Background: Balance Body Tape (BBT) is a recently developed taping-method with the aim to reduce pain and improve posture through change in movement behavior. However, the potential effects of a treatment with BBT are scarcely documented. Therefore, the aim with this study was to investigate the effect of a three-week Balance body tape-treatment on the intensity of perceived neck, shoulder and back pain and forward head posture.

Methods: In this RCT study, subjects (n = 26), who reported being university students or having a sedentary work and experiencing pain in neck, back or shoulders, were randomized to either an intervention (n = 12) or control group (n = 14). The intervention group received a three-week treatment with BBT, the control group received no treatment. A questionnaire regarding pain, including a Numeric Rating Scale (NRS) measuring pain intensity, and a Photographic posture analysis measurement (PPAM) regarding the craniovertebral (CV) angle were assessed before and after the intervention for both groups. Wilcoxon’s signed rank test and Mann-Whitney U test was used to assess intra- and between group differences respectively. The relationship between pain intensity and CV angle was assessed using Spearman’s correlation.

Results: No difference in demographic and physical characteristics between the groups were noted at baseline (p > 0.05). Pain intensity at baseline was 5 for the intervention group and 4 for the control group (p = 0.330). At follow up, the intervention group reported a lower score (NRS = 2.5, p = 0.003) whereas the control group had no significant difference in pain intensity (NRS = 3, p = 0.086). No significant change was found in the CV angle (p = 0.058) and no correlation was found between NRS and the CV angle (r = 0.102, p = 0.619).

Conclusion: A short treatment period with BBT may, compared to no treatment, have a small reducing effect on pain intensity in neck, back and/or shoulders. However, no effect was found on forward head posture in this study.

Trial registration: Registered retrospectively on 08/11/2021. NCT05111704. © 2022, The Author(s).

Objective: To assess function using the Signals of Functional Impairment (SOFI) instrument over 8 years, to study clinical variables associated with the change, and to study change over time of the SOFI items.

Methods: In total, 1,223 patients with early rheumatoid arthritis (RA) from the Better Anti-Rheumatic Farmacotherapy (BARFOT) cohort (mean ± SD age 56.9 ± 15.4 years, 67% women) were included in the analysis. Data from baseline and from 1 and 8 years were studied. The SOFI instrument includes measures of range of motion in the hand, shoulder/arm, and lower extremity (range 0–44, best to worst). The effects of baseline variables (sociodemographic, disease activity, joint destruction, and function) on change in SOFI scores were studied by linear regression analysis.

Results: During the first year, the improvement in mean ± SD SOFI scores was 2.7 ± 5.7 (P < 0.001). Worse scores in the Disease Activity Score in 28 joints and Health Assessment Questionnaire score at baseline were associated with this improvement (r² <= 0.11). During the next 7 years, the deterioration in SOFI scores was mean ± SD 1.5 ± 4.9 (P < 0.001). Based on change scores, we found that finger flexion, pincer grip, and toe-standing were the most important items to measure, explaining 58-61% of the total SOFI score, and these items were also associated with radiographic changes at the 8-year follow-up.

Conclusion: Function as assessed with SOFI scores improved during the first year in patients with early RA, but it deteriorated slowly thereafter. Impaired hand and foot function was associated with joint destruction at the 8-year follow-up. Measures of hand and foot function will complement self-reported and medical data, both in clinical work and in long-term research studies. Copyright © 2019, Emerald Publishing Limited

Background Hand function measured as grip force and finger extension force is often impaired in patients with rheumatoid arthritis (RA) and hand osteoarthritis (HOA) affecting performance of daily activities why hand exercises are recommended. A number of hand exercises are often used in the clinic but there is little information about “the effects of a minimal set of hand exercises” and if the choice of exercises is important to improve strength and function in the hand.

Objectives To study the effect on grip- and finger extension strength and patient reported hand function from two different sets of handexercises performed over 8 weeks using a randomized study design.

Methods Female patients with arthritis (RA and HOA, n=121) were randomly assigned to two different sets of handexercises (HE) for 8 weeks. The four hand exercises applied in the program were exercises commonly used in traditional hand training programs. The exercises were split into two groups depending on if the muscle activation (measured with EMG) were greater in forearm flexor (HE I, n=62) or in extensor muscles (HE II, n=59) (REF). HE I: isolated finger opposition (digits II-V) and rolling the putty with a flat hand, HE II: squeezing the putty and finger extension with putty resistance. The two HE were performed daily and each set was repeated 15 times, training time per day was maximum 5 minutes 7 days/week.

Grip strength was measured with Grippit and finger extension strength with EX-it both validated instruments (unit: N). Pain was measured with a Visual Analogue Scale (VAS), 0-10 (best to worst). Hand functions were evaluated with the patient reported questionnaire Quick Disability Arm Shoulder and Hand (QuickDASH), 0-100 (best to worst).

Results Mean grip strength (p=0.01) and mean finger extension force (p=0.004) increased after the training period in the group using HE I. In HE II the mean finger extension force increased (p=0.044), table 1. Hand function was stable over the training period.

Table 1.

Descriptive data of finger extension (EXIT) force and grip strength in the right hand, hand function (QuickDASH) and VAS pain presented as mean ± SD (min–max)

Conclusions Five daily minutes with two hand exercises resulted increased grip strength and finger extension force after eight weeks. We suggest that hand exercises should be combined and selected to improve both flexor and extensor muscle strength of the forearm.

Aims:

The overall aim of this thesis was to further our understanding of extensor muscles and their role for hand function.

The aims of the studies were:

To develop and evaluate a new device for finger extensor force measurements. To evaluate ultrasound as a tool for assessment of muscle architecture. To determine the correlation between extensor muscle force and hand function. To evaluate the degree of impaired finger extensor force in rheumatoid arthritis (RA) and the correlation to impaired... mer hand function. To analyse the effect of hand exercise in RA patients and healthy subjects with ultrasound and finger extension force measurements.

Method:

A new finger extension force measuring device was developed and an ultrasound based method was used to be able to objectively measure the finger extension force and analyze the static and dynamic extensor muscle architectures. Measurements were made of healthy volunteers (n=127) and RA patients (n=77) during uninfluenced and experimental conditions. A hand exercise program was performed and evaluated with hand force measurements, hand function test, patient relevant questionnaires (DASH and SF-36) and ultrasound measurements.

