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1.
  • Otten, Julia, 1973-, et al. (author)
  • Benefits of a Paleolithic diet with and without supervised exercise on fat mass, insulin sensitivity, and glycemic control : a randomized controlled trial in individuals with type 2 diabetes
  • 2017
  • In: Diabetes/Metabolism Research Reviews. - : Wiley. - 1520-7552 .- 1520-7560. ; 33:1
  • Journal article (peer-reviewed)abstract
    • BackgroundMeans to reduce future risk for cardiovascular disease in subjects with type 2 diabetes are urgently needed.MethodsThirty-two patients with type 2 diabetes (age 59 ± 8 years) followed a Paleolithic diet for 12 weeks. Participants were randomized to either standard care exercise recommendations (PD) or 1-h supervised exercise sessions (aerobic exercise and resistance training) three times per week (PD-EX).ResultsFor the within group analyses, fat mass decreased by 5.7 kg (IQR: −6.6, −4.1; p < 0.001) in the PD group and by 6.7 kg (−8.2, −5.3; p < 0.001) in the PD-EX group. Insulin sensitivity (HOMA-IR) improved by 45% in the PD (p < 0.001) and PD-EX (p < 0.001) groups. HbA1c decreased by 0.9% (−1.2, −0.6; p < 0.001) in the PD group and 1.1% (−1.7, −0.7; p < 0.01) in the PD-EX group. Leptin decreased by 62% (p < 0.001) in the PD group and 42% (p < 0.001) in the PD-EX group. Maximum oxygen uptake increased by 0.2 L/min (0.0, 0.3) in the PD-EX group, and remained unchanged in the PD group (p < 0.01 for the difference between intervention groups). Male participants decreased lean mass by 2.6 kg (−3.6, −1.3) in the PD group and by 1.2 kg (−1.3, 1.0) in the PD-EX group (p < 0.05 for the difference between intervention groups).ConclusionsA Paleolithic diet improves fat mass and metabolic balance including insulin sensitivity, glycemic control, and leptin in subjects with type 2 diabetes. Supervised exercise training may not enhance the effects on these outcomes, but preserves lean mass in men and increases cardiovascular fitness.
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  • Arnadottir, Solveig A, 1968-, et al. (author)
  • Application of rasch analysis to examine psychometric aspects of the activities-specific balance confidence scale when used in a new cultural context
  • 2010
  • In: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993 .- 1532-821X. ; 91:1, s. 156-163
  • Journal article (peer-reviewed)abstract
    • Arnadottir SA, Lundin-Olsson L, Gunnarsdottir ED, Fisher AG. Application of Rasch analysis to examine psychometric aspects of the Activities-Specific Balance Confidence Scale when used in a new cultural context. OBJECTIVE: To investigate by using Rasch analysis the psychometric properties of the Activities-Specific Balance Confidence (ABC) Scale when applied in a new Icelandic context. DESIGN: Cross-sectional, population-based, random selection from the Icelandic National Registry. SETTING: Community-based. PARTICIPANTS: Icelanders (N=183), 65 to 88 years old, and 48% women. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: ABC, an instrument used to evaluate how confident older people are in maintaining balance and remaining steady when moving through the environment. An Icelandic translation of the ABC (ABC-ICE) scale was evaluated by implementing Rasch rating scale analysis to transform ordinal ABC-ICE scores into interval measures and evaluating aspects of validity and reliability of the scale. RESULTS: Participants were not able to differentiate reliably between the 11 rating scale categories of the ABC-ICE. Additionally, 3 items failed to show acceptable goodness of fit to the ABC-ICE rating scale model. By collapsing categories and creating a new 5-category scale, only 1 item misfit. Removing that item resulted in a modified version of ABC-ICE with 5 categories and 15 items. Both item goodness-of-fit statistics and principal components analysis supported unidimensionality of the modified ABC-ICE. The ABC-ICE measures reliably separated the sample into at least 4 statistically distinct strata of balance confidence. Finally, the hierarchical order of item difficulties was consistent with theoretic expectations, and the items were reasonably well targeted to the balance confidence of the persons tested. CONCLUSIONS: Rasch analysis indicated a need to modify the ABC-ICE to improve its psychometric properties. Further studies are needed to determine if similar analyses of other versions of the ABC, including the original one, will yield similar results.
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  • Arnadottir, Solveig A, 1968-, et al. (author)
  • Are rural older Icelanders less physically active than those living in urban areas? : a population-based study
  • 2009
  • In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 37:4, s. 409-417
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Older people in rural areas have been labelled as physically inactive on the basis of leisure-time physical activity research. However, more research is needed to understand the total physical activity pattern in older adults, considering all domains of physical activity, including leisure, work, and domestic life. AIMS: We hypothesised that: (a) total physical activity would be the same for older people in urban and rural areas; and (b) urban and rural residency, along with gender and age, would be associated with differences in domain-specific physical activities. METHODS: Cross-sectional data were collected in Icelandic rural and urban communities from June through to September 2004. Participants were randomly selected, community-dwelling, 65-88 years old, and comprised 68 rural (40% females) and 118 urban (53% females) adults. The Physical Activity Scale for the Elderly (PASE) was used to obtain a total physical activity score and subscores in leisure, during domestic life, and at work. RESULTS: The total PASE score was not associated with rural vs. urban residency, but males were, in total, more physically active than females, and the 65-74-year-olds were more active than the 75-88-year-olds. In the leisure domain, rural people had lower physical activity scores than urban people. Rural males were, however, most likely of all to be physically active in the work domain. In both urban and rural areas, the majority of the physical activity behaviour occurred in relation to housework, with the rural females receiving the highest scores. CONCLUSIONS: Older Icelanders in rural areas should not be labelled as less physically active than those who live in urban areas. Urban vs. rural living may, however, influence the physical activity patterns among older people, even within a fairly socioeconomically and culturally homogeneous country such as Iceland. This reinforces the need to pay closer attention to the living environment when studying and developing strategies to promote physical activity.
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  • Arnadottir, Solveig A, et al. (author)
  • Determinants of self-rated health in old age : a population-based, cross-sectional study using the international classification of functioning
  • 2011
  • In: BMC Public Health. - London : BioMed Central. - 1471-2458. ; 11, s. 670-
  • Journal article (peer-reviewed)abstract
    • Background: Self-rated health (SRH) is a widely used indicator of general health and multiple studies have supported the predictive validity of SRH in older populations concerning future health, functional decline, disability, and mortality. The aim of this study was to use the theoretical framework of the International Classification of Functioning, Disability and Health (ICF) to create a better understanding of factors associated with SRH among community-dwelling older people in urban and rural areas.Methods: The study design was population-based and cross-sectional. Participants were 185 Icelanders, randomly selected from a national registry, community-dwelling, 65-88 years old, 63% urban residents, and 52% men. Participants were asked: "In general, would you say your health is excellent, very good, good, fair, or poor?" Associations with SRH were analyzed with ordinal logistic regression. Explanatory variables represented aspects of body functions, activities, participation, environmental factors and personal factors components of the ICF.Results: Univariate analysis revealed that SRH was significantly associated with all analyzed ICF components through 16 out of 18 explanatory variables. Multivariate analysis, however, demonstrated that SRH had an independent association with five variables representing ICF body functions, activities, and personal factors components: The likelihood of a better SRH increased with advanced lower extremity capacity (adjusted odds ratio [adjOR] = 1.05, p < 0.001), upper extremity capacity (adjOR = 1.13, p = 0.040), household physical activity (adjOR = 1.01, p = 0.016), and older age (adjOR = 1.09, p = 0.006); but decreased with more depressive symptoms (adjOR = 0.79, p < 0.001).Conclusions: The results highlight a collection of ICF body functions, activities and personal factors associated with higher SRH among community-dwelling older people. Some of these, such as physical capacity, depressive symptoms, and habitual physical activity are of particular interest due to their potential for change through public health interventions. The use of ICF conceptual framework and widely accepted standardized assessments should make these results comparable and relevant in an international context.
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  • Arnadottir, Solveig A, 1968-, et al. (author)
  • Participation frequency and perceived participation restrictions at older age : applying the International Classification of Functioning, Disability and Health (ICF) framework
  • 2011
  • In: Disability and Rehabilitation. - : Informa Healthcare. - 0963-8288 .- 1464-5165. ; 33:23-24, s. 2208-2216
  • Journal article (peer-reviewed)abstract
    • Purpose: To identify variables from different components of International Classification of Functioning, Disability and Health (ICF) associated with older people's participation frequency and perceived participation restrictions. Method: Participants (N = 186) were community-living, 65-88 years old and 52% men. The dependent variables, participation frequency (linear regression) and perceived participation restrictions (logistic regression), were measured using The Late-Life Function and Disability Instrument. Independent variables were selected from various ICF components. Results: Higher participation frequency was associated with living in urban rather than rural community (beta = 2.8, p < 0.001), physically active lifestyle (beta = 4.6, p < 0.001) and higher cognitive function (beta = 0.3, p = 0.009). Lower participation frequency was associated with being older (beta = -0.2, p = 0.002) and depressive symptoms (beta = -0.2, p = 0.029). Older adults living in urban areas, having more advanced lower extremities capacity, or that were employed had higher odds of less perceived participation restrictions (adjusted odds ratio [OR] = 5.5, p = 0.001; OR = 1.09, p < 0.001; OR = 3.7, p = 0.011; respectively). In contrast, the odds of less perceived participation restriction decreased as depressive symptoms increased (OR = 0.8, p = 0.011). Conclusions: Our results highlight the importance of capturing and understanding both frequency and restriction aspects of older persons' participation. ICF may be a helpful reference to map factors associated with participation and to study further potentially modifiable influencing factors such as depressive symptoms and advanced lower extremity capacity.
