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1.
  • Hudson, Lawrence N, et al. (author)
  • The database of the PREDICTS (Projecting Responses of Ecological Diversity In Changing Terrestrial Systems) project
  • 2017
  • In: Ecology and Evolution. - : John Wiley & Sons. - 2045-7758. ; 7:1, s. 145-188
  • Journal article (peer-reviewed)abstract
    • The PREDICTS project-Projecting Responses of Ecological Diversity In Changing Terrestrial Systems (www.predicts.org.uk)-has collated from published studies a large, reasonably representative database of comparable samples of biodiversity from multiple sites that differ in the nature or intensity of human impacts relating to land use. We have used this evidence base to develop global and regional statistical models of how local biodiversity responds to these measures. We describe and make freely available this 2016 release of the database, containing more than 3.2 million records sampled at over 26,000 locations and representing over 47,000 species. We outline how the database can help in answering a range of questions in ecology and conservation biology. To our knowledge, this is the largest and most geographically and taxonomically representative database of spatial comparisons of biodiversity that has been collated to date; it will be useful to researchers and international efforts wishing to model and understand the global status of biodiversity.
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2.
  • Albrecht, Franziska, et al. (author)
  • Effects of a Highly Challenging Balance Training Program on Motor Function and Brain Structure in Parkinson's Disease
  • 2021
  • In: Journal of Parkinson's Disease. - : IOS Press. - 1877-7171 .- 1877-718X. ; 11:4, s. 2057-2071
  • Journal article (peer-reviewed)abstract
    • Background: Parkinson's disease (PD) is characterized by motor deficits and brain alterations having a detrimental impact on balance, gait, and cognition. Intensive physical exercise can induce changes in the neural system, potentially counteracting neurodegeneration in PD and improving clinical symptoms. Objective: This randomized controlled trial investigated effects of a highly challenging, cognitively demanding, balance and gait training (HiBalance) program in participants with PD on brain structure. Methods: 95 participants were assigned to either the HiBalance or an active control speech training program. The group-based interventions were performed in 1-hour sessions, twice per week over a 10-week period. Participants underwent balance, gait, cognitive function, and structural magnetic resonance imaging assessments before and after the interventions. Voxel-based morphometry was analyzed in 34 HiBalance and 31 active controls. Additionally, structural covariance networks were assessed. Results: There was no significant time by group interaction between the HiBalance and control training in balance, gait, or brain volume. Within-HiBalance-group analyses showed higher left putamen volumes post-training. In repeated measures correlation a positive linear, non-significant relationship between gait speed and putamen volume was revealed. In the HiBalance group we found community structure changes and stronger thalamic-cerebellar connectivity in structural covariance networks. Neither brain volume changes nor topology changes were found for the active controls after the training. Conclusion: Thus, subtle structural brain changes occur after balance and gait training. Future studies need to determine whether training modifications or other assessment methods lead to stronger effects.
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3.
  • Bendt, Martina, et al. (author)
  • Adults with spina bifida : A cross-sectional study of health issues and living conditions
  • 2020
  • In: Brain and Behavior. - : John Wiley & Sons. - 2162-3279 .- 2162-3279. ; 10:8
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: To describe health issues and living conditions in a cohort of adults living with Spina bifida.MATERIAL AND METHODS: A cross-sectional study was conducted by a multidisciplinary team. Adults with spina bifida (n = 219) were invited to participate. One-hundred-and-ninety-six persons (104 women and 92 men; 18-73 years, median age 33 years) were included. Structured interviews, questionnaires, and clinical assessments for medical, social, physical, and cognitive functions were used.RESULTS: There was large variation among participants as regards the consequences of their spina bifida. Individuals < 46 years seemed to have more secondary conditions such as hydrocephalus, Chiari II malformation, tethered cord symptoms, and latex allergy. A higher proportion of the individuals >46 years and older was able to walk, and they had performed better in primary school and on tests of psychomotor speed and executive function.CONCLUSIONS: This study demonstrates that adults with spina bifida have a complex set of physical, cognitive, and social needs that need to be addressed in order to improve their health issues and living conditions. The high prevalence of urinary and fecal incontinence, pain, and overweight underline that these issues need much attention during follow-up. The future generations of older adults may need more attention in many ways, since they at a younger age do have more complex medical conditions, lower physical and cognitive functions, and lower prerequisites for independent living and participation in society than those > 46 years today. This elucidates that adults with spina bifida need systematic follow-up services and social support throughout life.
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4.
  • Bendt, Martina, et al. (author)
  • Adults with spina bifida : Ambulatory performance and cognitive capacity in relation to muscle function
  • 2022
  • In: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 60:2, s. 122-128
  • Journal article (peer-reviewed)abstract
    • STUDY DESIGN: Cross-sectional study.OBJECTIVE: Describe and compare ambulatory performance and cognitive capacity in relation to muscle function in an adult cohort with spina bifida. Also, explore factors associated with ambulation in participants with muscle function level 3.SETTING: Specialist clinic for adults with spinal cord disorders in Stockholm, Sweden.METHODS: A total regional cohort of adults (n = 219) with spina bifida was invited, 196 (104 women, mean age 35 years, SD 13 years) participated. Mode of mobility, cognitive capacity and muscle function were investigated. For participants with muscle function level 3, factors associated with ambulation were investigated using multivariate logistic regression analysis.RESULTS: In all, 84 participants (42%) were community ambulators, 22 (12%) household ambulators and 90 (46%) wheelchair users. There was a linear association between the lower degree of muscle function and scoliosis (P < 0.001). Mode of mobility varied despite similar muscle prerequisites in participants with muscle function level 3 (n = 58). Factors associated with ambulation in participants with muscle function level 3 were the absence of scoliosis, lower BMI and higher cognitive capacity.CONCLUSIONS: Cognitive capacity and mode of mobility varied widely across the cohort. However, in participants with muscle function level 3, despite similar muscular prerequisites, a large variation in the mode of mobility was found, suggesting that other factors were involved. It is important to prevent scoliosis, support a healthy lifestyle, as well as offer cognitive screening and support to promote ambulatory function and optimise independence in the everyday lives of adults with spina bifida.
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5.
  • Bendt, Martina, et al. (author)
  • Gait and dynamic balance in adults with spina bifida
  • 2022
  • In: Gait & Posture. - : Elsevier BV. - 0966-6362 .- 1879-2219. ; 96, s. 343-350
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Spina bifida (SB) is a complex congenital malformation, often causing impaired gait performance depending on the level and extent of malformation. Research regarding gait and balance performance in adults with SB, has not been sufficiently described yet.RESEARCH QUESTION: What are the characteristics of spatiotemporal gait parameters and balance performance in adults with SB? Further, do persons with muscle function (MF) level 3 differ regarding gait and balance performance from those with MF level 1-2?METHODS: Cross-sectional observational study at an outpatient clinic. 41 adults with SB (18-65 years), who walked regularly. Spatiotemporal parameters of gait was assessed with the APDM system and balance performance with the Mini Balance Evaluation Systems Test (Mini-BESTest). Muscle strength in the legs was assessed with 0-5 manual muscle test, and participants were classified according to level of MF into groups MF1, MF2, and MF3. Two-sided t-test was used for parametric independent variables, and Cohen's d was used for effect sizes. The Mann-Whitney U test was used for non-parametric independent data and effect size was calculated by the z value (r = z/√n).RESULTS: Mean gait speed was 0.96 (SD 0.20) m/s and mean stride length 1.08 m (SD 0.17), individuals with MF3 showed significantly slower gaitspeed and shorter stride length (p < 0.05). Lumbar rotation was 21° (SD 11), and thoracic lateral sway 15° (IQR 15) with significantley difference (p < 0.001 and p < 0.05) for individuals in MF3. Mini-BESTest showed a mean score of 11.3 (SD 6.9), and individuals with MF3 showed significantly lower scores (p ≤ 0.001).SIGNIFICANCE: Gait and balance performance was reduced compared to normative data in almost all parameters, especially in persons with less muscle function. Increased knowledge from advanced gait analysis may help healthcare professionals to design rehabilitation programmes, in order to achieve and maintain a sustainable gait and balance performance.
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6.
  • Bendt, Martina, et al. (author)
  • Living and health conditions for adults with spina bifida in Sweden – a comprehensive prevalence group study
  • 2018
  • Conference paper (peer-reviewed)abstract
    • Introduction Seventy-five per-cents of children born with Spina Bifida (SB) are expected to live into adulthood, meaning that the adults will need more attention in the future. Adulthood involves great demands for persons with SB, but also for their families, the social well-fare and healthcare systems, as the group has a persistent need for care and support. The aim is to describe the living and health conditions for adults with Spina Bifida in different life stages including medical, physical, psychological, cognitive and social aspects. Methods A cross-sectional study conducted by a multidisciplinary team. Data collection was performed through structured interviews, questionnaires and clinical assessments. All individuals > 18 years with SB (n=219) registered at a regional outpatient clinic were offered participation; 196 persons (104 women, 92 men 18-73 years) were included. Results There was a great variation in the group concerning problems related to their congenital injury. The persons > 45 years and especially > 61 years seems to have less problems such as less prevalence of hydrocephalus, Chiari II malformation, tethered cord syndrome and they also walked to a higher extent. They passed elementary school to a higher extent and performed better on the tests for psychomotor speed and executive function. Conclusions The study shows the multifaceted problems this group is facing as adults with SB and contributes to increased knowledge concerning the living and health conditions. Increased knowledge can lead to targeted interventions and better care, thereby decreasing secondary complications, reducing costs for society and hopefully increasing quality of life for persons with SB and their families.
