The Swedish version of OMAS is a reliable and valid outcome measure for patients with ankle fractures

BACKGROUND: The aim of this study was to evaluate the test-retest reliability and the validity of the self-reported questionnaire Olerud-Molander Ankle Score (OMAS) in subjects after an ankle fracture. METHODS: When evaluating the test-retest reliability of the OMAS, 42 subjects surgically treated due to an ankle fracture participated 12 months after injury. OMAS was completed by the patients on two occasions at one to two weeks’ interval. Concurrent criterion validity was evaluated using the five subscales of the Foot and Ankle Outcome Score (FAOS) and global self-rating function (GSRF), which is a five-grade Likert scale with the alternatives: “very good”, “good”, “fair”, “poor”, “very poor”. Forty-six patients participated in the validation against FAOS, and for GSRF 105 patients participated at 6 months and 99 at 12 months. Uni-, bi- and trimalleolar fractures were all included and both non-rigid and rigid surgical techniques were used. All fractures healed without complications. Before analysis of the results the five groups according to GSRF were reduced to three: “good”, “fair” and “poor”. Test-retest reliability was assessed using Spearman’s rank correlation, the intraclass correlation coefficient (ICC), the standard error of measurement (SEM and SEM%) and the smallest real difference (SRD and SRD%). The Cronbach’s alpha score and validity versus FAOS was assessed using Spearman’s rank correlation and validity versus GSRF using the Kruskal-Wallis Test and the Mann–Whitney U-Test as ad hoc analyses. RESULTS: The test-retest reliability correlation coefficient obtained was rho = 0.95 and ICC = 0.94. The SEM was 4.4 points and SEM% 5.8% and should be interpreted as the smallest change that indicates a real change of clinical interest for a group of subjects. The SRD was 12 points and SRD% 15.8% and should be interpreted as the smallest change that indicates a real change of clinical interest for a single subject. The correlation coefficients versus the five subscales of FAOS ranged from rho = 0.80 to 0.86. There were significant differences between GSRF groups “good”, “fair” and “poor” (p < 0.001) at both the six-month and the 12-month follow-up. The internal consistency for the OMAS was 0.76. The effect size between results from 6-month and 12-month follow-up turned out be 0.44 and should be considered as medium. CONCLUSION: The results showed that the test-retest reliability of the Swedish version of OMAS was very high in subjects after an ankle fracture and the standard error of measurement was low. Furthermore the OMAS was found to be valid using both the five subscales of FAOS and the GSRF. The OMAS can thus be used as an outcome measure after an ankle fracture

Urban sprawl and growth management – drivers, impacts and responses in selected European and US cities

Urban growth management has become a common term to circumscribe strategies and tools to regulate urban land use in metropolitan areas. It is particularly used to counteract negative impacts of urban sprawl but also to frame future urban development. We discuss recent challenges of urban growth in 6 European and 2 US American city-regions. The paper compares the urban development focusing on a quantification of drivers and effects of urban growth and a qualitative analysis of the applied urban growth management tools. We build our analysis on findings from the EU-FP6 project PLUREL. The cities have different success in dealing with urban growth pressure - some can accommodate most growth in existing urban areas and densify, others expand or sprawl. Urban growth management is no guarantee to contain urban growth, but the case studies offer some innovative ways how to deal with particular challenges

Effects of a training program after surgically treated ankle fracture: a prospective randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Despite conflicting results after surgically treated ankle fractures few studies have evaluated the effects of different types of training programs performed after plaster removal. The aim of this study was to evaluate the effects of a 12-week standardised but individually suited training program (training group) versus usual care (control group) after plaster removal in adults with surgically treated ankle fractures.</p> <p>Methods</p> <p>In total, 110 men and women, 18-64 years of age, with surgically treated ankle fracture were included and randomised to either a 12-week training program or to a control group. Six and twelve months after the injury the subjects were examined by the same physiotherapist who was blinded to the treatment group. The main outcome measure was the Olerud-Molander Ankle Score (OMAS) which rates symptoms and subjectively scored function. Secondary outcome measures were: quality of life (SF-36), timed walking tests, ankle mobility tests, muscle strength tests and radiological status.</p> <p>Results</p> <p>52 patients were randomised to the training group and 58 to the control group. Five patients dropped out before the six-month follow-up resulting in 50 patients in the training group and 55 in the control group. Nine patients dropped out between the six- and twelve-month follow-up resulting in 48 patients in both groups. When analysing the results in a mixed model analysis on repeated measures including interaction between age-group and treatment effect the training group demonstrated significantly improved results compared to the control group in subjects younger than 40 years of age regarding OMAS (p = 0.028), muscle strength in the plantar flexors (p = 0.029) and dorsiflexors (p = 0.030).</p> <p>Conclusion</p> <p>The results of this study suggest that when adjusting for interaction between age-group and treatment effect the training model employed in this study was superior to usual care in patients under the age of 40. However, as only three out of nine outcome measures showed a difference, the beneficial effect from an additional standardised individually suited training program can be expected to be limited. There is need for further studies to elucidate how a training program should be designed to increase and optimise function in patients middle-aged or older.</p> <p>Trial Registration</p> <p>Current Controlled Trials ACTRN12609000327280</p

