Træning som behandling hvorfor, hvordan og hvor lidt er nok?

Transkript

1 F o r s k n i n g s - o g U d v i k l i n g s s y m p o s i u m f o r f y s i o t e r a p e u t e r, R e g i o n N o r d j y l l a n d 8. n o v e m b e r Træning som behandling hvorfor, hvordan og hvor lidt er nok? Abstrakts og program Fysio- og Ergoterapi

2 VELKOMMEN til Forsknings- og Udviklingssymposium for fysioterapeuter, Region Nordjylland den 8. november 2016 Det er med stor glæde, at vi med et meget spændende program for fysioterapeuter og andre med interesse for forskning og udvikling i relation til fysioterapi kan afholde årets Forsknings- og Udviklingssymposium. Det er 5. gang, at vi i Region Nordjylland afholder symposiet, og endnu en gang har der været stor interesse for arrangementet. Vi takker for de 16 indsendte abstrakts til dagen, som alle præsenteres mundtligt og er samlet udgivet denne abstraktbog. Chefterapeut Hans Erik Madsen, Aalborg Universitetshospital og dekan ved det Sundhedsfaglige Fakultet Lars Hvilsted Rasmussen, Aalborg Universitet indleder dagen med velkomst og en lancering af et nyt initiativ, der vil styrke det fysioterapeutiske forsknings- og udviklingsmiljø i regionen. Titlen på symposiet i år er Træning som behandling hvorfor, hvordan og hvor lidt er nok?, og formiddagens oplægsholder Jørn Wulff Helge og oplægsholderne på de 3 minisymposier og workshops vil alle relatere deres oplæg til dette fysioterapiaktuelle tema. Vi ønsker alle en inspirerende og spændende dag sammen med andre forsknings- og udviklingsinteresserede kolleger. Velkommen! Planlægningsgruppen Side 2 af 25

3 Indhold Program for symposiet... 4 Emnesymposium Emnesymposium Emnesymposium Program for parallelle sessioner... 8 Pain during adolescence can be grouped into four pain clusters with distinct profiles: results from a population based cohort of 2953 adolescents... 9 Injury to the musculoskeletal system causes a shift in location of experimentally-induced referred pain Wobble board training influences single-leg early landing biomechanics Can we predict the outcome for people with patellofemoral pain? A systematic review on prognostic factors and treatment effect modifiers Kropsbevidsthed Ensidig sensorisk stimulation har indflydelse på vægtfordeling i stående stilling Kommunale intiativer til faldforebyggelse i Aalborg Kommune Effekten af hurtig opstart af vestiibulær træning hos patienter med akut neuritis vestibularis en rct-studieprotokol Faldprediktion hos hjemmeboende ældre borgere i Aalborg Kommune en studieprotkol til et prospektivt kohortestudie Patient and staff experiences of participation in an implementation study of physical activity and nutritional intervention at a medical ward: A qualitative study Unsupervised Progressive Elastic Band Exercises for Frail Geriatric Inpatients objectively monitored by new Exercise-integrated Technology - A Feasibility Trial with an embedded Qualitative Study Danish version of Lymphoedema Functioning, Disability and Health Questionnaire (Lymph- ICF) for breast cancer survivors: Translation, cross-cultural adaption, validity and reliability Inspiratory muscle training enhances recovery of activity levels in high-risk patients following lung cancer surgery One-year development of QOL following orthopaedic polytrauma a prospective observational cohort study of 53 patients Content Validation of the Tilburg Frailty Indicator by the Perspectives of Frail Older Medical patients. A Qualitative Explorative Study Does an 8-week homebased exercise programme affect physical capacity, quality of life, sick leave and use of psychoactive drugs in patients with pulmonary embolism? A multicentre randomised clinical trial Risk factors influencing the one year postoperative risk of reoperation after arthroscopic meniscal repair: a three year retrospective observational, cohort study Side 3 af 25

4 Program for symposiet Kaffe/te og snak Velkomst ved chefterapeut Hans Erik Madsen, Fysio- og Ergoterapi, Aalborg Universitetshospital Åbningstale ved dekan ved Det Sundhedsvidenskabelige Fakultet Lars Hvilsted Rasmussen, Aalborg Universitet Keynote-oplæg ved professor Jørn Wulff Helge, Københavns Universitet - Træning som behandling: hvor lidt kan vi nøjes med og hvor meget er optimalt? Kaffe/te og brød Korte oplæg parallelle sessioner 2 x Frokost Korte oplæg - parallelle sessioner 2 x Emnesymposier 1) Træning, patientuddannelse og alt det andet som er vigtigt i behandlingen af den smertefulde sene (tendinopati) 2) Tests, screening og træning af den ældre patient 3) Træning og fastholdelse af fysisk aktivitet i forbindelse med en kræftsygdom Kaffe/te og kage Praktisk workshop ifm. de tre symposier Side 4 af 25

5 Emnesymposium 1 Træning, patientuddannelse og alt det andet som er vigtigt i behandlingen af den smertefulde sene (tendinopati) Introduktion ved Michael Skovdal Rathleff, fysioterapeut, ph.d. og Thorvaldur Skuli Palsson, fysioterapeut, ph.d. Diagnostik og differentialdiagnostik af den smertefulde sene ved Jens Lykkegaard Olesen, reumatolog, ph.d. Behandling af patella tendinopati - what s new? ved Carsten Mølgaard, fysioterapeut, ph.d. Behandling af achilles tendinopati - what s new? ved Marianne Christensen, fysioterapeut, cand.scient.san. Behandling af plantar fasciopathi (fasciitis plantaris) - what s new? ved Michael Skovdal Rathleff, fysioterapeut, ph.d. Alt det andet der også er vigtigt i behandlingen af tendinopatier (aktivitetsmodifikation, patientuddannelse etc.) ved Jens Erik Jørgensen, fysioterapeut, M.Sc. Hvornår skal vi overveje at sende patienten videre til reumatolog eller ortopædkirurg? ved Jens Lykkegaard Olesen, reumatolog, ph.d. og Søren Kaalund, ortopædkirurg Workshop tilknyttet emnesymposium 1: Praktisk behandling af den smertefulde sene Gennemgang af de vigtigste øvelser til de tre tendinopatier vi taler om i symposiet. Der bliver tre stationer (patella, achillessene og plantar fasciopathi), hvor der roteres mellem stationerne. Ved stationerne vil der være fokus på praktisk fremvisning og afprøvning. Det vil sige finde f.eks. 10RM, korrekt range of motion, dosis med mere. Patellasenen: Jens Erik Jørgensen, fysioterapeut, M.Sc. Achillessenen: Marianne Christensen, fysioterapeut, cand.scient.san Plantar fasciopathy: Henrik Riel, fysioterapeut, stud.scient.san. Side 5 af 25

