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  • 1.
    Adaszak, Sofie
    et al.
    Örebro University, School of Health Sciences.
    Gustafsson, Johanna
    Örebro University, School of Health Sciences.
    Källström, Åsa
    Örebro University, School of Behavioural, Social and Legal Sciences.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Farias Vera, Lisette
    DepaKarolinska Institutet, Stockholm, Sweden.
    Navigating barriers and facilitators to support victims of violence in a close relationship with cognitive disability: Social workers´ perspectives2023Conference paper (Other academic)
    Abstract [en]

    The risk of violence in close relationships is higher for people with cognitive disabilities than in the general population. This is due to social isolation, and physical or financial dependence on others in everyday activities. To enable adequate protection for these victims, social workers need to take decisions and provide support that is based on knowledge about both violence and disability-related needs. By contrast, people with cognitive disabilities are de facto less likely to be provided with support adapted to their needs. Therefore, this study explores how social workers navigate barriers and facilitating aspects to support victims of violence with cognitive disabilities.Data were collected in individual interviews with 18 social workers, and analysed using content analysis. The inclusion criteria were 3 years or more experience in identifying and/or assessing exposure to violence in close relationships among people with cognitive disabilities.

    The emerging categories illustrate how social workers face dilemmas when navigating the balance between individuals’ rights for self-determination and complex needs for protection and support. The policies that frame social workers' practice in Sweden are discussed in relation to the need for flexible interventions and accessible support based on interprofessional collaboration related to violence and cognitive disability. The categories also problematize the power dynamics involved and how different actors’ experiences, values, and power influence the support process. The different actors involved add to the complexity that social workers need to navigate.

    This presentation focus on how social workers' practice is governed and hindered by policy, a focus on individuals' rights for self-determination, and the need to support and protect a group that may have difficulties to identify both violence and their needs for support.

  • 2.
    Arvidsson, Patrik
    et al.
    Centre for Research & Development, Region Gävleborg, Gävle, Sweden; School of Health and Welfare, Disability Research, Jönköping University, Jönköping, Sweden.
    Janeslätt, Gunnel
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Centre for Clinical Research in Dalarna, Uppsala University, Sweden.
    Wennberg, Birgitta
    Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Lidström-Holmqvist, Kajsa
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Hayat Roshanay, Afsaneh
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Evaluation of the group intervention "Let's Get Organized" for improving time management, organisational, and planning skills in people with mild intellectual disability2023In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 30, no 8, p. 1257-1266Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Limited time management skills cause problems in daily life for people with mild intellectual disability (ID) and "Let's Get Organized" (LGO) is a promising manual-based occupational therapy group intervention aiming to support management skills.

    AIMS/OBJECTIVES: To evaluate the applicability of the Swedish version of LGO-S by i) exploring enhancements in time management skills, satisfaction with daily occupations, and aspects of executive functioning in people with time-management difficulties and mild ID, and ii) describing clinical experiences of using the LGO-S for people with mild ID.

    MATERIAL AND METHODS: Twenty-one adults with mild ID were included. Data were collected pre-/post-intervention and at 3- and 12-month follow-ups with: Swedish version of Assessment of Time Management Skills (ATMS-S), Satisfaction with Daily Occupation (SDO-13), and Weekly Calendar Planning Activity (WCPA-SE). There were few follow-up participants (n = 6-9).

    RESULTS: Significant change in time management skills that maintained at 12-months follow-ups. Significant increase in regulation of emotions at 12-month follow-up. Results at 12-months follow-up indicated sustainability in outcomes as measured by ATMS-S. A non-significant positive trend was observed in other outcomes between pre- and post-intervention.

    CONCLUSIONS AND SIGNIFICANCE: LGO-S seems applicable for improving skills in time management, organisation and planning also for people with mild ID.

  • 3.
    Baric, Vedrana B
    et al.
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden. vedrana.baric@liu.se; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. vedrana.baric@liu.se.
    Yngve, Moa
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Feldman, Inna
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Wilder, Jenny
    Department of Special Education, Stockholm University, Stockholm, Sweden.
    Johansen, Kine
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Klang, Nina
    Department of Education, Uppsala University, Uppsala, Sweden; School of Education, Culture and Communication, Mälardalen University, Vasteras, Sweden.
    Lidström, Helene
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Borgestig, Maria
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Partnering for change (P4C) in Sweden: a study protocol of a collaborative school-based service delivery model to create inclusive learning environments2023In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 2219Article in journal (Refereed)
    Abstract [en]

    Background: Inclusive learning environments are considered as crucial for children's engagement with learning and participation in school. Partnering for change (P4C) is a collaborative school-based service delivery model where services are provided at three levels of intensity based on children's needs (class, group-, individual interventions). Interventions in P4C are provided universally to support all children with learning, not only children with special education needs (SEN), and as such are expected to be health-promoting.

