| 1. |
- Fagevik Olsén, Monika, 1964, et al.
(författare)
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First mobilisation after abdominal and cardiothoracic surgery : when is it actually performed? A national, multicentre, cross-sectional study
- 2024
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 14:2
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Knowledge of clinical practice regarding mobilisation after surgery is lacking. This study therefore aimed to reveal current mobilisation routines after abdominal and cardiothoracic surgery and to identify factors associated with mobilisation within 6 hours postoperatively. DESIGN: A prospective observational national multicentre study.SETTING: 18 different hospitals in Sweden.PARTICIPANTS: 1492 adult patients undergoing abdominal and cardiothoracic surgery with duration of anaesthesia>2 hours.PRIMARY AND SECONDARY OUTCOMES: Primary outcome was time to first postoperative mobilisation. Secondary outcomes were the type and duration of the first mobilisation. Data were analysed using multivariate logistic regression and general structural equation modelling, and data are presented as ORs with 95% CIs.RESULTS: Among the included patients, 52% were mobilised to at least sitting on the edge of the bed within 6 hours, 70% within 12 hours and 96% within 24 hours. Besides sitting on the edge of the bed, 76% stood up by the bed and 22% were walking away from the bedside the first time they were mobilised. Patients undergoing major upper abdominal surgery required the longest time before mobilisation with an average time of 11 hours post surgery. Factors associated with increased likelihood of mobilisation within 6 hours of surgery were daytime arrival at the postoperative recovery unit (OR: 5.13, 95% CI: 2.16 to 12.18), anaesthesia <4 hours (OR: 1.68, 95% CI: 1.17 to 2.40) and American Society of Anaesthesiologists (ASA) classification 1-2, (OR: 1.63, 95% CI: 1.13 to 2.36).CONCLUSIONS: In total, 96% if the patients were mobilised within 24 hours after surgery and 52% within 6 hours. Daytime arrival at the postoperative recovery unit, low ASA classification and shorter duration of anaesthesia were associated with a shorter time to mobilisation. TRIALREGISTRATION NUMBER: FoU, Forskning och Utveckling in VGR, Vastra Gotaland Region (Id:275357) and Clinical Trials (NCT04729634).
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| 2. |
- Fagevik Olsén, Monika, 1964, et al.
(författare)
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Technical Aspects of Devices and Equipment for Positive Expiratory Pressure With and Without Oscillation
- 2021
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Ingår i: Respiratory care. - : Daedalus Enterprises, Inc.. - 0020-1324 .- 1943-3654. ; 66:5, s. 862-877
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Breathing exercises with positive expiratory pressure (PEP) and oscillating PEP are common treatments for patients with respiratory impairments. There are several trials evaluating the clinical effects of a variety of commercially available and self-made devices. There is a lack of evaluation concerning technical aspects and construction of the devices. The aims of this review were to describe and compare technical aspects of devices and equipment used for PEP and oscillating PEP as a basis for clinical decisions regarding prescriptions.METHODS: In this systematic review, we included trials evaluating different technical aspects of devices and equipment for PEP and oscillating PEP until June 2019. The literature search was performed in PubMed, CINAHL, Cochrane Library, Embase and PEDro.RESULTS: The literature search resulted in 812 studies, which, after being read by 2 independent reviewers, were reduced to 21 trials that matched the inclusion criteria. The achieved PEP is dependent on the given resistance or achieved expiratory flow through the devices and their separate parts. Oscillation frequency in oscillating PEP devices affects the pressure and oscillation amplitude and flow. For some devices, the device's position also has an impact on the outcome. There are similarities and differences among all of the devices, and the equipment components are not interchangeable without changing the achieved PEP levels.CONCLUSIONS: Many devices are available to provide PEP and oscillating PEP treatment. These devices differ substantially in design as well as in performance. When using PEP devices, it is important to understand how all parts of the devices affect outcomes. An increased understanding of how PEP is produced for the spontaneously breathing patient is important to achieve desired treatment effects.
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| 3. |
- Westerdahl, Elisabeth, 1964-, et al.
