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  • 1.
    Ahlstrom, Christer
    et al.
    Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Lovgren, Maria Gink
    Volvo Bus Corp, Denmark.
    Nilsson, Mats
    Volvo Bus Corp, Denmark.
    Willstrand, Tania Dukic
    Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Anund, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    The effect of an active steering system on city bus drivers muscle activity2019In: International Journal of Occupational Safety and Ergonomics, ISSN 1080-3548, E-ISSN 2376-9130, Vol. 25, no 3, p. 377-385Article in journal (Refereed)
    Abstract [en]

    City bus drivers spend hours driving under time pressure, in congested traffic and in a monotonous sitting position. This leads to unhealthy working conditions, especially in terms of physical and psychological stress. The aim of this study is to investigate whether an active steering system can alleviate the musculoskeletal stress involved in manoeuvring a bus. Twenty bus drivers drove a city bus equipped with the Volvo dynamic steering (VDS) support system in real traffic. Steering effort was evaluated with electromyography and with a questionnaire. Compared to baseline, VDS significantly reduced the required muscle activity by on average 15-25% while turning, and up to 68% in the part of the manoeuvre requiring maximum effort. The bus drivers believed that VDS will help reduce neck and shoulder problems, and they expressed a desire to have VDS installed in their own bus.

  • 2.
    Ahlström, Christer
    et al.
    Swedish National Rd and Transport Research Institute VTI, S-58195 Linkoping, Sweden.
    Jansson, Sabina
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Anund, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Swedish National Rd and Transport Research Institute VTI, S-58195 Linkoping, Sweden.
    Local changes in the wake electroencephalogram precedes lane departures2017In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 26, no 6, p. 816-819Article in journal (Refereed)
    Abstract [en]

    The objective of this exploratory study is to investigate if lane departures are associated with local sleep, measured via source-localized electroencephalography (EEG) theta power in the 5-9 Hz frequency range. Thirty participants drove in an advanced driving simulator, resulting in 135 lane departures at high levels of self-reported sleepiness. These lane departures were compared to matching non-departures at the same sleepiness level within the same individual. There was no correspondence between lane departures and global theta activity. However, at the local level an increased risk for lane departures was associated with increased theta content in brain regions related to motor function.

  • 3.
    Anund, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Swedish National Rd and Transport Research Institute, Linkoping, Sweden.
    Ihlstrom, Jonas
    Swedish National Rd and Transport Research Institute, Linkoping, Sweden.
    Fors, Carina
    Swedish National Rd and Transport Research Institute, Linkoping, Sweden.
    Kecklund, Göran
    Stockholm University, Sweden.
    Filtness, Ashleigh
    Queensland University of Technology, Australia.
    Factors associated with self-reported driver sleepiness and incidents in city bus drivers2016In: Industrial Health, ISSN 0019-8366, E-ISSN 1880-8026, Vol. 54, no 4, p. 337-346Article in journal (Refereed)
    Abstract [en]

    Driver fatigue has received increased attention during recent years and is now considered to be a major contributor to approximately 15-30% of all crashes. However, little is known about fatigue in city bus drivers. It is hypothesized that city bus drivers suffer from sleepiness, which is due to a combination of working conditions, lack of health and reduced sleep quantity and quality. The overall aim with the current study is to investigate if severe driver sleepiness, as indicated by subjective reports of having to fight sleep while driving, is a problem for city based bus drivers in Sweden and if so, to identify the determinants related to working conditions, health and sleep which contribute towards this. The results indicate that driver sleepiness is a problem for city bus drivers, with 19% having to fight to stay awake while driving the bus 2-3 times each week or more and nearly half experiencing this at least 2-4 times per month. In conclusion, severe sleepiness, as indicated by having to fight sleep during driving, was common among the city bus drivers. Severe sleepiness correlated with fatigue related safety risks, such as near crashes.

  • 4.
    Areskoug-Josefsson, Kristina
    et al.
    Jönköping University, Sweden; Oslo Metropolitan University, Oslo, Norway; VID Specialized University, Sandnes, Norway.
    Hjalmarsson, Sara
    Swedish Rheumatism Association, Norrköping, Sweden.
    Björk, Mathilda
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Rheumatology.
    Sverker, Annette M.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Co-Creation of a Working Model to Improve Sexual Health for Persons Living with Rheumatological Diseases2020In: Open Journal of Rheumatology and Autoimmune Diseases, ISSN 2163-9914, Vol. 10, no 3, p. 109-124Article in journal (Refereed)
    Abstract [en]

    Background: Sexual health needs are insufficiently met for persons living with rheumatological diseases and it is necessary to create better ways to meet these needs.Objective: To co-create a working model to improve sexual health for persons living with rheumatological diseases, that can be used by rheumatological teams in regular rheumatology practice.Design: This study applied a co-creation design with three key features: 1) it took a systems perspective with emergent multiple interactive entities; 2) the research process was viewed as a creative endeavour with strong links to design, while human imagination and the individual experience of patient and staff were at the core of the creative design effort; 3) the process of the co-creative efforts was as important as the generated product.Results: A model defining the role of the patient, the professionals, and the team in optimizing sexual health for persons living with rheumatological diseases was co-created. The model can be seen as a practice guideline, which includes the support needed from and to each participant in the process of promoting sexual health, while being within the professional scope of the professionals’ knowledge and capacity, and in line with the needs of the persons living with rheumatological diseases.Discussion and Conclusions: The co-creative work process identified crucial factors in promoting sexual health, resulting in a useful model for patients, professionals and teams. Co-creation was experienced to be a useful research design to improve rheumatological care, through valuing and using the competence of all research members equally.

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  • 5.
    Augutis, Marika
    et al.
    Landstinget Västernorrland, Sweden.
    Ertzgaard, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Levi, Richard
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Sverige bör centralisera den pediatriska ryggmärgsskadevården2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, no 35-36Article in journal (Other academic)
    Abstract [en]

    [No abstract available]

  • 6.
    Awad, Amar
    et al.
    Umea Univ, Sweden.
    Levi, Richard
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Waller, Mikael
    Sunderby Hosp, Sweden.
    Westling, Goran
    Umea Univ, Sweden.
    Lindgren, Lenita
    Umea Univ, Sweden.
    Eriksson, Johan
    Umea Univ, Sweden.
    Preserved somatosensory conduction in complete spinal cord injury: Discomplete SCI2020In: Clinical Neurophysiology, ISSN 1388-2457, E-ISSN 1872-8952, Vol. 131, no 5, p. 1059-1067Article in journal (Refereed)
    Abstract [en]

    Objective: Spinal cord injury (SCI) disrupts the communication between brain and body parts innervated from below-injury spinal segments, but rarely results in complete anatomical transection of the spinal cord. The aim of this study was to investigate residual somatosensory conduction in clinically complete SCI, to corroborate the concept of sensory discomplete SCI. Methods: We used fMRI with a somatosensory protocol in which blinded and randomized tactile and nociceptive stimulation was applied on both legs (below-injury level) and one arm (above-injury level) in eleven participants with chronic complete SCI. The experimental design accounts for possible confounding mechanical (e.g. vibration) and cortico-cortical top-down mechanisms (e.g. attention/expectation). Results: Somatosensory stimulation on below-level insensate body regions activated the somatotopically corresponding part of the contralateral primary somatosensory cortex in six out of eleven participants. Conclusions: Our results represent afferent-driven cortical activation through preserved somatosensory connections to the brain in a subgroup of participants with clinically complete SCI, i.e. sensory discomplete SCI. Significance: Identifying patients with residual somatosensory connections might open the door for new rehabilitative and restorative strategies as well as inform research on SCI-related conditions such as neuropathic pain and spasticity. (C) 2020 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

  • 7.
    Baunsgaard, Carsten Bach
    et al.
    Univ Copenhagen, Denmark.
    Nissen, Ulla Vig
    Univ Copenhagen, Denmark.
    Brust, Anne Katrin
    SPC, Switzerland.
    Frotzler, Angela
    SPC, Switzerland.
    Ribeill, Cornelia
    Ulm Univ, Germany.
    Kalke, Yorck-Bernhard
    Ulm Univ, Germany.
    Leon, Natacha
    FLM, Spain.
    Gomez, Belen
    FLM, Spain.
    Samuelsson, Kersti
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Antepohl, Wolfram
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Holmstrom, Ulrika
    Uppsala Univ Hosp, Sweden.
    Marklund, Niklas
    Uppsala Univ Hosp, Sweden.
    Glott, Thomas
    Sunnaas Rehabil Hosp, Norway.
    Opheim, Arve
    Sunnaas Rehabil Hosp, Norway; Univ Gothenburg, Sweden.
    Benito, Jesus
    Neurorehabil Hosp, Spain.
    Murillo, Narda
    Neurorehabil Hosp, Spain.
    Nachtegaal, Janneke
    Heliomare Rehabil Ctr, Netherlands.
    Faber, Willemijn
    Heliomare Rehabil Ctr, Netherlands.
    Biering-Sorensen, Fin
    Univ Copenhagen, Denmark.
    Gait training after spinal cord injury: safety, feasibility and gait function following 8 weeks of training with the exoskeletons from Ekso Bionics2018In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 56, no 2, p. 106-116Article in journal (Refereed)
    Abstract [en]

    Study design Prospective quasi-experimental study, pre-and post-design. Objectives Assess safety, feasibility, training characteristics and changes in gait function for persons with spinal cord injury (SCI) using the robotic exoskeletons from Ekso Bionics. Setting Nine European rehabilitation centres. Methods Robotic exoskeleton gait training, three times weekly over 8 weeks. Time upright, time walking and steps in the device (training characteristics) were recorded longitudinally. Gait and neurological function were measured by 10 Metre Walk Test (10 MWT), Timed Up and Go (TUG), Berg Balance Scale (BBS), Walking Index for Spinal Cord Injury (WISCI) II and Lower Extremity Motor Score (LEMS). Results Fifty-two participants completed the training protocol. Median age: 35.8 years (IQR 27.5-52.5), men/women: N = 36/16, neurological level of injury: C1-L2 and severity: AIS A-D (American Spinal Injury Association Impairment Scale). Time since injury (TSI) amp;lt; 1 year, N = 25; amp;gt; 1 year, N = 27. No serious adverse events occurred. Three participants dropped out following ankle swelling (overuse injury). Four participants sustained a Category II pressure ulcer at contact points with the device but completed the study and skin normalized. Training characteristics increased significantly for all subgroups. The number of participants with TSI amp;lt; 1 year and gait function increased from 20 to 56% (P=0.004) and 10MWT, TUG, BBS and LEMS results improved (P amp;lt; 0.05). The number of participants with TSI amp;gt; 1 year and gait function, increased from 41 to 44% and TUG and BBS results improved (P amp;lt; 0.05). Conclusions Exoskeleton training was generally safe and feasible in a heterogeneous sample of persons with SCI. Results indicate potential benefits on gait function and balance.

  • 8.
    Baunsgaard, Carsten Bach
    et al.
    Univ Copenhagen, Denmark.
    Nissen, Ulla Vig
    Univ Copenhagen, Denmark.
    Brust, Anne Katrin
    SPC, Switzerland.
    Frotzler, Angela
    SPC, Switzerland.
    Ribeill, Cornelia
    Ulm Univ, Germany.
    Kalke, Yorck-Bernhard
    Ulm Univ, Germany.
    Leon, Natacha
    FLM, Spain.
    Gomez, Belen
    FLM, Spain.
    Samuelsson, Kersti
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Antepohl, Wolfram
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Holmstrom, Ulrike
    Uppsala Univ Hosp, Sweden.
    Marklund, Niklas
    Uppsala Univ Hosp, Sweden.
    Glott, Thomas
    Sunnaas Rehabil Hosp, Norway.
    Opheim, Arve
    Sunnaas Rehabil Hosp, Norway; Univ Gothenburg, Sweden; Reg Vastra Gotaland, Sweden.
    Benito Penalva, Jesus
    Neurorehabil Hosp, Spain.
    Murillo, Narda
    Neurorehabil Hosp, Spain.
    Nachtegaal, Janneke
    Heliomare Rehabil Ctr, Netherlands.
    Faber, Willemijn
    Heliomare Rehabil Ctr, Netherlands.
    Biering-Sorensen, Fin
    Univ Copenhagen, Denmark.
    EXOSKELETON GAIT TRAINING AFTER SPINAL CORD INJURY: AN EXPLORATORY STUDY ON SECONDARY HEALTH CONDITIONS2018In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 9, p. 806-813Article in journal (Refereed)
    Abstract [en]

    Objective: To explore changes in pain, spasticity, range of motion, activities of daily living, bowel and lower urinary tract function and quality of life of individuals with spinal cord injury following robotic exoskeleton gait training. Design: Prospective, observational, open-label multicentre study. Methods: Three training sessions per week for 8 weeks using an Ekso GT robotic exoskeleton (Ekso Bionics). Included were individuals with recent (amp;lt;1 year) or chronic (amp;gt;1 year) injury, paraplegia and tetraplegia, complete and incomplete injury, men and women. Results: Fifty-two participants completed the training protocol. Pain was reported by 52% of participants during the week prior to training and 17% during training, but no change occurred longitudinally. Spasticity decreased after a training session compared with before the training session (pamp;lt; 0.001), but not longitudinally. Chronically injured participants increased Spinal Cord Independence Measure (SCIM III) from 73 to 74 (p= 0.008) and improved life satisfaction (p= 0.036) over 8 weeks of training. Recently injured participants increased SCIM III from 62 to 70 (pamp;lt;0.001), but no significant change occurred in life satisfaction. Range of motion, bowel and lower urinary function did not change over time. Conclusion: Training seemed not to provoke new pain. Spasticity decreased after a single training session. SCIM III and quality of life increased longitudinally for subsets of participants.

