To Örebro University

PURPOSE: Time management is essential to handle daily life in today's society. This study aimed to evaluate the effectiveness of the Swedish version of the Let's Get Organised (LGO-S) intervention to improve time-management skills for adults with impaired time management due to attention deficit hyperactivity disorder (ADHD), autism or mental disorders compared to treatment as usual (TAU), which is individual occupational therapy.

MATERIALS AND METHODS: This was a multi-centre, open, two-armed pragmatic randomised controlled trial. The setting was out-patient adult habilitation centres and psychiatric clinics. At baseline the study had 75 participants aged 19-61 years (mean 32.3 years) whereof 44 were women.

RESULTS: Both intervention groups showed statistically significant improvements in time-management skills, organisation and planning, emotional regulation, general self-efficacy and satisfaction with activities at post-intervention test. Most of these within-group improvements were sustained after 3 months. Changes in time-management skills between LGO-S and TAU intervention were not statistically significant at post-intervention or after 3-months. Programme completers in LGO-S had significantly better time management skills at the 3-month follow-up than non-completers.

CONCLUSIONS: This pragmatic RCT, conducted in a clinical environment including participants with complex difficulties, showed that both LGO-S and individual occupational therapy are clinically useful/applicable interventions that effectively improve time-management skills.

PURPOSE: Phantom Limb Pain (PLP) frequently occurs after limb amputation and often negatively influences daily functioning. Phantom Motor Imagery (PMI) treatment intends to decrease PLP by imagining phantom movements guided by extended reality techniques. The aim of this study was to investigate the experiences of individuals with PLP after limb amputation who underwent PMI treatment, and to explore the consequences of PMI treatment on daily functioning.

MATERIALS AND METHODS: A qualitative study was performed, consisting of semi-structured interviews one month after PMI treatment among eight Dutch participants with chronic PLP after a lower-limb amputation (mean age 63 years, 50% female). Data analysis followed the Framework Method.

RESULTS: Most participants experienced better control of the phantom limb after PMI treatment. The treatment was considered mentally demanding. PLP decreased in most participants, enhancing mood, sleep and daily participation. Some experienced recurrence of PLP post-treatment and reported limited knowledge about PLP.

CONCLUSIONS: PMI treatment has the potential to reduce PLP, and consequently improve quality of life. Intermittent PMI sessions after completing the initial treatment would be advised for lasting effect. Regularly imagining moving their phantom limb could be beneficial for patients. Clinicians should educate patients about PLP.

BACKGROUND: Adults with attention deficit/hyperactivity disorder (ADHD) often experience difficulties regulating emotions and balancing activity and rest. Impairments such as motor skills challenges and reduced body awareness, including interpretation of sensory signals and attitudes toward the body, often receive little clinical attention despite their potential negative impact on daily functioning and health. The START intervention is a 12-week structured exercise program that combines regular physical exercise with mindful attention to the body during movement. This study aimed to evaluate the effect of the START intervention on body awareness and movement quality in adults with ADHD.

METHODS: In this randomized controlled trial, 63 adults with ADHD were assessed for body awareness and movement quality before and after a 12-week intervention or treatment-as-usual control period using the Body Awareness Scale - Movement Quality and Experience.

RESULTS: Thirty-nine participants completed the study (26 intervention/13 control). Participants in the intervention group showed significantly greater improvement in body awareness compared to the control group, both in total score and in subscales for muscular tension and physical activity. Movement quality improved significantly within the intervention group, although no significant between-group differences were observed.

CONCLUSIONS: Structured physical exercise with mindful attention to the body enhanced body awareness in adults with ADHD compared to standard care. Effects on movement quality were not statistically different between groups and therefore remain uncertain. These findings suggest that such exercise may be a useful complement to conventional treatments and may support a healthier relationship with the body.

INTRODUCTION: Traumatic brain injury (TBI) is a global health issue and a leading cause of long-term disabilities and mortality worldwide. There is growing evidence that TBI rehabilitation should be differentiated and individualised according to gender to provide more effective healthcare and rehabilitation. However, there is a lack of reviews focusing on the rehabilitation for women with TBI and there is a need to summarise existing knowledge to guide and individualise their rehabilitation. This scoping review aims to identify and map evidence on content and outcome of non-pharmacological rehabilitation for women with TBI aged below 65 years.

METHODS AND ANALYSIS: This scoping review will follow the methodological guidelines of the Joanna Briggs Institute (JBI) and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). The databases searched will be PubMed, CINAHL and PsycINFO. The following inclusion criteria will be applied: peer-reviewed studies published in English over the years 2000-2024 including description of content and outcomes of non-pharmacological TBI rehabilitation for women aged between 16 and 65 years in both inpatient and outpatient contexts. All severities of TBI ranging from concussion through to extremely severe will be included. Text and opinion papers, conference abstracts and grey literature will be excluded. Studies fulfilling the inclusion criteria will be independently reviewed by three researchers. A data extraction form will be used including specific details about the participants, concept, context, study methods and key findings. The results will be presented in tabular format accompanied by a narrative summary.

