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  • 1.
    Conradsson, Mia
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Littbrand, Håkan
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Lindelöf, Nina
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Effects of a high-intensity functional exercise programme on depressive symptoms and psychological well-being among older people living in residential care facilities: a cluster-randomized controlled trial2010In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 14, no 5, p. 565-576Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the effects of a high-intensity functional exercise programme on depressive symptoms and psychological well-being among older people dependent in activities of daily living (ADL) and living in residential care facilities. Method: Cluster-randomized controlled study. Participants were 191 older people, aged 65-100, dependent in ADL and with Mini Mental State Examination scores between 10 and 30. One-hundred (52%) of the participants had a diagnosed dementia disorder. A high-intensity functional weight-bearing exercise programme and a control activity were performed in groups. Sessions were held five times over each two week period for three months, a total of 29 times. The outcome measures, Geriatric Depression Scale (GDS-15) and Philadelphia Geriatric Center Morale Scale (PGCMS) were blindly assessed at baseline, three and six months. Results: At baseline, mean ± SD (range) for GDS was 4.4±3.2 (0-14), and for PGCMS 11.0±3.5 (2-17). There were no significant differences in GDS or PGCMS between the exercise and the control group at the three and six month follow-ups in the total sample. Among people with dementia, there was a between-group difference at three months in PGCMS scores in favour of the exercise group. Conclusion: A high-intensity functional exercise programme seems generally not to influence depressive symptoms or psychological well-being among older people dependent in ADL and living in residential care facilities. An individualized and multifactorial intervention may be needed in this group. However, an exercise programme as a single intervention may have a short-term effect on well-being among people with dementia

  • 2.
    Conradsson, Mia
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Lundin-Olsson, Lillemor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindelöf, Nina
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Littbrand, Håkan
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Malmqvist, Lisa
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Berg Balance Scale: intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities2007In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 87, no 9, p. 1155-1163Article in journal (Refereed)
    Abstract [en]

    The Berg Balance Scale (BBS) is frequently used to assess balance in older people, but knowledge is lacking about the absolute reliability of BBS scores. The aim of this study was to investigate the absolute and relative intrarater test-retest reliability of data obtained with the BBS when it is used among older people who are dependent in activities of daily living and living in residential care facilities. The participants were 45 older people (36 women and 9 men) who were living in 3 residential care facilities. Their mean age was 82.3 years (SD=6.6, range=68-96), and their mean score on the Mini Mental State Examination was 17.5 (SD=6.3, range=4-30). The BBS was assessed twice by the same assessor. The intrarater test-retest reliability assessments were made at approximately the same time of day and with 1 to 3 days in between assessments. Absolute reliability was calculated using an analysis of variance with a 95% confidence level, as suggested by Bland and Altman. Relative reliability was calculated using the intraclass correlation coefficient (ICC). The mean score was 30.1 points (SD=15.9, range=3-53) for the first BBS test and 30.6 points (SD=15.6, range=4-54) for the retest. The mean absolute difference between the 2 tests was 2.8 points (SD=2.7, range=0-11). The absolute reliability was calculated as being 7.7 points, and the ICC was calculated to .97. Despite a high ICC value, the absolute reliability showed that a change of 8 BBS points is required to reveal a genuine change in function among older people who are dependent in activities of daily living and living in residential care facilities. This knowledge is important in the clinical setting when evaluating an individual's change in balance function over time in this group of older people.

  • 3.
    Conradsson, Mia
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Lundin-Olsson, Lillemor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindelöf, Nina
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Littbrand, Håkan
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Malmqvist, Lisa
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    The Berg Balance Scale: Intra-rater reliability in older people dependent in ADL and living in residential care facilities2006In: 18th Nordic Congress of Gerontology: Innovations for an Ageing Society, 2006, p. 139-140Conference paper (Other academic)
  • 4.
    Conradsson, Mia
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Lundin-Olsson, Lillemor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindelöf, Nina
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Littbrand, Håkan
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Malmqvist, Lisa
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    The Berg balance scale: intra-rater reliability in older people dependent in ADL and living in residential care facilities2007In: 15th International Congress of The World Confederation for Physical Therapy: 2-6 June 2007, Vancouver, Canada, WCPT , 2007Conference paper (Other academic)
  • 5.
    Conradsson, Mia
    et al.
    Umeå universitet.
    Lundin-Olsson, Lillemor
    Umeå universitet.
    Lindelöf, Nina
    Umeå universitet.
    Littbrand, Håkan
    Umeå universitet.
    Malmqvist, Lisa
    Umeå universitet.
    Gustafson, Yngve
    Umeå universitet.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    The Berg Balance Scale: Intra-rater reliability in older people dependent in ADL and living in residential care facilities2006Conference paper (Other academic)
    Abstract [en]

    Aim: The aim of this study was to investigate the absolute and the relative intra-rater reliability of the Berg Balance Scale (BBS) among older people who are dependent in activities of daily living (ADL) and living in residential care facilities.Methods: The participants were 45 older people, 36 females and 9 men, who were dependent in ADL and living in three residential care facilities. Their mean age ± SD was 82.3 ± 6.6 (range 68-96) and mean ± SD of Mini Mental State Examination score was 17.5 ± 6.3 (range 4-30). The BBS was assessed twice by the same assessor, at approximately the same time of day, and with 1-3 days in between. The absolute reliability for the difference in score between the two test occasions was calculated with the Bland and Altman analysis of variance with 95 % confidence level. The relative reliability was calculated with Intraclass Correlation Coefficient (ICC).Results: For the first test of the BBS, mean ± SD was 30.1 ± 15.9 (range 3-53) points and for the retest 30.6 ± 15.6 (range 4-54). The absolute difference between the two test occasions was in mean ± SD 2.8 ± 2.7 (range 0-11) points. The absolute intra-rater reliability was calculated to 7.7 points and the ICC value was 0.97. Conclusions: Despite a high ICC value, the result of the absolute reliability show that a change of 8 BBS points is required to reveal a genuine change of function among older people who are dependent in ADL and living in residential care facilities. This knowledge is important in the clinical setting when evaluating an individual's change in balance function over time.

