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  • 1.
    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.

  • 2.
    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.

  • 3. 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)
  • 4.
    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.

  • 5.
    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)
  • 6. 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.

  • 7.
    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.

  • 8.
    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)
  • 9. 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. 

  • 10.
    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. 

  • 11.
    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. 

  • 12.
    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 (Other academic)
  • 13.
    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, ISSN 1471-2474, 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.

  • 14. 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.

  • 15. 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.

  • 16. 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.

  • 17. 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.

  • 18.
    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.

  • 19.
    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.

     

  • 20.
    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 1746-1553Article, 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.

  • 21.
    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.

  • 22. 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.

  • 23.
    Kallin, Sara
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    Deformation of human soft tissues: Experimental and numerical aspects2019Licentiate thesis, monograph (Other academic)
  • 24.
    Kerai, Kavita
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Roser, Louise
    Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Measuring function and mobility among clients with diabetes in Samoa2016Independent thesis Basic level (degree of Bachelor), 10 HE creditsStudent thesis
    Abstract [en]

    The aim of the thesis was to collect baseline data and to investigating suitable physical tests and a self-rapport questionnaire. Collected data was used to find a routine measurement when investigating foot health, function and mobility among clients suffering from diabetes in Samoa. Twenty-one participants suffering from diabetes were included in the study. Clients answered the Foot function index (FFI) questionnaire and performed physical tests, consisting of Bergs balance scale (BBS) and Time up and go (TUG). Results from the physical tests revealed a great balance disturbance and mobility limitations among the majority of the clients. General high weight and BMI was measured among both genders. Subjects with the highest BMI performed lowest time during TUG test. The statistic analyze revealed a strong correlation between the two physical tests, indicating that one of the tests could be applied as a routine measurement in the future, when evaluating function and mobility in Samoa. The compilation of self-report questionnaires indicated a general good foot health with a low amount of pain, disabilities and activity limitations.

  • 25.
    Lam, Wing-Kai
    et al.
    Department of Kinesiology, Shenyang Sport University, Shenyang, China.
    Lee, Winson C.-C.
    School of Mechanical, Materials, Mechatronic and Biomedical Engineering, University of Wollongong, Wollongong, NSW, Australia.
    Lee, Wei M.
    Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore.
    Ma, Christina Zong-Hao
    Interdisciplinary Division of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, Hong Kong.
    Kong, Pui W.
    Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore.
    Segmented forefoot plate in basketball footwear: Does it influence performance and foot joint kinematics and kinetics?2018In: Journal of Applied Biomechanics, ISSN 1065-8483, E-ISSN 1543-2688, Vol. 34, no 1, p. 31-38Article in journal (Refereed)
    Abstract [en]

    This study examined the effects of shoes' segmented forefoot stiffness on athletic performance and ankle and metatarsophalangeal joint kinematics and kinetics in basketball movements. Seventeen university basketball players performed running vertical jumps and 5-msprints atmaximumeffort with 3 basketball shoes of various forefoot plate conditions (medial plate, medial + lateral plates, and no-plate control). One-way repeated measures ANOVAs were used to examine the differences in athletic performance, joint kinematics, and joint kinetics among the 3 footwear conditions (α = .05). Results indicated that participants wearing medial + lateral plates shoes demonstrated 2.9% higher jump height than those wearing control shoes (P = .02), but there was no significant differences between medial plate and control shoes (P > .05). Medial plate shoes produced greater maximum plantar flexion velocity than the medial + lateral plates shoes (P < .05) during sprinting. There were no significant differences in sprint time. These findings implied that inserting plates spanning both the medial and lateral aspects of the forefoot could enhance jumping, but not sprinting performances. The use of a medial plate alone, although induced greater plantar flexion velocity at the metatarsophalangeal joint during sprinting, was not effective in improving jump heights or sprint times.

  • 26.
    Larsen, Louise B.
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    Tranberg, Roy
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, PO Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    Effects of thigh holster use on kinematics and kinetics of active duty police officers2016In: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 37, p. 77-82Article in journal (Refereed)
    Abstract [en]

    Background: Body armour, duty belts and belt mounted holsters are standard equipment used by the Swedish police and have been shown to affect performance of police specific tasks, to decrease mobility and to potentially influence back pain. This study aimed to investigate the effects on gait kinematics and kinetics associated with use of an alternate load carriage system incorporating a thigh holster.

