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  • 1.
    Carling, Anna
    Örebro University, School of Medical Sciences.
    Impaired balance and fall risk in people with multiple sclerosis2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The symptoms from the neurological disease multiple sclerosis vary from person to person and over time. Impaired balance is common in people with multiple sclerosis and can lead to falls. Fall frequency is high in people with multiple sclerosis, above 50%. Multiple sclerosis affects not only the person having the disease but also their next of kin. To be able to reduce fall risk it is important to know when, why and where people with multiple sclerosis fall, and how to improve balance and reduce falls with exercise. It is also important to know how the falls affect the residing next of kin to people with multiple sclerosis.

    The overall aim of this thesis was to gain enhanced knowledge by investigating when and why people with MS fall and how these falls possibly affect their next of kin, and also to evaluate the effects and perceptions of participating in a specific balance exercise.

    Data were gathered using four different data collections, and this thesis contains both qualitative and quantitative data.

    The major finding in this thesis is that people with multiple sclerosis fall in the course of everyday life activities, most often in their own homes due to various intrinsic and extrinsic factors. Balance can be improved and falls reduced and everyday life may be made easier and facilitated after participating in the CoDuSe balance exercise. This is important also for the next of kin, since they are adapting, adjusting and renouncing their activities due to the falls of the PwMS, in order to make it work for the whole family.

    List of papers
    1. Falls in people with multiple sclerosis: experiences of 115 fall situations
    Open this publication in new window or tab >>Falls in people with multiple sclerosis: experiences of 115 fall situations
    2018 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 32, no 4, p. 526-535Article in journal (Refereed) Published
    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.

    Place, publisher, year, edition, pages
    Sage Publications, 2018
    Keywords
    Accidental falls, multiple sclerosis, walking aid, content analysis
    National Category
    Neurology Physiotherapy
    Identifiers
    urn:nbn:se:oru:diva-65948 (URN)10.1177/0269215517730597 (DOI)000429777600011 ()28901164 (PubMedID)2-s2.0-85042230415 (Scopus ID)
    Available from: 2018-03-22 Created: 2018-03-22 Last updated: 2018-11-19Bibliographically approved
    2. CoDuSe group exercise programme improves balance and reduces falls in people with multiple sclerosis: A multi-centre, randomized, controlled pilot study
    Open this publication in new window or tab >>CoDuSe group exercise programme improves balance and reduces falls in people with multiple sclerosis: A multi-centre, randomized, controlled pilot study
    2017 (English)In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 23, no 10, p. 1394-1404Article in journal (Refereed) Published
    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.

    Place, publisher, year, edition, pages
    London, United Kingdom: Sage Publications, 2017
    Keywords
    Accidental falls, exercise, multiple sclerosis, postural balance, core stability
    National Category
    Neurology
    Identifiers
    urn:nbn:se:oru:diva-53488 (URN)10.1177/1352458516677591 (DOI)000407918800014 ()27834736 (PubMedID)2-s2.0-85027895184 (Scopus ID)
    Note

    Funding Agencies:

    Uppsala-Örebro Regional Research Committe  

    Research committee of Örebro County Council  

    Norrbacka-Eugenia Foundation 

    Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2018-11-19Bibliographically approved
    3. Balance exercise facilitates everyday life for people with multiple sclerosis: A qualitative study
    Open this publication in new window or tab >>Balance exercise facilitates everyday life for people with multiple sclerosis: A qualitative study
    2018 (English)In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 23, no 4, article id e1728Article in journal (Refereed) Published
    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.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2018
    Keywords
    Exercise, multiple sclerosis, postural balance, qualitative research
    National Category
    Occupational Therapy Other Health Sciences
    Research subject
    Disability Science
    Identifiers
    urn:nbn:se:oru:diva-68373 (URN)10.1002/pri.1728 (DOI)000447159800008 ()29962013 (PubMedID)2-s2.0-85050613048 (Scopus ID)
    Funder
    Swedish Research Council
    Note

    Funding Agencies:

    Norrbacka-Eugenia Foundation

    Uppsala-Örebro Regional Research Committee

    Available from: 2018-08-07 Created: 2018-08-07 Last updated: 2018-11-19Bibliographically approved
    4. Making it work: experience of living with a person who falls due to multiple sclerosis
    Open this publication in new window or tab >>Making it work: experience of living with a person who falls due to multiple sclerosis
    (English)Manuscript (preprint) (Other academic)
    National Category
    General Practice
    Identifiers
    urn:nbn:se:oru:diva-70253 (URN)
    Available from: 2018-11-19 Created: 2018-11-19 Last updated: 2018-11-19Bibliographically approved
  • 2.
    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)
  • 3.
    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.

  • 4.
    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)
  • 5.
    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)
  • 6.
    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.

  • 7.
    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)
  • 8.
    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)
  • 9.
    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

  • 10.
    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.

  • 11.
    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)
  • 12.
    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.

  • 13.
    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)
  • 14.
    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)
  • 15.
    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)
  • 16.
    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)
  • 17.
    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.

  • 18.
    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.

  • 19.
    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.

  • 20.
    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)
1 - 20 of 20
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