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Elvén, M., Hochwälder, J., Dean, E., Hallman, O. & Söderlund, A. (2018). Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists' clinical reasoning focused on behaviour change: 'Reasoning 4 Change'. AIMS PUBLIC HEALTH, 5(3), 235-259
Open this publication in new window or tab >>Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists' clinical reasoning focused on behaviour change: 'Reasoning 4 Change'
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2018 (English)In: AIMS PUBLIC HEALTH, ISSN 2327-8994, Vol. 5, no 3, p. 235-259Article in journal (Refereed) Published
Abstract [en]

Background and aim: 'Reasoning 4 Change' (R4C) is a newly developed instrument, including four domains (D1-D4), to assess clinical practitioners' and students' clinical reasoning with a focus on clients' behaviour change in a physiotherapy context. To establish its use in education and research, its psychometric properties needed to be evaluated. The aim of the study was to generate criterion scores and evaluate the reliability and construct validity of a web-based version of the R4C instrument. Methods: Fourteen physiotherapy experts and 39 final-year physiotherapy students completed the R4C instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Twelve experts and 17 students completed the R4C instrument on a second occasion. The R4C instrument was evaluated with regard to: internal consistency (five subscales of D1); test-retest reliability (D1-D4); inter-rater reliability (D2-D4); and construct validity in terms of convergent validity (D1.4, D2, D4). Criterion scores were generated based on the experts' responses to identify the scores of qualified practitioners' clinical reasoning abilities. Results: For the expert and student samples, the analyses demonstrated satisfactory internal consistency (alpha range: 0.67-0.91), satisfactory test-retest reliability (ICC range: 0.46-0.94) except for D3 for the experts and D4 for the students. The inter-rater reliability demonstrated excellent agreement within the expert group (ICC range: 0.94-1.0). The correlations between the R4C instrument and PABS-PT (r range: 0.06-0.76) supported acceptable construct validity. Conclusions: The web-based R4C instrument shows satisfactory psychometric properties and could be useful in education and research. The use of the instrument may contribute to a deeper understanding of physiotherapists' and students' clinical reasoning, valuable for curriculum development and improvements of competencies in clinical reasoning related to clients' behavioural change.

Place, publisher, year, edition, pages
AMER INST MATHEMATICAL SCIENCES-AIMS, 2018
Keywords
assessment, behaviour change, clinical reasoning, education, physiotherapy, psychometrics, reliability, validity, web application
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-40738 (URN)10.3934/publichealth.2018.3.235 (DOI)000442478900004 ()30280115 (PubMedID)
Available from: 2018-09-06 Created: 2018-09-06 Last updated: 2018-10-11Bibliographically approved
Elvén, M., Hochwälder, J., Dean, E. & Söderlund, A. (2018). Development and initial evaluation of an instrument to assess physiotherapists' clinical reasoning focused on clients' behavior change. Physiotherapy Theory and Practice, 34(5), 367-383
Open this publication in new window or tab >>Development and initial evaluation of an instrument to assess physiotherapists' clinical reasoning focused on clients' behavior change
2018 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 34, no 5, p. 367-383Article in journal (Refereed) Published
Abstract [en]

Background and Aim: A systematically developed and evaluated instrument is needed to support investigations of physiotherapists' clinical reasoning integrated with the process of clients' behavior change. This study's aim was to develop an instrument to assess physiotherapy students' and physiotherapists' clinical reasoning focused on clients' activity-related behavior and behavior change, and initiate its evaluation, including feasibility and content validity. Methods: The study was conducted in three phases: 1) determination of instrument structure and item generation, based on a model, guidelines for assessing clinical reasoning, and existing measures; 2) cognitive interviews with five physiotherapy students to evaluate item understanding and feasibility; and 3) a Delphi process with 18 experts to evaluate content relevance. Results: Phase 1 resulted in an instrument with four domains: Physiotherapist; Input from client; Functional behavioral analysis; and Strategies for behavior change. The instrument consists of case scenarios followed by items in which key features are identified, prioritized, or interpreted. Phase 2 resulted in revisions of problems and approval of feasibility. Phase 3 demonstrated high level of consensus regarding the instrument's content relevance. Conclusions: This feasible and content-validated instrument shows potential for use in investigations of physiotherapy students' and physiotherapists' clinical reasoning, however continued development and testing are needed.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS INC, 2018
Keywords
Behavior change, clinical reasoning, instrument development, physiotherapy, validity
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-38826 (URN)10.1080/09593985.2017.1419521 (DOI)000425789400004 ()29405848 (PubMedID)2-s2.0-85041579507 (Scopus ID)
Available from: 2018-03-08 Created: 2018-03-08 Last updated: 2018-09-18Bibliographically approved
Eklund, C., Elfström, M., Eriksson, Y. & Söderlund, A. (2018). Development of the web application My Stress Control—Integrating theories and existing evidence. Cogent Psychology, 5(1), 1-19
Open this publication in new window or tab >>Development of the web application My Stress Control—Integrating theories and existing evidence
2018 (English)In: Cogent Psychology, Vol. 5, no 1, p. 1-19Article in journal (Refereed) Published
Abstract [en]

