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. / Syftet med studien var att samla in grundata och att hitta ett lämpligt fysiskt test och ett självadministrativt formulär. Den insamlade grunddatan användes för att hitta ett rutinmässigt mätinstrument för undersökning av fothälsa, funktion och mobilitet hos klienter som lider av diabetes i landet Samoa. I undersökningen deltog 21 personer som lider av diabetes. Deltagarna fick besvara ett så kallat ”Foot Function Index formulär” (FFI) och utföra de två fysiska testerna ”Bergs Balance Scale” (BBS) och ”Time Up and Go” (TUG). Resultaten från de fysiska testerna påvisade såväl en stor balansrubbning som mobilitetsbegränsningar hos majoriteten av deltagarna. Ett generellt högt BMI-värde och stor vikt uppmättes hos båda könen. Personer med högst BMI-värde presterade kortast tid under TUG-testet. Den statistiska analysen påvisade en stark korrelation mellan de två fysiska testen, vilket indikerar att endast ett av testerna kan användas som mätinstrument i framtida undersökningar av funktion och mobilitet på Samoa. Sammanställningen av de självadministrativa formulären påvisade en generellt god fothälsa med begränsad smärta, oförmåga och aktivitetsbegränsning hos deltagarna i studien.

Syfte: Denna studie syftar till att undersöka vilken behandlingsmetod, plasticitetsgrundad eller icke-invasiv neuromodulering som presenterar bäst resultat av smärtlindring hos personer som upplever fantomsmärtor efter en amputation. Metod: Litteraturundersökningen utfördes i 3 databaser; MEDLINE, CINAHL och PsycINFO. Inkluderingskriterier användes för urval av studier. Bedömning av studiernas risk för bias gjordes med hjälp av mallar från Joanna Briggs Institut. Relevant data kopplad till frågeställningen extraherades och analyserades. Resultat: Totalt åtta artiklar inkluderades, där två presenterade resultat från icke-invasiv neuromodulering och sex studier inkluderade plasticitetsgrundade metoder. Smärtskalor mellan 0-10 användes för att mäta förändringen av smärtan. Den kritiska bedömningen drog slutsatsen att det saknades studier av hög kvalitet som inkluderar kontrollgrupper. Bevisen som analyserats i den aktuella studien indikerar att plasticitetsgrundade metoder tycks ge bättre smärtreduktion jämfört med icke-invasiv neuromodulering. Slutsats: Baserat på resultaten kan inte denna studie presentera bevis starka nog för att avgöra vilken grupp av metoder som har bäst smärtlindrande effekt. Brist av högkvalitativa studier inom området, i kombination med heterogenitet mellan inkluderade studier resulterar i att ingen slutsats kan dras. / Aim: This study aims to determine which treatment method, plasticity guided or non-invasive neuromodulation, presents the best result in reducing pain for amputees experiencing phantom limb pain. Method: Literature search was performed in 3 databases; MEDLINE, CINAHL and PsycINFO. Eligibility criteria were used for study selection. Critical appraisal tool by Joanna Briggs institute was used to assess the included articles’ risk of bias. Data relevant to the research question were extracted and analyzed. Result: A total of eight articles were included, where two presented results from non-invasive neuromodulation and six studies included plasticity guided methods. Pain scales ranging from 0-10 were applied as outcome measures to monitor improvements in phantom limb pain. The critical appraisal concluded lack of high-quality study designs including control groups. The evidence analysed in the present study indicate that plasticity guided methods appear to provide the best pain reduction when compared to non-invasive neuromodulation. Conclusion: Based on the results, this study does not present evidence strong enough to state which methods present the best pain reduction. Due to low amount of research within the field, combined with heterogeneity between included studies, no conclusion can be made.

