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Pettersson, BeatriceORCID iD iconorcid.org/0000-0002-5147-9715
Publications (10 of 14) Show all publications
Pettersson, B., Lundell, S., Lundin-Olsson, L. & Sandlund, M. (2023). 'Maintaining balance in life'—exploring older adults' long-term engagement in self-managed digital fall prevention exercise. European Review of Aging and Physical Activity, 20(1), Article ID 12.
Open this publication in new window or tab >>'Maintaining balance in life'—exploring older adults' long-term engagement in self-managed digital fall prevention exercise
2023 (English)In: European Review of Aging and Physical Activity, ISSN 1813-7253, E-ISSN 1861-6909, Vol. 20, no 1, article id 12Article in journal (Refereed) Published
Abstract [en]

Background: Accidental falls are one of the greatest threats to older adults’ health and well-being. The risk of falling can be significantly reduced with strength and balance interventions. However, there needs to be further knowledge into how older adults can be supported to achieve a maintained exercise behaviour. Therefore, the aim of this study was to explore factors that enabled older adults to maintain their exercise during a 1-year self-managed digital fall prevention exercise intervention.

Methods: This study used a grounded theory methodology. Semi-structured individual interviews were conducted by phone or conference call. Eighteen community-dwelling older adults aged 70 years or more participated. The participants had a self-reported exercise dose of 60 min or more per week during the last three months of participation in a 12-months intervention of self-managed digital fall prevention exercise, the Safe Step randomized controlled trial. Open, axial, and selective coding, along with constant comparative analysis, was used to analyze the data.

Results: The analysis resulted in a theoretical model. We found that the fall prevention exercise habits of adults were developed through three stages: Acting against threats to one’s own identity, Coordinating strategies to establish a routine, and Forming habits through cues and evaluation. The main category of Maintaining balance in life encases the participants transition through the three stages and reflects balance in both physical aspects and in between activities in daily life. The process of maintaining balance in life and desire to do so were mediated both by intrinsic person-dependent factors and the Safe Step application acting as an external mediator.

Conclusion: This study identified three stages of how older adults developed self-managed fall prevention exercise habits, supported by a digital application. The generated theoretical model can inform future interventions aiming to support long-term engagement in digitally supported and self-managed fall prevention interventions.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Aged, Behaviour change, eHealth, Exercise, Fall prevention, Grounded Theory, Habit formation, mHealth, Older adults, Self-management
National Category
Physiotherapy Geriatrics
Identifiers
urn:nbn:se:umu:diva-212503 (URN)10.1186/s11556-023-00322-7 (DOI)37464299 (PubMedID)2-s2.0-85165253094 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2020–00589
Available from: 2023-08-01 Created: 2023-08-01 Last updated: 2023-08-01Bibliographically approved
Månsson, L., Pettersson, B., Rosendahl, E., Skelton, D. A., Lundin-Olsson, L. & Sandlund, M. (2022). Feasibility of performance-based and self-reported outcomes in self-managed falls prevention exercise interventions for independent older adults living in the community. BMC Geriatrics, 22(1), Article ID 147.
Open this publication in new window or tab >>Feasibility of performance-based and self-reported outcomes in self-managed falls prevention exercise interventions for independent older adults living in the community
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2022 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 22, no 1, article id 147Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Little is known about associations between performance-based measurements and self-reported scales, nor about ceiling effects or sensitivity to change to evaluate effects in the target population for self-managed exercise interventions. This study aimed to explore the feasibility of using performance-based outcomes for gait speed, functional leg strength and balance, and self-reported outcomes of falls-efficacy and functional ability in two self-managed falls prevention exercise interventions for community dwelling older adults.

