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  • 1.
    Arkkukangas, Marina
    Dalarna University, School of Health and Welfare, Medical Science. Reg Sormland, Res & Dev Sormland; Malardalen Univ,.
    App-based strength and balance self-test in older adults: an exploratory study from a user perspective2021In: BMC Research Notes, E-ISSN 1756-0500, Vol. 14, no 1, article id 379Article in journal (Refereed)
    Abstract [en]

    Objectives Falls are a common problem, especially in the older population. The number of older adults aged over 65 years is increasing globally, leading to a major challenge in providing effective fall prevention interventions to older adults requiring such interventions. This study aimed to explore the usability of an app-based strength and balance self-tests in a small sample of four older adults. This study is a side product of another project. Results The results from this study indicated that self-test of strength and balance by using a smartphone application is a challenge for older adults. Basic test measures, such as start and stop and counts of sit-to-stand, were difficult to self-administer. However, from a user perspective, the possibility of independently performing these measures was considered important and needed to be further developed and evaluated in future studies.

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  • 2.
    Arkkukangas, Marina
    Mälardalens högskola, Hälsa och välfärd.
    Evaluation of the Otago Exercise Programme with or without motivational interviewing: Feasibility, experiences, effects and adherence among older community-dwelling people2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Falls and injuries related to falls are one of the most common health problems among older people and are becoming increasingly more frequent. Regular exercise has been identified as one of the most effective fall-prevention activities for older people; however, awareness of the impact of exercise programmes and adherence to recommended exercise among the elderly population is generally low. Research examining how an exercise programme is administered to and experienced by elderly community-dwelling people is needed.

    The overall aim of this thesis was to investigate the feasibility, experiences and effects of and adherence to the fall-preventive Otago Exercise Programme (OEP) with or without motivational interviewing (MI) among community-dwelling people aged 75 years or older.

    Four studies were performed from October 2012 to May 2016 in a sample of 175 people. Both quantitative and qualitative research methods were used. The methods included the feasibility for conducting a randomized controlled trial (RCT) (I), individual face-to-face interviews (II), an RCT (III) and a prospective cohort study (IV). The intervention was given to two groups. The participants who received OEP with or without MI were compared with a control group that received standard care.

    The feasibility of performing an exercise intervention with or without MI was acceptable from the perspective of the participating physiotherapists. From the perspective of the older participants performing the exercise with behavioural change support, the inclusion of monitored exercises in everyday life and daily routines was important. The participants also expressed experiencing more strength, improved physical functioning and greater hope for an extended active life during old age.

    From the short-term perspective, there were significant improvements within the OEP combined with MI group in terms of physical performance, fall self-efficacy, activity level, and handgrip strength. Improved physical performance and fall self-efficacy were also found within the control group; however, corresponding differences did not occur in the OEP group without MI. There were no significant differences between the study groups after 12 weeks of regular exercise. Adherence to the exercises in the pooled exercise group was 81% at the 12-week follow-up.

    At the 52-week follow-up, the behavioural factors being physically active and obtaining behavioural support in terms of MI had a significant association with adherence to the exercise programme.

    These studies provide some support for the combination of OEP with MI as the addition of MI was valuable for achieving adherence to the exercise programme over time in older community-dwelling people.

     

  • 3.
    Arkkukangas, Marina
    Dalarna University, School of Health and Welfare, Medical Science. Uppsala University; Mälardalen University.
    Involvement of Older Adults, the Golden Resources, as a Primary Measure for Fall Prevention.2023In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 18, p. 2165-2170Article in journal (Refereed)
    Abstract [en]

    Falls remain the second leading cause of injury-related deaths worldwide; therefore, longstanding practical fall-prevention efforts are needed. Falls can also lead to a reduction in independence and quality of life among older adults. Fall-prevention research has found that early prevention promotes a prolonged independence. However, it remains unknown which intervention is most beneficial for early prevention and how these interventions should be implemented for long-term effects. In addition, the present and future burden on social and healthcare services contributes to a gap in needs and requires an evidence-based fall prevention. Research suggests that strength, balance, and functional training are effective in reducing falls and fall-related injuries. Such training could greatly impacting independence. Fear of falling and strategies for managing falls are the suggested components to be included when evaluating fall-prevention programs. Thus, the preservation of physical functions is highly relevant for both independence and quality of life. It also contributes to psychological and social well-being, which are important factors for enabling individuals to stay at home for as long as possible. To meet future challenges associated with the expected increase in the older population, older adults should be viewed as a golden resource. With assistance from professionals and researchers, they can learn and gain the ability to institute fall-prevention programs in their own environments. These environments are primarily beyond the responsibilities of the healthcare sector. Therefore, programs comprising current knowledge about fall prevention should be developed, evaluated, and implemented with older adults by using a "train-The-trainer" approach, where a natural collaboration is established between civil society and/or volunteers, healthcare professionals, and researchers. For sustainable and effective fall-prevention programs, a co-design and early collaborative approach should be used in the natural environment, before social and healthcare services are required.

