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  • 1.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Body awareness therapy for patients with fibromyalgia and chronic pain2005In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 27, no 12, p. 725-8Article in journal (Refereed)
    Abstract [en]

    There are several therapies designed to increase body awareness. They are commonly known as body awareness therapies (BAT) and include Basic BAT, Mensendieck and Feldenkrais therapy. A focus on emotions is important in all these therapies. In this article the aim and development of Basic BAT is described together with evaluations of treatments including Basic BAT. Multidisciplinary studies have shown that Basic BAT can increase health-related quality of life and cost-effectiveness. However Basic BAT needs to be further studied in relation to patients with fibromyalgia (FM) and chronic pain. Studies so far indicate that Basic BAT has positive effects.

  • 2. Gard, Gunvor
    et al.
    Rivano, Marcelo
    Department of Rehabilitation, Lund University Hospital, Sweden.
    Grahn, Birgitta
    Kronoberg county council, R&D centre.
    Development and reliability of the Motivation for Change Questionnaire2005In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 27, no 17, p. 967-76Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this study was to describe the development of the Motivation for Change Questionnaire (MCQ) and to test its intra-patient reliability on musculoskeletal pain patients in interdisciplinary rehabilitation as a basis for use in rehabilitation planning. METHOD: The MCQ questionnaire was developed from a literature search in the Medline, Cinahl and Psychlit databases concerning motivating factors for change in the life and work situation. Questions covering these factors were developed (item generation). Factor analysis of the questions implied a reduction of the number of questions (item reduction). Inter-item correlation was assessed on the baseline administration of the questionnaire by calculating Cronbach's alpha. When testing the structure of the scales, it was shown that the MCQ questionnaire could be described in two scales, one scale relating to motivation for change in the life situation and the other focusing on motivation for change in the work situation and in total 49 questions. RESULTS: The test -- retest reliability was calculated using the intra-class correlation coefficient (ICC) and 95% confidence intervals were calculated. One question was excluded due to the threshold limit of > 0.5. Seven scales relating to the life situation were accepted by the analysis: social support, mastery in life, challenges in life, control in life, values, self-efficacy and self-confidence. Six scales relating to the work situation were also accepted: co-worker support, supervisory support, challenges in work, job control, interaction and job-satisfaction. CONCLUSIONS: The MCQ questionnaire with 48 questions is reliable for use on musculoskeletal pain patients in interdisciplinary rehabilitation. It can be used to identify each individual's motivating factors for change in life and work situation as a basis for motivational work within rehabilitation and/or to measure within-subject changes in motivation over time. The validity and the responsiveness of the MCQ, need to be studied.

  • 3.
    Gard, Gunvor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Söderberg, Siv
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    How can a work rehabilitation process be improved?: a qualitative study from the perspective of social insurance officers2004In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 26, no 5, p. 299-305Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study is to describe social insurance officers' experiences of a work rehabilitation process at a rehabilitation centre in the northern parts of Sweden. In Sweden the social insurance company has a key role to coordinate all efforts concerning work rehabilitation planning between all rehabilitation actors. METHOD: Ten social insurance officers at the social insurance company in a city in northern Sweden were interviewed using a narrative approach about their experiences of work rehabilitation processes in general. The interviews were analysed by qualitative content analysis with a focus on their experiences of goals, content and results of a work rehabilitation process. RESULTS: The social insurance officers' experiences of how a work rehabilitation process could be improved were described in six categories; (1) Early identification of problems, needs and interventions (2) clear goal formulations, (3) a focus on psychosocial factors (4) a greater variety of possible interventions, (5) activating employers to a higher extent in work rehabilitation and (6) a closer cooperation and information exchange with other rehabilitation actors. CONCLUSIONS: It is possible to improve a work rehabilitation process by focusing on early identification of problems, needs and interventions, with a variety of interventions to choose between and with clear goal formulations and recognizing psychosocial factors in the process. To activate employers to a higher extent in work rehabilitation and to make the information exchange between rehabilitation actors more frequent may also improve work rehabilitation processes

  • 4.
    Isaksson, Gunilla
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Josefsson, Staffan
    Neurotec Department, Division of Occupational Therapy, Karolinska Institute, Huddinge.
    Lexell, Jan
    Skär, Lisa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    To regain participation in occupations through human encounters: narratives from women with spinal cord injury2007In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 29, no 22, p. 1679-1688Article in journal (Refereed)
    Abstract [en]

    Purpose. To gain an understanding of how women with spinal cord injury (SCI) experienced human encounters in occupations and how these influenced their participation. Method. The data were collected through two or three in-depth interviews with 13 women (age 25 - 61 years) with SCI. Data analysis was carried out by using a paradigmatic analysis of narrative data, followed by an interpretation based on a narrative theory. Results. The results showed a complexity where the women's experiences and acting in human encounters changed over time. In these human encounters the women struggled with conflicts, supported other persons that were insecure and revaluated their apprehension about persons in their social network. These multidimensional human encounters thereby enabled them to regain participation in occupations. Conclusions. This shows that human encounters are important for persons with disabilities so they can restructure their occupational identity and their needs for participation in occupations. The study also showed that the use of narratives as a tool within rehabilitation could lead to an increased understanding of the subjective changes that occur over time for a person with a disability

  • 5.
    Isaksson, Gunilla
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Prellwitz, Maria
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    One woman's story about her everyday life after a spinal cord injury2010In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no 16, p. 1376-1386Article in journal (Refereed)
    Abstract [en]

