Occupational Therapists Research Articles

Mixed-Method Evaluation to Understand Clinician Perspectives of a Program to Implement High-Intensity Resistance Rehabilitation Into Skilled Nursing Facilities

ObjectiveTo assess rehabilitation clinicians’ viewpoints regarding a multicomponent implementation program aimed at promoting high-intensity resistance rehabilitation (HIR), as well as practical implications for its use in skilled nursing facility (SNF) rehabilitation. DesignProspective convergent mixed-method design. SettingEight rural SNFs within the Department of Veterans Affairs. ParticipantsPhysical rehabilitation clinicians (physical and occupational therapists, physical and occupational therapy assistants, recreational therapists, and kinesiotherapists) who engaged with the implementation program (n=38). InterventionsClinicians engaged with the multicomponent implementation program to promote the use of HIR in clinical practice. The program components included clinician training (i.e., virtual didactic modules with synchronous case discussions), provision of resources (e.g., equipment, job aids), and facilitated implementation (e.g., external implementation facilitator support, distributed tips and tricks). Main Outcome MeasuresAcceptability of Intervention Measure, Training Acceptability Rating Scale, study-specific questionnaires, and qualitative focus groups exploring perceived acceptability, feasibility, and effect on work experience. ResultsQuestionnaires revealed high levels of implementation program acceptability and perceived effect, alongside moderate levels of feasibility. Focus group themes supported these findings, explaining high acceptability and effect through differentiation from other trainings and prolonged engagement. Feasibility results were explained qualitatively by facilitatory factors (i.e., team participation, reduced caseloads, training characteristics) and inhibitory factors (i.e., training timing, self-paced scheduling logistics, lack of protected time and space). There was no reported negative effect on clinician work experience. ConclusionsAccording to SNF clinician perspectives, a positive HIR implementation experience may be enhanced through implementation programs that provide prolonged engagement and a self-paced structure with built-in accountability. Leadership and organizational support appear important to protect time and space for clinicians who experience competing priorities to successfully facilitate evidence uptake. Future work can evaluate the applicability across various contexts beyond rural VA SNFs.

Developing Self-Management in Type 1 Diabetes at Secondary Schools: Who Is Responsible? A Qualitative Study.

Occupational therapists have the proven capacity to improve outcomes for young adults who are self-managing Type 1 diabetes (T1D). There is insufficient understanding of adolescents' experiences of developing responsibility for diabetes self-management (DSM). To investigate adolescents' perceptions of sharing responsibility for T1D management at school. This study had a descriptive qualitative design and used semistructured interviews and thematic analysis. It is the second phase of a mixed-methods study with a sequential explanatory design that investigated mechanisms of responsibility-sharing at school. Secondary school in Australia. Purposive sample of adolescents (age 15-16 yr) with T1D (N = 11). Adolescents approached the complex occupation of school-based DSM primarily in partnership with their parents, with each adolescent having unique responsibilities while sharing others. Health care professionals and teachers reportedly had minimal involvement. Adolescents described owning most DSM tasks, with their perceptions of building independence limiting the sharing of this responsibility. A heightened sense of risk meant that adolescents were likely to communicate with others in cases of errant blood glucose readings. Current processes commonly resulted in reduced school participation. Adolescents valued working responsively and interdependently with their parents to manage T1D at school, which aligns with the occupational therapy model of co-occupation. Effective responsibility-sharing depends on clear, frequent, autonomy-supportive, team-based communications. Our results showed that patterns of communication for determining school-based DSM processes were fragmented and risk focused, with limited adolescent involvement, resulting in strategies that led to students at times being excluded from school activities. Plain-Language Summary: This is the first study to use an occupational lens to examine the way in which adolescents share their responsibility for diabetes care at school. Diabetes self-management in secondary schools occurs more often when adolescents work interdependently with their parents to manage their diabetes. Adolescent involvement in formal school processes and a clearer allocation of team roles and responsibilities would better support health-promoting habits and school participation.

The Face of Autism in Israel.

