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  • 1.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia.
    Evidence base and future research directions in the management of low back pain2016In: World Journal of Orthopedics, ISSN 2218-5836, E-ISSN 2218-5836, Vol. 7, no 3, p. 156-161Article in journal (Other academic)
    Abstract [en]

    Low back pain (LBP) is a prevalent and costly condition. Awareness of valid and reliable patient history taking, physical examination and clinical testing is important for diagnostic accuracy. Stratified care which targets treatment to patient subgroups based on key characteristics is reliant upon accurate diagnostics. Models of stratified care that can potentially improve treatment effects include prognostic risk profiling for persistent LBP, likely response to specific treatment based on clinical prediction models or suspected underlying causal mechanisms. The focus of this editorial is to highlight current research status and future directions for LBP diagnostics and stratified care.

  • 2.
    Abbott, Allan
    et al.
    Department of Physical Therapy, Neuro R1:07, Karolinska University Hospital, Stockholm, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Huddinge, Sweden; Institute of Health and Sport, Bond University, Queensland, Australia.
    Ghasemi-Kafash, Elaheh
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Huddinge, Sweden.
    Dedering, Åsa
    Department of Physical Therapy, Neuro R1:07, Karolinska University Hospital, Stockholm, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Huddinge, Sweden.
    The validity of using an electrocutaneous device for pain assessment in patients with cervical radiculopathy2014In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 30, no 7, p. 500-506Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to evaluate the validity and preference for assessing pain magnitude with electrocutaneous testing (ECT) compared to the visual analogue scale (VAS) and Borg CR10 scale in men and women with cervical radiculopathy of varying sensory phenotypes. An additional purpose was to investigate ECT sensory and pain thresholds in men and women with cervical radiculopathy of varying sensory phenotypes. This is a cross-sectional study of 34 patients with cervical radiculopathy. Scatterplots and linear regression were used to investigate bivariate relationships between ECT, VAS and Borg CR10 methods of pain magnitude measurement as well as ECT sensory and pain thresholds. The use of the ECT pain magnitude matching paradigm for patients with cervical radiculopathy with normal sensory phenotype shows good linear association with arm pain VAS (R(2) = 0.39), neck pain VAS (R(2) = 0.38), arm pain Borg CR10 scale (R(2) = 0.50) and neck pain Borg CR10 scale (R(2) = 0.49) suggesting acceptable validity of the procedure. For patients with hypoesthesia and hyperesthesia sensory phenotypes, the ECT pain magnitude matching paradigm does not show adequate linear association with rating scale methods rendering the validity of the procedure as doubtful. ECT for sensory and pain threshold investigation, however, provides a method to objectively assess global sensory function in conjunction with sensory receptor specific bedside examination measures.

  • 3.
    Abbott, Allan
    et al.
    Physiotherapist, Department for Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
    Halvorsen, Marie
    Physiotherapist, Department for Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
    Dedering, Åsa
    Physiotherapist, Department for Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
    Is there a need for cervical collar usage post anterior cervical decompression and fusion?: A randomized control pilot trial2013In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 29, no 4, p. 290-300Article in journal (Refereed)
    Abstract [en]

    Anterior cervical discectomy and fusion (ACDF) is a common surgical intervention for radiculopathy resulting from degenerative cervical spine conditions. Post-surgical cervical collar use is believed to reduce post-operative pain, provide the patient with a sense of security during activities of daily living and even reduce rates of non-fusion. This prospective randomized controlled pilot trial investigates trial design feasibility in relation to prospective physical, functional, and quality of life-related outcomes of patients undergoing ACDF with interbody cage, with (n = 17) and without (n = 16) post-operative cervical collar usage. Results show that the sample provides sufficient statistical power to show that the use of a rigid cervical collar during 6 post-operative weeks is associated with significantly lower levels of neck disability index after 6 weeks and significantly lower levels of prospective neck pain. To investigate causal quality of life or fusion rate outcomes, sample size needs to be increased at least fourfold and optimally sixfold when accounting for data loss in prospective follow-up. The study suggests that post-surgical cervical collar usage may help certain patients cope with initial post-operative pain and disability.

  • 4.
    Abbott, Allan
    et al.
    Karolinska University Hospital, Sweden; Karolinska Institute, Sweden; Bond University, Australia.
    Kjellman, Görel
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Multidimensional assessment of pain related disability after surgery for cervical disc disease2013In: APA Conference 2013: New moves, Australian Physiotherapy Association , 2013, p. 2-2Conference paper (Other academic)
    Abstract [en]

    Questions: Given only 25% of patients, 10 year post-surgery for cervical disc disease report clinically meaningful improvements in functional disability, what are the biopsychosocial factors associated with continued long-term disability? What are the implications for physiotherapy practice?

    Design: Cross-sectional observational study.

    Participants: Ninety patients who had undergone anterior discectomy and fusion (ACDF) surgery 10-13 years prior.

    Outcome Measures: The Neck Disability Index (NDI), ACDF surgery type, surgical fusion status, patient age and Part 1 of the West Haven-Yale multidimensional pain inventory Swedish version (MPI-S) were entered into a statistical model. Part 1 of the MPI-S contains 5 subscales: pain severity, interference, life control, affective distress and support.

    Results: Seventy-three patients answered the questionnaires. Non-linear categorical regression modeling (CATREG) of the selected predictive variables explained 76.1% of the variance in NDI outcomes 10-13 years post ACDF. Of these predictors, MPI-S affective distress subscale (β = 0.635, p = <0.001) and pain severity subscale (β = 0.354, p = <0.001) were significant individual predictors of NDI ratings.

    Conclusion: This is the first study to investigate potential factors associated with prolonged functional disability greater than 10 years post-surgery for cervical disc disease. The results suggest the importance of not only pain severity but also screening affective distress as a potential barrier to physical functioning in patients previously operated for cervical disc disease. Future research on the utility of affect-focused body awareness therapy and pain coping strategies for post-surgical patients with continuing pain and physical disability is indicated.

    Key Practice Points:

    •  The screening of pain severity and affective distress is of importance for patients presenting with continuing physical disability after previous surgery for cervical disc disorders

    •  Affect-focused body awareness therapies and pain coping strategies may be a potential treatment alternative for patients with continuing pain and physical disability.

  • 5.
    Abbott, Allan
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Tynni-Lenne, Raija
    Karolinska Institute, Stockholm, Sweden.
    Hedlund, Rune
    Karolinska Institute, Stockholm, Sweden.
    Early physiotherapeutic rehabilitation following lumbar spinal fusion surgery2009In: Oral Presentations: Cervical Spine: The Surgical Treatment of Painful Disorders, Springer, 2009, Vol. 18, Supplement 4, p. S409-S410Conference paper (Other academic)
    Abstract [en]

    Background: Physiotherapy after lumbar spinal fusion surgery is traditionally focused on physical exercise. Too few studies have investigatedthe efficacy of modern lumbar stabilization exercise regimes. Benefits have been shown for combining traditional physical exercise with a psychosocial intervention. No randomised controlled study has evaluated thecombined biopsychosocial effect of modern lumbar stabilization exercisesand cognitive behavioural intervention compared to traditional physical exercise starting immediately after lumbar spinal fusion.

    Purpose: To investigate the effectiveness of modern physiotherapy(MPT) compared to a traditional physiotherapy (TPT) starting immediately after lumber spinal fusion.

    Study design/setting: Randomized controlled clinical trial.

    Patient sample, inclusion period and follow-up: Patients between 18 and 65 years, selected for lumbar spinal fusion due to at least 12 months of CLBP symptoms caused by spinal stenosis, spondylosis, spondylolisthesis or degenerative disc disease were included in the study between 2005 and 2007. A total of 107 patients were randomly allocated to the MPT group (n = 53) and TPT group (n = 54). The TPT group was prescribed daily home based pain contingent training of traditional physical exercises for back, abdominal and leg muscles. The MPT group was prescribed daily home based training of lumbar stabilization exercises combined with 90 min of cognitive behavioural intervention at 3, 6 and 9 weeks after the operation. The patients outcomes were followed up at 3, 6, 12 months and 2–3 years

    Outcome measures: Oswestry disability index (ODI), pain intensity, HRQOL, kinesiophobia, anxiety/depression, self-efficacy, outcome expectancy, use of coping strategies, work status, sickness leave and health care use.

    Methods: Analysis of mean differences between groups.

    Results: 2–3 year follow-up showed that the MPT group had significantly lower percentage scores in ODI = 18.2 (P = 0.008), kinesiophobia= 30.0 (P = 0.001), catastrophizing = 21.8 (P = 0.006) and higher self-efficacy = 64.6 (P = 0.019) compared to TPT group’s ODI = 28.1, kinesiophobia = 41.9, catastrophizing = 31.3 and self-efficacy = 55.5. The MPT group had significantly more employment, less health care use (P = 0.035) and less long-term sickness leave (P = 0.040).

    Conclusions: This study provides evidence for the benefits of combining lumbar stabilization exercise and cognitive behavioural intervention starting immediately after lumbar fusion.

  • 6.
    Abbott, Allan
    et al.
    Karolinska University Hospital, Stockholm, Sweden.
    Tynni-Lenné, R
    Karolinska University Hospital, Stockholm, Sweden; Karolinska Institute, Stockholm, Sweden.
    Hedlund, R
    Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    The effectiveness of physiotherapeutic rehabilitation and issues of outcome prediction after lumber fusion surgery.2011In: Proceedings of the WCPT Congress, Amsterdam Netherlands. / [ed] Physiotherapy, World Confederation of Physical Therapy , 2011, Vol. 97 (Suppl 1), p. 20-Conference paper (Other academic)
    Abstract [en]

    Purpose: The primary purpose was to analyse the short and long term effectiveness of physiotherapeutic rehabilitation programs performed during the first 3 month after lumbar fusion surgery. A secondary purpose was to analyse factors predicting long-term disability, back pain and health related quality of life (HRQOL) outcomes after lumbar fusion.

    Relevance: The study provides evidence for the effectiveness of early physiotherapy after lumbar fusion. Furthermore improved knowledge of predictive factors can help physiotherapist in the screening of lumbar fusion candidates and the individualised implementation of pre-surgical and post-surgical interventions.

    Participants: A total of 107 patients were recruited from the Karolinska University Hospital's Orthopaedic Clinic, Stockholm, Sweden. The inclusion criteria were: men and women aged between 18 and 65 years with a >12 month history of back pain and/or sciatica; a primary diagnosis of spinal stenosis, degenerative or isthmic spondylolisthesis or degenerative disc disease; selected for lumbar fusion with or without decompression; competence in the Swedish language. The criteria for exclusion were: previous lumbar fusion, rheumatoid arthritis and ankylosing spondylitis.

    Methods: An open book randomised controlled trial with pre-surgical and post-surgical measures at 3, 6, 12 and 24-36 months was performed to investigate the effectiveness of a psychomotor therapy focusing on cognition, behaviour and motor relearning compared to exercise therapy focusing on strength and conditioning, applied during the first 3 months after lumbar fusion. Randomisation allocated 53 patients to psychomotor therapy and 54 patients to exercise therapy. The Oswestry disability index (ODI) was the primary outcome measure. Secondary measures included the Visual analogue scale for back pain (VAS), European quality of life questionnaire (EQ5D), as well as other clinical, psychological and work related variables.

    Analysis: A total of 78 patients were needed assuming a power = 80%. Patient compliance was analysed and an intention to treat principle applied to data analysis. For statistical comparison between the 2 independent groups, analysis of covariance was used. Categorical regression with optimal scaling transformation, elastic net regularization and bootstrapping were used to investigate pre-surgical predictor variables and address predictive model validity.

    Results: Follow-up rates were 93% at 12 months and 81% at 24-36 months after surgery. Psychomotor therapy improved functional disability, self-efficacy, outcome expectancy and fear of movement/(re)injury significantly more than exercise therapy at respective follow-up occasions. Pre-surgical control over pain significantly predicted functional disability and HRQOL. Pre-surgical catastrophizing and leg pain intensity significantly predicted functional disability and back pain while the pre-surgical lasegue test significantly predicted back pain. The implementation of post-operative psychomotor therapy also significantly predicted functional disability while pre-surgical outcome expectations significantly predicted HRQOL.

    Conclusions: The study shows that post-operative rehabilitation can be safely implemented during the first 3 months after lumbar fusion and should include measures to modify psychological as well as motor functions. The study also demonstrates the importance of pre-surgical psychological factors, leg pain intensity, the lasegue test and post-operative psychomotor therapy in the predictions of functional disability, back pain and HRQOL related outcomes.

    Implications: Physiotherapist should screen patients pain, psychological factors and neuromusculoskeletal system pre-surgically and rehabilitate patients with early psychomotor therapy after lumbar fusion.

  • 7.
    Abbott, Allan
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Tynni-Lenné, Raija
    Karolinska Institute, Stockholm, Sweden.
    Hedlund, Rune
    Gothenburg University, Gothenburg, Sweden.
    Early rehabilitation targeting cognition, behaviour and motor function after lumbar fusion: A randomised controlled trial2010In: Abstracts: Oral Presentations, 2010, p. 186-186Conference paper (Other academic)
    Abstract [en]

    Study Design: Open label randomised controlled trial with 3, 6, 12 month and 2-3 year follow-up.

    Objective. To investigate the effectiveness of a psychomotor therapy focusing on cognition, behaviour and motor relearning compared to exercise therapy applied during the first 3 months after lumbar fusion.

    Methods: The study recruited 107 patients, aged 18 to 65 years, selected for lumbar fusion due to 12 months of symptomatic spinal stenosis, degenerative/isthmic spondylolisthesis or degenerative disc disease. The exercise therapy group received a home program focusing on pain contingent training of back, abdominal and leg muscle functional strength and endurance, stretching and cardiovascular fitness. The psychomotor therapy group received a home program and 3 outpatient sessions focusing on modifying maladaptive pain cognitions, behaviours and motor control. Patient-rated questionnaires investigating functional disability, pain, health related quality of life, functional self-efficacy, outcome expectancy, fear of movement/(re)injury and copingwere assessed at baseline, 3, 6, 12 months and 2-3 years after surgery.

    Results: Follow-up rates were 93% at 12 months and 81% at 2-3 years after surgery. Psychomotor therapy improved functional disability, self-efficacy, outcome expectancy and fear of movement/(re)injury significantly more than exercise therapy at respective follow-up occasions. Similar results occurred for pain coping but group differences were non-significant at 2-3 year follow-up.

    Conclusions: The study shows that post-operative rehabilitation can be effectively implemented during the first 3 months after lumbar fusion and should include measures to modify psychological aswell as motor functions.

  • 8.
    Agnew, Louise
    et al.
    University of Queensland, Australia.
    Johnston, Venerina
    University of Queensland, Australia.
    Landén Ludvigsson, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Rehabilitation in Motala.
    Peterson, Gunnel
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Uppsala University, Sweden.
    Overmeer, Thomas
    Malardalen University, Sweden; University of Örebro, Sweden.
    Johansson, Gun
    Karolinska Institute, Sweden.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. University of Queensland, Australia.
    FACTORS ASSOCIATED WITH WORK ABILITY IN PATIENTS WITH CHRONIC WHIPLASH-ASSOCIATED DISORDER GRADE II-III: A CROSS-SECTIONAL ANALYSIS2015In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, no 6, p. 546-551Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the factors related to self-perceived work ability in patients with chronic whiplash-associated disorder grades II-III. Design: Cross-sectional analysis. Patients: A total of 166 working age patients with chronic whiplash-associated disorder. Methods: A comprehensive survey collected data on work ability (using the Work Ability Index); demographic, psychosocial, personal, work- and condition-related factors. Forward, stepwise regression modelling was used to assess the factors related to work ability. Results: The proportion of patients in each work ability category were as follows: poor (12.7%); moderate (39.8%); good (38.5%); excellent (9%). Seven factors explained 65% (adjusted R-2 = 0.65, p less than 0.01) of the variance in work ability. In descending order of strength of association, these factors are: greater neck disability due to pain; reduced self-rated health status and health-related quality of life; increased frequency of concentration problems; poor workplace satisfaction; lower self-efficacy for performing daily tasks; and greater work-related stress. Conclusion: Condition-specific and psychosocial factors are associated with self-perceived work ability of individuals with chronic whiplash-associated disorder.

  • 9.
    Alföldi, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dragioti, Elena
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Wiklund, Tobias
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    SPREADING OF PAIN AND INSOMNIA IN PATIENTS WITH CHRONIC PAIN: RESULTS FROM A NATIONAL QUALITY REGISTRY (SQRP)2017In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, no 1, p. 63-70Article in journal (Refereed)
    Abstract [en]

    Objective: To explore how demographics, pain, psychosocial factors and insomnia relate to the spread of chronic pain. Methods: The study included 708 patients (68% women; median age 46 years; interquartile range 3557 years) with chronic pain who were referred to a multidisciplinary pain centre. Spreading of pain was assessed using a questionnaire covering 36 anatomically predefined pain regions. Data were collected on demographics, pain symptoms, psychological distress, and insomnia (Insomnia Severity Index). Four sub-categories of chronic pain were established: chronic local pain, chronic regional pain medium, chronic regional pain heavy, and chronic widespread pain. Results: The median number of pain regions was 10 (interquartile range 6-18). Prevalence of chronic pain was as follows: chronic local pain 9%, chronic regional pain medium 21%, chronic regional pain heavy 39%, and chronic widespread pain 31%. In the regression models, being a woman and persistent pain duration had the strongest associations with spreading of pain, but anxiety, pain interference, and insomnia were also important factors. Conclusion: Spreading of chronic pain can only partly be explained by the simultaneous levels of insomnia. Female sex, pain duration, pain interference and anxiety appear to have more significant relationships with the spread of pain. Targeting these factors may lead to improvements in treatment and prevention strategies.

