| 1. |
- Månsson, Linda, et al.
(författare)
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Evaluation of Concurrent Validity between a Smartphone Self-Test Application and Clinical Tests for Balance and Leg Strength
- 2021
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Ingår i: Sensors. - : MDPI. - 1424-8220. ; 21:5
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Tidskriftsartikel (refereegranskat)abstract
- The evolving use of sensors to objectively assess movements is a potentially valuable addition to clinical assessments. We have developed a new self-test application prototype, MyBalance, in the context of fall prevention aimed for use by older adults in order to independently assess balance and functional leg strength. The objective of this study was to investigate the new self-test application for concurrent validity between clinical instruments and variables collected with a smartphone. The prototype has two test procedures: static standing balance test in two positions, and leg strength test performed as a sit-to-stand test. Thirty-one older adults were assessed for balance and functional leg strength, in an outpatient physiotherapy setting, using seven different clinical assessments and three sensor-tests. The results show that clinical instruments and sensor measurements correlate to a higher degree for the smartphone leg strength test. For balance tests, only a few moderate correlations were seen in the Feet Together position and no significant correlations for the Semi Tandem Stance. This study served as a first step to develop a smartphone self-test application for older adults to assess functional balance at home. Further research is needed to test validity, reliability, and user-experience of this new self-test application.
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| 2. |
- Månsson, Linda, 1973-
(författare)
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Digital fall prevention for older adults : Feasibility of a self-managed exercise application and development of a smartphone self-test for balance and leg strength
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- As the numbers of older adults grow, fall prevention is vital to reduce health care needs due to falls and to increase quality of life. Balance and strength exercises have been found to be effective in fall prevention, however, long-term adherence is often poor. The growth of digital technology in society has generated opportunities for fall prevention with eHealth. The aim of this thesis was to evaluate the feasibility and use of a new digital fall prevention exercise programme, and to develop and investigate a smartphone self-test application for balance and leg strength. Three different studies included community-dwelling older adults ≥ 70 years, who were able to rise from a chair and stand without support. A feasibility study evaluated a new digital exercise programme (DP) compared to a paper booklet exercise programme (PB) for self-managed fall prevention in a four-month controlled participant preference trial (n = 67) (Paper I & II). Self-reported data on adherence, falls efficacy, and functional ability were collected and analysed, along with performance-based measures of gait speed, balance, and chair stand test. In Paper II the feasibility was explored of using the self-reported scales and performance-based outcome measures. A self-test application was also developed (Paper III) in co-creation with 10 participants, who met during five sessions to design the application’s instructions and user interface. The participants’ preference for and their contribution to the application design was analysed with qualitative content analysis with a deductive-inductive approach. A concurrent validity study (n = 31) (Paper IV) assessed the correlations between variables from the self-test prototype and outcome measures from clinical instruments. Results from the feasibility study show that 43% chose the DP and 57% PB, and the attrition rate was 17% and 37% respectively. Both groups had similar adherence, but for the subgroup that exercised most, participants in the DP group reported significantly more exercise time (Paper I). Participants in both groups reported a boost in balance after the intervention, and in the DP group also improved leg strength. Significantly more participants continued to use the DP at 12 months. The self-managed exercise intervention (Paper II) resulted in improvements in functional leg strength, which positively correlated with exercise time, but no other performance-based outcomes showed any significant improvements. Performance-based measurements of balance as well as the self- reported balance confidence and fear of falling revealed ceiling effects. Pre-assessments of self-reported outcomes and performance-based measures showed significant but low correlations, no such correlations were seen in change scores. The deductive-inductive analysis of the co-creation process resulted in 17 subcategories within the seven facets of the Optimized Honeycomb model for iii user experience (Paper III). The main results were that participants desired clear and appropriate information to understand why things were done in a certain way, and their contributions enhanced the user experience of the self-test. The concurrent validity testing of the self-test prototype (IV) showed low to moderate correlations for the strength test but limited correlations for the balance test. In conclusion the DP group showed comparable adherence to the programme as the PB group, as well as to previous studies, indicating it was feasible to use the new DP. DP participants also reported better exercise maintenance after 12 months. Positive self-reported effects were expressed in addition to leg strength improvement. Outcome measures for balance and falls efficacy revealed ceiling effects, consequently, these instruments might not be suitable for assessments in all community-dwelling older adults. In particular, for balance related outcomes there is a need for new more sensitive measurements. The co-creation of the smartphone self-test was feasible and valuable for user experience, but further validity and reliability testing are needed before it can serve as an independent assessment tool.
