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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.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Schröder, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. 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.
    Effectiveness of implementing a best practice primary healthcare model for low back pain (BetterBack) compared with current routine care in the Swedish context: an internal pilot study informed protocol for an effectiveness-implementation hybrid type 2 trial2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 4Article in journal (Refereed)
    Abstract [en]

    Introduction Low back pain (LBP) is a major health problem commonly requiring healthcare. In Sweden, there is a call from healthcare practitioners (HCPs) for the development, implementation and evaluation of a best practice primary healthcare model for LBP.

    Aims (1) To improve and understand the mechanisms underlying changes in HCP confidence, attitudes and beliefs for providing best practice coherent primary healthcare for patients with LBP; (2) to improve and understand the mechanisms underlying illness beliefs, self-care enablement, pain, disability and quality of life in patients with LBP; and (3) to evaluate a multifaceted and sustained implementation strategy and the cost-effectiveness of the BetterBack☺ model of care (MOC) for LBP from the perspective of the Swedish primary healthcare context.

    Methods This study is an effectiveness-implementation hybrid type 2 trial testing the hypothesised superiority of the BetterBack☺ MOC compared with current routine care. The trial involves simultaneous testing of MOC effects at the HCP, patient and implementation process levels. This involves a prospective cohort study investigating implementation at the HCP level and a patient-blinded, pragmatic, cluster, randomised controlled trial with longitudinal follow-up at 3, 6 and 12 months post baseline for effectiveness at the patient level. A parallel process and economic analysis from a healthcare sector perspective will also be performed. Patients will be allocated to routine care (control group) or the BetterBack☺ MOC (intervention group) according to a stepped cluster dogleg structure with two assessments in routine care. Experimental conditions will be compared and causal mediation analysis investigated. Qualitative HCP and patient experiences of the BetterBack☺ MOC will also be investigated.

    Dissemination The findings will be published in peer-reviewed journals and presented at national and international conferences. Further national dissemination and implementation in Sweden and associated national quality register data collection are potential future developments of the project.

  • 3.
    Abbott, Rebecca
    et al.
    Northwestern Univ, IL 60611 USA.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    West, Janne
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Science & Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Elliott, James M.
    Northwestern Univ, IL 60611 USA; Univ Queensland, Australia; Zurich Univ Appl Sci, Switzerland.
    Åslund, Ulrika
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Karlsson, Anette
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Dahlqvist Leinhard, Olof
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    The qualitative grading of muscle fat infiltration in whiplash using fat and water magnetic resonance imaging2018In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 18, no 5, p. 717-725Article in journal (Refereed)
    Abstract [en]

    BACKGROUND CONTEXT: The development of muscle fat infiltration (MFI) in the neck muscles is associated with poor functional recovery following whiplash injury. Custom software and time-consuming manual segmentation of magnetic resonance imaging (MRI) is required for quantitative analysis and presents as a barrier for clinical translation. PURPOSE: The purpose of this work was to establish a qualitative MRI measure for MFI and evaluate its ability to differentiate between individuals with severe whiplash-associated disorder (WAD), mild or moderate WAD, and healthy controls. STUDY DESIGN/SETTING: This is a cross-sectional study. PATIENT SAMPLE: Thirty-one subjects with WAD and 31 age-and sex-matched controls were recruited from an ongoing randomized controlled trial. OUTCOME MEASURES: The cervical multifidus was visually identified and segmented into eighths in the axial fat/water images (C4-C7). Muscle fat infiltration was assessed on a visual scale: 0 for no or marginal MFI, 1 for light MFI, and 2 for distinct MFI. The participants with WAD were divided in two groups: mild or moderate and severe based on Neck Disability Index % scores. METHODS: The mean regional MFI was compared between the healthy controls and each of the WAD groups using the Mann-Whitney U test. Receiver operator characteristic (ROC) analyses were carried out to evaluate the validity of the qualitative method. RESULTS: Twenty (65%) patients had mild or moderate disability and 11 (35%) were considered severe. Inter- and intra-rater reliability was excellent when grading was averaged by level or when frequency of grade II was considered. Statistically significant differences (pamp;lt;.05) in regional MFI were particularly notable between the severe WAD group and healthy controls. The ROC curve, based on detection of distinct MFI, showed an area-under-the curve of 0.768 (95% confidence interval 0.59-0.94) for discrimination of WAD participants. CONCLUSIONS: These preliminary results suggest a qualitative MRI measure for MFI is reliable and valid, and may prove useful toward the classification of WAD in radiology practice. (C) 2017 Elsevier Inc. All rights reserved.

  • 4.
    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.

  • 5.
    Ardern, Clare
    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.
    Editorial Material: Systematic review hacks for the sports and exercise clinician: five essential methodological elements in BRITISH JOURNAL OF SPORTS MEDICINE, vol 50, issue 8, pp 447-4492016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 8, p. 447-449Article in journal (Other academic)
    Abstract [en]

    n/a

  • 6.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Aspetar Orthopaed Sports Medical Hospital, Qatar; La Trobe University, Australia.
    Serving the clinician and the patient: three ways that quality clinical guidelines can build on expert consensus statements and systematic reviews2017In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 51, no 7, p. 557-+Article in journal (Other academic)
    Abstract [en]

    n/a

  • 7.
    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.
    Bizzini, Mario
    Schulthess Clin, Switzerland.
    Bahr, Roald
    Aspetar Orthopaed and Sports Medical Hospital, Qatar; Norwegian School Sports Science, Norway.
    Editorial Material: It is time for consensus on return to play after injury: five key questions in BRITISH JOURNAL OF SPORTS MEDICINE, vol 50, issue 9, pp 506-5082016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 9, p. 506-508Article in journal (Other academic)
    Abstract [en]

    n/a

  • 8.
    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.

  • 9.
    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 Ranum
    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 F.
    Tennessee Orthopaed Alliance, TN USA.
    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, Minider 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, Michael
    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; ATOS Klin, Germany.
    Silvers-Granelli, Holly J.
    FIFA Med Ctr Excellence Veloc Phys Therapy, 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: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 7, p. 422-438Article 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 ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery amp; 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.

  • 10.
    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)
  • 11.
    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.
    Glasgow, Philip
    Sport Northern Ireland Sports Institute, North Ireland; University of Ulster, North Ireland.
    Schneiders, Anthony
    Central Queensland University, Australia.
    Witvrouw, Erik
    Aspetar Orthopaed and Sports Medical Hospital, Qatar; University of Ghent, Belgium.
    Clarsen, Benjamin
    Norwegian School Sports Science, Norway; Olymp Elite Sports Program Olympiatoppen, Norway.
    Cools, Ann
    University of Ghent, Belgium.
    Gojanovic, Boris
    Hop La Tour, Switzerland; Lausanne University of and Hospital, Switzerland.
    Griffin, Steffan
    University of Birmingham, England.
    Khan, Karim M.
    University of British Columbia, Canada.
    Moksnes, Havard
    Norwegian School Sports Science, Norway; Olymp Elite Sports Program Olympiatoppen, Norway.
    Mutch, Stephen A.
    SPACE Clin, Scotland; Murrayfield Stadium, Scotland.
    Phillips, Nicola
    Cardiff University, Wales.
    Reurink, Gustaaf
    Sports Phys Grp, Netherlands.
    Sadler, Robin
    Manchester City Football Club, England.
    Gravare Silbernagel, Karin
    University of Delaware, DE USA.
    Thorborg, Kristian
    University of Copenhagen, Denmark.
    Wangensteen, Arnlaug
    Aspetar Orthopaed and Sports Medical Hospital, Qatar; Norwegian School Sports Science, Norway.
    Wilk, Kevin E.
    Champ Sports Med, AL USA.
    Bizzini, Mario
    Schulthess Clin, Switzerland.
    2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 14, p. 853-864Article in journal (Refereed)
    Abstract [en]

    Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athletes return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport.

