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Stenvall, Michael
Publications (10 of 20) Show all publications
Berggren, M., Karlsson, Å., Lindelöf, N., Englund, U., Olofsson, B., Nordstöm, P., . . . Stenvall, M. (2019). Effects of geriatric interdisciplinary home rehabilitation on complications and readmissions after hip fracture: a randomized controlled trial. Clinical Rehabilitation, 33(1), 64-73
Open this publication in new window or tab >>Effects of geriatric interdisciplinary home rehabilitation on complications and readmissions after hip fracture: a randomized controlled trial
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2019 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 33, no 1, p. 64-73Article in journal (Refereed) Published
Abstract [en]

Objective: This pre-planned secondary analysis of geriatric interdisciplinary home rehabilitation, which was initially found to shorten the postoperative length of stay in hospital for older individuals following hip fracture, investigated whether such rehabilitation reduced the numbers of complications, readmissions, and total days spent in hospital after discharge during a 12-month follow-up period compared with conventional geriatric care and rehabilitation.

Design: Randomized controlled trial.

Setting: Geriatric department, participants' residential care facilities, and ordinary housing.

Subjects: Individuals aged ⩾70 years with acute hip fracture (n = 205) were included.

Intervention: Geriatric interdisciplinary home rehabilitation was individually designed and aimed at early discharge with the intention to prevent, detect, and treat complications after discharge.

Main measures: Complications, readmissions, and days spent in hospital were registered from patients' digital records and interviews conducted during hospitalization and at 3- and 12-month follow-up visits.

Results: No significant difference in outcomes was observed. Between discharge and the 12-month follow-up, among participants in the geriatric interdisciplinary home rehabilitation group (n = 106) and control group (n = 93), 57 (53.8%) and 44 (47.3%) had complications (P = 0.443), 46 (43.4%) and 38 (40.9%) fell (P = 0.828), and 38 (35.8%) and 27 (29.0%) were readmitted to hospital (P = 0.383); the median total days spent in hospital were 11.5 and 11.0 (P = 0.353), respectively.

Conclusion: Geriatric interdisciplinary home rehabilitation for older individuals following hip fracture resulted in similar proportions of complications, readmissions, and total days spent in hospital after discharge compared with conventional geriatric care and rehabilitation.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Falls, home rehabilitation, randomized controlled trial, hip fracture
National Category
Geriatrics Physiotherapy
Identifiers
urn:nbn:se:umu:diva-142127 (URN)10.1177/0269215518791003 (DOI)000454521300008 ()30064264 (PubMedID)2-s2.0-85052213545 (Scopus ID)
Note

Originally included in thesis in manuscript form with title: "Geriatric interdisciplinary home rehabilitation - effects on complications and readmissions after hip fracture: a randomized controlled trial"

Available from: 2017-11-22 Created: 2017-11-22 Last updated: 2019-01-14Bibliographically approved
Olofsson, B., Persson, M., Bellelli, G., Morandi, A., Gustafson, Y. & Stenvall, M. (2018). Development of dementia in patients with femoral neck fracture who experience postoperative delirium: A three-year follow-up study. International Journal of Geriatric Psychiatry, 33(4), 623-632
Open this publication in new window or tab >>Development of dementia in patients with femoral neck fracture who experience postoperative delirium: A three-year follow-up study
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2018 (English)In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 33, no 4, p. 623-632Article in journal (Refereed) Published
Abstract [en]

Objectives It remains unclear to what extent postoperative delirium (POD) affects the incidence of dementia in hip fracture patients, and the methods used to detect delirium and dementia require validation. The aim of this study was to investigate the development of dementia within 3 years of femoral neck fracture repair surgery, with a focus on POD as a potential predictive factor.

Methods Patients were assessed for cognition, delirium, depression, psychological well-being, and nutritional status during their hospitalization as well as 4, 12, and 36 months after the operation. Logistic regression models were used to analyse factors associated with POD and factors associated with the development of dementia.