METHODS: Independent living, community-dwelling older adults (n = 67) exercised with one of two self-managed falls prevention exercise programmes, a digital programme (DP) or a paper booklet (PB) in a 4-month participant preference trial. Pre- and post-assessments, by blinded assessors, included Short Physical Performance Battery (SPPB) and 30s Chair stand test (30s CST). Participants completed self-reported questionnaires: Activities-specific and Balance Confidence scale (ABC), Iconographical Falls Efficacy Scale (Icon-FES), Late-Life Function and Disability Instrument Function Component (LLFDI-FC). In addition, improvement in balance and leg strength was also self-rated at post-assessment. Participants' mean age was 76 ± 4 years and 72% were women.

RESULTS: Ceiling effects were evident for the balance sub-component of the SPPB, and also indicated for ABC and Icon-FES in this high functioning population. In SPPB, gait speed, 30s CST, and LLFDI-FC, 21-56% of participants did not change their scores beyond the Minimal Clinically Important Difference (MCID). At pre-assessment all performance-based tests correlated significantly with the self-reported scales, however, no such significant correlations were seen with change-scores. Improvement of performance-based functional leg strength with substantial effect sizes and significant correlations with self-reported exercise time was shown. There were no differences in outcomes between the exercise programmes except that DP users reported improved change of leg strength to a higher degree than PB users.

CONCLUSION: The LLFDI-FC and sit-to-stand tests were feasible and sensitive to change in this specific population. The balance sub-component of SPPB and self-reported measures ABC and Icon-FES indicated ceiling effects and might not be suitable as outcome measures for use in a high functioning older population. Development and evaluation of new outcome measures are needed for self-managed fall-preventive interventions with high functioning community-dwelling older adults.

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Aged, Falls prevention, Patient outcome assessment, Self-managed
National Category
Geriatrics Physiotherapy
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-192876 (URN)10.1186/s12877-022-02851-9 (DOI)000759555200002 ()35193495 (PubMedID)2-s2.0-85125155283 (Scopus ID)
Funder
Swedish Research Council, 2015-03481Swedish Research Council, 521-2011-3250Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2022-03-08 Created: 2022-03-08 Last updated: 2022-04-29Bibliographically approved
Janols, R., Sandlund, M., Lindgren, H. & Pettersson, B. (2022). Older adults as designers of behavior change strategies to increase physical activity: report of a participatory design process. Frontiers In Public Health, 10, Article ID 988470.
Open this publication in new window or tab >>Older adults as designers of behavior change strategies to increase physical activity: report of a participatory design process
2022 (English)In: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, article id 988470Article in journal (Refereed) Published
Abstract [en]

Background: Despite the significant value of physical activity for the health of older adults, this population often fails to achieve recommended activity levels. Digital interventions show promise in providing support for self-managed physical activity. However, more information is needed about older adults' preferences for digital support to change physical activity behaviors as well as the process of designing them. The aim of this paper was to describe the participatory design process in which older adults were involved in the co-creation of digitally supported behavioral change strategies to support self-managed physical activity, and how the results were integrated in a prototype.

Methods: The participatory design process involved with nine older adults and two researchers. The participants were divided in two groups, and each group participated in three workshops and completed home tasks in between workshops. Following an iterative design process influenced by theories of behavior change, the workshops and home tasks were continuously analyzed, and the content and process were developed between groups and the next set of workshops. Prototypes of a mobile health (mHealth) solution for fall preventive exercise for older adults were developed in which the conceptualized strategies were integrated. To support coherence in reporting and evaluation, the developed techniques were mapped to the Behavior Change Technique Taxonomy v1 and the basic human psychosocial needs according to the Self-determination Theory.

Results: The results highlight different preferences of older adults for feedback on physical activity performance, as well as the importance of transparency regarding the identification of the sender of feedback. Preferences for content and wording of feedback varied greatly. Subsequently, the design process resulted in a virtual health coach with three different motivational profiles and tools for goal setting and self-monitoring. These behavior change strategies were integrated in the exercise application Safe Step v1. The conformity of the design concepts with the needs of Self-determination Theory and Behavior Change Technique Taxonomy v1 are presented.

