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  • 1.
    Aalto, Lina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Läckberg Holmquist, Victor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nervrotsblockad i kombination med fysioterapi för patienter med diskbråck - en single subject experimental design2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Diskbråck i ländryggen med symtom av ischias, bensmärta, är en vanlig orsak till specifika ryggbesvär. Konservativa behandlingsmetoder rekommenderas före kirurgi. Diagnosen diskbråck är förknippad med kraftig smärta och begränsningar och är en vanlig orsak till att söka vård och behandling. Trots detta finns det idag ingen konsensus kring vilka behandlingsmetoder som är mest effektiva vid diskbråck.

    Syfte: Att undersöka effekten av nervrotsblockad i kombination med individanpassad fysioterapi på smärta och aktivitetsförmåga för patienter med symtomgivande lumbosakralt diskbråck.

    Metod: Studiens utformning var en Single Subject Experimental Design (SSED), med en A-B design. Under baslinjefasen, A och interventionsfasen, B utfördes systematiska och upprepade mätningar av smärtintensitet och aktivitetsförmåga över tid. Totalt fem patienter med lumbosakralt diskbråck rekryterades från en klinik. Studien omfattades av två interventioner. Två patienter behandlades med nervrotsblockad (NRB) i kombination med individanpassad fysioterapi och tre patienter behandlades endast med NRB. Mätdata presenteras med grafer i linjediagram och analyserades visuellt.

    Resultat: De två patienterna som fick NRB i kombination med individanpassad fysioterapi förbättrades avseende smärta respektive aktivitetsförmåga, under nio respektive fem veckors interventionsfas. Av de tre patienter som behandlades enbart med NRB upplevde en patient en försämring avseende smärta och aktivitetsförmåga, en valde att avsluta sin medverkan och en behandlades som bortfall.

    Slutsats: NRB i kombination med individanpassad fysioterapi kan minska smärta och förbättra aktivitetsförmåga för enskilda patienter med symtomgivande lumbosakralt diskbråck.

     

  • 2.
    Aasa, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Norrlandsklinikens hälsocentral, Umeå, Sweden.
    Berglund, Lars
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi.
    Aasa, Ulrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Individualized low-load motor control exercises and education versus a high-load lifting exercise and education to improve activity, pain intensity, and physical performance in patients with low back pain: a randomized controlled trial2015In: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 45, no 2, p. 77-85Article in journal (Refereed)
    Abstract [en]

    Study Design Randomized controlled trial. Background Low back pain is a common disorder. Patients with low back pain frequently have aberrant and pain-provocative movement patterns that often are addressed with motor control exercises. Objective To compare the effects of low-load motor control (LMC) exercise and those of a high-load lifting (HLL) exercise. Methods Seventy participants with recurrent low back pain, who were diagnosed with nociceptive mechanical pain as their dominating pain pattern, were randomized to either LMC or HLL exercise treatments. Participants were offered 12 treatment sessions over an 8-week period. All participants were also provided with education regarding pain mechanisms. Methods Participants were assessed prior to and following treatment. The primary outcome measures were activity (the Patient-Specific Functional Scale) and average pain intensity over the last 7 days (visual analog scale). The secondary outcome measure was a physical performance test battery that included 1 strength, 3 endurance, and 7 movement control tests for the lumbopelvic region. Results Both interventions resulted in significant within-group improvements in pain intensity, strength, and endurance. The LMC group showed significantly greater improvement on the Patient-Specific Functional Scale (4.2 points) compared with the HLL group (2.5 points) (P<.001). There were no significant between-group differences in pain intensity (P = .505), strength, and 1 of the 3 endurance tests. However, the LMC group showed an increase (from 2.9 to 5.9) on the movement control test subscale, whereas the HLL group showed no change (from 3.9 to 3.1) (P<.001). Conclusion An LMC intervention may result in superior outcomes in activity, movement control, and muscle endurance compared to an HLL intervention, but not in pain intensity, strength, or endurance.

  • 3.
    Aasa, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Hellqvist, Jonas
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Berglund, Lars
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi.
    Aasa, Ulrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    A characterisation of pain, disability, kinesiophobia and physical capacity in patients with predominantly peripherally mediated mechanical low back pain2011Conference paper (Refereed)
  • 4.
    Aasa, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Berglund, Lars
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Aasa, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Krafttag ska stoppa styrkelyftarnas skador2015Other (Other (popular science, discussion, etc.))
  • 5.
    Aasa, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundell, Sara
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Aasa, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Norrlandskliniken, Umeå, Sweden.
    Westerståhl, Maria
    Institutionen för laboratoriemedicin, Karolinska institutet.
    Physical Activity Might Be of Greater Importance for Good Spinal Control Than If You Have Had Pain or Not: A Longitudinal Study2015In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, no 24, p. 1926-1933Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: Longitudinal design. A cohort followed in 3 waves of data collection.

    OBJECTIVE: The aim of the study was to describe the relationships between the performance of 2 tests of spinal control at the age of 52 years and low back pain, physical activity level, and fitness earlier in life, as well as to describe the cross-sectional relationships between these measures.

    SUMMARY OF BACKGROUND DATA: Altered spinal control has been linked to pain; however, other stimuli may also lead to inability to control the movements of the spine.

    METHODS: Participants answered questions about physical activity and low back pain, and performed physical fitness tests at the age of 16, 34, and 52 years. The fitness test battery included tests of endurance in the back and abdominal muscles, a submaximal bicycle ergometer test to estimate maximal oxygen uptake, and measurements of hip flexion, thoracic spine flexibility, and anthropometrics. Two tests were aggregated to a physical fitness index. At the age of 52, also 2 tests of spinal control, the standing Waiter's bow (WB) and the supine double leg lower (LL) were performed.

    RESULTS: Logistic regression analyses showed that higher back muscle endurance at the age of 34 years could positively predict WB performance at 52 years and higher physical fitness at the age of 34 could positively predict LL performance at 52 years. Regarding cross-sectional relationships, an inability to perform the WB correctly was associated with lower physical fitness, flexibility and physical activity, and larger waist circumference. An inability to correctly perform the LL was associated with lower physical fitness. One-year prevalence of pain was not significantly associated with WB or LL test performance.

    CONCLUSION: An active life resulting in higher physical fitness is related to better spinal control in middle-aged men and women. This further strengthens the importance of physical activity throughout the life span.

    LEVEL OF EVIDENCE: 3.

  • 6.
    Aasa, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundell, Sara
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Barnekow-Bergkvist, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Jansson, Eva
    Westerståhl, Maria
    The Swedish physical activity and fitness cohort born in 1958 - dropout analysis and overview at 36-year follow-up2017In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 27, no 4, p. 418-429Article in journal (Refereed)
    Abstract [en]

    The main aim of the Swedish physical activity and fitness cohort study (SPAF-1958) was to describe physical fitness, physical activity, health, and lifestyle across part of the lifespan, and to assess the influences on these factors from the environment, personal factors, and genetics. There is inevitable dropout from longitudinal studies, and it may be systematic. The aim of this first paper of the second follow-up of SPAF-1958 was to provide a dropout analysis to consider to what extent the participants, at 52 years of age, remain a representative sample of the original adolescent study population. Additional aims were to provide an overview of the study protocol and the ongoing study population. Ongoing study participants in SPAF born in 1958 were, at the second follow-up at the age of 52, still representative of the study cohort in terms of sex, adolescent geographical area, upper secondary school program, adolescent body composition, muscular strength, and muscular endurance. However, a higher physical activity and, among women, a higher aerobic capacity in adolescence decreased the risk for dropout. It is important when interpreting results from longitudinal studies to adjust for the systematic dropout that could bias the conclusions drawn from the results.

  • 7.
    Aasa, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Paulin, Johan
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Madison, Guy
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Correspondence between physical self-concept and participation in, and fitness change after, bi-weekly body conditioning classes in sedentary women2017In: Journal of Strength and Conditioning Research, ISSN 1064-8011, E-ISSN 1533-4287, Vol. 31, no 2, p. 451-461Article in journal (Refereed)
    Abstract [en]

    The aims of the study were (1) to investigate the effects of participation in low impact body conditioning classes on physical fitness in sedentary women at different ages and (2) to examine the correspondence between physical self-concept and participation in, and fitness change after, the participation. Ninety-two sedentary women (mean age 44.2 years) participated in 11-weeks of bi-weekly classes that included cardiovascular, strength, core, endurance and mobility exercises, all performed in synchrony with music. Cardiorespiratory fitness, maximal lifting strength, mobility and balance tests were performed pre- and post the exercise period and the short-form Physical Self-Description Questionnaire (PSDQ-S) was completed. Zero-order Spearman correlation analyses showed that women who rated the PSDQ-S dimension Sport competence higher participated in a larger number of sessions (rs=0.24, p=0.040). At post-tests, all participants had increased their balance, the participants aged 20-34 years had increased their lifting strength, and the participants aged 35-65 years had increased their cardiorespiratory fitness and mobility. Most PSDQ-S dimensions did not affect performance change, but the perception of being physically active was related to increased cardiovascular fitness. We conclude that women with a sedentary lifestyle who wish to increase their physical capacity benefit from music exercise and that inquiries about perceived sport competence and physical activity can improve recommendations made by strength and conditioning professionals.