This article seeks to offer a comprehensive perspective on autism in Israel, aligning with global reports. It aims to serve as a foundational resource for policymakers in developing relevant support and point to unmet needs. The data was drawn from publications by Israeli government authorities and academic publications. In 2022, the prevalence of child and adolescent autism in Israel was approximately 1.13%, with a male-to-female ratio of 4:1, and an annual increase of 23%, particularly among young children. In Israel, the diagnosis of autism follows the DSM-5 guidelines and is conducted by a physician and a psychologist specializing in autism. Typically, diagnosis is at age 2. The autism intervention approaches prevalent in Israel are consistent with those that are globally accepted. Children with autism are entitled to special education services adapted to their needs and developmental levels. The legally established package of services for children with autism includes sessions with occupational therapists, speech-language pathologists (SLPs), physical therapists, psychologists, and social workers. Children and adults with autism are eligible for disability allowance along with support regarding residence, educational programs, and employment opportunities. Nonetheless, underdiagnosis and low accessibility to services are common in minority populations and rural areas. Furthermore, in recent years, services for autistic individuals have declined. This decline, particularly considering the ongoing rise in the prevalence of autism, pose significant challenges for Israeli government authorities in ensuring that autistic persons receive appropriate support.

La competencia de comunicación terapéutica en estudiantes de práctica profesional de Terapia Ocupacional: percepciones y opiniones desde los docentes

IntroductionCommunication is key in Occupational Therapy and its effectiveness affects up to 20% of therapeutic results. It must be developed throughout the occupational therapists training and professional career, with internships being a critical period for the acquisition of these skills. This study explores opinions and perceptions about the importance and performance of communication competencies in Occupational Therapy students during their professional internships. MethodologyMixed sequential explanatory cross-sectional design, with a descriptive scope, in which 32 teachers participated through an online survey and individual interviews. ResultsThe most relevant elements in relation to communication competence are: agreement on plans and problems, information, patient perspective and empathy. In addition, teachers found that the performance of communication competence in students improves at the end of professional internship. DiscussionsCommunication competence is important, but there are differences in its assessment. Personal, curricular factors and teaching skills can influence performance. It is suggested to incorporate it into the curriculum from the beginning of training. ConclusionsCommunication competence is essential for occupational therapists, especially during their professional internships. Its continuous development should be encouraged so that students acquire clear and effective communication skills that promote therapeutic success.

Inequitable barriers and opportunities for leadership and professional development, identified by early-career to mid-career allied health professionals

IntroductionInterprofessional leadership is essential to sustain the National Health Service (NHS) in pressured times, which should include the NHS’s third largest clinical workforce in England: allied health professionals (AHPs) (AHPs...

Preventing Surgeon Work-Related Musculoskeletal Disorders: A Pilot Study of the Comprehensive Operating Room Ergonomics (CORE) Program.

Work-related musculoskeletal disorders (WMSDs) among surgeons are markedly increasing. Several proposed interventions to reduce WMSDs among surgeons have been studied, but few follow an occupational therapy-oriented approach addressing biomechanical, psychophysical, and psychosocial risk factors. To design, implement, and assess the potential of the Comprehensive Operating Room Ergonomics (CORE) program for surgeons, a holistic evidence-based ergonomics and wellness intervention grounded in occupational therapy principles. Mixed-methods pilot study with the quantitative strand embedded in the qualitative strand. University-affiliated hospital. Six laparoscopic surgeons. CORE program outcomes were assessed using qualitative and quantitative data to indicate changes in posture, physical discomfort, sense of wellness, and operating room (OR) ergonomic performance. The Rapid Upper Limb Assessment (RULA) was used to quantify surgeons' WMSD risk level before and after intervention. There were 12 baseline observations (two for each participant), and two or three post-CORE implementation observations. A statistically significant difference, F(1, 6) = 8.57, p = .03, was found between pre- and post-occupational therapy intervention RULA scores. Thematic analysis of surgeon feedback, which was overwhelmingly positive, identified five themes: postural alignment, areas of commonly reported physical pain or discomfort, setup of the OR environment, surgical ergonomics training, and ergonomics in everyday life. The CORE program effectively decreased ergonomic risk factors to optimize surgeons' occupational performance in the OR. This study demonstrates a potential solution to how occupational therapists can holistically support surgeons and health care providers who are at risk for WMSDs. Plain-Language Summary: By 2025, a surgeon shortage is expected, partly because of the increase in surgeons' work-related musculoskeletal disorders, which affect their health and job continuity. This pilot study shows that the Comprehensive Operating Room Ergonomics program effectively addresses these problems. The study also serves as a framework for occupational therapy professionals to work with health care providers on ergonomics, benefiting population health. Results suggest that this approach could enhance surgeons' work conditions, supporting the American Occupational Therapy Association's Vision 2025 to improve health and quality of life.

