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Wilnerzon Thörn, R.-M., Forsberg, A., Stepniewski, J., Hjelmqvist, H., Magnuson, A., Ahlstrand, R. & Ljungqvist, O. (2024). Immediate mobilization in post-anesthesia care unit does not increase overall postoperative physical activity after elective colorectal surgery: A randomized, double-blinded controlled trial within an enhanced recovery protocol. World Journal of Surgery, 48(4), 956-966
Open this publication in new window or tab >>Immediate mobilization in post-anesthesia care unit does not increase overall postoperative physical activity after elective colorectal surgery: A randomized, double-blinded controlled trial within an enhanced recovery protocol
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2024 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 48, no 4, p. 956-966Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The level of post-operative mobilization according to Enhanced Recovery After Surgery (ERAS) guidelines is not always achieved. We investigated whether immediate mobilization increases postoperative physical activity. The objective was to evaluate the effects of immediate postoperative mobilization in the post-anesthesia care unit (PACU) compared to standard care.

METHODS: This randomized controlled trial, involved 144 patients, age ≥18 years, undergoing elective colorectal surgery. Patients were randomized to mobilization starting 30 min after arrival in the PACU, or to standard care. Standard care consisted of mobilization a few hours later at the ward according to ERAS guidelines. The primary outcome was physical activity, in terms of number of steps, measured with an accelerometer during postoperative days (PODs) 1-3. Secondary outcomes were physical capacity, functional mobility, time to readiness for discharge, complications, compliance with the ERAS protocol, and physical activity 1 month after surgery.

RESULTS: With the intention-to-treat analysis of 144 participants (median age 71, 58% female) 47% underwent laparoscopic-or robotic-assisted surgery. No differences in physical activity during hospital stay were found between the participants in the intervention group compared to the standard care group (adjusted mean ratio 0.97 on POD 1 [95% CI, 0.75-1.27], p = 0.84; 0.89 on POD 2 [95% CI, 0.68-1.16], p = 0.39, and 0.90 on POD 3 [95% CI, 0.69-1.17], p = 0.44); no differences were found in any of the other outcome measures.

CONCLUSIONS: Addition of the intervention of immediate mobilization to standard care did not make the patients more physically active during their hospital stay.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NTC 03357497.

Place, publisher, year, edition, pages
Springer, 2024
Keywords
colorectal surgery, early mobilization, enhanced recovery after surgery, randomized clinical trial
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-111664 (URN)10.1002/wjs.12102 (DOI)001160584400001 ()38348901 (PubMedID)
Funder
Region Örebro County
Note

This study was supported by grants from the Research Committee of Örebro County Council and Örebro University Hospital Research Foundation, Sweden.

Available from: 2024-02-21 Created: 2024-02-21 Last updated: 2024-04-11Bibliographically approved
Arvidsson Lindvall, M., Appelros, P., Forsberg, A. & Anderzen-Carlsson, A. (2023). Experiences of living with balance limitations after first-ever stroke. In: : . Paper presented at World Physiotherapy Congress, WCPT, Geneva, Switzerland, 2019.
Open this publication in new window or tab >>Experiences of living with balance limitations after first-ever stroke
2023 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background:  

Stroke is the leading cause of serious, long-term disability among adults. Balance control after stroke may be affected due to motor impairment such as muscle weakness, spasticity and impaired sensory function and also cognitive deficits may affect balance control. The balance limitations affect walking and independence in activities of daily living. Having good balance has been described as an important factor in outdoor walking and for participation in exercises. Studies in which persons with stroke describe their experience of balance in everyday life are scarce.

Purpose:  

The aim of the present presentation is to describe experiences of living with balance limitations in everyday life after first-ever stroke.

Methods:  

Twenty persons initially agreed to participate; however, one person later declined further participation, thus giving a sample size of 19 participants (10 females and 9 men), aged between 42-92 years. The inclusion criteria were: having had a first-ever stroke and having self-reported impaired balance, unaffected speech, independence in toileting and dressing, and walking ability indoors and outdoors with or without a walking aid. A qualitative data collection through individual interviews was conducted. Data was analysed by means of an inductive content analysis covering both the manifest and the latent content of the transcribed interviews.