  • 10.
    Andersson, Siv Folkhammar
    et al.
    Unit of Rehabilitation, Kalmar County Council, Oskarshamn, Sweden.
    Bergman, Stefan
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Henriksson Welin, Elisabet
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Divison of Nursing, Department of Neurobiology, Care Sciences and Society,Karolinska Institutet, Huddinge, Sweden.
    Bremander, Ann
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden.
    Arthritis management in primary care: A study of physiotherapists current practice, educational needs and adherence to national guidelines2017In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 15, no 4, p. 333-340Article in journal (Refereed)
    Abstract [en]

    Background

    With an increasing number of patients with osteoarthritis (OA) and rheumatoid arthritis (RA) in primary care, our aim was to investigate arthritis‐related practice in physiotherapy and to study adherence to evidence‐based care.

    Methods

    Seventy physiotherapists (PTs) working in primary care were emailed a questionnaire to investigate current practice and the number of roles assumed by PTs, the degree of confidence, educational needs and adherence to national guidelines in managing patients with OA or RA. Interventions supported by national guidelines were compared with reports of treatment modalities in the questionnaire.

    Results

    Sixty‐four (91%) PTs responded, and they reported a higher degree of confidence in assessment, treatment and education of patients with OA than for those with RA (p < 0.001). The total number of roles assumed by the PTs was higher in the management of OA than for RA (p < 0.001). PTs who assumed a greater number of roles also reported a stronger degree of confidence in assessing OA (p = 0.036). Those who assumed fewer roles also reported less confidence in RA treatment (p = 0.045). Recommendations in the guidelines were followed by the majority of PTs for eight of 11 treatment modalities in OA and for six of six in RA.

    Conclusions

    PTs reported a lower degree of confidence and the assumption of fewer roles in managing patients with RA compared with OA. There was good adherence to the national guidelines for almost all the treatment modalities listed. Even so, the results indicate a need for education, especially in chronic inflammatory arthritis care.

  • 11.
    Anund, Anna
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Swedish National Rd and Transport Research Institute VTI, Linkoping, Sweden..
    Ahlström, Christer
    Swedish National Rd and Transport Research Institute, Linkoping, Sweden.
    Fors, Carina
    Swedish National Rd and Transport Research Institute, Linkoping, Sweden.
    Åkerstedt, Torbjorn
    Karolinska Institute, Sweden; Stockholm University, Sweden.
    Are professional drivers less sleepy than non-professional drivers?2018In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 44, no 1, p. 88-95Article in journal (Refereed)
    Abstract [en]

    Objective It is generally believed that professional drivers can manage quite severe fatigue before routine driving performance is affected. In addition, there are results indicating that professional drivers can adapt to prolonged night shifts and may be able to learn to drive without decreased performance under high levels of sleepiness. However, very little research has been conducted to compare professionals and non-professionals when controlling for time driven and time of day. Method The aim of this study was to use a driving simulator to investigate whether professional drivers are more resistant to sleep deprivation than non-professional drivers. Differences in the development of sleepiness (self-reported, physiological and behavioral) during driving was investigated in 11 young professional and 15 non-professional drivers. Results Professional drivers self-reported significantly lower sleepiness while driving a simulator than nonprofessional drivers. In contradiction, they showed longer blink durations and more line crossings, both of which are indicators of sleepiness. They also drove faster. The reason for the discrepancy in the relation between the different sleepiness indicators for the two groups could be due to more experience to sleepiness among the professional drivers or possibly to the faster speed, which might unconsciously have been used by the professionals to try to counteract sleepiness. Conclusion Professional drivers self-reported significantly lower sleepiness while driving a simulator than non-professional drivers. However, they showed longer blink durations and more line crossings, both of which are indicators of sleepiness, and they drove faster.

  • 12.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Ekas, Guri
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway.
    Grindem, Hege
    Norwegian Sch Sport Sci, Norway.
    Moksnes, Havard
    Norwegian Sch Sport Sci, Norway.
    Anderson, Allen
    Not Found:[Ardern, Clare L.] Linkoping Univ, Div Physiotherapy, Linkoping, Sweden; [Ardern, Clare L.] La Trobe Univ, Sch Allied Hlth, Melbourne, Vic, Australia; [Ekas, Guri; Engebretsen, Lars] Oslo Univ Hosp, Div Orthopaed Surg, Oslo, Norway; [Ekas, Guri; Moksnes, Havard; Engebretsen, Lars] Norwegian Sch Sport Sci, Oslo Sports Trauma Res Ctr OSTRC, Oslo, Norway; [Ekas, Guri; Engebretsen, Lars] Univ Oslo, Inst Clin Med, Oslo, Norway; [Grindem, Hege] Norwegian Sch Sport Sci, Dept Sports Med, Oslo, Norway; [Chotel, Franck] Hop Femme Mere Enfant, Dept Pediat Orthopaed Surg, Lyon, France; [Cohen, Moises] Univ Fed Sao Paulo, Dept Orthoped, Sao Paulo, Brazil; [Forssblad, Magnus] Karolinska Inst, Stockholm Sports Trauma Res Ctr, Stockholm, Sweden; [Ganley, Theodore J.] Childrens Hosp Philadelphia, Dept Orthopaed, Philadelphia, PA 19104 USA; [Feller, Julian A.] Epworth Healthcare, OrthoSport Victoria Res Unit, Melbourne, Vic, Australia; [Feller, Julian A.] La Trobe Univ, Coll Sci Hlth and Engn, Melbourne, Vic, Australia; [Karlsson, Jon] Univ Gothenburg, Sahlgrenska Acad, Dept Orthopaed, Gothenburg, Sweden; [Kocher, Mininder S.; Micheli, Lyle] Boston Childrens Hosp, Div Sports Med, Boston, MA USA; [Kocher, Mininder S.; Micheli, Lyle] Harvard Med Sch, Boston, MA USA; [LaPrade, Robert F.] Steadman Philippon Res Inst, Vail, CO USA; [LaPrade, Robert F.] Steadman Clin, Vail, CO USA; [McNamee, Mike] Swansea Univ, Coll Engn, Swansea, W Glam, Wales; [Mandelbaum, Bert] Santa Monica Orthopaed and Sports Med Grp, Los Angeles, CA USA; [Micheli, Lyle] Micheli Ctr Sports Injury Prevent, Waltham, MA USA; [Mohtadi, Nicholas] Univ Calgary, Ctr Sports Med, Calgary, AB, Canada; [Reider, Bruce] Univ Chicago, Dept Orthopaed and Rehabil Med, Chicago, IL 60637 USA; [Roe, Justin] North Sydney Orthopaed and Sports Med Ctr, Sydney, NSW, Australia; [Seil, Romain] Ctr Hosp Luxembourg, Dept Orthopaed Surg, Luxembourg, Luxembourg; [Seil, Romain] Luxembourg Inst Hlth, Sports Med Res Lab, Luxembourg, Luxembourg; [Siebold, Rainer] Ruprecht Karls Univ Heidelberg, Inst Anat and Cell Biol, Heidelberg, Germany; [Siebold, Rainer] HKF Int Ctr Hip Knee Foot Surg and Sportstraumatol, ATOS Klin, Heidelberg, Germany; [Silvers-Granelli, Holly J.] FIFA Med Ctr Excellence, Veloc Phys Therapy, Los Angeles, CA USA; [Soligard, Torbjorn; Engebretsen, Lars] Int Olymp Comm, Med and Sci Dept, Lausanne, Switzerland; [Soligard, Torbjorn] Univ Calgary, Fac Kinesiol, Sports Injury Prevent Ctr, Calgary, AB, Canada; [Witvrouw, Erik] Univ Ghent, Fac Med and Healthsci, Dept Rehabil Sci and Physiotherapy, Ghent, Belgium;.
    Chotel, Franck
    Hop Femme Mere Enfant, France.
    Cohen, Moises
    Univ Fed Sao Paulo, Brazil.
    Forssblad, Magnus
    Karolinska Inst, Sweden.
    Ganley, Theodore J.
    Childrens Hosp Philadelphia, PA 19104 USA.
    Feller, Julian A.
    Epworth Healthcare, Australia; La Trobe Univ, Australia.
    Karlsson, Jon
    Univ Gothenburg, Sweden.
    Kocher, Mininder S.
    Boston Childrens Hosp, MA USA; Harvard Med Sch, MA USA.
    LaPrade, Robert F.
    Steadman Philippon Res Inst, CO USA; Steadman Clin, CO USA.
    McNamee, Mike
    Swansea Univ, Wales.
    Mandelbaum, Bert
    Santa Monica Orthopaed and Sports Med Grp, CA USA.
    Micheli, Lyle
    Boston Childrens Hosp, MA USA; Harvard Med Sch, MA USA; Micheli Ctr Sports Injury Prevent, MA USA.
    Mohtadi, Nicholas
    Univ Calgary, Canada.
    Reider, Bruce
    Univ Chicago, IL 60637 USA.
    Roe, Justin
    North Sydney Orthopaed and Sports Med Ctr, Australia.
    Seil, Romain
    Ctr Hosp Luxembourg, Luxembourg; Luxembourg Inst Hlth, Luxembourg.
    Siebold, Rainer
    Ruprecht Karls Univ Heidelberg, Germany; HKF Int Ctr Hip Knee Foot Surg and Sportstraumatol, Germany.
    Silvers-Granelli, Holly J.
    FIFA Med Ctr Excellence, CA USA.
    Soligard, Torbjorn
    Int Olymp Comm, Switzerland; Univ Calgary, Canada.
    Witvrouw, Erik
    Univ Ghent, Belgium.
    Engebretsen, Lars
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway; Int Olymp Comm, Switzerland.
    2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries2018In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, no 4, p. 989-1010Article in journal (Refereed)
    Abstract [en]

    In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric anterior cruciate ligament (ACL) injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery and Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America, and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis, and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions.

  • 13.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe University, Melbourne, Australia.
    Glasgow, Philip
    Sports Medicine, Sports Institute of Northern Ireland, Newtownabbey, UK.
    Schneiders, Anthony G
    School of Human, Health and Social Sciences, Central Queensland University, Branyan, Australia.
    Witvrouw, Erik
    Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Clarsen, Benjamin
    Oslo Sports Trauma Research Center, Oslo, Norway.
    Cools, Ann Mj
    Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Gojanovic, Boris
    Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Switzerland; Sports Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
    Griffin, Steffan
    College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
    Khan, Karim
    Department of Family Practice, The University of British Columbia, Vancouver, Canada; Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada.
    Moksnes, Håvard
    Oslo Sports Trauma Research Center, Oslo, Norway.
    Mutch, Stephen
    SPACE Clinics, Edinburgh, UK; Scottish Rugby, Edinburgh, UK.
    Phillips, Nicola
    Postgraduate Healthcare Studies, Cardiff University, Cardiff, UK.
    Reurink, Guus
    Sports Medicine, Sports Physicians Group, Amsterdam, The Netherlands.
    Sadler, Robin
    Sports Medicine, Manchester City Football Club Ltd, Manchester, UK; Derby County FC, Derby, UK.
    Gravare Silbernagel, Karin
    Department of Physical Therapy, University of Delaware, Newark, USA.
    Thorborg, Kristian
    Sports Orthopaedic Research Center Copenhagen (SORC-C), Amager-Hvidovre Hospital, Copenhagen, Denmark; Department of Orthopaedic Surgery and Physical Therapy, Amager-Hvidovre Hospital, Copenhagen, Denmark.
    Wangensteen, Arnlaug
    Oslo Sports Trauma Research Center, Oslo, Norway; Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
    Wilk, Kevin
    Champion Sports Medicine, Birmingham, USA.
    Bizzini, Mario
    Schulthess Clinic, Zürich, Switzerland.
    Infographic: 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern2017In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 51, no 13, p. 995-995Article in journal (Refereed)
  • 14.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Aspetar Orthopaed and Sports Medical Hospital, Qatar; La Trobe University, Australia; Uppsala University, Sweden.
    Peterson, Gunnel
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Uppsala University, Sweden.
    Landén Ludvigsson, Maria
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Rehabilitation in Motala. Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Satisfaction With the Outcome of Physical Therapist-Prescribed Exercise in Chronic Whiplash-Associated Disorders: Secondary Analysis of a Randomized Clinical Trial2016In: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 46, no 8, p. 640-+Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: Secondary analysis of a randomized clinical trial. BACKGROUND: Patient perception of the benefits gained from treatment is important, yet satisfaction with the outcome of treatment for chronic whiplash-associated disorders (WADs) has not been investigated. OBJECTIVES: To investigate whether satisfaction with the outcome of treatment for chronic WAD changed over time, and whether there were group differences. METHODS: Two hundred sixteen people with chronic WAD (66% women; mean age, 40.4 years) participated in a 3-month program of physical therapist-led neck-specific exercises with or without a behavioral approach, or received a prescription of general physical activity. The main outcome was satisfaction with the outcome of treatment, assessed at baseline and 3, 6, and 12 months later. Additional outcomes were enablement and expectation fulfillment. RESULTS: Satisfaction improved over time in the 3 groups (odds ratio = 1.15; 95% confidence interval: 1.10, 1.20; P amp;lt; .001). There was a significant group-by-time interaction (P amp;lt; 001), with increased odds of being satisfied in the groups receiving neck-specific exercises compared to general physical activity. Enablement increased after completion of the intervention in all groups (P amp;lt; .001). People who received neck-specific exercises reported greater enablement and expectation fulfillment than people prescribed general physical activity (P amp;lt; .01). CONCLUSION: Exercise interventions for chronic WAD led to increased satisfaction for 12 months following treatment that was unrelated to the type of exercise intervention received.

  • 15.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. School of Allied Health, La Trobe University, Melbourne, Australia, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
    Tagesson (Sonesson), Sofi
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Forssblad, M
    Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden. Capio Artro Clinic, Sophiahemmet, Stockholm, Sweden..
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Comparison of patient-reported outcomes among those who chose ACL reconstruction or non-surgical treatment.2017In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 27, no 5, p. 535-544Article in journal (Refereed)
    Abstract [en]

    The aim of our study was to cross-sectionally compare patient-reported knee function outcomes between people who chose non-surgical treatment for ACL injury and those who chose ACL reconstruction. We extracted Knee Injury and Osteoarthritis Outcome Score (KOOS) and EuroQoL-5D data entered into the Swedish National ACL Registry by patients with a non-surgically treated ACL injury within 180 days of injury (n = 306), 1 (n = 350), 2 (n = 358), and 5 years (n = 114) after injury. These data were compared cross-sectionally to data collected pre-operatively (n = 306) and at 1 (n = 350), 2 (n = 358), and 5 years (n = 114) post-operatively from age- and gender-matched groups of patients with primary ACL reconstruction. At the 1 and 2 year comparisons, patients who chose surgical treatment reported superior quality of life and function in sports (1 year mean difference 12.4 and 13.2 points, respectively; 2 year mean difference 4.5 and 6.9 points, respectively) compared to those who chose non-surgical treatment. Patients who chose ACL reconstruction reported superior outcomes for knee symptoms and function, and in knee-specific and health-related quality of life, compared to patients who chose non-surgical treatment.

  • 16.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Österberg, Annika
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Uppsala Univ, Ctr Clin Res Sormland, Eskilstuna, Sweden.
    Tagesson (Sonesson), Sofi
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Gauffin, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Webster, Kate E.
    La Trobe University, Australia.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction2014In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, no 22, p. 1613-U50Article in journal (Refereed)
    Abstract [en]

    Background This cross-sectional study aimed to examine whether appraisal of knee function, psychological and demographic factors were related to returning to the preinjury sport and recreational activity following anterior cruciate ligament (ACL) reconstruction. Method 164 participants completed a questionnaire battery at 1-7 years after primary ACL reconstruction. The battery included questionnaires evaluating knee self-efficacy, health locus of control, psychological readiness to return to sport and recreational activity, and fear of reinjury; and self-reported knee function in sport-specific tasks, knee-related quality of life and satisfaction with knee function. The primary outcome was returning to the preinjury sport or recreational activity. Results At follow-up, 40% (66/164) had returned to their preinjury activity. Those who returned had more positive psychological responses, reported better knee function in sport and recreational activities, perceived a higher knee-related quality of life and were more satisfied with their current knee function. The main reasons for not returning were not trusting the knee (28%), fear of a new injury (24%) and poor knee function (22%). Psychological readiness to return to sport and recreational activity, measured with the ACL-Return to Sport after Injury scale (was most strongly associated with returning to the preinjury activity). Age, sex and preinjury activity level were not related. Conclusions Less than 50% returned to their preinjury sport or recreational activity after ACL reconstruction. Psychological readiness to return to sport and recreation was the factor most strongly associated with returning to the preinjury activity. Including interventions aimed at improving this in postoperative rehabilitation programmes could be warranted to improve the rate of return to sport and recreational activities.

  • 17.
    Arundale, Amelia
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Football Research Group, Linköping University, Linköping, Sweden.
    Fältström, Anne
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.
    Jumping performance based on duration of rehabilitation in female football players after anterior cruciate ligament reconstruction2018In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Purpose

    To determine if female football players who had longer durations of rehabilitation, measured in months, after anterior cruciate ligament reconstruction would have lower tuck jump scores (fewer technique flaws) and smaller asymmetries during drop vertical jump landing.

    Methods

    One-hundred-and-seventeen female football players, aged 16ᅵ25 years, after primary unilateral ACL reconstruction (median 16 months, range 6ᅵ39) were included. Athletes reported the duration of rehabilitation they performed after anterior cruciate ligament reconstruction. Athletes also performed the tuck jump and drop vertical jump tests. Outcome variables were: tuck jump score, frontal plane knee motion and probability of peak knee abduction moment during drop vertical jump landing.