  • 6.
    Jensen, Jane
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Rosendahl, Erik
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Lundin-Olsson, Lillemor
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Effects of a fall prevention program including exercise on mobility and falls in frail older people living in residential care facilities2004In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 16, no 4, p. 283-92Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Impaired mobility is one of the strongest predictors for falls in older people. We hypothesized that exercise as part of a fall prevention program would have positive effects, both short- and long-term, on gait, balance and strength in older people at high risk of falling and with varying levels of cognition, residing in residential care facilities. A secondary hypothesis was that these effects would be associated with a reduced risk of falling. METHODS: 187 out of all residents living in 9 facilities, > or =65 years of age were at high risk of falling. The facilities were cluster-randomized to fall intervention or usual care. The intervention program comprised: education, environment, individually designed exercise, drug review, post-fall assessments, aids, and hip protectors. Data were adjusted for baseline performance and clustering. RESULTS: At 11 weeks, positive intervention effects were found on independent ambulation (FAC, p=0.026), maximum gait speed (p=0.002), and step height (> or =10 cm, p<0.001), but not significantly on the Berg Balance Scale. At 9 months (long-term outcome), 3 intervention and 15 control residents had lost the ability to walk (p=0.001). Independent ambulation and maximum gait speed were maintained in the intervention group but deteriorated in the control group (p=0.001). Residents with both higher and lower cognition benefited in most outcome measures. Noassociation was found between improved mobility and reduced risk of falling.CONCLUSIONS: Exercise, as part of a fall prevention program, appears to preserve the ability to walk, maintain gait speed, ambulate independently, and improve step height. Benefits were found in residents with both lower and higher cognitive impairment, but were not found to be associated with a reduced risk of falling

  • 7.
    Lindelöf, Nina
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Rosendahl, Erik
    Gustafsson, Samuel
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University.
    Nygaars, Joachim
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Perceptions of participating in high-intensity functional exercise among older people dependent in activities of daily living (ADL)2013In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 57, no 3, p. 369-376Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to evaluate how older people, dependent in ADL perceive their participation in a high-intensity, functional exercise program compared to the perceptions of those participating in a control activity. Forty-eight older people living in residential care facilities answered a questionnaire about their perceptions of participating in an activity for three months. They were aged 65-98, had a mean score of 24 on Mini Mental State Examination (MMSE) and 14 on Barthel ADL Index. The participants had been randomized to exercise (n = 20) or control activity (n = 28). Differences in responses between exercise and control activity were evaluated using logistic and ordinal regression analyses. The results show that a majority of the exercise group perceived positive changes in lower limb strength, balance, and in the ability to move more safely and securely compared to a minority of the control group (p < 0.001). Significantly more respondents in the exercise activity answered that they felt less tired due to the activity (p = 0.027) and that they prioritized this activity above other activities (p = 0.010). More exercise participants reported that meeting for three months was too short, and fewer that it was too long compared to the control group (p = 0.038). This study shows that older people living in residential care facilities, dependent in ADL, and with mild or no cognitive impairment had positive perceptions about participating in high-intensity functional exercise. The findings support the use of a high-intensity exercise program in this population of older people

  • 8.
    Littbrand, Håkan
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Lundin-Olsson, Lillemor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    The effect of a high-intensity functional exercise program on activities of daily living: a randomized controlled trial in residential care facilities2008Conference paper (Other academic)
  • 9.
    Littbrand, Håkan
    et al.
    Divisions of Geriatric Medicine and Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University.
    Lundin-Olsson, Lillemor
    Divisions of Geriatric Medicine and Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University.
    Gustafson, Yngve
    Divisions of Geriatric Medicine and Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    The effect of a high-intensity functional exercise program on activities of daily living: a randomized controlled trial in residential care facilities2009In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 57, no 10, p. 1741-1749Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate whether a high-intensity functional weight-bearing exercise program reduces dependency in activities of daily living (ADLs) in older people living in residential care facilities, focusing on people with dementia. DESIGN: Randomized, controlled trial. SETTING: Nine residential care facilities. PARTICIPANTS: One hundred ninety-one older people dependent in ADLs and with a Mini-Mental State Examination score of 10 or greater. One hundred (52.4%) of the participants had dementia. INTERVENTION: A high-intensity functional weight-bearing exercise program or a control activity consisting of 29 sessions over 3 months. MEASUREMENTS: The Barthel ADL Index; follow-up at 3 months (directly after the intervention) and 6 months with intention-to-treat analyses. RESULTS: There were no statistically significant differences between the groups regarding overall ADL performance. Analyses for each item revealed that a smaller proportion of participants in the exercise group had deteriorated in indoor mobility at 3 months (exercise 3.5% vs control 16.0%, P=.01) and 6 months (7.7% vs 19.8%, P=.03). For people with dementia, there was a significant difference in overall ADL performance in favor of the exercise group at 3 months (mean difference 1.1, P=.03) but not at 6 months. CONCLUSION: A high-intensity functional weight-bearing exercise program seems to reduce ADL decline related to indoor mobility for older people living in residential care facilities. The program does not appear to have an overall effect on ADLs. In people with dementia, the exercise program may prevent decline in overall ADL performance, but continuous training may be needed to maintain that effect.

