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  • 1.
    Brogårdh, Christina
    et al.
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Sjödahl Hammarlund, Catharina
    Department of Health Sciences, Lund University.
    Experiences of falls and strategies to manage the consequences of falls in persons with late effects of polio: a qualitative study2017In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, no 8, p. 652-658Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To explore how persons with late effects of polio experience falls and what strategies they use to manage the consequences of falls.

    DESIGN:

    A qualitative study with face-to-face interviews. Data were analysed by systematic text condensation.

    PARTICIPANTS:

    Fourteen ambulatory persons (7 women; mean age 70 years) with late effects of polio.

    RESULTS:

    Analysis resulted in one main theme, "Everyday life is a challenge to avoid the consequences of falls", and 3 categories with 7 subcategories. Participants perceived that falls were unpredictable and could occur anywhere. Even slightly uneven surfaces could cause a fall, and increased impairments following late effects of polio led to reduced movement control and an inability to adjust balance quickly. Physical injuries were described after the falls, as well as emotional and psychological reactions, such as embarrassment, frustration and fear of falling. Assistive devices, careful planning and strategic thinking were strategies to prevent falls, together with adaptation and social comparisons to mitigate the emotional reactions.

    CONCLUSION:

    Experiences of falls greatly affect persons with late effects of polio in daily life. To reduce falls and fall-related consequences both problem-focused and emotion-focused strategies are used. In order to increase daily functioning, these findings should be included in a multifaceted falls management programme.

  • 2.
    Ekstrand, Elisabeth
    et al.
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. Department of Health Sciences, Lund University.
    Brogårdh, Christina
    Department of Health Sciences, Lund University.
    Test-retest reliability of the life satisfaction questionnaire lisat-11 and association between items in individuals with chronic stroke2018In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 8, p. 713-718Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the test-retest reliability of the Life Satisfaction Questionnaire (LiSat-11) and the association between items in individuals with chronic stroke. Design: Test-retest design. Subjects: Forty-five individuals (mean age 65 years) with mild to moderate disability at least 6 months post-stroke. Methods: LiSat-11, which includes 1 global item "Life as a whole" and 10 domain-specific items, was rated on 2 occasions, one week apart. Test-retest reliability was evaluated by kappa statistics, the percent agreement (PA) and the Svensson rank-invariant method. The association between items was evaluated with the Spearman's rank correlation coefficient (rho). Results: The kappa coefficients showed good to excellent agreement (0.59-0.97) and the PA <= 1 point was high (> 89%) for all items. According to the Svensson method, a small systematic disagreement was found for "Partner relationship". The other items showed no systematic or random disagreements. All domain-specific items, except one ("Sexual life") were significantly correlated with "Life as a whole" (rhos 0.29-0.80). Conclusion: LiSat-11 is considered reliable and can be recommended for assessing life satisfaction after stroke. The association between items indicates that LiSat-11 measures various aspects that can impact on an individual's life satisfaction.

  • 3.
    Fallahpour, Mandana
    et al.
    Karolinska institute, Neurobiology Care Sciences and Society, Division of Occupational Therapy.
    Kottorp, Anders
    Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet.
    Nygard, Louise
    Karolinska institute, Neurobiology Care Sciences and Society, Division of Occupational Therapy.
    Larsson-Lund, Maria
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Percieved difficulty in use of everyday technology in persons with aquired brain injury of different severity: a comparison with controls2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 7, p. 635-641Article in journal (Refereed)
    Abstract [en]

    Objective: To compare the perceived difficulty in use of everyday technology in persons with acquired brain injury with different levels of severity of disability with that of controls.Methods: This comparison study recruited 2 samples of persons with acquired brain injury and controls, comprising a total of 161 participants, age range 18-64 years. The long and short versions of the Everyday Technology Use Questionnaire and the Extended Glasgow Outcome Scale were used to evaluate participants.Results: Persons with acquired brain injury demonstrated lower mean levels of perceived ability in use of everyday technology than controls (F=21.84, degrees of freedom =1, p<0.001). Further analysis showed a statistically significant mean difference in perceived difficulty in use of everyday technology between persons with severe disability and good recovery, between persons with severe disability and controls, and between persons with moderate disability and controls. No significant mean difference was found between persons with severe disability and moderate disability, between persons with moderate disability and good recovery, and between persons with good recovery and controls.Conclusion: Perceived difficulty in using everyday technology is significantly increased among persons with acquired brain injury with severe to moderate disability compared with controls. Rehabilitation services should consider the use of everyday technology in order to increase participation in everyday activities after acquired brain injury.

