Article

Experiences of using information and communication technology within the first year after stroke - a grounded theory study

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Purpose: The purpose of this study was to identify how people 6-12 months after stroke were using and integrating information and communication technology (ICT) in their everyday lives. Method: To capture the participants' experiences, one focus group and 14 individual interviews were carried out in Sweden and Denmark regarding the use of ICT in everyday life. The participants comprised 11 men and seven women aged 41-79 years. A grounded theory approach was used throughout the study and a constant comparative method was used in the analysis. Results: Five categories were identified from the analysis of the interviews with the participants: 1) Using the mobile phone to feel safe, 2) Staying connected with others, 3) Recreating everyday life, 4) A tool for managing everyday life, and 5) Overcoming obstacles for using ICT. From these categories one core category emerged: The drive to integrate ICT in everyday life after stroke. Conclusions: People with stroke had a strong drive to integrate ICT in order to manage and bring meaning to their everyday lives, although sometimes they needed support and adaptations. It is not only possible but also necessary to start using ICT in rehabilitation in order to support people's recovery and promote participation in everyday life after stroke. Implications for rehabilitation People with stroke have a strong drive for using information and communication technology in their everyday lives, although support and adaptations are needed. The recovery process of people with stroke could benefit from the use of ICT in the rehabilitation and ICT could possibly contribute to independence and promote participation in everyday life. Knowledge from this study can be used in the development of an ICT-based stroke rehabilitation model.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Persons with neurological disorders as stroke or traumatic brain injury may have cognitive impairment which can result in difficulties to perform activities of daily living [1][2]. For example to take initiatives, to plan, structure and organise everyday life and to remember to carry out planned activities. ...
... The increased demands in society to plan and organise everyday life as well as to coordinate activities with others, has made that the need of digital support for persons with cognitive impairment have grown. Digital support has proved to have a good potential for increasing activity for persons with cognitive impairment [1] in comparison with more traditional compensatory strategies, such as paper and pencil or diary/calendar, since digital support can have reminders as alarm and/or text messages [3]. When using a traditional calendar a common problem is to remember to look in it. ...
... They might require a long learning and implementation time for users or offers limited opportunities for feedback [6]. For these persons, a digital support may be an opportunity to increase their ability to be active [1] if the reminder has an alarm and/or send a text message. Therefore, an interactive web-based mobile reminder calendar has been developed by researchers at Linköping University, Sweden, called the Digital Support RemindMe (DSR). ...
Cognitive impairment may cause difficulties in planning and initiating daily activities, as well as remembering to do what is scheduled. This study investigates the effectiveness of an interactive web-based mobile reminder calendar that sends text messages to the users mobile phone as support in everyday life, for persons with cognitive impairment due to neurological injury/diagnoses. The study has a randomised controlled trail design with data collection at baseline and at follow-up sessions after two and four months. Data collection started in August 2016 and continues until December 2017. The interactive web-based mobile reminder calendar may give the needed support to remind the person and thus increase the ability to perform activities and to be independence in everyday life. Preliminary results will be presented regarding what effect the interactive web-based mobile reminder calendar have for the participants performance of everyday life activities as well as perceived quality of life.
... Studies suggest that ICT has the potential to improve the level and timing of information to patients and their significant others [13], and that individualized information can lead to better quality of life in both stroke survivors and significant others [25,26]. Furthermore, ICT has the potential to increase accessibility to rehabilitation in both rural and urban settings [27,28], reduce travel time and costs [22], increase participation in and adherence to therapeutic activities and to support shared decision-making in person-centred rehabilitation, thereby facilitating better rehabilitation outcomes [4,13,[29][30][31]. ICT solutions also have the potential to provide longer follow-up after discharge from acute care, thus extending the rehabilitation period [13,26,32]. ...
... The involvement of end users is a key element of the project. Therefore, several qualitative studies have been performed to explore the experiences of using ICT in everyday life and in rehabilitation after stroke -from the perspectives of stroke survivors, significant others and health professionals in different health care contexts [4,16,23,29]. This present study was carried out to explore the perspectives of OTs and PTs within rehabilitation after stroke in a Danish health care context. ...
... Each exercise was scheduled to last about 30-40 minutes. Furthermore, findings from our previous studies [4,29] were used to elaborate the interview guide, for example: "Some stroke survivors mentioned using ICT in new ways after their stroke; what experiences do you have regarding this?", or "Stroke survivors and their significant others mentioned the information level as challenging during the rehabilitation process; can you describe if you see any potential for ICT in accommodating this challenge?" Additionally, elaborative questions in the second focus group interview were used to uncover variations and similarities regarding current and potential use of ICT in the rehabilitation process. ...
Article
Full-text available
Aim The aim of this study was to explore the current and potential use of information and communication technology (ICT) to enhance coherent person-centred rehabilitation after stroke, from the perspectives of physiotherapists and occupational therapists. Method Five occupational therapists and four physiotherapists from different phases of the Danish stroke rehabilitation process were included and two focus group interviews were carried out. A grounded theory approach was used throughout the study and a constant comparative method was used in the analysis. Results Three subcategories were identified from the analysis of interviews with participants: 1) ICT and apps as meaningful and supportive in the rehabilitation process, 2) ICT as a tool in communication and documentation and 3) Barriers to the integration of ICT and apps in the rehabilitation process. From these categories one core category emerged: The potential of a personalized app solution to facilitate coherent person-centred rehabilitation. Conclusion ICT was perceived as important to integrate in stroke rehabilitation both for assessment, training and to compensate for remaining deficits. The development of a personalized app solution could accommodate stroke survivors’ and significant others’ need for insight into and overview over the rehabilitation process as well as access to relevant information, which would thereby empower them. Furthermore, a personalized app solution could also facilitate follow-up after discharge and was perceived to ease the communication and documentation within and between sectors, as well as communication with both stroke survivors and significant others.
... Even though the smaller number of stroke survivors used smartphones than age-matched adults with no history of neurological conditions, their daily use patterns for MT were similar (Wong et al., 2017). Stroke survivors in Sweden, Denmark, and New Zealand used MT to reach help in case of emergency, connect with others, and manage ADLs (Gustavsson et al., 2018;Lemke et al., 2020). Stroke survivors outside of the United States used MT most commonly to connect with others, organize ADLs, and call for help in emergency, and reported accepting MT for general or UE HEPs (Gustavsson et al., 2018;Kamwesiga et al., 2017;Lemke et al., 2020;Mahmood et al., 2019;Wong et al., 2017). ...
... Stroke survivors in Sweden, Denmark, and New Zealand used MT to reach help in case of emergency, connect with others, and manage ADLs (Gustavsson et al., 2018;Lemke et al., 2020). Stroke survivors outside of the United States used MT most commonly to connect with others, organize ADLs, and call for help in emergency, and reported accepting MT for general or UE HEPs (Gustavsson et al., 2018;Kamwesiga et al., 2017;Lemke et al., 2020;Mahmood et al., 2019;Wong et al., 2017). ...
... Furthermore, stroke participants were overwhelmingly receptive toward using MT to support their UE HEPs. Our results reinforce previous studies that also found positive attitudes toward MT outside of the United States (Emmerson et al., 2017;Gustavsson et al., 2018;Kamwesiga et al., 2017;Lemke et al., 2020;Wong et al., 2017). Interestingly, our stroke participants used MT more frequently for information searching, calendar and reminders, and social media compared to the control participants. ...
Article
Introduction The use of mobile technology (MT) in home-based occupational therapy is expected to continue growing. This study describes daily use patterns for MT and upper extremity (UE) home exercise programs (HEPs) for community-dwelling stroke survivors in the United States. Method Cross-sectional survey. Data were analyzed using descriptive statistics and bivariate comparisons. Results N = 61 (30 stroke and 31 controls). Individuals with stroke had similar levels of knowledge, skill, and use of MT compared with non-disabled age-matched adults. Stroke participants used MT more frequently for information searching, social media, and reminders compared to control participants. Stroke participants were motivated to improve UE function (93.3%) and reported a need for additional HEP training (56.7%). Perceived facilitators to improve UE use included talking to peers (73.3%), getting more information (73.3%), and talking to a therapist (63.3%). Conclusions MT may have multiple potential benefits when integrated into occupational therapy practice including supporting instrumental ADLs, facilitating social connection, and increasing adherence to UE HEPs. Future work should focus on maximizing adherence and providing performance feedback through the use of social media to promote peer support and consistent remote communication using text messaging, phone calls, or video calls to deliver information and reminders on exercises.
... In all these studies, participants were able to learn to use smartphones and tablets, and participants" overall A c c e p t e d M a n u s c r i p t 13 experiences were extremely positive. Tablet devices in particular were perceived as easy to use by people of all ages regardless of their previous use of or familiarity with them (Gustavsson et al., 2018). Where the study populations were older adults with cognitive impairment, participants were able to retain this knowledge of smartphone and tablet functions (Kwan et al., 2020;Rivest et al., 2018;Routhier et al., 2012), with some participants even demonstrating long-term retention of this learning at follow-up six and 12 months after the training intervention, despite the impact of their impairment on their memory, cognition, and fine motor skills (Bier et al., 2015;Bier et al., 2018;Gustavsson et al., 2018, Imbeault et al., 2018. ...
... Tablet devices in particular were perceived as easy to use by people of all ages regardless of their previous use of or familiarity with them (Gustavsson et al., 2018). Where the study populations were older adults with cognitive impairment, participants were able to retain this knowledge of smartphone and tablet functions (Kwan et al., 2020;Rivest et al., 2018;Routhier et al., 2012), with some participants even demonstrating long-term retention of this learning at follow-up six and 12 months after the training intervention, despite the impact of their impairment on their memory, cognition, and fine motor skills (Bier et al., 2015;Bier et al., 2018;Gustavsson et al., 2018, Imbeault et al., 2018. ...
... These activities included taking care of errands, paying bills, seeking information, staying connected with others, and staying home alone safely. Participants in employment used their smartphones and tablets to complete work tasks (Bos et al., 2017;Gustavsson et al., 2018). The ability to perform ADLs and iADLs promoted independence. ...
