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1.	Abbott, Allan, 1978-, et al. (författare) What biopsychosocial factors are associated with work ability in conservatively managed patients with cervical radiculopathy? : A cross-sectional analysis 2020 Ingår i: PM&R. - : John Wiley & Sons. - 1934-1482 .- 1934-1563. ; 12:1, s. 64-72 Tidskriftsartikel (refereegranskat)abstract BackgroundNo previous studies have investigated what biopsychosocial factors are associated with self‐reported work ability in conservatively managed patients with cervical radiculopathy.ObjectiveTo develop a theoretical model of factors and potential processes associated with variation in work ability based on a thorough assessment of biopsychosocial variables in conservatively managed patients with cervical radiculopathy.DesignCross‐sectional observational study.SettingTertiary neurosurgery clinic.PatientsA total of 144 conservatively managed patients with cervical pain and radiculopathy participated in the study.MethodsFrom 64 biopsychosocial candidate variables, significant (P < .05) bivariate correlators with Work Ability Index (WAI) were entered as independent variables in a categorical regression. Elastic net regularization maintained the most parsimonious set of independent variables significantly associated with variation in WAI as the dependent variable. Process analysis of significant independent variable associations with WAI was performed.Main Outcome MeasurementWAI.ResultsFrom 42 bivariate correlates of WAI, multivariate regression displayed a total of seven variables that were significantly (F [25,98] = 5.74, P < .05) associated with 65.8% of the variation in WAI. The Neck Disability Index (NDI) and Fear‐Avoidance Beliefs Questionnaire Work subscale (FABQ‐W) were significant individual factors within the final regression model. Process analysis displayed FABQ‐W having a significant specific indirect association with the direct association between NDI and WAI, with the model associated with 77% of the variability in WAI (F [2,84] = 141.17, P < .001).ConclusionOf 64 candidate biopsychosocial factors, NDI and FABQ‐W were the most significant multivariate correlates with work ability. FABQ‐W has a significant indirect association with baseline NDI scores and perceived work ability. This warrants future research trialing work‐related fear avoidance interventions in conservatively managed patients with cervical radiculopathy.Level of EvidenceIII
2.	Ambrosio, Fabrisia, et al. (författare) Biological basis of exercise-based treatments for musculoskeletal conditions 2011 Ingår i: PM&R. - : Elsevier. - 1934-1482 .- 1934-1563. ; 3:6 Suppl 1, s. S59-S63 Forskningsöversikt (refereegranskat)abstract Exercise-based therapies are the cornerstone of rehabilitation programs. While the benefits of exercise on systemic and tissue function are generally accepted, mechanisms underlying these benefits are sometimes poorly understood. An improved understanding of the effects of mechanical loading on molecular and cellular processes has the potential to lead to more disease-specific and efficacious exercise-based therapies. The purpose of this paper is to review the current literature examining the role of mechanical signaling on muscle and cartilage biology.
3.	Andersson, Nilla, et al. (författare) Test-Retest Reliability of the Reintegration to Normal Living Index (RNL-I) to Assess Perceived Participation in Adults With Late Effects of Polio 2020 Ingår i: PM&R. - : WILEY. - 1934-1482 .- 1934-1563. ; 12:2, s. 147-153 Tidskriftsartikel (refereegranskat)abstract Background: Many individuals with late effects of polio have difficulties participating in daily activities. The Reintegration to Normal Living Index (RNL-I) is a self-report questionnaire that evaluates perceived participation, but knowledge of the test-retest reliability and measurement errors in this population is lacking.Objective: To evaluate the test-retest reliability of the RNL-I in adults with late effects of polio.Design: A postal survey with a test-retest design.Setting: University hospital outpatient clinic.Participants: Fifty-one adults (20 women and 31 men; mean age 72 years) with late effects of polio.Main Outcome Measurements: The Reintegration to Normal Living Index (RNL-I).Methods: The participants responded to the RNL-I twice, 3 weeks apart. Data were analyzed with the following statistical methods: percentage agreement (PA), quadratic kappa coefficients, the intraclass correlation coefficient (ICC), mean difference, standard error of measurement (SEM/SEM%), and the smallest real difference (SRD/SRD%).Results: The PA (ie, the same scoring at both test occasions) was >70% for 10 of 11 items. The kappa coefficients showed good test-retest agreement (>0.61) for 7 items. The ICC was 0.88 and the mean difference was -0.74. The SEM (SEM%) was 7.4 (9.7%) and the SRD (SRD%) was 20.5 (27.0%).Conclusion: The RNL-I can be considered reliable for adults with mild to moderate late effects of polio. It can thereby be used to assess changes in perceived participation over time or after rehabilitation interventions, both for a group of individuals and a single individual.
4.	Blauwet, Cheri A., et al. (författare) The Road to Rio : Medical and Scientific Perspectives on the 2016 Paralympic Games 2016 Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 8:8, s. 798-801 Tidskriftsartikel (refereegranskat)abstract In August and September of this year, the world will turn its attention to Rio de Janeiro, Brazil, for the 2016 Summer Olympic and Paralympic Games. Of interest to physiatrists, the Paralympic Games will take place from September 7 to 18, with an estimated total of 4 billion viewers. In the United States, for the first time in history, the Summer Games will be broadcast over a total of 66 hours on NBCUniversal. The Paralympic Games represent the pinnacle of elite sport for athletes with disabilities while also changing perceptions around the importance of grassroots sport and physical activity opportunities for the disability community more broadly.It is no secret that the planning and preparation for the Rio Games has brought with it a number of challenges—the Zika virus, water quality, construction delays, and the oft-tenuous state of the Brazilian political system, to name a few. In some respects, these challenges are important as they stimulate discourse about the future of the Olympic and Paralympic Movement. In Paralympic sport, some of our current and most salient challenges are rooted in principles of sports medicine and science, as outlined herein. Because it is imperative to uphold the highest standards of athlete health and safety at the Games, this presents an unparalleled opportunity for the voice of physiatrists to come to the fore. As experts in disability and functional performance, neurologic and musculoskeletal rehabilitation, and sports medicine, we uniquely are suited to make an important and timely impact on Paralympic sport. Here, we provide a snapshot of what to watch out for in Rio.
5.	Brogårdh, Christina, et al. (författare) Construct Validity of a New Rating Scale for Self-Reported Impairments in Persons With Late Effects of Polio. 2013 Ingår i: PM & R : the journal of injury, function, and rehabilitation. - : Wiley. - 1934-1563 .- 1934-1482. ; 5:3, s. 176-181 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To evaluate the construct validity of a new rating scale for self-reported impairments in persons with late effects of polio. DESIGN: Psychometric analysis of data on self-perceived impairments in persons with prior polio. PARTICIPANTS: Two hundred and seventy-three persons with prior polio (119 men and 154 women; mean age, 63.5 years). METHOD: Rasch analysis of a 13-item rating scale with 5 response categories, in which the participants rated how much they have been bothered by various post-polio-related impairments during the past 2 weeks. RESULTS: The initial analysis showed disordered categories, misfit with some of the items, multidimensionality, and local dependency. After adjustment of the categories, which resulted in a 4-category rating scale, fit to the model was achieved, but the scale still showed signs of multidimensionality. Analyses of local dependency revealed correlations among some of the items, which resulted in a 5 testlet solution, which gave fit to the model and unidimensionality. CONCLUSION: After adjustment of the categories and local dependency, this new rating scale, Self-Reported Impairments in Persons With Late Effects of Polio, can be considered as unidimensional. The good psychometric properties implies that the Self-Reported Impairments in Persons With Late Effects of Polio scale could be a useful rating scale that would increase our understanding of the impairments that persons with late effects of polio can experience. With further refinements, this scale may assist in the planning and evaluation of appropriate rehabilitation interventions.
6.	Brogårdh, Christina, et al. (författare) Determinants of falls and fear of falling in ambulatory persons with late effects of polio 2017 Ingår i: PM&R. - : Elsevier. - 1934-1482 .- 1934-1563. ; 9:5, s. 455-463 Tidskriftsartikel (refereegranskat)abstract BackgroundFalls and fear of falling (FOF) are common in persons with late effects of polio but there is limited knowledge of associated factors.ObjectiveTo determine how knee muscle strength, dynamic balance and gait performance (adjusted for gender, age and BMI) are associated with falls and FOF in persons with late effects of polio.DesignA cross-sectional study.SettingA university hospital outpatient clinic.ParticipantsEighty-one ambulatory persons with verified late effects of polio (43 men; mean age 67 years).Main Outcome MeasurementsNumber of falls the past year, Falls Efficacy Scale –International (FES-I) to assess FOF, a Biodex dynamometer to measure knee muscle strength, the Timed Up and Go (TUG) test to assess dynamic balance and the Six Minute Walk test (6MWT) to assess gait performance. Univariate and multivariate logistic regression analyses were used for falls (categorical data) and linear regression analyses for FOF (continuous data) as dependent variables.ResultsFifty-nine % reported at least one fall during the past year and 79% experienced FOF. Reduced knee muscle strength in the more affected limb and gait performance were determinants of falls. An increase of 10 Nm in knee flexor and knee extensor strength reduced the OR between 0.70 and 0.83 (P=.01), and an increase of 100 meter in 6MWT reduced the OR to 0.41 (P=.001). All factors were determinants of FOF; reduced knee muscle strength in the more and less affected limbs explained 17% to 25% of the variance in FOF, dynamic balance 30% and gait performance 41%. Gender, age and BMI only marginally influenced the results.ConclusionsReduced gait performance, knee muscle strength and dynamic balance are to a varying degree determinants of falls and FOF in ambulatory persons with late effects of polio. Future studies need to evaluate if rehabilitation programs targeting these factors can reduce falls and FOF in this population.
