Traditionally scaphoid waist fractures have been treated with a long period, 10–12 weeks, of immobilization in a plaster cast until radiological union. The long period of immobilization sometimes infers great discomfort for the patients. To avoid this, surgical treatment with screw fixation has for the last decade been advocated as an option also for undisplaced fractures. In this report, we present five cases with undisplaced scaphoid waist fractures that have healed both radiologically and clinically without any immobilization at all or after a very short period of protection in a cast. These observations challenge the current treatment guidelines.

Introduktion: Ländryggssmärta är en av de diagnoser folk söker mest vård för i västvärlden och cirka 80% av alla vuxna kommer någon gång i livet drabbas av det. Primära orsaken är icke-specifik, det vill säga, att man inte vet vad som ligger bakom. Tidigare elektromyografi studier har visat att personer med icke-specifik ländryggssmärta kan utveckla förändrade muskelaktiveringsmönster för bålmuskulaturen. Till skillnad mot tidigare studier riktar denna sig till vardagliga aktiviteter där forskning i nuvarande läge lider brist Syfte: Syftet med studien var att undersöka aktiveringsmönster av bålmuskulaturen med hjälp av yt-EMG bland studenter vid utförande av funktionella aktiviteter. Metod: Två deltagare delades in i två grupper, en med icke specifik ländryggssmärta och en utan symtom. Tre funktionella tester utfördes med yt-EMG mätning av muskelaktivitet i bålen vid ett tillfälle. EMG amplituden beräknades med root mean square (RMS). Deltagarna fick skatta sin smärta på visual analogue scale (VAS) samt värdera sin upplevda funktion med Oswestry disability index (ODI). Resultat: Större muskelaktivering i erector spinae (ES) hos deltagaren med besvär jämfört med deltagaren utan besvär. Aktiveringsgraden hos lumbala multifidus (LMF) hade deltagaren utan besvär en större aktivering jämfört med deltagaren med besvär. Deltagaren med besvär hade 2-5 gånger större aktivering i främre bålmuskulatur i alla tester. Konklusion: Då studien är en pilot-studie med begränsat antal deltagare ses resultaten som preliminära indikationer. Framtida större studier kan ge svar på om och på vilket sätt neuromuskulära kontrollen påverkas vid vardagliga aktiviteter, dock är resultaten i studien i stora drag överensstämmande med tidigare studier.

The emergence of COVID-19 has changed the world as we know it, arguably none more so than for older people. In Sweden, the majority of COVID-19-related fatalities have been among people aged ⩾70 years, many of whom were receiving health and social care services. The pandemic has illuminated aspects within the care continuum requiring evaluative research, such as decision-making processes, the structure and organisation of care, and interventions within the complex public-health system. This short communication highlights several key areas for future interdisciplinary and multi-sectorial collaboration to improve health and social care services in Sweden. It also underlines that a valid, reliable and experiential evidence base is the sine qua non for evaluative research and effective public-health systems.

This poster explores the human dimension of non-motorised transport, i.e. soft-mobility in Arctic communities. Empirical results are used to show how people’s modal choice in the European Arctic is being influenced by climate evolution and human-made climate change. From these results, it is possible to conceive new visions of the how to design the outside environments of Arctic settlements that can better enable people to move around in Arctic communities with reduced reliance on vehicles. At the societal level, this research will help reduce energy consumption and pollution from transport.

Introduction

A detailed understanding of how the weather affects cycling is lacking. Where research has been carried out, the focus has often been on temperate and hotter climates; little research has been carried out regarding cycling in colder climate communities. This study therefore investigated the lived experience of winter-season cycling to provide empirical data for planning winter cycling in cold-climate communities.

Methods

Between 1 December 2017 and 30 April 2018, the activities of 13 cyclists (eight female and five male, mean age 42 years, age range 11–74 years) in Luleå, Sweden, were surveyed. Methods: Structured questionnaires, individual travel diaries, and recorded data for outdoor temperature, precipitation type, and snow cover were used.

Results

1) Cycle level and frequency could be maintained during the winter season; 2) in winter, participants were more likely to use their bicycles for commuting than other activities, 3) electric bicycles helped winter cycling significantly; 4) the quality of the cycling infrastructure is critical to making winter cycling attractive.

Conclusion

For winter cycling to be successful, town planners need to consider winter cycling as a specific activity with its own design, policy and management requirements. This study has shown that year-round cycling can be achieved in cold-climate communities, with all its attendant potential health benefits.

Objectives: To systematically perform a meta-analysis of the scientific literature to determine whether the outcomes of endurance training based on heart rate variability (HRV) are more favorable than those of predefined training.

Design: Systematic review and meta-analysis.

Methods: PubMed and Web of Science were searched systematically in March of 2020 using keywords related to endurance, the ANS, and training. To compare the outcomes of HRV-guided and predefined training, Hedges' g effect size and associated 95% confidence intervals were calculated.

Results: A total of 8 studies (198 participants) were identified comprising 9 interventions involving a variety of approaches. Compared to predefined training, most HRV-guided interventions included fewer moderate- and/or high-intensity training sessions. Fixed effects meta-analysis revealed a significant medium-sized positive effect of HRV-guided training on submaximal physiological parameters (g = 0.296, 95% CI 0.031 to 0.562, p = 0.028), but its effects on performance (g = 0.079, 95% CI −0.050 to 0.393, p = 0.597) and V̇O2peak (g = 0.171, 95% CI −0.213 to 0.371, p = 0.130) were small and not statistically significant. Moreover, with regards to performance, HRV-guided training was associated with fewer non-responders and more positive responders.

Conclusions: In comparison to predefined training, HRV-guided endurance training had a medium-sized effect on submaximal physiological parameters, but only a small and non-significant influence on performance and V̇O_2peak. There were fewer non-responders regarding performance with HRV-based training.

Aim: To describe what suffering multiple concussions meant for former semi-professional or professional hockey players who were forced to end their career. Results: Nine former Swedish hockey players, who once played on national or professional teams were interviewed. The interviews were analyzed with reference to hermeneutic phenomenology to interpret and explain their experiences. The theme of losing one’s identity as a hockey player was constructed from five subthemes: being limited in everyday life, returning to the hockey stadium as soon as possible, forming a post career identity, lacking understanding and support, and preventing injuries by respecting other players. Conclusion: The former hockey players struggled with developing their off-the-ice identities and with finding other sources of meaning for their lives.