Results:

The new finger extension force measurement device was developed and then validated with measurements of accuracy as well as test-retest reliability. The coefficient of variation was 1.8 % of the applied load, and the test-retest reliability showed a coefficient of variation no more than 7.1% for healthy subjects. Ultrasound examination on m. extensor digitorum communis (EDC) showed significant differences between healthy men and healthy women as well as between healthy women and RA patients. The extension and flexion force improved in both groups after six weeks of hand exercise (p<0.01). Hand function improved in both groups (p<0.01). The RA group showed improvement in the results of the DASH questionnaire (p<0.05). The cross-sectional area of the EDC increased significantly in both groups.

Conclusions:

A new finger extension force measuring device has been developed which provides objective and reliable data on the extension force capacity of normal and dysfunctional hands and is sufficiently sensitive to evaluate the effects of hand exercise. US provide useful information about muscle architecture. A significant improvement of hand strength and hand function in RA patients was seen after six weeks of hand training, the improvement was even more pronounced after 12 weeks. Hand exercise is thus an effective intervention for RA patients, providing better strength and function.

OBJECTIVE:

To evaluate the effects of hand exercise in patients with rheumatoid arthritis, and to compare the results with healthy controls.

METHODS:

Forty women (20 patients with rheumatoid arthritis and 20 healthy controls) performed a hand exercise programme. The results were evaluated after 6 and 12 weeks with hand force measurements (with a finger extension force measurement device (EX-it) and finger flexion force measurement with Grippit). Hand function was evaluated with the Grip Ability Test (GAT) and with patient relevant questionnaires (Disability of the Arm, Shoulder, and Hand (DASH) and Short Form-36). Ultrasound measurements were performed on m. extensor digitorum communis for analysis of the muscle response to the exercise programme.

RESULTS:

The extension and flexion force improved in both groups after 6 weeks (p < 0.01). Hand function (GAT) also improved in both groups (p < 0.01). The rheumatoid arthritis group showed improvement in the results of the DASH questionnaire (p < 0.05). The cross-sectional area of the extensor digitorum communis increased significantly in both groups measured with ultrasound.

CONCLUSION:

A significant improvement in hand force and hand function in patients with rheumatoid arthritis was seen after 6 weeks of hand training; the improvement was even more pronounced after 12 weeks. Hand exercise is thus an effective intervention for rheumatoid arthritis patients, leading to better strength and function.

OBJECTIVE: Balance between flexor and extensor muscle activity is essential for optimal function. The purpose of this pilot study was to compare the relationship between maximum finger flexion force and maximum finger extension force in women with rheumatoid arthritis and healthy women.

METHODS: Twenty healthy women (median age 61 years) and 20 women with rheumatoid arthritis (median age 59.5 years, median disease duration 16.5 years) were included in the study. Finger extension force was measured with an electronic device, EX-it, and finger flexion force using Grippit. The Grip Ability Test and the score from the patient-reported outcome Disability Arm Shoulder and Hand were used to evaluate activity limitations.

RESULTS: Patients with rheumatoid arthritis showed significantly decreased hand function compared with healthy controls. A correlation was found between extension force and flexion force in the healthy group (r = 0.65, p = 0.002),but not in the rheumatoid arthritis group (r = 0.25, p = 0.289).

CONCLUSION: Impaired hand function appears to influence the relationship between maximum finger flexion and extension force. This study showed a difference in the relationship between maximum finger flexion and extension force in healthy controls and those with rheumatoid arthritis. © 2012 Foundation of Rehabilitation Information.

Although often neglected, finger extension force is of great importance for developing grip strength. This paper describes the design and evaluation of a new finger extension force measurement device (EX-it) based on the biomechanics of the hand. Measurement accuracy and test-retest reliability were analysed. The device allows measurements on single fingers as well as all the fingers (excluding the thumb) of both healthy and deformed hands. The coefficient of variation in the device was 1.8% of the applied load, and the test-retest reliability showed a coefficient of variation no more than 7.1% for healthy subjects. This study also provides reference values for finger extension force in healthy subjects and patients with rheumatoid arthritis (RA). Significant differences were found in extension strength between healthy subject and RA patients (men, p < 0.05 and women, p < 0.001). EX-it provides objective and reliable data on the extension force capacity of normal and dysfunctional hands and can be used to evaluate the outcome of therapeutic interventions after hand trauma or disease

Objective: To study the long-term effects of weight reduction, quality of life and sense of coherence in a primary health care (PHC)-based programme with two different intensities. Design: Prospective two-armed randomised intervention. Setting: Three PHC centres in south west of Sweden. Subjects: In total, 289 women and men aged 40-65 years with a BMI of 28-35 were recruited for a two-year weight-reduction programme. Participants were randomized to high-intensity or low-intensity groups. Blood samples, physical measurements and questionnaires were analysed. Participants received cookbooks and dietary lectures. The high-intensity group also received Motivational interviewing (MI), dietary advice on prescription (DAP- advice), a grocery store lecture, a website and weekly e-mails. Main outcome measures: Weight, quality of life, risks and health factors. Results: In total, 182 (64%) participants completed the 2-year follow-up. The total sample reduced their weight by 1 kg (p = 0.006). No significant differences regarding weight were found between the groups. Anxiety/depression decreased in EQ5-D (p = 0.021), EQ5-D VAS (p = 0.002) and SOC (p = 0.042). Between the groups, there were significant differences in EQ5-D usual activities (p = 0.004), anxiety/depression (p = 0.013), pain/discomfort (p = 0.041), fruit and vegetables (p = 0.005), HLV anxiety (p = 0.005), and visits to nurses (p = 0.012). Conclusion: The total population lost weight, and the high-intensity and low-intensity programmes did not result in significant differences in terms of weight. The high-intensity programme reported health benefits linked to lower levels of anxiety and depression, increased activity and intake of greens and reduced visits to physicians and nurses.Key points Both groups had a consisting weight- reduction after two years. High intensity did not lead to a significant difference in weight reduction between the groups. The high-intensity group reported more health effects, such as better quality of life, reduced anxiety, and increased greenery intake. It is unknown how much support patients in a weight- reduction programme in PHC require to succeed with weight loss and a healthy lifestyle. © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

