In research and among clinicians, the focus has shifted from mainly symptom reduction and increasing functionality to a more recovery-oriented focus. Although there are instruments measuring recovery, there has been a lack of instruments sensitive enough to measure the quality of life for people with severe mental health disorders. Therefore, this study aimed to obtain a Swedish version of the Recovering Quality of Life (ReQoL) questionnaire adhering to best practice guidelines using various steps of translation, linguistic validation, and cognitive debriefing. The cognitive debriefing was conducted with seven participants, and all felt the items in the questionnaire were relevant to their health, apprehensible, and easy to complete. However, some issues were raised regarding wording and the concepts behind certain items. All feedback was considered, and some items were revised in response to criticism after continuous discussions. A Swedish version of ReQoL now exists, and although there is a need for ReQoL in different clinical research settings in Sweden, further research is required to psychometrically test the construct validity as well as reliability of the Swedish version in Sweden.

This article suggests a shift in focus from stories as verbal accounts to narrative interpretation of the every day as a resource for achieving person-centred health and social care. The aim is to explore Ricoeur's notion of narrative and action, as expressed in his arguments on a threefold mimesis process, using this as a grounding for the use of narration to achieve person-centredness in health and social care practice. This focus emerged from discussions on this matter at the IPONS conference in Gothenburg, 2021. Based on philosophical resources from Ricoeur's notions of narrative and action developed in his arguments on a threefold mimesis process, we propose a wider use of stories in health and social care practices. We suggest expanding from only focusing on verbal accounts to focusing on narrative as a human way to interpret and make sense of everyday life and circumstances and to communicate possible meanings. We discuss how such complementary focus can be a resource in getting patients involved and collaborating in their health and social care and thereby help develop person-centred practices.

This paper describes the initial phases of the design and development of the Everyday Life Rehabilitation (ELR) intervention, and it presents preliminary findings on usefulness and implementation aspects derived from an ongoing larger trial exploring the effect, cost-effectiveness, and usefulness of ELR. ELR is a model designed to meet the absence of meaningful activities and challenges with integrated, activity- and recovery-oriented rehabilitation in sheltered and supported housing facilities for persons with extensive psychiatric disabilities. The aim of the present study was to examine early experiences of implementing the ELR model from the perspectives of managers, housing staff, and occupational therapists. The paper will sum up preliminary findings based on process data included in an internal pilot prior to a full-scale pragmatic clustered RCT. Four Swedish municipalities with 19 housing facility units were involved and provided process data for the study. Thematic analysis were applied. The informants perceived the methodology to be well suited to the target group and context and to contribute to positive changes in participants' lives. The web-based training was also experienced as relevant and easily accessible to staff, as well as elements of collegial learning and feedback. However, they reported that their municipalities lacked basic conditions for making the whole concept work in such a short time. The ELR is overall perceived as useful, but experiences also make complex difficulties visible regarding integrated, coordinated rehabilitation and organizational readiness. Based on findings, a recommendation on basic prerequisites will be added to the ELR guidance for leadership and management. Clinical trial registration: [ClinicalTrials.gov, 24 September 2021], identifier [NCT05056415].

In general, people with severe psychiatric disability living in sheltered or supported housing lead passive, solitary lives. Current rehabilitative approaches often neglect considering an agentic perspective of the residents in sheltered or supported housing. Furthermore, the outreach and societal contexts are often not considered. Thus, practitioners tend to overlook the potential in providing support and rehabilitation that is adapted to their individual, collective and changing needs.

My approach was to develop a model for Everyday Life Rehabilitation (ELR), which has a potential to promote agency while targeting recovery, meaningful daily occupations, social participation, and person-driven goals. We employed two occupational therapists (OT) and offered an intervention with ELR in a medium-sized municipality in northernSwedenand evaluated this intervention from the perspectives of residents and community care workers (CCW), using a combination of quantitative and qualitative methods.

