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  • 1.
    Adenfelt, Gunilla
    et al.
    Örebro University, School of Health and Medical Sciences.
    Warnemark, Elisabeth
    Örebro University, School of Health and Medical Sciences.
    Arbetsskador hos sjukgymnaster: -en litteraturstudie2008Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 2.
    Agneklev, Ulrica
    et al.
    Örebro University, School of Health and Medical Sciences.
    Byström Utterheim, Inga-Lisa
    Örebro University, School of Health and Medical Sciences.
    Fysisk aktivitet hos personer som fått diagnosen transitorisk ischemisk attack (TIA) - behov av sjukgymnastråd2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna studie var att beskriva hur fysiskt aktiva personer som fått diagnosen TIA var. Frågeställningarna rörde vilka aktiviteter studiedeltagarna ägnade sig åt, hur de upplevde sin hälsa, begränsande faktorer, eventuell förändring av aktivitetsvanor, samt om deltagarna fått råd om fysisk aktivitet. Som metod valdes enkätundersökning och 195 enkäter skickades till personer som sökt Universitetssjukhuset Örebro 2007 och fått diagnosen TIA. Resultat: Svarsfrekvensen, efter externt och internt bortfall, blev 74 %. Mer än hälften av de 144 studiedeltagarna var fysiskt aktiva mindre än 30 minuter/dag. Den vanligaste aktiviteten var promenader, vilket 72 % ägnade sig åt. Yngre personer ägnade sig oftare åt tre eller fler aktiviteter jämfört med äldre personer. De deltagare som var regelbundet fysiskt aktiva skattade sin hälsa som god till utmärkt, medan de med stillasittande fritid skattade sin hälsa som någorlunda eller dålig. De mest begränsande faktorerna var sjukdom och smärta. Av studiedeltagarna uppgav 98 personer att de inte fått råd om fysisk aktivitet och hälften av deltagarna hade inte förändrat sina aktivitetsvanor. Slutsats: Studien visar att många personer som fått diagnosen TIA är fysiskt inaktiva. Begränsande faktorer, som, sjukdom, smärta och hög ålder, medför att råd om fysisk aktivitet bör vara individanpassade. Att ge råd om fysisk aktivitet på lämplig nivå, utifrån den enskilde personens förutsättningar är ett centralt kunskapsområde för sjukgymnaster. Därför bör dessa patienter ges möjlighet att träffa sjukgymnast.

  • 3.
    Andersson, Louise
    et al.
    Örebro University, School of Health and Medical Sciences.
    Björklund, Johanna
    Örebro University, School of Health and Medical Sciences.
    Hur används den transteoretiska beteendeförändringsmodellen för att främja fysisk aktivitet vid övervikt?2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 4.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro University, Örebro, Sweden.
    Lundholm, Ulla Persson
    Nora Health Care Centre, Örebro County Council, Nora, Sweden.
    Kohn, Monica
    Nora Health Care Centre, Örebro County Council, Nora, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro University, Örebro, Sweden.
    Medical yoga: another way of being in the world-A phenomenological study from the perspective of persons suffering from stress-related symptoms2014In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, article id 23033Article in journal (Refereed)
    Abstract [en]

    The prevalence of stress-related illness has grown in recent years. Many of these patients seek help in primary health care. Yoga can reduce stress and thus complements pharmacological therapy in medical practice. To our knowledge, no studies have investigated patients' experiences of yoga treatment in a primary health care setting or, specifically, the experiences of yoga when suffering from stress-related illness. Thus, the aim of the present study was to explore the meaning of participating in medical yoga as a complementary treatment for stress-related symptoms and diagnosis in a primary health care setting. This study has a descriptive phenomenological design and took place at a primary health care centre in Sweden during 2011. Five women and one man (43-51 years) participated. They were recruited from the intervention group (n = 18) in a randomized control trial, in which they had participated in a medical yoga group in addition to standard care for 12 weeks. Data were collected by means of qualitative interviews, and a phenomenological data analysis was conducted. The essential meaning of the medical yoga experience was that the medical yoga was not an endpoint of recovery but the start of a process towards an increased sense of wholeness. It was described as a way of alleviating suffering, and it provided the participants with a tool for dealing with their stress and current situation on a practical level. It led to greater self-awareness and self-esteem, which in turn had an implicit impact on their lifeworld. In phenomenological terms, this can be summarized as Another way of being in the world, encompassing a perception of deepened identity. From a philosophical perspective, due to using the body in a new way (yoga), the participants had learnt to see things differently, which enriched and recast their perception of themselves and their lives.

  • 5.
    Basic, Vladimir Tomislav
    et al.
    Department of Clinical Medicine, Örebro University, Örebro, Sweden.
    Tadele, Elsa
    Department of Clinical Medicine, Örebro University, Örebro, Sweden.
    Elmabsout, Ali Ateia
    Department of Clinical Medicine, Örebro University, Örebro, Sweden.
    Yao, Hongwei
    Department of Environmental Medicine, Lung Biology and Disease Program, University of Rochester Medical Center, Rochester NY, USA.
    Rahman, Irfan
    Department of Environmental Medicine, Lung Biology and Disease Program, University of Rochester Medical Center, Rochester NY, USA.
    Sirsjö, Allan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Abdel-Halim, Samy M.
    Department of Environmental Medicine, Lung Biology and Disease Program, University of Rochester Medical Center, Rochester NY, USA.
    Exposure to cigarette smoke induces overexpression of von Hippel-Lindau tumor suppressor in mouse skeletal muscle2012In: American Journal of Physiology - Lung cellular and Molecular Physiology, ISSN 1040-0605, E-ISSN 1522-1504, Vol. 303, no 6, p. L519-L527Article in journal (Refereed)
    Abstract [en]

    Cigarette smoke (CS) is a well established risk factor in the development of chronic obstructive pulmonary disease (COPD). In contrast, the extent to which CS exposure contributes to the development of the systemic manifestations of COPD, such as skeletal muscle dysfunction and wasting remains largely unknown. Decreased skeletal muscle capillarization has been previously reported in early stages of COPD and might play an important role in the development of COPD-associated skeletal muscle abnormalities. To investigate the effects of chronic CS exposure on skeletal muscle capillarization and exercise tolerance a mouse model of CS exposure was used. The129/SvJ mice were exposed to CS for 6 months, and the expression of putative elements of the hypoxia-angiogenic signaling cascade as well as muscle capillarization were studied. Additionally, functional tests assessing exercise tolerance/endurance were performed in mice. Compared to controls, skeletal muscles from CS-exposed mice exhibited significantly enhanced expression of von Hippel-Lindau tumor suppressor (VHL), ubiquitin-conjugating enzyme E2D1 (UBE2D1) and prolyl hydroxylase-2 (PHD2). In contrast, hypoxia-inducible factor-1 (HIF1-α) and vascular endothelial growth factor (VEGF) expression was reduced. Furthermore, reduced muscle fiber cross-sectional area, decreased skeletal muscle capillarization, and reduced exercise tolerance were also observed in CS-exposed animals. Taken together, the current results provide evidence linking chronic CS exposure and induction of VHL expression in skeletal muscles leading towards impaired hypoxia-angiogenesis signal transduction, reduced muscle fiber cross-sectional area and decreased exercise tolerance.