Conclusion: The participatory design process exemplifies how older adults successfully contributed to the design of theory-based digital behavior change support, from idea to finished solution. Tailoring feedback with a transparent sender is important to support and not undermine motivation.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
behavior change, co-creation, digital technology, mHealth, motivation, participatory design
National Category
Human Computer Interaction
Identifiers
urn:nbn:se:umu:diva-202585 (URN)10.3389/fpubh.2022.988470 (DOI)000910855400001 ()36620266 (PubMedID)2-s2.0-85145500489 (Scopus ID)
Funder
Swedish Research Council, 521–2011-3250Swedish Research Council, 2015-03481Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2023-01-12 Created: 2023-01-12 Last updated: 2023-09-05Bibliographically approved
Bajraktari, S., Zingmark, M., Pettersson, B., Rosendahl, E., Lundin-Olsson, L. & Sandlund, M. (2022). Reaching older people with a digital fall prevention intervention in a Swedish municipality context: an observational study. Frontiers In Public Health, 10, Article ID 857652.
Open this publication in new window or tab >>Reaching older people with a digital fall prevention intervention in a Swedish municipality context: an observational study
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2022 (English)In: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, article id 857652Article in journal (Refereed) Published
Abstract [en]

Background: There is robust evidence that falls in old age can be prevented by exercise programs that include balance training, functional exercises, and strength training. For the interventions to have a population health impact, outreach to the population of focus with suitable interventions is needed. While digital interventions are promising there is limited knowledge on the characteristics of who is reached. The aim of this study was to describe the recruitment process, estimate reach rate at the population level and to describe participants characteristics and representativeness in a digital fall prevention intervention study.

Methods: In a municipality-based observational study, reach of a digital fall prevention intervention was evaluated. The intervention included a digital exercise programme (Safe Step) and optional supportive strategies, complemented with a range of recruitment strategies to optimize reach. Recruitment during a period of 6 months was open to people 70 years or older who had experienced a fall or a decline in balance the past year. Reach was based on data from the baseline questionnaire including health and demographic characteristics of participants. Representativeness was estimated by comparing participants to a sample of older people from the Swedish National Public Health Survey.

Results: The recruitment rate was 4.7% (n = 173) in relation to the estimated population of focus (n = 3,706). Most participants signed up within the first month of the intervention (n = 131). The intervention attracted primarily women, older people with high education, individuals who used the internet or digital applications almost every day and those perceiving their balance as fair or poor. Safe step participants lived more commonly alone and had higher education and better walking ability in comparison to the Swedish National Public Health Survey.

Conclusions: With a range of recruitment strategies most participants were recruited to a digital fall intervention during the first month. The intervention attracted primarily highly educated women who frequently used the internet or smart technologies. In addition to digital fall prevention interventions, a higher diversity of intervention types (digital and non-digital) is more likely to reach a larger group of older people with different needs.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
accidental falls, aged, balance and strength exercise, digital health, mobile health, RE-AIM framework, reach
National Category
Physiotherapy Geriatrics
Identifiers
urn:nbn:se:umu:diva-194291 (URN)10.3389/fpubh.2022.857652 (DOI)000795835400001 ()35548075 (PubMedID)2-s2.0-85129978211 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2020-00589
Available from: 2022-04-29 Created: 2022-04-29 Last updated: 2023-04-04Bibliographically approved
Pettersson, B., Bajraktari, S., Skelton, D., Zingmark, M., Rosendahl, E., Lundin-Olsson, L. & Sandlund, M. (2022). Recruitment strategies and reach of a digital fall-prevention intervention for community-dwelling older adults. Digital health, 8, Article ID 20552076221126050.
Open this publication in new window or tab >>Recruitment strategies and reach of a digital fall-prevention intervention for community-dwelling older adults
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2022 (English)In: Digital health, Vol. 8, article id 20552076221126050Article in journal (Refereed) Published
Abstract [en]

Background: To have an impact on the population's health, preventive interventions have to reach a large proportion of the intended population. Digital solutions show potential for providing wider access to fall preventive exercise. However, there is a lack of knowledge about how to reach the target group. The aim of this study was to describe the recruitment process used in the Safe Step randomised controlled trial and the characteristics of the participants reached.

