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Hermansen, Anna
Publications (7 of 7) Show all publications
Hermansen, A., Peolsson, A., Hedlund, R. & Kammerlind, A.-S. (2019). Balance problems and dizziness after neck surgery - associations with pain and health-related quality of life.. Physiotherapy Theory and Practice, 1-8
Open this publication in new window or tab >>Balance problems and dizziness after neck surgery - associations with pain and health-related quality of life.
2019 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, p. 1-8Article in journal (Refereed) Epub ahead of print
Abstract [en]

INTRODUCTION: Symptoms of dizziness or imbalance are often present in individuals with a variety of neck-disorders. The aims of this study were to determine the prevalence of patient-reported balance problems and dizziness 10-13 years after surgery for cervical degenerative disc disease; evaluate associations with neck pain and health-related quality of life; and investigate how these individuals described dizziness.

MATERIAL AND METHODS: Sixty-eight individuals, 10 years or more after anterior cervical decompression and fusion surgery, who previously participated in a randomized controlled trial were included. Participants completed questionnaires including ratings of dizziness and balance problems, the Dizziness Handicap Inventory, and an open-ended question regarding their experience of dizziness. Secondary outcomes were neck pain and quality of life.

RESULTS: Seventy-two percent experienced occasional or daily symptoms of unsteadiness and/or dizziness. Intensity ratings for dizziness during movement and for balance problems were similar and rather low, but had an impact on quality of life. Ratings of dizziness at rest were even lower. Dizziness ratings were associated with neck pain. Strenuous activities were related to dizziness and dizziness was primarily described as intermittent and non-rotatory.

CONCLUSIONS: Dizziness or balance problems in the long-term after surgery for cervical degenerative disc disease are common and have an impact on daily life. Ratings of problem frequency and intensity were usually low. Dizziness and balance problems may affect quality of life. Patients' descriptions of these problems are in line with common symptoms of cervicogenic dizziness.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
Cervical spine, anterior cervical decompression and fusion, degenerative disease, dizziness
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-161041 (URN)10.1080/09593985.2019.1571137 (DOI)30686102 (PubMedID)
Available from: 2019-10-17 Created: 2019-10-17 Last updated: 2019-10-17
Peolsson, A., Peterson, G., Hermansen, A., Landén Ludvigsson, M., Dedering, A. & Lofgren, H. (2019). Physiotherapy after anterior cervical spine surgery for cervical disc disease: study protocol of a prospective randomised study to compare internet-based neck-specific exercise with prescribed physical activity. BMJ Open, 9(2), Article ID e027387.
Open this publication in new window or tab >>Physiotherapy after anterior cervical spine surgery for cervical disc disease: study protocol of a prospective randomised study to compare internet-based neck-specific exercise with prescribed physical activity
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 2, article id e027387Article in journal (Refereed) Published
Abstract [en]

