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Landén Ludvigsson, MariaORCID iD iconorcid.org/0000-0002-3259-3133
Publications (10 of 19) Show all publications
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: 2019-11-11Bibliographically approved
Landén Ludvigsson, M., Peterson, G. & Peolsson, A. (2019). The effect of three exercise approaches on health-related quality of life, and factors associated with its improvement in chronic whiplash-associated disorders: analysis of a randomized controlled trial.. Quality of Life Research, 28(2), 357-368
Open this publication in new window or tab >>The effect of three exercise approaches on health-related quality of life, and factors associated with its improvement in chronic whiplash-associated disorders: analysis of a randomized controlled trial.
2019 (English)In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 28, no 2, p. 357-368Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The aim was to evaluate whether neck-specific exercise, with (NSEB) or without (NSE) a behavioural approach, improves health-related quality of life (HRQoL) compared to physical activity prescription (PPA) in chronic whiplash-associated disorders (WAD) grades 2 and 3. A secondary aim was to identify factors associated with HRQoL and HRQoL improvement following exercise interventions.

METHODS: This is a secondary analysis of a multicentre randomized clinical trial. Participants (n = 216) with chronic WAD grades 2 and 3 were randomized to 12 weeks of PPA or physiotherapist-led NSE or NSEB. The EQ-5D 3L/EQ-VAS and SF-36v2 physical (PCS) and mental (MCS) component summaries were collected together with several neck-related and psychosocial outcomes at baseline, after 3, 6 and 12 months, and were analysed with linear mixed models (all time points) and multivariate linear regressions (baseline, 6 months).

RESULTS: NSE/NSEB resulted in better outcomes than PPA (EQ-VAS and SF-36 PCS, both groups, p < 0.01) but not in a higher EQ-5D score. Improvement over time was seen in EQ-5D/EQ-VAS for the NSEB group (p < 0.01), and for NSE/NSEB as measured with the PCS (p < 0.01). Factors associated with baseline HRQoL and change to 6 months in HRQoL (R2 = 0.38-0.59) were both neck-related and psychosocial (e.g. depression, work ability).

CONCLUSION: Neck-specific exercise, particularly with a behavioural approach, may have a more positive impact on HRQoL than physical activity prescription in chronic WAD grades 2 and 3. HRQoL is however complex, and other factors also need to be considered. Factors associated with HRQL and improvements in HRQoL following exercise are multidimensional.

TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, No. NCT01528579.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Chronic, Exercise, Physiotherapy, Quality of life, Spine, Whiplash
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-154060 (URN)10.1007/s11136-018-2004-3 (DOI)000457880300006 ()30225786 (PubMedID)
Note

Funding agencies: Vetenskapsradet [521-2014-2982]; Swedish Government through the REHSAM Foundation [RS2010/009]; Swedish Research Council; County Council of Ostergotland [LIO-533041, LIO-439541, LIO-197631, IO-276151, LIO-354241]; Centre for Clinical Research Sormland at 

Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-03-07
Lo, H. K., Johnston, V., Landén Ludvigsson, M., Peterson, G., Overmeer, T., David, M. & Peolsson, A. (2018). Factors associated with work ability following exercise interventions for people with chronic whiplash-associated disorders: Secondary analysis of a randomized controlled trial.. Journal of Rehabilitation Medicine, 50
Open this publication in new window or tab >>Factors associated with work ability following exercise interventions for people with chronic whiplash-associated disorders: Secondary analysis of a randomized controlled trial.
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2018 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the efficacy of exercise interventions and factors associated with changes in work ability for people with chronic whiplash-associated disorders.

DESIGN: Secondary analysis of a single-blind, randomized multi-centre controlled trial.

SETTING: Interventions were conducted in Swedish primary care settings.

PATIENTS: A total of 165 individuals with chronic whiplash-associated disorders grade II-III.

METHODS: Participants were randomly allocated to neck-specific exercise, neck-specific exercise with a behavioural approach, or prescribed physical activity interventions. Work ability was evaluated with the Work Ability Index at baseline, 3, 6 and 12 months.