Methods: Several recruitment methods, both digital and non-digital, were adopted to reach the intended sample size. Sociodemographic parameters from the baseline questionnaire were used to describe participant characteristics. The characteristics were also compared to a representative sample of older adults in the Swedish population.

Results: In total, 1628 older adults were recruited. Social media proved to be the most successful recruitment strategy, through which 76% of the participants were recruited. The participants reached had a mean age of 75.9 years, lived in both urban and rural locations, were already frequent users of the Internet and applications (smartphone/tablet) (79.9%), had higher education (71.9%), and a large proportion were women (79.4%). In comparison with the general population participants in the Safe Step study were more highly educated (p < 0.001), women in the study more frequently lived alone (p < 0.001) and men more often reported poorer self-rated health (p = 0.04). Within the study, men reported a faster deteriorating balance (p = 0.003) and more prescribed medication (p < 0.001) than women.

Conclusion: Recruitment via social media is a useful strategy for reaching older adults, especially women and frequent users of the Internet, for a fully self-managed and digital fall prevention exercise intervention. This study underlines that a range of interventions must be available to attract and suit older adults with different functional statuses and digital skills.

Place, publisher, year, edition, pages
Sage Publications, 2022
Keywords
accidental falls, aged, eHealth, exercise, fall prevention, Geriatric medicine, preventive medicine, reach, recruitment, self-management
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-183076 (URN)10.1177/20552076221126050 (DOI)000855672000001 ()36118253 (PubMedID)2-s2.0-85138745998 (Scopus ID)
Funder
Swedish Research Council, 2015-03481Forte, Swedish Research Council for Health, Working Life and Welfare, 2020-00589Umeå UniversityKarolinska Institute
Note

Originally included in thesis in manuscript form.

Available from: 2021-05-17 Created: 2021-05-17 Last updated: 2022-10-12Bibliographically approved
Pettersson, B. (2021). Fall prevention exercise for older adults: self-management with support of digital technology. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Fall prevention exercise for older adults: self-management with support of digital technology
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Digital fallprevention – egenträning för äldre personer
Abstract [en]

Background: Falls are a major public health issue, which can cause physical and psychological suffering for the individual as well as large costs for the society. To increase access and adherence to evidence-based fall prevention exercise, utilisation of older adults’ own capabilities and digital health offers promising solutions. The aim of this thesis was to explore a digital programme as support for self-management of fall preventive exercises in community-dwelling older adults with a focus on participant experiences, behaviour change, and intervention reach.

Methods: This thesis comprises four papers, of which Papers I and II report from a feasibility study comparing two self-managed fall prevention exercise programmes, a paper booklet and the digital Safe Step programme. Papers III and IV describes a randomised controlled trial, which evaluates the effectiveness of the Safe Step programme in combination with educational videos, to reduce falls in comparison with educational videos alone. In Paper I, individual interviews were analysed with inductive qualitative content analysis to explore older adults’ experiences of self-managing their fall prevention exercise. In Paper II, a deductive and inductive approach was utilised for the analysis of comments in questionnaires, individual, and focus group interviews to explore experiences of self-determination when using the Safe Step programme. The classification system of motivational and behaviour change strategies based on Self-determination theory was utilised as a categorisation matrix. An additional analysis of behavioural regulation for exercise according to the Self-determination theory was performed in this thesis. Paper III is a protocol for a randomised controlled trial, and Paper IV describes the recruitment strategies, and reach of this trial through comparison with another representative sample of adults 70 years or older by descriptive statistics.

