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  • 1.
    Arkkukangas, Marina
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Johnson, S. T.
    Uppsala University, Uppsala, Sweden.
    Hellström, K.
    Uppsala University, Uppsala, Sweden.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Eriksson, S.
    Centre for Clinical Research Sörmland, Sweden.
    Johansson, Ann-Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    A feasibility study of a randomised controlled trial comparing fall prevention using exercise with or without the support of motivational interviewing2015Inngår i: Preventive Medicine Reports, ISSN 2211-3355, Vol. 2, s. 134-140Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this investigation was to study the feasibility of a randomised controlled trial (RCT) based on a multicentre fall prevention intervention including exercise with or without motivational interviewing compared to standard care in community-living people 75. years and older. Method: The feasibility of a three-armed, randomised controlled trial was evaluated according to the following: process, resources, management by questionnaire, and treatment outcomes. The outcome measures were fall frequency, physical performance and falls self-efficacy evaluated after three months. Twelve physiotherapists conducted the measurements and treatments and responded to the questionnaire. The first 45 participants recruited to the ongoing RCT were included: 16 individuals in the Otago Exercise Program group (OEP), 16 individuals in the OEP combined with motivational interviewing group (MI), and 13 individuals in the control group. The study was conducted from November 2012 to December 2013. Results: The feasibility of the study process, resources and management reached the set goals in most aspects; however, the set goal regarding the MI guide and planned exercise for the participating older people was not completely reached. No significant differences were found between the groups regarding the outcome measures. Conclusion: This study confirmed the acceptable feasibility for the study protocol in the ongoing RCT.

  • 2.
    Arkkukangas, Marina
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Sundler, Annelie
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Eriksson, Staffan
    Johansson, Ann Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Older persons’ experiences of a home-based exercise programme with behavioural change support2017Inngår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, nr 12, s. 905-913Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: It is a challenge to promote exercise among older persons. Knowledge is needed regarding the maintenance of exercise aiming at preventing falls and promoting health and wellbeing in older persons.

    Purpose: This descriptive study used a qualitative inductive approach to describe older persons’ experiences of a fall-preventive, home-based exercise programme with support for behavioural change.

    Methods: Semi-structured interviews were conducted with twelve older persons aged 75 years or older, and a qualitative content analysis was performed.

    Results: Four categories emerged: facilitators of performing exercise in everyday life, the importance of support, perceived gains from exercise, and the existential aspects of exercise.

    Conclusion: With support from physiotherapists, home-based exercise can be adapted to individual circumstances in a meaningful way. By including exercises in everyday life and daily routines could support the experience of being stronger, result in better physical functioning and give hope for an extended active life in old age.

  • 3.
    Arkkukangas, Marina
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Eriksson, Staffan
    Uppsala University, Sweden.
    Johansson, Ann-Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Centrum för klinisk forskning LTV.
    Fall Preventive Exercise with or without behavior change support for community-dwelling older adults: A Randomized Controlled Trial With Short-Term Follow-up.2019Inngår i: Journal of Geriatric Physical Therapy, ISSN 1539-8412, E-ISSN 2152-0895, Vol. 42, nr 1, s. 9-17Artikkel i tidsskrift (Fagfellevurdert)
  • 4.
    Arkkukangas, Marina
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Eriksson, Staffan
    Johansson, Ann-Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    One- year adherence to the Otago Exercise Programme with or without motivational interviewing in older peopleManuskript (preprint) (Annet vitenskapelig)
  • 5.
    Arkkukangas, Marina
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Eriksson, Steffan
    Uppsala Univ, Sweden.
    Johansson, Ann-Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Uppsala Univ, Ctr Clin Res, Vasteras, Sweden..
    One-Year Adherence to the Otago Exercise Program With or Without Motivational Interviewing in Community-Dwelling Older Adults2018Inngår i: Journal of Aging and Physical Activity, ISSN 1063-8652, E-ISSN 1543-267X, Vol. 26, nr 3, s. 390-395Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study investigated if behavioral factors, treatment with behavioral support, readiness to change, fall self-efficacy, and activity habits could predict long-term adherence to an exercise program. Included in this study were 114 community-dwelling older adults who had participated in one of two home-based exercise interventions. Behavioral factors associated with adherence to the exercise program over 52 weeks were analyzed. The behavioral factors, specifically activity habits at baseline, significantly predicted adherence to the exercise program, with an odds ratio = 3.39, 95% confidence interval [1.38, 8.32], for exercise and an odds ratio = 6.11, 95% confidence interval [2.34, 15.94], for walks. Being allocated to a specific treatment including motivational interviewing was also significantly predictive: odds ratio = 2.47, 95% confidence interval [1.11, 5.49] for exercise adherence. In conclusion, activity habits and exercise in combination with motivational interviewing had a significant association with adherence to the exercise program at a 1-year follow-up.

