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Physiotherapeutic perspectives on balance control after stroke: exercises, experiences and measures
Örebro University, School of Health Sciences.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to investigate physiotherapeutic perspectives on balance after stroke, in terms of exercises, experiences and measurements. Study I was a pilot randomized controlled trial with 46 persons who had had a stroke, 24 of whom were included in the intervention group and 22 who were included in the control group. The intervention consisted of 8 weeks of body awareness therapy (BAT). There were no significant differences over time between the groups in the outcome measures of balance, walking, self-reported balance confidence and quality of life. Study II had a qualitative design using content analysis. Participants in the intervention group from Study I and the four physiotherapists who had been in charge of the BAT were interviewed. One overall theme emerged: "Simple yet challenging", which was based on six categories. Study III investigated the validity and test-retest reliability of the Six-Spot Step test (SSST), an instrument used to assess the ability to take load on each leg. A cross-sectional design with 81 persons who had had stroke was performed. The convergent validity was strong to moderate, and the test-retest reliability was good. In Study IV a mixed method design including both qualitative and quantitative data collection was used. The participants’ experiences of balance and its influence in everyday life were presented in two themes: "Feeling dizzy and unstable is a continuous challenge" and "Feeling trust and confidence despite dizziness and unsteadiness". Taken together, the different data sets provided complementary and confirmatory information about balance. All participants experienced the balance limitations as a continuous challenge in everyday life, yet they also felt trust and confidence.

In summary, BAT can be a complement in physiotherapeutic stroke rehabilitation and the SSST can be used as a measuring instrument of walking balance in persons with stroke. Living with balance limitations was experienced as a challenge but the participants were still able to manage their everyday life and activities.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2018. , p. 72
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 75
Keywords [en]
Stroke, balance, physiotherapy, measures, experiences
National Category
Other Health Sciences
Identifiers
URN: urn:nbn:se:oru:diva-65418ISBN: 978-91-7529-247-2 (print)OAI: oai:DiVA.org:oru-65418DiVA, id: diva2:1186992
Public defence
2018-06-01, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-03-02 Created: 2018-03-02 Last updated: 2018-08-08Bibliographically approved
List of papers
1. Body awareness therapy in persons with stroke: a pilot randomised controlled trial
Open this publication in new window or tab >>Body awareness therapy in persons with stroke: a pilot randomised controlled trial
2014 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 28, no 12, p. 1180-1188Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the effects of body awareness therapy on balance, mobility, balance confidence, and subjective health status in persons with stroke.

Design: A pilot randomized controlled study with follow-up at one and 4–6 weeks after the intervention period.

Setting: Four primary healthcare centres in Örebro County Council.

Subjects: Persons more than six months post stroke, with walking ability of 100 metres.

Intervention: The experimental intervention was body awareness therapy in groups once a week for eight weeks. The controls were instructed to continue their usual daily activities.

Main measures: Berg Balance Scale, Timed Up and Go Test, Timed Up and Go Test with a cognitive component, 6-minute walk test, and Timed-Stands Test. Self-rated balance confidence was assessed using the Activities-specific Balance Confidence Scale, and subjective health status using the Short Form 36 (SF-36) questionnaire.

Results: A total of 46 participants were included (mean age 64 years); 24 in the experimental intervention group and 22 in the control group. No significant differences in changed scores over time were found between the groups. Within the experimental intervention group, significant improvements over time was found for the tests Berg Balance Scale, Timed Up and Go cognitive, and 6-minute walk test. Within the control group, significant improvements over time were found for the Timed Up and Go Cognitive, and the Timed-Stands Test.

Conclusion: In comparison to no intervention, no effects were seen on balance, mobility, balance confidence, and subjective health status after eight weeks of body awareness therapy.

Place, publisher, year, edition, pages
Sage Publications, 2014
Keywords
Body awareness therapy, postural control, physiotherapy, stroke
National Category
Health Sciences Nursing
Research subject
Health and Medical Care Research; Rehabilitation Medicine
Identifiers
urn:nbn:se:oru:diva-35843 (URN)10.1177/0269215514527994 (DOI)000347118700004 ()24668360 (PubMedID)2-s2.0-84921668455 (Scopus ID)
Note

Funding Agencies:

Swedish Stroke Association

Norrbacka Eugenia Foundation 803-11

Research Committee Orebro County Council OLL-227701

Available from: 2014-08-04 Created: 2014-08-04 Last updated: 2018-05-09Bibliographically approved
2. Basic Body Awareness Therapy for patients with stroke: Experiences among participating patients and physiotherapists
Open this publication in new window or tab >>Basic Body Awareness Therapy for patients with stroke: Experiences among participating patients and physiotherapists
2016 (English)In: Journal of Bodywork & Movement Therapies, ISSN 1360-8592, E-ISSN 1532-9283, Vol. 20, no 1, p. 83-89Article in journal (Refereed) Published
Abstract [en]

Background: After a stroke many patients have muscle weakness, spasticity and compromised sensation leading to decreased postural stability. Basic Body Awareness Therapy includes slow movements that challenge postural control.

Aim: The aim was to describe experiences of 8 weeks of Basic Body Awareness Therapy from the perspective of both patients with stroke and physiotherapists.

Method: This study had a qualitative design. Twenty-one patients and four physiotherapists were interviewed. The interviews were analysed using manifest and latent content analysis.

Results: One overall theme emerged "Simple yet challenging" which was based on six categories: "Facing one's limitations", "Individualized movements", "A feeling of harmony", "Improved balance", "Integrated knowledge" and "Frustration and doubt". The patients described improvement in balance and stability, as well as increased wellbeing.

Conclusion: The patients and physiotherapists related that Basic Body Awareness Therapy challenges balance but also provides an opportunity to reflect on the body. (C) 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Basic Body Awareness Therapy, Physiotherapy, Qualitative study, Stroke
National Category
Nursing
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:oru:diva-52163 (URN)10.1016/j.jbmt.2015.06.004 (DOI)000381689000012 ()26891641 (PubMedID)2-s2.0-84958039596 (Scopus ID)
Available from: 2016-09-14 Created: 2016-09-14 Last updated: 2018-05-09Bibliographically approved
3. Validity and test-retest reliability of the Six-Spot Step Test in persons after stroke
Open this publication in new window or tab >>Validity and test-retest reliability of the Six-Spot Step Test in persons after stroke
(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-66907 (URN)
Available from: 2018-05-09 Created: 2018-05-09 Last updated: 2018-05-09Bibliographically approved
4. "I can still manage": a mixed-method study of balance after stroke
Open this publication in new window or tab >>"I can still manage": a mixed-method study of balance after stroke
(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-66909 (URN)
Available from: 2018-05-09 Created: 2018-05-09 Last updated: 2018-05-09Bibliographically approved

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Arvidsson Lindvall, Mialinn

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