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  • 9.
    Birberg Thornberg, Ulrika
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Andersson, Agnes
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Lindh, Malin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Hellgren, Lovisa
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department of Rehabilitation Medicine, Region Jönköping County.
    Divanoglou, Anestis
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Levi, Richard
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Neurocognitive deficits in COVID-19 patients five months after discharge from hospital2022In: Neuropsychological rehabilitation (Print), ISSN 0960-2011, E-ISSN 1464-0694Article in journal (Refereed)
    Abstract [en]

    This observational cohort study explored objective neurocognitive deficits in COVID-19 patients five months after discharge, and any associations with demographic factors and disease severity indicators. Medical notes of all COVID-19 patients admitted to hospital in Region ostergotland, Sweden, March-May 2020, were reviewed. After applying exclusion criteria, 433 patients were screened by telephone. Of these, 185 patients reported persistent and concerning post-COVID-19 problems, including but not restricted to cognitive functions, and were invited to a clinical evaluation. The Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and Colour-Word Interference Test (CWIT) were used to assess immediate memory, visuo-spatial function, language, attention, delayed memory, and executive function. A total of 133 patients had valid test performances. Mean RBANS Global Cognition Score was 83.4, with 37% scoring below cut-off (1.5 SD). Deficits in Attention and Memory indices were most common, each affecting approximately 30% of the patients. After adjustment for sex, language, level of education and premorbid function, neurocognitive performance was positively associated with length of hospital stay, but not with the disease severity indicators WHO CPS and CRP. Findings support that comprehensive neuropsychological assessment should be performed when patients report post-COVID-19 symptoms that affect daily life.

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  • 10.
    Boito, Deneb
    et al.
    Linköping University, Faculty of Science & Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering.
    Eklund, Anders
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Computer and Information Science, The Division of Statistics and Machine Learning.
    Tisell, Anders
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Center for Diagnostics, Medical radiation physics. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine.
    Levi, Richard
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Özarslan, Evren
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Blystad, Ida
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine.
    MRI with generalized diffusion encoding reveals damaged white matter in patients previously hospitalized for COVID-19 and with persisting symptoms at follow-up2023In: Brain Communications, E-ISSN 2632-1297, Vol. 5, no 6, article id fcad284Article in journal (Refereed)
    Abstract [en]

    There is mounting evidence of the long-term effects of COVID-19 on the central nervous system, with patients experiencing diverse symptoms, often suggesting brain involvement. Conventional brain MRI of these patients shows unspecific patterns, with no clear connection of the symptomatology to brain tissue abnormalities, whereas diffusion tensor studies and volumetric analyses detect measurable changes in the brain after COVID-19. Diffusion MRI exploits the random motion of water molecules to achieve unique sensitivity to structures at the microscopic level, and new sequences employing generalized diffusion encoding provide structural information which are sensitive to intravoxel features. In this observational study, a total of 32 persons were investigated: 16 patients previously hospitalized for COVID-19 with persisting symptoms of post-COVID condition (mean age 60 years: range 41–79, all male) at 7-month follow-up and 16 matched controls, not previously hospitalized for COVID-19, with no post-COVID symptoms (mean age 58 years, range 46–69, 11 males). Standard MRI and generalized diffusion encoding MRI were employed to examine the brain white matter of the subjects. To detect possible group differences, several tissue microstructure descriptors obtainable with the employed diffusion sequence, the fractional anisotropy, mean diffusivity, axial diffusivity, radial diffusivity, microscopic anisotropy, orientational coherence (Cc) and variance in compartment’s size (CMD) were analysed using the tract-based spatial statistics framework. The tract-based spatial statistics analysis showed widespread statistically significant differences (P < 0.05, corrected for multiple comparisons using the familywise error rate) in all the considered metrics in the white matter of the patients compared to the controls. Fractional anisotropy, microscopic anisotropy and Cc were lower in the patient group, while axial diffusivity, radial diffusivity, mean diffusivity and CMD were higher. Significant changes in fractional anisotropy, microscopic anisotropy and CMD affected approximately half of the analysed white matter voxels located across all brain lobes, while changes in Cc were mainly found in the occipital parts of the brain. Given the predominant alteration in microscopic anisotropy compared to Cc, the observed changes in diffusion anisotropy are mostly due to loss of local anisotropy, possibly connected to axonal damage, rather than white matter fibre coherence disruption. The increase in radial diffusivity is indicative of demyelination, while the changes in mean diffusivity and CMD are compatible with vasogenic oedema. In summary, these widespread alterations of white matter microstructure are indicative of vasogenic oedema, demyelination and axonal damage. These changes might be a contributing factor to the diversity of central nervous system symptoms that many patients experience after COVID-19.

  • 11.
    de Miranda, Luis
    et al.
    Uppsala Univ, Sweden.
    Levi, Richard
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Divanoglou, Alexis
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Tapping into the unimpossible: Philosophical health in lives with spinal cord injury2023In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 29, no 7, p. 1203-1210Article in journal (Refereed)
    Abstract [en]

    Background: We investigated the personal philosophies of eight persons with a tetraplegic condition (four male, four female), all living in Sweden with a chronic spinal cord injury (SCI) and all reporting a good life. Our purpose was to discover if there is a philosophical mindset that may play a role in living a good life with a traumatic SCI. Methods: Two rounds of in-depth qualitative interviews were performed by the same interviewer, a philosophical practitioner by training (de Miranda). The second round systematically covered the following elements: bodily sense, sense of self, sense of belonging, sense of the possible, sense of purpose and philosophical sense. This six-step method developed by de Miranda is called SMILE_PH, an acronym for Sense-Making Interviews Looking at Elements of Philosophical Health. Results: All the interviewees, as a consequence of their trauma, reported having gone through a reinvention of themselves which implied questioning the meaning and purpose of their life in particular and life in general. A philosophical rather than realistic sense of the possible was abstracted toward teleological growth. All interviewees developed a sense of purpose based on self-interested altruism and solidarity with disabled peers. Conclusions: To reinvent a good life with SCI, in addition to physical training and willpower, one needs to consider philosophical questions about the self and life, what Kant called the cosmic interests of reason: What may I hope? What must I do? What can I know? Our results indicate that we should, in the future, explore what the philosophical health approach may bring to rehabilitation processes in the months or years that follow the trauma.

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  • 12.
    Divanoglou, Anestis
    et al.
    Univ Iceland, Iceland; Cent Queensland Univ, Australia.
    Augutis, Marika
    Sundsvall Hosp, Sweden; Karonlinska Inst, Sweden.
    Sveinsson, Thorarinn
    Univ Iceland, Iceland.
    Hultling, Claes
    Karonlinska Inst, Sweden; Spinalis Fdn, Sweden.
    Levi, Richard
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    SELF-REPORTED HEALTH PROBLEMS AND PRIORITIZED GOALS IN COMMUNITY-DWELLING INDIVIDUALS WITH SPINAL CORD INJURY IN SWEDEN2018In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 10, p. 872-878Article in journal (Refereed)
    Abstract [en]

    Objective: To explore self-reported health problems and functional goals in community-dwelling individuals with spinal cord injury in Sweden. Design: Cross-sectional descriptive study that used a survey designed by an experienced peer mentor with spinal cord injury. Subjects: Community-dwelling individuals with spinal cord injury from Sweden. Methods: The survey was distributed online by the community peer-based organization RG Active Rehabilitation. Results: A total of 203 individuals (55% males, 90% acquired spinal cord injury) from all regions in Sweden completed the survey. Of these, 33% reported living with amp;gt; 2 unbearable physical or psychological problems. While some problems (e.g. problems related to bladder and balance) were consistently ranked to be common across all years since injury and type of spinal cord injury, distribution of some other unbearable problems (e.g. type of pain, excessive weight) varied between subgroups. Years since injury, level of acquired spinal cord injury and sex, but not age-group or type of spinal cord injury, explained some of the variation in the goals. Conclusion: The high proportion of reported "unbearable" problems point to the stronger need for systematic, comprehensive, life-long, multi-disciplinary follow-up for people with spinal cord injury. The high rate of goals related to improving strength and fitness across all participants independently of their characteristics highlight the important role of community organizations that offer such lifetime services.

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  • 13.
    Divanoglou, Anestis
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine.
    Samuelsson, Kersti
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Sjödahl, Rune
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Andersson, Christer
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Levi, Richard
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Rehabilitation needs and mortality associated with the Covid-19 pandemic: a population-based study of all hospitalised and home-healthcare individuals in a Swedish healthcare region2021In: eClinicalMedicine, E-ISSN 2589-5370, Vol. 36, article id 100920Article in journal (Refereed)
    Abstract [en]

    Background: This first report of the Linkoping Covid-19 Study (LinCoS) aimed at determination of Covid-19-associated mortality, impairments, activity and participation limitations denoting rehabilitation needs four months after discharge from hospital. Methods: An ambidirectional population-based cohort study including all confirmed Covid-19 cases admitted to hospital during 1/03-31/05 and those living in home healthcare settings identified through a regional registry and evaluated through medical records, including WHO Clinical Progression Scale (CPS). All patients discharged from hospital were followed-up by structured telephone interview at 4 months post-discharge. Respondents indicated any new or aggravated persisting problems in any of 25 body functions and 12 activity/participation items and rated them for impact on daily life. Findings: Out of 734 hospitalised patients, 149 were excluded, 125 died, and 460 were alive at 4-month follow-up of whom 433 (94.1%) were interviewed. In total, 40% reported impairments and activity/participation limitations affecting daily life and warranted further multi-professional rehabilitation assessment, predominantly those with severe disease and a considerable proportion of those with moderate disease. Cognitive and affective impairments were equally common in all groups and were reported by 20-40% of cases. Limb weakness was reported by 31%, with CPS 7-9 being four times more likely to report this problem as compared to CPS 4-5. 26% of those working or studying reported difficulties returning to these activities, this being 3.5 times more likely in CPS 7-9 as compared to CPS 4-5. 25% reported problems walking &gt;1 km, with CPS 7-9 over three times more likely to report this as compared to the other two sub-groups. 90-day mortality rate of Covid-19 associated deaths was 15.1%. Interpretation: Most rehabilitation needs after Covid-19 involved higher cerebral dysfunction both in patients with moderate and severe disease. This should be considered when designing services aiming at minimizing long-term disability. (C) 2021 The Author(s). Published by Elsevier Ltd.

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  • 14.
    Ehrmann, Cristina
    et al.
    Swiss Parapleg Res SPF, Switzerland; Univ Lucerne, Switzerland.
    Mahmoudi, Seyed Mandi
    Semnan Univ, Iran.
    Prodinger, Birgit
    Swiss Parapleg Res SPF, Switzerland; Univ Lucerne, Switzerland; Univ Appl Sci Rosenhe, Germany.
    Kiekens, Carlotte
    Montecatone Rehabil Inst, Italy; Univ Hosp Leuven, Belgium; Univ Leuven, Belgium.
    Ertzgaard, Per
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    IMPACT OF SPASTICITY ON FUNCTIONING IN SPINAL CORD INJURY: AN APPLICATION OF GRAPHICAL MODELLING2020In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 52, no 3, article id UNSP jrm00037Article in journal (Refereed)
    Abstract [en]

    Objective: To identify the impact of moderate-to-severe spasticity on functioning in people living with spinal cord injury. Design: Secondary analysis of cross-sectional survey data using graphical modelling. Subjects: Individuals (n= 1,436) with spinal cord injury aged over 16 years with reported spasticity problems. Methods: Spasticity and 13 other impairments in body functions were assessed using the spinal cord injury Secondary Conditions Scale. Impairments in mental functions were assessed using the Mental Health subscale of the 36-item Short Form (SF-36). Independence in activities was measured with the Spinal Cord Injury Independence Measure Self-Report. Restrictions in participation were measured with the Utrecht Scale for Evaluation Rehabilitation - Participation. Results: Fifty-one percent of participants reported moderate-to-severe spasticity. Graphical modelling showed that Chronic pain, Contractures, Tiredness, Doing housework, and Respiratory functions were associated with spasticity and were the top 5 potential targets for interventions to improve the experience of spasticity. The associations and intervention targets were dependent on the level and completeness of the lesion. Conclusion: This is the first application of graphical modelling in studying spasticity in people living with spinal cord injury. The results can be used as a basis for studies aiming to optimize rehabilitation interventions in people with moderate-to-severe spasticity.

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  • 15.
    Eldh, Ann Catrine
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Sverker, Annette M.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Bendtsen, Preben
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Nilsson, Evalill
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. e-Health Institute, Department of Medicine and Optometry, Linneaus University, Kalmar, Sweden.
    Health Care Professionals Experience of a Digital Tool for Patient Exchange, Anamnesis, and Triage in Primary Care: Qualitative Study2020In: JMIR Human Factors, E-ISSN 2292-9495, Vol. 7, no 4, article id e21698Article in journal (Refereed)
    Abstract [en]

    Background:Despite a growing body of knowledge about eHealth innovations, there is still limited understanding of the implementation of such tools in everyday primary care.

    Objective:The objective of our study was to describe health care staff’s experience with a digital communication system intended for patient-staff encounters via a digital route in primary care.