  • 6.
    Ehn, Maria
    et al.
    Mälardalens högskola, Akademin för innovation, design och teknik, Inbyggda system.
    Carlén Eriksson, Lennie
    Mälardalens högskola, Akademin för innovation, design och teknik, Inbyggda system.
    Åkerberg, Nina
    Västerås Municipality, Västerås, Sweden.
    Johansson, Ann-Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Activity Monitors as Support for Older Persons’ Physical Activity in Daily Life: Qualitative Study of the Users’ Experiences2018Inngår i: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 6, nr 2, artikkel-id e34Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Falls are a major threat to the health and independence of seniors. Regular physical activity (PA) can prevent 40% of all fall injuries. The challenge is to motivate and support seniors to be physically active. Persuasive systems can constitute valuable support for persons aiming at establishing and maintaining healthy habits. However, these systems need to support effective behavior change techniques (BCTs) for increasing older adults’ PA and meet the senior users’ requirements and preferences. Therefore, involving users as codesigners of new systems can be fruitful. Prestudies of the user’s experience with similar solutions can facilitate future user-centered design of novel persuasive systems.

    Objective

    The aim of this study was to investigate how seniors experience using activity monitors (AMs) as support for PA in daily life. The addressed research questions are as follows: (1) What are the overall experiences of senior persons, of different age and balance function, in using wearable AMs in daily life?; (2) Which aspects did the users perceive relevant to make the measurements as meaningful and useful in the long-term perspective?; and (3) What needs and requirements did the users perceive as more relevant for the activity monitors to be useful in a long-term perspective?

    Methods

    This qualitative interview study included 8 community-dwelling older adults (median age: 83 years). The participants’ experiences in using two commercial AMs together with tablet-based apps for 9 days were investigated. Activity diaries during the usage and interviews after the usage were exploited to gather user experience. Comments in diaries were summarized, and interviews were analyzed by inductive content analysis.

    Results

    The users (n=8) perceived that, by using the AMs, their awareness of own PA had increased. However, the AMs’ impact on the users’ motivation for PA and activity behavior varied between participants. The diaries showed that self-estimated physical effort varied between participants and varied for each individual over time. Additionally, participants reported different types of accomplished activities; talking walks was most frequently reported. To be meaningful, measurements need to provide the user with a reliable receipt of whether his or her current activity behavior is sufficient for reaching an activity goal. Moreover, praise when reaching a goal was described as motivating feedback. To be useful, the devices must be easy to handle. In this study, the users perceived wearables as easy to handle, whereas tablets were perceived difficult to maneuver. Users reported in the diaries that the devices had been functional 78% (58/74) of the total test days.

    Conclusions

    Activity monitors can be valuable for supporting seniors’ PA. However, the potential of the solutions for a broader group of seniors can significantly be increased. Areas of improvement include reliability, usability, and content supporting effective BCTs with respect to increasing older adults’ PA.

  • 7.
    Ehn, Maria
    et al.
    Mälardalens högskola, Akademin för innovation, design och teknik, Inbyggda system.
    Derneborg, Mattias
    Region Västmanland, Sweden.
    Ekström, Martin
    Mälardalens högskola, Akademin för innovation, design och teknik, Inbyggda system.
    Johansson, Ann-Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Inter- disciplinary and -sectorial cooperation for development of technology supporting behavioral change: Peer reviewed poster abstract2017Konferansepaper (Annet vitenskapelig)
  • 8.
    Ehn, Maria
    et al.
    Mälardalens högskola, Akademin för innovation, design och teknik, Inbyggda system.
    Johansson, Ann-Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Revenäs, Åsa
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Technology-Based Motivation Support for Seniors' Physical Activity-A Qualitative Study on Seniors' and Health Care Professionals' Views2019Inngår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, nr 13Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This paper investigates seniors' and health care professionals' (HCPs) perceptions on needed contributions and qualities of digital technology-based motivation support for seniors' physical activity (PA). Seniors and HCPs expressed their views in focus groups, which were analyzed separately by inductive content analysis. Similarities and differences in seniors' and HCPs' views were identified through thematic analysis of qualitative results from both focus groups. This article's main findings are that both seniors and HCPs believed digital technology should support and make PA more enjoyable in ways to strengthen seniors' control and well-being. However, seniors emphasized support for social interaction, while HCPs also requested support for increasing seniors' insight into PA and for facilitating their dialogue with seniors. Conclusions to be drawn are that seniors and HPCs shared overall views on digital technology's main contributions but had different perspectives on how those contributions could be obtained. This highlights the importance of the early identification of user groups and exploration of their different needs when developing new solutions. Moreover, seniors' and HCPs' perceptions included aspects relevant for personal motivation, technology acceptance, and PA behavioral change according to self-determination theory, unified theory of acceptance and use of technology, and behavioral change techniques for increasing PA.

  • 9.
    Hellström, K.
    et al.
    Uppsala University, Sweden.
    Sandström, M.
    Uppsala University, Sweden.
    Heideken Wågert, Petra
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Sandborgh, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Thors Adolfsson, E.
    Primary Care, Central Hospital Ing., Västerås, Sweden.
    Johansson, Ann-Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Fall-related self-efficacy in instrumental activities of daily living is associated with falls in older community-living people2013Inngår i: Physical & Occupational Therapy in Geriatrics, ISSN 0270-3181, E-ISSN 1541-3152, Vol. 31, nr 2, s. 128-139Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: The aim of this study was to identify fall risk factors in community-living people 75 years or older. Methods: From a random selection of 525 older adults, a total of 378 (72%) individuals participated in the study. Mean age was 81.7 years (range 75-101 years). A study-specific questionnaire including self-reported fall history for the past 6 months, the Falls-Efficacy Scale (Swedish version: FES(S)) and EuroQol 5 Dimensions (EQ5D) was used. Logistic regression analysis was conducted to find risk factors for falls. Results: The strongest significant predictor of falls was scoring low on FES(S) in instrumental activities of daily living (IADL), with an odds ratio of 7.89 (95% confidence interval 2.93-21.25). One fifth had experienced one or more falls during the past 6 months. Both fall-related self-efficacy and health-related quality of life were significantly lower among fallers. Conclusion: Our results imply that identifying community-living older adults with an increased risk of falling should include a measure of fall-related self-efficacy in IADL.

