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Hermansen, A., Peolsson, A., Hedlund, R. & Kammerlind, A.-S. (2019). Balance problems and dizziness after neck surgery: associations with pain and health-related quality of life. Physiotherapy Theory and Practice, 1-8
Åpne denne publikasjonen i ny fane eller vindu >>Balance problems and dizziness after neck surgery: associations with pain and health-related quality of life
2019 (engelsk)Inngår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, s. 1-8Artikkel i tidsskrift (Fagfellevurdert) Epub ahead of print
Abstract [en]

INTRODUCTION: Symptoms of dizziness or imbalance are often present in individuals with a variety of neck-disorders. The aims of this study were to determine the prevalence of patient-reported balance problems and dizziness 10-13 years after surgery for cervical degenerative disc disease; evaluate associations with neck pain and health-related quality of life; and investigate how these individuals described dizziness.

MATERIAL AND METHODS: Sixty-eight individuals, 10 years or more after anterior cervical decompression and fusion surgery, who previously participated in a randomized controlled trial were included. Participants completed questionnaires including ratings of dizziness and balance problems, the Dizziness Handicap Inventory, and an open-ended question regarding their experience of dizziness. Secondary outcomes were neck pain and quality of life.

RESULTS: Seventy-two percent experienced occasional or daily symptoms of unsteadiness and/or dizziness. Intensity ratings for dizziness during movement and for balance problems were similar and rather low, but had an impact on quality of life. Ratings of dizziness at rest were even lower. Dizziness ratings were associated with neck pain. Strenuous activities were related to dizziness and dizziness was primarily described as intermittent and non-rotatory.

CONCLUSIONS: Dizziness or balance problems in the long-term after surgery for cervical degenerative disc disease are common and have an impact on daily life. Ratings of problem frequency and intensity were usually low. Dizziness and balance problems may affect quality of life. Patients' descriptions of these problems are in line with common symptoms of cervicogenic dizziness.

