Factors associated with empowerment after participating in a supported osteoarthritis self-management program: An explorative study.

Objective: To explore factors associated with change in empowerment in patients that have participated in a 3-month Supported Osteoarthritis Self-Management Program (SOASP). Further, to evaluate empowerment in the longer term. Design: An explorative analysis including patients from a cohort study conducted in primary healthcare in Sweden was performed. Univariable linear regression models were performed to assess associations between demographics and patient-reported outcome measures (explanatory factors), respectively, and change in empowerment from baseline to 3-month follow-up (outcome variable). Long-term follow-up of empowerment was at 9 months. Results: Self-reported increase in enablement at the 3-month follow-up was associated with a greater improvement in empowerment (B â€‹= â€‹0.041, 95% CI (0.011, 0.07), p â€‹= â€‹0.008). Living alone was associated with less improvement in empowerment (B â€‹= â€‹-0.278, 95% CI (-0.469, -0.086), p â€‹= â€‹0.005) compared to living together. Physical exercise >120 â€‹min per week at baseline was associated with less improvement in empowerment (B â€‹= â€‹-0.293, 95% CI (-0.583, -0.004), p â€‹= â€‹0.047) compared to reporting no exercise at baseline. No other associations were observed (p â€‹> â€‹0.05). Empowerment improved from baseline to the 3-month follow-up (mean 0.20 (SD 0.5), p â€‹< â€‹0.001) but there was no change from baseline to the 9-month follow-up (mean 0.02 (SD 0.6), p â€‹= â€‹0.641). Conclusions: Self-reported increased enablement may lead to greater improvement in empowerment after SOASP. Greater efforts may be needed to support those that live alone, are physically active, and to sustain empowerment in the longer term after SOASP. More research is needed on empowerment to provide personalized support for patients with OA after SOASP.

Empowerment and enablement and their associations with change in health-related quality of life after a supported osteoarthritis self-management programme - a prospective observational study.

BACKGROUND: Osteoarthritis is a leading cause of disability worldwide. Current treatment supports coping strategies to improve health-related quality of life (HRQoL). The need to predict response to treatment has been raised to personalise care. This study aims to examine change in HRQoL from baseline to three and nine months follow-up after participating in a Supported Osteoarthritis Self-Management Programme (SOASP) and to examine if empowerment and/or enablement were associated with change in HRQoL after a SOASP. METHODS: Patients participating in a SOASP were recruited consecutively between April 2016 and June 2018. The EQ-5D was used to measure HRQoL, the Swedish Rheumatic Disease Empowerment Scale (SWE-RES-23) (score range 1-5) to measure empowerment and the Patient Enablement Instrument (PEI) (score range 0-12) to measure enablement. The instruments were answered before (EQ-5D, SWE-RES-23) and after (EQ-5D, SWE-RES-23, PEI) the SOASP. A patient partner was involved in the research process to enhance the patient perspective. Changes in outcome were examined with paired sample t-test and standardized effect sizes (Cohen´s d). Multiple linear regression analysis was performed to assess potential associations. RESULTS: One hundred forty-three patients participated in baseline measurement. Mean EQ-5D-5 L index score increased significantly from baseline to three months corresponding to a standardised effect size (Cohen´s d) of d = 0.43, 95% CI [0.24, 0.63] (n = 109), and from baseline to nine months d = 0.19, 95% CI [0.01, 0.37] (n = 119). The average EQ VAS score increased significantly from baseline to three months corresponding to a standardised effect size of d = 0.26, 95% CI [0.07, 0.45] (n = 109), and from baseline to nine months d = 0.18, 95% CI [0.00, 0.36] (n = 119). Neither SWE-RES-23 nor PEI at three months follow-up nor the change in the SWE-RES-23 score from baseline to three months follow-up were associated with change in either EQ-5D-5 L index (p > 0.05) or the EQ VAS (p > 0.05). CONCLUSIONS: Health-related quality of life increased after participating in a SOASP. Empowerment and enablement as measured with the SWE-RES-23 and the PEI were not associated with change in HRQoL among patients participating in a SOASP. TRIAL REGISTRATION: ClinicalTrials.gov. Identification number: NCT02974036. First registration 28/11/2016, retrospectively registered.

Study protocol for a feasibility study of an online educational programme for people working and living with persistent low back pain.