    Results

    There was no difference in tuck jump score based on duration of rehabilitation (n.s.). No interaction (n.s.), difference between limbs (n.s.), or duration of rehabilitation (n.s.) was found for peak knee abduction moment during drop vertical jump landing. No interaction (n.s.) or difference between limbs (n.s.) was found for frontal plane knee motion, but there was a difference based on duration of rehabilitation (P?=?0.01). Athletes with >?9 months of rehabilitation had more frontal plane knee motion (medial knee displacement) than athletes with <?6 months (P?=?0.01) or 6ᅵ9 months (P?=?0.03).

    Conclusion

    As there was no difference in tuck jump score or peak knee abduction moment based on duration of rehabilitation, the results of this study press upon clinicians the importance of using objective measures to progress rehabilitation and clear athletes for return to sport, rather than time alone.

  • 18.
    Baunsgaard, Carsten Bach
    et al.
    Univ Copenhagen, Denmark.
    Nissen, Ulla Vig
    Univ Copenhagen, Denmark.
    Brust, Anne Katrin
    SPC, Switzerland.
    Frotzler, Angela
    SPC, Switzerland.
    Ribeill, Cornelia
    Ulm Univ, Germany.
    Kalke, Yorck-Bernhard
    Ulm Univ, Germany.
    Leon, Natacha
    FLM, Spain.
    Gomez, Belen
    FLM, Spain.
    Samuelsson, Kersti
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Antepohl, Wolfram
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Holmstrom, Ulrika
    Uppsala Univ Hosp, Sweden.
    Marklund, Niklas
    Uppsala Univ Hosp, Sweden.
    Glott, Thomas
    Sunnaas Rehabil Hosp, Norway.
    Opheim, Arve
    Sunnaas Rehabil Hosp, Norway; Univ Gothenburg, Sweden.
    Benito, Jesus
    Neurorehabil Hosp, Spain.
    Murillo, Narda
    Neurorehabil Hosp, Spain.
    Nachtegaal, Janneke
    Heliomare Rehabil Ctr, Netherlands.
    Faber, Willemijn
    Heliomare Rehabil Ctr, Netherlands.
    Biering-Sorensen, Fin
    Univ Copenhagen, Denmark.
    Gait training after spinal cord injury: safety, feasibility and gait function following 8 weeks of training with the exoskeletons from Ekso Bionics2018In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 56, no 2, p. 106-116Article in journal (Refereed)
    Abstract [en]

    Study design Prospective quasi-experimental study, pre-and post-design. Objectives Assess safety, feasibility, training characteristics and changes in gait function for persons with spinal cord injury (SCI) using the robotic exoskeletons from Ekso Bionics. Setting Nine European rehabilitation centres. Methods Robotic exoskeleton gait training, three times weekly over 8 weeks. Time upright, time walking and steps in the device (training characteristics) were recorded longitudinally. Gait and neurological function were measured by 10 Metre Walk Test (10 MWT), Timed Up and Go (TUG), Berg Balance Scale (BBS), Walking Index for Spinal Cord Injury (WISCI) II and Lower Extremity Motor Score (LEMS). Results Fifty-two participants completed the training protocol. Median age: 35.8 years (IQR 27.5-52.5), men/women: N = 36/16, neurological level of injury: C1-L2 and severity: AIS A-D (American Spinal Injury Association Impairment Scale). Time since injury (TSI) amp;lt; 1 year, N = 25; amp;gt; 1 year, N = 27. No serious adverse events occurred. Three participants dropped out following ankle swelling (overuse injury). Four participants sustained a Category II pressure ulcer at contact points with the device but completed the study and skin normalized. Training characteristics increased significantly for all subgroups. The number of participants with TSI amp;lt; 1 year and gait function increased from 20 to 56% (P=0.004) and 10MWT, TUG, BBS and LEMS results improved (P amp;lt; 0.05). The number of participants with TSI amp;gt; 1 year and gait function, increased from 41 to 44% and TUG and BBS results improved (P amp;lt; 0.05). Conclusions Exoskeleton training was generally safe and feasible in a heterogeneous sample of persons with SCI. Results indicate potential benefits on gait function and balance.

  • 19.
    Baunsgaard, Carsten Bach
    et al.
    Univ Copenhagen, Denmark.
    Nissen, Ulla Vig
    Univ Copenhagen, Denmark.
    Brust, Anne Katrin
    SPC, Switzerland.
    Frotzler, Angela
    SPC, Switzerland.
    Ribeill, Cornelia
    Ulm Univ, Germany.
    Kalke, Yorck-Bernhard
    Ulm Univ, Germany.
    Leon, Natacha
    FLM, Spain.
    Gomez, Belen
    FLM, Spain.
    Samuelsson, Kersti
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Antepohl, Wolfram
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Holmstrom, Ulrike
    Uppsala Univ Hosp, Sweden.
    Marklund, Niklas
    Uppsala Univ Hosp, Sweden.
    Glott, Thomas
    Sunnaas Rehabil Hosp, Norway.
    Opheim, Arve
    Sunnaas Rehabil Hosp, Norway; Univ Gothenburg, Sweden; Reg Vastra Gotaland, Sweden.
    Benito Penalva, Jesus
    Neurorehabil Hosp, Spain.
    Murillo, Narda
    Neurorehabil Hosp, Spain.
    Nachtegaal, Janneke
    Heliomare Rehabil Ctr, Netherlands.
    Faber, Willemijn
    Heliomare Rehabil Ctr, Netherlands.
    Biering-Sorensen, Fin
    Univ Copenhagen, Denmark.
    EXOSKELETON GAIT TRAINING AFTER SPINAL CORD INJURY: AN EXPLORATORY STUDY ON SECONDARY HEALTH CONDITIONS2018In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 9, p. 806-813Article in journal (Refereed)
    Abstract [en]

    Objective: To explore changes in pain, spasticity, range of motion, activities of daily living, bowel and lower urinary tract function and quality of life of individuals with spinal cord injury following robotic exoskeleton gait training. Design: Prospective, observational, open-label multicentre study. Methods: Three training sessions per week for 8 weeks using an Ekso GT robotic exoskeleton (Ekso Bionics). Included were individuals with recent (amp;lt;1 year) or chronic (amp;gt;1 year) injury, paraplegia and tetraplegia, complete and incomplete injury, men and women. Results: Fifty-two participants completed the training protocol. Pain was reported by 52% of participants during the week prior to training and 17% during training, but no change occurred longitudinally. Spasticity decreased after a training session compared with before the training session (pamp;lt; 0.001), but not longitudinally. Chronically injured participants increased Spinal Cord Independence Measure (SCIM III) from 73 to 74 (p= 0.008) and improved life satisfaction (p= 0.036) over 8 weeks of training. Recently injured participants increased SCIM III from 62 to 70 (pamp;lt;0.001), but no significant change occurred in life satisfaction. Range of motion, bowel and lower urinary function did not change over time. Conclusion: Training seemed not to provoke new pain. Spasticity decreased after a single training session. SCIM III and quality of life increased longitudinally for subsets of participants.

  • 20.
    Bendelin, Nina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Internet-delivered aftercare following multimodal rehabilitation program for chronic pain: a qualitative feasibility study2018In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 11, p. 1715-1728Article in journal (Refereed)
    Abstract [en]

    Purpose: Methods for delivering aftercare to help chronic pain patients to continue practice self-management skills after rehabilitation are needed. Internet-delivered cognitive behavioral therapy (ICBT) has the potential to partly fill this gap given its accessibility and emphasis on self-care. Methods for engaging and motivating patients to persist throughout the full length of treatment are needed. The aim of this study was to describe how chronic pain patients work in an ICBT program, through their descriptions of what is important when they initiate behavior change in aftercare and their descriptions of what is important for ongoing practice of self-management skills in aftercare. Patients and methods: Following a multimodal rehabilitation program, 29 chronic pain patients participated in a 20-week-long Internet-delivered aftercare program (ACP) based on acceptance-based cognitive behavioral therapy. Latent content analysis was made on 138 chapters of diary-like texts written by participants in aftercare. Results: Attitudes regarding pain and body changed during ACP, as did attitudes toward self and the future for some participants. How participants practiced self-management skills was influenced by how they expressed motivation behind treatment goals. Whether they practiced acceptance strategies influenced their continuous self-management practice. Defusion techniques seemed to be helpful in the process of goal setting. Mindfulness strategies seemed to be helpful when setbacks occurred. Conclusion: Self-motivating goals are described as important both to initiate and in the ongoing practice of self-management skills. Experiencing a helpful effect of acceptance strategies seems to encourage participants to handle obstacles in new ways and to persist throughout treatment. Research on whether tailored therapist guidance might be helpful in stating self-motivating goals and contribute to ongoing practice of self-management skills is needed.

  • 21.
    Bergström, Maria
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ahlstrand, Inger
    Jönköping University, Sweden.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Jonköping University, Sweden; Curtin University, Australia.
    Börsbo, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Björk, Mathilda
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Like the worst toothache you've had - How people with rheumatoid arthritis describe and manage pain2017In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 24, no 6, p. 468-476Article in journal (Refereed)
    Abstract [en]

    Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease often associated with disability. Despite new treatments, pain and activity limitations are still present. Objectives: To describe how persons with RA experience and manage pain in their daily life. Methods: Seven semi-structured focus groups (FGs) were conducted and analyzed using content analysis. Results: The analysis revealed four categories: 1) Pain expresses itself in different ways referred to pain as overwhelming, aching or as a feeling of stiffness. 2) Mitigating pain referred to the use of heat, cold, medications and activities as distractions from the pain. 3) Adapting to pain referred to strategies employed as coping mechanisms for the pain, e.g. planning and adjustment of daily activities, and use of assistive devices. 4) Pain in a social context referred to the participants social environment as being both supportive and uncomprehending, the latter causing patients to hide their pain. Conclusions: Pain in RA is experienced in different ways. This emphasizes the multi-professional team to address this spectrum of experiences and to find pain management directed to the individual experience that also include the persons social environment.

  • 22.
    Bernhardsson, Susanne
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Advancing evidence-based practice in primary care physiotherapy: Guideline implementation, clinical practice, and patient preferences2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Research on physiotherapy treatment interventions has increased dramatically in the past 25 years and it is a challenge to transfer research findings into clinical practice, so that patients benefit from effective treatment. Development of clinical practice guidelines is a potentially useful strategy to implement research evidence into practice. However, the impact of guideline implementation in Swedish primary care physiotherapy is unknown. To achieve evidence-based practice (EBP), research evidence should be integrated with clinical expertise and patient preferences, but knowledge is limited about these factors in Swedish primary care physiotherapy.

    The overall aim of this thesis was to increase understanding of factors of importance for the implementation of EBP in Swedish primary care physiotherapy. Specific aims were: to translate and adapt a questionnaire for the measurement of EBP and guidelines; to investigate physiotherapists’ attitudes, knowledge and behaviour related to EBP and guidelines; to examine clinical practice patterns; to evaluate the effects of a tailored guideline implementation strategy; and to explore patients’ preferences for physiotherapy.

    The thesis comprises four studies (A-D), reported in five papers. In Study A, a questionnaire for the measurement of EBP and guidelines was translated, cross-culturally adapted, and tested for validity (n=10) and reliability (n=42). Study B was a cross-sectional study in which this questionnaire was used to survey primary care physiotherapists in the county council Region Västra Götaland (n=271). In Study C, a strategy for the implementation of guidelines was developed and evaluated, using the same questionnaire (n=271 at baseline, n=256 at follow-up), in a prospective controlled trial. The strategy was based on an implementation model, was tailored to address the determinants of guideline use identified in Study B, and comprised several components including an educational seminar. Study D was an exploratory qualitative study of patients with musculoskeletal disorders (n=20), using qualitative content analysis.

    The validity and reliability of the questionnaire was found to be satisfactory. Most physiotherapists have a positive regard for EBP and guidelines, although these attitudes are not fully reflected in the reported use of guidelines. The most important determinants of  guideline use were considering guidelines important to facilitate practice and knowing how to integrate patient preferences with guidelines. The tailored, multi-component guideline implementation significantly affected awareness of, knowledge of, and access to guidelines. Use of guidelines was significantly affected among those who attended an implementation seminar. Clinical practice for common musculoskeletal conditions included interventions supported by evidence of various strengths as well as interventions with insufficient research evidence. The most frequently reported interventions were advice and exercise therapy. The interviewed patients expressed trust and confidence in the professionalism of physiotherapists and in the therapists’ ability to choose appropriate treatment, rendering treatment preferences subordinate. This trust seemed to foster active engagement in their physiotherapy.

    In conclusion: The adapted questionnaire can be used to reliably measure EBP in physiotherapy. The positive attitudes found do not necessarily translate to guideline use, due to several perceived barriers. The tailored guideline implementation strategy used can be effective to reduce barriers and contribute to increased use of guidelines. The clinical practice patterns identified suggest that physiotherapists rely both on research evidence and their clinical expertise when choosing treatment methods. Patients’ trust in their physiotherapist’s competence and preference for active engagement in their therapy need to be embraced by the clinician and, together with the therapist’s clinical expertise, integrated with guideline use in the clinical decision making. Further research is needed on how the EBP components and different knowledge sources can be integrated in physiotherapy practice, as well as on implementation effects on patient outcomes.

    List of papers
    1. Measuring Evidence-Based Practice in Physical Therapy: Translation, Adaptation, Further Development, Validation, and Reliability Test of a Questionnaire
    Open this publication in new window or tab >>Measuring Evidence-Based Practice in Physical Therapy: Translation, Adaptation, Further Development, Validation, and Reliability Test of a Questionnaire
    2013 (English)In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 93, no 6, p. 819-832Article in journal (Refereed) Published
    Abstract [en]

    Background. Evidence-based practice (EBP) and evidence-based clinical practice guidelines are becoming increasingly important in physical therapy. For the purpose of meeting the goals of designing, implementing, and evaluating strategies to facilitate the development of more EBP in primary care physical therapy, a valid and reliable questionnaire for measuring attitudes, knowledge, behavior, prerequisites, and barriers related to EBP and guidelines is needed. less thanbrgreater than less thanbrgreater thanObjective. The 3 objectives of this study were: (1) to translate and cross-culturally adapt a questionnaire to a Swedish primary care context for the purpose of measuring various aspects of EBP and guidelines in physical therapy, (2) to further develop the questionnaire to examine more aspects of guidelines, and (3) to test the validity and reliability of the adapted Swedish questionnaire. less thanbrgreater than less thanbrgreater thanDesign. This was an instrument development study with validity and reliability testing. less thanbrgreater than less thanbrgreater thanMethods. A previously used questionnaire about EBP was translated and cross-culturally adapted to a Swedish primary care physical therapy context. Additional items were constructed. A draft version was pilot tested for content validity (n=10), and a revised version was tested for test-retest reliability (n=42). The percentage of agreement between the 2 tests was analyzed. less thanbrgreater than less thanbrgreater thanResults. The development process resulted in a first questionnaire draft containing 48 items. The validation process resulted in a second draft with acceptable content validity and consisting of 38 items. The test-retest analysis showed that the median percentage of agreement was 67% (range=41%-81%). After removal or revision of items with poor agreement, the final questionnaire included 31 items. less thanbrgreater than less thanbrgreater thanLimitations. Only face validity and content validity were tested. less thanbrgreater than less thanbrgreater thanConclusions. The final translated and adapted questionnaire was determined to have good face and content validity and acceptable reliability for measuring self-reported attitudes, knowledge, behavior, prerequisites, and barriers related to EBP and guidelines among physical therapists in primary care settings.

    Place, publisher, year, edition, pages
    American Physical Therapy Association (APTA), 2013
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-95503 (URN)10.2522/ptj.20120270 (DOI)000319546800010 ()
    Available from: 2013-07-05 Created: 2013-07-05 Last updated: 2017-12-06
    2. Determinants of Guideline Use in Primary Care Physical Therapy: A Cross-Sectional Survey of Attitudes, Knowledge, and Behavior
    Open this publication in new window or tab >>Determinants of Guideline Use in Primary Care Physical Therapy: A Cross-Sectional Survey of Attitudes, Knowledge, and Behavior
    Show others...
    2014 (English)In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 94, no 3, p. 343-354Article in journal (Refereed) Published
    Abstract [en]

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

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

    BACKGROUND:

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

    METHODS:

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

    RESULTS:

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

    CONCLUSIONS:

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

    Place, publisher, year, edition, pages
    BioMed Central, 2014
    Keywords
    Implementation; Physical therapy; Evidence-based practice; Practice guidelines
    National Category
    Physiotherapy
    Identifiers
    urn:nbn:se:liu:diva-105610 (URN)10.1186/1472-6963-14-105 (DOI)000333535400002 ()24589291 (PubMedID)
    Available from: 2014-03-28 Created: 2014-03-28 Last updated: 2017-12-05
    4. Clinical practice in line with evidence?: A survey among primary care physiotherapists in western Sweden
    Open this publication in new window or tab >>Clinical practice in line with evidence?: A survey among primary care physiotherapists in western Sweden
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    2015 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, no 6, p. 1169-1177Article in journal (Refereed) Published
    Abstract [en]

    Rationale, aims and objectives

    Evidence-based practice is becoming increasingly important in primary care physiotherapy. Clinical practice needs to reflect current best evidence and be concordant with evidence-based clinical guidelines. There is limited knowledge about therapeutic interventions used in primary care physiotherapy in Sweden. The objectives were to examine preferred treatment interventions reported by publicly employed physiotherapists in primary care for three common musculoskeletal disorders (low back pain, neck pain and subacromial pain), the extent to which these interventions were supported by evidence, and associations with demographic variables.

