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  • 1.
    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.

  • 2.
    Bergström, Maria
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Sverker, Annette M.
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Larsson Ranada, Åsa
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Valtersson, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Östlund, Gunnel
    Mälardalens högskola, Hälsa och välfärd, Sweden.
    Björk, Mathilda
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Significant others as both barriers and facilitators for participation in daily activities in persons with rheumatoid arthritis: an interview study within the Swedish TIRA project2017Conference paper (Other academic)
  • 3.
    Bergström, Maria
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Sverker, Annette
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Östlund, Gunnel
    Mälardalens högskola, Akademin för hälsa, vård och välfärd, Sweden.
    Larsson Ranada, Åsa
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Björk, Mathilda
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Valtersson, Eva
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Närståendes betydelse för delaktighet i vardagen hos personer med reumatoid artrit.2019In: Best Practice, ISSN 1329-1874Article in journal (Other (popular science, discussion, etc.))
  • 4.
    Björk, Mathilda
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Valtersson, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Stenström, Birgitta
    Reumatologförbundet, Sweden.
    Sverker, Annette
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Disability in the feet related to participation in daily life in patients with early RA: – an interview study in the Swedish TIRA project2017Conference paper (Refereed)
  • 5.
    Björk, Mathilda
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Valtersson, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Östlund, Gunnel
    School of Health Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden.
    Stenström, Birgitta
    Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Sverker, Annette
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Foot barriers in patients with early rheumatoid arthritis: an interview study among Swedish women and men2018In: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 70, no 9, p. 1348-1354Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Foot impairments are related to reduced mobility and participation restrictions in daily activities in patients with established rheumatoid arthritis (RA). The new biological medications are effective and reduce disease activity, but not disability to the same extent. Foot impairments are assumed to be related to participation restrictions also in patients with early RA, diagnosed after the introduction of biological medications. The knowledge of foot impairments needs to be more explored after the introduction of biological disease-modifying drugs (bDMARDs). The aim of this study was to explore the patients' perspective of foot impairments related to early RA.

    METHODS: The sample included 59 patients (20-63 years) who were interviewed about participation dilemmas in daily life using the Critical Incident Technique. The interviews were audio-recorded and transcribed. Data related to foot impairments were extracted and analyzed thematically. A research partner validated the analysis. The study was approved by the Regional Ethics Committee.

    RESULTS: Patients with early RA described a variety of participation restrictions related to foot impairments: 1) foot hindrances in domestic life, 2) foot impairments influencing work, 3) leisure activities restricted by one's feet 4) struggling to be mobile 5) foot impairments as an early sign of rheumatic disease.

    CONCLUSION: There is a need to focus on foot impairments related to early RA, and for health care professionals to understand these signs. A suggestion for future research is to conduct a longitudinal follow-up of foot impairment related to medication, disease activity and disability in patients diagnosed after the introduction of bDMARDs. This article is protected by copyright. All rights reserved.

  • 6.
    Dale, Richard Allan
    et al.
    Sahlgrenska Academy, University of Gothenburg, Sweden.
    Sverker, Annette
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Hasselberg, Marie
    Karolinska Institutet, Sweden.
    Östlund, Gunnel
    School of Health and Social Welfare, Mälardalen University, Sweden.
    Hensing, Gunnel
    University of Gothenburg, Sweden.
    Young adults' experiences with near-injury situations: a critical incident study in Sweden2017In: International Journal of Child, Youth & Family Studies, ISSN 1920-7298, E-ISSN 1920-7298, Vol. 8, no 1, p. 97-111Article in journal (Refereed)
    Abstract [en]

    As injuries are the main health threat for young adults (18–29 years) in industrial countries, a better understanding of injury risk is needed for this population. Using the Critical Incident Technique, this study explores how young people experience situations that have the potential to cause physical injury (i.e., near-injury situations). Clearly, understanding how and why near-injury situations arise can be used to develop strategies to help prevent severe injury. Content analysis was used to categorize the characteristics of the experiences into unexpected risk in ordinary tasksduty first, and price for learning. Young adults’ exposures to new or unusual environmental conditions, especially in unexpected risk in ordinary tasks, should be considered when planning injury prevention strategies. A combination of individual, social, and contextual demands and expectations was identified in both work- and sports-related experiences with near-injury situations. The price for learning, which arises from the added risk involved in learning situations, is another condition that was identified and requires further attention. The Critical Incident Technique proved to be a useful method for identifying near-injury situations that might otherwise have been difficult to recall. Young adults’ efforts to display their ability to handle difficult situations at work and in their everyday lives was identified as a major contributor to near-injury situations.

  • 7.
    Enthoven, Paul
    et al.
    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.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Wibault, Johanna
    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.
    Peterson, Gunnel
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    VALIDITY, INTERNAL CONSISTENCY AND SELF-RATED CHANGE OF THE PATIENT ENABLEMENT INSTRUMENT IN PATIENTS WITH CHRONIC MUSCULOSKELETAL PAIN2019In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 51, no 8, p. 587-597Article in journal (Refereed)
    Abstract [en]

