereed)
  • 24.
    Holmefur, Marie
    et al.
    Karolinska Institutet, Solna, Astrid Lindgrens Barnsjukhus, Stockholm, Sverige.
    Krumlinde-Sundholm, Lena
    Neuropediatriska Forskningsenheten, Karolinska Institutet, Astrid Lindgrens Barnsjukhus, Stockholm, Sverige.
    Eliasson, Ann-Christin
    Neuropediatriska Forskningsenheten, Karolinska Institutet, Astrid Lindgrens Barnsjukhus, Stockholm, Sverige.
    Assisting Hand Assessment: Validity and Reliability for the age range 18 months to 12 years2007Conference paper (Refereed)
  • 25.
    Holmefur, Marie
    et al.
    Karolinska Institutet, Institutionen för Kvinnors och Barns Hälsa, Astrid Lindgrens Barnsjukhus, Stockholm, Sverige.
    Krumlinde-Sundholm, Lena
    Eliasson, Ann-Christin
    Hur utvecklas bimanuell förmåga hos barn (18 mån – 8 år) med unilateral CP? En longitudinell studie2009Conference paper (Refereed)
  • 26.
    Holmefur, Marie
    et al.
    Örebro University, Department of Nursing and Caring Sciences.
    Krumlinde-Sundholm, Lena
    Karolinska Institutet.
    Eliasson, Ann-Christin
    Interrater and intrarater reliability of the Assisting Hand Assessment2007In: American Journal of Occupational Therapy, ISSN 0272-9490, Vol. 61, no 1, p. 79-84Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to evaluate interrater and intrarater reliability for the Assisting Hand Assessment.

    METHOD: For interrater reliability, two designs were used: 2 occupational therapists rated the same 18 children, and 20 occupational therapists rated the same 8 children. For intrarater reliability, 20 raters each rated one child twice. Both English and Swedish versions of the instrument were used. Intraclass correlation coefficients (ICCs) and standard error of measurement (SEM) were calculated.

    RESULTS: ICCs for the sum score for the interrater were 0.98 (two raters) and 0.97 (20 raters) and for the intrarater 0.99. SEM was 1.5 for interrater and 1.2 for the intrarater study, which gave an error interval of +/-3 raw scores for interrater and +/- 2.4 raw scores for intrarater.

    CONCLUSION: This study shows excellent interrater and intrarater reliability for sum scores.

  • 27.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences.
    Krumlinde-Sundholm, Lena
    Karolinska Institutet, Stockholm.
    Eliasson, Ann-Christin
    Karolinska Institutet, Stockholm.
    Longitudinal develpoment of affected hand use in bimanual tasks in children with unilateral cerebral palsy2009In: 3rd International Cerebral Palsy Conference, Sydney, Australia, 2009Conference paper (Refereed)
  • 28.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences.
    Krumlinde-Sundholm, Lena
    Karolinska Institutet, Stockholm.
    Eliasson, Ann-Christin
    Karolinska Institutet, Stockholm.
    Rater reliability of the Assisting Hand Assessment2006In: World Federation of Occupational Therapists Congress, 2006Conference paper (Refereed)
  • 29.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences.
    Krumlinde-Sundholm, Lena
    Karolinska Institutet, Stockholm.
    Eliasson, Ann-Christin
    Karolinska Institutet, Stockholm.
    Rater reliability of the Assisting Hand Assessment2006In: 18th Annual Meeting of the European Academy of Childhood Disability, 2006Conference paper (Refereed)
  • 30. Holmefur, Marie
    et al.
    Krumlinde-Sundholm, Lena
    Eliasson, Ann-Christin
    Utveckling av bimanuell förmåga hos barn med CP hemiplegi2008Conference paper (Other academic)
  • 31.
    Holmefur, Marie
    et al.
    Örebro University, School of Health Sciences.
    Lidström-Holmqvist, Kajsa
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Arvidsson, Patrik
    Jönköping University, Jönköping, Sweden.
    Roshanai, Afsaneh
    Uppsala University, Uppsala, Sweden.
    White, Suzanne
    SUNY Downstate University, New York, NY, USA.
    Janeslätt, Gunnel
    Uppsala University, Uppsala, Sweden.
    Let’s Get Organized: pilot study of an occupational therapy group intervention aimed to improve time management skills2018Conference paper (Refereed)
    Abstract [en]

    Introduction: Managing daily life activities requires time management and organizing skills. Individuals with cognitive disabilities commonly have poor ability to manage time, which often results in decreased ability to properly manage daily life activities. An intervention aimed to increase time management skills is "Let’s get organized" (LGO).

