luleå university of technology physiotherapy at home after...

LICENTIATE T H E S I S

Department of Health ScienceDivision of Health and Rehabilitation

Effects and patientsrsquo experiences of interactive video-based

physiotherapy at home after shoulder joint replacement

Lisbeth Eriksson

ISSN 1402-1757 ISBN 978-91-86233-93-8

Lulearing University of Technology 2009

Lisbeth Eriksson E

ffects and patientsrsquo experiences of interactive video-based physiotherapy at home after shoulder joint replacem

ent

ISSN 1402-1544 ISBN 978-91-86233-XX-X Se i listan och fyll i siffror daumlr kryssen aumlr

Effects and patientsrsquo experiences

of interactive video-based

physiotherapy at home after

shoulder joint replacement

Lisbeth Eriksson

Division of Health and Rehabilitation

Department of Health Science

Lulearing University of Technology

Lulearing 2009

Printed by Universitetstryckeriet Lulearing 2009

ISSN 1402-1757 ISBN 978-91-86233-93-8

Lulearing

wwwltuse

About wisdom

The beginning of true wisdom is to continuously correct the course An alert eye a sense of where youfind yourself Its not about finding the right path but rather its about not deviating too far Wisdom is balancing proximity and distance

Merete Mazzarella

To me and my beloved ones

CONTENTS

Abstract 1 Original papers 3 Clarification of terms and acronyms 4 Introduction 5

My context 5 The human with a painful shoulder 7 Shoulder joint replacement 7 Physiotherapy and shoulder surgery 8 Telerehabilitation 10 Rationale 13

Aims 15 Material and methods 17

Design and participants 17 Intervention 19 Data collection 20 Analyses 23 Ethical considerations 24

Results 27 Discussion 31

Feasibility of the video-based physiotherapy intervention 31 Telerehabilitation as a support for the recovery process 32 Methodological considerations 35 Conclusions and implications 37

Summary in Swedish ndash svensk sammanfattning 39 Acknowledgements 45 References 49Dissertations from the Department of Health Science Lulearing University of Technology Sweden 49

Doctoral theses 57 Licentiate theses 58

Paper I Paper II

1

ABSTRACT

Effects and patientsrsquo experiences of interactive video-based physiotherapy at home after shoulder joint replacement Lisbeth Eriksson Division of Health and Rehabilitation Department of Health Sicence Lulearing Uni-versity of Technology Lulearing Sweden

Physiotherapy is essential to optimize the results of shoulder joint replacement but requires a close monitoring and co-operation between patient and physiotherapist The development of telerehabili-tation brings opportunities for distance-spanning and home-based physiotherapy interventions The aim of this thesis is to explore effects and to describe experiences among patients participating in interactive video-based physiotherapy at home after shoulder joint replacement

A series of 22 patients underwent shoulder joint replacement and initial physiotherapy at the hospital After discharge 12 patients were referred to conventional out-patient physiotherapy (con-trol) while 10 patients participated in a telerehabilitation intervention in the form of interactive video-based physiotherapy at home Shoulder function activity limitations and health-related qual-ity of life were assessed before surgery and two months after surgery The experiences of participating in the telerehabilitation were described using open interviews and qualitative content analysis

Two months post surgery members of the telerehabilitation group had participated in more physiotherapy sessions (plt001) and showed significantly better recovery regarding shoulder pain (plt001) shoulder joint external rotation (p=002) shoulder function and activity limitations (plt001) and in two dimensions of health-related quality of life (p=004 and p=001) compared to the control group All telerehabilitation group participants expressed that they were satisfied with the rehabilitation and that they had experienced technique and exercise as safe In the interviews seven categories of the participantsrsquo experiences were revealed An odd reinforced communication Pain-free exercising as an effective routine The home as an exercising arena Closeness at a dis-tance From a dependent patient to a strengthened person Facilitated daily living Continuous rehabilitation process The identified theme was Achieving prerequisites for recovery competence

In conclusion interactive video-based physiotherapy at home after shoulder joint replacement was experienced positively by the participating patients and seemed more effective than conven-tional post-discharge rehabilitation procedures concerning short-time recovery This could be ex-plained by the fact that the telerehabilitation group participated in more patient-physiotherapy ses-sions compared to the control group but the interviews also indicate that the modality might have promoted continuity and patient participation and competence

Key words Physical Therapy Home Rehabilitation (non MESH) Interactive Videocommunication (non MESH) Telemedicine Shoulder joint Controlled Clinical Trial Interview

2

3

ORIGINAL PAPERS

This licentiate thesis is based on the following papers which will be referred to in the

text by their Roman numerals

I Eriksson L Lindstroumlm B Gard G amp Lysholm J (2009) Physiotherapy at a

distance a controlled study of rehabilitation at home after a shoulder joint opera-

tion Journal of Telemedicine and Telecare 15 215-220

II Eriksson L Lindstroumlm B amp Ekenberg L Patientsrsquo experiences of interactive

video-based home physiotherapy after shoulder joint replacement Manuscript

The published paper has been reprinted with kind permission of the publisher con-

cerned

4

CLARIFICATION OF TERMS AND ACRONYMS

Telemedicine The use of electronic information and communications technologies to provide and support health care when distance separates the par-ticipantsacute (Field 1996)

Rehabilitation Restoration of human functions to the maximum degree possible in a person or persons suffering from disease or injury Used with dis-eases and surgical procedures for restoration of function of the indi-vidual (National Library of Medicine 2009)

ICF An international framework and multipurpose classification system for use in describing functioning and in relation to a health condi-tion (International classification of functioning disability and health ICF 2001)

VAS Visual Analogue Scale (Price et al 1983)

ROM Range of motion (Domholdt 2000)

5

INTRODUCTION

The work presented in this thesis focused on people in rehabilitation after shoulder

joint replacement For an optimal recovery physiotherapy is essential However long

distances between patients and the physiotherapist may impede the rehabilitation

process in several ways In this thesis I present results from a telerehabilitation trial

including effects on shoulder function activity and health-related quality of life as

well as patientsrsquo experiences of interactive video-based home physiotherapy

My context

As a physiotherapist with a long record in orthopaedic rehabilitation I became very

interested in developing the rehabilitation and care for patients who have undergone

shoulder replacement by using modern information and communication technology I

was one of the initiators of a telerehabilitation project in which the aim was to offer

the patients a continuous rehabilitation at home after discharge with an experienced

physiotherapist participating by video-link

Previously I had been working as a medical secretary for many years at an out-

patient clinic for child psychiatry My tasks were admitting the families transcribing

medical journals and responsibility for the video-communication of family sessions

My working room had a window against the street were I could see the families visi-

ting the clinic I reflected over the sight of the families coming to the clinic They

looked burdened as if they were carrying their problems on their shoulders When the

families left the clinic I noticed that even if the meeting at the clinic was successful

they still had the same body posture After 15 years I changed occupation and began

to work as a physiotherapist and with my experiences in mind the goal of the work

was a patient with a body and mind working as a healthy unit

In my work as a physiotherapist I have met people with very different problems

Some have had a great importance for my pre-understanding My first work as a

physiotherapist was with young adults with disabilities I have also been working

6

with children adults and grownups in a psychiatric clinic in intensive care and with

patients with heart failure My interest in working in a team together with the pa-

tient increased and for many years I cooperated in improving the care and rehabili-

tation of patients with neck injuries For some years I was a project leader of a project

aimed at increasing the palliative routines for people at the end of their lives The best

possible quality of life for the patient is the ultimate goal for all health care and we

may achieve success if we are a team of people who work together with the patient

At the orthopaedic clinic I met people with different kinds of pain It was stimulating

to see the patientsrsquo improvement when we did our best to always put the patient in

focus with a holistic perspective both bodily and mentally

In my work at the hospital I have met shoulder patients at all phases postopera-

tively in intensive care at the ward as out-patients After the shoulder joint replace-

ment and the earliest phases of rehabilitation the patients were discharged from the

hospital and returned to their hometown where supervised physiotherapy started

Sometimes the patients and the physiotherapists called me by telephone They ex-

perienced problems as the exercising was difficult due to the patientsrsquo pain and they

were insecure about continuing the exercises This often resulted in the patient revis-

iting the hospital for an examining of the condition of the shoulder and the pain they

experienced during the exercising the shoulder Waiting for that examination led to

interrupting of the rehabilitation and anxiety Many of the patients had long distances

to travel between their home and the hospital and the patients experienced the travel-

ling as time consuming and uncomfortable

When conducting these studies I had a pre-understanding that I had to take into

account during my work We are all humans with a past and we see everything from

different perspectives When we are studying the reality we are never able to wholly

stand outside ourselves When reading about and participating with other humans and

experiences when collecting data when analysing and reflecting we may never

wholly be in a situation outside our own experiences and judgements Our interpreta-

tion and our understanding will always be based on our experiences My pre-under-

7

standing has been of great importance to my work with the shoulder patients in this

project

The human with a painful shoulder

Pain is a common problem among people and has also a central place in our history

Pain is often the patientrsquos predominating symptom and may be expressed in many

ways The definition of pain according to the International Association for the Study

of Pain (IASP) reads ldquoPain is an unpleasant sensory and emotional experience asso-

ciated with actual or potential tissue damage or described in terms of such damagerdquo

(IASP 2007)

The shoulder is a complex joint system with a complicated architecture in which

bones and fine system of muscles tendons and ligaments cooperate in order to gain a

large range of motion for the shoulder Dressing one self managing personal hygiene

taking a cup from a cupboard etc are all examples of activities requiring a complex

coordination of shoulder motion (Solem Bertoft 2007) Muscle weakness and a de-

creased range in shoulder motion disturb the normal pattern of movement Pain will

normally lead to a non voluntary interruption of the lifting of the arm The changed

pattern of the movement makes it hard to lift the arm to a high position The pain and

the decreased movement of the shoulder may seriously affect activity performance

and health-related quality of life (National Board of Health and Welfare 2009)

For some persons with shoulder pain adequate physiotherapy will solve the prob-

lem while others need surgery (Nationellt kompetenscentrum foumlr ortopedi 2006)

Shoulder joint replacement

Pain when at rest as well as at night and pain during shoulder movement decreased

function and destruction of the joint structures are indicators that surgery is necessary

for the shoulder (Boyd et al 1990) Common diagnoses are osteoarthrosis and rheu-

matoid arthritis The shoulder joint replacement could be done by either replacing or

8

resurfacing the humeral head hemi-arthroplasty or as a total shoulder joint replace-

ment where both the glenoid and the humeral head are replaced with prosthesis com-

ponents In Sweden approximately 525 shoulder hemiarthroplasties and approxi-

mately 365 total arthroplasies were made during 2008 more commonly among

women than men (personal communication with Bjoumlrn Salomonsson orthopaedic

surgeon Danderyd and in charge of the The Swedish Shoulder Arthroplasty Register

2009) The shoulder joint replacement is done in a limited number of few hospitals in

Sweden (The Swedish Shoulder arthroplasty Register 2009)