sted, utgiver, år, opplag, sider
Taylor & Francis Group, 2019
Emneord
Cervical spine, anterior cervical decompression and fusion, degenerative disease, dizziness
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-161041 (URN)10.1080/09593985.2019.1571137 (DOI)30686102 (PubMedID)2-s2.0-85060927284 (Scopus ID)
Tilgjengelig fra: 2019-10-17 Laget: 2019-10-17 Sist oppdatert: 2019-10-23bibliografisk kontrollert
Peolsson, A., Peterson, G., Hermansen, A., Landén Ludvigsson, M., Dedering, A. & Lofgren, H. (2019). Physiotherapy after anterior cervical spine surgery for cervical disc disease: study protocol of a prospective randomised study to compare internet-based neck-specific exercise with prescribed physical activity. BMJ Open, 9(2), Article ID e027387.
Åpne denne publikasjonen i ny fane eller vindu >>Physiotherapy after anterior cervical spine surgery for cervical disc disease: study protocol of a prospective randomised study to compare internet-based neck-specific exercise with prescribed physical activity
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2019 (engelsk)Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 2, artikkel-id e027387Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Introduction Patients suffering from remaining disability after anterior cervical decompression and fusion (ACDF) surgery for cervical disc disease may be prescribed physical activity (PPA) or neck-specific exercises (NSEs). Currently, we lack data for the success of either approach. There is also a knowledge gap concerning the use of internet-based care for cervical disc disease. The scarcity of these data, and the high proportion of patients with various degrees of incapacity following ACDF, warrant increased efforts to investigate and improve cost-effective rehabilitation. The objective is to compare the effectiveness of a structured, internet-based NSE programme, versus PPA following ACDF surgery. Methods and analysis This is a prospective, randomised, multicentre study that includes 140 patients with remaining disability (amp;gt;= 30% on the Neck Disability Index, NDI) following ACDF for radiculopathy due to cervical disc disease. Patient recruitment occurs following attendance at routine clinical appointments, scheduled at 3 months postsurgery. Patients are then randomised to one of two groups (70 patients/group) for a 3-month treatment programme/period of either internet-based NSE or PPA. Questionnaires on background data, pain and discomfort, physical and mental capacity, satisfaction with care, and health and workplace factors are completed, along with physical measures of neck-related function conducted by independent test leaders blinded to randomisation. Measures are collected at inclusion, after the 3-month treatments (end of treatment) and at a 2-year follow-up. Radiography will be completed at the 2-year follow-up. Preoperative data will be collected from the Swedish Spine Registry. Data on healthcare consumption, drug use and sick leave will be requested from the relevant national registers. Ethical considerations This study was approved by the Regional Ethical Review Board in Linkoping Ref. 2016/283-31 and 2017/91-32. The scientists are independent with no commercial ties. Patients are recruited after providing written informed consent. Patient data are presented at group level such that no connection to any individual can be made. All data are anonymised when reported, and subject to the Swedish Official Secrets Health Acts. The test leaders are independent and blinded for randomisation. Exercises, both general and neck-specific, have been used extensively in clinical practice and we anticipate no harm from their implementation other than a risk of muscle soreness. Both randomisation groups will receive care that is expected to relieve pain, although the group receiving NSE is expected to demonstrate a greater and more cost-effective improvement versu s the PPA group. Any significant harm or unintended effects in each group will be collected by the test leaders. All questionnaires and test materials are coded by the research group, with code lists stored in locked, fireproof file cabinets, housed at the university in a room with controlled (card-based) access. Only individuals in receipt of a unique website address posted by the researchers can access the programme; patients can neither communicate with each other nor with caregivers via the programme. Study participation might lead to improved rehabilitation versus non-participation, and might therefore be of benefit. The results of this study should also contribute to more effective and flexible rehabilitation, shorter waiting times, lower costs and the possibility to implement our findings on a wider level. Dissemination If effective, the protocols used in this study can be implemented in existing healthcare structures. The results of the study will be presented in scientific journals and popular science magazines of relevance to health. The findings will also be presented at local, regional, national and international conferences and meetings, as well as in the education of university students and at public lectures. Information about the results will be communicated to the general population in cooperation with patient organisations and the media.

sted, utgiver, år, opplag, sider
BMJ PUBLISHING GROUP, 2019
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-158984 (URN)10.1136/bmjopen-2018-027387 (DOI)000471124600275 ()30782952 (PubMedID)
Merknad

Funding Agencies|regional Center for Clinical Research; Region Council of Ostergotland County

Tilgjengelig fra: 2019-07-19 Laget: 2019-07-19 Sist oppdatert: 2019-11-11bibliografisk kontrollert
Khosravi, F., Peolsson, A., Karimi, N. & Rahnama, L. (2019). Scapular Upward Rotator Morphologic Characteristics in Individuals With and Without Forward Head Posture: A Case-Control Study. Journal of ultrasound in medicine, 38(2), 337-345
Åpne denne publikasjonen i ny fane eller vindu >>Scapular Upward Rotator Morphologic Characteristics in Individuals With and Without Forward Head Posture: A Case-Control Study
2019 (engelsk)Inngår i: Journal of ultrasound in medicine, ISSN 0278-4297, E-ISSN 1550-9613, Vol. 38, nr 2, s. 337-345Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objectives There are several reports suggesting that forward head posture contributes to alterations in scapular kinematics and muscle activity, leading to the development of shoulder problems. Currently, it is unknown whether forward head posture alters the thickness of the scapular muscles. The aim of this study was to compare the thickness of the serratus anterior and upper and lower trapezius muscles at rest and during loaded isometric contractions in individuals with and without forward head posture. Methods Twenty individuals with forward head posture and 20 individuals with normal head posture participated in this case-control study. Three separate ultrasound images of the serratus anterior and upper and lower trapezius muscles were captured under 2 randomized conditions: at rest and during a loaded isometric contraction. Results The thickness of each muscle significantly increased from rest to the loaded isometric contraction (P?<?.001). The only difference between the groups was that the thickness of the serratus anterior muscle at rest in the normal-posture group was larger than that in the forward-posture group (P?=?.01). Conclusions Forward head posture appears to be related to atrophy of the serratus anterior muscle, which may contribute to the development of shoulder problems. Further research is required to identify more about the association of forward head posture with the imbalance of shoulder girdle muscles and the impact of head posture on upper quadrant pain.

