The research, conducted by a team of Egyptian nursing scientists, focused on novice home healthcare nurses in Sharqia Governorate, a region in Egypt’s Nile Delta where demand for community-based care is rising sharply, driven by chronic disease, disability, and post-hospitalization support needs. Unlike their hospital-based counterparts, home healthcare nurses work largely alone, inside patients’ homes, making early decisions with limited immediate backup from peers or supervisors. They must communicate directly with patients and families, juggle multiple households and care needs, and exercise a degree of autonomy that most new graduates in institutional settings never encounter so soon. That independence, the researchers reasoned, makes the transition to practice in home care uniquely sensitive to both the quality of organized educational support and the individual nurse’s psychological adaptation.

To unpack that relationship, the team surveyed 215 novice home healthcare nurses—registered nurses in their first years of home care practice—using a cross-sectional, correlational design reported according to the STROBE guidelines. The sample size was calculated in advance with Epi Info 7 to detect a small-to-moderate correlation, and the final dataset comfortably exceeded the thresholds suggested by simulation studies for the mediation analyses that followed. Three standardized instruments anchored the study: the 10-item Connor–Davidson Resilience Scale to measure the capacity to cope with and recover from adversity; the Educational Support Assessment Scale for Novice Home Healthcare Nurses, which captures acquiring new knowledge, concrete experience, reflective observation, and managerial support; and the Transition Status Scale for Newly Graduated Nurses, a 38-item measure spanning interpersonal integration, active coping strategies, profession-related positive emotions, competence for nursing work, and work–life balance.

Because the original scales had been developed in English and Chinese contexts, the researchers undertook a rigorous translation and cultural adaptation process. Two independent bilingual translators produced Arabic versions—one with a nursing background to safeguard conceptual accuracy, one a linguist to ensure natural phrasing—followed by back-translation by two further translators blind to the originals. An expert panel of nursing academics, a clinical nurse specialist in home healthcare, and a bilingual language expert then reviewed every item, and a pilot test with 20 nurses outside the final sample refined wording and confirmed internal consistency. The Arabic versions performed strongly: Cronbach’s alpha reached 0.91 for the resilience scale, 0.89 for educational support, and 0.90 for transition status.

The statistical machinery behind the study was correspondingly thorough. Confirmatory factor analyses, estimated with diagonally weighted least squares to handle the ordinal questionnaire items, tested whether the multidimensional instruments could legitimately be summarized by overall scores. The educational support scale showed acceptable fit as a second-order model, with its four dimensions loading strongly onto a higher-order factor. The transition status scale showed marginal-to-acceptable fit, with all five dimensions loading significantly. The resilience scale’s one-factor model was more marginal, a caveat the authors acknowledge. With measurement established, the team ran partial correlations controlling for a battery of demographic and professional covariates, and then a structural equation model with 5,000 bootstrap resamples and bias-corrected confidence intervals.

The results were strikingly consistent. Educational support correlated positively with resilience (partial r = 0.539) and with transition status (partial r = 0.639), while resilience itself correlated with transition status (partial r = 0.614), all at p < 0.001. In the structural model, educational support showed a significant direct effect on transition status (β = 0.38) and a significant effect on resilience (β = 0.48), which in turn predicted transition status (β = 0.43). Crucially, the indirect pathway from educational support through resilience to transition status was significant (β = 0.21, 95% confidence interval 0.13 to 0.29), yielding a total standardized effect of 0.59. Because both direct and indirect paths held, the findings point to a partial indirect association: resilience carries part, but not all, of the relationship between training and successful adaptation.

The descriptive data added texture to the headline result. Male nurses reported considerably higher resilience and transition status than female nurses, and single nurses reported higher resilience than their married colleagues. Diploma holders outperformed bachelor’s and master’s degree holders across all three outcomes, and nurses with prior specialized training in home healthcare scored significantly higher on every measure. Those working more than 60 hours per week showed higher resilience and transition status, and nurses employed by private agencies rated themselves higher on both than those in public agencies. None of these factors, however, eliminated the core associations among educational support, resilience, and transition status, which survived adjustment for sex, education level, prior training, working hours, and agency type.

