Occupational therapy and physical therapy are academicised under the NVS umbrella

After many years of planning, the then Stockholm College of Health Sciences merged with KI in 1998. The move added seven new courses to KI’s offering for occupational therapists, audiologists, midwives, biomedical analysts, nurses, X-ray nurses, and dental hygienists. The primary aim of the nationalisation of nursing training was to improve the quality of, and access to, research.

Research areas contested

Lena Borell, professor, NVS. Photo: Stefan Zimmerman

Research and training in occupational therapy conducted at the Stockholm College of Health Sciences was incorporated in what was then called Neurotec. Among those who became part of the department was Lena Borell, Professor of Occupational Therapy. Borell was the first teacher on the programme to receive a doctorate in Occupational Therapy in 1992 with Winblad as the main supervisor. She subsequently began work to further develop KI’s Occupational Therapist programme into an academic university education with research and postgraduate training.

“It made sense for us to join the then Division of Geriatrics because we had a shared perspective on dementia research. We were very early, even internationally, in building up research in occupational therapy, so we constantly faced questions: should these uneducated women, not even real medics, really be doing research? But we were convinced that we had something to contribute, and that applied to everyone from occupational therapists to physiotherapists and nurses. We didn’t give up.”

Lena Borell, Professor in Occupational Therapy

Sweden was early in developing occupational therapy research, but it was also a struggle between different authorities. In 2001, Borell became Europe’s first professor of occupational therapy. Her research has constantly evolved at the intersection between everyday life, care and social care. Her focus has been on occupational therapy and rehabilitation, often with the goal of improving the everyday lives of nursing home residents. 

Among other things, the project has resulted in the establishment of the Verklighetslabbet clinical training centre at Stureby nursing home, south of Stockholm, a dementia care home with approximately 90 residents. Verklighetslabbet is a permanent testbed and development environment for testing projects with a focus on equal welfare technology and digitalisation, as well as the development of new forms of care and housing. Interdisciplinary research is also conducted, with researchers from KI, the Royal Institute of Technology, Södertörn University and elsewhere collaborating.

Internationally inspired

From the outset, the development of occupational therapy has been based on strong international collaborations. The early academisation of the subject has made NVS’s Division of Occupational Therapy a model for universities in other countries. Doctoral students from countries that did not have their own doctoral programmes in occupational therapy applied here early on.

In 2005, Lena Borell launched the Aging in Place research programme, which over the next six years involved essentially everyone at the then division. The programme meant a great deal to progress and produced a string of doctoral students. Aging in Place was later followed by additional multi-year programmes focusing on developing knowledge in four areas: use of digital products, preventing loneliness among the elderly, nursing home design, and technical support to contribute to the health and well-being of the elderly.

One of the researchers who understood early on the importance of technology for people with dementia was Louise Nygård. She was also Borell’s first doctoral student and received her doctorate in 1996. Her research has been based on the perspective of the elderly and has focused on areas such as how technology can be used to help people remain at home for as long as possible.

The results of the project have included assessment instruments that indicate people’s ability to use technology in everyday life. These instruments have been commercialised and are now used in clinical settings by occupational therapists and have been sold to other countries.

“We tackled the question: how do you cope with using everyday technology if you have a cognitive impairment or dementia? As we were the first to look at this, we developed research methods and tools. Our work had major international impacts.”

Louise Nygård, Professor of Occupational Therapy

Louise Nygård, professor, NVS. Photo: Ulf Sirborn

Nygård’s research has also created a completely new line of research that examines participation in life outside the home for people with dementia or cognitive impairment. The research is international with participation from countries such as Switzerland, Canada and the UK. The project seeks to compare and learn from how people in different countries cope with everyday life. What support and tools are there in different countries, and can methods, technology and working methods be shared between countries?

Nygård was also part of the Swedish Brain Power network to investigate how the ability to use everyday technology could be used as a marker for early cognitive decline. She has also been extremely active in the development of postgraduate education and the Research School in Health Science (FiH).

Borell also supervised Kerstin Tham, now professor and Vice Chancellor of Malmö University, where she was a doctoral student. Tham completed her doctorate at the Division of Neurology and then joined NVS at the Division of Occupational Therapy.

“Ever since its inception, NVS has thrived on an innovative spirit that has created a highly creative work environment. Over the years, the Department has played a key role in linking research to clinical activities in the healthcare system.”

Kerstin Tham, Vice Chancellor Malmö University, Head of Department NVS 2009-2013

Kerstin Tham, Vice Chancellor Malmö University, former Head of Department at NVS. Photo: Malin Palm

Early on, Tham’s research had the goal of creating a better understanding of those who have suffered brain damage or neuropsychological impairments, such as a stroke. She has developed new assessment instruments and contributed to the development of new rehabilitation methods.