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John Wiley & Sons, 2019
Emneord
musculoskeletal, scapular muscles, serratus anterior, thickness, trapezius, ultrasound
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-154050 (URN)10.1002/jum.14693 (DOI)000456851600007 ()
Merknad

Funding agencies: University of Social Welfare and Rehabilitation Sciences

Tilgjengelig fra: 2019-01-24 Laget: 2019-01-24 Sist oppdatert: 2019-03-06
Landén Ludvigsson, M., Peterson, G. & Peolsson, A. (2019). The effect of three exercise approaches on health-related quality of life, and factors associated with its improvement in chronic whiplash-associated disorders: analysis of a randomized controlled trial.. Quality of Life Research, 28(2), 357-368
Åpne denne publikasjonen i ny fane eller vindu >>The effect of three exercise approaches on health-related quality of life, and factors associated with its improvement in chronic whiplash-associated disorders: analysis of a randomized controlled trial.
2019 (engelsk)Inngår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 28, nr 2, s. 357-368Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

PURPOSE: The aim was to evaluate whether neck-specific exercise, with (NSEB) or without (NSE) a behavioural approach, improves health-related quality of life (HRQoL) compared to physical activity prescription (PPA) in chronic whiplash-associated disorders (WAD) grades 2 and 3. A secondary aim was to identify factors associated with HRQoL and HRQoL improvement following exercise interventions.

METHODS: This is a secondary analysis of a multicentre randomized clinical trial. Participants (n = 216) with chronic WAD grades 2 and 3 were randomized to 12 weeks of PPA or physiotherapist-led NSE or NSEB. The EQ-5D 3L/EQ-VAS and SF-36v2 physical (PCS) and mental (MCS) component summaries were collected together with several neck-related and psychosocial outcomes at baseline, after 3, 6 and 12 months, and were analysed with linear mixed models (all time points) and multivariate linear regressions (baseline, 6 months).

RESULTS: NSE/NSEB resulted in better outcomes than PPA (EQ-VAS and SF-36 PCS, both groups, p < 0.01) but not in a higher EQ-5D score. Improvement over time was seen in EQ-5D/EQ-VAS for the NSEB group (p < 0.01), and for NSE/NSEB as measured with the PCS (p < 0.01). Factors associated with baseline HRQoL and change to 6 months in HRQoL (R2 = 0.38-0.59) were both neck-related and psychosocial (e.g. depression, work ability).

CONCLUSION: Neck-specific exercise, particularly with a behavioural approach, may have a more positive impact on HRQoL than physical activity prescription in chronic WAD grades 2 and 3. HRQoL is however complex, and other factors also need to be considered. Factors associated with HRQL and improvements in HRQoL following exercise are multidimensional.

TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, No. NCT01528579.

sted, utgiver, år, opplag, sider
Springer, 2019
Emneord
Chronic, Exercise, Physiotherapy, Quality of life, Spine, Whiplash
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-154060 (URN)10.1007/s11136-018-2004-3 (DOI)000457880300006 ()30225786 (PubMedID)
Merknad

Funding agencies: Vetenskapsradet [521-2014-2982]; Swedish Government through the REHSAM Foundation [RS2010/009]; Swedish Research Council; County Council of Ostergotland [LIO-533041, LIO-439541, LIO-197631, IO-276151, LIO-354241]; Centre for Clinical Research Sormland at 