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  • Arnadottir, Solveig, 1968- (author)
  • Physical activity, participation and self-rated health among older community-dwelling Icelanders : a population-based study
  • 2010
  • Doctoral thesis (other academic/artistic)abstract
    • Background: The main objective of this study was to investigate older people’s physical activity, their participation in various life situations, and their perceptions of their own health. This included an exploration of potential influences of urban versus rural residency on these outcomes, an evaluation of the measurement properties of a balance confidence scale, and an examination of the proposed usefulness of the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework to facilitate analysis and understanding of selected outcomes.Methods: The study design was cross-sectional, population-based, with random selection from the national register of one urban and two rural municipalities in Northern Iceland. There were 186 participants, all community-dwelling, aged 65 to 88 years (mean = 73.8), and 48% of the group were women. The participation rate was 79%. Data was collected in 2004, in face-to-face interviews and through various standardized assessments. The main outcomes were total physical activity; leisure-time, household, and work-related physical activity; participation frequency and perceived participation restrictions; and self-rated health. Other assessments represented aspects of the ICF body functions, activities, environmental factors and personal factors. Moreover, Rasch analysis methods were applied to examine and modify the Activities-specific Balance Confidence (ABC) scale and the ICF used as a conceptual framework throughout the study.Results: The total physical activity score was the same for urban and rural people and the largest proportion of the total physical activity behavior was derived from the household domain. Rural females received the highest scores of all in household physical activity and rural males were more physically active than the others in the work-related domain. However, leisure-time physical activity was more common in urban than rural communities. A physically active lifestyle, urban living, a higher level of cognition, younger age, and fewer depressive symptoms were all associated with more frequent participation. Rural living and depressive symptoms were associated with perceived participation restrictions. Moreover, perceived participation restrictions were associated with not being employed and limitations in advanced lower extremity capacity. Both fewer depressive symptoms and advanced lower extremity capacity also increased the likelihood of better self-rated health, as did capacity in upper extremities, older age, and household physical activity. Rasch rating scale analysis indicated a need to modify the ABC to improve its psychometric properties. The modified ABC was then used to measure balance confidence which, however, was found not to play a major role in explaining participation or self-rated health. Finally, the ICF was useful as a conceptual framework for mapping various components of functioning and health and to facilitate analyses of their relationships.Conclusions: The results highlighted the commonalities and differences in factors associated with participation frequency, perceived participation restrictions, and self-rated health in old age. Some of these factors, such as advanced lower extremity capacity, depressive symptoms, and physical activity pattern should be of particular interest for geriatric physical therapy due to their potential for interventions. While the associations between depressive symptoms, participation, and self-rated health are well known, research is needed on the effects of advanced lower extremity capacity on participation and self-rated health in old age. The environment (urban versus rural) also presented itself as an important contextual variable to be aware of when working with older people’s participation and physically active life-style. Greater emphasis should be placed on using Rasch measurement methods for improving the availability of quality scientific measures to evaluate various aspects of functioning and health among older adults. Finally, a coordinated implementation of a conceptual framework such as ICF may further advance interdisciplinary and international studies on aging, functioning, and health.
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  • Bajraktari, Saranda, et al. (author)
  • Reaching older people with a digital fall prevention intervention in a Swedish municipality context : an observational study
  • 2022
  • In: Frontiers In Public Health. - : Frontiers Media S.A.. - 2296-2565. ; 10
  • Journal article (peer-reviewed)abstract
    • Background: There is robust evidence that falls in old age can be prevented by exercise programs that include balance training, functional exercises, and strength training. For the interventions to have a population health impact, outreach to the population of focus with suitable interventions is needed. While digital interventions are promising there is limited knowledge on the characteristics of who is reached. The aim of this study was to describe the recruitment process, estimate reach rate at the population level and to describe participants characteristics and representativeness in a digital fall prevention intervention study.Methods: In a municipality-based observational study, reach of a digital fall prevention intervention was evaluated. The intervention included a digital exercise programme (Safe Step) and optional supportive strategies, complemented with a range of recruitment strategies to optimize reach. Recruitment during a period of 6 months was open to people 70 years or older who had experienced a fall or a decline in balance the past year. Reach was based on data from the baseline questionnaire including health and demographic characteristics of participants. Representativeness was estimated by comparing participants to a sample of older people from the Swedish National Public Health Survey.Results: The recruitment rate was 4.7% (n = 173) in relation to the estimated population of focus (n = 3,706). Most participants signed up within the first month of the intervention (n = 131). The intervention attracted primarily women, older people with high education, individuals who used the internet or digital applications almost every day and those perceiving their balance as fair or poor. Safe step participants lived more commonly alone and had higher education and better walking ability in comparison to the Swedish National Public Health Survey.Conclusions: With a range of recruitment strategies most participants were recruited to a digital fall intervention during the first month. The intervention attracted primarily highly educated women who frequently used the internet or smart technologies. In addition to digital fall prevention interventions, a higher diversity of intervention types (digital and non-digital) is more likely to reach a larger group of older people with different needs.
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  • Berglund, Lars, 1986- (author)
  • Deadlift training for patients with mechanical low back pain : a comparison of the effects of a high-load lifting exercise and individualized low-load motor control exercises
  • 2016
  • Doctoral thesis (other academic/artistic)abstract
    • Disability due to low back pain is common. While evidence exist that exercise is effective in reducing pain and disability, it is still largely undetermined which kind of exercises that are most effective. The overall aim of this thesis was to evaluate and compare the effects of a high-load lifting exercise and individualized low-load motor control exercises for patients with nociceptive mechanical low back pain. A secondary aim was to evaluate which patients benefit from training with a high-load lifting exercise.All four papers in this thesis were based on a randomized controlled trial including 70 participants with nociceptive mechanical low back pain as their dominating pain pattern. Participants were randomized into training with either a high-load lifting exercise (HLL), the deadlift, (n=35) or individualized low-load motor control exercises (LMC) (n=35). Both interventions included aspects of pain education. All participants were offered twelve sessions during an eight week period. The effects of the interventions were evaluated directly after and twelve months after the end of the intervention period. Outcome measures were pain intensity, activity, disability, physical performance, lumbo-pelvic alignment and lumbar multifidus muscle thickness.There was a significant between-group effect in favour of the LMC intervention regarding improvements in activity, movement control tests and some tests of trunk muscle endurance. For pain intensity there were no significant differences between groups. A majority of participants in both intervention groups showed clinically meaningful improvements from baseline to two and twelve month follow-up regarding pain intensity and activity. There were no significant differences between HLL and LMC regarding the effect on lumbo-pelvic alignment or lumbar multifidus thickness. The participants who benefit the most from the HLL intervention were those with a low pain intensity and high performance in the Biering-Sørensen test at baseline.The results of this thesis showed that the HLL intervention was not more effective than the LMC intervention. The LMC was in fact more effective in improving activity, performance in movement control tests and some tests of trunk muscle endurance, compared to the HLL intervention.The results imply that the deadlift, when combined with education, could be considered as an exercise to produce clinically relevant improvements on pain intensity in patients who prefer a high-load exercise. However, before considering deadlift training, the results suggest that pain intensity and performance in the Biering-Sørensen test should be evaluated.