(författare)
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First initiation of mobilization out of bed after cardiac surgery : an observational cross-sectional study in Sweden
- 2024
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Ingår i: Journal of Cardiothoracic Surgery. - : BioMed Central (BMC). - 1749-8090. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cardiac surgery is associated with a period of postoperative bed rest. Although early mobilization is a vital component of postoperative care, for preventing complications and enhancing physical recovery, there is limited data on routine practices and optimal strategies for early mobilization after cardiac surgery. The aim of the study was to define the timing for the first initiation of out of bed mobilization after cardiac surgery and to describe the type of mobilization performed.METHODS: In this observational study, the first mobilization out of bed was studied in a subset of adult cardiac surgery patients (n = 290) from five of the eight university hospitals performing cardiothoracic surgery in Sweden. Over a five-week period, patients were evaluated for mobilization routines within the initial 24 h after cardiac surgery. Data on the timing of the first mobilization after the end of surgery, as well as the duration and type of mobilization, were documented. Additionally, information on patient characteristics, anesthesia, and surgery was collected.RESULTS: A total of 277 patients (96%) were mobilized out of bed within the first 24 h, and 39% of these patients were mobilized within 6 h after surgery. The time to first mobilization after the end of surgery was 8.7 ± 5.5 h; median of 7.1 [4.5-13.1] hours, with no significant differences between coronary artery bypass grafting, valve surgery, aortic surgery or other procedures (p = 0.156). First mobilization session lasted 20 ± 41 min with median of 10 [1-11]. Various kinds of first-time mobilization, including sitting on the edge of the bed, standing, and sitting in a chair, were revealed. A moderate association was found between longer intubation time and later first mobilization (ρ = 0.487, p < 0.001). Additionally, there was a moderate correlation between the first timing of mobilization duration of the first mobilization session (ρ = 0.315, p < 0.001).CONCLUSIONS: This study demonstrates a median time to first mobilization out of bed of 7 h after cardiac surgery. A moderate correlation was observed between earlier timing of mobilization and shorter duration of the mobilization session. Future research should explore reasons for delayed mobilization and investigate whether earlier mobilization correlates with clinical benefits.TRIAL REGISTRATION: FoU in VGR (Id 275,357) and Clinical Trials (NCT04729634).
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| 4. |
- Al Nouh, Micheline, et al.
(författare)
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Favourable outcome in survivors of CPR-related chest wall injuries
- 2024
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Ingår i: INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED. - 0020-1383 .- 1879-0267. ; 55:7
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a lack of studies focusing on long -term chest function after chest wall injury due to cardiopulmonary resuscitation (CPR). The purpose of this cross-sectional study was to investigate long -term pain, lung function, physical function, and fracture healing after manual or mechanical CPR and in patients with and without flail chest. Methods: Patients experiencing out -of -hospital cardiac arrest between 2013 and 2020 and transported to Sahlgrenska University Hospital were identified. Survivors who had undergone a computed tomography (CT) showing chest wall injury were contacted. Thirty-five patients answered a questionnaire regarding pain, physical function, and quality of life and 25 also attended a clinical examination to measure the respiratory and physical functions 3.9 (SD 1.7, min 2 -max 8) years after the CPR. In addition, 22 patients underwent an additional CT scan to evaluate fracture healing. Results: The initial CT showed bilateral rib fractures in all but one patient and sternum fracture in 69 %. At the time of the follow-up none of the patients had persistent pain, however, two patients were experiencing local discomfort in the chest wall. Lung function and thoracic expansion were significantly lower compared to reference values (FVC 14 %, FEV1 18 %, PEF 10 % and thoracic expansion 63 %) ( p < 0.05). Three of the patients had remaining unhealed injuries. Patients who had received mechanical CPR in additional to manual CPR had a lower peak expiratory flow (80 vs 98 % of predicted values) ( p =0.030) =0.030) and those having flail chest had less range of motion in the thoracic spine (84 vs 127 % of predicted) ( p = 0.019) otherwise the results were similar between the groups. Conclusion: None of the survivors had long -term pain after CPR-related chest wall injuries. Despite decreased lower lung function and thoracic expansion, most patients had no limitations in physical mobility. Only minor differences were seen after manual vs. mechanical CPR or with and without flail chest.
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| 5. |
- Andersson, Thomas K., et al.