The authors interpret their findings through the lens of established occupational psychology. In the job demands–resources model, employee adjustment depends on both organizational resources—such as structured learning opportunities—and personal resources, such as resilience, hope, optimism, and self-efficacy. Educational support, in this framing, is the organizational resource: planned learning experiences that reduce uncertainty, build perceived competence, and help novices process difficult clinical situations. Resilience is the personal resource that converts that support into adaptive capacity. The study also aligns with broader workplace adaptation research, which holds that successful newcomer adjustment involves role clarity, self-efficacy, social acceptance, and coping—dimensions mirrored in the transition status scale’s own subscales of interpersonal integration, active coping, and professional emotion.

The practical implications are concrete. The authors argue that educational programs for novice home healthcare nurses should not be confined to clinical knowledge and technical skills. Agencies could incorporate resilience-building components—structured preceptorship, guided reflection after difficult home visits, case-based learning, stress-management sessions, peer-support groups, and regular feedback meetings with supervisors—while monitoring novices’ adaptation during the first months of practice and intervening early when confidence, coping, or work–life balance falter. In a setting where nurses may be granted early independence with little immediate supervision, integrating clinical learning with adaptive coping strategies could make the difference between a nurse who thrives and one who burns out.

The team is careful about the limits of what can be claimed. Because data were collected at a single time point, the indirect pathway is an associative statistical model rather than proof of temporal or causal mediation; it remains possible, for example, that nurses who adapt well simply perceive more support. Self-reported questionnaires invite recall and social desirability bias, convenience sampling from a single governorate limits generalizability, and some model fit indices were marginal, suggesting the Arabic instrument versions need further validation in larger independent samples. Unmeasured factors—organizational culture, supervision quality, patient complexity, family responsibilities—could also confound the results. Still, as one of the first studies to examine these dynamics specifically among novice home healthcare nurses, the work opens a promising line of inquiry: if resilience can be deliberately cultivated through well-designed educational support, agencies may hold a powerful, testable lever for retaining the next generation of community-based nurses.

Subject of Research: The role of resilience in the relationship between educational support and transition status among novice home healthcare nurses

Article Title: The Indirect Association of Resilience in the Relationship Between Educational Support and Transition Status Among Novice Home Healthcare Nurses

Article References: Amin, S. M., El‐Gazar, H. E., Zoromba, M. A., Mohamed, H. S., Elbakry, M. A. A. E., Mohamed, M. A. A., Atta, M. H. R., Abdelaliem, S. M. F., Baghdadi, N. A., & El‐Ashry, A. M. (2026). The Indirect Association of Resilience in the Relationship Between Educational Support and Transition Status Among Novice Home Healthcare Nurses. Nursing Open, 13(9), Article e70849. https://doi.org/10.1002/nop2.70849

Image Credits: AI Generated

DOI: 10.1002/nop2.70849

Keywords: home healthcare nursing, novice nurses, resilience, educational support, transition to practice, structural equation modeling, job demands-resources model, nursing education, Egypt, burnout prevention, occupational adaptation, cross-sectional study

The Activity Calculator was developed by two occupational therapists from the Netherlands, Greke Hulstein–van Gennep and Karin ten Hove–Moerdijk, who recognized from their clinical experience that therapists needed a standardized, structured method to help patients with chronic fatigue participate in daily occupations in line with fatigue management recommendations. The method has since spread remarkably widely: certification courses have been organized for occupational therapists in the Netherlands since 2008 and in Norway since 2015, and more than 25 percent of all occupational therapists in the Netherlands and 8 percent of those in Norway have completed the training. Manuals are available in Dutch, Norwegian and English. That level of uptake, the researchers note, suggests the method fills a genuine clinical need. Yet until now, the tool has been criticized for lacking a solid theoretical foundation—a serious gap, since program theory describing how an intervention is expected to work, and under what conditions, is considered necessary before an intervention can be meaningfully evaluated.