RESULTS: The neck-specific exercise with a behavioural approach intervention significantly improved work ability compared with the prescribed physical activity intervention (3 months, p = 0.03; 6 months, p = 0.01; 12 months, p = 0.01), and neck-specific exercise at 12 months (p = 0.01). Neck-specific exercise was better than the prescribed physical activity intervention at 6 months (p = 0.05). An increase in work ability from baseline to one year for the neck-specific exercise with a behavioural approach group (p < 0.01) was the only significant within-group difference. Higher self-rated physical demands at work, greater disability, greater depression and poorer financial situation were associated with poorer work ability (p < 0.01).

CONCLUSION: This study found that neck-specific exercise with a behavioural approach intervention was better at improving self-reported work ability than neck-specific exercise or prescribed physical activity. Improvement in work ability is associated with a variety of factors.

Place, publisher, year, edition, pages
FOUNDATION REHABILITATION INFORMATION, 2018
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-150587 (URN)10.2340/16501977-2374 (DOI)000447771700008 ()30132011 (PubMedID)
Note

Funding agencies: Swedish government through the Swedish Research Council; Swedish Social Insurance Agency through the REHSAM Foundation Stockholm, Sweden; regional Center for Clinical Research of Ostergotland, Linkoping, Sweden; regional Center for Clinical Research of So

Available from: 2018-08-28 Created: 2018-08-28 Last updated: 2018-11-09
Landén Ludvigsson, M., Peterson, G. & Peolsson, A. (2018). Neck-specific exercise may reduce radiating pain and signs of neurological deficits in chronic whiplash - Analyses of a randomized clinical trial. Scientific Reports, 8(1), Article ID 12409.
Open this publication in new window or tab >>Neck-specific exercise may reduce radiating pain and signs of neurological deficits in chronic whiplash - Analyses of a randomized clinical trial
2018 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, no 1, article id 12409Article in journal (Refereed) Published
Abstract [en]

Up to 90% of people with neurological deficits following a whiplash injury do not recover and cervical muscle dysfunction is common. The aim of this multicentre, randomized controlled trial was to examine whether two versions of neck-specific exercise or prescription of physical activity (PPA) can improve radiating arm pain and clinical signs that can be associated with neurological deficits in people with chronic whiplash associated disorders (WAD). Participants with chronic WAD, arm symptoms and signs associated with neurological deficits (n = 171) were randomized to: 12 weeks of neck-specific exercise without (NSE) or with a behavioural approach (NSEB), or PPA. Pain/bothersomeness frequency, six measures of arm pain/paraesthesia (VAS scales), and four clinical neurological tests were evaluated after 3 months. The NSE group reported the lowest frequency and lowest levels of arm pain, the highest proportion of participants with at least 50% pain reduction and the highest proportion of normal arm muscle force. The NSEB group reported increased normal tendon reflexes. No improvements were recorded for the PPA group. Neck-specific exercise may improve arm pain and decrease signs of neurological deficits, but the addition of a behavioural approach does not seem to be of additional benefit. © 2018, The Author(s).

Place, publisher, year, edition, pages
Nature Publishing Group, 2018
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-150588 (URN)10.1038/s41598-018-30556-w (DOI)000441876700112 ()30120313 (PubMedID)2-s2.0-85051714527 (Scopus ID)
Note

Funding agencies: Swedish government through the REHSAM Foundation [RS2010/009]; Swedish Research Council [521-2014-2982]; regional Center for Clinical Research; County Council of Ostergotland [LIO-533041, LIO-439541, LIO-197631, LIO-276151, LIO-354241]; Centre for Clinica

Available from: 2018-08-28 Created: 2018-08-28 Last updated: 2018-09-21
Landén Ludvigsson, M., Peolsson, A., Peterson, G., Dedering, Å., Johansson, G. & Bernfort, L. (2017). Cost-effectiveness of neck-specific exercise with or without a behavioral approach versus physical activity prescription in the treatment of chronic whiplash-associated disorders Analyses of a randomized clinical trial. Medicine (Baltimore, Md.), 96(25), Article ID e7274.
Open this publication in new window or tab >>Cost-effectiveness of neck-specific exercise with or without a behavioral approach versus physical activity prescription in the treatment of chronic whiplash-associated disorders Analyses of a randomized clinical trial
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2017 (English)In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, no 25, article id e7274Article in journal (Refereed) Published
Abstract [en]

