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  • 1.
    Augutis, Marika
    et al.
    Landstinget Västernorrland, Sweden.
    Ertzgaard, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Levi, Richard
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Sverige bör centralisera den pediatriska ryggmärgsskadevården2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, no 35-36Article in journal (Other academic)
    Abstract [en]

    [No abstract available]

  • 2.
    Borg, Jorgen
    et al.
    Karolinska Institute.
    Ward, Anthony B
    Haywood Hospital.
    Wissel, Joerg
    Kliniken Beelitz GmbH.
    Kulkarni, Jai
    Manchester Royal Infirmary.
    Sakel, Mohamed
    E Kent University Fdn Hospital Trust.
    Ertzgaard, Per
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Rehabilitation Medicine UHL.
    Akerlund, Per
    Falu Lasarett.
    Reuter, Iris
    University Giessen.
    Herrmann, Christoph
    Asklepios Kliniken Schildautal.
    Satkunam, Lalith
    Glenrose Rehabil Hospital.
    Wein, Theodore
    Montreal General Hospital.
    Girod, Isabelle
    Allergan Ltd.
    Wright, Nicola
    Allergan Ltd.
    RATIONALE AND DESIGN OF A MULTICENTRE, DOUBLE-BLIND, PROSPECTIVE, RANDOMIZED, EUROPEAN AND CANADIAN STUDY: EVALUATING PATIENT OUTCOMES AND COSTS OF MANAGING ADULTS WITH POST-STROKE FOCAL SPASTICITY2011In: JOURNAL OF REHABILITATION MEDICINE, ISSN 1650-1977, Vol. 43, no 1, p. 15-22Article in journal (Refereed)
    Abstract [en]

    Objective: This report describes the design of a study aiming to provide evidence for the extended use of botulinum toxin A (BOTOX(R), Allergan Inc.) in focal post-stroke upper and lower limb spasticity and to evaluate the impact of incorporating botulinum toxin A treatment into the rehabilitation of patients with spasticity. Design: International, prospective, randomized, double-blind, placebo-controlled study with an open-label extension. Methods: Approximately 300 adults with a stroke occurring 23 months before screening, presenting with symptoms and signs of an upper motor neuron syndrome and focal spasticity-related functional impairment, were randomized to botulinum toxin A+standard care or placebo+standard care. Study medication was administered at baseline and again at Week 12 if required, with follow-up to 52 weeks. The primary endpoint was the number of patients who achieved their investigator-rated principal active functional goal (as measured by Goal Attainment Scaling), at 10 weeks after the second injection (Weeks 22-34) or at the 24-week visit if no second injection was administered. Secondary endpoints included changes from baseline in level of goal achievement, health-related quality of life and resource utilization. Conclusion: The BOTOX(R) Economic Spasticity Trial (BEST) will provide information regarding clinical and cost-effectiveness of botulinum toxin+standard care vs standard care alone in patients with upper and/or lower limb post-stroke spasticity typically seen in clinical practice.

  • 3.
    Budh Norrbrink, Cecilia
    et al.
    Spinalis SCI unit, Karolinska Hospital and Faculty of Public Health Sciences, Karolinska Institutet, Stockholm.
    Lund, Irene
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm.
    Ertzgaard, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Hulting, Claes
    Spinalis SCI unit, Karolinska Hospital and Faculty of Public Health Sciences, Karolinska Institutet, Stockholm.
    Holtz, Anders
    Department of Neurosurgery, University Hospital, Uppsala.
    Levi, Richard
    Frösunda Center, Solna and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm.
    Werhagen, Lars
    Spinalis SCI unit, Karolinska Hospital, Stockholm.
    Lundeberg, Thomas
    Spinalis SCI Unit, Karolinska Hospital, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Pain in a Swedish spinal cord injury population2003In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 17, no 6, p. 685-690Article in journal (Refereed)
    Abstract [en]