  • 4.
    Flansbjer, Ulla-Britt
    et al.
    Department of Rehabilitation Medicine, Skåne University Hospital.
    Lexell, Jan
    Luleå University of Technology, Department of Health Sciences, Medical Science.
    Reliability of knee extensor and flexor muscle strength measurements in persons with late effects of polio2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 6, p. 588-592Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the reliability of knee extensor and flexor muscle strength measurements in persons with late effects of polio. Design: A test-retest reliability study. Subjects: Thirty men and women (mean age 63 (standard deviation 6.4) years) with verified late effects of polio. Methods: Knee extensor and flexor muscle strength in both lower limbs were measured twice 7 days apart using a Biodex dynamometer (isokinetic concentric contractions at 60°/sec and isometric contractions with knee flexion angle 90º) and a Leg Extension/Curl Rehab exercise machine with pneumatic resistance (HUR) (isotonic contractions). Reliability was assessed with the intraclass correlation coefficient (ICC1,1), the mean difference between the test sessions (đ) together with the 95% confidence intervals for đ, the standard error of measurement (SEM and SEM%), the smallest real difference (SRD and SRD%) and Bland-Altman graphs. Results: Test-retest agreements were high, (ICC1,1 0.93-0.99) and measurement errors generally small. The SEM% was 4-14% and the SRD% 11-39%, with the highest values for the isokinetic measurements. Conclusion: Knee muscle strength can be measured reliably and can be used to detect real changes after an intervention for a group of persons with late effects of polio, whereas the values may be too high for single individuals or to detect smaller short-term changes over time for a group of individuals.

  • 5.
    Flansbjer, Ulla-Britt
    et al.
    Department of Rehabilitation, Lund University Hospital, Sweden.
    Miller, Michael
    Lund University, Department of Health Sciences, Divison of Physiotherapy.
    Dowham, David
    University of Liverpool, Department of mathematical sciences.
    Lexell, Jan
    Progressive resistance training after stroke: effects on muscle strength, muscle tone, gait performance and perceived participation2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 1, p. 42-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of progressive resistance training on muscle strength, muscle tone, gait performance and perceived participation after stroke. DESIGN: A randomized controlled trial. SUBJECTS: Twenty-four subjects (mean age 61 years (standard deviation 5)) 6-48 months post-stroke. METHODS: The training group (n = 15) participated in supervised progressive resistance training of the knee muscles (80% of maximum) twice weekly for 10 weeks, and the control group (n = 9) continued their usual daily activities. Both groups were assessed before and after the intervention and at follow-up after 5 months. Muscle strength was evaluated dynamically and isokinetically (60 degrees /sec) and muscle tone by the Modified Ashworth Scale. Gait performance was evaluated by Timed "Up & Go", Fast Gait Speed and 6-Minute Walk tests, and perceived participation by Stroke Impact Scale. RESULTS: Muscle strength increased significantly after progressive resistance training with no increase in muscle tone and improvements were maintained at follow-up. Both groups improved in gait performance, but at follow-up only Timed "Up & Go" and perceived participation were significantly better for the training group. CONCLUSIONS: Progressive resistance training is an effective intervention to improve muscle strength in chronic stroke. There appear to be long-term benefits, but further studies are needed to clarify the effects, specifically of progressive resistance training on gait performance and participation.

  • 6.
    Gard, Gunvor
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Gtrahn, Birgitta
    FoU Välfärd, Kronoberg County.
    Development of the motivation forchange questionnaire (MSQ)2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 4, p. 402-Article in journal (Other academic)
  • 7.
    Häggström, Anna
    et al.
    Kalix Hospital, Department of Occupational Therapy.
    Larsson-Lund, Maria
    The complexity of participation in daily life: A qualitative study of the experiences of persons with acquired brain injury2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 2, p. 89-95Article in journal (Refereed)
    Abstract [en]

    Objective: To describe and enhance the understanding of how adults with acquired brain injury experience participation in daily life. Patients and methods: Qualitative interviews with 11 persons of working age with acquired brain injuries were analysed using qualitative content analysis. Results: The informants' experiences formed 5 categories: "Performing tasks"; "Making decisions and exerting influence"; "Being engaged in meaningful activities"; "Doing things for others"; and "Belonging". The categories that needed to be present for the informants to experience a feeling of participation varied according to their individual daily life situations. In addition, their experiences showed that a variety of conditions, related to each of the 5 categories, influenced their participation. Individuals adopted a variety of strategies to enhance their experience of participation. Conclusion: The meaning of participation and the conditions and strategies influencing participation are complex. Many of the categories identified for participation can be understood only through subjective experience and cannot be captured by professionals' observation of the performance of activities. These results emphasize the importance of considering clients' unique experiences of participation when designing individually tailored rehabilitation programmes intended to enhance participation.

  • 8.
    Jörgensen, Sophie
    et al.
    Department of Health Sciences, PO Box 157, Lund University.
    Martin Ginis, Kathleen A.
    School of Health and Exercise Sciences, University of British Columbia, Okanagan Campus, Kelowna, BC.
    Iwarsson, Susanne
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Depressive symptoms among older adults with long-term spinal cord injury: Associations with secondary health conditions, sense of coherence, coping strategies and physical activity2017In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, no 8, p. 644-651Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    To assess the presence of depressive symptoms among older adults with long-term spinal cord injury and investigate the association with sociodemographic and injury characteristics; and to determine how potentially modifiable factors, i.e. secondary health conditions, sense of coherence, coping strategies and leisure-time physical activity, are associated with depressive symptoms.