    Purpose. The aim was to describe and offer an explanation for how one woman viewed her everyday life after a spinal cord injury (SCI). Method. Data were collected by conducting three interviews with one woman with a SCI. Open-ended questions were used with the intention of capturing the woman's own story. The narrative approach inspired by Polkinghorne was used to describe the woman's experiences of her everyday life after the SCI. Results. The analysis revealed that, events influenced her everyday life after a SCI and these events influenced her identity, habits and participation in activities. Further, how she has gone from a state of hopelessness in the early days to a reconstructed identity, associated with a new insight during the 2 years after the accident through a complex and dynamic process of change. In our interpretation we have attempted to provide an explanation of why this outcome came about. Conclusions. When using narratives, professionals within health-care could focus on the individual instead of the diagnosis or disability. Further, according to a client-centred perspective it is important to attain the client's experiences and knowledge to gain a more complete picture in order to obtain a profound understanding of the client.

  • 6.
    Isaksson, Gunilla
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Skär, Lisa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Lexell, Jan
    Women's perception of changes in the social network after a spinal cord injury2005In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 27, no 17, p. 1013-1021Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To describe how women with a spinal cord injury (SCI) perceived changes in the social network, and how these changes affected their ability to participate in occupation. METHOD: Thirteen women, aged 25 to 61 years, with a SCI were interviewed twice. The interviews focused on their ability to participate in occupation, their relations with individuals within the social network, and changes in the social network following the SCI. The analysis was carried out using qualitative content analysis. RESULTS: The women described an emotional need for social support after the SCI to participate in occupation. This was a new experience that required time to adapt to. The women also described a need for practical social support from the social network members to manage meaningful occupation. After the SCI, the women had developed new habits through close cooperation with members in the social network. The women felt that they had become more responsible for the development of their relations. Many relations had improved after the SCI, while some had decreased. The women had also developed new relations with other persons with disabilities. CONCLUSIONS: The women perceived substantial changes in the social network following the SCI, which in several ways affected their ability to participate in occupation. To adapt to their new life situation, the women gradually developed different strategies. The results point out the need to identify persons in the social network that women with SCI develop relations with, and integrate them in the rehabilitation process.

  • 7. Jumisko, Eija
    et al.
    Lexell, Jan
    Söderberg, Siv
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    The experiences of treatment from other people as narrated by people with moderate or severe traumatic brain injury and their close relatives2007In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 29, no 19, p. 1535-1543Article in journal (Refereed)
    Abstract [en]

    Purpose. The aim of this study was to describe the treatment from other people as experienced by people with moderate or severe traumatic brain injury (TBI) and their close relatives. Method. Twelve people with moderate or severe TBI and eight of their close relatives were interviewed. The interviews were analysed using thematic content analysis. Results. The results were described by the means of two themes: being excluded and missing confirmation. People with TBI and their close relatives had experiences of being avoided, being ruled by the authorities, being met with distrustfulness and being misjudged. They also searched for answers and longed for the right kind of help. People who listened to them, believed them and tried to understand and help them were appreciated. Conclusions. This study showed a lack of treatment which promotes well-being of the people with TBI and their close relatives. They experienced bad treatment also from authorities. Therefore, we emphasize that authorities should continuously reflect on how to make their practice a place which promotes dignity. Treatment of people with TBI and close relatives may be improved by increased knowledge about TBI, living with it and being a close relative to a person with TBI. This is a challenge to health care and rehabilitation professionals

  • 8.
    Juuso, Päivi
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Söderberg, Siv
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Olsson, Malin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Skär, Lisa
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    The significance of Associations for women with FM2014In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 36, no 21, p. 1755-1761Article in journal (Refereed)
    Abstract [en]

    Purpose: Living with fibromyalgia (FM) means living with a long-term pain syndrome that is invisible to others. Support and understanding from others seem to be important to managing the affected daily life. The aim of this study was to describe the significance of FM associations for women with FM. Methods: Data collection was carried out through focus group discussions with seventeen women with FM. Data were analyzed through thematic content analysis. Results: The findings show that women experienced associations for people with FM as important as they gave access to contacts with others with similar experiences. Their need of togetherness was fulfilled at the association and they described being strengthened by the support received. Because of the lack of information and knowledge about FM, the association was described as an important venue for getting and mediating information about the illness. Conclusions: At the association the women seem to be empowered, which increases their ability to manage their daily lives despite the limitations imposed by FM. Healthcare personnel could not satisfy the women’s needs and to manage to support women with FM. There is a need for communication based on a shared understanding between the women and healthcare personnel.Implications for Rehabilitation Read More: http://informahealthcare.com/eprint/hxrQu88eIVBPKf48aBpd/full

  • 9.
    Kottorp, Anders
    et al.
    Division of Occupational Therapy, Karolinska Institutet, Huddinge; Department of Occupational Therapy, University of Illinois at Chicago.
    Malinovsky, Camilla
    Division of Occupational Therapy, Karolinska Institutet, Huddinge.
    Larsson-Lund, Maria
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Nygård, Louise
    Division of Occupational Therapy, Karolinska Institutet, Huddinge.
    Gender and diagnostic impact on everyday technology use: a differential item functioning (DIF) analysis of the Everyday Technology Use Questionnaire (ETUQ)2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    Background: As the use of everyday technology is increasingly important for participation in daily activities, more in-depth knowledge of everyday technology use in relation to diagnosis and gender is needed. The purpose of this study was to investigate the stability of the perceived challenge of a variety of everyday technologies across different samples of varying diagnoses including both males and females.