    Objective: The current pilot study was designed to explore the outcome of the LGO with regards to time management skills, executive functions and satisfaction with daily occupations among individuals with cognitive disabilities.

    Method: Persons with mental and neurodevelopmental disorder with decreased ability to manage time in daily life according to self-rated measures, were recruited by their local Occupational Therapist. All participants took part in LGO, which is a 10-week manual based group intervention with weekly meetings. Each session has a separate theme, with a common structure and goal to improve time management skills and to implement the use of a calendar in daily life. Measured outcomes were time management skills (Assessment of Time Management Skills), executive functioning (Weekly Calendar Planning Activity) and overall satisfaction with daily activities (Satisfaction with Daily Occupations).

    Results: In all 55 persons participated in the study. Preliminary results from a subgroup indicate significant improvements in time management skills, in aspects of executive functioning and in overall satisfaction with daily occupations.

    Conclusion: The LGO seems to be a promising intervention to improve time management skills and satisfaction with daily occupations in the short term. The used instruments appear to be sensitive to capture change from LGO.

  • 32.
    Holmefur, Marie
    et al.
    Örebro University, School of Health Sciences.
    Lidström-Holmqvist, Kajsa
    Region Örebro Län, Örebro, Sweden.
    Roshanay, Afsaneh
    Arbetsförmedlingen, Kista, Sweden.
    Arvidsson, Patrik
    Vuxenhabiliteringen, Region Gävleborg, Sweden.
    White, Suzanne
    SUNY Downstate University, Brooklyn, NY, USA.
    Janeslätt, Gunnel
    Centrum för klinisk forskning, Landstinget Dalarna, Sweden.
    Ha koll!: pilotstudie av en arbetsterapeutisk gruppintervention som syftar till förbättrad tidshantering2019Conference paper (Refereed)
  • 33.
    Holmefur, Marie
    et al.
    Örebro University, School of Health Sciences.
    Lidström-Holmqvist, Kajsa
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Roshanay, Afsaneh Hayat
    Clinical Psychologist, Department of Public Health and Caring Sciences, Disability and Habilitation, Uppsala University, Uppsala, Sweden.
    Arvidsson, Patrik
    Swedish Institute for Disability Research, Jönköping University, Jönköping, Sweden; Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.
    White, Suzanne
    State University of New York Downstate Medical Center, Brooklyn, USA.
    Janeslätt, Gunnel
    Department of Public Health and Caring Sciences, Disability and Habilitation, and Researcher, Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Pilot Study of Let's Get Organized: A Group Intervention for Improving Time Management2019In: American Journal of Occupational Therapy, ISSN 0272-9490, E-ISSN 1943-7676, Vol. 73, no 5, article id 7305205020Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE: There is a need for evidence-based occupational therapy interventions to enhance time management in people with time management difficulties.

    OBJECTIVE: To pilot test the first part of the Let's Get Organized (LGO) occupational therapy intervention in a Swedish context by exploring enhancements of time management skills, aspects of executive functioning, and satisfaction with daily occupations in people with time management difficulties because of neurodevelopmental or mental disorders.

    DESIGN: One-group pretest-posttest design with 3-mo follow-up.

    SETTING: Outpatient psychiatric and habilitation settings.

    PARTICIPANTS: Fifty-five people with confirmed or suspected mental or neurodevelopmental disorder and self-reported difficulties with time management in daily life.

    INTERVENTION: Swedish version of Let's Get Organized (LGO-S) Part 1, with structured training in the use of cognitive assistive techniques and strategies using trial-and-error learning strategies in 10 weekly group sessions of 1.5 hr.

    OUTCOMES AND MEASURES: Time management, organization and planning, and emotional regulation were measured with the Swedish version of the Assessment of Time Management Skills (ATMS-S). Executive functioning was measured with the Swedish version of the Weekly Calendar Planning Activity, and satisfaction with daily occupations was assessed with the Satisfaction With Daily Occupations measure.

    RESULTS: Participants displayed significantly improved time management, organization and planning skills, and emotional regulation, as well as satisfaction with daily occupations. Aspects of executive functioning were partly improved. ATMS-S results were sustained at 3-mo follow-up.

    CONCLUSION AND RELEVANCE: LGO-S Part 1 is a promising intervention for improving time management skills and satisfaction with daily occupations and should be investigated further.

