Preferences for an eHealth tool to support physical activity and exercise training in COPD: a qualitative study from the viewpoint of prospective users.

BACKGROUND: Despite well-known positive effects of pulmonary rehabilitation, access is limited. New strategies to improve access are advocated, including the use of eHealth tools. OBJECTIVES: The aim of this study was to explore prospective users' preferences for an eHealth tool to support the self-management of physical activity and exercise training in COPD. METHODS: A qualitative research design was applied. Data was collected in six, audio recorded, digital co-creation workshops, which were guided by a participatory and appreciative action and reflection approach. A total of 17 prospective users took part in the process, including people with COPD (n = 10), relatives (n = 2), health care givers (n = 4) and a patient organization representative (n = 1). During the workshops, pre-selected relevant topics to exploring end-users' preferences for eHealth support in self-management in COPD were discussed. The workshops were recorded and transcribed. Data was analysed using inductive qualitative content analysis. RESULTS: The overarching theme "fusing with, rather than replacing existing support structures" was uncovered when the two-sided relationship between positive expectations towards digital solutions and the fear of losing access to established rehabilitation systems, emerged in the discussions. Three categories were identified, focused on wishes for an evidence-based support platform of information about COPD, a well-designed eHealth tool including functionalities to motivate in the self-management of physical activity and exercise training, and requirements of various forms of support. Co-creators believed that there were clear benefits in combining the best of digital and existing support systems. CONCLUSIONS: Co-creators viewed an eHealth tool including support for physical activity and exercise training as a valuable digital complement to the now existing rehabilitation services. A future eHealth tool needs to focus on user-friendliness and prospective users's requests.

Participatory methods in a digital setting: experiences from the co-creation of an eHealth tool for people with chronic obstructive pulmonary disease.

BACKGROUND: Using participatory methods to engage end-users in the development and design of eHealth is important to understand and incorporate their needs and context. Within participatory research, recent social distancing practice has forced a transition to digital communication platforms, a setting that warrants deeper understanding. The aim of this study was to describe the experiences of, and evaluate a digital co-creation process for developing an eHealth tool for people with chronic obstructive pulmonary disease (COPD). METHODS: The co-creation was guided by Participatory appreciative action and reflection, where a convenience sample (n = 17), including persons with COPD, health care professionals, relatives and a patient organization representative participated in six digital workshops. User instructions, technical equipment, and skilled support were provided if necessary. Workshops centred around different topics, with pre-recorded films, digital lectures and home assignments to up-skill participants. Process validity, experiences and ownership in the co-creation process were evaluated by repeated respondent validation, member checking, questionnaires and by assessing attendance. Data was analysed quantitatively or qualitatively as appropriate. RESULTS: The co-creators were in general satisfied with the digital format of the workshops. Mean attendance and perceived engagement in workshops was high and the experience described as enjoyable. Engagement was facilitated by up-skilling activities and discussions in small groups. Few had used digital communication previously, and feelings ranging from excitement to concern were expressed initially. Technical issues, mainly audio related, were resolved with support. At completion, skills using equipment and digital platform surpassed expectations. Few disadvantages with the digital format were identified, and advantages included reduced travel, time efficiency and reduced infection risk. CONCLUSIONS: Experiences of digital co-creation were overwhelmingly positive, despite initial barriers related to computer naivety and use of digital equipment and platforms. The high level of satisfaction, engagement, attendance rates, and agreement between individual and group views suggests that a digital co-creation process is a feasible method. Several important success factors were identified, such as the provision of information and education on discussion topics in advance of workshops, as well as the smaller group discussions during workshops. The knowledge gained herein will be useful for future digital co-creation processes.

Access to, use, knowledge, and preferences for information technology and technical equipment among people with chronic obstructive pulmonary disease (COPD) in Sweden. A cross-sectional survey study.

