ONGOING PROJECTS

Occupation-centred Occupational Therapy

The overall purpose with the HANDY project is to develop and evaluate the feasibility of a cross-sectorial management program for people with hand osteoarthritis within the context of general practice and community-based occupational therapy.

Osteoarthritis is a common disease, with an estimated 300 million affected people worldwide and a significant cause of disability among older adults. The prevalence of symptomatic hand osteoarthritis has been estimated to 13 and 26% among men and women, respectively, in older adults. People with hand osteoarthritis frequently experience problems with activities of daily living (ADL) involving the hands such as buttoning buttons and carrying groceries.

A recent audit involving a sample of Danish general practices revealed nearly 400 patients with hand osteoarthritis. Of these, 147 patients experienced decreased functioning. Only 1 of them had been referred from general practice to occupational therapy. Several established organisations advocate for multifactorial management of hand osteoarthritis. Still, the audit indicates that this is not the practice in Denmark for people with hand osteoarthritis.

The cross-sectorial management program will include a needs evaluation for when patients should be referred to occupational therapy, information material, referral procedures and a standardized occupational therapy program. Furthermore, descriptions of the collaboration between the two primary health sectors.

Aside from three studies included in the PhD project, the HANDY project also involves a post doc study and research activities designed to develop and revise the management program. 

 

 

 

 

 

 

 

 

 

 

 

The Go:OT trial is focused on evaluating the group-based occupational therapy program called ‘ADAPT Program’. The program is developed to support people with chronic conditions in the process of learning how to problem-solve more efficiently in daily live, i.e., how to overcome activities of daily living (ADL) problems by means of adaptations (planning and prioritizing tasks, using assistive devices, energy management etc.). The ADAPT Program combines short lectures, with peer-to-peer exchange, practical assignments and feedback focused on performing tasks more efficiently.

The ADAPT Program is based on core occupational therapy theory and – models, and informed by two descriptive studies, showing how ADL task performance problems manifests in people with a chronic pain condition (i.e., fibromyalgia). The ADAPT Program are found feasible for occupational therapists to deliver and relevant for people with a variety of chronic conditions to attend as part of the municipality rehabilitation. Initial ADAPT Program evaluations have shown outcome gains such as improved ADL ability and increased mental wellbeing. The Go:OT trial aims to evaluate short and long term effects, implementation process and cost-effectiveness of the ADAPT Program, when compared to usual occupational therapy i.e., one-to-one interventions in the clients home. The Go:OT trial is conducted ‘real life settings’, i.e. Rødovre municipality, and is currently in the pilot trial phase. The main Go:OT trial runs from August 2023 to December 2024, and is supported financially by Den Kommunale Kvalitetsudviklingspulje, Tværspuljen, UCSF Lundbeck Fonden and OAK foundation.

Project registration: 

Publications related to the ADAPT program:

von Bülow C, Amris K, la Cour K, Danneskiold-Samsøe B, & Ejlersen Wæhrens E. Differences in ability to perform activities of daily living among women with fibromyalgia: A cross-sectional study. Journal of Rehabilitation Medicine. 2015; 47(10), 941–947. https://doi.org/10.2340/16501977-2021

von Bülow C, Amris K, la Cour K, Danneskiold-Samsøe B & Ejlersen Wæhrens E. Ineffective ADL skills in women with fibromyalgia: a cross-sectional study, Scandinavian Journal of Occupational Therapy. 2016; 23:5, 391-397, https://doi.org/10.3109/11038128.2015.1095237

von Bülow C, Amris K, Bandak E, Danneskiold-Samsøe B & Ejlersen Wæhrens E. Improving activities of daily living ability in women with fibromyalgia: An exploratory, quasi-randomized, phase-two study, IMPROvE trial. Journal of Rehabilitation Medicine.2017; 49(3), 241–250. https://doi.org/10.2340/16501977-2198

Amris K, von Bülow C, Christensen R, et al. The benefit of adding a physiotherapy or occupational therapy intervention programme to a standardized group-based interdisciplinary rehabilitation programme for patients with chronic widespread pain: a randomized active-controlled non-blinded trial. Clinical Rehabilitation. 2019;33(8):1367-1381. https://doi.org/10.1177/0269215519843986

Thesis related to the ADAPT program:

von Bülow C. Development and Evaluation of an adaptational program. Syddansk Universitet. 2015.