    Methods: This cross-sectional study used 643 data records from clinical and research samples, including persons with dementia or related disorders, acquired brain injury, intellectual disability, various mental or medical disorders, and adults without known diagnoses. The Everyday Technology Use Questionnaire, comprising 93 everyday technology artifacts and services (items) measuring the level of everyday technology challenge and relevance of and perceived ability to use these was used for data gathering. A two-faceted Rasch model in combination with differential item functioning (DIF) analyses were used for comparing item hierarchies across samples.

    Results: Only three items (3.2%) demonstrated a clinically relevant DIF by gender, and nine items (9.7%) by diagnosis.

    Discussion: The findings support a stable hierarchy of everyday technology challenge in home and community that can facilitate planning of an accessible and inclusive society from a technological departure point.

    • Implications for Rehabilitation
    • The ability to manage everyday technology is increasingly important for participation in everyday activities at home and in the community for people with and without disabilities.

    • This study demonstrates that differences in perceived challenges in using various everyday technologies across gender and diagnosis are minimal.

    • The findings provide evidence of no or minor systematic bias in testing when using the Everyday Technology Use Questionnaire in clinical practice and research.

    • Empirical knowledge about the perceived challenge of specific everyday technologies of people with variations in gender or diagnosis is still sparse, hence this study can inspire practice and future research.

  • 10.
    Kumlien, Suzanne
    et al.
    Karolinska institutet, Department of Clinical Neuroscience and Family Medicine.
    Axelsson, Karin
    Ljunggren, Gunnar
    Karolinska institutet, Department of Clinical Neuroscience and Family Medicine.
    Winblad, Bengt
    Karolinska institutet, Department of Clinical Neuroscience and Family Medicine.
    Stroke patients ready for discharge from acute care: a multi-dimensional assessment of functions and further care1999In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 21, no 1, p. 31-8Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study was to describe actual functions, performance of activities and needs of further care in patients with stroke in acute care wards at the time the physicians decided that the patients were ready for discharge, in relation to placement after discharge and the motives for the decision. METHOD: Thus 114 stroke patients in Stockholm County were assessed with the Resident Assessment Instrument, and the motives for further care were reviewed in the patients' case records. RESULTS: The results showed that the oldest, most severely impaired stroke patients had the shortest mean length of stay before the physician considered the patients ready for discharge to nursing homes, where resources for long-term rehabilitation and stroke care vary. CONCLUSION: It is important to secure continuing adequate care and rehabilitation for elderly severely impaired stroke patients being discharged early from acute care hospitals.

  • 11.
    Larsson-Lund, Maria
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lexell, Jan
    Luleå University of Technology, Department of Health Sciences, Medical Science.
    Relationship between participation in life situations and life satisfaction in persons with late effects of polio2009In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 19, p. 1592-1597Article in journal (Refereed)
    Abstract [en]

    Purpose. To assess the relationship between participation and problems with participation in life situations, and life satisfaction in persons with late effects of polio. Methods. One hundred fifty-eight persons with late effects of polio responded to a postal questionnaire including the Swedish versions of the Impact on Participation and Autonomy Questionnaire (IPA-S) and Life Satisfaction Questionnaire (LiSat-11). Results. The persons' perceived participation in the five domains of participation in the IPA-S was significantly correlated with their satisfaction with life as a whole and with most of the 10 domains of life satisfaction. Significant differences in satisfaction with life as a whole and with eight of the 10 domains in LiSat-11 were found between groups of increasing severe problems with participation. Greater number of reports of severe problems with participation corresponded with gradually decreased satisfaction with life as a whole and with satisfaction in the eight domains in LiSat-11. Conclusions. Perceived participation and problems with participation in life situations are determinants of life satisfaction in persons with late effects of polio. This implies that addressing participation and problems with participation in the rehabilitation of persons with late effects of polio may lead to an enhanced life satisfaction.

  • 12.
    Larsson-Lund, Maria
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Nordlund, Anders
    Bernspång, Birgitta
    Institutionen för samhällsmedicin och rehabilitering, Umeå universitet.
    Lexell, Jan
    Luleå University of Technology, Department of Health Sciences.
    Perceived participation and problems in participation are determinants of life satisfaction in people with spinal cord injury2007In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 29, no 18, p. 1417-1422Article in journal (Refereed)
    Abstract [en]

    Purpose. To determine the relationships between perceived participation and problems in participation, and life satisfaction in people with spinal cord injury (SCI). Method. A total of 157 men and women with SCI completed the Swedish versions of the Impact on Participation and Autonomy Questionnaire (IPA) and the Life Satisfaction Questionnaire (LiSat-9). Results. The respondents' perceived participation in the five domains of the IPA was significantly correlated with their satisfaction with life as a whole (P < 0.01) and in most of the eight other domains of life satisfaction (P < 0.05 to P < 0.01) in the LiSat-9. The respondents' life satisfaction decreased gradually with increasing frequency of severe problems in participation and significant differences within groups of increasingly severe problems were found. The level of life satisfaction in respondents that perceived no severe problems with participation was similar to those of a normal population. Conclusions. Perceived participation and problems in participation are determinants of life satisfaction in people with SCI. The results emphasize the importance to focus on severe problems with participation in order to optimize life satisfaction during the rehabilitation after SCI.

