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  • 101.
    Gutke, Annelie
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Olsson, Christina B.
    Stockholm County Council, Sweden Karolinska Institute, Sweden .
    Vollestad, Nina
    Oslo University, Norway.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Nilsson Wikmar, Lena
    Karolinska Institute, Sweden .
    Stendal Robinson, Hilde
    University of Oslo, Norway .
    ASSOCIATION BETWEEN LUMBOPELVIC PAIN, DISABILITY AND SICK LEAVE DURING PREGNANCY - A COMPARISON OF THREE SCANDINAVIAN COHORTS2014Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, nr 5, s. 468-474Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore the association between disability and sick leave due to lumbopelvic pain in pregnant women in 3 cohorts in Sweden and Norway and to explore possible factors of importance to sick leave. A further aim was to compare the prevalence of sick leave due to lumbopelvic pain. Design/subjects: Pregnant women (n=898) from two cohorts in Sweden and one in Norway answered to questionnaires in gestational weeks 10-24; two of the cohorts additionally in weeks 28-38. Methods: Logistic regression models were performed with sick leave due to lumbopelvic pain as dependent factor. Disability, pain, age, parity, cohort, civilian status, and occupational classification were independents factors. Results: In gestational weeks 10-24 the regression model included 895 cases; 38 on sick leave due to lumbopelvic pain. Disability, pain and cohort affiliation were associated with sick leave. In weeks 28-38, disability, pain and occupation classification were the significant factors. The prevalence of lumbopelvic pain was higher in Norway than in Sweden (65%, vs 58% and 44%; pless than0.001). Conclusion: Disability, pain intensity and occupation were associated to sick leave due to lumbopelvic pain. Yet, there were significant variations between associated factors among the cohorts, suggesting that other factors than workability and the social security system are also of importance.

  • 102.
    Gutke, Annelie
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Sjödahl, Jenny
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Folkhälsovetenskapligt centrum.
    Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial2010Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, nr 10, s. 929-935Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To investigate the efficacy of home-based specific stabilizing exercises focusing on the local stabilizing muscles as the only intervention in the treatment of persistent postpartum pelvic girdle pain (PGP).

    Design: A prospective, randomized, single-blinded, clinically controlled study.

    Subjects: Eighty-eight women with PGP were recruited 3 months after delivery.

    Methods: The treatment consisted of specific stabilizing exercises targeting the local trunk muscles. The reference group had one telephone contact with a physiotherapist. Primary outcome was disability measured with Oswestry Disability Index. Secondary outcomes were pain, health-related quality of life (EQ-5D), symptom satisfaction, and muscle function.

    Results: No significant differences between groups could be found at 3- or 6-month follow-up regarding primary outcome in disability. Within-group comparisons showed some improvement in both groups in terms of disability, pain, symptom satisfaction and muscle function compared to baseline although the majority still experienced PGP.

    Conclusion: Treatment with this home-training concept of specific stabilizing exercises targeting the local muscles was no more effective in improving consequences of persistent postpartum PGP than the clinically natural course. Regardless of treatment with specific stabilizing exercises or not, the majority still experiences some back pain almost a year after pregnancy.

  • 103.
    Gutke, Annelie
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Östgaard, Hans Christian
    Sahlgrenska University.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Association between muscle function and low back pain in relation to pregnancy2008Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, nr 4, s. 304-311Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To investigate the association of muscle function and subgroups of low back pain (no low back pain, pelvic girdle pain, lumbar pain and combined pelvic girdle pain and lumbar pain) in relation to pregnancy.

    Design: Prospective cohort study.

    Subjects: Consecutively enrolled pregnant women seen in gestational weeks 12–18 (n = 301) and 3 months postpartum (n = 262).

    Methods: Classification into subgroups by means of mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history and a pain drawing. Trunk muscle endurance, hip muscle strength (dynamometer) and gait speed were investigated.

    Results: In pregnancy 116 women had no low back pain, 33% (n = 99) had pelvic girdle pain, 11% (n = 32) had lumbar pain and 18% (n = 54) had combined pelvic girdle pain and lumbar pain. The prevalence of pelvic girdle pain/combined pelvic girdle pain and lumbar pain decreased postpartum, whereas the prevalence of lumbar pain remained stable. Women with pelvic girdle pain and/or combined pelvic girdle pain and lumbar pain had lower values for trunk muscle endurance, hip extension and gait speed as compared to women without low back pain in pregnancy and postpartum (p < 0.001–0.04). Women with pelvic girdle pain throughout the study had lower values of back flexor endurance compared with women without low back pain.

    Conclusion: Muscle dysfunction was associated with pelvic girdle pain, which should be taken into consideration when developing treatment strategies and preventive measures.

  • 104.
    Hagel, Sofia
    et al.
    Department of Clinical Sciences in Lund, Section of Rheumatology & Orthopaedics, Lund University & Skane University Hospital, Lund, Sweden.
    Lindqvist, Elisabet
    Department of Clinical Sciences in Lund, Section of Rheumatology & Orthopaedics, Lund University & Skane University Hospital, Lund, Sweden.
    Petersson, Ingemar F
    Department of Clinical Sciences in Lund, Section of Rheumatology & Orthopaedics, Lund University & Skane University Hospital, Lund, Sweden.
    Meesters, Jorit J L
    Department of Rheumatology, Department of Physical Therapy, Leiden University Medical Center, Leiden, Netherlands & National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway .
    Klokkerud, Mari
    National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway .
    Aanerud, Gerd J
    National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway .
    Stovgaard, Inger H
    King Christian Xth Hospital for Rheumatic Diseases, University of Southern Denmark, Gråsten, Denmark.
    Hørslev-Petersen, Kim
    King Christian Xth Hospital for Rheumatic Diseases, University of Southern Denmark, Gråsten, Denmark.
    Strömbeck, Britta
    Department of Clinical Sciences in Lund, Orthopaedics, Lund University, Lund, Sweden.
    Vliet Vlieland, Thea P M
    Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands .
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS). Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden & School of Business and Engineering, Department of Exercise Physiology, Biomechanics and Health, Spenshult, Halmstad, Sweden.
    Which patients improve the most after arthritis rehabilitation? A study of predictors in patients with inflamatory arthritis in northern Europe, the STAR-ETIC collaboration2014Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, nr 3, s. 250-257Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To study health-related quality of life (HRQoL) in arthritis rehabilitation performed by multidisciplinary teams in patients with chronic inflammatory arthritis. Predictors of change in health-related quality of life and the proportion of patients with clinical improvement were investigated.

    DESIGN: Multicentre prospective observational study in 4 European countries.

    METHODS: HRQoL was measured with the European Quality 5 Dimensions (EQ-5D) and the Short Form 36 Health Survey (SF-36) in 731 patients who underwent multidisciplinary rehabilitation. Potential predictors were physical functioning (Health Assessment Questionnaire (HAQ)), self-efficacy (Arthritis Self Efficacy Scale (ASES)), psychological health (Hopkins Symptom Check List (HSCL-25)), pain/fatigue (numeric rating scales (NRS)), age, sex, diagnosis, comorbidity, education, clinical setting and change of medication during rehabilitation. Analysis of covariance (ANCOVA) was used to assess for potential predictors and interactions. The minimal important differences for HRQoL were analysed.

    RESULTS: Reporting worse function (b 0.05, p = 0.01), less psychological well-being (b 0.09, p = 0.000), and experiencing more pain (b 0.03, p = 0.000) or fatigue (b 0.02, p = 0.000) at admission predicted improved HRQoL. Change in medication during rehabilitation (b 0.08, p = 0.013) was associated with greater improvement in HRQoL. These EQ-5D findings were supported by SF-36 findings. Positive minimal important differences were noted in 46% (EQ-5D) and 23-47% (SF-36 subscales) of the patients.

    CONCLUSION: Patients with more severe symptoms experienced the largest gain in HRQoL post-intervention. The results of this study are of value for selecting the right patients for rheumatological team rehabilitation. © 2014 The Authors

  • 105.
    Hagel, Sofia
    et al.
    Department of Clinical Sciences Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Sweden.
    Lindqvist, Elisabet
    Department of Clinical Sciences Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Sweden.
    Petersson, Ingemar F
    Department of Clinical Sciences Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Sweden.
    Nilsson, Jan-Åke
    Department of Clinical Sciences Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Sweden.
    Bremander, Ann
    Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.
    Validation of outcome measurement instruments used in a multidisciplinary rehabilitation intervention for patients with chronic inflammatory arthritis: linking of the International Classification of Functioning, Disability and Health, construct validity and responsiveness to change.2011Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 43, nr 5, s. 411-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To determine the validity of 15 standardized instruments frequently used to measure the outcome of chronic arthritis treatment.

    METHODS: Analyses were performed on data collected at a rehabilitation programme (n=216). The outcome measures evaluated were health-related quality of life, global health, pain, physical function and aerobic capacity. The instrument items were linked to the International Classification of Functioning, Disability and Health (ICF) (content validity), construct validity was analysed based on predetermined hypothesis (Spearman's correlations, rs), and responsiveness (after 18 days and 12 months) by the standardized response mean.

    RESULTS: Most instruments covered the ICF component body function and/or activity-participation, only a few covered the environmental component. The short Euroqol-5 Dimensions performed as well as the longer health-related quality of life instruments in covering the ICF and in responsiveness. The health-related quality of life instruments did not measure similar constructs as hypothesized, neither did pain measures. The Bath Ankylosing Spondylitis indices covered several components of the ICF often exhibiting a large responsiveness. Aerobic capacity had the largest responsiveness of all measures.