She helped establish the then Occupational Therapy Division, became Head of Department at NVS, and then went on to hold increasingly higher management positions at KI. Throughout this journey, Tham has maintained a strong focus on increasing collaboration and co-operation with Stockholm County Council (now Region Stockholm).

Tham was also one of the initiators of Stockholm’s network of academic health centres. When the network merged with the Center for General Medicine, CeFAM, in 2015, the Academic Primary Care Center was formed. Today, this is one of the hubs for the region’s clinical collaboration between academia and healthcare.

Tham was appointed Vice Chancellor of Malmö University in 2015.

Academisation of physical therapy

In the late 1950s, a physiotherapy institute was founded in Stockholm. Physiotherapists were trained here until 1977, when the body was merged with KI.

The most important person for the academisation was Karin Harms-Ringdahl, not least through her supervision of countless degree projects at all levels, including doctoral level. Harms-Ringdahl joined the department as an assistant professor in 1995 and became Sweden's first physiotherapist to take up a professorship in 1998. Among her greatest achievements was the advanced course in physiotherapy that started in 1985 and was compulsory for physiotherapists to be eligible for postgraduate education.

Another milestone in the academisation of physiotherapy was the establishment of five research groups in physiotherapy in 1999. These were led by Karin Harms-Ringdahl (musculoskeletal system), Helga Hirschfeld (movement analysis), Eva Mattsson (respiration and circulation), Christina Stenström (Opava) (rheumatic diseases) and Lotta Widén-Holmqvist (neurological injuries and diseases).

 In 2002, the step was taken to incorporate the Department of Physiotherapy into the NVS. 

Elisabeth Olsson had been Head of Department at the Department of Physiotherapy and continued as head of what became the Division for Physiotherapy. In 1994, she recruited Christina Opava, today a professor of physical therapy, who became an important force in the academic development of the subject.

Christina H Opava, Professor emerita, Division of Physiotherapy, NVS.
Christina H Opava, professor emerita, division of physiotherapy, NVS. Photo: Fredrik Persson

“I got rheumatism when I was 24 years old and took my bike to the hospital. Once there, the treatment involved a heat pack and preferably not touching my joints when exercising muscles. I thought it was a world-renowned treatment and became interested in the benefits of physical activity and exercise.”

Christina Opava, Professor of Physiotherapy

Opava was soon running her own research group and throughout her career has had a strong focus on physical activity in rheumatic disease, especially as part of the Physical Activity in Rheumatoid Arthritis (PARA) project. With the help of the Swedish Rheumatology Quality Register (SRQ), patients with rheumatic complaints have been followed to increase knowledge of the impact of Health-Promoting Physical Activity (HFA). The results have been widely published.

Opava has always had a strong focus on building international networks. She has been a visiting professor at the University of Missouri in Columbia and at Dr. APJ Abdul Kalam College of Physiotherapy, PIMS, India.

She was also the driving force behind the research collaboration between KI and the Pravara Institute of Medical Sciences (PIMS) in Loni, India, which was launched in 2017.

Lena Nilsson-Wikmar, professor, NVS. Photo: Ulf Zirborn

Research links are further strengthened

Lena Nilsson Wikmar came to the Division of Physical Therapy in the early 1980s. In the late 80s, a large number of physiotherapists completed their doctorates at the Division, which significantly strengthened the subject’s relationship with research.

Nilsson Wikmar’s research has focused on several areas, including pregnancy-related back problems, chronic pain and traumatic spinal cord injury.

She has always had a particular focus on how pedagogy can be developed to increase students’ learning from a professional and interprofessional perspective. She has devoted particular effort to the physiotherapist programme, among other things with the goal of strengthening its connection to research and to increase student-centred learning and interaction between teaching staff and students.

Her unwavering commitment to pedagogy earned her KI’s teaching prize in 2018. Nilsson Wikmar has also initiated exchange programmes with several countries in Africa and supervised a number of African doctoral students.

“The merger with NVS has benefited our profession. It has provided the opportunity to interact with many other fields, such as geriatrics, occupational therapy, nursing and general medicine, where you need to argue your case. If you sit in your own bubble, you get no input.”

Lena Nilsson Wikmar, Professor of Physiotherapy, with a specialisation in educational development

Since 2014, physiotherapist is the new designation for the physiotherapy profession and a recognised professional title. Today, the Division of Physiotherapy houses eight research groups and includes epidemiological and experimental and translational studies, as well as clinical intervention and implementation studies. New research results are continuously integrated into the teaching of physiotherapy.

The Division has a well-established relationship with the healthcare system, for example through several researchers having combined employment with Karolinska University Hospital and the Academic Primary Care Center. The Division has been located in the Zanderska Building in Flemingsberg since 2002. 

TEXT: Magnus Trogen Pahlén