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  • 1.
    Bergh, Cecilia
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Fall, Katja
    Örebro University, School of Health and Medical Sciences, Örebro University, 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.
    Appelros, Peter
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Departnment of Epidemiology and Public Health, University College London, London, UK; Cinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Stress resilience in male adolescents and subsequent stroke risk: cohort study2014In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 85, no 12, p. 1331-1336Article in journal (Refereed)
    Abstract [en]

    Objective Exposure to psychosocial stress has been identified as a possible stroke risk, but the role of stress resilience which may be relevant to chronic exposure is uncertain. We investigated the association of stress resilience in adolescence with subsequent stroke risk.

    Methods Register-based cohort study. Some 237 879 males born between 1952 and 1956 were followed from 1987 to 2010 using information from Swedish registers. Cox regression estimated the association of stress resilience with stroke, after adjustment for established stroke risk factors.

    Results Some 3411 diagnoses of first stroke were identified. Lowest stress resilience (21.8%) compared with the highest (23.7%) was associated with increased stroke risk, producing unadjusted HR (with 95% CIs) of 1.54 (1.40 to 1.70). The association attenuated slightly to 1.48 (1.34 to 1.63) after adjustment for markers of socioeconomic circumstances in childhood; and after further adjustment for markers of development and disease in adolescence (blood pressure, cognitive function and pre-existing cardiovascular disease) to 1.30 (1.18 to 1.45). The greatest reduction followed further adjustment for markers of physical fitness (BMI and physical working capacity) in adolescence to 1.16 (1.04 to 1.29). The results were consistent when stroke was subdivided into fatal, ischaemic and haemorrhagic, with higher magnitude associations for fatal rather than non-fatal, and for haemorrhagic rather than ischaemic stroke.

    Conclusions Stress susceptibility and, therefore, psychosocial stress may be implicated in the aetiology of stroke. This association may be explained, in part, by poorer physical fitness. Effective prevention might focus on behaviour/lifestyle and psychosocial stress.

  • 2.
    Boström, Katrin
    et al.
    Department of Health and Medical Services, Örebro County Council, University Health Care Center, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences.
    A family matter: when a parent is diagnosed with multiple sclerosis. A qualitative study2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 7-8, p. 1053-1061Article in journal (Refereed)
    Abstract [en]

    Aims and objectives: The aim was to explore and describe from a triple perspective - that of the ill parent, the healthy parent and the children - experienced issues that are important to acknowledge and act upon to make it easier for a child to cope when a parent is diagnosed with multiple sclerosis.

    Background: A chronic disease affects the whole family and has a substantial impact on the children. Traditionally, the focus is on the patient, and communication with other family members is not generally integrated into health care. Health care professionals need to be aware of a child's needs when a parent is diagnosed with multiple sclerosis.

    Design: A qualitative design using content analysis with an inductive approach was used.

    Methods: Nine focus group interviews were conducted with the ill parents, the healthy parents and the children separately.

    Results: Participants jointly indicated that family members need to be recognised, both initially and onwards in their everyday lives. Seven categories were defined: Prerequisites within the families, Initial reactions, Trying to adapt and manage, Developing strategies, Everyday life, Thoughts about the future and Support from health care providers. Together they constituted the theme that multiple sclerosis is a family matter. Both ill and healthy parents wished for support from health care professionals in addressing their children's needs.

    Conclusions: Health care professionals need to pay attention to children as a parent's illness affects them. Not only the children would benefit, but so would their parents, as their worries for their children would be reduced.

    Relevance to clinical practice: Staff can be advised to pay attention to the parenting role, how the parenting role and parent-child relationship may change as a result of a chronic disease. Parents may need reassurance and benefit from advice about how to talk to their children about their condition and its impact.

  • 3.
    Cameron, Michelle H.
    et al.
    Department of Neurology, Oregon Health and Science University, Portland OR, USA.
    Nilsagård, Ylva E.
    Örebro University Hospital. School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Measurement and treatment of imbalance and fall risk in multiple sclerosis using the international classification of functioning, disability and health model2013In: Physical medicine and rehabilitation clinics of North America, ISSN 1047-9651, Vol. 24, no 2, p. 337-354Article in journal (Refereed)
    Abstract [en]

    Many people with multiple sclerosis MS (PwMS) have impaired balance and walking, and fall frequently. High-quality measures of imbalance and fall risk are essential for identifying who may benefit from interventions to improve balance and prevent falls, and for selecting the most appropriate interventions. We recommend the International Classification of Functioning, Disability and Health (ICF) model. Many measures are available to assess factors affecting balance, fall risk, and walking at the different levels of the ICF. Combining these measures provides the most complete, assessment of the individual and the best guidance for interventions by the health care team.