The new paper, published open access in the Scandinavian Journal of Occupational Therapy by Irma Pinxsterhuis and Fanny Alexandra Jakobsen of Oslo Metropolitan University and Kirsti Nordstokkå of Sørlandet Hospital, addresses that gap by elaborating three core concepts from occupational therapy and occupational science: occupational adaptation, patterns of daily occupation, and occupational balance. The authors systematically discuss how each concept maps onto the phases of the Activity Calculator intervention, from evaluation and goal-setting through the intervention itself to re-evaluation. Their conclusion is that the three concepts appear to serve as a suitable theoretical foundation, providing a conceptual framework that may explain how the method helps people organize and adjust their everyday occupations to promote health, participation and well-being.

The Activity Calculator itself is a person-centred, time-contingent method. Patients begin by categorizing their usual activities as light, medium, strenuous or relaxing, then complete time registration lists for three to five representative days. Points are assigned to each activity according to its category and the time spent on it, and the total yields an activity level—the number of points the patient can manage in one day, whether it is a good day or a bad day. Patients then plan their activities against this budget using an app, activity cards, a pre-set day or week schedule, a diary, or an individually designed tool. This makes the approach time-contingent, in contrast to symptom-contingent approaches that assume patients have an accurate view of their capabilities and respond reliably to warning signs. Over time, activity levels can be increased gradually to avoid relapses or worsening of fatigue, and the calculator can eventually be retired once patients have internalized the planning habit.

The first theoretical pillar, occupational adaptation, is historically and philosophically rooted in occupational therapy but has been defined ambiguously in the literature. First described by Schkade and Schultz in 1992 as a normative process most pronounced in periods of transition, the concept has been reconceptualized by later researchers into clinically applicable language. In contemporary usage, occupational adaptation describes both a transactional process between the person, their occupations and the occupational environment, and an outcome of occupational participation. When a person encounters an occupational challenge—an obstacle or demand encountered while performing an occupation—it is the desire for occupational engagement that drives the adaptive response, linked to internal processes such as perception of choice, conscious awareness, self-reflection, problem-solving, acceptance and emotional regulation. Adaptation is a lifelong, cumulative, non-linear process, and people can learn from earlier experiences to support future adaptation.

Two measures of adaptation as an outcome are particularly relevant to the Activity Calculator. Relative mastery refers to a person’s subjective experience of competence in an occupation, assessed through effective participation, efficiency in using available personal and environmental resources such as time, energy and social supports, and satisfaction with occupational performance. Adaptive capacity, meanwhile, describes whether an individual has sufficient tools in their toolbox to respond to occupational challenges—including the ability to creatively develop new strategies when old ones fail. Some studies have shown positive associations between occupational adaptation and experiences of health and well-being, which matters because the two aims of the Activity Calculator explicitly target adaptation: helping patients find a balance between what they want to do and what they are able to do, and helping them obtain congruence between occupational participation and their values and personal meaning.

The second pillar, patterns of daily occupation, is often described as doing in time. Researchers have explored these patterns by categorizing occupations using taxonomies such as work, play, rest and sleep, or, in a scheme from Erlandsson and Eklund, distinguishing main occupations that dominate time and awareness, hidden occupations performed routinely, and unexpected occupations that interrupt the others. Other work has examined the complexity of 24-hour cycles, including duration, frequency, parallel occupations performed simultaneously, and the social coordination of occupations with other people. Diaries are a standard tool for documenting and reflecting on these patterns, and the Activity Calculator’s time registration lists function in exactly this way. Review of the lists reveals the prevalence of different occupation types, temporal aspects such as duration and frequency, perceived time pressure, orchestration of activities with others, and changes over time. Patients may also be asked to label registered activities as main, hidden or unexpected occupations, and perceptions can be complemented by significant others—for instance when patients are minors or have cognitive impairments.

