liu.seSearch for publications in DiVA
Endre søk
Link to record
Permanent link

Direct link
BETA
Publikasjoner (10 av 18) Visa alla publikasjoner
Ertzgaard, P. (2018). Studies on Spasticity from an Interventional Perspective. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Åpne denne publikasjonen i ny fane eller vindu >>Studies on Spasticity from an Interventional Perspective
2018 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

This thesis focuses on interventional aspects of spasticity, but has a very holistic approach, grounded in the specialty of Rehabilitation medicine. This means capturing the effects of spasticity, on such a complex biological system as the human being, living in a psychosocial context affecting the situation. When evaluating spasticity there are a number of levels of evidence. The first of course, understanding what we mean with spasticity, where there unfortunately is no consensus. The second level is to study if our treatments affect spasticity in a positive direction. The third is to grasp if a decrease in spasticity improve or normalize patient’s movement patterns. The fourth level investigates if improvement in movement patterns improve patient’s ability to perform activities; and the fifth level, comprising whether this intervention improves life satisfaction. Finally, on a societal level, we wish to investigate whether the improvement in life satisfaction or health related quality of life would motivate society to fund the intervention.

Paper I on Goal Attainment Scaling pointed out necessary aspects to consider when using this instrument. This relates, among other things, to the need of learning (“the art of”) goal setting and deciding the purpose of the measurements. Research and clinical use puts different demands on the instrument, for the latter time-efficiency and simplicity to use being most important. For research, it is important to be able to register deterioration, and this can be achieved using the 6-step version.

In paper II, concerning validation of the portable motion system, we showed this system to be valid for short-term measurements and that the use of Exposure Variation Analysis (EVA) seems to be a valuable tool for graphically elucidating different movements. The equipment needs further development in handling long-term measurements (which is effectuated), and norms for normal movements in different activities has to be produced. The discriminative value of EVA needs confirmation in coming studies. For the future, there is the intriguing possibility of long-term measurements in patients’ every-day life, thereby getting objective measures on how our patients use their abilities, thus capturing the difference between what you can do and what you actually do.

The results from paper III demonstrated a large inequality in Sweden regarding the accessibility of BoNT-A treatment for spasticity. We could also show that treatment with BoNT-A is sound from a health-economic perspective, accounting for the uncertainty of data via the sensitivity analysis. For the future, we need to explore if this inequality also exists for other modes of spasticity treatments, e.g. multidisciplinary spasticity treatment and ITB pumps, and in other countries.

In paper IV evaluating multifocal TES, the results could not confirm efficacy with the treatment according to the protocol of the manufacturer. The results have to be interpreted with care, as low compliance and frequent adverse events made deduction not captured in the RCT study. Further studies are needed in a number of areas, e.g. what is the optimal stimulation frequency, what patients can gain from the treatment and how should adjunct treatment be organized.

In this thesis, I have had the privilege to explore different methods of evaluating spasticity interventions from a multimodal perspective as a starting point in an effort to understand more of this intriguing phenomenon. Some of the research questions above are already in the “pipeline” for coming studies; others are to be planned by our research group and others.

sted, utgiver, år, opplag, sider
Linköping: Linköping University Electronic Press, 2018. s. 67
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1644
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-152853 (URN)10.3384/diss.diva-152853 (DOI)9789176852095 (ISBN)
Disputas
2018-11-09, Belladonna, ingång 76, Campus US, Linköping, 13:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2018-11-22 Laget: 2018-11-22 Sist oppdatert: 2019-09-30bibliografisk kontrollert
Skogberg, O., Samuelsson, K., Ertzgaard, P. & Levi, R. (2017). CHANGES IN BODY COMPOSITION AFTER SPASTICITY TREATMENT WITH INTRATHECAL BACLOFEN. Journal of Rehabilitation Medicine, 49(1), 36-39
Åpne denne publikasjonen i ny fane eller vindu >>CHANGES IN BODY COMPOSITION AFTER SPASTICITY TREATMENT WITH INTRATHECAL BACLOFEN
2017 (engelsk)Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, nr 1, s. 36-39Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective: To assess changes in body composition, body weight and resting metabolic rate in patients who received intrathecal baclofen therapy for spasticity. Design: Prospective, longitudinal, quasi-experimental, with a pre/post design. Patients: Twelve patients with spasticity, fulfilling study criteria, and due for pump implantation for intrathecal baclofen therapy, completed the study. Methods: Data were obtained before, 6 months and 12 months after commencement of intrathecal baclofen therapy as regards body composition (by skinfold calliper), body weight, and resting metabolic rate (by resting oxygen consumption). Spasticity was assessed according to the Modified Ashworth Scale (MAS) and Penn Spasm Frequency Scale (PSFS). Results: A reduction in spasticity according to MAS occurred. Mean fat body mass increased and mean lean body mass decreased. Mean body weight showed a non-significant increase and resting metabolic rate a non-significant decrease. Conclusion: This explorative study indicates that unfavourable changes in body composition might occur after intrathecal baclofen therapy. Since obesity and increased fat body mass contribute to an increased cardiovascular risk, these findings may indicate a need for initiation of countermeasures, e.g. increased physical activity and/or dietary measures, in conjunction with intrathecal baclofen therapy. Further studies, including larger study samples and control groups, are needed to corroborate these findings.