Lay abstract

Despite considerable attention to improving the initial management of concussions suffered by hockey players, few studies have examined their long-term effects. In response, the study reported here aimed to describe what suffering multiple concussions meant for former semi-professional or professional hockey players who were forced to end their career. Nine former Swedish hockey players, who once played on national or professional teams were interviewed and the interviews were analyzed in order to interpret and explain their experiences. The overall theme was formulated as losing one’s identity as a hockey player. In conclusion, the former hockey players seem to struggle with developing their off-the-ice identities and with finding other sources of meaning for their lives.

Kinesiotape theoretically stimulates mechanoreceptive and proprioceptive sensory pathways that in turn may modulate the neuromuscular activity and locomotor function, so alteration of activation, locomotion and/or range of motion (ROM) can be achieved. The aim of this study was to determine whether kinesiotape applied to the abdominal muscles would affect the ROM in flexion-extension (sagittal plane) in the thoracolumbar back of horses at trot. The study design was a paired experimental study, with convenient sample. Each horse was randomly placed in the control or the intervention group and then the order reversed. Eight horses trotted at their own preferred speed in hand on a straight line, 2 × 30 m. Optical motion capture was used to collect kinematic data. Paired t-tests, normality tests and 1-Sample Wilcoxon test were used to assess the effects of the kinesiotape. No statistical significance (p < 0.05) for changes in flexion-extension of the thoracolumbar back in trot was shown in this group of horses. Some changes were shown indicating individual movement strategies in response to stimuli from the kinesiotape. More research in this popular and clinically used method is needed to fully understand the reacting mechanisms in horses.

Electrical stimulation has been used to treat spasticity in children with cerebral palsy.  Building on the benefits of electrical stimulation, a new assistive device, electro-​suit Mollii® with imbedded electrodes has been tested.  The aim of the study was to evaluate the possible effect of Mollii® on body function, activity and participation in self-​selected activities.  

Methods: Six children, five to ten years of age, used the electro-​suit for one hour, every other day for three months.  The impact was evaluated after four weeks and after three months by measuring passive range of motion (ROM)​, muscle tone, pain, gross motor function and participation.  

Results: All participants improved in the total score for Canadian Occupational Performance Measure (COPM)​, three of them showed significant clinical improvements.  Pain was reduced for children who estimated pain when the study started.  There were also small changes in ROM and muscle tone and gross motor function.  

Conclusion: Electro-​suit Mollii® had a positive impact on activity and participation in self-​selected activities among the children in this study.  Further studies with more children over a longer time are necessary to evaluate the impact and usefulness over time.

In recent decades, there has been a decline in active school transportation (AST). Parents play an important role as the key decision-makers of children’s AST, and there is a need of more knowledge about the decision-making process and parents’ beliefs towards AST. The overall aim of this study was to explore parents’ attitudes and beliefs towards AST in the northern part of Sweden. Twenty parents participated in semi-structured interviews, which was based on the theory of planned behaviour. Qualitative content analysis was used to analyse the interviews. The analysis yielded one main theme, “Parenting and active school transportation – making route choices in a changed landscape” and four subthemes, “Knowing that it is beneficial while struggling with daily life”, “Considering barriers and solutions to enable AST”, “Parenting is challenging and about balancing”, and “Reflecting and contemplating about what we and others do”. Winter conditions affect parents’ decisions, and this needs to be considered when facilitating AST in these regions. Overall better health, increased physical activity, time spent outdoors, and free play were revealed as positive outcomes of AST. Decisions were also influenced by social norms and how the idea of parenting has changed through generations. The findings of this study are likely to be important when promoting AST.

Background: Menstruating individuals can experience a decreased health during up to two weeks during a menstruation cycle, as a result of for instance irregular or unbalanced hormone levels. A decreased health is not a normal state for menstruating individuals and an abnormal ovulation can be seen as an indication of illness. Previous research indicates that an improved health during self-perceived premenstrual symptoms can be achieved through health promotive life choices such as the correct physical activity, diet, sleep and social contexts. Purpose: The purpose of the study is to examine how salutogenic health is connected to self-perceived premenstrual symptoms and knowledge among menstruating individuals about health promotive life choices aiming to a better well-being. Method: The data has been collected through a questionnaire using social media. In total 311 respondents from the age of 18 and older participated. To describe the data descriptive frequency analysis was used. To analyse the connection between health and self-perceived premenstrual symptoms and also knowledge about health promotive life choices logistic regression containing positive odds ratio (POR). Results: An association between all variables could be determined; between better health and less self-perceived premenstrual symptoms as well as between better health and a high level of knowledge about health promotive life choices. Conclusion: To experience an improved health, knowledge about health promotive life choices is an important tool. Since the study showed an association between a good health and less self-perceived premenstrual symptoms, menstruating individuals should receive more education and knowledge about how the general health can be improved. The material in the study can hence contribute to a more equal health.

Background: Sports-related concussion (SRC) is increasingly recognized as a potential health problem in ice hockey. Quality of life (QoL) in players retiring due to SRC has not been thoroughly addressed. Materials & methods: QoL using the Sports Concussion Assessment Tool 5th Edition, Impact of Event Scale-Revised and Short Form Health Survey was measured in Swedish ice hockey players who retired due to persistence of postconcussion symptoms or fear of attaining additional SRC. Results: A total of 76 players were assessed, on average of 5 years after their most recent SRC. Overall, retired players had a high burden of postconcussion symptoms and reduced QoL. Conclusion: Retired concussed ice hockey players have a reduced QoL, particularly those retiring due to postconcussion symptoms. Symptom burden should be continuously evaluated and guide the decision to retire.

