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Nilsing Strid, E., Wallin, L. & Nilsagård, Y. (2024). Exploring expectations and readiness for healthy lifestyle promotion in Swedish primary health care: a qualitative analysis of managers, facilitators, and professionals. Scandinavian Journal of Primary Health Care
Open this publication in new window or tab >>Exploring expectations and readiness for healthy lifestyle promotion in Swedish primary health care: a qualitative analysis of managers, facilitators, and professionals
2024 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: Prior to a multifaceted implementation strategy for a healthy lifestyle-promoting practice the expectations of primary health care managers, appointed internal facilitators and health care professionals on supporting change was explored.

DESIGN: This study had an explorative qualitative design using data gathered from individual interviews and focus groups. Qualitative content analysis with a deductive category development was applied using the Consolidated Framework for Implementation Research.

SETTING AND PARTICIPANTS: The study was conducted in a primary care setting in central Sweden as a part of the Act in Time research project. Prior to a multifaceted implementation strategy, we held 16 individual interviews with managers and appointed facilitators and five focus groups with 26 health care professionals.

RESULTS: Managers, facilitators, and professionals held similar expectations, where their expressed need for support corresponded to three constructs: Readiness for implementation, Implementation climate, and Engaging. Our findings indicate the need for strong leadership engagement to focus on how the healthy lifestyle-promoting practice can be anchored among the professionals. Managers at all levels should communicate the vision and goals, enable facilitators and professionals to improve their competencies, build inter-professional teams, and jointly plan the new practice.

CONCLUSION: To change to a healthy lifestyle promoting practice professionals request support from their managers, who in turn need support from the middle and top managers. The requested support includes helping to prioritise health promotion and enabling the primary care centres to build competence and take ownership of the implementation.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04799860.

Place, publisher, year, edition, pages
Taylor & Francis, 2024
Keywords
Qualitative research, health personnel, healthy lifestyle, implementation science, leadership, practice guidelines, primary health care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-111025 (URN)10.1080/02813432.2023.2301556 (DOI)001145189500001 ()38241166 (PubMedID)2-s2.0-85182677608 (Scopus ID)
Funder
Region Örebro County, OLL-969561
Available from: 2024-01-30 Created: 2024-01-30 Last updated: 2024-02-05Bibliographically approved
Nilsing Strid, E., Wallin, L. & Nilsagård, Y. (2023). Expectations on implementation of a health promotion practice using individually targeted lifestyle interventions in primary health care: a qualitative study. BMC primary care, 24(1), Article ID 122.
Open this publication in new window or tab >>Expectations on implementation of a health promotion practice using individually targeted lifestyle interventions in primary health care: a qualitative study
2023 (English)In: BMC primary care, ISSN 2731-4553, Vol. 24, no 1, article id 122Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is moderate to strong evidence of the effectiveness of health-promotion interventions, but implementation in routine primary health care (PHC) has been slow. In the Act in Time project implementation support is provided for a health promotion practice using individually targeted lifestyle interventions in a PHC setting. Identifying health care professionals' (HCPs') perceptions of barriers and facilitators helps adapt implementation activities and achieve a more successful implementation. This study aimed, at a pre-implementation stage, to describe the expectations of managers, appointed internal facilitators (IFs) and HCPs on implementing a healthy lifestyle-promoting practice in PHC.

METHODS: In this qualitative study five focus group discussions with 27 HCPs and 16 individual interviews with managers and appointed IFs were conducted at five PHC centres in central Sweden. The PHC centres are participating in the Act in Time project, evaluating the process and outcomes of a multifaceted implementation strategy for a healthy lifestyle-promoting practice. A deductive qualitative content analysis based on the Consolidated Framework for Implementation Research (CFIR) was followed using inductive analysis.

RESULTS: Twelve constructs from four of five CFIR domains were derived: Innovation characteristics, Outer setting, Inner setting, and Characteristics of individuals. These domains are related to the expectations of HCPs to implement a healthy lifestyle-promoting practice, which includes facilitating factors and barriers. The inductive analysis showed that the HCPs perceived a need for a health-promotion approach to PHC. It serves the needs of the patients and the expectations of the HCPs, but lifestyle interventions must be co-produced with the patient. The HCPs expected that changing routine practice into a healthy lifestyle-promoting practice would be challenging, requiring sustainability, improved structures, cooperation in inter-professional teams, and a common purpose. A collective understanding of the purpose of changing practice was vital to successful implementation.

CONCLUSIONS: The HCPs valued implementing a healthy lifestyle-promoting practice in a PHC setting. However, changing routine methods was challenging, implying that the implementation strategy should address obstacles and facilitating factors identified by the HCPs.

