ABSTRACT Purpose The purpose was to evaluate the psychometric properties of physical activity measures in persons with multiple sclerosis (PwMS). Methods Adults with multiple sclerosis were recruited, n = 30 (validation) and n = 57 (test–retest). Steps measured with PiezoRX, Yamax SW200 and ActiGraph GT9X Link (AGlink) and time in different positions measured with AGlink were validated against data from video analysis. Psychometric properties of the Physical Activity and Disability Survey – Revised Swedish version (PADS-R(Sw)) was evaluated. Results The most valid measures were AGlink using the low-frequency extension filter, and PiezoRX with median absolute percentage errors (MeAPEs) of 0.9–3.1% and 1.3–3.3%. The MeAPEs were higher for Yamax SW200 (2.9–21.0%), AGlink display (3.6–44.8%) and AGlink normal filter (8.9–48.9%), indicating low validity. AGlink was not valid in measurements of sitting (MeAPE 12.0–12.5%) or lying (MeAPE 31.0–41.7%). The correlation between PADS-R(Sw) and AGlink steps was r = 0.492 (p = .009). The relative reliability of PADS-R(Sw) was ICC2,1 0.85 (CI 0.76–0.91), and absolute reliability was SEM 0.54. Conclusion AGlink and PiezoRX were valid measures of steps in PwMS. The questionnaire PADS-R(Sw) was valid, with high relative reliability, but its absolute reliability was unsatisfactory.

Background Physiotherapists need to use pedagogical approaches and strategies in their work. However, there is no previous definition of what a pedagogical approach in physiotherapy means neither in general nor specifically to dementia. The purpose of this study was therefore to gain greater insight into physiotherapists’ pedagogical approach to dementia by investigating physiotherapists’ views and working methods in contact with older people with dementia, relatives, and nursing staff in elderly care. Methods This was a qualitative study with an inductive approach. Semi-structured individual interviews were conducted with 15 physiotherapists with experience of working with older people with dementia in elderly care. The interviews were analyzed with qualitative content analysis. Results The term “pedagogical approach” could sometimes be experienced as “vague” or “hard to grasp” . Our research nonetheless identified one overarching theme To see, meet and adapt which is based on insights from the interviews grouped in to five categories. This theme can be seen as an expression of the physiotherapists’ pedagogical approach in contact with older people with dementia, relatives, and nursing staff. It captures the participants’ desire to always see the person in front of them, meet them where they are and adapt their own way of working accordingly. Creating a trusting relationship was described as important and made it easier for the participants to adapt their working methods. The participants’ adaptations could apply to the way they communicated with people with dementia, and how they organized tutoring/education of relatives and nursing staff to maximize learning. Learning through experience and reflection was described as a key to advancing the pedagogical approach and the participants experienced their own learning as constantly ongoing. Conclusions This study provides increased understanding into physiotherapists’ pedagogical approach in contact with older people with dementia, relatives, and nursing staff in elderly care and shows that learning through experience and reflection can contribute to the development of the pedagogical approach. Thus, opportunity for reflection should be accommodated in the physiotherapists’ work. The importance of more pedagogical education for physiotherapists both in bachelor and master level were also highlighted. Increasing mobility and physical activity in older people with dementia is important since physical inactivity and sedentary behavior is common. Future research may be directed at further exploring physiotherapists’ pedagogical approach in tutoring/education of nursing staff, with the aim of increasing physical activity among older people with dementia.

The objective was to analyze predictive variables for falls in older community-dwelling adults who needed walking aids or home help service, to describe the circumstances and consequences of falls and fall injuries, and to describe the activities preceding falls, n = 175, mean age 83 years. Falls were self-reported monthly in a fall calendar and were followed up by a telephone interview. A logistic regression analysis was performed to investigate predictive baseline variables for falls. Injuries were reported in 82 of the 185 fall events. Previous falls and a high level of education had a significant association with falls odds ratios 1.9 (95% CI 1.3–2.7), and 2.7 (95% CI 1.4–5.3). Activities preceding the falls were classified according to the International Classification of Functioning (ICF). Falls and fall injuries were most common while moving around within the home and rising from sitting to standing.

