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  • 1.
    Abbott, Allan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Department of Physical Therapy, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Division of Orthopaedics, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
    Tyni-Lenné, Raija
    Department of Physical Therapy, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Hedlund, Rune
    Department for Orthopaedics, Institute for Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Leg pain and psychological variables predict outcome 2-3 years after lumber fusion surgery2011In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 20, no 10, p. 1626-1634Article in journal (Refereed)
    Abstract [en]

    Prediction studies testing a thorough range of psychological variables in addition to demographic, work-related and clinical variables are lacking in lumbar fusion surgery research. This prospective cohort study aimed at examining predictions of functional disability, back pain and health-related quality of life (HRQOL) 2-3 years after lumbar fusion by regressing nonlinear relations in a multivariate predictive model of pre-surgical variables. Before and 2-3 years after lumbar fusion surgery, patients completed measures investigating demographics, work-related variables, clinical variables, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, mental health and pain coping. Categorical regression with optimal scaling transformation, elastic net regularization and bootstrapping were used to investigate predictor variables and address predictive model validity. The most parsimonious and stable subset of pre-surgical predictor variables explained 41.6, 36.0 and 25.6% of the variance in functional disability, back pain intensity and HRQOL 2-3 years after lumbar fusion. 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 straight leg raise significantly predicted back pain. Post-operative psychomotor therapy also significantly predicted functional disability while pre-surgical outcome expectations significantly predicted HRQOL. For the median dichotomised classification of functional disability, back pain intensity and HRQOL levels 2-3 years post-surgery, the discriminative ability of the prediction models was of good quality. The results demonstrate the importance of pre-surgical psychological factors, leg pain intensity, straight leg raise and post-operative psychomotor therapy in the predictions of functional disability, back pain and HRQOL-related outcomes.

  • 2.
    Brink, Rob C.
    et al.
    Department of Orthopaedic Surgery, G05.228, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands..
    Vavruch, Ludvig
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Schlösser, Tom P. C.
    Department of Orthopaedic Surgery, G05.228, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands..
    Abul-Kasim, Kasim
    Division of Neuroradiology, Diagnostic Centre for Imaging and Functional Medicine, Faculty of Medicine, Lund University, Skåne University Hospital, Malmö, Sweden..
    Ohlin, Acke
    Department of Orthopaedic Surgery, Faculty of Medicine, Lund University, Skåne University Hospital, Malmö, Sweden..
    Tropp, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Castelein, René M.
    Department of Orthopaedic Surgery, G05.228, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. r.m.castelein@umcutrecht.nl..
    Vrtovec, Tomaž
    Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia..
    Three-dimensional pelvic incidence is much higher in (thoraco)lumbar scoliosis than in controls2019In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 28, no 3, p. 544-550Article in journal (Refereed)
    Abstract [en]

    Purpose

    The pelvic incidence (PI) is used to describe the sagittal spino-pelvic alignment. In previous studies, radiographs were used, leading to less accuracy in establishing the three-dimensional (3D) spino-pelvic parameters. The purpose of this study is to analyze the differences in the 3D sagittal spino-pelvic alignment in adolescent idiopathic scoliosis (AIS) subjects and non-scoliotic controls.

    Methods

    Thirty-seven female AIS patients that underwent preoperative supine low-dose computed tomography imaging of the spine, hips and pelvis as part of their general workup were included and compared to 44 non-scoliotic age-matched female controls. A previously validated computerized method was used to measure the PI in 3D, as the angle between the line orthogonal to the inclination of the sacral endplate and the line connecting the center of the sacral endplate with the hip axis.

    Results

    The PI was on average 46.8° ± 12.4° in AIS patients and 41.3° ± 11.4° in controls (p = 0.025), with a higher PI in Lenke type 5 curves (50.6° ± 16.2°) as compared to controls (p = 0.042), whereas the Lenke type 1 curves (45.9° ± 12.2°) did not differ from controls (p = 0.141).

    Conclusion

    Lenke type 5 curves show a significantly higher PI than controls, whereas the Lenke type 1 curves did not differ from controls. This suggests a role of pelvic morphology and spino-pelvic alignment in the pathogenesis of idiopathic scoliosis. Further longitudinal studies should explore the exact role of the PI in the initiation and progression of different AIS types.

