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  • 1. Abzhandadze, Tamar
    et al.
    Reinholdsson, Malin
    Palstam, Annie
    Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg.
    Eriksson, Marie
    Sunnerhagen, Katharina S
    Transforming self-reported outcomes from a stroke register to the modified Rankin Scale: a cross-sectional, explorative study.2020In: Scientific Reports, E-ISSN 2045-2322, Vol. 10, no 1, article id 17215Article in journal (Refereed)
    Abstract [en]

    The aim was to create an algorithm to transform self-reported outcomes from a stroke register to the modified Rankin Scale (mRS). Two stroke registers were used: the Väststroke, a local register in Gothenburg, Sweden, and the Riksstroke, a Swedish national register. The reference variable, mRS (from Väststroke), was mapped with seven self-reported questions from Riksstroke. The transformation algorithm was created as a result of manual mapping performed by healthcare professionals. A supervised machine learning method-decision tree-was used to further evaluate the transformation algorithm. Of 1145 patients, 54% were male, the mean age was 71 y. The mRS grades 0, 1 and 2 could not be distinguished as a result of manual mapping or by using the decision tree analysis. Thus, these grades were merged. With manual mapping, 78% of the patients were correctly classified, and the level of agreement was almost perfect, weighted Kappa (Kw) was 0.81. With the decision tree, 80% of the patients were correctly classified, and substantial agreement was achieved, Kw = 0.67. The self-reported outcomes from a stroke register can be transformed to the mRS. A mRS algorithm based on manual mapping might be useful for researchers using self-reported questionnaire data.

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  • 2.
    Abzhandadze, Tamar
    et al.
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Westerlind, Emma
    rg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Palstam, Annie
    Dalarna University, School of Health and Welfare, Medical Science. Sahlgrenska Academy, University of Gothenburg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Sunnerhagen, Katharina S
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Persson, Hanna C
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Sick leave one year after COVID-19 infection: a nationwide cohort study during the first wave in Sweden2024In: Scientific Reports, E-ISSN 2045-2322, Vol. 14, no 1, article id 572Article in journal (Refereed)
    Abstract [en]

    This study aimed to investigate the patterns of sick leave, as well as factors associated with sick leave due to COVID-19 during one year after the COVID-19 diagnosis, and sex-related aspects on sick leave. This nationwide study involved 11,902 individuals who received sickness benefits for COVID-19 during the first wave of the pandemic. Data from three Swedish registries were analyzed for sick leave that commenced between March 1 and August 31, 2020, with a follow-up period of 12 months. Sick leave due to COVID-19 was counted as the number of days with sickness benefits and required to include at least one registered COVID-19 diagnosis. The median duration of sick leave was 35 days, and 347 (2.9%) individuals continued their sick leave during the entire follow-up period. Furthermore, 1 year later, the cumulative incidence of sick leave was slightly higher in males (3.5%) compared to females (2.7%). Older age, being single with no children, diagnosed with the virus, medium income level, history of sick leave, and need for inpatient care were significantly associated with a higher duration of sick leave due to COVID-19, both in the total population and when stratified by sex. These results indicated that three out of 100 (3%) patients were still on sick leave 1 year after their COVID-19 diagnosis. Aspects regarding the importance of sick leave duration differed between males and females and comprised sociodemographic characteristics and need for inpatient care. The results indicated the complexity of sick leave due to COVID-19.

  • 3.
    Andersson, Mathias
    et al.
    Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Sport and Health Science. Smärtmottagningen Falun, Region Dalarna, Falun; Smärtehabilitering Säter, Region Dalarna, Säter.
    Åberg, Anna Cristina
    Dalarna University, School of Health and Welfare, Medical Science. Uppsala University.
    von Koch, Lena
    Karolinska Institutet.
    Palstam, Annie
    Dalarna University, School of Health and Welfare, Medical Science. University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Women with fibromyalgia prefer resistance exercise with heavy loads: A randomized crossover pilot study2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, article id 6276Article in journal (Refereed)
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  • 4. Bjersing, Jan L
    et al.
    Larsson, Anette
    Palstam, Annie
    Sahlgrenska Academy, University of Gothenburg.
    Ernberg, Malin
    Bileviciute-Ljungar, Indre
    Löfgren, Monika
    Gerdle, Björn
    Kosek, Eva
    Mannerkorpi, Kaisa
    Benefits of resistance exercise in lean women with fibromyalgia: involvement of IGF-1 and leptin2017In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 18, no 1, article id 106Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Chronic pain and fatigue improves by exercise in fibromyalgia (FM) but underlying mechanisms are not known. Obesity is increased among FM patients and associates with higher levels of pain. Symptom improvement after aerobic exercise is affected by body mass index (BMI) in FM. Metabolic factors such as insulin-like growth factor 1 (IGF-1) and leptin may be involved. In this study, the aim was to evaluate the role of metabolic factors in lean, overweight and obese women during resistance exercise, in relation to symptom severity and muscle strength in women with FM.

    METHODS: Forty-three women participated in supervised progressive resistance exercise, twice weekly for 15-weeks. Serum free and total IGF-1, IGF-binding protein 3 (IGFBP3), adiponectin, leptin and resistin were determined at baseline and after 15-weeks. Level of current pain was rated on a visual analogue scale (0-100 mm). Level of fatigue was rated by multidimensional fatigue inventory (MFI-20) subscale general fatigue (MFIGF). Knee extension force, elbow flexion force and handgrip force were assessed by dynamometers.

    RESULTS: Free IGF-1 (p = 0.047), IGFBP3 (p = 0.025) and leptin (p = 0.008) were significantly decreased in lean women (n = 18), but not in the overweight (n = 17) and the obese (n = 8). Lean women with FM benefited from resistance exercise with improvements in current pain (p= 0.039, n = 18), general fatigue (MFIGF, p = 0.022, n = 18) and improved elbow-flexion force (p = 0.017, n = 18). In overweight and obese women with FM there was no significant improvement in pain or fatigue but an improvement in elbow flexion (p = 0.049; p = 0.012) after 15 weeks of resistance exercise.

    CONCLUSION: The clearest clinical response to resistance exercise was found in lean patients with FM. In these individuals, individualized resistance exercise was followed by changes in IGF-1 and leptin, reduced pain, fatigue and improved muscular strength. In overweight and obese women FM markers of metabolic signaling and clinical symptoms were unchanged, but strength was improved in the upper limb. Resistance exercise combined with dietary interventions might benefit patients with FM and overweight.

    TRIAL REGISTRATION: The trial was registered 21 of October 2010 with ClinicalTrials.gov identification number: NCT01226784 .

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  • 5. Chen, Eric
    et al.
    Viktorisson, Adam
    Danielsson, Anna
    Palstam, Annie
    Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Sunnerhagen, Katharina S
    Levels of physical activity in acute stroke patients treated at a stroke unit: A prospective, observational study.2020In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 52, no 4, article id jrm00041Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: A prospective, observational study to describe levels of physical activity in patients with stroke on day 2 and day 5 or 6 after admission to a comprehensive stroke unit in Sweden.

    METHODS: The study was performed at the stroke unit at Sahlgrenska University Hospital during a period of 4 months between 2017 and 2018. Consecutive patients with stroke were observed for 1 min every 10 min while the multidisciplinary team was at work. The level of physical activity, location and the people present were noted at each time-point.

    RESULTS: A total of 46 patients were observed on day 2, of whom 29 were observed a second time on day 5 or 6. Patients were in bed half of the time and engaged in upright activity for less than 10% of day 2. Patients spent 73% of day 2 in the bedroom and 56% of this day alone. Over time, there was a significant shift of 10% from "in bed" activity to "sitting" (p §lt;0.001).

    CONCLUSION: Patients are physically inactive, alone and in their rooms for a majority of the time during the first days at a comprehensive stroke unit. There is some increase in physical activity during the first week after admission.

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  • 6. Christidis, Nikolaos
    et al.
    Ghafouri, Bijar
    Larsson, Anette
    Palstam, Annie
    Sahlgrenska Academy, University of Gothenburg.
    Mannerkorpi, Kaisa
    Bileviciute-Ljungar, Indre
    Löfgren, Monika
    Bjersing, Jan
    Kosek, Eva
    Ernberg, Malin
    Comparison of the levels of pro-inflammatory cytokines released in the vastus lateralis muscle of patients with fibromyalgia and healthy controls during contractions of the quadriceps muscle - A microdialysis study2015In: PLOS ONE, E-ISSN 1932-6203, Vol. 10, no 12, article id e0143856Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Fibromyalgia is associated with central hyperexcitability, but it is suggested that peripheral input is important to maintain central hyperexcitability. The primary aim was to investigate the levels of pro-inflammatory cytokines released in the vastus lateralis muscle during repetitive dynamic contractions of the quadriceps muscle in patients with fibromyalgia and healthy controls. Secondarily, to investigate if the levels of pro-inflammatory cytokines were correlated with pain or fatigue during these repetitive dynamic contractions.

    MATERIAL AND METHODS: 32 women with fibromyalgia and 32 healthy women (controls) participated in a 4 hour microdialysis session, to sample IL-1β, IL-6, IL-8, and TNF from the most painful point of the vastus lateralis muscle before, during and after 20 minutes of repeated dynamic contractions. Pain (visual analogue scale; 0-100) and fatigue Borg's Rating of Perceived Exertion Scale; 6-20) were assessed before and during the entire microdialysis session.