(författare)
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PACADI: translation and adaptation of a Swedish-language version of the pancreatic cancer disease impact score
- 2022
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Ingår i: Bmc Research Notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective The Norwegian pancreatic cancer disease impact score (PACADI) is a digitalized analogue questionnaire that assesses different disease-specific symptoms. There is a need of translations of it into other languages. Therefore, the aim of this article is to describe the translation process of a Swedish version of PACADI and present its validity to EORCT QLQ PAN26. The self-administered questionnaire PACADI was translated according to guidelines and assessed by an expert panel of health care personnel. The test of its validity was performed with the disease-specific questionnaire for EORCT QLQ PAN26. Both questionnaires were completed by 66 subjects with pancreatic cancer, either before, at discharge or three months after surgery. Result The results between the groups indicate that patients suffer from different symptoms at different times. The correlations between the different symptoms of the two questionnaires were fair to good. In conclusion, PACADI and QLQ PAN 26 have a good correlation and PACADI can be used in clinical practise.
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| 6. |
- Andreasson, Ingrid, et al.
(författare)
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Daily life one year after corrective osteotomy for malunion of a distal radius fracture an interview study
- 2022
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Medical Journals Sweden AB. - 2000-656X .- 2000-6764. ; 56:1, s. 16-22
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore the everyday life experiences of people one year after corrective osteotomy following a symptomatic, malunited, distal radius fracture. Semi-structured interviews were conducted with twenty respondents, median age 65 (22-81) years. The respondents were recruited consecutively. The interviews were subjected to qualitative content analysis. Three authors took part in the analysis. The result is presented as one theme, 'Daily life works again' with five categories: Relief of inconveniences and symptoms, Managing new symptoms and complications, Regaining abilities, Normalised social relationships, Increased wellbeing. The symptoms had declined in severity, some participants regarded themselves as fully restored and used their hand again without hesitation. Others were still bothered by their wrist occasionally and a few had to manage complications. The participants had regained the ability to perform many everyday life activities and reported increased independence and less irritation between spouses, as well as increased wellbeing. One year after a corrective osteotomy following malunion of a distal radius fracture, the patients' experiences represent a continuum. Some are still restricted by their wrist occasionally, the majority experience an increased ease in their performance of activities of daily life and some regard themselves as fully restored. The recovery has a positive impact on social relationships and the patients' wellbeing.
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| 7. |
- Andreasson, Ingrid, et al.
(författare)
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Functional outcome after corrective osteotomy for malunion of the distal radius: a randomised, controlled, double-blind trial
- 2020
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Ingår i: International Orthopaedics. - : Springer Science and Business Media LLC. - 0341-2695 .- 1432-5195. ; 44:7, s. 1353-1365
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The purpose of this randomised, controlled, double-blind trial was to evaluate functional outcome during the first year after corrective osteotomy for malunited distal radius fractures, with or without filling the osteotomy void. Method Patients were randomised to receive a HydroSet bone substitute or no graft. Cortical contact was maintained and stabilisation of the osteotomy was carried out with a DiPhos R- or RM Plate. To evaluate subjective functional outcome, the Patient-Rated Wrist Evaluation (PRWE), the Quick Disabilities of the Arm, Shoulder and Hand Questionnaire (Q-DASH), the Canadian Occupational Performance Measure (COPM) and the RAND-36 were used. Moreover, range of motion and grip strength were measured by blinded evaluators. Evaluations were made pre-operatively and three, six and 12 months post-operatively. Results There were no significant differences between the groups at any time point post-operatively with respect to any of the PROMs that were used or range of motion or grip strength (p> 0.05). In both groups, there was a significant improvement at the 12-month follow-up compared with pre-operatively for the PRWE, the Q-DASH and the COPM satisfaction scores. The RAND-36 revealed no significant differences except for two domains, in which there was an improvement in the treatment group (p< 0.05). For grip strength and for range of motion in all movement directions, except dorsal extension, there was a significant improvement in both groups (p< 0.05). Conclusion There is no significant difference in functional outcome during the first year after corrective open-wedge distal radius osteotomy, where cortical contact is maintained, regardless of whether or not bone substitute to fill the void is used.
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| 8. |
- Andreasson, Ingrid, et al.
