| 1. |
- Arkkukangas, Marina
(author)
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Evaluation of the Otago Exercise Programme with or without motivational interviewing : Feasibility, experiences, effects and adherence among older community-dwelling people
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Falls and injuries related to falls are one of the most common health problems among older people and are becoming increasingly more frequent. Regular exercise has been identified as one of the most effective fall-prevention activities for older people; however, awareness of the impact of exercise programmes and adherence to recommended exercise among the elderly population is generally low. Research examining how an exercise programme is administered to and experienced by elderly community-dwelling people is needed.The overall aim of this thesis was to investigate the feasibility, experiences and effects of and adherence to the fall-preventive Otago Exercise Programme (OEP) with or without motivational interviewing (MI) among community-dwelling people aged 75 years or older.Four studies were performed from October 2012 to May 2016 in a sample of 175 people. Both quantitative and qualitative research methods were used. The methods included the feasibility for conducting a randomized controlled trial (RCT) (I), individual face-to-face interviews (II), an RCT (III) and a prospective cohort study (IV). The intervention was given to two groups. The participants who received OEP with or without MI were compared with a control group that received standard care.The feasibility of performing an exercise intervention with or without MI was acceptable from the perspective of the participating physiotherapists. From the perspective of the older participants performing the exercise with behavioural change support, the inclusion of monitored exercises in everyday life and daily routines was important. The participants also expressed experiencing more strength, improved physical functioning and greater hope for an extended active life during old age.From the short-term perspective, there were significant improvements within the OEP combined with MI group in terms of physical performance, fall self-efficacy, activity level, and handgrip strength. Improved physical performance and fall self-efficacy were also found within the control group; however, corresponding differences did not occur in the OEP group without MI. There were no significant differences between the study groups after 12 weeks of regular exercise. Adherence to the exercises in the pooled exercise group was 81% at the 12-week follow-up.At the 52-week follow-up, the behavioural factors being physically active and obtaining behavioural support in terms of MI had a significant association with adherence to the exercise programme.These studies provide some support for the combination of OEP with MI as the addition of MI was valuable for achieving adherence to the exercise programme over time in older community-dwelling people.
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| 2. |
- Bergland, Astrid, et al.
(author)
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Health, balance, and walking as correlates of climbing steps
- 2008
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In: Journal of Aging and Physical Activity. - 1543-267X. ; 16:1, s. 42-52
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Journal article (peer-reviewed)abstract
- The aim of this study was to investigate walking and health among woman age 75 yr or older, in the associations between the highest step up performed without support by an individual and balance, walking, and health among women age 75+. Records of the highest step, balance, walking, and health were made for 307 women age 75-93 yr living in the community. Eighty percent managed to climb steps higher than 20 cm. There was a statistically significant negative relationship between age and stair-climbing capacity. The highest steps registered were significantly and independently associated with a short time on the timed up-and-go test, long functional reach, low body weight, lack of perceived difficulty walking outdoors, low number of "missteps" when walking in a figure of 8, longer time in one-leg stance, ability to carry out tandem stance, no walking aids outdoors, and not being afraid of falling. These variables together explained 67% of the variance in the step-height score.
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| 3. |
- Bergland, Astrid, et al.
(author)
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Self-reported walking, balance testing and risk of fall among the elderly
- 2006
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In: Tidsskrift for den Norske Laegeforening. - 0807-7096. ; 126:2, s. 176-178
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Journal article (peer-reviewed)abstract
- BACKGROUND: Falls represent an important health problem among the elderly. Balance testing as well as registration of self-reported balance problems may be appropriate in order to predict the risk of future falls. MATERIALS AND METHODS: Self-reported walking was assessed in 307 randomly selected women 75 years or older living at home. The women underwent testing of gait and balance and were followed up for one year with respect to falls and fall-related injuries. RESULTS: 155 of the women fell during the observation period; 308 falls were reported. 13% of the falls resulted in a fracture. Factor analysis identified five anamnestic questions measuring the same latent construct. The sum score of this self-reported walking index correlated highly with simple balance tests. A poor result on the walking index indicated a high risk of falling (odds ratio (OR) 1.83, 95% confidence interval 1.41-2.30) and of fall-related fractures (OR 2.65, 95 % CI 1.27-5.05) the subsequent year. The areas under the ROC curves (receiver-operating characteristics) were, however, only .57 for falls and .61 for fractures. INTERPRETATION: Simple questions give useful information on the risk of falls and fall-related fractures among elderly women.