    Objective: Patient enablement reflects patients understanding of and coping with illness. The aim of this study was to investigate the content validity, construct validity, internal consistency and selfrated change (SRC) of the Patient Enablement Instrument (PEI) in patients with whiplash-associated disorders, cervical radiculopathy and mixed chronic pain treated in different settings. Design: Psychometric analyses. Participants: Patients with disabling non-malignant chronic musculoskeletal pain. Methods: Participants answered questionnaires on disability (Neck Disability Index (NDI) or Functional Rating Index (FRI)), anxiety/depression (Hospital Anxiety and Depression Scale; HADS) and general health (EuroQol; EQ-5D). Content validity, construct validity (confirmatory factor analysis), internal consistency and cut-off for SRC were investigated for the PEI after treatment. The SRC value was the receiver operating characteristic (ROC) curve optimal cut-off point. Results: After treatment all items were completed by 516 patients (mean standard deviation (SD) age 45.1 years (SD 10.1), women 75% (n=385)). The 1-factor PEI model had approximate fit to the data. The internal consistency Cronbachs alpha was between 0.878 and 0.929 for the 3 groups. Correlations between the PEI and the NDI/FRI, HADS and EQ-5D were fair to good. The SRCROC for whiplash-associated disorders, cervical radiculopathy and mixed chronic pain groups was 5, 6 and 4 points in the PEI, respectively. Conclusion: The PEI showed fair content validity, construct validity and internal consistency. However, the scale needs further development to improve measurement of change.

  • 8.
    Gauffin, Håkan
    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.
    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.
    Meunier, Andreas
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology.
    Magnusson, Henrik
    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 Orthopaedics in Linköping.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms A 3-Year Follow-up of a Prospective, Randomized Study2017In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 45, no 9, p. 2077-2084Article in journal (Refereed)
    Abstract [en]

    Background: The optimal treatment for middle-aged patients with knee pain and meniscal lesions has been extensively debated. Most previous studies have revealed only short-term beneficial results of knee arthroscopic surgery. The authors have previously shown a positive benefit of knee arthroscopic surgery and an exercise program after 1 year when compared with an exercise program alone. Purpose: To evaluate if knee arthroscopic surgery combined with an exercise program provided an additional long-term benefit after 3 years compared with an exercise program alone in middle-aged patients with meniscal symptoms. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Of 179 eligible patients, aged 45 to 64 years, 150 were randomized to (1) a 3-month exercise program (nonsurgery group) or (2) the same as group 1 plus knee arthroscopic surgery within 4 weeks (surgery group). The primary outcome was the change in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscore of pain between baseline and the 3-year follow-up. Results from the 1-year follow-up have been published previously. Results: Both treatment groups improved significantly in the KOOS pain subscore at 3 years follow-up in the intention-to-treat and as-treated analyses (P amp;lt; .001). The between-group difference for the change in the KOOS pain subscore between baseline and the 3-year follow-up was no longer statistically significant, neither in the intention-to-treat analysis (7.6 points; 95% CI, -0.6 to 15.9; P = .068) nor in the as-treated analysis (5.3 points; 95% CI, -3.1 to 13.8; P = .216). The factorial analysis of the effect of the intervention and age, onset of pain, and mechanical symptoms indicated that older patients improved more, regardless of treatment, and surgery may be more beneficial for patients without mechanical symptoms (as-treated analysis). The effect of the predictive factors on the KOOS pain subscore was uncertain because of the small sample size in the subgroup analyses. Conclusion: The benefit of knee arthroscopic surgery, seen at 1 year in middle-aged patients with meniscal symptoms, was diminished at 3 years and was no longer statistically significant.

  • 9.
    Hermansen, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Clinical and patient-reported outcomes after anterior cervical decompression and fusion surgery: A focus on functioning and daily life2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

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

    List of papers
    1. A Comparison Between the Carbon Fiber Cage and the Cloward Procedure in Cervical Spine Surgery A Ten- to Thirteen-Year Follow-Up of a Prospective Randomized Study
    Open this publication in new window or tab >>A Comparison Between the Carbon Fiber Cage and the Cloward Procedure in Cervical Spine Surgery A Ten- to Thirteen-Year Follow-Up of a Prospective Randomized Study
    2011 (English)In: SPINE, ISSN 0362-2436, Vol. 36, no 12, p. 919-925Article in journal (Refereed) Published
    Abstract [en]

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

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

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

    Available from: 2011-05-27 Created: 2011-05-27 Last updated: 2015-04-23
    2. Positive predictive factors and subgroup analysis of clinically relevant improvement after anterior cervical decompression and fusion for cervical disc disease: a 10-to 13-year follow-up of a prospective randomized study Clinical article
    Open this publication in new window or tab >>Positive predictive factors and subgroup analysis of clinically relevant improvement after anterior cervical decompression and fusion for cervical disc disease: a 10-to 13-year follow-up of a prospective randomized study Clinical article
    2013 (English)In: Journal of Neurosurgery: Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 19, no 4, p. 403-411Article in journal (Refereed) Published
    Abstract [en]

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

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

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

    Available from: 2013-10-25 Created: 2013-10-25 Last updated: 2019-04-10
    3. Evaluation of Physical Function in Individuals 11 to 14 Years after AnteriorCervical Decompression and Fusion Surgery: A Comparison betweenPatients and Healthy Reference Samples and Between 2 Surgical Techniques
    Open this publication in new window or tab >>Evaluation of Physical Function in Individuals 11 to 14 Years after AnteriorCervical Decompression and Fusion Surgery: A Comparison betweenPatients and Healthy Reference Samples and Between 2 Surgical Techniques
    2014 (English)In: Journal of Manipulative and Physiological Therapeutics, ISSN 0161-4754, E-ISSN 1532-6586, Vol. 37, no 2, p. 87-96Article in journal (Refereed) Published
    Abstract [en]

