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  • 1.
    Ahlström, Isabell
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Anens, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Reliability of the Swedish version of the Exercise Self-Efficacy Scale (S-ESES): a test-retest study in adults with neurological disease2015In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 31, no 3, p. 194-199Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the test-retest reliability of the Swedish translated version of the Exercise Self-Efficacy Scale (S-ESES) in people with neurological disease and to examine internal consistency.

    Design: Test-retest study.

    Subjects: A total of 30 adults with neurological diseases including: Parkinson's disease; Multiple Sclerosis; Cervical Dystonia; and Charcot Marie Tooth disease.

    Method: The S-ESES was sent twice by surface mail. Completion interval mean was 16 days apart. Weighted kappa, intraclass correlation coefficient 2,1 [ICC (2,1)], standard error of measurement (SEM), also expressed as a percentage value (SEM%), and Cronbach's alpha were calculated.

    Results: The relative reliability of the test-retest results showed substantial agreement measured using weighted kappa (MD = 0.62) and a very high-reliability ICC (2,1) (0.92). Absolute reliability measured using SEM was 5.3 and SEM% was 20.7. Excellent internal consistency was shown, with an alpha coefficient of 0.91 (test 1) and 0.93 (test 2).

    Conclusion: The S-ESES is recommended for use in research and in clinical work for people with neurological diseases. The low-absolute reliability, however, indicates a limited ability to measure changes on an individual level.

  • 2.
    Anens, Elisabeth
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Exploratory Study of Physical Activity in Persons With Charcot-Marie-Tooth Disease2015In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 96, no 2, p. 260-268Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore and describe the perceived facilitators and barriers to physical activity, and to examine the physical activity correlates in people with Charcot-Marie-Tooth (CMT) disease. Design: Cross-sectional survey study. Setting: Community-living subjects. Participants: Swedish people with CMT disease (N=44; men, 54.5%; median age, 59.5y [interquartile range, 45.3-64.8y]). Interventions: Not applicable. Main Outcome Measures: The survey included open-ended questions and standardized self-reported scales measuring physical activity, fatigue, activity limitation, self-efficacy for physical activity, fall-related self-efficacy, social support, and enjoyment of physical activity. Physical activity was measured by the Physical Activity Disability Survey-Revised. Results: Qualitative content analysis revealed that personal factors such as fatigue, poor balance, muscle weakness, and pain were important barriers for physical activity behavior. Facilitators of physical activity were self-efficacy for physical activity, activity-related factors, and assistive devices. Multiple regression analysis showed that self-efficacy for physical activity (beta=.41) and fatigue (beta=-.30) explained 31.8% of the variation in physical activity (F-2,F-40=10.78, P=.000). Conclusions: Despite the well-known benefits of physical activity, physical activity in people with CMT disease is very sparsely studied. These new results contribute to the understanding of factors important for physical activity behavior in people with CMT disease and can guide health professionals to facilitate physical activity behavior in this group of patients. (C) 2015 by the American Congress of Rehabilitation Medicine

  • 3.
    Anens, Elisabeth
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Zetterberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Physical activity in subjects with multiple sclerosis with focus on gender differences: a survey2014In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 14, p. 47-Article in journal (Refereed)
    Abstract [en]

    Background: There is increasing research that examines gender-issues in multiple sclerosis (MS), but little focus has been placed on gender-issues regarding physical activity. The aim of the present study was to describe levels of physical activity, self-efficacy for physical activity, fall-related self-efficacy, social support for physical activity, fatigue levels and the impact of MS on daily life, in addition to investigating gender differences. Methods: The sample for this cross-sectional cohort study consisted of 287 (84 men; 29.3%) adults with MS recruited from the Swedish Multiple Sclerosis Registry. A questionnaire was sent to the subjects consisting of the self-administrated measurements: Physical Activity Disability Survey - Revised, Exercise Self-Efficacy Scale, Falls-Efficacy Scale (Swedish version), Social Influences on Physical Activity, Fatigue Severity Scale and Multiple Sclerosis Impact Scale. Response rate was 58.2%. Results: Men were less physically active, had lower self-efficacy for physical activity and lower fall-related self-efficacy than women. This was explained by men being more physically affected by the disease. Men also received less social support for physical activity from family members. The level of fatigue and psychological consequences of the disease were similar between the genders in the total sample, but subgroups of women with moderate MS and relapsing remitting MS experienced more fatigue than men. Conclusions: Men were less physically active, probably a result of being more physically affected by the disease. Men being more physically affected explained most of the gender differences found in this study. However, the number of men in the subgroup analyses was small and more research is needed. A gender perspective should be considered in strategies for promoting physical activity in subjects with MS, e. g. men may need more support to be physically active.

