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Öberg, Birgitta
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Publications (10 of 123) Show all publications
Abbott, A., Schröder, K., Enthoven, P., Nilsen, P. & Öberg, B. (2018). Effectiveness of implementing a best practice primary healthcare model for low back pain (BetterBack) compared with current routine care in the Swedish context: an internal pilot study informed protocol for an effectiveness-implementation hybrid type 2 trial. BMJ Open, 8(4), Article ID e019906.
Open this publication in new window or tab >>Effectiveness of implementing a best practice primary healthcare model for low back pain (BetterBack) compared with current routine care in the Swedish context: an internal pilot study informed protocol for an effectiveness-implementation hybrid type 2 trial
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 4, article id e019906Article in journal (Refereed) Published
Abstract [en]

Introduction Low back pain (LBP) is a major health problem commonly requiring healthcare. In Sweden, there is a call from healthcare practitioners (HCPs) for the development, implementation and evaluation of a best practice primary healthcare model for LBP.

Aims (1) To improve and understand the mechanisms underlying changes in HCP confidence, attitudes and beliefs for providing best practice coherent primary healthcare for patients with LBP; (2) to improve and understand the mechanisms underlying illness beliefs, self-care enablement, pain, disability and quality of life in patients with LBP; and (3) to evaluate a multifaceted and sustained implementation strategy and the cost-effectiveness of the BetterBack☺ model of care (MOC) for LBP from the perspective of the Swedish primary healthcare context.

Methods This study is an effectiveness-implementation hybrid type 2 trial testing the hypothesised superiority of the BetterBack☺ MOC compared with current routine care. The trial involves simultaneous testing of MOC effects at the HCP, patient and implementation process levels. This involves a prospective cohort study investigating implementation at the HCP level and a patient-blinded, pragmatic, cluster, randomised controlled trial with longitudinal follow-up at 3, 6 and 12 months post baseline for effectiveness at the patient level. A parallel process and economic analysis from a healthcare sector perspective will also be performed. Patients will be allocated to routine care (control group) or the BetterBack☺ MOC (intervention group) according to a stepped cluster dogleg structure with two assessments in routine care. Experimental conditions will be compared and causal mediation analysis investigated. Qualitative HCP and patient experiences of the BetterBack☺ MOC will also be investigated.

Dissemination The findings will be published in peer-reviewed journals and presented at national and international conferences. Further national dissemination and implementation in Sweden and associated national quality register data collection are potential future developments of the project.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-147879 (URN)10.1136/bmjopen-2017-019906 (DOI)000435176700106 ()29691246 (PubMedID)
Note

Funding agencies: Research Council in Southeast Sweden [FORSS<SUP>star</SUP>660371]; Swedish Research Council [2017<SUP>star</SUP>01444]

Available from: 2018-05-18 Created: 2018-05-18 Last updated: 2018-07-23Bibliographically approved
Engquist, M., Löfgren, H., Öberg, B., Holtz, A., Peolsson, A., Söderlund, A., . . . Lind, B. (2017). A 5-to 8-year randomized study on the treatment of cervical radiculopathy: anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone. JOURNAL OF NEUROSURGERY-SPINE, 26(1), 19-27
Open this publication in new window or tab >>A 5-to 8-year randomized study on the treatment of cervical radiculopathy: anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone
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2017 (English)In: JOURNAL OF NEUROSURGERY-SPINE, ISSN 1547-5654, Vol. 26, no 1, p. 19-27Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE The aim of this study was to evaluate the 5- to 8-year outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program as compared with that following the same physiotherapy program alone in patients with cervical radiculopathy. No previous prospective randomized studies with a follow-up of more than 2 years have compared outcomes of surgical versus nonsurgical intervention for cervical radiculopathy. METHODS Fifty-nine patients were randomized to ACDF surgery with postoperative physiotherapy (30 patients) or to structured physiotherapy alone (29 patients). The physiotherapy program included general and specific exercises as well as pain coping strategies. Outcome measures included neck disability (Neck Disability Index [NDI]), neck and arm pain intensity (visual analog scale [VAS]), health state (EQ-5D questionnaire), and a patient global assessment. Patients were followed up for 5-8 years. RESULTS After 5-8 years, the NDI was reduced by a mean score% of 21 (95% CI 14-28) in the surgical group and 11% (95% CI 4%-18%) in the nonsurgical group (p = 0.03). Neck pain was reduced by a mean score of 39 mm (95% CI 26-53 mm) compared with 19 mm (95% CI 7-30 mm; p = 0.01), and arm pain was reduced by a mean score of 33 mm (95% CI 18-49 mm) compared with 19 mm (95% CI 7-32 mm; p = 0.1), respectively. The EQ-5D had a mean respective increase of 0.29 (95% CI 0.13-0.45) compared with 0.14 (95% CI 0.01-0.27; p = 0.12). Ninety-three percent of patients in the surgical group rated their symptoms as "better" or "much better" compared with 62% in the nonsurgical group (p = 0.005). Both treatment groups experienced significant improvement over baseline for all outcome measures. CONCLUSIONS In this prospective randomized study of 5- to 8-year outcomes of surgical versus nonsurgical treatment in patients with cervical radiculopathy, ACDF combined with physiotherapy reduced neck disability and neck pain more effectively than physiotherapy alone. Self-rating by patients as regards treatment outcome was also superior in the surgery group. No significant differences were seen between the 2 patient groups as regards arm pain and health outcome.