    Aim: The aim of the study is to evaluate the effectiveness and cost-effectiveness of P4C as well as school staff members' and children's experiences after P4C.

    Methods: In a parallel, non-randomised controlled intervention design, 400 children, aged 6-12 years, and their teachers, will be recruited to either intervention classes, working according to the P4C, or to control classes (allocation ratio 1:1). Data will be collected at baseline, post-intervention (4 months), and 11 months follow-up post baseline. The primary outcome is children's engagement with learning in school. Secondary outcomes include for example children's health-related quality of life and wellbeing, occupational performance in school, attendance, and special educational needs. The difference-in-differences method using regression modelling will be applied to evaluate any potential changes following P4C. Focus group interviews focusing on children, and professionals' experiences will be performed after P4C. A health economic evaluation of P4C will be performed, both in the short term (post intervention) and the long term (11-month follow-up). This study will provide knowledge about the effectiveness of P4C on children's engagement with learning, mental health, and wellbeing, when creating inclusive learning environments using a combination of class-, group- and individual-level interventions.

  • 4.
    Eldh, Ann Catrine
    et al.
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Luhr, Kristina
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Wenemark, Marika
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Unit of Public Health and Statistics, Region Östergötland, Linköping, Sweden.
    Assessing and reporting patient participation by means of patient preferences and experiences2020In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 20, no 1, article id 702Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although patient participation is strongly associated with high quality of healthcare, valid means to measure and report a comprehensive notion of patient participation are scarce. The Patient Preferences for Patient Participation (4Ps) is a new healthcare practice and research tool, comprising patients' preferences as well as experiences. The 4Ps employs 12 items for the patient to conceptualise patient participation. The aim of this paper is to describe how the two perspectives of patient participation, namely preferences and experiences, can be combined to visualise and report preference-based patient participation.

    METHODS: With four response alternatives in each section, the 4Ps offers sixteen possible combinations of degree of match per item. Theoretical and clinical principles fostered a tentative order of six ranks and three levels of preference-based patient participation. To test the standard, statistical analyses for ordinal data were performed, using data from a randomised controlled trial evaluating an intervention aiming to improve patient participation. Further, structures for visualising the preference-based patient participation of individuals and groups were suggested.

    RESULTS: Data from the 4Ps demonstrated the individuals' preference-based patient participation, indicating either a match or a mismatch for each item. Mismatches represented either the experience of participation surpassing the patient's preferences, or the patient's preferences for patient participation not being established. At group level, the suggested approach for visualising and reporting the 4Ps demonstrated that the intervention group had a significantly higher proportion of sufficient preference-based patient participation for certain items than the control group. These results had not been identified earlier, when using the preferences and experiences of patient participation as separate measures.

    CONCLUSIONS: Ways to easily acquaint stakeholders with patients' preferences for patient participation are needed, in order for healthcare staff to better use resources to match the basic requirements of individuals and groups. While the 4Ps can guide professionals to patient participation as framed in legislations, concept analyses and by patients, a visualisation of the results is needed to capture preference-based patient participation. The proposed route to representing degree of match in preferences and experiences may also be relevant to other dimensions of quality of healthcare.

    Download full text (pdf)
    Assessing and reporting patientparticipation by means of patientpreferences and experiences
  • 5.
    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. 

  • 6.
    Eliasson, Ann-Christin
    et al.
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Nordstrand, Linda
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Backheden, Magnus
    Department of Leaning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Longitudinal development of hand use in children with unilateral spastic cerebral palsy from 18 months to 18 years.2023In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 65, no 3, p. 376-384Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the development of the use of the affected hand in bimanual tasks in children with unilateral cerebral palsy (CP) from 18 months to 18 years. Specifically, whether early development can be confirmed in a larger cohort and how development progresses during adolescence.

    METHOD: In total, 171 participants (95 males, 76 females; mean age 3 years 1 month [SD 3 years 8 months], range 18 months-16 years at inclusion) were classified in Manual Ability Classification System (MACS) levels I (n = 41), II (n = 91), and III (n = 39). Children were assessed repeatedly (median 7, range 2-16 times) with the Assisting Hand Assessment: in total 1197 assessments. Developmental trajectories were estimated using a nonlinear mixed effects model. To further analyse the adolescent period, a linear mixed model was applied.