  • 4.
    Anens, Elisabeth
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Zetterberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Urell, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Self-reported physical activity correlates in Swedish adults with multiple sclerosis: a cross-sectional study2017In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 17, article id 204Article in journal (Refereed)
    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.

  • 5.
    Arkkukangas, Marina
    et al.
    School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23 Västerås, Sweden.
    Tuvemo Johnson, Susanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Söderlund, Anne
    School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23 Västerås, Sweden.
    Eriksson, Staffan
    Centre for Clinical Research Sörmland, Uppsala University, Kungsgatan 41, 631 88 Eskilstuna, Sweden.; Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-901 87 Umeå, Sweden.
    Johansson, Ann-Christin
    School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23 Västerås, Sweden.
    A feasibility study of a randomised controlled trial comparing fall prevention using exercise with or without the support of motivational interviewing2015In: Preventive Medicine Reports, ISSN 0350-1159, E-ISSN 2211-3355, Vol. 2, p. 134-140Article in journal (Refereed)
  • 6.
    Bohlen, S
    et al.
    Department of Neurology, University Hospital Muenster, University of Muenster, Muenster, Germany;.
    Ekwall, Camilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Vesterlin, H
    Björnefur, M
    Wiklund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Reilmann, R
    Physical therapy in Huntington's disease: towards objective assessments?2013In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 20, no 2, p. 389-393Article in journal (Refereed)
    Abstract [en]

    Background and purpose

    Physical therapy is recommended for the treatment of Huntington's disease, but reliable studies investigating its efficacy are almost non-existent. This may in part be due to the lack of suitable outcome measures. Therefore, we investigated the applicability of novel quantitative and objective assessments of motor dysfunction in the evaluation of physical therapy interventions aimed at improving gait and posture.

    Methods

    Twelve patients with Huntington disease received a predefined twice-weekly intervention focusing on posture and gait over 6 weeks. The GAITRite mat and a force plate were used for objective and quantitative assessments. The Unified Huntingtons Disease Rating Scale Total Motor Score, the timed Up &Go test, and the Berg Balance Scale were used as clinical outcome measures.

    Results

    Significant improvements were seen in GAITRite measures after therapy. Improvements were also seen in the Up & Go test and Berg Balance Scale, whereas force plate measures and Total Motor Scores did not change.

    Conclusions

    The results suggest that physical therapy has a positive effect on gait in Huntington's disease. The study shows that objective and quantitative measures of gait and posture may serve as endpoints in trials assessing the efficacy of physical therapy. They should be explored further in larger trials applying a randomized controlled setting.