Place, publisher, year, edition, pages
AMER ASSOC NEUROLOGICAL SURGEONS, 2017
Keywords
cervical radiculopathy; randomized; surgery; physiotherapy; anterior cervical decompression and fusion; outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-134072 (URN)10.3171/2016.6.SPINE151427 (DOI)000390725200005 ()27564856 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden; Futurum, the Academy for Healthcare, Jonkoping County Council

Available from: 2017-01-26 Created: 2017-01-22 Last updated: 2017-03-22
Lindbäck, Y., Tropp, H., Enthoven, P., Gerdle, B., Abbott, A. & Öberg, B. (2017). Association between pain sensitivity in the hand and outcomes after surgery in patients with lumbar disc herniation or spinal stenosis.. European spine journal, 26(10), 2581-2588
Open this publication in new window or tab >>Association between pain sensitivity in the hand and outcomes after surgery in patients with lumbar disc herniation or spinal stenosis.
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2017 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 26, no 10, p. 2581-2588Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To investigate the association between pain sensitivity in the hand pre-surgery, and patient-reported outcomes (PROs) in function, pain and health pre- and post-surgery in patients with disc herniation or spinal stenosis.

METHODS: This is a prospective cohort study with 82 patients. Associations between pressure-, cold- and heat pain threshold (PPT, CPT, HPT) in the hand pre-surgery and Oswestry, VAS pain, EQ-5D, HADS, and Self-Efficacy Scale, pre- and three months post-surgery; were investigated with linear regression.

RESULTS: Patients with disc herniation more sensitive to pressure pain pre-surgery showed lower function and self-efficacy, and higher anxiety and depression pre-surgery, and lower function, and self-efficacy, and higher pain post-surgery. Results for cold pain were similar. In patients with spinal stenosis few associations with PROs were found and none for HPT and PROs.

CONCLUSIONS: Altered pain response in pressure- and cold pain in the hand, as a sign of widespread pain pre-surgery had associations with higher pain, lower function and self-efficacy post-surgery in patients with disc herniation.

Place, publisher, year, edition, pages
Springer, 2017
Keywords
Disc herniation, Quantitative sensory testing, Spinal stenosis, Spinal surgery, Widespread pain
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-136688 (URN)10.1007/s00586-017-4979-9 (DOI)000412841000013 ()28168345 (PubMedID)2-s2.0-85011710070 (Scopus ID)
Note

Funding agencies: Swedish Research Council [521-2019-3578]; Faculty of Medicine and Health, Linkoping University; County Council of Ostergotland, Linkoping, Sweden

Available from: 2017-05-12 Created: 2017-05-12 Last updated: 2018-05-03Bibliographically approved
Bernhardsson, S., Larsson, M. E. H., Johansson, K. & Öberg, B. (2017). “In the physio we trust”: A qualitative study on patients’ preferences for physiotherapy. Physiotherapy Theory and Practice, 33(7), 535-549
Open this publication in new window or tab >>“In the physio we trust”: A qualitative study on patients’ preferences for physiotherapy
2017 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, no 7, p. 535-549Article in journal (Refereed) Published
Abstract [en]

Background: Patient preferences are suggested to be incorporated in clinical decision making, but little is known about preferences for physiotherapy treatment of patients with musculoskeletal pain. This study aimed to explore preferences regarding physiotherapy treatment and participation in decision making, of patients who seek primary care physiotherapy for pain in the back, neck or shoulder.