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7.
  • Brogren, Elisabeth, et al. (author)
  • Striatal hand deformities in Parkinson's disease - hand surgical perspectives
  • 2022
  • In: Movement Disorders Clinical Practice. - : Wiley. - 2330-1619. ; 9:8, s. 1047-1054
  • Journal article (peer-reviewed)abstract
    • BackgroundThe knowledge about striatal hand deformities (SHD) in Parkinson’s disease (PD), has recently increased but need more attention due to their early impact on dexterity. The focus of clinical studies has been on the staging of SHD severity and neurological features. However, a hand surgical perspective has not been considered.ObjectivesOur purpose was to examine SHD in patients with PD using hand surgical assessmentmethods and the recommended staging of SHD.MethodsIn this observational study, a specialist in neurological physiotherapy examined 100 consecutive PD patients and identified 35 with suspected SHD, who were thenexamined by two hand surgeons. Their hands were clinically evaluated for severity of SHD, according to a previous proposed staging, focusing on metacarpophalangeal (MCP) joint flexion, presence of intrinsic and extrinsic tightness, as well as other hand deformities.ResultsThree kinds of deformities were identified among 35 included patients: surgicaldiagnoses unrelated to PD (n=5), SHD (n=23), and PD related hand deformities with increased extrinsic tightness (n=10); three of these 10 patients had also contralateral SHD, thus are included in SHD group. In addition to previously described MCP joint flexion, swan neck deformity and z-thumb deformity, we found in most hands finger “clefting”, abduction of the little finger and/or an increased intrinsic tightness, indicating pathology of intrinsic muscles of the hand involved in SHD.ConclusionsSHD diagnosed with a modified staging method, including features of intrinsic andextrinsic hand deformities, should be considered in PD to implement early and more accurate treatment
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8.
  • Ek, Stina, et al. (author)
  • Predicting First-Time Injurious Falls in Older Men and Women Living in the Community : Development of the First Injurious Fall Screening Tool
  • 2019
  • In: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 20:9, s. 1163-
  • Journal article (peer-reviewed)abstract
    • Objectives: The aim of this study was to create a screening tool to predict first-time injurious falls in community-living older men and women. Design: Longitudinal cohort study between 2001 and 2009. Setting: The Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), Sweden. Participants: Community-living older adults (n = 2808; 1750 women and 1058 men) aged >= 60 years (mean age 73, standard deviation 10.3). Measurements: The outcome was injurious falls within 5 years from baseline survey. Data on the risk factors for falls were collected through interviews, clinical examinations, and tests at baseline. Several previously established fall risk factors were identified for the development of the screening tool. The tool was formulated based on the beta coefficients from sex-specific multivariate Cox proportional hazards models. The discriminative power was assessed using Harrell C statistic. Results: Old age, living alone, being dependent in instrumental activities of daily living, and impaired balance were the factors included in the final score of the First Injurious Fall (FIF) screening tool. The predictive values (Harrell C statistic) for the scores were 0.75 for women and 0.77 for men. The sensitivity and specificity at the Youden cut-off points were 0.69 and 0.70 for women, and 0.72 and 0.71 for men. Conclusions and Implications: The FIF screening tool for first injurious fall in older persons consists of 3 questions and a physical test (5-second 1-leg standing balance with eyes open). Quick and easy to administer, it could be ideal for use in primary care or public health to identify older men and women at high fall risk, who may benefit from primary preventive interventions.
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11.
  • Franzén, Erika, et al. (author)
  • Depressive symptoms associated with concerns about falling in Parkinson's disease
  • 2016
  • In: Brain and Behavior. - : Wiley. - 2162-3279. ; 6:10
  • Journal article (peer-reviewed)abstract
    • Background: Concerns about falling, a construct related to fear of falling, is increased in people with Parkinson's disease (PD) and is recognized as a barrier for exercise, negatively affecting health-related quality of life and participation. Aim: To investigate modifiable factors associated with concerns about falling in elderly with mild-to-moderate PD. Methods: Eighty-nine elderly (39 females, mean age 73 years) with mild-to-moderate PD were recruited. Concerns about falling were assessed with the Falls Efficacy Scale-international, that is, the dependent variable in multiple linear regression analysis. Independent variables included both motor (e.g., objective measures of physical activity and gait) and nonmotor aspects such as depressive symptoms. Results: A model with three significant independent variables explained 33% of the variance in concerns about falling. According to the standardized regression coefficients (β), the strongest contributing factor was depressive symptoms (0.40), followed by balance performance (−0.25), and use of mobility devices (0.24). Conclusions: The findings imply that factors associated with concerns about falling are a multifactorial phenomenon. For its management in elderly with mild-to-moderate PD, one should consider depressive symptoms, balance deficits, and mobility devices.
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12.
  • Franzén, Erika, et al. (author)
  • The EXPANd trial : effects of exercise and exploring neuroplastic changes in people with Parkinson's disease
  • 2019
  • In: BMC Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 19:1
  • Journal article (peer-reviewed)abstract
    • Background: Parkinson's disease (PD) affects many physiological systems essential for balance control. Recent studies suggest that intensive and cognitively demanding physical exercise programs are capable of inducing plastic brain changes in PD. We have developed a highly challenging balance training (the HiBalance) program that emphasizes critical aspects of balance control through progressively introducing more challenging exercises which incorporates dual-tasking. Earlier studies have shown it to be effective in improving balance, gait and dual-tasking. The study design has thereafter been adjusted to link intervention-induced behavioral changes to brain morphology and function. Specifically, in this randomized controlled trial, we will determine the effects of the HiBalance program on balance, gait and cognition and relate this to task-evoked functional MRI (fMRI), as well as brain-derived neurotrophic factor (BDNF) in participants with mild-moderate PD.Methods: One hundred participants with idiopathic PD, Hoehn & Yahr stage 2 or 3, >= 60 years of age, >= 21 on Montreal Cognitive Assessment will be recruited in successive waves and randomized into either the HiBalance program or to an active control group (the HiCommunication program, targeting speech and communication). Both interventions will be performed in small groups, twice a week with 1 h sessions for 10 weeks. In addition, a 1 h, once a week, home exercise program will also be performed. A double-blinded design will be used. At the pre- and post-assessments, participants will be assessed on balance (main outcome), gait, cognitive functions, physical activity, voice/speech function, BDNF in serum and fMRI (3 T Philips) during performance of motor-cognitive tasks.Discussion: Since there is currently no cure for PD, findings of neuroplastic brain changes in response to exercise would revolutionize the way we treat PD, and, in turn, provide new hope to patients for a life with better health, greater independence and improved quality of life.
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13.
  • Freidle, Malin, et al. (author)
  • Measuring implicit sequence learning and dual task ability in mild to moderate Parkinson's disease: A feasibility study
  • 2021
  • In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:5
  • Journal article (peer-reviewed)abstract
    • We investigated the feasibility aspects of two choice reaction time tasks designed to assess implicit sequence learning and dual task ability in individuals with mild to moderate Parkinson's disease in comparison to healthy individuals. Twelve individuals with mild to moderate Parkinson's disease and 12 healthy individuals, all . 60 years of age, were included. A serial reaction time task was used as a measure of implicit sequence learning and a similar task but with the addition of a simple counting task, was used as a measure of dual task ability. We have present thorough descriptive statistics of the data but we have refrained from any inferential statistics due to the small sample size. All participants understood the task instructions and the difficulty level of both tasks was deemed acceptable. There were indications of task fatigue that demand careful choices for how best to analyse the data from such tasks in future trials. Ceiling effects were present in several accuracy outcomes, but not in the reaction time outcomes. Overall, we found both tasks to be feasible to use in samples of individuals with mild to moderate Parkinson's disease and healthy older individuals.
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14.
  • Frisendahl, Nathalie, et al. (author)
  • Can the 1-Leg Standing Test Be Replaced by Self-reported Balance in the First-Time Injurious Fall Screening Tool?