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  • Bråndal, Anna, 1966- (author)
  • Rehabilitation after stroke with focus on early supported discharge and post-stroke fatigue
  • 2016
  • Doctoral thesis (other academic/artistic)abstract
    • Background Stroke is a major cause of disability worldwide. After treatment in a specialized stroke unit, early supported discharge (ESD) followed by home rehabilitation has shown to be an effective way to improve patient outcome and quality of care for persons with mild to moderate stroke. ESD service is recommended in the national and international guidelines for stroke care, but has only partially been implemented in Sweden. Following stroke, fatigue is a common consequence that often becomes more evident when the patient comes home. Currently, there is insufficient evidence about how to measure, treat and handle post-stroke fatigue. The overall aim of this thesis was to evaluate and implement early supported discharge (ESD) based on stroke patients experience after discharge from the stroke unit and local conditions. The aim was also to evaluate post-stroke fatigue with a potentially valid and reliable scale and finally to prepare for a study to evaluate cardiorespiratory training as a part of ESD service for patients with post-stroke fatigue.Methods In paper I, nine strategically chosen patients were interviewed of their experience of falling ill, the hospital stay, discharge, contact with health care after discharge and their request of support. Papers II-III describe and evaluate the development, content, implementation and effects of a locally adopted method for early supported discharge (Umeå Stroke Center ESD) in modern stroke care. Paper II included 153 consecutive patients and paper III, 30 232 patients with first-ever stroke registered in the Riksstroke registry in Sweden. Paper II evaluated number of patients/year, clinical and functional health status, satisfaction in relation to needs, accidental falls/other injuries and resources with the result summarized in a value compass. The implementation process was evaluated retrospectively by means of Consolidated Framework for Implementation (CFIR). Paper III evaluated patient reported outcome measurements (PROMs) at 3 months. The primary outcome in paper III was satisfaction with the rehabilitation after discharge. Secondary outcomes were information about stroke provided, tiredness/fatigue, pain, dysthymia/depression, general health status and dependence in activities of daily living (mobility, toilet hygiene and dressing). Multivariable logistic regression models for each PROM was used to analyze associations between PROMs and ESD/no ESD. In Paper IV, the Fatigue Assessment scale (FAS) was translated into Swedish and evaluated regarding psychometric properties when self-administered by persons with mild to moderate stroke. 72 consecutively patients selected from the stroke unit admission register received a letter including three questionnaires: the FAS, the Short Form Health Survey (SF-36) subscale for vitality and the Geriatric Depression Scale GDS-15. A second letter with FAS was sent within 2 weeks, for re-test evaluation. Paper V is a study protocol for a planned randomized controlled trial (RCT) of 50 consecutive stroke patients will who receive stroke unit care followed by ESD-service at Umeå Stroke Center, University Hospital, Umeå, Sweden. Paper V will investigate if a structured cardiorespiratory interval training program (CITP) added to the ESD-service may result in relieved post-stroke fatigue and increased oxygen uptake.Results The interviews in Paper I revealed three main categories with subcategories: “Responsible and implicated”, “Depersonalized object for caring measures” and “The striving for repersonalization and autonomy”. The findings indicate that coming home gave the informants’ important insights and understanding of the stroke, its consequences and was also an important factor for the recovery. Paper II-III showed that it is possible to develop and implement an adapted ESD service for stroke patients based on the patients’ experiences and requests, evidence-based recommendations and local conditions. The ESD service reduced dependence of activity, increased mobility with seemingly no increased risk of accidental falls or other injuries. The patient satisfaction in relation to needs regarding the ESD was high. Paper III showed that patients that received ESD were more satisfied with rehabilitation after discharge, had less need for assistance with ADL and less dysthymia/depression compared to patients that did not receive ESD. Study IV showed that the Swedish FAS used at home as a selfadministered questionnaire is a reliable and valid questionnaire for measuring fatigue in persons with mild to moderate stroke. The internal consistency was good, the agreement between the test and retest reliability for individual items (weighted kappa) was for the majority of items good or moderate. The relative reliability for total scores was good and the absolute reliability was 9 points. The Swedish FAS had no floor nor ceiling effects and correlated both with the SF-36, subscale for vitality and the GDS-15 indicating convergent construct validity, but not divergent construct validity.Conclusion It is possible to develop and implement ESD care for stroke patients based on patients’ experience and needs, evidence-based principles and local conditions. Early supported discharge (ESD) in the setting of modern stroke unit care appears to have positive effects on rehabilitation in the subacute phase. The Swedish FAS used at home as a self-administered questionnaire is reliable and valid for measuring fatigue in persons with mild to moderate stroke.
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  • Bråndal, Anna, 1966-, et al. (author)
  • Reliability and validity of the Swedish Fatigue Assessment Scale when self-administrered by persons with mild to moderate stroke
  • 2016
  • In: Topics in Stroke Rehabilitation. - : Informa UK Limited. - 1074-9357 .- 1945-5119. ; 23:2, s. 90-97
  • Journal article (peer-reviewed)abstract
    • Objective: To examine internal consistency, test-retest reliability, floor/ceiling effects and construct validity of the Fatigue Assessment Scale (FAS), when self-administrated by persons with mild to moderate stroke.Method: The FAS was translated into Swedish and tested for psychometric properties when self-administrated by persons with mild to moderate stroke. Participants, consequently selected from the stroke unit admission register received a letter with three questionnaires: the FAS, Short Form Health Survey (SF-36) subscale for vitality and Geriatric Depression Scale, GDS-15. Within two weeks, a second letter with FAS was sent for re-test.Result: Seventy-tree persons with mild to moderate stroke participated in the study. Internal consistency was good (Cronbach’s alpha 0.82). The test and retest reliability of individual items showed that five items out of 10 items were good (weighted kappa > 0.60), four were moderate (0.40-0.60), and one was fair (0.22). The relative reliability between total scores was good (ICC 3.1 = 0.73) and the absolute reliability was nine points, meaning that a change of at least nine points in total score implies a real change of fatigue level. Correlation analysis showed that the Swedish FAS correlated with the SF-36 subscale for vitality (rs = - 0.73) and GDS-15 (rs = 0.62), suggesting convergent construct validity. There were no floor or ceiling effects.Conclusion: The Swedish translation of the FAS used as a self-administrated questionnaire is reliable and valid for measuring fatigue in persons with mild to moderate stroke.
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  • Carlsson, Maine, 1955-, et al. (author)
  • Effects of high-intensity exercise and protein supplement on muscle mass in ADL dependent older people with and without malnutrition : a randomized controlled trial
  • 2011
  • In: The Journal of Nutrition, Health & Aging. - : Springer Science and Business Media LLC. - 1279-7707 .- 1760-4788. ; 15:7, s. 554-560
  • Journal article (peer-reviewed)abstract
    • Background  Loss of muscle mass is common among old people living in institutions but trials that evaluate interventions aimed at increasing the muscle mass are lacking. Objective, participants and intervention  This randomized controlled trial was performed to evaluate the effect of a high-intensity functional exercise program and a timed protein-enriched drink on muscle mass in 177 people aged 65 to 99 with severe physical or cognitive impairments, and living in residential care facilities. Design  Three-month high-intensity exercise was compared with a control activity and a protein-enriched drink was compared with a placebo drink. A bioelectrical impedance spectrometer (BIS) was used in the evaluation. The amount of muscle mass and body weight (BW) were followed-up at three and six months and analyzed in a 2 × 2 factorial ANCOVA, using the intention to treat principle, and controlling for baseline values. Results  At 3-month follow-up there were no differences in muscle mass and BW between the exercise and the control group or between the protein and the placebo group. No interaction effects were seen between the exercise and nutritional intervention. Long-term negative effects on muscle mass and BW was seen in the exercise group at the 6-month follow-up. Conclusion  A three month high-intensity functional exercise program did not increase the amount of muscle mass and an intake of a protein-enriched drink immediately after the exercise did not induce any additional effect on muscle mass. There were negative long-term effects on muscle mass and BW, indicating that it is probably necessary to compensate for an increased energy demand when offering a high-intensity exercise program.
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  • Conradsson, Mia, et al. (author)
  • The Berg Balance Scale : Intra-rater reliability in older people dependent in ADL and living in residential care facilities
  • 2006
  • Conference paper (other academic/artistic)abstract
    • Aim: The aim of this study was to investigate the absolute and the relative intra-rater reliability of the Berg Balance Scale (BBS) among older people who are dependent in activities of daily living (ADL) and living in residential care facilities.Methods: The participants were 45 older people, 36 females and 9 men, who were dependent in ADL and living in three residential care facilities. Their mean age ± SD was 82.3 ± 6.6 (range 68-96) and mean ± SD of Mini Mental State Examination score was 17.5 ± 6.3 (range 4-30). The BBS was assessed twice by the same assessor, at approximately the same time of day, and with 1-3 days in between. The absolute reliability for the difference in score between the two test occasions was calculated with the Bland and Altman analysis of variance with 95 % confidence level. The relative reliability was calculated with Intraclass Correlation Coefficient (ICC).Results: For the first test of the BBS, mean ± SD was 30.1 ± 15.9 (range 3-53) points and for the retest 30.6 ± 15.6 (range 4-54). The absolute difference between the two test occasions was in mean ± SD 2.8 ± 2.7 (range 0-11) points. The absolute intra-rater reliability was calculated to 7.7 points and the ICC value was 0.97. Conclusions: Despite a high ICC value, the result of the absolute reliability show that a change of 8 BBS points is required to reveal a genuine change of function among older people who are dependent in ADL and living in residential care facilities. This knowledge is important in the clinical setting when evaluating an individual's change in balance function over time.