    RESULTS: The repetitive dynamic contractions increased pain in the patients with fibromyalgia (P < .001) and induced fatigue in both groups (P < .001). Perceived fatigue was significantly higher among patients with fibromyalgia than controls (P < .001). The levels of IL-1β did not change during contractions in either group. The levels of TNF did not change during contractions in patients with fibromyalgia, but increased in controls (P < .001) and were significantly higher compared to patients with fibromyalgia (P = .033). The levels of IL-6 and IL-8 increased in both groups alike during and after contractions (P's < .001). There were no correlations between pain or fatigue and cytokine levels after contractions.

    CONCLUSION: There were no differences between patients with fibromyalgia and controls in release of pro-inflammatory cytokines, and no correlations between levels of pro-inflammatory cytokines and pain or fatigue. Thus, this study indicates that IL-1β, IL-6, IL-8, and TNF do not seem to play an important role in maintenance of muscle pain in fibromyalgia.

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  • 7.
    Engwall, Marie
    et al.
    University of Gothenburg; University West, Trollhattan.
    Törnbom, Karin
    University of Gothenburg.
    Persson, Hanna C
    University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Palstam, Annie
    Dalarna University, School of Health and Welfare, Medical Science. University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Recovering from COVID-19 - A Process Characterised by Uncertainty: A Qualitative study2022In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 54, article id jrm00326Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To obtain a deeper understanding of the lived experiences of patients with COVID-19, the recovery process and consequences for everyday life 6 months after hospital discharge.

    DESIGN: An explorative qualitative study using individual interviews.

    SUBJECTS: A purposive sampling was applied to recruit persons who had received inpatient hospital care, were discharged approximately 6 months previously, were of working age and had persistent self-reported symptoms at a 3-month follow-up appointment.

    METHODS: Semi-structured interviews were conducted with 15 participants (10 men, 5 women), which were then transcribed and analysed with inductive thematic analysis.

    RESULTS: Three themes were identified: "Status of recovery - two steps forward, one step back", "Remaining symptoms caused limitations in everyday life" and "Strategies for recovery". Participants indicated the recovery process through 6 months after discharge was a challenging road, often involving setbacks. A wide range of persistent, fluctuating, or new symptoms negatively impacted many areas of daily life, with fatigue and lack of energy being especially prominent. Participants used a variety of strategies to cope and recover.

    CONCLUSION: This study increases our knowledge of the lived experiences of COVID-19 based individual experiences. Unexpected symptoms in the recovery process were described and not always possible to forecast.

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  • 8. Ericsson, Anna
    et al.
    Palstam, Annie
    Sahlgrenska Academy, University of Gothenburg.
    Larsson, Anette
    Löfgren, Monika
    Bileviciute-Ljungar, Indre
    Bjersing, Jan
    Gerdle, Björn
    Kosek, Eva
    Mannerkorpi, Kaisa
    Resistance exercise improves physical fatigue in women with fibromyalgia: a randomized controlled trial2016In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 18, article id 176Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Fibromyalgia (FM) affects approximately 1-3 % of the general population. Fatigue limits the work ability and social life of patients with FM. A few studies of physical exercise have included measures of fatigue in FM, indicating that exercise can decrease fatigue levels. There is limited knowledge about the effects of resistance exercise on multiple dimensions of fatigue in FM. The present study is a sub-study of a multicenter randomized controlled trial in women with FM. The purpose of the present sub-study was to examine the effects of a person-centered progressive resistance exercise program on multiple dimensions of fatigue in women with FM, and to investigate predictors of the potential change in fatigue.

    METHODS: A total of 130 women with FM (age 22-64 years) were included in this assessor-blinded randomized controlled multicenter trial examining the effects of person-centered progressive resistance exercise compared with an active control group. The intervention was performed twice a week for 15 weeks. Outcomes were five dimensions of fatigue measured with the Multidimensional Fatigue Inventory (MFI-20). Information about background was collected and the women also completed several health-related questionnaires. Multiple linear stepwise regression was used to analyze predictors of change in fatigue in the total population.

    RESULTS: A higher improvement was found at the post-treatment examination for change in the resistance exercise group, as compared to change in the active control group in the MFI-20 subscale of physical fatigue (resistance group Δ -1.7, SD 4.3, controls Δ 0.0, SD 2.7, p = 0.013), with an effect size of 0.33. Sleep efficiency was the strongest predictor of change in the MFI-20 subscale general fatigue (beta = -0.54, p = 0.031, R (2) = 0.05). Participating in resistance exercise (beta = 1.90, p = 0.010) and working fewer hours per week (beta = 0.84, p = 0.005) were independent significant predictors of change in physical fatigue (R (2) = 0.14).

    CONCLUSIONS: Person-centered progressive resistance exercise improved physical fatigue in women with FM when compared to an active control group.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT01226784 . Registered 21 October 2010.

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  • 9. Ernberg, M
    et al.
    Christidis, N
    Ghafouri, B
    Bileviciute-Ljungar, I
    Löfgren, M
    Bjersing, J
    Palstam, Annie
    Sahlgrenska Academy, University of Gothenburg.
    Larsson, A
    Mannerkorpi, K
    Kosek, E
    Plasma cytokine levels in fibromyalgia and their response to 15 weeks of progressive resistance exercise or relaxation therapy2018In: Mediators of Inflammation, ISSN 0962-9351, E-ISSN 1466-1861, Vol. 2018, article id 3985154Article in journal (Refereed)
    Abstract [en]

    The aims of this study were to compare circulating cytokines between FM and healthy controls and to investigate the effect on cytokine levels by 15 weeks of progressive resistance exercise or relaxation therapy in FM. Baseline plasma cytokine levels and clinical data were analyzed in 125 women with FM and 130 age-matched healthy women. The FM women were then randomized to progressive resistance exercise (n = 49) or relaxation (n = 43). Baseline IL-2, IL-6, TNF-α, IP-10, and eotaxin were higher in FM than in healthy controls (P < 0.041), whereas IL-1β was lower (P < 0.001). There were weak correlations between cytokine levels and clinical variables. After both interventions, IL-1ra had increased (P = 0.004), while IL-1β had increased in the relaxation group (P = 0.002). Changes of IFN-γ, IL-2, IL-4, IL-6, IL-8, and IL-17A were weakly correlated with changes of PPT, but there were no significant correlations between changes of cytokine and changes in other clinical variables. The elevated plasma levels of several cytokines supports the hypothesis that chronic systemic inflammation may underlie the pathophysiology of FM even if the relation to clinical variables was weak. However, 15 weeks of resistance exercise, as performed in this study, did not show any anti-inflammatory effect on neither FM symptoms nor clinical and functional variables. This trial is registered with ClinicalTrials.gov NCT01226784, registered October 21, 2010. The first patient was recruited October 28, 2010.

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  • 10. Ernberg, Malin
    et al.
    Christidis, Nikolaos
    Ghafouri, Bijar
    Bileviciute-Ljungar, Indre
    Löfgren, Monika
    Larsson, Anette
    Palstam, Annie
    Sahlgrenska Academy, University of Gothenburg.
    Bjersing, Jan
    Mannerkorpi, Kaisa
    Gerdle, Björn
    Effects of 15 weeks of resistance exercise on pro-inflammatory cytokine levels in the vastus lateralis muscle of patients with fibromyalgia2016In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 18, no 1, article id 137Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study aimed at investigating the effect of a resistance exercise intervention on the interstitial muscle levels of pro-inflammatory cytokines in fibromyalgia (FMS) and healthy controls (CON).

    METHODS: Twenty-four female patients with FMS (54 ± 8 years) and 27 female CON (54 ± 9 years) were subjected to intramuscular microdialysis of the most painful vastus lateralis muscle before and after 15 weeks of progressive resistance exercise twice per week. Baseline dialysates were sampled in the resting muscle 140 min after insertion of the microdialysis catheter. The participants then performed repetitive dynamic contractions (knee extension) for 20 min, followed by 60 min rest. Pain intensity was assessed with a 0-100 mm visual analogue scale (VAS), and fatigue was assessed with Borg's RPE throughout microdialysis. Dialysates were sampled every 20 min and analyzed with Luminex for interleukin (IL)-1β, tumor necrosis factor (TNF) alpha, IL-6, and IL-8.

    RESULTS: At both sessions and for both groups the dynamic contractions increased pain (P < 0.012) and fatigue (P < 0.001). The levels of TNF were lower in the FMS group than the CON group at both sessions (P < 0.05), but none of the other cytokines differed between the groups. IL-6 and IL-8 increased after the dynamic contractions in both groups (P < 0.010), while TNF increased only in CON (P < 0.05) and IL-1β did not change. Overall pain intensity was reduced after the 15 weeks of resistance exercise in FMS (P < 0.05), but there was no changes in fatigue or cytokine levels.

    CONCLUSION: Progressive resistance exercise for 15 weeks did not affect the interstitial levels of IL-1β, TNF, IL-6, and IL-8 in the vastus lateralis muscle of FMS patients or CON.

    TRIAL REGISTRATION: Clinicaltrials.gov NCT01226784 , registered 21 October 2010.

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  • 11. Lange, Elvira
    et al.
    Palstam, Annie
    The Sahlgrenska Academy, University of Gothenburg.
    Gjertsson, Inger
    Mannerkorpi, Kaisa
    Aspects of exercise with person-centred guidance influencing the transition to independent exercise: a qualitative interview study among older adults with rheumatoid arthritis2019In: European Review of Aging and Physical Activity, ISSN 1813-7253, E-ISSN 1861-6909, Vol. 16, no 4Article in journal (Refereed)
    Abstract [en]

    Background: Besides being health enhancing and disease preventing, exercise is also an important part of the management of chronic conditions, including the inflammatory joint disease rheumatoid arthritis (RA). However, older adults with RA present a lower level of physical activity than healthy older adults. The aim of this qualitative study was to explore aspects of participation in moderate- to high-intensity exercise with person-centred guidance influencing the transition to independent exercise for older adults with RA.