  • 4.
    Carling, Anna
    et al.
    Avdelningen för sjukgymnastik, Universitetssjukhuset Örebro, Örebro, Sweden.
    Andreasson, Malin
    NeuroRehab, Mälarsjukhuset, Eskilstuna, Sweden.
    Westerlin, Helena
    NeuroRehab, Mälarsjukhuset, Eskilstuna, Sweden.
    Forsberg, Anette
    Allmänmedicinskt forskningscentrum, Region Örebro län, Örebro, Sweden.
    Nilsagård, Ylva
    Vårdvetenskapligt forskningscentrum, Region Örebro län, Örebro, Sweden.
    Jämförelse mellan 5 och 10 sit-to-stand tests för personer med måttlig-avancerad Multipel Skleros2015In: Fysioterapi 2015, 2015Conference paper (Refereed)
  • 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.
    Forsberg, Anette
    Department of physiotherapy, Örebro University Hospital, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences.
    “Berg Balance Scale” and “Timed Up and Go” discriminates between fallers and non-fallers, in people with MS2016In: Sixth International Symposium on Gait and Balance in Multiple Sclerosis, 2016Conference paper (Refereed)
  • 7.
    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)
  • 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.
    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.

  • 9.
    Carling, Anna
    et al.
    Örebro University, School of Medical Sciences.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Concern of falling compared to actual fallsituations in people with MS2017Conference paper (Refereed)
  • 10.
    Carling, Anna
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Correlation between falls and near falls in people with moderate to advanced multiple sclerosis.2015In: Fifth International Symposium on Gait and Balance in Multiple Sclerosis, 2015Conference paper (Refereed)
  • 11.
    Carling, Anna
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Center for Healthcare Science, Örebro County Council, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The validity of the 5 and 10 sit-to-stand test2015In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 21, no 4, p. 532-532Article in journal (Other academic)
    Abstract [en]

    Background: To rise from a sitting to a standing position and to sit down again are categorized as basic transitional movements, and are performed approximately 50 times a day. The sit-to-stand test (STS test) evaluates strength in lower extremities, neuromuscular functions, balance and vestibular function. There are several versions of the test; two examples of these are the 5STS and 10STS tests. For people with multiple sclerosis (MS), only the 5STS test has been validated. A potential difference between the 5STS and 10STS test can be that more repetitions require more muscular endurance and, thus, the 10STS test will reveal impaired muscular endurance more than the 5STS test.

    Aim: The aim was to evaluate the validity for the 5STS and 10STS tests for people with moderate MS.

    Methods: Forty-seven people with MS with a limited (<200 m) but remaining (>20 m) walking ability were included (32 women; 30 secondary and 12 primary progressive MS). The STS tests were slightly modified for safety reasons; instead of crossing arms over the chest, hand support was allowed. Time was taken from the starting position sitting using the command ‘Go’ and stopped when the participant sat down again after completing the 10th standing position. An intermediate time was taken when sitting down after the fifth standing position (5STS test). Validity was evaluated using the timed up and go test (TUG), 10 minute walk test (10MWT), 2 minute walk test (2MWT) and the Berg balance scale (BBS); calculated using Spearman’s rank correlation. Correlations exceeding 0.60 were considered strong.

    Results: Strong correlations (r=0.60–0.70) were found between the 5STS and 10STS test and the TUG, the 10 MWT, the 2MWT and the BBS. The correlation between the 5STS and 10STS test (r=0.86) indicates that the tests measure slightly different abilities. A slightly stronger correlation was found between the 5STS and BBS (r=−0.68) compared to the 10STS and BBS (r=−0.61). The correlations were stronger between the 10STS and the walk tests compared to the 5STS and walk tests. The high correlation between the 10STS and the 2MWT (r=0.70) can possibly be explained by a muscular endurance component.