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

    Place, publisher, year, edition, pages
    Elsevier, 2014
    Keywords
    Cervical Vertebrae; Neck Muscles; Physical Endurance; Range of Motion; Postural Balance; Surgical Procedure
    National Category
    Physiotherapy
    Identifiers
    urn:nbn:se:liu:diva-104837 (URN)10.1016/j.jmpt.2013.11.002 (DOI)000330584200004 ()
    Available from: 2014-02-28 Created: 2014-02-28 Last updated: 2017-12-05Bibliographically approved
    4. Women’s experiences of daily life after anterior cervical decompression and fusion surgery: A qualitative interview study
    Open this publication in new window or tab >>Women’s experiences of daily life after anterior cervical decompression and fusion surgery: A qualitative interview study
    2016 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 48, no 4, p. 352-358Article in journal (Refereed) Published
    Abstract [en]

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

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

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

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

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

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

    Available from: 2015-04-23 Created: 2015-04-23 Last updated: 2017-12-04Bibliographically approved
  • 10.
    Hermansen, Anna
    et al.
    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.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Hedlund, Rune
    Department of Orthopaedics , Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Göteborg , Sweden.
    Kammerlind, Ann-Sofi
    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 Otorhinolaryngology. Futurum , Region Jönköping County , Jönköping , Sweden.
    Balance problems and dizziness after neck surgery: associations with pain and health-related quality of life2019In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, p. 1-8Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 11.
    Kvist, Joanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Karolinska Inst, Sweden.
    Gauffin, Håkan
    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.
    Tigerstrand Grevnerts, Hanna
    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.
    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.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Stalman, Anders
    Capio ArtroClin, Sweden.
    Frobell, Richard
    Lund Univ, Sweden.
    Natural corollaries and recovery after acute ACL injury: the NACOX cohort study protocol2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 6, article id e020543Article in journal (Refereed)
    Abstract [en]

    Introduction Anterior cruciate ligament (ACL) injury can result in joint instability, decreased functional performance, reduced physical activity and quality of life and an increased risk for post-traumatic osteoarthritis. Despite the development of new treatment techniques and extensive research, the complex and multifaceted nature of ACL injury and its consequences are yet to be fully understood. The overall aim of the NACOX study is to evaluate the natural corollaries and recovery after an ACL injury. Methods and analysis The NACOX study is a multicentre prospective prognostic cohort study of patients with acute ACL injury. At seven sites in Sweden, we will include patients aged 15-40 years, within 6 weeks after primary ACL injury. Patients will complete questionnaires at multiple occasions over the 3 years following injury or the 3 years following ACL reconstruction (for participants who have surgical treatment). In addition, a subgroup of 130 patients will be followed with clinical examinations, several imaging modalities and biological samples. Data analyses will he specific to each aim. Ethics and dissemination This study has been approved by the regional Ethical committee in Linkoping, Sweden (Dnr 2016/44-31 and 2017/221-32). We plan to present the results at national and international conferences and in peer-reviewed scientific journals. Participants will receive a short summary of the results following completion of the study.

  • 12.
    Marcusson, Jan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Nord, Magnus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Johansson, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Alwin, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Dannapfel, Petra
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Thomas, Kristin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Poksinska, Bozena
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering.
    Sverker, Annette M.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Olaison, Anna
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Cedersund, Elisabet
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Kelfve, Susanne
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Motel-Klingebiel, Andreas
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Hellstrom, Ingrid
    Norrkoping Univ, Sweden.
    Kullberg, Agneta
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Böttiger, Ylva
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Pharmacology.
    Dong, Huan-Ji
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Wass, Malin
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Lyth, Johan
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Operations management Region Östergötland, Research and Development Unit.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Operations management Region Östergötland, Research and Development Unit.
    Proactive healthcare for frail elderly persons: study protocol for a prospective controlled primary care intervention in Sweden2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, article id e027847Article in journal (Refereed)
    Abstract [en]

    Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.

    Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.

    Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.

  • 13.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Löfgren, Håkan
    Ryhov Hosp, Sweden.
    Dedering, Asa
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Zsigmond, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Hedevik, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Wibault, Johanna
    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.
    Postoperative structured rehabilitation in patients undergoing surgery for cervical radiculopathy: a 2-year follow-up of a randomized controlled trial2019In: Journal of Neurosurgery: Spine, ISSN 1547-5654, E-ISSN 1547-5646, Vol. 31, no 1, p. 60-69Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE Information about postoperative rehabilitation for cervical radiculopathy (CR) is scarce. The aim of this study was to investigate the additional benefits of structured postoperative rehabilitation (SPT), which was performed in all patients, compared with a pragmatic standard postoperative approach (SA), in which rehabilitation was used as needed and patients sought physiotherapy on their own without a referral, in patients with MRI evidence of disc herniation and concomitant clinical signs who underwent surgery for CR. METHODS Patients (n = 202) were randomized to receive SPT or SA. Included key variables in the present study were primary and selected secondary outcomes of a prospective randomized controlled multicenter study. The main outcome was the Neck Disability Index (NDI) score. The NDI score, pain variables, self-efficacy, and health-related quality of life were investigated at baseline and 3, 6, 12, and 24 months postoperatively. RESULTS SPT provided no additional benefits over SA (p = 0.08 to p = 0.99) at the postoperative 2-year follow-up. Both groups improved over time (p amp;lt; 0.0001), with no reported adverse effects. CONCLUSIONS One can conclude that SPT offered no additional benefits over SA; however, patients tolerated postoperative neck exercises without any negative side effects. These findings are important for the development of future active and neck-specific post-operative rehabilitation interventions for patients with CR.

