Awareness of driving disability in people with stroke tested in a simulator

The aim of this study was to explore and describe awareness of driving disability in people with driving difficulties after stroke. The study comprised a consecutive sample of 38 participants with stroke who showed difficulties in a technically advanced, interactive driving simulator. Driving ability in the simulator was measured using Performance Analysis of Driving Ability (P-Drive). Awareness of driving disability was measured using a modified version of Assessment of Awareness of Disability (AAD), measuring the discrepancy between observed driving actions and self-reported disability after a driving evaluation in a simulator. A majority of the participants (n = 36) demonstrated driving ability that was below the cut-off criterion for P-Drive. Furthermore, a majority of the items measuring awareness of driving disability were scored low, indicating that participants with stroke who did not pass a driving evaluation also had limited awareness of driving disability. A General Linear Model analysis indicated that awareness of driving disability and cognitive screening outcome explained 74% of the variance in driving ability. This study indicated that a majority of the people with stroke who fail a driving evaluation also have limited awareness of their disability, which indicates the need to address awareness in driving evaluations.     

P-Drive on-road: Internal scale validity and reliability of an assessment of on-road driving performance in people with neurological disorders

The aim of this study was to determine internal scale validity and reliability of P-Drive on-road by observing driving performance among people with neurological disorders. The study comprised a consecutive sample of 205 persons with stroke, dementia, or mild cognitive impairment who were remitted for and performed a standardized test in real traffic. Their driving abilities were evaluated with a new assessment tool, P-Drive on-road. Aspects of validity and reliability of the tool were analyzed using a Rasch rating scale model. The results indicated that the rating scale functioned as intended and a principal component analysis indicated that the items formed a unidimensional scale. Acceptable levels of person response validity were found and the scale was also able to distinguish between the abilities of the drivers with a person separation reliability of 0.90. The results indicate that P-Drive on-road is valid and reliable for producing a linear measure of driving ability in people with stroke, dementia and mild cognitive impairment, and has the potential to become a clinically useful assessment tool for on-road driving tests.     

Identifying scale and person response validity of a new assessment of driving ability

The purpose of this study was to evaluate evidence on the validity of a newly developed assessment tool, P-Drive (Performance Analysis of Driving Ability) intended to measure driving ability in a simulator. P-Drive was made available to a sample of 31 brain-damaged participants. P-Drive consists of 21 items relating to observable driving actions, each of which is scored on a 4-point criterion-referenced rating scale. A Rasch measurement model was used to evaluate whether P-Drive was a valid tool. The results indicated that P-Drive represented one single construct. All the items showed acceptable goodness-of-fit, indicating overall internal scale validity. The hierarchical order of the items in P-Drive was in agreement with the theories concerning driving ability after acquired brain injury, providing further evidence of validity. The participants also demonstrated acceptable levels of goodness-of-fit, indicating person response validity. The study indicates that the results for different aspects of the validity of P-Drive are promising, but that it needs to be reassessed for a larger and more heterogeneous group of participants. The results show that P-Drive has potential as a means of making valid evaluations of driving ability in a simulator.     

Enjoyable company in sharing stroke experiences; - lifestyle groups after stroke

Background: Even people with mild to moderate stroke will experience changes in their abilities to perform everyday occupations. Group interventions may be appropriate in late-stage rehabilitation. The aim of this study was to explore how the participants involved themselves in person-centered lifestyle groups after stroke in Norway.

Method: Semi-structured interviews were performed with six older adults with mild-to-moderate stroke who had participated in lifestyle groups over a period of nine months. The interviews were analyzed using qualitative content analysis.

Results: The participants involved themselves in the lifestyle groups in a variety of ways by creating enjoyable company in sharing stroke experiences, sharing knowledgeable interest, pushing and forcing each other forward and reflecting on self-worth. Through doing group activities together, they created various ways of being, belonging and becoming, addressing development of strategies for regaining self-belief and a sense of autonomy, and for adapting to everyday life post-stroke.

Conclusion: The participants were active contributors in the groups and pushed each other and themselves regarding involvement in meaningful occupations. This active participation seemed to bring the participants’ resources into focus and contrasted with the frequent negative perceptions of people post-stroke as ‘victims’.     

Activities of daily living among St Petersburg women after mild stroke

The aim of the present study was to determine how women living in St Petersburg, Russia, who have had a mild stroke, describe their performance in activities of daily living (ADL) and to elicit possible causes of their occupational dysfunction. Thirty-six women who had experienced a mild stroke and been referred to a rehabilitation centre participated in the study. Data collection was conducted through interviews, including the 'ADL Staircase' and a modified 'Frenchay Activities Index for Stroke Patients'. Additional data were collected through field notes and information from team members and relatives. The results showed that women who have had a mild stroke and ADL limitations experience occupational dysfunction in ADL that is most often caused by a combination of overprotection from relatives, the women's own feelings of anxiety and insecurity, and an overemphasizing of their disability. The results are limited, based on the small sample and restricted geographic area. There is a need to further investigate how individuals who have had a mild stroke can be physically and socially rehabilitated and reintegrated into the community in countries with developing economies such as Russia.     

Experiences of the return to work process after stroke while participating in a person-centred rehabilitation programme

Background: In Sweden, less than 50% of those getting stroke in working age return to work (RTW). Effective rehabilitation programmes need to be developed and therapeutic aspects understood.

Aim: To explore and describe how persons with stroke experience their RTW process while participating in a person-centred rehabilitation programme focusing on RTW.