  • 10.
    Johansson, Ann-Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Alumniundersökning vid Sjukgymnastprogrammet2009Rapport (Annet vitenskapelig)
  • 11.
    Johansson, Ann-Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Centrum för klinisk forskning LTV.
    Betydelsen av psykosociala faktorer vid diskbråcksoperation2015Inngår i: Best Practice, ISSN 1329-1874, nr 25, s. 13-15Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 12.
    Johansson, Ann-Christin
    Örebro universitet, Hälsoakademin.
    Psychosocial factors in patients with lumbar disc herniation: enhancing postoperative outcome by the identifiction of predictive factors and optimised physiotherapy2008Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Psychosocial factors have been advanced as an explanation for the development of chronic disability in 20 to 30% of patients treated by lumbar disc surgery.

    Aims: The overall aim of this thesis was to study the role of psychosocial factors in patients undergoing first-time lumbar disc surgery in relation to the outcome of both surgery and subsequent physiotherapy.

    Methods: Sixty-nine patients with lumbar disc herniation undergoing first-time disc surgery participated in the studies; in addition, Study I included 162 knee patients for comparison. Psychosocial factors were assessed preoperatively, as was the activation of the physiological stress response system. Pain, disabil-ity and quality of life were assessed before, and 3 and 12 months after surgery. Coping and kinesiophobia were analysed before and one year after surgery. The results of two different postoperative training programmes were compared.

    Results: There were no differences between disc and knee patients regarding the presence of psychosocial stress factors preoperatively (Study I). Disc patients with low diurnal cortisol variability had lower physical function, perceived fewer possibilities to influence their pain and were more prone to catastrophise than patients with high diurnal cortisol variability (Study II). The results of clinic-based physiotherapy and home training did not differ regarding postoperative disability and pain 3 months after surgery. The home-based group had less pain and higher quality of life in comparison to the clinic-based group 12 months after surgery (Study III). Patients’ expectations of returning to work could best predict pain, disability, quality of life and sick leave one year after surgery (Study IV). Psychosocial factors were only weakly asso-ciated to pain, disability, quality of life and sick leave preoperatively. However, these associations were stronger in patients with residual pain one year after surgery.

    Conclusion: Psychosocial factors and, in particular, patients’ expectations regarding outcome are associated with the results of lumbar disc surgery. Assessing psychosocial factors preoperatively and developing an active home training programme after surgery could create options leading to better results for these patients.

  • 13.
    Johansson, Ann-Christin
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Ask, Sofia
    Uppsala Universitet.
    Lindmark, Birgitta
    Uppsala Universitet.
    Utvärdering av continous passive motion (CPM) vid rehabilitering efter knäprotesoperation2003Inngår i: Nordisk fysioterapi, ISSN 1402-3024, ISSN 1402-3024, Vol. 7, nr 2, s. 29-39Artikkel i tidsskrift (Fagfellevurdert)
  • 14.
    Johansson, Ann-Christin
    et al.
    Örebro Universitet.
    Cornefjord, Michael
    Bergkvist, Leif
    Ohrvik, John
    Linton, Steven J
    Psychosocial stress factors among patients with lumbar disc herniation, scheduled for disc surgery in comparison with patients scheduled for arthroscopic knee surgery.2007Inngår i: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 16, nr 7, s. 961-970Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Returning to work after disc surgery appears to be more heavily influenced by psychological aspects of work than by MR-identified morphological alterations. It is still not known whether psychosocial factors of importance for outcome after disc surgery are present preoperatively or develop in the postoperative phase. The aim of this study was to investigate the presence of work-related stress, life satisfaction and demanding life events, among patients undergoing first-time surgery for lumbar disc herniation in comparison with patients scheduled for arthroscopic knee surgery. Sixty-nine patients with disc herniation and 162 patients awaiting arthroscopy were included in the study, during the time period March 2003 to May 2005. Sixty-two percent of the disc patients had been on sick leave for an average of 7.8 months and 14 percent of the knee patients had been on sick leave for an average of 4.2 months. The psychosocial factors were investigated preoperatively using a questionnaire, which was a combination of the questionnaire of quality of work competence (QWC), life satisfaction (LiSat9) and life events as a modification of the social readjustment scale. There were no significant differences between the two groups in terms of work-related stress or the occurrence of demanding life events. The disc patients were significantly less satisfied with functions highly inter-related to pain and discomfort, such as present work situation, leisure-time, activities of daily living (ADL) function and sleep. Patients with disc herniation on sick leave were significantly less satisfied with their present work situation than knee patients on sick leave; this sub-group of patients with disc herniation also reported significantly higher expectations in relation to future job satisfaction than knee patients. The results indicate that psychosocial stress is not more pronounced preoperatively in this selected group of disc patients, without co-morbidity waiting for first-time disc surgery, than among knee patients awaiting arthroscopy. It was notable that the disc patients had high expectations in terms of improved job satisfaction after treatment by surgery.