Results:  

The participants' experiences of balance and its influence in everyday life, are presented in two themes. The first theme “Feeling dizzy and unstable is a continuous challenge”, revolves around participants' descriptions of balance as a constant feeling of dizziness and unsteadiness. The second theme “Feeling trust and confidence despite dizziness and unsteadiness” is about perceived abilities and feelings of confidence about still being able to do things oneself, despite the dizziness and unsteadiness.

Conclusion(s):  

All participants experienced the balance limitations as a continuous challenge in everyday life, yet they also felt trust and confidence and experienced that they still managed their everyday life. In future research it would be of interest to establish which strategies can make persons with stroke feel in balance in relation to fear of falling.

Implications:

In physical therapy practice, the experiences of balance limitations after stroke from the person with stroke add valuable information to various assessments. By asking the person about their abilities and challenges in daily living, rehabilitation interventions can be more individualized and based on the person's actual condition and their wishes and needs.

Keywords
stroke, balance experience, qualitative method
National Category
Occupational Therapy Physiotherapy Neurology
Identifiers
urn:nbn:se:oru:diva-109619 (URN)
Conference
World Physiotherapy Congress, WCPT, Geneva, Switzerland, 2019
Funder
The Swedish Stroke Association, 2017Region Örebro County, OLL-636861
Available from: 2023-11-07 Created: 2023-11-07 Last updated: 2024-01-03Bibliographically approved
W. Thörn, R.-M., Stepniewski, J., Hjelmqvist, H., Forsberg, A., Ahlstrand, R. & Ljungqvist, O. (2022). Supervised Immediate Postoperative Mobilization After Elective Colorectal Surgery: A Feasibility Study. World Journal of Surgery, 46(1), 34-42
Open this publication in new window or tab >>Supervised Immediate Postoperative Mobilization After Elective Colorectal Surgery: A Feasibility Study
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2022 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 46, no 1, p. 34-42Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Early mobilization is a significant part of the ERAS® Society guidelines, in which patients are recommended to spend 2 h out of bed on the day of surgery. However, it is not yet known how early patients can safely be mobilized after completion of colorectal surgery. The aim of this study was to evaluate the feasibility, and safety of providing almost immediate structured supervised mobilization starting 30 min post-surgery at the postoperative anesthesia care unit (PACU), and to describe reactions to this approach.

METHODS: This feasibility study includes 42 patients aged ≥18 years who received elective colorectal surgery at Örebro University Hospital. They underwent a structured mobilization performed by a specialized physiotherapist using a modified Surgical ICU Optimal Mobilization Score (SOMS). SOMS determines the level of mobilization at four levels from no activity to ambulating. Mobilization was considered successful at SOMS ≥ 2, corresponding to sitting on the edge of the bed as a proxy of sitting in a chair due to lack of space.

RESULTS: In all, 71% (n = 30) of the patients reached their highest level of mobilization between the second and third hour of arrival in the PACU. Before discharge to the ward, 43% (n = 18) could stand at the edge of the bed and 38% (n = 16) could ambulate. Symptoms that delayed advancement of mobilization were pain, somnolence, hypotension, nausea, and patient refusal. No serious adverse events occurred.

CONCLUSIONS: Supervised mobilization is feasible and can safely be initiated in the immediate postoperative care after colorectal surgery. Trial registration Clinical trials.gov identifier: NTC03357497.

Place, publisher, year, edition, pages
Springer, 2022
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-95107 (URN)10.1007/s00268-021-06347-2 (DOI)000708755200004 ()34668047 (PubMedID)2-s2.0-85117270625 (Scopus ID)
Note

Funding Agencies:

Örebro University

Research Committee of Örebro County Council and Örebro University Hospital Research Foundation, Sweden

Available from: 2021-10-21 Created: 2021-10-21 Last updated: 2022-01-04Bibliographically approved
Arvidsson Lindvall, M., Forsberg, A., Appelros, P. & Anderzen-Carlsson, A. (2021). "I can manage the challenge": a qualitative study describing experiences of living with balance limitations after first-ever stroke. International Journal of Qualitative Studies on Health and Well-being, 16(1), Article ID 1857044.
Open this publication in new window or tab >>"I can manage the challenge": a qualitative study describing experiences of living with balance limitations after first-ever stroke
2021 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 16, no 1, article id 1857044Article in journal (Refereed) Published
Abstract [en]

Purpose: To describe experiences of living with balance limitations after first-ever stroke.

