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Hellström, Karin
Publications (10 of 31) Show all publications
Vahlberg, B., Bring, A., Hellström, K. & Zetterberg, L. (2018). Level of physical activity in men and women with chronic stroke. Physiotherapy Theory and Practice, 1-9
Open this publication in new window or tab >>Level of physical activity in men and women with chronic stroke
2018 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, p. 1-9Article in journal (Refereed) Epub ahead of print
Abstract [en]

INTRODUCTION: Community-dwelling stroke survivors generally show low levels of physical activity (PA). An improved understanding of the factors influencing participation in PA after stroke is imperative to improve levels of PA. Furthermore, gender differences in PA have received little attention in stroke research. The objective of this study was to examine gender differences in PA, physical functioning and psychological factors and the association between these factors and PA in men and women 1-3-year post-stroke.

MATERIALS AND METHODS: A total of 187 community-dwelling individuals with stroke (65-85 years old, 29% women) were included in a secondary analysis based on data from a cross-sectional study. The exclusion criteria were severe cognitive or language dysfunction or dementia. The level of PA was measured by the Physical Activity Scale for the Elderly. Physical function included balance, walking speed and mobility. Psychological factors included depression, health-related quality of life and fall-related self-efficacy. Falls and fear of falling were each measured with a single question.

RESULTS: There were no significant differences in PA levels between men and women. In multiple regression analyses, walking speed (p < 0.001) was associated with PA in men, and balance (p = 0.038) was associated with PA in women.

CONCLUSIONS: The results indicate that strategies to increase PA levels 1-3-year post-stroke could be improved by considering gender-specific factors.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Balance, fear of falling gait speed, physical activity, stroke
National Category
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-362346 (URN)10.1080/09593985.2018.1460646 (DOI)29659314 (PubMedID)
Available from: 2018-10-03 Created: 2018-10-03 Last updated: 2019-05-23Bibliographically approved
Tuvemo Johnson, S., Martin, C., Anens, E., Johansson, A.-C. & Hellström, K. (2018). Older adults' opinions on fall prevention in relation to physical activity level. Journal of Applied Gerontology, 37(1), 58-78
Open this publication in new window or tab >>Older adults' opinions on fall prevention in relation to physical activity level
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2018 (English)In: Journal of Applied Gerontology, ISSN 0733-4648, E-ISSN 1552-4523, Vol. 37, no 1, p. 58-78Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to explore and describe older adults' opinions regarding actions to prevent falls and to analyze differences in the opinions of highly versus less physically active older adults. An open-ended question was answered by 262 individuals aged 75 to 98 years living in the community. The answers were analyzed using qualitative content analysis, and differences in the categories were compared between highly and less physically active persons. Physical activity was measured according to a five-level scale. The content analysis resulted in eight categories: assistive devices, avoiding hazards, behavioral adaptive strategies, being physically active, healthy lifestyle, indoor modifications, outdoor modifications, and seeking assistance. Behavioral adaptive strategies were mentioned to a greater extent by highly active people, and indoor modifications were more often mentioned by less active older adults. Support for active self-directed behavioral strategies might be important for fall prevention among less physically active older adults.

National Category
Other Medical Sciences
Identifiers
urn:nbn:se:uu:diva-278203 (URN)10.1177/0733464815624776 (DOI)000417697100005 ()26769824 (PubMedID)
Available from: 2016-02-24 Created: 2016-02-24 Last updated: 2018-02-07Bibliographically approved
Vahlberg, B., Lindmark, B., Zetterberg, L., Hellström, K. & Cederholm, T. (2017). Body composition and physical function after progressive resistance and balance training among older adults after stroke: an exploratory randomized controlled trial. Disability and Rehabilitation, 39(12), 1207-1214
Open this publication in new window or tab >>Body composition and physical function after progressive resistance and balance training among older adults after stroke: an exploratory randomized controlled trial
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2017 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 39, no 12, p. 1207-1214Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate whether improvements in physical function are related to changes in body composition after a three-month progressive resistance and balance exercise program among individuals approximately one to three years after stroke.

METHODS: In this randomized controlled trial, 43 community-dwelling subjects (65-85 years, mean age 73 ± 5 years, 73% men) were allocated to a progressive resistance and balance exercise program twice weekly for three months (intervention group [IG], n = 20) or a control group (n = 23). The main outcome measures were fat mass (kg) and fat-free mass (kg), as measured by bioelectrical impedance analyses (Tanita®). Physical function was measured using the six-minute walk test.