BACKGROUND: Low back pain (LBP) is the main cause of activity limitation and work absence across the world, leading to a high social and economic burden for individuals, families, the labour market and society. The overall aim of this multicentre study is to test the usability, acceptability and feasibility of an evidence-based, digital education programme for people living and working with persistent LBP who are in sedentary or physically demanding jobs and need advice on ergonomics, self-management of pain and healthy behavioural strategies. METHODS: This is the protocol of a multinational, multicentre, prospective uncontrolled feasibility study targeting people with persistent LBP in Lithuania, Northern Ireland, Italy, Sweden and Portugal. Eligible participants will be offered the opportunity to use the MyRelief educational platform as part of their care and will undergo evaluations at baseline (enrollment) and 1-month follow-up. Feasibility will be assessed using measures of recruitment and retention, intervention engagement, outcome measure completion rates and within-group effect sizes in response to the digital education programme. DISCUSSION: This study will identify the challenges and implications of delivering a digital training programme in advance of potentially delivering the programme via an online educational platform available on mobile devices. The findings will inform the design of a future randomised controlled trial if it proves feasible. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04673773 . Registered 17 December 2020.

Exploring a New Application of Construct Specification Equations (CSEs) and Entropy: A Pilot Study with Balance Measurements.

Both construct specification equations (CSEs) and entropy can be used to provide a specific, causal, and rigorously mathematical conceptualization of item attributes in order to provide fit-for-purpose measurements of person abilities. This has been previously demonstrated for memory measurements. It can also be reasonably expected to be applicable to other kinds of measures of human abilities and task difficulty in health care, but further exploration is needed about how to incorporate qualitative explanatory variables in the CSE formulation. In this paper we report two case studies exploring the possibilities of advancing CSE and entropy to include human functional balance measurements. In case study I, physiotherapists have formulated a CSE for balance task difficulty by principal component regression of empirical balance task difficulty values from Berg's Balance Scale transformed using the Rasch model. In case study II, four balance tasks of increasing difficulty due to diminishing bases of support and vision were briefly investigated in relation to entropy as a measure of the amount of information and order as well as physical thermodynamics. The pilot study has explored both methodological and conceptual possibilities and concerns to be considered in further work. The results should not be considered as fully comprehensive or absolute, but rather open up for further discussion and investigations to advance measurements of person balance ability in clinical practice, research, and trials.

Factors associated with clinically relevant pain reduction after a self-management program including education and exercise for people with knee and/or hip osteoarthritis: Data from the BOA register.

AIM: To examine the associations between individual- and disease-related factors and the odds of reaching a clinically relevant pain reduction in people with knee and/or hip osteoarthritis (OA) who underwent a first-line self-management program. MATERIALS AND METHODS: An observational registry-based study including people with knee (n = 18,871) and hip (n = 7,767) OA who participated in a self-management program including education and exercise and had data recorded in the Better Management of patients with Osteoarthritis (BOA) register. We used multivariable logistic regression models to study the association between sex, age, body mass index (BMI), education, comorbidity, pain frequency, walking difficulties, willingness to undergo surgery and the odds of reaching a clinically relevant pain reduction (decrease of >33% on a 0-10 NRS scale) 3 and 12 months after the intervention. All analyses were stratified by joint (knee/hip). RESULTS: Both in the short- and long-term follow-up, a younger age (18-65 years), a lower BMI (< 25), a higher level of education (university), the absence of comorbidities impacting the ability to walk, less frequent pain and not being willing to undergo surgery were associated with higher odds of reaching a clinically relevant pain reduction in people with knee OA. We found similar results for people with hip OA, but with larger uncertainty in the estimates (wider 95% CI). CONCLUSION: Our study suggests that early fist line self-management interventions delivered when people have unilateral hip or knee OA with less frequent pain and are unwilling to undergo surgery, may be important for reaching a clinically relevant pain reduction after participation. Providing the most appropriate treatment to the right patient at the right time is a step in reducing the burden of OA for society and the patient.

Perceived Consequences of Post-COVID-19 and Factors Associated with Low Life Satisfaction.