    DESIGN:

    Cross-sectional study.

    SUBJECTS:

    A total of 122 individuals (70% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D), mean age 63 years, mean time since injury 24 years.

    METHODS:

    Data from the Swedish Aging with Spinal Cord Injury Study, collected using the Geriatric Depression Scale-15, the 13-item Sense of Coherence Scale, the Spinal Cord Lesion-related Coping Strategies Questionnaire and the Physical Activity Recall Assessment for people with Spinal Cord Injury. Associations were analysed using multivariable linear regression.

    RESULTS:

    A total of 29% reported clinically relevant depressive symptoms and 5% reported probable depression. Sense of coherence, the coping strategy Acceptance, neuropathic pain and leisure-time physical activity explained 53% of the variance in depressive symptoms.

    CONCLUSION:

    Older adults with long-term spinal cord injury report a low presence of probable depression. Mental health may be supported through rehabilitation that strengthens the ability to understand and confront life stressors, promotes acceptance of the injury, provides pain management and encourages participation in leisure-time physical activity.

  • 9.
    Larsson, Agneta
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Karlqvist, Lena
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    To Tailor health promoting interventions to user needs: effects of work ability and health promoting interventions for women with musculoskeletal symptoms2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 4, p. 402-403Article in journal (Other academic)
  • 10.
    Larsson-Lund, Maria
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Fisher, Anne G.
    Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University.
    Lexell, Jan
    Benspång, Birgitta
    Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University.
    Impact on participation and autonomy questionnaire: internal scale validity of the Swedish version for use in people with spinal cord injury2007In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 39, no 2, p. 156-162Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate aspects of internal scale validity and reliability of the Swedish version of the Impact on Participation and Autonomy questionnaire (IPA-S) for use in people with spinal cord injury. Subjects: A total of 161 persons with spinal cord injury. Method: IPA-S psychometric properties were evaluated using Rasch rating scale analysis. Results: The results show that the IPA-S has 27 items for perceived participation and 6 items for perceived problems with participation, indicating 2 underlying unidimensional constructs for use in people with spinal cord injury, after removal of misfitting items. The established hierarchical order of the item calibration values in both scales appeared logical and the distances between the items, with a few exceptions in the problem scale, were appropriate. Both scales demonstrated good separation reliability. The range of item calibration values in both scales did not fully cover the range of measures of persons' perceived participation and problems thereof. Conclusion: The psychometric properties of IPA-S are promising and indicate that IPA-S has potential to be developed further.

  • 11.
    Larsson-Lund, Maria
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lexell, Jan
    Luleå University of Technology, Department of Health Sciences, Medical Science.
    A positive turning point in life: how persons with late effects of polio experience the influence of an interdisciplinary rehabilitation programme2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 6, p. 559-565Article in journal (Refereed)
    Abstract [en]

    Objective: To describe and enhance our understanding of how persons with late effects of polio experience the influence of an interdisciplinary rehabilitation programme. Participants: Twelve persons with clinically verified late effects of polio who had participated in an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme. Methods: Qualitative research interviews analysed using the constant comparative method of grounded theory. Results: The rehabilitation programme was experienced as a turning point in the participants' lives. Before rehabilitation they felt they were on a downward slope without control. Rehabilitation was the start of a process of change whereby they acquired new skills, which, over time, contributed to a different but good life. After approximately a year, they had a sense of control and had accepted life with late effects of polio. They had also established new habits, taken on a changed valued self and could look to the future with confidence. Conclusion: This qualitative study has shown that persons with late effects of polio can benefit from an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme and experience positive changes in their manage­ment of daily activities and in their view of their late effects of polio, their future and their self.

  • 12.
    Larsson-Lund, Maria
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lexell, Jan
    Luleå University of Technology, Department of Health Sciences.
    Perceived participation in life situations in persons with late effects of polio2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 8, p. 659-664Article in journal (Refereed)
    Abstract [en]

    To investigate how persons with late effects of polio perceive their participation and problems with participation in life situations and to determine the association between perceived problems with participation and sex, age, marital status, use of mobility aids and access to instrumental support.Design: Cross-sectional.Subjects: A total of 160 persons with prior polio 6-30 months after an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme.Methods: All subjects answered the Swedish version of the Impact on Participation and Autonomy Questionnaire.Results: A majority of the respondents perceived their participation as sufficient in most activities and 65% of the respondents perceived no severe problems with participation. The remaining 35% perceived 1-6 severe problems with participation. All 5 domains of participation were positively correlated with the 9 items for problem experience. Most restrictions in participation were reported in the domains of Family role, Autonomy outdoors, and Work and education. Insufficient instrumental support was most strongly associated with the perception of severe problems with participation.Conclusion: Rehabilitation programmes for persons with late effects of polio need to focus on areas of participation that are perceived as a problem by these persons and to promote access to a supportive environment to enhance their participation.

