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  • 1.
    An, Qingfan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Agnello, Danielle
    Glasgow Caledonian University, Glasgow, United Kingdom.
    Mccaffrey, Lauren
    Glasgow Caledonian University, Glasgow, United Kingdom.
    Chastin, Sebastien
    Glasgow Caledonian University, Glasgow, United Kingdom.
    Helleday, Ragnberth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    A scoping review of co-creation practice in the development of non-pharmacological interventions for people with chronic obstructive pulmonary disease2023Ingår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 62, nr Suppl. 67, artikel-id PA2416Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Incorporating co-creation process in the development of interventions may improve the outcome. However, there is a lack of synthesis of co-creation practices in the development of Non-Pharmacological Interventions (NPIs) for Chronic Obstructive Pulmonary Disease (COPD).

    Objective: This scoping review aimed to examine the co-creation practice used when developing NPIs for people with COPD.

    Methods: The methodology proposed by Arksey and O’Malley for scoping reviews was followed, and it was reported according to the PRISMA-ScR framework. The search included PubMed, Scopus, CINAHL, and Web of Science. Studies reporting on the process and/or analysis of applying co-creation practice in developing NPIs for people with COPD were included.

    Results: 13 articles complied with the inclusion criteria. The composition of co-creators was diverse and reported in most of the included studies. Facilitating factors described in the co-creation practices included administrative preparations, diversity of stakeholders, cultural considerations, employment of creative methods, creation of an appreciative environment, and digital assistance. Few creative methods were mentioned or explained in the studies. Challenges around the physical limitations of patients, the absence of key stakeholder opinions, a prolonged process, recruitment, and digital illiteracy of co-creators were listed. Most of the studies did not report implementation considerations as a discussion point in their co-creation workshops.

    Conclusion: This review provides suggestions for evidence-based co-creation in COPD care which may improve the quality of care delivered by NPIs.

  • 2.
    An, Qingfan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Agnello, Danielle
    School of Health and Life Sciences, Glasgow Caledonian University, UK.
    McCaffrey, Lauren
    School of Health and Life Sciences, Glasgow Caledonian University, UK.
    Chastin, Sebastien
    School of Health and Life Sciences, Glasgow Caledonian University, UK; Department of Movement and Sports Sciences, Ghent University, 9000, Ghent, Belgium.
    Helleday, Ragnberth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    A scoping review of co-creation practice in the development of non-pharmacological interventions for people with chronic obstructive pulmonary disease: a health CASCADE study2023Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 211, artikel-id 107193Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Incorporating co-creation processes may improve the quality of outcome interventions. However, there is a lack of synthesis of co-creation practices in the development of Non-Pharmacological Interventions (NPIs) for people with Chronic Obstructive Pulmonary Disease (COPD), that could inform future co-creation practice and research for rigorously improving the quality of care.

    Objective: This scoping review aimed to examine the co-creation practice used when developing NPIs for people with COPD.

    Methods: This review followed Arksey and O'Malley scoping review framework and was reported according to the PRISMA-ScR framework. The search included PubMed, Scopus, CINAHL, and Web of Science Core Collection. Studies reporting on the process and/or analysis of applying co-creation practice in developing NPIs for people with COPD were included.

    Results: 13 articles complied with the inclusion criteria. Limited creative methods were reported in the studies. Facilitators described in the co-creation practices included administrative preparations, diversity of stakeholders, cultural considerations, employment of creative methods, creation of an appreciative environment, and digital assistance. Challenges around the physical limitations of patients, the absence of key stakeholder opinions, a prolonged process, recruitment, and digital illiteracy of co-creators were listed. Most of the studies did not report including implementation considerations as a discussion point in their co-creation workshops.

    Conclusion: Evidence-based co-creation in COPD care is critical for guiding future practice and improving the quality of care delivered by NPIs. This review provides evidence for improving systematic and reproducible co-creation. Future research should focus on systematically planning, conducting, evaluating, and reporting co-creation practices in COPD care.

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  • 3.
    Andersdotter Sandström, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Eskilsson, Therese
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Patients with stress-induced exhaustion disorder and their experiences of physical activity prescription in a group context2023Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 16, nr 1, artikel-id 2212950Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Physical activity is a useful means to improve symptoms and memory performance to some extent in individuals with stress-induced exhaustion disorder. Individuals in this group commonly do not need to reach the recommended levels of physical activity. Developing methods to support physical activity as a lasting behaviour is important.

    Objective: The aim of the study was to explore the processes involved when using physical activity prescription as part of rehabilitation in a group context for individuals with stress-induced exhaustion disorder.

    Method: A total of 27 individuals with stress-induced exhaustion disorder participated in six focus groups. The informants underwent a multimodal intervention including prescription of physical activity. The physical activity prescription had a cognitive behaviour approach and included information about physical activity, home assignments and goal setting. The data was analysed with grounded theory method using constant comparison.

    Results: The analysis of the data was developed into the core category ‘trying to integrate physical activity into daily life in a sustainable way’, and three categories: ‘acceptance of being good enough’, ‘learning physical activity by doing’ and ‘advocation for physical activity in rehabilitation’. The informants identified that during the physical activity prescription sessions they learned what physical activity was, what was ‘good enough’ in terms of dose and intensity of physical activity, and how to listen to the body’s signals. These insights, in combination with performing physical activity during home assignments and reflecting with peers, helped them incorporate physical activity in a new and sustainable way. A need for more customised physical activity with the ability to adjust to individual circumstances was requested.

    Conclusion: Prescription of physical activity in a group context may be a useful method of managing and adjusting physical activity in a sustainable way for individuals with stress-induced exhaustion disorder. However, identifying people who need more tailored support is important.

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  • 4.
    Bajraktari, Saranda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Hörling, Therese
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Pettersson, Beatrice
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Rosendahl, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Zingmark, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Self-managed fall preventive exercise intervention with an mHealth application: self-reported health outcomes over one yearManuskript (preprint) (Övrigt vetenskapligt)
  • 5.
    Bajraktari, Saranda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Pettersson, Beatrice
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Rosendahl, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Zingmark, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Cost-effectiveness analysis of the digital fall preventive intervention Safe Step among community dwelling older people aged 70 and overManuskript (preprint) (Övrigt vetenskapligt)
  • 6.
    Bajraktari, Saranda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Zingmark, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden.
    Health-promoting and preventive interventions for community-dwelling older people published from inception to 2019: a scoping review to guide decision making in a Swedish municipality context2020Ingår i: Archives of Public Health, ISSN 0778-7367, E-ISSN 2049-3258, Vol. 78, nr 1, artikel-id 97Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Despite the promising evidence of health-promoting and preventive interventions for maintaining health among older people, not all interventions can be implemented due to limited resources. Due to the variation of content in the interventions and the breadth of outcomes used to evaluate effects in such interventions, comparisons are difficult and the choice of which interventions to implement is challenging. Therefore, more information, beyond effects, is needed to guide decision-makers. The aim of this review was to investigate, to what degree factors important for decision-making have been reported in the existing health-promoting and preventive interventions literature for community-dwelling older people in the Nordic countries.

    Methods: This review was guided by the PRISMA-ScR checklist (Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews), the methodological steps for scoping reviews described in the Arksey and O ' Malley's framework, and the Medical Research Council's (MRC) guidance on complex interventions. Eligible studies for inclusion were randomised controlled trials (RCTs) concerning health promotion or primary prevention for community-dwelling older people implemented in the Nordic countries. Additionally, all included RCTs were searched for related papers that were reporting on additional factors. Eligible studies were searched in seven databases: PubMed, SCOPUS, CINAHL, Academic Search Elite, PsycINFO, SocINDEX, and SPORTDiscus.

    Results: Eighty-two studies met the inclusion criteria (twenty-seven unique studies and fifty-five related studies). Twelve studies focused on fall prevention, eleven had a health-promoting approach, and four studies focused on preventing disability. All interventions, besides one, reported positive effects on at least one health outcome. Three studies reported data on cost-effectiveness, three on experiences of participants and two conducted feasibility studies. Only one intervention, reported information on all seven factors.

