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Syfte: Studiens syfte var att reliabilitetspröva stabiliteten för M-SES för patienter med långvarig smärta genom test-retest metoden. Syftet var även att undersöka samtidig validitet för M-SES, genom att utföra M-SES och SES mätt vid samma tillfälle.

Metod: I studien undersöktes self-efficacy instrumentet M-SES på Uppsala Akademiska sjukhus, på avdelningarna för Smärtcentrum och Smärtrehabilitering. Frågeställningarna berörde vilken stabilitets reliabilitet mätt med test-retest som förelåg hos M-SES, samt vilken grad av samtidig validitet som förelåg för M-SES korrelerat med SES. Den slutliga undersökningsgruppen bestod i frågeställningen om stabilitets reliabilitet av 29 patienter (23 kvinnor, sex män), och i frågeställning om samtidig validitet av 22 patienter (17 kvinnor, fem män).

Resultat: Vid prövning av stabilitets reliabilitet för M-SES visade resultatet en stark korrelation, med korrelationskoefficient 0,92 och p<0,05. Det förelåg även en god överrensstämmelse för test-retest undersökningen. Prövningen av samtidig validitet för M-SES visade en stark korrelation, med koefficienten 0,88 och p<0,05.

Konklusion: Studiens resultat visade att det förelåg en stark stabilitets reliabilitet och samtidig validitet för M-SES för patienter med långvarig smärta. Då studien genomfördes med få deltagare bör resultatet tolkas med försiktighet.

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.

The overall aim of this thesis was to assess measurement properties of methods suitable for screening or monitoring of physical capacity and physical activity in subjects with chronic obstructive pulmonary disease (COPD), and to explore factors associated with physical activity levels.

Methods: Four observational studies were conducted. Participants in studies I-III (sample sizes) (n=49, n=15, n=73) were recruited from specialist clinics, and in study IV from a population-based cohort (COPD n=470 and Non-COPD n=659). Psychometric properties of methods assessing physical capacity (study I) and physical activity (study II) were investigated in laboratory settings. Daily physical activity and clinical characteristics were assessed with objective methods (study III) and with subjective methods (study IV).

Results: Physical capacity as measured by walking speed during a 30-metre walk test displayed high test-retest correlations (ICC>0.87) and small measurement error. The accuracy for step count and body positions differed between activity monitors and direct observations. In study III 92% of subjects had an activity level below what is recommended in guidelines. Forty five percent of subjects’ activity could be accounted for by clinical characteristics with lung function (22.5%), walking speed (10.1%), quadriceps strength (7.0%) and fat-free mass index (3.0%) being significant predictors. In study IV, low physical activity was significantly more prevalent in COPD subjects from GOLD grade ≥II than among Non-COPD subjects (22.4 vs. 14.6%, p = 0.016). The strongest factors associated with low activity in COPD subjects were a history of heart disease, OR (CI 95%) 2.11 (1.10-4.08) and fatigue, OR 2.33 (1.31-4.13) while obesity was the only significant factor in Non-COPD subjects, OR 2.26 (1.17-4.35).

Conclusion: The 30 meter walk test and activity monitors are useful when assessing physical capacity and physical activity, respectively in patients with COPD. Impaired physical activity in severe COPD is related to low lung function, low walking speed, low muscle strength and altered body composition, whereas comorbidities and fatigue are linked to insufficient physical activity in patients with moderately severe COPD.

Low physical activity and sedentary behaviour characterise the lives of patients with chronic obstructive pulmonary disease (COPD). Using activity monitors, assessment of both aspects are possible, but many outcomes are not well validated. The aim of this study was to assess the accuracy and equivalency of three activity monitors regarding steps, body position and their ability to differentiate between periods of physical activity and inactivity.

Fifteen patients with COPD (8 females; median (interquartile range, IQR) age, 64 (59-69) years; forced expiratory volume in one second, 37 (28-48) % predicted; six-minute walk distance, 444 (410-519) m) were enrolled. The DynaPort ADL-monitor, the DynaPort MiniMod monitor and the SenseWear Armband Pro 3 monitor were assessed. Subjects performed a structured protocol alternating physical activity and inactivity while simultaneously wearing all three monitors and being video recorded.