BACKGROUND: The use of information technology can make pulmonary rehabilitation interventions in people with chronic obstructive pulmonary disease (COPD) more flexible and thereby has the potential to reach a larger proportion of the population. However, the success of using information technology in pulmonary rehabilitation is dependent on the end-user's competence in information technology and access to the Internet. The aim was to describe the access to, and the use, knowledge, and preferences of information technology and technical equipment among people with COPD. METHODS: Telephone interviews were conducted using a standardised questionnaire on information technology and technical devises addressing the household, access to and usage of the Internet, contact with authorities, e-commerce, security, the workplace, digital competence, and disabilities. Questions were also posed regarding participants' views on a future eHealth tool for COPD, appropriate content, and the potential likelihood for them to use an eHealth tool for exercise training. RESULTS: In total 137 persons agreed to participate, 17 dropped out resulting in 120 included participants (response rate 88%). The participants (86 women) were aged 51 to 92 years (mean: 72.5), and all severity grades of COPD according to GOLD A-D were represented. Over 90% had access to the Internet. Smartphones were used by 81%, and over 90% used apps. Participants had high knowledge of how to use the Internet, 91% had used the Internet during the last 3 months, 85% almost every day. The most common requests for a future eHealth tool for COPD were evidence-based and trustworthy information on COPD, (including medication, exercise training, inhalation and breathing techniques), communication (chat) with others and with health carers. Access to individually adjusted exercise training, and support, (motivation via prompts, chat rooms, digital information board) was also desired. CONCLUSIONS: The present study showed that people with COPD in Sweden have high access and ability to use the Internet and information technology. They are frequent users and most of them take part in the digital society, even to a higher extent than the general population. The results show that the use of an eHealth tool could be a suitable strategy for people with COPD.

Remarkable increase of musculoskeletal disorders among soldiers preparing for international missions - comparison between 2002 and 2012.

BACKGROUND: Musculoskeletal disorders (MSD) are common among soldiers and constitute the most common reason for discontinuing military service within different military populations worldwide. The aims of this study were to investigate the prevalence of musculoskeletal disorders in two cohorts, 10 years apart, in the Swedish Armed Forces, to explore differences between these cohorts and to determine associated factors with MSD. METHOD: Comparative cross-sectional study. Participants were recruited from the Swedish Armed Forces, i.e. soldiers preparing for international missions in 2002 and 2012. A total of 961 soldiers, 7% women, participated in the study. Data were collected using the Musculoskeletal Screening Protocol (MSP), which includes questions regarding prevalence of MSD in ten anatomical locations (neck, upper back, low back, shoulders, elbow, hand, hip, knee, lower limb and foot). An additional five questions concern perceived self-rated health, i.e. how the respondent perceives their own physical body, mental health, social environment, physical environment and work ability. RESULTS: Over a ten-year period, both point prevalence and one-year prevalence of MSD in any body part increased significantly, with point prevalence increasing from 7.1 to 35.2% (p < 0.001) and one-year prevalence from 27.9 to 67.9% (p < 0.001). The knee was the most common anatomic location for MSD in both cohorts. Across each anatomical location (neck, upper back, low back, shoulders, elbow, hand, hip, knee, lower leg and foot), both point prevalence (p < 0.039) and one-year prevalence (p < 0.005) increased significantly from 2002 to 2012. Most soldiers reported good to excellent perceived health, i.e. self-perception of their physical body, mental health, physical and social environments, and work ability. The odds of reporting one-year prevalence of MSD in any body part was 5.28 times higher for soldiers in Cohort 2012, 1.91 times higher in age group 31-40 and 2.84 times higher in age group 41 and above. CONCLUSIONS: The prevalence of MSD increased remarkably over a ten-year period among Swedish soldiers preparing for international missions. With increasing age as one risk factor, systematic monitoring of MSD throughout the soldiers' careers and implementation of targeted primary-to-tertiary preventive programs are thus important.

Long-term effects of a progressive and specific balance-training programme with multi-task exercises for older adults with osteoporosis: a randomized controlled study.

