Liv Strand - Academia.edu (original) (raw)

Papers by Liv Strand

Journal Of Musculoskeletal Pain, 2007

Activities that require mobility of the trunk are often limited in patients with back problems. F... more Activities that require mobility of the trunk are often limited in patients with back problems. For this study, 5 tests (Sock Test, Pick-up Test, Roll-up Test, Fingertip-to-Floor Test, and Lift Test), all requiring sagittal-plane mobility, were performed, and the test scores were combined by the authors in a scale called the Back Performance Scale (BPS) to obtain a performance measure of mobility-related activities. The participants were 288 patients with long-lasting musculoskeletal pain. The basis for constructing a sum scale (BPS), discriminative ability, and responsiveness to important change of the BPS were examined in patients with back pain. Bivariate correlations (rs) of scores among tests ranged from.27 to.50, and correlations between separate tests and the BPS ranged from.63 to.73. The Cronbach alpha was.73. The BPS sum scores discriminated between patients with different return to work status and were higher for back pain than for other musculoskeletal pain. Responsiveness was high (effect size=1.33) in patients who had changed and low (effect size=0.31) in patients who had not changed, using return to work as an external indicator of important change. The BPS was more responsive than the separate tests. The BPS appears to measure an aspect of physical performance that is of clinical importance to patients with back pain.

BMJ Open

Objective: To compare the effects on balance and walking of three models of stroke rehabilitation... more Objective: To compare the effects on balance and walking of three models of stroke rehabilitation: early supported discharge with rehabilitation in a day unit or at home, and traditional uncoordinated treatment (control).

Physiological Reports, 2014

Ventilatory capacity is reduced in chronic obstructive pulmonary disease (COPD) patients. Tidal v... more Ventilatory capacity is reduced in chronic obstructive pulmonary disease (COPD) patients. Tidal volume (V T ) is lower and breathing frequency higher at a given ventilation (V E ) compared to healthy subjects. We examined whether airflow limitation and dynamic hyperinflation in COPD patients were related to breathing pattern. An incremental treadmill exercise test was performed in 63 COPD patients (35 men), aged 65 years (48-79 years) with a mean forced expiratory volume in 1 sec (FEV 1 ) of 48% of predicted (SD = 15%). Data were averaged over 20-sec intervals. The relationship between V E and V T was described by the quadratic equation V T = a + bV E + cV E 2 for each subject. The relationships between the curve parameters b and c, and spirometric variables and dynamic hyperinflation measured as the difference in inspiratory capacity from start to end of exercise, were analyzed by multivariate linear regression. The relationship between V E and V T could be described by a quadratic model in 59 patients with median R 2 of 0.90 (0.40-0.98). The linear coefficient (b) was negatively (P = 0.001) and the quadratic coefficient (c) positively (P < 0.001) related to FEV 1 . Forced vital capacity, gender, height, weight, age, inspiratory reserve volume, and dynamic hyperinflation were not associated with the curve parameters after adjusting for FEV 1 . We concluded that a quadratic model could satisfactorily describe the relationship between V E and V T in most COPD patients. The curve parameters were related to FEV 1 . With a lower FEV 1 , maximal V T was lower and achieved at a lower V E . Dynamic hyperinflation was not related to breathing pattern when adjusting for FEV 1 .

BMC Neurology, 2014

Background: Novel virtual reality rehabilitation systems provide the potential to increase intens... more Background: Novel virtual reality rehabilitation systems provide the potential to increase intensity and offer challenging and motivating tasks. The efficacy of virtual reality systems to improve arm motor function early after stroke has not been demonstrated yet in sufficiently powered studies. The objective of the study is to investigate whether VR training as an adjunct to conventional therapy is more effective in improving arm motor function in the subacute phase after stroke than dose-matched conventional training, to assess patient and therapist satisfaction when working with novel virtual reality training and to calculate cost-effectiveness in terms of resources required to regain some degree of dexterity.

Spine, 2001

A randomized, controlled trial. To examine the impact of physical function and pain on work statu... more A randomized, controlled trial. To examine the impact of physical function and pain on work status in patients who are long-term sick-listed because of back pain. Sickness benefit is granted to a person who is incapable of working because of reduced functioning. Improved physical function and decrease of pain may be important in considering return to work. Physical performance (five activities), disability, and pain (self-reported questionnaires) were assessed at baseline and at the 1-year follow-up evaluation in 117 patients randomized to an intervention group (n = 81) and a control group (n = 36). At the 1-year follow-up evaluation, 50% had returned to work. Statistically significant improvements were demonstrated from baseline to follow-up evaluation in returners to work: in the intervention group on all tests and in the control group on all except two performance tests. Improvement measures discriminated between returners and nonreturners to work in the intervention group on all physical tests and a pain test and in the control group on three physical tests and a pain test. In the intervention group, odds ratios for not having returned to work were high when test measures at follow-up indicated markedly impaired physical function and high pain; in the control group, this appeared in high pain. Return to work was related to physical function and pain. More importance seemed to be attributed to physical performance in the intervention group than in the controls as a basis for returning patients to work.