  • 2023
  • In: Journal of Geriatric Physical Therapy. - : Lippincott Williams & Wilkins. - 1539-8412 .- 2152-0895. ; 46:2, s. 103-109
  • Journal article (peer-reviewed)abstract
    • Background and Purpose:  The First-time Injurious Fall (FIF) screening tool was created to identify fall risk in community-living older men and women, who may be targets for primary preventive interventions. The FIF tool consists of 3 self-reported questions and 1 physical test (1-leg standing balance). The purpose of this study was to examine the predictive ability of the FIF tool and a modified FIF tool (in which 1-leg standing is replaced by self-reported balance) for first-time injurious falls.Methods:  A cohort of 1194 community-living people 60 years and older from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), Sweden, was followed longitudinally for 5 years. Data on injurious falls were collected from registered data and were defined as receipt of care after a fall. The predictive ability of the FIF tool and the m-FIF tool was explored using Harrell's C statistic, stratified by sex.Results and Discussion:  The injurious fall rate per 1000 person-years was 54.9 (95% CI: 47.22-63.78) for women and 36.3 (95% CI: 28.84-45.78) for men. The predictive ability for women and men according to Harrell's C statistic was 0.70 and 0.71 for the FIF tool and the m-FIF tool. The predictive ability was 0.70 and 0.69 for 1-leg standing, and 0.65 and 0.60 for self-reported balance problems.Conclusions:  The m-FIF tool presented similar predictive ability as the FIF tool regarding first-time injurious falls. This finding could extend the usefulness of the tool to other settings, such as to electronic health (eHealth). A quickly and easily administered screening tool can help physical therapists to identify people with a high risk of falling who may need to undergo a more comprehensive fall risk assessment.
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15.
  • Gronstedt, Helena, et al. (author)
  • Effect of Sit-to-Stand Exercises Combined With Protein-Rich Oral Supplementation in Older Persons : The Older Person's Exercise and Nutrition Study
  • 2020
  • In: Journal of the American Medical Directors Association. - : ELSEVIER SCIENCE INC. - 1525-8610 .- 1538-9375. ; 21:9, s. 1229-1237
  • Journal article (peer-reviewed)abstract
    • Objectives: Nursing home (NH) residents are often undernourished and physically inactive, which contributes to sarcopenia and frailty. The Older Person's Exercise and Nutrition Study aimed to investigate the effects of sit-to-stand exercises (STS) integrated into daily care, combined with a protein-rich oral nutritional supplement (ONS), on physical function, nutritional status, body composition, health-related quality of life, and resource use. Design: Residents in 8 NHs were randomized by NH units into an intervention group (IG) or a control group (CG) (n = 60/group). The IG was a combination of STS (4 times/day) and ONS (2 bottles/day providing 600 kcal and 36 g protein) for 12 weeks. Setting and Participants: The participants resided in NH units (dementia and somatic care), were >= 75 years of age, and able to rise from a seated position. Methods: The 30-second Chair Stand Test was the primary outcome. Secondary outcomes were balance, walking speed, dependence in activities of daily living, nutritional status and body composition, health-related quality of life, and resource use. Results: Altogether, 102 residents (age 86 +/- 5 years, 62% female) completed the study. No improvement in the physical function assessments was observed in the IG, whereas body weight increased significantly (2.05 +/- 3.5 kg, P = .013) vs the CG. Twenty-one (of 52) participants with high adherence to the intervention (ie, at least 40% compliance to the combined intervention) increased their fat free mass (2.12 kg (0.13, 4.26 interquartile range), P = .007 vs CG). Logistic regression analyses indicated that the odds ratio for maintained/improved 30-second Chair Stand Test was 3.5 (confidence interval 1.1, 10.9, P = .034) among the participants with high adherence compared with the CG. Conclusions/Implications: Twelve-week intervention of daily STS combined with ONS in NH residents did not improve physical function, but increased body weight. Subgroup analyses indicated that high adherence to the combined intervention was associated with maintained or improved physical function and a gain of fat free mass. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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  • Grönstedt, Helena, et al. (author)
  • A study protocol of Older Person's Exercise and Nutrition Study (OPEN) - a sit-to-stand activity combined with oral protein supplement - effects on physical function and independence : a cluster randomized clinical trial
  • 2018
  • In: BMC Geriatrics. - : BIOMED CENTRAL LTD. - 1471-2318. ; 18
  • Journal article (peer-reviewed)abstract
    • Background: Poor nutrition and age per see add to the development of sarcopenia, i.e. loss of muscle mass and strength, which contributes to increased risk of impaired activities of daily living (ADL) and reduced independence. Protein deficiency plays an important role in the development of sarcopenia. In order to increase the muscle mass protein intake should be combined with physical exercise. A daily physical activity, the sit-to-stand exercise, has been proven to decrease older persons' dependence in ADL. Our study aims to evaluate the effects of the sit-to-stand exercise in combination with a protein-rich nutritional supplement, on physical function and independence in frail nursing home residents. The resident's perceptions and experiences of the intervention and the staff's experiences of supporting the resident to complete the intervention will also be explored.Methods: The study is a two-arm cluster-randomized controlled trial which will be performed in nursing homes at two municipalities in Sweden. We will recruit 120 residents, age 75 or older and able to stand up from a seated position. Residents (n = 60) randomized to the intervention group will perform the sit-to-stand exercise at four occasions daily and will be offered a protein-rich oral supplement, twice a day. The intervention period will last for 12 weeks and measures of physical function, nutritional status, quality of life and health economy will be performed at baseline and at 12-weeks follow-up. The primary outcome will be the number of chair rises performed in 30 s. The control group will receive standard care. Data will be analysed by intention-to-treat analysis and with mixed effect models. During the last part of the intervention period individual interviews with the residents, on the topic of feasibility with the OPEN concept will be held. Likewise, focus-group-interviews with staff will be performed.Discussion: The residents' physical and mental health could be expected to improve. Even the work situation for staff could be positively affected. One innovative feature of the OPEN study is the simple intervention consisting of a basic daily activity that can be performed by several nursing home residents with the support of existing staff and available resources.
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17.
  • Holmlund, Tobias, et al. (author)
  • Defining accelerometer cut-points for different intensity levels in motor-complete spinal cord injury.
  • 2020
  • In: Spinal Cord. - : Nature Publishing Group. - 1362-4393 .- 1476-5624. ; 58, s. 116-124
  • Journal article (peer-reviewed)abstract
    • STUDY DESIGN: Descriptive.OBJECTIVE: The present aim was to define accelerometer cut-point values for wrist-worn accelerometers to identify absolute- and relative-intensity physical activity (PA) levels in people with motor-complete paraplegics (PP) and tetraplegics (TP).SETTINGS: Rehabilitation facility in Sweden.METHODS: The participants were 26 (19 men, 7 women) with C5-C8, AIS A and B (TP) and 37 (27 men, 10 women) with T7-T12 (PP), AIS A and B. Wrist-worn accelerometer recordings (Actigraph GT3X+) were taken during seven standardized activities. Oxygen consumption was measured, as well as at-rest and peak effort, with indirect calorimetry. Accelerometer cut-points for absolute and relative intensities were defined using ROC-curve analyses.RESULTS: The ROC-curve analyses for accelerometer cut-points revealed good-to-excellent accuracy (AUC >0.8), defining cut-points for absolute intensity (2, 3, 4, 5, 6, 7 METs for PP and 2 to 6 METs for TP) and relative intensity (30, 40, 50, 60, 70, and 80% for PP and 40-80% for TP). The cut-points for moderate-to-vigorous physical activity was defined as ≥9515 vector magnitude counts per minute (VMC) for PP and ≥4887 VMC/min for TP.CONCLUSION: This study presents cut-points for wrist-worn accelerometers in both PP and TP, which could be used in clinical practice to describe physical activity patterns and time spent at different intensity levels.
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18.
  • Holmlund, Tobias, et al. (author)
  • Energy expenditure after spinal cord injury in people with motor-complete tetraplegia or motor-complete paraplegia.
  • 2018
  • In: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 56:3, s. 274-283
  • Journal article (peer-reviewed)abstract
    • STUDY DESIGN: Cross-sectional.OBJECTIVES: This study aimed to describe and compare VO2 and energy expenditure at rest (REE) and during standardized sedentary, non-exercise physical activity, and exercise activities, in people with motor-complete tetraplegia (C5-C8). Further, REE and energy expenditure (EE) for the different activities were compared to data from a reference group of people with motor-complete paraplegia (T7-T12).SETTING: Sweden.METHODS: The sample of people with motor-complete tetraplegia consisted of 26 adults (seven women) with SCI, C5-C8 AIS A-B. REE and EE for the different activities were measured with indirect calorimetry. The results were further compared to people with motor-complete paraplegia.RESULTS: Resting VO2 was 2.57 ml O2 kg-1 min-1, 2.54 for men and 2.60 for women. The VO2 or activity energy expenditure related to body weight increased three to four times during non-exercise physical activity compared to sedentary activities for the people with motor-complete tetraplegia, and up to six times during exercise activity. No significant differences were seen in resting or sedentary activity VO2 between the people with motor-complete tetraplegia and those with motor-complete paraplegia. Activities of daily life revealed no or small differences in VO2, except for setting a table, while the people with tetraplegia had ∼50% lower VO2 during exercise activities.CONCLUSIONS: Non-exercise physical activities of daily life may be significant for increasing total daily EE in people with motor-complete tetraplegia. This might act to motivate the individual, and might be clinically important when designing adapted lifestyle intervention programs for the target group.
