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Johansson, Kajsa
Publications (10 of 31) Show all publications
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
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
Hultenheim Klintberg, I., Cools, A. M., Holmgren, T., Holzhausen, A.-C. G., Johansson, K., Maenhout, A. G., . . . Ginn, K. (2015). Consensus for physiotherapy for shoulder pain. International Orthopaedics, 39(4), 715-720
Open this publication in new window or tab >>Consensus for physiotherapy for shoulder pain
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2015 (English)In: International Orthopaedics, ISSN 0341-2695, E-ISSN 1432-5195, Vol. 39, no 4, p. 715-720Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Shoulder pain is a common disorder. Despite growing evidence of the importance of physiotherapy, in particular active exercise therapy, little data is available to guide treatment. The aim of this project was to contribute to the development of an internationally accepted assessment and treatment algorithm for patients with shoulder pain.

METHODS: Nine physiotherapists with expertise in the treatment of shoulder dysfunction met in Sweden 2012 to begin the process of developing a treatment algorithm. A questionnaire was completed prior to the meeting to guide discussions. Virtual conferences were thereafter the platform to reach consensus.

RESULTS: Consensus was achieved on a clinical reasoning algorithm to guide the assessment and treatment for patients presenting with local shoulder pain, without significant passive range of motion deficits and no symptoms or signs of instability. The algorithm emphasises that physiotherapy treatment decisions should be based on physical assessment findings and not structural pathology, that active exercises should be the primary treatment approach, and that regular re-assessment is performed to ensure that all clinical features contributing to the presenting shoulder pain are addressed. Consensus was also achieved on a set of guiding principles for implementing exercise therapy for shoulder pain, namely, a limited number of exercises, performed with appropriate scapulo-humeral coordination and humeral head alignment, in a graduated manner without provoking the presenting shoulder pain.

CONCLUSION: The assessment and treatment algorithm presented could contribute to a more formal, extensive process aimed at achieving international agreement on an algorithm to guide physiotherapy treatment for shoulder pain.

Place, publisher, year, edition, pages
Springer, 2015
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-115925 (URN)10.1007/s00264-014-2639-9 (DOI)000351516200014 ()25548127 (PubMedID)
Available from: 2015-03-24 Created: 2015-03-24 Last updated: 2017-12-04
Björnsson Hallgren, H., Holmgren, T., Öberg, B., Johansson, K. & Adolfsson, L. (2014). A specific exercise strategy reduced the need for surgery in subacromial pain patients. British Journal of Sports Medicine, 48(19), 1431-1436
Open this publication in new window or tab >>A specific exercise strategy reduced the need for surgery in subacromial pain patients
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2014 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, no 19, p. 1431-1436Article in journal (Refereed) Published
Abstract [en]

Background and purpose A programme based on eccentric exercises for treating subacromial pain was in a previous study found effective at 3-month follow-up. The purposes of the present study were to investigate whether the results were maintained after 1 year and whether the baseline Constant-Murley score, rotator cuff status and radiological findings influenced the outcome. Patients and methods 97 patients on the waiting list for arthroscopic subacromial decompression had been randomised to a specific exercise programme or unspecific exercises (controls). After 3 months of exercises, the patients were asked whether they still wanted surgery and this option was available until a 1-year follow-up. 1 year after inclusion or 1 year after surgery, the number of patients who decided to have surgery in each group was compared. The choice of surgery was related to the baseline Constant-Murley score, ultrasound and radiographs taken at inclusion. Results All patients had improved significantly (pless than0.0001) in the Constant-Murley score at the 1-year follow-up. Significantly more patients in the control group decided to have surgery (63%) than those in the specific exercise group (24%; pless than0.0001). Patients who decided to have surgery had a significantly lower baseline Constant-Murley score and more often a full-thickness tear. Patients with partial tears did not differ from those with intact tendons. Interpretation The positive short-term results of specific exercises were maintained after 1 year, and this exercise strategy reduces the need for surgery. Full-thickness tear and a low baseline Constant-Murley score appear to be a predictive marker for a less good outcome.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2014
Keywords
Shoulder injuries, Physiotherapy, Eccentric exercise, Tendon, Ultrasounds
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-111441 (URN)10.1136/bjsports-2013-093233 (DOI)000341947200009 ()24970843 (PubMedID)
Note