    Methods: A qualitative interview study was conducted. In-depth interviews with 16 adults with RA aged between 68 and 75 years, who had taken part in the intervention arm of a randomized controlled trial performing moderate- to- high-intensity exercise with person-centred guidance, were analysed using qualitative content analysis.

    Results: The analysis resulted in six main categories: A feasible opportunity to adopt exercise, Experiencing positive effects of exercise, Contextual factors affect the experience of exercise, Developing knowledge and thinking, Finding one's way, and Managing barriers for exercise. The exercise with person-centred guidance was described as a feasible opportunity to start exercising as a basis for the transition to independent exercise. They described developing knowledge and thinking about exercise during the intervention enabling them to manage the transition to independent exercise. Finding one's own way for exercise became important for sustaining independent exercise. Lastly, barriers for exercise and strategies for overcoming these were described. Reduced physical health, both temporary and permanent, was described as a considerable barrier for exercise.

    Conclusion: The participants described several aspects of participating in exercise that influenced and facilitated their transition to independent exercise. The exercise was experienced as manageable and positive, by a careful introduction and development of an individual exercise routine in partnership with a physiotherapist. This seems to have favored the development of self-efficacy, with importance for future independent exercise. Reduced physical health, both temporary and permanent, was described as a considerable barrier for exercise. The personal process of trying to make the exercise one's own, and developing knowledge about exercise and new thoughts about oneself, seemed to prepare the participants for managing independent exercise and overcoming barriers.

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  • 12.
    Larsson, Alexandra C
    et al.
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Engwall, Marie
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Health Sciences, University West, Trollhattan, Sweden.
    Palstam, Annie
    Dalarna University, School of Health and Welfare, Medical Science. Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department NeuroScience, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Persson, Hanna C
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Self-Assessed Aspects of Health 3 Months after COVID-19 Hospitalization: A Swedish Cross-Sectional Stud2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 13, article id 8020Article in journal (Refereed)
    Abstract [en]

    It is not yet fully understood how the patients self-assess their overall health in the early recovery after COVID-19 and if certain patient groups are more prominent in perceived long-time effects of COVID-19. The aim of this study was to describe self-assessed aspects of health in body function, activity and participation 3 months after hospitalization due to COVID-19 and identify difference between groups depending in age, sex and level of hospital care. This cross-sectional study consists of self-assessed aspects of health and recovery in 168 participants (mean age 64 years old, 69% men) previously hospitalized patients due to COVID-19. We have previously published data, from hospital discharge, on this cohort were predominantly the older patients and previous ICU-treated participants were affected. In this study there were differences in between groups. Of the study population 72% perceived fatigue, 64% respiratory difficulties, 37% perceived symptoms of anxiety. Three-months after COVID-19 this cohort was overall still affected. The recovery process is multifaced and the cohort heterogeneous, hence the rehabilitation needs to be highly individualized, and the follow-up of this patient group is of importance regardless of age, sex and previous level of hospital care.

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  • 13. Larsson, Alexandra C
    et al.
    Palstam, Annie
    Sahlgrenska Academy, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Persson, Hanna C
    Physical Function, Cognitive Function, and Daily Activities in Patients Hospitalized Due to COVID-19: A Descriptive Cross-Sectional Study in Sweden.2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 21, article id 11600Article in journal (Refereed)
    Abstract [en]

    An estimated 14-20% of people infected with COVID-19 require medical care. The aim of the present study was to evaluate physical function, cognitive function, and daily activities in patients hospitalized due to COVID-19, and to investigate differences depending on age and admission to the intensive care unit (ICU). This prospective descriptive cross-sectional study included a consecutive sample of 211 patients (mean age 65.1 years, 67.3% men) hospitalized due to COVID-19 in Sweden. Data regarding physical function and daily activities were collected in hospital from July 2020 to February 2021. The average length of hospital stay was 33.8 days, and 48.8% of the patients were admitted to the ICU. Physical function (grip- and lower body strength) was reduced in both groups, and significantly more in the older group, ≥65 years old, compared to the younger. Furthermore, the older group also had significantly less ability to perform activities in daily life, and had significantly reduced cognitive function as compared to the younger age group. In patients treated in the ICU, physical impairments as well as the activity level were significantly more pronounced compared to patients not treated in the ICU. Patients hospitalized due to COVID-19 are physically impaired, have mild cognitive impairments, and have difficulties performing daily activities. The findings in this study indicate the need for out-patient follow-up and rehabilitation for patients hospitalized due to COVID-19, especially in older patients and patients treated in the ICU.

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  • 14.
    Larsson, Alexandra C
    et al.
    Sahlgrenska Academy, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Törnbom, Karin
    Sahlgrenska Academy, University of Gothenburg; University of Gothenburg.
    Sunnerhagen, Katharina S
    Sahlgrenska Academy, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Palstam, Annie
    Dalarna University, School of Health and Welfare, Medical Science. Sahlgrenska Academy, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Persson, Hanna C
    Sahlgrenska Academy, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Figuring Out Life After Covid-19: a Qualitative Study From Sweden2023In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 55, article id jrm11931Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To obtain a deeper understanding of the daily life experiences of working aged people during the year following hospitalization due to SARS-CoV-2 (COVID-19), with a focus on function-ing in daily life and return to work.

    DESIGN: An explorative qualitative study using individual interviews.

    SUBJECTS: A purposive sample was selected of persons who had received inpatient hospital care, had been discharged approximately 1 year previously and were of working age.

    METHODS: Semi-structured interviews were conducted with 11 participants (9 men, 2 women). The interviews were transcribed and analysed with inductive thematic analysis.

    RESULTS: Four themes were identified. Navigating health, with or without support from healthcare, was described as challenging when managing consequences of COVID-19. Participants struggled with a lack of energy that interfered with daily life. It was a trial-and-error process trying to use familiar strategies in new ways to manage. The return to work process was facilitated by own strategies and support.

    CONCLUSION: This study contributes increased knowledge of everyday life experiences of people 1 year following hospitalization due to COVID-19. The lack of energy and a struggle to manage health while navigating the healthcare system emphasize the importance of strengthening personal and organizational health literacy to facilitate the recovery process after severe COVID-19.

  • 15. Larsson, Anette
    et al.
    Palstam, Annie
    Sahlgrenska Academy, University of Gothenburg.
    Bjersing, Jan
    Löfgren, Monika
    Ernberg, Malin
    Kosek, Eva
    Gerdle, Björn
    Mannerkorpi, Kaisa
    Controlled, cross-sectional, multi-center study of physical capacity and associated factors in women with fibromyalgia2018In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 19, no 1, article id 121Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Health and physical capacity are commonly associated with disease, age, and socioeconomic factors. The primary objective of this study was to investigate the degree to which physical capacity, defined as muscle strength and walking ability, is decreased in women with fibromyalgia (FM), as compared to healthy women, who are matched for age and level of education. The secondary aim was to investigate whether muscle strength and walking ability are associated with age, symptom duration, activity limitations and, Body Mass Index (BMI) in women with FM and control subjects.

    METHODS: This controlled, cross-sectional, multi-center study comprised 118 women with FM and 93 age- and education-level-matched healthy women. The outcome measures were isometric knee-extension force, isometric elbow-flexion force, isometric hand-grip force, and walking ability. Differences between the groups were calculated, and for the women with FM analyses of correlations between the measures of physical capacity and variables were performed.

    RESULTS: The women with FM showed 20% (p < 0.001) lower isometric knee-extension force, 36% (p < 0.001) lower isometric elbow-flexion force, 34% (p < 0.001) lower isometric hand-grip force, and 16% lower walking ability (p < 0.001), as compared to the healthy controls. All measures of muscle strength in women with FM showed significant weak to moderate relationship to symptom duration (rs = - 0.23-0.32) and walking ability (rs = 0.25-0.36). Isometric knee-extension force correlated with activity limitations, as measured using the SF-36 Physical function subscale (rs=0.23, p = 0.011).

    CONCLUSIONS: Physical capacity was considerably decreased in the women with FM, as compared to the age- and education-level-matched control group. All measures of physical capacity showed a significant association with symptom duration. Knee-extension force and walking ability were significantly associated with activity limitations, age, and BMI. It seems important to address this problem and to target interventions to prevent decline in muscle strength. Assessments of muscle strength and walking ability are easy to administer and should be routinely carried out in the clinical setting for women with FM.

    TRIAL REGISTRATION: ClinicalTrials.gov identification number: NCT01226784 , Oct 21, 2010.

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  • 16. Larsson, Anette
    et al.
    Palstam, Annie
    Sahlgrenska Academy, University of Gothenburg.
    Löfgren, Monika
    Ernberg, Malin
    Bjersing, Jan
    Bileviciute-Ljungar, Indre
    Gerdle, Björn
    Kosek, Eva
    Mannerkorpi, Kaisa
    Pain and fear avoidance partially mediate change in muscle strength during resistance exercise in women with fibromyalgia2017In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, no 9, p. 744-750Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Resistance exercise results in health benefits in fibromyalgia. The aim of this study was to determine the factors that mediate change in muscle strength in women with fibromyalgia as a result of resistance exercise.

