| 1. |
- Fristedt, Sofi, et al.
(author)
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Concurrent validity of the Swedish version of the life-space assessment questionnaire
- 2016
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In: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 16
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Journal article (peer-reviewed)abstract
- BACKGROUND: The Life-Space Assessment (LSA), developed in the USA, is an instrument focusing on mobility with respect to reaching different areas defined as life-spaces, extending from the room where the person sleeps to mobility outside one's hometown. A newly translated Swedish version of the LSA (LSA-S) has been tested for test-retest reliability, but the validity remains to be tested. The purpose of the present study was to examine the concurrent validity of the LSA-S, by comparing and correlating the LSA scores to other measures of mobility.METHOD: The LSA was included in a population-based study of health, functioning and mobility among older persons in Sweden, and the present analysis comprised 312 community-dwelling participants. To test the concurrent validity, the LSA scores were compared to a number of other mobility-related variables, including the Short Physical Performance Battery (SPPB) as well as "stair climbing", "transfers", "transportation", "food shopping", "travel for pleasure" and "community activities". The LSA total mean scores for different levels of the other mobility-related variables, and measures of correlation were calculated.RESULTS: Higher LSA total mean scores were observed with higher levels of all the other mobility related variables. Most of the correlations between the LSA and the other mobility variables were large (r = 0.5-1.0) and significant at the 0.01 level. The LSA total score, as well as independent life-space and assistive life-space correlated with transportation (0.63, 0.66, 0.64) and food shopping (0.55, 0.58, 0.55). Assistive life-space also correlated with SPPB (0.47). With respect to maximal life-space, the correlations with the mobility-related variables were generally lower (below 0.5), probably since this aspect of life-space mobility is highly influenced by social support and is not so dependent on the individual's own physical function.CONCLUSION: LSA was shown to be a valid measure of mobility when using the LSA total, independent LS or assistive LSA.
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| 2. |
- Fristedt, Sofi, et al.
(author)
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Factors Influencing the Use of Evidence-Based Practice among Physiotherapists and Occupational Therapists in Their Clinical Work
- 2016
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In: The Internet Journal of Allied Health Sciences & Practice. - : NSUWorks. - 1540-580X. ; 14:3
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Journal article (peer-reviewed)abstract
- Background: Evidence-based practice (EBP) is a process through which research is applied in daily clinical practice. Occupational therapists (OTs) and physiotherapists (PTs) are expected to work in line with EBP in order to optimise health care resources. This expectation is too seldom fulfilled. Consequently, research findings may not be implemented in clinical practice in a timely manner, or at all. To remedy this situation, additional knowledge is needed regarding what factors influence the process of EBP among practitioners. The purpose of the present study was to identify factors that influence the use of EBP and the experienced effects of the use of EBP among PTs and OTs in their clinical work. Method: This was a qualitative interview study that consisted of six group interviews involving either OTs or PTs employed by the Jönköping County Council in the South of Sweden. Resulting data were analysed using content analysis. Results: The analysis resulted in the following categories: “definition of evidence and EBP”, “sources of evidence”, “barriers to acquiring evidence and to using evidence in clinical work”, “factors that facilitate the acquisition of evidence and the use of evidence in clinical work”, and “personal experiences of using EBP”. Basing clinical practice on scientific evidence evoked positive experiences, although an ambivalent view towards acting on clinical experience was evident. Participants reported that time for and increased knowledge about searching for, evaluating, and implementing EBP were needed. Conclusion: Because OTs are more oriented towards professional theories and models, and PTs are more focused on randomised controlled trials of interventions, different strategies appear to be needed to increase EBP in these two professions. Management support was considered vital to the implementation of EBP. However, the personal obligation to work in line with EBP must also be emphasised; the participants apparently underestimate its importance.
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| 3. |
- Fristedt, Sofi, et al.
(author)
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Life-space mobility and participation in daily activities and social life among older men and women
- 2015
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Conference paper (peer-reviewed)abstract
- BackgroundLife-space mobility, i.e., the frequency and independence of transferring to different life-spaces (extending from a person’s bedroom to places beyond hometown), is evident to decrease in later life with potential risk of restricted participation in daily activities and social life. Modes of transport support participation through life-space mobility differently, and older men and women tend to choose different modes. The aim was to identify differences in participation in daily activities and social life related to life-space mobility and gender.MethodsData included the Life-Space Assessment (LSA), transportation, activities of daily living, and community activities. Participants living in their own housing in Sweden (n=312; 147 men, 165 women), aged 75+ (mean age 80), were randomly selected from a population register.ResultLSA total score differed significantly (p<0.001) between men (mean=72) and women (mean=58), and between different modes of transport (p<0.001) with bike users (mean=79) and car drivers (mean=77) reaching the highest LSA total scores. Gender differences were evident related to mode of transport (p<0.001), with men predominantly (74%) driving their own car, while women were driving (32%), going by car as a passenger (32%) or used public transportation (21%). Participation in community activities did not differ significantly between genders, but between LSA total scores (p<0.001). For example, LSA total score was lower for persons taking part in no (mean=55) compared to five (mean=84) community activities at least once a month.ConclusionLife-space mobility is vital to consider when aiming to support continuing participation in daily activities and social life.
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| 4. |
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| 5. |
- Fristedt, Sofi, 1969-, et al.
(author)
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Physical functioning associated with life-space mobility in later life among men and women
- 2022
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In: BMC Geriatrics. - London, United Kingdom : BioMed Central. - 1471-2318. ; 22:1
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Journal article (peer-reviewed)abstract
- BackgroundLife-space mobility is defined as the ability to access different areas extending from the room where the person sleeps to places outside one’s hometown. Life-space mobility is vital to support performance of daily life activities and autonomous participation in social life. However, there is a dearth of research that investigates a wider range of physical functions and functioning in relation to life-space mobility rather than just single aspects. Thus, the purpose of the present study was to identify and describe several measures of physical functioning associated with life-space mobility among older men and women.MethodsData used in this study was derived from the OCTO 2 study, a population-based study of health, functioning and mobility among older persons (n = 312) in Sweden. Associations between Life-Space Assessment (LSA) total score and age, sex, Short Physical Performance Battery (SPPB), dizziness, lung function i.e. Peak Expiratory Flow (PEF), grip strength, self-rated vision and hearing were analysed through bivariate and multivariate regression models.ResultsThe bivariate models showed that life-space mobility was significantly associated with sex, but also age, SPPB, PEF and grip strength in the total group as well as among men and women. In addition, hearing was significantly associated with life-space mobility among women. Those factors that were statistically significant in the bivariate models were further analysed in multivariable models for the total group, and for men and women separately. In these models, sex, grip strength and SPPB remained significantly associated with life-space mobility in the total group, as well as SPPB among both men and women.ConclusionSex, physical function in terms of physical performance measured by SPPB (balance, gait speed and chair stand), and grip strength are associated with life-space mobility. Consequently, these factors need to be considered in assessments and interventions aiming to maintain mobility in old age.
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| 6. |
- Fristedt, Sofi, 1969-, et al.
(author)
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Validitet och reliabilitet för Life-Space Assessment (LSA) - ett instrument för bedömning av äldre personers mobilitet
- 2015
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Conference paper (peer-reviewed)abstract
- Bakgrund: Förmågan och möjligheter att förflytta (mobilitet) begränsas ofta i senare delen av livet, med negativa konsekvenser fördelaktighet i dagliga och sociala aktiviteter. Såväl i praktisk verksamhet som för forskning behövs instrument som kanbedöma mobilitet. The Life Space Assessment (LSA), utvecklat i USA, är bedömer en individs mobilitet genom attfokusera på förmågan att ta sig till olika “life-spaces”, från rummet där personen sover till platser bortom hemorten undersenaste månaden. LSA beaktar dessutom hur ofta detta sker, och om det sker med hjälpmedel eller hjälp av annanperson.Syfte: Syftet var att undersöka samtidig validitet och testa reliabilitet av LSAs svenska version.Metod: LSA översattes till svenska och inkluderades tillsammans med andra hälsorelaterade mått i en populationsbaserad studiemed slumpmässigt utvalda personer mellan 75 och 90 år (medelålder 81 år) i enskilt boende. LSA summerades till fyrapoängsummor, dvs total, oberoende, assisterad och maximal life-space poäng. 298 individer ingick i reliabilitetstudienoch besvarade LSA vid två tillfällen med 14 dagars mellanrum. 312 individer ingick i validitetsstudien där LSA jämfördesmed andra mobilitetsrelaterade mått.Resultat/preliminärt resultat: Det fanns inga signifikanta skillnader mellan skattningarna över tid för LSA fyra poängsummor. Medelvärdet för total life-space poäng var t ex 65 (22) och 65 (23) (max 120). Korrelationsvärden (ICC) mellan 0.84-0.94 visar på god till utmärktreliabilitet för total, oberoende och assisterad LSA. Vad gäller validitet påvisas signifikanta (p<0.01) och måttligt till godakorrelationer (0.50- 0.75) mellan LSAs fyra poängsummor och förmåga till förflyttning (överflyttning, balans, uppresningoch gångförmåga), transport (vardagliga resor och nöjesresor), och aktivitet i samhället (inköp och fritid)Slutsats: Den svenska versionen av LSA har god validitet samt god till utmärkt reliabilitet och kan med förtroende användas för attbedöma mobilitet hos äldre i enskilt boende.