  • 8.
    Aasa, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Sport Sciences Center.
    Svartholm, Ivar
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Andersson, Fredrik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Berglund, Lars
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Sport Sciences Center.
    Injuries among weightlifters and powerlifters: a systematic review2017In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 51, no 4, p. 211-219Article in journal (Refereed)
    Abstract [en]

    Background Olympic weightlifting and powerlifting are two sports that expose the body to great forces. Injury characteristics have not been systematically reviewed for these two growing sports.

    Objective The purpose of this study was to systematically review the literature regarding various definitions of injuries used, injury localisation, the prevalence and incidence of injuries and the associated risk factors for injuries in weightlifting and powerlifting.

    Design Systematic review.

    Data sources Five databases, PubMed, MEDLINE, SPORTDiscus, Scopus and Web of Science, were searched between 9 March and 6 April 2015.

    Eligibility criteria for selecting studies Studies assessing injury incidence and prevalence in Olympic weightlifting and powerlifting were included. The Quality assessment tool for observational cohort and cross-sectional studies was used to assess methodological quality.

    Results 9 studies were included in the review. Injury was defined fairly consistently across studies. Most studies were of low methodological quality. The spine, shoulder and the knee were the most common injury localisations in both sports. The injury incidence in weightlifting was 2.4–3.3 injuries/1000 hours of training and 1.0–4.4 injuries/1000 hours of training in powerlifting. Only one retrospective study had analysed possible risk factors.

    Summary/conclusions The risk of injury in both sports were similar to other non-contact sports also requiring strength/power, but low compared to contact sports. The severity of injuries differed in the included studies. Since little has been studied regarding possible risk factors to injuries, further research is therefore warranted to explain why athletes get injured and how to prevent injuries.

    Trial registration number PROSPERO CRD42015014805.

  • 9.
    Aasted, Evelina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Danielsson, Johanna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Den laddade gymspegeln: - Unga styrketränande kvinnors förhållande till speglar på gymmet2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Spegeln har en lång historia som en väsentlig del i rehabilitering och används med varierade syften inom olika fysioterapeutiska områden. Forskning har dock visat att träning i speglade miljöer kan ge en negativ påverkan på självkänslan. Det är därför av stor vikt för fysioterapeuter att vara medveten om och inventera speglarnas olika påverkan.

    Syfte: Syftet med studien var att utforska unga styrketränande kvinnors förhållande till speglar på gymmet och hur det påverkar deras kroppsuppfattning och självkänsla.

    Metod: Studien baseras på kvalitativa intervjuer med fyra unga kvinnor. Inkluderingskriterierna är var unga styrketränande kvinnor i åldrarna 20-25 år. Intervjuguiden som användes är var semistrukturerade och analysmetoden är var Grounded Theory.

    Resultat: Resultatet av analysen utmynnade i kärnkategorin ”Den laddade gymspegeln” och kategorier med tillhörande underkategorier. De kategorier som formulerades fram var: ”Speglad trygghet och motivation”, ”Reflekterad osäkerhet”, ”Den dömande gymspegeln”, ”Gymspegeln skapar bidrar till stressig gymmiljö”, ”Gymspegeln som förstärkare av krävande kroppsideal”. Som sista steg i analysen skapades en modell.

    Konklusion: Unga styrketränande kvinnor upplevdeer att det finns en såväl positiv som negativ laddning med speglar på gymmet. Det var viktigt med speglar ur teknik- och skadepreventionssyfte. Samtidigt bidrog den speglade miljön till ett jämförande och ökat dömande. Det är fördelaktigt för fysioterapeuter att vara medvetna om speglarnas påverkan på unga styrketränande kvinnors självkänsla och kroppsuppfattning. Mer forskning krävs inom området.

  • 10.
    Abrahamsson, Johanna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Larsson, Madeleine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Supramaximala cykelsprintintervaller - hur påverkas autonom kontroll?: En gruppträningsintervention för äldre2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Fysisk inaktivitet är vanligt, och många äldre uppnår inte WHO:s rekommendationer om fysisk aktivitet, vilket kan leda till ohälsa. Fysisk aktivitet har positiv hälsopåverkan på autonoma nervsystemet, ANS, vilket kan återspeglas i hög hjärtfrekvensvariabilitet, HRV. Högintensiv intervallträning, HIT, är tidseffektivt och har påvisats påverka HRV och autonom kontroll.

    Syfte: Syftet med studien är att i) undersöka hur autonom funktion hos äldre, mätt som hjärtfrekvensvariabilitet i vila samt hjärtfrekvens under aktivitet, påverkas av högintensiv intervallträning ,HIT, i form av extremt korta cykelsprintintervaller, samt ii) undersöka genomförbarheten av självständiga mätningar av autonom funktion i hemmet.

    Metod: Åtta friska, fysiskt aktiva forskningspersoner, 65-75 år, genomförde modifierat Borgs Cycle Strength test och modifierat submaximalt Åstrandstest för att estimera maximal aerob och anaerob förmåga. Sju forskningspersoner (ett bortfall) genomförde en gruppträningsintervention av 6-sekunders HIT-intervaller. Självständiga HRV-mätningar genomfördes med pulsklocka, fyra ggr/vecka, under fem veckor. HRV, mätt i rMSSD,  samt hjärtfrekvens under uppvärmning och nedvarvning analyserades hos tre forskningspersoner i en single-subject-analys. Genomförbarheten av HRV-mätningarna studerades.

    Resultat: Positiv påverkan på autonom kontroll, mätt i Root Mean Square of Successive Differences, rMSSD,, påvisades med statistik signifikans hos två av tre forskningspersoner, a=0,05. Hjärtfrekvens under uppvärmning och nedvarvning, HRex, var lägre under nedvarvning vid sista träningstillfället än det första hos alla forskningspersoner. HRex under uppvärmning minskade från första till sista träningstillfället för en forskningsperson, och var densamma för två forskningspersoner. Genomförbarhetsundersökningen resulterade i 20/20 insamlade mätpunkter för HRV.

    Konklusion: HIT tycks ha positiv påverkan på autonom kontroll, i form av ökad HRV, hos friska, fysiskt aktiva äldre personer. Det är möjligt för äldre personer att självständigt mäta HRV med pulsklocka i hemmet.

  • 11.
    Abramowicz, Konrad
    et al.
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hérbert-Losier, Kim
    National Sports Institute of Malaysia.
    Pini, Alessia
    MOX – Department of Mathematics, Politecnico di Milano.
    Schelin, Lina
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Strandberg, Johan
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    Vantini, Simone
    MOX – Department of Mathematics, Politecnico di Milano.
    An inferential framework for domain selection in functional anova2014In: Contributions in infinite-dimensional statistics and related topics / [ed] Bongiorno, E.G., Salinelli, E., Goia, A., Vieu, P, Esculapio , 2014Conference paper (Refereed)
    Abstract [en]

    We present a procedure for performing an ANOVA test on functional data, including pairwise group comparisons. in a Scheff´e-like perspective. The test is based on the Interval Testing Procedure, and it selects intervals where the groups significantly differ. The procedure is applied on the 3D kinematic motion of the knee joint collected during a functional task (one leg hop) performed by three groups of individuals.

  • 12.
    Ahlgren, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Folkesson, Robert
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    The association between self-paced walking speed and cognitive function among very old people.2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Inledning:

    I Sverige förväntas medelåldern att stiga och den äldsta åldersgruppen förutspås växa sig allt större. Nedgång i fysisk funktion och kognitiv funktion är vanligt bland människor som är äldre. Nyligen genomförda tvärsnitts- och longitudinella studier visar att det finns ett samband mellan gång och kognition. Tyvärr är forskningen begränsad då den nästintill exkluderar mycket gamla människor.Syfte:

    Utforska sambandet mellan självvald gånghastighet och kognition hos mycket gamla människor. Det specifika syftet är att analysera sambandet vid baslinjen och vid 5 års uppföljning samt sambandet i förändringen hos mycket gamla människor. Metod:

    Deltagare undersökta i Umeå 85 + / Gerontologisk regional databas-studie (GERDA), med en ålder på 85 år eller äldre, bedömdes vid baslinjen och med 5 års uppföljning. Självvald gånghastighet mättes med 2,4 meters gångtest och individernas kognitiva funktion undersöktes med hjälp av Mini-Mental State Examination.Resultat:

    Medelåldern vid baslinjen var 89,76 (SD ± 4,82). Korrelation för förändringen i självvald gånghastighet och Mini-Mental State Examination mellan baslinjen och vid uppföljningen (n = 277), r = .251, p <.001, r2 värde .063. Konklusion:

    Det finns ett samband mellan självvald gånghastighet och kognitiv funktion bland de mycket gamla, både tvärsnitt och longitudinellt. Sambandet är starkt bland de som utvecklar demens.

  • 13.
    Ahlgren, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Johansson, Eva E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    The meanings given to gender in studies on multimodal rehabilitation for patients with chronic musculoskeletal pain: a literature review2016In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 23, p. 2255-2270Article, review/survey (Refereed)
    Abstract [en]

    Purpose: The purpose of this study is to assess and describe the meanings given to "gender" in scientific publications that evaluate multidisciplinary, interdisciplinary or multimodal rehabilitation for patients with chronic musculoskeletal pain.

    Method: A systematic literature search for papers evaluating multimodal rehabilitation was conducted. The PubMed and EBSCO databases were searched from 1995 to 2015. Two or three researchers independently read each paper, performed a quality assessment and coded meanings of gender using qualitative content analysis.

