| 1. |
- Ahlstrand, Inger, et al.
(författare)
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Self-efficacy and pain acceptance as mediators of the relationship between pain and performance of valued life activities in women and men with rheumatoid arthritis
- 2017
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Ingår i: Clinical Rehabilitation. - : Sage Publications. - 0269-2155 .- 1477-0873. ; 31:6, s. 824-834
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study whether personal factors (self-efficacy and pain acceptance) mediate the relationship between pain and performance of valued life activities in persons with rheumatoid arthritis.METHODS: Persons with rheumatoid arthritis for at least four years (n = 737; 73% women) answered a questionnaire measuring self-efficacy, pain acceptance, performance of valued life activities, and self-rated pain. Relationships among these constructs were explored using univariate and multivariate analyses. Structural equation modelling was then used to examine the mediational role of personal factors on the relationship between pain and performance of valued life activities.RESULTS: A direct negative association between pain and performance of valued life activities was identified (Beta = .34, P < .001). This suggests that people with rheumatoid arthritis who had higher levels of pain has increased difficulties in performing valued life activities. Self-efficacy and activity engagement component of pain acceptance mediated the relationship between pain and performance of valued life activities, however the pain willingness component of pain acceptance did not influence participation in valued life activities.CONCLUSION: These findings highlight the importance of considering personal factors, such as pain acceptance and self-efficacy, in facilitating participation in valued life activities.
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| 2. |
- Berggren, Monica, 1966-, et al.
(författare)
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Effects of geriatric interdisciplinary home rehabilitation on complications and readmissions after hip fracture : a randomized controlled trial
- 2019
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Ingår i: Clinical Rehabilitation. - : Sage Publications. - 0269-2155 .- 1477-0873. ; 33:1, s. 64-73
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This pre-planned secondary analysis of geriatric interdisciplinary home rehabilitation, which was initially found to shorten the postoperative length of stay in hospital for older individuals following hip fracture, investigated whether such rehabilitation reduced the numbers of complications, readmissions, and total days spent in hospital after discharge during a 12-month follow-up period compared with conventional geriatric care and rehabilitation.Design: Randomized controlled trial.Setting: Geriatric department, participants' residential care facilities, and ordinary housing.Subjects: Individuals aged ⩾70 years with acute hip fracture (n = 205) were included.Intervention: Geriatric interdisciplinary home rehabilitation was individually designed and aimed at early discharge with the intention to prevent, detect, and treat complications after discharge.Main measures: Complications, readmissions, and days spent in hospital were registered from patients' digital records and interviews conducted during hospitalization and at 3- and 12-month follow-up visits.Results: No significant difference in outcomes was observed. Between discharge and the 12-month follow-up, among participants in the geriatric interdisciplinary home rehabilitation group (n = 106) and control group (n = 93), 57 (53.8%) and 44 (47.3%) had complications (P = 0.443), 46 (43.4%) and 38 (40.9%) fell (P = 0.828), and 38 (35.8%) and 27 (29.0%) were readmitted to hospital (P = 0.383); the median total days spent in hospital were 11.5 and 11.0 (P = 0.353), respectively.Conclusion: Geriatric interdisciplinary home rehabilitation for older individuals following hip fracture resulted in similar proportions of complications, readmissions, and total days spent in hospital after discharge compared with conventional geriatric care and rehabilitation.
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| 3. |
- Bertilsson, Ann Sofie, et al.
(författare)
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A cluster randomized controlled trial of a client-centred, activities of daily living intervention for people with stroke : One year follow-up of caregivers
- 2016
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 30:8, s. 765-775
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Compare caregiver burden, provision of informal care, participation in everyday occupations and life satisfaction of caregivers to people with stroke, who either had received a client-centred, activities of daily living intervention or usual activities of daily living interventions. Design: A multicentre cluster randomized controlled trial in which 16 rehabilitation units were randomly assigned to deliver a client-centred, activities of daily living intervention or usual activities of daily living interventions. Caregiver outcomes were compared cross-sectionally at 12 months and changes in outcomes between three and 12 months after people with stroke were included in the study. Setting: Inpatient and outpatient rehabilitation. Participants: Caregivers of people with stroke enrolled in the trial. Intervention: A client-centred, activities of daily living intervention aiming to increase agency in daily activities and participation in everyday life for people after stroke. Main measures: Caregiver Burden Scale, Occupational Gaps Questionnaire, LiSat-11. Results: There were no differences in outcomes between caregivers in the client-centred, activities of daily living (n = 88) and the usual activities of daily living (n = 95) group at 12 months. The caregiver burden score was 42.7 vs. 41.8, p = 0.75, mean occupational gaps were 3.5 vs. 4.0, p = 0.52 and satisfaction with life was 53% vs. 50%, p = 0.87. There were no differences in changes between three and 12 months. However, within groups there were significant differences in caregiver burden, factor general strain, for caregivers in the client-centred, activities of daily living group, and in provision of informal care for the usual activities of daily living group. Conclusion: The client-centred intervention did not bring about any difference between caregiver-groups, but within groups some difference was found for caregiver burden and informal care.
