No description available.

The purpose of this thesis was to identify fall risk individuals (+55) after stroke by validating a fall risk index and in post-stroke individuals with high risk of falls evaluate the impact of an intervention program on fall risk factors.A previously developed fall risk index was validated, modified and re-validated. The validation showed a sensitivity of 97% and a specificity of 26%. This result was not considered sufficiently accurate. Therefore a modified index was created in the Validation sample and re-validated back in the Model fit sample. The modified index was reduced to three items and included postural stability + visuospatial hemi-inattention + male sex.The randomized controlled trial contained an intervention program (IP) with High-Intensity Functional Exercises as well as implementation these exercises in to real life situations together with educational group discussions. The participants were enrolled and randomized three to six months after their stroke. The assessments were performed at the Clinical Research Center at Norrlands University Hospital. The Intervention Group (IG) received a program of 35 sessions (exercise and group discussions) and the Control Group (CG) received five group discussions.Performing daily activities at 6 months follow-up and falls-efficacy post-intervention and at the 3 months follow-up showed significant improvement in the IG compared with the CG (p<0.05). The IP did not have a statistically significant impact on Balance or Lifestyle activities. When evaluating gait, step time variability for the paretic leg and the variability in Cycle Time for the paretic and non-paretic leg were improved for the IG. The time spent on the non –paretic leg in the gait cycles’ most stable phase, Double Support, was reduced by almost half (0.9 sec to 0.4 sec) since baseline for the IG after the intervention and remained reduced to the three month follow-up. Quality of Life showed an improvement in the CG compared with the IG for the mental scales, Mental Component Scale and Mental Health subscale at the 3 month follow-up (p=.02).In conclusion, this intervention program significantly improved performance of everyday life activities, falls-efficacy and the variability in gait. These are three major fall risk factors and might in the long run have an impact on decreasing falls in persons that had a stroke.

SummaryBackground Prosthetic users face significant challenges both physically and psychologically. Falling poses a significant risk for the individual, and a consequence of this is gaining a fear of falling and self-imposed restrictions. These consequences can have a major impact on the individuals’ health and quality of life. However, the research in this area is limited.   Objectives  This study aims to investigate prosthetic users’ fear of falling and the circumstances surrounding falls among individuals with a lower-limb amputation in England and Sweden.   Method  In April 2022 a cross-sectional survey was conducted in England and Sweden. 11 participants were recruited. The survey was aimed at the population of lower-limb amputated individuals at the age of 18 or above in the two countries. The survey consists of 111 items with mostly closed-ended questions. Descriptive and inferential statistical methods were used for the analysis of the data.       Results  The study showed that 8 (72.7%) out of 11 participants had not experienced a fall within the last 30 days and the most common frequency of falls was every six months (54,5%). 2 (18.2%) participants had a fall once every three months which was the highest frequency of falls reported in the survey. This is seen as low frequency, however, 7 (63,3%) out of 11 participants had a fear of falling. A correlation between Falls Efficacy Scale-International (FES-I), Activities-specific Balance Confidence Scale (ABC) and Gait-Specific Attentional Profile instruments (G-SAP) was performed using a Pearson’s product-moment correlation which showed there was a strong relationship between the three instruments. The correlation between the FES-I and G-SAP is 0,800, FES-I and ABC are -,853 and the correlation between ABC and G-SAP is -, 821.   Conclusion  A strong relationship was found between the Falls Efficacy Scale-International, Activities-specific Balance Confidence Scale and the Gait-Specific Attentional Profile. Regardless of having fallen within the past 30 days, a high concern of fear of falling was found, and the most common reason for falls was uneven surfaces such as gardens. / Bakgrund Protesanvändare står inför många tuffa utmaningar dagligen, beroende på såväl fysiska som psykiska faktorer. Det finns en överhängande risk att ramla för individen, en konsekvens av detta är att drabbas av fallrädsla och sedermera individutvecklade hinder i vardagen. Dessa konsekvenser och hinder kan ha stor inverkan på individens hälsa och livskvalitet. Forskningen på detta område är dock begränsad.   Mål Syftet med denna studie är att undersöka protesanvändares rädsla för att ramla, samt omständigheterna kring varför man ramlar, hos individer med underbensamputation i England och Sverige.   Metod Under april 2022 genomfördes en tvärsnittsundersökning i England och Sverige. 11 deltagare rekryterades. Undersökningen riktade sig till individer i England och Sverige som genomgått amputation av nedre extremitet och var minst 18 år. Enkäten bestod av 111 frågor med till största delen slutna frågor. Beskrivande och inferentiella statistikmetoder användes för analys av data.   Resultat Studien visade att 8 st (72,7%) av de 11 deltagarna inte hade upplevt ett fall de senaste 30 dagarna och att den vanligaste fallfrekvensen var ett fall var sjätte månad (54,5%). Två (18,2%) deltagare angav fallolyckor en gång var tredje månad, vilket var den högsta fallfrekvensen som rapporterades i undersökningen. Detta ses som en låg frekvens, men 7 st (63,3%) av de 11 deltagarna upplevde en rädsla för att ramla. En korrelationsanalys mellan Falls Efficacy Scale-International (FES-I), Activities-specific Balance Confidence Scale (ABC) och Gait-Specific Attentional Profile (G-SAP) utfördes med hjälp av Pearsons produkt-moment korrelationskoefficient, som visade att det fanns ett starkt samband mellan de treinstrumenten. Korrelationen mellan FES-I och G-SAP var 0,800, mellan FES-I och ABC var det -,853 och mellan ABC och G-SAP var det -,821.   Slutsats Ett starkt samband hittades mellan Falls Efficacy Scale-International, Activities-specific Balance Confidence Scale, och Gait-Specific Attentional Profile instrumenten. Oavsett om deltagarna hade ramlat under de senaste 30 dagarna, konstaterades en stor oro för att ramla, och den vanligaste fallorsaken var ojämna ytor såsom i trädgårdar.