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  • 51.
    Berglund, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hellqvist, Jonas
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Aasa, Björn
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Holmberg, David
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi.
    Michaelson, Peter
    Luleå Tekniska Universitet, Institutionen för hälsovetenskap, Avdelningen för hälsa och rehabilitering, Fysioterapi.
    Aasa, Ulrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Which patients with persistent mechanical low back pain will respond to high load motor control training?2011Conference paper (Refereed)
  • 52.
    Bergman, Frida
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Active workstations: a NEAT way to prevent and treat overweight and obesity?2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

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

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  • 53.
    Bergman, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Sörlin, Ann
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Increasing physical activity in officeworkers – the Inphact Treadmill study: a study protocol for a 13-month randomized controlled trial of treadmill workstations2015In: BMC Public Health, E-ISSN 1471-2458, Vol. 15, article id 632Article in journal (Refereed)
    Abstract [en]

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

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

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

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  • 54.
    Bergman, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Mattson-Frost, Tove
    Jonasson, Lars
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Chorell, Elin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Sörlin, Ann
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Öhberg, Fredrik
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Ryberg, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Levine, James
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Installing treadmill workstations in offices does little for cognitive performance and brain structure, despite a baseline association between sitting time and hippocampus volumeManuscript (preprint) (Other academic)
  • 55.
    Bergman, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wahlström, Viktoria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Stomby, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Otten, Julia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lanthén, Ellen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Renklint, Rebecka
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Waling, Maria
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Sörlin, Ann
    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 Center for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Öhberg, Fredrik
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Levine, James A.
    Department of Endocrinology, The Mayo Clinic, Rochester, MN, USA; Fondation IPSEN, Paris, France.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Treadmill workstations in office workers who are overweight or obese: a randomised controlled trial2018In: The Lancet Public Health, ISSN 2468-2667, Vol. 3, no 11, article id e523-e535Article in journal (Refereed)
    Abstract [en]

    Background: Treadmill workstations that enable office workers to walk on a treadmill while working at their computers might increase physical activity in offices, but long-term effects are unknown. We therefore investigated whether treadmill workstations in offices increased daily walking time.

    Methods: We did a randomised controlled trial of healthy office workers who were either overweight or obese. We recruited participants from 13 different companies, which comprised 17 offices, in Umeå, Sweden. We included people who were aged 40-67 years, had sedentary work tasks, and had a body-mass index (BMI) between 25 kg/m2 and 40 kg/m2. After the baseline measurement, we stratified participants by their BMI (25-30 kg/m2 and >30 to 40 kg/m2); subsequently, an external statistician randomly assigned these participants (1:1) to either the intervention group (who received treadmill workstations for optional use) or the control group (who continued to work at their sit-stand desks as usual). Participants in the intervention group received reminders in boosting emails sent out to them at four occasions during the study period. Researchers were masked to group assignment until after analysis of the primary outcome. After the baseline measurement, participants were not masked to group belongings. The primary outcome was total daily walking time at weekdays and weekends, measured at baseline, 2 months, 6 months, 10 months, and 13 months with the accelerometer activPAL (PAL Technologies, Glasgow, UK), which was worn on the thigh of participants for 24 h a day for 7 consecutive days. We used an intention-to-treat approach for our analyses. This trial is registered with ClinicalTrials.gov, number NCT01997970, and is closed to new participants.

    Findings: Between Nov 1, 2013, and June 30, 2014, a total of 80 participants were recruited and enrolled (n=40 in both the intervention and control groups). Daily walking time during total time awake at weekdays increased between baseline and 13 months by 18 min (95% CI 9 to 26) in the intervention group and 1 min (-7 to 9) in the control group (difference 22 min [95% CI 7 to 37], pinteraction=0·00045); for weekend walking, the change from baseline to 13 months was 5 min (-8 to 18) in the intervention group and 8 min (-5 to 21) in the control group (difference -1 min [-19 to 17]; pinteraction=0·00045). Neither measure met our predetermined primary outcome of 30 min difference in total walking time between the intervention and control group, so the primary outcome of the trial was not met. One adverse event was reported in a participant who accidently stepped on their Achilles tendon.

    Interpretation: In a sedentary work environment, treadmill workstations result in a statistically significant but smaller-than-expected increase in daily walking time. Future studies need to investigate how increasing physical activity at work might have potentially compensatory effects on non-work activity.

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  • 56.
    Bergman, Johanna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Vesterberg, Hanna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Webbaserad träning för patienter med långvarig smärtproblematik: En studie med Single Subject Experimental Design2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Patienter med långvarig smärta har ofta en nedsatt funktionsförmåga och fysisk aktivitetsnivå. Det finns stark vetenskaplig evidens för att olika träningsformer har effekt på smärta och funktion. Vilken typ av träning som ger bäst effekt är dock inte klarlagt. Webbaserad träning har fått stor genomslagskraft senaste åren men Socialstyrelsen kan i dagsläget inte rekommendera interventionen på grund av det otillräckliga vetenskapliga underlaget. De efterfrågar därför fler studier som utvärderar effekten av dessa.

     

    Syfte: Att undersöka om webbaserad träning kan påverka funktionsförmåga och minska smärta hos patienter som sökt fysioterapi för sin långvariga smärtproblematik och nedsatta funktionsförmåga. Vi vill även undersöka om tillgång till webbaserade träningsprogram kan leda till en ökad fysisk aktivitetsnivå och ökad fysisk kapacitet som i sin tur kan påverka patienternas smärtintensitet och funktionsförmåga.

     

    Metod: Studien har följt upplägget för en Single Subject Experimental Design med en A-B design. Under hela studiens fortlöpande skedde upprepade mätningar av beroende mätvariabler, smärtintensitet (NRS) och funktionsförmåga (PSFS). Baslinjefasen (A) varade i 1-3 veckor och interventionsfasen (B) varade i 4 veckor med webbaserad träning. Studiedesignen kompletterades med tester av den fysiska kapaciteten. Testerna utfördes innan och efter interventionen. Antalet deltagare i studien var 9 stycken i åldrarna 21-63 år.

     

    Resultat:  Fem deltagare fick en ökad funktionsförmåga under studiens gång och fyra deltagare hade ingen påtaglig förändring. Fem deltagare hade en oförändrad smärtintensitet under studiens gång och fyra deltagare fick en minskning.

     

    Konklusion: Fyra veckor med webbaserad träning kan ge positiva effekter på smärtintensitet och funktionsförmåga för patienter med långvarig smärta. Dock krävs en längre interventionsperiod för att påvisa ytterligare effekter.

  • 57.
    Bergqvist, Matilda
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lindahl, Maja
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Jämförelse av statisk och dynamisk lårmuskeluthållighet hos personer med kroniskt obstruktiv lungsjukdom och friska ålders- och könsmatchade kontroller: - en tvärsnittsstudie2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Även om kroniskt obstruktiv lungsjukdom (KOL) karakteriseras av en påverkan på luftvägar och lungvävnad, är manifestationer även utanför lungorna vanliga. Vid KOL är det exempelvis  vanligt med nedsatt lårmuskeluthållighet. Dock är det ej klarlagt om statisk och dynamisk uthållighet är nedsatt till samma grad vid KOL vilket är av betydelse för att kunna erbjuda adekvata behandlingsstrategier.

    Syfte: Att undersöka och jämföra statisk och dynamisk lårmuskeluthållighet hos personer med KOL och jämföra med friska ålders- och könsmatchade kontrollpersoner.

    Metod: Tvärsnittsstudie bestående av 17 personer med KOL och 31 friska ålder- och könsmatchade kontrollpersoner. Det genomfördes fyra tester, ett för maximal viljemässig kontraktion (MVK) samt tre uthållighetstester (isotonisk, isokinetisk, isometrisk) för lårmuskelfunktion. Testerna gjordes i en stationär dynamometer. Jämförelser mellan grupperna utfördes och redovisas i procent i differens mellan grupperna samt effektstorlek (ES) av relativt arbete (antal repetitioner respektive sekunder) och absolut arbete (totalt arbete i Joule).

    Resultat: En statistiskt signifikant skillnad mellan friska kontrollpersoner och personer med KOL uppmättes i MVK (31% skillnad, ES 0.47), isokinetisk uthållighet (32% skillnad, ES 0.52), isotoniskt absolut arbete i Joule (37% skillnad, ES 0.40) samt isometriskt absolut arbete i Joule (37% skillnad, ES 0.39) där de friska försökspersonerna fick högre värden. Däremot sågs ingen signifikant skillnad i relativt arbete i isotonisk (repetitioner) (15% skillnad, ES 0.16) eller isometrisk (sekunder) (0% skillnad, ES 0.00) uthållighet.

    Slutsats: Hos personer med KOL är såväl statisk som dynamisk uthållighet nedsatt i liknande utsträckning. I jämförelse med friska kontroller har personer med KOL en nedsatt absolut lårmuskelfunktion medan relativ lårmuskeluthållighet inte verkar vara nedsatt.

  • 58.
    Bergström, Matilda
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Larsson, Helena
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Konditionsträning i intervallform som behandling vid hjärntrötthet efter stroke: en single-subject-studie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Hjärntrötthet efter stroke är ett vanligt men ofta förbisett tillstånd. Det upplevs i många fall som det värsta symtomet efter stroke och kan vara en stor begränsning i vardagen. Orsak såväl som behandling är för närvarande okänt. En tänkbar orsak är att försämrad fysisk kapacitet leder till en negativ spiral där vardagliga aktiviteter kräver mer ansträngning vilket förvärrar hjärntröttheten och bidrar till en mer inaktiv livsstil. Konditionsträning i intervallform kan därför vara en möjlig behandlingsform då intervallträning har visat sig vara effektivt i syfte att uppnå konditionsförbättring i olika patientgrupper, inklusive stroke.

    Syfte: Undersöka om konditionsträning i intervallform på cykel påverkar hjärntrötthet efter stroke.

    Metod: Två män, 77 och 83 år, deltog i denna upprepade single-subject-studie. Interventionsfasen bestod av ett fyra veckor långt intervallträningsprogram. Träningspassen utfördes under övervakning tre gånger i veckan på cykel i testpersonernas hem. Genomförbarhet av interventionen registrerades. Hjärntrötthet mättes två gånger i veckan under baslinjefas och interventionsfas med Swedish fatigue assessment scale (S-FAS). Konditionstester genomfördes före och efter interventionen.

    Resultat: Samtliga träningspass genomfördes utan farliga händelser. En minskning av hjärntrötthet gick att observera, dock kunde en sann skillnad ej fastställas. Kondition förbättrades med 7 % respektive 17 % på sex minuters gångtest (6MWT) samt med 7 % respektive 35 % på Åstrands cykelergometertest.