  • 7.
    Dodd-Reynolds, Caroline Jane
    et al.
    Univ Durham, Sch Appl Social Sci, Durham, England..
    Åsenlöf, Pernilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Editorial: Special issue - physical activity and health2017In: Physical Therapy Reviews, ISSN 1083-3196, E-ISSN 1743-288X, Vol. 22, no 3-4, p. 101-102Article in journal (Other academic)
  • 8.
    Essner, Ann
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Sjostrom, Rita
    Ahlgren, Erik
    Gustas, Pia
    Edge-Hughes, Laurie
    Zetterberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Comparison of Polar RS800CX heart rate monitor and electrocardiogram for measuring inter-beat intervals in healthy dogs2015In: Physiology and Behavior, ISSN 0031-9384, E-ISSN 1873-507X, Vol. 138, p. 247-253Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to assess the criterion validity, relative reliability and level of agreement of Polar RS800CX heart rate monitor measuring inter-beat intervals (IBIs), compared to simultaneously recorded electrocardiogram (ECG) in dogs. METHODS: Five continuous minutes of simultaneously recorded IBIs from Polar RS800CX and Cardiostore ECG in 11 adult healthy dogs maintaining standing position were analyzed. Polar data was statistically compared to ECG data to assess for systematic differences between the methods. Three different methods for handling missing IBI data were used. Criterion validities were calculated by intraclass correlation coefficients (ICCs) and corresponding 95% confidence intervals (CIs). Relative reliabilities and levels of agreement were calculated by ICCs and the Bland and Altman analysis for repeated measurements per subject. RESULTS: Correlation coefficients between IBI data from ECG and Polar RS800CX varied between 0.73 and 0.84 depending on how missing values were handled. Polar was over- and underestimating IBI data compared to ECG. The mean difference in log transformed (base10) IBI data was 0.8%, and 93.2% of the values were within the limits of agreement. Internally excluding three subjects presenting IBI series containing more than 5% erroneous IBIs resulted in ICCs between 0.97 and 0.99. Bland and Altman analysis (n=8) showed mean difference was 1.8ms, and 98.5% of the IBI values were plotted inside limits of agreement. CONCLUSION: This study showed that Polar systematically biased recorded IBI series and that it was fundamental to detect measurement errors. For Polar RS800CX heart rate monitor to be used interchangeably to ECG, by showing excellent criterion validity and reliable IBI measures in group and individual samples, only less than 5% of artifacts could be accepted.

  • 9.
    Essner, Ann
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Sjostrom, Rita
    Reg Jamtland Harjedalen, Unit Res Educ & Dev, Ostersund, Sweden.;Mid Sweden Univ, Dept Hlth Sci, Ostersund, Sweden..
    Gustas, Pia
    Swedish Univ Agr Sci, Dept Clin Sci, Uppsala, Sweden..
    Edge-Hughes, Laurie
    Canine Fitness Ctr, Calgary, AB, Canada..
    Zetterberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala Univ, Dept Neurosci, Sect Physiotherapy, Uppsala, Sweden..
    Validity and reliability properties of canine short-term heart rate variability measures - a pilot study2015In: Journal of Veterinary Behavior: Clinical Applications and Research, ISSN 1558-7878, E-ISSN 1878-7517, Vol. 10, no 5, p. 384-390Article in journal (Refereed)
    Abstract [en]

    The objective of the pilot study was to compare validity and reliability properties of Polar RS800CX (Polar Electro Oy, Kempele, Finland) against simultaneously recorded electrocardiogram (ECG) measuring time-and frequency-based short-term heart rate variability (HRV) parameters, in dogs during stationary standing position. Five-minute recordings with less than 5% error rates from inter-beat interval (IBI) series obtained by Polar RS800CX and ECG, in 8 adult dogs, were used for HRV analysis. Polar data were statistically compared to the ECG data to assess for systematic differences in time-and frequency-based HRV parameters. Relative and absolute reliabilities were estimated by intraclass correlation coefficient, Spearman rho, Bland and Altman analysis, standard error of measurement, and standard error of measurements in percentage. Paired t test was used to determine the statistical significance of differences between the measurement methods. Results: There were high correlation coefficients between HRV parameters obtained from Polar RS800CX and ECG. Intraclass correlation coefficients were 0.98-1.00, and Spearman r was 0.93-0.98. There were differences between the methods in 2 HRV parameters, the standard deviation of normal-to-normal IBIs (SDNN) (P = 0.035) and the square root of the mean squared differences of successive normal-to normal IBIs (RMSSD) (P = 0.034). Standard error of measurements was between 2.8-11.6% in ECG and between 2.6-11.8% in Polar, indicating rather high measurement error in 3 of the HRV parameters in both measurement methods. Close agreements and high correlation estimates in this pilot study indicated acceptable relative reliability in Polar RS800CX measuring time-and frequency-based HRV parameters in the group of dogs studied. However, the present pilot study revealed differences between Polar RS800CX and ECG in time-based standard deviation of normal-to-normal and square root of the mean squared differences of successive normal-to normal parameters, and that small amounts of erroneous IBI segments from Polar negatively impact on the validity and reliability properties of Polar RS800CX.