This thesis is based on studies of the ten-year community-based intervention programme entitled, the Vadstena Osteoporosis Prevention Project (VOPP). The specific aims of the research were to describe the effects of physical activity and training programmes on bone mass and balance performance in adults, to determine whether a fall risk prevention programme could motivate personal actions among the elderly, to ascertain whether the intervention programme could reduce the incidence of forearm and hip fractures. Two studies addressed training programmes for middle-aged and old people. First, VOPP participants who were aged 40–70 years and had low forearm bone mineral density (BMD) values were invited to take part in a one-year weight-bearing training study. Thirty of those individuals were included in the investigation. Additional bone mass measurements were performed at the hip and the lumbar spine, and balance and aerobic capacity were also tested. The training programme was performed twice a week (I). In the second study, healthy persons aged 70–75 years were invited to participate in a balance-training study. Fifteen persons joined an exercise group, and another fifteen were controls. The training programme comprised specific balance exercises and was carried out twice a week for nine weeks (II). The association between forearm BMD values and several lifestyle factors was explored in random samples of the population aged 20–72 years (n=880) in a cross-sectional study (III). Another study explored the association between calcaneal stiffness, forearm BMD, and lifestyle factors amongst participants aged 20–79 years (n=956) at the final registration of the VOPP (V). Effects of the VOPP interventions directed at environmental risk factors for falls and the promotion of physical activity were examined in people aged ≥ 65 years (IV). The incidence of forearm and hip fractures was studied amongst middle-aged and elderly individuals in the intervention and the control communities during the study period 1987–2001 (VI). The exercise group (n=15) in the weight-bearing training study showed increases in BMD at the greater trochanter (p<0.01), one-leg stance balance with the eyes closed and coordination tests (p<0.05), and aerobic capacity (p<0.05). No significant difference was found when the groups were compared concerning changes in the different tests during the intervention period (I). In the balance-training study, the exercise group showed post-training improvement in the following tests: standing on the right leg with eyes closed (p<0.01), standing on the right leg (p<0.01) and on the left leg (p<0.05) while turning the head, and walking 30 metres (p<0.01). There were significant differences between the groups in these tests when changes were compared at the post-intervention test (II). Age (p<0.0001) and body mass index (p≤.0001) were associated with forearm BMD in both sexes. Reported moderate physical activity levels in men were positively associated with forearm BMD (p<0.05) (III). In both sexes, reported moderate (p<0.05) and high (women p<0.05 and men p<0.001) physical activity levels were positively associated with calcaneal stiffness. The correlation coefficient between forearm BMD and calcaneal stiffness was 0.58 in women and 0.34 in men (V). Persons aged ≥ 65 years at the follow-up in 1994 reported more use of shoe/cane spikes and moderate physical activity levels compared to controls (IV). There was no change in the general incidence of forearm and hip fractures between the communities for the study period. However, there was a tendency towards decreasing incidence of forearm and trochanteric hip fracture in both sexes during the late intervention period in the intervention community (VI). A community-based intervention programme aimed at reducing the incidence of osteoporotic fractures must be regarded as a long-term project and should preferably be monitored over an extended post-intervention period. / On the day of the public defence the statuses of articles IV and V were Submitted and VI was Manuscript

