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BACKGROUND: The occupational therapy intervention programme ABLE 1.0 was designed to enhance the ability to perform activities of daily living in persons living with chronic conditions. There is a need to determine if content and delivery of the ABLE 1.0 are acceptable among occupational therapists (OTs) and clients after having delivered or received the programme, respectively. OBJECTIVES: The paper reports on evaluation of content and delivery of the ABLE 1.0 among OTs and clients. This, in terms of acceptability of intervention in principle, and perceived value, benefits, harms, or unintended consequences of the intervention. MATERIAL AND METHODS: Qualitative semi-structured interviews were conducted with OTs having delivered and clients having received ABLE 1.0 in a Danish municipality. Content analysis was performed. FINDINGS: Two OTs and three clients participated. Analyses revealed six categories related to content and delivery; 'Overall perception of the programme'; 'Potential for implementation'; 'Evaluation, goal setting and clarification of reasons for ADL task performance problems'; 'Intervention: compensatory solutions'; 'Format and duration' and 'Preconditions for delivery'. CONCLUSIONS AND SIGNIFICANCE: The findings provided valuable information used for further development of the ABLE programme.

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BACKGROUND: Chronic conditions are associated with problems related to performance of activities of daily living (ADL) stressing a need to develop and evaluate intervention programmes addressing such problems. Hence, the ABLE programme was developed, and its feasibility evaluated. Implementing intervention programmes in community-based rehabilitation settings requires understanding of how the programme works in various contexts. Applying a realist evaluation approach, the aim of this study was to identify and evaluate interactions between contexts, mechanisms, and outcomes in the ABLE 2.0, to confirm, refine, or reject aspects of the initial programme theory. METHODS: Realist evaluation using qualitative data collected in the ABLE 2.0 randomised controlled trial (n = 78). Based on the ABLE 2.0 initial programme theory, qualitative realist interviews were conducted among receivers (n = 8) and deliverers (n = 3) of the ABLE 2.0 in a Danish municipality. Transcripts were coded, and context-mechanism-outcome configurations were extracted and grouped into contiguous themes. Results were then held up against the initial programme theory. RESULTS: Four contiguous themes were identified including a total of n = 28 context-mechanism-outcome configurations: building a foundation for the entire intervention; establishing the focus for further intervention; identifying and implementing relevant compensatory solutions; and re-evaluating ADL ability to finalise intervention. Overall, the ABLE 2.0 initial programme theory was confirmed. The evaluation added information on core facilitating mechanisms including active involvement of the client in the problem-solving process, a collaborative working relationship, mutual confidence, and a consultative occupation-based process using compensatory solutions. Several contextual factors were required to activate the desired mechanisms in terms of supportive management, referral procedures encouraging the problem-solving process, delivery in the client's home, skilled occupational therapists, and clients feeling ready for making changes. CONCLUSIONS: The ABLE 2.0 represents a coherent problem-solving occupational therapy process, applicable across sex, age, and diagnoses with the potential to enhance ADL ability among persons with chronic conditions, when delivered as part of community-based rehabilitation services. Knowledge about the interactions between contextual factors, mechanisms, and outcomes in the ABLE 2.0 is central in case of future implementation of the programme in community-based rehabilitation settings. TRIAL REGISTRATION: The trial was prospectively registered on www. CLINICALTRIALS: gov (registration date: 05/03/2020; identifier: NCT04295837 ) prior to data collection that occurred between August 2020 and October 2021.

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OBJECTIVE: Compare the effectiveness of a problem-solving, individualised, home-based occupational therapy intervention (ABLE 2.0), to usual occupational therapy, on activities of daily living (ADL) ability in persons with chronic conditions. DESIGN: A single-centre, double-blinded, randomised controlled trial with 10- and 26-week follow-up. SETTING: A Danish municipality. SUBJECTS: Persons with chronic conditions experiencing problems performing ADL tasks (n = 80). INTERVENTIONS: ABLE 2.0 was compared with usual occupational therapy. MAIN MEASURES: Coprimary outcomes were self-reported ADL ability (ADL-Interview Performance) and observed ADL motor ability (Assessment of Motor and Process Skills) at Week 10. Secondary outcomes were self-reported ADL ability (ADL-Interview Performance) and observed ADL motor ability (Assessment of Motor and Process Skills) at Week 26, and perceived satisfaction with ADL ability (ADL-Interview Satisfaction) and observed ADL process ability (Assessment of Motor and Process Skills) at Weeks 10 and 26. RESULTS: In total, 78 persons were randomly assigned: 40 to usual occupational therapy and 38 to ABLE 2.0. No statistically significant nor clinically relevant difference between group mean changes in primary outcomes was identified from baseline to Week 10 (ADL-Interview Performance [-0.16; 95% CI: -0.38 to 0.06] and Assessment of Motor and Process Skills ADL motor ability [-0.1; 95% CI: -0.3 to 0.1]). At Week 26, a statistically significant and clinically relevant difference was found in Assessment of Motor and Process Skills ADL motor ability (LS mean change: -0.3; 95% CI: -0.5 to -0.1) between groups. CONCLUSION: ABLE 2.0 was effective in improving observed ADL motor ability at 26 weeks.