  • 3.
    Fritzell, Peter
    et al.
    Department of Orthopedic Surgery, Falun Hospital, Falun, Sweden.
    Berg, Svante
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences.
    Borgström, Fredrik
    LIME/MMC, Karolinska Institutet, Stockholm, Sweden.
    Tullberg, Tycho
    Stockholm Spine Center, Upplands Väsby, Sweden.
    Tropp, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Cost effectiveness of disc prosthesis versus lumbar fusion in patients with chronic low back pain: randomized controlled trial with 2-year follow-up:  2011In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 20, no 7, p. 1001-1011Article in journal (Refereed)
    Abstract [en]

    When low back pain becomes chronic, surgery is sometimes performed. The gold standard today is lumbar fusion (FUS), using a variety of procedures. Total disc replacement (TDR) aimed at motion preservation is increasing in popularity. This randomized controlled health economic study assesses the cost-effectiveness of TDR (Charité/Prodisc/Maverick) compared with instrumented FUS (posterior lumbar fusion (PLF)/posterior lumbar interbody fusion (PLIF). Social and healthcare perspectives after two years are reported. In all, 152 patients were randomized to either TDR (n=80) or FUS (n=72). Cost to society, (total mean cost/patient, Swedish kronor=SEK, standard deviation) for TDR was SEK 599,560 (400,272), and for FUS SEK 685,919 (422,903) (ns). TDR was significantly less costly from a healthcare perspective, SEK 22,996 (43,055- -1,202). Number of days on sick leave among those who returned to work was 185 (146) in the TDR group, and 252 (189) in the FUS group (ns). Using EQ-5D, the total gain in quality adjusted life years (QALYs) over two years was 0.41 units for TDR and 0.40 units for FUS (ns). Based on EQ-5D, the incremental cost effectiveness ratio (ICER) of using TDR instead of FUS was difficult to analyze due to the “non-difference” in treatment outcome, which is why cost/QALY could not be defined. Using cost-effectiveness probabilistic analysis, the net benefit with CI) was found to be SEK 91,359 (-73,643 – 249,114) (ns).

    Conclusion: It is not possible to state whether TDR or FUS is more cost-effective after two years. Since disc replacement and lumbar fusion are based on different conceptual approaches, it is important to follow these results over time.

  • 4.
    Halvorsen, Marie
    et al.
    Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden .
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden; Bond University, Gold Coast, Australia .
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. University of Queensland, Brisbane, Australia .
    Dedering, Åsa
    Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden .
    Endurance and fatigue characteristics in the neck muscles during sub-maximal isometric test in patients with cervical radiculopathy2014In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 23, no 3, p. 590-598Article in journal (Refereed)
    Abstract [en]

    Purpose

    The aim of the study was to compare myoelectric manifestation in neck muscle endurance and fatigue characteristics during sub-maximal isometric endurance test in patients with cervical radiculopathy and asymptomatic subjects. An additional aim was to explore associations between primary neck muscle endurance, myoelectric fatigability, and self-rated levels of fatigue, pain and subjective health measurements in patients with cervical radiculopathy.

    Methods

    Muscle fatigue in the ventral and dorsal neck muscles was assessed in patients with cervical radiculopathy and in an asymptomatic group during an isometric neck muscle endurance test in prone and supine. 46 patients and 34 asymptomatic subjects participated. Surface electromyography signals were recorded from the sternocleidomastoid, cervical paraspinal muscles and upper and middle trapezius bilaterally during the endurance test. Subjective health measurements were assessed with questionnaires.

    Results

    The results showed altered neck muscle endurance in several of the muscles investigated with greater negative median frequency slope, greater variability, side imbalance, lower endurance time and higher experience of fatigue among the cervical radiculopathy patients compared with healthy subjects. Endurance times were significantly lower in both prone and in supine positions between the patients compared to asymptomatic subjects. During the neck muscle endurance test, fatigues in the upper trapezius muscles during the prone test and in the sternocleidomastoid muscles during the supine test were of more importance than self-perceived pain, fatigue, disability and kinesiophobia in predicting neck muscle endurance (NME).

    Conclusion

    NME testing in the primary neck muscles seems to be an important factor to take into consideration in rehabilitation.

