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  • 301.
    Lundqvist, Petter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Measuring Knee Joint Position Sense: Test-retest reliability of a new designed assessment method using 3D-motion analysis – A pilot study2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Aim: The purpose was to design an improved method for estimating knee joint position sense (JPS) in a 3D-motion analysis laboratory and examine its test-retest reliability.

    Methods: Nineteen adults (17 women and two men, 18-28 years) with varying activity level were recruited. The participants were standing blindfolded and performed a one-legged squat with balance support in a 3D-motion analysis laboratory. The participants flexed the standing leg until a signal sounded at the target knee angles of either 40° or 65°. In the reproduction test a trigger button was pressed when the participants thought the desired angle was reached. The participants performed five trials of each angle and leg at two occasions with at least one week apart. Intraclass correlation coefficients (ICC) with 95% confidence interval (CI 95%) were calculated between the mean absolute error (AE) to demonstrate relative reliability. Absolute reliability was illustrated through the limits of agreement in a Bland-Altman plot.

    Results: The mean AE at 40° was 3.70°± 1.64° and the test-retest reliability was good (ICC=0.62, CI 95%=0.38-0.78). The mean AE at 65° was 2.76°±154°and the test-retest reliability was good (ICC=0.72, CI 95%=0.52-0.85). There was a significant difference of the mean AE between 40° and 65° (p=0.006).

    Conclusion: This pilot study indicates good test-retest reliability of the proposed JPS test. It would be recommended that a larger study population is tested to confirm the reliability and identify minimal detectable changes. The validity also needs to be further investigated before the method can be fully implemented.

  • 302.
    Lundström, Christoffer
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Söderström, Gustav
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Påverkas styrkeprestation av kortvarig smärtande kylbehandling av handflatorna hos personer med multipel skleros samt friska individer?: En pilotstudie2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Bakgrunden till denna studie ligger i tidigare kliniska observationer inom styrkelyft, där en utövare använts sig av kraftig handkylning och därigenom upplevt en förbättring i prestationsförmåga. Då personer med multipel skleros (MS) kan få en ökad symptombild vid fysisk ansträngning som leder till en försämrad prestationsförmåga är det viktigt att undersöka inverkan av kyla.

    Syfte: Syftet med denna pilotstudie var att undersöka genomförbarheten för ett protokoll syftande till att studera om smärtande kyla påverkar styrkeprestationen i bröstpress hos personer drabbade av MS samt friska individer.

    Metod: Fyra testdeltagarei åldrarna 22-63 år, två friska och två diagnoserade med MS, fick under två testtillfällen utföra en koncentrisk enarmsbröstpress, 120 °/s, i en isokinetisk dynamometer. Vid varje tillfälle utförde deltagarna åtta set med tio repetitioner varav smärtande handkylning användes vid vartannat  set. Från testerna analyserades max- och medelkraften samt muskelaktiveringen i aktiva muskler mellan kylning och ingen kylning av handflatorna.

    Resultat: Hos de friska deltagarna sågs ingen märkbar skillnad i kraftutveckling i max- och medelkraft samt elektromyografi (EMG) mellan smärtande kylning och ingen kylning. Hos en av testdeltagarna med MS visade resultateten en ökad max- och medelkraft samt EMG vid smärtande kylning i ett av testtillfällena. Den andre MS-deltagaren uppvisade ingen skillnad i kraftutveckling och en nedsatt muskelaktivering sågs.  Konklusion: Genomförbarheten av protokollet bedömdes som god. Liknande studier skulle behövas där antingen den excentriska fasen innefattas, alternativt en studie där samma rörelse utförs men i olika hastigheter eller en studie med isotonisk rörelse och kraftig handkylning för att utreda effekt. Av resultaten som studien visar går det inte att dra några konkreta slutsatser gällande smärtande handkylning och styrkeprestation hos personer med MS och friska.

  • 303.
    Lycksell, Melina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Skarin, Hilma
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Fysioterapeuters syn på och upplevelse av att ge information om fysisk aktivitet samt träning till gravida2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Det förefaller att det finns ett ökat behov av information om fysisk aktivitet och träning till gravida. Tillsammans med barnmorskor har fysioterapeuter goda möjligheter att påverka gravidas levnadsvanor och uppmuntra till en aktiv livsstil. Fysioterapeuters kontakt med gravida verkar dock variera och kan anses vara en underutnyttjad resurs i hälso- och sjukvården.

     

    Syfte: Studiens syfte var att undersöka fysioterapeuters syn på och upplevelse av att ge information om fysisk aktivitet samt träning till gravida på familje- och hälsocentraler i Umeå kommun.

     

    Metod: Semistrukturerade intervjuer utfördes och analyserades med kvalitativ innehållsanalys. Sju fysioterapeuter från sex familje- och hälsocentraler i Umeå kommun rekryterades. Fysioterapeuterna hade en spridning på 2½-30år i arbetslivserfarenhet.

     

    Resultat: Analysen resulterade 13 underkategorier som sammanställdes i fem kategorier; Fysisk aktivitet och smärta är fysioterapeuters arena, En stöttande, individanpassad och rådgivande roll, Ett arbete med många utmaningar, Hälso- och sjukvårdens struktur påverkar Fysioterapeuters arbete och Ambition att med små medel göra stor skillnad.

     

    Slutsats: Fysioterapeuterna upplever att möjligheten att samarbeta med barnmorskor, vid information till gravida om fysisk aktivitet och träning, påverkas av familje- och hälsocentralens storlek samt tidsmässiga-, kollegiala- och ekonomiska resurser. På familje- och hälsocentraler i Umeå kommun finns inget självklart samarbete mellan fysioterapeuter och barnmorskor. Fysioterapeuterna har inte en självklar roll i arbetet med gravida även om de upplever sig vara trygga i att informera om och har goda kunskaper om fysisk aktivitet samt träning under graviditet. Tydligare riktlinjer om fysisk aktivitet och träning under graviditet skulle kunna underlätta för hälso- och sjukvårdspersonal att informera gravida. Fysioterapeutiska insatser i form av träningsgrupper, informationstillfällen, samtalsstöd, uppföljningar och ett samarbete med barnmorskor i föräldragrupper skulle kunna förbättra gravidvården, både under och efter graviditet.

  • 304.
    Malmberg Gavelin, Hanna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lisbeth, Slunga Järvholm
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Stigsdotter Neely, Anna
    Umeå University, Faculty of Social Sciences, Department of Psychology. Karlstad University.
    Effects of a process-based cognitive training intervention for patients with stress-related exhaustion2015In: Stress, ISSN 1025-3890, E-ISSN 1607-8888, Vol. 18, no 5, p. 578-588Article in journal (Refereed)
    Abstract [en]

    Stress-related exhaustion has been linked to a pattern of selective cognitive impairments, mainly affecting executive functioning, attention and episodic memory. Little is known about potential treatments of these cognitive deficits. The purpose of the present study was to evaluate the effects of a process-based cognitive training intervention, designed to target the specific cognitive impairments associated with stress-related exhaustion. To this end, patients diagnosed with exhaustion disorder (ED) were randomized to either a multimodal stress rehabilitation program with the addition of a process-based cognitive training intervention (training group, n = 27) or a treatment-as-usual control condition, consisting of multimodal stress rehabilitation with no additional training (control group, n = 32). Treatment effects were evaluated through an extensive cognitive test battery, assessing both near- and far transfer effects, as well as self-report forms regarding subjective cognitive complaints and burnout levels. Results showed pronounced training-related improvements on the criterion updating task (p < 0.001). Further, evidence was found of selective near transfer effects to updating (p = 0.01) and episodic memory (p = 0.04). Also, the trained group reported less subjective memory complaints (p = 0.02) and levels of burnout decreased for both groups, but more so for the trained group (p = 0.04), following the intervention. These findings suggest that process-based cognitive training may be a viable method to address the cognitive impairments associated with ED.

  • 305.
    Malmberg Gavelin, Hanna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS).
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Stigsdotter Neely, Anna
    Karlstad University.
    Effects of a process-based cognitive training intervention for patients with stress-related exhaustion: a randomized clinical trial2015In: International Convention of Psychological Science, Amsterdam, 2015Conference paper (Other academic)
    Abstract [en]

    The present study evaluated whether a computerized process-based cognitive training program improves cognitive function in patients with stress-related exhaustion (n=59). Results showed training effects that were generalizable beyond the specific training tasks, suggesting that cognitive training may be a viable part of the rehabilitation of stress-related exhaustion.

  • 306.
    Malmberg Gavelin, Hanna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Eskilsson, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark..
    Josefsson, Maria
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Stigsdotter Neely, Anna
    Umeå University, Faculty of Social Sciences, Department of Psychology. Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden..
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Rehabilitation for improved cognition in patients with stress-related exhaustion disorder: RECO – a randomized clinical trial2018In: Stress, ISSN 1025-3890, E-ISSN 1607-8888, Vol. 21, no 4, p. 279-291Article in journal (Refereed)
    Abstract [en]

    Stress-related exhaustion has been associated with selective and enduring cognitive impairments. However, little is known about how to address cognitive deficits in stress rehabilitation and how this influences stress recovery over time. The aim of this open-label, parallel randomized controlled trial (ClinicalTrials.gov: NCT03073772) was to investigate the long-term effects of 12 weeks cognitive or aerobic training on cognitive function, psychological health and work ability for patients diagnosed with exhaustion disorder (ED). One-hundred-and-thirty-two patients (111 women) participating in multimodal stress rehabilitation were randomized to receive additional cognitive training (n = 44), additional aerobic training (n = 47) or no additional training (n = 41). Treatment effects were assessed before, immediately after and one-year post intervention. The primary outcome was global cognitive function. Secondary outcomes included domain-specific cognition, self-reported burnout, depression, anxiety, fatigue and work ability, aerobic capacity and sick-leave levels. Intention-to-treat analysis revealed a small but lasting improvement in global cognitive functioning for the cognitive training group, paralleled by a large improvement on a trained updating task. The aerobic training group showed improvements in aerobic capacity and episodic memory immediately after training, but no long-term benefits. General improvements in psychological health and work ability were observed, with no difference between interventional groups. Our findings suggest that cognitive training may be a viable method to address cognitive impairments for patients with ED, whereas the effects of aerobic exercise on cognition may be more limited when performed during a restricted time period. The implications for clinical practice in supporting patients with ED to adhere to treatment are discussed.

