BACKGROUND:Physical activity (PA) after stroke has significant health benefits if it is conducted regularly, with sufficient intensity and duration. Because of the health benefits, it is important to identify those below the World Health Organization (WHO) recommended level of PA. However, few studies have assessed the level of PA after stroke in relation to the WHO recommendations and which sociodemographic factors and stroke characteristics are associated with those below the WHO recommendations. OBJECTIVE:To assess survivors of stroke at least 1 year after onset and (1) describe their self-reported level of PA; (2) explore the association between PA, sociodemographics, and stroke characteristics, and (3) determine the characteristics of those below the WHO recommended level of PA. DESIGN:Cross-sectional descriptive survey. SETTING:Community settings. PARTICIPANTS:Data were collected from 160 survivors of stroke (mean age 73 years, 46% women, mean time since stroke onset 35 months). INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:The Swedish National Board of Health and Welfare Physical Activity Questionnaire and the following sociodemographics and stroke characteristics: gender, age, marital status, vocational situation, need for home help, use of mobility devices, time since stroke onset, first-time stroke, type of stroke, location of stroke, and stroke treatment. RESULTS:Two thirds (66.3%) of the participants were below the WHO recommendations. The hierarchical regression analysis explained 13% of the variance in PA with need for home help as a single significant contributor. Those who did not meet the WHO recommendations were significantly older, more likely to live alone, and in need of home help and mobility devices. CONCLUSIONS:A majority of survivors of stroke do not meet the WHO recommended level of PA. Future studies should assess how other factors characterize those who are physically inactive. This knowledge could help rehabilitation professionals to target interventions and self-management programs to promote PA among survivors of stroke.

BACKGROUND:Survivors of stroke commonly report sleep disturbances. Studies of sleep disturbances after stroke are mostly performed in the acute phase. An increased knowledge of sleep disturbances and its determinants a longer time after stroke is needed to improve treatment and rehabilitation. OBJECTIVE:To assess survivors of stroke more than 1 year after stroke onset and (1) investigate self-reported sleep disturbances and (2) explore the association between self-reported sleep disturbances, gender, age, time since stroke, other stroke characteristics, and sociodemographic data. DESIGN:Cross-sectional survey. SETTING:Community setting. PARTICIPANTS:Participants (n = 160) in the Life After Stroke In Northern Sweden Study (LASINS) (46% women, mean age 73 years, mean time since stroke 35 months). INTERVENTIONS:Not applicable. MAIN OUTCOME MEASUREMENTS:Pittsburgh Sleep Quality Index (PSQI), stroke characteristics (time since stroke, first time stroke, type of stroke, location of stroke, stroke treatment and comorbidities) and sociodemographic data (gender, age, marital status, vocational situation, need for home help, and use of mobility devices). RESULTS:A total of 84 participants (53%) rated 6 points or more on the PSQI (mean 6.5 points, SD: ±4.2, min-max 0-18), indicating sleep disturbances. Gender (p = .002) and use of mobility devices (p = .036) explained 9.5% of the variance in PSQI. CONCLUSION:Survivors of stroke report sleep disturbances even several years after stroke onset. Women and those using mobility devices, indicating less recovery after stroke, report sleep disturbances to a higher degree, regardless of chronological age, time since stroke onset, other stroke characteristics, comorbidities, and sociodemographic data. Further studies with a longitudinal design are needed to gain a comprehensive understanding of how stroke-related factors and other reasons account for poststroke sleep disturbances in order to improve treatment and rehabilitation.