6 Emnesymposium 2 Tests, screening og træning af den ældre patient Introduktion ved Morten Villumsen, fysioterapeut, ph.d. og Jane Andreasen, forskningsansvarlig, ph.d.-stud. Enkle og let tilgængelige funktionsevnetests til den akut indlagte medicinske patient mhp. at identificere ældre patienter i risiko for funktionsevnetab. Hvilke funktionsevnetests er nødvendige? Hvad kan vi bruge dem til i daglig praksis? ved Ann Christine Bodilsen, fysioterapeut, ph.d. Enkel styrketræning for ældre medicinske patienter - hvorfor, hvordan og hvor lidt er nok? ved Mette Merete Pedersen, fysioterapeut, ph.d. Screening af skrøbelighed hos (akut indlagte) ældre med henblik på at identificere patienter i risiko for indlæggelse, genindlæggelse eller død. Hvad kan vi anvende screening af skrøbelighed til ud fra et behandler- og et patientperspektiv? ved Jane Andreasen, forsknings-ansvarlig, ph.d.-stud. Workshop tilknyttet emnesymposium 2: Praktisk gennemgang af tests og styrketræning af ældre medicinske patienter ved Ann Christine Bodilsen og Mette Merete Pedersen. Fokus i workshop er på praktisk fremvisning og afprøvning af tests og træningsprogrammer. Side 6 af 25

7 Emnesymposium 3 Træning og fastholdelse af fysisk aktivitet i forbindelse med en kræftsygdom Introduktion ved Barbara Brocki, fysioterapeut, ph.d. Træning i forbindelse med et kræftsygdom hvorfor og hvordan? ved Morten Quist, fysioterapeut, ph.d. Træning før operation giver det mening og hvem er målgruppen? ved Barbara Brocki, fysioterapeut, ph.d. Brugerinddragelse og fastholdelse af motionsvaner ved Charlotte Brun Thorup, sygeplejerske, ph.d. Workshop tilknyttet emnesymposium 3: Hvordan kan jeg tilrettelægge et træningsprogram til en person med en kræftdiagnose? Deltagere arbejder i grupper, hvor de ud fra en patientcase og med udgangspunkt i oplæggene, tilrettelægger et træningsprogram. Casen bliver efterfølgende diskuteret blandt deltagerne. Side 7 af 25

8 Program for parallelle sessioner Kl. SPOR A (Auditoriet) SPOR B (Mødelokale ) Chairman: Marianne Christensen Pain during adolescence can be grouped into four pain clusters with distinct profiles: results from a population based cohort of 2953 adolescents Sinead Holden, M.S. Rathleff, E. Roos, M.B. Jensen, N. Pourbordbari, T. Graven-Nielsen Injury to the musculoskeletal system causes a shift in location of experimentally-induced referred pain Thorvaldur Skuli Palsson, Hans Jørgen Krebs, Shellie A. Boudreau & Thomas Graven-Nielsen Chairman: Birgitte Hede Ebbesen Patient and staff experiences of participation in an implementation study of physical activity and nutritional intervention at a medical ward: A qualitative study. Jane Andreasen, Lise Nørregaard Søndergaard, Mette Holst Unsupervised Progressive Elastic Band Exercises for Frail Geriatric Inpatients objectively monitored by new Exercise-integrated Technology - A Feasibility Trial with an embedded Qualitative Study Camilla R. Rathleff, T. Bandholm, E. G. Spaich, M. Jorgensen, J. Andreasen Wobble board training influences single-leg early landing biomechanics Priscila de Brito Silva, Anderson de Souza Oliveira, Natalie Mrachacz-Kersting, Uwe Gustav Kersting Danish version of Lymphoedema Functioning, Disability and Health Questionnaire (Lymph-ICF) for breast cancer survivors: Translation, cross-cultural adaption, validity and reliability Karin Ravnsbæk Grarup Can we predict the outcome for people with patellofemoral pain? A systematic review on prognostic factors and treatment effect modifiers M. Matthews, Michael S. Rathleff, A. Claus, T. McPoil, R. Nee, K. Crossley, B. Vicenzino Kropsbevidsthed ensidig sensorisk stimulation har indflydelse på vægtfordeling i stående stilling Uffe Læssøe, Lasse Barth, Sindre Skeie, Kate McGirr Inspiratory muscle training enhances recovery of activity levels in high-risk patients following lung cancer surgery Barbara Christina Brocki, Jan Jesper Andreasen, Elisabeth Westerdahl One-year development of QOL following orthopaedic polytrauma a prospective observational cohort study of 53 patients Peter Larsen, Charlotte B. Goethgen, Sten Rasmussen, Annika B. Iyer, Rasmus Elsoe FROKOST FROKOST Chairman: Annette Fjerbæk Kommunale intiativer til faldforebyggelse i Aalborg Kommune Ulla Britt Mikkelsen, Mathilde Skovgaard Nielsen, Lena Hedegaard Malmberg, Morten Villumsen Chairman: Peter Skrejborg Content Validation of the Tilburg Frailty Indicator by the Perspectives of Frail Older Medical patients. A Qualitative Explorative Study. Jane Andreasen, Hans Lund, Mette Aadahl, Robbert JJ. Gobben, Erik E. Sørensen Effekten af hurtig opstart af vestiibulær træning hos patienter med akut neuritis vestibularis en rct-studieprotokol Christine Kjeldal Jensen, Uffe Læssøe, Dan Dupont Hougaard, Morten Villumsen Faldprediktion hos hjemmeboende ældre borgere i Aalborg Kommune en studieprotkol til et prospektivt kohortestudie Morten Villumsen, Bo Grarup, Steffan Wittrup Chistensen, Thorvaldur Skuli Palsson, Rogerio Pessoto Hirata Does an 8-week homebased exercise programme affect physical capacity, quality of life, sick leave and use of psychoactive drugs in patients with pulmonary embolism? A multicentre randomised clinical trial. Nanna Rolving, Barbara Christina Brocki, Hanne R. Mikkelsen, Pernille Ravn, Jannie Rhod Bloch-Nielsen, Lars Frost Risk factors influencing the one year postoperative risk of reoperation after arthroscopic meniscal repair: a three year retrospective observational, cohort study Carsten Mølgaard, Lotte Drustrup, Laura Fugelsang Bech, Helene Rovsing, Cecilie Rovsing, Sten Rasmussen Side 8 af 25

