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  • 1. Andersen, Nadja
    et al.
    Friis, Maria
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation.
    Donation of Used Assistive Devices2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The aim of the thesis was to explore the stakeholders’ opinions on and experiences with donation of used assistive devices from high-income countries to developing countries. Which was done by investigating the opinions and experiences of the different stakeholders, with donation of used assistive devices, and by exploring what used assistive devices are appropriate to donate.  

    The study included eight participating stakeholders, requited through purposive and snowball sampling. Of the eight participants, five participants were sending stakeholders from Scandinavia and three participants were receiving stakeholders from lower-middle-income countries in Africa and an upper-middle-income country in Europe. The interviews were conducted using semi-structured questions to explore the participants’ own opinions and experiences with donations. Qualitative content analysis was used to analyze the transcribed interviews inductively and with manifest content. 

    The results consisted of 4 main categories: Practical issues, Stakeholders opinions and cooperation, Donations are needed, and Considerations when donating. The main findings of the study were; the importance of quality control to ensure waste is not sent, the importance of communication between sender and receiver about needs, the importance of knowledge of the prerequisites and context of the receiver, and lastly, the importance of considering the responsibility of waste when the donations are worn out. In conclusion, the included stakeholders have a positive attitude towards donations and expressed a need for more knowledge.

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  • 2.
    Anderson, Sarah
    et al.
    School of Allied Health, Human Services, and Sport, La Trobe University, Melbourne, Australia.
    Barnett, Cleveland T.
    School of Science and Technology, Nottingham Trent University, Nottingham, U.K..
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Celebrating 50 years of the International Society for Prosthetics and Orthotics: Past, present, and future2020In: Prosthetics and Orthotics International, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 44, no 6, p. 365-367Article in journal (Other academic)
  • 3.
    Anderson, Sarah
    et al.
    School of Allied Health, Human Services, and Sport, La Trobe University, Melbourne, VIC, Australia.
    Barnett, Cleveland T.School of Science and Technology, Nottingham Trent University, Nottingham, UK.Rusaw, DavidJönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Editorial Special Issue: ISPO 50th Anniversary: Prosthetics and Orthotics International, Volume 44 Issue 6, December 20202020Collection (editor) (Other academic)
  • 4.
    Anderson, Sarah P.
    et al.
    School of Allied Health Human Services and Sport, La Trobe University, Australia.
    Barnett, Cleveland T.
    School of Science and Technology, Nottingham Trent University, UK.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Exploring the perspectives of prosthetic and orthotic users: Past and present experiences and insights for the future2022In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 44, no 18, p. 5284-5290Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this work was to qualitatively explore the personal perspectives of prosthetic and orthotic users, in the context of their past and present experiences and understand their insights for the future.

    Materials and Methods: A narrative exploration study design employing a phenomenological approach was used. Semi-structured interviews were conducted with three female and two male prosthetic and orthotic users from Australia and the United Kingdom. Interviews were analysed, coded and key themes and sub-themes identified. 

    Results: Three themes were identified. The Maximising Opportunity theme linked sub-themes of recreation and pushing boundaries.  The Health Care Network theme included sub-themes of communication, peer support and building a team. The final theme, Changes over time, included sub-themes of disability perception, advice and advancements over time. 

    Conclusion: Prosthetic and orthotic users identified there had been vast changes in disability perception, disability rights, and their role in the health care system, along with the variety of technology and materials available. Key findings were that prosthetic and orthotic users want to be listened to, considered central to the health care team, and had a deep understanding of their own health care needs.

  • 5.
    Axelsson, K. F.
    et al.
    Department of Orthopaedic Surgery, Skaraborg Hospital, Skövde, Sweden.
    Wallander, M.
    Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Johansson, H.
    Institute for Health and Ageing, Catholic University of Australia, Melbourne, VIC, Australia.
    Lundh, Dan
    School of Bioscience, University of Skövde, Skövde, Sweden.
    Lorentzon, M.
    Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Hip fracture risk and safety with alendronate treatment in the oldest-old2017In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 282, no 6, p. 546-559Article in journal (Refereed)
    Abstract [en]

    Background. There is high evidence for secondary prevention of fractures, including hip fracture, with alendronate treatment, but alendronate's efficacy to prevent hip fractures in the oldest-old (80 years old), the population with the highest fracture risk, has not been studied.

    Objective. To investigate whether alendronate treatment amongst the oldest-old with prior fracture was related to decreased hip fracture rate and sustained safety.

    Methods. Using a national database of men and women undergoing a fall risk assessment at a Swedish healthcare facility, we identified 90 795 patients who were 80 years or older and had a prior fracture. Propensity score matching (four to one) was then used to identify 7844 controls to 1961 alendronate-treated patients. The risk of incident hip fracture was investigated with Cox models and the interaction between age and treatment was investigated using an interaction term.

    Results. The case and control groups were well balanced in regard to age, sex, anthropometrics and comorbidity. Alendronate treatment was associated with a decreased risk of hip fracture in crude (hazard ratio (HR) 0.62 (0.49-0.79), P < 0.001) and multivariable models (HR 0.66 (0.51-0.86), P < 0.01). Alendronate was related to reduced mortality risk (HR 0.88 (0.82-0.95) but increased risk of mild upper gastrointestinal symptoms (UGI) (HR 1.58 (1.12-2.24). The alendronate association did not change with age for hip fractures or mild UGI.

    Conclusion. In old patients with prior fracture, alendronate treatment reduces the risk of hip fracture with sustained safety, indicating that this treatment should be considered in these high-risk patients.

  • 6.
    Axelsson, Kristian F.
    et al.
    Department of Orthopaedic Surgery, Region Västra Götaland, Skaraborg Hospital, Skövde, Sweden.
    Johansson, Helena
    Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
    Lundh, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.
    Möller, Michael
    Region Västra Götaland, Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Lorentzon, Mattias
    Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Association between recurrent fracture risk and implementation of fracture liaison services in four Swedish hospitals: A cohort study2020In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 35, no 7, p. 1216-1223Article in journal (Refereed)
    Abstract [en]

    Structured secondary preventions programs, called fracture liaison services (FLSs), increase the rate of evaluation with bone densitometry and use of osteoporosis medication after fracture. However, the evidence regarding the effect on the risk of recurrent fracture is insufficient. The aim of this study was to investigate if implementation of FLS was associated with reduced risk of recurrent fractures. In this retrospective cohort study, electronic health records during 2012 to 2017 were used to identify a total of 21,083 patients from four hospitals in Western Sweden, two with FLS (n = 15,449) and two without (n = 5634). All patients aged 50 years or older (mean age 73.9 [SD 12.4] years, 76% women) with a major osteoporotic index fracture (hip, clinical spine, humerus, radius, and pelvis) were included. The primary outcome was recurrent major osteoporotic fracture. All patients with an index fracture during the FLS period (n = 13,946) were compared with all patients in the period before FLS implementation (n = 7137) in an intention-to-treat analysis. Time periods corresponding to the FLS hospitals were used for the non-FLS hospitals. In the hospitals with FLSs, there were 1247 recurrent fractures during a median follow-up time of 2.2 years (range 0–6 years). In an unadjusted Cox model, the risk of recurrent fracture was 18% lower in the FLS period compared with the control period (hazard ratio = 0.82, 95% confidence interval [CI] 0.73–0.92, p = 0.001), corresponding to a 3-year number needed to screen of 61, and did not change after adjustment for clinical risk factors. In the hospitals without FLSs, no change in recurrent fracture rate was observed. Treatment decisions were made according to the Swedish treatment guidelines. In conclusion, implementation of FLS was associated with a reduced risk of recurrent fracture, indicating that FLSs should be included routinely at hospitals treating fracture patients. 

  • 7.
    Axelsson, Kristian F.
    et al.
    Department of Orthopaedic Surgery, Skaraborg Hospital, Skövde, Sweden.
    Nilsson, Anna G.
    Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Wedel, Hans
    Department of Endocrinology, Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Swede.
    Lundh, Dan
    School of Bioscience, University of Skövde, Skövde, Sweden.
    Lorentzon, Mattias
    Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Association between alendronate use and hip fracture risk in older patients using oral prednisolone2017In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 318, no 2, p. 146-155Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE Oral glucocorticoid treatment increases fracture risk, and evidence is lacking regarding the efficacy of alendronate to protect against hip fracture in older patients using glucocorticoids.

    OBJECTIVE To investigate whether alendronate treatment in older patients using oral prednisolone is associated with decreased hip fracture risk and adverse effects.

    DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using a national database (N = 433 195) of patients aged 65 years or older undergoing a health evaluation (baseline) at Swedish health care facilities; 1802 patients who were prescribed alendronate after at least 3 months of oral prednisolone treatment (>= 5mg/d) were identified. Propensity score matching was used to select 1802 patients without alendronate use from 6076 patients taking prednisolone with the same dose and treatment time criteria. Follow-up occurred between January 2008 and December 2014.

    EXPOSURES Alendronate vs no alendronate use; no patients had previously taken alendronate at the time of prednisolone initiation.

    MAIN OUTCOMES AND MEASURES The primary outcome was incident hip fracture.