BACKGROUND:To enable people with stroke to achieve an active everyday life under altered conditions, the development of self-management programs is essential to facilitate the process of change that individuals must undergo. To improve access to self-management, internet-based solutions have been proposed. The aim of this study was to evaluate the feasibility of a novel internet-based intervention, "Strategies for Empowering activities in Everyday Life" (SEE, version 1.0), for clients with stroke. METHODS:This feasibility study had a preposttest design without a control group and utilized a mixed-method approach. Data were collected through study-specific forms, outcome assessments, interviews, and field notes. Descriptive statistics and content analysis were subsequently applied. RESULTS:The study involved fifteen clients and staff at clinics in a hospital-based open-care rehabilitation setting. The results indicate that SEE is feasible for clients with stroke. When adopted as expected, SEE has the potential to empower self-management and enhance engagement, balance, and values in everyday activities. The study also indicates that SEE is feasible in terms of adherent delivery of dosage, acceptability, and value, as perceived by clients, occupational therapists, and clinic managers. However, adjustments are needed in the study design, in terms of recruitment strategies, the selection of assessor-based outcome assessment, and the evaluation of adherence. Additionally, the educational program for professionals should be enhanced to better support the implementation of SEE. CONCLUSION:After the study design, intervention, and educational program are refined, SEE can be prepared for a pilot randomized controlled trial. TRIAL REGISTRATION:clinicaltrails.gov NCT04588116, date of registration: 8th October 2020.

Background Late effects of polio (LEoP) is a progressive condition leading to a lifelong disability that can affect mental health. There is limited knowledge of depressive symptoms and associated factors in people with LEoP.Objective To assess the occurrence of depressive symptoms in people with LEoP and explore the association with sociodemographic and disability-related factors.Design Cross-sectional survey.Setting University hospital outpatient clinic.Study participants Eighty-one people (mean age 73 years, 49% women) with LEoP.Main outcome measurements Swedish versions of the 20-item Geriatric Depression Scale (GDS-20), the Self-reported Impairments in Persons with late effects of Polio (SIPP) scale, and the Reintegration to Normal Living Index (RNL-I).Methods The participants responded to a postal survey including the GDS-20 and questionnaires about sociodemographic factors (gender, age, marital status) and disability-related factors (SIPP, mobility, RNL-I). To determine factors associated with depressive symptoms (GDS-20, dependent variable), univariable and two separate multivariable logistic regression models were created, comprising sociodemographic and disability-related factors, respectively.Results Thirty-five people (43%) had a GDS score of six points or more, indicating suspected depression. In the model with sociodemographic factors, only marital status was significant (p = .001) with an odds ratio (OR) of 5.53 (95% confidence interval [CI], 1.97-15.54). In the model with disability-related factors, self-reported impairments and perceived participation remained significant, with self-reported impairments having the highest OR (OR, 1.49; 95% CI, 1.18-1.88). Overall, disability-related factors had a larger explanatory value (Nagelkerke R2 0.73) for suspected depression than sociodemographic factors (Nagelkerke R2 0.24).Conclusion The relatively high occurrence of suspected depression in people with LEoP implies that screening for depression is important. It remains to be determined if rehabilitation interventions targeting disability-related factors can affect mental health in people with LEoP.

Background There is a need to enhance access to and support for self-management of activities in everyday life after a stroke. Internet-based solutions have the potential to contribute to this development. Consequently, an internet-based intervention called Strategies for Empowering Activities in Everyday Life (SEE) was developed. The intervention aims to assist clients in developing management strategies that promote a healthy distribution and balanced engagement in various activities performed in different places and with other people. To further support the development and feasibility of this intervention, more knowledge is needed about clients’ experiences during the intervention process. Objective This study aims to explore and describe how clients with stroke experienced the SEE intervention process and whether participation in SEE influenced their experience of everyday life. Methods Overall, 9 clients with stroke who received SEE participated in the study—4 (44%) women and 5 (56%) men aged 37 to 73 years. Qualitative interviews about experiences with SEE were conducted twice during the intervention process with each participant. The data were analyzed using the constant comparative method of grounded theory. Results The participants’ experiences with the intervention process of SEE formed the core category, conceptualized as The relevance of and readiness for entering a change process in activities of everyday life differ among clients, constituting of two main categories: (1) an eye-opener providing agency for a change process and (2) never beginning a change process in activities in everyday life. The results showed that the relevance of and readiness for SEE differed between the participants. The experiences of 78% (7/9) of the participants reflected that the intervention process provided them with an agency to drive their own change process for activities in everyday life to promote health. Overall, 22% (2/9) of the participants refrained from entering a change process during SEE as they did not recognize any need for changes in their activities. When SEE was relevant and adopted as expected, the participants described it as an eye-opener for how they can alter their health based on how they distribute and spend their time on various activities. Conclusions SEE has the potential to support clients’ development of self-management and to take an active role in influencing their engagement in activities in everyday life and health. This study identified necessary improvements in the educational program for professionals to enhance delivery and strengthen the therapeutic mechanisms of SEE for future research. To effectively implement internet-based interventions such as SEE, it is crucial to identify clients who express a need for self-management in activities and are ready to invest the effort required to adopt a change process. Furthermore, it is indicated that participants’ self-analysis of their everyday activities empowers them to adopt new self-management strategies, which can also benefit other interventions.