  • 5.
    Javid, D.
    et al.
    Department of Orthopedic Surgery, Huddinge University Hospital, 141 86 Stockholm, Sweden.
    Hedlund, R.
    Department of Orthopedic Surgery, Huddinge University Hospital, 141 86 Stockholm, Sweden.
    Vavruch, Ludek
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Neurosurgery .
    Leszniewski, W.
    Is the efficacy of the Cloward procedure overestimated? Technique of evaluation affects the outcome2001In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 10, no 3, p. 222-227Article in journal (Refereed)
    Abstract [en]

    The purpose of the present study was to investigate the influence of the evaluation technique on the outcome of the Cloward procedure in cervical radiculopathy. The retrospective study included 94 consecutive patients operated on with anterior decompression and fusion with heterologous bone (Surgibone, Unilab). There were 56 men and 38 women, with a mean age of 48 years (range 27-78 years). Sixty-six patients had a single-level fusion, 26 a two-level fusion and one patient had a three-level fusion. The follow-up rate was 91/94 (97%) and evaluation was performed by an independent observer. Pain was quantified by visual analogue scale (VAS, range 0-100), functional disability by the new functional index Cervical Spine Functional Score (CSFS, range 0-100) and by the Neck Pain Disability Index (NPDI, range 0-100). The overall clinical outcome was assessed as excellent, good, fair or poor by both the patient and by the independent observer using Odom's criteria. At a mean follow-up of 26 months (range 12-56 months) the mean pain index was 39 (range 0-98), the mean CSFS 39 (range 0-85) and the mean NPDI 32 (range 0-76). The classification of the observer was 37% excellent, 40% good, 17% fair and 6% poor, and that of the patient was 53% excellent, 23% good, 20% fair and 4% poor. In the group classified as good by the observer, all scores were above 40, suggesting considerable remaining symptoms, and only 50% had returned to work. The results suggest that previous reports on the Cloward procedure using categorizations into excellent, good, fair or poor have overestimated the efficacy of the procedure. Only an excellent, but not a good, result as classified by the patient or an independent observer reflects a successful outcome. Neither of the variables studied seems independently sufficient for a balanced reflection of the outcome. The results suggest pain (VAS) as the primary outcome measurement, which, combined with the overall evaluation by the independent observer and work status, gives a multidimensional expression of the outcome.

  • 6.
    Laslett, Mark
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy.
    Aprill, C N
    McDonald, B
    Öberg, Birgitta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Clinical predictors of lumbar provocation discography: A study of clinical predictors of lumbar provocation discography2006In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 15, no 10, p. 1473-1484Article in journal (Refereed)
    Abstract [en]

    Discography is the only available method of directly challenging the discs for pain sensitivity. However, it is invasive, expensive and there is a debate about its clinical value. There is a need to identify clinical signs that may indicate the need for a discography examination. Pain centralization (retreat of referred pain to towards the spinal midline) has been associated with positive discography and possesses specificity between 80 and 100% depending on levels of disablement and psychosocial distress. Less than half of positive discography patients reports centralization and there is a need to identify other potentially valuable predictors. This study estimated the diagnostic accuracy of clinical variables in relation to provocation discography. In a blinded, prospective reference standard design in a private interventional radiology clinic, chronic low back patients received a detailed clinical examination followed by discography. Patients were typically disabled with high levels of psychosocial distress. Logistic regression modelling identified potentially useful clinical variables, and sensitivity, specificity and likelihood ratios were calculated for promising specific variables and combinations of variables. Of 118 consecutive discography cases, 107 had unconfounded data on discography results. History of persistent pain between acute episodes, a significant loss of extension and a subjective report of 'vulnerability' in what is termed as the 'neutral zone' had specificities of 83-92% and likelihood ratios between 2.0 and 4.1. Two combinations of variables were highly specific to positive discography, but no suitable screening test useful for ruling out positive discography was established. Three clinical variables have modest predictive power in relation to lumbar discography results and two combinations of variables were highly specific to positive discography. © 2006 Springer-Verlag.

  • 7.
    Lindbäck, Yvonne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Tropp, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Spinal Surgery.
    Enthoven, Paul
    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, Research & Development Unit in Local Health Care.
    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.
    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.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Association between pain sensitivity in the hand and outcomes after surgery in patients with lumbar disc herniation or spinal stenosis.2017In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 26, no 10, p. 2581-2588Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To investigate the association between pain sensitivity in the hand pre-surgery, and patient-reported outcomes (PROs) in function, pain and health pre- and post-surgery in patients with disc herniation or spinal stenosis.