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| 4. |
- Björk, Mathilda, 1977-, et al.
(författare)
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Validation and internal consistency of the Swedish version of the Valued Life Activities scale.
- 2016
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 30:12, s. 1211-1219
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The objective was to create a linguistically and culturally validated Swedish version of the Valued Life Activities scale. The aim was also to describe its content and concurrent validity and its internal consistency in persons with rheumatoid arthritis.METHODS: The Valued Life Activities scale was translated to Swedish and culturally adapted. In order to describe the content validity, both the Swedish and original Valued Life Activities scale were linked to the International Classification of Functioning, Disability and Health. The concurrent validity and internal consistency were evaluated in 737 patients with rheumatoid arthritis. To establish concurrent validity, the scale was correlated to disease activity, activity limitations, and life satisfaction. Internal consistency was assessed with Cronbach's alpha.RESULTS: The equivalence of meaning between the Swedish and the original Valued Life Activities scale was ensured by harmonization review. Content validity was high when linked to the International Classification of Functioning, Disability and Health. Concurrent validity showed a strong correlation with the activity limitations (r = 0.87), moderate with life satisfaction (r = -0.61), and weak with disease activity (r = 0.38). Internal consistency was excellent (Cronbach's alpha = 0.97).CONCLUSIONS: The Swedish Valued Life Activities scale has been tested in a large and well-characterized sample and found to be a linguistically valid and culturally adapted self-reported measure of participation. Content validity of the Valued Life Activities scale was excellent, concurrent validity strong, and the internal consistency excellent. Since both individual preferences and International Classification of Functioning, Disability and Health concepts of disability are taken into account, the Swedish Valued Life Activities scale appears to be a promising new scale addressing important aspects of participation.
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| 5. |
- Bring, Annika, et al.
(författare)
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What is the comparative effectiveness of current standard treatment, against an individually tailored behavioural programme delivered either on the Internet or face-to-face for people with acute whiplash associated disorder? : A randomized controlled trial
- 2016
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 30:5, s. 441-453
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the comparative effectiveness of current standard treatment, against an individually tailored behavioural programme delivered via the Internet or face-to-face for people with acute whiplash associated disorders.DESIGN: A multicentre, randomized, three-group design, with concealed allocation.SUBJECTS AND SETTINGS: A total of 55 participants (37 female), age 18-65, with acute Whiplash Associated Disorder (Grade I-II), recruited at two emergency clinics in Sweden.INTERVENTIONS: Before randomization all participants received standard self-care instructions. The Internet and face-to-face groups followed a seven-week behavioural programme involving individual tailoring, via email (Internet group), or in sessions at a physical therapy unit (face-to-face group). The control group only received the self-care instructions.MAIN MEASURES: Pain-related disability, pain intensity, self-efficacy in daily activities, catastrophizing and fear of movement/(re)injury. Assessments were performed at baseline (2-4 weeks postinjury) and at three, six and 12 months postintervention.RESULTS: Both the Internet (n = 16) and face-to-face (n = 14) group showed a larger decrease in pain-related disability than the control group (n = 16); -12 and -11, respectively, compared with -5 in the control group at 12-months follow-up. Significant differences between the groups in overall treatment effect were shown in all outcomes except pain intensity. All groups improved significantly over time in all outcomes, except for fear of movement/(re)injury and catastrophizing in the control group.CONCLUSION: An individually tailored behavioural programme improved biopsychosocial factors in patients with whiplash associated disorders up to 12 months after treatment. Internet-delivered intervention was as effective as clinic-based face-to-face therapy sessions.
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| 6. |
- Carling, Anna, 1985-, et al.
(författare)
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Falls in people with multiple sclerosis : experiences of 115 fall situations
- 2018
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Ingår i: Clinical Rehabilitation. - : Sage Publications. - 0269-2155 .- 1477-0873. ; 32:4, s. 526-535
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim was to describe falls and the perceived causes, experienced by people with multiple sclerosis shortly after falling.Design: A qualitative study using content analysis and quantitative data to illustrate where and why people report falls most commonly. Semi-structured telephone interviews were performed. Interviews were conducted shortly (0–10 days) after a fall.Subjects: In all, 67 informants who had reported at least one fall during the previous three-month period and who used a walking aid participated.Results: A total of 57 (85%) informants fell at least once during eight months resulting in 115 falls; 90 (78%) falls happened indoors, most commonly in the kitchen (n = 20; 17%) or bathroom (n = 16; 14%). Informants fell during everyday activities and walking aids had been used in more than a third of the reported falls. The falls were influenced of both intrinsic and extrinsic factors. Two categories emerged from the analysis: ‘activities when falling’ and ‘influencing factors’. The category contained three (basic activities of daily living, instrumental activities of daily living and leisure and work) and six (multiple sclerosis–related symptoms, fluctuating body symptoms, being distracted, losing body control, challenging surrounding and involvement of walking aid) subcategories, respectively.Conclusion: The majority of falls occurs indoors and in daily activities. Several factors interacted in fall situations and should be monitored and considered to reduce the gap between the person’s capacity and the environmental demands that cause fall risk. Fluctuation of bodily symptoms between and within a day is a variable not earlier targeted in multiple sclerosis fall risk research.