    Methods

    419 physiotherapists in primary care in western Sweden were surveyed using a validated web-based questionnaire.

    Results

    The survey was completed by 271 respondents (65%). Median number of interventions reported was 7 (range 1–16). The most common treatment interventions across the three conditions were advice on posture (reported by 82–94%), advice to stay active (86–92%), and different types of exercise (65–92%). Most of these interventions were supported by evidence. However, interventions with insufficient evidence, such as advice on posture, TENS and aquatic exercise, were also used by 29–96%. Modalities such as laser therapy and ultrasound were sparingly used (<5%), which is in line with evidence. For neck pain, use of evidence-based interventions was associated with gender and for subacromial pain, with work experience.

    Conclusions

    Advice and exercise therapy were the interventions most frequently reported across the three diagnoses, illustrating an active treatment strategy. While most reported interventions are supported by evidence, interventions with unclear or no evidence of effect were also used to a high extent.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2015
    Keywords
    clinical practice, evidence, evidence-based practice, interventions, physical therapy, treatment
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy General Practice
    Identifiers
    urn:nbn:se:liu:diva-122555 (URN)10.1111/jep.12380 (DOI)000371414500032 ()25988993 (PubMedID)
    Note

    Funding agencies: local Research and Development Board for Gothenburg and Sodra Bohuslan; Linkoping University

    Available from: 2015-11-09 Created: 2015-11-09 Last updated: 2018-01-10Bibliographically approved
    5. “In the physio we trust”: A qualitative study on patients’ preferences for physiotherapy
    Open this publication in new window or tab >>“In the physio we trust”: A qualitative study on patients’ preferences for physiotherapy
    2017 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, no 7, p. 535-549Article in journal (Refereed) Published
    Abstract [en]

    Background: Patient preferences are suggested to be incorporated in clinical decision making, but little is known about preferences for physiotherapy treatment of patients with musculoskeletal pain. This study aimed to explore preferences regarding physiotherapy treatment and participation in decision making, of patients who seek primary care physiotherapy for pain in the back, neck or shoulder.

    Methods: A qualitative study set in an urban physiotherapy clinic in Sweden. Individual, semi-structured interviews were conducted with a purposeful sample of 20 individuals who sought physiotherapy for back, neck or shoulder pain. The interviews were digitally recorded, transcribed verbatim and analysed with qualitative content analysis.

    Results: An overarching theme, embracing six categories, was conceptualised: Trust in the physiotherapist fosters active engagement in therapy. Most informants preferred active treatment strategies such as exercise and advice for self-management, allowing them to actively engage in their therapy. Some preferred passive treatments, primarily acupuncture (because they had heard that it works well) or massage therapy (because “it feels good”). Preferences were consistent across the three musculoskeletal conditions. Key influencers on treatment preferences were previous experiences and media. All informants wanted to be involved in the clinical decision making, but to varying extents. Some expressed a preference for an active role and wanting to share decisions while others were content with a passive role. Expectations for a professional management were reflected in trust and confidence in physiotherapists’ skills and competence, expectations for good outcomes, and believing that treatment methods should be evidence-based.

    Conclusions: Trust in the physiotherapist’s ability to choose appropriate treatment and confidence in the professional skills and competence of physiotherapists, as well as a desire to participate in clinical decision making, fostered active engagement in physiotherapy. Preferences for particular interventions were subordinate, although a preference for active treatments dominated. Preferences for active engagement need to be embraced by the physiotherapist. Awareness of these preferences can facilitate clinical decision making and contribute to increased quality of care for patients with musculoskeletal pain.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2017
    Keywords
    Physical therapy, patient preferences, shared decision making, primary care, guidelines
    National Category
    Physiotherapy Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-122556 (URN)10.1080/09593985.2017.1328720 (DOI)000403937700003 ()
    Note

    Funding agencies: Local Research and Development Board for Gothenburg; Local Research and Development Board for Sodra Bohuslan

    Previous status of this publication was Manuscript

    Available from: 2015-11-09 Created: 2015-11-09 Last updated: 2017-07-07Bibliographically approved
  • 23.
    Bernhardsson, Susanne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Larsson, Maria E. H.
    Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden / The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Johansson, Kajsa
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    “In the physio we trust”: A qualitative study on patients’ preferences for physiotherapy2017In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, no 7, p. 535-549Article in journal (Refereed)
    Abstract [en]

    Background: Patient preferences are suggested to be incorporated in clinical decision making, but little is known about preferences for physiotherapy treatment of patients with musculoskeletal pain. This study aimed to explore preferences regarding physiotherapy treatment and participation in decision making, of patients who seek primary care physiotherapy for pain in the back, neck or shoulder.

    Methods: A qualitative study set in an urban physiotherapy clinic in Sweden. Individual, semi-structured interviews were conducted with a purposeful sample of 20 individuals who sought physiotherapy for back, neck or shoulder pain. The interviews were digitally recorded, transcribed verbatim and analysed with qualitative content analysis.

    Results: An overarching theme, embracing six categories, was conceptualised: Trust in the physiotherapist fosters active engagement in therapy. Most informants preferred active treatment strategies such as exercise and advice for self-management, allowing them to actively engage in their therapy. Some preferred passive treatments, primarily acupuncture (because they had heard that it works well) or massage therapy (because “it feels good”). Preferences were consistent across the three musculoskeletal conditions. Key influencers on treatment preferences were previous experiences and media. All informants wanted to be involved in the clinical decision making, but to varying extents. Some expressed a preference for an active role and wanting to share decisions while others were content with a passive role. Expectations for a professional management were reflected in trust and confidence in physiotherapists’ skills and competence, expectations for good outcomes, and believing that treatment methods should be evidence-based.

    Conclusions: Trust in the physiotherapist’s ability to choose appropriate treatment and confidence in the professional skills and competence of physiotherapists, as well as a desire to participate in clinical decision making, fostered active engagement in physiotherapy. Preferences for particular interventions were subordinate, although a preference for active treatments dominated. Preferences for active engagement need to be embraced by the physiotherapist. Awareness of these preferences can facilitate clinical decision making and contribute to increased quality of care for patients with musculoskeletal pain.

  • 24.
    Bernhardsson, Susanne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Region Västra Götaland.
    Larsson, Maria
    Region Västra Götaland, Göteborgs universitet.
    Eggertsen, Robert
    Region Västra Götaland, Göteborgs universitet.
    Fagevik Olsén, Monika
    Göteborgs universitet.
    Johansson, Kajsa
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Nordeman, Lena
    Region Västra Götaland.
    van Tulder, Maurits
    VU University, Amsterdam, The Netherlands.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial.2014In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, no 1, p. 105-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

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

    METHODS:

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

    RESULTS:

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

    CONCLUSIONS:

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

  • 25.
    Bernhoff, Gabriella
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Landén Ludvigsson, Maria
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Rehabilitation in Motala. Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy.
    Peterson, Gunnel
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Uppsala University, Sweden.
    Bertilson, Bo Christer
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Elf, Madeleine
    Kista Rygg and Idrottsklin, Sweden.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    The pain drawing as an instrument for identifying cervical spine nerve involvement in chronic whiplash-associated disorders2016In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 9, p. 397-404Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of the study was to investigate the psychometric properties of a standardized assessment of pain drawing with regard to clinical signs of cervical spine nerve root involvement. Design: This cross-sectional study included data collected in a randomized controlled study. Patients: Two hundred and sixteen patients with chronic (amp;gt;= 6 months) whiplash-associated disorders, grade 2 or 3, were included in this study. Methods: The validity, sensitivity, and specificity of a standardized pain drawing assessment for determining nerve root involvement were analyzed, compared to the clinical assessment. In addition, we analyzed the interrater reliability with 50 pain drawings. Results: Agreement was poor between the standardized pain drawing assessment and the clinical assessment (kappa = 0.11, 95% CI: -0.03 to 0.20). Sensitivity was high (93%), but specificity was low (19%). Interrater reliability was good (kappa = 0.64, 95% CI: 0.53 to 0.76). Conclusion: The standardized pain drawing assessment of nerve root involvement in chronic whiplash-associated disorders was not in agreement with the clinical assessment. Further research is warranted to optimize the utilization of a pain/discomfort drawing as a supportive instrument for identifying nerve involvement in cervical spinal injuries.

  • 26.
    Bjersing, Jan L.
    et al.
    University of Gothenburg, Sweden; Sahlgrens University Hospital, Sweden.
    Larsson, Anette
    University of Gothenburg, Sweden.
    Palstam, Annie
    University of Gothenburg, Sweden.
    Ernberg, Malin
    Karolinska Institute, Sweden.
    Bileviciute-Ljungar, Indre
    Karolinska Institute, Sweden.
    Löfgren, Monika
    Karolinska Institute, Sweden.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Kosek, Eva
    Karolinska Institute, Sweden; Stockholm Spine Centre, Sweden.
    Mannerkorpi, Kaisa
    University of Gothenburg, Sweden; Sahlgrenska University Hospital, Sweden.
    Benefits of resistance exercise in lean women with fibromyalgia: involvement of IGF-1 and leptin2017In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, article id 106Article in journal (Refereed)
    Abstract [en]

    Background: Chronic pain and fatigue improves by exercise in fibromyalgia (FM) but underlying mechanisms are not known. Obesity is increased among FM patients and associates with higher levels of pain. Symptom improvement after aerobic exercise is affected by body mass index (BMI) in FM. Metabolic factors such as insulin-like growth factor 1 (IGF1) and leptin may be involved. In this study, the aim was to evaluate the role of metabolic factors in lean, overweight and obese women during resistance exercise, in relation to symptom severity and muscle strength in women with FM. Methods: Forty-three women participated in supervised progressive resistance exercise, twice weekly for 15-weeks. Serum free and total IGF-1, IGF-binding protein 3 (IGFBP3), adiponectin, leptin and resistin were determined at baseline and after 15-weeks. Level of current pain was rated on a visual analogue scale (0-100 mm). Level of fatigue was rated by multidimensional fatigue inventory (MFI-20) subscale general fatigue (MFIGF). Knee extension force, elbow flexion force and handgrip force were assessed by dynamometers. Results: Free IGF-1 (p = 0.047), IGFBP3 (p = 0.025) and leptin (p = 0.008) were significantly decreased in lean women (n = 18), but not in the overweight (n = 17) and the obese (n = 8). Lean women with FM benefited from resistance exercise with improvements in current pain (p= 0.039, n = 18), general fatigue (MFIGF, p = 0.022, n = 18) and improved elbow-flexion force (p = 0.017, n = 18). In overweight and obese women with FM there was no significant improvement in pain or fatigue but an improvement in elbow flexion (p = 0.049; p = 0.012) after 15 weeks of resistance exercise. Conclusion: The clearest clinical response to resistance exercise was found in lean patients with FM. In these individuals, individualized resistance exercise was followed by changes in IGF-1 and leptin, reduced pain, fatigue and improved muscular strength. In overweight and obese women FM markers of metabolic signaling and clinical symptoms were unchanged, but strength was improved in the upper limb. Resistance exercise combined with dietary interventions might benefit patients with FM and overweight.

  • 27.
    Bjurehed, Linda
    et al.
    Linköping University.
    Brodin, Nina
    Karolinska Institutet, Huddinge, Sweden; Danderyd Hospital, Stockholm, Sweden.
    Nordenskiold, Ulla
    Gothenburg University, Gothenburg, Sweden.
    Björk, Mathilda
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Improved Hand Function, Self-Rated Health, and Decreased Activity Limitations: Results After a Two-Month Hand Osteoarthritis Group Intervention2018In: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 70, no 7, p. 1039-1045Article in journal (Refereed)
    Abstract [en]

    Objective

    To evaluate the effects on hand function, activity limitations, and self‐rated health of a primary care hand osteoarthritis (OA) group intervention. Hand OA causes pain, impaired mobility, and reduced grip force, which cause activity limitations. OA group interventions in primary care settings are sparsely reported.

    Methods

    Sixty‐four individuals with hand OA agreed to participate; 15 were excluded due to not fulfilling the inclusion criteria. The 49 remaining (90% female) participated in an OA group intervention at a primary care unit with education, paraffin wax bath, and hand exercise over a 6‐week period. Data were collected at baseline, end of intervention, and after 1 year. Instruments used were the Grip Ability Test (GAT), the Signals of Functional Impairment (SOFI), dynamometry (grip force), hand pain at rest using a visual analog scale (VAS), the Patient‐Specific Functional Scale (PSFS), the Quick Disabilities of the Arm, Shoulder, and Hand (Quick‐DASH), and the EuroQol VAS (EQ VAS). Data were analyzed using nonparametric statistics.

    Results

    Hand function, activity limitation, and self‐rated health significantly improved from baseline to end of intervention, grip force (right hand: P < 0.001; left hand: P = 0.008), SOFI (P = 0.011), GAT (P < 0.001), hand pain at rest (P < 0.001), PSFS (1: P = 0.008, 2: P < 0.001, and 3: P = 0.004), Quick‐DASH (P = 0.001), and EQ VAS (P = 0.039), and the effects were sustained after 1 year.

    Conclusion

    The hand OA group intervention in primary care improves hand function, activity limitation, and self‐rated health. The benefits are sustained 1 year after completion of the intervention.

  • 28.
    Blane, Alison
    et al.
    Curtin Univ, Australia.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin Univ, Australia; Jonkoping Univ, Sweden; La Trobe Univ, Australia.
    Lee, Hoe C.
    Curtin Univ, Australia.
    Dukic Willstrand, Tania
    Swedish Natl Rd and Transport Res Inst VTI, Sweden.
    Investigating cognitive ability and self-reported driving performance of post-stroke adults in a driving simulator2018In: Topics in Stroke Rehabilitation, ISSN 1074-9357, E-ISSN 1945-5119, Vol. 25, no 1, p. 44-53Article in journal (Refereed)
    Abstract [en]

    Background: Safe driving is a complex activity that requires calibration. This means the driver can accurately assess the level of task demand required for task completion and can accurately evaluate their driving capability. There is much debate on the calibration ability of post-stroke drivers. Objectives: The aim of this study was to assess the cognition, self-rated performance, and estimation of task demand in a driving simulator with post-stroke drivers and controls. Methods: A between-groups study design was employed, which included a post-stroke driver group and a group of similarly aged older control drivers. Both groups were observed driving in two simulator-based driving scenarios and asked to complete the NASA Task Load Index (TLX) to assess their perceived task demand and self-rate their driving performance. Participants also completed a battery of psychometric tasks to assess attention and executive function, which was used to determine whether post-stroke cognitive impairment impacted on calibration. Results: There was no difference in the amount of perceived task demand required to complete the driving task. Despite impairments in cognition, the post-stroke drivers were not more likely to over-estimate their driving abilities than controls. On average, the post-stroke drivers self-rated themselves more poorly than the controls and this rating was related to cognitive ability. Conclusion: This study suggests that post-stroke drivers may be aware of their deficits and adjust their driving behavior. Furthermore, using self-performance measures alongside a driving simulator and cognitive assessments may provide complementary fitness-to-drive assessments, as well as rehabilitation tools during post-stroke recovery.

  • 29.
    Blom, Kerstin
    et al.
    Karolinska Institute, Sweden.
    Tarkian Tillgren, Hanna
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Wiklund, Tobias
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Danlycke, Ewa
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Forssen, Mattias
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Söderström, Alexandra
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Johansson, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Jernelov, Susanna
    Karolinska Institute, Sweden.
    Lindefors, Nils
    Karolinska Institute, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Kaldo, Viktor
    Karolinska Institute, Sweden.
    Internet-vs. group-delivered cognitive behavior therapy for insomnia: A randomized controlled non-inferiority trial2015In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 70, p. 47-55Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to compare guided Internet-delivered to group-delivered cognitive behavioral therapy (CBT) for insomnia. We conducted an 8-week randomized controlled non-inferiority trial with 6-months follow-up. Participants were forty-eight adults with insomnia, recruited via media. Interventions were guided Internet-delivered CBT (ICBT) and group-delivered CBT (GCBT) for insomnia. Primary outcome measure was the Insomnia Severity Index (ISI), secondary outcome measures were sleep diary data, depressive symptoms, response- and remission rates. Both treatment groups showed significant improvements and large effect sizes for ISI (Within Cohens d: ICBT post = 1.8, 6-months follow-up = 2.1; GCBT post = 2.1, 6-months follow-up = 2.2). Confidence interval of the difference between groups posttreatment and at FU6 indicated non-inferiority of ICBT compared to GCBT. At post-treatment, two thirds of patients in both groups were considered responders (ISI-reduction greater than 7p). Using diagnostic criteria, 63% (ICBT) and 75% (GCBT) were in remission. Sleep diary data showed moderate to large effect sizes. We conclude that both guided Internet-CBT and group-CBT in this study were efficacious with regard to insomnia severity, sleep parameters and depressive symptoms. The results are in line with previous research, and strengthen the evidence for guided Internet-CBT for insomnia. Trial registration: The study protocol was approved by, and registered with, the regional ethics review board in Linkoping, Sweden, registration number 2010/385-31.

  • 30.
    Borgestig, Maria
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    The impact of gaze-based assistive technology on daily activities in children with severe physical impairments2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: The aim of the thesis was to investigate the impact of gaze-based assistive technology on daily activities in children with severe physical impairments and without speech. The objectives were to develop and pilot a gaze-based assistive technology intervention (GAT intervention) at home and in school for these children and to understand its impact on daily activities as experienced by their parents.