  • 4. Arkkukangas, Marina
    Keep on and keep up the fall prevention work: older adults need evidence-based fall prevention actions now more than ever!2021In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 23, no 1, p. 1-2Article in journal (Other academic)
  • 5.
    Arkkukangas, Marina
    et al.
    Dalarna University, School of Health and Welfare, Medical Science. Res & Dev Sormland, Malardalen Univ.
    Cederbom, Sara
    OsloMet, Oslo Metropolitan Univ, Norway.
    Movement toward an evidence-Based, digital fall prevention future-Perceptions from a physiotherapy perspective2023In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 39, no 1, p. 128-136Article in journal (Refereed)
    Abstract [en]

    Background Physiotherapy plays an important role in fall prevention, and is a science- and evidence-based profession that is constantly undergoing development. Currently, the possibility of digital fall prevention is being explored; however, the perception of physiotherapists (PTs) toward a digital approach is still a sparsely investigated topic. Purpose This study aimed to explore the PT's experiences with a fall prevention exercise program used in their daily work and their thoughts regarding the use of digital support in this context. Methods Discussions were held in two focus groups with seven PTs (age: 26-48 years). A qualitative content analysis was performed. Results We identified two main categories: 1) The importance of evidence-based fall prevention exercise; and 2) Transition toward a digital fall prevention exercise approach. The participants expressed that they had time- and resource-related limitations affecting evidence-based work and adherence to fall prevention exercise programs. They stated that education and management support were required. Conclusion There is a need for fall prevention exercise to be evidence-based and prioritized in physiotherapy. The study results provide insights into the lack of adherence to fall prevention exercise programs and highlighted the need for a transition toward working digitally in the future.

  • 6. Arkkukangas, Marina
    et al.
    Cederbom, Sara
    Tonkonogi, Michail
    Dalarna University, School of Health and Welfare, Medical Science.
    Umb Carlsson, Õie
    Older adults’ experiences with mHealth for fall prevention exercise: usability and promotion of behavior change strategies2021In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 37, no 12, p. 1346-1352Article in journal (Refereed)
    Abstract [en]

    Background: With the rapidly growing aging population, older adults need to stay healthy and active for a longer time. Mobile health (mHealth) solutions could help support, prevent, or delay functional decline and falls in old age.Purpose: The aim was to explore older persons? experiences of a mobile application for fall prevention exercise, and to identify what possible behavior change techniques to include in the further development of the application.Methods: Two focus groups were conducted with 12 older adults (seven women and five men) 70 to 83 years of age. A qualitative content analysis was performed.Results: Two main results emerged: 1) external facilitators for using the application; and 2) internal facilitators for using the application and perceived gains, in addition 10 behavior change techniques were identified.Conclusion: With support, an application could be adapted for older adults to manage, motivate, and adhere to fall prevention exercise. To achieve long-term adherence to health behavior changes, behavior change strategies and techniques are recommended to be included in further development of the fallprevention application.

  • 7. Arkkukangas, Marina
    et al.
    Eriksson, Hans-Georg
    Denison, Eva
    Risk factors for fall-related injuries among community-dwelling men andwomen over 70 years of age, based on social cognitive theory: results from apopulation study2021In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 23, no 4, p. 221-226Article in journal (Refereed)
    Abstract [en]

    Introduction: Healthcare professionals’, especially physiotherapists’ role as promoters, preventers andrehabilitators play a significant role in prevention of falls. The purpose of this study was to gain knowledgeon the risk factors which are associated with fall-related injuries among community dwellingmen and women, based on Social Cognitive Theory (SCT) concepts.Patients and methods: The study includes 13,151 people who responded to a postal survey questionnairein 2017. The random sample consisted of men and women aged 70 years and older. Multivariate regressionmodels were used to explore associations between theory-based risk factors and fall-related injuries.Results: A total of 16% (1951 people) reported a fall-related injury during the past 12months. Formen, a total of seven risk factors were associated with fall-related injury: age, pain (neck/shoulder),incontinence, depression, help in daily living, education and sedentary behaviour. For women, a totalof nine risk factors were associated with fall-related injury: age, pain (extremities and neck/shoulder),tiredness, incontinence, appetite, economy, accommodation and participation in social activities.Conclusions: This study identified risk factors from all aspects of the SCT, serving as a clinically usefultheory in addition to traditional fall preventive actions. Gender differences should be considered whendesigning fall prevention strategies.