Results: Results from Papers I and II show that the older adults appreciated the autonomy of a self-managed exercise programme. They expressed a capability to independently select exercises and manage their progression with support from the programme. However, some wanted the support of others in their training. The behaviour change support in the Safe Step programme was voiced as motivating and supportive, and the diversity of behaviour change strategies was emphasized as important to suit many older adults’ preferences. In Paper II, the behaviour change support were found supportive for the basic human psychological needs according to the Self-determination theory, although, support for autonomy and competence were more clearly stated than for relatedness. An additional category was formed and proposed as an amendment to the classification system used as an analytical matrix. In the thesis, expressions of intrinsic and extrinsic motivations for doing the exercise from participants in Paper I were triangulated with results from the Behavioural Regulations in Exercise Questionnaire-2. The results confirmed the trend found in the qualitative analysis of more intrinsically motivated expressions in the group using the Safe Step programme. A study protocol was written that described the design of the Safe Step randomised controlled trial, including the aims, methodology and overall organisation of the research (Paper III). In Paper IV, the most successful recruitment strategy to the randomised controlled trial was identified as advertisement in social media. The recruited participants were predominantly women, highly educated, and frequently used applications or internet on mobile devices.

Conclusion: Finding of this thesis support implementation of fall prevention strategies through increased utilisation of older adults' self-management capabilities. Older adults’ experiences of exercising with a self-managed digital exercise program can be understood as managing pieces of a personal puzzle and was shaped more by the sum of the features and behaviour change support in the programme than by parts of the programme. The Safe step programme seems to provide support for more self-determined exercise motivation, than a paper booklet, which can support maintenance of the new exercise routines. The older adults’ experiences, as well as the characteristics of the participants reached, highlight the necessity for a variety of fall prevention strategies that reflect the diversified needs and preferences of older adults.

Abstract [sv]

Fallolyckor bland äldre personer är ett av vår tids största folkhälsoproblem. Fallen orsakar psykiskt och fysiskt lidande för individen och ger upphov till stora kostnader för samhället. Ungefär en tredjedel av alla personer som är minst 65 år och bor i sitt ordinarie boende faller varje år. Den äldre befolkningen växer och det är därför av stor vikt att arbeta fallförebyggande. Det finns stort vetenskapligt underlag för träningens effekter för att förhindra fallolyckor, därtill finns också kunskap om vilken typ av övningar som bör genomföras. Dock har det visat sig att hälften av alla som påbörjar fallpreventiv träning slutar inom ett år.

En möjlig lösning för att det ska vara lättare att träna under längre tid är att äldre personer är mer delaktiga i beslut om sin egen träning. Allt fler digitala lösningar utvecklas och utvärderas för att ge stöd för träning till fler äldre personer och ge möjlighet att vara delaktiga i att förebygga fall. Digital teknik kan stödja träningen i det egna hemmet och ger möjligheten att inkludera stöd för beteendeförändring, också över tid. Dock behövs mer forskning om vilket stöd som behövs för att äldre personer, med olika förutsättningar och förmågor, ska kunna vara mer självständiga i utformandet och utförandet av fallpreventionsträning. Syftet med denna avhandling var att utforska självständig fallförebyggande träning med stöd av digital teknologi.

Avhandlingen innehåller fyra delstudier. De två första delstudierna baseras på en genomförbarhetsstudie där deltagarna själva valt om de vill träna med ett digitalt program (Säkra steg) eller med ett pappersbaserat program under fyra månader. Den första delstudien utforskar deltagarnas upplevelser och erfarenheter av självständig träning genom individuella intervjuer med äldre personer i båda träningsgrupperna. Den andra delstudien utforskar deltagarnas erfarenheter av stöd för beteendeförändring i det digitala Säkra steg-programmet. Intervjuer genomfördes både individuellt och i fokusgrupper. Vid analysen inkluderades även kommentarer från enkäter. Båda delstudierna analyserades med kvalitativ innehållsanalys. I den andra delstudien relaterades deltagarnas upplevelser också till ett klassifikationssystem av motivations- och beteendeförändringstekniker baserat på självbestämmandeteorin. En tilläggsanalys i kappan beskriver deltagarnas motivation enligt denna teori före och efter studiens genomförande. De sista två delstudierna beskriver utformning av en nationell randomiserad kontrollerad studie och undersöker rekryteringen till denna samt vilka äldre personer som visat intresse för att delta. I den sista delstudien beskrivs och jämförs bakgrundsdata från de deltagare som inkluderats med data från personer 70 år och äldre som besvarat Folkhälsoenkäten utgiven av Folkhälsomyndigheten.