Relationship between sensory processing skills and motor skills in 12-month-old infants.

Identifying sensory processing problems of 12-month-old preterm and term children and defining their relationship with motor skills are essential for appropriate interventions and optimal sensory-motor development. This study aimed to determine sensory processing difficulties in 12-month-old babies and examine their relationship with motor skills. This cross-sectional study included 61 infants (28 preterm and 33 full-term, ages 12 months). The infants' sensory processing skills were evaluated using the Test of Sensory Functions in Infants (TSFI), and their gross and fine motor skills were assessed with the Peabody Developmental Motor Scales-2 (PDMS-2). Sensory processing difficulties were more common in preterm babies. Multiple linear regression models indicated a significant positive association between PDMS-2 gross/fine motor scores and TFSI total scores, reactivity to tactile deep pressure, and ocular-motor control in the total sample. Furthermore, there was a relationship between gross motor and adaptive motor function, and fine motor scores were found to be associated with visual-tactile integration sensory scores. Preterm babies are more likely than their full-term peers to have sensory processing problems around the age of one, which can affect their motor skills. The results support the relationship between children's sensory and motor processing skills. Practitioners such as occupational and physical therapists should be alert to this relationship in infants with sensory processing and motor problems. Taking this relationship into consideration when planning intervention programs can be a guide for an effective intervention.

Visual-Motor Integration (VMI) Is Also Relevant for Computer, Smartphone, and Tablet Use by Adults: Introducing the Brief Box Clicking Test.

Visual-motor integration (VMI) is typically examined in children to promote handwriting, but it may also be relevant for adults' capacity for technology use. To examine the reliability and validity of speed of completion of the box clicking test, a web-based test of VMI. Participants in the Understanding America Study completed online surveys on a regular basis, including a very brief (less than 30 s) self-administered box clicking test. For validity testing, we examined whether box clicking speed was associated with constructs relevant to visual-perceptual skills and motor coordination, the skills underlying VMI. Test-retest reliability was examined by computation of intraclass correlation coefficients. A total of 11,114 adults. Measures included the completion time for the box clicking task and measures relevant to visual perception (e.g., perceptual speed) and motor coordination (e.g., self-reported functional limitation). Results suggested that the box clicking test was a VMI task. Slower test performance was associated with lower visual-perceptual speed and a greater likelihood of reporting difficulties with dressing, a motor coordination relevant task. Box clicking tests taken within at least 2 yr of one another had moderate test-retest stability, but future studies are needed to examine test-retest reliabilities over brief (e.g., 2-wk) time intervals. The box clicking test may serve both as a tool for research and to clinically observe whether clients have VMI difficulties that interfere with computer, smartphone, or tablet use. Plain-Language Summary: Use of devices such as smartphones and computers is increasingly becoming integral for daily functioning. Visual-motor integration (VMI) has often been addressed by occupational therapists to support handwriting of children, but it may also be important for technology use by adults. Prior literature supports the relevance of VMI to technology use, and adults with various chronic conditions have been found to have decrements in VMI. We tested the psychometric properties of a brief box clicking test of VMI that could be used to examine VMI underlying technology use among adults. Overall, results suggested that the box clicking test was a VMI task. Just as speed of gait has been used as an index of functional mobility, speed on the box clicking task seemed serviceable as an index of VMI ability. The box clicking test may also be used for clinical observation of whether VMI interferes with technology use.

Behavioral Problems and Self-Feeding Independence Among Patients With Acute Stroke: A Single-Center Study.