    Methods: Study I was a pilot study in which the basic components that were developed for the intervention were evaluated for students with physical impairments. The study aimed at improving the use of computers as assistive technology (AT) in school. Based on the findings in Study I, the GAT intervention was developed. The GAT intervention aimed at implementing gaze-based AT in daily activities. It consisted of two parts; having access to gaze-based AT and having access to services from a multi professional communication team during nine to ten months. Studies II-IV concerned gazebased AT for children with severe physical impairments without speech who participated in the GAT intervention. The participants were ten children (ages 1-15) (Studies II, III), and their parents (Study IV). Studies II and III had longitudinal designs and children were followed during 15-20 months with repeated measurements before, after and at follow-up. In Study II children’s repertoire of computer activities, extent of use, and goal attainment with gaze-based AT was evaluated, as well as parents’ satisfaction with the AT and with services. In Study III children’s eye gaze performance when using gaze-based AT was examined. In Study IV, parents were interviewed twice with the aim of  exploring their experiences of children’s gaze-based AT use in daily life. In Study IV a hermeneutical approach was used.

    Results: The findings of Study I showed that the basic components of intervention improved the use of computers in school. Study II showed an increased repertoire of computer activities with the gazebased AT, maintained use in daily activities for all at follow up, and that all children attained goals for gaze-based AT use in daily activities. Parents were satisfied with the gaze-based AT, and with the services in the GAT intervention. In study III, nine children improved in eye gaze performance over time when using the gaze-based AT in daily activities. Study IV revealed that children’s gaze-based AT usage in daily activities made a difference to parents since the children demonstrated agency, and showed their personality and competencies by using gaze-based AT, and for the parents this opened up infinite possibilities for the child to do and learn things. Overall, children’s gaze-based AT usage provided parents with hope of a future in which their children could develop and have influence in life.

    Conclusions: This thesis shows that these children with severe physical impairments and without speech acquired sufficient gaze control skills to use gaze-based AT for daily activities in the home and at school. The gaze-based AT had a positive impact on performing activities, for example, play activities and communication- and interaction-related activities. For the parents, children’s gaze-based AT usage made a difference since it shaped a hope of a better future for their children, where they can develop and gain influence in their future life. Furthermore, the children continued to perform daily activities with gaze-based AT over time. This finding suggests that key persons were provided with sufficient knowledge and skills to support children in maintained use of gaze-based AT after withdrawal of the services provided in the GAT intervention.

    List of papers
    1. Improving computer usage for students with physical disabilities through a collaborative approach: A pilot study
    Open this publication in new window or tab >>Improving computer usage for students with physical disabilities through a collaborative approach: A pilot study
    2013 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 20, no 6, p. 463-470Article in journal (Refereed) Published
    Abstract [en]

    Objective: The aim of this study was to evaluate the effect of an assistive technology (AT) intervention to improve the use of available computers as assistive technology in educational tasks for students with physical disabilities during an ongoing school year. Methods: Fifteen students (aged 12-18) with physical disabilities, included in mainstream classrooms in Sweden, and their teachers took part in the intervention. Pre-, post-, and follow-up data were collected with Goal Attainment Scaling (GAS), a computer usage diary, and with the Psychosocial Impact of Assistive Devices Scale (PIADS). Teachers opinions of goal setting were collected at follow-up. Results: The intervention improved the goal-related computer usage in educational tasks and teachers reported they would use goal setting again when appropriate. At baseline, students reported a positive impact from computer usage with no differences over time regarding the PIADS subscales independence, adaptability, or self-esteem. Discussion: The AT intervention showed a positive effect on computer usage as AT in mainstream schools. Some additional support to teachers is recommended as not all students improved in all goal-related computer usage. A clinical implication is that students computer usage can be improved and collaboratively established computer-based strategies can be carried out by teachers in mainstream schools.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2013
    Keywords
    Assistive technology, children with disabilities, goal setting, intervention, self-help devices
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-102984 (URN)10.3109/11038128.2013.837506 (DOI)000328280300008 ()
    Note

    Funding Agencies|Swedish Research Council||Swedish Institute of Assistive Technology||Norrbacka-Eugeniastiftelsen||

    Available from: 2014-01-09 Created: 2014-01-09 Last updated: 2017-12-06
    2. Gaze-based assistive technology in daily activities in children with severe physical impairments: an intervention study
    Open this publication in new window or tab >>Gaze-based assistive technology in daily activities in children with severe physical impairments: an intervention study
    Show others...
    2017 (English)In: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 20, no 3, p. 129-141Article in journal (Refereed) Published
    Abstract [en]

    Objective: To establish the impact of a gaze-based assistive technology (AT) intervention on activity repertoire, autonomous use, and goal attainment in children with severe physical impairments, and to examine parents’ satisfaction with the gaze-based AT and with services related to the gaze-based AT intervention.

    Methods: Non-experimental multiple case study with before, after, and follow-up design. Ten children with severe physical impairments without speaking ability (aged 1–15 years) participated in gaze-based AT intervention for 9–10 months, during which period the gaze-based AT was implemented in daily activities.

    Results: Repertoire of computer activities increased for seven children. All children had sustained usage of gaze-based AT in daily activities at follow-up, all had attained goals, and parents’ satisfaction with the AT and with services was high.

    Discussion: The gaze-based AT intervention was effective in guiding parents and teachers to continue supporting the children to perform activities with the AT after the intervention program.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2017
    Keywords
    Cerebral palsy, computer activities, eye-tracking technology, goal achievement, self-help devices
    National Category
    Occupational Health and Environmental Health Occupational Therapy
    Identifiers
    urn:nbn:se:liu:diva-123300 (URN)10.3109/17518423.2015.1132281 (DOI)000399489800003 ()26930111 (PubMedID)
    Note

    Funding agencies|Swedish Research Council; Jimmy Dahlstens Fond; Stiftelsen Sunnerdahls Handikappfond

    At the time for thesis presentation publication was in status: Manuscript.

    Available from: 2015-12-10 Created: 2015-12-10 Last updated: 2018-01-10Bibliographically approved
    3. Eye gaze performance for children with severe physical impairments using gaze-based assistive technology: a longitudinal study
    Open this publication in new window or tab >>Eye gaze performance for children with severe physical impairments using gaze-based assistive technology: a longitudinal study
    Show others...
    2016 (English)In: Assistive technology, ISSN 1040-0435, E-ISSN 1949-3614, Vol. 28, no 2, p. 93-102Article in journal (Refereed) Published
    Abstract [en]

    Gaze-based assistive technology (gaze-based AT) has the potential to provide children affected by severe physical impairments with opportunities for communication and activities. This study aimed to examine changes in eye gaze performance over time (time on task and accuracy) in children with severe physical impairments, without speaking ability, using gaze-based AT. A longitudinal study with an AB design was conducted on ten children (aged 1–15 years) with severe physical impairments, who were beginners to gaze-based AT at baseline. Thereafter, all children used the gaze-based AT in daily activities over the course of the study. Compass computer software was used to measure time on task and accuracy with eye selection of targets on screen, and tests were performed with the children at baseline, after 5 months, 9–11 months, and after 15–20 months. Findings showed that the children improved in time on task after 5 months and became more accurate in selecting targets after 15–20 months. This study indicates that these children with severe physical impairments, who were unable to speak, could improve in eye gaze performance. However, the children needed time to practice on a long-term basis to acquire skills needed to develop fast and accurate eye gaze performance.

    Keywords
    assistive devices, computer access, physical disability
    National Category
    Pediatrics Psychology (excluding Applied Psychology)
    Identifiers
    urn:nbn:se:liu:diva-123301 (URN)10.1080/10400435.2015.1092182 (DOI)000376031400004 ()26496529 (PubMedID)
    Note

    Funding agencies: Swedish Research Council; Stiftelsen Sunnerdahls Handikappfond; Jimmy Dahlstens Fond

    Available from: 2015-12-10 Created: 2015-12-10 Last updated: 2018-03-17Bibliographically approved
    4. Gaze-based assistive technology used in daily life by children with severe physical impairments: parents’ experiences
    Open this publication in new window or tab >>Gaze-based assistive technology used in daily life by children with severe physical impairments: parents’ experiences
    2017 (English)In: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 20, no 5, p. 301-308Article in journal (Refereed) Published
    Abstract [en]

    This study aims to describe and explore parents’ experiences when their children with severe physical impairments receive gaze-based assistive technology (gaze-based AT) for use in daily life. Semi-structured interviews were conducted twice, with one year in between, with parents of eight children with cerebral palsy that used gaze-based AT in their daily activities. To understand the parents’ experiences, hermeneutical interpretations were used during data analysis. The results demonstrate that for parents, children’s gaze-based AT usage meant that children demonstrated agency, provided them with opportunities to show  personality and competencies, and gave children possibilities to develop. Overall, children’s gaze-based AT provides hope to parents for a better future for their children with severe physical impairments; a future in which the children can develop and gain influence in life. In conclusion, gaze-based AT provides children with new opportunities to perform activities and take initiatives to communicate, giving parents hope about the children’s future.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2017
    Keywords
    Activities in daily life, cerebral palsy, eye tracking controlled system, self-help devices, parental hope, qualitative
    National Category
    Occupational Health and Environmental Health Occupational Therapy
    Identifiers
    urn:nbn:se:liu:diva-123302 (URN)10.1080/17518423.2016.1211769 (DOI)000406527400008 ()
    Note

    Funding agencies: Swedish Research Council; Jimmy Dahlstens Fond; Stiftelsen Sunnerdahls Handikappfond