    Conclusions: All identified studies on health-promoting and preventive interventions for older people evaluated in the Nordic countries report positive effects although the magnitude of effects and number of follow-ups differed substantially. Overall, there was a general lack of studies on feasibility, cost-effectiveness, and experiences of participants, thus, limiting the basis for decision making. Considering all reported factors, promising candidates to be recommended for implementation in a Nordic municipality context are 'Senior meetings', 'preventive home visits' and 'exercise interventions' on its own or combined with other components.

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  • 7.
    Bajraktari, Saranda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Zingmark, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden.
    Pettersson, Beatrice
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Rosendahl, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Reaching older people with a digital fall prevention intervention in a Swedish municipality context: an observational study2022Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, artikel-id 857652Artikel i tidskrift (Refereegranskat)
    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.

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  • 8. Giné-Garriga, Maria
    et al.
    Dall, Philippa M.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Jerez-Roig, Javier
    Chastin, Sebastien F. M.
    Skelton, Dawn A.
    A Pilot Randomised Clinical Trial of a Novel Approach to Reduce Sedentary Behaviour in Care Home Residents: Feasibility and Preliminary Effects of the GET READY Study2020Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, nr 8, artikel-id 2866Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Care-home residents are among the most sedentary and least active of the population. We aimed to assess the feasibility, acceptability, safety, and preliminary effects of an intervention to reduce sedentary behaviour (SB) co-created with care home residents, staff, family members, and policymakers within a pilot two-armed pragmatic cluster randomized clinical trial (RCT). Four care homes from two European countries participated, and were randomly assigned to control (usual care, CG) or the Get Ready intervention (GR), delivered by a staff champion one-to-one with the care home resident and a family member. A total of thirty-one residents participated (51.6% female, 82.9 (13.6) years old). GR involves six face to face sessions over a 12-week period with goal-oriented prompts for movement throughout. The feasibility and acceptability of the intervention were assessed and adverse events (AEs) were collected. The preliminary effects of the GR on SB, quality of life, fear of falling, and physical function were assessed. Means and standard deviations are presented, with the mean change from baseline to post-intervention calculated along with 95% confidence intervals. The CG smoked more, sat more, and had more functional movement difficulties than the GR at baseline. The GR intervention was feasible and acceptable to residents and staff. No AEs occurred during the intervention. GR participants showed a decrease in daily hours spent sitting/lying (Cohen's d = 0.36) and an increase in daily hours stepping, and improvements in health-related quality of life, fear of falling, and habitual gait speed compared to usual care, but these effects need confirmation in a definitive RCT. The co-created GR was shown to be feasible and acceptable, with no AEs.

  • 9. Giné-Garriga, Maria
    et al.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Dall, Philippa M.
    Chastin, Sebastien F. M.
    Pérez, Susana
    Skelton, Dawn A.
    A co-created intervention with care home residents and university students following a service-learning methodology to reduce sedentary behaviour: The GET READY project protocol2018Ingår i: Journal of Frailty, Sarcopenia and Falls, ISSN 2459-4148, Vol. 3, nr 3, s. 132-137Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is a growing demand for long-term care settings. Care-home residents are a vulnerable group with high levels of physical dependency and cognitive impairment. Long-term care facilities need to adapt and offer more effective and sustainable interventions to address older residents’ complex physical and mental health needs. Despite the increasing emphasis on patient and public involvement, marginalised groups such as care-home residents, can be overlooked when including people in the research process. The GET READY project aims to integrate servicelearning methodology into Physical Therapy and Sport Sciences University degrees by offering students individual service opportunities with residential care homes, in order to co-create the best suited intervention with researchers, older adults of both genders (end-users) in care homes, health professionals, caregivers, relatives and policy makers. Methods: Stage 1 will integrate a service-learning methodology within a Physical Therapy module in Glasgow and Sport Sciences module in Barcelona, design two workshops for care home residents and one workshop for staff members, relatives and policy makers and conduct a co-creation procedure. Stage 2 will assess the feasibility, safety and preliminary effects of the co-created intervention in a group of 60 care home residents, within a two-armed pragmatic randomized clinical trial. ClinicalTrials.gov Identifier: NCT03505385.

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  • 10. Giné-Garriga, Maria
    et al.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Dall, Philippa M.
    Chastin, Sebastien F. M.
    Pérez, Susana
    Skelton, Dawn A.
    A Novel Approach to Reduce Sedentary Behaviour in Care Home Residents: The GET READY Study Utilising Service-Learning and Co-Creation2019Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, nr 3, artikel-id 418Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The GET READY study aimed to integrate service-learning methodology into University degrees by offering students individual service opportunities with residential care homes, to co-create the best suited intervention to reduce the sedentary behaviour (SB) of residents throughout the day, with researchers, end-users, care staff, family members and policymakers. Eight workshops with care home residents and four workshops with care staff, relatives and policymakers, led by undergraduate students, were audiotaped, transcribed verbatim and analysed with inductive thematic analysis to understand views and preferences for sustainable strategies to reduce SB and increase movement of residents. Perspectives about SB and movement in care homes highlighted four subthemes. Assets for decreasing SB included three subthemes, and suggestions and strategies encapsulated four subthemes. There is a need to include end-users in decision making, and involve care staff and relatives in enhancing strategies to reduce SB among residents if we want sustainable changes in behaviour. A change in the culture at a policymaker and care staff's level could provide opportunities to open care homes to the community with regular activities outside the care home premises, and offer household chores and opportunities to give residents a role in maintaining their home environment.

  • 11. Giné-Garriga, Maria
    et al.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Jerez-Roig, Javier
    Booth, Jo
    Skelton, Dawn A.
    Mission (im)possible: Engaging care homes, staff and residents in research studies2020Ingår i: Journal of frailty, sarcopenia and falls, ISSN 2459-4148, Vol. 5, nr 1, s. 6-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: With increasing age the risk of institutionalization increases. To address the problem of underrepresentation of care homes and their residents in future research studies, we aimed to explore care home staff members' thoughts on barriers, challenges, facilitators and key aspects of engaging in research studies.

    METHODS: Five staff members from four care homes in Glasgow and Barcelona were interviewed. Transcription of the interviews was completed verbatim and an inductive thematic analysis was conducted to understand the difficulties and challenges they perceive for engaging in research studies.

    RESULTS: Three themes emerged that encapsulated the staff members' perspectives. 'Too much to deal with' included two subthemes; 'interested but with support' encapsulated four subthemes; and 'on the residents' terms' highlighted three subthemes. Staff members showed interest in engaging in research studies if a clear management support accompanied by a whole team approach was evident. The involvement of the resident's relatives was seen as essential if residents were to be supported to be engaged.

    CONCLUSIONS: Despite the small sample size, the perspectives of staff members, irrespective of country, provided valuable insights for informing researchers on best approaches to maximize care home and resident engagement in research.

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  • 12.
    Guerrero, Esteban
    et al.
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Nieves, Juan Carlos
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Lindgren, Helena
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Activity qualifiers in an argumentation framework as instruments for agents when evaluating human activity2016Ingår i: Advances in Practical Applications of Scalable Multi-agent Systems. The PAAMS Collection: 14th International Conference, PAAMS 2016, Sevilla, Spain, June 1-3, 2016, Proceedings / [ed] Yves Demazeau, Takayuki Ito, Javier Bajo, Maria José Escalona, Springer, 2016, Vol. 9662, s. 133-144Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Theoretical frameworks have been developed for enabling software agents to evaluate simple activities such as walking and sitting. However, such frameworks typically do not include methods for how practically dealing with uncertain sensor information. We developed an argument-based method for evaluating complex goal-based activities by adapting two qualifiers: Performance and Capacity defined in the health domain. The first one evaluates what a person does, and the second one how "well" or "bad" an activity is executed. Our aim is to deal with uncertainty and inconsistent information; generate consistent hypotheses about the activity execution; and resemble an expert therapist judgment, where an initial hypothesis assessment can be retracted under new evidence. We conducted a pilot test in order to evaluate our approach using a Physiotherapy assessment test as a goal-based activity. Results show that skeptic argumentation semantics are may be useful for discriminating individuals without physical issues by considering Performance and Capacity; conversely, credulous semantics may be suitable for obtaining information in the evaluation of activity, which an intelligent agent may use for providing personalized assistance in an ambient assisted living environment.