Self-feeding independence is often the first goal in acute stroke rehabilitation. Attention deficits appear frequently after stroke, but neuropsychological tests may be difficult to perform in the acute phase, and the effect on self-feeding activities may be difficult to detect. Therefore, we aimed to clarify behavioral problems with self-feeding using the Moss Attention Rating Scale (MARS), a behavioral observational rating scale of attentional function, for a better understanding of the effects of self-feeding. To identify behavioral problems caused by attention deficits among patients with acute stroke who need assistance in self-feeding, using the MARS. Cross-sectional single-center study. St. Marianna University Yokohama Seibu Hospital, Kanagawa, Japan. A total of 96 patients (42 women and 54 men) were admitted to the hospital for stroke treatment. Patients' median age was 75.0 yr. The date of evaluation was a median of 3.0 days from admission. The primary outcome was the FIM® eating subscore. The secondary outcome was the MARS score. Significant differences were noted in the total raw MARS, logit, and three-factor scores for self-feeding independence (p < .01). The effect size of the consistent or sustained factor on independence was large (r = .83). Behavioral problems related to self-feeding dependence include the inability for sustained attention. Our results suggest that sustained concentration during self-feeding is necessary for eating independence. Rehabilitation focused on sustained attention is important for independent self-feeding. Plain-Language Summary: A patient's self-feeding independence is often the first goal in acute stroke rehabilitation. Patients frequently experience attention deficits after a stroke, but neuropsychological tests may be difficult to perform in the acute phase of rehabilitation, and the effect of attention deficits on self-feeding may be difficult to identify. To have a better understanding of the effects on self-feeding, this study aimed to identify behavioral problems using the Moss Attention Rating Scale (MARS). The study found that the MARS can be used to identify behavioral problems related to self-feeding independence, which can help occupational therapists to develop rehabilitation programs for their clients who have experienced a stroke.

The Effect of Touch and Massage Techniques Applied to Children on Parental Role Perception and Perceived Stress

Aim: The study examined the effects of tactile and massage techniques on the occupational therapist’s perspective on the role perception and stress levels of parents and the changes in children’s sensory processing. Method: A total of 30 children, (18 females and 12 males), aged 3-6, with normal development, and their parents were included in the study. A diverse community sample of mothers (M=33.6±5.521 years) and their preschool-aged children (M=4.5±1.2 years) participated in the study. The following instruments were employed: Parental Stress Index, Self-Perception Scale for Parenting Role, and Sensory Profile Test. Parents were instructed in a number of touch and massage techniques devised by the Occupational Therapist within the framework of Sensory Integration Theory. Following the 15-minute and 20-session implementation period, the parents were then tested. After the sessions were completed, the tests were repeated. Results: The findings indicated that at the end of the study, there was a decrease in parental stress levels, and an increase in parental role perception and children's sensory processing skills (p &amp;lt;0.05). The study demonstrated that touch and massage techniques can positively impact parent-child interaction. Conclusion: Studies examining the potential enduring effects of positive parental touch on stress levels and parental role perception rarely extend beyond infancy. It is believed that research with a larger sample size on this topic would contribute significantly to the existing literature.

Better education required for professionals in healthcare regarding auditory processing disorder.

Global research has revealed inadequate levels of Auditory Processing Disorder (APD) awareness and knowledge among related professionals leading to neglect of this specific type of hearing impairment that is estimated to present in 50% of children with learning disabilities (dyslexia included) and more than 70% of adults with presbycusis or mild cognitive impairment. The aim of the current study was to record APD awareness and knowledge among professionals working in both Healthcare and Education sectors. A 36-question questionnaire was developed and addressed to medical doctors of different specialties (ENTs and non-ENTs), therapists (speech & language therapists, occupational therapists, psychologists), and educators (of both typical and special education). The questionnaire was sent to Professional Societies of interest as well as a University Rectorate where authors are affiliated, requesting the spreading to all members, and was also posted to related private groups in social media. Data concerning APD-training and knowledge were gathered from 522 questionnaires. Level of knowledge was recorded both subjectively (self-rating) and objectively (pre-defined scoring of items). Analysis showed insufficient knowledge concerning APD among specialties. ENTs and/or therapists scored statistically significantly higher compared to other medical specialties and educators, while still lower than 50%. The current level of awareness on APD might negatively affect the way individuals with APD are addressed, all the way from referral to management. Levels of awareness and knowledge among professions which are related to APD either directly or indirectly can be further improved through formal education targeting bachelor, master and PhD programs of medical doctors, therapists and educators. We are proposing the development of educational programs that target ENT doctors so that children and adults receive more elaborate services both diagnostically and from a rehabilitation point of view. This will improve quality of life and mental health.

Essential Occupational Therapy Competencies for Low Vision and Blindness.

