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Vahlberg, B., Bring, A., Hellström, K. & Zetterberg, L. (2019). Level of physical activity in men and women with chronic stroke. Physiotherapy Theory and Practice, 35(10), 947-955
Open this publication in new window or tab >>Level of physical activity in men and women with chronic stroke
2019 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 35, no 10, p. 947-955Article in journal (Refereed) Published
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.

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)000486491600006 ()29659314 (PubMedID)
Available from: 2018-10-03 Created: 2018-10-03 Last updated: 2019-11-01Bibliographically approved
Vahlberg, B., Holmbäck, U., Eriksson, S. & Cederholm, T. (2018). Protocol and pilot study of a short message service-guided training after acute stroke/transient ischemic attack to increase walking capacity and physical activity. Preventive medicine reports, 11, 109-114
Open this publication in new window or tab >>Protocol and pilot study of a short message service-guided training after acute stroke/transient ischemic attack to increase walking capacity and physical activity
2018 (English)In: Preventive medicine reports, ISSN 2211-3355, Vol. 11, p. 109-114Article in journal (Refereed) Published
Abstract [en]

Physical activity in community-living individuals after a stroke is usually scarce. This protocol describes a study that will evaluate a method to increase physical activity by performing a 3-month outdoor walking and muscle strengthening program and will examine the 3-month and 1-year effects of this program on individuals with acute stroke (AS) or transient ischemic attack (TIA). In a prospective randomized controlled trial in Uppsala, Sweden, 80 individuals with AS or TIA who maintained cognitive and motor function will be randomized into groups for continuous training for three months or for regular standard care. The training will be supervised by daily cellphone-delivered messages (short message services; SMS), and the intensity, duration and workload will be gradually increased. The primary outcome is a change in walking capacity according to the 6-Minute Walk Test and chair-rising at three months. Secondary outcomes include mobility, gait speed, handgrip strength, body composition (fat mass and muscle mass), biochemical risk-markers, health-related quality of life, and cardiovascular events. Adherence to the training program will be documented with a self-reported diary and step counts over two weeks. The major study started in November 2016, and results are expected in 2019. In a pilot study of 15 subjects post-stroke (mean-age 65 years), we observed improved walking capacity (increasing from 23 to 255 m) and chair-rising (decreasing 2.42 s) from baseline to three months. SMS-guided outdoor training will be tested as a potential therapeutic strategy to increase physical activity and thereby improve walking capacity and physical function following a stroke.

Keywords
Acute stroke, Body composition, Mobility, Physical activity, Transient ischemic attack, Walking capacity
National Category
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-362343 (URN)10.1016/j.pmedr.2018.05.016 (DOI)30023162 (PubMedID)
Available from: 2018-10-03 Created: 2018-10-03 Last updated: 2018-11-29Bibliographically 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
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
Vahlberg, B. (2015). Physical Functioning, Body Composition and Exercise in Elderly Community-living Individuals with Stroke. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Physical Functioning, Body Composition and Exercise in Elderly Community-living Individuals with Stroke
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A comprehensive view of physical function, body composition and exercise post-stroke that is based on clinical examination is lacking. The effects of a progressive resistance and balance (PRB) exercise program have not been fully evaluated in community-living individuals after stroke.

The overall aim of this thesis was to explore and describe physical function, physical activity, body composition, nutritional status and psychological factors. Another aim was to evaluate both the short-term and long-term effects of a PRB exercise program.

Physical function, physical activity, body composition, nutritional status and psychological factors were assessed in community-living individuals (65-85 years) approximately 1 year after stroke. Paper I-II (n=195, n=134) had a cross-sectional design and the main outcome was mobility and physical activity. In paper III-IV, (n=67, n=43) individuals were randomly assigned to either a PRB exercise program group or a control group. The main outcomes were balance, mobility, fat-free mass (FFM) and fat-mass (FM).

In paper I, mobility was reduced and physical activity level was low compared to age-matched healthy controls. Factors explaining the variance in mobility were age, physical activity, fall-related self-efficacy and EQ-5D. In paper II, >20% had a BMI ≥30 kg/m2 and had an altered body composition that was mainly characterised by a high fat-mass index (FMI). Neither fat-free nor FM were associated with mobility in this cohort. The factors associated with low mobility were low physical activity Odds ratio (OR) (CI 95%) 8.2 (2.8-24.2), risk for malnutrition, OR 5.8 (1.6-21.1), and each 10-year period, OR 2.8 (1.24-6.24). Individuals participating in the PRB exercise program (paper III, n=67) revealed significantly higher balance, walking capacity and comfortable walking speed compared to the control group at 3 months. The faster walking speed persisted at 6 and 15 months. In paper IV (n=43), at 3 months, the PRB exercise group had a significant reduction in FM percentage and a decrease in IGF-1 compared with the control group. Further, changes in FMI were associated with improved walking capacity.

