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1.	Brogårdh, Christina, et al. (författare) Relationship between self-reported walking ability and objectively assessed gait performance in persons with late effects of polio. 2013 Ingår i: NeuroRehabilitation. - 1878-6448. ; 33:1, s. 127-132 Tidskriftsartikel (refereegranskat)abstract Muscle weakness in the lower limbs and impeded gait performance are common in persons with late effects of polio.
2.	Brogårdh, Christina, et al. (författare) The Benefit of a Flexible Ankle-Foot Orthosis on Balance and Walking Ability in Persons with Late Effects of Polio : A Mixed-Methods Study 2019 Ingår i: Journal of Prosthetics and Orthotics. - 1040-8800. ; 31:2, s. 95-103 Tidskriftsartikel (refereegranskat)abstract ABSTRACT Introduction Many persons with late effects of polio (LEoP) have muscle weakness in the lower limbs, which affects their balance and walking ability. Although an ankle-foot orthosis (AFO) is commonly prescribed for these persons, there is limited knowledge if an AFO improves their balance and walking ability in terms of speed, distance, and perceived safety. The aims of this study were 1) to assess if a flexible AFO improves dynamic balance as well as indoor and outdoor walking in persons with mild to moderate LEoP and 2) to describe the participants' own perceptions of walking ability and safety, as well as advantages and disadvantages with an AFO. Materials and Methods A mixed-methods, repeated-measures, crossover design was used. Nineteen participants were assessed at two test occasions, with and without an AFO, with a 1-week interval. Dynamic balance was evaluated with the timed up and go (TUG) test and walking ability by the 10-m fast gait speed (FGS) tests, the 6-minute walk test (6MWT), and timed walking over a 340-m-long pathway outdoors. The Borg Rating of Perceived Exertion (RPE) scale was used to assess perceived exertion. The participants' perceptions of their walking ability and safety as well as advantages and disadvantages with an AFO were evaluated with questionnaires. Results The AFO significantly improved (P < 0.05) gait speed, outdoor walking, and reduced perceived exertion at one of the test occasions, but had no effect on dynamic balance (P > 0.6). A majority perceived significantly improved walking ability (P < 0.05) and increased walking safety (P < 0.01) with the AFO. Perceived advantages of the AFO were feelings of increased stability and walking distance and reduced risk of falling. Disadvantages were that it could be difficult to put on and uncomfortable to wear. Conclusions A flexible AFO marginally improves walking ability in persons with LEoP, as assessed quantitatively, but the subjective benefit of walking ability and safety suggests that a flexible AFO can be useful to improve daily functioning. In the future, the design of the AFOs needs to be more user-friendly. ©
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.	Blom, Katarina Y., et al. (författare) Early intervention with compression garments prevents progression in mild breast cancer-related arm lymphedema : a randomized controlled trial 2022 Ingår i: Acta Oncologica. - 0284-186X. ; 61:7, s. 897-905 Tidskriftsartikel (refereegranskat)abstract Background: Early diagnosis and compression treatment are important to prevent progression in breast cancer-related arm lymphedema (BCRAL). However, some mild BCRAL can be reversible, and therefore, compression treatment may not be needed. The aim of this study was to investigate the proportion of women with mild BCRAL showing progression/no progression of lymphedema after treatment with or without compression garments, differences in changes of lymphedema relative volume (LRV), local tissue water and subjective symptoms during 6 months. Also, adherence to self-care was examined. Material and methods: Seventy-five women diagnosed with mild BCRAL were randomized to a compression group (CG) or noncompression group (NCG). Both groups received self-care instructions, and the CG were treated with a standard compression garment (ccl 1). Women in the NCG who progressed in LRV ≥2%, or exceeded 10% dropped out, and received appropriate treatment. The proportion showing progression/no progression of LRV, and changes in LRV was measured by Water Displacement Method. Changes in local tissue water were measured by Tissue Dielectric Constant (TDC), subjective symptoms by Visual Analogue Scale, and self-care by a questionnaire. Results: A smaller proportion of LRV progression was found in the CG compared to the NCG at 1, 2 and 6 months follow-up (p ≤ 0.013). At 6 months, 16% had progression of LRV in the CG, compared to 57% in the NCG, (p = 0.001). Thus, 43% in the NCG showed no progression and could manage without compression. Also, CG had a larger reduction in LRV, at all time-points (p ≤ 0.005), and in the highest TDC ratio, when same site followed, at 6 months (p = 0.025). Subjective symptoms did not differ between the groups, except at 1 month, where the CG experienced more reduced tension (p = 0.008). There were no differences in adherence to self-care. Conclusion: Early treatment with compression garment can prevent progression in mild BCRAL. Trial registration: ISRCT nr ISRCTN51918431.