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  • Holmlund, Tobias, et al. (author)
  • Intensity of physical activity as a percentage of peak oxygen uptake, heart rate and Borg RPE in motor-complete para- and tetraplegia.
  • 2019
  • In: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 14:12
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: The aims were to describe VO2peak, explore the potential influence of anthropometrics, demographics and level of physical activity within each cohort; b) to define common, standardized activities as percentages of VO2peak and categorize these as light, moderate and vigorous intensity levels according to present classification systems, and c) to explore how clinically accessible methods such as heart-rate monitoring and Borg rating of perceived exertion (RPE) correlate or can describe light, moderate and vigorous intensity levels.DESIGN: Cross sectional.SETTING: Rehabilitation facility and laboratory environment.SUBJECTS: Sixty-three individuals, thirty-seven (10 women) with motor-complete paraplegia (MCP), T7-T12, and twenty-six (7 women) with motor-complete tetraplegia (MCT), C5-C8.INTERVENTIONS: VO2peak was obtained during a graded peak test until exhaustion, and oxygen uptake during eleven different activities was assessed and categorized using indirect calorimetry.MAIN OUTCOME MEASURES: VO2peak, Absolute and relative oxygen consumption, Borg RPE.RESULTS: Absolute VO2peak was significantly higher in men than in women for both groups, with fairly small differences in relative VO2peak. For MCP sex, weight and time spent in vigorous-intensity activity explained 63% of VO2peak variance. For MCT sex and time in vigorous-intensity activity explained 55% of the variance. Moderate intensity corresponds to 61-72% HRpeak and RPE 10-13 for MCP vs. 71-79% HRpeak, RPE 13-14 for MCT.CONCLUSION: Using current classification systems, eleven commonly performed activities were categorized in relative intensity terms, (light, moderate and vigorous) based on percent of VO2peak, HRpeak and Borg RPE. This categorization enables clinicians to better guide persons with SCI to meet required physical activity levels.
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20.
  • Johansson, Gudrun M, 1963- (author)
  • Clinical and kinematic assessments of upper limb function in persons with post-stroke symptoms
  • 2015
  • Doctoral thesis (other academic/artistic)abstract
    • Stroke is a common and multifaceted disease that often involves motor deficits in the upper limb. This thesis investigated reliability and validity of existing clinical assessments of upper limb function in persons with post-stroke symptoms and in non-disabled controls. Study I was conducted in a clinical setting where the Motor Evaluation Scale of Upper Extremity in Stroke patients (MESUPES) was assessed in persons post-stroke by two physiotherapists selected from a group of four.  Study II-IV took place in a motion analysis laboratory with an optoelectronic system. Kinematic measures and clinical measures were used to investigate the validity of the Arm Posture Score (APS), the Finger-to-Nose test (FNT), and the Standardised Nine Hole Peg test (S-NHPT) in persons post-stroke and non-disabled controls. The results showed that the MESUPES had a high inter-rater reliability while the concurrent validity was not fully confirmed. MESUPES has a maximum score of 58 and the minimal detectable change ranged from 5 to 8 for a confidence level of 80% and 95%. The Arm Posture Scores, which include either four or six arm movement variables, were able to distinguish between the affected and non-affected arms, as well as between the affected arm and the non-dominant arm of the controls. The total movement time of the FNT, which is a coordination test, was able to distinguish persons post-stroke from controls, at least at a group level. Movement smoothness, accuracy and compensation, obtained from kinematic analysis, were the most discriminative variables for the FNT. Smoothness was most strongly correlated with the timed FNT and had the greatest association with the variance of the timed FNT. For the S-NHPT, which is a dexterity test involving grasping and reaching, the movement times, smoothness and compensation discriminated between the stroke group and the control group. Persons post-stroke spent considerably more time in the grasp-related parts of the task compared to controls. Smoothness and upper limb impairments had the strongest correlation with the S-NHPT. In conclusion, the clinical measures used within stroke rehabilitation seem valid and reliable, although some limitations are highlighted by the kinematic assessment. MESUPES was shown to be a reliable assessment of upper limb movement quality after stroke. The kinematic analysis revealed that the timed FNT does not have sufficient discriminative validity at an individual level. The timed FNT reflected speed-related aspects of pointing movements such as smoothness and length of the deceleration phase, but should not be used as an overall measure of upper limb coordination after stroke. The timed S-NHPT demonstrated sufficient discriminative validity and reflected smoothness and upper limb impairments. For both the FNT and S-NHPT, kinematic analysis showed that the clinical outcomes of those tests (time of performance) did not adequately detect qualitative aspects of the upper limb movements after stroke such as possible compensatory movements. Therefore, clinical assessments that capture qualitative aspects of upper limb movements would improve the assessment of upper limb coordination and dexterity after stroke. In addition, 3D movement analysis provided unique information about upper limb function after stroke, not least in persons with mild post-stroke impairments. The APS, for instance, which quantifies how much the arm swing during gait deviates from normal, discriminated between persons with stroke and non-disabled persons. Such subtle deviations are not possible to quantify with the human eye.
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21.
  • Johansson, Hanna, et al. (author)
  • Controlling the uncontrollable : Perceptions of balance in people with parkinson disease
  • 2019
  • In: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 99:11, s. 1501-1510
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Exercise improves balance in Parkinson disease (PD), yet the majority of people with the diagnosis are physically inactive. Insights gained from understanding how people with PD (PwPD) make sense of their symptoms and their ability to control them may inform the communication strategies and motivational approaches adopted by physical therapists. No previous study has qualitatively explored how PwPD perceive the concept of balance and the beliefs they hold concerning their ability to affect balance.OBJECTIVE: This study aimed to explore the meaning of balance for PwPD and the beliefs they hold regarding their ability to influence their balance in everyday life.DESIGN: The design is a qualitative study with an inductive approach.METHODS: In-depth interviews were conducted with 18 participants with PD (age range 46 to 83 years, Hoehn and Yahr range 1 to 4), and transcripts were analyzed using qualitative content analysis.RESULTS: Five main themes emerged from the analysis: remaining in control over the body; adapting behavior to deal with uncertainty; directing focus to stay one step ahead; resilience as a defense, and exercise beliefs and reservations. Interpretation of the underlying patterns in the main themes yielded the overarching theme of focus and determination to regain control over shifting balance.CONCLUSIONS: The concept of balance was perceived as both bodily equilibrium and mind-body interplay and was described in the context of remaining in control over one's body and everyday life. Cognitive resources were utilized in order to direct focus and attention during balance-challenging situations in a process involving internal dialogue. Even participants who did not express beliefs in their ability to affect balance through exercise used psychological resilience to counter the challenges of impaired balance.
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22.
  • Johansson, Hanna, et al. (author)
  • Exercise-induced neuroplasticity in Parkinson's disease : A metasynthesis of the literature
  • 2020
  • In: Neural Plasticity. - : Hindawi Limited. - 2090-5904 .- 1687-5443. ; 2020
  • Research review (peer-reviewed)abstract
    • Parkinson's disease (PD) is a neurodegenerative disorder for which there is currently only symptomatic treatment. During the last decade, there has been an increased interest in investigating physical exercise as a neuroprotective mechanism in PD. Animal studies have suggested that exercise may in fact induce neuroplastic changes, but evidence in humans is still scarce. A handful of reviews have previously reported on exercise-induced neuroplasticity in humans with PD, but few have been systematic, or have mixed studies on both animals and humans, or focused on one neuroplastic outcome only. Here, we provide a systematic review and metasynthesis of the published studies on humans in this research field where we have also included different methods of evaluating neuroplasticity. Our results indicate that various forms of physical exercise may lead to changes in various markers of neuroplasticity. A narrative synthesis suggests that brain function and structure can be altered in a positive direction after an exercise period, whereas a meta-analysis on neurochemical adaptations after exercise points in disparate directions. Finally, a GRADE analysis showed that the current overall level of evidence for exercise-induced neuroplasticity in people with PD is very low. Our results demonstrate that even though the results in this area point in a positive direction, researchers need to provide studies of higher quality using more rigorous methodology.
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23.