Objective:There are growing concerns about the short- and long-term consequences of sports-related concussion, which account for about 5-9% of all sports injuries. We hypothesized there may be sex differences in concussion history and concussion-related symptoms, evaluated among elite soccer players in Sweden. Design:Retrospective survey study. Participants and Setting:Soccer players (n= 1,030) from 55 Swedish elite soccer teams. Questionnaires were completed prior to the start of the 2017 season. Assessment of Risk Factors:Player history of soccer-related concussion (SoRC), symptoms and management following a SoRC were evaluated. Main Outcome Measures:Before the start of the season the players completed a baseline questionnaire assessing previous concussions. The Sports Concussion Assessment Tool 3 was included with regard to symptom evaluation. Results:Out of 993 responding players 334 (34.6%) reported a previous SoRC and 103 players (10.4%) reported a SoRC during the past year. After sustaining a SoRC, 114 players (34.2%) reported that they continued their ongoing activity without a period of rest, more commonly female (44.9%) than male players (27.7%;P= 0.002). Symptom resolution time was 1 week or less for 61.3% of the players that reported having persisting symptoms. A positive correlation was observed between number of previous concussions and prevalence of three persisting symptoms: fatigue (P< 0.001), concentration/memory issues (P= 0.002) and headache (P= 0.047). Conclusion:About 35% of male and female elite soccer players in Sweden have experienced a previous SoRC, and about 10% experienced a SoRC during the last year. Female players continued to play after a SoRC, without a period of rest, more often than males. A higher risk of persisting symptoms was observed in players with a history of multiple concussions.

The second most common cause of injury in the elderly population is falling. In an effort to understand the mechanism behind the reduced ability to maintain balance in any posture or activity, we study the performance of the central nervous system as a controller of the body, while maintaining the balance in some postures or activities. Towards this direction, forty-five subjects aged over 70 were tested in different trials of quiet stance: a) hard stable surface with open eyes, b) stable surface with closed eyes, c) soft unstable surface with open eyes, and d) unstable surface, while eyes were closed. In the sequel, the body kinematics were described by legs and trunk segment angles in the sagittal plane, while the muscle activations were described by a weighted sum of rectified EMG signals from tibialis anterior and gastrocnemius muscles of left and right legs. Using the neuro-science hypothesis and adaptive control theory, a completely novel model was identified for the CNS based on the feedback internal model. The proposed model is able to predict the output commands, based on a recurrent neural network, while the efficiency of the proposed scheme has been proven based on multiple experimental results, showing that the model can sufficiently predict the muscle activity based on the optimum sensory inputs.

Integrating health care services has proven to be important from both the patient and organizational perspectives. This study explores what defines a perceived well-functioning collaboration in the inter-organizational process of providing assistive devices in Sweden. Two focus groups comprising participants with profound knowledge of collaboration were performed, and data were analyzed in five steps, resulting in a data structure. Results yield the identification of three interacting processes: coordinating efforts to patient needs, ensuring evidence-based practice, and planning for efficient use of resources. These processes affected one another, and, therefore, would likely not have been effectively managed separately. The study contributes to theories of process management and organization by specifically focusing on how to analyze and improve sustainable collaboration in health care processes at both the management and professional levels. Theoretical frameworks that show different ways of organizing collaboration, as well as the concepts of action nets and boundary objects, can support both analysis and planning of collaboration. The intention would be to develop integration in inter-organizational health care processes, resulting in more person-centered care.

Objective

To investigate risk factors and characteristics of active tuberculosis (TB) in biologics-naïve rheumatoid arthritis (RA) patients.

Methods

Population-based case-control study using the Swedish Rheumatology Quality Register, the National Patient Register and the Tuberculosis Register to identify RA cases with active TB and matched RA controls without TB 2001-2014. Clinical data were obtained from medical records. TB risk was estimated as adjusted (adj) odds ratios (OR) with 95% confidence intervals (CI) using univariate and multivariable logistic regression analyses.

Results

After validation of diagnoses, the study included 31 RA cases with TB, and 122 matched RA controls. All except three cases had reactivation of latent TB. Pulmonary TB dominated (84%). Ever use of methotrexate was not associated with increased TB risk (adj OR 0.8; 95% CI 0.3-2.0), whereas ever treatment with leflunomide (adj OR 6.0; 95% CI 1.5-24.6), azathioprine (adj OR 3.8; 95% CI 1.1-13.8) and prednisolone (adj OR 2.4 (95% CI 1.0-5.9) was. There were no significant differences of maximum dose of prednisolone, treatment duration with prednisolone before TB, or cumulative dose of prednisolone the year before TB diagnosis between cases and controls. Obstructive pulmonary disease was associated with an increased TB risk (adj OR 3.9; 95% CI 1.4-10.7).

Conclusion

Several RA-associated factors may contribute to the increased TB risk in biologics-naïve RA patients, making risk of TB activation difficult to predict in the individual patient. To further decrease TB in RA patients, the results suggest that screening for latent TB should also be considered in biologics-naïve patients.

Aim: To identify novel genetic variants predisposing to elevation of Alanine aminotransferase (ALT) in rheumatoid arthritis (RA) patients after initiation of methotrexate (MTX) treatment. Patients & methods: We performed genome-wide association studies in 198 RA patients starting MTX. Outcomes were maximum level of ALT and ALT >1.5-times the upper level of normal within the first 6 months of treatment. Results: RAVER2 (rs72675408) was significantly associated with maximum level of ALT (p = 4.36 × 10-8). This variant is in linkage disequilibrium with rs72675451, which is associated with differential expression of JAK1 and RAVER2. Conclusion: We found an association between ALT elevation and genetic variants that may regulate the expression of JAK1 and RAVER2. JAK1 encodes a janus kinase involved in the pathogenesis of RA.

Recent decline in active transport and increase in motorised transport decreases physical activity and increases air pollution. Using games to motivate people to change their behaviour towards active transport can mitigate this. We proposed Tic-Tac-Training, a distributed, collaborative and competitive game for promoting active transport at workplaces. Tic-Tac-Training was developed through a multidisciplinary and iterative user-centred design (UCD) process in four stages: (i) paper prototype, (ii) low-fidelity prototypes, (iii) high-fidelity prototypes, (iv) digital prototype. User testing and playtesting (N=12) yielded a number of improvement suggestions. We also analysed how Tic-Tac-Training supports the eight core drives of gamification (Octalysis), and presented 17 lessons learned in four categories. Findings suggest that UCD can be useful for developing exergame interventions for workplaces. Moreover, the lessons learned can benefit exergame designers. More research is needed to measure the behaviour change effect of Tic-Tac-Training and its applicability to other use cases.