  • 6.
    Borgestig, Maria
    Linköpings universitet, Linköping, Sweden.
    The impact of gaze-based assistive technology on daily activities in children with severe physical impairments2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: The aim of the thesis was to investigate the impact of gaze-based assistive technology on daily activities in children with severe physical impairments and without speech. The objectives were to develop and pilot a gaze-based assistive technology intervention (GAT intervention) at home and in school for these children and to understand its impact on daily activities as experienced by their parents.

    Methods: Study I was a pilot study in which the basic components that were developed for the intervention were evaluated for students with physical impairments. The study aimed at improving the use of computers as assistive technology (AT) in school. Based on the findings in Study I, the GAT intervention was developed. The GAT intervention aimed at implementing gaze-based AT in daily activities. It consisted of two parts; having access to gaze-based AT and having access to services from a multi professional communication team during nine to ten months. Studies II-IV concerned gazebased AT for children with severe physical impairments without speech who participated in the GAT intervention. The participants were ten children (ages 1-15) (Studies II, III), and their parents (Study IV). Studies II and III had longitudinal designs and children were followed during 15-20 months with repeated measurements before, after and at follow-up. In Study II children’s repertoire of computer activities, extent of use, and goal attainment with gaze-based AT was evaluated, as well as parents’ satisfaction with the AT and with services. In Study III children’s eye gaze performance when using gaze-based AT was examined. In Study IV, parents were interviewed twice with the aim of  exploring their experiences of children’s gaze-based AT use in daily life. In Study IV a hermeneutical approach was used.

    Results: The findings of Study I showed that the basic components of intervention improved the use of computers in school. Study II showed an increased repertoire of computer activities with the gazebased AT, maintained use in daily activities for all at follow up, and that all children attained goals for gaze-based AT use in daily activities. Parents were satisfied with the gaze-based AT, and with the services in the GAT intervention. In study III, nine children improved in eye gaze performance over time when using the gaze-based AT in daily activities. Study IV revealed that children’s gaze-based AT usage in daily activities made a difference to parents since the children demonstrated agency, and showed their personality and competencies by using gaze-based AT, and for the parents this opened up infinite possibilities for the child to do and learn things. Overall, children’s gaze-based AT usage provided parents with hope of a future in which their children could develop and have influence in life.

    Conclusions: This thesis shows that these children with severe physical impairments and without speech acquired sufficient gaze control skills to use gaze-based AT for daily activities in the home and at school. The gaze-based AT had a positive impact on performing activities, for example, play activities and communication- and interaction-related activities. For the parents, children’s gaze-based AT usage made a difference since it shaped a hope of a better future for their children, where they can develop and gain influence in their future life. Furthermore, the children continued to perform daily activities with gaze-based AT over time. This finding suggests that key persons were provided with sufficient knowledge and skills to support children in maintained use of gaze-based AT after withdrawal of the services provided in the GAT intervention.

  • 7.
    Brocki, Barbara Cristina
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark .
    Andreasen, Jan Jesper
    Aalborg University, Aalborg, Denmark.
    Langer, Daniel
    Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
    Souza, Domingos S. R.
    Faculty of Medicine and Health, Surgery, Örebro University, Örebro, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: a randomized controlled trial2016In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 49, no 5, p. 1483-1491, article id 26489835Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES The aim was to investigate whether 2 weeks of inspiratory muscle training (IMT) could preserve respiratory muscle strength in high-risk patients referred for pulmonary resection on the suspicion of or confirmed lung cancer. Secondarily, we investigated the effect of the intervention on the incidence of postoperative pulmonary complications.

    METHODS The study was a single-centre, parallel-group, randomized trial with assessor blinding and intention-to-treat analysis. The intervention group (IG, n = 34) underwent 2 weeks of postoperative IMT twice daily with 2 × 30 breaths on a target intensity of 30% of maximal inspiratory pressure, in addition to standard postoperative physiotherapy. Standard physiotherapy in the control group (CG, n = 34) consisted of breathing exercises, coughing techniques and early mobilization. We measured respiratory muscle strength (maximal inspiratory/expiratory pressure, MIP/MEP), functional performance (6-min walk test), spirometry and peripheral oxygen saturation (SpO2), assessed the day before surgery and again 3–5 days and 2 weeks postoperatively. Postoperative pulmonary complications were evaluated 2 weeks after surgery.

    RESULTS The mean age was 70 ± 8 years and 57.5% were males. Thoracotomy was performed in 48.5% (n = 33) of cases. No effect of the intervention was found regarding MIP, MEP, lung volumes or functional performance at any time point. The overall incidence of pneumonia was 13% (n = 9), with no significant difference between groups [IG 6% (n = 2), CG 21% (n = 7), P = 0.14]. An improved SpO2 was found in the IG on the third and fourth postoperative days (Day 3: IG 93.8 ± 3.4 vs CG 91.9 ± 4.1%, P = 0.058; Day 4: IG 93.5 ± 3.5 vs CG 91 ± 3.9%, P = 0.02). We found no association between surgical procedure (thoracotomy versus thoracoscopy) and respiratory muscle strength, which was recovered in both groups 2 weeks after surgery.

    CONCLUSIONS Two weeks of additional postoperative IMT, compared with standard physiotherapy alone, did not preserve respiratory muscle strength but improved oxygenation in high-risk patients after lung cancer surgery. Respiratory muscle strength recovered in both groups 2 weeks after surgery.

  • 8.
    Brocki, Barbara Cristina
    et al.
    Aalborg University Hospital, Aalborg, Denmark.
    Andreasen, Jan Jesper
    Aalborg University Hospital, Aalborg, Denmark; Aalborg University, Aalborg, Denmark.
    Westerdahl, Elisabeth
    Örebro University, School of Health Sciences. Örebro University Hospital. Uppsala University, Uppsala, Sweden.
    Inspiratory Muscle Training in High-Risk Patients Following Lung Resection May Prevent a Postoperative Decline in Physical Activity Level2018In: Integrative Cancer Therapies, ISSN 1534-7354, E-ISSN 1552-695X, Vol. 17, no 4, p. 1095-1102Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To describe postoperative self-reported physical activity (PA) level and assess the effects of 2 weeks of postoperative inspiratory muscle training (IMT) in patients at high risk for postoperative pulmonary complications following lung resection.

    METHODS: This is a descriptive study reporting supplementary data from a randomized controlled trial that included 68 patients (mean age = 70 ± 8 years), randomized to an intervention group (IG; n = 34) or a control group (CG; n = 34). The IG underwent 2 weeks of postoperative IMT added to a standard postoperative physiotherapy given to both groups. The standard physiotherapy consisted of breathing exercises, coughing techniques, and early mobilization. We evaluated self-reported physical activity (Physical Activity Scale 2.1 questionnaire) and health status (EuroQol EQ-5D-5L questionnaire), assessed the day before surgery and 2 weeks postoperatively.

    RESULTS: A significant percentage of the patients in the IG reported less sedentary activity 2 weeks postoperatively when compared with the CG (sedentary 6% vs 22%, low activity 56% vs 66%, moderate activity 38% vs 12%, respectively; P = .006). The mean difference in EQ-5D-5L between the IG and CG 2 weeks postoperatively was nonsignificant ( P = .80). The overall preoperative EQ-5D-5L index score for the study population was comparable to a reference population.

    CONCLUSION: Postoperative IMT seems to prevent a decline in PA level 2 weeks postoperatively in high-risk patients undergoing lung resection. More research is needed to confirm these findings.

