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Öberg, Birgitta
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Lindbäck, Y., Enthoven, P. & Öberg, B. (2019). Patients' experiences of how symptoms are explained and influences on back-related health after pre-surgery physiotherapy: A qualitative study. Musculoskeletal science & practice, 40, 34-39
Open this publication in new window or tab >>Patients' experiences of how symptoms are explained and influences on back-related health after pre-surgery physiotherapy: A qualitative study
2019 (English)In: Musculoskeletal science & practice, ISSN 2468-7812, Vol. 40, p. 34-39Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Since the pre-surgery phase is a new setting for physiotherapy, exploring patients' experiences might contribute to new insights for future development of care in patients with degenerative lumbar spine disorders.

OBJECTIVES: To describe patients' experiences of how symptoms are explained, and their experiences of the influences on back-related health after pre-surgery physiotherapy.

DESIGN: Explorative qualitative design using semi-structured interviews analysed with content analysis.

PARTICIPANTS: Eighteen patients with degenerative lumbar spine disorder scheduled for surgery, participated in pre-surgery physiotherapy.

FINDINGS: Five categories were identified: Influences on symptoms, physical function and sleep; Influences on coping and well-being; Explanations of back-related symptoms and wanting to be well-informed; Influence on social functioning; The ability of the model of care to influence reassurance and prevention.

CONCLUSION: Improvements in back-related health in all the biopsychosocial dimensions emerged. Even those who expressed no symptom improvements, felt better performing exercises than being inactive, and exercises improved their frame of mind, a useful experience in possible low back pain recurrences. Pre-surgery physiotherapy provided reassurance and gave time to reflect on treatments and lifestyle. Despite pre-surgery physiotherapy, back-related symptoms were mainly described in line with a biomedical explanatory model. Those using broader explanations were confident that physiotherapy and self-management could influence their symptoms. Suggesting more emphasis on explanatory models suitable for surgery, pre- and post-surgery physiotherapy and self-management in the professionals' dialogue with patients.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Content analysis, Exercise therapy, Patients' experience, Physiotherapy, Qualitative study, Spinal surgery
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-154072 (URN)10.1016/j.msksp.2019.01.003 (DOI)000460108500005 ()30665046 (PubMedID)2-s2.0-85060104361 (Scopus ID)
Funder
Region Östergötland
Note

This article had the status submitted when included in the thesis with the title "Pre-surgery physiotherapy and pain thresholds in patients with degenerative lumbar spine disorders" and the permanent link http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-150553.

Funding agencies: County Council of Ostergotland, Linkoping, Sweden

Available from: 2019-01-28 Created: 2019-01-28 Last updated: 2019-03-20Bibliographically approved
Dufvenberg, M., Adeyemi, F., Rajendran, I., Öberg, B. & Abbott, A. (2018). Does postural stability differ between adolescents with idiopathic scoliosis and typically developed?: A systematic literature review and meta-analysis. Scoliosis and Spinal Disorders, 13(1), Article ID 19.
Open this publication in new window or tab >>Does postural stability differ between adolescents with idiopathic scoliosis and typically developed?: A systematic literature review and meta-analysis
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2018 (English)In: Scoliosis and Spinal Disorders, ISSN 2397-1789, Vol. 13, no 1, article id 19Article, review/survey (Refereed) Published
Abstract [en]

Background

Postural stability deficits have been proposed to influence the onset and progression of adolescent idiopathic scoliosis (AIS). This study aimed to systematically identify, critically evaluate and meta-analyse studies assessing postural stability during unperturbed stance with posturography in AIS compared to typically developed adolescents.

Methods

Studies from four electronic databases (PubMed, Scopus, CINAHL, PEDro) were searched and case-control methodological quality assessed using a risk-of-bias assessment tool and a posturography methodological quality checklist. Pooled data regarding centre of pressure (COP) parameters such as sway area, Mediolateral (ML) and Anteroposterior (AP) position and range were compared for AIS and typically developed adolescents using Cohen’s d effect size (ES) and homogeneity estimates.

