Abstract Aim of the study: Aim of the study was to investigate whether there were any connections in time between different parts of care in patients with cardiac arrest and hypothermia treatment and cognitive and physical function six months after cardiac arrest and to investigate neurological outcome related to primary registered cardiac arrest rhythm after six months and if there were any changes in cognitive and physical functions as well as self-related health between discharge from hospital and six months after cardiac arrest. Method: The study included 39 patients admitted to three Swedish hospitals between 2008-2011. Cognitive and physical function was evaluated with Cerebral Performance Cathegory, CPC completed with Mini Mental State Examination, MMSE for cognitive function and Bartels Index, BI for physical function and Euroqol-VAS for evaluating the self-related health. Result:  A significant connection was shown between time to start hypothermia treatment and BI, patients with longer time showed improved physical function after six months. Majority of the participants (66,7 %) had Ventricular fibrillation/Ventricular tachycardia, VF /VT, as primary registered cardiac arrest rhythm and in this group CPC and BI was significant better compared with the asystole /Pulsless Electrical Aktivity, PEA group. CPC, MMSE, BI and Euroqol-VAS were all improved over time. Conclusion: Participants with VF /VT as primary registered cardias arrest rhythm had significant better cognitive and physical function 6 months after hypothermia-treated cardiac arrest compared with participants with asystole/PEA as primary registered rhythm. This shows the importance of access to defibrillators in public places in the society and in hospitals and optimal education of lay people and medical staff. Cognitive and physical function and self-rated health improves over time, which might be a very important reason to convey patients, relatives and medical staff to continue cognitive and physical rehabilitation.   Keywords: Cardiac arrest, hypothermia, cognitive and physical function, wellbeeing

Obesity levels are increasing worldwide, and in the United Kingdom the prevalence of overweight and obesity is amongst the highest in the developed world. Obesity is associated with reduced physical function and health-related quality of life, as well as an increased risk of co-morbidities such as type 2 diabetes and hypertension. As a result of high levels of morbid obesity and a failure of conventional methods of weight loss, more people are resorting to invasive weight loss techniques such as bariatric surgery. Bariatric surgery combined with lifestyle modification is currently the most successful weight loss intervention for the treatment of obesity and its associated co-morbidities. However, weight regain is becoming more apparent, generally occurring between 12 and 24 months after surgery. Weight regain is generally attributed to the failure of individuals to adopt or maintain the necessary lifestyle changes. The most common factors leading to weight regain after bariatric surgery are insufficient exercise and returning to pre-operative eating behaviours. Increasing physical activity after surgery positively affects weight loss and physical function outcomes; therefore, adopting an active lifestyle is fundamental. This thesis combines three research studies which collectively provide evidence for understanding the importance of physical activity for optimising physical function and facilitating the prevention of weight regain. Study one is a systematic review and meta-analysis which assessed pre to post-operative changes in physical activity behaviour and physical function outcomes among obese adults receiving bariatric surgery. This demonstrates improvements in objective and self-reported activity and function by 12 months. Study two is an analysis of body mass, co-morbidity and physical function data from pre to post bariatric surgery. This retrospective NHS dataset analysis aimed to identify if and when weight regain occurs, the proportion of co-morbidity resolution, and physical function patterns in patients after bariatric surgery. Weight loss patterns indicate weight stability from 12 to 24 months and weight regain 24 months post-surgery. Study three is a randomised controlled trial, The MOTION Study, which examined the effect of a 12 week exercise intervention on physical function and body composition in patients 12-24 months post bariatric surgery. This trial also examined maintenance of effects at six months. Findings suggest that implementing exercise at the point of weight regain is effective, notably for improving physical function and body composition in this population. This thesis therefore contributes to advancing the understanding of the role of physical activity in enhancing long-term outcomes after bariatric surgery and to informing future post-operative bariatric care.