    Methods: Kinematic, kinetic and temporospatial data were collected using three dimensional gait analysis. Walking tests were conducted with nineteen active duty police officers under three different load carriage conditions: a) body armour and duty belt, b) load bearing vest, body armour and thigh holster and c) no equipment (control).

    Findings: No significant differences between testing conditions were found for temporospatial parameters. Range of trunk rotation was reduced for both load carriage conditions compared to the control condition (p < 0.017). Range of hip rotation was more similar to the control condition when wearing thigh holster rather than the belt mounted hip holster (p < 0.017). Moments and powers for both left and right ankles were significantly greater for both of the load carriage conditions compared to the control condition (p < 0.017).

    Interpretation: This study confirms that occupational loads carried by police have a significant effect on gait kinematics and kinetics. Although small differences were observed between the two load carriage conditions investigated in this study, results do not overwhelmingly support selection of one design over the other.

  • 27.
    Li, Yumeng
    et al.
    Department of Kinesiology, California State University, Chico, USA .
    Simpson, Kathy J.
    Department of Kinesiology, University of Georgia, Athens, USA .
    Nolan, Lee
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.
    Miller, Marilyn
    Millsboro, USA .
    Johnson, Benjamin
    epartment of Kinesiology and Health Promotion, University of Kentucky, Lexington, USA.
    Lower extremity kinematics of curve sprinting displayed by runners using a transtibial prosthesis2018In: Journal of Sports Sciences, ISSN 0264-0414, E-ISSN 1466-447X, Vol. 36, no 3, p. 293-302Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to determine if the kinematics exhibited by skilled runners wearing a unilateral, transtibial prosthesis during the curve section of a 200-m sprint race were influenced by interaction of limb-type (prosthetic limb (PROS-L) vs. nonprosthetic limb (NONPROS-L)) and curve-side (inside and outside limb relative to the centre of the curve). Step kinematics, toe clearance and knee and hip flexion/extension, hip ab/adduction for one stride of each limb were generated from video of 13 males running the curve during an international 200 m transtibial-classified competition. Using planned comparisons (P < 0.05), limb-type and curve-side interactions showed shortest support time and lowest hip abduction displacement by outside-NONPROS-L; shortest step length and longest time to peak knee flexion by the inside-PROS-L. For limb-type, greater maximum knee flexion angle and lower hip extension angles and displacement during support and toe clearance of PROS-Ls occurred. For curve-side, higher hip abduction angles during non-support were displayed by inside-limbs. Therefore, practitioners should consider that, for curve running, these kinematics are affected mostly by PROS-L limitations, with no clear advantage of having the PROS-L on either side of the curve. 

  • 28. Lundgren, Lina
    et al.
    Zügner, Roland
    Tranberg, Roy
    Gothenburg University, Gothenburg, Sweden.
    Brorsson, Sofia
    Osvalder, Anna-Lisa
    Effect of stance width on kinematics of laboratory landings with fixed feet on a kiteboard2017Conference paper (Refereed)
  • 29. Lundgren, Lina
    et al.
    Zügner, Roland
    Tranberg, Roy
    Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden.
    Osvalder, Anna-Lisa
    Brorsson, Sofia
    Normalizing stance width2012In: Proceedings of the XIXth Congress of the International Society of Electrophysiology & Kinesiology / [ed] Kylie Tucker, Bianca Butler & Paul Hodges, Brisbane: NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health , 2012, p. 221-221Conference paper (Other academic)
    Abstract [en]

    INTRODUCTION: In previous studies, stance widths are most often determined as a percentage of shoulder width, where 70% of shoulder width is considered a narrow stance width and 140% of shoulder width is considered a wide stance width. A few studies have also normalized stance width to the width of the hips (distance between trochanters). However, there are also a possibility to normalize stance width in relation to the length of the lower extremities, since this variable might not change as much in dynamic situations and may correlate higher to the angle of the lower extremity in a frontal plane. 

    AIM: This study aims to compare measurements of stance width when normalized to shoulder width, hip width and leg length for three different stance widths with feet attached to a board. 