  • Johansson, Hanna, et al. (author)
  • Feasibility aspects of exploring exercise-induced neuroplasticity in Parkinson's disease : A pilot randomized controlled trial
  • 2020
  • In: Parkinson's Disease. - : Hindawi Limited. - 2090-8083 .- 2042-0080. ; 2020
  • Journal article (peer-reviewed)abstract
    • Background: Recent studies indicate that exercise can induce neuroplastic changes in people with Parkinson's disease (PwPD). Reports of feasibility outcomes from existing pilot trials however are, of date, insufficient to enable replication by others in larger definitive trials.Objective: To evaluate trial design for a definitive trial by exploring process and scientific feasibility.Methods: The trial design was a parallel-group RCT pilot with a 1 : 1 allocation ratio to either HiBalance or an active control group (HiCommunication). Both groups received one-hour sessions twice weekly, plus home exercises weekly, for 10 weeks. Participants with mild-to-moderate Parkinson's disease (PD) were recruited via advertisement. Assessment included physical performance, structural and functional MRI, blood sampling, neuropsychological assessment, and speech/voice assessment. Process and scientific feasibility were monitored throughout the study. Process feasibility involved recruitment, participant acceptability of assessments and interventions, assessment procedures (focus on imaging, blood sampling, and dual-task gait analysis), and blinding procedures. Scientific feasibility involved trends in outcome response and safety during group training and home exercises. Data are presented in median, minimum, and maximum values. Changes from pre- to postintervention are reported descriptively.Results: Thirteen participants were included (4 women, mean age 69.7 years), with a recruitment rate of 31%. Attendance rates and follow-up questionnaires indicated that both groups were acceptable to participate. Image quality was acceptable; however, diplopia and/or sleepiness were observed in several participants during MRI. With regard to dual-task gait performance, there appeared to be a ceiling effect of the cognitive tasks with seven participants scoring all correct answers at pretest. Blinding of group allocation was successful for one assessor but was broken for half of participants for the other.Conclusions: The overall trial design proved feasible to perform, but further strengthening ahead of the definitive RCT is recommended, specifically with respect to MRI setup, cognitive dual-tasks during gait, and blinding procedures. This trial is registered with NCT03213873.
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24.
  • Jonasson, Stina B., et al. (author)
  • Prediction of Life Satisfaction in People with Parkinson's Disease
  • 2020
  • In: Parkinson's Disease. - : Hindawi Limited. - 2042-0080 .- 2090-8083. ; 2020
  • Journal article (peer-reviewed)abstract
    • Introduction. People with Parkinson's disease (PD) have lower life satisfaction (LS) than healthy peers. No study has yet identified predictors of LS in people with PD. Such information would be valuable for health care and future interventions that aim to maintain or increase LS. Aim. To examine how LS evolved in people with PD over a 3-year period, as well as to identify predictive factors of LS. Methods. We used data from baseline assessments and a 3-year follow-up of 163 people with PD (baseline, mean age 68 years; median PD duration 8 years, 35% women). LS was assessed with item 1 of the Life Satisfaction Questionnaire (LiSat-11). Dichotomized LS data from the 3-year follow-up were used as the dependent variable in multivariable logistic regression analyses. In the first step, independent variables included baseline information on sex, education, general self-efficacy, motor symptoms, perceived walking difficulties, fall-related activity avoidance, and difficulties with/need help in activities of daily living. At the second step, depressive symptoms were added as an independent variable. Results. The proportion of those who reported being satisfied with their lives reduced from 63.2% at baseline to 49.7% 3 years later (p=0.003). When depressive symptoms were not included in the analysis, general self-efficacy (odds ratio, OR = 1.081; 95% CI = 1.019-1.147) and perceived walking difficulties (OR = 0.962; 95% CI = 0.929-0.997) were significant (p<0.05) predictors of LS 3 years later. With depressive symptoms included, the influence of walking difficulties diminished, and depressive symptoms (OR = 0.730; 95% CI = 0.607-0.877) and general self-efficacy (OR = 1.074; 95% CI = 1.010-1.142) were the only significant predictors of LS 3 years later. Conclusions. LS is reduced over a 3-year period. The study suggests that perceived walking difficulties, general self-efficacy, and depressive symptoms are important predictors of LS in people with PD.
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25.
  • Karlsson, Emelie S., et al. (author)
  • Response and Adherence of Nursing Home Residents to a Nutrition/Exercise Intervention
  • 2021
  • In: Journal of the American Medical Directors Association. - : Elsevier. - 1525-8610 .- 1538-9375. ; 22:9, s. 1939-1945.e3
  • Journal article (peer-reviewed)abstract
    • Objectives: Interindividual response variability to nutrition and exercise interventions is extensive in older adults. A group of nursing home (NH) residents participated in a combined intervention. The objective of this post-hoc analysis was to identify factors associated with intervention response measured by change in physical function and body composition. Design: Post-hoc analyses in the Older Person's Exercise and Nutrition study, a 2-arm randomized trial. The primary outcomes were 30-second Chair Stand Test and composite scores combining physical function and fat-free mass. A secondary outcome was intervention adherence. A 12-week intervention of sit-to-stand exercises and protein-rich nutritional supplements did not improve chair-stand capacity vs control on intention-to-treat basis. Setting and Participants: Residents >75 years of age from dementia and somatic units in eight NHs in Sweden. Methods: Logistic regressions were performed to define factors associated with response (maintenance/ improvement) or nonresponse (deterioration) in 30-second Chair Stand Test, and with intervention adherence. Linear regressions were performed to explore factors associated with response in composite scores. Results: Mean age of participants (n = 52 intervention, n = 49 control) was 85.8 years. Sarcopenia was occurring in 74%. Sarcopenia at baseline (P = .005) and high adherence to nutritional supplements (P = .002) increased the odds of response. Higher independence in daily activities increased the odds of adherence to sit-to-stand exercises (P =.027) and the combined intervention (P = .020). Allocation to the intervention group and higher self-perceived health were associated with higher composite scores. Conclusions and Implications: NH residents with baseline sarcopenia, better self-perceived health, and high adherence to nutritional supplements benefitted most from a combined nutrition and exercise intervention regarding chair-stand capacity and composite scores of function and fat-free mass. Adherence was related to higher grade of independence. Understanding factors associated with response and adherence to an intervention will help target susceptible residents in most need of support and to optimize the outcome.
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26.
  • Kerstens, Vera S, et al. (author)
  • Reliability of dopamine transporter PET measurements with [18F]FE-PE2I in patients with Parkinson's disease.
  • 2020
  • In: EJNMMI Research. - : Springer Nature. - 2191-219X. ; 10:1
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Reliable quantification of dopamine transporter (DAT), a biomarker for Parkinson's disease (PD), is essential for diagnostic purposes as well as for evaluation of potential disease-modifying treatment. Due to degeneration of dopaminergic neurons and thus lower expected radioligand binding to DAT, higher measurement variability in PD patients might be expected than earlier reproducibility results in healthy controls. Therefore, we aimed to examine the test-retest properties of [18F]FE-PE2I-PET in PD patients.METHODS: Nine patients with PD (Hoehn and Yahr stage < 3) were included (men/women 6/3; mean age 65.2 ± 6.8 years). Each patient underwent two [18F]FE-PE2I-PET measurements within 7-28 days. The outcome measure was non-displaceable binding potential generated using wavelet-aided parametric imaging with cerebellum as reference region. We assessed test-retest performance using estimates of reliability and repeatability. Regions for primary analysis were caudate, putamen, ventral striatum, and substantia nigra. Exploratory analysis was performed for functional subdivisions of the striatum. We also compared the more vs. less affected side.RESULTS: [18F]FE-PE2I showed absolute variability estimates of 5.3-7.6% in striatal regions and 11% in substantia nigra and ICCs of 0.74-0.97 (median 0.91). The absolute variability for functional striatal subdivisions was 6.0-9.6% and ICCs of 0.76-0.91 (median 0.91). The less affected substantia nigra exhibited greater consistency than the more affected side. According to power calculations based on the current sample size, DAT changes of 5-11% in the striatum and 28% in the substantia nigra can be detected with a power of 0.8 (p < 0.0125).CONCLUSION: DAT-PET measurements with [18F]FE-PE2I in PD patients showed good repeatability and reliability. The slightly lower reliability in the substantia nigra in patients may be explained by lower DAT density and smaller anatomical size. Power calculations suggest that [18F]FE-PE2I PET is a suitable marker for longitudinal DAT decline in PD.TRIAL REGISTRATION: EudraCT 2017-003327-29.
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27.
  • Kvist, Alexander, et al. (author)
  • Validation of algorithms for calculating spatiotemporal gait parameters during continuous turning using lumbar and foot mounted inertial measurement units
  • 2024
  • In: Journal of Biomechanics. - : Elsevier. - 0021-9290 .- 1873-2380. ; 162
  • Journal article (peer-reviewed)abstract
    • Spatiotemporal gait parameters such as step time and walking speed can be used to quantify gait performance and determine physical function. Inertial measurement units (IMUs) allow for the measurement of spatiotemporal gait parameters in unconstrained environments but must be validated against a gold standard.While many IMU systems and algorithms have been validated during treadmill walking and overground walking in a straight line, fewer studies have validated algorithms during more complex walking conditions such as continuous turning in different directions.This study explored the concurrent validity in a population of healthy adults (range 26–52 years) of three different algorithms using lumbar and foot mounted IMUs to calculate spatiotemporal gait parameters: two methods utilizing an inverted pendulum model, and one method based on strapdown integration. IMU data was compared to a Vicon twelve-camera optoelectronic system, using data collected from 9 participants performing straight walking and continuous walking trials at different speeds, resulting in 162 walking trials in total. Intraclass correlation coefficients (ICCa,1) for absolute agreement were calculated between the algorithm outputs and Vicon output.Temporal parameters were comparable in all methods and ranged from moderate to excellent, except double support time which was poor. Strapdown integration performed better for estimating spatial parameters than pendulum models during straight walking, but worse during turning. Selecting the most appropriate model should take into consideration both speed and walking condition.