Article
Full-text available
Background and Objectives A systematic review was conducted to explore the use of smartphones and tablet computers as cognitive and memory aids by older adults with and without cognitive impairment, specifically the effects of smartphone and tablet use on participants’ cognition and memory, and the barriers to facilitators to smartphone and tablet use for cognitive and memory support. Research Design and Methods A systematic search of six key databases found 11,895 citations published between 2010 and 2021. Studies were included if they involved community-dwelling older adults with or without cognitive impairment arising from acquired brain injury, mild cognitive impairment, or dementia, and if they evaluated everyday smartphone or tablet device use for cognition, memory, or activities of daily living. Results A total of 28 papers were included in the narrative synthesis. There was some evidence that the use of smartphones and tablets could aid cognitive function in older adults without cognitive impairment, particularly executive function and processing speed. There was modest evidence that smartphone and tablet use could support memory in both older adults without cognitive impairment and those with acquired bran injury and dementia. Discussion and Implications Smartphones and tablets were seen by users as acceptable, enjoyable, and non-stigmatising alternatives to conventional assistive technology devices; however, current use of smartphone and tablet devices is hindered by the digital literacy of older adults, a lack of accommodation for older adult users’ motor and sensory impairments, and a lack of input from clinicians and researchers. Much of the evidence presented in this review derives from case studies and small-scale trials of smartphone and tablet training interventions. Further research is needed into older adults’ use of smartphones and tablets for cognitive support before and after the onset of cognitive impairment in order to develop effective evidence-based smart technology cognition and memory aids.
... ICT is already being used for patient-monitoring, to support the communication between health professionals and with the stroke survivor and significant others, to promote a seamless chain of rehabilitation and to increase self-management and rehabilitation interventions [7,[20][21][22][23]. Recent findings have furthermore shown that mobile phones can enable agency and participation in everyday life after stroke [6,24] and that also older citizens can learn to use ICT [18,25,26]. However, the integration of ICT in person-centred rehabilitation after stroke needs to be further investigated [6,18,22,27]. ...
... This study was performed as a collaboration between Denmark, Sweden, and Uganda, and is part of a larger project aiming to develop an ICT supported model for a person-centred rehabilitation after stroke to be used within a range of contexts, nationally and internationally. The two first studies concerning the development have been published [6,24]. ...
... The stroke survivors included in the study by Gustavsson et. al (2016), who had suffered a stroke 6-12 months previously, were asked to identify a significant other, e.g., spouse, parent, child, sibling or friend to participate in this study [24]. The term significant other refers in this study to someone who is close to the stroke survivor and offers support [11]. ...
Article
Aim: The aim of this study was to explore significant others’ perspectives on how information and communication technology can support the rehabilitation process after stroke and facilitate participation in everyday life. Method: Thirteen significant others were included in the study, and to capture their perspectives, two focus groups, and five individual interviews were carried out in Denmark and Sweden 6-12 months after the stroke incident. A grounded theory approach was used throughout the study and a constant comparative method was used in the analysis. Results: Five subcategories were identified from the analysis of the interviews: (1) Information and communication technology providing a sense of security, (2) Information and communication technology as a social mediator, (3) Information and communication technology as a compensator for deficits, (4) Information and communication technology as a way to reach information, and (5) Information and communication technology as a possibility to supplement the rehabilitation process. From these categories, one core category emerged: The potential of information and communication technology to facilitate participation in everyday life and thereby reduce the strains that significant others experience after stroke. Conclusion: Information and communication technology has the potential to facilitate participation in everyday life after stroke. It is important, therefore, to start using information and communication technology in the rehabilitation process after stroke, to bring meaning to everyday life and to support both the stroke survivors and their significant others. • IMPLICATIONS FOR REHABILITATION • Integration of information and communication technology in the rehabilitation process after stroke can accommodate several of the significant others´ needs. • Educating stroke survivors to use information and communication technology as part of the rehabilitation process offloads their significant others. • Integration of information and communication technology in the rehabilitation process after stroke can bring new meaning in everyday life and can facilitate both independence and participation in everyday life. https://www.tandfonline.com/doi/abs/10.1080/09638288.2018.1555614
... There is a small body of research exploring the experience of using smartphones and feature phones among people with stroke in the home environment. A study by Kamwesiga et al. [24] focused on the use of feature phones in Uganda, and a study by Gustavsson et al. [25] took place in Sweden and Denmark. Both studies offered insights into the motivation for and context of using ICT devices after stroke, highlighting that phones promote confidence; help to organize daily tasks; evoke a feeling of safety; and create a sense of belonging and social relationships [24,25]. ...
... A study by Kamwesiga et al. [24] focused on the use of feature phones in Uganda, and a study by Gustavsson et al. [25] took place in Sweden and Denmark. Both studies offered insights into the motivation for and context of using ICT devices after stroke, highlighting that phones promote confidence; help to organize daily tasks; evoke a feeling of safety; and create a sense of belonging and social relationships [24,25]. Whilst other research has described challenges in recognizing, using, and adjusting everyday technology (ET) including ICT devices following acquired brain injury [26,27], there is currently a paucity of robust research evidence exploring the use of ICT that include feature phones, smartphones, tablets, and computers in everyday activities following stroke. ...
... Deductive thematic data analysis leverages existing knowledge to develop an initial coding structure. We carried out the following steps: familiarization with the data by listening to the audio-recording, watching the video recording and reading the transcripts and researcher notes; initial coding was based on the themes by Kamwesiga et al. [24] and Gustavsson et al. [25], see Table 1 and Figure 1. Further themes were iteratively generated, themes were then mapped, reviewed, defined and named. ...
Article
Full-text available
Purpose: Information and communication technology devices have become a ubiquitous part of everyday life and a primary means of communication. The aim of this study was to describe the experience of information and communication technology and to explore the barriers and motivators to its use following stroke. Materials and methods: This observational study used semi-structured individual interviews and video observation of information and communication technology device use with six people, four men, and two women age 60–82 years with upper limb disability following stroke. They were analyzed using thematic analysis. Results: Three themes were identified that relate to barriers: (i) Sensory and motor impairments; (ii) Limited vision and impaired speech; and (iii) Device-specific limitations. Six themes were identified as motivators: (i) Connect with others; (ii) Provide safety; (iii) Facilitate reintegration; (iv) Reinforce technology adoption; (v) Leisure activities; and (vi) Contribute to the rehabilitation process. Conclusion: All participants used some form of information and communication technology daily to promote safety, enable daily activities, and social interaction, and to a lesser extent engage in leisure and rehabilitation activities. Barriers to information and communication technology use were primarily related to stroke related impairments and device-specific requirements, which limited use, particularly of smartphones. These barriers should be addressed to facilitate the use of information and communication technology devices. • Implications for rehabilitation • This research suggests that; • People with stroke are highly motivated to use information and communication technology devices in daily activities • Stroke-specific and age-related impairments limit the use and functionality of information and communication technology devices for people with stroke • Information and communication technology devices do not appear to be promoted or used in the rehabilitation or as assistive technologies
... ICT could be utilised in rehabilitation after stroke to monitor rehabilitation progress and interact at a distance [3,4]. The use of a mobile phone or computer has been shown to promote participation in everyday life and create a sense of security [11,12]. Furthermore, the use of ICTbased interventions could reduce the number of home visits, thereby saving time and travel costs, particularly in rural areas [12,13]. ...
... A concern among people with stroke is their potentially limited ability to manage different ICT devices. Earlier research has found that people could encounter a range of difficulties [11,17,18] but that people with acquired brain injury such as stroke could benefit from using ICT in their daily lives [11,19]. Moreover, ICT could be successfully introduced and used within rehabilitation after acquired brain injury, regardless of age or previous use [20]. ...
... A concern among people with stroke is their potentially limited ability to manage different ICT devices. Earlier research has found that people could encounter a range of difficulties [11,17,18] but that people with acquired brain injury such as stroke could benefit from using ICT in their daily lives [11,19]. Moreover, ICT could be successfully introduced and used within rehabilitation after acquired brain injury, regardless of age or previous use [20]. ...
Article
Full-text available
Background Globally, there is a growing use of Information and Communication Technology (ICT), including mobile phones, tablets and computers, which are being integrated into people’s daily activities. An ICT-based intervention called F@ce was developed in order to provide a structure for the process in stroke rehabilitation and facilitate change by integrating a global problem-solving strategy using SMS alerts. The aim of the study was to evaluate the feasibility of i) F@ce within in-patient and primary care rehabilitation after stroke, ii) the study design and outcome measures used, and iii) the fidelity, adherence and acceptability of the intervention. Methods Three teams comprising occupational therapists and physiotherapists who work in neurological rehabilitation participated in a preparatory workshop on F@ce and then enrolled 10 persons with stroke to participate in the intervention. Goals were set using the Canadian Occupational Performance Measure (COPM) and the participants with stroke rated their performance and satisfaction with the activities associated with the three goals every day for 8 weeks. Data were collected at inclusion, at four and 8 weeks, using the COPM, Stroke Impact Scale, Frenchay Activities Index, Life Satisfaction Checklist, Self-Efficacy Scale, Hospital Anxiety and Depression Scale, Fatigue Severity Scale, follow-up survey, daily ratings on the web platform and logbooks. Results All of the participants showed increased scores in the primary outcome (COPM) and a clinically meaningful improvement of ≥2 points was found in four participants regarding performance and in six participants regarding satisfaction. Overall fidelity to the components of F@ce was good. The response rates to the F@ce web platform were 44–100% (mean 78%). All of the participants stated that F@ce had supported their rehabilitation. Conclusion The results indicate that the most beneficial part of F@ce was the person-centred, goal-setting process and SMS alerts. All participants were satisfied with F@ce and highlighted the benefits of receiving daily alerts about their goals. This encouraged them to be more active. The only downside mentioned was that they felt under an obligation to practice, although this was described as “a positive obligation”.