  • 13.
    Larsson-Lund, Maria
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Nygård, Louise
    Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet.
    Kottorp, Anders
    Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet.
    Perceived difficulty in the use of everyday technology: relationships with everyday functioning in people with acquired brain injury with a special focus on returning to work2014In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 36, no 19, p. 1618-1625Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim was to explore the relationships between difficulties in the use of everyday technology (ET) and the ability to perform activities of daily life (ADL) in the home and in society and in the workplace in people with acquired brain injury (ABI). Method: The investigation comprises an explorative cross-sectional study of 74 people with ABI. The short version of the Everyday Technology Use Questionnaire (S-ETUQ) and a revised version of the ADL taxonomy were used to evaluate the participants. Rasch-generated person ability measures of ET use and ADL were used in correlation analyses, in group comparisons by ANOVA and in logistic regressions. Results: Difficulty in the use of ET was significantly correlated with ADL limitations. People who worked full-or part-time had significantly higher ability to use ET than those with some type of full-time, long-term sickness compensation. The ability to use ET, ADL ability and age were significantly related to return to work. Conclusion: The ability to use ET is related to all areas of everyday functioning in people with ABI. Therefore, a patient's ability to use ET needs to be considered in rehabilitation strategies following an ABI to enhance the patient's performance of activities in the home and in society and to support his or her likelihood of returning to work.Implications for Rehabilitation Ability to use everyday technology (ET) needs to be considered in rehabilitation following an ABI as difficulty in ET use is significantly related to the abilities of people with acquired brain injury (ABI) in all areas of everyday functioning (P/I ADL, leisure and work). The assessment S-ETUQ can assist professionals in screening and identifying ET that clients perceive supporting or challenging their everyday functioning. With respect to the Information and communication society of today, the match between users abilities and ET is important knowledge in designing an e-accessible and e-inclusive society for people with disabilities.Purpose: The aim was to explore the relationships between difficulties in the use of everyday technology (ET) and the ability to perform activities of daily life (ADL) in the home and in society and in the workplace in people with acquired brain injury (ABI). Method: The investigation comprises an explorative cross-sectional study of 74 people with ABI. The short version of the Everyday Technology Use Questionnaire (S-ETUQ) and a revised version of the ADL taxonomy were used to evaluate the participants. Rasch-generated person ability measures of ET use and ADL were used in correlation analyses, in group comparisons by ANOVA and in logistic regressions. Results: Difficulty in the use of ET was significantly correlated with ADL limitations. People who worked full- or part-time had significantly higher ability to use ET than those with some type of full-time, long-term sickness compensation. The ability to use ET, ADL ability and age were significantly related to return to work. Conclusion: The ability to use ET is related to all areas of everyday functioning in people with ABI. Therefore, a patient’s ability to use ET needs to be considered in rehabilitation strategies following an ABI to enhance the patient’s performance of activities in the home and in society and to support his or her likelihood of returning to work.Implications for Rehabilitation Read More: http://informahealthcare.com/eprint/TKG7s8c6S5PjgR6yIHY4/full

  • 14.
    Lexell, Eva Månsson
    et al.
    Department of Rehabilitation Medicine, Skåne University Hospital.
    Lexell, Jan
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Larsson-Lund, Maria
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    The rehabilitation plan can support clients’ active engagement and facilitate the process of change: experiences from people with late effects of polio participating in a rehabilitation programme2016In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 4, p. 329-336Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore how the rehabilitation plan influences the rehabilitation process and its outcome in people with late effects of polio participating in an individualised goal-oriented interdisciplinary rehabilitation programme. Methods: Four women and two men with late effects of polio were interviewed before rehabilitation, at discharge, and at follow-up. Data were analysed according to the constant comparative method of grounded theory. Findings: The participants’ experiences formed one core category: “The same starting point but different rehabilitation processes”. Before rehabilitation, all participants experienced a similar starting point: Naïve understanding of rehabilitation. During rehabilitation, two separate processes followed. Four participants experienced their rehabilitation as being a mutually shared process that led to a process of change. They were actively engaged, using the rehabilitation plan, and working towards goals targeting a broad perspective of daily activities. The remaining two participants experienced their rehabilitation as a staff-directed process, with limited use of the rehabilitation plan, focusing on goals mainly related to body functions and self-care, not leading to any substantial changes. Conclusion: When clients experience that they develop a mutually shared rehabilitation process, based on a rehabilitation plan, they became more engaged in their rehabilitation and gained a better understanding of their participation during the process. Knowledge of the differences in how clients use the rehabilitation plan during the rehabilitation process can support their active engagement during rehabilitation. This, in turn, can promote a more holistic view among clients and professionals during the rehabilitation for people with late effects of polio

  • 15. Lexell, Jan
    et al.
    Månsson, Eva
    Department of Rehabilitation, Lund University Hospital, Sweden.
    Performance of activities of daily living in multiple sclerosis2004In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 26, no 10, p. 576-85Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To assess the performance of activities of daily living (ADL) in individuals with moderate to severe multiple sclerosis (MS). METHOD: A total of 12 men and 32 women with MS (Expanded Disability Status Scale, EDSS, 6.0-8.5) were studied. The performance of personal ADL (P-ADL) and instrumental ADL (I-ADL) was assessed with the Functional Independence Measure (FIM) and the Assessment of Motor and Process Skills (AMPS). RESULTS: Twenty-four of the 44 individuals were rated dependent in P-ADL by the FIM motor score, mainly due to limitations in some areas of self-care and in transfers and locomotion. Only three individuals were rated dependent by the FIM cognitive score, indicating no or little cognitive disability. Two thirds of the individuals who were rated independent/modified independent in P-ADL by the FIM were rated dependent in I-ADL by the AMPS. Only the FIM motor score was significantly related to the EDSS score, indicating that ADL performance and disease severity is weakly related. CONCLUSIONS: Moderate to severe MS reduces the ability to perform both P-ADL and I-ADL. An individual with MS can be independent in P-ADL but still unable to perform I-ADL satisfactorily. Assessments of both P-ADL and I-ADL are advocated to evaluate ADL performance in order to implement appropriate management strategies for individuals with MS.