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  • 307.
    Malmberg Gavelin, Hanna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Stigsdotter Neely, Anna
    Umeå University, Faculty of Social Sciences, Department of Psychology. Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.
    Andersson, Micael
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
    Eskilsson, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental 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). Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark.
    Neural activation in stress-related exhaustion: cross-sectional observations and interventional effects2017In: Psychiatry Research: Neuroimaging, ISSN 0925-4927, E-ISSN 1872-7506, Vol. 269, p. 17-25Article in journal (Refereed)
    Abstract [en]

    The primary purpose of this study was to investigate the association between burnout and neural activation during working memory processing in patients with stress-related exhaustion. Additionally, we investigated the neural effects of cognitive training as part of stress rehabilitation. Fifty-five patients with clinical diagnosis of exhaustion disorder were administered the n-back task during fMRI scanning at baseline. Ten patients completed a 12-week cognitive training intervention, as an addition to stress rehabilitation. Eleven patients served as a treatment-as-usual control group. At baseline, burnout level was positively associated with neural activation in the rostral prefrontal cortex, the posterior parietal cortex and the striatum, primarily in the 2-back condition. Following stress rehabilitation, the striatal activity decreased as a function of improved levels of burnout. No significant association between burnout level and working memory performance was found, however, our findings indicate that frontostriatal neural responses related to working memory were modulated by burnout severity. We suggest that patients with high levels of burnout need to recruit additional cognitive resources to uphold task performance. Following cognitive training, increased neural activation was observed during 3-back in working memory-related regions, including the striatum, however, low sample size limits any firm conclusions.

  • 308.
    Malmberg Gavelin, Hanna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Stigsdotter Neely, Anna
    Institutionen för sociala och psykologiska studier, Karlstads Universitet.
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Slunga-Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Effects of a Process-based Cognitive Training Intervention for Patients With Stress-related Exhaustion - an fMRI study2016In: Cognitive Neuroscience Society: 2016 Annual Meeting Program, 2016, p. 161-161, article id D59Conference paper (Other academic)
  • 309.
    Malmgren-Olsson, Eva-Britt
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Department of Psychology.
    Health problems and treatment effects in patients with non-specific musculoskeletal disorders: a comparison between Body awareness therapy, Feldenkrais and individual physiotherapy2002Doctoral thesis, comprehensive summary (Other academic)
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  • 310.
    Markström, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Schelin, Lina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Elite women athletes with superior knee function present similar dynamic knee stability, although different movement strategies, when compared to controls2018In: 23rd annual Congress of the European College of Sport Science: Sport Science at the cutting edge, Dublin, Ireland, July 4-7, 2018: Book of Abstracts / [ed] Murphy, M.H., Boreham, C.A.G., De Vito, G., Tsolakidis, E., European College of Sport Sciences , 2018, p. 555-555Conference paper (Refereed)
    Abstract [en]

    INTRODUCTION: Neuromuscular training (NMT) of the lower limb is vital for athletes in learning correct movement technique to avoid risk of injury to the anterior cruciate ligament (ACL). The NMT aims for improved knee control while maintaining dynamic knee stability (DKS; resistance to linear/angular accelerations) during knee-challenging tasks. Assessing DKS is commonly attempted by evaluating discrete values of kinematic and kinetic variables during one-leg hops, but these measures may not sufficiently capture knee dynamics. We aimed to evaluate if elite women athletes who regularly perform NMT have greater DKS and/or different landing technique than normally active women who do not perform NMT, and if there are any correlations of DKS to peak knee extensor or flexor strength.

    METHODS: A motion capture system (Qualisys) synchronized with two force plates (Kistler) registered hip and knee 3D joint angles and moments during one-leg standardized lateral side hop landings for 39 women (19 athletes, 20 controls). Ten trials were performed for the dominant leg with hands behind their back holding a rope (25 cm), deemed successful following 3 s of single leg stance after landing without putting the contralateral foot on the ground or making major adjustments with the ipsilateral foot. DKS was evaluated using the inclination angle of the knee’s helical axis relative to the flexion-extension axis calculated for rotation intervals of 10 degrees, as has been proven useful (Grip and Häger, 2013), to quantify how much knee joint motion deviated from pure flexion-extension at landing. Hip and knee joint angles were analysed at initial contact (IC), and peak angles and peak moments were analysed during the deceleration phase of landing from IC to peak knee flexion (ind. t-tests, p < 0.05).

    RESULTS: Athletes had more successful hops, faster task execution, greater knee extension strength, greater hip flexion angle at IC, and higher peak moments of hip adduction and knee flexion than controls. There were however, no group differences in DKS or any significant correlations between DKS and knee extensor or flexor strength for any of the groups (r < absolute values of 0.41).

    CONCLUSION: Elite women athletes that perform NMT on a regular basis had superior knee function but similar DKS to controls when performing a sport-specific one-leg side hop maneuver. The greater hip flexion at IC for athletes shows a different movement strategy for landing preparation. Potential benefits of NMT in sports contexts, e.g. less ACL injuries (Sugimoto et al., 2016), may be due to movement alterations of the hip to increase landing control to avoid positions that strain the ACL rather than improving DKS. Further emphasis on knee-specific landing control may be important to also improve DKS, which seems unrelated to strength.

  • 311.
    Markström, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Schelin, Lina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Similar dynamic knee stability but different movement strategies and between-leg asymmetries for hip and knee joints for ACL-reconstructed persons relative to knee-healthy controls2018In: 8th World Congress of Biomechanics, Dublin, July 8-12, 2018, 2018Conference paper (Refereed)
    Abstract [en]

    Introduction: Jumping involves complex control processes of sensory input and feedback with coordination of multiple joints. Following anterior cruciate ligament reconstruction (ACLR), altered movement strategies identified by kinematics and/or kinetics unload the injured leg and increase demands on nearby joints. Dynamic knee stability (DKS; resistance to linear/angular accelerations) has not been evaluated for ACLR persons during sport-similar tasks. It is therefore unknown if there is true instability or altered task execution, e.g. due to fear. We hypothesized that DKS following rehabilitation after ACLR would be similar to that of knee-healthy controls, but with prevailing protective movement strategies.

    Methods: A motion capture system synchronized with two force plates registered hip and knee 3D angles and moments during a one-leg standardized side hop for 30 ACLR persons (7-129 months post-reconstruction) and 30 controls. EMG provided mean knee extensor and flexor muscle activation patterns and co-contraction ratios and indexes before (50ms window) and during landing. DKS was evaluated using a helical axis rotation interval of 10˚ to describe how much knee kinematics diverges from flexion-extension. DKS and muscle activation variables were analysed with t-tests. Hip and knee movement strategies were analysed for angles at initial contact, peak angles during landing, and peak moments during landing with MANOVAs between and within groups (p<0.05).

    Results: No significant differences in DKS was found between groups. A significant main effect of group was however observed for angles at initial contact (p=0.028) with ACLR showing greater hip and knee flexion than controls. A significant main effect of group was also found during landing for peak angles (p=0.001) and moments (p=0.017) with ACLR displaying greater hip flexion and knee internal rotation moment, and also greater mean knee flexor activation than controls (p=0.049). No group differences in muscle activation patterns were shown before landing. ACLR had between-leg asymmetries at initial contact (p=0.010) with greater hip flexion, and asymmetries for peak angles (p=0.008) and moments (p=0.030) during landing with greater hip flexion angle, greater hip flexion moment and less knee flexion moment in the injured leg.

    Discussion: Despite similar DKS, ACLR displayed different movement strategies and asymmetries relative to controls, which indicates a task-coping strategy in preparation for and during landing. The greater hip and knee flexion angles at initial contact in relation to the greater hip flexion moment and knee flexor activation that followed may have increased knee joint stiffness, which could explain the similar DKS relative to controls. The between-leg asymmetry with greater reliance on the hip and simultaneous unloading of the knee further supports a coping strategy for ACLR. Further attention should be given to the hip during rehabilitation for ACLR persons to avoid future injuries due to movement compensation.

  • 312.
    Markström, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Schelin, Lina
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Häger, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Dynamic knee control and movement strategies in athletes and non‐athletes in side hops: implications for knee injury2019In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 29, no 8, p. 1181-1189Article in journal (Refereed)
    Abstract [en]

    Athletes exposed to rapid maneuvers need a high level of dynamic knee stability and robustness, while also controlling whole body movement, to decrease the risk of non‐contact knee injury. The effects of high‐level athletic training on such measures of movement control have not, however, been thoroughly evaluated. This study investigated whether elite athletes (who regularly perform knee‐specific neuromuscular training) show greater dynamic knee robustness and/or different movement strategies than non‐athletic controls, in relation to overall knee function. Thirty‐nine women (19 athletes, 20 controls) performed standardized rebound side hops (SRSH) while a motion capture system synchronized with two force plates registered three‐dimensional trunk, hip, and knee joint angles and moments. Dynamic knee robustness was evaluated using finite helical axis (FHA) inclination angles extracted from knee rotation intervals of 10°, analyzed with independent t tests. Angle and moment curves were analyzed with inferential methods for functional data. Athletes had superior knee function (less laxity, greater hop performances, and strength) but presented similar FHA inclination angles to controls. Movement strategies during the landing phase differed; athletes presented larger (a) hip flexion angles (during 9%‐29% of the phase), (b) hip adduction moments (59%‐99%), (c) hip internal rotation moments (83%‐89%), and (d) knee flexion moments (79%‐93%). Thus, elite athletes may have a greater ability than non‐athletes to keep the knee robust while performing SRSH more efficiently through increased engagement of the hip. However, dynamic knee robustness associated with lower FHA inclination angles still show room for improvement, thus possibly decreasing knee injury risk.

