Tuulikki Sjögren

Effects of a workplace physical exercise intervention on the intensity of headache and neck and shoulder symptoms and upper extremity muscular strength of office workers : A cluster randomized controlled cross-over trial

&NA; The purpose of the study was to examine the effects of a workplace physical exercise intervention on the perceived intensity of headache and the intensity of symptoms in the neck and shoulders, as well as on the extension and flexion strength of the upper extremities. The study was a cluster randomized controlled trial. The cross‐over design consisted of physical exercise intervention (15 weeks) and no‐intervention (15 weeks). The subjects (n=53) were office workers (mean age 46.6 (SD 8.4)) who reported headache (n=41) symptoms in the neck (n=37) or shoulders (n=41), which had restricted their daily activities during the last 12 months. Pain symptoms were measured using the Borg CR10 scale and muscular strength with a 5RM test. Statistical analyses were based on linear mixed models. Physical exercise intervention resulted in a slight, but statistically significant, decrease in the intensity of headache and neck symptoms, as well as an increase in the extension strength of the upper extremities. The mean decrease in headache during the 5‐week period was 0.64 CR10 (95% CI 0.28–1.00) (P=0.001) or 49% (95% CI 22–77), and 0.42 CR10 (95% CI 0.11–0.72) (P=0.002) or 49% (95% CI 13–85) in the intensity of neck symptoms. The mean increase in the extension strength of the upper extremities was 1.3 kg (95% CI 0.5–2.1) (P=0.001) or 4% (95% CI 1–6). The intervention had no effect on the intensity of shoulder symptoms or the flexion strength of the upper extremities. Specific exercise may be clinically important to alleviate headache and neck symptoms.

Effectiveness of constraint-induced movement therapy on activity and participation after stroke: a systematic review and meta-analysis of randomized controlled trials

Objective: To examine the effect of constraint-induced movement therapy and modified constraint-induced movement therapy on activity and participation of patients with stroke (i.e. the effect of different treatment durations and frequency) by reviewing the results of randomized controlled trials. Data sources: A systematic literature search was conducted in MEDLINE, CINAHL, EMBASE, PEDro, OTSeeker, CENTRAL and by manual search. Review methods: Randomized controlled trials for patients over 18 years old with stroke and published in Finnish, Swedish, English or German were included. Studies were collected up to the first week in May 2011. The evidence was high, moderate, low or no evidence according to the quality of randomized controlled trial and the results of meta-analyses. Results: Search resulted in 30 papers reporting constraint-induced movement therapy, including 27 randomized controlled trials published between 2001 and 2011. Constraint-induced movement therapy practice for 60–72 hours over two weeks produced better mobility (i.e. ability to carry, move and handle objects) with high evidence compared to control treatment. Constraint-induced movement therapy for 20–56 hours over two weeks, 30 hours over three weeks and 15–30 hours over 10 weeks improved mobility of the affected upper extremity. However, with self-care as an outcome measure, only 30 hours of constraint-induced movement therapy practice over three weeks demonstrated an improvement. Conclusion: Constraint-induced movement therapy and modified constraint-induced movement therapy proved to be effective on affected hand mobility and to some extent self-care on the World Health Organization’s International Classification of Functioning, Disability and Health activity and participation component, but further studies are needed to find out the optimal treatment protocols for constraint-induced movement therapy.

Effects of a physical exercise intervention on subjective physical well‐being, psychosocial functioning and general well‐being among office workers: A cluster randomized‐controlled cross‐over design

The purpose of the study was to examine the effects of a workplace physical exercise intervention on subjective physical well‐being, psychosocial functioning and general well‐being.

Evidence for the effectiveness of walking training on walking and self-care after stroke. A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE To examine the effect of randomized controlled trials of walking training on walking and self-care in patients with stroke. DATA SOURCES MEDLINE, CINAHL, Embase, PEDro, OTSeeker, Central, and manual search to the end of August 2012. STUDY SELECTION English, Finnish, Swedish, or German language walking training randomized controlled trials for patients over 18 years of age with stroke. DATA SYNTHESIS The meta-analyses included 38 randomized controlled trials from 44 reports. There was high evidence that in the subacute stage of stroke, specific walking training resulted in improved walking speed and distance compared with traditional walking training of the same intensity. In the chronic stage, walking training resulted in increased walking speed and walking distance compared with no/placebo treatment, and increased walking speed compared with overall physio-therapy. On average, 24 training sessions for 7 weeks were needed. CONCLUSION Walking training improves walking capacity and, to some extent, self-care in different stages of stroke, but the training frequency should be fairly high.