    Methods:In this qualitative study we conducted 21 individual interviews with staff at 5 primary care centers in Sweden that had used a digital communication system for 6 months. The interviews were guided by narrative queries, transcribed verbatim, and subjected to content analysis.

    Results:While the digital communication system was easy to grasp, it was nevertheless complex to use, affecting both staffing and routines for communicating with patients, and documenting contacts. Templates strengthened equivalent procedures for patients but dictated a certain level of health and digital literacy for accuracy. Although patients expected a chat to be synchronous, asynchronous communication was extended over time. The system for digital communication benefited assessments and enabled more efficient use of resources, such as staff. On the other hand, telephone contact was faster and better for certain purposes, especially when the patient’s voice itself provided data. However, many primary care patients, particularly younger ones, expected digital routes for contact. To match preferences for communicating to a place and time that suited patients was significant; staff were willing to accept some nuisance from a suboptimal service—at least for a while—if it procured patient satisfaction. A team effort, including engaged managers, scaffolded the implementation process, whereas being subjected to a trial without likely success erected barriers.

    Conclusions:A digital communication system introduced in regular primary care involved complexity beyond merely learning how to manage the tool. Rather, it affected routines and required that both the team and the context were addressed. Further knowledge is needed about what factors facilitate implementation, and how. This study suggested including ethical perspectives on eHealth tools, providing an important but novel aspect of implementation.

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  • 16.
    Enthoven, Paul
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Menning, Linnea
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Öberg, Birgitta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Schröder, Karin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Fors, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Lindbäck, Yvonne
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Abbott, Allan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Physiotherapists' experiences of implementation of the BetterBack model of care for low back pain in primary care - a focus group interview study2024In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040Article in journal (Refereed)
    Abstract [en]

    Introduction: The BetterBack model of care (MoC), a best practice physiotherapy MoC for low back pain (LBP), was implemented in Swedish primary care to improve management of patients with LBP and provide patients with support tools to better self-manage episodes of LBP.Purpose: The objective was to describe how physiotherapists in primary care experienced the implementation of the BetterBack MoC for LBP.MethodsFocus group interviews were conducted with physiotherapists in 2018-2019, 14-18 months after the introduction of the BetterBack MoC. Data were analyzed using qualitative content analysis.Results: Five focus group interviews with 23 (15 female and 8 male) physiotherapists, age range 24-61 years were analyzed. A supportive organization and adaptation to the local culture, combined with health care professionals' attitudes and collaboration between physiotherapists emerged as important factors for a successful implementation and for long-term sustainability of the MoC. Physiotherapists had differing opinions if the implementation led to change in clinical practice. Improved confidence in how to manage patients with LBP was expressed by physiotherapists.Conclusions: Several barriers and facilitators influence the implementation of a best practice physiotherapy MoC for LBP in primary care, which need to be considered in future implementation and sustainability processes.

  • 17. Order onlineBuy this publication >>
    Ertzgaard, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Studies on Spasticity from an Interventional Perspective2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis focuses on interventional aspects of spasticity, but has a very holistic approach, grounded in the specialty of Rehabilitation medicine. This means capturing the effects of spasticity, on such a complex biological system as the human being, living in a psychosocial context affecting the situation. When evaluating spasticity there are a number of levels of evidence. The first of course, understanding what we mean with spasticity, where there unfortunately is no consensus. The second level is to study if our treatments affect spasticity in a positive direction. The third is to grasp if a decrease in spasticity improve or normalize patient’s movement patterns. The fourth level investigates if improvement in movement patterns improve patient’s ability to perform activities; and the fifth level, comprising whether this intervention improves life satisfaction. Finally, on a societal level, we wish to investigate whether the improvement in life satisfaction or health related quality of life would motivate society to fund the intervention.

    Paper I on Goal Attainment Scaling pointed out necessary aspects to consider when using this instrument. This relates, among other things, to the need of learning (“the art of”) goal setting and deciding the purpose of the measurements. Research and clinical use puts different demands on the instrument, for the latter time-efficiency and simplicity to use being most important. For research, it is important to be able to register deterioration, and this can be achieved using the 6-step version.

    In paper II, concerning validation of the portable motion system, we showed this system to be valid for short-term measurements and that the use of Exposure Variation Analysis (EVA) seems to be a valuable tool for graphically elucidating different movements. The equipment needs further development in handling long-term measurements (which is effectuated), and norms for normal movements in different activities has to be produced. The discriminative value of EVA needs confirmation in coming studies. For the future, there is the intriguing possibility of long-term measurements in patients’ every-day life, thereby getting objective measures on how our patients use their abilities, thus capturing the difference between what you can do and what you actually do.

    The results from paper III demonstrated a large inequality in Sweden regarding the accessibility of BoNT-A treatment for spasticity. We could also show that treatment with BoNT-A is sound from a health-economic perspective, accounting for the uncertainty of data via the sensitivity analysis. For the future, we need to explore if this inequality also exists for other modes of spasticity treatments, e.g. multidisciplinary spasticity treatment and ITB pumps, and in other countries.

    In paper IV evaluating multifocal TES, the results could not confirm efficacy with the treatment according to the protocol of the manufacturer. The results have to be interpreted with care, as low compliance and frequent adverse events made deduction not captured in the RCT study. Further studies are needed in a number of areas, e.g. what is the optimal stimulation frequency, what patients can gain from the treatment and how should adjunct treatment be organized.

    In this thesis, I have had the privilege to explore different methods of evaluating spasticity interventions from a multimodal perspective as a starting point in an effort to understand more of this intriguing phenomenon. Some of the research questions above are already in the “pipeline” for coming studies; others are to be planned by our research group and others.

    List of papers
    1. PRACTICAL CONSIDERATIONS FOR GOAL ATTAINMENT SCALING DURING REHABILITATION FOLLOWING ACQUIRED BRAIN INJURY
    Open this publication in new window or tab >>PRACTICAL CONSIDERATIONS FOR GOAL ATTAINMENT SCALING DURING REHABILITATION FOLLOWING ACQUIRED BRAIN INJURY
    2011 (English)In: JOURNAL OF REHABILITATION MEDICINE, ISSN 1650-1977, Vol. 43, no 1, p. 8-14Article in journal (Refereed) Published
    Abstract [en]

    Objective: Goal attainment scaling represents a unique approach to identifying and quantifying individualized, meaningful treatment outcomes, and its use in the rehabilitation medicine setting is increasing. The aim of this paper is to discuss the available literature for goal attainment scaling in patients with acquired brain injury, in terms of its advantages, disadvantages and practical application, including examples of goal setting and scaling.

    Place, publisher, year, edition, pages
    Foundation for Rehabilitation Information, 2011
    Keywords
    acquired brain injury, goal attainment scaling, rehabilitation
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-66870 (URN)10.2340/16501977-0664 (DOI)000288105200002 ()
    Available from: 2011-03-22 Created: 2011-03-21 Last updated: 2018-11-22
    2. A new way of assessing arm function in activity using kinematic Exposure Variation Analysis and portable inertial sensors - A validity study
    Open this publication in new window or tab >>A new way of assessing arm function in activity using kinematic Exposure Variation Analysis and portable inertial sensors - A validity study
    2016 (English)In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 21, p. 241-249Article in journal (Refereed) Published
    Abstract [en]

    Portable motion systems based on inertial motion sensors are promising methods, with the advantage compared to optoelectronic cameras of not being confined to a laboratory setting. A challenge is to develop relevant outcome measures for clinical use. The aim of this study was to characterize elbow and shoulder motion during functional tasks, using portable motion sensors and a modified Exposure Variation Analysis (EVA) and evaluate system accuracy with optoelectronic cameras. Ten healthy volunteers and one participant with sequel after stroke performed standardised functional arm tasks. Motion was registered simultaneously with a custom developed motion sensor system, including gyroscopes and accelerometers, and an optoelectronic camera system. The EVA was applied on elbow and shoulder joints, and angular and angular velocity EVA plots was calculated. The EVA showed characteristic patterns for each arm task in the healthy controls and a distinct difference between the affected and unaffected arm in the participant with sequel after stroke. The accuracy of the portable system was high with a systematic error ranging between -1.2 degrees and 2.0 degrees. The error was direction specific due to a drift component along the gravity vector. Portable motion sensor systems have high potential as clinical tools for evaluation of arm function. EVA effectively illustrates joint angle and joint angle velocity patterns that may capture deficiencies in arm function and movement quality. Next step will be to manage system drift by including magnetometers, to further develop clinically relevant outcome variables and apply this for relevant patient groups. (C) 2015 Elsevier Ltd. All rights reserved.

    Place, publisher, year, edition, pages
    CHURCHILL LIVINGSTONE, 2016
    Keywords
    Upper extremity motion analysis; Portable motion sensors; Exposure Variation Analysis; Validity
    National Category
    Basic Medicine
    Identifiers
    urn:nbn:se:liu:diva-127585 (URN)10.1016/j.math.2015.09.004 (DOI)000373615100033 ()26456185 (PubMedID)
    Available from: 2016-05-03 Created: 2016-05-03 Last updated: 2018-11-22
    3. Regional disparities in botulinum toxin A (BoNT-A) therapy for spasticity in Sweden: budgetary consequences of closing the estimated treatment gap
    Open this publication in new window or tab >>Regional disparities in botulinum toxin A (BoNT-A) therapy for spasticity in Sweden: budgetary consequences of closing the estimated treatment gap
    2017 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 135, no 3, p. 366-372Article in journal (Refereed) Published
    Abstract [en]

    Objectives: As no national treatment guidelines for spasticity have been issued in Sweden, different regional treatment practices may potentially occur. This study examines botulinum toxin A (BoNT-A) treatment for spasticity on a regional level in Sweden and presents budgetary consequences of closing the estimated treatment gap. Materials and Methods: Prevalence of spasticity in Sweden was estimated from published data. Regional sales data for BoNT-A were acquired from IMS Health. A set proportion of hospital BoNT-A use was assumed to represent treatment of spasticity. Total intervention cost of BoNT-A treatment was gathered from healthcare regional tariffs, while costs associated with spasticity were derived from publications on multiple sclerosis and stroke. Results: Results show that the regional variation in treatment of spasticity with BoNT-A is large, with approximately every fourth patient being treated in Southern healthcare region compared to every tenth in the Stockholm-Gotland or Western healthcare regions. The incremental cost of filling the reported treatment gap was also assessed and was estimated at around 9.4 million EUR. However, for the incremental cost to be offset by savings in spasticity-related costs, only a small proportion of treatment responders (defined as patients transitioning to a lower severity grade of spasticity) was required (12%). Conclusions: The study revealed apparent regional disparities of BoNT-A treatment for spasticity in Sweden. The results further suggest that the incremental cost of eliminating the treatment gap has a high probability of being offset by savings in direct costs, even at a low proportion of the patients reaching clinical improvement.

    Place, publisher, year, edition, pages
    WILEY, 2017
    Keywords
    botulinum toxins; costs and cost analysis; muscle spasticity; regional variation
    National Category
    Neurology
    Identifiers
    urn:nbn:se:liu:diva-136626 (URN)10.1111/ane.12610 (DOI)000397285600014 ()27220381 (PubMedID)
    Note

    Funding Agencies|University of Linkoping

    Available from: 2017-04-21 Created: 2017-04-21 Last updated: 2018-11-22
    4. Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomized placebo-controlled trial
    Open this publication in new window or tab >>Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomized placebo-controlled trial
    Show others...
    2018 (English)In: European Journal of Physical and Rehabilitation Medicine, ISSN 1973-9087, E-ISSN 1973-9095, Vol. 54, no 4, p. 507-517Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Spasticity is a common consequence of injury to the central nervous system negatively affecting patients everyday activities. Treatment mainly consists of training and different drugs, often with side effects. There is a need for treatment options that can be performed by the patient in their home environment. AIM: The objective of this study was to assess the effectiveness of an assistive technology (AT), Mono, a garment with integrated electrodes for multifocal transcutaneous electrical stimulation intended for self-treatment of spasticity, in study participants with spasticity due to stroke or CP. DESIGN: The study was a randomized, controlled, double-blind study with a cross-over design. SETTING: Participants were recruited from two rehabilitation clinics. Treatments were performed in participants homes and all follow-ups were performed in the two rehabilitation clinics. POPULATION: Thirty-one participants were included in the study and 27 completed the study. Four participants discontinued the study. Two declined participation before baseline and two withdrew due to problems handling the garment. METHODS: Participants used the AT with and without electrical stimulation (active/non-active period) for six weeks each. followed by six weeks without treatment. Goal Attainment Scaling (GAS), change in mobility, arm-hand ability, spasticity and pain were measured at baseline and after 6, 12 and 18 weeks. RESULTS: Fifteen of the 27 participants fulfilled the treatment protocol in terms of recommended use. Deviations were frequent. No statistically significant differences in outcome were found between the active and the non-active treatment periods. During the active period, an improvement was seen in the 10-meter comfortable gait test, time and steps. An improvement was seen in both the active and non-active periods for the GAS. CONCLUSIONS: Compliance was low, partly due to deviations related to the garment, complicating the interpretation of the results. Further research should focus on identifying the target population and concomitant rehabilitation strategies. CLINICAL REHABILITATION IMPACT: The evaluated concept of multifocal transcutaneous electrical stimulation (TES) represents an interesting addition to the existing repertoire of treatments to alleviate muscle spasticity. The evaluated concept allows TES to be self-administered by the patient in the home environment. A more elaborate design of training activities directly related to patients own rehabilitation goals is recommended and may increase the value of the evaluated concept.