TRIAL REGISTRATION: This study is part of the Act in Time project, registered in ClinicalTrials.gov with the number NCT04799860. Registered 03 March 2021.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Change Management, Clinical Practice Guidelines, Health Personnel, Healthy Lifestyle, Implementation Science, Primary Health Care, Qualitative Research
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-106397 (URN)10.1186/s12875-023-02079-5 (DOI)001012438000003 ()37328813 (PubMedID)2-s2.0-85162070185 (Scopus ID)
Funder
Örebro UniversityRegion Örebro County, OLL-969561
Available from: 2023-06-26 Created: 2023-06-26 Last updated: 2023-08-01Bibliographically approved
Anens, E., Ahlström, I., Emtner, M., Zetterberg, L., Nilsagård, Y. & Hellström, K. (2023). Validity and reliability of physical activity measures in multiple sclerosis. Physiotherapy Theory and Practice, 39(1), 137-153
Open this publication in new window or tab >>Validity and reliability of physical activity measures in multiple sclerosis
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2023 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 39, no 1, p. 137-153Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The purpose was to evaluate the psychometric properties of physical activity measures in persons with multiple sclerosis (PwMS).

METHODS: Adults with multiple sclerosis were recruited, n = 30 (validation) and n = 57 (test-retest). Steps measured with PiezoRX, Yamax SW200 and ActiGraph GT9X Link (AGlink) and time in different positions measured with AGlink were validated against data from video analysis. Psychometric properties of the Physical Activity and Disability Survey - Revised Swedish version (PADS-R(Sw)) was evaluated.

RESULTS: The most valid measures were AGlink using the low-frequency extension filter, and PiezoRX with median absolute percentage errors (MeAPEs) of 0.9-3.1% and 1.3-3.3%. The MeAPEs were higher for Yamax SW200 (2.9-21.0%), AGlink display (3.6-44.8%) and AGlink normal filter (8.9-48.9%), indicating low validity. AGlink was not valid in measurements of sitting (MeAPE 12.0-12.5%) or lying (MeAPE 31.0-41.7%). The correlation between PADS-R(Sw) and AGlink steps was r = 0.492 (p = .009). The relative reliability of PADS-R(Sw) was ICC2,1 0.85 (CI 0.76-0.91), and absolute reliability was SEM 0.54.

CONCLUSION: AGlink and PiezoRX were valid measures of steps in PwMS. The questionnaire PADS-R(Sw) was valid, with high relative reliability, but its absolute reliability was unsatisfactory.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Exercise, multiple sclerosis, physical activity, reproducibility of results, validation studies
National Category
Physiotherapy
Identifiers
urn:nbn:se:oru:diva-95328 (URN)10.1080/09593985.2021.1996498 (DOI)000714815700001 ()34738486 (PubMedID)2-s2.0-85118577741 (Scopus ID)
Funder
Norrbacka-Eugenia FoundationP.O. Zetterling Foundation
Available from: 2021-11-08 Created: 2021-11-08 Last updated: 2023-01-19Bibliographically approved
Nilsing Strid, E., Wallin, L. & Nilsagård, Y. (2022). Implementation of a Health Promotion Practice Using Individually Targeted Lifestyle Interventions in Primary Health Care: Protocol for the "Act in Time" Mixed Methods Process Evaluation Study. JMIR Research Protocols, 11(8), Article ID e37634.
Open this publication in new window or tab >>Implementation of a Health Promotion Practice Using Individually Targeted Lifestyle Interventions in Primary Health Care: Protocol for the "Act in Time" Mixed Methods Process Evaluation Study
2022 (English)In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 11, no 8, article id e37634Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is growing evidence that noncommunicable diseases (NCDs) can be attributable to unhealthy lifestyle habits. However, there has been little application of this knowledge in primary health care (PHC).

OBJECTIVE: This study aims to evaluate the process and outcomes of a multifaceted implementation strategy for a healthy lifestyle-promoting practice in a PHC setting. This practice is based on national guidelines targeting unhealthy lifestyle habits with a potential risk for NCDs.

METHODS: A pre-post implementation study design with a control group is used in a PHC setting in central Sweden. The Medical Research Council guidelines for process evaluation of complex interventions will be applied. The implementation process and outcomes will be assessed using a mix of qualitative and quantitative methods. A strategic sample of up to 6 PHC centers will be included as intervention centers, which will receive a 12-month multifaceted implementation strategy. Up to 6 matched PHC centers will serve as controls. Core components in the implementation strategy are external and internal facilitators in line with the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and the Astrakan change leadership model. Data will be collected at baseline, during the implementation phase, and 4-6 months after the implementation strategy. Questionnaires will be sent to roughly 500 patients in every PHC center and 200 health care professionals (HCPs) before and after implementation. In addition, purposeful sampling will be used for interviews and focus group discussions with managers, HCPs, patient representatives, and internal and external facilitators. Use of data from medical records and activity logs will be an additional data source.