Effects of a workplace physical exercise intervention on the intensity of low back symptoms in office workers: A cluster randomized controlled cross-over design

Objectives. The purpose of the study was to examine the effects of a workplace physical exercise intervention on the intensity of low back symptoms. Methods. The study was a cluster randomized controlled trial with department (n = 4) as the unit of randomization. The subjects were office workers [(n = 36), mean age 47.1 (SD 8.4) years] who self-reported low back symptoms, which restricted their daily activities during the last 12 months. Low back symptoms were measured using the Borg CR10 scale. The cross-over design consisted of one intervention period of light resistance training and guidance and no training and no guidance of 15 weeks duration. Statistical analyses were based on linear mixed models. Results. The active component of the intervention, light resistance training, resulted in a slight, but statistically significant, decrease in the intensity of low back symptoms (p = 0.020). At the average training time of 5 minutes per working day (25 min/week) the average decrease during the 15-week period was 0.42 CR10 (95% CI 0.07–0.77) and 19% (95% CI 3–35). Conclusion. A physical exercise intervention, which included daily light resistance training, conducted during the working day affected low back symptoms in a positive direction among symptomatic office workers.

Effects of Workplace Physical Exercise Intervention on the Physical Perceived and Measured Physical Functioning among Office Workers - A Cluster Randomized Controlled Cross-Over Design

Purpose: The main aim of the present study was to investigate the effects of a workplace exercise intervention on physical functioning. Dose of the exercise and other physical activity outside the intervention were controlled for. The other aims were to determine the physical strain of training and determine training force as a percentage of work time (OPA), leisure time (LTPA) and time spent on all activities (AT). Methods: The study was a cluster randomized controlled trial (CRT) with each department as the unit of randomization (n=36, n=19, n=15, n=25). The cross-over design consisted of one 15-week intervention period of resistance training (30% 1RM) and training guidance, and another period of the same length with no training or guidance. The subjects (n=90) were office workers [mean age 45.7 (SD 8.5) years]. Percentage body fat was measured using bioelectrical impedance, spinal flexibility with goniometer and a cervical measurement system, muscular strength with a 5RM test and a hand grip test. Subjective physical condition was assessed by questionnaire and physical activity by questionnaire and diary. The statistical analysis was based on linear mixed models. Results: The active component of the intervention, light resistance training, significantly increased both subjective physical condition (p=0.015) and upper extremity extension strength (p= 0.001). Intervention had no effect on percentage body fat, spinal flexibility, hand grip strength or lower extremity strength. The estimated increase in subjective physical condition during the 15-week period was 4 units (95% CI 1-7) or 6% and in upper extremity extension strength 1.3 kg (95% CI 0.5- 2.1) or 4%. Relative physical strain, measured as percentage of maximal oxygen consumption, was 33.7%. Training force was 1.12 metabolic equivalent hours per week, representing 2.0% OPA, 5.9% of LTPA and 1.2% of AT. Conclusion: Light resistance training during the working day had a positive effect on the office workers` subjective physical condition and strength of upper extremities. Controlling for training dose and other physical activity outside the intervention and confounding factors provides for a better specificity and understanding of the dose-response and effectiveness of exercise intervention on physical functioning among office workers.

Effectiveness of technology-based distance physical rehabilitation interventions on physical activity and walking in multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.

Abstract Objective: To determine the effectiveness of technology-based distance physical rehabilitation interventions in multiple sclerosis (MS) on physical activity and walking. Data sources: A systematic literature search was conducted in seven databases from January 2000 to September 2016. Randomized controlled trials of technology-based distance physical rehabilitation interventions on physical activity and walking outcome measures were included. Methods: Methodological quality of the studies was determined and a meta-analysis was performed. In addition, a subanalysis of technologies and an additional analysis comparing to no treatment were conducted. Results: The meta-analysis consisted of 11 studies. The methodological quality was good (8/13). The Internet, telephone, exergaming, and pedometers were the technologies enabling distance physical rehabilitation. Technology-based distance physical rehabilitation had a large effect on physical activity (standard mean difference (SMD) 0.59; 95% confidence interval (95% CI) 0.38 to 0.79; p < 0.00001) compared to control group with usual care, minimal treatment, and no treatment. A large effect was also observed on physical activity (SMD 0.59; 95% CI 0.34 to 0.83; p < 0.00001) when compared to no treatment alone. There were no differences in walking and the subanalysis of technologies. Conclusions: Technology-based distance physical rehabilitation increased physical activity among persons with MS, but further research on walking in MS is needed. Implications for Rehabilitation Technology-based distance physical rehabilitation interventions increase physical activity among persons with MS. This study was unable to identify if the technologies (Internet, telephone, or combinations) lead to differing effects on physical activity or walking in the distance physical rehabilitation interventions in MS. Further research on the effectiveness of technology-based distance physical rehabilitation interventions on walking in MS is needed.