Results The study sample consisted of 135 patients without a history of dementia, of whom 20 (14.8%) were delirious preoperatively and 75 (55.5%) postoperatively. Three years after their operations, 43/135 patients (31.8%) were diagnosed with dementia. A greater portion of patients diagnosed with dementia (39/43, 90.6%) than patients with no dementia (36/92, 39.1%) were included among the 75 patients who had experienced POD (P<0.001). In a logistic regression model, after adjustment for covariates (age, sex, diabetes, delirium pre- and postoperatively, hyperactive delirium, days with delirium, urinary tract infection, and Mini Nutritional Assessment score), POD emerged an independent predictor for the development of new dementia (odds ratio, 15.6; 95% confidence interval, 2.6-91.6) within 3 years after the operation.

Conclusion Geriatric hip fracture patients who exhibit POD should be monitored closely for the development of dementia.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
cognitive impairment, femoral neck fracture, geriatrics, logistic regression, mortality
National Category
Geriatrics Nursing
Identifiers
urn:nbn:se:umu:diva-146141 (URN)10.1002/gps.4832 (DOI)000426505700008 ()29292537 (PubMedID)
Available from: 2018-05-15 Created: 2018-05-15 Last updated: 2019-01-08Bibliographically approved
Berggren, M., Stenvall, M., Englund, U., Olofsson, B. & Gustafson, Y. (2016). Co-morbidities, complications and causes of death among people with femoral neck fracture: a three-year follow-up study. BMC Geriatrics, 16, Article ID 120.
Open this publication in new window or tab >>Co-morbidities, complications and causes of death among people with femoral neck fracture: a three-year follow-up study
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2016 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, article id 120Article in journal (Refereed) Published
Abstract [en]

Background: The poor outcome after a hip fracture is not fully understood. The aim of the study was to describe the prevalence of co-morbidities, complications and causes of death and to investigate factors that are able to predict mortality in old people with femoral neck fracture. Methods: Data was obtained from a randomized, controlled trial with a 3-year follow-up at Umea University Hospital, Sweden, which included 199 consecutive patients with femoral neck fracture, aged >= 70 years. The participants were assessed during hospitalization and in their homes 4, 12 and 36 months after surgery. Medical records and death certificates were analysed. Results: Multivariate analysis revealed that cancer, dependence in P-ADL (Personal Activities of Daily Living), cardiovascular disease, dementia at baseline or pulmonary emboli or cardiac failure during hospitalization were all independent predictors of 3-year mortality. Seventy-nine out of 199 participants (40 %) died within 3 years. Cardiovascular events (24 %), dementia (23 %), hip-fracture (19 %) and cancer (13 %) were the most common primary causes of death. In total, 136 participants suffered at least one urinary tract infection; 114 suffered 542 falls and 37 sustained 56 new fractures, including 13 hip fractures, during follow-up. Conclusion: Old people with femoral neck fracture have multiple co-morbidities and suffer numerous complications. Thus randomized intervention studies should focus on prevention of complications that might be avoidable such as infections, heart diseases, falls and fractures.

Keywords
Hip fracture, Cause of death, Complications
National Category
Geriatrics Nursing
Identifiers
urn:nbn:se:umu:diva-123051 (URN)10.1186/s12877-016-0291-5 (DOI)000377191100002 ()27260196 (PubMedID)
Available from: 2016-08-15 Created: 2016-06-27 Last updated: 2018-06-07Bibliographically approved
Karlsson, Å., Berggren, M., Gustafson, Y., Olofsson, B., Lindelöf, N. & Stenvall, M. (2016). Effects of Geriatric Interdisciplinary Home Rehabilitation on Walking Ability and Length of Hospital Stay After Hip Fracture: A Randomized Controlled Trial. Journal of the American Medical Directors Association, 17(5), 464.e9-464.e15
Open this publication in new window or tab >>Effects of Geriatric Interdisciplinary Home Rehabilitation on Walking Ability and Length of Hospital Stay After Hip Fracture: A Randomized Controlled Trial
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2016 (English)In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, no 5, p. 464.e9-464.e15Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate if Geriatric Interdisciplinary Home Rehabilitation could improve walking ability for older people with hip fracture compared with conventional geriatric care and rehabilitation. A secondary aim was to investigate the postoperative length of hospital stay (LOS).