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| 7. |
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| 8. |
- Emilson, Christina, et al.
(författare)
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A 10-year follow-up of tailored behavioural medicine treatment and exercise-based physiotherapy in persistent musculoskeletal pain
- 2017
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 31:2, s. 186-196
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting.Design: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants.Interventions: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition). Main measures: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes.Results: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome (p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment (p= 0.02), and at the 10-year follow-up (p=0.03).Discussion: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment.
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| 9. |
- Emilson, Christina, et al.
(författare)
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A 10-year follow-up of tailored behavioural treatment and exercise-based physiotherapy for persistent musculoskeletal pain
- 2017
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Ingår i: Clinical Rehabilitation. - London : Sage Publications. - 0269-2155 .- 1477-0873. ; 31:2, s. 186-196
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting.DESIGN: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants.INTERVENTIONS: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition).MAIN MEASURES: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes.RESULTS: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome (p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment (p= 0.02), and at the 10-year follow-up (p=0.03).DISCUSSION: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment. © The Author(s) 2016
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| 10. |
- Flink, M, et al.
(författare)
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Training in client-centeredness enhances occupational therapist documentation on goal setting and client participation in goal setting in the medical records of people with stroke
- 2016
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Ingår i: Clinical rehabilitation. - : SAGE Publications. - 1477-0873 .- 0269-2155. ; 30:12, s. 1200-1210
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to compare client-centeredness as it was documented by the occupational therapists in the units randomized to the intervention clusters with documentation by occupational therapists in the control clusters. Design: Comparison of medical records. Setting: The study is conducted in a context of a randomized controlled trial in Sweden, with 16 post-stroke rehabilitation units cluster randomized to intervention or control group. Subjects: Occupational therapist documentation in medical records of 279 clients with stroke. Main measures: The medical records were reviewed for their level of client-centeredness using a protocol developed from the Stewart et al model. The occupational therapists in the intervention groups participated in a workshop training to enhance their client-centeredness. Results: Occupational therapists with training in client-centeredness documented significantly more on goal setting (OR = 4.1; 95% CI, 1.87-8.81), on client participation in goal setting (OR=11.34; 95% CI, 5.97-21.57), on how the goals could be reached (OR=2.8; 95% CI, 1.7-4.62), on client participation in how goals could be reached (OR=4.56; 95% CI, 2.73-7.64), on the follow-up on goals (OR=5.77; 95% CI, 2.78-11-98) and on client participation in follow-up on goals (OR=7.44, 95% CI, 4.33-12.8). This association remained after adjustment for healthcare setting, client socio-demographic variables, and stroke severity. Conclusion: Documentation of goal setting and client participation in goal setting can be influenced by training.
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| 11. |
- Forsberg, Anette, 1965-, et al.
(författare)
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Balancing everyday life two years after falling ill with Guillain-Barre syndrome : a qualitative study
- 2015
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Ingår i: Clinical Rehabilitation. - London, United Kingdom : Sage Publications. - 0269-2155 .- 1477-0873. ; 29:6, s. 601-610
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim was to describe experiences of disability in everyday life and managing the recovery process two years after falling ill with Guillain-Barré syndrome.Design: Qualitative interview study.Methods: Interviews were conducted with 35 persons (22 male, mean age 50 years) two years after the onset of Guillain-Barré syndrome. The interviews were transcribed verbatim and analysed using content analysis.Results: The analysis revealed four categories and an overall theme: ‘Striving for balance in everyday life’. The participants described persistent lived body restrictions that affected their arms, legs, and face. Bodily symptoms and loss of energy limited or restricted many everyday activities. In connection with healthcare, both satisfaction and feeling vulnerable in a critical situation were described. Experiences of the recovery process varied. The participants described acceptance and reappraisal of a new life situation despite their limitations, and having gained the knowledge that life can change suddenly. However, they also expressed disappointment following an overly positive prognosis in the early stages, and over a continuous wait for recovery. For some participants life had returned to as before.Conclusion: The participants experienced limitations in everyday life and decreased functioning in several parts of the body. The recovery process may still be ongoing two years after onset. Rehabilitation intervention with an extended focus on supporting individualized coping processes could facilitate ways to live with persistent disability.