  • 13.
    Guerrero, Esteban
    et al.
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Nieves, Juan Carlos
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Lindgren, Helena
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Activity qualifiers using an argument-based construction2018Ingår i: Knowledge and Information Systems, ISSN 0219-1377, E-ISSN 0219-3116, Vol. 54, nr 3, s. 633-658Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Based on an argumentation theory approach, we present a novel method for evaluating complex goal-based activities by generalizing a notion of qualifier defined in the health domain. Three instances of the general qualifier are proposed: Performance, Actuation and Capacity; the first one evaluates what a person does, the second how an individual follows an action plan, and the third one how "well" or "bad" an activity is executed. Qualifiers are intended to be used by autonomous systems for evaluating human activity. We exemplify our approach using a health domain assessment protocol. Main results of this test show a partial correlation between ambiguities assessed by experts and our argument-based approach; and a multi-dimensional perspective how an activity is executed when a combined evaluation of qualifiers is used. This last outcome was interesting for some therapists consulted. Results also show differences between values of qualifiers using different argumentation semantics; two scenarios were proposed by therapist for using different semantics: preliminary activity screening and time-span follow-up evaluation.

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  • 14.
    Janols, Rebecka
    et al.
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för arbetsterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Lindgren, Helena
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Pettersson, Beatrice
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Older adults as designers of behavior change strategies to increase physical activity: report of a participatory design process2022Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, artikel-id 988470Artikel i tidskrift (Refereegranskat)
    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.

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  • 15.
    Larsson, Gunilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Swedish National Rett Center, Frösön, Sweden.
    Julu, Peter O. O.
    Engerström, Ingegerd Witt
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Lindström, Britta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Walking on treadmill with Rett syndrome: effects on the autonomic nervous system2018Ingår i: Research in Developmental Disabilities, ISSN 0891-4222, E-ISSN 1873-3379, Vol. 83, s. 99-107Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    People with Rett syndrome have deficient central autonomic control, which may interfere with walking. We have limited knowledge regarding the effects of exertion during physical activity in Rett syndrome. The aim was to investigate the autonomic responses during walking on a treadmill in Rett syndrome. Twenty-six females, 12 with Rett syndrome and 14 healthy females were included. All individuals started on the treadmill by standing still, followed by walking slowly with progressive speed until reaching maximum individual speed, which they kept for 6 min. Heart rate (HR), systolic (SBP), diastolic (DBP), mean arterial blood pressures (MAP), cardiac vagal tone (CVT), cardiac sensitivity to baroreflex (CSB), transcutaneous partial pressures of oxygen (pO2), carbon dioxide (pCO2), and breathing movements were recorded simultaneously and continuously. Autonomic responses were assessed by MAP, CSB and CVT during walking at 3 and 6 min. The changes in CSB and CVT in people with Rett syndrome compared to controls indicated more arousal, but only when the treadmill was started; as they continued walking, the arousal dropped to control level. People with Rett syndrome exhibited little changes in pCO2 whereas the controls showed increased values during walking. This suggests poor aerobic respiration in people with Rett syndrome during walking. Five people with Rett syndrome had Valsalva type of breathing at rest, three of those had normal breathing while walking on the treadmill while the remaining two started but soon stopped the Valsalva breathing during the walk. Our results show that individuals with Rett syndrome can walk for up to 6 min at their own maximum sustainable speed on a treadmill. Energy production may be low during walking in Rett syndrome, which could cause early tiredness. A treadmill can be used in people with Rett syndrome, but must be introduced slowly and should be individually tailored. We propose that walking promotes regular breathing in Rett syndrome.

  • 16.
    Larsson, Gunilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik. Swedish Rett Center, Jämtland County Council, Östersund, Sweden.
    Julu, Peter O.O.
    Breakspear Medical Group, Hertfordshire, UnitedKingdom.
    Witt Engerström, Ingegerd
    RettCenter, Jämtland CountyCouncil, Östersund, Sweden.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Lindström, Britta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Normal reactions to orthostatic stress in Rett syndrome2013Ingår i: Research in Developmental Disabilities, ISSN 0891-4222, E-ISSN 1873-3379, Vol. 34, nr 6, s. 1897-1905Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to investigate orthostatic reactions in females with Rett syndrome (RTT), and also whether the severity of the syndrome had an impact on autonomic reactions. Based on signs of impaired function of the central autonomic system found in RTT, it could be suspected that orthostatic reactions were affected. The orthostatic reactions in 21 females with RTT and 14 normally developed femalesmatched by age were investigated when they rose from a sitting position, and during standing for 3 min. Reactions of the heart, the blood pressure and the time for recovery of systolic blood pressure, were studied in real time, heartbeat by heartbeat, simultaneously. There was no difference between participants with RTT and the normally developed controls regarding general orthostatic reactions (heart rate, systolic and diastolic blood pressure, and mean arterial pressure) when getting up from a sitting position, and when standing erect for 3min. In the specific immediate response by the heart to standing up, the 30:15 ratio, significantly lower values were found for females with RTT. In the RTT group, the maximum fall of systolic blood pressure showed a tendency to a larger decrease, and the initial decrease in systolic blood pressure was significantly faster. The time for recovery of systolic blood pressure from standing erect did not differ between groups. At baseline the females with RTT had significantly lower systolic blood pressure and a tendency to a higher heart rate. The results do not indicate any autonomic limitations for people with RTT in getting up from a sitting position and standing. The participants with RTT had normal orthostatic reactions indicated by the heart and blood pressure responses when standing erect for 3 min. A faster initial drop in systolic blood pressure in people with RTT was notable.

  • 17.
    Leask, Calum F.
    et al.
    Glasgow Caledonian University, School of Health and Life Sciences, Institute of Applied Health Research, Glasgow, United Kingdom; NHS Grampian, Health Intelligence Department, Aberdeen, United Kingdom.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Skelton, Dawn A.
    Glasgow Caledonian University, School of Health and Life Sciences, Institute of Applied Health Research, Glasgow, United Kingdom.
    Altenburg, Teatske M.
    Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.
    Cardon, Greet
    Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Chinapaw, Mai J. M.
    Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.
    De Bourdeaudhuij, Ilse
    Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Verloigne, Maite
    Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Chastin, Sebastien F. M.
    Glasgow Caledonian University, School of Health and Life Sciences, Institute of Applied Health Research, Glasgow, United Kingdom; Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Framework, principles and recommendations for utilising participatory methodologies in the co-creation and evaluation of public health interventions2019Ingår i: Research Involvement and Engagement, E-ISSN 2056-7529, Vol. 5, nr 1, artikel-id 2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Due to the chronic disease burden on society, there is a need for preventive public health interventions to stimulate society towards a healthier lifestyle. To deal with the complex variability between individual lifestyles and settings, collaborating with end-users to develop interventions tailored to their unique circumstances has been suggested as a potential way to improve effectiveness and adherence. Co-creation of public health interventions using participatory methodologies has shown promise but lacks a framework to make this process systematic. The aim of this paper was to identify and set key principles and recommendations for systematically applying participatory methodologies to co-create and evaluate public health interventions.

    Methods: These principles and recommendations were derived using an iterative reflection process, combining key learning from published literature in addition to critical reflection on three case studies conducted by research groups in three European institutions, all of whom have expertise in co-creating public health interventions using different participatory methodologies.

    Results: Key principles and recommendations for using participatory methodologies in public health intervention co-creation are presented for the stages of: Planning (framing the aim of the study and identifying the appropriate sampling strategy); Conducting (defining the procedure, in addition to manifesting ownership); Evaluating (the process and the effectiveness) and Reporting (providing guidelines to report the findings). Three scaling models are proposed to demonstrate how to scale locally developed interventions to a population level.