5.	Blom, Katarina Y., et al. (författare) Impact on Health-Related quality of life after wearing compression garment or not for six months in women with mild breast cancer-related arm lymphedema. A cross-sectional study 2023 Ingår i: Acta Oncologica. - 0284-186X. ; 62:5, s. 528-534 Tidskriftsartikel (refereegranskat)abstract Background: Women with mild breast cancer-related arm lymphedema (BCRAL) mostly receive treatment with compression garments and instructions in self-care to prevent the progression of lymphedema. However, wearing a compression garment may be experienced as negative and may affect health-related quality of life (HRQOL) more than the lymphedema itself. The aim of this study was to investigate if there is a difference in lymphedema-specific HRQOL, between women with mild BCRAL wearing compression garments or not for 6 months. Material and methods: Participants with mild BCRAL (Lymphedema relative volume <10%) rated their HRQOL by the Lymphedema Quality of Life Inventory (LyQLI), 6 months after diagnosis and being randomized to compression group (CG) or non-compression group (NCG). Both groups received self-care instructions, and the CG was treated with a standard compression garment, compression class 1. Data from 51 women (30 in the CG and 21 in the NCG), were analyzed. Results: Both the CG and the NCG experienced a low negative impact on HRQOL in physical, psychosocial, and practical domains (score <1). However, the CG experienced a higher negative impact on median HRQOL in the practical domain compared to the NCG, 0.23/0.08 respectively, (p = 0.026). In the specific items, more participants in the CG reported a negative impact on HRQOL compared to the NCG in employment activities 23%/0%, (p = 0.032), embarrassment by lymphedema/compression garments 33%/5%, (p = 0.017), feeling discomfort/embarrassment while doing sports and hobbies 30%/5%, (p = 0.034) and having to answer questions about the lymphedema 27%/0% (p = 0.015). Conclusion: Overall, the lymphedema-specific HRQOL was high after 6 months in women with mild lymphedema, with only a minor difference between the groups. Some women may however perceive practical and emotional issues with the compression garment. These aspects should be considered in patient education and when planning/evaluating treatment. Trial registration: ISRCTN51918431.
6.	Brogårdh, Christina, et al. (författare) A 1-year follow-up after shortened constraint-induced movement therapy with and without mitt poststroke. 2010 Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993 .- 1532-821X. ; 91:3, s. 460-464 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To explore the long-term benefits of shortened constraint-induced movement therapy (CIMT) in the subacute phase poststroke. DESIGN: A 1-year follow-up after shortened CIMT (3h training/d for 2 wk) where the participants had been randomized to a mitt group or a nonmitt group. SETTING: A university hospital rehabilitation department. PARTICIPANTS: Poststroke patients (N=20, 15 men, 5 women; mean age 58.8 y; on average 14.8 mo poststroke) with mild to moderate impairments of hand function. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Sollerman hand function test, the modified Motor Assessment Scale, and the Motor Activity Log test. Assessments were made by blinded observers. RESULTS: One year after shortened CIMT, participants within both the mitt group and the nonmitt group showed statistically significant improvements in arm and hand motor performance and on self-reported motor ability compared with before and after treatment. No significant differences between the groups were found in any measure at any time. CONCLUSIONS: Shortened CIMT seems to be beneficial up to 1 year after training, but the restraint may not enhance upper motor function. To determine which components of CIMT are most effective, larger randomized studies are needed.
7.	Brogårdh, Christina, 1968- (författare) Constraint Induced Movement Therapy : influence of restraint and type of training on performance and on brain plasticity 2006 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Partial paralysis of the hand is one of the main impairments after stroke. Constraint Induced Movement Therapy (CIT) is a new treatment technique that appears to improve upper extremity function after stroke. CIT consists of 6 hours of training/day for the affected arm (mainly with shaping exercises) and of restraint (mitt) of the non affected arm for two weeks. There are concerns about the practicality and resource issues in carrying out CIT according to the original model. In this thesis the benefit of modifications of CIT, of an assessment tool and of two common types of hand training have been evaluated. CIT (n=16) administered in groups for two weeks (paper I) seems to be a feasible alternative to improve upper limb motor function after chronic stroke. The arm/hand motor performance improved significantly on Motor Assessment Scale (MAS; p= 0.003) and on Sollerman hand function test (p= 0.037). The median self reported motor ability (MAL) also improved (p < 0.001). No additional effect was seen from wearing a mitt for an extended period of three months. The reliability of the Sollerman hand function test (paper II) was studied in patients with chronic stroke. Three examiners observed 24 patients at three experimental sessions. There was agreement (kappa ≥ 0.4) between the examiners for 15/20 subtests. Using total sum scores, the agreement within the examiners was higher than 0.96 (for Spearman’s rhos and ICCs) and agreement between the examiners was higher than 0.96 (Spearman’s rhos) and 0.92 (ICCs), respectively. In a cohort of 24 patients with subacute stroke (paper III) forced use therapy (FUT; mitt use and 3 hours of training/day for 2 weeks) improved arm/hand function, but not more than regular arm therapy given to the control group. Significant improvements in arm/hand motor performance were found in the FUT group (n=12) as well as in the control group (n=12) on the Sollerman hand function test (p= 0.001), on MAS (p< 0.05) and on MAL (p < 0.05). No significant differences were seen between the groups pre- or post training or at three months follow up, demonstrating that the mitt had limited importance. In a separate study on 30 healthy subjects (paper IV), employing transcranial magnetic brain stimulation (TMS), we found that shaping exercises but not general activity training increased dexterity (p<0.05; Purdue peg board test) of the trained non dominant hand. After shaping exercises the cortical motor map shifted forwardly into the premotor area but did not expand. After general activity training the cortical motor map expanded significantly (p=0.03) in the posterior (sensory) direction. Shift of location of active TMS positions rather than their numbers might therefore be a critical factor for the interpretation of cortical plasticity. In conclusion, the studies in this thesis have shown that less resource consuming modifications of CIT may be feasible to improve upper limb motor function after stroke. The type and amount of training for the more affected arm seems to be an important factor rather than the mitt use in itself. Shaping exercises, at least in healthy people, are effective in improving dexterity and the Sollerman hand function test reliable to evaluate arm/hand function after stroke.
