Papers by Karin Hellström
Disability and Rehabilitation, 2011
Physiotherapy Theory and Practice, Nov 5, 2021
PURPOSE The purpose was to evaluate the psychometric properties of physical activity measures in ... more 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.
Acta Veterinaria Scandinavica, Jul 25, 2017
Disability and Rehabilitation, Jun 24, 2016
To study the effects of a progressive resistance and balance (PRB) exercise program on body compo... more To study the effects of a progressive resistance and balance (PRB) exercise program on body composition with regard to its associations with physical function among individuals approximately one year after stroke. Method: A total of 43 individuals from the community (age 73 years (SD 5.0), 73% men) were randomly assigned either to an intervention group (IG, n=20) that received a PRB exercise program twice weekly for three months or a control group (CG, n=23). The primary objectives were to correlate potential changes in the fat-free mass (FFM (kg) and FFM index (FFMI) (kg/m 2), and fat-mass (FM (kg), (%) of body weight, FMI (kg/m 2)), as measured by bioelectrical impedance analyses (Tanita®), with physical function, including walking capacity; i.e., the 6 Min Walk Test; 6MWT, balance and mobility. Results: At three months, a complete case analyses revealed a significant reduction in fat mass per cent in the intervention group when compared with the control group;-1.5 vs. 0.13 % respectively; effect size, ES=0.62 standard error (SE), 0.80; P=0.0.39). No between-group differences in FFM were observed. There was a between-group difference in the 6MWT (25 vs.-10 m) at three months in favor of the IG (r=0.47, P=0.04). Changes in FMI were associated with improved walking capacity in the IG. Conclusions: Three months of PRB training might reduce fat mass in older adults approximately one year after stroke. This exploratory study indicated an association between improvements in physical performance and changes in body fat mass.
BMC Geriatrics, 2022
Background Physiotherapists need to use pedagogical approaches and strategies in their work. Howe... more 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 insig...
The FASEB Journal, Apr 1, 2013
Interactions between physical performance, body composition and nutrition in individuals 1–3 year... more Interactions between physical performance, body composition and nutrition in individuals 1–3 years after stroke.ObjectiveTo explore muscle mass, physical activity and nutritional status and association to mobility in stroke survivors.Methods134 community living individuals (74±5 y, 69% men) participated. Mobility was measured by Short Physical Performance Battery (SPPB, 0–12 points). Bio‐impedance analysis (BIA) measured fat free mass index (FFMI; kg/m2), fat mass index (FMI; kg/m2) and FM%. Nutritional status was measured by Mini Nutritional Assessment‐Short Form (0–14 p), gait speed by 10 m walking test (m/s) and the self‐reported Physical Activity Scale for the Elderly (PASE, ≥0 points) were recorded.ResultsBMI showed that 71% were overweight or obese. 14% were at risk for malnutrition. FM% was >;20 in 86% of men, and >;30 in 90% of women (related to a ref population). 28% were considered as sarcopenic obese, i.e. FFMI <25th perc + FMI>;50th perc of a ref population. Sarcopenia, i.e. the combination of FFMI<25th perc of normal + gait speed <1 m/s, was observed in 10%. Walking speed was slow (1.1±0.25 m/s), and PASE was low (mean 108±65 p). SPPB was reduced (median 10 p), but neither associated to FFMI nor FMI. Logistic regression indicated that SPPB ≤9 p was significantly related to risk for malnutrition; OR 5.8, reduced physical activity; OR 8.2, and high age; OR 2.8 for each 10 y.ConclusionsObesity was observed in ~2/3 subjects 1–3 y after stroke. More than 1/4 was classified as sarcopenic obese. FFM was not related to physical performance, whereas risk for malnutrition, physical activity and age were. Thus, nutrition and physical activity may represent opportunities for rehabilitation after stroke.