Funding Agencies|Linkoping University Hospital

Available from: 2014-10-21 Created: 2014-10-17 Last updated: 2017-12-05
Bernhardsson, S., Johansson, K., Nilsen, P., Öberg, B. & Larsson, M. E. H. (2014). Determinants of Guideline Use in Primary Care Physical Therapy: A Cross-Sectional Survey of Attitudes, Knowledge, and Behavior. Physical Therapy, 94(3), 343-354
Open this publication in new window or tab >>Determinants of Guideline Use in Primary Care Physical Therapy: A Cross-Sectional Survey of Attitudes, Knowledge, and Behavior
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2014 (English)In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 94, no 3, p. 343-354Article in journal (Refereed) Published
Abstract [en]

Background. Understanding of attitudes, knowledge, and behavior related to evidence-based practice (ESP) and use of evidence-based clinical practice guidelines in primary care physical therapy is limited. Objectives. The objectives of this study were: (1) to investigate self-reported attitudes, knowledge, behavior, prerequisites, and barriers related to EBP and guideline use among physical therapists in primary care and (2) to explore associations of self-reported use of guidelines with these social cognitive factors along with demographic and workplace characteristics. Design. This was a cross-sectional survey. Methods. A web-based survey of 419 physical therapists in primary care in western Sweden was performed. Multiple logistic regression analysis was performed to examine factors associated with guideline use. Results. The response rate was 64.7%. Most respondents had positive attitudes toward EBP and guidelines: 90% considered EBP necessary, and 96% considered guidelines important. Approximately two thirds reported confidence in finding and using evidence. One third reported being aware of guidelines. Thirteen percent knew where to find guidelines, and only 9% reported having easy access to guidelines. Fewer than half reported using guidelines frequently. The most important barriers to using guidelines were lack of time, poor availability, and limited access to guidelines. Young age and brief work experience were associated with positive attitudes toward EBP. A postgraduate degree was associated with higher application of EBP. Positive attitudes, awareness of guidelines, considering guidelines to facilitate practice, and knowing how to integrate patient preferences with guideline use were associated with frequent use of guidelines. Limitations. Data were self-reported, which may have increased the risk of social.desirability bias. Conclusions. Use of guidelines was not as frequent as could be expected in view of the positive attitudes toward EBP and guidelines among physical therapists. Awareness of and perceived access to guidelines were limited. The identified determinants can be addressed when developing guideline implementation strategies.

Place, publisher, year, edition, pages
American Physical Therapy Association (APTA), 2014
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-106033 (URN)10.2522/ptj.20130147 (DOI)000332351300008 ()
Available from: 2014-04-17 Created: 2014-04-17 Last updated: 2017-12-05
Bernhardsson, S., Larsson, M., Eggertsen, R., Fagevik Olsén, M., Johansson, K., Nilsen, P., . . . Öberg, B. (2014). Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial.. BMC Health Services Research, 14(1), 105
Open this publication in new window or tab >>Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial.
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2014 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, no 1, p. 105-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence-based practice (EBP). There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy. The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden.

METHODS:

An implementation strategy based on theory and current evidence was developed. A tailored, multi-component implementation intervention, addressing earlier identified determinants, was carried out in three areas comprising 28 physical therapy practices including 277 physical therapists (PTs) (intervention group). In two adjacent areas, 171 PTs at 32 practices received no intervention (control group). The core component of the intervention was an implementation seminar with group discussions. Among other components were a website and email reminders. Data were collected at baseline and follow-up with a web-based questionnaire. Primary outcomes were the self-reported awareness of, knowledge of, access to, and use of guidelines. Secondary outcomes were self-reported attitudes toward EBP and guidelines. Analyses were performed using Pearson's χ2 test and approximative z-test.

RESULTS:

168 PTs (60.6%) in the intervention group and 88 PTs (51.5%) in the control group responded to the follow-up questionnaire. 186/277 PTs (67.1%) participated in the implementation seminars, of which 97 (52.2%) responded. The proportions of PTs reporting awareness of (absolute difference in change 20.6%, p = 0.023), knowledge where to find (20.4%, p = 0.007), access to (21.7%, p < 0.001), and frequent use of (9.5%, NS) guidelines increased more in the intervention group than in the control group. The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2% (p = 0.043) higher than the proportion in the control group. A higher proportion considered EBP helpful in decision making (p = 0.018). There were no other significant differences in secondary outcomes.