OBJECTIVE: To evaluate long-term effects of balance-training on concerns about falling, gait, balance performance, and physical function in older adults with osteoporosis and increased risk of falling. DESIGN: Randomized controlled trial, including three groups (training, training+physical activity, and control group), with follow-ups at three, nine, and 15 months. Short-term, three-month follow-up, benefits for those who fulfilled the first follow-up ( n = 69) have previously been reported. SETTING: Stockholm, Sweden. PARTICIPANTS: A total of 96 elderly, age 66-87, with verified osteoporosis. INTERVENTIONS: Balance-training programme including dual- and multitasks, with or without supplementary physical activity, three times/week over 12 weeks. MEASUREMENTS: Concerns about falling Falls Efficacy Scale -International (FES-I), walking at preferred speed with and without a cognitive dual-task and at fast speed, balance tests (one-leg stance and modified figure-of-eight), and physical function Late-Life Function and Disability Instrument (LLFDI). RESULTS: Participants in the training group maintained positive effects throughout the study period for concerns about falling (baseline vs. 15 months, median 27.5 vs. 23 points, p < 0.001) and walking performance (baseline vs. 15 months, p ⩽ 0.05 with an improvement of 0.9-1.4 m/s). The Training+physical activity group declined to baseline values at the nine-month follow-up, and were even lower at the 15-month follow-up for concerns about falling (median 26 vs. 26 points), walking performance (changes of -0.02 to 0.04 m/s), and physical function (mean 44.0 vs. 42.9 points). The control group remained unchanged throughout the study period. CONCLUSIONS: This balance-training programme reduced concerns about falling, and also improved gait in older adults with osteoporosis and increased risk of falling in a long-term perspective - important issues for fall prevention.

Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of a balance training program including dual- and multi-task exercises on fall-related self-efficacy, fear of falling, gait and balance performance, and physical function in older adults with osteoporosis with an increased risk of falling and to evaluate whether additional physical activity would further improve the effects. DESIGN: Randomized controlled trial, including three groups: two intervention groups (Training, or Training+Physical activity) and one Control group, with a 12-week follow-up. SETTING: Stockholm County, Sweden. PARTICIPANTS: Ninety-six older adults, aged 66-87, with verified osteoporosis. INTERVENTIONS: A specific and progressive balance training program including dual- and multi-task three times/week for 12 weeks, and physical activity for 30 minutes, three times/week. MAIN MEASURES: Fall-related self-efficacy (Falls Efficacy Scale-International), fear of falling (single-item question - 'In general, are you afraid of falling?'), gait speed with and without a cognitive dual-task at preferred pace and fast walking (GAITRite®), balance performance tests (one-leg stance, and modified figure of eight), and physical function (Late-Life Function and Disability Instrument). RESULTS: Both intervention groups significantly improved their fall-related self-efficacy as compared to the controls (p ≤ 0.034, 4 points) and improved their balance performance. Significant differences over time and between groups in favour of the intervention groups were found for walking speed with a dual-task (p=0.003), at fast walking speed (p=0.008), and for advanced lower extremity physical function (p=0.034). CONCLUSIONS: This balance training program, including dual- and multi-task, improves fall-related self-efficacy, gait speed, balance performance, and physical function in older adults with osteoporosis.

Taking balance training for older adults one step further: the rationale for and a description of a proven balance training programme.

OBJECTIVE: To give the rationale and evidence for and a detailed description of a rehabilitation programme of proven effectiveness in improving balance in older adults. BACKGROUND THEORY AND EVIDENCE: Based on the knowledge that balance loss usually occurs in situations when attention is divided, especially when being older, and that balance control relies on the interaction of several physiological systems, we have developed a specific and progressive balance training programme with dual- and multi-task exercises for older adults. PRACTICAL APPLICATION: Balance demanding exercises, specific to the various components of balance control and to situations in daily life, were performed in sitting, standing and walking at three different levels of progression (basic, moderate and advanced) of increasing difficulty and complexity. The training was performed in 45-minutes group sessions, with 6-10 participants in each group, three times per week during 12 weeks, with two or three physiotherapists present. CONCLUSIONS: This balance training programme strengthens self-efficacy in balance control leading to improved fall-related self-efficacy, reduced fear of falling, increased walking speed, and improved physical function. Participants found the programme motivating, valuable, fun, and enjoyable, which was reflected in a high attendance rate.