8.	Brogårdh, Christina, et al. (författare) Constraint-induced movement therapy in patients with stroke: a pilot study on effects of small group training and of extended mitt use 2006 Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 1477-0873 .- 0269-2155. ; 20:3, s. 218-227 Tidskriftsartikel (refereegranskat)abstract Objective: (1) To evaluate constraint-induced movement therapy for chronic stroke patients modified into group practice to limit the demand on therapist resources. (2) To explore whether extended mitt use alone may enhance outcome. Design: A combined case-control and randomized controlled study with pre- and post-treatment measures by blinded observers. Setting: A university hospital rehabilitation department. Participants: Sixteen stroke patients (nine men and seven women; mean age 56.7 years; on average 28.9 months post stroke, five of whom were 6-9 months post stroke) with moderate motor impairments in the contralateral upper limb. Intervention: Constraint-induced therapy (mitt on the less affected hand 90% of waking hours for 12 days) with 2-3 patients per therapist and 6 h of group training per day. After the training period, the patients were randomized either to using the mitt at home every other day for two-week periods for another three months (in total 21 days) or to no further treatment. Outcome measures: Modified Motor Assessment Scale, Sollerman Hand Function Test, Two-Point Discrimination test and Motor Activity Log. Results: The mean motor performance improved significantly after two weeks of constraint-induced group therapy on Motor Assessment Scale (1.44 (95% confidence interval (95% CI) 0.59-2.28) points; P = 0.003) and on Sollerman Hand Function Test (3.81 (95% CI 0.26-7.36) points; P = 0.037) but showed no sensory change in the Two-Point Discrimination Test (P = 0.283). The median difference in self-reported motor ability (Motor Activity Log) also improved (P < 0.001). However, no additional effect was seen from wearing a mitt for another three months. Conclusion: Constraint-induced group therapy, allowing several patients per therapist, seems to be a feasible alternative to improve upper limb motor function. The restraint alone, extended in time, did not enhance the treatment effect.
9.	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.
10.	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.
11.	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
12.	Brogårdh, Christina, et al. (författare) Experiences of falls and strategies to manage the consequences of falls in persons with late effects of polio : A qualitative study 2017 Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 49:8, s. 652-658 Tidskriftsartikel (refereegranskat)abstract Objective: To explore how persons with late effects of polio experience falls and what strategies they use to manage the consequences of falls. Design: A qualitative study with face-To-face interviews. Data were analysed by systematic text condensation. Participants: Fourteen ambulatory persons (7 women; mean age 70 years) with late effects of polio. Results: Analysis resulted in one main theme, "Everyday life is a challenge to avoid the consequences of falls", and 3 categories with 7 subcategories. Participants perceived that falls were unpredictable and could occur anywhere. Even slightly uneven surfaces could cause a fall, and increased impairments following late effects of polio led to reduced movement control and an inability to adjust balance quickly. Physical injuries were described after the falls, as well as emotional and psychological reactions, such as embarrassment, frustration and fear of falling. Assistive devices, careful planning and strategic thinking were strategies to prevent falls, together with adaptation and social comparisons to mitigate the emotional reactions. Conclusion: Experiences of falls greatly affect persons with late effects of polio in daily life. To reduce falls and fall-related consequences both problemfocused and emotion-focused strategies are used. In order to increase daily functioning, these findings should be included in a multifaceted falls management programme.
13.	Brogårdh, Christina, et al. (författare) Fall-Related activity avoidance among persons with late effects of polio and its influence on daily life : A mixed-methods study 2021 Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:13, s. 1-11 Tidskriftsartikel (refereegranskat)abstract Falls are common among persons with late effects of polio (LEoP), which may lead to fear of falling and activity avoidance in everyday life. Here, we assessed the occurrence of fall-related activity avoidance among persons with LEoP and explored how these experiences influenced daily life. Fourteen ambulatory persons (seven women; mean age 70 years) with LEoP participated. They responded to the modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE) and participated in individual interviews, which were analysed by systematic text condensation. Each quotation was deductively analysed from its representation with regard to mSAFFE. We found that many persons often avoided activities related to standing and walking, for example, taking a bath, performing household chores, walking outdoors, attending social events if there were stairs in the building and travelling by public transport, due to fear of falling, increased pain and fatigability. To facilitate the performance of daily activities participants expressed that strategic thinking and aids were important to use. In conclusion, fall-related activity avoidance is common in persons with LEoP, which negatively influence daily life and social participation. To increase daily functioning in this population, fall-related activity avoidance should be included in a multifaceted fall management program.
14.	Brogårdh, Christina, et al. (författare) Fall-related activity avoidance among persons with late effects of polio and its influence on daily life : A mixed-methods study 2021 Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:13 Tidskriftsartikel (refereegranskat)abstract Falls are common among persons with late effects of polio (LEoP), which may lead to fear of falling and activity avoidance in everyday life. Here, we assessed the occurrence of fall-related activity avoidance among persons with LEoP and explored how these experiences influenced daily life. Fourteen ambulatory persons (seven women; mean age 70 years) with LEoP participated. They responded to the modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE) and participated in individual interviews, which were analysed by systematic text condensation. Each quotation was deductively analysed from its representation with regard to mSAFFE. We found that many persons often avoided activities related to standing and walking, for example, taking a bath, performing household chores, walking outdoors, attending social events if there were stairs in the building and travelling by public transport, due to fear of falling, increased pain and fatigability. To facilitate the performance of daily activities participants expressed that strategic thinking and aids were important to use. In conclusion, fall-related activity avoidance is common in persons with LEoP, which negatively influence daily life and social participation. To increase daily functioning in this population, fall-related activity avoidance should be included in a multifaceted fall manage-ment program.
