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  • 1. Ahlström, Gerd
    et al.
    Lindvall, B.
    Wenneberg, Stig
    Örebro University, Department of Nursing and Caring Sciences.
    Gunnarsson, Lars-Gunnar
    Örebro University, Department of Clinical Medicine.
    A comprehensive rehabilitation programme tailored to the needs of adults with muscular dystrophy2006In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 20, no 2, p. 132-141Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess if activities of daily living (ADL), coping and quality of life could be improved in adults with muscular dystrophy through a comprehensive rehabilitation programme. DESIGN: Quasi-experimental, controlled clinical study comparing patients with similar age and disease aspects. SETTING: Two different counties in Sweden, being either study or control setting. SUBJECTS: The study group comprised 37 adults (21 women, 16 men; mean age 50 years), while the control group comprised 39 people (25 women, 14 men; mean age 46 years). INTERVENTIONS: Four rehabilitation sessions tailored to different medical, physical and psychosocial needs of the patients, comprising a total of 10 days over a period of 18 months. MAIN MEASURES: ADL, the Mental Adjustment to Cancer Scale measuring coping strategies, the Sickness Impact Profile measuring health-related quality of life, the Hospital Anxiety and Depression Scale, and the Psychosocial Well-being Questionnaire. RESULTS: No significant differences were found between groups with regard to the outcome measures. There was increased dependence on others in ADL after 18 months in both groups, but it was more pronounced in the control group. Furthermore, a clear trend was observed in the data with regard to coping patterns, the control group using more coping strategies such as 'Helplessness/hopelessness' (P= 0.057), 'Anxious preoccupation' (P = 0.085) and 'Fatalistic' (P= 0.073) when being compared to the study group. CONCLUSIONS: No apparent effects on ADL were found from the rehabilitation programme, although there was a tendency of reduction of maladaptive coping patterns in the study group. This initial study may provide the rationale and basis for a randomized controlled trial.

  • 2.
    Boström, Katrin
    et al.
    Örebro University, Department of Nursing and Caring Sciences.
    Sjöquist Nätterlund, Birgitta
    Örebro University, Department of Nursing and Caring Sciences.
    Ahlström, Gerd
    Örebro University, Department of Nursing and Caring Sciences.
    Sickness impact in people with muscular dystrophy: a longitudinal study over 10 years2005In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 19, no 6, p. 686-694Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe changes of function in terms of sickness impact over 10 years in adult patients with different types of muscular dystrophy. DESIGN: Patients with muscular dystrophy answered the Sickness Impact Profile and Self-report ADL questionnaires in 1991 and 2001. SETTING: The study population was identified in a comprehensive prevalence study in the county of Orebro, Sweden. SUBJECTS: The study group comprised 44 people grouped according to whether they had myotonic dystrophy or muscular dystrophy with proximal or distal muscles affected. MAIN MEASURES: Comparison was made between assessments of sickness impact in terms of function at the two time points. RESULTS: Most obvious deterioration over time was in activities of daily living that require finger and arm strength. Ambulation was significantly decreased in myotonic dystrophy and proximal muscular dystrophy. Those walking without assistive devices decreased from 91% to 52%, and the number with a disability pension increased from 36 to 55%. There was a relatively small influence with regard to psychosocial dysfunction assessed by the Sickness Impact Profile. CONCLUSIONS: This longitudinal study shows the deteriorating functions reported by patients with muscular dystrophy. This knowledge could be used to formulate new interventions in order to offer appropriate support and treatment to this patient group.

  • 3.
    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.

  • 4.
    Forsberg, Anette
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Physiotherapy, Neurotec Department, Karolinska Institutet, Stockholm, sweden.
    Press, Rayomand
    Section of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital at Huddinge, Stockholm, Sweden.
    Einarsson, Ulrika
    Division of Physiotherapy, Neurotec Department, Karolinska Institutet, Stockholm, Sweden.
    de Pedro-Cuesta, Jesus
    Section of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital at Huddinge, Stockholm, Sweden; Department of Applied Epidemiology, National Centre for Epidemiology, Carlos IlIl Institute of Health, Madrid, Spain.
    Widén Holmqvist, Lotta
    Division of Physiotherapy, Neurotec Department and Section of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital at Huddinge, Stockholm, Sweden.
    Disability and health-rated quality of life in Guillain-Barré syndrome during the first two years after onset: a prospective study2005In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 19, no 8, p. 900-909Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe changes in disability and health-related quality of life in patients with Guillain-Barré syndrome in Sweden during the first two years after onset.

    SUBJECTS: Forty-four patients were recruited from eight different hospitals, and 42 of them (mean age 52 years) were followed for two years. Evaluations were performed, primarily as home visits, at two weeks, two months, six months, one year and two years after onset.