7.	Brogårdh, Christina, et al. (författare) Effects of cardiorespiratory fitness and muscle-resistance training after stroke 2012 Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 4:11, s. 901-907 Tidskriftsartikel (refereegranskat)abstract Stroke is a leading cause of long-term disability. The physical and cognitive impairments after an ischemic or hemorrhagic stroke often lead to activity limitations and participation restrictions. Many persons after stroke have a sedentary lifestyle, are physically inactive, and have a low fitness level. Physical fitness training is known to be beneficial for persons with a number of comorbid conditions or risk factors for stroke. Although exercise and physical activity are considered valuable, the evidence of their benefits after stroke is still insufficient. In this review, we summarize published randomized controlled trials regarding the effects of cardiorespiratory fitness and muscle-resistance training after stroke on physical function, activity, participation, life satisfaction, and mood. We discuss various barriers that can impede the ability to perform exercise, and the importance of reducing these barriers to increase physical fitness levels after the completion of usual stroke rehabilitation, thereby enhancing leisure, well-being, and participation in society
8.	Brogårdh, Christina, et al. (författare) Falls, Fear of Falling, Self-Reported Impairments, and Walking Limitations in Persons With Late Effects of Polio. 2014 Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 6:10, s. 900-907 Tidskriftsartikel (refereegranskat)abstract To investigate fall frequency during the past year, circumstances relating to falls, fear of falling, self-reported impairments, and walking limitations in persons with mild to moderate late effects of polio.
9.	Brogårdh, Christina, et al. (författare) Intra-rater reliability of arm and hand muscle strength measurements in persons with late effects of polio. 2015 Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 7:10, s. 1035-1041 Tidskriftsartikel (refereegranskat)abstract Muscle weakness in the upper limb is common in persons with late effects of polio. To be able to measure muscle strength and follow changes over time, reliable measurements are needed.
10.	Brogårdh, Christina, et al. (författare) Measurement properties of the Falls Efficacy Scale-International (FES-I) in persons with late effects of polio : A cross-sectional study 2022 Ingår i: PM and R. - : Elsevier Inc.. - 1934-1482 .- 1934-1563. ; , s. 1-10 Tidskriftsartikel (refereegranskat)abstract Background : Fear of falling (FoF) is very common in persons with late effects of polio (LEoP). An internationally recognized rating scale to assess FoF is the Falls Efficacy Scale-International (FES-I). Yet, there is limited knowledge about its measurement properties in persons with LEoP. Objective: To investigate the measurement properties of FES-I (16-item version) and short FES-I (7-item version) in persons with LEoP. Design: Explorative factor analysis and Rasch model analysis of cross-sectional data. Setting: University Hospital. Participants : A total of 321 persons with LEoP (mean age 70 ± 10 years, 173 women). Main outcome measurement: The FES-I and short FES-I, comprising four response options about concerns of falling ranging from 1 (not at all concerned) to 4 (very concerned). Methods: Data were collected by a postal survey. First, a factor analysis was performed to investigate unidimensionality of the scale. Thereafter, a Rasch model analysis was used to further analyze the measurement properties of FES-I and short FES-I, such as local dependency, targeting, hierarchical order of items, Differential Item Functioning (DIF), response category functioning and reliability (Person Separation Index, PSI). Raw score transformation to interval measurements was also performed. Results: The factor analysis revealed that FES-I was unidimensional, even though the Rasch analysis showed some misfit to the Rasch model and local dependency. Targeting for FES-I and short FES-I was somewhat suboptimal as the participants on average reported less FoF than expected. A negligible gender DIF was found for two items in FES-I and for one item in short FES-I. Reliability was high (PSI >0.86), and the response category thresholds worked as intended for both FES-I, and short FES-I. Conclusion: The FES-I and the short FES-I have sufficient measurement properties in persons with LEoP. Both versions can be used to assess fear of falling in this population. This article is protected by copyright. All rights reserved.
11.	Brogårdh, Christina, et al. (författare) Muscle Weakness and Perceived Disability of Upper Limbs in Persons With Late Effects of Polio 2016 Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 8:9, s. 825-832 Tidskriftsartikel (refereegranskat)abstract Background: Muscle weakness in one or both upper limbs is common in persons with previous polio, but there is very limited knowledge how it influences daily life. Objective: To assess muscle weakness and self-perceived disability of the upper limbs in persons with late effects of polio and evaluate their association. Design: Cross-sectional study. Settings: University hospital outpatient clinic. Participants: Twenty-eight persons (mean age 67, SD 16 years) with late effects of polio in their upper limbs. Main Outcome Measures: A fixed dynamometer (Biodex System 3 PRO dynamometer (Biodex Medical Systems Inc., Shirley, NY) was used to measure isometric shoulder abduction and elbow flexion, as well as isokinetic concentric elbow flexion and extension. A hand-held dynamometer (Grippit, Hägersten, Sweden) was used to measure isometric grip strength. The Disabilities of Arm, Shoulder and Hand (DASH) questionnaire was used to assess self-perceived disability of the upper limbs. The relationships between the measures were analyzed with the Spearman rank correlation coefficients (rho). Results: The participants were 20%-31% weaker in their more-affected upper limb compared with their less-affected limb. The DASH score was on average 33.5 (SD 18.6), indicating a mild-to-moderate disability of their upper limbs. Changing a lightbulb overhead, carrying a heavy object, and performing recreational activities that required muscle force with the arms were perceived as most difficult. The correlations (rho) between the muscle strength measurements and DASH scores ranged from -0.46 (95% confidence interval [95% CI] -0.10 to -0.71) to -0.61 (95% CI -0.31 to -0.80) for the more affected upper limb, and from -0.54 (95% CI -0.21 to -0.76) to -0.68 (95% CI -0.41 to -0.84) for the less affected upper limb (P < .05-.01). Conclusions: Persons with previous polio and muscle weakness in their upper limbs perceive difficulties to use their arms in daily life, especially when performing activities above their head and strenuous household or leisure activities. The fair-to-moderate correlations of muscle strength with self-perceived disability imply that the weakness can only partially explain the perceived disabilities of arm, shoulder and hand. Other factors are therefore important to consider in the rehabilitation of persons with late effects of polio and upper limb disability. © 2016 American Academy of Physical Medicine and Rehabilitation.
12.	Brogårdh, Christina, et al. (författare) Psychometric properties of the Walking Impact Scale (Walk-12) in persons with late effects of polio 2021 Ingår i: PM&R. - : Wiley-Blackwell. - 1934-1482 .- 1934-1563. ; 13:3, s. 297-306 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Many persons with late effects of polio (LEoP) perceive walking limitations in everyday life. A common rating scale to assess walking limitations is the Walking Impact Scale (Walk-12). However, there is limited knowledge about its psychometric properties.OBJECTIVE: To investigate the psychometric properties of Walk-12 in persons with LEoP.DESIGN: Rasch model analysis of cross-sectional data.SETTING: University Hospital.PARTICIPANTS: A total of 325 persons with LEoP (175 women; mean age 70 ± 10 yr).MAIN OUTCOME MEASUREMENT: The Walk-12, comprising 12 items with five response categories ranging from 1 (not at all) to 5 (extremely).METHODS: Data of Walk-12 were collected by a postal survey. The Rasch model analysis was used to analyze unidimensionality of the scale, local dependency, targeting, hierarchical order of items, Differential Item Functioning (DIF), response category functioning and reliability (Person Separation Index, PSI). Raw score transformation to interval measurements was also performed.RESULTS: The analysis revealed that Walk-12 was multidimensional and suffered from some local dependency. Targeting was compromised among persons with less and worse walking limitations. Hierarchically, the most difficult item to perform was "running" and the easiest was "walking indoors with support". There was a minor DIF for gender in one item ("support when walking outdoors"). Reliability was high (PSI = 0.94). Disordered response category thresholds were found for three items; when merging the middle response categories for these items model fit slightly improved and unidimensionality was achieved.CONCLUSION: The Walk-12, in its current version, does not fully meet the rigorous psychometric Rasch measurement standards in persons with LEoP. Further development of the scale is warranted, including merging response categories and complementing Walk-12 with objective measures of gait in order to improve targeting. As these limitations can be considered minor, the current version of Walk-12 can still be useful for research and clinical practice. This article is protected by copyright. All rights reserved.