    CONCLUSION: Many instruments are not highly correlated, although at face value they appear to measure the same construct, information also applying to content validity and responsiveness. Results from this study can assist in choosing outcome measures in the clinic and in research.

  • 106.
    Halvorsen, Marie
    et al.
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Falla, Deborah
    University of Birmingham, England.
    Gizzi, Leonardo
    University of Stuttgart, Germany.
    Harms-Ringdahl, Karin
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Dedering, Asa
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    SHORT- AND LONG-TERM EFFECTS OF EXERCISE ON NECK MUSCLE FUNCTION IN CERVICAL RADICULOPATHY: A RANDOMIZED CLINICAL TRIAL2016Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 48, nr 8, s. 696-704Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To compare short-and long-term changes in neck muscle endurance, electromyography measures of neck muscle activation and fatigue and ratings of fatigue and pain after neck-specific training or physical activity in people with cervical radiculopathy. Design: Randomized clinical trial. Subjects/patients: Seventy-five patients with cervical radiculopathy. Methods: Patients underwent neck-specific training in combination with a cognitive behavioural approach or prescribed physical activity over a period of 14 weeks. Immediately after the intervention and 12 months later, surface electromyography was recorded from neck flexor and extensor muscles during neck endurance tests. Time to task failure, amplitude and median frequency of the electromyography signal, and subjective fatigue and pain ratings were analysed in 50 patients who completed at least one follow-up. Results: A significant increase in neck flexor endurance time was observed for both groups at 14 weeks compared with baseline and this was maintained at the 12-month follow-up (pamp;lt;0.005). No change was identified for the slope of the median frequency. For the neck-specific training group, splenius capitis was less active during neck flexion at both follow-ups (pamp;lt;0.01), indicating reduced muscle co-activation. Conclusion: Both specific and general exercise increased neck flexor endurance, but neck-specific training only reduced co-activation of antagonist muscles during sustained neck flexion.

  • 107.
    Hammer, Ann
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Lindmark, Birgitta
    Uppsala universitet.
    Test-retest intra-rater reliability of grip force in patients with stroke2003Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 35, nr 4, s. 189-194Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Coefficients of repeatability and reproducibility can be guides in differentiating between real changes and measurement error. The aim was to evaluate test-retest intra-rater reliability of a clinical procedure measuring grip force with Grippit in stroke patients, to assess relationship between grip force of the hands and between sustained and peak grip force. PATIENTS AND METHODS: Eighteen patients were tested using the Grippit at two occasions one hour apart. Each occasion comprised three consecutive trials per hand. RESULTS: The paretic hand needs to score a 50 N change within and between occasions to exceed the measurement error in 95% of the observations, irrespective of calculation method. Expressed by CV(within) the measurement error was 10%. There was no learning or fatigue effect during measuring. There was a wide variation between subjects but the mean ratio between sides was 0.66. The mean ratio between sustained and peak grip force was 0.80-0.84. CONCLUSION: The measurement errors were acceptable and the instrument can be recommended for the use in stroke patients at a department of rehabilitation medicine.

  • 108.
    Heiden, Marina
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Yrkesmedicin.
    Lyskov, Eugene
    Nakata, Minori
    Sahlin, Karin
    Sahlin, Tore
    Barnekow-Bergkvist, Margareta
    Evaluation of cognitive behavioural training and physical activity for patients with stress-related illnesses: a randomized controlled study.2007Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 39, nr 5, s. 366-373Artikkel i tidsskrift (Fagfellevurdert)
  • 109.
    Heiden, Marina
    et al.
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Lyskov, Eugene
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Nakata, Minori
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Sahlin, Karin
    Curomed Utbildning, Umeå, Sweden.
    Sahlin, Tore
    Curomed Utbildning, Umeå, Sweden.
    Barnekow-Bergkvist, Margareta
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Evaluation of cognitive behavioural training and physical activity for patients with stress-related illnesses: a randomized controlled study2007Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 39, nr 5, s. 366-373Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of a cognitive behavioural training programme and a physical activity programme for patients with stress-related illnesses. DESIGN: In a randomized controlled study, patients were allocated randomly to 1 of 3 groups, where group 1 participated in a cognitive behavioural training programme, group 2 participated in a physical activity programme, and group 3, the control group, was offered usual care for the course of the study. SUBJECTS: A total of 75 patients participated in the study. They had been on sick leave for at least 50% of the time for between 1 month and 2 years due to stress-related illnesses. METHODS: Measurements of autonomic activity, pressure-pain thresholds and subjective ratings of health and behaviour were made before and after a 10-week intervention period, and at 6 and 12 months after the intervention. RESULTS: Minor differences in autonomic activity and pressure-pain thresholds were found between the groups immediately after the intervention. At the 6- and 12-month follow-up assessments, the differences were no longer present. Patients in the cognitive behavioural training group improved their ratings of general health compared with the physical activity group throughout the study. CONCLUSION: The study showed little difference in the effect of cognitive behavioural training and physical activity, compared with usual care, for patients with stress-related illnesses.

  • 110.
    Hellström, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Lindmark, Birgitta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Wahlberg, Birgit
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Fugl-Meyer, Axel R
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Self-efficacy in relation to impairments and ADL disability in elderly stroke patients: A prospective investigation2003Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 35, nr 5, s. 202-207Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: The objectives of this prospective study, under-taken in elderly patients with stroke undergoing rehabilita-tion, were to determine to what extent fall-related self-efficacy changes over time, its relationships to objectivelyassessed functions and activities, and the predictive capacityof self-efficacy at discharge for activities of daily living 10months after stroke.

    Methods: The study comprised 37 patients, aged 66–89 years.Main outcome measurement instruments were the FallsEfficacy Scale (Swedish version), Berg Balance Scale andFunctional Independence Measure.

    Results: Significant improvements occurred in all thesemeasures from admission to discharge, but patients with lowself-efficacy at discharge showed less pronounced improve-ments than those with high self-efficacy. Falls Efficacy Scale(Swedish version) was closely associated with all othermeasures and was a more powerful predictor of activities ofdaily living than the observer-based measures of balance.

    Conclusion: To minimize dependence in activities of dailyliving, rehabilitation interventions should incorporate self-efficacy enhancement.

  • 111.
    Henriksson, Chris
    et al.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan. Linköpings universitet, Hälsouniversitetet.
    Carlberg, Ulla
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Rehabiliteringsmedicin. Linköpings universitet, Hälsouniversitetet.
    Kjällman, Mikael
    Rheumatology Clinic, Falu Hospital, Falun.
    Lundberg, Gunnar
    Ergonomicentrum, Nyköping, Sweden.
    Henriksson, Karl-Gösta
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan. Linköpings universitet, Hälsouniversitetet.
    Evaluation of four outpatient educational programmes for patients with longstanding fibromyalgia2004Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 36, nr 5, s. 211-219Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Four programmes based on educational and cognitive principles but with a variation in total length and number of staff/patient contact hours were compared in order to gain further insight into the importance of the format of the programme for the final outcome.

    DESIGN: A prospective non-randomized intervention study with 191 persons with fibromyalgia. Data were collected before, after and at 1-year follow-up. Participants served as their own controls. Results within and between the programmes were calculated.

    METHODS: Clinical investigations before and after intervention. Questionnaires were answered before, after and at 1-year follow-up.

    RESULTS: Most instruments showed no significant improvements after the programme. However, some improvements were found in important variables such as attitudes, self-efficacy, vitality and "days feeling well". Results were unchanged at the 1-year follow-up and 16 persons had started working. Seven had ceased working. Participants reported frequent use of coping strategies in everyday life. No major differences could be found between the programmes. Conclusions: More comprehensive programmes did not produce better results at group level. Also short and less costly interventions based on educational and cognitive principles were valuable for persons with longstanding fibromyalgia. More attention must be given to evaluating the clinical effect of programmes.

  • 112.
    Henriksson, Karl-Gösta
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Rehabiliteringsmedicin. Östergötlands Läns Landsting, Medicincentrum, Smärt- och rehabiliteringscentrum.
    Fibromyalgia - From syndrome to disease. Overview of pathogenetic mechanisms2003Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 35, s. 89-94Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    According to the classification criteria proposed by the American College of Rheumatology, fibromyalgia is a long-standing multifocal pain condition combined with generalised allodynia/hyperalgesia. It is the generalised allodynia/hyperalgesia that distinguishes fibromyalgia from other conditions with chronic musculoskeletal pain. Central sensitisation of nociceptive neurons in the dorsal horn due to activation of N-methyl-D-aspartic acid receptors and disinhibition of pain due to deficient function of the descending inhibitory system are probable pathogenic factors for allodynia/hyperalgesia. Furthermore, chronic pain is a chronic emotional and physical stressor. Chronic stress and chronic sleep disturbance are not specific for fibromyalgia but could be the causes of symptoms like fatigue, cognitive difficulties and other stress-related symptoms. They may also cause neuroendocrinological and immunological aberrations.