Pain and dysfunction after shoulder joint replacement may lead to changes in the

pattern of motions of the shoulder (Brems amp Wilde 1991 Deuschle amp Romeo 1998

Madhok 1993 Svendsen 2005) If these problems are left untreated they may be-

come permanent (Brems amp Wilde 1991 Bruzga 1999) Pain when resting and pain

at night should disappear early after surgery even if movement pain may be preva-

lent during the first four to six weeks (Deuschle amp Romeo 1998) When having se-

vere pain that hinders the progress of the necessary exercise the surgeon should be

contacted (Maybach 1995)

Physiotherapy and shoulder surgery

Many authors point out that a faster recovery relies on the preoperative physiotherapy

including information and instructions to the patient by the physiotherapist (Boyd et

al 1990 Brems amp Wilde 1991 Deuschle amp Romeo 1998)

All shoulder surgery leads to more or less pain decreased pattern of motion de-

creased shoulder movement swelling stiffness loss of muscle strength and de-

creased endurance Discomfort during physiotherapy and in activities of daily living

continues for the first 4 to 6 weeks (Deuschle amp Romeo 1998) The intention of the

physiotherapy is to minimize complications Inactivity and immobilization are nega-

tive factor for the recovery of the shoulder and during the initial phases of exercises

patients tend to perform better when the exercise sessions are broken down into short

sessions performed multiple times a day (Brown amp Friedman 1998) The physiother-

9

apy programme should proceed in a logical and well defined fashion (Brems amp

Wilde 1991) Additional restrictions may be required during the first four to six

weeks depending on the intraoperative findings (Deuschle amp Romeo 1998) Early

rehabilitation actions with movements of the shoulder should be emphazised in order

to achieve the best possible function (Brems amp Wilde 1994 Bruzga 1999 Deuschle

amp Romeo 1998 Maybach 1995 Petrella amp Bartha 2000 van Baar et al 1998)

Exercising of the shoulder should continue after discharge by home exercising

supervised by a physiotherapist (Brems amp Wilde 1991 Brems 1994 Bruzga 1999

Deuschle amp Romeo 1998 Maybach 1995) It is important for the physiotherapist to

guide the patient during exercising and to suggest relevant adjustments depending on

performance and pain Knowledge and awareness is also an important tool in the re-

habilitation process (Thornquist 1998) The patientsrsquo learning may include the cause

of the symptoms how to prevent disease and how to decrease the suffering Physical

body awareness exercises and relaxation exercises could be essential after the sur-

gery If the patient is aware of herhis body and symptoms this will be a help in hand-

ling and coping with pain in their daily lives

Most patients and some physiotherapists are not familiar with the rehabilitation

process after the shoulder joint surgery (Burdea 2000 Deuschle amp Romeo 1998) It

is of great importance that the surgeon gives information to the physiotherapist and

the physiotherapist to the patient during the rehabilitation after the surgery (Romeo

1996) ldquoThe greater knowledge a physical therapist has regarding a surgical proce-

dure the greater the likelihood that an appropriate rehabilitation program can be de-

velopedldquo (Unverzagt et al 2006)

The standard Swedish exercise programme after shoulder replacement (Nowak et

al 2001) consists of three phases of shoulder exercises and starts as soon as possible

after the surgery The physiotherapy exercises start at the hospital and are carried out

by a multi-disciplinary perioperative care team The physiotherapy aims at an indi-

vidualised initiation and progression of the exercises All patients receive as a usual

routine a written exercise programme which is instructed tried out and adapted to

individual conditions together with the hospital physiotherapist The exercise is to be

10

continued post discharge at home by the patients themselves and supplemented by

supervised out-patient care physiotherapists at the patientsrsquo place of residence The

phases are as follows Phase IA Optimize the healing conditions reduce the pain and

obstruct stiffness IB Increase active-assisted exercises and gain good muscle con-

trol IIA Optimize active-assisted movement and the range of motion Phase IIB

Improved active muscle control and optimize activities of daily living Phase III

Normalize muscle strength and endurance according to the patientrsquos need Normally

phase I is started at the hospital the other phases will commence after discharge due

to short hospital stays

The concept of movement has been seen as fragmented in physiotherapy and the

development of the profession leads to a more and more patient-centred focus (Eken-

berg 2000) Encouraging a patientrsquos sense of control over the problem and improving

self-efficiency are of importance (Klaber Moffet amp Richardson 1997) The patientsrsquo

self-efficiency may increase or decrease depending on the physiciansrsquo or the physio-

therapistsrsquo way of acting and commenting (Thomeeacute et al 2009) To reach a success-

ful outcome the physiotherapist must have empathy and an ability to communicate

with the patient (Brems 1994) Thus the relation and communication between the

physiotherapist and the patient are important One aspect of this is feedback to the

patient aiming at more and better experience of the movement and a reflection of the

body The contact with and understanding onersquos body is expressed in the treatment

and influences the confidence and the functioning of the patient (Rosberg 2000

Thornquist 1988)

Telerehabilitation

Traditionally only in cases when the patient is too disabled to travel to the physio-

therapist in-home services are made (Burdea 2000 Deuschle amp Romeo 1995) As

there are restrictions associated with travel this leads to a situation where in-home-

service as an alternative to face-to-face rehabilitation may only take place over small

geographical areas (Sandford amp Butterfield 2005)

11

After discharge exercises at home are traditionally supplemented with supervised

physiotherapy at the local centre (Deuschle amp Romeo 1998) Long distances between

the home and the therapist and lack of appropriate rehabilitation and resourses can

lead to permanent disabilities (Brems amp Wilde 1991 Burdea 2000 Deuschle amp

Romeo 1995 Madhok 1993 Maybach 1995)

During recent decades the development of telemedicine has brought opportunities

for distance-spanning health care In order to entail a broader scope the term tele-

health has evolved and in the beginning of the new millennium the concept of e-

health arouse indicating not only a technical development but also a networked

thinking and state of mind aimed at improving healthcare by using information and

communication technology (Eysenbach 2001 Koch 2005) When used in a rehabili-

tation context telerehabilitation described by Winters (2002) can be seen as one ap-

plication of telemedicine or e-health entailing delivery of rehabilitation services over

telecommunication networks and the internet There are many potential benefits of

telerehablitation such as improved access to information special services reduced

travels and reduced costs for health-care (Hjelm 2005 Huis inrsquot Veld et al 2006

Zampolini et al 2008) and telerehabilitation offers the possibility to deliver these

advantages through minimizing the barriers of distance (Winters 2002) Movement

therapy technology will likely play a key role in meeting the challenge of providing

optimal intensity and type of therapy (Eysenbach 2001 Koch 2006)

By development of information and communication technique health-care at the

patientsrsquo home has become more common Beyond the specialized clinic specialized

health care can be offered at the patientsrsquo home In additon the patient is in a safe and

familiar environment as well as in a physiological home ground (Harrefors 2009

Zingmark 2007)

Health-care at the patientsrsquo home has become more common at the same time as

the information and communication technique is developed Beyond the clinic the

special knowledge services are used between the special clinic and the patientsrsquo

home The patient is offered delivering of health services and the technique provides

consultations and daily support for elderly Besides that the patient is in a safe and

12

well-known environment as well as in a physiological home ground (Zingmark

2007)

Quantitatively designed studies of telerehabilitation showed reduced need for

travel and improvements of physical and functional outcomes (Burdea et al 2000

Petrella amp Bartha 2000 Russel 2003 Wong 2005) Palsbo amp Bauer (2000) describe

the possibility of telerehabilitaton as facilitating the patientsrsquo need Patients with or-

thopaedic problems had physical rehabilitation consultation via videoconferencing

and all clients were comfortable with and had confidence in the tele-consultations

(Lemaire et al 2001) In a study by Russel (2004) patients felt empowered after re-

mote physiotherapy services via low-bandwidth telemedicine after knee replacement

However they indicated that the physiotherapist was not able to deliver lsquohands-onrsquo in

the treatment Hughes et al (2003) showed that patients were satisfied with the tech-

nology of telerehabilitation Examining via videoconferencing was compared with

the examination of orthopaedic outpatients (Haukipuro et al 2000) This randomized

controlled trial showed that there were somewhat more problems in examining the

videoconferencing patients than the clinic patients The author claims that videocon-

ferencing between primary and secondary care can be used in the examination when-

ever no demanding imaging technology is needed

Hjelm (2005) has found a risk of a breakdown in the relationship between health

professionals and the patient when using video-link The risk might relate to commu-

nicative skills and lack of formal training when using the technique equipment The

author refers to anecdotal evidence that elderly patients at times do not accept that a

physician appearing on what looks like a TV screen can see and listen to them prop-

erly and requires further research into the interaction between professionals and pa-

tients On the other hand Saumlvenstedt et al (2007) consider that it is possible to experi-

ence psychological closeness at a distance through video communication depending

on the quality of the technology

13

Rationale

Patients who undergo shoulder surgery are at risk that pain and immobilization may

prevent an optimal recovery Patients need to be supported by skilled therapists with

specific knowledge of the body and functional and medical consequences of the sur-

gery

Traditionally travelling could be a hindrance for the continuity and the availabil-

ity of this support Telerehabilitation has been shown to minimize the barriers of dis-

tance in the delivery of rehabilitation services which opens the possibilities of having

access to specific knowledge of shoulder exercises when being a patient at home

Previous research has shown the advantages and disadvantages of telerehabilitation in

patients with several diagnoses The current trend towards shorter hospital stays fur-

ther emphasises the significance of providing skilled rehabilitation in the home

However we have not found any studies of interactive video-based home physio-

therapy after shoulder joint replacement a rehabilitation process regarded as espe-

cially demanding and requiring careful individualisation There are also different

opinions regarding the consequences of video-link communication for the patient-

therapist relation for example due to the fact that the therapist can not approach the

patient hands-on

Therefore increased knowledge about the effects and the patientsrsquo experiences of

interactive video-based home physiotherapy after shoulder joint replacement would

be a valuable scientific contribution

14

15

AIMS

The overall aim of this thesis was to explore effects and experiences among patients

participating in home-physiotherapy based on interactive video-communication after


The aim of study I was to compare a home physiotherapy intervention based on

interactive video-communication with conventional post-operative rehabilitation re-

garding its realization and effects on recovery in shoulder function activity limitation

and health related quality of life

The aim of study II was to describe the patientsrsquo experiences of participating in

interactive video-based home physiotherapy after shoulder joint replacement

16

17

MATERIAL AND METHODS

Design and participants

The study (Paper I and II) has been conducted within the Tryggve Project at the

Centre for Distance-spanning Healthcare (CDH) Lulearing University of Technology

(wwwcdhltuse) and the County Council of Norrbotten Lulearing Sweden The re-

search methods applied both quantitative and qualitative approaches The choice of

the method was determined by the research question The design is illustrated in

Figure 1

Before surgery Operation Physiotherapy including a written programme After intervention