    Results: Twenty-seven papers were included in the review. Gender was used very differently in the MMR studies investigated but primarily it referred to factual differences between men and women. Only one paper provided a definition of the concept of gender and how it had been used in that study. In the content analysis, the meaning of gender formed three categories: "Gender as a factual difference", "The man is the ideal" and "Gender as a result of social role expectations".

    Conclusions: The meaning of the concept of gender in multimodal rehabilitation is undefined and needs to be developed further. The way the concept is used should be defined in the design and evaluation of multimodal rehabilitation in future studies.

    Implications for rehabilitation

    Healthcare professionals should reflect on gender relations in encounters with patients, selection of patients into rehabilitation programs and design of programs. In rehabilitation for chronic pain the patients' social circumstances and cultural context should be given the same consideration as biological sex and pain symptoms.

  • 14.
    Ahlgren, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Hammarström, Anne
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Sandberg, Susanne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Larsson, Christel
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition. Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden .
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Engagement in New Dietary Habits: Obese Women's Experiences from Participating in a 2-Year Diet Intervention2016In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, no 1, p. 84-93Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Dietary weight loss interventions most often result in weight loss, but weight maintenance on a long-term basis is the main problem in obesity treatment. There is a need for an increased understanding of the behaviour patterns involved in adopting a new dietary behavior and to maintain the behaviour over time.

    PURPOSE: The purpose of this paper is to explore overweight and obese middle-aged women's experiences of the dietary change processes when participating in a 2-year-long diet intervention.

    METHODS: Qualitative semi-structured interviews with 12 overweight and obese women (54-71 years) were made after their participation in a diet intervention programme. The programme was designed as a RCT study comparing a diet according to the Nordic nutrition recommendations (NNR diet) and a Palaeolithic diet (PD). Interviews were analysed according to Grounded Theory principles.

    RESULTS: A core category "Engagement phases in the process of a diet intervention" concluded the analysis. Four categories included the informants' experiences during different stages of the process of dietary change: "Honeymoon phase", "Everyday life phase", "It's up to you phase" and "Crossroads phase". The early part of the intervention period was called "Honeymoon phase" and was characterised by positive experiences, including perceived weight loss and extensive support. The next phases, the "Everyday life phase" and "It's up to you phase", contained the largest obstacles to change. The home environment appeared as a crucial factor, which could be decisive for maintenance of the new dietary habits or relapse into old habits in the last phase called "Crossroads phase".

    CONCLUSION: We identified various phases of engagement in the process of a long-term dietary intervention among middle-aged women. A clear personal goal and support from family and friends seem to be of major importance for long-term maintenance of new dietary habits. Gender relations within the household must be considered as a possible obstacle for women engaging in diet intervention.

  • 15.
    Alexandersson, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Påverkas rehabiliteringen av att patienter som genomgår en total knäplastiksoperation opereras i blodtomt fält och i så  fall hur? .: Enrandomiserad kontrollerad studie2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: År 2011genomfördes 12 048 primära totala knäartroplastiker (TKA) i Sverige. Av dessa opererades 90 96 iblodtomt fält (BTF) och10 96 i icke BTF. För att åstadkomma ett bladtomt fält används en blodtrycksmanschett pä låret, trycket kan variera mellan olika kliniker. Effekten av trycket mot hud, muskler, nerver och lodkärl kan orsaka neuromuskulära skador som kan leda tillpost-operativ svaghet i quadriceps.

    Syfte:Att se om rehabiliteringsresultatet päskyndades ochförbättrades av att patienterna inte opereradesiblodtomt fält.

    Metod: 37 patienter med knäartros randomiserades till cementerad TKA i blodtomt fält respektive icke blodtomt fält Aktiv knäflexion, smärta, svullnad, quadricepsfunktion och timed up and go (TUG) mättes före ochupp till tre månader post-operativt.

    Resultat: ANCOVA visade ingen effekt på knäflexion dag trepost-operativt mellan grupperna. Inte heller något av de övriga utfallsmåtten visade en signifikant skillnad post­ operativt. Gruppen med BTF hade tendens till mindre smärta dag tre post-operativt och det fanns ingen signifikant skillnad avseende extra morfinkonsumtion utöver ordinarie dos.

    Konklusion:Operation av TKAiblodtomt fält påverkade inte knäflexion men ytterligare studier med fler deltagare behövs för att säkert kunna säga om rehabiliteringen påverkas av operation i blodtomt fält.

  • 16.
    Alkhed, Ann-Kristin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Har konditionsträning positiv effekt på hjärntrötthet, kognitiva förmågor och dynamisk balans under gång hos personer med förvärvad hjänskada?: En Single-Subject Experimental Design studie2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background and aim: People with acquired brain injury often have problems with fatigue, cognition and dynamic balance during walking. The aim of this study was to evaluate if aerobic exercise had positive effects on fatigue, cognition and dynamic balance during walking for persons with acquired brain injury

     

    Method: Single subject experimental design, A-B-design was used. The three participants were between 18-70 years, have had the injury for at least two years, had participated in a group rehabilitation program and had at least 4 on the Fatigue Severity Scale (FSS). They cycled 30 minutes, twice a week during twelve weeks on 70-80 % of maximum heart rate. The intervention consisted of warm-up and four intervals with recovery in-between. The exertion level had to be between 12 and 15 on the Rating of Percieved Exertion-scale. Other outcome measures that were used were FSS, Flanker, N-back, Stroop test and Dynamic Gait Index (DGI). Descriptive statistics, visual analysis and 2SD method were used.

     

    Results: The cognition improved for all three participants. The results showed no improvement in DGI but in FSS for one participant.

     

    Conclusion: Aerobic exercise could be used in the physical and cognitive rehabilitation for patients with acquired brain injury but seemingly has no positive effects on fatigue or dynamic balance during walking.

  • 17.
    Allo, Heba
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Paju, Victor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Styrketränande unga män: - en strävan mot respekterad manlighet2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Styrketräningen är mer än enbart det fysiska utförandet eftersom sociala normer har en inverkan på unga styrketränande mäns förhållningssätt till sin kropp. Det finns en idealbild av manlighet på gym som fysioterapeuter bör vara medvetna om.

    Syfte: Syftet är att utifrån ett maskulinitetsperspektiv undersöka vilken inställning unga styrketränande män mellan tonår och ung vuxenhet har till kropp och styrketräning.

    Metod: Studien baseras på kvalitativa intervjuer med fyra styrketränande unga män och en nyckelperson. Intervjuguiderna som används är semistrukturerade och analysmetoden Grounded Theory.

    Resultat: De kategorier som framkommer vid dataanalysen formar gemensamt kärnkategorin ”Upprätthålla respekterad manlighet genom styrketräning”. De fem kategorier som samlar underkategorierna är: Den obrydda mannen, Den odödliga mannen, Den presterande mannen, Den muskulösa mannen och Den sårbara mannen.

    Konklusion: Styrketräning handlar inte enbart om styrka och utseende utan även om manlighet, respekt och värdighet. Styrketräning kan väljas för dess stämpel som manlig aktivitet – således finns en djupare innebörd med styrketräningen. Det kan vara viktig att känna till för fysioterapeuter som möter unga styrketränande män i rehabiliteringssammanhang. Området är outforskat inom fysioterapi. Mer forskning fordras därför för att öka förståelsen om unga styrketränande män i dagens samhälle.

  • 18.
    Almlöf, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Haffling Carlsson, Sara
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Svenska elitidrottares studie- och privatlivssituation - Relaterat till stress och skador2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion:Ett fåtal idrottare kommer kunna livnära sig till följd av sitt idrottande under resten av livet, därför måste de ta beaktning till deras post-idrottsliga karriär vilket ofta resulterar i behovet av en akademisk utbildning. Ett uppmärksammat problem är hur de ska prioritera idrott, studier och privatliv på ett effektivt sätt. Detta är en påfrestande livssituation och kan ligga till grund för stress och skador hos individerna.

    Syfte:Syftet med studien var att kartlägga svenska elitidrottares studie- och privatlivssituation och relatera till stress och skador.

    Metod:Studiepopulationen bestod av 139 elitidrottare som är potentiella och aktuella landslagsidrottare som studerar på akademisk nivå på ett lärosäte i Sverige som erbjuder studieanpassning. Data samlades in genom en webbenkät som innehöll frågor som upplevd återhämtning och priatlivssituation och även generella frågor om studier och elitidrottande, samt frågeformuläret “The athlete burnout questionnaire”.

    Resultat:Det huvudsakliga resultatet var att majoriteten (71,9%) av deltagarna nådde upp till gränsen för medelhöga respektive höga symptom för idrottslig utbrändhet samt att majoriteten ofrivilligt tvingats avstå från ordinarie träning till följd av skada och/eller sjukdom det senaste året. Den självupplevda stressnivån var även signifikant associerad med låg nivå av upplevd privatlivssituation och låg nivå av upplevd återhämtning.

    Konklusion:Det finns en brist i forskningen som inkluderar alla de huvudområden vi undersöker: elitidrott, akademiska studier och privatliv. Något som bör fokuseras på i kommande undersökningar är kombinationen av anpassad studietakt och möjligheten till CSN då det inte undersöks så ingående i denna studie. 