9 Pain during adolescence can be grouped into four pain clusters with distinct profiles: results from a population based cohort of 2953 adolescents Holden S 1,2, Rathleff MS 1, Roos E 3, Jensen MB 1, Pourbordbari N 1, Graven-Nielsen T 2 1 Research Unit for General Praactice in Aalborg, and Department of Clinical Medicine, Aalborg University. 2 Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Aalborg University 3 Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark Background Multisite pain is common in adolescents, with one in three adolescents reporting pain in more than one site. Despite this, pain conditions are frequently diagnosed and treated in isolation. Identifying patterns of pain clusters could be important for the treatment of pain and for understanding prognosis of pain. This study aims to 1) investigate potential clusters of pain in a population based cohort of adolescents, and 2) explore the association between pain clusters and sex, sports participation, health related quality of life (HRQoL), and body mass index (BMI). Methods In 2011, a population based cohort of adolescents, aged years from Aalborg were asked to fill out an online questionnaire regarding pain, physical activity and quality of life. Number and location of pain sites were determined by instructing participants to mark the regions on a body mannequin where they currently experienced pain. The questionnaire also included information regarding age, height, weight, sex, school, sport participation, and HRQoL (assessed by Euro-QoL 5D-3L). Latent class analysis was used to identify pain clusters, based on number and location of pain sites. Results A total of 2,953 adolescents (73.7%) answered the questionnaire correctly and were included in the data analysis. Four clusters were identified: (1) no or one painful body site (55.4%), (2) widespread multi-site pain (25.8%) (3) localized knee pain with no other pain sites (11.2%), and (4) lower extremity multi-site pain (7.5%). There were no significant differences in number of pain sites between the two multi-site pain clusters (clusters 2 and 4). There was a significant relationship of sex and cluster type, p <0.001, and males were more likely to belong to the cluster with no or one painful site, whereas females were more likely to be allocated to the widespread multisite pain cluster. There were significant differences between clusters for sports participation, HRQoL and BMI, p< The lower extremity multisite pain group reported the highest sports participation (mean: 3.1; 95% CI 2.8 to 3.3 times / week), while the widespread multi-site group had the lowest EQ-5D score (mean 0.77; 95% CI 0.76 to 0.77) and the highest BMI (mean 21.5; 95% 21.3 to 21.8). Conclusions Using latent class analysis, four clusters of pain were identified in adolescents. The clusters identified demonstrated significant differences in terms of their sports participation, health related quality of life, and BMI. Females were more likely to belong to the widespread multi-site pain cluster. Side 9 af 25

10 Injury to the musculoskeletal system causes a shift in location of experimentally-induced referred pain Thorvaldur Skuli Palsson, Hans Jørgen Krebs, Shellie A. Boudreau & Thomas Graven-Nielsen Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University Aim of Investigation A common feature in musculoskeletal pain is the recurrence of pain after the initial painful episode even after complete tissue healing. This may suggest that the nociceptive system undergoes changes following the tissue insult which do not return to normal. This study aimed to investigate whether individuals who have recovered from a recent musculoskeletal injury demonstrate signs of hypersensitivity of the pain system. Methods Individuals whom recently recovered from of unilateral ankle injury (within 12 weeks from inclusion) (n=25) and healthy, pain-free control group (n=25) were recruited for this study. All subjects received injections of hypertonic saline into the tibialis anterior muscle on both sides (one at a time) to induce experimental muscle pain and, if present, referred pain to the ankle. Pain intensity was recorded on an electronic visual analogue scale (VAS). The area of pain was drawn on a digital body chart of the lower legs and the size, expressed as pixels, and location were extracted. For data analysis, a comparison was made between the control group (average of dominant and non-dominant leg) and the non-injured and injured leg in the previously injured group. Conditioned pain modulation (CPM) and temporal summation of pain (TSP) were assessed by a computer controlled cuff algometer mounted on the lower legs. The CPM-index indicates the increase in cuff pain thresholds during conditioning on the contralateral leg and the TSP-index is the ratio between the first and last VAS score after repeated stimulations. These were compared between the two groups. Results The pain intensity and associated duration did not differ between legs or groups. The saline-induced pain evoked a more frequent reports of referred pain, remote from the injection, in the foot region on the injured leg as compared to the non-injured leg and the control leg (P<0.05). The same applied when comparing the control leg with the non-injured leg (P<0.05). The group with a previous history of injury demonstrated an increased TSP-index compared with the control group (P<0.05). Conclusions The higher frequency of referred pain reported in the area of previous injury suggests that the nociceptive system remains altered and sensitized, particularly in neuroanatomical systems also excited by the initial tissue injury. Evidence of facilitated temporal summation of pain also existed when assessed remote from the original site injury, supporting a more general sensitization. Thus, increased sensitivity combined with a more general increased sensitivity of pain mechanisms appears to follow a painful injury. These findings may have implications for understanding the mechanisms behind recurring and chronic musculoskeletal pain conditions. Keywords Musculoskeletal pain, Pain memory, Pain referral, Hyperalgesia Side 10 af 25