  • 8.
    Arkkukangas, Marina
    et al.
    Dalarna University, School of Health and Welfare, Medical Science. Mälardalen University, Västerås.
    Hedberg Graff, Jenny
    Habilitation Center Region Sormland, Eskilstuna, Sweden.
    Denison, Eva
    School of Health, Care and Social Welfare, Department of Physiotherapy Malardalen University, Vasteras, Sweden.
    Evaluation of the electro-dress Mollii® to affect spasticity and motor function in children with cerebral palsy: Seven experimental single-case studies with an ABAB design2022In: Cogent Engineering, E-ISSN 2331-1916, Vol. 9, no 1, article id 2064587Article in journal (Refereed)
    Abstract [en]

    There are limited non-invasive treatment options in the home environment for children with cerebral palsy (CP); thus, evaluating such treatment options is needed. We aimed to evaluate the effect of an innovative full-body suit approach for non-invasive surface electrical stimulation ES, the electro-dress Mollii®. The full-body suit was primarily designed to reduce spasticity and improve motor function through the mechanism of reciprocal inhibition among children with CP. This study involved seven experimental single-case studies with an ABAB design. Seven studies were performed among children aged 4–17 years. The primary outcome (spasticity) was analyzed using graphed data with a visual inspection, and median values were analyzed for secondary outcomes (mobility, sitting, upper limb activity, sleep, pain, and adherence to treatment). The study protocol was recorded at clinicaltrials.gov (NCT04078321). Seven studies were analyzed, and the treatment with the electro-dress had little or no impact on the outcomes: spasticity, mobility, sitting, upper limb activity, sleep, and pain, in any of these seven studies. In conclusion, multiple ES treatment with the innovative electro-dress Mollii® revealed little or no observable changes on primary outcome (spasticity) in any of the seven studies. Further the possible impact on motor function is recommended to be further evaluated in future studies. © 2022 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.

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  • 9.
    Arkkukangas, Marina
    et al.
    Uppsala universitet.
    Hultgren, Staffan
    Region Västmanland.
    Implementation of motivational interviewing in a fall prevention exercise program: experiences from a randomized controlled trial2019In: BMC Research Notes, E-ISSN 1756-0500, Vol. 12, no 1, article id 270Article in journal (Refereed)
    Abstract [en]

    Objective: The elderly population over 65 is increasing globally, and interventions promoting health and preventive work, especially fall prevention, will constitute a large part of physiotherapists' duties in the near future. To address the challenges of promoting effective and sustainable health behavior changes among older persons, physiotherapists need support when it comes to how to apply behavior change strategies, especially in fall prevention. Therefore, the aim of this study was to describe implementation of motivational interviewing in a fall prevention exercise program. This study is a side product of another project.

    Results: Data from a recently performed three-armed randomized controlled trial were used to describe the implementation of motivational interviewing in the exercise group (n = 58). Level of motivation (priorities) and self-efficacy for both the physiotherapist and the participant in treatment, and to use a guide targeted towards the planned treatment are recommended actions. Regular meetings and follow ups as well as updates of motivational interviewing skills during a treatment period, should also be considered to achieve treatment fidelity. Trial registration NCT01778972, Retrospectively registered January 29, 2013.

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  • 10.
    Arkkukangas, Marina
    et al.
    Mälardalens högskola, Hälsa och välfärd.
    Johnson, S. T.
    Uppsala University, Uppsala, Sweden.
    Hellström, K.
    Uppsala University, Uppsala, Sweden.
    Söderlund, Anne
    Mälardalens högskola, Hälsa och välfärd.
    Eriksson, S.
    Centre for Clinical Research Sörmland, Sweden.
    Johansson, Ann-Christin
    Mälardalens högskola, Hälsa och välfärd.
    A feasibility study of a randomised controlled trial comparing fall prevention using exercise with or without the support of motivational interviewing2015In: Preventive Medicine Reports, E-ISSN 2211-3355, Vol. 2, p. 134-140Article in journal (Refereed)
    Abstract [en]

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

  • 11. Arkkukangas, Marina
    et al.
    Johnson, Susanna Tuvemo
    Hellström, Karin
    Anens, Elisabeth
    Tonkonogi, Michail
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Larsson, Ulf
    Fall prevention exercises with or without behavior change support for community-dwelling older adults: a two-year follow-up of a randomized controlled trial2019In: Journal of Aging and Physical Activity, ISSN 1063-8652, E-ISSN 1543-267X, Vol. 28, no 1, p. 34-41Article in journal (Refereed)
    Abstract [en]