Task-specific balance training improves self-assessed function in community-dwelling older adults with balance deficits and fear of falling: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of a 12-week balance training programme on self-assessed function and disability in healthy community-dwelling older adults with self-perceived balance deficits and fear of falling. DESIGN: A prospective, randomized controlled trial. SETTING: Stockholm County, Sweden. PARTICIPANTS: A total of 59 community-dwelling older adults (42 women and 17 men) aged 67-93 were randomized to either an intervention group (n = 38) or to serve as controls (n = 21) after baseline testing. INTERVENTION: The intervention was a 12-week, three times per week, progressive, specific and individually adjusted group balance-training programme. MAIN MEASURES: Self-perceived function and disability measured with Late Life Function and Disability Instrument. RESULTS: The intervention group reported improvement in overall function (p = 0.016), as well as in basic (p = 0.044) and advanced lower extremity function (p = 0.025) compared with the control group. The study showed no improvement in overall disability or upper extremity function. CONCLUSION: This group balance training programme improves self-assessed function in community-dwelling older adults with balance deficits and fear of falling.

High Physical Exposure During Female Recruits' Basic Military Training in Sweden-A Descriptive Study.

INTRODUCTION: There is a knowledge gap concerning the occurrence of physical complaints/injuries, i.e., musculoskeletal disorders (MSD), among Swedish women who undergo basic military training (BMT). The aims were to describe prevalence and factors related to MSD and explore physical exposure and performance in Swedish female recruits during BMT. MATERIALS AND METHODS: A total of 144 females (mean age 22 years) who underwent BMT in 2016 participated in this cross-sectional study. Data regarding self-reported MSD, physical performance, physical activity and exercise, motivation and mental and physical preparation, and physical exposure during BMT and perceived health were collected at the end of BMT through the Musculoskeletal Screening Protocol questionnaire. Additional data on muscle strength were retrieved from IsoKai isokinetic lift tests. Descriptive and analytic (paired samples t-test and logistic binary regression) statistics were used. RESULTS: The prevalence of MSD was high, with 33% (n = 48) reporting MSD before BMT, 78% (n = 113) during, and 50% (n = 72) at the end of BMT. Knee and upper back were the most frequently reported MSD locations. Forty-four (30%) participants felt insufficiently physically prepared for BMT. The physical exposure was high with loaded marches/runs and carrying heavy loads as the most demanding tasks. The longest walking distance was reportedly 55 km, and the reported maximum load was 50 kg. Forty-five participants (31%) had carried a load representing over 50% of their body weight. Most participants reported good to excellent health at the end of BMT. There was a small (8 N) but significant (P = 0.045) increase in mean force over time. Two variables, MSD before BMT (odds ratio 2.24, P = 0.03) and being physically unprepared (odds ratio 3.03, P < 0.01), were associated with MSD at the end of BMT. CONCLUSION: This study showed that the prevalence of MSD in Swedish female recruits was high before, during, and at the end of BMT, with knee and upper back as the most frequent locations. Although the physical exposure during BMT was occasionally high, self-rated health was mainly perceived as good to excellent at the end of BMT. Previous MSD and being physically unprepared were related to MSD at the end of BMT. These important and relevant findings indicate the necessity for implementing interventions to increase physical fitness and treat MSD at the beginning of BMT.

Long-term effects of new progressive group balance training for elderly people with increased risk of falling - a randomized controlled trial.