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  • 313.
    Markström, Jonas L.
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Schelin, Lina
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Häger, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    A novel standardised side hop test reliably evaluates landing mechanics for anterior cruciate ligament reconstructed persons and controls2021In: Sports Biomechanics, ISSN 1476-3141, E-ISSN 1752-6116, Vol. 20, no 2, p. 213-229Article in journal (Refereed)
    Abstract [en]

    We propose a novel one-leg standardised rebound side-hop test (SRSH) specifically designed for detailed analysis of landing mechanics. Anterior cruciate ligament reconstructed persons (ACLR, n = 30) and healthy-knee controls (CTRL, n = 30) were tested for within-session and test-retest (CTRL only, n = 25) reliability and agreement. Trunk, hip and knee angles and moments in sagittal, frontal, and transversal planes during landing, including time to stabilisation (TTS), were evaluated using intra-class correlations (ICCs), average within-person standard deviations (SW) and minimal differences. Excellent within-session reliability were found for angles in both groups (most ICCs > 0.90, SW ≤ 5°), and excellent to good for moments (most ICCs > 0.80, SW ≤ 0.34 Nm/kg). Only knee internal rotation moment showed poor reliability (ICC < 0.4). Test-retest results were excellent to fair for all angles and moments (ICCs 0.47–0.91, SW < 5° and ≤ 0.25 Nm/kg), except for peak trunk lateral bending angle and knee internal rotation moment. TTS showed excellent to fair within-session reliability but poor test-retest results. These results, with a few exceptions, suggest promising potential of evaluating landing mechanics during the SRSH for ACLR and CTRL, and emphasise the importance of joint-specific movement control variables in standardised tasks.

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  • 314.
    Markström, Jonas L.
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Grip, Helena
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Schelin, Lina
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Häger, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    A comparison of knee joint kinematics and kinetics during landings in three one-leg hop tests (hop for distance, vertical hop and side hop) performed by female elite floorball athletes2016In: XXI ISEK Congress: Bridges to Innovation, 2016Conference paper (Refereed)
  • 315.
    Markström, Jonas L.
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    ACL-reconstructed and ACL-deficient individuals show differentiated trunk, hip, and knee kinematics during vertical hops more than 20 years post-injury2018In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, no 2, p. 358-367Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Little is known regarding movement strategies in the long term following injury of the anterior cruciate ligament (ACL), and even less about comparisons of reconstructed and deficient knees in relation to healthy controls. The present purpose was to compare trunk, hip, and knee kinematics during a one-leg vertical hop (VH) ~20 years post-ACL injury between persons treated with surgery and physiotherapy (ACLR), solely physiotherapy (ACLPT), and controls (CTRL). Between-leg kinematic differences within groups were also investigated.

    METHODS: Sixty-six persons who suffered unilateral ACL injury on average 23 ± 2 years ago (32 ACLR, 34 ACLPT) and 33 controls performed the VH. Peak trunk, hip, and knee angles during Take-off and Landing phases recorded with a 3D motion capture system were analysed with multivariate statistics.

    RESULTS: Significant group effects during both Take-off and Landing were found, with ACLPT differing from CTRL in Take-off with a combination of less knee flexion and knee internal rotation, and from both ACLR and CTRL in Landing with less hip and knee flexion, knee internal rotation, and greater hip adduction. ACLR also presented different kinematics to ACLPT and CTRL in Take-off with a combination of greater trunk flexion, hip flexion, hip internal rotation, and less knee abduction, and in Landing with greater trunk flexion and hip internal rotation. Further, different kinematics and hop height were found between legs within groups in both Take-off and Landing for both ACL groups, but not for CTRL.

    CONCLUSION: Different kinematics for the injured leg for both ACL groups compared to CTRL and between treatment groups, as well as between legs within treatment groups, indicate long-term consequences of injury. Compensatory mechanisms for knee protection seem to prevail over time irrespective of initial treatment, possibly increasing the risk of re-injury and triggering the development of osteoarthritis. Detailed investigation of movement strategies during the VH provides important information and a more comprehensive evaluation of knee function than merely hop height. More attention should also be given to the trunk and hip in clinics when evaluating movement strategies after ACL injury.

    LEVEL OF EVIDENCE: Prospective cohort study, Level II.

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  • 316.
    Markström, Jonas L.
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Tengman, Eva
    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.
    A kinematic analysis of one-leg vertical jump on average 23 years after injury of the anterior cruciate ligament2015In: Gait & Posture: 24th Annual Meeting of ESMAC 2015 Abstracts, 2015, Vol. 42, p. 1-2, article id Session OS01 Best-Paper-Session - OutcomesConference paper (Refereed)
  • 317.
    Martin, Björklund
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hamberg, Jern
    Heiden, Marina
    Barnekow-Bergkvist, Margareta
    The assessment of symptoms and functional limitations in low back pain patients. Validity and reliability of a new questionnaire2007In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 16, p. 1799-1811Article in journal (Refereed)
  • 318.
    Martinsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nilsson, Malin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Upplevelser av integrerad träning: – att personer med och utan funktionsnedsättning tränar tillsammans2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Många personer med funktionsnedsättning avstår från att träna och har en generellt lägre aktivitetsnivå än andra jämnåriga. En strategi för att övervinna de barriärer som personer med funktionsnedsättning upplever för att vara fysiskt aktiva kan vara integrerad träning.

    Syfte: Syftet med studien är att få en bild av vilka upplevelser personer med och utan funktionsnedsättning har av att träna boxning integrerat på en idrottsförening.

    Metod: Semistrukturerade intervjuer genomfördes med sex deltagare i åldrarna 17-24 år från en boxningsklubb med ett uttalat integrationstänkande. Tre av deltagarna var utan funktionsnedsättning och tre med, fyra var kvinnor och två män. Intervjuerna transkriberades ordagrant och analyseras genom kvalitativ innehållsanalys, för att sedan utmynna i fyra teman.

    Resultat: Intervjuerna resulterade i fyra teman – "Att få ut något av träningen är viktigt", "Att träna på sin egen nivå men inspireras och motiveras av andra", "Att mötas i varandras olikheter" och "Att anpassa sig eller att omgivningen anpassas" – som berör hur effekter av träningen samt gruppens-, föreningens- respektive samhällets inverkan påverkade individens motivation. Integrerad träning är ett uppskattat träningssätt som kan berika idrottslivet, öka delaktigheten, motivationen för träning samt den sociala integreringen, men träningen måste anpassas utefter situation och alla övningar kan inte utföras integrerat.

    Slutsats: Integrerad träning tycks vara ett uppskattat träningssätt som ökar delaktigheten och motivationen oavsett om man har en funktionsnedsättning eller inte.

  • 319.
    Matkovic, Ana
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Diehl, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Characteristics of patients with low back pain and the variety of the impacts depending on gender and body weight: A cross-sectional secondary analysis2015Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Low back pain (LBP) is the most common musculoskeletal disorder which affects several aspects of a person’s life. Many studies have described the predisposing factors for LBP, but there is insufficient evidence of the profile of the LBP population, for example the influence of gender or obesity on the course of existing LBP.

    The aim was to complete a cross-sectional analysis, based on datasets from two randomized controlled trials conducted among people with LBP. The objectives were to describe and explore differences and associations within the sample regarding gender and participants’ weight.

    A combined dataset was constructed from two RCT studies. Demographical and clinical characteristics were described and used to compare for differences and associations.

    The population was 107 participants; mean age 46.1 (±SD 14.7) years. Between genders there was statistically significant difference in physical activity and functional disability. When compared between the weight categories, a difference in LBP intensity was found.

    The results imply that women tend to perceive higher levels of functional disability and have lower levels of physical activity then men. They also suggest that higher body weight seemed to influence pain intensity. Research is needed to better understand the impact LBP has on peoples’ lives. 

  • 320.
    Mattsson, Elin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Petersson, Josefin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Cykling på självvald intensitet vid kontorsarbete – hur påverkas arbetsförmågan?2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Att undersöka vilken relativ intensitet som väljs av friska individer vid cykling vid en simulerad kontorsarbetsplats och hur det påverkar arbetsförmågan jämfört med stående, samt att få mer information om upplevelsen av en aktiv arbetsstation.

    Metod: Tolv deltagare, samtliga studenter vid Umeå Universitet, utförde två olika testbetingelser i randomiserad ordning med 1-3 dagars mellanrum. Testbetingelserna bestod av stående under 30 minuter och cykling under 60 minuter på självvald intensitet. Under tiden utfördes tre olika kontorstester efter 10, 20 och 50 minuter för att utvärdera tangentbordsarbete, musarbete och kognition. I samband med den stående testbetingelsen utfördes ett submaximalt konditiontest.

    Resultat: Deltagarna valde en intensitet på 17,4% (medelvärde) av maximal aerobic power output (MAP). Deltagarna var långsammare i muspekaruppgiften efter 20 minuter cykling jämfört med efter 20 minuter stående (p=0,02). Det var ingen skillnad mellan cykel och stående vid tangentbordsarbete eller kognitionsuppgiften. Deltagarna presterade bättre i kognitionsuppgiften efter 50 minuters cykling jämfört med efter 20 minuter med avseende på antal avklarade omgångar samt antal rätt (p=0,03 resp. p=0,03). Det fanns inget samband mellan självvald intensitet och prestationen vid utförandet av kontorsuppgifterna.

    Konklusion: Resultaten pekar mot att arbetsprestationen med avseende på tangentbordsarbete och kognition inte påverkas nämnvärt vid cykling på självvald intensitet jämfört med stående. Viss försämring i arbete med datormus observerades vilket tyder på att cykling eventuellt inte är att rekommendera vid den typen av arbetsuppgifter. Låg power gör att resultaten från denna studie bör tolkas med försiktighet.

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

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

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  • 322.
    Mikko, Sanna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Effekter av neuromuskulär rehabiliteringsträning på knäproprioception hos individer med främre korsbandsskada – en narrativ översikt2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Neuromuskulär träning kan potentiellt stimulera proprioception hos individer med främre korsbandsskada. Fram till idag finns det ingen litteraturöversikt tillgänglig som summerar effekterna av neuromusculär rehabilitering på proprioceptionen i knät hos individer med främre korsbandsskada.

     

    Syften: 1) att utvärdera effekten av neuromuskulära rehabiliteringsprogram jämfört med en kontrollintervention, utvärderat med knä-specfika proprioceptionstester hos individer med främre korsbandsskada, med eller utan rekonstruktion och 2) att summera neuromuskulära träningsprogram som fokuserar på att förbättra proprioception i knät.

     

    Metod: Sju databaser användes för sökning från dataabasernas start fram till Oktober 2018. Artiklar som nkluderades var: Randomized- eller Controlled clinical trials; utvärderar effekterna av neuromuskulär rehabiliteringsprogram; utvärderat med knä-specifika proprioceptionstester; före och efter interventionsperioden; hos patienter med främre korsbandsskada. 