    METHOD: Motion capture (Qualisys, 16 Oqus-cameras) was used to measure 7 active male kitesurfers with their feet attached to a kiteboard (136 cm). They were 20-28 years old, in average 180 cm (SD=7 cm) and 78 kg (SD=7 kg). The subjects were standing with three different stance widths, using the same external rotation (20° bilaterally). Markers were attached to shoulders (acromion processes), knee joint lines, hips (trochanter major), heels (mid-posterior of calcaneus) and ankles (lateral and medial malleoli). Stance width was measured as the distance between the two medial ankle markers and normalized towards the distances between (1) the shoulder markers, (2) the hip markers and knee marker plus knee marker and lateral ankle marker and (3) the right and left hip marker. Furthermore, the angle of an extended lower extremity towards a vertical line in the frontal plane was measured. All measurements were done twice, and SPSS 20 was used for data analysis of correlation (Pearson’s r). 

    RESULTS: The measured stance widths between ankles were 39.9 cm, 43.6 cm, and 48 cm (SD=1.2-1.4) for all subjects. The correlations (r) between the angle of the leg towards a vertical line and normalized stance width for the three normalization variables were: (1) 0.79, (2) 0.96 and (3) 0.93. All of the correlations were significant at a level of p&gt;0.01. 

    CONCLUSION: The results show that the variables hip or leg length would be preferred to use when normalizing stance width for young male athletes, standing in wide stance widths. Further studies using a greater number of subjects, more stance widths and a more heterogeneous group are suggested for the future.

  • 30.
    Lundh, Dan
    et al.
    University of Skövde, Skövde, Sweden.
    Coleman, Scott
    Motion and Sports Lab, Baylor University Medical Center, Dallas, TX, United States.
    Riad, Jacques
    Orthopaedic Department, Skaraborg Hospital Skövde, Skövde, Sweden.
    Movement deviation and asymmetry assessment with three dimensional gait analysis of both upper- and lower extremity results in four different clinical relevant subgroups in unilateral cerebral palsy2014In: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 29, no 4, p. 381-386Article in journal (Refereed)
    Abstract [en]

    Background: In unilateral cerebral palsy, movement pattern can be difficult to define and quantify. The aim was to assess the degree of deviation and asymmetry in upper and lower extremities during walking.

    Methods: Forty-seven patients, 45 Gross Motor Function Classification Scale (GMFCS) I and 2 patients GMFCS 11, mean age 17.1 years (range 13.1 to 24.0) and 15 matched controls were evaluated. Gait profile score (GPS) and arm posture score (APS) were calculated from three-dimensional gait analysis (GA). Asymmetry was the calculated difference in deviation between affected and unaffected sides.

    Findings: The GPS was significantly increased compared to the control group on the affected side (6.93 (2.08) versus 4.23 (1.11) degrees) and on the unaffected side (6.67 (2.14)). The APS was also significantly increased on the affected side (10.39 (5.01) versus 5.52 (1.71) degrees) and on the unaffected side (7.13 (2.23)). The lower extremity asymmetry increased (significantly) in comparison with the control group (7.89 (3.82) versus 3.90 (1.01)) and correspondingly in the upper extremity (9.75 (4.62) versus 5.72 (1.84)). The GPS was not different between affected and unaffected sides, however the APS was different (statistically significant).

    Interpretation: We calculated deviation and asymmetry of movement during walking in unilateral CP, identifying four important clinical groups: close to normal, deviations mainly in the leg, deviations mainly in the arm and those with deviation in the arm and leg. This method can be applied to any patient group, and aid in diagnosing, planning treatment, and prognosis.

  • 31.
    Ma, Christina Zong-Hao
    et al.
    Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
    Lee, Winson C.-C.
    Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
    A wearable vibrotactile biofeedback system improves balance control of healthy young adults following perturbations from quiet stance2017In: Human Movement Science, ISSN 0167-9457, E-ISSN 1872-7646, Vol. 55, p. 54-60Article in journal (Refereed)
    Abstract [en]

    Maintaining postural equilibrium requires fast reactions and constant adjustments of the center of mass (CoM) position to prevent falls, especially when there is a sudden perturbation of the support surface. During this study, a newly developed wearable feedback system provided immediate vibrotactile clues to users based on plantar force measurement, in an attempt to reduce reaction time and CoM displacement in response to a perturbation of the floor. Ten healthy young adults participated in this study. They stood on a support surface, which suddenly moved in one of four horizontal directions (forward, backward, left and right), with the biofeedback system turned on or off. The testing sequence of the four perturbation directions and the two system conditions (turned on or off) was randomized. The resulting reaction time and CoM displacement were analysed. Results showed that the vibrotactile feedback system significantly improved balance control during translational perturbations. The positive results of this preliminary study highlight the potential of a plantar force measurement based biofeedback system in improving balance under perturbations of the support surface. Future system optimizations could facilitate its application in fall prevention in real life conditions, such as standing in buses or trains that suddenly decelerate or accelerate. 