The third pillar, occupational balance, is commonly defined as an individual’s perception of having the right amount of occupations and the right variation between them. A review by Eklund and colleagues identified three indicators: perception of the right variation and harmony between occupations, having the ability and resources for occupational engagement, and engagement in line with personal meaning and values. Jonsson and Persson proposed a tentative model in which balance is perceived through a relational mix of Exacting occupations that exceed actual skills, Flowing occupations with a reasonable match between skills and challenges, and Calming low-challenge experiences such as relaxation. A scoping review by Wagman and Håkansson added that occupational balance must be considered interpersonally, since it affects and is affected by partners, family members, employers and colleagues. The research base is striking: occupational balance is positively related to health, well-being, quality of life, life satisfaction and work ability, while imbalance has been linked to fatigue, stress and depression—one study finding that people with fatigue limited its consequences by applying adaptive strategies.

The authors’ discussion walks through how these concepts anchor each phase of the intervention. In the evaluation and goal-setting phase, occupational adaptation as a transactional process helps therapists identify occupational roles, role demands, occupational challenges and previously used responses, while assessments of relative mastery and adaptive capacity provide a picture of perceived adaptation. The Transtheoretical Model of Change, embedded in the Activity Calculator manuals, ensures the method is introduced only when patients have the intention and willingness to change, since decision-making about behaviour change depends on weighing the pros and cons of current behaviour. In the intervention phase, categorizing activities provides insight into the complexity of each patient’s daily patterns; registration reveals discrepancies between current occupational responses and perceived energy for mental or physical activity; and planning against the calculated activity level gives patients a framework for optimizing the relationship between time, energy and occupation. Patterns of daily occupation form the more objective, partly observable aspect of the framework, while occupational balance adds the subjective, emotional and personal dimension—and because the two constructs are interrelated, changes in one affect the other. Therapists support the process with education in energy conservation, spreading activities over the day and week, prioritizing and delegating, balancing engagement with rest, and modifying environments or adding assistive devices to make activities less strenuous.

At the end of the intervention, therapists assess the temptations and personal challenges patients face in maintaining adaptive occupational responses. Some patients continue to use the calculator indefinitely to maintain or improve their adaptation; others learn to engage without calculating points, responding to warning signs instead—taking a break, or switching to an activity that uses different muscles. At times of high risk, such as personal crises, social pressure, holidays or moving house, the calculator can be reintroduced, since these triggers may reactivate dysadaptive responses. Regular re-evaluation of patterns, balance, relative mastery and adaptive capacity detects when the activity level needs adjusting or new occupational responses need developing. The authors acknowledge that further research is needed to explore the relationship between using the Activity Calculator and improvements in health and well-being—but with this theoretical foundation in place, those studies can finally be designed on solid conceptual ground.

Subject of Research: A theoretical foundation for the Activity Calculator, an occupational therapy method for managing chronic fatigue through activity planning

Article Title: Theoretical foundation of the Activity Calculator – a method for fatigue management

Article References: Pinxsterhuis, I., Nordstokkå, K., & Jakobsen, F. A. (2025). Theoretical foundation of the Activity Calculator – a method for fatigue management. Scandinavian Journal of Occupational Therapy, 32(1), Article 2608471. https://doi.org/10.1080/11038128.2025.2608471

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2608471

Keywords: chronic fatigue, Activity Calculator, occupational therapy, occupational adaptation, occupational balance, patterns of daily occupation, energy conservation, pacing, long Covid, occupational science, fatigue management, rehabilitation

The underlying topic is important because returning to paid employment after a stroke is not determined solely by whether a person can walk, speak or perform a standard clinical task. Stroke can affect attention, information processing, movement, communication, mood and the ability to sustain effort over time. Fatigue adds another layer of difficulty. Post-stroke fatigue is commonly understood as a persistent or disproportionate feeling of exhaustion that can reduce physical, cognitive or emotional capacity, sometimes without an obvious increase in workload. It may fluctuate during the day and can become more apparent when a survivor resumes activities that require prolonged concentration or multitasking. In a workplace, that distinction matters. A person may appear able to complete a task briefly yet struggle to maintain the same performance across a full shift, recover between shifts or manage unexpected demands. The article’s title frames this return not as a simple recovery milestone but as an occupational adaptation process, in which people and workplaces must adjust activities, routines and expectations to accommodate changing capacity.