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| 7. |
- Kammerlind, Ann-Sofi, et al.
(author)
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Test–retest reliability of the Swedish version of the life-space assessment questionnaire among community-dwelling older adults
- 2014
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In: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 28:8, s. 817-823
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Journal article (peer-reviewed)abstract
- Objective: To examine the test–retest reliability of the Swedish version of the Life-Space Assessment Questionnaire.Design: Test–retest reliability study.Subjects: A total of 298 community-dwelling subjects between 75 and 90 years of age.Methods: The Life-Space Assessment Questionnaire was translated into Swedish. By personal interviews during home visits and two weeks later by telephone interviews the subjects were asked about their life-space mobility during the past four weeks, and how often and whether they were independent or needed assistance from another person or equipment to reach different life-space levels.Results: None of the four scoring methods showed significant difference between test sessions. The mean (SD) total scores were 65 (22) and 65 (23) out of the maximum possible score of 120 at the two sessions. High levels were found for independent, assisted, and maximal life-space at both sessions. Intraclass correlation coefficients and weighted Kappa-values between 0.84–0.94 were found for the total score, the independent, and the assisted life-space levels, indicating good to excellent reliability. A lower Kappa-value was observed for the maximal life-space level, mainly owing to skewed distributions. The method error values showed that a change of 10 in the total score and a change of one level in any of the three life-space levels can be considered to indicate a real change in clinical practice.Conclusion: The Swedish version of the Life-Space Assessment Questionnaire can be reliably used among community-dwelling older adults.
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| 8. |
- Areskoug Josefsson, Kristina, et al.
(author)
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Evidence-based practice in a multiprofessional context
- 2012
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In: International Journal of Evidence-Based Healthcare. - : Ovid Technologies (Wolters Kluwer Health). - 1744-1595 .- 1744-1609. ; 10:2, s. 117-125
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Journal article (peer-reviewed)abstract
- Background Healthcare today is a complex system with increasing needs of specific knowledge of evaluation of research and implementation into clinical practice. A critical issue is that we all apply evidence-based practice (EBP) with standardised methods and continuing and systematic improvements. EBP includes both scientific and critical assessed experience-based knowledge. For the individual, this means applying evidence-based knowledge to a specific situation, and for the organisation, it means catering for a systematic critical review and evaluation and compiling research into guidelines and programmes. In 2009, the County Council of Jönköping had approximately 335 000 inhabitants and the healthcare organisation had more than 10 000 employees. As the County Council actively promotes clinical improvement, it is interesting to explore how healthcare employees think about and act upon EBP. The aim of this survey was therefore to describe factors that facilitate or hinder the application of EBP in the clinical context.Method A quantitative study was performed with a questionnaire to healthcare staff employed in the County Council of Jönköping in 2009. The questionnaire consisted of questions concerning which factors are experienced to affect the development of evidence-based healthcare. There were 59 open and closed questions, divided into the following areas:• Sources of knowledge used in practice• Barriers to finding and evaluating research reports and guidelines• Barriers to changing practice on the basis of best evidence• Facilitating factors for changing practice on the basis of best evidence• Experience in finding, evaluating and using different sources of evidenceThe participants were selected using the county council's staff database and included medical, caring and rehabilitative staff within hospitals, primary care, dentistry and laboratory medicine. The inclusion criteria were permanent employment and clinical work. Invitations were sent to 5787 persons to participate in the study and 1445 persons answered the questionnaire.Results Knowledge used in daily clinical practice was mainly based on information about the patient, personal experience and local guidelines. Twenty per cent answered that they worked ‘in the way they always had’, and 11% responded that they used evidence from research as a basis for change. The participants experienced that EBP was not used enough in clinical healthcare and explained this with practical and structural barriers, which they thought should be better monitored by the organisation and directors.Conclusion Overall, the results indicate that the scientific evidence for healthcare is not used sufficiently as a base for decisions in daily practice as well as for changing practice. This is more prominent among assistant staff. As a consequence, this might affect the care of the patients in a negative way. Increased awareness of EBP and a stronger evidence-based approach are keys in the ongoing improvement work in the county. Local guidelines seem to be a way to implement knowledge. But, as the arena of activities is complex and the employees have diverse education levels, different strategies to facilitate and promote EBP are necessary.
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| 9. |
- Davidson, Thomas, et al.
(author)
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Robot-assisted pelvic and renal surgery compared with laparoscopic or open surgery: Literature review of cost-effectiveness and clinical outcomes
- 2023
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In: Scandinavian Journal of Surgery. - : SAGE PUBLICATIONS LTD. - 1457-4969 .- 1799-7267.
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Research review (peer-reviewed)abstract
- Background and aim: The purpose of this study was to evaluate clinical experiences and cost-effectiveness by comparing robot-assisted surgery with laparoscopic- or open surgery for pelvic and renal operations. Methods: A narrative review was carried out. Results: When using robotic-assisted surgery, oncological and functional results are similar to after laparoscopic or open surgery. One exception may be a shorter survival in cancer of the cervix uteri. In addition, postoperative complications after robotic-assisted surgery are similar, bleeding and transfusion needs are less, and the hospital stay is shorter but the preparation of the operating theater before and after surgery and the operation times are longer. Finally, robot-assisted surgery has, in several studies, been reported to be not cost-effective primarily due to high investment costs. However, more recent studies provide improved cost-effectiveness estimates due to more effective preparation of the operating theater before surgery, improved surgeon experience, and decreased investment costs. Conclusions: Complications and functional and oncological outcomes after robot-assisted surgery are similar to open surgery and laparoscopic surgery. The cost-effectiveness of robot-assisted surgery is likely to equal or surpass the alternatives.
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| 10. |
- Gustafsson, Kristin, 1976-, et al.
(author)
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Written instructions versus physiotherapist-supervised rehabilitation after acute ankle sprain
- 2017
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In: European Journal of Physiotherapy. - : Taylor & Francis Group. - 2167-9169 .- 2167-9177. ; 19:2, s. 76-83
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Journal article (peer-reviewed)abstract
- The aim of this study was to compare the effects of written instructions (WIs) versus physiotherapist-supervised rehabilitation on patient-rated ankle function, satisfaction and physical activity ability after an acute ankle sprain. Thirty-nine patients with an acute ankle sprain, recruited from an emergency department, received WIs on functional rehabilitation (WI group). The patients were evaluated six weeks and three months after their injury with the disease-specific Foot and Ankle Outcome Score (FAOS). The patients also rated how satisfied they were with their ankle and physical activity ability using visual analogue scales. The results from the WI group were compared with a group of patients (n ¼ 33) who received physiotherapist-supervised rehabilitation in a previous study (PT group). We found that compared with the PT group, the WI group had significantly worse scores in all of the FAOS subscales six weeks after the injury, and in three of five subscales three months after the injury. They also rated significantly lower satisfaction and significantly lower physical activity ability at both follow-ups. In conclusion, physiotherapist-supervised rehabilitation was more effective than WIs on improving patient-rated ankle function, satisfaction and physical activity ability after an acute ankle sprain.
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| 11. |
- Hermansen, Anna, 1974-, et al.
(author)
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Balance problems and dizziness after neck surgery–associations with pain and health-related quality of life
- 2020
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In: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040.