    Conclusions: These recommendations aim to facilitate public health intervention co-creation and evaluation utilising participatory methodologies by ensuring the process is systematic and reproducible.

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  • 18. Leask, Calum F.
    et al.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Skelton, Dawn A.
    Chastin, Sebastien F. M.
    Co-creating a tailored public health intervention to reduce older adults' sedentary behaviour2017Ingår i: Health Education Journal, ISSN 0017-8969, E-ISSN 1748-8176, Vol. 76, nr 5, s. 595-608Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The increasing health care costs associated with an ageing population and chronic disease burden are largely attributable to modifiable lifestyle factors that are complex and vary between individuals and settings. Traditional approaches to promoting healthy lifestyles have so far had limited success. Recently, co-creating public health interventions with end-users has been advocated to provide more effective and sustainable solutions. The aim of this study was to document and evaluate the co-creation of a public health intervention to reduce sedentary behaviour in older adults.

    Design: Community-dwelling older adults (N = 11, mean age = 74 years) and academic researchers attended 10 interactive co-creation workshops together.

    Setting: Workshops took place on university campus and the co-creators completed fieldwork tasks outside the workshops.

    Method: Workshops were informed by the Participatory and Appreciative Action and Reflection methodology. Data were collected using field notes, video recording and worksheet tasks. Analysis was conducted using a qualitative content analysis approach.

    Results: The co-creators developed a tailored intervention delivered through a mode congruent with older adults’ lives. Key elements of the intervention included (1) education on sedentary behaviour, (2) resources to interrupt sedentary behaviour, (3) self-monitoring, (4) action planning and (5) evaluating the benefits of interrupting sedentary behaviour.

    Conclusion: Co-creation is a feasible approach to develop public health interventions; however, it is limited by the lack of a systematic framework to guide the process. Future work should aim to develop principles and recommendations to ensure co-creation can be conducted in a more scientific and reproducible way. The effectiveness and scalability of the intervention should be assessed.

  • 19. Leask, Calum F.
    et al.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Skelton, Dawn A.
    Tulle, Emmanuelle
    Chastin, Sebastien F. M.
    Modifying Older Adults' Daily Sedentary Behaviour Using an Asset-based Solution: Views from Older Adults2016Ingår i: AIMS public health, ISSN 2327-8994, Vol. 3, nr 3, s. 542-554Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: There is a growing public health focus on the promotion of successful and active ageing. Interventions to reduce sedentary behaviour (SB) in older adults are feasible and are improved by tailoring to individuals' context and circumstances. SB is ubiquitous; therefore part of the tailoring process is to ensure individuals' daily sedentary routine can be modified. The aim of this study was to understand the views of older adults and identify important considerations when creating a solution to modify daily sedentary patterns. Method: This was a qualitative research study. Fifteen older adult volunteers (mean age = 78 years) participated in 1 of 4 focus groups to identify solutions to modify daily sedentary routine. Two researchers conducted the focus groups whilst a third took detailed fieldnotes on a flipchart to member check the findings. Data were recorded and analysed thematically. Results: Participants wanted a solution with a range of options which could be tailored to individual needs and circumstances. The strategy suggested was to use the activities of daily routine and reasons why individuals already naturally interrupting their SB, collectively framed as assets. These assets were categorised into 5 sub-themes: physical assets (eg. standing up to reduce stiffness); psychological assets (eg. standing up to reduce feelings of guilt); interpersonal assets (eg. standing up to answer the phone); knowledge assets (eg. standing up due to knowing the benefits of breaking SB) and activities of daily living assets (eg. standing up to get a drink). Conclusion: This study provides important considerations from older adults' perspectives to modify their daily sedentary patterns. The assets identified by participants could be used to co-create a tailored intervention with older adults to reduce SB, which may increase effectiveness and adherence.

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  • 20. Leask, Calum F.
    et al.
    Skelton, Dawn A.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Chastin, Sebastien F. M.
    Co-Creating a Tailored Intervention to Reduce Sedentary Behaviour in Older Adults2016Ingår i: Journal of Aging and Physical Activity, ISSN 1063-8652, E-ISSN 1543-267X, Vol. 24, s. 92-92Artikel i tidskrift (Övrigt vetenskapligt)
  • 21.
    Lindgren, Helena
    et al.
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Pohl, Petra
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    End users transforming experiences into formal information and process models for personalised health interventions2014Ingår i: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 205, s. 378-382Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Five physiotherapists organised a user-centric design process of a knowledge-based support system for promoting exercise and preventing falls. The process integrated focus group studies with 17 older adults and prototyping. The transformation of informal medical and rehabilitation expertise and older adults' experiences into formal information and process models during the development was studied. As tool they used ACKTUS, a development platform for knowledge-based applications. The process became agile and incremental, partly due to the diversity of expectations and preferences among both older adults and physiotherapists, and the participatory approach to design and development. In addition, there was a need to develop the knowledge content alongside with the formal models and their presentations, which allowed the participants to test hands-on and evaluate the ideas, content and design. The resulting application is modular, extendable, flexible and adaptable to the individual end user. Moreover, the physiotherapists are able to modify the information and process models, and in this way further develop the application. The main constraint was found to be the lack of support for the initial phase of concept modelling, which lead to a redesigned user interface and functionality of ACKTUS.

  • 22.
    Lundberg, Veronica
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Eriksson, Catharina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi.
    Janols, Rebecka
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Lind, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    How children and adolescents with juvenile idiopathic arthritis participate in their healthcare: health professionals' views2022Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 44, nr 10, s. 1908-1915Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The study explores how healthcare professionals view participation of children and adolescents with juvenile idiopathic arthritis, in healthcare encounters.

    Methods: This qualitative study includes focus groups of HCPs from different professions. The interviews were analysed with qualitative content analysis.

    Results: The theme “Creating an enabling arena” illuminates how HCPs face possibilities and challenges when enabling children to communicate and participate in clinical encounters. HCPs, parents, and the healthcare system need to adjust to the child. The sub-theme “Bringing different perspectives” describes how children and their parents cooperate and complement each other during healthcare encounters. The sub-theme “Building a safe and comfortable setting” includes how HCPs address the child’s self-identified needs and make the child feel comfortable during encounters. The sub-theme “Facilitating methods in a limiting organisation” includes how HCPs’ working methods and organization may help or hinder child participation during encounters.

    Conclusions: HCPs encourage children and adolescents to make their views known during healthcare encounters by creating an enabling arena. Collaboration and building good relationships between the child, the parents and the HCPs, before and during the healthcare encounters, can help the child express their wishes and experiences. Clinical examinations and use of technology, such as photos, films and web-bases questionnaires can be a good start for a better child communication in healthcare encounters.

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  • 23.
    Lundberg, Veronica
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Eriksson, Catharina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Janols, Rebecka
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Lind, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    How children with juvenile idiopathic arthritis participate in their healthcare: Health professionals' viewsManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background: This study explores how juvenile idiopathic arthritis (JIA) teams experience participation of children with arthritis in their own healthcare.

    Methods: This qualitative study includes focus groups of HCPs from different professions. The interviews were analysed with qualitative content analysis.

    Results: The theme “Creating an enabling arena” illuminates how HCPs face possibilities and challenges when enabling children to communicate and participate in clinical encounters. HCPs, parents, and the healthcare system need to adjust to the child. The sub-theme “Children and parents bring different perspectives” describes how children and their parents cooperate and complement each other during healthcare encounters. The sub-theme “Building a comfortable setting” includes how HCPs address the child’s self-identified needs and make the child feel comfortable during encounters. The sub-theme “Facilitating methods in a limiting system” includes how HCPs’ working methods and organization may help or hinder child participation during encounters.