Introduction Patients suffering from remaining disability after anterior cervical decompression and fusion (ACDF) surgery for cervical disc disease may be prescribed physical activity (PPA) or neck-specific exercises (NSEs). Currently, we lack data for the success of either approach. There is also a knowledge gap concerning the use of internet-based care for cervical disc disease. The scarcity of these data, and the high proportion of patients with various degrees of incapacity following ACDF, warrant increased efforts to investigate and improve cost-effective rehabilitation. The objective is to compare the effectiveness of a structured, internet-based NSE programme, versus PPA following ACDF surgery. Methods and analysis This is a prospective, randomised, multicentre study that includes 140 patients with remaining disability (amp;gt;= 30% on the Neck Disability Index, NDI) following ACDF for radiculopathy due to cervical disc disease. Patient recruitment occurs following attendance at routine clinical appointments, scheduled at 3 months postsurgery. Patients are then randomised to one of two groups (70 patients/group) for a 3-month treatment programme/period of either internet-based NSE or PPA. Questionnaires on background data, pain and discomfort, physical and mental capacity, satisfaction with care, and health and workplace factors are completed, along with physical measures of neck-related function conducted by independent test leaders blinded to randomisation. Measures are collected at inclusion, after the 3-month treatments (end of treatment) and at a 2-year follow-up. Radiography will be completed at the 2-year follow-up. Preoperative data will be collected from the Swedish Spine Registry. Data on healthcare consumption, drug use and sick leave will be requested from the relevant national registers. Ethical considerations This study was approved by the Regional Ethical Review Board in Linkoping Ref. 2016/283-31 and 2017/91-32. The scientists are independent with no commercial ties. Patients are recruited after providing written informed consent. Patient data are presented at group level such that no connection to any individual can be made. All data are anonymised when reported, and subject to the Swedish Official Secrets Health Acts. The test leaders are independent and blinded for randomisation. Exercises, both general and neck-specific, have been used extensively in clinical practice and we anticipate no harm from their implementation other than a risk of muscle soreness. Both randomisation groups will receive care that is expected to relieve pain, although the group receiving NSE is expected to demonstrate a greater and more cost-effective improvement versu s the PPA group. Any significant harm or unintended effects in each group will be collected by the test leaders. All questionnaires and test materials are coded by the research group, with code lists stored in locked, fireproof file cabinets, housed at the university in a room with controlled (card-based) access. Only individuals in receipt of a unique website address posted by the researchers can access the programme; patients can neither communicate with each other nor with caregivers via the programme. Study participation might lead to improved rehabilitation versus non-participation, and might therefore be of benefit. The results of this study should also contribute to more effective and flexible rehabilitation, shorter waiting times, lower costs and the possibility to implement our findings on a wider level. Dissemination If effective, the protocols used in this study can be implemented in existing healthcare structures. The results of the study will be presented in scientific journals and popular science magazines of relevance to health. The findings will also be presented at local, regional, national and international conferences and meetings, as well as in the education of university students and at public lectures. Information about the results will be communicated to the general population in cooperation with patient organisations and the media.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2019
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-158984 (URN)10.1136/bmjopen-2018-027387 (DOI)000471124600275 ()30782952 (PubMedID)
Note

Funding Agencies|regional Center for Clinical Research; Region Council of Ostergotland County

Available from: 2019-07-19 Created: 2019-07-19 Last updated: 2019-10-17Bibliographically approved
Hermansen, A., Peolsson, A., Kammerlind, A.-S. & Hjelm, K. (2016). Women’s experiences of daily life after anterior cervical decompression and fusion surgery: A qualitative interview study. Journal of Rehabilitation Medicine, 48(4), 352-358
Open this publication in new window or tab >>Women’s experiences of daily life after anterior cervical decompression and fusion surgery: A qualitative interview study
2016 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 48, no 4, p. 352-358Article in journal (Refereed) Published
Abstract [en]

Subjects: Fourteen women aged 39-62 years (median 52 years), were included 1.5 to 3 years after ACDF for cervical degenerative disc disease.

Methods: Individual semi-structured interviews were analyzed by qualitative content analysis with an inductive approach.

Results: The women described their experiences of daily life in five different ways; Experiences of recovery; Experiences of symptoms in daily life influence feelings and thoughts; Making daily life work; Importance of social  and occupational networks; Experiences of the influence of healthcare professionals and interventions on daily life.

Conclusion: This interview study provides insight into women’s daily life after ACDF. While improved after surgery, informants also experienced remaining symptoms and limitations in daily life. A variety of mostly active coping strategies were used to manage daily life. Social support from family, friends, occupational networks and healthcare professionals positively influenced daily life. These findings provide knowledge on aspects of daily life that should be considered in individualized postoperative care and rehabilitation in an attempt to provide better outcomes in women after ACDF.