  • 19.
    Andersson, Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Eriksson, Jakob
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Långtidsuppföljning av alpina skidgymnasieelever, 10 år senare: En jämförelse mellan skadefria och allvarligt skadade gällande fysisk aktivitet, allmän hälsa, smärta samt upplevd medicinsk support2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Syftet med denna studie var att undersöka skillnaden mellan skadefria och allvarligt skadade gällande fysisk aktivitetsnivå, allmän hälsa och smärta, i nuläget, samt upplevd tillgång till medicinsk support, hos elever som studerade vid alpina skidgymnasium läsåret 2007/2008.

     

    Metod: Denna enkätstudie bestod av tre delenkäter. En enkät från Socialstyrelsen har använts för att mäta fysisk aktivitetsnivå. En hälsoenkät har använts för att mäta allmän hälsa och smärta. Den tredje enkäten har utformats för övrig relevant information så som medicinsk support. För att analysera datan användes Mann-Whitney U-test med signifikansnivån α=0,05. Enkäterna skickades ut via e-post och Facebook till 195 tidigare skidgymnasieelever. Deltagarna delades in i två grupper: de som var skadefria samt de som drabbats av minst en allvarlig skada.

     

    Resultat: Svarsfrekvensen var 74%. Av dessa var 54 personer skadefria och 91 personer allvarligt skadade. Det fanns ingen signifikant skillnad i fysisk aktivitet, allmän hälsa eller smärta mellan grupperna. De som upplevt att de haft medicinsk support på skidgymnasiet var 29%.

     

    Konklusion: Före detta alpina skidgymnasieelever verkar, oberoende av tidigare skador, vara fysiskt aktiva jämfört med socialstyrelsens riktvärden. Det fanns ingen signifikand skillnad mellan skadefria och allvarligt skadade gällande allmän hälsa och smärta. Studien visade på brister i upplevd tillgång av medicinsk support. För att främja elevers hälsa och prestation bör det kartläggas hur det ser ut idag och om bristerna kvarstår bör detta åtgärdas.

  • 20.
    Andersson, Fredrik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hur fysioterapeuten i primärvården förstår och behandlar ländryggsmärta: En kvalitativ innehållsanalys2015Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Sammanfattning

     

    Syfte

    Att utveckla en djupare förståelse för hur fysioterapeuten i primärvården förstår och behandlar ländryggsmärta

     

    Metod

    Tio fysioterapeuter i primärvården intervjuades med semistrukturerade intervjuer.  Ljudinspelningar utfördes vilka sedan transkriberades och analyserades med kvalitativ innehållsanalys. Innehållet kodades och kategoriserades. Tre subteman framträdde.

     

    Resultat

    Två av subtemana förklarar hur fysioterapeuterna förstod ländryggsmärta genom ”att skaffa sig en bild av problemet” eller ”att förklara problemets orsak”. Det tredje subtemat ”Att förändra” beskriver hur problemet behandlades genom att försöka få patienter att göra förändringar. Förändringarna rörde oftast olika aspekter av fysisk aktivitet. Fokus i förändringsarbetet kunde vara innehållet i förändringarna eller att förändringarna blev av och vidmakthölls.

     

    Slutsatser

    Såväl biomedicinska som psycososiala och biopsykosociala perspektiv på ländryggsmärta förekom bland fysioterapeuterna. Det kan finnas ett behov av åtgärder som syftar till att föra in betéendemedicinska metoder och tankegångar bland de fysioterapeuter som har en tydligt biomekanisk orientering i relation till ländryggsmärta. Att systematiskt använda sig av kraften i den goda relationen i förändringsarbetet var en metod som förekom och som kan vara effektiv men behöver utvecklas genom att också förhålla sig till patientens upplevelse av vad som är en god relation.

  • 21.
    Andersson, Mari
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Granström, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Utvärdering av mobilapplikation för steptest i hemmet för patienter med kroniskt obstruktiv lungsjukdom, KOL2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: KOL förutspås år 2030 vara den tredje vanligaste dödsorsaken i världen. Rehabilitering har konstaterats bristfällig för patientgruppen. Det finns några utvärderingsinstrument för den fysiska förmågan men inget som är lämpligt för hemmiljö.

    Syfte: Studiens syfte var att testa en nyutvecklad mobilapplikation för ett steptest. Användarvänlighet och genomförbarhet hos steptestet utvärderades.

    Metod: Testet utfördes i hemmet av patienter med KOL via en smartphone och pulsoximeter. Data i form av pulsfrekvens, saturation och subjektiv skattning av dyspné lagrades. Deltagarna utvärderade användarbarheten i en enkät som författarna formulerat.

    Resultat: Tre patienter fullföljde studien. Mobilapplikationen visade sig vara svår att använda för de utan tidigare smartphone-vana. Mobilapplikationen hade brister i datalagringen då felaktig data registrerades. Detta gjorde bearbetningen tidskrävande och osäker. Takten 26 steg/min visade sig vara alltför hög för att den planerade tre minuters testperioden skulle vara genomförbar. Samtliga utförde istället steptestet under en minut.

    Slutsats: Förändringar är nödvändiga för att mobilapplikationen ska vara användarvänlig för både testpersonerna samt de som bearbetar datamaterialet. Föreslagna förändringar är förbättrad och tidsstämplad datainsamling, samt mindre justeringar i mobilapplikationens utformning. Testdeltagare med tidigare vana av smartphone samt testdeltagare som inte upplevde problem med testutrustningen var positiva till mobilapplikationen.

  • 22.
    Andersson, Tobias
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Andersson, Mikael
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Akuta effekter av boxningsträning på motorisk funktion vid cerebral pares: En pilotstudie med ett nyutvecklat portabelt rörelseanalyssystem2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: De vanligaste symtomen vid Cerebral Pares (CP) är muskelsvaghet, spasticitet och nedsatt koordination som tillsammans leder till nedsatt motorisk funktion. Styrketräning har i tidigare studier visat på ökad styrka men trots det haft begränsad effekt på motorisk funktion. Personer med CP har uttryckt att de upplevt en förbättrad rörelseförmåga efter boxningsträning.

    Syfte: Syftet med pilotstudien är undersöka om boxningsträning ger akuta effekter på motorisk funktion hos personer med cerebral pares.

    Metod: Under två tillfällen utförde en person tester som avsåg att utvärdera motorisk funktion. Under det andra testtillfället genomfördes ett boxningspass. Testerna som genomfördes riktade sig till spasticitet, koordination, förmåga att utföra explosiva rörelser samt maximal styrka. För att utvärdera rörelsekvalité och muskelaktivitet användes rörelseanalyssystemet AnyMo och elektromyografi. För att bedöma spasticitet användes VAS- och Ashworthskalan.

    Resultat: Testerna visade ingen entydig effekt på spasticitet dock visade bedömningen av Ashworthtestet en minskning efter boxning. Efter boxning sågs även en ökad muskulär aktivering samt en ökad vinkelhastighet vid utförandet av snabba växlande rörelser. Rörelsehastigheten förbättrades däremot inte vid isolerad sträckning av armen eller vid utförande av vardagliga rörelser.

    Slutsats: Boxningsträningen tycktes ge akuta effekter i form av ökad muskelaktivering vid snabbare rörelse samt ökad vinkelhastighet vid rörelser liknande de som utförs i boxningen. Dessa effekter styrker forskningspersonens upplevda förbättring. Däremot sågs ingen förbättring på vardagliga rörelser. Vad gäller graden av spasticitet sågs tendenser till en minskning efter boxning, dock visades detta bara i Ashworthtestet.

  • 23. Arkkukangas, Marina
    et al.
    Sundler, Annelie J.
    Soderlund, Anne
    Eriksson, Staffan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden.
    Johansson, Ann-Christin
    Older persons' experiences of a home-based exercise program with behavioral change support2017In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, no 12, p. 905-913Article in journal (Refereed)
    Abstract [en]

    Background: It is a challenge to promote exercise among older persons. Knowledge is needed regarding the maintenance of exercise aiming at preventing falls and promoting health and well-being in older persons.

    Purpose: This descriptive study used a qualitative inductive approach to describe older persons' experiences of a fall-preventive, home-based exercise program with support for behavioral change.

    Methods: Semi-structured interviews were conducted with 12 elderly persons aged 75years or older, and a qualitative content analysis was performed.

    Results: Four categories emerged: facilitators of performing exercise in everyday life, the importance of support, perceived gains from exercise, and the existential aspects of exercise.

    Conclusion: With support from physiotherapists (PTs), home-based exercise can be adapted to individual circumstances in a meaningful way. Including exercises in everyday life and daily routines could support the experience of being stronger, result in better physical functioning, and give hope for an extended active life in old age.

  • 24. Arkkukangas, Marina
    et al.
    Söderlund, Anne
    Eriksson, Staffan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Uppsala Univ, Ctr Clin Res Sormland, Eskilstuna, Sweden; Uppsala Univ, Dept Neurosci, Physiotherapy, Sweden.
    Johansson, Ann-Christin
    One-year adherence to the Otago Exercise Program with or without motivational interviewing in community-dwelling older adults2018In: Journal of Aging and Physical Activity, ISSN 1063-8652, E-ISSN 1543-267X, Vol. 26, no 3, p. 390-395Article in journal (Refereed)
    Abstract [en]

    This study investigated if behavioral factors, treatment with behavioral support, readiness to change, fall self-efficacy, and activity habits could predict long-term adherence to an exercise program. Included in this study were 114 community-dwelling older adults who had participated in one of two home-based exercise interventions. Behavioral factors associated with adherence to the exercise program over 52 weeks were analyzed. The behavioral factors, specifically activity habits at baseline, significantly predicted adherence to the exercise program, with an odds ratio = 3.39, 95% confidence interval [1.38, 8.32], for exercise and an odds ratio = 6.11, 95% confidence interval [2.34, 15.94], for walks. Being allocated to a specific treatment including motivational interviewing was also significantly predictive: odds ratio = 2.47, 95% confidence interval [1.11, 5.49] for exercise adherence. In conclusion, activity habits and exercise in combination with motivational interviewing had a significant association with adherence to the exercise program at a 1-year follow-up.

