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Zsigmond, Peter
Publications (10 of 38) Show all publications
Alonso, F., Zsigmond, P. & Wårdell, K. (2019). Influence of Virchow-Robin spaces in the Electric Field Distribution in Subthalamic Nucleus Deep Brain Stimulation. In: : . Paper presented at 18th Biennial meeting of the World Society for Stereotactic and Functional Neurosurgery. S. Karger
Open this publication in new window or tab >>Influence of Virchow-Robin spaces in the Electric Field Distribution in Subthalamic Nucleus Deep Brain Stimulation
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Objectives: Previous investigations have shown the appearance of cysts i.e. Virchow-Robin spaces (VR) in the basal ganglia and their relationship with parkinsonian symptoms [1-3]. Simulations [4]using the finite element method (FEM) suggests that VR affects the electric field around deep brain stimulation (DBS) electrodes. The aim of the study was to evaluate how the electric field is modified by the presence of cysts in the STN. Methods: The effect of cysts on the electric field around the DBS lead placed in the STN was evaluated using FEM. 3D patient-specific brain models were built with COMSOL 5.2 (COMSOL AB, Sweden) and an in-house developed software [5] to convert a T2 weighted MRI of Parkinsonian patients (ethics approval no: 2012/434-3) into electrical conductivity matrix readable by FEM software. VR was classified as CSF [6]assigning a high electrical conductivity (2.0 S/m). The stimulation amplitudes were set to the clinically programmed values. Depending on the lead used, the stimulation was set to voltage control (3389) or current control (6180, ring mode). The coordinates corresponding to the lowest (first) electrode and the third higher up in the lead, taken from the postoperative CT electrode artefact, were used to localize the leads in the brain model [7]. The electric field was visualized with a 0.2V/mm isosurface. Results: Simulations showed that the electric field distribution is affected by the cysts. The higher conductivity at these regions in the vicinity of the electrode redistributes the electric field pushing it away from the cyst. The same effect occurs regardless of the operating mode or the lead design as long as the directional lead is configured in ring mode. Conclusions: The use of patient-specific models has shown the importance of considering nuances of the patients’ anatomy in the STN. This information can be used to determine the stimulation parameter and to support the analysis of side effects induced by the stimulation. The potential advantage of directional leads can also be assessed by including in the model patient-specific data.

Place, publisher, year, edition, pages
S. Karger, 2019
Series
Stereotact Funct Neurosurg 2019;97:1–560, ISSN 1011-6125, E-ISSN 1423-0372
National Category
Other Medical Engineering
Identifiers
urn:nbn:se:liu:diva-160751 (URN)
Conference
18th Biennial meeting of the World Society for Stereotactic and Functional Neurosurgery
Funder
Swedish Foundation for Strategic Research , BD15-0032
Available from: 2019-10-07 Created: 2019-10-07 Last updated: 2019-10-07
Tobieson, L., Rossitti, S., Zsigmond, P., Hillman, J. & Marklund, N. (2019). Persistent Metabolic Disturbance in the Perihemorrhagic Zone Despite a Normalized Cerebral Blood Flow Following Surgery for Intracerebral Hemorrhage.. Neurosurgery (6), 1269-1278
Open this publication in new window or tab >>Persistent Metabolic Disturbance in the Perihemorrhagic Zone Despite a Normalized Cerebral Blood Flow Following Surgery for Intracerebral Hemorrhage.
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2019 (English)In: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, no 6, p. 1269-1278Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: We hypothesized that reduced cerebral blood flow (CBF) and/or energy metabolic disturbances exist in the tissue surrounding a surgically evacuated intracerebral hemorrhage (ICH). If present, such CBF and/or metabolic impairments may contribute to ongoing tissue injury and the modest clinical efficacy of ICH surgery.

OBJECTIVE: To conduct an observational study of CBF and the energy metabolic state in the perihemorrhagic zone (PHZ) tissue and in seemingly normal cortex (SNX) by microdialysis (MD) following surgical ICH evacuation.