  • 12.
    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.
    Khan, Karim M.
    Aspetar Orthopaed and Sports Medical Hospital, Qatar; University of British Columbia, Canada.
    Editorial Material: The old knee in the young athlete: knowns and unknowns in the return to play conversation in BRITISH JOURNAL OF SPORTS MEDICINE, vol 50, issue 9, pp 505-U892016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 9, p. 505-U89Article in journal (Other academic)
    Abstract [en]

    n/a

  • 13.
    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.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Webster, Kate E.
    School of Allied Health, La Trobe University, Melbourne, Australia.
    Psychological Aspects of Anterior Cruciate Ligament Injuries2016In: Operative techniques in sports medicine, ISSN 1060-1872, E-ISSN 1557-9794, Vol. 24, no 1, p. 77-83Article in journal (Refereed)
    Abstract [en]

    Impairment-based evaluation has, until recently, been the mainstay of orthopaedic research in anterior cruciate ligament (ACL) reconstruction. However, participation-based outcomes, in particular returning to sport, have lately garnered increased research attention. This is important because returning to sport is typically a main concern of injured athletes. Recent metaanalyses have demonstrated that the return to sport rate after ACL reconstruction is disappointingly low, and that a range of contextual factors including age, sex, sport participation level, and psychological factors may affect the return to sport rate. Moderate to large effect sizes have been demonstrated for greater psychological readiness to return to sport, and lower fear of reinjury favoring returning to the preinjury level sport after ACL reconstruction. Understanding the relationship between psychological factors and returning to sport is essential in light of the fact that most athletes recover good physical function after surgery, and many athletes with good knee function do not return to sport. Psychological factors are potentially modifiable with appropriate intervention, yet these factors are not systematically addressed in routine postoperative rehabilitation. This review summarizes the recent evidence for the relationship between psychological factors and ACL injury, including recovery from injury and returning to sport. Oper Tech Sports Med 24:77-83 Crown Copyright (C) 2015 Published by Elsevier Inc. All rights reserved.

  • 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 Medicine and Health Sciences. School of Allied Health, La Trobe University, Melbourne, Australia.
    Österberg, Annika
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Tagesson, Sofi
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Gauffin, Håkan
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Satisfaction With Knee Function After Primary Anterior Cruciate Ligament Reconstruction Is Associated With Self-Efficacy, Quality of Life, and Returning to the Preinjury Physical Activity2016In: Arthroscopy: The Journal of Arthroscopy And Related, ISSN 0749-8063, E-ISSN 1526-3231, Vol. 32, no 8, p. 1631-1638Article in journal (Refereed)
    Abstract [en]

    Purpose: To assess whether patient-reported outcomes (psychological factors, appraisals of knee function, and physical activity participation) were associated with satisfaction with knee function after anterior cruciate ligament (ACL) reconstruction. Methods: Participants who were aged 18 to 45 years and a minimum 12 months post primary ACL reconstruction completed a questionnaire battery evaluating knee self-efficacy, knee-related quality of life, self-reported function, and physical activity participation. Participants responses to the question "If you were to spend the rest of your life with your knee just the way it has been in the last week, would you feel.... (7-point ordinal scale; 1 = happy, 7 = unhappy)" were categorized as satisfied, mostly satisfied, or dissatisfied and used as the primary outcome. Ordinal regression was used to examine associations between independent variables and the primary outcome. Results: A total of 177 participants were included at an average of 3 years after primary ACL reconstruction. At follow-up, 44% reported they would be satisfied, 28% mostly satisfied, and 28% dissatisfied with the outcome of ACL reconstruction. There were significant differences in psychological responses and appraisal of knee function between the 3 groups (P = .001), and significantly more people in the satisfied group had returned to their preinjury activity (58%) than in the mostly satisfied (28%) and dissatisfied (26%) groups (P = .001). Multivariable analysis demonstrated that the odds of being satisfied increased by a factor of 3 with higher self-efficacy, greater knee-related quality of life, and returning to the preinjury activity. Conclusions: People who had returned to their preinjury physical activity and who reported higher knee-related self-efficacy and quality of life were more likely to be satisfied with the outcome of ACL reconstruction.

  • 17.
    Balasingam, Sadeshkumar
    et al.
    NU Hosp Grp Trollhattan Uddevalla, Sweden.
    Sernert, Ninni
    NU Hosp Grp Trollhattan Uddevalla, Sweden.
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Kartus, Juri
    NU Hosp Grp Trollhattan Uddevalla, Sweden.
    Patients With Concomitant Intra-articular Lesions at Index Surgery Deteriorate in Their Knee Injury and Osteoarthritis Outcome Score in the Long Term More Than Patients With Isolated Anterior Cruciate Ligament Rupture: A Study From the Swedish National Anterior Cruciate Ligament Register2018In: Arthroscopy: The Journal of Arthroscopy And Related, ISSN 0749-8063, E-ISSN 1526-3231, Vol. 34, no 5, p. 1520-1529Article in journal (Refereed)
    Abstract [en]

    Purpose: To analyze and compare clinical outcomes after anterior cruciate ligament (ACL) reconstruction 5 and 10 years postsurgery between patients with concomitant intra-articular injuries and those with isolated ACL injury at reconstruction. Methods: Registrations were made using a web-based protocol by physicians for baseline and surgical data. Patients registered their Knee Injury and Osteoarthritis Outcome Score (KOOS) preoperatively and at 5 and 10 years postsurgery. The exclusion criteria for the present study were revisions of previously unregistered ACL surgeries, non-ACL surgeries, patients for whom 10-year follow-up data had not yet been collected, and the proportion of index surgeries that were revision or contralateral interventions. Results: There were 1,295 KOOS scores available for patients 5 years postsurgery, and 1,023 10 years postsurgery from a baseline of 2,751 index reconstructions. A deterioration between the 5-and 10-year scores was observed for patients with concomitant meniscus injury on the KOOS subscales for pain (P = .015), symptoms (P = .005), sport and recreation (P = .011), and knee-related quality of life (QoL) (P = .03) compared with patients with isolated ACL injury. Correspondingly, KOOS subscale score deterioration was seen for combined concomitant cartilage and meniscus injuries for pain (P = .005), symptoms (P = .009), sport and recreation (P = .006), and QoL (P amp;lt; .001). The largest deteriorations were found in sport and recreation (-5.9 points; confidence interval [CI] -10.1, -1.1) and QoL (-6.5 points; CI -10.3, -2.8) subscale scores for patients with concomitant meniscal and cartilage injuries. A similar pattern was not seen between patients with concomitant cartilage injury and isolated ACL injury. Conclusions: The present study reveals that concomitant meniscus injuries at the index operation, either in isolation or in combination with cartilage lesions, render a deterioration of scores on the KOOS outcome subscales for pain, sport and recreation, and quality of life between 5-and 10-year postsurgery follow-up of ACL-reconstructed patients. No such deterioration was seen for patients who had isolated ACL injury.

  • 18.
    Bengtsson, Håkan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Match-related risk factors for injury in male professional football2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Injuries are common in professional football, especially during matches, and they cause suffering for players, in both the short and the long term. It is therefore important to try to prevent these injuries. One of the most important steps in injury prevention is to fully understand the different risk factors that contribute to these injuries.

    Aim: The aim of this thesis was therefore to investigate several match-related factors that have been suggested to be important for the risk of sustaining injuries during professional football matches.

    Methods: The thesis consists of four papers, and all analyses are based on data gathered during a large-scale prospective cohort study that has been running since 2001: the UEFA Elite Club Injury Study. Medical teams from 61 clubs have been involved in this study, and they have prospectively gathered data about football exposure and injuries for their first team players.

    Associations between the following factors and injuries have been analysed: • Match characteristics in terms of match venue, match result, and competition • Match congestion, both short and long term, and at team and individual player level • Number of completed training sessions between return to sport after an injury and the first match exposure

    Results: All match characteristics studied were shown to be associated with injury rates, with higher injury rates during home matches compared with away matches, in matches that were lost or drawn compared with matches won, and in domestic league and Champions League matches compared with Europa League and other cup matches. It was also shown that injury rates, muscle injury rates in particular, were higher if the recovery time between matches was short. This association between match congestion and injury rates was shown when match congestion was considered at both team and individual player level. Finally, the odds of injury during the first match exposure after a period of absence due to injury was found to be higher if players had completed few training sessions between return to sport and their first match.

    Conclusion: There are several match-related risk factors that contribute to the injury rate during professional football matches. A better understanding of these risk factors will help teams to make better estimations of the injury risks to which players are exposed in different situations (e.g. during periods of match congestion and when players return to sport after an injury). Knowledge about risk factors will also offer the possibility of reducing the number of injuries for football teams by addressing them with appropriate measures.