    Available from: 2015-12-10 Created: 2015-12-10 Last updated: 2018-04-19Bibliographically approved
  • 31.
    Bousquet, J.
    et al.
    University Hospital, France; European Innovat Partnership Act and Health Ageing Re, France; INSERM, France; University of Versailles St Quentin En Yvelines, France.
    Bewick, M.
    iQ4U Consultants Ltd, England.
    Cano, A.
    University of Valencia, Spain.
    Eklund, P.
    Umeå University, Sweden; Four Comp Oy, Finland.
    Fico, G.
    University of Politecn Madrid, Spain.
    Goswami, N.
    Medical University of Graz, Austria.
    Guldemond, N. A.
    University of Medical Centre Utrecht, Netherlands.
    Henderson, D.
    European Innovat Partnership Act and Health Ageing, Scotland.
    Hinkema, M. J.
    TNO, Netherlands.
    Liotta, G.
    University of Roma Tor Vergata, Italy.
    Mair, A.
    Scottish Govt Health Department, Scotland.
    Molloy, W.
    University of Coll, Ireland.
    Monaco, A.
    AIFA Agenzia Italiana Farmaco, Italy.
    Monsonis-Paya, I.
    University of Valencia, Spain.
    Nizinska, A.
    University of Lower Silesia, Poland.
    Papadopoulos, H.
    National Centre Science Research, Greece.
    Pavlickova, A.
    European Innovat Partnership Act and Health Ageing, Scotland.
    Pecorelli, S.
    University of Brescia, Italy.
    Prados-Torres, A.
    IIS Aragon Aragon Health Science Institute IACS, Spain.
    Roller-Wirnsberger, R. E.
    Medical University of Graz, Austria.
    Somekh, D.
    European Health Futures Forum, England.
    Vera-Munoz, C.
    University of Politecn Madrid, Spain.
    Visser, F.
    Avisco, Netherlands.
    Farrell, J.
    Department Health Social Serv and Public Safety, North Ireland.
    Malva, J.
    University of Coimbra, Portugal; Ageing Coimbra EIP AHA, Portugal.
    Andersen Ranberg, K.
    Odense University Hospital, Denmark.
    Camuzat, T.
    European Innovat Partnership Act and Health Ageing Re, France; Regional Languedoc Roussillon Midi Pyrenees, France.
    Carriazo, A. M.
    Regional Minist Health Andalusia, Spain.
    Crooks, G.
    European Innovat Partnership Act and Health Ageing, Scotland.
    Gutter, Z.
    University Hospital Olomouc, Czech Republic.
    Iaccarino, G.
    University of Salerno, Italy.
    Manuel De Keenoy, E.
    Kronikgune, Spain.
    Moda, G.
    Regional Piemonte, Italy.
    Rodriguez-Manas, L.
    Getafe University Hospital, Spain.
    Vontetsianos, T.
    Sotiria Hospital, Greece.
    Abreu, C.
    Coimbra School Nursing, Portugal.
    Alonso, J.
    IMIM Institute Hospital Mar Invest Mediques, Spain.
    Alonso-Bouzon, C.
    Getafe University Hospital, Spain.
    Ankri, J.
    INSERM, France; University of Versailles St Quentin En Yvelines, France.
    Arredondo, M. T.
    University of Politecn Madrid, Spain.
    Avolio, F.
    Regional Puglia, Italy.
    Bedbrook, A.
    European Innovat Partnership Act and Health Ageing Re, France.
    Bialoszewski, A. Z.
    Medical University of Warsaw, Poland.
    Blain, H.
    European Innovat Partnership Act and Health Ageing Re, France; Montpellier University Hospital, France; University of Montpellier, France.
    Bourret, R.
    European Innovat Partnership Act and Health Ageing Re, France; Montpellier University Hospital, France.
    Cabrera-Umpierrez, M. F.
    University of Politecn Madrid, Spain; University of Politecn Madrid, Spain.
    Catala, A.
    Technical University of Catalonia, Spain.
    OCaoimh, R.
    University of Coll, Ireland.
    Cesari, M.
    Gerontopole Toulouse, France.
    Chavannes, N. H.
    Leiden University, Netherlands.
    Correia-Da-Sousa, J.
    University of Minho, Portugal.
    Dedeu, T.
    European Regional and Local Health Assoc, Belgium; University of Edinburgh, Scotland.
    Ferrando, M.
    University of Valencia, Spain.
    Ferri, M.
    University of Valencia, Spain.
    Fokkens, W. J.
    Academic Medical Centre, Netherlands.
    Garcia-Lizana, F.
    Institute Health Carlos III, Spain.
    Guerin, O.
    CHRU Nice, France.
    Hellings, P. W.
    Katholieke University of Leuven, Belgium.
    Haahtela, T.
    Helsinki University Hospital, Finland.
    Illario, M.
    Federico II University Hospital Naples, Italy.
    Inzerilli, M. C.
    Community St Egidio Long Live Elderly Program, Italy.
    Lodrup Carlsen, K. C.
    Oslo University Hospital, Norway; University of Oslo, Norway; Oslo University Hospital, Norway; University of Oslo, Norway.
    Kardas, P.
    Medical University of Lodz, Poland.
    Keil, T.
    Charite, Germany; University of Wurzburg, Germany.
    Maggio, M.
    University of Parma, Italy.
    Mendez-Zorrilla, A.
    University of Deusto, Spain.
    Menditto, E.
    University of Naples Federico II, Italy.
    Mercier, J.
    European Innovat Partnership Act and Health Ageing Re, France; University of Montpellier, France.
    Michel, J. P.
    European Union Geriatr Medical Soc, Switzerland; European Geriatr Med, Switzerland.
    Murray, R.
    NHS Scotland, Scotland.
    Nogues, M.
    European Innovat Partnership Act and Health Ageing Re, France; Caisse Assurance Retraite and Sante Travail Langued, France.
    OByrne-Maguire, I.
    AFFINITY, Ireland.
    Pappa, D.
    National Centre Science Research, Greece.
    Parent, A. S.
    AGE Platform Europe, Belgium.
    Pastorino, M.
    University of Politecn Madrid, Spain.
    Robalo-Cordeiro, C.
    Coimbra University Hospital, Portugal.
    Samolinski, B.
    Medical University of Warsaw, Poland.
    Siciliano, P.
    CNR, Italy; INNOVAAL, Italy.
    Teixeira, A. M.
    University of Coimbra, Portugal.
    Tsartara, S. I.
    South East Europe Healthcare Integrated Care and Sr, Greece.
    Valiulis, A.
    Vilnius University, Lithuania; European Academic Paediat EAP UEMS SP, Belgium; European Academic Paediat, Belgium.
    Vandenplas, O.
    Catholic University of Louvain, Belgium.
    Vasankari, T.
    Finnish Lung Assoc, Finland.
    Vellas, B.
    Gerontopole Toulouse, France.
    Vollenbroek-Hutten, M.
    Telemed Grp, Netherlands; University of Twente, Netherlands.
    Wickman, M.
    Soder Sjukhuset, Sweden; Karolinska Institute, Sweden.
    Yorgancioglu, A.
    A Celal Bayar University, Turkey; GARD Execut Comm, Turkey.
    Zuberbier, T.
    Charite, Germany; Global Allergy and Asthma European Network, Germany.
    Barbagallo, M.
    University of Palermo, Italy.
    Canonica, G. W.
    University of Genoa, Italy.
    Klimek, L.
    KLIMEK, Germany.
    Maggi, S.
    CNR Aging Branch, Italy.
    Aberer, W.
    Medical University of Graz, Austria.
    Akdis, C.
    University of Zurich, Switzerland.
    Adcock, I. M.
    Imperial Coll London, England; Royal Brompton and Harefield NHS Trust, England.
    Agache, I.
    Transylvania University of Brasov, Romania.
    Albera, C.
    University of Turin, Italy.
    Alonso-Trujillo, F.
    Andalusian Agency Social Serv and Dependency, Spain.
    Angel Guarcia, M.
    University of Valencia, Spain.
    Annesi-Maesano, I.
    INSERM, France; UPMC, France.
    Apostolo, J.
    Coimbra School Nursing, Portugal.
    Arshad, S. H.
    David Hide Asthma and Allergy Research Centre, England.
    Attalin, V.
    Aviitam, France.
    Avignon, A.
    Montpellier University Hospital, France.
    Bachert, C.
    Ghent University Hospital, Belgium.
    Baroni, I.
    Telbios, Italy.
    Bel, E.
    University of Amsterdam, Netherlands.
    Benson, Mikael
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Allergy Center.
    Bescos, C.
    Phillips Research Institute, Netherlands.
    Blasi, F.
    University of Milan, Italy.
    Barbara, C.
    Portuguese National Programme Resp Disease, Portugal.
    Bergmann, K. C.
    Charite, Germany; Global Allergy and Asthma European Network, Germany.
    Bernard, P. L.
    University of Montpellier, France.
    Bonini, S.
    University of Naples 2, Italy; Italian National Research Council, Italy.
    Bousquet, P. J.
    INSERM, France; UPMC, France.
    Branchini, B.
    University of Valencia, Spain.
    Brightling, C. E.
    University Hospital Leicester NHS Trust, England; University of Leicester, England.
    Bruguiere, V.
    Caisse Assurance Retraite and Sante Travail Langued, France.
    Bunu, C.
    University of Medical and Farm Timisoara, Romania.
    Bush, A.
    Bush A Imperial Coll, England; Royal Brompton Hospital, England.
    Caimmi, D. P.
    Montpellier University Hospital, France.
    Calderon, M. A.
    University of London Imperial Coll Science Technology and Med, England.
    Canovas, G.
    Maire, France.
    Cardona, V.
    Hospital Valle De Hebron, Spain.
    Carlsen, K. H.
    Oslo University Hospital, Norway; University of Oslo, Norway; Oslo University Hospital, Norway; University of Oslo, Norway.
    Cesario, A.
    IRCCS Azienda Osped Santa Maria Nuova, Italy.
    Chkhartishvili, E.
    Grigol Robakidze University, Rep of Georgia.
    Chiron, R.
    Montpellier University Hospital, France.
    Chivato, T.
    University of CEU San Pablo, Spain.
    Chung, K. F.
    University of London Imperial Coll Science Technology and Med, England.
    DAngelantonio, M.
    Health Informat Management SA, Belgium.
    De Carlo, G.
    EFA European Federat Allergy and Airways Disease Patien, Belgium.
    Cholley, D.
    Direct Regional Serv Med, France.
    Chorin, F.
    CIU Sante, France.
    Combe, B.
    University Hospital, France.
    Compas, B.
    Conseil Dep Herault, France.
    Costa, D. J.
    European Innovat Partnership Act and Health Ageing Re, France.
    Costa, E.
    University of Porto, Portugal; University of Porto, Portugal.
    Coste, O.
    Direct Regional Jeunesse Sports and Cohes Sociale, France.
    Coupet, A. -L.
    Caisse Assurance Retraite and Sante Travail Langued, France.
    Crepaldi, G.
    CNR, Italy.
    Custovic, A.
    University of London Imperial Coll Science Technology and Med, England.
    Dahl, R.
    Odense University Hospital, Denmark.
    Dahlen, S. E.
    Karolinska Institute, Sweden.
    Demoly, P.
    INSERM, France; UPMC, France; Montpellier University Hospital, France.
    Devillier, P.
    Suresnes University of Versailles St Quentin, France.
    Didier, A.
    Rangueil Larrey Hospital, France.
    Dinh-Xuan, A. T.
    University of Paris 05, France.
    Djukanovic, R.
    University of Southampton, England; NIHR Southampton Resp Biomed Research Unit, England.
    Dokic, D.
    University of Clin Pulmol and Allergy, Macedonia.
    Du Toit, G.
    Kings Coll London, England.
    Dubakiene, R.
    Vilnius University, Lithuania.
    Dupeyron, A.
    University of Montpellier, France; University of Nimes Hospital, France.
    Emuzyte, R.
    Vilnius University, Lithuania.
    Fiocchi, A.
    Bambino Gesu Childrens Research Hospital, Italy.
    Wagner, A.
    Global Allergy and Asthma Platform GAAPP, Austria.
    Fletcher, M.
    Educ Heatlh, England.
    Fonseca, J.
    Institute CUF Porto Hospital CUF Porto, Portugal; University of Porto, Portugal.
    Fougere, B.
    Gerontopole Toulouse, France.
    Gamkrelidze, A.
    National Centre Disease Control and Public Health Georgia, Rep of Georgia.
    Garces, G.
    University of Valencia, Spain.
    Garcia-Aymeric, J.
    ISGLoBAL, Spain.
    Garcia-Zapirain, B.
    University of Deusto, Spain.
    Gemicioglu, B.
    Istanbul University, Turkey.
    Gouder, C.
    Resident Medical Specialist Medical Mater Dei Hospital, Malta.
    Hellquist-Dahl, B.
    Odense University Hospital, Denmark.
    Hermosilla-Gimeno, I.
    Institute Salud Carlos III, Spain.
    Heve, D.
    Agence Regional Sante, France.
    Holland, C.
    Aston University, England.
    Humbert, M.
    University of Paris 11, France.
    Hyland, M.
    University of Plymouth, England.
    Johnston, S. L.
    University of London Imperial Coll Science Technology and Med, England; MRC and Asthma UK Centre Allerg Mech Asthma, England.
    Just, J.
    University of Paris 06, France.
    Jutel, M.
    Wroclaw Medical University, Poland.
    Kaidashev, I. P.
    Ukrainina Medical Stomatol Acad, Ukraine.
    Khaitov, M.
    National Research Centre, Russia.
    Kalayci, O.
    Hacettepe University, Turkey.
    Kalyoncu, A. F.
    Hacettepe University, Turkey.
    Keijser, W.
    University of Twente, Netherlands; Health Informat Management Spain SL, Spain.
    Kerstjens, H.
    University of Groningen, Netherlands.
    Knezovic, J.
    University of Zagreb, Croatia.
    Kowalski, M.
    Medical University of Lodz, Poland; HARC, Poland.
    Koppelman, G. H.
    University of Groningen, Netherlands.
    Kotska, T.
    Medical University of Lodz, Poland.
    Kovac, M.
    University of Zagreb, Croatia.
    Kull, I.
    Soder Sjukhuset, Sweden; Karolinska Institute, Sweden.
    Kuna, P.
    Barlicki University Hospital, Poland.
    Kvedariene, V.
    Vilnius University, Lithuania.
    Lepore, V.
    AReS Puglia, Italy.
    Macnee, W.
    University of Edinburgh, Scotland.
    Maggio, M.
    University of Parma, Italy.
    Magnan, A.
    University of Nantes, France; Institute Thorax, France.
    Majer, I.
    University of Bratislava, Slovakia.
    Manning, P.
    Bon Secours Hospital, Ireland.
    Marcucci, M.
    University of Milan, Italy; University of Milan, Italy.
    Marti, T.
    Generalitat Catalunya, Spain.
    Masoli, M.
    University of Plymouth, England.
    Melen, E.
    Stockholm County Council, Sweden.
    Miculinic, N.
    Croatian Pulm Soc, Croatia.
    Mihaltan, F.
    National Institute Pneumol M Nasta, Romania.
    Milenkovic, B.
    University of Belgrade, Serbia.
    Millot-Keurinck, J.
    Caisse Assurance Retraite and Sante Travail Langued, France.
    Mlinaric, H.
    University of Zagreb, Croatia.
    Momas, I.
    Paris Descartes University, France; Paris Municipal Department Social Act Childhood and Heatlh, France.
    Montefort, S.
    University of Malta, Malta.
    Morais-Almeida, M.
    Hospital CUF Descobertas, Portugal; Soc Portuguesa Alergol and Imunol Clin, Portugal.
    Moreno-Casbas, T.
    Institute Health Carlos III, Spain.
    Moesges, R.
    University of Cologne, Germany.
    Mullol, J.
    CIBERES, Spain; CIBERES, Spain.
    Nadif, R.
    INSERM, France; University of Versailles St Quentin En Yvelines, France.
    Nalin, M.
    Telbios, Italy.
    Navarro-Pardo, E.
    University of Valencia, Spain; University of Valencia, Spain.
    Nekam, K.
    Hospital Hospitaller Brothers Buda, Hungary.
    Ninot, G.
    University of Montpellier I, France.
    Paccard, D.
    Caisse Assurance Retraite and Sante Travail Langued, France.
    Pais, S.
    University of Algarve, Portugal.
    Palummeri, E.
    Gakkiera Hospital, Italy.
    Panzner, P.
    Charles University of Prague, Czech Republic; Charles University of Prague, Czech Republic.
    Papadopoulos, N. K.
    University of Manchester, England; University of Athens, Greece.
    Papanikolaou, C.
    Laikon Gen Hospital Athens, Greece.
    Passalacqua, G.
    University of Genoa, Italy.
    Pastor, E.
    LETAPE, France; Conseil Regional Ordre Masseurs Kinesitherapeutes, France.
    Perrot, M.
    Regime Social Independants, France.
    Plavec, D.
    University of JJ Strossmayer, Croatia.
    Popov, T. A.
    Alexanders University Hospital, Bulgaria.
    Postma, D. S.
    University of Groningen, Netherlands.
    Price, D.
    Optimum Patient Care, England; University of Aberdeen, Scotland.
    Raffort, N.
    Soc Public Locale Exploitat Balaruc Les Bains, France.
    Reuzeau, J. C.
    Caisse Assurance Retraite and Sante Travail Langued, France.
    Robine, J. M.
    INSERM, France; INSERM, France; Ecole Prat Hautes Etud, France.
    Rodenas, F.
    University of Valencia, Spain.
    Robusto, F.
    AReS Puglia, Italy.
    Roche, N.
    Hop University of Paris, India.
    Romano, A.
    Complesso Integrato Columbus, Italy.
    Romano, V.
    Piedmonte Reference Site, Italy.
    Rosado-Pinto, J.
    Serv Imunoalergol Hospital Luz Lisboa, Portugal.
    Roubille, F.
    European Innovat Partnership Act and Health Ageing Re, France; Montpellier University Hospital, France.
    Ruiz, F.
    University of Valencia, Spain.
    Ryan, D.
    Woodbrook Medical Centre, England; University of Edinburgh, Scotland.
    Salcedo, T.
    University of Politecn Valencia, Spain.
    Schmid-Grendelmeier, P.
    University of Zurich Hospital, Switzerland.
    Schulz, H.
    Helmholtz Zentrum Munchen, Germany.
    Schunemann, H. J.
    University of Freiburg, Germany.
    Serrano, E.
    CHU Rangueil Larrey, France.
    Sheikh, A.
    University of Edinburgh, Scotland.
    Shields, M.
    Queens University of Belfast, North Ireland; Royal Belfast Hospital Sick Children, North Ireland.
    Siafakas, N.
    University Hospital Heraklion, Greece.
    Scichilone, N.
    University of Palermo, Italy.
    Siciliano, P.
    CNR, Italy; INNOVAAL, Italy.
    Skrindo, I.
    Akershun University Hospital, Norway.
    Smit, H. A.
    University of Utrecht, Netherlands.
    Sourdet, S.
    Gerontopole Toulouse, France.
    Sousa-Costa, E.
    University of Porto, Portugal.
    Spranger, O.
    Global Allergy and Asthma Platform GAAPP, Austria.
    Sooronbaev, T.
    Euro Asian Resp Soc, Kyrgyzstan.
    Sruk, V.
    University of Zagreb, Croatia.
    Sterk, P. J.
    University of Amsterdam, Netherlands.
    Todo-Bom, A.
    University of Coimbra, Portugal.
    Touchon, J.
    University Hospital Montpellier, France.
    Tramontano, D.
    University of Naples Federico II, Italy; GENS Fdn, Italy.
    Triggiani, M.
    University of Salerno, Italy.
    Tsartara, S. I.
    South East Europe Healthcare Integrated Care and Sr, Greece.
    Valero, A. L.
    IDIBAPS, Spain.
    Valovirta, E.
    University of Turku, Finland.
    Van Ganse, E.
    University of Lyon 1, France.
    Van Hage, M.
    Karolinska Institute and University Hospital, Sweden.
    Van den Berge, M.
    University of Groningen, Netherlands.
    Vandenplas, O.
    Catholic University of Louvain, Belgium.
    Ventura, M. T.
    University of Bari, Italy.
    Vergara, I.
    VERGARA Itziar Kronikgune, Spain.
    Vezzani, G.
    Research Hospital, Italy; Regional Agency Health and Social Care, Italy.
    Vidal, D.
    University of Valencia, Spain.
    Viegi, G.
    CNR, Italy.
    Wagemann, M.
    University of Klinikum Dusseldorf, Germany.
    Whalley, B.
    University of Plymouth, England.
    Wickman, M.
    Soder Sjukhuset, Sweden; Karolinska Institute, Sweden.
    Wilson, N.
    North England EU Health Partnership, Australia.
    Yiallouros, P. K.
    Cyprus University of Technology, Cyprus; Hospital Archbishop Makarios III, Cyprus.
    Zagar, M.
    University of Zagreb, Croatia.
    Zaidi, A.
    University of Southampton, England.
    Zidarn, M.
    University of Clin Resp and Allerg Disease, Slovenia.
    Hoogerwerf, E. J.
    Funka, Sweden.
    Usero, J.
    Funka, Sweden.
    Zuffada, R.
    Funka, Sweden.
    Senn, A.
    European Commiss, Belgium.
    De Oliveira-Alves, B.
    European Commiss, Belgium.
    BUILDING BRIDGES FOR INNOVATION IN AGEING: SYNERGIES BETWEEN ACTION GROUPS OF THE EIP ON AHA2017In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 21, no 1, p. 92-104Article in journal (Refereed)
    Abstract [en]

    The Strategic Implementation Plan of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) proposed six Action Groups. After almost three years of activity, many achievements have been obtained through commitments or collaborative work of the Action Groups. However, they have often worked in silos and, consequently, synergies between Action Groups have been proposed to strengthen the triple win of the EIP on AHA. The paper presents the methodology and current status of the Task Force on EIP on AHA synergies. Synergies are in line with the Action Groups new Renovated Action Plan (2016-2018) to ensure that their future objectives are coherent and fully connected. The outcomes and impact of synergies are using the Monitoring and Assessment Framework for the EIP on AHA (MAFEIP). Eight proposals for synergies have been approved by the Task Force: Five cross-cutting synergies which can be used for all current and future synergies as they consider overarching domains (appropriate polypharmacy, citizen empowerment, teaching and coaching on AHA, deployment of synergies to EU regions, Responsible Research and Innovation), and three cross-cutting synergies focussing on current Action Group activities (falls, frailty, integrated care and chronic respiratory diseases).

  • 32.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonkoping Univ, Sweden.
    Pakpour, Amir H.
    Jonkoping Univ, Sweden; Qazvin Univ Med Sci, Iran.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Development and psychometric evaluation of the Swedish propensity to achieve healthy lifestyle scale in patients with hypertension2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 21-22, p. 4040-4049Article in journal (Refereed)
    Abstract [en]

    PurposeTo develop and validate a Swedish questionnaire to measure propensity for behaviour change regarding food habits, physical activity and weight reduction in patients with hypertension. DesignCross-sectional design. MethodsA total of 270 consecutive patients with hypertension diagnosed at four primary care centres in Sweden were included. The 6-item Swedish version of the Propensity to Achieve Healthy Lifestyle Scale (PAHLS) was developed to measure propensity for behaviour change regarding food habits, physical activity and weight reduction. The PAHLS (i.e., including three items for preparedness and three items for capacity) was developed by three multiprofessional researchers inspired by the transtheoretical model of behaviour change in collaboration with clinically active nurses. Data were collected by questionnaires on food habits (i.e., the Food Frequency Questionnaire), physical activity (the International Physical Activity Questionnaire), propensity for a healthy lifestyle (the PHLQ), as well as during a clinical examination. Exploratory (EFA) and confirmatory factor analyses (CFA), as well as Rasch analysis, were used. ResultsOf the 270 patients (50% women), 27% scored low levels of physical activity on the International Physical Activity Questionnaire, and 34% of the patients were obese (body mass index 30kg/m(2)). The EFA (explaining 54% of the variance) showed unidimensionality for the PAHLS that was supported by both CFA and Rasch analyses. No floor and 1.9% ceiling effects were found. Multiple group CFA (an extension of structural equationmodelling) showed that the PAHLS operated equivalently across both male and female patients. Internal consistency (Cronbachs alpha 0.83) and composite reliability (0.89) were good. ConclusionThe initial testing of PAHLS provided good validity and reliability scores to measure propensity for behaviour change in patients with hypertension. Relevance to Clinical PracticeThe PAHLS can be used by nurses as a tool to simplify shared decision-making in relation to behavioural changes.