    RESULTS Of the 3604 included patients, the mean age was 79.9 (SD, 7.5) years, and 2524 (70%) were women. After a median follow-up of 1.32 years (interquartile range, 0.57-2.34 years), there were 27 hip fractures in the alendronate group and 73 in the no-alendronate group, corresponding to incidence rates of 9.5 (95% CI, 6.5-13.9) and 27.2 (95% CI, 21.6-34.2) fractures per 1000 person-years, with an absolute rate difference of -17.6 (95% CI, -24.8 to -10.4). The use of alendronate was associated with a lower risk of hip fracture in a multivariable-adjusted Cox model (hazard ratio, 0.35; 95% CI, 0.22-0.54). Alendronate treatment was not associated with increased risk of mild upper gastrointestinal tract symptoms (alendronate vs no alendronate, 15.6 [95% CI, 11.6-21.0] vs 12.9 [95% CI, 9.3-18.0] per 1000 person-years; P=.40) or peptic ulcers (10.9 [95% CI, 7.7-15.5] vs 11.4 [95% CI, 8.0-16.2] per 1000 person-years; P=.86). There were no cases of incident drug-induced osteonecrosis and only 1 case of femoral shaft fracture in each group.

    CONCLUSIONS AND RELEVANCE Among older patients using medium to high doses of prednisolone, alendronate treatment was associated with a significantly lower risk of hip fracture over a median of 1.32 years. Although the findings are limited by the observational study design and the small number of events, these results support the use of alendronate in this patient group.

  • 8. Barnett, C. T.
    et al.
    Vanicek, N.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    A longitudinal analysis of the relationships between postural control, falls efficacy and falling in unilateral transtibial prosthesis users2017Conference paper (Refereed)
  • 9.
    Barnett, Cleveland
    et al.
    Nottingham Trent University, Nottingham, United Kingdom.
    Miller, Bill
    University of British Columbia, Vancouver, Canada.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Department of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Anderson, Sarah
    La Trobe University, Melbourne, Australia.
    Dhariwal, Aditya
    The University of British Columbia, Vancouver, Canada.
    Balance and postural control of people with lower limb amputations: Perspectives from an interdisciplinary group of professionals2023In: ISPO 19th World Congress, 24-27 April 2023, Guadalajara, Mexico – Abstract book, Wolters Kluwer, 2023, Vol. 47 (Suppl.), no Suppl. 1, p. 39-39Conference paper (Refereed)
    Abstract [en]

    Balance, postural control and issues related to falling and the fear of falling are major problems for people with leg amputations. Structural changes after an amputation that affect balance and postural control include asymmetry of limb length. The inability to actively control posture via an intact foot and ankle complex on the affected side as well as altered sensory input may affect postural control. Such changes can be considered intrinsic factors as these are specific to the individual. Prosthetic restrictions that attempt to mitigate the above intrinsic limitations can be considered extrinsic factors. These intrinsic and extrinsic factors interact to determine an individual’s balance which is a key determinant of their likelihood of falling and/or fear of falling.

    The aim of this symposium is to bring together representatives from a variety of related fields relevant to lower limb amputation to provide a holistic view of the topic and future directions.

    As a basis for the symposium, the progress and current results of a scoping review to summarise the current state of research in balance and postural control will be presented. Based on this, we aim to explore future directions in both clinical care and research. The review will be summarised in two categories: intrinsic factors (person/patient-related) and extrinsic factors (prosthesis/environment).

    We will also provide additional viewpoints from a variety of perspectives, highlighting the interdisciplinary nature of this issue. These include practical aspects of physical therapy, balance and self-confidence and biomechanics, among others.

    Statement of the objective / learning objectivesThe aim of the symposium is to communicate the different approaches to research on this topic, in addition to the issues arising in clinical practice. Participants are be encouraged to join in the discussion. 

  • 10.
    Barnett, Cleveland T.
    et al.
    Nottingham Trent University, Nottingham, U.K. .
    Vanicek, Natalie
    University of Hull, Hull, U.K. .
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Do predictive relationships exist between postural control and falls efficacy in unilateral transtibial prosthesis users?2018In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 99, no 11, p. 2271-2278Article in journal (Refereed)
    Abstract [en]

    Objective

    To assess whether variables from a postural control test relate to and predict falls efficacy in prosthesis users.

    Design

    Twelve-month within and between subjects repeated measures design. Participants performed the Limits of Stability (LOS) test protocol at study baseline and at 6-month follow-up. Participants also completed the Falls Efficacy Scale-International (FES-I) questionnaire, reflecting the fear of falling, and reported the number of falls monthly between study baseline and 6-month follow-up, and additionally at 9- and 12-month follow-ups.

    Setting

    University biomechanics laboratories.

    Participants

    A group of active unilateral transtibial prosthesis users of primarily traumatic etiology (PROS) (n=12) with at least one year of prosthetic experience and age and gender matched control participants (CON) (n=12).

    Interventions

    Not applicable.

    Main Outcome Measure(s)

    Postural control variables derived from centre of pressure data obtained during the LOS test, which was performed on and reported by the Neurocom Pro Balance Master, namely; reaction time (RT), movement velocity (MVL), endpoint (EPE) and maximum (MXE) excursion and directional control (DCL). Number of falls and total FES-I scores.

    Results

    During the study period, the PROS group had higher FES-I scores (U = 33.5, p =0.02), but experienced a similar number of falls, compared to the CON group. Increased FES-I score were associated with decreased EPE (R=-0.73, p=0.02), MXE (R=-0.83, p<0.01) and MVL (R=-0.7, p=0.03) in the PROS group, and DCL (R=-0.82, p<0.01) in the CON group, all in the backwards direction.

    Conclusions

    Study baseline measures of postural control, in the backwards direction only, are related to and potentially predictive of subsequent 6-month FES-I scores in relatively mobile and experienced prosthesis users.

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  • 11.
    Barnett, Cleveland T.
    et al.
    Nottingham Trent University, Nottingham, UK.
    Vanicek, Natalie
    University of Hull, Hull, UK.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Does postural control predict falling and the fear of falling in lower limb amputees?2015In: Prosthetics and Orthotics International, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 39, no 1 (suppl.), article id 313Article in journal (Refereed)
  • 12. Brorsson, Annelie
    et al.
    Willy, R. W.
    Tranberg, Roy
    Gothenburg University, Institute of Clinical Sciences, Section for Anesthesiology, Biomaterials and Orthopaedics, Department of Orthopaedics.
    Grävare Silbernagel, Karin
    Heel-Rise Height Deficit 1 Year After Achilles Tendon Rupture Relates to Changes in Ankle Biomechanics 6 Years After Injury2017In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 45, no 13, p. 3060-3068Article in journal (Refereed)
    Abstract [en]

    Background: It is unknown whether the height of a heel-rise performed in the single-leg standing heel-rise test 1 year after an Achilles tendon rupture (ATR) correlates with ankle biomechanics during walking, jogging, and jumping in the long-term.

    Purpose: To explore the differences in ankle biomechanics, tendon length, calf muscle recovery, and patient-reported outcomes at a mean of 6 years after ATR between 2 groups that, at 1-year follow-up, had less than 15% versus greater than 30% differences in heel-rise height.

    Methods: Seventeen patients with less than 15% (<15% group) and 17 patients with greater than 30% (>30% group) side-toside difference in heel-rise height at 1 year after ATR were evaluated at a mean (SD) 6.1 (2.0) years after their ATR. Ankle kinematics and kinetics were sampled via standard motion capture procedures during walking, jogging, and jumping. Patient-reported outcome was evaluated with Achilles tendon Total Rupture Score (ATRS), Physical Activity Scale (PAS), and Foot and Ankle Outcome Score (FAOS). Tendon length was evaluated by ultrasonography. The Limb Symmetry Index (LSI = [Injured Side divided by Healthy Side x 3 100) was calculated for side differences.

    Results: The.30% group had significantly more deficits in ankle kinetics during all activities compared with patients in the <15% group at a mean of 6 years after ATR (LSI, 70%-149% and 84%-106%, respectively; P =.010-.024). The.30% group, compared with the <5% group, also had significantly lower values in heel-rise height (LSI, 72% and 95%, respectively; P<. 001) and heel-rise work (LSI, 58% and 91%, respectively; P<. 001) and significantly larger side-to-side difference in tendon length (114% and 106%, respectively; P =.012). Achilles tendon length correlated with ankle kinematic variables (r = 0.38-0.44; P =.015-.027) whereas heel-rise work correlated with kinetic variables (r = 20.57 to 0.56; P =.001-.047). LSI tendon length correlated negatively with LSI heel-rise height (r = 20.41; P =.018). No differences were found between groups in patient-reported outcome (P =.143-.852).

    Conclusion: Height obtained during the single-leg standing heel-rise test performed 1 year after ATR related to the long-term ability to regain normal ankle biomechanics. Minimizing tendon elongation and regaining heel-rise height may be important for the long-term recovery of ankle biomechanics, particularly during more demanding activities such as jumping.

  • 13.
    Burrola-Mendez, Yohali
    et al.
    School of Rehabilitation, Université de Montréal, Montréal, Canada; CHU Sainte-Justine Research Centre, Montréal, Canada.
    Kamalakannan, Sureshkumar
    Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom; Public Health Foundation of India, Institute of Public Health, Hyderabad, India.
    Rushton, Paula W
    School of Rehabilitation, Université de Montréal, Montréal, Canada; CHU Sainte-Justine Research Centre, Montréal, Canada.
    Bouziane, Selsabil-A
    School of Rehabilitation, Université de Montréal, Montréal, Canada.
    Giesbrecht, Ed
    Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba, Manitoba, Canada.
    Kirby, R. Lee
    Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Canada.
    Gowran, Rosemary J.
    School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, Health Implementation Science and Technology, University of Limerick, Limerick, Ireland; Assisting Living and Learning (ALL) Institute Maynooth University, Maynooth, Ireland.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Tasiemski, Tomasz
    Department of Adapted Physical Activity, Poznan University of Physical Education, Poznan, Poland.
    Goldberg, Mary
    Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA.
    Tofani, Marco
    Department of Intensive Neurorehabilitation and Robotics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
    Pedersen, Jessica P.
    Department of Physical Medicine, Northwestern University, Evanston, IL, USA.
    Pearlman, Jon
    Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA.
    Wheelchair service provision education for healthcare professional students, healthcare personnel and educators across low- to high-resourced settings: a scoping review2023In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 18, no 1, p. 67-88Article, review/survey (Refereed)
    Abstract [en]

    PURPOSE: This review aimed to collate and summarize available research literature about wheelchair service provision education available to healthcare professional students, healthcare personnel and educators across low- to high-resourced settings.