Design: Randomized controlled trial.

Setting: Geriatric ward, ordinary housing, and residential care facilities.

Participants: People operated on for a hip fracture (n = 205), aged 70 or older, including those with cognitive impairment, and living in the north of Sweden.

Intervention: Home rehabilitation with the aim of early hospital discharge that was individually designed and carried out by an interdisciplinary team for a maximum of 10 weeks. Special priority was given to prevention of falls, independence in daily activities, and walking ability both indoors and outdoors.

Measurements: Walking ability and the use of walking device was assessed in an interview during the hospital stay. These assessments were repeated along with gait speed measurements at 3- and 12-month follow-up. The length of the hospital stay after the hip fracture was recorded.

Results: No significant differences were observed in walking ability, use of walking device, and gait speed at the 3- and 12-month follow-up between the groups. At 12 months, 56.3% of the intervention group and 57.7% of the control group had regained or improved their prefracture walking ability. The median postoperative LOS in the geriatric ward was 6 days shorter for the intervention group (P = .003).

Conclusion: Participants receiving Geriatric Interdisciplinary Home Rehabilitation regained walking ability in the short-and long-term similar to those receiving conventional geriatric care and rehabilitation according to a multifactorial rehabilitation program. The intervention group had a significantly shorter postoperative LOS in the hospital.

Keywords
Hip fracture, home rehabilitation, interdisciplinary rehabilitation, walking ability, geriatrics, length of stay
National Category
Geriatrics Physiotherapy Nursing
Identifiers
urn:nbn:se:umu:diva-121563 (URN)10.1016/j.jamda.2016.02.001 (DOI)000375217300026 ()26975205 (PubMedID)
Available from: 2016-06-30 Created: 2016-06-03 Last updated: 2018-06-07Bibliographically approved
Stenvall, M., Berggren, M., Lundström, M., Gustafson, Y. & Olofsson, B. (2012). A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia: subgroup analyses of a randomized controlled trial. Archives of gerontology and geriatrics (Print), 54(3), E284-E289
Open this publication in new window or tab >>A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia: subgroup analyses of a randomized controlled trial
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2012 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 54, no 3, p. E284-E289Article in journal (Refereed) Published
Abstract [en]

Background: People with cognitive impairment and dementia have a poor outcome after a hip fracture surgery, about 30-50% of all those who sustain a hip fracture have dementia. Therefore the aim was to investigate whether a multidisciplinary postoperative intervention program could reduce postoperative complications and improve functional recovery among people with dementia.

Methods: A randomized controlled trial with subgroup analyses among patients with dementia. Sixty-four patients with femoral neck fracture, aged ≥70 years at Umeå University Hospital, Sweden. The intervention consisted of staff education, individualized care planning and rehabilitation, active prevention, detection and treatment of postoperative complications, especially delirium. The staff worked in teams to apply comprehensive geriatric assessment, management and rehabilitation, including a follow-up at 4 months postoperatively. The control group followed conventional postoperative routines.

Results: There were fewer postoperative complications in the intervention group such as urinary tract infections, p=0.001; nutritional problems, p=0.025; postoperative delirium, p=0.002; falls, p=0.006. At 4 months a larger proportion in the intervention group had regained their previous independent indoor walking ability performance, p=0.005. At 12 months a larger proportion in the intervention group had regained the activities of daily living (ADL) performance level they had before the fracture, p=0.027.

Conclusion: This study demonstrates that patients with dementia who suffer a hip fracture can benefit from multidisciplinary geriatric assessment and rehabilitation and should not be excluded from rehabilitation programs.

