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  • 1. Alexandersson, Maria
    et al.
    Wang, Eugen Yuhui
    Eriksson, Staffan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Centre for Clinical Research Sörmland, Uppsala University, Kungsgatan 41, 631 88 Eskilstuna, Sweden; Department of Neuroscience, Physiotherapy, Uppsala University, Box 593, 751 24 Uppsala, Sweden.
    A small difference in recovery between total knee arthroplasty with and without tourniquet use the first 3 months after surgery: a randomized controlled study2019In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, no 4, p. 1035-1042Article in journal (Refereed)
    Abstract [en]

    Purpose: When a tourniquet is used during surgery on the extremities, the pressure applied to the muscles, nerves and blood vessels can cause neuromuscular damage that contributes to postoperative weakness. The hypothesis was that the rehabilitation-related results would be improved if total knee arthroplasty (TKA) is performed without the use of a tourniquet.

    Methods: 81 patients with osteoarthritis of the knee who underwent TKA surgery were randomized to surgery with or without tourniquet. Active flexion and extension of the knee, pain by visual analog scale (VAS), swelling by knee circumference, quadriceps function by straight leg raise, and timed up and go (TUG) test results were measured before and up to 3 months after surgery.

    Results: ANCOVA revealed no between-groups effect for flexion of the knee at day 3 postsurgery. Compared with the tourniquet group, the nontourniquet group experienced elevated pain at 24 h, with a mean difference of 16.6 mm, p = 0.005. The effect on mobility (TUG test) at 3 months was better in the nontourniquet group, with a mean difference of -1.1 s, p = 0.029.

    Conclusions: The hypothesis that the rehabilitation-related results would be improved without a tourniquet is not supported by the results. When the results in this study for surgery performed with and without tourniquet are compared, no clear benefit for either procedure was observed, as the more pain exhibited by the nontourniquet group was only evident for a short period and the improved mobility in this group was not at a clinically relevant level.

    Level of evidence: Inconsistent results, Level II.

  • 2.
    Arumugam, Ashokan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Strong, Andrew
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Röijezon, Ulrik
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Psychometric properties of knee proprioception tests targeting healthy individuals and those with anterior cruciate ligament injury managed with or without reconstruction: a systematic review protocol2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 4, article id e027241Article, review/survey (Refereed)
    Abstract [en]

    Introduction: An anterior cruciate ligament (ACL) injury affects knee proprioception and sensorimotor control and might contribute to an increased risk of a second ACL injury and secondary knee osteoarthritis. Therefore, there is a growing need for valid, reliable and responsive knee proprioception tests. No previous study has comprehensively reviewed all the relevant psychometric properties (PMPs) of these tests together. The aim of this review protocol is to narrate the steps involved in synthesising the evidence for the PMPs of specific knee proprioception tests among individuals with an ACL injury and knee-healthy controls.

    Methods and analysis: The Preferred Reporting Items for Systematic reviews and Meta-Analyses will be followed to report the review. A combination of four conceptual groups of terms-(1) construct (knee proprioception), (2) target population (healthy individuals and those with an ACL injury managed conservatively or with a surgical reconstruction), (3) measurement instrument (specific knee proprioception tests) and (4) PMPs (reliability, validity and responsiveness)-will be used for electronic databases search. PubMed, AMED, CINAHL, SPORTDiscus, Web of Science, Scopus, the Cochrane Central Register of Controlled Trials and ProQuest will be searched from their inception to November 2018. Two reviewers will independently screen titles, abstracts and full text articles, extract data and perform risk of bias assessment using the updated COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist for the eligible studies. A narrative synthesis of the findings and a meta-analysis will be attempted as appropriate. Each PMP of knee proprioception tests will be classified as 'sufficient', 'indeterminate' or 'insufficient'. The overall level of evidence will be ascertained using an established set of criteria.

    Ethics and dissemination: Ethical approval or patient consent is not required for a systematic review. The review findings will be submitted as a series of manuscripts for peer-review and publication in scientific journals.

  • 3.
    Axén, Malin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Stålnacke, Hanna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Upplevelser av en multidisciplinär grupputbildning för patienter med diabetes typ II: En kvalitativ studie2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Det finns god evidens för att patientutbildning i grupp har bra effekt på långtidssocker (HbA1c) hos patienter med diabetes typ II. Det är dock ovisst om sådan grupputbildning är genomförbar i primärvård och hur den i så fall bör utformas. För att undersöka detta har det startats ett pilotprojekt med en grupputbildning på en vårdcentral i Västerbottens län.

    Syfte: Att studera deltagarnas upplevelser av en multidisciplinär grupputbildning för patienter med diabetes typ II, inom primärvården.