    METHODS: The Joanna Briggs Institute methodological steps for scoping reviews were followed. Included studies were mainly sourced from Medline, Embase, CINAHL, Scopus, Academic Search Complete and ProQuest. Independent title, abstract and full-text screening with defined inclusion and exclusion criteria was performed. All screening and extraction were performed independently by two authors. A thematic approach was used to synthesize results. Data extracted from included studies were charted according to a template that we created. The study quality was also appraised.

    RESULTS: A total of 25 articles were included (11, 36% from high-income settings) with 12 (48%) observational studies and 13 (52%) experimental studies. The literature addressed three main topics: (1) assessing wheelchair service provision knowledge, (2) implementing training interventions using in-person, online and/or hybrid learning approaches and (3) describing current wheelchair service provision education globally. The most frequently reported training programs used were the Wheelchair Skills Program and the World Health Organization Wheelchair Service Training Package - Basic Level.

    CONCLUSION: Limited information has been published about the integration of wheelchair content into the curricula of professional rehabilitation programs. Efforts to build international partnerships, improve the quality and currency of training programs and build resources that can assist educators in the integration of wheelchair-related content into professional rehabilitation programs should be prioritized.Implications for RehabilitationThis is the first review that examined and synthesized the current state of wheelchair service provision education for rehabilitation students and personnel across low- to high-income countries.Findings from this review indicate that there is limited information about the integration of wheelchair-related content into professional rehabilitation programs.Efforts to build international partnerships, standardize wheelchair service provision content and evaluation and integrate training into professional rehabilitation programs worldwide should be prioritized.

  • 14.
    Chaplin, John
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Gothenburg, Sweden.
    Wartenberg, Constanze
    Qual Registry Ctr West Gotaland, Gothenburg, Sweden.
    Petersson, Christina
    Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Danielsson, Aina
    Univ Gothenburg, Sahlgrenska Acad, Gothenburg, Sweden.
    Initial validation of Swedish PROMIS (R)-25 in an orthopaedic population of children with acute severe knee injury2018In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 27, no Suppl. 1, p. S122-S122, article id 2107Article in journal (Refereed)
    Abstract [en]

    Aims: The quality control of pediatric orthopaedic treatment options requires patient reported outcome measures that offer comparison to referenced populations. This study aimed to contribute to the validation of the Swedish translation of the norm-referenced PROMIS profile-25.

    Methods: Three questionnaires were administered one year after an acute knee injury via the Swedish paediatric orthopaedic registry (SPOQ). The questionnaires were: (1) The PROMIS Pediatric Profile-25, including the short-forms Mobility, Anxiety, Depression, Fatigue, Peer Relationships, Pain Interference and the single-item Pain Intensity, translated following the FACIT translation method, (2) the Knee Injury and Osteoarthritis Outcome scales for children (KOOS-Child, previously validated in Swedish) with the scales Pain, Symptoms, ADL, Sport/play and QoL (39 questions), and (3) a single VAS item, Overall Health Scale. Convergent validity was assessed by interscale correlations and a one-way ANOVA was used to identify differences between three injury categories.

    Results: Of 218 eligible patients, 104 (53 girls, 9-14 years, mean 13 years, 42 with patella luxation, 34 with anterior cruciate ligament rupture and 28 with other knee injuries), returned questionnaires. PROMIS and KOOS-Child had 1% incomplete answers. There was high positive correlation between all KOOS-Child scales, and KOOS-Child-Pain explained a large amount of variance in Symptoms (R2 = .610), ADL (R2 = .648), Sport/play (R2 = .462) and QoL (R2 = .423). An expected high correlation between KOOS-Child-pain and PROMIS-Pain-Interference was found (r = .581, p = \.001). The expected relationship between the PROMIS-Mobility scale and KOOS-Child-QoL (r = .815, p = \.001) was found, confirming that at this age QoL is associated with physical functioning. There were statistically significant differences between the three diagnosis categories for two PROMIS scales: PROMIS-mobility (F(2, 101) = 6.901, p = .002) and PROMIS-depression (F(2, 101) = 3.116, p = .049). The PROMIS subscales showed high Cronbach’s alpha (between 0.730 and 0.864).

    Conclusions: This study is the first in Sweden to investigate the psychometric properties of the PROMIS profile-25 and highlights its relationship to the criterion measure of KOOS-Child. PROMIS-25 uses self-report, ultra-brief measurement for screening, providing additional information that was not available using previous questionnaires. PROMIS-25 can contribute to quality control and lead to improved treatment decisions. Data collection is ongoing through the orthopaedic registry, which will provide further evidence of how PROMIS-25 performs in other paediatric orthopaedic conditions.

  • 15.
    Cochrane, Helen
    et al.
    University of Pittsburgh, USA.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Department of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Mullen, Ashley
    Baylor College of Medicine, Houston, USA.
    Spaulding, Sue
    University of Washington, USA.
    Brinkman, John
    Northwestern University, Chicago, USA.
    Evidence-based practice in education for prosthetic orthotic occupations2023In: ISPO 19th World Congress, 24-27 April 2023, Guadalajara, Mexico – Abstract book, Wolters Kluwer, 2023, Vol. 47 (Suppl.), no Suppl. 1, p. 48-48Conference paper (Refereed)
    Abstract [en]

    This symposium aims to present the current state of evidence-based practice in education for prosthetic orthotic occupations. Presenters will share the current evidence, best practices and ongoing development of a research plan for prosthetic orthotic educators.

    The symposium will follow on from the Global Educators Meeting (GEM) in June 2022 the symposium will present the findings of the educator focus groups held during the GEM and discuss the educators survey.

    Presented by educators aimed at educators this symposium offers an opportunity to learn, contribute and discuss how to get the most out of educational time.

    The objective of this symposium are to help educators in prosthetic orthotic occupations;

    • become more aware of the current evidence, best practices and the work currently ongoing to advance the evidence base for teaching in the field.
    • cultivate collaborations among educator peers.
    • develop and diversify educational practices to stimulate an effective learning environment.

    Statement of the objective/learning objectivesThe objectives of this symposium are to help educators in prosthetic orthotic occupations;

    • become more aware of the current evidence, best practices and the evidence base
    • cultivate collaborations
    • develop and diversify educational practices
  • 16.
    Dillon, M. P.
    et al.
    Department Physiotherapy, Podiatry, Prosthetics and Orthotics. La Trobe University, Melbourne, Australia.
    Fatone, S.
    Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
    Hafner, B. J.
    Department of Rehabilitation Medicine University of Washington, Seattle, WA, USA.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    2020 in Review: A Perspective From the Immediate Past Editors-in-Chief2021In: Prosthetics and Orthotics International, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 45, no 1, p. 1-5Article in journal (Other academic)
  • 17. Dillon, M. P.
    et al.
    Fatone, S.
    Hafner, B. J.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Keeping pace with the ever-growing orthotic and prosthetic profession: New faces and changes at Prosthetics and Orthotics International2019In: Prosthetics and Orthotics International, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 43, no 2, p. i-iiiArticle in journal (Other academic)
  • 18.
    Dillon, Michael P.
    et al.
    Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia.
    Fatone, Stefania
    Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Hafner, Brian J.
    Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
    Prosthetics and Orthotics International welcomes qualitative research submissions2019In: Prosthetics and Orthotics International, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 43, no 4, p. 366-368Article in journal (Other academic)
  • 19.
    Dillon, Michael P.
    et al.
    Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Fatone, Stefania
    Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
    Hafner, Brian J.
    Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
    2019 in review: A perspective from the Editors-in-Chief2020In: Prosthetics and Orthotics International, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 44, no 1, p. 6-9Article in journal (Other (popular science, discussion, etc.))
  • 20. Eek, M. N.
    et al.
    Zügner, Roland
    Stefansdottir, I.
    Tranberg, Roy
    Gothenburg University, Institute of Clinical Sciences, Section for Anesthesiology, Biomaterials and Orthopaedics, Department of Orthopaedics.
    Kinematic gait pattern in children with cerebral palsy and leg length discrepancy: Effects of an extra sole2017In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 55, p. 150-156Article in journal (Refereed)
    Abstract [en]

    The gait pattern in children with cerebral palsy (CP) often differs from normal, with slow velocity, problem with foot clearance and increased stress on joints. Several factors, such as muscle tone, impaired motor control, muscle contractures, skeletal deformities and leg length discrepancy affect gait. Leg length discrepancy can be treated surgically or with elevation of the shoe on the short leg. The purpose of this study was to examine whether compensating for leg length discrepancy, with elevation of the sole, leads to a change in movement pattern during walking in children with spastic CP. Results: Ten children with spastic CP, able to walk without aids, and 10 typically developing (TD) children aged between seven and 14 years were assessed with 3D gait analysis: 1) barefoot, 2) with shoes and 3) with an extra sole beneath the shoe for the shorter leg. All children with CP had a leg length discrepancy of more than or equal to 1.0 cm. In the barefoot condition, the velocity was slower and the stride length was shorter, in children with CP compared with TD. The stride length and gait velocity increased in children with CP with shoes and shoe + sole and the stance time became more symmetrical. Among children with CP, there was more flexion in the longer leg relative to the short leg during barefoot walking. Differences in the kinematic pattern between the long and the short leg decreased with the extra sole. 