RESULTS: Recruitment of PHC centers began in March 2021 and ended in Spring 2022. Based on the planned timeline with the 12-month implementation strategy and 4-6-month follow-up, we expect to collect the final data in Summer 2023.

CONCLUSIONS: This study will explain implementation process and outcomes using a multifaceted implementation strategy for a healthy lifestyle-promoting practice in a real-world PHC context. The study is expected to provide new knowledge about the role of facilitators and their contribution to implementation outcomes. These findings can guide policy makers, managers, and PHC staff to integrate health promotion and disease prevention in PHC and provide methodological support to facilitators.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04799860; https://clinicaltrials.gov/ct2/show/NCT04799860.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37634.

Place, publisher, year, edition, pages
JMIR Publications, Inc., 2022
Keywords
Facilitation, health personnel, health promotion, implementation science, lifestyle, practice guideline, primary health care, qualitative research, quality improvement
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-100730 (URN)10.2196/37634 (DOI)001096112800003 ()35984700 (PubMedID)2-s2.0-85136670571 (Scopus ID)
Available from: 2022-08-22 Created: 2022-08-22 Last updated: 2024-01-17Bibliographically approved
Westerdahl, E., Gunnarsson, M., Wittrin, A. & Nilsagård, Y. (2021). Pulmonary Function and Respiratory Muscle Strength in Patients with Multiple Sclerosis. Multiple Sclerosis International, 2021, Article ID 5532776.
Open this publication in new window or tab >>Pulmonary Function and Respiratory Muscle Strength in Patients with Multiple Sclerosis
2021 (English)In: Multiple Sclerosis International, ISSN 2090-2654, E-ISSN 2090-2662, Vol. 2021, article id 5532776Article in journal (Refereed) Published
Abstract [en]

Background: In patients with multiple sclerosis (MS), there is a decline in muscle strength and physical capacity due to demyelination and axonal loss in the central nervous system. In patients with advanced MS or in a later stage of the disease, also respiratory impairment may occur. The degree of pulmonary dysfunction in the earlier stages of MS has not been thoroughly described. Therefore, the primary aims of this study are to describe pulmonary function and respiratory muscle strength in patients with a moderate disease course and to identify associations between respiratory muscle strength and functional capacity.

Methods: A sample of 48 patients with a diagnosis of MS and mean age 56 +/- 11 years was studied using a descriptive cross-sectional design. The patients had a disease duration of 24 +/- 11 years and a median Expanded Disability Status Scale (EDSS) score of 4.5 (interquartile range 4.0-6.5). Pulmonary function assessed by spirometry, respiratory muscle strength, peak cough flow and peripheral oxygen saturation, subjective breathing and coughing ability, and physical capacity measured using the 6MWT were evaluated.

Results: The patients had normal pulmonary function with no significant abnormalities in dynamic spirometry (vital capacity 103 +/- 16% predicted, forced expiratory volume in 1 second 95 +/- 15% predicted). Peak expiratory flow rate 89 +/- 17% predicted was in the lower limit of normal. Respiratory muscle strength, determined by maximal inspiratory (MIP) and expiratory (MEP) static pressures, was normal but with large differences between individuals. MIP ranged from 26 to 143 cmH(2)O (98 +/- 31% predicted); the MEP values ranged from 43 to 166 cmH(2)O (104 +/- 29% predicted), with two patients having values below the lower limit of normal. Significant positive associations between MIP as well as MEP were found in several pulmonary function variables. A significant negative association was found between EDSS score and MEP (r=-0.312, p=0.031). Mean peak cough flow was 389 +/- 70 L/min, which is comparable with the values reported for healthy adults. The patients did not experience a severely decreased ability to take deep breaths or cough. There was a moderate correlation between MEP and physical capacity, as assessed by the 6MWT (r=0.399, p=0.010) and between peak expiratory flow (PEF) and the 6MWT (r=0.311, p=0.048).

Conclusion: Respiratory muscle strength, pulmonary function assessed by spirometry, and peak cough flow were normal in patients with mild to moderate MS; however, there were large individual differences demonstrating low respiratory muscle strength in some patients. Significant associations between MEP and functional capacity and between MEP and disease severity were found, indicating that patients with impaired respiratory muscle strength have lower functional capacity and more severe disease.