    List of papers
    1. Match Injury Rates in Professional Soccer Vary With Match Result, Match Venue, and Type of Competition
    Open this publication in new window or tab >>Match Injury Rates in Professional Soccer Vary With Match Result, Match Venue, and Type of Competition
    2013 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 41, no 7, p. 1505-1510Article in journal (Refereed) Published
    Abstract [en]

    Background: Player activities in soccer matches are influenced by the match result and match venue. It is not known whether injury rates are influenced by these factors. Purpose: To investigate whether there are associations between injury rates and the match result, venue, and type of competition in male soccer. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six professional clubs from 10 countries were followed prospectively during 9 seasons (2001-2002 to 2009-2010). All matches, and injuries occurring in these matches, were registered by the teams medical staff. An injury was registered if it resulted in player absence from training or matches. Information about match result, venue, and type of competition for all reported matches was gathered by the authors from online databases. Injury rates in matches with varying match characteristics were compared by use of generalized estimating equations. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: A total of 2738 injuries during 6010 matches were registered. There were no associations between odds of 1 injury occurrence and match result or type of competition, whereas the odds were decreased in matches played away compared with home matches (OR, 0.89; 95% CI, 0.80-0.99). The odds of 2 or more injury occurrences in a match were increased in matches resulting in a draw (OR, 1.39; 95% CI, 1.15-1.69) or loss (OR, 1.66; 95% CI, 1.38-1.98) compared with matches won and were decreased in other cup matches compared with league matches (OR, 0.57; 95% CI, 0.39-0.84) and in matches played away compared with home matches (OR, 0.70; 95% CI, 0.60-0.82). Finally, injuries with more than 1 weeks absence occurred more frequently in Champions League matches compared with league matches both for matches with 1 injury (OR, 1.26; 95% CI, 1.09-1.45) and matches with 2 or more injuries (OR, 1.57; 95% CI, 1.13-2.20). Conclusion: The odds of 2 or more injury occurrences in professional soccer were higher in matches resulting in a loss or a draw compared with a win, whereas the odds of injury occurrences were lower in matches played away compared with home matches. The rate of moderate and severe injuries increased with the importance of the match.

    Place, publisher, year, edition, pages
    SAGE Publications (UK and US): No SAGE Choice, 2013
    Keywords
    athletic injuries; competition; football; performance; risk factors
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-105047 (URN)10.1177/0363546513486769 (DOI)000330524000011 ()
    Available from: 2014-03-06 Created: 2014-03-06 Last updated: 2017-12-05
    2. Muscle injury rates in professional football increase with fixture congestion: an 11-year follow-up of the UEFA Champions League injury study
    Open this publication in new window or tab >>Muscle injury rates in professional football increase with fixture congestion: an 11-year follow-up of the UEFA Champions League injury study
    2013 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 12, p. 743-747Article in journal (Refereed) Published
    Abstract [en]

    Background The influence of fixture congestion on injury rates and team performance has only been scarcely investigated.

    Aim To study associations between recovery time and match load and injury rates and team performance in professional football.

    Methods Exposure and time loss injuries were registered prospectively from 27 teams over 11 seasons. Matches were grouped according to recovery days before each match (≤3 vs >3 days, and ≤4 vs ≥6 days). Injury rates and team performance were compared between groups. Match load in match sequences containing five consecutive matches was determined by the number of days separating the first match and the last training session during that match sequence. Linear regression was used to study associations between match load and injury rates and team performance.

    Results Team performance showed no association with match load, or recovery days prior to matches, except for Europa League matches that indicated more matches lost with short recovery (≤3 days) (p=0.048). Total injury rates and muscle injury rates were increased in league matches with ≤4 days compared with ≥6 days’ recovery (RR 1.09, 95% CI 1.00 to 1.18, and RR 1.32, 95% CI 1.15 to 1.51, respectively), specifically hamstring and quadriceps injuries. High match load was associated with increase in muscle injury rate in matches in the same match sequence (p=0.012), and increase in ligament injury rate in training in the subsequent match sequence (p=0.003).

    Conclusions Fixture congestion was associated with increased muscle injury rates but had no, or very limited, influence on team performance.

    Place, publisher, year, edition, pages
    BMJ Publishing Group, 2013
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-97448 (URN)10.1136/bjsports-2013-092383 (DOI)000322868800008 ()23851296 (PubMedID)
    Note

    Funding Agencies|Union of European Football Associations (UEFA)||Swedish National Centre for Research in Sports, and Praktikertjanst AB||

    Available from: 2013-09-12 Created: 2013-09-12 Last updated: 2017-12-06Bibliographically approved
  • 19.
    Berin, Emilia
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Hammar, Mats
    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 Gynaecology and Obstetrics in Linköping.
    Lindblom, Hanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Lindh Åstrand, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Spetz, Anna-Clara
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Resistance training for hot flushes in postmenopausal women: Randomized controlled trial protocol2016In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 85, p. 96-103Article in journal (Refereed)
    Abstract [en]

    Objectives: Hot flushes and night sweats affect 75% of all women after menopause and is a common reason for decreased quality of life in mid-aged women. Hormone therapy is effective in ameliorating symptoms but cannot be used by all women due to contraindications and side effects. Engagement in regular exercise is associated with fewer hot flushes in observational studies, but aerobic exercise has not proven effective in randomized controlled trials. It remains to be determined whether resistance training is effective in reducing hot flushes and improves quality of life in symptomatic postmenopausal women. The aim of this study is to investigate the effect of standardized resistance training on hot flushes and other health parameters in postmenopausal women. Study design: This is an open, parallel-group, randomized controlled intervention study conducted in Linkoping, Sweden. Sixty symptomatic and sedentary postmenopausal women with a mean of at least four moderate to severe hot flushes per day or 28 per week will be randomized to an exercise intervention or unchanged physical activity (control group). The intervention consists of 15 weeks of standardized resistance training performed three times a week under supervision of a physiotherapist. Main outcome measures: The primary outcome is hot flush frequency assessed by self-reported hot flush diaries, and the difference in change from baseline to week 15 will be compared between the intervention group and the control group. Conclusion: The intention is that this trial will contribute to the evidence base regarding effective treatment for hot flushes. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

  • 20.
    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
    Show others...
    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
  • 21.
    Bernhardsson, Susanne
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Riktlinjer inom fysioterapi i primärvården2014In: Implementering av evidensbaserad praktik / [ed] Per Nilsen, Malmö: Gleerups Utbildning AB, 2014, p. 155-169Chapter in book (Other academic)
  • 22.
    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.

  • 23.
    Bernhardsson, Susanne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Närhälsan Rehabilitation, Region Västra Götaland, Hönö, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Johansson, Kajsa
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. 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.
    Larsson, Maria E. H.
    Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden; The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Clinical practice in line with evidence?: A survey among primary care physiotherapists in western Sweden2015In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, no 6, p. 1169-1177Article in journal (Refereed)
    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.

  • 24.
    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.

  • 25.
    Bjorneboe, John
    et al.
    Norwegian School Sport Science, Norway.
    Kristensson, Karolina
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bengtsson, Håkan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ronsen, Ola
    Aker Solut, Norway.
    Einar Andersen, Thor
    Norwegian School Sport Science, Norway.
    Role of illness in male professional football: not a major contributor to time loss2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 11, p. 699-702Article in journal (Refereed)
    Abstract [en]

    Background There are limited data on the nature, type and incidence of illness in football. Previous studies indicate that gastrointestinal and respiratory tract illnesses are most common. Aim To describe the incidence and burden of illness in male professional football. Methods Over the 4-year study period, 2011-2014, 73 professional football teams in Europe participated, with a total of 1 261 367 player-days recorded. All time-loss illnesses were recorded by the medical staff of each club. A recordable illness episode was any physical or psychological symptom (not related to injury) that resulted in the player being unable to participate fully in training or match play. Results A total of 1914 illness episodes were recorded. The illness incidence was 1.5 per 1000 player-days, meaning that, on average, a player experienced an illness episode every second season, with a median of 3 days absence per illness episode. Severe illness (absence amp;gt;4 weeks) constituted 2% of all illnesses. Respiratory tract illness was the most common (58%), followed by gastrointestinal illness (38%). Respiratory tract illness, gastrointestinal illness and cardiovascular illness caused the highest illness burden. Conclusions The illness incidence among male professional football players is low compared with the injury incidence. We found that the highest illness burden was caused by illness to the respiratory tract, gastrointestinal tract and cardiovascular system.

  • 26.
    Björnsson Hallgren, Hanna C
    et al.
    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 Orthopaedics in Linköping.
    Adolfsson, Lars E
    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 Orthopaedics in Linköping.
    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.
    Petersson, Anna
    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 Orthopaedics in Linköping.
    Holmgren, Theresa M
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Specific exercises for subacromial pain: Good results maintained for 5 years2017In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 88, no 6, p. 600-605Article in journal (Refereed)
    Abstract [en]

    Background and purpose — We have previously shown that specific exercises reduced the need for surgery in subacromial painpatients at 1-year follow-up. We have now investigated whetherthis result was maintained after 5 years and compared the outcomesof surgery and non-surgical treatment.Patients and methods — 97 patients were included in the previouslyreported randomized study of patients on a waiting list forsurgery. These patients were randomized to specifi c or unspecifi cexercises. After 3 months of exercises the patients were asked ifthey still wanted surgery and this was also assessed at the present5-year follow-up. The 1-year assessment included Constant–Murley score, DASH, VAS at night, rest and activity, EQ-5D, andEQ-VAS. All these outcome assessments were repeated after 5years in 91 of the patients.Results — At the 5-year follow-up more patients in the specifi cexercise group had declined surgery, 33 of 47 as compared with16 of 44 (p = 0.001) in the unspecifi c exercise group. The meanConstant–Murley score continued to improve between the 1- and5-year follow-ups in both surgically and non-surgically treatedgroups. On a group level there was no clinically relevant changebetween 1 and 5 years in any of the other outcome measuresregardless of treatment.Interpretation — This 5-year follow-up of a previously publishedrandomized controlled trial found that specifi c exercisesreduced the need for surgery in patients with subacromial pain.Patients not responding to specifi c exercises may achieve similargood results with surgery. These fi ndings emphasize that a specifi cexercise program may serve as a selection tool for surgery.