    Objective: To describe pain and associated variables in a prevalence group of persons with a sustained spinal cord injury (SCI) in the Swedish capital and its surroundings. Setting: Spinalis SCI Unit (outpatient clinic), Stockholm, Sweden. Design: Assessment over a 12-month period in a yearly health control. Subjects: Four hundred and fifty-six SCI patients. Results: Two hundred and ninety-one out of 456 SCI patients (63.7%) suffered from pain, and in 45.7% of these it was classified as being neurogenic. Aching pain was the most used descriptor (38.5%). The onset of pain was commonly within three months (73.5%). In 70.4% of patients pain occurred below the level of the lesion. Most patients identified pain as coming from one (55.0%) or two (28.2%) body regions. Rating of the general pain intensity on a visual analogue scale (VAS) was 46 out of 100 and rating of the worst pain intensity was 78 out of 100. Ninety-four out of 276 patients (32.3%) considered that their quality of life was significantly affected by pain. Conclusion: Pain was most common in patients with incomplete lesions (ASIA impairment grade D) and there was a correlation between pain and higher mean age at injury and between pain and female gender.

  • 4.
    Ertzgaard, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Studies on Spasticity from an Interventional Perspective2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis focuses on interventional aspects of spasticity, but has a very holistic approach, grounded in the specialty of Rehabilitation medicine. This means capturing the effects of spasticity, on such a complex biological system as the human being, living in a psychosocial context affecting the situation. When evaluating spasticity there are a number of levels of evidence. The first of course, understanding what we mean with spasticity, where there unfortunately is no consensus. The second level is to study if our treatments affect spasticity in a positive direction. The third is to grasp if a decrease in spasticity improve or normalize patient’s movement patterns. The fourth level investigates if improvement in movement patterns improve patient’s ability to perform activities; and the fifth level, comprising whether this intervention improves life satisfaction. Finally, on a societal level, we wish to investigate whether the improvement in life satisfaction or health related quality of life would motivate society to fund the intervention.

    Paper I on Goal Attainment Scaling pointed out necessary aspects to consider when using this instrument. This relates, among other things, to the need of learning (“the art of”) goal setting and deciding the purpose of the measurements. Research and clinical use puts different demands on the instrument, for the latter time-efficiency and simplicity to use being most important. For research, it is important to be able to register deterioration, and this can be achieved using the 6-step version.

    In paper II, concerning validation of the portable motion system, we showed this system to be valid for short-term measurements and that the use of Exposure Variation Analysis (EVA) seems to be a valuable tool for graphically elucidating different movements. The equipment needs further development in handling long-term measurements (which is effectuated), and norms for normal movements in different activities has to be produced. The discriminative value of EVA needs confirmation in coming studies. For the future, there is the intriguing possibility of long-term measurements in patients’ every-day life, thereby getting objective measures on how our patients use their abilities, thus capturing the difference between what you can do and what you actually do.

    The results from paper III demonstrated a large inequality in Sweden regarding the accessibility of BoNT-A treatment for spasticity. We could also show that treatment with BoNT-A is sound from a health-economic perspective, accounting for the uncertainty of data via the sensitivity analysis. For the future, we need to explore if this inequality also exists for other modes of spasticity treatments, e.g. multidisciplinary spasticity treatment and ITB pumps, and in other countries.

    In paper IV evaluating multifocal TES, the results could not confirm efficacy with the treatment according to the protocol of the manufacturer. The results have to be interpreted with care, as low compliance and frequent adverse events made deduction not captured in the RCT study. Further studies are needed in a number of areas, e.g. what is the optimal stimulation frequency, what patients can gain from the treatment and how should adjunct treatment be organized.

    In this thesis, I have had the privilege to explore different methods of evaluating spasticity interventions from a multimodal perspective as a starting point in an effort to understand more of this intriguing phenomenon. Some of the research questions above are already in the “pipeline” for coming studies; others are to be planned by our research group and others.

    List of papers
    1. PRACTICAL CONSIDERATIONS FOR GOAL ATTAINMENT SCALING DURING REHABILITATION FOLLOWING ACQUIRED BRAIN INJURY
    Open this publication in new window or tab >>PRACTICAL CONSIDERATIONS FOR GOAL ATTAINMENT SCALING DURING REHABILITATION FOLLOWING ACQUIRED BRAIN INJURY
    2011 (English)In: JOURNAL OF REHABILITATION MEDICINE, ISSN 1650-1977, Vol. 43, no 1, p. 8-14Article in journal (Refereed) Published
    Abstract [en]

    Objective: Goal attainment scaling represents a unique approach to identifying and quantifying individualized, meaningful treatment outcomes, and its use in the rehabilitation medicine setting is increasing. The aim of this paper is to discuss the available literature for goal attainment scaling in patients with acquired brain injury, in terms of its advantages, disadvantages and practical application, including examples of goal setting and scaling.