    Metod: Semistrukturerade intervjuer utfördes med fyra informanter, som deltagit i grupputbildningen. Öppna frågor ställdes kring de ämnen som utbildningen behandlat samt huruvida informanterna gjort förändringar efter kursen. Intervjuerna analyserades med kvalitativ innehållsanalys.

    Resultat: Studien resulterade i fyra kategorier. Onödig undervisning men användbara tips: den teoretiska undervisningen upplevdes onödig, men konkreta tips var givande för att uppnå livsstilsförändringar. Viljan att lära av och stötta varandra: att få ta del av varandras erfarenheter ansågs vara det viktigaste i utbildningen. Känsla av otillräcklighet: de förändringar informanterna gjort sågs som otillräckliga och ibland för små för att nämna. Förnekar som skydd och söker efter hopp: skam, hopplöshet och en rädsla för framtiden uttrycktes. Förnekelse användes som försvarsmekanism samtidigt som informanterna sökte hopp om att kunna må bra.

    Slutsats: Resultatet antyder att en grupputbildning bör ge utrymme för deltagarna att utbyta erfarenheter. För informanterna var det viktigt att utbildningen ingav hopp om att kunna må bra. Det uppskattades att utbildningen bistod med konkreta tips om hur deltagarna kunde gå tillväga för att nå de övergripande livsstilsmålen.

  • 4.
    Bay, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lämås, Kristina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Berghammer, Malin
    Sandberg, Camilla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Enablers and barriers for physical activity in adults with congenital heart disease2019Conference paper (Refereed)
  • 5. Bui, Kim-Ly
    et al.
    Nyberg, Andre
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Rabinovich, Roberto
    Saey, Didier
    Maltais, François
    The Relevance of Limb Muscle Dysfunction in Chronic Obstructive Pulmonary Disease: A Review For Clinicians2019In: Clinics in Chest Medicine, ISSN 0272-5231, E-ISSN 1557-8216, Vol. 40, no 2, p. 367-383Article in journal (Refereed)
    Abstract [en]

    "Chronic obstructive pulmonary disease (COPD) is often accompanied by extrapulmonary manifestations such as limb muscle dysfunction. This term encompasses several features, including atrophy, weakness, and reduced oxidative capacity. Clinicians should become accustomed with this manifestation of COPD because of its relevance for important outcomes such as exercise tolerance and survival. Measuring muscle strength and mass can be performed with simple and valid tools that could be implemented in clinical practice. One identified, limb muscle dysfunction is amenable to therapy such as exercise training that has been repeatedly shown to improve muscle mass, strength, and oxidative capacity in COPD."

  • 6. Bui, Kim-Ly
    et al.
    Nyberg, André
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Maltais, François
    Saey, Didier
    Functional tests in chronic obstructive pulmonary disease part 2: measurement properties2017In: Annals of the American Thoracic Society, ISSN 2329-6933, E-ISSN 2325-6621, Vol. 14, no 5, p. 785-794Article in journal (Refereed)
    Abstract [en]

    Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide and an important cause of disability and handicap. For a thorough patient-centered outcome assessment and comprehensive management of the disease, measures of lung function, exercise capacity and health-related quality of life, but also of functional capacity in activities of daily life are necessary. In Part 2 of this Seminar Series, we will discuss the main functional tests to assess upper and lower body functional capacity in patients with COPD, to help clinicians substantiate their choice of functional outcome measures in COPD. In agreement with the International Classification of Functioning, Disability and Health to assess functional capacity representative of daily life activities, this review focuses on functional tests that include components such as changing and maintaining body positions, walking, moving and climbing, as well as carrying, moving and handling objects. We will review the validity, reliability and responsiveness of these tests. With 11 links to the International Classification of Functioning, Disability and Health framework addressing several upper and lower body components of functional activities, the Glittre Activities of Daily Life test seems to be the most promising and comprehensive test to evaluate functional capacity in activities of daily life. The links between functional capacity tests and real participation in daily life, as well as with important clinical outcomes such as morbidity and mortality, need further investigation. More studies are also recommended to document minimal detectable changes, minimal clinically important differences and normative values for these functional tests.

  • 7. Gendron, Louis McCusky
    et al.
    Nyberg, Andre
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada.
    Maltais, François
    Lacasse, Yves
    Active mind‐body movement therapies as an adjunct to or in comparison to pulmonary rehabilitation for people with chronic obstructive pulmonary disease2016In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 7, article id CD012290Article in journal (Refereed)
    Abstract [en]

    This is the protocol for a review and there is no abstract. The objectives are as follows:

    To assess the effect of active mind-body movement therapies (AMBMT) compared with pulmonary rehabilitation (PR), or in addition to PR, in the management of chronic obstructive pulmonary disease (COPD).

