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  • 1.
    Arvidsson Lindvall, Mialinn
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Anderzen-Carlsson, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre, Region Örebro County, Örebro, Sweden; Faculty of Health, Science, and Technology, Department of Health Sciences, Nursing, Karlstad University, Karlstad, Sweden.
    Appelros, Peter
    Faculty of Health, Science, and Technology, Department of Health Sciences, Nursing, Karlstad University, Karlstad, Sweden.
    Forsberg, Anette
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Validity and test-retest reliability of the six-spot step test in persons after stroke2018In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: After stroke, asymmetric weight distribution is common with decreased balance control in standing and walking. The six-spot step test (SSST) includes a 5-m walk during which one leg shoves wooden blocks out of circles marked on the floor, thus assessing the ability to take load on each leg. The aim of the present study was to investigate the convergent and discriminant validity and test-retest reliability of the SSST in persons with stroke.

    METHODS: Eighty-one participants were included. A cross-sectional study was performed, in which the SSST was conducted twice, 3-7 days apart. Validity was investigated using measures of dynamic balance and walking. Reliability was assessed using intraclass correlation coefficient, standard error of the measurement (SEM), and smallest real difference (SRD).

    RESULTS: The convergent validity was strong to moderate, and the test-retest reliability was good. The SEM% was 14.7%, and the SRD% was 40.8% based on the mean of four walks shoving twice with the paretic and twice with the non-paretic leg.

    CONCLUSION: Values on random measurement error were high affecting the use of the SSST for follow-up evaluations but the SSST can be a complementary measure of gait and balance.

  • 2.
    Arvidsson Lindvall, Mialinn
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Anderzen-Carlsson, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Forsberg, Anette
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Basic Body Awareness Therapy for patients with stroke: Experiences among participating patients and physiotherapists2016In: Journal of Bodywork & Movement Therapies, ISSN 1360-8592, E-ISSN 1532-9283, Vol. 20, no 1, p. 83-89Article in journal (Refereed)
    Abstract [en]

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

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

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

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

    Conclusion: The patients and physiotherapists related that Basic Body Awareness Therapy challenges balance but also provides an opportunity to reflect on the body.

  • 3.
    Arvidsson Lindvall, Mialinn
    et al.
    Örebro University, School of Health Sciences.
    Anderzén-Carlsson, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital. Karlstad University, Karlstad, Sweden.
    Appelros, Peter
    Department of University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Forsberg, Anette
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Validity and test-retest reliability of the Six-Spot Step Test in persons after strokeManuscript (preprint) (Other academic)
  • 4.
    Arvidsson Lindvall, Mialinn
    et al.
    Örebro University, School of Health Sciences.
    Forsberg, Anette
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Appelros, Peter
    Department of University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Anderzén-Carlsson, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital.
    "I can still manage": a mixed-method study of balance after strokeManuscript (preprint) (Other academic)
  • 5.
    Carling, Anna
    et al.
    Örebro University, School of Medical Sciences. University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Physiotherapy, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Forsberg, Anette
    Örebro University, School of Health Sciences. University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gunnarsson, Martin
    Örebro University, School of Medical Sciences. Department of Neurology.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences. Örebro University Hospital. University Healthcare Research Centre.
    CoDuSe group exercise programme improves balance and reduces falls in people with multiple sclerosis: A multi-centre, randomized, controlled pilot study2017In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 23, no 10, p. 1394-1404Article in journal (Refereed)
    Abstract [en]

    Background: Imbalance leading to falls is common in people with multiple sclerosis (PwMS).

    Objective: To evaluate the effects of a balance group exercise programme (CoDuSe) on balance and walking in PwMS (Expanded Disability Status Scale, 4.0-7.5).

    Methods: A multi-centre, randomized, controlled single-blinded pilot study with random allocation to early or late start of exercise, with the latter group serving as control group for the physical function measures. In total, 14 supervised 60-minute exercise sessions were delivered over 7 weeks. Pretest-posttest analyses were conducted for self-reported near falls and falls in the group starting late. Primary outcome was Berg Balance Scale (BBS). A total of 51 participants were initially enrolled; three were lost to follow-up.

    Results: Post-intervention, the exercise group showed statistically significant improvement (p = 0.015) in BBS and borderline significant improvement in MS Walking Scale (p = 0.051), both with large effect sizes (3.66; -2.89). No other significant differences were found between groups. In the group starting late, numbers of falls and near falls were statistically significantly reduced after exercise compared to before (p < 0.001; p < 0.004).

    Conclusion: This pilot study suggests that the CoDuSe exercise improved balance and reduced perceived walking limitations, compared to no exercise. The intervention reduced falls and near falls frequency.

  • 6.
    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)
  • 7.
    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.

  • 8.
    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.
    Nilsagård, Ylva
    Health Care Management, Region Örebro County, Örebro, Sweden.
    Forsberg, Anette
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Physiotherapy.
    Balance exercise facilitates everyday life for people with multiple sclerosis: A qualitative study2018In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 23, no 4, article id e1728Article in journal (Refereed)
    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.

  • 9.
    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.
    Nilsagård, Ylva
    Health Care Management, Region, Örebro County, Örebro, Sweden .
    Forsberg, Anette
    Department of Physiotherapy.
    Making it work: experience of living with a person who falls due to multiple sclerosisManuscript (preprint) (Other academic)
  • 10.
    Carling, Anna
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Centre; Department of Physiotherapy.
    Nilsagård, Ylva
    Health Care Management, Region Örebro County, Örebro, Sweden.
    Forsberg, Anette
    Örebro University, School of Medical Sciences.
    Making it work: experience of living with a person who falls due to multiple sclerosis2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, p. 1-8Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this study was to describe how everyday life is experienced by next of kin sharing residence with a person who falls due to multiple sclerosis (MS).

    METHODS: Twenty face-to-face interviews were analysed using a qualitative content analysis.