  • 27.
    Borg, Sabina
    et al.
    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.
    Nilsson, Lennart
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Söderlund, Anne
    Mälardalen University, Sweden.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    The role of a behavioural medicine intervention in physiotherapy for the effects of rehabilitation outcomes in exercise-based cardiac rehabilitation (ECRA) - the study protocol of a randomised, controlled trial2017In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 17, article id 134Article in journal (Refereed)
    Abstract [en]

    Background: To help patients with coronary artery disease (CAD) benefit from the positive health effects attained by exercise-based cardiac rehabilitation (CR), adherence to these programmes according to international guidelines is important. Strategies to increase adherence to exercise-based CR are mainly an unexplored area. The objective of this study is to investigate the effects of a behavioural medicine intervention in physiotherapy, containing goal-setting, self-monitoring and feedback, with the aim of improving rehabilitation outcomes for exercise-based CR, compared with usual care. Methods: This is a randomised, controlled trial. A total of 160 patients with CAD will be included consecutively at the Coronary Care Unit at a university hospital in Sweden. Patients are randomised 1:1 using sealed envelopes to usual care or a behavioural medicine intervention in physiotherapy, in addition to usual care for 4 months. Outcome assessment at baseline, 4 and 12 months includes submaximal aerobic capacity (primary outcome), exercise adherence, muscle endurance, level of physical activity, biomarkers, anxiety and depression, health-related quality of life, patient enablement and self-efficacy (secondary outcomes). Discussion: This is the first study to evaluate the role of an integrated behavioural medicine intervention in exercise-based CR in the effects of rehabilitation outcomes. The results of this study will provide valuable information about the effect of these interventions in exercise-based CR and it has the potential to inform and assist in further treatment in secondary prevention for patients with CAD.

  • 28.
    Buchbinder, Rachelle
    et al.
    Monash Univ, Australia.
    van Tulder, Maurits
    Vrije Univ Amsterdam, 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
    Univ Cidade Sao Paulo, Brazil.
    Woolf, Anthony
    Univ Exeter, England.
    Schoene, Mark
    The Back Letter, Newburyport MA, USA.
    Croft, Peter
    Keele Univ, England.
    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

  • 29.
    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
  • 30.
    Bäck, Maria
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens University Hospital, Sweden; University of Gothenburg, Sweden.
    Cider, Åsa
    Sahlgrens University Hospital, Sweden; University of Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Lundberg, Mari
    University of Gothenburg, Sweden.
    Jansson, Bengt
    University of Gothenburg, Sweden.
    Kinesiophobia mediates the influences on attendance at exercise-based cardiac rehabilitation in patients with coronary artery disease2016In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 32, no 8, p. 571-580Article in journal (Refereed)
    Abstract [en]

    Purpose: To identify predictors of attendance at exercise-based cardiac rehabilitation (CR) and to test the hypothesis that kinesiophobia mediates the influence on attendance at CR in patients with coronary artery disease (CAD). Patients: In total, 332 patients (75 women; mean age 65 +/- 9.1 years) with a diagnosis of CAD were recruited at Sahlgrenska University Hospital, Sweden. Methods: The patients were tested in terms of objective measurements, self-rated psychological measurements, and level of physical activity. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An exploratory selection of significant predictors was made. Results: A current incidence of coronary bypass grafting (p amp;lt; 0.001) and a diagnosis of ST-elevation myocardial infarction (p = 0.004) increased the probability of attendance at CR, while kinesiophobia (p = 0.001) reduced attendance. As a mediator, kinesiophobia was influenced by four predictors and the following indirect effects were found. General health and muscle endurance increased the probability of attendance at CR, while self-rated anxiety and current incidence of heart failure had the opposite effect. Conclusions: This study suggests that kinesiophobia has an influence on and a mediating role in attendance at CR. The results need to be further investigated in relation to clinical practice.

  • 31.
    Bäck, Maria
    et al.
    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.
    Krevers, Barbro
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Important aspects in relation to patients attendance at exercise-based cardiac rehabilitation - facilitators, barriers and physiotherapists role: a qualitative study2017In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 17, article id 77Article in journal (Refereed)
    Abstract [en]

    Background: In order to improve attendance at exercise-based cardiac rehabilitation (CR), a greater insight into patients perspectives is necessary. The aim of the study was to explore aspects that influence patients attendance at exercise-based CR after acute coronary artery disease (CAD) and the role of the physiotherapist in patients attendance at exercise-based CR. Methods: A total of 16 informants, (5 women; median age 64.5, range 47-79 years), diagnosed with CAD, were included in the study at the Cardiology Department, Linkping University Hospital, Sweden. Qualitative interviews were conducted and analysed according to inductive content analysis. Results: Four main categories were identified: (i) previous experience of exercise, (ii) needs in the acute phase, (iii) important prerequisites for attending exercise-based CR and (iv) future ambitions. The categories demonstrate that there are connections between the past, the present and the future, in terms of attitudes to facilitators, barriers and the use of strategies for managing exercise. An overall theme, defined as existential thoughts, had a major impact on the patients attitudes to attending exercise-based CR. The interaction and meetings with the physiotherapists in the acute phase were described as important factors for attending exercise-based CR. Moreover, informants could feel that the physiotherapists supported them in learning the right level of effort during exercise and reducing the fear of exercise. Conclusions: This study adds to previous knowledge of barriers and facilitators for exercise-based CR that patients with CAD get existential thoughts both related to exercise during the rehabilitation process and for future attitudes to exercise. This knowledge might necessitate greater attention to the physiotherapist-patient interaction. To be able to tailor exercise-based CR for patients, physiotherapists need to be aware of patients past experiences of exercise and previous phases of the rehabilitation process as these are important for how patients perceive their need and ability of exercise.

  • 32.
    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

  • 33.
    Dannapfel, Petra
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. 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.
    A Qualitative Study of Individual and Organizational Learning through Physiotherapists’ Participation in a Research Project2014In: International Journal of Clinical Medicine, ISSN 2158-284X, E-ISSN 2158-2882, Vol. 5, no 9, p. 514-524Article in journal (Refereed)
    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-

  • 34.
    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.

  • 35.
    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.

  • 36.
    Dieterich, Angela V.
    et al.
    University of Medical Centre, Germany.
    Botter, Alberto
    Politecn Torino, Italy.
    Martins Vieira, Taian
    Politecn Torino, Italy; University of Federal Rio de Janeiro, Brazil.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Petzke, Frank
    University of Medical Centre, Germany.
    Davey, Paul
    Curtin University, Australia.
    Falla, Deborah
    University of Birmingham, England.
    Spatial variation and inconsistency between estimates of onset of muscle activation from EMG and ultrasound2017In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 7, article id 42011Article in journal (Refereed)
    Abstract [en]

    Delayed onset of muscle activation can be a descriptor of impaired motor control. Activation onset can be estimated from electromyography (EMG)-registered muscle excitation and from ultrasound-registered muscle motion, which enables non-invasive measurements in deep muscles. However, in voluntary activation, EMG-and ultrasound-detected activation onsets may not correspond. To evaluate this, ten healthy men performed isometric elbow flexion at 20% to 70% of their maximal force. Utilising a multi-channel electrode transparent to ultrasound, EMG and M(otion)-mode ultrasound were recorded simultaneously over the biceps brachii muscle. The time intervals between automated and visually estimated activation onsets were correlated with the regional variation of EMG and muscle motion onset, contraction level and speed. Automated and visual onsets indicated variable time intervals between EMG-and motion onset, median (interquartile range) 96 (121) ms and 48 (72) ms, respectively. In 17% (computed analysis) or 23% (visual analysis) of trials, motion onset was detected before local EMG onset. Multi-channel EMG and M-mode ultrasound revealed regional differences in activation onset, which decreased with higher contraction speed (Spearman rho amp;gt;= 0.45, P amp;lt; 0.001). In voluntary activation the heterogeneous motor unit recruitment together with immediate motion transmission may explain the high variation of the time intervals between local EMG-and ultrasound-detected activation onset.