  • 10.
    Littbrand, Håkan
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Lundin-Olsson, Lillemor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    The effect on ADL of a high-intensity functional exercise program among older people dependent in ADL: a randomized controlled trial2007In: 15th International Congress of the World Confederation for Physical Therapy: 2-6 June 2007, Vancouver, Canada, WCPT , 2007Conference paper (Other academic)
    Abstract [en]

    PURPOSE: To investigate if a high-intensity functional weight-bearing exercise program reduces the dependency in personal care and mobility among older people dependent in activities of daily living (ADL), with focus on people with dementia. RELEVANCE: The number of older people with disability increases. Physical functional capacity can be improved by high-intensity exercise program, but there is no strong evidence that physical exercise is an effective method to reduce disability. PARTICIPANTS: 191 older people dependent in ADL, living in residential care facilities, and with a Mini-Mental State Examination (MMSE) score of ≥ 10 participated in this study (the FOPANU Study). Their mean score ± SD of the Barthel ADL was 13.1±4.2 and 52% of the participants had a diagnosed dementia disease. METHODS: The participants were randomized to a high-intensity functional weight-bearing exercise program (the HIFE Program) or a control activity, including 29 sessions over 3 months. The Barthel ADL Index, which includes ten items that are summarized to a total score of 20, was used to assess independency in personal care and mobility. The assessments were performed, by persons blinded to the participants’ group allocation, before the intervention, at 3 months (directly after the intervention period), and at 6 months. ANALYSIS: Between-group effects on the total score and each item were analyzed by ANCOVA and by logistic regression, respectively, using the intention-to-treat principle. RESULTS: When analyzing all participants, there was no statistical significant difference between the groups at 3 or 6 months in total score of the Barthel ADL Index. Analyses for each item revealed that a lower proportion of participants in the exercise group had deteriorated regarding mobility indoors (item 7) at 3 and 6 months (4% and 8%) compared to the control group (16% and 20%), P = 0.01 and 0.03, respectively. Among people with dementia, there was a significant difference in total score in favor of the exercise group at 3 months (mean difference 1.1, P = 0.03), but not at 6 months. CONCLUSIONS: A high-intensity functional weight-bearing exercise program does not appear to have an overall effect on ADL according to the Barthel ADL Index among older people who are dependent in ADL and living in residential care facilities, but the exercise program seems to have both short- and long-term effect in maintaining mobility indoors. In the subgroup of people with dementia, the exercise program seems to have a short-term overall effect on ADL. IMPLICATIONS: A high-intensity functional weight-bearing exercise program seems to be a promising method to reduce disability regarding mobility indoors for older people living in residential care facilities. For people with dementia, the exercise program may have an overall effect in personal care and mobility but continuously training may be needed to maintain the effect.

  • 11.
    Littbrand, Håkan
    et al.
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lindelöf, Nina
    Umeå, Geriatrisk centrum.
    Lundin-Olsson, Lillemor
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering.
    Gustafson, Yngve
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Nyberg, Lars
    A high-intensity functional weight-bearing exercise program for older people dependent in activities of daily living and living in residential care facilities: evaluation of the applicability with focus on cognitive function2006In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 86, no 4, p. 489-98Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Knowledge concerning the applicability and the effect of high-intensity exercise programs is very limited for older people with severe cognitive and physical impairments. The primary aim of this study was to evaluate the applicability of a high-intensity functional weight-bearing exercise program among older people who are dependent in activities of daily living and living in residential care facilities. A second aim was to analyze whether cognitive function was associated with the applicability of the program. SUBJECTS: The subjects were 91 older people (mean age=85.3 years, SD=6.1, range=68-100) who were dependent in personal activities of daily living and randomly assigned to participate in an exercise intervention. Their mean score for the Mini-Mental State Examination (MMSE) was 17.5 (SD=5.0, range=10-29). METHODS: A high-intensity functional weight-bearing exercise program was performed in groups of 3 to 7 participants who were supervised by physical therapists. There were 29 exercise sessions over 13 weeks. Attendance, intensity of lower-limb strength and balance exercises, and occurrence and seriousness of adverse events were the outcome variables in evaluating the applicability of the program. RESULTS: The median attendance rate was 76%. Lower-limb strength exercises with high intensity were performed in a median of 53% of the attended exercise sessions, and balance exercises with high intensity were performed in a median of 73% of the attended exercise sessions. The median rate of sessions with adverse events was 5%. All except 2 adverse events were assessed as minor and temporary, and none led to manifest injury or disease. No significant differences were observed in applicability when comparing participants with dementia and participants without dementia. In addition, there was no significant correlation between applicability and the MMSE score. DISCUSSION AND CONCLUSION: The results suggest that a high-intensity functional weight-bearing exercise program is applicable for use, regardless of cognitive function, among older people who are dependent in activities of daily living, living in residential care facilities, and have an MMSE score of 10 or higher.

  • 12.
    Littbrand, Håkan
    et al.
    Umeå universitet.
    Stenvall, Michael
    Umeå universitet.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Applicability and effects of physical exercise on physical and cognitive functions and activities of daily living among people with dementia: a systematic review2011In: American Journal of Physical Medicine & Rehabilitation, ISSN 0894-9115, E-ISSN 1537-7385, Vol. 90, no 6, p. 495-518Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to systematically review the applicability (attendance, achieved intensity, adverse events) and effects of physical exercise on physical functions, cognitive functions, and activities of daily living among people with dementia.Design: Randomized controlled trials were identified in PubMed, the Cumulative Index to Nursing and Allied Health, the Allied and Complementary Medicine Database, and the Cochrane Library on August 30 and September 1, 2010, according to predefined inclusion criteria. Two reviewers independently extracted predetermined data and assessed methodologic quality.Results: A qualitative analysis was performed, including ten studies. Most participants were people with Alzheimer disease in residential care facilities. Four studies reached "moderate" methodologic quality, and six reached "low." The studies of moderate quality evaluated the effects of combined functional weight-bearing exercise, combined functional and nonfunctional exercise, and walking exercise.Conclusions: Among older people with Alzheimer disease in residential care facilities, combined functional weight-bearing exercise seems applicable for use regarding attendance and adverse events, and there is some evidence that exercise improves walking performance and reduces the decline in activities of daily living. Furthermore, there is some evidence that walking exercise performed individually reduces decline in walking performance, but adverse events need to be evaluated. Among older people with various types of dementia disorders who are staying in a hospital, there is some evidence that combined functional and nonfunctional exercise over 2 wks has no effect on mobility. It seems important that the interventions last for at least a few months and that the exercises are task-specific and are intended to challenge the individual's physical capacity. Among older people with unspecified dementia disorders in residential care facilities, there is some evidence that walking exercise performed at a self-selected speed has no effect on cognitive functions. Whether physical exercise can improve cognitive functions among people with dementia remains unclear because studies evaluating this have either been of low methodologic quality or used an intervention of presumably insufficient intensity. There is a need for more studies of high methodologic quality, especially among people with dementia disorders other than Alzheimer disease.