  • 16.
    Lindgren, Ingrid
    et al.
    Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund.
    Brogårdh, Christina
    Lund University Hospital, Skåne University Hospital, Lund, Institutionen för hälsa, vård och samhälle, Lunds universitet, Department of Health Sciences, Lund University, Department of Rehabilitation Medicine, Skåne University Hospital.
    Shoulder pain after stroke – experiences, consequences in daily life and effects of interventions: a qualitative study2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, no 10, p. 1176-1182Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe experiences of shoulder pain after stroke, how pain affects daily life and perceived effects of interventions.

    Method: A qualitative interview study including 13 community-dwelling persons (six women; median age 65 years) with persistent shoulder pain after stroke.

    Results: Three categories emerged from the content analysis. In “Multiple pain characteristics” an insidious pain onset was reported. The pain existed both day and night and could be located around the shoulder girdle but also have radiation to the arm and hand. An explanation of the pain was seldom given. In “Limitations caused by the pain” it was described how the pain negatively influenced personal care, household activities and leisure, but also could lead to emotional reactions. In “Multiple pain interventions with various effects” a variety of interventions were described. Self-management interventions with gentle movements were perceived most effective. A restraint attitude to pain medication due to side effects was reported.

    Conclusions: Shoulder pain after stroke can lead to a variety of pain characteristics. As the pain is complex and may affect many important areas in a person’s life, multidisciplinary rehabilitation interventions are important.

  • 17.
    Lundström, Ulrica
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lilja, Margareta
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Gray, David
    Disability and Community Participation Research Office (DACPRO), Washington University School of Medicine.
    Isaksson, Gunilla
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Experiences of participation in everyday occupations among persons aging with a tetraplegia2015In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 11, p. 951-957Article in journal (Refereed)
    Abstract [en]

    This study aimed to gain understanding of participation in everyday occupations through life stories of persons aging with a traumatic spinal cord injury (SCI). Method: A narrative method was used for data collection and a paradigmatic analysis was used to analyze data. Results: The analysis resulted in three themes that illustrate how the participants acted to participate in everyday occupations, how that changed over time, and some concerns about their future. The first theme illustrates how participants following SCI acted to become agents of their lives and participate in everyday occupations. The second theme illustrates how participants had to prioritize participation in meaningful occupations due to personal and environmental factors. The third theme shows how they had to try new strategies to continue participation in occupations, due to secondary health complications related to aging. Conclusions: This study captures how persons aging with tetraplegia acted to participate in everyday occupations from soon after the injury until several decades later. In addition, their ability to act and participate changed over time. Our findings provide knowledge that can guide clinicians in their work within this complex area of rehabilitation. Besides, it can also guide the work with policy recommendations for healthcare and social service systems.Implications for Rehabilitation

  • 18.
    Löfgren, Britta
    et al.
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Arbetsterapi.
    Nyberg, Lars
    Österlind, Per-Olov
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Gustafson, Yngve
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    In-patient rehabilitation after stroke: outcome and factors associated with improvement1998In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 20, no 2, p. 55-61Article in journal (Refereed)
    Abstract [en]

    A study aimed at examining the outcome of activities of daily living (ADL) of patients undergoing geriatric stroke rehabilitation was performed. Background and admission data of 99 patients surviving the acute phase and needing further hospital rehabilitation were registered. Forty per cent of the patients improved their ADL ability. The logistic regression modelling with the dichotomous dependent variable improvement versus no improvement showed the following factors associated with improvement: a diagnosis of intracerebral haemorrhage, male sex, high postural stability score at the admission and cohabitation. In conclusion, the most severely affected stroke patients, especially patients with intracerebral haemorrhage, have a great potential for improving their ADL. The results of the logistic regression model can serve as a useful guide when it comes to identifying patients that stand a fair chance of improving during their rehabilitation stay. Equally important, patients with a poor rehabilitation prognosis who may need intensified rehabilitation efforts to achieve optimum improvement can now be identified.

  • 19.
    Mannerkorpi, Kaisa
    et al.
    Sahlgrenska akademin, Göteborg, Department of rheumatology and inflammation research.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Physiotherapy group treatment for patients with fibromyalgia: an embodied learning process2003In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 25, no 24, p. 1372-80Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To study how patients with fibromyalgia (FM) experienced physiotherapy group treatment comprising pool exercise and education. METHODS: Nineteen patients with FM were interviewed and the transcribed interviews were analysed using a phenomenological life-world approach. The participants' mean age was 45 years and their mean symptom duration was 10 years. RESULTS: Physiotherapy group treatment was experienced as an embodied learning process, comprising the themes: positive experience of body, sharing experiences of living with FM and creating new patterns of acting. The positive experience of body comprised the following categories: experiencing relaxation, experiencing physical capacity, acknowledging limitations and changing the pattern of activity. Sharing experiences comprised the following categories: not being alone and sharing joy. Three patterns of participation were identified: reciprocity, distancing and remaining outside. Creating new patterns comprised the following categories; calming down, creating a new relationship to self, creating a new relationship to social roles and creating new patterns for managing pain. CONCLUSIONS: The study indicates that physiotherapy group treatment was experienced as an embodied learning process. Positive experiences of body were intertwined with a new relationship to self and objects in the world. Interactions between the co-participants promoted the process of creating new patterns of thinking and acting in the social world.