Background. The prevalence of low vision and blindness in persons across the lifespan means that occupational therapists will encounter these conditions across all areas of practice. Practitioners must be equipped with competencies necessary to recognize and respond to vision loss-related concerns. Purpose. This study sought to identify essential occupational therapy competencies when providing services to people with low vision and blindness. Method. The study employed a three-phase modified Delphi methodology administered through online surveys and focus group. Respondents included people with low vision or blindness, professionals with special expertise in low vision/blindness, and occupational therapists in other practice areas. Data were analyzed using an iterative, consensus-generating strategy involving quantitative analysis of competencies, qualitative input, and expert panel review. Findings. The process yielded a 51-item competency framework organized into six domains. Implications. The framework provides the foundation for a common curriculum for Canadian occupational therapy programs and for the creation of educational resources.

Are occupational therapists in hand therapy working in an occupation-centered way? A cross sectional survey.

The dominance of the biomedical approach has previously caused a limited focus on occupation within hand therapy. This study aimed to investigate the rehabilitation offered to patients with a hand-related disorder (HRD) in Denmark including to determine the extent to which occupation-focused and/or occupation-based assessments and interventions are used and to identify barriers against their use. A cross-sectional survey with 45 questions was conducted among members of the Danish Association for Hand Therapy. Data were analysed with descriptive statistics. Categorical variables were reported with frequency and percentage, and continuous variables with average and standard deviation. One hundred and six occupational therapists working as hand therapists (n = 106) completed the survey. They reported common use of assessments measuring range of motion, pain, edema, and occupational performance. Occupational performance was assessed by non-standardized occupation-focused assessments, such as informal conversations. Exercise, pain management, and occupation-focused informal conversations were reported as the most frequently used interventions. Out of 82 respondents, 74 (91.4%) reported that they used interventions focused on body function and structures to the extent they wanted. Only 41 (50.0%) used occupation-focused or occupation-based interventions to the extent they wanted. Assessments and interventions reporting body function and structure were used most frequently whereas assessments and interventions reporting activity and participation were used to a lesser extent. Occupation-focused assessments and interventions were used more commonly than occupation-based. Hand therapists considered occupation-based assessments and interventions to be important in rehabilitation after HRD, despite using them with few patients. Several barriers were reported regarding the implementation of an occupation-centered approach: habit, workload, time constraints, and setting.

A Scoping Review of Intervention Implementation for Self-Care Skills among Children with Developmental Delay.

Difficulties with self-care skills are frequently observed in children with developmental delays. Given the scarcity of robust evidence backing self-care interventions for this group, this scoping review is designed to aggregate existing literature on the implementation of such interventions. Therefore, this scoping review aims to collate literature on the nature of self-care intervention implementation to increase understanding of the current practice and inform future research directions. This scoping review endeavoured to explore the body of literature concerning the existence of self-care interventions and their implementation strategies in children who have developmental delays. Relevant studies were identified by searching through the following databases: Web of Science (W0S), Scopus, ASEAN Citation Index (ACI), CINAHL EBSCO and PubMed. Six types of interventions using various approaches were identified. Occupational therapists mainly manage intervention providers with multidisciplinary co-facilitator and parents' involvement. Whilst session information varied, some evidence suggests that at least 30 min per session, minimum once per week up to twice per week, ranging from 10 to 23 sessions, may be sufficient. Intervention plans should be tailored to each child's unique needs, taking into account the variety of available interventions. Collaboration among occupational therapists, parents, educators and health professionals in home programmes enhances self-care intervention outcomes. These results are set to inform future research and practice, paving the way for enhanced support and improved outcomes for children with developmental delays.

Kinesiology Tape Application for Postoperative Ocular Edema: A Pilot Study

Occupational therapists (OTs) often adapt and implement specific treatment techniques and modalities to improve patient outcomes by improving patient positioning and reducing edema and pain. One such modality is the use of kinesiology tape (K-tape), an elastic therapeutic tape that alleviates pain, provides joint support, and manages edema. A pilot study was conducted with 20 patients to determine whether using K-tape after two specific neurosurgery procedures that cause occluded eyes would assist in reducing postoperative edema and ecchymosis in the operative-side eye and face, thereby reducing pain and increasing overall patient satisfaction. In 10 patients, K-tape was used in addition to the postoperative standard of care (cryotherapy and head-of-bed elevation to greater than 30°). The 10 control patients received only the standard of care. Patient surveys and OT documentation found that using K-tape for postoperative patients with ocular edema was more beneficial than the standard of care alone in assisting with edema and hematoma reduction and faster eye-opening. Patients completed verbal surveys up to three times during their stay, depending on length of stay. Patients tolerated this easy, cost-effective modality. Patients reported reduced pain, pressure, and swelling, which suggests that K-tape be considered by OTs as an additional modality in acute care.