RESULTS: Complete case analyses revealed reduced fat mass in the IG compared with the control (-1.5 vs. (0).13% of body weight, respectively; effect size =0.62; p = 0.048). In contrast, no between-group difference in fat-free mass was observed. The six-minute walk test was improved (25 vs. -10 m, respectively, effect size =0.69, p = 0.039) at three months in favor of the IG. The reduced fat mass was associated with an improved six-minute walk test (r = 0.48, p = 0.038) in the IG.

CONCLUSIONS: Three-month progressive resistance and balance training was associated with reduced fat mass, which was related to improvements in walking capacity in older adults approximately one year after stroke.

Implications for rehabilitation - This three-month PRB group exercise program supported by motivational discussions and daily home-based exercises indicate the following:

• Improved walking capacity was associated with a reduction in fat mass.

• IGF-1 is reduced, possibly indicating improved insulin sensitivity.

Keywords
Exercise, fat mass, muscles, postural balance, stroke, walking capacity
National Category
Geriatrics Physiotherapy
Research subject
Geriatrics; Nutrition; Physiotherapy
Identifiers
urn:nbn:se:uu:diva-236914 (URN)10.1080/09638288.2016.1191551 (DOI)000398436100007 ()27341068 (PubMedID)
Note

Title in Thesis list of papers: Body composition and physical function after progressive resistance and balance training among older adults after stroke

Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2018-09-03Bibliographically approved
Dodd-Reynolds, C. J., Åsenlöf, P. & Hellström, K. (2017). Editorial: Special issue - physical activity and health. Physical Therapy Reviews, 22(3-4), 101-102
Open this publication in new window or tab >>Editorial: Special issue - physical activity and health
2017 (English)In: Physical Therapy Reviews, ISSN 1083-3196, E-ISSN 1743-288X, Vol. 22, no 3-4, p. 101-102Article in journal, Editorial material (Other academic) Published
National Category
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-346805 (URN)10.1080/10833196.2017.1335823 (DOI)000414044200001 ()
Available from: 2018-03-22 Created: 2018-03-22 Last updated: 2018-03-22Bibliographically approved
Essner, A., Zetterberg, L., Hellström, K., Gustas, P., Högberg, H. & Sjöström, R. (2017). Psychometric evaluation of the canine brief pain inventory in a Swedish sample of dogs with pain related to osteoarthritis. Acta Veterinaria Scandinavica, 59, Article ID 44.
Open this publication in new window or tab >>Psychometric evaluation of the canine brief pain inventory in a Swedish sample of dogs with pain related to osteoarthritis
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2017 (English)In: Acta Veterinaria Scandinavica, ISSN 1751-0147, E-ISSN 1751-0147, Vol. 59, article id 44Article in journal (Refereed) Published
Abstract [en]

Background: To evaluate intervention, implement evidence-based practice and enhance the welfare of dogs with naturally occurring osteoarthritis (OA), access to valid, reliable and clinically relevant outcome measures is crucial for researchers, veterinarians and rehabilitation practitioners. The objectives of the present study were to translate and evaluate psychometric properties, in terms of internal consistency and construct validity, of the owner-reported measure canine brief pain inventory (CBPI) in a Swedish sample of dogs with pain related to OA. Results: Twenty-one owners of clinically sound dogs and 58 owners of dogs with pain related to OA were included in this observational and cross-sectional study. After being translated according to the guidelines for patient-reported outcome measures, the CBPI was completed by the canine owners. Construct validity was assessed by confirmatory factor analysis, by repeating the principal component analysis and by assessing for differences between clinically sound dogs and dogs with pain related to OA. Internal consistency was estimated by Cronbach's a. Confirmatory factor analysis was not able to confirm the factor-structure models tested in our sample. Principal component analysis showed a two-component structure, pain severity and pain interference of function. Two components accounted for 76.8% of the total variance, suggesting an acceptable fit of a two-component structure. The ratings from the clinically sound dogs differed from OA dogs and showed significantly lower CBPI total sum. Cronbach's a was 0.94 for the total CBPI, 0.91 for the pain severity and 0.91 for the pain interference of function. Conclusions: The results indicate that the translated version of the CBPI is valid for use in the Swedish language. The findings suggest satisfying psychometric properties in terms of high internal consistencies and ability to discriminate clinically sound dogs from OA dogs. However, based on the confirmatory factor analysis, the original factor structure in the CBPI is not ideally suited to measure pain related to OA in our sample and the hypothesis of the presented two-factor structure was rejected. Further research needs to be conducted to determine whether the original psychometric results from CBPI can be replicated across different target groups and particularly with larger sample size.