    RESULTS: The developmental trajectories were different between participants in MACS levels (MACS I-II, II-III) in both rate (0.019, 95% confidence interval [CI] 0.006-0.031, p = 0.034; 0.025, 95% CI 0.015-0.037, p < 0.001) and limit (19.9, 95% CI 16.6-23.3, p = 0.001; 7.2, 95% CI 3.3-11.2, p < 0.003). The individual variations were large within each level. The developmental trajectories were stable over time for all MACS levels between 7 and 18 years (p > 0.05).

    INTERPRETATION: Children and adolescents with unilateral CP have considerable development at an early age and a stable ability to use their affected hand in bimanual activities from 7 to 18 years in all MACS levels.

  • 7.
    Forsberg, Anette
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Region Örebro County, Physiotherapy, Örebro University Hospital, Örebro, Sweden.
    Fredriksson, Carin
    Örebro University, School of Health Sciences.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. University Health Care Centre.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences. Örebro University Hospital. Region Örebro County, Health Care Management, Örebro, Sweden.
    Prescribing rolling walkers: A survey study of experiences from physiotherapists2019Conference paper (Refereed)
  • 8.
    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.

  • 9.
    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.

  • 10.
    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.

  • 11.
    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)
  • 12.
    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)
  • 13.
    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)
  • 14.
    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)
  • 15.
    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.

  • 16.
    Holmefur, Marie
    et al.
    Örebro University, School of Health Sciences.
    Eliasson, Ann-Christin
    Institutionen för kvinnors och barns hälsa, Karolinska Institutet, Stockholm, Sverige.
    Kan CIMT-träning vid 2-3 års ålder ge en bättre framtida utveckling av handfunktion hos barn med unilateral CP?2015Conference paper (Refereed)
  • 17.
    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.

  • 18.
    Holmefur, Marie
    et al.
    Örebro University, School of Health Sciences.
    Elvrum, Ann-Kristin Gunnes
    Clinic of Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway and Department of Clinical and Molecular Medicine and Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
    Krumlinde-Sundholm, Lena
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    The assisting hand assessment for children and youth with brachial plexus birth injury: a study of validity and item hierarchy of AHA-Plex2023In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 55, article id jrm15325Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Functional assessments that focus on activity performance and that produce valid outcome measures for people with brachial plexus birth injury are lacking. The primary aim of this study was to re-evaluate the internal scale validity of the Assisting Hand Assessment specifically for children and adolescents with brachial plexus birth injury. Two further aims were investigating whether the scale could be shortened for this group while maintaining psychometric quality, and exploring and presenting its item difficulty hierarchy.

    DESIGN: A cross-sectional psychometric study.

    SUBJECTS: A convenience sample of 105 children and adolescents (aged 18 months to 18 years, mean 6 years, 7 months, standard deviation (SD) 4 years, 4 months) from Sweden, Norway, and the Netherlands with brachial plexus birth injury.

    METHODS: Participants were assessed with the Assisting Hand Assessment. Data were analysed with Rasch measurement analysis. RESULTS: The 20 Assisting Hand Assessment items together measured a unidimensional construct with high reliability (0.97) and the 4-level rating scale functioned well. Item reduction resulted in 15 items with good item fit, unidimensionality, reliability and acceptable targeting.

    CONCLUSION: Assisting Hand Assessment for people with brachial plexus birth injury, called AHA-Plex, has 15 items and good internal scale validity. A unique item hierarchy for people with brachial plexus birth injury is presented.

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  • 19.
    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.

  • 20.
    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.

  • 21.
    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)
  • 22.
    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)
  • 23.
    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.

  • 24.
    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)
  • 25.
    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)
  • 26.
    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.

  • 27.
    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)
  • 28.
    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.

  • 29.
    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)
  • 30.
    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)
  • 31.
    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)
  • 32.
    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)
  • 33.
    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.

  • 34.
    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)
  • 35.
    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)
  • 36.
    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)
  • 37. Holmefur, Marie
    et al.
    Krumlinde-Sundholm, Lena
    Eliasson, Ann-Christin
    Utveckling av bimanuell förmåga hos barn med CP hemiplegi2008Conference paper (Other academic)
  • 38.
    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.

  • 39.
    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)
  • 40.
    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.