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  • Dahlgren, Gunilla, et al. (author)
  • Reliabilitetstestning av den svenska versionen av Shoulder Rating Questionnaire, SRQ-S
  • 2002
  • In: Nordisk fysioterapi. - 1402-3024. ; 6, s. 134-143
  • Journal article (peer-reviewed)abstract
    • The aim of this study was to evaluatethe test-retest reliability of theSwedish version of the ShoulderRating Questionnaire - SRQ-S.This self-rating scale comprises21 questions, divided into sevenweighted domains concerninghealth, pain, daily activities, recreationaland athletic activities, work,satisfaction and areas for improvement.The Shoulder Rating Questionnairewas fi rst translated intoSwedish and slightly adapted. Itwas then sent twice to 38 patientswith clinically stable shoulder disordersat an Orthopaedic Clinicin Sweden. The majority of theanswers were identical or almostidentical on both occasions. Theagreement of the total score wasexcellent (both rs and ICC=0.97).All domains, except ‘recreationaland athletic activities’, also showedan excellent agreement (rs 0.90-0.97, ICC 0.88-0.97). Individualquestions resulted in a very highweighted Kappa value for sevenof the questions (0.81-1.0), elevenquestions with a substantial value(0.61-0.80) and three moderatevalues (0.41-0.60). We concludethat the questions posed wereeasily understood and answeredand that the SRQ–S is test-retestreliable. These qualities wouldmake it a useful instrument for theassessment of the outcome of treatmentof shoulder disorders.
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  • Eriksson, Staffan, et al. (author)
  • Circumstances surrounding falls in patients with dementia in a psychogeriatric ward
  • 2009
  • In: Archives of gerontology and geriatrics (Print). - : Elsevier BV. - 0167-4943 .- 1872-6976. ; 49:1, s. 80-87
  • Journal article (peer-reviewed)abstract
    • People with dementia have an increased risk of falling. Predisposing factors explain only a small part of the variation in falls among people with dementia. The purpose of this study was to explore circumstances that are hazardous regarding falls among people with dementia at a psychogeriatric ward. The study comprised 191 participants of whom seventy-five fell a total of 229 times. Prospective data were collected on falls. Hazardous circumstances were calculated in two ways. Firstly possible differences between day/night falls and women/men falls were calculated based on the 229 falls. Secondly time to first fall was used to estimate hazardous circumstances and was based on 75 falls. This study shows a fall rate that was equally high during the night and the day. The proportion of diurnal rhythm disturbances and activity disturbances was higher for falls at night than for falls during the day. Circumstances associated with an increased risk of falls, as shown by a short time to first fall, were anxiety, darkness, not wearing any shoes and, for women, urinary tract infection. All of these are circumstances that should be considered in future fall-related research among people with dementia.
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  • Eriksson, Staffan, et al. (author)
  • Comparison of three statistical methods for analysis of fall predictors in people with dementia : negative binomial regression (NBR), regression tree (RT), and partial least squares regression (PLSR)
  • 2009
  • In: Archives of gerontology and geriatrics (Print). - : Elsevier BV. - 0167-4943 .- 1872-6976. ; 49:3, s. 383-389
  • Journal article (peer-reviewed)abstract
    • Searching for background factors associated with falls in people with dementia is difficult because the population is heterogeneous. The aim of this study was to compare the efficacies of three statistical methods for analysis of fall predictors in people with dementia. NBR, RT and PLSR analyses were compared. Data used for the comparison were from a prospective cohort study of 192 patients at a psychogeriatric ward, specializing in patients with cognitive impairment and related behavioral and psychological symptoms. Seventy-eight of these patients fell a total of 238 times. PLSR and RT analyses are directed at finding patterns among predictor variables related to outcome, whereas an NBR model is directed at finding predictor variables that, independent of other variables, are related to the outcome. The NBR analysis explained an additional 10–15% variation compared with the PLSR and RT analyses. The results of PLSR and RT show a similar plausible pattern of predictor variables. However, none of these techniques appears to be sufficient in itself. In order to gain patterns of explanatory variables, RT would be a good complement to NBR for analysis of fall predictors.
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24.
  • Eriksson, Staffan, 1969- (author)
  • Falls in people with dementia
  • 2007
  • Doctoral thesis (other academic/artistic)abstract
    • Falls and concomitant injuries are common problems among large groups of the elderly population, leading to immobility and mortality. These problems are even more pronounced among people suffering from dementia. This thesis targets fall risk factors for people with dementia in institutions. The overall aim of this thesis was to investigate risk factors for falls, predisposing as well as related to circumstances surrounding falls, and to do this as efficiently as possible. In a prospective cohort study including residents of residential care facilities with and without dementia, the fall rate was higher for those with dementia, the crude incidence rate ratio (IRR) was 2.55 (95% CI 1.60–4.08) and the adjusted IRR was 3.79 (95% CI 1.95–7.36). In the group of people suffering from dementia, including 103 residents, a total of 197 falls resulted in 11 fractures during the 6-months follow-up period. From the same baseline measurements 26% and 55%, respectively, of the variation in falls could be explained in the group of residents with and without dementia. Fall predictors significantly and independently associated with an increased risk of falls in the group of people suffering from dementia were the category “man walking with an aid” and the use of more than four drugs. In a prospective cohort study, including 204 patients in a psychogeriatric ward, a total of 244 falls resulted in 14 fractures. Fall predictors significantly and independently associated with an increased risk of falls were male sex, failure to copy a design, use of clomethiazole, and walking difficulties. Treatment with statins was associated with a reduced risk of falls. With these fall predictors in the negative binomial regression (Nbreg) model, 48% of the variation in falls was explained. The data from the psychogeriatric ward were also analysed with the use of partial least squares regression (PLS) and regression tree to be compared with the results of the Nbreg analysis. PLS and regression tree are techniques based on combinations of variables. They both showed similar patterns, that a combination of a more severe level of dementia, behavioral complications and medication related to these complications is associated with an increased fall rate. Thirty-two percent and 38%, respectively, of the variation in fall rate were explained in the PLS and regression tree analysis. The circumstances surrounding the falls in the psychogeriatric ward were analysed. It was found that the fall rate was equally high during the night and the day. A large proportion of the falls was sustained in the patients’ own room and a small proportion of the falls was witnessed by the staff. This pattern was even more pronounced during the night. The proportion of diurnal rhythm disturbances and activity disturbances was higher for falls at night than for falls during the day. Circumstances associated with an increased risk of falls, as shown by a short time to first fall, were anxiety, darkness, not wearing any shoes and, for women, urinary tract infection. The proportion of urinary tract infection was also higher in connection to falls sustained by women than to falls sustained by men. This thesis confirms that people suffering from dementia are prone to fall. Walking difficulties, male sex and impaired visual perception are factors that should be considered in the work of reducing falls among people suffering from dementia. Furthermore, falls at night, behavioral complications and medication related to these complications should also be considered in this work, especially as the dementia disease progresses. A larger portion of the variation of the outcome variable was explained by the Nbreg model than the regression tree and PLS. However, these statistical methods, based on combinations of variables, gave a complementary perspective on how the fall predictors were related to falls.
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25.
  • Eriksson, Staffan, et al. (author)
  • Risk factors for falls in people with and without a diagnosis of dementia living in residential care facilities : a prospective study
  • 2008
  • In: Archives of gerontology and geriatrics (Print). - : Elsevier BV. - 0167-4943 .- 1872-6976. ; 46:3, s. 293-306
  • Journal article (peer-reviewed)abstract
    • People with dementia are at increased risk of falling. The purpose of this study was to identify predisposing risk factors for falls in older people with and without a diagnose of dementia living in residential care facilities, and to compare the results. Eighty-three residents without dementia (mean age ± S.D.; 83.5 ± 7.1 years) and 103 with dementia (83.6 ± 6.3 years) in Umeå, Sweden, participated. The baseline assessment included probable risk factors like walking ability, diagnoses and treatment with drugs. The follow-up period was 6 months. In people with dementia, the fall rate was higher (crude incidence rate ratio 2.55, 95% CI 1.60–4.08) and a larger proportion experienced falls (62% versus 41%). In the group without dementia 54.8% of the variation in falls was explained by a model including orthostatism, “women walking with aid”, and treatment with Angiotensin Converting Enzyme (ACE) inhibitors. In the group with dementia 25.5% of the variation in falls was explained by a model including “man walking with aid”. Our results show that with the same set of common risk factors for falls a considerably lower proportion of the variation in falls can be explained in the group of people with dementia.
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26.