     

    Resultat: Totalt åtta studier inkluderades. Sex studier använde joint position sense (JPS) och två threshold to detection of passive motion (TTDPM) för att utvärdera proprioception i knät. Två studier visade statistiskt signifikant skillnad på proprioception mellan experiment- och kontrollgrupp. Intervention av träningsövningar i de neuromusculära träningsprogrammen var: whole body vibration therapy (WBVT), övningar på balansbräda, vattenträning, styrketräning och plyometrisk- ”agility drills”- och grenspecifika övningar.

     

    Slutsats: De flesta neuromuskulära rehabiliteringsprogrammen visade ingen statistiskt signifikant skillnad på proprioception, förutom WBVT och övningar på balansbräda som visade sig förbättra proprioception i knät efter främre korsbandsskada. De inkluderade artiklarnas studiedesign, validitet och sensitivitet av de knä-specifika proprioceptionstesterna kan ha bidragit till resultaten. En definitiv konklusion är svårt att ge med tanke på avsaknad av analys för bedömningsbias samt få inkluderade artiklar. Fortsatt forskning inom området behövs.

     

     

     

  • 323.
    Minde, Victor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Ponseti treatment of children with clubfoot at a Physiotherapy clinic in Tanzania – Evaluation of the casting phase by Pirani scoring analysis2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Inledning: Klumpfot är en av de vanligaste medfödda fotdeformiteterna och förkommer främst bland pojkar. Cirka 80 % av klumpfot förekommer i låg- och medelinkomstländer. Det finns således ett stort behov av specialiserad behandling för att öka barnens livskvalitet senare i livet. Den mest använda behandlingen är Ponseti-metoden med manipulation, gipsning, förlängning av Akillessenan och ortosbehandling. Ponseti-metoden har visat sig vara effektiv vid både idiopatisk och icke-idiopatisk klumpfot. Fysioterapeuter tillsammans med ortopedkirurger har varit i frontlinjen vid användningen av Ponseti metoden.

    Syfte: Syftet med denna studie var att vid en fysioterapiklinik utvärdera Ponseti-metoden (Korrektionsfasen) vid behandling av klumpfot och faktorer som är associerade med behandlingsutfallet.

    Metoder: Studien är en retrospektiv studie av 224 fötter hos 138 barn behandlade med Ponseti-metoden från januari 2008 till september 2018. Utvärderingen av deformiteten gjordes med Pirani-poäng före och under varje veckas behandling. Demografiska data, kliniska mått och behandlingsresultat hämtades från en databas för klumpfot. Det primära utfallsmåttet var antalet gipsningar till slutförandet av behandlingen och de sekundära utfallsmåtten var förändringen i Pirani-poäng, antal gipsningar och andel som genomgick tenotomi.

    Resultat: En majoritet av barnen med klumpfot var pojkar (71,0%) och de flesta var ett år eller yngre när behandlingen startade. En majoritet av barne

    n hade bilateral klumpfot (64,5%). Medelvärdet för Pirani poängen vid behandlingens början var

    4,1 (SD ± 1,7). Det genomsnittliga antalet gipsningar som behövdes för att uppnå totalkorrigering var 4,9 (SD ± 2,8). Den initiala Pisani-poängen predicerade signifikant antalet gipsningar som krävdes till totalkorrigering.

    Slutsats: Ponseti metoden för behandling av klumpfot visade på ett bra behandlingsresultat utförd av fysioterapeuter.

  • 324. Molenaar, Claire E.
    et al.
    Geithner, Christina A.
    Henriksson, Tommy
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports Medicine.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gilenstam, Kajsa
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports Medicine.
    The Relative Age Effect in Women's Ice Hockey: International and Positional Comparison2015In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 47, no 5S, p. 629-630Article in journal (Other academic)
    Abstract [en]

    A relative age effect (RAE), or chronological age differences among individuals within the same age group, has been observed in 14 sports (Cobley et al., 2009). A strong RAE has been reported in men’s ice hockey since 1985 (Barnsley et al., 1985). In contrast, research on RAE in women’s ice hockey is limited (Wattie et al., 2007; Weir et al., 2010) and findings are equivocal.PURPOSE: To determine whether there is a RAE in women’s ice hockey, and if it varies by country or player position.

    METHODS: Participants were 117 female ice hockey players (mean age=19.9±2.3 yr) on 2 Swedish elite-level club teams (n=54) and 4 Canadian university teams (n=63). Players reported birthdate and position (Forward=F, Defenseman=D, Goalie=G). Birthdates were coded by quartiles (Q1: Jan.-March, Q2: April-June, Q3: July-Sept., Q4: Oct.-Dec.) and by half-year. Birthdate data were submitted to chi-square analyses for the sample, by country, and by position. SPSS 17.0 for Windows was used for all analyses (significance level: p<0.05). RESULTS: A significant RAE was observed for the entire sample by quartile (Q1: 28.2%, Q2: 34.2%, Q3: 25.6%, Q4: 12.0%; χ2=12.402, p=0.006). More players were born in the first half of the year than the second (62.4% vs. 37.6%, respectively; χ2=7.188, p=0.007). In contrast, Q4 was underrepresented for the sample and by country (Canada: 12.7%, Sweden: 11.1%). A RAE was present for the Canadian players by quartile (χ2=13.381, p=0.004) and half-year (χ2=9.921, p=0.002); however, no RAE was observed for Swedish players. In addition, a significant RAE was observed for the entire sample by position for G and D by quartiles (G - χ2=10.077, p=0.018; D - χ2=8.444, p=0.038) and half year (G - χ2=6.231, p=0.013; D - χ2=4.000, p=0.046), but not for F.

    CONCLUSIONS: The significant RAE in this sample is consistent with that in men’s ice hockey and the tendency for greater participation by relatively older players in women’s ice hockey. RAE absence in the Swedish players may reflect lower participant number, competitive level, and sociocultural support, as well as greater variation in skill level. The significant RAEs observed in Canadian players and by position support the findings of Weir et al. (2010), but the positional differences found were inconsistent, perhaps due to differences in sample size and competitive level between studies. 

  • 325.
    Moshi, Haleluya
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Traumatic spinal cord injuries in rural Tanzania: occurrences, clinical outcomes and life situations of persons living in the Kilimanjaro region2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Traumatic spinal cord injury (TSCI) is one of the most troubling health condition as it leaves the inflicted individual with irreversible sensorimotor impairment. Rural areas of Tanzania and other low income countries are characterized by inadequate emergency, medical and rehabilitation services and are mostly inaccessible by wheelchair. The studies in this thesis aimed to create an understanding of the epidemiology, clinical outcomes of SCI, as well as living with the condition, in a typical rural area of a low-income country.

    Methods: Four studies were conducted with two being hospital-based and two carried out in the community. A retrospective study assessed the magnitude, etiology and clinical outcomes for past five years (2010-2014) by using patients’ data from archives of the Kilimanjaro Christian Medical Centre (KCMC). In the same setting, another study assessed the same variables prospectively for one year (2017) with greater focus being placed on classifying severity of injury and health complications. In the community, a qualitative study was used to conceptualize coping resources for persons with SCI in one study, while in another, the WHOQoL-BREF questionnaire was used to assess the quality of life of these persons quantitatively.

    Results: The retrospective study obtained 213 full patient records in which the leading cause of injury was falls 104(48.8%) followed by road traffic accidents 73(34.3%). The annual incidence for the Kilimanjaro region (population 1,640,087) was estimated at more than 26 persons per million for this period. The most documented complications were pressure ulcers at 19.7%, respiratory complications at 15.0% and multiple complications at 13.1%. The in-hospital mortality rate was 24.4%. The prospective study involved 87 persons who sustained SCI in 2017, of whom 66.7% were due to falls (especially from a position of height), 28.7% to road traffic accidents and 4.6% from other causes. The annual incidence rate based on Kilimanjaro region (population 1,910, 555) was estimated at more than 38 new cases per million. The majority of the injuries occurred at the cervical 56.3% and lumbar 31% levels. Most of the injuries 59.8% were incomplete while 40.2% were complete. The questionnaire study reports that the majority of the participants rated their quality of lives as neither poor nor good 39(48.8%) and poor life 20(25%). The mean score for domains of QoL showed the highest score in social relations and psychological well-being, while the lowest scores were rated for physical health and environment. There was no significant mean difference in the score of domains based on sociodemographic characteristics, except for physical environment in which quadriplegia scored lower than paraplegia (p = 0.038). The qualitative interview study identified acceptance as the core category for identification and utilization of both internal and external coping resources for persons with TSCI in the community. Internal coping resources related to personal factors and external coping resources related to family and community were found to be important.

    Conclusion: Most of the traumatic SCI in Kilimanjaro rural area are due to falls, followed by road traffic accidents. SCI-related complications are common and hospital mortality is still high. Persons with SCI faces various challenges pertaining to health and accessibility that affect them physically, socially and environmentally. Establishment of emergency and critical care services, trauma registries, community-based rehabilitation and population-based surveys would address major issues pertaining to TSCI in these areas.

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  • 326.
    Moshi, Haleluya
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Faculty of Rehabilitation Medicine, Physiotherapy Department, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sahlen, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Nursing.
    Sörlin, Ann
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Traumatic spinal cord injury in the north-east Tanzania: describing incidence, etiology and clinical outcomes retrospectively2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1355604Article in journal (Refereed)
    Abstract [en]

    Background: Causes, magnitude and consequences of traumatic spinal cord injury depend largely on geography, infrastructure, socioeconomic and cultural activities of a given region. There is a scarcity of literature on profile of traumatic spinal cord injury to inform prevention and rehabilitation of this health condition in African rural settings, particularly Tanzania. Objective: To describe the incidence, etiology and clinical outcomes of traumatic spinal cord injury and issues related to retrospective study in underdeveloped setting.

    Methods: Records for patients with traumatic spinal cord injury for five consecutive years (2010–2014) were obtained retrospectively from the admission wards and health records archives of the Kilimanjaro Christian Medical Center. Sociodemographic, cause, complications and patients’ condition on discharge were recorded and analyzed descriptively.