A significant number of individuals experience post-COVID-19 symptoms, but knowledge of perceived consequences and life satisfaction is lacking. Here, we investigate perceived consequences regarding everyday life, health, physical activity and work post-COVID-19 and factors associated with low life satisfaction. A total of 766 people (mean age 48; 672 women) experiencing post-COVID-19 symptoms at least two months after infection (mean 13 months) responded to an online survey. A majority (≥77%) perceived physical fatigue, mental fatigue, dizziness, reduced work ability, low life satisfaction and a reduced level of aerobic capacity. In the final logistic regression model (Nagelkerke R Square 0.296, p < 0.001), poor work ability was the most important factor for perceiving low satisfaction with life (Odds ratio 3.369, 95% CI 2.040-5.565, p < 0.001, Nagelkerke R Square 0.177). Reduced aerobic capacity, fatigue and living in a city also increased the odds of low life satisfaction. As people with post-COVID-19 report several long-term consequences, this suggests that there is a need for targeted care for this group. The results of this study can serve as guidance for healthcare authorities regarding important long-term consequences that should be considered in rehabilitation programs directed toward post-COVID-19.

Correlation between self-efficacy, fear of movement, empowerment, enablement, and number of visits to physiotherapist among patients with musculoskeletal disorders in primary health care: a feasibility study.

BACKGROUND: Musculoskeletal disorders are a costly burden for health care and social care services. Patients with musculoskeletal disorders are often treated by physiotherapists in primary health care. Psychosocial variables can be a significant obstacle to recovering from musculoskeletal injuries. The primary aim of this pilot study was to assess the feasibility of performing a prospective study investigating whether self-efficacy, fear of movement, empowerment, or enablement has any relation to the number of visits to physiotherapists among patients with a musculoskeletal disorder in primary health care. METHODS: Prospective study with a consecutive selection including eleven female and eight male patients age ranged between 22 and 82 years old seeking physiotherapist for the first time for a musculoskeletal disorder in primary health care. Primary outcome measures included operational and practical feasibility regarding recruitment of participants, use of questionnaires, and key variables to be collected as part of the study. Secondary outcomes included the correlation between self-efficacy (Exercise Self-Efficacy Scale (ESES-S)), fear of movement (Tampa Scale for Kinesiophobia (TSK-SV)), empowerment (Making Decisions Scale), enablement (Patient Enablement Instrument (PEI)), and the number of visits to physiotherapists. Statistical analysis was done using IBM SPSS statistics version 28 with analysis of correlation using Spearman's rank correlation coefficient. RESULTS: Nineteen patients accepted to participate in the study and were included in the final analysis. Between 14 and 18 completed questionnaires were included. There was a statistically significant correlation between the number of visits to the physiotherapist and self-efficacy, rho=0.692 and p=0.006. CONCLUSION: The results of the study showed that the design is feasible in terms of recruitment of participants and use of questionnaires. New variables to collect in a large-scale study were identified. In a large-scale study, attention needs to be focused on the improvement of the number of completed questionnaires. The results of this study indicate that the present care of patients with a low level of self-efficacy is not optimal.

Promoting work ability with a wearable activity tracker in working age individuals with hip and/or knee osteoarthritis: a randomized controlled trial.

BACKGROUND: Physical activity (PA) may improve work ability and health in individuals with hip and/or knee osteoarthritis (OA). The use of wearable activity trackers (WATs) has been shown to increase PA and improve other health outcomes but little is known concerning their effect on work ability. The objectives of this study were to examine the effect of self-monitoring PA with a WAT on work ability, PA and work productivity among individuals of working age with hip and/or knee OA. METHODS: Individuals (n = 160) were included and cluster-randomized to a Supported Osteoarthritis Self-management Program (SOASP) with the addition of self-monitoring PA using a commercial WAT for 12 weeks (n = 86), or only the SOASP (n = 74). Primary outcome was self-reported work ability measured with the Work Ability Index (WAI) and secondary outcomes were self-reported PA measured with the International Physical Activity Questionnaire - Short Form (IPAQ-SF) and work productivity, measured with the Work Productivity and Activity Impairment scale: Osteoarthritis (WPAI:OA) at baseline and after 3, 6 and 12 months. Data was primarily analysed with linear mixed models. RESULTS: Participants with data from baseline and at least one follow-up were included in the analyses (n = 124). Linear mixed models showed no statistically significant difference between groups regarding pattern of change in work ability or PA, from baseline to follow-ups. Also, neither group had a statistically significant difference in work ability between baseline and each follow-up. CONCLUSION: The SOASP together with self-monitoring PA with a WAT did not have any effect on the primary outcome variable work ability. Participants already at baseline had good work ability and were physically active, which could have reduced the possibility for improvements. Future interventions should target a population with lower work ability and PA-level. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03354091 . Registered 15/11/2017.