    Conclusion: Both the 5STS and 10STS test are valid for people with moderate MS but they do not measure the exact same ability

  • 12.
    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.

  • 13.
    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)
  • 14.
    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.

  • 15.
    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)
  • 16.
    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)
  • 17.
    Davidsson, Oskar
    et al.
    Nyköpings lasarett, Nyköping, Sweden.
    Franzén, Lisbeth
    Nyköpings lasarett, Nyköping, Sweden.
    Carling, Anna
    Avdelningen för sjukgymnastik, Universitetssjukhuset Örebro, Örebro, Sweden.
    Nilsagård, Ylva
    Vårdvetenskapligt forskningscentrum, Region Örebro län, Örebro, Sweden.
    Forsberg, Anette
    Allmänmedicinskt forskningscentrum, Region Örebro län, Örebro, Sweden.
    Validering av Trunk Impairment Scale version 1.0 och 2.0 för personer med måttlig till avancerad multipel skleros2015In: Fysioterapi 2015, 2015Conference paper (Refereed)
  • 18.
    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.

  • 19.
    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)
  • 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 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.

  • 25.
    Geijer, Håkan
    et al.
    Örebro University, School of Medical Sciences. Centre for Assessment of Medical Technology in Örebro, Region Örebro County, Örebro, Sweden; Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro University, School of Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Lohse, Georg
    Centre for Assessment of Medical Technology in Örebro, Region Örebro County, Örebro, Sweden; Örebro Rehab Center, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences. Centre for Assessment of Medical Technology in Örebro, Region Örebro County, Örebro, Sweden; Department of Medicine, Örebro University Hospital, Örebro, Sweden.
    Temperature measurements with a temporal scanner: systematic review and meta-analysis2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 3, article id e009509Article in journal (Refereed)
    Abstract [en]

    Objectives: Systematic review and meta-analysis on the diagnostic accuracy of temporal artery thermometers (TAT).

    Design: Systematic review and meta-analysis. The index test consisted of temperature measurement with TAT. The reference test consisted of an estimation of core temperature.

    Participants: Clinical patients as well as healthy participants, with or without fever.

    Interventions: Literature search in PubMed, Embase, Cinahl and Web of Science. Three reviewers selected articles for full-text reading after which a further selection was made. Risk of bias was assessed with QUADAS-2. Pooled difference and limits of agreement (LoA) were estimated with an inverse variance weighted approach. Subgroup and sensitivity analyses were performed. Sensitivity and specificity were estimated using hierarchical models. Quality of evidence was assessed according to the GRADE system.

    Primary and secondary outcome measures: The primary outcome was measurement accuracy expressed as mean difference ±95% LoA. A secondary outcome was sensitivity and specificity to detect fever. If tympanic thermometers were assessed in the same population as TAT, these results were recorded as well.

    Results: 37 articles comprising 5026 participants were selected. Pooled difference was -0.19°C (95% LoA -1.16 to 0.77°C), with moderate quality of evidence. Pooled sensitivity was 0.72 (95% CI 0.61 to 0.81) with a specificity of 0.94 (95% CI 0.87 to 0.97). The subgroup analysis revealed a trend towards underestimation of the temperature for febrile patients. There was a large heterogeneity among included studies with wide LoA which reduced the quality of evidence.

    Conclusions: TAT is not sufficiently accurate to replace one of the reference methods such as rectal, bladder or more invasive temperature measurement methods. The results are, however, similar to those with tympanic thermometers, both in our meta-analysis and when compared with others. Thus, it seems that TAT could replace tympanic thermometers with the caveat that both methods are inaccurate.

    Trial registration number: CRD42014008832.