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Journal article (peer-reviewed)abstract
- Introduction: Symptoms of dizziness or imbalance are often present in individuals with a variety of neck-disorders. The aims of this study were to determine the prevalence of patient-reported balance problems and dizziness 10–13years after surgery for cervical degenerative disc disease; evaluate associations with neck pain and health-related quality of life; and investigate how these individuals described dizziness. Material and methods: Sixty-eight individuals, 10years or more after anterior cervical decompression and fusion surgery, who previously participated in a randomized controlled trial were included. Participants completed questionnaires including ratings of dizziness and balance problems, the Dizziness Handicap Inventory, and an open-ended question regarding their experience of dizziness. Secondary outcomes were neck pain and quality of life. Results: Seventy-two percent experienced occasional or daily symptoms of unsteadiness and/or dizziness. Intensity ratings for dizziness during movement and for balance problems were similar and rather low, but had an impact on quality of life. Ratings of dizziness at rest were even lower. Dizziness ratings were associated with neck pain. Strenuous activities were related to dizziness and dizziness was primarily described as intermittent and non-rotatory. Conclusions: Dizziness or balance problems in the long-term after surgery for cervical degenerative disc disease are common and have an impact on daily life. Ratings of problem frequency and intensity were usually low. Dizziness and balance problems may affect quality of life. Patients’ descriptions of these problems are in line with common symptoms of cervicogenic dizziness. © 2019, © 2019 The Author(s). Published by Taylor & Francis.
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| 12. |
- Hermansen, Anna
(author)
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Clinical and patient-reported outcomes after anterior cervical decompression and fusion surgery : A focus on functioning and daily life
- 2015
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Doctoral thesis (other academic/artistic)abstract
- Anterior cervical decompression and fusion (ACDF), with or without an intervertebral cage to add support to the fused segment, is an established surgical treatment of cervical radiculopathy due to cervical disc disease. High recovery rates and pain reductions after surgery have been reported, with similar results with or without a cage. A few small studies have evaluated neck-related physical function and patient-reported disability with less promising results. No previous studies have evaluated clinical and patientreported measures of functioning or compared the Cloward Procedure with the Cervical Intervertebral Fusion Cage (CIFC) more than 10 year after surgery. No studies have explored the patients’ perspective on surgical outcome Knowledge on long-term functioning may provide a base for improved postoperative care and rehabilitation. Combining the perspectives of clinicians and patients may provide a better understanding of outcome after ACDF surgery than has previously been reported.The overall aim of the thesis was to evaluate long-term functioning after anterior cervical decompression and fusion surgery due to cervical disc disease, and to provide new insights into patients’ experiences of daily life after surgery.The more than 10-year patient-reported outcomes of pain, disability and psychosocial factors (n=77), as well as clinical outcomes of neck-related physical function (n=51) were evaluated and compared between the Cloward Procedure and the CIFC. Preoperative and surgery-related factors of importance for a good outcome in neck-related pain and disability at 10-year follow-up were also identified. Fourteen women were interviewed at 1.5 to 3 years after ACDF to explore their experiences of daily life.There were no differences between the surgical techniques in long-term neck-related pain or patient-reported disability. Secondary outcomes were, with a few exceptions, similar between groups. Neck-related pain decreased after surgery and remained improved from the 2-year to the 10-year follow-up. However, disability ratings remained improved only in the CIFC group. Predictors of a successful outcome in neck-related pain intensity were high preoperative neck-related pain intensity (Odds Ratio 1.06) and nonsmoking (Odds Ratio 3.03). Male gender was the only predictive factor of a successful outcome in neck-related disability (Odds Ratio 4.33). Moderate to severe pain and patient-reported disability were seen in half of the participants at the 10-year follow-up, and neck-related physical impairments were seen in between 18% (cervical flexion) and 82% (neck-muscle endurance) of participants. Daily life was experienced as recovered or improved by women after ACDF surgery. However they were at the same time affected and limited by remaining symptoms. Behaviors and activities were altered to adjust to the symptoms. Social support provided by family, social and occupational networks, and by healthcare professionals were experienced as important in a good daily life.In conclusion: long-term pain, physical function and patient-reported disability were similar between the two ACDF techniques. High preoperative pain intensity, non-smoking and male gender predicted a good long-term outcome. Individuals after ACDF surgery experienced improvements in pain intensity and a good effect of surgery although they simultaneously reported residual or recurrent disability.
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| 13. |
- Hermansen, Anna, et al.
(author)
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Dizziness and balance outcomes after two different postoperative rehabilitation approaches following neck surgery : analyses of a multicenter randomized controlled trial
- 2023
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In: Physiotherapy Theory and Practice. - Philadelphia, PA, United States : Taylor & Francis. - 0959-3985 .- 1532-5040. ; 39:4, s. 750-760
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Journal article (peer-reviewed)abstract
- Background Dizziness and balance problems are common symptoms in patients with cervical radiculopathy. Objective To evaluate the effect of neck surgery postoperatively combined with either structured rehabilitation or standard approach in patients with cervical radiculopathy and dizziness and/or balance problems, and investigate factors influencing dizziness and balance at 6-month follow-up.Methods Individuals (n = 149) with cervical radiculopathy and dizziness and/or balance problems were randomized preoperatively to structured postoperative rehabilitation or standard postoperative approach. Outcomes were intensity of dizziness and subjective balance, and clinical measures of balance.Results Self-reported measures improved at three months (p < 0.001 to p = .007) and the standing balance at six months (p = .008). No between-group differences. Baseline values, neck pain, and physical activity level explained 23-39% of the variance in 6-month outcomes for self-reported measures. Baseline values and physical activity level explained 71% of the variance in walking balance, and lower baseline scores were significantly associated with standing balance impairments (OR 0.876).Conclusion Patients improved significantly in dizziness and subjective balance intensity shortly after surgery, and in standing balance at 6 months, independent of postoperative rehabilitation. Neck pain, physical activity, and neck muscle function influenced dizziness and balance, although preoperative values and neck pain were of most importance for 6-month outcomes.
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| 14. |
- Hermansen, Anna, et al.
(author)
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Evaluation of Physical Function in Individuals 11 to 14 Years after AnteriorCervical Decompression and Fusion Surgery : A Comparison betweenPatients and Healthy Reference Samples and Between 2 Surgical Techniques
- 2014
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In: Journal of Manipulative and Physiological Therapeutics. - : Elsevier. - 0161-4754 .- 1532-6586. ; 37:2, s. 87-96
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Journal article (peer-reviewed)abstract
- Objective: The purpose of this study was to evaluate neck-related physical function in individuals 11 to 14 years after anterior cervical decompression and fusion (ACDF) surgery for degenerative cervical disk disease and to compare the long-term outcome of 2 surgical techniques, including the Cloward procedure and cervical intervertebral fusion cage. Methods: In this cross-sectional study, 51 individuals, 11 years or more after ACDF, underwent testing of cervical active range of motion, hand-grip strength, static and dynamic balance, neck muscle endurance, and completed pain ratings. The participants values were compared with values of age-and sex-matched healthy individuals to evaluate impairments. Correlations between different test scores and pain were performed. Group differences were analyzed between the 2 surgical techniques. Results: Sixty-five percent and 82% exhibited impairment in ventral and dorsal neck muscle endurance, respectively. Impairment rates of 18% to 39% for cervical active range of motion, 27% to 43% for hand-grip strength, 37% for standing balance, and 35% for dynamic balance were recorded. Twenty-nine percent of the participants had impairment (greater than30 mm visual analog scale) in pain. There were no significant differences in physical function between the 2 surgical treatment groups (Cloward procedure or cervical intervertebral fusion cage) (P = .10-.92). Conclusions: In those studied, a large percentage of patients who had anterior cervical decompression and fusion surgery have impairments in neck-related physical function when compared 11 to 14 years after surgery with age-and sex-matched healthy reference individuals. Neck-specific function, but not balance, was statistically correlated to pain. Neck muscle endurance was most affected, and balance impairments were also present in one-third of the individuals. There were no differences in long-term physical function between the 2 surgical techniques.
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| 15. |
- Hermansen, Anna, et al.