Background Digital work can be cognitively challenging especially for people with cognitive difficulties. New occupational therapy interventions are needed to empower these persons to self-manage challenges in digital work and everyday life. To address this need, the internet-based intervention ‘Strategies for Empowering Activities in Everyday Life’ (SEE 2.0) was tested.Aim To explore and describe how SEE can support the development of self-management in people with cognitive difficulties who engage in digital work and other occupations in everyday life.Material and methods A qualitative, descriptive case study included four participants with cognitive difficulties due to neurological disorders who participated in SEE. Data were collected through semi-structured interviews, self-reports and assessments then analysed using pattern matching.Results Three cases were formed. Two cases (three people) adhered to SEE’s intervention process, resulting in increased work hours, improved occupational balance, and greater engagement in valued occupations. One case (one person) could not fully adhere to the process and struggled to adopt changes.Conclusions SEE shows potential in supporting self-management, promoting sustainable digital work and everyday life.Significance SEE can add to existing vocational rehabilitation programs by empowering persons to utilise their own resources to manage challenges in everyday life.

Background: Sense of coherence (SOC), comprising "comprehensibility", "manageability" and "meaningfulness", is important for successful adaptation in persons with late effects of polio (LEoP) and can be used as an estimate of the ability to cope with stressors. Coping behaviours are the actions a person performs to reduce stress and can be divided into problem-focused coping, emotion-focused coping and less useful coping. Our knowledge is very limited of what coping behaviours persons with LEoP use to manage their life situation as well as the association between SOC and coping behaviours.Objective: The aims of this cross-sectional study were to assess coping behaviours and to explore the association between SOC and coping behaviours in persons with LEoP.Methods: In total, 93 ambulant persons (52% women, mean [SD] age 74 [8] years) with clinically and electromyographically verified LEoP responded to a postal survey with the Sense of Coherence Scale 13 items (SOC13) and the Brief Cope Scale. Three linear regression analyses were used to explore the association between SOC and problem-focused coping, emotion-focused coping and less useful coping, controlling for age and sex. Results: The most-used coping behaviours belonged to the categories problem-focused and emotion-focused coping. We found a significant negative association between SOC and less useful coping; less useful coping explained 34% of the variance of SOC (adj R2 = 0.34, p < 0.001), whereas age and sex were not significant in the analyses.Conclusions: Persons with LEoP primarily use problem-focused and emotion-focused coping behaviours, which suggests that generally they have adapted well to their disability. Regardless of age and sex, persons with lower SOC scores use less useful coping behaviours, which suggests that they are not as well adapted. These results can facilitate the development of rehabilitation interventions that help persons with LEoP adapt to their situation with a life-long disability.(c) 2021 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Sense of Coherence (SOC), comprising comprehensibility, manageability and meaningfulness, is important for the sense of living a good life with Late Effects of Polio (LEoP). However, there is a lack of knowledge about the meaning of these three components. The aim of this study was to explore in-depth the meaning of SOC among persons living with LEoP, in terms of comprehensibility, manageability and meaningfulness. A directed content analysis was performed based on individual interviews with 7 men and 7 women with LEoP (mean age 73 years). SOC in persons with LEoP existed in two overarching themes that were closely intertwined: a state of motion and a state of being. The state of motion comprised active approaches, choices and actions, and was a process aimed at achieving a stronger comprehensibility, manageability and meaningfulness. The state of being comprised the comprehensibility, manageability and meaningfulness that the persons currently experienced. A profound understanding of SOC as both a state of motion and state being is essential for rehabilitation professionals when providing self-management support to persons living with LEoP. This understanding can increase their sense of living a good life and also be used in the rehabilitation of other life-long conditions.