  • 25. Arne, Mats
    et al.
    Emtner, Margareta
    Lisspers, Karin
    Wadell, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stallberg, Bjorn
    Availability of pulmonary rehabilitation in primary care for patients with COPD: a cross-sectional study in Sweden2016In: EUROPEAN CLINICAL RESPIRATORY JOURNAL, ISSN 2001-8525, Vol. 3, article id 31601Article in journal (Refereed)
    Abstract [en]

    Background: Pulmonary rehabilitation (PR) is an important, evidence-based component for the management of individuals with chronic obstructive pulmonary disease (COPD). In daily practice, the majority of COPD patients are treated in primary care. However, information about the availability of PR in primary care in Sweden is lacking. The aim was to investigate the availability of rehabilitation resources in primary care settings for patients with COPD in Sweden. Methods: A cross-sectional descriptive design was applied, using web-based questionnaires sent to all primary care centres in four regions, comprising more than half of the 9.6 million inhabitants of Sweden. The main questionnaire included questions about the content and availability of rehabilitation resources for COPD patients. PR was defined as exercise training and one or more of the following activities: education, nutritional intervention, energy conservation techniques or psychosocial support. Results: A total of 381 (55.9%) of the 682 primary care centres answered the main questionnaire. In addition to physicians and nurses, availability of healthcare professionals for rehabilitation in primary care settings was physiotherapists 92.0%, occupational therapists 91.9%, dieticians 83.9% and social workers or psychologists 98.4%. At 23.7% of all centres, PRwas not available toCOPD patients - neither in primary care nor at hospitals. Conclusion: Despite high availability of professionals for rehabilitation in primary care settings, about one-quarter of managers at primary care centres stated that their COPD patients had no access to PR. This indicates a need to structure resources for rehabilitation and to present and communicate the available resources within the healthcare system.

  • 26.
    Arumugam, Ashokan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Clinical versus radiological findings: A paradox in diagnosing minor hamstring injuries2018In: International Journal of Osteopathic Medicine, ISSN 1746-0689, E-ISSN 1878-0164, Vol. 27, p. 52-56Article in journal (Refereed)
    Abstract [en]

    Hamstring injuries occur commonly in athletes participating in sports that require sprinting/high velocity running, kicking a ball or agility. In the first instance, clinical assessment and management play a pivotal role in managing these injuries. Radiological investigations such as ultrasonography (US) and magnetic resonance imaging (MRI) are also recommended to confirm one or more parameters related to hamstring injury (the location, length, cross-sectional area, volume, edema, hemorrhage, etc.) and predicting return-to-play. However, hamstring injuries that are minor in nature, diagnosed clinically, may not be discernible on conventional US or MRI in some cases. Certain reasons for these paradoxical (clinical vs. radiological) findings may include pain referral to the posterior thigh from lumbosacral dysfunction or sciatic nerve pathoneurodynamics. Conversely, minor hamstring injuries might remain indiscernible within the threshold of conventional MRI sensitivity. To date, there is neither clear consensus on a standardized criteria nor strong evidence for using MRI to prognosticate return-to-play following hamstring injuries. This paper briefly discusses the controversy between contradicting clinical and radiological findings encountered by clinicians in the diagnosis of minor hamstring injuries. If posterior thigh pain appears with clinical signs and symptoms of a minor hamstring injury without pain referral from neighboring structures, but presents with negative findings on US or MRI, the diagnosis remains a challenge. However, such conditions are pragmatically treated as (nonstructural) hamstring injuries unless certain differential diagnoses can be established. 

  • 27.
    Arumugam, Ashokan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sacral Osteosarcoma Masquerading as Posterior Thigh Pain2018In: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 48, no 8, p. 665-665Article in journal (Other academic)
  • 28.
    Arumugam, Ashokan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Markström, Jonas L.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Introducing a novel test with unanticipated medial/lateral diagonal hops that reliably captures hip and knee kinematics in healthy women2018In: Journal of Biomechanics, ISSN 0021-9290, E-ISSN 1873-2380Article in journal (Refereed)
    Abstract [en]

    Despite a vast literature on one-leg hops and cutting maneuvers assessing knee control pre/post-injury of the anterior cruciate ligament (ACL), comprehensive and reliable tests performed under unpredictable conditions are lacking. This study aimed to: (1) assess the feasibility of an innovative, knee-challenging, one-leg double-hop test consisting of a forward hop followed by a diagonal hop (45°) performed medially (UMDH) or laterally (ULDH) in an unanticipated manner; and (2) determine within- and between-session reliability for 3-dimensional hip and knee kinematics and kinetics of these tests. Twenty-two healthy women (22.3 ± 3.3 years) performed three successful UMDH and ULDH, twice 1–4 weeks apart. Hop success rate was 69–84%. Peak hip and knee angles demonstrated moderate to excellent within-session reliability (intraclass correlation coefficient [ICC] 95% confidence interval [CI]: 0.67–0.99, standard error of measurement [SEM] ≤  3°) and poor to excellent between-session reliability (ICC CI: 0.22–0.94, SEM ≤ 3°) for UMDH and ULDH. The smallest real difference (SRD) was low (≤ 5°) for nearly all peak angles. Peak hip and knee moments demonstrated poor to excellent reliability (ICC CI: 0–0.97) and, in general, moments were more reliable within-session (SEM ≤ 0.14 N.m/kg.m, both directions) than between-session (SRD ≤ 0.43 N.m/kg.m). Our novel test was feasible and, in most but not all cases, provided reliable angle estimates (within-session > between-session, both directions) albeit less reliable moments (within-session > between-session, both directions). The relatively large hip and knee movements in the frontal and transverse planes during the unanticipated hops suggest substantial challenge of dynamic knee control. Thus, the test seems appropriate for evaluating knee function during ACL injury rehabilitation.

  • 29.
    Aspdahl, Magnus
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Comparison of joint status with ultrasound and physical examination in children with hemophilia A2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: Hemophilia A is a bleeding disorder that can cause chronic artropathy, when not treated optimally. To detect early signs of hemophilic artropathy patients with moderate or severe hemophilia undergo yearly examinations by a physiotherapist defining the joint status by a scoring system, “HJHS”. A new ultrasound-based scoring system, HEAD-US, has been developed to evaluate joint disease progression and treatment results. The aim of this study is to evaluate if there is a correlation between HJHS 2.1 and HEAD-US in children with hemophilia A. Furthermore, to evaluate if there is a correlation between physical activity and hemophilic artropathy and finally to asses if there are any differences in artropathy between sub-groups within the study group.

    Methods: A prospective study where all patients between ages 3 to 18 years with moderate or severe hemophilia followed at the Karolinska University Hospital 2015-2016 were asked to participate. Patients were asked to fill in a questionnaire regarding physical activity and joint bleeds and clinical data were retrospectively collected from the patients’ medical records. Joints were evaluated by the author according to HJHS and HEAD-US.

    Results: There was a significant correlation between the total-, elbow-, knee- and ankle scores for HJHS and HEAD-US scores. There was a statistically significant correlation between annual bleeding rate and total scores for HJHS and HEAD-US. No statistically significant correlation was seen between the total score of HJHS or HEAD-US and the level of physical activity.

    Conclusions: This study demonstrates that the total score and individual joint scores with HEAD-US correlate well with the current method HJHS 2.1 in children with hemophilia A. 

  • 30.
    Balnožan, Stevan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Isgren, Andreas
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Samband mellan träningsbelastning vid högintensiva cykelintervaller och styrkekapacitet hos yngre, friska och tränade individer: En pilotstudie2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Under senare år har olika former av mycket högintensiv intervallträning givits ett ökat intresse. Denna träningsmetod har potential att vara användbar av många. Problematiken idag är att det inte finns någon kliniskt användbar metod för att styra/reglera träningsintensiteten på ett säkert sätt. 

    Syfte: Att undersöka om tester av styrkeprestation vid 30s Chair Stand Test och Isometriskt marklyft kan användas som mått för att reglera intensitet vid högintensiva intervaller.

    Metod: 12 försökspersoner mellan åldrarna 20-30år (6 kvinnor, 6 män)[BR1]  genomförde Borg Cycle Strenght [BR2] Test för att estimera maximal anaerob effekt (Watt) för 30 sekunders cykelarbete (MAnP, Maximal Anaerobic Power). Därutöver genomfördes två styrketester: Isometriskt marklyft och 30s Chair Stand Test. Sambandet mellan kapaciteten i styrketesterna och MAnP analyserades med Pearson`s[BR3]  korrelationstest.

    Resultat: Signifikant korrelation fanns i båda styrketesten i relation till Cycle Strenght Test, (p<0.01, r=0,77 för 30s Chair Stand Test och p<0.05, r=0,61 för det isometriska marklyftet).

