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Adaptation and Ability in Daily Occupations in People with Poliomyelitis Sequelae

The aims of these studies were to explore the adaptive process from an occupational perspective by revealing strategies used to manage daily occupations, to examine factors influencing the development of strategies, to investigate ability and perceived difficulty in ADL, use of assistive devices and to investigate the prevalence of distress in aspects of perceived health. Methods. Both qualitative and quantitative analyses were used. The adaptive process was explored by tape-recorded interviews, observations in the subjects' own homes and analysis according to grounded theory. Structured interviews regarding demographic data, use of assistive devices and housing adaptations were also included. Assessments used in the studies were: the NRH postpolio limb classification for the progress and degree of polio; the staircase of ADL (an extension of Katz' index) supplemented with self-ratings of perceived difficulty; walking speed for 30 m indoors and the Nottingham Health Profile (NHP). Subjects. In the qualitative analysis, 22 persons were selected according to theoretical sampling from a longitudinal study of volunteers with poliomyelitis sequelae. In the quantitative analysis, 133 participants with polio were obtained from a consecutive clinical group. Results. Six broad groups of strategies were used to keep some kind of balance among goals, abilities and environmental demands in daily occupations. One group of strategies was emotion-focused, while five groups were problem-focused: utilising physical capability, promoting concrete problem-solving, altering the pattern of occupations, influencing relations and facilitating future activities. The examination of factors influencing the development and choice of everyday life strategies resulted in identification of the concept conception of occupational self, which comprised the participant's body image, sense of competence, values and goals in interaction with the environment. Coming to a new approach towards the shift in one's capabilities revealed two integrated processes: one dealing with the process of realisation and reorganisation, the other six patterns of behaviour in daily occupations. The participants had a high degree of independence in personal ADL, whereas more than 50% were dependent in cleaning, shopping and transportation. However, a great number of independent persons reported difficulties in some activities. Most distress was found in the dimensions of physical mobility, pain and energy according to NHP and most health-related problems were reported in housework, employment and leisure. Fifty-nine percent of the participants were in gainful employment. Conclusions. The results showed that the persons with poliomyelitis sequelae tried to maintain their independence despite perceived difficulties in ADL and might be reluctant to use assistive devices. Signs of overload indicate that balance among goals, abilities and environmental demands might be difficult to achieve. Flexibility in the use of strategies facilitated participation in daily occupations. Requirements for this adaptive pattern seemed to be time to realise and modify behaviour; energy and ability to solve problems; access to information and support and being ready to compensate with assistive devices. The results suggest that late effects of polio interfere with many areas of daily activities and that there is a need for multidisciplinary support.