... ICT could be utilised in rehabilitation after stroke to monitor rehabilitation progress and interact at a distance [3,4]. The use of a mobile phone or computer has been shown to promote participation in everyday life and create a sense of security [11,12]. Furthermore, the use of ICTbased interventions could reduce the number of home visits, thereby saving time and travel costs, particularly in rural areas [12,13]. ...
... A concern among people with stroke is their potentially limited ability to manage different ICT devices. Earlier research has found that people could encounter a range of difficulties [11,17,18] but that people with acquired brain injury such as stroke could benefit from using ICT in their daily lives [11,19]. Moreover, ICT could be successfully introduced and used within rehabilitation after acquired brain injury, regardless of age or previous use [20]. ...
... A concern among people with stroke is their potentially limited ability to manage different ICT devices. Earlier research has found that people could encounter a range of difficulties [11,17,18] but that people with acquired brain injury such as stroke could benefit from using ICT in their daily lives [11,19]. Moreover, ICT could be successfully introduced and used within rehabilitation after acquired brain injury, regardless of age or previous use [20]. ...
Article
Full-text available
AbstractBackground:Globally, there is a growing use of Information and Communication Technology (ICT), includingmobile phones, tablets and computers, which are being integrated into people’s daily activities. An ICT-basedintervention called F@ce was developed in order to provide a structure for the process in stroke rehabilitation andfacilitate change by integrating a global problem-solving strategy using SMS alerts. The aim of the study was toevaluate the feasibility of i) F@ce within in-patient and primary care rehabilitation after stroke, ii) the study designand outcome measures used, and iii) the fidelity, adherence and acceptability of the intervention.Methods:Three teams comprising occupational therapists and physiotherapists who work in neurologicalrehabilitation participated in a preparatory workshop on F@ce and then enrolled 10 persons with stroke toparticipate in the intervention. Goals were set using the Canadian Occupational Performance Measure (COPM) andthe participants with stroke rated their performance and satisfaction with the activities associated with the threegoals every day for 8 weeks. Data were collected at inclusion, at four and 8 weeks, using the COPM, Stroke ImpactScale, Frenchay Activities Index, Life Satisfaction Checklist, Self-Efficacy Scale, Hospital Anxiety and Depression Scale,Fatigue Severity Scale, follow-up survey, daily ratings on the web platform and logbooks.Results:All of the participants showed increased scores in the primary outcome (COPM) and a clinically meaningfulimprovement of≥2 points was found in four participants regarding performance and in six participants regardingsatisfaction. Overall fidelity to the components of F@ce was good. The response rates to the F@ce web platformwere 44–100% (mean 78%). All of the participants stated that F@ce had supported their rehabilitation. Conclusion:The results indicate that the most beneficial part of F@ce was the person-centred, goal-setting processand SMS alerts. All participants were satisfied with F@ce and highlighted the benefits of receiving daily alerts abouttheir goals. This encouraged them to be more active. The only downside mentioned was that they felt under anobligation to practice, although this was described as“a positive obligation”. Keywords:ADL, Disability, eHealth, Mobile phone, Occupational therapy, Participation in everyday life,Physiotherapy, Tablet, Tele rehabilitation, Telehealth
... With respect to global smartphone usage in 2015, more than 1.08 billion smartphones were in use from 5 billion mobile phones. The data showed that a greater penetration of smartphones existed in Americans aged [25][26][27][28][29][30][31][32][33][34], and women took the lead with 56% of women owning smartphones [14][15][16][17]. Two-thirds of the world's population comprised 4.8 billion mobile subscriptions, which amounted to a total revenue of $1.05 trillion by the end of 2016. ...
... To the best of our knowledge, thus far no research study has specifically examined the impact of ICT on IADLS. The limited research that exists: (1) analyzes the impact of ICT on particular aspects of functional limitations for specific populations with disabilities; (2) investigates the impact of ICT broadly on society and its future [14][15][16][17][25][26][27][28]; and (3) focuses on the impact of specific ICT-enabled devices or their use on particular environments or on unique functional aspects like productivity, innovation, and organizational performance in the context of ICT [2,29]. Moreover, in a study [2] to assess the impact of ICT on the working and personal lives of employees, recommended categorizing the impact of ICT as: (1) positive and negative experiences of ICT on both work and personal lives; (2) increased expectations; and (3) impact on relationships. ...
Article
Purpose: Information Communication Technology, such as smartphones, apps, the internet, etc., has become all-pervasive in our society. To learn the impact of Information Communication Technology (ICT) on everyday functioning, specifically Instrumental Activities of Daily Living (IADL), an exploratory review was undertaken. Methods: We identified how many primary IADL domains were substantially influenced by ICT, by examining primary IADL domains, in terms of traditional and ICT-enabled ways of completing these common tasks. The study further explored the implications of the pervasiveness of ICT and the ICT-enabled new normal in everyday functioning that underpins the need to redefine IADLs. Results: This examination revealed that the impact of ICT on IADLs has been so profound, that it marks a paradigm shift in the way we assess IADL completion. Creation of the concept of “Electronic Instrumental Activities of Daily Living (eIADLs)” would be a first step in marking this paradigm shift, and would foster further advances for understanding the mechanisms underlying the ICT-based life style related outcome measurement in rehabilitation science. • IMPLICATIONS FOR REHABILITATION • The presence of Information Communication Technology (ICT) has substantially influenced the way we complete our Instrumental Activities of Daily Living (IADL). Indeed, the impact is so profound, that it marks a paradigm shift in the way we should assess and measure everyday functioning. • Creation of the concept of eIADLs would be a first step in marking this paradigm shift, and would foster further advances for understanding the mechanisms underlying the ICT-based life style related outcome measurement in the rehabilitation sciences.
... However, patients unable to use technologies due to motor or cognitive deficits are often excluded from studies (67) as shown in our scoping review. Given that 25% of stroke survivors are at risk of a new stroke or in life-long need of support (81), technologies supporting activity and participation should be taken into account (6,7,82). Stroke survivors who are cognitively challenged may require more training (69) and/or assistance from a significant other (54) to use the app independently. ...
... Only three studies included in this scoping review aimed to support several components of the rehabilitation process (not only information regarding how to manage stroke-related deficits (video/text/pictures), but also discharge support, in addition to providing exercise programmes (videos and text) (76) and goal-setting (49). Stroke survivors, their significant others, and health professionals, have expressed a need for more timely information, a more coordinated cross-sectional transition from inpatient to outpatient rehabilitation, a better overview of the entire rehabilitation process, and improved follow-up and contact with health professionals after discharge (6,7,42,82). An app solution aimed at supporting people with chronic diseases and accommodating patients' needs for a more comprehensive solution and a greater overview of the rehabilitation process has been tested in patients newly diagnosed with osteoporosis in Denmark (83). ...
Article
Aim: The aim of this study was to describe, and review evidence of mobile and web-based applications being used to support the rehabilitation process after stroke. The secondary aim was to describe participants' stroke severity, and use of applications in relation to, respectively, the setting and phase of the rehabilitation process. Method: A scoping review methodology was used to identify studies, through databases as PubMed, Cinahl, Embase and AMED. Additionally, grey literature was searched. The studies were categorized using the model of rehabilitation by Derick Wade. Results: The literature search resulted in 10,142 records. Thirty-six studies were included in which applications were used to support: assessment (n=13); training (n=20); discharge from hospital (n=2); and both training and discharge from hospital (n=1). Of the 36 studies, 25 studies included participants with mild to moderate stroke, and four studies included participants with severe stroke. In seven studies the stroke severity was not reported. Eighteen studies included participants with chronic stroke, 12 acute-subacute stroke, and three included participants with acute and/or subacute and/or chronic stroke. In three studies, stroke onset was not reported. Applications were used in a rehabilitation setting (n=16), home setting (n=13), both settings (n=3). In four studies the setting were not reported. Conclusion: Most included studies of applications developed to support the rehabilitation process after stroke have been explorative. They included primarily participants with mild or moderate stroke and focused on a limited aspect of the rehabilitation process, e.g., assessment or training. Future applications to support stroke rehabilitation should accommodate stroke survivors' and caregivers' need for solutions, irrespective of stroke severity and throughout the entire rehabilitation process.
... Of the total respondents, 57% (n = 90) reported that they were familiar with ICT, but only 31% (n = 49) used it therapeutically. Integrating ICT into the rehabilitation process can support clients' social participation [28,29] and contribute to improving their quality of life [30,31]. Healthcare professionals play a key role in providing appropriate ICT solutions to clients and caregivers [24,32]. ...
... However, the results of this survey revealed a gap between the performance role required for ICT use and the knowledge and usage practices of ICT by domestic OTs. Despite the changes in healthcare paradigms due to the development of ICT and the therapeutic use and positive effects of ICT reported in various studies [24,29,31], various aspects of ICT utilization in the current domestic practice of OTs are not clearly integrated. Although the potential of ICT as a therapeutic tool and the underlying evidence for its clinical application need to be actively addressed by clinicians, the current opportunities for continuing ICT education or ICT knowledge acquisition are insufficient. ...
Article
Full-text available
The convergence and development of information and communication technology (ICT) have brought changes to occupational therapy practices, posing novel challenges for occupational therapists (OTs). This study aimed to investigate current practices of ICT use and factors affecting the clinical use of ICT among Korean OTs. An online survey was conducted among 158 domestic OTs working in hospitals. Participants reported that the therapeutic use of ICT positively affected client outcomes, ICT choice, and continued use. Participants highlighted the necessity to assess the ability of clients to use smart devices and ensure familiarity in the OT process. Of respondents, 31% reported the application of ICT-based interventions or recommendations in clinical practice. The use of ICT was predominantly associated with cognitive function, leisure activities, and information access and communication. A significant difference in barriers to ICT use was observed between familiar users and non-users. Familiar users reported a lack of knowledge and training as major barriers, whereas non-users reported expensive products or technology. Ease of use and usefulness were facilitators of ICT use among familiar users. Information and training opportunities are required to promote ICT use by OTs, and the usefulness of ICT must be realized via client-centered, customized approaches.