    Place, publisher, year, edition, pages
    Foundation for Rehabilitation Information, 2011
    Keywords
    acquired brain injury, goal attainment scaling, rehabilitation
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-66870 (URN)10.2340/16501977-0664 (DOI)000288105200002 ()
    Available from: 2011-03-22 Created: 2011-03-21 Last updated: 2018-11-22
    2. A new way of assessing arm function in activity using kinematic Exposure Variation Analysis and portable inertial sensors - A validity study
    Open this publication in new window or tab >>A new way of assessing arm function in activity using kinematic Exposure Variation Analysis and portable inertial sensors - A validity study
    2016 (English)In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 21, p. 241-249Article in journal (Refereed) Published
    Abstract [en]

    Portable motion systems based on inertial motion sensors are promising methods, with the advantage compared to optoelectronic cameras of not being confined to a laboratory setting. A challenge is to develop relevant outcome measures for clinical use. The aim of this study was to characterize elbow and shoulder motion during functional tasks, using portable motion sensors and a modified Exposure Variation Analysis (EVA) and evaluate system accuracy with optoelectronic cameras. Ten healthy volunteers and one participant with sequel after stroke performed standardised functional arm tasks. Motion was registered simultaneously with a custom developed motion sensor system, including gyroscopes and accelerometers, and an optoelectronic camera system. The EVA was applied on elbow and shoulder joints, and angular and angular velocity EVA plots was calculated. The EVA showed characteristic patterns for each arm task in the healthy controls and a distinct difference between the affected and unaffected arm in the participant with sequel after stroke. The accuracy of the portable system was high with a systematic error ranging between -1.2 degrees and 2.0 degrees. The error was direction specific due to a drift component along the gravity vector. Portable motion sensor systems have high potential as clinical tools for evaluation of arm function. EVA effectively illustrates joint angle and joint angle velocity patterns that may capture deficiencies in arm function and movement quality. Next step will be to manage system drift by including magnetometers, to further develop clinically relevant outcome variables and apply this for relevant patient groups. (C) 2015 Elsevier Ltd. All rights reserved.

    Place, publisher, year, edition, pages
    CHURCHILL LIVINGSTONE, 2016
    Keywords
    Upper extremity motion analysis; Portable motion sensors; Exposure Variation Analysis; Validity
    National Category
    Basic Medicine
    Identifiers
    urn:nbn:se:liu:diva-127585 (URN)10.1016/j.math.2015.09.004 (DOI)000373615100033 ()26456185 (PubMedID)
    Available from: 2016-05-03 Created: 2016-05-03 Last updated: 2018-11-22
    3. Regional disparities in botulinum toxin A (BoNT-A) therapy for spasticity in Sweden: budgetary consequences of closing the estimated treatment gap
    Open this publication in new window or tab >>Regional disparities in botulinum toxin A (BoNT-A) therapy for spasticity in Sweden: budgetary consequences of closing the estimated treatment gap
    2017 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 135, no 3, p. 366-372Article in journal (Refereed) Published
    Abstract [en]

    Objectives: As no national treatment guidelines for spasticity have been issued in Sweden, different regional treatment practices may potentially occur. This study examines botulinum toxin A (BoNT-A) treatment for spasticity on a regional level in Sweden and presents budgetary consequences of closing the estimated treatment gap. Materials and Methods: Prevalence of spasticity in Sweden was estimated from published data. Regional sales data for BoNT-A were acquired from IMS Health. A set proportion of hospital BoNT-A use was assumed to represent treatment of spasticity. Total intervention cost of BoNT-A treatment was gathered from healthcare regional tariffs, while costs associated with spasticity were derived from publications on multiple sclerosis and stroke. Results: Results show that the regional variation in treatment of spasticity with BoNT-A is large, with approximately every fourth patient being treated in Southern healthcare region compared to every tenth in the Stockholm-Gotland or Western healthcare regions. The incremental cost of filling the reported treatment gap was also assessed and was estimated at around 9.4 million EUR. However, for the incremental cost to be offset by savings in spasticity-related costs, only a small proportion of treatment responders (defined as patients transitioning to a lower severity grade of spasticity) was required (12%). Conclusions: The study revealed apparent regional disparities of BoNT-A treatment for spasticity in Sweden. The results further suggest that the incremental cost of eliminating the treatment gap has a high probability of being offset by savings in direct costs, even at a low proportion of the patients reaching clinical improvement.