15.	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.
16.	Brogårdh, Christina, et al. (författare) Forced use therapy in patients with subacute stroke: The mitt can be thrown! : A randomised controlled study with blinded observers Annan publikation (övrigt vetenskapligt/konstnärligt)
17.	Brogårdh, Christina, et al. (författare) How various self-reported impairments influence walking ability in persons with late effects of polio. 2015 Ingår i: NeuroRehabilitation. - 1878-6448. ; 37:2, s. 291-298 Tidskriftsartikel (refereegranskat)abstract Many persons with late effects of polio experience new or increased impairments, which can lead to walking limitations in daily life. No study has comprehensively analyzed how various self-reported impairments are associated with different aspects of self-reported walking limitations.
18.	Brogårdh, Christina, et al. (författare) ICF and neurorehabilitation. 2015 Ingår i: NeuroRehabilitation. - 1878-6448. ; 36:1, s. 1-3 Tidskriftsartikel (refereegranskat)
19.	Brogårdh, Christina, et al. (författare) Intra- and inter-rater reliability of the Sollerman hand function test in patients with chronic stroke 2007 Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 29:2, s. 145-154 Tidskriftsartikel (refereegranskat)abstract Purpose. To examine whether the Sollerman hand function test is reliable in a test-retest situation in patients with chronic stroke. Method. Three independent examiners observed each patient at three experimental sessions; two days in week I (short-term test-retest) and one day in week 4 (long-term test-retest). A total of 24 patients with chronic stroke (mean age; 59.7 years, mean time since stroke onset 29.6 months) participated. The examiners simultaneously assessed the patients' ability to perform 20 subtests. Both ordinal data (generalized kappa) and total sum scores (Spearman's rank correlation coefficient (Spearman's rho), intra class correlation coefficient (ICC2,1) and mean differences) were used in the statistical analysis. Results. There was agreement (kappa >= 0.4) between the examiners for 15 out of the 20 subtests. Using total sum scores, the agreement within the examiners, both short- and long-term, was higher than 0.96 (for Spearman's rho and ICC, respectively). The mean differences were 0.29-1.0/80 points within each examiner. Agreement between the examiners at each session was higher than 0.96 (Spearman's rho) and 0.92 (ICC), respectively. Systematic differences (p < 0.05) were, however, found between examiners A and B/C for all sessions. Conclusions. The Sollerman hand function test seems to be a reliable test in patients with chronic stroke, but we recommend that the same examiner evaluates a patient's hand function pre- and post-treatment.
20.	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.
21.	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.
22.	Brogårdh, Christina, et al. (författare) Mode of hand training determines cortical reorganisation: A randomized controlled study in healthy adults 2010 Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 42:8, s. 789-794 Tidskriftsartikel (refereegranskat)abstract Objective: To evaluate two commonly used forms of hand training with respect to influence on dexterity and cortical reorganization. Subjects: Thirty healthy volunteers (mean age 24.2 years). Methods: The subjects were randomized to 25 min of shaping exercises or general activity training of the non-dominant hand. The dexterity and the cortical motor maps (number of excitable positions) of the abductor pollicis brevis muscle were evaluated pre- and post-training by the Purdue Peg Board test and transcranial magnetic stimulation, respectively. Results: After shaping exercises the dexterity increased significantly (p <= 0.005) for both hands, mostly so in the non-dominant hand. The cortical motor map of the abductor pollicis brevis muscle shifted forwardly into the pre-motor area without expanding. After general activity training, no significant improvements in dexterity were found for the non-dominant hand. The cortical motor map of the non-dominant abductor pollicis brevis muscle expanded significantly (p = 0.03) in the posterior (sensory) direction. Conclusion: These results indicate that shaping exercises, but not general activity training, increase dexterity of the trained non-dominant hand in parallel with a shift of location of active transcranial magnetic stimulation positions. Shifts of active cortical areas might be important for the interpretation of brain plasticity in common behavioural tasks.
23.	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.
24.	Brogårdh, Christina, et al. (författare) No Effects of Whole-Body Vibration Training on Muscle Strength and Gait Performance in Persons With Late Effects of Polio: A Pilot Study. 2010 Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993 .- 1532-821X. ; 91:9, s. 1474-1477 Tidskriftsartikel (refereegranskat)abstract Brogårdh C, Flansbjer U-B, Lexell J. No effects of whole-body vibration training on muscle strength and gait performance in people with late effects of polio: a pilot study. OBJECTIVE: To evaluate the feasibility and possible effects of whole-body vibration (WBV) training on muscle strength and gait performance in people with late effects of polio. DESIGN: A case-controlled pilot study with assessments before and after training. SETTING: A university hospital rehabilitation department. PARTICIPANTS: People (N=5; 3 men, 2 women; mean age, 64+/-6.7y; range, 55-71y) with clinically and electrophysiologically verified late effects of polio. INTERVENTIONS: All participants underwent 10 sessions of supervised WBV training (standing with knees flexed 40 degrees -55 degrees up to 60 seconds per repetition and 10 repetitions per session twice weekly for 5 weeks). MAIN OUTCOME MEASURES: Isokinetic and isometric knee muscle strength (dynamometer), and gait performance (Timed Up & Go, Comfortable Gait Speed, Fast Gait Speed, and six-minute walk tests). RESULTS: All participants completed the 5 weeks of WBV training, with no discernible discomfort. No significant changes in knee muscle strength or gait performance were found after the WBV training period. CONCLUSIONS: This pilot study did not show any significant improvements in knee muscle strength and gait performance following a standard protocol of WBV training. Thus, the results do not lend support to WBV training for people with late effects of polio.