Respiratory Medicine, 2014

Background: The 6-min walk distance (6MWD) is widely used to evaluate functional capacity in pati... more Background: The 6-min walk distance (6MWD) is widely used to evaluate functional capacity in patients with chronic obstructive pulmonary disease (COPD). Aim: To examine predictors for longitudinal change in 6MWD including self-reported physical activity, smoking habits, body composition, exacerbations, comorbidity and lung function. Methods: The cohort included 389 patients aged 44e75 years, with clinically stable COPD in GOLD stages IIeIV. The follow-up time was 3 years. Measurements included 6MWD, spirometry, fat and fat free mass index (FMI and FFMI), and assessment of physical activity, smoking habits, comorbidities and exacerbations by questionnaires. Generalized estimating equations (GEE) regression analyses were used to analyze predictors for the change in 6MWD. Results: There was a reduction in 6MWD from baseline to 3 years for patients in GOLD stages III and IV (B Z À36 m, 95% CI Z À51 to À7, p Z 0.009 and B Z À79 m, CI Z À125 to À20, p Z 0.007). The unadjusted GEE analysis demonstrated that baseline self-reported physical activity level, forced expiratory volume in one second (FEV 1 ), forced vital capacity, FFMI, GOLD stages and age predicted change in 6MWD, but in the adjusted GEE analysis only self-reported physical activity level (p Z 0.001) and FEV 1 (p Z 0.019) predicted change over time.

Spine, 2004

A single group design to examine reliability and validity of the Back Performance Scale.

Journal of Advanced Nursing, 1997

ABSTRACT The McGill Pain Questionnaire (MPQ) is a well recognized measuring instrument for pain i... more ABSTRACT The McGill Pain Questionnaire (MPQ) is a well recognized measuring instrument for pain in English-speaking countries. Several efforts have been made to develop equivalent pain-measuring instruments in other languages. However, the method of translating the English words contained in the MPQ into another language implies that questions about validity may be posed. In Norway three different pain questionnaires have been developed which are inspired by the MPQ. A primary focus for developing the Norwegian Pain Questionnaire (NPQ) was the semantics of pain; the focus of the adapted MPQ was to include commonly used somatosensory Norwegian descriptors of pain in the population of patients with low back pain; the Norwegian McGill Pain Questionnaire (NMPQ) was literally translated into Norwegian to provide a equivalent pain questionnaire to the MPQ for cross-cultural comparisons of pain. Examination of content validity of the adapted MPQ and the translated version of the MPQ is examined by comparing the words in those questionnaires with words collected among Norwegians in the process of developing the NPQ. The findings support the content validity of the adapted MPQ. The NMPQ, however, should be further refined to better fit the semantics of pain in Norway.

Developmental Medicine & Child Neurology, 2008

The aim of this study was to examine observer reliability of the Gross Motor Performance Measure ... more The aim of this study was to examine observer reliability of the Gross Motor Performance Measure (GMPM) and the Quality of Upper Extremity Skills Test (QUEST) based on video clips. The tests were administered to 26 children with cerebral palsy (CP; 14 males, 12 females; range 2-13y, mean 7y 6mo), 24 with spastic CP, and two with dyskinesia. Respectively, five, six, five, four, and six children were classified in Gross Motor Function Classification System Levels I to V; and four, nine, five, five, and three children were classified in Manual Ability Classification System levels I to V. The children's performances were recorded and edited. Two experienced paediatric physical therapists assessed the children from watching the video clips. Intraobserver and interobserver reliability values of the total scores were mostly high, intraclass correlation coefficient (ICC) 1,1 varying from 0.69 to 0.97 with only one coefficient below 0.89. The ICCs of subscores varied from 0.36 to 0.95, finding 'Alignment' and 'Weight shift' in GMPM and 'Protective extension' in QUEST highly reliable. The subscores 'Dissociated movements' in GMPM and QUEST, and 'Grasp' in QUEST were the least reliable, and recommendations are made to increase reliability of these subscores. Video scoring was time consuming, but was found to offer many advantages; the possibility to review performance, to use special trained observers for scoring and less demanding assessment for the children.