The aim of this study was to compare the effects of autoregulating strength training volume based on an objective (external load match performance) versus a subjective (self-selected) method in professional male football players. Sixteen players completed a 10-week strength training programme where the number of sets was regulated based on football match high-intensity running distance (HIR >19.8 km/h, AUTO, n = 7), or self-selected (SELF, n = 9). In addition to traditional physical performance assessments (30-m sprint, countermovement jump, leg-strength, and body composition), external load match performance was assessed with five matches in the beginning and in the end of the study period. Both groups performed ~ 1 weekly bout of ~ 6 sets in leg extensor exercises during the 10-week period, and maintained physical performance during the competitive season, with no group differences detected after the training period. Non-overlap of all pairs (NAP) analysis showed weak-to-moderate effects in external load match performance from before to after the study period, suggesting that players maintained or improved their performance. In conclusion, no group differences were observed, suggesting that both external load autoregulated and self-selected, low-volume in-season strength training maintained physical, and external load match performance in professional male football players. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Inom projektet har hittills genomförts följande aktiviteter:

1. Inhämtat teoretiska kunskaper inom området mikrovågsteknik
2. Genomfört studier avseende vilka molekyler som är av intresse för stål- och metallindustrin att mäta på.
3. Kontrollerat mot JPL databas samt NBS om dessa molekyler finns definierade i mikrovågsområdet av det elektromagnetiska spektret och då på vilka frekvenser.
4. Designat och tillverkat en sensor, bestående av antenner, mixer samt LO, som klarar av att mäta vid de relevanta molekylära frekvenserna.
5. Testat och utvärderat sensortekniken på laboratorienivå avseende signalkarak- täristik.
6. Genomfört pilotförsök på MEFOS: i. Höga gastemperaturer; ii. Olika gaskoncentrationer
7. Genomförtverksförsök: i. LKAB, Rotary Kiln; ii. Boliden Mineral, Kopparkonverter
8. Utvärderat försöksdata

Background: Executive functions (EF) help the individual to manage thoughts and actions to achieve specific goals. The importance of EF may play a pivotal role in the performance of an athlete, in certain types of sports, allowing athletes to make tactical and quick decisions while maintaining focus under pressure. Many researchers have presented a clear result in their studies, indicating that athletes have better EF in comparison with non-athletes which means that physical activity (PA) in the form of exercise related to sport could beneficially influence EF. Still, there is a knowledge gap concerning whether moderate PA beyond regular training acutely could enhance EF performance in athletes.  

Aim: The aim of this study was to test the acute effect of moderate PA on EF in female soccer players. A second aim was to study the association between two different tests measuring EF, the Digit Span Tasks (DST) and Trail Making Tests (TMT) 

Method: In an experimental intervention design 14 active, healthy female young soccer players were tested on two occasions. Data was collected on EF from two different tests: DST (forward and backward) measuring in digits, and TMT (TMT-A and TMT-B) measuring in time (sec) pre and post performing a moderate PA. The Wilcoxon Signed Ranged test was used to study differences pre and post PA, and Spearman’s correlation was used to analyze the association between the different EF tests. 

Results: The participants had a mean ± SD age 21 years ± 3. No statistically significant differences were found in DST forward pre and post PA (p=0.705), or DST backward (p=0.083). In addition, no statistically significant differences were found in TMT-A pre and post PA (p=0.245), or in TMT-B (p=0.124). The association between DST forward and TMT-A post PA indicated a high negative correlation (r = - 0.653), and association between DST backward and TMT-B post PA indicated a moderate negative correlation (r = - 0.334).  

Conclusion: There were no significant acute effects of moderate PA on EF measured with the DST and the TMT tests in female soccer players. Further, the DST and TMT tests had a moderate to high association, indicating the two different tests could be used equivalently in measuring EF. 

Perceived confidence is an important dimension of an athlete’s psychological readiness to return-to-play. However, there is no established and validated tool to evaluate confidence in professional football. This study aimed to provide preliminary evaluation of the internal structure of the Injury-Psychological Readiness to Return-to-Sport scale (I-PRRS) in a cohort of injured male professional footballers. Over an 18-month period, 29 teams from 17 leagues participated. Players sustaining injuries eliciting (Formula presented.) 3 weeks’ time-loss were recruited. Cross culturally adapted to 4 further languages, the I-PRRS was administered on two occasions: 1) day before returning-to-training and 2) day before returning-to-match-play. In total, 113 injuries were recorded with 96 completed I-PRRS data sets collected. Confirmatory factor analysis indicated the I-PRRS was a unidimensional scale, with all items measuring the same construct. The scale demonstrated good internal consistency (ω =.88). When examining longitudinal invariance of the I-PRRS across administration time-points, indices of model fit supported scalar invariance. There was preliminary evidence of good internal structure for the I-PRRS in professional male footballers. However, before further research involving the I-PRRS can be endorsed, efforts to confirm or refute empirical developments pertaining to psychological readiness are necessary. © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Objectives The aim was to study physical function in individuals with rheumatoid arthritis (RA) as measured by SOFI (observed physical function) and HAQ (self-rated physical function) over 15 years and describe associated variables, with focus on gender differences.

Methods In all 2558 patients (847 men and 1711 women) age (SD) 58 (16) were recruited from the BARFOT inception cohort of patients with early RA. They had at inclusion a disease duration of one year or less and fulfilled the ACR 1987 criteria. At 15 years follow-up 663 out of 690 patients participated. Physical function was assessed by the SOFI (Signals of functional impairment) test, (scores 0-44, best to worst) which includes 12 performance tests measuring objective physical function, and the HAQ (Health Assessment Questionnaire) (scores 0-3, best to worst) measuring self-reported activity. A logistic regression model was performed to assess if being in the highest quartile of SOFI and HAQ, respectively, at the15 year follow up visit was associated to gender. Age, disease duration at inclusion, disease activity, smoking habits, RF positivity and pain were included in the model.

