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  • 1.
    Olofsson, Alexandra
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Möjlighet till aktivitet och delaktighet utanför hemmet för personer med förvärvad hjärnskada2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to investigate the possibility for activity and participation outside the home for people of working age with acquired brain injury(ABI). Study I aimed to explore and describe how people with ABI experience engagement in activities outside the home. Interviews were conducted with eight participants and data were analyzed using constant comparative methodology. The results showed that difficulties in processing impressions, fatigue, preparation and perceived risks were crucial to participants´ reduced engagement in activities. People with ABI used new strategies to enable engagement in activities that had different consequences for their lives. Study II aimed to explore and identify problematic situations related to everyday activities outside the home for persons with ABI. Repeated interviews and participant observations were conducted with two participants, and the generated data were analyzed using narrative method. The participants' stories reflected how they constantly struggled to handle unexpected events and control the different situations they faced when engaging in activities outside the home. Furthermore, the narratives expressed how they withdrew from different places, which meant that their social lives were diminished, and more activities were performed alone and at home after their injury. Study III aimed to describe and compare the perceived participation in places for activities outside the home for people with stroke and the relationship between the total number of places visited, the severity of disability and sociodemographic data. Interviews were conducted with sixty-three participants with stroke based on the ACT-OUT instrument. Data were analysed using descriptive statistics, non-parametric tests, ANOVA and General Linear Model (GLM). The results showed that the good recovery group visited the most number of places on average followed by those with moderate and severe disabilities, and the difference between the groups was significant. Differences in visited places were primarily related to places for social, cultural and spiritual activities, as well as places for recreational and physical activities. Regardless of the severity of disability, participants wanted to visit places in the future that they did not visit in the present. The severity of disability and driving a car were significantly associated with the total number of visited places for activities outside the home. Study IV aimed to explore patterns of participation in places for activities outside the home and if these patterns were related to severity of disability and environmental factors. Interviews were conducted with the same participants and instruments as in Study III and analysed using descriptive statistics, non-parametric tests and a two-stage cluster analysis. The analysis revealed five patterns of participation containing four facilitating and hindering aspects: the perceived distance to the place, how frequently the place was visited, the familiarity of the place and the familiarity of the way to the place. The results showed that there were only significant differences between the patterns in terms of transportation to and from the place and social support.

    In summary, this thesis contributes knowledge of the multifaceted, ever-changing challenges and problematic situations experienced by people with ABI when they are engaged in activities outside the home, as well as strategies that enable people with ABI to resume and/or maintain activities outside the home. This thesis also contributes knowledge regarding relationships and patterns that affect experienced participation in places for activities outside the home, which is important for understanding the relationship between activities and places. To develop the design of rehabilitation interventions that strengthen the possibility of activity and participation after ABI, both activities and places outside the home need to be considered as well as aspects influencing the relationships between them.

     

  • 2.
    Malinowsky, Camilla
    et al.
    Division of Occupational Therapy, Department of Neurobiology, Care Science and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
    Olofsson, Alexandra
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Nyman, Anneli
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Larsson-Lund, Maria
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Patterns of participation: Facilitating and hindering aspects related to places for activities outside the home after stroke2019In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014Article in journal (Refereed)
    Abstract [en]

    Background: Being engaged in activities in places outside the home after a stroke can be challenging. Knowledge about what characterize places outside the home is important to support participation.

    Objectives: To explore patterns of participation in places for activities outside the home after stroke and whether these patterns were associated with personal and environmental aspects.

    Material and methods: Sixty-three people with stroke were interviewed using the Participation in Activities and Places Outside Home (ACT-OUT) questionnaire. A two-step cluster analysis was used to identify patterns of participation and non-parametric test was used to explore potential associations to the patterns of participation.

    Results: Four clusters of patterns of participation, based on frequency, familiarity of the place/the way to the place and perceived distance, were identified. The patterns were significantly associated with type of place, activity domain, retained or abandoned participation, transportation and being accompanied by someone. The severity of disability was significantly associated with groups of individuals with different patterns of participation.

    Conclusions: Different combinations of aspects facilitated and hindered whether or not participation changed. To support people with stroke in their endeavour to retain or recapture participation, social support is important to consider in relation to transportation, activities and places outside the home.

