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  • 1.
    Biguet, Gabriele
    et al.
    Department of Neurobiology, Care Sciences and Society, division of Physiotherapy, Karolinska institutet.
    Nilsson Wikmar, Lena
    Department of Neurobiology, Caring Sciences and Society, Division of Physiotherapy, Karoliniska Institutet.
    Bullington, Jennifer
    Ersta Sköndal University College, Department of Health Care Sciences.
    Flink, Berit
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet.
    Löfgren, Monika
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet.
    Meanings of "acceptance" for patients with long-term pain when starting rehabilitation2016In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 13, p. 1257-1267Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The study aimed to elucidate the meaning of acceptance in relation to the lived body and sense of self when entering a pain rehabilitation programme.

    METHODS: Six women and three men with long-term pain were interviewed. The interviews were analysed according to interpretative phenomenological analysis.

    RESULTS: The analysis revealed three different meaning structures, first: acceptance as a process of personal empowerment, "the only way forward". Here, the individuals expressed that the body felt integrated: a trusting cooperation between self and body gave rise to hope. Second: acceptance as an equivocal project, a possible but challenging way forward. The hopeful insight was there, acknowledging that acceptance was the way to move forward, but there was also uncertainty and doubt about one's ability with a body ambiguous and confusing, difficult but important to understand. Third, in acceptance as a threat and a personal failure, "no way forward" the integration of the aching body in sense of self was impossible and pain was incomprehensible, unacceptable and unfair. Pain was the cause of feeling stuck in the body, affecting the sense of self and the person's entire life.

    CONCLUSIONS: The meaning of acceptance was related to acceptance of the persistency of pain, to how the individual related to the lived body and the need for changes in core aspects of self, and to the issue of whether to include others in the struggle of learning to move on with a meaningful life. Implications for Rehabilitation Healthcare professionals should be aware that individuals with long-term pain conceptualize and hold different meanings of acceptance when starting rehabilitation; this should be considered and addressed in rehabilitation programmes. The meaning given to acceptance is related to the experience of the lived body and the sense of self, as well as to getting legitimization/acceptance by others; therefore these aspects need to be considered during rehabilitation. The process of achieving acceptance seems to embrace different processes which can be understood as, and facilitated by, an embodied learning process. The bodily existential challenges presented in the present study, for example to develop an integrated and cooperative relationship with the painful body, can inspire health professionals to develop interventions and communication strategies focusing on the lived body. A wide range of competencies in rehabilitation clinics seems to be needed.

  • 2.
    Björkdahl, Ann
    et al.
    Ersta Sköndal University College, Department of Social Sciences. Göteborgs universitet.
    Esbjörnsson, Eva
    Göteborgs Universitet.
    Ljungqvist, Johan
    Göteborgs Universitet.
    Skoglund, Thomas
    Göteborgs Universitet.
    Stibrant Sunnerhagen, Katharina
    Göteborgs Universitet.
    Decline in cognitive function due to diffuse axonal injury does not necessarily imply a corresponding decline in ability to perform activities2016In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 10, p. 1006-1015Article in journal (Refereed)
    Abstract [en]

    Purpose: The study explored the direction of change (decline vs. improvement) after diffuse axonal injury (DAI) in the domains of the ICF: body structure, body function, and activity.

    Methods: Thirteen patients with DAI were assessed by using diffusion tensor imaging (DTI) to measure body structure, the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) to measure body function, and the Assessment of Motor and Process Skills (AMPS) to measure activity. The DTI, BNIS, and AMPS were applied at the acute phase (A1), and at 6 and 12 months post-injury (A2 and A3). Visual and statistical analyses were conducted to explore time-dependent changes in the ICF domains.

    Results: Improvements were observed for most patients in all ICF domains from injury until six months. Thereafter, the results diverged, with half of the subjects showing a decline in DTI and BNIS scores between A2–A3, and all but one of the patients exhibiting identical or better A2–A3 AMPS process skill scores.

    Conclusions: From 6 to 12 months post-injury, some patients underwent an ongoing degenerative process, causing a decline in cognitive function. The same decline was not observed in the activity measure, which might be explained by the use of compensatory strategies.