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| 12. |
- Halvarsson, A, et al.
(författare)
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Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial
- 2015
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Ingår i: Clinical rehabilitation. - : SAGE Publications. - 1477-0873 .- 0269-2155. ; 29:4, s. 365-375
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate the effects of a balance training program including dual- and multi-task exercises on fall-related self-efficacy, fear of falling, gait and balance performance, and physical function in older adults with osteoporosis with an increased risk of falling and to evaluate whether additional physical activity would further improve the effects. Design: Randomized controlled trial, including three groups: two intervention groups (Training, or Training+Physical activity) and one Control group, with a 12-week follow-up. Setting: Stockholm County, Sweden. Participants: Ninety-six older adults, aged 66-87, with verified osteoporosis. Interventions: A specific and progressive balance training program including dual- and multi-task three times/week for 12 weeks, and physical activity for 30 minutes, three times/week. Main measures: Fall-related self-efficacy (Falls Efficacy Scale-International), fear of falling (single-item question – ‘In general, are you afraid of falling?’), gait speed with and without a cognitive dual-task at preferred pace and fast walking (GAITRite®), balance performance tests (one-leg stance, and modified figure of eight), and physical function (Late-Life Function and Disability Instrument). Results: Both intervention groups significantly improved their fall-related self-efficacy as compared to the controls ( p ≤ 0.034, 4 points) and improved their balance performance. Significant differences over time and between groups in favour of the intervention groups were found for walking speed with a dual-task ( p=0.003), at fast walking speed ( p=0.008), and for advanced lower extremity physical function ( p=0.034). Conclusions: This balance training program, including dual- and multi-task, improves fall-related self-efficacy, gait speed, balance performance, and physical function in older adults with osteoporosis.
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| 13. |
- Halvarsson, A, et al.
(författare)
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Long-term effects of a progressive and specific balance-training programme with multi-task exercises for older adults with osteoporosis: a randomized controlled study
- 2016
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Ingår i: Clinical rehabilitation. - : SAGE Publications. - 1477-0873 .- 0269-2155. ; 30:11, s. 1049-1059
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate long-term effects of balance-training on concerns about falling, gait, balance performance, and physical function in older adults with osteoporosis and increased risk of falling. Design: Randomized controlled trial, including three groups (training, training+physical activity, and control group), with follow-ups at three, nine, and 15 months. Short-term, three-month follow-up, benefits for those who fulfilled the first follow-up ( n = 69) have previously been reported. Setting: Stockholm, Sweden. Participants: A total of 96 elderly, age 66–87, with verified osteoporosis. Interventions: Balance-training programme including dual- and multitasks, with or without supplementary physical activity, three times/week over 12 weeks. Measurements: Concerns about falling Falls Efficacy Scale -International (FES-I), walking at preferred speed with and without a cognitive dual-task and at fast speed, balance tests (one-leg stance and modified figure-of-eight), and physical function Late-Life Function and Disability Instrument (LLFDI). Results: Participants in the training group maintained positive effects throughout the study period for concerns about falling (baseline vs. 15 months, median 27.5 vs. 23 points, p < 0.001) and walking performance (baseline vs. 15 months, p ⩽ 0.05 with an improvement of 0.9–1.4 m/s). The Training+physical activity group declined to baseline values at the nine-month follow-up, and were even lower at the 15-month follow-up for concerns about falling (median 26 vs. 26 points), walking performance (changes of −0.02 to 0.04 m/s), and physical function (mean 44.0 vs. 42.9 points). The control group remained unchanged throughout the study period. Conclusions: This balance-training programme reduced concerns about falling, and also improved gait in older adults with osteoporosis and increased risk of falling in a long-term perspective – important issues for fall prevention.
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| 14. |
- Halvarsson, A, et al.
(författare)
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Taking balance training for older adults one step further: the rationale for and a description of a proven balance training programme
- 2015
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Ingår i: Clinical rehabilitation. - : SAGE Publications. - 1477-0873 .- 0269-2155. ; 29:5, s. 417-425
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Tidskriftsartikel (refereegranskat)abstract
- To give the rationale and evidence for and a detailed description of a rehabilitation programme of proven effectiveness in improving balance in older adults. Background theory and evidence: Based on the knowledge that balance loss usually occurs in situations when attention is divided, especially when being older, and that balance control relies on the interaction of several physiological systems, we have developed a specific and progressive balance training programme with dual- and multi-task exercises for older adults. Practical application: Balance demanding exercises, specific to the various components of balance control and to situations in daily life, were performed in sitting, standing and walking at three different levels of progression (basic, moderate and advanced) of increasing difficulty and complexity. The training was performed in 45-minutes group sessions, with 6–10 participants in each group, three times per week during 12 weeks, with two or three physiotherapists present. Conclusions: This balance training programme strengthens self-efficacy in balance control leading to improved fall-related self-efficacy, reduced fear of falling, increased walking speed, and improved physical function. Participants found the programme motivating, valuable, fun, and enjoyable, which was reflected in a high attendance rate.