This thesis comprises four studies that focus on a home and community context, late rehabilitation efforts, daily occupations, and client-centredness. The overall aim is to understand and evaluate the impact of recovery- and occupation-oriented interventions in a home context for people with severe psychiatric disability. The study settings are sheltered and supported housing facilities.

The first study (n=6) explores the significance of home for occupational transformations. The analysis reveals how residential conditions facilitate rehabilitative interactions, generating occupational transformations such as increasing social competence and taking charge of daily occupations. The second study evaluates occupation- and health-related outcomes of the ELR-intervention for residents (n=17). Pre-, post-, and follow-up differences in tests scores on goal attainment, occupation, and health-related factors indicate that important progress is made. The third study explores residents’ (n=16) narratives about occupational transformations in the context of everyday life and life history. Narrative analysis discloses stories of ‘rediscovering agency’, referring to occupational and identity transformations. The fourth study illuminates community care workers’ (n=21) experiences of collaborating with residents and OTs, using ELR. The CCW’ view on residents, rehabilitation, and the own role, along with organisational conditions in the housing facility, seem to characterise different outlooks influencing the CCWs responsiveness or resistance to the intervention.

In conclusion, rehabilitation in a supported housing context appears paradoxical due to tensions between opposing values such as authentic versus artificial, and independence versus dependence. However, if residents are engaged in challenging these tensions, they can function as ‘progressive tensions’ generating change. Considering the personal and social meaning of home also appears to be valuable. The intervention studies on ELR, demonstrate its value for participants and indicates that a recovery approach applying ELR would promote shared perspectives among residents, CCWs, and OTs, while facilitating ‘agent-supported rehabilitation’ and ‘out-of-housing strategies’. The thesis provides initial support for the use of ELR-interventions and proposes continued research.

Att tala om vardagslivets rehabilitering är angeläget då begreppet rehabilitering ofta förknippas med arbete och återgång till arbete. Rehabilitering kan vara mer än så. Meningsfulla vardagsaktiviteter i reell miljö utgör en viktig plattform för utveckling vid psykiskt funktionshinder och bör vara utgångspunkt i basal rehabilitering.

Rehabilitering och ett rehabiliterande förhållningssätt är ett ansvar för både kommuner och landsting enligt hälso- och sjukvårdslagen (HSL). Det är viktigt att rehabilitering utgår från ett individperspektiv och hennes resurser och begränsningar i aktivitet och delaktighet i det dagliga livet.

Projektidén utgår dels från ett brukarperspektiv och dels från ett arbetsterapiperspektiv, mot bakgrund av att arbetsterapeuter uttalats vara en underutnyttjad resurs i socialpsykiatri. Den främsta drivkraften är att erbjuda brukare systematiskt prövade rehabiliteringsinsatser, på brukarens villkor och i de miljöer och aktiviteter som brukaren vill nå ökad självständighet inom.

Modellverksamhetens grundtanke är att en arbetsterapeut i kommunpsykiatrisk organisation ska samverka med närstående och/eller baspersonal för att, via ett pedagogiskt och terapeutisk sätt, vägleda personer med psykiskt funktionshinder till att lättare självständigt kunna utföra meningsfulla aktiviteter i vardagen och uppleva delaktighet i livssituationer och omgivande samhälle.

Slutrapporten är skriven utifrån direktivet ”en överblick av vad som görs i Sverige när det gäller rehabilitering i vardagslivets aktiviteter för personer med psykiskt funktionshinder”. Intentionen har varit att belysa aktuellt kunskapsläge från verksamhetsnära till vetenskaplig nivå via kanaler som strategiskt utvalda rehabiliteringsverksamheter i kommuner och landsting, olika universitet/högskolor, fackliga nätverk och liknande. Rapporten utger sig inte för att vara en heltäckande inventering utan en överblick med nedslag i vissa kommuner/landsting över spridda landsändar, publikationer och några goda exempel. Rapporten ger en nulägesbild av svensk arbetsterapi i psykiatri med särskilt fokus på utvecklingspotential i kommunal psykiatri.