OBJECTIVE: To evaluate the long-term effects of a progressive and specific balance group-based program in healthy elderly individuals with increased risk of falling. DESIGN: Follow-up of a randomized controlled trial at nine and 15 months on a population that has previously been described at three months. SETTING: The study was conducted in Stockholm, Sweden. SUBJECTS: 59 community-dwelling elderly (age 67-93 years), recruited by advertisement, were randomly allocated to training or to serve as controls. INTERVENTION: Group balance training three times per week during 12 weeks with a 15 month follow-up time. MAIN MEASURES: Participants were assessed at baseline, three, nine, and 15 months thereafter for gait function (preferred and fast walking), rapid step execution (single and dual task), fear of falling, and likelihood of depression. RESULTS: Fast gait speed (p = 0.004), dual task step execution (p = 0.006) and fear of falling (p = 0.001) were still improved in the training group at nine months follow-up. Only self-perceived fear of falling remained significantly improved (p = 0.012) at 15 months follow-up. Although fast gait speed had decreased to baseline level in the training group (1.49 m/s) it remained significantly higher than in the control group (1.37 m/s) at the end of the study, a difference between the groups that was not seen at baseline. CONCLUSION: This training program provided important positive short and long-term benefits to gait, balance function, and fear of falling.

Test-Retest Reliability and Translation of the Musculoskeletal Screening Protocol Questionnaire Used in the Swedish Armed Forces.

INTRODUCTION: Musculoskeletal disorders (MSDs) in military personnel are common, and it is important to identify those at risk so that appropriate preventive and rehabilitative strategies can be undertaken. The Musculoskeletal Screening Protocol (MSP) questionnaire is part of the implemented prevention strategy to reduce MSDs in the Swedish Armed Forces. The aims of this study were to evaluate the questionnaire's reliability and to translate it into English. MATERIALS AND METHODS: One-week test-retest reliability of the questionnaire was evaluated in a sample of 35 Swedish military personnel. Reliability was evaluated by calculations of Cohen's kappa or quadratic-weighted kappa. Percent agreement was used as a parameter for measurement error. Translation into English included forward and backward translations and expert committee discussions. RESULTS: Kappa values relating to physical complaints/injuries were excellent (>0.75) except for knee and lower leg MSDs and for the intensity ratings, where Kappa values were mostly interpreted as fair-to-good (0.4-0.75). Kappa values of items pertaining physical performance, physical activity and exercise, eating and tobacco habits, sleep, and perceived health ranged between 0.72 and 1. Kappa values for feeling mentally or physical prepared were 0.47 and 0.65, respectively. Most percentage agreement values ranged between 90% and 100%. The English version was found to be satisfactorily equivalent to the Swedish MSP questionnaire. CONCLUSION: The Swedish MSP questionnaire was found to be highly reliable and was satisfactorily translated into English. This provides support for the questionnaire's ability to trustworthily capture the prevalence of MSDs and perceived health in military personnel. Future research is warranted on the psychometric properties of the English MSP questionnaire.

Clinical supervisors' experience of giving feedback to students during clinical integrated learning.

Background: For students within health-care education, clinical integrated learning has an important role in combining theory and practice. Constructive feedback is a cornerstone of effective clinical teaching, even though it can be a challenging task for both students and supervisors. There are limited studies on clinical physiotherapists' experience of giving feedback to students.Purpose: To explore clinical physiotherapy supervisors' experience of giving feedback to students during clinical integrated learning.Method: Twelve physiotherapists were interviewed in focus groups about their experiences of giving feedback to students. The interviews were analyzed using qualitative content analysis. Results: One latent, overarching theme was identified, which was continuous development and support within the social network at the workplace facilitates the work of giving feedback to students and three manifest main themes: (1) constructive dialog; (2) professionalism; and (3) enabling strategies.Conclusion: The current study focuses on supervisors' experiences of giving feedback to students in a clinical setting. The findings showed that giving feedback to students was a part of continuous development, facilitated by the social network at the workplace, and that the supervisors aimed to be professional while handling emotions in social interactions between supervisors and students.