METHODS: We evaluated 12 patients (median age 64; range 26-71 yr) for changes in CBF and energy metabolism following surgical ICH evacuation using Xenon-enhanced computed tomography (n = 10) or computed tomography perfusion (n = 2) for CBF and dual MD catheters, placed in the PHZ and the SNX at ICH surgery.

RESULTS: CBF was evaluated at a mean of 21 and 58 h postsurgery. In the hemisphere ipsilateral to the ICH, CBF improved between the investigations (36.6 ± 20 vs 40.6 ± 20 mL/100 g/min; P < .05). In total, 1026 MD samples were analyzed for energy metabolic alterations including glucose and the lactate/pyruvate ratio (LPR). The LPR was persistently elevated in the PHZ compared to the SNX region (P < .05). LPR elevations in the PHZ were predominately type II (pyruvate normal-high; indicating mitochondrial dysfunction) as opposed to type I (pyruvate low; indicating ischemia) at 4 to 48 h (70% vs 30%) and at 49 to 84 h (79% vs 21%; P < .05) postsurgery.

CONCLUSION: Despite normalization of CBF following ICH evacuation, an energy metabolic disturbance suggestive of mitochondrial dysfunction persists in the perihemorrhagic zone.

Place, publisher, year, edition, pages
Oxford University Press, 2019
National Category
Neurology
Identifiers
urn:nbn:se:liu:diva-150994 (URN)10.1093/neuros/nyy179 (DOI)000471247000038 ()29788388 (PubMedID)
Note

Funding agencies: STROKE-Riksforbundet (Skarholmen, Sweden); local hospital ALF-funds (Region Ostergotland, Linkoping, Sweden); Anaesthesia, Operations and Specialty Surgery Centre

Available from: 2018-09-10 Created: 2018-09-10 Last updated: 2019-07-15
Wårdell, K., Zsigmond, P., Richter, J. & Hemm, S. (2018). Optical Guidance System for Deep Brain Stimulation Surgery: from Experimental Studies to Clinical Use. In: : . Paper presented at Biophotonics Congress: Biomedical Optics Congress, The Diplomat Beach Resort, Hollywood, Florida USA, 3–6 April 2018. Hollywood, Florida, United States, Article ID CTh2B.3.
Open this publication in new window or tab >>Optical Guidance System for Deep Brain Stimulation Surgery: from Experimental Studies to Clinical Use
2018 (English)In: , Hollywood, Florida, United States, 2018, article id CTh2B.3Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Laser Doppler flowmetry (LDF) has been adapted for optical guidance during stereotactic deep brain stimulation (DBS) surgery. It has been used in more than 130 DBS implantations. The necessary steps to go from experimental studies to clinical use in the neurosurgical setting are reviewed.

Place, publisher, year, edition, pages
Hollywood, Florida, United States: , 2018
Series
(Microscopy/Translational/Brain/OTS)
National Category
Other Medical Engineering
Identifiers
urn:nbn:se:liu:diva-147678 (URN)10.1364/TRANSLATIONAL.2018.CTh2B.3 (DOI)978-1-943580-41-5 (ISBN)
Conference
Biophotonics Congress: Biomedical Optics Congress, The Diplomat Beach Resort, Hollywood, Florida USA, 3–6 April 2018
Funder
Swedish Research Council, 621-2013-6078Swedish Foundation for Strategic Research , BD15-0032
Available from: 2018-05-04 Created: 2018-05-04 Last updated: 2018-05-15Bibliographically 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
Nord, M., Zsigmond, P., Kullman, A. & Dizdar Segrell, N. (2017). Levodopa Pharmacokinetics in Brain after Both Oral and Intravenous Levodopa in One Patient with Advanced Parkinson’s Disease. Advances in Parkinsons Disease, 6(2), 52-66
Open this publication in new window or tab >>Levodopa Pharmacokinetics in Brain after Both Oral and Intravenous Levodopa in One Patient with Advanced Parkinson’s Disease
2017 (English)In: Advances in Parkinsons Disease, ISSN 2169-9712, Vol. 6, no 2, p. 52-66Article in journal (Refereed) Published
Abstract [en]

Objective: One patient received oral levodopa during a study aiming for better understanding of the basal ganglia and of the mechanisms of deep brain stimulation of the subthalamic nucleus (STN DBS) with and without intravenous (IV) levodopa infusion in patients with Parkinson’s disease (PD). The results from oral and IV levodopa treatment are presented.