A comprehensive view of physical function, body composition and exercise post-stroke that is base... more A comprehensive view of physical function, body composition and exercise post-stroke that is based on clinical examination is lacking. The effects of a progressive resistance and balance (PRB) exercise program have not been fully evaluated in community-living individuals after stroke.The overall aim of this thesis was to explore and describe physical function, physical activity, body composition, nutritional status and psychological factors. Another aim was to evaluate both the short-term and long-term effects of a PRB exercise program.Physical function, physical activity, body composition, nutritional status and psychological factors were assessed in community-living individuals (65-85 years) approximately 1 year after stroke. Paper I-II (n=195, n=134) had a cross-sectional design and the main outcome was mobility and physical activity. In paper III-IV, (n=67, n=43) individuals were randomly assigned to either a PRB exercise program group or a control group. The main outcomes were balance, mobility, fat-free mass (FFM) and fat-mass (FM).In paper I, mobility was reduced and physical activity level was low compared to age-matched healthy controls. Factors explaining the variance in mobility were age, physical activity, fall-related self-efficacy and EQ-5D. In paper II, >20% had a BMI ≥30 kg/m2 and had an altered body composition that was mainly characterised by a high fat-mass index (FMI). Neither fat-free nor FM were associated with mobility in this cohort. The factors associated with low mobility were low physical activity Odds ratio (OR) (CI 95%) 8.2 (2.8-24.2), risk for malnutrition, OR 5.8 (1.6-21.1), and each 10-year period, OR 2.8 (1.24-6.24). Individuals participating in the PRB exercise program (paper III, n=67) revealed significantly higher balance, walking capacity and comfortable walking speed compared to the control group at 3 months. The faster walking speed persisted at 6 and 15 months. In paper IV (n=43), at 3 months, the PRB exercise group had a significant reduction in FM percentage and a decrease in IGF-1 compared with the control group. Further, changes in FMI were associated with improved walking capacity.Many individuals perceived partly modifiable disabilities 1 year after stroke. Exercising in groups for 3 months improved physical function and decreased fat-mass percentage and IGF-1.
Objective: To analyze the effects of a progressive resistance and balance exercise program on the... more Objective: To analyze the effects of a progressive resistance and balance exercise program on the physical functioning, physical activity and psychological factors of individuals with chronic strok ...
The FASEB Journal, Apr 1, 2014
Objective: To analyze the effects of a progressive resistance and balance exercise program on the... more Objective: To analyze the effects of a progressive resistance and balance exercise program on the physical functioning, physical activity and psychological factors of individuals with chronic strok ...
BMC Neurology, Dec 1, 2017
Background: The benefits of physical activity in persons with Multiple Sclerosis (MS) are conside... more Background: 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 selfefficacy, 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. Methods: This is a cross-sectional survey study including Swedish community living adults with MS, 287 persons, response rate 58.2%. The survey included standardized self-reported scales measuring physical activity, disease severity, fatigue, selfefficacy for physical activity, falls self-efficacy, and social support. Physical activity was measured by the Physical Activity Disability Survey-Revised. Results: Multiple regression analyzes showed that 59% (F(6,3) = 64.9, p = 0.000) of the variation in physical activity was explained by having less severe disease (β = −0.30), being employed (β = 0.26), having high falls self-efficacy (β = 0.20), having high self-efficacy for physical activity (β = 0.17), and enjoying physical activity (β = 0.11). In persons with moderate/severe MS, self-efficacy for physical activity explained physical activity. Conclusions: Consistent with previous research in persons with MS in other countries this study shows that disease severity, employment and self-efficacy for physical activity are important for physical activity. Additional important factors were falls self-efficacy and enjoyment. More research is needed to confirm this and the subgroup differences.
Journal of Veterinary Behavior, Sep 1, 2015
The objective of the pilot study was to compare validity and reliability properties of Polar RS80... more The objective of the pilot study was to compare validity and reliability properties of Polar RS800CX (Polar Electro Oy, Kempele, Finland) against simultaneously recorded electrocardiogram (ECG) measuring timeand frequency-based short-term heart rate variability (HRV) parameters, in dogs during stationary standing position. Five-minute recordings with less than 5% error rates from inter-beat interval (IBI) series obtained by Polar RS800CX and ECG, in 8 adult dogs, were used for HRV analysis. Polar data were statistically compared to the ECG data to assess for systematic differences in time-and frequency-based HRV parameters. Relative and absolute reliabilities were estimated by intraclass correlation coefficient, Spearman r, Bland and Altman analysis, standard error of measurement, and standard error of measurements in percentage. Paired t test was used to determine the statistical significance of differences between the measurement methods. Results: There were high correlation coefficients between HRV parameters obtained from Polar RS800CX and ECG. Intraclass correlation coefficients were 0.98-1.00, and Spearman r was 0.93-0.98. There were differences between the methods in 2 HRV parameters, the standard deviation of normal-to-normal IBIs (SDNN) (P ¼ 0.035) and the square root of the mean squared differences of successive normal-to normal IBIs (RMSSD) (P ¼ 0.034). Standard error of measurements was between 2.8-11.6% in ECG and between 2.6-11.8% in Polar, indicating rather high measurement error in 3 of the HRV parameters in both measurement methods. Close agreements and high correlation estimates in this pilot study indicated acceptable relative reliability in Polar RS800CX measuring time-and frequency-based HRV parameters in the group of dogs studied. However, the present pilot study revealed differences between Polar RS800CX and ECG in time-based standard deviation of normal-to-normal and square root of the mean squared differences of successive normal-to normal parameters, and that small amounts of erroneous IBI segments from Polar negatively impact on the validity and reliability properties of Polar RS800CX.