  • 37.
    Eckerblad, Jeanette
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Tödt, Kristina
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Respiratory Medicine.
    Jakobsson, Per
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Respiratory Medicine.
    Unosson, Mitra
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Skargren, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kentsson, M.
    Ryhov Hospital, Jönköping, Sweden.
    Theander, K.
    Karlstad University, Sweden; Värmland County Council, Karlstad, Sweden.
    Symptom burden in stable COPD patients with moderate or severe airflow limitation2014In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 43, no 4, p. 351-357Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    To describe a multidimensional symptom profile in patients with stable chronic obstructive pulmonary disease (COPD) and determine whether symptom experience differed between patients with moderate or severe airflow limitations.

    BACKGROUND:

    Patients with severe airflow limitation experience numerous symptoms, but little is known regarding patients with moderate airflow limitation.

    METHODS:

    A multidimensional symptom profile (Memorial Symptom Assessment Scale) was assessed in 42 outpatients with moderate and 49 with severe airflow limitations.

    RESULTS:

    The mean number of symptoms in the total sample was 7.9 (±4.3) with no difference between patients with moderate and severe airflow limitations. The most prevalent symptoms with the highest MSAS symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy in both groups.

    CONCLUSIONS:

    Patients with moderate or severe airflow limitations experience multiple symptoms with high severity and distress. An assessment of their multidimensional symptom profile might contribute to better symptom management.

  • 38.
    Ekas, Guri Ranum
    et al.
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Grindem, Hege
    Norwegian Sch Sport Sci, Norway.
    Engebretsen, Lars
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway.
    New meniscal tears after ACL injury: what is the risk? A systematic review protocol2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 6, article id 386Article, review/survey (Refereed)
    Abstract [en]

    Background Secondary meniscal tears after ACL injuries increase the risk of knee osteoarthritis. The current literature on secondary meniscal injuries after ACL injury is not consistent and may have methodological shortcomings. This protocol describes the methods of a systematic review investigating the rate of secondary meniscal injuries in children and adults after treatment (operative or non-operative) for ACL injury. Methods We will search electronic databases (Embase, Ovid Medline, Cochrane, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, PEDro and Google Scholar) from database inception. Extracted data will include demographic data, methodology, intervention details and patient outcomes. Risk of bias will be assessed using the Newcastle Ottawa checklist for cohort studies. Article screening, eligibility assessment, risk of bias assessment and data extraction will be performed in duplicate by independent reviewers. A proportion meta-analysis will be performed if studies are homogeneous (I-2 amp;lt; 75%). If meta-analysis is precluded, data will be synthesised descriptively using best-evidence synthesis. The strength of recommendations and quality of evidence will be assessed using the Grading of Recommendations Assessment Development and Evaluation working group methodology. Ethics and dissemination This protocol is written according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses, and was registered in the International Prospective Register of Systematic Reviews on 22 March 2016.

  • 39.
    Ekberg, Kerstin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Wåhlin, Charlotte
    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, Occupational and Environmental Medicine Center. Karolinska Institutet, Stockholm, Sweden.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Allergy Center.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Early and Late Return to Work After Sick Leave: Predictors in a Cohort of Sick-Listed Individuals with Common Mental Disorders2015In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, no 3, p. 627-637Article in journal (Refereed)
    Abstract [en]

    Objectives The study aims to identify individual and workplace factors associated with early return to work (RTW)-defined as within 3 months-and factors associated with later RTW-between 3 and 12 months after being sick-listed-in a cohort of newly sick-listed individuals with common mental disorders. Methods In a prospective cohort study, a cross-sectional analysis was performed on baseline measures of patients granted sick leave due to common mental disorders. A total of 533 newly sick-listed individuals fulfilled the inclusion criteria and agreed to participate. A baseline questionnaire was sent by post within 3 weeks of their first day of certified medical sickness; 354 (66 %) responded. Those who were unemployed were excluded, resulting in a study population of 319 individuals. Sick leave was recorded for each individual from the Social Insurance Office during 1 year. Analyses were made with multiple Cox regression analyses. Results Early RTW was associated with lower education, better work ability at baseline, positive expectations of treatment and low perceived interactional justice with the supervisor. RTW after 3 months was associated with a need to reduce demands at work, and turnover intentions. Conclusions Early RTW among sick-listed individuals with common mental disorders seems to be associated with the individuals need to secure her/his employment situation, whereas later RTW is associated with variables reflecting dissatisfaction with work conditions. No health measures were associated with RTW. The study highlights the importance of considering not only health and functioning, but also workplace conditions and relations at the workplace in implementing RTW interventions.

  • 40.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. UEFA Medical Comm, Switzerland.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Hamstring injuries have increased by 4% annually in mens professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 12, p. 731-737Article in journal (Refereed)
    Abstract [en]

    Background There are limited data on hamstring injury rates over time in football. Aim To analyse time trends in hamstring injury rates in male professional footballers over 13 consecutive seasons and to distinguish the relative contribution of training and match injuries. Methods 36 clubs from 12 European countries were followed between 2001 and 2014. Team medical staff recorded individual player exposure and time-loss injuries. Injuries per 1000 h were compared as a rate ratio (RR) with 95% CI. Injury burden was the number of lay off days per 1000 h. Seasonal trend for injury was analysed using linear regression. Results A total of 1614 hamstring injuries were recorded; 22% of players sustained at least one hamstring injury during a season. The overall hamstring injury rate over the 13-year period was 1.20 injuries per 1000 h; the match injury rate (4.77) being 9 times higher than the training injury rate (0.51; RR 9.4; 95% CI 8.5 to 10.4). The time-trend analysis showed an annual average 2.3% year on year increase in the total hamstring injury rate over the 13-year period (R-2=0.431, b=0.023, 95% CI 0.006 to 0.041, p=0.015). This increase over time was most pronounced for training injuries-these increased by 4.0% per year (R-2=0.450, b=0.040, 95% CI 0.011 to 0.070, p=0.012). The average hamstring injury burden was 19.7 days per 1000 h (annual average increase 4.1%) (R-2=0.437, b=0.041, 95% CI 0.010 to 0.072, p=0.014). Conclusions Training-related hamstring injury rates have increased substantially since 2001 but match-related injury rates have remained stable. The challenge is for clubs to reduce training-related hamstring injury rates without impairing match performance.

  • 41.
    Enblom, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Patients and physiotherapists belief in and use of acupuncture for cancer-related symptoms2017In: Acupuncture in Medicine, ISSN 0964-5284, E-ISSN 1759-9873, Vol. 35, no 4, p. 251-258Article in journal (Refereed)
    Abstract [en]

    Background It is important to investigate attitudes to acupuncture, because therapists and patients expectations may affect the treatment outcome. Aim To explore the use of and belief in acupuncture among oncological physiotherapists and to explore patients interest in receiving acupuncture during cancer therapy and their belief in its effectiveness. Methods 522 patients (80% female, mean age 67 years) reported on their interest in receiving acupuncture for nausea during radiotherapy treatment; a subgroup (n=198) additionally disclosed their belief in the effectiveness of acupuncture. 117 Swedish oncological physiotherapists (96% female, mean age 48 years) answered a questionnaire regarding their use of and belief in acupuncture. Results Of the patients initiating cancer therapy, 359 (69%) were interested in receiving acupuncture. The patients believed acupuncture to be effective for pain (79%), nausea (79%) and vasomotor symptoms (48%). Of the 117 physiotherapists, 66 (56%) practised acupuncture. Physiotherapists generally believed in the effectiveness of acupuncture. For pain, 89% believed that acupuncture was effective and 42% of them practised it. Similar responses were noted for chemotherapy-induced nausea (86% and 38%, respectively) and vasomotor symptoms (80% and 28%, respectively). Younger physiotherapists and patients were more likely to believe in the effectiveness of acupuncture compared with older ones. Conclusions More than two thirds of patients with cancer were interested in receiving acupuncture during therapy. Patients and oncological physiotherapists believed that acupuncture was effective for cancer pain, nausea and vasomotor symptoms. Further studies of acupuncture for cancer-related symptoms and of the effect of patients and clinicians therapeutic relationships, including treatment expectations, would be welcome.