  • 32.
    Ma, Christina Zong-Hao
    et al.
    Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
    Wan, Anson H. -P
    Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
    Wong, Duo W.-C.
    Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
    Zheng, Yong-Ping
    Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
    Lee, Winson C.-C.
    Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
    A vibrotactile and plantar force measurement-based biofeedback system: Paving the way towards wearable balance-improving devices2015In: Sensors, ISSN 1424-8220, E-ISSN 1424-8220, Vol. 15, no 12, p. 31709-31722Article in journal (Refereed)
    Abstract [en]

    Although biofeedback systems have been used to improve balance with success, they were confined to hospital training applications. Little attempt has been made to investigate the use of in-shoe plantar force measurement and wireless technology to turn hospital training biofeedback systems into wearable devices. This research developed a wearable biofeedback system which detects body sway by analyzing the plantar force and provides users with the corresponding haptic cues. The effects of this system were evaluated in thirty young and elderly subjects with simulated reduced foot sensation. Subjects performed a Romberg test under three conditions: (1) no socks, system turned-off; (2) wearing five layers of socks, system turned-off; (3) wearing five layers of socks, and system turned-on. Degree of body sway was investigated by computing the center of pressure (COP) movement measured by a floor-mounted force platform. Plantar tactile sensation was evaluated using a monofilament test. Wearing multiple socks significantly decreased the plantar tactile sensory input (p < 0.05), and increased the COP parameters (p < 0.017), indicating increased postural sway. After turning on the biofeedback system, the COP parameters decreased significantly (p < 0.017). The positive results of this study should inspire future development of wearable plantar force-based biofeedback systems for improving balance in people with sensory deficits. 

  • 33.
    Ma, Christina Zong-Hao
    et al.
    Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
    Wong, Duo W.-C.
    Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
    Lam, Wing K.
    Li Ning Sports Science Research Center, Beijing, China.
    Wan, Anson H.-P.
    Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
    Lee, Winson C.-C.
    Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
    Balance improvement effects of biofeedback systems with state-of-the-art wearable sensors: A systematic review2016In: Sensors, ISSN 1424-8220, E-ISSN 1424-8220, Vol. 16, no 4, article id 434Article, review/survey (Refereed)
    Abstract [en]

    Falls and fall-induced injuries are major global public health problems. Balance and gait disorders have been the second leading cause of falls. Inertial motion sensors and force sensors have been widely used to monitor both static and dynamic balance performance. Based on the detected performance, instant visual, auditory, electrotactile and vibrotactile biofeedback could be provided to augment the somatosensory input and enhance balance control. This review aims to synthesize the research examining the effect of biofeedback systems, with wearable inertial motion sensors and force sensors, on balance performance. Randomized and non-randomized clinical trials were included in this review. All studies were evaluated based on the methodological quality. Sample characteristics, device design and study characteristics were summarized. Most previous studies suggested that biofeedback devices were effective in enhancing static and dynamic balance in healthy young and older adults, and patients with balance and gait disorders. Attention should be paid to the choice of appropriate types of sensors and biofeedback for different intended purposes. Maximizing the computing capacity of the micro-processer, while minimizing the size of the electronic components, appears to be the future direction of optimizing the devices. Wearable balance-improving devices have their potential of serving as balance aids in daily life, which can be used indoors and outdoors. 

  • 34.
    Ma, Christina Zong-Hao
    et al.
    The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Wong, Duo W.-C.
    The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Wan, Anson H.-P.
    The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Lee, Winson C.-C.
    Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia.
    Effects of orthopedic insoles on static balance of older adults wearing thick socks2018In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 42, no 3, p. 357-362Article in journal (Refereed)
    Abstract [en]

    Background: The wearing of socks and insoles may affect the ability of the foot to detect tactile input influencing postural balance.

    Objectives: The aim of this study was to investigate whether (1) thick socks adversely affected the elderly postural balance and (2) orthopedic insoles could improve the elderly postural balance while wearing thick socks.

    Study design: Repeated-measures study design. Methods: In total, 14 healthy older adults were recruited. A monofilament test was conducted to evaluate foot plantar sensation with and without thick socks. Subjects then performed the Romberg tests under three conditions: (1) barefoot, (2) with socks only, and (3) with both socks and insoles. Postural balance was assessed by measuring the center of pressure movement during standing in each experimental condition.