    Conclusions: Using age-appropriate explanations, HCPs encourage children to express their everyday challenges. Collaboration between children and parents before a healthcare encounter and between children, parents, and HCPs during an encounter help children express their wishes and experiences. HCPs enable child participation by creating a good relationship with the children and their parents and by strengthening the children’s confidence and autonomy. 

  • 24.
    Månsson, Linda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Bäckman, Pernilla
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Öhberg, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Sandlund, Jonas
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Selling, Jonas
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Evaluation of Concurrent Validity between a Smartphone Self-Test Application and Clinical Tests for Balance and Leg Strength2021Ingår i: Sensors, E-ISSN 1424-8220, Vol. 21, nr 5, artikel-id 1765Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The evolving use of sensors to objectively assess movements is a potentially valuable addition to clinical assessments. We have developed a new self-test application prototype, MyBalance, in the context of fall prevention aimed for use by older adults in order to independently assess balance and functional leg strength. The objective of this study was to investigate the new self-test application for concurrent validity between clinical instruments and variables collected with a smartphone. The prototype has two test procedures: static standing balance test in two positions, and leg strength test performed as a sit-to-stand test. Thirty-one older adults were assessed for balance and functional leg strength, in an outpatient physiotherapy setting, using seven different clinical assessments and three sensor-tests. The results show that clinical instruments and sensor measurements correlate to a higher degree for the smartphone leg strength test. For balance tests, only a few moderate correlations were seen in the Feet Together position and no significant correlations for the Semi Tandem Stance. This study served as a first step to develop a smartphone self-test application for older adults to assess functional balance at home. Further research is needed to test validity, reliability, and user-experience of this new self-test application.

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  • 25.
    Månsson, Linda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Skelton, Dawn A.
    School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
    Janols, Rebecka
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Lindgren, Helena
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Rosendahl, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Older adults' preferences for, adherence to and experiences of two self-management falls prevention home exercise programmes: a comparison between a digital programme and a paper booklet2020Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 20, nr 1, artikel-id 209Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Fall prevention exercise programmes are known to be effective, but access to these programmes is not always possible. The use of eHealth solutions might be a way forward to increase access and reach a wider population. In this feasibility study the aim was to explore the choice of programme, adherence, and self-reported experiences comparing two exercise programmes – a digital programme and a paper booklet.

    Methods: A participant preference trial of two self-managed fall prevention exercise interventions. Community-dwelling adults aged 70 years and older exercised independently for four months after one introduction meeting. Baseline information was collected at study start, including a short introduction of the exercise programme, a short physical assessment, and completion of questionnaires. During the four months intervention period, participants self-reported their performed exercises in an exercise diary. At a final meeting, questionnaires about their experiences, and post-assessments, were completed. For adherence analyses data from diaries were used and four subgroups for different levels of participation were compared. Exercise maintenance was followed up with a survey 12 months after study start.

    Results: Sixty-seven participants, with mean age 77 ± 4 years were included, 72% were women. Forty-three percent chose the digital programme. Attrition rate was 17% in the digital programme group and 37% in the paper booklet group (p = .078). In both groups 50–59% reported exercise at least 75% of the intervention period. The only significant difference for adherence was in the subgroup that completed ≥75% of exercise duration, the digital programme users exercised more minutes per week (p = .001). Participants in both groups were content with their programme but digital programme users reported a significantly higher (p = .026) degree of being content, and feeling supported by the programme (p = .044). At 12 months follow-up 67% of participants using the digital programme continued to exercise regularly compared with 35% for the paper booklet (p = .036).

    Conclusions: Exercise interventions based on either a digital programme or a paper booklet can be used as a self-managed, independent fall prevention programme. There is a similar adherence in both programmes during a 4-month intervention, but the digital programme seems to facilitate long-term maintenance in regular exercise.

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  • 26.
    Månsson, Linda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Pettersson, Beatrice
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Rosendahl, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Skelton, Dawn A.
    School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Feasibility of performance-based and self-reported outcomes in self-managed falls prevention exercise interventions for independent older adults living in the community2022Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 22, nr 1, artikel-id 147Artikel i tidskrift (Refereegranskat)
    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.

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  • 27.
    Månsson, Linda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Pettersson, Beatrice
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Rosendahl, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Skelton, Dawn A
    Glasgow Caledonian University, Glasgow, UK.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Self-managed fall prevention exercise guided by a digital programme or a paper booklet: effectiveness and feasibility of outcomesManuskript (preprint) (Övrigt vetenskapligt)
  • 28.
    Månsson, Linda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Öhberg, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Danielsson, Karin
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för informatik.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Co-Creation with Older Adults to Improve User-Experience of a Smartphone Self-Test Application to Assess Balance Function2020Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, nr 11, artikel-id 3768Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This co-creation study aimed to develop a smartphone self-test application for balance and leg strength in collaboration between older adults and the research team. The paper describes older participants' preferences for, and their contribution to, the application design. Technology to assess movements is available in smartphones with built-in sensors, and one of the challenges is to develop a valuable self-test for older adults. The participants contributed to the design of the application's instructions and user interface. Multiple data collection methods were used: user-test with Think aloud method, mock-ups, homework assignment as co-researcher, audio and video recordings. Qualitative content analysis with a deductive-inductive approach was used, guided by the Optimized Honeycomb model for user experience (UX) as a categorization matrix. The analysis resulted in 17 subcategories within the seven facets of the UX Honeycomb model (findable, accessible, usable, desirable, credible, useful, and valuable), and describes the older participants' preferences and experiences. The main results were participants' desire to know why, to get clear and appropriate information, and expectations of the self-test to be useful. It was feasible and valuable to develop the self-test application in co-creation with the intended user-group, in order to get direct feedback and suggestions for the development.

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  • 29.
    Nedergård, Heidi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Arumugam, Ashokan
    Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Bråndal, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Effect of robotic-assisted gait training on objective biomechanical measures of gait in persons post-stroke: a systematic review and meta-analysis2021Ingår i: Journal of NeuroEngineering and Rehabilitation, E-ISSN 1743-0003, Vol. 18, nr 1, artikel-id 64Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Robotic-Assisted Gait Training (RAGT) may enable high-intensive and task-specific gait training post-stroke. The effect of RAGT on gait movement patterns has however not been comprehensively reviewed. The purpose of this review was to summarize the evidence for potentially superior effects of RAGT on biomechanical measures of gait post-stroke when compared with non-robotic gait training alone.

    Methods: Nine databases were searched using database-specific search terms from their inception until January 2021. We included randomized controlled trials investigating the effects of RAGT (e.g., using exoskeletons or end-effectors) on spatiotemporal, kinematic and kinetic parameters among adults suffering from any stage of stroke. Screening, data extraction and judgement of risk of bias (using the Cochrane Risk of bias 2 tool) were performed by 2–3 independent reviewers. The Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria were used to evaluate the certainty of evidence for the biomechanical gait measures of interest.

    Results: Thirteen studies including a total of 412 individuals (mean age: 52–69 years; 264 males) met eligibility criteria and were included. RAGT was employed either as monotherapy or in combination with other therapies in a subacute or chronic phase post-stroke. The included studies showed a high risk of bias (n = 6), some concerns (n = 6) or a low risk of bias (n = 1). Meta-analyses using a random-effects model for gait speed, cadence, step length (non-affected side) and spatial asymmetry revealed no significant differences between the RAGT and comparator groups, while stride length (mean difference [MD] 2.86 cm), step length (affected side; MD 2.67 cm) and temporal asymmetry calculated in ratio-values (MD 0.09) improved slightly more in the RAGT groups. There were serious weaknesses with almost all GRADE domains (risk of bias, consistency, directness, or precision of the findings) for the included outcome measures (spatiotemporal and kinematic gait parameters). Kinetic parameters were not reported at all.

    Conclusion: There were few relevant studies and the review synthesis revealed a very low certainty in current evidence for employing RAGT to improve gait biomechanics post-stroke. Further high-quality, robust clinical trials on RAGT that complement clinical data with biomechanical data are thus warranted to disentangle the potential effects of such interventions on gait biomechanics post-stroke.