Place, publisher, year, edition, pages
Hindawi Limited, 2021
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-93240 (URN)10.1155/2021/5532776 (DOI)000669928900001 ()34221507 (PubMedID)
Available from: 2021-07-29 Created: 2021-07-29 Last updated: 2021-07-29Bibliographically 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
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: 2020-12-01Bibliographically approved
Carling, A., Nilsagård, Y. & Forsberg, A. (2018). Balance exercise facilitates everyday life for people with multiple sclerosis: A qualitative study. Physiotherapy Research International, 23(4), Article ID e1728.
Open this publication in new window or tab >>Balance exercise facilitates everyday life for people with multiple sclerosis: A qualitative study
2018 (English)In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 23, no 4, article id e1728Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The aim of this qualitative study was to describe the experience and perceived effects on everyday life for people with multiple sclerosis after participating in a balance exercise programme focusing on core stability, dual tasking, and sensory strategies (the CoDuSe programme).

METHODS: A qualitative approach was chosen, using face-to-face interviews analysed with content analysis. Twenty-seven people with multiple sclerosis (20 women, 7 men) who had participated in the CoDuSe programme were included. All could walk 20 m with or without walking aids but could not walk further than 200 m. The CoDuSe programme was given twice weekly during a 7-week period.

RESULTS: The analysis revealed five categories. Learning to activate the core muscles described how the participants gained knowledge of using their core muscles and transferred this core muscle activation into everyday life activities. Improved bodily confidence covered narratives of being more certain of the ability to control their bodies. Easier and safer activities showed how they could now perform activities in everyday life more safely and easily. Increased independence and participation involved the participants' improved ability and self-confidence to execute activities by themselves, as well as their increased participation in activities in daily living. Experiences of the balance exercise programme revealed that they found the programme novel and challenging. The overall theme was balance exercise facilitates everyday life.

CONCLUSION: Participating in the CoDuSe programme was perceived to facilitate everyday life for people with multiple sclerosis. Taking part in the balance exercise programme taught the participants how to activate and use the core muscles, which increased their bodily confidence. Having increased bodily confidence helped them to perform everyday life activities with more ease and safety, which increased their independence and participation. The participants described the CoDuSe programme as novel and challenging, yet feasible.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
Exercise, multiple sclerosis, postural balance, qualitative research
National Category
Occupational Therapy Other Health Sciences
Research subject
Disability Science
Identifiers
urn:nbn:se:oru:diva-68373 (URN)10.1002/pri.1728 (DOI)000447159800008 ()29962013 (PubMedID)2-s2.0-85050613048 (Scopus ID)
Funder
Swedish Research Council
Note

Funding Agencies:

Norrbacka-Eugenia Foundation

Uppsala-Örebro Regional Research Committee

Available from: 2018-08-07 Created: 2018-08-07 Last updated: 2020-12-01Bibliographically approved
Carling, A., Forsberg, A. & Nilsagård, Y. (2018). Falls in people with multiple sclerosis: experiences of 115 fall situations. Clinical Rehabilitation, 32(4), 526-535
Open this publication in new window or tab >>Falls in people with multiple sclerosis: experiences of 115 fall situations
2018 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 32, no 4, p. 526-535Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim was to describe falls and the perceived causes, experienced by people with multiple sclerosis shortly after falling.

Design: A qualitative study using content analysis and quantitative data to illustrate where and why people report falls most commonly. Semi-structured telephone interviews were performed. Interviews were conducted shortly (0–10 days) after a fall.

Subjects: In all, 67 informants who had reported at least one fall during the previous three-month period and who used a walking aid participated.

Results: A total of 57 (85%) informants fell at least once during eight months resulting in 115 falls; 90 (78%) falls happened indoors, most commonly in the kitchen (n = 20; 17%) or bathroom (n = 16; 14%). Informants fell during everyday activities and walking aids had been used in more than a third of the reported falls. The falls were influenced of both intrinsic and extrinsic factors. Two categories emerged from the analysis: ‘activities when falling’ and ‘influencing factors’. The category contained three (basic activities of daily living, instrumental activities of daily living and leisure and work) and six (multiple sclerosis–related symptoms, fluctuating body symptoms, being distracted, losing body control, challenging surrounding and involvement of walking aid) subcategories, respectively.

Conclusion: The majority of falls occurs indoors and in daily activities. Several factors interacted in fall situations and should be monitored and considered to reduce the gap between the person’s capacity and the environmental demands that cause fall risk. Fluctuation of bodily symptoms between and within a day is a variable not earlier targeted in multiple sclerosis fall risk research.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Accidental falls, multiple sclerosis, walking aid, content analysis
National Category
Neurology Physiotherapy
Identifiers
urn:nbn:se:oru:diva-65948 (URN)10.1177/0269215517730597 (DOI)000429777600011 ()28901164 (PubMedID)2-s2.0-85042230415 (Scopus ID)
Available from: 2018-03-22 Created: 2018-03-22 Last updated: 2020-12-01Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9760-3785

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