    Konklusion: I den här pilotstudien visar resultatet att det finns ett samband mellan prestationsförmågan vid Marklyft respektive 30s Chair Stand Test och maximal prestationsförmåga vid cykling under 30 sekunder hos unga individer. 30s Chair Stand Test visar sig vara ett mer lämpat styrketest än det isometriska marklyftet för att kunna styra träningsintensiteten vid supramaximala 30 sekunders intervaller. Testmetodiken kan vara möjlig för att kunna styra träningsintensiteten. Vidare studier krävs för användning i klinisk miljö exempelvis bland äldre.

  • 31. Barreto, Philipe de Souto
    et al.
    Morley, John E.
    Chodzko-Zajko, Wojtek
    Pitkala, Kaisu H.
    Weening-Djiksterhuis, Elizabeth
    Rodriguez-Manas, Leocadio
    Barbagallo, Mario
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sinclair, Alan
    Landi, Francesco
    Izquierdo, Mikel
    Vellas, Bruno
    Rolland, Yves
    Recommendations on Physical Activity and Exercise for Older Adults Living in Long-Term Care Facilities: A Taskforce Report2016In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, no 5, p. 381-392Article in journal (Refereed)
    Abstract [en]

    A taskforce, under the auspices of The International Association of Gerontology and Geriatrics-Global Aging Research Network (IAGG-GARN) and the IAGG European Region Clinical Section, composed of experts from the fields of exercise science and geriatrics, met in Toulouse, in December 2015, with the aim of establishing recommendations of physical activity and exercise for older adults living in long-term care facilities (LTCFs). Due to the high heterogeneity in terms of functional ability and cognitive function that characterizes older adults living in LTCFs, taskforce members established 2 sets of recommendations: recommendations for reducing sedentary behaviors for all LTCF residents and recommendations for defining specific, evidence-based guidelines for exercise training for subgroups of LTCF residents. To promote a successful implementation of recommendations, taskforce experts highlighted the importance of promoting residents' motivation and pleasure, the key factors that can be increased when taking into account residents' desires, preferences, beliefs, and attitudes toward physical activity and exercise. The importance of organizational factors related to LTCFs and health care systems were recognized by the experts. In conclusion, this taskforce report proposes standards for the elaboration of strategies to increase physical activity as well as to prescribe exercise programs for older adults living in LTCFs. This report should be used as a guide for professionals working in LTCF settings.

  • 32.
    Bay, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Dellborg, Mikael
    Berghammer, Malin
    Sandberg, Camilla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Engström, Gunnar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Moons, Philip
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Patient reported outcomes are associated with physical activity level in adults with congenital heart disease2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 243, p. 174-179Article in journal (Refereed)
    Abstract [en]

    Background: In general, adults with congenital heart disease (CHD) have impaired exercise capacity, and approximately 50% do not reach current recommendations on physical activity. Herein we analysed factors associated with physical activity level (PAL) in adults with CHD by using patient-reported outcomes (PRO). Methods: Patients with CHD (n = 471) were randomly selected from the national register on CHD and categorized according to complexity of lesions -simple (n = 172, 39.1 +/- 14.6 years), moderate (n = 212, 39 +/- 14.1 years), and severe (n = 87, 31.7 +/- 10.7 years). Participants completed a standardized questionnaire measuring PRO-domains including PAL. Variables associated with PAL were tested in multivariate logistic regression. Results: PAL was categorized into high (>= 3 METs = 2.5 h/week, n = 192) and low (>= 3 METs <2.5 h/week, n = 279). Patients with low PAL were older (42.6 vs. 35.8 years, p = 0.001), had more prescribed medications (51% vs. 39%, p = 0.009), more symptoms (25% vs. 16%, p = 0.02) and comorbidity (45% vs. 34% p= 0.02). Patients with low PAL rated a lower quality of life (76.6 vs. 83.4, p < 0.001), satisfaction with life (25.6 vs. 27.3, p = 0.003), a lower Physical Component Summary score (PCS) (78.1 vs. 90.5, p < 0.001) andMental Component Summary score (MCS) (73.5 vs. 79.5, p < 0.001). Complexity of heart lesion was not associated with PAL. The included PROs-separately tested in the model, together with age were associated with PAL. Conclusions: PCS and MCS are stronger associated with PAL than age and medical factors. The use of these PROs could therefore provide valuable information of benefit for individualized advice regarding physical activity to patients with CHD.

  • 33.
    Bay, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Nursing.
    Sandberg, Camilla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Thilén, Ulf
    Wadell, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Exercise self-efficacy in adults with congenital heart disease2018In: International Journal of Cardiology: Heart and vasculature, E-ISSN 2352-9067, Vol. 18, p. 7-11Article in journal (Refereed)
    Abstract [en]

    Background: Physical activity improves health, exercise tolerance and quality of life in adults with congenital heart disease (CHD), and exercise training is in most patients a high-benefit low risk intervention. However, factors that influence the confidence to perform exercise training, i.e. exercise self-efficacy (ESE), in CHD patients are virtually unknown. We aimed to identify factors related to low ESE in adults with CHD, and potential strategies for being physically active.

    Methods: Seventy-nine adults with CHD; 38 with simple lesions (16 women) and 41 with complex lesions (17 women) with mean age 36.7 ± 14.6 years and 42 matched controls were recruited. All participants completed questionnaires on ESE and quality of life, carried an activity monitor (Actiheart) during four consecutive days and performed muscle endurance tests.

    Results: ESE in patients was categorised into low, based on the lowest quartile within controls, (≤ 29 points, n = 34) and high (> 29 points, n = 45). Patients with low ESE were older (42.9 ± 15.1 vs. 32.0 ± 12.4 years, p = 0.001), had more complex lesions (65% vs. 42%, p = 0.05) more often had New York Heart Association functional class III (24% vs. 4%, p = 0.01) and performed fewer shoulder flexions (32.5 ± 15.5 vs. 47.7 ± 25.0, p = 0.001) compared with those with high ESE. In a logistic multivariate model age (OR; 1.06, 95% CI 1.02-1.10), and number of shoulder flexions (OR; 0.96, 95% CI 0.93-0.99) were associated with ESE.

    Conclusion: In this study we show that many adults with CHD have low ESE. Age is an important predictor of low ESE and should, therefore, be considered in counselling patients with CHD. In addition, muscle endurance training may improve ESE, and thus enhance the potential for being physically active in this population.

  • 34.
    Bengs, Carita
    et al.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Kropp och hälsa2015In: Feministiskt tänkande och sociologi: teorier, begrepp och tillämpningar / [ed] Anna Hedenus, Sofia Björk, Oksana Shmulyar Gréen, Lund: Studentlitteratur AB, 2015, p. 151-167Chapter in book (Refereed)
  • 35.
    Bengtsson, Victor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    The three-dimensional movement patterns in the thoracolumbar and lumbopelvic spine during the deadlift exercise2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Marklyft är en vanlig styrketräningsövning. Det saknas emellertid studier av ryggradens rörelsemönster under utförandet av marklyft. Syftet med den här studien var att kvantifiera ryggradens tredimensionella rörelsemönster under utförandet av marklyft och vid vanehållning i de thorakolumbala och lumbosakrala regionerna samt studera inverkan av kön.

    Tjugofyra tävlande lyftare, 14 män och 10 kvinnor med 1 repetition maximum (1RM) i marklyft på 162.5 ± 55.5 kg, utförde tre repetitioner av tunga marklyft. Ryggens tredimensionella rörelsemönster, rörelseomfång (ROM) och kurvatur i thorakolumbala (T11-L2) och lumbosakrala (L2-S2) regionerna mättes med rörelsesensorer.

    Resultatet visade att rörelser sker i sagittal-, frontal- och horizontalplanet i thorakolumbala (ROM = 11.8 ± 7.6, 4.3 ± 2.8, and 3.4 ± 1.6 degrees) och lumbosakrala regionerna (ROM = 21.7 ± 6.5, 2.8 ± 1.7, och 2.8 ± 1.4 grader) under marklyftsutförandet. I jämförelse med vanehållningen ändrades ryggens kurvatur i start- och stoppläget mot ett mer flekterat läge. Signifikanta skillnader hittades mellan könen avseende vanehållning, startläge och ROM.

    Sammanfattningsvis ändras ryggens kurvatur under utförandet av tunga marklyft i sagittalplanet samt att vanehållningen och rörelsemönster skiljer sig mellan män och kvinnor.

  • 36.
    Bengtsson, Victor
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Berglund, Lars
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Sport Sciences Center.
    Aasa, Ulrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Sport Sciences Center. Medfit, Primary Care Rehabilitation and Fitness Centre, Stockholm, Sweden.
    Narrative review of injuries in powerlifting with special reference to their association to the squat, bench press and deadlift2018In: BMJ Open Sport and Exercise Medicine, E-ISSN 2055-7647, Vol. 4, no 1Article in journal (Refereed)
    Abstract [en]

    Pain and injuries are considered a common problem among elite athletes and recreational lifters performing the squat, bench press and deadlift. Since all three lifts engage multiple joints and expose the lifters' bodies to high physical demands often several times a week, it has been suggested that their injuries might be related to the excessively heavy loads, the large range of motion during the exercises, insufficient resting times between training sessions and/or faulty lifting technique. However, no previous article has summarised what is known about specific injuries and the injury aetiology associated with the three lifts. Thus, the aim of this narrative review was to summarise what is known about the relationships between the powerlifting exercises and the specific injuries or movement impairments that are common among lifters and recreationally active individuals.