<p> </p><p>In orthopaedic practice, fractures are usually stabilised with metal screws or rods. This is done in order to keep the fracture parts in place during the rather slow healing process. The healing time can potentially be reduced by local- or systemic treatment with different bone promoting drugs. In later years, lithium, otherwise used to treat bipolar disease, has shown promise to be such a drug.</p><p> </p><p>The aim of this master thesis was to find a way to coat metal bone screws with lithium and to characterise the coating. The coating was to be designed in such a way that it could release lithium to the surrounding bone tissue.</p><p> </p><p>Lithium chloride was incorporated into a titanate sol-gel and attached to silicon wafers and stainless steel screws by dip coating. Wafers were used for initial <em>in vitro</em> studies of how lithium changed coating characteristics. This was studied using ellipsometry, AFM and SEM. Lithium is most probably physisorbed and not incorporated into the network building up the sol-gel. Coating structure is changed as more lithium is incorporated. For large amounts of lithium, the nanoparticles normally formed when curing the sol-gel are inhibited. One effect of this is reduced bioactivity, seen as a reduced ability for calcium phosphate crystals to nucleate on the coating when immersed in simulated body fluid.</p><p>Lithium release was investigated using AAS. Lithium is released from the coating, showing a burst effect. By changing the number of coating layers used, the release profile can be partly altered. The coating was also applied to screws, showing good attachment, and the lithium release profile was similar to the one seen from wafers.</p><p>Finally, a screw model was used in rats to assess the effect of local lithium treatment from screws and systemic lithium treatment on fracture healing. In the model, a screw was inserted in tibia, mimicking a fracture. When the bone around the screw was healed, a pullout test was performed, giving information about the strength of the bone surrounding the screw. No significant difference could be found for either local- or systemic lithium treatment compared to control. However, when evaluating the strength of intact bone in a similar way, a positive effect of systemic lithium treatment could be seen. Therefore, it is still likely that lithium has a positive effect on bone and further studies are needed to fully evaluate its role in fracture healing.</p><p> </p> / <p><p>Vid behandling av benbrott stabiliseras vanligtvis frakturen internt med metallskruvar och</p><p>metallstavar. Detta görs för att hålla brottbitarna på plats under den relativt långsamma läkprocessen. Det är möjligt att minska tiden för frakturläkning genom att lokalt eller systemiskt behandla med olika läkemedel som främjar bentillväxt. På senare år har det presenterats bevis för att litium, som annars används som psykofarmaka, fungerar som ett sådant läkemedel.</p><p> </p><p>Syftet med detta examensarbete var att hitta en metod för att fästa litium på benimplantat. Litium skulle fästas på ett sådant sätt att frisläppning till omgivande vävnad blev möjlig.</p><p> </p><p>Litiumklorid inkorporerades i en titanat-solgel och lager av detta lades på kiselytor och rostfria skruvar genom s.k. ”dip-coating”. Kiselytorna användes för initiala <em>in vitro</em>-studier av hur litium ändrade beläggningens egenskaper. Litium sitter antagligen fast på ytan av det tredimensionella nätverk som utgör solgelen, istället för att sitta inbundet i nätverket. Lagerstrukturen ändras ju mer litium som inkorporeras och vid stora mängder skapas inte de nanopartiklar som vanligtvis finns i en solgel-baserad beläggning. En följd av detta är reducerad bioaktivitet för beläggningen, dvs. en minskad förmåga för kalciumfosfatkristaller att bildas på ytan. Litium frisläpps från beläggningen, dock sker denna frisläppning snabbt. Genom att belägga ytan med flera lager av solgel kan frisläppningskinetiken delvis ändras. Solgelen kunde också med god vidhäftning appliceras på skruvar och frisläppningskinetiken från en skruv är liknande den från en kiselyta.</p>Slutligen användes en skruvmodell i råtta för att undersöka vilken effekt lokal respektive systemisk litiumbehandling har på frakturläkning. I modellen efterliknas ett benbrott genom att en skruv sätts in i skenbenet.  När benvävnaden runt skruven har läkt görs ett utdragstest på skruven vilket ger information om benets styrka. Ingen signifikant skillnad i skruvens utdragskraft kunde ses mellan de båda försöksgrupperna och kontrollgruppen. Däremot hade gruppen som fick systemisk litiumbehandling fått starkare ben totalt, vilket indikerar att litium har effekt på <em>intakt</em> ben. På grund av dessa resultat finns det fortfarande skäl att tro att litium har en positiv påverkan på ben, varför dess effekt på frakturläkning bör undersökas ytterligare. </p>