    MAIN MEASURES: Disability was measured using the Katz Personal and Extended Activities of Daily Living Indexes, the Barthel Index, the Frenchay Activity Index and assessments of work capacity; health-related quality of life using the Sickness impact Profile.

    RESULTS: At two weeks, one year and two years after onset of Guillain-Barré syndrome, 76%, 14% and 12% of patients were dependent in personal activities of daily life (ADL); and 98%, 28% and 26% were dependent in instrumental ADL. At two weeks, all of the patients that were working before onset were unable to work owing to Guillain-Barré syndrome; at two years, 17% were unable to work. At two weeks, scores on Sickness Impact Profile were elevated in all dimensions; at two years, they remained elevated in the physical dimension and in the categories home management, work and recreation and pastimes.

    CONCLUSIONS: The impact of Guillain-Barré syndrome on ADL, work, social activities and health-related quality is considerable two years after onset and presumably persists beyond this time point.

  • 5.
    Forsberg, Anette
    et al.
    Örebro University Hospital. Division of Neurology, Karolinska Institutet, Stockholm, Sweden; Family Medicine Research Centre, Örebro County Council, Örebro, Sweden.
    Widén-Holmqvist, Lotta
    Division of Neurology, Karolinska Institutet, Stockholm, Sweden; Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.
    Ahlström, Gerd
    Department of Health Sciences, Lund University, Lund, Sweden.
    Balancing everyday life two years after falling ill with Guillain-Barre syndrome: a qualitative study2015In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 29, no 6, p. 601-610Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim was to describe experiences of disability in everyday life and managing the recovery process two years after falling ill with Guillain-Barré syndrome.

    Design: Qualitative interview study.

    Methods: Interviews were conducted with 35 persons (22 male, mean age 50 years) two years after the onset of Guillain-Barré syndrome. The interviews were transcribed verbatim and analysed using content analysis.

    Results: The analysis revealed four categories and an overall theme: ‘Striving for balance in everyday life’. The participants described persistent lived body restrictions that affected their arms, legs, and face. Bodily symptoms and loss of energy limited or restricted many everyday activities. In connection with healthcare, both satisfaction and feeling vulnerable in a critical situation were described. Experiences of the recovery process varied. The participants described acceptance and reappraisal of a new life situation despite their limitations, and having gained the knowledge that life can change suddenly. However, they also expressed disappointment following an overly positive prognosis in the early stages, and over a continuous wait for recovery. For some participants life had returned to as before.

    Conclusion: The participants experienced limitations in everyday life and decreased functioning in several parts of the body. The recovery process may still be ongoing two years after onset. Rehabilitation intervention with an extended focus on supporting individualized coping processes could facilitate ways to live with persistent disability.

  • 6.
    Franzén-Dahlin, Åsa
    et al.
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Larson [Windahl], Jenny
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Murray, Veronica
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Wredling, Regina
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Billing, Ewa
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    A randomized controlled trial evaluating the effect of a support and education programme for spouses of people affected by stroke2008In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 22, no 8, p. 722-30Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine whether a nurse-led support and education programme for spouses of patients affected by stroke improved the psychological health of the spouses.

    DESIGN: A longitudinal, open, randomized controlled trial.

    SAMPLE: One hundred spouses of stroke patients were randomly assigned to either an intervention or a control group.

    SETTING: The study was conducted in a hospital setting.

    INTERVENTION: The intervention consisted of six group meetings during six months, with a follow-up after further six months. Comparison between the intervention and the control groups was made at baseline, after six and 12 months using analysis with repeated measures.

    MAIN MEASURES: The Comprehensive Psychopathological Rating Scale--Self-Affective for psychological health.

    RESULTS: No significant difference was found between the intervention and control groups concerning overall psychological health. However, a subanalysis revealed that those who participated more frequently in the group meetings (five or six times) had significantly stronger psychological health (P<0.05). Knowledge about stroke increased over time in both groups, but participants in the intervention group learned more (P=0.041).

    CONCLUSION: Encouraging participation in the group meetings of a support programme might have a positive effect on psychological health.

  • 7.
    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.

  • 8.
    Lindvall, Mialinn Arvidsson
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Family Medicine Research Centre, Örebro County Council, Örebro, Sweden .
    Forsberg, Anette
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Family Medicine Research Centre, Örebro County Council, Örebro, Sweden .
    Body awareness therapy in persons with stroke: a pilot randomised controlled trial2014In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 28, no 12, p. 1180-1188Article in journal (Refereed)
    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.