A Telemedicine group

Equipmentinstallation atthe patientshome

B Control group

Eight weeks physiotherapyat the patients home at a distance

Physiotherapyat the hospital

Continuingconventionalphysiotherapyat the localplace

Continuingconventionalphysiotherapyat the local place

~8 w

~8 w

Measure 1 Measure 2

Measure 2Measure 1Referred to conventionalphysiotherapy at the local place


questionnaires and measurements one week before operation follow-up questionnaires and measurements 8 weeks after operation

Figure 1 Study design

18

A series of twenty-five patients were selected from the waiting list for a shoulder

replacement at an orthopaedic clinic at a hospital in Northern Sweden To be included

they needed to be Swedish speaking adults with either primary osteoarthrosis or

rheumatoid arthritis and secondary osteoarthrosis The exclusion criteria were hu-

meral fracture cuff arthropathy (irreparable tear of muscles of ldquorotator cuffrdquo) the

presence of medical conditions that precluded safe participation in exercises (eg re-

cent myocardial infarction stroke or severe pulmonary disease) and significant psy-

chiatric or neurological disease serious impaired hearing or vision or dementia

The inclusion of patients continued during four years from February 2003 until

January 2007 Patients who met with study criteria mentioned above were consecu-

tively included It was practically possible to manage three contemporaneous telere-

habilitation group patients If there was such a telerehabilitation facility available

when the patient was scheduled for surgery she or he was allocated to the telereha-

bilitation group if not to the control group This was done consecutively for all pa-

tients who met the inclusion but not the exclusion criteria An overview of the selec-

tion of the participants the data collection and data analysis is presented in Table 1

Table 1 Outline of the content of the thesis Study Participants Data collection Data analysis Paper I 22 Questionnaires

Test of functionDescriptive and hypothesis-testing statistics

Paper II 10 (telerehabilitationgroup participants from paper I)

Individual interview

Content analysis

19

All patients who were offered participation accepted however there were three

drop-outs during the study two patients in the telerehabilitation group and one in the

control group The reasons for discontinuing were post-operative delirium (one in the

telerehabilitation and one in the control group) and severe hearing disorder impeding

participation (telerehabilitation group) Thus 22 patients actually participated in the

study ten in the telemedicine group (median age 70 years range 53-85 eight women

and 2 men) and twelve in the control group (median age 73 years range 50-86 nine

women and three men)

Intervention

All patients underwent the same shoulder joint replacement with hemiarthroplasty

(with a Bigliani-Flatow prostesis and with a standard delto-pectoral approach) All

surgeries were made by the same orthopaedic surgeon After the surgery all patients

as a standard routine followed the first step of a written three-phase programme

(Nowak et al 2001) at the hospital instructed by a physiotherapist

The control patients were as a usual routine referred to continue the exercise pro-

gramme after hospital discharge under supervision by a physiotherapist in the out-

patient care at their place of residence besides progressive home-exercise of their

own The physiotherapy aimed at daily home exercises supplemented by 2-3 indi-

vidually supervised training sessions a week gradually reduced to once every week or

every second week

The patients in the telerehabilitation group participated in 8 weeks of individually

supervised physiotherapy at home including exercising on their own The physio-

therapist who had long experience of treating patients after shoulder surgery was

situated at the hospital The patient was connected by a videoconference system

which permitted the physiotherapist to continuously supervise the exercise pro-

gramme with the patient and they saw and could speak to each other

20

Standard commercial video-conferencing units were used in the patientrsquos home

and the clinic (Tandberg 800 Sony PCS-50 Polycom VSX 3000) In the home the

equipment was connected via the patientrsquos broadband service Initially the connec-

tion in the clinic was via ISDN (Integrated Service Digital Network) and then later a

secure IP (Internet Protocol) connection was used in stead The connection bandwidth

varied from 256 to 768 kbitsec

Data collection

Assessments were made at baseline during the week before the surgery and at the

end of the intervention (week 8) in both groups (n=22) (Fig 1 page 17) The met-

hods of assessment that we have used in paper I and paper II are described and also

their relation to the International Classification of Functioning Disability and Health

(ICF) (World Health Organization 2001) in Table 2 (next page) Interviews with the

participants of the telerehabilitation group (n=10) were carried out at the end of the

intervention Demographic data the length of stay at the hospital and the number of

physiotherapy sessions during the rehabilitation period were derived from the medi-

cal records All clinical assessments were made by the same physical therapist

Self-rated shoulder pain was assessed as perceived pain on a Visual Analogue

Scale (VAS) with the endpoints from none to extreme pain (Price et al 1983)

Maximum active pain-free shoulder range of motion (ROM) was assessed using a

manual goniometer with the patient in a sitting position external rotation around the

long axis of the humerus was recorded with the arm hanging by the side of the body

and the elbow flexed 90deg body segment references were the trunk the humerus and

the ulnae Forward flexion was recorded with the humerus in the sagittal plane (Della

Valle et al 2001 Domholdt 2000 Youdas et al 1994)

21

Table 2 Data collection used in paper I and paper II Method of data collec-tion

Related ICF domain Data target

Targetgroup

Type of data collection

Paper I Visual Ana-logue Scale (VAS)

Body func-tionsBody struc-tures

Pain Person with pain

Self-ratingformula

Range of mo-tion (ROM)

Body func-tionsBody structu-res

Maximum active pain free motion of the shoulder

Not dis-ease spe-cific

Test of func-tion

Constantscore

Body func-tionsBody struc-turesActivitiesParticipation

Shoulderfunction

Personwith dis-ease of the shoulder

Test of func-tionGlobal ques-tionnaire

SRQ-S Body func-tionsBody struc-turesActivities

Shouldercondition


Self-ratingquestionnaire

Health related quality of life SF-36

ActivitiesParticipation Health related quality of life

Health re-lated quality of life



Paper II Interviews Activities

Participation Context

Experiences Not dis-ease spe-cific

Individual in-terviews

Shoulder function was assessed by using the Constant score combining self-rating

and objectively measured functional assessment by items covering pain ability to

perform activities of daily living (ADL) and active ROM The basis of the score is a

100-point scale Muscle strength was not measured due to the short period of time

after the surgery That excluded 25-points from the score Consequently the maxi-

22

mum score was 75 points The higher the score rating the less severely affected was

the shoulder (Constant amp Murley 1987 Kuhn amp Blasier 1995 Romeo et al 1996)

The condition of the shoulder was self-rated by the Swedish version of the stan-

dardized Shoulder Rating Questionnaire (SRQ-S) covering health related to the

shoulder rated on a VAS 0-10 cm scale and pain ADL recreational and athletic ac-

tivities and work on a five-point scale The higher the score (17-100 points) the better

was the condition of the shoulder The score also had two additional questions per-

taining to shoulder satisfaction and areas for improvement (not used to calculate the

overall SRQ-S score) (Dahlgren et al 2002 LInsalata et al 1997)

The Short Form 36 Health-Related Quality of Life (SF-36) self-rating question-

naire covers the eight domains physical functioning role limitation due to physical

problems pain general health energyfatigue (vitality) social functioning role

limitation due to emotional problems and mental health perceptions The minimum

score is 0 and the maximum 100 with a higher score representing better health

(Sullivan et al 1995)

Qualitative research interviews (Kvale 1997) were carried out at the end of the

intervention period in the telerehabilitation group in connection with the revisit to the

hospital All interviews were made by the author a physiotherapist with long experi-

ence of interacting with patients with shoulder problems An interview guide provid-

ing a general framework of the experience of interactive home physiotherapy through

videocommunication was used The interview was encouraged via supporting and

clarifying questions for example ldquocould you please tell me a little more about thatrdquo

The interview lasted between 35 to 95 minutes was tape-recorded and transcribed

verbatim including notations of nonverbal expressions such as silence and laughter

The transcribed interviews were sent to the patients for corrections and accep-

tance The purpose was to give the patients the opportunity to improve clarity and

supplement the content of the interviews The patients did not make any corrections

rdquoMember checkrdquo of the interpretation of the data was not used in this study Accord-

ing to Krippendorff (1980) member check is not a presupposition for content analy-

sis Downe-Wamboldt (1992) adds that the researcher may have a broader under-

23

standing of the historical context of social structures and may have developed a

broader understanding in the findings in addition to the understanding that the re-

searcher share with the participants Finally the author emphasised that rdquoMultiple

meanings are always present in data ndash there is no right meaning only the most accu-

rate meaning from a particular perspectiverdquo

Analysis

Because of small numbers the non-parametric Mann-Whitney U-test was used for

between-group comparisons The significance level was set at plt05 Due to the dis-

parity of initial values at baseline the differences between the values at baseline and

the values after follow-up were calculated and used for the analysis of the effect of

the treatment Standard software (SPSS version 150) was used for the analysis

A power calculation was made based on a Mann-Whitney test of Constant score

results of the first six patients Based on the differences between baseline and follow-

up the calculations showed that for 90 statistical power of detecting a significant

difference (plt05) nine persons in each group were needed

The interviews were analysed by qualitative content analysis according to the con-

cepts of Graneheim and Lundman (2004) Lundman and Graneheim (2008) com-

pleted with the conventional content analysis approach according to Hsieh and Shan-

non (2005) Manifest and latent content analysis were used and the interpretations

varied in depth and level of abstraction (Graneheim amp Lundman 2004) During the

first three steps of the analysis we chose to work with manifest interpretations ie

near by the text without trying to interpret The coding was a way of labelling a con-

densed meaning unit and gain a new thought on the data When creating the catego-

ries we looked for a thread throughout the codes answering the question ldquoWhatrdquo

(Graneheim amp Lundman 2004) The analysis was made in several steps in a dialectic

movement between understanding and explanation between parts and the whole of

the text

24

The co-workers read independently of each other the whole text to gain a sense of

the whole Parts of the text that could identify the person and were not meaningful

according to the aim were removed The interview text was divided into meaning

units ie words or meanings related to each other and identified corresponding to the

aim Those meaning-units were condensed through shortening the text while still pre-

serving the core The codes describing the content of the meaning-units were then

developed Categories were identified and sorted by similarities and differences

Definitions of the categories were developed A recontextualisation was made to

confirm that the results from the decontextualised material still agreed with the

original context (Malterud 1998) Thus I and my co-workers validated the parts in

relation to the whole

Finally the underlying understanding through the condensed meaning-units codes

and categories was emerged by a theme In the final step the whole text the theme

and the categories were reflected in the interpretation in relation to the co-workersrsquo

pre-understanding and relevant literature

Ethical considerations

All patients provided written consent to participate However as the research implied

a relatively novel technology-based physiotherapy intervention in the patientsrsquo home

the ethical considerations were essential

The patients were treated by a registered physiotherapist who followed the profes-

sional ethical rules and healthcare regulations The research was carried out following

research ethics regulations

Considerations were made about being connected by image and voice communi-

cation in the home The therapist was ldquocoming in tordquo the home of another person

which could be experienced as insulting The participants were given information that

they could decide and control the situation by switching on and off the video com-

munication equipment They also took part in placing the technical equipment The

equipment at the clinic was placed in a separate room in order to give the participants