Ökade krav ställs generellt på alla yrkesgrupper med efterfrågan om ett mer evidensbaserat arbetssätt. Arbetsterapeutisk professionalitet handlar om att kunna förena teori och praktik i ett väl avvägt förhållningssätt, baserat på bästa tillgängliga evidens, med fokus på människors utförande av meningsfulla uppgifter. Arbetsterapeuter har genom sin forskning och utveckling specialiserat sig på att förstå och möjliggöra meningsfulla vardagsaktiviteter hos enskilda individer, trots sjukdom eller funktionshinder.

Background: Young and adult users of electric wheelchairs (EWs) describe how EWs have personal, functional, emotional, and symbolic values and are considered by some to be part of the self.

Aim: The aim of this study was to increase our understanding of how occupational identity is constructed in the daily practices of EW users.

Material and methods: Context-based, in-depth oral stories and filmed sequences of daily practice enactments of persons who have used an EW since childhood were the basis for the narrative analysis.

Findings: The findings elucidate how the informants enact and tell about their identity-development in response to daily and relational practices, and its relevance to the informant's sense of self, belonging, competence, life-prospects, conduct, and awareness of shifting values, and this was likewise demonstrated in different appearances and roles related to social recognition. A model illustrating the findings is proposed.

Conclusions and significance: Contextual values and exploring experiences, such as possibilities to develop competences and roles, along with encountering social recognition, but also hindering regulations and adversities, influence the development of occupational identities. Findings in this study can contribute to increased understanding, conscious political decisions, as well as a more person-centred approach within healthcare.

the authors offered home-based occupational therapy integrated into supported or sheltered housing to help individuals with severe psychiatric disability identify their specific needs of engagement in meaningful occupation. This study aimed to evaluate the client outcomes in activities of daily living (ADL) ability and health factors following their participation in occupation-centered interventions in home and community settings. Seventeen participants (7 women) between the ages of 27 to 66 years, living in sheltered or supported housing participated in the intervention project based on the Everyday Life Rehabilitation (ELR). The following instruments were administered before and after the intervention and at a six-month follow-up: Goal Attainment Scaling, Assessment of Motor and Process Skills, Assessment of Social Interaction, Satisfaction with Daily Occupations, ADL-taxonomy with an effort-scale, and the Symptom Check List-90. Pretest, posttest, and follow-up differences in test scores on goal attainment, occupation, and health-related factors indicate that important progress was made.  These findings support the use of the intervention and suggest that larger randomized clinical trials are needed.

Background: The study illuminated how persons with psychiatric disabilities experienced the processes of change in a residential context.

Material: Qualitative interviews with residents living in supported housing were conducted and analyzed using constant comparative analysis.

Discussion: Residential conditions appear to provide a complex structure that facilitates rehabilitative interactions, in which ‘progressive tensions’ arise between opposing values, such as authentic versus artificial, and independence versus dependence, both of which are important in the process of change.

Conclusions: A client-centred approach could be taken further if clients are engaged in productive discussions about challenging these ‘progressive tensions’. Awareness of the meaning of home also emerged as central.

The importance of engagement in meaningful occupations and participation in life situations of people with psychiatric disabilities is well known. Therefore, community care workers (CCWs) in sheltered or supported housing are a key resource in the facility context. Yet, the role and views of CCWs, in facilitating or inhibiting rehabilitative opportunities for residents, is only beginning to be understood. We offered an intervention project using the Everyday Life Rehabilitation (ELR), to integrate recovery- and occupation-oriented interventions, including collaboration between occupational therapists (OT) and CCWs, into supported or sheltered housing. As one part of the intervention project, focus group interviews were conducted with 21 CCWs involved in the intervention project. The aim was to illuminate the views of CCWs working with residents partaking the Everyday Life Rehabilitation. Qualitative content analysis revealed seven categories, with associated subcategories. These categories relate to two different disability ideologies: a stabilisation oriented, and a recovery oriented approach to rehabilitation. Related to organisational aspects, we have also identified two different tensions to change: resistance, and responsiveness to the intervention. The findings have implications for the forthcoming development of housing facilities, personnel development, and rehabilitative efforts for people with severe psychiatric disability.