  • 113.
    Herlitz, Johan
    et al.
    [external].
    Wiklund, I
    Sjöland, H
    Karlson, BW
    Karlsson, T
    Haglid, M
    Hartford, M
    Caidahl, K
    Impact of age in improvement in health related Quality of Life five years after coronary artery bypass grafting2000Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 32, nr 1, s. 41-48Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to describe the relief of symptoms and improvement in other aspects of health-related quality of life 5 years after coronary artery by-pass grafting in relation to age. Patients in western Sweden were approached with an inquiry prior to surgery and 5 years after the operation. Health-related quality of life was estimated with 3 different instruments: Physical Activity Score (PAS), Nottingham Health Profile (NHP), Psychological General Well-Being Index (PGWB). Prior to surgery patients were approached either in the ward or by post and 5 years after surgery they were approached by post. A total of 1719 patients were available for the survey, of whom 876 (51%) responded to the survey both prior to and after 5 years. Among the 876 respondents 287 were <60 years, 331 were 60-67 years and 258 were >67 years. In terms of physical activity, chest pain and dyspnoea, a similar improvement was observed regardless of age. In terms of health-related quality of life questionnaires, there was an inverse association between age and improvement when using PAS and a similar trend was observed with NHP and PGWB. In conclusion, 5 years after coronary artery bypass grafting relief of symptoms and improvement in physical activity was not associated with age, whereas improvement in other aspects of health-related quality of life tended to be less marked in elderly people. Overall age seemed to have a small impact on the improved well-being 5 years after coronary surgery. However, due to the limited response rate the results may not be applicable to a non-selected coronary artery bypass grafting population.

  • 114.
    Hermansen, Anna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Kammerlind, Ann-Sofi
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Futurum Region Jönköping County.
    Hjelm, Katarina
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Women’s experiences of daily life after anterior cervical decompression and fusion surgery: A qualitative interview study2016Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 48, nr 4, s. 352-358Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Subjects: Fourteen women aged 39-62 years (median 52 years), were included 1.5 to 3 years after ACDF for cervical degenerative disc disease.

    Methods: Individual semi-structured interviews were analyzed by qualitative content analysis with an inductive approach.

    Results: The women described their experiences of daily life in five different ways; Experiences of recovery; Experiences of symptoms in daily life influence feelings and thoughts; Making daily life work; Importance of social  and occupational networks; Experiences of the influence of healthcare professionals and interventions on daily life.

    Conclusion: This interview study provides insight into women’s daily life after ACDF. While improved after surgery, informants also experienced remaining symptoms and limitations in daily life. A variety of mostly active coping strategies were used to manage daily life. Social support from family, friends, occupational networks and healthcare professionals positively influenced daily life. These findings provide knowledge on aspects of daily life that should be considered in individualized postoperative care and rehabilitation in an attempt to provide better outcomes in women after ACDF.

  • 115.
    Hermansson, Liselotte M.
    et al.
    Limb Deficiency and Arm Prosthesis Centre, Orebro University Hospital, SE-701 85 Orebro, Sweden; Karolinska Institute, Stockholm, Sweden.
    Bodin, Lennart
    Limb Deficiency and Arm Prosthesis Centre, Orebro University Hospital, SE-701 85 Orebro, Sweden.
    Eliasson, Ann-Christin
    Karolinska Institute, Stockholm, Sweden.
    Intra- and inter-rater reliability of the assessment of capacity for myoelectric control2006Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 38, nr 2, s. 118-23Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To examine the reliability of the Assessment of Capacity for Myoelectric Control (ACMC) in children and adults with a myoelectric prosthetic hand.

    DESIGN: Intra-rater and inter-rater reliability estimated from reported assessments by 3 different raters.

    PATIENTS: A sample of convenience of 26 subjects (11 males, 15 females) with upper limb reduction deficiency or amputation and myoelectric prosthetic hands were video-taped during a regular clinical visit for ACMC. Participants' ages ranged from 2 to 40 years.

    METHODS: After instruction, 3 occupational therapists with no, 10 weeks' and 15 years' clinical experience of myoelectric prosthesis training and follow-up independently rated the 30 ACMC items for each patient. The ratings were repeated after 2-4 weeks. Inter- and intra-rater reliability in items was examined by using weighted kappa statistics and Rasch-measurement analyses.

    RESULTS: The mean intra-rater agreement in items was excellent (kappa 0.81) in the more experienced raters. Fit statistics showed too much variation in the least experienced rater, who also had only good (kappa 0.65) agreement in items. The stability of rater calibrations between first and second assessment showed that no rater varied beyond chance (>0.50 logit) in severity. The mean inter-rater agreement in items was fair; kappa 0.60, between the experienced raters and kappa 0.47 between raters with no and 10 weeks' experience.

    CONCLUSION: Overall, the agreement was higher in the more experienced raters, indicating that reliable measures of the ACMC require clinical experience from myoelectric prosthesis training.

  • 116.
    Hermansson, Liselotte M.
    et al.
    Örebro University Hospital, Örebro, Sweden; Karolinska Institute, Stockholm, Sweden.
    Fisher, Anne G.
    Umeå University, Umeå, Sweden.
    Bernspång, Birgitta
    Umeå University, Umeå, Sweden.
    Eliasson, Ann-Christin
    Karolinska Institute, Stockholm, Sweden.
    Assessment of capacity for myoelectric control: a new Rasch-built measure of prosthetic hand control2005Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 37, nr 3, s. 166-71Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To report the results from a Rasch rating scale analysis of the Assessment of Capacity for Myoelectric Control (ACMC) implemented to evaluate internal scale validity, person response validity, separation reliability, targeting and responsiveness of the measures over time.

    DESIGN: Longitudinal data (18 months) from a prospective study of development of capacity for myoelectric control in children and adults were used for the analysis.

    PATIENTS: A consecutive sample of 75 subjects (43 males, 32 females) with upper limb reduction deficiency or amputation and myoelectric prosthetic hands referred for occupational therapy from September 2000 to March 2002. Participants' ages ranged from 2 to 57 years.

    METHODS: Outcome measure was the ACMC. Occupational therapists completed 210 assessments at an arm prosthesis centre in Sweden. A two-faceted rating scale analysis of the data was performed.

    RESULTS: All 30 ACMC items and 96.2% of participants demonstrated goodness-of-fit to the rating scale model for the ACMC. Separation and SE values suggested adequate reliability of the item and person estimates.

    CONCLUSION: The items demonstrated internal scale validity and the participants demonstrated person response validity. The ACMC was well targeted and sensitive enough to detect expected change in ability.

  • 117.
    Holmefur, Marie
    et al.
    Örebro universitet, Hälsoakademin.
    Aarts, Pauline
    Hoare, Brian
    Krumlinde-Sundholm, Lena
    Test-retest and alternate forms reliability of the assisting hand assessment2009Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 41, nr 11, s. 886-891Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The Assisting Hand Assessment (AHA) has earlier demonstrated excellent validity and rater reliability. This study aimed to evaluate test-retest reliability of the AHA and alternate forms reliability between Small kids vs School kids AHA and the 2 board games in School kids AHA.

    DESIGN: Test-retest and alternate forms reliability was evaluated by repeated testing with 2 weeks interval.

    SUBJECTS: Fifty-five children with unilateral cerebral palsy, age range 2 years and 3 months to 11 years and 2 months.

    METHODS: Intraclass correlation coefficients and smallest detectable difference were calculated. Common item and common person linking plots using Rasch analysis and Bland-Altman plots were created.

    RESULTS: Intraclass correlation coefficients for test-retest was 0.99. Alternate forms intraclass correlation coefficients were 0.99 between Small kids and School kids AHA and 0.98 between board games. Smallest detectable difference was 3.89 points (sum scores). Items in common item linking plots and persons in common person linking plots were within 95% confidence intervals, indicating equivalence across test forms.

    CONCLUSION: The AHA has excellent test-retest and alternate forms reliability. A change of 4 points or more between test occasions represents a significant change. Different forms of the AHA give equivalent results.

  • 118.
    Häggström, Anna
    et al.
    Kalix Hospital, Department of Occupational Therapy.
    Larsson-Lund, Maria
    The complexity of participation in daily life: A qualitative study of the experiences of persons with acquired brain injury2008Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, nr 2, s. 89-95Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To describe and enhance the understanding of how adults with acquired brain injury experience participation in daily life. Patients and methods: Qualitative interviews with 11 persons of working age with acquired brain injuries were analysed using qualitative content analysis. Results: The informants' experiences formed 5 categories: "Performing tasks"; "Making decisions and exerting influence"; "Being engaged in meaningful activities"; "Doing things for others"; and "Belonging". The categories that needed to be present for the informants to experience a feeling of participation varied according to their individual daily life situations. In addition, their experiences showed that a variety of conditions, related to each of the 5 categories, influenced their participation. Individuals adopted a variety of strategies to enhance their experience of participation. Conclusion: The meaning of participation and the conditions and strategies influencing participation are complex. Many of the categories identified for participation can be understood only through subjective experience and cannot be captured by professionals' observation of the performance of activities. These results emphasize the importance of considering clients' unique experiences of participation when designing individually tailored rehabilitation programmes intended to enhance participation.

