Although the therapists recognize evidence-based practice as a framework for achieving quality in rehabilitation, findings suggest that they do not employ research-based evidence to the fullest extent. Implications for Rehabilitation In order to individualize the rehabilitation offered, more attention and focus on involving and giving words to patients' expectations, perceptions, experiences, and perspectives is needed. With the intention of enabling meaningful participation the health professionals need to pay more attention to the importance of environmental factors. Both guidelines and clinical practice should consider all components of the International Classification of Functioning, Disability and Health when formulating, and implementing, recommendations in rehabilitation praxis in order to aim for rehabilitation that is based both on evidence and a holistic approach.
Aim To investigate the subjective experiences of occupational performance of activities of daily living (ADL) in patients with mild stroke. Methodology Data was generated from January – December 2011 and consisted of 41 individual ADL-I interviews with patients in hospital and another 41 interviews with the same patients 1 month after discharge. The last eight interviews were extended with semi-structured interviews. Results The study participants consisted of 16 women and 25 men with a mean age of 69 years. The majority of the participants were independent in the PADL- and IADL-activities included in the ADL-I interviews. However, a minority of participants experienced difficulties in performing normal daily activities without the help of alternative strategies or assistive devices. This resulted in them having to spend more time on these activities, and this increased their fatigue and risk of accidents. Conclusion It is important to view the patients with mild stroke as heterogeneous, and consider post-stroke fatigue and emotional reactions when evaluating rehabilitation needs. Therefore, it is important to look further into structured tools, which examine how well the participant performs daily activities and how this is perceived, to understand fully the patient's rehabilitation needs.
BackgroundStudies have shown that Workplace Health Promoting Programmes (WHPP) can facilitate healthier behaviour. Despite the benefits achieved from participating in a WHPP, a systematic review showed that only 10–50% of the employees participated and a challenge was lack of participation. Previous studies stress that understanding the barriers that prevent participants from attending WHPPs are important for designing highly effective interventions. To exploit the potential of a WHPP, it requires a deep insight into the attendance barriers experienced by the participants who voluntarily sign-up for a WHPP; and particularly those who want to stay in the programme but are prevented from participating in it regularly. Thus, the aim of this study was to identify and explore attendance barriers experienced by female Health Care Workers (HCWs) who voluntarily participated in a weekly one-hour multi-component training session, within a WHPP, over a one-year period.MethodsThis study was carried out within a RCT named FRIDOM (FRamed Intervention to Decrease Occupational Muscle pain) and was designed as a single-case study with an inductive approach for analysing the content of in-depth semi-structured qualitative interviews. Data was collected at two home care workplaces and two retirement homes in Denmark. Nine HCWs from the intervention group were selected as participants in the present study.ResultsThe attendance barriers identified, consisted of three main themes and six related sub-themes: 1) organizational factors (work inflexibility, lack of support from team leaders), 2) intervention factors (training sessions organized outside normal work hours, incongruence between information received and reality, content and intensity of the program) and 3) individual factors (personal factors).ConclusionOrganizational and intervention factors are the two most important attendance barriers in future WHPPs. To overcome these barriers; training sessions should be organized within or in connection with work hours, support should be secured from team management and work shifts should be planned to enable attendance for all participants. Furthermore, the attendance barriers may be minimized by including participants in the decision-making process. This relates to both the content and intensity of the intervention, not only in the planning stage but throughout the intervention process.Trial registrationClinicalTrials.gov. NCT02843269 - 06.27.2016 - retrospectively registered.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6254-3) contains supplementary material, which is available to authorized users.
Background/Aims: Holistic, multidisciplinary rehabilitation is often the most appropriate for stroke patients. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides a comprehensive conceptual framework and systematic terminology used by health professionals worldwide. The purpose of this study was to explore how the components of the ICF were addressed by physiotherapists and occupational therapists in stroke rehabilitation. Methods: A prospective cohort study, including all service levels within Danish stroke rehabilitation, was carried out. Consecutive patients with a diagnosis of stroke (n=131; 70 males and 61 females; mean age: 72 years) admitted to a university hospital between May and December 2012 were enrolled by 13 physiotherapists and occupational therapists. Physiotherapist and occupational therapist documentation was collected from participants' medical records and analysed using deductive content analysis until saturation was reached. Data were generated in four settings that encompass the general Danish health care service to adult stroke patients in hospitals and community-based settings. Results: Patient data were documented according to three of the ICF components, i.e. body functions and structures, activity and participation, and environmental factors. No distinct pattern emerged that would enable a differentiation between therapists' notes in the four settings. Conclusions: The ICF framework may contribute to a holistic approach in stroke rehabilitation, including an understanding of functioning and the ability to participate in everyday life. Using this approach to rehabilitation, disability is not only perceived as a consequence of stroke but also in the context of the individual person, where interactions between the biological, psychological, social and environmental aspects must be taken into account in order to provide an adequate rehabilitation service. Nevertheless, more attention seems to be paid to health components at the expense of the contextual factors; this needs to be addressed to augment the holistic approach.
Purpose: To explore how psychologically vulnerable citizens experienced performing their everyday-life activities, identify activities experienced as particularly challenging and evaluate the significance of the Acceptance and Commitment Theory-based (ACT)-based program, Well-being in Daily Life, had on the participants everyday-life activities. Methods: Semi-structured interviews were conducted with eight participants from the Well-being in Daily Life program. Data were analysed using Systematic Text Condensation. Results and Conclusion: The participants experienced anxiety, fatigue, lack of structure, and chaos when performing their everyday-life activities; in addition to being uncertain about the limitations of their own resources. Furthermore, balancing between demands and resources was challenging, also leading to uncertainty and identity conflicts that contributed to the participants’ concerns about re-entering the workforce. The program enabled the participants to develop social skills and trust which contributed to providing the participants with confidence, individually-tailored-possibilities for developing new competencies and courage; thus, facilitating their recovery process.
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