    Place, publisher, year, edition, pages
    WILEY, 2017
    Keywords
    botulinum toxins; costs and cost analysis; muscle spasticity; regional variation
    National Category
    Neurology
    Identifiers
    urn:nbn:se:liu:diva-136626 (URN)10.1111/ane.12610 (DOI)000397285600014 ()27220381 (PubMedID)
    Note

    Funding Agencies|University of Linkoping

    Available from: 2017-04-21 Created: 2017-04-21 Last updated: 2018-11-22
    4. Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomized placebo-controlled trial
    Open this publication in new window or tab >>Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomized placebo-controlled trial
    Show others...
    2018 (English)In: European Journal of Physical and Rehabilitation Medicine, ISSN 1973-9087, E-ISSN 1973-9095, Vol. 54, no 4, p. 507-517Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Spasticity is a common consequence of injury to the central nervous system negatively affecting patients everyday activities. Treatment mainly consists of training and different drugs, often with side effects. There is a need for treatment options that can be performed by the patient in their home environment. AIM: The objective of this study was to assess the effectiveness of an assistive technology (AT), Mono, a garment with integrated electrodes for multifocal transcutaneous electrical stimulation intended for self-treatment of spasticity, in study participants with spasticity due to stroke or CP. DESIGN: The study was a randomized, controlled, double-blind study with a cross-over design. SETTING: Participants were recruited from two rehabilitation clinics. Treatments were performed in participants homes and all follow-ups were performed in the two rehabilitation clinics. POPULATION: Thirty-one participants were included in the study and 27 completed the study. Four participants discontinued the study. Two declined participation before baseline and two withdrew due to problems handling the garment. METHODS: Participants used the AT with and without electrical stimulation (active/non-active period) for six weeks each. followed by six weeks without treatment. Goal Attainment Scaling (GAS), change in mobility, arm-hand ability, spasticity and pain were measured at baseline and after 6, 12 and 18 weeks. RESULTS: Fifteen of the 27 participants fulfilled the treatment protocol in terms of recommended use. Deviations were frequent. No statistically significant differences in outcome were found between the active and the non-active treatment periods. During the active period, an improvement was seen in the 10-meter comfortable gait test, time and steps. An improvement was seen in both the active and non-active periods for the GAS. CONCLUSIONS: Compliance was low, partly due to deviations related to the garment, complicating the interpretation of the results. Further research should focus on identifying the target population and concomitant rehabilitation strategies. CLINICAL REHABILITATION IMPACT: The evaluated concept of multifocal transcutaneous electrical stimulation (TES) represents an interesting addition to the existing repertoire of treatments to alleviate muscle spasticity. The evaluated concept allows TES to be self-administered by the patient in the home environment. A more elaborate design of training activities directly related to patients own rehabilitation goals is recommended and may increase the value of the evaluated concept.

    Place, publisher, year, edition, pages
    EDIZIONI MINERVA MEDICA, 2018
    Keywords
    Muscle spasticity; Randomized controlled trial; Cerebral palsy; Stroke; Transcutaneous electric nerve stimulation
    National Category
    Rheumatology and Autoimmunity
    Identifiers
    urn:nbn:se:liu:diva-151798 (URN)10.23736/S1973-9087.17.04791-8 (DOI)000445298800001 ()29072043 (PubMedID)
    Note

    Funding Agencies|Region Ostergotland; Promobilia Foundation; Inerventions AB (Vinnova)