(author)
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Women’s experiences of daily life after anterior cervical decompression and fusion surgery : A qualitative interview study
- 2016
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In: Journal of Rehabilitation Medicine. - Uppsala, Sweden : Stiftelsen Rehabiliteringsinformation /Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 48:4, s. 352-358
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Journal article (peer-reviewed)abstract
- Subjects: Fourteen women aged 39-62 years (median 52 years), were included 1.5 to 3 years after ACDF for cervical degenerative disc disease.Methods: Individual semi-structured interviews were analyzed by qualitative content analysis with an inductive approach.Results: The women described their experiences of daily life in five different ways; Experiences of recovery; Experiences of symptoms in daily life influence feelings and thoughts; Making daily life work; Importance of social and occupational networks; Experiences of the influence of healthcare professionals and interventions on daily life.Conclusion: This interview study provides insight into women’s daily life after ACDF. While improved after surgery, informants also experienced remaining symptoms and limitations in daily life. A variety of mostly active coping strategies were used to manage daily life. Social support from family, friends, occupational networks and healthcare professionals positively influenced daily life. These findings provide knowledge on aspects of daily life that should be considered in individualized postoperative care and rehabilitation in an attempt to provide better outcomes in women after ACDF.
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| 16. |
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| 17. |
- Kammerlind, Ann-Sofi C., et al.
(author)
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Recovery after acute unilateral vestibular loss and predictors for remaining symptoms
- 2011
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In: American Journal of Otolaryngology. - : WB Saunders. - 0196-0709 .- 1532-818X. ; 32:5, s. 366-375
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Journal article (peer-reviewed)abstract
- Purpose: The aims of this study were to follow recovery during the first 6 months after acute unilateral vestibular loss (AUVL) and to determine predictors for self-rated remaining symptoms. Materials and methods: Forty-two subjects were included less than 10 days after AUVL. Static and dynamic clinical balance tests, visual analogue scales, University of California Los Angeles Dizziness Questionnaire, Dizziness Beliefs Scale, European Quality of Life questionnaire, Dizziness Handicap Inventory, and Hospital Anxiety and Depression Scale were performed at inclusion and at 7 follow-ups over 6 months. Subjects rated their symptoms on visual analogue scales daily at home. Videonystagmography was performed in the acute stage and after 10 weeks. Results: Decrease of symptoms and improvement of balance function were larger during the first compared with the latter part of the follow-up period. Visual analogue scale ratings for balance problems were higher than those for dizziness. A prediction model was created based on the results of 4 tests in the acute stage: standing on foam with eyes closed, standing on 1 leg with eyes open, visual analogue scale rating of vertigo at rest, and European Quality of Life questionnaire rating of health-related quality of life. The prediction model identified subjects at risk of having remaining symptoms after 6 months with a sensitivity of 86% and a specificity of 79%. Conclusions: Recovery mainly takes place during the first weeks after AUVL. Subjects rate more balance problems than dizziness. Self-rated remaining symptoms after 6 months may be predicted by clinical balance tests and subjective ratings in the acute stage.
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| 18. |
- Kammerlind, Ann-Sofi, 1969-, et al.
(author)
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Dizziness in older persons at high risk of future hospitalization : prevalence, differences between those with and without dizziness, and effect of a proactive primary care intervention
- 2022
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In: BMC Geriatrics. - London, United Kingdom : BioMed Central. - 1471-2318. ; 22:1
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Journal article (peer-reviewed)abstract
- Background: Dizziness is a common reason for seeking care, and frequently affects older persons. The aims were to determine the prevalence of dizziness in older persons at high risk of hospitalization, to compare subjects with and without dizziness, and to examine the effects on dizziness of a proactive primary care intervention in comparison with conventional care after one year.Methods: Data were derived from a prospective multicentre clinical trial in persons aged 75 and older and at high risk of hospitalization. A baseline questionnaire included demographic data, use of aids, questions about everyday physical activity and exercise, pain (intensity, frequency, and duration), activities of daily living measured using the ADL Staircase, and health-related quality of life measured using the EQ-5D-3L vertical visual analogue scale. Both at baseline and after one year, subjects were asked about dizziness, and those with dizziness answered the Dizziness Handicap Inventory - Screening version. Subjects in the intervention group were evaluated by a primary care team and when needed proactive care plans were established. Groups were compared using the Mann Whitney U-test or chi-squared test.Results: Of the 779 subjects, 493 (63%) experienced dizziness. Persons with dizziness differed regarding sex, homecare service, aids, activities of daily living, health-related quality of life, physical activity, and pain. The intervention did not significantly reduce the level of dizziness.Conclusions: Dizziness is common in vulnerable older persons, and individuals with dizziness differ in several respects. Further studies are needed employing more dizziness-specific assessment and individually tailored interventions.
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| 19. |
- Kammerlind, Ann-Sofi, 1969-, et al.
(author)
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Effects of balance training in elderly people with nonperipheral vertigo and unsteadiness
- 2001
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In: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 15:5, s. 463-470
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Journal article (peer-reviewed)abstract
- Objective: To evaluate the effect of balance training in group in elderly people with nonperipheral vertigo and unsteadiness.Design: Randomized controlled study.Setting: Ear, nose and throat department, University Hospital, Sweden.Subjects: Twenty-three elderly subjects with nonperipheral vertigo and/or unsteadiness randomized into training group and control group.Intervention: The training group attended balance training in group twice a week for eight weeks.Main outcome measures: Timed static balance tests, walking tests and six sensory organization tests on EquiTest dynamic posturography were performed before and after the training period. Besides, the patients estimated their vertigo and unsteadiness on a visual analogue scale (VAS) before and after the training period.Results: The training group improved significantly in standing on one leg with eyes open, walking forward on a line, walking speed, in three out of six tests on dynamic posturography and estimated less vertigo and unsteadiness measured with VAS. No changes were seen in the control group.Conclusion: Balance training in elderly people with nonperipheral vertigo and unsteadiness seems to improve both objective and perceived balance.
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| 20. |
- Kammerlind, Ann-Sofi, 1969-, et al.
(author)
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Effects of home training and additional physical therapy on recovery after acute unilateral vestibular loss : a randomized study
- 2005
-
In: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 19:1, s. 54-62
-
Journal article (peer-reviewed)abstract
- Objective: To evaluate the effects of additional physical therapy on recovery after acute unilateral vestibular loss given to patients receiving home training.Design: Randomized controlled trial.Setting: Ear, nose and throat departments in three hospitals.Subjects: Fifty-four patients (mean age 52 years) with acute unilateral vestibular loss within the last week confirmed with electronystagmography testing were included. Patients with central neurologic or auditory symptoms or other vertigo disease were excluded.Interventions: Home training with or without additional physical therapy 12 times during 10 weeks.Main measures: Electronystagmography testing was performed before and after the training period. Clinical static (Romberg?s test, sharpened Romberg?s test, standing on foam and standing on one leg) and dynamic (walking forward and backward on a line) balance tests and subjective ratings of vertigo and balance problems on a visual analogue scale were done one week, 10 weeks and six months after the start of training.Results: Similar changes were seen in the two training groups.Conclusions: No significant differences in outcome regarding balance function or perceived symptoms were found between home training with or without additional physical therapy.
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| 21. |
- Kammerlind, Ann-Sofi, 1969-, et al.
(author)
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Influence of asymmetry of vestibular caloric response and age on balance and perceived symptoms after acute unilateral vestibular loss
- 2006
-
In: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 20:2, s. 142-148
-
Journal article (peer-reviewed)abstract
- Objective: To evaluate the influence of asymmetry of vestibular caloric response and age on balance and perceived symptoms after acute unilateral vestibular loss.Design: Prospective study.Setting: Ear, nose and throat departments in three hospitals.Subjects: Fifty-four patients (mean age 52 years) with acute unilateral vestibular loss participating in a randomized controlled training study were included.Main measures: Electronystagmography testing was performed within one week after onset of symptoms and after 10 weeks. The outcome measures clinical static balance tests (sharpened Romberg's test with eyes closed, standing on foam with eyes closed, and standing on one leg with eyes open and closed) and subjective symptom ratings on a visual analogue scale were done after one week, 10 weeks and six months. The correlation between age and asymmetry of vestibular caloric response, respectively, and the outcome measures were analysed.Results: Greater caloric asymmetry correlated with poorer performance at the sharpened Romberg's test and standing on one leg with eyes closed at all three follow-ups (rho=-0.31 to -0.54), and with higher symptom ratings at the 10-week and six-month follow-ups (rho=0.30-0.60). Higher age was associated with poorer performance on the sharpened Romberg's test and standing on one leg at all three follow-ups (rho=0.31-0.64), but did not change over time. Higher age was also associated with higher ratings of vertigo at the six-month follow-up, and less reduction of vertigo between the 10-week and six-month follow-ups (rho=0.29-0.48).Conclusions: A higher degree of asymmetry of vestibular caloric response and high age seem to be associated with poor outcome in balance and perceived symptoms after acute unilateral vestibular loss.