This study aimed to assess the impact of meteorological conditions on the use of public space in Scandinavia and Canada. Between September 21 and December 18, 2017, a cross-sectional online survey ‘EAMQ-Climate: space’ was distributed via web-based platforms. Survey responses were received from 361 residents (258 people from Scandinavia and 103 from Canada). The relative impact of the meteorological determinants on the use of public space was calculated, and a factor analysis was performed. Disparities between Canada and Scandinavia as well as between the climate zones represented were analysed using ANOVA. Overall results showed that the most significant meteorological enablers for the use of outdoor public spaces in winter were solar gain, snowfall and snow-covered surfaces. The main barriers were slush-covered and icy surfaces, rainfall and darkness. Wind and cold were conditions with less influence. The impact of rain and ice, however, differed between climatic zones. It was also established that, when addressing the meteorological impact on avoiding the use of public spaces in winter, it is vital to discriminate between conditions related to a) the ground surface and b) ambient conditions, as well as the particular significance of c) snow and sun, and d) darkness. For the design of public space in winter cities, we conclude that designers need to focus on a wider range of weather conditions than sun, wind and cold, and include snow, rainfall, slushy and icy ground and poor visibility. The study suggests that winter public space has a higher climatic design requirement to be successful than streets and pathways that are mainly used for soft mobility.

Background: The use of digital technology might contribute to social engagement and mental health in an ageing population. Objective: To systematically map and describe the scientific knowledge and knowledge gaps on the effects of different types of digital tools for outcomes related to social engagement in older adults at risk for mental health decline. Methods: Thirteen groups of outcomes (domains) were defined, related to social engagement, by the use of digital tools. Thereafter, a systematic literature search was conducted in April 2017 to identify systematic reviews in line with the objective, an additional search for systematic reviews published since April 2017 was done in September 2019. In addition, reference lists as well as protocols from the Cochrane Collaboration and Campbell were searched. The final sample includes nine systematic reviews, published between 2012 and 2019, with both qualitative and quantitative results. Results: This evidence map shows that education in and use of digital tools, including computers and the internet, might decrease loneliness. Research is still limited, but the existing research points towards positive effects from the use of digital tools on outcomes related to social engagement, such as loneliness, social isolation, social interaction and/or social support, participation, depression, physical health/activities, as well as security, self-esteem or empowerment. Scientific knowledge gaps are present for the domains of quality of life, activities in daily living (ADL), cognition, autonomy, and usability. Conclusion: The evidence map shows inconclusive evidence about the effects on outcomes related to social engagement from the use of digital tools for older adults at risk of mental health decline or mental illness. More research is needed, and future research should include studies with a strong design, larger populations, and various subgroups of older adults in different contexts to further evaluate the effects of the digital tools related to social engagement for older adults at risk of mental health decline or mental illness.

The digital transformation of society and the increased need for digital competence implies extensive changes in peoples’ everyday lives and occupations. Heretofore, the discussion in the field of occupational therapy about the consequences of digitalisation has been vague. The aim of this discussion paper is to outline some reflections and to offer some arguments on how to meet the changes following digitalisation and its impact on occupational therapy. The discussion focuses on three issues: the new conditions for participation in a digital society and the role of occupational therapy and occupational therapists in the evolving digital society as well as what occupational therapists need to be pro-active and to embrace the ongoing changes in a digital society. In conclusion, occupational therapy needs to advance its position and become pro-active to cross the threshold and to embrace the possibilities that digitalisation holds for peoples’ everyday lives to support occupational justice and health.

Background: Physical inactivity is globally recognized as a major risk factor for morbidity, particularly the incidence of non-communicable diseases, and mortality. Engaging in active transportation (AT) is a viable approach toward increasing physical activity (PA) on a daily basis. Mobile (mHealth) interventions enable promoting AT to a larger population. The Smart City Active Mobile Phone Intervention (SCAMPI) study is a randomized controlled trial designed to evaluate a smartphone application (app)’s ability to motivate participants to increase their PA by engaging in AT.

Objective: This qualitative study examines the acceptance and usability of the SCAMPI app from the participants’ perspectives.

Methods: Seventeen residents of Stockholm county (13 women; age range 25-61 years), who had completed the three-month, app-based behavioral change program in the SCAMPI randomized controlled trial during 2018 agreed to participate in a semi-structured telephone-based interview. These 17 participants were well representative of the whole intervention group (n = 127) in terms of baseline characteristics such as age, sex, and area of residence. The interviews were audio-recorded, transcribed verbatim, and analyzed using inductive qualitative content analysis.

Results: The content analysis revealed two themes and four subcategories. The first theme “Main motivators: monitoring and messages” highlighted that monitoring AT and being able to set weekly goals using the app were the primary motivators reported among study participants. The second theme “Acceptable but modifiable” reflects that the app was well accepted and effectively encouraged many participants to use more AT. Nevertheless, there were functions in the app that require modification. For example, while the automated travel tracking feature was appreciated, participants found it time-consuming and unreliable at times.

Conclusions: This study contributes novel insight into healthy adults’ experiences of using a mobile app to promote the use of AT. The results showed that the app was well-accepted and that self-monitoring and goal setting were the main motivators to engage in more AT. The automated tracking of AT was appreciated; however, it was also reported to be energy- and time-consuming when it failed to work. Thus, this feature should be improved going forward.

Visualization and expression of health-related experiences and conditions by young migrants from five different countries residing in Sweden were examined in this study. Using photovoice, the participants were invited to describe and discuss their experiences in three stages: (a) document and portray their everyday lives by taking pictures, (b) discuss their findings, and (c) present their views on health to the adults who are present in their everyday life and that are important for improving young migrants’ health conditions. The overall findings indicate that temporal, spatial, and social conditions are important for the well-being of these young migrants. Thus, in order for the young migrants to feel well in a new cultural context, a search for meaning and meaningfulness in relation to time, place, and other people was important. These findings are discussed in light of social, mental, and existential health dimensions and in relation to the selected study methods.