    • Implications for rehabilitation
    • In rehabilitation it is essential to be aware that in some cases with TBI, an ongoing degenerative process in the white matter can be expected, causing an adverse late effect on cognitive function.

    • The cognitive decline, caused by DAI, does not necessarily mean a concurrent decrease in activity performance, possibly explained by the use of compensatory strategies. This suggests that, after the post-acute phase, rehabilitation offering strategy training may be beneficial to enhance every-day functioning.

    • Strategy use requires awareness, which imply the need to assess level of awareness in order to guide rehabilitation.

  • 3.
    Björkman Randström, Kerstin
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Asplund, Kenneth
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Svedlund, Marianne
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Impact of environmental factors in home rehabilitation: A qualitative study from the perspective of older persons using the International Classification of Functioning, Disability and Health to describe facilitators and barriers2012In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 9, p. 779-787Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to explore older people’s experience of environmental factors that impact on their activity and participation in home rehabilitation.

    Method: Older people aged between 68 and 93 years and receiving home rehabilitation were interviewed. A qualitative content analysis was performed on the interview text using the predetermined structure of the International Classification of Functioning, Disability and Health (ICF) environmental domain. The text was linked to the closest ICF category.

    Results: The results identified environmental facilitators and barriers that influenced activity and participation among older people receiving home rehabilitation. Approaches that provided a facilitative environment were access to assistive products and technologies, alterations to the physical environment, social support and relationships, and adjusted health and social care services.

    Conclusions: A qualitative study using ICF-listed environmental factors contributed a holistic view of facilitators and barriers in home rehabilitation for older people. Awareness of the importance of the impact of the social environment on activities and participation could improve home rehabilitation services for older people. The study represents an important step towards a holistic approach using the ICF, which aims to enable all health care professionals to describe, plan and evaluate rehabilitation services together with older people across the health and social care sectors.

  • 4.
    Gutke, Annelie
    et al.
    Göteborgs universitet.
    Bullington, Jennifer
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences.
    Lund, Madeleine
    Göteborgs stad.
    Lundberg, Mari
    Karolinska Institutet; Sahlgrenska Universitetssjukhuset.
    Adaptation to a changed body: Experiences of living with long-term pelvic girdle pain after childbirth2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, no 25, p. 3054-3060Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore how women experience living with long-term pregnancy-related pelvic girdle pain.

    Materials and methods: Nine women with persistent pregnancy-related pelvic girdle pain of 2–13 years were recruited by means of purposive sampling from long-term follow-up studies. The women were 28–42 years of age and had given birth to 2–3 children. Audio-taped in-depth interview with open-ended questions were used with the guiding question 'How do you experience living with pregnancy-related pelvic girdle pain?'. The Empirical Phenomenological Psychological method was chosen for analysis.

    Results: The pregnancy-related pelvic girdle pain syndrome has a profound impact on everyday life for many years after pregnancy. Three constituents were identified as central to the experience of living with pregnancy-related pelvic girdle pain: (1) the importance of the body for identity, (2) the understanding of pain, and (3) stages of change. The manner in which the women experienced their pain was interpreted in terms of two typologies: the ongoing struggle against the pain, and adaptation and acceptance.

    Conclusion: The participants’ narratives highlighted that the pain led to severe functional limitations that threatened their capability to perform meaningful daily activities, and interfered with their sense of identity. It appears essential to meet with each patient individually and to manage long-term pregnancy-related pelvic girdle pain as a pain syndrome.

    IMPLICATIONS FOR REHABILITATION

    Chronic pregnancy-related pelvic girdle pain

    • Pregnancy-related pelvic girdle pain impairs women’s capacity to perform meaningful activities of daily life for many years after pregnancy.
    • The participants’ narratives highlighted that the pain interfered with their sense of identity.
    • It appears essential to meet with each patient individually and to manage long-term pregnancy-related pelvic girdle pain as a pain syndrome.
  • 5.
    Juuso, Päivi
    et al.
    Luleå tekniska universitet.
    Söderberg, Siv
    Luleå tekniska universitet.
    Olsson, Malin
    Luleå tekniska universitet.
    Skär, Lisa
    Luleå tekniska universitet.
    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

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