  • 9.
    Brocki, Barbara Cristina
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Andreasen, Jan Jesper
    Department of Cardiothoracic surgery and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
    Souza, Domingos S. R.
    Faculty of Medicine and Health, Surgery, Örebro University, Örebro, Sweden .
    Improvements in physical performance and health-related quality of life one year after radical operation for lung cancer2015In: Cancer Treatment Communications, ISSN 2213-0896, Vol. 4, p. 65-74Article in journal (Refereed)
    Abstract [en]

    Micro abstract: This study assessed physical performance and health-related quality of life one year after lung cancer surgery and investigated the potential association between both outcomes. We found that the walked distance was associated with the subjective perception of the physical functioning. Patients improved health-related quality of life, reaching values similar to a healthy reference population.

    Background: Resuming an acceptable level of lifestyle and health-related quality of life after lung cancer surgery has become an important issue. We aimed to evaluate the course of recovery of physical performance and health-related quality of life following pulmonary resection for lung cancer, as well as examine the potential association between these outcomes.

    Methods: In an observational design, we assessed 78 individuals radically operated for lungcancer. We measured health-related quality of life (SF-36), six-minute walk test (6MWT) and lung function (spirometry)three weeks (baseline), four and twelve months after surgery. SF-36 values were compared to an age-and gender-matched reference population.

    Results: The mean age was 65 years (SD9), 59% were males. Thoracotomy was performed in 77% of the cases. Compared to baseline values, we found significant improvements after one year in SF-36 physical and mental component summary components of large effect size (0.8 and 0.9 respectively). Values for both SF-36 summary components were comparable to those of the reference population. The improvement in 6MWT was of moderate effect size (0.6). We found a positive association between 6MWT and the SF-36 domain for physical functioning (β=0.05, 95% CI [0.00;0.09], p=0.03) one year after surgery.

    Conclusion: Individuals who were radically operated for lung cancer improved health-related quality of life one year after surgery, reaching values similar to a healthy reference population. The walked distance was positively associated with the subjective perception of physical functioning. The clinical significance of these findings deserves further investigation.

  • 10.
    Brocki, Barbara Cristina
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Aalborg University Hospital, Aalborg, Denmark.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Souza, Domingos S. R.
    Department of Cardiothoracic Surgery and Anaesthesiology, Örebro University Hospital, Örebro, Sweden.
    Andreasen, Jan Jesper
    University Hospital, Aalborg, Denmark.
    Factors influencing postoperative pulmonary complications following pulmonary resection due to malignant or benign lung tumour: preliminary results2014Conference paper (Refereed)
  • 11.
    Brocki, Barbara
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg,.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Langer, Daniel
    KU Leuven Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium; Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Belgium; .
    Souza, Domingos SR
    Faculty of Medicine and Health, Surgery, Örebro University, Örebro, Sweden.
    Andreasen, Jan Jesper
    Departments of Cardiothoracic Surgery and Clinical Medicine, Aalborg University Hospital,.
    Respiratory muscle strength is not affected two weeks and six months following pulmonary resectionManuscript (preprint) (Other academic)
  • 12.
    Carlfjord, Siw
    et al.
    Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden.
    Nilsing-Strid, Emma
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre.
    Johansson, Kajsa
    Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden.
    Holmgren, Theresa
    Department of Medical and Health Sciences, Community Medicine, Linköping University, Linköping, Sweden; Department of Orthopaedics, Region Östergötland, Linköping, Sweden.
    Öberg, Birgitta
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Practitioner experiences from the structured implementation of evidence-based practice in primary care physiotherapy: A qualitative study2019In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 25, no 4, p. 622-629Article in journal (Refereed)
    Abstract [en]

    RATIONALE, AIMS, AND OBJECTIVES: To provide best available care, the practitioners in primary health care (PHC) must have adequate knowledge about effective interventions. The implementation of such interventions is challenging. A structured implementation strategy developed by researchers at Linköping University, Sweden, was used for the implementation of an evidence-based assessment and treatment programme for patients with subacromial pain among physiotherapists in PHC. To further develop strategies for implementation of evidence-based practices, it was deemed important to study the implementation from the practitioners' perspective. The aim of this study was to explore the practitioners' experiences from the implementation.

    METHODS: A qualitative design with focus group discussions was applied. The implementation in terms of perceptions of process and outcome was evaluated by focus group discussions with, in total, 16 physiotherapists in the target group. Data were analysed using the method qualitative content analysis.

    RESULTS: The components of the strategy were viewed positively, and the applicability and evidence base behind the programme were appreciated. The programme was perceived to be adopted, and the practitioners described a changed behaviour and increased confidence in handling patients with subacromial pain. Both patient- and provider-related challenges to the implementation were mentioned.

    CONCLUSIONS: The practitioners' experiences from the implementation were mainly positive. A strategy with collaboration between academy and practice, and with education and implementation teams as facilitators, resulted in changes in practice. Critical voices concerned interprofessional collaboration and that the programme was focused explicitly on the shoulder, not including other components of physical function.

  • 13.
    Carling, Anna
    et al.
    Avdelningen för sjukgymnastik, Universitetssjukhuset Örebro, Örebro, Sweden.
    Andreasson, Malin
    NeuroRehab, Mälarsjukhuset, Eskilstuna, Sweden.
    Westerlin, Helena
    NeuroRehab, Mälarsjukhuset, Eskilstuna, Sweden.
    Forsberg, Anette
    Allmänmedicinskt forskningscentrum, Region Örebro län, Örebro, Sweden.
    Nilsagård, Ylva
    Vårdvetenskapligt forskningscentrum, Region Örebro län, Örebro, Sweden.
    Jämförelse mellan 5 och 10 sit-to-stand tests för personer med måttlig-avancerad Multipel Skleros2015In: Fysioterapi 2015, 2015Conference paper (Refereed)
  • 14.
    Carling, Anna
    et al.
    Örebro University, School of Medical Sciences.
    Forsberg, Anette
    Department of physiotherapy, Örebro University Hospital, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences.
    “Berg Balance Scale” and “Timed Up and Go” discriminates between fallers and non-fallers, in people with MS2016In: Sixth International Symposium on Gait and Balance in Multiple Sclerosis, 2016Conference paper (Refereed)
  • 15.
    Carling, Anna
    et al.
    Örebro University, School of Medical Sciences. Department of Physiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Forsberg, Anette
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Physiology, Örebro University Hospital, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences. Örebro University Hospital. Health Care Management, Region Örebro County, Örebro, Sweden.
    Fall bland personer med multipel skleros2017In: Best Practice, ISSN 1329-1874, no 20, p. 24-27Article in journal (Other academic)
  • 16.
    Carling, Anna
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Forsberg, Anette
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Physiotherapy.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Falls in people with multiple sclerosis: experiences of 115 fall situations2018In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 32, no 4, p. 526-535Article in journal (Refereed)
    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.