  • 33.
    Buchbinder, Rachelle
    et al.
    Cabrini-Monash Department of Clinical Epidemiology, Cabrini Institute and Monash University, Malvern, VIC, Australia.
    van Tulder, Maurits
    Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Costa, Luciola Menezes
    Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
    Woolf, Anthony
    Royal Cornwall Hospital and University of Exeter Medical School, Truro, UK.
    Schoene, Mark
    The Back Letter, Newburyport MA, USA.
    Croft, Peter
    Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
    Low back pain: a call for action2018In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 391, no 10137, p. 2384-2388Article in journal (Other academic)
    Abstract [en]

    n/a

  • 34.
    Bylinder Westerberg, Johanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy.
    Borén, Elin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy.
    Knä- och höftartrospatienters erfarenheter av artrosskolan: - En kvalitativ studie2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 35.
    Bylund, Ami
    et al.
    Linnaeus University, Sweden; Karolinska Institute, Sweden; Ersta Hospital, Sweden.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Linnaeus University, Sweden.
    Benzein, Eva
    Linnaeus University, Sweden.
    Thorell, Anders
    Karolinska Institute, Sweden; Ersta Hospital, Sweden.
    Persson, Carina
    Linnaeus University, Sweden.
    Assessment of family functioning: evaluation of the General Functioning Scale in a Swedish Bariatric Sample2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 3, p. 614-622Article in journal (Refereed)
    Abstract [en]

    BackgroundThe General Functioning Scale (GFS) was developed to assess self-perceived overall family functioning. The scale has satisfactory psychometric properties, is internationally recognised and has been used in different contexts. However, no validated Swedish version is available. Healthy family functioning can support patients and help them adhere to treatment regimens. Moreover, it maintains the physical and emotional health and that of the family as a unit. Yet, there is limited information regarding family functioning postgastric bypass surgery. Thus, it is important to use validated instruments to understand family functioning in bariatric contexts. AimTo evaluate aspects of reliability and validity in GFS in a Swedish bariatric sample, focusing on factor structure. MethodThe Swedish version of the GFS (S-GFS) was administered on two occasions to 163 participants who had undergone gastric bypass surgery 6-8 weeks prior to testing. Internal consistency, temporal stability and construct validity were assessed. ResultsData were positively skewed. The S-GFS showed good internal consistency (ordinal = 0.92) with a sufficient overall mean interitem correlation (0.500) and adequate temporal stability (intraclass correlation coefficient = 0.833). After modifying response alternatives, confirmatory factor analysis indicated acceptable fit for a one-factor model. ConclusionThe scale is a promising tool for assessing family functioning in bariatric settings. The S-GFS showed satisfactory reliability - consistent with prior research - and acceptable validity in the study sample. This study contributes to the limited research on the scales validity. However, the S-GFS needs to be evaluated in different cultural and clinical contexts, focusing on various aspects of validity and responsiveness (sensitivity to detect significant change over time) in different samples.

  • 36.
    Bäck, Maria
    et al.
    Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg.
    Jivegård, Lennart
    Department of Vascular Surgery, Sahlgrenska University Hospital/Sahlgrenska.
    Johansson, Anna
    Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg.
    Nordanstig, Joakim
    Department of Vascular Surgery, Sahlgrenska University Hospital/Sahlgrenska.
    Svanberg, Therese
    HTA-Centrum, Region Västra.
    Adania, Ulla Wikberg
    Medical Library, Sahlgrenska University Hospital/Mölndal, Gothenburg, Sweden.
    Sjögren, Petteri
    HTA-Centrum, Region Västra.
    Home-based supervised exercise versus hospital-based supervised exercise or unsupervised walk advice as treatment for intermittent claudication: a systematic review.2015In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, no 9, p. 801-808Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of home-based supervised exercise vs hospital-based supervised exercise, and the effects of home-based supervised exercise vs unsupervised "go home and walk advice" on daily life and corridor-walking capacity, health-related quality of life and patient-reported functional walking capacity in patients with intermittent claudication.

    DATA SOURCES: Systematic literature searches were conducted in PubMed, EMBASE, ProQuest, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Allied and Complementary Medicine Database (AMED), the Cochrane Library, and a number of Health Technology Assessment (HTA)-databases in October 2014.

    STUDY SELECTION: Randomized controlled trials and non-randomized controlled trials (> 100 patients) were considered for inclusion.

    DATA EXTRACTION: Data extraction and risk of bias assessment was performed independently and discussed in meetings.

    DATA SYNTHESIS: Seven randomized controlled trials and 2 non-randomized controlled studies fulfilled the inclusion criteria. The included studies had some, or major, limitations.

    CONCLUSION: Based on a low quality of evidence, home-based supervised exercise may lead to less improvement in maximum and pain-free walking distance, and in more improvement in daily life walking capacity, compared with hospital-based supervised exercise. Home-based supervised exercise may improve maximum and pain-free walking distance compared with "go home and walk advice" and result in little or no difference in health-related quality of life and functional walking capacity compared with hospital-based supervised exercise or "go home and walk advice". Further research is needed to establish the optimal exercise modality for these patients.

  • 37.
    Bäck, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Lundberg, Mari
    Karolinska Inst, Sweden.
    Cider, Asa
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Herlitz, Johan
    Univ Boras, Sweden.
    Jansson, Bengt
    Univ Gothenburg, Sweden.
    Relevance of Kinesiophobia in Relation to Changes Over Time Among Patients After an Acute Coronary Artery Disease Event2018In: JOURNAL OF CARDIOPULMONARY REHABILITATION AND PREVENTION, ISSN 1932-7501, Vol. 38, no 4, p. 224-230Article in journal (Refereed)
    Abstract [en]

    Purpose: To identify levels of kinesiophobia during the first 4 months after an acute episode of coronary artery disease (CAD), while controlling for gender, anxiety, depression, and personality traits. Methods: In all, 106 patients with CAD (25 women), mean age 63.1 11.5 years, were included in the study at the cardiac intensive care unit, Sahlgrenska University Hospital, Sweden. The patients completed questionnaires at 3 time points: in the cardiac intensive care unit (baseline), 2 weeks, and 4 months after baseline. The primary outcome measure was kinesiophobia. Secondary outcome measures were gender, anxiety, depression, harm avoidance, and positive and negative affect. A linear mixed model procedure was used to compare kinesiophobia across time points and gender. Secondary outcome measures were used as covariates. Results: Kinesiophobia decreased over time (P = .005) and there was a significant effect of gender (P = .045; higher values for women). The presence of a high level of kinesiophobia was 25.4% at baseline, 19% after 2 weeks, and 21.1% after 4 months. Inclusion of the covariates showed that positive and negative affect and harm avoidance increased model fit. The effects of time and gender remained significant. Conclusions: This study highlights that kinesiophobia decreased over time after an acute CAD episode. Nonetheless, a substantial part of the patients were identified with a high level of kinesiophobia across time, which emphasizes the need for screening and the design of a treatment intervention.

  • 38.
    Bäckryd, Emmanuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Do the potential benefits outweigh the risks? An update on the use of ziconotide in clinical practice2018In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 22, no 7, p. 1193-1202Article, review/survey (Refereed)
    Abstract [en]

    Ziconotide is a selective and potent blocker of N-type voltage-gated calcium channels. It was approved by the Food and Drug Administration in 2004 and by the European Medicines Agency in 2005 for the treatment of severe chronic pain in patients needing intrathecal analgesia (ITA). The aim of this paper is to provide a practitioner-oriented, educational, narrative, up-to-date review on the use of ziconotide in clinical pain medicine. Of special concern regarding safety is the partial incongruity between dosing statements in the Summary ofProduct Characteristics and novel low-dosage, slow uptitration recommendations. Even though ziconotide has obvious advantages compared to opioids, pain practitioners pondering the use of ziconotide nonetheless have to balance its proved potential analgesic effect against its neurological side effects, with special consideration being given to dosing and neuropsychiatric dangers. Using a seesaw analogy, the paper discusses what factors pain physicians should weigh in when considering ziconotide as ITA drug, the non-opioid advantages of ziconotide being counterbalanced by its potential psychiatric side effects. Ziconotide is an important part of the armamentarium of modern interventional pain medicine. If ITA is deemed necessary, ziconotide is a rational alternative, at least in chronic (neuropathic) non-cancer pain. However, in many European countries, ziconotide treatment is only available in a few (if any) centres. The safety profile of ziconotide is not fundamentally more worrying than that of opioids or cannabinoids; it is just different. This paper provides a concise, up-to-date and clinically-oriented summary of the use of ziconotide in clinical practice, not least concerning safety and dosage issues.

    The full text will be freely available from 2019-04-10 13:50
  • 39.
    Bäckryd, Emmanuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Linköping University, Faculty of Health Sciences.
    Pain in the Blood? Envisioning Mechanism-Based Diagnoses and Biomarkers in Clinical Pain Medicine.2015In: Diagnostics, ISSN 1777-781X, Vol. 5, no 1, p. 84-95Article in journal (Refereed)
    Abstract [en]

    Chronic pain is highly prevalent, and pain medicine lacks objective biomarkers to guide diagnosis and choice of treatment. The current U.S. "opioid epidemic" is a reminder of the paucity of effective and safe treatment options. Traditional pain diagnoses according to the International Classification of Diseases are often unspecific, and analgesics are often prescribed on a trial-and-error basis. In contrast to this current state of affairs, the vision of future mechanism-based diagnoses of chronic pain conditions is presented in this non-technical paper, focusing on the need for biomarkers and the theoretical complexity of the task. Pain is and will remain a subjective experience, and as such is not objectively measurable. Therefore, the concept of "noci-marker" is presented as an alternative to "pain biomarker", the goal being to find objective, measurable correlates of the pathophysiological processes involved in different chronic pain conditions. This vision entails a call for more translational pain research in order to bridge the gap between clinical pain medicine and preclinical science.

  • 40.
    Bøttcher, L.
    et al.
    Department of Education, Aarhus University, Copenhagen, Denmark.
    Stadskleiv, K.
    Department of Psychology, University of Oslo, Oslo, Norway.
    Berntsen, T.
    Department of Child Neurology, Oslo University Hospital, Oslo, Norway.
    Christensen, K.
    The Danish Society for Cerebral Palsy, Copenhagen, Denmark.
    Korsfelt, Å.
    Länssjukhuset Ryhov, Jönköping, Sweden.
    Kihlgren, M.
    Department of Clinical Sciences, Lund University, Lund, Sweden.
    Ödman, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Systematic cognitive monitoring of children with cerebral palsy: the development of an assessment and follow-up protocol2016In: Scandinavian Journal of Disability Research, ISSN 1501-7419, E-ISSN 1745-3011, Vol. 18, no 4, p. 304-315Article in journal (Refereed)
    Abstract [en]

    Cerebral palsy (CP) is associated with cognitive impairments, learning difficulties and reduced social participation. Individual assessment is necessary for individually tailored interventions. This paper describes the development of a systematic follow-up programme of cognition, and the challenges of integrating it into the regular follow-up of children with CP. Initiated by the Nordic users‘ organisations, a group of psychologists proposed a protocol of follow-up of cognition in children with CP – the CP Cog. This protocol consists of neuropsychological instruments covering general cognitive functioning, visuospatial and executive functioning. The article presents a natural experiment describing development and implementation of the cognitive protocol in three Scandinavian countries. This introduction illustrates challenges associated with implementation, especially how the success of the protocol hinges on structural backup within the different countries. In conclusion the CP Cog assessment protocol holds the promise of increasing the awareness among habilitation professionals that children with CP are in need of cognitive evaluation and educational support. © 2015 Nordic Network on Disability Research

  • 41.
    Carlsson, E
    et al.
    1The Biomedical Platform, Department of Natural Science and Biomedicine, School of Health Sciences, Jönköping University, Jönköping.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Huus, K
    CHILD Research Group, Department of Nursing, School of Health Sciences, Jönköping University, Jönköping.
    Faresjö, M
    The Biomedical Platform, Department of Natural Science and Biomedicine, School of Health Sciences, Jönköping University, Jönköping.
    High physical activity in young children suggests positive effects by altering autoantigen-induced immune activity2016In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 26, no 4, p. 441-450Article in journal (Refereed)
    Abstract [en]

    Physical activity in children is associated with several positive health outcomes such as decreased cardiovascular risk factors, improved lung function, enhanced motor skill development, healthier body composition, and also improved defense against inflammatory diseases. We examined how high physical activity vs a sedentary lifestyle in young children influences the immune response with focus on autoimmunity. Peripheral blood mononuclear cells, collected from 55 5-year-old children with either high physical activity (n = 14), average physical activity (n = 27), or low physical activity (n = 14), from the All Babies In Southeast Sweden (ABIS) cohort, were stimulated with antigens (tetanus toxoid and beta-lactoglobulin) and autoantigens (GAD65 , insulin, HSP60, and IA-2). Immune markers (cytokines and chemokines), C-peptide and proinsulin were analyzed. Children with high physical activity showed decreased immune activity toward the autoantigens GAD65 (IL-5, P < 0.05), HSP60 and IA-2 (IL-10, P < 0.05) and also low spontaneous pro-inflammatory immune activity (IL-6, IL-13, IFN-γ, TNF-α, and CCL2 (P < 0.05)) compared with children with an average or low physical activity. High physical activity in young children seems to have positive effects on the immune system by altering autoantigen-induced immune activity.

  • 42.
    Christina, Snöbohm
    et al.
    KI, sjukgymnastik.
    Friedrichsen, Maria
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of LAH/Linnéa.
    Heiwe, Sussanne
    KI, sjukgymnastik.
    Experiencing one's body after a diagnosis of cancer-a phenomenological study of young adults.2010In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 19, no 8, p. 863-869Article in journal (Refereed)
    Abstract [en]

    Young adults with cancer are still in the process of shaping their lives and are therefore at a vulnerable stage. Altered body image may change how patients cope with the disease and impact rehabilitation capacity.Objective: To describe the essence of how young adults with cancer experience their bodies.Methods: Interviews (12 informants), transcribed verbatim. Analysis: Giorgi's phenomenological method.Results: Identified themes: experience of 'physical body change', 'discomfort', 'the body at the moment without reflecting on the disease and treatment', 'body image' and 'grasping the illness'. Essences: The body as the bearer of life; conflict between age and disease; manifest changes in appearance, physically and mentally; the body no longer a whole; the body as influenceable and able to recover and heal.Conclusions: These patients undergo physical and mental changes that affect their self-image and health-related life quality. Thus, future studies need to explore interventions that may enhance the individualś perception of their body.

  • 43.
    Daley, M
    et al.
    Bond University, Australia.
    McDonald, M
    Ozcare, Robina, Australia.
    Irwin, J
    Ozcare, Robina, Australia.
    Abbott, AD
    Bond University, Australia.
    Factors effecting participation rates in chronic disease self-management programmes.2013In: APA Conference 2013: New moves, Australian Physiotherapy Association , 2013, p. 2-2Conference paper (Other academic)
    Abstract [en]

    Question: What factors contribute to a lack of participation in community health care based Chronic Disease Self-Management (CDSM) programmes?

    Design: Descriptive study

    Participants: Twenty two patients eligible to participate in a community health care based CDSM program and 17 general practitioners (GP).

    Outcome Measures: A patient self-reported questionnaire was used to investigate expectations, potential facilitators and barriers to patient participation and GP referral to a CDSM program.

    Results: For eligible CDSM participants, 57% were expecting relevant health maintenance advice, 18% expected improved general health and 25% were unsure what to expect. The main facilitators to participation were active recruitment by CDSM providers and that the program was cost free. Main barriers to participation included patient perceived relevance of the CDSM and scheduling issues. For GP’s, a lack of awareness, uncertainty of referral pathway, their time constraints, and appropriateness for their client were the main barrier to referring to CDSM programs.

    Conclusion: Clear information on CDSM program content and referral pathways directed at both potential participants and those who would refer participants should be greatly improved.

    Key Practice Points:

    •  Community health CDSM providers should consider improving awareness of programs through marketing clear program content and referral pathways to potential patients directly and local health care professionals.

  • 44.
    Dannapfel, Petra
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Evidence-Based Practice in Practice: Exploring Conditions for Using Research in Physiotherapy2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Research developments have led to increased opportunities for the use of improved diagnostic and treatment methods in physiotherapy and other areas of health care. The emergence of the evidence-based practice (EBP) movement has led to higher expectations for a more research-informed health care practice that integrates the best available research evidence with clinical experience and patient priorities and values. Physiotherapy research has grown exponentially, contributing to an increased interest in achieving a more evidence-based physiotherapy practice. However, implementation research has identified many individual and contextual barriers to research use. Strategies to achieve a more EBP tend to narrowly target individual practitioners to influence their knowledge, skills and attitudes concerning research use. However, there is an emerging recognition that contextual conditions such as leadership and culture are critical to successfully implementing EBP.

    Against this background, the overall aim of this thesis was to explore conditions at different levels, from the individual level to the organizational level and beyond, for the use of research and implementation of an evidence-based physiotherapy practice. The thesis consists of four interrelated papers that address various aspects of the aim. Individual and focus group interviews were conducted with physiotherapists and managers within physiotherapy in various county councils in Sweden between 2011 and 2014. Data were analysed using qualitative content analysis, direct content analysis and hermeneutics.

    It was found that many different types of motivation underlie physiotherapists’ use of research in their clinical practice, from amotivation (i.e. a lack of intention to engage in research use) to intrinsic motivation (research use is perceived as interesting and satisfying in itself). Most physiotherapists tend to view research use in favourable terms. Physiotherapists’ participation in a research project can yield many individual learning experiences that might contribute to a more research-informed physiotherapy practice. However, organizational learning was more limited. Numerous conditions at different levels (individual, workplace and extra-organizational levels) provide support for physiotherapists’ use of research in their clinical practice. However, physiotherapy leaders appear to contribute to a modest degree to establishing a culture that is conducive to implementing EBP in physiotherapy practice. Instead, EBP issues largely seem to depend on committed individual physiotherapists who keep to up to date with research in physiotherapy and inform colleagues about the latest research findings.