Aim: To describe the systematic development of an evidence-based, tailored, interactive web application for self-management of work-related stress, and to test usability issues regarding how to proceed through the programme. Methods: Evidence from the fields of stress management, behaviour change and web-based interventions was the foundation for the theoretical framework and content. The next step was the development process of the web application and validation among experts and one possible end user. Last, a usability test with 14 possible end users was conducted. Results: The web-application, My Stress Control (MSC), was built on a solid theoretical framework. It consists of 12 modules including: introduction, psychoeducation, ambivalence, stress management strategies, lifestyle change, and maintenance. Self-monitoring, goal-setting, re-evaluating goals, feedback, and prompting formulation of intention to change are central techniques supporting behaviour change. The usability test revealed difficulties in understanding how to proceed through the programme. Conclusion: The development contributes to filling a gap in the literature regarding development of complex web-based interventions. MSC is dissimilar to existing programs in the field, considering the tailoring and multi-tracked opportunities. Although developed from the evidence in multiple fields, the web application would benefit from further development to support users in reaching the end module.

Place, publisher, year, edition, pages
Cogent OA, 2018
Keywords
behaviour change, health promotion, internet, occupational stress, stress management, stress prevention
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-40238 (URN)10.1080/23311908.2018.1489457 (DOI)000436962900001 ()2-s2.0-85049310511 (Scopus ID)
Funder
AFA Insurance, 130263
Available from: 2018-07-12 Created: 2018-07-12 Last updated: 2018-07-20
Eklund, C., Elfström, M., Eriksson, Y. & Söderlund, A. (2018). Evaluation of a Web-Based Stress Management Application: A Feasibility Study. Journal of Technology in Behavioral Science, 3(3), 150-160
Open this publication in new window or tab >>Evaluation of a Web-Based Stress Management Application: A Feasibility Study
2018 (English)In: Journal of Technology in Behavioral Science, ISSN 2366-5963, Vol. 3, no 3, p. 150-160Article in journal (Refereed) Published
Abstract [en]