  • 3.
    Olofsson, Alexandra
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Nyman, Anneli
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Kassberg, Ann-Charlotte
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Malinowsky, Camilla
    Department of Neurobiology, Care Science and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
    Larsson-Lund, Maria
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Places visited for activities outside the home after stroke: Relationship with the severity of disability2019In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006Article in journal (Refereed)
    Abstract [en]

    Introduction

    Knowledge about the places people visit or do not visit after stroke is lacking. The aim of this study was to describe and compare the places visited for activities outside the home of people with stroke of working age and to explore the influence of the severity of disability, fatigue, driving a car and sociodemographic characteristics on the total number of places visited for activities outside the home.

    Methods

    An exploratory cross-sectional study was conducted and 63 people with stroke were interviewed with instruments that covered places outside the home, severity of disability and fatigue. Data were analysed using non-parametric tests, analysis of variance and the general linear model.

    Results

    Significant difference in the total number of places visited for activities outside the home were found between all three groups of severity of disability. The good recovery group visited eight places to a significantly higher extent than those with severe/moderate disability. The severity of disability and driving a car were the only aspects that significantly influenced the total number of places visited.

    Conclusions

    Places for activities outside the home people with stroke visit and changes therein can add valuable knowledge about participation that can be used in the design of rehabilitation.

  • 4.
    Olofsson, Alexandra
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Larsson-Lund, Maria
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Nyman, Anneli
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Everyday activities outside the home are a struggle: Narratives from two persons with acquired brain injury2018In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Participation restriction is a common consequence after acquired brain injury (ABI).

    AIM

    To explore and identify problematic situations in everyday activities outside the home for persons with acquired brain injury.MATERIAL AND METHODTwo persons of working age with ABI were included. Data were generated through repeated semi-structured interviews and participant observations. Narrative analysis was used to capture ongoing processes related to problematic situations during engagement in everyday activities outside the home.

    RESULTS

    The narratives reflect how places, everyday activities and social relations were closely connected and influenced engagement in everyday activities outside the home. The participants visited fewer places and performed more of their everyday activities alone in their homes after the injury compared to before. They were struggling to create meaning in their lives and trying to reformulate their identity. Problematic situations often occurred outside the home as a result of unexpected events. The narratives indicate a struggle to find new routines to handle challenging situations.

    CONCLUSIONS

    The results provide an understanding of how problematic situations occurred and were managed in different ways. By observing everyday situations professionals can gain access to how persons with ABI act in and reflect upon problematic situations which can eventually improve the design of individually tailored interventions.

  • 5.
    Olofsson, Alexandra
    et al.
    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.
    Nyman, Anneli
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Att leva som förut är inte ett alternativ: Berättelser från två personer med förvärvad hjärnskada2017Conference paper (Refereed)
    Abstract [sv]

    Aktiviteter utanför hemmet kan vara utmanande för personer med förvärvad hjärnskada (FHS) och måste betraktas i förhållande till personens hela repertoar av aktiviteter. Vi vet idag lite om den komplexitet av interagerande faktorer som kan orsaka problematiska situationer för personer med FHS vilket gör att dessa är svåra att förutse. För att hantera pågående förändringar i aktivitetssituationer krävs stödjande strategier. Mer kunskap behövs därför om den ömsesidiga relationen mellan person och kontext för att bättre förstå hur det påverkar personens agerande och hur de influerar tillgång till platser samt aktiviteter utanför hemmet. Syftet med studien var att utforska och identifiera problematiska situationer relaterat till aktiviteter utanför hemmet. Metod: Berättelser från två personer med FHS användes för att illustrera hur de agerade i och reflekterade över problematiska situationer. Data samlades in via kvalitativa intervjuer och deltagande observationer som genomfördes vid upprepade tillfällen. En narrativ metod användes för att kunna fånga pågående processer relaterat till hur deltagarna agerade och reflekterade kring problematiska situationer relaterat till deras engagemang i aktiviteter utanför hemmet. Resultatet: visar hur deltagarna på olika sätt ställs inför problematiska situationer i samband med att de engagerar sig i aktiviteter utanför hemmet. Att leva ett liv som tidigare är inte längre ett alternativ och de kämpar för att upprätthålla men också finna nya vanor och rutiner som får vardagen att fungera. Det är en ständigt pågående kamp att försöka hantera oförutsedda händelser och försöka kontrollera olika situationer de ställs inför. Då de inte längre yrkesarbetar blir aktiviteter utanför hemmet än viktigare än tidigare men deras berättelser speglar hur deras aktivitetsrepertoar minskar och hur de dragit sig tillbaka från olika arenor vilket medfört att deras sociala värld har krympt och de utför fler aktiviteter ensam och i hemmet.