    Results: Thick socks significantly decreased the monofilament score (p < 0.001), suggesting reduction in ability to detect external forces. All center of pressure parameters increased significantly while wearing thick socks (p < 0.017), implying reduction of postural stability. They then decreased significantly with the additional use of insoles (p < 0.017).

    Conclusion: Previous studies have documented the changes in plantar pressure distribution with the use of orthopedic insoles. This study further suggests that such changes in contact mechanics could produce some balance-improving effects, which appears not to have been reported earlier.

    Clinical relevance: Wearing thick socks reduces plantar pressure sensitivity and increases postural sway which may increase risk of falls. Orthopedic insoles and footwear with similar design could potentially be a cost-effective method in maintaining postural balance when wearing thick socks. 

  • 35.
    Ma, Christina Zong-Hao
    et al.
    Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
    Zheng, Yong-Ping
    Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
    Lee, Winson C.-C.
    Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong.
    Changes in gait and plantar foot loading upon using vibrotactile wearable biofeedback system in patients with stroke2018In: Topics in Stroke Rehabilitation, ISSN 1074-9357, E-ISSN 1945-5119, Vol. 25, no 1, p. 20-27Article in journal (Refereed)
    Abstract [en]

    Background: Patients with stroke walk with excessive foot inversion at the affected side, which may disturb their balance and gait.

    Objectives: This study aimed to investigate the effects of instant biofeedback of plantar force at the medial and lateral forefoot regions on gait and plantar foot loading in patients with stroke.

    Methods: A total of eight patients with hemiplegic stroke, who had flexible rearfoot varus deformity at the affected side, participated in this study. A vibrotactile biofeedback system was developed and evaluated. It analyzed forces at the medial and lateral forefeet, and instantly provided vibration clues when the plantar force at medial forefoot was less than a threshold. Each subject’s three-dimensional gait parameters and plantar-pressure distribution during walking were measured under two experimental conditions (sequence randomized): with and without the device turned on (Trial-registration number: ChiCTR-IPB-15006530 and HKCTR-1853).

    Results: Providing biofeedback significantly reduced the foot inversion and increased the mid-stance foot–floor contact area and medial midfoot plantar pressure of the affected limb, bringing the values of these parameters closer to those of the unaffected side. The biofeedback also significantly reduced the unaffected side’s excessive knee flexion and hip abduction.

    Conclusions: There were signs of improved foot loading characteristics and gait upon provision of instant vibrotactile biofeedback of plantar force. The positive results of this study further support the development of wearable biofeedback devices for improving gait of patients with stroke. 

  • 36.
    Mlakar, Maja
    et al.
    University Rehabilitation Institute, Ljubljana, Slovenia.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Burger, Helena
    University Rehabilitation Institute, Ljubljana, Slovenia.
    Vidmar, Gaj
    University Rehabilitation Institute, Ljubljana, Slovenia.
    Effect of custom-made and prefabricated orthoses on grip strength in persons with carpal tunnel syndrome2014In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 38, no 3, p. 193-198Article in journal (Refereed)
    Abstract [en]

    Background: Based on the literature, patients with carpal tunnel syndrome are suggested to wear a custom-made wrist orthosis immobilizing the wrist in a neutral position. Many prefabricated orthoses are available on the market, but the majority of those do not assure neutral wrist position. Objectives: We hypothesized that the use of orthosis affects grip strength in persons with carpal tunnel syndrome in a way that supports preference for custom-made orthoses with neutral wrist position over prefabricated orthoses. Study design: Experimental. Methods: Comparisons of grip strength for three types of grips (cylindrical, lateral, and pinch) were made across orthosis types (custom-made, prefabricated with wrist in 20 degrees of flexion, and none) on the affected side immediately after fitting, as well as between affected side without orthosis and nonaffected side. Results: Orthosis type did not significantly affect grip strength (p = 0.661). Cylindrical grip was by far the strongest, followed by lateral and pinch grips (p < 0.050). The grips of the affected side were weaker than those of the nonaffected side (p = 0.002). Conclusions: In persons with carpal tunnel syndrome, neither prefabricated orthoses with 20 degrees wrist extension nor custom-made wrist orthoses with neutral wrist position influenced grip strength of the affected hand. Compared to the nonaffected side, the grips of the affected side were weaker. Clinical relevance The findings from this study can be used to guide application of orthoses to patients with carpal tunnel syndrome.

