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  • 1.
    Amer, Ahmed
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden.
    Jarl, Gustav M
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro County Council, Örebro, Sweden.
    Hermansson, Liselotte M. N.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro County Council, Örebro, Sweden.
    The effect of insoles on foot pain and daily activities2014In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 38, no 6, p. 474-480Article in journal (Other academic)
    Abstract [en]

    BACKGROUND:

    Foot pain decreases individuals' ability to perform daily activities. Insoles are often prescribed to reduce the pain which, in turn, may promote return to normal activities.

    OBJECTIVES:

    To evaluate the effects of insoles on foot pain and daily activities, and to investigate the relationship between individuals' satisfaction with insoles and actual use of them.

    STUDY DESIGN:

    A 4-week pre-post intervention follow-up.

    METHODS:

    Brief Pain Inventory, International Physical Activity Questionnaire and Lower Extremities Functional Status were used as outcome measures. Client Satisfaction with Device was used in the follow-up.

    RESULTS:

    A total of 67 participants answered the questionnaires (81% women). Overall, a reduction in Pain Severity (p = 0.002) and Pain Interference (p = 0.008) was shown. Secondary analyses revealed a significant effect only in women. No changes in daily activities (Walking, p = 0.867; Total Physical Activity, p = 0.842; Lower Extremities Functional Status, p = 0.939) could be seen. There was no relation between Client Satisfaction with Device measures and duration of insole use. A difference in sex was shown; women scored higher than men on Pain Severity.

    CONCLUSION:

    Insoles reduce pain and pain interference with daily activities for women with foot pain. Satisfaction with the insoles is not a predictor of actual insole use. The effect of insoles on activity performance needs further study.

    CLINICAL RELEVANCE:

    This study provides evidence for prescribing insoles to people with foot pain. Nonetheless, insoles are not enough to increase their physical activity level in the short term. Satisfaction with insoles and duration of use are not correlated and cannot be inferred from each other.

  • 2.
    Hermansson, Liselotte M
    The Arm Prosthetic Clinic, Örebro Medical Center, Örebro.
    Structured training of children fitted with myoelectric prostheses.1991In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 15, no 2, p. 88-92Article in journal (Refereed)
    Abstract [en]

    This paper presents an occupational therapy method for training children fitted with myoelectric prostheses. It is based upon a structured way of describing the accomplishments of a child fitted with a myoelectric prosthesis, called the Skill Index Ranking Scale (SIRS). By using the SIRS when designing the training session, the therapist can progressively increase the demands presented to the child. Furthermore, the SIRS facilitates for the therapist the documentation and communication of the childs ability with the myoelectric prosthesis.

  • 3.
    Jarl, Gustav
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hellstrand Tang, Ulla
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Nordén, Erika
    Ottobock, Medical Care Sweden, Stockholm, Sweden.
    Johannesson, Anton
    Össur Clinics Scandinavia, Stockholm, Sweden.
    Rusaw, David Francis
    School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Nordic clinical guidelines for orthotic treatment of osteoarthritis of the knee: A systematic review using the AGREE II instrument2019In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: High-quality clinical practice guidelines are necessary for effective use of resources both at an individual patient- and national-level. Nordic clinical practice guidelines recommendations for orthotic treatment of knee osteoarthritis vary and little is known about their quality.

    OBJECTIVES: The aim of the study was to critically evaluate the quality of clinical practice guidelines in orthotic management of knee osteoarthritis in the Nordic countries.

    STUDY DESIGN: Systematic review.

    METHODS: Four national clinical practice guidelines for treatment of knee osteoarthritis were assessed for methodological rigour and transparency by four independent assessors using the AGREE II instrument. Summary domain scores and inter-rater agreement (Kendall's W) were calculated.

    RESULTS:  < 0.001).

    CONCLUSION: Quality of clinical practice guidelines for orthotic treatment of knee osteoarthritis in the Nordic region is variable. Future guideline development should focus on improving methodology by involving relevant stakeholders (e.g. certified prosthetist/orthotists (CPOs)), specifying conflicts of interest and providing guidance for implementation.

    CLINICAL RELEVANCE: The current review suggests that, for the Nordic region, there are areas of improvement which can be addressed, which ensure clinical practice guidelines are developed under stringent conditions and based on sound methods. These improvements would ensure knee osteoarthritis patients are receiving orthotic interventions based on appropriate guidance from published guidelines.

  • 4.
    Jarl, Gustav
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. Department of Prosthetics and Orthotics.
    A modified walk-in system versus scheduled appointments in a secondary-care prosthetic and orthotic clinic2018In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 42, no 5, p. 483-489Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Waiting is common in health care, delays intervention, and has negative effects on satisfaction with services.