    METHODS: Sixty-seven women with fibromyalgia (age range 25-64 years) were included. Tests of muscle strength and questionnaires related to pain, fear avoidance and physical activity were carried out. Multivariable stepwise regression was used to analyse explanatory factors for change and predictors for final values of knee-extension force, elbow-flexion force and hand-grip force.

    RESULTS: Change in knee-extension force was explained by fear avoidance beliefs about physical activity at baseline, together with change in pain intensity, knee-extension force at baseline, age and body mass index (BMI) (R2=0.40, p = 0.013). Change in elbow-flexion force was explained by pain intensity at baseline, together with baseline fear avoidance beliefs about physical activity, BMI and elbow-flexion force at baseline (R2 = 0.32, p = 0.043). Change in hand-grip force was explained by hand-grip force at baseline, change in pain intensity and baseline fear avoidance (R2 = 0.37, p = 0.009). Final muscle strength was predicted by the same variables as change, except pain.

    CONCLUSION: Pain and fear avoidance are important factors to consider in rehabilitation using resistance exercise for women with fibromyalgia.

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  • 17. Larsson, Anette
    et al.
    Palstam, Annie
    Sahlgrenska Academy, University of Gothenburg.
    Löfgren, Monika
    Ernberg, Malin
    Bjersing, Jan
    Bileviciute-Ljungar, Indre
    Gerdle, Björn
    Kosek, Eva
    Mannerkorpi, Kaisa
    Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia - a randomized controlled trial2015In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 17, article id 161Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Fibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness. Muscle strength in women with FM is reduced compared to healthy women. The aim of this study was to examine the effects of a progressive resistance exercise program on muscle strength, health status, and current pain intensity in women with FM.

    METHODS: A total of 130 women with FM (age 22-64 years, symptom duration 0-35 years) were included in this assessor-blinded randomized controlled multi-center trial examining the effects of progressive resistance group exercise compared with an active control group. A person-centred model of exercise was used to support the participants' self-confidence for management of exercise because of known risks of activity-induced pain in FM. The intervention was performed twice a week for 15 weeks and was supervised by experienced physiotherapists. Primary outcome measure was isometric knee-extension force (Steve Strong®), secondary outcome measures were health status (FIQ total score), current pain intensity (VAS), 6MWT, isometric elbow-flexion force, hand-grip force, health related quality of life, pain disability, pain acceptance, fear avoidance beliefs, and patient global impression of change (PGIC). Outcomes were assessed at baseline and immediately after the intervention. Long-term follow up comprised the self-reported questionnaires only and was conducted after 13-18 months. Between-group and within-group differences were calculated using non-parametric statistics.

    RESULTS: Significant improvements were found for isometric knee-extension force (p = 0.010), health status (p = 0.038), current pain intensity (p = 0.033), 6MWT (p = 0.003), isometric elbow flexion force (p = 0.02), pain disability (p = 0.005), and pain acceptance (p = 0.043) in the resistance exercise group (n = 56) when compared to the control group (n = 49). PGIC differed significantly (p = 0.001) in favor of the resistance exercise group at post-treatment examinations. No significant differences between the resistance exercise group and the active control group were found regarding change in self-reported questionnaires from baseline to 13-18 months.

    CONCLUSIONS: Person-centered progressive resistance exercise was found to be a feasible mode of exercise for women with FM, improving muscle strength, health status, and current pain intensity when assessed immediately after the intervention.

    TRIAL REGISTRATION: ClinicalTrials.gov identification number: NCT01226784, Oct 21, 2010.

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  • 18. Lundgren-Nilsson, Åsa
    et al.
    Dencker, Anna
    Palstam, Annie
    Sahlgrenska Academy, University of Gothenburg.
    Person, Gert
    Horton, Mike C
    Escorpizo, Reuben
    Küçükdeveci, Ayse A
    Kutlay, Sehim
    Elhan, Atilla H
    Conaghan, Philip G
    Patient-reported outcome measures in osteoarthritis: a systematic search and review of their use and psychometric properties.2018In: RMD Open, E-ISSN 2056-5933, Vol. 4, no 2, article id e000715Article in journal (Refereed)
    Abstract [en]

    Introduction: Patient-reported outcome measures (PROM) or self-completed questionnaires have been used to report outcomes in osteoarthritis (OA) for over 35 years. Choices will always need to be made about what should be measured and, if relevant, what would be the most appropriate PROM to use. The current study aims to describe the available PROMs used in OA and their performance quality, so that informed choices can be made about the most appropriate PROM for a particular task.

    Methods: The study included a systematic search for PROMs that have been in use over 17 years (period 2000-2016), and to catalogue their psychometric properties, and to present the evidence in a user-friendly fashion.

    Results: 78 PROMs were identified with psychometric evidence available. The domains of pain, self-care, mobility and work dominated, whereas domains such as cleaning and laundry and leisure, together with psychological and contextual factors, were poorly served. The most frequently used PROMs included the Western Ontario McMaster Osteoarthritis Index, the Short Form 36 and the Knee Disability and Osteoarthritis Outcome Score which, between them, appeared in more than 4000 papers. Most domains had at least one PROM with the highest level of psychometric evidence.

    Conclusion: A broad range of PROMs are available for measuring OA outcomes. Some have good psychometric evidence, others not so. Some important psychological areas such as self-efficacy were poorly served. The study provides a current baseline for what is available, and identifies the shortfall in key domains if the full biopsychosocial model is to be explored.

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  • 19.
    Palstam, Annie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Andersson, Mathias
    Dalarna University, School of Education, Health and Social Studies, Care Sciences. Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Grenholm, Anton
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Sustainable development in the physiotherapy masters program at Dalarna University in Sweden2020Conference paper (Refereed)
    Abstract [en]

    Background: The transition towards a sustainable society is urgently needed, and needs to be implemented in all sectors of society. The Swedish Higher Education Act states that sustainable development (SD) should be promoted in the activities of the Swedish universities. However, a national investigation has found that the majority of institutions for higher education in Sweden have difficulties to fulfil the criteria for SD. We here describe our ongoing work to integrate SD in the curriculum of the physiotherapy masters program at Dalarna University.

    Methods: The physiotherapy masters program has made efforts to include all three dimensions of SD in the curriculum. We have analyzed the connections between SD and physiotherapy and, based on this analysis, attempted to approach issues of conventional physiotherapy from the perspective of SD.

    Results: SD is now included in the curriculum of three courses in the program. The first course provides an introduction to the UN's Sustainable Development Goals, this by having students choose two goals and relate those to their chosen subject in an essay assignment with focus on clinical pain. The second course concerns physical activity and exercise, also including a wider societal perspective. Through lectures, literature and a seminar, issues relating to lifestyle changes, public health promotion, and the role of physiotherapy for SD within these areas are discussed. The third course contains an assignment in project planning, were students are asked to argue for the relations between the research project and SD. Results from student evaluations are yet to be analysed.

    Discussion: Great effort has been put in to the implementation of SD in the curriculum resulting in specific learning objectives and assignments. After three years, SD is included in in three out of four courses. We have yet to evaluate in which ways SD is best implemented in the curricular activities.

    Conclusion: It is possible to include social-, economic, and ecological sustainability in physiotherapy education. In which ways SD is best implemented in the curricular activities is yet to be evaluated.

  • 20.
    Palstam, Annie
    et al.
    Dalarna University, School of Health and Welfare, Medical Science. University of Gothenburg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Andersson, Mathias
    Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Sport and Health Science. Smärtrehabilitering Säter/Smärtmottagning Falun, Region Dalarna.
    Lange, Elvira
    Grenholm, Anton
    Dalarna University, School of Health and Welfare, Medical Science.
    A Call to Include a Perspective of Sustainable Development in Physical Therapy Research2021In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 101, no 3, article id pzaa228Article in journal (Refereed)
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  • 21.
    Palstam, Annie
    et al.
    Sahlgrenska Academy, University of Gothenburg.
    Bjersing, Jan L
    Mannerkorpi, Kaisa
    Which aspects of health differ between working and nonworking women with fibromyalgia? A cross-sectional study of work status and health.2012In: BMC Public Health, E-ISSN 1471-2458, Vol. 12, article id 1076Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Women with fibromyalgia (FM) describe great difficulties in managing work. Reported work ability in women with FM varies from 34 to 77 percent in studies from different countries. Many factors are suggested to affect the ability to work in women with FM, including pain, fatigue, impaired physical capacity and activity limitations. However, it is difficult to define to which extent symptom severity can be compatible with work. The aim of this study was to investigate which aspects of health differ between working women with FM and nonworking women with FM.

    METHODS: A cross-sectional study of 129 women of working age with FM which included clinical assessment, structured interviews, questionnaires and performance-based tests. The women were categorized as working or nonworking. Aspects of health are presented according to the International Classification of Functioning, Disability and Health (ICF).

    RESULTS: Working women with FM presented better health than nonworking women with FM in ratings of body function (FIQ pain p < 0.001, FIQ fatigue p = 0.006, FIQ stiffness p = 0.009, HADS-Depression p = 0.007). Ratings of overall health status were also significantly better in working women with FM than in nonworking women with FM (FIQ total, eight-item p = 0.001 and SF-36 PCS p < 0.001). No significant differences were found between working- and nonworking women in tests of physical capacity. FIQ pain was an independent explanatory factor for work in stepwise multiple logistic regression analysis (OR 0.95, CI 0.93- 0.98), p < 0.001.