  • 9.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health and Medical Sciences.
    Lundholm, Cecilia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute.
    Denison, E.
    School of Health, Care and Social Welfare, Mälardalen University.
    Gunnarsson, Lars-Gunnar
    Örebro University, School of Health and Medical Sciences.
    Predicting accidental falls in people with multiple sclerosis: a longitudinal study2009In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 23, no 3, p. 259-269Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate accidental falls and near fall incidents in people with multiple sclerosis with respect to clinical variables and the predictive values of four tests. Design: A longitudinal, multi-centred cohort study with prospectively collected falls. Procedures: Self-reported incidents during the three months following a standardized test procedure. Subjects: Seventy-six people with multiple sclerosis and an Expanded Disability Status Scale score between 3.5 and 6.0. Main outcome measures: Berg Balance Scale, Timed Up and Go cognitive, Four Square Step Test (FSST) and 12-item Multiple Sclerosis Walking Scale. Results: Forty-eight people (63%) registered 270 falls. Most falls occurred indoors during activities of daily life. We found a correlation of rs=0.57 between near falls and falls, and of rs = 0.82 between registered and retrospectively recalled falls. Fallers and non-fallers differed significantly regarding Expanded Disability Status Score (odds ratio (OR) 1.99, 95% confidence interval (CI) 1.22; 3.40), spasticity (OR 1.14, CI 1.02; 1.31), proprioception (OR 2.50, CI 1.36; 5.12) and use of walking aids (OR 2.27, CI 1.23; 4.37). Reported use of walking aids both indoors and outdoors increased the odds of falling fivefold while disturbed proprioception increased the odds 2.5—15.6 times depending on severity. The odds of falling were doubled for each degree of increased Expanded Disability Status Score and more than doubled for each degree of increased spasticity. The Berg Balance Scale, use of walking aids and Timed Up and Go cognitive best identified fallers (73—94%) and proprioception, Expanded Disability Status Score, 12-item Multiple Sclerosis Walking Scale and Four Square Step Test best identified non-fallers (75—93%). Conclusions: In clinical practice, looking at the use of walking aids, investigating proprioception and spasticity, rating Expanded Disability Status Score and using Berg Balance Scale or Timed Up and Go cognitive all contribute when identifying fallers.

  • 10. Rydwik, E.
    et al.
    Karlsson, C.
    Frändin, K.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Muscle strength testing with one repetition maximum in the arm/shoulder for people aged 75 + - test-retest reliability2007In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 21, no 3, p. 258-65Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the reliability of a muscle strength test of the arm/shoulder in elderly people, aged 75 and older, and to compare subjects with and without previous muscle strength training experience.

    DESIGN: Reliability study - test-retest.

    SETTING: Research centre for the elderly.

    MAIN MEASURES: One repetition maximum (1 RM) was measured using an arm/shoulder strength-training device (Pull Down, Norway). Two measurements were conducted, approximately one week apart.

    RESULTS: Forty people were included in the study and 34 completed both sessions. Eleven participants had previous muscle strength training experience on the indicated device. There was a high correlation between the test sessions, r = 0.97 for both groups. The analysis of 95% limits of agreement for the mean difference was -4.3/+6.9 kg for the group without and -3.0/+6.4 kg for the group with previous experience, respectively.

    CONCLUSION: One repetition maximum evaluated by the Pull Down device seems to be a reliable and safe method for dosing and evaluating a muscle strength training programme for elderly people. The observed variation of approximately -4/+7 kg cannot be interpreted as an effect of muscle training, but is more likely an effect of learning, fluctuations in daily condition and/or motivation.

  • 11. Rydwik, Elisabeth
    et al.
    Eliasson, Sara
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    The effect of exercise of the affected foot in stroke patients: a randomized controlled pilot trial2006In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 20, no 8, p. 645-655Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the effect of treatment with a portable device called Stimulo on range of motion, muscle strength and spasticity in the ankle joint and its effect on walking ability, balance, activities of daily living (ADL) and health-related quality of life in stroke patients.

    DESIGN: A randomized controlled pilot study.

    SETTING: A research centre.

    SUBJECTS: Ambulatory or partly ambulatory chronic stroke patients with remaining spasticity and/or decreased range of motion in the hemiparetic leg/ankle. Interventions: Standardized and individualized programme including active and passive range of motion of the ankle with a portable device (Stimulo), performed three times a week for 30 min, over a six-week period.

    MAIN MEASURES: Range of motion, muscle strength, spasticity, gait variables, balance, ADL and health-related quality of life.

    RESULTS: Eighteen subjects were included in the study with a mean age of 75 years. The compliance rate was 94-99%. There were no significant differences between the groups.

    CONCLUSION: The study showed no significant effect of an ankle-exercise intervention programme with Stimulo. Further studies with a larger sample size are of importance before any further conclusions can be drawn.

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