Traumatic brain injury (TBI) and repeated sports-related concussions (rSRCs) are associated with an increased risk for neurodegeneration. Autopsy findings of selected cohorts of long-term TBI survivors and rSRC athletes reveal increased tau aggregation and a persistent neuroinflammation. To assess in vivo tau aggregation and neuroinflammation in young adult TBI and rSRC cohorts, we evaluated 9 healthy controls (mean age 26 ± 5 years; 4 males, 5 females), 12 symptomatic athletes (26 ± 7 years; 6 males, 6 females) attaining ≥ 3 previous SRCs, and 6 moderate-to severe TBI patients (27 ± 7 years; 4 males, 2 females) in a combined positron emission tomography (PET)/ magnetic resonance (MR) scanner ≥6 months post-injury. Dual PET tracers, [¹⁸F]THK5317 for tau aggregation and [¹¹C]PK11195 for neuroinflammation/microglial activation, were investigated on the same day. The Repeated Battery Assessment of Neurological Status (RBANS) scores, used for cognitive evaluation, were lower in both the rSRC and TBI groups (p<0.05). Neurofilament-light (NF-L) levels were increased in plasma and cerebrospinal fluid (CSF; p<0.05), and serum tau levels lower, in TBI although not in rSRC. In rSRC athletes, PET imaging showed increased neuroinflammation in the hippocampus and tau aggregation in the corpus callosum. In TBI patients, tau aggregation was observed in thalami, temporal white matter and midbrain; widespread neuroinflammation was found e.g. in temporal white matter, hippocampus and corpus callosum. In mixed-sex cohorts of young adult athletes with persistent post-concussion symptoms and in TBI patients, increased tau aggregation and neuroinflammation are observed at ≥ 6 months post-injury using PET. Studies with extended clinical follow-up, biomarker examinations and renewed PET imaging are needed to evaluate whether these findings progress to a neurodegenerative disorder or if spontaneous resolution is possible.

Introduktion: Stroke drabbar över 30000 människor per år i Sverige. Vanliga symptom efter en stroke involverar motoriska problem, spasticitet och mer eller mindre uttalad halvsidesförlamning. Konsensus för rehabilitering är att så tidigt som möjligt utföra rehabilitering med tidig mobilisering och påbörja rörelse- och gångträning. Detta utförs enligt beprövad erfarenhet enligt ett systematiskt konsensusförfarande men det vetenskapliga underlaget bedöms som otillräckligt. Detta skapar frågan hur tidig kan rehabiliteringen påbörjas efter stroke och vilka effekter det medför. Syfte: Syftet med denna studie var att sammanställa konsekvenserna av ökad intensitet och tidigt initierad strokerehabilitering jämfört med ordinär behandling. Metod: Sökning utfördes i databaserna SportDiscuss, PubMed och CINAHL vilket gav sammanlagt 7 relevanta artiklar som inkluderades i studien. Resultat: Riskfaktorer i form av maladaptiva förändringar och ökad dödlighet kunde härledas till en tidigare och intensivare rehabilitering. Detta kunde kopplas mot en neurologisk teorier om hjärnans plasticitet. Konklusion: Denna litteraturstudie har visat på att det finns en indikation på att en tidig intensiv mobilisering och rehabilitering efter stroke kan innebära risker för patientens hälsa. En viloperiod efter stroke försämrar ej möjligheten till att återfå lika god fysisk förmåga som vid tidig rehabilitering. Mer forskning behövs för att hitta en optimal balans mellan vila och fysioterapeutiska behandlingsmetoder för att uppnå en bättre rehabilitering för strokedrabbade patienter.

Background: It is well known that engagement in occupations becomes restricted after acquired brain injury (ABI), but little is known about how this influences occupational values and occupational balance.

Aim: To describe the extent to which persons with ABI perceived occupational value; to explore whether occupational value and occupational balance were associated with life satisfaction, and to explore how occupational value, occupational balance, the severity of disability, fatigue and sociodemographic characteristics influenced life satisfaction.

Materials and methods: A cross-sectional study was undertaken with 75 participants of work- ing age with ABI who responded to questionnaires on occupational value, occupational balance, and life satisfaction. Additionally, instruments covering fatigue and severity of disability were administered. Data were analyzed by means of comparisons, correlations and logistic regression.

Results: A high perceived occupational value and a high perceived occupational balance were significantly associated with satisfaction with life as a whole, psychological health and somatic health. The logistic regression showed that occupational value, occupational balance and sever- ity of disability significantly impacted satisfaction with life as a whole.

Conclusions and significance: Occupational value and occupational balance together with severity of disability, are important areas of focus in the later phase of rehabilitation after ABI to promote satisfaction with life as a whole.

Background: Participation restriction is a common consequence after acquired brain injury (ABI).

Aim: To explore and identify problematic situations in everyday activities outside the home for persons with acquired brain injury.

Material and Method: Two persons of working age with ABI were included. Data were generated through repeated semi-structured interviews and participant observations. Narrative analysis was used to capture ongoing processes related to problematic situations during engagement in everyday activities outside the home.

Results: The narratives reflect how places, everyday activities and social relations were closely connected and influenced engagement in everyday activities outside the home. The participants visited fewer places and performed more of their everyday activities alone in their homes after the injury compared to before. They were struggling to create meaning in their lives and trying to reformulate their identity. Problematic situations often occurred outside the home as a result of unexpected events. The narratives indicate a struggle to find new routines to handle challenging situations.

Conclusions: The results provide an understanding of how problematic situations occurred and were managed in different ways. By observing everyday situations professionals can gain access to how persons with ABI act in and reflect upon problematic situations which can eventually improve the design of individually tailored interventions.

Introduction

Knowledge about the places people visit or do not visit after stroke is lacking. The aim of this study was to describe and compare the places visited for activities outside the home of people with stroke of working age and to explore the influence of the severity of disability, fatigue, driving a car and sociodemographic characteristics on the total number of places visited for activities outside the home.

Methods

An exploratory cross-sectional study was conducted and 63 people with stroke were interviewed with instruments that covered places outside the home, severity of disability and fatigue. Data were analysed using non-parametric tests, analysis of variance and the general linear model.

Results

Significant difference in the total number of places visited for activities outside the home were found between all three groups of severity of disability. The good recovery group visited eight places to a significantly higher extent than those with severe/moderate disability. The severity of disability and driving a car were the only aspects that significantly influenced the total number of places visited.

Conclusions

Places for activities outside the home people with stroke visit and changes therein can add valuable knowledge about participation that can be used in the design of rehabilitation.