ETHICS AND DISSEMINATION: Due to the nature of data, no approval from an ethics committee is required. Dissemination of results are planned in an open-access peer-reviewed journal and in professional networks.

REVIEW REGISTRATION NUMBER: OSF, https://doi.org/10.17605/OSF.IO/QUY3T.

Adult ADHD is associated with various health challenges and reduced quality of life. Current guidelines recommend multimodal treatment, and physical exercise has emerged as a promising non-pharmacological alternative, although evidence from randomized controlled trials remains limited. In this randomized controlled trial, we aimed to assess the clinical effectiveness of physical exercise as an add-on treatment for adults with ADHD compared to treatment as usual. The trial included adults with a clinically confirmed diagnosis of ADHD was conducted at one Psychiatric clinic in Sweden. Participants were randomly assigned (2:1, no stratification) using an electronic case-report platform, to either physical exercise (the protocolized 12-week intervention START) or treatment as usual (local community care). Primary outcome was the ASRS-v1.1 Symptom checklist at 12 weeks after inclusion. The analysis followed a modified intention-to-treat principle, excluding participants who provided no data beyond baseline. Of the 63 participants enrolled, 43 were randomly assigned to START physical exercise intervention and 20 to treatment as usual. After accounting for withdrawals (n = 11) and loss to follow up (n = 11), the primary analysis included data from 41 participants (30 assigned to START intervention and 11 to treatment as usual). The START intervention resulted in improved ADHD symptoms after 12 weeks, as measured by ASRS-v1.1. Symptom improvement differed significantly between groups (mean difference -6.98, 95% CI: -12.30 to -1.65; p = 0.012) with an effect size of 0.93 favoring the intervention group. No serious adverse events were reported. The results suggest that physical exercise may be a feasible, safe and clinically meaningful complement to standard care for adults with ADHD. However, the findings should be interpreted in the light of potential confounders and methodological limitations. This trial is registered with the ClinicalTrials.gov. Date of registration: 2021-05-14.

CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT05049239, identifier NCT05049239.

BACKGROUND: Living in residential aged care (RAC) facilities can have a passivating effect on older adults. Reablement is an approach to increase activity and participation in daily life. However, research on reablement in RAC facilities remains limited, making further research necessary.

AIMS/OBJECTIVES: This study aimed to investigate the feasibility of an 8-week reablement programme, Reablement in Residential Aged Care (Re-RAC), prior to a planned randomized controlled trial (RCT).

MATERIAL AND METHODS: Re-RAC aligns with the Swedish RAC context and international reablement principles. Qualitative and quantitative data on occupational performance, physical activity, psychological well-being, quality of life, adherence, and residents' and staff experiences were collected at an RAC facility in Sweden. Descriptive statistics and content analysis were used.

RESULTS: Six residents and 12 staff participated in the intervention. The methodology and intervention procedures were feasible overall. Participants requested more regular occupational therapy support, and staff requested support to motivate participants.

CONCLUSIONS: This study demonstrates that Re-RAC was a feasible and well-accepted intervention in a Swedish RAC facility, although some areas for improvement were identified. Maintaining motivation was highlighted, and extended support will be incorporated.

SIGNIFICANCE: This study provides practical guidance for reablement in RAC facilities, emphasizing resident motivation and staff engagement.

BACKGROUND: Living in residential aged care (RAC) facilities can be passivating and negatively impact residents' well-being and quality of life. With a growing global population of older adults and an increasing number residing in RAC facilities, it is crucial to address these concerns. Person-centered reablement, which enhances activity and participation through tailored, multidisciplinary strategies, has shown promising results in home settings. However, its implementation in RAC facilities, especially in Sweden, requires further evaluation. This research project will examine whether the reablement intervention in RAC (Re-RAC) impacts activity performance and satisfaction, participation, quality of life, and well-being, in older adults living in RAC facilities. Additionally, the project will evaluate the health-economic effects of the intervention and explore potential associations with the outcomes. A further aim is to describe the experiences of both the participating older adults and RAC facility staff involved in Re-RAC.

