OBJECTIVE:To describe arterial stiffness, ankle-brachial index (ABI), advanced glycation end products (AGE) and glycosylated hemoglobin (HbA1c) in middle-aged people with cervical and upper thoracic SCI, and compare findings with the general population. DESIGN:Cross-sectional study with matched controls. SETTING:Tertiary outpatient SCI unit in southern Sweden. PARTICIPANTS:Participants (n = 25) in the Swedish Spinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment (SPICA) (20% women, mean age 58 years, mean time since injury 28 years, injury levels C2-T6, American Spinal Injury Association Impairment Scale A-C). Controls (n = 250; ratio 10:1) from the general population were obtained from the Swedish CArdioPulmonary bioImage Study (SCAPIS). OUTCOME MEASURES:Aortic augmentation index at heart rate of 75 bpm (Aortic Aix@75), pulse wave velocity, ABI, AGE, HbA1c and anthropometry. RESULTS:The participants had significantly higher measures of Aortic Aix@75 (mean 35 vs 21, P = 0.004) and AGE (mean 2.6 vs 2.1, P < 0.001), and lower ABI (mean 1.07 vs 1.26, P < 0.001) and HbA1c (mean 36 vs 37, P = 0.007) than the controls. An abnormal HbA1c level (<31 or >46) was present in eight (32%) and 23 (9%) of the participants with SCI and controls, respectively (P = 0.003). Pulse wave velocity was similar between participants with SCI and controls (mean 8.6 m/s vs 8.5 m/s, P = 0.53). CONCLUSIONS:The difference in cardiometabolic factors between middle-aged people with long-term cervical and upper thoracic SCI and the general population implies that their cardiometabolic health is compromised. Further studies are needed to determine the prognostic significance of these differences.Trial registration: ClinicalTrials.gov identifier: NCT03515122.

BackgroundOlder adults aging with long-term spinal cord injury (SCI) are insufficiently physically active to reach health benefits. However, little is known about their perceptions of physical activity (PA) and barriers and facilitators to their PA engagement.ObjectivesTo explore perceptions and experiences of engagement and participation in PA among older adults aging with long-term SCI.MethodsWe interviewed 74 men and women (56–88 years) from the Swedish Aging with Spinal Cord Injury Study (SASCIS) using a semi-structured interview guide. Interviews were transcribed verbatim and analysed with an inductive thematic analysis. Meaning units and codes were generated directly from the data without being influenced by pre-existing research frameworks. A latent approach was applied when forming themes, aiming to capture underlying assumptions and patterns.ResultsFour different themes were revealed: “The multifaceted benefits of PA”, “PA comes in different forms; from incidental daily movement to formalized exercise”, “Restricted access: It is complex and difficult to be physically active” and “Unlocking potential: facilitators of PA”.ConclusionsThis study highlights the essential role of PA in promoting well-being and independence for older adults aging with long-term SCI. Participants faced significant barriers, including accessibility, health-related challenges and lack of professional guidance, and emphasized facilitators such as the need for supervised training, social support and improved accessibility. Addressing these barriers and facilitators can create more inclusive opportunities for PA and exercise, ultimately supporting healthy, sustainable and active aging many years after SCI.

CONTEXT:Life satisfaction (LS) is associated with health and longevity but decreases after spinal cord injury (SCI). Yet, little is known about changes in LS over time, many years after SCI. OBJECTIVES:To assess changes in LS over six years among older adults aging with long-term SCI, determine how changes in LS are associated with sex, age, injury characteristics, and with changes in secondary health conditions (SHCs), activity limitations, marital status and vocational situation. DESIGN:Longitudinal cohort study from the Swedish Aging with Spinal Cord Injury Study (SASCIS). SETTING:Community settings, Sweden. PARTICIPANTS:Seventy-eight individuals (32% women), mean age 68 years, mean time since injury 31 years, injury levels C1-L3, AIS A-D. OUTCOME MEASURES:The Life Satisfaction Questionnaire (LiSat-11), consisting of life as a whole and ten different life domains. RESULTS:Over six years, there were no statistically significant changes in self-rated LS at the group level, but some variability at the individual level. To stop working was associated with increased LS, whereas none of the included variables were associated with decreased LS. A majority of the participants were dissatisfied with life as a whole and with five of the ten life domains, particularly with sexual life, somatic health, and self-care. CONCLUSIONS:Our findings indicate stability in global and domain-specific LS over time in older adults aging with long-term SCI. Giving up work can be beneficial for LS in this population as they age. The low LS in several life domains calls for attention in the long-term follow-up after SCI.