    METHODS: This is a prospective cohort study with 82 patients. Associations between pressure-, cold- and heat pain threshold (PPT, CPT, HPT) in the hand pre-surgery and Oswestry, VAS pain, EQ-5D, HADS, and Self-Efficacy Scale, pre- and three months post-surgery; were investigated with linear regression.

    RESULTS: Patients with disc herniation more sensitive to pressure pain pre-surgery showed lower function and self-efficacy, and higher anxiety and depression pre-surgery, and lower function, and self-efficacy, and higher pain post-surgery. Results for cold pain were similar. In patients with spinal stenosis few associations with PROs were found and none for HPT and PROs.

    CONCLUSIONS: Altered pain response in pressure- and cold pain in the hand, as a sign of widespread pain pre-surgery had associations with higher pain, lower function and self-efficacy post-surgery in patients with disc herniation.

  • 8.
    Normelli, Helena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine.
    Re: Vertebral hydatid cyst infection (Ecchinococcus granulosus)2002In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 11, no 4, p. 395Other (Other academic)
    Abstract [en]

    [No abstract available]

  • 9.
    Peolsson, Anneli
    Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Investigation of clinically important benefit of anterior cervical decompression and fusion2007In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 16, no 4, p. 507-514Article in journal (Refereed)
    Abstract [en]

    The objectives of the prospective randomized study are to investigate the clinically relevant change after anterior cervical decompression and fusion (ACDF) using measures of pain intensity (visual analog scale, VAS) and neck disability index (NDI). And to determine the number of subjects showing persistent pain and disability at 6-year follow-up. To investigate the possibility of differences in outcome between ACDF with the cervical intervertebral fusion cage (CIFC) and the Cloward procedure (CP). Clinically relevant change and residual, postoperative pain intensity and disability after ACDF have been investigated a little. Ninety-five patients with neck and radicular arm pain lasting for at least 6 months were randomly selected to receive ACDF with the CP or the CIFC. Questionnaires concerning pain and NDI were obtained from 83 patients (87%) at a mean follow-up time of 76 months (range 56–94 months). When evaluating clinical benefits regarding pain intensity 6 years after ACDF, according to different cut-off points and relative percentages, symptoms improved in 46–78% of patients. Improvement in NDI was seen in 18–20% of patients. Approximately 70% of the patients had persistent pain and disability at 6-year follow-up. There was no clinically important difference following CP versus CIFC. Thirty millimeter and 20% in pain intensity and NDI, respectively, are reasonable criteria to suggest a clinically relevant change after ACDF. Before patients undergo ACDF, they should be informed that they have an approximate 50% probability of achieving pain relief and little probability of functional improvement. The findings demonstrate that there is poor evidence for difference between CIFC and CP.

  • 10.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Hedlund, Rune
    Department of Orthopaedics, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden.
    Vavruch, Ludek
    Department of Neuro-Orthopaedic Surgery, Ryhov Hospital, Jönköping, Sweden.
    Prediction of fusion and importance of radiological variables for the outcome of anterior cervical decompression and fusion2004In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 13, no 3, p. 229-234Article in journal (Refereed)
    Abstract [en]

    In a prospective randomised study with a 2-year follow-up, 103 patients were randomised to anterior cervical decompression and fusion (ACDF) with a cervical carbon-fibre intervertebral fusion cage (CIFC) or the Cloward procedure (CP). The purpose of the present study was to report predictors for fusion and also to investigate the importance of radiological variables for the clinical outcome. Gender, age, smoking habits, disc height, segmental kyphosis and type of surgical procedure were used as independent (before surgery) variables in a multiple regression model. Male gender, one-level surgery and CP treatment were significant predictors of fusion and explained 14% of the variability of fusion status at follow-up. Number of levels operated on, however, did not influence the clinical outcome. Fifty-two per cent of the women and 17% of the men in the CIFC group, and 25% of the women and 8% of the men in the CP group, had pseudarthrosis. Although patients with a healed fusion had significantly less pain intensity than patients with pseudarthrosis, radiological variables explained only 4% of the variability of pain at follow-up. Apart from a significant correlation between preoperative kyphosis and neck disability index at follow-up, no significant correlation between either postoperative kyphosis or preoperative or postoperative disc height and clinical outcome was found. Neither degree of segmental kyphosis nor disc height was different between patients with healed fusion and pseudarthrosis. One can conclude that male gender and type of surgery were significant predictors for a healed fusion and that pseudarthrosis affected outcome. In contrast to the commonly held view based mainly on theoretical considerations, no effect on clinical outcome could be demonstrated for segmental kyphosis and disc height at follow-up. Overall, the study shows that the importance of radiological factors as predictors for fusion as well as clinical outcome is limited.