  • Fjellman-Wiklund, Anncristine, et al. (author)
  • Reach the Person behind the Dementia Physical Therapists' Reflections and Strategies when Composing Physical Training
  • 2016
  • In: PLOS ONE. - : Public library science. - 1932-6203. ; 11:12
  • Journal article (peer-reviewed)abstract
    • Dementia is a disease characterized by cognitive impairment and physical decline that worsens over time. Exercise is one lifestyle factor that has been identified as a potential means of reducing or delaying progression of the symptoms of dementia, maximizing function and independence. The purpose of this study was to explore physical therapists' (PTs) experiences and reflections on facilitating high-intensity functional exercise with older people living with dementia, in residential care home settings. The study used a qualitative design based on interviews, individually or in small groups, with seven PTs engaged as leaders in the training of older people with dementia. The interviews were analyzed with a modified Grounded Theory method with focus on constant comparisons. To increase trustworthiness the study used triangulation within investigators and member checking. The core category "Discover and act in the moment-learn over time" reflects how the PTs continuously developed their own learning in an iterative process. They built on previous knowledge to communicate with residents and staff and to tailor the high intensity training in relation to each individual at that time point. The category "Be on your toes" highlights how the PTs searched for sufficient information about each individual, before and during training, by eliciting the person's current status from staff and by interpreting the person's body language. The category "Build a bond with a palette of strategies" describes the importance of confirmation to build up trust and the use of group members and the room to create an interplay between exercise and social interaction. These findings highlight the continuous iterative process of building on existing knowledge, sharing and reflecting, being alert to any alterations needed for individuals that day, communication skills (both with residents and staff) and building a relationship and trust with residents in the effective delivery of high intensity functional exercise to older people living with dementia in care settings.
  •  
27.
  • Hasselgren, Lotta, et al. (author)
  • Is leg muscle strength correlated with functional balance and mobility among inpatients in geriatric rehabilitation?
  • 2011
  • In: Archives of gerontology and geriatrics (Print). - : Elsevier BV. - 0167-4943 .- 1872-6976. ; 52:3, s. E220-E225
  • Journal article (peer-reviewed)abstract
    • Determinants of previous termfunctional balance and mobilitynext term have rarely been investigated in geriatric wards. This study examined if leg muscle previous termstrengthnext term correlates to previous termfunctional balance and mobilitynext term among geriatric inpatients. Fifty inpatients, 29 women and 21 men (mean age 79.6 years) were included. previous termFunctional balancenext term was assessed with the Berg previous termBalancenext term Scale (BBS) and previous termmobilitynext term was assessed with the Physiotherapy Clinical Outcome Variable Scale (COVS). previous termStrengthnext term in the leg extension muscles was measured as 1 Repetition Maximum (1RM) in a leg press and previous termstrengthnext term in the ankle muscles was measured with Medical Research Council grades (MRC, 0–5). The sum scores, and most of the single items, of the BBS and the COVS significantly previous termcorrelatednext term to 1RM/body weight, ankle dorsiflexion, and plantar flexion. In a stepwise multiple regression, ankle dorsiflexion and 1RM/body weight together accounted for 39% of the variance of the BBS and 41% of the variance of the COVS. Estimated values of the BBS and the COVS can be calculated from the equation. In clinical work, the knowledge about how leg muscle previous termstrengthnext term associates with previous termbalance and mobilitynext term may be useful in analyzing underlying causes of reduced previous termbalance and mobilitynext term function, and in planning rehabilitation programs.
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28.
  • Hellner, Britt Marie, et al. (author)
  • Systematiskt arbete för äldres säkerhet : om fall, trafikolyckor och bränder
  • 2007
  • Book (peer-reviewed)abstract
    • Äldre personer är överrepresenterade i nästan alla olyckor. Förutom stort personligt lidande för individen leder skadorna ofta till omfattande kostnader för samhället. Därför har Räddningsverket och IMS/Socialstyrelsen tilsammans med forskare vid Umeå Universitet, Karlstad Universitet, Krolinska Insitutet, FoU Välfärd Örebro samt Vägverket gemensamt sammaställt denna bok. Syftet är att inspirera och vägleda ett systematiskt arbete i samhället för att öka säkerheten och minska skadorna till följd av olyckor bland äldre. Boken riktar sig till verksamma inom vård och omsorg för äldre, tjänstemän och politiker på olika nivåer i samhället
  •  
29.
  •  
30.
  • Holmbom, Johannes, et al. (author)
  • Motivationsekvationen : att vägleda äldre personer till fysisk aktivitet
  • 2008
  • In: Fysioterapi. ; :5, s. 38-45
  • Journal article (other academic/artistic)abstract
    • Det finns ett tydligt samband mellan ökad ålder och minskande fysisk aktivitet, trots att aktiviteten ger hälsovinster för äldre personer på alla funktionsnivåer. Många äldre har kontakt med hälso- och sjukvården, vilket ger personalen en ypperlig möjlighet att påverka dem. För att vägleda äldre personer till fysisk aktivitet gäller det att finna faktorer som ökar motivationen och att identifiera barriärer. Motivationsekvationen, som presenteras här, är en modell som belyser sambandet mellan fyra faktorer: ”upplevd chans att lyckas” och ”upplevd betydelse av målet” i förhållande till ”upplevd kostnad” och ”benägenhet att bli stillasittande”. Samspelet mellan dem styr våra medvetna och omedvetna val när det gäller att påbörja och bibehålla olika beteenden. Faktorerna kan påverkas, direkt eller indirekt, och genom att öka de båda förstnämnda och minska de båda senare skapas hög motivation. Motivationsekvationen kan användas för att kartlägga patientens motivationsnivå. Tillsammans med det vägledande samtalet ger den möjlighet till individuellt skräddarsydda åtgärder.
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31.
  • Häggqvist, Beatrice, et al. (author)
  • "The balancing act". Licensed practical nurse experiences of falls and fall prevention : a qualitative study
  • 2012
  • In: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 12, s. 62-
  • Journal article (peer-reviewed)abstract
    • Background: Falls are common in old age and may have serious consequences. There are many strategies to predict and prevent falls from occurring in long-term care and hospitals. The aim of this study was to describe licensed practical nurse experiences of predicting and preventing further falls when working with patients who had experienced a fall-related fracture. Licensed practical nurses are the main caretakers that work most closely with the patients.Methods: A qualitative study of focus groups interviews and field observations was done. 15 licensed practical nurses from a rehabilitation ward and an acute ward in a hospital in northern Sweden were interviewed. Content was analyzed using qualitative content analysis.Results: The result of the licensed practical nurse thoughts and experiences about risk of falling and fall prevention work is represented in one theme, "the balancing act". The theme includes three categories: "the right to decide", "the constant watch", and "the ongoing negotiation" as well as nine subcategories. The analysis showed similarities and differences between rehabilitation and acute wards. At both wards it was a core strategy in the licensed practical nurse work to always be ready and to pay attention to patients' appearance and behavior. At the rehabilitation ward, it was an explicit working task to judge the patients' risk of falling and to be active to prevent falls. At the acute ward, the words "risk of falling" were not used and fall prevention were not discussed; instead the licensed practical nurses used for example "dizzy and pale". The results also indicated differences in components that facilitate workplace learning and knowledge transfer.Conclusions: Differences between the wards are most probably rooted in organizational differences. When it is expected by the leadership, licensed practical nurses can express patient risk of falling, share their observations with others, and take actions to prevent falls. The climate and the structure of the ward are essential if licensed practical nurses are to be encouraged to routinely consider risk of falling and implement risk reduction strategies.
  •  
32.
  • Hörnsten, Carl, et al. (author)
  • Measurement error of the Mini-Mental State Examination among individuals with dementia that reside in nursing homes
  • 2021
  • In: European Journal of Ageing. - : Springer. - 1613-9372 .- 1613-9380. ; 18:1, s. 109-115
  • Journal article (peer-reviewed)abstract
    • Few studies have investigated the measurement error of the Mini-Mental State Examination (MMSE) in the same unit of measurement, also known as absolute reliability. This measurement can help determine whether an observed score change for an individual is likely to represent true change. The aim of this study was to investigate the absolute reliability of the MMSE among individuals with dementia that reside in nursing homes. Among 88 participants, 19 (21.6%) were men, 35 (39.8%) had Alzheimer's disease, 35 (39.8%) had vascular dementia, and the mean age was 84.0 years (range 65-98). The participants were tested and retested with the MMSE within 1-6 days. Both tests were administered by the same assessor at the same time of day. The mean MMSE score was 13.7 (range 0-28). The absolute difference between MMSE scores varied from 0 to 6 points, and the differences did not correlate with the corresponding score means (p = 0.874). The smallest detectable change (SDC) between two measurements was 4.00. The SDC was independent of depression, impaired vision and hearing, delirium within the last week, dementia type and age. However, the SDC was 5.56 among men and 3.50 among women (p = 0.003). In conclusion, for individuals with dementia that reside in nursing homes, it seems like their MMSE score needs to change by four or more points between two measurements in order for their score change to be reliably higher than the measurement error.
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33.