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| 4. |
- Cederbom, Sara, 1973-, et al.
(author)
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A qualitative study exploring physical therapists’ views on the Otago Exercise Programme for fall prevention : a stepping stone to “age in place” and to give faith in the future
- 2020
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In: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040. ; 38:1, s. 132-140
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Journal article (peer-reviewed)abstract
- Background: One of the most effective interventions to prevent falls is exercise. A commonly used program that prevents falls is the Otago Exercise Programme (OEP). Despite this, user-based knowledge of its applicability in real-world settings for older adults who are dependent on formal care in their homes is lacking. Purposes: To explore how physical therapists (PTs) experience the applicability of the OEP in clinical practice for home-dwelling older adults who are dependent on formal home care and to determine their beliefs regarding the benefits of the OEP for living longer at home. Methods: Semi-structured interviews were conducted with 17 physical therapists. Data were analyzed using qualitative thematic analysis. Results: The OEP was described by PTs to be applicable in clinical practice. Their experience was that the OEP seemed to be meaningful and to have a strong relationship with everyday activities. The OEP improved physical function, mood, self-efficacy, and participation in social activities in older adults, as well as provided faith in the future. Conclusion: The OEP is suitable for use in a primary care setting, and according to the perceptions of physical therapists, the OEP contributes to older adults' capability to live longer at home.
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| 5. |
- Cederbom, Sara, 1973-, et al.
(author)
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Effects of a behavioral medicine intervention on pain, health, and behavior among community-dwelling older adults : a randomized controlled trial
- 2019
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In: Clinical Interventions in Aging. - : Informa UK Limited. - 1176-9092 .- 1178-1998. ; 14, s. 1207-1220
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Journal article (peer-reviewed)abstract
- Purpose: The aim of the study was to evaluate the effects of an intervention, based on a behavioral medicine approach in physical therapy (BMPI), on pain-related disability and physical performance as well as on pain severity, pain catastrophizing, physical activity levels, falls efficacy, and health-related quality of life (HRQL) by comparing the effects to standard care.Patients and methods: The study was a pragmatic randomized controlled trial with a two-group design and included measurements preintervention and postintervention and a 12-week follow-up. In total, 105 older adults, aged >75 years with chronic musculoskeletal pain living alone at home and dependent on formal care to manage their everyday lives, were included in the study. All statistical analyses were performed using an intention to treat approach.Results: The intervention, based on a behavioral medicine approach, compared to usual care, had a positive effect on pain-related disability, pain severity, level of physical activity, HRQL, management of everyday life, and self-efficacy.Conclusion: BMPI can be a suitable evidence-based intervention for community-dwelling older adults, even for those who are very old and frail. BMPI can support and promote an active aging and "age in place" for the target population, which is currently the main goal of all interventions in this field.
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| 6. |
- Cederbom, Sara, 1973-, et al.