Objective: To analyze the multivariate associations between self-rated level of physical activity and demographic characteristics, self-efficacy for physical activity, fall-related self-efficacy, fear of falling, enjoyment from participation in physical activity, social support, fatigue, and health-related quality of life in persons with PD with a focus on gender. Method: Participants were persons with PD (n = 285, mean age 69.1 +/- 7 years). Self-reported scales measuring level of physical activity (Physical Activity Disability Survey-Revised), enjoyment of physical activity (study- specific questions), self-efficacy for physical activity (Exercise Self-Efficacy Scale), fall-related self-efficacy (Falls Efficacy Scale), social support (Social Influences on Physical Activity), fatigue (Fatigue Severity Scale) and health-related quality of life (Parkinson's Disease Questionnaire-39) were used. The response rate was 58.2%. Results: Multiple regression analyses showed that 54.5% of the level of physical activity was explained by low-degree limitations in mobility and activities of daily life (ADL), being younger, higher self-efficacy for physical activity, communication limitations, bodily discomfort, social support and shorter time since diagnosis. Enjoyment of physical activity explained the level of physical activity for women, whereas self-efficacy for physical activity explained the level of physical activity for men. Conclusion: Implementing strategies to increase functional mobility, self-efficacy for physical activity, social support, and enjoyment of physical activity might facilitate persons with PD beginning and/or maintain different physical activities.

The aim of this randomized controlled trial was to examine the 12-month effects of the home-based Otago Exercise Program (OEP) with or without the support of motivational interviewing (MI) on community-dwelling people 75 years and older who needed walking aids and/or home help service. In total, 175 participants were randomized into three groups: OEP (n = 61), OEP with MI (n = 58), and a control group (n = 56) (M age = 83 years). Measures were physical performance, physical activity level, balance, grip strength, fall-related self-efficacy, fall rate, and fall injury rate. The OEP with and the OEP without MI, with the support of a physical therapist (six home visits and three phone calls), demonstrated no benefits in any of the measures compared with a control group. In this subgroup of pre-frail older adults, more frequent support by personnel may be required to secure efficient intensity and progression in the exercises performed on your own at home.

Purpose: Translate and adapt the Multidimensional Outcome Expectations for Exercise Scale (MOEES) into Swedish language and to explore psychometric properties, in terms of test-retest reliability, internal consistency as well as factor structure and floor and ceiling effects, of the Swedish version of MOEES in cardiac patients.Materials and methods:This prospective psychometrical study set in a Swedish cardiac rehabilitation outpatient clinic included 74 patients; age (3)18 years after acute coronary syndrome or that had undergone cardiac surgery. Translation and adaptation procedure of the MOEES followed established international guidelines. To evaluate test-retest reliability, relative (intra-class correlation coefficient ICC, 2.1)and absolute reliability (standard error of measurement (SEM) standard error of measurement % (SEM%), percentage of absolute agreement and Kappa coefficient for each item were calculated. Internal consistency was assessed with Cronbach ' s alpha. The original 3-factor structure was tested with a confirmatory factor analysis. Floor and ceiling effects were calculated. Results: In total, 60 patients, mean age 65 years, were included in the study. The test-retest showed for the three outcome expectations subscales (Physical, Self-evaluative and Social) ICC-values of 0.40 (CI 95% 0.20-0.58), 0.57 (0.39-0.71) and 0.72 (0.57-0.83), respectively. In general, the Kappa coefficients were low and varied between 0.11 and 0.44. Two questions had low loadings in the confirmatory factor analysis (<0.5) , contributing to a weak fit of the model. There was no floor effect, but the subscales physical and self-evaluative outcome expectation showed ceiling effects. Conclusion:This is the first study to analyse test-retest reliability of the translated version of MOEES into Swedish in cardiac patients and shows need for further development of the instrument before use in clinical practice and research.

Objectives: To evaluate the test-retest reliability and internal consistency of the Swedish version of the MAastrIcht Nurses Activities INventory (MAINtAIN(S)) developed to measure nursing staff perceived behaviours and barriers for promotion of everyday activities in nursing home residents. Method: Nursing staff completed the MAINtAIN(S) questionnaire on two occasions at 3-week intervals. Relative reliability, absolute reliability and internal consistency with Cronbach's alpha were calculated. Results: The test--retest reliability of MAINtAIN(S)-behaviours subscales ranged from ICC2. = 0.78--0.91 and MAINtAIN(S)-barriers subscales from ICC2.1 = 0.60--0.84. Cronbach's alpha varied between 0.60 and 0.91 for the different subscales. The MAINtAIN(S) inventory shows acceptable reliability and internal consistency. MAINtAIN(S) seems to be a promising tool for identifying behaviours and barriers in promoting everyday activities in nursing home residents and can be used to develop ward specific interventions for promotion of daily physical activity level in the care of older adults. (C) 2020 The Author(s). Published by Elsevier Inc.