Methods: Five patients with advanced PD were included in the original study. During planned STN DBS surgery microdialysis probes were implanted in the right putamen and in the right and left globus pallidus interna (Gpi). During the study, microdialysis was performed continuously and STN DBS, with and without IV levodopa infusion, was performed according to a specific protocol. After DBS surgery, but before STN DBS was started, one patient received oral levodopa/ benserazide and entacapone tablets out of protocol due to distressing parkinsonism.

Results: The levodopa levels increased prompt in the central nervous system after the first PD medication intakes but declined after the last. Immediately the levodopa seemed to be metabolized to dopamine (DA) since the levels of DA correlated well with levodopa concentrations. Left STN DBS seemed to further increase DA levels in left Gpi while right STN DBS seemed to increase DA levels in the right putamen and right Gpi. There was no obvious effect on levodopa levels.

Conclusions: The results indicate that PD patients still have capacity to metabolize levodopa to DA despite advanced disease with on-off symptoms and probably pronounced nigral degeneration. STN DBS seems to increase DA levels with a more pronounced effect on ipsilateral structures in striatum.

Place, publisher, year, edition, pages
Scientific Research Publishing Inc, 2017
Keywords
Parkinson’s Disease, Levodopa, Dopamine, Brain, Microdialysis, Deep Brain Stimulation
National Category
Neurology Cardiac and Cardiovascular Systems Gastroenterology and Hepatology Anesthesiology and Intensive Care Other Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-139251 (URN)10.4236/apd.2017.62006 (DOI)
Available from: 2017-07-07 Created: 2017-07-07 Last updated: 2018-01-12Bibliographically 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
Zsigmond, P., Hemm-Ode, S. & Wårdell, K. (2017). Optical Measurements during Deep Brain Stimulation Lead Implantation: Safety Aspects. Stereotactic and Functional Neurosurgery, 95(6), 392-399
Open this publication in new window or tab >>Optical Measurements during Deep Brain Stimulation Lead Implantation: Safety Aspects
2017 (English)In: Stereotactic and Functional Neurosurgery, ISSN 1011-6125, E-ISSN 1423-0372, Vol. 95, no 6, p. 392-399Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Intracerebral hemorrhage (ICH) is the most feared complication in deep brain stimulation (DBS) surgery. The aim of the study was to evaluate patient safety and outcome using laser Doppler flowmetry (LDF) as guidance tool during DBS implantations.

METHODS: An LDF probe adapted for the stereotactic system was used as guide for creation of the trajectory. The microcirculation along 83 preplanned trajectories was measured with the guide during DBS surgery for movement disorders. The microvascular blood flow levels were investigated for all measurement positions. Medical record and postoperative radiology were retrospectively reviewed.

RESULTS: Of 2,963 measurement positions, 234 (7.9%) showed at least a doubled blood flow compared to the surrounding tissue. Of these 2.2% had a more than 5 times higher blood flow in front of the probe tip. Along 1 trajectory, a small ICH was detected during surgery. Increased blood flow was more common close to sulci and verticals.

CONCLUSION: Real-time LDF measurement of the microcirculation using a forward-looking probe during DBS surgery can detect blood flow peaks and further minimize the risk of developing ICH. No separate guide tube is necessary as the probe also creates the trajectory for the DBS lead.