The aim of the current study was to investigate the feasibility of a Web-based program that promotes behavior change for stress-related problems in terms of the program’s acceptability, practicability, and any possible effects. In addition, the aim was also to study how appropriate and realistic the study’s process and resource management would be for conducting a randomized controlled trial. A convenience sample consisting of 14 individuals was recruited from a university in Sweden. The participants had access to the program for a duration of 9 weeks. Questionnaires were answered before accessing, during use of, and after completing the program. Both qualitative and quantitative data were collected and analyzed. The program was considered acceptable and practically feasible, though small adjustments have to be made. The program was considered time-consuming, extensive, and in need of some clarifications. Regarding process and resource management, the study participants required minimum support. It was difficult to identify the time point when to send out the process measures because the participants worked at their own pace. Also, one of the process measurements, the motivation to change, remained stable. With some adjustments to the instructions to the study participants and minor changes in the program, the intervention and study’s procedure were considered as feasible and can be carried out in a randomized controlled trial.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
stress, internet, behaviour change, occupational stress, health promotion, feasibility
National Category
Medical and Health Sciences Health Sciences
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-40272 (URN)10.1007/s41347-018-0044-8 (DOI)
Funder
AFA Insurance, 130263
Available from: 2018-07-20 Created: 2018-07-20 Last updated: 2018-09-10Bibliographically approved
Söderlund, A., Nordgren, L., Sterling, M. & Stalnacke, B.-M. (2018). Exploring patients' experiences of the whiplash injury-recovery process - a meta-synthesis. Journal of Pain Research, 11, 1263-1271
Open this publication in new window or tab >>Exploring patients' experiences of the whiplash injury-recovery process - a meta-synthesis
2018 (English)In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 11, p. 1263-1271Article, review/survey (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to conduct a meta-synthesis to analyze qualitative research findings and thereby understand patients' experiences of whiplash-associated disorders (WAD) and the injury-recovery process. Materials and methods: A qualitative meta-synthesis, which is an interpretive integration of existing qualitative findings, was performed. The databases PubMed, PsychINFO, Scopus, and Web of Science were searched. The Critical Assessment Skills Programme was used to assess the quality of the included studies. Results: Four studies were included. The synthesis resulted in several codes, 6 categories, and 3 themes (distancing from normalcy, self-efficacy in controlling the life situation after the injury, and readjustment and acceptance) that described the participants' pain beliefs, their WAD-related life situation and their future expectations and acceptance. Changes in self-image were difficult to cope with and likely led to perceived stigmatization. Struggling with feelings of loss of control appeared to lead to low confidence and insecurity. Focusing on increasing knowledge and understanding the pain and its consequences were believed to lead to better strategies for handling the situation. Furthermore, recapturing life roles, including returning to work, was challenging, but an optimistic outlook reinforced symptom improvements and contributed to feelings of happiness. Conclusion: The results of the present study provide a comprehensive understanding of patients' complex, multifaceted experiences of WAD, and the injury-recovery process. The findings can guide us in the development of new ways to evaluate and manage WAD. The results also indicate that a more patient-centered approach is needed to determine the depth and breadth of each patient's problems.

Place, publisher, year, edition, pages
DOVE MEDICAL PRESS LTD, 2018
Keywords
whiplash-associated disorders, control, self-efficacy, happiness, life situation
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-40257 (URN)10.2147/JPR.S158807 (DOI)000437149100001 ()29988716 (PubMedID)
Available from: 2018-07-19 Created: 2018-07-19 Last updated: 2018-07-19Bibliographically approved
Arkkukangas, M., Söderlund, A., Eriksson, S. & Johansson, A.-C. (2018). One-Year Adherence to the Otago Exercise Program With or Without Motivational Interviewing in Community-Dwelling Older Adults. Journal of Aging and Physical Activity, 26(3), 390-395
Open this publication in new window or tab >>One-Year Adherence to the Otago Exercise Program With or Without Motivational Interviewing in Community-Dwelling Older Adults
2018 (English)In: Journal of Aging and Physical Activity, ISSN 1063-8652, E-ISSN 1543-267X, Vol. 26, no 3, p. 390-395Article in journal (Refereed) Published
Abstract [en]

This study investigated if behavioral factors, treatment with behavioral support, readiness to change, fall self-efficacy, and activity habits could predict long-term adherence to an exercise program. Included in this study were 114 community-dwelling older adults who had participated in one of two home-based exercise interventions. Behavioral factors associated with adherence to the exercise program over 52 weeks were analyzed. The behavioral factors, specifically activity habits at baseline, significantly predicted adherence to the exercise program, with an odds ratio = 3.39, 95% confidence interval [1.38, 8.32], for exercise and an odds ratio = 6.11, 95% confidence interval [2.34, 15.94], for walks. Being allocated to a specific treatment including motivational interviewing was also significantly predictive: odds ratio = 2.47, 95% confidence interval [1.11, 5.49] for exercise adherence. In conclusion, activity habits and exercise in combination with motivational interviewing had a significant association with adherence to the exercise program at a 1-year follow-up.