Many individuals perceived partly modifiable disabilities 1 year after stroke. Exercising in groups for 3 months improved physical function and decreased fat-mass percentage and IGF-1.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. p. 81
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1058
National Category
Medical and Health Sciences
Research subject
Geriatrics; Neurology; Nutrition
Identifiers
urn:nbn:se:uu:diva-236899 (URN)978-91-554-9120-8 (ISBN)
Public defence
2015-01-23, Gunne-salen, Ingång 10, Akademiska sjukhuset, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2014-12-18 Created: 2014-11-25 Last updated: 2015-02-03
Vahlberg, B., Cederholm, T., Lindmark, B., Zetterberg, L. & Hellström, K. (2013). Factors Related to Performance-Based Mobility and Self-reported Physical Activity in Individuals 1-3 Years after Stroke: A Cross-sectional Cohort Study. Journal of Stroke & Cerebrovascular Diseases, 22(8), E426-E434
Open this publication in new window or tab >>Factors Related to Performance-Based Mobility and Self-reported Physical Activity in Individuals 1-3 Years after Stroke: A Cross-sectional Cohort Study
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2013 (English)In: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 22, no 8, p. E426-E434Article in journal (Refereed) Published
Abstract [en]

Background: Low mobility and low level of physical activity is common after stroke. The objective of this study was to relate these outcomes to physical, psychological, and demographic determinants. Methods: In this cross-sectional cohort study, a consecutive sample of 195 community-living individuals, 65-85 years of age (74 +/- 5 years, 71% men) with a previous stroke was included. Exclusion criteria were severe aphasia and severe cognitive dysfunction. Mobility status was measured by the Short Physical Performance Battery (SPPB, 0-12 points), and physical activity was measured using the Physical Activity Scale for the Elderly (PASE). Results: Mobility (SPPB, median 9 points) and level of physical activity were low (mean PASE 97 +/- 66 points), and walking speed was slow (1.10 +/- .86 m/s), in relation to a healthy population-based sample. In multiple regression analyses, age (P = .001), physical activity (P < .001), fall-related self-efficacy (P = .001), and health-related quality of life (HRQoL) (P = .02) were associated with mobility (SPPB). Mobility (P < .001), HRQoL (P = .014), and fall-related self-efficacy (P = .031) were likewise associated with self-reported physical activity as the dependent variable. The regression models described 42% and 31% of the variance in mobility and physical activity, respectively. Conclusions: Individuals perceived disabilities that are partly potentially modifiable 1-3 years after stroke. Future poststroke rehabilitation studies need to evaluate if actions to improve fall-related self-efficacy and mobility could promote the physical activity level in this patient population.

Keywords
Stroke, mobility, walking speed, physical activity, health-related quality of life, fall-related self-efficacy, multiple regression
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-213936 (URN)10.1016/j.jstrokecerebrovasdis.2013.04.028 (DOI)000327719000024 ()
Available from: 2014-01-05 Created: 2014-01-05 Last updated: 2018-02-22Bibliographically approved
Hellström, K., Vahlberg, B., Urell, C. & Emtner, M. (2009). Fear of falling, fall-related self-efficacy, anxiety and depression in individuals with chronic obstructive pulmonary disease. Clinical Rehabilitation, 23(12), 1136-1144
Open this publication in new window or tab >>Fear of falling, fall-related self-efficacy, anxiety and depression in individuals with chronic obstructive pulmonary disease
2009 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 23, no 12, p. 1136-1144Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To examine the risk and frequency of falls, prevalence of fear of falling and activity avoidance, the magnitude of fall-related self-efficacy, and anxiety and depression in patients with chronic obstructive pulmonary disease. DESIGN AND SETTINGS: A cross-sectional study in patients with a diagnosis of chronic obstructive pulmonary disease who visited a lung clinic at a university hospital in Sweden. SUBJECTS: Successive inclusion from autumn 2005 to spring 2006 of 80 patients with a mean age of 65 years. INTERVENTION: Nil. MAIN MEASURES: A questionnaire about fall history and consequences of fall, The Falls Efficacy Scale, Swedish version, and the Hospital Anxiety and Depression Scale were used. RESULTS: Twenty patients (25%) reported at least one fall in the last year and 29% displayed fear of falling. Odds ratio for falling was 4-5 times higher in patients with severe chronic obstructive pulmonary disease. Older patients, women and patients with previous falls had a higher rate of fear of falling, and those with fear of falling had lower fall-related self-efficacy, increased level of anxiety and depression, more activity avoidance and use of assistive device. CONCLUSION: The increased risk of falls in patients with chronic obstructive pulmonary disease warrants attention in order to reduce serious and adverse health consequences of falls.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-124375 (URN)10.1177/0269215509342329 (DOI)000272632900009 ()19906765 (PubMedID)
Available from: 2010-05-03 Created: 2010-05-03 Last updated: 2017-12-12Bibliographically approved
Vahlberg, B. & Hellström, K. (2008). Treatment and assessment of neglect after stroke – from a physiotherapy perspective: A systematic review. Advances in Physiotherapy, 10(4), 178-187
Open this publication in new window or tab >>Treatment and assessment of neglect after stroke – from a physiotherapy perspective: A systematic review
2008 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 10, no 4, p. 178-187Article, review/survey (Refereed) Published
Abstract [en]