  • 11.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Hedlund, Rune
    Department of Orthopaedics, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden.
    Vavruch, Ludek
    Department of Neuro-Orthopaedic Surgery, Ryhov Hospital, Jönköping, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Predictive factors for the outcome of anterior cervical decompression and fusion2003In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 12, no 3, p. 274-280Article in journal (Refereed)
    Abstract [en]

    In a prospective study, 103 patients were randomised to anterior cervical decompression and fusion (ACDF) with a cervical carbon-fibre intervertebral fusion cage or the Cloward procedure. Preoperative background variables, active range of neck motion, handgrip strength, radiological evaluation and subjective variables were used in a multiple regression model to find the strongest predictors of postoperative outcome as measured by current pain intensity and the Neck Disability Index (NDI). Male sex, greater kyphosis at the level operated on, non-smoking, a greater neck mobility in right rotation, low disability on NDI, and older age were predictors of pain reduction and explained 30% of current pain intensity at follow-up. Higher educational level, non-smoking, greater kyphosis at the level operated on, a greater flexion mobility, greater right handgrip strength and lower current pain intensity were predictors of improvement, and explained 28% of the postoperative outcome on NDI. The most important predictor for postoperative pain intensity was the magnitude of the preoperative kyphosis. Preoperative pain intensity was the most important predictor for improved NDI. At follow-up about 70% of the patients still had deficit based on current pain intensity and NDI, and 44% had remaining dysfunction based on Odom's criteria. In conclusion, the multivariate analysis shows that male sex, non-smoking, greater segmental kyphosis and a low pain and disability level are preoperative predictors of a good outcome in ACDF. In addition, the study suggests the importance of other predictive variables than those studied for the outcome of ACDF.

  • 12.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Peolsson, Michael
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Predictive factors for long-term outcome of anterior cervical decompression and fusion: a multivariate data analysis2008In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 17, no 3, p. 406-414Article in journal (Refereed)
    Abstract [en]

    We conducted a prospective randomized study to investigate predictive factors for short- and long-term outcome of anterior cervical decompression and fusion (ACDF) as measured by current pain intensity on the Visual Analogue Scale (VAS) and by disability using the Neck Disability Index (NDI). Current understanding about how preoperative and short-term outcome data predict long-term outcome is sparse, and there are few studies involving analysis of short-term follow-up using multivariate approaches with quantification of the relative importance of each variable studied. A total of 95 patients were randomly allocated for ACDF with the cervical intervertebral fusion cage or the Cloward procedure. The mean follow-up time was 19 months (range 12-24) for short-term follow-up and 76 months (range 56-94 months) for long-term. Background factors, radiologically detected findings, physiological measurements, treatment type, pain, and disability were used as potential predictors. Multivariate statistical analysis by projection to latent structures was used to investigate predictors of importance for short- and long-term outcome of ACDF. A "preoperative" low disability and pain intensity, non-smoking status, male sex, good hand strength, and an active range of motion (AROM) in the neck were significant predictors for good short- and long-term outcomes. The short-term outcome data were better at predicting long-term outcome than were baseline data. Radiologically detected findings and surgical technique used were mainly insignificant as predictors. We suggest that the inclusion criteria for ACDF should be based on a bio-psycho-social model including NDI. NDI may also be regarded as an important outcome measurement in evaluation of ACDF.

  • 13.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Vavruch, Ludek
    Department of Neuro-Orthopedic Surgery, Ryhov Hospital, Jönköping, Sweden.
    Hedlund, Rune
    Department of Orthopedics, Karolinska University Hospital, Huddinge, Sweden.
    Long-term randomised comparison between a carbon fibre cage and the Cloward procedure in the cervical spine2007In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 16, no 2, p. 173-178Article in journal (Refereed)
    Abstract [en]