Materials and methods: This study has a qualitative design, comprising interviews with 19 persons with first-ever stroke, ten women and nine men. Their mean age was 77 years and the mean time since stroke was 15 months. Stroke survivors who were able to walk outdoors with or without a walking aid and who were independent in toileting and dressing were invited to participate. Semi-structured individual interviews were performed. An inductive qualitative content analysis of the manifest and latent content was conducted.

Results: The results are presented in two themes illustrating the latent content of the data, "Feeling dizzy and unstable is a continuous challenge" and "Feeling confidence despite dizziness and unsteadiness", and seven categories illustrating the manifest content: Limitations in daily life; Being emotionally affected; The need for physical support; Everything takes time; I can still manage; Feelings of acceptance; and Finding individual solutions.

Conclusions: All participants experienced the balance limitations as a continuous challenge in their everyday life, yet they also felt confidence. They had to some degree adapted their activities and were able to manage their daily life. 

Place, publisher, year, edition, pages
Co-Action Publishing, 2021
Keywords
Balance experience, postural stability, qualitative study, recovery, stroke
National Category
Occupational Therapy
Identifiers
urn:nbn:se:oru:diva-88128 (URN)10.1080/17482631.2020.1857044 (DOI)000598914900001 ()33323049 (PubMedID)2-s2.0-85097602135 (Scopus ID)
Note

Funding Agencies:

Swedish Stroke Association  

Research Committee of Örebro County Council OLL-636861

Available from: 2020-12-18 Created: 2020-12-18 Last updated: 2022-11-02Bibliographically approved
Arvidsson Lindvall, M., Appelros, P., Forsberg, A. & Anderzen-Carlsson, A. (2020). LIVING WITH BALANCE LIMITATIONS AFTER FIRST-EVER STROKE. Paper presented at The Joint European Stroke Organisation and World Stroke Organization Conference (ESO-WSO 2020), Virtual Conference, November 7-9, 2020. International Journal of Stroke, 15(Suppl. 1), 257-257
Open this publication in new window or tab >>LIVING WITH BALANCE LIMITATIONS AFTER FIRST-EVER STROKE
2020 (English)In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 15, no Suppl. 1, p. 257-257Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Stroke is the leading cause of serious, long-term disability among adults. Balance can be limited after stroke and the limitations affect walking and independence in activities of daily living. Having good balance has been described as an important factor in outdoor walking and for participation in exercises. Studies in which persons with stroke describe their experience of balance in everyday life are scarce.

Aim: To describe experiences of living with balance limitations after first-ever stroke.

Methods: A qualitative design, comprising interviews with 19 persons with first-ever stroke, ten women and nine men, aged between 42–92 years. Inclusion criteria were: having had a first-ever stroke and self-reported impaired balance, unaffected speech, independence in toileting and dressing, and walking ability indoors and outdoors with or without a walking aid. Data was analysed by means of an inductive content analysis covering both the manifest and the latent content of the transcribed interviews.

Results: The results are presented in two themes illustrating the latent content of the data. “Feeling dizzy and unstable is a continuous challenge” revolves around participants’ descriptions of balance as a constant feeling of dizziness and unsteadiness. “Feeling trust and confidence despite dizziness and unsteadiness” is about perceived abilities and feelings of confidence about still being able to do things oneself, despite the dizziness and unsteadiness.