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INTRODUCTION: The need to develop and evaluate interventions, addressing problems performing activities of daily living (ADL) among persons with chronic conditions, is evident. Guided by the British Medical Research Council's guidance on how to develop and evaluate complex interventions, the occupational therapy programme (A Better everyday LifE (ABLE)) was developed and feasibility tested. The aim of this protocol is to report the planned design and methods for evaluating effectiveness, process and cost-effectiveness of the programme. METHODS AND ANALYSIS: The evaluation is designed as a randomised controlled trial with blinded assessors and investigators. Eighty participants with chronic conditions and ADL problems are randomly allocated to ABLE or usual occupational therapy. Data for effectiveness and cost-effectiveness evaluations are collected at baseline (week 0), post intervention (week 10) and follow-up (week 26). Coprimary outcomes are self-reported ADL ability (ADL-Interview (ADL-I) performance) and observed ADL motor ability (Assessment of Motor and Process Skills (AMPS)). Secondary outcomes are perceived satisfaction with ADL ability (ADL-I satisfaction); and observed ADL process ability (AMPS). Explorative outcomes are occupational balance (Occupational Balance Questionnaire); perceived change (Client-Weighted Problems Questionnaire) and general health (first question of the MOS 36-item Short Form Survey Instrument). The process evaluation is based on quantitative data from registration forms and qualitative interview data, collected during and after the intervention period. A realist evaluation approach is applied. A programme theory expresses how context (C) and mechanisms (M) in the programme may lead to certain outcomes (O), in so-called CMO configurations. Outcomes in the cost-effectiveness evaluation are quality-adjusted life years (EuroQool 5-dimension) and changes in ADL ability (AMPS, ADL-I). Costs are estimated from microcosting and national registers. ETHICS AND DISSEMINATION: Danish Data Protection Service Agency approval: Journal-nr.: P-2020-203. The Ethical Committee confirmed no approval needed: Journal-nr.: 19 045 758. Dissemination for study participants, in peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: NCT04295837.

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BACKGROUND: The ABLE intervention was developed to enhance the ability to perform activities of daily living (ADL) tasks among persons living with chronic conditions. ABLE is a generic, home-based, individualised, 8-week occupational therapy intervention program, developed to be delivered in Danish municipalities. In a previous study, the feasibility of ABLE was evaluated in terms of content and delivery. In this pilot study, the remaining feasibility aspects of a randomised controlled trial including (i) trial procedures (recruitment and retention), (ii) randomisation, (iii) adherence to program, (iv) feasibility of additional outcome measurements, and (iv) access to information on usual occupational therapy were evaluated. METHODS: The study was conducted in a Danish municipality, using a two-armed parallel randomised controlled design, planning a recruitment strategy including 20 persons living with one/more chronic conditions and experiencing problems performing ADL. The following progression criteria were used to determine if a future full-scale randomised controlled trial was feasible: (i) recruitment (50% met the eligibility criteria) and retention (80%), (ii) randomisation (80% accepted randomisation, procedure was executed as planned), (iii) adherence to program (100% followed the treatment protocol), (iv) outcome measurements (80% of the participants delivered relevantly and fully answered questionnaires), and (v) usual occupational therapy (extraction of needed information was successful). RESULTS: Due to the COVID-19 pandemic, the study was truncated resulting in limited but sufficient data to answer most of the study questions. (i) Eighteen of 37 eligible persons (48.6%) were recruited; of those treated (n = 6), all remained (100%); (ii) 18 accepted randomisation (100%), and procedure was effective; (iii) ABLE was delivered with adherence (100%); (iv) 92.3-100% of the participants gave relevant and complete answers in two of three questionnaires; and (v) needed information on usual occupational therapy was extractable in seven of nine aspects. CONCLUSIONS: Proceeding to full-scale trial is recommendable; however, a few adjustments on outcome measurements, inclusion criteria and extraction of information on usual occupational therapy are needed. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (Identifier: NCT04295837 ) on December 5th, 2019. Retrospectively registered.

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BACKGROUND: Some clients with cognitive and communicative impairments after a brain injury are unable to participate in the Canadian Occupational Performance Measure (COPM) without support. The study originates from an assumption that some of these clients are able to participate independently in the COPM interview by using a visual material. AIM: The aim was to investigate the clinical utility of COPM supported by Talking Mats (TM) for community-based clients with cognitive and communicative impairments. METHODS: Six clients (51-60 years) were included. After matching the visual material of TM to COPM, the COPM interview was administered twice with an interval of 10 days, once using TM and once without. Interviews were videotaped and studied by six evaluators. RESULTS: The most obvious benefits of using TM as a supportive tool in the COPM interview were related to the first two steps of the COPM interview. CONCLUSION: Using TM in the COPM interview with clients with cognitive and communicative impairments after a brain injury is recommended as the basis for goal setting. The present study demonstrates a possibility to include a COPM interview to clients who had not been able to complete a COPM interview and thus start a rehabilitation process in a client-centered manner.

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