... According to the MRC's guidelines, the creation of evidence together with identifying the evidence base are key elements of the development before new, complex interventions can be modeled, tested and eventually implemented [19]. As part of the development of theory, a previous study was performed which showed that people 6-12 months after a stroke had the drive and need to use ICT in their everyday lives, despite having physical and cognitive impairments resulting from the stroke [20]. Another previous study within the research group showed that occupational therapists and people after a stroke emphasized the importance of "sharing and transparency" during the rehabilitation process in order to facilitate a person-centred approach [21,22]. ...
... Additionally, digitalization of healthcare is needed in order for the society to manage the challenges of the future with an aging population, lack of healthcare staff and increased demands for accessibility [10]. Our previous study that explored the use of ICT among people after a stroke showed that ICT was used in everyday life, for example to feel safe, staying connected with friends and family and managing daily life [20]. Using a web platform for documentation that is accessible to everyone could enable professionals to make goals and plans more transparent for all stakeholders. ...
Article
Full-text available
Background: Using Information and Communication Technology (ICT) could increase the intensity of rehabilitation, the level of patient activity and participation in everyday life after stroke and is in line with having a person-centred approach. Aim: To explore how healthcare professionals use and could potentially use ICT to enable a person-centred rehabilitation process after stroke. Methods: Six individual and two focus group interviews were conducted with a group of healthcare professionals working within rehabilitation after stroke. A grounded theory approach was used to collect and analyze the data. Results: The professionals described their current use of ICT as well as their vision of how ICT could be incorporated as a tool in rehabilitation for sharing in four categories: (1) Sharing of information, (2) Collaborating from a distance, (3) Having transparency in the documentation and (4) Supporting patients’ use of ICT. Conclusion: Professionals state that using ICT solutions in rehabilitation after stroke could increase sharing between professionals and their patients and increase patient participation in the rehabilitation process. Significance: This study highlights the importance of developing ICT that healthcare professionals could use along with a person-centred approach. The results will be used to develop an ICT-supported multidisciplinary intervention for rehabilitation after stroke.
... This casts light on the right to occupation that is ensured by access to and use of the internet, regardless of differences or individual impairments. For example, in cognitive rehabilitation after stroke the internet and the use of internet-enabled devices was found to be not only useful but required in order to manage and recreate everyday lives (Gustavsson, Ytterberg, Nabsen Marwaa, Tham, & Guidetti, 2018). The focus on occupational rights, extends to that of social justice, to move beyond the individual approach and assess and adapt people's contexts to allow for doing occupations rather than enhancing the abilities of the individual client (Hammell, 2015a;Nilsson & Townsend, 2014). ...
... The project planners draw on experiences within the research group dealing with information and communication technology (ICT) solutions in interdisciplinary rehabilitation interventions. [16][17][18] The smart products (digitally based) will be used to facilitate and manage the reablement programme in this study. Smart products in reablement programme have been suggested but have not as yet, been integrated into services 19 making this study unique. ...
Article
Full-text available
Introduction Older persons with functional limitations often need assistance from home care staff to thrive and continue to live in their home environments. Reablement, a proactive, preventative approach administered by home care staff, stimulating active engagement of the older person, is often recommended. Even though reablement has a potential to become a new rehabilitation model and has been implemented in different countries in various degrees, there is a lack of knowledge regarding the process of establishing reablement, the theoretical underpinnings and the conditionality and outcomes in different contexts. This knowledge is needed before full-scale recommendations can be made for implementation in specific contexts. Aim This study protocol aims to present a feasibility study of the intervention, ASSIST 1.0, a theory-based reablement programme, which includes coaching of home care staff and digitally based smart products, in a Swedish context. Methods and analysis This feasibility study will evaluate the perceived value and acceptability of ASSIST 1.0 intervention programme regarding fidelity, reach and dose, and potential outcomes by using a pretest and post-test design involving an intervention group and a control group (n=30) of older persons living at home, needing home care services. Qualitative interviews with home care staff delivering ASSIST and the older adults receiving the intervention as well as their significant others will be conducted to explore aspects affecting the intervention. Ethics and dissemination This study has been approved by the regional ethics board. The results of the feasibility study will form the base for refinement of the ASSIST programme and for the subsequent planning of a full-scale randomised controlled trial investigating the effect of the programme on a larger scale. Dissemination will include peer-reviewed publications and presentations at national and international conferences as well as information to involved stakeholders. Trial registration number NCT03505619
... The potential of using Information and Communication Technology (ICT), including mobile phone solutions among stroke survivors, is supported by previous studies [12][13][14][15], but more research is needed. Some studies conducted in high-income settings suggest that ICT can be used as a tool for communication between healthcare professionals and clients in home care, in order to promote and improve the performance of activities in daily living (ADL), or it can be used as complementary service [13,14,16,17]. ...
Article
Full-text available
Background: The prevalence of stroke in Uganda is increasing. In stroke rehabilitation, information and communication technology has been shown to have potential in improving service delivery in high-income countries but there is limited knowledge of its use and impact in low-income countries. The aim of the study was to evaluate the implementation process of a mobile phone-supported family-centred rehabilitation intervention and to gain knowledge on the mechanisms of impact as well as the contextual factors that might have affected the implementation process and its outcome. Method: This was a single-case study design using the integrated Promoting Action on Research Implementation in Health Services framework and the Medical Research Council guidance as frameworks. Quantitative process data was derived from 14 log books used by occupational therapists during the implementation. Qualitative semi-structured interviews were conducted with 12 implementers in different professions, 12 months into the implementation, in order to obtain the primary data. Secondary data was derived from six semi-structured interviews conducted directly after pre-intervention workshops and 6 months later. The framework method was used in the data analysis. Results: In 11 out of 14 cases, the clients were compliant with the intervention. Yet, challenges such as technical problems were reported. The target of conducting 16 phone calls for each client was achieved to 74%. Eight categories emerged from the qualitative analysis of the interviews including: 1) perceptions on facilitation, 2) using scientific and experience-based knowledge, 3) tailoring the intervention, 4) supportive working culture, 5) barriers to the service delivery, 6) implementers' interaction with the intervention, 7) perceptions on motivations and values, and 8) improving the model and enabling sustainability. Mechanisms contributing to the implementation of the intervention included engaged facilitators and motivated participants. Challenges in the client recruitment and poor information dissemination were some of the mechanisms impeding the implementation. Conclusions: The intervention was partially delivered in accordance with the logic model for the project, where the implementation process was influenced by several barriers in the context such as technical setbacks. However, there were also several mediators in the process driving the project forward, including strong facilitation and motivated participants.
... For instance, White et al. [16] described how, among persons with stroke, the use of a tablet was experienced as contributing to motivation, socialization, and was non-burdensome. This is also in line with earlier research showing that people after a stroke were using smartphones and tablets in their everyday life [17,18]. Moreover, smartphones and tablets have been widely integrated in the performance of everyday activities [19,20]. ...
Article
Full-text available
Background and purpose: The increase in use of everyday information and communication technologies can lead to the need for health professionals to incorporate technology use competencies in practice. Information and communication technologies has the potential to improve participation in daily life among people with disability. The aim was to review and describe evidence of the use of information and communication technology, including mobile technology, for improving participation in everyday life. A secondary aim was to describe how study outcomes were related to participation. Materials and methods: A scoping review methodology was used to identify studies through databases as MEDLINE, CINAHL, Cochrane Library. Thereafter, the studies were screened and assessed for inclusion. Results: Eleven studies were included. The most commonly used technology were videoconferencing and the telephone. Ten of the 11 studies reported a change in participation in everyday life. Participation was mainly described as involvement in a life situation or related to activities of daily living. Conclusion: Delivering an intervention to improve participation through information and communication technology can be a valid option in rehabilitation. There is a need to measure and describe the intervention and its outcomes in relation to a definition of participation in future studies. • IMPLICATIONS FOR REHABILITATION • The use of an information and communication technology application seems to be as good as the face-to-face intervention. • There is a need for defining the concept of participation related to outcome measures in future studies.
... From another perspective, a descriptive study carried out in Sweden justifies the importance of the use of technologies in four dimensions: security, connection, management of daily life and problem-solving. In the analysis of interviews regarding Stroke survivors, authors concluded that the use of technologies creates a new meaning after Stroke, although in some cases the role of family members or caregivers is essential for its introduction and re-adaptation in the households [17]. ...
Article
Full-text available
Purpose Stroke is one of the leading causes of disability in the adult population. It is feasible to think about the use of telerehabilitation devices, such as the smartphone, to respond to the growing demand, even in isolation cases, such as during confinement due to coronavirus disease in 2020. It is intended to explore the available Apps for Spanish-speaking patients with Stroke for a specific sensory-motor rehabilitation process. Materials and methods A search of the available apps in Google Play and Apple Store was carried out using the keywords “Stroke”, “hemiplegia” and “hemiparesis”. The Apps detected have been described and evaluated by an anonymous survey among stroke survivors. Results Nine Apps have been identified and explored, four of which are available in Spanish: “NeuroRHB”, “Stroke Hope Health4TheWorld”, “9zest stroke recovery” and “Farmalarm”. Twelve survivors with stroke have participated in the anonymous survey evaluating with the best score the App “Farmalarm”. Conclusions There are few specific Apps for the Stroke rehabilitation of sensory-motor impairments, and with important limitations that prevent their incorporation into clinical practice. The creation and adaptation of Apps for health professionals such as physiotherapists and occupational therapists and their users are recommended. • Implications for rehabilitation • It is necessary to create and adapt specific telerehabilitation tools to address sensory-motor disorders. • Telerehabilitation should be introduced in the clinical practice of physiotherapy and occupational therapy. • Telerehabilitation via App can be a solution, easily accessible by patients, to reduce healthcare inequality, intensify the rehabilitation process and provide continuity after discharge from the hospital.
... tablet, dan komputer, telah terintegrasi ke dalam aktivitas sehari-hari. Terdapat berbagai aplikasi di smartphone dan tablet yang dapat digunakan untuk melakukan aktivitas sehari-hari, seperti membaca koran, bermain game, dan berkomunikasi dengan keluarga dan teman, dan tuntutan dari masyarakat untuk menggunakan TIK juga meningkat pesat dan dalam (Gustavsson et. al, 2016 ...