OBJECTIVES:To compare head acceleration between blind football players and non-disabled football players, and between anticipated and unanticipated conditions in blind football players. DESIGN:Laboratory-based exploratory study. METHODS:Participants were ten football players (five blind football, five non-disabled; 80% female). Standardized head perturbations were applied in flexion, extension, lateral flexion, and rotation using a custom-built apparatus, under both anticipated and unanticipated conditions. Peak linear (g) and angular (rad/s2) head accelerations were measured. RESULTS:Between-group comparisons did not reveal statistically significant differences; however, a descriptive pattern was observed for peak angular acceleration during rotational perturbations, with blind football players demonstrating higher values in both anticipated (44.75 ± 4.38 vs. 38.09 ± 7.20 rad/s2; p 0.12) and unanticipated (48.0 ± 4.8 vs. 40.9 ± 5.5 rad/s2; p 0.06) conditions. In blind football group, unanticipated perturbations produced higher accelerations than anticipated, with the largest descriptive differences observed in lateral flexion for both peak linear (0.25 ± 0.03 vs. 0.21 ± 0.03 g; p 0.00) and angular accelerations (21.73 ± 4.71 vs. 18.36 ± 6.45 rad/s2; p 0.24). CONCLUSIONS:Descriptively higher peak angular acceleration during rotational trials was observed in blind football compared to non-disabled football players, alongside consistently higher head accelerations in unanticipated than anticipated conditions. While the observed patterns suggest that anticipatory control may influence head acceleration responses, adequately powered studies are needed to confirm the observed directional trends in angular head acceleration between blind football and non-disabled football players and clarify their implications for sport-related concussion prevention strategies in blind football.

OBJECTIVE:To describe the epidemiology of injuries and illnesses at the Paris 2024 Paralympic Games. METHODS:Injuries and illnesses were recorded daily via a web-based injury and illness surveillance system and local organising committee medical facilities. Adjusted incidences (injuries/illnesses per 1000 athlete days; 95% CIs), injury prevalence (IP; %) and injury burden (days lost per 1000 athlete days; 95% CIs) are reported. RESULTS:In total, 4450 athletes (1978 female; 2472 male) from 163 National Paralympic Committees were monitored prospectively during the 14-day Games period (62300 athlete days). A total of 535 injuries (IP=10.9%) were reported in 485 athletes, with an incidence of 8.6 (7.9-9.4). Taekwondo (27.3 (20.7-35.8)), football 5-a-side (22.3 (14.4-37.7)) and sitting volleyball (19.9 (14.8-26.7)) showed higher incidences of injury compared to other sports (p<0.001). Injury burden was 8.5 (6.5-11.1) and 19.1% of injuries resulting in time loss from training/competition. The highest burden was observed in taekwondo (64.3 (35.9-115.2)) and football 5-a-side (23.4 (6.2-88.3)). A total of 520 illnesses were reported in 467 athletes (IP=10.5%), with an incidence of 8.3 (7.6-9.1). Illness incidence for female athletes (10.6 (9.4-11.9)) was higher than recorded for male athletes (6.6 (5.7-7.5)); p<0.001 and higher in triathlon (18.2 (12.6-26.7)) compared to other sports (p<0.05). CONCLUSION:The incidence and burden of injury in taekwondo and football 5-a-side were significantly higher compared with other sports at the Paris 2024 Paralympic Games. The highest incidence of illness was observed in triathlon and female athletes had a higher illness incidence than male athletes.