Purpose The Lysholm Knee Scoring Scale (LKSS) and the Tegner Activity Scale (TAS) are widely used instruments for assessing knee function and activity level in various knee pathologies, especially knee ligament injuries. The purpose of this study was to translate and crossculturally adapt the Greek versions of the Lysholm Knee Scoring Scale (Gr-LKSS) and Tegner Activity Scale (Gr-TAS) and assess their reliability and validity in Greek patients suffering from various knee problems. Materials and methods Translation of the LKSS and TAS questionnaires was done according to established international guidelines. Fifty-five patients (32 males and 23 females; mean age: 24 +/- 7 years; range: 17-54 years) with various knee pathologies completed the Gr-LKSS and Gr-TAS along with the Greek versions of International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, the Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS) and the Oxford Knee Score (OKS). Test-retest reliability was evaluated with the intraclass correlation coefficient (ICC) in 53 (96%) individuals, who completed the questionnaires again after 48-72 hours while abstaining from all forms of treatment. Internal consistency for the Gr-LKSS was measured using Cronbach’s alpha and criterion-related validity was evaluated with the Pearson’s correlation coefficient (r) in relation to control questionnaires (IKDC, KOS-ADLS, OKS). The distribution of floor and ceiling effects were also determined. Results There were no problems during the forward-backward translation and cultural adaptation of the Gr-LKSS and Gr-TAS. Criterion-related validity was confirmed with moderate to high associations of Gr-LKSS and Gr-TAS (after injury) with the IKDC and KOS-ADLS (Pearson’s r ranging between 0.61-0.71 and 0.64-0.73, respectively). However, weak correlations were yielded between both questionnaires with the OKS (r=0.14-0.19). The internal consistency for Gr-LKSS was high (Cronbach’s alpha: 0.779) and the test-retest reliability was high for both questionnaires (Gr-LKSS: ICCm3.950; Gr-TAS before and after injury: ICCs of 0.877 and 0.876, respectively). Conclusion The cultural adaptation and validity of Gr-LKSS and Gr-TAS were successfully accomplished. These questionnaires are recommended for use in the evaluation of soft tissue knee disorders in both clinical practice and research.

Human postural control is a complex system and changes as we age. Frequency based analyses have been argued to be useful to identify altered postural control strategies in balance tasks. The aim of this study was to explore the frequency domain of the quiet stance centre of pressure of older adults with various degrees of fall-related concerns and sensorimotor functioning. We included 45 community dwelling older adults and used a force plate to register 30 seconds of quiet stance with eyes open and closed respectively. We also measured sensory and motor functions, as well as fall-related concerns and morale. We analysed the centre of pressure power spectrum density and extracted the frequency of 4 of its features for each participant. Orthogonal projection of latent structures–discriminant analysis revealed two groups for each quiet stance trial. Group 1 of each trial showed less sensory and motor decline, low/no fall-related concerns and higher frequencies. Group 2 showed more decline, higher fall-related concerns and lower frequencies. During the closed eyes trial, group 1 and group 2 shifted their features to higher frequencies, but only group 1 did so in any significant way. Higher fall-related concerns, sensory and motor decline, and explorative balancing strategies are highly correlated. The control system of individuals experiencing this seems to be highly dependent on vision. Higher fall-related concerns, and sensory and motor decline are also correlated with the inability to adjust to faster, more reactive balancing strategies, when vision is not available.

Elderly population across the world is on the rise and municipalities along with caregivers are struggling to provide care due to limited resources. Sweden’s elderly population is set to grow significantly by 2050 where the number of people between 65–79 years and 80 years and over is expected to increase by 45% and 87% respectively. The same trend continues within Europe where 25% of the population will be over 65 years of age by the year 2020, and the age group of 65–80 years is predicted to rise by 40% from the year 2010 to 2030. The rise in elderly population has increased the stress on municipalities and caregivers; and has created the need for new healthcare solutions that are feasible, affordable and easily accessible to all. Smart homes equipped with sensors have already made life easier for those living in them for many decades now by providing home automation solutions. We are also witnessing an increase in the use of Information Communication Technologies (ICT) to assist elderly population and decrease in operational costs. ICT systems in assisting elderly population have an immense potential for providing in-home care to the elderly. The advent of the Internet of Things (IoT) with low-cost and prolific sensors has furthered this trend of home automation and monitoring solutions being used for elderly healthcare. Alongside, the field of ambient assisted homes has continuously paved the way for providing an improved quality of life for those in need such as patients with dementia or chronic conditions as well as elderly living alone at home.

There is a global need for sustainable interventions that increase physical activity among children, and active school transportation (AST) can promote physical activity among schoolchildren. Therefore, an intervention based on gamification, empowerment, and social cognitive theory was initiated in 2016 to promote AST. The aim of this study was to follow up on participants’ experiences one and two years after the AST intervention was initiated. Data were collected through focus groups and individual interviews which were analyzed using qualitative content analysis. Thirty-one pupils (2017), and forty pupils (2018) aged 9–10 years, two teachers (2017, 2018) and one principal (2018) participated in the study. The result is presented as one main theme; “Unity for an active community-An intervention towards making the active choice the easy choice” and three sub-themes; “Well begun is half done-Engagement sparks motivation”, “It takes two to tango-Keep moving with gamifications and togetherness” and “Jumping on the bandwagon–From project to everyday use.” The results show that the concept of the intervention was attractive to re-use and that it created a habit to use AST among the children. Interventions to promote AST can benefit from the use of engagement, togetherness, and gamification.

Objective: To investigate whether professional athletes with post-concussion syndrome (PCS) due to repetitive concussive traumatic brain injury (rcTBI) have elevated cerebrospinal fluid (CSF) and plasma neurofilament light (NF-L) and tau as compared to controls, and whether elevated concentrations of these biomarkers are associated with persistent PCS.

Background: Recently, CSF NF-L and tau have been reported to increase following acute repetitive head trauma. However, whether these biomarkers are elevated in CSF and plasma of athletes with PCS following rcTBI is unknown.

Design/Methods: A total of 109 participants (31 professional athletes with PCS due to rcTBI, 48 concussed athletes without PCS, and 30 non-concussed athletic controls) were enrolled between September 2013 and September 2017. Athletes with PCS due to rcTBI also underwent paired CSF and plasma biomarker assessments, Rivermead Post-Concussion Symptoms Questionnaire (RPQ), and structural MRI of the brain (median, 1.5 years since last concussion).