  • 119. Hållstam, Andrea
    et al.
    Stålnacke, Britt Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Svensen, Christer
    Löfgren, Monika
    "Change is possible": patients' experience of a multimodal chronic pain rehabilitation programme2015Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, nr 3, s. 242-248Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore patients' experiences of activity, participation and quality of life one year after a rehabilitation programme for chronic pain, and to determine the impact of the programme on their current life situation. Design: Qualitative study with emergent design. Subjects and methods: The 14 informants were patients with chronic pain who had participated in rehabilitation at a pain clinic. Individual semi-structured interviews were analysed with inductive, qualitative content analysis. Results: The core theme "Change is possible" and the themes "A life ruled by pain" (the situation before rehabilitation), "The penny's dropped" (experience during rehabilitation) and "Live a life, not only survive" (the situation at the time of the interviews) emerged from the data. These themes represent a process through which, during and after rehabilitation, the informants integrated earlier disabling symptoms into a functioning lifestyle. Conclusion: Individuals living with disabling chronic pain can create a better life by integrating their illness. A prerequisite is that healthcare professionals empower patients to develop the strength to take responsibility for their daily lives. This process is facilitated by skills to reduce pain and handle life, plus support from significant others.

  • 120. Ibragimova, Nina Klang
    et al.
    Pless, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Adolfsson, Margareta
    Granlund, Mats
    Björck-Åkesson, Eva
    Using content analysis to link texts on assessment and intervention to the International Classification of Functioning, Disability and Health: version for Children and Youth (ICF-CY)2011Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 43, nr 8, s. 728-733Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore how content analysis can be used together with linking rules to link texts on assessment and intervention to the International Classification of Functioning, Disability and Health version for children and youth (ICF-CY). Methods: Individual habilitation plans containing texts on assessment and intervention for children with disabilities and their families were linked to the ICF-CY using content analysis. Texts were first divided into meaning units in order to extract meaningful concepts. Meaningful concepts that were difficult to link to ICF-CY codes were grouped, and coding schemes with critical attributes were developed. Meaningful concepts that could not be linked to the ICF-CY were assigned to the categories "not-definable" and "not-covered", using coding schemes with mutually exclusive categories. Results: The size of the meaning units selected resulted in different numbers and contents of meaningful concepts. Coding schemes with critical attributes of ICF-CY codes facilitated the linking of meaningful concepts to the most appropriate ICF-CY codes. Coding schemes with mutually exclusive categories facilitated the classification of meaningful concepts that could or could not be linked to the ICF-CY. Conclusion: Content analysis techniques can be applied together with linking rules in order to link texts on assessment and intervention to the ICF-CY.

  • 121. Ibragimova, Nina Klang
    et al.
    Pless, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Adolfsson, Margareta
    Granlund, Mats
    Björck-Åkesson, Eva
    Using content analysis to link texts on assessment and intervention to the International Classification of Functioning, Disability and Health: version for Children and Youth (ICF-CY)2011Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 43, nr 8, s. 728-733Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore how content analysis can be used together with linking rules to link texts on assessment and intervention to the International Classification of Functioning, Disability and Health version for children and youth (ICF-CY). Methods: Individual habilitation plans containing texts on assessment and intervention for children with disabilities and their families were linked to the ICF-CY using content analysis. Texts were first divided into meaning units in order to extract meaningful concepts. Meaningful concepts that were difficult to link to ICF-CY codes were grouped, and coding schemes with critical attributes were developed. Meaningful concepts that could not be linked to the ICF-CY were assigned to the categories "not-definable" and "not-covered", using coding schemes with mutually exclusive categories. Results: The size of the meaning units selected resulted in different numbers and contents of meaningful concepts. Coding schemes with critical attributes of ICF-CY codes facilitated the linking of meaningful concepts to the most appropriate ICF-CY codes. Coding schemes with mutually exclusive categories facilitated the classification of meaningful concepts that could or could not be linked to the ICF-CY. Conclusion: Content analysis techniques can be applied together with linking rules in order to link texts on assessment and intervention to the ICF-CY.

  • 122.
    Jacobson, Dan N. O.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Womens & Childrens Hlth, Neuropediat Unit, Stockholm, Sweden.
    Lowing, Kristina
    Karolinska Inst, Dept Womens & Childrens Hlth, Neuropediat Unit, Stockholm, Sweden;Karolinska Univ Hosp, Stockholm, Sweden.
    Hjelmarsson, Emma
    Karolinska Univ Hosp, Stockholm, Sweden.
    Tedroff, Krishna
    Karolinska Inst, Dept Womens & Childrens Hlth, Neuropediat Unit, Stockholm, Sweden.
    Exploring social participation in young adults with cerebral palsy2019Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 51, nr 3, s. 167-174Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives:

    To describe social outcomes for young adults with cerebral palsy, and to explore associations of social outcomes with their classification levels within the Gross Motor Function, Manual Ability and Communication Function Classification Systems, and with the presence of intellectual disability.

    Design:

    A cross-sectional study with a population-based inclusion approach at a neuropaediatric referral centre in Sweden.

    Subjects:

    Sixty-one young adults with cerebral palsy, age 20-22 years.

    Methods:

    Physical examination and questionnaires on social outcomes including living arrangements, relationships, occupation, personal finances, extent of family support with personal care, and physical examination.

    Results:

    Twenty percent of the young adults with cerebral palsy had moved out of the parental home. Forty-three percent were dependent on family support for basic activities of daily living. Seventy-nine percent of those without intellectual disability were employed or studying. The Communication Function Classification Systems, and presence of intellectual disability, demonstrated associations with most social outcomes, followed in significance by Manual Ability Classification System.

    Conclusion:

    In this study young adults with cerebral palsy to a high extent lived in the parental home, and more often without employment, compared with their peers. Many were dependent on parental support, financially, and with activities of daily living. Intellectual disability and communication function were important determinants of social participation. Interventions aimed at alleviating the impact of these particular disabilities should be prioritized.

  • 123. Johansson, Sverker
    et al.
    Ytterberg, Charlotte
    Back, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Widen Holmqvist, Lotta
    von Koch, Lena
    The Swedish occupational fatigue inventory in people with multiple sclerosis2008Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, nr 9, s. 737-743Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To investigate the applicability of the Swedish Occupational Fatigue Inventory and its ability to identify different dimensions of fatigue in people with multiple sclerosis with varying, degrees of disease severity, and the correlation of each of its 5 dimensions with the Fatigue Severity Scale.

    Design: An observational. prospective study.

    Subjects: Two hundred and nineteen outpatients: 59.5% had mild. 170%, moderate and 23.5% severe disease severity; 83%, received immunomodulatory treatment.

    Methods: Both questionnaires were administered at inclusion, and at 12 and 24 months. Analyses of internal consistency. item-total correlation, factor analysis and tests of correlations were performed.

    Results: The instrument was completed by 97% of subjects. Internal consistency was satisfactory in the dimensions Lack of energy, Lack of motivation and Sleepiness, but not in Physical exertion and Physical discomfort. Factor analysis revealed that all but 3 items (2 in Physical exertion, 1 in Physical discomfort) loaded satisfactorily in 5 dimensions. Correlations between the dimensions and the Fatigue Severity Scale were low, except for a moderate correlation found for Lack of energy.

    Conclusion: The dimensions Lack of energy, Lack of motivation and Sleepiness appear applicable for use in people with multiple sclerosis. Further development of the physical dimensions and studies on the instrument's capacity to measure changes are needed.

  • 124.
    Jörgensen, Sophie
    et al.
    Department of Health Sciences, PO Box 157, Lund University.
    Martin Ginis, Kathleen A.
    School of Health and Exercise Sciences, University of British Columbia, Okanagan Campus, Kelowna, BC.
    Iwarsson, Susanne
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Depressive symptoms among older adults with long-term spinal cord injury: Associations with secondary health conditions, sense of coherence, coping strategies and physical activity2017Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, nr 8, s. 644-651Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES:

    To assess the presence of depressive symptoms among older adults with long-term spinal cord injury and investigate the association with sociodemographic and injury characteristics; and to determine how potentially modifiable factors, i.e. secondary health conditions, sense of coherence, coping strategies and leisure-time physical activity, are associated with depressive symptoms.

    DESIGN:

    Cross-sectional study.

    SUBJECTS:

    A total of 122 individuals (70% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D), mean age 63 years, mean time since injury 24 years.

    METHODS:

    Data from the Swedish Aging with Spinal Cord Injury Study, collected using the Geriatric Depression Scale-15, the 13-item Sense of Coherence Scale, the Spinal Cord Lesion-related Coping Strategies Questionnaire and the Physical Activity Recall Assessment for people with Spinal Cord Injury. Associations were analysed using multivariable linear regression.

    RESULTS:

    A total of 29% reported clinically relevant depressive symptoms and 5% reported probable depression. Sense of coherence, the coping strategy Acceptance, neuropathic pain and leisure-time physical activity explained 53% of the variance in depressive symptoms.

    CONCLUSION:

    Older adults with long-term spinal cord injury report a low presence of probable depression. Mental health may be supported through rehabilitation that strengthens the ability to understand and confront life stressors, promotes acceptance of the injury, provides pain management and encourages participation in leisure-time physical activity.