  • 14.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Peterson, Gunnel
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Hermansen, Anna
    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.
    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.
    Dedering, Asa
    Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Lofgren, Hakan
    Ryhov Hosp, Sweden.
    Physiotherapy after anterior cervical spine surgery for cervical disc disease: study protocol of a prospective randomised study to compare internet-based neck-specific exercise with prescribed physical activity2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 2, article id e027387Article in journal (Refereed)
    Abstract [en]

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

  • 15.
    Pohl, Petra
    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.
    The Ronnie Gardiner Method: An Innovative Music-Based Intervention for Neurological Rehabilitation - Theoretical Background and Contemporary Research with Focus on Parkinson`s Disease2018In: Neurophysiology and Rehabilitation, ISSN 2641-8991, Vol. 1, no 1, p. 32-37Article in journal (Refereed)
    Abstract [en]

    The Ronnie Gardiner Method (RGM) is an innovative, practitioner-led, music-based intervention using sensorimotor and cognitive integration. RGM was originally developed by the Swedish musician Ronnie Gardiner. Since 2010, RGM has been successfully implemented within neurorehabilitation in many countries. The purpose of this article is to outline some of the theoretical assumptions underpinning the potential benefits from this intervention, using Parkinson’s disease as an example. RGM is based on principles of neuroplasticity, motor learning, and postural control, and uses energizing, beat-based music to provide multisensory input (visual, audio, kinetic, and tactile) in order to stimulate experience-dependent neuroplastic processes. It aims at stimulating cognitive and motor function (e.g., memory, concentration, executive function, multitasking, coordination, mobility, balance, and motor skills). In addition, it may aid body awareness, self-esteem, and social skills. RGM has been scientifically evaluated as a means of multimodal sensory stimulation after stroke and as a means of improving mobility and cognitive function in Parkinson’s disease. RGM is a complex multi-task intervention with the potential to be beneficial in different settings and in different neurological conditions. It can be performed either while standing up or sitting down and can be practiced with the advantages gained as a group activity or individually, which makes it very flexible. It is currently being used as rehabilitation activity for people with stroke, Parkinson’s disease, multiple sclerosis, dementia, and depression. Furthermore, RGM is used in programs targeting healthy aging, ADHD, autism, and dyslexia, and in ordinary school environments.

  • 16.
    Pohl, Petra
    et al.
    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. Univ Gothenburg, Sweden.
    Carlsson, Gunnel
    Univ Gothenburg, Sweden.
    Kall, Lina Bunketorp
    Sahlgrenska Univ Hosp Molndal, Sweden; Univ Gothenburg, Sweden.
    Nilsson, Michael
    Univ Gothenburg, Sweden; Univ Newcastle, Australia.
    Blomstrand, Christian
    Univ Gothenburg, Sweden.
    A qualitative exploration of post-acute stroke participants experiences of a multimodal intervention incorporating horseback riding2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 9, article id e0203933Article in journal (Refereed)
    Abstract [en]

    Background Multimodal rehabilitation interventions delivered in late phase of stroke recovery involve physical (motor and sensory), social, and cognitively challenging activities. Horseback riding can be incorporated within such interventions, leading to meaningful long-term improvements when applied to individuals with moderate levels of disability. There is a lack of research illuminating stroke survivors experiences and perceptions of horseback riding in the context of multimodal interventions. Aim To explore stroke survivors experiences of participation in a multimodal group-based intervention that included horseback riding. Methods An explorative interview study was conducted with individual face-to-face interviews performed on a single occasion, utilising a semi-structured interview guide. Eighteen participants were purposively selected from a larger trial (mean age 62, 12 men, 6 women) within four weeks after treatment completion. The interview duration was between 17 and 50 minutes. The data was analysed using a qualitative content analysis method. Findings Four broad themes were identified from the analysis. These themes were: transformative experiences; human-horse interaction; togetherness and belonging; and the all-in-one solution. Interacting with the horse and peers had a profound emotional impact on the participants. The participants also reported having learned new skills, increased self-efficacy and self-esteem, and improvements in balance and gait, all of which could be transferred to everyday life. The horse itself played a central role, but other components, such as the other group members, the instructors, and the challenging tasks on the horseback, were also important. Conclusion A multimodal rehabilitation intervention that includes horseback riding may provide stroke survivors in a late phase of recovery with rich pleasurable experiences that may have life-changing and profound impacts on their emotional and physical state.

  • 17.
    Pohl, Petra
    et al.
    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. Univ Gothenburg, Sweden.
    Carlsson, Gunnel
    Univ Gothenburg, Sweden.
    Kall, Lina Bunketorp
    Sahlgrenska Univ Hosp Molndal, Sweden; Univ Gothenburg, Sweden.
    Nilsson, Michael
    Univ Gothenburg, Sweden; Univ Newcastle, Australia.
    Blomstrand, Christian
    Univ Gothenburg, Sweden.
    Experiences from a multimodal rhythm and music-based rehabilitation program in late phase of stroke recovery - A qualitative study2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 9, article id e0204215Article in journal (Refereed)
    Abstract [en]

    Background Rehabilitative stroke interventions based on principles of multimodal stimulation have the potential to profoundly affect neuroplastic processes beyond the sub-acute phase. In order to identify important core mechanisms, there is a need to explore how interventions that combine physical, social, sensory, and cognitively challenging activities are perceived and experienced by the participants. This qualitative study, based on an interpretive interactionist perspective, explored the experiences of stroke survivors who participated in a group-based multimodal rehabilitation program based on rhythm and music. Methods and findings Within four weeks after completion of the multimodal rehabilitation program, face-to-face semi-structured interviews were conducted on a single occasion with 15 purposively selected individuals (mean age 65, 8 men, 7 women). The interview duration was between 13 and 44 minutes. Qualitative content analysis with an inductive approach was used to analyze data. Three categories were identified, each containing several sub-categories: To be intellectually challenged (energy-consuming activity and coordinating multiple input and output), Perceived therapeutic benefits (motor skills, cognitive skills, emotional and psychological responses), and Pros and cons with social integration (fellowship, competing with others, and instructor characteristics). From these categories, an overall theme was derived: The multifaceted layers of multimodal stimulation. Enjoying music, being part of a group with peers, a skilled instructor, and being able to manage the challenging movements, were related to positive experiences. In contrast, negative experiences were associated with not being able to perform the exercises, and with group members who dominated the conversational space. Conclusion This study shows that access to a multimodal rehabilitation program with rhythm and music as operating ingredients may contribute to positive experiences for many individuals in a late phase after stroke in terms of motor, cognitive, as well as emotional enhancements. Important components were the music, the social interaction, the challenging exercises, and the skilled instructor.