  • 10.
    Essner, Ann
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Evidensia Djurkliniken Gefle, Gävle, Sweden.
    Zetterberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Gustas, Pia
    Swedish Univ Agr Sci, Fac Vet Med & Anim Husb, Dept Clin Sci, Box 7054, S-75007 Uppsala, Sweden..
    Högberg, Hans
    Univ Gavle, Fac Hlth & Occupat Studies, Dept Hlth & Caring Sci, S-80176 Gavle, Sweden..
    Sjöström, Rita
    Reg Jamtland Harjedalen, Unit Res Educ & Dev, Box 654, S-83127 Ostersund, Sweden.;Umea Univ, Fac Physiotherapy, Dept Community Med & Rehabil, S-90187 Umea, Sweden..
    Psychometric evaluation of the canine brief pain inventory in a Swedish sample of dogs with pain related to osteoarthritis2017In: Acta Veterinaria Scandinavica, ISSN 1751-0147, E-ISSN 1751-0147, Vol. 59, article id 44Article in journal (Refereed)
    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.

  • 11.
    Frandin, Kerstin
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden..
    Gronstedt, Helena
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.;Karolinska Univ, Huddinge Hosp, Dept Physiotherapy, Huddinge, Sweden..
    Helbostad, Jorunn L.
    Norwegian Univ Sci & Technol, Dept Neurosci, Trondheim, Norway.;St Olavs Univ Hosp, Dept Geriatr, Clin Serv, Trondheim, Norway..
    Bergland, Astrid
    Oslo & Akershus Univ Coll, Fac Hlth Sci, Oslo, Norway..
    Andresen, Mette
    Univ Coll Sjaelland, Dept Res & Innovat, Naestved, Denmark..
    Puggaard, Lis
    Univ Southern Denmark, Odense, Denmark..
    Harms-Ringdahl, Karin
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.;Karolinska Univ, Huddinge Hosp, Dept Physiotherapy, Huddinge, Sweden..
    Granbo, Randi
    Sor Trondelag Univ Coll, Fac Hlth Educ & Social Work, Trondheim, Norway..
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    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 Trial2016In: Gerontology, ISSN 0304-324X, E-ISSN 1423-0003, Vol. 62, no 6, p. 571-580Article in journal (Refereed)
    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.

  • 12.
    Fredriksson, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Reliability, validity and refernce values for the Functional Balance Test for Geriatric patients (FBG)2012In: Physical & Occupational Therapy in Geriatrics, ISSN 0270-3181, E-ISSN 1541-3152, Vol. 30, no 3, p. 177-188Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to establish the inter-rater reliability of the Functional Balance test for Geriatric patients (FBG) and concurrent validity between the FBG and the Berg balance scale, and to present reference values for the FBG. Patients (n = 22) aged between 66 and 87 years with varying diagnoses and elderly subjects without balance problems (n = 145) were assessed. The inter-rater reliability, calculated with intraclass correlation (ICC2.1) for FBG total was 0.99. Cohen's kappa coefficient (κ) varied between 0.83 and 0.94 for the four items in the FBG. The correlation between the total scores for FBG and the Berg balance scale, calculated with Spearman's rank correlation coefficient (rs) had a correlation of 0.96. The reference value for FBG total was 24 for men and woman aged 65–69 years, 23 for men and woman aged 70–79 years, 22 for men 80 years and older, and 21 for woman 80 years or older.

  • 13. Gronstedt, Helena
    et al.
    Frandin, Kerstin
    Bergland, Astrid
    Helbostad, Jorunn L.
    Granbo, Randi
    Puggaard, Lis
    Andresen, Mette
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Effects of Individually Tailored Physical and Daily Activities in Nursing Home Residents on Activities of Daily Living, Physical Performance and Physical Activity Level: A Randomized Controlled Trial2013In: Gerontology, ISSN 0304-324X, E-ISSN 1423-0003, Vol. 59, no 3, p. 220-229Article in journal (Refereed)
    Abstract [en]