  • 20.
    Mannerkorpi, Kaisa
    et al.
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, Göteborg University.
    Rivano-Fischer, Marcelo
    Department of Rehabilitation, Lund University.
    Ericsson, Anna
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, Göteborg University.
    Nordeman, Lena
    Primary Health Care, Alingsås.
    Gard, Gunvor
    Experience of physical activity in patients with fibromyalgia and chronic widespread pain2008In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 30, no 3, p. 213-221Article in journal (Refereed)
    Abstract [en]

    Purpose. Patients with fibromyalgia (FM) and chronic widespread pain (CWP) find physical activity troublesome. The purpose was to develop a questionnaire to investigate the experience of physical activity in FM and CWP populations. Method. A questionnaire was developed from a qualitative study. After that, a total of 204 patients with FM or CWP completed the questionnaire. A factor analysis was conducted and the internal consistency was investigated. The relationship between the factors and pain, health status (the Fibromyalgia Impact Questionnaire, FIQ), distress (the Hospital Anxiety and Distress scale, HAD) and leisure time physical activity (the Leisure Time Physical Activity Instrument, LTPAI) was investigated. Results. Five factors were identified: Physical Relaxation (PR), Well-being (WB), Activity Beliefs (AB), Activity-related Symptoms (AS) and Activity Habits (AH). Cronbach's alpha ranged from 0.57 to 0.86. The PR showed a correlation (rho 0.28, p < 0.01) with the FIQ Pain. The AS showed a correlation (rho 0.25, p < 0.01) with the FIQ total score, while the AH showed a correlation with the HAD Depression (0.26, p < 0.01) and with strenuous physical activity (LTPAI) (-0.32, p < 0.01). Conclusion. A new instrument was developed to study the experience of physical activity in persons with long-lasting pain. Five factors were identified using factor analysis, and three of them showed fair associations with FM symptoms, distress or physical activity

  • 21.
    Palstam, Annie
    et al.
    Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg.
    Gard, Gunvor
    Mannerkorpi, Kaisa
    Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg.
    Factors promoting sustainable work in women with fibromyalgia2013In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 35, no 19, p. 1622-1629Article in journal (Refereed)
    Abstract [en]

    Purpose: To examine and describe the factors promoting sustainable work in women with fibromyalgia (FM). Methods: A qualitative interview study. Twenty-seven gainfully employed women with FM participated in five focus group interviews. Their median age was 52 years, ranging from 33 to 62. The interviews were recorded, transcribed verbatim and analysed by qualitative latent content analysis. Results: Four categories were identified describing factors promoting sustainable work: the meaning of work and individual strategies were individual promoters while a favourable work environment and social support outside work were environmental promoters. The meaning of work included individual meaning and social meaning. The individual strategies included handling symptoms, the work day and long-term work life. A favourable work environment included the physical and psychosocial work environment. Social support outside work included societal and private social supports. Conclusions: Promoting factors for work were identified, involving individual and environmental factors. These working women with FM had developed advanced well-functioning strategies to enhance their work ability. The development of such strategies should be supported by health-care professionals as well as employers to promote sustainable work in women with FM.Implications for Rehabilitation

  • 22.
    Rutberg, Stina
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Kostenius, Catrine
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Öhrling, Kerstin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Professional tools and a personal touch: experiences of physical therapy of persons with migraine2013In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 35, no 19, p. 1614-1621Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim was to explore the lived experience of physical therapy of persons with migraine. Method: Data were collected by conducting narrative interviews with 11 persons with migraine. Inspired by van Manen, a hermeneutic phenomenological method was used to analyse the experiences of physical therapy which these persons had. Results: Physical therapy for persons with migraine meant making an effort in terms of time and energy to improve their health by meeting a person who was utilising his or her knowledge and skill to help. Being respected and treated as an individual and having confidence in the physical therapist were highlighted aspects. The analysis revealed a main theme, “meeting a physical therapist with professional tools and a personal touch”. The main theme included four sub-themes, “investing time and energy to feel better”, “relying on the competence of the physical therapist”, “wanting to be treated and to become involved as an individual” and “being respected in a trustful relationship”. Conclusions: The therapeutic relationship with the physical therapist is important and the findings of this study can increase awareness about relational aspects of physical therapy and encourage thoughtfulness among physical therapists and other healthcare professionals interacting with persons with migraine. Implications for Rehabilitation •Physical therapists use both professional tools and a personal touch in their interaction with persons with migraine and this article can increase physical therapists’ awareness and encourage thoughtfulness in their professional practice.•Being respected and treated as an individual and having confidence in the physical therapist are important aspects of the therapeutic relationship and indicate a need for patient-centred care.•By making the effort of spending the time and energy required, physical therapy could be a complement or an alternative to medication to ease the consequences of migraine.

