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Lange, E., Palstam, A., Gjertsson, I. & Mannerkorpi, K. (2019). Aspects of exercise with person-centred guidance influencing the transition to independent exercise: a qualitative interview study among older adults with rheumatoid arthritis. European Review of Aging and Physical Activity, 16(4)
Open this publication in new window or tab >>Aspects of exercise with person-centred guidance influencing the transition to independent exercise: a qualitative interview study among older adults with rheumatoid arthritis
2019 (English)In: European Review of Aging and Physical Activity, ISSN 1813-7253, E-ISSN 1861-6909, Vol. 16, no 4Article in journal (Refereed) Published
Abstract [en]

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

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

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

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

Keywords
Exercise, Patient-centered, Person-centered, Person-centred, Physical therapy, Physiotherapy, Qualitative research, Rheumatology
National Category
Health Sciences
Identifiers
urn:nbn:se:du-30204 (URN)10.1186/s11556-019-0211-8 (DOI)30988827 (PubMedID)
Available from: 2019-06-13 Created: 2019-06-13 Last updated: 2019-06-18Bibliographically approved
Törnbom, K., Lundälv, J., Palstam, A. & Sunnerhagen, K. S. (2019). "My life after stroke through a camera lens"- A photovoice study on participation in Sweden.. PLoS ONE, 14(9), Article ID e0222099.
Open this publication in new window or tab >>"My life after stroke through a camera lens"- A photovoice study on participation in Sweden.
2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 9, article id e0222099Article in journal (Refereed) Published
Abstract [en]

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

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

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

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

National Category
Health Sciences
Identifiers
urn:nbn:se:du-31044 (URN)10.1371/journal.pone.0222099 (DOI)31509564 (PubMedID)
Available from: 2019-10-29 Created: 2019-10-29 Last updated: 2019-10-29Bibliographically approved
Palstam, A., Sjödin, A. & Sunnerhagen, K. S. (2019). Participation and autonomy five years after stroke: A longitudinal observational study.. PLoS ONE, 14(7), Article ID e0219513.
Open this publication in new window or tab >>Participation and autonomy five years after stroke: A longitudinal observational study.
2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 7, article id e0219513Article in journal (Refereed) Published
Abstract [en]

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

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

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

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

National Category
Health Sciences
Identifiers
urn:nbn:se:du-31045 (URN)10.1371/journal.pone.0219513 (DOI)31283800 (PubMedID)
Available from: 2019-10-29 Created: 2019-10-29 Last updated: 2019-10-29
Palstam, A., Westerlind, E., Persson, H. C. & Sunnerhagen, K. S. (2019). Work-related predictors for return to work after stroke.. Acta Neurologica Scandinavica, 139(4), 382-388
Open this publication in new window or tab >>Work-related predictors for return to work after stroke.
2019 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 139, no 4, p. 382-388Article in journal (Refereed) Published
Abstract [en]

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

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

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

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

National Category
Health Sciences
Identifiers
urn:nbn:se:du-30205 (URN)10.1111/ane.13067 (DOI)30657175 (PubMedID)
Available from: 2019-06-13 Created: 2019-06-13 Last updated: 2019-06-18Bibliographically approved
Larsson, A., Palstam, A., Bjersing, J., Löfgren, M., Ernberg, M., Kosek, E., . . . Mannerkorpi, K. (2018). Controlled, cross-sectional, multi-center study of physical capacity and associated factors in women with fibromyalgia. BMC Musculoskeletal Disorders, 19(1), Article ID 121.
Open this publication in new window or tab >>Controlled, cross-sectional, multi-center study of physical capacity and associated factors in women with fibromyalgia
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2018 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 19, no 1, article id 121Article in journal (Refereed) Published
Abstract [en]

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

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

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

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

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

Keywords
Activity limitations, Fibromyalgia, Muscle strength, Physical capacity, Symptom duration, Walking ability
National Category
Clinical Medicine
Identifiers
urn:nbn:se:du-30271 (URN)10.1186/s12891-018-2047-1 (DOI)29673356 (PubMedID)
Available from: 2019-06-18 Created: 2019-06-18 Last updated: 2019-06-18Bibliographically approved
Palstam, A., Törnbom, M. & Sunnerhagen, K. S. (2018). Experiences of returning to work and maintaining work 7 to 8 years after a stroke: a qualitative interview study in Sweden. BMJ Open, 8(7), Article ID e021182.
Open this publication in new window or tab >>Experiences of returning to work and maintaining work 7 to 8 years after a stroke: a qualitative interview study in Sweden
2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 7, article id e021182Article in journal (Refereed) Published
Abstract [en]

