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  • 1. Asker, Martin
    et al.
    Waldén, Markus
    Källberg, Henrik
    Holm, Lena W
    Skillgate, Eva
    Sophiahemmet University.
    Preseason clinical shoulder test results and shoulder injury rate in adolescent elite handball players: a prospective study2020In: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 50, no 2, p. 67-74Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: Prospective cohort study.

    BACKGROUND: Shoulder injuries are common in handball. Shoulder weakness, scapular dyskinesia and range of motion (ROM) deficits are associated with shoulder injury in adults, but studies of adolescent players are scarce.

    OBJECTIVE: To investigate if elite adolescent female and male handball players with shoulder muscle weakness, deficits in shoulder rotation ROM or joint position sense (JPS), or scapular dyskinesia in preseason have an increased shoulder injury rate compared to players not having these characteristics.

    METHODS: 341 uninjured players (452 player-seasons, 50% females) had isometric external rotational (IER), internal rotational (IIR), abduction (IABD) and eccentric external rotational (EER) shoulder strength, shoulder ROM, JPS, and scapular dyskinesia measured during pre-season. Players were monitored weekly regarding match- and training hours and shoulder injuries during one or two seasons. We used multivariable Cox proportional hazard models to calculate hazard rate ratios (HRR) related to the first injury with 95% confidence intervals (95% CI).

    RESULTS: 48 new shoulder injuries were reported during the two seasons. In females, the HRR for IER was 2.37 (95% CI 1.03-5.44), for IIR 2.44 (95% CI 1.06-5.61), and for scapular dyskinesia 1.53 (95% CI 0.36-6.52). In males, the HRR for IER was 1.02 (95% CI 0.44-2.36), for IIR 0.74 (95% CI 0.31-1.75), and for scapular dyskinesia 3.43 (95% CI 1.49-7.92). There were no associations between new shoulder injuries and deficits in ROM or JPS.

    CONCLUSION: In adolescent elite handball, male players with pre-season scapula dyskinesia, and female players with pre-season internal or external rotation shoulder weakness, had an increased shoulder injury rate. J Orthop Sports Phys Ther, Epub 27 Nov 2019. doi:10.2519/jospt.2020.9044.

  • 2. Franzén, Erika
    et al.
    Johansson, Hanna
    Freidle, Malin
    Ekman, Urban
    Wallén, Martin Benka
    Schalling, Ellika
    Lebedev, Alexander
    Lövdén, Martin
    Holmin, Staffan
    Svenningsson, Per
    Hagströmer, Maria
    Sophiahemmet University.
    The EXPANd trial: effects of exercise and exploring neuroplastic changes in people with Parkinson's disease2019In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 19, no 1, article id 280Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Parkinson's disease (PD) affects many physiological systems essential for balance control. Recent studies suggest that intensive and cognitively demanding physical exercise programs are capable of inducing plastic brain changes in PD. We have developed a highly challenging balance training (the HiBalance) program that emphasizes critical aspects of balance control through progressively introducing more challenging exercises which incorporates dual-tasking. Earlier studies have shown it to be effective in improving balance, gait and dual-tasking. The study design has thereafter been adjusted to link intervention-induced behavioral changes to brain morphology and function. Specifically, in this randomized controlled trial, we will determine the effects of the HiBalance program on balance, gait and cognition and relate this to task-evoked functional MRI (fMRI), as well as brain-derived neurotrophic factor (BDNF) in participants with mild-moderate PD.

    METHODS: One hundred participants with idiopathic PD, Hoehn & Yahr stage 2 or 3, ≥ 60 years of age, ≥ 21 on Montreal Cognitive Assessment will be recruited in successive waves and randomized into either the HiBalance program or to an active control group (the HiCommunication program, targeting speech and communication). Both interventions will be performed in small groups, twice a week with 1 h sessions for 10 weeks. In addition, a 1 h, once a week, home exercise program will also be performed. A double-blinded design will be used. At the pre- and post-assessments, participants will be assessed on balance (main outcome), gait, cognitive functions, physical activity, voice/speech function, BDNF in serum and fMRI (3 T Philips) during performance of motor-cognitive tasks.

    DISCUSSION: Since there is currently no cure for PD, findings of neuroplastic brain changes in response to exercise would revolutionize the way we treat PD, and, in turn, provide new hope to patients for a life with better health, greater independence and improved quality of life.

    TRIAL REGISTRATION: ClincalTrials.gov: NCT03213873, first posted July 11, 2017.

  • 3. Johansson, Hanna
    et al.
    Franzén, Erika
    Roaldsen, Kirsti Skavberg
    Hagströmer, Maria
    Sophiahemmet University.
    Leavy, Breiffni
    Controlling the uncontrollable: Perceptions of balance in people with parkinson disease2019In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 99, no 11, p. 1501-1510, article id pzz117Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Exercise improves balance in Parkinson disease (PD), yet the majority of people with the diagnosis are physically inactive. Insights gained from understanding how people with PD (PwPD) make sense of their symptoms and their ability to control them may inform the communication strategies and motivational approaches adopted by physical therapists. No previous study has qualitatively explored how PwPD perceive the concept of balance and the beliefs they hold concerning their ability to affect balance.

    OBJECTIVE: This study aimed to explore the meaning of balance for PwPD and the beliefs they hold regarding their ability to influence their balance in everyday life.