13.	Brogårdh, Christina, et al. (författare) Psychometric properties of the Walking Impact Scale (Walk-12) in persons with late effects of polio 2021 Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 13:3, s. 297-306 Tidskriftsartikel (refereegranskat)abstract Background: Many persons with late effects of polio (LEoP) perceive walking limitations in everyday life. A common rating scale to assess walking limitations is the Walking Impact Scale (Walk-12). However, there is limited knowledge about its psychometric properties. Objective: To investigate the psychometric properties of Walk-12 in persons with LEoP. Design: Rasch model analysis of cross-sectional data. Setting: University hospital. Participants: A total of 325 persons with LEoP (175 women; mean age 70 ± 10 years). Main Outcome Measurement: The Walk-12, comprising 12 items with five response categories ranging from 1 (not at all) to 5 (extremely). Methods: Data of Walk-12 were collected by a postal survey. The Rasch model analysis was used to analyze unidimensionality of the scale, local dependency, targeting, hierarchical order of items, Differential Item Functioning (DIF), response category functioning, and reliability (Person Separation Index, PSI). Raw score transformation to interval measurements was also performed. Results: The analysis revealed that Walk-12 was multidimensional and suffered from some local dependency. Targeting was compromised among persons with less and more walking limitations. Hierarchically, the most difficult item to perform was “running” and the easiest was “walking indoors with support”. There was a minor DIF for gender in one item (“support when walking outdoors”). Reliability was high (PSI = 0.94). Disordered response category thresholds were found for three items; when merging the middle response categories for these items model fit slightly improved and unidimensionality was achieved. Conclusions: The Walk-12, in its current version, does not fully meet the rigorous psychometric Rasch measurement standards in persons with LEoP. Further development of the scale is warranted, including merging response categories and complementing Walk-12 with objective measures of gait in order to improve targeting. As these limitations can be considered minor, the current version of Walk-12 can still be useful for research and clinical practice.
14.	Brogårdh, Christina, et al. (författare) Self-reported walking ability in persons with chronic stroke and the relationship with gait performance tests 2012 Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 4:10, s. 734-738 Tidskriftsartikel (refereegranskat)abstract Objective: To assess self-reported walking ability in individuals with chronic stroke and to determine the relationship with gait performance tests. Design: Descriptive analysis of a convenience sample. Setting: A university hospital rehabilitation medicine clinic. Participants: Fifty ambulatory community-dwelling poststroke individuals (mean age, 64 years [range, 44-74 years] and mean time since stroke onset 42 months [range, 6-101 months]). Main Outcome Measures: The Walking Impact Scale (the Walk-12) to assess self-reported walking ability, and the Timed "Up & Go" test, 10-m Comfortable Gait Speed and Fast Gait Speed tests, and 6-Minute Walk Test to assess gait performance. Results: A majority of the participants (94%) reported limitations in their walking ability. The most common limitations were related to standing or walking, walking speed and distance, effort, and gait quality aspects. The ability to run was reported as most affected, whereas the need for support indoors or outdoors was least affected. Significant correlations (. P < .01) were found between the Walk-12 and the 4 gait performance tests (ρ = -0.60 to 0.60). Conclusions: Persons with chronic stroke perceive limitations in their walking ability. The relationship between the Walk-12 and the 4 gait performance tests indicates that self-reports and quantitative assessments are associated. Because the Walk-12 reflects broader dimensions than the gait performance tests, it can be a complementary tool when walking ability in persons with chronic stroke is evaluated.
15.	Brogårdh, Christina, et al. (författare) Test-retest reliability of the rating scale Self-reported Impairments in Persons with late effects Polio (SIPP). 2016 Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 8:5, s. 399-404 Tidskriftsartikel (refereegranskat)abstract A new 13 items rating scale assessing self-reported impairments in persons with late effects of polio (SIPP) has been developed. SIPP has been Rasch analyzed and shown good construct validity and internal consistency. To establish its clinical utility, further evaluation of its psychometric properties is needed.
16.	Carlsson, Håkan, et al. (författare) Efficacy and feasibility of SENSory relearning of the UPPer limb (SENSUPP) in people with chronic stroke: A pilot randomized controlled trial 2022 Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 14:12, s. 1461-1473 Tidskriftsartikel (refereegranskat)abstract Background Sensorimotor impairments of the upper limb (UL) are common after stroke, but there is a lack of evidence-based interventions to improve functioning of UL. Objective To evaluate (1) the efficacy of sensory relearning and task-specific training compared to task-specific training only, and (2) the feasibility of the training in chronic stroke. Design A pilot randomized controlled trial. Setting University hospital outpatient clinic. Participants Twenty-seven participants (median age; 62 years, 20 men) were randomized to an intervention group (IG; n = 15) or to a control group (CG; n = 12). Intervention Both groups received training twice weekly in 2.5-hour sessions for 5 weeks. The training in the IG consisted of sensory relearning, task-specific training, and home training. The training in the CG consisted of task-specific training. Main Outcome Measures Primary outcome was sensory function (touch thresholds, touch discrimination, light touch, and proprioception). Secondary outcomes were dexterity, ability to use the hand in daily activities, and perceived participation. A blinded assessor conducted the assessments at baseline (T1), post intervention (T2), and at 3-month follow-up (T3). Nonparametric analyses and effect-size calculations (r) were performed. Feasibility was evaluated by a questionnaire. Results After the training, only touch thresholds improved significantly from T1 to T2 (p = .007, r = 0.61) in the IG compared to the CG. Within the IG, significant improvements were found from T1 to T2 regarding use of the hand in daily activities (p = .001, r = 0.96) and movement quality (p = .004, r = 0.85) and from T1 to T3 regarding satisfaction with performance in meaningful activities (p = .004, r = 0.94). The CG significantly improved the performance of using the hand in meaningful activities from T1 to T2 (p = .017, r = 0.86). The training was well tolerated by the participants and performed without any adverse events. Conclusions Combined sensory relearning and task-specific training may be a promising and feasible intervention to improve UL sensorimotor function after stroke.
17.	Carlsson, Håkan, et al. (författare) Sensory Function, Measured as Active Discriminative Touch, is Associated With Dexterity after Stroke 2019 Ingår i: PM and R. - : Wiley. - 1934-1482 .- 1934-1563. ; 11:8, s. 821-827 Tidskriftsartikel (refereegranskat)abstract Background: Reduced dexterity is common after stroke, which can affect the ability to perform upper limb daily activities. To improve upper limb function after stroke, it is important to understand which factors are most associated with dexterity. Objective: To evaluate how several factors are associated with dexterity after stroke. Design: Cross-sectional study. Setting: A university hospital. Participants: A convenience sample of 75 persons (54 men and 21 women, mean age 66 years) with mild to moderate impairments of the upper limb after stroke. Methods: Dexterity and potentially associated factors (age, gender, affected hand, social situation, vocational situation, grip strength, spasticity, sensory function, and pain) were evaluated by linear regression models. Main Outcome Measurements: Dexterity was measured with the mini Sollerman Hand Function Test, sensory function with both the Fugl-Meyer Assessment of the Upper Extremity (to assess light touch and proprioception) and the Shape Texture Identification Test (to assess active discriminative touch), spasticity with the Modified Ashworth Scale, and grip strength with the Grippit dynamometer. Results: Active discriminative touch had the strongest association with dexterity, explaining 46% of the variance. When spasticity and grip strength were added, the explained variance increased to 57% in the final multivariate model. Conclusions: This study indicates that sensory function in terms of active discriminative touch is a major contributing factor to dexterity in persons with mild to moderate stroke, whereas spasticity and grip strength may be of lesser importance. Level of Evidence: III.
18.	Danielsson, Anna, 1957, et al. (författare) Physical Activity in Community-Dwelling Stroke Survivors and a Healthy Population Is Not Explained byMotor Function Only. 2014 Ingår i: PM & R : the journal of injury, function, and rehabilitation. - : Wiley. - 1934-1563. ; 6:2, s. 139-145 Tidskriftsartikel (refereegranskat)abstract To explore the relationship between self-reporting and physical measures and compare self-reported physical activity (PA) levels in persons who have had a stroke with self-reported PA levels in a control population.