    This study investigates the effectiveness of two fall prevention exercise interventions targeting physical performance, activity level, fall-related self-efficacy, health-related quality of life, and falls: the Otago Exercise Programme (OEP) with and the OEP without behavior change support. In this randomized controlled trial (RCT), 175 participants were randomised into two intervention groups and one control group. A total of 124 community-dwelling older adults over the age of 75 who needed walking aids or home support participated in the two-year follow-up. The OEP with and the OEP without support for behavior change displayed no long-term benefits on physical performance, fall-related self-efficacy, health-related quality of life, and falls compared to a control group. Although no significant differences were detected between the groups, the results implied the control group's physical activity level decreased compared to the intervention groups at two-year follow up.

  • 12.
    Arkkukangas, Marina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Research and Development in Sörmland, Eskilstuna, Sweden.
    Strömqvist Bååthe, Karin
    Dalarna University, School of Health and Welfare, Medical Science.
    Ekholm, Anna
    Tonkonogi, Michail
    Dalarna University, School of Health and Welfare, Medical Science.
    A 10-week judo-based exercise programme improves physical functions such as balance, strength and falling techniques in working age adults2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 744Article in journal (Refereed)
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  • 13. Arkkukangas, Marina
    et al.
    Strömqvist Bååthe, Karin
    Ekholm, Anna
    Tonkonogi, Michail
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Health promotion and prevention: The impact of specifically adapted judo-inspired training program on risk factors for falls among adults.2020In: Preventive Medicine Reports, E-ISSN 2211-3355, Vol. 19, article id 101126Article in journal (Refereed)
    Abstract [en]

    Globally, falls and fall-related injuries constitute a severe threat to public health at all ages. New approaches are warranted since existing knowledge and actions have failed to reduce the incidence of falls and fall-related injuries, both at work and during leisure time. The purpose of this quasi-experimental study was to investigate the impact of a 10-week supervised judo-inspired exercise program, Judo4Balance, provided in a workplace setting among men and women targeting: physical functions, activity level, fall-related self-efficacy, and techniques for safe landing when falling. A total of 79 adults from seven different workplaces in Sweden, mean age 45 years (18-68), participated in the program. The study was conducted from May 2018 to June 2019. The 10-week exercise program performed in a workplace setting improved physical and psychological functions, as well as techniques for falling safely, factors of great importance to prevent falls and fall-related injuries among men and women. Therefore, it is suggested that the judo-inspired exercise program may be an effective tool in the quest to promote health and prevention of risk factors for falls and fall-related injuries among those of working age.

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  • 14.
    Arkkukangas, Marina
    et al.
    Dalarna University, School of Health and Welfare, Medical Science. School of Health, Care and Social Welfare, Department of Physiotherapy, Mälardalen University, Västerås; Research and Development in Sörmland, Region Sörmland, Eskilstuna.
    Strömqvist Bååthe, Karin
    Dalarna University, School of Health and Welfare, Medical Science.
    Ekholm, Anna
    Research and Development in Sörmland, Region Sörmland, Eskilstuna.
    Tonkonogi, Michail
    Dalarna University, School of Health and Welfare, Medical Science.
    Short Multicomponent Group Exercise Intervention Promotes Long-Term Physical Activity Habits among Community-Dwelling Older Adults during COVID-19 Restrictions: A Cohort Study2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 22, article id 15140Article in journal (Refereed)
    Abstract [en]

    This study investigated whether strength, balance, body mass index, falls self-efficacy, activity levels, self-rated health, and participation in a multicomponent exercise intervention could predict physical activity levels after 5 months of self-quarantine due to the COVID-19 pandemic. This study included baseline data of 200 community-dwelling older adults (79% women, 21% men) with a mean age of 72 years who participated in a randomized controlled trial investigating a multicomponent exercise program, with 7-month follow-up survey data of their physical activity levels. The results showed significant associations with the activity levels at the 7-month follow-up. The activity levels (odds ratio (OR): 2.83, 95% CI: 1.20-6.71), the self-rated health score (2.80, 1.42-5.53), and being allocated to a specific multicomponent group-based exercise program (2.04, 1.04-4.00) showed a significant association with the activity habits at the 7-month follow-up. As this study suggests, besides the physical activity levels and the self-rated health score, participation in a high challenge multicomponent exercise program was significantly associated with physical activity levels at the 7-month follow-up. This study indicates that a relatively short multicomponent group exercise program (6-9 weeks) can motivate individuals to sustain their own training and activity levels even several months after the program has been paused or terminated. Identifying older adults' physical activity levels and self-rated health scores and prescribing multicomponent group-based exercise programs to promote sustained physical activity habits may be a successful alternative to provide for older adults in the future.