25.	Brogårdh, Christina, et al. (författare) No specific effect of whole-body vibration training in chronic stroke: a double-blind randomized controlled study. 2012 Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993. ; 93:2, s. 253-258 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To evaluate the effects of whole-body vibration (WBV) training in individuals after stroke. DESIGN: A double-blind randomized controlled study with assessments pre- and posttraining. SETTING: A university hospital rehabilitation department. PARTICIPANTS: Participants (N=31; mean age ± SD, 62±7y; 6-101mo poststroke) were randomized to an intervention group or a control group. INTERVENTIONS: Supervised WBV training (2 sessions/wk for 6wk; 12 repetitions of 40-60s WBV per session). The intervention group trained on a vibrating platform with a conventional amplitude (3.75mm) and the control group on a "placebo" vibrating platform (0.2mm amplitude); the frequency was 25Hz on both platforms. All participants and examiners were blinded to the amplitudes of the 2 platforms. MAIN OUTCOME MEASURES: Primary outcome measures were isokinetic and isometric knee muscle strength (dynamometer). Secondary outcome measures were balance (Berg Balance Scale), muscle tone (Modified Ashworth Scale), gait performance (Timed Up & Go, comfortable gait speed, fast gait speed, and six-minute walk tests), and perceived participation (Stroke Impact Scale). RESULTS: There were no significant differences between the 2 groups after the WBV training. Significant but small improvements (P<.05) in body function and gait performance were found within both groups, but the magnitude of the changes was in the range of normative variation. CONCLUSIONS: Six weeks of WBV training on a vibration platform with conventional amplitude was not more efficient than a placebo vibrating platform. Therefore, the use of WBV training in individuals with chronic stroke and mild to moderate disability is not supported.
26.	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.
27.	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.
28.	Brogårdh, Christina, et al. (författare) Rapidly Emerging Role of Whole Body Vibration Therapy in the Management of Neurologic Diseases Besides Polio Response 2011 Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993. ; 92:4, s. 677-678 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
29.	Brogårdh, Christina, et al. (författare) Self-Perceived Life Satisfaction during the First Wave of the COVID-19 Pandemic in Sweden : A Cross-Sectional Study 2021 Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601 .- 1661-7827. ; 18:12 Tidskriftsartikel (refereegranskat)abstract Currently, there is limited knowledge on how the Swedish strategy with more lenient public health restrictions during the COVID-19 pandemic has influenced people's life satisfaction. Here, we investigated self-reported life satisfaction during the first wave of the pandemic in Sweden, and perceived changes in life satisfaction in relation to various sociodemographic factors. A total of 1082 people (mean age 48 (SD 12.2); 82% women) responded to an online survey during autumn 2020 including the "Life Satisfaction Questionnaire-11". A majority (69%) were satisfied with life as a whole, and with other important life domains, with the exception of contact with friends and sexual life. An equal share reported that life as a whole had either deteriorated (28%) or improved (29%). Of those that perceived a deterioration, 95% considered it to be due to the pandemic. Regarding deteriorated satisfaction with life as a whole, higher odds were found in the following groups: having no children living at home; being middle aged; having other sources of income than being employed; and having a chronic disease. The Swedish strategy might have contributed to the high proportion of satisfied people. Those who perceived a deterioration in life satisfaction may, however, need attention from Swedish Welfare Authorities.
30.	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.
31.	Brogårdh, Christina, et al. (författare) Shortened constraint-induced movement therapy in subacute stroke - no effect of using a restraint : a randomized controlled study with independent observers 2009 Ingår i: Journal of Rehabilitation Medicine. - : Stiftelsen Rehabiliteringsinformation. - 1650-1977 .- 1651-2081. ; 41:4, s. 231-236 Tidskriftsartikel (refereegranskat)abstract Objective: To examine the effect of using a mitt during shortened constraint-induced movement therapy for patients in the subacute phase after stroke.Subjects: Twenty-four patients with stroke (mean age 57.6 (standard deviation 8.5) years; average 7 weeks post-stroke) with mild to moderate impaired hand function.Methods: The patients were randomized to mitt use or no mitt use on the less affected hand for 90% of waking hours for 12 days. All patients received 3 h of arm and hand training per day for 2 weeks. Assessments were made by blinded observers using the modified Motor Assessment Scale, the Sollerman hand function test, the 2-Point Discrimination test and Motor Activity Log test.Results: Patients in both groups showed significant improvements in arm and hand motor performance and on self-reported motor ability after 2 weeks of therapy and at 3 months follow-up. However, no statistically significant differences between the groups were found in any measures at any point in time.Conclusion: In this study, no effect of using a restraint in patients with subacute stroke was found. Thus, this component in the constraint-induced therapy concept seems to be of minor importance for the outcome.
32.	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.
33.	Brogårdh, Christina, et al. (författare) The Influence of Walking Limitations on Daily Life : A Mixed-Methods Study of 14 Persons with Late Effects of Polio 2022 Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 19:13 Tidskriftsartikel (refereegranskat)abstract Reduced walking ability is common in persons with late effects of polio (LEoP). Here, we explored how many walking limitations persons with LEoP perceive, and how these limitations influence daily life, by using a mixed-methods design. Fourteen persons (mean age 70 years, whereof 7 women) with LEoP responded to the Walking Impact Scale (Walk-12), and were inter-viewed individually. Qualitative data were analysed by systematic text condensation, and each quotation was deductively analysed in relation to the items in Walk-12. Running was perceived as most limited, whereas walking indoors without using support was perceived as least limited. A majority (>70%) were moderately to extremely limited in standing or walking, in walking speed and distance, which affected concentration and effort, as well as gait quality aspects. The limited walking ability intruded on many everyday activities, both indoors and outdoors, which affected social participation negatively. To increase safety when walking and reduce the fall risk, various strategies were adopted such as using aids, walking carefully, and avoiding risky activities. In conclusion, LEoP-related walking limitations influence participants’ activity and participation greatly. By using both the Walk-12 scale and face-to-face interviews, an increased understanding of how walking limitations influence everyday life was achieved.