  • 17.
    Carling, Anna
    et al.
    Örebro University, School of Medical Sciences.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Concern of falling compared to actual fallsituations in people with MS2017Conference paper (Refereed)
  • 18.
    Carling, Anna
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Correlation between falls and near falls in people with moderate to advanced multiple sclerosis.2015In: Fifth International Symposium on Gait and Balance in Multiple Sclerosis, 2015Conference paper (Refereed)
  • 19.
    Carling, Anna
    et al.
    Örebro University, School of Medical Sciences.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Forsberg, Anette
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Practice in the use of a walking aid in people with multiple sclerosis2017Conference paper (Refereed)
  • 20.
    Carling, Anna
    et al.
    Örebro University, School of Medical Sciences. Department of Physiotherapy, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nilsagård, Ylva
    Health Care Management, Region Örebro County, Örebro, Sweden.
    Forsberg, Anette
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden.
    Practice in the use of a walking aid in people with multiple sclerosis2017Conference paper (Refereed)
  • 21.
    Crommert, Martin Eriksson
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. The Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden.
    Halvorsen, K.
    School of Technology and Health, KTH Royal Institute of Technology, Stockholm, Sweden; Department of Information Technology, Uppsala University, Uppsala, Sweden.
    Ekblom, M. M.
    The Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden; Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Trunk Muscle Activation at the Initiation and Braking of Bilateral Shoulder Flexion Movements of Different Amplitudes2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 11, article id e0141777Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate if trunk muscle activation patterns during rapid bilateral shoulder flexions are affected by movement amplitude. Eleven healthy males performed shoulder flexion movements starting from a position with arms along sides (0 degrees) to either 45 degrees, 90 degrees or 180 degrees. EMG was measured bilaterally from transversus abdominis (TrA), obliquus internus (OI) with intra-muscular electrodes, and from rectus abdominis (RA), erector spinae (ES) and deltoideus with surface electrodes. 3D kinematics was recorded and inverse dynamics was used to calculate the reactive linear forces and torque about the shoulders and the linear and angular impulses. The sequencing of trunk muscle onsets at the initiation of arm movements was the same across movement amplitudes with ES as the first muscle activated, followed by TrA, RA and OI. All arm movements induced a flexion angular impulse about the shoulders during acceleration that was reversed during deceleration. Increased movement amplitude led to shortened onset latencies of the abdominal muscles and increased level of activation in TrA and ES. The activation magnitude of TrA was similar in acceleration and deceleration where the other muscles were specific to acceleration or deceleration. The findings show that arm movements need to be standardized when used as a method to evaluate trunk muscle activation patterns and that inclusion of the deceleration of the arms in the analysis allow the study of the relationship between trunk muscle activation and direction of perturbing torque during one and the same arm movement.

  • 22.
    Davidsson, Oskar
    et al.
    Nyköpings lasarett, Nyköping, Sweden.
    Franzén, Lisbeth
    Nyköpings lasarett, Nyköping, Sweden.
    Carling, Anna
    Avdelningen för sjukgymnastik, Universitetssjukhuset Örebro, Örebro, Sweden.
    Nilsagård, Ylva
    Vårdvetenskapligt forskningscentrum, Region Örebro län, Örebro, Sweden.
    Forsberg, Anette
    Allmänmedicinskt forskningscentrum, Region Örebro län, Örebro, Sweden.
    Validering av Trunk Impairment Scale version 1.0 och 2.0 för personer med måttlig till avancerad multipel skleros2015In: Fysioterapi 2015, 2015Conference paper (Refereed)
  • 23.
    Edholm, Peter
    et al.
    Örebro University, School of Health Sciences.
    Strandberg, Emelie
    Örebro University, School of Health Sciences.
    Kadi, Fawzi
    Örebro University, School of Health Sciences.
    Lower limb explosive strength capacity in elderly women: effects of resistance training and healthy diet2017In: Journal of applied physiology, ISSN 8750-7587, E-ISSN 1522-1601, Vol. 123, no 1, p. 190-196Article in journal (Refereed)
    Abstract [en]

    The effects of 24 wk of resistance training combined with a healthy diet on lower limb explosive strength capacity were investigated in a population of healthy elderly women. Participants (n = 63; 67.5 ± 0.4 yr) were randomized into three groups; resistance training (RT), resistance training and healthy diet (RT-HD), and control (CON). Progressive resistance training was performed at a load of 75-85% one-repetition maximum. A major adjustment in the healthy dietary approach was an n-6/n-3 polyunsaturated fatty acid (PUFA) ratio below 2. Lower limb maximal strength, explosive force capacity during dynamic and isometric movements, whole body lean mass, and physical function were assessed. Whole body lean mass significantly increased by 1.5 ± 0.5% in RT-HD only. Isometric strength performance during knee extension as well as the performance in the five sit-to-stand and single-leg-stance tests increased similarly in RT and RT-HD. Improvements in dynamic peak power and time to reach peak power (i.e shorter time) during knee extension occurred in both RT (+15.7 ± 2.6 and -11.0 ± 3.8%, respectively) and RT-HD (+24.6 ± 2.6 and -20.3 ± 2.7%, respectively); however, changes were significantly larger in RT-HD. Similarly, changes in peak force and rate of force development during squat jump were higher in RT-HD (+58.5 ± 8.4 and +185.4 ± 32.9%, respectively) compared with RT (+35.7 ± 6.9 and +105.4 ± 22.4%, respectively). In conclusion, a healthy diet rich in n-3 PUFA can optimize the effects of resistance training on dynamic explosive strength capacity during isolated lower limb movements and multijoint exercises in healthy elderly women.

    NEW & NOTEWORTHY Age-related decline in lower limb explosive strength leads to impaired ability to perform daily living tasks. The present randomized controlled trial demonstrates that a healthy diet rich in n-3 polyunsaturated fatty acid (n-3 PUFA) enhances resistance training-induced gains in dynamic explosive strength capacity during isolated lower limb movements and multijoint exercises in healthy elderly women. This supports the use of strategies combining resistance training and dietary changes to mitigate the decline in explosive strength capacity in older adults.

  • 24.
    Fagevik Olsén, Monika
    et al.
    Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Occupational and Physical Therapy, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Lindstrand, Hilda
    Department of Occupational and Physical Therapy, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Lind Broberg, Jenny
    Department of Occupational and Physical Therapy, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Sciences, Clinical Physiology, Uppsala University Hospital, Uppsala, Sweden.
    Measuring chest expansion; a study comparing two different instructions2011In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 13, no 3, p. 128-132Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to examine and compare the effect of two alternative instructions when measuring chest expansion. In 100 healthy subjects, chest expansion was measured using a circumference tape. In 30 healthy subjects, chest expansion was measured by a Respiratory Movement Measuring Instrument (RMMI). Both measurements were made at the level of the fourth rib and the xiphoid process. The two instructions evaluated were the traditional one: “breathe in maximally” and “breathe out maximally”, which were compared with a new one “breathe in maximally and make yourself as big as possible” and “breathe out maximally and make yourself as small as possible”. The addition of “make yourself as big/small as possible” in the new instruction resulted in a significantly increased thoracic excusion, 1.4 cm in upper and 0.9 cm in lower level of thorax, measured by tape, compared with the traditional instruction (p < 0.001). Measurements obtained using the RMMI also showed a significant difference, 2.3 mm in upper and 4.1 mm in lower level of thorax, between the two instructions in favour of the new instruction (p < 0.05). The verbal instruction during measurement of chest expansion is of importance when measured by tape and RMMI. To assess the maximal range of motion in the chest, the patient should be instructed not only to “breathe in/out maximally”, but also instructed to “make yourself as big/small as possible”

  • 25.
    Fagevik Olsén, Monika
    et al.
    Department of Physiotherapy, Sahlgrenska University Hospital and Institute for Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg .
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences.
    Positive expiratory pressure in patients with chronic obstructive pulmonary disease: a systematic review2009In: Respiration, ISSN 0025-7931, E-ISSN 1423-0356, Vol. 77, no 1, p. 110-118Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Breathing exercises against a resistance during expiration are often used as treatment for patients with chronic obstructive pulmonary disease (COPD). Controversy still exists regarding the clinical application and efficacy.