  • 18.
    Sverker, Annette
    et al.
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Björk, Mathilda
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Rheumatology. Linköping University, Department of Clinical and Experimental Medicine, Rheumatology. Linköping University, Faculty of Health Sciences.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Rheumatology.
    Thyberg, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Valtersson, Eva
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Rehabilitation in Central County.
    Östlund, Gunnel
    Mälardalen University, Eskilstuna, Sweden.
    AB1154-HPR Men's Strategies of Handling Participation Restrictions Related to Rheumatoid Arthritis (The Swedish Tira Study)2014Conference paper (Other academic)
    Abstract [en]

    Background: In spite of early interventions and advancements in medication disability and restricted work capacity is closely related to rheumatoid arthritis (RA). Around 1/3 of diagnosed patients are men, however few studies describe men's need and experiences of living with RA [1].Objectives: To explore male strategies of handling participating restriction in everyday life.Methods: In this study 25 men with early RA from the TIRA2 cohort [2], age 20 – 63, were interviewed about participation restrictions with Critical Incident Technique [3]. Transcribed interviews were synthesized into dilemmas and linked to ICF participation [4] codes and the strategies in handling these dilemmas were analyzed and categorized using content analysis [5].Results: The men described four types of strategies of handling participating restriction in everyday life. Resilience strategies; to find enjoyments, develop self-trust, and a new body-knowledge. Daily routine strategies; use more time on each task and rest in between activities, adjust medication to activity, adjust movements finding new ways to conduct work tasks and physical training. Avoidance strategies; avoid alcohol, social contacts after work, inform of RA and sometimes medicine. Action strategies; continue activities, attend activities as a spectator instead of being an active participant, go home if needed, say no, ask for help, and talk about RA. Acceptance strategies; accept pain, accept less work pace, accept less endurance and fewer activities.Conclusions: Men described dilemmas in everyday life due to RA, but not all experienced being restricted in life they rather expressed reorganizing their everyday lives.References:Shuttleworth RP (2004). Disabled masculinity; Expanding the masculine repertoire. In Smith BG, Hutchinson B (Eds). Gendering disability, New Brunswick, NJ; Rutgers University Press.Björk M, Thyberg I, Rikner K, Balogh I, Gerdle B. Sick leave before and after diagnosis of rheumatoid arthritis: a report from the Swedish TIRA project. J Rheumatol 2009;36:1170-1179.Flanagan, C (1954). The critical incident technique. Psychological Bulletin, 51: p. 327-358.Cieza A, Geyh S, Chatterji S, Kostanjsek N, Ustun B, Stucki G ICF linking rules: an update based on lessons learned. J Rehabil Med. 2005;37:212-8.Sverker A, Thyberg I, Östlund G, Valtersson E, Thyberg M. (2013). Participation in work in early rheumatoid arthritis: A qualitative interview study interpreted in terms of the ICF. Disability & Rehabilitation May (3); ISSN1464-5165

  • 19.
    Sverker, Annette
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Valtersson, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Björk, Mathilda
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology. Department of Rheumatology, Department of Social and Welfare Studies, Linköping University, Sweden.
    Hjalmarsson, Sara
    Patient Research Partner, Swedish Rheumatism Association, Norrköping, Sweden.
    Östlund, Gunnel
    Mälardalen University, Eskilstuna, Sweden.
    Time to update the ICF by including socioemotional qualities of participation?: The development of a ‘patient ladder of participation’ based on interview data of people with early rheumatoid arthritis (The Swedish TIRA study)2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of was to identify and illustrate in what situations and with what qualities people with early RA experience participation in every day’s life.

    Methods: 59 patients (age 18-63 years) were interviewed; 25 men and 34 women. Content analysis was used to identify meaning units which were sorted based on type of situations described and later on, categories based on quality aspects of participation were developed.

    Results: Participation was described as: 1. being part of a group, where a sense of belonging arose. 2. In doing activities with others for example at work or in leisure. 3. When sharing everyday chores and responsibilities for example in domestic duties. 4. When experiencing influence on actions such as when being asked for opinions on how to conduct a specific task. 5. When having the possibility to give direction of goals in rehabilitation, or elsewhere. 6. When sharing decision making and experiencing a high degree of influence in the situation.

    Conclusions: Participation from an individual’s perspective is about belonging and having influence that mediates a positive feeling of being included and that you matter as a person. The results are important when using participation as a goal in clinical care. It’s important to expand participation beyond the definitions in ICF and guidelines to include the patients’ socio-emotional participation in order to promote health.