Methods: A qualitative study set in an urban physiotherapy clinic in Sweden. Individual, semi-structured interviews were conducted with a purposeful sample of 20 individuals who sought physiotherapy for back, neck or shoulder pain. The interviews were digitally recorded, transcribed verbatim and analysed with qualitative content analysis.

Results: An overarching theme, embracing six categories, was conceptualised: Trust in the physiotherapist fosters active engagement in therapy. Most informants preferred active treatment strategies such as exercise and advice for self-management, allowing them to actively engage in their therapy. Some preferred passive treatments, primarily acupuncture (because they had heard that it works well) or massage therapy (because “it feels good”). Preferences were consistent across the three musculoskeletal conditions. Key influencers on treatment preferences were previous experiences and media. All informants wanted to be involved in the clinical decision making, but to varying extents. Some expressed a preference for an active role and wanting to share decisions while others were content with a passive role. Expectations for a professional management were reflected in trust and confidence in physiotherapists’ skills and competence, expectations for good outcomes, and believing that treatment methods should be evidence-based.

Conclusions: Trust in the physiotherapist’s ability to choose appropriate treatment and confidence in the professional skills and competence of physiotherapists, as well as a desire to participate in clinical decision making, fostered active engagement in physiotherapy. Preferences for particular interventions were subordinate, although a preference for active treatments dominated. Preferences for active engagement need to be embraced by the physiotherapist. Awareness of these preferences can facilitate clinical decision making and contribute to increased quality of care for patients with musculoskeletal pain.

Place, publisher, year, edition, pages
Taylor & Francis, 2017
Keywords
Physical therapy, patient preferences, shared decision making, primary care, guidelines
National Category
Physiotherapy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-122556 (URN)10.1080/09593985.2017.1328720 (DOI)000403937700003 ()
Note

Funding agencies: Local Research and Development Board for Gothenburg; Local Research and Development Board for Sodra Bohuslan

Previous status of this publication was Manuscript

Available from: 2015-11-09 Created: 2015-11-09 Last updated: 2017-07-07Bibliographically approved
Wibault, J., Öberg, B., Dedring, Å., Löfgren, H., Zsigmond, P., Persson, L., . . . Peolsson, A. (2017). Neck-related physical function, self-efficacy and coping strategies in patients with cervical radiculopathy: a randomized clinical trial of postoperative physiotherapy. Journal of Manipulative and Physiological Therapeutics, 40(5), 330-339
Open this publication in new window or tab >>Neck-related physical function, self-efficacy and coping strategies in patients with cervical radiculopathy: a randomized clinical trial of postoperative physiotherapy
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2017 (English)In: Journal of Manipulative and Physiological Therapeutics, ISSN 0161-4754, E-ISSN 1532-6586, Vol. 40, no 5, p. 330-339Article in journal (Refereed) Published
Abstract [en]

Objective: To compare postoperative rehabilitation with structured physiotherapy to standard approach in patients with cervical radiculopathy (CR) based on measures of neck-related physical function, self-efficacy and coping strategies at 6 months follow-up.

Design: A randomized clinical trial of postoperative physiotherapy in patients with CR.

Subjects: Patients (n= 202) with persistent CR who were scheduled for surgery.

Methods: Patients were preoperatively randomized to receive structured postoperative physiotherapy (SPT, n=101) or standard postoperative approach (SA, n=101). SPT combined neck-specific exercises with a behavioral approach. Baseline, 3-month, and 6-month evaluations included questionnaires and clinical examinations. Neck muscle endurance, active cervical range of motion, self-efficacy, pain catastrophizing (CSQ_CAT), perceived control over pain, and ability to decrease pain were analyzed for between-group differences using complete case and per-protocol approaches.

Results: No between-group difference was reported at the 6-month follow-up (p = 0.05 to 0.99), but all outcomes had improved from baseline (p<0.001). Patients in the SPT group with ≥50% attendance to treatment sessions showed larger improvements in CSQ_CAT (p= 0.04) during the rehabilitation period from 3 to 6 months after surgery compared to the patients who received SA.

Conclusion: No between-group difference in outcomes was found at 6 months after surgery based on measures of neck-related physical function, self-efficacy and coping strategies. However, the results confirm that neck-specific exercises are tolerated by patients with CR after surgery, and that there may be a benefit from combining surgery with structured postoperative physiotherapy in patients with CR.