  • 21.
    Elhadi, Mustafa M. O.
    et al.
    Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
    Ma, Christina Zong-Hao
    Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
    Lam, Wing K.
    Li Ning Sports Science Research Center, Li Ning (China) Sports Goods, Co. Ltd., Beijing, China.
    Lee, Winson C.-C.
    School of Mechanical, Materials, Mechatronic and Biomedical Engineering, University of Wollongong, Wollongong, Australia.
    Biomechanical approach in facilitating long-distance walking of elderly people using footwear modifications2018In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 64, p. 101-107Article in journal (Refereed)
    Abstract [en]

    Background: Long-distance walking is a convenient way for prompting physical activity of elderly people. However, walking ability declines with aging.

    Research question: This study assessed if silicone insoles with heel lifts (named here the prescribed insoles) could facilitate long-distance walking of older adults.

    Methods: Fifteen adults aged over 65, who did not have obvious lower-limb problems, walked on a treadmill for totally 60 min in two separate walking sessions: 1) with the prescribed insoles, and 2) with original insoles of the standardized shoes. Gait tests using force plates and a motion analysis system, and subjective evaluation using visual analog and Borg's CR10 scales were conducted at different time points of the treadmill walking.

    Results: Objective gait anaylsis showed that without using the prescribed insoles, there were significant reductions (p < 0.05) in stance time, vertical ground reaction force, ankle dorsiflexion angle and ankle power generation of the dominant leg after the 60-minute treadmill walk. Such significant reductions were not observed in the same group of subjects upon using the prescribed insoles. Meanwhile, significant improvements in subjective perception of physical exertion, pain and fatigue were observed.

    Significance: Heel lifts and silicone insoles are generally used to relieve plantar pain and reduce strain of plantar flexors in patients. This study showed they might also be solutions to facilitate long-distance walking of older adults, an approach which could prompt their physical activity. 

  • 22.
    Elhadi, Mustafa M. O.
    et al.
    Interdisciplinary Division of Biomedical Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong.
    Ma, Christina Zong-Hao
    Interdisciplinary Division of Biomedical Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong.
    Wong, Duo W. C.
    Interdisciplinary Division of Biomedical Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong.
    Wan, Anson H. P.
    Interdisciplinary Division of Biomedical Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong.
    Lee, Winson C. C.
    Interdisciplinary Division of Biomedical Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong.
    Comprehensive gait analysis of healthy older adults who have undergone long-distance walking2017In: Journal of Aging and Physical Activity, ISSN 1063-8652, E-ISSN 1543-267X, Vol. 25, no 3, p. 367-377Article in journal (Refereed)
    Abstract [en]

    Many older adults do not adhere to the recommended physical activity levels. This study examines the gait changes upon longdistance walking among healthy older adults. Gait tests of 24 adults aged 65 or more were conducted at baseline and at the end of 30 and 60min of treadmill walking. Spatial temporal, kinematic, and kinetic gait data were computed. Perceived level of exertion was evaluated for each subject. Ten subjects (group B) perceived higher exertion levels than the remaining 14 subjects (group A). After walking, group B had significant reductions in dominant-side ankle joint range of motion and power, suggesting lower-leg muscle fatigue, which appeared to be compensated by significantly increased nondominant-side knee and hip motions. These changes were not observed in group A. Differences in gait parameters between groups A and B implied that some biomechanical factors might contribute to the lack of walking of some older adults. 

  • 23.
    Fatone, Stefania
    et al.
    Northwestern Univ, Chicago, IL 60611 USA..
    Hafner, Brian J.
    Univ Washington, Seattle, WA 98195 USA..
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD. Jonkoping Univ, Jonkoping, Sweden..
    Dillon, Michael P.
    La Trobe Univ, Melbourne, Vic, Australia..
    2020 SAGE Elite Reviewer Award2020In: Prosthetics and Orthotics International, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 44, no 3, p. 114-115Article in journal (Other academic)
  • 24.
    Fatone, Stefania
    et al.
    Northwestern University, Chicago, USA.
    Paul, Charlton
    Barnett, Cleveland
    Nottingham Trent University, UK.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Balancing Act: Exploring Clinical, Theoretical, and Evidence-Based Perspectives in the Optimization of Balance using orthoses in Peripheral Neuropathy2018In: Journal of prosthetics and orthotics, ISSN 1040-8800, E-ISSN 1534-6331, Vol. 30, no 2S, article id 0S9Article in journal (Refereed)
  • 25.
    Flodin, Ulf
    et al.
    Occupational and Environmental Medicine, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Rolander, Bo
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Futurum, Academy for Health and Care, Region Jönköping County, Jönköping, Sweden.
    Löfgren, H.
    Neuro-Orthopedic Center, Ryhov Hospital, Jönköping, Sweden.
    Krapi, B.
    Occupational and Environmental Medicine, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Nyqvist, F.
    Occupational and Environmental Medicine, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Wåhlin, C.
    Occupational and Environmental Medicine, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Risk factors for neck pain among forklift truck operators: a retrospective cohort study2018In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 19, no 44, p. 1-10Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: No previous research has been performed into neck pain among forklift operators. This is a common complaint among these workers, who number around 150,000 in Sweden and six million in Europe. The aim of the study was to examine long-term exposure to unnatural neck positions among forklift operators as a risk factor for neck pain.

    METHODS: A retrospective cohort study was conducted of all eligible employees at a high-level warehouse. Forklift operators and office workers answered an 18-page questionnaire comprising questions about joint pain, work tasks, work postures and year of start for all items. By using person years in the exposed and less-exposed groups before start of neck pain we were able to calculate Incident Rate ratios for various exposures.

    RESULTS: Forty nine percent of the forklift operators reported having experienced neck pain compared to 30 % of office workers. Being a forklift operator was associated with an increased risk of neck pain (OR = 5.1, 95% CI 1.4-18.2). Holding the head in an unnatural position resulted in significantly increased risks for neck pain, irrespective of type of position. The risks for neck pain remained after taking other ergonomic exposures and psychosocial aspects into consideration.

    CONCLUSIONS: This is the first published study showing that forklift operators have an increased risk of neck pain. The results are therefore of significance for improving work schedules, the adjustment of work tasks for these workers and the design of the vehicles.

  • 26.
    Fors, Nils Olov
    et al.
    Kanda University of International Studies, Chiba, Japan.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Languaged education: Developing language-conscious pedagogy for an undergraduate English-taught program at a Swedish university2021Conference paper (Refereed)
  • 27.
    Fritzell, Peter
    et al.
    Futurum Academy, Länssjukhuset Ryhov, Jönköping, Sweden.
    Welinder-Olsson, Christina
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Jönsson, Bodil
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Melhus, Åsa
    Uppsala University Hospital, Uppsala, Sweden.
    Andersson, Siv G. E.
    Department of Cell and Molecular Biology, Biomedical Center, Uppsala University, Uppsala, Sweden.
    Bergström, Tomas
    Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Göteborg, Sweden.
    Tropp, Hans
    Linköping University, Linköping, Sweden.
    Gerdhem, Paul
    Karolinska University Hospital, Stockholm, Sweden.
    Hägg, Olle
    Spine Center Göteborg, Västra Frölunda, Sweden.
    Laestander, Hans
    Spine Center Göteborg, Västra Frölunda, Sweden.
    Knutsson, Björn
    Sundsvall Hospital, Sundsvall, Sweden.
    Lundin, Anders
    Örebro University Hospital, Örebro, Sweden.
    Ekman, Per
    Södersjukhuset, Stockholm, Sweden.
    Rydman, Eric
    Södersjukhuset, Stockholm, Sweden.
    Skorpil, Mikael
    Karolinska University Hospital, Stockholm, Sweden.
    Bacteria: back pain, leg pain and Modic sign—a surgical multicentre comparative study2019In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 28, no 12, p. 2981-2989Article in journal (Refereed)
    Abstract [en]

    Purpose: To compare bacterial findings in pain-generating degenerated discs in adults operated on for lumbar disc herniation (LDH), and mostly also suffering from low back pain (LBP), with findings in adolescent patients with non-degenerated non-pain-generating discs operated on for scoliosis, and to evaluate associations with Modic signs on magnetic resonance imaging (MRI). Cutibacterium acnes (Propionibacterium acnes) has been found in painful degenerated discs, why it has been suggested treating patients with LDH/LBP with antibiotics. As multidrug-resistant bacteria are a worldwide concern, new indications for using antibiotics should be based on solid scientific evidence.

    Methods: Between 2015 and 2017, 40 adults with LDH/LBP (median age 43, IQR 33–49) and 20 control patients with scoliosis (median age 17, IQR 15–20) underwent surgery at seven Swedish hospitals. Samples were cultured from skin, surgical wound, discs and vertebrae. Genetic relatedness of C. acnes isolates was investigated using single-nucleotide polymorphism analysis. DNA samples collected from discs/vertebrae were analysed using 16S rRNA-based PCR sequencing. MRI findings were assessed for Modic changes.