Translation of Self-Assessment of Modes Questionnaire (SAMQ) and Clinical Assessment of Modes Questionnaires (CAMQs) and psychometric evaluations of the Danish versions; D-SAMQ and D-CAMQs

The aims of this project were a) to translate the Self-Assessment of Modes Questionnaire (SAMQ) and the Clinical Assessment of Modes questionnaires (CAMQs) into Danish and b) to evaluate the psychometric properties of the Danish versions of the assessments D-SAMQ and D-CAMQs.

The SAMQ is an instrument providing an individual profile of which modes (ways of relating to the client) the occupational therapist (OT) or occupational therapy student (OTS) feels most comfortable with or prefers to employ when interacting with a client.

The CAMQs consist of three instruments evaluating preferred modes (CAM-C1) and modes used from the perspectives of both the client (CAM-C2) and the occupational therapist (OT) or occupational therapy student (OTS) (CAM-T).

In 2016-2021 the SAMQ and the CAMQs were translated and initially validated using a guideline for translation and cultural adaptation of patient-reported outcome measures recommended by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force.

Since 2020, a total of four studies were initiated to evaluate aspects related to reliability and validity, clinical utility and client-centered practice in relation to D-SAMQ and D-CAMQs.

Publications related to the DIRM project:

Pilegaard MS, Sithamparanathan T, Nielsen KT, Taylor R & Waehrens EE. Danish translation, cultural adaptation and initial validation of the Self-Assessment of modes questionnaire (D-SAMQ), Scandinavian Journal of Occupational Therapy. 2021; 28:4, 285-293, https://doi.org/10.1080/11038128.2020.1817543

Pilegaard MS, Nielsen KT, Larsen AE & Wæhrens EE. Reliability and validity of the Danish version of the Self-Assessment of Modes Questionnaire, Scandinavian Journal of Occupational Therapy.2023; 30:4, 497-504, https://doi.org/10.1080/11038128.2022.2164350

Larsen AE, Nielsen KT, Taylor R, Pilegaard MS & Wæhrens EE. Danish translation, adaptation and initial validation of the clinical assessment of modes questionnaires, Scandinavian Journal of Occupational Therapy. 2023; 30:6, 822-836, https://doi.org/10.1080/11038128.2021.1954997

Nielsen KT, Larsen AE, Wæhrens EE & Pilegaard MS. Clinical utility of the Danish version of the Self-Assessment of Modes Questionnaire (D-SAMQ), Scandinavian Journal of Occupational Therapy. 2023, https://doi.org/10.1080/11038128.2023.2226371

Development, evaluation, and implementation of an occupational therapy intervention programme (ABLE) for people living with chronic conditions   

The “A Better everyday Life” research programme was founded on the idea of developing an occupational therapy intervention programme addressing problems related to performance of Activities of Daily Living (ADL) tasks in people with chronic conditions. Since the establishment of the research programme in 2015 several studies have been conducted, inspired by the United Kingdom’s Medical Research Council framework on how to develop and evaluate complex interventions in four phases (development, feasibility/piloting, evaluation, implementation).

The development of the programme was initiated in 2015 and was based on a literature search to identify existing knowledge on ADL interventions, a study aiming at identifying, organizing and prioritizing ideas on how to enhance ADL ability according to both persons living with chronic conditions and occupational therapists and a study on selv-reported ADL ability in four diagnostic groups living with chronic conditions. Thus, resulting in the first version of the ABLE program (ABLE 1.0). Next, in 2017 a feasibility study was conducted to evaluate content and delivery in a Danish municipality. This study revealed that ABLE 1.0 was feasible. However minor adjustments were needed before proceeding to a pilot RCT.