  • 37.
    Berggren, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Karlsson, Åsa
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Englund, Undis
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Stenvall, Michael
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Effects of geriatric interdisciplinary home rehabilitation on complications and readmissions after hip fracture: a randomized controlled trial2018In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, article id 269215518791003Article in journal (Refereed)
    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.

  • 38.
    Berggren, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Karlsson, Åsa
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Englund, Undis
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Umeå University, Faculty of Medicine, Department of Nursing.
    Nordstöm, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Stenvall, Michael
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Geriatric interdisciplinary home rehabilitation - effects on complications and readmissions after hip fracture: arandomized controlled trialManuscript (preprint) (Other academic)
  • 39.
    Berglund, Lars
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Deadlift training for patients with mechanical low back pain: a comparison of the effects of a high-load lifting exercise and individualized low-load motor control exercises2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Disability due to low back pain is common. While evidence exist that exercise is effective in reducing pain and disability, it is still largely undetermined which kind of exercises that are most effective. The overall aim of this thesis was to evaluate and compare the effects of a high-load lifting exercise and individualized low-load motor control exercises for patients with nociceptive mechanical low back pain. A secondary aim was to evaluate which patients benefit from training with a high-load lifting exercise.

    All four papers in this thesis were based on a randomized controlled trial including 70 participants with nociceptive mechanical low back pain as their dominating pain pattern. Participants were randomized into training with either a high-load lifting exercise (HLL), the deadlift, (n=35) or individualized low-load motor control exercises (LMC) (n=35). Both interventions included aspects of pain education. All participants were offered twelve sessions during an eight week period. The effects of the interventions were evaluated directly after and twelve months after the end of the intervention period. Outcome measures were pain intensity, activity, disability, physical performance, lumbo-pelvic alignment and lumbar multifidus muscle thickness.

    There was a significant between-group effect in favour of the LMC intervention regarding improvements in activity, movement control tests and some tests of trunk muscle endurance. For pain intensity there were no significant differences between groups. A majority of participants in both intervention groups showed clinically meaningful improvements from baseline to two and twelve month follow-up regarding pain intensity and activity. There were no significant differences between HLL and LMC regarding the effect on lumbo-pelvic alignment or lumbar multifidus thickness. The participants who benefit the most from the HLL intervention were those with a low pain intensity and high performance in the Biering-Sørensen test at baseline.

    The results of this thesis showed that the HLL intervention was not more effective than the LMC intervention. The LMC was in fact more effective in improving activity, performance in movement control tests and some tests of trunk muscle endurance, compared to the HLL intervention.

    The results imply that the deadlift, when combined with education, could be considered as an exercise to produce clinically relevant improvements on pain intensity in patients who prefer a high-load exercise. However, before considering deadlift training, the results suggest that pain intensity and performance in the Biering-Sørensen test should be evaluated.

  • 40.
    Berglund, Lars
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Which patients with persistent mechanical low back pain will respond to highload motor control training?2010Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Introduction

    A previous pilot study has shown that high load motor control training with the conventional deadlift exercise can reduce pain intensity and activity limitation in patients with persistent low back pain. However, it is still unknown which variables characterize the ideal patient for this exercise.

    Aim

    The aim of this study was to explore variables influencing success or failure of eight weeks of high loadmotor control training with the conventional deadlift exercise for patients with persistent mechanical low back pain.

    Method

    The study design was a prospective cohort study of patients with persistent mechanical low back pain(n=35). The intervention consisted of eight weeks of training with the conventional deadlift exercise. Possible predictive variables were collected at baseline. To discriminate patients with a successful or failed outcome of treatment, change in the patient-specific functional scale was used and a cut-off at 50 %improvement was set. Of the 35 patients, 15 were categorized as treatment success (≥50 % improvement) and 20 patients as treatment failure (<50 % improvement).

    Results

    No variables at baseline were recognized as possible predictors of successful or failed treatment.

    Conclusion

    From the results of this study it appears that none of the variables in this study could influence success or failure of high load motor control training with the conventional deadlift exercise. However, the conventional deadlift could be considered a potent exercise when administered by a PT well experienced in resistance training and analyzing movement patterns.

  • 41.
    Berglund, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Aasa, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Aasa, Ulrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi.
    Styrketräning som behandling vid långvariga ländryggsbesvär2017In: Fysioterapi, ISSN 1653-5804, no 4, p. 8p. 28-33Article, review/survey (Other academic)
    Abstract [sv]

    Fysisk träning är viktigt för en god hälsa och fungerar även som behandlingsform vid många sjukdomar, så även ländryggsbesvär. Styrketräning har visat sig vara en mer effektiv träningsform än till exempel aerob träning vid behandling av långvariga ländryggsbesvär. I dagsläget finns det ingen konsensus kring vilket det mest effektiva styrketräningsupplägget kan vara. Den vanligaste designen av styrketräningsprogram vid ländryggsbesvär tycks vara ett upplägg med syftet att förbättra styrkan/uthålligheten av ryggsträckarmuskulaturen och därigenom uppnå smärtlindring och funktionsförbättring. I en studie från Umeå universitet och Luleå tekniska universitet har träning av marklyft för patienter med långvariga ländryggsbesvär utvärderats. Marklyftsträningen förväntades öka deltagarnas bålstyrka samtidigt som den fokuserade på förbättring av rörelsekontroll kring såväl höft som ländrygg. När den åtta veckor långa träningsperioden var slut, visade det sig att gruppen som tränat marklyft hade ökat sin bålstyrka, minskat smärta, ökat funktionsförmåga och hälsorelaterad livskvalitet i samma omfattning som gruppen som tränade individanpassad träning av rörelsekontroll. Men de hade inte förbättrats lika mycket gällande rörelsekontroll eller vardagsfunktion. Vidare forskning pågår vid Umeå universitet om skador i samband med tung styrketräning samt lyftteknikens betydelse för skador och besvär vid tung styrketräning.

  • 42.
    Berglund, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Aasa, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Hellqvist, Jonas
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi .
    Aasa, Ulrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Which patients with low back pain benefit from deadlift training?2015In: Journal of Strength and Conditioning Research, ISSN 1064-8011, E-ISSN 1533-4287, Vol. 29, no 7, p. 1803-1811Article in journal (Refereed)
    Abstract [en]

    Recent studies have indicated that the deadlift exercise may be effective in decreasing pain intensity and increasing activity for most, but not all, patients with a dominating mechanical low back pain pattern. This study aimed to evaluate which individual factors measured at baseline could predict activity, disability, and pain intensity in patients with mechanical low back pain after an 8-week training period involving the deadlift as a rehabilitative exercise. Thirty-five participants performed deadlift training under the supervision of a physical therapist with powerlifting experience. Measures of pain-related fear of movement, hip and trunk muscle endurance and lumbopelvic movement control were collected at baseline. Measures of activity, disability and pain intensity were collected at baseline and at follow-up. Linear regression analyses were used to create models to predict activity, disability and pain intensity at follow-up. Results showed that participants with less disability, less pain intensity and higher performance on the Biering-Sørensen test, which tests the endurance of hip and back extensor muscles, at baseline benefit from deadlift training. The Biering-Sørensen test was the strongest predictor since it was included in all predictive models. Pain intensity was the next best predictor as it was included in two predictive models. Thus, for strength and conditioning professionals who use the deadlift as a rehabilitative exercise for individuals with mechanical low back pain, it is important to ensure that clients have sufficient back extensor strength and endurance and a sufficiently low pain intensity level to benefit from training involving the deadlift exercise.

  • 43.
    Berglund, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Aasa, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Norrlandskliniken Hlth Care Ctr, Umea, Sweden.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi .
    Aasa, Ulrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Effects of Low-Load Motor Control Exercises and a High-Load Lifting Exercise on Lumbar Multifidus Thickness: A Randomized Controlled Trial2017In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 42, no 15, p. E876-E882Article in journal (Refereed)
    Abstract [en]

    Study Design. Randomized controlled trial.Objective. The aim of this study was to compare the effects of low-load motor control (LMC) exercises and a high-load lifting (HLL) exercise, on lumbar multifidus (LM) thickness on either side of the spine and whether the effects were affected by pain intensity or change in pain intensity. Summary of Background Data. There is evidence that patients with low back pain (LBP) may have a decreased size of the LM muscles with an asymmetry between sides in the lower back. It has also been shown that LMC training can affect this asymmetry. It is, however, not known whether a high-load exercise has the same effect. Methods. Sixty-five participants diagnosed with nociceptive mechanical LBP were included and randomized into LMC exercises or a HLL exercise, the deadlift. The LM thickness was measured using rehabilitative ultrasound imaging (RUSI), at baseline and after a 2-month training period. Results. There were no differences between interventions regarding effect on LM muscle thickness. However, the analysis showed a significant effect for asymmetry. The thickness of the LM muscle on the small side increased significantly compared with the large side in both intervention groups, without influence of pain at baseline, or change in pain intensity.Conclusion. At baseline, there was a difference in thickness of the LM muscles between sides. It seems that exercises focusing on spinal alignment may increase the thickness of the LM muscles on the small side, irrespective of exercise load. The increase in LM thickness does not appear to be mediated by either current pain intensity or the magnitude of change in pain intensity.