METHODS: This is a multi-center prospective pragmatic randomized controlled trial has two parallel groups comparing the Re-RAC intervention with usual care. A total of 86 participants are planned to be enrolled. The 8-week intervention will be evaluated using quantitative, qualitative, and health-economic methods. Data will be collected at baseline and after the intervention. Health-economic data will also be gathered 3 months before and after intervention. Primary outcomes are activity performance and satisfaction with performance captured using the Canadian Occupational Performance Measure; secondary outcomes, i.e., health-related quality of life, psychological well-being, and physical activity levels will also be evaluated. Experiences of participants and staff will be captured through individual and focus-group interviews. Cost-effectiveness will be estimated by calculating the cost per quality-adjusted life year gained. Quantitative data will be analyzed using descriptive and comparative statistics; qualitative data will be analyzed using thematic analysis and focus-group methodology.

DISCUSSION: This study evaluates the Re-RAC intervention for older adults in RAC through a real-world pragmatic trial, examining activity performance, satisfaction, quality of life, well-being, and health outcomes for older adults in RAC facilities. The study also explores participant and staff experiences and evaluates cost-effectiveness. The results will offer valuable insights informing the future implementation and assessment of reablement interventions in RAC settings.

TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT06793501 . Registered on 20 January 2025.

PURPOSE: Phantom limb pain (PLP) is a condition that greatly diminishes quality of life. Phantom motor execution (PME), enabled by myoelectric pattern recognition combined with virtual and augmented reality, is a novel treatment for PLP. Here we, aimed to describe patients' experiences of this treatment.

MATERIAL AND METHODS: Qualitative, using semi-structured interviews one month after completed PME treatment. Twenty-one Swedish and Dutch patients (mean age 57, 16 males, 16 lower limb amputations) participated. The analysis followed the framework approach.

RESULTS: The main themes were 1) treatment effects on the perception of the phantom limb, 2) living with PLP before and after treatment, and 3) facilitators and barriers to treatment. Most participants learned to control their phantom limb, perceived it more positively and as more complete. This control over the phantom limb became a tool for managing PLP. Most participants' outlook on life and energy levels improved after treatment. Being mentally focused during treatment was important. Therapists were pivotal to the success of the treatment.

CONCLUSION: Controlling the phantom limb improved their perception of it and pain management, self-agency, and quality of life. The therapists' role was invaluable. We suggest training for patients in phantom limb control before and after amputation.

OBJECTIVES: Phantom limb pain (PLP) is common after limb amputation and can lead to chronic pain and psychosocial risks, potentially leading to suicide or euthanasia. This study aimed to explore the consequences of intractable PLP on a person's life before, during, and after receiving phantom motor imagery (PMI) treatment, focusing on the person's experiences with PMI and how it influenced his life and decision regarding euthanasia.

METHODS: This case study focused on a single participant from the PMI treatment group of a PLP randomized clinical trial (RCT). The participant, who joined the RCT as a last resort before euthanasia, experienced decreased PLP during the trial, but the pain returned 1 month post-treatment. Subsequently, the participant initiated self-administered PMI training at home. A mixed quantitative-qualitative method approach was used to analyze this case study.

RESULTS: Understanding and living with PLP was challenging for the participant, making him lose interest in life. Despite starting with low expectations, the participant enjoyed PMI, particularly home training. PLP disappeared during the RCT, returned after therapy cessation, and vanished again during PMI home training. PMI returned his motivation to live, leading him to discontinue his plans for euthanasia.

CONCLUSIONS: This case illustrates the severity of chronic PLP, highlighting also the complex interaction of biopsychosocial factors in pain, which can lead a person to consider euthanasia. Representing the first use of PMI in a home setting, this study, along with previous studies in clinical setting, indicates PMI to be a promising and feasible innovative intervention for decreasing PLP, encouraging further research. This study also emphasizes the need to enhance PLP education among clinicians and people with amputations.

PURPOSE: Time management skills are essential to maintain activities in daily life including work and family life. Parenting demands a high degree of attention, planning, problem solving and also time management. Managing time and organizing daily life can be a challenge for people with ADHD and consequently complicate parenting. Let’s Get Organized is an occupational therapy group intervention aiming at training skills in time management and planning and organization. The aim of this study was to describe parents’ experiences of time management and parenting after participating in the occupational therapy group intervention Let’s Get Organized.

DESIGN: The study had a descriptive qualitative design. Participants (n=15) with self-reported difficulties in time management skills due to ADHD were recruited from three psychiatric and habilitation outpatient services in Sweden.

METHOD: Interviews with a study-specific interview guide were performed after completed intervention. Data was analysed using qualitative inductive content analysis.

RESULTS: The findings describe the parents’ experiences in one overarching main category, Active parenting och better relations within and outside the family through daily time management. Three underlying generic categories were identified: Let’s Get Organized facilitates empowerment in daily life; The individual and family – both facilitators of and obstacles to implementation of time management strategies; and A changed parenting and family life.

CONCLUSION: Participants experienced a positive impact on time management skills after Let’s Get Organized which generated more active parenting and better predictability in the whole family. Let’s Get Organized can be a valuable occupational therapy intervention for parents with ADHD.