  • 37.
    Möller, Saffran
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Functioning in prosthetic users provided with and without a microprocessor-controlled prosthetic knee – relative effects on mobility, self-efficacy and attentional demand2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: To undergo a lower limb amputation is a traumatic experience affecting the individual on physical as well as psychological levels and often leading to limitations in a person´s daily life. Following an amputation individual often receive a prosthesis to address impairments in mobility and functioning. The mechanical properties of the prosthesis can vary, and the choice of specific components to include in the device has been demonstrated to influence patient outcomes. Studies investigating the relative effects of different prosthetic knee components have generally focused upon physical and biomechanical outcomes, providing a rather narrow view of health-related states in prosthetic users. There is a need to view health and wellbeing of prosthetic users from a broader perspective by evaluating outcomes that reflect a variety of different factors that can influence their functioning.

    Aim: The overall aim of this thesis was to describe and compare functioning in individuals with a trans-femoral amputation or knee disarticulation and to evaluate the relative effects of using non-microprocessor-controlled prosthetic knees (non-MPK) or microprocessor-controlled prosthetic knees (MPK).

    Methods: The four studies presented in this thesis used a cross-sectional, quantitative design with different types of data collection methods. These included self-report measures, capacity tests, a survey with two questionnaires and a measure of cortical brain activity during normal level waking and while performing a secondary task. One group of 42 individuals with lowerlimb amputations, using a prosthetic knee with or without microprocessor-control was included in the survey study. Another group of 29 individuals with a lower limb amputation, using a prosthetic knee with or without a microprocessor-control and a control group (n=16) participated in the remaining studies. Statistical tests were used to compare differences between groups using different knee joints, between prosthesis users and controls.

    Results: Individuals using a non-MPK had lower self-reported mobility and balance confidence as well as poorer results on mobility tests compared to those using an MPK. Results revealed no significant differences in self-rated health, daily step count or general self-efficacy. Increased cortical brain activity was seen in frontal cortex in individuals using a non-MPK in single-task walking compare to the MPK group and controls. A significant increase in brain activity was also seen in prefrontal cortex in dual-task walking compared to single-task walking in those walking with an MPK and controls.

    Conclusion: Combined results of all four studies suggest that persons provided with an MPK had better mobility, both self-rated and objectively evaluated, and better self-rated balance confidence than those who were using a non-MPK. Results also showed that an individual’s belief in their own ability was associated with the number of hours they use their prosthesis per week. Participants using a non-MPK had higher levels of cortical brain activity in the frontal cortex during walking, suggesting that the attentional demand required to walk was greater than for individuals using an MPK. Of particular interest for health professionals involved in prosthetic rehabilitation was the finding that significant increases in attentional demand were not always reflected in temporospatial gait parameters. This suggests that cognitive demands may not always be reflected in variables that are commonly evaluated in the clinical setting.

  • 38.
    Möller, Saffran
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. 0000-0002-5360-7776.
    Hagberg, Kerstin
    Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Samuelsson, Kersti
    Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Perceived self-efficacy and specific self-reported outcomes in persons with lower-limb amputation using a non-microprocessor-controlled versus a microprocessor-controlled prosthetic knee2018In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 13, no 3, p. 220-225Article in journal (Refereed)
    Abstract [en]

    Purpose: To measure self-efficacy in a group of individuals who have undergone a lower-limb amputation and investigate the relationship between self-efficacy and prosthetic-specific outcomes including prosthetic use, mobility, amputation-related problems and global health. A second purpose was to examine if differences exist in outcomes based upon the type of prosthetic knee unit being used.

    Method: Cross-sectional study using the General Self-Efficacy (GSE) Scale and the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA). Forty-two individuals participated in the study. Twenty-three used a non-microprocessor-controlled prosthetic knee joint (non-MPK) and 19 used a microprocessor-controlled prosthetic knee joint (MPK).

    Results: The study sample had quite high GSE scores (32/40). GSE scores were significantly correlated to the Q-TFA prosthetic use, mobility and problem scores. High GSE scores were related to higher levels of prosthetic use, mobility, global scores and negatively related to problem score. No significant difference was observed between individuals using a non-MPK versus MPK joints. Conclusions: Individuals with high self-efficacy used their prosthesis to a higher degree and high self-efficacy was related to higher level of mobility, global scores and fewer problems related to the amputation in individuals who have undergone a lower-limb amputation and were using a non-MPK or MPK knee. Implications for rehabilitationPerceived self-efficacy has has been shown to be related to quality of life, prosthetic mobility and capability as well as social activities in daily life. Prosthetic rehabilitation is primary focusing on physical improvement rather than psychological interventions. More attention should be directed towards the relationship between self-efficacy and prosthetic related outcomes during prosthetic rehabilitation after a lower-limb amputation. 