Article
Full-text available
Industrial Revolution 4.0 has changed human life. Humans become dependent on device connectivity, product digitisation and service and information access openness. This study discusses my Police application. National Police's first national online application. This application is the result of 26 online applications that were previously built separately by work units and territorial units within the National Police. My police are integrated to improve services for the people of Indonesia. This research is used to adapt and apply Information and Communication Technology to the Community in realizing digital-based community services. The method used is research, to get insights from the application, the way adaptation is done by POLRI personnel with the presence of the technology and how it is applied in implementing digital services to the community. The results obtained show that the Police of Baintelkam officers have not been able to adapt to the connectivity of SKCK services, data relating to blood and legality of the legality of community leaders. In addition, for Personnel Readiness, traffic, moderation facilities have not been evenly distributed, access to Online SIM access has not been established nationally. Meanwhile, only the Information Technology Division and Baharkam and Criminal Investigation Offices are ready with Police Post data and Emergency Call services, because of the back-office system from the center to the police station to assist with the operation and digitization of police services in my police.
Conference Paper
Full-text available
There are over 80 million stroke survivors globally, making it the main cause of long-term disability worldwide. Not only do the challenges associated with stroke affect the quality of life (QoL) of survivors, but also of their families. To explore these challenges and define design opportunities for technologies to improve the QoL of both stakeholders, we conducted semi-structured interviews with 10 survivors and one of their family members. We uncovered three major inter-linked themes: strategies to cope with technological barriers, the (in)adequacy of assistive technologies, and limitations of the rehabilitation process. Findings highlight multiple design opportunities, including the need for meaningful patient-centered tools and methods to improve rehabilitation effectiveness , emotion-aware computing for family emotional support, and rethinking the nature of assistive technologies to consider the perception of transitory stroke-related disabilities. We thus argue for a new class of dual-purpose technologies that fit survivors' abilities while promoting the regain of function.
Article
This article views that technology plays an integral role in the social impacts of religious information, instead of being a threat to the religion itself. That is, technology is present in religious life, and is increasingly giving social impacts. Technology offers a new nuance in today's modern life in almost every aspect of human life. Sometimes, technology serves as a primary tool that assists us in our daily lives, and in some other time, it only serves as a supporting tool. As an important part of people's lives, al-Qur'an exegesis in its development is in separable from technology. This article provides evidences on religion's presence in the society, illustrated through the important roles of technology in al-Quran exegesis. Technology supports the presence of religion in millennial periods and not vice versa. This role of technology still serves only as a supporting system or secondary role. This can be seen in the Tafsir Ilmi Kementrian Agama (Tafsir Ilmi compiled by the Indonesian Ministry of Religious Affairs). Furthermore, this argument is a valid proof of the novelty of technology's roles in the development of religious materials in millennial era.
Article
Purpose: This study compared Internet use post-stroke in people with aphasia (n = 25) and without aphasia (n = 17). The purpose was to understand how people with aphasia were using the Internet and to investigate the impact of aphasia on their use. Materials and methods: A face-to-face supported questionnaire explored the use of technologies, types of Internet use, traditional and Internet communication, the perception of abilities, and possible barriers to acquiring or improving Internet skills. Descriptive and inferential statistics were used to analyze the data. Results: Internet use ranged from fully independent to by proxy across both groups. Most participants perceived their aphasia as a barrier, but for the majority, it was not the sole reason for failing to acquire or improve skills. Aphasia was related to difficulties with technology-based written communication. Educational attainment was related to participant’s feelings about their own skills. Whilst aphasia was important, analysis revealed that age was a stronger predictor of Internet use per se. Conclusions: It is clear that aphasia often negatively affects Internet use and proficiency. However, this research clearly demonstrates that it is important to consider the influence of factors such as age, proxy use, education, and previous technology use and experience. • Implications for rehabilitation • Post-stroke aphasia contributes negatively to Internet use, particularly in the use of online communication tools such as email and messaging services. • Sub-groups of people with aphasia are likely to be more vulnerable to exclusion from the benefits of the Internet; specifically, older people and those with lower levels of educational attainment. • It is common for both older adults with and without aphasia to use the Internet via a proxy. Independent use may not always be the desired goal within rehabilitation. • People with aphasia may perceive their age and disability as barriers to using the Internet and may lack confidence in their own ability or potential.
Article
Purpose: Recovering from stroke in remote Australia has rarely been considered, even though rehabilitation services are generally scarce. The primary purpose of this study was to explore stroke recovery, from the perspective of stroke survivors in remote northwest Queensland (NWQ), to explicate the lens through which they view recovering. The secondary purpose was to explore the role of technology to support stroke survivors in remote locations along their recovery journey. Methods: A qualitative study was undertaken using elements of constructivist grounded theory for data collection and analysis. Semi-structured interviews were conducted with fifteen stroke survivors and two partners living, working or travelling in remote NWQ. Results: From the participants' perspective, recovering in a remote area after stroke is about living my life, as it evolves by endeavouring to recover my way and navigating my recovery in my world. Technology was only considered helpful when it supported participants to recover their way in their world. Conclusion: Recovering from stroke from the perspective of stroke survivors in remote NWQ is about living their life, as they want it to be, and as it unfolds within their own context. Technology only has a place when it can support them to recover their way in their world. These findings reinforce the importance of health professionals listening, learning about, and enabling stroke survivors along their recovery journey, within their remote context and support network.Implications for RehabilitationRecovering from the perspective of stroke survivors is about living their life as it evolves.To support stroke survivors from remote areas, health professionals need to listen to and learn from each stroke survivor about what matters to them, what works for them, and about their world; including the challenges (e.g., switching between services) and enablers (e.g., community support) as the stroke survivor perceives them.Finding ways to utilise the strengths within and around them, may improve the recovery process for the stroke survivor in a remote area, ensuring they can access care that meets their needs in their world.Working together with stroke survivors, health professionals need to consider how technology could help them to live their life, while recovering their way and in their world.
Article
Full-text available
Background Existing everyday technology as well as potential future technology may offer both challenges and possibilities in the everyday occupations of persons with cognitive decline. To meet their wishes and needs, the perspective of the persons themselves is an important starting point in intervention planning involving technology. The aim of this study was to explore how persons with mild cognitive impairment relate to technology as a part of and as potential support in everyday life – both present and future. Methods Qualitative in-depth interviews with six participants aged 61–86 were conducted and analyzed, using a grounded theory approach. Results The findings describe the participants’ different ways of relating to existing and potential future technology in everyday occupations as a continuum of downsizing, retaining, and updating. Multiple conditions in different combinations affected both their actions taken and assumptions made towards technology in this continuum. Both when downsizing doing and technology use to achieve simplicity in everyday life and when striving for or struggling with updating, trade-offs between desired and adverse outcomes were made, challenging take-off runs were endured, and negotiations of the price worth paying took place. Conclusions Our findings suggest that persons with mild cognitive impairment may relate to technology in various ways to meet needs of downsized doing, but are reluctant to adopt video-based monitoring technology intended to support valued occupations. Feasibility testing of using already-incorporated everyday technologies such as smartphones and tablets as platforms for future technology support in everyday occupations is suggested.
Article
Full-text available
Aim The aim of this study was to describe the experiences and meaning of using mobile phones in everyday life after stroke, among persons with stroke and their family members. Methods Qualitative semi-structured interviews were conducted among 11 persons with stroke and 9 family members 2 months to 2 years after the stroke. The interviews were analysed by using constant comparative grounded theory (GT) approach. Results Seven categories were identified from the analysis of the participants’ experiences. The mobile phone: (1) as an enabler of communication and connections with other people, (2) a source of inspiration for agency, (3) structuring routine and activities in daily life, (4) as a facilitator of social and economic wellbeing of an individual or family, (5) promoter of belonging and participation in social relationships, (6) facilitator of reintegration to community living and (7) enabler of family members to feel secure. From these categories, a core category emerged: The mobile phone as a “life line” and an extension of the body enabling connection, belonging and agency to act in a complex everyday life situation. Conclusion The study gives support for the possibility of using mobile phones to facilitate change and community integration in the rehabilitation process after stroke. • Implications for Rehabilitation • Stroke leads to decreased functioning in everyday life due to impairments, activity limitations and participation restrictions as well caregiver burden. • Mobile phones seem to be an accessible and affordable technology used in daily life of persons with stroke and family members and connects them to the needed services and social relationships. • The mobile phone technology reduces resource and infrastructural challenges and increases accessibility to rehabilitation interventions. • The mobile phone was an important instrument that facilitated the quality of life of persons with stroke and their family members and could increase their participation in rehabilitation interventions.
Article
Full-text available
We investigated the feasibility of providing telerehabilitation in the home as an alternative to conventional ambulatory rehabilitation. Two groups of patients were accepted for telerehabilitation. The first group were community patients who needed rehabilitation, e.g. following a stroke, a fracture or prolonged hospital admission. The second group was from two rural nursing homes where residents were identified with a recent injury, fall or hospitalisation. Telerehabilitation employed a coaching model, with fewer therapist home visits, more feedback and "homework" for the patient. Patients had a tablet computer loaded with a videoconferencing app to connect with therapists and relevant therapeutic apps. Multidisciplinary care was provided for up to 8 weeks. The majority (86%) of eligible patients consented to receive telerehabilitation in their own home (n = 61) or in the country nursing home where they lived (n = 17). Most services were delivered using the 3G and 4G wireless networks with few technical problems. On average participants felt that they had achieved 75% of the goals set at the beginning of the programme. High levels of satisfaction were recorded. There was a 50% reduction in home visits by staff, or 10 visits per patient. Speech therapists were able to double occasions of service and direct patient contact time, whilst halving their travel time. Previous experience with technology and age were not barriers to this method of delivery but did affect recruitment. Telerehabilitation using off-the-shelf technology is feasible for post-acute treatment.