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| 22. |
- Kammerlind, Ann-Sofi, 1969-, et al.
(author)
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Long-term follow-up after acute unilateral vestibular loss and comparison between subjects with and without remaining symptoms
- 2005
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In: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 125:9, s. 946-953
-
Journal article (peer-reviewed)abstract
- Conclusions. About half of the subjects in this study reported remaining symptoms 3–6 years after acute unilateral vestibular loss. Differences could be seen between subjects with and without remaining symptoms regarding health-related quality of life, anxiety and depression.Objective. To evaluate the presence of self-rated remaining symptoms 3–6 years after acute unilateral vestibular loss, and to compare subjects with and without such symptoms.Material and methods. Firstly, 51 subjects answered a questionnaire which included the EuroQol EQ-5D, the Hospital Anxiety and Depression Scale, the University of California Los Angeles Dizziness Questionnaire, visual analogue scales and the Dizziness Handicap Inventory. Secondly, nine subjects with and nine without remaining symptoms participated in an extended testing procedure, including electronystagmography (ENG), determination of vestibular-evoked myogenic potentials (VEMPs) and clinical balance tests.Results. In the first part of the study, 27 subjects reported remaining symptoms, 3 reported 1 additional period of symptoms and 21 had not experienced any symptoms at all in the 3–6 years since acute unilateral vestibular loss. In the second part, the group with remaining symptoms rated a lower health-related quality of life and a higher level of anxiety and depression. There were no differences between the two groups in terms of ENG tests, VEMPs or clinical balance tests.
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| 23. |
- Kammerlind, Ann-Sofi, et al.
(author)
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Prevalence of and factors related to mild and substantial dizziness in community-dwelling older adults : A cross-sectional study
- 2016
-
In: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 16:1
-
Journal article (peer-reviewed)abstract
- BackgroundDizziness is highly prevalent among older people and associated with many health factors. The aim of the study was to determine the prevalence of and factors related to dizziness among community-dwelling older adults in Sweden. In contrast to previous studies, the subjects with dizziness were divided into two groups, mild and substantial dizziness, according to the frequency and intensity of dizziness.MethodsA sample of 305 older persons between 75 and 90 years of age (mean age 81 years) were interviewed and examined. Subjects with dizziness answered the University of California Los Angeles Dizziness Questionnaire and questions about provoking movements. The groups with substantial, mild, or no dizziness were compared with regard to age, sex, diseases, drugs, blood pressure, physical activity, exercises, falls, fear of falling, quality of life, general health, mobility aids, and physical performance.ResultsIn this sample, 79 subjects experienced substantial and 46 mild dizziness. Subjects with substantial dizziness were less physically active, reported more fear of falling, falls, depression/anxiety, diabetes, stroke/TIA, heart disease, a higher total number of drugs and antihypertensive drugs, lower quality of life and general health, and performed worse physically.ConclusionsThere are many and complex associations between dizziness and factors like falls, diseases, drugs, physical performance, and activity. For most of these factors, the associations are stronger in subjects with substantial dizziness compared with subjects with mild or no dizziness; therefore, it is relevant to differ between mild and substantial dizziness symptoms in research and clinical practice in the future.
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| 24. |
- Kammerlind, Ann-Sofi, 1969-, et al.
(author)
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Reliability of clinical balance tests and subjective ratings in dizziness and disequilibrium
- 2005
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In: Advances in Physiotherapy. - : Informa UK Limited. - 1403-8196 .- 1651-1948. ; 7:3, s. 96-107
-
Journal article (peer-reviewed)abstract
- The aim was to assess (i) the test–retest and inter-rater reliability of, and (ii) the relationships between, commonly used clinical balance tests and subjective ratings in subjects with dizziness and disequilibrium. Fifty subjects (26 men and 24 women, mean age 63 years) with dizziness and disequilibrium following acute unilateral vestibular loss or central neurological dysfunction were tested with static and dynamic clinical balance tests, visual analogue scales (VAS), University of California Los Angeles Dizziness Questionnaire (UCLA-DQ), Dizziness Beliefs Scale (DBS), European Quality of Life questionnaire (EQ-5D), Dizziness Handicap Inventory (DHI), and Hospital Anxiety and Depression Scale (HADS). Most tests showed good test–retest and inter-rater reliability. Few correlations were seen between objective and subjective tests, but several correlations were found between the different subjective instruments. Sharpened Romberg's test eyes closed, standing on foam eyes closed, standing on one leg eyes open and walking in a figure-of-eight are recommended as reliable and appropriate clinical balance tests in subjects with dizziness and disequilibrium. Subjects with central lesions may have difficulties when rating their symptoms on VAS. Total scores rather than scores for separate items are recommended for UCLA-DQ and DHI.
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| 25. |
- Kammerlind, Ann-Sofi, 1969-
(author)
-
Vestibular rehabilitation therapy in dizziness and disequilibrium
- 2005
-
Doctoral thesis (other academic/artistic)abstract
- Dizziness and disequilibrium can be caused by several dysfunctions within the balance system, and are common symptoms especially in higher ages. The general aim of this thesis was to evaluate the effects of vestibular rehabilitation therapy in patients with dizziness and disequilibrium, and to examine the influence of age, vestibular function and psychological aspects on recovery.Four study samples were included in the thesis: physically active elderly, central vestibular dysfunction (CVD), acute unilateral vestibular loss (AUVL), and in the last study both AUVL and CVD. The measurements static and dynamic clinical balance tests, V AS, EuroQol, Hospital Anxiety and Depression Scale, UCLA Dizziness Questionnaire, Dizziness Handicap Inventory, Dizziness Beliefs Scale, electronystagmography, vestibular-evoked myogenic potentials, and computerized dynamic posturography were used.The change in balance performance over a 7-year period was evaluated in 17 physically active elderly. Both static clinical balance tests and maximum walking speed showed impaired balance. The amount of sway measured by computerized dynamic posturography had not changed, but increased latencies of force response to sudden backward translations of the platform were seen.The effects of balance training were evaluated in 23 elderly patients with dizziness and disequilibrium caused by CVD. Patients were randomized to exercise group or control group. The exercise group received group balance training twice a week for eight weeks. Improvements were seen only in the exercise group in clinical balance tests, dynamic posturography, maximum walking speed and subjective ratings.The effects of home training with and without additional individualized physical therapy were evaluated in a randomized controlled study of 54 patients during six months after AUVL. Similar recovery was seen in the two training groups. Higher age correlated with worse performance on clinical balance tests on follow-ups but not with change over time. Higher age also correlated with higher subjective ratings of vertigo at the six-month follow-up. Greater caloric vestibular asymmetry correlated with worse performance on clinical balance tests and higher subjective ratings.In a long-term follow-up after 3-6 years, about half of the patients reported residual symptoms after the AUVL. Patients with and without reported symptoms differed with respect to health-related quality of life, anxiety and depression, but not in clinical balance tests, electronystagmography or vestibular-evoked myogenic potentials.The test-retest and inter-rater reliability of, and the relationships between, clinical balance tests and subjective ratings and questionnaires were assessed in 50 patients with residual symptoms of dizziness and disequilibrium after AUVL or CVD. Sharpened Romberg's test with eyes closed, standing on foam with eyes closed, standing on one leg with eyes open, and walking in a figure-of-eight were the most reliable and appropriate clinical balance tests. Clinical balance tests were seldom correlated with subjective ratings and questionnaires, which shows the importance of measuring both aspects of dizziness and disequilibrium.In conclusion, balance performance deteriorates with aging, vestibular rehabilitation therapy may improve balance and decrease symptoms of dizziness and disequilibrium, and it is important to use clinical balance tests together with subjective ratings and questionnaires in these patients.
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| 26. |
- Ledin, Torbjörn, et al.