Place, publisher, year, edition, pages
Basel: S. Karger, 2017
Keywords
Deep brain stimulation, Intracerebral hemorrhage, Laser Doppler flowmetry, Safety
National Category
Medical Engineering
Identifiers
urn:nbn:se:liu:diva-144203 (URN)10.1159/000484944 (DOI)000426220600005 ()29301132 (PubMedID)2-s2.0-85040026633 (Scopus ID)
Note

Funding agencies: Swedish Research Council [621-2013-6078]; Parkinson Foundation at Linkoping University

Available from: 2018-01-10 Created: 2018-01-10 Last updated: 2018-09-07Bibliographically approved
Göransson, N., Johansson, J., Alonso, F., Wårdell, K. & Zsigmond, P. (2017). Postoperative lead movement after deep brain stimulation surgery and changes of stimulation area. In: : . Paper presented at World Society for Stereotactic and Functional Neurosurgery, 17th Quadrennial meeting, Berlin June 26-29, 2017. S. Karger
Open this publication in new window or tab >>Postoperative lead movement after deep brain stimulation surgery and changes of stimulation area
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2017 (English)Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Introduction

Lead movement after deep brain stimulation (DBS) may occur and influence the area of stimulation. The cause of the displacement is not fully understood. The aim of the study was to investigate differences in lead position between the day after surgery and approximately one month postoperatively and also simulate the electric field (EF) around the active contacts.

Methods

23 patients with movement disorders underwent DBS surgery (37 leads). CT at the two time points were co-fused respectively with the stereotactic images in Surgiplan. The coordinates (x, y, z) of the lead tips were compared between the two dates (paired t-test). 8 of these patients were selected for the EF simulation in Comsol Multiphysics.

Results

There was a significant discrepancy (mean ± s.d.) on the left lead: x (0.44 ± 0.72, p < 0.01), y (0.64 ± 0.54, p < 0.001), z (0.62 ± 0.71, p < 0.001).  On the right lead, corresponding values were: x (-0.11 ± 0.61, n.s.), y (0.71 ± 0.54, p < 0.001), z (0.49 ± 0.81, p < 0.05).  No correlation was found between bilateral (n =14) vs. unilateral DBS, gender (n = 17 male) and age < 60 years (n = 8).  The lead movement affected the EF spread (Fig. 1).

Conclusion

The left lead tip displayed a tendency to move lateral, anterior and inferior and the right a tendency to move anterior and inferior. Lead movement after DBS can be a factor to consider before starting the stimulation. The differences in the area of stimulation might affect clinical outcome.

Place, publisher, year, edition, pages
S. Karger, 2017
Series
Stereotactic and Functional Neurosurgery, ISSN 1011-6125, E-ISSN 1423-0372
National Category
Medical Engineering
Identifiers
urn:nbn:se:liu:diva-139886 (URN)10.1159/000478281 (DOI)
Conference
World Society for Stereotactic and Functional Neurosurgery, 17th Quadrennial meeting, Berlin June 26-29, 2017
Available from: 2017-08-21 Created: 2017-08-21 Last updated: 2017-09-04
Wårdell, K., Hemm-Ode, S., Rejmstad, P. & Zsigmond, P. (2016). High-Resolution Laser Doppler Measurements of Microcirculation in the Deep Brain Structures: A Method for Potential Vessel Tracking.. Stereotactic and Functional Neurosurgery, 94(1), 1-9
Open this publication in new window or tab >>High-Resolution Laser Doppler Measurements of Microcirculation in the Deep Brain Structures: A Method for Potential Vessel Tracking.
2016 (English)In: Stereotactic and Functional Neurosurgery, ISSN 1011-6125, E-ISSN 1423-0372, Vol. 94, no 1, p. 1-9Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Laser Doppler flowmetry (LDF) can be used to measure cerebral microcirculation in relation to stereotactic deep brain stimulation (DBS) implantations.

OBJECTIVE: To investigate the microcirculation and total light intensity (TLI) corresponding to tissue grayness in DBS target regions with high-resolution LDF recordings, and to define a resolution which enables detection of small vessels.