Article
Full-text available
Objective: To examine data collected using the Stroke Impact Scale 3.0 (SIS) at 3 and 12 months post-stroke, and to explore any clinically meaningful changes in everyday life in relation to age, gender and stroke severity. Design: Prospective longitudinal study. Methods: A total of 204 persons were assessed using the SIS at 3 and 12 months after onset of stroke. Changes in domain scores were calculated over time and in relation to age, gender and stroke severity. Results: The Strength, Hand Function and Participation domains had the highest perceived impact at 3 and 12 months, indicating problems in everyday life. Stroke recovery was perceived to be significantly higher at 12 than at 3 months irrespective of stroke severity, age or gender. The impact on the Strength and Emotion domains was significantly lower at 12 months than at 3 months. Most clinically meaningful changes, both positive and negative (± 15 points), were seen in the Participation domain and in Stroke recovery. Few changes were associated with age, gender or stroke severity. Conclusion: Both positive and negative clinically meaningful changes related to impact of stroke were found between 3 and 12 months post-stroke. Therefore it is important to pay close attention to patients' perceptions of their everyday life situation during rehabilitation and at discharge.
Article
Full-text available
Purpose: The aim was to better understand how information and communication technology (ICT) can provide support to elderly family caregivers caring for significant others suffering from dementia or stroke. Method: Ten households equipped with an ICT system, with a family caregiver and a spouse diagnosed with dementia or stroke, were followed and observed in a two-year case study. The family caregivers had regular meetings in groups organised by the municipal care of the elderly. Data from observations, semi-structured interviews, user data from the ICT system and data about the support provided by the municipality has been used to validate the findings. Results: The family caregivers socialised with users in the group as long as the users were stayed in the group. Meetings in the group were an important opportunity for exchanging experiences and to easing one"s mind. The ICT system did not reduce the municipality"s level of services to the participating families. The information built into the system has to be constantly updated to be of interest. Conclusions: An ICT support must be provided in a context of personal meetings and with a formal caregiver backing. This will empower informal or family caregivers. Such support must give the user the possibility to communicate and get access to the Internet. Implications for rehabilitation: Benefits were obtained when informal caregivers met with a group of people with whom they share the same kind of experiences and were supported by a formal caregiver. Informal caregivers need more attention and recognition. ICT systems can help but must be current and maintain the users interest.
Article
Full-text available
This paper demonstrates how the software package QSR‐NVivo can be used to faciitate a grounded theory approach. Recent research evidence has questioned the methodological quality of many studies that claim to utilise grounded theory. This paper argues that qualitative data analysis software can be used to encourage good quality grounded theory research by facilitating many of the key processes and characteristics associated with this approach. To achieve this, the paper identifies a number of grounded theory characteristics, common to all revisions of the methodology. It then describes the development of a recent study, which examined how people successfully maintain long‐term physical activity behaviour change. The purpose of this is to demonstrate how different functions of QSR‐NVivo may be used in conjunction with the key grounded theory characteristics. In summary, QSR‐NVivo is a powerful tool that, if used appropriately, can facilitate many aspects of the grounded theory process from the design and early sampling procedures, through to the analysis of data, theoretical development and presentation of findings.
Article
Full-text available
Telerehabilitation can offer prolonged rehabilitation for patients with stroke after being discharged from the hospital, whilst remote diagnostics may reduce the frequency of the outpatient services required. Here, we compared a novel telerehabilitation system for virtual reality-supported balance training with balance training with only a standing frame and with conventional therapy in the hospital. The proposed low-cost experimental system for balance training enabling multiple home systems, real-time tracking of task's performance and different views of captured data with balance training, consists of a standing frame equipped with a tilt sensor, a low-cost computer, display, and internet connection. Goal-based tasks for balance training in the virtual environment proved motivating for the participating individuals. The physiotherapist, located in the remote healthcare center, could remotely adjust the level of complexity and difficulty or preview the outcomes and instructions with the application on the mobile smartphone. Patients using the virtual reality-supported balance training showed an improvement in the task performance time of 45% and number of collisions of 68%, showing significant improvements in the Berg Balance Scale, Timed 'Up and Go', and 10 m Walk Test. The clinical outcomes were not significantly different from balance training with only the standing frame or conventional therapy. The proposed telerehabilitation can facilitate the physiotherapists' work and thus enable rehabilitation to a larger number of patients after release from the hospital because it requires less time and infrequent presence of the clinical staff. However, a comprehensive clinical evaluation is required to confirm the applicability of the concept.
Article
Full-text available
Stroke is the leading cause of long-term disability for adults in industrialized societies. Rehabilitation's efforts are tended to avoid long-term impairments, but, actually, the rehabilitative outcomes are still poor. Novel tools based on new technologies have been developed to improve the motor recovery. In this paper, we have taken into account seven promising technologies that can improve rehabilitation of patients with stroke in the early future: (1) robotic devices for lower and upper limb recovery, (2) brain computer interfaces, (3) noninvasive brain stimulators, (4) neuroprostheses, (5) wearable devices for quantitative human movement analysis, (6) virtual reality, and (7) tablet-pc used for neurorehabilitation.
Article
Full-text available
Focus groups are used by researchers in the social and behavioural sciences to explore phenomena and are accepted as a legitimate qualitative methodology. The primary goal of focus groups is to use interaction data resulting from discussion among participants to increase the depth of the enquiry and reveal aspects of the phenomenon assumed to be otherwise less accessible. This article, the first of three articles on focus groups, examines the nature of focus groups, issues regarding planning focus groups, selecting participants and the size of the groups. This article is aimed at students who are undertaking research modules as part of their academic studies or writing a research proposal as well as at novice researchers who intend to use focus groups as a means of data collection.
Article
Full-text available
Purpose: To explore and describe how persons with an acquired brain injury (ABI) managed the everyday technology (ET) that they needed to use in their workplace and how this use influences their opportunities to work. Methods: Nine persons with an ABI were interviewed and observed when managing ET in their workplace. The data were analysed qualitatively with a constant comparative method. Results: The main category, "The challenge of managing ET in the workplace", consisted of three categories, all of which reflected different kinds of discrepancies between the participants' ability to manage ET and the demands that ET imposes on them in work: "Struggling with ET to be able to continue to work; "Depending on strategies to cope with ET to continue in a particular profession", and "Managing ET at work but concerned about keeping up with the changes". Conclusions: The result revealed discrepancies between the abilities of the persons with ABI to manage ET in relation to the demands that technology imposed on them in their work setting. This indicated that professionals need to consider the role of ET when designing interventions supporting a person's return to work after an ABI.
Article
Full-text available
The literature suggests that stroke is a major risk factor for falls, but there is a lack of prospective, controlled studies which quantify fall-risk after stroke. The purpose of this study was to compare the rates, location and predictors among individuals recently discharged home from stroke rehabilitation to age and sex matched controls. A sample of 80 people with stroke and 90 controls received baseline assessments of balance, mobility and balance confidence. Falls were recorded prospectively over 13 months for both groups. Group differences in fall rates and contribution of clinical measures to falls were determined using negative binomial regression. Fall location was compared between groups using χ(2) statistics. The rate of falls for individuals with stroke was 1.77 times the rate for the control group. People with stroke were more likely to fall at home. Poorer balance (Berg Balance Scale) was associated with greater falls for both stroke and control groups (incidence rate ratio [IRR]: 0.908 and IRR: 0.877 respectively). A faster Timed Up and Go Test was associated with greater falls for the stroke group (IRR: 0.955) while better walking endurance (Six Minute Walk Test) was associated with greater falls for the controls (IRR: 1.004). Balance confidence was not an independent predictor in either group. Individuals recently discharged home are at greater risk of falling than individuals without stroke. Attention to home environment is warranted. Balance function can predict falls for both people with stroke and age and sex matched controls. Increased mobility may increase exposure to fall opportunities.
Article
Full-text available
PURPOSE. The purpose of this study is to illuminate how persons with acquired brain injury (ABI) and their significant others experienced individualised occupation-based interventions using commonly available everyday technology (ET) to compensate for perceived difficulties with performance of tasks in daily life. METHOD. Qualitative research interviews were conducted with 10 persons with ABI and with one of their significant others. The data were analysed according to qualitative content analysis. RESULTS. The persons with ABI experienced that they mastered their lives in a better way by the compensatory use of ET. They became capable of doing tasks independently and experienced themselves as being a new person. During the intervention process, persons with ABI became aware of the compensatory potential of familiar ET, and they were supported to use effective compensatory strategies and incorporate them into their habits. Their significant others felt a relief in daily life, and their mood was positively affected as they experienced reduced responsibility and need of control. CONCLUSIONS. This qualitative study has shown that persons with ABI, as well as their significant others, experienced a multitude of benefits from occupation-based interventions using commonly available ET to compensate for their difficulties in the performance of tasks in daily life and that the goals achieved affected their overall contentment with life.
Article
Full-text available
In this lecture, I have reviewed theoretical discussions and definitions of occupational balance, findings from selected studies, and highlighted some methods for measuring aspects of occupational balance. Are any of these ideas directly applicable to occupational therapy practice, education and research? Consider the hassles of everyday life, and add the complicating factors of illness, injury, disability, and limited income. Life, and the pursuit of necessary, desirable and obligatory occupations, can become overwhelming. Given that occupational therapists aim to enable individuals, regardless of ability, to successfully engage in a range of occupations, the answer to the question is yes. Furthering our understanding of occupational balance can improve our ability to serve individual clients and society. In 2001, Fearing stated in her Muriel Driver Memorial Lecture: We will not only recognize and value the skill of maintaining balance, our own and that of our clients, but we will live it. Balance will not be viewed as a set of scales that has equal parts such as work on one side and play on the other but rather the kind of balance that comes from being centred so that we act from a stable base. From that stable base, we will gain a keen sensitivity to rhythm--knowing when to move and when to let go. (Fearing, 2001 pp. 214-215) Perhaps these reflections have added a little coherence to the study of occupational balance. Occupational balance is a relative state, recognizable by a happy or pleasant integration of life activities and demands. There are indicators of imbalance, more so than tangible ways to measure it, and once recognized occupational therapists have the strategies to help restore a sense of occupational balance. Given our collective history and skill in client-centred practice, occupational therapists are capable of both advancing this line of inquiry and attaining occupational balance for ourselves and our clients.