19.	Ekstrand, Elisabeth, et al. (författare) Life satisfaction after stroke and the association with upper extremity disability, sociodemographics, and participation 2022 Ingår i: PM and R. - : Wiley. - 1934-1482 .- 1934-1563. ; 14:8, s. 922-930 Tidskriftsartikel (refereegranskat)abstract Introduction: Remaining disability after stroke can reduce a person's life satisfaction. Because previous studies of life satisfaction show inconsistent results, there is a need for more knowledge regarding perceived life satisfaction after stroke and associated factors. Objective: To assess perceived life satisfaction after stroke in relation to Swedish reference values; and the association with upper extremity disability, sociodemographics, and participation. Design: Cross-sectional study. Setting: University hospital. Participants: Seventy-five persons (72% male) with mild to moderate disability in a stable phase after stroke. Interventions: Not applicable. Main Outcome Measure: Life satisfaction was assessed with the Life Satisfaction Questionnaire (LiSat-11), which includes one global item Life as a whole and 10 domain-specific items. Global life satisfaction and explanatory factors were evaluated in two multivariate logistic regression models. Results: Fifty-three percent of the participants were satisfied with Life as a whole. Highest satisfaction was found for Family life (78%) and Partner relationship (77%) and lowest satisfaction for Vocational situation (32%), Sexual life (25%), and Physical health (23%). Life as a whole and most domain-specific items showed a significantly lower proportion of satisfied persons compared to Swedish reference values. In the first regression model with factors of upper extremity disability, manual ability was the strongest explanatory variable for Life as a whole (p value =.032, Nagelkerke R Square 0.117). In the second regression model, participation, social, and working status were the final explanatory variables (p value =.006, Nagelkerke R Square = 0.207). Conclusion: Our findings indicate that persons with mild to moderate disability after stroke perceive overall less satisfaction with Life as a whole and domain-specific items than the general Swedish population. To increase a person's life satisfaction after stroke, rehabilitation interventions should target a variety of aspects including enhancing functioning of upper extremity, reducing participation restrictions, and providing support regarding social and vocational situation.
20.	Ekstrand, Elisabeth, et al. (författare) Life Satisfaction in Persons With Late Effects of Polio : A Test-Retest Reliability Study 2020 Ingår i: PM and R. - : Wiley. - 1934-1482 .- 1934-1563. ; 12:10, s. 997-1002 Tidskriftsartikel (refereegranskat)abstract Background: The Life Satisfaction Questionnaire (LiSat-11), including one global item and 10 domain-specific items, is used to evaluate life satisfaction in persons with the late effects of polio (LEoPs). However, there is a lack of knowledge about its psychometric properties. Objective: To evaluate the test-retest reliability of the LiSat-11 and the associations between the global and domain-specific items in persons with LEoPs. Design: A test-retest design, where data were collected by a postal survey. Setting: University Hospital, Outpatient Clinic. Participants: A cross-sectional sample of persons (20 women and 31 men; mean age 72 years) with LEoPs. Main Outcome Measurements: LiSat-11, assessing how satisfied a person is with different aspects of life, such as life as a whole, vocation, economy, leisure, contacts with friends and acquaintances, sexual life, activities of daily living (ADLs), family life, partner relationship, somatic health, and psychological health. Methods: LiSat-11 was administered on two occasions, 2 weeks apart. The test-retest reliability was evaluated by Kappa statistics, the percent agreement (PA), and the Svensson rank-invariant method. The association between the items was evaluated with the Spearman rank correlation coefficient (rho). Results: The Kappa coefficients showed good to excellent agreement (0.64-0.90) and the PA ≤1 point was high (>92%) for all items. No items showed any systematic or random disagreements according to the Svensson method. All domain-specific items correlated significantly with the global item “Life as a whole” (P <.01; rhos 0.41 to 0.75). Conclusions: LiSat-11 is reliable for assessing life satisfaction in persons with LEoPs. The global item “Life as a whole” is useful as an overall measure but cannot fully replace the information obtained from the domain-specific items of LiSat-11.
21.	Ekstrand, Elisabeth, et al. (författare) Test-Retest Reliability and Convergent Validity of Three Manual Dexterity Measures in Persons With Chronic Stroke 2016 Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 8:10, s. 935-943 Tidskriftsartikel (refereegranskat)abstract Background: Decreased manual dexterity is common in persons after stroke. Different measures are used to assess manual dexterity, but a lack of knowledge exists about their reliability and how they are related. Objective: To evaluate the test-retest reliability and convergent validity of 3 manual dexterity measures after stroke. Design: A test-retest design. Setting: University Hospital. Participants: Forty-five persons (mean age 65 years) with mild-to-moderate impairments in the upper extremity at least 6 months after stroke. Main Outcome Measures: Manual dexterity was assessed on 2 occasions, 1 week apart using the Box and Block Test (BBT), the Nine-Hole Peg Test (NHPT), and the modified Sollerman Hand Function Test (mSHFT). The reliability of the BBT and NHPT was evaluated with the intraclass correlation coefficient together with systematic and random measurement errors. Reliability of the mSHFT was evaluated with the Kappa coefficient and the Svensson rank-invariant method (percent agreement and systematic and random disagreements). Convergent validity of the total scores was evaluated with the Spearman rank correlation coefficients (rho). Results: The intraclass correlation coefficient for the BBT and the NHPT ranged from 0.83 to 0.99. Significant systematic measurement errors were found for both tests and hands. The Kappa coefficient for the total sum score of the mSHFT was 0.95 for the more affected hand and 0.59 for the less affected hand. One of the 3 items showed systematic disagreements for both hands. The convergent validity (rho) for the more affected hand ranged from 0.41 (BBT versus mSHFT) to -0.68 (NHPT versus mSHFT). Conclusion: The test-retest reliability of the BBT, NHPT and mSHFT was high but all measures showed learning effects. The relationships between the 3 measures indicate that they partly complement one another. The BBT may be preferred for persons with moderate impairments of the upper extremity and the NHPT and the mSHFT for persons with milder impairments. As the mSHFT has the advantage of reflecting activities in daily life it may be a suitable alternative to the NHPT.
22.	Ekstrand, Elisabeth, et al. (författare) Test-retest reliability of the ABILHAND Questionnaire in persons with chronic stroke. 2014 Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 6:4, s. 324-331 Tidskriftsartikel (refereegranskat)abstract To be able to evaluate recovery, effects of rehabilitation interventions and changes over time, reliable and valid outcome measures are needed. The ABILHAND Questionnaire is a measure of self-reported ability to perform complex daily hand activities. It is commonly used in stroke rehabilitation, but data about the measurement variability are missing.
23.	Fagher, Kristina, et al. (författare) Mental health, sleep, and pain in elite Para athletes and the association with injury and illness-A prospective study 2023 Ingår i: PM&R. - : WILEY. - 1934-1482 .- 1934-1563. ; 15:9, s. 1130-1139 Tidskriftsartikel (refereegranskat)abstract IntroductionThe interest in the health of Para athletes continues to increase. Still, there are few studies that have evaluated health parameters beyond injury and illness in this athlete population. ObjectiveTo assess (1) the weekly proportion of elite Para athletes reporting anxiety/depression, low sleep levels (<= 7 hours), and pain over 52 weeks; (2) and to explore whether these health parameters are associated with the risk for a sports injury or illness. DesignA 52-week prospective study, part of the Sports-related Injury and Illness in Paralympic Sport Study (SRIIPSS). SettingA total of 107 Swedish elite Para athletes with physical, visual, and intellectual impairment participated. Main outcome measuresData on self-reported anxiety/depression, sleep levels, pain, and injuries/illnesses were collected weekly. Comparisons of these parameters preceding an injury/illness were made using Friedmans analysis of variance (ANOVA). ResultsThe proportion of athletes reporting weekly anxiety/depression was 34.1%; 60.9% of athletes reported sleeping <= 7 hours and 49.9% reported pain. In exploratory analyses, there were no significant differences between weeks before an injury for any of the variables. There were significant differences in levels of sleep over the weeks, where sleep levels were significantly higher (>10 hours) 4 weeks prior to an illness (p = .016). ConclusionThis cohort of elite Para athletes reported relatively high levels of anxiety/depression, low sleep levels, and pain, which is a concern. High sleep levels and the risk for illness might be an indication of overtraining, which commonly leads to persistent fatigue and an increased susceptibility to infections. Monitoring of the health of elite Para athletes is recommended to be able to improve performance and health in this population.
24.	Fagher, Kristina, et al. (författare) Prevalence of Sports-Related Injuries and Illnesses in Paralympic Athletes 2020 Ingår i: PM&R. - : WILEY. - 1934-1482 .- 1934-1563. ; 12:3, s. 271-280 Tidskriftsartikel (refereegranskat)abstract BackgroundWith increased participation in Paralympic sports, the burden of sports-related injuries and illnesses may increase. However, there is limited knowledge about the epidemiology of sports-related injuries and illnesses in Paralympic sports (SRIIPS). ObjectiveTo describe among Swedish Paralympic athletes the 1-year retrospective period prevalence of severe SRIIPS and the point prevalence of all SRIIPS and to examine differences in prevalence proportions between athletes with different impairments, behaviors, and sport characteristics. DesignCross-sectional study. SettingSwedish Paralympic Programme. ParticipantsOne hundred and four Paralympic athletes with visual, physical, and intellectual impairment. MethodsAn eHealth application adapted to Paralympic athletes was used to collect self-report data on existing and previous SRIIPS, as well as impairment, behavior, and sport characteristics. Main Outcome MeasurementsOne-year retrospective period prevalence and point prevalence. ResultsThe period prevalence of severe injuries was 31% (95% CI 23-40) and the point prevalence 32% (95% CI 24-41). The period prevalence of severe illnesses was 14% (95% CI 9-23), and 13% of the athletes (95% CI 8-22) reported a current illness. More severe injuries (Pamp;lt;.05) were reported by athletes aged 18 to 25years, not using assistive device, having pain during sport, using analgesics, continuing training injured, and feeling guilt when missing exercise. Athletes who reported a previous severe injury, having pain in daily life and during sport, using analgesics, and being upset when unable to exercise had a higher prevalence of current injuries (Pamp;lt;.05). Being female, reporting previous severe illness, using prescribed medication, and feeling anxious/depressed were features associated with ongoing illnesses (Pamp;lt;.05). ConclusionParalympic athletes report a high prevalence of SRIIPS. Behavioral and psychological aspects as well as pain and use of medication appear to be associated with the occurrence of SRIIPS. The results imply that factors leading to SRIIPS are complex and call for a broad biopsychosocial approach when developing preventive measures. Level of EvidenceIII.