  • 8.
    Johansson, Susanna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Schau, Mikael
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Ser vi samma sak? Interbedömarreliabiliteten för erfarna och oerfarna bedömare av rörelsekontroll för ländryggen hos styrkelyftare2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    BAKGRUND: Ländryggssmärta är idag ett av de största folkhälsoproblemen och drabbar majoriteten av människor någon gång under deras livstid. Det är viktigt med validerade och reliabla tester för att undersöka problematiken. Nedsatt rörelsekontroll är en trolig källa till symptom i ländryggen. Styrkelyftare utsätts för stora externa krafter på ländryggen, framförallt i knäböj och marklyft, vilket gör att de tillhör riskgruppen för ländryggssmärta. SYFTE: Syftet med denna studie var att undersöka interbedömarreliabiliteten för erfarna och oerfarna bedömare av rörelsekontroll för ländryggen hos styrkelyftare. Det sekundära syftet var att undersöka om det fanns en skillnad i total testbatteripoäng mellan styrkelyftare med och utan ländryggssmärta. METOD: Åtta deltagare filmades när de utförde tester enligt ett testbatteri utvecklat av Luomajoki et al. Dessa filmer bedömdes av två erfarna samt två oerfarna bedömare för att undersöka interbedömarreliabiliteten. RESULTAT: Resultaten presenterades med Cohens kappa samt med procentuell överensstämmelse. Resultaten visade tendenser till att erfarna bedömare hade bättre överensstämmelse än oerfarna bedömare i detta testbatteri. Av de åtta tester som analyserades med Cohens kappa hade de erfarna bedömarna högre kappakoefficienter i fem av testerna. Sett till procentuell överensstämmelse var inte tendensen lika tydlig. Ingen signifikant skillnad fanns i total testbatteripoäng mellan styrkelyftare med och utan ländryggssmärta. SLUTSATS: Tendensen tyder på att erfarna bedömare är mer samstämmiga i sin bedömning än oerfarna bedömare. I den här studien kunde man inte se någon skillnad i resultatet mellan styrkelyftare med respektive utan ländryggsmärta på ett testbatteri för rörelsekontroll i ländryggen. Några säkra slutsatser kunde inte dras av resultaten, framförallt på grund av det låga deltagarantalet.

  • 9.
    Johansson, Tobias
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Ottehall, Daniel
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Reliabilitet och validitet för ett hopptest: Objektiv mätning av knästabilitet med rörelsesensorer2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Stabilitet i knäleden bedöms ofta genom funktionella hopptester tillsammans med teknisk utrustning. Ett problem med de funktionella tester som används är brist på standardisering.

    Syfte: Syftet med denna studie var att med hjälp av rörelsesensorer utvärdera reliabilitet och validitet av Norells ACL jumptest för att mäta dynamisk stabilitet i knäleden hos unga friska personer.

    Metod: Sju unga friska män fick uföra Norells ACL jumptest, Drop jump och One-leg hop for distance vid två testtillfällen. Rörelsedata från första kontakt med marken analyserades. Reliabiliteten utvärderades genom test-återtest och samtidig validitet genom att procentuell differens mellan resultaten från Norells ACL jumptest och Drop jump respektive One-leg hop for distance räknades ut. Deltagarna fick även fylla i självuppskattningsformulären KOOS och IPAQ.

    Resultat: Det fanns en stor spridning i deltagarnas medianvärde gällande både bakåt-framåt- och sidledsacceleration vid test-återtest. Även stor spridning uppmättes i jämförelsen av de tre testerna. Det fanns inget samband mellan ökad stabilitet och dominant ben. Inget samband mellan resultatet på hopptesterna och självskattning av KOOS och IPAQ kunde påvisas.

    Slutsats:Reliabilitet och samtidig validitet av Norells ACL jumptest värderas som låg i denna studie. Inget samband mellan självupplevd knästabilitet och den stabilitet som uppmätts med RS kunde påvisas. Det kunde heller inte påvisas ett samband mellan dominant ben och en ökad knästabilitet. Norells ACL jumptest verkar dock vara ett likvärdigt funktionellt test jämfört med Drop jump och One-leg hop for distance gällande mätning av dynamisk stabilitet i knä enligt denna studie.