    RESULTS: The overall theme "Making it work" represents the next of kin's struggle to make life work. It comprises three themes: "Taking responsibility", "Making adjustments", and "Standing aside for someone else". The two first themes reflect what relatives do to make the situation work, and the last theme represents what they give up.

    CONCLUSION: Next of kin who share residence and everyday life with a person with MS are affected by that person's occasional falls. They often take on the responsibility of preventing such falls and adapt their lives practically and emotionally. However, adaptation is neither always enough or always possible. In these cases, relatives often deprioritize their own needs and free time to make everyday life in the home work. Implications for rehabilitation By highlighting that next of kin also are affected by the falls of their cohabiting person with multiple sclerosis enhances the importance of fall prevention activities that should include the next of kin. Next of kin to people who occasionally fall due to multiple sclerosis can be in need of both practical and emotional support from the health care system. Enhanced information from the health care system can empower and help them to take care of themselves while managing to live with, care for, and protect the person with multiple sclerosis from falls.

  • 11.
    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)
  • 12.
    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)
  • 13. Cesta, Amedeo
    et al.
    Cortellessa, Gabriella
    Fracasso, Francessca
    Orlandini, Andrea
    Fredriksson, Carin
    Lidskog, Marie
    Pettersson, Ingvor
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Engfeldt, Peter
    Forsberg, Anette
    Östlund, Britt
    Lund University, Lund, Sweden.
    Turno, Marcello
    Gutierrez, Carlos
    GiraffPlus: D1.1 User Requirements and Design Principles Report2012Report (Other academic)
    Abstract [en]

    This document reports on the work performed in Task 1.1 User requirements analysis and Task 1.2 GiraffPlus Environment Design Principles. Specifically, it describes the results of a deep involvement of users, both primary (elderly living in their apartment), and secondary (health care professional or family members and friends) recruited in our studies. The report details the qualitative and quantitative research carried out in the three countries of Sweden, Spain and Italy, to elicit user requirements and expectations in terms of type of services as well as system design and appearance. Some qualitative cross-cultural analysis has also been performed in order to highlight differences emerged during the studies in the three countries. Result of this effort is list of user requirements and a set of preferences on different mockups of a component of the system that can be both used to influence the future architecture definition and functional specification of the GiraffPlus system. The work described in this deliverable constitutes the starting point of T1.3 Technological Component Assessment and Selection and overall provides useful hints to the whole system development.

  • 14. Eriksson Westblad, Mimmi
    et al.
    Forsberg, Anette
    Örebro University, School of Health and Medical Sciences.
    Press, Rayomand
    Disability and health status in patients with chronic inflammatory demyelinating polyneuropathy2009In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 9, p. 720-725Article in journal (Refereed)
    Abstract [en]

    Purpose. Chronic inflammatory demyelinating polyneuropathy (CIDP) is a disorder affecting the peripheral nerves. The purpose of this study was to describe disability and health status in patients with CIDP in Sweden. Methods. All 22 adult patients with CIDP at the Karolinska University Hospital, Huddinge were invited to participate. Twenty-one patients performed all measures. Their mean age was 54 years. The following measures were used: vibration perception threshold (VPT); the Fatigue Severity Scale (FSS); the Berg Balance Scale; finger dexterity using the Nine-Hole Peg Test (NHPT); functional mobility using the Timed 'Up and Go' Test; health status with the SF-36 questionnaire. Results. Fifty-seven per cent of the patients had a higher thumb and ankle VPT than published normative data. The FSS showed that 38% scored over 5, indicating severe fatigue. The majority of the patients had reduced functional balance. Sixty-two per cent had a subnormal result on the NHPT. Results of the SF-36 showed lower scores than the Swedish norm on the sub-scales describing physical health. Conclusions. The majority of the patients with CIDP had disabilities and decreased physical health status. The presence of fatigue may be taken into consideration in immunomodulatory treatments and during physical rehabilitation.

  • 15.
    Forsberg, Anette
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ahlström, Gerd
    Widén Holmqvist, Lotta
    Falling ill with Guillain-Barré syndrome: patients' experiences during the initial phase2008In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 2, p. 220-226Article in journal (Refereed)
    Abstract [en]

    Objective: Research describing the personal experiences of Guillain-Barré syndrome (GBS) is limited, but is important for identifying the patients' need of support. The aim of this study was to describe experiences of falling ill with GBS, with the focus on the onset of disease, the diagnosis and the illness progress during hospital care.

    Methods: The study included 35 persons, 20–78 years old. They were interviewed 2 years after the onset of GBS. The interviews were analysed using qualitative content analysis.

    Results: The onset was described as either an incomprehensible, prolonged, increasing deterioration with puzzling sensations or as a frightening, rapid onset with a sudden loss of body control. The majority of the persons relied heavily on the reassurance of a positive prognosis, and expressed immense confidence in being able to recover. During the early phase at the hospital, a rapid and steady course of improvement inspired hope in many persons. In contrast, even in this early phase of hospital care some individuals expressed doubts of a slow recovery. Feelings of fear and insecurity were evident when losing body functions, thus causing helplessness. Sensations of pain, numbness and lost body image increased their vulnerability. Half of the ventilator-treated persons expressed vivid memories of scary hallucinations.

    Conclusion: The onset is characterized by an incomprehensible bodily deterioration or a frightening, rapid paralysis. In the initial phase, there is hope for recovery, which for many individuals is reinforced by a steady recovery. In contrast, early psychosocial support may be necessary for some persons with an alarmingly slow recovery. 