Place, publisher, year, edition, pages
Uppsala, Sweden: Stiftelsen Rehabiliteringsinformation /Foundation for Rehabilitation Information, 2016
Keywords
Daily life, cervical spine, research interview, content analysis
National Category
Medical and Health Sciences Physiotherapy
Identifiers
urn:nbn:se:liu:diva-117344 (URN)10.2340/16501977-2076 (DOI)000372456100005 ()26999327 (PubMedID)
Note

Funding agencies: NSC FoU-fond; County Council of Ostergotland

Available from: 2015-04-23 Created: 2015-04-23 Last updated: 2017-12-04Bibliographically approved
Hermansen, A. (2015). Clinical and patient-reported outcomes after anterior cervical decompression and fusion surgery: A focus on functioning and daily life. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Clinical and patient-reported outcomes after anterior cervical decompression and fusion surgery: A focus on functioning and daily life
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Anterior cervical decompression and fusion (ACDF), with or without an intervertebral cage to add support to the fused segment, is an established surgical treatment of cervical radiculopathy due to cervical disc disease. High recovery rates and pain reductions after surgery have been reported, with similar results with or without a cage. A few small studies have evaluated neck-related physical function and patient-reported disability with less promising results. No previous studies have evaluated clinical and patientreported measures of functioning or compared the Cloward Procedure with the Cervical Intervertebral Fusion Cage (CIFC) more than 10 year after surgery. No studies have explored the patients’ perspective on surgical outcome Knowledge on long-term functioning may provide a base for improved postoperative care and rehabilitation. Combining the perspectives of clinicians and patients may provide a better understanding of outcome after ACDF surgery than has previously been reported.

The overall aim of the thesis was to evaluate long-term functioning after anterior cervical decompression and fusion surgery due to cervical disc disease, and to provide new insights into patients’ experiences of daily life after surgery.

The more than 10-year patient-reported outcomes of pain, disability and psychosocial factors (n=77), as well as clinical outcomes of neck-related physical function (n=51) were evaluated and compared between the Cloward Procedure and the CIFC. Preoperative and surgery-related factors of importance for a good outcome in neck-related pain and disability at 10-year follow-up were also identified. Fourteen women were interviewed at 1.5 to 3 years after ACDF to explore their experiences of daily life.

There were no differences between the surgical techniques in long-term neck-related pain or patient-reported disability. Secondary outcomes were, with a few exceptions, similar between groups. Neck-related pain decreased after surgery and remained improved from the 2-year to the 10-year follow-up. However, disability ratings remained improved only in the CIFC group. Predictors of a successful outcome in neck-related pain intensity were high preoperative neck-related pain intensity (Odds Ratio 1.06) and nonsmoking (Odds Ratio 3.03). Male gender was the only predictive factor of a successful outcome in neck-related disability (Odds Ratio 4.33). Moderate to severe pain and patient-reported disability were seen in half of the participants at the 10-year follow-up, and neck-related physical impairments were seen in between 18% (cervical flexion) and 82% (neck-muscle endurance) of participants. Daily life was experienced as recovered or improved by women after ACDF surgery. However they were at the same time affected and limited by remaining symptoms. Behaviors and activities were altered to adjust to the symptoms. Social support provided by family, social and occupational networks, and by healthcare professionals were experienced as important in a good daily life.

In conclusion: long-term pain, physical function and patient-reported disability were similar between the two ACDF techniques. High preoperative pain intensity, non-smoking and male gender predicted a good long-term outcome. Individuals after ACDF surgery experienced improvements in pain intensity and a good effect of surgery although they simultaneously reported residual or recurrent disability.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. p. 77
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1443
National Category
Physiotherapy Nursing
Identifiers
urn:nbn:se:liu:diva-117347 (URN)10.3384/diss.diva-117347 (DOI)978-91-7519-134-8 (ISBN)
Public defence
2015-05-22, Berzeliussalen, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-04-23 Created: 2015-04-23 Last updated: 2015-05-06Bibliographically approved
Hermansen, A., Cleland, J. A., Kammerlind, A.-S. & Peolsson, L. (2014). Evaluation of Physical Function in Individuals 11 to 14 Years after AnteriorCervical Decompression and Fusion Surgery: A Comparison betweenPatients and Healthy Reference Samples and Between 2 Surgical Techniques. Journal of Manipulative and Physiological Therapeutics, 37(2), 87-96
Open this publication in new window or tab >>Evaluation of Physical Function in Individuals 11 to 14 Years after AnteriorCervical Decompression and Fusion Surgery: A Comparison betweenPatients and Healthy Reference Samples and Between 2 Surgical Techniques
2014 (English)In: Journal of Manipulative and Physiological Therapeutics, ISSN 0161-4754, E-ISSN 1532-6586, Vol. 37, no 2, p. 87-96Article in journal (Refereed) Published
Abstract [en]

