| 1. |
- Bergfeldt, Ulla, et al.
(författare)
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Functional outcomes of spasticity-reducing surgery and rehabilitation at 1-year follow-up in 30 patients
- 2020
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Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 45:8, s. 807-812
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Tidskriftsartikel (refereegranskat)abstract
- The effects of spasticity-reducing surgery in the upper extremity were assessed in a prospective observational study of 30 consecutive patients with stroke (n = 13), incomplete spinal cord injury (n = 9), traumatic brain injury (n = 5), cerebral palsy (n = 2), and degenerative central nervous system disease (n = 1). Surgery, which included lengthening of tendons and release of muscles, was followed by early rehabilitation at three intensity levels depending on the patients’ specific needs and conditions. At 12 months follow-up there were significant improvements in all outcome measures with the following mean values: spasticity decreased by 1.4 points (Modified Ashworth Scale, 0–5), visual analogue pain score by 1.3 points, and both Canadian Occupational Performance Measures increased (performance by 3.4 and satisfaction by 3.6), and most measures of joint position or mobility improved. Hand surgery combined with early and comprehensive rehabilitation improves function, activity and patients’ satisfaction in patients with disabling spasticity with improvement lasting for at least 1 year. Level of evidence: II. © The Author(s) 2020.
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| 2. |
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| 3. |
- Ramström, Therese, et al.
(författare)
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Arm Activity Measure (ArmA): Psychometric Evaluation of the Swedish Version
- 2021
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Ingår i: Research Square. - : Research Square Platform LLC. - 2693-5015.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Spasticity after an injury to the central nervous system (CNS) can cause profound disability (1). The prevalence of spasticity differs among various diagnoses, depending on how it is defined. Spasticity is reported to be present in 80% of patients with spinal cord injury (SCI) (2, 3), 60% of patients with traumatic brain injury (TBI) (4), and 30% of patients with stroke (5, 6). The consequences of spasticity in the upper limb (UL) range from reduced grip control to a clenched fist and can prevent prehension and grasp, which are critical for independence in activities of daily living (ADLs) (7). Left untreated, spasticity can lead to severe contractures, deformity, pain, and involuntary movement and severely compromise occupational performance [3, 9-11]. Since being active is fundamentally important for all living beings, and participation in activities is necessary for human physical and mental wellbeing (8), disabling UL spasticity can have devastating consequences.
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| 4. |
- Ramström, Therese, et al.
(författare)
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Arm activity measure (ArmA): psychometric evaluation of the Swedish version
- 2021
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Ingår i: Journal of Patient-Reported Outcomes. - : Springer Science and Business Media LLC. - 2509-8020. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Patient Reported Outcomes Measure (PROM) are commonly used in research and essential to understand the patient experience when receiving treatment. Arm Activity Measure (ArmA) is a valid and reliable self-report questionnaire for assessing passive (section A) and active (section B) real-life arm function in patients with disabling spasticity. The original English version of ArmA has been psychometrically tested and translated into Thai. Aims Translate and cross-culturally adapt ArmA to Swedish language and context. Further, to evaluate the reliability, validity and sensitivity of the Swedish version of the questionnaire (ArmA-S) in patients with disabling upper limb spasticity caused by injuries to the central nervous system (CNS). Materials and methods ArmA was translated and cross-culturally adapted according to established guidelines. Validity and reliability were evaluated in 61 patients with disabling spasticity. Face and content validity was evaluated by expert opinions from clinicians and feedback from patients with upper limb spasticity. Internal consistency reliability was assessed with Cronbach's alpha and test-retest reliability was assessed using the quadratic weighted kappa. Results ArmA-S was shown to be clinically feasible, with good face and content validity and no floor or ceiling effects. Internal consistency of ArmA-S was high and equivalent to ArmA; with Chronbach ' s alpha coefficients values of 0.94 and 0.93 for section A and B, respectively. Test-retest reliability was good, with kappa values of 0.86 and 0.83 for section A and B, respectively. Some layout modifications of ArmA-S were made to further increase the user-friendliness, test-retest reliability, and responsiveness. Conclusion ArmA-S was shown to be a reliable and valid self-report questionnaire for use in clinical practice and research to assess improvements in passive and active upper limb function in patients with disabling spasticity.
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| 5. |
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| 6. |
- Ramström, Therese, et al.