  • 23.
    Rutberg, Stina
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Öhrling, Kerstin
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Migraine − more than a headache: women's experiences of living with migraine2012In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 4, p. 329-336Article in journal (Refereed)
    Abstract [en]

    Purpose: In this qualitative study the aim was to explore the meaning of living with migraine. Method: In-depth interviews were conducted with ten women about their experience of living with migraine. Halfway through the interview, the women drew a picture of what living with migraine is like, and the interview continued with the conversation being guided by the picture. The interviews were analyzed using a hermeneutic phenomenological method inspired by van Manen. Results: The analysis revealed an essence “Being obliged to endure a life accompanied by an unpredictable and invisible disorder” and three themes “Being besieged by an attack”, “Struggling in a life characterized by uncertainty” and “Living with an invisible disorder.” Conclusion: Migraine is a debilitating disorder which accompanies life in the sense that it or the threat of its return is always present, and yet invisible to others. The struggle of enduring life with migraine is worsened by the feeling of having an invisible disorder and of being doubted. There is a need to increase the knowledge among healthcare professionals about what it means to live with migraine, something this qualitative study offers. Read More: http://informahealthcare.com/eprint/dMX3Yk2JskPHanvF8JyK/full

  • 24.
    Röding, Jenny
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Glader, Eva-Lotta
    Department of Pharmacology and Clinical Neuroscience, Umeå University.
    Malm, Jan
    Department of Pharmacology and Clinical Neuroscience, Umeå University.
    Eriksson, Marie
    Department of Public Health and Clinical Medicine, Umeå university.
    Lindström, Britta
    Umeå University, Department of Community Medicine and Rehabilitation.
    Perceived impaired physical and cognitive functions after stroke in men and women between 18 and 55 years of age: a national survey2009In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 13, p. 1092-1099Article in journal (Refereed)
    Abstract [en]

    Purpose. We describe self-reported consequences for physical and cognitive functions, detect possible gender differences, and find factors that were associated with deteriorated physical function in younger stroke patients, independent in their personal activities of daily life. Methods. This study involved all first ever stroke patients, aged 18-55 years, registered in the Swedish national quality register for stroke. A questionnaire was answered by 1068 patients 8-36 months after the stroke. Changes were sought in physical and cognitive functions as compared with the pre-stroke condition. Results. Eight hundred and sixty-seven patients (83%) were independent in personal activities of daily life. Significant differences between men and women were found: deteriorated physical ability was reported by 56-71% of the men and 65-79% of the women; deteriorated cognitive function was reported by 48-57% of the men and 57-68% of the women. Many patients (70% men, 77% women) reported that they had received insufficient information about physical exertion. Significant associations were found between deteriorated physical function and deteriorated cognitive function as well as fear of physical exertion. Conclusions. Deterioration was found in physical and cognitive functions greater in women then in men. Insecurity regarding physical exertion existed indicating that younger stroke patients might need information directly aimed at physical functioning and more gender specific than today. This study has raised the awareness that there also might be gender differences in other fields, which needs further studies.

  • 25. Röding, Jenny
    et al.
    Lindström, Britta
    Umeå University, Department of Community Medicine and Rehabilitation.
    Malm, Jan
    Umeå University, Department of Pharmacology and Clinical Neuroscience.
    Öhman, Ann
    Umeå University, Department of Community Medicine and Rehabilitation.
    Frustrated and invisible: younger stroke patients' experiences of the rehabilitation process2003In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 25, no 15, p. 867-74Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This study aimed to get knowledge of the younger stroke patient's viewpoint and to describe how young stroke patients experience the rehabilitation process. The purpose was also to develop hypotheses about the relationship between young stroke patients and the rehabilitation process. METHOD: Thematised in-depth interviews were performed with two women and three men who suffered from stroke (37 - 54 years). The analysis used was the Grounded Theory method of constant comparison. RESULTS: The analyses resulted in the core category 'Frustration' which was derived from the categories labelled 'The paralysed everyday' and 'Outside and invisible'. 'The paralysed everyday' category involved different aspects of everyday life after a stroke. Because of their fatigue they were unable to work and their family and social life were negatively affected. They found it difficult to engage in daily life activities and felt indifferent. The three women expressed frustration over the demands they experienced as being mothers and housekeepers, whereas the two men emphasised economic responsibility of the family as problematic. The category 'Outside and invisible' describes the lack of participation the informants experienced regarding the rehabilitation process. The informants felt they lacked information and age-adapted interventions. Their needs were not provided for and they felt distant from the other patients. Their remaining symptoms were probably on a cognitive basis and therefore invisible. This was a source of frustration. CONCLUSION: The hypotheses generated indicated that young stroke patients are frustrated and invisible due to the fact that the rehabilitation setting does not acknowledge the different needs of young stroke patients compared with older patients.

  • 26.
    Sjödahl, Catharina
    et al.
    Lund University Hospital, Scandinavian Orthopaedic Laboratory.
    Gard, Gunvor
    Jarnlo, Gun-Britt
    University of Lund, Department of Physical Therapy.
    Coping after trans-femoral amputation due to trauma or tumour: a phenomenological approach2004In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 26, no 14/15, p. 851-61Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To describe, by use of a phenomenological approach, how relatively young trans-femoral amputees experienced their amputation and their coping strategies in the acute phase and over time. METHOD: Eleven trans-femoral amputees, median age 33.5 years, were interviewed. The amputation was caused by tumour, motorcycle accidents or work-related traumas. Amputation was made in median 7.5 years before the interview. The informants were community dwelling and managed well indoors. One had a half disablement pension and all the others were working or studying full time. The interviews were tape-recorded and transcribed verbatim. RESULTS: Two themes emerged. In the first theme 'Experiences of the amputation' denial and avoidance were the coping strategies mainly used. In the second theme 'Coping strategies to relate to a new norm' the informants used downward comparison, positive comparison and repression. Only one informant indicated a full acceptance of his situation. CONCLUSION: Relatively young, trans-femoral amputees within this sample, have not reached the acceptance level, though a long time has passed since the amputation. They might have benefited from professional support and guidance during the rehabilitation process in order to improve coping strategies to relate to a new norm.