Manual Therapy, 2005

Manual therapists (MTs) are specialized in examining and treating patients with low back pain (LB... more Manual therapists (MTs) are specialized in examining and treating patients with low back pain (LBP). The aim of the study was to investigate if patients' consultations with Norwegian MTs are in accordance with clinical guidelines for the management of acute LBP. Semi-structured interviews were conducted based on observation of the first consultation. Twenty-two MT students observed two consultations, and thereafter interviewed MTs (convenience sample) about clinical findings, information, advice and specific therapeutic procedures given. The interviews were tape-recorded, transcribed, and organized. Forty-two reports were derived from 34 MTs (12% of all in Norway). The MTs commonly informed the patients of main clinical findings. The intention to eliminate fear avoidance was specifically mentioned in 43% of the interviews. Advice of being active in daily life activities was given to 50% of the patients, and 43% were advised to avoid particular pain provoking movements. Working ability and sick leave was considered in only 20% of those employed. The most frequent treatment modalities recommended were home-exercises (69%) and a combination of joint mobilization and individually tailored exercises (48%). To some extent the MTs acted according to main points of clinical guidelines. However, functioning at the participation level was little emphasized in the consultations. r

Health Qual Life …, 2009

The impact of dizziness on quality of life is often assessed by the Dizziness Handicap Inventory ... more The impact of dizziness on quality of life is often assessed by the Dizziness Handicap Inventory (DHI), which is used as a discriminate and evaluative measure. The aim of the present study was to examine reliability and validity of a translated Norwegian version (DHI-N), also examining responsiveness to important change in the construct being measured.

Clinical Rehabilitation, 2008

Objective: To examine the effect of functional strength training in subacute stroke. Design: A si... more Objective: To examine the effect of functional strength training in subacute stroke. Design: A single-blinded randomized controlled trial. Setting: Two rehabilitation units. Subjects: Eighteen patients in the subacute phase post stroke, randomly allocated to a functional strength training (intervention) group (n ¼ 8) and a training-as-usual (comparison) group (n ¼ 10). Intervention: The functional strength training group participated in functional progressive strength training of the affected lower extremity. The training-as-usual group had traditional training, excessive muscle power being avoided to prevent associated reactions. All trained 50 minutes five days a week for four weeks. Main measures: Maximum weight-bearing in standing (primary outcome), isometric muscle strength, gait speed and items of Motor Assessment Scale. Results: Maximum weight-bearing on the affected leg improved more in the functional strength training group (mean 17.4% of body weight) than in the training-as-usual group (mean 5.6% of body weight), but taking test data at inclusion into consideration, the difference in change was not statistically significant (P ¼ 0.056). More patients in the functional strength training group (57%) could weight-bear on the affected leg while stepping forward, than in the training-as-usual group (17%). Improvement was clinically significant in 7 of 9 outcome measures in the functional strength training group (effect size 0.80, large), but in only 3 of 9 in the training-as-usual group. All patients in the functional strength training group and 70% of the patients in the training-as-usual group rated their overall status as 'much' or 'very much' improved. Conclusions: This pilot study indicates that functional strength training of lower extremities improves physical performance more than traditional training.

… journal of caring …, 2007

Relationships between demographic, clinical and pain variables and health-related quality of life... more Relationships between demographic, clinical and pain variables and health-related quality of life in patients with chronic low back pain treated with instrumented fusion The purpose of this cross-sectional study was to assess the relationships between demographic, clinical and pain variables and health-related quality of life (HRQOL) in patients who had undergone instrumented spinal fusion because of chronic low back pain (CLBP). The sample comprises 101 patients (70% women, mean age 46 years) who had received surgery between 1993 and 2000. The SF-36 Health Survey was used to assess HRQOL. Pain was assessed by sensory, affective and evaluative subgroups of the Norwegian Pain Questionnaire (modified McGill Pain Questionnaire). Age, work status, number of years after surgery, physical training, other chronic conditions and affective and evaluative pain (all p < 0.05) were the most prominent factors affecting HRQOL. The highest adjusted R 2 to explain the variance was physical function (52%) and the lowest was emotional role limitations (15%). Pain, particularly affective and evaluative pain, contributed more to the explained variance of HRQOL than demographic and clinical variables.