  • 15.
    Johansson, Ann-Christin
    et al.
    Örebro Universitet.
    Gunnarsson, Lars-Gunnar
    Örebro Universitet.
    Linton, Steven J
    Örebro Universitet.
    Bergkvist, Leif
    Örebro Universitet.
    Stridsberg, Mats
    Uppsala Univ Hosp.
    Nilsson, Olle
    Uppsala Univ Hosp.
    Cornefjord, Michael
    Uppsala Univ Hosp.
    Pain, disability and coping reflected in the diurnal cortisol variability in patients scheduled for lumbar disc surgery.2008Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, nr 5, s. 633-40Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Symptoms of lumbar disc herniation can be induced by both mechanical compression of the nerve roots and by biochemical irritants from the disc tissues. Proinflammatory cytokines, as well as stress are potent stimulators of the hypothalamic-pituitary-adrenal axis, reflected in enhanced release of cortisol from the adrenal cortex. Altered cortisol production is also associated to behaviour and coping patterns. The aim of the present study was to explore the relation between pain, physical function, psychosocial factors and quality of life to the diurnal cortisol variability, in patients with lumbar disc herniation.

    METHOD: This study had a cross-sectional design. Forty-two patients with lumbar disc herniation, verified by magnetic resonance imaging and a clinical examination by an orthopaedic surgeon, were included in the study. All patients were scheduled for disc surgery. The diurnal cortisol variability was examined before surgery. The patients were dichotomised into two groups based on low or high diurnal cortisol variability. Pain, disability, work related stress, quality of life, coping and fear avoidance beliefs, were estimated by standardised questionnaires.

    RESULTS: The low diurnal cortisol variability group was distinguished by a higher median score regarding leg pain at activity and significantly more disability (p<0.05). The patients with a low diurnal cortisol variability had significantly lower coping self-statement scores, but higher pain coping catastrophising scores (p<0.05).

    CONCLUSION: Patients with lumbar disc herniation and a low diurnal cortisol variability had lower physical function, perceived lower possibilities of influencing their pain, and were more prone to catastrophise than patients with lumbar disc herniation and a high diurnal cortisol variability.

  • 16.
    Johansson, Ann-Christin
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Karlsson, Hillevi
    Department of Orthopedics, Hospital of Västmanland County, Västerås, Sweden.
    The Star Excursion Balance Test: Criterion and divergent validity on patients with femoral acetabular impingement2016Inngår i: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 26, s. 104-109Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background A valid functional test, evaluating dynamic balance control, might be valuable clinic tool for evaluation of treatment outcome on patients with femoral acetabular impingement (FAI). Objectives The aim of this study was to evaluate criterion and divergent validity of the Star Excursion Balance Test (SEBT) on patients with bilateral FAI- changes, with unilateral clinical symptoms. Method In this cross sectional correlational and comparative study fifteen patients with bilateral FAI with unilateral symptoms and 15 controls participated. Criterion validity was determined by analysing agreement between SEBT and The Copenhagen Hip and Groin Outcome Score (HAGOS), The Hip Sports Activity Scale (HSAS), pain and leg strength on FAI patients. Divergent validity was determined by comparing SEBT on FAI patients with controls and by comparing SEBT on patient's symptomatic and asymptomatic hips. Results/findings SEBT posterolateral and posteromedial direction had high criterion validity in relation to HAGOS subscale pain intensity and symptoms (rs = 0.75, p = 0.001, respectively rs = 0.70, p = 0.004). Criterion validity was low in relation to HAGOS subscales sports, recreation, participation in physical activity and quality of life. SEBT in the posterolateral and posteromedial direction had good divergent validity (p = 0.006, respectively p = 0.001) and in the posterolateral direction SEBT could differentiate between patient's symptomatic and asymptomatic hip (p = 0.005). Conclusions SEBT in posterolateral and posteromedial direction has good criterion validity in relation to pain and other symptoms. In the posterolateral and posteromedial direction SEBT also had divergent validity. Clinically it is recommended to combine SEBT in the posterolateral and posteromedial direction with other measurements on patients with FAI.

  • 17.
    Johansson, Ann-Christin
    et al.
    Örebro universitet.
    Linton, Steven J
    Örebro universitet.
    Bergkvist, Leif
    Uppsala universitet.
    Nilsson, Olle
    Cornefjord, Michael
    Uppsala University Hospital.
    Clinic-based training in comparison to home-based training after first-time lumbar disc surgery: a randomised controlled trial.2009Inngår i: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 18, nr 3, s. 398-409Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The effectiveness of physiotherapy after first-time lumbar disc surgery is still largely unknown. Studies in this field are heterogeneous and behavioural treatment principles have only been evaluated in one earlier study. The aim of this randomised study was to compare clinic-based physiotherapy with a behavioural approach to a home-based training programme regarding back disability, activity level, behavioural aspects, pain and global health measures. A total of 59 lumbar disc patients without any previous spine surgery or comorbidity participated in the study. Clinic-based physiotherapy with a behavioural approach was compared to home-based training 3 and 12 months after surgery. Additionally, the home training group was followed up 3 months after surgery by a structured telephone interview evaluating adherence to the exercise programme. Outcome measures were: Oswestry Disability Index (ODI), physical activity level, kinesiophobia, coping, pain, quality of life and patient satisfaction. Treatment compliance was high in both groups. There were no differences between the two groups regarding back pain disability measured by ODI 3 and 12 months after surgery. However, back pain reduction and increase in quality of life were significantly higher in the home-based training group. The patients in the clinic-based training group had significantly higher activity levels 12 months after surgery and were significantly more satisfied with physiotherapy care 3 months after surgery compared to the home-based training group. Rehabilitation after first-time lumbar disc surgery can be based on home training as long as the patients receive both careful instructions from a physiotherapist and strategies for active pain coping, and have access to the physiotherapist if questions regarding training arise. This might be a convenient treatment arrangement for most patients.

