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  • 51.
    Nilsagård, Ylva
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    von Koch, Lena Kristina
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Department of Neurology, Karolinska University Hospital, Solna, Sweden.
    Nilsson, Malin
    Rehabunit, Central Hospital Karlstad, Karlstad, Sweden.
    Forsberg, Anette
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Family Medicine Research Centre, Örebro County Council, Örebro, Sweden.
    Balance exercise program reduced falls in people with multiple sclerosis: a single-group, pretest-posttest trial2014Inngår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 95, nr 12, s. 2428-2434Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

    Setting: Seven rehabilitation units within 5 county councils.

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

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

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

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

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

  • 52.
    Nilsagård, Ylva
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Health Care Management.
    Westerdahl, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Department of Physical Therapy.
    Forsberg, Anette
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Department of Physical Therapy.
    Engagement in performing clinical physiotherapy research: Perspectives from leaders and physiotherapists2019Inngår i: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 24, nr 2, artikkel-id e1767Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The recent increase in physiotherapy research has led to more physiotherapists being involved in research. Consequently, leaders must make a standpoint on whether the department should engage in research, whereas individual physiotherapists have to decide if they want to play an active role in carrying out a research project. The purpose of this study was to explore perceptions and experiences of both participating physiotherapists and their leaders regarding taking part in clinical physiotherapy research projects.

    METHODS: A qualitative study using face-to-face interviews was conducted. All (n = 8) leaders were interviewed individually. Physiotherapists (n = 18) were interviewed either individually (n = 5) or in small groups including two to three persons (n = 13). The interviews were analysed using inductive conventional content analysis.

    RESULTS: There was a consensus that engagement of the leaders was a prerequisite for entering research projects and that the research had to be in line with the department's regular assignment. For the physiotherapists, the key factors for success were having designated time and having support from their leader, especially when feelings of responsibility became overwhelming. The leaders stressed the importance of being well informed. Participating in clinical research created value such as personal and professional growth for the physiotherapists, who also inspired their colleagues and thus positively affected the organization. Engaging in research contributed to being an attractive employer and gave a boost to evidence-based practice.

    CONCLUSION: The study provides perspectives from leaders and physiotherapists on engaging in research. There was a consensus that participating in a research project was beneficial for the organization, the individual physiotherapist, and the patients. However, clinical applicability, support, sufficient time, and early involvement of leaders are significant prerequisites.

  • 53.
    Nilsagård, Ylva
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Ctr Hlth Care Sci, Örebro Univ Hosp, Örebro, Sweden.
    Westerdahl, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Wittrin, A.
    Gunnarsson, Martin
    Örebro universitet, Institutionen för läkarutbildning.
    Correlation between maximal walking distance and self-rated limitations in walking2014Inngår i: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 20, nr 7, s. 992-992Artikkel i tidsskrift (Annet vitenskapelig)
  • 54.
    Nilsagård, Ylva
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Westerdahl, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Wittrin, Anna
    Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Gunnarsson, Martin
    Örebro universitet, Institutionen för läkarutbildning. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Walking Distance as a Predictor of Falls in People With Multiple Sclerosis2016Inngår i: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 21, nr 2, s. 102-108Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and purpose: People with multiple sclerosis (PwMS) experience falls, usually when walking and transferring. The aim was to investigate if walking distance and patient overestimate of walking distance are predictors of falls in PwMS.

    Methods: A prospective study was conducted, with a single test occasion followed by prospective registration of falls for 3 months. All PwMS in Region Örebro County with a previously registered Expanded Disability Status Scale score between 3.0 and 7.0 in the Swedish MS Registry were invited to participate (n = 149). Altogether, data from 49 PwMS being relapse free for at least 3 months and with a confirmed Expanded Disability Status Scale between 1.5 and 7.0 upon study entry were analysed.

    Results: Twenty-two PwMS (45%) fell during the study period, providing information of 66 falls. Walking distance or overestimate of one's walking distance, as compared with test results, did not predict falls in this MS sample.