    WHAT THIS ARTICLE ADDS: This study shows that LGO-S Part 1 is feasible for use in psychiatric and habilitation outpatient services. The results are promising for improved time management skills, organization and planning skills, and satisfaction with daily occupations and need to be confirmed in further studies.

  • 34.
    Holmefur, Marie
    et al.
    Örebro University, School of Health Sciences.
    Lidström-Holmqvist, Kajsa
    Örebro University, School of Health Sciences.
    White, Suzanne
    College Of Health Related Professions, SUNY Downstate Medical Center, New York, USA.
    Janeslätt, Gunnel
    Centre For Clinical Research, Dalarna County Council, Falun, Sweden.
    Assessment of Time Management Skills: psychometric properties of the Swedish version (ATMS-S)2017Conference paper (Refereed)
  • 35.
    Holmefur, Marie
    et al.
    Örebro University, School of Health Sciences.
    Lidström-Holmqvist, Kajsa
    Örebro University, School of Health Sciences.
    White, Suzanne
    Occupational Therapy Program, Downstate University, New York, USA.
    Janeslätt, Gunnel
    Centrum för klinisk forskning, Landstinget i Dalarna, Falun, Sverige.
    Prövning av validitet hos den svenska versionen av Assessment of Time Management Skills (ATMS-S)2017Conference paper (Refereed)
  • 36.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro County Council, Örebro, sweden.
    Sundberg, Kay
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Wettergren, Lena
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Langius-Eklöf, Ann
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Measurement properties of the 13-item sense of coherence scale using Rasch analysis2015In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 24, no 6, p. 1455-1463Article in journal (Refereed)
    Abstract [en]

    Purpose: The sense of coherence (SOC) scale is widely used and has an extensive history in research. The psychometric properties of the SOC scale have been investigated using classic test theory, but modern test theory enables a more multifaceted investigation of the properties of the SOC scale. The aim of this study was to explore the measurement properties of the SOC scale using the Rasch measurement model.

    Methods: SOC questionnaires from a sample of 623 healthy adults were analysed using Rasch analysis. Aspects analysed were rating scale functioning, item fit, unidimensionality, differential item functioning (DIF), targeting, and reliability.

    Results: Rating scale analysis showed that the seven scale steps were not utilized in the intended manner and that a shortening to five categories would be beneficial. Twelve out of the 13 items showed acceptable goodness-of-fit and 43 % of the variance was explained by the SOC dimension in the principal components analysis. There was no DIF between subgroups in the sample. The items were well targeted to the sample SOC level with no ceiling or floor effects. Item and person reliability were good and the person separation index was 2.05 indicating that the scale can separate three different levels of SOC, which corresponds well to its theoretical base.

    Conclusions: The SOC scale is generally well functioning; however, the three components of SOC seem to influence the PCA results. The scale would benefit from a reduction from seven to five scale steps, which would need to be investigated further.

  • 37.
    Holmqvist, Kajsa
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ivarsson, Ann-Britt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Holmefur, Marie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Occupational therapists' practice patterns for clients having cognitive impairments following acquired brain injury2012In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 26, no 4-5, p. 458-459Article in journal (Refereed)
    Abstract [en]

    Objectives: Studies have shown that occupational therapy interventions for clients with cognitive impairment following acquired brain injury (CIABI) have a positive effect on performance of activities of daily living, although the exact nature of the interventions are not clearly described. A better understanding of current practice is therefore needed to move further in the search for evidence based occupational therapy for clients with CIABI. Research on occupational therapists’ (OTs’) practice can play an important role to explore and describe current practice and furthermore define and evaluate the effectiveness of different components in OT interventions. The aim of this study was to survey Swedish OTs’ practice patterns for clients having CIABI.

    Methods: The study had a cross-sectional design using a questionnaire developed in two former studies. A stratified random sample was done with 250 OTs each from the following areas: regional care, somatic county care, primary care and municipal eldercare. The questionnaire was sent out using on-line survey software and 462 participants responded. Data is currently analyzed by descriptive and comparative statistics.