25.	Flansbjer, Ulla-Britt, et al. (författare) Men With Late Effects of Polio Decline More Than Women in Lower Limb Muscle Strength: A 4-Year Longitudinal Study. 2015 Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 7:11, s. 1127-1136 Tidskriftsartikel (refereegranskat)abstract In persons with prior paralytic poliomyelitis, progressive muscle weakness can occur after a stable period of at least 15 years. Knowledge is limited about which factors influence changes in lower limb muscle strength in these persons. Objective. To assess changes in lower limb muscle strength annually over 4 years in persons with late effects of polio and to identify prognostic factors for changes in muscle strength. A prospective, longitudinal study. University hospital outpatient program. Fifty-two ambulant persons (mean age ± standard deviation: 64 ± 6 years) with verified late effects of polio. Mixed linear models were used to analyze changes in muscle strength and to identify determinants among the following covariates: gender, age, age at acute polio infection, time with late effects of polio, body mass index, and estimated baseline muscle weakness. Knee extensor and flexor and ankle dorsiflexor muscle strength were measured annually with a Biodex dynamometer. The men (n = 28) had significant linear change over time for all knee muscle strength measurements, from −1.4% (P < .05) per year for isokinetic knee flexion in the less-affected lower limb to −4.2% (P < .001) for isokinetic knee extension in the more-affected lower limb, and for 2 ankle dorsiflexor muscle strength measurements (−3.3%-1.4% per year [P < .05]). The women (n = 24) had a significant linear change over time only for ankle dorsiflexor measurements (4.0%-5.5% per year [P < .01]). Gender was the strongest factor that predicted a change in muscle strength over time.Over 4 years, men had a greater decline in muscle strength than did women, but the rate of decline did not accelerate. This finding indicates that gender could be a contributing factor to the progressive decline in muscle strength in persons with late effects of polio.
26.	Flansbjer, Ulla-Britt, et al. (författare) Reliability of Gait Performance Tests in Individuals With Late Effects of Polio. 2010 Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 2:2, s. 125-131 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To assess the reliability of 4 gait performance tests in individuals with late effects of polio. DESIGN: An intrarater (between occasions) test-retest reliability study. SETTINGS: University hospital. PARTICIPANTS: Thirty men and women (mean age 63 +/- 6.4 years) with clinically and electrophysiologically verified late effects of polio. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: The Timed "Up & Go" test, the Comfortable and the Fast Gait Speed tests, and the 6-Minute Walk test were assessed 7 days apart. Reliability was evaluated with the intraclass correlation coefficient (ICC(2,1)), the mean difference between the test sessions (d), and the 95% confidence intervals for d, the standard error of measurement (SEM and SEM%), the smallest real difference (SRD and SRD%) and the Bland & Altman graphs. RESULTS: Test-retest agreements were high (ICC(2,1) 0.82-0.97) and measurement errors generally small. The standard error of measurement (SEM%), representing the smallest change that indicates a real (clinical) improvement for a group of individuals, was small (4%-7%). The smallest real difference (SRD%), representing the smallest change that indicates a real (clinical) improvement for a single individual also was small (12%-21%). CONCLUSION: These commonly used gait performance tests are highly reliable and can be recommended to evaluate improvements in various aspects of gait performance in groups of individuals as well as single individuals with late effects of polio.
27.	Flansbjer, Ulla-Britt, et al. (författare) The Reproducibility of Berg Balance Scale and the Single-Leg Stance in Chronic Stroke and the Relationship Between the Two Tests. 2012 Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 4:3, s. 165-170 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To assess the reproducibility of the Berg Balance Scale (BBS) and the Single-leg Stance (SLS), and the validity of the SLS as an independent test of upright postural control in patients with chronic stroke. DESIGN: An intra-rater test-retest reproducibility study. The BBS and the SLS were assessed twice, 7 days apart. SETTING: A university hospital. PARTICIPANTS: Fifty individuals; 6-46 months after a stroke. MAIN OUTCOME MEASUREMENTS: The reproducibility of the BBS and the SLS was evaluated with intraclass correlation coefficient (ICC(2,1)), the mean difference between the 2 test sessions (d̄) with 95% confidence interval (95% CI), the standard error of measurement (standard error of measurement [SEM]%), the smallest real difference (SRD%), and the Bland-Altman graphs. To assess validity of SLS, the relationship between the SLS and the BBS was analyzed by the Pearson correlation coefficient. RESULTS: The ICC(2,1) was 0.88 for the BBS, and the ICC(2,1) values were 0.88 for the nonparetic limb and 0.92 for the paretic lower limb for the SLS. The smallest change that indicates a real improvement for a group of individuals, SEM%, was 3% for BBS, 15% for the nonparetic limb and 27% for the paretic limb for SLS. The smallest real difference for a single individual was 8% for BBS but was higher for SLS, at 42% for the nonparetic limb, and 74% for the paretic limb. There was a significant relationship between the SLS and the BBS (r = 0.65-0.79; P < .001). CONCLUSIONS: The BBS and the SLS are reproducible measurements in patients with chronic stroke, but only the BBS is sensitive enough to follow changes over time or after an intervention. The SLS is strongly related to the BBS and can be used as an independent test to measure upright postural control after a stroke.
28.	Hodges, P. W., et al. (författare) Building a Collaborative Model of Sacroiliac Joint Dysfunction and Pelvic Girdle Pain to Understand the Diverse Perspectives of Experts 2019 Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 11:Suppl. 1 Tidskriftsartikel (refereegranskat)abstract Background: Pelvic girdle pain (PGP) and sacroiliac joint (SIJ) dysfunction/pain are considered frequent contributors to low back pain (LBP). Like other persistent pain conditions, PGP is increasingly recognized as a multifactorial problem involving biological, psychological, and social factors. Perspectives differ between experts and a diversity of treatments (with variable degrees of evidence) have been utilized. Objective: To develop a collaborative model of PGP that represents the collective view of a group of experts. Specific goals were to analyze structure and composition of conceptual models contributed by participants, to aggregate them into a metamodel, to analyze the metamodel's composition, and to consider predicted efficacy of treatments. Design: To develop a collaborative model of PGP, models were generated by invited individuals to represent their understanding of PGP using fuzzy cognitive mapping (FCM). FCMs involved proposal of components related to causes, outcomes, and treatments for pain, disability, and quality of life, and their connections. Components were classified into thematic categories. Weighting of connections was summed for components to judge their relative importance. FCMs were aggregated into a metamodel for analysis of the collective opinion it represented and to evaluate expected efficacy of treatments. Results: From 21 potential contributors, 14 (67%) agreed to participate (representing six disciplines and seven countries). Participants' models included a mean (SD) of 22 (5) components each. FCMs were refined to combine similar terms, leaving 89 components in 10 categories. Biomechanical factors were the most important in individual FCMs. The collective opinion from the metamodel predicted greatest efficacy for injection, exercise therapy, and surgery for pain relief. Conclusions: The collaborative model of PGP showed a bias toward biomechanical factors. Most efficacious treatments predicted by the model have modest to no evidence from clinical trials, suggesting a mismatch between opinion and evidence. The model enables integration and communication of the collection of opinions on PGP.