  • 20.
    Sverker, Annette
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Östlund, Gunnel
    Division of Social Work, School of Health Care and Social Welfare, Mälardalen University, Sweden.
    Börjesson, Martin
    Ersta Sköndal Bräcke University College, Sweden.
    Hägerström, Margareta
    Karolinska University Hospital, Sweden.
    Gåfvels, Catharina
    Academic Primary Health Care Centre and Karolinska Institutet, Sweden.
    The Importance of Social Work in Healthcare forIndividuals with Rheumatoid Arthritis2017In: Quality in Primary Care, ISSN 1479-1072, E-ISSN 1479-1064, Vol. 25, no 3, p. 138-147Article, review/survey (Refereed)
    Abstract [en]

    People with rheumatoid arthritis (RA), often associatedwith psychosocial problems and reduced quality of life, benefitfrom the guidance of trained medical social workers. Thisstudy explores the effectiveness of psychosocial treatmentin patients with RA using a structured interview to detectpsychosocial problems for 100 patients. These individualswere offered regular sessions with a medical social worker.Three types of mixed-problems were found: mixed problemsrelated to RA, mixed problems related to the life situation, andmixed problems related to a combination of RA and the lifesituation. The RA patients who reported mixed-problems attime of their diagnosis received psychosocial treatment froma medical social worker regardless of the mixed problems theyexperienced. In addition, we found that disease-related mixedproblems seemed more treatable than other problems. Socialwork in somatic healthcare seems most successful in patientswith sickness-related social and psychosocial problems.

  • 21.
    Tagesson (Sonesson), Sofi
    et al.
    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.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Dynamic and static tibial translation in patients with anterior cruciate ligament deficiency initially treated with a structured rehabilitation protocol2017In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 25, no 8, p. 2337-2346Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    To compare dynamic and static tibial translation, in patients with anterior cruciate ligament deficiency, at 2- to 5-year follow-up, with the tibial translation after 4 months of rehabilitation initiated early after the injury. Secondarily, to compare tibial translation in the injured knee and non-injured knee and explore correlations between dynamic and static tibial translation.

    METHODS:

    Twelve patients with ACL rupture were assessed at 3-8 weeks after ACL injury, after 4 months of structured rehabilitation, and 2-5 years after ACL injury. Sagittal tibial translation was measured during the Lachman test (static translation) and during gait (dynamic translation) using a CA-4000 electrogoniometer.

    RESULTS:

    Static tibial translation was increased bilateral 2-5 years after ACL injury, whereas the dynamic tibial translation was unchanged. Tibial translation was greater in the injured knee compared with the non-injured knee (Lachman test 134 N 9.1 ± 1.0 vs. 7.0 ± 1.7 mm, P = 0.001, gait 5.6 ± 2.1 vs. 4.7 ± 1.8 mm, P = 0.011). There were no correlations between dynamic and static tibial translation.

    CONCLUSION:

    Dynamic tibial translation was unchanged in spite of increased static tibial translation in the ACL-deficient knee at 2- to 5-year follow-up compared to directly after rehabilitation. Dynamic tibial translation did not correlate with the static tibial translation. A more normal gait kinematics may be maintained from completion of a rehabilitation programme to mid-term follow-up in patients with ACL deficiency treated with rehabilitation only.

  • 22.
    Tagesson (Sonesson), Sofi
    et al.
    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.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ardern, Clare
    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.
    Österberg, Annika
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    Grävare Silbernagel, Karin
    Department of Physical Therapy, University of Delaware, Newark, DE, USA..
    Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy.2017In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 25, no 5, p. 1375-1384Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To describe individuals' expectations, motivation, and satisfaction before, during, and after rehabilitation for ACL reconstruction and to explore how these factors were associated with return to pre-injury sport activity at 1-year follow-up.

    METHODS: Sixty-five individuals (34 males), median age 22 (15-45) years, scheduled for ACL reconstruction participated. Participants completed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and questions about expectations, satisfaction, and motivation pre-operatively and at 16 and 52 weeks after surgery.

    RESULTS: Prior to surgery, 86 % of participants stated that their goal was to return to their pre-injury sport activity. Those who had returned to their pre-injury sport activity at 52 weeks were more motivated during rehabilitation to return to their pre-injury activity level, more satisfied with their activity level and knee function at 52 weeks, and scored significantly higher on the IKDC-SKF [median 92.0 (range 66.7-100.0)] at 52 weeks, compared to those who had not returned [median 77.6 (range 50.6-97.7)].

    CONCLUSION: Prior to ACL reconstruction, most participants expected to return to their pre-injury activity level. Higher motivation during rehabilitation was associated with returning to the pre-injury sport activity. The participants who had returned to their pre-injury sport activity were more satisfied with their activity level and knee function 1 year after the ACL reconstruction. Facilitating motivation might be important to support individuals in achieving their participation goals after ACL reconstruction.

    LEVEL OF EVIDENCE: Prospective cohort study, Level II.

  • 23.
    Thyberg, Ingrid
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Östlund, Gunnel
    Mälardalens högskola, Hälsa och välfärd, Sverige.
    Björk, Mathilda
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Region Östergötland, Heart and Medicine Center, Department of Rheumatology. Linköping University, Faculty of Health Sciences.
    Thyberg, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Valtersson, Eva
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Rehabilitation in Central County.
    Stenström, Birgitta
    Reumatolog förbundet, Sweden.
    Sverker, Annette
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health. Linköping University, Faculty of Health Sciences.
    Känslor relaterade till delaktighets begränsningar vid reumatoid artrit.: En kvalitativ intervjustudie.2015Conference paper (Refereed)
  • 24.
    Tigerstrand Grevnerts, Hanna
    et al.
    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.
    Fältström, Anne
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Ryhov Cty Hosp, Sweden.
    Sonesson, 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 Orthopaedics in Linköping.
    Gauffin, Håkan
    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.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. 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.
    Activity demands and instability are the most important factors for recommending to treat ACL injuries with reconstruction2018In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, no 8, p. 2401-2409Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to (1) study and compare the factors that Swedish orthopaedic surgeons and physical therapists consider important for recommending ACL reconstruction and, (2) to assess how orthopaedic surgeons and physical therapists consider their own and each others, as well as patients, roles are in the treatment decision. A web-based survey assessing the relevance of 21 predetermined factors, in the choice to recommend ACL reconstruction, was sent to orthopaedic surgeons and physical therapists. Respondents were also asked to rate the importance of the assessment made by themselves, the other clinician (physical therapists rated the importance of surgeons, surgeons rated the importance of physical therapists), and the patients preferences. Orthopaedic surgeons agreed of eight, and physical therapists of seven factors as important in the choice to recommend ACL reconstruction. The factors both groups reported as important were; "patients wishes to return to contact/pivoting sports", "instability in physical activity", "instability in activities of daily living despite adequate rehabilitation", "physically demanding occupation", and "young age". Both professions rated their own and each others assessments as well as patients wishes as important for the decision to recommend ACL reconstruction. Orthopaedic surgeons and physical therapists agree about factors that are important for their decision to recommend ACL reconstruction, showing that both professions share a common ground in perceptions of factors that are important in recommending ACL reconstruction. Diagnostic study: Level III.