Tilgjengelig fra: 2019-01-24 Laget: 2019-01-24 Sist oppdatert: 2019-03-07
Lo, H. K., Johnston, V., Landén Ludvigsson, M., Peterson, G., Overmeer, T., David, M. & Peolsson, A. (2018). Factors associated with work ability following exercise interventions for people with chronic whiplash-associated disorders: Secondary analysis of a randomized controlled trial.. Journal of Rehabilitation Medicine, 50
Åpne denne publikasjonen i ny fane eller vindu >>Factors associated with work ability following exercise interventions for people with chronic whiplash-associated disorders: Secondary analysis of a randomized controlled trial.
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2018 (engelsk)Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

OBJECTIVE: To investigate the efficacy of exercise interventions and factors associated with changes in work ability for people with chronic whiplash-associated disorders.

DESIGN: Secondary analysis of a single-blind, randomized multi-centre controlled trial.

SETTING: Interventions were conducted in Swedish primary care settings.

PATIENTS: A total of 165 individuals with chronic whiplash-associated disorders grade II-III.

METHODS: Participants were randomly allocated to neck-specific exercise, neck-specific exercise with a behavioural approach, or prescribed physical activity interventions. Work ability was evaluated with the Work Ability Index at baseline, 3, 6 and 12 months.

RESULTS: The neck-specific exercise with a behavioural approach intervention significantly improved work ability compared with the prescribed physical activity intervention (3 months, p = 0.03; 6 months, p = 0.01; 12 months, p = 0.01), and neck-specific exercise at 12 months (p = 0.01). Neck-specific exercise was better than the prescribed physical activity intervention at 6 months (p = 0.05). An increase in work ability from baseline to one year for the neck-specific exercise with a behavioural approach group (p < 0.01) was the only significant within-group difference. Higher self-rated physical demands at work, greater disability, greater depression and poorer financial situation were associated with poorer work ability (p < 0.01).

CONCLUSION: This study found that neck-specific exercise with a behavioural approach intervention was better at improving self-reported work ability than neck-specific exercise or prescribed physical activity. Improvement in work ability is associated with a variety of factors.

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FOUNDATION REHABILITATION INFORMATION, 2018
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-150587 (URN)10.2340/16501977-2374 (DOI)000447771700008 ()30132011 (PubMedID)
Merknad

Funding agencies: Swedish government through the Swedish Research Council; Swedish Social Insurance Agency through the REHSAM Foundation Stockholm, Sweden; regional Center for Clinical Research of Ostergotland, Linkoping, Sweden; regional Center for Clinical Research of So

Tilgjengelig fra: 2018-08-28 Laget: 2018-08-28 Sist oppdatert: 2018-11-09
Amiri Arimi, S., Mohseni Bandpei, M. A., Rezasoltani, A., Peolsson, A. & Mohammadi, M. (2018). Multifidus muscle size changes at different directions of head and neck movements in females with unilateral chronic non-specific neck pain and healthy subjects using ultrasonography. Journal of Bodywork & Movement Therapies, 22(3), 560-565
Åpne denne publikasjonen i ny fane eller vindu >>Multifidus muscle size changes at different directions of head and neck movements in females with unilateral chronic non-specific neck pain and healthy subjects using ultrasonography
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2018 (engelsk)Inngår i: Journal of Bodywork & Movement Therapies, ISSN 1360-8592, E-ISSN 1532-9283, Vol. 22, nr 3, s. 560-565Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

OBJECTIVE: The aim of the study was to compare the dimensions of cervical multifidus muscle (CMM) in different conditions.

METHODS: Twenty five women with neck pain and 25 healthy subjects participated in this study. The dimensions of the CMM were measured at rest, 50% and 100% maximum isometric voluntary contraction (MIVC) at six directions of neck movements, using ultrasonography.