Physiotherapy Theory and Practice, Apr 16, 2018
ABSTRACT Introduction: Community-dwelling stroke survivors generally show low levels of physical ... more 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.
Gerontology and Geriatric Medicine
The objective was to analyze predictive variables for falls in older community-dwelling adults wh... more 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.
All in-text references underlined in blue are linked to publications on ResearchGate, letting you... more All in-text references underlined in blue are linked to publications on ResearchGate, letting you access and read them immediately.
European Geriatric Medicine, Sep 1, 2015
Disability and Rehabilitation, 2002
The overall aim of this prospective investigation was to evaluate the ability of the Falls Effica... more The overall aim of this prospective investigation was to evaluate the ability of the Falls Efficacy Scale (Swedish version) (FES(S)) to reflect clinically meaningful changes over time. Changes on the FES(S) scale were compared with changes in two different standardized measures of observer-assessed balance, the Berg Balance Scale (BBS), the Fugl-Meyer balance subscale (FMB), and of motor function and ambulation in 62 stroke patients. Assessments took place on admission for rehabilitation, at discharge and 10 months after the stroke. Indices of effect size were used to evaluate responsiveness of the instruments. Three time periods were studied: admission to discharge (early response), discharge to 10 month follow-up (late response) and admission to follow-up (overall response). The main findings are that the FES(S) is as responsive as BBS and FMB in detecting changes during the early and overall response periods. Changes in FES(S) scores between admission and discharge correlated significantly with changes in observer-assessed balance, motor function and ambulation scores. The present results suggest that measurement of perceived confidence in task performance using the FES(S) scale is responsive to improvement in patients with hemiparesis at an early stage after stroke.
Clinical Rehabilitation, Dec 1, 1999
European Geriatric Medicine, Sep 1, 2013
Introduction and objectives.-Storetveit nursing home has organized a 19-bed intermediate care uni... more Introduction and objectives.-Storetveit nursing home has organized a 19-bed intermediate care unit staffed with a geriatrician and increased multidisciplinary staff. A heterogeneous group of elderly (70+ years) community-living patients with acute illness and/or trauma are transferred after acute hospitalization for further treatment and rehabilitation. The aim was to explore factors associated with 6 months survival. Methods.-A prospective observational study was initiated in July 2011. Pre-hospital informations, comprehensive geriatric assessment and patient outcome were registered on all consecutive patients. The data were analyzed with univariate and multivariate regression analyses. Results-Four hundred and seventy-eight patients with median age 85 years have been followed for at least 6 months. Fifty-five of the patients (11%) died, with median 72 days (range 9-168) alive before death. Barthel ADL index at discharge (P = 0.048), proBNP (P = 0.001) and readmission to hospital from the intermediate care unit (P < 0.001) were significantly associated with 6-month survival in the multivariate regression analysis. Cognition, depression, nutrition, drug prescription, living condition or other blood tests did not demonstrate significant association. Key conclusions.-A high proBNP and a low Barthel ADL index at discharge were significantly associated with mortality at 6 months. Readmission to hospital during stay in the intermediate care unit was the strongest predictor for death.
Gerontology, Dec 20, 2012
strength. Results: At baseline, 322 nursing home residents were included, of whom 266 were assess... more strength. Results: At baseline, 322 nursing home residents were included, of whom 266 were assessed after 3 months of intervention. Following the intervention, a significant difference was found between participants in the IG and CG on measures of balance, physical activity and transfers. The CG significantly improved walking/wheelchair speed and functional leg muscle strength. The CG had significantly deteriorated in ADL, balance and transfers. Persons who had taken part in the intervention for more than 150 min/week significantly improved their balance and physical activity level. Participation in more than 10 weeks of intervention significantly improved physical activity and walking/wheelchair speed, while a deterioration was seen in those who had participated less. Conclusion: Individually tailored intervention in nursing home residents focusing on physical and daily activities is effective in improving transfers, balance and physical activity level compared to usual care. The effect of the intervention is dependent on the total activity time.
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Papers by Karin Hellström