  • 41.
    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)
  • 42.
    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)
  • 43.
    Holmefur, Marie
    et al.
    Örebro University, School of Health Sciences.
    Roshanay, Afsaneh
    Lidström-Holmqvist, Kajsa
    Örebro University, School of Health Sciences. Örebro University Hospital.
    White, Suzanne
    The Psychometric Properties of the Original Version of Assessment of Time Management Skills (ATMS)2022Conference paper (Other academic)
  • 44.
    Holmefur, Marie
    et al.
    Örebro University, School of Health Sciences.
    Roshanay, Afsaneh
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    White, Suzanne
    State University of New York, Downstate Medical Center, Brooklyn, New York, USA.
    Janeslätt, Gunnel
    Department of Public Health and Caring Sciences, Uppsala University and Centre for Clinical Research in Dalarna, Uppsala University, Falun, Sweden.
    Vimefall, Elin
    Örebro University, Örebro University School of Business.
    Lidström-Holmqvist, Kajsa
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Evaluation of the "Let's Get Organized" group intervention to improve time management: protocol for a multi-centre randomised controlled trial2021In: Trials, E-ISSN 1745-6215, Vol. 22, no 1, article id 640Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Time management skills are essential for living in modern society. People with mental or neurodevelopmental disorders typically have cognitive limitations, including affected time management, which might lead to poor occupational balance, low self-efficacy, and poor parental sense of competence. "Let's Get Organized" (LGO) is a recently developed manual-based group intervention to train time management skills. The aim of this trial is to evaluate the efficiency of the Swedish version of LGO (LGO-S) compared to treatment as usual (individual occupational therapy) to improve time management for adults with impaired time management skills due to mental or neurodevelopmental disorders. Furthermore, to evaluate if the intervention is a cost-effective way to improve the quality of life and time management skills of these individuals, we will conduct a health economic evaluation.

    METHODS: The trial will have a multi-centre, open, parallel randomised controlled design. A total of 104 adults with cognitive limitations due to mental or neurodevelopmental disorders will be recruited from open psychiatric or habilitation care units. Outcomes will be measured before and after a 10-week intervention, with a follow-up 3 months after completing the intervention. The primary outcome will be self-assessed time management skills. Secondary outcomes will be e.g. self-assessed skills in organisation and planning, regulation of emotions, satisfaction with daily occupations, occupational balance, self-efficacy, and quality-adjusted life years.

    DISCUSSION: A recent feasibility study has shown promising results for LGO-S, and a randomised trial will provide robust evidence for the possible efficacy of LGO-S in comparison to treatment as usual.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT03654248 . Registered on 20 August 2018.

  • 45.
    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.

  • 46.
    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.

  • 47.
    Hugelius, Karin
    et al.
    Örebro University, School of Health Sciences. School of Education and Social Sciences, International Leadership University, Nairobi, Kenya.
    Nandain, Charles
    School of Education and Social Sciences, International Leadership University, Nairobi, Kenya.
    Semrau, Maya
    Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    The Reliability and Feasibility of the HESPER Web to Assess Perceived Needs in a Population Affected by a Humanitarian Emergency2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 4, article id 1399Article in journal (Refereed)
    Abstract [en]

    Needs assessment is essential in the humanitarian response, and perceived needs can be associated with the levels of health in populations affected by humanitarian emergencies. This study aimed to evaluate the reliability and feasibility of The Humanitarian Emergency Settings Perceived Needs Web (HESPER Web) in a humanitarian context and to compare perceived needs of a random walk study sample with a self-selected study sample recruited though social media. The study context was the Dadaab refugee camp in Kenya. An alternate forms reliability evaluation and a feasibility evaluation was conducted. In total, 308 refugees participated in the study. HESPER Web was found to be reliable and usable for assessing needs, with an intraclass correlation coefficient (ICC) of 0.88, Cohen's κ between 0.43 and 1.0 and a first priority need rating match of 81%. The HESPER Web was positively experienced, and the self-recruited study sample reported similar levels of needs and similar demographics as the randomized sample. The participants reported several unmet needs. HESPER Web offers a reliable tool for needs assessment in humanitarian emergencies where web-based surveys are considered as practical and suitable. It offers new possibilities for conducting remote assessments and research studies that include humanitarian populations that are rarely included in such evaluations.

  • 48.
    Hugelius, Karin
    et al.
    Örebro University, School of Health Sciences.
    Semrau, Maya
    Center for Global Health Research, Brighton and Sussex Medical School, Brighton, UK.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    HESPER web - development and reliability evaluation of a web-based version of the humanitarian emergency settings perceived needs scale2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, no 1, article id 323Article in journal (Refereed)
    Abstract [en]

    Background: The Humanitarian Emergency Settings Perceived Needs Scale (HESPER) assesses a wide range of physical, psychological and social perceived needs across 26 questions, and can be used in humanitarian emergencies and disasters for needs assessment or research studies. The original HESPER collects data through individual interviews. Today, a large number of people have access to the internet, including in humanitarian emergencies and disasters. Therefore, this paper aimed to report the development, reliability evaluation and feasibility evaluation of the HESPER Web.