  • 42.
    Enblom, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Johnsson, Anna
    Skåne University Hospital, Sweden; Lund University, Sweden.
    Type and frequency of side effects during PC6 acupuncture: observations from therapists and patients participating in clinical efficacy trials of acupuncture2017In: Acupuncture in Medicine, ISSN 0964-5284, E-ISSN 1759-9873, Vol. 35, no 6, p. 421-429Article in journal (Refereed)
    Abstract [en]

    Background Many therapists practise PC6 acupuncture for emesis (nausea and vomiting) during pregnancy, different cancer therapies, palliative care, after surgery, or to induce relaxing effects in general. Knowledge of side effects is central to shared decision-making. Aim To describe the type and frequency of side effects and the level of needle-induced pain during PC6 acupuncture. Methods We included 1298 PC6 acupuncture treatments, delivered to 221 participants (77% women, mean age 52.5, range 18-91 years). The subjects had received genuine PC6 acupuncture, in one of two previous randomised controlled trials, aimed at inducing antiemetic (n=100, with 100 providing data on side effects and 94 on needle-induced pain, respectively) or relaxing (n=121, with 120 providing data) effects. Side effects during and after the acupuncture treatments were registered in structured treatment protocols and study diaries. Results No serious complications occurred. Side effects during the acupuncture sessions included minor bleeding in 5.0%, tiredness in 4.9%, numbness in 4.5% and dizziness in 1.4% of the 1298 treatments. After treatment, the mean proportions of participants reporting side effects each week were: tiredness 25.8%; feeling cold 17.8%; dizziness 9.7%; sweating 9.3%; haematoma 8.8%; and soreness at the needling sites 4.3%. Participants perceived the needling to be not painful (47.4% of participants), or mildly (39.1%), moderately (11.6%) or very painful (1.4%). Conclusions Few side effects occurred and those that did were mild. Nearly 90% found PC6 acupuncture to be not painful or only mildly painful. Healthcare professionals may consider the observed levels of side effects when informing patients about side effects of PC6 acupuncture.

  • 43.
    Enblom, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Lindquist, H.
    Karolinska Inst, Sweden.
    Bergmark, K.
    Sahlgrens Univ Hosp, Sweden.
    Participation in water-exercising long-term after breast cancer surgery: Experiences of significant factors for continuing exercising as a part of cancer rehabilitation2018In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 27, no 1, article id e12736Article in journal (Refereed)
    Abstract [en]

    Although physical exercising has great benefits, little is known regarding factors of significance for cancer survivors to continue exercising within their rehabilitation. The objective was to describe factors experienced to be of significance for cancer survivors to continue with water-exercising long-term after breast cancer surgery. Women (n=29) who had undergone breast cancer surgery (mastectomy 79%, axillary surgery 86%, and radiotherapy 86%) for median (md) 13 (25th-75th percentile 3-21.5) was followed up regarding their rehabilitation, arm function Disabilities of Arm Shoulder and Hand (md 14, IQR 7-32), EQ-5D score (md 0.8, IQR 0.73-1.0) and quality of life EQ health barometer (md 80, IQR 64-95). We performed qualitative focus-group interviews regarding the womens views (n=24). The women had participated in water-exercising 1-46 semesters, md 8 (25th-75th percentile 3-21.5) semesters. Nearly all, 97%, participated in the water-exercising group every week, and 21 (72%) had participated in the water-exercising group at least half of the time since their breast cancer surgery, without complications. The women experienced that factors of significance to continue with water-exercising were the convenience of easily modified weightless exercising in the water, social interaction, and access to a private dressing room. These factors would be important to consider to encourage continuing in exercising.

  • 44.
    Enblom, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Steineck, Gunnar
    Karolinska Institute, Sweden; Gothenburg University, Sweden.
    Börjeson, Sussanne
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Complementary and alternative medicine self-care strategies for nausea in patients undergoing abdominal or pelvic irradiation for cancer: A longitudinal observational study of implementation in routine care2017In: Complementary Therapies in Medicine, ISSN 0965-2299, E-ISSN 1873-6963, Vol. 34, p. 141-148Article in journal (Refereed)
    Abstract [en]

    Objective: To longitudinally describe practice of Complementary and Alternative Medicine (CAM) self-care strategies for nausea during radiotherapy. Methods: Two hundred patients daily registered nausea and practice of CAM self-care strategies, beside conventional antiemetic medications, for nausea during abdominal/pelvic irradiation (median five weeks) for gynecological (69%) colorectal (27%) or other tumors (4%). Results: During radiotherapy, 131 (66%) experienced nausea, and 50 (25%) practiced self-care for nausea at least once, for a mean (m) of 15.9 days. The six of 50 patients who stayed free from nausea practiced self-care more frequent (m = 25.8 days) than the 44 patients experiencing nausea (m = 14.5) (p = 0.013). The CAM self-care strategies were: modifying eating (80% of all self-care practicing patients, 80% of the nauseous patients versus 83% of the patients free from nausea; ns) or drinking habits (38%, 41% vs 17%; ns), taking rests (18%, 20% vs 0%; ns), physical exercising (6%, 2% vs 33%; p = 0.035), acupressure (4%, 5% vs 0%; ns) and self-induced vomiting (2%, 2% vs 0%; ns). Conclusion: A fourth of patients undergoing emetogenic radiotherapy practiced CAM self-care for nausea, mostly by modifying eating or drinking habits. The CAM self-care practicing patients who did not become nauseous practiced self-care more frequent than the nauseous patients did. To make such self-care evidence based, we need studies evaluating its efficacy.

  • 45.
    Enblom, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Institutionen för klinisk neurovetenskap, Osher centrum för integrativ medicin, Karolinska Institutet, Stockholm, Sweden.
    Steineck, Gunnar
    Institutionen för onkologi-patologi, Karolinska Institutet, Stockholm; Institutionen för kliniska vetenskaper, avdelning för onkologi, Sahlgrenska akademin, Göteborgs universitet, Göteborg, Sweden.
    Hammar, Mats
    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, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Börjeson, Sussanne
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Reduced Need for Rescue Antiemetics and Improved Capacity to Eat in Patients Receiving Acupuncture Compared to Patients Receiving Sham Acupuncture or Standard Care during Radiotherapy.2017In: Evidence-based Complementary and Alternative Medicine, ISSN 1741-427X, E-ISSN 1741-4288, Vol. 2017, article id 5806351Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate if consumption of emesis-related care and eating capacity differed between patients receiving verum acupuncture, sham acupuncture, or standard care only during radiotherapy. Methods. Patients were randomized to verum (n = 100) or sham (n = 100) acupuncture (telescopic blunt sham needle) (median 12 sessions) and registered daily their consumption of antiemetics and eating capacity. A standard care group (n = 62) received standard care only and delivered these data once. Results. More patients in the verum (n = 73 of 89 patients still undergoing radiotherapy; 82%, Relative Risk (RR) 1.23, 95% Confidence Interval (CI) 1.01-1.50) and the sham acupuncture group (n = 79 of 95; 83%, RR 1.24, CI 1.03-1.52) did not need any antiemetic medications, as compared to the standard care group (n = 42 out of 63; 67%) after receiving 27 Gray dose of radiotherapy. More patients in the verum (n = 50 of 89; 56%, RR 1.78, CI 1.31-2.42) and the sham acupuncture group (n = 58 of 94 answering patients; 62%, RR 1.83, CI 1.20-2.80) were capable of eating as usual, compared to the standard care group (n = 20 of 63; 39%). Conclusion. Patients receiving acupuncture had lower consumption of antiemetics and better eating capacity than patients receiving standard antiemetic care, plausible by nonspecific effects of the extra care during acupuncture.

  • 46.
    Engkvist, Inga-Lill
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. KTH Royal Institute Technology, Sweden.
    Eklund, Jörgen
    Linköping University, Department of Management and Engineering. Linköping University, The Institute of Technology. KTH Royal Institute Technology, Sweden.
    Krook, Joakim
    Linköping University, Department of Management and Engineering, Environmental Technology and Management. Linköping University, Faculty of Science & Engineering.
    Björkman, Mats
    Linköping University, Department of Management and Engineering, Manufacturing Engineering. Linköping University, Faculty of Science & Engineering.
    Sundin, Erik
    Linköping University, Department of Management and Engineering, Manufacturing Engineering. Linköping University, Faculty of Science & Engineering.
    Perspectives on recycling centres and future developments2016In: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 57, p. 17-27Article in journal (Refereed)
    Abstract [en]

    The overall aim of this paper is to draw combined, all-embracing conclusions based on a long-term multidisciplinary research programme on recycling centres in Sweden, focussing on working conditions, environment and system performance. A second aim is to give recommendations for their development of new and existing recycling centres and to discuss implications for the future design and organisation. Several opportunities for improvement of recycling centres were identified, such as design, layout, ease with which users could sort their waste, the work environment, conflicting needs and goals within the industry, and industrialisation. Combining all results from the research, which consisted of different disciplinary aspects, made it possible to analyse and elucidate their interrelations. Waste sorting quality was recognized as the most prominent improvement field in the recycling centre system. The research identified the importance of involving stakeholders with different perspectives when planning a recycling centre in order to get functionality and high performance. Practical proposals of how to plan and build recycling centres are given in a detailed checklist. (C) 2016 Elsevier Ltd. All rights reserved.