Occupational adaptation is a technical concept used in rehabilitation and occupational therapy to describe how people respond to demands in their everyday environments. “Occupation” in this context does not mean only a job; it includes meaningful activities and roles, such as household responsibilities, social participation and employment. After a stroke, adaptation can involve changing how a task is performed, modifying the environment, redistributing responsibilities or developing strategies that reduce the impact of impaired stamina. At work, examples might include taking planned recovery periods, reducing interruptions, simplifying sequences of actions, using written prompts or gradually increasing hours. These examples are general rehabilitation approaches, not results reported by the correction itself. The central point is that work capacity is relational: it emerges from the interaction between an individual’s abilities and the demands, pace, predictability and supportiveness of a particular job. Two people with similar clinical impairments may therefore experience very different barriers when attempting to return to employment.

Fatigue is especially difficult to assess because it is partly subjective and does not always correspond neatly to visible impairment. Conventional neurological examinations can document strength, coordination or language, but they may not capture the effort required to maintain attention, suppress distractions or switch between tasks. A worker may compensate effectively during a brief assessment while using substantial mental energy to do so. Later, that hidden cost can appear as slowed performance, mistakes, reduced communication or a need for extended recovery. Fatigue can also interact with sleep disturbance, pain, depression, anxiety, medication effects and the neurological consequences of the stroke. These factors can reinforce one another, making it challenging to identify a single cause or a universal remedy. For occupational rehabilitation, the practical implication is that assessment should consider patterns over time and in real activities, not only performance at one moment. A return-to-work plan may need to account for both what a worker can do and how long that ability can be sustained safely and consistently.

The corrected publication does not provide a new set of clinical recommendations, and it does not report a new analysis of stroke-related fatigue. Its purpose is narrower but still consequential: to repair the public research record. Funding disclosures are part of that record because they allow readers to understand how a study was supported and whether sponsors had a role in decisions that could influence the work. In this case, the corrected statement explicitly separates financial support from scientific control. The listed organizations provided funding, while the notice says they had no involvement in design, data collection, analysis, publication decisions or writing. That distinction does not prove that a study is correct, nor does a funding declaration replace independent scrutiny. It does, however, give readers a clearer basis for assessing the article alongside its methods, evidence and limitations. Corrections of this kind are therefore not merely administrative updates; they help preserve the accuracy and transparency on which cumulative science depends.

The article was authored by Jessica Vollertsen, Mathilda Björk, Anna-Karin Norlin and Elin Ekbladh, with affiliations at Linköping University in Sweden. Vollertsen is associated with the university’s Department of Rehabilitation and Department of Health, Medicine and Caring Sciences in Motala. Björk and Norlin are affiliated with the Pain and Rehabilitation Center and the Department of Health, Medicine and Caring Sciences in Linköping, while Ekbladh is affiliated with the Department of Health, Medicine and Caring Sciences. The study’s placement in an occupational therapy journal reflects the need to connect neurological recovery with the practical realities of daily work. Clinical rehabilitation can improve movement, communication or cognitive function, but employment also depends on workplace schedules, task design, social expectations and the availability of adjustments. A person may need coordination among stroke specialists, occupational therapists, employers, human-resources staff and the worker themselves. Such coordination is most effective when fatigue is treated as a legitimate functional issue rather than as a lack of motivation or evidence that recovery has failed.