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| 15. |
- Hedman, Annicka, et al.
(författare)
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Five-year follow-up of a cluster-randomized controlled trial of a client-centred activities of daily living intervention for people with stroke
- 2019
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 33:2, s. 262-276
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare five-year outcomes and changes over time of a client-centred activities of daily living (ADL) intervention versus usual ADL interventions for people with stroke and their significant others.Design: Five-year follow-up of a cluster-randomized controlled trial where a client-centred ADL intervention (n = 129) or usual ADL interventions (n = 151) were delivered to people with stroke.Setting: Multicentre study including 16 inpatient or home-based rehabilitation units.Participants: People with stroke and significant others.Intervention: The client-centred ADL intervention aimed at enabling agency in daily activities and participation in everyday life and at reducing caregiver burden.Main measures: For people with stroke, perceived participation (Stroke Impact Scale), independence in ADL, life satisfaction, and use of formal/informal care were measured. For significant others, caregiver burden, life satisfaction, and mood (Hospital Anxiety and Depression Scale) were assessed.Results: Five years post-intervention, data were collected from 145 people with stroke (intervention group: n = 71/control group: n = 74) and 75 significant others (intervention group: n = 36/control group: n = 39). For those with stroke, the Participation domain of the Stroke Impact Scale showed no group differences at year five (68.9 vs 75.4, P = 0.062) or in changes over time. At year five, the control group had better outcomes regarding Other help/supervision. Significant others in the control group were more likely to show signs of depression at year five (odds ratio = 22.3; P < 0.001).Conclusion: The client-centred ADL intervention appears to render similar long-term effects as usual ADL interventions for people with stroke, but for significant others signs of depression might be reduced.
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| 16. |
- Jones, Kelly M., et al.
(författare)
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Determining the feasibility and preliminary efficacy of a stroke instructional and educational DVD in a multinational context : a randomized controlled pilot study
- 2018
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 32:8, s. 1086-1097
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the feasibility of conducting a randomized controlled trial of an instructional and educational stroke DVD and determine the feasibility and preliminary efficacy of this intervention in a multinational context. Design: Non-funded, pilot randomized controlled trial of intervention versus usual care. Setting: International, multicentre, community-based. Participants: Community-living adults up to three years post stroke with moderate to severe disability and their nominated informal caregivers. Interventions: Intervention patients viewed and practised rehabilitation techniques demonstrated in the DVD over six weeks. Main measures: Trial feasibility by number of active recruitment sites, recruitment efficiency, randomization and follow-up. Intervention feasibility by patient and caregiver impressions. Preliminary efficacy by the quality of life – 5-level EuroQol-5D (EQ-5D) health status measure, General Health Questionnaire and Centre for Epidemiological Studies–Depression at two months. Results: In total, 14 recruitment sites were established across eight countries. Recruitment was achieved at nine (64%) sites. Over 16 months, 66 participants were recruited (mean (SD) age = 63.5 (12.47) years) and randomized to intervention (n = 34) and control (n = 32) groups. In total, 54 (82%) completed a follow-up assessment. Patient and/or caregiver comments about the benefits and barriers to accessing the intervention were mixed. There were no significant between-group differences in outcomes at two months (P > 0.05). Conclusion: Conducting a multinational trial of a stroke DVD requires full funding. The intervention was acceptable to some patients and their caregivers, yet a generalized education approach did not fully meet their needs and/or expectations. A more individualized method may be required to meet peoples’ changing needs during stroke recovery.
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| 17. |
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| 18. |
- Joseph, C, et al.