  • 13.
    Larsson-Lund, Maria
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Nordlund, Anders
    Nygård, Louise
    Karolinska institutet, Divison of occupational therapy. Department of Neurotec.
    Lexell, Jan
    Luleå University of Technology, Department of Health Sciences.
    Bernspång, Birgitta
    Umeå University, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Perceptions of participation and predictors of perceived problems with participation in persons with spinal cord injury2005In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 37, no 1, p. 3-8Article in journal (Refereed)
    Abstract [en]

    Objective: To describe how persons with spinal cord injury perceived their participation in life situations and to determine the relationship between their participation and perceived problems therewith. The purpose was also to evaluate the influence of age, sex, level of injury, time since injury, marital status and access to social support on perceived problems with participation. Design: Cross-sectional. Subjects: One hundred sixty-one persons with spinal cord injury. Methods: A postal questionnaire including socio-demographic characteristics and a Swedish version of the Impact on Participation and Autonomy questionnaire. Results: A majority of the respondents perceived their participation as sufficient in most activities addressed. Still, a majority of the respondents perceived one or more severe problems with their participation. Access to social support was the most influencing variable in predicting perceived severe problems with participation as compared with certain personal and health-related factors. Conclusion: The results suggest that it is important to consider access to social support along with other factors in the person-environment interaction and their influence on severe problems with participation in enhancing clients' participation in rehabilitation.

  • 14. Lexell, Jan
    et al.
    Flansbjer, Ulla-Britt
    Department of Rehabilitation, Lund University Hospital, Sweden.
    Holmbäck, Anna Maria
    Department of Rehabilitation, Lund University Hospital, Sweden.
    Downham, David
    Department of Rehabilitation, Lund University Hospital, Sweden.
    Patten, Carolynn
    Department of Rehabilitation, Lund University Hospital, Sweden.
    Reliability of gait performance tests in men and women with hemiparesis after stroke.2005In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 37, no 2, p. 75-82Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the reliability of 6 gait performance tests in individuals with chronic mild to moderate post-stroke hemiparesis. Design: An intra-rater (between occasions) test-retest reliability study. Subjects: Fifty men and women (mean age 58+/-6.4 years) 6-46 months post-stroke. METHODS: The Timed "Up & Go" test, the Comfortable and the Fast Gait Speed tests, the Stair Climbing ascend and descend tests and the 6-Minute Walk test were assessed 7 days apart. Reliability was evaluated with the intraclass correlation coefficient (ICC(2,1)), the Bland & Altman analysis, the standard error of measurement (SEM and SEM%) and the smallest real difference (SRD and SRD%). RESULTS: Test-retest agreements were high (ICC(2,1) 0.94-0.99) with no discernible systematic differences between the tests. The standard error of measurement (SEM%), representing the smallest change that indicates a real (clinical) improvement for a group of individuals, was small (< 9%). The smallest real difference (SRD%), representing the smallest change that indicates a real (clinical) improvement for a single individual, was also small (13-23%). CONCLUSION: These commonly used gait performance tests are highly reliable and can be recommended to evaluate improvements in various aspects of gait performance in individuals with chronic mild to moderate hemiparesis after stroke

  • 15. Lexell, Jan
    et al.
    Holmbäck, Anna-Maria
    Department of Physical Therapy, Lund University.
    Downham, David
    Department of Mathematical Sciences, University of Liverpool.
    Porter, Michell M
    Faculty of Physical Education and Recreation Studies, University of Manitoba, Winnipeg, Manitoba.
    Ankle dorsiflexor muscle performance in healthy young men and women: reliability of eccentric peak torque and work measurements2001In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 33, no 2, p. 90-96Article in journal (Refereed)
    Abstract [en]

    The aims of this study were: (i) to assess the test-retest intrarater reliability of eccentric ankle dorsiflexor muscle performance in young healthy men and women using the Biodex dynamometer; and (ii) to examine different statistical indices for the interpretation of reliability. Thirty men and women (age 22.5 +/- 2.5 years, mean +/- S.D.) performed three maximal eccentric contractions at 30 degrees/second and 90 degrees/second, with 7-10 days between test sessions. Reliability was evaluated with three intraclass correlation coefficients (ICC1,1, ICC2,1 and ICC3,1), and was excellent for peak torque (ICC 0.90-0.96) and good to excellent for work (ICC 0.69-0.83), with no discernible differences among the three ICCs. Method errors, assessed by the standard error of the measurement (S.E.M.) and S.E.M.%, were low. The Bland & Altman graphs and analyses indicated no significant systematic bias in the data. In conclusion, measurements of eccentric ankle dorsiflexor muscle performance in young healthy individuals using the Biodex are highly reliable.