The mean difference (limits of agreement) in step count from monitors compared to manual step count was -69 (-443 to 305) for the ADL-monitor, -19 (-141 to 103) for the MiniMod and -479 (-855 to -103) for the SenseWear Armband. Compared to the video, the sitting time was 97 (94-100) % when measured by the ADL-monitor and 121 (110-139) % by the MiniMod. Standing time was 114 (107-122) % when measured by the ADL-monitor and 68 (47-106) % by the MiniMod.

Activity monitors are not equivalent in their abilities to detect steps or body positions. The choice of monitor should be based on the particular outcome of interest. 

AIMS:

To examine test-retest reliability of the 30-metre walk test (30mWT) in patients with chronic obstructive pulmonary disease (COPD) and to compare the 30mWT with the 6-minute walk test (6MWT).

METHODS:

Forty-nine subjects with stable COPD were included. The 30mWT consists of walking at different walking intensities over a distance of 30 metres - self-selected speed (ss-30mWT) and maximal speed (ms-30mWT). The test was conducted twice and the time to walk 30 metres was recorded. The 6MWT was performed in duplicate on the same day.

RESULTS:

Test-retest reliability was high: intraclass correlation coefficient (ICC2.1) = 0.93 (95% CI 0.87 to 0.97) for maximal walking speed and 0.87 (95% CI 0.78 to 0.93) for self-selected walking speed. Both maximal and self-selected speed had a standard error of measurement (SEM) of 0.07 m/s and SEM% was 4.4 for maximal speed and 5.9 for self-selected speed. The correlation, criterion validity, between ms-30mWT and the 6MWT was r=0.78 (p<0.001). Heart rate, dyspnoea, exertion and oxygen saturation were more affected after the 6MWT than after the 30mWT (p<0.001).

CONCLUSIONS:

The 30mWT is a reliable submaximal test that is easy to perform and can be used to measure physical function (walking ability) in patients with COPD. It may be well suited for primary care settings.

Background: Decreased physical activity is associated with higher mortality in subjects with COPD. The aim of this study was to assess clinical characteristics and physical activity levels (PALs) in subjects with COPD. Methods: Seventy-three subjects with COPD (67 +/- 7 yrs, 44 female) with one-second forced expiratory volume percentage (FEV1%) predicted values of 43 +/- 16 were included. The ratio of total energy expenditure (TEE) and resting metabolic rate (RMR) was used to define the physical activity level (PAL) (PAL = TEE/RMR). TEE was assessed with an activity monitor (ActiReg), and RMR was measured by indirect calorimetry. Walking speed (measured over 30-meters), maximal quadriceps muscle strength, fat-free mass and systemic inflammation were measured as clinical characteristics. Hierarchical linear regression was applied to investigate the explanatory values of the clinical correlates to PAL. Results: The mean PAL was 1.47 +/- 0.19, and 92% of subjects were classified as physically very inactive or sedentary. The walking speed was 1.02 +/- 0.23 m/s, the quadriceps strength was 31.3 +/- 11.2 kg, and the fat-free mass index (FFMI) was 15.7 +/- 2.3 kg/m(2), identifying 42% of subjects as slow walkers, 21% as muscle-weak and 49% as FFM-depleted. The regression model explained 45.5% (p < 0.001) of the variance in PAL. The FEV1% predicted explained the largest proportion (22.5%), with further improvements in the model from walking speed (10.1%), muscle strength (7.0%) and FFMI (3.0%). Neither age, gender nor systemic inflammation contributed to the model. Conclusions: Apart from lung function, walking speed and muscle strength are important correlates of physical activity. Further explorations of the longitudinal effects of the factors characterizing the most inactive subjects are warranted.

Introduction

Dyspnea with exertion and fatigue are the cardinal symptoms of chronic obstructive pulmonary disease (COPD); impaired muscle function and reduced exercise capacity are also frequently associated with COPD. We aimed to assess the physical activity levels, in a population based sample study, of subjects with and without COPD. We also aimed to investigate the factors associated with low physical activity in these groups.