Objective: The purpose of this study was to evaluate neck-related physical function in individuals 11 to 14 years after anterior cervical decompression and fusion (ACDF) surgery for degenerative cervical disk disease and to compare the long-term outcome of 2 surgical techniques, including the Cloward procedure and cervical intervertebral fusion cage. Methods: In this cross-sectional study, 51 individuals, 11 years or more after ACDF, underwent testing of cervical active range of motion, hand-grip strength, static and dynamic balance, neck muscle endurance, and completed pain ratings. The participants values were compared with values of age-and sex-matched healthy individuals to evaluate impairments. Correlations between different test scores and pain were performed. Group differences were analyzed between the 2 surgical techniques. Results: Sixty-five percent and 82% exhibited impairment in ventral and dorsal neck muscle endurance, respectively. Impairment rates of 18% to 39% for cervical active range of motion, 27% to 43% for hand-grip strength, 37% for standing balance, and 35% for dynamic balance were recorded. Twenty-nine percent of the participants had impairment (greater than30 mm visual analog scale) in pain. There were no significant differences in physical function between the 2 surgical treatment groups (Cloward procedure or cervical intervertebral fusion cage) (P = .10-.92). Conclusions: In those studied, a large percentage of patients who had anterior cervical decompression and fusion surgery have impairments in neck-related physical function when compared 11 to 14 years after surgery with age-and sex-matched healthy reference individuals. Neck-specific function, but not balance, was statistically correlated to pain. Neck muscle endurance was most affected, and balance impairments were also present in one-third of the individuals. There were no differences in long-term physical function between the 2 surgical techniques.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Cervical Vertebrae; Neck Muscles; Physical Endurance; Range of Motion; Postural Balance; Surgical Procedure
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-104837 (URN)10.1016/j.jmpt.2013.11.002 (DOI)000330584200004 ()
Available from: 2014-02-28 Created: 2014-02-28 Last updated: 2017-12-05Bibliographically approved
Hermansen, A., Hedlund, R., Vavruch, L. & Peolsson, A. (2013). Positive predictive factors and subgroup analysis of clinically relevant improvement after anterior cervical decompression and fusion for cervical disc disease: a 10-to 13-year follow-up of a prospective randomized study Clinical article. Journal of Neurosurgery: Spine, 19(4), 403-411
Open this publication in new window or tab >>Positive predictive factors and subgroup analysis of clinically relevant improvement after anterior cervical decompression and fusion for cervical disc disease: a 10-to 13-year follow-up of a prospective randomized study Clinical article
2013 (English)In: Journal of Neurosurgery: Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 19, no 4, p. 403-411Article in journal (Refereed) Published
Abstract [en]

Object. The main purpose of this 10- to 13-year follow-up of a prospective randomized study was to identify preoperative factors that predicted good long-term outcome after anterior cervical decompression and fusion (ACDF) with the Cloward procedure or the cervical intervertebral fusion cage. A second purpose was to investigate subgroup differences at the 10-year follow-up between patients with and without clinically relevant improvement (CRI) and between men and women. less thanbrgreater than less thanbrgreater thanMethods. To evaluate clinically meaningful outcomes, good outcome was defined as CRI in neck-related pain intensity (andgt;= 30-mm improvement on a visual analog scale), and CRI in neck-specific disability (andgt;= 20% improvement in the neck disability index [NUT]) from preoperative measurements to the 10-year follow-up. A total of 73 patients (77% of the original study sample) completed questionnaires at least 10 years after ACDF. less thanbrgreater than less thanbrgreater thanResults. High preoperative neck-related pain intensity and preoperative nonsmoking status were predictors of CRI in neck-related pain intensity, and male sex was a predictor of CRI in neck-specific disability; however, no additional predictive factors were identified for good outcome after ACDF. The surgical procedure, number of operated levels, and radiological factors such as healing status did not influence the prediction models. Individuals without CRI in neck-specific disability (75%) and pain intensity (43%) reported a worse outcome for several psychosocial outcome variables compared with those with CRI. At the 10-year follow-up, women reported significantly greater neck- and arm-related pain intensity than men, and women also reported more disability and worse psychosocial status. Women reported CRI on the NDI less frequently than men (p = 0.01). less thanbrgreater than less thanbrgreater thanConclusions. Preoperative predictive factors of good outcome 10-13 years after ACDF included initial high neck-related pain intensity, nonsmoking status at the time of surgery, and male sex. There were greater improvements in pain intensity than in neck-specific disability, and the latter showed a greater association with psychosocial factors. These results suggest the need for multimodal postoperative rehabilitation for patients who do not have a satisfactory outcome after ACDF.