  • 13.
    Lundin-Olsson, Lillemor
    et al.
    Umeå universitet, Institutionen för Samhällsmedicin, Avdelningen för Sjukgymnastik.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Att förebygga fallolyckor bland äldre personer2008Report (Other academic)
  • 14.
    Nordin, Ellinor
    et al.
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindelöf, Nina
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Jensen, Jane
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundin-Olsson, Lillemor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Prognostic validity of the Timed Up-and-Go test: a modified Get-Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities2008In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 37, no 4, p. 442-448Article in journal (Refereed)
    Abstract [en]

    Objectives: to evaluate and compare the prognostic validity relative to falls of the Timed Up-and-Go test (TUG), a modified Get-Up-and-Go test (GUG-m), staff's judgement of global rating of fall risk (GLORF) and fall history among frail older people. Design: cohort study, 6-month prospective follow-up for falls. Participants: 183 frail persons living in residential care facilities in Sweden, mean age 84 years, 73% women. Methods: the occurrence of falls during the follow-up period were compared to the following assessments at baseline: the TUG at normal speed; the GUG-m, a rating of fall risk scored from 1 (no risk) to 5 (very high risk); the GLORF, staff's rating of fall risk as 'high' or 'low'; a history of falls in the previous 6 months. These assessment tools were evaluated using sensitivity, specificity and positive and negative likelihood ratios (LR+ to rule in and LR- to rule out a high fall risk). Results: 53% of the participants fell at least once. Various cut-off values of the TUG (12, 15, 20, 25, 30, 35, 40 s) and the GUG-m showed LR+ between 0.9 and 2.6 and LR- between 0.1 and 1.0. The GLORF showed an LR+ of 2.8 and an LR- of 0.6 and fall history showed an LR+ of 2.4 and an LR- of 0.6. Conclusions: in this population of frail older people, staff judgement of their residents' fall risk as well as previous falls both appear superior to the performance-based measures TUG and GUG-m in ruling in a high fall risk. A TUG score of less than 15 s gives guidance in ruling out a high fall risk but insufficient information in ruling in such a risk. The grading of fall risk by GUG-m appears of very limited value.

  • 15.
    Nordin, Ellinor
    et al.
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering.
    Rosendahl, Erik
    Lundin-Olsson, Lillemor
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering.
    Timed "Up & Go" test: reliability in older people dependent in activities of daily living - focus on cognitive state2006In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 86, no 5, p. 646-55Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: It is unknown how cognitive impairment affects the reliability of Timed "Up & Go" Test (TUG) scores. The aim of the present study was to investigate the expected variability of TUG scores in older subjects dependent in activities of daily living (ADL) and with different levels of cognitive state. The hypothesis was that cognitive impairment would increase the variability of TUG scores. SUBJECTS: Seventy-eight subjects with multiple impairments, dependent in ADL, and living in residential care facilities were included in this study. The subjects were 84.8+/-5.7 (mean+/-SD) years of age, and their Mini-Mental State Examination score was 18.7+/-5.6. METHODS: The TUG assessments were performed on 3 different days. Intrarater and interrater analyses were carried out. RESULTS: Cognitive impairment was not related to the size of the variability of TUG scores. There was a significant relationship between the variability and the time taken to perform the TUG. The intraclass correlations were greater than .90 and were similar within and between raters. In repeated measurements at the individual level, an observed value of 10 seconds was expected to vary from 7 to 15 seconds and an observed value of 40 seconds was expected to vary from 26 to 61 seconds for 95% of the observations. DISCUSSION AND CONCLUSION: The measurement error of a TUG assessment is substantial for a frail older person dependent in ADL, regardless of the level of cognitive function, when verbal cuing is permitted during testing. The variability increases with the time to perform the TUG. Despite high intraclass correlation coefficients, the ranges of expected variability can be wide and are similar within and between raters. Physical therapists should be aware of this variability before they interpret the TUG score for a particular individual.

  • 16.
    Nordin, Ellinor
    et al.
    Umeå universitet.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lundin-Olsson, Lillemor
    Umeå universitet.
    Timed Up&Go Test: Reliability in Older People dependent in Activities of Daily Living - Focus on Cognitive State2006Conference paper (Other academic)
    Abstract [en]

    Background and Purpose: It is unknown how cognitive impairment affects the reliability of Timed Up&Go Test (TUG). The aim of the present study was to investigate the expected variability of Timed Up&Go in older persons, dependent in activities of daily living (ADL), and with different levels of cognitive state. The hypothesis was that cognitive impairment would increase the variability of TUG scores.Subjects: Seventy-eight persons with multiple impairments, dependent in ADL and living in residential-care facilities were included in this study. The subjects were 84.8±5.7 (mean±SD) years old, and their Mini-mental State Examination score was 18.7±5.6. Methods: TUG assessments were performed on three different days. Intra- and inter rater analyses were carried out. Results: Cognitive impairment was not related to the size of the variability of TUG scores. There was a significant relationship between the variability and the time taken to perform TUG (p<0.001). The intraclass correlation were greater than .90, and were similar within and between raters. In repeated measurements at the individual level, an observed value of 10 seconds was expected to vary from 7 to 15 seconds, and an observed value of 40 seconds was expected to vary from 26 to 61 seconds for 95% of the observations. Discussion and Conclusions: The measurement error of a TUG assessment is substantial for a frail, older person dependent in ADL, regardless of the level of cognitive function, when verbal cuing is permitted during testing. The variability increases with the time to perform TUG. Despite high intraclass correlation coefficients, the ranges of expected variability can be wide and are similar within and between raters. Physical therapists should be aware of this variability before they interpret the TUG score for a particular patient.