    CONCLUSION: Working women with FM reported better health than nonworking women with FM in terms of pain, fatigue, stiffness, depression, disease specific health status and physical aspects of quality of life, which represent body functions and overall health status. However, they were equally impaired in tests of physical capacity. Moderate pain levels were compatible with work, while severe pain appeared to compromise work. Fatigue was better tolerated, as women scoring severe levels of fatigue worked.

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  • 22.
    Palstam, Annie
    et al.
    Sahlgrenska Academy, University of Gothenburg.
    Gard, Gunvor
    Mannerkorpi, Kaisa
    Factors promoting sustainable work in women with fibromyalgia.2013In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 35, no 19, p. 1622-1629Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To examine and describe the factors promoting sustainable work in women with fibromyalgia (FM).

    METHODS: A qualitative interview study. Twenty-seven gainfully employed women with FM participated in five focus group interviews. Their median age was 52 years, ranging from 33 to 62. The interviews were recorded, transcribed verbatim and analysed by qualitative latent content analysis.

    RESULTS: Four categories were identified describing factors promoting sustainable work: the meaning of work and individual strategies were individual promoters while a favourable work environment and social support outside work were environmental promoters. The meaning of work included individual meaning and social meaning. The individual strategies included handling symptoms, the work day and long-term work life. A favourable work environment included the physical and psychosocial work environment. Social support outside work included societal and private social supports.

    CONCLUSIONS: Promoting factors for work were identified, involving individual and environmental factors. These working women with FM had developed advanced well-functioning strategies to enhance their work ability. The development of such strategies should be supported by health-care professionals as well as employers to promote sustainable work in women with FM.

    IMPLICATIONS FOR REHABILITATION: Work disability is a common consequence of fibromyalgia (FM). Working women with FM appear to have developed advanced well-functioning individual strategies to enhance their work ability. The development of individual strategies should be supported by health-care professionals as well as employers to promote sustainable work and health in women with FM.

  • 23.
    Palstam, Annie
    et al.
    Dalarna University, School of Health and Welfare, Medical Science. Sahlgrenska akademin, Göteborgs universitet/Sahlgrenska universitetssjukhuset.
    Grenholm, Anton
    Dalarna University, School of Health and Welfare, Medical Science.
    Andersson, Mathias
    Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Sport and Health Science. Smärtrehabilitering Säter/Smärtmottagning Falun, Region Dalarna.
    Lange, Elvira
    Sektionen för fysioterapi, avdelningen för hälsa och rehabilitering, Institutionen för neurovetenskap och fysiologi, Sahlgrenska akademin, Göteborgs universitet.
    Fysioterapi och hållbar utveckling: Hänger det ihop – och varför behöver vi engagera oss?2021In: Fysioterapi, ISSN 1653-5804, no 4, p. 38-44Article in journal (Other academic)
    Abstract [sv]

    Klimatförändringarna utgör det största hotet mot folkhälsan under detta århundrade, något som förväntasbåde öka och förändra den framtida belastningen på hälso- och sjukvården. Samtidigt bidrar hälso- ochsjukvården genom sin egen verksamhet till en betydande del av samhällets miljöbelastning. Ytterligare enkoppling mellan miljö och hälsa är att många förändringar som syftar till att minska miljöbelastningen samtidigtmedför vinster för folkhälsan. Sammantaget medför dessa samband att hälso- och sjukvården har en mycketcentral roll i omställningen mot hållbar utveckling. I detta sammanhang har fysioterapin unika och specifikamöjligheter att bidra, något som bör medvetandegöras, utvärderas och kommuniceras. Denna artikel tar uppbegreppet hållbar utveckling i relation till fysioterapi och föreslår samtidigt en riktning för fortsatt reflektion därfysioterapin har möjligheten att stärkas som en ledande aktör i omställningen mot framtidens hälso- ochsjukvård.

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  • 24.
    Palstam, Annie
    et al.
    Sahlgrenska Academy, University of Gothenburg.
    Larsson, Anette
    Bjersing, Jan
    Löfgren, Monika
    Ernberg, Malin
    Bileviciute-Ljungar, Indre
    Ghafouri, Bijar
    Sjörs, Anna
    Larsson, Britt
    Mannerkorpi, Kaisa
    Perceived exertion at work in women with fibromyalgia: explanatory factors and comparison with healthy women.2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 8, p. 773-80Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate perceived exertion at work in women with fibromyalgia.

    DESIGN: A controlled cross-sectional multi-centre study.

    SUBJECTS AND METHODS: Seventy-three women with fibromyalgia and 73 healthy women matched by occupation and physical workload were compared in terms of perceived exertion at work (0-14), muscle strength, 6-min walk test, symptoms rated by Fibromyalgia Impact Questionnaire (FIQ), work status (25-100%), fear avoidance work beliefs (0-42), physical activity at work (7-21) and physical workload (1-5). Spearman's correlation coefficient and linear regression analysis were conducted.

    RESULTS: Perceived exertion at work was significantly higher in the fibromyalgia group than in the reference group (p = 0.002), while physical activity at work did not differ between the groups. Physical capacity was lower and symptom severity higher in fibromyalgia compared with references (p < 0.05). In fibromyalgia, perceived exertion at work showed moderate correlation with physical activity at work, physical workload and fear avoidance work beliefs (rs = 0.53-0.65, p < 0.001) and a fair correlation with anxiety (rs = 0.26, p = 0.027). Regression analysis indicated that the physical activity at work and fear avoidance work beliefs explained 50% of the perceived exertion at work.

    CONCLUSION: Women with fibromyalgia perceive an elevated exertion at work, which is associated with physical work-related factors and factors related to fear and anxiety.

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  • 25.
    Palstam, Annie
    et al.
    Sahlgrenska Academy, University of Gothenburg.
    Larsson, Anette
    Löfgren, Monika
    Ernberg, Malin
    Bjersing, Jan
    Bileviciute-Ljungar, Indre
    Gerdle, Björn
    Kosek, Eva
    Mannerkorpi, Kaisa
    Decrease of fear avoidance beliefs following person-centered progressive resistance exercise contributes to reduced pain disability in women with fibromyalgia: secondary exploratory analyses from a randomized controlled trial2016In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 18, no 1, article id 116Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Fibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness. Women with FM also report disability, in terms of negative consequences on activities of daily living. Our recent randomized controlled trial (RCT) is the first study of resistance exercise to show positive effects on pain disability. The resistance exercise program of our RCT emphasized active involvement of participants in planning and progression of the exercise, using the principles of person-centeredness, to support each participant's ability to manage the exercise and the progress of it. The aim of this sub-study was to investigate explanatory factors for reduced pain disability in women with FM participating in a 15-week person-centered progressive resistance exercise program.

    METHODS: A total of 67 women with FM were included in this sub-study of an RCT examining the effects of person-centered progressive resistance exercise performed twice a week for 15 weeks. Tests of physical capacity and health-related questionnaires were assessed at baseline and after the intervention period. Multivariable stepwise regression was used to analyze explanatory factors for improvements in pain disability.

    RESULTS: Reduced pain disability was explained by higher pain disability at baseline together with decreased fear avoidance beliefs about physical activity (R (2) = 28, p = 0.005). The improvements in the disability domains of recreation and social activity were explained by decreased fear avoidance beliefs about physical activity together with higher baseline values of each disability domain respectively (R (2) = 32, p = 0.025 and R (2) = 30, p = 0.017). The improvement in occupational disability was explained by higher baseline values of occupational disability (R (2) = 19, p = 0.001).

    CONCLUSION: The person-centered resistance exercise intervention, based on principles of self-efficacy, had a positive effect on recreational, social and occupational disability. The reduced pain disability seemed to be mediated by decreased fear avoidance beliefs. Age, symptom duration, pain intensity, and muscle strength at baseline had no explanatory value for reduced pain disability, indicating that the person-centered resistance exercise program has the potential to work for anyone with FM who has interest in physical exercise. The trial was registered on October 21, 2010 with ClinicalTrials.gov identification number: NCT01226784 .

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  • 26.
    Palstam, Annie
    et al.
    Sahlgrenska Academy, University of Gothenburg.
    Mannerkorpi, Kaisa
    Work ability in fibromyalgia: an update in the 21st century2017In: Current Rheumatology Reviews, ISSN 1573-3971, E-ISSN 1875-6360, Vol. 13, no 3, p. 180-187Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Fibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness. People with FM also report activity limitations and impaired work ability.

    OBJECTIVE: This article aims to compile the findings of recently published research on work ability in people with fibromyalgia, and to present how work ability is influenced by various aspects.

    METHODS: A systematic search of the literature published from the year 2000 and onwards was conducted. Thirtyfour articles were included in the review.

    RESULT: Symptom severity was found to influence work ability in people with FM. Physically demanding jobs and work tasks were especially troublesome and were reported to constitute higher risks pof work disability. Working people with FM seemed to hold a careful balancing act to manage the risk of overload where well-functioning strategies such as making a career change, working part-time, and developing personal skills were necessary for managing work, in the short- and long term. The support of management and colleagues enabled people with FM to manage the risk of overload at work. Treatment studies evaluating work disability as outcome in FM are scarce. None of the included studies presented any effects on measures of sick-leave or work disability compared with a control group.

    CONCLUSION: More studies of treatment effects on outcomes related to work ability in people with FM, and more longitudinal studies to explore long-term effects of symptoms on work ability and sick leave, are needed in order to be able to plan evidence based rehabilitation to improve or maintain work ability in people with FM.