(author)
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Dizziness and disequlibrium
- 2010
-
In: Physical activity in the prevention and treatment of disease. - Stockholm : Swedish National Institute of Public Health. - 9789172577152 ; , s. 356-366
-
Book chapter (other academic/artistic)abstract
- Svimmelhet er en vanlig forekommende tilstand, og forekomsten øker med stigendealder. Nedsatt, mistet eller forstyrret funksjon i en eller flere av delene ibalansesystemet kan forårsakes av aldring samt av mange forskjellige sykdommerog skader og kan føre til forstyrret balansefunksjon og bevegelsesillusjoner(svimmelhet). Diagnostikken består blant annet av nøyaktig anamnese, tester avvestibulær funksjon, posisjonstester og vurdering av postural kontroll. Denneframstillingen behandler noen svimmelhetstilstander der bevegelsestrening erviktig for å oppnå størst mulig grad av tilheling.Akutt perifert vestibulært tap av balansenervens funksjon på den ene siden girrask og kraftig svimmelhet og balanseforstyrrelser. Tilheling kan påskyndes ved åstimulere sentral kompensasjon med øyebevegelser, hodebevegelser og balanseøvelserav gradvis økende intensitet. Ved godartet posisjonssvimmelhet, det vil sibenign paroksysmal posisjonell vertigo (BPPV), har noen otolitter løsnet og flyttetseg fra hinnesekk til buegang i det indre øret, noe som gir svimmelhet ved hodebevegelserog endringer i kroppsstilling. Ved BPPV brukes to forskjellige behandlingsprinsipper,habitueringstrening og manøverbehandling. Skader i sentralnervesystemetog aldersrelatere forandringer av balansesystemets funksjon kan også føretil svimmelhet og balanseforstyrrelser. Svimmelhet og balansevanskeligheter hoseldre er en stor risikofaktor for fall og påfølgende fraktur. Ved skade på sentralnervesystemetog ved aldersrelatert svimmelhet skal treningen forbedre balanse,koordinasjon og styrke, redusere bevegelsesfrykten og øke aktivitetsgraden.
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| 27. |
- Ledin, Torbjörn, et al.
(author)
-
Svimmelhet og Balanseforstyrrelser
- 2009
-
In: Aktivitetshåndboken. - : Helsedirektoratet. ; , s. 610-620
-
Book chapter (other academic/artistic)abstract
- Svimmelhet er en vanlig forekommende tilstand, og forekomsten øker med stigendealder. Nedsatt, mistet eller forstyrret funksjon i en eller flere av delene ibalansesystemet kan forårsakes av aldring samt av mange forskjellige sykdommerog skader og kan føre til forstyrret balansefunksjon og bevegelsesillusjoner(svimmelhet). Diagnostikken består blant annet av nøyaktig anamnese, tester avvestibulær funksjon, posisjonstester og vurdering av postural kontroll. Denneframstillingen behandler noen svimmelhetstilstander der bevegelsestrening erviktig for å oppnå størst mulig grad av tilheling.Akutt perifert vestibulært tap av balansenervens funksjon på den ene siden girrask og kraftig svimmelhet og balanseforstyrrelser. Tilheling kan påskyndes ved åstimulere sentral kompensasjon med øyebevegelser, hodebevegelser og balanseøvelserav gradvis økende intensitet. Ved godartet posisjonssvimmelhet, det vil sibenign paroksysmal posisjonell vertigo (BPPV), har noen otolitter løsnet og flyttetseg fra hinnesekk til buegang i det indre øret, noe som gir svimmelhet ved hodebevegelserog endringer i kroppsstilling. Ved BPPV brukes to forskjellige behandlingsprinsipper,habitueringstrening og manøverbehandling. Skader i sentralnervesystemetog aldersrelatere forandringer av balansesystemets funksjon kan også føretil svimmelhet og balanseforstyrrelser. Svimmelhet og balansevanskeligheter hoseldre er en stor risikofaktor for fall og påfølgende fraktur. Ved skade på sentralnervesystemetog ved aldersrelatert svimmelhet skal treningen forbedre balanse,koordinasjon og styrke, redusere bevegelsesfrykten og øke aktivitetsgraden.
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| 28. |
- Ledin, Torbjörn, et al.
(author)
-
Yrsel och balansrubbningar
- 2004
-
In: FYSS för alla. - Stockholm : Yrkesföreningar för fysisk aktivitet. - 9185574511
-
Book chapter (other academic/artistic)abstract
- Yrsel är vanligt förekommande och förekomsten ökar med stigande ålder. Nedsatt, förlorad eller störd funktion i en eller flera av balanssystemets delar kan orsakas av åldrande samt av många olika sjukdomar och skador och leda till störd balansfunktion och rörelseillusioner (yrsel). Diagnostiken består av bl.a. anamnestagning, tester av vestibulär funktion, lägestester och bedömning av den posturala kontrollen. Vi diskuterar i denna framställning några yrseltillstånd där rörelseträning är betydelsefull för största möjliga tillfrisknande. Akut perifert vestibulärt bortfall av ena sidans balansnervsfunktion ger akut insättande kraftig yrsel och balansrubbning. Tillfrisknandet kan påskyndas genom stimulering av central kompensation med ögonrörelser, huvudrörelser och balansövningar av successivt ökad intensitet. Vid BPPV (godartad lägesyrsel) har otoliter lossnat och förflyttats från hinnsäck till båggång vilket ger yrsel vid huvudrörelser och kroppslägesändringar. Vid BPPV används två olika behandlingsprinciper; habitueringsträning och manöverbehandling. Skador i det centrala nervsystemet och åldersrelaterade förändringar av balanssystemets funktion kan också leda till yrsel och balansrubbningar. Yrsel och balanssvårigheter hos äldre är en riskfaktor för fall och frakturer. Vid skador på centrala nervsystemet och vid åldersrelaterad yrsel syftar träningen till förbättrad balans, koordination och styrka, minskad rörelserädsla och ökad aktivitetsgrad.
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| 29. |
- Ledin, Torbörn, et al.
(author)
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Yrsel och balansrubbningar
- 2009. - 1
-
In: Ordination motion. - : Bromberg. - 9789173372244 ; , s. 162-165
-
Book chapter (other academic/artistic)abstract
- Visste du att svenska läkare allt oftare skriver ut motion på recept? Att vi mår bättre när vi rör på oss och att det kan förebygga många skador är ett obestritt faktum, men att fysisk aktivitet även kan lindra och behandla krämpor och sjukdomar som redan har uppstått är ny kunskap. Det är inte farligt att vara fysiskt aktiv då man drabbats av sjukdom bara man undviker för hög belastning. Det kan dock vara svårt att veta vilka träningsformer som är bra och vilka man ska undvika. I boken Ordination:motion förmedlar svenska experter, främst läkare och sjukgymnaster, fakta på ett ingående och lättförståeligt sätt. Boken består av två delar - en »friskdel« för att förebygga sjukdom och en »sjukdel« som visar hur vi kan lindra vissa sjukdomar med hjälp av vardagsmotion och därmed uppnå bättre hälsa. Boken bygger på FYSS 2008, som är skriven av en rad medicinska experter och används inom sjukvården.
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| 30. |
- Peolsson, Anneli, 1967-, et al.
(author)
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Dynamic posturography in patients with cervical disc disease compared with patients with whiplash-associated disorders and healthy volunteers
- 2004
-
In: Advances in Physiotherapy. - : Informa UK Limited. - 1403-8196 .- 1651-1948. ; 6:4, s. 173-181
-
Journal article (peer-reviewed)abstract
- Background: Today there is limited knowledge of postural control and remaining dizziness after anterior cervical decompression and fusion (ACDF).Objective: The purpose of the present study was to compare the results from dynamic posturography (sensory organization test (SOT) 1–6 and SOT 1–2 in flexed and extended neck position, respectively) in patients with cervical disc disease with healthy controls and with patients with a previous whiplash-associated disorder (WAD). Another purpose was to investigate which objective and/or subjective factors that were related to the outcome on SOT 5 and SOT 6 in patients after ACDF.Design: Fifteen patients, half with self-perceived dizziness, who had undergone ACDF with cervical carbon fibre intervertebral fusion cage, were consecutively included in the study. Background data, active range of motion of the neck, neck and hand strength, neck muscle endurance and subjective variables were used in a multiple regression model to find the strongest factor of a good postural performance.Results: Not only WAD patients but also a major part of ACDF patients had dizziness and impaired postural control. Male patients without dizziness, with a low pain and disability level had the best results on dynamic posturography. Conclusions: Many patients with cervical disc disease had remaining disability due to postural control and are in need of specific physiotherapy after ACDF.
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| 31. |
- Peolsson, Anneli, et al.