    Discussion: Walking and standing activities are associated with numerous falls in PwMS. Our data do not clearly support routine measurements of walking distance in assessing individual fall risk.

  • 55.
    Rådman, Lisa
    et al.
    Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden; Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Forsberg, Anette
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Family Medicine Research Centre, , Region Örebro County, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Modified Rivermead Mobility Index: a reliable measure in people within 14 days post-stroke2015Inngår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 31, nr 2, s. 126-129Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

  • 56.
    Rådman, Lisa
    et al.
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden; Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden.
    Gunnarsson, Lars-Gunnar
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro universitet, Institutionen för hälsovetenskaper.
    Nilsson, Tohr
    Department of Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Neurosensory findings among electricians with self-reported remaining symptoms after an electrical injury: A case series2016Inngår i: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 42, nr 8, s. 1712-1720Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: Symptoms described in previous studies indicate that electrical injury can cause longstanding injuries to the neurosensory nerves. The aim of the present case series was to objectively assess the profile of neurosensory dysfunction in electricians in relation to high voltage or low voltage electrical injury and the "no-let-go phenomenon".

    Methods: Twenty-three Swedish male electricians exposed to electrical injury were studied by using a battery of clinical instruments, including quantitative sensory testing (QST). The clinical test followed a predetermined order of assessments: thermal perceptions thresholds, vibration perception thresholds, tactile gnosis (the Shape and Texture Identification test), manual dexterity (Purdue Pegboard Test), and grip strength. In addition, pain was studied by means of a questionnaire, and a colour chart was used for estimation of white fingers.

    Results: The main findings in the present case series were reduced thermal perceptions thresholds, where half of the group showed abnormal values for warm thermal perception and/or cold thermal perception. Also, the tactile gnosis and manual dexterity were reduced. High voltage injury was associated with more reduced sensibility compared to those with low voltage.

    Conclusion: Neurosensory injury can be objectively assessed after an electrical injury by using QST with thermal perception thresholds. The findings are consistent with injuries to small nerve fibres. In the clinical setting thermal perception threshold is therefore recommended, in addition to tests of tactile gnosis and manual dexterity (Purdue Pegboard).

  • 57.
    Rådman, Lisa
    et al.
    Department of Occupational and Environmental Medicin, Örebro University Hospital, Örebro, Sweden; Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro universitet, Institutionen för hälsovetenskaper.
    Jakobsson, Kristina
    Division of Occupational and Environmental Medicine, Scania University Hospital, Lund, Sweden.
    Ek, Åsa
    Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, Lund, Sweden.
    Gunnarsson, Lars-Gunnar
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Electrical injury in relation to voltage, "no-let-go" phenomenon, symptoms and perceived safety culture: a survey of Swedish male electricians2016Inngår i: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 89, nr 2, s. 261-270Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Professional electricians are highly subjected to electrical injuries. Previous studies describing symptoms after electrical injury have not included people with less severe initial injuries. The purpose of the present study was to describe symptoms at different time points after electrical injury, the impact of "no-let-go" phenomenon and different electrical potential [high voltage (HV) vs. low voltage (LV)], and the safety culture at the workplace.

    A retrospective survey was conducted with 523 Swedish electricians. Two questionnaires were issued: the first to identify electricians who had experienced electrical injury and the second to gain information about symptoms and safety culture. Self-reported symptoms were described at different time points following injury. Symptoms for HV and LV accidents were compared. Occurrence or nonoccurrence of "no-let-go" phenomenon was analysed using two-tailed Chi-2. Safety culture was assessed with a validated questionnaire.

    Nearly all reported having symptoms directly after the injury, mainly paraesthesia and pain. For the first weeks after injury, pain and muscle weakness dominated. The most frequently occurring symptoms at follow-up were pain, muscle weakness and loss of sensation. HV injuries and "no-let go" phenomenon were associated with more sustained symptoms. Deficiencies in the reporting routines were present, as well as shortage of preventive measures.

    The results indicate that symptoms are reported also long time after an electrical injury and that special attention should be paid to HV injuries and "no-let go" accidents. The workplace routines to reduce the number of work-related electrical injuries for Swedish electricians can be improved.