  • 26.
    Gunn, H.
    et al.
    University of Plymouth, Plymouth, England.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Cameron, M.
    Oregon Health & Science University, Portland OR, USA.
    Hoang, P.
    Neuroscience Research Australia, Randwick NSW, Australia.
    Mazumder, R.
    Oregon Health & Science University, Portland OR, USA.
    Freeman, J.
    University of Plymouth, Plymouth, England.
    Lord, S.
    Neuroscience Research Australia, Randwick NSW, Australia.
    Falls in people with multiple sclerosis: an international perspective2013In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 19, no 11, p. 45-45Article in journal (Other academic)
  • 27.
    Gunnarsson, Martin
    et al.
    Örebro University, School of Medicine, Örebro University, Sweden.
    Udumyan, Ruzan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bahmanyar, S.
    Clinical Epidemiology Unit and Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden; Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran .
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Research Department of Epidemiology and Public Health, University College London, London, United Kingdom .
    Characteristics in childhood and adolescence associated with future multiple sclerosis risk in men: cohort study2015In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 22, no 7, p. 1131-1137Article in journal (Refereed)
    Abstract [en]

    Background and purpose: Associations with multiple sclerosis (MS) of living conditions in childhood and characteristics in adolescence including physical fitness, cognitive function and psychological stress resilience were investigated.

    Methods: A cohort of male Swedish residents born 1952-1956 who were included in the Swedish Military Conscription Register was used to create a nested case-control study comprising 628 MS cases and 6187 controls matched on birth year, county of residence and vital status at time of diagnosis. Conscription examination records were linked with other national register data. Conditional logistic regression was used to evaluate associations with MS subsequent to the conscription examination.

    Results and conclusions: Men with MS were less likely to be from more crowded households in childhood (>two persons per room) with an adjusted odds ratio of 0.67 (95% confidence interval 0.51-0.86, P=0.023). They had lower physical working capacity in adolescence with adjusted odds ratio of 0.94 (95% confidence interval 0.89-0.99, P=0.026). Cognitive function and stress resilience scores displayed no significant differences between cases and controls. Parental occupation in childhood and body mass index in adolescence were not associated with future MS risk. The inverse association of MS risk with higher levels of household crowding may reflect environmental factors such as the pattern of exposure to microorganisms. Lower physical fitness in men at MS risk may indicate a protective effect of exercise or could be due to prodromal disease activity, although there was no association with cognitive function. Poor psychological stress resilience (and thus risk of chronic stress arousal) was not associated with MS.

  • 28.
    Hammer, Ann M.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences.
    Wallquist, Magnus
    Balance training in stroke patients: a systematic review of randomized, controlled trials2008In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 10, no 4, p. 163-172Article in journal (Refereed)
    Abstract [en]

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

  • 29.
    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.

  • 30.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences.
    Laserbehandling vid nacksmärta2014Report (Refereed)
  • 31.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences.
    Walking ability, balance and accidental falls in persons with Multiple Sclerosis2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    By using a pragmatic paradigm, different research methodologies were employed in this thesis. MS-related symptoms may be exaggerated due to heatsensitivity and it is supposed that cooling garments relieve the symptoms. The effects of wearing a Rehband® vest were evaluated in a sample of 42 persons with MS in a randomised controlled crossover study. Both objective and subjective statistically significant improvements were found when a cooled Rehband® vest was worn compared to the wearing of a room-tempered vest. Using a repeated-measures design, 10m and 30m timed walks and Timed Up and Go were studied in 42 persons with MS. Reproducibility was investigated within and between test points. High reproducibility was found both within (r=0.97–0.98) and between measure points (r=0.91–0.93). The correlation between the three tests was high (r=0.85). Differences at –23% to +40% were established as being needed to detect genuine changes. Severity of MS infl uenced the size of the differences, especially for the 30m timed walk test. The 12-item MS Walking Scale was translated and used in a cross-sectional study. Out of 81 persons with MS, 89–96% perceived limitations in standing or walking. The internal consistency of the scale was acceptable for nine items (0.69–0.84). The concurrent validity between the 12-item MS Walking Scale and the investigated objective tests was low: Berg Balance Scale (r=–0.368**), Four Square Step Test (r=0.338**) and Timed Up and Gocognitive (r=0.319*).

    A prevalence of falling was found at 63% in a longitudinal cohort study with prospectively registered falls including 76 persons with MS. The odds of falling were fi ve fold when there was a reported need of using a walking aid indoors and outdoors and by 2.5 to 15.6 times while there was disturbed proprioception, depending on severity. The highest sensitivity was found for the Berg Balance Scale (94%) and the highest specifi city was found for the 12-item MS Walking Scale (82%). Positive predictive values at 70–83% were found for the Berg Balance Scale, Timed Up and Gocognitive, the Four Square Step Test and the 12-item MS Walking Scale. Finally, we explored and described factors that persons with MS perceive as related to accidental falls. A content analysis with a deductive approach was chosen. By conducting interviews, we found previously untargeted factors: divided attention, reduced muscular endurance, fatigue and heat-sensitivity. The content of the interviews also gave support to previously reported risk factors such as changes in gait pattern, walking disability, impaired proprioception and vision, and spasticity.