… journal of caring …, 2007

… Journal of Caring …, 2010

Pain in older persons with severe dementia. Psychometric properties of the Mobilization-Observati... more Pain in older persons with severe dementia. Psychometric properties of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID-2) Pain Scale in a clinical setting Background: To assess pain in older persons with severe dementia is a challenge due to reduced self-report capacity. Recently, the development and psychometric property testing of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID) Pain Scale was described using video-recording. The purpose of this article was to present the further development of this instrument. In MOBID-2 Pain Scale, the assessment of inferred pain intensity is based on patient's pain behaviours in connection with standardized, guided movements of different body parts (Part 1). In addition, MOBID-2 includes the observation of pain behaviours related to internal organs, head and skin registered on pain drawings and monitored over time (Part 2). Objective: The aim of this study was to examine psychometric properties of the MOBID-2 Pain Scale, like interrater and test-retest reliability, internal consistency, as well as face-, construct-and concurrent validity. Subjects and Setting: Patients with severe dementia (n = 77) were examined by 28 primary caregivers in clinical practice, who concurrently and independently completed the MOBID-2 Pain Scale. Characteristics of the patients' pain were also investigated by their physicians (n = 4). Results: Prevalence of any pain was 81%, with predominance to the musculoskeletal system, highly associated with the MOBID-2 overall pain score (rho = 0.82). Most frequent and painful were mobilizing legs. Pain in pelvis and/or genital organs was frequently observed. Moderate to excellent agreement was demonstrated for behaviours and pain drawings (j = 0.41-0.90 and j = 0.46-0.93).

Journal of pain and …, 2007

Pain assessment in older persons with severe cognitive impairment (SCI) is a challenge due to red... more Pain assessment in older persons with severe cognitive impairment (SCI) is a challenge due to reduced self-report capacity and lack of movement-related pain assessment instruments. The purpose of this article was to describe the development of the Mobilization-Observation-Behaviour-Intensity-Dementia Pain Scale (MOBID) and to investigate aspects of reliability and validity. MOBID is a nurse-administered instrument developed for use in patients with SCI, where presence of pain behavior indicators (pain noises, facial expression, and defense) may be observed during standardized active, guided movements, and then inferred to represent pain intensity. Initially, the MOBID contained seven items (observing at rest, mobilization of the hands, arms, legs, turn over in bed, sitting on bedside, and teeth/mouth care). This was tested in 26 nursing home patients with SCI. Their primary caregivers, five registered nurses and six licensed practical nurses (LPNs), rated the patients' pain intensity during regular morning care, and by MOBID, both at bedside and from video uptakes. Three external raters (LPNs), not knowing the patients, also completed the MOBID by rating the videos. Internal consistency of the MOBID indicated high Cronbach's alpha (a ¼ 0.90) after deleting the items for observation at rest and observation of teeth/mouth care. MOBID disclosed significantly more pain than did pain scorings during regular morning care, and video observation demonstrated higher pain intensity than bedside scoring. Intertester reliability for inferred pain intensity was high to excellent (intraclass correlation coefficient ¼ 0.70e0.96), but varied between poor and excellent for pain behavior indicators (k ¼ 0.05e0.84). These results suggest that registration of pain behavior indicators during active, guided movements, as performed by the MOBID procedure, is useful to disclose reliable

Brain Injury, 2010

The aim of this study was to explore changes in motor function in patients with incomplete LIS re... more The aim of this study was to explore changes in motor function in patients with incomplete LIS referred to rehabilitation. A prospective, explorative, multiple case study design was applied. A multidisciplinary intervention programme was conducted including treadmill therapy (TT) with body weight support. Patients being able to stand upright supported by a standing frame were consecutively recruited to TT from 2001-2005. Physical performance was recorded on video and treadmill data were registered. Performances of transfer and walking were selected as the focus of observation. Two external observers described the performances independently, using an observational form and validated the joint and condensed descriptions. A total of nine patients fulfilled the intervention programme and no adverse events were noted. Personal assistance and body weight support were reduced during the TT period and all patients demonstrated improved physical performance. While five patients were able to practice some kind of walking activity at the end of rehabilitation, four patients demonstrated improvement in body functions, showing better postural control. This study indicates that TT can be a safe and useful method to intensify the rehabilitation programme for patients with incomplete LIS.

BMC Pediatrics, 2010

Background: The effects of intensive training for children with cerebral palsy (CP) remain uncert... more Background: The effects of intensive training for children with cerebral palsy (CP) remain uncertain. The aim of the study was to investigate the impact on motor function, quality of movements and everyday activities of three hours of goal-directed activity-focused physiotherapy in a group setting, five days a week for a period of three weeks.