    Results: Preliminary results show that the interventions targeted a wide range of cognitive impairments and its consequences. Interventions were both remedial and compensatory with graded activity as the most common remediating intervention. To compensate for activity limitations prescription, or recommendation, of assistive devices (AD) as well as supporting clients in finding internal strategies were used extensively. The ADs used consisted of both high and low technology devices. Eighty-two percent also included different specific interventions to improve clients’ decreased self-awareness in their practice. A vast majority of the OTs (94%) preferred to use observations in daily activities to assess both activity limitations and cognitive impairment. Almost all participants also used interviews and sixty-two percent used tests on impairment level. To support practice general Occupational Therapy models were widely used while theories focusing on cognitive impairments specifically were used less. The participants’ answers reflected a client-centered attitude with collaborative goal-setting and feedback discussions after each session. Eighty- four percent felt dependent on relatives to reach a successful outcome and most of them worked deliberately to involve relatives in the rehabilitation. The OTs responses were evenly distributed over the spheres of activity. Ninety-two percent of the participants worked in team and the most common diagnoses were stroke and traumatic brain injury. There were some differences in responses between the spheres.

    Conclusions: Preliminary conclusions are that the OTs practice patterns included interventions targeting most cognitive impairments and their consequences in daily activities. The use of daily activities as a mean was preferred irrespective of whether the interventions were remediative or compensatory. Interventions targeting decreased self-awareness as well as the use of ADs were common. A client-centered approach was dominating including collaboration with relatives.

    For personal

    centered approach was dominating including collaboration

    with relatives.

  • 38.
    Janeslätt, Gunnel Kristina
    et al.
    Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden; Department of Public Health and Caring Sciences, Disability and Habilitation, Uppsala University, Uppsala, Sweden.
    Lidström-Holmqvist, Kajsa
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    White, Suzanne
    Occupational therapy program, State University of New York Downstate Medical Center, Brooklyn NY, USA.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Assessment of time management skills: psychometric properties of the Swedish version2018In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 25, no 3, p. 153-161Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Persons with impaired time management skills are often in need of occupational therapy. Valid and reliable instruments to assess time management and organizational skills are needed for the evaluation of intervention. The purpose of this study was to evaluate the psychometric properties of a Swedish version of the Assessment of Time Management Skills (ATMS-S) for persons with and without impaired time management skills.

    METHOD: A total of 238 persons participated in the study, of whom 94 had self-reported impaired time management skills due to mental disorders such as schizophrenic spectrum or neurodevelopmental disorders such as attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and mild intellectual disabilities, and 144 persons had no reported impaired time management skills. Rasch analysis was used to analyze data.

    RESULTS: Three subscales were detected: the time management subscale with 11 items, the organization & planning subscale with 11 items, and the subscale of regulation of emotions with 5 items, with excellent to acceptable psychometric properties. The conclusions were that: ATMS-S is a valid instrument for self-rating of time management, organization & planning and for the regulation of emotions. ATMS-S can be useful for persons with mental disorders including mild neurodevelopmental disorders.

  • 39.
    Jarl, Gustav
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Rehabilitation Research, Örebro University, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Holmefur, Marie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro University, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Hermansson, Liselotte M. N.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro University, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Test-retest reliability of the Swedish version of the Orthotics and Prosthetics Users' Survey2014In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 38, no 1, p. 21-26Article in journal (Refereed)
    Abstract [en]

    Background: The Orthotics and Prosthetics Users' Survey consists of five modules to assess outcomes of orthotic and prosthetic interventions: lower extremity functional status, upper extremity functional status, client satisfaction with device, client satisfaction with services and health-related quality of life.

    Objectives: To investigate the test-retest reliability and calculate the smallest detectable difference for all modules of the Swedish Orthotics and Prosthetics Users' Survey.

    Study design: Test-retest reliability study design.

    Methods: A total of 69 patients at a Department of Prosthetics and Orthotics completed Orthotics and Prosthetics Users' Survey on two occasions separated by a 2-week interval, giving 18 answers on lower extremity functional status, 41 on upper extremity functional status, 53 on client satisfaction with device, 12 on client satisfaction with services and 67 answers on health-related quality of life. Raw scores were converted into Orthotics and Prosthetics Users' Survey units on a 0-100 scale. Intra-class correlation coefficients, Bland-Altman plots, common person linking plots and t-tests of person mean measures were used to investigate the reliability. The 95% confidence level smallest detectable differences were calculated.

    Results: The intra-class correlation coefficients ranged from 0.77 to 0.96 for the modules, and no systematic differences were detected between the response occasions. The smallest detectable differences ranged from 7.4 to 16.6 units.

    Conclusions: The test-retest reliability was satisfactory for all Orthotics and Prosthetics Users' Survey modules. The smallest detectable difference was large on all modules except the health-related quality of life module.