(author)
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The tensions between micro-, meso- and macro-levels : physiotherapists’ views of their role towards fall prevention in the community – a qualitative study
- 2020
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In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 20:1
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Journal article (peer-reviewed)abstract
- Background: Falls are a global public health concern. Physiotherapists are a key resource in this context, but there is sparse knowledge about how they perceive their role in the primary care setting. Therefore, the purpose of the present study is to explore physical therapists’ (PTs) view of how they experience and perceive their role working with fall prevention in a community care setting.Methods: Semi-structured interviews were conducted with 17 physiotherapists. Data were analysed using a qualitative thematic analysis.Results: The analysis resulted in a core theme and three subthemes. The core theme was ‘capability to cope with the tensions between the micro-, meso- and macro-levels in fall, prevention’, which indicated the importance of an evolving multifaceted, evidence based and innovative physiotherapy role. A key factor for this role is to take an integrative biopsychosocial approach based on how biological and psychosocial factors are uniquely related in fall prevention. The three themes were as follows: 1) always moving and changing: the competent explorative knowledge-hungry clinician’s multifaceted role; 2) multiprofessional – but in the end alone; 3) reaching out – from the bottom to the top. Success in the role of physiotherapists in fall prevention depends on the empowering leadership and working culture, as well as on the time and multifaceted professional competence of the clinicians.Conclusion: Our findings indicate that the PTs’ role reflects their abilities to change and improve their professional work in accordance with evidence based knowledge. To ensure good quality the PTs focused on the special needs of the patients, evidence-based fall prevention, interdisciplinary team work, good clinical competences, good skills in communication, and interpersonal relations. Attention should be placed on the importance of biopsychosocial perspective framing in the actual clinical and political context. The PTs saw the need for working at the micro-, meso- and macro-levels to succeed in the work of fall prevention.
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| 7. |
- Frandin, Kerstin, et al.
(author)
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Long-Term Effects of Individually Tailored Physical Training and Activity on Physical Function, Well-Being and Cognition in Scandinavian Nursing Home Residents : A Randomized Controlled Trial
- 2016
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In: Gerontology. - : S. Karger AG. - 0304-324X .- 1423-0003. ; 62:6, s. 571-580
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Journal article (peer-reviewed)abstract
- Background: The preservation of physical functions such as muscle strength, balance and mobility is fundamental to maintaining independence in activities of daily living (ADL). The physical activity level of most nursing home residents is very low, which implies that they are often subject to a decline in health, mobility, autonomy and social contacts and are also at risk of suffering a decline in mental well-being. In a previous study, we demonstrated that transfers, balance and physical activity level improved after 3 months of individually tailored intervention in nursing home residents. Objective: To evaluate the long-term effects on ADL, balance function, physical activity level, physical performance, falls related self-efficacy, well-being and cognitive function 3 months after the completion of our intervention in nursing home residents. Methods: The study was a multicenter randomized, controlled clinical trial with a parallel-group design. It was conducted in nursing homes in Sweden, Norway and Denmark, with an intervention period lasting 3 months and a follow-up at 6 months. Initially, 322 nursing home residents with a mean age of 85 years were included; 85 from Sweden, 171 from Norway and 66 from Denmark. Of these, 241 [129 intervention group (IG), 112 control group (CG)] were eligible for the 6-month follow-up tests. The level of dependence in ADL, physical activity level, several dimensions of physical function, well-being, falls-related self-efficacy and cognitive function were assessed with reliable and valid instruments at baseline, immediately after 3 months of intervention and 3 months later at the 6-month follow-up.Results: After 3 months of intervention and an additional period of 3 months without intervention, only the following 2 variables demonstrated significant group differences: social and cognitive function, measured by the Functional Independence Measure n-r, where the IG deteriorated while the CG was almost stable. However, regarding transfers, the IG deteriorated significantly less than the CG. Conclusion: Without supervised physical exercise that challenged the individuals' capability, gains in ADL function, balance and transfer ability deteriorated during the 3 months following the intervention period. Thus, continuous, individually adjusted and supported physical activity seems crucial for the maintenance of physical functions in these vulnerable elderly persons.
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| 8. |
- Frändin, Kerstin, et al.