  • 39.
    Möller, Saffran
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Hagberg, Kerstin
    Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Cortical brain activity of transfemoral or knee-disarticulation prosthesis users performing single and dual-task walking activitiesManuscript (preprint) (Other academic)
  • 40.
    Möller, Saffran
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Hagberg, Kerstin
    Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Differences in mobility for individuals using a non-microprocessor-controlled versus a microprocessor-controlled prosthetic kneeManuscript (preprint) (Other academic)
  • 41.
    Möller, Saffran
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Hagberg, Kerstin
    Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Sweden.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Reduced cortical brain activity with the use of microprocessor-controlled prosthetic knees during walking2019In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 43, no 3, p. 257-265Article in journal (Refereed)
    Abstract [en]

    Background: Individuals using a lower-limb prosthesis indicate that they need to concentrate on every step they take. Despite self-reports of increased cognitive demand, there is limited understanding of the link between cognitive processes and walking when using a lower-limb prosthesis.

    Objective: The objective was to assess cortical brain activity during level walking in individuals using different prosthetic knee components and compare them to healthy controls. It was hypothesized that the least activity would be observed in the healthy control group, followed by individuals using a microprocessor-controlled prosthetic knee and finally individuals using a non-microprocessor-controlled prosthetic knee.

    Study Design: Cross-sectional study.

    Methods:: An optical brain imaging system was used to measure relative changes in concentration of oxygenated and de-oxygenated haemoglobin in the frontal and motor cortices during level walking. The number of steps and time to walk 10 m was also recorded. The 6-min walk test was assessed as a measure of functional capacity.

    Results: Individuals with a transfemoral or knee-disarticulation amputation, using non-microprocessor-controlled prosthetic knee ( n = 14) or microprocessor-controlled prosthetic knee ( n = 15) joints and healthy controls ( n = 16) participated in the study. A significant increase was observed in cortical brain activity of individuals walking with a non-microprocessor-controlled prosthetic knee when compared to healthy controls ( p < 0.05) and individuals walking with an microprocessor-controlled prosthetic knee joint ( p < 0.05).

    Conclusion: Individuals walking with a non-microprocessor-controlled prosthetic knee demonstrated an increase in cortical brain activity compared to healthy individuals. Use of a microprocessor-controlled prosthetic knee was associated with less cortical brain activity than use of a non-microprocessor-controlled prosthetic knee.

    Clinical Relevance: Increased understanding of cognitive processes underlying walking when using different types of prosthetic knees can help to optimize selection of prosthetic components and provide an opportunity to enhance functioning with a prosthesis.

  • 42.
    Nolan, Lee
    et al.
    Jönköping University, School of Health Science, HHJ. Prosthetics and Orthotics.
    Patritti, Benjamin L.
    Repatriat Gen Hosp, Dept Rehabil & Aged Care, Adelaide, SA, Australia.
    Simpson, Kathy J.
    Univ Georgia, Dept Kinesiol, Athens, GA 30602 USA.
    Effect of take-off from prosthetic versus intact limb on transtibial amputee long jump technique2012In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 36, no 3, p. 297-305Article in journal (Refereed)
    Abstract [en]

    Background: Increasing numbers of long jumpers with lower limb amputations choose to take off from their prosthetic limb. It is not yet known what difference in technique, if any, this requires, or which is more advantageous. Objectives: To investigate kinematic differences in long jump technique in athletes with a unilateral transtibial ampution (TT) who take off from their prosthetic limb versus those who take off from their intact limb. Study Design: Naturalistic, field-based, observational; independent group, nonparametric comparison. Methods: Two-dimensional sagittal plane kinematic analysis was performed on all athletes competing in the men's Paralympic TT long jump finals. Five athletes took off from their prosthetic limb (TOprosth) and five from their intact limb (TOintact). Results: No differences were seen between the two groups in terms of jump distance, approach speed or vertical velocity at touch down. While in contact with the take-off board, the two groups gained a similar amount of vertical velocity. However, the TOprosth group appeared to conserve horizontal velocity by using the prosthesis as a 'springboard', minimizing the large hip and knee range of motion displayed by the TOintact group and athletes in previous studies. Conclusions: While differences in technique were observed, no difference was found for jump distance.