  • 10. Kahn, Nicolas
    et al.
    Tomos, Ioannis
    Andrianopoulos, Vasileios
    Arikan, Husevin
    van der Does, Anne
    Almendros, Isaac
    Bonvivi, Sara
    Morgan, Ann
    Nenna, Raffaella
    Magouliotis, Dimitrios
    Rutter, Matthew
    De Soomer, Kevin
    Nyberg, Andre
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Lundell, Sara
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Leceuvre, Katleen
    Singanayagam, Aran
    Bostantzoglou, Clementine
    Karmouty-Quintana, Harry
    De Brandt, Jana
    Early Career Members at the ERS International Congress 2017: highlights from the Assemblies.2017In: Breathe, ISSN 1810-6838, E-ISSN 2073-4735, Vol. 13, no 4, p. e121-e129Article in journal (Refereed)
    Abstract [en]

    The 2017 ERS International Congress was, as always, well organised, providing participants with a good mixture of translational and clinical science. Early career members were very well represented in thematic poster, poster discussion and oral presentation sessions and were also actively involved in chairing sessions. The efforts of the Early Career Members Committee (ECMC) to increase the number of early career members included in the competence list (the list of early career members with an interest in being more actively involved in the society) paid off immensely, because the number of early career members registered improved hugely across all assemblies after the Congress. Several newly registered early career members have collated some highlights of the Congress for their assemblies, which should be of interest to all members. As assemblies 12 and 13 are new, there is no report from assembly 12 as there is not yet, at the time of writing, an early career member representative for this newly created assembly.

  • 11.
    Karlsson, Fredrika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Samband mellan muskelstyrka nedre extremitet, muskelmassa och fysisk funktion hos älfdre män - finns skillnader i funktion hos de som faller?2018Independent thesis Advanced level (degree of Master (One Year)), 40 credits / 60 HE creditsStudent thesis
    Abstract [sv]

    Sammanfattning:  Introduktion: Muskelstyrka, muskelmassa och fysisk funktion försämras med åldern. Fall är vanligt förekommande och leder till en stor kostnad för samhället och ett stort lidande för individen. Primära riskfaktorer för fall är nedsatt muskelstyrka, balans och gång. Syfte: Syftet med denna studie var att undersöka sambandet mellan muskelstyrka, muskelmassa och fysisk funktion i nedre extremitet hos äldre män samt undersöka om det finns skillnader hos de som faller jämfört med de som inte faller gällande dessa parametrar. Metod: Detta var en tvärsnittsstudie där 203 försökspersoner deltog. Mätvariabler var lårmuskelstyrka mätt i Newtonmeter med vinkelhastigheter (koncentriskt 60° och 180°/ sekund och excentriskt 60°/sekund) mätt med Kin com isokinestisk muskeldynamometer, muskelmassa mätt med Lunar prodigy DXA, timed stand test, 6-m gångtest och 20 cm smalspårig gång. Frågeformulär gällande om de fallit eller ej. Resultat: Resultatet visade samband mellan muskelstyrka (60◦ och 180°/sekund koncentriskt, 60°/sekund excentriskt) och muskelmassa p<0.001. Både muskelstyrka och muskelmassa korrelerade med de båda gångtesterna p<0,05-0,001, med ett något starkare samband för muskelstyrka. Timed stands test korrelerade endast med 180◦ koncentrisk muskelstyrka p<0,05. Tjugofem procent av männen angav att de fallit det senaste året. Ingen skillnad förelåg i muskelstyrka, muskelmassa eller fysisk funktion hos de som fallit eller de som inte fallit.  Slutsats: Det fanns ett samband mellan muskelstyrka och muskelmassa, mindre samband mellan muskelstyrka och fysisk funktion. Det påvisades ingen skillnad hos fallare eller icke fallare vad gäller muskelstyrka, muskelmassa eller fysisk funktion.

  • 12.
    Larsson, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Sandberg, Camilla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Apers, Silke
    Kovacs, Adrienne H.
    Luyckx, Koen
    Thomet, Corina
    Budts, Werner
    Enomoto, Junko
    Sluman, Maayke A.
    Wang, Jou-Kou
    Jackson, Jamie L.
    Khairy, Paul
    Cook, Stephen C.
    Alday, Luis
    Eriksen, Katrine
    Dellborg, Mikael
    Berghammer, Malin
    Rempel, Gwen
    Menahem, Samuel
    Caruana, Maryanne
    Tomlin, Martha
    Soufi, Alexandra
    Fernandes, Susan M.
    White, Kamila
    Callus, Edward
    Kutty, Shelby
    Moons, Philip
    Geographical variation and predictors of physical activity level in adults with congenital heart disease2019In: IJC Heart & Vasculature, ISSN 2352-9067, Vol. 22, p. 20-25Article in journal (Refereed)
    Abstract [en]

    Background: Physical activity is important to maintain and promote health. This is of particular interest in patients with congenital heart disease (CHD) where acquired heart disease should be prevented. The World Health Organization (WHO) recommends a minimum of 2.5 h/week of physical activity exceeding 3 metabolic equivalents(METS) to achieve positive health effects. It is unknown whether physical activity levels (PAL) in adult CHD patients differ by country of origin.