  • 16. Lexell, Jan
    et al.
    Malec, James F.
    Rehabilitation Hospital of Indiana and Indiana University School of Medicine.
    Jacobsson, Lars J.
    Medical Rehabilitation Section, Department of General Medicine, Kalix Hospitral.
    Mapping the Mayo-Portland Adaptability Inventory to the International Classification of Functioning, Disability and Health2012In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 1, p. 65-72Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the contents of the Mayo-Portland Adaptability Inventory (MPAI-4) by mapping it to the International Classification of Functioning, Disability and Health (ICF). Methods: Each of the 30 scoreable items in the MPAI-4 was mapped to the most precise ICF categories. Results: All 30 items could be mapped to components and categories in the ICF. A total of 88 meaningful concepts were identified. There were, on average, 2.9 meaningful concepts per item, and 65% of all concepts could be mapped. Items in the Ability and Adjustment subscales mapped to categories in both the Body Functions and Activity/Participation components of the ICF, whereas all except 1 in the Participation subscale were to categories in the Activity/Participation component. The items could also be mapped to 34 (13%) of the 258 Environmental Factors in the ICF. Conclusion: This mapping provides better definition through more concrete examples (as listed in the ICF) of the types of body functions, activities, and participation indicators that are represented by the 30 scoreable MPAI-4 items. This may assist users throughout the world in understanding the intent of each item, and support further development and the possibility to report results in the form of an ICF categorical profile, making it universally interpretable

  • 17.
    Lindström, Britta
    et al.
    Umeå University, Department of Community Medicine and Rehabilitation.
    Röding, Jenny
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Sundelin, Gunnevi
    Umeå University, Department of Community Medicine and Rehabilitation.
    Positive attitudes and preserved high level of motor performance are important factors for return to work in younger persons after stroke: a national survey2009In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 41, no 9, p. 714-718Article in journal (Refereed)
    Abstract [en]

    Objective: Significant numbers of younger persons with stroke should be given the opportunity to return to work. The aim of this study was to investigate factors of importance for return to work among persons after first ever stroke, in the age range 18-55 years. Methods: A questionnaire was sent to all persons who had experienced a first ever stroke, 18-55 years of age, registered in the Swedish national quality register for stroke care, Riks-Stroke. Of the 1068 who answered the questionnaire, 855 (539 men and 316 women) were in paid employment before their stroke, and were included in this study. Results:Sixty-five percent returned to work and, of these, an equal proportion were men and women. Significant factors associated with return to work were the perceived importance of work (odds ratio (OR) 5.10), not perceiving themselves as a burden on others (OR 3.33), support from others for return to work (OR 3.66), retaining the ability to run a short distance (OR 2.77), and higher socioeconomic codes (OR 2.12). A negative association was found between those rehabilitated in wards intended for younger persons and return to work (OR 0.37). Conclusion: External support from others, and positive attitudes towards return to work, were factors associated with successful return to work after stroke. Contrary to what was expected, independence in personal activities of daily living and cognitive factors were not associated with return to work to the same extent as persistent higher level of physical functions, such as ability to run a short distance.

  • 18.
    Michaelson, Peter
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Holmberg, David
    Cederkliniken Primary Health Care Centre.
    Aasa, Björn
    Department of Orthopaedics, Surgical and Perioperative Sciences, Umeå University.
    Aasa, Ulrika
    Umeå University, Department of Community Medicine and Rehabilitation, Division of Physiotherapy.
    High load lifting exercise and low load motor control exercises as interventions for patients with mechanical low back pain: A randomized controlled trial with 24-month follow-up2016In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 48, no 5, p. 456-463Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to compare the effects of a high load lifting exercise with low load motor control exercises on pain intensity, disability and health-related quality of life for patients with mechanical low back pain.DESIGN: A randomized controlled trial.SUBJECTS: Patients with mechanical low back pain as their dominating pain mechanism. METHODS: The intervention programme consisted of a high load lifting exercise, while the control group received low load motor control exercises over 8 weeks (12 sessions) with pain education included in both intervention arms. The primary outcome was pain intensity and disability, and the secondary outcome was health-related quality of life. RESULTS: Each intervention arm included 35 participants, analysed following 2-, 12- and 24-month follow-up. There was no significant difference between the high load lifting and low load motor control interventions for the primary or secondary outcome measures. Between 50% and 80% of participants reported a decrease in perceived pain intensity and disability for both short- and long-term follow-up.CONCLUSION: No difference was observed between the high low load lifting and low load motor control interventions. Both interventions included retraining of movement patterns and pain education, which might explain the positive results over time