  • 6.
    Olofsson, Alexandra
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Nyman, Anneli
    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.
    Occupations outside the home: Experiences of people with acquired brain injury2017In: British Journal of Occupational Therapy, ISSN 0308-0226, E-ISSN 1477-6006, Vol. 80, no 8, p. 486-493Article in journal (Refereed)
    Abstract [en]

    Introduction

    Understanding those occupations outside the home that people with acquired brain injury find difficult, including the influencing factors, may help to develop appropriate support. The aim of this paper was to explore and describe how people with acquired brain injury experience engagement in occupations outside the home.

    Method

    This qualitative study included repeated semi-structured interviews with eight working-age persons with acquired brain injury, which were analysed by a constant comparison analysis.

    Findings

    The findings indicated that there were three influencing factors that had a critical effect on the participants’ changes in their engagement in occupations, the strategies they adopted, and the consequences for their lives. The categories reflected how the different changes in occupations outside the home were influenced by their struggles with sensory processing and fatigue, difficulties with completing preparations, and occupational risks.

    Conclusion

    The findings indicate that to improve engagement in occupations outside the home for people with acquired brain injury, professionals need to identify the different factors that are critical for each person’s engagement. The findings also indicate the importance of considering not only occupations outside the home but also preparations required at home and recovery afterward, and how engagement outside the home is influenced by the entire occupational repertoire.

  • 7.
    Olofsson, Alexandra
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Nyman, Anneli
    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.
    Engagemang i aktivitet i offentliga miljöer: erfarenheter hos personer med förvärvad hjärnskada2015Conference paper (Other academic)
  • 8.
    Olofsson, Alexandra
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Nyman, Anneli
    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.
    Engagement in occupations outside home: Experiences of people with acquired brain injury2015Conference paper (Refereed)
  • 9.
    Olofsson, Alexandra
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Participation in places for activities outside home after stroke: Relationship with the severity of disabilityManuscript (preprint) (Other academic)
    Abstract [en]

    Purpose: To describe and compare the perceived participation in places for activities outside the home of people with different severities of disability after stroke. The secondary aim was to explore the relationship between the perceived participation in places for activities outside the home and the severity of disability, fatigue and sociodemographic characteristics.

    Methods: An exploratory cross-sectional study was conducted, and 63 people with stroke were interviewed about their participation in places for activities outside the home, as well as their severity of disability and fatigue. Data were analysed using descriptive statistics, non-parametric tests, ANOVA and General linear model.

    Results: Comparisons within the severity of disability groups showed that after the injury, those in the severe/moderate disability group visited five of the 27 investigated places to a significantly lower extent than before the injury, and those with good recovery visited one place to a significantly lower extent. Both groups reported a significant desire to increase participation in a number of places in the future. Moreover, a significantly lower number of people in the severe/moderate disability group did not visit eight of the places compared to those in the good recovery group. Those with good recovery had a significantly higher mean total number of places currently visited for activities outside the home, followed by those with moderate and severe disabilities. The severity of disability and driving a car were the only factors significantly associated with the total number of places visited.

    Conclusions: Participation in places for activities outside the home and changes in relation to engagement in such activities can add to rehabilitation that aims to increase the possibility of resuming participation after stroke.

  • 10.
    Olofsson, Alexandra
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Perceived participation in places for activities outside the home after stroke: Facilitating and hindering aspects.Manuscript (preprint) (Other academic)
    Abstract [en]

    Purpose: The aim of this study was to explore patterns of participation in places for activities outside the home after stroke and whether these patterns were associated with the severity of the disability and environmental characteristics.

    Method: Sixty-three people with stroke were interviewed using the Participation in Activities and Places Outside Home for Older Adults (ACT-OUT) questionnaire and the Glasgow Outcome Scale Extended. A two-step cluster analysis was used to identify patterns of participation in places for activities outside the home, and non-parametric tests were used to detect associations with the identified clusters/patterns.

    Results: Five clusters of patterns of participation in places for activities outside the home were identified, which included four facilitating and hindering aspects: the perceived distance, the frequency of visitation, the familiarity of the place and the familiarity of the way to the place. The patterns were significantly associated with transportation to the place and “accompanied by someone”, but not with the severity of disability or place of residence.

    Conclusions: Different combinations of aspects facilitate and hinder whether or not participation in places for activities outside the home changes. Moreover, the mode of transportation and “accompanied by someone” can also influence participation. To support people with stroke in their endeavour to continue or recapture engagement in activities outside the home, the importance of other peoples influence on participation should be emphasized.

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