    Background: Nursing home residents are extremely inactive and deterioration in health and an increasing dependence in activities of daily living (ADL) are common. Physical activity and exercise play a major role in the preservation of physical function and quality of life late in life. However, evidence for the benefit of rehabilitation in nursing home residents is conflicting and inconclusive. Objective: To evaluate the effect of an individually tailored intervention program of 3 months, for nursing home residents, on ADL, balance, physical activity level, mobility and muscle strength. Methods:In this single-blind randomized clinical trial with parallel groups, nursing home residents >64 years of age from three Nordic countries were included. The intervention group (IG) was assigned to individually tailored physical and daily activities, while the control group (CG) received ordinary care. Primary outcomes were ADL and balance, and secondary outcomes physical activity level, mobility and muscle strength. Results: At baseline, 322 nursing home residents were included, of whom 266 were assessed after 3 months of intervention. Following the intervention, a significant difference was found between participants in the IG and CG on measures of balance, physical activity and transfers. The IG significantly improved walking/wheelchair speed and functional leg muscle strength. The CG had significantly deteriorated in ADL, balance and transfers. Persons who had taken part in the intervention for more than 150 min/week significantly improved their balance and physical activity level. Participation in more than 10 weeks of intervention significantly improved physical activity and walking/wheelchair speed, while a deterioration was seen in those who had participated less. Conclusion: Individually tailored intervention in nursing home residents focusing on physical and daily activities is effective in improving transfers, balance and physical activity level compared to usual care. The effect of the intervention is dependent on the total activity time.

  • 14. Grönstedt, Helena
    et al.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Bergland, A
    Helbostad, J
    Puggaard, L
    Andresen, M
    Granbo, Randi
    Frändin, K
    Functional level, physical activity and wellbeing in nursing home residents in three Nordic countries2011In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 23, no 5-6, p. 413-420Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to describe physical and cognitive function and wellbeing among nursing home residents in three Nordic countries. A second aim was to compare groups of different age, level of dependency in daily life activities (ADL), degree of fall-related self-efficacy, wellbeing and cognitive function. Methods: 322 residents from nursing homes in Sweden, Norway and Denmark were included. Physical and cognitive function, level of physical activity and wellbeing were assessed by means of reliable and valid instruments.

    Results: The mean age of the participants was 85 years. Sixty percent could rise from a chair and 64% could walk independently. Men were younger and more physically active than women. Participants with a high level of dependency in ADL had a lower physical and cognitive function, were less physically active and had a lower fall-related self-efficacy than others. Participants with a low level of cognitive function showed a high fall-related self-efficacy.

    Conclusion: These data demonstrate that elderly residents in nursing homes in Sweden, Norway and Denmark are frail but heterogeneous. Significant differences in physical activity, physical function and dependency in ADL were seen in relation to age, fall-related self-efficacy, wellbeing and cognitive function.

  • 15.
    Hellström, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine.
    Lindmark, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Fugl-Meyer, A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine.
    The Falls-Efficacy Scale, Swedish version: does it reflect clinically meaningful changes after stroke?2002In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 24, no 9, p. 471-481Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    The overall aim of this prospective investigation was to evaluate the ability of the Falls Efficacy Scale (Swedish version) (FES(S)) to reflect clinically meaningful changes over time.

    METHOD:

    Changes on the FES(S) scale were compared with changes in two different standardized measures of observer-assessed balance, the Berg Balance Scale (BBS), the Fugl-Meyer balance subscale (FMB), and of motor function and ambulation in 62 stroke patients. Assessments took place on admission for rehabilitation, at discharge and 10 months after the stroke. Indices of effect size were used to evaluate responsiveness of the instruments. Three time periods were studied: admission to discharge (early response), discharge to 10 month follow-up (late response) and admission to follow-up (overall response).

    RESULTS:

    The main findings are that the FES(S) is as responsive as BBS and FMB in detecting changes during the early and overall response periods. Changes in FES(S) scores between admission and discharge correlated significantly with changes in observer-assessed balance, motor function and ambulation scores.

    CONCLUSIONS:

    The present results suggest that measurement of perceived confidence in task performance using the FES(S) scale is responsive to improvement in patients with hemiparesis at an early stage after stroke.

  • 16.
    Hellström, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Lindmark, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Wahlberg, Birgit
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Fugl-Meyer, Axel R
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Self-efficacy in relation to impairments and ADL disability in elderly stroke patients: A prospective investigation2003In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 35, no 5, p. 202-207Article in journal (Refereed)
    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.