  • 19. Michaelson, Peter
    et al.
    Michaelson, Magdalena
    Southern Lapland Research Department, Vilhelmina.
    Jaric, Slobodan
    University of Gävle, Centre of Musculoskeletal Research.
    Latash, Mark L.
    Pennsylvania State University, Department of Kinesiology.
    Sjölander, Per
    Southern Lapland Research Department, Vilhelmina.
    Djupsjöbacka, Mats
    University of Gävle, Centre of Musculoskeletal Research.
    Vertical posture and head stability in patients with chronic neck pain2003In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 35, no 5, p. 229-35Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate postural performance and head stabilization of patients with chronic neck pain. DESIGN: A single-blind comparative group study. SUBJECTS: Patients with work-related chronic neck pain (n = 9), with chronic whiplash associated disorders (n = 9) and healthy subjects (n = 16). METHODS: During quiet standing in different conditions (e.g. 1 and 2 feet standing, tandem standing, and open and closed eyes) the sway areas and the ability to maintain the postures were measured. The maximal peak-to-peak displacement of the centre of pressure and the head translation were analysed during predictable and unpredictable postural perturbations. RESULTS: Patients with chronic neck pain, in particular those with whiplash-associated disorders, showed larger sway areas and reduced ability to successfully execute more challenging balance tasks. They also displayed larger sway areas and reduced head stability during perturbations. CONCLUSION: The results show that disturbances of postural control in chronic neck pain are dependent on the aetiology, and that it is possible to quantify characteristic postural disturbances in different neck pain conditions. It is suggested that the dissimilarities in postural performance are a reflection of different degrees of disturbances of the proprioceptive input to the central nervous system and/or of the central processing of such input.

  • 20.
    Nordin, Catharina
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Gard, Gunvor
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Fjellman-Wiklund, Anncristine
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University.
    Being in an exchange process: experiences of patient participation in multimodal pain rehabilitation2013In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 6, p. 580-586Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore primary healthcare patients’ experiences of patients participation in multimodal pain rehabilitation. Patients and methods: A total of 17 patients who had completed multimodal rehabilitation for persistent pain were interviewed. The interviews were analysed using qualitative content analysis. RESULTS: One theme, Being in an exchange process, and 4 categories emerged. The theme depicted patient participation as a continuous exchange of emotions, thoughts and knowledge. The category Fruitful encounters represented the basic prerequisites for patient participation through dialogue and platforms to meet. Patients’ emotional and cognitive resources and restrictions, as well as knowledge gaps, were conditions influencing patient participation in the category Inequality in co-operation. Mutual trust and respect were crucial conditions in patient’s personal relationships with the health professionals, forming the category Confidence-inspiring alliance. In the category Competent health professionals, the health professionals’ expertise, empathy and personal qualities, were emphasized to favour patient participation. CONCLUSION: Patient participation can be understood as complex and individualized. A confidence-inspiring alliance enables a trusting relationship to be formed between patients and health professionals. Patients emphasized that health professionals need to play an active role in building common ground in the interaction. Understanding each patient’s needs in the participation process may favour patient participation.

  • 21.
    Näslund, Annika
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Sundelin, Gunnevi
    Umeå universitet, Institutionen för Samhällsmedicin, Avdelningen för Sjukgymnastik.
    Hirschfeld, Helga
    Karolinska Institutet, Forskningslaboratoriet för motorisk kontroll och sjukgymnastik, Institutionen Neurotec.
    Reach performance and postural adjustments during standing in children with severe spastic diplegia using dynamic ankle-foot orthoses2007In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 39, no 9, p. 715-23Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the co-ordination between reaching, ground reaction forces and muscle activity in standing children with severe spastic diplegia wearing dynamic ankle-foot orthoses compared with typically developing children. DESIGN: Clinical experimental study. SUBJECTS: Six children with spastic diplegia (Gross Motor Function Classification System level III-IV) and 6 controls. METHODS: Ground reaction forces (AMTI force plates), ankle muscle activity (electromyography and displacement of the hand (ELITE systems) were investigated while reaching for an object. RESULTS: For the children with severe spastic diplegia who were wearing dynamic ankle-foot orthoses, co-ordination between upward and forward reach velocity differed regarding the temporal sequencing and amplitude of velocity peaks. During reaching, these children lacked interplay of pushing force beneath the reach leg and braking force beneath the non-reach leg and co-ordinated ankle muscle activity, compared with controls. CONCLUSION: The results suggest differences in reach performance and postural adjustments for balance control during a reaching movement in standing between children with spastic diplegia Gross Motor Function Classification System level III-IV, wearing dynamic ankle-foot orthoses compared with typically developing children.

  • 22.
    Petersson, Ingela
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet.
    Lilja, Margareta
    Hammel, Joy M.
    Department of Occupational Therapy, University of Illinois.
    Kottorp, Anders
    Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet.
    Impact of home modification services on ability in everyday life for people ageing with disabilities2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 4, p. 253-260Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the impact of home modifications on self-rated ability in everyday life from various aspects for people ageing with disabilities. Methods: The study sample was recruited from an agency providing home modification services in Sweden and comprised 73 subjects whose referrals had been approved and who were scheduled to receive home modifications (intervention group) and 41 subjects waiting for their applications to be assessed for approval (comparison group). The subjects rated their ability in everyday life using the Client-Clinician Assessment Protocol Part I on 2 occasions: at baseline and follow-up. The Client-Clinician Assessment Protocol Part I provides data on the clients' self-rated independence, difficulty and safety in everyday life. The data were first subjected to Rasch analysis in order to convert the raw scores into interval measures. Further analyses to investigate changes in self-rated ability were conducted with parametric statistics. Results: Subjects who had received home modifications reported a statistically significant improvement in their self-rated ability in everyday life compared with those in the comparison group. Subjects who had received home modifications reported less difficulty and increased safety, especially in tasks related to self-care in the bathroom and transfers, such as getting in and out of the home. Conclusion: Home modifications have a positive impact on self-rated ability in everyday life, especially on decreasing the level of difficulty and increasing safety.