sted, utgiver, år, opplag, sider
FOUNDATION REHABILITATION INFORMATION, 2017
Emneord
intrathecal baclofen; body composition; cardiovascular risk; obesity
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-134611 (URN)10.2340/16501977-2169 (DOI)000392498800006 ()28101564 (PubMedID)
Tilgjengelig fra: 2017-02-21 Laget: 2017-02-21 Sist oppdatert: 2018-04-18bibliografisk kontrollert
Ertzgaard, P., Campo, C. & Calabrese, A. (2017). EFFICACY AND SAFETY OF ORAL BACLOFEN IN THE MANAGEMENT OF SPASTICITY: A RATIONALE FOR INTRATHECAL BACLOFEN. Journal of Rehabilitation Medicine, 49(3), 193-203
Åpne denne publikasjonen i ny fane eller vindu >>EFFICACY AND SAFETY OF ORAL BACLOFEN IN THE MANAGEMENT OF SPASTICITY: A RATIONALE FOR INTRATHECAL BACLOFEN
2017 (engelsk)Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, nr 3, s. 193-203Artikkel, forskningsoversikt (Fagfellevurdert) Published
Abstract [en]

Oral baclofen has long been a mainstay in the management of spasticity. This review looks at the clinical evidence for the efficacy and safety of oral baclofen in patients with spasticity of any origin or severity, to determine whether there is a rationale for the use of intrathecal baclofen. Results suggest that oral baclofen may be effective in many patients with spasticity, regardless of the underlying disease or severity, and that it is at least comparable with other antispasmodic agents. However, adverse effects, such as muscle weakness, nausea, somnolence and paraesthesia, are common with oral baclofen, affecting between 25% and 75% of patients, and limiting its usefulness. Intrathecal baclofen may be an effective alternative as the drug is delivered directly into the cerebrospinal fluid, thus bypassing the blood-brain barrier and thereby optimizing the efficacy of baclofen while minimizing drug-related side-effects. Intrathecal baclofen is a viable option in patients who experience intolerable side-effects or who fail to respond to the maximum recommended dose of oral baclofen.

sted, utgiver, år, opplag, sider
FOUNDATION REHABILITATION INFORMATION, 2017
Emneord
intrathecal baclofen; oral baclofen; spasticity
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-136621 (URN)10.2340/16501977-2211 (DOI)000398050300001 ()28233010 (PubMedID)
Merknad