  • 58.
    Sjöberg, Lis
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Paediatrics, Limb Deficiency and Arm Prosthesis Centre, Örebro University Hospital, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Centre for Health Care Sciences, Örebro University, Örebro, Sweden.
    Fredriksson, Carin
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Life situation of adults with congenital limb reduction deficiency in Sweden2014Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, nr 18, s. 1562-1571Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To describe the current life situation of adults with congenital limb reduction deficiencies (CLRD), living in Sweden, regarding their main daily occupation, leisure activities and self-reported general health.

    Method: A cross-sectional survey was conducted using a study-specific questionnaire, sent by post. A hundred and seventeen persons with different extent, forms, and levels of CLRD (mean age 33 years) responded to the questionnaire.

    Results: Work or study was the main occupation for 86 % of the participants and 50 % had completed a college or university education. Seven per cent were unemployed and three per cent were on sick leave. The participants were highly involved in social and physical activities during leisure time. The majority reported good or very good general health.

    Conclusion: This study is the first investigation of the life situation of adults with CLRD described with a perspective from Swedish society. The participants were educated and worked to a great extent, which corresponds well to the Swedish population as a whole. Further research is needed especially with a focus on the internal perspective of life situation, different aspects of work capacity, occurences of strain injuries and the benefit of assistive devices among adults with CLRD.

  • 59.
    Westerdahl, Elisabeth
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Wittrin, Anna
    Faculty of Medicine and Health, Department of Neurology and Neurophysiology, Örebro University, Örebro, Sweden.
    Kånåhols, Margareta
    Faculty of Medicine and Health, Department of Neurology and Neurophysiology, Örebro University, Örebro, Sweden.
    Gunnarsson, Martin
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län. Department of Neurology and Neurophysiology, Örebro University Hospital, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Deep breathing exercises with positive expiratory pressure in patients with multiple sclerosis: a randomized controlled trial2016Inngår i: Clinical Respiratory Journal, ISSN 1752-6981, E-ISSN 1752-699X, Vol. 10, nr 6, s. 698-706Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Breathing exercises with positive expiratory pressure are often recommended to patients with advanced neurological deficits, but the potential benefit in multiple sclerosis (MS) patients with mild and moderate symptoms has not yet been investigated in randomized controlled trials.

    Objectives: To study the effects of 2 months of home-based breathing exercises for patients with mild to moderate MS on respiratory muscle strength, lung function, and subjective breathing and health status outcomes.

    Methods: Forty-eight patients with MS according to the revised McDonald criteria were enrolled in a randomized controlled trial. Patients performing breathing exercises (n = 23) were compared with a control group (n = 25) performing no breathing exercises. The breathing exercises were performed with a positive expiratory pressure device (10-15 cmH2 O) and consisted of 30 slow deep breaths performed twice a day for 2 months. Respiratory muscle strength (maximal inspiratory and expiratory pressure at the mouth), spirometry, oxygenation, thoracic excursion, subjective perceptions of breathing and self-reported health status were evaluated before and after the intervention period.

    Results: Following the intervention, there was a significant difference between the breathing group and the control group regarding the relative change in lung function, favoring the breathing group (vital capacity: P < 0.043; forced vital capacity: P < 0.025). There were no other significant differences between the groups.

    Conclusion: Breathing exercises may be beneficial in patients with mild to moderate stages of MS. However, the clinical significance needs to be clarified, and it remains to be seen whether a sustainable effect in delaying the development of respiratory dysfunction in MS can be obtained.

  • 60.
    Wittrin, A.
    et al.
    Örebro Univ Hosp, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Westerdahl, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Gunnarsson, Martin
    Örebro universitet, Institutionen för läkarutbildning. Örebro Univ Hosp, Örebro, Sweden.
    Self-assessment of walking ability in patients with multiple sclerosis and its impact on the expanded disability status scale (EDSS) score2013Inngår i: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 19, nr 11, s. 118-118Artikkel i tidsskrift (Annet vitenskapelig)
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