RESULTS: The size of multifidus was smaller in patients than healthy individuals at rest state (P < 0.05). A significant smaller CMM dimension was found in the affected side compared with unaffected side in patients group (P < 0.05). The result of ANOVA for MLD showed a significant difference for contraction levels (P < 0.001) and neck movements (P < 0.001) in both groups. The MLD of the CMM was significantly different between CMM at rest and 50%, and 100% MIVC (P < 0.001). No significant differences were found between the groups at 50% and 100% MIVC (P > 0.05 in both instances). The most prominent CMM size change was observed during neck extension, flexion, ipsilateral lateral-flexion, and ipsilateral rotation, respectively (P < 0.05).

CONCLUSIONS: Results of the present study indicate that the size of CMM was decreased in patients with neck pain in rest state. The size of CMM changes in all directions of neck movements, although the most prominent was during neck extension. This points out CMM stabilization role's in different directions of neck movements.

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Churchill Livingstone, 2018
Emneord
Cervical muscles, Multifidus, Neck pain, Size, Ultrasonography
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-154059 (URN)10.1016/j.jbmt.2017.09.011 (DOI)30100277 (PubMedID)
Tilgjengelig fra: 2019-01-24 Laget: 2019-01-24 Sist oppdatert: 2019-01-24
Peterson, G., Nilsson, D., Trygg, J. & Peolsson, A. (2018). Neck-specific exercise improves impaired interactions between ventral neck muscles in chronic whiplash: A randomized controlled ultrasound study. Scientific Reports, 8, Article ID 9649.
Åpne denne publikasjonen i ny fane eller vindu >>Neck-specific exercise improves impaired interactions between ventral neck muscles in chronic whiplash: A randomized controlled ultrasound study
2018 (engelsk)Inngår i: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, artikkel-id 9649Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Chronic pain and disability is common in whiplash-associated disorders (WAD), leading to personal suffering, sick leave, and social cost. The cervical spine is heavily dependent on muscular support and whiplash injury can cause damage to the neck muscles, but diagnostic tools to measure neck muscle impairment and evaluate exercise interventions are lacking. Therefore, the present study investigated ventral neck muscle interactions in 26 individuals with chronic WAD randomized to neck-specific exercise (NSE) or remaining on a waiting list (WL) in 3 months. We performed real-time, non-invasive ultrasound measurements with speckle tracking analysis and calculated the deformation area and deformation rate in three ventral neck muscles. Multivariate statistics were used to analyse interactions between the muscles. After 3 months of NSE, significant improvements were observed in neck muscle interactions and pain intensity in the NSE group compared to the WL group. Thus, this study demonstrates that non-invasive ultrasound can be a diagnostic tool for muscle impairment and used to evaluate exercise interventions in WAD and stands to make a breakthrough for better management in chronic WAD.

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NATURE PUBLISHING GROUP, 2018
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-149713 (URN)10.1038/s41598-018-27685-7 (DOI)000436078500012 ()29941911 (PubMedID)
Merknad

Funding Agencies|Swedish government; Swedish Social Insurance Agency through the REHSAM foundation; Swedish Research Council; Centre for Clinical Research Sormland at Uppsala University Sweden; Uppsala-Orebro Regional Research Council Sweden

Tilgjengelig fra: 2018-07-24 Laget: 2018-07-24 Sist oppdatert: 2018-08-14
Landén Ludvigsson, M., Peterson, G. & Peolsson, A. (2018). Neck-specific exercise may reduce radiating pain and signs of neurological deficits in chronic whiplash - Analyses of a randomized clinical trial. Scientific Reports, 8(1), Article ID 12409.
Åpne denne publikasjonen i ny fane eller vindu >>Neck-specific exercise may reduce radiating pain and signs of neurological deficits in chronic whiplash - Analyses of a randomized clinical trial
2018 (engelsk)Inngår i: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, nr 1, artikkel-id 12409Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Up to 90% of people with neurological deficits following a whiplash injury do not recover and cervical muscle dysfunction is common. The aim of this multicentre, randomized controlled trial was to examine whether two versions of neck-specific exercise or prescription of physical activity (PPA) can improve radiating arm pain and clinical signs that can be associated with neurological deficits in people with chronic whiplash associated disorders (WAD). Participants with chronic WAD, arm symptoms and signs associated with neurological deficits (n = 171) were randomized to: 12 weeks of neck-specific exercise without (NSE) or with a behavioural approach (NSEB), or PPA. Pain/bothersomeness frequency, six measures of arm pain/paraesthesia (VAS scales), and four clinical neurological tests were evaluated after 3 months. The NSE group reported the lowest frequency and lowest levels of arm pain, the highest proportion of participants with at least 50% pain reduction and the highest proportion of normal arm muscle force. The NSEB group reported increased normal tendon reflexes. No improvements were recorded for the PPA group. Neck-specific exercise may improve arm pain and decrease signs of neurological deficits, but the addition of a behavioural approach does not seem to be of additional benefit. © 2018, The Author(s).