  • 17.
    Nyberg, Lars
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lundin-Olsson, Lillemor
    Umeå universitet, Institutionen för Samhällsmedicin, Avdelningen för Sjukgymnastik.
    Sondell, Björn
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Backman, Anders
    Umeå universitet.
    Holmlund, Kenneth
    Umeå universitet, VRlab.
    Eriksson, Staffan
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Stenvall, Michael
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Rosendahl, Erik
    Maxhall, Marcus
    Umeå Center for Interaction Technology.
    Bucht, Gösta
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    The development of a virtual reality system to stud tendency of falling among older people2004In: The 5th International Conference on Disability, Virtual Reality and Associated Technologies: Proceedings : ICDVRAT, September 20-22 Oxford UK / [ed] Paul Sharkey; Rachel McCrindle; David Brown, Reading: University of Reading , 2004, p. 315-320Conference paper (Refereed)
  • 18.
    Nyberg, Lars
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lundin-Olsson, Lillemor
    Umeå universitet, Institutionen för Samhällsmedicin, Avdelningen för Sjukgymnastik.
    Sondell, Björn
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Backman, Anders
    Umeå universitet.
    Holmlund, Kenneth
    Umeå universitet, VRlab.
    Eriksson, Staffan
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Stenvall, Michael
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Rosendahl, Erik
    Maxhall, Marcus
    Umeå Center for Interaction Technology.
    Bucht, Gösta
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    The development of a virtual reality system to study tendency of falling among older people2005In: International Journal on Disability and Human Development, ISSN 1565-012X, Vol. 4, no 3, p. 239-243Article in journal (Refereed)
    Abstract [en]

    Injuries related to falls are a major threat to the health of older persons. A fall may result not only in an injury but also in a decreased sense of autonomy in the daily life. To be able to prevent such falls, a need to further understand the complex mechanisms involved in balance and walking is needed. Here we present an immersive virtual reality system, in which a person can move around while being subjected to various events, which may influence balance and walking

  • 19.
    Nyberg, Lars
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lundin-Olsson, Lillemor
    Umeå universitet, Institutionen för Samhällsmedicin, Avdelningen för Sjukgymnastik.
    Sondell, Björn
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Backman, Anders
    Umeå universitet.
    Holmlund, Kenneth
    Umeå universitet, VRlab.
    Eriksson, Staffan
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Stenvall, Michael
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Rosendahl, Erik
    Maxhall, Marcus
    Umeå Center for Interaction Technology.
    Bucht, Gösta
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Using a virtual reality system to study balance and walking in a virtual outdoor environment: a pilot study2006In: Cyberpsychology & Behavior, ISSN 1094-9313, E-ISSN 1557-8364, Vol. 9, no 4, p. 388-95Article in journal (Refereed)
    Abstract [en]

    Falls and fall-related injuries are a major problem for elderly persons. Most falls occur during walking and turning, and the risk of falling increases when attention is diverted to something besides walking. It is often difficult to standardize methods for testing balance and fall tendency in a clinically relevant setting. We describe the development of a system using a virtual environment (VE) to assess how attention demanding and unexpected events influence a person's capacity to control balance and movement. The hardware in the system consists of a head-mounted display (HMD), a magnetic tracker system, and two SGI computers. The software consists of the image generation of the VE and the management and visualization of motion tracking data. In a preliminary pilot study eight subjects (age 23-80) participated. Each subject walked on a normal floor and was visually presented a familiar outdoor environment in the HMD. They were exposed to different unexpected events, such as a virtual snowfall and tilting of the VE. Disturbances of balance and walking patterns such as changes in speed, stride length and balance reactions like slipping were observed. Two subjects experienced symptoms of cyber sickness with a SSQ score above 25 points. Walking with sensors only did not affect walking time, but in VE the subjects generally walked more slowly. Virtual tilting of the environment had an impact on balance performance during walking. This effect was not observed while the test subjects were walking in a virtual snowfall. The model needs further development but may hold a potential for clinical use.

  • 20.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Effect size underestimates the effects of interventions among older people with severe physical or cognitive impairments?2007In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 55, no 8, p. 1315-1316Article in journal (Other academic)
    Abstract [en]

    The use of effect sizes for comparison of the effects of various studies could potentially underestimate the effect among older people with severe physical or cognitive impairment. In a Cochrane Review about strength training in older adults, Standardized Mean Difference (SMD) was used to estimate the effect on lower-limb strength, calculated as the difference in means (between the intervention and the control group) of the outcome divided by the standard deviation of the outcome. Using a calculation where the effect is divided by the variation in ability between participants may underestimate the effect in studies which have broad inclusion criteria (often the case in studies on older people with severe impairments) since the same change over time in the absolute value of an outcome will produce a higher effect size in a more homogeneous group, as is to be expected if the participants are more healthy. However, this seems not to have been considered in the Cochrane Review for all included studies. Hopefully, in future, a consensus will be reached concerning how to calculate effect sizes in randomized trials. For the present, it is recommended that effect sizes are presented but the definitions in the CONSORT statement, e.g., for continuous outcome "difference in means," need to be clarified to ensure that the calculation is made in the same way in all studies.

