| 1. |
- Andreasson, Ingrid, et al.
(författare)
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Daily life one year after corrective osteotomy for malunion of a distal radius fracture an interview study
- 2022
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Medical Journals Sweden AB. - 2000-656X .- 2000-6764. ; 56:1, s. 16-22
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore the everyday life experiences of people one year after corrective osteotomy following a symptomatic, malunited, distal radius fracture. Semi-structured interviews were conducted with twenty respondents, median age 65 (22-81) years. The respondents were recruited consecutively. The interviews were subjected to qualitative content analysis. Three authors took part in the analysis. The result is presented as one theme, 'Daily life works again' with five categories: Relief of inconveniences and symptoms, Managing new symptoms and complications, Regaining abilities, Normalised social relationships, Increased wellbeing. The symptoms had declined in severity, some participants regarded themselves as fully restored and used their hand again without hesitation. Others were still bothered by their wrist occasionally and a few had to manage complications. The participants had regained the ability to perform many everyday life activities and reported increased independence and less irritation between spouses, as well as increased wellbeing. One year after a corrective osteotomy following malunion of a distal radius fracture, the patients' experiences represent a continuum. Some are still restricted by their wrist occasionally, the majority experience an increased ease in their performance of activities of daily life and some regard themselves as fully restored. The recovery has a positive impact on social relationships and the patients' wellbeing.
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| 2. |
- Andreasson, Ingrid, et al.
(författare)
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Life has become troublesome–my wrist bothers me around the clock: an interview study relating to daily life with a malunited distal radius fracture
- 2020
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 42:16, s. 2344-2350
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to explore the everyday life experiences of people suffering from a symptomatic, malunited, distal radius fracture. Method: Qualitative interviews were conducted with twenty respondents, median age 59 [16–85] years. The interviews were subjected to qualitative content analysis. Results: The result, presented as one main theme with categories and subcategories, describes the impact of the injury. Everyday life was affected in all participants, very much in a few highly valued activities such as sports and work, whenever the hand was used, or even at rest. This study indicates that the injury has an impact on the ability to move around, other parts of the body, sleep, emotions, self-perception and relationships. It also shows that the patients used several strategies to manage the situation. Conclusion: The malunion of a distal radius fracture has a negative impact on a wide range of daily activities, as well as other aspects of daily life. There is a need for information between caregivers and patients, and clear routines, once a malunion has occurred.Implications for rehabilitation The symptomatic malunion of a distal radius fracture should be acknowledged as a complex condition requiring comprehensive interventions Technical equipment, braces and new solutions on practical problems was necessary to manage everyday life and should be a focus of intervention for this patient group The consequences of the injury was not only restricted activity performance but also affected social relationships and emotions Information about fracture healing and how a malunion can occur, as well as information on how much the wrist can be loaded at different time points, is important to reduce anxiety. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.
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| 3. |
- Asplin, Gillian, et al.
(författare)
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See me, teach me, guide me, but it’s up to me! Patients’ experiences of recovery during the acute phase after hip fracture
- 2021
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Ingår i: European Journal of Physiotherapy. - : Informa UK Limited. - 2167-9169 .- 2167-9177. ; 23:3, s. 135-143
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore patients’ experiences of their recovery after hip fracture surgery and the use of Traffic Light System-BasicADL in their rehabilitation process. Method: Nineteen patients (13 females and 6 males), aged 66–94, were interviewed. A qualitative content analysis method was used for analysis of data. Results: Two categories were identified: ‘Being seen as a person’ with subcategories; Interaction affects trust and security; Information is key to understanding; and Encouragement is essential to promote activity. And ‘Striving for Independence’, with subcategories; Accepting the situation while trying to remain positive; The greener the better, but it’s up to me; Ask me, I have goals; and Uncertainties concerning future. Conclusion: The findings of this study mirror clinical reality. There is a continued need for organisations to reflect over existing practise and question routines and procedures. In order to improve services and provide better quality of care, it is essential to acknowledge the patients’ experiences, needs and preferences and make efforts to accommodate these where possible. Health care professionals must recognise that patients with hip fracture are individuals, with varying needs that change across the continuum of recovery.