Keywords
CBPI, Dogs, Measurement properties, Osteoarthritis, Pain, Physiotherapy, Rehabilitation
National Category
Veterinary Science
Identifiers
urn:nbn:se:uu:diva-330036 (URN)10.1186/s13028-017-0311-2 (DOI)000404805500001 ()
Available from: 2017-09-29 Created: 2017-09-29 Last updated: 2017-12-05
Anens, E., Zetterberg, L., Urell, C., Emtner, M. & Hellström, K. (2017). Self-reported physical activity correlates in Swedish adults with multiple sclerosis: a cross-sectional study. BMC Neurology, 17, Article ID 204.
Open this publication in new window or tab >>Self-reported physical activity correlates in Swedish adults with multiple sclerosis: a cross-sectional study
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2017 (English)In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 17, article id 204Article in journal (Refereed) Published
Abstract [en]

Background: The benefits of physical activity in persons with Multiple Sclerosis (MS) are considerable. Knowledge about factors that correlate to physical activity is helpful in order to develop successful strategies to increase physical activity in persons with MS. Previous studies have focused on correlates to physical activity in MS, however falls self-efficacy, social support and enjoyment of physical activity are not much studied, as well as if the correlates differ with regard to disease severity. The aim of the study was to examine associations between physical activity and age, gender, employment, having children living at home, education, disease type, disease severity, fatigue, self-efficacy for physical activity, falls self-efficacy, social support and enjoyment of physical activity in a sample of persons with MS and in subgroups with regard to disease severity.

Methods: This is a cross-sectional survey study including Swedish community living adults with MS, 287 persons, response rate 58.2%. The survey included standardized self-reported scales measuring physical activity, disease severity, fatigue, self-efficacy for physical activity, falls self-efficacy, and social support. Physical activity was measured by the Physical Activity Disability Survey – Revised.

Results: Multiple regression analyzes showed that 59% (F(6,3)=64.9, p=0.000) of the variation in physical activity was explained by having less severe disease (β=-0.30), being employed (β=0.26), having high falls self-efficacy (β=0.20), having high self-efficacy for physical activity (β=0.17), and enjoying physical activity (β=0.11). In persons with moderate/severe MS, self-efficacy for physical activity explained physical activity.

Conclusions: Consistent with previous research in persons with MS in other countries this study shows that disease severity, employment and self-efficacy for physical activity are important for physical activity. Additional important factors were falls self-efficacy and enjoyment. More research is needed to confirm this and the subgroup differences.

Keywords
Exercise, Multiple sclerosis, Physical therapy, Rehabilitaton, Self-efficacy
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-335306 (URN)10.1186/s12883-017-0981-4 (DOI)000416928600001 ()29191168 (PubMedID)
Available from: 2017-12-04 Created: 2017-12-04 Last updated: 2018-03-06Bibliographically approved
Vahlberg, B., Cederholm, T., Lindmark, B., Zetterberg, L. & Hellström, K. (2017). Short-term and long-term effects of a progressive resistance and balance exercise program in individuals with chronic stroke: a randomized controlled trial. Disability and Rehabilitation, 39(16), 1615-1622
Open this publication in new window or tab >>Short-term and long-term effects of a progressive resistance and balance exercise program in individuals with chronic stroke: a randomized controlled trial
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2017 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 39, no 16, p. 1615-1622Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate the effects of progressive resistance and balance (PRB) exercises on physical and psychological functions of post-stroke individuals.

MATERIALS AND METHODS: In a randomized controlled trial with follow-up at 3, 6 and 15 months, 67 community-living individuals (76% male; 65-85 years) with a stroke 1-3 years previously were allocated to an intervention group (IG, n = 34; PRB exercises combined with motivational group discussions twice weekly for 3 months) or a control group (CG, n = 33). The primary outcomes were balance (Berg Balance Scale, 0-56 points) and mobility (Short Physical Performance Battery, 0-12 points) at 3 months. The secondary outcomes were 10 m comfortable walking speed, physical activity levels, health-related quality of life, depression and fall-related self-efficacy.