    List of papers
    1. Evaluation of a single session with cooling garment for persons with multiple sclerosis: a randomized trial
    Open this publication in new window or tab >>Evaluation of a single session with cooling garment for persons with multiple sclerosis: a randomized trial
    2006 (English)In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, Vol. 1, no 4, p. 225-233Article in journal (Refereed) Published
    National Category
    Medical and Health Sciences Physiotherapy Nursing
    Research subject
    Medicine; Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-3012 (URN)10.1080/09638280500493696 (DOI)
    Available from: 2008-10-15 Created: 2008-10-15 Last updated: 2017-10-18Bibliographically approved
    2. Clinical relevance using timed walk tests and 'timed up and go' testing in persons with multiple sclerosis
    Open this publication in new window or tab >>Clinical relevance using timed walk tests and 'timed up and go' testing in persons with multiple sclerosis
    2007 (English)In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 12, no 2, p. 105-14Article in journal (Refereed) Published
    Abstract [en]

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

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

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

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

    Place, publisher, year, edition, pages
    London: Whurr Publishers, 2007
    Keywords
    Adult, Cross-Over Studies, Female, Gait/physiology, Humans, Locomotion/physiology, Male, Middle Aged, Motor Activity/*physiology, Multiple Sclerosis/physiopathology/*rehabilitation, Musculoskeletal Equilibrium/physiology, Reproducibility of Results, Time Factors, Walking/*physiology
    National Category
    Physiotherapy
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-4699 (URN)10.1002/pri.358 (DOI)17536648 (PubMedID)
    Available from: 2008-11-12 Created: 2008-11-12 Last updated: 2017-12-14Bibliographically approved
    3. Self-perceived limitations of gait in persons with multiple sclerosis
    Open this publication in new window or tab >>Self-perceived limitations of gait in persons with multiple sclerosis
    2007 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 9, no 3, p. 136-143Article in journal (Refereed) Published
    Abstract [en]

    This study aimed to describe the self-perceived walking limitations of those with multiple sclerosis (MS) using the Swedish translation of the 12-item MS Walking Scale [MSWS-12 (S)], and to investigate it for concurrent validity and internal consistency. Eighty-one persons, recruited from five centres in Sweden, were tested using the Four Square Step Test (FSST), the Timed Up and Go cognitive (TUGcog) and the Berg Balance Scale (BBS) in randomized order, besides filling in the MSWS-12 (S). Perceived limitations were reported in 89-96% of the sample, i.e. performance of activities related to standing or walking, decreased speed and distance, and qualitative aspects; and self-perception regarding the ability to run being most extremely affected. Correlations between the MSWS-12 (S) and the objective tests were low, as were correlations between items in the MSWS-12 (S) and the BBS or time taken to complete the TUGcog or the FSST. The internal consistency was acceptable for nine of the 12 items (0.7-0.84). The majority of the sample experienced limitations in several aspects of their walking ability. Concurrent validity was not established between the MSWS-12 (S) and the other tests. There may be a discrepancy in self- perception of disability and objective measures. The use of subjective, as well as objective measures is recommended.

    Place, publisher, year, edition, pages
    London: Taylor & Francis, 2007
    Keywords
    12-item MS Walking Scale, internal consistency, Swedish, balance, validity
    National Category
    Social Sciences Interdisciplinary Nursing
    Research subject
    vårdvetenskap
    Identifiers
    urn:nbn:se:oru:diva-3014 (URN)10.1080/14038190701256402 (DOI)
    Available from: 2008-10-15 Created: 2008-10-15 Last updated: 2018-01-13Bibliographically approved
    4. Predicting accidental falls in persons with Multiple Sclerosis: a longitudinal study
    Open this publication in new window or tab >>Predicting accidental falls in persons with Multiple Sclerosis: a longitudinal study
    (English)Manuscript (preprint) (Other academic)
    National Category
    Medical and Health Sciences
    Research subject
    Rehabilitation Medicine
    Identifiers
    urn:nbn:se:oru:diva-3015 (URN)
    Available from: 2008-10-15 Created: 2008-10-15 Last updated: 2017-10-18Bibliographically approved
    5. Factors perceived as being related to accidental falls by persons with multiple sclerosis
    Open this publication in new window or tab >>Factors perceived as being related to accidental falls by persons with multiple sclerosis
    2009 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 16, p. 1301-1310Article in journal (Refereed) Published
    Abstract [en]