Results Women had lower mean SOFI than men at inclusion and during the first study year, p<0.001. HAQ showed a conversed pattern, where women reported worse physical function than men on all occasions, p<0.001. During the first year SOFI and HAQ decreased in both genders, p<0.001. Thereafter throughout the study period mean SOFI and HAQ increased in men and women, p<0.001, figure 1A and B.

At the 15 year follow up visit being in the highest quartile of SOFI (score ≥10) was not associated with gender while women had a higher risk to be in the highest quartile of HAQ (score ≥1.13) OR (95% CI) 2.86 (1.73-4.74), p<0.001. DAS 28 at inclusion showed a weak association with SOFI, OR (95% CI) 1.36 (1.11-1.68), p=0.003 while pain at inclusion was somewhat closer associated with HAQ, 1.02 (1.01-1.03), p<0.001. The correlation between the two functional test was r=0.54.

Conclusions Women had an almost three times higher risk of worse outcome of HAQ after 15 years while the outcome of SOFI was not associated with gender. These two measures provide information of different aspects of physical function and should be used concomitantly.

Disclosure of Interest None declared

OBJECTIVE: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting.

DESIGN: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants.

INTERVENTIONS: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition).

MAIN MEASURES: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes.

RESULTS: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome (p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment (p= 0.02), and at the 10-year follow-up (p=0.03).

DISCUSSION: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment. 

© The Author(s) 2016

Varje år skadar sig drygt 100 000 individer inom idrotten och skulle man ta all fysisk aktivitet i beaktning som är vårdkrävande drabbas cirka 280 000 individer i Sverige. Detta uppskattas vara en kostnad mellan 3-4 miljarder kronor varje år. 

Dagens rehabiliteringsmetoder lider av brist på faktabaserad uppföljning, vilket gör det svårt att bedöma framsteg på ett konkret sätt. Istället tvingas man förlita sig på sin känsla och antaganden för att avgöra vilken metod som fungerar bäst, och det kan dröja månader innan man vet om tillfrisknandet går åt rätt håll. 

Projektgruppens syfte har varit att ta fram ett koncept som ska underlätta, förbättra och effektivisera rehabiliteringsprocessen. Genom ett iterativt arbete har konceptet utvecklats längs projektets gång med hjälp av egna erfarenheter, dialoger med fysioterapeuter och patienter, faktainsamling samt relevanta verktyg och metoder. Med implementering av känd och modern teknik inom ett nytt arbetsområde har projektet resulterat i en innovativ lösning som möjliggör utvärdering och vägledning med mätdata. 

Resultatet har därmed döpts till Resma Therapy - Rehab Smart: som står för en smartare rehabilitering. Detta kommer resultera i en effektivare rehabiliteringsprocess, som också möjliggör att det ska vara roligt och motiverande att genomföra sin rehabilitering under hela resans gång. Under projektets gång har man också identifierat andra användningsområden där möjligheten att konceptet appliceras på andra typer av skador har stor potential. Därav ser projektgruppen att vidareutveckling av konceptet kan göra stor skillnad inom vården.

Background: Modern strategies for knee osteoarthritis (OA) treatment and prevention includes early detection and analyses about pain, gait and lower extremity muscle function including both strength and stability. The very first sign of knee OA is pain or perceived knee instability, often experienced during weight bearing activities e.g. walking. Increased muscle strength will provide dynamic joint stability, reduce pain, and disability. Specific measures of gait symmetry (GS) can be assessed objectively by using accelerometers, which potentially is a feasible method when evaluating early symptoms of symptomatic knee OA.

Objectives: The aim was to study if symptoms of early knee pain affected gait symmetry, and the association between lower extremity muscles function and gait symmetry in patients with symptomatic knee OA.

Methods: Thirty-five participants (mean age 52 SD 9 years, 66% women) with uni- or bilateral symptomatic knee OA, and without signs of an inflammatory rheumatic disease or knee trauma were included. Pain was assessed by a numeric rating scale (NRS, range 0-10 best to worse), tests of lower extremity muscle function with the maximum number of one leg rises. Dynamic stability was measured as GS by using wearable inertial sensors (PXNordic senseneering platform), during the 6 min walking test to obtain spatio-temporal gait parameters. GS was computed based on stride time (temporal symmetry, TS) and stride length (spatial symmetry, SS). Stride length was normalized by height. Kruskal-Wallis and Spearman’s correlation coefficient were used for analyses.

Results: Reports of knee pain did not differ between gender (women 4.7, SD 2.4 vs. men 3.9, SD 2.4, p= 0.362), neither did one leg rises or gait symmetry. Participants who reported unilateral knee pain (left/right side n=9/13), had a shorter stride length on the painful side. The mean difference in stride length was 0.7% of the subject’s height (SD 1.3). Participants with unilateral pain also presented less SS gait than those who reported bilateral pain (p=0.005). The higher number of one-leg rises performed, the better TS was observed. We found a significant relationship between TS and one-leg rise for the right r s =-0.39, p=0.006, and left r s =-0.40, p=0.004 left side). No significant relationship was observed between SS and one-leg rises.

Conclusion: Our results is in line with earlier findings stating that knee pain affects GS negatively and that lower extremity muscle function is an important feature for symmetry and dynamic joint stability in patients with symptomatic knee OA. We also found that pain in one leg was related to impaired GS. Bilateral knee pain was however more symmetrical and will need healthy controls for comparison to better understand the negative impact of symptomatic knee OA.

Introduction: Children gain increased health and wellbeing by participating in physical activity (PA). In children and adolescents with cerebral palsy who are non-ambulant (children with CP-NA), levels of PA have been indicated to be lower compared to children and adolescents without physical disabilities. However, research on PA in children with CP-NA is limited. Therefore, this study aims to evaluate objectively assessed PA over the course of one year when using ActiGraph GT3X accelerometer in children with CP-NA. 

Participants and methods: Accelerometer data were retrieved from 32 children with CP-NA (4 - 17 years) in Region Skane, Sweden. Participants wore the ActiGraph GT3X accelerometer all waking hours for up to four periods of seven consecutive days over a year. Statistically sensitivity analyses were run to explore differences in PA between subtypes of cerebral palsy and GMFCS level IV and V. 