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| 4. |
- Bolin, Karin, et al.
(författare)
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Variants in BANK1 are associated with lupus nephritis of European ancestry
- 2021
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Ingår i: Genes and Immunity. - : Springer Nature. - 1466-4879 .- 1476-5470. ; 22:3, s. 194-202
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Tidskriftsartikel (refereegranskat)abstract
- The genetic background of lupus nephritis (LN) has not been completely elucidated. We performed a case-only study of 2886 SLE patients, including 947 (33%) with LN. Renal biopsies were available from 396 patients. The discovery cohort (Sweden, n = 1091) and replication cohort 1 (US, n = 962) were genotyped on the Immunochip and replication cohort 2 (Denmark/Norway, n = 833) on a custom array. Patients with LN, proliferative nephritis, or LN with end-stage renal disease were compared with SLE without nephritis. Six loci were associated with LN (p < 1 × 10−4, NFKBIA, CACNA1S, ITGA1, BANK1, OR2Y, and ACER3) in the discovery cohort. Variants in BANK1 showed the strongest association with LN in replication cohort 1 (p = 9.5 × 10−4) and proliferative nephritis in a meta-analysis of discovery and replication cohort 1. There was a weak association between BANK1 and LN in replication cohort 2 (p = 0.052), and in the meta-analysis of all three cohorts the association was strengthened (p = 2.2 × 10−7). DNA methylation data in 180 LN patients demonstrated methylation quantitative trait loci (meQTL) effects between a CpG site and BANK1 variants. To conclude, we describe genetic variations in BANK1 associated with LN and evidence for genetic regulation of DNA methylation within the BANK1 locus. This indicates a role for BANK1 in LN pathogenesis.
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| 5. |
- Jansson, A. S. B., et al.
(författare)
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Physical activity on prescription at the time of stroke or transient ischemic attack diagnosis - from a patient perspective
- 2021
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 43:8, s. 1121-1128
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Physical activity is known to reduce the risk of recurrent stroke. Despite this many individuals diagnosed with stroke have an insufficient level of physical activity. Physical activity on prescription is provided within healthcare to encourage increased physical activity. Purpose: To examine individuals' experiences of physical activity on prescription at the time of stroke or transient ischemic attack diagnosis and explore various factors affecting the ability to follow the prescription. Material and method: A qualitative approach was undertaken; using interviews, analyzed with content analysis to elicit information from individuals who had been admitted to a stroke unit due to stroke or transient ischemic attack. Results: Five women and five men (median age 60.5 years), eight with stroke and two with TIA (median NIHSS at onset 2.5), participated and the analysis resulted in an overall theme Change of life-style through physical activity on prescription - a multifaceted process containing the categories Experience of support, Barriers and opportunities and Personal motivators. Conclusion: Individuals need to participate in the prescription process when prescription on physical activity is initiated in acute stroke care and clinicians need to reflect on how the prescription is implemented and followed-up; creating good conditions for long-term effects.
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| 6. |
- Kjörk, Emma, et al.
(författare)
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Development of a Digital Tool for People With a Long-Term Condition Using Stroke as a Case Example: Participatory Design Approach.