    Konklusion: Resultaten antyder att hjärntrötthet kan minska samt att kondition kan förbättras efter intervallträning på cykel hos personer som drabbats av stroke. Längre interventionstid krävs för att påvisa en eventuell sann skillnad i hjärntrötthet.

  • 59.
    Bergström, Sara
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Patienters syn på personcentrerad vård: - En kvalitativ studie med personer som genomgått reumatisk rehabilitering2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Personcentrerad vård är en vårdmodell där patienten ses som   expert på sig själv och sin situation. I en personcentrerad vård anpassas   vården efter varje individ och patienten är aktiv i sin egen vård.

    Syfte:   Syftet med uppsatsen var att undersöka erfarenheter av och synen   på personcentrerad vård hos personer som genomgått reumatisk rehabilitering.

    Metod:   Kvalitativ metod användes och uppsatsen baserades på fem   semistrukturerade intervjuer som analyserades med kvalitativ innehållsanalys.   Inklusionskriterierna var att ha genomgått rehabilitering på reumatologens   dagvård någon gång under senaste halvåret.

    Resultat: Analysen utmynnade i tre kategorier som var Patientens   självkännedom, Vårdpersonalens kunskap och Interaktion mellan patient,   vårdpersonal och grupp. Kategorierna bildade temat Personcentrerad vård- när   patient och vård möts genom förmågor och gemensamt engagemang. Intervjupersonerna   beskrev att de hade betydelsefull självkännedom och att vårdpersonalen hade   betydelsefull kunskap för rehabiliteringen. För att självkännedomen/kunskapen   skulle kunna nyttjas i rehabiliteringen krävdes, enligt intervjupersonerna,   ett gott samarbete mellan patient och vårdpersonal där båda parter var   engagerade. Intervjupersonernas acceptans av sin funktionsnedsättning samt   förväntningar på en personcentrerad vård både från patient och vårdpersonal   gynnade, enligt intervjupersonerna, en personcentrerad vård.

    Slutsats: Resultatet visade att både patient och vårdpersonal hade en aktiv roll i att uppnå en personcentrerad vård vilket skulle kunna betyda att vården blir personcentrerad i olika utsträckning beroende på patienten. Mer forskning krävs för att undersöka patientens påverkan på att uppnå en personcentrerad vård och för att undersöka ämnet utifrån vårdpersonalens perspektiv.

  • 60.
    Betten, Carola
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Skånevård Kryh, Division Primärvård Skurup, Sweden.
    Sandell, Christofer
    Hill, Jonathan C.
    Gutke, Annelie
    Cross-cultural adaptation and validation of the Swedish STarT Back Screening Tool2015In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 17, no 1, p. 29-36Article in journal (Refereed)
    Abstract [en]

    Objectives : The STarT Back Screening Tool (SBT) is a newly validated questionnaire that identifies modifiable risk factors of poor prognosis in patients with low back pain (LBP). The aim of this study was to cross-culturally adapt the SBT into Swedish and to test its concurrent validity in patients with LBP in primary healthcare.

    Methods: The SBT was translated according to established guidelines. Concurrent validity was tested on 62 patients by comparing the SBT with the Orebro Musculoskeletal Pain Screening Questionnaire, short form (OMPSQ-short). Analysis of correlations between the instruments' total scores and between psychosocial sub-score of SBT and OMPSQ-short was performed using Spearman's rank correlation.

    Results: A translation of the SBT into Swedish required minor semantic adaptation until the final version was acceptable. Correlation between the SBT and the OMPSQ-short was large with r = 0.61 (SBT total with OMPSQ-short total score) and r = 0.60 (SBT psychosocial subscale with OMPSQ-short total score).

    Conclusion: The original SBT was successfully translated into Swedish. Correlation between the Swedish SBT and OMPSQ- short was large. The present study supports the use of the Swedish SBT for further clinical practice and research.

  • 61.
    Bjerke, Joakim
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Gait and postural control after total knee arthroplasty2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of the thesis was to investigate deficits and compensatory strategies after total knee arthroplasty (TKA) in different conditions during gait and quiet standing. Although TKA is considered the gold standard treatment for end-stage knee osteoarthritis, it is associated with a number of implications. Reduced physical function after osteoarthritis is partly, but apparently not fully, remedied by surgery. The two most common deficits are reduced knee muscle strength and limited range of knee joint motion (ROM), partly due to prosthesis mechanics. Reduced postural control has also been shown shortly after surgery. In spite of sufficient passive knee joint ROM for normal ambulation, gait patterns are characterized by reduced knee flexion. Several factors such as reduced knee muscle strength, reduced proprioception, habitual strategies or fear of movement may be suggested as explanations for difficulties in gait and posture. As an effect, compensatory strategies may result. In order to focus on the implications of TKA, participants had to be less than 65 years of age and healthy, TKA being the only factor different form controls. The same 23 individuals with unilateral TKA ~ 19 months post-operative and 23 controls participated in all studies.

     

    3D whole body kinematics was used to assess gait and posture and electromyography was used to record muscle activity. Isokinetic measurements were used to determine dynamic knee muscle strength. Gait in the frontal and sagittal planes were assessed. The tasks included in the test protocol were negotiation up and down stairs, gait on hard and soft surface, quiet standing with sensory modulation (with and without vision and on soft surface), and single limb stance.  Primary outcome variables addressed were: knee and hip joint kinematics in frontal and sagittal planes, upper body inclination, postural sway and relative knee muscle activity as an indicator of relative effort. Background factors used to explain group differences in the primary outcomes were derived from demographics, clinical examination, and questionnaires. Demographic factors were age, body mass index (BMI), and time since surgery. Clinical examinations were conducted for passive knee joint ROM, joint position sense, knee muscle strength, anterior knee joint laxity, and leg length. Questionnaires assessed fear of movement, pain, and knee related function and quality of life. The results showed that knee flexion was reduced during stair descent in both the prosthetic and the contralateral knee in the TKA group compared to controls. Although reduced passive knee joint flexion in the TKA group was sufficient for normal stair descent, it was the only factor identified that explained reduced knee flexion in stair descent. As knee muscle strength was significantly reduced in the TKA group, it is reasonable to suggest that as a contributing factor. Furthermore, the TKA group also displayed increased hip adduction during stair descent, which may indicate both a compensatory strategy as well as reduced hip muscle strength. In stair ascent, no significant group differences were found in relative knee muscle activity as expected due to knee muscle weakness. Nor were there any indications of compensatory forward inclination of the trunk to reduce knee joint moments. Instead, probably compensating for muscle weakness, the TKA group ascended stairs at a significantly slower speed. Surface modulation during level gait showed that reduced knee flexion in the prosthetic knee during the stance phase when walking on a hard surface was further decreased during gait on a soft surface. Knee and hip adduction at the stance phase were not affected by surface conditions. Nevertheless, the TKA group displayed increased knee adduction and hip adduction compared to controls, particularly in the prosthetic side. In addition, the TKA group displayed increased step width on the soft compared to hard surface. Single-limb stance for 20 seconds failed in 30 % of the TKA group and in 4 % of the control group. Those in the TKA group who were able to perform single-limb stance performed equally well as controls. During bilateral quiet standing, postural sway was similar in both groups, and inability to stand on one leg did not affect bilateral stance. Older age, higher BMI and reduced quadriceps strength determined the failure to maintain single-limb stance in the TKA group.

     

    In conclusion, this thesis indicates that reduced knee muscle strength is a common denominator as part of the explanatory factors for reduced performance and compensatory strategies in individuals with TKA. Reduced speed during stair ascent as well as reduced knee flexion during stair descent may be compensations for reduced lower extremity strength. Increased hip adduction may compensate for reduced knee flexion in stair descent, but may also represent hip muscle weakness or reduced motor control as increased hip adduction is found also in level gait. The failure to maintain single-limb stance in the TKA group is also partly explained by reduced knee muscle strength. Muscle weakness may be and indicator for reduced physical capacity in general.

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  • 62.
    Bjerke, Joakim
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Department of Physiotherapy, School of Health Education & Social Work, Sør-Trøndelag University College, Trondheim, Norway.
    Öhberg, Fredrik
    Department of Biomedical Engineering & Informatics, Umeå University Hospital, Umeå, Sweden.
    Nilsson, Kjell G
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Stensdotter, Ann-Katrin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Department of Physiotherapy, School of Health Education & Social Work, Sør-Trøndelag University College, Trondheim, Norway.
    Compensatory strategies for muscle weakness during stair ascent in subjects with total knee arthroplasty2014In: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 29, no 7, p. 1499-1502Article in journal (Refereed)
    Abstract [en]

    Subjects with total knee arthroplasty (TKA) exhibit decreased quadriceps and hamstring strength. This may bring about greater relative effort or compensatory strategies to reduce knee joint moments in daily activities. To study gait and map out the resource capacity, knee muscle strength was assessed by maximal voluntary concentric contractions, and whole body kinematics and root mean square (RMS) electromyography (EMG) of vastus lateralis and semitendinosus were recorded during stair ascent in 23 unilateral TKA-subjects ~19months post-operation, and in 23 healthy controls. Muscle strength and gait velocity were lower in the TKA group, but no significant group differences were found in RMS EMG or forward trunk lean. The results suggest that reduced walking velocity sufficiently compensated for reduced knee muscle strength.

  • 63.
    Bjerke, Joakim
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Department of Physiotherapy, School of Health Education & Social Work, Sør-Trøndelag University College, Trondheim, Norway.
    Öhberg, Fredrik
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Nilsson, Kjell G
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Stensdotter, Ann-Katrin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Department of Physiotherapy, School of Health Education & Social Work, Sør-Trøndelag University College, Trondheim, Norway.
    Gait on soft versus hard surface after total knee arthroplastyManuscript (preprint) (Other academic)
    Abstract [en]

    Asymmetric gait patterns are common following total knee arthroplasty (TKA). Gait on even and hard surface is primarily characterized by reduced peak knee flexion in the prosthetic knee, increased contralateral knee adduction angle, and decreased walking speed compared to controls. Natural conditions may however lead to different strategies. Therefore, the objective of the present study was to explore how gait patterns may differ when walking on a soft surface. Methods: 3D kinematics during gait on hard and soft surface were assessed in 23 unilateral TKA-subjects ~19 months post-operative, and in 23 controls. Results: Gait characteristics in TKA-subjects that differed from controls observed on hard surface were amplified on soft surface. Flexion in the prosthetic knee was further decreased and a tendency towards reduced flexion in the contralateral knee was observed. Knee and hip adduction were not affected by surface conditions nevertheless there was a difference between groups, in particular with regard to the prosthetic side. In addition, step width increased on soft surface in TKA-subjects. Conclusion: Gait on an even and soft surface did not amplify asymmetries in TKA-subjects, but decreased knee flexion and increased step-width, albeit with similar gait speed as the control group suggests that the soft surface provided a small but significant challenge making the TKA-subjects precautious.