    Methods: 3896 adults with CHD recruited from 15 countries over 5 continents completed self-reported instruments, including the Health Behaviour Scale (HBS-CHD), within the APPROACH-IS project. For each patient, we calculated whether WHO recommendations were achieved or not. Associated factors were investigated using Generalized Linear Mixed Models.

    Results: On average, 31% reached the WHO recommendations but with a great variation between geographical areas (India: 10%–Norway: 53%). Predictors for physical activity level in line with the WHO recommendations, with country of residence as random effect, were male sex (OR 1.78, 95%CI 1.52–2.08), NYHA-class I (OR 3.10, 95%CI 1.71–5.62) and less complex disease (OR 1.46, 95%CI 1.16–1.83). In contrast, older age (OR 0.97, 95%CI 0.96–0.98), lower educational level (OR 0.41, 95%CI 0.26–0.64) and being unemployed (OR 0.57, 95%CI 0.42–0.77) were negatively associated with reaching WHO recommendations.

    Conclusions: A significant proportion of patients with CHD did not reach the WHO physical activity recommendations. There was a large variation in physical activity level by country of origin. Based on identified predictors, vulnerable patients may be identified and offered specific behavioral interventions.

  • 13.
    Larsson, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Wadell, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Thilen, Ulf
    Sandberg, Camilla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Adults with congenital heart disease overestimate their physical activity level2019In: IJC Heart & Vasculature, ISSN 2352-9067, Vol. 22, p. 13-17Article in journal (Refereed)
    Abstract [en]

    Background: Physical activity reduces the risk of acquired cardiovascular disease, which is of great importance in patients with congenital heart disease (CHD). There are diverging data whether physical activity level (PAL) differs between patients with CHD and controls. Furthermore, it is unknown if PAL can be reliably assessed in patients with CHD using self-reported instruments.

    Methods: Seventy-five patients with CHD (mean age 37.5 ± 15.5 years, women n = 29 [38.7%]) and 42 age and sex matched controls completed the International Physical Activity Questionnaire (IPAQ) and carried the activity monitor Actiheart over 4 days. Time spent at ≥3 METS ≥21.4 min/day, i.e. reaching the WHO recommendation for PAL to promote health, was used as the outcome measure. Data on PAL obtained from IPAQ were compared with Actiheart.

    Results: The proportion of individuals reaching target PAL according to IPAQ was similar in patients with CHD and controls (70.7%vs.76.2%, p = 0.52) as well as between patients with simple and complex lesions. There was an overall difference between IPAQ and Actiheart in detecting recommended PAL (72.6%vs.51.3%, p b 0.001). In a subgroup analysis, this difference was also detected in patients but was borderline for controls. The negative predictive value for IPAQ in detecting insufficient PAL was higher in patients than in controls (73%vs.40%).

    Conclusions: The proportion of persons reaching sufficient PAL to promote health was similar in patients and controls. The self-reported instrument overestimated PAL in relation to objective measurements. However, with a high negative predictive value, IPAQ is a potentially useful tool for detecting patients with insufficient PAL.

  • 14.
    Markström, Jonas L.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Movement strategies and dynamic knee control after anterior cruciate ligament injury: a three-dimensional biomechanical analysis2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Rupture of the anterior cruciate ligament (ACL) is common and mainly occurs in non-contact situations in sports, often due to momentarily poor movement control. Assessment of movement quality during sport-like tasks iscrucial to understand how to decrease the high risk of reinjury for ACL-injured persons, but also how to prevent primary injury. This thesis addresses movement quality after ACL injury and includes development and evaluation of a novel standardized rebound side hop test (SRSH) for reliability and agreement of landing mechanics, and compares these outcomes between asymptomatic persons with different athletic levels, and between different hop tests.

    Methods: This thesis involves five papers based on two separate data collections performed in a motion analysis laboratory. Paper I is a long-term follow up of ACL-injured persons treated with or without ACL reconstruction (ACLR) compared to asymptomatic persons (total N = 99, age 35-63), while papers II-V included ACLR persons, and asymptomatic elite athletes and non-athletes (total N = 79, age 17-34). A motion capture system synchronized with force plates and surface electromyography (EMG) registered trunk, hip and knee angles and moments and knee muscle activity during the hop for distance, vertical hop, and SRSH. Novel measures of dynamic knee robustness were also evaluated using finite helical axis inclination angles extracted from knee rotation intervals of 10˚.