  • 18.
    Johansson, Ann-Christin
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd. Örebro Universitet.
    Linton, Steven J
    Örebro Universitet.
    Rosenblad, Andreas
    Uppsala Universitet.
    Bergkvist, Leif
    Uppsala Universitet.
    Nilsson, Olle
    Uppsala Universitet.
    A prospective study of cognitive behavioural factors as predictors of pain, disability and quality of life one year after lumbar disc surgery.2010Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, nr 7, s. 521-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: The primary aim of this study was to analyse the predictive value of cognitive and behavioural factors, in relation to pain, disability and quality of life (QoL) one year after lumbar disc surgery.

    METHOD: The study design was prospective. Fifty-nine patients scheduled for first time lumbar disc surgery were included. Pain, disability, QoL, coping, fear avoidance beliefs, expected outcome and sick leave were assessed preoperatively and 12 months after surgery. Multiple backward stepwise logistic regression analyses were performed to study the contribution of the preoperatively measured independent behavioural/cognitive factors (coping, fear avoidance beliefs and assessed chance to return to work within 3 months) to the dependent variables pain, disability and quality of life at 12 months after surgery.

    RESULTS: Low expectations on work return within 3 months after surgery was significantly predictive for residual leg pain, odds ratio (OR) = 8.2, back pain, OR = 9.7, disability, OR = 13.8 and sick leave, OR = 19.5. Low QoL, was best predicted by preoperatively high scores on fear avoidance beliefs OR = 6.6 and being a woman OR = 6.0. The regression model explained 26-40% of the variance in pain, disability, QoL and sick leave.

    CONCLUSIONS: Eliciting patients' expectations on work return after surgery could contribute to early identification of those who run the risk of developing long-term disability and sick-leave.

  • 19.
    Johansson, Ann-Christin
    et al.
    Uppsala universitet.
    Rothman, Mats Georg
    Uppsala universitet.
    Ortendahl, Monica
    KTH.
    Rosenblad, Andreas
    Uppsala universitet.
    Improved quality of life, working ability and patient satisfaction after pretreatment multimodal assesment method in patients with mixed chronic muscular pain: A randomized- controlled study2013Inngår i: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 29, nr 3, s. 195-204Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE:: To investigate whether a pretreatment multimodal (MM) assessment of patients with chronic muscular pain has an impact on treatment outcome. METHODS:: The present randomized-controlled study evaluated an MM assessment compared with routine multidisciplinary assessment given to a control group. The study population consisted of primary care patients with mixed chronic muscular pain. Variables assessed were: pain intensity, depression, life stress, quality of life (QOL), disability, working ability, and treatment satisfaction. Follow-up was performed at 15 months and 182 patients of 220 (83%) completed the study. RESULTS:: Univariate and multivariate logistic regression showed from baseline to 15 months a significant improvement in QOL as measured by Short-Form 36 in the MM group compared with the control group on the domains of physical function (odds ratio 2.40; 95% confidence interval 1.32-4.37), role physical (2.37; 1.10-5.09), and role emotional (2.05; 1.05-3.96). Working ability improved more significantly in the MM group (46% vs. 35%) and impairment was less (1% vs. 15%) compared with the control group (P=0.016). Satisfaction with the assessment was, on average, higher (P<0.001) in the MM group than in the control group. DISCUSSION:: Patients who underwent an MM assessment before treatment in comparison with patients receiving routine multidisciplinary assessment improved QOL, working ability, and were also significantly more satisfied. This result indicates that MM pretreatment assessment could be advantageous in the selection of patients for suitable rehabilitation treatment in a primary care setting, and also be used to prepare patients for future rehabilitation

  • 20.
    Johansson, Ann-Christin
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Centrum för klinisk forskning LTV.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Öhrvik, John
    Karolinska Institutet, Sweden.
    Associations among pain, disability and psychosocial factors and the predictive value of expectations on returning to work in patients who undergo lumbar disc surgery.2016Inngår i: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 25, nr 1, s. 296-203Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Abstract

    PURPOSE:

    The aim of this study was to describe the associations among pain, disability and psychosocial factors preoperatively as well as 3 and 24 months later for patients who undergo first time discectomy and to analyse the predictive value of psychosocial factors on the outcome 24 months after surgery.