CONCLUSIONS:

A tailored, theory- and evidence-informed, multi-component intervention for the implementation of clinical practice guidelines had a modest, positive effect on awareness of, knowledge of, access to, and use of guidelines, among PTs in primary care in western Sweden. In general, attitudes to EBP and guidelines were not affected.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keywords
Implementation; Physical therapy; Evidence-based practice; Practice guidelines
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-105610 (URN)10.1186/1472-6963-14-105 (DOI)000333535400002 ()24589291 (PubMedID)
Available from: 2014-03-28 Created: 2014-03-28 Last updated: 2017-12-05
Holmgren, T., Öberg, B., Adolfsson, L. & Johansson, K. (2014). Minimal important changes in the Constant Murley score in patients with subacromial pain. Journal of shoulder and elbow surgery, 23(8), 1083-1090
Open this publication in new window or tab >>Minimal important changes in the Constant Murley score in patients with subacromial pain
2014 (English)In: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 23, no 8, p. 1083-1090Article in journal (Refereed) Published
Abstract [en]

Objective: The purpose of this study was to determine the minimal important change (MIC) of improvement in the Constant‐Murley score (CM score) in patients with longstanding subacromial pain and in subgroups of patients with subacromial pain with and without rotator cuff ruptures.

Method: The MIC was estimated by using the visual anchor‐based MIC distribution method, which integrates an anchor‐ and distribution‐based approach: the optimal cut‐off point of the receiver operator characteristic curve (MIC ROC) and the 95% limit cut‐ off point (MIC 95%limit). The study population consisted of 93 patients included in a randomized clinical trial evaluating the effect of a specific exercise strategy in patients with longstanding subacromial pain.

Results: The MIC ROC was found at a mean change of 17 points in the CM score. The MIC 95% limit was found at a mean change of 24 points. In the subgroup analysis the MIC ROC was found at a mean change of 19 points and the MIC 95% limit at 18 points in patients with an intact rotator cuff. In patients with rotator cuff ruptures the MIC ROC was found at a mean change of 15 points and the MIC 95% limit at 30 points.

Conclusion: The CM score is able to detect the minimal important change in individual patients with long‐standing subacromial pain when the rotator cuff is intact. In all patients with longstanding subacromial pain, the MIC value was dependent on the subgroup as well as the choice of statistical analysis. The estimated MIC values could be used as an indication for relevant changes in the CM score in clinical practice and guide the clinician in how to interpret the results of specific treatments for patients with longstanding subacromial pain.

Place, publisher, year, edition, pages
Mosby-Elsevier, 2014
National Category
Health Sciences Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-90020 (URN)10.1016/j.jse.2014.01.014 (DOI)000341135000006 ()
Available from: 2013-03-15 Created: 2013-03-15 Last updated: 2017-12-06
Holmgren, T., Björnsson Hallgren, H., Öberg, B., Adolfsson, L. & Johansson, K. (2014). Republished research: Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. British Journal of Sports Medicine, 48(19), 1456-1457
Open this publication in new window or tab >>Republished research: Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study
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2014 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, no 19, p. 1456-1457Article in journal, Editorial material (Other academic) Published
Abstract [en]

STUDY QUESTION Can a specific exercise strategy improve shoulder function and pain in patients with subacromial impingement syndrome, thereby decreasing the need for arthroscopic subacromial decompression? SUMMARY ANSWER Compared with a control exercise group, patients in the specific exercise group had significantly greater improvements in shoulder function and pain and fewer patients needed surgery at the three month assessment. WHAT IS KNOWN AND WHAT THIS PAPER ADDS Different exercise programmes are used as first line treatment in patients with subacromial impingement syndrome, but conclusive evidence to support the efficacy for these programmes is lacking. This specific exercise strategy proved effective in improving shoulder function and pain in patients in whom earlier conservative treatment had failed.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2014
National Category
Clinical Medicine Health Sciences
Identifiers
urn:nbn:se:liu:diva-111443 (URN)10.1136/bjsports-2014-e787rep (DOI)000341947200013 ()25213604 (PubMedID)
Note

Republished research from the BMJ

Available from: 2014-10-21 Created: 2014-10-17 Last updated: 2017-12-05
Holmgren, T., Björnsson Hallgren, H., Öberg, B., Adolfsson, L. & Johansson, K. (2013). Republished research: Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. British Journal of Sports Medicine, 47(14), 908-908
Open this publication in new window or tab >>Republished research: Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study
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2013 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 14, p. 908-908Article in journal, Editorial material (Other academic) Published
Abstract [en]

Study question

Can a specific exercise strategy improve shoulder function and pain in patients with subacromial impingement syndrome, thereby decreasing the need for arthroscopic subacromial decompression?