Keywords
Cervical radiculopathy, Postoperative physiotherapy, Randomized clinical trial, Physical function, Coping strategies
National Category
Neurology Physiotherapy
Identifiers
urn:nbn:se:liu:diva-122694 (URN)10.1016/j.jmpt.2017.02.012 (DOI)000404024700003 ()
Note

Funding agencies: Swedish Research Council; Swedish Society of Medicine; Medical Research Council of Southeast Sweden; Region Ostergotland; Lions; Futurum (Academy of Health and Care, Region Jonkoping County)

Available from: 2015-11-16 Created: 2015-11-16 Last updated: 2017-08-21Bibliographically approved
Lindbäck, Y., Tropp, H., Enthoven, P., Abbott, A. & Öberg, B. (2017). PREPARE: presurgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial. The spine journal
Open this publication in new window or tab >>PREPARE: presurgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial
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2017 (English)In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background Context

Surgery because of disc herniation or spinal stenosis results mostly in large improvement in the short-term, but mild to moderate improvements for pain and disability at long-term follow-up. Prehabilitation has been defined as augmenting functional capacity before surgery, which may have beneficial effect on outcome after surgery.

Purpose

The aim was to study if presurgery physiotherapy improves function, pain, and health in patients with degenerative lumbar spine disorder scheduled for surgery.

Study Design

A single-blinded, two-arm, randomized controlled trial (RCT).

Patient Sample

A total of 197 patients were consecutively included at a spine clinic. The inclusion criteria were patients scheduled for surgery because of disc herniation, spinal stenosis, spondylolisthesis, or degenerative disc disease (DDD), 25–80 years of age.

Outcome Measures

Primary outcome was Oswestry Disability Index (ODI). Secondary outcomes were pain intensity, anxiety, depression, self-efficacy, fear avoidance, physical activity, and treatment effect.

Methods

Patients were randomized to either presurgery physiotherapy or standardized information, with follow-up after the presurgery intervention as well as 3 and 12 months post surgery. The study was funded by regional research funds for US$77,342. No conflict of interest is declared.

Results

The presurgery physiotherapy group had better ODI, visual analog scale (VAS) back pain, EuroQol-5D (EQ-5D), EQ-VAS, Fear Avoidance Belief Questionnaire-Physical Activity (FABQ-PA), Self-Efficacy Scale (SES), and Hospital Anxiety and Depression Scale (HADS) depression scores and activity level compared with the waiting-list group after the presurgery intervention. The improvements were small, but larger than the study-specific minimal clinical important change (MCIC) in VAS back and leg pain, EQ-5D, and FABQ-PA, and almost in line with MCIC in ODI and Physical Component Summary (PCS) in the physiotherapy group. Post surgery, the only difference between the groups was higher activity level in the physiotherapy group compared with the waiting-list group.

Conclusions

Presurgery physiotherapy decreases pain, risk of avoidance behavior, and worsening of psychological well-being, and improves quality of life and physical activity levels before surgery compared with waiting-list controls. These results were maintained only for activity levelspost surgery. Still, presurgery selection, content, dosage of exercises, and importance of being active in a presurgery physiotherapy intervention is of interest to study further to improve long-term outcome.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Disc herniation, Function, Physiotherapy, Spinal stenosis, Stratification, Surgery
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-147620 (URN)10.1016/j.spinee.2017.12.009 (DOI)29253630 (PubMedID)2-s2.0-85044627865 (Scopus ID)
Available from: 2018-04-27 Created: 2018-04-27 Last updated: 2018-05-08Bibliographically approved
Lindbäck, Y., Tropp, H., Enthoven, P., Abbott, A. & Öberg, B. (2016). PREPARE: Pre-surgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial protocol. BMC Musculoskeletal Disorders, 17(270)
Open this publication in new window or tab >>PREPARE: Pre-surgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial protocol
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2016 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, no 270Article in journal (Refereed) Published
Abstract [en]