    METHODS:

    Fifty-nine patients, 41 % women, with a mean age of 40 years and without comorbidities were included, of whom 56 responded to the 24-month follow-up; at that point, they were divided into patients with complaints (C, n = 36) and patients without complaints (NC, n = 20). Correlations among the pain intensity, disability and psychosocial factors were analysed preoperatively, 3 and 24 months after discectomy, and regression analyses of psychosocial factors on the outcome at 24 months were performed.

    RESULTS:

    Psychosocial variables were weakly correlated with the pain intensity and disability preoperatively. High expectations on the return to work were predictive of both pain intensity (β = 8.0, p = 0.03) and disability (β = 9.1, p < 0.001) at 24 months. Associations between psychosocial variables and outcome variables were strengthened at the 3-month follow-up in the C group, and this association remained 24 months after surgery. Fear of movement was most strongly correlated with leg pain intensity (r s 0.64, p < 0.001) and the ability to decrease pain was the most correlated with disability (r s 0.78, p < 0.001).

    CONCLUSION:

    Having high expectations on the return to work after surgery was the strongest predictor for a favourable outcome. Therefore, low preoperative expectations on return to work convey an important prognostic signal.

  • 21.
    Kyhlbäck, Maria
    et al.
    Akademiska Sjukhuset Uppsala.
    Kjellby-Wendt, Gunilla
    Sahlgrenaka Akademin.
    Abbott, Allan
    Karolinska Institutet.
    Millisdotter, Monica
    Lunds Universitetssjukhus.
    Grönlund, Per
    Östersunds sjukgymnastik.
    Johansson, Mia
    Umeå Universitetssjukhus.
    Johansson, Ann-Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Postoperativ rehabilitering vid ländryggsdiskbråck2011Inngår i: Fysioterapi, ISSN 1653-5804, nr 1, s. 32-37Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [sv]

    Bakgrund och syfte:Under 2008 har en grupp sjukgymnaster tagit fram nationella behandlingsriktlinjer för patienter som genomgått diskbråcksoperation. Syftet var att dessa skulle baseras på vetenskaplig evidens och klinisk erfarenhet.Metoder:Litteratursökning gjordes i sju olika databaser, sökningen omfattade randomiserade, kontrollerade studier under tidsperioden 1990-2008. Inkluderade studier granskades utifrån ett modifierat kvalitetsindex enligt SBU (Statens Beredning för medicinsk Utvärdering). För bevisvärdering av studieresultat användes SBU:s gradering högt, medelhögt och lågt bevisvärde. Evidensgrad för olika sjukgymnastiska metoder som förekom i de inkluderade studierna kategoriserades i enlighet med SBU:s nivåer för vetenskaplig evidens; starkt vetenskapligt underlag, måttligt starkt vetenskapligt underlag, begränsat vetenskapligt underlag och otillräckligt vetenskapligt underlag. Resultat:Sexton artiklar som uppfyllde kriterierna för granskning inkluderades i granskningen.Baserat på dessa studier finns måttligt stark evidens för att aktiv träning som inkluderar ett mer aktivt förhållningssätt är mer effektiv på kort sikt än mer försiktig/passiv träning och förhållningssätt (< 6 månader efter operation). Det finns ett starkt vetenskapligt stöd för att den aktiva träningen inte påverkar smärta och funktion på lång sikt (ett år efter operation), liksom att tidig, aktiv träning inte ökar komplikationsrisken efter operation. Det vetenskapliga stödet är begränsat vad gäller de positiva effekterna av enbart råd om fysisk aktivitet, motsägande beträffande effekten av övervakad träning jämfört med hemträning och otillräckligt beträffande effekten av beteendemedicinskt inriktad träning.Konklusion:Sjukgymnastiken efter diskbråcksoperation bör ha ett aktivt förhållningssätt inkluderande tidig, aktiv träning för att förbättra patienternas ryggfunktion och höja aktivitetsgraden efter operation.

  • 22.
    Lindblad, Katarina
    et al.
    Västmanland County Hospital, Västerås, Sweden.
    Bergkvist, Leif
    Västmanland County Hospital, Västerås, Sweden.
    Johansson, Ann-Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Västmanland County Hospital, Västerås, Sweden.
    Evaluation of the treatment of chronic chemotherapy-induced peripheral neuropathy using long-wave diathermy and interferential currents: a randomisezed controlled trial2016Inngår i: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, nr 6, s. 2523-2531Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose. The purpose was to investigate the effects of long-wave diathermy in combination with interferential currents (interferential therapy and long-wave diathermy at high power (ITH)) in comparison with long-wave diathermy at a power below the active treatment dose (long-wave diathermy at low power (LDL), control group) on sensory and motor symptoms in patients with chronic chemotherapy-induced peripheral neuropathy (CIPN) in the lower extremities.

    Methods. Sixty-seven patients with chronic CIPN were randomized to 12 weeks of either ITH or LDL. Follow-up assessments were performed after the treatment period and at 37 weeks after randomization. The primary outcome was pain (Numeric Rating Scale (NRS)), and the secondary outcomes were discomfort, nerve symptoms, subjective measurement of dizziness (Dizziness Handicap Inventory), and balance. Differences within and between groups were analyzed.

