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Wilnerzon Thörn RM, Forsberg A, Stepniewski J, Hjelmqvist H, Magnuson A, Ahlstrand R, Ljungqvist O. Immediate mobilization in post-anesthesia care unit does not increase overall postoperative physical activity after elective colorectal surgery: A randomized, double-blinded controlled trial within an enhanced recovery protocol. World J Surg 2024; 48:956-966. [PMID: 38348901 DOI: 10.1002/wjs.12102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/27/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND The level of post-operative mobilization according to Enhanced Recovery After Surgery (ERAS) guidelines is not always achieved. We investigated whether immediate mobilization increases postoperative physical activity. The objective was to evaluate the effects of immediate postoperative mobilization in the post-anesthesia care unit (PACU) compared to standard care. METHODS This randomized controlled trial, involved 144 patients, age ≥18 years, undergoing elective colorectal surgery. Patients were randomized to mobilization starting 30 min after arrival in the PACU, or to standard care. Standard care consisted of mobilization a few hours later at the ward according to ERAS guidelines. The primary outcome was physical activity, in terms of number of steps, measured with an accelerometer during postoperative days (PODs) 1-3. Secondary outcomes were physical capacity, functional mobility, time to readiness for discharge, complications, compliance with the ERAS protocol, and physical activity 1 month after surgery. RESULTS With the intention-to-treat analysis of 144 participants (median age 71, 58% female) 47% underwent laparoscopic-or robotic-assisted surgery. No differences in physical activity during hospital stay were found between the participants in the intervention group compared to the standard care group (adjusted mean ratio 0.97 on POD 1 [95% CI, 0.75-1.27], p = 0.84; 0.89 on POD 2 [95% CI, 0.68-1.16], p = 0.39, and 0.90 on POD 3 [95% CI, 0.69-1.17], p = 0.44); no differences were found in any of the other outcome measures. CONCLUSIONS Addition of the intervention of immediate mobilization to standard care did not make the patients more physically active during their hospital stay. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NTC 03357497.
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Affiliation(s)
| | - Anette Forsberg
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jan Stepniewski
- Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden
| | - Hans Hjelmqvist
- Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Rebecca Ahlstrand
- Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Olle Ljungqvist
- Department of Surgery, School of Medical Sciences, Örebro University, Örebro, Sweden
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Pengel LHM, Kaisar M, Benjamens S, Ibrahim M, Ricci V, Bellini MI, Breithaupt-Faloppa AC, Falk C, Maple H, Marson L, Ortiz F, Papalois V, Paredes D, Forsberg A. Equity, Diversity and Inclusion (EDI) in Organ Transplantation: An ESOT Survey About EDI Within ESOT as an Organization and its Educational Activities, and Transplantation Research and Science. Transpl Int 2023; 36:11331. [PMID: 37680646 PMCID: PMC10481529 DOI: 10.3389/ti.2023.11331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023]
Abstract
The European Society of Organ Transplantation (ESOT) strives to promote equity, diversity, and inclusion (EDI) across all its activities. We surveyed the transplant community's experiences and perspectives regarding EDI within ESOT as an organization and its educational activities, and research in general. A total of 299 respondents completed the questionnaire. About half agreed that ESOT's Executive Committee, Council, and Sections/Committees are diverse and inclusive (51%) and that ESOT promotes EDI in its live and digital educational activities (54%). Forty percent of respondents agreed that scientific and clinical trials in the field of transplantation are diverse and inclusive. Despite the wide distribution of the survey, most of the respondents self-identified as White and were either physician or surgeon. However, the results contribute a unique insight into the experiences and perspectives of the transplantation community regarding EDI. Whilst ESOT is committed to the principles of EDI, perceptions and the high number of proposals show the apparent need to prioritize efforts to embed EDI across ESOT and transplantation science. These data should constitute a starting point for change and provide guidance for future efforts to promote EDI within the transplantation community.
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Affiliation(s)
- L. H. M. Pengel
- Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
- Peter Morris Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - M. Kaisar
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - S. Benjamens
- Department of Surgery, Ikazia Hospital, Rotterdam, Netherlands
| | - M. Ibrahim
- Manchester Royal Infirmary, Manchester, United Kingdom
| | - V. Ricci
- European Society for Organ Transplantation, Padua, Italy
| | - M. I. Bellini
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - A. C. Breithaupt-Faloppa
- LIM-11, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C. Falk
- Institut für Transplantationsimmunologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - H. Maple
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - L. Marson
- The Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - F. Ortiz
- Abdominal Center Unit, Nephrology, Helsinki University Hospital, Helsinki, Finland
| | - V. Papalois
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - D. Paredes
- Donation and Transplant Coordination Unit, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - A. Forsberg
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Thoracic Surgery, Skane University Hospital, Lund, Sweden
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Strömberg U, Bonander C, Westerberg M, Levin L, Metcalfe C, Steele R, Holmberg L, Forsberg A, Hultcrantz R. Colorectal cancer screening with fecal immunochemical testing or primary colonoscopy: An analysis of health equity based on a randomised trial. EClinicalMedicine 2022; 47:101398. [PMID: 35480071 PMCID: PMC9035727 DOI: 10.1016/j.eclinm.2022.101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We have addressed health equity attained by fecal immunochemical testing (FIT) and primary colonoscopy (PCOL), respectively, in the randomised controlled screening trial SCREESCO conducted in Sweden. METHODS We analysed data on the individuals recruited between March 2014, and March 2020, within the study registered with ClinicalTrials.gov, NCT02078804. Swedish population registry data on educational level, household income, country of birth, and marital status were linked to each 60-year-old man and woman who had been randomised to two rounds of FIT 2 years apart (n = 60,123) or once-only PCOL (n = 30,390). Furthermore, we geo-coded each study individual to his/her residential area and assessed neighbourhood-level data on deprivation, proportion of non-Western immigrants, population density, and average distance to healthcare center for colonoscopy. We estimated adjusted associations of each covariate with the colonoscopy attendance proportion out of all invited to respective arms; ie, the preferred outcome for addressing health equity. In the FIT arm, the test uptake and the colonoscopy uptake among the test positives were considered as the secondary outcomes. FINDINGS We found a marked socioeconomic gradient in the colonoscopy attendance proportion in the PCOL arm (adjusted odds ratio [95% credibility interval] between the groups categorised in the highest vs. lowest national quartile for household income: 2·20 [2·01-2·42]) in parallel with the gradient in the test uptake of the FIT × 2 screening (2·08 [1·96-2·20]). The corresponding gradient in the colonoscopy attendance proportion out of all invited to FIT was less pronounced (1·29 [1·16-1·42]), due to higher proportions of FIT positives in socioeconomically disadvantaged groups. INTERPRETATION The unintended risk of exacerbating inequalities in health by organised colorectal cancer screening may be higher with a PCOL strategy than a FIT strategy, despite parallel socioeconomic gradients in uptake. FUNDING This work was supported by the Swedish Cancer Society under Grant 20 0719. CB and US provided economic support from the Swedish Research Council for Health, Working life, and Welfare under Grant 2020-00962.