(författare)
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Life has become troublesome–my wrist bothers me around the clock: an interview study relating to daily life with a malunited distal radius fracture
- 2020
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 42:16, s. 2344-2350
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to explore the everyday life experiences of people suffering from a symptomatic, malunited, distal radius fracture. Method: Qualitative interviews were conducted with twenty respondents, median age 59 [16–85] years. The interviews were subjected to qualitative content analysis. Results: The result, presented as one main theme with categories and subcategories, describes the impact of the injury. Everyday life was affected in all participants, very much in a few highly valued activities such as sports and work, whenever the hand was used, or even at rest. This study indicates that the injury has an impact on the ability to move around, other parts of the body, sleep, emotions, self-perception and relationships. It also shows that the patients used several strategies to manage the situation. Conclusion: The malunion of a distal radius fracture has a negative impact on a wide range of daily activities, as well as other aspects of daily life. There is a need for information between caregivers and patients, and clear routines, once a malunion has occurred.Implications for rehabilitation The symptomatic malunion of a distal radius fracture should be acknowledged as a complex condition requiring comprehensive interventions Technical equipment, braces and new solutions on practical problems was necessary to manage everyday life and should be a focus of intervention for this patient group The consequences of the injury was not only restricted activity performance but also affected social relationships and emotions Information about fracture healing and how a malunion can occur, as well as information on how much the wrist can be loaded at different time points, is important to reduce anxiety. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.
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| 9. |
- Andreasson, Ingrid, et al.
(författare)
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Long-term outcomes of corrective osteotomy for malunited fractures of the distal radius
- 2020
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Medical Journals Sweden AB. - 2000-656X .- 2000-6764. ; 54:2, s. 94-100
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to investigate the long-term outcome after corrective osteotomy for malunion of distal radius fractures. Radiological findings, function, activity performance, pain, health-related quality of life and self-efficacy were studied. Evaluation of 37 patients 3-10 years after osteotomy fixated with a volar plate. Conventional radiographs were taken. Grip strength and range of motion were evaluated. Scores from the Patient Rated Wrist Evaluation (PRWE) were compared with normative values. The RAND-36 was used for evaluation of health-related quality of life and the General Self-Efficacy scale (S-GSE) for self-efficacy. Radial height, volar tilt, and ulnar variance improved postoperatively. In the long term, the corrections were maintained. Radiographs showed significantly more advanced osteoarthritis. Mean grip strength was 31 kg (SD 13) 89%, and range of motion varied between 80% and 95% compared to the uninjured side. The median PRWE was 12 points (0-99). The study group experienced higher levels of pain than reference values. There was a moderate correlation between the PRWE and volar tilt (rs = 0.453, p = .006) and grip strength (rs = 0.40, p = .014). At long-term follow-up functional outcome after a corrective osteotomy is generally good, but patients may experience some degree of pain. Corrective osteotomy might be considered for patients with a poor functional outcome after a distal radius fracture.
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| 10. |
- Asplin, Gillian, et al.
(författare)
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Concurrent validity and responsiveness of Traffic Light System-BasicADL (TLS-BasicADL)
- 2022
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Ingår i: European Journal of Physiotherapy. - : Informa UK Limited. - 2167-9169 .- 2167-9177. ; 24:6, s. 372-380
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To test validity and responsiveness of Traffic Light System-BasicADL (TLS-BasicADL). Method: Validity: Data according to TLS-BasicADL, modified Functional Independence Measure (FIM) and Barthel Index (BI) were collected from 50 patients with mixed medical diagnoses. Responsiveness: 106 patients following hip fracture assessed according to TLS-Basic ADL and modified Katz Index. Percentage change in TLS-BasicADL from pre-fracture status, to post-operatively, discharge and 1 month follow-up was calculated. TLS-BasicADL and modified Katz Index were also correlated at discharge and 1 month. For analysis of responsiveness, Spearman's rho coefficient (rs) was used and for distribution at item level, percentage change and sign test. Results: Validity: Strong-excellent correlations between TLS-BasicADL and modified FIM (0.65-0.95), TLS-BasicADL and modified BI (0.77-0.97) for individual items. Analysis of total scores revealed excellent correlations between instruments (0.96-0.98). Responsiveness: Significant differences between assessments for each item of TLS-BasicADL except upper hygiene, dressing and eating. Excellent correlation was found between TLS-BasicADL and modified Katz Index between pre-fracture - discharge (0.897) and moderate-strong (0.597) discharge - 1 month. Conclusion: TLS-BasicADL is shown to have acceptable concurrent validity for measuring basic mobility and self-care in elderly patients with mixed medical diagnoses and responsive for patients following hip fracture surgery.
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