25

the opportunity to see and identify the person to whom they communicated mostly

the physiotherapist involved in the rehabilitation

There have been many questions of reflection during the project Is the patientsrsquo

possibility to autonomy compromised Is personal integrity or human dignity threat-

ened Do I think of the patientsrsquo rights during the work Do I know what is best for

the patient Is the work based on moral grounds that lead to good actions Can I as a

researcher understand all consequences of the actions in the study In practise it is

very hard to notice and foresee the consequences of the decisions that are made

The basis of the research work is mostly scientific facts as well as experiences or

old traditions together with common sense When considering and analysing com-

mon sense and ethical and moral judgement has formed the basis for the work Dif-

ferent experiences also play a role such as attitudes in the health care Open discus-

sions and the intention of doing good and preventing harm or risks have been

considered carefully throughout the whole process of the work

The heads of the Department of Orthopaedics and Department of Rehabilitation

units at the hospital involved gave their permission for undertaking the studies The

study was approved by The Regional Ethical Review Board in Umearing Sweden Dnr

06-034M

26

27

RESULTS

There was no significant difference between the groups regarding sex age length of

stay in hospital after surgery or prevalence of osteoarthrosis and rheumatoid arthritis

There was no delay in the post-discharge rehabilitation for the telerehabilitation

group they all participated in the first remote-session in one or two days after the

discharge For the control group the delay was 7-15 days after discharge median 11

days

Median number of post-discharge physiotherapy sessions was 215 (range 11-36)

for the telerehabilitation group as compared to 35 (range 0-12) for the control group

plt001 Three members of the control group had no documented post-discharge

physiotherapy sessions The sessions varied from 10 min to 60 min sessions for the

telerehabilitation group and were estimated to last for 30 min for each session for the

control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab

Figure 2 Median differences after-before intervention for telerehabilitation and control

groups Statistical significance is indicated as ns no significance p lt05 and p

lt001

ns

28

As can be seen in Figure 2 there were significantly greater improvement two

months after surgery in the telerehabilitation group than in the control group regard-

ing pain shoulder function (Constant score and SRQ-S) and external rotation range

of motion of the affected shoulder Regarding flexion no significant difference was

seen between the groups

Change in health related quality of life (SF-36) were significantly greater in the

telerehabilitation group concerning the pain and vitality dimensions (plt01) No sig-

nificant difference between group effects were seen on physical function role-physi-

cal general health social functioning role-emotional and mental health dimensions

The findings of the analysis of the interviews indicate that all patients participat-

ing in the telerehabilitation group were highly satisfied with the physiotherapy ser-

vices at home Seven categories and one comprehensive theme emerged and are pre-

sented in Table 3

Table 3 Theme and categories of the analysis of the interventionTheme Achieving prerequisites for recovery competenceCategories An odd reinforced communication

Pain-free exercising as an effective routine The home as an exercising arenaCloseness at a distance From a dependent patient to a strengthened personFacilitated daily living Continuous rehabilitation process

The participants felt safe competent and empowered in their daily exercises rou-

tine as a result of frequent continued supervised physiotherapy and collaboration in

exercises with an experienced physiotherapist by video-link Factors contributing to

the good outcomes of the participantsrsquo treatment were the access to daily specific

adjusted physiotherapy at home without having to travel directly after returning

home They initially experienced the view of themselves at the TV-screen as odd

29

During the communication via the video-link they experienced being in focus and

expressed a high degree of attention and they expressed a way of respectful and con-

siderate communication They experienced closeness although they were at a dis-

tance Their participation developed their knowledge about the surgery the body and

shoulder movements how to handle the pain and manage the technical equipment

This competence became finally a routine at home where they were motivated to

pain-free exercise To be at home was important and contributed to a flexible and ac-

tive living

The participants expressed advantages with the continuous rehabilitation process

from the hospital to the home and to the out-patient care physiotherapist through the

video-link to the hospital-physiotherapist However they emphasized that they saw

telerehabilitation as a supplement to the conventional physiotherapy and that personal

meetings could not be replaced

30

31

DISCUSSION

To my knowledge this is the first study to describe the effects and experiences of in-

teractive video-based physiotherapy at home after a shoulder joint replacement

Feasibility of the video-based physiotherapy intervention

Compared to conventional physiotherapy rehabilitation this telerehabilitation inter-

vention resulted in more physiotherapy sessions with an earlier start There was a

greater recovery two months after surgery regarding pain and shoulder function as

well as pain and vitality dimension of health-related quality of life The interviews

revealed that all patients participating in the telerehabilitation were highly satisfied

with the remote-technology provided physiotherapy services at home Factors con-

tributing to this were the daily access to specific adjusted physiotherapy at home

starting without delay after their homecoming The participants also described a high

degree of participation which was expressed as an important factor of recovery com-

petence

These findings are in accordance with Sanford and Butterfield (2005) who showed

that remote-technology services to underserved elders provided access to the patient

in his or her own home and enabled the physiotherapist to observe in order to make

adjustments change and provide new prescriptions for adaptive methods and

modifications that otherwise would not have been possible Nilsson et al (2006) de-

scribed how older people with chronic illness living at home were satisfied with the

use of information and communication technology when receiving nursing care at

home Demiris et al (2000) described that an initial fear of using such a technology

seemed to reduce with time These positive findings are however in contrast to Mair

and Whitten (2000) who described that 11 out of 22 patients expressed concerns

about telemedicine communication because the physician was not physically present

with them

32

The higher recovery degree in the telerehabilitation group could obviously be ex-

plained by the fact that the intervention resulted in more patient-physiotherapist ses-

sions more total therapy time and an earlier onset than was the case with the conven-

tional post-discharge treatment This was of course one of the purposes with the in-

tervention in itself However as can be seen in the discussion below there were also

indications from the participantsrsquo experiences that the telerehabilitaton physiotherapy

and the way in which it was delivered might have contributed to a qualitative reha-

bilitation process

Telerehabilitation as a support for the recovery process

The findings of this study are in several respects supported by other findings in the

literature regarding positive factors for recovery after shoulder surgery This includes

early onset of mobilization and avoidance of immobilization (Brems 1994 Brown amp

Friedman 1998) patient and therapist competence (Deuschle amp Romeo 1998

Brems 1994) Maybach and Schlegel (1995) and Brems (1994) stated that discussing

the patientrsquos goal and expectations in order to make the patients to see them selves as

an active and not a passive receiver is a way to gain a fast recovery The role of the

physiotherapist being available to support patients exercising at home is emphasized

by Smith et al (2005) Sluijs et al (1991) pointed out that the greatest drop in compli-

ance with exercise regimes was associated with the time of discharge and Melander-

Wikman (2006) also found that patients in rehabilitation thought that most support

was needed when they were tired of the exercises and wanted to give up

The participantsrsquo experience of a high degree of participation could be explained

partly by the initial careful information and the interplay with the physiotherapist

including acknowledgement reassurance and confidence The findings indicated that

the patients were learning about how to handle exercises how to handle the body

and how to handle the technical equipment This competence helped them to be ac-

tive and responsible They saw the physiotherapist as an expert in consultation and

this contributed to a feeling of safety while being remote-guided at home Lundvik

33

Gyllensten et al (1999) showed that the quality of the interaction between patient and

physiotherapist may have a great effect on the patient outcome Melander Wikman et

al (2008) and Lindberg et al (2009) emphasise the importance of usersrsquo feeling of

control over the technique

The fact that the exercises were performed at the patientsrsquo home may have shifted

the balance of power between the patient and the physiotherapist in favour of the pa-

tientsrsquo voice Zingmark (2007) and Harrefors (2009) mean that to be home represent

safety power and freedom for the person The remote-physiotherapy could be inte-

grated by the activities at home in a simple way The rehabilitation process as well as

the daily living was facilitated by being at home This differs from a conventional

treatment context where the patient goes to the physiotherapistsrsquo office were the

physiotherapists are seen as being the most powerful (Edward 2004)

Our findings indicated a reinforced communication with a focus of attention on

oneself and on the body when receiving feedback and support from the physiothera-

pist at the TV-screen A changed communication via telemedicine may require spe-

cial methods of giving information and special skills of communication as this may

alter the meetings and the relationship between the therapist and the patient (Currel et

al 2007) When conversing in a video-communication session participants have to

listen without interruption which was obvious in the present study The participants

adapted to the delayed sound in the conversation of the physiotherapist by the video-

link They waited for the other person that was speaking to finish before starting to

speak themselves This is in accordance with one ground rule for trustful therapy or

teaching listening with close attention and no interruptions of each otherrsquos ideas

(Levitt amp Goldschmied 1990) Perhaps the delayed replies lead to a better ability to

listen greater concentration and more time for reflection which in turn may im-

prove the communication

Another factor that may have influenced the reinforced communication was the

gaze of the TV-screen Normally the use of gaze and bodily position are basic means

of creating joint attention (Kendon 1990) The gaze does not focus during the major-

ity of the time during normal conversation It alternates between different points and

34

focusing often serves as a mark of the end of the conversation Saumlvenstedt et al

(2005) found in a study of establishing joint attention in remote talks that both

nurses and participating older people maintained their focus by gazing at the screen

almost the whole time In the present study the participants expressed a feeling of

being seen when they spoke and when they exercised remotely with the physiothera-

pist The gaze of the TV-image was expressed as a feeling of being in the centre of

the physiotherapistrsquos attention

Participants expressed confidence with the physiotherapist as well as self-confi-

dence during the telerehabilitation process Presumably the reinforced communica-

tion and management of the technique contributed to this confidence

In conventional physiotherapy the hands of the physiotherapist appeared to be a

perpetual source of communication to the patient as well as used for therapeutic in-

tervention (Jensen et al 1990) The participants in the actual study experienced that

they did not miss hands-on treatment as they expressed the remote-physiotherapy so

intensively This is in line with Jensen et al (1990) who found that therapists who

were experienced were more responsive and listened intensely compared to inexperi-

enced physiotherapists

The variation in the duration of the remote physiotherapy sessions imply that there

were individual judgements by the physiotherapist and possibly by the patients

themselves of each patientrsquos needs The patients described efficiency in time-usage

as they were prepared and dressed in suitable clothes when they met the physiothera-

pist through the video-link

In the present study patients had met the physiotherapist at the hospital before

meeting through the video This could explain why they emphasized that telereha-

bilitation physiotherapy at home was seen as a supplement to the conventional

physiotherapy and that personal meetings could not be replaced Similar findings are

also reported by Sanford and Butterfield (2007) and Lindberg (2009)

35

Methodological considerations

When interpreting the differences in recovery between telerehabilitation and control

groups I must emphasize that the study was not designed to compare the effects of

the telerehabilitation intervention to conventional face-to-face physiotherapy in itself

but to conventional post-discharge treatment conditions

The quantitative findings are strengthened by the facts that all patients asked to

participate accepted that groups were reasonably similar regarding important charac-

teristics that all patients received the same treatment during surgery and hospital

stay that there were few dropouts and that reliable valid and well-known assessment

instruments were used by experienced staff following standardised procedures

Power calculations showed that the size of the groups were sufficient for the purpose