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| 3. |
- Pettersson, Beatrice, 1987-
(författare)
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Fall prevention exercise for older adults : self-management with support of digital technology
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Falls are a major public health issue, which can cause physical and psychological suffering for the individual as well as large costs for the society. To increase access and adherence to evidence-based fall prevention exercise, utilisation of older adults’ own capabilities and digital health offers promising solutions. The aim of this thesis was to explore a digital programme as support for self-management of fall preventive exercises in community-dwelling older adults with a focus on participant experiences, behaviour change, and intervention reach.Methods: This thesis comprises four papers, of which Papers I and II report from a feasibility study comparing two self-managed fall prevention exercise programmes, a paper booklet and the digital Safe Step programme. Papers III and IV describes a randomised controlled trial, which evaluates the effectiveness of the Safe Step programme in combination with educational videos, to reduce falls in comparison with educational videos alone. In Paper I, individual interviews were analysed with inductive qualitative content analysis to explore older adults’ experiences of self-managing their fall prevention exercise. In Paper II, a deductive and inductive approach was utilised for the analysis of comments in questionnaires, individual, and focus group interviews to explore experiences of self-determination when using the Safe Step programme. The classification system of motivational and behaviour change strategies based on Self-determination theory was utilised as a categorisation matrix. An additional analysis of behavioural regulation for exercise according to the Self-determination theory was performed in this thesis. Paper III is a protocol for a randomised controlled trial, and Paper IV describes the recruitment strategies, and reach of this trial through comparison with another representative sample of adults 70 years or older by descriptive statistics.Results: Results from Papers I and II show that the older adults appreciated the autonomy of a self-managed exercise programme. They expressed a capability to independently select exercises and manage their progression with support from the programme. However, some wanted the support of others in their training. The behaviour change support in the Safe Step programme was voiced as motivating and supportive, and the diversity of behaviour change strategies was emphasized as important to suit many older adults’ preferences. In Paper II, the behaviour change support were found supportive for the basic human psychological needs according to the Self-determination theory, although, support for autonomy and competence were more clearly stated than for relatedness. An additional category was formed and proposed as an amendment to the classification system used as an analytical matrix. In the thesis, expressions of intrinsic and extrinsic motivations for doing the exercise from participants in Paper I were triangulated with results from the Behavioural Regulations in Exercise Questionnaire-2. The results confirmed the trend found in the qualitative analysis of more intrinsically motivated expressions in the group using the Safe Step programme. A study protocol was written that described the design of the Safe Step randomised controlled trial, including the aims, methodology and overall organisation of the research (Paper III). In Paper IV, the most successful recruitment strategy to the randomised controlled trial was identified as advertisement in social media. The recruited participants were predominantly women, highly educated, and frequently used applications or internet on mobile devices.Conclusion: Finding of this thesis support implementation of fall prevention strategies through increased utilisation of older adults' self-management capabilities. Older adults’ experiences of exercising with a self-managed digital exercise program can be understood as managing pieces of a personal puzzle and was shaped more by the sum of the features and behaviour change support in the programme than by parts of the programme. The Safe step programme seems to provide support for more self-determined exercise motivation, than a paper booklet, which can support maintenance of the new exercise routines. The older adults’ experiences, as well as the characteristics of the participants reached, highlight the necessity for a variety of fall prevention strategies that reflect the diversified needs and preferences of older adults.
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| 4. |
- Sandlund, Marlene, et al.
(författare)
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Gender perspectives on views and preferences of older people on exercise to prevent falls : mixed studies review
- 2017
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDTo offer fall prevention exercise programs that attract older people of both sexes there is a need to understand both women's and men's views and preferences regarding these programs. This paper aims to systematically review the literature to explore any underlying gender perspectives or gender interpretations on older people's views or preferences regarding uptake and adherence to exercise to prevent falls.METHODSA review of the literature was carried out using a convergent qualitative design based on systematic searches of seven electronic databases (PubMed, CINAHL, Amed, PsycINFO, Scopus, PEDro, and OTseeker). Two investigators identified eligible studies. Each included article was read by at least two authors independently to extract data into tables. Views and preferences reported were coded and summarized in themes of facilitators and barriers using a thematic analysis approach.RESULTSNine hundred and nine unique studies were identified. Twenty five studies met the criteria for inclusion. Only five of these contained a gender analysis of men's and women's views on fall prevention exercises. The results suggests that both women and men see women as more receptive to and in more need of fall prevention messages. The synthesis from all 25 studies identified six themes illustrating facilitators and six themes describing barriers for older people either starting or adhering to fall prevention exercise. The facilitators were: support from professionals or family; social interaction; perceived benefits; a supportive exercise context; feelings of commitment; and having fun. Barriers were: practical issues; concerns about exercise; unawareness; reduced health status; lack of support; and lack of interest. Considerably more women than men were included in the studies.CONCLUSIONAlthough there is plenty of information on the facilitators and barriers to falls prevention exercise in older people, there is a distinct lack of studies investigating differences or similarities in older women's and men's views regarding fall prevention exercise. In order to ensure that fall prevention exercise is appealing to both sexes and that the inclusion of both men and women are encouraged, more research is needed to find out whether gender differences exists and whether practitioners need to offer a range of opportunities and support strategies to attract both women and men to falls prevention exercise.
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| 5. |
- Melander-Wikman, Anita, et al.
(författare)
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Project: Early signs of mobility limitations and fall events in old age: long-term consequences and tailored preventive interventions through interactive media
- 2012
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Annan publikation (populärvet., debatt m.m.)abstract
- The aims of this project are 1) to investigate the consequences over five years of early signs of mobility limitations expressed as fallevents, a changed walking pattern with a cognitive load (dual-task costs), and decreased balance confidence on severe fall-relatedinjuries, perceived health, participation, activities of daily living, and gait performance, and 2) to develop, together with older people,and evaluate tailored fall-prevention through interactive media in a randomized controlled trial with two arms.