  • 17.
    Hellström, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Sandström, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Heldeken Wågert, Petra
    Sandborgh, Maria
    Söderlund, Anne
    Thors Adolfsson, Eva
    Johansson, Ann-Christin
    Fall-related self-efficacy in instrumental activities of daily living is associated with falls in older community-living people2013In: Physical & Occupational Therapy in Geriatrics, ISSN 0270-3181, E-ISSN 1541-3152, Vol. 31, no 2, p. 128-139Article in journal (Refereed)
    Abstract [en]

    Introduction

    The aim of this study was to identify fall risk factors in community-living people 75 years or older.

    Methods

    From a random selection of 525 older adults, a total of 378 (72%) individuals participated in the study. Mean age was 81.7 years (range 75–101 years). A study-specific questionnaire including self-reported fall history for the past 6 months, the Falls-Efficacy Scale (Swedish version: FES(S)) and EuroQol 5 Dimensions (EQ5D) was used. Logistic regression analysis was conducted to find risk factors for falls.

    Results

    The strongest significant predictor of falls was scoring low on FES(S) in instrumental activities of daily living (IADL), with an odds ratio of 7.89 (95% confidence interval 2.93–21.25). One fifth had experienced one or more falls during the past 6 months. Both fall-related self-efficacy and health-related quality of life were significantly lower among fallers.

    Conclusion

    Our results imply that identifying community-living older adults with an increased risk of falling should include a measure of fall-related self-efficacy in IADL.

  • 18.
    Hellström, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Vahlberg, Birgit
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Urell, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Fear of falling, fall-related self-efficacy, anxiety and depression in individuals with chronic obstructive pulmonary disease2009In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 23, no 12, p. 1136-1144Article in journal (Refereed)
    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.

  • 19.
    Lindmark, Birgitta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Liljenäs, Åsa
    Department of Physiotherapy, University Hospital in Uppsala, Uppsala.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Assessment of minor or moderate balance disorders: A reliability study and comparison with healthy subjects2012In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 14, no 1, p. 3-9Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to examine the inter-rater, test–retest reliability and internal consistency of a new scale, the BDL Balance Scale, for assessing balance in patients with mild or moderate balance problems. An additional aim was to compare the results of assessed patients with the results of healthy subjects in order to demonstrate the discriminate ability of the scale. Patients (n = 30) aged 25–65 years and with neurological disorder and healthy subjects (n = 35) aged 30–65 years were assessed. The patients were assessed twice, by two different observers with 20 min in between, and the healthy subjects were assessed once. The reliability of the results obtained when testing the patients was calculated as intraclass correlation coefficient (ICC2.1), Cohen's kappa coefficient and Cronbach's alpha coefficient. The score differences were plotted in Bland–Altman graphs. The median total score was 24.0 points for the patients and 38.5 points for the healthy subjects (max 40 points). Cronbach's alpha coefficient was 0.89. The kappa coefficient for inter-rater reliability varied between 0.56 and 1.0, and ICC2.1 for the total score was 0.99. The kappa coefficients for test–retest reliability varied between 0.39 and 0.73, and ICC2.1 for the total scores was 0.96. The score between test occasions must be at least 5 points before the patients balance could be considered improved or deteriorated. The BDL Balance Scale has excellent to good intra-rater reliability and fairly good test–retest reliability and can differ between people with mild to moderate balance problems and healthy people of the same age. The sensitivity of the scales has to be further investigated.

  • 20.
    Lövgren, Anneli
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Reliability and validity of measurement and associations between disability and behavioural factors in patients with Colles' fracture2012In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 28, no 3, p. 188-197Article in journal (Refereed)
    Abstract [en]