11 Wobble board training influences single-leg early landing biomechanics Priscila de Brito Silva, Anderson de Souza Oliveira, Natalie Mrachacz-Kersting, Uwe Gustav Kersting. Poor control of postural sway has repeatedly been identified as a risk factor for sustaining ankle sprains among sports practitioners. Studies have shown that different balance training interventions protect sports practitioners from injuries especially ankle sprains amongst those without chronic instability (1). Nonetheless, little is known about the underlying mechanism that provide this protection. Additionally, it has been shown that landing from a jump is a complex sport movement, during which a large proportion of ankle injuries occur (2). This fact might be related to the high demand that single-leg landing represents for neuromuscular control and coordination of body segments in order to distribute energy dissipation. This way, considering that balance is a trainable skill that can affect occurrence of injuries in sports practice, the present investigation aimed to investigate whether adaptations to wobble board (WB) balance training can be transferred to biomechanical aspects of single-leg landing from a lateral jump (LL). We hypothesized that the adaptations elicited by WB training would alter ankle, knee and hip joint positioning at initial contact, reduce peak ground reaction forces, as well as influence joint velocity and joint work during the early contact phase of landing. Twenty healthy men were randomly assigned to either a control or a training group, who engaged in four weeks of WB training. Full-body kinematics and ground reaction force data were collected from 100 ms before and after initial foot contact for lateral single-leg landings. Repeated-measures analysis of variance main results showed a group x time interaction revealing opposite trends for both groups for the following variables: early landing trunk flexion velocity increased by 36% for trained participants, while it decreased by 41% for controls (p=0.036); ankle joint eccentric work increased 1.2 times in the frontal (p=0.007) and 4.4 times in the transverse plane (p=0.007) for the training group, likely to oppose inversion external moments exerted by the ground reaction force vector. In conclusion, WB balance training influenced early LL biomechanics at the lower limb and trunk. These results suggest that WB training elicits adaptations that can be transferred to landing biomechanics, by optimizing ankle stability and use the trunk to dissipate energy. Therefore, our study demonstrates evidence for transferred adaptations from balance training to landing. These results provide a new perspective on how WB training effects take place during sports related situations. Future studies should investigate whether those adaptations can provide protection against ankle sprain. References 1. Hübscher, M, Zech, A, Pfeifer, K, Hänsel, F, Vogt, L, and Banzer, W. Neuromuscular training for sports injury prevention: a systematic review. Med Sci Sports Exerc 42: , 2010.Available from: 2. McKay, GD, Goldie, PA, Payne, WR, and Oakes, BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med 35: , 2001.Available from: Side 11 af 25

12 Can we predict the outcome for people with patellofemoral pain? A systematic review on prognostic factors and treatment effect modifiers. Matthews M 1, Rathleff MS 2,3, Claus A 1, McPoil T 4, Nee R 5, Crossley K 6 and Vicenzino B 1 1 The University of Queensland, School of Health and Rehabilitation Sciences, Sports Injuries Rehabilitation and Prevention for Health research unit, CCRE Spine, Brisbane, Australia 2 Research Unit for General Practice in Aalborg and Department of Clinical Medicine, Aalborg, Denmark 3 Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital 4 School of Physical Therapy, Rueckert-Hartman College for Health Professions, Regis University, Denver, USA 5 School of Physical Therapy, Pacific University, Hillsboro, USA 6 La Trobe University, La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Australia Background Patellofemoral pain is a multifactorial and often persistent knee condition. More than one third of patients with PFP still report symptoms despite receiving evidence-based treatments that are initially effective. One strategy to enhance long-term patient outcomes is using clinically assessable patient characteristics to predict the outcome and match a specific treatment to an individual. The aim of this systematic review was to determine whether baseline patient characteristics were i) associated with patient outcome (prognosis); or ii) modified patient outcome from a specific treatment (treatment effect modifiers). Methods Six electronic databases were searched (July 2016) for studies evaluating the association between those with patellofemoral pain, their characteristics and outcome. All studies were appraised using the Epidemiological Appraisal Instrument and select studies underwent a checklist for methodological quality. Results The 24 included studies evaluated 180 participant characteristics. Twelve studies investigated prognosis, and 12 studies investigated potential treatment effect modifiers. Important methodological limitations were identified. Some prognostic studies used a retrospective design. Some studies identifying treatment effect modifiers over-fitted variables to the limiting sample group, and failed to use a control or comparator treatment group. Sixteen factors were reported to be associated with a poor prognosis with >4 months duration of symptoms the most reported. Preliminary evidence suggests increased midfoot mobility may predict those who have a successful outcome to foot orthoses. Conclusion Clinicians can use the current evidence to identify those with raised risk of a poor outcome but current evidence makes it difficult predict the outcome of one specific treatment compared with another until adequately designed randomised trials are conducted. Side 12 af 25