Resultaten från denna avhandling ger insikter om äldre personers erfarenheter och förmågor att självständigt genomföra fallförebyggande träning i hemmet. Deltagarnas erfarenheter byggde på ett dynamiskt samspel mellan personens egna drivkrafter och motivation, stödet från programmet samt hur man utformar sina träningsrutiner. Det digitala Säkra steg-programmet verkar ha bidragit med ett större stöd för deltagarna att bibehålla sin träning. Detta stöds både av intervjuerna men också av tilläggsanalyser i avhandlingen baserat på enkäten gällande motivation enligt självbestämmandeteorin. Rekryteringen till den nationella randomiserade kontrollerade studien var mer framgångsrik via annonser i sociala medier än via andra rekryteringsstrategier. Äldre personer intresserade av att delta studien var till största delen kvinnor, de hade hög utbildning och använde ofta internet eller applikationer på sin mobiltelefon eller surfplatta dagligen. Andelen kvinnor och utbildningsnivå var också högre i studien än i jämförelse med äldre personer som besvarat Folkhälsoenkäten.

En mängd olika insatser för fallprevention behövs, både när ett fall har skett men också innan. Äldre personer bildar inte en homogen grupp när det gäller förutsättningar, preferenser och motivation och därför kan inte ett enskilt fallpreventivt program passa alla. Resultatet från denna avhandling visar att ett digitalt träningsprogram med stöd för beteendeförändring är en sådan möjlighet. Deltagarnas uttryckta förmåga till att vara aktiva deltagare i sin fallpreventionsträning kan bidra till vägledning i fortsatt utformning av fallpreventionsinsatser för äldre personer.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2021. p. 78
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2122
Keywords
eHealth, digital health, fall prevention, self-management, smartphone, digital technology, behavioural change support, Self-determination theory, Fallprevention, eHälsa, egenvård, digital teknik, beteendeförändring, självbestämmandeteorin
National Category
Physiotherapy
Research subject
physiotherapy; Public health
Identifiers
urn:nbn:se:umu:diva-183077 (URN)978-91-7855-537-6 (ISBN)978-91-7855-536-9 (ISBN)
Public defence
2021-06-10, Aula Biologica, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2021-05-20 Created: 2021-05-17 Last updated: 2022-04-29Bibliographically approved
Pettersson, B., Janols, R., Wiklund, M., Lundin-Olsson, L. & Sandlund, M. (2021). Older adults’ experiences of behavior change support in a digital fall prevention exercise program: A qualitative study framed by the self-determination theory. Journal of Medical Internet Research, 23(7), Article ID e26235.
Open this publication in new window or tab >>Older adults’ experiences of behavior change support in a digital fall prevention exercise program: A qualitative study framed by the self-determination theory
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2021 (English)In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 23, no 7, article id e26235Article in journal (Refereed) Published
Abstract [en]

Background: Exercise is an effective intervention to prevent falls in older adults; however, long-term adherence is often poor. To increase adherence, additional support for behavior change has been advocated. However, consistency in the reporting of interventions using behavior change techniques is lacking. Recently, a classification system has been developed to increase consistency in studies using behavior change techniques within the self-determination theory.

Objective: This study aimed to explore expressions of self-determination among community-dwelling older adults using a self-managed digital fall prevention exercise program comprising behavior change support (the Safe Step program), which was developed in co-creation with intended users.

Methods: The qualitative study design was based on open-ended responses to questionnaires, and individual and focus group interviews. A deductive qualitative content analysis was applied using the classification system of motivation and behavior change techniques as an analytical matrix, followed by an inductive analysis. Twenty-five participants took part in a feasibility study and exercised in their homes with the Safe Step program for 4 months. The exercise program was available on computers, smartphones, and tablets, and was fully self-managed.