    The aims of the study were to 1) investigate the test-retest reliability, the internal consistency in instruments that measure behavioural factors and disability as well as to investigate convergent validity between the Disabilities of the Arm, Shoulder, and Hand Outcome Questionnaire (DASH) and the Patient-Rated Wrist Evaluation (PRWE), in patients with Colles' fracture; and 2) assess the relationship between the behavioural measures and the region-specific measures addressing the patient perceptions of impairment, functional loss, and disability. Two samples (sample 1 = 16; sample 2 = 16) of patients with the fracture immobilised in plaster cast were included. The participants answered the Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand Outcome Questionnaire (DASH), Tampa Scale of Kinesophobia (TSK), Catastrophizing Subscale (CAT) of the Coping Strategies Questionnaire (CSQ), and Self-Efficacy Scale (SES) twice. Test-retest reliability was satisfactory for all instruments. The internal consistency examined with Cronbach's alpha was between 0.68 and 0.97. Because acceptable to good test-retest reliability and internal consistency were demonstrated for the PRWE, DASH, TSK, CAT of the CSQ, and SES, they can be used to detect and monitor fear of movement/(re)injury, catastrophic cognitions, and self-efficacy in patients with radius fracture in the acute and subacute phase. Generally low to moderate correlations were found between behavioural and region-specific measures, indicating that there are two distinct concepts that are not interchangeable.

  • 21.
    Lübcke, Ammis
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Martin, Cathrin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Older adults' perceptions of exercising in a senior gym2012In: Activities, adaption & aging, Vol. 36, no 2, p. 131-146Article in journal (Refereed)
    Abstract [en]

    This qualitative study investigated what factors influenced older adults to start and continue to exercise in a senior gym. Eight individuals, ages 65–81, were interviewed. The interviews were analyzed by manifest content analysis. Exercising at their own pace and finding peers, competent staff, and accessible machines were all positive factors for continuing to exercise in a senior gym. Initially, training was something to do to take control of life, physically or time-wise. Later, training became a health investment and a social activity. The found factors can be used as strategies for changing physical activity behavior in older adults.

  • 22. Mosallanezhad, Z
    et al.
    Salavati, M
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Sotoudeh, GR
    Nilsson Wikmar, L
    Frändin, K
    Cross-cultural adaptation, reliability and validity of the Persian version of the modified Falls Efficacy Scale2011In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 25-26, p. 2446-2453Article in journal (Refereed)
    Abstract [en]

    Purpose. To translate the Swedish version of the Falls Efficacy Scale (FES), the FES(S), into Persian, and to determine reliability and validity of the scale to be used for Persian speaking elderly people. Method. The 'forward-backward' procedure was applied to translate the FES(S) into Persian. A methodological study was then carried out to determine the psychometric properties of the Persian version of the scale. Eighty-one community-dwelling elderly persons (≥65 years) were included. Results. Both reliability and validity of the Persian FES(S) were found to be acceptable (Cronbach's α = 0.75, interclass correlation coefficients = 0.99, p < 0.001 and standard errors of measurements = 1.82). Low to moderate negative correlations of the total score of the scale with the age of the participants and number of falls in the past year were shown. There were also low to moderate correlations between the Persian FES(S) score and the Mini-Mental State Examination score, duration of walks and physical fitness. The participants who took a daily walk, felt healthy, reported no general tiredness and who had had no fall during the past year rated their self-efficacy higher than did their peers. Conclusions. The present study verified that the Persian FES(S) is a culturally relevant, valid and reliable tool for measuring self-perceived confidence in Iranian older adults.

  • 23.
    Mosallanezhad, Zahra
    et al.
    KI.
    Salavati, Mahyar
    Hellström, Karin
    Sotoudeh, Gholam Reza
    Nilsson Wikmar, Lena
    Frändin, Kerstin
    Cross-cultural adaption, reliability and validity of Persian version of the modified Falls Efficacy Scale2011In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 25-26, p. 2446-2453Article in journal (Refereed)
    Abstract [en]

    Purpose.To translate the Swedish version of the Falls Efficacy Scale (FES), the FES(S), into Persian, and to determinereliability and validity of the scale to be used for Persian speaking elderly people.Method.The ‘forward-backward’ procedure was applied to translate the FES(S) into Persian. A methodological study wasthen carried out to determine the psychometric properties of the Persian version of the scale. Eighty-one community-dwelling elderly persons (65 years) were included.Results.Both reliability and validity of the Persian FES(S) were found to be acceptable (Cronbach’sa¼0.75, interclasscorrelation coefficients¼0.99,p50.001 and standard errors of measurements¼1.82). Low to moderate negativecorrelations of the total score of the scale with the age of the participants and number of falls in the past year were shown.There were also low to moderate correlations between the Persian FES(S) score and the Mini-Mental State Examinationscore, duration of walks and physical fitness. The participants who took a daily walk, felt healthy, reported no generaltiredness and who had had no fall during the past year rated their self-efficacy higher than did their peers.Conclusions.The present study verified that the Persian FES(S) is a culturally relevant, valid and reliable tool for measuringself-perceived confidence in Iranian older adults.