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Affiliation(s)
- U. Strömberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, PO Box 463, Gothenburg SE-405 30, Sweden
- Corresponding author.
| | - C. Bonander
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, PO Box 463, Gothenburg SE-405 30, Sweden
| | - M. Westerberg
- Department of Mathematics, Uppsala University, Box 480, Uppsala SE-751 06, Sweden
| | - L.Å. Levin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping SE-581 83, Sweden
| | - C. Metcalfe
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, United Kingdom
| | - R. Steele
- Department of Surgery, Population Health and Genomics, School of Medicine, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, United Kingdom
| | - L. Holmberg
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, St Thomas Street, London SE1 9RT, United Kingdom
- Department of Surgical Sciences, Uppsala University, Uppsala SE-751 85, Sweden
| | - A. Forsberg
- Department of Medicine K2, Solna, Karolinska Institutet, Stockholm SE-171 76, Sweden
| | - R. Hultcrantz
- Department of Medicine K2, Solna, Karolinska Institutet, Stockholm SE-171 76, Sweden
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Thörn RMW, Stepniewski J, Hjelmqvist H, Forsberg A, Ahlstrand R, Ljungqvist O. Supervised Immediate Postoperative Mobilization After Elective Colorectal Surgery: A Feasibility Study. World J Surg 2021; 46:34-42. [PMID: 34668047 PMCID: PMC8677683 DOI: 10.1007/s00268-021-06347-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early mobilization is a significant part of the ERAS® Society guidelines, in which patients are recommended to spend 2 h out of bed on the day of surgery. However, it is not yet known how early patients can safely be mobilized after completion of colorectal surgery. The aim of this study was to evaluate the feasibility, and safety of providing almost immediate structured supervised mobilization starting 30 min post-surgery at the postoperative anesthesia care unit (PACU), and to describe reactions to this approach. METHODS This feasibility study includes 42 patients aged ≥18 years who received elective colorectal surgery at Örebro University Hospital. They underwent a structured mobilization performed by a specialized physiotherapist using a modified Surgical ICU Optimal Mobilization Score (SOMS). SOMS determines the level of mobilization at four levels from no activity to ambulating. Mobilization was considered successful at SOMS ≥ 2, corresponding to sitting on the edge of the bed as a proxy of sitting in a chair due to lack of space. RESULTS In all, 71% (n = 30) of the patients reached their highest level of mobilization between the second and third hour of arrival in the PACU. Before discharge to the ward, 43% (n = 18) could stand at the edge of the bed and 38% (n = 16) could ambulate. Symptoms that delayed advancement of mobilization were pain, somnolence, hypotension, nausea, and patient refusal. No serious adverse events occurred. CONCLUSIONS Supervised mobilization is feasible and can safely be initiated in the immediate postoperative care after colorectal surgery. Trial registration Clinical trials.gov identifier: NTC03357497.
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Affiliation(s)
- Rose-Marie W Thörn
- Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden.
| | - Jan Stepniewski
- Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden
| | - Hans Hjelmqvist
- Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anette Forsberg
- Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden
| | - Rebecca Ahlstrand
- Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Arvidsson Lindvall M, Forsberg A, Appelros P, Anderzén-Carlsson A. "I can manage the challenge" - a qualitative study describing experiences of living with balance limitations after first-ever stroke. Int J Qual Stud Health Well-being 2020; 16:1857044. [PMID: 33323049 PMCID: PMC7744151 DOI: 10.1080/17482631.2020.1857044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: To describe experiences of living with balance limitations after first-ever stroke. Materials and methods: This study has a qualitative design, comprising interviews with 19 persons with first-ever stroke, ten women and nine men. Their mean age was 77 years and the mean time since stroke was 15 months. Stroke survivors who were able to walk outdoors with or without a walking aid and who were independent in toileting and dressing were invited to participate. Semi-structured individual interviews were performed. An inductive qualitative content analysis of the manifest and latent content was conducted. Results: The results are presented in two themes illustrating the latent content of the data, “Feeling dizzy and unstable is a continuous challenge” and “Feeling confidence despite dizziness and unsteadiness”, and seven categories illustrating the manifest content: Limitations in daily life; Being emotionally affected; The need for physical support; Everything takes time; I can still manage; Feelings of acceptance; and Finding individual solutions. Conclusions: All participants experienced the balance limitations as a continuous challenge in their everyday life, yet they also felt confidence. They had to some degree adapted their activities and were able to manage their daily life.
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Affiliation(s)
- Mialinn Arvidsson Lindvall
- Department of University Health Care Research Center, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
| | - Anette Forsberg
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
| | - Peter Appelros
- Department of University Health Care Research Center, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
| | - Agneta Anderzén-Carlsson
- Department of University Health Care Research Center, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
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6
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Forsberg A, Abrahamsson TR, Nilsson L, Ernerudh J, Duchén K, Jenmalm MC. Changes in peripheral immune populations during pregnancy and modulation by probiotics and ω-3 fatty acids. Sci Rep 2020; 10:18723. [PMID: 33127947 PMCID: PMC7599237 DOI: 10.1038/s41598-020-75312-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 10/07/2020] [Indexed: 02/08/2023] Open
Abstract
Allergic diseases have become a major health problem, partly due to reduced microbial stimulation and a decreased dietary ω-3/ω-6 long-chain polyunsaturated fatty acid ratio. Prenatal exposures have been reported to influence allergy development, possibly induced via changes in maternal immune regulation. In a randomized double-blind placebo-controlled multicenter allergy prevention trial (PROOM-3), pregnant women were recruited at gestational week 20, and randomized to four study groups, one receiving both L. reuteri oil drops and ω-3 PUFA capsules (n = 22), the second receiving ω-3 PUFA supplementation and placebo regarding L. reuteri (n = 21), the third receiving L. reuteri and placebo regarding ω-3 PUFA (n = 22) and the fourth group receiving placebo capsules and placebo oil drops (n = 23). In this substudy, supplemental and pregnancy-related effects on maternal peripheral immune cell populations during pregnancy were assessed by flow cytometry immune phenotyping at gestational week 20, 32 and 4 days after delivery. The numbers of activated and regulatory T (Treg) cells (CD45RA− Foxp3++/CD45RA+Foxp3+) were reduced after delivery, with the lowest count in the L. reuteri supplemented group compared with the placebo group 4 days after delivery, while the ω-3 PUFA group did not differ from the placebo group. Several treatment-independent changes were observed during and after pregnancy in lymphocytes (CD4+/8+/19+/56+/45RA+/−), CD14+16+/− monocytes, and in subpopulations of T helper cells (Th) CD4+CD45RA−Tbet+ (Th1) and CD4+CD45RA−RORC+ (Th17) cells. In conclusion, probiotic supplementation to the mother during the second half of pregnancy resulted in immunomodulatory effects among activated and resting Treg cells. Furthermore, several systemic immune modifying effects of pregnancy were observed.