Results: In the deductive analysis, expressions of support were demonstrated for all three basic human psychological needs, namely, autonomy, competence, and relatedness. These expressions were related to 11 of the 21 motivation and behavior change techniques in the classification system. The inductive analysis indicated that autonomy (to be in control) was valued and enabled individual adaptations according to different rationales for realizing exercise goals. However, the experience of autonomy was also two-sided and depended on the participants’ competence in exercise and the use of technology. The clarity of the program and exercise videos was seen as key for support in performance and competent choices. Although augmented techniques for social support were requested, support through relatedness was found within the program.

Conclusions: In this study, the Safe Step program supported the establishment of new exercise routines, as well as the three basic human psychological needs, with autonomy and competence being expressed as central in this context. Based on the participants’ experiences, a proposed addition to the classification system used as an analytical matrix has been presented.

Place, publisher, year, edition, pages
JMIR Publications, 2021
Keywords
Accidental falls, Aged, Behavior change, Behavior change techniques, Classification of motivation, EHealth, Exercise, Fall prevention, Qualitative research, Self-determination theory, Self-management
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-183075 (URN)10.2196/26235 (DOI)000680402200002 ()34328438 (PubMedID)2-s2.0-85111690599 (Scopus ID)
Note

Originally included in thesis in manuscript form.

Available from: 2021-05-17 Created: 2021-05-17 Last updated: 2024-01-17Bibliographically approved
Pettersson, B., Lundin-Olsson, L., Skelton, D. A., Liv, P., Zingmark, M., Rosendahl, E. & Sandlund, M. (2020). Effectiveness of a self-managed digital exercise programme to prevent falls in older community-dwelling adults: study protocol for the Safe Step randomised controlled trial. BMJ Open, 10(5), Article ID e036194.
Open this publication in new window or tab >>Effectiveness of a self-managed digital exercise programme to prevent falls in older community-dwelling adults: study protocol for the Safe Step randomised controlled trial
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2020 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 5, article id e036194Article in journal (Refereed) Published
Abstract [en]

Introduction: Exercise interventions have a strong evidence base for falls prevention. However, exercise can be challenging to implement and often has limited reach and poor adherence. Digital technology provides opportunities for both increased access to the intervention and support over time. Further knowledge needs to be gained regarding the effectiveness of completely self-managed digital exercise interventions. The main objective of this study is to compare the effectiveness of a self-managed digital exercise programme, Safe Step, in combination with monthly educational videos with educational videos alone, on falls over 1 year in older community-dwelling adults.

Methods and analysis: A two-arm parallel randomised controlled trial will be conducted with at least 1400 community-living older adults (70+ years) who experience impaired balance. Participants will be recruited throughout Sweden with enrolment through the project website. They will be randomly allocated to either the Safe Step exercise programme with additional monthly educational videos about healthy ageing and fall prevention, or the monthly education videos alone. Participants receiving the exercise intervention will be asked to exercise at home for at least 30 min, 3 times/week with support of the Safe Step application. The primary outcome will be rate of falls (fall per person year). Participants will keep a fall calendar and report falls at the end of each month through a digital questionnaire. Further assessments of secondary outcomes will be made through self-reported questionnaires and a self-test of 30 s chair stand test at baseline and 3, 6, 9 and 12 months after study start. Data will be analysed according to the intention-to-treat principle.

Ethics and dissemination: Ethical approval was obtained by The Regional Ethical Review Board in Umeå (Dnr 2018/433-31). Findings will be disseminated through the project web-site, peer-reviewed journals, national and international conferences and through senior citizen organisations’ newsletters.