Owners' ability to recognize signs of chronic pain in dogs undergoing pharmacologic and nonpharmacologic pain interventions during a period of physical rehabilitation is not known. This study aimed to compare dogs with and without chronic pain, and to assess the relationship between explanatory factors, including the probability of owners' response bias induced by pharmacologic and nonpharmacologic pain intervention, and chronic pain in dogs with osteoarthritis (OA). Seventy-one dogs with OA were included in this observational study. Owner-perceived pain interference was measured by Canine Brief Pain Inventory (CBPI) and owner-perceived pain behavior was assessed using Helsinki Chronic Pain Index. A dichotomous variable of Helsinki Chronic Pain Index was used in regression analysis to investigate the association between chronic pain and explanatory factors (body condition, anti-inflammatory medication, animal physiotherapy consultation once or more and owners' perception of pain interfering). Seventy-five percent of the dogs had ongoing anti-inflammatory medication, 51% of were overweight and 45% had a physiotherapy consultation. Higher levels of overt pain behaviors were reported in items addressing activities. Body condition, physiotherapy consultation and medication were not associated with chronic pain. Odds ratio (OR) and 95% confidence intervals of OR for the CBPI were 1.74 (1.23-2.47) and significantly associated with chronic pain. The adjusted OR of the CBPI did not differ from the crude OR. Owner-perceived pain behavior was not confounded by the dogs' medication. Results indicated that CBPI was not mediated by the medication. The CBPI pain interference score was not associated with response bias and may be used as clinical outcome measure of chronic pain and pain-related disability in dogs with OA along a period of physical rehabilitation comprising pharmacologic and nonpharmacologic pain interventions.

Purpose: The aims of this study to investigate the level of physical activity and physical function three months post-surgery in patients > 55 years old who had received knee arthroplasty. A second aim was to examine the relationship between objectively measured physical activity level and physical function. Methods: A consecutive sample of 43 participants, 28 (65%) men, 15 (35%) women with a mean age of 70.7 years three months after total knee arthroplasty were included. Outcome measures were levels of physical activity (steps and total energy expenditure) registered with accelerometer worn for seven days. Physical function was measured with the Short Physical Performance Battery. Results: Participants walked on average 6068 steps per day, and the mean total energy expenditure was 2494 kcal per day three months after surgery. Walking speed was low. The correlation values between the number of steps per day and walking speed indicated that those more physical active had better physical function. Conclusion: Three months after knee replacement surgery, participants, had not reached the recommended level of physical activity. Thus, interventions aiming to increase physical activity early in rehabilitation should be emphasized.

Aims: The overall aim was to describe and examine if there is a difference between men and women in fall-related self-efficacy (SE). Another aim was to examine the strength of associations between fall-related SE and physical function and health-related quality of life (QoL) in community-living individuals poststroke. Methods: A cros-ssectional study was conducted within two weeks of admission to rehabilitation or first week follow-up after discharge from hospital. Used tests were fall-related self-efficacy (FES-S), Functional Ambulation Classification (FAC), 10 meter walking test (10 mWT), the functional independence measure (FIM), and health-related QoL (EQ5D). The analysis was based on 37 individuals with a mean age off 68.5 years. Results: The results showed that physical factors but not QoL had association with perceived confidence in task performing without falling. No gender difference was shown. Conclusion: In this study physical function was associated with fall-related SE.

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

The purpose of this study was to explore and describe older adults’ opinions regarding actions to prevent falls and to analyze differences in the opinions of highly versus less physically active older adults. An open-ended question was answered by 262 individuals aged 75 to 98 years living in the community. The answers were analyzed using qualitative content analysis, and differences in the categories were compared between highly and less physically active persons. Physical activity was measured according to a five-level scale. The content analysis resulted in eight categories: assistive devices, avoiding hazards, behavioral adaptive strategies, being physically active, healthy lifestyle, indoor modifications, outdoor modifications, and seeking assistance. Behavioral adaptive strategies were mentioned to a greater extent by highly active people, and indoor modifications were more often mentioned by less active older adults. Support for active self-directed behavioral strategies might be important for fall prevention among less physically active older adults.

ABSTRACT Introduction: Community-dwelling stroke survivors generally show low levels of physical activity (PA). An improved understanding of the factors influencing participation in PA after stroke is imperative to improve levels of PA. Furthermore, gender differences in PA have received little attention in stroke research. The objective of this study was to examine gender differences in PA, physical functioning and psychological factors and the association between these factors and PA in men and women 1–3-year post-stroke. Materials and methods: A total of 187 community-dwelling individuals with stroke (65–85 years old, 29% women) were included in a secondary analysis based on data from a cross-sectional study. The exclusion criteria were severe cognitive or language dysfunction or dementia. The level of PA was measured by the Physical Activity Scale for the Elderly. Physical function included balance, walking speed and mobility. Psychological factors included depression, health-related quality of life and fall-related self-efficacy. Falls and fear of falling were each measured with a single question. Results: There were no significant differences in PA levels between men and women. In multiple regression analyses, walking speed (p < 0.001) was associated with PA in men, and balance (p = 0.038) was associated with PA in women. Conclusions: The results indicate that strategies to increase PA levels 1–3-year post-stroke could be improved by considering gender-specific factors.