    OBJECTIVES: The aim of this systematic review was to determine the effects of chest physiotherapy techniques with positive expiratory pressure (PEP) for the prevention and treatment of pulmonary impairment in adults with COPD.

    METHODS: The review was conducted on randomised, controlled clinical trials in which breathing exercises with positive expiratory pressure were compared with other chest physical therapy techniques or with no treatment, in adult patients with COPD. A computer-assisted literature search of available databases from 1970 to January 2008 was performed. Two reviewers extracted data independently and assessed the trials systematically with an instrument for measuring methodological quality.

    RESULTS: In total, 11 trials met the inclusion criteria, of which 5 reached an adequate level of internal validity. Several kinds of PEP techniques with a diversity of intensities and durations of treatment have been evaluated with different outcome measures and follow-up periods. Benefits of PEP were found in isolated outcome measures in separate studies with a follow-up period <1 month. Concerning long-term effects, the results are contradictory.

    CONCLUSION: Prior to widespread prescription of long-term PEP treatment, more research is required to establish the benefit of the technique in patients with COPD.

  • 26.
    Forsberg, Anette
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Carling, Anna
    Örebro University, School of Medical Sciences.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Effects on balance and walking with a CoreStability Exercise Program in people with multiple sclerosis2017Conference paper (Refereed)
  • 27.
    Forsberg, Anette
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro County Council, Örebro , Sweden.
    Lindmark, Birgitta
    Uppsala University, Uppsala, Sweden.
    Användandet av riktmärken vid gång för patienter med Parkinsons sjukdom2001In: Nordisk fysioterapi, ISSN 1402-3024, Vol. 5, no 1, p. 35-40Article in journal (Refereed)
  • 28.
    Franzén, Yvonne
    Örebro University, School of Health and Medical Sciences.
    Lateral höftsmärta vid reumatisk inflammatorisk sjukdom: Kartläggning av sjukgymnastiska undersöknings- och behandlingsmetoder2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 29.
    Frisk, Benny
    Örebro University, School of Health and Medical Sciences.
    Ökad kondition med promenader: -en jämförande studie av intervallgång och kontinuerlig gång2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 30. Grahn Kronhed, Ann-Charlotte
    et al.
    Hallberg, Inger
    Ödkvist, Lars
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences.
    Effect of training on health-related quality of life, pain and falls in osteoporotic women2009In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 11, no 3, p. 154-165Article in journal (Refereed)
    Abstract [en]

    Physical inactivity is a risk factor for osteoporosis and fractures. The aim of the study was to see if supervised training would improve health-related quality of life (HRQL), reduce pain and falls in osteoporotic women. Women with established osteoporosis (n=124) were invited to a 1-year, follow-up study. Seventy-three women aged 60-81 years met the inclusion criteria and were randomized to an exercise (E) or control (C) group. A 4-month, supervised group training programme was designed. Participants were studied using HRQL questionnaires, clinical tests and dynamic posturography. Thirty-one women in the E-group and 34 women in the C-group completed the study. The E-group improved in six SF-36 domains and mental component summary (MCsum) index and also in worst pain intensity (p<0.01) after the supervised exercise training. Differences were found between the groups when comparing changes in four SF-36 domains, MCsum and worst pain (p=0.001). Physical activity level decreased in the E-group after the supervised period. Mean time to first fall occurred earlier in the C-group than in the E-group for the first 4 months but the trend did not last for the 1-year follow-up. The study suggests that supervised group training is beneficial for women with established osteoporosis.

  • 31.
    Hammer, Ann
    et al.
    Örebro University, Department of Clinical Medicine.
    Lindmark, Birgitta
    Uppsala universitet.
    Test-retest intra-rater reliability of grip force in patients with stroke2003In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 35, no 4, p. 189-194Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Coefficients of repeatability and reproducibility can be guides in differentiating between real changes and measurement error. The aim was to evaluate test-retest intra-rater reliability of a clinical procedure measuring grip force with Grippit in stroke patients, to assess relationship between grip force of the hands and between sustained and peak grip force. PATIENTS AND METHODS: Eighteen patients were tested using the Grippit at two occasions one hour apart. Each occasion comprised three consecutive trials per hand. RESULTS: The paretic hand needs to score a 50 N change within and between occasions to exceed the measurement error in 95% of the observations, irrespective of calculation method. Expressed by CV(within) the measurement error was 10%. There was no learning or fatigue effect during measuring. There was a wide variation between subjects but the mean ratio between sides was 0.66. The mean ratio between sustained and peak grip force was 0.80-0.84. CONCLUSION: The measurement errors were acceptable and the instrument can be recommended for the use in stroke patients at a department of rehabilitation medicine.

  • 32.
    Hammer, Ann M.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Lindmark, Birgitta
    Uppsala Universitet.
    Effects of forced use on arm function in the subacute phase after stroke: a randomized, clinical pilot study2009In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 89, no 6, p. 526-539Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: Following stroke, it is common to exhibit motor impairments and decreased use of the upper limb. The objective of the present study was to evaluate forced use on arm function during the subacute phase after stroke.

    DESIGN: A comparison of standard rehabilitation only and standard rehabilitation together with a restraining sling was made through a randomized, nonblinded, clinical pilot trial with assessments before intervention, after intervention, and at 1- and 3-month follow-ups.

    SETTING: The present study took place at the departments of rehabilitation medicine, geriatrics, and neurology at a university hospital.

    PARTICIPANTS: A convenience sample of 30 people 1 to 6 months (mean, 2.4 mo) after stroke was randomized into 2 groups (forced-use group and standard training group) of 15 people each. Twenty-six participants completed the 3-month follow-up.

    INTERVENTION: All participants received their standard rehabilitation program with training 5 days per week for 2 weeks as inpatients or outpatients. The forced-use group also wore a restraining sling on the nonparetic arm with a target of 6 hours per day.

    MEASUREMENTS: The Fugl-Meyer (FM) test, the Action Research Arm Test, the Motor Assessment Scale (MAS) (sum of scores for the upper limb), a 16-hole peg test (16HPT), a grip strength ratio (paretic hand to nonparetic hand), and the Modified Ashworth Scale were used to obtain measurements. RESULTS: The changes in the forced-use group did not differ from the changes in the standard training group for any of the outcome measures. Both groups improved over time, with statistically significant changes in the FM test (mean score changed from 52 to 57), MAS (mean score changed from 10.1 to 12.4), 16HPT (mean time changed from >92 seconds to 60 seconds), and grip strength ratio (mean changed from 0.40 to 0.55).

    LIMITATIONS: The limitations of this pilot study include an extended study time, a nonblinded assessor, a lack of control of treatment content, and a small sample size.

    CONCLUSIONS: The results of the present pilot study did not support forced use as a reinforcement of standard rehabilitation in the subacute phase after stroke. Forced use did not generate greater improvements with regard to motor impairment and capacity than standard rehabilitation alone. The findings of this effectiveness study will be used to help design future clinical trials with the aim of revealing a definitive conclusion regarding the clinical implementation of forced use for upper-limb rehabilitation.