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Nature Publishing Group, 2018
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-150588 (URN)10.1038/s41598-018-30556-w (DOI)000441876700112 ()30120313 (PubMedID)2-s2.0-85051714527 (Scopus ID)
Merknad

Funding agencies: Swedish government through the REHSAM Foundation [RS2010/009]; Swedish Research Council [521-2014-2982]; regional Center for Clinical Research; County Council of Ostergotland [LIO-533041, LIO-439541, LIO-197631, LIO-276151, LIO-354241]; Centre for Clinica

Tilgjengelig fra: 2018-08-28 Laget: 2018-08-28 Sist oppdatert: 2018-09-21
Wibault, J., Öberg, B., Dedring, Å., Löfgren, H., Zsigmond, P. & Peolsson, A. (2018). Structured postoperative physiotherapy in patients with cervical radiculopathy: 6-month outcomes of a randomized clinical trial. Journal of Neurosurgery: Spine, 28(1), 1-9
Åpne denne publikasjonen i ny fane eller vindu >>Structured postoperative physiotherapy in patients with cervical radiculopathy: 6-month outcomes of a randomized clinical trial
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2018 (engelsk)Inngår i: Journal of Neurosurgery: Spine, ISSN 1547-5654, Vol. 28, nr 1, s. 1-9Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective: To investigate the additional benefit of structured postoperative physiotherapy combining neck-specific exercises with a behavioral approach to standard postoperative approach in patients with cervical radiculopathy (CR) at 6 months after surgery.

Design: A prospective multi-center randomized clinical trial.

Subjects: Patients with CR (n=202, mean age 50.0, SD 8.4) who were scheduled for surgery.

Methods: Patients were randomized pre-operatively to structured postoperative physiotherapy (n=101) or standard approach (n=101) which in accordance with Swedish usual care may have included pragmatic physiotherapy after surgery when needed. Outcome measures at baseline and at 3 and 6 months follow-up included the Neck Disability Index (NDI), pain intensity in the neck and arm measured with a visual analogue scale (VAS) and global outcome of treatment. Between-group differences were investigated using complete case and per-protocol approaches.

Results: No between-group difference was found in NDI, VAS, or global outcome at 6 months after surgery (p> 0.18). The NDI and VAS neck and arm pain were improved in both groups from before surgery to 6 months after surgery (p< 0.001). Sixty-one percent of the patients who received SA reported additional use of postoperative physiotherapy. Global outcome improved during the postoperative period in patients who received structured postoperative physiotherapy only (p< 0.01).

Conclusions: No additional benefit of structured postoperative physiotherapy compared to standard postoperative approach was found at 6 months of follow-up based on patientreported measures of pain, neck disability and global outcome. However, many patients with CR perceived a need for additional treatments after surgery; and the results may suggest a benefit from combining surgery with structured postoperative physiotherapy in patients with CR. Moreover, the results confirm that neck-specific exercises are tolerated by patients with CR after surgery.