Summary answer

Compared with a control exercise group, patients in the specific exercise group had significantly greater improvements in shoulder function and pain and fewer patients needed surgery at the three month assessment.

What is known and what this paper adds

Different exercise programmes are used as first line treatment in patients with subacromial impingement syndrome, but conclusive evidence to support the efficacy for these programmes is lacking. This specific exercise strategy proved effective in improving shoulder function and pain in patients in whom earlier conservative treatment had failed.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-97432 (URN)10.1136/bjsports-2012-e787rep (DOI)000323442500008 ()
Note

Republished research from the BMJ

Available from: 2013-09-12 Created: 2013-09-12 Last updated: 2017-12-06Bibliographically approved
Holmgren, T., Björnsson Hallgren, H., Öberg, B., Adolfsson, L. & Johansson, K. (2012). Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. BMJ. British Medical Journal (International Ed.), 344, e787
Open this publication in new window or tab >>Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study
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2012 (English)In: BMJ. British Medical Journal (International Ed.), ISSN 0959-8146, E-ISSN 0959-535X, Vol. 344, p. e787-Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate if a specific exercise strategy, targeting the rotator cuff and scapula stabilisers, improves shoulder function and pain more than unspecific exercises in patients with subacromial impingement syndrome, thereby decreasing the need for arthroscopic subacromial decompression.

DESIGN: Randomised, participant and single assessor blinded, controlled study.

SETTING: Department of orthopaedics in a Swedish university hospital.

PARTICIPANTS: 102 patients with long standing (over six months) persistent subacromial impingement syndrome in whom earlier conservative treatment had failed, recruited through orthopaedic specialists.

INTERVENTIONS: The specific exercise strategy consisted of strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilisers in combination with manual mobilisation. The control exercise programme consisted of unspecific movement exercises for the neck and shoulder. Patients in both groups received five to six individual guided treatment sessions during 12 weeks. In between these supervised sessions the participants performed home exercises once or twice a day for 12 weeks.

MAIN OUTCOME MEASURES: The primary outcome was the Constant-Murley shoulder assessment score evaluating shoulder function and pain. Secondary outcomes were patients' global impression of change because of treatment and decision regarding surgery.

RESULTS: Most (97, 95%) participants completed the 12 week study. There was a significantly greater improvement in the Constant-Murley score in the specific exercise group than in the control exercise group (24 points (95% confidence interval 19 to 28.0) v 9 points (5 to 13); mean difference between group: 15 points (8.5 to 20.6)). Significantly more patients in the specific exercise group reported successful outcome (defined as large improvement or recovered) in the patients' global assessment of change because of treatment: 69% (35/51) v 24% (11/46); odds ratio 7.6, 3.1 to 18.9; P<0.001. A significantly lower proportion of patients in the specific exercise group subsequently chose to undergo surgery: 20% (10/51) v 63% (29/46); odds ratio 7.7, 3.1 to 19.4; P<0.001).

CONCLUSION: A specific exercise strategy, focusing on strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilisers, is effective in reducing pain and improving shoulder function in patients with persistent subacromial impingement syndrome. By extension, this exercise strategy reduces the need for arthroscopic subacromial decompression within the three month timeframe used in the study.

TRIAL REGISTRATION: Clinical trials NCT01037673.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2012
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-75436 (URN)10.1136/bmj.e787 (DOI)000300881600009 ()22349588 (PubMedID)
Note

funding agencies|physiotherapy orthopaedic department of the University Hospital in Linkoping, Sweden||research council in the south east of Sweden (FORSS)||

Available from: 2012-03-01 Created: 2012-03-01 Last updated: 2017-12-07
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