Para Alpine skiing is one of the largest sports at the Paralympic Winter Games. Recent studies report high injury rates in this sport. However, limited evidence exists regarding sport-specific injury characteristics, which is essential for targeted prevention. The aim of this study was to describe the overall incidence proportion and incidence of injuries reported by athletes participating in Alpine skiing at the Sochi 2014, PyeongChang 2018, and Beijing 2022 Paralympic Winter Games, and to describe injuries by sex, age, impairment, competition period, onset (chronicity), anatomical area, and estimated injury burden. Prospective epidemiological data regarding injuries at the three Paralympic Games (including 486 athletes and 6002 athlete days) were reported by medical staff through the validated web-based injury and illness surveillance system (WEB-IISS) and Paralympic polyclinics. Data were coded and analyzed according to the IOC Para consensus statement using descriptive and analytical statistics (incidence, incidence proportion with 95% CIs, and generalized linear Poisson's regression modeling). The overall injury incidence was 29.4 (95% CI 24.9-34.6) injuries per 1000 athlete days, with an incidence proportion of 28.4%. Injury incidence was significantly higher in the pre-competition period (54.4; 95% CI 42.5-69.7) compared with the competition period (21.2; 95% CI 17.2-26.1). Acute injuries predominated, with 24% of athletes sustaining at least one acute injury during the Games. The head/face/neck (24%) and knee (20%) were most affected. Common mechanisms included collisions and loss of control. Ten percent of injuries resulted in > 28 days of expected time loss, and the overall injury burden was 70.6 days lost per 1000 days. No difference in injury incidence was found with regards to sex and age. Athletes with limb deficiency reported the highest injury proportions, followed by those with spinal cord injury. Across three Paralympic Games, nearly one-third of Para Alpine skiers sustained an injury. These findings highlight a need for enhanced prevention strategies, particularly those targeting the high-risk pre-competition period and focusing on mechanisms to protect the head/face/neck and knee.

BackgroundChronic pain in children can significantly impact daily functioning. While interdisciplinary pain rehabilitation is the recommended treatment, it is resource-intensive and limited in availability. Therefore, children with more complex symptoms, classified as High Impact Chronic Pain (HICP), need to be prioritized for interdisciplinary pain rehabilitation. However, HICP in children has been incompletely defined in previous literature, and associated factors remain underexplored. This study aimed to explore a broader biopsychosocial definition of HICP in children and to investigate characteristics and clinical factors in children and parents associated with HICP.MethodThis exploratory retrospective cross-sectional registry study included 484 children with chronic pain and their parents, referred to a tertiary pediatric pain clinic in Sweden. HICP was defined using five variables: pain intensity, pain interference, overall well-being, insomnia, and school absence. Children who met thresholds in at least three of these variables were classified as having HICP. Multivariable logistic regression models were used to identify factors in children and parents associated with HICP.ResultsA total of 60% of the participants met the criteria for HICP. Variables significantly associated with HICP included symptoms of depression (OR 1.10, p = 0.001) and psychological inflexibility (OR 1.06, p = 0.001) in children, as well as pain reactivity in parents (OR 1.05, p = 0.018).ConclusionPsychiatric comorbidity and behavioral aspects, including psychological inflexibility and parental pain reactivity, play key roles in pediatric HICP and should be considered when assessing and planning interventions. Addressing these factors may improve treatment outcomes and reduce long-term challenges.

ObjectiveLongitudinal health monitoring studies, including Para athletes, are lacking in low- and middle-income countries. This study aimed to introduce a surveillance program developed for Swedish Para athletes to high-level South African Para athletes and describe their self-reported health outcomes.DesignUsing a prospective cohort design, we distributed weekly electronic surveys to Para athletes for 88 wks. These included questions relating to training (e.g., volume, intensity), health (e.g., pain, injury, illness, symptoms of anxiety or depression), and lifestyle (e.g., diet, sleep).ResultsOf 28 recruited athletes, 21 responded to >= 1 survey (13 males and 8 females; 42.6% response rate). During an average week, 50% of athletes experienced mild-to-severe pain, 25% reported a new or ongoing injury or illness, 69% slept less than 8 hrs per night, and 20% reported symptoms of anxiety or depression. The overall injury incidence was 3.1 per 1000 hrs.ConclusionsLongitudinal health monitoring is challenging in low- and middle-income countries, and each setting's unique barriers and facilitators must be explored and acknowledged if such programs are to be sustained. Our data suggest that pain, injuries, illnesses, and symptoms of anxiety or depression are common among high-level South African Para athletes and efforts should be made to manage these.