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28.
  • LaGrone, Sofie, et al. (author)
  • Choreographing life-experiences of balance control in people with Parkinson's disease
  • 2020
  • In: BMC Neurology. - : Springer Nature. - 1471-2377. ; 20
  • Journal article (peer-reviewed)abstract
    • Background: Parkinson’s disease (PD) is a devastating neurodegenerative disorder. Reduced balance is one of the cardinal symptoms of PD, predisposing people living with PD to experience difficulties with the execution of tasks and activities, as well as hindering their involvement in meaningful life areas. The overarching aim of this study was to explore how deficits in balance control manifest in everyday life and how it is managed by people with PD (PwPD).Methods: Qualitative description was used as methodology, and in-depth interviews were conducted with 18 participants, between the ages of 46 to 83 years, with mild to severe PD. Interview transcripts were analyzed using qualitative content analysis, following an inductive approach.Results: One theme emerged from the analysis: Increased planning—choreographing life. Within this overarching theme, two categories were identified, namely Limitations in mobility and New restricted functioning in everyday life, each with 3–4 sub-categories. The categories described how PwPD handled decreased balance control in their everyday life by using motor and cognitive strategies as a consequence of not trusting their body’s capacity to control balance. Activities in everyday life, as well as the ability to partake in leisure and social activities were profoundly affected.Conclusion: People with mild to severe PD used strategies to handle decreased balance and they choreographed their lives around their individual current state of mobility and balance. The knowledge gained from this study can be used to develop targeted interventions addressing the nuances of balance deficits in everyday life.
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29.
  • Leavy, Breiffni, et al. (author)
  • Outcome evaluation of highly challenging balance training for people with Parkinson disease : A multicenter effectiveness-implementation study
  • 2020
  • In: Journal of Neurologic Physical Therapy. - 1557-0576 .- 1557-0584. ; 44:1, s. 15-22
  • Journal article (peer-reviewed)abstract
    • BACKGROUND AND PURPOSE: In order for people with Parkinson disease (PwPD) to benefit from neurorehabilitation research, interventions tested in research settings require assessment in real-world clinical practice. There is little evidence for whether efficacious exercise interventions for PwPD remain effective when transferred to standard clinical settings. The aim of this study was to assess the clinical effectiveness of the adapted HiBalance program on balance control and gait among PwPD.METHODS: Participants (n = 117) with mild-moderate Parkinson disease were consecutively included into either the 10-week HiBalance group training (n = 61) or the control (n = 56) group. The main outcome was balance performance (Mini-BESTest). Secondary outcomes were comfortable gait speed (10-m Walk Test); functional mobility (Timed Up and Go [TUG] test) and dual-task interference (cognitive TUG test); physical activity level (steps per day); perceived balance confidence (Activities-specific Balance Confidence scale) and perceived walking difficulty (Walk-12G) and self-rated health (EQ-5D visual analog scale).RESULTS: In total, 98 people completed the trial. Compared with controls, the training group showed significant improvement in balance performance (P < 0.001), gait speed (P = 0.001), and dual-task interference (P = 0.04) following the intervention. No group differences were observed for physical activity level or any patient-reported measures.DISCUSSION AND CONCLUSIONS: Highly challenging balance training is effective at improving balance, gait, and dual-task performance when delivered at a clinically feasible dose, in a range of rehabilitation settings, without direct involvement of the research group.Video Abstract available for more insights from the authors (see the Video, Supplementary Digital Content 1, available at: http://links.lww.com/JNPT/A299).
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30.
  • Leavy, Breiffni, et al. (author)
  • Patient-reported and performance-based measures of walking in mild–moderate Parkinson's disease
  • 2018
  • In: Brain and Behavior. - : Wiley. - 2162-3279. ; 8:9
  • Journal article (peer-reviewed)abstract
    • Background: Knowledge of the relationships between patient-reported and performance-based walking measures in Parkinson's disease (PD) should inform clinical decision-making. The Walk-12G reliably captures perceived walking difficulties but has not been compared to performance-based walking in laboratory or free-living settings or across different groups. Objectives: To investigate the relationship between patient-reported walking difficulties (Walk-12G) and performance-based walking in laboratory and free-living conditions and to determine whether the Walk-12G can distinguish between the subgroups, (i) people with/without PD and (ii) mild/moderate disease stages. Methods: Forty-seven people without and 49 people with PD (Hoehn and Yahr stage II and III) were assessed in relation to patient-reported walking difficulties (Walk-12G scale); spatiotemporal gait characteristics (Pace; Rhythm; Asymmetry; Variability; and Postural control) using a laboratory-based electronic walkway; and walking behavior (mean steps/day and minutes of brisk walking/day) using accelerometers in free-living conditions. Results: The Walk-12G correlated moderately with the spatiotemporal domain step velocity (r = −0.46) and walking behavior, measured as mean steps/day (r = −0.46). Weaker correlations were observed for step length and minutes spent in brisk walking (r = −0.36 and r = −0.35, respectively). Poor correlations were observed for all other spatiotemporal domains. The Walk-12G could distinguish between people with and without PD (Effect size, r = 0.82) and between those at mild/moderate disease stages (r = 0.34). Conclusions: Perceived walking difficulties showed weak to moderate associations with performance-based measures of walking in mild–moderate PD. As the strongest associations were observed for step velocity and walking behavior, targeting these specific gait aspects could improve perceived walking difficulties in daily life.
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31.
  • Lindholm, Beata, et al. (author)
  • Clinical usefulness of retropulsion tests in persons with mild to moderate parkinson’s disease
  • 2021
  • In: International Journal of Environmental Research and Public Health. - : MDPI Multidisciplinary Digital Publishing Institute. - 1661-7827 .- 1660-4601. ; 18:23, s. 1-10
  • Journal article (peer-reviewed)abstract
    • People with Parkinson’s disease (PwPD) have an increased risk for falls and near falls. They have particular difficulties with maintaining balance against an external perturbation, and several retropulsion tests exist. The Unified PD Rating Scale item 30 (UPDRS30) is the most common, involving an expected shoulder pull. Others recommend using an unexpected shoulder pull, e.g., the Nutt Retropulsion Test (NRT). We aimed to evaluate the clinical usefulness of these tests for detecting future fallers. By using two different golden standards related to self-reported prospective falls and near falls over 6 months following two different time points with 3.5 years between, we estimated sensitivity/specificity, Youden index, predictive values, and likelihood ratios for each test. The different time points yielded a different prevalence of falls and near falls, as well as different predictive values. When comparing the performance of the NRT and UPDRS30 for detecting future fallers, we found that the NRT consistentlyperformed better than UPDRS30. However, neither test exhibited optimal performance in terms of predictive values and associated likelihood ratios. Our findings speak against using either of these tests as a single assessment for this purpose and support previous recommendations of using a multifactorial approach when targeting balance problems in PwPD.
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32.
  • Lindholm, Beata, et al. (author)
  • Does fatigue in Parkinson’s disease impact one’s physical function in daily live?
  • 2023
  • In: Movement Disorders. - 0885-3185. ; 38:Suppl 1, s. 824-824
  • Conference paper (peer-reviewed)abstract
    • Objective: To investigate fatigue at baseline and 3.5 years later and its association with balance and gait over time.Background: In Parkinson’s disease (PD), fatigue is considered one of the most common and disabling nonmotor symptoms that may persist or even worsen over time. Fatigue in generally has been described as a significantly diminished energy level or an increased perception of effort disproportionate to attempted activities. Fatigue has been associated to several nonmotor symptoms (e.g., depression, apathy, anxiety, sleep disturbances) and negatively impact quality of life in cross-sectional PD-studies. However, few studies have investigated fatigue over time and its association with other physical symptoms.Method: A prospective cohort of 70 persons with mild to moderate PD was assessed at baseline and 3.5 years later. Mean (SD) age and PD duration at baseline were 66 (8.9) and 4 (4.0) years, respectively and median (q1-q3) “on” phase motor symptoms (Unified PD Rating Scale, UPDRS, part III) were 11 (7-18). Fatigue was investigated with The Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F, higher=better). Multiple linear regression analysis was performed with FACIT-F scores at baseline as dependent variable and a battery of clinical balance and gait tests targeting functional, reactive, and dynamic balance (Bergs Balance Scale vs Nutt Retropulsion Test vs Tandem gait, respectively), comfortable and fast gait speed and functional mobility (Timed up and go, TUG) as independent variables. The results were controlled for age and motor symptoms.Results: The median (q1-q3) FACIT-F scores at baseline (39 (30-36)) were significantly higher than corresponding value 3.5 years later (33.5 (22.5-41)). Significant association was found between FACIT-F scores at baseline and time needed to perform TUG 3.5 years later (B (95% CI); -0,568 (-0,925, -0.211), P=0.002)). These results suggest more than half a second longer time to perform the TUG for every point/score on the FACIT-F.Conclusion: Fatigue in people with PD seem to increase substantially over a relatively short time of 3.5 years. Fatigue also impacts functional mobility incorporating components of balance and gait ability in PD (gait speed, turning and sit-to-stand transfers). More longitudinal studies are needed to investigate long-term impact of fatigue on physical function in daily live.