Article
Full-text available
To evaluate the chronic consequences of stroke in terms of activity limitations, restricted participation and dissatisfaction from life, and the relationship between these variables, in stroke survivors living in the community one-year post onset. A total of 56 stroke patients (mean age: 57.7) who completed an in-patient rehabilitation programme, were evaluated one-year post onset in their homes, using the following instruments: Functional Independence Measure (FIM), Instrumental Activities of Daily Living Questionnaire (IADLq), Activity Card Sort (ACS), a work questionnaire, Life-Satisfaction Questionnaire (Li-Sat 9) and the Geriatric Depression Scale (GDS). One year post stroke onset the mean FIM motor score was 75.88 (max score: 91), yet more than 50% of the sample still required assistance (usually mild to moderate) in dressing, bathing and use of stairs. The majority of the sample required full assistance in some IADL domains, notably meal preparation (77%), housekeeping (70%) and laundry (82%). Only one subject returned to paid employment and the mean activity level (ACS), representing the percentage of leisure and IADL activities retained from before stroke, was 42.8%. Satisfaction ratings were generally low but varied between domains. Only 39% were satisfied from 'life as a whole'. The lowest satisfaction rates were noted for 'vocational situation' (14%), 'leisure situation' (34%) and 'ability in self-care' (43%), whereas the satisfaction rate from family life was high (84%). Significant correlations were found between overall life satisfaction scores and the overall FIM motor, IADLq, and ACS scores (Pearson r values: 0.32, 0.48 and 0.57, respectively). Activity level was found to be a significant predictor of satisfaction (p = 0.007) beyond that accounted for by demographic variables and depression. Stroke survivors dwelling in the community demonstrate long-standing dissatisfaction one-year post onset, correlating with activity limitation and restricted participation. The findings present a compelling need for rehabilitation services with a focus on participation in IADL and leisure activities, in order to improve the satisfaction of this population.
Article
This article discusses threats and challenges that may arise when conducting qualitative interviews with persons with language handicap or frail elderly who have difficulties providing detailed accounts of their experiences. The literature on qualitative research seems to assume that qualitative interviews of good quality consist of long, uninterrupted narratives. This ideal encompasses particular requirements to study participants. Qualitative studies including frail elderly or people with communicative handicaps may be harmed by biased samples or thin descriptions. Strategies to maximize the quality of interview data, such as larger and more varied samples, investing sufficient time to establish rapport in the interview situation, repeated interviews, specific interview techniques, and combining interviewing and participant observations are suggested. Key words: Qualitative methods, qualitative interview, interviewing, stroke survivors, frail elderly
Article
Background: Clinician interest in the role of tablet technology in commercially available tablet devices (i.e. iPads) following stroke is rising. Tablets have the potential to encourage engagement in therapeutic activities. We aimed to explore stroke survivor acceptability of and experience of tablet use during the first three months of stroke recovery. Design: A qualitative study using an inductive thematic approach incorporating the process of constant comparison was utilized to collect and analyse data. Setting: Community dwelling stroke survivors in metropolitan Newcastle, New South Wales, Australia. Participants: Twelve stroke survivors (8 male, 4 female; median age of 73 (IQR 58-83) years). Main outcome measures: Qualitative outcomes were participants' perceptions using in-depth, semi-structured interviews. Results: Participants' found tablets easy to use and beneficial. Most stroke survivors used the tablet to engage in therapeutic and leisure activities on most days during the three months. Three key themes emerged: (1) Getting established on the iPad: "It just became easier and easier", (2) Technology as a means for increased stimulation: "Something to keep me interested", and (3) Personal experiences of access to an iPad: "It's been very helpful". Conclusions: Incorporating tablet technology into the delivery of stroke rehabilitation appears to be feasible and acceptable at a patient level. This process has the potential to improve participation in therapeutic and or leisure; however further evaluation towards the impact of tablet technology on patient outcome and quality of life is required. Implications for Rehabilitation The use of tablet technology provides a platform to increase the variety and intensity of stroke therapy, both in the hospital setting and following discharge from hospital, facilitating physical, cognitive and social activity. Stroke survivors experienced increased participation in therapeutic activities, increased socialization and less inactivity and boredom through access to tablet technology. Tablet technology is feasible and acceptable at a patient level, providing preliminary support for the use of interactive computer devices during stroke recovery.
Aims: To gain an in-depth understanding of issues expressed by survivors of stroke and their spousal caregivers related to falling and fear of falling (FoF). Methods: The phenomenological qualitative research tradition was used to conduct in-depth semi-structured interviews, which were audio recorded, transcribed verbatim, and member checked. The Activities-specific Balance Confidence Scale was embedded within each interview. Researchers independently open coded, triangulated data, and allowed categories and themes to emerge. Results: Six survivors of chronic stroke and spouses were interviewed. All survivors reported at least one fall since hospital discharge, with half reporting injurious falls. Two reported FoF when asked, but most indicated impaired balance confidence. The overarching theme of adjustment emerged, with sub-themes of (1) physical and (2) emotional/cognitive adjustment. Conclusions: Clinicians’ heightened awareness of issues expressed by these couples may improve care (education and practice), provided in various settings, as adjustment continues to be expressed years after stroke.
Article
The proliferation of tablet technology and the development of apps to support aphasia rehabilitation offer increasing opportunities for speech-language pathologists in a clinical setting. This article describes the components of an Intensive Comprehensive Aphasia Program at Boston University and details how usage of the iPad (Apple Inc., Cupertino, CA) was incorporated. We describe how the iPad was customized for use in individual, dyadic, and group treatment formats and how its use was encouraged through home practice tasks. In addition to providing the participants with step-by-step instructions for the usage of each new app, participants had multiple opportunities for practice across various treatment formats. Examples of how the participants continued using their iPad beyond the program suggest how the usage of this device has generalized into their day-to-day life. An overall summary of performance on targeted linguistic measures as well as an analysis of functional and quality-of-life measures reveal statistically significant improvements pre- to posttreatment.
Article
The use of mobile technology, including smartphones and tablet devices, is a growing trend among adults nationwide, and its potential use in aphasia rehabilitation has generated widespread interest. Despite this trend, adults living with disability are less likely than other adults to go online. Complicating things further, most adults living with aphasia come from a generation where computers and technology were not an integral part of their lives. Additionally, training adults with aphasia requires a different approach than training those in the same age bracket without a disability. This article describes the mobile technology program at the Adler Aphasia Center in Maywood, New Jersey. The goal of this program is to improve access to mobile technology for people with aphasia. The use of mobile devices is the focus of the article. Mobile technology concepts and skills needed to establish a strong foundation for successful iPad (Apple Inc., Cupertino, CA) use are suggested. We discuss how apps may be used to support aphasia therapy with a focus on apps that are native to the iPad and on other apps that were not specifically developed for aphasia rehabilitation. Challenges in implementing a mobile technology program for people with aphasia and individual member success stories are included.
Article
Two home telehealth technologies (the Intel Health Guide and the Apple iPad) were trialled by four clinical services of the Hunter New England Local Health District. The iPad was selected by the Paediatric Palliative Care Service, the Stroke Service and the Brain Injury Rehabilitation Service. The Intel Health Guide was selected by the Cardiac Coaching Service. The telehealth devices were loaned to a total of 102 patients for different lengths of time, depending on clinical needs, but typically for about 3 months. A total of 42 clinicians were involved. During the trial, 16 technical problems were recorded and resolved, most concerning problems with connectivity. Nonetheless, the use of home telehealth technologies was positively received by clinicians, management and patients alike. Telehealth is now being integrated into the standard practices of the health district.
Article
This article argues that there is a need for more methodological discussions and examples upon how to include the social interaction element in analysing focus group data. It is suggested that from a practice theoretical perspective, focus group data (like other types of qualitative data) are understood as social enactments. The article gives examples of four different but related methodological tools of analysis that can help integrating interaction and content in analysing focus group enactments, namely tools from Goffman-inspired interaction analysis, conversation analysis, discourse psychology and positioning theory. The examples are unfolded on focus group data-material from a qualitative empirical research project on how Danish women cook and relate to normative issues in cooking, and the choice of specific examples of tools of analysis are linked to the specific knowledge interests of this research project.
Article
This article discusses threats and challenges that may arise when conducting qualitative interviews with persons with language handicap or frail elderly who have difficulties providing detailed accounts of their experiences. The literature on qualitative research seems to assume that qualitative interviews of good quality consist of long, uninterrupted narratives. This ideal encompasses particular requirements to study participants. Qualitative studies including frail elderly or people with communicative handicaps may be harmed by biased samples or thin descriptions. Strategies to maximize the quality of interview data, such as larger and more varied samples, investing sufficient time to establish rapport in the interview situation, repeated interviews, specific interview techniques, and combining interviewing and participant observations are suggested.
Book
Most writing on sociological method has been concerned with how accurate facts can be obtained and how theory can thereby be more rigorously tested. In The Discovery of Grounded Theory, Barney Glaser and Anselm Strauss address the equally Important enterprise of how the discovery of theory from data--systematically obtained and analyzed in social research--can be furthered. The discovery of theory from data--grounded theory--is a major task confronting sociology, for such a theory fits empirical situations, and is understandable to sociologists and laymen alike. Most important, it provides relevant predictions, explanations, interpretations, and applications. In Part I of the book, "Generation Theory by Comparative Analysis," the authors present a strategy whereby sociologists can facilitate the discovery of grounded theory, both substantive and formal. This strategy involves the systematic choice and study of several comparison groups. In Part II, The Flexible Use of Data," the generation of theory from qualitative, especially documentary, and quantitative data Is considered. In Part III, "Implications of Grounded Theory," Glaser and Strauss examine the credibility of grounded theory. The Discovery of Grounded Theory is directed toward improving social scientists' capacity for generating theory that will be relevant to their research. While aimed primarily at sociologists, it will be useful to anyone Interested In studying social phenomena--political, educational, economic, industrial-- especially If their studies are based on qualitative data.