OBJECTIVE:To qualitatively explore the perceptions of Para athletes, coaches and stakeholders of the implementation, use and effects of the health promotion intervention 'Safe and Healthy Para sport' (SHAPE). A secondary aim was to explore participants' perceptions of how safety and health in Para sport could be further developed. METHODS:As part of a process evaluation, this qualitative, descriptive study applied a thematic analysis approach. In total, 18 participants (athletes, coaches and staff) from Sweden and South Africa participated in three focus groups. RESULTS:Three themes were generated from the focus groups: 'how to reach every Para athlete in implementation and use', 'proactive athlete growth and support', and 'opportunities for sustainable Para sport'. Participants perceived that the SHAPE intervention was end-user friendly and that it was difficult to find health promotion material for Para athletes elsewhere. Athletes had used the health information to recover from injuries, and their awareness of mental health conditions had increased. Athletes also identified a need for more individualised content, but some athletes were not aware of the health platform. It was suggested that health promotion in Para sport could be better facilitated by peer support. The weekly athlete health monitoring fostered a sense of accountability both among athletes and within the sports organisation, but participants still perceived that medical evaluations are mostly neglected in Para sport and voiced a need to strengthen medical and economic support structures. CONCLUSION:Health promotion can be used to improve health and well-being among Para athletes. However, it was challenging to reach out to the individual athlete, suggesting that health promotion should be implemented in each layer of the socioecological model within Para sport.

BACKGROUND:Physical activity (PA) after stroke has significant health benefits if it is conducted regularly, with sufficient intensity and duration. Because of the health benefits, it is important to identify those below the World Health Organization (WHO) recommended level of PA. However, few studies have assessed the level of PA after stroke in relation to the WHO recommendations and which sociodemographic factors and stroke characteristics are associated with those below the WHO recommendations. OBJECTIVE:To assess survivors of stroke at least 1 year after onset and (1) describe their self-reported level of PA; (2) explore the association between PA, sociodemographics, and stroke characteristics, and (3) determine the characteristics of those below the WHO recommended level of PA. DESIGN:Cross-sectional descriptive survey. SETTING:Community settings. PARTICIPANTS:Data were collected from 160 survivors of stroke (mean age 73 years, 46% women, mean time since stroke onset 35 months). INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:The Swedish National Board of Health and Welfare Physical Activity Questionnaire and the following sociodemographics and stroke characteristics: gender, age, marital status, vocational situation, need for home help, use of mobility devices, time since stroke onset, first-time stroke, type of stroke, location of stroke, and stroke treatment. RESULTS:Two thirds (66.3%) of the participants were below the WHO recommendations. The hierarchical regression analysis explained 13% of the variance in PA with need for home help as a single significant contributor. Those who did not meet the WHO recommendations were significantly older, more likely to live alone, and in need of home help and mobility devices. CONCLUSIONS:A majority of survivors of stroke do not meet the WHO recommended level of PA. Future studies should assess how other factors characterize those who are physically inactive. This knowledge could help rehabilitation professionals to target interventions and self-management programs to promote PA among survivors of stroke.

OBJECTIVE:Longitudinal health monitoring studies, including Para athletes, are lacking in low- and middle-income countries. This study aimed to introduce a surveillance program developed for Swedish Para athletes to high-level South African Para athletes and describe their self-reported health outcomes. DESIGN:Using a prospective cohort design, we distributed weekly electronic surveys to Para athletes for 88 wks. These included questions relating to training (e.g., volume, intensity), health (e.g., pain, injury, illness, symptoms of anxiety or depression), and lifestyle (e.g., diet, sleep). RESULTS:Of 28 recruited athletes, 21 responded to ≥1 survey (13 males and 8 females; 42.6% response rate). During an average week, 50% of athletes experienced mild-to-severe pain, 25% reported a new or ongoing injury or illness, 69% slept less than 8 hrs per night, and 20% reported symptoms of anxiety or depression. The overall injury incidence was 3.1 per 1000 hrs. CONCLUSIONS:Longitudinal health monitoring is challenging in low- and middle-income countries, and each setting's unique barriers and facilitators must be explored and acknowledged if such programs are to be sustained. Our data suggest that pain, injuries, illnesses, and symptoms of anxiety or depression are common among high-level South African Para athletes and efforts should be made to manage these.