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| 6. |
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| 7. |
- Pohl, Petra, et al.
(författare)
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Fall risk awareness and safety precautions taken by older community-dwelling women and men : a qualitative study using focus group discussions
- 2015
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:3
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Daily life requires frequent estimations of the risk of falling and the ability to avoid a fall. The objective of this study was to explore older women's and men's understanding of fall risk and their experiences with safety precautions taken to prevent falls.Methods A qualitative study with focus group discussions was conducted. Eighteen community-dwelling people [10 women and 8 men] with and without a history of falls were purposively recruited. Participants were divided into two groups, and each group met four times. A participatory and appreciative action and reflection approach was used to guide the discussions. All discussions were audio recorded and transcribed verbatim. Data were analysed by qualitative content analysis, and categories were determined inductively.Findings Three categories describing the process of becoming aware of fall risks in everyday life were identified: 1] Facing various feelings, 2] Recognizing one's fall risk, and 3] Taking precautions. Each category comprised several subcategories. The comprehensive theme derived from the categories was "Safety precautions through fall risk awareness". Three strategies of ignoring [continuing a risky activity], gaining insight [realizing the danger in a certain situation], and anticipating [thinking ahead and acting in advance] were related to all choices of actions and could fluctuate in the same person in different contexts.Conclusions The fall risk awareness process might be initiated for various reasons and can involve different feelings and precautions as well as different strategies. This finding highlights that there are many possible channels to reach older people with information about fall risk and fall prevention, including the media and their peers. The findings offer a deeper understanding of older peoples' conceptualizations about fall risk awareness and make an important contribution to the development and implementation of fall prevention programmes.
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| 8. |
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| 9. |
- Pohl, Petra, et al.
(författare)
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Older women and men as co-creators in design of a mobile application for fall prevention
- 2013
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Konferensbidrag (refereegranskat)abstract
- There is a plethora of fall prevention programs for older community-dwelling people. The evidence for exercise-based programs is strong. There is a problem however with implementation and adherence. Motivational factors and barriers have been identified to some extent. Previous studies have shown that what works best is when exercise programs are tailor made, home based, and when people have access to personal feedback on a regular basis. Mobile applications for Smartphones with exercises have these advantages, and have been available for a long time, but these are most commonly directed to young and middle-aged people. There are no applications for fall prevention developed based on senior’s own wishes. The aim was to investigate how healthy older community-dwelling women and men reason and what exercises they prefer when participating in development and design of a fall prevention program in shape of a mobile application for Smartphones.Method Participatory and appreciative action research design with focus group interviews and workshops. Qualitative data analysis.Results The preliminary results show that when older community-dwelling men and women participate in developing a fall prevention program for Smartphones, they have many ideas, thoughts and experiences that may serve as a motivational factor for following a fall prevention program regularly.ConclusionThe implementation and adherence for evidence based fall preventative exercise programs is insufficient. This study will gain knowledge to design tailor made, home based fall prevention exercise programs among community-dwelling healthy seniors.
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| 10. |
- Pohl, Petra, et al.
(författare)
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Äldre män och kvinnor som med-aktörer i design av tränings-appar för fallprevention
- 2013
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Konferensbidrag (refereegranskat)abstract
- Bakgrund och syfte:Det finns en uppsjö av olika fallpreventiva evidensbaserade träningsprogram för äldre i ordinärt boende. Även om evidensgraden är hög för viss träning finns det svårigheter med att få äldre personer att utföra träningen. Vissa motivationsfaktorer och hindrande faktorer har redan identifierats och forskningen visar att skräddarsydda, hembaserade träningsprogram med möjlighet till regelbunden återkoppling är det som fungerar bäst. Applikationer till mobiltelefoner och surfplattor erbjuder denna möjlighet, och har funnits sedan en längre tid, men dessa vänder sig oftast till yngre och medelålders personer. Det finns ännu ingen applikation som är baserad på de äldres egna önskemål. Syftet med studien är att undersöka hur friska äldre män och kvinnor i ordinärt boende resonerar och vilka övningar de föredrar när de deltar i utveckling och design av ett fallpreventivt träningsprogram i form av en applikation till smarta telefoner och surfplattor. Metoder:18 deltagare > 70 år. Deltagande och uppskattande aktionsforskning samt fokusgruppsintervjuer och workshops. Kvalitativ innehållsanalys. Resultat:De preliminära resultaten visar att när äldre män och kvinnor i ordinärt boende deltar i utvecklingen av ett fallpreventivt träningsprogram för smarta telefoner och surfplattor har de många idéer, tankar och erfarenheter som kan fungera som motiverande faktorer i syfte att utföra regelbunden fallpreventiv träning. Konklusion:Implementeringen och följsamheten för evidensbaserade fallpreventiva träningsprogram är otillräcklig. Denna studie bidrar med kunskaper för att designa skräddarsydda, hembaserade fallpreventiva träningsprogram för friska äldre personer i ordinärt boende.
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