The overall aim of this thesis on congenital clubfoot was to estimate the incidence with a national perspective, analyse residual deformities and their management, and evaluate patient reported long-term quality of life and foot function. Paper I was a prospective, nationwide sampling of 280 children with congenital clubfoot during 1995-96. The average incidence was 1.4‰. There was regional heterogeneity but no seasonal variation. Paper II evaluated ultrasonography on 54 newborn, prospectively followed up to 12 months of age. Significant increase of medial malleolus to navicular distance (MM-N-distance) and of soft tissue thickness with increasing age was seen and with acceptable reliability. Paper III assessed 35 children (47 feet) after previous posterior release, mean age of 4.5 years, and the MM-N-distance was shorter in unilateral clubfeet (21 patients) than in contralateral normal feet. No association between navicular position and forefoot adduction (FFA) was determined. Smaller FFA yielded better subjective and functional outcome. Paper IV reviewed distraction treatment with Ilizarov External Fixator in seven patients (10 feet), 6-15 years of age, with relapsed deformities. All patients, except one, reported satisfaction with the overall result but less stiffness was experienced in only 4/10 feet. Paper V evaluated self-estimated outcome in 83 patients (63 males, 20 females), mean age of 64 years, through SF-36 and EQ-5D, and through AAOS foot and ankle score. Age and gender adjusted norm groups were used. Female patients scored worse than male patients did. Both males and females reported negative influence on foot and ankle function. Conclusion: The incidence of congenital clubfoot in Sweden is higher than in previous Scandinavian studies. Ultrasonography is reliable for describing pathoanatomy of the talo-navicular joint in clubfeet and can detect "spurious" (false) correction. Distraction treatment with the Ilizarov External Fixator yields subjective improvement but stiffness remains. Long-term influence on daily life activities is limited to foot and ankle function for both genders, but only female patients report negative influence on physical aspects of quality of life.

In orthopaedic practice, fractures are usually stabilised with metal screws or rods. This is done in order to keep the fracture parts in place during the rather slow healing process. The healing time can potentially be reduced by local- or systemic treatment with different bone promoting drugs. In later years, lithium, otherwise used to treat bipolar disease, has shown promise to be such a drug.   The aim of this master thesis was to find a way to coat metal bone screws with lithium and to characterise the coating. The coating was to be designed in such a way that it could release lithium to the surrounding bone tissue.   Lithium chloride was incorporated into a titanate sol-gel and attached to silicon wafers and stainless steel screws by dip coating. Wafers were used for initial in vitro studies of how lithium changed coating characteristics. This was studied using ellipsometry, AFM and SEM. Lithium is most probably physisorbed and not incorporated into the network building up the sol-gel. Coating structure is changed as more lithium is incorporated. For large amounts of lithium, the nanoparticles normally formed when curing the sol-gel are inhibited. One effect of this is reduced bioactivity, seen as a reduced ability for calcium phosphate crystals to nucleate on the coating when immersed in simulated body fluid. Lithium release was investigated using AAS. Lithium is released from the coating, showing a burst effect. By changing the number of coating layers used, the release profile can be partly altered. The coating was also applied to screws, showing good attachment, and the lithium release profile was similar to the one seen from wafers. Finally, a screw model was used in rats to assess the effect of local lithium treatment from screws and systemic lithium treatment on fracture healing. In the model, a screw was inserted in tibia, mimicking a fracture. When the bone around the screw was healed, a pullout test was performed, giving information