Methods

In this study, 470 subjects with COPD (FEV1/FVC< 0.70) and 569 subjects without COPD (Non-COPD) were analyzed. Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ). Fatigue was investigated with the Functional Assessment of Chronic Illness Therapy - Fatigue scale (FACIT-F). An interview questionnaire was used to record the sample characteristics and history of heart disease. Binary logistic regression was used to investigate the factors associated with low physical activity.

Results

Low physical activity was significantly more prevalent in GOLD grade ≥II COPD subjects, and this prevalence was higher than that for Non-COPD subjects (22.4 vs. 14.6%, p = 0.016). The strongest factors associated with low physical activity in COPD subjects were a history of heart disease, OR (CI 95%) 2.11 (1.10 - 4.08), and clinically significant fatigue, OR 2.33 (1.31 - 4.13); obesity was the only significant factor in Non-COPD subjects, OR 2.26 (1.17 – 4.35).

Conclusion

Physical activity levels are reduced for COPD grade II and higher, and the factors associated with lower levels of physical activity are different for the COPD group compared to the Non-COPD group. We propose that measurements of fatigue and a history of heart disease are useful tools to include when screening subjects for pulmonary rehabilitation.

Abstract

Background: Plantar fasciitis is the most common heel injury and is a long-term pain syndrom in the attachment of the plantar fascia to the calcaneus bone. The condition is treated mainly in primary care, but there is currently no treatment guideline for the treatment of plantar fasciitis in Sweden. The purpose of this study was to investigate which treatment that occurred in primary care in Dalarna, Gävleborg and Västmanland counties, which treatments that were most common alone and in combination with each other. The aim was also to investigate if the four most commonly used treatment methods as physical therapists said they had used were supported in the literature, and if there was any difference between county employees and private physical therapists in the choice of treatment method.

Method: 100 physiotherapists in primary care in Dalarna, Gävleborg and Västmanland counties, received a questionnaire by mail. 80 of the 100 physiotherapists were county employees and 20 were private employees. They were asked about what treatment methods they used for plantar fasciitis, both individual treatments and combination treatments. A comparison was made between county employees and private employees' choice of treatments and the four individual most frequently used treatments were examined on the basis of recent research.

Results: 65 physiotherapists answered the survey, of which 61 of them treated patients with plantar fasciitis. The four most frequently used treatments were taping, stretch of the plantar fascia, advice about start using insoles and advice about changing of shoes. The first three treatments named above were also those most commonly used in combination with each other. This was true for physiotherapists in county as well as in private employment. There is some evidence that these three treatments relieve pain particularly in short term.

Conclusion: The four most frequently used treatments were taping, stretch of the plantar fascia, advice about start using insoles and advice about changing of shoes. The conclusion drawn from the evidence currently available to taping, stretch of the plantar fascia and insoles is that it should be a part of the treatment plan for patients with plantar fasciitis. Further research is needed where larger studies and follow-up studies over a longer time is made. Studies of the most common combination treatments should be made, to mimic how they are used in everyday clinical practice.

Syftet med studien var att undersöka fallrelaterad self-efficacy mätt med Falls Efficacy Scale (Swedish version) (FES(S)) samt att beräkna rekommenderade referensvärden för totalpoängen på FES(S) hos friska äldre män och kvinnor indelade i åldersgrupperna 65-75 år samt > 75 år. Vidare syftade studien till att undersöka om det fanns några skillnader i resultatet mellan åldersgrupperna samt mellan män och kvinnor.

Undersökningsgruppen bestod av totalt 70 individer över 65 års ålder, varav 45 var kvinnor och 25 var män. Testdeltagarna kontaktades via PRO i Uppsala. Även vänner och bekanta till författarna deltog i studien. Testdeltagarnas fallrelaterade self-efficacy undersöktes med hjälp av instrumentet FES(S), där testdeltagarna fick skatta hur säkra de känner sig på att utföra 13 olika vardagsaktiviteter utan att falla, maximal poäng 130.