  • 47.
    Engquist, Markus
    et al.
    Ryhov Hospital, Sweden; University of Gothenburg, Sweden.
    Lofgren, Hakan
    Ryhov Hospital, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Holtz, Anders
    University of Uppsala Hospital, Sweden.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Soderlund, Anne
    Malardalen University, Sweden.
    Vavruch, Ludek
    Ryhov Hospital, Sweden.
    Lind, Bengt
    University of Gothenburg, Sweden; Spine Centre Göteborg, Sweden.
    Factors Affecting the Outcome of Surgical Versus Nonsurgical Treatment of Cervical Radiculopathy2015In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 40, no 20, p. 1553-1563Article in journal (Refereed)
    Abstract [en]

    Study Design. Prospective randomized controlled trial. Objective. To analyze factors that may influence the outcome of anterior cervical decompression and fusion (ACDF) followed by physiotherapy versus physiotherapy alone for treatment of patients with cervical radiculopathy. Summary of Background Data. An understanding of patient-related factors affecting the outcome of ACDF is important for preoperative patient selection. No previous prospective, randomized study of treatment effect modifiers relating to outcome of ACDF compared with physiotherapy has been carried out. Methods. 60 patients with cervical radiculopathy were randomized to ACDF followed by physiotherapy or physiotherapy alone. Data for possible modifiers of treatment outcome at 1 year, such as sex, age, duration of pain, pain intensity, disability (Neck Disability Index, NDI), patient expectations of treatment, anxiety due to neck/arm pain, distress (Distress and Risk Assessment Method), self-efficacy (Self-Efficacy Scale) health status (EQ-5D), and magnetic resonance imaging findings were collected. A multivariate analysis was performed to find treatment effect modifiers affecting the outcome regarding arm/neck pain intensity and NDI. Results. Factors that significantly altered the treatment effect between treatment groups in favor of surgery were: duration of neck pain less than 12 months (P = 0.007), duration of arm pain less than 12 months (P = 0.01) and female sex (P = 0.007) (outcome: arm pain), low EQ-5D index (outcome: neck pain, P = 0.02), high levels of anxiety due to neck/arm pain (outcome: neck pain, P = 0.02 and NDI, P = 0.02), low Self-Efficacy Scale score (P = 0.05), and high Distress and Risk Assessment Method score (P = 0.04) (outcome: NDI). No factors were found to be associated with better outcome with physiotherapy alone. Conclusion. In this prospective, randomized study of patients with cervical radiculopathy, short duration of pain, female sex, low health quality, high levels of anxiety due to neck/arm pain, low self-efficacy, and a high level of distress before treatment were associated with better outcome from surgery. No factors were found to be associated with better outcome from physiotherapy alone.

  • 48.
    Engquist, Markus
    et al.
    Ryhov Hospital, Sweden.
    Löfgren, Håkan
    Ryhov Hospital, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Holtz, Anders
    University of Uppsala Hospital, Sweden.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Söderlund, Anne
    Mälardalen University, Sweden.
    Vavruch, Ludek
    Ryhov Hospital, Sweden.
    Lind, Bengt
    University of Gothenburg, Sweden; Spine Centre Göteborg, Sweden.
    A 5-to 8-year randomized study on the treatment of cervical radiculopathy: anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone2017In: JOURNAL OF NEUROSURGERY-SPINE, ISSN 1547-5654, Vol. 26, no 1, p. 19-27Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE The aim of this study was to evaluate the 5- to 8-year outcome of anterior cervical decompression and fusion (ACDF) combined with a structured physiotherapy program as compared with that following the same physiotherapy program alone in patients with cervical radiculopathy. No previous prospective randomized studies with a follow-up of more than 2 years have compared outcomes of surgical versus nonsurgical intervention for cervical radiculopathy. METHODS Fifty-nine patients were randomized to ACDF surgery with postoperative physiotherapy (30 patients) or to structured physiotherapy alone (29 patients). The physiotherapy program included general and specific exercises as well as pain coping strategies. Outcome measures included neck disability (Neck Disability Index [NDI]), neck and arm pain intensity (visual analog scale [VAS]), health state (EQ-5D questionnaire), and a patient global assessment. Patients were followed up for 5-8 years. RESULTS After 5-8 years, the NDI was reduced by a mean score% of 21 (95% CI 14-28) in the surgical group and 11% (95% CI 4%-18%) in the nonsurgical group (p = 0.03). Neck pain was reduced by a mean score of 39 mm (95% CI 26-53 mm) compared with 19 mm (95% CI 7-30 mm; p = 0.01), and arm pain was reduced by a mean score of 33 mm (95% CI 18-49 mm) compared with 19 mm (95% CI 7-32 mm; p = 0.1), respectively. The EQ-5D had a mean respective increase of 0.29 (95% CI 0.13-0.45) compared with 0.14 (95% CI 0.01-0.27; p = 0.12). Ninety-three percent of patients in the surgical group rated their symptoms as "better" or "much better" compared with 62% in the nonsurgical group (p = 0.005). Both treatment groups experienced significant improvement over baseline for all outcome measures. CONCLUSIONS In this prospective randomized study of 5- to 8-year outcomes of surgical versus nonsurgical treatment in patients with cervical radiculopathy, ACDF combined with physiotherapy reduced neck disability and neck pain more effectively than physiotherapy alone. Self-rating by patients as regards treatment outcome was also superior in the surgery group. No significant differences were seen between the 2 patient groups as regards arm pain and health outcome.

  • 49.
    Engstrand, Christina
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Hand function in patients with Dupuytren’s disease: Assessment, results & patients’ perspectives2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Dupuytren’s Disease (DD) is a soft tissue disorder that leads to finger joint contractures affecting hand function. DD can be treated with surgery or injection and hand therapy to improve finger joint extension and thereby improve hand function. However, this does not cure the disease and recurrence is common. Previous research on DD has shown improvement in finger joint extension and in self-reported disability of the upper extremity after surgery and hand therapy for DD. However, this provides only a limited perspective on hand function, and multiple dimensions of changes in hand function (i.e. physical, psychosocial aspects and including the patients’ views of results) have not been reported as a whole.

    Aim: The overall aim of the thesis was to explore hand function before and after surgery and hand therapy in patients with DD, including assessment, results and patients’ perspectives.

    Methods: The thesis comprises three studies: Study A was a methodological study of interrater reliability in goniometry of the finger joints. Study B was a prospective cohort study with a repeated measures design. Study C was a qualitative interview study, using the model of Patient Evaluation Process and content analysis.

    Results: Interrater reliability was high or very high for goniometer measurement of finger joint range of motion (ROM) in patients with DD when experienced raters follow our standardized guidelines developed for the study. Changes in hand function consisted of improvement of finger joint extension while active finger flexion was significantly impaired during the first year after surgery and hand therapy. No patient reached a normal ROM, but the majority reached a functional ROM. Sensibility remained unaffected. Patients with surgery on multiple fingers had worse scar pliability than patients with surgery on a single finger. Most patients had their expectations met and were pleased or delighted with their hand function at 12 months after surgery and hand therapy. Safety issues of hand function were of greater concern than social issues. Patients reported less disability and improved health-related quality of life after surgery and hand therapy. The three variables “need to take special precautions”, “avoid using the hand in social context”, and health-related quality of life had significant importance for patients’ rating of functional recovery. Together, these variables explained 62% of the variance in functional recovery. Patients’ perspectives of undergoing a surgical intervention process were described through five categories. Previous experiences of care influenced participants’ expectations of results and the care they were about to receive. Previous experiences and expectations were used as references for appraisal of results, which concerned perceived changes in hand function, the care process, competency, and organization. Appraisal of results could also vary in relation to  patient character. Appraisal of results of the intervention process influenced participants’ expectations of future hand function, health and care.

    Conclusions: Surgery and hand therapy for DD improve hand function and patients regain a functional ROM needed for performance of common daily activities. Despite the negative effect on finger flexion present during the first year after surgery, patients’ regards their hand function as recovered six to eight months after surgery and hand therapy. Measuring digital ROM in the finger joints with a goniometer is a reliable assessment method. However, from the patient’s perspective, it is not enough to evaluate results only in terms of digital extension or ROM. From their view, results of treatment concern consequences on daily use of the hand, what happens during the care process in terms of interaction between patient and health care provider, as well as their view of the competence and logistics of the organization providing the care.