    Available from: 2018-10-04 Created: 2018-10-04 Last updated: 2018-11-22
  • 5.
    Ertzgaard, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Alwin, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Sorbo, Ann
    Sahlgrens Acad, Sweden; Sodra Alvsborg Hosp, Sweden.
    Lindgren, Marie
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Sandsjo, Leif
    Univ Boras, Sweden.
    Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomized placebo-controlled trial2018In: European Journal of Physical and Rehabilitation Medicine, ISSN 1973-9087, E-ISSN 1973-9095, Vol. 54, no 4, p. 507-517Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Spasticity is a common consequence of injury to the central nervous system negatively affecting patients everyday activities. Treatment mainly consists of training and different drugs, often with side effects. There is a need for treatment options that can be performed by the patient in their home environment. AIM: The objective of this study was to assess the effectiveness of an assistive technology (AT), Mono, a garment with integrated electrodes for multifocal transcutaneous electrical stimulation intended for self-treatment of spasticity, in study participants with spasticity due to stroke or CP. DESIGN: The study was a randomized, controlled, double-blind study with a cross-over design. SETTING: Participants were recruited from two rehabilitation clinics. Treatments were performed in participants homes and all follow-ups were performed in the two rehabilitation clinics. POPULATION: Thirty-one participants were included in the study and 27 completed the study. Four participants discontinued the study. Two declined participation before baseline and two withdrew due to problems handling the garment. METHODS: Participants used the AT with and without electrical stimulation (active/non-active period) for six weeks each. followed by six weeks without treatment. Goal Attainment Scaling (GAS), change in mobility, arm-hand ability, spasticity and pain were measured at baseline and after 6, 12 and 18 weeks. RESULTS: Fifteen of the 27 participants fulfilled the treatment protocol in terms of recommended use. Deviations were frequent. No statistically significant differences in outcome were found between the active and the non-active treatment periods. During the active period, an improvement was seen in the 10-meter comfortable gait test, time and steps. An improvement was seen in both the active and non-active periods for the GAS. CONCLUSIONS: Compliance was low, partly due to deviations related to the garment, complicating the interpretation of the results. Further research should focus on identifying the target population and concomitant rehabilitation strategies. CLINICAL REHABILITATION IMPACT: The evaluated concept of multifocal transcutaneous electrical stimulation (TES) represents an interesting addition to the existing repertoire of treatments to alleviate muscle spasticity. The evaluated concept allows TES to be self-administered by the patient in the home environment. A more elaborate design of training activities directly related to patients own rehabilitation goals is recommended and may increase the value of the evaluated concept.

  • 6.
    Ertzgaard, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Anhammer, M.
    Ipsen, Sweden.
    Forsmark, A.
    Nordic Health Econ AB, Sweden.
    Regional disparities in botulinum toxin A (BoNT-A) therapy for spasticity in Sweden: budgetary consequences of closing the estimated treatment gap2017In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 135, no 3, p. 366-372Article in journal (Refereed)
    Abstract [en]

    Objectives: As no national treatment guidelines for spasticity have been issued in Sweden, different regional treatment practices may potentially occur. This study examines botulinum toxin A (BoNT-A) treatment for spasticity on a regional level in Sweden and presents budgetary consequences of closing the estimated treatment gap. Materials and Methods: Prevalence of spasticity in Sweden was estimated from published data. Regional sales data for BoNT-A were acquired from IMS Health. A set proportion of hospital BoNT-A use was assumed to represent treatment of spasticity. Total intervention cost of BoNT-A treatment was gathered from healthcare regional tariffs, while costs associated with spasticity were derived from publications on multiple sclerosis and stroke. Results: Results show that the regional variation in treatment of spasticity with BoNT-A is large, with approximately every fourth patient being treated in Southern healthcare region compared to every tenth in the Stockholm-Gotland or Western healthcare regions. The incremental cost of filling the reported treatment gap was also assessed and was estimated at around 9.4 million EUR. However, for the incremental cost to be offset by savings in spasticity-related costs, only a small proportion of treatment responders (defined as patients transitioning to a lower severity grade of spasticity) was required (12%). Conclusions: The study revealed apparent regional disparities of BoNT-A treatment for spasticity in Sweden. The results further suggest that the incremental cost of eliminating the treatment gap has a high probability of being offset by savings in direct costs, even at a low proportion of the patients reaching clinical improvement.

  • 7.
    Ertzgaard, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Campo, Claudia
    Medtron EMEA Regional Clin Centre, Italy.
    Calabrese, Alessandra
    Medtron Int Trading Sarl, Switzerland.
    EFFICACY AND SAFETY OF ORAL BACLOFEN IN THE MANAGEMENT OF SPASTICITY: A RATIONALE FOR INTRATHECAL BACLOFEN2017In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, no 3, p. 193-203Article, review/survey (Refereed)
    Abstract [en]