    Results: No bacterial growth was found in 6/40 (15%) LDH patients, compared with 3/20 (15%) scoliosis patients. Most positive samples in both groups were isolated from the skin and then from subcutis or deep within the wound. Of the four disc and vertebral samples from each of the 60 patients, 235/240 (98%) were DNA negative by bacterial PCR. A single species, C. acnes, was found exclusively in the disc/vertebra from one patient in each group. In the LDH group, 29/40 (72%) patients had at least one sample with growth of C. acnes, compared to 14/20 (70%) in the scoliosis group. Bacterial findings and Modic changes were not associated.

    Conclusions: Cutibacterium acnes found in discs and vertebrae during surgery for disc herniation in adults with degenerated discs may be caused by contamination, as findings in this group were similar to findings in a control group of young patients with scoliosis and non-degenerated discs. Furthermore, such findings were almost always combined with bacterial findings on the skin and/or in the wound. There was no association between preoperative Modic changes and bacterial findings. Antibiotic treatment of lumbar disc herniation with sciatica and/or low back pain, without signs of clinical discitis/spondylitis, should be seriously questioned. 

  • 28.
    Gigante, Isabella
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Sigurjónsdóttir, Elva Dröfn
    Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Offloading interventions of diabetes-related neuropathic foot ulcers in Swedish prosthetic and orthotic clinics: a cross-sectional survey2021Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: The project aimed to assess the frequency of offloading provision for diabetes-related plantar neuropathic forefoot ulcers and the factors influencing the choice.

    Methods: Operational managers from 51 prosthetic and orthotic clinics in Sweden were contacted to select the participants. An online survey including seven closed-ended questions was conducted through SurveyMonkey.

    Results: The response rate was 68.6%. The majority of the participants provided the least efficient offloading intervention being off-the-shelf footwear combined with the insole to treat diabetes-related plantar neuropathic forefoot ulcers.  It also resulted that the two gold-standard devices to treat this ulcer type being total contact cast (TCC) and non-removable knee-high walker, were vastly underutilized. Most of the practitioner, patient, intervention, and wound-related factors were considered a median of “often” or “always” being considered when providing offloading interventions for this type of ulcer. The majority of the participants did not consider TCC or non-removable knee-high walkers being the gold standard. 

    Conclusions: A variety of offloading interventions resulted in being provided to patients having diabetes-related plantar neuropathic forefoot ulcers. Participants mainly provided the inadequate pressure distribution offloading intervention, being off-the-shelf footwear with modifications combined with an insole. The gold standards TCC and non-removable knee-high walkers were underutilized. That is, the pattern of providing offloading devices was almost exactly opposite to what evidence-based guidelines recommend. The clinicians’ unawareness regarding gold standard devices may have contributed to the underutilization of TCC and non-removable knee-high walker. Different factors were considered when providing offloading interventions to patients with diabetes-related plantar neuropathic forefoot ulcers. It is concluded that clinicians in Swedish P&O clinics need to have greater awareness regarding the most appropriate offloading device for plantar neuropathic forefoot DFUs. This is of great importance due to the choice of the offloading device greatly impacts ulcer healing.

  • 29.
    Hafner, Brian J.
    et al.
    Univ Washington, Seattle, WA 98195 USA..
    Fatone, Stefania
    Northwestern Univ, Chicago, IL 60611 USA..
    Dillon, Michael P.
    La Trobe Univ, Melbourne, Vic, Australia..
    Ramstrand, Nerrolyn
    Jonkoping Univ, Jonkoping, Sweden..
    Improving the submission, review and publication process for Prosthetics and Orthotics International2020In: Prosthetics and Orthotics International, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 44, no 3, p. 109-113Article in journal (Other academic)
  • 30.
    Heitzmann, Daniel Walter Werner
    et al.
    University Hospital Heidelberg.
    Barnett, Cleveland T.
    Nottingham Trent University.
    Berli, Martin
    University of Zürich, Switzerland.
    Johansson, Paola
    Jönköping University, The University Library.
    Miller, William
    University of British Columbia.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Scheepers, Lisan
    Össur hf, Reykjavik, Iceland.
    Dhariwal, Aditya
    University of British Columbia.
    Balance and postural control of people with a lower-limb amputation: a systematic review of the influence of intrinsic and extrinsic factors [protocol]2022Other (Other academic)
    Abstract [en]

    Review question: What are the research outcomes and methodologies that focus on issues specifically related to either (a) theindividual (intrinsic) and/or (b) factor surrounding the individual (extrinsic)?

    Aim - To identify the foci ofresearch addressing issues related to balance, fear of falling and falls in prosthesis users. 

  • 31.
    Hellgren, Elin
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Breiner, Magnus
    A pilot study on plantar pressure differences at the interface between the metatarsal pad and foot plantar surface: Comparing groups of claw toe, hammer toe and/or hallux valgus toe deformity2021Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 32.
    Hellstrand Tang, Ulla
    et al.
    Göteborgs universitet.
    Jarl, Gustav
    Örebro universitet.
    Eriksson, Marie
    TeamOlmed, Stockholm.
    Johannesson, Anton
    TeamOlmed, Stockholm.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Kliniska riktlinjer som innefattar ortopedtekniska lösningar i Sverige2022Conference paper (Other academic)
  • 33.
    Hellstrand Tang, Ulla
    et al.
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jarl, Gustav
    Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Eriksson, Marie
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Johannesson, G. Anton
    Össur Clinics Scandinavia, Stockholm, Sweden.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Department of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Clinical guidelines recommending prosthetics and orthotics in Sweden: agreement between national and regional guidelines2023In: Prosthetics and Orthotics International, ISSN 0309-3646, E-ISSN 1746-1553Article in journal (Refereed)
    Abstract [en]

    Background and purpose: Despite the presence of both national and regional clinical practical guidelines (CPGs) in Sweden, no previous studies have investigated the quality of CPGs or the level of agreement between national and regional CPGs. This study aimed to examine the quality of national CPGs recommending prosthetics and orthotics (P&O), and; quantify agreement between national and regional CPGs in Sweden.

    Materials and Methods: National and regional CPGs were identified in public databases and by surveyed local Nurse Practitioners. Quality of the national guidelines was assessed by using AGREE II. Agreement between recommendations in the national and regional CPGs were quantified on a four-grade rating scale ("similar", "partially similar", "not similar/not present" and "different").

    Results: Of 18 national CPGs, three CPGs (CPGs of Diabetes, Musculoskeletal disorders and Stroke) had nine recommendations related to P&O. The Musculoskeletal disorders and Stroke CPGs had quality scores >60% in all domains and the Diabetes CPG had scores >60% in five out of six domains according to AGREE II. Seven regional CPGs for P&O treatment were identified. Three national recommendations (in Diabetes CPG) showed "similar" content for all regions and two national recommendations (in Diabetes CPG) showed "not similar" content for all regions. The remaining four national recommendations (in Diabetes, Musculoskeletal disorders and Stroke CPGs) had varying agreement with regional CPGs.

    Interpretation: There is a limited number of national recommendations for treatment within P&O. There was variation in the agreement of P&O-related recommendations in national and regional CPGs, which might lead to unequal care throughout the national healthcare system.

  • 34. Hellstrand Tang, Ulla
    et al.
    Siegenthler, Jacqueline
    Hagberg, Kerstin
    Karlsson, Jon
    Tranberg, Roy
    Gothenburg University, Institute of Clinical Sciences, Section for Anesthesiology, Biomaterials and Orthopaedics.
    Foot anthropometrics in individuals with diabetes compared with the general Swedish population: Implications for shoe design2017In: Foot and Ankle Online Journal, ISSN 1941-6806, Vol. 10, no 3Article in journal (Refereed)
    Abstract [en]

    Background: The literature offers sparse information about foot anthropometrics in patients with diabetes related to foot length, foot width and toe height, although these measurements are important in shoe fitting. A poorly fitted shoe is one of many contributory factors in the development of diabetic foot ulcers. The purpose of this study was to describe the foot anthropometrics in groups of patients with diabetes, in groups representing the general population and to explore whether foot anthropometrics differ between patients with diabetes and the general population.

    Method: Foot anthropometrics (foot length, foot width and maximum toe height) was measured in 164 patients with diabetes, with and without neuropathy (n = 102 and n = 62 respectively). The general population was represented by 855 participants from two sources.

    Results: Foot length, foot width and toe height varied (220-305 mm; 82-132 mm and 15-45 mm respectively) in the diabetic group and in the group representing the general population (194-306 mm; 74-121 mm and 17-31 mm respectively). Age, gender and BMI influence the foot anthropometrics, however, when adjusting for theses variables the index foot length/width was lower (2.58) in patients with diabetes without neuropathy vs. controls (2.63), p = 0.018. Moreover, patients with diabetes with neuropathy had wider feet (98.6 mm) compared with the controls (97.0 mm), p = 0.047.

    Conclusions: The individual variations of foot length, foot width and maximum toe height were large. The impact of gender on foot anthropometrics was confirmed and the impact of age and BMI were shown. Patients with diabetes seemed to have a wider forefoot width and a lower foot length to foot width ratio compared to the controls.