(author)
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Effects of neck-specific exercise with or without a behavioural approach in addition to prescribed physical activity for individuals with chronic whiplash-associated disorders: a prospective randomised study
- 2013
-
In: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 14:311
-
Journal article (peer-reviewed)abstract
- Background: Up to 50% of chronic whiplash associated disorders (WAD) patients experience considerable pain and disability and remain on sick-leave. No evidence supports the use of physiotherapy treatment of chronic WAD, although exercise is recommended. Previous randomised controlled studies did not evaluate the value of adding a behavioural therapy intervention to neck-specific exercises, nor did they compare these treatments to prescription of general physical activity. Few exercise studies focus on patients with chronic WAD, and few have looked at patients ability to return to work and the cost-effectiveness of treatments. Thus, there is a great need to develop successful evidence-based rehabilitation models. The study aim is to investigate whether neck-specific exercise with or without a behavioural approach (facilitated by a single caregiver per patient) improves functioning compared to prescription of general physical activity for individuals with chronic WAD. less thanbrgreater than less thanbrgreater thanMethods/Design: The study is a prospective, randomised, controlled, multi-centre study with a 2-year follow-up that includes 216 patients with chronic WAD (andgt;6 months and andlt;3 years). The patients (aged 18 to 63) must be classified as WAD grade 2 or 3. Eligibility will be determined with a questionnaire, telephone interview and clinical examination. The participants will be randomised into one of three treatments: (A) neck-specific exercise followed by prescription of physical activity; (B) neck-specific exercise with a behavioural approach followed by prescription of physical activity; or (C) prescription of physical activity alone without neck-specific exercises. Treatments will be performed for 3 months. We will examine physical and psychological function, pain intensity, health care consumption, the ability to resume work and economic health benefits. An independent, blinded investigator will perform the measurements at baseline and 3, 6, 12 and 24 months after inclusion. The main study outcome will be improvement in neck-specific disability as measured with the Neck Disability Index. All treatments will be recorded in treatment diaries and medical records. less thanbrgreater than less thanbrgreater thanDiscussion: The study findings will help improve the treatment of patients with chronic WAD.
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| 32. |
- Peolsson, Anneli, et al.
(author)
-
Outcome of physiotherapy after surgery for cervical disc disease: a prospective randomised multi-centre trial
- 2014
-
In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 15
-
Journal article (peer-reviewed)abstract
- Background: Many patients with cervical disc disease require leave from work, due to long-lasting, complex symptoms, including chronic pain and reduced levels of physical and psychological function. Surgery on a few segmental levels might be expected to resolve disc-specific pain and reduce neurological deficits, but not the non-specific neck pain and the frequent illness. No study has investigated whether post-surgery physiotherapy might improve the outcome of surgery. The main purpose of this study was to evaluate whether a well-structured rehabilitation programme might add benefit to the customary post-surgical treatment for cervical disc disease, with respect to function, disability, work capability, and cost effectiveness. Methods/Design: This study was designed as a prospective, randomised, controlled, multi-centre study. An independent, blinded investigator will compare two alternatives of rehabilitation. We will include 200 patients of working age, with cervical disc disease confirmed by clinical findings and symptoms of cervical nerve root compression. After providing informed consent, study participants will be randomised to one of two alternative physiotherapy regimes; (A) customary treatment (information and advice on a specialist clinic); or (B) customary treatment plus active physiotherapy. Physiotherapy will follow a standardised, structured programme of neck-specific exercises combined with a behavioural approach. All patients will be evaluated both clinically and subjectively (with questionnaires) before surgery and at 6 weeks, 3 months, 6 months, 12 months, and 24 months after surgery. The main outcome variable will be neck-specific disability. Cost-effectiveness will also be calculated. Discussion: We anticipate that the results of this study will provide evidence to support physiotherapeutic rehabilitation applied after surgery for cervical radiculopathy due to cervical disc disease.
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| 33. |
- Sjödahl, Rune, 1938-, et al.
(author)
-
Robotassisterad bäcken- och njurkirurgi – en utvärdering
- 2022
-
In: Läkartidningen. - Stockholm, Sweden : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 119
-
Research review (peer-reviewed)abstract
- Current studies indicate that robotic-assisted surgery is not inferior to laparoscopic or open surgery regarding oncologic or functional outcomes. An exception may be uterine cervix cancer, where the survival after minimal invasive surgery might not be as good as after open surgery. There is less bleeding and need for blood transfusion after robotic-assisted surgery, and postoperative complications are similar to open or laparoscopic surgery. Robotic-assisted surgery offers ergonomic advantages compared to laparoscopic surgery. The effect of the surgical learning curve is not sufficiently studied. Presently robotic-assisted surgery is not cost-effective due to high costs of investments. The operation is more time consuming than laparoscopic or open surgery with risks of delaying and cancellation of other operations.
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| 34. |
- Sjöholm, Hanna, 1975-
(author)
-
Assessments and Risk Factors for Falls in Persons with Acute Stroke
- 2021
-
Doctoral thesis (other academic/artistic)abstract
- Background: Early identification of risk factors is crucial for reducing the high fall risk associated with stroke, and sex differences in relation to falls need to be further investigated. There is a lack of uniform, standardized, and reliable testing procedures for postural reactions, and existing tests assessing negotiating obstacles while walking cannot be performed when walking aids are used.Aim: To investigate the predictive validity of fall risk in persons with acute stroke for easily administered data and assessments, as well as to investigate the psychometric properties of two new tests.Methods: The Postural Rections Test (PRT) and the Cone Evasion Walk Test (CEW) were developed based on literature, and on input from an expert panel. To estimate the reliability of the PRT and CEW, video-recordings of 20 persons with acute stroke performing each item in the PRT and CEW were assessed by 10 physiotherapists on two occasions, at least two weeks apart. The construct validity of the CEW (n = 221), was examined in relation to selected corresponding tests, and predictive validity by correlating the CEW to falls within six months. In 124 women and 160 men the results from the PRT and CEW, along with other easily administered data and assessments on participant characteristics, functions, and activities were analyzed in relation to the number of days to the first fall by Cox regression, while fall incidence was analyzed by negative binomial regression, both for the total cohort, and for women and men separately. Sex differences in monthly fall incidence were analyzed with Poisson regression.Results: For the intra-rater reliability of the PRT, the overall proportion of agreement was 87 − 92% for the different postural reactions, and in median 9–10 out of 10 physiotherapists scored the same value for inter-rater reliability. In the CEW the intra-class correlation coefficients for intra-rater and inter-rater reliability were 0.88–0.98. The results showed expected poor to moderate correlations to the selected tests for construct validity, and to falls within six months. Participants touched significantly more cones on the side that was opposite to the side of their lesion. The Cox regression analysis showed that intake of more than eight medications, paresis in the arms, paresis in the legs, impaired protective reactions in sitting, and limitations in self-care activities were decisive risk factors for the time to the first fall, and according to the negative binomial regression, limitations in mobility activities was a decisive risk factor for high fall incidence in the total cohort (p<0.0005). The assessor’s judgment of a person’s six-month fall risk, was particularly well suited for identification of individuals with a high risk for multiple falls; however only in women when analyzed for each sex separately (p<0.0005). Compared to men, a higher number of fall risk factors were identified in women, including impaired mental functions, paresis in the arms, and limitations in several activities of self-care and mobility (p<0.0005). In men, the most decisive fall risk factors were intake of a high number of medications, intake of antidepressants, and mobility limitations (p=0.001). Fall incidence during the first month from discharge was significantly higher in men compared to women.Conclusions: The PRT and CEW can be reliably used in persons with acute stroke, and are valid for assessment of fall risk. A high quantity and wide range of rapid and easily collected data can be used for identification of persons at high risk for falls. The risk factors differed in part when analyzing the time to the first fall, and six-month fall incidence, and different fall risk factors were the most decisive when analyzed separately in women and men. Monthly fall incidence was higher in men during the first month.
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| 35. |
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| 36. |
- Sjöholm, Hanna, 1975-, et al.