29.	Jonasson, Stina, et al. (författare) Content Analysis of Four Fear of Falling Rating Scales by Linking to the International Classification of Functioning, Disability and Health. 2013 Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 5:7, s. 573-582 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To gain a deeper understanding of the content of 4 fear of falling (FOF) rating scales by linking them to the International Classification of Functioning, Disability and Health (ICF). DESIGN: Linking study according to the ICF linking rules. SETTING: Not applicable. PATIENTS: Not applicable. METHODS: The rating scales were the Falls Efficacy Scale-International (FES-I), the Swedish version of the Falls Efficacy Scale (FES[S]), the Activities-specific Balance Confidence Scale (ABC), and the modified Survey of Activities and Fear of Falling in the Elderly (SAFFE). The process followed the established and updated linking rules. Three linkers independently identified all meaningful concepts in the rating scales and linked them to the most precise ICF categories. The linkers then discussed their results to reach consensus. If consensus was not attained, the linkers pursued the discussions with a fourth person to reach consensus. MAIN OUTCOME MEASUREMENTS: Not applicable. RESULTS: Most meaningful concepts from the overall questions were linked to the ICF component of body functions. Of the 62 items, all but one meaningful concept were linked to the component of activities and participation. All 4 rating scales covered the chapters of mobility and domestic life and had most linkages to the mobility chapter. CONCLUSIONS: The linking process revealed similarities and differences between the 4 FOF rating scales, as well as methodologic challenges in linking instruments to the ICF. By providing a content description that allows for a direct comparison of the rating scales, the results may be helpful when choosing an appropriate rating scale assessing FOF in clinical practice and research. A further head-to-head comparison through psychometric analyses is required to recommend appropriate FOF rating scales. Studies are also needed to investigate how the overall question and response categories of a rating scale affect respondents' answers.
30.	Jörgensen, Sophie, et al. (författare) Cardiovascular Risk Factors Among Older Adults With Long-Term Spinal Cord Injury 2019 Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 11:1, s. 8-16 Tidskriftsartikel (refereegranskat)abstract Background: Individuals with spinal cord injury (SCI) now live longer, which increases the risk of cardiovascular disease. Knowledge of cardiovascular risk factors amenable to intervention are therefore needed to support their healthy aging.Objective: To describe the occurrence of cardiovascular risk factors among older adults with long‐term SCI and investigate the association with sociodemographics and injury characteristics.Design: Cross‐sectional descriptive cohort study.Setting: Home settings.Participants: In total, 123 individuals (71% men, injury levels C1–L5, American Spinal Injury Association Impairment Scale A–D), mean age 63 years, mean time since injury 24 years.Methods: Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS), collected through interviews and assessments during home visits and from medical records.Main Outcome Measures: Anthropometric measurements, blood pressure, fasting plasma glucose and blood lipids, and data on cardiovascular comorbidity and tobacco use.Results: One third had a previous diagnosis of hypertension, and 55% presented with a blood pressure ≥ 140/90 mm Hg at the time of assessment. Sixteen percent had a history of diabetes and in 15% fasting glucose levels were ≥ 7 mmol/L. Dyslipidemia was present in 76%, whereas 16% had prediagnosed dyslipidemia. Mean body mass index (BMI) was 27 kg/m2 and mean waist circumference was 101 cm. When SCI‐adjusted BMI cut‐off values were used, 93% were considered overweight (BMI ≥22 kg/m2), and 60% had a waist circumference associated with cardiometabolic risk. A total of 16% smoked regularly. The median number of cardiovascular risk factors was 3. No significant associations were found between the total number of risk factors and sociodemographics and injury characteristics.Conclusions: The high occurrence of cardiovascular risk factors among older adults with long‐term SCI can pose additional consequences to their health. Regular assessments and interventions targeting cardiovascular risk in this population are therefore warranted. Further research is needed to identify modifiable factors associated with their risk profile.Level of Evidence: III
31.	Jörgensen, Sophie, et al. (författare) Secondary health conditions, activity limitations, and life satisfaction in older adults with long-term spinal cord injury 2017 Ingår i: PM&R. - : Elsevier. - 1934-1482 .- 1934-1563. ; 9:4, s. 356-366 Tidskriftsartikel (refereegranskat)abstract BackgroundMany individuals with a spinal cord injury (SCI) have lived several decades with their injury, leading to a need for a deeper understanding of factors associated with healthy aging in people with long-term SCI.ObjectivesTo (1) describe secondary health conditions, activity limitations, and life satisfaction in older adults with long-term SCI, and to (2) investigate how sociodemographics, injury characteristics, and secondary health conditions are associated with their activity limitations and life satisfaction.DesignCross-sectional descriptive cohort study.SettingHome and community settings.ParticipantsA total of 123 individuals (71% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D), mean age 63 years, mean time since injury 24 years.MethodsBaseline data as part of the Swedish Aging with Spinal Cord Injury Study. Associations between variables were investigated with multivariable linear regression analyses.Main Outcome MeasurementsBowel and bladder function, nociceptive and neuropathic pain, spasticity, the Spinal Cord Independence Measure, third version, and the Satisfaction With Life Scale.ResultsBowel-related and bladder-related problems were reported by 32% and 44%, respectively, 66% reported moderate or severe nociceptive and/or neuropathic pain, and 44% reported spasticity. Activity limitations were moderate (mean Spinal Cord Independence Measure, third version, total score 65.2, range 8-100) where injury characteristics and spasticity explained 68% of the variance. Higher level and more severe SCI (based on the American Spinal Injury Association Impairment Scale) exhibited the strongest association with more activity limitations. Life satisfaction was rated just above the midpoint between satisfied and dissatisfied with life (mean Satisfaction With Life Scale total score 20.7, range 6-34). Marital status, vocational situation, bladder function and injury characteristics explained 38% of the variance, where having a partner showed the strongest association with greater life satisfaction. Activity limitations and life satisfaction were not associated with gender, age and time since injury.ConclusionOlder adults with long-term SCI can maintain a relatively high level of physical independence and generally are satisfied with their lives, regardless of gender, age or time since injury. The associations demonstrate the importance of injury characteristics for the performance of daily activities and the social context for life satisfaction in older adults with long-term SCI.Level of EvidenceIII
32.	Jörgensen, Sophie, et al. (författare) The Swedish Aging with Spinal Cord Injury Study (SASCIS): Methodology and initial results 2016 Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 8:7, s. 667-677 Tidskriftsartikel (refereegranskat)abstract Advances in acute treatment, physiatric care and rehabilitation have greatly improved survival after spinal cord injury (SCI) and increased longevity. This has led to a need for an in-depth understanding of factors associated with healthy aging in people with long-term SCI.
33.	Laskowski, Edward R., et al. (författare) Exercise and sports for health promotion, disease, and disability 2012 Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 4:11, s. 795-796 Tidskriftsartikel (refereegranskat)
34.	Lee, AC, et al. (författare) Dose-Response Effects of Tai Chi and Physical Therapy Exercise Interventions in Symptomatic Knee Osteoarthritis 2018 Ingår i: PM & R : the journal of injury, function, and rehabilitation. - : Wiley. - 1934-1563. ; 10:7, s. 712-723 Tidskriftsartikel (refereegranskat)
35.	Lexell, Jan, et al. (författare) Physical medicine and rehabilitation: interdisciplinary, interventional, and international. 2012 Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 4:10, s. 768-769 Tidskriftsartikel (refereegranskat)
36.	Lexell, Jan (författare) What's on the Horizon : Defining Physiatry Through Rehabilitation Methodology 2012 Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 4:5, s. 331-334 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
37.	Lindgren, Ingrid, et al. (författare) Left-Sided Hemiparesis, Pain Frequency, and Decreased Passive Shoulder Range of Abduction Are Predictors of Long-Lasting Poststroke Shoulder Pain 2012 Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 4:8, s. 561-568 Tidskriftsartikel (refereegranskat)abstract Objective: To determine the proportion of persons with poststroke shoulder pain 4 months after onset of the stroke in whom long-lasting shoulder pain develops and to assess the extent to which age, side of paresis at stroke onset, pain frequency and pain intensity, passive shoulder range of motion, resistance to passive movements, motor function, and subluxation at 4 months after stroke predict shoulder pain 1 year later. Design: A prospective study. Setting: A university hospital outpatient clinical setting. Participants: Fifty-eight men and women with their first-ever stroke (mean age, 71 years) and affected sensory-motor function in the upper extremity at stroke onset who all reported shoulder pain in the affected side 4 months after onset of the stroke. Methods: At 4 and 16 months after having a stroke, the participants rated their selfperceived shoulder pain (frequency and intensity). Passive range of shoulder abduction and external rotation, resistance to passive movements in the elbow, and motor function in the shoulder were assessed by a physical therapist. Main Outcome Measurements: A question about pain frequency (constant, often, or occasional), the Visual Analogue Scale for Pain for self-perceived shoulder pain intensity, a goniometer for range of motion, the Modified Ashworth Scale for resistance to passive movements, and the Motor Assessment Scale for motor function. Results: Of the 58 participants who had shoulder pain 4 months after having a stroke, 42 (72%) still had pain at 16 months. The logistic regression indicated an association between shoulder pain at 16 months and left-sided hemiparesis at stroke onset (P= .01; odds ratio [OR] 10.47; 95% confidence interval [CI] 1.92-57.05), pain frequency (P = .02; OR 6.85; 95% CI 1.46-32.14), decreased passive abduction at 4 months (P = .05; OR 4.46; 95% CI 0.99-20.10), and age (P = .07; OR 1.05; 95% CI 1.0-1.12). Conclusions: A high proportion of persons with shoulder pain 4 months after having a stroke are at risk of having persistent shoulder pain 1 year later. Left-sided hemiparesis, pain reported frequently, and decreased passive shoulder range of abduction at 4 months are predictors of long-lasting poststroke shoulder pain and require increased attention in the rehabilitation setting.