  • 33.
    Hammer, Ann M.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Lindmark, Birgitta
    Uppsala Universitet.
    Is forced use of the paretic upper limb beneficial?: A randomized pilot study during subacute post-stroke recovery2009In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 23, no 5, p. 424-433Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the effect of two weeks of forced use of the paretic upper limb, as a supplement to the rehabilitation programme in the subacute phase after stroke, on self-rated use of that limb.

    Design: A randomized, non-blind, parallel group, clinical, before-and-after trial. A forced use group and a conventional group were followed up one and three months after intervention.

    Setting: In- and outpatient units of rehabilitation at a University Hospital.Subjects: Thirty patients were allocated to two groups, 15 in each, 1-6 months (mean 2.4) after stroke onset. Twenty-six patients completed the study.

    Interventions: The patients of both groups participated in two weeks of daily training on weekdays. In addition, the forced use group wore a restraining sling on the non-paretic arm for up to 6 hours per weekday.

    Main measure: The Motor Activity Log; patients scored 0-5 for 30 daily tasks concerning both amount of use and quality of movement.

    Results: The forced use group tended to achieve larger improvements immediately post-intervention, but this was not clearly demonstrated. The small differences also levelled out up to the three-month follow-up, with both groups earning an approximately 1.0 score point on both scales of the Motor Activity Log.

    Conclusions: This pilot study did not reveal any additional benefit of forced use on self-rated performance in daily use of the paretic upper limb. Both groups performed fairly extensive, active training with a similar duration, amount and content.

  • 34.
    Hammer, Ann M.
    et al.
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Lindmark, Birgitta
    Dept Neurosci, Sect Physiotherapy, Uppsala Univ, Uppsala, Sweden.
    Responsiveness and validity of the Motor Activity Log in patients during the subacute phase after stroke2010In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no 14, p. 1184-1193Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate the responsiveness and cross-sectional and longitudinal validity of the Motor Activity Log (MAL) in the subacute phase after stroke.

    Method: Data were collected pre-intervention, post-intervention, and at 3-month follow-up evaluations from 30 patients with stroke participating in a randomized trial of forced use. Assessments included MAL, the Fugl-Meyer test, the 16-hole peg test, grip strength, the Action Research Arm Test, and the Motor Assessment Scale. Measurements of responsiveness were effect size, standardized response mean (SRM), and responsiveness ratio (RR). Relationships between the MAL and the other measures were determined with Spearman correlations.

    Results: The MAL is responsive to change, with effect size, SRM, and RR ›1.0 at the 3-month follow-up, and SRM and RR ›1.0 at post-intervention. Correlations at the separate test occasions between MAL and the other measures were mostly close to 0.50, which shows fair to moderate construct validity. Correlations between changes in MAL and in the other measures were weaker than cross-sectional relationships.

    Conclusions: The MAL is a responsive measure of daily hand use in patients participating in rehabilitation in the subacute phase after stroke. Correlations of construct validity indicate that daily hand use may need to be measured separately from body function and activity capacity, in line with the underlying constructs of International Classification of Functioning, Disability and Health. To strengthen our findings, they should be repeated in larger samples of patients.

  • 35.
    Hammer, Ann M.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences.
    Wallquist, Magnus
    Balance training in stroke patients: a systematic review of randomized, controlled trials2008In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 10, no 4, p. 163-172Article in journal (Refereed)
    Abstract [en]

    The purpose of this review was to investigate and summarize the scientific evidence base for physiotherapy interventions aimed at restoring balance after stroke without extensive technical equipment. A search was performed in the Medline, Cochrane, Cinahl and PEDro databases. Key words were "stroke", "balance" and, "physiotherapy". The search was limited to randomized, controlled trials (RCTs) in English. For classifying study quality and relevance, the PEDro scale was used for methodological ratings and power analyses were noted. Fourteen RCTs of 360 titles were included. Six studies were of high quality and six were of medium quality. Results in the acute phase showed evidence regarding supported standing for severely impaired patients. In the sub-acute phase, intense, supervised home-exercise programmes were superior to standard care. Several activity-focused approaches to balance challenges were efficient. It also appeared possible for post-stroke persons in the late phase to improve their balance. All but one study showed at least one statistically significant or clinically relevant improvement within or between groups. This systematic review suggests that balance following stroke could be improved by a variety of physiotherapeutic interventions performed without the use of extensive technical equipment.

  • 36.
    Hammer, Ann
    et al.
    Örebro University, Department of Clinical Medicine.
    Nilsagård, Ylva
    Örebro University Hospital, Örebro, Sweden.
    Forsberg, Anette
    Örebro County Council, Örebro, Sweden.
    Pepa, Helena
    Örebro University Hospital, Örebro, Sweden.
    Skargren, Elisabeth
    Linköping University, Linköping, Sweden.
    Öberg, Birgitta
    Linköping University, Linköping, Sweden.
    Evaluation of therapeutic riding (Sweden)/hippotherapy (United States): a single-subject experimental design study replicated in eleven patients with multiple sclerosis2005In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 21, no 1, p. 51-77Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate whether therapeutic riding (TR, Sweden) hippotherapy (HT, United States) may affect balance, gait, spasticity, functional strength, coordination, pain, self-rated level of muscle tension (SRLMT), activities of daily living (ADL), and health-related quality of life. Eleven patients with multiple sclerosis (MS) were studied in a single-subject experimental design iSSED) study, type A-B-A. The intervention comprised ten weekly TR/HT sessions of 30 minutes each. The subjects were measured a maximum of 13 times. Physical tests were: the Berg balance scale, talking a figure of eight, the timed up and go test, 10 m walking, the modified Ashworth scale, the Index of Muscle Function, the Birgitta Lindmark motor assessment, part B, and individual measurements. Self-rated measures were. the Visual Analog Scale for pain, a scale for SRLMT, the Patient-Specific Functional Scale for ADL, and the SF-36. Data were analyzed visually, semi-statistically and considering clinical significance. Results showed improvement for ten subjects in one or more of the variables, particularly balance, and some improvements were also seen in pain, muscle tension, and ADL. Changes in SF-36 were mostly positive, with an improvement in Role-Emotional seen in eight patients. Conclusively, balance and Role-Emotional were the variables most often improved, but TR/HT appeared to benefit the subjects differently.

  • 37.
    Hess Engström, Andrea
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Evidens för sjukgymnastiska åtgärder som förbättrar balans i senare skede efter stroke: en litteraturstudie2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 38.
    Hua, Wenzhe
    et al.
    School of Nursing, Shanghai Jiao Tong University, South Chongqing Road, Shanghai, PR China.
    Song, Daoping
    Department of General Medicine, Jinyang Community Health Service Center, Jinyang Road, Shanghai, PR China.
    Xue, Jinhua
    Department of General Medicine, Hudong Community Health Service Center, Laiyang Road, Shanghai, PR China.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, stokholm, Sweden.
    Zhu, Daqiao
    School of Nursing, Shanghai Jiao Tong University, South Chongqing Road, Shanghai, PR China; School of Nursing, Second Military Medical University, Xiangyin Road, Shanghai, PR China.
    Improving Knowledge/Skills, Self-efficacy and Practices Regarding Weight Management among General Practitioners: A Pilot Trial of an Integrated Intervention Program2018In: Primary Healthcare: Open Access, ISSN 2167-1079, Vol. 8, no 4, article id 313Article in journal (Other academic)
    Abstract [en]

    Objective: To examine the effects of an integrated intervention program on the knowledge/skills, self-efficacy, and weight management practices among General Practitioners (GPs).