  • 64.
    Bjerke, Joakim
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Department of Physiotherapy, Faculty of Health and Social Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
    Öhberg, Fredrik
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Nilsson, Kjell G
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Stensdotter, Ann-Katrin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. epartment of Physiotherapy, Faculty of Health and Social Sciences, Norwegian University of Science and Technology, Trondheim, Norway .
    Walking on a compliant surface does not enhance kinematic gait asymmetries after unilateral total knee arthroplasty2016In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, no 8, p. 2606-2613Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To investigate gait asymmetries and the effect of walking on compliant surfaces in individuals with unilateral total knee arthroplasty (TKA), hypothesizing that asymmetries would increase as an effect of the compliant surface.

    METHODS: Individuals with unilateral TKA ~19 months post-operative (n = 23, median age 59 years) recruited from one orthopaedic clinic and age- and gender-matched healthy individuals without knee complaints (n = 23, median age 56 years) walked at comfortable speed on a hard surface and on a compliant surface. 3D kinematic analyses were made for knee and hip angles in sagittal and frontal planes, stance time, step length, and gait velocity.

    RESULTS: Shorter stance time (p < 0.01) and less peak knee flexion (p < 0.001) at weight bearing acceptance was found in the prosthetic side compared with the contralateral side. Larger knee (p < 0.01) and hip (p < 0.001) adduction was found compared with healthy controls. Neither asymmetries between the prosthetic and the contralateral side nor differences compared with healthy controls were enhanced when walking on compliant surfaces compared with hard surfaces.

    CONCLUSION: The TKA group adapted their gait to compliant surfaces similarly to healthy controls. Gait asymmetries in the TKA group observed on hard surface were not enhanced, and adduction in hip and knee joints did not increase further as an effect of walking on compliant surfaces. Thus, unfavourable knee joint loading did not increase when walking on a compliant surface. This implies that recommendations for walking on soft surfaces to reduce knee joint loading are not counteracted by increased gait asymmetries and unfavourable joint loading configurations.

    LEVEL OF EVIDENCE: III.

  • 65.
    Björkholm, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wahlström, Olivia
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Är yt-EMG ett reliabelt instrument i kombination med Biodex vid mätning av bukmuskelaktivitet?: En pilotstudie med friska kontrollpersoner och personer med abdominal rektusdiastas.2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Abdominal rektusdiastas (ARD) är ett tillstånd då de raka magmusklerna delar på sig för att linea alba blir slapp. Detta kan drabba kvinnor under graviditet och kraftigt överviktiga. Personer med ARD kan uppleva nedsatt styrka och obehagskänsla.

    Metod: Totalt fem deltagare medverkade i bukmuskelmätningar, tre friska kontrollpersoner och två personer med ARD. Elektroder för yt-elektromyografi (yt-EMG) placerades på sex olika ställen över deltagarnas m. rectus abdominis och m. obliquus externus abdominis. Muskelaktivitet och muskelstyrka mättes genom isometriska kontraktioner i Biodex dynamometer. Deltagarna fick utföra fem kontraktioner om fem sekunder med fem sekunder vila mellan varje kontraktion. Detta upprepades två gånger för varje deltagare med en veckas mellanrum. Relativ och absolut test-retest relabilitet beräknades med intraclass correlation coefficient (ICC) och minimal detectable change i % (MDC %) på timing, amplitud och fatigue uppmätt med yt-EMG och muskelstyrka uppmätt med Biodex.

    Resultat: Den relativa och absoluta reliabiliteten visade sig vara varierad avseende samtliga variabler. Relativ reliabilitet gick från låg till utmärkt (ICC: 0,36—0,92) och absolut reliabilitet visade MDC % 42—362

    Konklusion: Denna pilotstudie kan ge en grund för vidare studier om hur muskelfunktionen är påverkad hos personer med ARD med hjälp av yt-EMG, dock krävs fortsatta studier med fler deltagare för att resultat ska kunna generaliseras.

  • 66.
    Björkkvist, Johan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Interplay in deformation between dorsal neck muscles: an observational ultrasound study2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: Neck pain is an increasing problem today and impaired neck muscle function may lead to disability. Neck specific training can reduce pain and increase function, but the activation of the muscles is unknown. Ultrasound with post-process speckle tracking can be used to measure deformation and deformation rate of the muscles. No previous studies have investigated neck exercise used in rehabilitation of neck pain. Aim: To investigate differences in deformation between different muscle layers in dorsal neck muscles and their interplay during quadruped rotational training in neck-healthy subjects. Method: Deformation and deformation rate were investigated in three dorsal neck muscles in twenty neck healthy subjects by ultrasonography with speckle tracking analyses. Repeated measures ANOVA was used to measure differences between the muscles and Kendall’s tau correlation was used to calculate the interplay between the muscles. Results: The semispinalis capitis muscle show the highest deformation in left rotation (F(1.23, 24.26)=6.90, p=0.01) compared to the multifidus (p=0.05) and trapezius (p=0.03) muscles. Interplay was seen between semispinalis capitis and the trapezius muscles in both left and right rotation, respectively (r=0.42 and r=0.34) regarding deformation. In deformation rate the semispinalis capitis muscle showed the highest degree of deformation in both left (F(1.43, 27.25)=9.05, p=<0.01) and right rotation (F(2, 38)=14.26, p=< 0.01). Interplay was seen between the semispinalis capitis and the trapezius muscle in right rotation (r=0.47) the multifidus muscles in both left (r=0.58) and right rotation (r=0.62). Conclusion: The ultra sound examination shows that the semispinalis capitis muscle is activated mainly but that it interacts with both the trapezius and the multifidus muscle. This result should be interpreted with care. More studies are needed to confirm if the deformations are active or passive.

  • 67.
    Björklund, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Djupsjöbacka, Mats
    Svedmark, Åsa
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Effects of tailored versus non-tailored treatment on pain and pressure pain threshold in women with non-specific neck pain: A randomized controlled trial2014Conference paper (Other academic)
  • 68.
    Björklund, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Ga¨vle.
    Wiitavaara, Birgitta
    Heiden, Marina
    Responsiveness and minimal important change for the ProFitMap-neck questionnaire and the Neck Disability Index in women with neck-shoulder pain2017In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 26, no 1, p. 161-170Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim was to determine the responsiveness and minimal important change (MIC) of the questionnaire ProFitMap-neck that measures symptoms and functional limitations in women with neck pain. The same measurement properties were determined for Neck Disability Index (NDI) for comparison purposes.

    METHODS: Longitudinal data were derived from two randomized controlled trials, including 103 and 120 women with non-specific neck pain, with questionnaire measurements performed before and after interventions. Sensitivity and specificity to discriminate between improved and not or little changed participants, based on categorization of a global rating of change scale (GRCS), were determined for the ProFitMap-neck indices and NDI by using area under receiver operating characteristic curves (AUC). Correlations between the GRCS anchor and change scores of the questionnaires were also used to assess responsiveness. The change score that showed the highest combination of sensitivity and specificity was set for MIC.

    RESULTS: The ProFitMap-neck indices showed similar responsiveness as NDI with AUC exceeding 0.70 (Range: ProFitMap-neck, 0.74-0.83; NDI, 0.75-0.86). The MIC in the two samples ranged between 6.6 and 13.6 % for ProFitMap-neck indices and 5.2 and 6.3 % for NDI. Both questionnaires had significant correlations with GRCS (Spearman's rho 0.47-0.72).

    CONCLUSIONS: Validity of change scores was endorsed for the ProFitMap-neck indices and NDI with adequate ability to discriminate between improved and not or little changed participants. Values of minimal important change were presented.

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  • 69.
    Björnfot, Elina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Eriksson, Amanda
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Samband mellan fysisk aktivitetsnivå, kinesiofobi och symtomskattning hos kvinnor med lokal nacksmärta och generaliserad spinal smärta: En korrelationsstudie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Nacksmärta är ett globalt hälsoproblem och samtidig smärta i nacke och rygg påträffas ofta, särskilt hos kvinnor. Den bakomliggande orsaken är till stor del okänd och en funktionsnedsättande rädsla för rörelse, dvs. kinesiofobi är vanligt förekommande hos personer med muskuloskeletal smärta vilket är problematisk då fysisk aktivitet har visat fördelaktiga effekter mot ospecifik nacksmärta.Syfte: Att undersöka samband mellan symtomskattning, fysisk aktivitetsnivå och kinesiofobi hos kvinnor med kronisk ospecifik nacksmärta, samt analysera eventuella skillnader mellan lokal nacksmärta och samtidig rygg- och nacksmärta (generaliserad spinal smärta). Metod: I studien ingick 118 deltagare. Två undergrupper skapades för att skilja generaliserad spinal smärta och lokal nacksmärta. Symtomskattning baserades på ProFitMap-neck, kinesiofobi på the Tampa Scale for Kinesiophobia och fysisk aktivitetsnivå på utvalda frågor från LIV2000. En korrelationsanalys gjordes mellan variablerna i helgrupp och därefter i undergrupper, enligt Spearman’s rho. Test av skillnader i undergrupperna gjordes enligt Mann Whitney och oparat t-test. Resultat: Ett signifikant samband sågs mellan kinesiofobi och fysisk aktivitetsnivå i helgrupp (rho= -0,261 p=0,005), samt hos personer med generaliserad spinal smärta (rho= -0,308 p=0,013). För personer med generaliserad spinal smärta sågs en signifikant högre symtomskattning (p=0,003) jämfört med personer med lokal nacksmärta. Slutsats: Kvinnor med generaliserad spinal smärta upplever mer symtom än kvinnor med lokal nacksmärta, därför är det viktigt att ta hänsyn till utbredningen av symtom vid utredning och rehabilitering av kronisk ospecifik nacksmärta. Fler studier bör utföras för att undersöka hur symtom samverkar med kinesiofobi och fysisk aktivitetsnivå hos personer med generaliserad spinal smärta och lokal nacksmärta. 