The aim of the review was to determine, from a physiotherapeutic perspective, existing tools that assess neglect and whether there was support for the positive effect of physiotherapeutic interventions on neglect after stroke. The review was based on publicized randomized controlled studies and reviews about neglect and stroke. The databases PubMed (Medline), Ahmed, Cinahl, PeDRO and PsycINFO were queried from 1980 until March 2007. A checklist from the Swedish Council on Technology Assessment in Health Care (SBU) was used to evaluate the quality of randomized controlled studies; a model for analysis of systematic reviews from SBU was used for reviews. Specific training for the neglect syndrome was recommended. There was moderate evidence for spatio-motor cueing and scanning training towards the effected side. The literature also indicated that trunk rotation or repeated neck muscle vibrations when associated with an extensive training programme, mental imagery training, video feedback training and prism adaptation could be recommended for the rehabilitation of stroke patients with neglect. Treatment with Constraint-Induced Movement Therapy (CIMT) has shown some promising results. None of the tools designed to assess neglect evaluated physical performance. From a physiotherapeutic point of view, there is limited evidence for treatment of patients with neglect after stroke and the way neglect should be assessed. Scanning training and activation of the affected hemisphere with spatio-motor cueing can be effectual. Several assessment tools in combination are recommended. Further randomized controlled trials with larger samples concerning physiotherapeutic interventions are warranted, in order to evaluate new techniques targeting cognitive processes contributing to clinical manifestations of neglect.

Keywords
Assessment tool, hemi-inattention, inattention, neglect, stroke, systematic reviews, treatment, visual perception
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-104014 (URN)10.1080/14038190701661239 (DOI)
Available from: 2009-05-26 Created: 2009-05-26 Last updated: 2017-12-13Bibliographically approved
Hellström, K., Lindmark, B., Wahlberg, B. & Fugl-Meyer, A. R. (2003). Self-efficacy in relation to impairments and ADL disability in elderly stroke patients: A prospective investigation. Journal of Rehabilitation Medicine, 35(5), 202-207
Open this publication in new window or tab >>Self-efficacy in relation to impairments and ADL disability in elderly stroke patients: A prospective investigation
2003 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 35, no 5, p. 202-207Article in journal (Refereed) Published
Abstract [en]

Objectives: The objectives of this prospective study, under-taken in elderly patients with stroke undergoing rehabilita-tion, were to determine to what extent fall-related self-efficacy changes over time, its relationships to objectivelyassessed functions and activities, and the predictive capacityof self-efficacy at discharge for activities of daily living 10months after stroke.

Methods: The study comprised 37 patients, aged 66–89 years.Main outcome measurement instruments were the FallsEfficacy Scale (Swedish version), Berg Balance Scale andFunctional Independence Measure.

Results: Significant improvements occurred in all thesemeasures from admission to discharge, but patients with lowself-efficacy at discharge showed less pronounced improve-ments than those with high self-efficacy. Falls Efficacy Scale(Swedish version) was closely associated with all othermeasures and was a more powerful predictor of activities ofdaily living than the observer-based measures of balance.

Conclusion: To minimize dependence in activities of dailyliving, rehabilitation interventions should incorporate self-efficacy enhancement.

National Category
Health Sciences
Identifiers
urn:nbn:se:uu:diva-89586 (URN)10.1080/16501970310000836 (DOI)14582550 (PubMedID)
Available from: 2002-01-10 Created: 2002-01-10 Last updated: 2017-12-14Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1508-1435

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