    Results: On average 23 years after injury, ACL injured persons performed the vertical hop with diverse angles compared to controls and their non-injured leg.The younger groups of ACLR persons and controls generally displayed excellent reliability and agreement for SRSH landing mechanics. These outcomes differed between the groups, and between legs for ACLR persons, despite similar dynamic knee robustness and acceptable knee function outcomes. Curve analyses further displayed differences between athletes and non-athletes, mainly with greater hip moments for athletes, although with similar values for dynamic knee robustness. Finally, greater knee angles and moments considered strenuous for the ACL were evident during the first rebound landing in SRSH compared to the other landings.

    Conclusions: Persons who have suffered an ACL injury, regardless of whether treated with ACLR or not, appear to use task-coping strategies in preparation for and during landings to decrease knee joint loading, probably to preserve dynamic knee robustness. More attention should be given to the trunk and hip in clinics when evaluating movement quality after ACL injury to reduce the risk of future injuries due to movement compensation. High-level athletic training may also improve the ability to maintain dynamic knee robustness whilst performing a sport-like side-to-side task more efficiently through increased engagement of the hip. Finally, side hop landings should be assessed when evaluating and correcting for erroneous landing mechanics to improve knee landing control.

  • 15.
    Nordin, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Nyberg, Andre
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Sandberg, Camilla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Concurrent validity of a fixated hand-held dynamometer for measuring isometric knee extension strength in adults with congenital heart disease2019In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this study was to examine the concurrent validity of a fixated hand-held dynamometer (HHD) in comparison to a load cell in measurement of maximal isometric knee extension force in adults with congenital heart disease (CHD) and healthy adults.

    Methods: Fourteen adults with CHD and fourteen healthy adults were included. Each participant was tested three times with each method and the mean of the top two results for each participant and method was used in analysis.

    Results: The agreement between the two methods was excellent in both groups (intraclass correlation coefficient [ICC], 95% confidence interval [CI]) 0.98 (0.92–1.00) in the CHD group and ICC 0.99 (0.96–1.00) in the healthy group). There was a small difference of 19.5 Newton or 4.8% (p<.05) between the two methods in the CHD group. No significant difference was seen between the two methods in the healthy group (p>.05).

    Conclusions: The fixated HHD demonstrated excellent concurrent validity when compared to a load cell among adults with CHD as well as in healthy adults. Thus, in a healthy population the methods can be used interchangeably, however, a small difference between the methods is seen in the CHD group.

  • 16.
    Nyberg, Andre
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Saey, Didier
    Martin, Mickael
    Maltais, Francois
    Cardiorespiratory and muscle oxygenation responses to single-limb and two-limb low load/high-repetitive resistance exercises in COPD and healthy controls2017In: Journal of applied physiology, ISSN 8750-7587, E-ISSN 1522-1601Article in journal (Refereed)
  • 17.
    Nyberg, Andre
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Tistad, Malin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. School of Education Health and Social studies, Dalarna University, Falun, Sweden.
    Wadell, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Can the COPD web be used to promote self-management in patients with COPD in swedish primary care: a controlled pragmatic pilot trial with 3 month- and 12 month follow-up2019In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, no 1, p. 69-82Article in journal (Refereed)
    Abstract [en]

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

    Design: Parallel-group controlled pragmatic pilot trial.

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

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

    Results: At 3 months, 77% of the intervention group was considered users, and the majority of time spent on the site was related to PA and exercises and was spent during the first month (>80%). In addition, the intervention group reported increased PA (odds ratio [OR] = 4.4, P < .001), increased conceptual knowledge in five domains (OR = 2.6-4.2, all P < .05), and altered disease management strategies (e.g., increased PA) (OR >= 2.7 P < .05) in comparison to the control group. The latter was also different between groups at 12 months (OR = 3.7, P = .044). Knowledge of PA was correlated with level of PA (rho = .425-.512, P < .05) as well as to the use of PA as a strategy to manage their disease (chi(2) = 11.2-32.9, P < .05).

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

  • 18.
    Nyström, Miriam
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Karlsson, Helge
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Att optimera patientmöten genom kommunikation: Fyra fysioterapeuters reflektioner2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Kommunikationen mellan patient och fysioterapeut i patientmötet utgör den största delen av den faktiska tiden för mötet, utöver undersökning och behandling som också bör ses som kommunikativa. Kommunikation i patientmötet varierar och är ett komplext område där viktiga faktorer såsom att se till patienters behov beror på situation. Att identifiera kommunikativa metoder och hitta medel för att optimera kommunikationen generellt underlättar fysioterapeutens förståelse för patientens behov och för patienten att bättre ta emot vården som erbjuds. I denna uppsats belyses kommunikationens betydelse för en varierad fysioterapeutisk arbetserfarenhet inom primärvården.