  • 27.
    Palstam, Annie
    et al.
    Dalarna University, School of Health and Welfare, Medical Science. Sahlgrenska Academy, University of Gothenburg.
    Sehdev, Simran
    Barna, Stefi
    Andersson, Mathias
    Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Sport and Health Science.
    Liebenberg, Nina
    Sustainability in physiotherapy and rehabilitation2022In: Orthopaedics and Trauma, ISSN 1877-1327, Vol. 36, no 5, p. 279-283Article in journal (Refereed)
  • 28.
    Palstam, Annie
    et al.
    Dalarna University, School of Health and Welfare, Medical Science. Sahlgrenska Academy, University of Gothenburg, Göteborg; Sahlgrenska University Hospital, Göteborg.
    Seljelid, Johanna
    Sahlgrenska Academy, University of Gothenburg, Göteborg.
    Persson, Hanna Charlotte
    Sahlgrenska Academy, University of Gothenburg, Göteborg; Sahlgrenska University Hospital, Göteborg.
    Sunnerhagen, Katharina S
    Sahlgrenska Academy, University of Gothenburg, Göteborg; Sahlgrenska University Hospital, Göteborg.
    Physical activity, acute severity and long-term consequences of COVID-19: an 18-month follow-up survey based on a Swedish national cohort2024In: BMJ Open, E-ISSN 2044-6055, Vol. 14, no 1, article id e079927Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate how changes in levels of physical activity (PA) in regard to acute disease severity relate to perceived difficulties in performing daily life activities 18 months after COVID-19 infection.

    DESIGN: An observational study with an 18-month follow-up survey based on registry data from a national cohort.

    PARTICIPANTS: 5464 responders to the 18-month follow-up survey of a Swedish national cohort of 11 955 individuals on sick leave due to COVID-19 during the first wave of the pandemic.

    OUTCOMES: The follow-up survey included questions on daily life activities, as well as present and retrospective level of PA. Changes in PA level from before COVID-19 to follow-up were assessed by the Saltin-Grimby PA Level Scale and analysed by the Wilcoxon signed-rank test. Comparisons of groups were analysed by the Student's t-test, Mann-Whitney U test and χ2. Multiple binary logistic regression was performed to assess the association of changes in PA with perceived difficulties in performing daily life activities.

    RESULTS: Among the 5464 responders (45% of national cohort), the PA level decreased. Hospitalised individuals had a lower PA level both prior to COVID-19 (p=0.035) and at the 18-month follow-up (p=0.008) compared with non-hospitalised responders. However, the level of PA decreased in both groups. A decrease in PA level increased the odds (OR 5.58, 95% CI 4.90 to 6.34) of having difficulties performing daily life activities.

    CONCLUSIONS: PA levels were reduced 18 months after COVID-19 infection. A decrease in PA over that time was associated with perceived difficulties performing daily life activities 18 months after COVID-19. As PA is important in maintaining health and deconditioning takes time to reverse, this decline may have long-term implications for PA and health.

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  • 29.
    Palstam, Annie
    et al.
    University of Gothenburg.
    Sjödin, Astrid
    University of Gothenburg.
    Sunnerhagen, Katharina Stibrant
    University of Gothenburg.
    Participation and autonomy five years after stroke: A longitudinal observational study.2019In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 7, article id e0219513Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Stroke is the second most common cause of disability in the world. The purpose of this study was to evaluate the participation and autonomy of persons with stroke, five years after a stroke, and to explore potential associations between factors and perceived restrictions in participation and autonomy.

    METHODS: This five-year follow-up survey study included individuals diagnosed with a first-time stroke during 2009-2010, in Gothenburg. The survey included the Impact of Participation and Autonomy-questionnaire (IPA-E), which comprised five domains: Autonomy Indoor, Family Role, Autonomy Outdoor, Work & Education, and Social Life & Relationships. Logistic regression analyses were used to analyze factors associated with participation restrictions.

    RESULTS: At 5 years after a stroke, 457 patients were alive; of these, 281 responded to the follow-up survey. Participation restrictions were most pronounced in the IPA-E domains of Autonomy Outdoors, Work/Education, and Social Life and Relationships. In contrast, restrictions were less pronounced in the IPA-E domains of Autonomy Indoors and Family Role. Severe stroke, older age, and female sex predicted participation restrictions at five years after a stroke. Participation restrictions were partly explained by feelings of depression at five years after stroke. Problems associated with participation restrictions were most frequently observed in the areas of mobility, leisure, and help/support from other people.

    CONCLUSION: This study showed that participation and autonomy were restricted among persons with stroke at five years after the stroke. The domains perceived as most restricted were those that required high levels of physical, social, and cognitive abilities.

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  • 30.
    Palstam, Annie
    et al.
    Sahlgrenska Academy, University of Gothenburg.
    Törnbom, Marie
    Sunnerhagen, Katharina Stibrant
    Experiences of returning to work and maintaining work 7 to 8 years after a stroke: a qualitative interview study in Sweden2018In: BMJ Open, E-ISSN 2044-6055, Vol. 8, no 7, article id e021182Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore how persons experienced return to work (RTW) and their work situation 7 to 8 years after a stroke.

    DESIGN: An explorative qualitative design with individual interviews. The data analysis was inductive thematic and three researchers collaborated during the analysis process.

    PARTICIPANTS: The study population included five women and eight men who had a stroke during 2009-2010, received care at the Sahlgrenska University Hospital in Gothenburg, Sweden and RTW after stroke and it was a heterogenic sample based on age, occupation, stroke severity and time to RTW.

    RESULTS: The analysis led to four themes; motivated and RTW while struggling with impairments, mixed feelings in the RTW process, still at work though restricted and social support for a sustainable work situation. The themes revealed that participants were motivated to RTW while struggling with impairments. The RTW process evoked mixed feelings of worry and grief over lost functions but also acceptance and gratitude for being able to work. Although maintaining work 7 to 8 years after experiencing a stroke, most were restricted in some way. Fatigue and cognitive impairments meant having to set limits, omit work tasks and rest at work, but also rest during free time and refraining from social activities in order to manage work. Participants avoided work-related stress if they could because of aggravated symptoms and/or fear of a new stroke. Support from supervisors and colleagues was often crucial for a sustainable work situation.

    CONCLUSION: Maintaining work can be a continuous struggle with invisible impairments many years after a stroke. Strategies for managing work are dependent on each individual work situation, where support and understanding at work seem to be crucial for a sustainable work situation.

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  • 31.
    Palstam, Annie
    et al.
    The Sahlgrenska Academy, University of Gothenburg.
    Westerlind, Emma
    Persson, Hanna C
    Sunnerhagen, Katharina S
    Work-related predictors for return to work after stroke.2019In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 139, no 4, p. 382-388Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Disability due to stroke imposes a large burden on individuals, and on society, in terms of impaired work ability and sick leave. The reported return to work (RTW) rate after stroke varies globally and is influenced by a range of different aspects. The aim of this study was to investigate the influence of work-related factors on time to RTW after stroke, and possible differences between the sexes.

    MATERIALS & METHODS: Data from 204 persons with first-time stroke in the years 2009-2010 in Gothenburg, Sweden, who were of working age and had worked prior to their stroke, were analysed. Disease-related characteristics were retrieved from medical records, and work-related- and socio-economic data were collected up to 6 years post-stroke from Statistics Sweden and the Swedish Social Insurance Agency. Cox regression was used to analyse predictors for time to RTW.

    RESULTS: We identified qualified occupation and large organizational size as work-related predictors for shorter time to RTW after stroke. Being male predicted a faster and higher frequency of RTW. Qualified occupation predicted shorter time to RTW in men but not in women. For women, the only predictor for RTW was physical dependency at discharge.

    CONCLUSION: Type of work and organizational size are work-related factors of importance for RTW after stroke. Work-related factors were important for RTW in men, but not in women. Reasons for differences between men and women in work-related factors that influence RTW need to be further investigated to better understand how to support women in the RTW process.

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  • 32.
    Palstam, Annie
    et al.
    Sahlgrenska Academy, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Westerlind, Emma
    Sunnerhagen, Katharina S
    Persson, Hanna C
    Recurrent sick leave after COVID-19: investigating the first wave of the pandemic in a comprehensive Swedish registry-based study.2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 1914Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sick-leave due to COVID-19 vary in length and might lead to re-current episodes. The aim was to investigate recurrent sick leave due to COVID-19 during the first wave.

    METHODS: This is a registry-based cohort study. The study comprises all people with sickness benefit due to COVID-19 in Sweden in March 1-August 31, 2020. Data from the Swedish Social Insurance Agency, the Swedish National Board of Health and Welfare, and Statistics Sweden were merged.

    RESULTS: Within the follow-up period of 4 months, 11,955 people were subject to sickness benefit due to COVID-19, whereof 242 people (2.0%) took recurrent sick leave due to COVID-19, and of those 136 (56.2%) remained on sick leave at the end of follow-up. People with recurrent sick leave were older, more often women, and more likely to have been on sick leave prior to the COVID-19 pandemic.

    CONCLUSION: A group of people presented with recurrent sick leave due to COVID-19. For half of them, the second sick leave lasted throughout the follow-up. People with recurrent sick leave differ in several aspects from those with shorter sick leave. To capture long-term sick-leave patterns due to COVID-19, a longer period of follow-up is needed.