  • 24.
    Nyström, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Fall risk six weeks from onset of stroke and the ability of the Prediction of Falls in Rehabilitation Settings Tool and motor function to predict falls2013In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 27, no 5, p. 473-479Article in journal (Refereed)
    Abstract [en]

    Objective

    To investigate whether the Prediction of Falls in Rehabilitation Settings Tool (Predict FIRST) and motor function could be used to identify people at risk of falling during the first six weeks after stroke, and to compare the risk of falling according to Predict FIRST with real falls frequency.

    Design

    A longitudinal, prospective study.

    Patients

    Sixty-eight people newly diagnosed with stroke admitted to an acute stroke unit.

    Methods

    The participants underwent an assessment of motor ability (Modified Motor Assessment Scale according to Uppsala University Hospital version 99 (M-MAS UAS-99)) and falls risk (Predict FIRST) on the first to fourth day at the acute stroke unit. Falls occurring in the acute stroke unit were recorded and falls occurring after discharge were reported by telephone follow-up. The prediction of falls was analysed with binary logistic regression.

    Results

    Fourteen of the patients (21%) fell at least once during the first six weeks after stroke. The strongest significant predictor for falls was a high score on Predict FIRST (odds ratio 5.21, confidence interval (CI) 1.10–24.78) followed by M-MAS UAS-99 parts C–E (odds ratio 0.65, CI 0.44–0.95). Predict FIRST underestimated the risk of falling as the median fall risk was 9% according to Predict FIRST.

    Conclusion

    Although Predict FIRST has the ability to predict falls in people with recent onset of stroke, there is some underestimation of fall risk.

  • 25.
    Tuvemo Johnson, Susanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Martin, Cathrin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Educational Sciences, Department of Education.
    Anens, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Johansson, Ann-Christin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Mälardalen Univ, Phys Therapy, Västeras, Sweden.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Older adults' opinions on fall prevention in relation to physical activity level2018In: Journal of Applied Gerontology, ISSN 0733-4648, E-ISSN 1552-4523, Vol. 37, no 1, p. 58-78Article in journal (Refereed)
    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.

  • 26.
    Vahlberg, Birgit
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Bring, Annika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Zetterberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Level of physical activity in men and women with chronic stroke2018In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, p. 1-9Article in journal (Refereed)
    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.

  • 27.
    Vahlberg, Birgit
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Lindmark, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Zetterberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Factors Related to Performance-Based Mobility and Self-reported Physical Activity in Individuals 1-3 Years after Stroke: A Cross-sectional Cohort Study2013In: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 22, no 8, p. E426-E434Article in journal (Refereed)
    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.

  • 28.
    Vahlberg, Birgit
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Lindmark, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Zetterberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Short-term and long-term effects of a progressive resistance and balance exercise program in individuals with chronic stroke: a randomized controlled trial2017In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 39, no 16, p. 1615-1622Article in journal (Refereed)
    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.

  • 29.
    Vahlberg, Birgit
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
    Treatment and assessment of neglect after stroke – from a physiotherapy perspective: A systematic review2008In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 10, no 4, p. 178-187Article, review/survey (Refereed)
    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.

  • 30.
    Vahlberg, Birgit
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Lindmark, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Zetterberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Body composition and physical function after progressive resistance and balance training among older adults after stroke: an exploratory randomized controlled trial2017In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 39, no 12, p. 1207-1214Article in journal (Refereed)
    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.

  • 31.
    Vahlberg, Birgit
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Zetterberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Lindmark, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Functional performance, nutritional status, and body composition in ambulant community-dwelling individuals 1-3 years after suffering from a cerebral infarction or intracerebral bleeding2016In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, article id 48Article in journal (Refereed)
    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

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