| 1. |
- Vahlberg, Birgit, 1964-, et al.
(författare)
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Effects on walking performance and lower body strength by short message service guided training after stroke or transient ischemic attack (The STROKEWALK Study) : a randomized controlled trial
- 2021
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Ingår i: Clinical Rehabilitation. - : Sage Publications. - 0269-2155 .- 1477-0873. ; 35:2, s. 276-287
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate whetherdaily mobile-phone delivered messages with training instructions during three months increase physical activity and overall mobility in patients soon after stroke or transient ischemic attack.DESIGN: Randomised controlled trial with intention-to-treat analyses.SETTING: University hospital. Data collection from November 2016 until December2018.SUBJECTS: Seventy-nine patients (mean (SD) age 63.9 (10.4) years, 29 were women) were allocated to either intervention (n = 40) or control group (n = 39). Participants had to be independent (modified Ranking Scale ⩽2) and able to perform the six-minute walking test at discharge from the hospital.INTERVENTIONS: The intervention group received standard care and daily mobile phone instructional text messages to perform regular outdoor walking and functional leg exercises. The control group received standard care; that is, primary care follow-up.MAIN MEASURES: Walking performance by six-minute walking test (m), lower body strength by five times chair-stand test (s), the short physical performance battery (0-12 points) and 10-metres walk test (m/s) were assessed at baseline and after three months.RESULTS: The estimated median difference in the six-minute walking test was in favour of the intervention group by 30 metres (95% CI, 55 to 1; effect size 0.64; P = 0.037) and in the chair-stand test by 0.88 seconds (95% CI, 0.02 to 1.72; effect size 0.64; P = 0.034). There were no differences between groups on the short physical performance battery or in 10-metres walking time.CONCLUSIONS: Three months of daily mobile phone text messages with guided training instructions improved composite mobility measures; that is, walking performanceand lower body strength.CLINICAL TRIAL REGISTRY: The study is registered with ClinicalTrials.gov, number NCT02902367.
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| 2. |
- Vahlberg, Birgit, 1964-, et al.
(författare)
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Factors associated with changes in walking performance in individuals 3 months after stroke or TIA : secondary analyses from a randomised controlled trial of SMS-delivered training instructions in Sweden
- 2024
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 14:3
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This study aimed to identify factors related to changes in walking performance in individuals 3 months after a stroke or TIA.Design: Cross-sectional study with post hoc analysis of a randomised controlled study.Setting: University Hospital, Sweden. Participants 79 individuals, 64 (10) years, 37% women, who were acutely hospitalised because of stroke or TIA between November 2016 and December 2018. Inclusion criteria were patients aged 18 or above and the major eligibility criterion was the ability to perform the 6 min walking test.Intervention: The intervention group received standard care plus daily mobile phone text messages (short message service) with instructions to perform regular outdoor walking and functional leg exercises in combination with step counting and training diaries. The control group received standard care. Outcome measures Multivariate analysis was performed and age, sex, group allocation, comorbidity, baseline 6 min walk test, body mass index (BMI), cognition and chair-stand tests were entered as possible determinants for changes in the 6 min walk test.Results: Multiple regression analyses showed that age (standardised beta -0.33, 95% CI -3.8 to -1.05, p<0.001), sex (-0.24, 95% CI -66.9 to -8.0, p=0.014), no comorbidity (-0.16, 95% CI -55.5 to 5.4, p=0.11), baseline BMI (-0.29, 95% CI -8.1 to -1.6, p=0.004), baseline 6 min walk test (-0.55, 95% CI -0.5 to -0.3, p<0.001) were associated with changes in 6 min walk test 3 months after the stroke event. The regression model described 36% of the variance in changes in the 6 min walk test.Conclusions: Post hoc regression analyses indicated that younger age, male sex, lower BMI and shorter 6 min walk test at baseline and possible no comorbidity contributed to improvement in walking performance at 3 months in patients with a recent stroke or TIA. These factors may be important when planning secondary prevention actions.
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| 3. |
- Vahlberg, Birgit, 1964-, et al.