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  • 30.
    Nedergård, Heidi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Arumugam, Ashokan
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Bråndal, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Effect of robotic-assisted gait training on objective biomechanical measures of gait in persons post-stroke: a systematic review and meta-analysis2021Konferensbidrag (Refereegranskat)
  • 31.
    Nedergård, Heidi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Palmcrantz, Susanne
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Users’ experiences of intensive robotic-assisted gait training post-stroke: “a push forward or feeling pushed around?”2022Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Robotic-assisted gait training (RAGT) is suggested to improve walking ability after stroke. The purpose of this study was to describe experiences of robotic-assisted gait training as part of a gait training intervention among persons in the chronic phase after stroke.

    Materials and methods: Semi-structured interviews were performed with 13 participants after a 6-week intervention including treadmill gait training with the Hybrid Assistive Limb® (HAL) exoskeleton. Data were analysed using qualitative content analysis.

    Results: Four categories emerged: (1) A rare opportunity for potential improvements describes the mindset before the start of the intervention; (2) Being pushed to the limit represents the experience of engaging in intensive gait training; (3) Walking with both resistance and constraints reveals barriers and facilitators during HAL training; (4) Reaching the end and taking the next step alone illustrates feelings of confidence or concern as the intervention ended.

    Conclusions: The gait training intervention including RAGT was considered demanding but appreciated. Support and concrete, individual feedback was crucial for motivation, whilst the lack of variation was a barrier. Results encourage further development of exoskeletons that are comfortable to wear and stimulate active participation by enabling smoothly synchronised movements performed during task-specific activities in different environments.

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  • 32.
    Pettersson, Beatrice
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Bajraktari, Saranda
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Skelton, Dawn
    School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
    Zingmark, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Rosendahl, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Recruitment strategies and reach of a digital fall-prevention intervention for community-dwelling older adults2022Ingår i: Digital health, Vol. 8, artikel-id 20552076221126050Artikel i tidskrift (Refereegranskat)
    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.

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  • 33.
    Pettersson, Beatrice
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Janols, Rebecka
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för arbetsterapi.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Older adults’ experiences of behavior change support in a digital fall prevention exercise program: A qualitative study framed by the self-determination theory2021Ingår i: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 23, nr 7, artikel-id e26235Artikel i tidskrift (Refereegranskat)
    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.

  • 34.
    Pettersson, Beatrice
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Lundell, Sara
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    'Maintaining balance in life'—exploring older adults' long-term engagement in self-managed digital fall prevention exercise2023Ingår i: European Review of Aging and Physical Activity, ISSN 1813-7253, E-ISSN 1861-6909, Vol. 20, nr 1, artikel-id 12Artikel i tidskrift (Refereegranskat)
    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.

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  • 35.
    Pettersson, Beatrice
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Skelton, Dawn A.
    School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
    Liv, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Zingmark, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden.
    Rosendahl, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Effectiveness of a self-managed digital exercise programme to prevent falls in older community-dwelling adults: study protocol for the Safe Step randomised controlled trial2020Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 10, nr 5, artikel-id e036194Artikel i tidskrift (Refereegranskat)
    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.

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  • 36.
    Pettersson, Beatrice
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Wiklund, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Janols, Rebecka
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Arbetsterapi. Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Lindgren, Helena
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Skelton, Dawn A.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    "Managing pieces of a personal puzzle': Older people's experiences of self-management falls prevention exercise guided by a digital program or a booklet2019Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, artikel-id 43Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Exercise is effective in order to prevent falls in community-dwelling older people. Self-management programs have the potential to increase access and reduce costs related to exercise-based fall prevention. However, information regarding older people's views of participating in such programs is needed to support implementation. The aim of this study was to explore older people's experiences of a self-management fall prevention exercise routine guided either by a digital program (web-based or mobile) or a paper booklet.

    Methods: This qualitative study was part of a feasibility study exploring two completely self-managed exercise interventions in which the participants tailored their own program, guided either by a digital program or a paper booklet. Individual face-to-face semi-structured interviews were conducted with a purposeful sample of 28 participants (18 women), mean age 76yrs. Qualitative content analysis was used to analyse the data.

    Results: Self-managing and self-tailoring these exercise programs was experienced as Managing pieces of a personal puzzle'. To independently being able to create a program and manage exercise was described in the categories Finding my own level' and Programming it into my life'. The participants experienced the flexibility and independence provided by completely self-managed exercise as positive and constructive although it required discipline. Furthermore, different needs and preferences when managing their exercise were described, as well as varying sources of motivation for doing the exercise, as highlighted in the category Defining my source of motivation'. The category Evolving my acquired knowledge' captures the participants' views of building their competence and strategies for maintenance of the exercise. It describes a combined process of learning the program and developing reflection, which was more clearly articulated by participants using the digital program.

    Conclusions: This study provides new knowledge regarding experiences, preferences and motivations of older people to engage in home-based self-managed fall prevention exercise. They expressed both a capability and willingness to independently manage their exercise. A digital program seems to have strengthened the feeling of support while creating their own exercise program and tailoring it to their preferences and circumstances, which might therefore create better opportunities for adoption and adherence in the long term.

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  • 37.
    Pohl, Petra
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Ahlgren, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Bergvall-Kårebom, Birgitta
    Luleå universitet.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Melander Wikman, Anita
    Luleå universitet.
    Fall risk awareness and safety precautions taken by older community-dwelling women and men: a qualitative study using focus group discussions2015Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 10, nr 3, artikel-id e0119630Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Daily life requires frequent estimations of the risk of falling and the ability to avoid a fall. The objective of this study was to explore older women's and men's understanding of fall risk and their experiences with safety precautions taken to prevent falls.

    Methods A qualitative study with focus group discussions was conducted. Eighteen community-dwelling people [10 women and 8 men] with and without a history of falls were purposively recruited. Participants were divided into two groups, and each group met four times. A participatory and appreciative action and reflection approach was used to guide the discussions. All discussions were audio recorded and transcribed verbatim. Data were analysed by qualitative content analysis, and categories were determined inductively.

    Findings Three categories describing the process of becoming aware of fall risks in everyday life were identified: 1] Facing various feelings, 2] Recognizing one's fall risk, and 3] Taking precautions. Each category comprised several subcategories. The comprehensive theme derived from the categories was "Safety precautions through fall risk awareness". Three strategies of ignoring [continuing a risky activity], gaining insight [realizing the danger in a certain situation], and anticipating [thinking ahead and acting in advance] were related to all choices of actions and could fluctuate in the same person in different contexts.

    Conclusions The fall risk awareness process might be initiated for various reasons and can involve different feelings and precautions as well as different strategies. This finding highlights that there are many possible channels to reach older people with information about fall risk and fall prevention, including the media and their peers. The findings offer a deeper understanding of older peoples' conceptualizations about fall risk awareness and make an important contribution to the development and implementation of fall prevention programmes.

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  • 38.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Motion interactive games for children with motor disorders: motivation, physical activity, and motor control2011Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    As motion interactive games have become more widespread the interest in using these games in rehabilitation of children with motor disorders has increased among both clinical professionals and the families of these children. The general aim of this thesis was to evaluate the feasibility of using interactive games in rehabilitation of children to promote motivation for practice, physical activity, and motor control. A systematic review of published intervention studies was conducted to obtain an overview of existing research and the current levels of evidence for using interactive games in motor rehabilitation of children. Sixteen studies met the inclusion criteria, out of these three were randomized controlled trials while half were case series or case reports. Thirteen studies presented positive findings, which indicated a promising potential. However, more convincing research is needed.