Introduction Digitalization has changed working life and increased cognitive demands on employees in general. Nevertheless, the consequences for employees with cognitive impairments and subjective cognitive difficulties are to a large extent unexplored. The aim of this study was to explore and describe how employees with subjective cognitive difficulties who are performing digital work tasks experience their vocational situation and how this situation influences their everyday life. Methods A qualitative, descriptive, multiple-case study was designed. Self-reports, assessments and qualitative interviews were used to collect data from the seven participants with neurological disorders. The data were analysed using pattern matching. Findings The analysed data formed four categories conceptualized as “Working to my full potential”, “Working, but it is largely up to me”, “Working at the expense of everyday life” and “Working without known difficulties”, and these categories included one to four subcategories. Conclusion Managing subjective cognitive difficulties in vocational situations and everyday life was challenging in a digitalized working life for participants with neurological disorders. To provide equal access to preventive measures and rehabilitation and a sustainable working life, it is important to investigate the influence of subjective cognitive difficulties systematically on work, everyday life and management strategies in people with neurological disorders in digitalized work.

OBJECTIVES:With increased long-term survival after traumatic brain injury (TBI), there is a need to understand the life situation many years after the injury. In this study, we have assessed persons on average 16 years after their injury and determined changes over 6 years in overall outcome, living condition, marital status and vocational situation, and in their functioning and disability.MATERIALS & METHODS:Individuals (n = 49, mean age 45 years, 28-70 years) who were assessed 6-15 years (average 10 years) post-TBI were reassessed 12-21 years after their injury (average 16 years) using internationally established TBI outcome measures.RESULTS:From the first to the second assessment, overall outcome using the Glasgow Outcome Scale (GOS) was stable for a large majority and no significant changes in marital status or vocational situation were found. There was some significant, but very small, decline regarding cognitive function, home integration and social integration. In the multiple regression analysis, there was a small significant decline in the Mayo-Portland Adaptability Inventory (MPAI-4) Adjustment subscale score for women with a moderate-to-severe injury.CONCLUSIONS:The very small changes over 6 years imply that persons with a TBI can reach and maintain a stable level of functioning many years post-TBI. Women with a moderate-to-severe TBI seem to be more vulnerable and may experience a small decline in some aspects of their functioning related to anxiety, depression, irritability, pain and headache and fatigue. The relatively small sample requires further studies to confirm these findings.

BackgroundSense of Coherence (SOC) is important for successful adaptation in persons with life‐long disabilities. A previous study has shown that persons with Late Effects of Polio (LEoP) have a level of SOC indicating that they generally have the ability to understand, handle, and have the motivation to deal with stressful events and problems arising in their lives. However, no study has explored the associations between SOC, sociodemographics, and disability‐related factors in persons with LEoP.ObjectiveTo explore the associations between SOC, sociodemographics, and disability‐related factors in persons with LEoP.DesignA cross‐sectional design.SettingUniversity hospital outpatient clinic.Study ParticipantsNinety‐three persons (mean age 74 years, 52% women) with LEoP.Main Outcome MeasurementsSwedish versions of the Sense of Coherence scale (SOC‐13), Self‐reported Impairments in Persons with Late Effects of Polio (SIPP) scale, Reintegration to Normal Living Index (RNL‐I) (subscales “Daily Functioning” and “Perceptions of Self”), and Satisfaction With Life Scale (SWLS).MethodsThe participants responded to a postal survey with background information and the four rating scales. To determine factors associated with SOC, a hierarchical regression analysis was performed with SOC as the dependent variable.ResultsHigher age, less bothered by symptoms of LEoP, better perceptions of self, and higher life satisfaction were significantly associated with a greater SOC score. The final model explained 60% of the variance in the SOC (R2 Adj = 0.60, P < .001).ConclusionsThe strong association between SOC, higher age, and disability‐related factors is important to consider in the rehabilitation of persons with LEoP. This knowledge can assist rehabilitation professionals to plan interventions that enable people with LEoP to develop strategies to better manage their daily life.Level of EvidenceIII.