Objectives: To explore the pain mechanism and the origin of the pain and to evaluate a short-term pain relief treatment in women suffering from CPP persisting after childbirth in order to enable physiotherapeutic intervention. Material and methods: Thirty-six parous women with chronic pelvic pain persisting after childbirth were recruited at the Department of Physiotherapy, SundsvallHospital and by advertisements in newspapers and 29 parous women without chronic pelvic pain were recruited from an organized gynaecological screening at a midwifery surgery. All women were provoked by intra-pelvic palpation of 13 predetermined intra-pelvic landmarks. The provoked pain distribution was expressed in pain drawings and the pain intensity verbally on a Likert scale.Also, in a randomised controlled trial the 36 women with chronic pelvic pain were allocated to bilateral injection treatment with either triamcinolone or saline solutions, given once on the ischial spine with follow-up after four weeks. Results: Referred pain provoked on intra-pelvic landmarks follows a specific pattern. In general, pain provoked by palpation of the posterior intra-pelvic landmarks was mostly referred to the sacral region and pain provoked by palpation of the ischial and pubic bones was mostly referred to the groin and pubic regions. In women with chronic pelvic pain the provoked pain distribution area and pain intensity were magnified as compared to women without chronic pelvic pain. In the clinical trial decreased pain intensity, decreased distribution of pain and improved physical function was achieved among the triamcinolone treatment group as compared to the saline treatment group. Also, a positive correlation was shown between reduced pain intensity and improved function. Conclusions: Referred pain patterns provoked on intra-pelvic landmarks in women with chronic pelvic pain persisting after childbirth are consistent with sclerotomal sensory innervations and indicates allodynia and central sensitisation. This suggests that pain mapping can be used to evaluate and confirm the pain experience and contribute to diagnosis. Also, the pain intensity provoked by stimulation of the intra-pelvic landmarks is suggested to be useful to differentiate women with chronic pelvic pain from those without. Corticosteroid treatment to the ischial spine resulted in decreased pain and increased function.

Background: Malnutrition is a major problem in Bangladesh. One third of the population in Bangladesh is malnourished, but figures for older persons specifically are scant. Aims: This thesis describes the nutritional status of individuals aged 60+ years, living in a rural community in Bangladesh, with particular focus on the impact of demographic, health and social factors on nutritional status. A main aim is to examine the magnitude of malnutrition in this population. Second, the thesis focuses on the impact of demographic, health and social factors on nutritional status. Third, this thesis also aims to investigate the influence of nutritional status on functional abilities. Methods: A cross-sectional study of people aged 60+ years was conducted in Matlab, a rural area in Bangladesh during 2003-2004. Data were obtained through home interviews, clinical examination and cognitive tests. Nutritional status was assessed using a modified form of the Mini Nutritional Assessment. Physical function was measured by self-reported and performance-based instruments. Cognitive function was assessed using general and specific cognitive tasks. A total of 850 individuals were randomly selected for the purpose of the study, of which 625 participated in the home interviews and 473 underwent clinical examinations and cognitive tests. Information on complete nutritional status was available for 457 individuals. Results: About 26% of older people living in a rural community in Bangladesh were malnourished and 62% were at risk of malnutrition (Studies I-IV). Self-reported health problems (Study I), physician’s diagnoses (Study II), food expenditure (Study I), literacy (Studies I, II), personal income (Study II), female gender (Studies I, II) and financial support (Study II) were significantly associated with nutritional status. Health indicators accounted for the largest variations in nutritional status compared to demographic and socio-economic indicators (Studies I, II). Nutritional status was directly associated with self-reported and performance-based physical functions (Study III), as well as general and specific cognitive functions (Study IV). Conclusion: In low income countries, nutritional status of older persons needs to be addressed both from a health and a socio-economic perspective. Good nutritional status is essential for older persons to be functionally active, both physically and cognitively.