Circumstances and consequences of falls in community-dwelling older adults who need walking aids or home support - with a focus on activities connected to falls and fall injuries

BACKGROUND:To evaluate intervention, implement evidence-based practice and enhance the welfare of dogs with naturally occurring osteoarthritis (OA), access to valid, reliable and clinically relevant outcome measures is crucial for researchers, veterinarians and rehabilitation practitioners. The objectives of the present study were to translate and evaluate psychometric properties, in terms of internal consistency and construct validity, of the owner-reported measure canine brief pain inventory (CBPI) in a Swedish sample of dogs with pain related to OA.RESULTS:Twenty-one owners of clinically sound dogs and 58 owners of dogs with pain related to OA were included in this observational and cross-sectional study. After being translated according to the guidelines for patient-reported outcome measures, the CBPI was completed by the canine owners. Construct validity was assessed by confirmatory factor analysis, by repeating the principal component analysis and by assessing for differences between clinically sound dogs and dogs with pain related to OA. Internal consistency was estimated by Cronbach's α. Confirmatory factor analysis was not able to confirm the factor-structure models tested in our sample. Principal component analysis showed a two-component structure, pain severity and pain interference of function. Two components accounted for 76.8% of the total variance, suggesting an acceptable fit of a two-component structure. The ratings from the clinically sound dogs differed from OA dogs and showed significantly lower CBPI total sum. Cronbach's α was 0.94 for the total CBPI, 0.91 for the pain severity and 0.91 for the pain interference of function.CONCLUSIONS:The results indicate that the translated version of the CBPI is valid for use in the Swedish language. The findings suggest satisfying psychometric properties in terms of high internal consistencies and ability to discriminate clinically sound dogs from OA dogs. However, based on the confirmatory factor analysis, the original factor structure in the CBPI is not ideally suited to measure pain related to OA in our sample and the hypothesis of the presented two-factor structure was rejected. Further research needs to be conducted to determine whether the original psychometric results from CBPI can be replicated across different target groups and particularly with larger sample size.

The benefits of physical activity in persons with Multiple Sclerosis (MS) are considerable. Knowledge about factors that correlate to physical activity is helpful in order to develop successful strategies to increase physical activity in persons with MS. Previous studies have focused on correlates to physical activity in MS, however falls self-efficacy, social support and enjoyment of physical activity are not much studied, as well as if the correlates differ with regard to disease severity. The aim of the study was to examine associations between physical activity and age, gender, employment, having children living at home, education, disease type, disease severity, fatigue, self-efficacy for physical activity, falls self-efficacy, social support and enjoyment of physical activity in a sample of persons with MS and in subgroups with regard to disease severity.

When Editor in Chief, David Baxter, suggested a Special Issue focussed entirely on physical activity and health, Pernilla, Karin and I warmly welcomed the opportunity to Guest Edit this collection....

Cancer quality registers are attracting increasing attention as metrics for quality assurance and improvement. Comprehensive, high-quality data in nationwide population-based registers are also an ideal basis for observational studies. Here we describe the organization of the National Prostate Cancer Register (NPCR) of Sweden as well as some examples of reports and results from analyses based on NPCR and other health-care registers.

Abstract Purpose: To evaluate whether improvements in physical function are related to changes in body composition after a three-month progressive resistance and balance exercise program among individuals approximately one to three years after stroke. Methods: In this randomized controlled trial, 43 community-dwelling subjects (65–85 years, mean age 73 ± 5 years, 73% men) were allocated to a progressive resistance and balance exercise program twice weekly for three months (intervention group [IG], n = 20) or a control group (n = 23). The main outcome measures were fat mass (kg) and fat-free mass (kg), as measured by bioelectrical impedance analyses (Tanita®). Physical function was measured using the six-minute walk test. Results: Complete case analyses revealed reduced fat mass in the IG compared with the control (−1.5 vs. (0).13% of body weight, respectively; effect size =0.62; p = 0.048). In contrast, no between-group difference in fat-free mass was observed. The six-minute walk test was improved (25 vs. −10 m, respectively, effect size =0.69, p = 0.039) at three months in favor of the IG. The reduced fat mass was associated with an improved six-minute walk test (r = 0.48, p = 0.038) in the IG. Conclusions: Three-month progressive resistance and balance training was associated with reduced fat mass, which was related to improvements in walking capacity in older adults approximately one year after stroke. Implications for rehabilitation   This three-month PRB group exercise program supported by motivational discussions and daily home-based exercises indicate the following:   • Improved walking capacity was associated with a reduction in fat mass.   • IGF-1 is reduced, possibly indicating improved insulin sensitivity.

Muscle wasting and obesity may complicate the post-stroke trajectory. We investigated the relationships between nutritional status, body composition, and mobility one to 3 years after stroke.