Results: In total 481 days and 85 periods of valid accelerometer data were obtained. Light PA was statically significantly higher for children with dyskinetic CP-NA compared to spastic CP-NA (median (IQR) 57 (37.42-88.1) vs. 34.42 (20.42-55.96), p = <0.001). Light PA (median (IQR) 57 (36.67-88.5) vs. 25.42 (17-38.75), p = <0.001) and moderate to vigorous PA (median (IQR) 1.83 (1-4.17) vs. 1.67 (0.67-2), p = <0.001) were statically significantly higher for children with CP-NA GMFCS level IV compared to level V. 

Conclusion: Preliminary results indicate differences in PA levels between subtype of cerebral palsy and GMFCS level. Further analyses to explore potential differences in PA over the year will be run.

This study aimed to explore whether a six-week intervention, based on participation in outdoor exercise, including activity-tracking devices and combined with individual consulting sessions, can both increase physical activity and yield positive changes in physiological and psychological health measures. A total of six participants, with a mean age of 41.2 (range 33-50 years), completed the ten-week study and the six-week intervention. The full study consisted of a four-week control/baseline and a six-week intervention period in which each participant acted as their own controls. Continuous measures of physical activity data were collected using a wrist-worn activity sensor during the ten-week study, along with pre- and post-measures of cardiovascular fitness, upper-body strength, BMI, general health, and motivation to exercise. The intervention consisted of a resistance-training programme for an outdoor gym and three motivational interviewing sessions. Effect sizes (percentage) for changes pre- to post-training were calculated. The results, because of the small sample size, are presented as individual cases, but the group, as a whole, showed average increases from baseline (pre-) to post-measures in strength (maximum row; 15.33%), time to exhaustion (3.58%), number of steps per day (4%), and autonomous motivation (12%) and average decreases in body weight (-1.08%), fat percentage (-7.58%), strength (chest; -2.5%), and stress symptoms (-2.17%). The six-week intervention programme showed promising results regarding physical activity changes. This study contributes to the limited evidence of the impact of resistance training programmes using outdoor gyms, electronic tracker, and motivational interviewing on physical activity outcomes. © 2019 by the authors.

Purpose The randomized controlled trial REACT (NCT03320746) examined the effect of a 12-month consumer-based activity tracker intervention on accelerometer-measured physical activity among recent retirees. Methods Altogether 231 recently retired Finnish adults (age, 65.2 ± 1.1 yr, mean ± SD; 83% women) were randomized to intervention and control groups. Intervention participants were requested to wear a commercial wrist-worn activity tracker (Polar Loop 2; Polar, Kempele, Finland) for 12 months, to try to reach the daily activity goals shown on the tracker display, and to upload their activity data to a Web-based program every week. The control group received no intervention. Accelerometer-based outcome measurements of daily total, light physical activity (LPA), and moderate to vigorous (MVPA) physical activity were conducted at baseline and at 3-, 6-, and 12-month time points. Hierarchical linear mixed models were used to examine the differences between the groups over time. All analyses were performed by intention-to-treat principle and adjusted for wake wear time. Results The use of a commercial activity tracker did not increase daily total activity, LPA, or MVPA over the 12-months period when compared with nonuser controls (group-time interaction, P = 0.39, 0.23, and 0.77, respectively). There was an increase in LPA over the first 6 months in both the intervention (26 min·d-1, 95% confidence interval [CI] = 13 to 39) and the control (14 min·d-1, 95% CI = 1 to 27) groups, but the difference between the groups was not significant (12 min·d-1, 95% CI = -6 to 30). In both groups, LPA decreased from 6 to 12 months. Conclusion The 12-month use of a commercial activity tracker does not appear to elicit significant changes in the daily total activity among a general population sample of recent retirees, thus highlighting the need to explore other alternatives to increase physical activity in this target group. © Lippincott Williams & Wilkins.

Sensory disorder is a factor preventing recovery from motor paralysis after stroke. Although several robot-assisted exercises for the hemiplegic upper limb of stroke patients have been proposed, few studies have examined improvement in function in stroke patients with sensory disorder using robot-assisted training. In this study, the efficacies of robot training for the hemiplegic upper limb of three stroke patients with complete sensory loss were compared with those of 19 patients without complete sensory loss. Robot training to assist reach motion was performed in 10 sessions over a 2-week period for 5 days per week at 1 h per day. Before and after the training, the total Fugl–Meyer Assessment score excluding coordination and tendon reflex (FMA-total) and the FMA shoulder and elbow score excluding tendon reflex (FMA-S/E) were evaluated. Reach and patherrors (RE and PE) during the reach motion were also evaluated by the arm-training robot. In most cases, both the FMA-total and the FMA-S/E scores improved. Cases with complete sensory loss showed worse RE and PE scores. Our results suggest that motor paralysis is improved by robot training. However, improvement may be varied according to the presence or absence of somatic sensory feedback. © 2019 MDPI (Basel, Switzerland).