(författare)
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Potential effects on cardiometabolic risk factors and body composition by short message service (SMS)-guided training after recent minor stroke or transient ischaemic attack : Post hoc analyses of the STROKEWALK randomised controlled trial
- 2021
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:10
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To evaluate effects of mobile phone text-messaging exercise instructions on body composition, cardiometabolic risk markers and self-reported health at 3 months after stroke.Design: Randomised controlled intervention study with per-protocol analyses.Setting: University Hospital in Sweden.Participants: Seventy-nine patients (mean (SD) age 64 (10) years, 37% female) ≥18 years with good motor function (modified Rankin Scale ≤2) and capable to perform 6 min walking test at hospital discharge were randomised to either intervention (n=40) or control group (n=39). Key exclusion criteria: Subarachnoid bleeding, uncontrolled hypertension, severe psychiatric problems or cognitive limitations.Interventions: The intervention group received beyond standard care, daily mobile phone instructional text messages to perform regular outdoor walking and functional leg exercises. The control group received standard care.Main outcome measures: Fat mass and fat-free mass were estimated by bioelectric impedance analysis. Cardiometabolic risk factors like blood lipids, glycated haemoglobin and blood glucose were analysed at baseline and after 3 months.Results: Both groups changed favourably in fat-free mass (1.83 kg, 95% CI 0.77 to 2.89; p=0.01, effect size (ES)=0.63 vs 1.22 kg, 95% CI 0.39 to 2.0; p=0.05, ES=0.54) and fat mass (-1.30 kg, 95% CI-2.45 to-0.14; p=0.029, ES=0.41 vs-0.76 kg, 95% CI-1.74 to 0.22; p=0.123, ES=0.28). Also, many cholesterol related biomarkers improved; for example, total cholesterol-0.65 mmol/L, 95% CI-1.10 to-0.2; p=0.06, ES: 0.5 vs-1.1 mmol/L, 95% CI-1.47 to-0.56; p>0.001, ES=0.8. However, there were no between-group differences. At 3 months, 94% and 86%, respectively, reported very good/fairly good health in the text messaging and control groups.Conclusions: No clear effect of 3 months daily mobile phone delivered training instructions was detected on body composition, cardiovascular biochemical risk factors or self-perceived health. Further research is needed to evaluate secondary prevention efforts in larger populations after recent stroke.Trial registration number: NCT02902367.
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| 4. |
- Ekvall Hansson, Eva, et al.
(författare)
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Vestibular rehabilitation for persons with stroke and concomitant dizziness : a pilot study
- 2020
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Ingår i: Pilot and Feasibility Studies. - : Springer Nature. - 2055-5784. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Dizziness is common among patients with first time stroke. It affects self-perceived health and is a risk factor for falls. Vestibular rehabilitation (VR) is effective for treating dizziness among various conditions, but the effect of dizziness with origin in the central nervous system is poorly studied.This pilot study of a randomized controlled trial aimed at investigating a vestibular rehabilitation programme among patients with first time stroke and concomitant dizziness. A second aim was to study the feasibility of performing the randomized controlled trial.Methods: The participants were computer generated randomized to either an intervention or a control group. The intervention comprised of four different vestibular rehabilitation exercises, adapted for each patient and usual rehabilitation. The control group received usual rehabilitation without the vestibular rehabilitation exercises. Outcome measures used were The Activities-specific Balance Confidence Scale, the Berg Balance Scale, the Functional Gait Assessment Scale and the EuroQol-5D. Feasibility was studied in terms of recruitment, adherence and retention rates, also as the ability to collect primary and secondary outcomes as well as to find indications of treatment differences.Results: Self-rated health improved for all participants. No other differences between baseline and follow-up were detected neither within nor between groups. Recruitment rate was 23%, adherence to the intervention 90%, retention rate 69% and ability to collect outcome measures 90%. No adverse events occurred.Conclusion: Both the intervention and the control groups improved in self-perceived health. The measures of feasibility were satisfactory in this study, apart from a low recruitment rate.
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| 5. |
- Vahlberg, Birgit, 1964-, et al.