about the strength of the bone surrounding the screw. No significant difference could be found for either local- or systemic lithium treatment compared to control. However, when evaluating the strength of intact bone in a similar way, a positive effect of systemic lithium treatment could be seen. Therefore, it is still likely that lithium has a positive effect on bone and further studies are needed to fully evaluate its role in fracture healing. / Vid behandling av benbrott stabiliseras vanligtvis frakturen internt med metallskruvar och metallstavar. Detta görs för att hålla brottbitarna på plats under den relativt långsamma läkprocessen. Det är möjligt att minska tiden för frakturläkning genom att lokalt eller systemiskt behandla med olika läkemedel som främjar bentillväxt. På senare år har det presenterats bevis för att litium, som annars används som psykofarmaka, fungerar som ett sådant läkemedel.   Syftet med detta examensarbete var att hitta en metod för att fästa litium på benimplantat. Litium skulle fästas på ett sådant sätt att frisläppning till omgivande vävnad blev möjlig.   Litiumklorid inkorporerades i en titanat-solgel och lager av detta lades på kiselytor och rostfria skruvar genom s.k. ”dip-coating”. Kiselytorna användes för initiala in vitro-studier av hur litium ändrade beläggningens egenskaper. Litium sitter antagligen fast på ytan av det tredimensionella nätverk som utgör solgelen, istället för att sitta inbundet i nätverket. Lagerstrukturen ändras ju mer litium som inkorporeras och vid stora mängder skapas inte de nanopartiklar som vanligtvis finns i en solgel-baserad beläggning. En följd av detta är reducerad bioaktivitet för beläggningen, dvs. en minskad förmåga för kalciumfosfatkristaller att bildas på ytan. Litium frisläpps från beläggningen, dock sker denna frisläppning snabbt. Genom att belägga ytan med flera lager av solgel kan frisläppningskinetiken delvis ändras. Solgelen kunde också med god vidhäftning appliceras på skruvar och frisläppningskinetiken från en skruv är liknande den från en kiselyta. Slutligen användes en skruvmodell i råtta för att undersöka vilken effekt lokal respektive systemisk litiumbehandling har på frakturläkning. I modellen efterliknas ett benbrott genom att en skruv sätts in i skenbenet.  När benvävnaden runt skruven har läkt görs ett utdragstest på skruven vilket ger information om benets styrka. Ingen signifikant skillnad i skruvens utdragskraft kunde ses mellan de båda försöksgrupperna och kontrollgruppen. Däremot hade gruppen som fick systemisk litiumbehandling fått starkare ben totalt, vilket indikerar att litium har effekt på intakt ben. På grund av dessa resultat finns det fortfarande skäl att tro att litium har en positiv påverkan på ben, varför dess effekt på frakturläkning bör undersökas ytterligare.

Matrix metalloproteinases (MMPs), such as collagenases, are a family of enzymes capable of degrading most constituents of the extracellular matrix. MMPs are thought to be involved in the aetiopathogenesis of tendon rupture. Additionally, failure of healing has in some instances been associated with elevated levels of MMPs. We have studied (a) the effects of the MMP-inhibitor doxycycline on healing of tendons and intestines in experimental models and (b) systemic levels of MMPs and their endogenous inhibitors (TIMPs) in patients with tendon rupture. In the first study, systemic doxycycline treatment lead to weakened rat Achilles tendons during healing after injury. Subsequently, systemic doxycycline was shown to improve biomechanical properties of tendon suture fixation in the rat Achilles tendon. Sutures were also coated with doxycycline, leading to similar improvement in mechanical strength of the suture construct during healing. In the third study, doxycycline-coated sutures improved the strength of healing intestinal anastomoses in an experimental model. Finally, we showed that patients with a history of Achilles tendon rupture had elevated levels of MMP-2, MMP-7 and TIMP-2 in serum. In addition, MMP-7 correlated inversely to mechanical strength of the tendon during healing. In conclusion, MMP-inhibitors can be administered systemically and locally to manipulate healing of tendons and intestines. Generalised alterations in the MMP-TIMP system may be involved in the pathogenesis of Achilles tendon rupture and associated with differences in outcome of healing.