Journal Of Musculoskeletal Pain, 2007

Activities that require mobility of the trunk are often limited in patients with back problems. F... more Activities that require mobility of the trunk are often limited in patients with back problems. For this study, 5 tests (Sock Test, Pick-up Test, Roll-up Test, Fingertip-to-Floor Test, and Lift Test), all requiring sagittal-plane mobility, were performed, and the test scores were combined by the authors in a scale called the Back Performance Scale (BPS) to obtain a performance measure of mobility-related activities. The participants were 288 patients with long-lasting musculoskeletal pain. The basis for constructing a sum scale (BPS), discriminative ability, and responsiveness to important change of the BPS were examined in patients with back pain. Bivariate correlations (rs) of scores among tests ranged from.27 to.50, and correlations between separate tests and the BPS ranged from.63 to.73. The Cronbach alpha was.73. The BPS sum scores discriminated between patients with different return to work status and were higher for back pain than for other musculoskeletal pain. Responsiveness was high (effect size=1.33) in patients who had changed and low (effect size=0.31) in patients who had not changed, using return to work as an external indicator of important change. The BPS was more responsive than the separate tests. The BPS appears to measure an aspect of physical performance that is of clinical importance to patients with back pain.

BMJ Open

Objective: To compare the effects on balance and walking of three models of stroke rehabilitation... more Objective: To compare the effects on balance and walking of three models of stroke rehabilitation: early supported discharge with rehabilitation in a day unit or at home, and traditional uncoordinated treatment (control).

Physiological Reports, 2014

Ventilatory capacity is reduced in chronic obstructive pulmonary disease (COPD) patients. Tidal v... more Ventilatory capacity is reduced in chronic obstructive pulmonary disease (COPD) patients. Tidal volume (V T ) is lower and breathing frequency higher at a given ventilation (V E ) compared to healthy subjects. We examined whether airflow limitation and dynamic hyperinflation in COPD patients were related to breathing pattern. An incremental treadmill exercise test was performed in 63 COPD patients (35 men), aged 65 years (48-79 years) with a mean forced expiratory volume in 1 sec (FEV 1 ) of 48% of predicted (SD = 15%). Data were averaged over 20-sec intervals. The relationship between V E and V T was described by the quadratic equation V T = a + bV E + cV E 2 for each subject. The relationships between the curve parameters b and c, and spirometric variables and dynamic hyperinflation measured as the difference in inspiratory capacity from start to end of exercise, were analyzed by multivariate linear regression. The relationship between V E and V T could be described by a quadratic model in 59 patients with median R 2 of 0.90 (0.40-0.98). The linear coefficient (b) was negatively (P = 0.001) and the quadratic coefficient (c) positively (P < 0.001) related to FEV 1 . Forced vital capacity, gender, height, weight, age, inspiratory reserve volume, and dynamic hyperinflation were not associated with the curve parameters after adjusting for FEV 1 . We concluded that a quadratic model could satisfactorily describe the relationship between V E and V T in most COPD patients. The curve parameters were related to FEV 1 . With a lower FEV 1 , maximal V T was lower and achieved at a lower V E . Dynamic hyperinflation was not related to breathing pattern when adjusting for FEV 1 .

BMC Neurology, 2014

Background: Novel virtual reality rehabilitation systems provide the potential to increase intens... more Background: Novel virtual reality rehabilitation systems provide the potential to increase intensity and offer challenging and motivating tasks. The efficacy of virtual reality systems to improve arm motor function early after stroke has not been demonstrated yet in sufficiently powered studies. The objective of the study is to investigate whether VR training as an adjunct to conventional therapy is more effective in improving arm motor function in the subacute phase after stroke than dose-matched conventional training, to assess patient and therapist satisfaction when working with novel virtual reality training and to calculate cost-effectiveness in terms of resources required to regain some degree of dexterity.

Spine, 2001

A randomized, controlled trial. To examine the impact of physical function and pain on work statu... more A randomized, controlled trial. To examine the impact of physical function and pain on work status in patients who are long-term sick-listed because of back pain. Sickness benefit is granted to a person who is incapable of working because of reduced functioning. Improved physical function and decrease of pain may be important in considering return to work. Physical performance (five activities), disability, and pain (self-reported questionnaires) were assessed at baseline and at the 1-year follow-up evaluation in 117 patients randomized to an intervention group (n = 81) and a control group (n = 36). At the 1-year follow-up evaluation, 50% had returned to work. Statistically significant improvements were demonstrated from baseline to follow-up evaluation in returners to work: in the intervention group on all tests and in the control group on all except two performance tests. Improvement measures discriminated between returners and nonreturners to work in the intervention group on all physical tests and a pain test and in the control group on three physical tests and a pain test. In the intervention group, odds ratios for not having returned to work were high when test measures at follow-up indicated markedly impaired physical function and high pain; in the control group, this appeared in high pain. Return to work was related to physical function and pain. More importance seemed to be attributed to physical performance in the intervention group than in the controls as a basis for returning patients to work.

