Rehabilitation and everyday life in people with stress-related ill health

Abstract: The overall aim was to explore and describe knowledge of the perceived occupational repertoire in people with stress-related ill health and their experiences from the rehabilitation process, with a specific focus on rehabilitation in a therapeutic garden and how the rehabilitation experiences are connecting with everyday life. Study I was a cross-sectional study that aimed to describe and compare how occupational gaps were reported in everyday occupations in a rehabilitation group of people with musculoskeletal pain or stress-related ill health and in a reference group from the Swedish population. Study II used a grounded theory approach to describe how former clients with stress-related disorders and rehabilitation team members experience the rehabilitation process and to describe how experiences from the rehabilitation have been integrated into the former clients‟ everyday lives. In Studies III and IV, a qualitative longitudinal design was used and analyses were done using a constant comparative approach (Study III) and the empirical phenomenological psychological method (Study IV). The aim in Study III was to explore and describe how women with stress-related ill health, who are on sick leave, experience the rehabilitation process in a therapeutic garden and how these experiences connect to their everyday life. Study IV focused on describing and understanding how connecting rehabilitation experiences and everyday life was characterised in the lived experiences during rehabilitation in women with stress-related ill health. The findings in Study I showed that occupational gaps were reported more often in the rehabilitation group than in the reference group. Instrumental ADL were more often reported as desired by the participants who had been on sick leave for more than a year compared to those who had been on sick leave for less than a year. Findings in Studies II-III highlighted the value of recurrently practicing creative occupations in a safe place during rehabilitation. This enabled an understanding and re-evaluation of the occupations based on the participants own practical experiences. Furthermore, it inspired the participants to start to prioritise enjoyable occupations in everyday life and to add them to their occupational repertoire thereby contributing to an occupational balance. In Studies II-IV it was found that the rehabilitation programme in the therapeutic garden facilitated recovery and occupational balance in the participants´ private arena in everyday life. However, in Study IV difficulties in connecting rehabilitation experiences and the working situation were evident. Connecting rehabilitation experiences and the working situations created experiences of a sense of frustration and being left alone. In conclusion, the findings showed that in order to promote occupational balance and return to work in people with stress-related ill health who have been participating in a rehabilitation programme, it is important to focus on creating a safe place for rehabilitation and on the participants‟ own understanding of occupations. Important clinical implications of this thesis concern the need for rehabilitation programmes to focus on the private as well as the work arenas in everyday life to achieve occupational balance and return to work. Furthermore, rehabilitation needs to include creative, relaxing and work-related activities, support in a constructive dialogue between the participant and the workplace, and continued support of the clients in follow-ups targeting the workplace after the intensive rehabilitation programme has ended.