Place, publisher, year, edition, pages
HUMAN KINETICS PUBL INC, 2018
Keywords
motivation, older adults, physical activity
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-40560 (URN)10.1123/japa.2017-0009 (DOI)000441464400005 ()28952864 (PubMedID)
Available from: 2018-08-30 Created: 2018-08-30 Last updated: 2018-08-30Bibliographically approved
Söderlund, A., Löfgren, M. & Stålnacke, B.-M. (2018). Predictors before and after multimodal rehabilitation for pain acceptance and engagement in activities at a 1-year follow-up for patients with whiplash-associated disorders (WAD)-a study based on the Swedish Quality Registry for Pain Rehabilitation (SQRP). The spine journal, 18(8), 1475-1482
Open this publication in new window or tab >>Predictors before and after multimodal rehabilitation for pain acceptance and engagement in activities at a 1-year follow-up for patients with whiplash-associated disorders (WAD)-a study based on the Swedish Quality Registry for Pain Rehabilitation (SQRP)
2018 (English)In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 18, no 8, p. 1475-1482Article in journal (Refereed) Published
Abstract [en]

BACKGROUND CONTEXT: Studies have shown that pain acceptance strategies related to psychological flexibility are important in the presence of chronic musculoskeletal pain. However, the predictors of these strategies have not been studied extensively in patients with whiplash-associated disorders (WAD). PURPOSE: The purpose of this study was to predict chronic pain acceptance and engagement in activities at 1-year follow-up with pain intensity, fear of movement. perceived responses from significant others, outcome expectancies, and demographic variables in patients with WAD before and after multimodal rehabilitation (MMR). STUDY DESIGN: The design of this investigation was a cohort study with 1-year postrehabilitation follow-up. STUDY SETTING: The subjects participated in MMR at a Swedish rehabilitation clinic during 2009-2015. PATIENT SAMPLE: The patients had experienced a whiplash trauma (WAD grade I-II) and were suffering from pain and reduced functionality. A total of 386 participants were included: 297 fulfilled the postrehabilitation measures, and 177 were followed up at 1 year after MMR. OUTCOME MEASURES: Demographic variables, pain intensity, fear of movement, perceived responses from significant others, and outcome expectations were measured at the start and after MMR. Chronic pain acceptance and engagement in activities were measured at follow-up. METHODS: The data were obtained from a Swedish Quality Registry for Pain Rehabilitation (SQRPR). RESULTS: Outcome expectancies of recovery, supporting and distracting responses of significant others, and fear of (re)injury and movement before MMR were significant predictors of engagement in activities at follow-up. Pain intensity and fear of (re)injury and movement after MMR significantly predicted engagement in activities at follow-up. Supporting responses of significant others and fear of (re)injury and movement before MMR were significant predictors of pain acceptance at the 1-year follow-up. Solicitous responses of significant others and fear of (re)injury and movement at postrehabilitation significantly predicted pain acceptance at follow-up. CONCLUSION: For engagement in activities and pain acceptance, the fear of movement appears to emerge as the strongest predictor. but patients' perceived reactions from their spouses need to be considered in planning the management of WAD. 

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2018
Keywords
Engagement in activities, Fear of movement, Outcome expectancy, Pain acceptance, Quality registry, Whiplash-associated disorders
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-40936 (URN)10.1016/j.spinee.2017.11.014 (DOI)000443585000023 ()29155342 (PubMedID)
Available from: 2018-09-13 Created: 2018-09-13 Last updated: 2018-09-13Bibliographically approved
Nordgren, L. & Söderlund, A. (2018). Social support, self-rated health and low mood in people on sick leave due to heart failure: a cross-sectional study. Scandinavian Journal of Public Health, 46(6), 606-612
Open this publication in new window or tab >>Social support, self-rated health and low mood in people on sick leave due to heart failure: a cross-sectional study
2018 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, no 6, p. 606-612Article in journal (Refereed) Published
Abstract [en]