    Commercially available motion interactive games have only been used in a few studies on motor control, and in none of these home based practice was provided. Moreover, no earlier studies have evaluated if these games may increase motivation for training and daily physical activity among children with disabilities. To address these issues a feasibility intervention including 15 children in the ages 6-16 years and with mild to moderate cerebral palsy was conducted. Each child was provided with a Sony PlayStation2â and the EyeToyâ games in Play3, and was recommended to practice with the provided games for at least 20 minutes/day during four weeks. The intervention was evaluated with gaming diaries, physical activity monitors (SenseWear Armband), interviews with the parents, and the clinical motor tests Movement Assessment Battery for Children-2 (mABC-2), Bruininks-Oseretsky Test of Motor Proficiency subtest 5:6, and the 1 Minute Walk Test. In addition, 3D motion analysis was used to evaluate effects on quality of goal-directed arm movements towards virtual and real objects, respectively.

    Motivation for practice and compliance of training were high, although declining somewhat during the course of the four weeks. The children’s physical activity increased significantly during the intervention. However, four children were excluded from this analysis due to lack of complete data from the physical activity monitors. According to mABC-2 the children’s motor performance improved, but there were both floor and ceiling effects, indicating a low sensibility of this test. The two additional motor tests showed only non-significant progress. Results from the 3D motion analysis suggest that the children improved movement precision when playing the games, movement smoothness when reaching for real objects, and used a more economic reaching strategy with less trunk involvement. In the interviews the parents expressed the view that motion interactive games promote positive experiences of physical training and add elements of social interaction to the training. They also experienced less urge to take on a coaching role. The training provided by the games was considered unspecific and there was a desire for individualized games to better address the unique rehabilitative need of each child.

    In conclusion, it is feasible to use motion interactive games in home rehabilitation for children with cerebral palsy to promote short term motivation for practice and general physical training. Specific effects on motor control need to be further explored and there is also a need for reliable tests that are adequate and sensitive enough to capture changes in movement control. In future development of interactive games for rehabilitation purposes, it is a challenge to preserve the motivational and social features of games while at the same time optimizing an individualized physical training.

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  • 39.
    Sandlund, Marlene
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Dock, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Häger, Charlotte K
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Lindh Waterworth, Eva
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för informatik.
    Motion interactive video games in home training for children with cerebral palsy: parents' perceptions2012Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, nr 11, s. 925-933Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To explore parents' perceptions of using low-cost motion interactive video games as home training for their children with mild/moderate cerebral palsy.

    Method: Semi-structured interviews were carried out with parents from 15 families after participation in an intervention where motion interactive games were used daily in home training for their child. A qualitative content analysis approach was applied.

    Results: The parents' perception of the training was very positive. They expressed the view that motion interactive video games may promote positive experiences of physical training in rehabilitation, where the social aspects of gaming were especially valued. Further, the parents experienced less need to take on coaching while gaming stimulated independent training. However, there was a desire for more controlled and individualized games to better challenge the specific rehabilitative need of each child.

    Conclusions: Low-cost motion interactive games may provide increased motivation and social interaction to home training and promote independent training with reduced coaching efforts for the parents. In future designs of interactive games for rehabilitation purposes, it is important to preserve the motivational and social features of games while optimizing the individualized physical exercise.

  • 40.
    Sandlund, Marlene
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Domellöf, Erik
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Grip, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Rönnqvist, Louise
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Effect of practice with motion interactive video games on goal-directed arm movements in children with cerebral palsy: a kinematic evaluationManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Objective: The aim of the present study was to evaluate the quality of goal-directed arm movements in children with cerebral palsy after four weeks of daily practice with motion interactive games, and to explore and compare the applicability of various kinematic parameters in a virtual context compared to a situation with real objects.

    Methods: Fifteen children with CP, 6-16 years, practiced with the EyeToyâ for PlayStation2â in their homes during four weeks. Before and after the intervention kinematics and kinetics were captured with a five camera motion analysis system (Proreflex, Qualisys AB, Gothenburg, Sweden) and a force plate. The children performed arm movements towards both virtual and real targets.

    Results: The children used a more economic reaching strategy with shorter Centre of pressure paths, improved Movement precision, and reduced variability in Maximal shoulder angles during play after practice. Transfer of improved motor control to goal-directed arm movements towards real targets was also indicated by increased Movement smoothness, and while reaching with the non-dominant side, reduced Centre of pressure paths path. The spatiotemporal characteristics proved complex to interpret in terms of improved motor control.

    Conclusions: When taking the constraints of the tasks into account the relevant kinematic parameters explored support the conclusion that practice with motion interactive games resulted in an improved motor control. The results of this study illuminate the importance of considering both the nature of the task and the context in which movements are performed when selecting and interpreting kinematic parameters.

  • 41.
    Sandlund, Marlene
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Domellöf, Erik
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Grip, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Rönnqvist, Louise
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Häger, Charlotte K.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Training of goal directed arm movements with motion interactive video games in children with cerebral palsy: a kinematic evaluation2014Ingår i: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 17, nr 5, s. 318-326Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The main aim of this study was to evaluate the quality of goal-directed arm movements in 15 children with cerebral palsy (CP) following four weeks of home-based training with motion interactive video games. A further aim was to investigate the applicability and characteristics of kinematic parameters in a virtual context in comparison to a physical context.

    Method: Kinematics and kinetics were captured while the children performed arm movements directed towards both virtual and physical targets.

    Results: The children’s movement precision improved, their centre of pressure paths decreased, as did the variability in maximal shoulder angles when reaching for virtual objects. Transfer to a situation with physical targets was mainly indicated by increased movement smoothness.

    Conclusion: Training with motion interactive games seems to improve arm motor control in children with CP. The results highlight the importance of considering both the context and the task itself when investigating kinematic parameters.

  • 42.
    Sandlund, Marlene
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Grip, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Domellöf, Erik
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Rönnqvist, Louise
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Low-cost motion interactive video games in home training for children with cerebral palsy: A kinematic evaluation2011Ingår i: 2011 International Conference on Virtual Rehabilitation, ICVR / [ed] Daniel Thalmann, IEEE conference proceedings, 2011Konferensbidrag (Refereegranskat)
    Abstract [en]

    3D motion analysis was applied to assess goal-directed arm movements in 15 children with cerebral palsy (CP) before and after four weeks of home training with low-cost motion interactive video games. The results indicated that the children improved movement precision when playing the virtual games, improved movement smoothness when reaching for real targets, and reduced the involvement of the trunk especially when reaching with the non-dominant side. © 2011 IEEE.

  • 43.
    Sandlund, Marlene
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Hoshi, Kei
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för informatik.
    Lindh Waterworth, Eva
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för informatik.
    Häger-Ross, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    A conceptual framework for design of interactive computer play in rehabilitation of children with sensorimotor disorders2009Ingår i: Physical Therapy Reviews, ISSN 1083-3196, E-ISSN 1743-288X, Vol. 14, nr 5, s. 348-354Artikel i tidskrift (Refereegranskat)
  • 44.
    Sandlund, Marlene
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Lindgren, Helena
    Umeå universitet.
    Pohl, Petra
    Umeå universitet.
    Melander-Wikman, Anita
    Bergvall-Kåreborn, Birgitta
    Lundin-Olsson, Lillemor
    Umeå universitet.
    Towards a Mobile Exercise Application to Prevent Falls: a Participatory Design Process2015Ingår i: Technology, Rehabilitation and Empowerment of People with Special Needs / [ed] Lena Pareto, Paul M Sharkey, Joav Merrick, Nova Science Publishers, Inc., 2015, s. 157-168Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    The digitalization of society is spreading around the world and technology has become part of many people’s daily lives. It acts as a means of communication, work, education and leisure. For populations with special needs (people with some kind of disability or disorder) technology can play an essential role in their rehabilitation and treatment. It also empowers the individuals themselves. The aim of this multi-disciplinary research for decades has been to explore, develop and evaluate innovative technology to aid people with disabilities through virtual reality and associated machinery. The field engages researchers from health sectors, areas of engineering and schools of education to collaborate in order to take on a holistic approach to meet these challenges.