Materials and methods: Seven persons with mild or moderate stroke were interviewed twice during the intervention in the vocational training phase using semi-structured interviews. Data were analysed using grounded theory.

Results: Having a coordinator by their side gave support and guidance during the RTW process. Knowledge of stroke, strategies and a straightforward communication created a structure for the RTW process. Expressing one’s own wishes increased opportunities to influence and decide which path to follow in order to reach the goal.

Conclusion: Straightforward, open and recurring communication facilitated the possibility to adapt to the situation. These aspects increased insight and awareness which facilitated the RTW process.

Significance: The findings indicate that a precondition for a fruitful RTW process was that suitable platforms at work were created in which the actors involved could cooperate. This knowledge might also be valuable in the RTW process for people with other diagnosis.     

Efficacy of Occupational Therapy Task‐oriented Approach in Upper Extremity Post‐stroke Rehabilitation

There is a need for more effective rehabilitation methods for individuals post‐stroke. Occupational Therapy Task‐Oriented (TO) approach has not been evaluated in a randomized clinical trial. The purpose of this study was to evaluate functional and impairment efficacies of TO approach on the more‐affected Upper Extremity (UE) of persons post‐stroke. A randomized single‐blinded cross‐over trial recruited 20 participants post‐stroke (mean chronicity = 62 months) who demonstrated at least 10° active more‐affected shoulder flexion and abduction and elbow flexion‐extension. Participants were randomized into immediate (n = 10) and delayed intervention (n = 10) groups. Immediate group had 6 weeks of 3 hr/week TO intervention followed by 6 weeks of no‐intervention control. Delayed intervention group underwent the reversed order. Functional measures included Canadian Occupational Performance Measure (COPM), Motor Activity Log (MAL), and Wolf Motor Function Test (WMFT). Impairment measures included UE Active Range of Motion (AROM) and handheld dynamometry strength. Measurements were obtained at baseline, cross over, and end of the study. TO intervention showed statistically higher functional change scores. COPM performance and satisfaction scores were 2.83 and 3.46 units greater respectively (p < .001), MAL amount of use and quality of use scores were 1.1 and 0.87 units greater, respectively (p < .001), WMFT time was 8.35 seconds faster (p = .009). TO impairment outcomes were not significantly larger than control ones. TO approach appears to be an effective UE post‐stroke rehabilitation approach inducing clinically meaningful functional improvements. More studies are needed with larger samples and specific stroke chronicity and severity. Copyright © 2016 John Wiley & Sons, Ltd.     

Empowerment and occupational engagement among people with psychiatric disabilities

Background: Empowerment is essential in the rehabilitation process for people with psychiatric disabilities and knowledge about factors that may play a key role within this process would be valuable for further development of the day centre services. Objective: The present study investigates day centre attendees’ perceptions of empowerment. The aim was to investigate which factors show the strongest relationships to empowerment when considering occupational engagement, client satisfaction with day centres, and health-related and socio-demographic factors as correlates. Methods: 123 Swedish day centre attendees participated in a cross-sectional study by completing questionnaires regarding empowerment and the targeted correlates. Data were analysed with non-parametric statistics. Results: Empowerment was shown to be significantly correlated with occupational engagement and client satisfaction and also with self-rated health and symptoms rated by a research assistant. The strongest indicator for belonging to the group with the highest ratings on empowerment was self-rated health, followed by occupational engagement and symptom severity. Implications: Occupational engagement added to the beneficial influence of self-rated health on empowerment. Enabling occupational engagement in meaningful activities and providing occupations that can generate client satisfaction is an important focus for day centres in order to assist the attendees’ rehabilitation process so that it promotes empowerment.     

Impact on Participation and Autonomy (IPA): Psychometric evaluation of the Persian version to use for persons with stroke

Abstract

The aim of this study was to evaluate the psychometric properties of the Persian version of the Impact on Participation and Autonomy questionnaire (IPA-P) to use for persons with stroke. A total of 102 persons diagnosed with first-ever stroke participated in this cross-sectional study. The psychometric properties were evaluated using a Rasch rating scale model. The results showed that IPA-P could not measure perceived participation as one unidimensional construct according to the criteria, but supported two different but related constructs. Performance-based participation consisted of 19 items including three IPA domains: autonomy indoors, family role, and autonomy outdoors. Social-based participation consisted of seven items from the social relations domain. The results provided evidence of internal scale validity, person response validity, and sensitivity for each of the two constructs of IPA-P. In conclusion, the results supported the psychometric properties of two constructs of perceived participation in the Persian sample tested. However further evaluation of psychometric properties of the IPA is needed in a variety of diagnoses and in other cultural backgrounds.     

An exploration of participation in leisure activities post‐stroke

Aim: The purpose of this study was to illuminate the experiences of older adults’ return to leisure activities, following rehabilitation, post‐stroke. Method: A phenomenological approach was used to explore the experiences of re‐engaging in leisure occupations post‐stroke. In‐depth interviews were conducted with five community‐dwelling individuals (three men, two women) aged 68–74 years who had experienced a stroke in the past year. Data were analysed using thematic analysis. Findings: Four themes emerged: (i) Re‐engaging in leisure activities, (ii) acceptance of physical limitations post‐stroke, (iii) gratitude for help and support and (iv) looking forward to the future. Conclusion: Implications revealed that post‐stroke interventions need a more occupation‐focussed approach, including return to leisure at an earlier stage of stroke rehabilitation.