34.	Brogårdh, Christina, et al. (författare) What is the long-term benefit of constraint-induced movement therapy? A four-year follow-up. 2009 Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 1477-0873 .- 0269-2155. ; 23, s. 418-423 Tidskriftsartikel (refereegranskat)abstract Objective: To evaluate the long-term benefits of constraint-induced movement therapy in chronic stroke.Design: A four-year follow-up after constraint-induced group therapy assessing arm and hand function and self-reported daily hand use.Subjects: Fourteen post-stroke individuals (six women and eight men; mean age 59.6 +/- 12.7 years, range 23-75 years) with mild to moderate impairments of hand function. OUTCOME MEASURES: The Sollerman hand function test and the Motor Activity Log test.Results: Four years after constraint-induced group therapy the participants had maintained their hand function, as measured by the Sollerman hand function test. The self-reported use and quality of movements of the more affected hand, as measured by the Motor Activity Log test, had decreased compared to post-treatment and three months follow-up (P < 0.01), but was still significantly higher than pre-treatment (P < 0.05).Conclusion: There seems to be a long-term benefit of constraint-induced group therapy. Hand function was maintained over time and daily hand use had increased compared to pre-treatment. To provide guidelines about the clinical use of constraint-induced movement therapy further, larger and controlled studies are needed.
35.	Brycke, Sara, et al. (författare) Implementation of evidence-based interventions according to the Swedish national guidelines for strokecare : a nationwide survey among physiotherapists 2024 Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden. - 1650-1977 .- 1651-2081. ; 56 Tidskriftsartikel (refereegranskat)abstract Objective: To investigate (i) to what extent physiotherapists (PTs) working in stroke rehabilitation in various parts of the stroke care chain have implemented interventions according to the national guidelines for stroke (NGS), (ii) facilita-ting and hindering factors for the implementation, and (iii) differences between various care settings.Design: A cross-sectional study.Subjects: 148 PTs working in stroke rehabilitation in various parts of the care chain in Sweden.Methods: Data were collected by a web-based survey.Results: Task-specific training for walking (80–98%), impaired motor function (64–100%) and fall prevention (73–92%) were most implemented. Factors that facilitated implementation were: important to comply with the NGS, that PTs had confidence to per-form the interventions, and that interventions were clearly described. Limited time, lack of resources, no clear goals or routines at the workplace hindered the implementation. Significant differences (p < 0.05) between the settings existed. Municipal and primary care reported most challenges in implementing the NGS and providing evidence-based interventions.Conclusion: Most interventions, with high priority according to NGS, are provided by PTs working in stroke rehabilitation, although differences in various parts of the care chain exist. Knowledge, time, education and supportive management are important factors when implementing evidence-based interventions.
36.	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.
37.	Carlsson, H., et al. (författare) Experiences of SENSory Relearning of the UPPer Limb (SENSUPP) after Stroke and Perceived Effects: A Qualitative Study 2022 Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601 .- 1661-7827. ; 19:6 Tidskriftsartikel (refereegranskat)abstract Recently, it was shown that sensory relearning of the upper limb (SENSUPP) is a promising intervention to improve sensorimotor function after stroke. There is limited knowledge, however, of how participants perceive the training. Here, we explored how persons with sensory impairments in the upper limb experienced the SENSUPP protocol (combined sensory- and motor training and home exercises for 5 weeks) and its effect. Fifteen persons (mean age 59 years; 10 men; >6 months post-stroke) were individually interviewed, and data were analyzed with qualitative content analysis. An overall theme 'Sensory relearning was meaningful and led to improved ability to perform daily hand activities' and two categories with six subcategories emerged. The outpatient training was perceived as meaningful, although the exercises were demanding and required concentration. Support from the therapist was helpful and training in small groups appreciated. The home training was challenging due to lack of support, time, and motivation. Small improvements in sensory function were perceived, whereas increased movement control and ability in performing daily hand activities were reported. In conclusion, the SENSUPP protocol is meaningful and beneficial in improving the functioning of the UL in chronic stroke. Improving compliance to the home training, regular follow-ups, and an exercise diary are recommended.
38.	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.