    Results: The admission books in the wards registered 288 new traumatic spinal cord injury cases from January 2010 to December 2014. Of the 288 cases registered in the books, 224 were males and 64 females with mean age 39.1(39.1 ± 16.3) years and the majority of individuals 196(68.1%) were aged between 16 and 45 years. A search of the hospital archives provided 213 full patient records in which the leading cause of injury was falls 104(48.8%) followed by road traffic accidents 73(34.3%). Cervical 81(39.9%) and lumbar 71(34.74%) spinal levels were the most affected. The annual incidence for the Kilimanjaro region (population 1,640,087) was estimated at more than 26 persons per million population. The most docu- mented complications were pressure ulcers 42(19.7%), respiratory complications 32(15.0%) and multiple complications 28(13.1%). The mean length of hospital stay was 64.2 ± 54.3 days and the mortality rate was 24.4%.

    Conclusion: Prevention of traumatic spinal cord injury in North-east Tanzania should consider falls (particularly from height) as the leading cause, targeting male teenagers and young adults. Pressure ulcers, respiratory complications, in-hospital mortality and availability of wheelchairs should be addressed. 

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  • 327.
    Moshi, Haleluya
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Kilimanjaro Cristian Medical University College, Moshi, Tanzania.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sahlén, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Nursing.
    Anthea, Rhoda
    Sörlin, Ann
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Coping Resources for Persons With Traumatic Spinal Cord Injury in A Tanzania Rural Area2018In: Global Journal of Health Science, ISSN 1916-9736, E-ISSN 1916-9744, Vol. 10, no 5, p. 138-153Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Persons with traumatic spinal cord injury (TSCI) in Tanzanian rural settings face a variety of geographical and socioeconomic challenges that make life almost impossible for them. However, some have managed to live relatively long lives despite these difficult conditions. This study aimed at exploring secrets behind successful lives of persons with TSCI in typical resource-constrained rural Tanzanian settings.

    METHODS: A modified constructivist grounded theory was employed for the analysis of data from 10 individuals who have lived between 7 and 28 years with TSCI in typical Tanzanian rural area. The 10 were purposively selected from 15 interviews that were conducted in 2011. The analysis followed the constructivist approach in which data was first open and axial coded, prior to categories being constructed. The categories were frequently reviewed in light of the available literature to determine the over-arching core category that described or connected the rest.

    RESULTS: Nine categories (identified as internal and external coping resources) were constructed. The internal coping resources were: secured in God, increase in awareness on health risk, problem-solving skills and social skills. External coping resources were: having a reliable family, varying support from the community, a matter of possession and left without means for mobility. Acceptance was later identified as a core category that determines identification and utilization of the rest of the coping resources.

    CONCLUSION: Persons with traumatic spinal cord injury can survive for a relatively long time despite the hostile environment. Coping with these environments requires the employment of various coping resources, acceptance being the most important.

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  • 328.
    Moshi, Haleluya
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sahlén, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sörlin, Ann
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Incidence of traumatic spinal cord injury and prevalence of medical complications among hospitalized patients at Kilimanjaro: a one year prospective studyManuscript (preprint) (Other academic)
  • 329.
    Moshi, Haleluya
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Physiotherapy Department, Faculty of Rehabilitation Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Sundelin, Gunnevi
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Sahlén, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Sörlin, Ann
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Quality of life of persons with traumatic spinal cord injury in rural Kilimanjaro, Tanzania: a community survey2021In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 43, no 20, p. 2838-2845Article in journal (Refereed)
    Abstract [en]

    Aim: To describe the quality of life of persons with traumatic spinal cord injury (TSCI) in a rural area of a low-income country.

    Methods: This was a cross-sectional descriptive study in which snowballing was used to identify persons with TSCI in their homes. A Kiswahili version of the short version of the World Health Organization quality of life questionnaire was used for data collection. Data were analyzed descriptively and independent samples t-tests were used to calculate the difference in the mean scores between groups.

    Results: Eighty persons with TSCI with a mean age of 42.29 +/- 11.4 years were identified, 68.8% of whom were males. The highest scoring domains were psychological (12.76 +/- 2.55) and social relationships (12.62 +/- 2.95). The lowest scores were for physical (11.48 +/- 2.74) and environment (9.59 +/- 2.68) domains. Significantly higher scores were associated with younger age in: physical (0.05), social relationships (0.01), and environment (0.02) domains (p value < 0.05).

    Conclusions: Persons with TSCI in the Kilimanjaro rural area registered a relatively low quality of life in which the most affected domains are physical health and environment.

  • 330.
    Mtavangu, Grace
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Barriers and possibilities of physical exercises in pregnant Tanzanian women attending antenatal care2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: Exercise during pregnancy can improve women’s mental health, reduce gestational weight gain, reduce back pain, reduce length of labor, decrease caesarean section rates and reduce recovery times.

    Aim: The aim of the current study was to explore barriers and possibilities of physical exercises in pregnant Tanzanian women attending antenatal care.

    Methods: The study recruited twenty five participants through purposive sampling strategy. They were aged between 19- 41 years (median 24 years), 6 first trimester, 12 second trimester and 7 third trimester; with number of birth (gravida) ranging between 1-5. Focus group interviews were used during data collection and analyzed with qualitative content analysis.

    Results: The result comprises of a theme: ‘A journey towards a safe and comfortable pregnancy’ and four categories ‘limited knowledge on physical exercises’ ‘fueling a painful sexual relationship’ ‘coping with pelvic pain’ ‘poor support of physical exercises the from community members’ and. These findings revealed the efforts and struggle to have a pain-free pregnancy especially when the women were involved in physical exercises.

    Conclusion

    This present study has shown a knowledge gap on pregnant women towards exercising during pregnancy. There was also little support from the community members in terms of participation to physical exercise. Pain was the main reason for either not to participate or practicing less physical exercise with great consciousness and care. Pregnant women struggled to cope with all challenges throughout pregnancy. Physiotherapy services were not provided to pregnant women especially when visiting an antenatal clinic.

  • 331.
    Mårell, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lindgren, Monica
    Ternulf Nyhlin, Kerstin
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Berglund, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    "Struggle to obtain redress": women's experiences of living with symptoms attributed to dental restorative materials and/or electromagnetic fields2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, no 1, article id 32820Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore the experiences of illness and the encounters with health care professionals among women who attributed their symptoms and illness to either dental restorative materials and/or electromagnetic fields, despite the fact that research on health effects from dental fillings or electricity has failed to substantiate the reported symptoms. Thirteen women (aged 37-63 years) were invited to the study and a qualitative approach was chosen as the study design, and data were collected using semi-structured interviews. The analysis was conducted with a constant comparative method, according to Grounded Theory. The analysis of the results can be described with the core category, "Struggle to obtain redress," the two categories, "Stricken with illness" and "A blot in the protocol," and five subcategories. The core category represents the women's fight for approval and arose in the conflict between their experience of developing a severe illness and the doctors' or dentists' rejection of the symptoms as a disease, which made the women feel like malingerers. The informants experienced better support and confirmation from alternative medicine practitioners. However, sick-leave certificates from alternative medicine practitioners were not approved and this led to a continuous cycle of visits in the health care system. To avoid conflicting encounters, it is important for caregivers to listen to the patient's explanatory models and experience of illness, even if a medical answer cannot be given.

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  • 332. Naili, J. E.
    et al.
    Iversen, M. D.
    Esbjörnsson, A. -C
    Hedström, M.
    Schwartz, M. H.
    Häger, Charlotte K.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Broström, E. W.
    Challenging the effect of hip and knee replacement for osteoarthritis: a prospective one year follow-up study of 64 patients evaluating function and gait dynamics2016In: Osteoarthritis and Cartilage, ISSN 1063-4584, E-ISSN 1522-9653, Vol. 24, p. S111-S111Article in journal (Other academic)
  • 333. Naili, Josefine E
    et al.
    Iversen, Maura D.
    Esbjörnsson, Anna-Clara
    Hedström, Margareta
    Schwartz, Michael H.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Broström, Eva W.
    Deficits in functional performance and gait one year after total knee arthroplasty despite improved self-reported function2017In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 25, no 11, p. 3378-3386Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The current literature lacks sufficient information about improvements in gait patterns and function after total knee arthroplasty (TKA) and whether patients return to full function. This study evaluated change in gait, performance-based function, and self-reported function 1 year after TKA in patients with symptomatic knee osteoarthritis and how these aspects interrelate.

    METHODS: A total of 28 patients (64 % female) with knee osteoarthritis, with a mean age of 66 (±7) years, and 25 age- and gender-matched controls participated in this prospective cohort study. Three-dimensional gait analysis generated comprehensive measures of kinematic and kinetic gait deviations, respectively. Participants completed the Five Times Sit-to-Stand (5STS) test, and the self-reported questionnaire Knee Injury and Osteoarthritis Outcome Score (KOOS), at baseline prior to surgery and 1 year after TKA.

    RESULTS: Kinetic gait deviations of both the operated and non-operated limb persisted in patients with knee osteoarthritis at 1 year after surgery, while kinematic gait patterns were comparable to controls. Performance on the 5STS and KOOS scores in patients with knee osteoarthritis improved significantly 1 year after surgery (effect size 0.5-1.5), but did not reach the level of controls. Ten patients with knee osteoarthritis (36 %) exceeded the minimally detectable change on the 5STS.

    CONCLUSION: Measures of overall gait patterns and the 5STS revealed improvements in function 1 year after TKA, but were not restored to the level of healthy controls. Based on change in 5STS performance, we identified patients with substantial improvements in gait patterns. Self-reported measures of function could not detect differences between patients improving in 5STS performance and those who did not. These findings highlight the use of the 5STS in clinical practice since improvement on this test seems to follow the reduction in gait pattern deviations.

    LEVEL OF EVIDENCE: II.