BACKGROUND:Survivors of stroke commonly report sleep disturbances. Studies of sleep disturbances after stroke are mostly performed in the acute phase. An increased knowledge of sleep disturbances and its determinants a longer time after stroke is needed to improve treatment and rehabilitation. OBJECTIVE:To assess survivors of stroke more than 1 year after stroke onset and (1) investigate self-reported sleep disturbances and (2) explore the association between self-reported sleep disturbances, gender, age, time since stroke, other stroke characteristics, and sociodemographic data. DESIGN:Cross-sectional survey. SETTING:Community setting. PARTICIPANTS:Participants (n = 160) in the Life After Stroke In Northern Sweden Study (LASINS) (46% women, mean age 73 years, mean time since stroke 35 months). INTERVENTIONS:Not applicable. MAIN OUTCOME MEASUREMENTS:Pittsburgh Sleep Quality Index (PSQI), stroke characteristics (time since stroke, first time stroke, type of stroke, location of stroke, stroke treatment and comorbidities) and sociodemographic data (gender, age, marital status, vocational situation, need for home help, and use of mobility devices). RESULTS:A total of 84 participants (53%) rated 6 points or more on the PSQI (mean 6.5 points, SD: ±4.2, min-max 0-18), indicating sleep disturbances. Gender (p = .002) and use of mobility devices (p = .036) explained 9.5% of the variance in PSQI. CONCLUSION:Survivors of stroke report sleep disturbances even several years after stroke onset. Women and those using mobility devices, indicating less recovery after stroke, report sleep disturbances to a higher degree, regardless of chronological age, time since stroke onset, other stroke characteristics, comorbidities, and sociodemographic data. Further studies with a longitudinal design are needed to gain a comprehensive understanding of how stroke-related factors and other reasons account for poststroke sleep disturbances in order to improve treatment and rehabilitation.

Pain avoidant behavior is a predictive factor for reduced function in children with persistent pain. A model to explain this is the Fear-Avoidance Model of Pain (FAM). In FAM pain-related fear plays an important role in the development and maintenance of avoidant behavior. The Fear of Pain Questionnaire-Child Report Short Form (FOPQC-SF) was developed to assess pain-related fear in children 8 to 18 years old. Self-report questionnaires must be translated and adapted to the language and context where they will be used. The aim of this study was therefore to develop a Swedish version of the FOPQC-SF in collaboration with children. Translation and linguistic adaptation of the FOPQC-SF was performed using the dual-panel method in two steps. First, a bilingual panel created a first Swedish version of the questionnaire. This first version was then presented to a panel of five children without persistent pain and revised according to their feedback. Secondly, the translated and revised Swedish version of the FOPQC-SF was used for individual cognitive interviews with six children with persistent pain. The bilingual panel found the FOPQC-SF unproblematic to translate and consensus was easily achieved. Revisions were made regarding instructions, response options, item-wording and layout. The children also found the questionnaire acceptable and relevant. In conclusion, we consider the Swedish version of the FOPQC-SF to be a relevant and useful tool in research as well as in clinical practice to assess pain-related fear. Psychometric testing will provide further information about the tool's clinical usefulness.

ObjectiveElite para athletes report a high incidence of sports injuries. Research suggests that athletes’ strategies to manage adversities may influence the sports injury risk, but knowledge about para athletes’ coping behaviours and their association with injuries is limited. The aim was to describe the distribution of coping behaviours in Swedish elite para athletes by sex, age, impairment, sport and to examine associations between coping behaviours and the probability of reporting a prospective sports injury during a 52-week study period.MethodEighty-three para athletes participating in the ‘Sports-related injuries and illnesses in Paralympic sport study’ completed the Brief COPE Inventory. Over the following 52 weeks, athletes reported any sports injuries they sustained. The analysis of coping behaviours comprised descriptive statistics and linear regression, and associations between coping behaviour and the probability of being injured were examined by logistic regression analyses.ResultsThe most frequently used coping behaviours were acceptance, active coping and planning. The most common less-useful coping behaviour was self-blame. Athletes with more active coping behaviours were less likely to report an injury, and using humour as coping behaviour was associated with a higher probability of injury among young athletes. Also, athletes with physical impairment reported a higher use of active coping and emotional support compared with athletes with visual impairment, and athletes participating in individual sports used acceptance as a coping behaviour to a larger extent than athletes in team sports.ConclusionUse of active coping in Swedish elite para athletes was associated with a lower likelihood of reporting an injury. Young athletes using humour as a coping strategy had a higher likelihood of reporting an injury. The results suggest that support of active coping behaviours and a sport context fostering help-seeking behaviours should be considered in future prevention measures.