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  • 33. Reinholdsson, Malin
    et al.
    Abzhandadze, Tamar
    Palstam, Annie
    Sahlgrenska Academy, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Sunnerhagen, Katharina S
    A register-based study on associations between pre-stroke physical activity and cognition early after stroke (part of PAPSIGOT).2022In: Scientific Reports, E-ISSN 2045-2322, Vol. 12, no 1, article id 5779Article in journal (Refereed)
    Abstract [en]

    The objective was to investigate if pre-stroke physical activity is associated with intact cognition early after stroke. The study design was a cross-sectional, register-based study. The study sample included 1111 adults with first stroke (mild or moderate severity) admitted to three Swedish stroke units. The main outcome was cognition. The associations of pre-stroke physical activity, age, sex, smoking, diabetes, atrial fibrillation, previous TIA, statin treatment, hypertension treatment, reperfusion therapies, stroke severity, and education on the outcome cognition were analyzed using binary logistic regression. Physical activity was assessed within 48 h of admittance, and cognition was screened during stroke unit care. The results were: mean age 70 years, 40% women, 61% pre-stroke physically active, and 53% with post-stroke cognitive impairment. Patients with pre-stroke light or moderate physical activity have higher odds for intact cognition compared to inactive: odds ratio (95% confidence interval) 1.32 (0.97-1.80) and 2.04 (1.18-3.53), respectively. In addition to pre-stroke physical activity, people with younger age, a higher level of education, less severe stroke (more mild than moderate), being non-diabetic, and non-smoking have higher odds for intact cognition. In conclusion physical activity before stroke is associated with intact cognition in patients with mild and moderate stroke.

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  • 34. Reinholdsson, Malin
    et al.
    Herranen, Gisela
    Sunnerhagen, Katharina S
    Palstam, Annie
    Dalarna University, School of Health and Welfare, Medical Science. Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Patient experiences of physical activity and inactivity in the stroke unit: an interview study.2024In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 56, article id jrm19502Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Stroke unit care is highly recommended after stroke, but patients in these units are often physically inactive. The aim of this study was to explore patient experiences of physical activity and inactivity in the stroke unit.

    DESIGN: Qualitative interview study.

    SUBJECTS: Sixteen participants with stroke; a heterogeneous sample with differences in sex, age, and stroke severity from 8 Swedish stroke units.

    METHODS: In-depth interviews 1-2 weeks after discharge analysed using thematic analysis.

    RESULTS: The analysis resulted in three themes: 1: Dealing with the challenges of a changed body while striving to become independent; 2: The stroke unit is crucial for physical activity; and 3: Physical activity is important for interaction with others, autonomy, and feeling seen. Participants described how they coped with a new situation when finding new ways to move and function. In addition, they wanted to be involved in their own stroke rehabilitation.

    CONCLUSION: The participants expressed the following experiences of being in the stroke unit: movement is more important than physical activity and involves being seen and respected; physical activity and exercise are necessary to achieve independence; process involvement is of importance to regain abilities; physical activity offers the possibility of choosing between community and being alone and influences the ability to connect with others and the outside world.

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  • 35. Reinholdsson, Malin
    et al.
    Palstam, Annie
    Sahlgrenska Academy, University of Gothenburg.
    Sunnerhagen, Katharina S
    Prestroke physical activity could influence acute stroke severity (part of PAPSIGOT)2018In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 91, no 16, p. e1461-e1467Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the influence of prestroke physical activity (PA) on acute stroke severity.

    METHODS: Data from patients with first stroke were retrieved from registries with a cross-sectional design. The variables were PA, age, sex, smoking, diabetes, hypertension and statin treatment, stroke severity, myocardial infarction, new stroke during hospital stay, and duration of inpatient care at stroke unit. PA was assessed with Saltin-Grimby's 4-level Physical Activity Level Scale, and stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Logistic regression was used to predict stroke severity, and negative binomial regression was used to compare the level of PA and stroke severity.

    RESULTS: The study included 925 patients with a mean age of 73.1 years, and 45.2% were women. Patients who reported light or moderate PA levels were more likely to present a mild stroke (NIHSS score 0 to 5) compared with physically inactive patients in a model that also included younger age as a predictor (odds ratio = 2.02 for PA and odds ratio = 0.97 for age). The explanatory value was limited at 6.8%. Prestroke PA was associated with less severe stroke, and both light PA such as walking at least 4 h/wk and moderate PA 2-3 h/wk appear to be beneficial. Physical inactivity was associated with increased stroke severity.

    CONCLUSIONS: This study suggests that PA and younger age could result in a less severe stroke. Both light PA such as walking at least 4 h/wk and moderate PA 2-3 h/wk appear to be beneficial.

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  • 36. Tour, Jeanette
    et al.
    Löfgren, Monika
    Mannerkorpi, Kaisa
    Gerdle, Björn
    Larsson, Anette
    Palstam, Annie
    Sahlgrenska Academy, University of Gothenburg.
    Bileviciute-Ljungar, Indre
    Bjersing, Jan
    Martin, Ingvar
    Kosek, Eva
    Gene-to-gene interactions regulate endogenous pain modulation in fibromyalgia patients and healthy controls-antagonistic effects between opioid and serotonin-related genes.2017In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 158, no 7, p. 1194-1203Article in journal (Refereed)
    Abstract [en]

    Chronic pain is associated with dysfunctional endogenous pain modulation, involving both central opioid and serotonergic (5-HT) signaling. Fibromyalgia (FM) is a chronic pain syndrome, characterized by widespread musculoskeletal pain and reduced exercise-induced hypoalgesia (EIH). In this study, we assessed the effects of 3 functional genetic polymorphisms on EIH in 130 patients with FM and 132 healthy controls. Subjects were genotyped regarding the mu-opioid receptor (OPRM1) gene (rs1799971), the serotonin transporter (5-HTT) gene (5-HTTLPR/rs25531), and the serotonin-1a receptor (5-HT1a) gene (rs6296). The patients with FM had increased pain sensitivity and reduced EIH compared with healthy controls. None of the polymorphisms had an effect on EIH on their own. We found significant gene-to-gene interactions between OPRM1 x 5-HTT and OPRM1 x 5-HT1a regarding activation of EIH, with no statistically significant difference between groups. Better EIH was found in individuals with genetically inferred strong endogenous opioid signaling (OPRM1 G) in combination with weak 5-HT tone (5-HTT low/5-HT1a G), compared with strong 5-HT tone (5-HTT high/5-HT1a CC). Based on the proposed mechanisms of these genetic variants, the findings indicate antagonistic interactions between opioid and serotonergic mechanisms during EIH. Moreover, despite different baseline pain level, similar results were detected in FM and controls, not supporting an altered interaction between opioid and 5-HT mechanisms as the basis for dysfunction of EIH in patients with FM. In summary, our results suggest that, by genetic association, the mu-opioid receptor interacts with 2 major serotonergic structures involved in 5-HT reuptake and release, to modulate EIH.

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  • 37. Törnbom, K.
    et al.
    Larsson, A.
    Sunnerhagen, K. S.
    Palstam, Annie
    Dalarna University, School of Health and Welfare, Medical Science. Sahlgrenska Academy, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg; .
    Persson, H. C.
    Understanding concerns after severe COVID-19: A self-imposed lockdown guarded by anxiety?2023In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Many people are struggling to get back to their lives after severe COVID-19. To facilitate their reintegration into everyday life, we need to understand how the process is experienced. We aimed to gain deeper knowledge about this process by interviewing persons one year after hospitalisation due to COVID-19. METHODS: The study is based on a qualitative design, with eleven in-depth interviews conducted one year after discharge for COVID-19. Participants were recruited to form a heterogeneous sample with respect to age, gender and socioeconomic background. All interviews were analysed utilising inductive thematic analysis. RESULTS: From the participants' narratives four themes were identified: 'Concerns and worries in everyday life', 'Supportive and concerned relatives', 'A new way of life-sorrows and advantages' and 'Seize the day-a greater awareness of one´s mortality'. Participants described how they tried to create a functioning everyday life. They were generally afraid of getting COVID-19 again and concerned about future life, where their lack of energy played a major role. Narratives were diverse regarding to what extent the struggle to cope was experienced as emotionally challenging or not. CONCLUSIONS: Participants described an unpredictable recovery after COVID-19, characterised by ups and downs, which created worries concerning their future. In some cases, the worry of getting COVID-19 again was strong enough to keep participants in their homes, as a self-imposed lockdown guarded by anxiety. However, the narratives also revealed gratitude towards being alive and having coped so well. This led to a more positive outlook on life with a greater focus on intrinsic values, close social relations and the deeper meaning of life. Copyright: © 2023 Törnbom et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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  • 38.
    Törnbom, Karin
    et al.
    University of Gothenburg.
    Engwall, Marie
    University of Gothenburg; University West, Trollhattan.
    Persson, Hanna C
    University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Palstam, Annie
    Dalarna University, School of Health and Welfare, Medical Science. University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Back to life: Is it possible to be myself again? A qualitative study with persons initially hospitalised due to COVID-19.2022In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 54, article id jrm00327Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To gain a deeper understanding of the lived experiences of patients with COVID-19, regarding rehabilitation, work and social life 6 months after hospital discharge.

    DESIGN: An explorative qualitative study with individual interviews.

    SUBJECTS: Patients of working age with persistent self-reported symptoms at a 3-month follow-up who had received inpatient hospital care with discharge approximately 6 months previously were purposively sampled.

    METHODS: Semi-structured interviews were performed with 10 men and 5 women. The interviews were transcribed verbatim and analysed with inductive thematic analysis.

    RESULTS: Four themes were identified: "Social support - crucial, but decreased over time", "Varying needs of, and access to, rehabilitation", "Returning to work after COVID-19 - crucial for future prospects" and "An overwhelming experience that essentially changed one's personality".