    A prospective randomised study. To compare the long-term outcome of anterior cervical decompression and fusion (ACDF) with a cervical intervertebral fusion cage (CIFC) and the Cloward procedure (CP). We have previously shown that the 2 year outcome of ACDF with the CIFC is the same as for the CP. The fusion rate in CIFC group was, however, only 55%, compared to 85% in CP group. The long-term outcome of CIFC ispoorly documented. Ninety-five patients with at least 6 months duration of neck pain and radicular arm pain were randomly allocated for ACDF with the CIFC or the CP. Radiographs were obtained at 2 years. Questionnaires about pain, disability (Neck Disability Index, NDI), distress, quality of life and global outcome were obtained from 83 patients (87%) (43 CIFC, 40 CP) at a mean follow-up time of 6 years (range 56–94 months). There were no significant differences in any outcome variable between the two treatments. For both CP and CIFC the pain intensity improved (P<0.0001) whereas the NDI was unchanged at long-term follow-up compared to preoperatively. In the CIFC group patients with a healed fusion had significantly less mean pain (24 mm) and NDI (26%) than patients with pseudarthrosis (42 and 41, respectively). Furthermore, the mean pain and NDI reported by CIFC patients with a healed fusion was significantly less than in healed CP patients (37 and 38, respectively). The long-term outcome is the same for the CIFC and the CP, with similar improvements of pain but with considerable remaining functional disability. However, in the subgroup of patients with healed CIFC the outcome was clearly better than for the non-healed CIFC group, and also clearly better than for the healed CP group. Thus, if the healing problem associated with the CIFC can be solved the results indicate that a better outcome can be expected with the cage than with the CP.

  • 14. Pettersson, K
    et al.
    Brändström, Sven
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Psychiatry .
    Toolanen, G
    Hildingsson, C
    Nylander, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Psychiatry .
    Temperament and character: prognostic factors in whiplash patients?2004In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 13, no 5, p. 408-414Article in journal (Refereed)
    Abstract [en]

    We studied the relationship between whiplash injury and personality in 40 whiplash patients who admitted the hospital within 8 h from the car accident and 80 age- and gender-matched controls. For this purpose we used the Temperament and Character Inventory (TCI). We found that personality dimensions in whiplash patients both in the acute phase and at follow-up 2 years later showed the same results, i.e., significantly less Harm Avoidant (less anxious, low HA) than controls, but when dividing patients into groups depending on severity of outcome from whiplash injury 2 years after, no differences were found. According to our results personality symptoms related to whiplash injury is probably not a secondary phenomenon. Whiplash patients were normally developed in character, i.e., self-directedness (SD), and CO (cooperativeness) and therefore in general are capable of coping with their somatic problems.

  • 15.
    Prowse, Ashleigh
    et al.
    Department of Physiotherapy, Faculty of Health Science and Medicine, Bond University, Robina, Australia.
    Pope, Rodney
    Department of Physiotherapy, Faculty of Health Science and Medicine, Bond University, Robina, Australia.
    Gerdhem, Paul
    Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Department of Physiotherapy, Karolinska University Hospital, Huddinge, Sweden.
    Reliability and validity of inexpensive and easily administered anthropometric clinical evaluation methods of postural asymmetry measurement in adolescent idiopathic scoliosis: a systematic review2016In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 25, no 2, p. 450-466Article, review/survey (Refereed)
    Abstract [en]

    PURPOSE:

    As accurate and reproducible measurements of spinal curvature are crucial in the examination of patients with adolescent idiopathic scoliosis (AIS), this systematic review aims to report on the reliability and validity of a range of inexpensive and easily administered anthropometric methods of postural asymmetry measurement in an AIS population, to inform practice in a clinical setting.

    METHODS:

    A systematic search of health research databases located studies assessing reliability and validity of inexpensive and easily administered anthropometric measures.

    RESULTS:

    Fourteen studies satisfied eligibility criteria. The methodological quality of included studies ranged from low to high. Validity studies were of moderate to high quality. In total, nine clinically applicable, inexpensive and easily administered anthropometric methods were identified, for assessing AIS curvature. All methods demonstrated high to very high inter-observer and intra-observer reliability. Reported criterion validity of the scoliometer and 2D photographs, when compared to Cobb angle assessed from radiographs, ranged from low to very high. iPhone measurements correlated well with scoliometer measurements. 2D photography results had a moderate to high correlation with 3D topography results.