13 Kropsbevidsthed Ensidig sensorisk stimulation har indflydelse på vægtfordeling i stående stilling Uffe Laessoe, Lasse Barth, Sindre Skeie, Kate McGirr Resumé Der hersker uklarhed om begreberne kropsbevidsthed, kropsbillede og kropsskema. Ud fra klinisk erfaring tyder det på, at man ved hjælp af sensorisk stimulation kan øge en patients fornemmelse for sin krop og påvirke kropsskemaet. Ensidig massage benyttes således til at påvirke midtlinje-fornemmelsen. Fx kan man forsøge at stimulere en patient til tage mere vægt på et ben som ubegrundet aflastes efter immobilisering. Der er dog kun sparsom dokumentation for effekten af denne praksis. Dette studie undersøgte en mulig effekt af ensidig stimulation på den spontane vægtfordeling i stående stilling. Enogtyve raske unge mennesker deltog i en eksperimentel undersøgelse, hvor to kraftplatforme målte vægtfordeling mellem benene i stående stilling før og efter unilateral manuel stimulation af benene. Ved stimulation af benet med mindst vægtbæring øgedes den gennemsnitlige vægtfordeling på dette ben signifikant fra 48,2% til 49,0%. En lignende, men omvendt virkning blev set, når det contra-lateral ben blev stimuleret. Ved analyse af data med hensyn til stimulation af det ikke-dominante ben øgedes vægten på dette ben fra 49,6% til 51,3%. Disse resultater viser, at manuel sensorisk stimulation kan påvirke kropsopfattelsen og ændre kropsskema og midtlinjefornemmelsen. Det foreslås at resultaterne afprøves i forhold til en relevant patientpopulation. Side 13 af 25

14 Kommunale intiativer til faldforebyggelse i Aalborg Kommune Ulla Britt Mikkelsen 1, Mathilde Skovgaard Nielsen 2, Lena Hedegaard Malmberg 1, Morten Villumsen 1,3 1 Aalborg Kommune, Ældre- og Handicapforvaltningen, Ældre og Sundhedsafdelingen, Aalborg, Danmark 2 Aalborg Kommune, Ældre- og Handicapforvaltningen, Kvalitet- og Innovationsenheden, Aalborg Danmark 3 University College Nordjylland, Fysioterapeutuddannelsen, Aalborg, Danmark. For uddybende information: Faldteam@aalborg.dk, tlf Formål Med Aalborg Kommunes faldforebyggelsesindsats ønskes der at sikre implementering og udvikling af ny faldforebyggelsesstrategi på tværs af funktionerne i Ældre- og Sundhedsafdelingen, Aalborg Kommune. Faldforebyggelsesindsatsen bistår med kompetenceudvikling hos frontmedarbejdere i organisationen, tværfaglig forankring af faldforebyggelse samt vidensdeling om forebyggelse af fald. Der vil være særlig fokus på implementering af de faldforebyggende indsatser og fastsættelse af specifikke effektmål med henblik på opfølgning og evaluering af gevinstrealiseringen [1]. Det overordnede formål med faldforebyggelsesindsatsen er, at kunne tilbyde borgere i Aalborg Kommune koordinerede indsatser for at reducere antallet af fald. Anvendte metode(r) Faldforebyggelsesindsatsen er en del af kerneopgaven i Ældre- og Handicapforvaltningen, som skal fremme borgerens mulighed for at leve en selvstændig tilværelse [2]. Faldforebyggelsesindsatsen omhandler opsporing, identificering og begrænsning af risici og kan inddeles som følgende: a) tidlig indsats hos borgere, hvor det primære fokus er oplysning, vejledning og rådgivning, b) hjemmeboende borgere med risiko for fald, som har tilknytning til hjemmeplejen og c) plejehjemsbeboere i høj risiko for fald. Aalborg Kommune har etableret et faldteam, hvor ressourcepersoner skal sikre udvikling og kvalitet i faldforebyggelsesindsatserne. Faldteamets indsatser omfatter bl.a. a) etablering af faldskoler - herunder træning samt dialog om faldrisici, b) bedre ældreliv på plejehjem, c) registrering med henblik på kvalitetssikring, d) E-learning, e) samarbejde med UCN i forhold til kvalitetsudvikling i forhold til screening og intervention, f) hoftebeskyttere og g) kompetenceudvikling af alt frontpersonale. Resultater Aalborg Kommune forventer, at faldforebyggelsesindsatsen kan medvirke til at reducere antallet af fald blandt borgerne i Aalborg Kommune. Ydermere forventes det, at effekten af forskellige interventionstyper til forebyggelse af fald bliver belyst. Dette i samarbejde med UCN og AAU. Konklusion Med faldforebyggelsesindsatsen ønsker Aalborg Kommune at tilbyde borgere en koordineret indsats med henblik på reduktion af fald. Aalborg Kommunes faldforebyggelsesindsats forventer at kunne generere en gevinst i forhold til de økonomiske og menneskelige omkostninger, der er forbundet med fald. Referencer Side 14 af 25