(författare)
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Linking Prioritized Occupational Performance in Patients Undergoing Spasticity-Correcting Upper Limb Surgery to the International Classification of Functioning, Disability, and Health
- 2022
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Ingår i: Occupational Therapy International. - : Hindawi Limited. - 0966-7903 .- 1557-0703. ; 2022
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Tidskriftsartikel (refereegranskat)abstract
- Background. Spasticity is generally caused by damage to the spinal cord or the areas of the brain that controls movements, which poses significant limitations in occupational tasks. Objectives. The aims of the study were to (I) describe prioritized occupational performance problems (POPP) among patients who underwent upper limb spasticity-correcting surgery and map them to the International Classification of Function, Disability, and Health (ICF); (II) assess outcomes postsurgery; (III) assess whether the results are influenced by the diagnosis, gender, and residual muscle function; and (IV) assess correlation between changes in COPM and gains in grasp ability and grip strength. Methods. In this retrospective study, assessments occurred pre- and postsurgery, including the Canadian Occupational Performance Measure (COPM), grip strength, and grasp ability. POPP were transformed to prioritized occupational performance goals (POPG) during subsequent rehabilitation. Results. 60 patients with a history of spinal cord injury (SCI) (n=42; 59%), stroke (n=25; 34%), traumatic brain injury (TBI) (n=4; 6%), and reason unknown (n=1; 1%) were included, with a mean age of 57 (±13) years. Of those, 11 had bilateral surgery, generating 71 COPM forms and 320 POPG. The POPG were mapped to the ICF activity and participation chapter, most often to self-care (n=131; 41%), domestic life (n=68; 21%), and mobility (n=58; 18%). COPM scores were significantly increased postsurgery, irrespective of diagnosis, gender, and muscle function. No clear correlation between COPM improvement and hand function gains was shown. Conclusion. Patients who underwent spasticity-correcting upper limb surgery identified difficulties with a wide range of occupational tasks that they considered as important to regain. Treatment-induced gains in occupational performance were significant but had no clear correlation with gains in grasp ability and hand strength. Independent of diagnosis, gender, and residual muscle function, it seems important to address the activity- and participation-specific aspects in the assessment and rehabilitation of patients.
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| 7. |
- Ramström, Therese
(författare)
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Rehabilitation and outcomes after spasticity-correcting surgery in the upper limb
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The ability to perform everyday life activities is beneficial for one’s self-identity and contributes to human well-being. Enhancement of activity performance is therefore central in all forms of rehabilitation. Spasticity is a common secondary complication after injuries to the central nervous system (CNS), which can negatively affect the ability to perform activities. There is conflicting evidence regarding the effectiveness of available spasticity treatments. Surgical treatment for spasticity has been an option for many years, but due to limitations in outcomes and the diversity of techniques, conclusions about the effectiveness cannot be drawn. Aim: The main aim is to describe and evaluate the feasibility of a treatment algorithm for upper limb (UL) spasticity-correcting surgery with tendon lengthening and comprehensive rehabilitation and its impact on the everyday life of patients with disabling spasticity after CNS injuries. More specifically, the aims were to investigate the feasibility of the treatment algorithm, describe patients’ experiences with the treatment, describe prioritized occupational performance problems (POPPs) that patients identify before surgery, and map those problems onto the International Classification of Function, Disability, and Health (ICF). An additional aim was to translate the self-report Arm Activity Measure into Swedish (ArmA-S) and evaluate the psychometric properties of ArmA-S. Methods: In Study I, 30 consecutive patients who underwent surgery between March 2015 and January 2017 were assessed before and 12 months after surgery. In a retrospective study (Study II), data were extracted from patients who underwent UL surgery between February 2017 and June 2019. In Study II, data from the assessments before and 6 months after surgery were used to evaluate the feasibility and outcome of the treatment algorithm allocating patients to high-, low-, or non-functioning treatment regimens (HFR, LFR, NFR). In a methodological study (Study III), the translated ArmA-S was subjected to psychometric evaluation. In a qualitative study (Study IV), interviews were conducted and analysed using a phenomenographic approach. In Study V, POPPs were identified using the Canadian Occupational Performance Measure (COPM) and mapped onto the ICF. Results: Twelve months after surgery (Study I), significant improvements were found for UL spasticity graded according to the Modified Ashworth Scale (MAS) (average decrease: 1.4; p < 0.01) and grip strength (average increase: 4.1; p < 0.01). The regimen-specific primary outcome measures for all three groups (HFR, LFR, NFR) were significantly