  • 70. Blain, H.
    et al.
    Masud, T.
    Dargent-Molina, P.
    Martin, F. C.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    van der Velde, N.
    Bousquet, J.
    Benetos, A.
    Cooper, C.
    Kanis, J. A.
    Reginster, J. Y.
    Rizzoli, R.
    Cortet, B.
    Barbagallo, M.
    Dreinhoefer, K. E.
    Vellas, B.
    Maggi, S.
    Strandberg, T.
    A comprehensive fracture prevention strategy in older adults: the European Union Geriatric Medicine Society (EUGMS) statement2016In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 28, no 4, p. 797-803Article in journal (Refereed)
    Abstract [en]

    Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest Group on Falls and Fracture Prevention of the European Union Geriatric Medicine Society, in collaboration with the International Association of Gerontology and Geriatrics for the European Region, the European Union of Medical Specialists, and the International Osteoporosis Foundation-European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people.

  • 71. Blain, H.
    et al.
    Masud, T.
    Dargent-Molina, P.
    Martin, F. C.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    van der Velde, N.
    Bousquet, J.
    Benetos, A.
    Cooper, C.
    Kanis, J. A.
    Reginster, J. Y.
    Rizzoli, R.
    Cortet, B.
    Barbagallo, M.
    Dreinhofer, K. E.
    Vellas, B.
    Maggi, S.
    Strandberg, T.
    A comprehensive fracture prevention strategy in older adults: the European Union Geriatric Medicine Society (EUGMS) statement2016In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 20, no 6, p. 647-652Article in journal (Refereed)
    Abstract [en]

    Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest Group on Falls and Fracture Prevention of the European Union Geriatric Medicine Society (EUGMS), in collaboration with the International Association of Gerontology and Geriatrics for the European Region (IAGG-ER), the European Union of Medical Specialists (EUMS), the International Osteoporosis Foundation - European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people.

  • 72. Blain, H.
    et al.
    Masud, T.
    Dargent-Molina, P.
    Martin, F. C.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    van der Velde, N.
    Bousquet, J.
    Benetos, A.
    Cooper, C.
    Kanis, J. A.
    Reginster, J. Y.
    Rizzoli, R.
    Cortet, B.
    Barbagallo, M.
    Dreinhöfer, K.
    Vellas, B.
    Maggi, S.
    Strandberg, T.
    Alvarez, M. N.
    Annweiler, C.
    Bernard, P. -L
    Beswetherick, N.
    Bischoff-Ferrari, H. A.
    Bloch, F.
    Boddaert, J.
    Bonnefoy, M.
    Bousson, V.
    Bourdel-Marchasson, I.
    Capisizu, A.
    Che, H.
    Clara, J. G.
    Combe, B.
    Delignieres, D.
    Eklund, Patrik
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Emmelot-Vonk, M.
    Freiberger, E.
    Gauvain, J. -B
    Goswami, N.
    Guldemond, N.
    Herrero, A. C.
    Joel, M. -E
    Jonsdottir, A. B.
    Kemoun, G.
    Kiss, I.
    Kolk, H.
    Kowalski, M. L.
    Krajcik, S.
    Kutsal, Y. G.
    Lauretani, F.
    Macijauskiene, J.
    Mellingsaeter, M.
    Morel, J.
    Mourey, F.
    Nourashemi, F.
    Nyakas, C.
    Puisieux, F.
    Rambourg, P.
    Ramirez, A. G.
    Rapp, K.
    Rolland, Y.
    Ryg, J.
    Sahota, O.
    Snoeijs, S.
    Stephan, Y.
    Thomas, E.
    Todd, C.
    Treml, J.
    Adachi, R.
    Agnusdei, D.
    Body, J. -J
    Breuil, V.
    Bruyere, O.
    Burckardt, P.
    Cannata-Andia, J. B.
    Carey, J.
    Chan, D. -C
    Chapuis, L.
    Chevalley, T.
    Cohen-Solal, M.
    Dawson-Hughes, B.
    Dennison, E. M.
    Devogelaer, J. -P
    Fardellone, P.
    Feron, J. -M
    Perez, A. D.
    Felsenberg, D.
    Glueer, C.
    Harvey, N.
    Hiligsman, M.
    Javaid, M. K.
    Jorgensen, N. R.
    Kendler, D.
    Kraenzlin, M.
    Laroche, M.
    Legrand, E.
    Leslie, W. D.
    Lespessailles, E.
    Lewiecki, E. M.
    Nakamura, T.
    Papaioannou, A.
    Roux, C.
    Silverman, S.
    Henriquez, M. S.
    Thomas, T.
    Vasikaran, S.
    Watts, N. B.
    Weryha, G.
    A comprehensive fracture prevention strategy in older adults: the European union geriatric medicine society (EUGMS) statement2016In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 7, no 6, p. 519-525Article in journal (Refereed)
    Abstract [en]

    Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest group on falls and fracture prevention of the European union geriatric medicine society (EUGMS), in collaboration with the International association of gerontology and geriatrics for the European region (IAGG-ER), the European union of medical specialists (EUMS), the Fragility fracture network (FFN), the International osteoporosis foundation (IOF) - European society for clinical and economic aspects of osteoporosis and osteoarthritis (ECCEO), outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people.

  • 73.
    Blom, Anna-Klara
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Andersson, Charlotta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Akuta responser vid högintensiv uppvärmning hos idrottare2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Att undersöka förändringar i autonom balans och forcerad expiratorisk volym (FEV1) före jämfört med efter specifik intervalluppvärmning hos idrottare utan någon form av astma eller ansträngningsutlöst bronkokonstriktion (EIB). Detta för att se vilken belastning som är bäst lämpad att använda i vidare studie av akuta responser vid högintensiv uppvärmning hos individer med EIB, samt om en förskjutning i autonom balans mot en förhöjd sympatikusaktivitet parallellt med ett ökat FEV1 kan ses hos friska idrottare. 

    Metod: Fyra deltagare utförde ett Maximal Aerobic Power output test (MAP) för att beräkna maximal aerob effekt. Cykelintervaller utfördes sedan på fyra olika nivåer av intensitet (75–150% av MAP) där hjärtfrekvensvariabilitet och FEV1 mättes före och efter.

    Resultat: Endast vid cykelintervaller på 150% av MAP sågs en förändring i autonom balans med ett ökat sympatikuspåslag och ett minskat parasympatikuspåslag hos alla deltagare före jämfört med efter intervallerna. Ingen tydlig ökning sågs i FEV1 före jämfört med efter cykelintervaller på de fyra olika nivåerna av belastning (75–150% av MAP).

    Slutsats: En belastning på minst 150% av MAP kan leda till en förskjutning i autonom balans mot en förhöjd sympatikusaktivitet skall ske hos friska idrottare. FEV1 tycks ej följa kurvan för autonom balans vid samma belastning hos idrottare utan astma.

  • 74.
    Blomqvist, Sven
    et al.
    Gävle Högskola.
    Lönnberg, Lisa
    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, Physiotherapy.
    Wester, Anita
    Skolverket.
    Rehn, Börje
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Physical Exercise Frequency Seem not to Influence Postural Balance but Trunk Muscle Endurance in Young Persons with Intellectual Disability2017In: Journal of Physical Education and Sports Management, ISSN 2373-2156, E-ISSN 2373-2164, Vol. 4, no 2, p. 38-47Article in journal (Refereed)
    Abstract [en]

    Background: The influence of various physical exercise frequencies on postural balance and muscle performance among young persons with intellectual disability (ID) is not well understood.

    Method: Cross-sectional data from 26 elite athletes were compared with 37 students at a sports school and to 57 students at a special school, all diagnosed with mild to moderate ID and with different exercise frequencies. Data were also compared with a group of 149 age-matched participants without ID.

    Results: There were no significant differences in postural balance between young ID groups regardless of physical exercise frequency, all of them had however impaired postural balance compared to the non-ID group. The group with high exercise performed better than the other ID groups in the trunk muscle endurance test.

    Conclusions: It appears as if physical exercise frequency don’t improve postural balance but endurance in the trunk muscles for young persons with ID.

  • 75.
    Blomqvist, Sven
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wester, Anita
    Skolverket.
    Rehn, Börje
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Postural muscle responses and adaptations to backward platform perturbations in young people with and without intellectual disability2014In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 39, no 3, p. 904-908Article in journal (Refereed)
    Abstract [en]

    This study examines postural muscle responses to backward perturbations in young people with and without intellectual disability (ID). The study included 56 young people with ID and 43 age-matched without ID volunteers. The subjects stood on a platform that was moved backwards in a surface translation. Lower and upper leg muscles and lower back spine muscles were recorded with surface electromyography (EMG). Muscle onset latency, time to peak amplitude (EMG), adaption of muscle responses to repeated perturbations (using IEMG for epochs), and synergies and strategies were assessed. The result showed no differences between the two groups in muscle onset latency, time to peak amplitude, synergies, and strategies. However, young people with ID tended to adapt their IEMG less compared to the controls. These findings suggest that young people with ID have limited ability to adapt their postural muscle responses to repeated perturbations.

  • 76.
    Bohman, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Upplevelser av hur fysisk aktivitet på recept - FaR - påverkar den fysiska och mentala hälsan hos patienter inom primärvården: En intervjustudie2016Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Otillräcklig fysisk aktivitet är idag ett stort problem på både individ- och samhällsnivå. Fysisk aktivitet på recept, FaR, har på senare år blivit ett vanligt verktyg för att behandla och förebygga sjukdomar hos patienter inom primärvården. Det råder idag en brist på information om patienternas upplevelser av FaR. Syftet med studien var därför att undersöka hur patienter, som har blivit ordinerade FaR, upplever att receptet har påverkat den fysiska och mentala hälsan.

    Metod: I processen har en kvalitativ, beskrivande forskningsdesign använts. Studien bygger på intervjuer med 10 personer och individuella intervjuer med ett semistrukturerat frågeformulär användes. Intervjuerna transkriberades och analyserades med hjälp av kvalitativ innehållsanalys. Målet med den induktiva, kvalitativa innehållsanalysen var att ge en ökad kunskap och förståelse inom det undersökta området.

    Resultat: Resultatet av innehållsanalysen visade på upplevelser av bland annat ökat fysiskt och psykosomatiskt välbefinnande samt ökad fysisk uthållighet och styrka .

    Slutsats: Studien visar på ett antal olika upplevelser hos patienter inom primärvården som har ökat sin fysiska aktivitetsnivå via FaR. Upplevelser som kan tas tillvara på av sjukgymnaster/fysioterapeuter i det kliniska arbetet för att stödja patienter i deras strävan till ett mer aktivt liv. Fortsatt forskning inom området premieras förhoppningsvis i framtiden för att ytterligare öka förståelsen kring upplevelser av FaR samt för att öka förståelsen kring vilka motivationsfaktorer som kan vara avgörande för en ökad fysisk aktivitet.