Results: Plasma NF-L concentrations were significantly increased in both the concussed and PCS group as compared with athletic controls. Among athletes with PCS, the highest concentrations of NF-L were observed in athletes with PCS > 1 year as compared to those with PCS < 1 year (area under the receiver-operating characteristics, 0.85). Furthermore, plasma concentrations of NF-L correlated with RPQ scores and lifetime number of concussions. In contrast, CSF and plasma concentrations of tau were not associated with injury severity or duration of PCS. Consistently, CSF NF-L correlated with corresponding plasma (r = 0.81, P < 0.001), while there was no significant correlation between CSF tau and corresponding plasma.

Conclusions: Persistent PCS due to rcTBI is associated with axonal injury, which can be monitored by measuring NF-L in plasma samples months to year after last concussion. From a clinical standpoint, incorporation of plasma NF-L in the work-up may aid in distinguishing patients at increased risk of developing persistent PCS.

Disclosure: Dr. Shahim has nothing to disclose. Dr. Tegner has nothing to disclose. Dr. Blennow has nothing to disclose. Dr. Zetterberg has nothing to disclose.

Background

Patients with chronic pain who live in rural areas often need to travel long distances to participate in multimodal rehabilitation programs. To reduce traveling during the programs, patients sometimes live at a residency close to the clinic and thus far from home.

Aims

The aim of this study was to explore how patients with chronic pain experience participation in an Multimodal rehabilitation program while living at a residency

Method

Twelve patients from two specialist clinics in northern Sweden were interviewed about their experiences of participating in multimodal rehabilitation program. The data were analysed qualitatively using a grounded theory method with an emergent design.

Results

The analyses resulted in a model with the core category “Finding my self-worth” consisting of four categories: “Space for myself”, “Mirroring myself”, “I am of value” and “Dealing with returning to everyday life”. The model illustrates the process whereby participants are given space for themselves and an opportunity to mirror themselves in interaction with other participants. That provided insight about their self-worth which was valuable for return to everyday life at home and work.

Conclusion

Living at a residency during multimodal rehabilitation provided added value when patients were relived from the obligations of everyday life at home, and given time for reflection and interaction with others in similar situations. This contributed to awareness of their own value and the necessity of taking care of themselves. This new insight led to increased motivation to act differently at home.

Background:

Hand grip strength is frequently used as a measurement of muscle strength, especially among older adults. Muscle strength is only one of the many components in postural control and it is currently unclear to what extent hand grip strength is associated with postural control. The aim was to analyze the association between hand grip strength and lower limb muscle strength, and postural control among older adults.

Methods:

Forty-five community-dwelling individuals over 70 years of age provided isometric hand grip strength and lower limb strength (including hip extension and abduction, knee flexion and extension, and ankle dorsiflexion and plantarflexion), as well as postural control measurements. In the latter, center of pressure excursions were recorded for quiet stance and limits of stability tests on a force plate. Orthogonal projection of latent structures regression models were used to analyze associations between hand grip strength and lower limb strength as well as postural control, respectively.

Results:

Lower limb strength explained 74.4% of the variance in hand grip strength. All lower limb muscle groups were significantly associated with hand grip strength. In a corresponding model, postural control measured with center of pressure excursions explained 20.7% of the variance in a statistically significant, albeit weak, model.

Conclusions:

These results support that hand grip strength is a valid method to estimate lower limb strength among older adults on a group level. However, strength measurements seem insufficient as a substitute for measuring postural control, and therefore specific balance tests are necessary.

Objectives

The aim of this study was to describe patients’ expressed needs during cardiac rehabilitation after suffering a second myocardial infarction in comparison to personnel’s descriptions of how they work with these patients.

Research methodology

A descriptive qualitative design. Interviews were conducted with patients affected by two myocardial infarctions and registered nurses, physiotherapists and cardiologists working with cardiac rehabilitation. Data were analysed with qualitative content analysis.

Findings

An interpretation of the underlying meaning in the categories was formulated into one theme: ‘To be seen as a unique person’. Patients expressed a need for individualised care; they wanted the cardiac rehabilitation to be customised to their condition and prognosis; however, they did not perceive their care was individualised. Personnel described the importance of the care being individualised, although they had guidelines to follow. It was crucial for them to see the individual and discover what was important for each patient.

Conclusions

There was a shared opinion from patients and personnel that individual care is essential. Using the concept and working in accordance with person-centred care could meet the patients’ need for individualised care.

Aims: To investigate whether variants of MTHFR, TYMS and SLCO1B1 are associated with alanine aminotransferase (ALT) elevation in rheumatoid arthritis patients starting methotrexate (MTX).

Patients & Methods: Clinical and laboratory data were collected from the start of MTX treatment. Genotyping of MTHFR, TYMS and SLCO1B1 was performed. Univariate and multiple logistic regression were used for statistical analysis.

Results: 34 out of 369 patients experienced ALT >1.5xULN less than 6 months from start. MTHFR A1298C (rs1801131) was nominally associated with an ALT > 1.5 xULN within 6 months after the start of MTX (OR = 1.7 [95% CI: 1.04–2.9]; p = 0.03), but did not pass correction for multiple testing. A multiple model containing MTHFR 1298C and clinical factors predicted the outcome (C-statistic 0.735). TYMS and SLCO1B1 were not associated with the outcome.

Conclusions: A model containing MTHFR 1298C and clinical factors might predict risk of early ALT elevation.

Objectives

Sport‐related concussions are an increasingly recognized health problem. Soccer is the most popular sport in the world although recent studies on concussion incidence are scarce. Here, a nation‐wide prospective study on concussion incidence, symptom severity, risk factors, gender differences and return‐to‐play after concussion was performed in 51 Swedish elite soccer teams during the 2017 season.

Methods

In the first and second soccer leagues for men and women, a Sport Concussion Assessment Tool (SCAT) ‐based questionnaire study was performed at pre‐season (baseline) and from 48h up to three months post‐concussion.

Results

We followed 959 players (389 women, 570 men) for 25146 player game hours (9867 h for women, 15279 h for men). Concussion incidence (n= 36) was 1.19/1000 player game hours (females 1.22/1000 h, males 1.18/1000 h; p= 0.85). Twenty‐seven percent (females 8%, males 40%) of players continued to play immediately after the concussion. When compared to male players, female players had worse initial symptom severity scores (median and IQR 30 (17‐50.5) vs. 11 (4‐26.25), p=0.02) and longer return to play (p=0.02). Risk factors for concussion were baseline symptoms and previous concussion.