For employers, the subject raises questions about how work is organized and how performance is evaluated. A gradual return may involve fewer hours, lighter workloads or a staged increase in complexity, but the appropriate arrangement depends on the job and the person’s recovery. Flexibility can be particularly important when fatigue varies unpredictably or when cognitive tasks are more demanding than physical ones. A quiet workspace, reduced multitasking, predictable scheduling or additional time for complex instructions may change the energy cost of work without removing the essential role. These adjustments should be developed collaboratively and reviewed as circumstances change. They should also be distinguished from assumptions that every stroke survivor has the same limitations. Some people return to their previous work, some change roles, and some cannot return to paid employment. The corrected study record cannot establish how common any particular outcome is, because the correction reports no new outcome data. What it does is keep attention on a problem that can be overlooked when recovery is judged only by visible physical function.

The correction also points to a broader lesson for research on long-term disability: accurate scientific communication includes both substantive findings and the administrative details surrounding them. The original article remains identified by its own publication DOI, 10.1080/11038128.2026.2613621, while the correction has a separate canonical DOI, 10.1007/s44474-026-00005-3. The notice makes clear that the funding statement was the element that required amendment. Readers consulting the article should therefore distinguish the correction from a new investigation and avoid treating the updated notice as evidence of a newly discovered medical effect. The research question remains focused on fatigue and the complex process of adapting work after stroke. By correcting the disclosure, the journal provides a more complete account of the study’s provenance while leaving interpretation to the evidence reported in the original article. For survivors and clinicians, the enduring message is that a successful return to work may require attention to invisible fatigue, task demands and workplace adaptation alongside conventional measures of neurological recovery.

Publication corrections serve an important role in maintaining a reliable scientific record because they distinguish an error in the published article from a change in the underlying research. In this case, the journal’s notice identifies the funding statement as the specific element requiring amendment. That narrow scope matters when readers interpret the correction: the notice should be read as an update to the article’s disclosure information, not as a report of additional participants, revised measurements or a new clinical conclusion. The corrected record also preserves the connection between the notice and the earlier study by naming the original article and its authors.

The funding information places the work within a Swedish rehabilitation and occupational-health research setting. Support came from organizations with interests spanning insurance, regional health services, stroke advocacy and occupational or social concerns, while the statement explicitly records that the funders did not participate in the scientific or editorial stages listed by the authors. Such disclosures help readers separate a study’s financial provenance from its operational independence. They are also useful for indexing and archiving: future readers who encounter the original publication can identify why a later notice exists and which portion of the record has been amended.

The correction is openly accessible under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence. This permits non-commercial reuse with appropriate credit, but it does not authorize distribution of adapted material derived from the article. The notice also cautions that some images or other third-party material may have separate rights if they are excluded from the article’s licence. These conditions are relevant when research findings are shared in educational, clinical or public settings, where reproducing the text or figures may involve permissions beyond simply linking to the publication.

The author affiliations further show the interdisciplinary setting in which the work was produced, combining rehabilitation, health and caring sciences with a pain and rehabilitation centre at Linköping University. That institutional context is consistent with a research focus on how health changes affect participation in everyday roles. It also underscores why a correction about funding, although administrative in form, belongs alongside the scholarly record: transparent reporting helps readers evaluate the provenance of research that may inform rehabilitation practice, workplace discussions and future studies of employment after stroke.

Subject of Research: Workplace adaptation and fatigue after stroke

Article Title: Correction to: Return to Work with Fatigue After Stroke: A Complex Occupational Adaptation Process

Article References: Vollertsen, J., Björk, M., Norlin, A.-K., & Ekbladh, E. (2026). Correction to: Return to Work with Fatigue After Stroke: A Complex Occupational Adaptation Process. Scandinavian Journal of Occupational Therapy, 33(1), Article 4. https://doi.org/10.1007/s44474-026-00005-3

Image Credits: AI Generated

DOI: 10.1007/s44474-026-00005-3

Keywords: stroke recovery, post-stroke fatigue, return to work, occupational therapy, occupational adaptation, rehabilitation, workplace accommodations, research transparency, Correction, Return, Work, Fatigue