  • 77.
    Bolin, Jonas
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    En motorisk 5 års-uppföljning av underburna barn på Sundsvalls Sjukhus2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Sammanfattning:  Syfte: Att beskriva perinatala bakgrundsfaktorers betydelse avseende motorisk utveckling vid fem års ålder hos barn födda före vecka 32+0 GA, vårdade vid länsverksamheten Barn och Ungdom, Sundsvalls sjukhus mellan åren 2006-2009. Ett annat syfte var att se vilken motorisk förmåga denna grupp underburna barn hade vid fem års ålder jämfört med normalpopulationen.

    Metod: En retrospektiv longitudinell journalstudie där journaldata för 43 barn födda före vecka 32+0 GA vid Sundsvall sjukhus, avseende bakgrundsfaktorer som födelsevikt, födelselängd, huvudomfång samt om barnen initialt vårdats i respirator jämfördes med resultat från ett motoriskt test vid fem års ålder (Movement ABC) Resultatet vid den motoriska uppföljningen vid fem års ålder analyserades även mot normativa data från Movement ABC.

    Resultat: Gruppen barn (n=43) födda före vecka 32+0 GA visade signifikant större motoriska funktionsnedsättningar än normalpopulationen p<0,0001. Av dessa hamnade 23,3 % i kategorin avvikande motorisk förmåga (under percentil 5). Ingen skillnad noterades mellan de mycket underburna och de extremt underburna barnen (<vecka 28+0 GA). Födelselängd, födelsevikt samt hur många dygn barnen legat i respirator initialt inverkade inte på det motoriska resultatet vid femårsuppföljningen. Barn med större huvudomfång (≥+1SD) vid födseln uppvisade större motoriska svårigheter vid uppföljningen (p=0,035). En tendens sågs även mot att flickor klarade sig bättre än pojkarna motoriskt men skillnaden var inte signifikant (p=0,06).

    Slutsats: Gruppen mycket och extremt underburna får oftare än fullgångna barn motoriska svårigheter. Därför är det viktigt att denna grupp följs upp så att barn som behöver extra stöd snabbt kan få detta. Stor försiktighet bör iakttas vid tolkning av perinatala bakgrundsfaktorers påverkan då studiepopulationen var mycket liten.

  • 78.
    Borg, Tina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Smärtvariabilitet hos tandläkarstudenter med nackbesvär.: En longitudinell studie.2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Syftet var att beskriva smärtfrekvens och smärtvariabilitet med avseende på nacksmärta hos en grupp tandläkarstudenter under klinisk utbildning. Ytterligare ett syfte var att redogöra för faktorer som predicerar smärtvariabilitet.

     

    Metod: Designen var en longitudinell kohortstudie. Sjutton tandläkarstudenter med nackbesvär fick besvara frågor om smärta, symptom, funktion, stress, fysisk aktivitet, hälsorelaterad livskvalitet och medicinering samt genomgå en funktionsundersökning. Därefter skattades smärtintensiteten under 4 veckor med numerical rating scale (NRS). Variabiliteten beräknades genom den intraindividuella standardavvikelsen av samtliga smärtskattningar. Multipel linjär regression användes för att undersöka predicerande faktorer.

     

    Resultat: Samtliga upplevde återkommande besvär, 53 % angav besvär ibland/då och då, 24 % flera gånger i veckan och 24 % dagligen. Medelvärdet för smärtvariabiliteten var 1,2 (variationsvidd 0-3). Att ha besvär utan diagnos predicerade ökad variabilitet (2,2 skalsteg på NRS). En diagnos på cervikalgi eller trapeziusmyalgi predicerade en minskning av variabiliteten (1,8 resp. 1,2 skalsteg på NRS).

     

    Slutsats: Tandläkarstudenter med nackbesvär upplever återkommande nackbesvär. Smärtan uppvisar variabilitet i intensitet för de allra flesta och variabiliteten motsvarar en klinisk relevant skillnad för över två tredjedelar. Att inte ha en funktionsdiagnos predicerar hög variabilitet och att ha en diagnos på trapeziusmyalgi eller cervikalgi predicerar låg variabilitet. Urvalet var litet så resultatet bör tolkas med försiktighet.

     

  • 79.
    Boström, Gustaf
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Conradsson, Mia
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Hörnsten, Carl
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Littbrand, Håkan
    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.
    Effects of a high-intensity functional exercise program on depressive symptoms among people with dementia in residential care: a randomized controlled trial2016In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 31, no 8, p. 868-878Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study is to evaluate the effect of a high-intensity functional exercise program on depressive symptoms among older care facility residents with dementia.

    METHODS: Residents (n = 186) with a diagnosis of dementia, age ≥ 65 years, Mini-Mental State Examination score ≥ 10, and dependence in activities of daily living were included. Participants were randomized to a high-intensity functional exercise program or a non-exercise control activity conducted 45 min every other weekday for 4 months. The 15-item Geriatric Depression Scale (GDS) and the Montgomery-Åsberg Depression Rating Scale (MADRS) were administered by blinded assessors at baseline, 4, and 7 months.

    RESULTS: No difference between the exercise and control activity was found in GDS or MADRS score at 4 or 7 months. Among participants with GDS scores ≥ 5, reductions in GDS score were observed in the exercise and control groups at 4 months (-1.58, P = 0.001 and -1.54, P = 0.004) and 7 months (-1.25, P = 0.01 and -1.45, P = 0.007). Among participants with MADRS scores ≥ 7, a reduction in MADRS score was observed at 4 months in the control group (-2.80, P = 0.009) and at 7 months in the exercise and control groups (-3.17, P = 0.003 and -3.34, P = 0.002).

    CONCLUSIONS: A 4-month high-intensity functional exercise program has no superior effect on depressive symptoms relative to a control activity among older people with dementia living in residential care facilities. Exercise and non-exercise group activities may reduce high levels of depressive symptoms.

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  • 80.
    Brinckmann, Paula
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sjöberg, Anna
    Time to stabilization during a single-leg hop is less variabe in participants with anterior cruciate ligament reconstruction than in controls2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Objective: The purpose of this study was to compare time to stabilization (TTS) and standard deviation (SD) during a single-leg hop of individuals with anterior cruciate ligament reconstruction (ACLR) to healthy controls, and between the reconstructed and the contralateral uninjured sides.

    Design: Cross-sectional study with two groups.

    Participants: A total number of 62 participants (36 ACLR and 26 Controls).

    Main Outcome Measure: Participants performed five trials of horizontal single-leg hops for each side onto a force plate, and TTS were calculated for the landing phase. Main outcome measures were: mean TTS mediolateral direction, mean TTS anteroposterior direction, SD TTS mediolateral direction and standard deviation TTS anteroposterior direction. General linear models repeated measures analyses of variance were conducted to analyze between-group and with-in group differences (2 x 2, group x side). If significant effects or interactions were found, post-hoc analyses with Bonferroni corrections were performed (P≤0.05).

    Results: No significant group or side effects or interactions were found for mean TTS or for SD TTS in the anteroposterior direction. However, significant group effect and group x side interaction was found for SD TTS in mediolateral direction. SD TTS in the mediolateral direction was significantly lower on the ACLR injured side compared to controls (P=0.031).

    Conclusions: The results indicate that the ACLR group had a less varied movement pattern during a single-leg hop compared to the control group, as reflected by TTS.

  • 81.
    Broman, Karolina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    "Den svåra balansgången": Pedagogers upplevelse av att arbeta med barn med motoriska svårigheter: En kvalitativ studie2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Prevalensen av barn med fördröjd utveckling är nästan ett av var sjätte barn, och eftersom barns första åtta år är en viktig period för tillväxt och utveckling som kan påverka barnets fortsatta liv, bör barnen tidigt erhålla ett gott stöd.

    Syfte: Syftet med uppsatsen är att nå ökad kunskap om hur pedagoger upplever sitt arbete med barn med motoriska svårigheter, och vilket stöd de upplever att de får av en fysioterapeut.

    Metod: Kvalitativ studie grundad på semistrukturerade intervjuer med fem pedagoger som arbetar med barn som har motoriska svårigheter. Barnens ålder är 1-9 år. Intervjuerna analyserades med hjälp av the grounded theory, och för att öka trovärdigheten i datamaterialet genomfördes en triangulering av materialet med totalt tre personer.

    Resultat: En huvudkategori: ”Den svåra balansgången” och fem kategorier: ”Områden som skapar osäkerhet hos pedagogen”,Stöd för pedagogen”, ”Varför en diagnos? ”, ”Målet: ett självständigt barn” och ”Respekt” identifierades. Huvudkategorin, ”Den svåra balansgången”, representerar pedagogernas strävan att nå balans i sitt arbete med barn som har motoriska svårigheter medan kategorierna visar delar som påverkar balansen.

    Slutsats: Pedagogerna upplever att deras arbete är en ständig balansgång där olika delar i arbetet måste avvägas mot varandra i en kontinuerlig strävan efter jämnvikt.

  • 82.
    Brännlund, Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sahlström, Robin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Trapezius pain pressure threshold as a predictor for neck muscle functions and cervical range of motion: A comparison of female chronic neck pain patients with or without traumatic background2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Neck pain is one of the most common causes of disability with a lifetime prevalence of approximately 50%. Few previous studies have investigated the correlation between pain and muscle functions and they’ve all used subjective self-estimated pain-rating scales as pain measurements. Pain pressure threshold (PPT) as a pain measurement gives a definite value of the pain which could be clinically useful for therapists.

    Purpose: The primary purpose of this study is to examine if Trapezius PPT can predict muscle functions and cervical range of motion (CROM) in women with chronic neck pain. Other purposes are to examine differences between patients with whiplash associated disorders (WAD) and idiopathic neck pain (INP) as well as if central sensitization affects the examined variables.

    Method: The subjects were devided into three groups; healthy controls (n=29), WAD (n=28) and INP (n=36). PPTs, neck muscle strengths, neuromuscular controll, muscle endurance and CROM were measured and regression analysis as well as difference tests were performed.

    Result: The results show several significant differences between the WAD and INP patients. The regression analysis shows that Trapezius PPT might be used for predicting muscle functions and CROM in the WAD group. The results also show that central sensitization negatively affects the examined variables.

    Conclusion: There are major differences between chronic WAD and INP patients. One might suggest to separate these groups in future studies. The clinical usability of Trapezius PPT as a single predictor for neck muscle functions and CROM needs to be further examined.