  • 16.
    Forsberg, Anette
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Andreasson, Malin
    Mälardalen Hospital, Eskilstuna, Sweden.
    Nilsagård, Ylva E.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Validity of the Dynamic Gait Index in People With Multiple Sclerosis2013In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 93, no 10, p. 1369-1376Article in journal (Refereed)
    Abstract [en]

    Background. Evaluation of walking capacity and risk of falls in people with multiple sclerosis often are performed in rehabilitation. The Dynamic Gait Index (DGI) evaluates walking during different tasks, but the feasibility in identifying people at risk for falls needs to be further investigated. Objective. The objective of this study was to investigate (1) the construct validity (known groups, convergent, and discriminant) of the DGI and (2) the accuracy of predicting falls and establishing a cutoff point to identify fallers. Design. This trial was a multicenter, cross-sectional study.

    Methods. A convenience sample was composed of 81 people with multiple sclerosis with subjective gait and balance impairment who were able to walk 100 m (comparable to Expanded Disability Status Scale 1-6). Mean age of the participants was 49 years; 76% were women. The 25-Foot Timed Walk Test, Timed "Up & Go" Test, Four Square Step Test, Timed Sit-to-Stand Test, MS Walking Scale, Multiple Sclerosis Impact Scale, and self-reported falls during the previous 2 months were used for validation, to establish cutoff points for identifying fallers, and to investigate predictive values.

    Results. Significantly lower DGI scores (P <=.001) were found for participants reporting falls (n=31). High sensitivity (87%) in identifying falters was found, with a cutoff score <= 19. The positive predictive value was 50%, and the negative predictive value was 87%. The positive likelihood ratio was 1.77, and the negative likelihood ratio was 0.26. The convergent validity was moderate to strong (rho=0.58-0.80), with the highest correlation coefficient found for the 25-Foot Timed Walk Test. Discriminant validity was shown with low correlation for the psychological subscale of the Multiple Sclerosis Impact Scale. Limitations. The sample included ambulatory people participating in a randomized controlled trial investigating balance training.

    Conclusions. The DGI is a valid measure of dynamic balance during walking for ambulatory people with multiple sclerosis. With the cutoff point of <= 19, sensitivity was high in identifying people at risk of falls.

  • 17.
    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)
  • 18.
    Forsberg, Anette
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro, Sweden; Division of Physiotherapy, Neurotec Department.
    de Pedro-Cuesta, Jesús
    Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
    Widén Holmqvist, Lotta
    Division of Physiotherapy, Neurotec Department; Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Use of health-care, patient satisfaction and burden of care in Guillain-Barré syndrome2006In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 38, no 4, p. 230-236Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to investigate, in an unselected sample of patients with Guillain-Barré syndrome in Sweden, the utilization of healthcare resources, satisfaction with these resources, informal help and the burden of care on family caregivers during the first 2 years after onset.SUBJECTS: Forty-four patients were enrolled from 8 hospitals, and 42 of them were followed for 2 years.METHODS: Data on the utilization of hospital inpatient and outpatient care, primary care and community-based services were collected via computerized registry information, medical records and a specific protocol. Patient satisfaction and the burden on family caregivers were studied using questionnaires.RESULTS: Forty-one patients required inpatient hospitalization for a mean of 82 days. Patients with persistent dependency during activities of daily living had significantly longer hospital stays and more days of outpatient rehabilitation. The majority of patients were satisfied with their care, but dissatisfaction was found regarding information and finances. At 2 years after onset, 26% of patients still depended on informal help. The spouses expressed increased concern and responsibility for household and family.CONCLUSION: Patients with persistent disability due to Guillain-Barré syndrome were found to have long-term need for services from the healthcare system and informal help.

  • 19.
    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)
  • 20.
    Forsberg, Anette
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Familiy Medicine Research Centre, Region Örebro County, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Measuring postural sway in people with multiple sclerosis2015In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 21, no 4, p. 531-531Article in journal (Other academic)
    Abstract [en]

    Background: Many people with multiple sclerosis (MS) have increased postural sway, which is associated with a higher risk of falls. Significantly increased sway has been found in people with slight or no balance impairment. Measuring postural sway is appropriate to perform in clinical settings; however, technical devices can be costly. The Swaymeter is a low-tech cheaper alter-native, considered reliable and valid in both younger and older populations (Sturnieks et al, 2011).

    Aims: To investigate the feasibility and validity of the Swaymeter in people with MS.

    Methods: Baseline values in a trial were used, with inclusion cri-teria unable to stand in tandem for 30 seconds; 87 persons with MS were tested in outpatient clinical settings, mean age 54 years (SD 11). Fifteen participants (17%) used an assistive walking device indoors and 52 (59%) outdoors. Assessments of sway were done in the bipedal stance for 30 seconds with no shoes, four con-ditions: floor eyes open (EO); floor eyes closed (EC); foam EO; and foam EC. The Swaymeter recorded displacements of the body in the horizontal plane at waist level. The displacement sway area was calculated in millimetres (anterioposterior × mediolateral). Construct validity was investigated through correlations with the Berg balance scale (BBS), the timed up and go (TUG) test, and the sit-to-stand test.

    Results: The postural sway displacements were large: floor EO (n=87) mean area 1393 mm (SD 1612); floor EC (n=82) mean area 3041 mm (SD 4447); foam EO (n=83) mean area 4007 mm (SD 3466); foam EC (n=62) mean area 9178 mm (SD 6514). For floor EO and foam EC, there was no significant correlation between the sway area and any of the balance tests. For floor with EC there was a low correlation (r=−0.266, P=0.016) between the sway area and the BBS, but not the other tests. For the condition foam with EO there were significant low–moderate correlation coefficients for the BBS (r=−0.45, P<0.001), the TUG test (r=0.26, P=0.016), and the sit-to-stand test (r=0.33, P=0.003).

    Conclusions: The Swaymeter was feasible in a clinical setting, but only 62 (71%) participants could stand on foam with EC for 30 seconds. Construct convergent validity with dynamic balance tests could not be established becausee most correlation coeffi-cients were low and non-significant. Further studies are needed to investigate the properties of the Swaymeter in MS.