Background: Current guidelines for the management of patients with specific low back pain pathology suggest non-surgical intervention as first-line treatment, but there is insufficient evidence to make recommendations of the content in the non-surgical intervention. Opinions regarding the dose of non-surgical intervention that should be trialled prior to decision making about surgery intervention vary. The aim of the present study is to investigate if physiotherapy administrated before surgery improves function, pain and health in patients with degenerative lumbar spine disorder scheduled for surgery. The patients are followed over two years. A secondary aim is to study what factors predict short and long term outcomes. Methods: This study is a single blinded, 2-arm, randomized controlled trial with follow-up after the completion of pre-surgery intervention as well as 3, 12 and 24 months post-surgery. The study will recruit men and women, 25 to 80 years of age, scheduled for surgery due to; disc herniation, spinal stenosis, spondylolisthesis or degenerative disc disease. A total of 202 patients will be randomly allocated to a pre-surgery physiotherapy intervention or a waiting list group for 9 weeks. The waiting-list group will receive standardized information about surgery, post-surgical rehabilitation and advice to stay active. The pre-surgery physiotherapy group will receive physiotherapy 2 times per week, consisting of a stratified classification treatment, based on assessment findings. One of the following treatments will be selected; a) Specific exercises and mobilization, b) Motor control exercises or c) Traction. The pre-surgery physiotherapy group will also be prescribed a tailor-made general supervised exercise program. The physiotherapist will use a behavioral approach aimed at reducing patient fear avoidance and increasing activity levels. They will also receive standardized information about surgery, post-surgical rehabilitation and advice to stay active. Primary outcome measure is Oswestry Disability Index. Secondary outcome measures are the visual analogue scale for back and leg pain, pain drawing, health related quality of life, Hospital anxiety and depression scale, Fear avoidance beliefs questionnaire, Self-efficacy scale and Work Ability Index. Discussion: The study findings will help improve the treatment of patients with degenerative lumbar spine disorder scheduled for surgery.

Place, publisher, year, edition, pages
BioMed Central, 2016
Keywords
Low back pain; Physiotherapy; Stratification; Surgery; Function
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-130385 (URN)10.1186/s12891-016-1126-4 (DOI)000379714500001 ()27400960 (PubMedID)2-s2.0-84979702278 (Scopus ID)
Note

Funding Agencies|Faculty of Medicine and Health, Linkoping University; NHS FoU fond, County Council of Ostergotland

Available from: 2016-08-15 Created: 2016-08-05 Last updated: 2017-11-28Bibliographically approved
Sjödahl, J., Gutke, A., Ghaffari, G., Strömberg, T. & Öberg, B. (2016). Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the Active Straight Leg Raise in women with and without pelvic girdle pain: An experimental study. Clinical Biomechanics, 35, 49-55
Open this publication in new window or tab >>Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the Active Straight Leg Raise in women with and without pelvic girdle pain: An experimental study
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2016 (English)In: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 35, p. 49-55Article in journal (Refereed) Published
Abstract [en]

Background: The relationship between activation of the stabilizing muscles of the lumbopelvic region during the Active Straight Leg Raise test and pelvic girdle pain remains unknown. Therefore, the aim was to examine automatic contractions in relation to pre-activation in the muscles of the pelvic floor and the lower lateral abdominal wall during leg lifts, performed as the Active Straight Leg Raise test, in women with and without persistent postpartum pelvic girdle pain. Methods: Sixteen women with pelvic girdle pain and eleven pain-free women performed contralateral and ipsilateral leg lifts, while surface electromyographic activity was recorded from the pelvic floor and unilaterally from the lower lateral abdominal wall. As participants performed leg lifts onset time was calculated as the time from increased muscle activity to leg lift initiation. Findings: No significant differences were observed between the groups during the contralateral leg lift. During the subsequent ipsilateral leg lift, pre-activation in the pelvic floor muscles was observed in 36% of women with pelvic girdle pain and in 91% of pain-free women (P = 0.01). Compared to pain-free women, women with pelvic girdle pain also showed significantly later onset time in both the pelvic floor muscles (P = 0.01) and the muscles of the lower lateral abdominal wall (P amp;lt; 0.01). Interpretation: We suggest that disturbed motor activation patterns influence womens ability to stabilize the pelvis during leg lifts. This could be linked to provocation of pain during repeated movements. (C) 2016 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2016
Keywords
Chronic pelvic pain; Electromyography; Joint instability; Low back pain; Pelvic pain; Post-partum
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-130297 (URN)10.1016/j.clinbiomech.2016.04.007 (DOI)000378366900008 ()27128765 (PubMedID)
Note

Funding Agencies|Swedish Research Council [521-2019-3578]; Linkoping University, Sweden

Available from: 2016-07-31 Created: 2016-07-28 Last updated: 2017-05-07Bibliographically approved
Bernhardsson, S., Öberg, B., Johansson, K., Nilsen, P. & Larsson, M. E. H. (2015). Clinical practice in line with evidence?: A survey among primary care physiotherapists in western Sweden. Journal of Evaluation In Clinical Practice, 21(6), 1169-1177
Open this publication in new window or tab >>Clinical practice in line with evidence?: A survey among primary care physiotherapists in western Sweden
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2015 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, no 6, p. 1169-1177Article in journal (Refereed) Published
Abstract [en]