Aims: The aim of this study was to investigate social support in relation to self-rated health and the prevalence of low mood in people on sick leave due to heart failure. Methods: A cross-sectional design was used, and 590 individuals on sick leave due to heart failure in Sweden responded to the postal questionnaire. The questions therein concerned received and needed functional and structural support from managers, work colleagues, families and friends. Multivariate analyses were conducted. Results: The variables of income and needed support from family contributed significantly and negatively to self-rated health. Those who perceived that they needed more support from their manager reported experiencing low mood more frequently. Conclusions: The results showed a negative relation between manager support and low mood. Thus, support from managers and perceptions of low mood during sick leave are negatively associated, however, we do not know anything about the causality of this association. The results also indicated that needed support from family was negatively associated with self-rated health. The results also highlighted a multidimensional frailty in people with heart failure that needs to be recognized in future research as well as in clinical practice.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2018
Keywords
Cross-sectional, depression, heart failure, self-rated health, sick leave, social support
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-40559 (URN)10.1177/1403494817718070 (DOI)000441724500003 ()29160157 (PubMedID)
Available from: 2018-08-30 Created: 2018-08-30 Last updated: 2018-08-30Bibliographically approved
Söderlund, A. (2018). WHO's sustainable development goals and physiotherapy in 2018: editorial. European Journal of Physiotherapy, 20(1), 1-1
Open this publication in new window or tab >>WHO's sustainable development goals and physiotherapy in 2018: editorial
2018 (English)In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 20, no 1, p. 1-1Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2018
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-39362 (URN)10.1080/21679169.2018.1426700 (DOI)000432136500001 ()
Available from: 2018-05-31 Created: 2018-05-31 Last updated: 2018-05-31Bibliographically approved
Engquist, M., Lofgren, H., Oberg, B., Holtz, A., Peolsson, A., Söderlund, A., . . . Lind, B. (2017). A 5-to 8-year randomized study on the treatment of cervical radiculopathy: anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone. JOURNAL OF NEUROSURGERY-SPINE, 26(1), 19-27
Open this publication in new window or tab >>A 5-to 8-year randomized study on the treatment of cervical radiculopathy: anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone
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2017 (English)In: JOURNAL OF NEUROSURGERY-SPINE, ISSN 1547-5654, Vol. 26, no 1, p. 19-27Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE The aim of this study was to evaluate the 5- to 8-year outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program as compared with that following the same physiotherapy program alone in patients with cervical radiculopathy. No previous prospective randomized studies with a follow-up of more than 2 years have compared outcomes of surgical versus nonsurgical intervention for cervical radiculopathy. METHODS Fifty-nine patients were randomized to ACDF surgery with postoperative physiotherapy (30 patients) or to structured physiotherapy alone (29 patients). The physiotherapy program included general and specific exercises as well as pain coping strategies. Outcome measures included neck disability (Neck Disability Index [NDI]), neck and arm pain intensity (visual analog scale [VAS]), health state (EQ-5D questionnaire), and a patient global assessment. Patients were followed up for 5-8 years. RESULTS After 5-8 years, the NDI was reduced by a mean score% of 21 (95% CI 14-28) in the surgical group and 11% (95% CI 4%-18%) in the nonsurgical group (p = 0.03). Neck pain was reduced by a mean score of 39 mm (95% CI 26-53 mm) compared with 19 mm (95% CI 7-30 mm; p = 0.01), and arm pain was reduced by a mean score of 33 mm (95% CI 18-49 mm) compared with 19 mm (95% CI 7-32 mm; p = 0.1), respectively. The EQ-5D had a mean respective increase of 0.29 (95% CI 0.13-0.45) compared with 0.14 (95% CI 0.01-0.27; p = 0.12). Ninety-three percent of patients in the surgical group rated their symptoms as "better" or "much better" compared with 62% in the nonsurgical group (p = 0.005). Both treatment groups experienced significant improvement over baseline for all outcome measures. CONCLUSIONS In this prospective randomized study of 5- to 8-year outcomes of surgical versus nonsurgical treatment in patients with cervical radiculopathy, ACDF combined with physiotherapy reduced neck disability and neck pain more effectively than physiotherapy alone. Self-rating by patients as regards treatment outcome was also superior in the surgery group. No significant differences were seen between the 2 patient groups as regards arm pain and health outcome.

Keywords
cervical radiculopathy, randomized, surgery, physiotherapy, anterior cervical decompression and fusion, outcome
National Category
Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-34664 (URN)10.3171/2016.6.SPINE151427 (DOI)000390725200005 ()27564856 (PubMedID)2-s2.0-85013176762 (Scopus ID)
Available from: 2017-01-19 Created: 2017-01-19 Last updated: 2018-10-16Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4537-030X

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