  • 21.
    Forsberg, Anette
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Validity and reliability of the Swedish version of the activities-specific balance confidence scale in people with chronic stroke2013In: Physiotherapy Canada, ISSN 0300-0508, E-ISSN 1708-8313, Vol. 65, no 2, p. 141-147Article in journal (Refereed)
    Abstract [en]

    Purpose: To evaluate the validity and reliability of the Swedish version of the Activities-specific Balance Confidence (ABC) scale in people> 1 year after stroke.

    Method: In a multi-centre study design, using initial cross-sectional data collection with follow-up, the timed up-and-go (TUG) test, 10 m timed walk (10TW), and 6-Minute Walk Test (6MWT) were performed; ABC scale and Short Form 36 Health Survey (SF-36) were completed; and falls history data were collected during one session. One week later, the ABC scale was sent to participants for a second rating. Spearman correlation coefficients were calculated, and reliability was assessed via the intra-class correlation coefficient (ICC) and Cronbach alpha.

    Results: A convenience sample of 67 people was included (mean age 68 y). The median score for the ABC scale changed from 57 at the first rating to 43 at the second; 19 participants 28%) reported falls during the previous 3 months. Scores on the ABC scale were moderately correlated with the TUG (r¼0.48), 10TW (r¼0.52), 6MWT (r¼ 0.45), and SF-36 physical component summary score (r¼0.43). Internal consistency was high for the ABC scale at test and retest (a¼ 0.95–0.97). The ICC was 0.82 (95% CI, 0.72–0.88).

    Conclusions: The Swedish version of the ABC scale is a valid and reliable measure for investigating balance confidence in people >1 year after stroke.

  • 22.
    Forsberg, Anette
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Family Med Res Ctr, Örebro Cty Council, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Ctr Hlth Care Sci, Örebro Univ Hosp, Örebro, Sweden.
    Validity of a timed sit-to-stand test in people with multiple sclerosis2014In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 20, no 7, p. 992-993Article in journal (Other academic)
  • 23.
    Forsberg, Anette
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Family Medicine Research Centre, Örebro University Hospital, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Boström, Katrin
    Department of Health and Medical Services, Örebro University Hospital, Örebro, Sweden.
    Perceptions of using videogames in rehabilitation: a dual perspective of people with multiple sclerosis and physiotherapists2014In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 4, p. 338-344Article in journal (Refereed)
    Abstract [en]

    Purpose: Our aim was to describe experiences of using Nintendo Wii Fit™ for balance exercise, from the perspectives of patients with multiple sclerosis (MS) and their physiotherapists (PT).

    Methods: Individual interviews with 15 patients with MS were conducted, recruited from a multi-centre study investigating the effects of balance exercising using Wii Fit. We also conducted a single focus group interview with nine PT involved in the study. The interviews were audio-recorded, transcribed, and analysed using content analysis.

    Results: Both patients and PT said that exercising with Wii Fit games was fun, and that it challenged the patients’ physical and cognitive capacities. The competitive content in the games provided motivation to continue playing. Patients and PT reported improved body control and, more importantly, positive effects on balance and walking in daily life. The PT regarded Wii training as an effective alternative to other balance training, but some felt unsure in how to manage the video game. The patients regarded Wii training as a possible home training solution.

    Conclusions: Patients with MS and their PT considered Wii Fit exercises to be fun, challenging, and self-motivating. Exercising with Wii games can address balance impairments in MS, and can be performed at home as well as in rehabilitation settings.Implications for Rehabilitation

    • Nintendo Wii Fit™ can be used as a fun and challenging way to perform balance exercises.

    • The competitive content embedded in the games triggers continued playing and exercising.

    • The positive effect on balance control can improve standing and walking in everyday activities.

  • 24.
    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.

  • 25. Forsberg, Anette
    et al.
    Press, Rayomand
    Karolinska Institutet, Karolinska University Hospital at Huddinge, Stockholm, Sweden.
    Einarsson, Ulrika
    Karolinska Institutet, Karolinska University Hospital at Huddinge, Stockholm, Sweden.
    de Pedro-Cuesta, Jesus
    Karolinska Institutet, Karolinska University Hospital at Huddinge, Stockholm, Sweden; National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
    Widén Holmqvist, Lotta
    Karolinska Institutet, Karolinska University Hospital at Huddinge, Stockholm, Sweden.
    Network Members of the Swedish Epidemiological Study Group,
    Impairment in Guillain-Barré syndrome during the first 2 years after onset: A prospective study2004In: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 227, no 1, p. 131-138Article in journal (Refereed)
    Abstract [en]

    Objectives

    To provide a comprehensive description of impairment in patients with Guillain–Barré syndrome (GBS) in Sweden during the first 2 years after disease onset.

    Methods

    In this prospective multi-centre study, 42 patients, mean age 52 years, were evaluated at 2 weeks, 2 months, 6 months, 1 year and 2 years. Evaluations made use of validated, reliable measures of muscle strength, grip strength, finger dexterity, balance, facial-muscle function, respiratory function, gait, motor performance and sensory examination, and included patients' owns assessments of pain, fatigue and paraesthesia.

    Results

    Mechanical ventilation was required in 21% of patients. At 2 weeks, 1 year and 2 years after GBS onset: 100%, 62% and 55% of patients had submaximal overall muscle strength; 98%, 38% and 31% subnormal grip strength; and 38%, 14% and 12% affected facial-muscle function. At the same time points, 62%, 10% and 7% of patients were unable to walk 10 m independently; and affected sensation was detected in 93%, 55% and 52%.

    Conclusions

    Recovery occurred mainly during the first year after onset. At 2 years, motor impairment and sensory impairment were each still detectable in more than 50% of patients. We conclude that residual impairment is significant, somatically widespread and, likely, persistent.

