Daniëls R, Winding K, Borell L. Experiences of occupational therapists in stroke rehabilitation: dilemmas of some occupational therapists in inpatient stroke rehabilitation. Scand J Occup Ther 2002; 9: 167 -175.The aim of this study was to explore and gain an understanding of occupational therapists' experiences of therapy with patients in inpatient stroke rehabilitation, through the identi cation of their deliberations for practice. Two focus-group interviews were conducted. The deliberations for action were triggered by using a written case sample. The analysis of the study involved a perspective of meaning interpretation of the statements of the occupational therapists. The meaning structure that arose was that occupational therapists experience dilemmas when they are considering the courses of action open to them. Three dilemmas were named: ''focusing on adaptation while the patient is focused on recovery'', ''being client centred and protective simultaneously'' and ''setting meaningful goals in an institutional context''. The results of the study are discussed in relation to theoretical concepts in occupational therapy: a two-body practice, client centredness and meaningful goal setting in a realistic context. Further research regarding the use of meaningful occupation in stroke rehabilitation is recommended.

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This paper presents a new insight into the limitations experienced by older people with reduced vision in daily life activities. With an ageing population, increasing numbers of Dutch people are affected by visual impairment. In contrast to other European countries, occupational therapists in the Netherlands do work with this specific group, but little research has as yet been conducted in this field. This study explores in detail the mobility experiences of 10 older people with a visual impairment. Each participant was interviewed twice; the data were transcribed verbatim and analysed using Giorgi's method of empirical phenomenology. The participants' severely limited mobility clearly influenced their occupational choices, space and independence, with a particularly negative change in activities of daily living. They attended fewer social activities and became more dependent on assistance, which made them anxious. Visual impairments were often misunderstood by others and the absence of facial recognition was experienced as a severe barrier to social interaction. Some specific difficulties that visually impaired older people may experience are now more transparent, which might inspire occupational therapists in other countries to work in this field.

This explorative study examined the influence of chronic lower back pain on the motives for occupational performance. A narrative interview was conducted with seven Dutch clients. Three phases in the process of living with lower back pain were identified in which the self, the pain, and the environment were seen as interrelated elements that influence the creation of motives. In the first phase, clients wanted to meet social and personal expectations, which led to their ignoring the lower back pain. In the second phase, the pain took control and the clients withdrew from social participation, which led to “emotional pain.” In the third phase, clients became more conscious of the dynamics and dilemmas between the self, the pain, and the environment. Analysis of study results suggests that clients' narratives can help occupational therapists gain a deeper understanding of clients' experiences of dealing with chronic pain.

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