Effectiveness of technology-based distance interventions promoting physical activity : Systematic review, meta-analysis and meta-regression

OBJECTIVE To determine the effectiveness of technology-based distance interventions for promoting physical activity, using systematic review and meta-analysis. METHODS A literature search of studies published between 2000 and 2015 was conducted in the following databases: CENTRAL, EMBASE, Ovid MEDLINE, CINAHL, PsycINFO, OTseeker, WOS and PEDro. Studies were selected according to the PICOS framework, as follows: P (population): adults; I (intervention): technology-based distance intervention for promoting physical activity; C (comparison) similar distance intervention without technology, O (outcomes) physical activity; S (study design) randomized controlled trial. Physical activity outcomes were extracted and quality was assessed by 2 independent authors. RESULTS Eight studies were included in the meta-analysis. The mean (standard deviation; range) me thodological quality score of the studies was 6 (1.3; 4-8). Technology-based distance interventions were not more or less effective than conventional treatment whether measured as steps/day (mean difference 1,657; 95% confidence interval (95% CI) -1,861 to 5,176, p = 0.18), physical activity min/week (mean difference 0.34; 95% CI -146.3 to 146.9, p = 0.92), or as overall physical activity (response ratio 1.1; 95% CI 0.8-1.4, p = 0.65). No associations between the intervention duration or study quality and physical activity outcomes were found. Data were statistically and clinically heterogeneous. CONCLUSION The effectiveness of technology-based distance interventions for promoting physical activity is similar to that of conventional treatment.

Technology users’ experiences of remote rehabilitation as part of counseling planning: a qualitative study (Preprint)

Background Even though technology is becoming increasingly common in rehabilitation programs, insufficient data are as yet available on rehabilitees’ perceptions and experiences. It is important to understand their abilities when using technology for remote rehabilitation. Objective This is a qualitative study on technology experiences of persons affected by cardiovascular disease assessed before remote rehabilitation. The aim of the study was to explore rehabilitees’ experiences and attitudes toward technology before 12 months of remote rehabilitation. Methods Qualitative interviews were conducted with 39 rehabilitees in four focus groups. The subjects were aged 34 to 77 years (average age 54.8 years) and 74% (29/39) of them were male. They had been diagnosed with coronary artery disease and were undergoing treatment in a rehabilitation center. The interviews were conducted between September 2015 and November 2016. Data were analyzed using Glaser’s mode of the grounded theory approach. Results The result of the study was an “identifying e-usage” experience category, which refers to the rehabilitees’ notions of the use of information and communication technologies (e-usage) in the process of behavior change. The main category comprises four subcategories that define the rehabilitees’ technology experience. These subcategories are “feeling outsider,” “being uninterested,” “reflecting benefit,” and “enthusiastic using.” All rehabilitees expected that technology should be simple, flexible, and easy to use and learn. The results reflecting their technology experience can be used in e-rehabilitation programs. Rehabilitees who feel like outsiders and are not interested in technology need face-to-face communication for the major part of rehabilitation, while rehabilitees who reflect benefit and are enthusiastic about the use of technology need incrementally less face-to-face interaction and feel that Web-based coaching could offer sufficient support for rehabilitation. Conclusions The findings show that persons affected by heart disease had different experiences with technology and expectations toward counseling, while all rehabilitees expected technology to be easy to use and their experiences to be smooth and problem-free. The results can be used more widely in different contexts of social and health care for the planning of and training in remote rehabilitation counseling and education. Trial Registration ISRCTN Registry ISRCTN61225589; http://www.isrctn.com/ISRCTN61225589 (Archived by WebCite at http://www.webcitation.org/74jmrTXFD)