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  • 15. Arkkukangas, Marina
    et al.
    Strömqvist Bååthe, Karin
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Hamilton, Julia
    Ekholm, Anna
    Tonkonogi, Michail
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Feasibility of a novel Judo4Balance – fall preventive exercise programme targeting community-dwelling older adults2020In: Journal of Frailty, Sarcopenia and Falls, ISSN 2459-4148, Vol. 5, no 3, p. 47-52Article in journal (Refereed)
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  • 16. Arkkukangas, Marina
    et al.
    Strömqvist Bååthe, Karin
    Dalarna University, School of Health and Welfare, Medical Science.
    Hamilton, Julia
    Ekholm, Anna
    Tonkonogi, Michail
    Dalarna University, School of Health and Welfare, Medical Science.
    Pilotstudie av genomförbarheten av Judo4Balance - ett fallförebyggande träningsprogram för äldre personer i eget boende.2021In: Äldre i Centrum Vetenskapligt Supplement, ISSN 2003-9069, Vol. 1, no 1, p. 27-37Article in journal (Refereed)
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  • 17.
    Arkkukangas, Marina
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Mälardalen University.
    Sundler, Annelie Johansson
    Söderlund, Anne
    Eriksson, Staffan
    Johansson, Ann Christin
    Older persons’ experiences of a home-based exercise programme with behavioural change support2017In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, no 12, p. 905-913Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 18. Arkkukangas, Marina
    et al.
    Söderlund, Anne
    Eriksson, Staffan
    Johansson, Ann-Christin
    Fall Preventive Exercise with or without behavior change support for community-dwelling older adults: A Randomized Controlled Trial With Short-Term Follow-up.2019In: Journal of Geriatric Physical Therapy, ISSN 1539-8412, E-ISSN 2152-0895, Vol. 42, no 1, p. 9-17Article in journal (Refereed)
  • 19. Arkkukangas, Marina
    et al.
    Söderlund, Anne
    Eriksson, Steffan
    Johansson, Ann-Christin
    One-Year Adherence to the Otago Exercise Program With or Without Motivational Interviewing in Community-Dwelling Older Adults2018In: Journal of Aging and Physical Activity, ISSN 1063-8652, E-ISSN 1543-267X, Vol. 26, no 3, p. 390-395Article in journal (Refereed)
    Abstract [en]

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

  • 20.
    Arkkukangas, Marina
    et al.
    Dalarna University, School of Health and Welfare, Medical Science.
    Tonkonogi, Michail
    Dalarna University, School of Health and Welfare, Medical Science.
    Fall, fallrisk och fallprevention: genom träning2021Book (Other academic)
    Abstract [sv]

    Är fallolyckor en naturlig följd av åldrandet? Vilka möjligheter finns det för trygg rörelse och aktivitet även i hög ålder? Går det att förebygga fall och fallskador genom specifik och målinriktad träning?

    Denna bok har som ambition att täcka såväl teoretiska som praktiska aspekter på de specifika fallrisker som följer med åldrandet. Författarna beskriver det aktuella kunskapsläget kring förekomst, konsekvenser, riskanalys och prevention av fallolyckor. Dessutom presenteras tydligt, i såväl bild som text, praktiska träningsprogram och övningar inriktade på att förebygga fall och fallskador.

    Fall, fallrisk och fallprevention vänder sig till studerande inom fysioterapi, arbetsterapi, omvårdnad, medicin och omsorg samt till kliniskt verksamma som arbetar med äldre personer. Boken kan även vara intressant för äldre personer som vill stärka sin hälsa och sitt välbefinnande samt minska risken för en fallolycka.