  • Jensen, Jane, et al. (author)
  • Effects of a fall prevention program including exercise on mobility and falls in frail older people living in residential care facilities
  • 2004
  • In: Aging Clinical and Experimental Research. - 1594-0667 .- 1720-8319. ; 16:4, s. 283-92
  • Journal article (peer-reviewed)abstract
    • BACKGROUND AND AIMS: Impaired mobility is one of the strongest predictors for falls in older people. We hypothesized that exercise as part of a fall prevention program would have positive effects, both short- and long-term, on gait, balance and strength in older people at high risk of falling and with varying levels of cognition, residing in residential care facilities. A secondary hypothesis was that these effects would be associated with a reduced risk of falling. METHODS: 187 out of all residents living in 9 facilities, > or =65 years of age were at high risk of falling. The facilities were cluster-randomized to fall intervention or usual care. The intervention program comprised: education, environment, individually designed exercise, drug review, post-fall assessments, aids, and hip protectors. Data were adjusted for baseline performance and clustering. RESULTS: At 11 weeks, positive intervention effects were found on independent ambulation (FAC, p=0.026), maximum gait speed (p=0.002), and step height (> or =10 cm, p<0.001), but not significantly on the Berg Balance Scale. At 9 months (long-term outcome), 3 intervention and 15 control residents had lost the ability to walk (p=0.001). Independent ambulation and maximum gait speed were maintained in the intervention group but deteriorated in the control group (p=0.001). Residents with both higher and lower cognition benefited in most outcome measures. Noassociation was found between improved mobility and reduced risk of falling.CONCLUSIONS: Exercise, as part of a fall prevention program, appears to preserve the ability to walk, maintain gait speed, ambulate independently, and improve step height. Benefits were found in residents with both lower and higher cognitive impairment, but were not found to be associated with a reduced risk of falling
  •  
34.
  •  
35.
  • Jensen, Jane, et al. (author)
  • Fall and injury prevention in older people living in residential care facilities : A cluster randomized trial
  • 2002
  • In: Annals of Internal Medicine. - : American College of Physicians. - 0003-4819 .- 1539-3704. ; 136:10, s. 733-41
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Falls and resulting injuries are particularly common in older people living in residential care facilities, but knowledge about the prevention of falls is limited. OBJECTIVE: To investigate whether a multifactorial intervention program would reduce falls and fall-related injuries. DESIGN: A cluster randomized, controlled, nonblinded trial. SETTING: 9 residential care facilities located in a northern Swedish city. PATIENTS: 439 residents 65 years of age or older. INTERVENTION: An 11-week multidisciplinary program that included both general and resident-specific, tailored strategies. The strategies comprised educating staff, modifying the environment, implementing exercise programs, supplying and repairing aids, reviewing drug regimens, providing free hip protectors, having post-fall problem-solving conferences, and guiding staff. MEASUREMENTS: The primary outcomes were the number of residents sustaining a fall, the number of falls, and the time to occurrence of the first fall. A secondary outcome was the number of injuries resulting from falls. RESULTS: During the 34-week follow-up period, 82 residents (44%) in the intervention program sustained a fall compared with 109 residents (56%) in the control group (risk ratio, 0.78 [95% CI, 0.64 to 0.96]). The adjusted odds ratio was 0.49 (CI, 0.37 to 0.65), and the adjusted incidence rate ratio of falls was 0.60 (CI, 0.50 to 0.73). Each of 3 residents in the intervention group and 12 in the control group had 1 femoral fracture (adjusted odds ratio, 0.23 [CI, 0.06 to 0.94]). Clustering was considered in all regression models. CONCLUSION: An interdisciplinary and multifactorial prevention program targeting residents, staff, and the environment may reduce falls and femoral fractures.
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36.
  • Jensen, Jane, et al. (author)
  • Fall and injury prevention in residential care : effects in residents with higher and lower levels of cognition
  • 2003
  • In: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 51:5, s. 627-35
  • Journal article (peer-reviewed)abstract
    • OBJECTIVES: To evaluate the effectiveness of a multifactorial fall and injury prevention program in older people with higher and lower levels of cognition. DESIGN: A preplanned subgroup comparison of the effectiveness of a cluster-randomized, nonblinded, usual-care, controlled trial.SETTING: Nine residential facilities in Umea, Sweden. PARTICIPANTS: All consenting residents living in the facilities, aged 65 and older, who could be assessed using the Mini-Mental State Examination (MMSE; n = 378).An MMSE score of 19 was used to divide the sample into one group with lower and one with higher level of cognition. The lower MMSE group was older (mean +/- standard deviation = 83.9 +/- 5.8 vs 82.2 +/- 7.5) and more functionally impaired (Barthel Index, median (interquartile range) 11 (6-15) vs 17 (13-18)) and had a higher risk of falling (64% vs 36%) than the higher MMSE group. INTERVENTION: A multifactorial fall prevention program comprising staff education, environmental adjustment, exercise, drug review, aids, hip protectors, and postfall problem-solving conferences. MEASUREMENTS: The number of falls, time to first fall, and number of injuries were evaluated and compared by study group (intervention vs control) and by MMSE group. RESULTS: A significant intervention effect on falls appeared in the higher MMSE group but not in the lower MMSE group (adjusted incidence rates ratio of falls P =.016 and P =.121 and adjusted hazard ratio P <.001 and P =.420, respectively). In the lower MMSE group, 10 femoral fractures were found, all of which occurred in the control group (P =.006). CONCLUSION: The higher MMSE group experienced fewer falls after this multifactorial intervention program, whereas the lower MMSE group did not respond as well to the intervention, but femoral fractures were reduced in the lower MMSE group
  •  
37.
  • Jensen, Jane, et al. (author)
  • Falls among frail older people in residential care
  • 2002
  • In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 30:1, s. 54-61
  • Journal article (peer-reviewed)abstract
    • Aims: A prospective study was carried out to investigate the incidence, circumstances, and injuries from falls among frail older people living in three different types of Swedish residential care settings. Methods: The settings were senior citizens' apartments, an old people's home, and a group dwelling for people with dementia. The falls were registered during the three-year study period on a semi-structured fall report, and injurious falls were categorized according to severity. Results: In total 428 falls occurred among 121 residents. The incidence rate of falls at the group dwelling was twice the rates of the old people's home and senior citizens' apartments (4282 compared with 1709 and 2114 falls per 1000 person-years respectively). Some 27% of the falls occurred during the night (2100 h to 0600 h) and 28% were related to a visit to the lavatory. The presence of acute disease at the time of a fall was diagnosed in 23% of the falls. Some type of injury occurred in 118 falls (28%) and 36 of these (8%) led to moderate or serious injuries. In total 48 fractures were diagnosed. Conclusions: In a preventive programme for falls and injuries in residential care settings, areas of particular interest should include falls after mealtimes and falls at night, conditions of acute diseases, rising up from sitting, walking, and activities in progress, especially visits to the lavatory.
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38.
  • Johansson, Hanna, et al. (author)
  • Cognitive function and walking velocity in people with dementia : a comparison of backward and forward walking
  • 2017
  • In: Gait & Posture. - : Elsevier. - 0966-6362 .- 1879-2219. ; 58, s. 481-486
  • Journal article (peer-reviewed)abstract
    • How forward and backward walking, both central to everyday life, relate to cognition are relatively unexplored in people with dementia. This study aimed to investigate if forward and backward walking velocity respectively, associated with global cognition and executive function in people with dementia, and whether the association differed according to walking aid use or dementia type. Using a cross-sectional design, 161 participants (77% women), a mean Mini-Mental State Examination (MMSE) score of 15, and mean age of 85.5 years and living in nursing homes were included. Self-paced forward walking (FW) and backward walking (BW) velocity over 2.4 m was measured. Global cognitive outcome measurements included MMSE and Alzheimer Disease Assessment Scale - Cognitive subscale (ADAS-Cog). Executive function was measured using Verbal Fluency (VF). In comprehensively adjusted multivariate linear regression analyses, FW was independently associated with VF (p = 0.001), but not MMSE (p = 0.126) or ADAS-Cog (p = 0.818). BW was independently associated with VF (p = 0.043) and MMSE (p = 0.022), but not ADAS-Cog (p = 0.519). Interaction analyses showed that the association between BW velocity and executive function were stronger in participants who walked without a walking aid. No associations differed according to dementia type. In conclusion, executive function appears important to walking velocity, both forward and backward, in people with dementia with mild to moderately severe cognitive impairment. Global cognitive function was associated with backward walking only, perhaps due to it being more challenging. The association between BW velocity and executive function differed according to use of walking aids, which appeared to attenuate the association.
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39.