Background Late effects of polio (LEoP) is a progressive condition leading to a lifelong disability that can affect mental health. There is limited knowledge of depressive symptoms and associated factors in people with LEoP.Objective To assess the occurrence of depressive symptoms in people with LEoP and explore the association with sociodemographic and disability-related factors.Design Cross-sectional survey.Setting University hospital outpatient clinic.Study participants Eighty-one people (mean age 73 years, 49% women) with LEoP.Main outcome measurements Swedish versions of the 20-item Geriatric Depression Scale (GDS-20), the Self-reported Impairments in Persons with late effects of Polio (SIPP) scale, and the Reintegration to Normal Living Index (RNL-I).Methods The participants responded to a postal survey including the GDS-20 and questionnaires about sociodemographic factors (gender, age, marital status) and disability-related factors (SIPP, mobility, RNL-I). To determine factors associated with depressive symptoms (GDS-20, dependent variable), univariable and two separate multivariable logistic regression models were created, comprising sociodemographic and disability-related factors, respectively.Results Thirty-five people (43%) had a GDS score of six points or more, indicating suspected depression. In the model with sociodemographic factors, only marital status was significant (p = .001) with an odds ratio (OR) of 5.53 (95% confidence interval [CI], 1.97-15.54). In the model with disability-related factors, self-reported impairments and perceived participation remained significant, with self-reported impairments having the highest OR (OR, 1.49; 95% CI, 1.18-1.88). Overall, disability-related factors had a larger explanatory value (Nagelkerke R2 0.73) for suspected depression than sociodemographic factors (Nagelkerke R2 0.24).Conclusion The relatively high occurrence of suspected depression in people with LEoP implies that screening for depression is important. It remains to be determined if rehabilitation interventions targeting disability-related factors can affect mental health in people with LEoP.

BACKGROUND:Many people ageing with late effects of polio (LEoP) experience new or increased impairments which could negatively influence daily life. Currently, there is limited knowledge how LEoP-related impairments change over time. OBJECTIVES:To assess how various self-reported impairments change over 10 years among people with LEoP, and explore factors associated with the changes. METHODS:This is a longitudinal cohort study, in which 181 people with LEoP (mean age 77 [SD 9] years, 99 women) responded to a postal survey twice, 10 years apart. The survey included questions on demographics, clinical characteristics, and self-reported impairments as assessed with the Self-reported Impairments in Persons with late effects of Polio (SIPP) scale. The SIPP comprises 13 items and asks how much participants have been bothered by various LEoP-related impairments during the past 2 weeks. Changes in SIPP scores were analyzed by paired sample t-test. Factors associated with the changes in SIPP total scores were analyzed with univariable linear regression analyses. RESULTS:Seven items in the SIPP increased significantly over the 10 years (P < 0.05): muscle weakness, muscle fatigue, sensory disturbances, breathing difficulties at rest and during physical activity, cold intolerance, and general fatigue (corresponding to 1-12%). The SIPP total score increased on average 1.64 points (CI, 0.88 - 2.41, P < 0.001), corresponding to 6%. Two variables were significantly associated with the change in SIPP total score: self-reported degree of LEoP-related disability (B = 2.96, 95% CI, 0.88-5.03; P = 0.006) and presence of co-morbidities (B = 1.72, 95% CI, 0.14-3.30; P = 0.033). CONCLUSIONS:Impairments following LEoP seem to increase over a 10-year period but to a small degree. Having moderate to severe LEoP-related disability and comorbidities are associated with increased impairments. These findings can be accommodated in follow-ups and when providing and developing person-centered interventions for people with LEoP.