  • 45.
    Sandlund, Marlene
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Lindgren, Helena
    Umeå universitet.
    Pohl, Petra
    Umeå universitet.
    Melander-Wikman, Anita
    Bergvall-Kåreborn, Birgitta
    Lundin-Olsson, Lillemor
    Umeå universitet.
    Towards a Mobile Exercise Application to Prevent Falls: a Participatory Design Process2016Ingår i: International Journal of Child Health and Human Development, ISSN 1939-5965, Vol. 9, nr 3, s. 389-398Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this cross-disciplinary project senior citizens and researchers participated in the collaborative design and development of a mobile exercise application to prevent falls. The methods Form-IT and Participatory and Appreciative Action and Reflection were applied in a series of workshops, facilitating the creation of new knowledge and a socio-technical platform for an end-user development process. The participation of the older adults was key to understanding the broad range of preferences and motivational aspects. The outcomes emerged into prototypes, which were composed using the ACKTUS platform for end-user development, resulting in a dynamic application, easily adaptable to future needs and studies.

  • 46.
    Sandlund, Marlene
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Lindh Waterworth, Eva
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för informatik.
    McDonough, Suzanne
    Häger-Ross, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Interactive games in motor rehabilitation for children with sensor motor disorders2007Ingår i: 2007 virtual rehabilitation, New York: IEEE conference proceedings, 2007, s. 78-78Konferensbidrag (Refereegranskat)
    Abstract [en]

    Interactive computer environments may be a good way to make motor practice more fun and motivating for children with sensorimotor disorders. However, appropriate computer environments that could be used for this purpose need to be systematically tested in rehabilitation settings in order to evaluate their impact on motor aspects as well as on motivation and activity levels. This abstract describes pilot data from an ongoing intervention study involving children diagnosed with cerebral palsy. The interactive environment used is the Sony's EyeToy system for PlayStation2. The intervention is evaluated through interviews as well as with activity monitoring and motor assessments, including 3D motion analysis. Here we will report pilot data based on the interviews.

  • 47.
    Sandlund, Marlene
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    McDonough, Suzanne
    Häger-Ross, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Interactive computer play in rehabilitation of children with sensorimotor disorders: a systematic review2009Ingår i: Developmental medicine and child neurology, ISSN 1469-8749, Vol. 51, nr 3, s. 173-179Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this review was to examine systematically the evidence for the application of interactive computer play in the rehabilitation of children with sensorimotor disorders. A literature search of 11 electronic databases was conducted to identify articles published between January 1995 and May 2008. The review was restricted to reports of intervention studies evaluating the impact of interactive computer play on motor rehabilitation in children. For each study the quality of the methods and the strength of the evidence were assessed by two independent reviewers using the guidelines of the American Academy for Cerebral Palsy and Developmental Medicine. A total of 74 articles were identified, of which 16 met the inclusion criteria. Three studies were randomized controlled trials (RCTs) and half were case series or case reports. Areas investigated were movement quality, spatial orientation and mobility, and motivational aspects. Thirteen studies presented positive findings. Two of the three RCTs investigating movement quality and one level III study examining spatial orientation showed no significant improvements. Interactive computer play is a potentially promising tool for the motor rehabilitation of children but the level of evidence is too limited to assess its value fully. Further and more convincing research is needed.

  • 48.
    Sandlund, Marlene
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Pohl, Petra
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Ahlgren, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Skelton, Dawn A.
    Melander-Wikman, Anita
    Bergvall-Kareborn, Birgitta
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Gender Perspective on Older People's Exercise Preferences and Motivators in the Context of Falls Prevention: A Qualitative Study2018Ingår i: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, artikel-id 6865156Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Several factors have previously been identified to positively influence the uptake and adherence for fall prevention exercise programmes. There is, however, a lack of studies investigating if men and women differ in their views and preferences for fall prevention exercises.

    Aim: To explore exercise preferences and motivators of older community-dwelling women and men in the context of falls prevention from a gender perspective.

    Methods: Workshops including multistage focus group discussions were conducted with 18 older community-dwelling people with and without history of falls. Participants were purposively selected and divided into two groups. Each group met on six occasions over a period of five months. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis.

    Results: Older participants had many diverse preferences and confirmed that individually tailored exercise, in terms of mode, intensity, challenge, and social context, is important. Moreover, important factors for exercise adherence and maintenance included the experience of individual confirmation; different spirit lifters to increase enjoyment; and personal tricks to maintain exercise routines. The individual differences within genders were more diverse than the differences between women and men.

    Conclusion: Exercise interventions to prevent falls should be individually tailored, based on the specific needs and preferences of the older participant, and do not appear to require gender specific approaches. To increase adherence, intrinsic motivation for exercise may be encouraged by competence enhancing confirmations, energizing spirit lifters, and practical tips for exercise maintenance. The study provides an awareness about women's and men's preferences for fall prevention exercises, and this information could be used as guidance in designing inclusive exercise interventions.

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  • 49.
    Sandlund, Marlene
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Pohl, Petra
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Ahlgren, christina
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Skelton, Dawn
    Glasgow Caledonian University.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Gender Perspective on Older People’s Preferences for Exercises in the Context of Falls Prevention: A qualitative studyManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    The aim with this study was to explore the preferences of community-dwelling older women and men regarding exercise characteristics in the context of preventing falls. Multistage focus group discussions were conducted with 18 older community-dwelling people with or without a history of falls. Participants were purposively sampled, and divided into two groups. Each group met six times. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis. Six categories emerged from the analysis. Two categories were related to motives and barriers for uptake, and four categories were related to adherence and maintenance: exercise characteristics; confirmation; spirit lifters and maintenance tricks. Small differences and many similarities in what women and men perceived as motivating factors in an exercise situation were displayed. To conclude, older people have many diverse preferences regarding exercise in the context of preventing falls, and the individual differences within genders seem to be greater than the differences between men and women. Exercise interventions to prevent falls should be individually tailored based on the specific needs and preferences of the older participant. In order to encourage internalization and intrinsic motivation for exercises, autonomy-supportive approaches may be applied and accompanied by competence strengthening confirmations, energizing spirit lifters and practical tips for exercise maintenance

  • 50.
    Sandlund, Marlene
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Skelton, Dawn A.
    Pohl, Petra
    Ahlgren, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Melander-Wikman, Anita
    Lundin-Olsson, Lillemor
    Gender perspectives on views and preferences of older people on exercise to prevent falls: a systematic mixed studies review2017Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, artikel-id 58Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To offer fall prevention exercise programs that attract older people of both sexes there is a need to understand both women's and men's views and preferences regarding these programs. This paper aims to systematically review the literature to explore any underlying gender perspectives or gender interpretations on older people's views or preferences regarding uptake and adherence to exercise to prevent falls. Methods: A review of the literature was carried out using a convergent qualitative design based on systematic searches of seven electronic databases (PubMed, CINAHL, Amed, PsycINFO, Scopus, PEDro, and OTseeker). Two investigators identified eligible studies. Each included article was read by at least two authors independently to extract data into tables. Views and preferences reported were coded and summarized in themes of facilitators and barriers using a thematic analysis approach. Results: Nine hundred and nine unique studies were identified. Twenty five studies met the criteria for inclusion. Only five of these contained a gender analysis of men's and women's views on fall prevention exercises. The results suggests that both women and men see women as more receptive to and in more need of fall prevention messages. The synthesis from all 25 studies identified six themes illustrating facilitators and six themes describing barriers for older people either starting or adhering to fall prevention exercise. The facilitators were: support from professionals or family; social interaction; perceived benefits; a supportive exercise context; feelings of commitment; and having fun. Barriers were: practical issues; concerns about exercise; unawareness; reduced health status; lack of support; and lack of interest. Considerably more women than men were included in the studies. Conclusion: Although there is plenty of information on the facilitators and barriers to falls prevention exercise in older people, there is a distinct lack of studies investigating differences or similarities in older women's and men's views regarding fall prevention exercise. In order to ensure that fall prevention exercise is appealing to both sexes and that the inclusion of both men and women are encouraged, more research is needed to find out whether gender differences exists and whether practitioners need to offer a range of opportunities and support strategies to attract both women and men to falls prevention exercise.

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