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Affiliation(s)
- A Forsberg
- Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - T R Abrahamsson
- Department of Paediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - L Nilsson
- Department of Clinical and Experimental Medicine, Allergy Centre, Linköping University, Linköping, Sweden
| | - J Ernerudh
- Department of Clinical Immunology and Transfusion Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - K Duchén
- Department of Paediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - M C Jenmalm
- Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Dalvindt M, Nozhoor S, Kisch A, Forsberg A. Chronic Pain One to Five Years after Heart Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Forsberg A, Lennerling A, Kisch A, Jakobsson S. Fatigue One to Five Years after Lung Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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9
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Forsberg A, Lampa J, Estelius J, Cervenka S, Farde L, Halldin C, Lekander M, Olgart Höglund C, Kosek E. Disease activity in rheumatoid arthritis is inversely related to cerebral TSPO binding assessed by [ 11C]PBR28 positron emission tomography. J Neuroimmunol 2019; 334:577000. [PMID: 31260948 DOI: 10.1016/j.jneuroim.2019.577000] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/20/2019] [Indexed: 12/12/2022]
Abstract
Reumatoid Arthritis (RA) is an autoimmune disorder characterized by peripheral joint inflammation. Recently, an engagement of the brain immune system has been proposed. The aim with the current investigation was to study the glial cell activation marker translocator protein (TSPO) in a well characterized cohort of RA patients and to relate it to disease activity, peripheral markers of inflammation and autonomic activity. Fifteen RA patients and fifteen healthy controls matched for age, sex and TSPO genotype (rs6971) were included in the study. TSPO was measured using Positron emission tomography (PET) and the radioligand [11C]PBR28. The outcome measure was total distribution volume (VT) estimated using Logan graphical analysis, with grey matter (GM) as the primary region of interest. Additional regions of interest analyses as well as voxel-wise analyses were also performed. Clinical evaluation of disease activity, symptom assessments, serum analyses of cytokines and heart rate variability (HRV) analysis of 24 h ambulatory ECG were performed in all subjects. There were no statistically significant group differences in TSPO binding, either when using the primary outcome VT or when normalizing VT to the lateral occipital cortex (p > 0.05). RA patients had numerically lower VT values than healthy controls (Cohen's D for GM = -0.21). In the RA group, there was a strong negative correlation between [11C]PBR28 VT in GM and disease activity (DAS28)(r = -0.745, p = 0.002, corrected for rs6971 genotype). Higher serum levels of IFNγ and TNF-α were found in RA patients compared to controls (p < 0.05) and several measures of autonomic activity showed significant differences between RA and controls (p < 0.05). However, no associations between markers of systemic inflammation or autonomic activity and cerebral TSPO binding were found. In conclusion, no statistically significant group differences in TSPO binding as measured with [11C]PBR28 PET were detected. Within the RA group, lower cerebral TSPO binding was associated with higher disease activity, suggesting that cerebral TSPO expression may be related to disease modifying mechanisms in RA. In light of the earlier confirmed neuro-immune features of RA, these results warrant further investigations regarding neuro-immune joint-to-CNS signalling to open up for potentially new treatment strategies.
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Affiliation(s)
- A Forsberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm County Council, SE-171 76 Stockholm, Sweden.
| | - J Lampa
- Department of Medicine, Rheumatology Unit, Center for Molecular Medicine (CMM), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J Estelius
- Department of Medicine, Rheumatology Unit, Center for Molecular Medicine (CMM), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - S Cervenka
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm County Council, SE-171 76 Stockholm, Sweden
| | - L Farde
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm County Council, SE-171 76 Stockholm, Sweden; PET Science Centre, Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Karolinska Institutet, Sweden
| | - C Halldin
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm County Council, SE-171 76 Stockholm, Sweden
| | - M Lekander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - C Olgart Höglund
- Department of Medicine and Center for Molecular Medicine (CMM), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - E Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Stepniewski J, Thörn RM, Ahlstrand R, Hjelmqvist H, Forsberg A, Ljungqvist O. Feasibility of immediate postoperative mobilisation within an enhanced recovery protocol after colorectal surgery. Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2019.03.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Nilsagård Y, Westerdahl E, Forsberg A. Engagement in performing clinical physiotherapy research: Perspectives from leaders and physiotherapists. Physiother Res Int 2019; 24:e1767. [DOI: 10.1002/pri.1767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 08/16/2018] [Accepted: 12/17/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Ylva Nilsagård
- Health Care Management, Faculty of Medicine and HealthÖrebro University Örebro Sweden
| | - Elisabeth Westerdahl
- Department of Physical Therapy, Faculty of Medicine and HealthÖrebro University Örebro Sweden
| | - Anette Forsberg
- Department of Physical Therapy, Faculty of Medicine and HealthÖrebro University Örebro Sweden
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Abstract
Purpose: The purpose of this study was to describe how everyday life is experienced by next of kin sharing residence with a person who falls due to multiple sclerosis (MS).Methods: Twenty face-to-face interviews were analysed using a qualitative content analysis.Results: The overall theme "Making it work" represents the next of kin's struggle to make life work. It comprises three themes: "Taking responsibility", "Making adjustments", and "Standing aside for someone else". The two first themes reflect what relatives do to make the situation work, and the last theme represents what they give up.Conclusion: Next of kin who share residence and everyday life with a person with MS are affected by that person's occasional falls. They often take on the responsibility of preventing such falls and adapt their lives practically and emotionally. However, adaptation is neither always enough or always possible. In these cases, relatives often deprioritize their own needs and free time to make everyday life in the home work.Implications for rehabilitationBy highlighting that next of kin also are affected by the falls of their cohabiting person with multiple sclerosis enhances the importance of fall prevention activities that should include the next of kin.Next of kin to people who occasionally fall due to multiple sclerosis can be in need of both practical and emotional support from the health care system.Enhanced information from the health care system can empower and help them to take care of themselves while managing to live with, care for, and protect the person with multiple sclerosis from falls.
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Affiliation(s)
- Anna Carling
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ylva Nilsagård
- Health Care Management, Region Örebro County, Örebro, Sweden
| | - Anette Forsberg
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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13
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Carling A, Nilsagård Y, Forsberg A. Balance exercise facilitates everyday life for people with multiple sclerosis: A qualitative study. Physiother Res Int 2018; 23:e1728. [PMID: 29962013 PMCID: PMC6220996 DOI: 10.1002/pri.1728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 04/27/2018] [Accepted: 05/29/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The aim of this qualitative study was to describe the experience and perceived effects on everyday life for people with multiple sclerosis after participating in a balance exercise programme focusing on core stability, dual tasking, and sensory strategies (the CoDuSe programme). METHODS A qualitative approach was chosen, using face-to-face interviews analysed with content analysis. Twenty-seven people with multiple sclerosis (20 women, 7 men) who had participated in the CoDuSe programme were included. All could walk 20 m with or without walking aids but could not walk further than 200 m. The CoDuSe programme was given twice weekly during a 7-week period. RESULTS The analysis revealed five categories. Learning to activate the core muscles described how the participants gained knowledge of using their core muscles and transferred this core muscle activation into everyday life activities. Improved bodily confidence covered narratives of being more certain of the ability to control their bodies. Easier and safer activities showed how they could now perform activities in everyday life more safely and easily. Increased independence and participation involved the participants' improved ability and self-confidence to execute activities by themselves, as well as their increased participation in activities in daily living. Experiences of the balance exercise programme revealed that they found the programme novel and challenging. The overall theme was balance exercise facilitates everyday life. CONCLUSION Participating in the CoDuSe programme was perceived to facilitate everyday life for people with multiple sclerosis. Taking part in the balance exercise programme taught the participants how to activate and use the core muscles, which increased their bodily confidence. Having increased bodily confidence helped them to perform everyday life activities with more ease and safety, which increased their independence and participation. The participants described the CoDuSe programme as novel and challenging, yet feasible.