Physiotherapists' experiences of osteoarthritis guidelines in primary health care - an interview study.

BACKGROUND: Osteoarthritis is a common joint disease, globally. Guidelines recommend information, exercise and, if needed, weight reduction as core treatment. There is a gap between evidence-based recommended care for osteoarthritis and clinical practice. To increase compliance to guidelines, implementation was conducted. The aim of the study was to explore physiotherapists' experiences of osteoarthritis guidelines and their experiences of implementation of the guidelines in primary health care in a region in southern Sweden. METHODS: Eighteen individual, semi-structured interviews with physiotherapists in primary health care were analysed with inductive qualitative content analysis. RESULTS: The analysis resulted in two categories and four subcategories. The physiotherapists were confident in their role as primary assessors for patients with osteoarthritis and the guidelines were aligned with their professional beliefs. The Supported Osteoarthritis Self-Management Programme, that is part of the guidelines, was found to be efficient for the patients. Even though the physiotherapists followed the guidelines they saw room for improvement since all patients with hip and/or knee osteoarthritis did not receive treatment according to the guidelines. Furthermore, the physiotherapists emphasised the need for management's support and that guidelines should be easy to follow. CONCLUSION: The physiotherapists believed in the guidelines and were confident in providing first line treatment to patients with osteoarthritis. However, information about the guidelines probably needs to be repeated to all health care providers and management. Data from a national quality register on osteoarthritis could be used to a greater extent in daily clinical work in primary health care to improve quality of care for patients with osteoarthritis.

Self-Perceived Life Satisfaction during the First Wave of the COVID-19 Pandemic in Sweden: A Cross-Sectional Study.

Currently, there is limited knowledge on how the Swedish strategy with more lenient public health restrictions during the COVID-19 pandemic has influenced people's life satisfaction. Here, we investigated self-reported life satisfaction during the first wave of the pandemic in Sweden, and perceived changes in life satisfaction in relation to various sociodemographic factors. A total of 1082 people (mean age 48 (SD 12.2); 82% women) responded to an online survey during autumn 2020 including the "Life Satisfaction Questionnaire-11". A majority (69%) were satisfied with life as a whole, and with other important life domains, with the exception of contact with friends and sexual life. An equal share reported that life as a whole had either deteriorated (28%) or improved (29%). Of those that perceived a deterioration, 95% considered it to be due to the pandemic. Regarding deteriorated satisfaction with life as a whole, higher odds were found in the following groups: having no children living at home; being middle aged; having other sources of income than being employed; and having a chronic disease. The Swedish strategy might have contributed to the high proportion of satisfied people. Those who perceived a deterioration in life satisfaction may, however, need attention from Swedish Welfare Authorities.

The Psychometric Properties of the Meaning of Home and Housing-Related Control Beliefs Scales among 67-70 Year-Olds in Sweden.

BACKGROUND: The housing environment is important for health and well-being among older people, and it is important to consider both physical and perceived aspects of housing. Psychometrically sound scales are necessary to assess perceived housing. This study evaluated the psychometric properties of two instruments that measure perceived aspects of housing among a younger cohort of older adults in Sweden. METHODS: A random sample of 371 participants aged 67 to 70 years (mean 67.9 (SD = 0.98)) was used. Participants lived in ordinary housing in the south of Sweden. Data on perceived aspects of housing were collected with the Meaning of Home Questionnaire (MOH) and the Housing-Related Control Beliefs Questionnaire (HCQ). Internal consistency, corrected item-total correlations, floor and ceiling effects, and construct validity were analyzed. RESULTS: Cronbach's alphas for all four subscales of MOH and two of three subscales of HCQ had acceptable levels (α > 0.50). Some items from both scales had low item-total correlations. All subscales, except for one from HCQ, had good construct validity. CONCLUSION: While both instruments had some limitations, all subscales with one exception had adequate psychometric properties. When used in different national contexts, further development may be necessary to achieve conceptual equivalence.