"A manageable and challenging fall prevention intervention with impact on society" - older women's perspectives on participation in the stayBalanced training programme.

INTRODUCTION: Efficient and effective evidence-based practice (EBP) strategies for managing fall prevention in primary health care are of great importance. To ensure that EBP methods have the potential to be implemented and maintained in clinical practice, patient perspective must be ensured. Novel programs need to be perceived as meaningful and feasible, and in line with the patients' values, preferences and needs. PURPOSE: To describe how older women with osteoporosis experience participation in the StayBalanced Programme. METHODS: Individual semi-structured interviews with 39 women aged 67-86 with osteoporosis, impaired balance and fear of falling. Data were analyzed with thematic analysis. RESULTS: The analysis resulted in three main themes; "Managing and challenging training through support and enjoyment," "Structured training leads to safety and self-awareness" and "Lack of structured balance training means missed benefits, for both the individual and society." The participants experienced that the increased safety and self-awareness achieved through the challenging and motivating training, were transferred to daily life, thus, leaving them less exposed to falls, fall injuries and fear of falling. They expressed concerns about lack of knowledge translation regarding the positive effects of structured and challenging balance training, which left older adults and society without the benefits of evidence-based intervention. CONCLUSIONS: The StayBalanced Programme was appreciated and acceptable from the perspective of the participants, and in line with their values and preferences, one of three key components of EPB. The results of this study may support the uptake of the evidence-based StayBalanced Programme for fall prevention in clinical practice.

Effects of new, individually adjusted, progressive balance group training for elderly people with fear of falling and tend to fall: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of a new, individually adjusted, progressive and specific balance group training programme on fear of falling, step execution, and gait in healthy elderly people with fear of falling and tend to fall. DESIGN: Randomized controlled trial. SETTING: The study was conducted in Stockholm County, Sweden. SUBJECTS: Fifty-nine community dwelling elderly people were recruited by advertisement, and allocated at random to an intervention group (n = 38) or a control group (n = 21). INTERVENTION: Individually adjusted, progressive and specific balance group training was given three times a week for three months. The training incorporated elements included in, and required for, independent activities of daily living, and for reactions to loss of balance during dual or multiple tasks. MAIN MEASURES: Fear of falling was assessed with Falls Efficacy Scale International (FES-I). The reaction time of step execution was measured with the step-execution test, and gait was measured with GAITRite®. RESULTS: After three months the intervention group showed significant positive changes in the FES-I (P = 0.008), in the step-execution phase of dual-task performance (P = 0.012), and in gait at preferred speed during single-task performance; in cadence (P = 0.030) and, at fast speed, in velocity (P = 0.004) and cadence (P = 0.001). Significant decreases were also found for the likelihood of depression after participating in the training programme. CONCLUSION: This new balance training programme is feasible and leads to decreased fear of falling, decreased time for step execution during dual-task performance and increased velocity during fast walking.

StayBalanced: implementation of evidence-based fall prevention balance training for older adults-cluster randomized controlled and hybrid type 3 trial.