RESULTS: At 3 months, the IG exhibited significant improvements in balance (MD 2.5 versus 0 points; effect size [ES], 0.72; p < 0.01) and comfortable walking speed (MD 0.04 versus -0.05 m/s; ES, 0.68; p = 0.01) relative to the CG. A faster walking speed persisted at 6 months. No differences were found for the other outcomes.

CONCLUSIONS: In chronic stroke patients, 3 months of PRB exercises and motivational discussions induced improvements in balance at 3 months and in walking speed at 3 and 6 months. Implications for Rehabilitation A progressive resistance and balance exercise program supported by motivational group discussions and one home-based exercise appears to be an effective means of improving the short-term balance and the walking speed in individuals with chronic stroke. People with poor balance and motor function discontinued the study more often and may require additional support. There is a need for powerful and cost-effective strategies that target changes in behavior to obtain long-term changes in physical function after exercising.

Keywords
Depression; health-related quality of life, high-intensity functional exercise, self-related self-efficacy, walking
National Category
Physiotherapy Neurology Geriatrics
Research subject
Neurology; Geriatrics; Physiotherapy
Identifiers
urn:nbn:se:uu:diva-236912 (URN)10.1080/09638288.2016.1206631 (DOI)000401704500007 ()27415645 (PubMedID)
Note

Title in Thesis list of papers: Effects of Progressive Resistance and Balance training in Chronic Stroke: A Randomized Controlled Trial

Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2018-09-10Bibliographically approved
Vahlberg, B., Zetterberg, L., Lindmark, B., Hellström, K. & Cederholm, T. (2016). Functional performance, nutritional status, and body composition in ambulant community-dwelling individuals 1-3 years after suffering from a cerebral infarction or intracerebral bleeding. BMC Geriatrics, 16, Article ID 48.
Open this publication in new window or tab >>Functional performance, nutritional status, and body composition in ambulant community-dwelling individuals 1-3 years after suffering from a cerebral infarction or intracerebral bleeding
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2016 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, article id 48Article in journal (Refereed) Published
Abstract [en]

Background:Muscle wasting and obesity may complicate the post-stroke trajectory. We investigated the relationshipsbetween nutritional status, body composition, and mobility one to 3 years after stroke.

Methods:Among 279 eligible home-dwelling individuals who had suffered a stroke (except for subarachnoidbleeding) 1–3 years earlier, 134 (74 ± 5 years, 69 % men) were examined according to the Mini NutritionalAssessment-Short Form (MNA-SF, 0–14 points), including body mass index (BMI, kg/m2), body composition bybio-impedance analyses (Tanita BC-545), the Short Physical Performance Battery (SPPB, 0–12 points) combiningwalking speed, balance, and chair stand capacity, and the self-reported Physical Activity Scale for the Elderly (PASE).

Results:BMI≥30 kg/m2was observed in 22 % of cases, and 14 % were at risk for malnutrition according to theMNA-SF. SPPB scores≤8 in 28 % of cases indicated high risk for disability. Mobility based on the SPPB was notassociated with the fat-free mass index (FFMI) or fat mass index (FMI). Multivariate logistic regression indicatedthat low mobility, i.e., SPPB≤8 points, was independently related to risk for malnutrition (OR 4.3, CI 1.7–10.5,P= 0.02), low physical activity (PASE) (OR 6.5, CI 2.0–21.2,P= 0.02), and high age (OR 0.36, CI 0.15–0.85,P= 0.02).Sarcopenia, defined as a reduced FFMI combined with SPPB scores≤8 or reduced gait speed (<1 m/s), was observedin 7 % of cases. None of the individuals displayed sarcopenic obesity (SO), defined as sarcopenia with BMI > 30 kg/m2.