Effect of mindfulness on physical activity in primary healthcare patients: a randomised controlled trial pilot study.

Increased physical activity can have health benefits among inactive individuals. In Sweden, the healthcare system uses physical activity on prescription (PAP) to motivate patients to increase their physical activity level. Mindfulness may further heighten the internal motivation to engage in physical activity. However, previous research has not demonstrated clear evidence of such an association. AIM: Examine the feasibility of the study design as a preparation for a full-scale study, and examine the differences, between three interventions, in change over time in physical activity levels and in related variables. METHOD: Comparison between three different interventions in an ordinary primary health care setting: PAP, mindfulness, and a combination of PAP and mindfulness. Physical activity was measured with self-report and ACTi Graph GT1X activity monitor. Statistical analysis was performed with a mixed-effect model to account for repeated observations and estimate differences both within groups and between groups at 3- and 6-months follow-up. RESULTS: Between September 2016 and December 2018, a total of 88 participants were randomised into three groups. The total dropout rate was 20.4%, the attendance rate to the mindfulness courses (52% > 6 times) and the web-based mindfulness training (8% > 800 min) was low according to the stated feasibility criteria. Eleven participants were excluded from analysis due to low activity monitor wear time. Neither the activity monitor data nor self-reported physical activity showed any significant differences between the groups. CONCLUSION: The study design needs adjustment for the mindfulness intervention design before a fully scaled study can be conducted. A combination of PAP and mindfulness may increase physical activity and self-rated health more than PAP or mindfulness alone. TRIAL REGISTRATION: ClinicalTrials.gov, registration number NCT02869854 . Regional Ethical Review Board in Lund registration number 2016/404.

A combination of clinical balance measures and FRAX® to improve identification of high-risk fallers.

BACKGROUND: The FRAX® algorithm quantifies a patient's 10-year probability of a hip or major osteoporotic fracture without taking an individual's balance into account. Balance measures assess the functional ability of an individual and the FRAX® algorithm is a model that integrates the individual patients clinical risk factors [not balance] and bone mineral density. Thus, clinical balance measures capture aspects that the FRAX® algorithm does not, and vice versa. It is therefore possible that combining FRAX® and clinical balance measures can improve the identification of patients at high fall risk and thereby high fracture risk. Our study aim was to explore whether there is an association between clinical balance measures and fracture prediction obtained from FRAX®. METHOD: A cross-sectional study design was used where post hoc was performed on a dataset of 82 participants (54 to 89 years of age, mean age 71.4, 77 female), with a fall-related wrist-fracture between 2008 and 2012. Balance was measured by tandem stance, standing one leg, walking in the figure of eight, walking heel to toe on a line, walking as fast as possible for 30 m and five times sit to stand balance measures [tandem stance and standing one leg measured first with open and then with closed eyes] and each one analyzed for bivariate relations with the 10-year probability values for hip and major osteoporotic fractures as calculated by FRAX® using Spearman's rank correlation test. RESULTS: Individuals with high FRAX® values had poor outcome in balance measures; however the significance level of the correlation differed between tests. Standing one leg eyes closed had strongest correlation to FRAX® (0.610 p = < 0.01) and Five times sit to stand was the only test that did not correlate with FRAX® (0.013). CONCLUSION: This study showed that there is an association between clinical balance measures and FRAX®. Hence, the use of clinical balance measures and FRAX® in combination, might improve the identification of individuals with high risk of falls and thereby following fractures. Results enable healthcare providers to optimize treatment and prevention of fall-related fractures. TRIAL REGISTRATION: The study has been registered in Clinical Trials.gov, registration number NCT00988572 .

Vestibular asymmetry increases double support time variability in a counter-balanced study on elderly fallers.

Vestibular asymmetry is a common cause of dizziness in the elderly, for whom it precipitates the risk of falling. Previous studies have shown that those with vestibular asymmetry displayed an altered variability in double support time (DST) compared to controls. However, swing time (SwT) variability findings are conflicting. In this study, we investigated if vestibular asymmetry might be causally connected to increased DST variability. We studied a group of eight elderly fallers with wrist fractures across three months, during which time four of them regained vestibular symmetry while four others developed an asymmetry. We evaluated the variability of DST and SwT, both when the participants suffered from vestibular asymmetry and when they did not. On average, variability in DST was significantly greater by 2.38%CV (coefficient of variation) when participants scored positive for vestibular asymmetry compared to when not, t(5)=4.39, p=0.01, ξ=1.67. In contrast, SwT variability differed non-significantly by 0.44%CV when participants had tested positive versus negative for vestibular asymmetry, t(5)=-0.87, p=0.39, ξ=-0.29. As a possible rationale for our results, we propose that increased DST variability may be the result of a re-stabilization strategy. Further research on DST variability and its correlation to the duration of vestibular asymmetry is recommended.