However the most important study limitations are that the study was not randomised

and that assessors were not blinded for group allocation This was the consequence of

practical and financial limitations It is also reasonable to assume a positive attitude

and expectancy among those who were included in the telerehabilitation group The

result of between-group analyses must therefore be interpreted with caution and re-

sults be seen as indicative of a possible feasibility which should be confirmed in ran-

domised and blind trials I would suggest that the novelty of the intervention justifies

the trial despite its limitations

Throughout the whole research process I tried to be aware of my experiences and

of my pre-understanding My pre-understanding might have been an advantage as I

knew the context of the patientsrsquo situation This may have led to an easier way to

meet and relate to each other The participant knew that I was aware of the context

which may have made it easier to tell me about herhis experiences

On the other hand I must be aware that my pre-understanding may have been a

hindrance in the work During fieldwork with earlier interviews (Eriksson 2004) I

became aware of my pre-understanding depending on earlier experiences and com-

petences of physiotherapy and of patients who had undergone a shoulder joint re-

placement

36

This made me encourage the participants with attendant questions during the in-

terviews The intention was to invite the participants in an explicit way to narrate

their valuable experiences both advantages and disadvantages The purpose was to

gain a rich content of the interviews The interviews have been carried out during a

time of four years and the experiences of interviewing were changed the more I learnt

about the interview technique

As the world is complex the reality can be interpretive in various ways However

it was important that the interpretation always was in concordance with the interview

text My co-workers had another pre-understanding which contributed to new critical

views towards the work and we found the interpretation as a balancing act with inter-

esting discussions lasting many hours which improved reflecting and understanding

I and my co-workers have tried to obtain knowledge about patients of both sexes

of different ages and representing the two common underlying diagnoses We as-

sume that these participants had various experiences and that this knowledge should

contribute to a richer variation of participantsrsquo experiences of video-based physio-

therapy at home The findings are primarily valid for people who undergo shoulder

replacements because of joint destructive processes related to osteoarthrosis and

rheumatoid arthritis however I deem that the findings could reasonably be extended

to other patient groups in similar situations

How could I further minimize the risk of influencing the participants I questioned

my pre-understanding did I really know what they were talking about When I was

aware of my pre-understanding I tried to put it away and my intention was to be as

open-minded as possible in my work of the interviews and the analysis of the inter-

views

I believe that the use of both quantitative and qualitative approaches strengthen

the study The quantitative findings may serve as indicators of the effects on patient

recovery in important function and ability dimensions while the qualitative findings

may teach about the participantsrsquo own understanding and explanation of their experi-

ences something that is important for development of the rehabilitation

37

Conclusions and implications

Interactive video-based physiotherapy at home after a shoulder joint replacement was

experienced positively by the participating patients and seemed more effective than

conventional rehabilitation procedures after hospital discharge concerning short-time

recovery This could be explained by the fact that the telerehabilitation group partici-

pated in more patient-physiotherapy sessions compared to the control group but the

interviews also indicate that the modality might have promoted continuity and patient

participation and competence Continuity collaboration reinforced communication

body knowledge and being at home emerged as aspects contributing to an experience

of recovery competence

The findings indicate that telerehabilitation approaches might be of great value in

the development of physiotherapy practice This may be of value in order to increase

accessibility but another aspect important on its own seems to be the use of the pa-

tientrsquos own home as an arena for the rehabilitation The findings further emphasise

the importance of the quality of patient-therapist interplay and control of the technol-

ogy and it seems possible that the interactive video-communication might promote

this in certain aspects

Further research could preferably include randomised controlled trials with blind

assessments of outcome variables cost-effectiveness analyses and studies of long-

term effects Comparisons of experiences of participants in telerehabilitation and

standard procedure therapy would be of value to further investigate the properties of

telerehabilitation approaches There could also be a further development of remote

technology besides audio-visual communication and information accessibility To-

day there is no possibility to make a physical hands-on examination eg palpation

at a distance This would add important qualities to the distance-spanning-meeting

between the patient and the physiotherapist

38

39

SUMMARY IN SWEDISH ndash SVENSK SAMMANFATTNING

Effekter och upplevelser av interaktiv videobaserad sjukgymnastik i hemmet

efter skulderledsoperation

Introduktion

Denna avhandling fokuserar paring personer som blivit opererade med skulderledsplastik

och den efterfoumlljande sjukgymnastiska rehabiliteringen Smaumlrta och immobilisering

kan foumlrhindra ett optimalt tillfrisknande och patienterna aumlr i behov av stoumld fraringn

specialiserade sjukgymnaster i sin rehabilitering Tillgaumlngligheten till rehabilitering

kan stoumlras av avstaringnd mellan patienten och terapeuten efter utskrivningen fraringn

sjukhus och kortare varingrdtider staumlller ytterligare krav paring moumljligheterna att kunna

erbjuda rehabilitering i hemmiljouml

Telerehabilitering med hjaumllp av interaktiv videokommunikation mellan patienten i

sitt hem och sjukgymnasten paring sjukhuset kunde daumlrfoumlr vara en moumljlighet men det

saknas studier oumlver saringdan rehabilitering foumlr den aktuella patientgruppen Det finns

ocksaring motstridiga uppfattningar om konsekvenserna av telerehabilitering foumlr samar-

betet mellan patient och terapeut och naumlr det gaumlller betydelsen av att sjukgymnasten

ska kunna anvaumlnda sina haumlnder som redskap i rehabiliteringen

Syfte

Det oumlvergripande syftet med denna avhandling var att utforska effekter och beskriva

patienters erfarenheter av interaktiv videobaserad sjukgymnastik i hemmet hos

personer som genomgaringtt skulderledsplastik

40

Material och metod

Studien genomfoumlrdes inom ett e-haumllsoprojekt Centrum foumlr Distansoumlverbryggande

Haumllso- och sjukvaringrd (CDH) Lulearing Tekniska Universitet Lulearing i samarbete med

Norrbottens Laumlns Landsting Lulearing Sverige

Till studien inkluderades 25 vuxna kvinnor och maumln fraringn vaumlntelistan infoumlr en

skulderledsoperation vid en ortopedklinik vid ett sjukhus i norra Sverige Efter tre

personers bortfall kvarstod 22 patienter 12 i en kontrollgrupp och 10 i en telerehabi-

literingsgrupp Alla patienter genomgick en hemiplastikoperation med byte av oumlver-

armens skulderled till en protes Paring sjukhuset instruerades alla patienter av en sjuk-

gymnast och man traumlnade efter ett skriftligt program

Vid utskrivningen fraringn sjukhuset remitterades kontrollgruppens patienter till

individuell vaumlgledning av sjukgymnast paring hemorten och successivt utoumlkad

egentraumlning i hemmet enligt det paringboumlrjade programmet Telerehabiliteringsgruppens

patienter deltog efter utskrivning fraringn sjukhuset i traumlning i hemmet med individuell

vaumlgledning av sjukgymnast fraringn sjukhuset paring distans samt successivt utoumlkad

egentraumlning i hemmet Distanstraumlningen skedde via en video-

kommunikationsutrustning daumlr patient och sjukgymnast saringg och pratade med

varandra

Maumltningar av skulderfunktion aktivitetsfoumlrmaringga och haumllsorelaterad livskvalitet

gjordes foumlre operationen samt tvaring maringnader efter operationen i baringda grupperna och

resultaten jaumlmfoumlrdes mellan grupperna Foumlr att faring kunskap om hur deltagarna i telere-

habiliteringsgruppen upplevde interaktiv sjukgymnastik i hemmet paring distans gjordes

individuella intervjuer med dem efter distansperiodens slut

Resultat

Resultatet visade att det inte var naringgra avbrott i den postoperativa sjukgymnastiska

traumlningen foumlr telerehabiliteringsgruppen Foumlr kontrollgruppen varierade den foumlrsta

traumlningen med sjukgymnast fraringn 7 till 15 dagar efter utskrivning fraringn sjukhuset

41

Antalet moumlten mellan sjukgymnast och patient var i medeltal 215 i

telerehabiliteringsgruppen jaumlmfoumlrt med 35 i kontrollgruppen Foumlr tre deltagare ur

kontrollgruppen fanns inte naringgra dokumenterade vaumlgledda traumlningstillfaumlllen med

sjukgymnast Tiden foumlr moumltena mellan sjukgymnast och patient i telerehabili-

teringsgruppen varierade mellan 10 och 60 minuter foumlr kontrollgruppen var den be-

raumlknade tiden foumlr moumltena mellan sjukgymnast och patient 30 min

Tvaring maringnader efter operation och traumlning visades signifikant stoumlrre foumlrbaumlttringar foumlr

telerehabiliteringsgruppen jaumlmfoumlrt med kontrollgruppen naumlr det gaumlllde smaumlrta skul-

derfunktion och utaringtrotation i skuldran Mellan grupperna saringgs inga signifikanta

skillnader naumlr det gaumlllde flexion Foumlrbaumlttringar i haumllsorelaterad livskvalitet var signifi-

kant stoumlrre i telerehabiliteringsgruppen naumlr det gaumlllde dimensionerna smaumlrta och vita-

litet Foumlr dimensionerna fysisk funktion rollfunktion-fysiska orsaker allmaumln haumllsa

social funktion rollfunktion-emotionella orsaker och psykiskt vaumllbefinnande saringgs

inga signifikanta skillnader mellan grupperna

Analyserna av intervjuerna visade att alla patienter i telerehabiliteringsgruppen var

mycket noumljda med tvaring maringnaders sjukgymnastik paring distans i hemmet under interaktiv

vaumlgledning av sjukgymnast paring sjukhuset De sju kategorier som framkom i analysen

var 1 En annorlunda och foumlrstaumlrkt kommunikation 2 Smaumlrtfri traumlning som en ef-

fektiv rutin 3 Hemmet som traumlningsarena 4 Naumlrhet paring distans 5 Fraringn beroende

patient till en staumlrkt person 6 Foumlrenklat dagligt liv 7 Kontinuerlig rehabiliterings-

process Ett oumlvergripande tema var Uppnaring foumlrutsaumlttningar foumlr foumlrmaringga till aringterhaumlmt-

ning

Deltagarna kaumlnde sig saumlkra kompetenta och staumlrkta i sin dagliga traumlning Till-

garingngen till frekvent specifik anpassad sjukgymnastik i hemmet utan resor direkt

efter utskrivningen fraringn sjukhuset var viktiga faktorer foumlr ett bra resultat Kommuni-

kationen via video upplevdes fraringn boumlrjan som annorlunda men den upplevelsen foumlr-

svann efter naringgra sessioner Genom att dels fokusera paring bilden och dels tala paring ett

respektfullt och haumlnsynsfullt saumltt daumlr man invaumlntade varandra upplevdes en houmlg grad

av uppmaumlrksamhet Deltagarna upplevde en kaumlnsla av naumlrhet trots att de var paring laringngt

avstaringnd fraringn sjukgymnasten Ett viktigt resultat var utvecklande av kunskap om