Conclusion: All participants experienced the balance limitations as a continuous challenge in everyday life, yet they also felt trust and confidence and experienced that they still managed their everyday life.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Asia, 2020
National Category
Cardiac and Cardiovascular Systems Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-88895 (URN)10.1177/1747493020963387 (DOI)000587365201213 ()
Conference
The Joint European Stroke Organisation and World Stroke Organization Conference (ESO-WSO 2020), Virtual Conference, November 7-9, 2020
Available from: 2021-01-25 Created: 2021-01-25 Last updated: 2022-11-02Bibliographically approved
Carling, A., Nilsagård, Y. & Forsberg, A. (2020). Making it work: experience of living with a person who falls due to multiple sclerosis. Disability and Rehabilitation, 42(7), 940-947
Open this publication in new window or tab >>Making it work: experience of living with a person who falls due to multiple sclerosis
2020 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 42, no 7, p. 940-947Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The purpose of this study was to describe how everyday life is experienced by next of kin sharing residence with a person who falls due to multiple sclerosis (MS).

METHODS: Twenty face-to-face interviews were analysed using a qualitative content analysis.

RESULTS: The overall theme "Making it work" represents the next of kin's struggle to make life work. It comprises three themes: "Taking responsibility", "Making adjustments", and "Standing aside for someone else". The two first themes reflect what relatives do to make the situation work, and the last theme represents what they give up.

CONCLUSION: Next of kin who share residence and everyday life with a person with MS are affected by that person's occasional falls. They often take on the responsibility of preventing such falls and adapt their lives practically and emotionally. However, adaptation is neither always enough or always possible. In these cases, relatives often deprioritize their own needs and free time to make everyday life in the home work.

Implications for rehabilitation

  • By highlighting that next of kin also are affected by the falls of their cohabiting person with multiple sclerosis enhances the importance of fall prevention activities that should include the next of kin.
  • Next of kin to people who occasionally fall due to multiple sclerosis can be in need of both practical and emotional support from the health care system.
  • Enhanced information from the health care system can empower and help them to take care of themselves while managing to live with, care for, and protect the person with multiple sclerosis from falls.
Place, publisher, year, edition, pages
Taylor & Francis, 2020
Keywords
Accidental falls, family, multiple sclerosis, qualitative research
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-69584 (URN)10.1080/09638288.2018.1514078 (DOI)000522831300006 ()30299167 (PubMedID)2-s2.0-85054725821 (Scopus ID)
Note

Funding Agencies:

Uppsala-Örebro Regional Research Committee  RFR-747211

Research committee of the Örebro County Council  

NEURO Sweden 

Available from: 2018-10-16 Created: 2018-10-16 Last updated: 2020-04-20Bibliographically approved
Arvidsson Lindvall, M., Anderzen-Carlsson, A., Appelros, P. & Forsberg, A. (2020). Validity and test-retest reliability of the six-spot step test in persons after stroke. Physiotherapy Theory and Practice, 36(1), 211-218
Open this publication in new window or tab >>Validity and test-retest reliability of the six-spot step test in persons after stroke
2020 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 36, no 1, p. 211-218Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: After stroke, asymmetric weight distribution is common with decreased balance control in standing and walking. The six-spot step test (SSST) includes a 5-m walk during which one leg shoves wooden blocks out of circles marked on the floor, thus assessing the ability to take load on each leg. The aim of the present study was to investigate the convergent and discriminant validity and test-retest reliability of the SSST in persons with stroke.

METHODS: Eighty-one participants were included. A cross-sectional study was performed, in which the SSST was conducted twice, 3-7 days apart. Validity was investigated using measures of dynamic balance and walking. Reliability was assessed using intraclass correlation coefficient, standard error of the measurement (SEM), and smallest real difference (SRD).

RESULTS: The convergent validity was strong to moderate, and the test-retest reliability was good. The SEM% was 14.7%, and the SRD% was 40.8% based on the mean of four walks shoving twice with the paretic and twice with the non-paretic leg.

CONCLUSION: Values on random measurement error were high affecting the use of the SSST for follow-up evaluations but the SSST can be a complementary measure of gait and balance.