  • 26.
    Forsberg, Anette
    et al.
    Division of neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Family Medicine Research Centre, Örebro county council, Örebro, Sweden.
    Press, Rayomand
    Division of neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
    Widén Holmqvist, Lotta
    Division of neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Division of physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Residual disability 10 years after falling ill in Guillain-Barré syndrome: a prospective follow-up study2012In: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 317, no 1-2, p. 74-79Article in journal (Refereed)
    Abstract [en]

    Objective: To describe residual disability 10years after onset of Guillain-Barré syndrome (GBS) and longitudinal changes from 2weeks after onset until 10years afterwards. The Erasmus GBS Outcome score (EGOS) was applied for predicting prognosis at 2 and 10years.

    Methods: Twenty-nine patients, mean age at onset 49years, were followed prospectively from 2weeks to 10years after GBS onset. Measures included; GBS disability score, EGOS, Barthel Index, Frenchay Activity Index, Sickness Impact Profile (SIP), Overall Neuropathy Limitations Scale (ONLS), Walk-12, and Fatigue Severity Scale.

    Results: At 10years, the facial paralysis found in 5 participants at 2years was still present, 11 participants (38%) experienced paresthesia, 6 (21%) had limitations in their arms, and 15 (52%) had limitations in walking. Decreased health-related quality of life on comparison to the general population was seen in the physical dimension of SIP at 10years. The median EGOS at 2weeks was 4.5, which correlated highly only with the Barthel Index at 2years and the ONLS arm scale at 10years.

    Conclusion: The residual disabilities at 1-2years comprised mainly of reduced walking ability, and are still persistent 10years after GBS onset. For some individuals, facial paralysis caused major disability. The EGOS only partly predicted residual disability at 2 and 10years after onset.

  • 27.
    Forsberg, Anette
    et al.
    Örebro University, School of Health Sciences.
    von Koch, Lena
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences.
    Effects on Balance and Walking with the CoDuSe Balance Exercise Program in People with Multiple Sclerosis: A Multicenter Randomized Controlled Trial2016In: Multiple Sclerosis International, ISSN 2090-2654, E-ISSN 2090-2662, article id 7076265Article in journal (Refereed)
    Abstract [en]

    Background: Balance and walking impairments are frequent in people with multiple sclerosis (MS).

    Objective: The aim was to investigate the effects of a group-based balance exercise program targeting core stability, dual tasking, and sensory strategies (CoDuSe) on balance, postural sway, walking, perceived walking limitations, and balance confidence.

    Design: A single-blinded randomized multicenter trial. No intervention was given to controls. Participants. People with MS able to walk 100 meters but unable to maintain tandem stance >= 30 seconds. Eighty-seven participants were randomized to intervention or control.

    Intervention: The 60-minute CoDuSe group program, twice weekly for seven weeks, supervised by physical therapists.

    Measurements: Primary outcome was dynamic balance (Berg Balance Scale (BBS)). Secondary outcomes were postural sway, walking (Timed-Up and Go test; Functional Gait Assessment (FGA)), MS Walking Scale, and Activities-specific Balance Confidence (ABC) Scale. Assessments were performed before and after (week 8) the intervention.

    Results: 73 participants fulfilled the study. There were significant differences between the intervention and the control groups in change in the BBS and in the secondary measures: postural sway with eyes open, FGA, MS Walking Scale, and ABC scale in favor of the intervention.

    Conclusions: The seven-week CoDuSe program improved dynamic balance more than no intervention.

  • 28.
    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.

  • 29.
    Frennert, Susanne Anna
    et al.
    Department of Design Sciences, Certec, Lund University, Lund, Sweden .
    Forsberg, Anette Susanne
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Östlund, Britt
    Department of Design Sciences, Lund University, Lund, Sweden .
    Elderly People's Perceptions of a Telehealthcare System: Relative Advantage, Compatibility, Complexity and Observability2013In: Journal of technology in human services, ISSN 1522-8835, E-ISSN 1522-8991, Vol. 31, no 3, p. 218-237Article in journal (Refereed)
    Abstract [en]

    The use of telehealthcare systems to promote independent living for elderly people is growing. The results presented in this article, derived from an initial user lab test of a telecare system-GiraffPlus-indicate that the crucial factor for adoption of telehealthcare systems is not usability but the system's ability to support autonomy in everyday life. Eleven users tested the usability and reported what they perceived as possible benefits of having such a system at home. To support autonomy, customization is crucial for the system to be perceived as meaningful for the individual. Our analysis confirms previous research. © 2013 Copyright Taylor and Francis Group, LLC.

  • 30.
    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.

  • 31.
    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.

  • 32.
    Lorin, K.
    et al.
    Child and Youth Habilitation Centre, Region Örebro County, Örebro, Sweden.
    Forsberg, Anette
    Örebro University, School of Health Sciences.
    Treatment with botulinum toxin in children with cerebral palsy: a qualitative study of parents' experiences2016In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 42, no 4, p. 494-502Article in journal (Refereed)
    Abstract [en]

    Background: In children with cerebral palsy everyday movements such as walking, standing and using one's hands can be difficult to perform because of spasticity. Botulinum neurotoxin type A (BoNT-A) are often used to reduce spasticity. The aim of this study was to describe how parents of children with cerebral palsy experienced the child's treatment with BoNT-A, how the child was affected by the treatment and how spasticity affected the child.

    Methods: A qualitative study in which 15 parents of children (6-13 years old) with cerebral palsy were interviewed about their experiences of the BoNT-A treatment. The children had received several BoNT-A treatments. An interview guide was used with topics: the child's functions before and after the treatment, the outcomes of the treatment and how they valued the BoNT-A treatment. Content analysis was used to analyse the interviews.

    Results: The analyses resulted in two themes: 'When softness comes and goes' and 'Both want and do not want'. The reduction of spasticity - softness - was described to promote motor functions, and facilitate the next step in motor development. The children were described as being more active out of their own initiative and having a happier mood. Spasticity, described as stiffness, was described to make walking more strenuous as well as interfering with activities. The BoNT-A injection procedure was perceived as troublesome and painful for the child, and sometimes traumatic for both children and parents.