improved six months after surgery (Study II). In the HFR group, the average increase in the Grasp and Release Test (GRT) was 19.6 ± 19 (p < 0.001). In the LFR group, the average median (IQR) decrease for ArmA-S section B was -5 (-1 to -12.5) (p < 0.001). In the NFR group, the average median (IQR) decrease for ArmA-S section B was -12 (-10 to -14) (p < 0.02). Study III demonstrated that ArmA-S could be considered a reliable, valid, and clinically feasible measure of passive (section A) and active (section B) hand function. The interviews (Study IV) revealed the patients’ experiences with surgery in everyday life, such as bodily changes, improved occupational performance, regained control, enhanced interpersonal interactions, and psychological well-being. In Study V, 320 POPPs were translated into prioritized occupational performance goals (POPGs). The POPGs were mapped onto the ICF activity domain, most often relating to self-care (41%), domestic life (21%), and mobility (18%). Diagnosis, gender, and motor function did not influence patients’ preferences. Study V also showed significant increases in COPM scores after surgery, but these improvements were not or only weakly correlated with hand function. Conclusions: The algorithm for spasticity-correcting surgery that customizes the postoperative treatment regimen to the individual’s degree of residual motor control was shown to be feasible and successful. Patients had improvements in various domains, such as spasticity, pain, hand function, and occupational performance, with sustained effects at long-term follow-up. ArmA-S is a suitable measure for monitoring changes in patients receiving UL spasticity-correcting surgery. Participants’ improvements experienced in everyday life include activities, body functions, and psychological and social well-being. Yet the treatment-induced significant gains in occupational performance had no clear correlation with gains in grip ability or grip strength. Independently of diagnosis, gender, and residual motor function, it seems to be important for patients to address self-care activities, but also activities relating to domestic life and mobility, in the rehabilitation after spasticity-correcting surgery.
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| 8. |
- Ramström, Therese, et al.
(författare)
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Spasticity-correcting surgery can have long-lasting effects
- 2023
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Ingår i: Lakartidningen. - 1652-7518. ; 120
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Tidskriftsartikel (refereegranskat)abstract
- Spasticity is a common secondary complication after injuries to the central nervous system (CNS). Spasticity may severely impair arm and hand function, and consequently, affect an individual's function, resulting in disabilities or limiting activities and participation. Today, there is conflicting evidence regarding the effectiveness of available spasticity treatments. The population of adults with spasticity problems due to a CNS injury is heterogenic. A multidisciplinary approach is essential in customizing treatment to individual needs. The planning of treatment should consider the remaining upper limb functions and the patient's potential to improveme. Spasticity-correcting surgery is an option that seems underutilized. This article describes a structured and standardized program for the preoperative assessment, the surgical technique and the postoperative rehabilitation of patients undergoing upper limb spasticity-correcting surgery.
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| 9. |
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| 10. |
- Ramström, Therese, et al.
(författare)
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The impact of upper limb spasticity-correcting surgery on the everyday life of patients with disabling spasticity: a qualitative analysis
- 2022
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 44:21, s. 6295-6303
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The aim of this study was to explore the patient perspective of their experiences of daily life after spasticity-correcting surgery for disabling upper limb (UL) spasticity after spinal cord injury (SCI) and stroke. Materials and methods Eight patients with UL spasticity resulting from SCI (n= 6) or stroke (n= 2) were interviewed 6-9 months after spasticity-correcting surgery. A phenomenographic approach was used to analyze the interviews. Results Five themes emerged from the interviews: (1) bodily changes, such as increased muscle strength, range of motion, and reduced muscle-hypertonicity; (2) improved occupational performance, facilitating tasks, mobility, and self-care; (3) regained control, explicating the perception of regaining bodily control and a more adaptable body; (4) enhanced interpersonal interactions, entailing the sense of being more comfortable undertaking social activities and personal interactions; and (5) enhanced psychological well-being, including having more energy, increased self-esteem, and greater happiness after surgery. Conclusions The participants experienced improvements in their everyday lives, including body functions, activities, social life, and psychological well-being. The benefits derived from surgery made activities easier, increased occupational performance, allowed patients regain their roles and interpersonal interactions, and enhanced their psychological well-being.
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