  • 125. Karrholm, Jenny
    et al.
    SUBEkholm, Karolina
    Ekholm, Jan
    Bergroth, Alf
    Ekholm, Kristina Schuldt
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Nationalekonomiska institutionen.
    Systematic co-operation between employer, occupational health service and social insurance office: A 6-year follow-up of vocational rehabilitation for people on sick-leave, including economic benefits2008Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, nr 8, s. 628-636Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate the effects of systematic co-operation among municipal employees on the number of sick-leave days per month and the type of benefit granted by the Social Insurance Office. A further aim was to evaluate the economic consequences for society. Design: A 6-year follow-up study with a matched-pairs design. Methods: Days on sick-leave were calculated for each subject one year before the intervention started and yearly for the following 6-year period. Statistical mixed-model analysis was used. The economic benefit of the intervention was estimated as the increased production stemming from fewer days on sick-leave. Subjects: Sixty-four employees on long-term sick-leave were individually matched with controls from another Social Insurance Office in a county with a socioeconomic structure similar to that of the study group. Results: The study group had 5.7 fewer days on sick-leave per month and person over the 6-year period (p=0.003). The estimated average economic benefit of the intervention was (sic)36,600 per person over the 6-year period. In conclusion, those who received systematic co-operation in vocational rehabilitation had fewer days on sick-leave than their ""treatment-as-usual"" peers. This effect persisted over 6 years, generating substantial net economic gains for society.

  • 126.
    Kilebrant, Sophie
    et al.
    Regional Vastra Gotaland Child and Youth Habilitat, Sweden.
    Braathen, Gunnar
    Regional Vastra Gotaland Child and Youth Habilitat, Sweden.
    Emilsson, Roger
    Regional Vastra Gotaland Child and Youth Habilitat, Sweden.
    Glansen, Ulla
    Regional Vastra Gotaland Child and Youth Habilitat, Sweden.
    Soderpalm, Ann-Charlott
    University of Gothenburg, Sweden.
    Zetterlund, Bo
    Regional Vastra Gotaland Child and Youth Habilitat, Sweden.
    Westerberg, Barbro
    Regional Vastra Gotaland Child and Youth Habilitat, Sweden.
    Magnusson, Per
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk kemi.
    Swolin-Eide, Diana
    University of Gothenburg, Sweden.
    WHOLE-BODY VIBRATION THERAPY IN CHILDREN WITH SEVERE MOTOR DISABILITIES2015Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, nr 3, s. 223-228Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To study the effect of whole-body vibration therapy on bone mass, bone turnover and body composition in severely disabled children. Methods: Nineteen non-ambulatory children aged 5.1-16.3 years (6 males, 13 females) with severe motor disabilities participated in an intervention programme with standing exercise on a self-controlled dynamic platform, which included whole-body vibration therapy (vibration, jump and rotation movements). Whole-body vibration therapy was performed at 40-42 Hz, with an oscillation amplitude of 0.2 mm, 5-15 min/treatment, twice/week for 6 months. Bone mass parameters and bone markers were measured at the study start, and after 6 and 12 months. Results: Whole-body vibration therapy was appreciated by the children. Total-body bone mineral density increased during the study period (p less than0.05). Z-scores for total-body bone mineral density ranged from -5.10 to -0.60 at study start and remained unchanged throughout. Approximately 50% of the subjects had increased levels of carboxy-terminal telopeptides of type I collagen and decreased levels of osteocalcin at the start. Body mass index did not change during the intervention period, but had increased by the 12-month follow-up (pless than 0.05). Conclusion: Whole-body vibration therapy appeared to be well tolerated by children with severe motor disabilities. Total-body bone mineral density increased after 6 months of whole-body vibration therapy. Higher carboxy-terminal telopeptides of type I collagen and lower osteocalcin values indicated that severely disabled children have a reduced capacity for bone acquisition.

  • 127.
    Kjellman, Görel
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Öberg, Birgitta
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik. Östergötlands Läns Landsting, Folkhälsovetenskapligt centrum, Folkhälsovetenskapligt centrum.
    A randomized clinical trial comparing general exercise, McKenzie treatment and a control group in patients with neck pain2002Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 34, nr 4, s. 183-190Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Seventy-seven patients with neck pain in the primary health care were included in a prospective, randomized clinical trial and randomly assigned to general exercise, McKenzie treatment, or a control group. Seventy patients completed the treatment, response rate 93% at 12-month follow-up. All three groups showed significant improvement regarding the main outcomes, pain intensity and Neck Disability Index, even at 12-month follow-up, but there was no significant difference between the groups. In all, 79% reported that they were better or completely restored after treatment, although 51% reported constant/daily pain. In the McKenzie group compared with the control group, a tendency toward greater improvement was noted for pain intensity at 3 weeks and at 6-month follow-up, and for post-treatment Neck Disability Index. Significant improvement in Distress and Risk Assessment Method scores was shown in the McKenzie group only. The three groups had similar recurrence rates, although after 12 months the McKenzie group showed a tendency toward fewer visits for additional health care. The study did not provide a definite evidence of treatment efficacy in patients with neck pain, however, there was a tendency toward a better outcome with the two active alternatives compared with the control group.

  • 128.
    Klang Ibragimova, Nina
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Pless, Mia
    Dept Publ Hlth & Caring Sci, Uppsala Univ, Uppsala, Sweden .
    Adolfsson, Margareta
    SIDR, Jönköping Univ, Jönköping, Sweden; Sch Educ & Commun, Jönköping Univ, Jönköping, Sweden.
    Granlund, Mats
    SIDR, Jönköping Univ, Jönköping, Sweden; Sch Hlth Sci, Jönköping Univ, Jönköping, Sweden.
    Björck Åkesson, Eva
    Sch Educ & Commun, Jönköping Univ, Jönköping, Sweden.
    Using content analysis to link texts on assessment and intervention to the international classification of functioning, disability and health: version for children and youth (ICF-CY)2011Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 43, nr 8, s. 728-733Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore how content analysis can be used together with linking rules to link texts on assessment and intervention to the International Classification of Functioning, Disability and Health – version for children and youth (ICF-CY).

    Methods: Individual habilitation plans containing texts on assessment and intervention for children with disabilities and their families were linked to the ICF-CY using content analysis. Texts were first divided into meaning units in order to extract meaningful concepts. Meaningful concepts that were difficult to link to ICF-CY codes were grouped, and coding schemes with critical attributes were developed. Meaningful concepts that could not be linked to the ICF-CY were assigned to the categories “not-definable” and “not-covered”, using coding schemes with mutually exclusive categories.

    Results: The size of the meaning units selected resulted in different numbers and contents of meaningful concepts. Coding schemes with critical attributes of ICF-CY codes facilitated the linking of meaningful concepts to the most appropriate ICF-CY codes. Coding schemes with mutually exclusive categories facilitated the classification of meaningful concepts that could or could not be linked to the ICF-CY.

    Conclusion: Content analysis techniques can be applied together with linking rules in order to link texts on assessment and intervention to the ICF-CY.

  • 129.
    Klang Ibragimova, Nina
    et al.
    Mälardalens högskola, Akademin för utbildning, kultur och kommunikation.
    Pless, Mia
    Uppsala Univ.
    Adolfsson, Margareta
    Jönköping Univ.
    Granlund, Mats
    Jönköping Univ.
    Björck-Åkesson, Eva
    Jönköping Univ.
    Using content analysis to link texts of assessment and intervention to International Classification of Functioning, Disability and Health - version for children and youth (ICF-CY)2011Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 43, nr 8, s. 728-733Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore how content analysis can be used together with linking rules to link texts on assessment and intervention to the International Classification of Functioning, Disability and Health version for children and youth (ICF-CY).

    Methods: Individual habilitation plans containing texts on assessment and intervention for children with disabilities and their families were linked to the ICF-CY using content analysis. Texts were first divided into meaning units in order to extract meaningful concepts. Meaningful concepts that were difficult to link to ICF-CY codes were grouped, and coding schemes with critical attributes were developed. Meaningful concepts that could not be linked to the ICF-CY were assigned to the categories "not-definable" and "not-covered", using coding schemes with mutually exclusive categories.

    Results: The size of the meaning units selected resulted in different numbers and contents of meaningful concepts. Coding schemes with critical attributes of ICF-CY codes facilitated the linking of meaningful concepts to the most appropriate ICF-CY codes. Coding schemes with mutually exclusive categories facilitated the classification of meaningful concepts that could or could not be linked to the ICF-CY.

    Conclusion: Content analysis techniques can be applied together with linking rules in order to link texts on assessment and intervention to the ICF-CY.

  • 130.
    Klang Ibragimova, Nina
    et al.
    School of Education, Culture and Communication, Mälardalen university.
    Pless, Mia
    Department of Public Health and Caring Sciences, Uppsala universitet.
    Adolfsson, Margareta
    Högskolan i Jönköping, Högskolan för lärande och kommunikation, HLK, CHILD.
    Granlund, Mats
    Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD. Högskolan i Jönköping, Högskolan för lärande och kommunikation, HLK, CHILD.
    Björck-Åkesson, Eva
    Högskolan i Jönköping, Högskolan för lärande och kommunikation, HLK, CHILD.
    Using content analysis to link texts on assessment and intervention to the International Classification of Functioning, Disability and Health - version for Children and Youth (ICF-CY)2011Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 43, nr 8, s. 728-733Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore how content analysis can be used together with linking rules to link texts on assessment and intervention to the International Classification of Functioning, Disability and Health – version for children and youth (ICF-CY).

    Methods: Individual habilitation plans containing texts on assessment and intervention for children with disabilities and their families were linked to the ICF-CY using content analysis. Texts were first divided into meaning units in order to extract meaningful concepts. Meaningful concepts that were difficult to link to ICF-CY codes were grouped, and coding schemes with critical attributes were developed. Meaningful concepts that could not be linked to the ICF-CY were assigned to the categories “not-definable” and “not-covered”, using coding schemes with mutually exclusive categories.