    List of papers
    1. Interrater Reliability in Finger Joint Goniometer Measurement in Dupuytrens Disease
    Open this publication in new window or tab >>Interrater Reliability in Finger Joint Goniometer Measurement in Dupuytrens Disease
    2012 (English)In: American Journal of Occupational Therapy, ISSN 0272-9490, E-ISSN 1943-7676, Vol. 66, no 1, p. 98-103Article in journal (Refereed) Published
    Abstract [en]

    We investigated interrater reliability of range of motion (ROM) measurement in the finger joints of people with Dupuytrens disease. Eight raters measured flexion and extension of the three finger joints in one affected finger of each of 13 people with different levels of severity of Dupuytrens disease, giving 104 measures of joints and motions. Reliability measures, represented by intraclass correlation coefficient (ICC), standard error of the mean (SEM), and differences between raters with the highest and lowest mean scores, were calculated. ICCs ranged from .832 to .973 depending on joint and motion. The SEM was andlt;= 3 degrees for all joints and motions. Differences in mean between highest and lowest raters were larger for flexion than for extension; the largest difference was in the distal interphalangeal joint. The results indicate that following these standardized guidelines, the interrater reliability of goniometer measurements is high for digital ROM in people with Dupuytrens disease.

    Place, publisher, year, edition, pages
    American Occupational Therapy Association, 2012
    Keywords
    arthrometry, articular, Dupuytren contracture, finger joint, range of motion, articular, reproducibility of results
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-75284 (URN)10.5014/ajot.2012.001925 (DOI)000299362000012 ()
    Available from: 2012-02-27 Created: 2012-02-24 Last updated: 2017-12-07
    2. Hand function and quality of life before and after fasciectomy for Dupuytren contracture
    Open this publication in new window or tab >>Hand function and quality of life before and after fasciectomy for Dupuytren contracture
    2014 (English)In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 39, no 7, p. 1333-1343Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE:

    To describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease.

    METHODS:

    This prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Ninety patients with total active extension deficits of 60° or more from Dupuytren contracture were included. Outcomes measures were range of motion; sensibility; scar pliability; self-reported outcomes on expectations, recovery, and satisfaction with hand function; Disabilities of the Arm, Shoulder, and Hand scores; safety and social issues of hand function; physical activity habits; and quality of life with the Euroqol.

    RESULTS:

    The extension deficit decreased, and there was a transient decrease in active finger flexion during the first year after surgery. Sensibility remained unaffected. Generally, patients with surgery on multiple fingers had worse scar pliability. The majority of the patients had their expectations met, and at 6 months, 32% considered hand function as fully recovered, and 73% were satisfied with their hand function. Fear of hurting the hand and worry about not trusting the hand function were of greatest concern among safety and social issues. The Disability of the Arm, Shoulder, and Hand score and the Euroqol improved over time.

    CONCLUSIONS:

    After surgery and hand therapy, disability decreased independent of single or multiple operated fingers. The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment.

    Place, publisher, year, edition, pages
    Elsevier, 2014
    Keywords
    Dupuytren contracture; surgical treatment; range of motion; satisfaction; occupational therapy
    National Category
    Clinical Medicine Physiotherapy
    Identifiers
    urn:nbn:se:liu:diva-109387 (URN)10.1016/j.jhsa.2014.04.029 (DOI)000338905000014 ()24969497 (PubMedID)
    Available from: 2014-08-15 Created: 2014-08-15 Last updated: 2017-12-05Bibliographically approved
    3. Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease
    Open this publication in new window or tab >>Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease
    2015 (English)In: Journal of Hand Therapy, ISSN 0894-1130, E-ISSN 1545-004X, Vol. 28, no 3, p. 255-260Article in journal (Refereed) Published
    Abstract [en]

    Study design: Prospective cohort study. Introduction: The evidence of the relationship between functional recovery and impairment after surgery and hand therapy are inconsistent. Purpose of the study: To explore factors that were most related to functional recovery as measured by DASH in patients with Dupuytrens disease. Methods: Eighty-one patients undergoing surgery and hand therapy were consecutively recruited. Functional recovery was measured by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Explanatory variables: range of motion of the finger joints, five questions regarding safety and social issues of hand function, and health-related quality of life (Euroqol). Results: The three variables "need to take special precautions", "avoid using the hand in social context", and health-related quality of life (EQ-5D index) explained 62.1% of the variance in DASH, where the first variable had the greatest relative effect. Discussion: Safety and social issues of hand function and quality of life had an evident association with functional recovery. Level of evidence: IV.

    Place, publisher, year, edition, pages
    Elsevier, 2015
    Keywords
    Dupuytrens contracture; Emotional function; Range of motion; Recovery of function; Quality of life
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-121325 (URN)10.1016/j.jht.2014.11.006 (DOI)000359329100005 ()25998546 (PubMedID)
    Note

    Funding Agencies|Medical Research Council of southeast Sweden [FORSS-72231]; County Council of Ostergotland, Sweden [LIO-77311]

    Available from: 2015-09-14 Created: 2015-09-14 Last updated: 2017-12-04
    4. Patients'€™ perspective on surgical intervention for Dupuytren'€™s disease€: experiences, expectations and appraisal of results
    Open this publication in new window or tab >>Patients'€™ perspective on surgical intervention for Dupuytren'€™s disease€: experiences, expectations and appraisal of results
    2016 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 24-26, p. 2538-2549Article in journal (Refereed) Published
    Abstract [en]

    Purpose To explore patients’ perspectives on surgical intervention for Dupuytren’s disease (DD), focusing on patients’ appraisal of results, involving previous experiences, expectations and patient characters.

    Method The participants were 21 men, mean age 66 years, scheduled for DD surgery. Qualitative interviews were conducted 2–4 weeks before surgery and 6–8 months after surgery. The model of the Patient Evaluation Process was used as theoretical framework. Data were analyzed using problem-driven content analysis.

    Results Five categories are described: previous experiences, expectations before surgery, appraisal of results, expectations of the future and patient character. Previous experiences influenced participants’ expectations, and these were used along with other aspects as references for appraisal of results. Participants’ appraisal of results concerned perceived changes in hand function, care process, competency and organization, and could vary in relation to patient character. The appraisal of results influenced participants’ expectations of future hand function, health and care.

    Conclusions Patients’ appraisal of results involved multidimensional reasoning reflecting on hand function, interaction with staff and organizational matters. Thus, it is not enough to evaluate results after DD surgery only by health outcomes as this provides only a limited perspective. Rather, evaluation of results should also cover process and structure aspects of care.

    Implications for Rehabilitation

    • To improve health care services, it is important to be aware of the role played by patient’s previous experiences, expectations as well as staff and organizational aspects of care.
    • Knowledge about patients’ experience and view of the results from surgery and rehabilitation should be established by assessment of care effects on health as well as structure and process aspects of care.
    • Evaluation of structure and process aspects of care can be done by using questions about if the patient felt listened to, received clear information and explanations, was included in decision-making, and their view of waiting time or continuity of care.
    • Improving health care services means not only providing the best treatment method available but also developing individualized care by ensuring good interaction with the patient, providing accurate information, and working to improve the structure of the care process.
    • Before treatment, health care providers should have a dialogue with the patient and consider previous experiences and expectations in order to ensure the patient has balanced expectations of the outcome.
    Keywords
    Care process; hand function; hand surgery; interviews; outcome
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy Nursing Physiotherapy
    Identifiers
    urn:nbn:se:liu:diva-125964 (URN)10.3109/09638288.2015.1137981 (DOI)000385478900020 ()26878688 (PubMedID)
    Note

    Funding agencies: County Council of Ostergotland, Sweden

    Available from: 2016-03-10 Created: 2016-03-10 Last updated: 2017-11-30Bibliographically approved
  • 50.
    Engstrand, Christina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Krevers, Barbro
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. 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.
    Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease2015In: Journal of Hand Therapy, ISSN 0894-1130, E-ISSN 1545-004X, Vol. 28, no 3, p. 255-260Article in journal (Refereed)
    Abstract [en]

    Study design: Prospective cohort study. Introduction: The evidence of the relationship between functional recovery and impairment after surgery and hand therapy are inconsistent. Purpose of the study: To explore factors that were most related to functional recovery as measured by DASH in patients with Dupuytrens disease. Methods: Eighty-one patients undergoing surgery and hand therapy were consecutively recruited. Functional recovery was measured by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Explanatory variables: range of motion of the finger joints, five questions regarding safety and social issues of hand function, and health-related quality of life (Euroqol). Results: The three variables "need to take special precautions", "avoid using the hand in social context", and health-related quality of life (EQ-5D index) explained 62.1% of the variance in DASH, where the first variable had the greatest relative effect. Discussion: Safety and social issues of hand function and quality of life had an evident association with functional recovery. Level of evidence: IV.

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