    Methods: First, the original HESPER was developed into a web based survey. Thereafter, alternate forms reliability between the HESPER and HESPER Web, and test-retest reliability for the HESPER Web, was evaluated using a study sample of 85 asylum seekers in Sweden in total.

    Results: The alternate forms reliability evaluation showed that the HESPER Web was a reliable instrument to assess perceived needs. Intraclass correlation coefficient (ICC) for total number of serious needs was 0.96 (CI 0.93–09.98, p < 0.001). Cohen’s κ was used to analyse the alternate forms reliability between the HESPER and HESPER Web item per item; the correspondence between HESPER and HESPER Web varied between 0.54 and 1.0 for the 26 questions. There was a strong nominal association in first priority need between the HESPER and HESPER Web (Cramer’s V 0.845, p < 0.001). In the test-retest reliability evaluation of HESPER Web, ICC was 0.98 (CI 0.97–0.99, p < 0.001), and Cohen’s κ varied between 0.53 and 1.0. There was a strong nominal association in first priority need between test and re-test (Cramer’s V 0.93, p < 0.001). The HESPER Web was experienced as easy and safe to use and was found less time consuming than the original HESPER interview, according to the study participants.

    Conclusion: The HESPER Web is a reliable and usable instrument to assess perceived needs. It can reduce a number of practical challenges both for needs assessment in disasters or humanitarian emergencies as well as in research.

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    HESPER web - development and reliability evaluation of a web-based version of the humanitarian emergency settings perceived needs scale
  • 49.
    Hugelius, Karin
    et al.
    Örebro University, School of Health Sciences.
    Semrau, Maya
    Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Perceived Needs Among Asylum Seekers in Sweden: A Mixed Methods Study2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 4, article id 4983Article in journal (Refereed)
    Abstract [en]

    The health and well-being of asylum seekers in high-income countries is a concern from both individual and community perspectives. This study aims to describe the perceived needs of adult asylum seekers in Sweden. A mixed methods study was conducted that combined a non-randomized descriptive cross-sectional assessment of perceived serious needs using the Humanitarian Emergency Settings Perceived Needs Scale (HESPER) Web with 85 adult asylum seekers and focus group discussions with 14 adult asylum seekers in Sweden. Descriptive and comparative statistics were used for the quantitative part, and thematic analysis for the qualitative part. The total number of perceived serious needs reported by respondents ranged from zero to 13 needs per person with a mean of four needs (SD 2.71). The most commonly perceived serious needs were related to income or livelihood, separation from loved ones, being displaced from home, distress, and concerns about accessing adequate health care services. Many of the perceived needs appeared to be related to experiences of being dependent, in limbo, and vulnerable. Addressing people's current perceived needs can contribute to resilience and well-being and therefore should be considered in health care systems that cater to immigrants.

  • 50.
    Hugelius, Karin
    et al.
    Örebro University, School of Health Sciences.
    Semrau, Maya
    Brighton and Sussex Medical School, Brighton, United Kingdom.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Use of the HESPER Web to assess perceived needs immediately after multiple disaster events in Fiji2023In: Disaster Medicine and Public Health Preparedness, ISSN 1935-7893, E-ISSN 1938-744X, Vol. 17, article id e385; PII S1935789323000472Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In January 2022, Fiji was hit by multiple natural disasters including a cyclone causing flooding, an underwater volcanic eruption and tsunami. This study aimed to investigate perceived needs among the disaster-affected people in Fiji and to evaluate the feasibility of the Humanitarian Emergency Settings Perceived Needs Scale (HESPER Web) during the early stage after multiple natural disasters.

    METHODS: A cross-sectional study using a self-selected, non-representative study sample was conducted. The HESPER Web was used to collect data.

    RESULTS: In all, 242 people participated. The number of perceived serious needs ranged between 2 and 14 (out of a possible 26), with a mean of 6 (SD 3). The top three most reported needs were access to toilets (60%), care for people in the community who are on their own (55%), and distress (51%). Volunteers reported fewer needs than the general public.

    CONCLUSIONS: The top three needs reported were related to water and sanitation and psychosocial needs. Such needs should not be underestimated in the emergency phase after natural disasters, and may require more attention from responding actors. The HESPER Web was be considered as a usable tool for needs assessment in a sudden onset disaster.

123 1 - 50 of 104
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