Rehabilitation and mobility training of post-stroke patients is crucial for their functional recovery. While traditional methods can still help patients, new rehabilitation and mobility training methods are necessary to facilitate better recovery at lower costs. In this work, our objective was to design and develop a rehabilitation training system targeting the functional recovery ofpost-stroke users with high efficiency. To accomplish this goal, we applied a bilateral training method, which proved to be effective in enhancing motor recovery using tactile feedback for the training. One participant with hemiparesis underwent six weeks of training. Two protocols, “contralater alarm matching” and “both arms moving together”, were carried out by the participant. Each ofthe protocols consisted of “shoulder abduction” and “shoulder flexion” at angles close to 30 and 60 degrees. The participant carried out 15 repetitions at each angle for each task. For example, in the“contralateral arm matching” protocol, the unaffected arm of the participant was set to an angle close to 30 degrees. He was then requested to keep the unaffected arm at the specified angle while trying to match the position with the affected arm. Whenever the two arms matched, a vibration was given on both brachialis muscles. For the “both arms moving together” protocol, the two arms were first set approximately to an angle of either 30 or 60 degrees. The participant was asked to return both arms to a relaxed position before moving both arms back to the remembered specified angle.The arm that was slower in moving to the specified angle received a vibration. We performed clinical assessments before, midway through, and after the training period using a Fugl-Meyer assessment (FMA), a Wolf motor function test (WMFT), and a proprioceptive assessment. For the assessments, two ipsilateral and contralateral arm matching tasks, each consisting of three movements (shoulder abduction, shoulder flexion, and elbow flexion), were used. Movements were performed at two angles, 30 and 60 degrees. For both tasks, the same procedure was used. For example, in the case of the ipsilateral arm matching task, an experimenter positioned the affected arm of the participant at 30 degrees of shoulder abduction. The participant was requested to keep the arm in that positionfor ~5 s before returning to a relaxed initial position. Then, after another ~5-s delay, the participant moved the affected arm back to the remembered position. An experimenter measured this shoulder abduction angle manually using a goniometer. The same procedure was repeated for the 60 degree angle and for the other two movements. We applied a low-cost Kinect to extract the participant’s body joint position data. Tactile feedback was given based on the arm position detected by the Kinect sensor. By using a Kinect sensor, we demonstrated the feasibility of the system for the training ofa post-stroke user. The proposed system can further be employed for self-training of patients at home. The results of the FMA, WMFT, and goniometer angle measurements showed improvements in several tasks, suggesting a positive effect of the training system and its feasibility for further application for stroke survivors’ rehabilitation. © 2019 by the authors.

Up to 50% of patients who suffer an anterior cruciate ligament (ACL) injury receive or opt for rehabilitation alone as initial treatment in Scandinavia. Knowledge of whether patients treated with rehabilitation alone after ACL injury are satisfied is lacking. This study aimed to explore the experiences of patients treated with rehabilitation alone after an ACL injury. Fourteen patients (35.9 (19-56) years old) who suffered an ACL injury treated with rehabilitation alone, a mean of 32 months before inclusion, were interviewed. The interview transcripts were analysed using qualitative content analysis with an inductive approach. The experiences of patients treated with rehabilitation after an ACL injury were summarised in one theme: Is the grass greener on the other side? Context characterised by uncertainty', supported by three main categories and nine subcategories. Uncertainty permeated the context of all levels of knee-related life following ACL injury: (1) in the past, patients felt uncertainty regarding treatment choices, (2) in the present, patients felt uncertainty regarding their physical capacity and knee self-efficacy, and (3) for the future, patients felt uncertainty regarding what might happen. With few exceptions, patients' experiences after an ACL injury treated with rehabilitation alone are characterised by uncertainty regarding their physical function, psychological impairments and possible future limitation of knee function. Uncertainty is experienced by patients in the past, the present and the future. Patients experience the knee as a symptomatic obstacle and need to adapt the physical activity to the presence of symptoms. © 2023 BMJ Publishing Group. All rights reserved.

Objective: The goal of this study was to provide a greater understanding of physical activity in patients with early rheumatoidarthritis. The aim was twofold: first to explore if physical activity was associated with factors in the clinical picture of rheumatoid arthritis in this patient group, and second, to explore factors influencing physical activity in patients with early rheumatoid arthritis.

Methods: A total of 66 patients with early rheumatoid arthritis were included in the study. A sequential explanatorymixed-methods design was used, where quantitative data from a questionnaire were analysed with Mann–Whitney, post hocKruskal–Wallis and χ2 test in order to detect differences between groups, and find possible associations between physical activity and independent variables, such as disease activity, health-related quality of life and physical function. Qualitative datawere collected in a follow-up questionnaire with open-ended questions that focused on factors influencing physical activity.

Results: Associations between physical activity, disease activity and health-related quality of life were seen in patients withearly rheumatoid arthritis together with strong negative correlations between physical activity and physical function. Patientson sick leave showed the strongest associations between disease-related variables and lower levels of physical activity.The findings from the qualitative analysis showed that physical limitations, awareness as a motivational factor and external environment factors influenced physical activity in patients with early rheumatoid arthritis.

Conclusion: The results showed a complex underlying motive where physical, psychological and environmental factors influenced the physical activity in patients with early rheumatoid arthritis. In order to provide more effective health interventions, it is important to consider the complex nature of practicing physical activity, where a person-centred approach should be considered. Factors such as physical limitations, economic aspects and time for practicing physical activity shouldbe included in the person-centred approach.

In spite of the large-scale growth of walking sport (WS) programmes globally, limited research has explored the experiences of the key stakeholders involved in such programmes (i.e. decision-makers, facilitators, and players). We aimed to explore stakeholder experiences of community-based WS programmes to better understand the appeal of such sport options for middle-aged and older adults, and propose tentative recommendations for the feasibility and sustainability of these types of programmes. We conducted semi-structured interviews with 21 stakeholders who were involved with WS programmes in Australia as decision-makers, facilitators, and/or players. Data were analysed with reflexive thematic analysis. Four key themes pertaining to the WS experience were identified–‘a renewed lease of life’, ‘navigating ageing stereotypes’, ‘tension between organisational demands and players’ needs’, and ‘WS facilitators as catalysts of success’. Specifically, we found that WS participation enabled a positive ageing discourse for middle-aged and older adults. WS players had to negotiate stereotypes that, at times, were perceived as participation barriers. We also noted some tensions between the demands of sport organisations and the needs of middle-aged and older adults regarding sport participation. Finally, we also noted the importance of the facilitators’ role in increasing accessibility of, and long-term participation in, such programmes. We suggest that to offer feasible and sustainable community-based WS programmes across Australia, incompatibilities across various stakeholders’ perspectives need to be addressed. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

BACKGROUND: Effective strategies to reverse the increasing trend of sedentary behavior after retirement are needed. The aim of this study was to examine the effect of 12-month activity tracker-based intervention on daily total and prolonged sedentary time (≥60 minutes) among recent retirees.