    Purpose. This study explores and describes factors that persons with multiple sclerosis (MS) perceive as being related to accidental falls. Method. A qualitative content analysis with primarily deductive approach was conducted using the International Classification of Functioning, Disability and Health. Twelve persons with MS, and identified as fallers, were interviewed. Results. Factors perceived to cause accidental falls that had not previously been targeted in MS populations in relation to falls were identified as divided attention, reduced muscular endurance, fatigue and heat sensitivity. Previously reported risk factors such as changed gait pattern, limited walking ability, impaired proprioception, vision and spasticity were supported. Activities involving walking, recreation and leisure, maintaining and changing body position, lifting or carrying, taking care of the home, washing the body, moving around, preparing meals and housekeeping were limited and considered to be risk activities. Supportive persons and assistive device reduced falls, and unsuitable physical environments and climate conditions induced falls. Several preventative strategies were described as partially compensating for the impairments, limitations and restrictions. Conclusions. Investigating accidental falls using the perspective of the patient gave important information about variables not earlier targeted in MS research.

    Place, publisher, year, edition, pages
    London: Taylor & Francis, 2009
    Keywords
    Multiple sclerosis, accidental falls, international classification of functioning, disability and health, balance, qualitative content analysis
    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-3016 (URN)10.1080/09638280802532639 (DOI)000268663000001 ()19479575 (PubMedID)2-s2.0-70449729791 (Scopus ID)
    Available from: 2008-10-15 Created: 2008-10-15 Last updated: 2017-12-14Bibliographically approved
  • 32.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Medicine, Örebro University Hospital, Örebro, Sweden.
    Andreasson, Malin
    NeuroRehab Unit, Mälar Hospital, Eskilstuna, Sweden.
    Carling, Anna
    Örebro University, School of Medical Sciences. Department of Physiotherapy, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Vesterlin, Helena
    NeuroRehab Unit, Mälar Hospital, Eskilstuna, Sweden.
    Examining the validity and sensitivity to change of the 5 and 10 sit-to-stand tests in people with multiple sclerosis2017In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 22, no 4, article id e1681Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 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, Department of Clinical Medicine.
    Denison, Eva
    Gunnarsson, Lars-Gunnar
    Örebro University, Department of Clinical Medicine.
    Evaluation of a single session with cooling garment for persons with multiple sclerosis: a randomized trial2006In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, Vol. 1, no 4, p. 225-233Article in journal (Refereed)
  • 37.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health and Medical Sciences.
    Denison, Eva
    Gunnarsson, Lars-Gunnar
    Boström, Katrin
    Factors perceived as being related to accidental falls by persons with multiple sclerosis2009In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 16, p. 1301-1310Article in journal (Refereed)
    Abstract [en]

    Purpose. This study explores and describes factors that persons with multiple sclerosis (MS) perceive as being related to accidental falls. Method. A qualitative content analysis with primarily deductive approach was conducted using the International Classification of Functioning, Disability and Health. Twelve persons with MS, and identified as fallers, were interviewed. Results. Factors perceived to cause accidental falls that had not previously been targeted in MS populations in relation to falls were identified as divided attention, reduced muscular endurance, fatigue and heat sensitivity. Previously reported risk factors such as changed gait pattern, limited walking ability, impaired proprioception, vision and spasticity were supported. Activities involving walking, recreation and leisure, maintaining and changing body position, lifting or carrying, taking care of the home, washing the body, moving around, preparing meals and housekeeping were limited and considered to be risk activities. Supportive persons and assistive device reduced falls, and unsuitable physical environments and climate conditions induced falls. Several preventative strategies were described as partially compensating for the impairments, limitations and restrictions. Conclusions. Investigating accidental falls using the perspective of the patient gave important information about variables not earlier targeted in MS research.