  • 83.
    Brännström, Johan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Teamsamarbete i företagshälsovården: En kartläggning i fyra svenska län2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion

    Teamsamarbete mellan professioner inom företagshälsovård kan förbättra arbetets kvalité, resultat och säkerhet.Vidare kan teamsamarbete främja teamets interna hälsa och teamets rehabiliteringsfokus kan vara avgörande för patientens arbetsåtergång.

     

    Syfte

    -Att kartlägga hur teamsamarbetet fungerar inom företagshälsovård.

    -Att undersöka skillnader mellan respondenter som upplevde sällan respektive oftast välfungerande team vad gäller arbetstillfredställelse, självskattad hälsa samt syn på rehabilitering avseende hälsa och arbetsåtergång

     

    Metod

    Enkäten Assessment of Interprofessional Team Collaboration Scale – Svensk version (AITCS-s), med subskalorna partnerskap/delat beslutsfattande, samarbete och koordination användes vid kartläggningen av teamsamarbetet utifrån en femgradig skala. Frågor kring självskattad hälsa, arbetstillfredställelse samt syn på patientrehabilitering avseende hälsa och arbetsåtergång bifogades enkäten.och den tredje 168 personer vid 14 företagshälsovårdsenheter erbjöds deltagande varav 73 personer ingick i studien.

     

    Resultat

    Respondenterna skattade sitt teamsamarbete som välfungerande inom subskalorna partnerskap/delat beslutsfattande (4,11 poäng, SD 0,59) och samarbete (4,13 poäng, SD 0,56). Subskalan koordination skattades lägre (3,88 poäng, SD 0,63). Ingen skillnad mellan respondenter som upplevde sällan respektive oftast välfungerande team noterades för arbetstillfredställelse (p=0,058), självskattad hälsa (p=0,31) eller syn på rehabilitering (hälsa: p=1,00 och arbetsåtergång: p=0,20)

     

    Konklusion

    Teamsamarbetet bedömdes vara välfungerande vilket indikerar effektiv rehabilitering avseende arbetsåtergång. Ingen skillnad mellan sällan respektive oftast välfungerande team noterades för arbetstillfredställelse, självskattad hälsa eller syn på rehabilitering. 

  • 84.
    Brännström, Jon
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Boström, Gustaf
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Psychotropic drug use and mortality in old people with dementia: investigating sex differences2017In: BMC Pharmacology & Toxicology, E-ISSN 2050-6511, Vol. 18, article id 36Article in journal (Refereed)
    Abstract [en]

    Background: Psychotropic drugs are common among old people with dementia, and have been associated with increased mortality. Previous studies have not investigated sex differences in this risk. This study was conducted to analyse associations between the use of antipsychotics, antidepressants, and benzodiazepines and 2-year mortality in old people with dementia, and to investigate sex differences therein.

    Methods: In total, 1037 participants (74% women; mean age, 89 years) with dementia were included from four cohort studies and followed for 2 years. Data were collected through home visits and medical records. Cox proportional hazard regression models were used to analyse associations between ongoing baseline drug use and mortality. Multiple possible confounders were evaluated and adjusted for.

    Results: In fully adjusted models including data from the whole population, no association between baseline psychotropic drug use and increased 2-year mortality was seen. Significant sex differences were found in mortality associated with antidepressant use, which was protective in men, but not in women (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.40–0.92 and HR 1.09, 95% CI 0.87–1.38, respectively). The interaction term for sex was significant in analyses of benzodiazepine use, with a higher mortality risk among men than among women.

    Conclusions: Among old people with dementia, ongoing psychotropic drug use at baseline was not associated with increased mortality in analyses adjusted for multiple confounders. Sex differences in mortality risk associated with antidepressant and benzodiazepine use were seen, highlighting the need for further investigation of the impact of sex.

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  • 85.
    Bråndal, Anna
    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.
    Rehabilitation after stroke with focus on early supported discharge and post-stroke fatigue2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background Stroke is a major cause of disability worldwide. After treatment in a specialized stroke unit, early supported discharge (ESD) followed by home rehabilitation has shown to be an effective way to improve patient outcome and quality of care for persons with mild to moderate stroke. ESD service is recommended in the national and international guidelines for stroke care, but has only partially been implemented in Sweden. Following stroke, fatigue is a common consequence that often becomes more evident when the patient comes home. Currently, there is insufficient evidence about how to measure, treat and handle post-stroke fatigue. The overall aim of this thesis was to evaluate and implement early supported discharge (ESD) based on stroke patients experience after discharge from the stroke unit and local conditions. The aim was also to evaluate post-stroke fatigue with a potentially valid and reliable scale and finally to prepare for a study to evaluate cardiorespiratory training as a part of ESD service for patients with post-stroke fatigue.

    Methods In paper I, nine strategically chosen patients were interviewed of their experience of falling ill, the hospital stay, discharge, contact with health care after discharge and their request of support. Papers II-III describe and evaluate the development, content, implementation and effects of a locally adopted method for early supported discharge (Umeå Stroke Center ESD) in modern stroke care. Paper II included 153 consecutive patients and paper III, 30 232 patients with first-ever stroke registered in the Riksstroke registry in Sweden. Paper II evaluated number of patients/year, clinical and functional health status, satisfaction in relation to needs, accidental falls/other injuries and resources with the result summarized in a value compass. The implementation process was evaluated retrospectively by means of Consolidated Framework for Implementation (CFIR). Paper III evaluated patient reported outcome measurements (PROMs) at 3 months. The primary outcome in paper III was satisfaction with the rehabilitation after discharge. Secondary outcomes were information about stroke provided, tiredness/fatigue, pain, dysthymia/depression, general health status and dependence in activities of daily living (mobility, toilet hygiene and dressing). Multivariable logistic regression models for each PROM was used to analyze associations between PROMs and ESD/no ESD. In Paper IV, the Fatigue Assessment scale (FAS) was translated into Swedish and evaluated regarding psychometric properties when self-administered by persons with mild to moderate stroke. 72 consecutively patients selected from the stroke unit admission register received a letter including three questionnaires: the FAS, the Short Form Health Survey (SF-36) subscale for vitality and the Geriatric Depression Scale GDS-15. A second letter with FAS was sent within 2 weeks, for re-test evaluation. Paper V is a study protocol for a planned randomized controlled trial (RCT) of 50 consecutive stroke patients will who receive stroke unit care followed by ESD-service at Umeå Stroke Center, University Hospital, Umeå, Sweden. Paper V will investigate if a structured cardiorespiratory interval training program (CITP) added to the ESD-service may result in relieved post-stroke fatigue and increased oxygen uptake.

    Results The interviews in Paper I revealed three main categories with subcategories: “Responsible and implicated”, “Depersonalized object for caring measures” and “The striving for repersonalization and autonomy”. The findings indicate that coming home gave the informants’ important insights and understanding of the stroke, its consequences and was also an important factor for the recovery. Paper II-III showed that it is possible to develop and implement an adapted ESD service for stroke patients based on the patients’ experiences and requests, evidence-based recommendations and local conditions. The ESD service reduced dependence of activity, increased mobility with seemingly no increased risk of accidental falls or other injuries. The patient satisfaction in relation to needs regarding the ESD was high. Paper III showed that patients that received ESD were more satisfied with rehabilitation after discharge, had less need for assistance with ADL and less dysthymia/depression compared to patients that did not receive ESD. Study IV showed that the Swedish FAS used at home as a selfadministered questionnaire is a reliable and valid questionnaire for measuring fatigue in persons with mild to moderate stroke. The internal consistency was good, the agreement between the test and retest reliability for individual items (weighted kappa) was for the majority of items good or moderate. The relative reliability for total scores was good and the absolute reliability was 9 points. The Swedish FAS had no floor nor ceiling effects and correlated both with the SF-36, subscale for vitality and the GDS-15 indicating convergent construct validity, but not divergent construct validity.

    Conclusion It is possible to develop and implement ESD care for stroke patients based on patients’ experience and needs, evidence-based principles and local conditions. Early supported discharge (ESD) in the setting of modern stroke unit care appears to have positive effects on rehabilitation in the subacute phase. The Swedish FAS used at home as a self-administered questionnaire is reliable and valid for measuring fatigue in persons with mild to moderate stroke.

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  • 86.
    Bråndal, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Glader, Eva-Lotta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Department of Clinical Sciences, Karolinska Institute, Danderyd hospital, Stockholm, Sweden.
    Effect of early supported discharge after stroke on patient reported outcome based on the Swedish Riksstroke registry2019In: BMC Neurology, E-ISSN 1471-2377, Vol. 19, article id 40Article in journal (Refereed)
    Abstract [en]

    Background: The efficacy of early supported discharge (ESD) has not been tested in current stroke care setting, which provide relatively short hospital stays, access to hyper-acute therapies and early carotid stenosis interventions. This study aimed to compare patient-reported outcome measures (PROM) among patients with stroke that received modern stroke unit care with or without ESD.

    Methods: Observational study of 30,232 patients with first-ever stroke registered in the Riksstroke registry in Sweden, between 1 January 2010 and 31 December 2013. Patient characteristics were collected from the Riksstroke and Statistics Sweden databases. The primary outcome was satisfaction with the rehabilitation at 3 months after discharge. Secondary outcome were information about stroke provided, tiredness/fatigue, pain, dysthymia/ depression, general health status and dependence in activities of daily living (mobility, toileting and dressing) at 3 months after the stroke. We used separate multivariable logistic regression models for each PROM variable to analyze associations between PROMs and ESD/no ESD.

    Results: The ESD group comprised 1495 participants: the control group comprised 28,737 participants. Multivariable logistic regression models of PROMs showed that, compared to controls, the ESD group was more satisfied with rehabilitation after discharge (OR: 1.78, 95% CI: 1.17–2.49), experienced less dysthymia/depression (OR: 0.68, 95% 0.55–0.84) and showed more independence in mobility (OR: 1.50, 95% CI: 1.17–1.92), toileting (OR: 1.30, 95%CI: 1.05–1.61), and dressing (OR: 1.23, 95%CI: 1.02–1.48).

    Conclusion: In the setting of modern stroke unit care, ESD appeared to have positive effects on stroke rehabilitation, in the subacute phase.

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  • 87.
    Bråndal, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Reliability and validity of the Swedish Fatigue Assessment Scale when self-administrered by persons with mild to moderate stroke2016In: Topics in Stroke Rehabilitation, ISSN 1074-9357, E-ISSN 1945-5119, Vol. 23, no 2, p. 90-97Article in journal (Refereed)
    Abstract [en]

    Objective: To examine internal consistency, test-retest reliability, floor/ceiling effects and construct validity of the Fatigue Assessment Scale (FAS), when self-administrated by persons with mild to moderate stroke.