    OBJECTIVES: To evaluate effects of a modified walk-in system, where patients were invited consecutively from the waiting list to attend the clinic on a walk-in basis, on waiting times, services, and work environment.

    STUDY DESIGN: Parallel-group trial.

    METHODS: In all, 1286 consecutive patients in need of shoe insoles were randomized to waiting lists for modified walk-in ( n = 655) or a scheduled appointment ( n = 631). Seven staff members also participated.

    RESULTS: The median indirect waiting time to first appointment was 40 days shorter for modified walk-in (135 days) than for scheduled appointment (175 days; p < 0.001); 17% of those randomized to modified walk-in did not attend the clinic compared to 6% for scheduled appointment ( p < 0.001). Mean direct waiting time in the waiting room was 9.9 min longer for modified walk-in than for scheduled appointment ( p < 0.001). Patients attending modified walk-in or a scheduled appointment reported similar levels of satisfaction with services. Staff reported more support from co-workers with modified walk-in than with scheduled appointment ( p = 0.041).

    CONCLUSION: The modified walk-in can reduce indirect waiting times without any substantial worsening of direct waiting times, service quality, or work environment. Studies are needed to investigate why many patients drop out from modified walk-in. Clinical relevance A modified walk-in system can cut the queues and create more timely interventions by reducing indirect waiting times. This system can therefore be recommended in secondary-care prosthetic and orthotic clinics to reduce patients' suffering from their health condition.

  • 5.
    Jarl, Gustav
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Rehabilitation Research, Örebro University, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Holmefur, Marie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro University, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Hermansson, Liselotte M. N.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro University, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Test-retest reliability of the Swedish version of the Orthotics and Prosthetics Users' Survey2014In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 38, no 1, p. 21-26Article in journal (Refereed)
    Abstract [en]

    Background: The Orthotics and Prosthetics Users' Survey consists of five modules to assess outcomes of orthotic and prosthetic interventions: lower extremity functional status, upper extremity functional status, client satisfaction with device, client satisfaction with services and health-related quality of life.

    Objectives: To investigate the test-retest reliability and calculate the smallest detectable difference for all modules of the Swedish Orthotics and Prosthetics Users' Survey.

    Study design: Test-retest reliability study design.

    Methods: A total of 69 patients at a Department of Prosthetics and Orthotics completed Orthotics and Prosthetics Users' Survey on two occasions separated by a 2-week interval, giving 18 answers on lower extremity functional status, 41 on upper extremity functional status, 53 on client satisfaction with device, 12 on client satisfaction with services and 67 answers on health-related quality of life. Raw scores were converted into Orthotics and Prosthetics Users' Survey units on a 0-100 scale. Intra-class correlation coefficients, Bland-Altman plots, common person linking plots and t-tests of person mean measures were used to investigate the reliability. The 95% confidence level smallest detectable differences were calculated.

    Results: The intra-class correlation coefficients ranged from 0.77 to 0.96 for the modules, and no systematic differences were detected between the response occasions. The smallest detectable differences ranged from 7.4 to 16.6 units.

    Conclusions: The test-retest reliability was satisfactory for all Orthotics and Prosthetics Users' Survey modules. The smallest detectable difference was large on all modules except the health-related quality of life module.

    Clinical relevance: The Orthotics and Prosthetics Users' Survey modules are reliable and, thus, can be recommended for repeated measurements of patients over time. Relatively large changes are needed to achieve statistical significance when assessing individual patients.

  • 6.
    Jarl, Gustav M.
    et al.
    Örebro University, School of Health and Medical Sciences. Institution for Rehabilitation, Centre for Rehabilitation Research, Örebro; Örebro University Hospital, Örebro .
    Norling Hermansson, Liselotte Maria
    Institution for Rehabilitation, Centre for Rehabilitation Research, Örebro; Örebro University Hospital, Örebro.
    Translation and linguistic validation of the Swedish version of Orthotics and Prosthetics Users' Survey2009In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 33, no 4, p. 329-338Article in journal (Refereed)
    Abstract [en]

    There is an increasing need for outcome measures in the orthotic and prosthetic field and specifically a lack of outcome measures in Swedish. The Orthotics and Prosthetics Users' Survey (OPUS) was developed in the USA for assessment of the outcome of orthotic and prosthetic interventions, and could potentially also be used for shoe insoles and orthopaedic shoes. The aims of this study were to translate OPUS into Swedish and test the translated version's linguistic validity in a Swedish context. The Orthotic and Prosthetic Users' Survey was translated into Swedish and back-translated into English, following a modified version of the World Health Organization guidelines. After revision of the Swedish version, 39 Swedish clients (12 men, 27 women) answered the OPUS questionnaires and were systematically debriefed afterwards. Most items were understood correctly by the respondents, but some words and expressions had to be changed to avoid misunderstandings or unintended interpretations. The resulting Swedish version of OPUS, OPUS-Swe, showed acceptable linguistic validity and has potential for use in both clinical practice and scientific settings. Nevertheless, before OPUS-Swe can be fully implemented, its psychometric properties need to be evaluated.