Perifer facialispares beror på en skada på ansiktets rörelsenerv, facialisnerven. Tillståndet för med sig ett flertal funktionella begränsningar som omfattar fysisk, psykisk och social funktion. För patienter som lider av perifer facialispares, kan förlust av dessa funktioner inverka på livskvaliteten. Tillståndet går inte att bota, behandlingens syfte är att minska symtom genom att återskapa symmetri och funktion. Det finns en rad olika behandlingsmetoder. För att kunna mäta om behandling av facialispares kan minska symtom och ge en högre skattad livskvalitet, behöver patienternas livskvalitet initialt utvärderas före behandling. Detta var studiens syfte. Som metod användes kvantitativ ansats, datainsamling bestod av två patientbaserade mätinstrument, Facial disability index (FDI) och Facial Clinimetric Evaluation (FaCE) scale. Instrumenten är validerade och anpassade för att mäta livskvalitet vid perifer facialispares. Poängen transformerades till en 100-gradig intervallskala där lägsta värdet indikerar allvarlig funktionsnedsättning och det högsta värdet frånvaro av funktionshinder. För fysisk funktion redovisas ett medelvärde på 53,7. Social funktion/välbefinnande redovisar ett medelvärde på 64. Funktionerna ansiktsrörlighet, ansiktskomfort, oral funktion, ögonkomfort, kontroll av tårproduktion samt social funktion redovisar medelvärden på 50 eller lägre. Ansiktsrörlighet var den funktion som skattades lägst (medel = 20,6). Totalt för frågeformuläret FaCE scale redovisas ett medelvärde på 36,8. Ett signifikant positivt samband påvisades mellan fysisk funktion och social funktion/välbefinnande (r = 0,55, p = 0,05). Resultatet påvisar också samband mellan flera av delskalorna i FDI och FaCE scale. Starkast samband hade fysisk funktion (FDI) och ansiktskomfort (FaCE scale) (r = 0,73, p = 0,05). Slutsats: Resultatet redovisar en genomgående låg livskvalitet hos patienter med nydiagnostiserad bestående perifer facialispares. / Peripheral facial palsy is caused by a damage on the facial nerve. The condition brings a lot of functional limitations and include physical, psychological and social function. For patients suffering from peripheral facial palsy, the loss of these functions affects the quality of life. The condition can not be cured, the treatment goal is therefore to reduce symptoms by recreating symmetry and function. There is a lot of different treatment options. To evaluate if facial palsy treatment can reduce symptoms and give a higher valued quality of life, the patients quality of life initially needs to be valued before treatment. This was the aim of the study. As a method, a quantitative approach was used, data collections consisted of two patient-reported outcome measures, Facial disability index (FDI) and Facial Clinimetric Evaluation (FaCE) scale. The instruments are validated and developed to measure quality of life in peripheral facial paralysis patients. The scores were transformed into a 100-point interval scale where the lowest value indicates severe paralysis, and the highest value indicates normal facial function. For physical function the mean value is 53,7. The social/well-being function shows a mean value of 64. The functions of facial movement, facial comfort, oral function, eye comfort, lacrimal control and social function show mean values of 50 or lower. Facial movement was the lowest scored function (mean= 20,6). The total of FaCE scale questionnaire declares a mean value of 36,8. A significant positive correlation was seen between physical function and social/well-being function (r = 0,55, p < 0,05). The result shows a positive correlation between several subscales in FDI and FaCE scale. The strongest correlation was seen between physical function (FDI) and facial comfort (FaCE scale) (r = 0,73, p < 0,05). Conclusion: The result highlights a general low quality of life in newly diagnosed facial palsy patients.

Ageing is accompanied by a progressive decline in skeletal muscle mass and strength which may lead to impaired ability to perform activities of daily living in older adults. Although the exact cause of the gradual decline in muscle mass is unknown, identifying efficient strategies aiming to prevent age-related loss of muscle mass and strength is important in order to promote healthy ageing. The overall aim of this thesis was to explore the effects of resistance training alone or combined with a healthy diet on skeletal muscle mass and function of healthy recreationally active older women and to determine mechanisms by which elevated systemic inflammation may contribute to the age-related decline of muscle mass in older adults. The combination of resistance training and a healthy diet induced gains in leg lean mass as well as greater gains in dynamic explosive force than resistance training alone in healthy recreationally active older women. The observed gains in leg lean mass were accompanied by increases in the size of type IIA muscle fibres together with down-regulation in gene expression of a pro-inflammatory factor (IL-1β) and upregulation in gene expression of a regulator of cellular growth (mTOR) in skeletal muscle of older women. Additionally, reduced muscle protein synthesis and size of muscle cells may mediate the detrimental effects of elevated circulating markers of inflammation on muscle mass in older adults. In conclusion, the present thesis depicts mechanistic links between elevated systemic marker of inflammation and muscle mass and provides new information on the effects of combined resistance training and healthy diet on muscle mass and strength in a group of healthy recreationally active older women. This knowledge is instrumental for development of strategies aiming to prevent age-related loss of muscle mass and function.