BACKGROUND: The StayBalanced programme has shown positive effects on fall prevention, balance control and fear of falling. Despite convincing evidence on the efficacy and effectiveness of balance training, there is a gap between research findings and what is provided in community-based and clinical health care settings. Therefore, transferring evidence-based balance training into clinical practice is needed. METHODS: This project, designed as a hybrid type 3 trial, is a cluster-randomized study with a mixed-method design, carried out in primary health care settings. The aim is to investigate the effectiveness of two different strategies to facilitate the implementation of an intervention, the StayBalanced balance training programme, in primary health care, including evaluation of relative changes and maintenance in patient outcomes between intervention arms over 24 months. The StayBalanced programme will be launched through a website with information on the balance training and how to use it in clinical practice. One implementation strategy will include close facilitation, i.e. support and close follow-ups initiated by the researchers, in addition to access to the website. The other strategy simply includes access to the StayBalanced website. Outcome measures in the project consist of implementation outcomes, such as acceptability, feasibility, fidelity and sustainability of the StayBalanced programme. Outcomes at an individual level for older adults participating in the training will include fall-related concerns, health-related quality of life, balance performance, gait, physical activity, muscle strength in lower extremities, number of falls and compliance with training. DISCUSSION: This study will generate new understanding of effective strategies for transferring research to clinical practice and thereby reduce an important knowledge gap, as well as aid decision-making for future implementation of evidence-based methods. Furthermore, it will contribute to improved balance and gait, increased level of physical activity and function, and improved health-related quality of life for the individuals participating in the programme. TRIAL REGISTRATION: ClinicalTrials.gov NCT02909374 . Registered on September 21, 2016.

Use of an eHealth tool for exercise training and online contact in people with severe chronic obstructive pulmonary disease on long-term oxygen treatment: A feasibility study.

Technology developments and demand for flexibility in health care and in contact with the health care system are two factors leading to increased use of eHealth solutions. The use of eHealth has been shown to have positive effects in people with chronic obstructive pulmonary disease, but the full potential for this group needs to be explored. Therefore, the aim was to evaluate the feasibility of an eHealth tool used for exercise training and online contacts for people with severe chronic obstructive pulmonary disease. The 10-week intervention included an eHealth tool for exercise training in home environment and regular online contacts, as well as weekly e-rounds for health care professionals. Seven of the nine participants completed the study. The eHealth tool was found to be feasible for e-rounds, exercise training and online contacts. Participants could manage the tool and adhere to training; positive effects were shown, and no adverse events occurred. Technical functions need to be improved.

"Stay balanced" - effectiveness of evidence-based balance training for older adults transferred into a physical therapy primary care setting - a pilot study.

Purpose: To evaluate the effects of the Stay Balanced program when this is transferred into a clinical setting regarding balance, gait speed, leg muscle strength, concerns about falling, and physical activity.Method: Implementation pilot study with a pre-post intervention design. Fifteen older adults, 75-91 years of age, participated in a progressive balance training program with a focus on divided attention. The balance training was performed in group sessions twice a week for 10 weeks at a primary care physical therapy clinic. Training efficacy was evaluated after completion of training as well as after 3 months using the Mini-Balance Evaluation Systems Test (Mini-BESTest), 10-meter walk test, 30-s chair stand test, Fall Efficacy Scale-International (FES-I), and steps/day.Results: Significant improvements were shown at the 10-week follow up for balance, gait speed, leg muscle strength, and concerns about falling (p < 0.008). At the 3-month follow-up balance, leg muscle strength and concerns about falling showed persistent improvement compared to baseline (p < 0.045). No significant differences were found for physical activity.Conclusions: This study confirms the results of our previous randomized controlled trials (RCTs), and suggests that the Stay Balanced program can be transferred to clinical physiotherapy practice. The program was appreciated by the participants and proved to be safe, effective, and feasible in primary care.Implication for rehabilitationThe Stay Balance program can easily be transferred to clinical practice without losing the effectiveness of the intervention in older adults with balance problems.The program was appreciated by the participants and proved to be safe, effective, and feasible when executed in primary care.Stay Balance program is an individually adjusted and progressive group balance training including exercises with divided attention that can easily be transferred to tasks in daily life.

Reliability of the Swedish version of the Evidence-Based Practice Attitude Scale assessing physiotherapist's attitudes to implementation of evidence-based practice.