Based on the results of the feasibility study the ABLE 1.0 was revised, resulting in ABLE 2.0; a systematic, individualised, home-based, and problem-solving occupational therapy intervention programme, using adaptational strategies, to address ADL task performance problems in people with chronic conditions. It was developed to be applicable across diagnoses, age, and sex, representing an occupation-centered intervention programme, applying occupation-based and/or occupation-focused approached during evaluation of ADL ability, goal setting, application of intervention components and re-evaluation of ADL ability to finalise the intervention.

In 2019-2022 the ABLE 2.0 was evaluated applying several evaluation models, including a pilot RCT, followed by a full-scale randomised controlled trial, process evaluation, realist evaluation, and evaluation of cost-effectiveness.

Currently implementation studies are being planned, aiming to implement ABLE 2.0 as part of community-based rehabilitation services in Denmark. Furthermore, in cooperation with researchers from Lund University, studies are being planned to adapt and feasibility evaluate the ABLE programme in Sweden.

Project registration:

https://classic.clinicaltrials.gov/ct2/show/NCT03335709

https://classic.clinicaltrials.gov/ct2/show/NCT04295837

 

Publications related to the ABLE programme:

Guidetti S, Nielsen KT, von Bülow C, Pilegaard MS, Klokker L & Wæhrens EE. Evaluation of an intervention programme addressing ability to perform activities of daily living among persons with chronic conditions: study protocol for a feasibility trial (ABLE). BMJ Open. 2018;8:e020812. https://bmjopen.bmj.com/content/8/5/e020812

Nielsen KT, Klokker L, Guidetti S, & Wæhrens EE. Identifying, organizing and prioritizing ideas on how to enhance ADL ability, Scandinavian Journal of Occupational Therapy. 2019; 26:5, 382-393https://doi.org/10.1080/11038128.2018.1424235

Nielsen KT, Klokker L & Wæhrens EE. Self-reported quality of activities of daily living task performance in four diagnostic groups with chronic conditions. International Journal of Therapy and Rehabilitation. 2021; 28:4, 1-10https://doi.org/10.12968/ijtr.2020.0025

Nielsen KT, Guidetti S, von Bülow C, Klokker L & Wæhrens EE. Feasibility of ABLE 1.0—a program aiming at enhancing the ability to perform activities of daily living in persons with chronic conditions. Pilot Feasibility Stud. 2021; 7:52. https://doi.org/10.1186/s40814-021-00790-7

Hagelskjær V, Nielsen KT, von Bülow C, Graff M & Wæhrens EE. Occupational therapy addressing the ability to perform activities of daily living among persons living with chronic conditions: a randomised controlled pilot study of ABLE 2.0. Pilot Feasibility Stud. 2021; 7:122. https://doi.org/10.1186/s40814-021-00861-9

Hagelskjær V, Nielsen KT, von Bulow C, Oestergaard LG, Graff M & Wæhrens EE. Evaluating a complex intervention addressing ability to perform activities of daily living among persons with chronic conditions: study protocol for a randomised controlled trial (ABLE). BMJ Open 2021;11:e051722. https://bmjopen.bmj.com/content/11/11/e051722.info

Hagelskjær V, Bülow CV, Nielsen KT, Henriksen M, Wæhrens EE. Effectiveness of an individualised occupational therapy intervention programme (ABLE) using adaptational strategies on activities of daily living among persons with chronic conditions: A randomised controlled trial (RCT). Clin Rehabil. 2023 Jun 12:2692155231180720. https://journals.sagepub.com/doi/10.1177/02692155231180720 Epub ahead of print. PMID: 37309135.

 

Thesis related to the ABLE programme:

Nielsen KT. Occupational therapy for persons living with chronic conditions - Development and feasibility of the ABLE program. Syddansk Universitet, 2018.

Hagelskjær V. Occupational therapy for persons with chronic conditions – Effectiveness and process evaluation of the ABLE programme. Syddansk Universitet, 2022.