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Affiliation(s)
- Anna Carling
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ylva Nilsagård
- Health Care Management, Region Örebro County, Örebro, Sweden
| | - Anette Forsberg
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Arvidsson Lindvall M, Anderzén-Carlsson A, Appelros P, Forsberg A. Validity and test–retest reliability of the six-spot step test in persons after stroke. Physiother Theory Pract 2018; 36:211-218. [DOI: 10.1080/09593985.2018.1482511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Mialinn Arvidsson Lindvall
- Department of University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Agneta Anderzén-Carlsson
- Department of University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Faculty of Health, Science, and Technology, Department of Health Sciences, Nursing, Karlstad University, Karlstad, Sweden
| | - Peter Appelros
- Department of University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anette Forsberg
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Forsberg A, West CE, Prescott SL, Jenmalm MC. Pre- and probiotics for allergy prevention: time to revisit recommendations? Clin Exp Allergy 2017; 46:1506-1521. [PMID: 27770467 DOI: 10.1111/cea.12838] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Reduced intensity and diversity of microbial exposure is considered a major factor driving abnormal postnatal immune maturation and increasing allergy prevalence, particularly in more affluent regions. Quantitatively, the largest important source of early immune-microbial interaction, the gut microbiota, is of particular interest in this context, with variations in composition and diversity in the first months of life associated with subsequent allergy development. Attempting to restore the health consequences of the 'dysbiotic drift' in modern society, interventions modulating gut microbiota for allergy prevention have been evaluated in several randomized placebo-controlled trials. In this review, we provide an overview of these trials and discuss recommendations from international expert bodies regarding prebiotic, probiotic and synbiotic interventions. Recent guidelines from the World Allergy Organization recommend the use of probiotics for the primary prevention of eczema in pregnant and breastfeeding mothers of infants at high risk for developing allergy and in high-risk infants. It is however stressed that these recommendations are conditional, based on very low-quality evidence and great heterogeneity between studies, which also impedes specific and practical advice to consumers on the most effective regimens. We discuss how the choice of probiotic strains, timing and duration of administration can critically influence the outcome due to different effects on immune modulation and gut microbiota composition. Furthermore, we propose strategies to potentially improve allergy-preventive effects and enable future evidence-based implementation.
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Affiliation(s)
- A Forsberg
- Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - C E West
- International Inflammation (in-FLAME) network of the World Universities Network, Umeå, Sweden.,Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - S L Prescott
- International Inflammation (in-FLAME) network of the World Universities Network, Umeå, Sweden.,School of Paediatrics and Child Health, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA, Australia
| | - M C Jenmalm
- Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,International Inflammation (in-FLAME) network of the World Universities Network, Umeå, Sweden
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Abstract
Objectives: The aim was to describe falls and the perceived causes, experienced by people with multiple sclerosis shortly after falling. Design: A qualitative study using content analysis and quantitative data to illustrate where and why people report falls most commonly. Semi-structured telephone interviews were performed. Interviews were conducted shortly (0–10 days) after a fall. Subjects: In all, 67 informants who had reported at least one fall during the previous three-month period and who used a walking aid participated. Results: A total of 57 (85%) informants fell at least once during eight months resulting in 115 falls; 90 (78%) falls happened indoors, most commonly in the kitchen (n = 20; 17%) or bathroom (n = 16; 14%). Informants fell during everyday activities and walking aids had been used in more than a third of the reported falls. The falls were influenced of both intrinsic and extrinsic factors. Two categories emerged from the analysis: ‘activities when falling’ and ‘influencing factors’. The category contained three (basic activities of daily living, instrumental activities of daily living and leisure and work) and six (multiple sclerosis–related symptoms, fluctuating body symptoms, being distracted, losing body control, challenging surrounding and involvement of walking aid) subcategories, respectively. Conclusion: The majority of falls occurs indoors and in daily activities. Several factors interacted in fall situations and should be monitored and considered to reduce the gap between the person’s capacity and the environmental demands that cause fall risk. Fluctuation of bodily symptoms between and within a day is a variable not earlier targeted in multiple sclerosis fall risk research.
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Affiliation(s)
- Anna Carling
- 1 University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,2 Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anette Forsberg
- 2 Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ylva Nilsagård
- 3 Health Care Management, Region Örebro County, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Nilsagård Y, Carling A, Davidsson O, Franzén L, Forsberg A. Comparison of trunk impairment scale versions 1.0 and 2.0 in people with multiple sclerosis: A validation study. Physiother Theory Pract 2017; 33:772-779. [PMID: 28715271 DOI: 10.1080/09593985.2017.1346025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Trunk control impairment often accompanies multiple sclerosis (MS). Trunk stability is necessary for movements of extremities, as are selective trunk movements for normal gait. Measuring trunk function is thus of interest. METHODS We examined the relationships between the Trunk Impairment Scale (TIS1.0 and TIS2.0) and the Berg Balance Scale (BBS), 5 sit-to-stand test (5STS), Timed Up and Go test (TUG), 10-m timed walk test (10TW), 2-min walk test (2MWT), Falls Efficacy Scale - International, and 12-item MS Walking Scale (MSWS-12) in 47 outpatients. We determined construct validity by calculating the degree to which the TIS versions produced different scores between known groups: use or nonuse of walking aid, MS disability status, and whether participants experienced a fall or not during 14 weeks. RESULTS TIS correlated moderately with BBS and 5STS; moderately (TIS1.0) or weakly (TIS2.0) with TUG, 10TW, and 2MWT; and weakly to moderately with MSWS-12 in subgroups with Expanded Disability Status Scale (EDSS) >6.0. No other clear correlation patterns were found. TIS did not discriminate between known groups. CONCLUSIONS TIS1.0 is recommended for individuals with MS (EDSS score 4.0-7.5). Better trunk function correlates with better balance and walking ability. TIS has limited value in fall risk screening.
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Affiliation(s)
- Ylva Nilsagård
- a Health Care Management, Faculty of Medicine and Health , University Health Care Research Center, Örebro University , Örebro , Sweden
| | - Anna Carling
- b Department of Physiotherapy, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | | | | | - Anette Forsberg
- a Health Care Management, Faculty of Medicine and Health , University Health Care Research Center, Örebro University , Örebro , Sweden
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18
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Almgren M, Lundmark M, Lennerling A, Forsberg A. Chronic Pain One and Four Years After Heart Transplantation - A Multicentre Study. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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19
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Lundmark M, Claëson M, Almgren M, Forsberg A. Symptom Prevalence and Symptom Distress One to Five Years After Lung Transplantation - A Multicentre Study. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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20
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Forsberg A, Claëson M, Lundmark M, Almgren M, Lennerling A. Chronic Pain One to Five Years After Lung Transplantation - A Multicentre Study. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Lundmark M, Claëson M, Almgren M, Forsberg A. Fear of Graft Rejection and Psychological Distress One to Five Years After Lung Transplantation - A Multicentre Study. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Forsberg A, Andreasson M, Nilsagård Y. The Functional Gait Assessment in People with Multiple Sclerosis: Validity and Sensitivity to Change. Int J MS Care 2017; 19:66-72. [PMID: 32607064 DOI: 10.7224/1537-2073.2015-061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Assessments of balance and walking are often performed in rehabilitation of people with multiple sclerosis (MS). The Functional Gait Assessment (FGA) is a test of walking balance including challenging items such as walking with a narrow base of support, with eyes closed, and backward. The aim was to investigate the validity (concurrent, discriminant, and known-groups) and sensitivity to change of the modified FGA in ambulatory individuals with MS. Methods A convenience sample of 87 individuals with MS was included (mean age, 54 years; 79% women). Concurrent and discriminant validity was investigated using tests of dynamic balance and the Multiple Sclerosis Walking Scale and Multiple Sclerosis Impact Scale (MSIS). Known-groups validity was investigated with self-reported number of falls and use of walking devices. Sensitivity to change was investigated with data from a group balance training study. Results The median FGA score was 15 (range, 1-26). Concurrent validity with tests of dynamic balance was moderate to strong, with the Timed Up and Go test having the highest correlation coefficient (rho = -0.74). Discriminant validity was shown with a low correlation coefficient with the MSIS psychological subscale (rho = 0.14). The FGA scores differed significantly for users of walking devices versus nonusers but not for reported falls. Sensitivity to change was moderate to low. Conclusions The FGA is a valid measure of balance during walking in people with MS, but further investigation is required for the ability to detect people at risk for falls.