Keywords
Activities of daily living, dementia, hip fracture, rehabilitation, intervention
National Category
Geriatrics Nursing
Identifiers
urn:nbn:se:umu:diva-52739 (URN)10.1016/j.archger.2011.08.013 (DOI)000302959400006 ()21930310 (PubMedID)
Available from: 2012-03-01 Created: 2012-03-01 Last updated: 2018-06-08Bibliographically approved
Lundström, M., Stenvall, M. & Olofsson, B. (2012). Symptom profile of postoperative delirium in patients with and without dementia. Journal of Geriatric Psychiatry and Neurology, 25(3), 162-169
Open this publication in new window or tab >>Symptom profile of postoperative delirium in patients with and without dementia
2012 (English)In: Journal of Geriatric Psychiatry and Neurology, ISSN 0891-9887, E-ISSN 1552-5708, Vol. 25, no 3, p. 162-169Article in journal (Refereed) Published
Abstract [en]

This study compares the symptom profile of patients with postoperative delirium after femoral neck fracture surgery in those with and without dementia. In this study, 129 patients of age >= 70 years (mean age +/- SD, 86 +/- 6 yr, 72% women) with postoperative delirium, were included. Delirium and dementia were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Of the 129 patients with delirium, 54 (42%) had a dementia disorder. Patients with delirium superimposed on dementia more often had any hyperactive and pure emotional delirium. Communication difficulties and symptoms such as restlessness/agitation, aggressive behavior, and irritability were more commonly found in the dementia group. In contrast, patients with delirium but without dementia were more often diagnosed with pure hypoactive and any psychotic delirium. The symptom profile of postoperative delirium varies according to whether it occurs in patients with or without dementia. This may indicate that postoperative delirium among patients with hip fracture differs based on the presence or absence of dementia.

Place, publisher, year, edition, pages
Sage Publications, 2012
Keywords
delirium, symptom, dementia, femoral neck fracture
National Category
Gerontology, specialising in Medical and Health Sciences Neurology Psychiatry Nursing
Identifiers
urn:nbn:se:umu:diva-61986 (URN)10.1177/0891988712455221 (DOI)000310627400005 ()
Available from: 2012-12-13 Created: 2012-12-04 Last updated: 2018-06-08Bibliographically approved
Häggqvist, B., Stenvall, M., Fjellman-Wiklund, A., Westerberg, K. & Lundin-Olsson, L. (2012). "The balancing act". Licensed practical nurse experiences of falls and fall prevention: a qualitative study. BMC Geriatrics, 12, 62
Open this publication in new window or tab >>"The balancing act". Licensed practical nurse experiences of falls and fall prevention: a qualitative study
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2012 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 12, p. 62-Article in journal (Refereed) Published
Abstract [en]

Background: Falls are common in old age and may have serious consequences. There are many strategies to predict and prevent falls from occurring in long-term care and hospitals. The aim of this study was to describe licensed practical nurse experiences of predicting and preventing further falls when working with patients who had experienced a fall-related fracture. Licensed practical nurses are the main caretakers that work most closely with the patients.

Methods: A qualitative study of focus groups interviews and field observations was done. 15 licensed practical nurses from a rehabilitation ward and an acute ward in a hospital in northern Sweden were interviewed. Content was analyzed using qualitative content analysis.

Results: The result of the licensed practical nurse thoughts and experiences about risk of falling and fall prevention work is represented in one theme, "the balancing act". The theme includes three categories: "the right to decide", "the constant watch", and "the ongoing negotiation" as well as nine subcategories. The analysis showed similarities and differences between rehabilitation and acute wards. At both wards it was a core strategy in the licensed practical nurse work to always be ready and to pay attention to patients' appearance and behavior. At the rehabilitation ward, it was an explicit working task to judge the patients' risk of falling and to be active to prevent falls. At the acute ward, the words "risk of falling" were not used and fall prevention were not discussed; instead the licensed practical nurses used for example "dizzy and pale". The results also indicated differences in components that facilitate workplace learning and knowledge transfer.

Conclusions: Differences between the wards are most probably rooted in organizational differences. When it is expected by the leadership, licensed practical nurses can express patient risk of falling, share their observations with others, and take actions to prevent falls. The climate and the structure of the ward are essential if licensed practical nurses are to be encouraged to routinely consider risk of falling and implement risk reduction strategies.