     

    Syfte: Att undersöka hur fysioterapeuter inom primärvården optimerar patientmöten genom kommunikation.

     

    Metod: Studien har genomförts med kvalitativ metod utifrån fyra semistrukturerade intervjuer och kvalitativ innehållsanalys som analysmetod.

     

    Resultat: Utifrån 3 kategorier och 11 subkategorier är temat definierat som: god kommunikation är vägen till patient. Kategorin “kommunikativa verktyg” framställer metoder för att främja kommunikation, kategorin “kommunikativa hinder” identifierar hämmande faktorer för kommunikation. Samtliga informanter strävar efter att ständigt förbättra sin kommunikativa förmåga genom att anpassa kommunikationen till patienter vilket illustreras i den tredje kategorin “strävan att ständigt förbättras”.

     

    Diskussion: För att möjliggöra patientens välmående och ge denna en god vård krävs utvecklade kommunikativa förmågor och en strävan efter att ständigt förbättra dessa genom reflektion och självutvärdering hos fysioterapeuter.

  • 19. Sole, Gisela
    et al.
    Pataky, Todd
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Institute of Fiber Engineering, Department of Bioengineering, Shinshu University, Tokida 3-15-1, Ueda, Nagano 386-8567, Japan.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Analysis of three-dimensional knee kinematics during stair descent two decades post-ACL rupture: Data revisited using statistical parametric mapping2017In: Journal of Electromyography & Kinesiology, ISSN 1050-6411, E-ISSN 1873-5711, Vol. 32, p. 44-50Article in journal (Refereed)
    Abstract [en]

    Changes in movement patterns following knee injuries have generally used analyses of pre-defined discrete event-related variables, whereas Statistical Parametric Mapping (SPM) assesses continuous data over time. We applied SPM to test differences for knee trajectories during stair descent between participants with past anterior cruciate ligament (ACL) rupture who underwent reconstruction or only physical therapy compared to healthy controls. Three-dimensional knee joint kinematics during stair descent were registered for 31 subjects with ACL reconstruction (ACLR), 36 subjects with ACL rupture managed with physical therapy only (ACLPT) (∼23years post-injury), and 32 uninjured controls. SPM was used to assess differences between groups for the entire three-component knee trajectory. A significant difference between the three groups was found for the first ∼10% of stance phase. Post-hoc analyses showed between-group differences when comparing the ACLPT to the control groups. Analyses of ACLPT versus control groups for individual vector components suggested a combination of less flexion at initial foot contact, and less adduction during weight acceptance (∼40% of stance). Altered knee kinematics were confirmed during weight acceptance of stair descent for the ACLPT group compared to controls, but not for ACLR group. Further exploration of the use of SPM and agreement with clinical gait assessment is warranted.

  • 20.
    Toots, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Taylor, M.
    Lord, S.
    Close, J.
    The relationship between cognitive domain function and gait speed in community-dwelling older people with cognitive impairment2019In: Australasian Journal on Ageing, ISSN 1440-6381, E-ISSN 1741-6612, Vol. 38, p. 29-29Article in journal (Other academic)
  • 21.
    Toots, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Wiklund, Robert
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    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, Section of Physiotherapy.
    Nordin, Ellinor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Gustafson, Yngve
    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, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    The Effects of Exercise on Falls in Older People With Dementia Living in Nursing Homes: A Randomized Controlled Trial2019In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 20, no 7, p. 835-842Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate exercise effects on falls in people with dementia living in nursing homes, and whether effects were dependent on sex, dementia type, or improvement in balance. A further aim was to describe the occurrence of fall-related injuries.

    DESIGN: A cluster-randomized controlled trial.

    SETTING AND PARTICIPANTS: The Umeå Dementia and Exercise study was set in 16 nursing homes in Umeå, Sweden and included 141 women and 45 men, a mean age of 85 years, and with a mean Mini-Mental State Examination score of 15.

    INTERVENTION: Participants were randomized to the high-intensity functional exercise program or a seated attention control activity; each conducted 2-3 times per week for 4 months.

    MEASURES: Falls and fall-related injuries were followed for 12 months (after intervention completion) by blinded review of medical records. Injuries were classified according to severity.