Respiratory Medicine, 2014

Background: The 6-min walk distance (6MWD) is widely used to evaluate functional capacity in pati... more Background: The 6-min walk distance (6MWD) is widely used to evaluate functional capacity in patients with chronic obstructive pulmonary disease (COPD). Aim: To examine predictors for longitudinal change in 6MWD including self-reported physical activity, smoking habits, body composition, exacerbations, comorbidity and lung function. Methods: The cohort included 389 patients aged 44e75 years, with clinically stable COPD in GOLD stages IIeIV. The follow-up time was 3 years. Measurements included 6MWD, spirometry, fat and fat free mass index (FMI and FFMI), and assessment of physical activity, smoking habits, comorbidities and exacerbations by questionnaires. Generalized estimating equations (GEE) regression analyses were used to analyze predictors for the change in 6MWD. Results: There was a reduction in 6MWD from baseline to 3 years for patients in GOLD stages III and IV (B Z À36 m, 95% CI Z À51 to À7, p Z 0.009 and B Z À79 m, CI Z À125 to À20, p Z 0.007). The unadjusted GEE analysis demonstrated that baseline self-reported physical activity level, forced expiratory volume in one second (FEV 1 ), forced vital capacity, FFMI, GOLD stages and age predicted change in 6MWD, but in the adjusted GEE analysis only self-reported physical activity level (p Z 0.001) and FEV 1 (p Z 0.019) predicted change over time.

Spine, 2004

A single group design to examine reliability and validity of the Back Performance Scale.

Journal of Advanced Nursing, 1997

ABSTRACT The McGill Pain Questionnaire (MPQ) is a well recognized measuring instrument for pain i... more ABSTRACT The McGill Pain Questionnaire (MPQ) is a well recognized measuring instrument for pain in English-speaking countries. Several efforts have been made to develop equivalent pain-measuring instruments in other languages. However, the method of translating the English words contained in the MPQ into another language implies that questions about validity may be posed. In Norway three different pain questionnaires have been developed which are inspired by the MPQ. A primary focus for developing the Norwegian Pain Questionnaire (NPQ) was the semantics of pain; the focus of the adapted MPQ was to include commonly used somatosensory Norwegian descriptors of pain in the population of patients with low back pain; the Norwegian McGill Pain Questionnaire (NMPQ) was literally translated into Norwegian to provide a equivalent pain questionnaire to the MPQ for cross-cultural comparisons of pain. Examination of content validity of the adapted MPQ and the translated version of the MPQ is examined by comparing the words in those questionnaires with words collected among Norwegians in the process of developing the NPQ. The findings support the content validity of the adapted MPQ. The NMPQ, however, should be further refined to better fit the semantics of pain in Norway.

Developmental Medicine & Child Neurology, 2008

The aim of this study was to examine observer reliability of the Gross Motor Performance Measure ... more The aim of this study was to examine observer reliability of the Gross Motor Performance Measure (GMPM) and the Quality of Upper Extremity Skills Test (QUEST) based on video clips. The tests were administered to 26 children with cerebral palsy (CP; 14 males, 12 females; range 2-13y, mean 7y 6mo), 24 with spastic CP, and two with dyskinesia. Respectively, five, six, five, four, and six children were classified in Gross Motor Function Classification System Levels I to V; and four, nine, five, five, and three children were classified in Manual Ability Classification System levels I to V. The children's performances were recorded and edited. Two experienced paediatric physical therapists assessed the children from watching the video clips. Intraobserver and interobserver reliability values of the total scores were mostly high, intraclass correlation coefficient (ICC) 1,1 varying from 0.69 to 0.97 with only one coefficient below 0.89. The ICCs of subscores varied from 0.36 to 0.95, finding 'Alignment' and 'Weight shift' in GMPM and 'Protective extension' in QUEST highly reliable. The subscores 'Dissociated movements' in GMPM and QUEST, and 'Grasp' in QUEST were the least reliable, and recommendations are made to increase reliability of these subscores. Video scoring was time consuming, but was found to offer many advantages; the possibility to review performance, to use special trained observers for scoring and less demanding assessment for the children.