Resultatet visade att det rekommenderade referensvärdet för totalpoängen på FES(S) blev 124 poäng för kvinnor i åldern 65-75 år och 126 poäng för män i samma ålder. För kvinnor > 75 år ålder blev det rekommenderade referensvärdet 118 poäng och för män 105 poäng. Det fanns en statistiskt signifikant skillnad för totalpoängen på FES(S) mellan de två åldersgrupperna, p=0,005. Ingen statistiskt signifikant skillnad kunde påvisas mellan könen, p=0,632. För att få fram mer generaliserbara referensvärden behövs ytterligare studier med ett mer representativt urval och en större undersökningsgrupp.

OBJECTIVE: Chronic diseases interfere with the life situation of the affected person in different ways. The aim was to compare the burden of disease in three chronic diseases - chronic obstructive pulmonary disease (COPD), rheumatoid arthritis (RA), diabetes mellitus (DM) - and in healthy subjects, with a particular interest in physical activity, quality of life, and psychological health. DESIGN: Cross-sectional, observational study. SETTING AND SUBJECTS: Postal survey questionnaire to a stratified, random population of 68 460 subjects aged 18-84 years in Sweden. The subjects included were 40-84 years old (n = 43 589) and data were analysed for COPD (n = 526), RA (n = 1120), DM (n = 2149) and healthy subjects (n = 6960). RESULT: Some 84% of subjects with COPD, 74% (RA), 72% (DM), and 60% in healthy subjects (p < 0.001, COPD versus RA, DM, and healthy subjects) had a physical activity level considered too low to maintain good health according to guidelines. Quality of life (EuroQol five-dimension questionnaire, EQ-5D) was lower in COPD and RA than in DM. Anxiety/depression was more common in subjects with COPD (53%) than in those with RA (48%) and DM (35%) (p < 0.001, COPD versus RA and DM), whereas mobility problems were more common in RA (55%) than COPD (48%) and DM (36%) (p < 0.001, RA versus COPD and DM). All differences between groups remained significant after adjusting for age, sex, and socioeconomic background factors. CONCLUSION: Subjects with chronic diseases had a low level of physical activity, most evident in subjects with COPD. COPD and RA had a higher negative impact on quality of life than DM. Our results indicate that increased attention regarding physical inactivity in subjects with chronic diseases is needed to minimize the burden of disease.

Background: Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality worldwide. Diagnosis is customarily confirmed with spirometry, but there are few studies on documented spirometry use in everyday clinical practice. Methods: In a cross-sectional survey and study of the medical records of primary and secondary care COPD patients aged 18-75 in a Swedish region, patients with COPD were randomly selected from the registers of 56 primary care centres and 14 hospital outpatient clinics. Spirometry data at diagnosis ±6 months were analyzed. Results: From 1,114 patients with COPD, 533 with a new diagnosis of COPD during the four-year study period were identified. In 59% (n=316), spirometry data in connection with diagnosis were found in the medical records. Spirometry data with post-bronchodilator forced expiratory volume in one second (FEV₁)/ vital capacity (VC) ratios were available in 45% (n=241). FEV₁/VC ratio <0.70 were found in 160 patients, which corresponds to 30% of the patients with a new diagnosis. Lower age, female gender, current smoking, higher body mass index (BMI) and shorter forced exhalation time were related to COPD diagnosis despite an FEV₁/VC ratio of ≥0.70. The most common problem in the quality assessment was an insufficient exhalation time. Conclusions: Only a third of Swedish patients with COPD had their diagnosis confirmed with spirometry. Our data indicate that female gender, current smoking, higher BMI and short exhalation time increase the risk of being diagnosed with COPD without fulfilling the spirometric criteria for the disease.

Background: Recent guidelines for chronic obstructive pulmonary disease (COPD) state that COPD is both preventable and treatable. To gain a more positive outlook on the disease it is interesting to investigate factors associated with good, self-rated health and quality of life in subjects with self-reported COPD in the population.

Methods: In a cross-sectional study design, postal survey questionnaires were sent to a stratified, random population in Sweden in 2004 and 2008. The prevalence of subjects (40–84 years) who reported having COPD was 2.1% in 2004 and 2.7% in 2008. Data were analyzed for 1475 subjects. Regression models were used to analyze the associations between health measures (general health status, the General Health Questionnaire, the EuroQol five-dimension questionnaire) and influencing factors.