Background: People with severe psychiatric disabilities and impaired autonomy, living in sheltered or supported housing facilities, often lead sedentary, solitary lives indoors and have significantly poorer health than others in the population. Meaningful everyday activities are important for the recovery towards an enrichening, agentic, social, and hopeful everyday life. The Everyday Life Rehabilitation (ELR) model—a person-centred activity- and recovery-oriented intervention—has shown positive outcomes in feasibility studies, and thus a randomised controlled trial (RCT) is required to establish the effectiveness of ELR, along with calculations of cost-effectiveness.

Methods: The ELR-RCT is a pragmatic, two-parallel-armed cluster RCT evaluating the effect and cost-effectiveness of using ELR from two measurement points over 6 months (pre-post intervention) and in three waves over 3 years. The primary outcome is recovering quality of life (ReQoL) at 6 months, and the secondary outcome is self-perceived recovery and daily functioning (RAS-DS) at 6 months. Additionally, Goal Attainment Scaling (GAS) will be used for the intervention group. Power analysis has been conducted for primary outcome measure. The first wave will include an internal pilot, to be evaluated after 6 months, used as basis for decisions on updating the required sample size and any other need for adaptations before continuing with the full-scale RCT in the second and third wave. All municipalities within a geographic area in northern Sweden, with a minimum of one sheltered or supported housing facility for people with severe psychiatric or neuropsychiatric disability, including access to occupational therapy, will be enrolled. Participants will be block-randomised to receive ELR plus treatment as usual (TAU) or TAU alone for a control period. The control group will thereafter receive delayed ELR. Occupational therapists and housing staff will receive an educational package, manuals, and tools, as well as reflections with colleagues during the intervention period. Housing managers will receive questions for monthly follow-up and coaching with staff.

Discussion: This is a protocol for both an internal pilot and full trial of the first RCT study using the ELR intervention model in sheltered or supported housing facilities, evaluating the effects together with cost-effectiveness.

As part of a larger study, we offered Everyday Life Rehabilitation (ELR) as a model for integrated occupational therapy in sheltered or supported housing facilities, to enable meaningful daily occupations for people with psychiatric disabilities. Our aim of this article was to understand how participants make sense of their occupational transformations in the context of their everyday life and life history. We carried out qualitative interviews and field observations with 16 participants with psychosis-related disorders. We used narrative analysis and disclosed stories of ‘rediscovering agency’, referring to occupational and identity transformations. A parallel outcome article has shown positive results for participants, and by narrative inquiry we contribute with a deeper understanding of the meaning-making of their transformations and mechanisms of the intervention; i.e. hope, extended value of reaching goals, re-entering the majority world, and transparency of process and attunement to the individual. The findings support the use of the ELR-intervention.

Purpose: To explore the experiences of using an electric wheelchair in daily living. Methods: Fifteen participants, eight women and seven men, living in different parts of a Nordic country were interviewed. The interviews were conducted in the home or at the workplace. Open-ended questions were used. The data were collected and analyzed according to the grounded theory. Results: Analysis resulted in one core category: "Integrating the electric wheelchair - a manifold process", describing a process commencing from initial resistance against use of an electric wheelchair, to acceptance with various extent of integration. Six categories emerged that represent this core process: incorporating the electric wheelchair into the self-identity process, calculating functional consequences, encountering the reactions of others, facing duality in movability, using proactive strategies, and being at the mercy of the system. Findings indicate that the integration process is complex and manifold. Practical, personal, and social dimensions were intertwined and significantly involved. Conclusions: Integrating an electric wheelchair is a process closely connected to symbolic value, usability, community mobility and identity. These aspects should be considered in the production, prescription, and adaptation processes. Implications for Rehabilitation Integrating an electric wheelchair is a process closely connected to symbolic value, usability, community mobility, and identity. These aspects should be considered in the wheelchair production, prescription, and adaptation processes.