Outcome and quality of life after surgically treated ankle fractures in patients 65 years or older

<p>Abstract</p> <p>Background</p> <p>Despite high incidence of ankle fractures in the elderly, studies evaluating outcome and impact of quality of life in this age group specifically are sparse. The aim of this study was to evaluate outcome and quality of life 6 and 12 months after injury in patients 65 years or older who had been operated on due to an ankle fracture.</p> <p>Methods</p> <p>Sixty patients 65 years or older were invited to participate in the study. 6 and 12 months after the injury a questionnaire including inquiry to participate, the Olerud-Molander Ankle Score (OMAS), Short-Form 36 (SF-36), Linear Analogue Scale (LAS), Self-rated Ankle Function and some supplementary questions was sent home to the patients. The supplementary questions concerned subjective experience of ankle instability, sporting and physical activity level before injury and recaptured activity level at follow-ups, need of walking aid before injury, state of living before injury and at follow-ups and co-morbidities. After the 12-month follow-up the patients were also called for a radiological examination.</p> <p>Results</p> <p>Fifty patients (83%) answered the questionnaire at 6-month and 46 (77%) at the 12-month follow-up. Although, 45 (90%) fractures were low-energy trauma 44 (88%) were bi- or trimalleolar and post-operative reduction results were complete in 23 (46%) ankles. The median OMAS improved from 60 (Interquartile range (IQR) 36) at 6-month to 70 (IQR 35) at 12-month (p = 0.002), but at 12-month still sixty percent or more of the patients reported pain, swelling, problems when stair-climbing and reduced activities of daily life. Twenty (40%) rated their ankle function as 'good' or 'very good' at 6-month and 30 (60%) at 12-month. Forty-one (82%) were physically active before injury but still one year after only 18/41 had returned to their pre-injury physical activity level. According to SF-36 four dimensions differed from the age- and gender matched normative data of the Swedish population, 'physical function', 'role physical' and 'role emotional' were below norms at 6-month for women (p = 0.010, p = 0.024 and 0.031) and 'general health' was above norms at 12-month for men (p = 0.044).</p> <p>Conclusion</p> <p>One year after surgically treated ankle fractures a majority of patients continue to have symptoms and reported functional limitations. However, SF-36 scores indicate that only females had functional status below the age- and gender matched normative data of the Swedish population.</p

Balance in single-limb stance after surgically treated ankle fractures: a 14-month follow-up

BACKGROUND: The maintenance of postural control is fundamental for different types of physical activity. This can be measured by having subjects stand on one leg on a force plate. Many studies assessing standing balance have previously been carried out in patients with ankle ligament injuries but not in patients with ankle fractures. The aim of this study was to evaluate whether patients operated on because of an ankle fracture had impaired postural control compared to an uninjured age- and gender-matched control group. METHODS: Fifty-four individuals (patients) operated on because of an ankle fracture were examined 14 months postoperatively. Muscle strength, ankle mobility, and single-limb stance on a force-platform were measured. Average speed of centre of pressure movements and number of movements exceeding 10 mm from the mean value of centre of pressure were registered in the frontal and sagittal planes on a force-platform. Fifty-four age- and gender-matched uninjured individuals (controls) were examined in the single-limb stance test only. The paired Student t-test was used for comparisons between patients' injured and uninjured legs and between side-matched legs within the controls. The independent Student t-test was used for comparisons between patients and controls. The Chi-square test, and when applicable, Fisher's exact test were used for comparisons between groups. Multiple logistic regression was performed to identify factors associated with belonging to the group unable to complete the single-limb stance test on the force-platform. RESULTS: Fourteen of the 54 patients (26%) did not manage to complete the single-limb stance test on the force-platform, whereas all controls managed this (p < 0.001). Age over 45 years was the only factor significantly associated with not managing the test. When not adjusted for age, decreased strength in the ankle plantar flexors and dorsiflexors was significantly associated with not managing the test. In the 40 patients who managed to complete the single-limb stance test no differences were found between the results of patients' injured leg and the side-matched leg of the controls regarding average speed and the number of centre of pressure movements. CONCLUSION: One in four patients operated on because of an ankle fracture had impaired postural control compared to an age- and gender-matched control group. Age over 45 years and decreased strength in the ankle plantar flexors and dorsiflexors were found to be associated with decreased balance performance. Further, longitudinal studies are required to evaluate whether muscle and balance training in the rehabilitation phase may improve postural control

Ankle fractures. Outcome and rehabilitation. A physiotherapeutic perspective.