Results: The most important factor associated with good, self-rated health and quality of life was level of physical activity. Odds ratios for general health varied from 2.4 to 7.7 depending on degree of physical activity, where subjects with the highest physical activity level reported the best health and also highest quality of life. Social support and absence of economic problems almost doubled the odds ratios for better health and quality of life.

Conclusions: In this population-based public health survey, better self-rated health status and quality of life in subjects with self-reported COPD was associated with higher levels of physical activity, social support, and absence of economic problems. The findings indicated that of possible factors that could be influenced, promoting physical activity and strengthening social support are important in maintaining or improving the health and quality of life in subjects with COPD. Severity of the disease as a possible confounding effect should be investigated in future population studies.

Purpose: To investigate a group of physiotherapists’ experiences of using treatment plans for patients in stroke units in Landstinget Gävleborg.

Design and method: Descriptive qualitative design. Semi-structured interviews. Qualitative content analysis was conducted.

Results: The physiotherapists found treatment plans to be useful in early rehabilitation of stroke patients. Early goal setting assist to give the patients motivation and understanding of their situation, but brain injury could make participation difficult. Treatment plans was perceived to have the potential to act as a unifying document for the team though the physiotherapists felt a constant struggle for rehab thinking in the team. Technical problems hindered the transfer of treatment plans to the next level of care.

Conclusion: The physiotherapists saw the benefits of early goal setting, but held a constant struggle to gather the team around the treatment plan. The study suggests that the treatment plan as working instrument is not being used in all its potential. The study may contribute when forming  routines for treatment plans in the future.

Purpose: The purpose of this study was to examine outcome expectations in terms of physical, self-evaluative and social expectations of regular physical activity/exercise in physically active or physically inactive older adults, and compare the two groups and see if any difference existed.Method: The participants were 32 conveniently selected individuals, representing the population elderly (> 65 years) and healthy individuals who are regularly physically active or inactive. The participants answered a questionnarie regarding their level of physical activity during the last 12 months which divided them into two groups, physically active or physically inactive. The Multidimensional Outcome Expectations for Exercise Scale (MOEES) questionnaire was then used to measure the participant´s level of outcome expectations of regular physical activity/exercise.

Results: The regularly physically active participants had higher scores on MOEES, in terms of physical expectations than participants who were physically inactive. No significant difference where seen between the two when comparing the total score of MOEES and the subgroups self-evaluative, and social expectations for regular physical activity/exercise.

Conclusion: This study showed that there in older adults, is a relation between being physically active and having higher physical outcome expectations of physical activity/exercise. Further studies which examines outcome expectations in terms of physical, self-evaluative and social expectations of regular physical activity/exercise, in physically active or physically inactive older adults is warranted.

Background

The purpose of this study is to investigate the feasibility of measurements of muscle strength, balance, cognitive function, mobility, activities of daily living (ADL), and physical activity for use in a Scandinavian nursing home population and to examine intercorrelations between these measurements.

Method

The design was cross-sectional and 322 residents’ functions were evaluated by grip strength, the Timed Chair Stand Test, Berg’s Balance Scale, Falls Efficacy Scale, Swedish version of Mini-Mental State Examination, 10-m walking and wheelchair propulsion at self-selected and maximum speed, functional independence measure, physiotherapy clinical outcome variables, and the Nursing Home Life Space Diameter.

Results

The mean age of the group was 85 years. Sixty-four percent were able to walk with or without walking aids, and 59% were able to rise independently from chair once. The level of participation in the tests was 70% or more, except for the 10-m walking/wheeling test and the Timed Chair Stand Test. No floor or ceiling effect was discovered. The significant correlation coefficients between different measurements of muscle strength, balance, cognitive function, mobility, ADL, and physical activity range from 0.14 to 0.90.

Conclusion

The instruments seem to be feasible for residents in Scandinavian nursing homes, and the residents appear to be a heterogeneous group with respect to functioning, mostly at low level.