Funding Agencies|Medtronic International Trading Sarl

Tilgjengelig fra: 2017-04-21 Laget: 2017-04-21 Sist oppdatert: 2018-04-18
Ertzgaard, P., Anhammer, M. & Forsmark, A. (2017). Regional disparities in botulinum toxin A (BoNT-A) therapy for spasticity in Sweden: budgetary consequences of closing the estimated treatment gap. Acta Neurologica Scandinavica, 135(3), 366-372
Åpne denne publikasjonen i ny fane eller vindu >>Regional disparities in botulinum toxin A (BoNT-A) therapy for spasticity in Sweden: budgetary consequences of closing the estimated treatment gap
2017 (engelsk)Inngår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 135, nr 3, s. 366-372Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objectives: As no national treatment guidelines for spasticity have been issued in Sweden, different regional treatment practices may potentially occur. This study examines botulinum toxin A (BoNT-A) treatment for spasticity on a regional level in Sweden and presents budgetary consequences of closing the estimated treatment gap. Materials and Methods: Prevalence of spasticity in Sweden was estimated from published data. Regional sales data for BoNT-A were acquired from IMS Health. A set proportion of hospital BoNT-A use was assumed to represent treatment of spasticity. Total intervention cost of BoNT-A treatment was gathered from healthcare regional tariffs, while costs associated with spasticity were derived from publications on multiple sclerosis and stroke. Results: Results show that the regional variation in treatment of spasticity with BoNT-A is large, with approximately every fourth patient being treated in Southern healthcare region compared to every tenth in the Stockholm-Gotland or Western healthcare regions. The incremental cost of filling the reported treatment gap was also assessed and was estimated at around 9.4 million EUR. However, for the incremental cost to be offset by savings in spasticity-related costs, only a small proportion of treatment responders (defined as patients transitioning to a lower severity grade of spasticity) was required (12%). Conclusions: The study revealed apparent regional disparities of BoNT-A treatment for spasticity in Sweden. The results further suggest that the incremental cost of eliminating the treatment gap has a high probability of being offset by savings in direct costs, even at a low proportion of the patients reaching clinical improvement.

sted, utgiver, år, opplag, sider
WILEY, 2017
Emneord
botulinum toxins; costs and cost analysis; muscle spasticity; regional variation
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-136626 (URN)10.1111/ane.12610 (DOI)000397285600014 ()27220381 (PubMedID)
Merknad

Funding Agencies|University of Linkoping

Tilgjengelig fra: 2017-04-21 Laget: 2017-04-21 Sist oppdatert: 2018-11-22
Augutis, M., Ertzgaard, P. & Levi, R. (2017). Sverige bör centralisera den pediatriska ryggmärgsskadevården. Läkartidningen, 114(35-36)
Åpne denne publikasjonen i ny fane eller vindu >>Sverige bör centralisera den pediatriska ryggmärgsskadevården
2017 (svensk)Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, nr 35-36Artikkel i tidsskrift, Editorial material (Annet vitenskapelig) Published
Abstract [en]

[No abstract available]

sted, utgiver, år, opplag, sider
Swedish Medical Association, 2017
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-147498 (URN)2-s2.0-85028655987 (Scopus ID)
Tilgjengelig fra: 2018-04-20 Laget: 2018-04-20 Sist oppdatert: 2018-05-03
Ertzgaard, P., Ohberg, F., Gerdle, B. & Grip, H. (2016). A new way of assessing arm function in activity using kinematic Exposure Variation Analysis and portable inertial sensors - A validity study. Manual Therapy, 21, 241-249
Åpne denne publikasjonen i ny fane eller vindu >>A new way of assessing arm function in activity using kinematic Exposure Variation Analysis and portable inertial sensors - A validity study
2016 (engelsk)Inngår i: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 21, s. 241-249Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Portable motion systems based on inertial motion sensors are promising methods, with the advantage compared to optoelectronic cameras of not being confined to a laboratory setting. A challenge is to develop relevant outcome measures for clinical use. The aim of this study was to characterize elbow and shoulder motion during functional tasks, using portable motion sensors and a modified Exposure Variation Analysis (EVA) and evaluate system accuracy with optoelectronic cameras. Ten healthy volunteers and one participant with sequel after stroke performed standardised functional arm tasks. Motion was registered simultaneously with a custom developed motion sensor system, including gyroscopes and accelerometers, and an optoelectronic camera system. The EVA was applied on elbow and shoulder joints, and angular and angular velocity EVA plots was calculated. The EVA showed characteristic patterns for each arm task in the healthy controls and a distinct difference between the affected and unaffected arm in the participant with sequel after stroke. The accuracy of the portable system was high with a systematic error ranging between -1.2 degrees and 2.0 degrees. The error was direction specific due to a drift component along the gravity vector. Portable motion sensor systems have high potential as clinical tools for evaluation of arm function. EVA effectively illustrates joint angle and joint angle velocity patterns that may capture deficiencies in arm function and movement quality. Next step will be to manage system drift by including magnetometers, to further develop clinically relevant outcome variables and apply this for relevant patient groups. (C) 2015 Elsevier Ltd. All rights reserved.