Manual Therapy, 2005

Manual therapists (MTs) are specialized in examining and treating patients with low back pain (LB... more Manual therapists (MTs) are specialized in examining and treating patients with low back pain (LBP). The aim of the study was to investigate if patients' consultations with Norwegian MTs are in accordance with clinical guidelines for the management of acute LBP. Semi-structured interviews were conducted based on observation of the first consultation. Twenty-two MT students observed two consultations, and thereafter interviewed MTs (convenience sample) about clinical findings, information, advice and specific therapeutic procedures given. The interviews were tape-recorded, transcribed, and organized. Forty-two reports were derived from 34 MTs (12% of all in Norway). The MTs commonly informed the patients of main clinical findings. The intention to eliminate fear avoidance was specifically mentioned in 43% of the interviews. Advice of being active in daily life activities was given to 50% of the patients, and 43% were advised to avoid particular pain provoking movements. Working ability and sick leave was considered in only 20% of those employed. The most frequent treatment modalities recommended were home-exercises (69%) and a combination of joint mobilization and individually tailored exercises (48%). To some extent the MTs acted according to main points of clinical guidelines. However, functioning at the participation level was little emphasized in the consultations. r

Health Qual Life …, 2009

The impact of dizziness on quality of life is often assessed by the Dizziness Handicap Inventory ... more The impact of dizziness on quality of life is often assessed by the Dizziness Handicap Inventory (DHI), which is used as a discriminate and evaluative measure. The aim of the present study was to examine reliability and validity of a translated Norwegian version (DHI-N), also examining responsiveness to important change in the construct being measured.

Clinical Rehabilitation, 2008

Objective: To examine the effect of functional strength training in subacute stroke. Design: A si... more Objective: To examine the effect of functional strength training in subacute stroke. Design: A single-blinded randomized controlled trial. Setting: Two rehabilitation units. Subjects: Eighteen patients in the subacute phase post stroke, randomly allocated to a functional strength training (intervention) group (n ¼ 8) and a training-as-usual (comparison) group (n ¼ 10). Intervention: The functional strength training group participated in functional progressive strength training of the affected lower extremity. The training-as-usual group had traditional training, excessive muscle power being avoided to prevent associated reactions. All trained 50 minutes five days a week for four weeks. Main measures: Maximum weight-bearing in standing (primary outcome), isometric muscle strength, gait speed and items of Motor Assessment Scale. Results: Maximum weight-bearing on the affected leg improved more in the functional strength training group (mean 17.4% of body weight) than in the training-as-usual group (mean 5.6% of body weight), but taking test data at inclusion into consideration, the difference in change was not statistically significant (P ¼ 0.056). More patients in the functional strength training group (57%) could weight-bear on the affected leg while stepping forward, than in the training-as-usual group (17%). Improvement was clinically significant in 7 of 9 outcome measures in the functional strength training group (effect size 0.80, large), but in only 3 of 9 in the training-as-usual group. All patients in the functional strength training group and 70% of the patients in the training-as-usual group rated their overall status as 'much' or 'very much' improved. Conclusions: This pilot study indicates that functional strength training of lower extremities improves physical performance more than traditional training.

… journal of caring …, 2007

Relationships between demographic, clinical and pain variables and health-related quality of life... more Relationships between demographic, clinical and pain variables and health-related quality of life in patients with chronic low back pain treated with instrumented fusion The purpose of this cross-sectional study was to assess the relationships between demographic, clinical and pain variables and health-related quality of life (HRQOL) in patients who had undergone instrumented spinal fusion because of chronic low back pain (CLBP). The sample comprises 101 patients (70% women, mean age 46 years) who had received surgery between 1993 and 2000. The SF-36 Health Survey was used to assess HRQOL. Pain was assessed by sensory, affective and evaluative subgroups of the Norwegian Pain Questionnaire (modified McGill Pain Questionnaire). Age, work status, number of years after surgery, physical training, other chronic conditions and affective and evaluative pain (all p < 0.05) were the most prominent factors affecting HRQOL. The highest adjusted R 2 to explain the variance was physical function (52%) and the lowest was emotional role limitations (15%). Pain, particularly affective and evaluative pain, contributed more to the explained variance of HRQOL than demographic and clinical variables.