Article
The aim of this study was to examine in depth how computer-based assistive technology (AT) for cognitive support influenced the everyday lives of both persons who had had a stroke and their significant others. Four participants, who had experienced cognitive limitations after a stroke, and their significant others were included in the study. The study included an intervention with a specific type of computer-based AT that was installed in the homes of the four participants for a 6-month period. Semistructured interviews were conducted before the installation to learn about the participants needs and repeated interviews took place after the installation. All collected data were analyzed based on qualitative methodology. The findings illustrated how routines developed with support from the AT influenced the participants towards increased control of their everyday life, and also created daily structure and helped them regain social contacts. The findings demonstrated how the spouses also benefitted and could reduce their reminding and checking responsibilities. Computer-based AT has the potential to bring about changes in the everyday life for people with cognitive limitations by supporting the development of routines and by introducing, maintaining, reinforcing or regaining valuable activities.
Article
As people with intellectual disabilities (ID) today live integrated in society and use different technological artefacts and services in their everyday life, more in-depth evaluation methods are crucial to detect strengths and limitations of their everyday technology use. The Everyday Technology Use Questionnaire (ETUQ) was originally designed to investigate the extent to which older adults with cognitive limitations can use the everyday technology that is of relevance to them. The purpose of this study was to explore and evaluate evidence of the validity of ETUQ among adult persons with ID. The original 93-item ETUQ was used to interview 120 adult participants with ID, recruited from a region in northern Sweden. A Rasch model was used to analyse the psychometric properties of the rating scale, scale validity, person response validity and person separation. The ETUQ rating scale displayed sound psychometric properties when used with this sample. The goodness-of-fit statistics showed that 15 (16%) of the 93 items demonstrated higher values than expected. A step-by-step removal process of items not demonstrating fit to the model resulted in an ETUQ version with 46 items (49%) that met all the criteria for scale validity. Fifteen participants (12%), primarily with mild ID, still demonstrated a higher number of unexpected responses included in ETUQ. The results of this study indicate that the ETUQ generates a valid measure of perceived difficulty in using everyday technology including adult persons with ID.
Article
Technology increasingly influences the everyday lives of most people, and the ability to manage technology can be seen as a prerequisite for participation in everyday occupations. However, knowledge of the ability and skills required for management of technology is sparse. This study aimed to validate a new observation-based assessment, the Management of Everyday Technology Assessment (META). The META has been developed to assess the ability to manage technology in everyday life. A sample of 116 older adults with and without cognitive impairment were observed and interviewed by the use of the META when managing their everyday technology at home. The results indicate that the META demonstrates acceptable person response validity and technology goodness-of-fit. Additionally, the META can separate individuals with higher ability from individuals with lower ability to manage everyday technology. The META can be seen as a complement to existing ADL assessment techniques and is planned to be used in both research and practice.
Article
To be useful for clinical research, an outcome measure must be feasible to administer and have sound psychometric attributes, including reliability, validity, and sensitivity to change. This study characterizes the psychometric properties of the Stroke Impact Scale (SIS) Version 2.0. Version 2.0 of the SIS is a self-report measure that includes 64 items and assesses 8 domains (strength, hand function, ADL/IADL, mobility, communication, emotion, memory and thinking, and participation). Subjects with mild and moderate strokes completed the SIS at 1 month (n=91), at 3 months (n=80), and at 6 months after stroke (n=69). Twenty-five subjects had a replicate administration of the SIS 1 week after the 3-month or 6-month test. We evaluated internal consistency and test-retest reliability. The validity of the SIS domains was examined by comparing the SIS to existing stroke measures and by comparing differences in SIS scores across Rankin scale levels. The mixed model procedure was used to evaluate responsiveness of the SIS domain scores to change. Each of the 8 domains met or approached the standard of 0.9 alpha-coefficient for comparing the same patients across time. The intraclass correlation coefficients for test-retest reliability of SIS domains ranged from 0.70 to 0.92, except for the emotion domain (0.57). When the domains were compared with established outcome measures, the correlations were moderate to strong (0.44 to 0.84). The participation domain was most strongly associated with SF-36 social role function. SIS domain scores discriminated across 4 Rankin levels. SIS domains are responsive to change due to ongoing recovery. Responsiveness to change is affected by stroke severity and time since stroke. This new, stroke-specific outcome measure is reliable, valid, and sensitive to change. We are optimistic about the utility of measure. More studies are required to evaluate the SIS in larger and more heterogeneous populations and to evaluate the feasibility and validity of proxy responses for the most severely impaired patients.
Article
To assess multiple psychometric characteristics of a new stroke outcome measure, the Stroke Impact Scale (SIS), using Rasch analysis, and to identify and remove misfitting items from the 8 domains that comprise the SIS. Secondary analysis of 3-month outcomes for the Glycine Antagonist in Neuroprotection (GAIN) Americas randomized stroke trial. A multicenter randomized trial performed in 132 centers in the United States and Canada. A total of 696 individuals with stroke who were community-dwelling and independent prior to acute stroke. Not applicable. Main Outcome Measures: Rasch analysis was performed using WINSTEPS, version 3.31, to evaluate 4 psychometric characteristics of the SIS: (1) unidimensionality or fit (the extent to which items measure a single construct), (2) targeting (the extent to which the items are of appropriate difficulty for the sample), (3) item difficulty (the ordering of items from least to most difficult to perform), and (4) separation (the extent to which the items distinguish distinct levels of functioning within the sample). (1) Within each domain, most of the items measured a single construct. Only 3 items misfit the constructs and were deleted ("add and subtract numbers," "get up from a chair," "feel emotionally connected") and 2 items ("handle money," "manage money") misfit the combined physical domain. These items were deleted to create SIS, version 3.0. (2) Overall, the items are well targeted to the sample. The physical and participation domains have a wide range of items that capture difficulties that most individuals with stroke experience in physical and role functions, while the memory, emotion, and communication domains include items that capture limitations in the most impaired patients. (3) The order of items from less to more difficult was clinically meaningful. (4) The individual physical domains differentiated at least 3 (high, average, low) levels of functioning and the composite physical domain differentiated more than 4 levels of functioning. However, because difficulties with communication, memory, and emotion were not as frequently reported and difficulties with hand function were more frequently reported, these domains only differentiated 2 (high, low) to 3 (high, average, low) strata of patients. Time from stroke onset to administration of the SIS had little effect on item functioning. Rasch analysis further established the validity of the SIS. The domains are unidimensional, the items have an excellent range of difficulty, and the domain scores differentiated patients into multiple strata. The activities of daily living/instrumental activities of daily living, mobility, strength, composite physical, and participation domains have the most robust psychometric characteristics. The composite physical domain is most able to discriminate difficulty in function in individuals after stroke, while the communication, memory, and emotion domain items only capture limitations in function in the more impaired groups of patients.
Article
There is a need to identify different rehabilitation needs over time among individuals with stroke in order to implement client-centred rehabilitation interventions after stroke. The objective of this research was to describe changes in some aspects of functioning and to explore the patterns of change in functioning in everyday life during the first year after stroke for elderly patients participating in rehabilitation at home. Patients who fulfilled the inclusion criteria for a regular rehabilitation-at-home programme after stroke were considered for participation in this study. Twenty-seven elderly patients participated on four data collection occasions during the year immediately subsequent to a stroke. The mean age of the 27 participants was 78.8 years (SD = 5.9) and 67% of the participants were women. Data on certain aspects of functioning were collected and a person-oriented approach was used to describe the patterns in the change in functioning for individuals. Four different patterns were identified: (a) moderate change in functioning (n = 4), (b) minor change in functioning (n = 11), (c) minor change despite major life event (n = 7), (d) disrupted change in functioning (n = 5). The study group improved significantly in most aspects of functioning, but still, most participants (n = 20) showed dissatisfaction with life as a whole 12 months after their stroke. This study identified different patterns of change in functioning in everyday life. This knowledge should serve to help guide rehabilitation professionals in their assessment of clients' needs during different phases after stroke.
The Swedes and the Internet -summary 2015. The Internet Foundation in Sweden
  • O Findahl
Findahl O. The Swedes and the Internet -summary 2015. The Internet Foundation in Sweden; 2015.
  • G A Donnan
  • M Fisher
  • M Macleod
Donnan GA, Fisher M, Macleod M, et al. Stroke. Lancet. 2008;371:1612-1623.
Nationella riktlinjer f€ or strokesjukvård 2009: st€ od f€ or styrning och ledning. Stockholm: Socialstyrelsen/The National Board for Health and Welfare
National Guidelines for Strokecare 2009/Nationella riktlinjer f€ or strokesjukvård 2009: st€ od f€ or styrning och ledning. Stockholm: Socialstyrelsen/The National Board for Health and Welfare; 2010.
Using everyday technology to compensate for difficulties in task performance in daily life: experiences in persons with acquired brain injury and their significant others
  • Larsson Lund
  • Lvgren-Engstrm A-L Lexell
Larsson Lund M, Lvgren-Engstrm A-L, Lexell J. Using everyday technology to compensate for difficulties in task performance in daily life: experiences in persons with acquired brain injury and their significant others. Disabil Rehabil Assist Technol. 2011;6:402-411.
Riksstroke/The Swedish stroke register
  • B Norrwing
Norrwing B. Riksstroke/The Swedish stroke register, 2016 [cited 2016 Oct 21]. Available from: www.riksstroke.org.
Kvalitativa metoder i medicinsk forskning: en introduktion
  • K Malterud
Malterud K. Kvalitativa metoder i medicinsk forskning: en introduktion [in Swedish]. Lund: Studentlitteratur; 2014.
Model of human occupation: theory and application
  • G Kielhofner
Kielhofner G. Model of human occupation: theory and application. Baltimore, MD: Lippincott Williams & Wilkins; 2007.