    List of papers
    1. Applying self-determination theory for improved understanding of physiotherapists rationale for using research in clinical practice: a qualitative study in Sweden
    Open this publication in new window or tab >>Applying self-determination theory for improved understanding of physiotherapists rationale for using research in clinical practice: a qualitative study in Sweden
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    2014 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 30, no 1, p. 20-28Article in journal (Refereed) Published
    Abstract [en]

    Physiotherapists are generally positive to evidence-based practice (EBP) and the use of research in clinical practice, yet many still base clinical decisions on knowledge obtained during their initial education and/or personal experience. Our aim was to explore motivations behind physiotherapists use of research in clinical practice. Self-Determination Theory was applied to identify the different types of motivation for use of research. This theory posits that all behaviours lie along a continuum of relative autonomy, reflecting the extent to which a person endorses their actions. Eleven focus group interviews were conducted, involving 45 physiotherapists in various settings in Sweden. Data were analysed using qualitative content analysis and the findings compared with Self-Determination Theory using a deductive approach. Motivations underlying physiotherapists use of research in clinical practice were identified. Most physiotherapists expressed autonomous forms of motivation for research use, but some exhibited more controlled motivation. Several implications about how more evidence-based physiotherapy can be achieved are discussed, including the potential to tailor educational programs on EBP to better account for differences in motivation among participants, using autonomously motivated physiotherapists as change agents and creating favourable conditions to encourage autonomous motivation by way of feelings of competence, autonomy and a sense of relatedness.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2014
    Keywords
    Physiotherapy, research use, self-determination theory
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-102843 (URN)10.3109/09593985.2013.814185 (DOI)000328150600004 ()
    Available from: 2014-01-07 Created: 2014-01-02 Last updated: 2017-12-06
    2. What supports physiotherapists’ use of research in clinical practice? A qualitative study in Sweden
    Open this publication in new window or tab >>What supports physiotherapists’ use of research in clinical practice? A qualitative study in Sweden
    2013 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 8Article in journal (Refereed) Published
    Abstract [en]

    Background

    Evidence-based practice has increasingly been recognized as a priority by professional physiotherapy organizations and influential researchers and clinicians in the field. Numerous studies in the past decade have documented that physiotherapists hold generally favorable attitudes to evidence-based practice and recognize the importance of using research to guide their clinical practice. Research has predominantly investigated barriers to research use. Less is known about the circumstances that actually support use of research by physiotherapists. This study explores the conditions at different system levels that physiotherapists in Sweden perceive to be supportive of their use of research in clinical practice.

    Methods

    Patients in Sweden do not need a referral from a physician to consult a physiotherapist and physiotherapists are entitled to choose and perform any assessment and treatment technique they find suitable for each patient. Eleven focus group interviews were conducted with 45 physiotherapists, each lasting between 90 and 110 minutes. An inductive approach was applied, using topics rather than questions to allow the participants to generate their own questions and pursue their own priorities within the framework of the aim. The data were analyzed using qualitative content analysis.

    Results

    Analysis of the data yielded nine favorable conditions at three system levels supporting the participant’s use of research in clinical practice: two at the individual level (attitudes and motivation concerning research use; research-related knowledge and skills), four at the workplace level (leadership support; organizational culture; research-related resources; knowledge exchange) and three at the extra-organizational level (evidence-based practice guidelines; external meetings, networks, and conferences; academic research and education).

    Conclusions

    Supportive conditions for physiotherapists’ use of research exist at multiple interdependent levels, including the individual, workplace, and extra-organizational levels. Research use in physiotherapy appears to be an interactive and interpretative social process that involves a great deal of interaction with various people, including colleagues and patients.

    Place, publisher, year, edition, pages
    BioMed Central, 2013
    Keywords
    Physical therapy, Evidence-based practice, Research use, System levels, Attitudes, Clinical practice
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-93865 (URN)10.1186/1748-5908-8-31 (DOI)000318418500001 ()
    Available from: 2013-06-11 Created: 2013-06-11 Last updated: 2017-12-06
    3. A Qualitative Study of Individual and Organizational Learning through Physiotherapists’ Participation in a Research Project
    Open this publication in new window or tab >>A Qualitative Study of Individual and Organizational Learning through Physiotherapists’ Participation in a Research Project
    2014 (English)In: International Journal of Clinical Medicine, ISSN 2158-284X, E-ISSN 2158-2882, Vol. 5, no 9, p. 514-524Article in journal (Refereed) Published
    Abstract [en]

    The need for evidence-based practice has been recognized by physiotherapy organizations over the past decades. Earlier studies have documented facilitators and barriers that affect the use and implementation of evidence-based practice. Less is known about what kind of interventions might be useful to implement evidence-based practice. This study explores what physiotherapists learn through participation in a research project relevant to their professional development towards achieving a more evidence-based physiotherapy practice. To what extent this learning was transferred to colleagues for organizational learning is also examined. This study was set in Sweden, where health care is publicly funded. Patients do not need a referral from a physician to consult a physiotherapist. Eleven interviews were conducted with physiotherapists who had participated in a randomized, controlled, multicenter, physiotherapy intervention investigating neck-specific exercise for patients with whiplash disorder. Gadamer’s hermeneutics was used to analyze the data. The physiotherapists described a range of learning experiences from their project participation, including instrumental learning (the concrete application of knowledge to achieve changes in practice) and conceptual learning (changes in knowledge, understanding or attitudes). The research project enabled the physiotherapists to develop new treatment techniques for broader application and extend their competence in techniques already known (instrumental learning). The physiotherapists believed that project participation enhanced their overall competence as physiotherapists, increased their job motivation and strengthened their self-confidence and self-efficacy (conceptual learning). Physiotherapists’ participation in the research project yielded many individual learning experiences, fostered positive attitudes to research and was conducive to achieving a more research-informed physiotherapy practice. Participation was associated with a deeper understanding of the challenges involved in conducting research. The transfer from indi-

    National Category
    Information Systems, Social aspects
    Identifiers
    urn:nbn:se:liu:diva-119152 (URN)10.4236/ijcm.2014.59071 (DOI)
    Available from: 2015-06-10 Created: 2015-06-10 Last updated: 2017-12-04
    4. Fostering a culture of evidence-based physiotherapy practice: a qualitative analysis of the influence of health care leaders in Sweden
    Open this publication in new window or tab >>Fostering a culture of evidence-based physiotherapy practice: a qualitative analysis of the influence of health care leaders in Sweden
    2015 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Research in physiotherapy has increased rapidly over the last decade, yet studies have shown that many practice decisions continue to be based on knowledge obtained during initial physiotherapy education and/or personal experience, rather than findings from research. Both barriers and facilitators to achieving a more evidence-based practice (EBP) in physiotherapy have been identified. Leadership is one facilitator that has been recognized to have an important influence on the implementation of EBP in various settings. Our aim was to explore how physiotherapy leaders in Sweden influence the culture for implementation of evidence-based physiotherapy practice.

    Methods: Nine interviews with managers of physiotherapy clinics were conducted in various settings in Sweden. Data were analysed using qualitative analysis and a framework developed by Schein (Schein EH. Organizational culture and leadership. 4th ed. San Francisco, CA: Jossey-Bass; 2010) was applied.

    Results: The framework identifies a number mechanisms by which leaders can influence the culture of an organization and/or groups within an organization. The mechanisms of paying attention to, measuring and controlling on a regular basis as well as deliberate role modelling, teaching and coaching did have some relevance. However, EBP issues seemed to depend on committed individuals, often younger physiotherapists, who were interested in research.

    Conclusions: Overall, there was limited relevance for most of the embedding mechanisms. The findings suggest that physiotherapy leaders in Sweden contribute to a modest degree to establishing a culture conducive to implementation of an evidence-based physiotherapy practice.

    Keywords
    Leadership; Culture; Evidence-based practice; Implementation; Physiotherapy
    National Category
    Physiotherapy
    Identifiers
    urn:nbn:se:liu:diva-122171 (URN)
    Available from: 2015-10-23 Created: 2015-10-23 Last updated: 2015-10-23Bibliographically approved
  • 45.
    Dannapfel, Petra
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Fostering a culture of evidence-based physiotherapy practice: a qualitative analysis of the influence of health care leaders in Sweden2015Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Research in physiotherapy has increased rapidly over the last decade, yet studies have shown that many practice decisions continue to be based on knowledge obtained during initial physiotherapy education and/or personal experience, rather than findings from research. Both barriers and facilitators to achieving a more evidence-based practice (EBP) in physiotherapy have been identified. Leadership is one facilitator that has been recognized to have an important influence on the implementation of EBP in various settings. Our aim was to explore how physiotherapy leaders in Sweden influence the culture for implementation of evidence-based physiotherapy practice.

    Methods: Nine interviews with managers of physiotherapy clinics were conducted in various settings in Sweden. Data were analysed using qualitative analysis and a framework developed by Schein (Schein EH. Organizational culture and leadership. 4th ed. San Francisco, CA: Jossey-Bass; 2010) was applied.

    Results: The framework identifies a number mechanisms by which leaders can influence the culture of an organization and/or groups within an organization. The mechanisms of paying attention to, measuring and controlling on a regular basis as well as deliberate role modelling, teaching and coaching did have some relevance. However, EBP issues seemed to depend on committed individuals, often younger physiotherapists, who were interested in research.

    Conclusions: Overall, there was limited relevance for most of the embedding mechanisms. The findings suggest that physiotherapy leaders in Sweden contribute to a modest degree to establishing a culture conducive to implementation of an evidence-based physiotherapy practice.

  • 46.
    Devitt, Brian M
    et al.
    OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia; School of Allied Health, La Trobe University, Melbourne, Australia.
    Bell, Stuart W.
    OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Hartwig, Taylor
    OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia.
    Porter, Tabitha J
    OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia.
    Feller, Julian A
    OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia.
    Webster, Kate E
    School of Allied Health, La Trobe University, Melbourne, Australia.
    The Role of Lateral Extra-articular Tenodesis in Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review With Meta-analysis and Best-Evidence Synthesis2017In: The Orthopaedic Journal of Sports Medicine, ISSN 2325-9671, Vol. 5, no 10Article in journal (Refereed)
    Abstract [en]

    The role of lateral extra-articular tenodesis (LEAT) to augment primary anterior cruciate ligament reconstruction (ACLR) remains controversial.

  • 47.
    Diarberkali, Elias
    et al.
    Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden ; Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
    Grauers, Anna
    Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Orthopaedics, Sundsvall and Härnösand County Hospital, Sundsvall, Sweden.
    Möller, Hans
    Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden ; Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Faculty of Health Science and Medicine, Bond University, Gold Coast, Australia.
    Gerdhem, Paul
    Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden ; Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
    Adolescents with and without idiopathic scoliosis have similar self-reported level of physical activity: a cross-sectional study2016In: Scoliosis and Spinal Disorders, ISSN 2397-1789, Vol. 11, no 17, p. 1-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Little is known about physical activity levels in individuals with idiopathic scoliosis. The aim of this study was to describe the level of physical activity in adolescents with and without idiopathic scoliosis.

    METHODS:

    Two hundred thirty-nine adolescents, median (25th, 75th percentile) age 16.0 (14.4, 17.6) with idiopathic scoliosis and 58 randomly recruited population-based individuals without scoliosis aged 14.6 (12.8, 16.3) participated. The 239 idiopathic scoliosis patients consisted of 88 untreated, 43 previously braced, 36 with ongoing brace-treatment and 72 surgically treated individuals. Main outcome measure was the proportion achieving at least moderate activity level, as estimated by the International Physical Activity Questionnaire short form (IPAQ-SF). Other outcome measures were Metabolic Equivalent Task (MET) minutes/week, time spent sitting, spare time activity level and sporting activities. Statistical analyses were adjusted for age and sex.

    RESULTS:

    The proportion of individuals with scoliosis with moderate activity level was 180 out of 239 (75 %) and for individuals without scoliosis 49 out of 58 (85 %) (p = 0.14). Median MET-minutes/week (25th,75th percentile) was for individuals with scoliosis scoliosis 1977 (840,3777) and for individuals without scoliosis 2120 (887,4598) (p = 0.11). Sporting activities did not differ (p = 0.28). The ongoing brace-treatment group had a significantly higher proportion of individuals categorizing themselves at high spare time activity level compared to the surgically treated and previously braced individuals (p = 0.046). No difference was seen between the treatment groups regarding the proportion achieving moderate activity (p = 0.11) and sporting activities (p = 0.20). Median MET minutes/week was 2160 (794,3797) for the untreated group, 989 (661,2706) for the previously braced group, 2055 (1010, 4026) for the surgery group and 2106 (990,4480) for the ongoing brace-treatment group (p = 0.031).

    CONCLUSION:

    Adolescents with idiopathic scoliosis show similar levels of self-reported physical activity as individuals without idiopathic scoliosis. Bracing and surgery do not appear to inhibit physical activity.

  • 48.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Ioannina, Greece.
    Evangelou, Evangelos
    Univ Ioannina, Greece; Imperial Coll London, England.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    EFFECTIVENESS OF MULTIDISCIPLINARY PROGRAMMES FOR CLINICAL PAIN CONDITIONS: AN UMBRELLA REVIEW2018In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 9, p. 779-791Article, review/survey (Refereed)
    Abstract [en]

    Objective: To evaluate the strength of the evidence for multimodal/multidisciplinary rehabilitation programmes (MMRPs) for common pain outcomes. Data sources: PubMed, PsychInfo, PEDro and Co-chrane Library were searched from inception to August 2017. Study selection: Meta-analyses of randomized controlled trials or controlled clinical trials and qualitative systematic reviews of randomized controlled trials and non-randomized controlled trials were considered eligible. Data extraction: Two independent reviewers abstracted data and evaluated the methodological quality of the reviews. The strength of the evidence was graded using several criteria. Data synthesis: Twelve meta-analyses, including 134 associations, and 24 qualitative systematic reviews were selected. None of the associations in meta-analyses and qualitative systematic reviews were supported by either strong or highly suggestive evidence. In meta-analyses, only 8 (6%) associations that were significant at p-value amp;lt;= 0.05 were supported by suggestive evidence, whereas 44 (33%) associations were supported by weak evidence. Moderate evidence was found only in 4 (17%) qualitative systematic reviews, while 14 (58%) qualitative systematic reviews had limited evidence. Conclusion: There is no evidence that MMRPs are effective for prevalent clinical pain conditions. The majority of the evidence remains ambiguous and susceptible to biases due to the small sample size of participants and the limited number of studies included.

  • 49.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    A cross-sectional study of factors associated with the number of anatomical pain sites in an actual elderly general population: results from the PainS65+cohort2017In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 10, p. 2009-2019Article in journal (Refereed)
    Abstract [en]

    Background: Several studies have illustrated that multisite pain is more frequent than single pain site, and it is associated with an array of negative consequences. However, there is limited knowledge available about the potential factors associated with multisite pain in the elderly general population. Objective: This cross-sectional study examines whether the number of anatomical pain sites (APSs) is related to sociodemographic and health-related factors in older adults including oldestold ages using a new method (APSs) to assess the location of pain on the body. Materials and methods: The sample came from the PainS65+ cohort, which included 6,611 older individuals (mean age = 76.0 years; standard deviation [SD] = 7.4) residing in southeastern Sweden. All the participants completed and returned a postal survey that measured sociodemographic data, total annual income, pain intensity and frequency, general well-being, and quality of life. The number of pain sites (NPS) was marked on a body manikin of 45 sections, and a total of 23 APSs were then calculated. Univariable and multivariable models of regression analysis were performed. Results: Approximately 39% of the respondents had at least two painful sites. The results of the regression analysis showed an independent association between the APSs and the age group of 75-79 years, women, married, high pain intensity and frequency, and low well-being and quality of life, after adjustments for consumption of analgesics and comorbidities. The strongest association was observed for the higher frequency of pain. Conclusion: Our results suggest that APSs are highly prevalent with strong relationships with various sociodemographic and health-related factors and concur well with the notion that multisite pain is a potential indicator of increased pain severity and impaired quality of life in the elderly. Our comprehensive method of calculating the number of sites could be an essential part of the clinical presentation, assessment, and treatment of multisite pain.

  • 50.
    Dragioti, Elena
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Allergy Center.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Prevalence of different pain categories based on pain spreading on the bodies of older adults in Sweden: a descriptive-level and multilevel association with demographics, comorbidities, medications, and certain lifestyle factors (PainS65+)2016In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 9, p. 1131-1141Article in journal (Refereed)
    Abstract [en]

    Background and objective: There is limited knowledge about the prevalence of pain and its relation to comorbidities, medication, and certain lifestyle factors in older adults. To address this limitation, this cross-sectional study examined the spreading of pain on the body in a sample of 6611 subjects amp;gt;= 65 years old (mean age = 75.0 years; standard deviation [SD] = 7.7) living in southeastern Sweden. Methods: Sex, age, comorbidities, medication, nicotine, alcohol intake, and physical activity were analyzed in relation to the following pain categories: local pain (LP) (24.1%), regional pain medium (RP-Medium) (20.3%), regional pain heavy (RP-Heavy) (5.2%), and widespread pain (WSP) (1.7%). Results: RP-Medium, RP-Heavy, and WSP were associated more strongly with women than with men (all pamp;lt;0.01). RP-Heavy was less likely in the 80-84 and amp;gt;85 age groups compared to the 65-69 age group (both pamp;lt;0.01). Traumatic injuries, rheumatoid arthritis/osteoarthritis, and analgesics were associated with all pain categories (all pamp;lt;0.001). An association with gastrointestinal disorders was found in LP, RP-Medium, and RP-Heavy (all pamp;lt;0.01). Depressive disorders were associated with all pain categories, except for LP (all pamp;lt;0.05). Disorders of the central nervous system were associated with both RP-Heavy and WSP (all pamp;lt;0.05). Medication for peripheral vascular disorders was associated with RP-Medium (pamp;lt;0.05), and hypnotics were associated with RP-Heavy (pamp;lt;0.01). Conclusion: More than 50% of older adults suffered from different pain spread categories. Women were more likely to experience greater spreading of pain than men. A noteworthy number of common comorbidities and medications were associated with increased likelihood of pain spread from LP to RP-Medium, RP-Heavy, and WSP. Effective management plans should consider these observed associations to improve functional deficiency and decrease spreading of pain-related disability in older adults.

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