… journal of caring …, 2007

… Journal of Caring …, 2010

Pain in older persons with severe dementia. Psychometric properties of the Mobilization-Observati... more Pain in older persons with severe dementia. Psychometric properties of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID-2) Pain Scale in a clinical setting Background: To assess pain in older persons with severe dementia is a challenge due to reduced self-report capacity. Recently, the development and psychometric property testing of the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID) Pain Scale was described using video-recording. The purpose of this article was to present the further development of this instrument. In MOBID-2 Pain Scale, the assessment of inferred pain intensity is based on patient's pain behaviours in connection with standardized, guided movements of different body parts (Part 1). In addition, MOBID-2 includes the observation of pain behaviours related to internal organs, head and skin registered on pain drawings and monitored over time (Part 2). Objective: The aim of this study was to examine psychometric properties of the MOBID-2 Pain Scale, like interrater and test-retest reliability, internal consistency, as well as face-, construct-and concurrent validity. Subjects and Setting: Patients with severe dementia (n = 77) were examined by 28 primary caregivers in clinical practice, who concurrently and independently completed the MOBID-2 Pain Scale. Characteristics of the patients' pain were also investigated by their physicians (n = 4). Results: Prevalence of any pain was 81%, with predominance to the musculoskeletal system, highly associated with the MOBID-2 overall pain score (rho = 0.82). Most frequent and painful were mobilizing legs. Pain in pelvis and/or genital organs was frequently observed. Moderate to excellent agreement was demonstrated for behaviours and pain drawings (j = 0.41-0.90 and j = 0.46-0.93).

Journal of pain and …, 2007

Pain assessment in older persons with severe cognitive impairment (SCI) is a challenge due to red... more Pain assessment in older persons with severe cognitive impairment (SCI) is a challenge due to reduced self-report capacity and lack of movement-related pain assessment instruments. The purpose of this article was to describe the development of the Mobilization-Observation-Behaviour-Intensity-Dementia Pain Scale (MOBID) and to investigate aspects of reliability and validity. MOBID is a nurse-administered instrument developed for use in patients with SCI, where presence of pain behavior indicators (pain noises, facial expression, and defense) may be observed during standardized active, guided movements, and then inferred to represent pain intensity. Initially, the MOBID contained seven items (observing at rest, mobilization of the hands, arms, legs, turn over in bed, sitting on bedside, and teeth/mouth care). This was tested in 26 nursing home patients with SCI. Their primary caregivers, five registered nurses and six licensed practical nurses (LPNs), rated the patients' pain intensity during regular morning care, and by MOBID, both at bedside and from video uptakes. Three external raters (LPNs), not knowing the patients, also completed the MOBID by rating the videos. Internal consistency of the MOBID indicated high Cronbach's alpha (a ¼ 0.90) after deleting the items for observation at rest and observation of teeth/mouth care. MOBID disclosed significantly more pain than did pain scorings during regular morning care, and video observation demonstrated higher pain intensity than bedside scoring. Intertester reliability for inferred pain intensity was high to excellent (intraclass correlation coefficient ¼ 0.70e0.96), but varied between poor and excellent for pain behavior indicators (k ¼ 0.05e0.84). These results suggest that registration of pain behavior indicators during active, guided movements, as performed by the MOBID procedure, is useful to disclose reliable

Brain Injury, 2010

The aim of this study was to explore changes in motor function in patients with incomplete LIS re... more The aim of this study was to explore changes in motor function in patients with incomplete LIS referred to rehabilitation. A prospective, explorative, multiple case study design was applied. A multidisciplinary intervention programme was conducted including treadmill therapy (TT) with body weight support. Patients being able to stand upright supported by a standing frame were consecutively recruited to TT from 2001-2005. Physical performance was recorded on video and treadmill data were registered. Performances of transfer and walking were selected as the focus of observation. Two external observers described the performances independently, using an observational form and validated the joint and condensed descriptions. A total of nine patients fulfilled the intervention programme and no adverse events were noted. Personal assistance and body weight support were reduced during the TT period and all patients demonstrated improved physical performance. While five patients were able to practice some kind of walking activity at the end of rehabilitation, four patients demonstrated improvement in body functions, showing better postural control. This study indicates that TT can be a safe and useful method to intensify the rehabilitation programme for patients with incomplete LIS.

BMC Pediatrics, 2010

Background: The effects of intensive training for children with cerebral palsy (CP) remain uncert... more Background: The effects of intensive training for children with cerebral palsy (CP) remain uncertain. The aim of the study was to investigate the impact on motor function, quality of movements and everyday activities of three hours of goal-directed activity-focused physiotherapy in a group setting, five days a week for a period of three weeks.