Background: Fifty percent of people injured by whiplash still report neck pain after 1 year and costs associated with whiplash associated disorders (WAD) are mostly attributed to health service and sick-leave costs in chronic conditions. With increasing health care expenditures the economic impact of interventions needs to be considered. Objective: To analyze the cost-effectiveness of physiotherapist-led neck-specific exercise without (NSE) or with a behavioral approach (NSEB), or prescription of physical activity (PPA) in chronic WAD, grade 2 to 3. Methods: This is a secondary cost-effectiveness analysis of a multicenter randomized clinical trial of 216 participants with chronic WAD grade 2 to 3. The interventions were physiotherapist-led neck-specific exercise without or with a behavioral approach, or prescription of physical activity for 12 weeks. Incremental cost-effectiveness ratios (ICERs) were determined after 1 year and bootstrapped cost-effectiveness planes and sensitivity analyses of physiotherapy visits were performed. Health care and production loss costs were included and quality-adjusted life years (QALYs) were estimated, using the Euroqol-5D questionnaire. Comparisons with the Short Form-6D, and neck disability index (NDI) were also made. Results: The 1-year follow-up was completed by 170 participants (79%). Both physiotherapist-led groups improved in health related quality of life. The intervention cost alone, per quality-adjusted life year (QALY) gain in the NSE group was US$12,067. A trend for higher QALY gains were observed in the NSEB group but the costs were also higher. The ICERs varied depending on questionnaire used, but the addition of a behavioral approach to neck-specific exercise alone was not cost-effective from a societal perspective (ICER primary outcome $127,800 [95% confidence interval [CI], 37,816-711,302]). The sensitivity analyses confirmed the results. The prescription of physical activity did not result in any QALY gain and the societal costs were not lower. Conclusion: Neck-specific exercise was cost-effective from a societal perspective in the treatment of chronic WAD compared with the other exercise interventions. ICERS varied depending on health-related quality of life questionnaires used, but the addition of a behavioral approach was not cost-effective from a societal perspective. The prescription of physical activity did not result in any QALY gain and was thus not considered a relevant option.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2017
Keywords
chronic; cost; cost-effectiveness; exercise; physiotherapy; rehabilitation; whiplash
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-139409 (URN)10.1097/MD.0000000000007274 (DOI)000404116900065 ()28640136 (PubMedID)
Note

Funding Agencies|Swedish Research Council; Swedish government through the REHSAM foundation; Medical Research Council of Southeast Sweden; County Council of Ostergotland; regional Center for Clinical Research; Centre for Clinical Research Sormland at Uppsala University; Uppsala-Orebro Regional Research Council, Sweden

Available from: 2017-08-07 Created: 2017-08-07 Last updated: 2019-01-24
Treleaven, J., Peterson, G., Landén Ludvigsson, M., Kammerlind, A.-S. & Peolsson, A. (2016). Balance, dizziness and proprioception in patients with chronic whiplash associated disorders complaining of dizziness: A prospective randomized study comparing three exercise programs. Manual Therapy, 22, 122-130
Open this publication in new window or tab >>Balance, dizziness and proprioception in patients with chronic whiplash associated disorders complaining of dizziness: A prospective randomized study comparing three exercise programs
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2016 (English)In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 22, p. 122-130Article in journal (Refereed) Published
Abstract [en]