    Results. Pain intensity decreased significantly only in the LDL group directly after the treatment period from NRS median 25 to median 12.5 (P = 0.017). At the 37-week follow-up, no changes were detected, irrespective of group (NRS 13 vs. 20, P = 0.885). Discomfort decreased significantly in both groups at both 12 and 37 weeks after the baseline (P < 0.05). Balance disability showed significant declines in both groups at 12 and 37 weeks (P = 0.001/0.025 in the ITH group vs P = 0.001/<0.001 in the LDL group). Balance ability (tightened Romberg test) increased significantly at both 12 and 37 weeks in both groups (P = 0.004/<0.040 in the ITH group) but did not improve in the LDL group at any of the follow-up time points (P = 0.203 vs P = 0.383). The one-legged stance test was unchanged in the ITH group after 12 weeks but improved 37 weeks after baseline (P = 0.03). No significant changes were observed in the LDL group at any of the follow-up time points.

    Conclusion. This study provides no support for the use of a combination of long-wave diathermy and ITH as a treatment option for patients with chronic CIPN. However, the chronic CIPN symptoms decreased with time irrespective of the treatment.

  • 23.
    Revenäs, Åsa
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Johansson, Ann-Christin
    Central Hospital Västerås.
    Leppert, J.
    Central Hospital Västerås.
    A randomized study of two physiotherapeutic approaches after knee ligament reconstruction2009Inngår i: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 11, nr 1, s. 30-41Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Little is known about whether physiotherapeutic knee classes provide additional benefits in the rehabilitation after anterior cruciate ligament reconstruction (ACLR). In the present randomized study, we compare the results of a hospital-based programme, Knee-class Therapy (KT), with an individual programme with limited physiotherapy appointments, Guided Therapy (GT), 6 and 12 months after knee surgery, in terms of function, activity level, muscle strength, knee-joint stability and knee-joint mobility. After ACLR, 24 patients were randomized to the KT group and 27 to the GT group. Fourteen patients in the KT group and 24 in the GT group completed the physiotherapy appointments as prescribed. At 6 months after surgery, the median Lysholm knee score was significantly higher in the KT group. At the 12-month follow-up, the GT group's improvement in the Lysholm knee score was significantly greater than the KT group's. Non-compliance was high in the KT group. The subgroup analysis of the non-compliers in the KT group showed that their improvement in the Lysholm knee score between 0 and 12 months was significantly greater than that of the KT group's compliers. These results could indicate that an individual exercise programme with limited physiotherapy appointments might be as effective as physiotherapeutic knee classes.

  • 24.
    Rodby-Bousquet, Elisabet
    et al.
    Lund University.
    Augustson, Atli
    Rehabilitation Centre of Excellence, Kópavogur, Iceland.
    Jonsdottir, Gudny
    Rehabilitation Centre of Excellence, Kópavogur, Iceland.
    Czuba, Tomasz
    Lund university.
    Johansson, Ann-Christin
    Uppsala University.
    Hägglund, Gunnar
    Lund University, Skåne University Hospital, Lund, Sweden.
    Interrater reliability and construct validity of the posture and postural ability scale in adults with cerebral pulsy in supine, prone, siting and standing position2014Inngår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 28, nr 1, s. 82-90Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Objective To evaluate reliability, internal consistency and construct validity of the Posture and Postural Ability Scale for adults with cerebral palsy. Design Psychometric evaluation of a clinical assessment tool. Setting Rehabilitation Centres in Sweden and Iceland. Subjects Thirty adults with cerebral palsy aged 19-22 years, six people at each level I-V of the Gross Motor Function Classification System. Main measures The Posture and Postural Ability Scale contains a 7-point ordinal scale for postural ability in supine, prone, sitting, and standing and items for assessment of posture. Posture and postural ability was rated from photos and videos by three independent assessors. Interrater reliability was calculated using weighted Kappa. Internal consistency was analysed with Cronbach’s alpha if item deleted and corrected item-total correlation. Construct validity was evaluated based on known groups, using Jonckheere Terpstra for averaged values of the three raters relative to the Gross Motor Function Classification System. Results There was an excellent interrater reliability (kappa=0.85-0.99) and a high internal consistency (alpha=0.96-0.97, item-total correlation=0.60-0.91). Median values differed (p<0.02) between known groups represented by the levels of gross motor function, showing construct validity for all items. Conclusion The Posture and Postural Ability scale showed an excellent interrater reliability for experienced raters, a high internal consistency and construct validity. It can detect postural asymmetries in adults with cerebral palsy at all levels of gross motor function.

  • 25.
    Sandborgh, Maria
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Dean, Elizabeth
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. University of British Columbia , Vancouver , Canada.
    Denison, Eva
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Norwegian Institute of Public Health , Nydalen , Oslo , Norway.
    Elvén, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Fritz, Johanna
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    von Heideken Wågert, Petra
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Moberg, Johan
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Overmeer, Thomas
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Örebro University, Örebro, Sweden.
    Snöljung, Åsa
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Johansson, Ann-Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Integration of Behavioral Medicine Competencies into Physical Therapy Curriculum in an Exemplary Swedish Program: Rationale, Process and Ten-year ReviewInngår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy program. Program developers constructed the curriculum with behavioral medicine content that reflected the contemporary definition and values of the physiotherapy profession aligning it with current best practices, evidence, and the International Classification of Functioning, Disability, and Health (ICF). The new curriculum conceptualized movement and function as modifiable behaviors in that they reflect behavioral contingencies, perceptions, beliefs, and lifestyle factors as well as pathophysiology and environmental factors. The purpose of this article is to describe how one university accordingly structured its new curriculum and its review. We describe the rationale for the curriculum's behavioral medicinecontent and competencies, its development and implementation, challenges, long-term outcomes, and its related research enterprise. We conclude that physiotherapy practiced by our graduates augments that taught in other programs based on accreditation reviews. With their expanded practice scope, graduates are systematically practicing within the constructs of health and function conceptualized within the ICF. Our intent in sharing our experience is to exemplify one university's initiative to best prepare students with respect to maximizing physiotherapy outcomes as well as establish a dialogue regarding minimum standards of behavioral medicine competencies in physiotherapy education and practice.