Conclusions:Nutritional disorders, i.e., obesity, sarcopenia, or risk for malnutrition, were observed in about one-thirdof individuals 1 year after stroke. Risk for malnutrition, self-reported physical activity, and age were related to mobility(SPPB), whereas fat-free mass (FFM) and fat mass (FM) were not. Nutrition and exercise treatment could be furtherevaluated as rehabilitation opportunities after stroke

Keywords
mobility limitations, stroke, sarcopenia, muscle atrophy, sarcopen obesitas, physical activity, obesity, malnutrition, aging
National Category
Medical and Health Sciences
Research subject
Geriatrics; Nutrition
Identifiers
urn:nbn:se:uu:diva-236911 (URN)10.1186/s12877-016-0226-1 (DOI)000370483600001 ()26895855 (PubMedID)
Note

Title in Thesis list of papers: Body Composition, Nutritional Status, and Physical Function in Community-Living Individuals 1-2 Years after Suffering a Stroke

Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2018-02-22Bibliographically approved
Frandin, K., Gronstedt, H., Helbostad, J. L., Bergland, A., Andresen, M., Puggaard, L., . . . Hellström, K. (2016). Long-Term Effects of Individually Tailored Physical Training and Activity on Physical Function, Well-Being and Cognition in Scandinavian Nursing Home Residents: A Randomized Controlled Trial. Gerontology, 62(6), 571-580
Open this publication in new window or tab >>Long-Term Effects of Individually Tailored Physical Training and Activity on Physical Function, Well-Being and Cognition in Scandinavian Nursing Home Residents: A Randomized Controlled Trial
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2016 (English)In: Gerontology, ISSN 0304-324X, E-ISSN 1423-0003, Vol. 62, no 6, p. 571-580Article in journal (Refereed) Published
Abstract [en]

Background: The preservation of physical functions such as muscle strength, balance and mobility is fundamental to maintaining independence in activities of daily living (ADL). The physical activity level of most nursing home residents is very low, which implies that they are often subject to a decline in health, mobility, autonomy and social contacts and are also at risk of suffering a decline in mental well-being. In a previous study, we demonstrated that transfers, balance and physical activity level improved after 3 months of individually tailored intervention in nursing home residents. Objective: To evaluate the long-term effects on ADL, balance function, physical activity level, physical performance, falls related self-efficacy, well-being and cognitive function 3 months after the completion of our intervention in nursing home residents. Methods: The study was a multicenter randomized, controlled clinical trial with a parallel-group design. It was conducted in nursing homes in Sweden, Norway and Denmark, with an intervention period lasting 3 months and a follow-up at 6 months. Initially, 322 nursing home residents with a mean age of 85 years were included; 85 from Sweden, 171 from Norway and 66 from Denmark. Of these, 241 [129 intervention group (IG), 112 control group (CG)] were eligible for the 6-month follow-up tests. The level of dependence in ADL, physical activity level, several dimensions of physical function, well-being, falls-related self-efficacy and cognitive function were assessed with reliable and valid instruments at baseline, immediately after 3 months of intervention and 3 months later at the 6-month follow-up.Results: After 3 months of intervention and an additional period of 3 months without intervention, only the following 2 variables demonstrated significant group differences: social and cognitive function, measured by the Functional Independence Measure n-r, where the IG deteriorated while the CG was almost stable. However, regarding transfers, the IG deteriorated significantly less than the CG. Conclusion: Without supervised physical exercise that challenged the individuals' capability, gains in ADL function, balance and transfer ability deteriorated during the 3 months following the intervention period. Thus, continuous, individually adjusted and supported physical activity seems crucial for the maintenance of physical functions in these vulnerable elderly persons.

Keywords
Individually tailored physical activity, Physical function, Nursing home, Well-being
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-308806 (URN)10.1159/000443611 (DOI)000386416100001 ()26963569 (PubMedID)
Funder
Swedish Research Council
Available from: 2016-12-01 Created: 2016-11-30 Last updated: 2018-01-13Bibliographically approved
Arkkukangas, M., Tuvemo Johnson, S., Hellström, K., Söderlund, A., Eriksson, S. & Johansson, A.-C. (2015). A feasibility study of a randomised controlled trial comparing fall prevention using exercise with or without the support of motivational interviewing. Preventive Medicine Reports, 2, 134-140
Open this publication in new window or tab >>A feasibility study of a randomised controlled trial comparing fall prevention using exercise with or without the support of motivational interviewing
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2015 (English)In: Preventive Medicine Reports, ISSN 0350-1159, E-ISSN 2211-3355, Vol. 2, p. 134-140Article in journal (Refereed) Published
National Category
Health Sciences
Identifiers
urn:nbn:se:uu:diva-278198 (URN)10.1016/j.pmedr.2015.01.007 (DOI)
Available from: 2016-02-24 Created: 2016-02-24 Last updated: 2018-02-21Bibliographically approved
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