Place, publisher, year, edition, pages
American Association of Neurological Surgeons, 2013
Keywords
cervical disc disease, radiculopathy, anterior cervical fusion, clinical relevant outcome, prognostic factors
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-100024 (URN)10.3171/2013.7.SPINE12843 (DOI)000324964700002 ()
Note

Funding Agencies|Swedish Research Council||Medical Research Council of Southeast Sweden (FORSS)||County Council of Ostergotland||

Available from: 2013-10-25 Created: 2013-10-25 Last updated: 2019-04-10
Hermansen, A., Hedlund, R., Vavruch, L. & Peolsson, A. (2011). A Comparison Between the Carbon Fiber Cage and the Cloward Procedure in Cervical Spine Surgery A Ten- to Thirteen-Year Follow-Up of a Prospective Randomized Study. SPINE, 36(12), 919-925
Open this publication in new window or tab >>A Comparison Between the Carbon Fiber Cage and the Cloward Procedure in Cervical Spine Surgery A Ten- to Thirteen-Year Follow-Up of a Prospective Randomized Study
2011 (English)In: SPINE, ISSN 0362-2436, Vol. 36, no 12, p. 919-925Article in journal (Refereed) Published
Abstract [en]

Study Design. Ten- to 13-year follow-up of a prospective randomized study. Objective. To compare the 10- to 13-year outcomes of anterior cervical decompression and fusion (ACDF) with a cervical intervertebral fusion cage (CIFC), and the Cloward procedure (CP) using a broad clinical and patient-centered assessment. Summary of Background Data. There are few prospective studies and none with a follow-up of 10 years or more. Methods. Patient questionnaires completed 10 years or more after ACDF. Seventy-three patients (77%) responded. Radiographs were obtained at 2 years. Results. Apart from greater fulfillment of preoperative expectation (P = 0.01) and less headache (P = 0.005) in the CIFC group compared with the CP group, there were no significant differences in the outcomes of the two surgical methods. Pain intensity improved in comparison with preoperative levels in both the CIFC and CP groups (P andlt; 0.0001), but the Neck Disability Index (NDI) only improved in the CIFC group (P = 0.04). Only those with a healed fusion benefited from an improved NDI (P = 0.02). There was no deterioration in pain intensity or NDI after the 2-year follow-up. Conclusion. The outcomes of the two surgical methods, with a few exceptions, were equal at 10- to 13-year follow-up, and there was no deterioration in outcome after the 2-year follow-up. Pain intensity improved more than disability, which may indicate that further improvement of physical function requires early more extensive postoperative rehabilitation. Despite persisting disability, repeat surgery was relatively uncommon.

Place, publisher, year, edition, pages
J B Lippincott Co, 2011
Keywords
cervical spine, disc, cage, Cloward, outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-68683 (URN)10.1097/BRS.0b013e3181e8e4a3 (DOI)000290473500011 ()
Note

Original Publication: Anna Hermansen, Rune Hedlund, Ludek Vavruch and Anneli Peolsson, A Comparison Between the Carbon Fiber Cage and the Cloward Procedure in Cervical Spine Surgery A Ten- to Thirteen-Year Follow-Up of a Prospective Randomized Study, 2011, SPINE, (36), 12, 919-925. http://dx.doi.org/10.1097/BRS.0b013e3181e8e4a3 Copyright: J B Lippincott Co http://www.lww.com/

Available from: 2011-05-27 Created: 2011-05-27 Last updated: 2015-04-23
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