Does a mineral wristband affect balance? A randomized, controlled, double-blind study.

BACKGROUND: Having good balance is a facilitating factor in the performance of everyday activities. Good balance is also essential in various sport activities in order to both get results and prevent injury. A common measure of balance is postural sway, which can be measured both antero-posteriorly and medio-laterally. There are several companies marketing wristbands whose intended function is to improve balance, strength and flexibility. Randomized controlled trials have shown that wristbands with holograms have no effect on balance but studies on wristbands with minerals seem to be lacking. OBJECTIVE: The aim of this study was to investigate if the mineral wristband had any effect on postural sway in a group of healthy individuals. STUDY DESIGN: Randomized, controlled, double-blind study. MATERIAL/METHODS: The study group consisted of 40 healthy persons. Postural sway was measured antero-posteriorly and medio-laterally on a force plate, to compare: the mineral wristband, a placebo wristband, and without any wristband. The measurements were performed for 30 s, in four situations: with open eyes and closed eyes, standing on a firm surface and on foam. Analyses were made with multilevel technique. RESULTS: The use of wristband with or without minerals did not alter postural sway. Closed eyes and standing on foam both prolonged the dependent measurement, irrespective if it was medio-lateral or antero-posterior. Wearing any wristband (mineral or placebo) gave a small (0.22-0.36 mm/s) but not statistically significant reduction of postural sway compared to not wearing wristband. CONCLUSION: This study showed no effect on postural sway by using the mineral wristband, compared with a placebo wristband or no wristband. Wearing any wristband at all (mineral or placebo) gave a small but not statistically significant reduction in postural sway, probably caused by sensory input.

Somali women's view of physical activity--a focus group study.

BACKGROUND: Physical inactivity presents a major public health challenge and is estimated to cause six to ten percent of the major non-communicable diseases. Studies show that immigrants, especially women, have an increased risk of non-communicable diseases compared to ethnic Swedes. Somali immigrant women have increased rates of overweight and obesity, low fitness levels and low levels of cardiorespiratory fitness compared to non-immigrant women. These findings suggest that Somali women are at increased risk of developing lifestyle-related diseases. Few studies explore determinants of physical activity among Somali women. The aim of this study was to explore Somali women's views and experiences of physical activity after migration to Sweden. METHODS: A qualitative focused ethnographic approach was used in this study. Four focus groups were conducted with twenty-six Somali women ranging from 17 to 67 years of age. Focus group discussions were recorded, transcribed verbatim and analysed using qualitative content analysis. RESULTS: The analysis resulted in four main themes and ten categories: Life in Somalia and Life in Sweden, Understanding and enhancing health and Facilitators and barriers to physical activity. Great differences were seen between living in Somalia and in Sweden but also similarities such as finding time to manage housework, the family and the health of the woman. The extended family is non-existent in Sweden, making life more difficult. Health was considered a gift from God but living a healthy life was perceived as the responsibility of the individual. Misconceptions about enhancing health occurred depending on the woman's previous life experience and traditions. There was an awareness of the importance of physical activity among the participants but lack of knowledge of how to enhance activity on an individual basis. Enhancing factors to an active lifestyle were identified as being a safe and comfortable environment. CONCLUSIONS: Some barriers, such as climate, lack of motivation and time are universal barriers to an active lifestyle, but some factors, such as tradition and religion, are distinctive for Somali women. Since traditional Somali life never involves leisure-time physical activity, one cannot expect to compensate for the low daily activity level with leisure-time activity the Swedish way. Immigrant Somali women are a heterogeneous group with individual needs depending on age, education and background. Tailored interventions with respect to Somali traditions are necessary to achieve an actual increase in physical activity among migrant women of Somalian origin.

Fighting for control in an unpredictable life - a qualitative study of older persons' experiences of living with chronic dizziness.