  • 38.
    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.

  • 39.
    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

  • 40.
    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.

  • 41.
    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)
  • 42.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Gunn, H.
    University of Plymouth, Plymouth, England.
    Freeman, J.
    University of Plymouth, Plymouth, England.
    Hoang, P.
    University of NSW, Sydney, Australia.
    Lord, S.
    University of NSW, Sydney, Australia.
    Mazumder, Rajarshi
    Oregon Health and Science University, Portland, USA.
    Cameron, Michelle
    Oregon Health and Science University, Portland, USA.
    Falls in people with MS-an individual data meta-analysis from studies from Australia, Sweden, United Kingdom and the United States2015In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 21, no 1, p. 92-100Article in journal (Refereed)
    Abstract [en]

    Background: Falls are common in people with multiple sclerosis (PwMS). Previous studies have generally included small samples and had varied methods.

    Objectives: The objectives of this paper are to compile fall rates across a broad range of ages and disease severity and to definitively assess the extent to which MS-associated and demographic factors influence fall rates.

    Methods: Individual data from studies in four countries that prospectively measured falls for three months were analyzed. We determined fall rates, prevalence of fallers (1 falls) and frequent fallers (2 falls), location and timing of falls, and fall-related demographic factors.

    Results: A total of 537 participants reported 1721 falls: 56% were fallers and 37% frequent fallers. Most falls occurred indoors (65%) between 6 a.m. and 6 p.m. (75%). Primary progressive MS was associated with significantly increased odds of being a faller (odds ratio (OR) 2.02; CI 1.08-3.78). Fall risk peaked at EDSS levels of 4.0 and 6.0 with significant ORs between 5.30 (2.23-12.64) and 5.10 (2.08-12.47). The fall rate was lower in women than men (relative risk (RR) 0.80; CI 0.67-0.94) and decreased with increasing age (RR 0.97 for each year, CI 0.95-0.98).

    Conclusion: PwMS are at high risk of falls and there are important associations between falls and MS-associated disability, gender and age.

  • 43.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health and Medical Sciences.
    Gunnarsson, Lars-Gunnar
    Denison, Eva
    Self-perceived limitations of gait in persons with multiple sclerosis2007In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 9, no 3, p. 136-143Article in journal (Refereed)
    Abstract [en]

    This study aimed to describe the self-perceived walking limitations of those with multiple sclerosis (MS) using the Swedish translation of the 12-item MS Walking Scale [MSWS-12 (S)], and to investigate it for concurrent validity and internal consistency. Eighty-one persons, recruited from five centres in Sweden, were tested using the Four Square Step Test (FSST), the Timed Up and Go cognitive (TUGcog) and the Berg Balance Scale (BBS) in randomized order, besides filling in the MSWS-12 (S). Perceived limitations were reported in 89-96% of the sample, i.e. performance of activities related to standing or walking, decreased speed and distance, and qualitative aspects; and self-perception regarding the ability to run being most extremely affected. Correlations between the MSWS-12 (S) and the objective tests were low, as were correlations between items in the MSWS-12 (S) and the BBS or time taken to complete the TUGcog or the FSST. The internal consistency was acceptable for nine of the 12 items (0.7-0.84). The majority of the sample experienced limitations in several aspects of their walking ability. Concurrent validity was not established between the MSWS-12 (S) and the other tests. There may be a discrepancy in self- perception of disability and objective measures. The use of subjective, as well as objective measures is recommended.

  • 44.
    Nilsagård, Ylva
    et al.
    Örebro University, Department of Clinical Medicine.
    Hammer, Ann
    Örebro University, Department of Clinical Medicine.
    Timed up and go – ett test i tiden: en litteraturöversikt2003In: Nordisk Fysioterapi, ISSN 1402-3024, Vol. 7, no 3, p. 32-48Article, review/survey (Refereed)
    Abstract [en]

    The Timed Up and Go-test (TUG) measures balance/physical mobility. The aim of this review was to illustrate TUG's developmental steps, describe the different modifications of TUG and the efforts that has been made to test validity and reliability and finally in what other types of studies it have been used. A literature search in Medline and Cinahl was carried through and resulted in 100 abstracts that were analyzed and categorized according to their content. Some variants of TUG describe adding a manual or cognitive task and calculating the difference in time between TUG and TUG manual/ cognitive; diffTUG. Reliability and validity has been demonstrated to be high for older people. There is some disagreement regarding TUG's predictive value for falls. TUG has been used in effect-, survey- and correlationstudies, and as criterioninstrument as well as in reviews. TUG may in it's simplicity be recommended both in clinical environment and for research purposes, especially for older people.