  • 21.
    Byström, Elin
    et al.
    Region Vastmanland - Uppsala University Centre for Clinical Research, Vastmanland Hospital Vasteras, Västerås; Department of Public Health and Caring Sciences, Uppsala University, Uppsala.
    Wennlöf, Björn
    Region Vastmanland - Uppsala University Centre for Clinical Research, Vastmanland Hospital Vasteras, Västerås; Department of Public Health and Caring Sciences, Uppsala University, Uppsala.
    Johansson, Inger
    The Swedish Partnership for Mental Health in Vastmanland, NSPH, Västerås.
    Lönnberg, Lena
    Region Vastmanland - Uppsala University Centre for Clinical Research, Vastmanland Hospital Vasteras, Västerås; Department of Public Health and Caring Sciences, Uppsala University, Uppsala.
    Arkkukangas, Marina
    Dalarna University, School of Health and Welfare, Medical Science. Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna; Department of Physiotherapy, School of Health, Care and Social Welfare, Malardalen University, Västerås.
    Pellas, Johnny
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala.
    Damberg, Mattias
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala.
    DepActive: study protocol for a randomised controlled multicentre trial of telephone-delivered behavioural activation for the treatment of depression in older adults in primary care2024In: Trials, E-ISSN 1745-6215, Vol. 25, no 1, article id 659Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Depression is common in older adults and is related to reduced quality of life and functional ability as well as increased mortality and morbidity. Current guidelines recommend psychological treatments for the treatment of depression in adults. Studies show that about 30% of older adults with depression in Sweden receive pharmacological treatment and about 3% receive psychological treatment. However, a majority receive no treatment at all. There is a need for effective and scalable psychological treatment options for older adults with depression in primary care. Behavioural activation is an extensively evaluated, effective, and relatively simple treatment for depression that can be delivered by health care professionals without comprehensive training in psychological treatment.

    METHODS: We will conduct a randomised controlled 2-armed parallel group multicentre trial comparing treatment as usual in primary care to a five-session telephone-delivered behavioural activation treatment as add on to treatment as usual. The current trial is open labelled. In all, 250 older adults (≥ 65 years) with depression will be recruited from primary healthcare centres in three Swedish regions. The primary outcome is depressive symptoms measured with the Montgomery Åsberg Depression Rating Scale - Self rating version (MADRS-S) after treatment and at 3- and 6-month follow-up. Secondary outcomes include depression diagnoses, activity level (self-rated and measured with accelerometer), and self-rated anxiety, daily functioning, quality of life, self-efficacy, and loneliness.

    DISCUSSION: There is a need for fully powered studies of brief behavioural activation for older adults with depression delivered by telephone in a primary care context. This study has the potential to improve first-line treatment of depression in older adults in primary care, consequently reducing morbidity and mortality within this population. Increasing the availability and accessibility to effective psychological treatment for depression in older adults is needed to meet future demographic changes.

    TRIAL REGISTRATION: ClinicalTrials.gov: NCT06284889 . Registered February 28, 2024.

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  • 22.
    Cederbom, Sara
    et al.
    OsloMet, Oslo Metropolitan University, Norway.
    Arkkukangas, Marina
    Uppsala universitet.
    Impact of the fall prevention Otago Exercise Programme on pain among community-dwelling older adults: a short- and long-term follow-up study2019In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 14, p. 721-726Article in journal (Refereed)
    Abstract [en]

    Background: Pain is a major public health issue among community-dwelling older adults, with a prevalence of 45-80%. In addition to being strongly associated with reduced physical function, loss of independence, psychological distress, lower quality of life, and risk of earlier death. Recent research has also found that pain in older adults is associated with a higher risk of falls, which itself is another major health concern. Long-term and high-intensity pain are predictors of chronic pain and pain-related disability. Therefore, establishing an evidence-based intervention that can reduce both pain and falls in older adults is of high importance.

    Purpose: This study aimed to investigate whether a home-based fall-preventive exercise-program can reduce pain in the target population over both the short and long term.

    Patients and methods: This was a quasi-experimental study with a 1-group pretest-posttest design. We included 119 participants who had participated in a recent 2-year fall prevention intervention in a randomized controlled trial. The intervention included exercises based on the Otago Exercise Programme (OEP), an individually tailored and prescribed program that involves home-based exercises supervised by a physiotherapist. Pain was measured using an item from the EuroQol-5D questionnaire.

    Results: Pain was significantly reduced from baseline (n=119) at 3 (n=105, p=0.003), 12 (n=96, p=0.041), and 24 (n=80, p=0.028) months following the commencement of OEP-based exercises.

    Conclusions: These results indicate that the OEP could be a suitable evidence-based program for both pain management and fall prevention among community-dwelling older people who live with pain and are at a higher risk of falling. Our study highlights an effective technique for better pain management and fall prevention in older adults.