Trial registration number: NCT03963570.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2020
Keywords
geriatric medicine, preventive medicine, public health, statistics & research methods
National Category
Public Health, Global Health, Social Medicine and Epidemiology Physiotherapy Geriatrics
Identifiers
urn:nbn:se:umu:diva-177628 (URN)10.1136/bmjopen-2019-036194 (DOI)000738373200077 ()32423936 (PubMedID)2-s2.0-85084786663 (Scopus ID)
Available from: 2020-12-15 Created: 2020-12-15 Last updated: 2023-09-05Bibliographically approved
Pettersson, B., Nordin, E., Ramnemark, A. & Lundin-Olsson, L. (2020). Neither Timed Up and Go test nor Short Physical Performance Battery predict future falls among independent adults aged ≥75 years living in the community. Journal of frailty, sarcopenia and falls, 5(2), 24-30
Open this publication in new window or tab >>Neither Timed Up and Go test nor Short Physical Performance Battery predict future falls among independent adults aged ≥75 years living in the community
2020 (English)In: Journal of frailty, sarcopenia and falls, E-ISSN 2459-4148, Vol. 5, no 2, p. 24-30Article in journal (Refereed) Published
Abstract [en]

Objectives: Previous research has shown that balance and gait difficulties are predictors of falls. The aim of this study was to evaluate the predictive validity of two tools reporting on balance and gait among older community living adults independent in personal activities of daily living (p-ADL).

Methods: Prospective study design. Baseline assessment included the Timed Up and Go test (TUG) and the Short Physical Performance Battery (SPPB). Following baseline, falls were recorded monthly for one year by 202 participants (70.1% women) who were independent in p-ADL, and at least 75 years old (79.2±3.5). ROC-curves were made and AUC were calculated.

Results: Fortyseven percent of the participants reported falls. AUCs calculated for TUG were 0.5 (95% CI: 0.5-0.6) for those with at least one fall, and 0.5 (95% CI: 0.5-0.6) for recurrent fallers. Corresponding figures for SPPB were 0.5 (95% CI: 0.5-0.6) and 0.5 (95% CI: 0.5-0.6).

Conclusion: This study does not support a recommendation to use the Timed Up and Go test or the Short Physical Performance Battery as tools for the identification of fall-prone persons among older adults living in the community. These results reinforce the need for further research into appropriate tools for identifying independent but fall-prone older adults.

Place, publisher, year, edition, pages
Hylonome Publications, 2020
Keywords
Accidental falls, Aged, Functional ability, Geriatric assessment/methods, Postural balance
National Category
Geriatrics
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-222595 (URN)10.22540/jfsf-05-024 (DOI)
Available from: 2024-03-21 Created: 2024-03-21 Last updated: 2024-03-22Bibliographically approved
Pettersson, B., Nordin, E., Ramnemark, A. & Lundin-Olsson, L. (2020). Proposals for continued research to determine older adults’ falls risk. Journal of Frailty, Sarcopenia and Falls, 5(4), 89-91
Open this publication in new window or tab >>Proposals for continued research to determine older adults’ falls risk
2020 (English)In: Journal of Frailty, Sarcopenia and Falls, E-ISSN 2459-4148, Vol. 5, no 4, p. 89-91Article in journal (Other academic) Published
Abstract [en]

Early detection of older adults with an increased risk of falling could enable early onset of preventative measures. Currently used fall risk assessment tools have not proven sufficiently effective in differentiating between high and low fall risk in community-living older adults. There are a number of tests and measures available, but many timed and observation-based tools are performed on a flat floor without interaction with the surrounding. To improve falls prediction, measurements in other areas that challenge mobility in dynamic conditions and that take a persons’ own perception of steadiness into account should be further developed and evaluated as single or combined measures. The tools should be easy to apply in clinical practice or used as a self-assessment by the older adults themselves.

Place, publisher, year, edition, pages
Hylonome Publications, 2020
Keywords
Accidental falls, Aged, Functional ability, Geriatric assessment/methods, Postural balance
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-222631 (URN)10.22540/jfsf-05-089 (DOI)
Available from: 2024-03-22 Created: 2024-03-22 Last updated: 2024-03-25Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5147-9715

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