  • 7.
    Jarl, Gustav
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden; University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Ramstrand, Nerrolyn
    CHILD research group, Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    A model to facilitate implementation of the International Classification of Functioning, Disability and Health into prosthetics and orthotics2018In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 42, no 5, p. 468-475Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The International Classification of Functioning, Disability and Health is a classification of human functioning and disability and is based on a biopsychosocial model of health. As such, International Classification of Functioning, Disability and Health seems suitable as a basis for constructing models defining the clinical P&O process. The aim was to use International Classification of Functioning, Disability and Health to facilitate development of such a model.

    Proposed model: A model, the Prosthetic and Orthotic Process (POP) model, is proposed. The Prosthetic and Orthotic Process model is based on the concepts of the International Classification of Functioning, Disability and Health and comprises four steps in a cycle: (1) Assessment, including the medical history and physical examination of the patient. (2) Goals, specified on four levels including those related to participation, activity, body functions and structures and technical requirements of the device. (3) Intervention, in which the appropriate course of action is determined based on the specified goal and evidence-based practice. (4) Evaluation of outcomes, where the outcomes are assessed and compared to the corresponding goals. After the evaluation of goal fulfilment, the first cycle in the process is complete, and a broad evaluation is now made including overriding questions about the patient's satisfaction with the outcomes and the process. This evaluation will determine if the process should be ended or if another cycle in the process should be initiated.

    CONCLUSION: The Prosthetic and Orthotic Process model can provide a common understanding of the P&O process. Concepts of International Classification of Functioning, Disability and Health have been incorporated into the model to facilitate communication with other rehabilitation professionals and encourage a holistic and patient-centred approach in clinical practice.

    Clinical relevance: The Prosthetic and Orthotic Process model can support the implementation of International Classification of Functioning, Disability and Health in P&O practice, thereby providing a common understanding of the P&O process and a common language to facilitate communication with other rehabilitation professionals.

  • 8.
    Lindner, Helen Y
    et al.
    Örebro University, School of Health Sciences.
    Hiyoshi, Ayako
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Hermansson, Liselotte
    Örebro University Hospital. Örebro University, School of Health Sciences. Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Relation between capacity and performance in paediatric upper limb prosthesis users2018In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 42, no 1, p. 14-20Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The International Classification of functioning, disability and health refers capacity to what an individual can do in a standardised environment and describes performance as what an individual really does and whether the individual encounters any difficulty in the real-life environment. Measures of capacity and performance can help to determine if there is any gap between them that may restrict participation. The aim of this study was to explore the relationship between capacity scores obtained in a standardised clinical setting and proportional ease of performance obtained from a real-life environment.

    METHODS: The Assessment of Capacity for Myoelectric Control and the Prosthetic Upper Extremity Functional Index were used to assess capacity and performance in 62 prosthetic users (age 3-17). Spearman coefficient and generalised linear model were used to examine the association between these measures.

    RESULTS: A strong correlation (Spearman = 0.75) was found between the capacity scores and the ease of performance. In both unadjusted and adjusted models, capacity was significantly associated with proportional ease of performance. The adjusted model showed that, by 1 unit increase in the Assessment of Capacity for Myoelectric Control score, the ratio of proportional ease of performance increases by 45%.

    CONCLUSION: This implies that Assessment of Capacity for Myoelectric Control can be a predictor for ease of performance in real-life environment.

    Clinical relevance: The ACMC scores may serve as an indicator to predict the difficulties that the children may encounter in their home environment. This prediction can help the clinician to make decisions, such that if the child requires more control training or is ready to move on to learn more complex tasks.

  • 9.
    Lindner, Helen Y. N.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Nätterlund, Birgitta Sjöqvist
    Centre for Rehabilitation Research, Örebro University Hospital, Örebro, Sweden.
    Hermansson, Liselotte M. N.
    Örebro University Hospital, Örebro, Sweden .
    Upper limb prosthetic outcome measures: Review and content comparison based on International Classification of Functioning, Disability and Health2010In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 34, no 2, p. 109-128Article, review/survey (Refereed)
    Abstract [en]