Keywords
Accidental falls/*prevention&control, Licensed practical nurses, Focus groups, Safety culture
National Category
Physiotherapy Geriatrics
Identifiers
urn:nbn:se:umu:diva-65935 (URN)10.1186/1471-2318-12-62 (DOI)000313489800001 ()
Available from: 2013-03-19 Created: 2013-02-13 Last updated: 2018-06-08Bibliographically approved
Littbrand, H., Stenvall, M. & Rosendahl, E. (2011). Applicability and effects of physical exercise on physical and cognitive functions and activities of daily living among people with dementia: a systematic review. American Journal of Physical Medicine & Rehabilitation, 90(6), 495-518
Open this publication in new window or tab >>Applicability and effects of physical exercise on physical and cognitive functions and activities of daily living among people with dementia: a systematic review
2011 (English)In: American Journal of Physical Medicine & Rehabilitation, ISSN 0894-9115, E-ISSN 1537-7385, Vol. 90, no 6, p. 495-518Article, review/survey (Refereed) Published
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.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2011
Keywords
Dementia; Alzheimer Disease; Exercise; Rehabilitation
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-49859 (URN)10.1097/PHM.0b013e318214de26 (DOI)000290433200008 ()21430516 (PubMedID)
Funder
Swedish Research Council, K2005-27VX-15357-01ASwedish Research Council, K2009-69P-21298-01-4
Available from: 2011-11-22 Created: 2011-11-22 Last updated: 2018-06-08Bibliographically approved
Olofsson, B., Stenvall, M., Lundström, M., Gustafson, Y. & Svensson, O. (2009). Mental status and surgical methods in patients with femoral neck fracture. Orthopedic Nursing, 28(6), 305-313
Open this publication in new window or tab >>Mental status and surgical methods in patients with femoral neck fracture
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2009 (English)In: Orthopedic Nursing, ISSN 0744-6020, E-ISSN 1542-538X, Vol. 28, no 6, p. 305-313Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: About one third of hip-fractured patients have dementia and thus may have difficulties adhering to postoperative instructions. Hip replacement is the most common treatment when a femoral neck fracture is displaced in healthy older people, whereas for those with dementia and other severe comorbidities, internal fixation (IF) is generally recommended.

PURPOSE: To evaluate complications, functional outcome, and mortality for both surgical methods, IF and hemiarthroplasty (HAP), in older patients suffering from femoral neck fracture with or without dementia. SAMPLE: One hundred eighty patients, aged 70 years or older, who were operated on using IF (n = 69) in undisplaced femoral neck fracture and HAP (n = 111) if the fractures were displaced.

DATA COLLECTION: Mental state was assessed using the Mini-Mental State Examination and Organic Brain Syndrome scale, and dementia and delirium were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Outcomes of mortality, complications, functional ability, and quality of life were measured.

FINDINGS: There was no difference in complications or mortality at 4 months and 1 year for the IF or HAP groups. Patients with and without dementia, operated on with HAP, had a better functional outcome after 1 year than those operated on with IF. The result of this study indicates that dementia per se is not a reason for disqualifying those patients from the most appropriate surgical method.

National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-30493 (URN)10.1097/NOR.0b013e3181c015c5 (DOI)
Available from: 2010-01-04 Created: 2010-01-04 Last updated: 2018-06-08Bibliographically approved
Stenvall, M., Olofsson, B., Nyberg, L., Lundström, M. & Gustafson, Y. (2008). Bättre resultat med ett multidisciplinärt vårdprogram för äldre med höftfraktur.
Open this publication in new window or tab >>Bättre resultat med ett multidisciplinärt vårdprogram för äldre med höftfraktur
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2008 (Swedish)Report (Other academic)
Publisher
p. 10
Series
Äldrecentrum Västerbotten ; 2007:2
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-86384 (URN)
Available from: 2014-02-25 Created: 2014-02-25 Last updated: 2018-06-08Bibliographically approved
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