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33.
  • Lindholm, Beata, et al. (author)
  • Gait and balance among people with de novo vs. mild to moderate Parkinson’s disease
  • 2022
  • Conference paper (peer-reviewed)abstract
    • We have investigated how a de novo cohort of people with Parkinson’s disease (PD) differs in terms of balance and gait function as well as frequency of near falls and falls in comparison to a cohort with mild to moderate PD that has been medicated for several years. Preliminary results (Table 1) showed that people with de novo PD have balance and gait impairments and that some have also experienced near falls and falls. On the contrary, the cohort with more advanced disease has significantly fewer motor symptoms, as shown in the UPDRS motor score, compared to those newly diagnosed. This is probably related to successful symptomatic medication in the more advanced cohort. Despite less motor symptoms, those with a more advanced disease performed significantly worse on the balance-demanding tests (i.e., Timed Up and Go, Tandem Gait) and reported more near falls and falls. These results are consistent with previous studies reporting that dopaminergic medication improves motor symptoms, but has less effects on mobility and balance in PD. This indicates a need for balance-promoting efforts from an early stage of the disease.
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34.
  • Nedergård, Heidi, 1978- (author)
  • “Taking the next step” : whole-body biomechanical gait analysis, and user-perspectives on robotic-assisted gait training post-stroke
  • 2021
  • Doctoral thesis (other academic/artistic)abstract
    • Background: Stroke, and its subsequent motor function impairments may result in limited gait ability characterised by compensatory movement patterns that include deviations and asymmetries. How these movement patterns should be evaluated and quantified in order to be monitored and treated in the long term is not yet standardised. Limitations in walking quality and quantity negatively affect quality of life and lead to great costs for society if independence is lost. Improved walking ability is hence highly prioritised in stroke rehabilitation. Gait-assisting robots have been developed to enable favourable controlled, high-intensive and task-specific training. Studies evaluating the effects of robotic-assisted gait training (RAGT) have, however, shown inconsistent results. Identifying responders to treatment may facilitate further development of RAGT to improve outcomes. This requires in-depth knowledge of how specific gait movement patterns should best be identified, quantified and treated in rehabilitation. There is also a need for greater insight into how individuals experience gait training in general, and RAGT in particular, as this will likely affect the performance and outcomes of training.Aim: This thesis aims to contribute to the discussion on how to quantify gait movement patterns post-stroke from a whole-body perspective. It will also evaluate the effects of RAGT on biomechanical measures of gait and explore the experience of high-intensive and robotic-assisted gait training in persons with impaired walking ability due to stroke.Methods: A systematic review and meta-analysis consolidated the evidence for the effects of RAGT on biomechanical measures of gait in persons post-stroke. Two descriptive, cross-sectional studies based on kinematic gait data (31 persons post-stroke and 41 non-disabled controls) investigated potential variables to quantify post-stroke gait. The size and angular velocity of the inclination angles between the Centre of Mass (CoM) and the ankle or head, respectively, was investigated with curve analyses covering the entire gait cycle. Furthermore, misclassification rates were calculated based on leave-one-out cross-validation and logistic regression to address the combinations of kinematic variables that most correctly classify a person post-stroke when compared to controls. Finally, individual interviews were performed and analysed using qualitative content analysis to explore the experiences of high-intensive gait training, including RAGT, among persons post-stroke.Results: The systematic review included 13 studies with a total of 412 individuals. The meta-analyses did generally not reveal significant differences between RAGT and comparator groups for biomechanical parameters. Risk of bias assessments raised concerns for several of the studies and the general quality of evidence for these outcomes was very low. An important finding was an inconsistency of biomechanical outcome measures. Data from the primary cross-sectional studies included in this thesis indicated a bilateral lower body adaptation likely to increase the base of support and an upper body leaning towards the affected side during walking in persons post-stroke. Furthermore, core sets of 2-3 kinematic gait variables were identified from both the upper and lower body that, when combined, were most likely to differentiate post-stroke gait from gait in non-disabled controls. Finally, qualitative analysis of participants’ perspectives on high-intensive gait training including RAGT revealed four categories which described: 1) A generally positive mindset when starting the gait training intervention; 2) That engaging in a high-intensive gait training programme was appreciated although experienced as mentally and physically exhausting. The role of the physiotherapist was perceived as crucial; 3) Potential barriers during RAGT, such as discomfort and lost control during walking with the robot, but also facilitators like concrete feedback and the possibility to walk longer distances, and; 4) The participants’ feelings of confidence or concern for the future.      Conclusions: The systematic review demonstrated a very low certainty in current evidence for employing RAGT instead of non-robotic gait training to improve gait biomechanics post-stroke. In addition, it emphasized the lack of standardised guidelines as to which outcome measures most sufficiently quantify gait post-stroke. The cross-sectional studies included in this thesis, presenting upper and lower body kinematic variables to differentiate gait patterns between individuals with stroke and those without, highlight the advantages of adopting a whole-body perspective when evaluating gait post-stroke. Finally, interviews identified valuable aspects from the user’s perspective that should be considered during further development of RAGT devices and the design of high-intensive gait rehabilitation programmes post-stroke. 
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35.
  • Rennie, Linda, et al. (author)
  • The reliability of gait variability measures for individuals with Parkinson's disease and healthy older adults - The effect of gait speed.
  • 2018
  • In: Gait & posture. - : Elsevier BV. - 1879-2219 .- 0966-6362. ; 62, s. 505-509
  • Journal article (peer-reviewed)abstract
    • Step-to-step variability is a marker of reduced motor control and a frequently studied outcome measure in neurodegenerative disorders such as Parkinson's disease (PD) as compared to healthy older adults (HOA). To challenge motor control of gait, walking should be tested at different gait speeds. Good reliability is essential, and gait variability estimates show good reproducibility when sampled at normal gait speed. The aim was therefore to investigate if gait variability could be reliably sampled at slow and fast speeds for individuals with PD and HOA by evaluating test-retest reliability.29 (14 males) subjects with idiopathic PD, Hoehn &Yahr 2 (n=18) and 3,≥60years, and 25 age matched HOAwere included. Spatiotemporal gait data was collected (GAITRite) during slow, normal, and fast walking on two occasions.Measurement error was lowest for gait variability estimates based on 40 steps in both groups. This was true across all speeds in HOA, but only for normal and fast gait speeds in the PD cohort. Due to increased homogeneity in the variability estimates intraclass correlation coefficients (ICC) were low for HOA, except for step width variability. In the PD cohort ICCs were good to excellent for temporal- and step width gait variability across speeds.HOA demonstrated reliable gait variability estimates across all speeds, whereas Individuals with PD were reliable at normal and fast gait speeds only Estimates should be based on at least 40 steps. Step width variability was overall the most reliable variable across groups and speed conditions.
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36.
  • Rennie, Linda, et al. (author)
  • The validity of the Gait Variability Index for individuals with mild to moderate Parkinson's disease.
  • 2017
  • In: Gait & posture. - : Elsevier BV. - 1879-2219 .- 0966-6362. ; 54, s. 311-317
  • Journal article (peer-reviewed)abstract
    • Increased step-to-step variability is a feature of gait in individuals with Parkinson's disease (PD) and is associated with increased disease severity and reductions in balance and mobility. The Gait Variability Index (GVI) quantifies gait variability in spatiotemporal variables where a score ≥100 indicates a similar level of gait variability as the control group, and lower scores denote increased gait variability. The study aim was to explore mean GVI score and investigate construct validity of the index for individuals with mild to moderate PD. 100 (57 males) subjects with idiopathic PD, Hoehn & Yahr 2 (n=44) and 3, and ≥60 years were included. Data on disease severity, dynamic balance, mobility and spatiotemporal gait parameters at self-selected speed (GAITRite) was collected. The results showed a mean overall GVI: 97.5 (SD 11.7) and mean GVI for the most affected side: 94.5 (SD 10.6). The associations between the GVI and Mini- BESTest and TUG were low (r=0.33 and 0.42) and the GVI could not distinguish between Hoehn & Yahr 2 and 3 (AUC=0.529, SE=0.058, p=0.622). The mean GVI was similar to previously reported values for older adults, contrary to consistent reports of increased gait variability in PD compared to healthy peers. Therefore, the validity of the GVI could not be confirmed for individuals with mild to moderate PD in its current form due to low associations with validated tests for functional balance and mobility and poor discriminatory ability. Future work should aim to establish which spatiotemporal variables are most informative regarding gait variability in individuals with PD.
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37.