    CONCLUSIONS:

    Overall, strong levels of evidence exist for iPhone and scoliometer measurements, with a high to very high reliability and moderate to very high validity. Moderate levels of evidence exist for scoliometer with mathematical formula and clinical examination with moderate and low validity, respectively. Limited evidence exists for aesthetic tools TRACE and AI and 2D photography. These results indicate there are accurate and reproducible anthropometric measures that are inexpensive and applicable in therapy settings to assess postural asymmetry; however, these only exist for measurement in the transverse plane, despite 3D characteristics of AIS. Further research is required into an inexpensive and easily administered method that can assess postural asymmetry in all anatomical planes.

  • 16.
    Reigo, Tomas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Tropp, Hans
    Department of Orthopaedic Surgery, Norrköping Hospital, Sweden.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Absence of back disorders in adults and work-related predictive factors in a 5-year perspective2001In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 10, no 3, p. 215-220Article in journal (Refereed)
    Abstract [en]

    Factors important for avoiding back disorders in different age-groups have seldom been compared and studied over time. We therefore set out to study age-related differences in socio-economic and work-related factors associated with the absence of back disorders in a 5-year comparative cohort study using a mailed questionnaire. Two subgroups (aged 25-34 and 54-59 years) derived from a representative sample of the Swedish population were followed at baseline, 1 year and 5 years. Questions were asked about the duration of back pain episodes, relapses, work changes and work satisfaction. A work adaptability, partnership, growth, affection, resolve (APGAR) score was included in the final questionnaire. Multivariate logistic regression was used to identify factors predicting the absence of back disorders. Absence of physically heavy work predicted an absence of back disorders [odds ratio (OR), 2.86, 95% confidence interval (CI), 1.3-6.3] in the older group. In the younger age-group, the absence of stressful work predicted absence of back disorders (OR, 2.0, 95% CI, 1.1-3.6). Thirty-seven per cent of the younger age-group and 43% of the older age-group did not experience any back pain episodes during the study period. The exploratory work APGAR scores indicated that back disorders were only associated with lower work satisfaction in the older group. The analyses point out the importance of avoiding perceived psychological stress in the young and avoiding perceived physically heavy work in the older age-group for avoiding back disorders. The results suggest a need for different programmes at workplaces to avoid back disorders depending on the age of the employees concerned.

  • 17.
    Sjödahl, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Gutke, Annelie
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Predictors for long-term disability in women with persistent postpartum pelvic girdle pain2013In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 22, no 7, p. 1665-1673Article in journal (Refereed)
    Abstract [en]

    Purpose

    The majority of prognostic studies on postpartum lumbopelvic pain have investigated factors during pregnancy. Since the majority of women recover within the first few months of delivery, it is unknown if the same predictors are valid for long-term consequences. It is also important to investigate predictors within subgroups of patients with pregnancy-related lumbopelvic pain due to their different clinical courses. The aim of this study was to identify predictors for disability 15 months postpartum in women with persistent postpartum pelvic girdle pain (PGP).

    Methods

    Data were obtained by clinical tests and questionnaires 3 months postpartum. The outcome 15 months postpartum was disability measured with the Oswestry Disability Index.

    Results

    A multiple linear regression analysis identified two significant two-way interaction effects that were predictive of disability 15 months postpartum: (a) age + trunk flexor endurance, and (b) disability + hip extensor strength.

    Conclusions

    Age, muscle function and disability seem to influence the long-term outcome on disability in women with persistent postpartum PGP. It may be important to consider the possibility of different variables impact on each other when predicting long-term disability. In addition, further studies are needed to investigate the impact of interaction effects on long-term consequences in women with persistent postpartum PGP.

  • 18.
    Skold, Caroline
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Tropp, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Berg, Svante
    Karolinska Institute, Sweden .
    Five-year follow-up of total disc replacement compared to fusion: a randomized controlled trial2013In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 22, no 10, p. 2288-2295Article in journal (Refereed)
    Abstract [en]