    Results: The size of the meaning units selected resulted in different numbers and contents of meaningful concepts. Coding schemes with critical attributes of ICF-CY codes facilitated the linking of meaningful concepts to the most appropriate ICF-CY codes. Coding schemes with mutually exclusive categories facilitated the classification of meaningful concepts that could or could not be linked to the ICF-CY.

    Conclusion: Content analysis techniques can be applied togetherwith linking rules in order to link texts on assessmentand intervention to the ICF-CY.

  • 131.
    Klokkerud, Mari
    et al.
    University of Oslo, Institute of Health and Society, Norway.
    Hagen, Kåre Birger
    University of Oslo, Institute of Health and Society, Norway.
    Kjeken, Ingvild
    University of Oslo, Institute of Health and Society, Norway.
    Bremander, Ann
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden.
    Hørslev-Petersen, Kim
    King Christian Xth Hospital for Rheumatic Diseases, Gråsten, Denmark.
    Vlieland, Thea Vliet
    Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands.
    Grotle, Margreth
    FORMI (Communication Unit for Musculoskeletal Disorders), Oslo University Hospital, Ullevaal, Oslo, Norway.
    Development of a framework identifying domains and elements of importance for arthritis rehabilitation2012Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, nr 5, s. 406-13Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Rehabilitation is effective and beneficial for patients with arthritis. The lack of a common structure for describing the content of rehabilitation makes it difficult to compare, transfer and implement research evidence into clinical practice.

    OBJECTIVE: To develop a framework comprising domains and elements of importance when describing arthritis rehabilitation.

    METHODS: On the basis of a systematic literature search and review, the framework was developed through a 9-step development process, including 5 Delphi consensus rounds within the Scandinavian Team Arthritis Register - European Team Initiative for Care Research (STAR-ETIC) collaboration, a group of clinicians, researchers and patients from northern Europe.

    RESULTS: Based on Donabedian's healthcare model, the Inter-national Classification of Function, Disability and Health, and a rehabilitation model by D. T. Wade, 4 domains (context, structure, process and outcome) were defined. Within each domain, the most important and relevant key elements for describing rehabilitation were selected. This framework contains 1 key element under context, 9 under structure, 3 under process, and 9 under outcome.

    CONCLUSION: The STAR-ETIC framework can be used to describe arthritis rehabilitation, by emphasizing key elements in 4 main domains. A common framework may facilitate comparisons of rehabilitation programmes across countries and different levels of care, and may improve the implementation of rehabilitation research in clinical practice. © 2012 Foundation of Rehabilitation Information.

  • 132.
    Klompstra, Leonie
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    An in-depth, longitudinal examination of the daily physical activity of a patient with heart failure using a Nintendo Wii at home: a case report2013Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, nr 6, s. 599-602Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To explore the influence of the Nintendo Wii on the daily physical activity of a patient with chronic heart failure at home.

    METHODS: A 74-year-old Swedish patient with heart failure had access to a Nintendo Wii at home for 12 weeks. Exercise motivation, exercise self-efficacy and exercise capacity were assessed before and after the intervention. Data on perceived physical effort, global well-being and expended energy were collected every day during the intervention.

    RESULTS: During the 12 weeks of access to the Nintendo Wii, daily physical activity increased by 200% on weekdays and 57% on weekends, compared with baseline. The patient’s exercise motivation and exercise self-efficacy increased during the study, whereas perceived physical effort and global well-being did not change. The patient had no difficulties in using the system and did not suffer any major harm.

    DISCUSSION: The results of this case study suggest that providing patients with heart failure access to a Nintendo Wii is a promising and safe intervention. The energy expended by the patient per day increased, as did exercise capacity. Playing the Nintendo Wii did not increase the perceived physical effort, but increased motivation to exercise and decreased barriers to exercising.

  • 133.
    Kouwijzer, Ingrid
    et al.
    Reade Amsterdam, Amsterdam Rehabil Res Ctr, Amsterdam, Netherlands.;Heliomare Rehabil Ctr, Res & Dev, Wijk Aan Zee, Netherlands.;Univ Groningen, Univ Med Ctr Groningen, Ctr Human Movement Sci, Groningen, Netherlands..
    Nooijen, Carla F J
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap. Karolinska Inst, Dept Publ Hlth Sci, Solna, Sweden.;Swedish Sch Sport & Hlth Sci GIH, Stockholm, Sweden..
    Van Breukelen, Kees
    Vrije Univ Amsterdam, Fac Behav & Human Movement Sci, Int Wheelchairsport Classifier Handcyding Wheelch, Amsterdam, Netherlands..
    Janssen, Thomas W. J.
    Reade Amsterdam, Amsterdam Rehabil Res Ctr, Amsterdam, Netherlands.;Vrije Univ Amsterdam, Fac Behav & Human Movement Sci, Dept Human Movement Sci, Amsterdam, Netherlands.;Ctr Adapted Sports Amsterdam Reade, Amsterdam, Netherlands..
    De Groot, Sonja
    Reade Amsterdam, Amsterdam Rehabil Res Ctr, Amsterdam, Netherlands.;Univ Groningen, Univ Med Ctr Groningen, Ctr Human Movement Sci, Groningen, Netherlands..
    EFFECTS OF PUSH-OFF ABILITY AND HANDCYCLE TYPE ON HANDCYCLING PERFORMANCE IN ABLE-BODIED PARTICIPANTS2018Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, nr 6, s. 563-568Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To assess the effects on handcycling performance and physiological responses, of: (i) making a closed chain by comparing handcycling in a recumbent bike with 2-feet footrest (closed chain) with handcycling with 1 footrest (partial closed chain) and without a footrest (no closed chain); (ii) equipment by comparing handcycling in a recumbent bike with a kneeling bike. Methods: Ten able-bodied participants performed submaximal exercise and sprint tests, once in a kneeling bike and 3 times on a recumbent: 2-feet support, 1-foot support and without foot support. Physical strain (submaximal oxygen uptake and heart rate), peak (POpeak) and mean power output (POmean) were measured. Results: Significantly higher POpeak, and POmean were found with 2-feet support (mean 415 W (standard deviation (SD) 163) and mean 281 W (SD 96)) and higher POmean with 1-foot support (mean 279 W (SD 104)) compared with no foot support (mean 332 W (SD 127) and mean 254 W (SD 101)), p<0.05. No differences were found for physical strain. In the kneeling bike, POpeak and POmean were significantly higher (mean 628 W (SD 231) and 391 W (SD 121)) than in the recumbent (mean 415 W (SD 163) and 281 W (SD 96)), p=0.001. Conclusion: The ability to make a closed chain has a significant positive effect on handcycling sprint performance; therefore, this ability may be a discriminating factor. Sprint performance was significantly higher in kneeling compared with recumbent handcycling.

  • 134.
    Kärrholm, Jenny
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Ekholm, Karolina
    Jakobsson, Björn
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Ekholm, Jan
    Bergroth, Alf
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Schüldt Ekholm, Kristina
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Systematic co-operation between employer, occupational health service and social insurance office: A 6-year follow-up of vocational rehabilitation for people on sick-leave, including economic benefits2008Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, nr 8, s. 628-636Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate the effects of systematic co-operation among municipal employees on the number of sick-leave days per month and the type of benefit granted by the Social Insurance Office. A further aim was to evaluate the economic consequences for society.Design: A 6-year follow-up study with a matched-pairs design.Methods: Days on sick-leave were calculated for each subject one year before the intervention started and yearly for the following 6-year period. Statistical mixed-model analysis was used. The economic benefit of the intervention was estimated as the increased production stemming from fewer days on sick-leave.Subjects: Sixty-four employees on long-term sick-leave were individually matched with controls from another Social Insurance Office in a county with a socioeconomic structure similar to that of the study group.Results: The study group had 5.7 fewer days on sick-leave per month and person over the 6-year period (p=0.003). The estimated average economic benefit of the intervention was (sic)36,600 per person over the 6-year period. In conclusion, those who received systematic co-operation in vocational rehabilitation had fewer days on sick-leave than their "treatment-as-usual" peers. This effect persisted over 6 years, generating substantial net economic gains for society.

  • 135.
    Landstad, Bodil J
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Schuldt, K
    Karolinska Inst, Dept Publ Hlth Sci, Div Rehabil Med, Stockholm.
    Ekholm, J
    Karolinska Inst, Dept Publ Hlth Sci, Div Rehabil Med, Stockholm.
    Broman, L
    Karolinska Inst, Dept Publ Hlth Sci, Div Rehabil Med, Stockholm.
    Bergroth, Alf
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Women at work despite ill health: Diagnoses and pain before and after personnel support - A prospective study of hospital cleaners/home-help personnel with comparison groups2001Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 33, s. 216-224Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The present study sought to elicit the diagnoses behind the pain conditions causing complaints by female hospital cleaners and home-help personnel who were working despite their symptoms. We also wished to describe the prevalence of musculoskeletal diagnoses and the intensity, frequency and location of pain, and changes in the clinical picture and pain after personnel supporting interventions. A prospective study was carried out with intervention groups and non-randomized comparison groups. The hospital cleaners intervention programme comprised occupational organizational measures, competence development, physical and psychosocial working environmental measures and individual and rehabilitation measures on both an individual and a group basis. The home-help programme comprised a 2-week stay at an orthopaedic rehabilitation unit, training of supervisors, comrade massage, purchase of training equipment and stress management. Myalgia/tendinitis occurred in 61% of shoulder girdle elevators, 18% of rotator cuffs, 16% of dorsal neck muscles and 29% of hip muscles. There was musculoskeletal pain in the lower back in 28% of cases. Referred pain from a musculoskeletal focus occurred in about one-sixth to one-third of individuals with the diagnosis in question. Neurogenic pain occurred in 6% of cases. No fibromyalgia syndrome was found. One-third of individuals felt pain all the time or almost all the time. The mean rated perceived “worst pain” was 70 mm on a visual analogue scale of 1-100 mm. Comparisons between intervention and reference groups indicated that some improvement in the clinical picture can be attained using this kind of general support programme for employees.