    Methods: A quasi-experimental (pre-and post-test) design was used. A convenience sample of 118 GPs from two community health services in Shanghai, China was recruited. The interventions included two 100 min training lectures with educational materials, including guidelines, brochures, and posters. Data were collected via self-administered questionnaires to measure knowledge/skills, self-efficacy, and practices regarding weight management at baseline and three-month post-intervention.

    Results: Overall, the knowledge/skills, self-efficacy, and practices related to obesity management among GPs were improved. There were significant increases in the frequencies of all items describing weight management practice after the intervention (P<0.05). The number of participants who rated themselves at the “high” level of weight management skills/knowledge increased significantly (P<0.05). The scores of self-efficacy increased in eight items, with the total score of the scale were observed to be increased when compared to pre-intervention (P<0.05).

    Conclusion: The integrated intervention program improved GPs’ knowledge/skills, self-efficacy, and professional practices. Comprehensive and specific strategies based on GPs’ professional behaviors and attitudes are expected to be developed in the future.

  • 39. Håkanson, Margareta
    et al.
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences.
    Lindström, Ingalill
    Mattsson, Bengt
    The horse as the healer: a study of riding in patients with back pain2009In: Journal of Bodywork & Movement Therapies, ISSN 1360-8592, E-ISSN 1532-9283, Vol. 13, no 1, p. 43-52Article in journal (Refereed)
    Abstract [en]

    A total of 24 patients, considerably disabled in daily activities by back pain, participated in an Equine Assisted Therapy (EAT) programme. The patients also had several health problems in addition to their current pain. The programme emphasised the principles of body awareness. The study is aimed at investigating not only whether symptom reduction would be achieved, but also at identifying qualities of EAT that were particularly beneficial for the patients' well being. The study was performed according to action research principles. The treatment reduced the pain and lessened other symptoms. The EAT also had an influence on the patients' self-image and a positive chain of effects was observed. The consequences were described according to four dimensions; the dimension of body awareness, competence, emotion and environment. The dimensions were interrelated having the simultaneous influence of a transition process and symptom reduction towards health.

  • 40.
    Johansson, Anneli
    Örebro University, School of Health and Medical Sciences.
    Kulturkompetens hos sjukgymnaster: en litteraturstudie2008Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 41.
    Johansson, Henrik
    et al.
    Department of Neuroscience, Physical therapy, Uppsala University, Uppsala, Sweden.
    Sjöholm, Rebecca
    Department of Neuroscience, Physical therapy, Uppsala University, Uppsala, Sweden.
    Stafberg, Anders
    Department of Neuroscience, Physical therapy, Uppsala University, Uppsala, Sweden Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.
    Breathing exercises with positive expiratory pressure after abdominal surgery: the current physical therapy practice in Sweden2013In: Journal of Anesthesia & Clinical Research, ISSN 2155-6148, E-ISSN 2155-6148, Vol. 4, no 6, p. 325-Article in journal (Other academic)
    Abstract [en]

    Objectives: In Sweden breathing exercises with Positive Expiratory Pressure (PEP) are commonly recommended for the prevention of pulmonary complications after abdominal surgery. Scientific documentation of the effects of PEP treatment is limited. The aim of this national survey was to describe the current physical therapy practice of PEP treatment after abdominal surgery in Sweden.

    Methods: A questionnaire was sent by e-mail to the 45 physical therapists who work with abdominal surgery patients in all seven university hospitals in Sweden. The questionnaire contained questions about the usage of PEP after abdominal surgery.

    Results: In total, 24 (54%) of the physical therapists answered the questionnaire. All reported using PEP as a treatment option after abdominal surgery. The most commonly used PEP device was the Blow bottle system and the PEP ventil system connected to a mouthpiece. Recommendations regarding treatment frequency and implementation varied significantly across respondents. The number of breaths per treatment varied considerably.

    Conclusion: All respondentsreported using PEP as a postoperative treatment on abdominal surgery wards. The treatment is most often recommended hourly during the first postoperative days. The common first-choice PEP devices were the Blow bottle system, Pep/Rmt set with mouthpiece or mask, Breathing exerciser/PEP valve system 22, and the Mini-PEP.

  • 42.
    Kadi, Fawzi
    et al.
    Örebro University, School of Health Sciences.
    Nilsson, Andreas
    Örebro University, School of Health Sciences.
    Motion mot inflammation: fysisk aktivitet viktigt för äldres hälsa2018In: Idrottsforskning, ISSN 2002-3944, article id 9 janArticle in journal (Other (popular science, discussion, etc.))
  • 43.
    Kollén, Lena
    et al.
    Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hörder, Helena
    Division of Neuropsychiatric Epidemiology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, sweden.
    Möller, Claes
    Örebro University, School of Health Sciences. Örebro University Hospital. Audiological Research Centre, Region Örebro County, Örebro, Sweden; Swedish Institute for Disability Research (SIDR), Örebro University, Örebro, Sweden.
    Frändin, Kerstin
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Physical functioning in older persons with dizziness: a population-based study2017In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 29, no 2, p. 197-205Article in journal (Refereed)
    Abstract [en]

    Background: Dizziness is one of the most prevalent symptoms in old age and tends to increase with age.

    Aims: To report physical functioning, health-related aspects and gender differences in elderly persons with and without dizziness in a population-based sample of 75-year-olds.

    Methods: A cross-sectional sample of 75-year-olds from Gothenburg, Sweden (n = 675, 398 women and 277 men) was examined by means of questionnaires and functional tests. The questions concerned dizziness/imbalance, physical activity level, walking habits, falls efficacy, number of falls, subjective health or general fatigue and medication. The tests included were self-selected and maximum gait speed, stair climbing capacity, one leg stance and grip strength.

    Results: More women than men reported dizziness/imbalance (40 vs 30 %, p < 0.001). Persons with dizziness, compared to those without dizziness, less often regularly exercised at a moderate intensity level (summer: 62 vs 74 %, p < 0.001; winter: 41 vs 51 %, p < 0.001), less often took a daily walk (p < 0.05), had lower scores on the FES(S) (p < 0.001), more often reported general fatigue (p < 0.001), more often had fallen in the previous year (40 vs 23 %, p < 0.001) and had a higher intake of medical drugs (4.6 vs 3.3, p < 0.001). They also performed worse regarding gait speed, stair climbing and one leg stance (p < 0.001), but there was no difference in grip strength.

    Conclusion: Older persons with dizziness are less physically active, have worse lower extremity function, are more often fallers and report lower self-rated health than persons without dizziness.