The overall aim of this work was to evaluate symptoms, subjectively scored function and physical outcome in patients with surgically treated ankle fractures. Another aim was also to evaluate the effects of a standardised but individually suited supervised training program. In all, 209 patients with surgically treated ankle fractures were included in three different samples: 54 individuals aged 18-64 years (Paper I, II and III), 50 individuals aged 65 years or older (Paper IV) and 105 patients 18-64 years (Paper V). Fifty-four uninjured persons served as a control group (Paper III). Subjective outcome was evaluated by the Olerud-Molander Ankle Scale (OMAS), the Linear Analogue Scale, Self-rated ankle function using an ordinal scale and SF-36. Physical outcome was evaluated by ankle range of motion, muscle strength in the plantar flexors and dorsiflexors, balance tests by one-leg stance on the floor and by stabilometry. Furthermore timed walking tests in a stair-case and on plain ground was evaluated. Radiological outcome was performed pre-surgery, immediately post-surgery and 12 months after surgery. Symptoms like pain, stiffness, swelling, functional ankle instability and problems when stair-walking were frequently reported from subjects in working ages one year after injury and almost fifty percent had not returned to their pre-injury physical activity level (Paper I). Subjects 40 years of age or older reported lower subjective function as measured by the OMAS compared to those under the age of 40 (Paper II). Ankle range of motion, muscle strength in the plantar flexors and dorsiflexors and standing balance capacity were decreased in the injured leg compared to the uninjured. Results from the physical tests were reflected in subjective outcome as decreased physical outcome was associated with lower subjective outcome (Paper I). At the 14-month follow-up all fractures were healed, in 40 out of 51 cases with no displacement and in eleven cases with slight displacement. Fractures with bimalleolar internal fixation showed more frequently residual displacement than those with unimalleolar fixation. Ankle osteoarthritis had developed in ten out of 51 patients, only in subjects over 40 years of age, more often in women and more often in fractures requiring bimalleolar internal fixation (Paper II). Only 40 of the 54 patients managed to complete the 25 second single-limb stance test on the force-platform whereas all controls managed. Poorer results were found in the patients’ injured leg compared to the uninjured whereas no differences were found between patients injured leg and the side-matched leg of the controls. Age over 45 years and decreased strength in the ankle plantar flexors and dorsiflexors provided a higher risk not managing the stabilometric test (Paper III). In patients 65 years or older subjectively scored function improved between six- and twelve month follow-up but still one year after injury symptoms, functional limitations and reduced physical activity were frequently reported. Health related quality of life (SF-36) was reduced in three subscales at six-month in women compared to the age and gender matched normative data of the Swedish population. At twelve month the differences were eliminated. (Paper IV). Only subjects under the age of 40 had benefits from a twelve week standardised but individually suited supervised training program starting within one week after plaster removal. Both subjectively scored function, health-related quality of life and results from a number of physical measurements were superior in the training group compared to the usual care group. At twelve months most differences had levelled out except for subjectively scored function (OMAS), muscle strength in the plantar flexors, walking speed and dynamic balance (Paper V). In conclusion, from the findings in this thesis functional limitations can be expected at least one year after a surgically treated ankle fracture and more frequent in middle-aged and older persons. The standardised but individually suited supervised training model as designed in this thesis may be useful in subjects under the age of 40. Future studies should focus on a deeper understanding of the problems in the middle-aged and elderly

Isförhållanden i södra Öresund : en litteratur- och dataundersökning av de faktorer som påverkar isläget i södra Öresund

In this paper the different factors that are of importance for the iceconditions in the southern part of the Sound are discussed. The factors are: the air temperature, the water temperature, the wind, the current, the salinity, the coastlines and the quantity of ice in the southwestern part of the Baltic Sea. The wind and the current have an influence on the iceconditions, and this is studied more in detail. Icetroubles that the ferryline between Limhamn on the Swedish coast and Dragör on the Danish coast experienced during 1985 and 1987 have been compared to wind data and current data from the Drogden Lighthouse. The results show that during periods with severe coldness, the wind and the current are not as important as they are during periods normal air temperature. When the weather was mild, the ferries had problems almost merely outside the harbours, and then the wind blew towards land. Furthermore, the paper contains a summary of the winters of 1985, 1986 and 1987 and a description of the icewinter in general in the southern part of the Sound

Sjuksköterskans möte med patienter med HIV/AIDS

Bakgrund: HIV/AIDS har blivit ett allt större problem i världen varför sjuksköterskor kommer att möta patienter med denna sjukdom i allt större utsträckning. Runt 39,5 miljoner är smittade av HIV/AIDS och cirka 25 miljoner har dött. Det är därför viktigt att undersöka vad sjuksköterskan upplever i sitt möte med patienter med HIV/AIDS. Syfte: Syftet med studien var att beskriva vad sjuksköterskor och sjuksköterskestuderande upplever i sitt möte med patienter med HIV/AIDS. Metod: Metoden som författarna valt är en litteraturstudie. Tio vetenskapliga artiklar med både kvalitativ och kvantitativ metod valdes ut för att granskas med innehållsanalys. Resultat: Fem kategorier med tillhörande subkategorier genererades. Det visade sig att de flesta sjuksköterskor och sjuksköterskestuderande har positiva inställningar till patienter med HIV/AIDS även om många rädslor förknippas med vården av denna patientgrupp. Relationen till patienterna framhävs som betydelsefull och många av sjuksköterskorna beskriver livsbejakande lärdomar av patienterna. Slutsats: Sjuksköterskor och sjuksköterskestuderande har i de flesta fall positiva inställningar till patienter med HIV/AIDS men upplever rädsla för att smittas