    Place, publisher, year, edition, pages
    EDIZIONI MINERVA MEDICA, 2018
    Keywords
    Muscle spasticity; Randomized controlled trial; Cerebral palsy; Stroke; Transcutaneous electric nerve stimulation
    National Category
    Rheumatology and Autoimmunity
    Identifiers
    urn:nbn:se:liu:diva-151798 (URN)10.23736/S1973-9087.17.04791-8 (DOI)000445298800001 ()29072043 (PubMedID)
    Note

    Funding Agencies|Region Ostergotland; Promobilia Foundation; Inerventions AB (Vinnova)

    Available from: 2018-10-04 Created: 2018-10-04 Last updated: 2018-11-22
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  • 18.
    Ertzgaard, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Alwin, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Sorbo, Ann
    Sahlgrens Acad, Sweden; Sodra Alvsborg Hosp, Sweden.
    Lindgren, Marie
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Sandsjo, Leif
    Univ Boras, Sweden.
    Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomized placebo-controlled trial2018In: European Journal of Physical and Rehabilitation Medicine, ISSN 1973-9087, E-ISSN 1973-9095, Vol. 54, no 4, p. 507-517Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Spasticity is a common consequence of injury to the central nervous system negatively affecting patients everyday activities. Treatment mainly consists of training and different drugs, often with side effects. There is a need for treatment options that can be performed by the patient in their home environment. AIM: The objective of this study was to assess the effectiveness of an assistive technology (AT), Mono, a garment with integrated electrodes for multifocal transcutaneous electrical stimulation intended for self-treatment of spasticity, in study participants with spasticity due to stroke or CP. DESIGN: The study was a randomized, controlled, double-blind study with a cross-over design. SETTING: Participants were recruited from two rehabilitation clinics. Treatments were performed in participants homes and all follow-ups were performed in the two rehabilitation clinics. POPULATION: Thirty-one participants were included in the study and 27 completed the study. Four participants discontinued the study. Two declined participation before baseline and two withdrew due to problems handling the garment. METHODS: Participants used the AT with and without electrical stimulation (active/non-active period) for six weeks each. followed by six weeks without treatment. Goal Attainment Scaling (GAS), change in mobility, arm-hand ability, spasticity and pain were measured at baseline and after 6, 12 and 18 weeks. RESULTS: Fifteen of the 27 participants fulfilled the treatment protocol in terms of recommended use. Deviations were frequent. No statistically significant differences in outcome were found between the active and the non-active treatment periods. During the active period, an improvement was seen in the 10-meter comfortable gait test, time and steps. An improvement was seen in both the active and non-active periods for the GAS. CONCLUSIONS: Compliance was low, partly due to deviations related to the garment, complicating the interpretation of the results. Further research should focus on identifying the target population and concomitant rehabilitation strategies. CLINICAL REHABILITATION IMPACT: The evaluated concept of multifocal transcutaneous electrical stimulation (TES) represents an interesting addition to the existing repertoire of treatments to alleviate muscle spasticity. The evaluated concept allows TES to be self-administered by the patient in the home environment. A more elaborate design of training activities directly related to patients own rehabilitation goals is recommended and may increase the value of the evaluated concept.

  • 19.
    Ertzgaard, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Anhammer, M.
    Ipsen, Sweden.
    Forsmark, A.
    Nordic Health Econ AB, Sweden.
    Regional disparities in botulinum toxin A (BoNT-A) therapy for spasticity in Sweden: budgetary consequences of closing the estimated treatment gap2017In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 135, no 3, p. 366-372Article in journal (Refereed)
    Abstract [en]

    Objectives: As no national treatment guidelines for spasticity have been issued in Sweden, different regional treatment practices may potentially occur. This study examines botulinum toxin A (BoNT-A) treatment for spasticity on a regional level in Sweden and presents budgetary consequences of closing the estimated treatment gap. Materials and Methods: Prevalence of spasticity in Sweden was estimated from published data. Regional sales data for BoNT-A were acquired from IMS Health. A set proportion of hospital BoNT-A use was assumed to represent treatment of spasticity. Total intervention cost of BoNT-A treatment was gathered from healthcare regional tariffs, while costs associated with spasticity were derived from publications on multiple sclerosis and stroke. Results: Results show that the regional variation in treatment of spasticity with BoNT-A is large, with approximately every fourth patient being treated in Southern healthcare region compared to every tenth in the Stockholm-Gotland or Western healthcare regions. The incremental cost of filling the reported treatment gap was also assessed and was estimated at around 9.4 million EUR. However, for the incremental cost to be offset by savings in spasticity-related costs, only a small proportion of treatment responders (defined as patients transitioning to a lower severity grade of spasticity) was required (12%). Conclusions: The study revealed apparent regional disparities of BoNT-A treatment for spasticity in Sweden. The results further suggest that the incremental cost of eliminating the treatment gap has a high probability of being offset by savings in direct costs, even at a low proportion of the patients reaching clinical improvement.

  • 20.
    Ertzgaard, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Campo, Claudia
    Medtron EMEA Regional Clin Centre, Italy.
    Calabrese, Alessandra
    Medtron Int Trading Sarl, Switzerland.
    EFFICACY AND SAFETY OF ORAL BACLOFEN IN THE MANAGEMENT OF SPASTICITY: A RATIONALE FOR INTRATHECAL BACLOFEN2017In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, no 3, p. 193-203Article, review/survey (Refereed)
    Abstract [en]

    Oral baclofen has long been a mainstay in the management of spasticity. This review looks at the clinical evidence for the efficacy and safety of oral baclofen in patients with spasticity of any origin or severity, to determine whether there is a rationale for the use of intrathecal baclofen. Results suggest that oral baclofen may be effective in many patients with spasticity, regardless of the underlying disease or severity, and that it is at least comparable with other antispasmodic agents. However, adverse effects, such as muscle weakness, nausea, somnolence and paraesthesia, are common with oral baclofen, affecting between 25% and 75% of patients, and limiting its usefulness. Intrathecal baclofen may be an effective alternative as the drug is delivered directly into the cerebrospinal fluid, thus bypassing the blood-brain barrier and thereby optimizing the efficacy of baclofen while minimizing drug-related side-effects. Intrathecal baclofen is a viable option in patients who experience intolerable side-effects or who fail to respond to the maximum recommended dose of oral baclofen.

  • 21.
    Ertzgaard, Per
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Nene, Anand
    Roessingh Res & Dev, Netherlands.
    Kiekens, Carlotte
    KU Leuven Univ Leuven, Belgium; Univ Hosp Leuven, Belgium.
    Burns, Anthony S.
    Univ Toronto, Canada.
    A review and evaluation of patient-reported outcome measures for spasticity in persons with spinal cord damage: Recommendations from the Ability Network - an international initiative2020In: Journal of Spinal Cord Medicine (JSCM), ISSN 1079-0268, E-ISSN 2045-7723, Vol. 43, no 6, p. 813-823Article, review/survey (Refereed)
    Abstract [en]

    Context: Patient-reported outcome measures (PROMs) are valuable for capturing the impact of spasticity on health-related quality of life (HRQoL) in persons with spinal cord damage (SCD) and evaluating the efficacy of interventions. Objective: To provide practical guidance for measuring HRQoL in persons with spasticity following SCD. Methods: Literature reviews identified measures of HRQoL and caregiver burden, utilized in studies addressing spasticity in SCD. Identified measures were evaluated for clinical relevance and practicality for use in clinical practice and research. The PRISM, SCI-SET, EQ-5D and SF-36 instruments were mapped to the International Classification of Functioning, Disability and Health (ICF). The PRISM and SCI-SET were evaluated using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Results: Two spasticity-specific, five generic, and four preference-based measures were identified. ICF mapping and the COSMIN checklist supported the use of the PRISM and SCI-SET in SCD. The SF-36 is considered the most useful generic measure; disability-adapted versions may be more acceptable but further studies on psychometric properties are required. The SF-36 can be converted to a preference-based measure (SF-6D), or alternatively the EQ-5D can be used. While no measures specific to caregivers of people with SCD were identified, the Caregiver Burden Scale and the Zarit Burden Interview are considered suitable. Conclusion: Recommended measures include the PRISM and SCI-SET (condition-specific), SF-36 (generic), and Caregiver Burden Scale and Zarit Burden Interview (caregiver burden). Consideration should be given to using condition-specific and generic measures in combination; the PRISM or SCI-SET combined with SF-36 is recommended.

  • 22.
    Ertzgaard, Per
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine.
    Nyman, Per
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Jakobsson, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Johansson, Jan
    Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institute, Stockholm, Sweden.
    Oculomotor screening and neuro-visual rehabilitation following pediatric brain tumor resection2023In: Journal of Pediatric Rehabilitation Medicine, ISSN 1874-5393, E-ISSN 1875-8894, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Visual difficulties are common after brain tumors, despite a lack of visual complaints at diagnosis. These include difficulties with eye movements, visual coordination, vergence, accommodation, and photophobia, in addition to more obvious problems such as visual field defects.This case report presents the results of a thorough neuro-visual evaluation in a boy with sequelae after a brain tumor including intermittent double vision that was not explained by routine visual examination. Subjective complaints included poor reading perseverance, intermittent blurred and double vision, headache around the eyes when performing near activities, less efficient eye movement behavior in reading tasks, and increased sensitivity to visual motion. The patient participated in a multidisciplinary visual rehabilitation program that included reading glasses with prism compensation and tinted glasses, as well as training with the aim of improving eye teaming, near vision functions, and perseverance in eye movements.The patient responded quickly to the vision therapy program, with positive changes after just four weeks. Repeated neuro-visual evaluations over eight months showed remarkable improvements that were stable over time. This encouraging case report supports the notion that neuro-visual evaluation and rehabilitation should be included in the follow-up of patients after brain tumors.

  • 23.
    Ertzgaard, Per
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Ohberg, Fredrik
    Umeå University, Sweden.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Grip, Helena
    Umeå University, Sweden.
    A new way of assessing arm function in activity using kinematic Exposure Variation Analysis and portable inertial sensors - A validity study2016In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 21, p. 241-249Article in journal (Refereed)
    Abstract [en]

    Portable motion systems based on inertial motion sensors are promising methods, with the advantage compared to optoelectronic cameras of not being confined to a laboratory setting. A challenge is to develop relevant outcome measures for clinical use. The aim of this study was to characterize elbow and shoulder motion during functional tasks, using portable motion sensors and a modified Exposure Variation Analysis (EVA) and evaluate system accuracy with optoelectronic cameras. Ten healthy volunteers and one participant with sequel after stroke performed standardised functional arm tasks. Motion was registered simultaneously with a custom developed motion sensor system, including gyroscopes and accelerometers, and an optoelectronic camera system. The EVA was applied on elbow and shoulder joints, and angular and angular velocity EVA plots was calculated. The EVA showed characteristic patterns for each arm task in the healthy controls and a distinct difference between the affected and unaffected arm in the participant with sequel after stroke. The accuracy of the portable system was high with a systematic error ranging between -1.2 degrees and 2.0 degrees. The error was direction specific due to a drift component along the gravity vector. Portable motion sensor systems have high potential as clinical tools for evaluation of arm function. EVA effectively illustrates joint angle and joint angle velocity patterns that may capture deficiencies in arm function and movement quality. Next step will be to manage system drift by including magnetometers, to further develop clinically relevant outcome variables and apply this for relevant patient groups. (C) 2015 Elsevier Ltd. All rights reserved.

  • 24.
    Fors, Carina
    et al.
    Swedish Natl Rd and Transport Res Inst, SE-58195 Linkoping, Sweden.
    Ahlström, Christer
    Swedish Natl Rd and Transport Res Inst, SE-58195 Linkoping, Sweden.
    Anund, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Swedish Natl Rd and Transport Res Inst, SE-58195 Linkoping, Sweden.
    A comparison of driver sleepiness in the simulator and on the real road2018In: JOURNAL OF TRANSPORTATION SAFETY and SECURITY, ISSN 1943-9962, Vol. 10, no 1-2, p. 72-87Article in journal (Refereed)
    Abstract [en]

    For safety reasons as well as for experimental control, driver sleepiness experiments are often run in simulators. The aim of this study is to compare the development of driver sleepiness in an advanced driving simulator experiment with real road driving. Sixteen drivers participated in the experiment, which included daytime and night-time driving on a real motorway and in an advanced driving simulator. The results showed that there were significantly higher levels of Karolinska Sleepiness Scale (KSS) ratings, longer blink durations, lower percentage of gazes directed toward the road center (PRC), and higher speed, in the simulator compared to the real road. The pattern of change with task progression was consistent between simulator driving and real road driving for all investigated variables, that is, speed, KSS, line crossings, blink duration, and PRC. However, the relative differences were higher during daytime compared to night-time driving. Results from a questionnaire showed that it was more boring and more demanding to stay alert in the simulator. In conclusion, the development of sleepiness over time is similar in the simulator as compared to the real road, though the absolute sleepiness level is higher in the simulator.