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

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

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

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

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

Keywords
qualitative research, rehabilitation medicine, return to work, stroke, stroke medicine
National Category
Clinical Medicine
Identifiers
urn:nbn:se:du-30269 (URN)10.1136/bmjopen-2017-021182 (DOI)30012785 (PubMedID)
Available from: 2019-06-18 Created: 2019-06-18 Last updated: 2019-06-18Bibliographically approved
Lundgren-Nilsson, Å., Dencker, A., Palstam, A., Person, G., Horton, M. C., Escorpizo, R., . . . Conaghan, P. G. (2018). Patient-reported outcome measures in osteoarthritis: a systematic search and review of their use and psychometric properties.. RMD Open, 4(2), Article ID e000715.
Open this publication in new window or tab >>Patient-reported outcome measures in osteoarthritis: a systematic search and review of their use and psychometric properties.
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2018 (English)In: RMD Open, E-ISSN 2056-5933, Vol. 4, no 2, article id e000715Article in journal (Refereed) Published
Abstract [en]

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

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

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

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

Keywords
osteoarthritis, patient, reported outcome measure, questionnaire
National Category
Clinical Medicine
Identifiers
urn:nbn:se:du-30267 (URN)10.1136/rmdopen-2018-000715 (DOI)30622735 (PubMedID)
Available from: 2019-06-18 Created: 2019-06-18 Last updated: 2019-06-18Bibliographically approved
Ernberg, M., Christidis, N., Ghafouri, B., Bileviciute-Ljungar, I., Löfgren, M., Bjersing, J., . . . Kosek, E. (2018). Plasma cytokine levels in fibromyalgia and their response to 15 weeks of progressive resistance exercise or relaxation therapy. Mediators of Inflammation, 2018, Article ID 3985154.
Open this publication in new window or tab >>Plasma cytokine levels in fibromyalgia and their response to 15 weeks of progressive resistance exercise or relaxation therapy
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2018 (English)In: Mediators of Inflammation, ISSN 0962-9351, E-ISSN 1466-1861, Vol. 2018, article id 3985154Article in journal (Refereed) Published
Abstract [en]

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

National Category
Medical Biotechnology
Identifiers
urn:nbn:se:du-30270 (URN)10.1155/2018/3985154 (DOI)29849487 (PubMedID)
Available from: 2019-06-18 Created: 2019-06-18 Last updated: 2019-06-18Bibliographically approved
Reinholdsson, M., Palstam, A. & Sunnerhagen, K. S. (2018). Prestroke physical activity could influence acute stroke severity (part of PAPSIGOT). Neurology, 91(16), e1461-e1467
Open this publication in new window or tab >>Prestroke physical activity could influence acute stroke severity (part of PAPSIGOT)
2018 (English)In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 91, no 16, p. e1461-e1467Article in journal (Refereed) Published
Abstract [en]

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

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

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

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

National Category
Clinical Medicine
Identifiers
urn:nbn:se:du-30268 (URN)10.1212/WNL.0000000000006354 (DOI)30232251 (PubMedID)
Available from: 2019-06-18 Created: 2019-06-18 Last updated: 2019-06-18Bibliographically approved
Bjersing, J. L., Larsson, A., Palstam, A., Ernberg, M., Bileviciute-Ljungar, I., Löfgren, M., . . . Mannerkorpi, K. (2017). Benefits of resistance exercise in lean women with fibromyalgia: involvement of IGF-1 and leptin. BMC Musculoskeletal Disorders, 18(1), Article ID 106.
Open this publication in new window or tab >>Benefits of resistance exercise in lean women with fibromyalgia: involvement of IGF-1 and leptin
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2017 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, no 1, article id 106Article in journal (Refereed) Published
Abstract [en]

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

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

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

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

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

Keywords
Resistance Exercise, Aerobic Exercise, Lean Woman, Multidimensional Fatigue Inventory, Resistance Exercise Program
National Category
Clinical Medicine
Identifiers
urn:nbn:se:du-30274 (URN)10.1186/s12891-017-1477-5 (DOI)28288611 (PubMedID)
Available from: 2019-06-18 Created: 2019-06-18 Last updated: 2019-06-18Bibliographically approved
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-7127-213x

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