Background In the Global North, advances in occupational therapy benefitted unduly from the oppression, disablement and suffering of thousands of people in the South (and beyond). To prevent the recurrence of these injustices, history must be unveiled and occupational therapists urged to come to terms with their own involvement and responsibility. Objective and Method Utilising Achille Mbembe’s concept of necropolitics, this academic essay blends select historical and philosophical perspectives to explore occupational therapy’s concealed role in manifestations of institutionalised violence. Results By examining its roles in World War II and France’s colonisation of Algeria, we make visible the development of occupational therapy’s distinct ‘shadow side’. In Nazi Germany’s Euthanasia Programme, it became a tool for identifying which lives were deemed ‘worthy of living’ and which were not, which indirectly contributed to the killing of 200,000 disabled persons. Under France’s colonial medical system, occupational therapy imposed Western standards that alienated and completely depersonalised Algerian patients. Conclusion and Significance Entrenched in a (bio)economy that has endured beyond these events, occupational therapists must exercise vigilance, remaining mindful of the potential to unintentionally overlook individuals labelled as ‘unproductive’. This requires confronting the profession’s assumptions of inherent ‘goodness’ and acknowledging and addressing its shadow side.

Various performance-based instruments exist to assess mental function after stroke and users have to select one for research or clinical practice. To evaluate the measurement properties of performance-based instruments to assess (any aspect of) mental function during activity and participation in persons after stroke. We searched in five electronic databases. COSMIN methodology was used to conduct the review. The strength of evidence was assessed using a modified GRADE approach. Fifty articles were included reporting on 20 instruments assessing (1) multiple mental functions including ≥ four subdomains (2) attention, memory and executive functions, or single subdomains (3) executive functions, (4) perception, and (5) mental function of language. Highest quality evidence for sufficient results was found for some measurement properties in seven instruments. These instruments included: FIM + FAM, MPAI-4 and EFPT, MET, CBS/KF-NAP, BIT and the Scenario Test. Further studies of high methodological quality are needed that evaluate the measurement properties of instruments to allow clinicians and researchers to select the most suitable performance-based measures for purpose. Results may be used to select the most suitable performance-based instrument to measure mental function during activity and participation in persons with stroke. PROSPERO CRD42018086744.

Background A need was identified for an occupational therapy intervention for stroke survivors in a Danish municipal healthcare setting with emphasis on its ability to transfer and generalise what is learned in occupational therapy to everyday life post therapy. Being a possible candidate, the Cognitive Orientation to daily Occupational Performance (CO-OP) approach needed to be adapted to the target group and context, and its feasibility needed examination regarding reach, dose, intervention components, fidelity, perceived value, benefits, harms, and potential outcomes. Aim To adapt the CO-OP to a Danish healthcare setting and present a protocol for examining its feasibility. Material and methods The Adapting interventions to new contexts (ADAPT) guidance was followed to (1) Assess the rationale for intervention and consider intervention-context fit, (2) Plan and undertake adaptations, and (3) Plan a feasibility study. Results Intervention materials and procedures were translated and adapted for home-based occupational therapy with people in the subacute phase of stroke. A protocol was developed to examine feasibility aspects. Quantitative and qualitative evaluations were planned and measurements chosen. Conclusions and significance The planned feasibility study will contribute to further developing and refining the intervention before performing a possible large-scale effectiveness study.

Background Research is limited about how the introduction of new ways of delivering and conducting occupational therapy, in accordance with expected changes in health care, is experienced by occupational therapists (OTs). Aim To explore how OTs experienced use of a new internet-based intervention, ‘Strategies for Empowering activities in Everyday life’ (SEE), focusing on supporting client resources to manage an active everyday life after stroke. Material and methods A focus group study with periodical repeated discussion was designed. Four sessions during a period of 22 months were conducted with a total of four OTs. Result Overall, the results reflected that the OTs experienced that the use of SEE for persons with stroke was a valuable complement to existing rehabilitation. The process of introducing SEE included a multifaceted transition involving context, intervention process and delivery that renewed occupational therapy. Conclusion These results indicate how the use of new internet-based interventions such as SEE can influence and support renewal of occupational therapy that extends beyond the particular intervention. Continued research is needed to explore more aspects of SEE feasibility.

Background The vast majority of older adults live in their own homes. Many of them live with chronic conditions that lead to activity limitations and participation restrictions. To support them adequately, we need to better understand how they cope with everyday difficulties. Aim To identify and examine difficulties in everyday life older people with chronic conditions who live in private homes face and how they and their significant others interpret, navigate, and overcome these difficulties. Material and Methods We conducted a focus group interview with 10 participants including eight older adults with chronic conditions and two of their significant others. We then transcribed the interviews verbatim and thematically analysed them. Results We generated the three closely interrelated themes struggling not to lose control, a shifting balance between resources and environmental challenges, and negotiating independence and interdependence. Participants interpreted the difficulties they faced as multicausal. Their main goal was maintaining autonomy, agency, and a positive identity. They employed individual, creative strategies to achieve these goals. Conclusions Older persons with chronic conditions prioritise autonomy and agency in order to maintain a positive identity. Significance Interventions to support older persons with chronic conditions should centre their priorities and build on their creativity.