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  • 334. Naili, Josefine
    et al.
    Esbjörnsson, Anna-Clara
    Iversen, Maura
    Schwarz, Michael
    Hedström, Margareta
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Broström, Eva
    The impact of symptomatic knee osteoarthritis on gait pattern and its association with performance-based measures and patient-reported outcomes2017In: Knee (Oxford), ISSN 0968-0160, E-ISSN 1873-5800, Vol. 24, no 3, p. 536-546Article in journal (Refereed)
    Abstract [en]

    Background: Limited knowledge exists regarding the impact of symptomatic knee osteoarthritis (OA) on the overall gait pattern; and whether gait deviations are associated with performance based measures (PBMs) and patient-reported outcomes (PROs). This cross-sectional study evaluated overall gait patterns in patients with knee OA using the Gait Deviation Index for kinematics (GDI) and kinetics (GDI-kinetic), and explored associations between gait deviations, PBMs, and PROs. Methods: Forty patients with knee OA and 25 age and gender-matched controls underwent three-dimensional gait analysis. Participants performed the Timed Up and Go (TUG), Five Times Sit-to-Stand (5STS), and Single Limb Mini Squat (SLMS) tests and completed a disease specific PRO. Associations between gait deviations, PBMs, and PROs were assessed by Pearson's correlation and multiple linear regression. Results: Patients with OA demonstrated significantly lower GDI and GDI-kinetic scores of the OA and contralateral limbs compared to controls; with GDI-kinetic scores on the contralateral limb more impacted than the OA limb. On the contralateral limb, GDI-kinetic score significantly correlated with TUG (r = -0.42) and 5STS (r = -033), while on the OA limb with TUG (r = -0.68), 5STS (r = -0.38), SLMS (r = -0.38), activities of daily living (r = -0.35) and Knee-related Quality of Life (r = -035). No significant associations existed between kinematic GDI scores, PBMs and PROs. Conclusion: The overall gait pattern, as represented by GDI and GDI-kinetic scores, in patients with symptomatic knee OA is affected both on the painful OA limb and the contralateral limb. The GDI and GDI-kinetic scores provide different information regarding function that is not revealed by PBMs or PROs.

  • 335.
    Nilsson, Erik
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lewin, Elin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gymnasieelevers förståelse för ergonomi och informationsteknologi: - En intervjustudie2015Independent thesis Basic level (degree of Bachelor), 180 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Informationsteknologiska produkter (ITP) såsom datorer tar en allt större plats i undervisningen i svenska skolor. Forskning har visat samband mellan intensivt datoranvändande och besvär i bland annat rörelseapparaten och skolan kan således vara en ergonomisk riskmiljö.

    Syfte: Granska gymnasieelevers förståelse om ergonomi och ITP, samt beskriva hur de vill utforma framtida ergonomikunskap. Dessutom tillvarata deras åsikter och idéer kring ett fiktivt datorteknologiskt verktyg vars mål är att öka ergonomisk medvetenhet vid arbete med ITP.

    Metod: Kvalitativ semistrukturerad intervjustudie med fyra fokusgrupper med totalt 25 personer, varav 14 flickor och 11 pojkar i åldrarna 16-17 år. Datamaterialet analyserades med kvalitativ innehållsanalys enligt Granheim och Lundman.

    Resultat: Analysen mynnade ut i fem kategorier, Begränsad ergonomisk medvetenhet, Informationsteknologins negativa följder, Upplevelse av skolmiljö och undervisningsstruktur, Elevers vilja att lära sig mer om ergonomi samt Elevstyrd utformning av applikation för förbättrad ergonomi.

  • 336.
    Nilsson, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Håkansson, Magnus
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hälsokonsekvenser av fysiska och psykosociala arbetsmiljöfaktorer: En kombinerad tvärsnitt- och longitudinell studie2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Arbetsmiljön präglas av fysiska och psykosociala komponenter, så som fysisk arbetsposition, upplevda krav, kontroll och stöd. Arbetsförhållanden, individuella förhållanden eller okända faktorer kan påverka hälsan och medföra stressrelaterade symtom, som huvudvärk, oro och sömnbesvär.

    Syftet med föreliggande studie var att undersöka samband mellan arbetsmiljöfaktorer och hälsa vid 34 och 52 års ålder hos kohorten i ”The Swedish Physical Activity and Fitness Cohort study” (n=292). År 1992 och 2010 besvarades frågeformulär om fysisk och psykosocial arbetsmiljö samt hälsa och stressrelaterade symtom. Genom kombinerad tvärsnitts- och longitudinell design analyserades insamlat material.

    Resultatet visade att kvinnornas arbetsposition försämrades mellan 1992 och 2010. Andelen kvinnor och män som upplevde sömnbesvär ökade. Såväl kvinnor som män upplevde minskad kontroll och högre krav. Dessutom upplevde männen minskat socialt stöd. Den univariata logistiska regressionsanalysen visade inga longitudinella samband. Dock framkom att män som upplever låg kontroll 2010 löpte en ökad risk att drabbas av huvudvärk  (OR 0.323, CI 95 % 0.124-0.840). Kvinnor som upplevde höga krav 2010 löpte en ökad risk att drabbas av ängslan/oro/ångest (OR 0.413, CI 95 % 0.191-0.893).

    Hälsa, fysiska och psykosociala arbetsmiljöfaktorer försämras över tid, samverkar i olika utsträckning och varierar mellan kön. Ett ytterligare behov av forskning som hanterar orsakssamband föreligger. 

  • 337.
    Nilsson, Stina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Muskuloskeletala besvär bland arbetstagare med repetitivt arbete och betydelsen av maximal syreupptagningsförmåga2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Muskuloskeletala besvär vid repetitivt arbete är vanligt förekommande och en god arbetshälsa kräver viss fysisk funktionsförmåga hos anställda. Hög maximal syreupptagningsförmåga (VO2max) kan öka effektiviteten och minska sjukfrånvaro. Det saknas dock studier kring betydelse av VO2max och upplevda besvär vid repetitivt arbete.

    Syfte: Undersöka upplevda muskuloskeletala besvär bland arbetstagare med repetitivt arbete samt om dessa besvär skiljer sig mellan arbetstagare med hög- respektive låg nivå av VO2max.

    Metod: I studien deltog totalt 23 personer, 4 män och 19 kvinnor (medelålder 48, SD 9,2) med repetitiva arbetsuppgifter (laboratoriearbetare och lokalvårdare). Muskuloskeletala besvär mättes med frågeformulär kring upplevda besvär, besvärsområde enligt smärtteckning och grad av besvär enligt visuell analog skala (VAS). VO2max bedömdes med Åstrands konditionstest på cykel.

    Resultat: Muskuloskeletala besvär rapporterades hos 65 % av deltagarna. Inga skillnader påvisades mellan arbetstagare med hög- respektive låg VO2max gällande upplevda besvär eller smärtskattning med VAS. De med låg VO2max var äldre och rapporterade signifikant mer besvär från nedre extremitet som knä och höft än de med hög VO2max.

    Diskussion: Muskuloskeletala besvär är vanligt förekommande vid repetitivt arbete bland laboratoriepersonal och lokalvårdare. Låg VO2max ger mer besvär i höft- och knäled, men kan troligtvis vara relaterat till högre BMI och ålder. Fler studier med större population behövs för att undersöka betydelse av VO2max för förekomst av muskuloskeletala besvär.

  • 338.
    Nissemark, Catarina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Can training of non-affected leg with eccentric overload technique improve muscle function, balance, walking ability and perceived participation in chronic stroke subjects?2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Abstract:

    Aim: The purpose of this study was to investigate effects of training of the non-affected leg with coupled concentric and eccentric contractions including brief episodes of eccentric overload on strength in the non-affected and affected leg as well as on balance, walking ability and perceived participation in chronic stroke subjects.

    Methods: The design was an explorative experimental pilot study. Nine chronic stroke subjects (> 4 years post-stroke) performed eccentric overload training with non- affected leg, 2 times per week during 8 weeks. Peak power, isometric leg press force and training data were measured during all training session. Aspects of balance, gait and movement performance were assessed before and after the training period using Timed-up-and-go test, Bergs Balance scale, 30 sec chair-stand-test, 6-min walk test and Modified Ashworth scale. Stroke Impact Scale instrument was administered in order to assess some aspects of perceived participation.

    Result: Peak power measured during training increased between session 1 and 16 for both concentric (12.7% p<0.001) and eccentric action (13.4% p<0.001) for the trained non-affected leg. Peak power in the affected leg increased for both concentric (22 % p=0.028) and eccentric action (38 % p=0.015). No significant changes were seen for isometric leg press force. Timed-up-and-go (14 % p=0.021), Berg balance test (3% p=0.026), 30 CST (24% p=0.020) all improved. No changes were seen on Modified Ashworth Scale, 6 minutes walk test or Stroke Impact Scale.

    Conclusion: Training of the non-affected leg with eccentric overload technique in the flywheel leg press apparatus in chronic stroke subjects was safe and it improved concentric and eccentric peak power in both the affected and the non-affected leg, as well as balance, short-distance gait and functional leg strength. 

  • 339.
    Nordin, Emma
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Shi, Jesse
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    The Frequency of Behaviour Change Techniques in Exercise Applications2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Smartphone applications may have an impact on our physical activity behaviour, The use of Behaviour Change Techniques (BCTs) in these applications is relatively unexplored.

    Aim: The purpose was to identify and categorize the presence of specific Behaviour Change Techniques in 20 most common exercise applications available for Apple iOS in Sweden. Also if there are specific Behaviour Change Techniques for older people.

    Method: 20 applications were selected from the 150 toplist of health and fitness applications. The Behaviour Change Techniques-taxonomy was used to identify and code 10 free and 10 pay applications. Three game applications were also studied.

    Results: No difference was found in the amount of specific Behaviour Change Techniques between the free and pay applications p=0,760. There was no correlation between price and specific Behaviour Change Techniques p=0,333 r=0,306.  Five of the 16 Behaviour Change Techniques groups were more commonly used with a even distribution between free and pay applications p=0,211 – 1, 0. Most commonly used specific Behaviour Change Techniques were: body changes, feedback on behaviour, social support (unspecified), demonstration of the behaviour and instruction on how to perform the behaviour. 60,8% of all applications included specific BCTs for increasing physical activity among older people and 30% included specific Behaviour Change Techniques for increasing self-efficacy in relation to exercise for this group.

    Conclusion: The results of this study show that free applications could be as good as pay applications when it comes to the presentation of specific Behaviour Change Techniques and Behaviour Change Technique groups. The applications studied include specific Behaviour Change Techniques that could promote physical activity among the population. This opens new possibilities for physical therapist whom could use exercise applications in smartphones as a instrument to promote physical activity.   