    To evaluate long-term clinical results of lumbar total disc replacement (TDR) compared with posterior lumbar fusion. less thanbrgreater than less thanbrgreater thanThis prospective randomized controlled trial comprised 152 patients; 80 were randomized to TDR and 72 to fusion. All patients had chronic low back pain (CLBP) and had not responded to nonsurgical treatment. Primary outcome measure was global assessment of back pain (GA), secondary outcome measures were back and leg pain, Oswestry Disability Index (ODI), EQ5D, and SF-36. All measures were collected from SweSpine (Swedish national register for spinal surgery) at 1, 2, and 5 years. Follow-up rate at 5 years was 99.3 %. less thanbrgreater than less thanbrgreater thanBoth groups showed clinical improvement at 5-year follow-up. For GA, 38 % (30/80) in the TDR group were totally pain free vs. 15 % (11/71) in the fusion group (p andlt; 0.003). Back pain and improvement of back pain were better in the TDR group: VAS back pain at 5 years 23 +/- A 29 vs. 31 +/- A 27, p = 0.009, and VAS improvement of back pain at 5 years 40 +/- A 32 vs. 28 +/- A 32, p = 0.022. ODI and improvement in ODI were also better in the TDR group: ODI at 5 years 17 +/- A 19 vs. 23 + 17, p = 0.02 and ODI improvement at 5 years 25 +/- A 18 vs. 18 +/- A 19 (p = 0.02). There was no difference in complications and reoperations between the two groups. less thanbrgreater than less thanbrgreater thanGlobal assessment of low back pain differed between the two surgical groups at all follow-up occasions. Significant differences between groups concerning back pain, pain improvement, and ODI were present at 1 year and disappeared at 2 years, but reappeared at the 5-year follow-up.

  • 19.
    Theis, Jennifer
    et al.
    Department of Clinical and Rehabilitation Services, Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Australia.
    Gerdhem, Paul
    Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Abbott, Allan
    Department of Clinical and Rehabilitation Services, Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Australia; Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Quality of life outcomes in surgically treated adult scoliosis patients: A systematic review2015In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 24, no 7, p. 1343-1355Article, review/survey (Refereed)
    Abstract [en]

    PURPOSE:

    The aim of this systematic review was to identify prospective studies reporting the impact of surgical intervention on health-related quality of life (HRQL) outcomes for adults with scoliosis at a minimum 2 year follow-up.

    METHOD:

    An electronic database search was conducted for January 2000-November 2013 in conjunction with a reference list search of two related systematic reviews for prospective studies of adults with scoliosis reporting HRQL outcome measure. Methodological quality of included articles was assessed using the Downs and Black checklist. Cohen's d effect size was calculated for Scoliosis Research Society Questionnaire (SRS) and Oswestry Disability Index (ODI) outcomes for included studies and pooled data.

    RESULTS:

    The database and reference list searches returned 349 potential articles; three articles met the inclusion criteria. Downs and Black scores ranged from 18/28 to 21/28 (fair-good quality evidence). Total number of 188 patients were treated surgically and had a mean age of 38 years or older. All studies showed significant improvement in reported HRQL outcomes for at least a 2 year follow-up. The Cohen's d effect size for SRS was d = 1.4 (n = 188, 95 % CI; 0.9, 1.8) and for ODI d = 0.9 (n = 120, 95 % CI; 0.4, 1.4).

    CONCLUSION:

    Findings from this review suggest surgery improves HRQL in patients with adult scoliosis at a minimum 2 year follow-up. However, these findings are based on limited data of fair to good quality which needs to be taken into consideration when interpreting the results and highlights the need for additional high quality prospective studies.

  • 20.
    Wibault, Johanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Dedring, Åsa
    Karolinska University Hospital, Stockholm, Sweden .
    Löfgren, Håkan
    Ryhov Hospital, Jönköping, Sweden .
    Zsigmond, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Persson, Liselotte
    Lunds University, Sweden .
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. University of Queensland, Brisbane, Australia.
    Individual factors associated with neck disability in patients with cervical radiculopathy scheduled for surgery: a study on physical impairments, psychosocial factors, and life style habits2014In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 23, no 3, p. 599-605Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    The influence of individual factors on patient-reported outcomes is important in the interpretation of disability and treatment effectiveness. The purpose of this study was to assess how physical impairments, psychosocial factors, and life style habits were associated with neck disability based on the Neck Disability Index (NDI), in patients with cervical radiculopathy scheduled for surgery.

    METHODS:

    This cross-sectional study included 201 patients (105 men, 96 women; mean age 50 years). Data included self-reported measures and a clinical examination. Multiple linear regressions were performed to identify significant influencing factors.

    RESULTS:

    Pain, physical impairments in the cervical active range of motion, low self-efficacy, depression, and sickness-related absences explained 73 % of the variance in NDI scores (p < 0.001).

    CONCLUSION:

    Assessments of physical impairments and psychosocial factors in patients with cervical radiculopathy could improve the description of neck disability and the interpretation of treatment outcomes in longitudinal studies.

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