BACKGROUND: Sense of Coherence (SOC) is important for successful adaptation and mental well-being in people with life-long medical conditions. Late effects of polio (LEoP) often lead to a life-long disability, but no study has assessed SOC in this population. OBJECTIVE: To assess SOC in persons with LEoP and to explore the association between SOC, demographics (age, gender, marital status and level of education) and variables related to LEoP (age at polio onset, number of years from polio until onset of LEoP and self-rated disability). METHOD: Ninety-three community-dwelling persons with clinically verified LEoP responded to a postal survey with the Sense of Coherence Scale (SOC-13). A hierarchical multiple regression analysis was performed to explore the associations with SOC. RESULTS: SOC varied considerably among the participants. The mean and median SOC-13 total sum score was 71.8 and 76 points, which is similar to age-matched non-disabled people. The number of years before onset of LEoP and self-rated disability together with the participants' marital status and level of education explained 37% (p < 0.001) of the variance in SOC. CONCLUSION: Persons with LEoP have a level of SOC indicating that they generally have the ability to understand, handle and being motivated when dealing with stressful events and problems arising in their lives as a result of their disability. Being married and having a higher education, living many years before onset of LEoP and perceiving a mild to moderate disability contributed to a strong SOC.

A number of papers have provided insight into frequencies of violence-related trauma, especially skull trauma, in Northern European skeletal assemblages dating to the Neolithic and Bronze Age. Although the cases are often well described, they lack further discussion about the consequences of skull trauma for the injured individual and the implications for the surrounding society, especially considering severe skull trauma leading to traumatic brain injuries. In this paper, we address questions of trauma and care for one individual associated with the Swedish-Norwegian Battle Axe Culture who suffered from 2 severe ante mortem skull traumas probably leading to brain injuries. These questions are addressed using the Web-based application and analytic tool Index of Care. We found that daily care, both short term with basic needs such as nutrition and grooming and long term with cognitive impairments, was available in the Neolithic society. Considering the frequent number of ante mortem skull trauma in the Neolithic and Bronze Age skeletal assemblages, traumatic brain injury was probably a common phenomenon. We argue that the care provided was a necessity for survival and maintenance of a socially sustainable society.

Long-term outcome after traumatic brain injuries in Northern Sweden : Changes in life satisfaction and sense of coherence between 6-15 and 12-21 years post-injury

BACKGROUND:An optimal life satisfaction (LS) is considered an important long-term outcome after a traumatic brain injury (TBI). It is, however, not clear to what extent a single instrument captures all aspects of LS, and different instruments may be needed to comprehensively describe LS. The aim of this study was to compare self-ratings of life satisfaction after a TBI with two commonly used instruments.METHODS:Life Satisfaction Questionnaire (LiSat-11), comprising eleven items and Satisfaction With Life Scale (SWLS), comprising five items, were administered to 67 individuals (51 men and 16 women). Secondary analysis of data collected as part of a survey of individuals with TBI 6 to 15 years post TBI.RESULTS:Item 1 in LiSat-11 ('Life as a whole') and the total SWLS score was strongly correlated (Spearman's rho = 0.66; p < 0.001). The total score in SWLS had the strongest correlation with items in LiSat-11. All items in LiSat-11, except 'Family life' and 'Partner relationship', were moderately to strongly correlated with items in SWLS. The item 'Partner relationship' in LiSat-11 did not correlate with any of the items in SWLS or the total score. The item 'If I could live my life over, I would change nothing' in SWLS had the weakest correlations with items in LiSat-11. Items 'Vocation' and 'Leisure' in LISat-11 were most strongly correlated with items in SWLS, whereas the item 'ADL' in LiSat-11 was more weakly correlated with items in SWLS.CONCLUSIONS:The strength of the relationships implies that the two instruments assess similar but not identical aspects of LS and therefore complement each other when it is rated.