42

operationen om kroppen och skulderroumlrelser samt hur de skulle hantera smaumlrta

Tekniken upplevdes som anvaumlndarvaumlnlig och de laumlrde sig att hantera tekniken i

hemmet paring distans Slutligen vaumlxte kompetensen till en rutin i hemmet daumlr de var

motiverade till smaumlrtfri traumlning Att vara i hemmet var viktigt och bidrog till

flexibilitet och att vara aktiv

Deltagarna beskrev den kontinuerliga rehabiliteringsprocessen utan avbrott fraringn

sjukhuset till hemmet och daumlrefter till traumlning hos sjukgymnast i oumlppenvaringrden som

positiv Detta var moumljligt tack vare tekniken som saringgs som ett viktigt hjaumllpmedel men

deltagarna betonade att det personliga moumltet inte kunde bytas ut helt mot tekniken

Avslutande reflektion

Att traumlna hemma med sjukgymnast via videolaumlnk efter genomgaringngen operation med

byte av axelleden upplevdes positivt av de deltagande patienterna Skillnaden efter

tvaring maringnaders postoperativ traumlning via telerehabilitering i hemmet jaumlmfoumlrt med

traditionell sjukgymnastik efter skulderledsbyte indikerade att telerehabilitering visar

paring ett effektivare saumltt att traumlna paring jaumlmfoumlrt med traditionell traumlning Detta kan bero paring

att telerehabliteringsgruppen deltog i fler sjukgymnastledda traumlningar jaumlmfoumlrt med

vad kontrollgruppen gjorde Intervjuerna visade aumlven att traumlna i hemmet paring distans

ledde till kontinuitet och att patienterna kaumlnde en houmlg grad av delaktighet och

kompetens efter traumlningsperioden Kontinuitet samarbete foumlrstaumlrkt kommunikation i

traumlningssituationerna och att samtidigt vara i hemmet och traumlna paring distans var

aspekter som bidrog till upplevelsen av rdquorecovery competencerdquo Resultaten pekar paring

att telerehabilitering kan vara av stort vaumlrde vid utvecklandet av den sjukgymnastiska

professionen

Telerehablitering oumlkar tillgaringngen till sjukgymnast med specifik kunskap och en

annan viktig aspekt verkar vara att patienten kan traumlna i sitt hem I resultaten betonas

aumlven vikten av houmlg kvalitet i relationen och samspelet mellan sjukgymnast och pati-

ent samt att videokommunikationstekniken kan ha bidragit som en staumlrkande faktor

till detta

43

Det vore intressant att se framtida forskning med randomiserade kontrollerade

studier med rdquoblindadrdquo undersoumlkare samt studier foumlr att undersoumlka kostnadseffektivi-

teten och laringngtidsresultat av patienter som traumlnar i hemmet via telerehablitering Jaumlm-

foumlrelser av erfarenheter av telerehabilitering och standardprocedurer inom sjukgym-

nastik vore av vaumlrde vid framtida studier Ytterligare utveckling av informations- och

kommunikationsteknologin foumlrutom bild- och ljudtekniken vore av intresse att

genomfoumlra Idag finns inte moumljlighet att utfoumlra undersoumlkningar rdquohands-onrdquo palpation

paring distans Vore detta moumljligt skulle det kunna tillfoumlra viktiga kvaliteter i distans-

oumlverbryggande moumlten mellan patient och sjukgymnast

44

45

ACKNOWLEDGEMENTS

This study was carried out at the Division of Health and Rehabilitation Department

of Health Science Lulearing University of Technology in cooperation with the

Department of Physiotherapy and the Department of Orthopaedic at Sunderby

hospital Lulearing Sweden I wish to express my sincere gratitude to all of you who

helped and supported me in so many various ways The following persons have

contributed in their own special way

First of all the persons participating in the studies for letting me share your experi-

ences You made this work possible and I have tried to meet you with honesty and

respect

Especially gratitude to Barbro Ukonsaari the leader of the Department of

Physiotherapy Sunderby Hospital for being there believing in me and always giving

me support and a safe base at the Department of Physiotherapy I really trust in your

cleverness and wisdom as I know that you always have the patient in the focus and

want to improve the care Because of your support I continued this work though

many times of doubts

Ulla Klippmark my colleague and co-worker from the very beginning when we

started the project for many laughs for your good moral for your patience your

cleverness for being a very competent physiotherapist and being a good friend

Because of you this work was possible

Lars Nyberg my main supervisor for sharing your extensive scientific knowledge

for interesting discussions for friendly support and encouragement

Jack Lysholm my second supervisor co-author and co-worker for being at the

same time professional and personal Nobody sees things as sharply as you do

Through the whole project and all scientific questions I have always been assured that

I could rely on you though we have met many obstacles Without you there had never

been any project

46

Lilly Ekenberg my second supervisor co-author and co-worker for you being such

an understanding dedicating person giving inspiration for research really interesting

discussions of life for generously sharing all your knowledge and your wisdom

Britta Lindstroumlm my co-author and co-worker for inspiring discussions support

and good advices

Gunvor Gard my co-author and co-worker for your ideas and thoughts your

scientific knowledge supervising me in the first parts of my work and friendly

support in the whole process

Lars Holmgren for helping me with statistical analysis valuable discussions and

having great patience with me

All my colleagues and wonderful friends at the Department of Physiotherapy

Sunderby Hospital Lulearing for encouraging and supporting me in this work Especially

Anette Karlstroumlm Kristina Larsson Agneta Westerberg Jessica Magnusson and

Susanne Roseacuten for always making me feel welcome when I arrive to the department

Ursula Ingers for giving me joy and caring for me as a very dear friend

Helene Soumlderholm and Ulla Ericson for joy and empathy on days when I needed it

All my colleagues and friends at the Division of Health and Rehabilitation Depart-

ment of Health Science Lulearing University of Technology especially Anita Melander-

Wikman for your encouragement inspiration and support Malin Mattsson for good

companionship support and real friendship and especially for all telephone calls

Birgitta Lindberg for giving me good support and advice in a friendly honourable

way

Britt-Mari Bergstroumlm my dearest neighbour Ann-Katrin Persson Christina

Harrefors Ulla Myhr all for being true friends and giving me good support and

inspiration

Birgitta Frohm and Helena Forsman for being my truly friends and supporters for

critical advice and all energy I got from you

Berit Ekblom for being my mentor you supported and believed in my ability from

the early beginning of my period as physiotherapist and researcher

47

Anders Granstroumlm my former co-worker at CDH for good support and advice

Billy Grey for helping me with all the translation

The staff at the Library at Lulearing University for your fantastic service especially

Lotta Frank and Eva Nordlund

The staff at the Department of Orthopaedics especially Birgitta Wallsten and Lena

Uusitaalo

My sincere thankfulness to all my beloved family

Barbro my sister and Soumlren my brother for being there with your families you are

so important for me Daniel Anna Elin Iris AnnaMaria Niclas Jakob and Saana

for skilful help and joy David and Sandra for joy and professional help with the

computer when I needed it mostly

Last the most important persons in my life Beda my mother for being in heaven

and caring for me Arne my father for always believing in me and for giving me a

small piece of your curiosity and stubbornness Erling my companion through life

for supporting supporting and supporting me when I needed it mostly for your joy

and constructive critics - now I will make dinner and we will walk together hand in

hand in the woods - my sons Patrik and David you are so deeply important for me

for being you please take care of your shoulders I love you

Finally the very important financial support for the work of this thesis was

provided by the Centre for Distance-spanning Healthcare (CDH) Lulearing University

of Technology and the County Council of Norrbotten Lulearing Sweden which I am

very grateful for

48

49

REFERENCES

van Baar M E Dekker J Oostendorp R A B Bijl D Voorn T B Lemmens J

A M amp Bijlsma J W J (1998) The effectiveness of exercise therapy in pa-

tients with osteoarthritis of the hip or knee A randomized clinical trial The jour-

nal of rheumatology 25(12) 2432-2439

Boyd A D Thomas WH Scott R D Sledge C B amp Thornhill T S (1990)

Total shoulder arthroplasty versus hemiarthroplasty Journal of Arthroplasty 5(4)

329-336

Brems J J amp Wilde A H (1991) Shoulder arthroplasty principles Surgical disor-

ders of the shoulder London Churchill Livingstone 459-71

Brems JJ (1994) Rehabilitation following total shoulder arthroplasty Section in

symposium Clinical Orthopaedics amp Related Research 307 70-85

Brown D amp Friedman RJ (1998) Postoperative rehabilitaton following total

shoulder arthroplasty Orthopedic Clinics of North America 29(3) 535-47

Bruzga B amp Speer K (1999) Challenges of rehabilitation after shoulder surgery

Clinics in sports medicine 18(4)769-93

Burdea G Popescu V Hentz V amp Colbert K (2000) Virtual reality-based or-

thopedic telerehabilitation Rehabilitation Engineering IEEE Transactions on [see

also IEEE Trans on Neural Systems and Rehabilitation] 8(3) 430-2

Constant C R amp Murley A H (1987) A clinical method of functional assessment

of the shoulder Clinical Orthopaedics amp Related Research 214 160-4

Currell R Urquhart C Wainwright P amp Lewis R (2000) Telemedicine versus

face to face patient care effects on professional practice and health care outcomes

Cochrane Database of Systematic Reviews 2 No CD002098 Available from

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Dahlgren G Hjalmarsson U amp Lundin-Olsson L (2002) Reliability testing of the

Swedish version of the Shoulder Rating Questionnaires SRQ-S

Reliabilitetstestning av den svenska versionen av Shoulder Rating Questionnaires

50

SRQ-S Cited 2008 Sept 20 Available from httpmicrkibkisenetacginph-

Published In Swedish in Nordisk Fysioterapi 6(3)134-43

Della Valle C J Rokito A S Birdcell M G amp Zuckerman J D (2001)

Biomechanics of the shoulder p 318-39 In Basic Biomechanics of the

Musculoskeletal System (3rd ed) Nordin M Frankel VH Philadelphia

Lippincott Williams amp Wilkins

Demiris G Speedie S M amp Finkelstein S (2000) A questionnaire for the as-

sessment of patientrsquos impressions of risks and benefits of home telecare Journal

of Telemedicine and Telecare 6 278-284

Deuschle JA amp Romeo AA (1998) Understanding shoulder arthroplasty

Orthopedic Nursing 17(5) 7-21

Domholdt E (2000) Physical Therapy Research (2nd eds) Philadelphia Saunders

Downe-Wamboldt B (1992) Content Analysis Method Applications and Issues

Health Care for Woman International 13 313-32

Edwards I Jones M Higgs J Trede F amp Jensen G (2004)What is collaborative

reasoning Advances in Physiotherapy 6(2) 70-83

Eysenbach G (2001) What is eHealth Journal of Med Internet Res 3(2) E20

Eriksson L (2004) Physiotherapy and transfer of information by telemedicine after

a shoulder joint operation Sjukgymnastik och informationsoumlverfoumlring via teleme-

dicin efter axelledsoperation en pilotstudie [Swedish] Not available in English

Available from httpepublluthse1402-1552200407LTU-DUPP-0407-SE]