Rationale, aims and objectives

Evidence-based practice is becoming increasingly important in primary care physiotherapy. Clinical practice needs to reflect current best evidence and be concordant with evidence-based clinical guidelines. There is limited knowledge about therapeutic interventions used in primary care physiotherapy in Sweden. The objectives were to examine preferred treatment interventions reported by publicly employed physiotherapists in primary care for three common musculoskeletal disorders (low back pain, neck pain and subacromial pain), the extent to which these interventions were supported by evidence, and associations with demographic variables.

Methods

419 physiotherapists in primary care in western Sweden were surveyed using a validated web-based questionnaire.

Results

The survey was completed by 271 respondents (65%). Median number of interventions reported was 7 (range 1–16). The most common treatment interventions across the three conditions were advice on posture (reported by 82–94%), advice to stay active (86–92%), and different types of exercise (65–92%). Most of these interventions were supported by evidence. However, interventions with insufficient evidence, such as advice on posture, TENS and aquatic exercise, were also used by 29–96%. Modalities such as laser therapy and ultrasound were sparingly used (<5%), which is in line with evidence. For neck pain, use of evidence-based interventions was associated with gender and for subacromial pain, with work experience.

Conclusions

Advice and exercise therapy were the interventions most frequently reported across the three diagnoses, illustrating an active treatment strategy. While most reported interventions are supported by evidence, interventions with unclear or no evidence of effect were also used to a high extent.

Place, publisher, year, edition, pages
John Wiley & Sons, 2015
Keywords
clinical practice, evidence, evidence-based practice, interventions, physical therapy, treatment
National Category
Health Care Service and Management, Health Policy and Services and Health Economy General Practice
Identifiers
urn:nbn:se:liu:diva-122555 (URN)10.1111/jep.12380 (DOI)000371414500032 ()25988993 (PubMedID)
Note

Funding agencies: local Research and Development Board for Gothenburg and Sodra Bohuslan; Linkoping University

Available from: 2015-11-09 Created: 2015-11-09 Last updated: 2018-01-10Bibliographically approved
Persson, J., Bernfort, L., Wåhlin, C., Öberg, B. & Ekberg, K. (2015). Costs of production loss and primary health care interventions for return-to-work of sick-listed workers in Sweden. Disability and Rehabilitation, 37(9), 771-776
Open this publication in new window or tab >>Costs of production loss and primary health care interventions for return-to-work of sick-listed workers in Sweden
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2015 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 9, p. 771-776Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to investigate, from the perspective of society, the costs of sick leave and rehabilitation of recently sick-listed workers with musculoskeletal disorders (MSD) or mental disorders (MD). Methods: In a prospective cohort study, 812 sick-listed workers with MSD (518) or MD (294) were included. Data on consumption of health care and production loss were collected over six months from an administrative casebook system of the health care provider. Production loss was estimated based on the number of sick-leave days. Societal costs were based on the human capital approach. Results: The mean costs of production loss per person were EUR 5978 (MSD) and EUR 6381 (MD). Health care interventions accounted for 9.3% (MSD) and 8.2% (MD) of the costs of production loss. Corresponding figures for rehabilitation activities were 3.7% (MSD) and 3.1% (MD). Health care interventions were received by about 95% in both diagnostic groups. For nearly half of the cohort, no rehabilitation intervention at all was provided. Conclusions: Costs associated with sick leave were dominated by production loss. Resources invested in rehabilitation were small. By increasing investment in early rehabilitation, costs to society and the individual might be reduced. Implications for Rehabilitation Resources invested in rehabilitation for sick-listed with musculoskeletal and mental disorders in Sweden are very small in comparison with the costs of production loss. For policy makers, there may be much to gain through investments into improved rehabilitation processes for return to work. Health care professionals need to develop rehabilitative activities aiming for return to work, rather than symptoms treatment only.

Keywords
Economic analysis; Sweden; mental disorders; musculoskeletal disorders; rehabilitation; sick leave; societal costs
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-114181 (URN)10.3109/09638288.2014.941021 (DOI)000352139300006 ()25055999 (PubMedID)
Available from: 2015-02-11 Created: 2015-02-11 Last updated: 2018-01-11
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