  • 25.
    Forsberg, Gustaf
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Berg, Sören
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Divanoglou, Anestis
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Levi, Richard
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Ekqvist, David
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Östholm Balkhed, Åse
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Niward, Katarina
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Improved 60-day survival but impaired general health in Swedish ICU-COVID patients: An ambidirectional population-based study2022In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 66, no 5, p. 569-579Article in journal (Refereed)
    Abstract [en]

    Background Survival among critically ill COVID-19 patients varies between countries and time periods. Mortality rates up to 60% have been reported in intensive care units (ICUs). Standard-of-care has evolved throughout the pandemic. The purpose of the study was to explore management and mortality of COVID-19 ICU-patients during the first pandemic wave and assess their post-ICU health status. Methods We conducted an exploratory observational ambidirectional population-based study of ICU-patients with COVID-19 in a Swedish county during 1 March-30 June 2020. Primary outcome was 60-day mortality with secondary outcomes including treatments, complications, self-reported general health and dyspnoea post-discharge. Patients were consecutively divided into equal tertiles with cut-offs on April 4 and April 20, 2020, to analyse time trends. Results One hundred patients, median age was 63 years, were included, and 60-day mortality rate was 22%. Ninety-one percent had moderate/severe ARDS and 88% required mechanical ventilation. In the first tertile of patients 60-day mortality was 33%, declining to 15% and 18% in the following two. This reduction paralleled increased use of thromboprophylaxis, less steep rise of treated ICU-patients per day and expanded ICU resources. Four months post-discharge, 63% of survivors reported self-assessed decline in general health retrospectively compared to prior COVID-19. Conclusions In this cohort, the initial 60-day mortality quickly declined, despite continuous admittance of critically ill patients. This was parallel to adaptation to increased workload and more intense thromboembolic prophylaxis. A majority of survivors reported declined general health four months after discharge. Further studies on long-term health status of ICU-survivors are indicated.

  • 26.
    Forsmark, Annabelle
    et al.
    PharmaLex, Sweden.
    Rosengren, Linda
    Ipsen, Sweden.
    Ertzgaard, Per
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Inequalities in pharmacologic treatment of spasticity in Sweden: health economic consequences of closing the treatment gap2020In: Health Economics Review, E-ISSN 2191-1991, Vol. 10, no 1, article id 4Article in journal (Refereed)
    Abstract [en]

    Background

    The Swedish Healthcare Act states that patients should have equal access to healthcare. This study addresses at how this translates to pharmacological treatment of adult spasticity, including injections with botulinum toxin A (BoNT-A) and pumps for intrathecal baclofen (ITB). To address potential economic incentives for treatment differences, the results are also set into a health economic perspective.

    Thus, the current study provides a detailed and comprehensive overview for informed decision- and policymaking.

    Methods

    Botulinum toxin use was retrieved from sales data. Clinical practice regarding mean BoNT-A treatment dose and proportion used for spasticity indication were validated in five county councils, while the number of ITB pumps were mapped for all county councils. Published costs and quality of life data was used for estimating required responder rates for cost-balance or cost-effectiveness.

    Results

    The proportion of patients treated with BoNT-A varied between 5.8% and 13.6% across healthcare regions, with a mean of 9.2% on a national level. The reported number of ITB pumps per 100,000 inhabitants varied between 3.6 and 14.1 across healthcare regions, with a national mean of 6/100,000.

    The estimated incremental cost for reaching treatment equity was EUR 1,976,773 per year for BoNT-A and EUR 3,326,692 for ITB pumps. Based on expected cost-savings, responder rates ranging between 4% and 15% cancelled out the incremental cost for BoNT-A. Assuming no cost-savings, responder rates of 14% or 36% was required for cost-effectiveness.

    Conclusions

    There is a marked variation in pharmacologic treatment of adult spasticity in Sweden. Overall, the results indicate an underuse of treatment and need for harmonisation of clinical practice. Furthermore, the incremental cost for reaching treatment equity is likely to be offset by spasticity-associated cost-savings.

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  • 27.
    Fällman, Katarina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Wressle, Ewa
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Marcusson, Jan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Classon, Elisabet
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Swedish normative data and longitudinal effects of aging for older adults: The Boston Naming Test 30-item and a short version of the Token Test2022In: Applied neuropsychology. Adult, ISSN 2327-9095, E-ISSN 2327-9109Article in journal (Refereed)
    Abstract [en]

    Naming ability and verbal comprehension are cognitive functions that may be affected both by normal aging and by disease. Neuropsychological testing is crucial to evaluate changes in language ability and reliable normative data for all ages are needed. We present clinically useful test norms, together with subsample analysis of longitudinal effects of aging, for two robust and well-known tests that evaluate naming ability and verbal comprehension where the present norms for older adults (aged 85 and older) are sparse or missing. Participants (n = 338) from a Swedish population-based study, the Elderly in Linkoping Screening Assessment, were cognitively evaluated with a cognitive screening battery at the age of 85 years and followed to the age of 93 years. Normative data at age 85 years were calculated from a sample (n = 207) that was determined as cognitively healthy after application of rigorous exclusion criteria. Effects of normal aging were investigated by analyzing follow-up performance at age 90 and 93 years for the subsample of cognitively healthy that completed the entire study. The evaluated tests in this study are Swedish versions of the Boston Naming Test 30-item Odd Version (BNT-30) and a short form of the Token Test, Part V (TokV). Analyzes of effects of aging showed that performance decreased with age for BNT-30, but not for TokV. Higher education was associated with better performance in both tests and men performed better than women on the BNT-30. Results also showed naming ability to be more sensitive to aging than verbal comprehension.

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  • 28. Order onlineBuy this publication >>
    Gunnarsson, Stina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    What makes a patient satisfied with intrathecal baclofen treatment for spasticity: Expectations and experiences2022Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Patients often report reduced spasticity and/or pain, improved function and comfort, and a high level of satisfaction after treatment with intrathecal baclofen (ITB). However, dissatisfaction, complications and unmet goals are also reported. The overall aim of the thesis was to identify, describe, and analyse what makes a patient satisfied with the effect of ITB treatment for spasticity, by considering patient expectations, experience, outcome, as well as satisfaction with treatment.  

    Four studies are included, all focusing on patients undergoing ITB treatment or about to start treatment. Study I, a qualitative interview study, describes the experiences of 14 patients on ITB from one university hospital. Study II, a cross-sectional study, includes 6 of the 7 main hospitals in Sweden working with ITB treatment. Through questionnaires and medical records, data were collected from 83 patients, on general expectations/optimism, satisfaction with treatment and reports on complications. Study III is based on data from study II on baclofen doses for 81 patients to analyse the development of dose patterns. Study IV, a prospective longitudinal study, includes 29 patients from 2 university hospitals. Data collection focused on pre-expectations, effect at 1-year follow-up and satisfaction with treatment. The results of the thesis are summarized in 3 topics: (1) variables of interest for formulation of patients’ pre-expectations; (2) pre-expectations of outcome and ongoing ITB treatment; (3) outcomes and satisfaction with ITB treatment. Together, those topics describe what makes a patient satisfied with ITB treatment. Patients reported improvements in symptoms and reduced consequences from spasticity, however improvements were not always as good as expected. Reported satisfaction with ITB treatment varied in the 4 studies, but mostly a high level of satisfaction was reported. Variables of importance for satisfaction were improved occupational performance, pre-expectations met and initial status regarding occupational performance.  

    In conclusion, results from this thesis emphasize the need for a dialogue between the patient and health care professionals to enable the formulation of realistic individual pre-expectations and goals. In addition, unmet pre-expectations, complications and frequent hospital visits should be included in the discussion about the benefits of ITB treatment versus the disadvantages. 

    List of papers
    1. Patient experiences with intrathecal baclofen as a treatment for spatsticity - a pilot study
    Open this publication in new window or tab >>Patient experiences with intrathecal baclofen as a treatment for spatsticity - a pilot study
    2015 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 10, p. 834-841Article in journal (Refereed) Published
    Abstract [en]

    Purpose: This study describes how patients experience intrathecal baclofen (ITB) treatment. Methods: Data were collected from interviews with 14 patients (19–76 years old) who were diagnosed with spinal cord injury (SCI), multiple sclerosis (MS), or cerebral palsy (CP). Data were analyzed using conventional content analysis. Result: The analysis resulted in 16 subcategories arranged into five main categories: procedures before treatment, the effect of ITB on daily life and activities, continuous follow-up, expected and unexpected consequences of ITB, and overall level of satisfaction with ITB. Together these categories described the patients' experiences with ITB treatment. When the patients were asked whether they would undergo ITB again, they all stated that they would. Conclusion: Patients stated that they were highly satisfied with the ITB treatment. However, the patients identified several areas that could be improved. Specifically, the patients wanted more information about the different steps in the treatment process and what to expect from ITB treatment.Implications for Rehabilitation

    • An overall satisfaction with the effect from ITB treatment was shown, but some areas still need to be improved.

    • Complications following ITB treatment still remain a major concern for the patient group.

    • Future clinical practice, should address how to take into account patients' expectations and define relevant goals with respect to ITB treatment as well as how to supply professional information.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2015
    National Category
    Other Basic Medicine
    Identifiers
    urn:nbn:se:liu:diva-115760 (URN)10.3109/09638288.2014.943844 (DOI)000352702500002 ()25052099 (PubMedID)
    Available from: 2015-03-18 Created: 2015-03-18 Last updated: 2022-10-21Bibliographically approved
    2. Experiences from intrathecal baclofen treatment based on medical records and patient- and proxy-reported outcome: a multicentre study
    Open this publication in new window or tab >>Experiences from intrathecal baclofen treatment based on medical records and patient- and proxy-reported outcome: a multicentre study
    Show others...
    2019 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 41, no 9, p. 1037-1043Article in journal (Refereed) Published
    Abstract [en]

    Purpose: To investigate patient satisfaction with intrathecal baclofen treatment, complications from the treatment, and the impact of general expectations on treatment outcome in relation to satisfaction.

    Methods: A multicentre study with cross-sectional design. Data were collected through questionnaires and patient records. Patients were recruited from six outpatient intrathecal baclofen clinics in Sweden. Eighty-three patients who had been treated with intrathecal baclofen for 1–4 years were included. For patients unable to communicate, data were collected through a proxy. The Patient Global Impression of Change was used to measure patients’ general satisfaction with change from intrathecal baclofen treatment. The Life Orientation Test – revised, was used to measure general expectations/optimism.

    Results: General satisfaction with intrathecal baclofen treatment was high; 51/77 patients reported “much improved” or “very much improved.” There was no relationship between the two main outcomes (general satisfaction and general expectations/optimism) (rs = 0.12, p = 0.382). The two groups; those who could and those who could not communicate, did differ regarding personal characteristics and should be evaluated as such.

    Conclusions: Most patients/proxies reported a high level of satisfaction with intrathecal baclofen treatment. The reported satisfaction with intrathecal baclofen treatment was not dependent on general expectations.

    • Implications for Rehabilitation
    • Patients with intrathecal baclofen treatment report low levels of health and quality of life at the same time as they are highly satisfied with their treatment.

    • Intrathecal baclofen should be equally offered to both optimistic and less optimistic patients.

    • Patients who are able to/not able to communicate, differs in characteristics and should be informed and followed up in different ways in daily clinical practice.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2019
    Keywords
    General expectations, optimism, ITB, satisfaction, proxy
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-144427 (URN)10.1080/09638288.2017.1419291 (DOI)000465207500004 ()29307239 (PubMedID)2-s2.0-85041008064 (Scopus ID)
    Note

    Funding agencies:  County Council of Ostergotland; Medical Research Council of Southeast Sweden; Swedish Association of Persons with Neurological Disabilities

    Available from: 2018-01-22 Created: 2018-01-22 Last updated: 2022-10-21Bibliographically approved
    3. Dosing Patterns In Treatment of Disabling Spasticity With Intrathecal Baclofen
    Open this publication in new window or tab >>Dosing Patterns In Treatment of Disabling Spasticity With Intrathecal Baclofen
    Show others...
    2021 (English)In: REHABILITATION NURSING, ISSN 0278-4807, Vol. 46, no 6, p. 315-322Article in journal (Refereed) Published
    Abstract [en]

    Purpose The aim of this study was to describe and analyze dosing patterns for patients with ITB treatment over time and to identify possible subgroups demonstrating diversity in patterns. Design A retrospective design. Methods For 81 patients from six different hospitals, baclofen doses from the first 2 years of treatment were identified using medical records. Line graphs of each patients doses were analyzed and grouped based on similarities in dosing pattern. Findings The analyses of the dosing patterns resulted in four different subgroups classified as stable, slow increase, rapid increase, and fluctuating. Conclusion The results highlight the clinical challenge of predicting dose development over time.

    Place, publisher, year, edition, pages
    LIPPINCOTT WILLIAMS & WILKINS, 2021
    Keywords
    Dosing patterns; spasticity; intrathecal baclofen
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:liu:diva-181056 (URN)10.1097/RNJ.0000000000000323 (DOI)000713723600007 ()33788806 (PubMedID)
    Note

    Funding Agencies|County Council of Ostergotland; Medical Research Council of Southeast SwedenUK Research & Innovation (UKRI)Medical Research Council UK (MRC); Swedish Association of Persons With Neurological Disabilities

    Available from: 2021-11-18 Created: 2021-11-18 Last updated: 2022-10-21
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  • 29.
    Gunnarsson, Stina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Lemming, Dag
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ertzgaard, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Berntsson, Shala Ghaderi
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Samuelsson, Kersti
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Experiences from intrathecal baclofen treatment based on medical records and patient- and proxy-reported outcome: a multicentre study2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 41, no 9, p. 1037-1043Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate patient satisfaction with intrathecal baclofen treatment, complications from the treatment, and the impact of general expectations on treatment outcome in relation to satisfaction.