BACKGROUND: Dizziness in older people is associated with disability and reduced quality of life. Few studies have investigated how daily life is affected from the older person's perspective. Identifying barriers and resources in daily life could guide health care in how to direct efficient interventions. The aim of this study was to explore older persons' experiences of living with chronic dizziness. METHODS: In this qualitative study seven women aged 74-84 years and six men aged 73-87 years with chronic dizziness (≥3 months) recruited from a primary health care centre in 2012 participated in semi-structured interviews. The interviews were analysed by content analysis. RESULTS: Interpretation of the interviews resulted in the overall theme "Fighting for control in an unpredictable life" with two themes. The first theme "Striving towards normality" revealed a struggle in daily life in searching for a cure or improvement and finding a way to maintain ordinary life. This process could result in feelings of resignation or adaption to daily life, and factors that supported living with chronic dizziness were described. The second theme "Having a precarious existence" revealed that daily life included being exposed to threats such as a fear of recurrent attacks or of falling, which resulted in an insecure and inflexible way of life. A feeling that symptoms were not taken seriously was described. CONCLUSIONS: The present study showed that older persons with chronic dizziness have needs that are not met by health care. Despite the fact that frequent contact with health care was described, the respondents described barriers in daily life that led to a restricted, inflexible and insecure daily life. Health care should therefore be individually tailored with focus on aspects of daily life, especially safety aspects. Support should also be continued until the older persons with chronic dizziness have developed coping strategies to gain control of their daily life.

Stroke and unsteadiness - a cross-sectional study from primary health care.

BACKGROUND: Dizziness is seldom the only symptom among patients who develop stroke but patients, hospitalized for vertigo are at higher risk of stroke than the general population. The proportions of patients who have remaining dizziness after a stroke seem to be unclear. OBJECTIVES: To study the frequency of dizziness among stroke patients referred to rehabilitation in primary health care and to study the relation between dizziness and gender, age, activity and self-rated health. METHODS: Patients with first-time stroke who were referred to rehabilitation in primary health care after the initial hospital stay were included. Dependence/independence in daily activities and self-rated health was measured. A question about whether the patient had experienced any dizziness or unsteadiness was asked. RESULTS: Sixty three patients were included in the study, (39 men, 24 women) aged 36-85 years. The majority of patients were dizzy (70%). Being female increased the risk of being dizzy substantially (OR 9.43). Patients with dizziness had poorer self-rated health than patients without dizziness (p = 0.001). CONCLUSION: Dizziness is a common symptom among patients with stroke, especially among female patients, and is associated with lower self-rated health. Therefore, it is important to address dizziness in the rehabilitation of stroke patients.

Psychometric properties of the Tampa Scale of Kinesiophobia (TSK-11) among older people with chronic pain.

OBJECTIVES: The study aimed to test the construct validity, factor structure and reliability of the 11-item version of the Tampa Scale for Kinesiophobia (TSK-11, Swedish version) among older people (65+) with chronic pain. DESIGN: Methodological study. SUBJECTS: 433 participants with chronic pain (mean age 74.8, 65-98 years) completed postal questionnaires. 264 of the participants completed a test-retest assessment. METHODS: Construct validity was evaluated through corrected item-total correlations. Convergent validity was analyzed by correlations with activity/activities of daily living (ADL) dependence, pain intensity and physical activity (all of which are constructs related to kinesiophobia according to fear-avoidance theories). Factor structure was tested through confirmatory factor analysis. Reliability was assessed with Cronbach's α and test-retest reliability, analyzed by intra-class correlation coefficient (ICC) and weighted κ coefficient analysis. RESULTS: Evidence of convergent validity was shown by significant positive correlations with activity/ADL dependence (r = 0.20) and pain intensity (r = 0.31), and a significant negative correlation with physical activity (r = -0.38). Confirmatory factor analysis showed that both one- and two factor-solutions were possible. Cronbach's α coefficients ranged between 0.74 and 0.87. Test-retest analysis showed strong agreement regarding ICC (r = 0.75, 95% confidence interval 0.64-0.82). The weighted κ coefficients for the individual items showed fair to moderate reliability. CONCLUSION: The Swedish version of TSK-11 had acceptable construct validity, factor structure, and reliability and, hence, can be considered suitable for older people with chronic pain.