METHODS: Randomization to intervention and control groups was performed to 231 retirees (mean age 65.2 [SD 1.1] years, 83% women). Intervention participants wore a consumer-based wrist-worn activity tracker (Polar Loop 2, Polar, Kempele, Finland), including daily activity goal, every day and night for 12 months. The activity tracker also gave vibrating reminders to break up uninterrupted inactivity periods after 55 minutes. A wrist-worn triaxial ActiGraph wGT3X-BT accelerometer was used to measure sedentary time at baseline and at 3-, 6-, and 12-month time points.

RESULTS: The use of an activity tracker did not reduce daily total or prolonged sedentary time over 12 months (p values for time * group interaction 0.39 and 0.27, respectively). In the post hoc analysis focusing on short- and medium-term effects on prolonged sedentary time, no differences between the intervention and control groups over 3 months were found, but a tendency for a greater decrease in prolonged sedentary time in the intervention group over 6 months was seen (mean difference in changes between the groups 29 minutes, 95% CI -2 to 61).

CONCLUSIONS: The activity tracker with inactivity alerts did not elicit changes in sedentary time over 12 months among recent retirees. Alternative approaches may be needed to achieve long-term changes in sedentary time among retirees.

Clinical Trials registration Number: NCT03320746. © The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America.

The overall purpose of this thesis was to explore the impact of exercise and functional performance on development and treatment of knee osteoarthritis in the middle aged.

In this thesis, I have studied a population based cohort of middle-aged subjects (35-54 years, 42 % women) with chronic knee pain at baseline, to evaluate the longitudinal effect of muscle weakness on knee osteoarthritis development, the relationship between muscle function and joint load and the effects of exercise on joint load. I have also studied the effect of exercise on pain and function in another middle-aged cohort (36-65 years, 51 % women) with moderate to severe knee osteoarthritis, and explored their conceptions of exercise as treatment. In the first study, 148 subjects with chronic knee pain underwent radiographic examination and tests of functional performance at baseline. 94 of them had no radiographic signs of knee osteoarthritis. Five years later they had new radiographs taken and 41/94 (44 %) had developed incident knee osteoarthritis. I found that reduced functional performance, assessed by maximum number of one-leg rises from a stool, predicted knee osteoarthritis development. The result was controlled for the previously known risk factors of age, BMI and pain.

In the second study, I used 3-dimensional motion analysis to explore the possibility of altering joint load by exercise. The medial compartment joint load (peak adduction moment) during maximum number of one-leg rises was assessed in 13 subjects with early radiographic signs of knee osteoarthritis from the cohort in study one, before and after 8 weeks of exercise. Two subjects were lost to follow up for reasons not related to the knee. The peak adduction moment could be reduced by exercise, and a high maximum number of one-leg rises was associated with lower levels of peak adduction moment.

The third study included 61 subjects with moderate to severe radiographic knee osteoarthritis. They were randomized to 6 weeks of intensive exercise or to a control group. The effects of exercise were assessed using questionnaires. No effects were seen on pain or self estimated function, however, the quality of life improved. The individual response to exercise ranged from clinically significant improvement to clinically significant worsening.

As an attempt to understand this large inter individual response to exercise, I designed the fourth study, where I interviewed 16 of the 30 patients in the exercise group about their conceptions of exercise as treatment. The interviews were analysed using qualitative methodology, and it was revealed that all patients were aware of the general health benefits of exercise, but had doubts about exercise as treatment of osteoarthritis even if they had perceived pain relief and improvement in physical function from the exercise intervention. The pain experienced during exercise caused the patients to believe that exercise was harmful to their knees, and some of them would prefer not to exercise at all. They thought that exercise should be introduced early during the course of the disease, and all of them expressed the need of continuous encouragement and support to adhere to exercise.

From this thesis I conclude that reduced muscle function is a risk factor of knee osteoarthritis development among middle aged subjects with knee pain. Reduced muscle function is associated with increased joint load, which seem to be modifiable by exercise. Initial pain when starting exercise, or occasional pain from exercise, should be treated by combining exercise with pain relief such as analgesics or acupuncture. Pain contributes to the difficulty patients have determining the degree of benefit or damage related to exercise, and thus causes feelings of anxiety and helplessness (paper IV). Pain also seems to interfere with the possibility of achieving increased functional performance (paper II, III, IV).

Background: Studies on exercise in knee osteoarthritis (OA) have focused on elderly subjects. Subjects in this study were middle-aged with symptomatic and definite radiographic knee osteoarthritis. The aim was to test the effects of a short-term, high-intensity exercise program on self-reported pain, function and quality of life. Methods: Patients aged 36-65, with OA grade III (Kellgren & Lawrence) were recruited. They had been referred for radiographic examination due to knee pain and had no history of major knee injury. They were randomized to a twice weekly supervised one hour exercise intervention for six weeks, or to a non-intervention control group. Exercise was performed at ≥ 60% of maximum heart rate (HR max). The primary outcome measure was the Knee injury and Osteoarthritis Outcome Score (KOOS). Follow-up occurred at 6 weeks and 6 months. Results: Sixty-one subjects (mean age 56 (SD 6), 51 % women, mean BMI 29.5 (SD 4.8)) were randomly assigned to intervention (n = 30) or control group (n = 31). No significant differences in the KOOS subscales assessing pain, other symptoms, or function in daily life or in sport and recreation were seen at any time point between exercisers and controls. In the exercise group, an improvement was seen at 6 weeks in the KOOS subscale quality of life compared to the control group (mean change 4.0 vs. -0.7, p = 0.05). The difference between groups was still persistent at 6 months (p = 0.02). Conclusion: A six-week high-intensive exercise program had no effect on pain or function in middle-aged patients with moderate to severe radiographic knee OA. Some effect was seen on quality of life in the exercise group compared to the control group. © 2005 Thorstensson et al; licensee BioMed Central Ltd.

Purpose: To investigate acute and long-term changes in hormonal and inflammatory biomarkers in nonambulant children with cerebral palsy in response to dynamic standing exercise.

Methods: Fourteen children with severe cerebral palsy were recruited. Anthropometrics and body composition measures were obtained. Physical activity levels before the study were assessed using hip-worn accelerometry. All children underwent a 30-minute dynamic standing exercise using the Innowalk standing aid. Respiratory data during exercise were collected using indirect calorimetry. Blood samples were collected before and after exercise. Blood samples were also obtained after two 16-week exercise protocols, in a resting state. Hormonal and inflammatory metabolites were measured from blood serum/plasma, and acute and long-term changes in biomarker levels were assessed using Wilcoxon signed-rank tests.