  • 23.
    Röding, Jenny
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Glader, Eva-Lotta
    Department of Public Health and Clinical Medicine, Umeå university.
    Malm, Jan
    Department of Clinical Neuroscience, Umeå University.
    Lindström, Britta
    Department of Community Medicine, Umeå university.
    Life satisfaction in younger individuals after stroke: different predisposing factors among men and women2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 2, p. 155-161Article in journal (Refereed)
    Abstract [en]

    OBJECT: To describe self-reported life satisfaction of younger persons after stroke and to investigate differences between men and women and factors associated with life satisfaction. DESIGN: A cross-sectional study. METHODS: Subjects were all persons after stroke, aged 18-55 years, registered in the Swedish National Quality Register for Stroke Care. A questionnaire was completed by 1068 individuals 8-36 months after stroke. Perceived Life Satisfaction was measured with LiSat-9. RESULTS: Less than half of the participants were satisfied with life as a whole. For women, significant associations were found between not being satisfied with life as a whole and haemorrhage (odds ratio (OR) 4.00) as well as a deteriorated ability to concentrate (OR 2.11). For men, significant associations were found to be not having a significant other (OR 3.17), not working (OR 2.26) and deteriorated ability to concentrate (OR 2.04). CONCLUSION: There were different factors for being satisfied with life as a whole between men and women, indicating a need for a more gender-specific rehabilitation than is currently used. The impact that deteriorated ability to concentrate has on life satisfaction is an important finding that needs to be considered in the rehabilitation process of younger patients after stroke.

  • 24.
    Röijezon, Ulrik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Assessment and exercise of sensorimotor function in neck pain disorders2011In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 43, no Suppl 50Article in journal (Other academic)
    Abstract [en]

    Recent research on sensorimotor function has contributed essentially to the understanding of possible pathophysiological mechanisms, associations between pain and altered motor control and to the development of assessment and rehabilitation methods of musculoskeletal pain disorders. The sensory and motor functions of the cervical spine are fundamental for the stability and movement control of the head, for the arm and hand function, as well as for the postural control. Thus, sensorimotor deficiencies in neck pain disorders may have important impact not only regarding symptoms but also on physical functioning in daily living and work life. Pathophysiological models explaining the associations between pain and altered sensorimotor function include, e.g., disturbed proprioceptive information due to altered sensitivity of muscle spindle afferents, and altered muscle activation patterns due to pain adaptations. According to these models, sensorimotor deficiencies may be of immense importance for the recurrence, persistence and spread of musculoskeletal pain disorders. Assessments of sensorimotor function in neck pain disorders have revealed deficiencies including, e.g., reduced range of motion and movement speed of cervical movements; reduced acuity in movements of the neck, shoulder and elbow; and reduced muscle strength, as well as altered activation synergies of the deep and superficial cervical muscles. Disturbances have also been identified for occulomotor function and postural control, especially in neck pain related to trauma and cervicogenic dizziness. For references see, e.g. (1). In line with the above, specific exercise regimes designed to improve sensorimotor function, such as neck coordination and proprioception exercises, have shown promising results in reducing pain and improving motor functions, e.g., (2). A common characteristic of these exercises is that they involve slow movements and closed skills tasks (i.e., the task is highly predictable). According to the literature on motor learning, exercises involving more open skills tasks can be useful for training sensorimotor function. Therefore, new methods have been developed which involve less predictable exercises and thereby increase the demand for on-line adjustments of the neuromuscular control system (3, 4). Taken together, these theoretical and empirical premises support the value of assessment and exercise of sensorimotor function in the rehabilitation of neck pain disorders. Further research is, however, warranted, e.g., regarding the neuromuscular mechanisms involved in various types of exercises; the predictive ability of the efficiency of interventions for a specific individual; and RCT-studies including long-term follow-up. References1. Röijezon U. Sensorimotor function in chronic neck pain: Objective assessmentsand a novel method for neck coordination exercise [PhD-thesis]:Umeå University, ISSN 0346-6612; ISBN: 978-91-7264-809-8; 2009.2. Jull G, Falla D, Treleaven J, Hodges P, Vicenzino B. Retraining cervicaljoint position sense: The effect of two exercise regimes. J Orthop Res2007 Mar; 25: 404–412.3. Kristjansson E, Oddsdottir GL. “The Fly”: A new clinical assessment andtreatment method for deficits of movement control in the cervical spinereliability and validity. Spine 2010; 35: E1298–E305.4. Röijezon U, Björklund M, Bergenheim M, Djupsjöbacka M. A novelmethod for neck coordination exercise--a pilot study on persons withchronic non-specific neck pain. J Neuroeng Rehabil 2008; 5: 36.