Results

Eighteen studies for quality analysis and 9 of these for meta-analysis were identified from 971 records. Risk-of-bias assessment identified 6 high, 10 moderate and 2 low risk-of-bias studies. The posturography methodological quality checklist identified 4 low, 7 moderate and 7 high-quality studies. Meta-analysis was performed for sway area whereas ML and AP are presented in three different meta-analyses due to divergent measurement units used in the studies: ML position 1 (MLP1), ML position 2 (MLP2) and ML range (MLR); AP position 1 (APP1), AP position 2 (APP2) and AP range (APR). Cohen’s d showed a medium ES difference in sway area 0.65, 95% CI (0.49–0.63), whereas ML showed no (MLP1, MLP2) and large (MLR) ES differences; MLP1 0.15, 95% CI (0.08–0.22); MLP2 0.14, 95% CI (0.08–0.19); and MLR 0.94, 95% CI (0.83–1.04). Cohen’s d for AP showed small ES (APP1) and large ES difference (APP2 and APR); APP1 0.43, 95% CI (0.31–0.54); APP2 0.85, 95% CI (0.72–0.97); and APR 0.98, 95% CI (0.87–1.09). Cochran’s Q and Higgins I2 showed homogeneity between studies.

Conclusions

There is moderate quality evidence for decreased postural stability in AIS measured as COP parameters sway area, ML and AP range with a positional shift posteriorly in the sagittal plane. The findings support studying postural stability in early stage AIS and also prospectively identify cause and effect of the curvature as well as effectiveness of postural control interventions in the prevention of scoliosis progression.

Keywords
Adolescent idiopathic scoliosis, Postural balance, Postural control, Postural stability, Posturography, Force plate, Centre of pressure, Sway area, Anteroposterior, Mediolateral
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-152577 (URN)10.1186/s13013-018-0163-1 (DOI)
Available from: 2018-11-08 Created: 2018-11-08 Last updated: 2019-04-17
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: 2019-04-10Bibliographically approved
Carlfjord, S., Nilsing-Strid, E., Johansson, K., Holmgren, T. & Öberg, B. (2018). Practitioner experiences from the structured implementation of evidence-based practice in primary care physiotherapy: A qualitative study. Journal of Evaluation In Clinical Practice
Open this publication in new window or tab >>Practitioner experiences from the structured implementation of evidence-based practice in primary care physiotherapy: A qualitative study
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2018 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753Article in journal (Refereed) Epub ahead of print
Abstract [en]

Rationale, Aims, and Objectives

To provide best available care, the practitioners in primary health care (PHC) must have adequate knowledge about effective interventions. The implementation of such interventions is challenging. A structured implementation strategy developed by researchers at Linköping University, Sweden, was used for the implementation of an evidence‐based assessment and treatment programme for patients with subacromial pain among physiotherapists in PHC. To further develop strategies for implementation of evidence‐based practices, it was deemed important to study the implementation from the practitioners' perspective. The aim of this study was to explore the practitioners' experiences from the implementation.

Methods

A qualitative design with focus group discussions was applied. The implementation in terms of perceptions of process and outcome was evaluated by focus group discussions with, in total, 16 physiotherapists in the target group. Data were analysed using the method qualitative content analysis.

Results

The components of the strategy were viewed positively, and the applicability and evidence base behind the programme were appreciated. The programme was perceived to be adopted, and the practitioners described a changed behaviour and increased confidence in handling patients with subacromial pain. Both patient‐ and provider‐related challenges to the implementation were mentioned.