38.	Lindgren, Ingrid, et al. (författare) Poststroke Shoulder Pain and Its Association With Upper Extremity Sensorimotor Function, Daily Hand Activities, Perceived Participation, and Life Satisfaction. 2014 Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 6:9, s. 781-789 Tidskriftsartikel (refereegranskat)abstract To assess the differences in upper extremity sensorimotor function, daily hand activities, and perceived participation and life satisfaction between individuals with and without poststroke shoulder pain (PSSP), and to determine how PSSP is associated with these variables.
39.	Martin Ginis, Kathleen A., et al. (författare) Exercise and Sport for Persons With Spinal Cord Injury 2012 Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 4:11, s. 894-900 Tidskriftsartikel (refereegranskat)abstract This review article provides an overview of the evidence that links exercise and sports participation to physical and psychological well-being among people with spinal cord injury. Two aspects of physical well-being are examined, including the prevention of chronic disease and the promotion of physical fitness. Multiple aspect's of psychosocial well-being are discussed, including mental health, social participation, and life satisfaction. The review concludes with future research recommendations and a discussion of challenges and opportunities for using exercise and sports to promote health and well-being among people living with spinal cord injury. PM R 2012;4:894-900
40.	Nolvi, Maria, et al. (författare) Sense of Coherence and the Association with Sociodemographics and Disability Related Factors in Persons with Late Effects of Polio 2020 Ingår i: PM&R. - : WILEY. - 1934-1482 .- 1934-1563. ; 12:2, s. 154-160 Tidskriftsartikel (refereegranskat)abstract Background: Sense of Coherence (SOC) is important for successful adaptation in persons with life-long disabilities. A previous study has shown that persons with Late Effects of Polio (LEoP) have a level of SOC indicating that they generally have the ability to understand, handle, and have the motivation to deal with stressful events and problems arising in their lives. However, no study has explored the associations between SOC, sociodemographics, and disability-related factors in persons with LEoP.Objective: To explore the associations between SOC, sociodemographics, and disability-related factors in persons with LEoP.Design: A cross-sectional design.Setting: University hospital outpatient clinic.Study Participants: Ninety-three persons (mean age 74 years, 52% women) with LEoP.Main Outcome Measurements: Swedish versions of the Sense of Coherence scale (SOC-13), Self-reported Impairments in Persons with Late Effects of Polio (SIPP) scale, Reintegration to Normal Living Index (RNL-I) (subscales "Daily Functioning" and "Perceptions of Self"), and Satisfaction With Life Scale (SWLS).Methods: The participants responded to a postal survey with background information and the four rating scales. To determine factors associated with SOC, a hierarchical regression analysis was performed with SOC as the dependent variable.Results: Higher age, less bothered by symptoms of LEoP, better perceptions of self, and higher life satisfaction were significantly associated with a greater SOC score. The final model explained 60% of the variance in the SOC (R-2 Adj = 0.60, P < .001).Conclusions: The strong association between SOC, higher age, and disability-related factors is important to consider in the rehabilitation of persons with LEoP. This knowledge can assist rehabilitation professionals to plan interventions that enable people with LEoP to develop strategies to better manage their daily life.
41.	Persson, Elisabeth, et al. (författare) Positive Effects of a Musculoskeletal Pain Rehabilitation Program Regardless of Pain Duration or Diagnosis 2012 Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 4:5, s. 355-366 Tidskriftsartikel (refereegranskat)abstract Objectives: To investigate how sociodemographic and clinical factors are associated with psychosocial functioning and disability at admission to a musculoskeletal pain rehabilitation program and at 1-year follow-up. Design: A cohort pre-post study. Setting: A University hospital specialized pain rehabilitation unit. Participants: Five hundred nine participants with musculoskeletal pain (neck disorders, 29%; fibromyalgia, 24%; low back pain, 24%; myalgia, 14%; and other pain diagnoses, 8%). Intervention: A 5-week outpatient, group-based, and goal-oriented comprehensive musculoskeletal interdisciplinary pain rehabilitation program based on cognitive behavioral principles. Main Outcome Measures: The Multidimensional Pain Inventory (MPI), the Disability Rating Index (DRI), and forms including sociodemographic factors (gender, age, ethnicity, marital status, educational level, and vocational situation) and clinical factors (pain duration and pain diagnoses). Data were analyzed with multivariate logistic regression. Results: At admission, factors associated with more positive scores on the MPI were being older than 40 years, being at work, being Nordic born, attainment of a higher educational level, and a diagnosis of fibromyalgia (compared with a neck disorder) (. P < .05). Being at work and a diagnosis of fibromyalgia (compared with low back pain) were associated with more positive scores on the DRI (. P < .05). On the basis of cut points for clinically important change on the MPI, participants rated themselves as most improved on the Affective Distress (52%), Life Control (49%), and Pain Severity (43%) subscales, and on the DRI index, the improvement rate was 22%. At the 1-year follow-up, neither sociodemographic nor clinical factors were associated with clinically important improvements of the MPI and the DRI, but younger age was related to deteriorations in pain severity. Conclusions: The lack of an association between sociodemographic and clinical factors and psychosocial functioning and disability at a 1-year follow-up after a musculoskeletal pain rehabilitation program suggests that the program was effective regardless of the participants' initial characteristics, except for age. The changes at the 1-year follow-up indicate that the program influenced the participants' psychosocial functioning more than their perception of disability.
42.	Sahlin, Barbara, et al. (författare) Impact of Organized Sports on Activity, Participation, and Quality of Life in People With Neurologic Disabilities. 2015 Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 7:10, s. 1081-1088 Forskningsöversikt (refereegranskat)abstract Physical activity and exercise is the mainstay of chronic disease prevention and health maintenance for all people with and without a disability, and clear evidence exists of the benefits among various populations with neurologic disabilities. However, the potential benefits of organized sports for people with neurologic disabilities are not as well explored. In this narrative review, current evidence regarding the impact of organized sports on activity, participation, and quality of life in people with neurologic disabilities of all ages is summarized, and facilitators of and barriers to participation in sports for this population are discussed. The articles reviewed were divided into 2 sets: (1) children and adolescents and (2) adults. The subjects of almost all of the studies were persons with a spinal cord injury. Children and adolescents with a disability who engaged in sports reported self-concept scores close to those of able-bodied athletes, as well as higher levels of physical activity. Adults with a spinal cord injury who engaged in organized sports reported decreased depression and anxiety, increased life satisfaction, and increased opportunity for gainful employment compared with nonathletic persons with disabilities. General facilitators, regardless of age, were fitness, fun, health, competence, and social aspects, whereas overall barriers were lack of or inappropriate medical advice and facilities, decreased self-esteem, poor finances, dependency on others, and views held by others. The importance of this topic for further research is highlighted, and suggestions for future studies are proposed.
43.	Schwartz, Jaclyn K., et al. (författare) Classification of Mild Stroke : A Mapping Review 2019 Ingår i: PM&R. - : American Academy of Physical Medicine and Rehabilitation. - 1934-1482 .- 1934-1563. ; 11:9, s. 996-1003 Forskningsöversikt (refereegranskat)abstract Persons with mild stroke experience motor and cognitive impairments that negatively affect their health and quality of life. To address these deficits, it is essential for clinicians and researchers to precisely identify mild stroke survivors. Despite the fact that half of all strokes are categorized as mild, no standards exist on what constitutes a "mild" stroke. The purpose of this study is to summarize the current classification of mild stroke using a mapping review approach. Strategies to categorize "mild stroke" severity were explored in 188 papers indexed in the PubMed database. The results indicate that there was substantial variability in the procedures and scoring criteria used to determine mild stroke. To identify persons with mild stroke, researchers have largely applied assessment instruments developed to inform acute stroke care (eg, National Institutes of Health Stroke Scale, Modified Rankin Scale, Barthel Index). Unfortunately, these approaches demonstrate floor effects and fail to detect the long-term disabling impairments that often limit the outcomes of mild stroke survivors. Additional research is warranted to suggest an evidence-based mild stroke categorization strategy that enhances diagnosis, treatment, and referral decisions to the benefit of mild stroke survivors.