39.	Carlsson, Håkan, et al. (författare) SENSory re-learning of the UPPer limb after stroke (SENSUPP) : Study protocol for a pilot randomized controlled trial 2018 Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 19:1 Tidskriftsartikel (refereegranskat)abstract Background: Many stroke survivors suffer from sensory impairments of their affected upper limb (UL). Although such impairments can affect the ability to use the UL in everyday activities, very little attention is paid to sensory impairments in stroke rehabilitation. The purpose of this trial is to investigate if sensory re-learning in combination with task-specific training may prove to be more effective than task-specific training alone to improve sensory function of the hand, dexterity, the ability to use the hand in daily activities, perceived participation, and life satisfaction. Methods/design: This study is a single-blinded pilot randomized controlled trial (RCT) with two treatment arms. The participants will be randomly assigned either to sensory re-learning in combination with task-specific training (sensory group) or to task-specific training only (control group). The training will consist of 2.5 h of group training per session, 2 times per week for 5 weeks. The primary outcome measures to assess sensory function are as follows: Semmes-Weinstein monofilament, Shape/Texture Identification (STI™) test, Fugl-Meyer Assessment-upper extremity (FMA-UE; sensory section), and tactile object identification test. The secondary outcome measures to assess motor function are as follows: Box and Block Test (BBT), mini Sollerman Hand Function Test (mSHFT), Modified Motor Assessment Scale (M-MAS), and Grippit. To assess the ability to use the hand in daily activities, perceived participation, and life satisfaction, the Motor Activity Log (MAL), Canadian Occupational Performance Measure (COPM), Stroke Impact Scale (SIS) participation domain, and Life Satisfaction checklist will be used. Assessments will be performed pre- and post-training and at 3-month follow-up by independent assessors, who are blinded to the participants' group allocation. At the 3-month follow-up, the participants in the sensory group will also be interviewed about their general experience of the training and how effective they perceived the training. Discussion: The results from this study can add new knowledge about the effectiveness of sensory re-learning in combination with task-specific training on UL functioning after stroke. If the new training approach proves efficient, the results can provide information on how to design a larger RCT in the future in persons with sensory impairments of the UL after stroke.
40.	Carlsson, Håkan, et al. (författare) SENSory re-learning of the UPPer limb (SENSUPP) after stroke : development and description of a novel intervention using the TIDieR checklist 2021 Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 22:1 Tidskriftsartikel (refereegranskat)abstract Background: Sensorimotor impairments of upper limb (UL) are common after stroke, leading to difficulty to use the UL in daily life. Even though many have sensory impairments in the UL, specific sensory training is often lacking in stroke rehabilitation. Thus, the aim of this paper is to provide a detailed description of the novel intervention “SENSory re-learning of the UPPer limb after stroke (SENSUPP)” that we have developed to improve functioning in the UL in persons with mild to moderate impairments after stroke. Methods: The SENSUPP protocol was designed using information from literature reviews, clinical experience and through consultation of experts in the field. The protocol integrates learning principles based on current neurobiological knowledge and includes repetitive intensive practice, difficulty graded exercises, attentive exploration of a stimulus with focus on the sensory component, and task-specific training in meaningful activities that includes feedback. For reporting the SENSUPP protocol, the Template for Intervention Description and Replication (TIDieR) checklist was used. Results: The essential features of the SENSUPP intervention comprise four components: applying learning principles based on current neurobiological knowledge, sensory re-learning (exercises for touch discrimination, proprioception and tactile object recognition), task-specific training in meaningful activities, and home-training. The training is performed twice a week, in 2.5-h sessions for 5 weeks. Conclusion: Since there is close interaction between the sensory and motor systems, the SENSUPP intervention may be a promising method to improve UL functioning after stroke. The TIDieR checklist has been very useful for reporting the procedure and development of the training. Trial registration: ClinicalTrials.govNCT03336749. Registered on 8 November 2017.
41.	Carlsson, Håkan, et al. (författare) The relationship between isokinetic and isometric knee muscle strength and maximal step-up height after stroke: A pilot study. 2015 Ingår i: Isokinetics and Exercise Science. - 1878-5913. ; 23:3, s. 143-149 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: A novel way to evaluate muscle strength and functioning in the lower limbs is to measure how high a person could step up on a platform, the so called Maximal Step-up Test (MST). Studies of healthy persons and overweight women have shown that the maximal step-up height (MSH) is associated with both muscle strength and physical function, but no study has assessed persons after stroke. OBJECTIVE: To evaluate the relationship between isokinetic and isometric knee muscle strength and maximal step-up height after stroke. METHODS: A convenience sample of 21 ambulatory persons with stroke (13 men and eight women; mean age 63 +/- 12 years; mean time since stroke onset 26 +/- 36 months). Isokinetic concentric knee extension and knee flexion strength at 60 degrees/s and isometric knee extension strength at 90. were measured for both lower limbs with a Biodex dynamometer. Maximal step-up height was measured using a 40 cm x 60 cm platform, which could be raised from 3 cm to 45 cm with 3 cm intervals. The relationship between knee muscle strength (normalized to body weight) and the maximal step-up height was analysed with the Pearson's correlation coefficient (r). RESULTS: There were significant but only moderate relationships between the paretic isokinetic knee extension, and flexion, strength and maximal step-up height, r = 0.49; p < 0.05, and r = 0.57; p < 0.01, respectively. CONCLUSION: These moderate relationships indicate that muscle weakness is only partially associated with maximal step-up height after stroke. The MST may therefore have limited value in the assessment of muscle strength after stroke.
42.	Carlsson, Håkan, et al. (författare) Upper-limb sensory impairments after stroke : Self-reported experiences of daily life and rehabilitation 2018 Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977. ; 50:1, s. 45-51 Tidskriftsartikel (refereegranskat)abstract Objective: To describe stroke survivors' experiences of sensory impairment in the upper limb, the influence of such impairment on daily life, coping strategies used, and sensory training for the affected hand. Design: A qualitative study with a content analysis approach. Subjects: Fifteen post-stroke patients interviewed individually. Results: Five categories emerged from the data: "Changed and varied perception of the sensation"; "Affected movement control"; "Problems using the hand in daily life"; "Various strategies to cope with upper limb disability"; and "Lack of sensory training". Numbness and tingling, changes in temperature sensitivity, and increased sensitivity to touch and pain were reported. Many subjects had difficulty adjusting their grip force and performing movements with precision. It was problematic and mentally fatiguing managing personal care and carrying out household and leisure activities. Practical adaptations, compensation with vision, increased concentration, and use of the less affected hand were strategies used to overcome difficulties. Despite their problems very few subjects had received any specific sensory training for the hand. Conclusion: Stroke survivors perceive that sensory impairment of the upper limb has a highly negative impact on daily life, but specific rehabilitation for the upper limb is lacking. These findings imply that the clinical management of upper limb sensory impairment after stroke requires more attention.
