{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:15:40Z","timestamp":1760242540290,"version":"build-2065373602"},"reference-count":52,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2017,11,7]],"date-time":"2017-11-07T00:00:00Z","timestamp":1510012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Stroke is a major cause of disability worldwide and different types of impairments can affect the individual\u2019s ability to manage everyday activities such as travel that is essential for participation in society. The purpose of this study was to investigate the feasibility of a new self-management intervention (BUS TRIPS) focusing on travelling by bus, and potential contributions to an improved ability to travel by bus for people with cognitive impairments after stroke. This is a pilot study of five individuals, utilizing a multiple case study design with a mixed methods approach. Assessments (Stroke Impact Scale, General Self-Efficacy Scale and Life Satisfaction Scale-11, Item 1) were performed before, two weeks after, and three months after the program. The data collection also comprised reflection notes from the group leaders (an occupational therapist and a physiotherapist), a semi-structured group interview and an individual phone survey. The feasibility of the intervention was presented in four sub-categories: (1) appreciated group format despite too short sessions; (2) the importance of skilled leaders and motivated participants; (3) session material adequate but needs minor revision to fit the target group; and (4) homework is valuable but reflective group discussions must be supported. The narratives of each case showed that all participants made some progress related to travelling by bus, but the overall positive results could not be verified by all of the quantitative assessments. We conclude that the BUS TRIPS intervention is feasible and can potentially contribute to an improved ability to travel by bus for the target group. Future studies is called for, and should focus on recruitment challenges, to clarify assessments that would be suitable to use in larger scale clinical trials and during subsequent implementation in clinical practice.<\/jats:p>","DOI":"10.3390\/ijerph14111353","type":"journal-article","created":{"date-parts":[[2017,11,7]],"date-time":"2017-11-07T11:46:01Z","timestamp":1510055161000},"page":"1353","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["BUS TRIPS\u2014A Self-Management Program for People with Cognitive Impairments after Stroke"],"prefix":"10.3390","volume":"14","author":[{"given":"Emma","family":"Carlstedt","sequence":"first","affiliation":[{"name":"Department of Health Sciences, Lund University, P.O. Box 157, SE-22100 Lund, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne","family":"Iwarsson","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Lund University, P.O. Box 157, SE-22100 Lund, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agneta","family":"St\u00e5hl","sequence":"additional","affiliation":[{"name":"Department of Technology and Society, Lund University, P.O. Box 118, SE-22100 Lund, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H\u00e9l\u00e8ne","family":"Pessah-Rasmussen","sequence":"additional","affiliation":[{"name":"Department of Neurology and Rehabilitation Medicine, Sk\u00e5ne University Hospital, SE-22185 Lund-Malm\u00f6, Sweden"},{"name":"Department of Clinical Sciences, Lund University, P.O. Box 117, SE-22100 Lund, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"M\u00e5nsson Lexell","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Lund University, P.O. Box 157, SE-22100 Lund, Sweden"},{"name":"Department of Neurology and Rehabilitation Medicine, Sk\u00e5ne University Hospital, SE-22185 Lund-Malm\u00f6, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2017,11,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"667","DOI":"10.3109\/09638288.2014.923523","article-title":"Impact of first-ever mild stroke on participation at 3 and 6 month post-event: The TABASCO study","volume":"37","author":"Adamit","year":"2015","journal-title":"Disabil. Rehabil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"860","DOI":"10.3109\/09638288.2012.717575","article-title":"Is walking faster or walking farther more important to persons with chronic stroke?","volume":"35","author":"Combs","year":"2013","journal-title":"Disabil. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Balakrishnan, R., Kaplan, B., Negron, R., Fei, K., Goldfinger, J.Z., and Horowitz, C.R. (2017). Life after stroke in an urban minority population: A photovoice project. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14030293"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/11038120802326222","article-title":"Bus use and older people: A literature review applying the Person-Environment-Occupation model in macro practice","volume":"16","author":"Broome","year":"2009","journal-title":"Scand. J. Occup. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"77","DOI":"10.5014\/ajot.62.1.77","article-title":"Two dimensions of participation in very old age and their relations to home and neighborhood environments","volume":"62","author":"Haak","year":"2008","journal-title":"Am. J. Occup. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s11845-010-0528-9","article-title":"Factors affecting return to driving post-stroke","volume":"180","author":"Tan","year":"2011","journal-title":"Ir. J. Med. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1080\/15017419.2011.640408","article-title":"Use of public transport by stroke survivors with persistent disability","volume":"14","author":"Asplund","year":"2012","journal-title":"Scand. J. Disabil. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"162","DOI":"10.3109\/11038120902964450","article-title":"Post-stroke functional limitations and changes in use of mode of transport","volume":"17","author":"Wendel","year":"2010","journal-title":"Scand. J. Occup. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.trf.2015.01.002","article-title":"Use of local public transport among people with cognitive impairments\u2014A literature review","volume":"29","author":"Risser","year":"2015","journal-title":"Transp. Res. Part F Traffic Psychol. Behav."},{"key":"ref_10","unstructured":"Wretstrand, A., and St\u00e5hl, A. (2008). User Needs and Expectations Relative to Accessible Transport: Framework for Mobility Planning, European Commission. WP2-Lund-Deliverable2-v.1.0."},{"key":"ref_11","first-page":"1","article-title":"Facilitators for traveling with local public transport among people with mild cognitive limitations after stroke","volume":"24","year":"2017","journal-title":"Scand. J. Occup. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta18290","article-title":"Rehabilitation aimed at improving outdoor mobility for people after stroke: A multicentre randomised controlled study (the Getting out of the House Study)","volume":"18","author":"Logan","year":"2014","journal-title":"Health Technol. Assess."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"831","DOI":"10.3109\/09638288.2011.623754","article-title":"Access and participation in the community: A prospective qualitative study of driving post stroke","volume":"34","author":"White","year":"2012","journal-title":"Disabil. Rehabil."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1080\/17450100903435011","article-title":"Exploring mobility in public environments among people with cognitive functional limitations\u2014Challenges and implications for planning","volume":"5","author":"Rosenkvist","year":"2010","journal-title":"Mobilities"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/j.1440-1630.2011.00935.x","article-title":"What people say about travelling outdoors after their stroke: A qualitative study","volume":"59","author":"Barnsley","year":"2012","journal-title":"Aust. Occup. Ther. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1207\/S15324796ABM2601_01","article-title":"Self-management education: History, definition, outcomes, and mechanisms","volume":"26","author":"Lorig","year":"2003","journal-title":"Ann. Behav. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"257","DOI":"10.3109\/09638288.2012.691938","article-title":"Self-management after stroke: Time for some more questions?","volume":"35","author":"Jones","year":"2013","journal-title":"Disabil. Rehabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1310\/tsr1505-503","article-title":"Implementation, process, and preliminary outcome evaluation of two community programs for persons with stroke and their care partners","volume":"15","author":"Huijbregts","year":"2008","journal-title":"Top. Stroke. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.socscimed.2006.09.012","article-title":"Recovery following stroke: The role of self-management education","volume":"64","author":"Kendall","year":"2007","journal-title":"Soc. Sci. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.3109\/09638288.2014.996674","article-title":"A systematic review of the effectiveness of stroke self-management programs for improving function and participation outcomes: Self-management programs for stroke survivors","volume":"37","author":"Warner","year":"2015","journal-title":"Disabil. Rehabil."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1080\/10749357.2016.1155278","article-title":"The development of the improving participation after stroke self-management program (IPASS): An exploratory randomized clinical study","volume":"23","author":"Wolf","year":"2016","journal-title":"Top. Stroke Rehabil."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"797","DOI":"10.3109\/09638288.2010.511415","article-title":"Self-efficacy and self-management after stroke: A systematic review","volume":"33","author":"Jones","year":"2011","journal-title":"Desabil. Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.pec.2008.11.007","article-title":"Process evaluation of a self-management cognitive program for persons with multiple sclerosis","volume":"76","author":"Shevil","year":"2009","journal-title":"Patient Educ. Couns."},{"key":"ref_24","unstructured":"Shevil, E. (2008). Developing and Pilot Testing a Cognitive Intervention Program for Persons with Multiple Sclerosis. [Ph.D. Thesis, University of Illinois]."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"214","DOI":"10.3109\/17483107.2010.528142","article-title":"Improvements of task performance in daily life after acquired brain injury using commonly available everyday technology","volume":"6","author":"Lexell","year":"2011","journal-title":"Disabil. Rehabil. Assist. Technol."},{"key":"ref_26","unstructured":"Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., and Petticrew, M. (2017, October 04). Developing and Evaluating Complex Interventions: New Guidance. Available online: http:\/\/www.mrc.ac.uk\/documents\/pdf\/complex-interventions-guidance\/."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Law, M., Polatajko, H., Pollock, N., McColl, M.A., Carswell, A., and Baptiste, S. (2006). Canadian Occupational Performance Measure, CAOT Publications. [4th ed.].","DOI":"10.1037\/t71986-000"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/j.1532-5415.1991.tb01616.x","article-title":"The timed \u201cUp & Go\u201d: A test of basic functional mobility for frail elderly persons","volume":"39","author":"Podsiadlo","year":"1991","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1519\/00139143-200608000-00004","article-title":"Reference values for the timed up and go test: A descriptive meta-analysis","volume":"29","author":"Bohannon","year":"2006","journal-title":"J. Geriatr. Phys. Ther."