44.	Smith, Jay, et al. (författare) Differential Plantaris-Achilles Tendon Motion : A Sonographic and Cadaveric Investigation 2017 Ingår i: PM&R. - : ELSEVIER SCIENCE INC. - 1934-1482 .- 1934-1563. ; 9:7, s. 691-698 Tidskriftsartikel (refereegranskat)abstract Background: Differential motion between the plantaris and Achilles tendons has been hypothesized to contribute to pain in some patients presenting with Achilles tendinopathy. However, objective evidence of differential Achilles-plantaris motion is currently lacking from the literature. Objective: To determine whether differential, multidirectional motion exists between the plantaris tendon (PT) and Achilles tendon (AT) as documented by dynamic ultrasound (US) and postdissection examination in an unembalmed cadaveric model. Design: Prospective, cadaveric laboratory investigation. Setting: Procedural skills laboratory in a tertiary medical center. Subjects: Twenty unembalmed knee-ankle-foot specimens (9 right, 11 left) obtained from 6 male and 10 female donors ages 55-96 years (mean 80 years) with body mass indices of 14.1-33.2 kg/m(2) (mean 22.5 kg/m(2)). Methods: A single, experienced operator used high -resolution dynamic US to qualitatively document differential PT-AT motion during passive ankle dorsifiexion-plantarflexion. Specimens were then dissected and passive dorsiflexion-plantarfiexion was repeated while differential PT-AT motion was visualized directly. Main Outcome Measurements: Presence or absence of multidirectional differential PT-AT motion. Results: All 20 specimens exhibited smooth but variable amplitude multidirectional differential PT-AT motion. Whereas US readily demonstrated medial-lateral and anterior-posterior PT motion relative to the AT, differential longitudinal motion was only appreciated on dissection and direct inspection. Many specimens exhibited partial or complete encasement of the PT between the gastrocnemius portion of the AT and the soleus aponeurosis. Conclusion: Some degree of multidirectional differential PT-AT motion appears to be a normal phenomenon, and PT motion can be evaluated sonographically in both the medial -lateral and anterior-posterior directions. The existence of normal differential PT-AT motion suggests that alterations in PT motion or repetitive stress within the PT-AT interval may produce symptoms in some patients presenting with Achilles region pain syndromes. The PT should be evaluated in all patients presenting with Achilles, plantaris, or calf pain syndromes. Future research would benefit from the development of a sonographic classification system for PT anatomy and motion with the goal of differentiating normal versus pathologic states and identifying risk factors for symptom development.
45.	Smith, Jay, et al. (författare) Sonographically Guided Plantaris Tendon Release : A Cadaveric Validation Study 2019 Ingår i: PM&R. - : John Wiley & Sons. - 1934-1482 .- 1934-1563. ; 11:1, s. 56-63 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The plantaris tendon (PT) has been implicated in the pathogenesis of symptoms in a subset of patients with Achilles region pain syndromes and traditionally has been managed via open surgical resection. Although the PT can be visualized on ultrasound, a minimally invasive technique for sonographically guided PT release has not been formally described.OBJECTIVE: To validate a technique to perform sonographically guided PT release in an unembalmed cadaveric model.DESIGN: Prospective, cadaveric laboratory investigation.SETTING: Procedural skills laboratory in a tertiary medical center.SUBJECTS: Twenty unembalmed cadaveric knee-ankle-foot specimens (10 right, 10 left) obtained from 16 donors (6 male, 10 female) ages 55-96 years (mean 82.6 years) with body mass indexes of 14.1-33.2 kg/m2 (mean 23.3 kg/m2).METHODS: After simulated local anesthesia and sonographically guided hydrodissection of the plantaris tendon-Achilles tendon interval, a single experienced operator performed sonographically guided PT release on each specimen using an in-plane, lateral-to-medial approach, a commercially available, disposable 3.0-mm hook knife, and either a 17-5 MHz or 15-7 MHz linear array transducer. Each specimen was subsequently dissected to assess for PT release and iatrogenic injury.MAIN OUTCOME: Status of the PT, Achilles tendon, and regional neurovascular structures as determined by dissection.RESULTS: All 20 PT releases were completed in a single attempt through a 3- to 5-mm incision. Dissection confirmed complete PT release in all specimens without damage to the adjacent Achilles tendon or regional neurovascular structures.CONCLUSION: Sonographically guided PT release is technically feasible and can be performed while avoiding injury to the Achilles tendon and regional neurovascular structures. Additional research is warranted to further define the role of sonographically guided PT release in patients with suspected PT-mediated Achilles region pain syndromes.LEVEL OF EVIDENCE: IV.
46.	Styrke, Johan, 1980-, et al. (författare) A 10-year incidence of acute whiplash injuries after road traffic crashes in a defined population in Northern Sweden 2012 Ingår i: PM&R. - New York, NY, USA : Elsevier. - 1934-1482 .- 1934-1563. ; 4:10, s. 739-747 Tidskriftsartikel (refereegranskat)abstract ObjectiveTo examine the annual incidence of acute whiplash injuries after road traffic crashes in a geographic catchment area in Northern Sweden during the period 2000-2009.DesignDescriptive epidemiology determined by prospectively collected data from a defined population.SettingThe study was conducted at a public hospital in Sweden.ParticipantsThe population of the hospital's catchment area (136,600 inhabitants in 1999 and 144,500 in 2009).MethodsAt the emergency department, all injured persons (approximately 11,000 per year) were asked to answer a questionnaire about the injury incident. Data from the medical records also were analyzed. From 2000-2009, 15,506 persons were injured in vehicle crashes. Persons who were subject to an acute neck injury within whiplash-associated disorder grades 1-3 were included. The overall and annual incidences were calculated as incidence. Age, gender, type of injury event, and direction of impact were described. The incidences were compared with national statistics on insurance claims from 2003, 2007, and 2008 to detect changes in the proportions of claims.Main Outcome MeasuresThe annual incidence of acute whiplash injuries. Secondary outcome measures were types of injury events, age and gender distribution, changes in the proportion of rear-end crashes during 2000-2009, and changes in the proportion of insurance claims during 2003-2008.ResultsDuring 2000-2009, 3297 cases of acute whiplash injury were encountered. The overall incidence was 235/100,000/year. The average yearly increase in incidence was 1.0%. Women comprised 51.9% and men 48.1% of the injured. Car occupants (86.4%) and bicycle riders (6.1%) were most frequently injured. The proportion of rear-end crashes decreased from 55% to 45% from 2000-2009. The proportion of insurance claims significantly decreased between 2003 and 2008 (P < .0001, χ2 test).ConclusionThe incidence of emergency department visits attributable to acute whiplash injuries after road traffic crashes have been relatively stable during the past decade in our area, except in 2007 and 2008, when a peak occurred.
47.	Sund, Terje, et al. (författare) Effectiveness of Powered Mobility Devices in Community Mobility-Related Participation: A Prospective Study Among People With Mobility Restrictions. 2015 Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 7:8, s. 859-870 Tidskriftsartikel (refereegranskat)abstract To investigate the effectiveness of powered mobility device (i.e. powered wheelchair and scooter) interventions over a one year period in the Nordic context.
48.	Waller, Mikael, et al. (författare) Changes over 6 years in secondary health conditions and activity limitations in older adults aging with long-term spinal cord injury 2023 Ingår i: PM and R. - : Wiley. - 1934-1482 .- 1934-1563. ; 15:2, s. 157-167 Tidskriftsartikel (refereegranskat)abstract Background: The number of individuals aging with long-term spinal cord injury (SCI) is increasing. Still, there is limited knowledge about changes in secondary health conditions (SHCs) and activity limitations over time. Objectives: To determine changes in SHCs and activity limitations in older adults aging with long-term SCI over 6 years, and to investigate how changes in SHCs and activity limitations are associated with gender, age, and injury characteristics. Design: Longitudinal cohort study from the Swedish Aging with Spinal Cord Injury Study (SASCIS). Setting: Community settings, Sweden. Participants: From the initial 123 participants in the SASCIS: 78 individuals (32% women); mean age 68 years; mean time since injury 31 years; injury levels C1-L3, AIS A-D. Interventions: Not applicable. Main Outcome Measure: Bowel and bladder function and problems, pain, spasticity, and the Spinal Cord Independence Measure (SCIM III). Results: Over 6 years, bowel-related problems increased (31% to 47%, p =.015) and the occurrence of constipation doubled to 24% (p =.013). There were increases in frequent urinary tract infections (10% to 26%, p =.004), use of indwelling urinary catheters (15% to 23%, p =.031), and other bladder-related problems (4% to 22%, p <.001). The occurrence of pain was high (85%), with no significant change. Spasticity increased from 41% to 62% (p <.001). Activity limitations increased (SCIM III total score mean 67 to 61, p <.001, with significant decreases in all subscales). The increase in bowel-related problems was greater in males, and the deterioration in self-care was greater in participants with longer time since injury and with traumatic injuries. Conclusions: These findings support the notion that SHCs and activity limitations increase over time in older adults aging with long-term SCI. The results can inform clinicians and call for a proactive, holistic approach in the long-term follow-up to support healthy and active aging.
49.	Willick, Stuart E, et al. (författare) Paralympic sports medicine and sports science-introduction. 2014 Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 6:8 Suppl, s. 1-3 Tidskriftsartikel (refereegranskat)
50.	Willick, Stuart, et al. (författare) Stories from sochi: sun, sea, snow, and salt. 2014 Ingår i: PM&R. - : Wiley. - 1934-1563 .- 1934-1482. ; 6:8 Suppl, s. 76-79 Tidskriftsartikel (refereegranskat)

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