    Clinical relevance: The Orthotics and Prosthetics Users' Survey modules are reliable and, thus, can be recommended for repeated measurements of patients over time. Relatively large changes are needed to achieve statistical significance when assessing individual patients.

  • 40.
    Jarl, Gustav M.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Holmefur, Marie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hermansson, Liselotte M N
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Test-retest reliability of the Orthotics and prosthetics users´ survey2013In: ISPO 2013 World Congress: Inclusion, Participation & Empowerment, 2013Conference paper (Refereed)
  • 41.
    Jönsson, Marie
    et al.
    Örebro University, School of Health Sciences. marie.jonsson@regionorebrolan.se.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Fredriksson, Carin
    Örebro University, School of Health Sciences.
    Possibilities and hindrances in daily occupations for older readmitted people discharged to home2018Conference paper (Refereed)
    Abstract [en]

    Introduction: Older people admitted to hospital are at risk of decreased ability to perform ADL, lower quality of life and dependency after discharge. There is also a higher risk for readmission to hospital shortly after discharge. The specific needs of this group of older people have been poorly described from these older peoples’ perspective. A deeper understanding may help the occupational therapist and other health professions to choose interventions in order to maintain daily occupations for this group. The aim of this study was to describe barriers and opportunities in daily occupations for older people repeatedly readmitted to hospital and now discharged to home.

    Methods: Sixteen participants 75 years and older were interviewed in their homes after discharge from an acute medical ward. A qualitative content analysis was used to analyze barriers and opportunities in daily occupations.

    Results: An overarching theme was found trying to manage an unpredictable everyday life. Three categories and seven subcategories were identified representing barriers and opportunities. The categories were Dealing with an unstable day, Dealing with social relations and Dealing with the health care system. These were important for maintaining daily occupations for most of the participants.

    Conclusion: The result indicates that daily occupations and contact from relatives were of importance. Therefore, appropriate support and occupational interventions are required in acute care and these must be communicated at discharge. Occupational therapy interventions and timed support are of particular importance for the group of older people who do not have close social relations at home.

  • 42. Krumlinde-Sundholm, Lena
    et al.
    Holmefur, Marie
    Eliasson, Ann-Christin
    Validitet, reliabilitet och känslighet för förändring hos Assisting Hand Assessment2005Conference paper (Refereed)
  • 43.
    Krumlinde-Sundholm, Lena
    et al.
    Karolinska Institutet.
    Holmefur, Marie
    Örebro University, Department of Nursing and Caring Sciences.
    Kottorp, Anders
    Karolinska Institutet.
    Eliasson, Ann-Christin
    Karolinska Institutet.
    The Assisting Hand Assessment: current evidence of validity, reliability, and responsiveness to change2007In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 49, no 4, p. 259-264Article in journal (Refereed)
    Abstract [en]

    The Assisting Hand Assessment (AHA) provides a new perspective of hand function evaluation relevant for children with unilateral upper limb disabilities. It measures how effectively the involved hand is actually used for bimanual activity, which, for these children, might be the most important aspect of their hand function. The aim of this paper is to report the conceptual framework and the evidence for validity, reliability, and responsiveness to change for the measures. Previously, the AHA has been evaluated for children aged 18 months to 5 years and excellent inter- and intrarater reliability was demonstrated. This paper reports further evidence of construct validity and reliability for the AHA measures involving an extended age range of children with hemiplegic cerebral palsy or obstetric brachial plexus palsy from 18 months to 12 years of age (mean age 4y 11mo [SD 2y 9mo] range 18mo-12y 8mo). A Rasch measurement model was used to analyze 409 assessments from 303 children (170 males, 133 females). The analysis generated a scale demonstrating large capacity to reliably separate and spread personal ability measures, indicating sensitivity to change and a hierarchy of the items ranging them from easy to hard. Aspects of item fit, relationship between age and ability measures, and development of assisting hand function are discussed.

  • 44.
    Lidström Holmqvist, Kajsa
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Holmefur, Marie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ivarsson, Ann-Britt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Therapeutic use of self as defined by Swedish occupational therapists working with clients with cognitive impairment following acquired brain injury: a Delphi study2013In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 60, no 1, p. 48-55Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/AIM: The concept therapeutic use of self has mainly been described theoretically. Empirical descriptions are few and empirical validation is needed to make the concept more useful for informing practice and explaining what occupational therapists do in the interaction with their clients to facilitate successful outcomes. The aim of this study was to empirically define the aspects that occupational therapists working with clients with cognitive impairments following acquired brain injury find are consistent with the concept of therapeutic use of self.