    Methods: A multicentre study with cross-sectional design. Data were collected through questionnaires and patient records. Patients were recruited from six outpatient intrathecal baclofen clinics in Sweden. Eighty-three patients who had been treated with intrathecal baclofen for 1–4 years were included. For patients unable to communicate, data were collected through a proxy. The Patient Global Impression of Change was used to measure patients’ general satisfaction with change from intrathecal baclofen treatment. The Life Orientation Test – revised, was used to measure general expectations/optimism.

    Results: General satisfaction with intrathecal baclofen treatment was high; 51/77 patients reported “much improved” or “very much improved.” There was no relationship between the two main outcomes (general satisfaction and general expectations/optimism) (rs = 0.12, p = 0.382). The two groups; those who could and those who could not communicate, did differ regarding personal characteristics and should be evaluated as such.

    Conclusions: Most patients/proxies reported a high level of satisfaction with intrathecal baclofen treatment. The reported satisfaction with intrathecal baclofen treatment was not dependent on general expectations.

    • Implications for Rehabilitation
    • Patients with intrathecal baclofen treatment report low levels of health and quality of life at the same time as they are highly satisfied with their treatment.

    • Intrathecal baclofen should be equally offered to both optimistic and less optimistic patients.

    • Patients who are able to/not able to communicate, differs in characteristics and should be informed and followed up in different ways in daily clinical practice.

  • 30.
    Gunnarsson, Stina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Lemming, Dag
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Alehagen, Siw
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bergenheim, Tommy
    Umes Univ, Sweden.
    Gerdle, Björn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Samuelsson, Kersti
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Patients Expectations Before Initiation of Intrathecal Baclofen Treatment: A Longitudinal Study with 1-Year Follow-Up2023In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 55, article id jrm00371Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate patients expectations, met/unmet expectations and satisfaction with intrathecal baclofen treatment in relation to effect on spasticity, pain intensity, sleep quality, occupational performance, well-being and self-efficacy. Design: A prospective longitudinal study with follow-up at 1 year. Patients: Consecutive patients, age &gt;= 18 years with a disabling spasticity of cerebral or spinal origin selected for intrathecal baclofen treatment at 2 university hospitals in Sweden were included. From August 2016 to June 2019, 35 patients began intrathecal baclofen treatment; 29 patients were included and completed the study. Methods: Baseline and 1-year follow-up included assessment of spasticity by physiotherapists, a semi-structured interview regarding occupational performance using the Canadian Occupational Performance Measure and a questionnaire. Results: Overall satisfaction with treatment and satisfaction with occupational performance were reported as moderate. Important variables that explained satisfaction with occupational performance were improvements in performance, expectations and performance before treatment. Patients had higher expectations compared with the 1-year outcomes regarding occupational performance, spasticity, pain intensity and sleep quality, although improvements were reported. Conclusion: A thorough discussion of goal setting with intrathecal baclofen treatment before implantation is necessary to give patients individual and realistic expectations.

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  • 31.
    Gunnarsson, Stina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Lemming, Dag
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Alehagen, Siw
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Berntsson, Shala
    Uppsala Univ, Sweden.
    Ertzgaard, Per
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Samuelsson, Kersti
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Dosing Patterns In Treatment of Disabling Spasticity With Intrathecal Baclofen2021In: REHABILITATION NURSING, ISSN 0278-4807, Vol. 46, no 6, p. 315-322Article in journal (Refereed)
    Abstract [en]

    Purpose The aim of this study was to describe and analyze dosing patterns for patients with ITB treatment over time and to identify possible subgroups demonstrating diversity in patterns. Design A retrospective design. Methods For 81 patients from six different hospitals, baclofen doses from the first 2 years of treatment were identified using medical records. Line graphs of each patients doses were analyzed and grouped based on similarities in dosing pattern. Findings The analyses of the dosing patterns resulted in four different subgroups classified as stable, slow increase, rapid increase, and fluctuating. Conclusion The results highlight the clinical challenge of predicting dose development over time.

  • 32.
    Gunnarsson, Stina
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Samuelsson, Kersti
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Patient experiences with intrathecal baclofen as a treatment for spatsticity - a pilot study2015In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 10, p. 834-841Article in journal (Refereed)
    Abstract [en]

    Purpose: This study describes how patients experience intrathecal baclofen (ITB) treatment. Methods: Data were collected from interviews with 14 patients (19–76 years old) who were diagnosed with spinal cord injury (SCI), multiple sclerosis (MS), or cerebral palsy (CP). Data were analyzed using conventional content analysis. Result: The analysis resulted in 16 subcategories arranged into five main categories: procedures before treatment, the effect of ITB on daily life and activities, continuous follow-up, expected and unexpected consequences of ITB, and overall level of satisfaction with ITB. Together these categories described the patients' experiences with ITB treatment. When the patients were asked whether they would undergo ITB again, they all stated that they would. Conclusion: Patients stated that they were highly satisfied with the ITB treatment. However, the patients identified several areas that could be improved. Specifically, the patients wanted more information about the different steps in the treatment process and what to expect from ITB treatment.Implications for Rehabilitation

    • An overall satisfaction with the effect from ITB treatment was shown, but some areas still need to be improved.

    • Complications following ITB treatment still remain a major concern for the patient group.

    • Future clinical practice, should address how to take into account patients' expectations and define relevant goals with respect to ITB treatment as well as how to supply professional information.

  • 33.
    Hellgren, Lovisa
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Birberg Thornberg, Ulrika
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Samuelsson, Kersti
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Levi, Richard
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Divanoglou, Anestis
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine.
    Blystad, Ida
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Brain MRI and neuropsychological findings at long-term follow-up after COVID-19 hospitalisation: an observational cohort study2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 10, article id e055164Article in journal (Refereed)
    Abstract [en]

    Objectives To report findings on brain MRI and neurocognitive function, as well as persisting fatigue at long-term follow-up after COVID-19 hospitalisation in patients identified as high risk for affection of the central nervous system. Design Ambidirectional observational cohort study. Setting All 734 patients from a regional population in Sweden with a laboratory-confirmed COVID-19 diagnosis admitted to hospital during the period 1 March to 31 May 2020. Participants A subgroup (n=185) with persisting symptoms still interfering with daily life at a telephone follow-up 4 months after discharge were invited for a medical and neuropsychological evaluation. Thirty-five of those who were assessed with a neurocognitive test battery at the clinical visit, and presented a clinical picture concerning for COVID-19-related brain pathology, were further investigated by brain MRI. Main outcome measures Findings on brain MRI, neurocognitive test results and reported fatigue. Results Twenty-five patients (71%) had abnormalities on MRI; multiple white matter lesions were the most common finding. Sixteen patients (46%) demonstrated impaired neurocognitive function, of which 10 (29%) had severe impairment. Twenty-six patients (74%) reported clinically significant fatigue. Patients with abnormalities on MRI had a lower Visuospatial Index (p=0.031) compared with the group with normal MRI findings. Conclusions In this group of patients selected to undergo MRI after a clinical evaluation, a majority of patients had abnormal MRI and/or neurocognitive test results. Abnormal findings were not restricted to patients with severe disease.

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  • 34.
    Hellgren, Lovisa
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department of Rehabilitation Medicine, Region Jönköping County, Sweden.
    Levi, Richard
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Divanoglou, Anestis
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Birberg Thornberg, Ulrika
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Samuelsson, Kersti
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Seven Domains of Persisting Problems after Hospital-Treated Covid-19 Indicate a Need For a Multiprofessional Rehabilitation Approach2022In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 54, article id jrm00301Article in journal (Refereed)
    Abstract [en]

    Objectives: To identify domains of persisting problems at 4 months after discharge in patients previously hospitalized due to COVID-19, with a focus on a subgroup of patients reporting symptoms to an extent indicative of rehabilitation needs. Design: Ambidirectional observational cohort study. Patients: All patients with a laboratory-confirmed COVID-19 diagnosis admitted to hospital in a Swedish healthcare region during the period 1 March to 31 May 2020. After exclusion, 94% of all survivors (n = 433) participated in the study. Forty-three percent (n = 185) of these reported persisting problems indicating rehabilitation needs and formed a subgroup. Methods: Explorative factor analysis based on results from comprehensive telephone interviews covering persisting symptoms, including assessment of impact on daily life. Results: Seven domains were identified, comprising problems related to vision, cognition, mental fatigue, swallowing, voice, sensorimotor dysfunction, and feeling anxious/depressed. The patients in the subgroup reported a median of 8 symptoms/limitations affecting everyday life, and two-thirds reported symptoms/limitations in 3 or more domains. Conclusion: Seven problem domains corresponding to specific modalities of rehabilitative interventions were identified. A majority of patients reported problems from several domains, indicating the need for multiprofessional teams in post-COVID-19 rehabilitation. Screening of patients previously hospitalized due to COVID-19 should cover all 7 domains of persisting problems.

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  • 35.
    Hellgren, Lovisa
    et al.
    Clinical Department of Rehabilitation Medicine, County Hospital Ryhov, Jönköping, Sweden.
    Samuelsson, Kersti
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Lundqvist, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Börsbo, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Clinical Department of Rehabilitation Medicine, County Hospital Ryhov, Jönköping, Sweden.
    Computerized Training of Working Memoryfor Patients with Acquired Brain Injury2015In: Open Journal of Therapy and Rehabilitation, ISSN 2332-1822, Vol. 3, p. 46-55Article in journal (Refereed)
    Abstract [en]

    Background: Patients with acquired brain injury often experience impaired working memory(WM), a condition that can make everyday life activities and work difficult. Objectives: This studyinvestigates the effects of computerized WM training on WM skills, cognitive tests, activity performanceand estimated health and whether the effects of computerized WM training can be attributedto sex or time since injury. Methods: Forty-eight patients with acquired brain injury underwentcomputerized WM training. Patients were tested by a neuropsychologist and interviewedby an occupational therapist just prior and 20 weeks after completion of training. Results: Patientswho participated in computerized WM training significantly improved their WM skills shown inWM index, their neuropsychological test scores, and their self-estimated health scores. They alsosignificantly improved their performance of individually defined WM-related everyday activitiesand their satisfaction with the performance of these activities. There was a significant differencein terms of WM index, WM-related daily activity performance, and satisfaction with respect to timesince injury. Conclusion: Computerized WM training can improve cognitive and everyday performancefor patients with acquired brain injury. Patients can improve their cognitive functions along time after suffering a brain injury or disease. This effect is greater if WM training is used earlyin the rehabilitation.

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  • 36.
    Hesselstrand, Malin
    et al.
    Linköping University, Department of Medical and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Linköping University, Faculty of Medicine and Health Sciences.
    Samuelsson, Kersti
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Liedberg, Gunilla
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Occupational Therapy Interventions in Chronic Pain - A Systematic Review2015In: Occupational Therapy International, ISSN 0966-7903, E-ISSN 1557-0703, Vol. 22, no 4, p. 183-194Article, review/survey (Refereed)
    Abstract [en]

    The use of interventions based on the best available evidence in occupational therapy is essential, and evaluation of research is part of an evidence-based practice. The aim of this study was to assess the quality of studies describing and evaluating the effects of occupational therapy interventions on chronic pain. A systematic review of studies with diverse designs was carried out. A quality assessment was conducted, and the level of evidence was defined using the Research Pyramid Model. Of 19 included studies, three received the highest evidence level, and three were considered to be of high quality. The clinical recommendations that can be derived from this study are the following: occupational therapy interventions should start from the identified needs of the person with chronic pain; no support exists for the effectiveness of electromyographic biofeedback training as a supplement, more studies are needed to confirm this result; the efficacy of instructions on body mechanics was significant during work-hardening treatment; and occupational therapists need to perform and present more clinical studies of high quality and high-evidence level to build up a trustworthy arsenal of evidence-based interventions, for example, in persons with chronic pain. Copyright (C) 2015 John Wiley & Sons, Ltd.

  • 37.
    Hill, Mattias
    et al.
    Institutionen för hälsovetenskaper, Lunds universitet, Sverige; Skånes universitetssjukhus, Sverige.
    Jörgensen, Sophie
    Institutionen för hälsovetenskaper, Lunds universitet, Sverige; Skånes universitetssjukhus, Sverige.
    Levi, Richard
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine.
    Ryggmärgsskada – ett ovanligttillstånd med komplexa behov: interdisciplinär teamrehabilitering kan, utifrånförutsättningarna, bidra till ett rikt och aktivt liv [Spinal cord injury rehabilitation]2021In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118Article, review/survey (Refereed)
    Abstract [en]

    Spinal cord injury (SCI) challenges many aspects of life. Common secondary health conditions are sensorimotor impairments, autonomic dysfunction affecting bowel, bladder, sexual and cardiovascular function, pressure ulcers, pulmonary dysfunction, pain and psychological distress. Primary rehabilitation and lifelong follow-up from a specialized interdisciplinary rehabilitation team is needed to attain and maintain maximum functioning and participation in all aspects of life, and to reduce the risk of complications in the acute and chronic phases after SCI. Most of the almost 300 people who sustain a SCI in Sweden each year can today be expected to live long lives. However, the growing population of people aging with long-term SCI and the increasing number of older adults sustaining an SCI are major challenges for the health care system.  Important research areas are improved neurological diagnostics, regenerative research and long-term consequences of aging with SCI.