  • 26.
    Sandborgh, Maria
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Johansson, Ann-Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Söderlund, Anne
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    The relation between the fear-avoidance model and constructs from the social cognitive theory in acute WAD2016Inngår i: Pain Research & Management, ISSN 1203-6765, E-ISSN 1918-1523, Vol. 2016, artikkel-id 8281926Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In the fear-avoidance (FA) model social cognitive constructs could add to explaining the disabling process in whiplash associated disorder (WAD). The aim was to exemplify the possible input from Social Cognitive Theory on the FA model.Specifically the role of functional self-efficacy and perceived responses from a spouse/intimate partner was studied. A cross-sectional and correlational design was used. Data from 64 patients with acute WAD were used. Measures were pain intensity measured with a numerical rating scale, the Pain Disability Index, support, punishing responses, solicitous responses, and distracting responses subscales from the Multidimensional Pain Inventory, the Catastrophizing subscale from the Coping Strategies Questionnaire, the Tampa Scale of Kinesiophobia, and the Self-Efficacy Scale. Bivariate correlational, simple linear regression, and multiple regression analyses were used. In the statistical prediction models high pain intensity indicated high punishing responses, which indicated high catastrophizing. High catastrophizing indicated high fear of movement, which indicated low self-efficacy. Low self-efficacy indicated high disability, which indicated high pain intensity. All independent variables together explained 66.4% of the variance in pain disability, p < 0.001. Results suggest a possible link between one aspect of the social environment, perceived punishing responses from a spouse/intimate partner, pain intensity, and catastrophizing. Further, results support a mediating role of self-efficacy between fear of movement and disability in WAD.

  • 27.
    Söderlund, Anne
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Sandborgh, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Johansson, Ann-Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Is self-efficacy and catastrophizing in pain-related disability mediated by control over pain and ability to decrease pain in whiplash-associated disorders?2017Inngår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, nr 5, s. 376-385Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Pain perception is influenced by several cognitive and behavioral factors of which some identified as mediators are important in pain management. We studied the mediating role of control over pain and ability to decrease pain in relation to functional self-efficacy, catastrophizing, and pain-related disability in patients with Whiplash-Associated Disorders, (WAD). Further, if the possible mediating impact differs over time from acute to three and 12 months after an accident, cross-sectional and prospective design was used, and 123 patients with WAD were included. Regression analyses were conducted to examine the mediating effect. The results showed that control over pain and ability to decrease pain were not mediators between self-efficacy, catastrophizing, and disability. Self-efficacy had a larger direct effect on pain-related disability compared to catastrophizing. Thus, healthcare staff should give priority to increase patients' self-efficacy, decrease catastrophic thinking, and have least focus on control over pain or ability to decrease pain.

  • 28.
    Söderlund, Anne
    et al.
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Sandborgh, Maria
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd.
    Johansson, Ann-Christin
    The fear avoidance model; does punishing responses of significant other and self-efficacy in activities have role in the model2013Konferansepaper (Fagfellevurdert)
  • 29.
    Tuvemo Johnson, Susanna
    et al.
    Uppsala University, Uppsala, Sweden.
    Martin, Catrin
    Uppsala University, Uppsala, Sweden.
    Anens, Elisabeth
    Uppsala University, Uppsala, Sweden.
    Johansson, Ann-Christin
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Hälsa och välfärd. Centrum för klinisk forskning LTV.
    Hellström, Karin
    Uppsala University, Uppsala, Sweden.
    Older Adults’ Opinions on Fall Prevention in Relation to Physical Activity Level2018Inngår i: Journal of Applied Gerontology, ISSN 0733-4648, E-ISSN 1552-4523, Vol. 37, nr 1, s. 53-78Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this study was to explore and describe older adults’opinions regarding actions to prevent falls and to analyze differences in theopinions of highly versus less physically active older adults. An open-endedquestion was answered by 262 individuals aged 75 to 98 years living in thecommunity. The answers were analyzed using qualitative content analysis,and differences in the categories were compared between highly and lessphysically active persons. Physical activity was measured according to afive-level scale. The content analysis resulted in eight categories: assistivedevices, avoiding hazards, behavioral adaptive strategies, being physicallyactive, healthy lifestyle, indoor modifications, outdoor modifications, andseeking assistance. Behavioral adaptive strategies were mentioned to agreater extent by highly active people, and indoor modifications were moreoften mentioned by less active older adults. Support for active self-directedbehavioral strategies might be important for fall prevention among lessphysically active older adults.

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