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  • 23.
    Folke, Mia
    et al.
    Mälardalens högskola, Inbyggda system.
    Åkerberg, Anna
    Mälardalens högskola, Hälsa och välfärd.
    Arkkukangas, Marina
    Research and Development in Sörmland, Eskilstuna, Sweden.
    Kärnsund, Annika
    Center for Clinical Research, Västerås, Sweden.
    Johnsson, Mikael
    Blekinge Institute of Technology, Karlskrona, Sweden.
    Evaluation of the content of a web tool aimed to identify early markers related to fall risk among middle-aged people2020In: Health and Technology, ISSN 2190-7188, E-ISSN 2190-7196, p. 1571-1578Article in journal (Refereed)
    Abstract [en]

    Today, the health care sector has no test for early age-related deterioration in physical ability. The aim of this study was to evaluate questionnaires, videos and physical tests whose task will be to identify early markers related to an increased fall risk in middle-aged people. If the person is aware of deficits in physical ability related to fall risk, the person can then use that knowledge to perform relevant training that can strengthen the physical ability related to fall risk. Self-efficacy for balance and strength, physical ability related to fall risk and body composition were measured for 36 middle-aged test participants. This study shows that the tested physical exercises were useful for self-assessment of physical ability. Impairment in physical ability could not be identified solely with measurement of body composition, walking speed, questions, videos that show adjustments that are common in people with impaired balance, or an extended version of the Short version of Activities-specific Balance Confidence scale. This study indicates that a combination of questionnaires, videos and physical exercises can evaluate physical ability and act as a method to identify early markers related to increased fall risk. The questionnaire, videos and physical exercises can be implemented in a web tool that could make persons aware that they have decreased physical ability regarding fall risk or that they needlessly make physical compensations when performing daily activities and thus are missing opportunities to strengthen their physical ability every day.

  • 24. Gusdal, Annelie K
    et al.
    Johansson-Pajala, Rose-Marie
    Arkkukangas, Marina
    Ekholm, A.
    Zander, Viktoria
    Preventing Falls and Malnutrition among Older Adults in Municipal Residential Care in Sweden: A Registry Study2021In: Sage Open Nursing, E-ISSN 2377-9608, Vol. 7Article in journal (Refereed)
    Abstract [en]

    Introduction: Older adults in municipal residential care are among the most vulnerable and in need of most care. The prevalence of negative events, such as falls and malnutrition, is increased among these older adults. The need for strategies to prevent falls and malnutrition is emphasized in guidelines and systematic, individualized risk assessments are prerequisites for adequate interventions. Objectives: The overall purpose of this study was to investigate the assessed risks of, and risk factors for, falling and malnutrition and the correlations between these assessed risks among older women and men in residential care. Further, the purpose was to investigate the consistency between planned and performed interventions among women and men assessed as at risk. Methods: A cross-sectional registry study based on risk assessment data in the Swedish national quality registry, Senior Alert. Altogether, 5,919 older adults ≥65 in nursing homes and dementia care units in 19 municipalities in Sweden were included. Results: Of the older adults, 77% were at risk of falls, and 59% were at risk of malnutrition. The most prevalent risk factors for falls were previous falls and not being cognitively oriented; and for malnutrition were having mild or severe dementia or depression. A significant positive correlation between the risk of falling and the risk of malnutrition was found. Less than half of the planned interventions for falls and malnutrition were performed. Care staff’s least common interventions to prevent falls were balance, muscular function, and strength training, which contrasts with the recommendations; interventions to prevent malnutrition were only partially adhering to recommendations. Conclusions: This cross-sectional registry study points towards the importance of using an evidence-based approach, based on adherence to recommended guidelines, in the prevention of falling and malnutrition. Further, the implementation of clinical practice guidelines is needed, which requires educational training for care staff and supportive leadership.

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  • 25.
    Liljeroos, Maria
    et al.
    Linköping University, Linköping; Uppsala University, Eskilstuna.
    Arkkukangas, Marina
    Dalarna University, School of Health and Welfare, Medical Science. Uppsala University, Eskilstuna; Mälardalen University, Västerås.
    Implementation of Telemonitoring in Health Care: Facilitators and Barriers for Using eHealth for Older Adults with Chronic Conditions2023In: Risk Management and Healthcare Policy, E-ISSN 1179-1594, Vol. 16, p. 43-53Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The retrospective study used a hybrid design aimed to a) describe the implementation process of telemonitoring from stakeholders' perspectives and b) identify facilitators and barriers perceived by the care team.

    PATIENTS AND METHODS: Qualitative interview data were analyzed using manifest inductive qualitative content analysis to describe what was perceived as barriers and what facilitated the implementation. Participating healthcare professionals recruited from a multi-professional care team in Sweden. Overall, 14 healthcare professionals comprising 8 assistant nurses, 3 nurses, 1 physiotherapist, 1 occupational therapist, and one general practitioner participated in five interviews.