15 Effekten af hurtig opstart af vestiibulær træning hos patienter med akut neuritis vestibularis en rct-studieprotokol Christine Kjeldal Jensen 1, Uffe Læssøe 2, Dan Dupont Hougaard 3, Morten Villumsen 1,2 1 Aalborg Kommune, Ældre- og Handicapforvaltningen, Træningsenheden, Aalborg, Danmark 2 University College Nordjylland, Fysioterapeutuddannelsen, Aalborg, Danmark. 3 Aalborg Universitetshospital, Klinik Hoved-, Orto, Øre-, Næse-, Halskirurgisk & Audiologisk Afdeling, Aalborg, Danmark. Formål Neuritis vestibularis eller virus på balancenerven er kendetegnet ved akut indsættende, voldsom, konstant rotatorisk svimmelhed, som skyldes akut påvirkning af det ene balanceorgan. Symptomerne skyldes oftest en betændelsestilstand med kan også ses på baggrund af en lille blodprop [1]. Neuritis vestibularis medfører ofte både negative samfundsmæssige og individuelle konsekvenser, herunder langtidssygefravær og øget inaktivitet grundet deres ubehag ved eksempelvis stillingsskift. Til trods for at studier indikerer, at vestibulær træning har en positiv effekt [2], tilbydes alle patienter med neuritis vestibularis ikke automatisk vestibulær træning. Hovedformålet med projektet er a) baseret på registerudtræk at skabe et overblik over patientgruppen, der vurderes at have gavnlig effekt af dette træningstilbud, b) at udvikle et kommunalt teknologibaseret rehabiliteringstilbud til disse borgere i samarbejde imellem Aalborg Kommune og Aalborg Universitetshospital, og c) at vurdere effekten af dette tilbud i forhold til den eksisterende praksis igennem et RCT-studie. Metode Patienter (>18 år), der bliver diagnosticeret med neuritis vestibularis, jvf. gældende kriterier herfor, af speciallæge på Øre-, Næse, Halskirurgisk afdeling, Aalborg Universitetshospital, vil blive tilbudt inklusion i studiet. Patienter, der samtykker til studiet, vil få foretaget en baseline og follow-up undersøgelse jvf. gældende instruks (indeholdende blandt andet VOR test, Video Hit Impulse Test (V-HIT) og test for spontannystagmus). Patienterne vil herefter blive randomiseret til enten en kontrolgruppe (patienter, der vil gennemgå den nuværende praksis) eller interventionsgruppe (nuværende praksis med supplerende specialiseret, forskningsbaseret træning) med opstart hos Aalborg Kommune ca. 3-5 dage efter den akutte fase. Selve interventionen vil foregå over 6 uger med løbende effektmålinger baseret på kliniske tests og objektive målinger, herunder objektiv aktivitetsmonitorering af fysisk (in)aktivitet og svimmelhedsapplikation indeholdende blandt andet elektronisk dagbog. Behandlingseffekten vil blive målt fra baseline til slutmåling med inddragelse af objektive, daglige kontinuerlige målinger. Dertil kommer, at der ønskes en prospektiv opfølgning 1, 3, 6 og 12 mdr. senere indeholdende (langtids)sygefravær samt ændring af svimmelhedssymptomer ud fra en udviklet svimmelhedsapplikation. Resultater Projektets resultater vil være udvikling af et specialiseret træningstilbud for borgere med neuritis vestibularis, med udgangspunkt i evidensbaseret viden og borgernær teknologi. Det årlige patientflow fra Aalborg Universitetshospital ønskes undersøgt. Desuden ønskes effekten af vestibulær træning hos patienter med neuritis vestibularis vurderet. Referencer: 1. G. M. Halmagyi, K. P. Weber, and I. S. Curthoys, Vestibular function after acute vestibular neuritis., Restor. Neurol. Neurosci., vol. 28, no. 1, pp , Sundhed.dk, Balancenerven, betændelse (vestibularisneurit) - Patienthåndbogen på sundhed.dk. [Online]. Available: Side 15 af 25

16 Faldprediktion hos hjemmeboende ældre borgere i Aalborg Kommune en studieprotkol til et prospektivt kohortestudie Morten Villumsen 1,2, Bo Grarup 1, Steffan Wittrup Chistensen 2,3, Thorvaldur Skuli Palsson 3, Rogerio Pessoto Hirata 3 1 Aalborg Kommune, Ældre- og Handicapforvaltningen, Aalborg, Danmark 2 University College Nordjylland, Fysioterapeutuddannelsen, Aalborg, Danmark. 3 SMI, Department of Health Science and Technology, Aalborg Universitet, Danmark. Formål Faldulykker er den hyppigste ulykkestype blandt ældre og udgør et vigtigt folkesundhedsproblem. En tredjedel af alle ældre mennesker over 65 år falder mindst én gang om året. Det første skridt mod at mindske faldrisiko er således at identificere de personer, der er i risiko. Et screeningsredskab er derfor nødvendigt for at kunne identificere faldtruede ældre. I takt med udvikling af kommercielle aktivitetstrackere, der kan belyse den ældres aktivitetsniveau, er der kommet øget fokus på sammenhængen mellem aktivitetsniveau og faldrisiko. Dette understreges af to nylige studier med fokus på monitorering af ældres aktivitetsniveau, hvilket viste en u-formet sammenhæng; selv om de mindst aktive, som ventet, havde den største faldrisiko, så havde de mest aktive ældre også en øget faldrisiko (Jefferis et al. 2015; Klenk et al. 2015). Det vil derfor være yderst interessant at undersøge om den ældres aktivitetsniveau, sammenholdt med kendte, udvalgte fysiske og psykiske risikofaktorer, med større sikkerhed kan forudsige fald. Projektets overordnede formål er at udvikle et testbatteri, som kan benyttes i klinisk praksis til identifikation af faldtruede ældre. Her undersøges, i hvilken grad monitorering af aktivitetsniveau sammenholdt med den ældres balance, muskelstyrke, smerteoplevelse, frygt for at falde og medicinforbrug kan diskriminere mellem de, der falder, og de, der ikke falder, hos ældre hjemmeboende borgere + 65 i Aalborg Kommune. Metode Undersøgelsen gennemføres som et flerårigt, observationelt, prospektivt kohortestudie. Til forsøget rekrutteres 600 ældre hjemmeboende borgere +65 år over en fireårig periode (fra 2016 til 2020). Baselinemålinger består af spørgeskemaer, der afdækker deltagerkarakteristika, selvoplevet smerte, selvrapporteret fysisk aktivitet indenfor de sidste syv dage, medicinering og bekymring for at falde. Der foretages yderligere objektive målinger af muskelstyrken i over- og underekstremiteterne samt kliniske balance tests, kraftplatformsmålinger samt daglig, heldags- og kontinuerlig accelerometerbaseret monitorering af fysisk aktivitet over en femdages periode. Ved afslutning af baselinemålingerne bliver deltagerne introduceret i og udstyret med en falddagbog. Der vil være et 6 og 12 måneders follow-up, hvor data fra falddagbøgerne indsamles. Resultater Med det formål at udvikle et testbatteri, der kan identificere faldtruede ældre, identificeres ved regressionsanalyse de faktorer, som er signifikant associeret med fald, samt mulige modeller til at forklare den indvirkning en given variabel har, korrigeret for øvrige variabler. Desuden udarbejdes sensitivitets- og specificitetsanalyse for relevante prædiktorer samt mulig cut of score med anvendelse af the receiver operating curve og area under the curve. Referencer 1. Jefferis, Barbara J. et al Physical Activity and Falls in Older Men. Medicine & Science in Sports & Exercise (14): Klenk, Jochen et al Physical Activity and Different Concepts of Fall Risk Estimation in Older People-Results of the ActiFE-Ulm Study. PloS one 10(6): e Side 16 af 25