  • 25.
    Tigerstrand Grevnerts, Hanna
    et al.
    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.
    Gravare Silbernagel, K.
    University of Delaware, DE USA.
    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.
    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.
    Österberg, Annika
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Uppsala University, Sweden.
    Gauffin, Håkan
    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.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Translation and testing of measurement properties of the Swedish version of the IKDC subjective knee form2017In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 27, no 5, p. 554-562Article in journal (Refereed)
    Abstract [en]

    To translate to Swedish language and cross-culturally adapt the IKDC-SKF and to test the measurement properties of the Swedish version of IKDC-SKF in ACL-injured patients undergoing reconstruction surgery.The translation and cross-cultural adaption was performed according to guidelines. Seventy-six patients with an ACL injury filled out the IKDC-SKF and other questionnaires before ACL reconstruction and at 4, 6, and 12months after surgery. A total of 203 patients from the Swedish ACL Registry participated at 8months post-operative. Measurement properties were tested according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.The Swedish IKDC-SKF had high internal consistency (Cronbachs alpha=0.90) and test-retest reliability (ICC2,1=0.92, CI 95%: 0.81-0.97, Pamp;lt;.001). A single factor solution accounted for 46.1% of the variance in IKDC-SKF scores. Criterion validity was moderate to high. All ten predefined hypotheses for hypothesis testing were confirmed. The six hypotheses for responsiveness testing were confirmed. The effect size was 1.8, the standardized response mean was 1.9, the and minimal clinically important difference was 13.9 points.The Swedish version of the IKDC-SKF had good measurement properties and can be recommended for use in a population of ACL-deficient patients undergoing ACL reconstruction.

  • 26.
    Wibault, Johanna
    et al.
    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.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Dedring, Åsa
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden / Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden .
    Löfgren, Håkan
    Neuro-Orthopedic Center, Ryhov Hospital, Jönköping, Sweden.
    Zsigmond, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Structured postoperative physiotherapy in patients with cervical radiculopathy: 6-month outcomes of a randomized clinical trial2018In: Journal of Neurosurgery: Spine, ISSN 1547-5654, Vol. 28, no 1, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the additional benefit of structured postoperative physiotherapy combining neck-specific exercises with a behavioral approach to standard postoperative approach in patients with cervical radiculopathy (CR) at 6 months after surgery.

    Design: A prospective multi-center randomized clinical trial.

    Subjects: Patients with CR (n=202, mean age 50.0, SD 8.4) who were scheduled for surgery.

    Methods: Patients were randomized pre-operatively to structured postoperative physiotherapy (n=101) or standard approach (n=101) which in accordance with Swedish usual care may have included pragmatic physiotherapy after surgery when needed. Outcome measures at baseline and at 3 and 6 months follow-up included the Neck Disability Index (NDI), pain intensity in the neck and arm measured with a visual analogue scale (VAS) and global outcome of treatment. Between-group differences were investigated using complete case and per-protocol approaches.

    Results: No between-group difference was found in NDI, VAS, or global outcome at 6 months after surgery (p> 0.18). The NDI and VAS neck and arm pain were improved in both groups from before surgery to 6 months after surgery (p< 0.001). Sixty-one percent of the patients who received SA reported additional use of postoperative physiotherapy. Global outcome improved during the postoperative period in patients who received structured postoperative physiotherapy only (p< 0.01).

    Conclusions: No additional benefit of structured postoperative physiotherapy compared to standard postoperative approach was found at 6 months of follow-up based on patientreported measures of pain, neck disability and global outcome. However, many patients with CR perceived a need for additional treatments after surgery; and the results may suggest a benefit from combining surgery with structured postoperative physiotherapy in patients with CR. Moreover, the results confirm that neck-specific exercises are tolerated by patients with CR after surgery.

  • 27.
    Östlund, Gunnel
    et al.
    Mälardalens högskola, Hälsa och välfärd, Sweden.
    Björk, Mathilda
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Valtersson, Eva
    Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Sverker, Annette
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Adjustment, avoidance, interaction, and acceptance strategies where used by men with participation restrictions due to early RA2015Conference paper (Refereed)
    Abstract [en]

    Background: Approximately 1/3 of patients diagnosed with the chronic disease Rheumatoid Arthritis (RA) are men, however few studies describe experiences and strategies to handle daily activities [2]. Daily life with a chronic disease means learning to live under new circumstances. This also foresee a continuous adaptation to new ways of living. The process of coping in which the individual change the perceived cause of stress as in problem-focused coping or when managing the emotions of stress, as in emotion-focused coping where first mentioned by Lazarus and Folkman [1]. Coping is described as an individual style to handle stressful events that might be changed over time.