  • 44.
    Berglund, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Sport Sciences Center.
    Aasa, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Norrlandskliniken Health Care Centre, Umeå, Sweden.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi .
    Aasa, Ulrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Sport Sciences Center.
    Sagittal lumbopelvic alignment in patients with low back pain and the effects of a high-load lifting exercise and individualized low-load motor control exercises: a randomized controlled trial2018In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 18, no 3, p. 399-406Article in journal (Refereed)
    Abstract [en]

    Background Context Assessment of posture and lumbopelvic alignment is often the main focus in the classification and treatment of patients with low back pain (LBP). However, little is known regarding the effects of motor control interventions on objective measures of lumbopelvic alignment.

    Purpose The primary aim of this study was to describe the variation of sagittal lumbopelvic alignment in patients with nociceptive mechanical LBP. The secondary aim was to compare the effects of a high-load lifting exercise (HLL) and low-load motor control exercises (LMC) on the change in lumbopelvic alignment with a special emphasis on patients with high and low degrees of lumbar lordosis (lu) and sacral angle (sa).

    Study Design This study is a secondary analysis of a randomized controlled trial evaluating the effects of HLL and LMC.

    Patient Sample Patients from the primary study, that is, patients categorized with nociceptive mechanical LBP, who agreed to participate in the radiographic examination were included (n=66).

    Outcome Measures Lateral plain radiographic images were used to evaluate lumbopelvic alignment regarding the lumbar lordosis and the sacral angle as outcomes, with posterior bend as an explanatory variable.

    Materials and Methods The participants were recruited to the study from two occupational health-care facilities. They were randomized to either the HLL or the LMC intervention group and offered 12 supervised exercise sessions. Outcome measures were collected at baseline and following the end of intervention period 2 months after baseline. Between- and within-group analyses of intervention groups and subgroups based on the distribution of the baseline values for the lumbar lordosis and the sacral angle, respectively (LOW, MID, and HIGH), were performed using both parametric and non-parametric statistics.

    Results The ranges of values for the present sample were 26.9–91.6° (M=59.0°, standard deviation [SD]=11.5°) for the lumbar lordosis and 18.2–72.1° (M=42.0°, SD=9.6°) for the sacral angle. There were no significant differences between the intervention groups in the percent change of eitheroutcome measure. Neither did any outcome change significantly over time within the intervention groups. In the subgroups, based on the distribution of respective baseline values, LOWlu showed a significantly increased lumbar lordosis, whereas HIGHsa showed a significantly decreased sacral angle following intervention.

    Conclusions This study describes the wide distribution of values for lumbopelvic alignment for patients with nociceptive mechanical LBP. Further research is needed to investigate subgroups of other types of LBP and contrast findings to those presented in this study. Our results also suggest that retraining of the lumbopelvic alignment could be possible for patients with LBP.

  • 45.
    Berglund, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Aasa, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi .
    Aasa, Ulrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    The effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness – a randomized controlled trialManuscript (preprint) (Other academic)
    Abstract [en]

    Study Design

    Randomized controlled trial

    Objective

    The aim of this study was to compare the effects of low-load motor control exercises and a high-load lifting exercise on lumbar multifidus thickness among patients with nociceptive mechanical low back pain.

    Summary of Background Data

    There is evidence that patients with low back pain may have a decreased size of the lumbar multifidus muscles with an asymmetry between left/right sides in the lower back. It has also been shown that low-load motor control training can affect this asymmetry; essentially, it is effective in equalizing side differences in lumbar multifidus muscle size. It is, however, not known whether a high-load exercise has the same effect.

    Methods

    Sixty-five participants diagnosed with nociceptive mechanical low back pain were included and randomized into low-load motor control exercises or a high-load lifting exercise, the deadlift. The lumbar multifidus thickness at the fifth lumbar vertebra was measured, using rehabilitative ultrasound imaging, at baseline and after a 2-month training period.

    Results

    There were no differences between interventions regarding effect on lumbar multifidus muscle thickness. However, the linear mixed model analysis showed a significant effect for asymmetry. The thickness of the lumbar multifidus muscle on the small side increased significantly compared to the large side in both intervention groups.

    Conclusions

    There was a difference in thickness of the lumbar multifidus muscles between sides. It seems that exercises focusing on spinal alignment may increase the thickness of the lumbar multifidus muscles on the small side, irrespective of exercise load.

  • 46.
    Berglund, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Falk, Jimmy
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Eliasson, Kim
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Aasa, Ulrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    What is the best squat and deadlift technique?2015Conference paper (Refereed)
  • 47.
    Berglund, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hellqvist, Jonas
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Aasa, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Holmberg, David
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi.
    Aasa, Ulrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Which patients with persistent mechanical low back pain will respond to high load motor control training?2011Conference paper (Refereed)
  • 48.
    Bergman, Frida
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Active workstations: a NEAT way to prevent and treat overweight and obesity?2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Modern society is triggering sedentary behaviours in different domains. Different strategies can be used to reduce the time spent sitting and increase physical activity in the office environment, which is one domain where sedentary time is often high. One such strategy could be to install treadmill workstations. With these, the office workers can walk on a treadmill while performing their usual work tasks at the computer. However, the long-term effects of these workstations are not known. 

    Aim: The overall aim of this thesis was to investigate the long-term effects on sedentary behaviour, physical activity and associated health factors of installing treadmill workstations in offices compared to regular office work.

    Method: In this randomized controlled trial, 80 sedentary, middle-aged, healthy office workers with overweight or obesity were individually randomized into either an intervention or a control group. Those in the intervention group had a treadmill workstation installed at their sit-stand desk, to use for at least one hour per day for 13 months. They further received boosting e-mails at four time-points during the study. Participants in the control group continued to work as normal at their sit-stand office desk. All participants also received a health consultation at the beginning of the study, where they got to discuss physical activity and diet recommendations. Measurements reported include physical activity and sedentary behaviour, anthropometric measurements, body composition, metabolic outcomes, stress, depression and anxiety, cognitive function, structural brain images and interview data. Linear mixed models were used for the main statistical analyses of the quantitative data. An exploratory approach was also undertaken, using orthogonal partial least squares regression on the baseline data. Finally, interview data from participants in the intervention group were analysed using a modified Grounded Theory approach.

    Results: The intervention group increased their daily walking time and their number of steps at all follow-ups compared to the control group. Concomitantly, a decrease in moderate-to-vigorous intensity physical activity (MVPA) was observed within both groups, mainly during weekends. No intervention effects were observed on any of the body, cognitive or brain volume measurements. Our exploratory analyses revealed a significant association between smaller hippocampal volume and percentage sitting time among participants over 51 years of age. From the interview data, we discovered a core category, “The Capacity to Benefit”. The categories were described as the ideal types the Convinced, the Competitive, the Responsible and the Vacillating, based on the principal characteristics of the participants representing their different motivational status and strategies to reach the goal of benefitting from the intervention.  

    Conclusion: It is possible to increase daily physical activity in office environments by introducing treadmill workstations. Future interventions should adapt strategies for the individuals based on their motivational level, but should also workwith the social and physical environment and with factors within the organization to gain the best effects of these interventions.

    The full text will be freely available from 2019-11-16 00:00
  • 49.
    Bergman, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Sörlin, Ann
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Increasing physical activity in officeworkers – the Inphact Treadmill study: a study protocol for a 13-month randomized controlled trial of treadmill workstations2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 632Article in journal (Refereed)
    Abstract [en]

    Background: Sedentary behaviour is an independent risk factor for mortality and morbidity, especially for type 2 diabetes. Since office work is related to long periods that are largely sedentary, it is of major importance to find ways for office workers to engage in light intensity physical activity (LPA). The Inphact Treadmill study aims to investigate the effects of installing treadmill workstations in offices compared to conventional workstations.

    Methods/Design: A two-arm, 13-month, randomized controlled trial (RCT) will be conducted. Healthy overweight and obese office workers (n = 80) with mainly sedentary tasks will be recruited from office workplaces in Umeå, Sweden. The intervention group will receive a health consultation and a treadmill desk, which they will use for at least one hour per day for 13 months. The control group will receive the same health consultation, but continue to work at their regular workstations. Physical activity and sedentary time during workdays and non-workdays as well as during working and non-working hours on workdays will be measured objectively using accelerometers (Actigraph and activPAL) at baseline and after 2, 6, 10, and 13 months of follow-up. Food intake will be recorded and metabolic and anthropometric variables, body composition, stress, pain, depression, anxiety, cognitive function, and functional magnetic resonance imaging will be measured at 3–5 time points during the study period. Interviews with participants from the intervention group will be performed at the end of the study.

    Discussion: This will be the first long-term RCT on the effects of treadmill workstations on objectively measured physical activity and sedentary time as well as other body functions and structures/morphology during working and non-working hours among office workers. This will provide further insight on the effects of active workstations on our health and could fill in some of the knowledge gaps regarding how we can reduce sedentary time in office environments.

  • 50.
    Bergman, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Mattson-Frost, Tove
    Jonasson, Lars
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Chorell, Elin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Sörlin, Ann
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Öhberg, Fredrik
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Ryberg, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Levine, James
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Installing treadmill workstations in offices does little for cognitive performance and brain structure, despite a baseline association between sitting time and hippocampus volumeManuscript (preprint) (Other academic)
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