Syftet med denna systematiska litteraturöversikt var att jämföra radiell mot fokuserad stötvågsbehandling samt att undersöka effekten utav stötvågsbehandling för att reducera smärta och återfå fysisk funktion vid Akillestendinopati. Litteraturöversikten har följt checklistan PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis). Inklusionskriterier till litteraturöversikten är utformade efter PICO (population, intervention, control, outcome) och databaser som använts är PubMed, SPORTDiscus, CINAHL, Scopus och Web of Science. Data har analyserats narrativt och tillförlitligheten hos utfallen har bedömts med GRADE.Sju studier inkluderades till litteraturöversikten varav fyra studier som utfört radiell och tre studier som utfört fokuserad stötvågsbehandling som intervention. En signifikant skillnad för smärtreduktion sågs i två av studierna för båda behandlingarna. När radiell stötvågsbehandling användes hade interventionsgrupperna en högre smärtreduktion än kontrollgrupperna och när fokuserad stötvågsbehandling användes hade kontrollgrupperna en högre smärtreduktion än interventionsgrupperna. En signifikant skillnad för återställande utav den fysiska funktionen i ankeln sågs i tre studier för radiell stötvågsbehandling och två studier för fokuserad stötvågsbehandling. Där radiell stötvågsbehandling användes hade interventionsgrupperna en större ökad fysisk funktion än kontrollgrupperna och där fokuserad stötvågsbehandling användes hade kontrollgrupperna en större ökad fysisk funktion än interventionsgrupperna.Radiell stötvågsbehandling verkar kunna fungera för att reducera smärta och öka fysisk funktion vid Akillestendinopati. Tillförlitligheten för utfallen vid fokuserad stötvågsbehandling är för låg för att kunna dra någon slutsats om vilken typ av stötvågsbehandling som är mest effektiv. Ifall det varit känt vilken typ av stötvågsbehandling som ger bäst resultat hade det varit en bra vägledning för vårdpersonal som arbetar med stötvågsbehandling. / The purpose of this review was to compare radial versus focused shock wave therapy and to review shock wave therapies usage to reduce pain and increase physical function for the Achilles tendinopathy.The review has followed PRISMA’s checklist while using PubMed, SPORTDiscus, CINAHL, Scopus and Web of Science databases. Data has been analyzed narratively and the evidence of the outcomes has been assessed.A significant difference in pain reduction was seen within two studies for both interventions. Where radial shock wave therapy was administered the intervention groups had a higher pain reduction than the control group. Where focused shock wave therapy was administered the control group had a higher pain reduction than the intervention group. A significant difference in the restoration of physical function was seen within three studies for radial shock wave therapy and two studies for focused shock wave therapy. Where radial shock wave therapy was administered the intervention groups had a greater increased physical function than the control groups and where focused shock wave treatment was administered the control groups had a greater increased physical function than the intervention groups.Radial shock wave therapy seems to be effective to reduce pain and increase physical function in the Achilles tendinopathy. The evidence of the results for focused shock wave therapy is too low to draw any conclusion, or allow us to compare the two methods. Had the studies allowed for a direct comparison between the two methods, this could have led to a guide for healthcare professionals.

Objectives:Following the loss of vestibular function, some patients functionally improve and are minimally bothered by their loss of peripheral function while others remain more symptomatic and are unable to return to their activities of daily living. To date, the mechanisms for functional improvement remain poorly understood. The purpose of the present study was to examine the association between corrective saccades and measures of handicap, dynamic visual acuity, gait, and falls. Design:A retrospective chart review was performed to identify patients who were diagnosed with unilateral or bilateral vestibular hypofunction and who also completed a baseline vestibular rehabilitation evaluation. A total of 82 patients with unilateral vestibular hypofunction and 17 patients with bilateral vestibular hypofunction were identified. The video head impulse test results for each patient were grouped based on the type of presenting saccades. Specifically, the saccade grouping included the following: (1) covert, (2) overt, or (3) a combination of both types of saccades. Results:The results show that covert saccades are associated with better performance on measures of dynamic visual acuity, gait, and balance in patients with unilateral vestibular hypofunction. Patients exhibiting overt saccades or combination of both covert and overt saccades were more often found to have an abnormal gait speed and be characterized as being at risk for falls using the Dynamic Gait Index. We observed no differences in physical function for those patients with bilateral vestibular hypofunction as a function of saccade grouping. Conclusions:When comparing saccade groups (covert, overt, or combination of both), patients with unilateral vestibular hypofunction and covert saccades demonstrated better performance on standard baseline physical therapy measures of dynamic visual acuity and gait and balance. We did not observe any significant associations between saccade group and physical function in patients with bilateral vestibular hypofunction; however, additional studies are needed with adequate sample sizes. Our findings may suggest that corrective saccade latency in patients with unilateral vestibular hypofunction is related to measures of physical function. The extent to which saccade latency has the potential to be a useful target for vestibular rehabilitation is still to be determined and may be promising target to improve functional outcomes.

This study examines a possible relationship between Total Body Water (TBW) levels, osteoarthritic pain and functional performance in a sample of untrained adults. Participants complete a Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire, TBW is measured using single-frequency bioelectrical impedance (SF-BIA) and strength, balance and physical function are measured by the completion of 7 standardized functional tests. Participants in this study will include adult men and women, age 35 years and older, who have been previously diagnosed with Osteoarthritis (OA) in the hip or knee, or who score 35 or higher on the WOMAC. This study aims to determine if TBW values, specifically its intracellular compartment (ICW), will have a relationship to WOMAC scores and if intracellular water (ICW) will have a positive correlation to participants’ overall performance on balance, strength, and physical function tests. It is hypothesized that the data will show a negative correlation between ICW and WOMAC scores and a positive correlation between ICW and performance on balance, strength and physical function tests. Little research exists on the relationship between TBW and functional performance in older adults; particularly those whose TBW may be affected by inflammatory conditions such as OA. A goal of this study is to contribute to existing research on the relationship between performance and TBW, while providing insight and data on this relationship in an untrained population.

No description available.