17 Patient and staff experiences of participation in an implementation study of physical activity and nutritional intervention at a medical ward: A qualitative study. Jane Andreasen, PT, MLP, PhD. Student. Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital Lise Nørregaard Søndergaard, RN, SD, MPH, Department of Health Promotion, Aalborg University Hospital Mette Holst, RN, MCN, PhD, Center for Nutrition and Bowel Disease. Department of Gastroenterology, Aalborg University Hospital. Introduction Evaluation of feasibility and implementation studies on health promoting interventions for medical patients in hospitals is scarce, especially studies involving both a patient and a staff perspective. An explorative approach to gather experiences from both health professionals and patients is important to improve future evidence-based initiatives to enhance health promoting interventions. Purpose and Methods The aim was to explore how patients and staff experienced a multifaceted health promoting intervention concerning physical activity and nutrition during admission, and secondly to explore how the knowledge and experience was used afterwards. Two focus groups interviews were conducted to explore in-depth knowledge. Additionally individual telephone interviews were conducted as three patients were not available at the time of the group interview. An inductive thematic content analysis was the fundamental for the findings of the study. Results Patients and staff described experiences at various levels from an intrapersonal and interpersonal level to an organisational and environmental level. Both groups found the supportive behaviour of the physiotherapist and the dietician facilitated motivation and changed their usual behaviour. Staff members experienced time issues and limited resources, and patients reported that their situation and being on their own were barriers for health promoting activities. It was difficult to maintain the new behaviours in both groups but for different reasons. Conclusion An ecological inspired framework seemed a constructive method for implementing a multifaceted health promoting intervention on physical activity and nutrition at a medical ward and both staff and patients expressed primarily positive experiences. However, the staff did not fully take part in the intervention and after the project period adherence diminished and patient compliance differed as well. Side 17 af 25

18 Unsupervised Progressive Elastic Band Exercises for Frail Geriatric Inpatients objectively monitored by new Exercise-integrated Technology - A Feasibility Trial with an embedded Qualitative Study Rathleff C.R 1, Bandholm T. 2, Spaich E. G. 3, Jorgensen M. 4, Andreasen J. 1 1: Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg 2: Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Department of Orthopedic Surgery, Clinical Research Center, Amager-Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. 3: Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7-D3, 9220 Aalborg, Denmark 4: Geriatric Department, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark Background Frailty is a serious condition frequently present in geriatric inpatients that potentially causes serious adverse events. Strength training is widely accepted as a means of preventing or delaying frailty and loss of function in these patients. However limited hospital resources challenge the amount of supervised training, and unsupervised training could possibly supplement the supervised training thereby increasing the total exercise dose during admission. A new valid and reliable technology, the BandCizer, makes it possible to objectively measure the training dosage and thus capture the exact training dosage performed by the patient. The purpose of this study was therefore to investigate the feasibility and acceptability of an unsupervised progressive strength training intervention monitored by the BandCizer for frail geriatric inpatients. Methods This feasibility study was performed in a geriatric ward and included 15 frail inpatients. At hospitalization, the patients were prescribed two elastic band exercises that should each be performed unsupervised one time per day. A BandCizer Datalogger that allows measuring number of sets, repetitions, and time-undertension was attached to the elastic band. The feasibility criterion for the unsupervised progressive exercises was that 33% of the recommended number of sets should be performed by at least 30% of patients. In addition, patients and staff were interviewed about their experiences with the intervention. Results The intervention was feasible for 4/15 patients (27%). The training dosage varied considerably between patients but those who trained performed 19-27% of the prescribed dosage, regarding number of sets, repetitions and time-under-tension. Patients and staff expressed a positive attitude towards the unsupervised training as an addition to the supervised training sessions. However, barriers were also described - especially constant interruptions. Conclusions Based on the pre-defined criteria for feasibility, the unsupervised training was not feasible, as the frail geriatric inpatients in general did not perform the prescribed training dosage. However, there seem to be potential as patients and staff expressed primarily positive attitudes towards the unsupervised training. Even a smaller training dosage has been shown to improve the physical performance why the intervention might be useful if adjusted before any future large scale studies are initiated. Side 18 af 25

19 Danish version of Lymphoedema Functioning, Disability and Health Questionnaire (Lymph-ICF) for breast cancer survivors: Translation, cross-cultural adaption, validity and reliability Grarup, KR. Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark. Background Findings suggest that approximately 20 % of women, who survive breast cancer, will develop armlymphedema. Volume measurements are well-known, valuable methods to assess and evaluate the efficacy of reducing the swelling in lymphedema treatment. However, volume and/or severity of lymphedema is poorly related to the perceived impact of lymphedema on health by the patient. An important factor for optimal treatment and management of lymphedema is sound measurement of its consequences at different levels of a person s functioning. Lymph-ICF is a Dutch questionnaire designed to assess self-reported impairments, activity limitations, and participation restrictions in patients with breast cancer related armlymphedema. Purpose The aim of this study was to translate and cross-culturally adapt the original Dutch version of Lymph-ICF into Danish and to examine validity and reliability of the Danish version. Methods The translation and cross-cultural adaptation was conducted according to international recommendations and principles of good practice, following steps presented by the International Society for Pharmacoeconomics and Outcome Research (ISPOR). Cognitive Interviewing was conducted in 15 women with breast cancer related arm-lymphedema to explore understandability, interpretation, and cultural relevance of the translated version. Content validity and test-retest reliability are currently examined in the target population. Content validity is examined by asking three questions developed by the authors of the original version of Lymph-ICF to examine content validity of the questionnaire. Intraclass correlation coefficients (ICC [1,1]) are calculated as measures of relative reliability. ICC values > 0.70 are considered satisfactory. As a measure of absolute reliability, Standard Error of Measurement (SEM) is calculated. The Smallest Detectable Change (SDC) is calculated by 2.77 SEM to give an estimate of the smallest change in score that, with 95% CI, can be interpreted as a real change above measurement error in an individual. Preliminary results The cognitive interviews lead to an adapted and apparently improved version of the Danish questionnaire. Preliminary results (n=35) indicate that content validity is satisfactory, as are values for test-retest reliability. ICC for the total score of the Danish version of Lymph-ICF is 0.94; SEM is 4.91 and SDC Implications for practice Making this questionnaire available in Denmark for use in research and clinical practice can help increase knowledge about impairments in function, activity limitations, and participation restrictions of Danish breast cancer survivors with arm-lymphedema. It will also give physical therapists a tool for systematic planning, monitoring and evaluation of lymphedema treatment. Side 19 af 25