  • 21.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Effekter på aktiviteter i det dagliga livet av ett högintensivt funktionellt träningsprogram: en randomiserad kontrollerad studie bland äldre personer på särskilt boende2008In: Forskning i Norr, 21-22 maj 2008, Mittuniversitetet , 2008, p. 155-Conference paper (Other academic)
  • 22. Rosendahl, Erik
    Evaluation of a high-intensity functional weight-bearing exercise program for older persons dependent in ADL2005In: European conference on adapted physical activity, ECAPA , 2005Conference paper (Other academic)
  • 23. Rosendahl, Erik
    Fall prediction and a high-intensity functional exercise programme to improve physical functions and to prevent falls among older people living in residential care facilities2006Doctoral thesis, comprehensive summary (Other academic)
  • 24.
    Rosendahl, Erik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nordin, Ellinor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundin-Olsson, Lillemor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nyberg, Lars
    A randomized controlled trial of fall prevention by a high-intensity functional exercise program for older people living in residential care facilities2008In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 20, no 1, p. 67-75Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Falls are particularly common among older people living in residential care facilities. The aim of this randomized controlled trial was to evaluate the effectiveness of a high-intensity functional exercise program in reducing falls in residential care facilities. METHODS: Participants comprised 191 older people, 139 women and 52 men, who were dependent in activities of daily living. Their mean±SD score on the Mini-Mental State Examination was 17.8±5.1 (range 10-30). Participants were randomized to a high-intensity functional exercise program or a control activity, consisting of 29 sessions over 3 months. The fall rate and proportion of participants sustaining a fall were the outcome measures, subsequently analysed using negative binominal analysis and logistic regression analysis, respectively. RESULTS: During the 6- month follow-up period, when all participants were compared, no statistically significant differences between groups were found for fall rate (exercise group 3.6 falls per person years [PY], control group 4.6 falls per PY), incidence rate ratio (95% CI) 0.82 (0.49-1.39), p=0.46, or the proportion of participants sustaining a fall (exercise 53%, control 51%), odds ratio (95% CI) 0.95 (0.52-1.74), p=0.86. A subgroup interaction analysis revealed that, among participants who improved their balance during the intervention period, the exercise group had a lower fall rate than the control group (exercise 2.7 falls per PY, control 5.9 falls per PY), incidence rate ratio (95% CI) 0.44 (0.21-0.91), p=0.03. CONCLUSIONS: In older people living in residential care facilities, a high-intensity functional exercise program may prevent falls among those who improve their balance.

  • 25.
    Rosendahl, Erik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nordin, Ellinor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundin-Olsson, Lillemor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nyberg, Lars
    High-intensity functional exercise program for older people dependent in ADL: a randomized controlled trial evaluating the effects on falls2008Conference paper (Other academic)
    Abstract [en]

    PURPOSE: To determine if a high-intensity functional exercise program improves balance, gait ability, and lower-limb strength in older people dependent in activities of daily living (ADL), if an intake of protein-enriched energy supplement immediately after the exercises increases these effects of the training, and if the exercise program reduces falls. RELEVANCE: Impairments in physical functions among older people can lead to dramatic consequences for the individual such as admission to nursing home, falls and fractures. High-intensity exercise programs are effective to improve physical functions among older people but knowledge is limited concerning the effects for older people with severe cognitive or physical impairments. PARTICIPANTS: 191 older people dependent in ADL, living in residential care facilities, and with a Mini-Mental State Examination (MMSE) score of ≥ 10 participated in this study (the FOPANU Study). METHODS: The participants were randomized to a high-intensity functional weight-bearing exercise program (the HIFE Program) or a control activity, including 29 sessions over 3 months, as well as to protein-enriched energy supplement or placebo. Berg Balance Scale, usual and maximum gait speed, and one-repetition maximum in lower-limb strength were followed-up at 3 and 6 months by assessors blinded to group allocation. Fall rate and the proportion of participants sustaining a fall during the six months following the intervention were the outcome measures of the fall preventive effect of the exercise program. ANALYSIS: The intention-to-treat principle was used. Balance, gait ability, and lower-limb strength: 2 x 2 factorial ANCOVA. Falls: Negative binominal analysis and logistic regression analysis. RESULTS: At 3 months, the exercise group had improved significantly in usual gait speed compared with the control group (mean difference 0.04 m/s, P = 0.02). At 6 months, there were significant improvements favoring the exercise group for Berg Balance Scale (1.9 points, P = 0.05), usual gait speed (0.05 m/s, P = 0.009), and lower-limb strength (10.8 kg, P = 0.03). No interaction effects were seen between the exercise and nutrition interventions. When all participants were compared, no statistically significant differences between groups were found for fall rate (exercise group 3.6 falls per person years and control group 4.6 fall per person years) or the proportion of participants sustaining a fall (exercise 53% and control 51%). A subgroup interaction analysis revealed that among participants who improved their balance during the intervention period, the exercise group had a lower fall rate than the control group (exercise 2.7 falls per person years and control 5.9 falls per person years, incidence rate ratio 0.44, P = 0.03). CONCLUSIONS: A high-intensity functional exercise program has positive long-term effects in balance, gait ability, and lower-limb strength for older people who are dependent in ADL. An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase these effects of the training. In addition, the high-intensity functional exercise program may have an effect in preventing falls among those who respond to the intervention. IMPLICATIONS: High-intensity functional exercise can be offered to improve physical functions among older people who are living in residential care facilities and have severe cognitive or physical impairments.

