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Holmgren, Theresa
Publications (10 of 11) Show all publications
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
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
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. (2013). Exercise treatment of patients with long-standing subacromial pain. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Exercise treatment of patients with long-standing subacromial pain
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Subacromial pain is the most common problem among patients with shoulder complaints seeking primary care. The recommended treatment for these patients is primarily non-surgical with a focus on exercise treatment. If this treatment fails arthroscopic subacromial decompression (ASD) followed by exercise treatment is recommended. Surgical treatment with ASD has increased substantially in Sweden in recent years even though studies comparing exercise treatment with surgery report equally positive results. Still, there is a need of evidence based preand postoperative exercise treatments, standardised and described in detail, to guide treatment of these patients in clinical practice.

The overall aim of this thesis was to evaluate the efficacy of pre- and postoperative exercise strategies on shoulder function and how the preoperative strategy affects the need for surgery in patients with long-standing subacromial pain.

This thesis comprises four papers which are based on two randomised controlled trials. In study A, patients were randomised after ASD surgery to either physical therapist (PT) supervised strength-endurance exercises for the rotator cuff and scapula stabilisers or to home-based movement exercises for a period of three months. Shoulder function and pain, health related quality of life and return to work was evaluated for 6 months (paper I). In study B, patients on the waiting list for surgery were randomised to either specific exercise strategy with strengthendurance exercises for the rotator cuff and the scapula stabilisers or to control exercises with movement exercises for the neck and shoulders for a period of three months. After completing the exercise program and also after 12 months, shoulder function and pain, need for surgery and health related quality of life was evaluated. Baseline shoulder function, rotator cuff status and radiological findings were analysed in relation to the choice of surgery (paper II, III). The minimal important clinical change (MIC) of the Constant-Murley (CM) score, used as primary outcome in this thesis, was determined by using a visual anchor-based MIC distribution method (paper IV).

Six months after ASD surgery, patients who performed PT-supervised strength-endurance exercises improved significantly more in shoulder function and pain compared to patients who had performed home-based movement exercises (paper I). Patients on the waiting list for surgery who performed specific strength-endurance exercises had significantly greater improvements in shoulder function and pain compared to patients performing movement exercises (paper II). A significantly lower proportion of those performing specific strength-endurance exercises chose surgery at the three- and 12 months follow-ups (paper II, paper III). Low baseline values in shoulder function and pain measured with the CM score and/or having a full thickness rotator cuff rupture were associated with an increased risk of choosing surgery (paper III). Regarding the CM score, a change between 17-24 points seems to be clinically important for patients with long-standing subacromial pain (paper IV).

Supervised strength-endurance exercises seem to be more effective than home-based movement exercises after ASD surgery. For patients on the waiting list for surgery, the specific strategy of strength-endurance exercises was effective in improving shoulder function and pain and the need for surgery was reduced at 12 months. Low baseline values for shoulder function and pain measured with the CM score and/or having a full thickness rotator cuff tear seem to be predictors for choosing surgery. The CM score is able to detect the MIC 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.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. p. 95
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1352
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-90021 (URN)978-91-7519-695-4 (ISBN)
Public defence
2013-04-12, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-03-15 Created: 2013-03-15 Last updated: 2013-03-15Bibliographically approved
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
Holmgren, T., Öberg, B., Sjöberg, I. & Johansson, K. (2012). Supervised strengthening exercises versus home-based movement exercises after arthroscopic acromioplasty: A randomized clinical trial. Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine, 44(1), 12-18
Open this publication in new window or tab >>Supervised strengthening exercises versus home-based movement exercises after arthroscopic acromioplasty: A randomized clinical trial
2012 (English)In: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine, ISSN 1651-2081, Vol. 44, no 1, p. 12-18Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate and compare the efficacy of 2 rehabilitation strategies after arthroscopic acromioplasty: supervised physical therapy focusing on strengthening exercises of the rotator cuff and scapula stabilizers (PT-group) vs home-based movement exercises (H-group). Design: A randomized, single-blinded, clinically controlled study. Patients: Thirty-six patients entered the study. Thirteen in the PT-group and 16 in the H-group fulfilled all the assessments. Methods: For 12 weeks following surgery, patients performed either supervised physical therapy or home exercises. Follow-ups were conducted periodically for 6 months after surgery to evaluate shoulder function, pain (Constant-Murley (CM) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores), and health-related quality of life. Results: The PT-group exhibited significantly greater improvements in CM (p  =0.02) and DASH (p = 0.05) scores. After treatment, the between-group mean difference in CM scores was 14.2 p (95% confidence interval 2-26). At the 6-month follow-up, the between-group mean difference in DASH scores was 13.4 p (95% confidence interval 0.1-23). Conclusion: PT-supervised rehabilitation with strengthening exercises of the rotator cuff and scapula stabilizers seems to be superior to home exercises focusing on mobility for improving shoulder function after arthroscopic acromioplasty.

Keywords
arthroscopic acromioplasty; exercise; rehabilitation; rotator cuff; subacromial impingement; physical therapy.
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-72791 (URN)10.2340/16501977-0889 (DOI)000300263900003 ()22124602 (PubMedID)
Available from: 2011-12-07 Created: 2011-12-07 Last updated: 2013-03-15
Bjuremark, A., Nilsberth, C., Dufvenberg, M. & Holmgren, T. (2008). Kursutvärdering som incitament till förändring. Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Kursutvärdering som incitament till förändring
2008 (Swedish)Report (Other academic)
Alternative title[en]
Ingår i rapporten: Variation på temat examination : En rapport från grundutbildningsdag och rundabordssamtal vid LiU 2007
Abstract [en]

En kursutvärdering får inte bli ett självändamål. Syftet är istället att med hjälp av den feedback man som lärare får, återkoppla och förbättra en kurs/utbildning. Fry et al., (2000) anser att lärare ibland kan ha nytta av att få hjälp med analys av utvärderingarna, för att på ett nyanserat sätt kunna ta emot den kritik som annars lätt skulle kunna avfärdas och bortses ifrån. Det kan vara jobbigt att ta in negativ kritik.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2008. p. 2
Series
CUL-rapporter, ISSN 1652-9278 ; 2008:13
Keywords
Kursutvärdering
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-44849 (URN)77830 (Local ID)978-91-7393-719-1 (ISBN)77830 (Archive number)77830 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2018-11-06Bibliographically approved
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