(author)
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A Nordic multi-center study on physical and daily activities for residents in nursing home settings : design of a randomized, controlled trial
- 2009
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In: Aging Clinical and Experimental Research. - 1594-0667 .- 1720-8319. ; 21:4-5, s. 314-322
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Journal article (peer-reviewed)abstract
- Background and aims: Nursing home residents constitute a frail, multi-diseased and heterogeneous group. As physical activity is essential for the preservation of function, personalized training and activities are of great importance, The main objective of this study was to describe the influence of an individually tailored intervention program, in a nursing home setting, on physical capacity, degree of dependence in Activities of Daily Living (ADL), long-term participation in physical and/or daily activities, and self-rated wellbeing. The aim of the present work is to describe the overall design of the study. Methods: Nursing homes in Sweden, Norway and Denmark were involved, and 322 residents were randomized to either Intervention or Control groups. The intervention lasted for three months and consisted of physical and daily activities, led by physiotherapists and occupational therapists, and was built on their evaluations and on the goals expressed by each resident. Tests of muscle strength, mobility, balance function and confidence, ADL, level of physical activity, wellbeing and cognitive function were performed at baseline, directly after the intervention period and three months later. Results: They will be presented in articles to follow. Conclusions: Although it is a great challenge to carry out an intervention study directed toward such a frail population, it is of great interest to find out whether individually tailored and enhanced activities can lead to decreased dependence in ADL and increased wellbeing.
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| 9. |
- Gronstedt, Helena, et al.
(author)
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Effects of Individually Tailored Physical and Daily Activities in Nursing Home Residents on Activities of Daily Living, Physical Performance and Physical Activity Level : A Randomized Controlled Trial
- 2013
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In: Gerontology. - : S. Karger AG. - 0304-324X .- 1423-0003. ; 59:3, s. 220-229
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Journal article (peer-reviewed)abstract
- Background: Nursing home residents are extremely inactive and deterioration in health and an increasing dependence in activities of daily living (ADL) are common. Physical activity and exercise play a major role in the preservation of physical function and quality of life late in life. However, evidence for the benefit of rehabilitation in nursing home residents is conflicting and inconclusive. Objective: To evaluate the effect of an individually tailored intervention program of 3 months, for nursing home residents, on ADL, balance, physical activity level, mobility and muscle strength. Methods:In this single-blind randomized clinical trial with parallel groups, nursing home residents >64 years of age from three Nordic countries were included. The intervention group (IG) was assigned to individually tailored physical and daily activities, while the control group (CG) received ordinary care. Primary outcomes were ADL and balance, and secondary outcomes physical activity level, mobility and muscle strength. Results: At baseline, 322 nursing home residents were included, of whom 266 were assessed after 3 months of intervention. Following the intervention, a significant difference was found between participants in the IG and CG on measures of balance, physical activity and transfers. The IG significantly improved walking/wheelchair speed and functional leg muscle strength. The CG had significantly deteriorated in ADL, balance and transfers. Persons who had taken part in the intervention for more than 150 min/week significantly improved their balance and physical activity level. Participation in more than 10 weeks of intervention significantly improved physical activity and walking/wheelchair speed, while a deterioration was seen in those who had participated less. Conclusion: Individually tailored intervention in nursing home residents focusing on physical and daily activities is effective in improving transfers, balance and physical activity level compared to usual care. The effect of the intervention is dependent on the total activity time.
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| 10. |
- Idland, Gro, et al.
(author)
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Predictors of mobility in community-dwelling women aged 85 and older
- 2013
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In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 35:11, s. 881-887
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Journal article (peer-reviewed)abstract
- Purpose: To describe changes in mobility measured with the Timed Up and Go test (TUG) from baseline to follow-up 9 years later, and to examine which of the demographic, physical performance and health variables measured at baseline were predictors of the TUG at follow-up in a sample of women aged 85 or older. Method: This prospective cohort study included 113 community-dwelling women with a baseline mean age of 79.5 years. TUG was measured at baseline and at follow-up. The following baseline measurements were used as predictors: demographics, step-climbing ability, functional reach, and health. Results: At follow-up 110 women had decline in the TUG. Mean TUG scores at baseline and at follow-up were 6.7 s (SD = 1.3) and 13.2 s (SD = 6.8) respectively. Higher age, higher BMI, poorer results on; functional reach, step-climbing and self-rated health were independent predictors of poorer TUG at the 9-year follow-up. Exhibiting sufficient strength to climb a step of 40 cm or more protected significantly against mobility decline. Improving balance measured by the functional reach test by 1 cm lowered the probability of major mobility decline by 7%. Conclusions: Our results suggest that to decrease the risk of mobility decline focus should be on strength, balance and nutrition.
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