(författare)
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Cost-effectiveness of the HiBalance training program for elderly with Parkinson's disease: analysis of data from a randomized controlled trial
- 2019
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Ingår i: Clinical rehabilitation. - : SAGE Publications. - 1477-0873 .- 0269-2155. ; 33:2, s. 222-232
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Tidskriftsartikel (refereegranskat)abstract
- To determine the cost-effectiveness of the HiBalance training program for managing Parkinson’s disease (PD)-related balance and gait disorders. Design: Cost comparison design following the randomized controlled trial comparing a novel balance training intervention with care as usual. Subjects: A total of 100 participants with mild–moderate PD were randomized to either the intervention ( n = 51) or the control group ( n = 49). Intervention: A 10-week (three times per week), group-based, progressive balance training program, led by two physical therapists. Main outcomes: All program costs were collected for both groups. Cost-utility was evaluated using quality-adjusted life years (QALYs) and cost-effectiveness measures were the Mini Balance Evaluation Systems Test (Mini-BESTest; assessing balance performance) and gait velocity. Incremental cost-effectiveness ratios were calculated and a probabilistic sensitivity analysis was conducted. Results: The between-group difference in QALYs was 0.043 (95% confidence interval (CI): 0.011–0.075), favoring the intervention group. Between-group differences in balance performance and gait velocity were 2.16 points (95% CI: 1.19–3.13) and 8.2 cm/second (95% CI: 2.9–13.6), respectively, favoring the intervention group. The mean cost per participant in the intervention group was 16,222 SEK (€1649) compared to 2696 SEK (€274) for controls. The estimated incremental cost-effectiveness ratios were 314,558 SEK (€31,969) for an additional QALY, 6262 SEK (€631) for one point improvement in balance performance, and 1650 SEK (€166) for 1 cm/second increase in gait velocity. Sensitivity analyses indicated a high probability (85%) of program success. Conclusion: In terms of QALYs, the HiBalance program demonstrated a high probability of cost-effectiveness in the short-term perspective when considering the willingness-to-pay thresholds used in Europe.
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| 19. |
- Lindgren, Ingrid, et al.
(författare)
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Pain management strategies among persons with long-term shoulder pain after stroke : a qualitative study
- 2019
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Ingår i: Clinical Rehabilitation. - : Sage Publications. - 0269-2155 .- 1477-0873. ; 33:2, s. 357-364
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore strategies that persons with persistent shoulder pain after stroke use to manage their pain in daily life. Design: A qualitative study using semi-structured face-to-face interviews, analysed by content analysis. Setting: A university hospital. Subjects: Thirteen community-dwelling persons (six women; median age: 65 years; range 57-77) with shoulder pain after stroke were interviewed median two years after the pain onset. Results: An overall theme 'Managing shoulder pain by adopting various practical and cognitive strategies' emerged from the analysis. Three categories were identified: (1) practical modifications to solve daily life problems; (2) changed movement patterns and specific actions to mitigate the pain, by non-painful movements, avoidance of pain-provoking activities and various pain distracting activities and (3) learned how to deal with the pain mentally. Several strategies were used simultaneously and they were experienced successful to various degrees. Conclusion: The findings in the present study indicate that persons with persistent shoulder pain after stroke use both practical and cognitive strategies to manage their pain.
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| 20. |
- Neri, SGR, et al.
(författare)
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Do virtual reality games improve mobility skills and balance measurements in community-dwelling older adults? Systematic review and meta-analysis
- 2017
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Ingår i: Clinical rehabilitation. - : SAGE Publications. - 1477-0873 .- 0269-2155. ; 31:10, s. 1292-1304
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Tidskriftsartikel (refereegranskat)abstract
- To summarize evidence on the effectiveness of virtual reality games and conventional therapy or no-intervention for fall prevention in the elderly.Data sources:An electronic data search (last searched December 2016) was performed on 10 databases (Web of Science, EMBASE, PUBMED, CINAHL, LILACS, SPORTDiscus, Cochrane Library, Scopus, SciELO, PEDro) and retained only randomized controlled trials.Review method:Sample characteristics and intervention parameters were compared, focusing on clinical homogeneity of demographic characteristics, type/duration of interventions, outcomes (balance, reaction time, mobility, lower limb strength and fear of falling) and low risk of bias. Based on homogeneity, a meta-analysis was considered. Two independent reviewers assessed the risk of bias.Results:A total of 28 studies met the inclusion criteria and were appraised ( n: 1121 elderly participants). We found that virtual reality games presented positive effects on balance and fear of falling compared with no-intervention. Virtual reality games were also superior to conventional interventions for balance improvements and fear of falling. The six studies included in the meta-analysis demonstrated that virtual reality games significantly improved mobility and balance after 3–6 and 8–12 weeks of intervention when compared with no-intervention. The risk of bias revealed that less than one-third of the studies correctly described the random sequence generation and allocation concealment procedures.Conclusion:Our review suggests positive clinical effects of virtual reality games for balance and mobility improvements compared with no-treatment and conventional interventions. However, owing to the high risk of bias and large variability of intervention protocols, the evidence remains inconclusive and further research is warranted.
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| 21. |
- Nooijen, C. F., et al.