Place, publisher, year, edition, pages
Taylor & Francis, 2020
Keywords
Balance, reliability, stroke, validity
National Category
Physiology
Identifiers
urn:nbn:se:oru:diva-67220 (URN)10.1080/09593985.2018.1482511 (DOI)000509034600019 ()29873590 (PubMedID)2-s2.0-85048142150 (Scopus ID)
Note

Funding Agencies:

Swedish Stroke Association  

Norrbacka-Eugenia Foundation  804-14

Research Committee, Örebro County Council  OLL-457471

Available from: 2018-06-11 Created: 2018-06-11 Last updated: 2022-11-02Bibliographically approved
Nilsagård, Y., Westerdahl, E. & Forsberg, A. (2019). Engagement in performing clinical physiotherapy research: Perspectives from leaders and physiotherapists. Physiotherapy Research International, 24(2), Article ID e1767.
Open this publication in new window or tab >>Engagement in performing clinical physiotherapy research: Perspectives from leaders and physiotherapists
2019 (English)In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 24, no 2, article id e1767Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The recent increase in physiotherapy research has led to more physiotherapists being involved in research. Consequently, leaders must make a standpoint on whether the department should engage in research, whereas individual physiotherapists have to decide if they want to play an active role in carrying out a research project. The purpose of this study was to explore perceptions and experiences of both participating physiotherapists and their leaders regarding taking part in clinical physiotherapy research projects.

METHODS: A qualitative study using face-to-face interviews was conducted. All (n = 8) leaders were interviewed individually. Physiotherapists (n = 18) were interviewed either individually (n = 5) or in small groups including two to three persons (n = 13). The interviews were analysed using inductive conventional content analysis.

RESULTS: There was a consensus that engagement of the leaders was a prerequisite for entering research projects and that the research had to be in line with the department's regular assignment. For the physiotherapists, the key factors for success were having designated time and having support from their leader, especially when feelings of responsibility became overwhelming. The leaders stressed the importance of being well informed. Participating in clinical research created value such as personal and professional growth for the physiotherapists, who also inspired their colleagues and thus positively affected the organization. Engaging in research contributed to being an attractive employer and gave a boost to evidence-based practice.

CONCLUSION: The study provides perspectives from leaders and physiotherapists on engaging in research. There was a consensus that participating in a research project was beneficial for the organization, the individual physiotherapist, and the patients. However, clinical applicability, support, sufficient time, and early involvement of leaders are significant prerequisites.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Evidence-based practice, physical therapy, professional development, qualitative research
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-71652 (URN)10.1002/pri.1767 (DOI)000463029100007 ()30657235 (PubMedID)2-s2.0-85060229693 (Scopus ID)
Note

Funding Agency:

Örebro Research Committee, Sweden

Available from: 2019-01-22 Created: 2019-01-22 Last updated: 2024-01-30Bibliographically approved
Forsberg, A., Fredriksson, C., Hermansson, L., Holmefur, M. & Nilsagård, Y. (2019). Prescribing rolling walkers: A survey study of experiences from physiotherapists. In: : . Paper presented at World Confederation of Physiotherapists Congress, Geneva, Switzerland, 10-13 May, 2019..
Open this publication in new window or tab >>Prescribing rolling walkers: A survey study of experiences from physiotherapists
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2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Keywords
Assistive device, prescription, older people
National Category
Health Sciences Occupational Therapy
Identifiers
urn:nbn:se:oru:diva-83585 (URN)
Conference
World Confederation of Physiotherapists Congress, Geneva, Switzerland, 10-13 May, 2019.
Available from: 2020-06-24 Created: 2020-06-24 Last updated: 2024-03-04Bibliographically approved
Zakrisson, A.-B., Anerös, T., Eliason, G. & Forsberg, A. (2019). Projekt Region Örebro län: Att använda en mobil app med larm för att motivera till fysisk aktivitet hos patienter med KOL – en mixed method pilot-studie. Lung och Allergi Forum, 32-39
Open this publication in new window or tab >>Projekt Region Örebro län: Att använda en mobil app med larm för att motivera till fysisk aktivitet hos patienter med KOL – en mixed method pilot-studie
2019 (Swedish)In: Lung och Allergi Forum, ISSN 2000-5237, p. 32-39Article in journal (Other academic) Published
Place, publisher, year, edition, pages
Mediahuset i Göteborg AB, 2019
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:oru:diva-73737 (URN)
Available from: 2019-04-15 Created: 2019-04-15 Last updated: 2024-01-02Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6768-5740

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