Hip fracture is a global and a growing public health problem. More women than men sustain hip fractures, the incidence increases exponentially with age and mean age is above 80. About one third of hip-fracture patients suffer from dementia and are prone to develop acute confusional state (delirium). Delirium is one of the most common complications after hip-fracture surgery, and seriously impacts on morbidity and mortality. Malnutrition is also common in hip-fracture patients and is associated with postoperative complications, such as delayed healing of the wound, infections and decubitus ulcers. Arthroplasty is usually preferred procedure in displaced femoral neck fractures but is, however, controversial in patients with dementia due to the fear of dislocation of the prosthesis. The aims of this thesis are to identify risk factors for delirium and the impact of delirium on rehabilitation outcome, to evaluate whether a postoperative multi-factorial intervention program could reduce delirium, to investigate the effect of a nutritional intervention and to evaluate complications, functional outcome and mortality regarding two surgical methods, hemiarthroplasty (HAP) and internal fixation (IF), in old patients with femoral neck fracture. Thirty-eight out of 61 consecutive patients (62%) were delirious on admission to hospital or developed postoperative delirium. An increased risk of postoperative delirium was found among hip-fracture patients with dementia and/or depression. Delirious patients were hospitalized longer, were more dependent in their activities of daily living, had poorer psychological well-being and suffered more complications than non-delirious patients. A postoperative multi-factorial and multidisciplinary intervention program reduced the incidence, at 55% vs 75% (p=0.003), and number of days with delirium, 5 vs 10 days (p=0.009). Postoperative complications were also reduced; decubitus ulcers 9% vs 22% (p= 0.010), urinary tract infections 31% vs 51% (p=0.005), falls 12% vs 27% (p=0.007), and the mean hospitalization period was 10 days shorter in the intervention group (p=0.030). Malnutrition was common among all these patients (53 %) and associated with postoperative complications such as decubitus ulcers and delirium. However, the nutritional intervention had no effect on nutritional parameters at four months, nevertheless men had better nutritional outcomes than women. A higher proportion of patients with dementia operated on using HAP had regained their pre-fracture ability to walk independently at the one-year follow up compared with those operated on using IF. Six of 83 patients dislocated their HAP during hospitalization and during an episode of delirium, none had dementia. No difference in mortality between the surgical methods was seen. Dementia per se should not be a reason to disqualify patients from being treated with the most appropriate surgical method. It is clinically important to discriminate between dementia and delirium, since delirium can be prevented and treated even in patients with dementia. Old patients undergoing surgery have special needs that are not always catered for in ordinary orthopaedic or surgical wards. The special care for these patients should include: a combined nursing and medical care based on comprehensive geriatric assessments, systematic prevention, detection and treatment of postoperative complications such as delirium, hypoxemia, urinary tract infections, pain, malnutrition and an active rehabilitation. It is obvious that improved quality of care reduces patient suffering and seemingly the costs for society.

Aim: The aim of this thesis is to evaluate patients’ satisfaction with prosthetic device and service on lower limb amputations in Danang, Vietnam and to implement comparisons between the subgroups gender, living area, amputation cause and level. Method: A cross-sectional study design was conducted using the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) 2.0 questionnaire to measure patients’ satisfaction. Fifty patients were recruited through the International Committee of the Red Cross (ICRC) and the data collection was performed in the patients own homes with an interpreter. The collected data was statistically analyzed with suitable tests using Statistical Package for the Social Sciences (SPSS). Result: The patients were quite satisfied with their prosthetic devices (mean 4.16 SD ± 0.561) and more or less satisfied with their given services (mean 2.83 SD ± 1.213). Significant differences were found between genders regarding the patients’ satisfaction with prosthetic device. There were no significant differences between the remaining subgroups; living area, amputation cause and amputation level. Conclusion: This thesis demonstrates that the patients in Danang appear to be quite satisfied with their prosthetic device, even