20 Inspiratory muscle training enhances recovery of activity levels in high-risk patients following lung cancer surgery Barbara Cristina Brocki 1 ; Jan Jesper Andreasen 2,3 ; Elisabeth Westerdahl 4 1 Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark 2 Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark 3 Department of Clinical Medicine, Aalborg University, Aalborg, Denmark 4 Faculty of Medicine and Health, School of Heath Sciences, Örebro University, Örebro, Sweden Background and aims A deterioration in ambulatory capacity and physical activity levels is common for individuals surgically treated for lung cancer (1). Higher levels of physical activity are associated with better health-related quality of life in this population (2), but methods for enhancing postoperative physical recovery have been scarcely evaluated. This study evaluated the effect of postoperative inspiratory training for two weeks on self-reported physical activity in high-risk patients who underwent lung cancer surgery. Furthermore, we aimed at identifying potential predictors for enhanced recovery of activity level. Methods The study was a single-centre, parallel-group, randomised trial with assessor blinding and intention-to treatanalysis. The intervention group (IG, n=34) underwent two weeks of postoperative inspiratory muscle training, twice daily with 2 x 30 breaths on a target intensity of 30% of maximal inspiratory pressure in addition to standard postoperative physiotherapy. Standard physiotherapy in the control group (CG, n=34) consisted of breathing exercises, coughing techniques and early mobilisation. We assessed pulmonary function, respiratory muscle strength (maximal inspiratory/expiratory pressure, MIP/MEP), functional performance (6-minute walk test) and self-reported physical activity (PAS 2 questionnaire) the day before surgery and two weeks postoperatively. Results The mean age (±SD) in the study sample was 70 ± 8 years and 58 % were males. Thoracotomy was performed in 48 % (n= 33) of the cases. Two weeks postoperatively, a significant number of participants from the IG reported on a higher activity levels, compared with the CG (inactive 6 % vs. 2%, low activity 6% vs. 6%, moderate activity 38% vs. 12%), p = , for the IG and the CG, respectively (Mantel Haenzel Chi Square test). There were no significant differences between groups regarding postoperative respiratory muscle strength, functional performance and pulmonary function. In a multivariable logistic regression analysis we found that higher preoperative carbon monoxide diffusion capacity (DlCO) and MIP values at two weeks were associated with higher activity levels (OR 1.56, 95% CI [1.00;2.45], p = and OR 1.31, 95% CI [1.03; 1.67], p = ) respectively for DlCO and MIP. Conclusion Postoperative inspiratory muscle training enhances recovery of activity levels following lung cancer surgery. More research is needed to confirm these findings. References 1. Coups EJ, Park BJ, Feinstein MB et al. Physical activity among lung cancer survivors: changes across the cancer trajectory and associations with quality of life, Cancer Epidemiol Biomarkers Prev 2009 (02);18: Granger CL, Parry SM, Edbrooke L, Denehy L. Deterioration in physical activity and function differs according to treatment type in non-small cell lung cancer- future directions for physiotherapy management. Physioth 2016 (102): Side 20 af 25

21 One-year development of QOL following orthopaedic polytrauma a prospective observational cohort study of 53 patients Peter Larsen (PL), PT, PhD1, Charlotte B. Goethgen (CBG), MD2, Sten Rasmussen (SR), MD, PhD3,4, Annika B. Iyer (ABI), PT1, Rasmus Elsoe (RE), MD, PhD3 1 Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg Denmark. 2 Clinic for Neuro- and Orthopedic Diseases, Aalborg University Hospital, Aalborg Denmark. 3 Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg Denmark. 4 Department of Clinical Medicine, Aalborg University, Denmark Introduction Most studies of polytrauma examined highly mixed patient groups. The objective of the present study was to report the development of patient-reported quality of life (QOL), in a patient group with musculoskeletal polytrauma, excluding patients with major thoracic, abdominal and brain injuries. Material and Methods The study design was a one-year cohort follow-up study. Recordings of injury severity were measured with the ISS and NISS. Patient-reported QOL was measured with the questionnaires Ed5d-5L and SF-36 and compared to age-matched reference populations. Moreover, patients return to work status was measured. Data were collected prospectively at discharge, 3, 6 and 12 months. Results 53 patients were included. The mean age was 42.3 years, ranging from 17 to 78 years. Twelve months after trauma admission the mean Eq5d-5L index was (95%CI: ). A progressive increasing Eq5d-5L index and SF-36 PCS was observed between discharge and the 12- month follow-up (p<0.001). The development in QOL from 6- to 12-month almost shows identically scores. Throughout the study period patients reported significant worse QOL compared with the established reference population. 32% of patients have resumed earlier employment status at one-year followup. Conclusions Throughout the 12-month observational period, patients reported worse QOLcompared to the age matched reference population. The development of QOL from 6- to 12-month time points almost showed identically scores with only little improvement. At the end of one-year follow-up, 32% of patients had resumed prior employment status. Side 21 af 25