  • 38.
    Hofers, Wiebke
    et al.
    Sunnaas Rehabil Hosp, Norway; Oslo Metropolitan Univ, Norway.
    Jorgensen, Vivien
    Sunnaas Rehabil Hosp, Norway.
    Sallstrom, Susanne
    Sunnaas Rehabil Hosp, Norway.
    Vege, Kristine M.
    Sunnaas Rehabil Hosp, Norway; Sunnaas Rehabil Hosp, Norway.
    Strom, Mona
    Sunnaas Rehabil Hosp, Norway.
    New, Peter W.
    Alfred Hlth, Australia; Monash Univ, Australia; Monash Univ, Australia.
    Bushnik, Tamara
    NYU Langone Hlth, NY USA.
    Zakharova, Olga
    Childrens City Hosp, Russia.
    Krasovsky, Tal
    Edmond & Lily Safra Childrens Hosp, Israel; Univ Haifa, Israel.
    Guttman, Dafna
    Edmond & Lily Safra Childrens Hosp, Israel.
    Ghatasha, Atheer
    Bethlehem Arab Soc Specialized Rehabil & Surg Hos, Palestine.
    Genlin, Liu
    Capital Med Univ, Peoples R China.
    Yang, Chen
    Bayi Rehabil Ctr, Peoples R China.
    Qin, Yu-Xi
    Bayi Rehabil Ctr, Peoples R China.
    Wahman, Kerstin
    Karolinska Inst, Sweden; Aleris Rehab Stn, Sweden.
    Sunnerhagen, Katharina S.
    Sahlgrens Univ Hosp, Sweden.
    Ertzgaard, Per
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Sukhov, Renat
    NYU Langone Hlth, NY USA.
    Augutis, Marika
    Karolinska Inst, Sweden.
    Stanghelle, Johan K.
    Univ Oslo, Norway.
    Roaldsen, Kirsti S.
    Sunnaas Rehabil Hosp, Norway; Karolinska Inst, Sweden; UiT Arctic Univ Norway, Norway.
    Organisation of services and systems of care in paediatric spinal cord injury rehabilitation in seven countries: a survey with a descriptive cross-sectional design2022In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 60, no 4, p. 339-347Article in journal (Refereed)
    Abstract [en]

    Study design International multicentre cross-sectional study. Objectives To describe the organisation and systems of paediatric spinal cord injury (SCI) rehabilitation services in seven countries and compare them with available recommendations and key features of paediatric SCI. Setting Ten SCI rehabilitation units in seven countries admitting children and adolescents with SCI &lt; 18 years of age. Methods An online survey reporting data from 2017. Descriptive and qualitative analysis were used to describe the data. Results The units reported large variations in catchment area, paediatric population and referrals, but similar challenges in discharge policy. Nine of the units were publicly funded. Three units had a paediatric SCI unit. The most frequent causes of traumatic injury were motor vehicle accidents, falls, and sports accidents. Unlike the other units, the Chinese units reported acrobatic dancing as a major cause. Mean length of stay in primary rehabilitation ranged between 18 and 203 days. Seven units offered life-long follow-up. There was a notable variation in staffing between the units; some of the teams were not optimal regarding the interdisciplinary and multiprofessional nature of the field. Eight units followed acknowledged standards and recommendations for specialised paediatric SCI rehabilitation and focused on family-centred care and rehabilitation as a dynamic process adapting to the child and the family. Conclusions As anticipated, we found differences in the organisation and administration of rehabilitation services for paediatric SCI in the ten rehabilitation units in seven countries. This might indicate a need for internationally approved, evidence-based guidelines for specialised paediatric SCI rehabilitation.

  • 39.
    Ihlstrom, Jonas
    et al.
    Swedish National Rd and Transport Research Institute, Linkoping, Sweden.
    Kecklund, Goran
    Stockholm University, Sweden.
    Anund, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Swedish National Rd and Transport Research Institute, Linkoping, Sweden.
    Split-shift work in relation to stress, health and psychosocial work factors among bus drivers2017In: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 56, no 4, p. 531-538Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Shift work has been associated with poor health, sleep and fatigue problems and low satisfaction with working hours. However, one type of shift working, namely split shifts, have received little attention. OBJECTIVE: This study examined stress, health and psychosocial aspects of split-shift schedules among bus drivers in urban transport. METHODS: A questionnaire was distributed to drivers working more than 70% of full time which 235 drivers in total answered. RESULTS: In general, drivers working split-shift schedules (n = 146) did not differ from drivers not working such shifts (n = 83) as regards any of the outcome variables that were studied. However, when individual perceptions towards split-shift schedules were taken into account, a different picture appeared. Bus drivers who reported problems working split shifts (36%) reported poorer health, higher perceived stress, working hours interfering with social life, lower sleep quality, more persistent fatigue and lower general work satisfaction than those who did not view split shifts as a problem. Moreover, drivers who reported problems with split shifts also perceived lower possibilities to influence working hours, indicating lower work time control. CONCLUSIONS: This study indicates that split shifts were not associated with increased stress, poorer health and adverse psychosocial work factors for the entire study sample. However, the results showed that individual differences were important and approximately one third of the drivers reported problems with split shifts, which in turn was associated with stress, poor health and negative psychosocial work conditions. More research is needed to understand the individual and organizational determinants of tolerance to split shifts.

  • 40.
    Johansson, Jan
    et al.
    Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institute, Stockholm.
    Levi, Richard
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine.
    Jakobsson, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Gunnarsson, Stina
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine.
    Samuelsson, Kersti
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine.
    Multiprofessional Neurorehabilitation After COVID-19 Infection Should Include Assessment of Visual Function.2022In: Archives of Rehabilitation Research and Clinical Translation, E-ISSN 2590-1095, Vol. 4, no 2, article id 100184Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To report vision-related symptoms and neuro-visual clinical signs in patients approximately 4 months after discharge from hospitalization after COVID-19 infection. To report on coexisting functional and activity limitations.

    DESIGN: The study is part of an ambidirectional population-based cohort study.

    SETTING: An outpatient setting in a hospital environment.

    PARTICIPANTS: Patients from a population-based cohort study including all patients with laboratory-confirmed COVID-19 admitted to hospital during a 3-month period in a health care region in Sweden. Among patients who, based on a standardized telephone interview, were identified as having persisting rehabilitation needs 4 months after discharge (n=185), several (n=57) reported vision-related symptoms. All 57 patients were invited to a neuro-visual examination. Six patients declined, 6 were unavailable, and 3 did not fulfil the inclusion criteria. Thus, 42 patients were included in the analysis (N=42).

    INTERVENTIONS: Not applicable.

    MAIN OUTCOME MEASURES: Vision-related symptoms, neuro-visual function, and coexisting impairments affecting activities of daily life and participation.

    RESULTS: A total of 31% of patients with rehabilitation needs after COVID-19 reported vision-related symptoms. Reading-related issues (73.8%), blurry vision (69.0%), and light sensitivity (66.7%) were the most common symptoms. Patients with reading-related issues showed a higher level of eye strain (P<.001). Neuro-visual deficits were found in 83.3% of the patients, mainly concerning eye teaming (23.1%-66.7%) and eye movement (28.6%-30.8%) functions. Patients with vision-related symptoms reported fatigue and 18 other coexisting symptoms to a greater extent (P≤.0001 to .049).

    CONCLUSIONS: Neuro-visual symptoms and signs should be considered when assessing rehabilitation needs after COVID-19. The association between vision-related issues and coexisting symptoms with an effect on body function and activity and/or participation underlines the need for multiprofessional rehabilitation assessment and intervention.

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  • 41.
    Jonasson, Lise-Lotte
    et al.
    Jonkoping Univ, Sweden.
    Sörbo, Ann
    Reg Vastra Gotaland, Sweden; Dept Res Educ & Innovat, Sweden.
    Ertzgaard, Per
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Sandsjö, Leif
    Univ Boras, Sweden; Chalmers Univ Technol, Sweden.
    Patients’ Experiences of Self-Administered Electrotherapy for Spasticity in Stroke and Cerebral Palsy: A Qualitative Study2022In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 54, article id jrm00263Article in journal (Refereed)
    Abstract [en]

    Objective: To explore patients experiences of a self-administered electrotherapy treatment for muscle spasticity in cerebral palsy and stroke; the Exopulse Mollii Suit (R). Design: Qualitative design with an inductive approach Subjects: Fifteen patients with spasticity due to stroke or cerebral palsy, participating in a previous randomized controlled trial evaluating the treatment concept. Methods: Information letters were sent to all potential participants (n = 27) in the previous study. Semi-structured interviews (21-57 min) were carried out with all subjects who volunteered (n = 15), administered by an experienced interviewer who was not involved in the previous study. Transcribed interviews were subject to content analysis. Results: The 5 categories that emerged from the content analysis were "New method gives hope", experiences related to "Using the assistive technology", "Outcome from training with the assistive technology", "The assistive technology" and "Taking part in the study". Respondents felt hopeful when included in the previous study, motivated when experiencing a treatment effect, and disappointed when not. Conclusion: The qualitative approach used in this study elicited complementary information that was not evident from the previous randomized controlled trial. This included statements regarding increased mobility, reduced spasticity, reduced use of medication, and problems related to using the treatment concept.

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  • 42.
    Jorgensen, Sophie
    et al.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Forslund, Emelie Butler
    Karolinska Inst Stockholm, Sweden; Aleris Rehab Stn, Sweden.
    Lundstrom, Ulrica
    Reg Norrbotten, Sweden.
    Nilsson, Erika
    Spinalis Fdn, Sweden.
    Levi, Richard
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Berndtsson, Erik
    Skane Univ Hosp, Sweden.
    Divanoglou, Anestis
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    SOUND PSYCHOMETRIC PROPERTIES OF THE SWEDISH VERSION OF THE SPINAL CORD INDEPENDENCE MEASURE SELF-REPORT2021In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 53, no 5, article id jrm00197Article in journal (Refereed)
    Abstract [en]

    Objective: To describe data completeness, target & shy; ing and reliability of the Swedish version of the Spinal Cord Independence Measure Self & shy;Report (s & shy;SCIM & shy;SR). Design: Translation and reliability study. Subjects: Programme participants (n = 48) and peer mentors (n = 42) with spinal cord injury enrolled in the INTERnational Project for the Evaluation of & ldquo;activE Rehabilitation & rdquo; (inter & shy;PEER). Methods: The translation process was based on guidelines/recommendations, and involved expert competence, including consumers. The s & shy;SCIM & shy;SR was distributed online, once for programme partici & shy; pants and twice for peer mentors. Results: Sixty & shy;nine individuals (77%) obtained a total score. Most missing data were found in the items Respiration and Using the toilet. Cronbach & rsquo;s alpha for the full scale was 0.89, for Self & shy;care 0.92, for Respiration and sphincter management 0.37 and for Mobility 0.86. The intraclass correlation coef & shy; ficient was excellent for all subscales and the full scale. Measures of variability showed high sensitiv & shy; ity to changes and Bland Altman analyses revealed no systematic changes between evaluation points. Conclusion: These results support the data complete & shy; ness, targeting and reliability of the Swedish version of the SCIM & shy;SR. However, some problems were found in the subscale Respiration and sphincter management. The s & shy;SCIM & shy;SR can be considered psy & shy; chometrically sound and suitable to assess physical independence among persons with spinal cord injury in Swedish community settings.

  • 43.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Ertzgaard, Per
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Förvärvade ryggmärgsskador2015In: Rehabiliteringsmedicin: teori och praktik / [ed] Jörgen Borg, Kristian Borg, Björn Gerdle, Katharina Stibrant Sunnerhagen, Lund: Studentlitteratur AB, 2015, 1, p. 375-388Chapter in book (Other academic)
    Abstract [sv]

    Rehabiliteringsmedicinsk kunskap är relevant vid alla sjukdomar och skador som medför långvariga, komplexa funktionshinder och är därför relevant inom stora delar av sjukvården. Inom den rehabiliteringsmedicinska specialiteten handläggs idag främst patienter med skador och sjukdomar i nervsystemet respektive med långvariga smärttillstånd.

    Denna reviderade upplaga inleds med en sektion som avhandlar rehabiliteringsmedicinens utveckling och nuvarande plats i sjukvården, centrala rehabiliteringsmedicinska koncept, mät- och arbetsmetoder. Följande sektioner omfattar rehabiliteringsmedicinsk funktionsdiagnostik, läkningsmekanismer och behandling vid långvariga smärttillstånd respektive vid skador och kroniska sjukdomar i nervsystemet. Bokens omfång har ökat något. Några kapitel har fått större utrymme och nya kapitel om beteendestörning och medicinska komplikationer efter svår hjärnskada liksom om anoxisk hjärnskada har tillkommit. Andra kapitel, som inte rör dagens kärnverksamhet inom praktisk rehabiliteringsmedicin, har utgått.

    Rehabiliteringsmedicin är avsedd för grundutbildning av läkare, arbetsterapeuter och sjukgymnaster, logopeder samt för läkare under ATtjänstgöring. Den är också lämplig som introduktion i specialistutbildningen i rehabiliteringsmedicin, geriatrik, neurologi och smärtlindring, i vidareutbildningar av olika vårdyrkesgrupper och som referenslitteratur av yrkesverksamma med intresse för rehabiliteringsmedicin.

  • 44.
    Lilliecreutz, Eva Kristina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Felixson, Beatrice
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Department of Rehabilitation Medicine, Västervik Hospital, Västervik, Sweden.
    Lundqvist, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Samuelsson, Kersti
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Effects of guided aerobic exercise and mindfulness after acquired brain injury: a pilot study2017In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 19, no 4, p. 229-236Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this study was to examine whether a specific guided programme of aerobic exercise together with mindfulness could have an effect on estimated health status and occupational performance in individuals with acquired brain injury (ABI). As secondary outcomes, the effects on health-related quality of life, cognition and mental fatigue were analysed.