  • Rydja, Johanna, 1972- (author)
  • Gait Characteristics, Physical Activity and Subjective Outcome after Shunt Surgery in Normal Pressure Hydrocephalus
  • 2024
  • Doctoral thesis (other academic/artistic)abstract
    • Background  Idiopathic normal pressure hydrocephalus (iNPH) is a common but under-diagnosed disease among the elderly. The condition is characterised by gait disturbance, postural instability, cognitive decline and incontinence, caused by accumulated cerebrospinal fluid within the central nerve system. The treatment is a shunt insertion to divert excess fluid. Few studies have described the detailed gait in INPH, there is a lack of research about physical activity, and patient-reported outcomes after shunt surgery are sparsely described.  The overall aim of this thesis was to increase the knowledge of the gait pattern, the level of physical activity, and to evaluate the effect of a physical exercise programme in iNPH. Another aim was to evaluate the patient’s self-experienced outcome after surgery.  Methods and results, study I In total 127 patients were randomised to either a supervised 12-week high-intensity exercise programme or to standard care after shunt surgery. Evaluation was performed with the iNPH scale and goal attainment after the intervention and after six months. There was low compliance to the exercise programme and no differences between the groups could be detected according to the iNPH scale at any of the follow-ups. Patients with high attendance rate achieved their set goals to a higher extent than the control group at the post intervention follow-up. Methods and results, study II In total 109 patients from the population in study I, were evaluated with an actigraphy recording of physical activity variables for seven days before and three- and six months after shunt surgery. In addition, physical performance was evaluated with the 10-meter walk test, the 6-minute walk test and 30 s chair stand test. The patients walked faster with improved results on the walking tests postoperatively. Improvement in the 30 s chair stand test was interpreted as improved postural control. The physical activity intensity was not affected by surgery. The patients had very low energy expenditure and were to a large extent sedentary, before and after shunt surgery. The exercise intervention had no effect on physical activity or the physical performance tests.   Methods and results, study III In total 47 patients were included to a gait analysis with an inertial sensor system. Additionally, the patients were assessed with the Timed Up and Go test and the iNPH scale, pre- and three months postoperatively and in relation with 42 older healthy individuals. The patients walked with shorter strides, decreased velocity, increased time in stance and with decreased joint angles, especially in the ankle joint. The gait pattern im-proved after shunt surgery, but outcome on all variables were still worse compared to the healthy individuals, except for step hight that was normalised. Shunt surgery had no effect on stride length variability.   Methods and results, study IV  In total 58 patients rated their experienced changes three months after shunt surgery. The subjective outcome was analysed in relation to objective clinical outcomes (the iNPH scale) and questionnaires regarding, sense of coherence, quality of life, anxiety and depression. Clinical outcome and the questionnaires were evaluated before and three months after shunt surgery and in relation to 42 older healthy individuals. The patients reported most frequently some degree of positive changes after surgery. The subjective outcomes in overall experience, gait and continence correlated moderately with the corresponding objective outcomes, but there were not correlations within the cognition and balance areas. Depression and quality of life improved after surgery, but the result was still lower than for healthy individuals. There was no correlation between the patients´ sense of coherence and the subjective outcome.  Conclusion   Shunt surgery contributes to improved walking patterns, improved physical functions, reduced signs of depression and increased quality of life, but patients with iNPH are still more affected than healthy elderly. The patients report most frequently positive changes, but not total recovery after shunt surgery. Despite improvements within several areas the physical activity level is very low, both before and after the shunt operation. A postoperative high-intensity physical training program had no additional effect, which is explained by the fact that few patients completed the program. Patients with iNPH probably need guidance to additional improvement and to increase physical activity through meaningful activities after shunt surgery. Further research is needed to evaluate interventions that address the specific iNPH impairments. 
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38.
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39.
  • Steurer, Hanna, et al. (author)
  • Characterization of Mild and Moderate Dysarthria in Parkinson's Disease : Behavioral Measures and Neural Correlates
  • 2022
  • In: Frontiers in Aging Neuroscience. - : Frontiers Media S.A.. - 1663-4365. ; 14
  • Journal article (peer-reviewed)abstract
    • PurposeAlterations in speech and voice are among the most common symptoms in Parkinson's disease (PD), often resulting in motor speech disorders such as hypokinetic dysarthria. We investigated dysarthria, verbal fluency, executive functions, and global cognitive function in relation to structural and resting-state brain changes in people with PD. MethodsParticipants with mild-moderate PD (n = 83) were recruited within a randomized controlled trial and divided into groups with varying degrees of dysarthria: no dysarthria (noDPD), mild dysarthria (mildDPD), moderate dysarthria (modDPD), and also combined mildDPD and modDPD into one group (totDPD). Voice sound level and dysphonia, verbal fluency, motor symptoms, executive functions, disease severity, global cognition, and neuroimaging were compared between groups. Gray matter volume and intensity of spontaneous brain activity were analyzed. Additionally, regressions between behavioral and neuroimaging data were performed. ResultsThe groups differed significantly in mean voice sound level, dysphonia, and motor symptom severity. Comparing different severity levels of dysarthria to noDPD, groups differed focally in resting-state activity, but not in brain structure. In totDPD, lower scores on semantic verbal fluency, a composite score of executive functions, and global cognition correlated with lower superior temporal gyrus volume. ConclusionThis study shows that severity of dysarthria may be related to underlying structural and resting-state brain alterations in PD as well as behavioral changes. Further, the superior temporal gyrus may play an important role in executive functions, language, and global cognition in people with PD and dysarthria.
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40.
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41.
  • Vikström, Sofia, et al. (author)
  • A health concept with a social potential : an interview study with nursing home residents
  • 2020
  • In: BMC Geriatrics. - : BMC. - 1471-2318. ; 20
  • Journal article (peer-reviewed)abstract
    • Background: A qualitative, interview-based study was embedded in a randomized intervention trial, the Older People Exercise and Nutrition (OPEN) study. Participants in the OPEN study were encouraged to conduct sessions of sit-to-stand (STS) exercises combined with Oral Nutritional Supplements (ONS) intake. The aim was to describe the older persons' perceptions and experiences of being given the daily opportunity to perform the STS exercise and drink ONS.Methods: In-depth interviews were conducted in six nursing homes with the participants using a semi-structured interview guide. One or two individual interviews were performed with each included participant. Twenty-three NH residents (16 women and 7 men) participated in the qualitative study. Their ages ranged between 76 and 96 years, and their Mini Mental State Examination (MMSE) scored between 8 and 29. The transcribed interviews and field notes written during the visits were analyzed inductively following a constant comparative method described in Grounded Theory.Results: The exercise and nutritional intervention was described as highly practical by the NH residents, who claimed it also had a social aspect as they felt acknowledged and empowered to engage others in the combined intervention. Experiences of the intervention ranged from neutral to mainly positive and could be sorted into 5 categories: 1. Perceived hopes and expectations, 2. Health-related driving forces, 3. Appreciated daily activities, 4. A concept easy to perform and integrate into daily life, 5. A beneficial health concept for all. The intervention created perceived benefits on various health aspects due to participants feeling energized and stronger. An overall theme was identified as A health concept with a social potential, as participants feel acknowledged and strong enough to help others.Conclusions: The intervention was described by participants as a health concept that could potentially be beneficial for a broader spectrum of NH residents. The findings indicate that health concepts, such as STS/ONS, might contribute to a more meaningful day for older people, even vulnerable NH residents approaching the end of life.
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42.
  • von Rosen, Philip, et al. (author)
  • Physical activity profiles in Parkinson's disease
  • 2021
  • In: BMC Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 21:1
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Identifying physical activity (PA) profiles of people with Parkinson's Disease (PD) could provide clinically meaningful knowledge concerning how to tailor PA interventions. Our objectives were therefore to i) identify distinct PA profiles in people with PD based on accelerometer data, ii) explore differences between the profiles regarding personal characteristics and physical function.METHODS: Accelerometer data from 301 participants (43% women, mean age: 71 years) was analysed using latent profile analyses of 15 derived PA variables. Physical function measurements included balance performance, comfortable gait speed and single and dual-task functional mobility.RESULTS: Three distinct profiles were identified; "Sedentary" (N = 68), "Light Movers" (N = 115), "Steady Movers" (N = 118). "Sedentary" included people with PD with high absolute and relative time spent in Sedentary behaviour (SB), little time light intensity physical activity (LIPA) and negligible moderate-to-vigorous physical activity (MVPA). "Light Movers" were people with PD with values close to the mean for all activity variables. "Steady Movers" spent less time in SB during midday, and more time in LIPA and MVPA throughout the day, compared to the other profiles. "Sedentary" people had poorer balance (P = 0.006), poorer functional mobility (P = 0.027) and were more likely to have fallen previously (P = 0.027), compared to "Light Movers. The Timed Up and Go test, an easily performed clinical test of functional mobility, was the only test that could distinguish between all three profiles.CONCLUSION: Distinct PA profiles, with clear differences in how the time awake is spent exist among people with mild-moderate PD.
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