Background: Dizziness and unsteadiness are common symptoms following a whiplash injury. Objective: To compare the effect of 3 exercise programs on balance, dizziness, proprioception and pain in patients with chronic whiplash complaining of dizziness. Design: A sub-analysis of a randomized study. Methods: One hundred and forty subjects were randomized to either a physiotherapist-guided neck-specific exercise (NSE), physiotherapist-guided neck-specific exercise, with a behavioural approach (NSEB) or prescription of general physical activity (PPA) group. Pre intervention, 3, 6 and 12 months post baseline they completed the University of California Los Angeles Dizziness Questionnaire (UCLA-DQ), Visual Analogue Scales (VAS) for, dizziness at rest and during activity and physical measures (static and dynamic clinical balance tests and head repositioning accuracy (HRA)). Results: There were significant time by group differences with respect to dizziness during activity and UCLA-Q favouring the physiotherapy led neck specific exercise group with a behavioural approach. Within group analysis of changes over time also revealed significant changes in most variables apart from static balance. Conclusion: Between and within group comparisons suggest that physiotherapist led neck exercise groups including a behavioural approach had advantages in improving measures of dizziness compared with the general physical activity group, although many still complained of dizziness and balance impairment. Future studies should consider exercises specifically designed to address balance, dizziness and cervical proprioception in those with persistent whiplash. Crown Copyright (C) 2015 Published by Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
CHURCHILL LIVINGSTONE, 2016
Keywords
Dizziness; Balance; Proprioception; Whiplash
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-127561 (URN)10.1016/j.math.2015.10.017 (DOI)000373615700021 ()26678652 (PubMedID)
Note

Funding Agencies|Swedish government through the REHSAM foundation; regional Centres for Clinical Research of Ostergotland and Sormland County Councils; Medical Research Council of Southeast Sweden; Swedish government; Swedish Social Insurance Agency through the REHSAM foundation; Centre for Clinical Research Sormland at Uppsala University Sweden; Uppsala-Orebro Regional Research Council Sweden; Swedish Research Council; County Council of Ostergotland; County Council of Jonkoping

Available from: 2016-05-04 Created: 2016-05-03 Last updated: 2017-11-30
Peolsson, A., Landén Ludvigsson, M., Tigerfors, A.-M. & Peterson, G. (2016). Effects of Neck-Specific Exercises Compared to Waiting List for Individuals With Chronic Whiplash-Associated Disorders: A Prospective, Randomized Controlled Study. Archives of Physical Medicine and Rehabilitation, 97(2), 189-195
Open this publication in new window or tab >>Effects of Neck-Specific Exercises Compared to Waiting List for Individuals With Chronic Whiplash-Associated Disorders: A Prospective, Randomized Controlled Study
2016 (English)In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 97, no 2, p. 189-195Article in journal (Refereed) Published
Abstract [en]

Objective: To determine whether 3 months of neck-specific exercises (NSEs) could benefit individuals with chronic whiplash-associated disorder (WAD) who were on a waiting list (WL) for treatment. Design: A prospective, randomized controlled study. Setting: Primary health care. Participants: Individuals (N=41; 31 women, 10 men; mean age +/- SD, 38 +/- 11.2y) with chronic (6-36mo) WAD, grades 2 and 3, were analyzed. Interventions: Patients were randomly assigned to NSEs or no treatment for 3 months. Main Outcome Measures: Neck-specific disability (Neck Disability Index [NDI]), neck pain (visual analog scale), general pain-related disability (Pain Disability Index [PDI]), self-perceived performance ability (Self-Efficacy Scale [SES]), and health-related quality of life (EuroQol 5 dimensions [EQ-5D]) were measured. Results: NSEs significantly improved the NDI, SES, and EQ-5D compared with WL (P&lt;.01). There was significant improvement (P&lt;.0001) over time in all outcomes for NSEs, and apart from the PDI, significant worsening (P=.002-.0002) over time for the untreated group. Conclusions: NSEs were more beneficial than no intervention while on a WL for individuals with chronic WAD. (C) 2016 by the American Congress of Rehabilitation Medicine

Place, publisher, year, edition, pages
W B SAUNDERS CO-ELSEVIER INC, 2016
Keywords
Exercise; Randomized controlled trial; Rehabilitation; Whiplash injuries
National Category
Health Sciences Medical and Health Sciences Physiotherapy
Identifiers
urn:nbn:se:liu:diva-125676 (URN)10.1016/j.apmr.2015.10.087 (DOI)000369207500002 ()26514296 (PubMedID)
Available from: 2016-03-02 Created: 2016-02-29 Last updated: 2017-04-24
Landén Ludvigsson, M., Peterson, G., Dedering, A., Falla, D. & Peolsson, A. (2016). Factors associated with pain and disability reduction following exercise interventions in chronic whiplash. European Journal of Pain, 20(2), 307-315
Open this publication in new window or tab >>Factors associated with pain and disability reduction following exercise interventions in chronic whiplash
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2016 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 20, no 2, p. 307-315Article in journal (Refereed) Published
Abstract [en]