    Method: The FAS was translated into Swedish and tested for psychometric properties when self-administrated by persons with mild to moderate stroke. Participants, consequently selected from the stroke unit admission register received a letter with three questionnaires: the FAS, Short Form Health Survey (SF-36) subscale for vitality and Geriatric Depression Scale, GDS-15. Within two weeks, a second letter with FAS was sent for re-test.

    Result: Seventy-tree persons with mild to moderate stroke participated in the study. Internal consistency was good (Cronbach’s alpha 0.82). The test and retest reliability of individual items showed that five items out of 10 items were good (weighted kappa > 0.60), four were moderate (0.40-0.60), and one was fair (0.22). The relative reliability between total scores was good (ICC 3.1 = 0.73) and the absolute reliability was nine points, meaning that a change of at least nine points in total score implies a real change of fatigue level. Correlation analysis showed that the Swedish FAS correlated with the SF-36 subscale for vitality (rs = - 0.73) and GDS-15 (rs = 0.62), suggesting convergent construct validity. There were no floor or ceiling effects.

    Conclusion: The Swedish translation of the FAS used as a self-administrated questionnaire is reliable and valid for measuring fatigue in persons with mild to moderate stroke.

  • 88.
    Bråndal, Anna
    et al.
    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.
    Glader, Eva-Lotta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Does a cardiorespiratory interval training program at home improve post-stroke fatigue? Study protocol of a randomized controlled trialManuscript (preprint) (Other academic)
  • 89.
    Buck, Sebastian
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Development of a new functional test targeting proprioceptive ability following anterior cruciate ligament injury2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Movement control is critically dependent on exteroceptive and proprioceptive information. Reduced proprioception of the knee has been demonstrated after injury of the anterior cruciate ligament (ACL). Various test have been proposed in research, but their implementation and evaluation still represent clinical challenges. There is thus a pronounced need for improved clinical discriminative knee function tests related to proprioceptive ability.

    Aim: Our main aim of this pilot study was to develop and evaluate a new functional proprioception test, and secondly evaluate if our test could discriminate ACL injured from controls.

    Method: We developed a test in which participants step repeatedly over an obstacle, with downward vision occluded. Kinematics were collected in 3D motion laboratory from participants with ACL injury (n=8) and healthy controls (n=10). Coefficient of variation were calculated for the following variables: foot clearance, knee flexion angle and step length and compared between legs within group and between groups.

     

    Results: For between-group comparison larger variability of step length on the trailing leg of both legs were found in the ACL group. No other significant differences were found between the groups and within group differences were also nonsignificant.  

    Conclusion: Our test, so far in a small population, did not discriminate between legs within ACL injured persons or between ACL injured persons and healthy controls. This test needs to be further developed to determine whether it can discriminate between ACL injured and controls. If so, obstacle task may provide a valuable functional test of sensorimotor control following an ACL injury.

  • 90. Bui, Kim-Ly
    et al.
    Nyberg, André
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Maltais, François
    Saey, Didier
    Functional tests in chronic obstructive pulmonary disease part 1: clinical relevance and links to the International classification of functioning, disability and health2017In: Annals of the American Thoracic Society, ISSN 2329-6933, E-ISSN 2325-6621, Vol. 14, no 5, p. 778-784Article in journal (Refereed)
    Abstract [en]

    Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide and an important cause of disability. A thorough patient-centered outcome assessment, including not only measures of lung function, exercise capacity and health-related quality of life, but also of functional capacity and performance in activities of daily life, is imperative for a comprehensive management of chronic obstructive pulmonary disease. This American Thoracic Society Seminar Series is devoted to help clinicians substantiate their choice of functional outcome measures in this population. In Part 1 of this two-part Seminar Series, we aim to describe the various domains of functional status, to elucidate terms and key concepts intertwined with functioning, and to demonstrate the clinical relevance of assessing functional capacity in the context of activities of daily living, in agreement with the International Classification of Functioning, Disability and Health. We hope that a better understanding of the various defining components of functional status will be instrumental to healthcare providers to optimize chronic obstructive pulmonary disease evaluation and management, ultimately leading to improved quality of life of patients afflicted by this condition. This first paper also serves as an introduction to Part 2 of this Seminar Series, where the main functional tests available to assess upper and lower body functional capacity of these patients will be discussed.

  • 91.
    Byman, Emelie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Wahlberg, Jenny
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Tankar kring bemötande och behandling av gravida kvinnors bäcken- och ländryggssmärta: En kvalitativ intervjustudie med fem barnmorskor2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Graviditetsrelaterad bäcken- och ländryggssmärta är en komplikation som drabbar närmare 50 % av alla gravida. Det är dock inte fastställt varför bara vissa kvinnor drabbas. Om de drabbade kvinnorna däremot identifieras redan vid inskrivning på mödravårdscentralen kan symtomen lindras om tidiga åtgärder sätts in.

     

    Syfte: Att undersöka barnmorskors tankar och upplevelser kring graviditetsrelaterad bäcken- och ländryggssmärta utifrån ett interprofessionellt samarbete med fysioterapeuter.

     

    Metod: Studien bygger på semistrukturerade intervjuer med fem barnmorskor. Datamaterialet genomgick en kvalitativ innehållsanalys i enlighet med Graneheim och Lundman.

     

    Resultat: Analysen resulterade i fem kategorier som berör områdena: Bemötande, diagnostisering, behandlingsalternativ, individanpassning och prevention samt interprofessionellt samarbete. Ett antal subkategorier skapades.

     

    Slutsats: Denna studie visar på att barnmorskor har stor erfarenhet och kunskap om hur graviditetsrelaterad bäcken- och ländryggssmärta diagnostiseras, tack vare deras kliniska erfarenhet. Barnmorskorna vittnar även om en viss tveksamhet i sin syn på hur dessa smärtproblem ska behandlas, vilket vittnar om behovet av att utveckla ett bättre samarbete med fysioterapeuter. I framtiden skulle de båda yrkesgrupperna i så fall kunna erbjuda dessa kvinnor bättre och mer effektiv behandling. Ökad information gällande kvinnohälsa och graviditetsrelaterad bäcken- och ländryggssmärta på bådas respektive grundutbildningar borde förbättras enligt författarna och informanterna, för att öka kunskapen och intresset för detta folkhälsoproblem.  

  • 92.
    Bäckman, Pernilla
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Validering av självtest för balans och funktionell styrka med mobiltelefon för äldre personer2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Att testa balans och styrka med hjälp av en mobiltelefon skulle kunna göra det möjligt för äldre att själva utföra enklare balans- och styrketest i hemmiljö. En prototyp av ett sådant test har tagits fram och som en del i utvecklingen av prototypen ska testresultat jämföras mot kliniskt validerade test. Syfte: Undersöka den samtidiga validiteten mellan kliniska test och rörelsevariabler insamlade samt beräknade med en prototyp av en mobil applikation. Metod: 21 personer (medelålder 78år) inkluderades. Korrelation mellan mobiltelefonens registreringar under 4- stage balance test samt en maximal uppresning och resultatet för sju kliniska test (five times sit to stand, 1 repetitions maximum i benpress, 30 sekunders uppresningstest, MiniBESTest, functional reach, modifierat stepping test och 4-stage balance test) beräknades. Resultat: De variabler som beräknats från mobiltelefonens registreringar under maximalt uppresningstest korrelerade samtliga signifikant med resultatet på 30 sekunders uppresningstest. För balanstesten sågs en korrelation mellan mobiltelefonens registreringar av svaj i den svåraste fotpositionen deltagarna klarat och den totala tiden deltagarna balanserat i 4-stage balance test. I övrigt fanns inga signifikanta korrelationer. Slutsats: Mätningar med en mobiltelefon under en maximal uppresning skulle kunna kvantifiera äldres funktionella benstyrka i likhet med 30 sekunders uppresningstest. En mobiltelefons mätningar verkar inte kunna kvantifiera äldre personers balans på liknande sätt som kliniska balanstest

  • 93.
    Bäckström Andersson, Solveig
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Vårdvetenskapligt forskningscentrum, Örebro läns landsting.
    Medicinsk yoga för personer med multipel skleros: En feasibility studie2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Summary

    Background and objective: Physical activity affects people with Multiple sclerosis (PwMS) in a positive way. The number of studies that shows if yoga is a suitable activity with positive effects for PwMS is still inadequate. The attention with this study was to examine the feasibility of a tutorled groupyoga with 2 sessions per week for 8 weeks combine with homepractice  and the feasibility as well as relevance of choosen measurements and assessments to detect change in fatigue, balance, walking ability and quality of life for PwMS.

     

    Method: A feasibilitystudy of an intervention with measurements taken before and after was conducted. 15 people from two clinics in Stockholm were invited and 12(80%) accepted. Timed Up and Go (TUG), postural stability and reaching ability with swajmeter were selected for function. Patientrelated assessments were Activities-specific Balance Confidence scale (ABC), MS Walking Scale (MSWS-12), The Fatigue Scale for Motor and Cognitive Functions (FMCF), Euroqual EQ-5D and Multiple Sclerosis Impact Scale (MSIS-29). Compliance to anticipation as well as prospective falls were measured and by the attendents noted in a logbook. After completed intervention the attendants described the experiance with tutorled groupyoga vs homepractice, possible effects, future interest in attending medical yoga, the study´s design and the extention of measurements and intervention.

     

    Results: All of the attendants completed the intervention and the compliance in the groupled yoga was good with 88% attendance. The compliance of homepractice varied greatly from one to several times per week. No falls were rapported. The yoga practice was highly appreciated, all of the attendants wished to continue to yoga and recommended PwMS to try. Most of the choosen methods and assessments including the loggbook were found to be doable both by the attendants and the assistant. Some parts of the postural stability tests were found to be too difficult for this group, as well as ABC. Even though the intervention included few attendants, small improvements were noted in functional balance through TUG (p=0.006) and patient reported level of psycological and physical function through MSIS-29 (p=0.01).

     

     

     

    Conclusion: The feasibility and compliance of an 8-week tutorled groupyoga was good but the compliance of home practice varied amongst the attendants. To evaluate the effects of medical yoga for this group of patients the tutorled yoga is adequate. TUG and parts of the postural stability seem to be relevant. The amount of patientrelated assessments need to be reduced. MSWS and MSIS-29 tend to be sensitive for change in this study. Other assessments for fatigue and quality of life should be considered.