},{"key":"ref_30","first-page":"197","article-title":"Associations between perceptions of environmental barriers and participation in persons with late effects of polio","volume":"16","author":"Lund","year":"2009","journal-title":"Scand. J. Occup. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1016\/j.apmr.2003.09.027","article-title":"Quantifying environmental factors: A measure of physical, attitudinal, service, productivity, and policy barriers","volume":"85","author":"Whiteneck","year":"2004","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1016\/j.apmr.2015.01.024","article-title":"Barriers to activity and participation for stroke survivors in rural China","volume":"96","author":"Zhang","year":"2015","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1097\/MRR.0b013e3283021912","article-title":"Long-term cognitive functional limitations post stroke: Objective assessment compared with self-evaluations and spouse reports","volume":"31","author":"Wendel","year":"2008","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1002\/(SICI)1099-1166(199710)12:10<1029::AID-GPS683>3.0.CO;2-D","article-title":"Experience with a Swedish version of the Geriatric Depression Scale in primary care centres","volume":"12","author":"Gottfries","year":"1997","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1161\/01.STR.30.10.2131","article-title":"The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change","volume":"30","author":"Duncan","year":"1999","journal-title":"Stroke"},{"key":"ref_37","unstructured":"(2017, June 13). Swedish Version of the General Self-Efficacy Scale. Available online: http:\/\/userpage.fu-berlin.de\/~health\/swedish.htm."},{"key":"ref_38","unstructured":"Weiman, J., Wright, S., and Johnston, M. (1995). Generalized self-efficacy scale. Measures in Health Psychology: A User\u2019s Portfolio. Causal and Control Beliefs, Nfer-Nelson."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1080\/165019702760279242","article-title":"Life satisfaction in 18- to 64-year-old Swedes: In relation to gender, age, partner and immigrant status","volume":"34","author":"Melin","year":"2002","journal-title":"J. Rehabil. Med."},{"key":"ref_40","unstructured":"Yin, R.K. (2014). Case Study Research: Design and Methods, Sage Publications, Inc.. [5th ed.]."},{"key":"ref_41","unstructured":"Creswell, J.W., and Plano Clark, V.L. (2011). Designing and Conducting Mixed Methods Research, SAGE Publications, Inc.. [2nd ed.]."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three approaches to qualitative content analysis","volume":"15","author":"Hsieh","year":"2005","journal-title":"Qual. Health Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1097\/JNN.0b013e3182478c96","article-title":"Lessons learned in recruitment and retention of stroke survivors","volume":"44","author":"Hadidi","year":"2012","journal-title":"J. Neurosci. Nurs."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.3109\/09638288.2015.1111436","article-title":"Group-based delivery of interventions in traumatic brain injury rehabilitation: A scoping review","volume":"38","author":"Patterson","year":"2016","journal-title":"Disabil. Rehabil."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Norcross, J.C., and Goldfried, M.R. (2005). The Transtheoretical approach. Handbook of Psychotherapy Integration, Oxford University Press. [2nd ed.].","DOI":"10.1093\/med\/9780195165791.001.0001"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/MRR.0000000000000131","article-title":"Psychometric properties of the Swedish version of the General Self-Efficacy Scale in stroke survivors","volume":"38","author":"Carlstedt","year":"2015","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_47","unstructured":"Bandura, A. (1997). Self-Efficacy: The Exercise of Control, W.H. Freeman and Company."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"672","DOI":"10.2340\/16501977-1989","article-title":"The challenge of assessment in rehabilitation","volume":"47","author":"Lejeune","year":"2015","journal-title":"J. Rehabil. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.3109\/09638288.2014.887796","article-title":"Social participation post stroke: A meta-ethnographic review of the experiences and views of community-dwelling stroke survivors","volume":"36","author":"Woodman","year":"2014","journal-title":"Disabil. Rehabil."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2836","DOI":"10.1161\/STR.0000000000000033","article-title":"Evidence for stroke family caregiver and dyad interventions: A statement for healthcare professionals from the American Heart Association and American Stroke Association","volume":"45","author":"Bakas","year":"2014","journal-title":"Stroke"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"8","DOI":"10.7748\/nr.23.5.8.s3","article-title":"Exploring recruitment issues in stroke research: A qualitative study of nurse researchers\u2019 experiences","volume":"23","author":"Boxall","year":"2016","journal-title":"Nurse Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1111\/j.1747-4949.2011.00624.x","article-title":"Poststroke fatigue: An emerging, critical issue in stroke medicine","volume":"6","author":"Kim","year":"2011","journal-title":"Int. J. Stroke"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/11\/1353\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:48:24Z","timestamp":1760208504000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/11\/1353"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,7]]},"references-count":52,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2017,11]]}},"alternative-id":["ijerph14111353"],"URL":"https:\/\/doi.org\/10.3390\/ijerph14111353","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2017,11,7]]}}}