  • 340.
    Nordin, Fredrik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Validitet för fixerad handhållen dynamoteter vid mätning av isometrisk knäextension styrka hos vuxna med medfött hjärtfel2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: Congenital heart disease is defined as a structural or functional abnormality of the heart or the great vessels that is present at birth. Individuals with congenital heart disease have lower limb muscle endurance, and possibly, limb muscle strength than healthy individuals.  An easy to use, clinically applicable way to measure strength is the hand-held dynamometer. The hand-held dynamometer has not been validated in a population with congenital heart disease before. Aim: The aim is to examine the concurrent validity of using a fixated hand-held dynamometer to measure isometric knee extension strength in individuals with congenital heart disease and healthy adults. Methods: Fourteen individuals with congenital heart disease and fourteen healthy individuals was included. Each person was tested three times with each method and the mean of the top two results for each individual and methods was used for analysis. Results: The correlation between the two methods was excellent in both groups (0.98 in the group with individuals with congenital heart disease and 0.99 in the healthy group). The hand-held dynamometer measured higher values than the load cell in the group of individuals with congenital heart disease (p-value: 0.03) which was not seen in the healthy group (p-value: 0.37). Conclusion: The fixated hand-held dynamometer and the load cell have excellent correlation in both groups. In a healthy population the methods can be used interchangeably but a small difference is seen between the methods in a population with congenital heart disease

  • 341.
    Nordin, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Stenlund, Kristoffer
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Högintensiv intervallträning för äldre och dess påverkan på hjärtrytmvariabilitet och affektion över tid: Ett pilotprojekt med supramaximala cykelsprintintervaller2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    IntroduktionHögintensiv intervallträning, HIT, är en tidseffektiv träningsform med påvisade positiva hälsoeffekter för äldre. Det autonoma nervsystemets funktion, ANS, som mäts genom hjärtrytmvariabiliteten kan förbättras genom HIT-träning. HIT-träning kan även främja gynnsamma affektiva tillstånd. För att en individ ska ha motivation att fortsätta med sin träning är det viktigt att den kan främja både fysiologiska och affektiva markörer. Detta gör HIT till en särskilt intressant träningsform.

     

    SyfteAtt undersöka om en sex veckor lång träningsintervention med HIT-intervaller påverkar HRV och affektion på äldre över tid.

     

    Metod

    Sex friska personer mellan 65-75 år och fysiskt aktiva inkluderades. Aerob kondition estimerades genom ett modifierat Åstrands cykelergometertest och anaerob förmåga genom Borgs Cycle Strength Test. HRV- mätningar genomfördes självständigt i hemmen med en pulsklocka fyra ggr/veckan under 7 veckor. I samband med dessa mätningar skattade deltagarna även affektion efter Feeling Scale, FS. Efter en veckas baslinjefas genomfördes 6-sekunders HIT-intervaller i sex veckor. Dessa analyserades genom att dela upp träningsperioden i 3 tvåveckors perioder och en baslinje-fas. Individerna analyserades enskilt och sen som grupp för att se om det förelåg förändringar över tid genom Wilcoxon tecken-rangtest.

     

    Resultat För gruppen som helhet så har en liten förbättring i HRV skett över tid sett till medianen. Denna skillnaden blev ej signifikant enligt Wilcoxon tecken-rangtest. Utvecklingen av affektion mätt genom FS-skalan visar inte på några signifikanta förändringar över tid. Då datan för de olika perioderna ställdes upp i ett linjediagram så syntes en ökad spridning över tid gällande HRV medan spridningen i affektion minskade.

  • 342.
    Nordström, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Toots, Annika
    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.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Thorngren, Karl-Göran
    Hommel, Ami
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Bisphosphonate Use After Hip Fracture in Older Adults: A Nationwide Retrospective Cohort Study2017In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 18, no 6, p. 515-521Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to investigate the association between bisphosphonate use and the risk of new fracture in a nationwide cohort of individuals with previous hip fractures, with emphasis on individuals above 80 years of age.

    DESIGN, SETTING, AND PARTICIPANTS: From a nationwide cohort with hip fracture (2006-2012) (n = 93, 601), each individual prescribed bisphosphonates after hip fracture (n = 5845) was matched with up to three individuals not prescribed bisphosphonates, resulting in a cohort of 21,363 individuals.

    MAIN OUTCOME MEASURE: A new hip fracture.

    RESULTS: During a mean follow-up period of 2.98 (range, 0.02-8) years, 4581 fractures occurred in the cohort. Before the initiation of bisphosphonate therapy, individuals later prescribed bisphosphonates had an increased risk of hip fracture (multivariable adjusted odds ratio [OR], 2.63; 95% confidence interval [CI], 2.23-3.24) compared with controls. In the period after bisphosphonate therapy initiation, individuals prescribed bisphosphonates had a lower risk of hip fracture (multivariable adjusted hazard ratio [HR], 0.76; 95% CI, 0.65-0.90) compared with controls. Similar effects were seen after the initiation of bisphosphonates in individuals aged more than 80 years (HR, 0.79; 95% CI, 0.62-0.99). In contrast, the initiation of bisphosphonate therapy did not influence the risk of injurious falls not resulting in fracture (HR, 0.95; 95% CI, 0.86-1.05).

    CONCLUSION: Bisphosphonate use was associated with a decreased risk of hip fracture in this nationwide cohort of older men and women, with similar risk reductions in individuals older than 80 years.

  • 343.
    Nordvall Strömberg, Petronella
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wadell, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Enhanced information regarding exercise training as treatment is needed. An interview study in patients with chronic obstructive pulmonary disease2015In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 16, p. 1424-1430Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this study is to describe thoughts and attitudes of patients with chronic obstructive pulmonary disease (COPD) when talking about exercise training as treatment.

    METHODS: Semi-structured interviews were performed and analyzed with the grounded theory method. Four men and six women were interviewed (ages 66-84 years), with moderate to severe COPD, and no experience of organized exercise training as treatment for COPD.

    RESULTS: The analysis resulted in one core category, unknown territory, and three categories, good for those who can, but not for me; fear of future; and mastering. Exercise training as treatment was perceived by the participants as something unknown. It was also described as important for others but not for them. Their perceptions were that they could not perform exercise training, and did not have the knowledge of what or how to perform exercise that was good for them.

    CONCLUSIONS: Patients with COPD, with no previous experience of exercise training as treatment for their disease, describe exercise training as something unknown and unimportant for them. The results provide important knowledge for healthcare professionals regarding how to educate patients with COPD about the content and benefits of exercise training as treatment. Implications for Rehabilitation Exercise training is effective for patients with chronic obstructive pulmonary disease (COPD) with regard to dyspnea, physical capacity, health-related quality of life, and health care use. Patients with COPD perceive a lack of information regarding exercise training as treatment. The information and the presentation of exercise training as treatment might be of importance to get better adherence to this treatment.

  • 344.
    Norrbohm, Elin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Juvenil Idiopatisk Artrit kan påverka den hälsorelaterade livskvalitén2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Barnreumatism även kallad Juvenil idiopatisk artrit (JIA) består av sju undergrupper. Gemensamt för sjukdomen är inflammationer i leder och muskler. Den hälsorelaterade livskvalitén (HRQOL) har rapporterats lägre hos barn och ungdomar med JIA jämfört med friska i motsvarande ålder.

    Syftet med den här studien var att, hos barn och ungdomar med JIA, undersöka vilken påverkan graden av ledskador, självskattad ledsvullnad, självskattad smärta, sjukdomsaktivitet och funktionsnedsättning hade på HRQOL genom att undersöka skillnader mellan pojkar/flickor, yngre/äldre barn avseende dessa variabler samt undersöka samband mellan HRQOL och testade variabler.

    Totalt ingick 56 personer med JIA. HRQOL mättes med Pediatric Quality of Life Inventory 4.0 Generic Core Scales, ledskador med Juvenile Arthritis Damage Index for Articular Damage, smärta med Visuell Analog Skala, funktionsnedsättning med Childhood Health Assessement Questionnaire, självskattad ledsmärta/ledsvullnad genom "smärtgubbar" och sjukdomsaktivitet genom Erythrocyte Sedimentation Rate (ESR) och läkare. Jämförelseanalys gjordes med Mann Whitney U test och sambandsanalys gjordes med Spearmans rho. Statistisk signifikansnivå var p<0,05.

    Enda signifikanta skillnaden mellan pojkar/flickor och äldre/yngre barn var ESR. Signifikanta negativa samband fanns mellan en större grad av funktionsnedsättning, högre självskattad smärta, högre sjukdomsaktivitet, större ledskador och ett lägre HRQOL. Pojkarna visade på starkare samband mellan funktionsnedsättning, smärta och HRQOL än flickorna. Den yngre åldersgruppen hade inga signifikanta samband medan de äldre barnen visade på signifikanta negativa samband mellan alla testade variabler och HRQOL förutom självskattad ledsvullnad och ESR .

  • 345.
    Nyberg, Andre
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Single limb exercises in patients with chronic obstructive pulmonary disease: feasibility, methodology, effects and evidence2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. COPD is a slowly progressive, inflammatory disease in the airways and lungs, caused mainly by smoking. The inflammation leads to a narrowing of the small airways (airway obstruction) and a destruction of tissue in the lungs. This gives a decreased expiratory airflow which leads to dyspnea, the primary symptom of the disease. The chronic airflow limitation also is associated with the development of limb muscle dysfunction. Decreases in both limb muscle strength and endurance have been shown which, in turn, is associated with exercise intolerance, one of the key disabling factors of the disease. Pulmonary rehabilitation including exercise training is the cornerstone of treatment and is strongly recommended. However, it is still unclear how to optimize exercise training for this group of patients. Also how to address the increase in dyspnea which limits the exercise stimulus, and how to assess muscular strength, need further study. Partitioning the exercising muscle mass, known as single limb exercises, is a novel exercise strategy aimed at reducing the negative consequences of chronic airflow limitation in patients with COPD.

    The aim of this thesis was to study the current evidence of single limb approaches in patients with COPD, to examine the feasibility and effects of a high-repetitive single limb exercise (HRSLE) regimen in patients with COPD and to examine whether elastic resistance could be used to evaluate muscular strength.