    The International Classification of Functioning, Disability and Health (ICF) has been recommended as a framework for evaluation of aspects of health. The aim of this study was to compare the contents of outcome measures for upper limb prosthesis users by using the ICF. Measurement focus and psychometric properties of these measures were also investigated. Outcome measures that used upper limb prosthesis users as subjects in their development and psychometric evaluations were selected. The psychometric studies (n - 14) were reviewed and scored and the items in the measures were linked to the ICF. One measure for all ages (ACMC), five paediatric measures (CAPP-FSI, CAPP-PSI, PUFI, UBET and UNB) and two adult measures (OPUS and TAPES) were selected. The concepts extracted (n - 393) were linked to 54 categories in the ICF. The ACMC, CAPP-FSI, UBET, UNB and PUFI measure categories mostly under the ICF component 'Activity and participation'. The TAPES and OPUS also measure ICF categories that describe the emotional and social status of a person. The main conclusion is that the use of a mixture of outcome measures would give a better picture on the aspects of our clients. Measures that focus on the social interaction in paediatric users are required.

  • 10.
    Sjöberg, Lis
    et al.
    Örebro University, School of Health Sciences.
    Lindner, Helen Y.
    Örebro University, School of Health Sciences.
    Hermansson, Liselotte
    Örebro University Hospital. Örebro University, School of Health Sciences. Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Long-term results of early myoelectric prosthesis fittings: A prospective case-control study2018In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 42, no 5, p. 527-533Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Different recommendations exist regarding what age is best for first-time fitting of myoelectric hand prostheses in children.

    OBJECTIVES: To compare prosthetic skill, prosthetic use and risk for rejection over time between children fitted with myoelectric hand prostheses before or after 2½ years of age.

    STUDY DESIGN: Prospective case-control design.

    METHODS: The cases were nine children fitted with myoelectric hand prostheses before the age of 2½ years, whereas the controls were 27 children who were fitted with myoelectric hand prostheses after the age of 2½ years. The Skills Index Ranking Scale was used to classify prosthetic skill, and prosthetic use was categorised based on wearing time and pattern. Independent samples tests were used to compare data between groups. To estimate and compare the risk of prosthesis rejection between groups and over time, survival analysis was used.

    RESULTS: Cases showed prosthetic skill early, but controls had caught up by the age of 3½ years. Cases had a significant ( p = 0.046) decrease in prosthetic use at the age of 9 years. In the long term, cases had a higher percentage of prosthesis rejection.

    CONCLUSIONS: Considering young children's development of prosthetic skill and prosthetic use over time, this study shows no additional advantages from fitting a myoelectric hand prosthesis before 2½ years of age. Clinical relevance Children may be fitted with myoelectric hand prostheses to assist in daily tasks and to prevent future over-use problems. Most children fitted with myoelectric hand prostheses before 4 years of age become regular users. No advantages of fitting myoelectric hand prostheses before 2½ years of age were observed.

  • 11.
    Widehammar, Cathrine
    et al.
    Örebro University, School of Health Sciences. Department of Pediatrics, Department of Prosthetics and Orthotics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Pettersson, Ingvor
    Örebro University, School of Health Sciences.
    Janeslätt, Gunnel
    Center for Clinical Research Dalarna, Falun, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. Department of Prosthetics and Orthotics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    The influence of environment: experiences of users of myoelectric arm prosthesis - a qualitative study2018In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 42, no 1, p. 28-36Article in journal (Refereed)
    Abstract [en]

    Background: Prostheses are used to varying degrees; however, little is known about how environmental aspects influence this use.

    Objectives: To describe users" experiences of how environmental factors influence their use of a myoelectric arm prosthesis.

    Study design: Qualitative and descriptive.

    Methods: A total of 13 patients previously provided with a myoelectric prosthetic hand participated. Their age, sex, deficiency level, etiology, current prosthesis use, and experience varied. Semi-structured interviews were audiotaped, transcribed, and analyzed through inductive content analysis.

    Results: Four categories were created from the data: "Prosthesis function," "Other people's attitudes," "Support from family and healthcare," and "Individual's attitude and strategies." The overarching theme, "Various degrees of embodiment lead to different experiences of environmental barriers and facilitators," emerged from differences in individual responses depending on whether the individual was a daily or a non-daily prosthesis user. Environmental facilitators such as support from family and healthcare and good function and fit of the prosthesis seemed to help the embodiment of the prosthesis, leading to daily use. This embodiment seemed to reduce the influence of environmental barriers, for example, climate, attitudes, and technical shortcomings.

    Conclusion: Embodiment of prostheses seems to reduce the impact of environmental barriers. Support and training may facilitate the embodiment of myoelectric prosthesis use.

    Clinical relevance: For successful prosthetic rehabilitation, environmental factors such as support and information to the patient and their social network about the benefits of prosthesis use are important. Local access to training in myoelectric control gives more people the opportunity to adapt to prosthesis use and experience less environmental barriers.

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