    Methods: The study included individuals with mild to moderate ABI (n = 21) with residual cognitive impairments. Guided interventions were given three times per week for 12 weeks. Neuropsychological and physical tests as well as patient-reported outcome measures were used as outcomes.

    Results: Estimated health status, self-reported occupational performance as well as satisfaction with performance improved together with physical capacity. Improvements in cognitive functions were related to attention and information processing speed; in addition, self-reported mental fatigue was reduced after the intervention. Cognitive function related to working memory and health-related quality of life were not affected.

    Conclusions: Support to improve physical capacity combined with practicing mindfulness, bringing attention to the present moment, seems to have a positive impact on occupational performance, estimated health status, attention and information processing speed as well as mental fatigue in individuals with cognitive dysfunction after ABI.

  • 45.
    Linden, Josefine
    et al.
    Umea Univ, Sweden.
    Stenberg, Gunilla
    Umea Univ, Sweden.
    Divanoglou, Anestis
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    The vulnerable superhero-a qualitative study investigating how spinal cord injury peer mentors experience their role in Active Rehabilitation training programs2023In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624Article in journal (Refereed)
    Abstract [en]

    Study designQualitative study.ObjectivesTo explore how peer mentors with spinal cord injury (SCI) experience their role in Active Rehabilitation programs in Sweden.SettingCommunity peer-based training programs in Sweden.MethodsTwenty active peer mentors were strategically selected and invited to participate. Nine individuals of diverse age, level of SCI and time since injury participated in semi-structured interviews via video link. Qualitative content analysis was used to analyze the data.ResultsThe theme: Being a vulnerable superhero-a balancing act with rewards was based upon five categories: Being a suitable fit for a demanding culture, Offering a shortcut to coping with spinal cord injury life, Feeling rewarded by helping others, Building trust is reciprocal, and Constituting the norm in a temporary community. The peer mentors expressed vulnerability of sharing life experiences, being a role model and building relationships with mentees. The theme emerged from notions of high expectations and demands of the SCI peer mentor role. Being a peer mentor empowered, educated and inspired the peer mentors themselves.ConclusionsPeer mentors were continuously balancing between being open and vulnerable, and being strong and capable. Personality traits were reported as more important aspects of the role than physical skills. The individual mentor-mentee meetings and relationships were considered more important than the actual training sessions. Feeling part of a community and the norm through meeting others in a similar situation was perceived as a reward and motivation for participating as a peer mentor.

  • 46.
    Lindgren, Marie
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Stålnacke, Britt-Marie
    Institutionen för samhällsmedicin och rehabilitering, Umeå universitet; Smärtcentrum, Neuro-huvud-hals-centrum, Norrlands universitetssjukhus, Umeå.
    Nygren Deboussard, Catharina
    Institutionen för kliniska vetenskaper, rehabiliteringsmedicin, Danderyds sjukhus, Karolinska institutet, Stockholm; rehabiliteringsmedicinska universitetskliniken Stockholm, Danderyds sjukhus.
    Rehabilitering vid traumatisk hjärnskada behöver samordnas: Stora skillnader i Tillgång till hjärnskaderehabilitering ochspecialistkunskap i alla faser i förloppet och över landet2021In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118Article, review/survey (Refereed)
    Abstract [sv]

    Traumatisk hjärnskada är vanligt förekommande i alla åldrar och kan leda till behov av rehabiliteringsinsatser under många år.

    Kunskap och samarbete mellan flera specialiteter och samordning av insatser är viktiga för patienten genom hela vårdkedjan.

    Det finns ett behov av mer jämlik vård och stöd i att hantera hjärnskaderelaterade frågor genom hela livet.

    Vid specialiserad hjärnskaderehabilitering bedöms och behandlas komplexa förlopp med symtom som långvarig svår medvetandestörning, posttraumatisk agitation, kognitiva funktionsnedsättningar, fatigue, motoriska och kommunikativa svårigheter, synsvårigheter, yrsel och stimuluskänslighet efter traumatisk hjärnskada.

  • 47.
    Magaard, Gustaf
    et al.
    Umea Univ, Sweden.
    Wester, Per
    Umea Univ, Sweden; Karolinska Inst, Sweden.
    Levi, Richard
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Lindvall, Peter
    Umea Univ, Sweden.
    Gustafsson, Emma
    Umea Univ, Sweden.
    Sedeh, Arzhang Nazemroaya
    Umea Univ, Sweden.
    Lonnqvist, Malin
    Umea Univ, Sweden.
    Berggren, Stina
    Umea Univ, Sweden.
    Nyman, Kristin
    Umea Univ, Sweden.
    Hu, Xiaolei
    Umea Univ, Sweden.
    Identifying Unmet Rehabilitation Needs in Patients After Stroke With a Graphic Rehab-Compass (TM)2018In: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 27, no 11, p. 3224-3235Article in journal (Refereed)
    Abstract [en]

    Background: Unmet rehabilitation needs are common among stroke survivors. We aimed to evaluate whether a comprehensive graphic "Rehab-Compass," a novel combination of structured patient-reported outcome measures, was feasible and useful in facilitating a capture of patients rehabilitation needs in clinical practice. Methods: A new graphic overview of broad unmet rehabilitation needs covers deficits in functioning, daily activity, participation, and quality of life. It was constructed by using 5 patient-oriented, well-validated, and reliable existing instruments with converted data into a 0 (worst outcome) to 100 (best outcome) scale but unchanged in terms of variable properties. Satisfaction of the Rehab-Compass (TM) was studied by a qualitative interview of 9 patients with stroke and 3 clinicians. Practical feasibility and capacity of the instrument were evaluated in a cross sectional study with 48 patients at 5-month follow-ups after subarachnoid hemorrhage. Results: The Rehab-Compass (TM) identified and graphically visualized a panoramic view of the multidimensional needs over time which was completed before clinical consultation. The Rehab-Compass (TM) appeared to be feasible and time efficient in clinical use. The interviews of both patients and clinicians showed high satisfaction when using the Rehab-Compass (TM) graph. In the studied stroke patients, the Rehab-Compass (TM) identified memory and processing information, fatigue, mood, and pain after subarachnoid hemorrhage as the most common problems. Conclusions: The graphic Rehab-Compass (TM) seems to be a feasible, useful, and time-saving tool for identification of unmet rehabilitation needs among stroke survivors in clinical practice. Further research is needed to make the Rehab-Compass (TM) more concise and evaluate the instrument among different stroke subgroups.

  • 48.
    Mangold, Jasmin
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Univ Hosp Tubingen, Germany.
    Divanoglou, Anestis
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Middleton, James W.
    Royal North Shore Hosp, Australia; Univ Sydney, Australia; Royal Rehab, Australia.
    Joergensen, Sophie
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    The Swedish version of the Moorong Self-Efficacy Scale (s-MSES) - translation process and psychometric properties in a community setting2024In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624Article in journal (Refereed)
    Abstract [en]

    Study designPsychometric study.ObjectivesTo i) describe the translation process and ii) explore the data completeness, targeting, reliability and aspects of validity of the Swedish version of Moorong Self-Efficacy Scale (s-MSES).SettingsCommunity rehabilitation program.MethodsNinety-two program participants and 42 peer mentors with spinal cord injury (SCI) in Active Rehabilitation training programs (enrolled in the International Project for the Evaluation of activE Rehabilitation (Inter-PEER)) were included. The s-MSES was completed online, once for program participants and twice for peer mentors. The translation process was based on guidelines and involved researchers, clinicians and consumers.ResultsMinor linguistic adaptations were made. Ninety-one percent obtained a total score. As expected, peer mentors exhibited ceiling effects in all subscales. Cronbach ' s alpha for the total scale was 0.92 (subscales 0.74-0.83). The intraclass correlation coefficient was excellent for the total and subscale scores (0.78-0.91). The s-MSES exhibited sensitivity to changes and there were no systematic changes between evaluation points. The s-MSES correlated significantly and positively with life satisfaction and resilience, and negatively with depression/anxiety.ConclusionThe s-MSES was translated through a rigorous, consumer-involved process ensuring accurate linguistic translation and cultural adaptation. Our results support the data completeness, targeting, reliability and aspects of validity of the s-MSES. The s-MSES can thus be considered suitable to assess self-efficacy in persons with SCI in community rehabilitation settings. The now available Swedish version of the MSES will facilitate national research, clinical evaluations and international comparisons.SponsorshipNot applicable.

  • 49.
    McIntyre, Amanda
    et al.
    Parkwood Inst, Canada.
    Sadowsky, Cristina
    Johns Hopkins Univ, MD USA; Kennedy Krieger Inst, MD USA.
    Behrman, Andrea
    Univ Louisville, KY USA; Kosair Char Ctr Pediat Neurorecovery, KY USA.
    Martin, Rebecca
    Johns Hopkins Univ, MD USA; Kennedy Krieger Inst, MD USA.
    Augutis, Marika
    Karolinska Inst, Sweden.
    Cassidy, Caitlin
    Parkwood Inst, Canada.
    Betz, Randal
    Inst Spine & Scoliosis, NJ USA; Mt Sinai Hosp, NY USA.
    Ertzgaard, Per
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Mulcahey, M. J.
    Thomas Jefferson Univ, NJ USA.
    the SCIRE Project Research Group,
    A Systematic Review of the Scientific Literature for Rehabilitation/Habilitation Among Individuals With Pediatric-Onset Spinal Cord Injury2022In: Topics in Spinal Cord Injury Rehabilitation, ISSN 1082-0744, E-ISSN 1945-5763, Vol. 28, no 2, p. 13-90Article, review/survey (Refereed)
    Abstract [en]

    Objectives: To conduct a systematic review to examine the scientific literature for rehabilitation/habilitation among individuals with pediatric-onset spinal cord injury (SCI). Methods: A literature search of multiple databases (i.e., PubMed/MEDLINE, CINAHL, EMBASE, PsychINFO) was conducted and was filtered to include studies involving humans, published as full-length articles up to December 2020, and in English. Included studies met the following inclusion criteria: (1) &gt;= 50% of the study sample had experienced a traumatic, acquired, nonprogressive spinal cord injury (SCI) or a nontraumatic, acquired, noncongenital SCI; (2) SCI onset occurred at &lt;= 21 years of age; and (3) sample was assessed for a rehabilitation/habilitationrelated topic. Studies were assigned a level of evidence using an adapted Sackett scale modified down to five levels. Data extracted from each study included author(s), year of publication, country of origin, study design, subject characteristics, rehabilitation/habilitation topic area, intervention (if applicable), and outcome measures. Results: One hundred seventy-six studies were included for review (1974-2020) with the majority originating from the United States (81.3%). Most studies were noninterventional observational studies (n = 100; 56.8%) or noninterventional case report studies (n = 5; 2.8%). Sample sizes ranged from 1 to 3172 with a median of 26 (interquartile range [IQR], 116.5). Rehabilitation/habilitation topics were categorized by the International Classification of Functioning, Disability and Health (ICF); most studies evaluated ICF Body Function. There were 69 unique clinical health outcome measures reported. Conclusion: The evidence for rehabilitation/habilitation of pediatric-onset SCI is extremely limited; nearly all studies (98%) are level 4-5 evidence. Future studies across several domains should be conducted with novel approaches to research design to alleviate issues related to sample sizes and heterogeneity.

  • 50.
    Moschovou, Maria
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Antepohl, Wolfram
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Halvorsen, Annette
    Trondheim Reg & Univ Hosp, Norway; Trondheim Reg & Univ Hosp, Norway.
    Pettersen, Ann Louise
    Trondheim Reg & Univ Hosp, Norway.
    Divanoglou, Anestis
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Temporal changes in demographic and injury characteristics of traumatic spinal cord injuries in Nordic countries-a systematic review with meta-analysis2022In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 60, p. 765-773Article, review/survey (Refereed)
    Abstract [en]

    Study design Systematic review with meta-analysis. Objectives To explore temporal changes in incidence rates, demographic and injury characteristics of incident traumatic spinal cord injury (TSCI) in Nordic countries. Methods Peer-reviewed publications and periodic reports about epidemiology of TSCI in the Nordic countries (Denmark, Finland, Iceland, Norway, Sweden) are identified, reviewed and included in the meta-analysis. Data are stratified into 20-year intervals to allow for chronological comparisons. Pooled estimates are derived using random effects meta-analysis. Results Twenty-three data sources are included presenting a total of 5416 cases. The pooled incidence rate for 2001-2020 is 15.4 cases/million/year compared to 17.6 and 18.3 cases/million/year during the two previous 20-year intervals. The proportion of cases with TSCI in the 15-29 age-group decreases from 50% (1961-1980) to 20% (2001-2020), while it increases from 9% to 35% in 60+ age-group. Transportation-related injuries decrease from 44% (1961-1980) to 27% (2001-2020). Conversely, fall-related injuries increase from 32% (1961-1980) to 46% (2001-2020). The proportion of individuals with incomplete tetraplegia increases from 31% (1961-1980) to 43% (2001-2020), while complete paraplegia decreases from 25% to 16%. Conclusion The characteristics of TSCI in the Nordic countries have changed drastically over the last six decades, in line with clinical experiences, and limited research evidence from other countries. These changes indicate the need for adapting research focus, prevention strategies, design and provision of care, rehabilitation and community services towards older individuals, fall-related injuries, and incomplete injuries in Nordic countries and other settings internationally where such changes occur.

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