  • 35. Hellstrand Tang, Ulla
    et al.
    Tranberg, Roy
    Gothenburg University, Institute of Clinical Sciences, Section for Anesthesiology, Biomaterials and Orthopaedics, Department of Orthopaedics.
    Zügner, Roland
    Karlsson, Jon
    Lisovskaja, Vera
    Siegenthaler, Jacueline
    Hagberg, Kerstin
    The D-Foot, for prosthetists and orthotists, a new eHealth tool useful in useful in risk classification and foot assessment in diabetes2017In: Foot and Ankle Online Journal, ISSN 1941-6806, Vol. 10, no 2Article in journal (Refereed)
    Abstract [en]

    Background: The prevention and care of foot problems in diabetes begins with a risk classification. Today, the prosthetists and orthotists (CPO) and other health care professionals assess the risk of developing foot ulcers more or less subjectively. The objective of the study was to describe the construction of an eHealth tool, the D-Foot, which generates a risk classification. The reliability of the D-Foot was tested.

    Methods: The D-Foot includes 22 clinical assessments and four self-reported questions. The content validity was assured by expert group consensus and the reliability was assessed through an empirical test-retest study. Inter- and intra-rater reliability was calculated using patients referred to four departments of prosthetics and orthotics (DPO).

    Results: The agreement for the risk classification generated using the D-Foot was 0.82 (pooled kappa 0.31, varying from 0.16 to 1.00 at single DPOs). The inter-rater agreement was > 0.80 regarding the assessments of amputation, Charcot deformity, foot ulcer, gait deviation, hallux valgus/hallux varus and risk grade. The inter- and intra-rater agreements for the discrete measurements were > 0.59 and > 0.72 respectively. For continuous measurements, the inter- and intra-rater correlation varied (0.33-0.98 and 0.25-0.99 respectively).

    Conclusion: The D-Foot gave a reliable risk foot classification. However, there was a variation in the inter- and intra-rater reliability of the assessments included and refinements are needed for variables with low agreement. Based on the results, the D-Foot will be revised before it is implemented in clinical practice.

  • 36. Hellstrand Tang, Ulla
    et al.
    Zügner, Roland
    Lisovskaja, Vera
    Karlsson, Jon
    Hagberg, Kerstin
    Tranberg, Roy
    Gothenburg University, Institute of Clinical Sciences, Section for Anesthesiology, Biomaterials and Orthopaedics, Department of Orthopaedics.
    Comparison of plantar pressure in three types of insole given to patients with diabetes at risk of developing foot ulcers – A two-year, randomized trial2014In: Journal of Clinical & Translational Endocrinology, ISSN 2214-6237, Vol. 1, no 4, p. 121-132Article in journal (Refereed)
    Abstract [en]

    Background

    Special insoles and shoes designed to prevent foot ulcerscaused by repetitive high pressures are recommended for patients with diabetes who have any of the following risk factors: neuropathy; peripheral vascular disease; foot deformities; previous ulcers; amputation; and skin pathologies. However, there is a need for increased knowledge regarding: a) differences in the peak pressure (PP) and pressure time integral (PTI) for different types of insoles; and b) the properties of the pressure distribution for insoles used over a period of several months. We present the results of a randomized trial to compare the plantar pressures of three commonly used insoles.

    Objectives

    The primary objective was to compare the PP and PTI between three types of insoles. The secondary objective was to explore the long-term pattern of peak plantar pressure distribution and variations in specific regions of interest (ROI). The tertiary objective was to investigate the impacts of insole adjustments, how much the insoles were used, and the levels of patient satisfaction.

    Methods

    In a 2-year trial, 114 patients with type 1 (N = 31) or type 2 (N = 83) diabetes (62 men and 52 women; mean age, 57.7 ± 15.4 years; duration of diabetes, 12.3 ± 11.2 years; neuropathy, 38%), were randomized to be supplied with one of three different insoles. The ethylene vinyl acetate (EVA) insoles were used in outdoor walking shoes. The 35 EVA group (N = 39) received soft custom-made insoles composed of EVA of 35 shore A hardness, the 55 EVA group (N = 37) received custom-made insoles composed of EVA of 55 shore hardness, and the control group (N = 38) received prefabricated insoles composed of a hard core with a top layer of soft 12 shore hardness microfiber. Using F-Scan®, the in-shoe plantar pressures were measured at seven ROI (hallux, metatarsal head 1, metatarsal head 2, metatarsal head 4, metatarsal head 5, lateral aspect of the mid-foot, heel) on five occasions during the study period. The plantar-pressure variables used were PP (main outcome) and PTI. The plantar patterns of load were explored, satisfaction and usage of the insoles were rated by the participants, and insole adjustments were recorded.

    Results

    A mixed model analysis estimated lower PP values in the heel regions for the 35 EVA and 55 EVA insoles (171 ± 13 and 161 ± 13 kPa, respectively) than for the prefabricated insoles (234 ± 10 kPa) (p < 0.001). Also for some of the other six ROI indications of difference in PP or PTI could be observed. The redistribution of peak plantar pressure for all of the insoles, was stable at the mid-foot, while the proportion of load on the distal area changed during the study period According to the self-reported answers (scale, 0–100), the average usage of the insoles was rated as 79 and satisfaction was rated as 85 (N = 75). Thirty-two percent of the subjects had not received foot care. Fourteen adjustments to insoles were made during the study period, and 86 pairs of insoles were exchanged due to wear, with 49% being exchanged in the 35 EVA group.

    Conclusions

    Custom-made insoles used in combination with stable walking shoes gave lower pressures at the heel region. The variation makes it difficult to detect a systematic difference in plantar pressure for the 6 ROI, if such a difference indeed exists. The levels of satisfaction and usage for all the insoles tested were high. The insoles maintained their pressure redistribution properties over long periods, and few adjustments were needed.

  • 37. Hellstrand Tang, Ulla
    et al.
    Zügner, Roland
    Lisovskaja, Vera
    Karlsson, Jon
    Hagberg, Kerstin
    Tranberg, Roy
    Gothenburg University, Institute of Clinical Sciences, Section for Anesthesiology, Biomaterials and Orthopaedics, Department of Orthopaedics.
    Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers2015In: Diabetic Foot & Ankle, ISSN 2000-625X, Vol. 6, no 1Article in journal (Refereed)
    Abstract [en]

    Objective: Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. 

    Patients and methods: Patients diagnosed with type 1 (n = 27) or type 2 (n = 47) diabetes (mean age 60.0 +/- 15.0 years) were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan (R). An exploratory analysis of the association of risk factors with PP was performed. 

    Results: Neuropathy was present in 28 (38%), and 39 (53%) had callosities in the heel region. Low forefoot arch was present in 57 (77%). Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2 +/- 0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI) was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. 

    Conclusions: This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU). Hallux valgus and hallux rigidus appeared to increase the PP under the medial forefoot and a high BMI appeared to increase the PP under the lateral forefoot. There is a need to construct a simple, valid, and reliable assessment routine to detect potential risk factors for the onset of DFU.

  • 38.
    Herngren, B.
    et al.
    Lund University, Department of Clinical Sciences, Lund, Sweden.
    Stenmarker, M.
    Futurum - Academy for Health and Care, Jonkoping County Council, Department of Orthopaedics, Ryhov County hospital, Jonkoping, Sweden.
    Enskär, Karin
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Hägglund, G
    Department of Orthopaedics, Skane University Hospital, Lund, Sweden.
    Outcomes after slipped capital femoral epiphysis: a population-based study with three-year follow-up.2018In: Journal of Children's Orthopaedics, ISSN 1863-2521, E-ISSN 1863-2548, Vol. 12, no 5, p. 434-443Article in journal (Refereed)
    Abstract [en]

    Purpose: To evaluate outcomes three years after treatment for slipped capital femoral epiphysis (SCFE): development of a vascular necrosis (AVN), subsequent surgery, hip function and the contralateral hip.

    Methods: This prospective cohort study included a total national population of 379 children treated for SCFE between 2007 and 2013. A total of 449 hips treated for SCFE and 151 hips treated with a prophylactic fixation were identified. The Barnhöft questionnaire, a valid patient-reported outcome measure (PROM), was used.

    Results: In all, 90 hips had a severe slip, 61 of these were clinically unstable. AVN developed in 25 of the 449 hips. Six of 15 hips treated with capital realignment developed AVN. A peri-implant femur fracture occurred in three slipped hips and in two prophylactically pinned hips. In three of these five hips technical difficulties during surgery was identified. In 43 of 201 hips scheduled for regular follow-up a subsequent SCFE developed in the contralateral hip. Implant extraction after physeal closure was performed in 156 of 449 hips treated for SCFE and in 51 of 151 prophylactically fixed hips. Children with impaired hip function could be identified using the Barnhöft questionnaire.

    Conclusion: Fixation in situ is justified to remain as the primary treatment of choice in SCFE. Overweight is more common in children with SCFE than in the average population. Prophylactic fixation is a safe procedure when performed using a correct technique. The number of patients who developed AVN after capital realignment is of concern. We recommend rigorous follow-up of both hips, including PROM evaluation, until physeal closure.

    Level of Evidence: II - prospective cohort study.

  • 39.
    Hultberg, Malin
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    Johansson, Nellie
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    EN JÄMFÖRELSE AV GÅNGMÖNSTER: GÅNGANALYS MED EN CANVAS TENNISSKO JÄMFÖRT MED EN SPORTSKO2020Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: In Sweden it is a general perception that a sports shoe is a better choice than a canvas tennis shoe for everyday use. Previous studies have investigated how different shoe models affect the gait, but none have studied the differences between sport shoes and canvas tennis shoes.

    Aim: Investigate how a shoe with unstable last and a flat insole (canvas tennis shoe) and a shoe with steady last, a sole with good shock absorbing and roll off (sport shoe) affect the mediolateral stability differently during stance.