(author)
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Exploring possible risk factors for time to first fall and 6-month fall incidence in persons with acute stroke
- 2022
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In: SAGE Open Medicine. - Mannheim, Germany : SAGE Open. - 2050-3121. ; 10
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Journal article (peer-reviewed)abstract
- Objectives:The aim was to explore how the time to the first fall and 6-month fall incidence relates to rapidly and easily collected data in persons with acute stroke.Methods:Out of consecutively admitted patients with stroke at three stroke units, 284 with at least one follow-up were included in this prospective cohort study. During 6 months following discharge, participants reported falls using a diary and monthly phone calls. Data about participants’ characteristics, functions, and activities were collected during hospital stay and analyzed in relation to time to first fall by Cox regression and fall incidence by negative binomial regression.Results:Use of ⩾9 medications, paresis in arms, paresis in legs (National Institutes of Health Stroke Scale), impaired protective reactions in sitting (Postural Reactions Test), and limitations in self-care (Barthel Index) were decisive risk factors for time to first fall. Limitations in mobility (Step Test, 30-s Chair Stand Test) were decisive risk factors for high fall incidence (p < 0.0005).Conclusion:Several easily collected participant characteristics, functions, and activities were identified as risk factors for falls. The findings emphasize the width of assessments that can be used for the identification of individuals at risk for falls and that the risk factors vary in different strata of the population. These results are important when developing multivariate risk models. The risk factors differed in part when analyzing the time to the first fall and 6-month fall incidence.
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| 37. |
- Sjöholm, Hanna, et al.
(author)
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Reliability of test procedures for postural reactions in people with acute stroke
- 2018
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In: International Journal of Therapy and Rehabilitation. - London : Mark Allen Group. - 1741-1645 .- 1759-779X. ; 25:11, s. 576-586
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Journal article (peer-reviewed)abstract
- Regaining and maintaining balance requires postural reactions such as righting reactions, equilibrium reactions, and protective reactions. There is a lack of uniform, standardised, and reliable testing procedures for postural reactions. The aim of the present study was to examine the intra- And interrater reliability of a newly developed postural reactions assessment for use in people with acute stroke. Methods: The Postural Reactions Test was developed based on the literature, on previous tests, and on input from an expert panel. A total of 10 physiotherapists assessed a total of 20 video recordings of people with acute stroke performing each postural reaction. These assessments were carried out on two occasions at least 2 weeks apart. The study thus included 400 ratings. Findings: For intrarater reliability, the overall proportion of agreement was 86 - 93% for the different postural reactions. For interrater reliability, the most common score for each participant and the number of physiotherapists giving that score were noted. A median of 9-10 out of 10 physiotherapists scored the same value. Conclusions: The results indicate that the Postural Reactions Test can be used to reliably assess function in people with acute stroke and that the test can complement the existing assessments for people with affected postural control
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| 38. |
- Sjöholm, Hanna, et al.
(author)
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The Cone Evasion Walk test : Reliability and validity in acute stroke
- 2019
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In: Physiotherapy Research International. - : John Wiley & Sons. - 1358-2267 .- 1471-2865. ; 24:1
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Journal article (peer-reviewed)abstract
- OBJECTIVETo estimate the reliability and validity of the Cone Evasion Walk test (CEW), a new test assessing the ability to evade obstacles, in people with acute stroke.METHODSTo estimate the reliability of the CEW, video recordings of 20 people with acute stroke performing the test were assessed by 10 physiotherapists on two occasions, resulting in a total of 400 ratings. Patients performed the CEW (n = 221), functional ambulation classification (FAC; n = 204), Timed Up and Go (TUG; n = 173), TUG cognitive (TUG-cog; n = 139), Serial 7s attention task from the Montreal Cognitive Assessment (MoCA-S7; n = 127), and the Star Cancellation Test (SCT; n = 151). These tests and side of lesion (n = 143) were used to examine construct validity. The predictive validity was evaluated in relation to falls during the following 6 months (n = 203).RESULTSThe intraclass correlation coefficients for intrarater and interrater reliability were 0.88-0.98. For validity, there were significant correlations between the CEW and FAC (rs = -0.67), TUG (rs = 0.45), MoCA-S7 (rs = -0.36), and SCT total score (rs = -0.36). There was a significant correlation between the number of cones touched on the left side and the proportion of cancelled stars on the left (rs = -0.23) and right (rs = 0.23) side in the SCT. Among right hemisphere stroke participants (n = 79), significantly more persons hit cones on the left side (n = 25) than the right side (n = 8), whereas among those with a left hemisphere stroke (n = 64) significantly more persons hit cones on the right side (n = 11) than the left (n = 3). Cox regression showed that participants who touched four to eight cones had an increased risk of falls over time (hazard ratio 2.11, 95% CI [1.07, 4.17]) compared with those who touched none.
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| 39. |
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| 40. |
- Treleaven, Julia, et al.
(author)
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Balance, dizziness and proprioception in patients with chronic whiplash associated disorders complaining of dizziness : A prospective randomized study comparing three exercise programs
- 2016
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In: Manual Therapy. - : Elsevier BV. - 1356-689X .- 1532-2769. ; 22, s. 122-130
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Journal article (peer-reviewed)abstract
- Background: Dizziness and unsteadiness are common symptoms following a whiplash injury. Objective: To compare the effect of 3 exercise programs on balance, dizziness, proprioception and pain in patients with chronic whiplash complaining of dizziness.Design: A sub-analysis of a randomized study.Methods: One hundred and forty subjects were randomized to either a physiotherapist-guided neck-specific exercise (NSE), physiotherapist-guided neck-specific exercise, with a behavioural approach (NSEB) or prescription of general physical activity (PPA) group. Pre intervention, 3, 6 and 12 months post baseline they completed the University of California Los Angeles Dizziness Questionnaire (UCLA-DQ), Visual Analogue Scales (VAS) for, dizziness at rest and during activity and physical measures (static and dynamic clinical balance tests and head repositioning accuracy (HRA)).Results: There were significant time by group differences with respect to dizziness during activity and UCLA-Q favouring the physiotherapy led neck specific exercise group with a behavioural approach. Within group analysis of changes over time also revealed significant changes in most variables apart from static balance. Conclusion: Between and within group comparisons suggest that physiotherapist led neck exercise groups including a behavioural approach had advantages in improving measures of dizziness compared with the general physical activity group, although many still complained of dizziness and balance impairment. Future studies should consider exercises specifically designed to address balance, dizziness and cervical proprioception in those with persistent whiplash.
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| 41. |
- Ånfors, Samuel, et al.
(author)
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Test-retest reliability of physical activity questionnaires in Parkinson’s disease
- 2021
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In: BMC Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 21:1
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Journal article (peer-reviewed)abstract
- Background: People with Parkinson’s disease are less physically active than controls. It is important to promote physical activity, which can be assessed using different methods. Subjective measures include physical activity questionnaires, which are easy and cheap to administer in clinical practice. Knowledge of the psychometric properties of physical activity questionnaires for people with Parkinson’s disease is limited. The aim of this study was to evaluate the test-retest reliability of physical activity questionnaires in individuals with Parkinson’s disease without cognitive impairment. Methods: Forty-nine individuals with Parkinson’s disease without cognitive impairment participated in a test-retest reliability study. At two outpatient visits 8 days apart, the participants completed comprehensive questionnaires and single-item questions: International Physical Activity Questionnaire-Short Form (IPAQ-SF), Physical Activity Scale for the Elderly (PASE), Saltin-Grimby Physical Activity Level Scale (SGPALS) and Health on Equal Terms (HOET). Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), limits of agreement, weighted kappa or the Svensson method. Results: Several of the physical activity questionnaires had relatively low test-retest reliability, including the comprehensive questionnaires (IPAQ-SF and PASE). Total physical activity according to IPAQ-SF had an ICC value of 0.46 (95% confidence interval [CI], 0.21–0.66) and SEM was 2891 MET-min/week. The PASE total score had an ICC value of 0.66 (95% CI, 0.46–0.79), whereas the SEM was 30 points. The single-item scales of SGPALS-past six months (SGPALS-6 m) and HOET question 1 (HOET-q1) with longer time frames (6 or 12 months, respectively) showed better results. Weighted kappa values were 0.64 (95% CI, 0.45–0.83) for SGPALS-6 m and 0.60 (95% CI, 0.39–0.80) for HOET-q1, whereas the single-item questions with a shorter recall period had kappa values < 0.40. Conclusions: Single-item questions with a longer time frame (6 or 12 months) for physical activity were shown to be more reliable than multi-item questionnaires such as the IPAQ-SF and PASE in individuals with Parkinson’s disease without cognitive impairments. There is a need to develop a core outcome set to measure physical activity in people with Parkinson’s disease, and there might be a need to develop new physical activity questionnaires.
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