    METHOD: Thirteen expert occupational therapists participated. Reactive Delphi technique in three rounds was used where each round built on the results of the previous one. A questionnaire based on current literature was developed for the first round.

    RESULTS: Twenty of 33 statements reached a consensus level of 75% or more. These statements reflected the therapists' consciousness, self-awareness and use of personal characteristics. The statements also concerned the intentions of therapeutic use of self, including client group-specific intentions such as enhancing self-awareness. The results indicate that the content of the concept may be defined differently depending on the client group.

    CONCLUSIONS: The empirical descriptions generated from this study may help occupational therapists working with clients with cognitive impairments following acquired brain injury to describe how and with what intention they use themselves therapeutically in the rehabilitation process. In occupational therapy education, the results may be used to highlight how the concept may be understood in practice and to discuss it in relation to different client groups.

  • 45.
    Lidström Holmqvist, Kajsa
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ivarsson, Ann-Britt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Holmefur, Marie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Occupational therapist practice patterns in relation to clients with cognitive impairment following acquired brain injury2014In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 28, no 11, p. 1365-1373Article in journal (Refereed)
    Abstract [en]

    Primary objective: To describe Swedish occupational therapist practice patterns for clients with cognitive impairment following acquired brain injury.

    Research design: A cross-sectional stratified random sample of 462 occupational therapists.

    Methods: An online questionnaire was used to collect data.

    Main results: The predominant practice pattern was the use of ADL-activities for assessment and therapy regardless of whether limitations in occupational performance or cognitive function were assessed or whether the approach was remedial or compensatory. For assessment, general ADL-instruments were used more often than instruments that assessed cognitive function. Instruments were used less often within municipal rehabilitation facilities compared to regional, county and primary care facilities. The most common focus of the therapies was in regard to abilities related to executive functioning. Another prominent practice pattern was a collaborative approach involving clients, relatives and other staff. The theories used in practice were, to a large extent, general in nature and did not focus specifically on cognitive functioning.

    Conclusions: Swedish occupational therapy practice for clients with cognitive impairments following acquired brain injury focuses highly on occupational performance. Therapies targeting executive functioning seem particularly important in practice and a collaborative approach involving clients, relatives and other staff is a prominent feature in practice.

  • 46.
    Lidström-Holmqvist, Kajsa
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    The ADL taxonomy for persons with mental disorders: adaptation and evaluation2019In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 26, no 7, p. 524-534Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is a lack of occupation-focused instruments to assess Activities of Daily Living (ADL) that are intended for persons with mental disorders. The ADL Taxonomy is an instrument that is widely-used within clinical practice for persons with physical impairment. The aim of this study was to adapt the ADL Taxonomy for persons with mental disorders and evaluate its validity.

    METHODS: An expert group of Occupational Therapists (OTs) from psychiatric care adapted the ADL Taxonomy to fit the client group, including creating three new items. OTs in psychiatric care collected client data and evaluated the instrument for usability. Rasch analysis was used to evaluate the contruct validity of 16 activities separately.

    RESULTS: The OTs collected 123 assessments from clients with various mental disorders. Ten activities had excellent, and four had acceptable, psychometric properties with regard to item and person fit and unidimensionality. The activity managing the day/time gave complex results and would benefit from further development. The OTs found the test version intelligible, relevant and easy to use.

    CONCLUSIONS: The ADL Taxonomy for persons with mental disorders has 16 activities with three to six actions each, and is now ready for clinical use.

  • 47.
    Lidström-Holmqvist, Kajsa
    et al.
    Örebro University, School of Health Sciences.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Arvidsson, Patrik
    Reliabilitetsprövning av Weekly Calendar Planning Activity (WCPA): ett instrument för att mäta exekutiva funktioner2015Conference paper (Refereed)
  • 48.
    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 functioning2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, p. 1-6Article 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.

  • 49.
    Lidström-Holmqvist, Kajsa
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Ivarsson, Ann-Britt
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Arbetsterapeuters praxismönster i relation till klienter med kognitiva nedsättningar efter förvärvad hjärnskada2017Conference paper (Refereed)
  • 50.
    Lidström-Holmqvist, Kajsa
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Universitetssjukvårdens forskningscentrum.
    Tollén, Anita
    Örebro University, School of Health Sciences.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Erfarenheter av att delta i gruppinterventionen Ha Koll! för personer med nedsatt tidshanteringsförmåga2019Conference paper (Refereed)
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