Self-reported quality of task performance of activities of daily living in four diagnostic groups with chronic conditions

Background/aims To design intervention programmes addressing activities of daily living task performance problems in individuals with chronic conditions, more knowledge about the types of challenges these individuals experience is needed. The aim of this study was to examine the types of activities of daily living tasks, as well as the types of problems related to the quality of task performance, that individuals with chronic conditions report and determine similarities and differences in four diagnostic sub-groups. Methods Data on self-reported quality of activities of daily living task performance were collected among 593 individuals with rheumatological disease, incurable cancer, chronic obstructive pulmonary disease and schizophrenia, using the ADL-Interview. Activities of daily living tasks most frequently reported as problematic were identified within each sub-group. Sub-group profiles were generated to identify similarities and differences in quality of performance. Results Participants reported problems performing similar types of activities of daily living tasks across diagnostic sub-groups, especially within instrumental activities of daily living. Moreover, participants mainly reported a decreased quality of performance in terms of using extra time and/or increased physical effort while performing personal activities of daily living. conclusions As individuals across four chronic conditions reported somewhat similar problems related to activities of daily living task performance, generic activities of daily living interventions addressing these problems seem appropriate, especially interventions addressing problems related to use of extra time and increased effort.</p

Qualitative realist evaluation of an occupational therapy intervention programme (ABLE), addressing ability to perform activities of daily living among persons with chronic conditions

Background: Chronic conditions are associated with problems related to performance of activities of daily living (ADL) stressing a need to develop and evaluate intervention programmes addressing such problems. Hence, the ABLE programme was developed, and its feasibility evaluated. Implementing intervention programmes in community-based rehabilitation settings requires understanding of how the programme works in various contexts. Applying a realist evaluation approach, the aim of this study was to identify and evaluate interactions between contexts, mechanisms, and outcomes in the ABLE 2.0, to confirm, refine, or reject aspects of the initial programme theory. Methods: Realist evaluation using qualitative data collected in the ABLE 2.0 randomised controlled trial (n = 78). Based on the ABLE 2.0 initial programme theory, qualitative realist interviews were conducted among receivers (n = 8) and deliverers (n = 3) of the ABLE 2.0 in a Danish municipality. Transcripts were coded, and context-mechanism-outcome configurations were extracted and grouped into contiguous themes. Results were then held up against the initial programme theory. Results: Four contiguous themes were identified including a total of n = 28 context-mechanism-outcome configurations: building a foundation for the entire intervention; establishing the focus for further intervention; identifying and implementing relevant compensatory solutions; and re-evaluating ADL ability to finalise intervention. Overall, the ABLE 2.0 initial programme theory was confirmed. The evaluation added information on core facilitating mechanisms including active involvement of the client in the problem-solving process, a collaborative working relationship, mutual confidence, and a consultative occupation-based process using compensatory solutions. Several contextual factors were required to activate the desired mechanisms in terms of supportive management, referral procedures encouraging the problem-solving process, delivery in the client’s home, skilled occupational therapists, and clients feeling ready for making changes. Conclusions: The ABLE 2.0 represents a coherent problem-solving occupational therapy process, applicable across sex, age, and diagnoses with the potential to enhance ADL ability among persons with chronic conditions, when delivered as part of community-based rehabilitation services. Knowledge about the interactions between contextual factors, mechanisms, and outcomes in the ABLE 2.0 is central in case of future implementation of the programme in community-based rehabilitation settings. Trial registration: The trial was prospectively registered on www.ClinicalTrials.gov (registration date: 05/03/2020; identifier: NCT04295837) prior to data collection that occurred between August 2020 and October 2021.</p

Identifying, Organizing, and Prioritizing Ideas on How to Support the Entangled Relation between Theory and Practice in Occupational Therapy Education: A Group Concept Mapping Study

Transfer of learning from an academic setting to clinical practice and vice versa represents a challenge. The aim of this study was therefore to identify, organize, and prioritize ideas on how to support the entangled relation between theory and practice in occupational therapy (OT) education. To gain broad perspectives on the topic, Group Concept Mapping (GCM) was applied among OT students, lecturers, and fieldwork educators. GCM included six phases: Preparing (formulating a focus prompt), Generating ideas (brainstorming based on focus prompt: “To support the relation between theoretical and practical elements in the OT program there is a need for...”), Structuring statements (sorting and rating importance), Analyses (multidimensional scaling analysis and cluster analysis), Interpreting the map (validation meeting), and Utilization (developing a conceptual model). A total of 39 participants generated 123 unique ideas. Next, 30 participants sorted and rated the ideas, resulting in a cluster rating map. At a validation meeting the cluster rating map was discussed and adjusted. The results revealed seven clusters (i.e. themes) with included statements: 1. Collaborative knowledge exchange (n=17), 2. Experience-oriented teaching (n=17), 3. Theory-practice integration in learning (n=20), 4. Integrating clinical practice in education (n=25), 5. Collaboration on the joint task (n=12), 6. Professional development for fieldwork educators (n=17), and 7. Conditions at the fieldwork placement (n= 15). The themes provided the basis for developing a conceptual model on how to support the entangled relation between theory and practice in OT education. The model is useful during the process of planning and developing OT education

Danish translation, adaptation and initial validation of the clinical assessment of modes questionnaires

Background: The Clinical Assessment of Modes questionnaires (CAMQs) determine clients' preferential modes for therapy (CAM-C1), clients’ perception of modes used by the occupational therapist (OTs) during therapy (CAM-C2), or modes the OTs believed to have used (CAM-T). Access to valid CAMQs for Danish OTs and clients required a rigorous translation and cultural adaptation process. Objectives: To translate and culturally adapt the CAMQs into Danish, examining face validity in a Danish context. Material and methods: A 10-step guideline for the process of translating and culturally adapting questionnaires was followed. Steps 1–6 included translation into Danish, steps 7–8 involved cognitive debriefing interviews and validation based on the Content Validity Index (CVI) analyzed using Kappa statistics. Steps 9–10 finalized the process. Results: CAMQs were translated into Danish. Based on cognitive debriefing interviews and CVIs involving 15 clients and 7 OTs, modifications regarding titles, layouts, instructions, wording and response categories were performed in all Danish CAMQs. The Item CVI and the modified kappa revealed that most participants had a high level of agreement on the cultural relevance. Conclusions and significance: Translated versions of the CAMQs have been culturally adapted into Danish. The current Danish versions seem culturally relevant and useable in Danish occupational therapy.</p

Fostering Change Through Occupation-Based Intervention:An International Joint Group Concept Mapping Study

Further consolidation and clarity regarding occupation as a means to foster change in interventions are needed. The study aimed to utilize the knowledge of occupational scholars to systematically determine what is required to use occupation as means to foster change within occupation-based interventions and to generate a conceptual model from those results. Group Concept Mapping involved the following: preparation, generation of ideas, structuring of statements, data analysis, interpretation of maps, and development of conceptual model. Fifty-two international occupational scholars brainstormed 125 ideas. A cluster rating map with nine clusters posed the foundation for a conceptual model with seven themes, namely, artful use of occupation, evidence-based use of occupation, collaboration to promote occupation, coordinating intervention fit, client factors, sociocultural context, and structural influences. The conceptual model, capturing dimensions and dynamics required for using occupation to foster change, may guide future research into occupation-based interventions.</p