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Carling A, Forsberg A, Gunnarsson M, Nilsagård Y. CoDuSe group exercise programme improves balance and reduces falls in people with multiple sclerosis: A multi-centre, randomized, controlled pilot study. Mult Scler 2016; 23:1394-1404. [PMID: 27834736 PMCID: PMC5564949 DOI: 10.1177/1352458516677591] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Imbalance leading to falls is common in people with multiple sclerosis (PwMS). Objective: To evaluate the effects of a balance group exercise programme (CoDuSe) on balance and walking in PwMS (Expanded Disability Status Scale, 4.0–7.5). Methods: A multi-centre, randomized, controlled single-blinded pilot study with random allocation to early or late start of exercise, with the latter group serving as control group for the physical function measures. In total, 14 supervised 60-minute exercise sessions were delivered over 7 weeks. Pretest–posttest analyses were conducted for self-reported near falls and falls in the group starting late. Primary outcome was Berg Balance Scale (BBS). A total of 51 participants were initially enrolled; three were lost to follow-up. Results: Post-intervention, the exercise group showed statistically significant improvement (p = 0.015) in BBS and borderline significant improvement in MS Walking Scale (p = 0.051), both with large effect sizes (3.66; −2.89). No other significant differences were found between groups. In the group starting late, numbers of falls and near falls were statistically significantly reduced after exercise compared to before (p < 0.001; p < 0.004). Conclusion: This pilot study suggests that the CoDuSe exercise improved balance and reduced perceived walking limitations, compared to no exercise. The intervention reduced falls and near falls frequency.
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Affiliation(s)
- Anna Carling
- University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden/Department of Physiotherapy, School of Medical Sciences, Örebro University, Örebro University Hospital, Örebro, Sweden
| | - Anette Forsberg
- University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Martin Gunnarsson
- Department of Neurology, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ylva Nilsagård
- University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Winberg C, Palmer M, Henriksson H, Wideen I, Forsberg A, Lenne R. The physiotherapist's role in lifestyle changes in persons with stroke and TIA – forming a knowledge base for primary care. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Forsberg A, Press R, Einarsson U, de Pedro-Cuesta J, Holmqvist LW. Disability and health-related quality of life in Guillain-Barré syndrome during the first two years after onset: a prospective study. Clin Rehabil 2016; 19:900-9. [PMID: 16323390 DOI: 10.1191/0269215505cr918oa] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To describe changes in disability and health-related quality of life in patients with Guillain-Barré syndrome in Sweden during the first two years after onset. Subjects: Forty-four patients were recruited from eight different hospitals, and 42 of them (mean age 52 years) were followed for two years. Evaluations were performed, primarily as home visits, at two weeks, two months, six months, one year and two years after onset. Main measures: Disability was measured using the Katz Personal and Extended Activities of Daily Living Indexes, the Barthel Index, the Frenchay Activity Index and assessments of work capacity; health-related quality of life using the Sickness Impact Profile. Results: At two weeks, one year and two years after onset of Guillain-Barrésyndrome, 76%, 14% and 12% of patients were dependent in personal activities of daily life (ADL); and 98%, 28% and 26% were dependent in instrumental ADL. At two weeks, all of the patients that were working before onset were unable to work owing to Guillain-Barré syndrome; at two years, 17% were unable to work. At two weeks, scores on Sickness Impact Profile were elevated in all dimensions; at two years, they remained elevated in the physical dimension and in the categories home management, work and recreation and pastimes. Conclusions: The impact of Guillain-Barré syndrome on ADL, work, social activities and health-related quality is considerable two years after onset and presumably persists beyond this time point.
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Affiliation(s)
- Anette Forsberg
- Centre for Rehabilitation Research, Orebro and Division of Physiotherapy, Neurotec Department, Karolinska Institutet, Stockholm, Sweden.
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Lorin K, Forsberg A. Treatment with botulinum toxin in children with cerebral palsy: a qualitative study of parents' experiences. Child Care Health Dev 2016; 42:494-503. [PMID: 27198886 DOI: 10.1111/cch.12350] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 03/30/2016] [Accepted: 04/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND In children with cerebral palsy everyday movements such as walking, standing and using one's hands can be difficult to perform because of spasticity. Botulinum neurotoxin type A (BoNT-A) are often used to reduce spasticity. The aim of this study was to describe how parents of children with cerebral palsy experienced the child's treatment with BoNT-A, how the child was affected by the treatment and how spasticity affected the child. METHODS A qualitative study in which 15 parents of children (6-13 years old) with cerebral palsy were interviewed about their experiences of the BoNT-A treatment. The children had received several BoNT-A treatments. An interview guide was used with topics: the child's functions before and after the treatment, the outcomes of the treatment and how they valued the BoNT-A treatment. Content analysis was used to analyse the interviews. RESULTS The analyses resulted in two themes: 'When softness comes and goes' and 'Both want and do not want'. The reduction of spasticity - softness - was described to promote motor functions, and facilitate the next step in motor development. The children were described as being more active out of their own initiative and having a happier mood. Spasticity, described as stiffness, was described to make walking more strenuous as well as interfering with activities. The BoNT-A injection procedure was perceived as troublesome and painful for the child, and sometimes traumatic for both children and parents. CONCLUSIONS Treatment with BoNT-A was described as facilitating motor development and activity. The children's and the parents' negative experiences of the injection procedure should be addressed.
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Affiliation(s)
- K Lorin
- Child and Youth Habilitation Centre, Region Örebro County, Örebro, Sweden
| | - A Forsberg
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Lindvall MA, Anderzén Carlsson A, Forsberg A. Basic Body Awareness Therapy for patients with stroke: Experiences among participating patients and physiotherapists. J Bodyw Mov Ther 2016; 20:83-89. [PMID: 26891641 DOI: 10.1016/j.jbmt.2015.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/17/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND After a stroke many patients have muscle weakness, spasticity and compromised sensation leading to decreased postural stability. Basic Body Awareness Therapy includes slow movements that challenge postural control. AIM The aim was to describe experiences of 8 weeks of Basic Body Awareness Therapy from the perspective of both patients with stroke and physiotherapists. METHOD This study had a qualitative design. Twenty-one patients and four physiotherapists were interviewed. The interviews were analysed using manifest and latent content analysis. RESULTS One overall theme emerged "Simple yet challenging" which was based on six categories: "Facing one's limitations", "Individualized movements", "A feeling of harmony", "Improved balance", "Integrated knowledge" and "Frustration and doubt". The patients described improvement in balance and stability, as well as increased wellbeing. CONCLUSION The patients and physiotherapists related that Basic Body Awareness Therapy challenges balance but also provides an opportunity to reflect on the body.