sted, utgiver, år, opplag, sider
CHURCHILL LIVINGSTONE, 2016
Emneord
Upper extremity motion analysis; Portable motion sensors; Exposure Variation Analysis; Validity
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-127585 (URN)10.1016/j.math.2015.09.004 (DOI)000373615100033 ()26456185 (PubMedID)
Tilgjengelig fra: 2016-05-03 Laget: 2016-05-03 Sist oppdatert: 2018-11-22
Levi, R. & Ertzgaard, P. (2015). Förvärvade ryggmärgsskador (1ed.). In: Jörgen Borg, Kristian Borg, Björn Gerdle, Katharina Stibrant Sunnerhagen (Ed.), Rehabiliteringsmedicin: teori och praktik (pp. 375-388). Lund: Studentlitteratur AB
Åpne denne publikasjonen i ny fane eller vindu >>Förvärvade ryggmärgsskador
2015 (svensk)Inngår i: Rehabiliteringsmedicin: teori och praktik / [ed] Jörgen Borg, Kristian Borg, Björn Gerdle, Katharina Stibrant Sunnerhagen, Lund: Studentlitteratur AB, 2015, 1, s. 375-388Kapittel i bok, del av antologi (Annet vitenskapelig)
Abstract [sv]

Rehabiliteringsmedicinsk kunskap är relevant vid alla sjukdomar och skador som medför långvariga, komplexa funktionshinder och är därför relevant inom stora delar av sjukvården. Inom den rehabiliteringsmedicinska specialiteten handläggs idag främst patienter med skador och sjukdomar i nervsystemet respektive med långvariga smärttillstånd.

Denna reviderade upplaga inleds med en sektion som avhandlar rehabiliteringsmedicinens utveckling och nuvarande plats i sjukvården, centrala rehabiliteringsmedicinska koncept, mät- och arbetsmetoder. Följande sektioner omfattar rehabiliteringsmedicinsk funktionsdiagnostik, läkningsmekanismer och behandling vid långvariga smärttillstånd respektive vid skador och kroniska sjukdomar i nervsystemet. Bokens omfång har ökat något. Några kapitel har fått större utrymme och nya kapitel om beteendestörning och medicinska komplikationer efter svår hjärnskada liksom om anoxisk hjärnskada har tillkommit. Andra kapitel, som inte rör dagens kärnverksamhet inom praktisk rehabiliteringsmedicin, har utgått.

Rehabiliteringsmedicin är avsedd för grundutbildning av läkare, arbetsterapeuter och sjukgymnaster, logopeder samt för läkare under ATtjänstgöring. Den är också lämplig som introduktion i specialistutbildningen i rehabiliteringsmedicin, geriatrik, neurologi och smärtlindring, i vidareutbildningar av olika vårdyrkesgrupper och som referenslitteratur av yrkesverksamma med intresse för rehabiliteringsmedicin.

sted, utgiver, år, opplag, sider
Lund: Studentlitteratur AB, 2015 Opplag: 1
Emneord
Ryggmärgsskador
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-126546 (URN)978-91-4410-196-5 (ISBN)
Tilgjengelig fra: 2016-03-30 Laget: 2016-03-30 Sist oppdatert: 2016-04-19bibliografisk kontrollert
Ward, A. B., Wissel, J., Borg, J., Ertzgaard, P., Herrmann, C., Kulkarni, J., . . . Fulford-Smith, A. (2014). Functional goal achievement in post-stroke spasticity patients: The BOTOX® Economic Spasticity Trial (BEST). Journal of Rehabilitation Medicine, 46(6), 504-513
Åpne denne publikasjonen i ny fane eller vindu >>Functional goal achievement in post-stroke spasticity patients: The BOTOX® Economic Spasticity Trial (BEST)
Vise andre…
2014 (engelsk)Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, nr 6, s. 504-513Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

OBJECTIVE:

Evaluate changes in active and passive function with onabotulinumtoxinA + standard of care within goal-oriented rehabilitation programmes in adults with focal post-stroke spasticity.

METHODS:

Prospective, 24-week double-blind study with an open-label extension. Subjects were randomized to onabotulinumtoxinA + standard of care or placebo + standard of care, at baseline and at 12 weeks, if judged appropriate, with follow-up to 52 weeks. The primary endpoint was the number of patients achieving their principal active functional goal at 24 weeks (or 10 weeks after an optional second injection). Secondary endpoints included achievement of a different active or a passive goal at this timepoint.