  • Kallin, Kristina, et al. (author)
  • Predisposing and precipitating factors for falls among older people in residential care
  • 2002
  • In: Public Health. - 0033-3506 .- 1476-5616. ; 116:5, s. 263-271
  • Journal article (peer-reviewed)abstract
    • Falls and their consequences are serious health problems among older populations. To study predisposing and precipitating factors for falls among older people in residential care we used a cross-sectional study design with a prospective follow up for falls. Fifty-eight women and 25 men, with a mean age of 79.6 y, were included and prospectively followed up regarding falls for a period of 1 y after baseline assessments. All those who fell were assessed regarding factors that might have precipitated the fall. The incidence rate was 2.29 falls/person years. Antidepressants (selective serotonin reuptake inhibitors, SSRIs), impaired vision and being unable to use stairs without assistance were independently associated with being a 'faller'. Twenty-eight (53.8%) of the fallers suffered injuries as a result of their falls, including 21 fractures. Twenty-seven percent of the falls were judged to be precipitated by an acute illness or disease and 8.6% by a side effect of a drug. Acute symptoms of diseases or drug side effects were associated with 58% of the falls which resulted in fractures. We conclude that SSRIs seem to constitute one important factor that predisposes older people to fall, once or repeatedly. Since acute illnesses and drug side-effects were important precipitating factors, falls should be regarded as a possible symptom of disease or a side-effect of a drug until it is proven otherwise.
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40.
  • Kallin, Kristina, et al. (author)
  • Why the elderly fall in residential care facilities, and suggested remedies.
  • 2004
  • In: The Journal of family practice. - 0094-3509 .- 1533-7294. ; 53:1, s. 41-52
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: To study precipitating factors for falls among older people living in residential care facilities. DESIGN: Prospective cohort study. SETTING: Five residential care facilities. PARTICIPANTS: 140 women and 59 men, mean age +/- SD 82.4 +/- 6.8 (range, 65-97). MEASUREMENTS: After baseline assessments, falls in the population were tracked for 1 year. A physician, a nurse, and a physiotherapist investigated each event, and reached a consensus concerning the most probable precipitating factors for the fall. RESULTS: Previous falls and treatment with antidepressants were found to be the most important predisposing factors for falls. Probable precipitating factors could be determined in 331 (68.7%) of the 482 registered falls. Acute disease or symptoms of disease were judged to be precipitating, alone or in combination in 186 (38.6%) of all falls; delirium was a factor in 48 falls (10.0%), and infection, most often urinary tract infection, was a factor in 38 falls (7.9%). Benzodiazepines or neuroleptics were involved in the majority of the 37 falls (7.7%) precipitated by drugs. External factors, such as material defects and obstacles, precipitated 38 (7.9%) of the falls. Other conditions both related to the individual and the environment, such as misinterpretation (eg, overestimation of capacity or forgetfulness), misuse of a roller walker, or mistakes made by the staff were precipitating factors in 83 (17.2%) of falls. CONCLUSION: Among older people in residential care facilities, acute diseases and side effects of drugs are important precipitating factors for falls. Falls should therefore be regarded as a possible symptom of disease or a drug side effect until proven otherwise. Timely correction of precipitating and predisposing factors will help prevent further falls.
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41.
  • Larsson, Jenny, et al. (author)
  • Falls and Fear of Falling in Shunted Idiopathic Normal Pressure Hydrocephalus : The Idiopathic Normal Pressure Hydrocephalus Comorbidity and Risk Factors Associated With Hydrocephalus Study
  • 2021
  • In: Neurosurgery. - : Oxford University Press. - 0148-396X .- 1524-4040. ; 89:1, s. 122-128
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Gait and balance impairment are typical symptoms of idiopathic normal pressure hydrocephalus (INPH), implicating that falls may afflict these patients.OBJECTIVE: To investigate falls, related injuries, and associated psychological features, before and after shunt surgery for INPH and compared to the general population.METHODS: The study included 176 patients shunted for INPH and 368 age- and sex-matched controls. Falls, fear of falling (FOF), fall-related injuries (mild-severe), confidence in avoiding falls (Swedish Falls Efficacy Scale (FES(S)), quality of life (QoL; EuroQoL 5-dimension 5 level instrument), and symptoms of depression (Geriatric Depression Scale 15) were investigated. Pre- and postoperative observational times were 12 mo before surgery and 21 mo after (mean). Recurrent fallers fell ≥2 times.RESULTS: More INPH patients than controls were recurrent fallers (67% vs 11%; P < .001). They feared falling more often (FOF, mean ± standard deviation: 3.3 ± 1.1 vs 1.6 ± 0.9; P < .001) and had lower confidence in avoiding falls (FES(S) 78 ± 40 vs 126 ± 14; P < .001). After surgery, INPH patients improved in all parameters but they did not reach the levels of the controls. Among fallers there was no difference between patients and controls in the severity of injuries suffered. Low QoL and symptoms of depression were more common among recurrent fallers than one-time or nonfallers in both shunted patients and controls (P ≤ .001).CONCLUSION: Falls, FOF, and low confidence in avoiding falls are considerable problems in INPH that may be reduced by shunt surgery. We suggest that remaining risk of falling and preventative measures are routinely considered in postoperative follow-ups and rehabilitation planning.
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42.
  • Lindberg, Jonatan, et al. (author)
  • En spark i baken för ett aktivare liv
  • 2011
  • Reports (other academic/artistic)abstract
    • Efter årtionden av inaktivitet fick några patienter i 60-årsåldern fysisk aktivitet på recept (FaR). Vår studie pekar på att det var ett bra sätt att hjälpa dem att finna motivation och att ta ett första steg mot ett aktivare liv.
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43.
  • Lindelöf, Nina, et al. (author)
  • Experiences of older people with dementia participating in a high-intensity functional exercise program in nursing homes : "While it's tough, it's useful"
  • 2017
  • In: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 12:11
  • Journal article (peer-reviewed)abstract
    • The objective of the study was to describe the views and experiences of participation in a high-intensity functional exercise (HIFE) program among older people with dementia in nursing homes. The study design was a qualitative interview study with 21 participants (15 women), aged 74-96, and with a Mini-Mental State Examination score of 10-23 at study start. The HIFE-program comprises exercises performed in functional weight-bearing positions and including movements used in everyday tasks. The exercise was individually designed, supervised in small groups in the nursing homes and performed during four months. Interviews were performed directly after exercise sessions and field notes about the sessions were recorded. Qualitative content analysis was used for analyses. The analysis revealed four themes: Exercise is challenging but achievable; Exercise gives pleasure and strength; Exercise evokes body memories; and Togetherness gives comfort, joy, and encouragement. The intense and tailored exercise, adapted to each participant, was perceived as challenging but achievable, and gave pleasure and improvements in mental and bodily strength. Memories of previous physical activities aroused and participants rediscovered bodily capabilities. Importance of individualized and supervised exercise in small groups was emphasized and created feelings of encouragement, safety, and coherence. The findings from the interviews reinforces the positive meaning of intense exercise to older people with moderate to severe dementia in nursing homes. The participants were able to safely adhere to and understand the necessity of the exercise. Providers of exercise should consider the aspects valued by participants, e.g. supervision, individualization, small groups, encouragement, and that exercise involved joy and rediscovery of body competencies.
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44.
  • Lindemann, Ulrich, et al. (author)
  • Maximum step length as a potential screening tool for falls in non-disabled older adults living in the community.
  • 2008
  • In: Aging Clinical and Experimental Research. - 1594-0667 .- 1720-8319. ; 20:5, s. 394-9
  • Journal article (peer-reviewed)abstract
    • BACKGROUND AND AIMS: Identification of the risk of falls in a cohort of interest is a prerequisite for a targeted fall prevention study. Motor tasks are widely used as baseline assessment in such studies, but there are only a few well-evaluated tests of motor performance to predict falls prospectively. This study was conducted to find out if the potential of the maximum step length (MSL) test can predict future falls in non-disabled older persons. METHODS: A modified version of the MSL test was used for baseline assessment in 56 community-dwelling, non-disabled elderly persons (mean age 67.7 yrs, SD 6 yrs; 57% women). During a follow-up of 1 year, falls were recorded in a daily calendar. RESULTS: During the follow-up, 30 persons (54%) fell, with no gender difference in reporting of falls between men and women. The adjusted mean valid step length and adjusted maximum valid step length were predictive of future falls with a sensitivity/specificity of 77%/62% and 70%/69%, respectively. Combining MSL test results with fall history increased sensitivity to 93% and 90%, respectively, but decreased specificity to 54% and 58%, respectively. CONCLUSIONS: The MSL test is a feasible tool, with low requirements in space, predicting future falls in community-dwelling older persons. In combination with history of falls, the sensitivity of the test increased considerably.
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45.
  • Lindgren, Helena, et al. (author)
  • End users transforming experiences into formal information and process models for personalised health interventions
  • 2014
  • In: Studies in Health Technology and Informatics. - 0926-9630 .- 1879-8365. ; 205, s. 378-382
  • Journal article (peer-reviewed)abstract
    • Five physiotherapists organised a user-centric design process of a knowledge-based support system for promoting exercise and preventing falls. The process integrated focus group studies with 17 older adults and prototyping. The transformation of informal medical and rehabilitation expertise and older adults' experiences into formal information and process models during the development was studied. As tool they used ACKTUS, a development platform for knowledge-based applications. The process became agile and incremental, partly due to the diversity of expectations and preferences among both older adults and physiotherapists, and the participatory approach to design and development. In addition, there was a need to develop the knowledge content alongside with the formal models and their presentations, which allowed the participants to test hands-on and evaluate the ideas, content and design. The resulting application is modular, extendable, flexible and adaptable to the individual end user. Moreover, the physiotherapists are able to modify the information and process models, and in this way further develop the application. The main constraint was found to be the lack of support for the initial phase of concept modelling, which lead to a redesigned user interface and functionality of ACKTUS.