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Affiliation(s)
- Mialinn Arvidsson Lindvall
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Agneta Anderzén Carlsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anette Forsberg
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Collste K, Forsberg A, Varrone A, Amini N, Aeinehband S, Yakushev I, Halldin C, Farde L, Cervenka S. Test-retest reproducibility of [(11)C]PBR28 binding to TSPO in healthy control subjects. Eur J Nucl Med Mol Imaging 2015; 43:173-183. [PMID: 26293827 DOI: 10.1007/s00259-015-3149-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/20/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The PET radioligand [(11)C]PBR28 binds to the translocator protein (TSPO), a marker of brain immune activation. We examined the reproducibility of [(11)C]PBR28 binding in healthy subjects with quantification on a regional and voxel-by-voxel basis. In addition, we performed a preliminary analysis of diurnal changes in TSPO availability. METHODS Twelve subjects were examined using a high-resolution research tomograph and [(11)C]PBR28, six in the morning and afternoon of the same day, and six in the morning on two separate days. Regional volumes of distribution (V T) were derived using a region-of-interest based two-tissue compartmental analysis (2TCM), as well as a parametric approach. Metabolite-corrected arterial plasma was used as input function. RESULTS For the whole sample, the mean absolute variability in V T in the grey matter (GM) was 18.3 ± 12.7 %. Intraclass correlation coefficients in GM regions ranged from 0.90 to 0.94. Reducing the time of analysis from 91 to 63 min yielded a variability of 16.9 ± 14.9 %. There was a strong correlation between the parametric and 2TCM-derived GM values (r = 0.99). A significant increase in GM V T was observed between the morning and afternoon examinations when using secondary methods of quantification (p = 0.028). In the subjects examined at the same time of the day, the absolute variability was 15.9 ± 12.2 % for the 91-min 2TCM data. CONCLUSION V T of [(11)C]PBR28 binding showed medium reproducibility and high reliability in GM regions. Our findings support the use of parametric approaches for determining [(11)C]PBR28 V T values, and indicate that the acquisition time could be shortened. Diurnal changes in TSPO binding in the brain may be a potential confounder in clinical studies and should be investigated further.
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Affiliation(s)
- K Collste
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
| | - A Forsberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - A Varrone
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - N Amini
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - S Aeinehband
- Department of Clinical Neuroscience, Neuroimmunology Unit, Karolinska Institutet, Stockholm, Sweden
| | - I Yakushev
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Department of Nuclear Medicine and TUM Neuroimaging Center (TUM-NIC), Technische Universität München, Munich, Germany
| | - C Halldin
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - L Farde
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - S Cervenka
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
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Arvidsson Lindvalll M, Anderzén Carlsson A, Forsberg A. Body awareness therapy in persons with stroke: experiences among patients and physiotherapists. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Elisabet Nilsagård Y, Forsberg A. Practicability and Sensitivity to Change of the Activities-specific Balance Confidence Scale and 12-Item Walking Scale for Stroke. Top Stroke Rehabil 2015; 19:13-22. [DOI: 10.1310/tsr1901-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
PURPOSE The reliability of the Modified Rivermead Mobility Index (MRMI) has not previously been investigated in the very early post-stroke phase. The aim of the study was to evaluate inter-rater and intra-rater reliability and internal consistency in patients, 1-14 d post-stroke. METHOD A cohort study with repeated measures within 24 h, on 37 patients, 1-14 d post-stroke was conducted. Inter-rater (two raters) and intra-rater (one rater) reliability was analyzed using weighted kappa (κ) statistics and internal consistency with Cronbach's alpha and intra-class correlation (ICC), 3.k. RESULTS Inter-rater and intra-rater reliability was excellent (ICC coefficient 0.97 and 0.99) for MRMI summary score. Intra-rater exact agreement for separate items was between 77% and 97%; κ between 0.81 and 0.96. Inter-rater exact agreement for separate items was between 68% and 92%; κ 0.59-0.87. The internal consistency was high (α 0.96; ICC 3.k 0.99). CONCLUSION The MRMI is a reliable measure of physical mobility in the early post-stroke phase.
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Affiliation(s)
- Lisa Rådman
- Department of Physiotherapy, Örebro University Hospital , Örebro , Sweden
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Forsberg A, Widén-Holmqvist L, Ahlström G. Balancing everyday life two years after falling ill with Guillain-Barré syndrome: a qualitative study. Clin Rehabil 2014; 29:601-10. [DOI: 10.1177/0269215514549564] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 08/09/2014] [Indexed: 11/16/2022]
Abstract
Purpose: The aim was to describe experiences of disability in everyday life and managing the recovery process two years after falling ill with Guillain-Barré syndrome. Design: Qualitative interview study. Methods: Interviews were conducted with 35 persons (22 male, mean age 50 years) two years after the onset of Guillain-Barré syndrome. The interviews were transcribed verbatim and analysed using content analysis. Results: The analysis revealed four categories and an overall theme: ‘Striving for balance in everyday life’. The participants described persistent lived body restrictions that affected their arms, legs, and face. Bodily symptoms and loss of energy limited or restricted many everyday activities. In connection with healthcare, both satisfaction and feeling vulnerable in a critical situation were described. Experiences of the recovery process varied. The participants described acceptance and reappraisal of a new life situation despite their limitations, and having gained the knowledge that life can change suddenly. However, they also expressed disappointment following an overly positive prognosis in the early stages, and over a continuous wait for recovery. For some participants life had returned to as before. Conclusion: The participants experienced limitations in everyday life and decreased functioning in several parts of the body. The recovery process may still be ongoing two years after onset. Rehabilitation intervention with an extended focus on supporting individualized coping processes could facilitate ways to live with persistent disability.
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Affiliation(s)
- Anette Forsberg
- Division of Neurology, Karolinska Institutet, Stockholm, Sweden
- Family Medicine Research Centre, Örebro County Council, Örebro, Sweden
| | - Lotta Widén-Holmqvist
- Division of Neurology, Karolinska Institutet, Stockholm, Sweden
- Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Lund University, Lund, Sweden
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Nilsagård Y, Kollén L, Axelsson H, Bjerlemo B, Forsberg A. Functional gait assessment: Reliability and validity in people with peripheral vestibular disorders. International Journal of Therapy and Rehabilitation 2014. [DOI: 10.12968/ijtr.2014.21.8.367] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ylva Nilsagård
- Research supervisor and physiotherapist at the Centre for Health Care Sciences, Orebro County Council and a lecturer at the School of Health and Medical Sciences, Orebro University
| | - Lena Kollén
- Research supervisor and a physiotherapist at the Physiotherapy Department, Sahlgrenska University Hospital, Gothenburg
| | - Hans Axelsson
- Physiotherapist at the Audiological clinic, Habilitation and Assistive Devices, Orebro County Council
| | - Berit Bjerlemo
- Physiotherapist at the Physiotherapy Department, Sahlgrenska University Hospital, Gothenburg
| | - Anette Forsberg
- Research supervisor and physiotherapist at the Family Medicine Research Centre, Orebro County Council, Sweden School of Health and a lecturer at the School of Medical Sciences, Sweden
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Forsberg A, Nilsagård Y, Boström K. Perceptions of using videogames in rehabilitation: a dual perspective of people with multiple sclerosis and physiotherapists. Disabil Rehabil 2014; 37:338-44. [PMID: 24833535 PMCID: PMC4364246 DOI: 10.3109/09638288.2014.918196] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: Our aim was to describe experiences of using Nintendo Wii Fit™ for balance exercise, from the perspectives of patients with multiple sclerosis (MS) and their physiotherapists (PT). Methods: Individual interviews with 15 patients with MS were conducted, recruited from a multi-centre study investigating the effects of balance exercising using Wii Fit. We also conducted a single focus group interview with nine PT involved in the study. The interviews were audio-recorded, transcribed, and analysed using content analysis. Results: Both patients and PT said that exercising with Wii Fit games was fun, and that it challenged the patients' physical and cognitive capacities. The competitive content in the games provided motivation to continue playing. Patients and PT reported improved body control and, more importantly, positive effects on balance and walking in daily life. The PT regarded Wii training as an effective alternative to other balance training, but some felt unsure in how to manage the video game. The patients regarded Wii training as a possible home training solution. Conclusions: Patients with MS and their PT considered Wii Fit exercises to be fun, challenging, and self-motivating. Exercising with Wii games can address balance impairments in MS, and can be performed at home as well as in rehabilitation settings. Implications for Rehabilitation Nintendo Wii Fit™ can be used as a fun and challenging way to perform balance exercises. The competitive content embedded in the games triggers continued playing and exercising. The positive effect on balance control can improve standing and walking in everyday activities.