Conclusions

The practitioners' experiences from the implementation were mainly positive. A strategy with collaboration between academy and practice, and with education and implementation teams as facilitators, resulted in changes in practice. Critical voices concerned interprofessional collaboration and that the programme was focused explicitly on the shoulder, not including other components of physical function.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018
Keywords
exercise; implementation; physiotherapy; primary health care; qualitative study; shoulder pain
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-155031 (URN)10.1111/jep.13034 (DOI)30246293 (PubMedID)2-s2.0-85053702144 (Scopus ID)
Available from: 2019-03-11 Created: 2019-03-11 Last updated: 2019-06-28Bibliographically approved
Lindbäck, Y., Tropp, H., Enthoven, P., Abbott, A. & Öberg, B. (2018). PREPARE: presurgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial. The spine journal, 18(8), 1347-1355
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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2018 (English)In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 18, no 8, p. 1347-1355Article in journal (Refereed) Published
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, 2018
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)000443585000006 ()29253630 (PubMedID)2-s2.0-85044627865 (Scopus ID)
Available from: 2018-04-27 Created: 2018-04-27 Last updated: 2019-05-01Bibliographically approved
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
Open this publication in new window or tab >>Structured postoperative physiotherapy in patients with cervical radiculopathy: 6-month outcomes of a randomized clinical trial
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2018 (English)In: Journal of Neurosurgery: Spine, ISSN 1547-5654, Vol. 28, no 1, p. 1-9Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
American Association of Neurological Surgeons, 2018
Keywords
Cervical radiculopathy; Postoperative physiotherapy; Neck Disability Index; Global outcome
National Category
Neurology Physiotherapy
Identifiers
urn:nbn:se:liu:diva-122692 (URN)10.3171/2017.5.SPINE16736 (DOI)000418927300001 ()29087809 (PubMedID)
Available from: 2015-11-16 Created: 2015-11-16 Last updated: 2019-05-02Bibliographically 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). Altered somatosensory profile according to quantitative sensory testing in patients with degenerative lumbar spine disorders scheduled for surgery. BMC Musculoskeletal Disorders, 18, Article ID 264.
Open this publication in new window or tab >>Altered somatosensory profile according to quantitative sensory testing in patients with degenerative lumbar spine disorders scheduled for surgery
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2017 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, article id 264Article in journal (Refereed) Published
Abstract [en]

Background: Somatosensory profiling in affected and non-affected body regions can strengthen our insight regarding the underlying pain mechanisms, which can be valuable in treatment decision making and to improve outcomes, in patients with degenerative lumbar spine disorders pre-surgery. The aim was to describe somatosensory profiles in patients with degenerative lumbar spine disorders, to identify the proportion with altered somatosensory profile, and to analyze demographic characteristics, self-reported function, pain, and health pre- and 3 months post-surgery. Methods: In this prospective cohort study in a Spine Clinic, 105 patients scheduled for surgery for spinal stenosis, disc herniation, degenerative disc disease, or spondylolisthesis were consecutively recruited. Exclusion criteria were; indication for acute surgery or previous surgery at the same spinal level or severe grade of pathology. Quantitative sensory testing (QST) and self-reported function, pain, and health was measured pre- and 3 months post-surgery. The somatosensory profile included cold detection threshold, warmth detection threshold, cold pain threshold, heat pain threshold and pressure pain threshold in affected and non-affected body regions. Results: On a group level, the patients somatosensory profiles were within the 95% confidence interval (CI) from normative reference data means. On an individual level, an altered somatosensory profile was defined as having two or more body regions (including a non-affected region) with QST values outside of normal ranges for reference data. The 23 patients (22%) with altered somatosensory profiles, with mostly loss of function, were older (P = 0.031), more often female (P = 0.005), had higher back and leg pain (P = 0.016, 0.020), lower mental health component summary score (SF 36 MCS) (P = 0.004) and larger pain distribution (P = 0.047), compared to others in the cohort. Post-surgery there was a tendency to worse pain, function and health in the group with altered somatosensory profile pre-surgery. Conclusions: On a group level, patients with degenerative lumbar spine disorders scheduled for surgery were within normal range for the QST measurements compared to reference values. On an individual level, an altered somatosensory profile outside of normal range in both affected and non-affected body regions occurred in 22% of patients, which may indicate disturbed somatosensory function. Those patients had mostly loss of sensory function and had worse self-reported outcome pre-surgery, compared to the rest of the cohort. Future prospective studies are needed to further examine whether these dimensions can be useful in predicting post-surgery outcome and guide need of additional treatments.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2017
Keywords
Disc herniation; Spinal stenosis; Spondylolisthesis; Degenerative disc disease; Spine surgery; Quantitative sensory testing; Outcome
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-139285 (URN)10.1186/s12891-017-1581-6 (DOI)000403494900001 ()28623897 (PubMedID)
Note

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

Available from: 2017-07-07 Created: 2017-07-07 Last updated: 2018-08-28
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: 2018-08-27Bibliographically 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
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