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  • 1.
    Carling, Anna
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. 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.
    Nilsagård, Ylva
    Health Care Management, Region Örebro County, Örebro, Sweden.
    Forsberg, Anette
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Department of Physiotherapy.
    Balance exercise facilitates everyday life for people with multiple sclerosis: A qualitative study2018Inngår i: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 23, nr 4, artikkel-id e1728Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 2.
    Nilsagård, Ylva
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Department of Medicine, Örebro University Hospital, Örebro, Sweden.
    Andreasson, Malin
    NeuroRehab Unit, Mälar Hospital, Eskilstuna, Sweden.
    Carling, Anna
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Physiotherapy, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Vesterlin, Helena
    NeuroRehab Unit, Mälar Hospital, Eskilstuna, Sweden.
    Examining the validity and sensitivity to change of the 5 and 10 sit-to-stand tests in people with multiple sclerosis2017Inngår i: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 22, nr 4, artikkel-id e1681Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and Purpose: Sit-to-stand transfers are frequently performed, and transfers have been associated with fall risk among people with multiple sclerosis (PwMS). There is limited research regarding the validity of sit-to-stand tests (STSs) in PwMS. The purpose of this study was to investigate the concurrent, divergent, and discriminant validity and sensitivity to change of the 5 and 10 STSs.

    Methods: A repeated-measurement design was used, with data collected before and directly after a 7-week intervention, as well as prospectively reported near-fall incidents and falls during a 14-week period. One hundred two PwMS with a limited (≤200 m) but retained (≥20 m) walking ability were identified by physiotherapists at outpatient rehabilitation centres in 5 Swedish County Council areas and invited to participate in an intervention study. Of the 52 participants agreeing to participate and fulfilling the inclusion criteria, 47 managed the tests at baseline, and 39 of these returned complete fall diaries. The main outcomes were the Berg Balance Scale (BBS), Timed Up and Go test (TUG), 10-m walk test, 2-min walk test, Fatigue Scale for Motor and Cognitive Function, falls, near-fall incidents, and use of walking aids.

    Results: Correlations in the total sample were above .60 between the STSs and BBS, TUG, 10-m walk test, and 2-min walk test and above .50 between the STSs and total number of falls. Both tests discriminated between those who did and did not use walking aids for the TUG, but not between fallers and nonfallers. There were no significant correlations between the STSs and number of falls or near-fall incidents. The STSs did not differentiate between participants with changed and unchanged results on the BBS.

    Discussion: The 5 and 10 STSs are valid in PwMS with an Expanded Disability Status Scale score ≤6.0 but do not identify fallers and have limited ability to detect change.

  • 3.
    Nilsagård, Ylva
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Lundholm, Cecilia
    Gunnarsson, Lars-Gunnar
    Örebro universitet, Institutionen för klinisk medicin.
    Denison, Eva
    Clinical relevance using timed walk tests and 'timed up and go' testing in persons with multiple sclerosis2007Inngår i: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 12, nr 2, s. 105-14Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND AND PURPOSE: One must understand the potentials and limitations of all tests used to evaluate interventions. The aim of the present study was to clarify the reproducibility, smallest percentage difference needed to be able to detect a genuine change and correlation regarding the 10-m and 30-m timed walks (10TW 30TW) and the 'timed up and go' (TUG) test in people with moderate multiple sclerosis (MS).

    METHOD: A repeated-measures design was used, with randomization into two groups and different time intervals used for testing. The 10TW and 30TW were performed three times and TUG twice at each testing. Self-selected speed was used for 10TW and forced speed (quickly but safely) for 30TW and TUG. Forty-three people were tested on three occasions within one week. Each person was tested at approximately the same time of the day and by the same physiotherapist on each occasion.

    RESULTS: The reproducibility was very high. For a single testing occasion, the intraclass correlation was 0.97 for the 10TW and 0.98 for the 30TW and TUG. The smallest percentage difference needed to be able to detect a genuine change in the entire study group was approximately -23% or +31% for either the 1OTW or TUG. It was evident from the 30TW testing results that lower values applied to those with less (-14% to +17%) rather than more (-38% or +60%) disability. The correlation between all tests for the entire study group was 0.85 (0.76-0.91).

    CONCLUSION: It is sufficient to use only one attempt and to choose only one of the tests when evaluating people with moderate MS. In the case of the 30TW greater attention must be paid to the degree of disability when determining the smallest percentage difference needed to establish a genuine change, than

  • 4.
    Nilsagård, Ylva
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Health Care Management.
    Westerdahl, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Department of Physical Therapy.
    Forsberg, Anette
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Department of Physical Therapy.
    Engagement in performing clinical physiotherapy research: Perspectives from leaders and physiotherapists2019Inngår i: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 24, nr 2, artikkel-id e1767Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 5.
    Nilsagård, Ylva
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Westerdahl, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Wittrin, Anna
    Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Gunnarsson, Martin
    Örebro universitet, Institutionen för läkarutbildning. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Walking Distance as a Predictor of Falls in People With Multiple Sclerosis2016Inngår i: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 21, nr 2, s. 102-108Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and purpose: People with multiple sclerosis (PwMS) experience falls, usually when walking and transferring. The aim was to investigate if walking distance and patient overestimate of walking distance are predictors of falls in PwMS.

    Methods: A prospective study was conducted, with a single test occasion followed by prospective registration of falls for 3 months. All PwMS in Region Örebro County with a previously registered Expanded Disability Status Scale score between 3.0 and 7.0 in the Swedish MS Registry were invited to participate (n = 149). Altogether, data from 49 PwMS being relapse free for at least 3 months and with a confirmed Expanded Disability Status Scale between 1.5 and 7.0 upon study entry were analysed.

    Results: Twenty-two PwMS (45%) fell during the study period, providing information of 66 falls. Walking distance or overestimate of one's walking distance, as compared with test results, did not predict falls in this MS sample.

    Discussion: Walking and standing activities are associated with numerous falls in PwMS. Our data do not clearly support routine measurements of walking distance in assessing individual fall risk.

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