(författare)
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Level of physical activity in men and women with chronic stroke
- 2019
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Ingår i: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040. ; 35:10, s. 947-955
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 6. |
- Vahlberg, Birgit, 1964-
(författare)
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Physical Functioning, Body Composition and Exercise in Elderly Community-living Individuals with Stroke
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A comprehensive view of physical function, body composition and exercise post-stroke that is based on clinical examination is lacking. The effects of a progressive resistance and balance (PRB) exercise program have not been fully evaluated in community-living individuals after stroke.The overall aim of this thesis was to explore and describe physical function, physical activity, body composition, nutritional status and psychological factors. Another aim was to evaluate both the short-term and long-term effects of a PRB exercise program.Physical function, physical activity, body composition, nutritional status and psychological factors were assessed in community-living individuals (65-85 years) approximately 1 year after stroke. Paper I-II (n=195, n=134) had a cross-sectional design and the main outcome was mobility and physical activity. In paper III-IV, (n=67, n=43) individuals were randomly assigned to either a PRB exercise program group or a control group. The main outcomes were balance, mobility, fat-free mass (FFM) and fat-mass (FM).In paper I, mobility was reduced and physical activity level was low compared to age-matched healthy controls. Factors explaining the variance in mobility were age, physical activity, fall-related self-efficacy and EQ-5D. In paper II, >20% had a BMI ≥30 kg/m2 and had an altered body composition that was mainly characterised by a high fat-mass index (FMI). Neither fat-free nor FM were associated with mobility in this cohort. The factors associated with low mobility were low physical activity Odds ratio (OR) (CI 95%) 8.2 (2.8-24.2), risk for malnutrition, OR 5.8 (1.6-21.1), and each 10-year period, OR 2.8 (1.24-6.24). Individuals participating in the PRB exercise program (paper III, n=67) revealed significantly higher balance, walking capacity and comfortable walking speed compared to the control group at 3 months. The faster walking speed persisted at 6 and 15 months. In paper IV (n=43), at 3 months, the PRB exercise group had a significant reduction in FM percentage and a decrease in IGF-1 compared with the control group. Further, changes in FMI were associated with improved walking capacity.Many individuals perceived partly modifiable disabilities 1 year after stroke. Exercising in groups for 3 months improved physical function and decreased fat-mass percentage and IGF-1.
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| 7. |
- Vahlberg, Birgit, 1964-, et al.
(författare)
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Protocol and pilot study of a short message service-guided training after acute stroke/transient ischemic attack to increase walking capacity and physical activity
- 2018
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Ingår i: Preventive Medicine Reports. - : Elsevier BV. - 2211-3355. ; 11, s. 109-114
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Tidskriftsartikel (refereegranskat)abstract
- Physical activity in community-living individuals after a stroke is usually scarce. This protocol describes a study that will evaluate a method to increase physical activity by performing a 3-month outdoor walking and muscle strengthening program and will examine the 3-month and 1-year effects of this program on individuals with acute stroke (AS) or transient ischemic attack (TIA). In a prospective randomized controlled trial in Uppsala, Sweden, 80 individuals with AS or TIA who maintained cognitive and motor function will be randomized into groups for continuous training for three months or for regular standard care. The training will be supervised by daily cellphone-delivered messages (short message services; SMS), and the intensity, duration and workload will be gradually increased. The primary outcome is a change in walking capacity according to the 6-Minute Walk Test and chair-rising at three months. Secondary outcomes include mobility, gait speed, handgrip strength, body composition (fat mass and muscle mass), biochemical risk-markers, health-related quality of life, and cardiovascular events. Adherence to the training program will be documented with a self-reported diary and step counts over two weeks. The major study started in November 2016, and results are expected in 2019. In a pilot study of 15 subjects post-stroke (mean-age 65 years), we observed improved walking capacity (increasing from 23 to 255 m) and chair-rising (decreasing 2.42 s) from baseline to three months. SMS-guided outdoor training will be tested as a potential therapeutic strategy to increase physical activity and thereby improve walking capacity and physical function following a stroke.
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