  • 136.
    Landén Ludvigsson, Maria
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Rehab Väst.
    Peterson, Gunnel
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Uppsala University, Sweden.
    Dedering, Asa
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    One- and two-year follow-up of a randomized trial of neck-specific exercise with or without a behavioural approach compared with prescription of physical activity in chronic whiplash disorder2016Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 48, nr 1, s. 56-64Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore whether neck-specific exercise, with or without a behavioural approach, has benefits after 1 and 2 years compared with prescribed physical activity regarding pain, self-rated functioning/disability, and self-efficacy in management of chronic whiplash. Design: Follow-up of a randomized, assessor blinded, clinical trial. Patients: A total of 216 volunteers with chronic whiplash associated disorders, grades 2 or 3. Methods: Participants were randomized to 1 of 3 exercise interventions: neck-specific exercise with or without a behavioural approach, or physical activity prescription. Self-rated pain (visual analogue scale), disability/functioning (Neck Disability Index/Patient Specific Functional Scale) and self-efficacy (Self-Efficacy Scale) were evaluated after 1 and 2 years. Results: Both neck-specific exercise groups maintained more improvement regarding disability/functioning than the prescribed physical activity group at both time-points (p &lt;= 0.02). At 1 year, 61% of subjects in the neck-specific group reported at least 50% pain reduction, compared with 26% of those in the physical activity prescription group (p &lt; 0.001), but at 2 years the difference was not significant. Conclusion: After 1-2 years, participants with chronic whiplash who were randomized to neck-specific exercise, with or without a behavioural approach, remained more improved than participants who were prescribed general physical activity.

  • 137.
    Lannsjö, Marianne
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rehabiliteringsmedicin.
    Borg, Jörgen
    Björklund, Gunilla
    Af Geijerstam, Jean-Luc
    Lundgren-Nilsson, Asa
    Internal construct validity of the Rivermead Post-Concussion Symptoms Questionnaire2011Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 43, nr 11, s. 997-1002Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To investigate the internal construct validity of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) by Rasch analysis of data from a national cohort of patients with mild traumatic brain injury.

    METHODS: Data collected at 3 months after mild traumatic brain injury from 2,523 patients were analysed using the partial credit model, describing rating scale structure, local dependency, age and gender differential functioning, dimensionality and model fit.

    RESULTS: Categories did not work in a consistent manner; however, collapsing of Categories 1 and 2 yielded ordered thresholds. Local dependency of items was present and 2 item pairs were combined. There was no differential item functioning by gender or age. The Rasch factor explained 47.7% of the variance and the first contrast explained 12.4% of the unexplained variance (eigenvalue 1.9). Further analysis indicated 3 or more dimensions. Person measure had a mean of -2.16, showing poor targeting of persons to items. Person reliability was 0.71 and person separation index was 1.56.

    CONCLUSION: According to this Rasch analysis of data from a representative sample of mild traumatic brain injury, the RPQ may not be optimal for this population. Even after reducing the number of categories and collapsing items with local dependency, unidimensionality was not reached, which argues against summation of a total score. However, the scale is unbiased for gender and age.

  • 138.
    Lannsjö, Marianne
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rehabiliteringsmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Raininko, Raili
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för radiologi.
    Bustamante, Mariana
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Avdelningen för visuell information och interaktion. Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Matematisk-datavetenskapliga sektionen, Institutionen för informationsteknologi, Bildanalys och människa-datorinteraktion.
    von Seth, Charlotta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rehabiliteringsmedicin.
    Borg, Jörgen
    Brain pathology after mild traumatic brain injury: An exploratory study by repeated magnetic resonance examination2013Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, nr 8, s. 721-728Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective:

    To explore brain pathology after mild traumatic brain injury by repeated magnetic resonance examination.

    Design:

    A prospective follow-up study.

    Subjects:

    Nineteen patients with mild traumatic brain injury presenting with Glasgow Coma Scale (GCS) 14-15.

    Methods:

    The patients were examined on day 2 or 3 and 3-7 months after the injury. The magnetic resonance protocol comprised conventional T1- and T2-weighted sequences including fluid attenuated inversion recovery (FLAIR), two susceptibility-weighted sequences to reveal haemorrhages, and diffusion-weighted sequences. Computer-aided volume comparison was performed. Clinical outcome was assessed by the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), Hospital Anxiety and Depression Scale (HADS) and Glasgow Outcome Scale Extended (GOSE).

    Results:

    At follow-up, 7 patients (37%) reported ≥  3 symptoms in RPQ, 5 reported some anxiety and 1 reported mild depression. Fifteen patients reported upper level of good recovery and 4 patients lower level of good recovery (GOSE 8 and 7, respectively). Magnetic resonance pathology was found in 1 patient at the first examination, but 4 patients (21%) showed volume loss at the second examination, at which 3 of them reported < 3 symptoms and 1 ≥ 3 symptoms, all exhibiting GOSE scores of 8.

    Conclusion:

    Loss of brain volume, demonstrated by computer-aided magnetic resonance imaging volumetry, may be a feasible marker of brain pathology after mild traumatic brain injury.

  • 139.
    Larsson, Agneta
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Karlqvist, Lena
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Gard, Gunvor
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    To Tailor health promoting interventions to user needs: effects of work ability and health promoting interventions for women with musculoskeletal symptoms2010Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, nr 4, s. 402-403Artikkel i tidsskrift (Annet vitenskapelig)
  • 140.
    Larsson, Anette
    et al.
    University of Gothenburg, Sweden.
    Palstam, Annie
    University of Gothenburg, Sweden.
    Loefgren, Monika
    Karolinska Institute, Sweden; Danderyd Hospital, Sweden.
    Ernberg, Malin
    Karolinska Institute, Sweden; SCON, Sweden.
    Bjersing, Jan
    Sahlgrens University Hospital, Sweden.
    Bileviciute-Ljungar, Indre
    Karolinska Institute, Sweden; Danderyd Hospital, Sweden.
    Gerdle, Björn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Kosek, Eva
    Karolinska Institute, Sweden; Stockholm Spine Centre, Sweden.
    Mannerkorpi, Kaisa
    University of Gothenburg, Sweden; University of Gothenburg, Sweden; Sahlgrens University Hospital, Sweden.
    PAIN AND FEAR AVOIDANCE PARTIALLY MEDIATE CHANGE IN MUSCLE STRENGTH DURING RESISTANCE EXERCISE IN WOMEN WITH FIBROMYALGIA2017Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, nr 9, s. 744-750Artikkel i tidsskrift (Fagfellevurdert)
    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) (R-2= 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 (R-2 = 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 (R-2 = 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.

  • 141. 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 fibromyalgia2017Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, nr 9, s. 744-750Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 142.
    Larsson, Britt
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Dragioti, Elena
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Grimby-Ekman, Anna
    Health Metrics, University of Gothenburg, Gothenburg, Sweden.
    Gerdle, Björn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Ejork, Jonas
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Predictors of chronic pain intensity, spread, and sensitivity in the general population: A two-year follow-up study from the SWEPAIN cohort2019Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 51, nr 3, s. 183-192Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To determine whether the intensity, spread and sensitivity of chronic pain can be predicted using demographic features, socioeconomic conditions and comorbidities.

    Design: A longitudinal study design was employed. Data was collected at baseline and at 2-year follow-up. Setting: General population in south-eastern Sweden.

    Subjects: A representative stratified random sample of 34,000 individuals, between 18 and 85 years of age, selected from a sampling frame of 404,661 individuals based on the Swedish Total Population Register.

    Methods: Eligible individuals were sent postal surveys in 2013 and 2015. The 2 surveys included the same questions about basic demographic data, comorbidities, and chronic pain intensity, spread and sensitivity.

    Results: Several socio-demographic features and comorbidities at baseline were significant predictors of characteristics of pain (intensity, spread and sensitivity) at the 2-year follow-up. When characteristics of pain at baseline were included in the regression analyses they were relatively strong significant predictors of characteristics of pain after 2 years. After this adjustment there were fewer socio-demographic and comorbidity predictors; the effect estimates for those significant predictors had decreased.

    Conclusion: Clinical assessment should focus on several characteristics of pain and include a broad medical screening to capture the overall burden of pain in adults from a longitudinal perspective.

  • 143.
    Larsson, Jerry
    et al.
    Rehabiliteringsmedicin, Institutionen för neurovetenskap och fysiologi, Sahlgrenska Akademin, Göteborgs Universitet.
    Björkdahl, Ann
    Ersta Sköndal högskola, Institutionen för socialvetenskap.
    Esbjörnsson, Eva
    Rehabiliteringsmedicin, Institutionen för neurovetenskap och fysiologi, Sahlgrenska Akademin, Göteborgs Universitet.
    Stibrant Sunnerhagen, Katharina
    Rehabiliteringsmedicin, Institutionen för neurovetenskap och fysiologi, Sahlgrenska Akademin, Göteborgs Universitet.
    Factors affecting participation after traumatic brain injury2013Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, nr 8, s. 765-770Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The aim of this work was to explore the extent to which social, cognitive, emotional and physical aspects influence participation after a traumatic brain injury (TBI).