RESULTS:

The intent-to-treat population comprised 273 patients. The proportion of patients achieving their principal active functional goal and secondary active functional goal with onabotulinumtoxinA + standard of care was not statistically different from placebo + standard of care. Significantly more patients achieved their secondary passive goal with onabotulinumtoxinA + standard of care (60.0%) vs. placebo + standard of care (38.6%) (odds ratio, 2.46; 95% confidence interval, 1.18-5.14) as well as higher Goal Attainment Scaling levels for upper limb and ankle flexor subgroups.

CONCLUSIONS:

Addition of onabotulinumtoxinA to standard of care as part of goal-oriented rehabilitation in post-stroke spasticity patients significantly increased passive goal achievement and was associated with higher levels of active function.

sted, utgiver, år, opplag, sider
Foundation for Rehabilitation Information, 2014
Emneord
botulinum neurotoxin A; functional change; goal attainment scaling; onabotulinumtoxinA; post-stroke spasticity; rehabilitation
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-109282 (URN)10.2340/16501977-1817 (DOI)000338393300003 ()24715249 (PubMedID)
Tilgjengelig fra: 2014-08-12 Laget: 2014-08-11 Sist oppdatert: 2017-12-05bibliografisk kontrollert
Wissel, J., Ward, A. B., Borg, J., Reuter, I., Kulkarni, J., Ertzgaard, P., . . . Wright, N. (2011). GOAL SETTING PERTAINING TO UPPER LIMB FUNCTION IN POST-STROKE SPASTICITY (PSS) PATIENTS: THE BOTOX (R) ECONOMIC SPASTICITY TRIAL (BEST) in EUROPEAN JOURNAL OF NEUROLOGY, vol 18, issue SI, pp 445-445. In: EUROPEAN JOURNAL OF NEUROLOGY (pp. 445-445). Wiley-Blackwell, 18(SI)
Åpne denne publikasjonen i ny fane eller vindu >>GOAL SETTING PERTAINING TO UPPER LIMB FUNCTION IN POST-STROKE SPASTICITY (PSS) PATIENTS: THE BOTOX (R) ECONOMIC SPASTICITY TRIAL (BEST) in EUROPEAN JOURNAL OF NEUROLOGY, vol 18, issue SI, pp 445-445
Vise andre…
2011 (engelsk)Inngår i: EUROPEAN JOURNAL OF NEUROLOGY, Wiley-Blackwell , 2011, Vol. 18, nr SI, s. 445-445Konferansepaper, Publicerat paper (Fagfellevurdert)
Abstract [en]

n/a

sted, utgiver, år, opplag, sider
Wiley-Blackwell, 2011
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-71087 (URN)000294806601178 ()
Tilgjengelig fra: 2011-09-30 Laget: 2011-09-30 Sist oppdatert: 2013-09-16
Ertzgaard, P., Ward, A. B., Wissel, J. & Borg, J. (2011). PRACTICAL CONSIDERATIONS FOR GOAL ATTAINMENT SCALING DURING REHABILITATION FOLLOWING ACQUIRED BRAIN INJURY. JOURNAL OF REHABILITATION MEDICINE, 43(1), 8-14
Åpne denne publikasjonen i ny fane eller vindu >>PRACTICAL CONSIDERATIONS FOR GOAL ATTAINMENT SCALING DURING REHABILITATION FOLLOWING ACQUIRED BRAIN INJURY
2011 (engelsk)Inngår i: JOURNAL OF REHABILITATION MEDICINE, ISSN 1650-1977, Vol. 43, nr 1, s. 8-14Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective: Goal attainment scaling represents a unique approach to identifying and quantifying individualized, meaningful treatment outcomes, and its use in the rehabilitation medicine setting is increasing. The aim of this paper is to discuss the available literature for goal attainment scaling in patients with acquired brain injury, in terms of its advantages, disadvantages and practical application, including examples of goal setting and scaling.

sted, utgiver, år, opplag, sider
Foundation for Rehabilitation Information, 2011
Emneord
acquired brain injury, goal attainment scaling, rehabilitation
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-66870 (URN)10.2340/16501977-0664 (DOI)000288105200002 ()
Tilgjengelig fra: 2011-03-22 Laget: 2011-03-21 Sist oppdatert: 2018-11-22
Organisasjoner
Identifikatorer
ORCID-id: ORCID iD iconorcid.org/0000-0001-6464-9130