    RESULTS: Four categories were derived from the interview analysis: previous experience with digital technology, the need for preparation before implementation, perceptions of using telemonitoring in daily practice from the patient's perspective, and perceptions of the relevance and reasons for applying telemonitoring from the care team's perspective. The identification of stakeholders and the need to plan carefully when proposing the introduction of telemonitoring systems into work practices are both crucial.

    CONCLUSION: The attitudes of healthcare professionals can be a significant factor in the acceptance and efficiency of the use of telemonitoring in practice. Therefore, implementing new technology in healthcare should involve healthcare professionals at an early stage to gain common understanding.

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  • 26.
    Liljeroos, Maria
    et al.
    Linköping University, Linköping; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna.
    Arkkukangas, Marina
    Dalarna University, School of Health and Welfare, Medical Science. Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna; Mälardalen University, Västeras.
    Strömberg, Anna
    Linköping University, Linköping; .
    The long-term effect of an m-health tool on self-care in patients with heart failure: a pre-post interventional study with a mixed-method analysis2024In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 23, no 5, p. 470-477, article id zvad107Article in journal (Refereed)
    Abstract [en]

    AIMS: The aims of this study were (i) to evaluate the effects of using an m-health tool on self-care behaviour at 3 and 12 months and (ii) to explore the experiences and perceptions of heart failure (HF) patients about the m-health tool.

    METHODS AND RESULTS: In this pre-post interventional study with a mixed-method analysis, 71 patients diagnosed with HF [49% female, mean age 76.7 years, New York Heart Association (NYHA) II 31%, NYHA III 69%] were enrolled and had the m-health tool installed in their home for 1 year. The tool consisted of a pre-programmed tablet including a weighing scale and interactive education about HF self-care. At baseline, and at 3 and 12 months, self-care was assessed using the European Heart Failure Self-care Behaviour (EHFScB-9) Scale, an eight-item self-administered questionnaire assessing the experiences of the m-health tool. The mean EHFScB-9 at baseline was 63.8 ± 2.8 and it improved to 67.6 ± 7.6 after 3 months (P < 0.05). After 1 year, the score had decreased to 63.2 ± 7.1 (P = 0.68). Most patients rated the tool as 'good', both at 3 months (92%) and after 12 months (93%). Some found the system to be unnecessary to some degree, and this number increased between 3 and 12 months (P < 0.001). Most patients felt that m-health increased their feelings of security, and 85% responded that the system increased their family members' sense of security.

    CONCLUSION: The m-health tool significantly improved patients' self-care behaviour after 3 months, but this effect did not persist after 1 year. For achieving long-term effects and outcomes, additional and regularly updated self-care support may be needed.

    REGISTRATION: ClinicalTrials.gov: NCT04955600.

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  • 27.
    Tonkonogi, Michail
    et al.
    Dalarna University, School of Health and Welfare, Medical Science.
    Arkkukangas, Marina
    Dalarna University, School of Health and Welfare, Medical Science.
    Strömqvist Bååthe, Karin
    Dalarna University, School of Health and Welfare, Medical Science.
    Ekholm, Anna
    High challenge exercise and learning safe landing strategies among community dwelling older adults: a randomized controlled trial2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 12, article id 7370Article in journal (Refereed)
    Abstract [en]

    There is limited research on optimal exercise programs that effectively decrease falls and fall-related injuries in older populations. This randomized controlled trial (RCT) aimed to explore the effects of a 12-week Judo4Balance program on falling techniques, physical and psychological functions, health status, and physical activity levels among 200 community-dwelling older adults (79% women and 21% men) with a mean age of 72 years. The 200 participants were randomly allocated for the Judo4Balce program (n = 100) or control group (n = 100). The RCT intervention started in mid-January 2020 and was abruptly interrupted because of the COVID-19 pandemic. A restart of the RCT was initiated in September 2021, and the 12-week intervention was offered to two groups. This study reports the results from three points of assessment: baseline, 20-month follow-up, and 12-week postintervention. At 20 months follow-up, the control group had significantly decreased physical activity levels (summer p = 0.002 and winter p = 0.003); similar changes were not seen in the exercise group. In the exercise group, learning falling techniques in 6-9 weeks led to sustained fall competence at 20 months follow-up. Further, significant improvements in physical function (exercise group p = 0.009 and control group p &lt; 0.001) and learning falling techniques (p &lt; 0.001 for both groups) were noted in both groups after the 12-week intervention. This effective, supervised, group-based, high-challenge multicomponent exercise program needs to be further evaluated for possible impact on falls and fall-related injuries. 

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