  • 27.
    Sjödahl, Catharina
    et al.
    Lund University Hospital, Scandinavian Orthopaedic Laboratory.
    Gard, Gunvor
    Jarnlo, Gun-Britt
    University of Lund, Department of Physical Therapy.
    Transfemoral amputees' experiences of the first meeting and subsequent interactions with hospital staff2008In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 30, no 16, p. 1192-1203Article in journal (Refereed)
    Abstract [en]

    Purpose. To describe, by use of a phenomenological approach, how transfemoral amputees experience their first meeting and subsequent interaction with hospital staff in the acute phase, in the long term and suggestions for future care-giving. Method. Eleven transfemoral amputees, median age 33.5 years, were interviewed. The amputations, performed in median 7.5 years before the interview, were caused by tumour, motorcycle accidents or work-related traumas. The participants were community dwelling and managed well indoors. All, except one, worked or studied full time. The interviews were tape-recorded and transcribed verbatim. Results. Three themes emerged: (i) Communication/information - limitations in preparing the patient for the new situation, (ii) empathy and emotional support, and (iii) ability to meet the need of individually tailored rehabilitation. For future care-giving three categories emerged: (i) Individually tailored communication/information, (ii) rehabilitation to be prepared to adapt to one's new situation, and (iii) support in regaining control. Conclusion. The participants expressed a need for both professional and emotional support in the acute phase. Over time they preferred a patient-centred approach which improved coping skills and facilitated their own ability to gain control. Increased awareness of how meeting and interacting with hospital staff influences rehabilitation processes may further improve patient satisfaction and outcomes.

  • 28.
    Söderberg, Siv
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Jumisko, Eija
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Clients' experiences of a work rehabilitation process2004In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 26, no 7, p. 419-24Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study was to describe clients' experiences of a work rehabilitation process. METHOD: Ten clients who had participated in work-related rehabilitation at a rehabilitation centre in the northern parts of Sweden were interviewed using a narrative approach. The interviews were analysed using qualitative content analysis focusing on clients' descriptions of the goals, contents and results of the work rehabilitation process. RESULTS: At the beginning of the rehabilitation the goal was often to confirm a diagnosis, to become healthy and able to return to work. It was hard to be forced to change the goals. When fortunate the rehabilitation provided more profound guidance and function assessment. It resulted in changes varying from practical alterations to important insights into life. It was important to get support and understanding. When the rehabilitation was not adjusted to clients' needs, feelings of disappointment emerged and life became a struggle with various authorities in order to gain understanding and other forms of rehabilitation. CONCLUSIONS: This study shows the need to develop truly client-centred practice. Therefore, we emphasized, based on this study, the importance of professionals involved in rehabilitation working on different levels and in various settings having regular discussions about what the term client-centred practice means to them. Integrating individual perceptions is essential to advancing a multidimensional approach in return-to-work research.

  • 29.
    Tamm, Maare
    Boden University College of Health Sciences.
    What does a home mean and when does it cease to be a home?: Home as a setting for rehabilitation and care1999In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 21, no 1, p. 49-55Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This article addresses three issues: (1) what does a home mean to a person? (2) what happens when the patients are rehabilitated in the home? and (3) can the home become a workplace for a professional? METHOD: A literature review based on research literature and on the author's research project in the north of Sweden 'Rehabilitation in a home setting--ethical, psychological and occupational therapeutic aspects,. RESULTS: For most people, the home is an important and meaningful place, where ultimate goals can be cultivated, sheltered from the intrusions of public life. In connection with chronic illness, functional impairment and rehabilitation in the home, the individual will often lose the home as a private territory and much of his/her own autonomy. No longer is the home an existential centre for the family, but a place where many unfamiliar people come and go. Rehabilitation in a home setting means, furthermore, that the public sector is moved into the home, and the home has to function as a public workplace, ensuring a good working environment. CONCLUSIONS: The question for the future is: can the combination of home and public workplace work at all? More research is needed to answer this question. Prior documented experiences show that it is difficult

  • 30.
    Vik, Kjersti
    et al.
    Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute.
    Nygård, Louise
    Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute.
    Lilja, Margareta
    Encountering staff in the home: Three older adults' experience during six months of home-based rehabilitation2009In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 8, p. 619-629Article in journal (Refereed)
    Abstract [en]

    Purpose. The purpose of the present study was to explore and describe how older adults who received home-based rehabilitation perceived the staff during a period of 6 months when they received rehabilitation. Specifically, the study focused on how the participants collaborated with and made use of the services from the staff. Method. In this case-oriented study, three older adults were interviewed continuously during the 6-month period they received home-based rehabilitation. The interviews were analysed continuously using a grounded theory approach. Results. Five different modes of perceiving the staff were identified among the participants: as small talk persons, as discussions partners, as instructors and advisors, as teachers and as persons who carry out tasks efficiently. The three conditions that most came to influence the way the participants perceived collaborated with the staff were as follows: 'experience and encounters with the staff', 'expectations for the future daily life', and 'the participants' needs and tasks related to their disability'. Conclusions. To achieve collaboration and user involvement, the staffs have to encounter each client differently in accordance with the various tasks that must be carried out during rehabilitation. Our findings indicate that this is particularly important for older adults during home-based rehabilitation, since older adults often have changing needs because of comorbidity

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