Conclusion

In Swedish elite soccer, the concussion incidence was 1.19/1000 without gender differences. Most players recovered to play within four weeks post‐injury. Almost one third of players continued to play at time of concussion. Female players had worse initial symptoms and longer return‐to‐play time than males, and a prolonged recovery beyond three months was only observed among female players.

Musical performance is a multimodal experience, for performers and listeners alike. This paper reports on a pilot study which constitutes the first step toward a comprehensive approach to the experience of music as performed. We aim at bridging the gap between qualitative and quantitative approaches, by combining methods for data collection. The purpose is to build a data corpus containing multimodal measures linked to high-level subjective observations. This will allow for a systematic inclusion of the knowledge of music professionals in an analytic framework, which synthesizes methods across established research disciplines. We outline the methods we are currently developing for the creation of a multimodal data corpus dedicated to the analysis and exploration of instrumental music performance from the perspective of embodied music cognition. This will enable the study of the multiple facets of instrumental music performance in great detail, as well as lead to the development of music creation techniques that take advantage of the cross-modal relationships and higher-level qualities emerging from the analysis of this multi-layered, multimodal corpus. The results of the pilot project suggest that qualitative analysis through stimulated recall is an efficient method for generating higher-level understandings of musical performance. Furthermore, the results indicate several directions for further development, regarding observational movement analysis, and computational analysis of coarticulation, chunking, and movement qualities in musical performance. We argue that the development of methods for combining qualitative and quantitative data are required to fully understand expressive musical performance, especially in a broader scenario in which arts, humanities, and science are increasingly entangled. The future work in the project will therefore entail an increasingly multimodal analysis, aiming to become as holistic as is music in performance.

Background

Inclusive playgrounds aim to enable all children to participate and be socially included on playgrounds through the way they are designed. However, knowledge is lacking about how children with and without disabilities perceive playing on inclusive playgrounds and whether these playgrounds lead to more social inclusion.

Aims/Objectives

The study explores the experiences of children, with and without disabilities, of playing on inclusive playgrounds.

Material and methods

Semi-structured interviews and observations were conducted on six inclusive playgrounds in Switzerland. Overall, 32 children aged 7–12 years participated; 14 children had a disability while 18 children did not. A qualitative content analysis was used for data analysis.

Results

The children’s experiences of playing on an inclusive playground resulted in the creation of three categories describing: how children with and without disabilities experience play activities on inclusive playgrounds; invisible barriers on inclusive playgrounds; and the fact that children with disabilities have recommendations for the design of inclusive playgrounds.

Conclusions and significance

The results showed that achieving inclusion on a playground is complex and must be considered as a transaction among different environments. For occupational therapists, this could mean that, to support play as an activity on inclusive playgrounds, intervention is necessary at the community and political levels.

The Swedish Agency for Health Technology Assessment and Assessment of Social Services has evaluated quantitative and qualitative research regarding rehabilitation for persons with traumatic brain injury (TBI) through systematic reviews. The results indicate that specialized brain injury rehabilitation for persons with post-concussion symptoms after mild TBI results in improved health, when compared to usual care (results with low certainty according to GRADE). As few high-quality studies were identified, it was not possible to assess the effects of vocational rehabilitation, rehabilitation with case management/coordinator, residential living or specialized brain rehabilitation for persons with moderate to severe TBI. A synthesis of qualitative studies showed that persons with TBI experience insufficient coordination of health services and access to rehabilitation (results with low to moderate confidence according to CERQual).

Aim: The aim of this study was to describe occupational therapists' experiences of the importance of digitalization for the profession with its opportunities and challenges in different areas of activity. Method: 9 semistructured interviews were conducted with occupational therapists and collected data were analyzed with a qualitative content analysis.Results: The impact of digitalization on occupational therapists’ day-to-day work presents many opportunities but also challenges. Everyday technology influences and changes the administrative work, client meetings and also the organizational work. A consequence is also an affected work environment. Sometimes risks are also seen in relation to digitalization. The conditions for using everyday technology in the profession vary among the occupational therapists. It comes to access to or lack of resources such as equipment, time and skills. There is usually access to technical support but the occupational therapists see an upcoming need for competence development, also in order to be updated along with the client. Conclusion: The study shows occupational therapists' experiences of the importance of digitalization for the profession with its opportunities and challenges in different areas of activity. The study shows that digital competence is and will be a prerequisite for the day-to-day work of the occupational therapist. Furthermore, the study shows that a good working digitalization requires resources and also critical thinking. There is a need for further research in the field as there are currently few studies that illustrate the importance of digitalization for occupational therapists.

BACKGROUND: We have previously evaluated muscle functions and morphology in power athletes of long term (5 to15 years) abuse of anabolic androgen steroids (AAS; Doped) and in clean power athletes (Clean), and observed significant improvements in both muscle morphology and muscle functions in Doped. To our knowledge, the effects of long term AAS abuse on human muscle protein profile have never been studied.

METHODS: The study examined further the muscle biopsies using a two-dimensional difference gel electrophoresis (2D DIGE) for proteomic screening and protein expression. Cellular localization/distribution of specific proteins identified by proteomic analysis was examined using immunohistochemistry (IHC).

RESULTS: Different protein profiles were observed between Doped and Clean, and a valid orthogonal projection of latent structure discriminant analysis model was built (N = 16, X = 5, R2 = 0.88/Q2 = 0.84, p = 0.0005), which separated Doped from Clean. Liquid chromatography followed by tandem spectrometry identified 14 protein spots (representing nine different proteins) of significant difference in relative quantity (p < 0.05), of which nine spots were down-regulated in Doped compared with Clean. IHC revealed no significant alteration in cellular localization in phosphoglucomutase-1 and heat shock protein beta-1, but indeed in two reference proteins desmin and F-actin in Doped.

CONCLUSIONS: Long term abuse of AAS in combination with training is potentially associated with alterations in skeletal muscle protein profile and protein expression, and structural proteins rather than non-structural proteins are preferentially affected in cellular localization/distribution.