    Conclusions: Treatment with BoNT-A was described as facilitating motor development and activity. The children's and the parents' negative experiences of the injection procedure should be addressed.

  • 33.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Carling, Anna
    Örebro University, School of Medical Sciences. Department of Physiotherapy, Faculty of Medicine and Health , Örebro University , Örebro , Sweden.
    Davidsson, Oskar
    NeuroRehab, Nyköping Hospital, Nyköping, Sweden.
    Franzén, Lisbeth
    NeuroRehab, Nyköping Hospital, Nyköping, Sweden.
    Forsberg, Anette
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Comparison of trunk impairment scale versions 1.0 and 2.0 in people with multiple sclerosis: A validation study2017In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, no 10, p. 772-779Article in journal (Refereed)
    Abstract [en]

    Background: Trunk control impairment often accompanies multiple sclerosis (MS). Trunk stability is necessary for movements of extremities, as are selective trunk movements for normal gait. Measuring trunk function is thus of interest.

    Methods: We examined the relationships between the Trunk Impairment Scale (TIS1.0 and TIS2.0) and the Berg Balance Scale (BBS), 5 sit-to-stand test (5STS), Timed Up and Go test (TUG), 10-m timed walk test (10TW), 2-min walk test (2MWT), Falls Efficacy Scale - International, and 12-item MS Walking Scale (MSWS-12) in 47 outpatients. We determined construct validity by calculating the degree to which the TIS versions produced different scores between known groups: use or nonuse of walking aid, MS disability status, and whether participants experienced a fall or not during 14 weeks.

    Results: TIS correlated moderately with BBS and 5STS; moderately (TIS1.0) or weakly (TIS2.0) with TUG, 10TW, and 2MWT; and weakly to moderately with MSWS-12 in subgroups with Expanded Disability Status Scale (EDSS) > 6.0. No other clear correlation patterns were found. TIS did not discriminate between known groups.

    Conclusions: TIS1.0 is recommended for individuals with MS (EDSS score 4.0-7.5). Better trunk function correlates with better balance and walking ability. TIS has limited value in fall risk screening.

  • 34.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Carling, Anna
    Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden; Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden.
    Forsberg, Anette
    Family Medicine Research Centre, Örebro County Council, Örebro, Sweden.
    Activities-specific balance confidence in people with multiple sclerosis2012In: Multiple Sclerosis International, ISSN 2090-2654, E-ISSN 2090-2662, Vol. 2012, article id 613925Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the validity of the Activities-specific Balance Confidence scale (ABC) in people with multiple sclerosis (PwMS). Design. A multicentre, crosssectional study. Setting. Six rural and urban Swedish sites, including specialized units at hospitals and primary care centers.

    Participants: A sample of 84 PwMS with subjective gait and balance impairment but still able to walk 100 m (comparable with EDSS 1–6).

    Outcome Measures: Timed Up and Go, Timed Up and Gocog, 25-foot Timed Walk Test, Four Square Step Test, Dynamic Gait Index, Chair Stand Test, 12-item MS Walking Scale, selfreported falls, and use of assistive walking device were used for validation. Results. The concurrent convergent validity was moderate to good (0.50 to −0.75) with the highest correlation found for the 12-item MS Walking Scale. The ABC discriminated between multiple fallers and nonfallers but not between men and women. Ecological validity is suggested since ABC discriminated between users of assistive walking device and nonusers. The internal consistency was high at 𝛼 = 0 . 9 5 , and interitem correlations were between 0.30 and 0.83.

    Conclusion: This study supports the validity of the ABC for persons with mild-to-moderate MS. The participants lacked balance confidence in many everyday activities, likely restricting their participation in society.

  • 35.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Carling, Anna
    Örebro University, School of Medical Sciences.
    Forsberg, Anette
    Örebro University, School of Health Sciences. Örebro University Hospital.
    The CoDuSe group balance exercise program reduces falls in people with MS2017Conference paper (Refereed)
  • 36.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Forsberg, Anette
    Family Medicine Research Centre, Örebro County Council, Örebro, Sweden.
    Practicability and sensitivity to change of the Activities-specific Balance confidence and 12-item Walking scale for stroke2012In: Topics in Stroke Rehabilitation, ISSN 1074-9357, E-ISSN 1945-5119, Vol. 19, no 1, p. 13-22Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate the practicability and sensitivity to change of the Activities-specific Balance Confidence Scale (ABC) and the 12-item Walking Scale (WS-12) in persons at different phases after stroke.

    Method: A longitudinal data collection with repeated measurements at 0 to 14 days and 3 months post stroke combined with a cross-sectional approach for persons more than 1 year post stroke. The participants were 37 persons (median age, 79 years; interquartile range [IQR] 67-86) in the acute phase admitted to the University Hospital of Orebro (sample A) of whom 31 were measured at follow-up, and 67 persons at 4 primary care centers in Orebro County Council (median age, 68 years; IQR, 61-76) who were more than 1 year post stroke (sample B).

    Results: The ABC registered balance confidence during activities and the WS-12 measured walking limitations as perceived by participants. The observed score range per item and for the total scores covered a wide range with no floor or ceiling effects. For the older persons in sample A, 3 ABC items requiring high balance levels were found difficult even before stroke. The item for running in the WS-12 was also often commented on as being not possible before stroke. The ABC showed moderate ability and the WS-12 showed good ability to measure change.

    Conclusion: The scales are practical to use and sensitive to change for persons with remaining walking ability at different phases post stroke.