- 2022
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Ingår i: JMIR human factors. - : JMIR Publications Inc.. - 2292-9495. ; 9:2
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Tidskriftsartikel (refereegranskat)abstract
- In patient care, demand is growing for digital health tools to enable remote services and enhance patient involvement. People with chronic conditions often have multiple health problems, and long-term follow-up is recommended to meet their needs and enable access to appropriate support. A digital tool for previsit preparation could enhance time efficiency and guide the conversation during the visit toward the patient's priorities.This study aims to develop a digital previsit tool and explore potential end user's perceptions, using a participatory approach with stroke as a case example.The digital tool was developed and prototyped according to service design principles, informed by qualitative participant data and feedback from an expert panel. All features were processed in workshops with a team that included a patient partner. The resulting tool presented questions about health problems and health information. Study participants were people with stroke recruited from an outpatient clinic and patient organizations in Sweden. Development and data collection were conducted in parallel. For conceptualization, the initial prototype was based on the Post-Stroke Checklist and research. Needs and relevance were explored in focus groups, and we used a web survey and individual interviews to explore perceived utility, ease of use, and acceptance. Data were thematically analyzed following the Framework Method.The development process included 22 participants (9 women) with a median age of 59 (range 42-83) years and a median of 51 (range 4-228) months since stroke. Participants were satisfied or very satisfied with using the tool and recommended its use in clinical practice. Three main themes were constructed based on focus group data (n=12) and interviews (n=10). First, valuable accessible information illuminated the need for information to confirm experiences, facilitate responses, and invite engagement in their care. Amendments to the information in turn reconfigured their expectations. Second, utility and complexity in answering confirmed that the questions were relevant and comprehensible. Some participants perceived the answer options as limiting and suggested additional space for free text. Third, capturing needs and value of the tool highlighted the tool's potential to identify health problems and the importance of encouraging further dialog. The resulting digital tool, Strokehälsa [Strokehealth] version 1.0, is now incorporated into a national health platform.The participatory approach to tool development yielded a previsit digital tool that the study group perceived as useful. The holistic development process used here, which integrated health information, validated questions, and digital functionality, offers an example that could be applicable in the context of other long-term conditions. Beyond its potential to identify care needs, the tool offers information that confirms experiences and supports answering the questions in the tool. The tool is freely shared for adaptation in different contexts.researchweb 236341; https://www.researchweb.org/is/vgr/project/236341.
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| 7. |
- Lundtoft, Christian, et al.
(författare)
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Function of multiple sclerosis-protective HLA class I alleles revealed by genome-wide protein-quantitative trait loci mapping of interferon signalling
- 2020
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Ingår i: PLOS Genetics. - : Public Library of Science (PLoS). - 1553-7390 .- 1553-7404. ; 16:10
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Tidskriftsartikel (refereegranskat)abstract
- Interferons (IFNs) are cytokines that are central to the host defence against viruses and other microorganisms. If not properly regulated, IFNs may contribute to the pathogenesis of inflammatory autoimmune, or infectious diseases. To identify genetic polymorphisms regulating the IFN system we performed an unbiased genome-wide protein-quantitative trait loci (pQTL) mapping of cell-type specific type I and type II IFN receptor levels and their responses in immune cells from 303 healthy individuals. Seven genome-wide significant (p < 5.0E-8) pQTLs were identified. Two independent SNPs that tagged the multiple sclerosis (MS)-protective HLA class I alleles A*02/A*68 and B*44, respectively, were associated with increased levels of IFNAR2 in B and T cells, with the most prominent effect in IgD–CD27+ memory B cells. The increased IFNAR2 levels in B cells were replicated in cells from an independent set of healthy individuals and in MS patients. Despite increased IFNAR2 levels, B and T cells carrying the MS-protective alleles displayed a reduced response to type I IFN stimulation. Expression and methylation-QTL analysis demonstrated increased mRNA expression of the pseudogene HLA-J in B cells carrying the MS-protective class I alleles, possibly driven via methylation-dependent transcriptional regulation. Together these data suggest that the MS-protective effects of HLA class I alleles are unrelated to their antigen-presenting function, and propose a previously unappreciated function of type I IFN signalling in B and T cells in MS immune-pathogenesis.Author summaryGenetic association studies have been very successful in identifying disease-associated single nucleotide polymorphisms (SNPs), but it has been challenging to define the molecular mechanisms underlying these associations. As interferons (IFNs) have a central role in the immune system, we hypothesized that some of the SNPs associated to immune-mediated diseases would affect the IFN system. By combining genetic data with characterization of interferon receptor levels and their responses on the protein level in immune cells from 303 genotyped healthy individuals, we show that two SNPs tagging the HLA class I alleles A*02/A*68 and B*44 are associated with a decreased response to type I IFN stimulation in B cells and T cells. Notably, both HLA-A*02 and HLA-B*44 confer protection from developing multiple sclerosis (MS), which is a chronic inflammatory neurologic disease. In addition to suggesting a pathogenic role of enhanced type I interferon signalling in B cells and T cells in MS, our data emphasize the fact that genetic associations in the HLA locus can affect functions not directly associated to antigen presentation, which conceptually may be important for other diseases genetically associated to the HLA locus.