PURPOSE: To translate and apply a cross-cultural adaptation of the Evidence-Based Practice Attitude Scale (EBPAS) in Swedish and investigate its absolute and relative reliability. METHODS: The original EBPAS (a questionnaire assessing health professionals' attitudes to implementation of evidence-based practice) was translated into Swedish using a forward and backward procedure, including a group discussion and expert committee. To assess reliability, 55 physiotherapists (48 women) aged 23-64 years from different clinical settings in the Stockholm region answered the EBPAS by postal survey twice within an interval of 2 weeks. RESULTS: The Cronbach's alpha values for EBPAS were >0.721. The intraclass correlation (ICC) between test and retest (relative reliability) was moderate to good for the four subscales, with ICC(A.1) and ICC(C.1) values approximately equal and in the range 0.56-0.89. Values for the absolute reliability of the mean score were a standard error of measurement of about 7% and a smallest real difference of about 19%. CONCLUSION: The Swedish version of the EBPAS shows mainly good reliability.

The effects of dual-task balance training on gait in older women with osteoporosis: A randomized controlled trial.

BACKGROUND: Although there is a growing body of literature showing promising effects of balance training on gait in older adults, little is known about the effects of dual-task training on varying domains of spatial and temporal gait parameters. RESEARCH QUESTION: Does the short-term effects of dual-task balance training differ between single and dual-task gait in older women with osteoporosis with regards to different gait domains (pace, rhythm, variability, asymmetry and postural control)? METHODS: Elderly women with osteoporosis who experienced fear of falling and/or ≥1 fall the last 12 months were recruited. Ninety-five participants were randomized to 12 weeks of balance training or to a control group. The participants in the training group (n = 65) received 12 weeks (3 times/week) of balance and gait exercises including dual-tasks, and the control group (n = 30) received care as usual. Single- and dual-task gait were assessed before and after the intervention with an electronic walkway system and analyzed using non-parametric statistics and effect sizes. RESULTS: 68 participants completed the study. The training group walked faster for single- and dual-task gait following training (P ≤ .044) by increasing their cadence (P ≤ .012) and reducing step and swing time (P ≤ .045) compared with the control group. Significant between-group differences in favor of the training group were found for gait variability during dual-task gait (P ≤ .041). The improvement in speed were greater for dual- than single-task gait (0.10 vs. 0.05 m/s) and the effect sizes revealed small to medium effects for dual-task gait, and either non-existent or small for single-task gait. SIGNIFICANCE: Greater training effects found on a variety of domains of dual-task gait compared to single-task gait support the role of cognitively demanding exercises for the maintenance of safe ambulation in older women with osteoporosis.

Psychometric properties of the Swedish version of the Falls Efficacy Scale-International for older adults with osteoporosis, self-reported balance deficits and fear of falling.

PURPOSE: Investigate the psychometric properties of the Swedish version of the Falls Efficacy Scale-International (FES-I). METHOD: Cross-sectional study. Community-dwelling older adults with self-reported balance deficits and fear of falling were recruited from an ongoing randomised controlled study to evaluate the psychometric properties of the FES-I using Rasch model analysis. RESULTS: The Rasch model analysis revealed good category function, the questionnaire measured one dimension with an explained variance of 68.6% and item goodness-of-fit with mean square values (MnSq) 0.7-1.44. The item map showed that all items are spread over the scale, which indicates different difficulties in the items. Non-satisfactory person goodness-of-fit was shown with seven persons and showed person misfit according to both the MnSq-value and the z-value, 38 persons (40%) showed a person misfit when only following the threshold for MnSq. CONCLUSIONS: The Swedish version of FES-I shows good psychometric properties with unidimensionality and item goodness-of-fit. Lower person goodness-of-fit was shown probably because of confounding factors that may influence the answers. The transformed values of the FES-I make it possible to use parametric statistics preferable for this population in future research. Implications for rehabilitation The Falls Efficacy Scale-International (FES-I) shows good psychometric properties with unidimensionality, item goodness-of-fit and good item reliability, which means that FES-I is a valuable tool when measuring concerns about falling in an older population with osteoporosis and could be useful in clinical settings. Confounding factors such as pain, high number of falls, low fall self-efficacy, experience of previous falls, and vertigo may influence the answers and result in low person goodness-of-fit.