(författare)
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A behavioral intervention promoting physical activity in people with subacute spinal cord injury : secondary effects on health, social participation and quality of life
- 2017
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 31:6, s. 772-780
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess, for people with subacute spinal cord injury, if rehabilitation that is reinforced with the addition of a behavioral intervention to promote physical activity leads to a better health, participation and quality of life. DESIGN: Randomized controlled trial. SETTING: Rehabilitation centers. PARTICIPANTS: A total of 39 participants analyzed (45 included), with subacute spinal cord injury in inpatient rehabilitation, dependent on a manual wheelchair (33% tetraplegia, 62% motor complete, 150 +/-74 days postinjury). INTERVENTION: A behavioral intervention promoting physical activity after discharge, involving 13 individual sessions delivered by a coach trained in motivational interviewing, beginning two months before and ending six months after discharge from inpatient rehabilitation. MAIN MEASURES: Physical capacity as determined during a maximal exercise test, body mass index, blood pressure, fasting lipid profile, and social participation (IMPACT-S) and quality of life (SF-36) were determined using questionnaires. Measurements were performed two months before discharge, at discharge, and six and 12 months after discharge from inpatient rehabilitation. B represents the between-group difference. RESULTS: Twelve months after discharge, significant intervention effects were found for diastolic blood pressure (B = -11.35 mmHg, 95% CI = -19.98 to -2.71), total cholesterol (B = -0.89 mmol/L, 95% CI = -1.59 to -0.20), low-density lipoprotein cholesterol (B = -0.63 mmol/L, 95% CI = -1.25 to -0.00) and participation (B = 9.91, 95% CI = 3.34 to 16.48). CONCLUSIONS: A behavioral intervention promoting physical activity after discharge from inpatient rehabilitation improves social participation and seems to reduce risk factors for cardiovascular disease in people with subacute spinal cord injury.
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| 22. |
- Nygren DeBoussard, Catharina, et al.
(författare)
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Behavioural problems in the first year after Severe traumatic brain injury : a prospective multicentre study
- 2017
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 31:4, s. 555-566
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the occurrence of behavioural problems in patients with severe traumatic brain injury during the first year after injury and potential associations with outcome. An additional post hoc objective was to analyse the frequency of behaviours with need for intervention from staff.DESIGN AND SETTING: In a prospective population based cohort study 114 patients with severe traumatic brain injury were assessed at three weeks, three months and one year after injury.MAIN MEASURES: Assessments included clinical examination and standardised instruments. Agitation was assessed with the Agitated Behaviour Scale, the course of recovery by the Rancho Los Amigo Scale and outcome by Glasgow Outcome Scale Extended.RESULTS: Agitation were most common at 3 weeks post injury and 28% (n=68) of the patients showed at least one agitated behaviour requiring intervention from staff. Presence of significant agitation at 3 weeks after injury was not associated with poor outcome. At 3 months agitation was present in 11% (n=90) and apathy in 26 out of 81 assessed patients. At 3 months agitation and apathy were associated with poor outcome at one year.CONCLUSIONS: Most agitated behaviours in the early phase are transient and are not associated with poor outcome. Agitation and apathy are uncommon at three months but when present are associated with poor outcome at one year after injury. In the early phase after a severe traumatic brain injury agitated behaviour in need of interventions from staff occur in a substantial proportion of patients.
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| 23. |
- Persson, Carina Ulla, 1970, et al.
(författare)
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Risk of falling in a stroke unit after acute stroke: The Fall Study of Gothenburg (FallsGOT).
- 2018
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Ingår i: Clinical rehabilitation. - : SAGE Publications. - 1477-0873 .- 0269-2155. ; 32:3, s. 398-409
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to investigate incidence of falls and different baseline variables and their association with falling during hospitalization in a stroke unit among patients with acute stroke.Prospective observational study.A stroke unit at a university hospital.A consecutive sample of stroke patients, out of which 504 were included, while 101 declined participation.The patients were assessed a mean of 1.7days after admission and 3.8days after stroke onset.The primary end-point was any fall, from admission to the stroke unit to discharge. Factors associated with falling were analysed using univariable and multivariable Cox hazard regression analyses. Independent variables were related to function, activity and participation, as well as personal and environmental factors.In total, 65 patients (13%) fell at least once. Factors statistically significantly associated with falling in the multivariable analysis were male sex (hazard ratio (HR): 1.88, 95% confidence interval (CI): 1.13-3.14, P=0.015), use of a walking aid (HR: 2.11, 95% CI: 1.24-3.60, P=0.006) and postural control as assessed with the modified version of the Postural Assessment Scale for Stroke Patients (SwePASS). No association was found with age, cognition or stroke severity, the HR for low SwePASS scores (⩽24) was 9.33 (95% CI: 2.19-39.78, P=0.003) and for medium SwePASS scores (25-30) was 6.34 (95% CI: 1.46-27.51, P=0.014), compared with high SwePASS scores (⩾31).Postural control, male sex and use of a walking aid are associated with falling during hospitalization after acute stroke.
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| 24. |
- Rodby-Bousquet, Elisabet, et al.