though they reported problems with the durability of the device. Furthermore, the patients were more or less satisfied with their prosthetic services. The findings in this thesis also reveals that women were less satisfied compared to men regarding the prosthetic device. These conclusions should however be taken with caution, since the reliability and validity was lower than desired and it’s difficult to generalize the results to the population. / Syfte: Syftet med denna studie är att evaluera patienters nöjdhet med deras utgivna protes och service på nedre extremitetsamputerade i Danang, Vietnam och att implementera jämförelser mellan subgrupperna kön, bostadsområde, amputations- orsak och nivå. Metod: En cross-sectional studiedesign blev utförd genom användning av Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) 2.0 enkäten för att mäta patienters nöjdhet. Femtio patienter blev rekryterade genom International Committee of the Red Cross (ICRC) och datainsamlingen blev utförd i patienternas egna hushåll med en tolk. Den insamlade datan blev statistiskt analyserad med lämpliga tester genom användning av Statistical Package for the Social Sciences (SPSS). Resultat: Patienterna var ganska nöjda med deras utgivna proteser (medelvärde 4,16 SD ± 0,561) och mer eller mindre nöjda med deras utgivna service (medelvärde 2,83 SD ± 1,213). Signifikanta skillnader hittades mellan kön gällande patienters nöjdhet med deras utgivna protes. Det fanns inga signifikanta skillnader mellan de resterande subgrupperna; bostadsområde, amputationsorsak och amputationsnivå. Slutsats: Den här studien demonstrerar att patienterna i Danang verkar vara ganska nöjda med deras utgivna proteser, fastän de rapporterade problem med protesens hållbarhet. Dessutom var patienterna mer eller mindre nöjda med deras utgivna service. Fynden i denna studie påvisar också att kvinnorna var mindre nöjda gällande protesen jämfört med männen. Dessa slutsatser skall dock tas med aktsamhet, eftersom reliabiliteten och validiteten blev lägre än önskat och det var svårt att generalisera resultaten till populationen.

Bakgrund: För att uppnå en god barnanpassad vård inom ortopedteknik krävs information om hur barn uppfattar mötet på en ortopedteknisk avdelning. Genom att ta del av barns tankar, åsikter och förslag kan verksamheter i framtiden lättare argumentera för exempelvis hur lokaler bör inredas och hur man bör bemöta barn.   Syfte: Syftet med denna studie är att undersöka hur barn upplever mötet på en ortopedteknisk avdelning i avseendet vårdmiljö och möte med ortopedingenjören.   Metod: En kvalitativ metod där deltagarna får rita och berätta kallad “Draw and tell” och åtta intervjuer med barn mellan 6 till 12 år om deras upplevelse efter besöket hos en ortopedingenjör genomfördes. Intervjuerna transkripterades och en innehållsanalys genomfördes.   Resultat: Vissa gemensamma faktorer hittades i intervjuerna så som att det ansågs att det samtalades för mycket utan att engagera barnet samt att aktiviteter som fanns sågs som bra då det kunde bli lite väntan under besöket. Det fanns flera förslag på andra aktiviteter som önskades under väntan och speglade barnens egna intressen så som datorspel och böcker.   Slutsats: Denna studie visar att det som ortopedingenjören är viktigt att engagera barnen vid mötena samt att aktiviteter finns till hands under långa väntetider.   Nyckelord: Barns upplevelser, ortopedteknik, ortopedingenjör, bemötande, miljö / Background: To achieve good child centered care in the field of prosthetics/orthotics, information about how children perceive a meeting with a prosthetist/orthotist is needed. Knowing children’s thoughts, opinions and suggestions about the situation can help increase knowledge about how to set up the environment and meetings. Aim: The aim of this study is to investigate how children experience the interactions with health professionals and the environment when meeting a prosthetist or orthotist. Method: A qualitative method called “draw and tell” was used. Eight children aged between 6 to 12 years were interviewed after a meeting with a prosthetist/orthostist. The interviews were transcribed and a content analysis was performed. Result: Too much talk without engaging the child and long waiting times were found as negative factors and activities such as books and toys and that the prosthetist/orthotist was kind were found as positive factors during the meeting. Multiple suggestions were given about what kinds of activity could be available to children when waiting these included computer games and books. Conclusion:  This study shows that it is important for a prosthetist/orthoptist to engage children in the meetings and that possibilities for activities are available when children are waiting to see the clinician.   Keywords: Children’s experience, Prosthetics, Orthotics,  Enviroment, Consultation