    Methods: Gait analysis on five female participants. Kinetic and kinematic data collected with3D-modionanalysis system.

    Results: The range of motion differs more between participants than between shoe models. The sport shoe have a negligible lower range of motion than the canvas tennis shoe. Walking in sport shoe shows a more inverted gait than gait in canvas tennis shoe. Step length and stance time are the same in both shoe models.

    Conclusion: The range of motion and motion pattern of the foot in the coronal plane does not differ between canvas tennis shoes and sport shoes during stance phase, but the sport shoe has a more inverted motion.

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  • 40.
    Höög, Gustav
    et al.
    Jönköping University, School of Health and Welfare.
    Högström, Oscar
    Jönköping University, School of Health and Welfare.
    Transtibial Incisiontypes in Prosthetic Rehabilitation: A Scoping Review: Investigating the data available for Different Transtibial Amputation Techniques in Prosthetic Rehabilitation.2023Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Transtibial amputation is a major surgical procedure where both short- and long-term perspectives are important. The surgical method can directly impact stump quality which can affect the prosthetic user’squality of life. 

    The aim of this scoping review is to summarize and give an overview of the research area of different incision types in relation to prosthetic rehabilitation, to help future researchers and potentially unveil areas where further research is needed.

    The research question: What is the data available for Different Transtibial Amputation Techniques in Prosthetic Rehabilitation, which was divided into three sub questions. The 6-step framework for scoping reviews by the Joanna Briggs Institute was used to structure the review.

    From a total of 736 studies screened, 28 were selected and mapped onto 12 different outcome measures.

    Extensive data were found regarding what amputation method has what surgical outcomes. Areas that appear to have research gaps are dressing types and contractures when contrasted with surgical methods. No study could be found regarding length of hospital stay and the Skew flap method. We conclude that there is a research gap when it comes to patient reported assessments, surveys and qualitative evaluations.

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  • 41.
    Jardenius, Daniel
    et al.
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation.
    Johansson, Emil
    Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation.
    Fotens plantara tryck med hellånga variserande och valgiserande inläggskilar2008Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Introduction

    Wedged shoe insoles are used as a treatment for different problems in order to change the ground reaction force. They can secondary cause different loading patterns under the foot compared to normal. No previous study has, to the author’s knowledge, clinically evaluated the plantar foot pressure with different full-length wedges in normal persons.

    Purpose

    The purpose was to evaluate the plantar pressure with different degrees of full-length wedges in normal persons.

    Method

    Twenty persons with normal feet have participated in this single blind study. Wedges were produced clinically in four different shapes, 3° valgus, 0° flat, 3° varus och 6° varus. The test persons were told to walk with the wedges in their comfortable pace in a randomized order. The plantar pressure was measured in the medial and lateral heel as well as in the first and fifth metatarsal head.

    Results

    The results show significant increased mean pressure for varus wedges compared to flat as well as valgus wedges, in the area of the medial heel and first metatarsal joint. Also, valgus wedges show significant increased mean pressure compared to flat condition in area of the medial heel. There is no correlation between wedge height and mean pressure for any of the wedge conditions.

    Conclusion

    Treatment with wedges leads secondary to increased mean pressure for varus wedges compared to flat as well as valgus wedges, in medial heel and first metatarsal joint. Furthermore, valgus wedges show increased mean pressure compared to flat condition in medial heel. Patients sensitive to high plantar pressures in these areas should be treated with caution.  Further studies are recommended.

     

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  • 42.
    Jarl, Gustav
    et al.
    Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Alnemo, John
    Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Tranberg, Roy
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Lundqvist, Lars-Olov
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gender differences in attitudes and attributes of people using therapeutic shoes for diabetic foot complications2019In: Journal of Foot and Ankle Research, ISSN 1757-1146, Vol. 12, article id 21Article in journal (Refereed)
    Abstract [en]

    Background: Therapeutic shoes can prevent diabetic foot reulcerations but their use is complicated by the fact that shoes have psychological and social meanings, which is believed to put a larger burden on women than men. The aim was to compare attitudes and attributes of women and men using therapeutic shoes for diabetic foot complications.

    Methods: A questionnaire was posted to 1230 people with diabetes who had been fitted with therapeutic shoes. Women's and men's answers were compared using t-tests, Mann-Whitney U tests and chi-square tests with Fischer's exact tests. P-values < 0.05 were considered statistically significant.

    Results: Questionnaires from 443 (36.0%) respondents (294 men, 149 women, mean age 69.2 years) were analyzed. More men than women (p < 0.05) had paid employment (20.4% vs 9.4%), had someone who reminded them to wear their therapeutic shoes (27.6% vs 10.0%), and had a history of foot ulcers (62.9% vs 46.3%) or minor amputation (17.7% vs 6.7%). More women than men received disability pension (18.8% vs 10.2%). Women reported worse general health, lower internal locus of control regarding ulcer prevention, and more negative attitudes to the appearance and price of therapeutic shoes and how they felt about wearing them in public. Other comparisons were non-significant: other shoe attributes, education, diabetes type, current foot ulcers, major amputations, satisfaction with shoe services, understanding of neuropathy as a risk factor, locus of control regarding ulcer healing, belief in the shoes' efficacy to prevent and heal ulcers, worries about ulcer healing and new ulcerations, self-efficacy, depression, shoe use/adherence, paying a fee for therapeutic shoes, and social support.

    Conclusions: Men had worse foot complications. Women had worse general health, lower internal locus of control regarding ulcer prevention, and more negative attitudes toward therapeutic shoes. Clinicians should pay more attention to their female patients' concerns. Future research and development should focus on improving the weight and appearance of therapeutic shoes, particularly for women. Research is also needed on how to facilitate the adaption and reevaluation process where patients change from viewing shoes purely as items of clothing to also viewing them as medical interventions.

  • 43.
    Jarl, Gustav
    et al.
    Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hellstrand Tang, Ulla
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Nordén, Erika
    Ottobock, Medical Care Sweden, Stockholm, Sweden.
    Johannesson, Anton
    Össur Clinics Scandinavia, Stockholm, Sweden.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Nordic clinical guidelines for orthotic treatment of osteoarthritis of the knee: A systematic review using the AGREE II instrument2019In: Prosthetics and Orthotics International, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 43, no 5, p. 556-563Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: High-quality clinical practice guidelines are necessary for effective use of resources both at an individual patient- and national-level. Nordic clinical practice guidelines recommendations for orthotic treatment of knee osteoarthritis vary and little is known about their quality.

    OBJECTIVES: The aim of the study was to critically evaluate the quality of clinical practice guidelines in orthotic management of knee osteoarthritis in the Nordic countries.

    STUDY DESIGN: Systematic review.

    METHODS: Four national clinical practice guidelines for treatment of knee osteoarthritis were assessed for methodological rigour and transparency by four independent assessors using the AGREE II instrument. Summary domain scores and inter-rater agreement (Kendall's W) were calculated.

    RESULTS: Domain scores indicate that many guidelines have not sufficiently addressed stakeholder involvement (average score: 55%), applicability (20%) and editorial independence (33%) in the development process. Inter-rater agreement for assessors indicated 'good' agreement for clinical practice guidelines from Finland, Norway and Sweden (W = 0.653, p < 0.001; W = 0.512, p = 0.003 and W = 0.532, p = 0.002, respectively) and 'strong' agreement for the clinical practice guideline from Denmark (W = 0.800, p < 0.001).

    CONCLUSION: Quality of clinical practice guidelines for orthotic treatment of knee osteoarthritis in the Nordic region is variable. Future guideline development should focus on improving methodology by involving relevant stakeholders (e.g. certified prosthetist/orthotists (CPOs)), specifying conflicts of interest and providing guidance for implementation.

    CLINICAL RELEVANCE: The current review suggests that, for the Nordic region, there are areas of improvement which can be addressed, which ensure clinical practice guidelines are developed under stringent conditions and based on sound methods. These improvements would ensure knee osteoarthritis patients are receiving orthotic interventions based on appropriate guidance from published guidelines.

  • 44.
    Jarl, Gustav
    et al.
    Örebro University, Sweden.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    A model to facilitate implementation of the International Classification of Functioning, Disability and Health into prosthetics and orthotics2018In: Prosthetics and Orthotics International, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 42, no 5, p. 468-475Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The International Classification of Functioning, Disability and Health is a classification of human functioning and disability and is based on a biopsychosocial model of health. As such, International Classification of Functioning, Disability and Health seems suitable as a basis for constructing models defining the clinical P&O process. The aim was to use International Classification of Functioning, Disability and Health to facilitate development of such a model. Proposed model: A model, the Prosthetic and Orthotic Process (POP) model, is proposed. The Prosthetic and Orthotic Process model is based on the concepts of the International Classification of Functioning, Disability and Health and comprises four steps in a cycle: (1) Assessment, including the medical history and physical examination of the patient. (2) Goals, specified on four levels including those related to participation, activity, body functions and structures and technical requirements of the device. (3) Intervention, in which the appropriate course of action is determined based on the specified goal and evidence-based practice. (4) Evaluation of outcomes, where the outcomes are assessed and compared to the corresponding goals. After the evaluation of goal fulfilment, the first cycle in the process is complete, and a broad evaluation is now made including overriding questions about the patient's satisfaction with the outcomes and the process. This evaluation will determine if the process should be ended or if another cycle in the process should be initiated.