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Affiliation(s)
- Anette Forsberg
- Family Medicine Research Centre, Örebro County Council , Örebro , Sweden
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Abstract
OBJECTIVE To investigate the effects of body awareness therapy on balance, mobility, balance confidence, and subjective health status in persons with stroke. DESIGN A pilot randomized controlled study with follow-up at one and 4-6 weeks after the intervention period. SETTING Four primary healthcare centres in Örebro County Council. SUBJECTS Persons more than six months post stroke, with walking ability of 100 metres. INTERVENTION The experimental intervention was body awareness therapy in groups once a week for eight weeks. The controls were instructed to continue their usual daily activities. MAIN MEASURES Berg Balance Scale, Timed Up and Go Test, Timed Up and Go Test with a cognitive component, 6-minute walk test, and Timed-Stands Test. Self-rated balance confidence was assessed using the Activities-specific Balance Confidence Scale, and subjective health status using the Short Form 36 (SF-36) questionnaire. RESULTS A total of 46 participants were included (mean age 64 years); 24 in the experimental intervention group and 22 in the control group. No significant differences in changed scores over time were found between the groups. Within the experimental intervention group, significant improvements over time was found for the tests Berg Balance Scale, Timed Up and Go cognitive, and 6-minute walk test. Within the control group, significant improvements over time were found for the Timed Up and Go Cognitive, and the Timed-Stands Test. CONCLUSION In comparison to no intervention, no effects were seen on balance, mobility, balance confidence, and subjective health status after eight weeks of body awareness therapy.
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Affiliation(s)
- Mialinn A Lindvall
- Family Medicine Research Centre, Örebro County Council, Örebro, Sweden School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Anette Forsberg
- Family Medicine Research Centre, Örebro County Council, Örebro, Sweden School of Health and Medical Sciences, Örebro University, Örebro, Sweden
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Tholin H, Forsberg A. Satisfaction with care and rehabilitation among people with stroke, from hospital to community care. Scand J Caring Sci 2014; 28:822-9. [DOI: 10.1111/scs.12116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/28/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Helena Tholin
- Family Medicine Research Centre; Örebro County Council; Örebro Sweden
- Karla Primary Health Centre; Örebro County Council; Örebro Sweden
| | - Anette Forsberg
- Family Medicine Research Centre; Örebro County Council; Örebro Sweden
- School for Health and Medical Sciences; Örebro University; Örebro Sweden
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Forsberg A, Nilsagård Y. Validity and Reliability of the Swedish Version of the Activities-specific Balance Confidence Scale in People with Chronic Stroke. Physiother Can 2014; 65:141-7. [PMID: 24403675 DOI: 10.3138/ptc.2011-54] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the validity and reliability of the Swedish version of the Activities-specific Balance Confidence (ABC) scale in people >1 year after stroke. METHOD In a multi-centre study design, using initial cross-sectional data collection with follow-up, the timed up-and-go (TUG) test, 10 m timed walk (10TW), and 6-Minute Walk Test (6MWT) were performed; ABC scale and Short Form 36 Health Survey (SF-36) were completed; and falls history data were collected during one session. One week later, the ABC scale was sent to participants for a second rating. Spearman correlation coefficients were calculated, and reliability was assessed via the intra-class correlation coefficient (ICC) and Cronbach alpha. RESULTS A convenience sample of 67 people was included (mean age 68 y). The median score for the ABC scale changed from 57 at the first rating to 43 at the second; 19 participants (28%) reported falls during the previous 3 months. Scores on the ABC scale were moderately correlated with the TUG (r=-0.48), 10TW (r=-0.52), 6MWT (r=0.45), and SF-36 physical component summary score (r=0.43). Internal consistency was high for the ABC scale at test and retest (α=0.95-0.97). The ICC was 0.82 (95% CI, 0.72-0.88). CONCLUSIONS The Swedish version of the ABC scale is a valid and reliable measure for investigating balance confidence in people >1 year after stroke.
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Affiliation(s)
| | - Ylva Nilsagård
- Centre for Health Care Sciences, Örebro University Hospital ; School of Health and Medical Sciences, Örebro University, Örebro, Sweden
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Fridlund B, Jönsson AC, Andersson EK, Bala SV, Dahlman GB, Forsberg A, Glasdam S, Hommel A, Kristensson A, Lindberg C, Sivberg B, Sjöström-Strand A, Wihlborg J, Samuelson K. Essentials of Nursing Care in Randomized Controlled Trials of Nurse-Led Interventions in Somatic Care: A Systematic Review. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojn.2014.43023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Paul G, Zachrisson O, Varrone A, Almqvist P, Jerling M, Lindh G, Rehncrona S, Linderoth B, Bjartmarz H, Svensson M, Mercer KJ, Forsberg A, Shafer L, Lang AJ, Halldin C, Svenningsson P, Widner H, Frisen J, Pålhagen S, Haegerstrand A. Safety and efficacy of recombinant human platelet derived growth factor (Rhpdgf) in Parkinson's disease. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Forsberg A, Abrahamsson TR, Björkstén B, Jenmalm MC. Pre- and post-natalLactobacillus reuterisupplementation decreases allergen responsiveness in infancy. Clin Exp Allergy 2013; 43:434-42. [DOI: 10.1111/cea.12082] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/20/2012] [Accepted: 12/21/2012] [Indexed: 02/01/2023]
Affiliation(s)
- A. Forsberg
- Unit of Autoimmunity and Immune Regulation; Division of Clinical Immunology; Department of Clinical and Experimental Medicine; Linköping University; Sweden
| | - T. R. Abrahamsson
- Division of Pediatrics; Department of Clinical and Experimental Medicine; Linköping University; Sweden
| | | | - M. C. Jenmalm
- Unit of Autoimmunity and Immune Regulation; Division of Clinical Immunology; Department of Clinical and Experimental Medicine; Linköping University; Sweden
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Abrahamsson TR, Sandberg Abelius M, Forsberg A, Björkstén B, Jenmalm MC. A Th1/Th2-associated chemokine imbalance during infancy in children developing eczema, wheeze and sensitization. Clin Exp Allergy 2011; 41:1729-39. [PMID: 21801246 DOI: 10.1111/j.1365-2222.2011.03827.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Analyses of circulating chemokines offer novel tools to investigate the T helper (Th)1/Th2 imbalance in allergic disease in vivo. OBJECTIVE To relate circulating Th1- and Th2-associated chemokines in infancy to allergic disease, sensitization and probiotic supplementation. METHODS Circulating levels of Th1-associated CXC-chemokine ligand (CXCL)9, CXCL10 and CXCL11 and Th2-associated CC-chemokine ligand (CCL)17 and CCL22 were assessed with Luminex and CCL18 with enzyme-linked immunosorbent assay at birth (n=109), 6 (n=104), 12 (n=116) and 24 months (n=123) in 161 infants completing a double-blind placebo-controlled allergy prevention trial with Lactobacillus reuteri during the last month of gestation and through the first year of life. The infants were followed regarding the development of allergic disease and sensitization until 2 years of age. RESULTS The Th2-associated chemokines CCL17 and CCL22 were the highest at birth and then decreased, whereas CCL18 and the Th1-associated chemokines increased with age. High Th2-associated chemokine levels were observed in children developing allergic disease. Sensitization was preceded by elevated levels of the Th2-associated CCL22 and reduced levels of the Th1-associated CXCL11 already at birth. The Th2-associated CCL17 was also elevated at birth in infants developing recurrent wheeze. A high Th2/Th1 ratio (CCL22/CXCL10) at birth associated with both sensitization and eczema development. The presence of L. reuteri in stool in the first week of life was associated with low CCL17 and CCL22 and high CXCL11 levels at 6 months of age. High Th1-associated chemokine levels were associated with day-care. CONCLUSION AND CLINICAL RELEVANCE Allergic disease and sensitization in infancy was associated with low circulating Th1- and high Th2-associated chemokine levels already from birth. Circulating chemokines are useful for investigating the Th1/Th2 imbalance in allergic disease in vivo. Elucidation of the role of chemokines in allergic diseases may lead to future treatments (ClinicalTrials.gov NCT01285830).