Ekenberg L (2000) The meaning of physiotherapy Experiences of parents of young

adults with impairment Doctoral dissertation Lulearing Lulearing University of Tech-

nology

Field M J (1996) Telemedicine A guide to assessing telecommunications in health

care Washington DC National Academy Press

Graneheim U H amp Lundman B (2004) Qualitative content analysis in nursing

research concepts procedures and measures to achieve trustworthiness Nurse

Education Today 24 105-112

51

Harrefors C (2009) Elderly peoplersquos perceptions about care and the use of assistive

technology services (ATS) Lulearing university of Technology Licentiate thesis

Haukipuro K Ohinmaa A Winblad I Linden T amp Vuolio S (2000) The

feasibility of telemedicine for orthopaedic outpatient clinics--a randomized con-

trolled trial Journal of Telemedicine and Telecare 6(4) 193-8

Hjelm N M (2005) Benefits and drawbacks of telemedicine Journal of Telemedi-

cine and Telecare 11(2) 60-70

Hughes G Hudgins B Hooper J E amp Wallace B (2003) User satisfaction with

rehabilitation services delivered using Internet video Journal of Telemedicine and

Telecare 9(3) 180-183

Hsieh H-F amp Shannon S (2005) Three approaches to qualitative content analysis

Qualitative Health Research 15(9) 1277-1288

Huis Int Veld M H A van Dijk H Hermens H J amp Vollenbroek-Hutten M M

R (2006) A systematic review of the methodology of telemedicine evaluation in

patients with postural and movement disorders Journal of Telemedicine and Tele-

care 12 289-97

International Association for the Study of Pain (2007) Pain Terminology Kyoto

(cited 2009-07-11) Available from httpwwwiasp-painorgAM

TemplatecfmSection=Pain_DefinitionsampTemplate=CMHTMLDisplaycfmampI

ASP

Jensen G M Shepard K F amp Hack L M (1990) The novice versus the experi-

enced clinician Insights into the work of the physical therapist Physical Therapy

70 (5) May 314-23

Kendon A (1990) Conducting interaction patterns of behavior in focused encoun-

ters Cambridge Cambridge University Press

Klaber Moffett J A Richardson P H (1997) The influence of the physiotherapist-

patient relationchip on pain and disability Physiotherapy theory and practice 13

89-96

Koch S (2006) Home telehealth ndash Current state and future trends International

Journal of Medical Informatics 75 565-576

52

Krippendorff K (1980) Content analysis An introduction to its methodology (4th

ed) Newbury Park CA Sage

Kuhn J E amp Blasier R B (1995) Measuring outcomes in shoulder arthroplasty

Semin Arthroplasty 6 245-64

Kvale S (1997) Den kvalitativa forskningsintervjun [Swedish] (The qualitative

research interview) Lund Studentlitteratur

Lemaire E D Boudrias Y amp Greene G (2001) Low-bandwidth Internet-based

videoconferencing for physical rehabilitation consultations Journal of Telemedi-


Levitt S amp Goldschmied E (1990) As we teach so we treat Physiotherapy Theory

and Practice 6 227-237

Lindberg B Axelsson K amp Oumlhrling K (2009) Taking care of their baby at home

but with nursing staff as support The use of videoconferencing in providing neo-

natal support to parents of preterm infants Journal of Neonatal Nursing 15 47-55

LInsalata J C Warren R F Cohen S B Altchek D W amp Peterson M G

(1997) A self-administered questionnaire for assessment of symptoms and func-

tion of the shoulder Journal of Bone and Joint Surgery Am 79 738-48

Lundman B amp Haumlllgren-Graneheim U (2008) Kvalitativ inneharingllsanalys

[Swedish] In Granskaumlr Monica amp Houmlglund-Nielsen Birgitta (red) Tillaumlmpad

kvalitativ forskning inom haumllso- och sjukvaringrd (Qualitative content analysis)

Lund Studentlitteratur

Lundvik Gyllensten A Gard G Salford E amp Ekdahl C (1999) Interaction be-

tween patient and physiotherapist a qualitative study reflecting the physiothera-

pistrsquos perspective Physiotherapy Research International 4(2) 89-109

Madhok R Lewallen D G Wallrichs SL Ilstrup D M amp Melton (3rd) LJ

(1993) Utilization of upper limb joint replacements during 1972-90 the Mayo

Clinic experience Proc Inst Mech Eng [H] 207(4) 239-44

Mair F amp Whitten P (2000) Systematic review of studies of patient satisfaction

with telemedicine BMJ 320 1517-20

53

Malterud K (1998) Kvalitativa metoder i medicinsk forskning [Swedish]

(Qualitative methods in medical research) Lund Studentlitteratur

Maybach A amp Schlegel T E (1995) Shoulder rehabilitation for the arthritic

glenohumeral joint preoperative and postoperative considerations Seminars in

Arthroplasty 6(4) 297-304

Melander-Wikman A amp Faumlltholm Y (2006) Patient empowerment in rehabilita-

tion ldquoSomebody told me to get rehabilitatedrdquo Advances in Physiotherapy 8(1)

23-32

Melander-Wikman A Faumlltholm Y amp Gard G (2008) Safety vs Privacy elderly

personsrsquo experiences of a mobile safety alarm Health and Social Care in the

Community 16 (4) 337-346

National Board of Health and Welfare (2009) Socialstyrelsen Varingrdutnyttjande rouml-

relseorganens sjukdomar Available from wwwsocialstyrelsense cited 2009-07-

11

National Library of Medicine (2009) Rehabilitation (1967) In MeSH Database

Available (2009-08-31) from URLhttpwwwncbinlmnihgovmesh81000534ordinalpos=2ampitool=EntrezSystem2PEntrezMe

shMesh_ResultsPanelMesh_RVDocSum

Nationellt kompetenscentrum foumlr ortopedi (2006) Indikationer foumlr behandling inom

ortopedi[Swedish] (Indications of treatments within orthopaedics) Nationella

medicinska indikationer foumlr axelkirurgi Lund Available from

httpwwwsocialstyrelsenseStatistikstatistikdatabasindexhtm

Nilsson C Oumlhman M amp Soumlderberg S (2006) Information and communication

technology in supporting people with serious chronic illness living at home ndash an

intervention study Journal of Telemedicine and Telecare 12 198-202

Nowak J Svensson B Blondell C Schroumlder-Winter H Lind-Johansson C amp

Waumlnstrand B (2001) Obruten varingrdkedja foumlr patienter med sjukdomstillstaringnd i

skuldran [Swedish] Unbroken chain of care with the help of Axelina Laumlkar-

tidningen 98 2452-5

54

Palsbo S E amp Bauer D (2000) Telerehabilitation managed cares new opportu-

nity Managed care quarterly 8(4) 56-64

Petrella R J amp Bartha C (2000) Home based exercise therapy for older patients

with knee osteoarthritis a randomized clinical trial The Journal of rheumatology

27(9) 2215-21

Price D D McGrath P A Rafii A amp Buckingham B (1983) The validation of

visual analogue scales as ratio scale measures for chronic and experimental pain

Pain 17 45-56

Romeo A A Bach B R amp OacuteHalloran K L (1996) Scoring systems for shoul-

der conditions American Journal of Sports Medicine 24(4) 472-476

Rosberg S (2000) Kropp varande och mening i ett sjukgymnastiskt perspektiv

[Swedish] Akademisk avhandling Goumlteborgs universitet Institutionen foumlr social

arbete Available from httpwwwubgusefulltextavhandlingare000204srpdf

Russell T G Buttrum P Wootton R amp Jull G A (2003) Low-bandwidth

telerehabilitation for patients who have undergone total knee replacement

preliminary results Journal of Telemedicine and Telecare 9 (Suppl 2)7

Russel T Buttrum P Wootton R amp Jull G A (2004) Rehabilitation after total

knee replacement via bow-bandwidth telemedicine the patient and therapist ex-

perience Journal of Telemedicine andTelecare 10(Suppl 1) 85-87

Sanford J amp Butterfield T (2005)Using remote assessment to provide home modi-

fication services to underserved elders The gerontologist 45(3) 389-398

Sanford J Hoenig H Griffith C Butterfield T Richardson P amp Hargraves K

(2007) A comparison of televideo and traditional in-home rehabilitation in mo-

bility impaired older adults Physical amp Occupational Therapy in Geriatrics Vol

25(3) 1-18

Sjuijs E M amp Knibbe J J (1991) Patient compliance with exercise different

theoretical approaches to short-term and long-term compliance Patient Education

and Counselling 17 191-204

55

Solem Bertoft E (2007) Sjukgymnastisk undersoumlkning och behandling av smaumlrttill-

staringnd i skuldran In Roumlrelseorganens funktionsstoumlrningar Klinik och sjukgymnas-

tik [Swedish] Holmstroumlm E amp Moritz U (Eds) Studentlitteratur

Sullivan M Karlsson J amp Ware J E Jr (1995) The Swedish SF-36 Health Sur-

vey -- I Evaluation of data quality scaling assumptions reliability and construct

validity across general populations in Sweden Soc Sci Med 41 1349-58

Svendsen K B Andersen S Arnason S Arner S Breivik H Heiskanene E

Kalso U Kongsgaard P Sjogren P Strang P Bach F W amp Jensen T S

(2005) Breakthrough pain in malignant and non-malignant diseases a review of

prevalence characteristics and mechanisms European journal of pain 9(2)195-

206

Swedish Shoulder arthroplasty Register (2009) Svenska axelartoplastikregistret

[Swedish] The Swedish register of shoulder arthroplasty Available from

httpwwwssasseaxelreportsphpcited 2009-08-11

Saumlvenstedt S Zingmark K Hydeacuten L-C amp Brulin C (2005) Establishing joint

attention in remote talks with the elderly about health a study of nursesrsquo conver-

sation with elderly persons in teleconsultations Scandinavian Journal of Caring

Science 19 317-324

Saumlvenstedt S Naumlrhet och distans In Saumlvenstedt S Zingmark K Saumlvenstedt G

(2007) Ehaumllsa i varingrd och omsorg av aumlldre Teknik etik och praktik [Swedish]

(Closeness and distance In EacuteHealth in caring for the elderly Technology ethics

and practice) Lund Studentlitteratur

Thomeeacute P Waumlhrborg P Boumlrjesson M Thomeeacute R Eriksson B I amp Karlsson J

(2009) Att tro paring sig sjaumllv ndash grund foumlr lyckad rehabilitering Laumlkartidningen 106