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| 8. |
- Vive, Sara, et al.
(författare)
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Experience of enriched rehabilitation in the chronic phase of stroke
- 2022
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 44:3, s. 412-419
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Tidskriftsartikel (refereegranskat)abstract
- Purpose:In this study, we explored the experiences of patients who participated in an enriched task-specific therapy (ETT) program in the chronic phase after stroke. Method:Focus group interviews were conducted with twenty participants with a mean time since stroke of 30 months and mean age 61 years, who completed the ETT program including task-specific training and environmental enrichment. ETT was delivered 3.5-6 h per day, 51/2 days per week for 3 weeks in a climate suitable for both indoor and outdoor activities. The training consisted of repetitive mass practice of gradually increasing difficulty. Directly after the intervention, qualitative interviews were conducted in six focus groups. The interviews were analysed with qualitative content analysis. Results:Three main categories describing the informants' experiences of the ETT program were identified. These categories were; 1.The program-different and hard- highlighting the participants view of the ETT as strenuous and different in nature; 2.My body and mind learn to know better- describing positive changes in participants' body function and functional ability as well as behavioural changes experienced throughout the ETT; and 3.The need and trust from others- emphasizing the perceived importance of trust in rehabilitation clinicians and the support of family and other participants. From these categories, a main theme emerged:It's hard but possible-but not alone! Conclusion:A therapy program including task-specific training and environmental enrichment may provide late-phase stroke survivors with perceived improvements in functional ability, knowledge insights, perceptions of rehabilitation needs and enriching emotional impacts.
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| 9. |
- Wassenius, Charlotte, et al.
(författare)
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Integrating consequences of stroke into everyday life–Experiences from a long-term perspective
- 2022
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 29:2, s. 126-138
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Tidskriftsartikel (refereegranskat)abstract
- Background: Occupational engagement encompasses both objective and subjective aspects of occupation. Long-term follow-up studies indicate that stroke can have a negative impact on the ability to perform IADL. Less is known about the subjective experiences of occupational engagement and how engagement may evolve after stroke. Objective: To explore stroke survivors’ experiences of occupational engagement and how engagement changed over time and across contexts. Material and methods: Repeat, semi-structured interviews 15–18 years post-stroke, analysed using thematic analysis. Eight out of nine participants were classified as having had a mild stroke at onset. Results: The analysis resulted in five themes that together formed the main theme ‘It takes time–integrating consequences of stroke into everyday life by engaging in occupation, using internal resources and adapting to context’. This illustrated how occupational outcome was the result of a continuous process in which occupational engagement was a way of gradually integrating consequences of stroke into everyday life. Conclusion and significance: Occupational engagement plays an important part in the process of moving on with life and can serve as both goal and means of achieving desired outcomes after stroke. Interventions that focus on enabling opportunities for occupational engagement in valued occupations and support the use of abilities and internal resources can reduce the impact of stroke in everyday life. © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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| 10. |
- Wassenius, Charlotte, et al.
(författare)
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The centrality of work in everyday life after stroke: A qualitative study of long-term stroke survivors
- 2023
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 30:4, s. 539-549
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundWork is an occupation of great concern for younger stroke survivors. Given the high rate of people not working after stroke, there is a need to explore work after stroke from a long-term perspective, including not just an initial return to work, but also the ability to retain employment and how this may affect everyday life after stroke. Therefore, the objective of this study was to explore experiences relating to work and to work incapacity among long-term stroke survivors.MethodThis study used thematic analysis on data gathered through individual semi-structured interviews with long-term stroke survivors.ResultsThe analysis resulted in four themes that together comprised the main theme 'The centrality of work in everyday life', containing descriptions of how everyday life was affected by aspects of work both for those who did work and those who did not return to work after stroke.Conclusion and significanceThe results highlight the importance of addressing return to work not just as an isolated outcome but as part of everyday life after stroke. The results indicate a need for a more flexible approach to supporting return to work that continues past the initial return.
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