BACKGROUND: Life satisfaction (LS) is an overall goal in the long-term management and rehabilitation of persons with Parkinson's disease (PD). However, very little is known about LS in persons with PD and no study has examined factors associated with their LS.OBJECTIVE: To describe LS in persons with mild to moderate PD and to evaluate the association with gender, age, years since diagnosis, and sense of coherence, perceived participation, and mental and emotional status.METHODS: Eighty persons with mild to moderate PD (46 men and 34 women, mean age 70.1 years, mean time since diagnosis 7.4 years) responded to a postal survey with the Swedish versions of the Satisfaction With Life Scale (SWLS), the Sense of Coherence scale (SOC-13), the Reintegration to Normal Living Index (RNLI) and the Geriatric Depression Scale (GDS-20). Hierarchical multiple regression analyses were used to evaluate the association with LS.RESULTS: The mean SWLS total score was 21.8 points, and 45% rated themselves as satisfied to highly satisfied with their lives. SOC and years since diagnosis explained 36% of the variance, where a strong SOC, indicating a person's capacity to adapt to the overall strains of the disease, showed the strongest association with a high LS.CONCLUSIONS: Persons with mild to moderate PD seem to be generally satisfied with their lives but LS may decrease as the disease progresses. The strong association with SOC implies that LS may increase through rehabilitation that support persons with PD to understand and confront the nature of problems arising in their lives as a result of their PD.

Primary objective: To describe vocational outcome 6-15 years after a traumatic brain injury (TBI) among individuals who were productive by working or studying at the time of their TBI and determine the associations with variables related to the time of injury and at follow-up.Methods and procedures: Thirty-four individuals with a mild TBI and 45 with a moderate-to-severe TBI were assessed on average 10 years post-injury. Logistic regression was used to determine the association between their current vocational situation and variables related to the time of injury (gender, age, injury severity and educational level) and at follow-up (time since injury, marital status and overall disability).Results: A total of 67% were productive at follow-up. Age at injury, injury severity and the degree of disability at follow-up were strongly associated with being productive. Younger individuals with milder TBI and less severe disability were significantly more likely to be fully productive. No significant associations were found between productivity and gender, education, time since injury or marital status.Conclusions: This study indicates that return to productivity in a long-term perspective after a TBI is possible, in particular when the individual is young, has sustained a mild TBI and has a milder form of overall disability.

Purpose: To investigate and describe how persons with an acquired brain injury (ABI) manage everyday technology (ET) in their daily activities and to explore whether the ability to manage ET was related to the severity of the disability.Method: Eighty-one persons with ABI were observed while managing ET by using the Management of Everyday Technology Assessment (META). The Glasgow Outcome Scale-Extended (GOSE) was used to assess the severity of disability after the ABI. A computer application of a Rasch measurement model was used to generate measures of the participants' ability to manage ET and the measures were compared groupwise with analysis of covariance (ANCOVA).Results: The degree of severity of disability had a significant main effect on the ability to manage ET. The groups with severe and moderate disability exhibited a significantly lower ability to manage ET compared to the group with good recovery.Conclusion: The result indicates that the ability to manage ET in daily activities can be related to the global severity of disability after ABI. This demonstrates the importance of considering the ability to manage ET to support the performance of activities at home, at work and in society in persons with ABI.