Using a questionnaire, demographic data characterizing the clients were collected at baseline: age, gender, diagnosis, job situation, civil status, type of help at home, and self-reported general health. General health was assessed using the first question (SF1) of the 36-item Short Form Survey (SF36) [36]. A previous study supports applying the SF1 among persons with chronic conditions [36]. Demographic data on the OTs (age, gender, years since graduation, years working with persons with chronic conditions) and the OTSs (age and gender) were collected at the first training session.

As described in the protocol paper [17], specific objectives and related data collection methods (Additional file 1) were based on the framework by O’Cathain et al. [20].The feasibility evaluation of content and delivery of ABLE 1.0 was conducted using a combination of data from registration forms and ADL evaluations. Most aspects in the registration forms were evaluated using Visual Analog Scales (VAS) from one to five; 1 = very low degree, 2 = low degree, 3 = fair degree, 4 = high degree, and 5 = very high degree.

A registration form (for example see Additional file 2) was developed to be filled in by OT/OTS reporting on deviations from the ABLE 1.0 manual (intervention development); components applied, time use, and needed equipment (intervention components); if the session (i.e., the applied components) contributed to progress toward goal attainment (mechanisms of action); unintended side effects and perceived degree of meaningfulness (perceived value, benefits, harms, or unintended consequences); retention, challenges, satisfaction, confidence, and facilitators and barriers (feasibility and acceptability in practice); and number of sessions, time use, and dose sufficiency (fidelity, reach, and dose of intervention) (Additional file 1) [17, 20]. Based on the registration forms, the number of clients treated by each OT was also determined.

Similarly, a registration form (see example in Additional file 3) was developed to report on aspects related to the feasibility of the intervention from the client’s perspective: if the session contributed to progress toward goal attainment (mechanisms of action); the perceived degree of meaningfulness (perceived value, benefits, harms, or unintended consequences); to which extent the client perceived to be informed and involved, the perceived degree of satisfaction (feasibility and acceptability of intervention in practice) and dose sufficiency (fidelity, reach and dose of intervention) (Additional file 1) [17, 20].

To explore mechanisms of actions, data on ADL ability were gathered to determine the proportion of clients obtaining clinically relevant improvements in ADL ability and the extent to which intervention components contributed to goal attainment. Data on ADL ability comprised self-reported and observed ADL ability measured at baseline and post intervention using ADL-I [31], AMPS [32, 33], and GAS [34, 35].

The ADL-I [31] is a standardized evaluation interview used by OTs to describe and measure self-reported quality of ADL task performance in 47 ADL tasks in terms of physical effort and/or fatigue, efficiency, safety, and independence. During the interview, the person rates the perceived quality of performance. The baseline quality of performance ratings form the basis for identification of ADL task performance problems to be prioritized at goal setting. To measure change in self-reported quality of ADL task performance, the 47 quality of performance ratings are transformed into one overall linear (interval scale) ADL-I measure of self-reported quality of ADL task performance, adjusted for the difficulty of the ADL tasks, based on Rasch measurement methods [31]. The measures are expressed in logits (log-odds probability units) [2, 31]. Previous studies indicate that the ADL-I can be used to generate valid and reliable measures of self-reported quality of ADL task performance among persons with various chronic conditions [3, 4, 31].

The AMPS [32, 33] is a standardized observation-based evaluation to measure observed quality of ADL task performance in terms of physical effort and/or fatigue, efficiency, safety, and independence. The person chooses and performs at least two relevant standardized ADL tasks of appropriate challenge. Two domains are evaluated; motor skills (16 items) and process skills (20 items). After the observation, the quality of each skill is evaluated on a four-point ordinal scale according to scoring criteria in the AMPS manual [33]. AMPS software [37], based on Many-Faceted Rasch statistics, is used to convert ordinal raw scores into overall linear ADL motor and ADL process ability measures adjusted for task challenge, skill item difficulty, and rater severity. Measures are expressed in logits (log-odds probability units) [32]. ADL motor ability measures below the 2.0 logits competence cutoff indicate increased physical effort, fatigue, and clumsiness during task performance and ADL process ability measures below the 1.0 logit competence cutoff indicate inefficient and potentially unsafe ADL task performance suggesting need for assistance in everyday life [32, 33]. Several studies support reliability and validity of AMPS ADL ability measures among persons with chronic conditions [2, 3, 3840].

The GAS (34, 35) is a tool for defining and monitoring individual goals. The person is involved in defining goals and describing levels from − 2 to + 2 of goal attainment: “less than expected” (level − 2), “unchanged/actual level” (level − 1), “expected” (level 0), “more than expected” (level + 1), and “much more than expected” (level + 2). Measurable and observable indicators (e.g., independence, duration, frequency) are used, when goals are described. GAS has been found applicable among older adults with multiple chronic conditions living at home [41].

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