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American Association of Neurological Surgeons, 2018
Emneord
Cervical radiculopathy; Postoperative physiotherapy; Neck Disability Index; Global outcome
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-122692 (URN)10.3171/2017.5.SPINE16736 (DOI)000418927300001 ()29087809 (PubMedID)
Tilgjengelig fra: 2015-11-16 Laget: 2015-11-16 Sist oppdatert: 2019-05-02bibliografisk kontrollert
Landén Ludvigsson, M., Peolsson, A., Peterson, G., Dedering, Å., Johansson, G. & Bernfort, L. (2017). Cost-effectiveness of neck-specific exercise with or without a behavioral approach versus physical activity prescription in the treatment of chronic whiplash-associated disorders Analyses of a randomized clinical trial. Medicine (Baltimore, Md.), 96(25), Article ID e7274.
Åpne denne publikasjonen i ny fane eller vindu >>Cost-effectiveness of neck-specific exercise with or without a behavioral approach versus physical activity prescription in the treatment of chronic whiplash-associated disorders Analyses of a randomized clinical trial
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2017 (engelsk)Inngår i: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, nr 25, artikkel-id e7274Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Fifty percent of people injured by whiplash still report neck pain after 1 year and costs associated with whiplash associated disorders (WAD) are mostly attributed to health service and sick-leave costs in chronic conditions. With increasing health care expenditures the economic impact of interventions needs to be considered. Objective: To analyze the cost-effectiveness of physiotherapist-led neck-specific exercise without (NSE) or with a behavioral approach (NSEB), or prescription of physical activity (PPA) in chronic WAD, grade 2 to 3. Methods: This is a secondary cost-effectiveness analysis of a multicenter randomized clinical trial of 216 participants with chronic WAD grade 2 to 3. The interventions were physiotherapist-led neck-specific exercise without or with a behavioral approach, or prescription of physical activity for 12 weeks. Incremental cost-effectiveness ratios (ICERs) were determined after 1 year and bootstrapped cost-effectiveness planes and sensitivity analyses of physiotherapy visits were performed. Health care and production loss costs were included and quality-adjusted life years (QALYs) were estimated, using the Euroqol-5D questionnaire. Comparisons with the Short Form-6D, and neck disability index (NDI) were also made. Results: The 1-year follow-up was completed by 170 participants (79%). Both physiotherapist-led groups improved in health related quality of life. The intervention cost alone, per quality-adjusted life year (QALY) gain in the NSE group was US$12,067. A trend for higher QALY gains were observed in the NSEB group but the costs were also higher. The ICERs varied depending on questionnaire used, but the addition of a behavioral approach to neck-specific exercise alone was not cost-effective from a societal perspective (ICER primary outcome $127,800 [95% confidence interval [CI], 37,816-711,302]). The sensitivity analyses confirmed the results. The prescription of physical activity did not result in any QALY gain and the societal costs were not lower. Conclusion: Neck-specific exercise was cost-effective from a societal perspective in the treatment of chronic WAD compared with the other exercise interventions. ICERS varied depending on health-related quality of life questionnaires used, but the addition of a behavioral approach was not cost-effective from a societal perspective. The prescription of physical activity did not result in any QALY gain and was thus not considered a relevant option.

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LIPPINCOTT WILLIAMS & WILKINS, 2017
Emneord
chronic; cost; cost-effectiveness; exercise; physiotherapy; rehabilitation; whiplash
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-139409 (URN)10.1097/MD.0000000000007274 (DOI)000404116900065 ()28640136 (PubMedID)
Merknad

Funding Agencies|Swedish Research Council; Swedish government through the REHSAM foundation; Medical Research Council of Southeast Sweden; County Council of Ostergotland; regional Center for Clinical Research; Centre for Clinical Research Sormland at Uppsala University; Uppsala-Orebro Regional Research Council, Sweden

Tilgjengelig fra: 2017-08-07 Laget: 2017-08-07 Sist oppdatert: 2019-01-24
Organisasjoner
Identifikatorer
ORCID-id: ORCID iD iconorcid.org/0000-0002-6075-4432