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46.
  • Littbrand, Håkan, 1966-, et al. (author)
  • A high-intensity functional weight-bearing exercise program for older people dependent in activities of daily living and living in residential care facilities : evaluation of the applicability with focus on cognitive function
  • 2006
  • In: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 86:4, s. 489-498
  • Journal article (peer-reviewed)abstract
    • BACKGROUND AND PURPOSE: Knowledge concerning the applicability and the effect of high-intensity exercise programs is very limited for older people with severe cognitive and physical impairments. The primary aim of this study was to evaluate the applicability of a high-intensity functional weight-bearing exercise program among older people who are dependent in activities of daily living and living in residential care facilities. A second aim was to analyze whether cognitive function was associated with the applicability of the program. SUBJECTS: The subjects were 91 older people (mean age=85.3 years, SD=6.1, range=68-100) who were dependent in personal activities of daily living and randomly assigned to participate in an exercise intervention. Their mean score for the Mini-Mental State Examination (MMSE) was 17.5 (SD=5.0, range=10-29). METHODS: A high-intensity functional weight-bearing exercise program was performed in groups of 3 to 7 participants who were supervised by physical therapists. There were 29 exercise sessions over 13 weeks. Attendance, intensity of lower-limb strength and balance exercises, and occurrence and seriousness of adverse events were the outcome variables in evaluating the applicability of the program. RESULTS: The median attendance rate was 76%. Lower-limb strength exercises with high intensity were performed in a median of 53% of the attended exercise sessions, and balance exercises with high intensity were performed in a median of 73% of the attended exercise sessions. The median rate of sessions with adverse events was 5%. All except 2 adverse events were assessed as minor and temporary, and none led to manifest injury or disease. No significant differences were observed in applicability when comparing participants with dementia and participants without dementia. In addition, there was no significant correlation between applicability and the MMSE score. DISCUSSION AND CONCLUSION: The results suggest that a high-intensity functional weight-bearing exercise program is applicable for use, regardless of cognitive function, among older people who are dependent in activities of daily living, living in residential care facilities, and have an MMSE score of 10 or higher.
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47.
  • Littbrand, Håkan, 1966-, et al. (author)
  • Effect of a high-intensity functional exercise program on functional balance : preplanned subgroup analyses of a randomized controlled trial in residential care facilities
  • 2011
  • In: Journal of The American Geriatrics Society. - : John Wiley & Sons. - 0002-8614 .- 1532-5415. ; 59:7, s. 1274-1282
  • Journal article (peer-reviewed)abstract
    • OBJECTIVES: To evaluate whether age, sex, depression, dementia disorder, nutritional status, or level of functional balance capacity influences the effect of a high-intensity functional weight-bearing exercise program on functional balance.DESIGN: Preplanned subgroup analyses of a randomized controlled trial.SETTING: Nine residential care facilities.PARTICIPANTS: One hundred ninety-one people aged 65 to 100 dependent in activities of daily living and with Mini-Mental State Examination scores of 10 or greater.INTERVENTION: A high-intensity functional weight-bearing exercise program or a control activity, each comprising 29 sessions over 3 months.MEASUREMENTS: Functional balance capacity was assessed blindly using the Berg Balance Scale (BBS) at baseline, 3 months, and 6 months. The BBS consists of 14 tasks, common in everyday life, such as standing up from sitting and, while standing, reaching forward or turning 360°. Interactions between allocation to activity group and each subgroup were evaluated according to the intention-to-treat principle.RESULTS: The subgroup analyses revealed no statistically significant interaction for age, sex, depression, dementia disorder, nutritional status, or level of functional balance capacity at 3 (P=.65,.65,.51,.78,.09,.67, respectively) or 6 (P=.69,.62,.20,.94,.48,.85, respectively) months. In addition, at 3 and 6 months there was no significant interaction for cognitive level (P=.28,.47, respectively) or number of depressive symptoms (P=.85,.49, respectively).CONCLUSION: Older age, female sex, depression, mild to moderate dementia syndrome, malnutrition, and severe physical impairment do not seem to have a negative effect on functional balance from a high-intensity functional weight-bearing exercise program. Consequently, people with these characteristics in residential care facilities should not be excluded from offers of rehabilitation including high-intensity exercises.
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48.
  •  
49.
  • Littbrand, Håkan, 1966-, et al. (author)
  • The effect of a high-intensity functional exercise program on activities of daily living : a randomized controlled trial in residential care facilities
  • 2009
  • In: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 57:10, s. 1741-1749
  • Journal article (peer-reviewed)abstract
    • OBJECTIVES: To evaluate whether a high-intensity functional weight-bearing exercise program reduces dependency in activities of daily living (ADLs) in older people living in residential care facilities, focusing on people with dementia. DESIGN: Randomized, controlled trial. SETTING: Nine residential care facilities. PARTICIPANTS: One hundred ninety-one older people dependent in ADLs and with a Mini-Mental State Examination score of 10 or greater. One hundred (52.4%) of the participants had dementia. INTERVENTION: A high-intensity functional weight-bearing exercise program or a control activity consisting of 29 sessions over 3 months. MEASUREMENTS: The Barthel ADL Index; follow-up at 3 months (directly after the intervention) and 6 months with intention-to-treat analyses. RESULTS: There were no statistically significant differences between the groups regarding overall ADL performance. Analyses for each item revealed that a smaller proportion of participants in the exercise group had deteriorated in indoor mobility at 3 months (exercise 3.5% vs control 16.0%, P=.01) and 6 months (7.7% vs 19.8%, P=.03). For people with dementia, there was a significant difference in overall ADL performance in favor of the exercise group at 3 months (mean difference 1.1, P=.03) but not at 6 months. CONCLUSION: A high-intensity functional weight-bearing exercise program seems to reduce ADL decline related to indoor mobility for older people living in residential care facilities. The program does not appear to have an overall effect on ADLs. In people with dementia, the exercise program may prevent decline in overall ADL performance, but continuous training may be needed to maintain that effect.
  •  
50.
  • Littbrand, Håkan, et al. (author)
  • The effect on ADL of a high-intensity functional exercise program among older people dependent in ADL : a randomized controlled trial
  • 2007
  • In: 15th International Congress of the World Confederation for Physical Therapy. - : WCPT.
  • Conference paper (other academic/artistic)abstract
    • PURPOSE: To investigate if a high-intensity functional weight-bearing exercise program reduces the dependency in personal care and mobility among older people dependent in activities of daily living (ADL), with focus on people with dementia. RELEVANCE: The number of older people with disability increases. Physical functional capacity can be improved by high-intensity exercise program, but there is no strong evidence that physical exercise is an effective method to reduce disability. PARTICIPANTS: 191 older people dependent in ADL, living in residential care facilities, and with a Mini-Mental State Examination (MMSE) score of ≥ 10 participated in this study (the FOPANU Study). Their mean score ± SD of the Barthel ADL was 13.1±4.2 and 52% of the participants had a diagnosed dementia disease. METHODS: The participants were randomized to a high-intensity functional weight-bearing exercise program (the HIFE Program) or a control activity, including 29 sessions over 3 months. The Barthel ADL Index, which includes ten items that are summarized to a total score of 20, was used to assess independency in personal care and mobility. The assessments were performed, by persons blinded to the participants’ group allocation, before the intervention, at 3 months (directly after the intervention period), and at 6 months. ANALYSIS: Between-group effects on the total score and each item were analyzed by ANCOVA and by logistic regression, respectively, using the intention-to-treat principle. RESULTS: When analyzing all participants, there was no statistical significant difference between the groups at 3 or 6 months in total score of the Barthel ADL Index. Analyses for each item revealed that a lower proportion of participants in the exercise group had deteriorated regarding mobility indoors (item 7) at 3 and 6 months (4% and 8%) compared to the control group (16% and 20%), P = 0.01 and 0.03, respectively. Among people with dementia, there was a significant difference in total score in favor of the exercise group at 3 months (mean difference 1.1, P = 0.03), but not at 6 months. CONCLUSIONS: A high-intensity functional weight-bearing exercise program does not appear to have an overall effect on ADL according to the Barthel ADL Index among older people who are dependent in ADL and living in residential care facilities, but the exercise program seems to have both short- and long-term effect in maintaining mobility indoors. In the subgroup of people with dementia, the exercise program seems to have a short-term overall effect on ADL. IMPLICATIONS: A high-intensity functional weight-bearing exercise program seems to be a promising method to reduce disability regarding mobility indoors for older people living in residential care facilities. For people with dementia, the exercise program may have an overall effect in personal care and mobility but continuously training may be needed to maintain the effect.
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