    This thesis is based on five papers. In order to study the evidence on single limb exercises, a systematic review of randomized controlled trials was performed. The review showed that single limb exercises, performed as one-legged cycling appeared to be more effective than two-legged cycling with regard to exercise capacity but not dyspnea, and might be included in exercise programs for patients with COPD (Paper I). Thirty healthy older women and men participated in a validation study comparing elastic resistance maximal strength with isokinetic dynamometry measurements. Excellent levels of agreement and no differences between the two pieces of equipment were found which indicates that elastic resistance could be used to evaluate muscular strength (Paper II). A study protocol was created for a randomized controlled trial designed to identify the effects of HRSLE in combination with COPD-specific patient training (experimental group) in comparison to patient information alone (control group) (Paper III). HRSLE was performed as resistance training, using a single limb at a time, elastic bands as resistance and a high number of repetitions (25 repetitions in 2 sets) with the aim of increasing limb muscle endurance. After eight weeks of exercise, the differences between the groups were in favor of the experimental group on lower- and upper-extremity functional capacity, upper-extremity endurance capacity and muscular function. No differences were seen between the groups on endurance-cycle capacity or health-related quality of life (Paper IV). In patients with COPD, the HRSLE regimen was considered feasible with a high attendance rate, excellent compliance and high relative exercise intensity. No severe adverse events occurred. The physiotherapists conducting the HRSLE in the clinical setting also found it to be feasible (Paper V).

    This thesis shows that single limb exercises performed as one-legged cycling may be useful and effective for patients with COPD. Eight weeks of HRSLE was feasible and effective with regard to exercise capacity but without effect with regard to health-related quality of life. Elastic resistance could be used as exercise equipment to improve limb muscle function in patients with COPD and to evaluate muscular strength in healthy older adults.

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  • 346.
    Nyberg, Andre
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Centre de recherche, Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada.
    Carvalho, João
    Bui, Kim-Ly
    Saey, Didier
    Maltais, François
    Adaptations in limb muscle function following pulmonary rehabilitation in patients with COPD – a review2016In: Revista Portuguesa de Pneumologia, ISSN 0873-2159, E-ISSN 2172-6825, Vol. 22, no 6, p. 342-350Article, review/survey (Refereed)
    Abstract [en]

    Even though chronic obstructive pulmonary disease (COPD) is primarily a disease of the respiratory system, limb muscle dysfunction characterized by muscle weakness, reduced muscle endurance and higher muscle fatigability, is a common secondary consequence and a major systemic manifestation of the disease. Muscle dysfunction is especially relevant in COPD because it is related to important clinical outcomes such as mortality, quality of life and exercise intolerance, independently of lung function impairment. Thus, improving muscle function is considered an important therapeutic goal in COPD management. Pulmonary rehabilitation (PR) is a multidisciplinary, evidence-based and comprehensive approach used to promote better self-management of the disease, minimize symptom burden, optimize functional status, and increase participation in activities of daily life. Exercise training, including cardiovascular and muscle exercises, is the cornerstone of PR and is considered the best available strategy to improve exercise tolerance and muscle function among patients with COPD. This paper addresses the various components of exercise training within PR used to improve limb muscle function in COPD, providing clinicians and health-care professionals with an overview and description of these various exercise modalities and of their effects on limb muscle function. Guidance and recommendations to help design optimal limb muscle training regimens for these patients are also presented.

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  • 347.
    Nyberg, Andre
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindström, Britta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Aronsson, Nils
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Näslund, Magnus
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wadell, Karin
    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.
    Validity of using elastic bands to measure knee extension strength in older adults2016In: Journal of Novel Physiotherapy and Physical Rehabilitation, ISSN 2455-5487, Vol. 3, no 1, p. 16-21Article in journal (Refereed)
    Abstract [en]

    Background and objectives: Maximal strength assessment of knee extensors in older adults using elastic resistance bands have rarely been addressed even though resistance training using elastic bands have shown large effects on muscle strength in this group of people. We therefore aim to determine the validity of maximal knee extension strength assessment using elastic resistance bands in older women and men.

    Methods: Twenty-four participants (12 women and 12 men; 61.8 ± 6.0 years; 173.5 ± 10.2 cm; 71.9 ± 15.7 kg) were included. To assess maximal knee extension strength, participants performed one-repetition maximum testing of concentric knee extension using elastic resistance bands as well as a maximal concentric knee extension isokinetic test at 60°/s using a stationary isokinetic dynamometer. Concurrent validity of the two measurement techniques were assed using intraclass correlation coefficient (ICC2.1), Pearson correlations (R), concordance correlations (Rc) and by determining variations on an individual level using 95% limits of agreement (LoA) with isokinetic dynamometry measurement as the reference standard.

    Results: Validity analysis showed good to excellent agreement and relationships but wide 95% LoA between elastic one-repetition maximum and isokinetic peak torque for all participants (ICC = 0.88; R = 0.90; Rc = 0.85, LoA = 10.5 kg), for women (ICC = 0.67; R = 0.77; Rc = .62, LoA = 7.7 kg) and for men (ICC = 0.80; R = 0.85; Rc = 0.78, LoA = 13.1 kg), respectively.

    Conclusion: One-repetition maximum testing using elastic resistance bands provides valid measurements of maximal knee extension strength in older women and men but with wide variations on an individual level.

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  • 348.
    Nyberg, Andre
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Saey, Didier
    Martin, Mickaël
    Maltais, François
    Muscular and functional effects of partitioning exercising muscle mass in patients with chronic obstructive pulmonary disease - a study protocol for a randomized controlled trial2015In: Trials, E-ISSN 1745-6215, Vol. 16, article id 194Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Low-load, high-repetitive single-limb resistance training may increase limb muscle function and functional exercise capacity in patients with chronic obstructive pulmonary disease (COPD) while minimizing the occurrence of limiting exertional symptoms. Whether high-repetitive single-limb resistance training would perform better than high-repetitive two-limb resistance training is unknown. In addition, the mechanisms underlying possible benefits of high-repetitive resistance training has not been investigated. The aims of this study are to compare single versus two-limb high-repetitive resistance training in patients with COPD and to investigate mechanisms of action of these training modalities.

    METHODS/DESIGN: This trial is a prospective, assessor-blind, randomized controlled trial. The participants are patients with stable severe to very severe COPD who are older than 40 years of age and healthy controls. The intervention is single-limb, high-repetitive, resistance training with elastic bands, three times/week for 8 weeks. The control is two-limb high-repetitive resistance training with elastic bands, three times/week for 8 weeks. The primary outcomes is change in the 6-min walking distance after 8 weeks of single-limb or two-limb high-repetitive resistance training. The secondary outcomes are changes in limb muscle strength and endurance capacity, key protein involved in quadriceps anabolic/catabolic signalization, fiber-type distribution and capillarization, subjective dyspnea and muscle fatigue, muscle oxygenation, cardiorespiratory demand and health-related quality-of-life after 8 weeks of single-limb or two-limb high-repetitive resistance training. The acute effects of single-limb versus two-limb high-repetitive resistance training on contractile fatigue, exercise stimulus (the product of number of repetition and load), subjective dyspnea and muscle fatigue, muscle oxygenation, and cardiorespiratory demand during upper and lower limb exercises will also be investigated in patients with COPD and healthy controls. Randomization will be performed using a random number generator by a person independent of the recruitment process, using 1:1 allocation to the intervention and the control group using random block sizes. Blinding: All outcome assessors will be blinded to group assignment.

    DISCUSSION: The results of this project will provide important information to help developing and implementing customized exercise training programs for patients with COPD.

    TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT02283580 Registration date: 4 November 2014. First participant randomized: 10 November 2014.

  • 349.
    Nyberg, Andre
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Tistad, Malin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wadell, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Can the COPD web be used to promote self-management in patients with COPD in swedish primary care: a controlled pragmatic pilot trial with 3 month- and 12 month follow-up2019In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, no 1, p. 69-82Article in journal (Refereed)
    Abstract [en]

    Objective: Evaluate the feasibility of the COPD Web and its study design and study procedures and to increase the understanding of the potential effect of the tool in order to provide guidance for a future large scale trial.

    Design: Parallel-group controlled pragmatic pilot trial.

    Subjects: There was a total of 83 patients with COPD (mean age 70 ± 8 years with a forced expiratory volume in first second percent predicted of 60 ± 17%). The intervention group (n = 43) was introduced to and had access to the COPD Web in addition to usual care, while the control group (n = 40) received usual care alone.

    Main outcome measures: The feasibility of the COPD Web (i.e., if and how the COPD Web was used) was automatically collected through the website, while outcomes on health, conceptual knowledge, and physical activity (PA) were collected through questionnaires at baseline, 3 months and 12 months.

    Results: At 3 months, 77% of the intervention group was considered users, and the majority of time spent on the site was related to PA and exercises and was spent during the first month (>80%). In addition, the intervention group reported increased PA (odds ratio [OR] = 4.4, P < .001), increased conceptual knowledge in five domains (OR = 2.6–4.2, all P < .05), and altered disease management strategies (e.g., increased PA) (OR ≥ 2.7 P < .05) in comparison to the control group. The latter was also different between groups at 12 months (OR = 3.7, P = .044). Knowledge of PA was correlated with level of PA (ρ = .425–.512, P < .05) as well as to the use of PA as a strategy to manage their disease (χ2 = 11.2–32.9, P < .05).

    Conclusion: Giving patients with COPD access to the COPD Web in addition to their ordinary primary care might be an effective shorter term (3 month) strategy to promote self-management. However, these results needs to be confirmed in a definitive large-scale trial.

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  • 350.
    Nyberg, Andre
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Törnberg, Anna
    Department of Neurobiology, Care Sciences and Society, Karolinska Instiitutet, Stockholm, Sweden.
    Wadell, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Correlation between limb muscle endurance, strength and functional capacity in people with chronic obstructive pulmonary disease2016In: Physiotherapy Canada, ISSN 0300-0508, E-ISSN 1708-8313, Vol. 68, no 1, p. 46-53Article in journal (Refereed)
    Abstract [en]

    Purpose: To examine the correlation between limb muscle function (endurance and strength) and functional capacity in upper limbs (ULs) and lower limbs (LLs) of people with chronic obstructive pulmonary disease (COPD). Method: This article describes a secondary analysis of data from a randomized controlled trial. A stationary dynamometer was used to measure isokinetic muscle strength and endurance; the 6-minute walk test, the 6-minute pegboard and ring test, and the unsupported UL exercise test were used to measure functional capacity. Results: Participants were 44 adults with COPD. Muscle strength and endurance in ULs and LLs demonstrated a moderate to strong correlation with functional capacity. When controlling for muscle strength, muscle endurance was moderately correlated with functional capacity in ULs and LLs, but when controlling for muscle endurance, there was no positive and significant correlation between muscle strength and functional capacity for the ULs or LLs. Conclusions: Functional capacity seems to be more closely related to limb muscle endurance than to limb muscle strength in people with COPD.

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