BackgroundSome studies support the prescription of exercise for people with whiplash-associated disorders (WAD); however, the response is highly variable. Further research is necessary to identify factors which predict response. MethodsThis is a secondary analysis of a randomized, multicentre controlled clinical trial of 202 volunteers with chronic WAD (grades 2 and 3). They received either neck-specific exercise with, or without a behavioural approach, or prescription of physical activity for 12weeks. Treatment response, defined as a clinical important reduction in pain or disability, was registered after 3 and 12months, and factors associated with treatment response were explored using logistic regression. ResultsParticipation in the neck-specific exercise group was the only significant factor associated with both neck pain and neck disability reduction both at 3 and 12months. Patients in this group had up to 5.3 times higher odds of disability reduction and 3.9 times higher odds of pain reduction compared to those in the physical activity group. Different baseline features were identified as predictors of response depending on the time point examined and the outcome measure selected (pain vs. disability). ConclusionFactors associated with treatment response after exercise interventions differ in the short and long term and differ depending on whether neck pain or disability is considered as the primary outcome. Participation in a neck-specific exercise intervention, in contrast to general physical activity, was the only factor that consistently indicated higher odds of treatment success. These results support the prescription of neck-specific exercise for individuals with chronic WAD.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2016
National Category
Health Sciences Medical and Health Sciences Physiotherapy
Identifiers
urn:nbn:se:liu:diva-125302 (URN)10.1002/ejp.729 (DOI)000368819500016 ()26031995 (PubMedID)
Note

Funding Agencies|Swedish government through the REH-SAM Foundation; Clinical Research of Ostergotland Council; Clinical Research of Sormland County Council; Medical Research Council of Southeast Sweden; Uppsala-O rebro Regional Research Council Sweden; Swedish Research Council

Available from: 2016-02-24 Created: 2016-02-19 Last updated: 2017-11-30
Landén Ludvigsson, M., Peterson, G., Jull, G., Trygg, J. & Peolsson, A. (2016). Mechanical properties of the trapezius during scapular elevation in people with chronic whiplash associated disorders - A case-control ultrasound speckle tracking analysis. Manual Therapy, 21, 177-182
Open this publication in new window or tab >>Mechanical properties of the trapezius during scapular elevation in people with chronic whiplash associated disorders - A case-control ultrasound speckle tracking analysis
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2016 (English)In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 21, p. 177-182Article in journal (Refereed) Published
Abstract [en]

Background: Approximately 50% of people with Whiplash Associated Disorders (WAD) report longstanding symptoms. The upper trapezius is commonly painful yet its mechanical properties are not fully understood. Objectives: This study examined the deformation of different depths of the upper trapezius muscle during a scapular elevation task (shoulder shrugging) before and following loaded arm abduction. Design and Methods: A cross-sectional case-control study of 36 people (26 female and 10 male, mean age 38 (SD 11)) with chronic WAD and 36 controls, matched for age and gender. Real-time ultrasound recordings of upper trapezius were taken during both scapular elevation tasks. Post-process speckle tracking analysis was undertaken of three different sections of the upper trapezius muscle (superficial, middle, deep). Results: The WAD group had lower deformation of the superficial section of the upper trapezius compared to the control group in both concentric and eccentric phases of scapular elevation (p &lt; 0.05) especially before the loaded arm abduction. After arm abduction, the deformation of the trapezius was reduced in both groups but only significantly in the WAD-group (p = 0.03). Within-group analysis revealed that the control group least engaged the deep section of upper trapezius during the task (p &lt; 0.01). Conclusion: This study, measuring mechanical deformation of the upper trapezius during a scapular elevation task indicates that persons with WAD may display different patterns in engagement of the muscle sections than those in the control group. Further research is needed to replicate and understand the reasons for and implications of this possible change in motor strategy within upper trapezius. (C) 2015 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
CHURCHILL LIVINGSTONE, 2016
Keywords
Ultrasound; Whiplash; Chronic; Trapezius
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-127584 (URN)10.1016/j.math.2015.07.009 (DOI)000373615100024 ()26277485 (PubMedID)
Available from: 2016-05-03 Created: 2016-05-03 Last updated: 2017-04-25
Landén Ludvigsson, M. (2016). Neck-specific exercise with or without a behavioural approach, or prescription of physical activity in chronic whiplash associated disorders. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Neck-specific exercise with or without a behavioural approach, or prescription of physical activity in chronic whiplash associated disorders
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Although 50% of those who suffer a whiplash injury still report neck pain after one year, there is a lack of knowledge about effective treatment for chronic whiplash associated disorders (WAD). Exercise is potentially useful, but the response to exercise in chronic WAD is highly variable between individuals and factors associated with good outcomes as well as the cost-effectiveness are unknown.