    CONCLUSION: Rehabilitation provided participants with the valuable tools for recovery, giving them hope for future recovery. Support from next of kin was highly valued, creating stronger family bonds. A new meaning and greater appreciation of life was expressed.

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  • 39.
    Törnbom, Karin
    et al.
    University of Gothenburg.
    Lundälv, Jörgen
    University of Gothenburg.
    Palstam, Annie
    University of Gothenburg.
    Sunnerhagen, Katharina S
    University of Gothenburg.
    "My life after stroke through a camera lens"- A photovoice study on participation in Sweden.2019In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 9, article id e0222099Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: An increasing number of people with stroke live in their communities, yet the understanding of how their reintegration into society can best be facilitated is incomplete. If needs are not sufficiently met and difficulties overcome, it may result in limited participation and decreased life satisfaction for this group. We aimed to understand life after stroke through the lens of participants' cameras, and hence their views and experiences guided this study.

    METHODS: By the means of photovoice, an action research method, this study was conducted in a collaborative format with six women and five men after stroke. Participants photographed in everyday life for up to four weeks and then met to discuss all images in a focus group setting. Subsequently, participants gave feedback on the method and discussed the upcoming photography exhibition. All photos and the three focus group discussions were analyzed using a thematic analysis with an inductive approach.

    RESULTS: In the focus group discussions, life after stroke were conceptualized through five main themes: a driving force to participate in society; managing everyday life through inventiveness and persistent training; insufficient healthcare and rehabilitation in the long-term perspective; finding meaningful relationships and activities in daily life. Participants' voices are made clear through selected photos, which aim to present each theme and make results easier to understand.

    CONCLUSIONS: Participants found new ways to approach everyday life situations and had thereby regained a sense of control in life. However, it was evident that psychological processes towards adaptation were hindered by depression and that some individuals felt alone in an ongoing struggle. Additionally, available interventions a long time after stroke were not flexible enough to address all participants' needs.

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  • 40.
    Viktorisson, Adam
    et al.
    Sahlgrenska Academy, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Buvarp, Dongni
    Sahlgrenska Academy, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Reinholdsson, Malin
    Sahlgrenska Academy, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Danielsson, Anna
    Sahlgrenska Academy, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Palstam, Annie
    Dalarna University, School of Health and Welfare, Medical Science.
    Sunnerhagen, Katharina Stibrant
    Sahlgrenska Academy, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Associations of Prestroke Physical Activity With Stroke Severity and Mortality After Intracerebral Hemorrhage Compared to Ischemic Stroke2022In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 99, no 19, p. e2137-e2148, article id 10.1212/WNL.0000000000201097Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Pre-stroke physical activity may protect the brain from severe consequences of stroke. However, prior studies on this subject included mainly ischemic stroke cases, and the association between pre-stroke physical activity and outcomes after intracerebral hemorrhage is uncertain. Therefore, we sought to examine the associations between pre-stroke physical activity, stroke severity, and all-cause mortality after intracerebral hemorrhage in comparison to ischemic stroke.

    METHODS: This was a longitudinal, register-based, cohort study. All adult patients with intracerebral hemorrhage or ischemic stroke admitted to three stroke units in Gothenburg, Sweden between 1 November 2014 and 30 June 2019 were screened for inclusion. Physical activity was defined as light physical activity ≥4 h/week, or moderate physical activity ≥2 h/week the year before stroke. Stroke severity was assessed on admission using the National Institutes of Health Stroke Scale. All-cause mortality rates were followed up to 7 years, from the time of incident stroke until death or censoring. Ordinal logit models and Cox proportional-hazards models were used to estimate adjusted associations of pre-stroke physical activity.

    RESULTS: We included 763 patients with intracerebral hemorrhage and 4225 with ischemic stroke. Pre-stroke physical activity was associated with less severe strokes by an adjusted odds ratio of 3.57 (99% CI, 2.35-5.47) for intracerebral hemorrhages and 1.92 (99% CI 1.59-2.33) for ischemic strokes. During a median follow-up of 4.7 (IQR 3.5-5.9) years, 48.5% of patients with intracerebral hemorrhage died, compared to 37.5% with ischemic stroke. Pre-stroke physical activity was associated with decreased short-term mortality (0 to 30 days) by an adjusted hazard ratio of 0.30 (99% CI 0.17-0.54) after intracerebral hemorrhage, and 0.22 (99% CI 0.13-0.37) after ischemic stroke. Pre-stroke physical activity was further associated with decreased long-term mortality (30 days to 2 years) by an adjusted hazard ratio of 0.40 (99% CI 0.21-0.77) after intracerebral hemorrhage, and 0.49 (99% CI 0.38-0.62) after ischemic stroke.

    DISCUSSION: Pre-stroke physical activity was associated with decreased stroke severity and all-cause mortality after intracerebral hemorrhage and ischemic stroke, independent of other risk factors. Based on current knowledge, health care professionals should promote physical activity as part of primary stroke prevention.

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  • 41. Viktorisson, Adam
    et al.
    Reinholdsson, Malin
    Danielsson, Anna
    Palstam, Annie
    Institute of neuroscience and physiology, Gothenburg University.
    Sunnerhagen, Katharina S.
    Pre-stroke physical activity in relation to post-stroke outcomes - linked to the International Classification of Functioning, Disability and Health (ICF): A scoping review2021In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This scoping review aims to identify how pre-stroke physical activity (PA) has been studied in relation to outcomes after stroke using the ICF framework.

    METHODS: MEDLINE, CINAHL, Scopus, and grey literature databases were systematically searched from inception to March 15, 2021, with no language restrictions. Risk of bias was evaluated for all included studies. Identified outcome measures were linked to ICF components using linking rules, and the main findings were summarized.

    RESULTS: Of 3664 records screened, 35 studies were included. The risk of bias was graded as moderate to critical for all studies. There were 60 unique outcome measures studied in relation to pre-stroke PA, covering the hyper acute to chronic phases of stroke recovery. Outcome measures linked to body functions were most common (n=19), followed by activities and participation (n=14), body structures (n=7), environmental factors (n=4) and personal factors (n=2). There were large differences in assessments of pre-stroke PA, and only one study analysed haemorrhagic cases separately.

    CONCLUSIONS: Pre-stroke PA has been studied in relation to all components in the ICF framework.  However, this review highlights the high risk of bias, heterogeneity in pre-stroke PA assessments, and the lack of information regarding haemorrhagic strokes in the current literature.

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  • 42. Westerlind, Emma
    et al.
    Palstam, Annie
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Sunnerhagen, Katharina S
    Persson, Hanna C
    Patterns and predictors of sick leave after Covid-19 and long Covid in a national Swedish cohort.2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 1023Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The impact of Covid-19 and its long-term consequences is not yet fully understood. Sick leave can be seen as an indicator of health in a working age population, and the present study aimed to investigate sick-leave patterns after Covid-19, and potential factors predicting longer sick leave in hospitalised and non-hospitalised people with Covid-19.

    METHODS: The present study is a comprehensive national registry-based study in Sweden with a 4-month follow-up. All people who started to receive sickness benefits for Covid-19 during March 1 to August 31, 2020, were included. Predictors of sick leave ≥1 month and long Covid (≥12 weeks) were analysed with logistic regression in the total population and in separate models depending on inpatient care due to Covid-19.

    RESULTS: A total of 11,955 people started sick leave for Covid-19 within the inclusion period. The median sick leave was 35 days, 13.3% were on sick leave for long Covid, and 9.0% remained on sick leave for the whole follow-up period. There were 2960 people who received inpatient care due to Covid-19, which was the strongest predictor of longer sick leave. Sick leave the year prior to Covid-19 and older age also predicted longer sick leave. No clear pattern of socioeconomic factors was noted.

    CONCLUSIONS: A substantial number of people are on sick leave due to Covid-19. Sick leave may be protracted, and sick leave for long Covid is quite common. The severity of Covid-19 (needing inpatient care), prior sick leave, and age all seem to predict the likelihood of longer sick leave. However, no socioeconomic factor could clearly predict longer sick leave, indicating the complexity of this condition. The group needing long sick leave after Covid-19 seems to be heterogeneous, indicating a knowledge gap.

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  • 43. Westerlind, Emma
    et al.
    Persson, Hanna C
    Palstam, Annie
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Eriksson, Marie
    Norrving, Bo
    Sunnerhagen, Katharina S
    Differences in self-perceived general health, pain, and depression 1 to 5 years post-stroke related to work status at 1 year.2020In: Scientific Reports, E-ISSN 2045-2322, Vol. 10, no 1, article id 13251Article in journal (Refereed)
    Abstract [en]

    Stroke is one of the most common diseases and has several potential consequences, such as psychological problems and pain. Return to work (RTW) after stroke in working-age individuals is incomplete. The present study aimed to investigate differences in self-perceived general health, pain, and depression between 1 and 5 years post-stroke related to RTW status. The study was nationwide, registry-based and the study population (n = 398) consisted of working-age people who had a stroke in 2011 and participated in 1-year and 5-year follow-up questionnaire surveys. Shift analyses with the Wilcoxon signed rank test and logistic regression were used. RTW within the first year post-stroke was associated with better self-perceived general health, less pain, and less depression both at 1 and 5 years post-stroke, compared with the no-RTW group. However, the RTW group had significant deterioration in general health and pain between 1 and 5 years, while the no-RTW group had no significant change. RTW was a significant predictor of lower odds of improvement in general health and pain between 1 and 5 years. This emphasizes the need for continued follow-up and support to ensure a balance between work and health for RTW individuals after stroke.

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