BackgroundRestrictions in social and leisure activity can have negative consequences for the health and well-being of stroke survivors. To support the growing number of people who are ageing with stroke, knowledge is needed about factors that influence such activity in a long-term perspective.AimTo identify long-term predictors of the frequency of social and leisure activities 10 years after stroke.Method145 stroke survivors in Sweden were followed-up at16 months and 10 years after a first-ever stroke. Data representing body functions, activities & participation, environmental factors and personal factors at 16 months after stroke, were used in multiple linear regression analyses to identify predictors of the activity frequency after 10 years, as assessed by the ‘Community, social and civic life’ sub-domain of the Frenchay Activities Index (FAI-CSC).ResultsAt the 10-year follow-up the frequency of social and leisure activities varied considerably among the participants, with FAI-CSC scores spanning the entire score range 0–9 (mean/median 4.9/5.0). Several factors at 16 months post stroke were independently related to the long-term activity frequency. The final regression model included four significant explanatory variables. Driving a car (B = 0.999), ability to walk a few hundred meters (B = 1.698) and extent of social network (B = 1.235) had a positive effect on activity frequency, whereas an age ≥ 75 years had a negative effect (B = -1.657). This model explained 36.9% of the variance in the FAI-CSC (p<0.001).ConclusionStroke survivors who drive a car, have the ability to walk a few hundred meters and have a wide social network at 16 months after a first-ever stroke are more likely to have a high frequency of social and leisure activities after 10 years, indicating that supporting outdoor mobility and social anchorage of stroke survivors during rehabilitation is important to counteract long-term inactivity.

Long-term participation after stroke is possible despite impairments, but is influenced by a range of personal and environmental conditions. Stroke rehabilitation should be based on an awareness of this influence and address conditions that change with time and ageing during different phases after stroke.

Link to publication Citation for published version (APA): Norlander, A., Jönsson, A-C., Ståhl, A., Lindgren, A., & Iwarsson, S. (2016). Activity among long-term stroke survivors. A study based on an ICF-oriented analysis of two established ADL and social activity instruments. Disability and Rehabilitation, 38(20), 2028-2037. DOI: 10.3109/09638288.2015 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Frenchay Activities Index (mFAI) using the ICF framework.Method: Assessments were performed by means of the BI and the mFAI at a ten-year follow-up of 145 consecutive stroke survivors from Lund Stroke Register, Sweden. After linking the two instruments to the ICF core set for stroke, data were analyzed and presented in terms of activityspecific domain-scores for the total sample and sub-groups according to gender and age.Results: Together the two instruments covered 69 % of the Activities and participation component of the ICF core set for stroke. Two activity-specific domains were identified within the BI and six within the mFAI. Most participants reported a high overall activity level. Inactivity was most common among those ≥80 years. Men and women participated in different types of activities and used different modes of transport.Conclusions: Long-term stroke survivors have a high activity level in daily life, though individual variation is considerable. The structure provided by linking instruments to the ICF core set for stroke can be used for more fine-tuned descriptions of activity.3

Lexell (2021): Participation in social and leisure activities while re-constructing the self: understanding strategies used by stroke survivors from a long-term perspective, Disability and Rehabilitation,

The leading cause of work related accidents in Sweden is falls. Many slips and falls occur on icy and snowy surfaces, but there is limited knowledge about how to prevent accidents during outdoor work in winter conditions. The purpose of this study was to describe risk factors of slips and falls and criteria for slip-resistant winter shoes from a user perspective. The result is based on focus group interviews with 20 men and women working in mail delivery, construction and home care in Sweden. The data was analyzed with qualitative content analysis.Risk factors described were related to physical work environment, risky work situations, individual and organizational factors. User criteria for winter work shoes focused on safety, adaptation to the environment, usability and own priorities.The mechanisms of slips and falls during outdoor work are complex. There is a need for more functional and user friendly work shoes than those available and user preferences should be considered by shoe designers. Future challenges include finding ways to make individually adapted shoes suitable for changing work environments, situations and tasks.

Objective To assess the occurrence of self-reported fatigue among men and women who have returned to work after stroke, and the association between 2 fatigue rating scales. Design A cross-sectional study. Subjects A total of 91 adults (58 men/33 women, mean age 53 years) with mild to moderate disability. Methods: Questionnaires were posted to participants approximately one year after stroke. Fatigue was assessed with the Fatigue Severity Scale (FSS) and the Mental Fatigue Scale (MFS). Results In total, 58% of the women and 33% of the men reported fatigue on the FSS (total score ≥ 4), and 46% of the women and 28% of the men reported mental fatigue on the MFS (total score ≥ 10.5). Being easily fatigued, decreased motivation, mental fatigability and sensitivity to stress were the most reported problems. FSS and MFS were moderately associated (rho 0.517–0.732). Conclusion Fatigue is common among persons who have returned to work after stroke, and interferes with daily life. The long-term consequences of fatigue should be addressed after stroke, especially in women. The FSS and the MFS can be used in combination, as they provide information on different aspects of fatigue. LAY ABSTRACT Fatigue can be a long-lasting and disabling impairment following stroke. There is a need for increased knowledge of how fatigue affects people who have returned to work after stroke, and which fatigue rating scales capture their problems most appropriately. The aim of this study was to assess the occurrence of self-reported fatigue among men and women who have returned to work after stroke, and to determine the association between 2 fatigue rating scales. The study was based on a postal survey and includes 91 participants. Fatigue was found to be common 1 year after stroke, especially in women, and interfered with daily life. The 2 fatigue rating scales could be used in combination, as they provide different information on fatigue. The findings could be used to develop support that enables people with stroke to return to and to stay at work long-term.

Although people with cardiovascular conditions were subjected to more rigorous restrictions during the COVID-19 pandemic, there is limited knowledge of how the restrictions affected their lives and well-being. Thus, the aim of this study was to describe how people with cardiovascular conditions experienced their life situation and physical and mental health during the second wave of the pandemic in Sweden. Fifteen participants (median age 69 years; nine women) were individually interviewed, and data were analyzed with systematic text condensation. The findings revealed that some of the participants were fearful of contracting COVID-19 as their medical condition made them vulnerable. Additionally, the restrictions changed their daily routines and their ability to take part in social activities, as well as their access to specialized outpatient care (medical check-ups and physiotherapy). Although emotional and psychological distress were present, several participants found strategies that reduced their worries, such as exercising and meeting friends outdoors. However, some had adopted a more sedentary lifestyle and unhealthy diets. These findings indicate that healthcare professionals should provide individualized support to persons with cardiovascular diseases in order to find well-functioning emotion- and problem-focused strategies aimed at improving physical and mental health during crises such as pandemics.