(författare)
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Psychometric evaluation of the Posture and Postural Ability Scale for children with cerebral palsy
- 2016
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 30:7, s. 697-704
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate construct validity, internal consistency and inter-rater reliability of the Posture and Postural Ability Scale for children with cerebral palsy.DESIGN: Evaluation of psychometric properties.SETTING: Five child rehabilitation centres in the south of Sweden, in November 2013 to March 2014.SUBJECTS: A total of 29 children with cerebral palsy (15 boys, 14 girls), 6-16 years old, classified at Gross Motor Function Classification System (GMFCS) levels II (n = 10), III (n = 7), IV (n = 6) and V (n = 6).MAIN MEASURES: Three independent raters (two physiotherapists and one orthopaedic surgeon) assessed posture and postural ability of all children in supine, prone, sitting and standing positions, according to the Posture and Postural Ability Scale. Construct validity was evaluated based on averaged values for the raters relative to known-groups in terms of GMFCS levels. Internal consistency was analysed with Cronbach's alpha and corrected Item-Total correlation. Inter-rater reliability was calculated using weighted kappa scores.RESULTS: The Posture and Postural Ability Scale showed construct validity and median values differed between GMFCS levels (p < 0.01). There was a good internal consistency (alpha = 0.95-0.96; item-total correlation = 0.55-0.91), and an excellent inter-rater reliability (kappa score = 0.77-0.99).CONCLUSION: The Posture and Postural Ability Scale shows high psychometric properties for children with cerebral palsy, as previously seen when evaluated for adults. It enables detection of postural deficits and asymmetries indicating potential need for support and where it needs to be applied.
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| 25. |
- Samuelsson, Carina M, et al.
(författare)
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Early prediction of falls after stroke: a 12-month follow-up of 490 patients in The Fall Study of Gothenburg (FallsGOT).
- 2019
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 1477-0873 .- 0269-2155. ; 33:4, s. 773-783
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Tidskriftsartikel (refereegranskat)abstract
- To identify the incidence of falls and factors present shortly after stroke, which are associated with the occurrence of falls over the first 12months after stroke onset, following discharge from inpatient rehabilitation.Prospective follow-up study.Stroke unit and outpatient department.A total of 490 individuals with acute stroke.Postural control was assessed using the Swedish modified version of the Postural Assessment Scale for Stroke Patients. Data on self-reported falls were collected using a standardized questionnaire at threemonths after discharge and six and 12months after stroke onset. Associations between characteristics during the acute phase after a stroke and falls after six and 12months were investigated using univariable and multivariable regression analyses.The endpoint was a self-reported fall.Within threemonths after discharge, 38 of 165 respondents (23%) had experienced at least one fall. Within six and 12months after stroke onset, respectively, 108 of 376 (29%) and 140 of 348 (40%) of the respondents had experienced at least one fall. Poor postural control (odds ratio 3.92, 95% confidence interval 2.07-7.45, P<0.0001) and using a walking aid (odds ratio 2.84, 95% confidence interval 1.71-4.72, P<0.0001) were predictors of falls after discharge within 12months after stroke onset. The same variables were independent predictors of falls within sixmonths.Poor postural control and using a walking aid in the acute phase after a stroke are associated with falls after discharge from a stroke unit within 12months after stroke onset.
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| 26. |
- Van de Velde, D, et al.
(författare)
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Measuring participation as defined by the World Health Organization in the International Classification of Functioning, Disability and Health. Psychometric properties of the Ghent Participation Scale
- 2017
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Ingår i: Clinical rehabilitation. - : SAGE Publications. - 1477-0873 .- 0269-2155. ; 31:3, s. 379-393
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Tidskriftsartikel (refereegranskat)abstract
- To examine the internal consistency, test–retest reliability, construct validity, discriminant validity and responsiveness of the Ghent Participation Scale. Design: Cross-sectional study with a test–retest sample. Setting: Six outpatient rehabilitation centres in Belgium. Subjects: A total of 365 outpatients from eight diagnostic groups. Measures: The Ghent Participation Scale, the Impact on Participation and Autonomy, the Utrecht Scale for Evaluation of Rehabilitation-Participation and the Medical outcome study Short Form SF-36. Results: The Ghent Participation Scale was found to have good internal consistency (Cronbach’s α between 0.75 and 0.83). At item level, the test–retest reliability was good; weighted kappas ranged between 0.57 and 0.88. On the dimension level intraclass correlation coefficients ranged between 0.80 and 0.90. Evidence for construct validity came from high correlations between the subscales of the Ghent Participation Scale and four subscales of the Impact on Participation and Autonomy (range, r = −0.71 to −0.87) and two subscales of the Utrecht Scale for Evaluation of Rehabilitation-Participation (range, r = 0.54 to 0.72). Standardized response mean ranged between 0.23 and 0.68 and the area under the curve ranged between 68% and 88%. Conclusion: The Ghent Participation Scale appears to be a valid and reliable method of assessing participation irrespective of the respondent’s health condition. The Ghent Participation Scale is responsive and is able to detect changes over time.
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| 27. |
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