  • 45.
    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.

  • 46.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lohse, Georg
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro County Council, Örebro, Sweden.
    Evidence-based physiotherapy: A survey of knowledge, behaviour, attitudes and prerequisites2010In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 12, no 4, p. 179-186Article in journal (Refereed)
    Abstract [en]

    The purpose was to describe knowledge, attitude, behaviour, and prerequisites regarding evidence-based physiotherapy

    (EBPT) and to evaluate potential differences related to employment sectors and levels of education. A cross-sectional study

    was conducted using a web-based questionnaire to a random sample of 2,160 physiotherapists (PTs). Self-rated knowledge

    of evidence-based medicine (EBM) was rather high (median

    69; IQ1;IQ3 50 – 77), although only 12 – 36% correctly identifi

    ed all EBM components. Approximately 70% reported good ability to formulate clinical questions and critically appraise

    scientifi c literature. Only 28% performed database searches weekly or monthly. Eighty-six per cent reported using evidencebased

    guidelines in clinical practice. Lack of time (86%), advisors (80%), knowledge (55%) and superiors ’ lack of interest

    in EBM (46%) were common barriers. EBM was considered important (median

    82, IQ1;IQ3 75 – 91) and believed to

    improve the quality of care (median

    80, IQ1;IQ3 74 – 90). Employment sector differences were most obvious for behaviour

    and prerequisites with a disadvantage for municipality-employed PTs. The higher the level of education, the greater the

    knowledge, the more positive the attitudes, the better the prerequisites and the fewer the barriers reported.

  • 47.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health and Medical Sciences.
    Lundholm, Cecilia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute.
    Denison, E.
    School of Health, Care and Social Welfare, Mälardalen University.
    Gunnarsson, Lars-Gunnar
    Örebro University, School of Health and Medical Sciences.
    Predicting accidental falls in people with multiple sclerosis: a longitudinal study2009In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 23, no 3, p. 259-269Article in journal (Refereed)
    Abstract [en]

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

  • 48.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health and Medical Sciences.
    Lundholm, Cecilia
    Denison, Eva
    Gunnarsson, Lars-Gunnar
    Predicting accidental falls in persons with Multiple Sclerosis: a longitudinal studyManuscript (preprint) (Other academic)
  • 49.
    Nilsagård, Ylva
    et al.
    Örebro University, Department of Clinical Medicine.
    Lundholm, Cecilia
    Gunnarsson, Lars-Gunnar
    Örebro University, Department of Clinical Medicine.
    Denison, Eva
    Clinical relevance using timed walk tests and 'timed up and go' testing in persons with multiple sclerosis2007In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 12, no 2, p. 105-14Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 50.
    Nilsagård, Ylva
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Rådman, Lisa
    Jakobsson, Kristina
    Gunnarsson, Lars-Gunnar
    Örebro University, School of Medical Sciences.
    Symtom efter strömgenomgång2017In: Elolyckor i arbetet / [ed] Kjell Torén, Lars-Gunnar Gunnarsson, Sara Thomée och Kristina Jakobsson, Göteborg, Sweden: Göteborgs universitet, 2017, p. 21-26Chapter in book (Other academic)
    Abstract [sv]

    523 elektriker som hade varit med om minst en elolycka med strömgenomgång besvarade en fördjupad enkät med fokus på frågor om symtom från perifera och centrala nervsystemet och muskulatur.

     Nio av tio som varit med om högspänningsolycka hade sökt akut sjukvård. Endast två av tio hade sökt vård efter lågspänningsolycka.

     Besvär framför allt i form av smärta och nedsatt känsel efter strömgenomgång var relativt vanligt, men för de allra flesta blev inte dessa besvär bestående.

     Symtom från nervsystem och hjärna var betydligt vanligare hos de som hade varit utsatta för högspänningsolyckor eller fastnat vid strömkällan på grund av muskelkramp.

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