  • 43.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Clinical outcome measures to evaluate the effects of lower-limb orthotic management post-stroke2018Conference paper (Other academic)
  • 44.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Considerations for developing an evidenced-based practice in orthotics and prosthetics2018In: International Central European ISPO conference 2018, September 20-22, 2018, Portorož, Slovenia: Book of abstracts, 2018, p. 54-54Conference paper (Refereed)
  • 45.
    Ramstrand, Nerrolyn
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    The Prosthetic and Orthotic process model (POP)2018Conference paper (Refereed)
  • 46.
    Ramstrand, Nerrolyn
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Andersson, Christina Björk
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Effects of an unstable shoe construction on standing balance in children with developmental disabilities: a pilot study2008In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 32, no 4, p. 422-433Article in journal (Refereed)
    Abstract [en]

    This study aimed to investigate if prolonged use of shoes incorporating an unstable sole construction could facilitate improvements of balance in a sample of developmentally disabled children. Ten children (six male and four female) aged between 10 and 17 years participated in the study. Children were fitted with shoes incorporating an unstable sole (Masai Barefoot Technology) and instructed to wear them for a minimum of two hours per day for eight weeks. A within subjects repeated measures design was used. Children were tested prior to receiving the shoes, four weeks after receiving the shoes and eight weeks after receiving the shoes. A force plate capable of rotating about a single axis (NeuroCom International Inc, Oregon) was used to test static balance, reactive balance and directional control. Static balance was not found to be influenced by prolonged use of the footwear; however, significant improvements were noted in children's reactive balance both with the shoes and barefoot. Results suggest that reactive balance can be improved by prolonged and regular use of shoes incorporating an unstable sole construction.

  • 47.
    Ramstrand, Nerrolyn
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Brodtkorb, T.-H.
    Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Considerations for developing an evidenced-based practice in orthotics and prosthetics2008In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 32, no 1, p. 93-102Article in journal (Refereed)
  • 48.
    Ramstrand, Nerrolyn
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Gjøvaag, T.
    Starholmen, I.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Effects of knee orthosis design on proprioception and balance2017Conference paper (Refereed)
  • 49.
    Ramstrand, Nerrolyn
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Gjøvaag, Terje
    Oslo Metropolitan University, Norway.
    Starholm, Inger Marie
    Oslo Metropolitan University, Norway.
    Rusaw, David
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Effects of knee orthoses on kinesthetic awareness and balance in healthy individuals2019In: Journal of Rehabilitation and Assistive Technologies Engineering, ISSN 2055-6683, Vol. 6Article in journal (Refereed)
    Abstract [en]

    Introduction: Conflicting evidence exists regarding the effects of knee orthoses on proprioception. One belief is that pressure applied by orthoses heightens kinesthetic awareness and that this affects balance. This study aimed to investigate effects of two different orthosis designs on kinesthetic awareness and balance in healthy individuals.

    Methods: Twenty individuals (13 women) participated in this case series study. Each were tested wearing 1/no orthosis, 2/soft elastic orthosis and 3/non-elastic jointed orthosis. Pressure under orthoses was recorded. Kinesthetic awareness was investigated by testing Joint Position Sense (JPS) and Threshold to Detection of Passive Motion (TDPM). Balance was tested using a Modified Sensory Organization Test (mSOT).

    Results: Non-elastic jointed orthoses applied the greatest pressure to the knee. With non-elastic jointed orthoses, TDPM was significantly poorer for pooled results (p= 0.02) and when the start position of the knee was 70 degrees (mean threshold = 0.6 º, 0.6 º, 0.7º for no-orthosis, elastic and jointed-orthoses; p= 0.03). No major differences were observed in JPS or balance and correlation between proprioception and balance was poor.

    Conclusions: There may be a limit to the amount of pressure that should be applied to the knee joint by an orthosis. Exceeding this limit may compromise kinesthetic awareness.

  • 50.
    Ramstrand, Nerrolyn
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. Prosthetics and Orthotics.
    Jacobs, Norman
    ISPO Consensus Conference on Appropriate Lower Limb Orthotics for Developing Countries: Conclusions and Recommendations2007In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 31, no 2, p. 214-216Article in journal (Other academic)
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