METHODS: Stereotactic LDF measurements were made prior to DBS implantation with 0.5-mm steps in the vicinity to 4 deep brain targets (STN, GPi, Vim, Zi) along 20 trajectories. The Mann-Whitney U test was used to compare the microcirculation and TLI between targets, and the measurement resolution (0.5 vs. 1 mm). The numbers of high blood flow spots along the trajectories were calculated.

RESULTS: There was a significant difference (p < 0.05) in microcirculation between the targets. High blood flow spots were present at 15 out of 510 positions, 7 along Vim and GPi trajectories, respectively. There was no statistical difference between resolutions even though both local blood flow and TLI peaks could appear at 0.5-mm steps.

CONCLUSIONS: LDF can be used for online tracking of critical regions presenting blood flow and TLI peaks, possibly relating to vessel structures and thin laminas along stereotactic trajectories.

Place, publisher, year, edition, pages
S. Karger, 2016
Keywords
Deep brain stimulation · Laser Doppler flowmetry ·Stereotactic neurosurgery · Microcirculation · Navigation
National Category
Biomedical Laboratory Science/Technology Neurology
Identifiers
urn:nbn:se:liu:diva-124691 (URN)10.1159/000442894 (DOI)000373869900001 ()26795207 (PubMedID)
Note

Funding agencies:  Swedish Research Council [621-2013-6078]; Parkinson Foundation at Linkoping University; Swiss National Science Foundation [205321-135285]

Available from: 2016-02-10 Created: 2016-02-10 Last updated: 2017-11-30Bibliographically approved
Ng, E., Johnston, V., Wibault, J., Lofgren, H., Dedering, A., Öberg, B., . . . Peolsson, A. (2015). Factors Associated With Work Ability in Patients Undergoing Surgery for Cervical Radiculopathy. Spine, 40(16), 1270-1276
Open this publication in new window or tab >>Factors Associated With Work Ability in Patients Undergoing Surgery for Cervical Radiculopathy
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2015 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, no 16, p. 1270-1276Article in journal (Refereed) Published
Abstract [en]

Study Design. Cross-sectional study. Objective. To investigate the factors associated with work ability in patients undergoing surgery for cervical radiculopathy. Summary of Background Data. Surgery is a common treatment of cervical radiculopathy in people of working age. However, few studies have investigated the impact on the work ability of these patients. Methods. Patients undergoing surgery for cervical radiculopathy (n = 201) were recruited from spine centers in Sweden to complete a battery of questionnaires and physical measures the day before surgery. The associations between various individual, psychological, and work-related factors and self-reported work ability were investigated by Spearman rank correlation coefficient, multivariate linear regression, and forward stepwise regression analyses. Factors that were significant (P &lt; 0.05) in each statistical analysis were entered into the successive analysis to reveal the factors most related to work ability. Work ability was assessed using the Work Ability Index. Results. The mean Work Ability Index score was 28 (SD, 9.0). The forward stepwise regression analysis revealed 6 factors significantly associated with work ability, which explained 62% of the variance in the Work Ability Index. Factors highly correlated with greater work ability included greater self-efficacy in performing self-cares, lower physical load on the neck at work, greater self-reported chance of being able to work in 6 months time, greater use of active coping strategies, lower frequency of hand weakness, and higher health-related quality of life. Conclusion. Psychological, work-related and individual factors were significantly associated with work ability in patients undergoing surgery for cervical radiculopathy. High self-efficacy was most associated with greater work ability. Consideration of these factors by surgeons preoperatively may provide optimal return to work outcomes after surgery.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2015
Keywords
work ability; Work Ability Index; neck pain; cervical radiculopathy; self-efficacy
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-125696 (URN)10.1097/BRS.0000000000001010 (DOI)000369220000011 ()26076434 (PubMedID)
Note

Funding Agencies|Swedish Research Council; Medical Research Council of Southeast Sweden; Swedish Society of Medicine, Lions; County Council of Ostergotland; Jonkoping County Council funds

Available from: 2016-03-01 Created: 2016-02-29 Last updated: 2017-11-30
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