  • 94.
    Caiman, Lisa
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Dryselius, Alice
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Group exercise as a fall prevention intervention for people with intellectual disability: A feasibility case study2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: People with intellectual disability (ID) have an increased risk of falling and of falls related injuries. During a 12 month period approximately 30 percent of people with ID experience at least one fall. In the older population fall prevention programmes and exercise interventions have been established and used successfully, but for people with ID evidence is currently lacking.

    Purpose: The aim of this case-study was to evaluate the feasibility of a group exercise program based on the Otago Exercise Programme (OEP) in people with ID.

    Method: Four individuals with mild-moderate ID participated in this study. A mixed method approach was used: before-after evaluation and a qualitative interview evaluation of the group class. Balance, gait and participation were assessed at baseline and 8 weeks later, with 7 standardized measures. The qualitative interview was analysed using content analysis method.

    Result: A consistent, positive change was found across all participants on measure Video Based Balance Scale for ID (BSID). The qualitative interview resulted in one theme; The group exercise class was enjoyable, suitable and stimulating. One fall was recorded during the intervention period.

    Conclusion: The exercise programme resulted in some improvements in gait and balance, however beneficial psychosocial effects were found in this group. The OEP could be feasible for people with ID, thus further studies are needed. 

  • 95.
    Camilla, Sandberg
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Pomeroy, Jeremy
    Thilén, Ulf
    Gradmark, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Wadell, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Habitual Physical Activity in Adults with Congenital Heart Disease Compared with Age- and Sex- Matched Controls2016In: Canadian Journal of Cardiology, ISSN 0828-282X, E-ISSN 1916-7075, Vol. 32, no 4, p. 547-553Article in journal (Refereed)
    Abstract [en]

    Background: Most adult patients with congenital heart disease (CHD) have reduced aerobic exercise capacity. Their habitual physical activity (PA) level is, however, less well studied. In this study habitual PA level in a cohort of adults with CHD compared to healthy age and gender matched controls was investigated.

    Methods: Eighty adults with CHD, classed as either “complex” (n=40) or “simple” (n=40), and 42 healthy controls were studied with a combined uniaxial accelerometer and heart rate monitor worn during 4 consecutive days. We analysed 1) the time spent during ≥ moderate/vigorous PA, 2) accelerometer counts/day and 3) to what extent the World Health Organization recommendations on PA were reached.

    Results: Patients with simple lesions had higher total accelerometer counts/day compared to both patients with complex lesions and controls (simple lesions; median (IQR) 107.7(63.4) vs. complex lesions; 72.8(53.5) and controls; 78.3(49.6), p≤0.001 and p=0.002). Furthermore, no differences in time spent during ≥ moderate-to-vigorous PA was found between patients and controls. In addition 46% of the patients with simple lesions, 55% of the patients with complex lesions and 44% of the controls did not reach the W.H.O.-recommended level of daily PA, but no significant differences between groups were found. There were no differences in achieving recommended PA level between patients in NYHA I vs. NYHA II+III.

    Conclusions: Patients with CHD follow the same PA-level pattern as the general population. Broad strategies promoting an active lifestyle are needed across the population and especially for patients with complex CHD and impaired NYHA class.

  • 96.
    Carlson, Victor
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hedberg, Joel
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Validering av Självskattningsskalan C-SMIT30 vid högintensiv intervallträning på cykel: en pilotstudie2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte Syftet med denna pilotstudie är att utvärdera ifall självskattning med C-smit30-skalan är valid för att mäta upplevd ansträngning vid högintensiv intervallträning på cykel för yngre och tränade individer.

    Metod Totalt 12 träningsvana testpersoner, 6 kvinnor och 6 män i åldrarna 20-30 år utförde sammanlagt 6 olika tester. Ingen av testdeltagarna var elitidrottare och samtliga såg sig själva som friska under testtillfället. Testdeltagarna cyklade på olika motstånd och självskattade upplevd ansträngning enligt Borg’s RPE-skala. För att validera C-SMIT30-skalan användes ett test där testpersonerna fick cykla tre stycken 30-sekundersintervaller då de sedan fick skatta upplevd ansträngning enligt Borg’s RPE-skala samt den nya C-SMIT30-skalan. Ytterligare ett test utfördes för samtliga testpersoner där de fick göra ett test för att se hur länge de faktiskt kunde fortsätta cykla på den satta effekten. Samtliga cykeltest utfördes på en spinningcykel med en kadens på 85 Rounds Per Minute (RPM).

    Resultat Tre av testpersonerna (25%) cyklade kortare tid än vad de uppskattade, fyra (33%) cyklade längre än vad de uppskattade och fem (42%) cyklade lika länge som de hade skattat. Fyra av testpersonerna var inom fyra sekunder från att skatta rätt. Korrelationen av självskattningen kontra det faktiskta resultatet var +0,860 och testet var signifikant (p<0,01).

    Slutsats C-SMIT30-skalan kan användas som självskattningskala för att utvärdera om individer tränar på rätt motstånd vid högintensiv intervallträning på cykel. Vidare forskning av ämnet behövs.

  • 97.
    Carlsson, Carl
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Effekten av muskeltrötthet på avvikande rörelsemönster- screeningtester för elit-herrjuniorer i fotboll.2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 98.
    Carlsson, Elin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Medin, Frida
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Feedback och dess effekter på resultatet vid utförande av The Functional Movement Screen (FMS)2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Abstrakt

     

    Introduktion Testning av kroppsfunktioner kan vara viktigt för att upptäcka nedsättningar som kan leda till skador. The Functional Movement Screen (FMS) är ett testbatteri med sju grundläggande rörelsetester som undersöker asymmetrier som nedsatt styrka och rörlighet. FMS används numera i hela världen men har ifrågasatts när det gäller testernas tillförlitlighet och validitet.

     Syfte

    Syftet med den här studien är att undersöka om feedback påverkar resultatet av The Functional Movement Screen.

     Metod

    I studien deltog 19 Fysioterapeutstudenter från Umeå Universitet. Deltagarna delades in i två randomiserade grupper, en kontrollgrupp (n=10) och en interventionsgrupp (n=9).  Samtliga blev bedömda i FMS vid två tillfällen, interventionsgruppen fick inför andra testtillfället feedback på deras utförande från första tillfället.

     

    Resultat

    Kontrollgruppen visade inte på några signifikanta skillnader mellan försöken. Interventionsgruppen visade på signifikanta skillnader i DS (p=0,046), ASLR (p=0,025) samt i  totalpoängen (p=0,011).  Mellangruppsjämförelsen visade signifikanta skillnader i delmomenten DS (p=0,017),  ASLR (p=0,008) samt i totalpoängen (p=0,001).

    Konklusion

    Denna studie visar att feedback kan förbättra resultatet av The Functional Movement Screen. Detta innebär i förlängningen att delmomenten i FMS kanske inte speglar den verkliga kroppsfunktionen hos de som testas utan om och hur det förstått instruktionerna samt vilka bedömningskriterierna för de sju testerna är. Ytterligare studier krävs inom ämnet med ett högre deltagarantal.

  • 99.
    Carlsson, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Samband mellan rörelseutslag i ryggkotpelaren och antropometriska mått vid exponering för mekanisk stöt i sittande: En laboratorieundersökning2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Sammanfattning: Vid körning av maskiner i terräng utsätts kroppen för mekaniska stötar och vibrationer vilket kan ge muskuloskeletala besvär, främst i ryggraden. Det saknas kunskap om hur kroppsliga reaktioner vid mekanisk stöt påverkas av kroppens storleksförhållanden (antropometri). Syfte: Att undersöka samband mellan rörelseutslag i ryggkotpelaren och antropometriska mått då en person utsätts för en translatorisk stöt i sidled under sittande position. Vidare var syftet att se om sambandet påverkades om personen samtidigt utför en kognitiv uppgift då forskning visat att det kan påverka postural kontroll i andra situationer. Metod: Tjugotre friska manliga forskningspersoner (19-36år) satt på en stol monterad på en rörelsesimulator. De utsattes för 10 stötar med eller utan samtidig kognitiv uppgift. Rörelseutslag registrerades som relativa vinklar mellan olika ryggsegment genom orienteringsmätare fästa på huden. Resultat: Flera svaga men signifikanta samband fanns. Det högst uppmätta korrelationsvärdet var r=0,55 (avstånd mellan huvud-sits och rörelseutslag i nacken). Inga starka samband gick att finna och att samtidigt utföra en kognitiv uppgift påverkade inte sambanden. Slutsats: Antropometriska mått tycks ha viss betydelse för hur stora rörelseutslagen blir i ryggraden hos unga friska män som utsätts för mekanisk stöt. Sambanden påverkas inte av att man samtidigt utför en kognitiv uppgift.

  • 100.
    Carlsson, Pernilla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Antfolk, Amanda
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Rörelserädsla och tvångsmässig träning hos personer med utmattningssyndrom2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Psykisk ohälsa ökar i Sverige och andelen drabbade kvinnor är nästan dubbelt så stor som andelen män. Utmattningssyndrom är en diagnos som tillhör psykisk ohälsa och vanliga symtom är fysisk trötthet, ångest, nedstämdhet och även kognitiva symtom är vanligt. Fysisk aktivitet har positiva effekter vid ångest, depression och utmattningssyndrom men det finns bristfällig evidens på vad personer med utmattningssyndrom har för inställning till fysisk aktivitet och om det eventuellt förekommer rörelserädsla eller tvångsmässig träning hos den här patientgruppen. Syfte: Syftet med denna studie är att undersöka förekomsten av rörelserädsla och tvångsmässig träning hos personer med utmattningssyndrom, samt dess samband med utmattning, ångest, depression och fysisk aktivitet. Metod: 42 deltagare med en medelålder på 45,5 i ett multimodalt rehabiliteringsprogram svarade på en enkät angående rörelserädsla, tvångsmässig träning, utmattning, ångest, depression och fysisk aktivitet. Resultat: Rörelserädsla förekom hos 50% av deltagarna och det fanns tendenser till tvångsmässig träning hos drygt hälften av deltagarna. Rörelserädsla och tendenser till tvångsmässig träning var vanligare bland kvinnor än bland män. Det fanns ett signifikant samband (r=0,378) mellan rörelserädsla och utmattningssyndrom. Det fanns också ett svagt negativt samband (r=-195) mellan tvångsmässig träning och fysisk aktivitet, samt ett svagt samband (r=0,224) mellan ångest och rörelserädsla. Konklusion: Resultatet i studien visar att det förekommer rörelserädsla hos personer med utmattningssyndrom samt att det förekommer tendenser till tvångsmässig träning. Få studier har studerat sambandet mellan dessa variabler därför krävs mer forskning inom området.

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