32-33

Thornquist E (1988) Conceiving Function An investigation of epistemological pre-

conditions conceptualisations and methodologies in physiotherapy Doctoral the-

sis University of Oslo Department of Family Medicine

56

Unverzagt C Ross O amp Hughes C (2006) Case report rehabilitation and out-

comes for a patient following implant of a reverse delta III shoulder prosthesis

Orthopaedic Practice 18(2) 32-37

Winters J M (2002)Telerehabilitation research Emerging opportunities Annual

Reviews of Biomedical Engeenering 4 287-320

Wong Y K Hui E amp Woo J (2005) A community-based exercise programme

for older persons with knee pain using telemedicine Journal of Telemedicine and

Telecare 11(6) 310-5

World Health Organization (2001) International Classification of Functioning Dis-

ability and Health (ICF) Geneva World Health Organization

ISBN 91-7201-755-4 ICF Also available from Helsedirektoratet

httpwwwhelsedirektoratetnonordclassicficf___internasjonal_klassifikasjon_a

v_funksjon__funksjonshemming_og_helse_280814

Youdas J W Carey J R Garrett T R amp Suman V J (1994) Reliability of go-

niometric measurements of active arm elevation in the scapular plane obtained in

a clinical setting Arch Phys Medical Rehabilitation 75 1137-44

Zampolini M Todeschini E Guitart M B Hemens H Ilsbroukx S Macellari

V Magni R Rogante M Marchese S S Vollenbroek M amp Giacomozzi C

(2008) Tele-rehabilitation Present and future Annali dellIstituto superiore di

sanitagrave 44(2) 125-134

Zingmark K (2007) Modern teknologi och foumlraumlndring aringldrande hem och vaumlrdighet

In Saumlvenstedt S Zingmark K Saumlvenstedt G Ehaumllsa i varingrd och omsorg av aumlldre

Teknik etik och praktik ISBN 978-91-44-04628-0 Lund Studentlitteratur

57

DISSERTATIONS FROM THE DEPARTMENT OF HEALTH SCIENCE LULEAring UNIVERSITY OF

TECHNOLOGY SWEDEN

Doctoral theses

Terttu Haumlggstroumlm Life-story perspective on caring within cultural contexts experi-

ences of severe illness and of caring (Nursing) 2004

Inger Jacobson Injuries among female football players (Physiotherapy) 2006

Karl Elling Ellingsen Lovregulert tvang og refleksiv praksis (Health Science and

Human Services) 2006

Annika Naumlslund Dynamic ankle-foot orthoses in children with spastic diplegia in-

terview and experimental studies (Physiotherapy) 2007

Inger Lindberg Postpartum care in transition parentsrsquo and midwivesrsquo expectations

and experience of postpartum care including the use of videoconferencing (Nur-

sing) 2007

Aringsa Widman Det aumlr saring mycket som kan spela in ndash en studie av vaumlgar till genom och

fraringn sjukskrivning baserad paring intervjuer med laringngtidssjukskrivna (Health Science

and Human Services) 2007

Eija Jumisko Striving to become familiar with life with traumatic brain injury

experiences of people with traumatic brain injury and their close relatives

(Nursing) 2007

Gunilla Isaksson Det sociala naumltverkets betydelse foumlr delaktighet i dagliga

aktiviteter erfarenheter fraringn kvinnor med ryggmaumlrgsskada och deras maumln (Health

Science and Human Services) 2007

Nina Lindeloumlf Effects and experiences of high-intensity functional exercise pro-

grammes among older people with physical or cognitive impairment (Physiother-

apy) 2008

58

Aringsa Engstroumlm A wish to be near experiences of close relatives within intensive

care from the perspective of close relatives formerly critically ill people and criti-

cal care nurses (Nursing) 2008

Catrine Kostenius Giving voice and space to children in health promotion (Health


Anita Melander Wikman Ageing well mobile ICT as a tool for empowerment of

elderly people in home health care and rehabilitation (Physiotherapy) 2008

Sedigheh Iranmanesh Caring for dying and meeting death the views of Iranian and

Swedish nurses and student nurses (Nursing) 2009

Birgitta Lindberg When the baby is premature Experiences of parenthood and get-

ting support via videoconferencing (Nursing) 2009

Licentiate theses

Marja Oumlhman Living with serious chronic illness from the perspective ofpeople

with serious chronic illness close relatives and district nurses (Nursing) 2003

Kerstin Nystroumlm Experiences of parenthood and parental support during the childs

first year (Nursing) 2004

Eija Jumisko Being forced to live a different everyday life the experiences of peo-

ple with traumatic brain injury and those of their close relatives (Nursing) 2005

Aringsa Engstroumlm Close relatives of critically ill persons in intensive and critical care

the experiences of close relatives and critical care nurses (Nursing) 2006

Anita Melander Wikman Empowerment in living practice mobile ICT as a tool for

empowerment of elderly people in home health care (Physiotherapy) 2007

Carina Nilsson Using information and communication technology to support people

with serious chronic illness living at home (Nursing) 2007

Malin Olsson Expressions of freedom in everyday life the meaning of womens ex-

periences of living with multiple sclerosis (Nursing) 2007

59

Lena Widerlund Nya perspektiv men inarbetad praxis en studie av utvecklings-

stoumlrdas delaktighet och sjaumllvbestaumlmmande (Health Science and Human Services)

2007

Birgitta Lindberg Fathersrsquo experiences of having an infant born prematurely

(Nursing) 2007

Christina Harrefors Elderly peoplersquos perception about care and the use of assistive

technology services (ATS) (Nursing) 2009

For purchase information

Department of Health Science Lulearing University of Technology S-971 87 Lulearing

Sweden

60

Effects and patientsrsquo experiences

of interactive video-based

physiotherapy at home after


Lisbeth Eriksson

Division of Health and Rehabilitation

Department of Health Science

Lulearing University of Technology

Lulearing 2009


ISSN 1402-1757 ISBN 978-91-86233-93-8

Lulearing

wwwltuse

About wisdom


Merete Mazzarella


CONTENTS









Paper I Paper II

1

ABSTRACT







2

3

ORIGINAL PAPERS









cerned

4







5

INTRODUCTION







My context




















6






























7


project







(IASP 2007)


















8





























9































10






















Thornquist 1988)

Telerehabilitation






11

























Zingmark 2007)






12


2007)


























13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60


ISSN 1402-1757 ISBN 978-91-86233-93-8

Lulearing

wwwltuse

About wisdom


Merete Mazzarella


CONTENTS









Paper I Paper II

1

ABSTRACT







2

3

ORIGINAL PAPERS









cerned

4







5

INTRODUCTION







My context




















6






























7


project







(IASP 2007)


















8





























9































10






















Thornquist 1988)

Telerehabilitation






11

























Zingmark 2007)






12


2007)


























13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

About wisdom


Merete Mazzarella


CONTENTS









Paper I Paper II

1

ABSTRACT







2

3

ORIGINAL PAPERS









cerned

4







5

INTRODUCTION







My context




















6






























7


project







(IASP 2007)


















8





























9































10






















Thornquist 1988)

Telerehabilitation






11

























Zingmark 2007)






12


2007)


























13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

CONTENTS









Paper I Paper II

1

ABSTRACT







2

3

ORIGINAL PAPERS









cerned

4







5

INTRODUCTION







My context




















6






























7


project







(IASP 2007)


















8





























9































10






















Thornquist 1988)

Telerehabilitation






11

























Zingmark 2007)






12


2007)


























13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

1

ABSTRACT







2

3

ORIGINAL PAPERS









cerned

4







5

INTRODUCTION







My context




















6






























7


project







(IASP 2007)


















8





























9































10






















Thornquist 1988)

Telerehabilitation






11

























Zingmark 2007)






12


2007)


























13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

2

3

ORIGINAL PAPERS









cerned

4







5

INTRODUCTION







My context




















6






























7


project







(IASP 2007)


















8





























9































10






















Thornquist 1988)

Telerehabilitation






11

























Zingmark 2007)






12


2007)


























13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

3

ORIGINAL PAPERS









cerned

4







5

INTRODUCTION







My context




















6






























7


project







(IASP 2007)


















8





























9































10






















Thornquist 1988)

Telerehabilitation






11

























Zingmark 2007)






12


2007)


























13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

4







5

INTRODUCTION







My context




















6






























7


project







(IASP 2007)


















8





























9































10






















Thornquist 1988)

Telerehabilitation






11

























Zingmark 2007)






12


2007)


























13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

5

INTRODUCTION







My context




















6






























7


project







(IASP 2007)


















8





























9































10






















Thornquist 1988)

Telerehabilitation






11

























Zingmark 2007)






12


2007)


























13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

6






























7


project







(IASP 2007)


















8





























9































10






















Thornquist 1988)

Telerehabilitation






11

























Zingmark 2007)






12


2007)


























13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

7


project







(IASP 2007)


















8





























9































10






















Thornquist 1988)

Telerehabilitation






11

























Zingmark 2007)






12


2007)


























13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

8





























9































10






















Thornquist 1988)

Telerehabilitation






11

























Zingmark 2007)






12


2007)


























13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

9































10






















Thornquist 1988)

Telerehabilitation






11

























Zingmark 2007)






12


2007)


























13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

10






















Thornquist 1988)

Telerehabilitation






11

























Zingmark 2007)






12


2007)


























13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

11

























Zingmark 2007)






12


2007)


























13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

12


2007)


























13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

13

Rationale




gery













patient hands-on




14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

14

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

15

AIMS










16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

16

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

17








Figure 1




B Control group





~8 w

~8 w

Measure 1 Measure 2





18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

18





















Content analysis

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

19









Intervention











every second week







20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

20







Data collection


















21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

21



Targetgroup





Self-ratingformula





Test of func-tion

Constantscore


Shoulderfunction




Shouldercondition

















22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

22































23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

23






Analysis





















the text

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

24





























25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

25


















06-034M

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

26

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

27

RESULTS






days






control group

0 10 20 30 40 50

Pain (VAS cm)

Constant score

SRQ-S

Ext rotation (degr)

Flexion (degr)

ControlTelerehab



lt001

ns

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

28













sented in Table 3









29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

29








tive living






30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

30

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

31

DISCUSSION













petence












with them

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

32








bilitation process





















33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

33































34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

34




























35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

35





























placement

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

36
























views






37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

37



























38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

38

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

39




Introduktion














Syfte




40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

40

Material och metod

















varandra






Resultat




41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

41






















ning









42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

42























professionen





till detta

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

43










44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

44

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

45

ACKNOWLEDGEMENTS









respect

















been any project

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

46





and good advices

















way



inspiration





47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

47






Uusitaalo
















very grateful for

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

48

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

49

REFERENCES







329-336


















mehtml




50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

50
























nology






51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

51










Telecare 9(3) 180-183






care 12 289-97




ASP



70 (5) May 314-23





89-96



52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

52






























53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

53








23-32



Community 16 (4) 337-346



11














tidningen 98 2452-5

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

54





27(9) 2215-21



Pain 17 45-56

















25(3) 1-18




55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

55











206







Science 19 317-324







32-33




56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

56
























57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

57


TECHNOLOGY SWEDEN

Doctoral theses










sing) 2007






(Nursing) 2007






apy) 2008

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

58












Licentiate theses















59



2007


(Nursing) 2007





Sweden

60

59



2007


(Nursing) 2007





Sweden

60

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