    CONCLUSION: The Prosthetic and Orthotic Process model can provide a common understanding of the P&O process. Concepts of International Classification of Functioning, Disability and Health have been incorporated into the model to facilitate communication with other rehabilitation professionals and encourage a holistic and patient-centred approach in clinical practice. Clinical relevance The Prosthetic and Orthotic Process model can support the implementation of International Classification of Functioning, Disability and Health in P&O practice, thereby providing a common understanding of the P&O process and a common language to facilitate communication with other rehabilitation professionals.

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  • 45.
    Jarl, Gustav
    et al.
    Örebro universitet.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Eriksson, Marie
    TeamOlmed, Stockholm.
    Hellstrand Tang, Ulla
    Göteborgs universitet.
    Johannesson, Anton
    TeamOlmed, Stockholm.
    Regionala variationer i egenavgifter2022Conference paper (Other academic)
  • 46.
    Jarl, Gustav
    et al.
    Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Terrill, Alexander J.
    School of Mechanical, Medical and Process Engineering, Queensland University of Technology (QUT), Brisbane, QLD, Australia; Centre for Biomedical Technologies, Queensland University of Technology (QUT), Brisbane, QLD, Australia; Faculty of Health, Southern Cross University, Gold Coast, QLD, Australia.
    Barnett, Cleveland T.
    School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom.
    Woodruff, Maria A.
    School of Mechanical, Medical and Process Engineering, Queensland University of Technology (QUT), Brisbane, QLD, Australia; Centre for Biomedical Technologies, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
    Lazzarini, Peter A.
    School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia.
    Personalized offloading treatments for healing plantar diabetic foot ulcers2023In: Journal of Diabetes Science and Technology, E-ISSN 1932-2968, Vol. 17, no 1, p. 99-106Article in journal (Refereed)
    Abstract [en]

    Background: Non-removable knee-high devices are the gold-standard offloading treatments to heal plantar diabetic footulcers (DFUs). These devices are underused in practice for a variety of reasons. Recommending these devices for all patients,regardless of their circumstances and preferences influencing their ability to tolerate the devices, does not seem a fruitfulapproach.

    Purpose: The aim of this article is to explore the potential implications of a more personalized approach to offloading DFUsand suggest avenues for future research and development.

    Methods: Non-removable knee-high devices effectively heal plantar DFUs by reducing plantar pressure and shear at theDFU, reducing weight-bearing activity and enforcing high adherence. We propose that future offloading devices shouldbe developed that aim to optimize these mechanisms according to each individual’s needs. We suggest three differentapproaches may be developed to achieve such personalized offloading treatment. First, we suggest modular devices, wheredifferent mechanical features (rocker-bottom sole, knee-high cast walls/struts, etc.) can be added or removed from thedevice to accommodate different patients’ needs and the evolving needs of the patient throughout the treatment period. Second, advanced manufacturing techniques and novel materials could be used to personalize the design of their devices,thereby improving common hindrances to their use, such as devices being heavy, bulky, and hot. Third, sensors could be usedto provide real-time feedback to patients and clinicians on plantar pressures, shear, weight-bearing activity, and adherence.

    Conclusions: By the use of these approaches, we could provide patients with personalized devices to optimize plantartissue stress, thereby improving clinical outcomes.

  • 47. Jarl, Gustav
    et al.
    Tranberg, Roy
    Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    An innovative sealed shoe to off-load and heal diabetic forefoot ulcers - a feasibility study2017In: Diabetic Foot & Ankle, ISSN 2000-625X, Vol. 8, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Non-removable knee-high devices are the gold standard to treat diabetic foot ulcers located on the plantar forefoot, but they immobilize the ankle, which restricts daily life activities and has negative effects on joint functioning.Objective: To investigate the feasibility of sealing a therapeutic shoe to off-load and heal diabetic forefoot ulcers.

    Design: A case series of seven men with type 2 diabetes and a metatarsal head ulcer were prescribed therapeutic shoes and custom-made insoles. The shoe was sealed with a plastic band. Off-loading was assessed with the F-scan pressure measurement system. Adherence to wearing the shoe was assessed with a temperature sensor and by documenting the status of the seal.

    Results: The off-loading was effective and all ulcers healed. Median time to healing was 56 days (range 8-160). Complications were secondary ulcer (n = 1) and plantar hematoma (n = 1). Five of seven participants did not disturb the seal.

    Conclusions: Sealing a therapeutic shoe is a feasible way to off-load and heal forefoot ulcers. A controlled trial is needed to compare the effectiveness and safety of a sealed shoe to other non-removable devices.

  • 48.
    Johansson, Robin
    et al.
    Jönköping University, School of Health and Welfare.
    Jensen, Louise
    Jönköping University, School of Health and Welfare. Southern Älvsborg Hospital, Borås, Sweden.
    Barnett, Cleveland T.
    School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Department of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Quantitative methods used to evaluate balance, postural control and the fear of falling in lower limb prosthesis users: A systematic review2023In: Prosthetics and Orthotics International, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 47, no 6, p. 586-598Article, review/survey (Refereed)
    Abstract [en]

    Problems with balance, postural control and fear of falling are highly prevalent in lower limb prosthesis users, with much research conducted to understand these issues. The variety of tools used to assess these concepts presents a challenge when interpreting research outcomes. This systematic review aimed to provide a synthesis of quantifiable methods used in the evaluation of balance, postural control and fear of falling in lower limb prosthesis users with an amputation level at or proximal to the ankle joint. A systematic search was conducted in CINAHL, Medline, AMED, Cochrane, Ageline, Scopus, Web of Science, Proquest, PsychINFO, PsycArticles and PubPsych databases followed by additional manual searching via reference lists in the reviewed articles databases. Included articles utilized quantitative measure of balance or postural control as one of the dependent variables, lower limb prosthesis users as a sample group, were published in a peer-reviewed journal in English. Relevant assessment questions were created by the investigators to rate the assessment methods used in the individual studies. Descriptive and summary statistics are utilized to synthesize the results. The search yielded (n=187) articles assessing balance or postural control (n=5487 persons in total) and (n=66) articles assessing fear of falling or balance confidence (n=7325 persons in total). A large number of studies did not present if the chosen methods were valid and reliable for the lower limb prosthesis users. Among study limitations, small sample size was common.

  • 49.
    Jónsdóttir, Berglind
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Halldórsson, Tóbias
    Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Experiences of Treatment Options for Individuals with Proximal Femoral Focal Deficiency: A qualitative interview study about the certified prosthetist/orthotist perspective from the nordic countries2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Proximal femoral focal deficiency (PFFD) is a rare congenital deficiency of the femur. The deficiency is neglected in the creation of literature as other rare diagnoses. There is a need for research regarding the prosthetic treatment and management of PFFD. This study sheds a light on the perspectives of the certified prosthetists/orthotists relating to PFFD management.     

    Aim: The aim of the study will be to explore and increase knowledge about the treatment options available for patients with PFFD and to give insight into the perspectives of CPOs.

    Method: This study is a qualitative interview study, where interviews were conducted by using a semi-structured technique to collect data. 5 participants were interviewed from clinics in the nordic countries. Content analysis was performed using an inductive approach to analyse the data.   

    Results: The findings of interviews produced nine sub-categories which were then divided into between three categories: experience and treatment, working conditions and knowledge. Results revealed that CPOs’ perspectives differed immensely. 

    Conclusions: The study revealed the importance of interprofessional teamwork, resource access and early PFFD management. Additionally, it identified the use of social media in CPO knowledge seeking. A need for a specialised support team for CPOs and immediate family of the individual with PFFD as well as the individual, was discovered.

  • 50. Jónsdóttir, Unnur
    et al.
    Brorsson, Annelie
    Tranberg, Roy
    Gothenburg University, Institute of Clinical Sciences, Department of Orthopaedics.
    Grävare Silbernagel, Karin
    Briem, Kristín
    Dissimilar limb symmetry effect of fatigue on ankle kinetics during single-leg drop jump two years after an Achilles tendon rupture2019Conference paper (Refereed)
    Abstract [en]

    BACKGROUND

    Deficits in calf muscle performance and altered lower limb kinetics exist in patients after an Achilles tendon rupture (ATR). However, the influence of fatigue on functional performance is unclear. The aim of this study was to determine the effect of fatigue on a single-leg drop counter movement jump (drop CMJ) after an ATR.

    MATERIAL AND METHODS

    Twenty-seven subjects (22 male) with the mean (SD) age of 42.8 (9.3) years were evaluated 23.5 (8.4) months after ATR. Conventional motion capture procedures were used for data collection as participants performed drop CMJs before and after a standard fatigue protocol, consisting of bilateral single-leg standing heel-rise test followed by a 5-minute progressive slide board protocol. Data analysis focused on: a) eccentric and concentric ankle joint power (AJP); b) time from initial contact to peak eccentric and concentric AJP.

    RESULTS

    A significant limb by fatigue interaction was found for both eccentric (involved -0.83 W/kg; uninvolved -1.44 W/kg, p<0.001) and concentric AJP (involved -0.20 W/kg; uninvolved -0.71 W/kg, p<0.001), reflecting greater effects of fatigue on the uninvolved side. There was also significant difference in how fatigue delayed time to peak power during concentric (involved 15ms; uninvolved 29ms, p<0.001) but not eccentric AJP (p=0.854)

    CONCLUSION

    Fatigue had a greater effect on the uninvolved compared to the involved side. Since the uninvolved side seems to compensate for deficits in the involved side, there is a risk that the uninvolved side is more prone to injuries when returning back to sports after an ATR.

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