Background: There is a lack of knowledge about how persons with cerebral palsy (CP) perceive their ‘process of doing’ while performing everyday occupations. As described in the Model of the Process of Doing (MPoD), performing an occupation is a complex process consisting of six phases (generate idea, plan, initiate, enact, adjust, end) and time management. Aim: To collect the experiences of young adults with CP, classified at Manual Ability Classification System (MACS) level I or II, regarding how they perceive challenges in their occupational performance in relation to the different phases of the ‘process of doing’. Method: Semi-structured interviews were performed with ten participants with CP aged 19–30 years, MACS level I or II. The interview material was related to the MPoD phases using directed content analysis. Results: The participants’ descriptions of how they perceived their personal ‘process of doing’ showed problems in all MPoD phases. All participants experienced difficulties in one or more phases, but none had difficulties in all phases. Difficulties were more frequent in some phases than in others. Conclusion/Significance: To understand the complexity of doing everyday occupations in young adults with CP, there is a need to address all phases of the ‘process of doing’.

Background The increasing survival after a lung cancer diagnosis implies that patients live longer with the disease, which means that symptoms and side effects of the treatment become part of everyday life. Aim The study explored how older adults make meaning of everyday life when undergoing treatment for their lung cancer. Material and methods A qualitative study using semi-structured interviews was conducted with 12 older adults with lung cancer undergoing various treatments. The analysis followed Giorgi’s phenomenologic five-step method. Results The analysis revealed three partly overlapping themes: meeting the health care system, losing identity, and struggling for meaning in everyday life. The patients appreciate clear and coherent communication at the oncology clinic. They had different needs for support from organised support groups, friends, communities, or relatives to make meaning of everyday life. Conclusion Creating meaning in everyday life is essential despite the disease and the treatments’ side effects. Interpersonal relationships create meaningfulness in everyday life through a salutogenic perspective that makes everyday life comprehensible and manageable. Significance The patients need an everyday life perspective on the disease and the side effects, which a salutogenic approach in the encounter with the health care system could support.

Background The ADAPT Program have improved activities of daily living (ADL) in women with fibromyalgia. To understand the functioning of the program, it is relevant to evaluate how program theory components are linked to outcomes (mechanisms) and how the randomised controlled trial (RCT) context, influenced delivery and outcomes Objective To evaluate ADAPT in terms of dose, mechanisms of change and contextual factors. Material/Methods Dose was recorded on the n = 21 participants receiving ADAPT in the IMPROvE trial (NCT01352052). A subsample of n = 16 attended one of three 2-hour focusgroups, evaluating mechanisms of change and contextual factors. Interview questions explored participants’ interaction with four program components, i.e. how the ‘client-centred approach’, ‘group-based peer-exchange format’, ‘teaching-learning strategies’ and ‘long-term program format’ triggered mechanisms facilitating/hindering outcomes. Moreover, how randomisation procedures influenced delivery and outcomes. Results Attending a long-term educational peer-exchange program, in which participants experienced met by a health professional that legitimised difficulties, facilitated participants knowledge, insights and motivation for changing habits. With time and support, participants experienced increased acceptance of their situation and began to implement more effective ways to perform ADL tasks. Conclusions/Significance Results support previous findings of improved ADL ability post-ADAPT and provide initial evidence to support the ADAPT Program theory.

Background Mental health problems (MHP) are a major public health challenge. Conventional healthcare has shown limitation on reducing MHP and there is a call for offering methods beyond healthcare as well as improve access to healthcare. Aims To explore experiences among people having MHP of (i) taking part in existential conversations in groups beyond conventional healthcare and (ii) seeking and receiving conventional healthcare. Materials and methods Four focus group interviews were conducted after finishing existential conversations in groups. Data was analyzed following thematic analysis. Results The theme Access to a community for exploration and acceptance describes communication through impressions and expressions together with others. A reflective perspective on everyday life, describes re-evaluation through reflection. Within the theme Experiences of healthcare related encounters, referring to the second aim, participants recollected feelings of disconnectedness, difficulties verbalizing MHP and dealing with rigid, standardized measures. Conclusion Existential conversations in group may contribute to a more reflected doing in accordance with one’s own values as well as improved mental health literacy. Design and measures within healthcare need to explicitly address MHP and consider individual’s own preferences. Significance This study contributes to understanding of coping with MHP in everyday life from an existential perspective.

Background Young adult cancer survivors (YACS) aged 18–39 report age-specific multifactorial challenges with self-care, leisure, work and education requiring multicomponent rehabilitation intervention. Therefore, the ‘Young Adult Taking Action’ (YATAC) programme was developed. Aims/Objectives To present a protocol for a feasibility study evaluating the acceptability of the YATAC programme and exploring implementation, mechanisms of impact and outcomes. Material and methods A mixed-method feasibility study with a convergent research design will be conducted. The programme is an age-specific, multicomponent, goal-oriented, and peer-based rehabilitation programme delivered by an interdisciplinary staff consisting of nine components: 1) Goal setting, 2) Everyday life, 3) Physical activity, 4) Psychological issues, 5) Work and study, 6) Sexuality and relationship, 7) Rights and finance, 8) Peer-to-peer support and 9) Individual consultation. Quantitative and qualitative data about acceptability, implementation, mechanisms of impact and outcomes will be collected. Results The results will provide essential knowledge about the programme’s acceptability, implementation, mechanisms of impact and outcomes. Conclusion and significance The study will inform adjustment of the programme and will provide knowledge of whether and how to deliver age-specific rehabilitation to YACS.