    DESIGN: The design is a qualitative study with an inductive approach.

    METHODS: In-depth interviews were conducted with 18 participants with PD (age range 46 to 83 years, Hoehn and Yahr range 1 to 4), and transcripts were analyzed using qualitative content analysis.

    RESULTS: Five main themes emerged from the analysis: remaining in control over the body; adapting behavior to deal with uncertainty; directing focus to stay one step ahead; resilience as a defense, and exercise beliefs and reservations. Interpretation of the underlying patterns in the main themes yielded the overarching theme of focus and determination to regain control over shifting balance.

    CONCLUSIONS: The concept of balance was perceived as both bodily equilibrium and mind-body interplay and was described in the context of remaining in control over one's body and everyday life. Cognitive resources were utilized in order to direct focus and attention during balance-challenging situations in a process involving internal dialogue. Even participants who did not express beliefs in their ability to affect balance through exercise used psychological resilience to counter the challenges of impaired balance.

  • 4. Leavy, Breiffni
    et al.
    Joseph, Conran
    Löfgren, Niklas
    Johansson, Hanna
    Hagströmer, Maria
    Sophiahemmet University.
    Franzén, Erika
    Outcome evaluation of highly challenging balance training for people with Parkinson disease: a multicenter effectiveness-implementation study2020In: Journal of Neurologic Physical Therapy, ISSN 1557-0576, E-ISSN 1557-0584, Vol. 44, no 1, p. 15-22Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: In order for people with Parkinson disease (PwPD) to benefit from neurorehabilitation research, interventions tested in research settings require assessment in real-world clinical practice. There is little evidence for whether efficacious exercise interventions for PwPD remain effective when transferred to standard clinical settings. The aim of this study was to assess the clinical effectiveness of the adapted HiBalance program on balance control and gait among PwPD.

    METHODS: Participants (n = 117) with mild-moderate Parkinson disease were consecutively included into either the 10-week HiBalance group training (n = 61) or the control (n = 56) group. The main outcome was balance performance (Mini-BESTest). Secondary outcomes were comfortable gait speed (10-m Walk Test); functional mobility (Timed Up and Go [TUG] test) and dual-task interference (cognitive TUG test); physical activity level (steps per day); perceived balance confidence (Activities-specific Balance Confidence scale) and perceived walking difficulty (Walk-12G) and self-rated health (EQ-5D visual analog scale).

    RESULTS: In total, 98 people completed the trial. Compared with controls, the training group showed significant improvement in balance performance (P < 0.001), gait speed (P = 0.001), and dual-task interference (P = 0.04) following the intervention. No group differences were observed for physical activity level or any patient-reported measures.

    DISCUSSION AND CONCLUSIONS: Highly challenging balance training is effective at improving balance, gait, and dual-task performance when delivered at a clinically feasible dose, in a range of rehabilitation settings, without direct involvement of the research group.Video Abstract available for more insights from the authors (see the Video, Supplementary Digital Content 1, available at: http://links.lww.com/JNPT/A299).

  • 5. Skavberg Roaldsen, Kirsti
    et al.
    Lindholm, Christina
    Sophiahemmet University.
    Fysisk aktivitet och träning vid venös och arteriell insufficiens och bensår2012In: Äldres hälsa: ett sjukgymnastiskt perspektiv / [ed] Elisabeth Rydwik, Lund: Studentlitteratur, 2012, 1, p. 259-270Chapter in book (Other academic)
  • 6. Tabell, Vesa
    et al.
    Tarkka, Ina M
    Holm, Lena W
    Skillgate, Eva
    Sophiahemmet University.
    Do adverse events after manual therapy for back and/or neck pain have an impact on the chance to recover?: A cohort study2019In: Chinese Physics B, ISSN 0069-3715, E-ISSN 2045-709X, Vol. 27, article id 27Article in journal (Refereed)
    Abstract [en]

    Background: Manual therapy is a commonly used treatment for patients with back and neck pain. Studies have shown that manual therapy-related adverse events are mainly short in duration and mild or moderate by their intensity, affecting up to 50% of the patients. If the presence of adverse events has an impact on the chance to recover from back/neck pain is poorly understood. The aim of this study was to investigate if mild or moderate adverse events after manual therapy has an impact on the chance to recover from back/neck pain in men and women.

    Methods: A prospective cohort study of 771 patients with at least three treatment sessions in a randomized controlled trial performed in January 2010 - December 2013. Adverse events within 24 h after each treatment were measured with questionnaires and categorized as: no, mild or moderate, based on bothersomeness. Outcome measure was the perceived recovery at seven weeks and at three months follow-up. Odds Ratios (OR) and 95% confidence intervals (CI) were calculated by Logistic regression to investigate the associations between the exposure and outcome, and to test and adjust for potential confounding.

    Results: There were no statistically significant associations observed between the experience of mild or moderate adverse events and being recovered at the seven weeks follow-up. The only statistically significant association observed at the three months follow-up was for mild adverse events in men with an OR of 2.44, 95% CI: 1.24-4.80 in comparison to men with no adverse events.

    Conclusion: This study indicates that mild adverse events after manual therapy may be related to a better chance to recover in men.

    Trial registration: The study is based on data from a trial registered in Current Controlled Trials (ISRCTN92249294).

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