Results: Of the 14 children at baseline, all had slightly/moderately/severely elevated C-reactive protein and cortisol levels. C-reactive protein levels were decreased following a 30-minute bout of dynamic standing (before exercise: 53 mg/L [interquartile range: 40-201]; after exercise: 39 mg/L [interquartile range: 20-107]; P = .04).

Conclusions: We show that several hormonal and inflammatory biomarkers are dysregulated in children with cerebral palsy. Our preliminary results from a small, but deep-phenotyped prospective cohort indicate acute and long-term alterations of several biomarkers in response to exercise. ©2023 The Authors.

In a general rehabilitation phase weight training is an important part because of muscle weakness may contribute lower functional ability and could lead to decreasing movement patterns. Limited range of motion (ROM) in the upper extremity is a contributing factor to individuals unable to perform everyday activities. Several studies have documented that patients with rheumatoid arthritis (RA) have impaired hand function due to reduced grip strength and limitations in ROM. Functional training is designed to strengthen the weak muscles that cause imbalance or pain while your body becomes more mobile. Using everyday movements and implement them with training will make the training more functional. The purpose of this study was to develop and evaluate a new wrist support that increases the possibilities to functional training of upper extremities for rheumatoid arthritis patients.

The study involved 27 women, 8 were diagnosed with RA and 19 healthy subjects. The average age was 38 year (20-73year). Muscle activity in m. trapezius and m. rhomboideus was measured using surface electromyography (sEMG) in three exercises to compare the differences between both RA and healthy, and with and without a developed product.

The results showed that it was possible to perform functional training of upper extremities without using the hand grip strength. There were no significant differences in muscle activity in m. trapezius and m. rhomboideii with or without the product. The results also showed that rheumatic muscles are not different from healthy muscles. The participants' subjective opinions were very positive there 24 of 27 participants found it easier to carry out the exercise

with the product and 9 of 27 felt it was easier to focus on exercise.

The study resulted in a new wrist support that allows functional training of m.trapezius and m.rhomboideus for patients with rheumatoid arthritis.

Background: Physical exercise is a component of the recommended treatment for individuals diagnosed with axial spondyloarthritis (axSpA). Various forms of cardiorespiratory training, including supervised high-intensity interval training (HIIT), have been well-documented in enhancing overall health and cardiorespiratory function. Nevertheless, there exists a gap in our understanding regarding the experiences and utilization of digital-based HIIT in individuals with axSpA. 

Objective: The study aimed to describe experiences of a twelve-week digital-based HIIT intervention among participants with axSpA.  

Method: In this qualitative study, participants were recruited from a randomized controlled trial that implemented a standardized training intervention, including two HIIT sessions and one optional cardiorespiratory training session weekly in self-selected activities for twelve weeks with digital-based coaching. Individual interviews were conducted with the participants (7 females/5 males) after completing the intervention. Open-ended questions were employed, such as: "How did you experience the HIIT intervention?" and "How has the HIIT intervention influenced you?". A qualitative content analysis was performed on the interviews. To describe the participants, self-reported data was collected, and test of aerobic capacity was performed. Participants with axSpA (n=12) were recruited from two rheumatology clinics in southern Sweden. The median age at baseline was 47 years (min-max, 31-66), aerobic capacity was 32 ml O2/kg/min (24-54), self-reported health status (EQ5D) was 0.80 (0.73-1), disease activity (BASDAI) was 2.4 (0.6-3.3), and physical function (BASFI) was 1.1 (0-1.8). The qualitative content analysis resulted in four categories constituted of twelve sub-categories. 

Results: The results revealed that participation in a digital-based HIIT intervention was experienced as the intervention design creates opportunities for exercise through easy accessibility, time efficiency, and increased self-awareness. The encouragement facilitates exercise by feelings of being cared for, individual coaching, and social support. HIIT influences well-being by health effects, altered pain, and feelings of self-satisfaction. Yet, also emphasized was the need to overcome barriers to perform HIIT by facing practical difficulties, effort and motivation, and feelings of uncertainty and failures. 

Conclusion: Individuals with axSpA experienced that the digital-based HIIT intervention created diverse exercise opportunities. The importance of encouragement in the intervention design, along with the positive health effects, was highlighted. However, the need to overcome difficulties connected to HIIT was also emphasized. The findings should be considered when implementing rehabilitation containing HIIT.

Underactuation is widely used when designing anthropomorphic hand, which involves fewer degrees of actuation than degrees of freedom. However, the similarities between coordinated joint movements and movement variances across different grasp tasks have not been suitably examined. This work suggests a systematic approach to identify the actuation strategy with the minimum number for degrees of actuation for anthropomorphic hands. This work evaluates the correlations of coordinated movements in human hands during 23 grasp tasks to suggest actuation strategies for anthropomorphic hands. Our approach proceeds as follows: first, we find the best description for each coordinated joint movement in each grasp task by using multiple linear regression; then, based on the similarities between joint movements, we classify hand joints into groups by using hierarchical cluster analysis; finally, we reduce the dimensionality of each group of joints by employing principal components analysis. The metacarpophalangeal joints and proximal interphalangeal joints have the best and most consistent description of their coordinated movements across all grasp tasks. The thumb metacarpophalangeal and abduction/adduction between the ring and little fingers exhibit relatively high independence of movement. The distal interphalangeal joints show a high degree of independent movement but not for all grasp tasks. Analysis of the results indicates that for the distal interphalangeal joints, their coordinated movements are better explained when all fingers wrap around the object. Our approach fails to provide more information for the other joints. We conclude that 19 degrees of freedom for an anthropomorphic hand can be reduced to 13 degrees of actuation distributed between six groups of joints. The number of degrees of actuation can be further reduced to six by relaxing the dimensionality reduction criteria. Other resolutions are as follows: (a) the joint coupling scheme should be joint-based rather than finger-based and (b) hand designs may need to include finger abduction/adduction movements.