    RESULTS: During follow-up, 118(67%) of the participants fell 473 times in total. At the interim 6-month follow-up, the incidence rate was 2.7 and 2.8 falls per person-year in exercise and control group, respectively, and at 12-month follow-up 3.0 and 3.2 falls per person-year, respectively. Negative binomial regression analyses indicated no difference in fall rate between groups at 6 or 12 months (incidence rate ratio 0.9, 95% confidence interval (CI) 0.5-1.7, P = .838 and incidence rate ratio 0.9, 95% CI 0.5-1.6, P = .782, respectively). No differences in exercise effects were found according to sex, dementia type, or improvement in balance. Participants in the exercise group were less likely to sustain moderate/serious fall-related injuries at 12-month follow-up (odds ratio 0.31, 95% CI 0.10-0.94, P = .039).

    CONCLUSIONS/IMPLICATIONS: In older people with dementia living in nursing homes, a high-intensity functional exercise program alone did not prevent falls when compared with an attention control group. In high-risk populations, in which multimorbidity and polypharmacy are common, a multifactorial fall-prevention approach may be required. Encouraging effects on fall-related injuries were observed, which merits future investigations.

  • 22.
    Wallin, Stina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Faculty of Education and Welfare Studies, Health Sciences, Åbo Akademi University, Vaasa, Finland.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Act with respect: Views of supportive actions for older workers after completion of comprehensive vocational rehabilitation services2019In: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 62, no 4, p. 585-598Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The number of older workers will expand during the next decades. Older workers have more long-term health problems and related limitations.

    OBJECTIVE: This study examined supportive actions provided in occupational healthcare services to older workers after vocational rehabilitation. An additional purpose was to explore occupational healthcare professionals' views on how to realize and improve adequate support activities.

    METHODS: Qualitative and quantitative methods were used, including a postal questionnaire and focus group discussions. Sixty-seven occupational healthcare service units participated in the postal questionnaire. Eight occupational healthcare professionals participated in two focus group discussions. The qualitative data was analyzed using qualitative content analysis.

    RESULTS: The qualitative analysis resulted in one theme (Act with respect), and four categories (Need for cooperation, Collaborative resources of involved stakeholders, Individual needs for support, and Gender as homogenous and separate groups). Quantitative results revealed that the workers' initiative strongly influenced the support carried out. Recommendations from the rehabilitation clinic were almost always considered when deciding on supportive actions. Focus group discussions brought up gender differences especially highlighted in the category Gender as homogenous and separate groups.

    CONCLUSIONS: Appropriate support of older workers requires cooperation between involved stakeholders, including occupational healthcare services. Provided support should be based on individual needs, but a mutual practice of determining needed support is requested.

  • 23.
    Westerlund, Liza
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Persson, Linnea
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Graviditetsbesvär, fysisk aktivtet och stillasittande: En studie av aktivitetsnivå och hälsa hos gravida kvinnor i Västerbotten. (ingående i Northpop-kohorten)2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Trots att det är allmänt känt att fysisk aktivitet främjar vårt välmående både fysiskt och psykiskt är det långt ifrån alla som når upp till den aktivitetsnivå som förespråkas. För gravida kvinnor verkar denna utmaning vara än mer påtaglig. Förutom grad av fysisk aktivitet har på senare tid stillasittandets betydelse för hälsa uppmärksammats allt mer. En stillasittande livsstil på mer än 10h per dag har visat en kraftigt accelererande risk att dö i förtid. Övergripande syfte var därför att undersöka samband mellan låg grad av fysisk aktivitet, hög grad av stillasittande och graviditetsbesvär.

    Denna delstudie innefattar data från ett större pågående projekt vid namn Northpop. Frågor gällande förekomst av graviditetsbesvär, fysisk aktivitetsnivå och stillasittande besvarades av 1569 gravida kvinnor i Västerbotten via enkäter under tidsperioden maj 2016 till februari 2018. All data har analyserats i SPSS. Majoriteten (n= 74%) av kvinnorna i vår studie nådde inte upp till rekommendationerna för fysisk aktivitet trots att det idag finns tydliga riktlinjer, samtidigt som hela 25% satt mer än 10h per dag. Statistiskt signifikanta samband sågs mellan låg fysisk aktivitet och foglossning (p = 0,00) samt blod och järnbrist (p = 0,00). Även ett högt antal stillasittande timmar resulterade i statistiskt signifikanta samband, graviditetsdiabetes (p = 0,03) och preeklampsi (p = 0,02).

    Resultaten i vår studie visar att det finns samband mellan både låg fysisk aktivitetsnivå och hög grad av stillasittande tid samt negativa hälsoutfall hos gravida kvinnor i Västerbotten.

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