Aim: The general aim of this thesis was to evaluate the effect on  self-reported disability/ functioning, pain and selfefficacy of three different exercise interventions in chronic WAD grade 2 and 3, and to determine the cost-effectiveness of these interventions.

Material and methods: A total of 216 participants with chronic WAD took part in this randomized, assessor blinded, controlled, clinical trial. Participants were randomized to either neck-specific exercise without (NSE), or with a behavioural approach (NSEB), or prescription of physical activity (PPA) for 12 weeks. Evaluations of change scores and proportion of clinically relevantly improved participants regarding disability/functioning (Neck Disability Index (NDI)/Patient Specific Functional Scale (PSFS)), pain (Visual Analogue Scale of current neck pain (VAS-P), pain bothersomeness (VAS-B)) and Self-efficacy (Self-Efficacy Scale (SES)) were made after 3, 6, 12 and 24 months. Secondary analyses were made, regarding factors associated with clinically relevant improvements in disability, pain and regarding cost-effectiveness.

Results: Disability was more improved in the NSE/NSEB groups (NDI, P=0.02) than the PPA group, which reported no improvement, at 3 and 6 months, results remaining at 12 and 24 months (p ≤ 0.02). Functioning (PSFS) was also more improved in the NSE/NSEB groups than the PPA group at 3 months, in the NSEB compared to the PPA group at 6 months, and the NSE compared to the PPA groups at 12 and 24 months. The proportion of participants reaching clinically relevant improvement regarding NDI and PSFS was also larger in the NSE/NSEB groups at all time points (P<0.05), except NDI at 3 months and PSFS at 24 months. There were no differences between groups in VAS-P, VASB or SES change scores. The proportion of participants with clinically relevant reduction in VAS-P and VAS-B was however higher (P<0.02) in the NSE/NSEB groups compared with the PPA group at 3 and 12 months. Self-efficacy was only improved in the NSE group but without any between-group differences. There were no significant differences in any outcomes between the NSE/NSEB groups.

The only significant factor associated with both clinically relevant improvements in disability and neck pain both at 3 and 12 months was participation in the NSE group, with odds up to 5.3 times higher than in the PPA group. Different baseline features were associated with the improvements depending on the outcome and time point examined. From a societal perspective, NSE was the cost-effective option.

Conclusion: Physiotherapist-led neck-specific exercise resulted in better outcomes than prescription of physical activity regarding disability, functioning, and pain. The observed benefits of adding a behavioural approach to neck-specific exercise were inconclusive, and NSE was the cost-effective option from a societal perspective. Factors associated with clinically relevant improvements after exercise interventions in chronic WAD differed whether disability or neck pain was the outcome, but also differed in the short and long term. Participation in the NSE group was the only factor associated with both outcomes after both 3 and 12 months.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. p. 82
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1509
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-126782 (URN)10.3384/diss.diva-126782 (DOI)978-91-7685-839-4 (ISBN)
Public defence
2016-05-20, Berzeliussalen, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Research CouncilRegion ÖstergötlandMedical Research Council of Southeast Sweden (FORSS)
Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2019-10-29Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3259-3133

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