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Affiliation(s)
- T R Abrahamsson
- Department of Clinical and Experimental Medicine, Division of Pediatrics, Linköping University, Linköping, Sweden.
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Ernerudh J, Forsberg A, Straka E, Johansson E, Mehta R, Svensson J, Matthiesen L, Boij R, Berg G, Mjösberg J, Jenmalm M. T helper cells and T helper cell plasticity in pregnancy. J Reprod Immunol 2011. [DOI: 10.1016/j.jri.2011.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Forsberg A, Straka E, Johansson E, Mehta R, Berg G, Jenmalm M, Mjösberg J, Ernerudh J. Plasticity and flexibility of T cells in human pregnancy. J Reprod Immunol 2011. [DOI: 10.1016/j.jri.2011.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zhou ZY, Wu J, Baker J, Curtis R, Forsberg A, Huszti H, Koerper M, Lou M, Miller R, Parish K, Riske B, Shapiro A, Ullman M, Johnson K. Haemophilia utilization group study - Part Va (HUGS Va): design, methods and baseline data. Haemophilia 2011; 17:729-36. [PMID: 21689212 DOI: 10.1111/j.1365-2516.2011.02595.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
To describe the study design, procedures and baseline characteristics of the Haemophilia Utilization Group Study - Part Va (HUGS Va), a US multi-center observational study evaluating the cost of care and burden of illness in persons with factor VIII deficiency. Patients with factor VIII level ≤ 30%, age 2-64 years, receiving treatment at one of six federally supported haemophilia treatment centres (HTCs) were enrolled in the study. Participants completed an initial interview including questions on socio-demographical characteristics, health insurance status, co-morbidities, access to care, haemophilia treatment regimen, factor utilization, self-reported joint pain and motion limitation and health-related quality of life. A periodic follow-up survey collected data regarding time lost from usual activities, disability days, health care utilization and outcomes of care. HTC clinicians documented participants' baseline clinical characteristics and pharmacy dispensing records for 2 years. Between July 2005 and July 2007, 329 participants were enrolled. Average age was 9.7 years for children and 33.5 years for adults; two-thirds had severe haemophilia. The distributions of age, marital status, education level and barriers to haemophilia care were relatively consistent across haemophilic severity categories. Differences were found in participants' employment status, insurance status and income. Overall, children with haemophilia had quality of life scores comparable to healthy counterparts. Adults had significantly lower physical functioning than the general US population. As one of the largest economic studies of haemophilia care, HUGS Va will provide detailed information regarding the burden of illness and health care utilization in the US haemophilia A population.
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Affiliation(s)
- Z-Y Zhou
- University of Southern California, Los Angeles, CA, USA
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Ledenius K, Stålhammar F, Wiklund LM, Fredriksson C, Forsberg A, Thilander-Klang A. Evaluation of image-enhanced paediatric computed tomography brain examinations. Radiat Prot Dosimetry 2010; 139:287-292. [PMID: 20382975 DOI: 10.1093/rpd/ncq097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The aim of this study was to evaluate the possibility of reducing the radiation dose to paediatric patients undergoing computed tomography (CT) brain examination by using image-enhancing software. Artificial noise was added to the raw data collected from 20 patients aged between 1 and 10 y to simulate tube current reductions of 20, 40 and 60 mA. All images were created in duplicate; one set of images remained unprocessed whereas the other was processed with image-enhancing software. Three paediatric radiologists assessed the image quality based on their ability to visualise the high- and low-contrast structures and their overall impression of the diagnostic value of the image. For patients aged 6-10 y, it was found that dose reductions from 27 mGy (CTDI(vol)) to 23 mGy (15 %) in the upper brain and from 32 to 28 mGy (13 %) in the lower brain were possible for standard diagnostic CT examinations when using the image-enhancing filter. For patients 1-5 y, the results for standard diagnostics in the upper brain were inconclusive, for the lower brain no dose reductions were found possible.
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Affiliation(s)
- K Ledenius
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Karlsson V, Forsberg A, Bergbom I. Relatives’ experiences of visiting a conscious, mechanically ventilated patient—A hermeneutic study. Intensive Crit Care Nurs 2010; 26:91-100. [DOI: 10.1016/j.iccn.2009.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 12/04/2009] [Accepted: 12/05/2009] [Indexed: 11/16/2022]
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Forsberg A, Almkvist O, Engler H, Wall A, Langstrom B, Nordberg A. High PIB Retention in Alzheimers Disease is an Early Event with Complex Relationship with CSF Biomarkers and Functional Parameters. Curr Alzheimer Res 2010; 7:56-66. [DOI: 10.2174/156720510790274446] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 08/11/2009] [Indexed: 11/22/2022]
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Westblad ME, Forsberg A, Press R. Disability and health status in patients with chronic inflammatory demyelinating polyneuropathy. Disabil Rehabil 2009; 31:720-5. [DOI: 10.1080/09638280802306497] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hammer A, Nilsagård Y, Forsberg A, Pepa H, Skargren E, Oberg B. Evaluation of therapeutic riding (Sweden)/hippotherapy (United States). A single-subject experimental design study replicated in eleven patients with multiple sclerosis. Physiother Theory Pract 2009; 21:51-77. [PMID: 16385943 DOI: 10.1080/09593980590911525] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to investigate whether therapeutic riding (TR, Sweden) hippotherapy (HT, United States) may affect balance, gait, spasticity, functional strength, coordination, pain, self-rated level of muscle tension (SRLMT), activities of daily living (ADL), and health-related quality of life. Eleven patients with multiple sclerosis (MS) were studied in a single-subject experimental design iSSED) study, type A-B-A. The intervention comprised ten weekly TR/HT sessions of 30 minutes each. The subjects were measured a maximum of 13 times. Physical tests were: the Berg balance scale, talking a figure of eight, the timed up and go test, 10 m walking, the modified Ashworth scale, the Index of Muscle Function, the Birgitta Lindmark motor assessment, part B, and individual measurements. Self-rated measures were. the Visual Analog Scale for pain, a scale for SRLMT, the Patient-Specific Functional Scale for ADL, and the SF-36. Data were analyzed visually, semi-statistically and considering clinical significance. Results showed improvement for ten subjects in one or more of the variables, particularly balance, and some improvements were also seen in pain, muscle tension, and ADL. Changes in SF-36 were mostly positive, with an improvement in Role-Emotional seen in eight patients. Conclusively, balance and Role-Emotional were the variables most often improved, but TR/HT appeared to benefit the subjects differently.
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Affiliation(s)
- Ann Hammer
- Department of Rehabilitation Medicine, Orebro University Hospital, S-701 85 Orebro, Sweden.
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Forsberg A, Ahlström G, Holmqvist LW. Falling ill with Guillain-Barré syndrome: patients’ experiences during the initial phase. Scand J Caring Sci 2008; 22:220-6. [DOI: 10.1111/j.1471-6712.2007.00517.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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