  • 26.
    Rosendahl, Erik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lindelöf, Nina
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Littbrand, Håkan
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Yifter-Lindgren, Elinor
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Lundin-Olsson, Lillemor
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Håglin, Lena
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nyberg, Lars
    High-intensity functional exercise program and protein-enriched energy supplement for older persons dependent in activities of daily living: a randomised controlled trial2006In: Australian Journal of Physiotherapy, ISSN 0004-9514, Vol. 52, no 2, p. 105-13Article in journal (Refereed)
    Abstract [en]

    The aims of this randomised controlled trial were to determine if a high-intensity functional exercise program improves balance, gait ability, and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training. One hundred and ninety-one older persons dependent in activities of daily living, living in residential care facilities, and with a Mini-Mental State Examination (MMSE) score of ? 10 participated. They were randomised to a high-intensity functional exercise program or a control activity, which included 29 sessions over 3 months, as well as to protein-enriched energy supplement or placebo. Berg Balance Scale, self-paced and maximum gait speed, and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA, using the intention-to-treat principle. At three months, the exercise group had improved significantly in self-paced gait speed compared with the control group (mean difference 0.04 m/s, p = 0.02). At six months, there were significant improvements favouring the exercise group for Berg Balance Scale (1.9 points, p = 0.05), self-paced gait speed (0.05 m/s, p = 0.009), and lower-limb strength (10.8 kg, p = 0.03). No interaction effects were seen between the exercise and nutrition interventions. In conclusion, a high-intensity functional exercise program has positive long-term effects in balance, gait ability, and lower-limb strength for older persons dependent in activities of daily living. An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training.

  • 27.
    Rosendahl, Erik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lindelöf, Nina
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Littbrand, Håkan
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Yifter-Lindgren, Elinor
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nordin, Ellinor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundin-Olsson, Lillemor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Håglin, Lena
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nyberg, Lars
    High-intensity functional exercise program and protein-enriched energy supplement for older persons dependent in ADL: A randomised controlled trial evaluating the effects on physical functions and falls2006In: 18th Nordic Congress of Gerontology: Innovations for an Ageing Society, 2006, p. 184-185Conference paper (Other academic)
  • 28.
    Rosendahl, Erik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lindelöf, Nina
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Littbrand, Håkan
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Yifter-Lindgren, Elinor
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nordin, Ellinor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundin-Olsson, Lillemor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Håglin, Lena
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nyberg, Lars
    High-intensity functional exercise program for older people dependent in ADL: an RCT evaluating the effects on physical functions and falls2007In: 15th International Congress of The World Confederation for Physical Therapy: 2-6 June 2007, Vancouver, Canada, WCPT , 2007Conference paper (Other academic)
  • 29.
    Rosendahl, Erik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lindelöf, Nina
    Umeå, Geriatrisk centrum.
    Yifter-Lindgren, Elinor
    Norrlands universitetssjukhus.
    Littbrand, Håkan
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Lundin-Olsson, Lillemor
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Håglin, Lena
    Norrlands universitetssjukhus.
    Gustafson, Yngve
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Nyberg, Lars
    High-intensity functional exercise program and protein-enriched energy supplement for older persons dependent in ADL2005In: 18th World Congress of Gerontology: Active aging in the XXI century, participation, health and security, IAGG , 2005Conference paper (Other academic)
  • 30.
    Rosendahl, Erik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lindgren, Elinor Yifter
    Norrlands universitetssjukhus.
    Lindelöf, Nina
    Umeå, Gerontologiskt centrum.
    Littbrand, Håkan
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Håglin, Lena
    Norrlands universitetssjukhus.
    Lundin-Olsson, Lillemor
    Institutionen för samhällsmedicin och rehabilitering, sjukgymnastik, Umeå universitet.
    Gustafson, Yngve
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Nyberg, Lars
    Effekten på fysisk funktion av ett högintensivt funktionellt träningsprogram och nutritionstillskott med protein för äldre ADL-beroende personer vid särskilda boenden: en randomiserad kontrollerad studie2004In: Svenska läkaresällskapets riksstämma 24-26 november 2004, Stockholm: Svenska läkaresällskapet , 2004, p. 54-Conference paper (Other academic)
  • 31.
    Rosendahl, Erik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Littbrand, Håkan
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Lindelöf, Nina
    Umeå, Gerontologiskt centrum.
    Gustafson, Yngve
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Nyberg, Lars
    Functional physical exercise program for frail older people2003In: Advanced health care sciences of tomorrow, The Swedish institute for health sciences , 2003, p. 24-Conference paper (Other academic)
  • 32.
    Rosendahl, Erik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Littbrand, Håkan
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Lindelöf, Nina
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Lundin-Olsson, Lillemor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Yngve, Gustafson
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nyberg, Lars
    A high-intensity functional exercise program is applicable for older people with cognitive impairment2007In: Research and practice in Alzheimer's disease, Paris: Serdi publisher , 2007, p. 212-215Chapter in book (Other academic)
    Abstract [en]

    Maintaining or improving physical functions among older people with cognitive impairment in effective ways is of great importance, since cognitive decline is associated with a decline in physical performance. Training at high intensity has a greater effect than at a lower intensity, but there are few studies evaluating high-intensity training among older people with severe cognitive impairment. However, results from a recent study (the FOPANU Study) among older people dependent in activities of daily living and living in residential care facilities showed that a high-intensity functional weigh-bearing program had positive long-term effects on balance, gait ability and lower-limb strength. The mean score for the Mini-Mental State Examination was 18 (range 10-29) and 52% of the participants had a dementia disease. Regarding the applicability of the exercise program, no statistically significant differences in attendance, intensity or adverse events were observed when participants with dementia were compared with participants without dementia. A main clinical implication of the FOPANU Study is that people with severe cognitive impairment can be offered high-intensity functional exercise programs.