43.	Ekstrand, Elisabeth, et al. (författare) Grip strength is a representative measure of muscle weakness in the upper extremity after stroke 2016 Ingår i: Topics in Stroke Rehabilitation. - : Informa UK Limited. - 1074-9357 .- 1945-5119. ; 23:6, s. 400-405 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Muscle weakness is the most common impairment in the upper extremity after stroke, leading to a reduced ability to use the arm and the hand in daily activities. Grip strength is easier to measure than precise, but more time-consuming, isokinetic and isometric arm muscle strength measurements. It would therefore be advantageous in a clinical setting if grip strength could be used as a proxy for muscle strength in the entire upper extremity.OBJECTIVE: To investigate the association between grip strength and isometric and isokinetic arm muscle strength in persons with chronic stroke.METHODS: Forty-five persons with mild-to-moderate paresis in the upper extremity, at least 6 months post-stroke participated. Isometric grip strength was measured with a computerized grip dynamometer and arm strength (isometric shoulder abduction and elbow flexion as well as isokinetic elbow extension and flexion) with an isokinetic dynamometer. Pearson's correlation coefficient was used to determine the association between the muscle strength measurements.RESULTS: There were significant correlations (p < .0001) between grip strength and all arm strength measurements in both the more affected (r = 0.77-0.82) and the less affected upper extremity (r = 0.65-0.82).CONCLUSION: This cross-sectional study showed that grip strength is strongly associated with muscle strength in the arm in persons in the chronic phase after stroke. As grip strength is easy to measure and less time-consuming than arm muscle strength measurements, this implies that grip strength can be a representative measure of muscle weakness of the entire upper extremity in the chronic phase after stroke.
44.	Ekstrand, Elisabeth, et al. (författare) Isometric and isokinetic muscle strength in the upper extremity can be reliably measured in persons with chronic stroke. 2015 Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 47:8, s. 706-713 Tidskriftsartikel (refereegranskat)abstract To evaluate the test-retest reliability of isometric and isokinetic muscle strength measurements in the upper extremity after stroke.
45.	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.
46.	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.
47.	Ekstrand, Elisabeth, et al. (författare) Perceived ability to perform daily hand activities after stroke and associated factors : A cross-sectional study 2016 Ingår i: BMC Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 16:1 Tidskriftsartikel (refereegranskat)abstract Background: Despite that disability of the upper extremity is common after stroke, there is limited knowledge how it influences self-perceived ability to perform daily hand activities. The aim of this study was to describe which daily hand activities that persons with mild to moderate impairments of the upper extremity after stroke perceive difficult to perform and to evaluate how several potential factors are associated with the self-perceived performance. Methods: Seventy-five persons (72% male) with mild to moderate impairments of the upper extremity after stroke (4 to 116months) participated. Self-perceived ability to perform daily hand activities was rated with the ABILHAND Questionnaire. The perceived ability to perform daily hand activities and the potentially associated factors (age, gender, social and vocational situation, affected hand, upper extremity pain, spasticity, grip strength, somatosensation of the hand, manual dexterity, perceived participation and life satisfaction) were evaluated by linear regression models. Results: The activities that were perceived difficult or impossible for a majority of the participants were bimanual tasks that required fine manual dexterity of the more affected hand. The factor that had the strongest association with perceived ability to perform daily hand activities was dexterity (p<0.001), which together with perceived participation (p=0.002) explained 48% of the variance in the final multivariate model. Conclusion: Persons with mild to moderate impairments of the upper extremity after stroke perceive that bimanual activities requiring fine manual dexterity are the most difficult to perform. Dexterity and perceived participation are factors specifically important to consider in the rehabilitation of the upper extremity after stroke in order to improve the ability to use the hands in daily life.
48.	Ekstrand, Elisabeth, et al. (författare) Perceived Consequences of Post-COVID-19 and Factors Associated with Low Life Satisfaction 2022 Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 19:22 Tidskriftsartikel (refereegranskat)abstract A significant number of individuals experience post-COVID-19 symptoms, but knowledge of perceived consequences and life satisfaction is lacking. Here, we investigate perceived consequences regarding everyday life, health, physical activity and work post-COVID-19 and factors associated with low life satisfaction. A total of 766 people (mean age 48; 672 women) experiencing post-COVID-19 symptoms at least two months after infection (mean 13 months) responded to an online survey. A majority (≥77%) perceived physical fatigue, mental fatigue, dizziness, reduced work ability, low life satisfaction and a reduced level of aerobic capacity. In the final logistic regression model (Nagelkerke R Square 0.296, p < 0.001), poor work ability was the most important factor for perceiving low satisfaction with life (Odds ratio 3.369, 95% CI 2.040–5.565, p < 0.001, Nagelkerke R Square 0.177). Reduced aerobic capacity, fatigue and living in a city also increased the odds of low life satisfaction. As people with post-COVID-19 report several long-term consequences, this suggests that there is a need for targeted care for this group. The results of this study can serve as guidance for healthcare authorities regarding important long-term consequences that should be considered in rehabilitation programs directed toward post-COVID-19.
49.	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.
50.	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.

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