  • 37.
    Nilsagård, Ylva
    et al.
    Centre for Health Care Sciences, Örebro, Sweden.
    Forsberg, Anette
    Family Medicine Research Centre, Örebro, Sweden.
    Psychometric properties of the Activities-Specific Balance Confidence Scale in persons 0-14 days and 3 months post stroke2012In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 14, p. 1186-1191Article in journal (Refereed)
    Abstract [en]

    Purpose: To test the internal consistency and validity of a Swedish translation of the Activities-specific Balance Confidence Scale (ABC) 0-14 days and 3 months post stroke.

    Method: 37 persons were tested at 0-14 days (median 5 days) post stroke and 31 were retested 3 months later (median 87 days). In addition to the ABC, the Functional Ambulation Categories, modified Rivermead Mobility Index, timed up and go test, 10-meter timed walk, SF-36 and the 12-item Walking Scale were used.

    Results: The internal consistency was high at α = 0.94 to 0.97. Kendall correlation-τ coefficients were moderate and varied somewhat depending on time poststroke. At 0-14 days post stroke the highest correlation was found between the ABC and the 12-item Walking Scale (-0.55, p < 0.01). At 3 months poststroke, the correlations with the Functional Ambulation Categories was 0.49 (p < 0.01), timed up and go test -0.43 (p < 0.01), 10-meter timed walk -0.41 (p < 0.01), and modified Rivermead Mobility Index 0.46 (p < 0.01). Divergent validity was established by the non-significant correlation (0.12) between the ABC and SF-36 mental component summary.

    Conclusions: The Swedish version of ABC has high internal consistency and is valid for measuring balance confidence in the acute and sub acute phases of stroke

  • 38.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Forsberg, Anette
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    von Koch, Lena
    Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. .
    Balance exercise for persons with multiple sclerosis using Wii games: a randomised, controlled multi-centre study2013In: Multiple Sclerosis Journal, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 19, no 2, p. 209-216Article in journal (Refereed)
    Abstract [en]

    Background: The use of interactive video games is expanding within rehabilitation. The evidence base is, however, limited.

    Objective: Our aim was to evaluate the effects of a Nintendo Wii Fit® balance exercise programme on balance function and walking ability in people with multiple sclerosis (MS).

    Methods: A multi-centre, randomised, controlled single-blinded trial with random allocation to exercise or no exercise. The exercise group participated in a programme of 12 supervised 30-min sessions of balance exercises using Wii games, twice a week for 6–7 weeks. Primary outcome was the Timed Up and Go test (TUG). In total, 84 participants were enrolled; four were lost to follow-up.

    Results: After the intervention, there were no statistically significant differences between groups but effect sizes for the TUG, TUGcognitive and, the Dynamic Gait Index (DGI) were moderate and small for all other measures. Statistically significant improvements within the exercise group were present for all measures (large to moderate effect sizes) except in walking speed and balance confidence. The non-exercise group showed statistically significant improvements for the Four Square Step Test and the DGI.

    Conclusion: In comparison with no intervention, a programme of supervised balance exercise using Nintendo Wii Fit® did not render statistically significant differences, but presented moderate effect sizes for several measures of balance performance.

  • 39.
    Nilsagård, Ylva
    et al.
    Örebro University Hospital. Centre for Health Care Sciences.
    Forsberg, Anette
    Örebro University Hospital. Family Medicine Research Centre.
    von Koch, Lena
    Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Reply to Guidi et al. 'Effects of balance-specific Wii exercise on balance in persons with multiple sclerosis'2013In: Multiple Sclerosis Journal, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 19, no 7, p. 964-964Article in journal (Refereed)
  • 40.
    Nilsagård, Ylva
    et al.
    Örebro University Hospital. Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Kollén, L.
    Physiotherapy Department, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Axelsson, H.
    Audiological clinic, Habilitation and Assistive Devices, Örebro County Council, Örebro, Sweden.
    Bjerlemo, B.
    Audiological clinic, Habilitation and Assistive Devices, Örebro County Council, Örebro, Sweden.
    Forsberg, Anette
    Örebro University Hospital. Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Family Medicine Research Centre, Örebro County Council, Örebro, Sweden.
    Functional gait assessment: Reliability and validity in people with peripheral vestibular disorders2014In: International Journal of Therapy and Rehabilitation, ISSN 1741-1645, E-ISSN 1759-779X, Vol. 21, no 8, p. 367-373Article in journal (Refereed)
    Abstract [en]

    Background/aim: Reliable and valid measures evaluating imbalance during walking are important for targeting rehabilitation efforts. This study aimed to investigate the reliability and validity of the Functional Gait Assessment (FGA) in people with peripheral vestibular disorder.

    Methods: This study used a cross-sectional design and tested the reliability and validity of the FGA in 43 participants with peripheral vestibular disorder. The participants' performance on the FGA was filmed. To test intra-rater reliability, three raters reassessed 39 of these participants using the video uptakes. Interrater reliability was assessed by five raters analysing the video uptakes. Concurrent validity was investigated using timed measures of dynamic balance and the Activities-specific Balance Confidence scale.

    Results: The intra-rater reliability for the FGA score was high, with a intraclass correlation coefficient (ICC) (model 2,1)=0.94 (95% CI=0.85; 0.97). The intra-rater percentage of agreement for all raters for separate items was moderate to high, and weighted kappa was good to very good, ranging from 0.61 for change in speed to 0.95 for stair climbing. The inter-rater reliability was ICC (model 2,1)=0.73 (95% CI=0.49; 0.86). Agreement for two random raters was 45-92%. Weighted kappa was fair to very good, ranging from 0.27 for change in speed to 0.87 for walking with a narrow base of support. The internal consistency was high (α=0.88). Gait with eyes closed had the lowest item-to-total (0.33) and item-to-item (<0.30) correlation. Concurrent validity was moderate to strong (rho=0.50-0.76) with the highest correlation coefficient for the Timed Up and Go test.

    Conclusions: The FGA is a reliable and valid measure in people with peripheral vestibular disorder. For improving internal consistency, removal of the item 'gait with eyes closed' may be considered.