    DESIGN/SUBJECTS: An explorative study of the patient perspective of participation 4 years after TBI. The cohort consisted of all patients (age range 18-65 years), presenting in 1999-2000, admitted to the hospital (n = 129). Sixty-three patients responded; 46 males and 17 females, mean age 41 (range 19-60) years.

    METHODS: Four years after the injury, the European Brain Injury Questionnaire (EBIQ), EuroQol-5D, Swedish Stroke Register Questionnaire and Impact on Participation and Autonomy (IPA) questionnaire were sent to the sample. Data were analysed with logistic regression.

    RESULTS: On the EBIQ, 40% of the sample reported problems in most questions. According to IPA, between 20% and 40% did not perceive that they had a good participation. The analyses gave 5 predictors reflecting emotional and social aspects, which could explain up to 70% of the variation in participation.

    CONCLUSION: It is not easy to find single predictors, as there seems to be a close interaction between several aspects. Motor deficits appear to have smaller significance for participation in this late state, while emotional and social factors play a major role.

  • 144.
    Larsson Lund, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Lexell, Jan
    A positive turning point in life: How persons with late effects of polio experience the influence of an interdisciplinary rehabilitation programme2010Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, nr 6, s. 559-565Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To describe and enhance our understanding of how persons with late effects of polio experience the influence of an interdisciplinary rehabilitation programme. Participants: Twelve persons with clinically verified late effects of polio who had participated in an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme. Methods: Qualitative research interviews analysed using the constant comparative method of grounded theory. Results: The rehabilitation programme was experienced as a turning point in the participants' lives. Before rehabilitation they felt they were on a downward slope without control. Rehabilitation was the start of a process of change whereby they acquired new skills, which, over time, contributed to a different but good life. After approximately a year, they had a sense of control and had accepted life with late effects of polio. They had also established new habits, taken on a changed valued self and could look to the future with confidence. Conclusion: This qualitative study has shown that persons with late effects of polio can benefit from an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme and experience positive changes in their management of daily activities and in their view of their late effects of polio, their future and their self.

  • 145.
    Larsson Lund, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Arbetsterapi.
    Lexell, Jan
    Perceived participation in life situations in persons with late effects of polio2008Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, nr 8, s. 659-664Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To investigate how persons with late effects of polio perceive their participation and problems with participation in life situations and to determine the association between perceived problems with participation and sex, age, marital status, use of mobility aids and access to instrumental support.

    Design: Cross-sectional.

    Subjects: A total of 160 persons with prior polio 6-30 months after an individualized, goal-oriented, comprehensive inter-disciplinary rehabilitation programme.

    Methods: All subjects answered the Swedish version of the Impact on Participation and Autonomy Questionnaire.

    Results: A majority of the respondents perceived their participation as sufficient in most activities and 65% of the respondents perceived no severe problems with participation. The remaining 35% perceived 1-6 severe problems with participation. All 5 domains of participation were positively correlated with the 9 items for problem experience. Most restrictions in participation were reported in the domains of Family role, Autonomy outdoors, and Work and education. Insufficient instrumental support was most strongly associated with the perception of severe problems with participation.

    Conclusion: Rehabilitation programmes for persons with late effects of polio need to focus on areas of participation that are perceived as a problem by these persons and to promote access to a supportive environment to enhance their participation.

  • 146.
    Larsson Lund, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Arbetsterapi.
    Nordlund, Anders
    Nygård, Louise
    Lexell, Jan
    Bernspång, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Arbetsterapi.
    Perceptions of participation and predictors of perceived problems with participation in persons with spinal cord injury2005Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 37, nr 1, s. 3-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To describe how persons with spinal cord injury perceived their participation in life situations and to determine the relationship between their participation and perceived problems therewith. The purpose was also to evaluate the influence of age, sex, level of injury, time since injury, marital status and access to social support on perceived problems with participation. DESIGN: Cross-sectional. SUBJECTS: One hundred sixty-one persons with spinal cord injury. METHODS: A postal questionnaire including socio-demographic characteristics and a Swedish version of the Impact on Participation and Autonomy questionnaire. RESULTS: A majority of the respondents perceived their participation as sufficient in most activities addressed. Still, a majority of the respondents perceived one or more severe problems with their participation. Access to social support was the most influencing variable in predicting perceived severe problems with participation as compared with certain personal and health-related factors. CONCLUSION: The results suggest that it is important to consider access to social support along with other factors in the person-environment interaction and their influence on severe problems with participation in enhancing clients' participation in rehabilitation.

  • 147.
    Larsson-Lund, Maria
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Fisher, Anne G.
    Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University.
    Lexell, Jan
    Benspång, Birgitta
    Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University.
    Impact on participation and autonomy questionnaire: internal scale validity of the Swedish version for use in people with spinal cord injury2007Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 39, nr 2, s. 156-162Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate aspects of internal scale validity and reliability of the Swedish version of the Impact on Participation and Autonomy questionnaire (IPA-S) for use in people with spinal cord injury. Subjects: A total of 161 persons with spinal cord injury. Method: IPA-S psychometric properties were evaluated using Rasch rating scale analysis. Results: The results show that the IPA-S has 27 items for perceived participation and 6 items for perceived problems with participation, indicating 2 underlying unidimensional constructs for use in people with spinal cord injury, after removal of misfitting items. The established hierarchical order of the item calibration values in both scales appeared logical and the distances between the items, with a few exceptions in the problem scale, were appropriate. Both scales demonstrated good separation reliability. The range of item calibration values in both scales did not fully cover the range of measures of persons' perceived participation and problems thereof. Conclusion: The psychometric properties of IPA-S are promising and indicate that IPA-S has potential to be developed further.

  • 148.
    Larsson-Lund, Maria
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    A positive turning point in life: how persons with late effects of polio experience the influence of an interdisciplinary rehabilitation programme2010Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, nr 6, s. 559-565Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To describe and enhance our understanding of how persons with late effects of polio experience the influence of an interdisciplinary rehabilitation programme. Participants: Twelve persons with clinically verified late effects of polio who had participated in an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme. Methods: Qualitative research interviews analysed using the constant comparative method of grounded theory. Results: The rehabilitation programme was experienced as a turning point in the participants' lives. Before rehabilitation they felt they were on a downward slope without control. Rehabilitation was the start of a process of change whereby they acquired new skills, which, over time, contributed to a different but good life. After approximately a year, they had a sense of control and had accepted life with late effects of polio. They had also established new habits, taken on a changed valued self and could look to the future with confidence. Conclusion: This qualitative study has shown that persons with late effects of polio can benefit from an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme and experience positive changes in their manage­ment of daily activities and in their view of their late effects of polio, their future and their self.

  • 149.
    Larsson-Lund, Maria
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap.
    Perceived participation in life situations in persons with late effects of polio2008Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, nr 8, s. 659-664Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To investigate how persons with late effects of polio perceive their participation and problems with participation in life situations and to determine the association between perceived problems with participation and sex, age, marital status, use of mobility aids and access to instrumental support.Design: Cross-sectional.Subjects: A total of 160 persons with prior polio 6-30 months after an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme.Methods: All subjects answered the Swedish version of the Impact on Participation and Autonomy Questionnaire.Results: A majority of the respondents perceived their participation as sufficient in most activities and 65% of the respondents perceived no severe problems with participation. The remaining 35% perceived 1-6 severe problems with participation. All 5 domains of participation were positively correlated with the 9 items for problem experience. Most restrictions in participation were reported in the domains of Family role, Autonomy outdoors, and Work and education. Insufficient instrumental support was most strongly associated with the perception of severe problems with participation.Conclusion: Rehabilitation programmes for persons with late effects of polio need to focus on areas of participation that are perceived as a problem by these persons and to promote access to a supportive environment to enhance their participation.

  • 150.
    Larsson-Lund, Maria
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Nordlund, Anders
    Nygård, Louise
    Karolinska institutet, Divison of occupational therapy. Department of Neurotec.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap.
    Bernspång, Birgitta
    Umeå University, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Perceptions of participation and predictors of perceived problems with participation in persons with spinal cord injury2005Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 37, nr 1, s. 3-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To describe how persons with spinal cord injury perceived their participation in life situations and to determine the relationship between their participation and perceived problems therewith. The purpose was also to evaluate the influence of age, sex, level of injury, time since injury, marital status and access to social support on perceived problems with participation. Design: Cross-sectional. Subjects: One hundred sixty-one persons with spinal cord injury. Methods: A postal questionnaire including socio-demographic characteristics and a Swedish version of the Impact on Participation and Autonomy questionnaire. Results: A majority of the respondents perceived their participation as sufficient in most activities addressed. Still, a majority of the respondents perceived one or more severe problems with their participation. Access to social support was the most influencing variable in predicting perceived severe problems with participation as compared with certain personal and health-related factors. Conclusion: The results suggest that it is important to consider access to social support along with other factors in the person-environment interaction and their influence on severe problems with participation in enhancing clients' participation in rehabilitation.

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