  • 44.
    Kononowicz, Andrzej A.
    et al.
    Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Stockholm, Sweden; Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Kraków, Poland.
    Woodham, Luke
    Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Stockholm, Sweden; Institute of Medical and Biomedical Education, St George’s, University of London, London, UK.
    Georg, Carina
    Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Stockholm, Sweden.
    Edelbring, Samuel
    Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Stockholm, Sweden; Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
    Stathakarou, Natalia
    Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Stockholm, Sweden.
    Davies, David
    Warwick Medical School, University of Warwick, Warwick, UK.
    Masiello, Italo
    Department of Clinical Science and Education, Karolinska Institutet, Solna, Stockholm, Sweden.
    Saxena, Nakul
    Health Services and Outcomes Research (HSOR), National Healthcare Group, Singapore, Singapore.
    Tudor Car, Lorainne
    Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
    Car, Josip
    Health Services and Outcomes Research Programme, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK; Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
    Zary, Nabil
    Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Stockholm, Sweden; Mohammed VI University of Health Sciences, Casablanca, Morocco; Medical Education Research and Scholarship Unit, Lee Kong Chian Sch ool of Medicine, Nanyang Technological University, Singapore, Singapore.
    Virtual patient simulations for health professional education2016In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 5, article id CD012194Article in journal (Refereed)
    Abstract [en]

    This is the protocol for a review and there is no abstract. The objectives are as follows: The objective of this review is to evaluate the effectiveness of virtual patient simulation as an educational intervention versus traditional learning, other types of e-Learning interventions and other forms of virtual patient simulation interventions for delivering pre-registration and post-registration healthcare professional education. We will primarily assess the impact of these interventions on learners knowledge, skills and attitudes. Our secondary objective is to assess the cost-effectiveness of these interventions.

  • 45.
    Kramer Lohse, Maria
    Örebro University, School of Health and Medical Sciences.
    Kronisk bäckensmärta: Effekter av manuell behandling av bäckenbottenmuskulaturen2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 46.
    Köhn, M.
    et al.
    Nora Health Care Centre, Örebro County Council, Nora, Sweden.
    Persson Lundholm, U.
    Nora Health Care Centre, Örebro County Council, Nora, Sweden.
    Bryngelsson, I.-L.
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Anderzén-Carlsson, Agneta
    Örebro University Hospital. Centre for Health Care Sciences.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences.
    Medical yoga for patients with stress-related symptoms and diagnosis in primary health care: a randomized control trial2013In: Evidence-based Complementary and Alternative Medicine, ISSN 1741-427X, E-ISSN 1741-4288, article id 215348Article in journal (Refereed)
    Abstract [en]

    An increasing number of patients are suffering from stress-related symptoms and diagnoses. The purpose of this study was to evaluate the medical yoga treatment in patients with stress-related symptoms and diagnoses in primary health care. A randomized controlled study was performed at a primary health care centre in Sweden from March to June, 2011. Patients were randomly allocated to a control group receiving standard care or a yoga group treated with medical yoga for 1 hour, once a week, over a 12-week period in addition to the standard care. A total of 37 men and women, mean age of years were included. General stress level (measured using Perceived Stress Scale (PSS)), burnout (Shirom-Melamed Burnout Questionnaire (SMBQ)), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), insomnia severity (Insomnia Severity Index (ISI)), pain (visual analogue scale (VAS)), and overall health status (Euro Quality of Life VAS (EQ-VAS)) were measured before and after 12 weeks. Patients assigned to the Yoga group showed significantly greater improvements on measures of general stress level ( ), anxiety ( ), and overall health status ( ) compared to controls. Treatment with medical yoga is effective in reducing levels of stress and anxiety in patients with stress-related symptoms in primary health care.

  • 47.
    Larsson, Christine
    et al.
    Örebro University, School of Health and Medical Sciences.
    Forsberg, Lotta
    Örebro University, School of Health and Medical Sciences.
    Stoltest för äldre personer i särskilt boende- en reliabilitetsstudie2007Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 48.
    Lennefors, Madeleine
    Örebro University. Örebro University, School of Health and Medical Sciences.
    Uppföljning av Artrosskola för personer med höft-eller knäartros i primärvården  i Örebro län.2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 49.
    Lidström-Holmqvist, Kajsa
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center .
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Arvidsson, Patrik
    CHILD, Swedish Institute for Disability Research, Jönköping University, Sweden; Centre for Research & Development, Region Gävleborg, Uppsala University, Sweden.
    Test-retest reliability of the Swedish version of the Weekly Calendar Planning Activity: a performance-based test of executive functioning2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, p. 1-6Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The Weekly Calendar Planning Activity is a performance test aiming to examine how subtle problems with executive functioning influence the performance of multi-step activities in daily life. The purpose of this study was to explore the Swedish version of the Weekly Calendar Planning Activity, regarding test-retest reliability and possible learning effects.

    MATERIAL AND METHODS: Twenty-four adults with psychiatric, neurodevelopmental or mild intellectual disorders and with difficulties in executive functioning performed the test on three separate occasions, with two weeks apart. Test-retest reliability was determined using intraclass correlation coefficients. Possible learning effects were evaluated. The smallest detectable change was calculated to determine the precision of individual scores.

    RESULTS AND CONCLUSION: The intraclass correlation coefficients between the first two test occasions were weak (0.42-0.66), but were acceptable to excellent (0.65-0.91) between test occasions 2 and 3. There was a considerable amount of random variation in the results, but little systematic variation, indicating no or possibly a small learning effect in the total number of accurately recorded appointments. This variation indicates a need to use two consecutive baseline measurements when the Swedish version of the Weelky Calendar Planning Acitivity is used as an outcome measure. Together, our results suggest that the Swedish version of the Weelky Calendar Planning Acitivity is a useful performance-based measure of how subtle problems in executive functioning affects activity performance. Implications for rehabilitation Executive functioning is crucial for managing daily life, and ecologically valid tests are needed to measure such functioning. The Weekly Calendar Planning Activity is a new performance-based test using a task that is relevant to daily life. The outcomes obtained in the Weekly Calendar Planning Activity are highly useful in clinical practice. The day-to-day variation in the Weekly Calendar Planning Activity results warrants the need for two consecutive baseline measurements when it is used to measure change.

  • 50.
    Lomi, Constantina
    et al.
    Department of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden .
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Physical therapy treatment after cardiac surgery: a national survey of practice in Greece2013In: Journal of Clinical & Experimental Cardiology, ISSN 2155-9880, no S7, p. 004-Article in journal (Other academic)
    Abstract [en]

    Physical therapy is offered to patients undergoing cardiac surgery in many countries. There is limited published data on what physical therapy treatments are provided and what exercises are recommended to patients after cardiac surgery in Europe. The aim of this survey was to establish the current practice of physical therapy for cardiac surgery patients in Greece. A prospective survey was carried out among a total population sample of physical therapists at all public and private cardiothoracic centers in Greece. A postal questionnaire was used to determine the actual physical therapy management of cardiac surgery patients. In total, 45 physical therapists (response rate 78%) from public and private hospitals completed the survey. The mean work experience as physical therapist at a department of cardiothoracic surgery was 10 ± 6 years. Preoperative information was given, according to half of the physical therapists. During the first postoperative days the patients usually received 1 to 6 treatment sessions a day by the physical therapist. Usual physical therapy treatments during the first postoperative days were breathing exercises, coughing techniques, chest wall vibrations, and mobilization. Coughing support was provided to the patients, according to 91% of the physical therapists. Manual coughing support from the physical therapist was the most common technique. In total, 93% of the physical therapists instructed the patients to perform breathing exercises on a regular basis postoperatively. Deep breathing exercises and incentive spirometry were the two most frequently used techniques. Recommendations to continue the breathing exercises for a period of between 3 days and 8 months were given postoperatively. This survey provides an initial insight into physical therapy practice for cardiac surgery patients in Greece. Further comparison between countries is warranted to improve the management of the cardiac surgery patient.

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