    Objectives: The aim was to explore men's strategies for dealing with participation restrictions in everyday life due to early RA.

    Methods: This study is associated with the prospective multi-centre early arthritis project under the Swedish acronym “TIRA-2” [3]. Participants were 25 males of which 22 were work active, mean age 53 years, contemporary treated with mean disease duration of 3 years. Individual interviews were done using the Critical Incident Technique (CIT) [4]. The verbatim transcribed text were analyzed and categorized using content analysis. The study has been approved by the Ethics Committee.

    Results: The men experienced that RA partly required a changed life style and most of them used a combination of strategies to deal with the participation restrictions in relation to RA. In the adjustment strategy new behaviors and tools were used to solve participation restrictions. The avoidance strategy included deliberate avoidance of possible participation restrictions, such as staying at home in the evenings and avoiding socializing with friends. The interaction strategy included to verbally express needs and give demands in relation to others both at work and in the family and ask for help when needed. The acceptance strategy was identified by the wordings used when talking about the experienced participation restrictions as “I accept that everything takes longer time”.

    Conclusions: The interviewed men with early RA were contemporary treated and active in the work force, still, all of them had to deal with some participation restrictions. Moreover, this study claims that most men used a combination of strategies to deal with the experienced participation restriction.

  • 28.
    Östlund, Gunnel
    et al.
    Division of Social Work, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden.
    Björk, Mathilda
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Valtersson, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Sverker, Annette
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Womens situation-specific strategies in managing participation restrictions due to early rheumatoid arthritis: A gender comparison2018In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 16, no 2, p. 251-259Article in journal (Refereed)
    Abstract [en]

    Introduction

    The present study explored how women describe their use of situation‐specific strategies when managing rheumatoid arthritis (RA). The aim was also to compare women's strategies with those of men, and see the extent to which they used the same strategies.

    Methods

    The data were collected using semi‐structured interviews based on the critical incident technique. The sample consisted of women with early rheumatic arthritis (n = 34), and the results were compared with data reported in a previous study on men (n = 25) from the same cohort. The patient‐described participation restrictions due to RA were firstly linked to the domains of the International Classification of Functioning, Disability and Health (ICF). The different strategies used were then categorized. The study was approved by the Research Ethics Committee of the Faculty of Health Sciences, Linköping University, Sweden.

    Results

    The study found that women used four situation‐specific strategies: adjustment, avoidance, interaction and acceptance. The same strategies had been found previously in interviews with men with RA. Women and men used these strategies to a similar extent in the ICF domains of mobility; major life arenas; domestic life; interpersonal interactions and relationships; and community, social and civic life. However, some differences were found, relating to the reported activities in self‐care and domestic life, in which women reported using strategies to a greater extent than men.

    Conclusions

    Women and men used four types of situation‐specific strategies in managing RA; adjustment, avoidance, interaction and acceptance. These situation‐specific strategies provide useful knowledge, in terms of multidisciplinary rehabilitation and for patients' significant others.

  • 29.
    Östlund, Gunnel
    et al.
    Mälardalens högskola, Hälsa och välfärd, Sweden.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Björk, Mathilda
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Valtersson, Eva
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Sverker, Annette M.
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health. Linköpings universitet, Sweden.
    Hur hanterar män med reumatoid artrit delaktighetsinskränkningar i vardagslivet?2017In: Best Practice, ISSN 1329-1874, Vol. 31, no 9, p. 10-13Article in journal (Other academic)
  • 30.
    Östlund, Gunnel
    et al.
    Division of Social Work, School of Health, Care and Social Welfare, Mälardalen University, Sverige.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Rheumatology. Linköping University, Faculty of Medicine and Health Sciences.
    Valtersson, Eva
    Linköping University, Department of Medical and Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Activity and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Björk, Mathilda
    Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Rehabilitation Center. Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy.
    Sverker, Annette M.
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    The Use of Avoidance, Adjustment, Interaction and Acceptance Strategies to Handle Participation Restrictions Among Swedish Men with Early Rheumatoid Arthritis.2016In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 14, no 4, p. 206-218Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Living with a chronic disease means learning to live under new circumstances and involves a continuous adaptation to new ways of living. There is increasing knowledge about how people cope with stressful life events and adapt to new life situations. Approximately a third of patients diagnosed with rheumatoid arthritis (RA) are men; however, few studies have described the needs and experiences of men living with RA. The aim of the present study was to explore men's strategies for handling challenges related to participation in everyday life.

    METHODS: The present study was associated with the prospective Swedish multicentre early arthritis project (given the Swedish acronym TIRA), which, in 2006-2009, included patients with early RA, contemporarily treated, with a mean disease duration of three years. From this cohort, 25 men, aged 20-63 years, were recruited consecutively. Data were collected in individual interviews, using the critical incident technique. The strategies for dealing with the challenges of RA in everyday life were analysed and categorized using content analysis.

    RESULTS: Men with RA described four types of strategy for dealing with participation restrictions in everyday life: (i) Adjustment strategies - adjust behaviour, movements, medication, equipment and clothing to find new ways to conduct tasks or activities; (ii) Avoidance strategies - avoid activities, movements, social contacts and sometimes medication; (iii) Interaction strategies - say no, ask for help and work together to handle participation restrictions; and (iv) Acceptance strategies - learn to accept RA, with the pain, the slower work pace and the extended time needed.

    CONCLUSIONS: According to men's lived experiences, a combination of strategies was used to deal with RA, depending on the situation and the experienced restriction. The results provided an understanding of how men with RA manage their disease, to reduce physical, social and emotional challenges. This knowledge may be used further to develop multi-professional interventions and patient education tailored to men with RA.

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