  • 25. Sandlund, Jonas
    et al.
    Röijezon, Ulrik
    Björklund, Martin
    Djupsjöbacka, Mats
    Acuity of goal-directed arm movements to visible targets in chronic neck pain2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 5, p. 366-74Article in journal (Refereed)
  • 26.
    Spinord, Linda
    et al.
    Department of Community Medicine and Rehabilitation, Umeå University.
    Kassberg, Ann-Charlotte
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. Department of Research, Region Norrbotten, Luleå.
    Stenberg, Gunilla
    Department of Community Medicine and Rehabilitation, Umeå University.
    Lundqvist, Robert
    Department of Research, Region Norrbotten, Luleå.
    Stålnacke, Britt-Marie
    Department of Community Medicine and Rehabilitation, Umeå University.
    Comparison of two multimodal pain rehabilitation programmes, in relation to sex and age2018In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 7, p. 619-628Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate patient-reported outcome measures in 2 different multimodal pain rehabilitation programmes and to determine whether outcomes are related to sex or age at 1-year follow-up. Design: Longitudinal retrospective study. Subjects: Patients who had participated in 1 of 2 multimodal pain rehabilitation programmes at 2 rehabilitation centres. A total of 356 women and 83 men, divided into 3 age groups. Methods: Data from the Swedish Quality Registry for Pain Rehabilitation regarding activity and physical functions, pain intensity, health status and emotional functions analysed with descriptive statistics. Results: Significant improvements in activity and physical functions, pain intensity and emotional functions were found in both multimodal pain rehabilitation programmes. Women improved more than men. The older group improved in all emotional functions (depression, anxiety, mental component summary), while the younger group improved only in depression. The intermediate group improved in all variables except anxiety. Conclusion: Patients improved regardless of the design of the multimodal pain rehabilitation programme. Although only small differences were found between men and women and among the 3 age groups in terms of the measured variables, these findings may have clinical relevance and indicate a need to vary the design of the interventions in multimodal rehabilitation programmes for these subgroups.

  • 27.
    Stenvall, Michael
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Olofsson, Birgitta
    Department of Orthopaedics, Surgical and Perioperative Sciences, Umeå University.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lundström, Maria
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomized controlled trial with 1-year follow-up2007In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 39, no 3, p. 232-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the short- and long-term effects of a multidisciplinary postoperative rehabilitation programme in patients with femoral neck fracture. DESIGN AND SUBJECTS: A randomized controlled trial in patients (n = 199) with femoral neck fracture, aged >or= 70 years. METHODS: The primary outcomes were: living conditions, walking ability and activities of daily living performance on discharge, 4 and 12 months postoperatively. The intervention consisted of staff education, individualized care planning and rehabilitation, active prevention, detection and treatment of postoperative complications. The staff worked in teams to apply comprehensive geriatric assessment, management and rehabilitation. A geriatric team assessed those in the intervention group 4 months postoperatively, in order to detect and treat any complications. The control group followed conventional postoperative routines. RESULTS: Despite shorter hospitalization, significantly more people from the intervention group had regained independence in personal activities of daily living performance at the 4- and 12-month follow-ups; odds ratios (95% confidence interval (CI) ) 2.51 (1.00-6.30) and 3.49 (1.31-9.23), respectively. More patients in the intervention group had also regained the ability to walk independently indoors without walking aids by the end of the study period, odds ratio (95% confidence interval) 3.01 (1.18-7.61). CONCLUSION: A multidisciplinary postoperative intervention programme enhances activities of daily living performance and mobility after hip fracture, from both a short-term and long-term perspective

  • 28.
    Åberg, Anna Christina
    et al.
    Department of Public Health and Caring Sciences/Geriatrics, Uppsala University.
    Lundin-Olsson, Lillemor
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Implementation of evidence-based prevention of falls in rehabilitation units: A staff's interactive approach2009In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 41, no 13, p. 1034-1040Article in journal (Refereed)
    Abstract [en]

    Objective: To provide strategies to assist healthcare professionals in the area of rehabilitation to improve prevention of falls. Design: A conceptual framework is described as a foundation for the proposal of 2 intertwined strategies, of intervention and implementation, which target the questions: Which strategies for intervention represent the current best evidence? and: How can these strategies be implemented and continuously developed? Results: Strategies for multifactorial and multiprofessional fall preventive interventions are presented in terms of a "fall prevention pyramid model", including general, individualized, and acute interventions. A systematic global fall risk rating by the staff is recommended as an initial procedure. Fall event recording and follow-up are stressed as important components of local learning and safety improvement. Development of implementation strategies in 3 phases, focusing on interaction, facilitation and organizational culture, is described Conclusion: A well-developed patient safety culture focusing on prevention of falls will, when successfully achieved, be seen by staff, patients and their significant others as being characteristic of the organization, and will be evident in attitudes, routines and actions. Moreover, it provides potential for positive side-effects concerning organizational and clinical improvements in additional areas

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