  • 33.
    Rosendahl, Erik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Littbrand, Håkan
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Lindelöf, Nina
    Umeå, Gerontologiskt centrum.
    Nyberg, Lars
    Functional exercise program for frail older people2003In: 14th International Congress of the World Confederation for Physical Therapy, WCPT , 2003Conference paper (Other academic)
  • 34.
    Rosendahl, Erik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Littbrand, Håkan
    Umeå universitet, Institutionen för Samhällsmedicin, Avdelningen för Sjukgymnastik.
    Stenvall, Michael
    Umeå universitet, Institutionen för Samhällsmedicin, Avdelningen för Sjukgymnastik.
    Fysisk träning och rehabilitering för personer med demenssjukdom2007In: Abstraktbok Sjukgymnstdagarna 10-12 oktober 2007, Stockholm: LSR , 2007, p. 23-Conference paper (Other academic)
  • 35. Rosendahl, Erik
    et al.
    Lundin-Olsson, Lillemor
    Umeå universitet, Institutionen för Samhällsmedicin, Avdelningen för Sjukgymnastik.
    Eriksson, Staffan
    Umeå universitet, Institutionen för Samhällsmedicin, Avdelningen för Sjukgymnastik.
    Jensen, Jane
    Umeå universitet, Institutionen för Samhällsmedicin, Avdelningen för Sjukgymnastik.
    Gustafson, Yngve
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences.
    Effekten av fysisk träning på fallriskfaktorer bland sköra äldre2001In: Abstractbok för sjukgymnastdagarna 2001, Stockholm: Legitimerade sjukgymnasters riksförbund , 2001, p. 63-Conference paper (Other academic)
  • 36.
    Rosendahl, Erik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lundin-Olsson, Lillemor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Eriksson, Staffan
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Jensen, Jane
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gustafson, Yngve
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nyberg, Lars
    Exercise improves physical performance among older people with high fall risk in residential care facilities2003In: 14th International Congress of the World Confederation for Physical Therapy, WCPT , 2003Conference paper (Other academic)
  • 37.
    Rosendahl, Erik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lundin-Olsson, Lillemor
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Kallin, Kristina
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Jensen, Jane
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nyberg, Lars
    Prediction of falls among older people in residential care facilities by the Downton index2003In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 15, no 2, p. 142-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Falls are frequent among older people living in residential care facilities. The aim of this study was to investigate the prediction accuracy of the Downton fall risk index among older people living in residential care facilities at 3, 6 and 12 months, and with two different definitions of falls. METHODS: Seventy-eight residents in one residential care facility, 56 women and 22 men, mean +/- SD age 81 +/- 6 years, participated in this study. Forty-seven percent of participants had dementia, 45% depression, and 32% previous stroke. Forty-one percent of participants used a walking device indoors, and the median score of the Barthel ADL Index was 16. At baseline, the Downton fall risk index was scored for each individual. A score of 3 or more was taken to indicate high risk of falls. Participants were followed up prospectively for 12 months, with regard to falls indoors. RESULTS: At 3, 6 and 12 months, and using a fall definition including all indoor falls, sensitivity ranged from 81 to 95% with the highest value at 3 months, and specificity ranged from 35 to 40%. The prognostic separation values ranged from 0.26 to 0.37. Within 3 months, the risk of falling was 36% in the high-risk group (index score > or = 3) and 5% in the low-risk group. The accuracy of predictions did not improve when applying a fall definition in which falls precipitated by acute illness, acute disease, or drug side-effects were excluded. CONCLUSIONS: Already after 3 months, the Downton fall risk index appears to be a useful tool for predicting falls, irrespective of their cause, among older people in residential care facilities

  • 38.
    Rosendahl, Erik
    et al.
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering.
    Lundin-Olsson, Lillemor
    Umeå universitet, Institutionen för Samhällsmedicin, Avdelningen för Sjukgymnastik.
    Kallin, Kristina
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Jensen, Jane
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering. Sjukgymnastik.
    Gustafson, Yngve
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering, Geriatrik.
    Nyberg, Lars
    Predictions of falls among old people in residential care facilities by the Downton index2001In: 17th World congress of gerontology, IAGG , 2001, p. 499-Conference paper (Other academic)
  • 39.
    Wågert, Petra von Heideken
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Rönnmark, Birgitta
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Rosendahl, Erik
    Lundin-Olsson, Lillemor
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Gustavsson, Janna M.C.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nygren, Björn
    Umeå University, Department of Nursing.
    Lundman, Berit
    Umeå University, Department of Nursing.
    Norberg, Astrid
    Umeå University, Department of Nursing.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Morale in the oldest old: the Umea 85+ study2005In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 34, no 3, p. 249-55Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to describe morale among the oldest old, and to investigate which social, functional and medical factors are associated with morale in this population. DESIGN: a cross-sectional study. SETTING: a population-based study in the municipality of Umea, a city in Northern Sweden. SUBJECTS: half of the 85-year-old population, and the total population of 90-year-olds and > or = 95-year-olds (95-103) were asked to participate (n = 319) and 238 were interviewed. METHODS: structured interviews and assessments during home visits, interviews with relatives and caregivers and review of medical charts. The 17-item Philadelphia Geriatric Center Morale Scale (PGCMS) was used to measure morale. Participants were assessed with the Barthel Activities of Daily Living (ADL) Index, Geriatric Depression Scale (GDS-15), Mini-Mental State Examination (MMSE), Mini Nutritional Assessment (MNA), and a symptom questionnaire. Multiple regression analyses were conducted to find independent factors to explain the variation in the PGCMS score. RESULTS: eighty-four per cent (n = 199) of those interviewed answered the PGCMS. Three-quarters had middle range or high morale. GDS score, type of housing, previous stroke, loneliness and number of symptoms, adjusted for age group and sex, explained 49.3% of the variance of total PGCMS score. CONCLUSIONS: a large proportion of the oldest old had high morale. The most important factors for high morale were the absence of depressive symptoms, living in ordinary housing, having previously had a stroke and yet still living in ordinary housing, not feeling lonely and low number of symptoms. The PGCMS seems applicable in the evaluation of morale among the oldest old.

  • 40.
    Åberg, Anna Christina
    et al.
    Akademiska sjukhuset, Uppsala.
    Lundin-Olsson, Lillemor
    Umeå universitet, Institutionen för Samhällsmedicin och Rehabilitering.
    Rosendahl, Erik
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Förebygg fall och fallskador i samband med vård: nationell satsning för ökad patientsäkerhet2008Report (Other academic)
  • 41.
    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

1 - 41 of 41
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