  • 41.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    von Koch, Lena Kristina
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Department of Neurology, Karolinska University Hospital, Solna, Sweden.
    Nilsson, Malin
    Rehabunit, Central Hospital Karlstad, Karlstad, 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.
    Balance exercise program reduced falls in people with multiple sclerosis: a single-group, pretest-posttest trial2014In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 95, no 12, p. 2428-2434Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the effects of a balance exercise program on falls in people with mild to moderate multiple sclerosis (MS).

    Design: Multicenter, single-blinded, single-group, pretest-posttest trial.

    Setting: Seven rehabilitation units within 5 county councils.

    Participants: Community-dwelling adults with MS (NZ32) able to walk 100m but unable to maintain 30-second tandem stance with armsalongside the body.

    Intervention: Seven weeks of twice-weekly, physiotherapist-led 60-minute sessions of group-based balance exercise targeting core stability, dualtasking, and sensory strategies (CoDuSe).

    Main Outcome Measures: Primary outcomes: number of prospectively reported falls and proportion of participants classified as fallers during 7preintervention weeks, intervention period, and 7 postintervention weeks. Secondary outcomes: balance performance on the Berg Balance Scale,Four Square Step Test, sit-to-stand test, timed Up and Go test (alone and with cognitive component), and Functional Gait Assessment Scale;perceived limitations in walking on the 12-item MS Walking Scale; and balance confidence on the Activities-specific Balance Confidence Scalerated 7 weeks before intervention, directly after intervention, and 7 weeks later.

    Results: Number of falls (166 to 43;P.001) and proportion of fallers (17/32 to 10/32;P.039) decreased significantly between thepreintervention and postintervention periods. Balance performance improved significantly. No significant differences were detected forperceived limitations in walking, balance confidence, the timed Up and Go test, or sit-to-stand test.

    Conclusions: The CoDuSe program reduced falls and proportion of fallers and improved balance performance in people with mild to moderateMS but did not significantly alter perceived limitations in walking and balance confidence

  • 42.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Health Care Management.
    Westerdahl, Elisabeth
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Physical Therapy.
    Forsberg, Anette
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Physical Therapy.
    Engagement in performing clinical physiotherapy research: Perspectives from leaders and physiotherapists2019In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 24, no 2, article id e1767Article in journal (Refereed)
    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.

  • 43.
    Rådman, Lisa
    et al.
    Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden; Centre for Health Care Sciences, 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, , Region Örebro County, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Modified Rivermead Mobility Index: a reliable measure in people within 14 days post-stroke2015In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 31, no 2, p. 126-129Article in journal (Refereed)
    Abstract [en]

    Purpose: The reliability of the Modified Rivermead Mobility Index (MRMI) has not previously been investigated in the very early post-stroke phase. The aim of the study was to evaluate inter-rater and intra-rater reliability and internal consistency in patients, 1-14 d post-stroke.

    Method: A cohort study with repeated measures within 24 h, on 37 patients, 1-14 d post-stroke was conducted. Inter-rater (two raters) and intra-rater (one rater) reliability was analyzed using weighted kappa (kappa) statistics and internal consistency with Cronbach's alpha and intra-class correlation (ICC), 3.k.

    Results: Inter-rater and intra-rater reliability was excellent (ICC coefficient 0.97 and 0.99) for MRMI summary score. Intra-rater exact agreement for separate items was between 77% and 97%; kappa between 0.81 and 0.96. Inter-rater exact agreement for separate items was between 68% and 92%; kappa 0.59-0.87. The internal consistency was high (alpha 0.96; ICC 3.k 0.99). Conclusion: The MRMI is a reliable measure of physical mobility in the early post-stroke phase.

  • 44.
    Tholin, Helena
    et al.
    Family Medicine Research Centre, Örebro County Council, Örebro, Sweden; Karla Primary Health 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.
    Satisfaction with care and rehabilitation among people with stroke, from hospital to community care2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 4, p. 822-829Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Despite recent improvements in Swedish stroke care some patients still experience a lack of support and follow-up after discharge from hospital. In order to provide good care according to the National Board of Health and Welfare, systematic evaluations of stroke care must be performed. Quality indicators in the national guidelines could be useful when measuring quality of care in all parts of the stroke care chain.

    AIM: To investigate how people with stroke experienced their care, rehabilitation, support, and participation from hospital to community care.

    METHOD: Qualitative interviews were performed with 11 people in 2009-2010 covering their experiences of care, rehabilitation, support, and participation. The interviews were analysed with qualitative content analysis.

    RESULT: The interviewees were satisfied with their hospital care, but reported both positive and negative experiences of the continuing care. Most of them appreciated intense, specific, and professional rehabilitation, and had experienced these qualities in the rehabilitation they received in most parts of the stroke care chain. Those who received support from the community services expressed satisfaction with the staff, but also felt that autonomy was lost. Several did not feel involved in the health care planning, but instead relied on the judgement of the staff.

    CONCLUSION: To ensure high quality throughout the whole stroke care chain, people with stroke must be invited to participate in the care and the planning of care. To offer evidence-based stroke rehabilitation, it is important that the rehabilitation is specific, intense, and performed by professionals, regardless of where the rehabilitation is performed. A changed view of the patient's autonomy in residential community services should be developed, and this process must start from the staff and residents.

  • 45.
    Zakrisson, Ann-Britt
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Universitetssjukvårdens Forskningscentrum.
    Anerös, Terese
    Örebro University, School of Health Sciences. Universitetssjukvårdens Forskningscentrum, Region Örebro Län, Örebro, Sweden.
    Eliason, Gabriella
    Örebro University, School of Health Sciences.
    Forsberg, Anette
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Projekt Region Örebro län: Att använda en mobil app med larm för att motivera till fysisk aktivitet hos patienter med KOL – en mixed method pilot-studie2019In: Lung och Allergi Forum, ISSN 2000-5237, p. 32-39Article in journal (Other academic)
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