Iðjuþjálfinn - 01.01.2019, Blaðsíða 27

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depending on the clients’ activity profile;
some clients may show great variety in act-
ivity level from day to day, while others
have a high activity level during the beginn-
ing of the day without taking breaks, or
generally have a low activity level.
Finally, clients plan their activities based on
the calculated activity level and their pri-
orities. Based on the preferences of the cli-
ents, they then choose a tool to plan their
activities. This may be activity cards, pre-
-set day or week schedule (on paper or digi-
tal in Excel), a diary, the Activity Calculator
App or an individually designed tool.
HOW TO USE THE ACTIVITY CALCULATOR
WITHIN THE OCCUPATIONAL THERAPY
TREATMENT?
In the initial stages of the Canadian Pract-
ice  Process  Framework (CPPF) (Townsend
& Polatajko, 2007) it is im portant to assess
the client’s awareness of how current
behaviour influences the onset, mainten-
ance, deteriorations and improvement of
fatigue and how it affects occupational
participation. Once aware, the clients
consider pros and cons of the old and the
new behaviour. This consideration may
result in the intention and willingness to
change (Prochaska, 2008).
COPM may be used to define long term and
short term goals (CPPF – step 4). At this
stage, the Activity Calculator can be
considered as a method to obtain these
goals and simultaneously work on the last
barriers that may hinder the clients from
making behavioural changes.
The Activity Calculator is especially suita-
ble for clients that experience problems
with:
-Structuring the day
-Doing too little or doing too much
-Handling the number of activities
-Finding a balance between activity and rest
-Increasing the number of activities
-Gaining insight into their own capacities
and activity level
-Communicating their limitations to others
The Activity Calculator should not be in-
troduced to clients who:
-May use the Activity Calculator to avoid
certain responsibilities
-Relate problems with fatigue to mainly
external factors and not to their own
behaviour
-Show a tendency to over-control
-Are not ready to change behaviour
-Need to prioritise other goals in life,
including treatment goals
-Can be offered only one or two consulta-
tions and no follow-up elsewhere
-Have a language barrier with the OT
In the treatment phase (CPPF – stage 5), the
clients receive instructions about the Acti-
vity Calculator. The clients start with comp-
leting a record with activities they normally
carry out during a day, week or month. In
addition, the clients complete some time
registration lists. During therapy sessions,
the OT provides guidance and support with
categorising the activities, awarding points
to the activities, calculating the activity
level, and planning activities based on the
activity level. Between the occupational
therapy sessions, the clients are encouraged
to work with the Activity Calculator
independently.
It may take some time before the clients are
able to plan activities based on the activity
level, as this may involve major changes in
both the client’s and their family’s lives.
Ideally, the activity level is the limit of what
the clients are able to do in one day, and
this limit should not be reached before the
end of the day. This means that it is not
advisable to go beyond the activity level
during the day and use relaxation point
during the rest of the day to get down to
activity level at bedtime. However, it is
acceptable that the clients may choose to
ignore this advice occasionally due to
special events or extraordinary situations.
In the treatment phase, working with the
Activity Calculator is combined with ed-
ucation in energy management. This may
help the clients to become more aware of
the meaning of activities. The clients may
perform activities that he or she ex-
periences as strenuous or time consuming
but not meaningful, while he or she is una-
ble to prioritise meaningful activities due to
fatigue. The occupational therapist may
use terms such as “Patterns of daily occu-
pations” and “occupational balance”
(Eklund, o.fl.4, 2017) when explaining to cli-
ents how a balance between what they
wish to do and what they are able to do can
be achieved.
Once the client is familiar with the planning
system, the Activity Calculator can be used
as a method to support the performance of
the COPM goals.
As soon as clients have started to work with
the Activity Calculator, it is important to
evaluate regularly to detect the need for
modifications (CPPF – step 6). During the
sessions, the clients can show how they are
working with the registration records or
their individual planning tool. The OT can
also ask the clients to write down their
maximum scores for each day to evaluate
the activity level. If the clients experience
improvement, the activity level can be
adjusted gradually. It is also possible to use
the activity level to achieve the clients’ final
goal. In this case, the clients start with
describing an “ideal day” or “ideal week”.
All the activities on the “ideal day” or “ideal
week” are awarded points, and the total
score will tell the clients what the activity
level of their final goal will be. The OT
discusses with the clients how they gradu-
ally can work towards this ideal activity
level.
During the final stages of CPPF, it is import-
ant to assess personal challenges the cli-
ents might face to maintain the use of the
Activity Calculator after finishing the
occupational therapy treatment in a way
that makes sense to them. Some continue
to use the chosen tool (cards, day or week
schedule, App etc.) to plan their activities
over time. Others have learned how much
they are able to do from day to day, without
calculations, and have thus achieved
behavioural change. At times of high risk,
such as personal crises, social pressure,
holidays or moving to another house, the
clients may be better able to manage his
energy by using the Activity Calculator aga-
in for some time.
RESEARCH CONCERNING THE ACTIVITY
CALCULATOR
A few studies concerning the Activity
Calculator have been conducted by BSc.
students at different schools for
occupational therapy in the Netherland. In
addition, the Activity Calculator is being
researched by Jacqueline Leenders and
colleagues, as part of the Lifebalance study
at Radboud UMC in the Netherlands.
One study showed that the Framework
Occupational Adaptation may be most
suitable as theoretical model behind the
Activity Calculator (Boezeman & Jorna,
2011).
BSc. students van Dijke, Frijters, Steijsiger
and Westerveld interviewed ten patients
with chronic pain about their experiences
with the Activity Calculator. They found
that the Activity Calculator, even 6 – 24
months following its introduction, still