Can physiotherapists and occupational therapists help mitigate understaffing in nursing care? A qualitative explorative study from Denmark

Can physiotherapists and occupational therapists help mitigate understaffing in nursing care? A qualitative explorative study from Denmark

Diversion of hospital admissions from the emergency department using an interprofessional team: a propensity score analysis.

To examine if an ED interprofessional team ("ED1Team") could safely decrease hospital admissions among older persons. This single-center, retrospective, propensity score matched study was performed at a single ED during a control (December 2/2018-March 31/2019) and intervention (December 2/2019-March 31/2020) period. The intervention was assessed by the ED1Team, which could include an occupational therapist, physiotherapist, and social worker. We compared admission rates between period in persons age ≥ 70years. Next, we compared visits attended by the ED1Team to (a) control period visits, and (b) intervention period visits without ED1Team attendance. ED length-of-stay, 7-day subsequent hospital admission and mortality in discharged patients. There were 5496 and 4876 eligible ED visits during the control and intervention periods, respectively. In the latter group, 556 (11.4%) received ED1Team assessment. After matching, there was an absolute 2.3% (p = 0.07) reduction in the admission rate between control and intervention periods. After matching the 556 ED1Team attended visits to control period visits, and to intervention period visits without the intervention, admission rates decreased by 10.0% (p = 0.006) and 13.5% (p < 0.001), respectively. For discharged patients, median ED length-of-stay decreased by 1.0h (p < 0.001) between control and intervention periods and increased by 2.3h (p < 0.001) compared to intervention period without the intervention. For patients discharged by the ED1Team, subsequent readmissions after 7days were slightly higher, but mortality was not significantly different. ED1Team consultation was associated with a decreased hospital admission rate in older ED patients. It was associated with a slightly longer ED length-of-stay and subsequent early hospitalizations. Given that even a small increase in freed hospital beds would release some of the pressure on an overextended healthcare system, these results suggest that upscaling of the intervention might procure systems-wide benefits.

Informing creation of the FEEDS Toolkit to support parent-delivered interventions for eating, drinking and swallowing difficulties in young children with neurodisability: intervention use by neurodevelopmental diagnosis and healthcare professional role

BackgroundThe FEEDS (Focus on Early Eating, Drinking and Swallowing) study focused on interventions used to improve feeding for children with neurodisability and eating, drinking and swallowing difficulties (EDSD), and the...

Balancing between dual belongings when organised into interdisciplinary teams, with the trust model as the context: A qualitative study

BackgroundHome-based healthcare services are facing challenges and pressures of increasing needs due to an ageing population, rising workload for an overburdened workforce, and limited financial resources. The trust model is an approach to address the challenges, by organizing the home-based healthcare services into smaller, autonomous interdisciplinary teams. The aim is to involve users and next of kin in decision-making and trusting frontline workers’ professional judgement, thus making the services more flexible and individually tailored. This study explores frontline workers’ practices and experiences of working within interdisciplinary teams according to the trust model’s goals.MethodsObservations, individual-, and focus groups interviews were conducted within home-based healthcare service in a Norwegian municipality. The participants were leaders and frontline workers at different levels of the home-based healthcare services, including registered nurses, auxiliary nurses, occupational therapists, physiotherapists, and other unskilled healthcare personnel. Data was analysed thematically.ResultsThe results are presented in terms of themes: ‘We all want the best for service users’, ‘Belonging to an interdisciplinary team’ and ‘Maintaining belonging to those with similar work tasks and responsibilities’. The results show a diversity among the participants’ experiences of working within interdisciplinary teams. It demonstrates a dilemma between creating belonging to and forming identities within the interdisciplinary team, and at the same time, the importance of maintaining belonging and identity with those in the same profession or with the same tasks and responsibilities.ConclusionThis study suggests that the frontline workers need for dual belonging seems to be underestimated within the trust model, and by acknowledging this, organisations and policymakers can create environments that support both. Which in turn can enhance the possibility to deliver flexible and individually tailored services for service users.

Self-management interventions among community-dwelling older adults with type 2 diabetes mellitus: a scoping review protocol

BackgroundGlobally, the number of older adults is increasing rapidly; simultaneously, there is an epidemiological shift toward chronic diseases. One such chronic disease is type 2 diabetes mellitus (DM) which is...