    Oral baclofen has long been a mainstay in the management of spasticity. This review looks at the clinical evidence for the efficacy and safety of oral baclofen in patients with spasticity of any origin or severity, to determine whether there is a rationale for the use of intrathecal baclofen. Results suggest that oral baclofen may be effective in many patients with spasticity, regardless of the underlying disease or severity, and that it is at least comparable with other antispasmodic agents. However, adverse effects, such as muscle weakness, nausea, somnolence and paraesthesia, are common with oral baclofen, affecting between 25% and 75% of patients, and limiting its usefulness. Intrathecal baclofen may be an effective alternative as the drug is delivered directly into the cerebrospinal fluid, thus bypassing the blood-brain barrier and thereby optimizing the efficacy of baclofen while minimizing drug-related side-effects. Intrathecal baclofen is a viable option in patients who experience intolerable side-effects or who fail to respond to the maximum recommended dose of oral baclofen.

  • 8.
    Ertzgaard, Per
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Levi, Richard
    Karolinska institutet Stockholm.
    Stjernberg, Leif
    Akademiska sjukhuset Uppsala.
    Gladh, Gunilla
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Mattsson, Sven
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Ryggmärgsskador och ryggmärgsbråck2006In: Rehabiliteringsmedicin: Teori och praktik / [ed] Borg, Jörgen, Lund: Studenlitteratur , 2006, 1, p. 276-287Chapter in book (Other academic)
    Abstract [sv]

      Kapitel om rehabiliteringsmedicinens utveckling och nuvarande plats i sjukvården samt begrepp och metodik inleder boken. I två delar ges därefter rehabiliteringsmedicinska aspekter på de dominerande sjukdomsgrupperna - komplexa smärttillstånd respektive skador och sjukdomar i nervsystemet. Som avslutning beskrivs bland annat  stressrelaterade tillstånd. Läroboken är avsedd för grundutbildning av läkare, arbetsterapeuter och sjukgymnaster, logopeder samt för läkare under AT-tjänstgöring. Den är också lämplig som introduktion i specialistutbildningen i rehabiliteringsmedicin, geriatrik, neurologi och smärtlindring. Vidareutbildningar av olika vårdyrkesgrupper kan ha nytta av boken och den kan också användas som referenslitteratur av yrkesverksamma med intresse för rehabiliteringsmedicin.

  • 9.
    Ertzgaard, Per
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Ohberg, Fredrik
    Umeå University, Sweden.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Grip, Helena
    Umeå University, Sweden.
    A new way of assessing arm function in activity using kinematic Exposure Variation Analysis and portable inertial sensors - A validity study2016In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 21, p. 241-249Article in journal (Refereed)
    Abstract [en]

    Portable motion systems based on inertial motion sensors are promising methods, with the advantage compared to optoelectronic cameras of not being confined to a laboratory setting. A challenge is to develop relevant outcome measures for clinical use. The aim of this study was to characterize elbow and shoulder motion during functional tasks, using portable motion sensors and a modified Exposure Variation Analysis (EVA) and evaluate system accuracy with optoelectronic cameras. Ten healthy volunteers and one participant with sequel after stroke performed standardised functional arm tasks. Motion was registered simultaneously with a custom developed motion sensor system, including gyroscopes and accelerometers, and an optoelectronic camera system. The EVA was applied on elbow and shoulder joints, and angular and angular velocity EVA plots was calculated. The EVA showed characteristic patterns for each arm task in the healthy controls and a distinct difference between the affected and unaffected arm in the participant with sequel after stroke. The accuracy of the portable system was high with a systematic error ranging between -1.2 degrees and 2.0 degrees. The error was direction specific due to a drift component along the gravity vector. Portable motion sensor systems have high potential as clinical tools for evaluation of arm function. EVA effectively illustrates joint angle and joint angle velocity patterns that may capture deficiencies in arm function and movement quality. Next step will be to manage system drift by including magnetometers, to further develop clinically relevant outcome variables and apply this for relevant patient groups. (C) 2015 Elsevier Ltd. All rights reserved.

  • 10.
    Ertzgaard, Per
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Rehabilitation Medicine UHL.
    Ward, Anthony B
    Haywood Hospital.
    Wissel, Joerg
    Kliniken Beelitz GmbH.
    Borg, Jorgen
    Karolinska Institute.
    PRACTICAL CONSIDERATIONS FOR GOAL ATTAINMENT SCALING DURING REHABILITATION FOLLOWING ACQUIRED BRAIN INJURY2011In: JOURNAL OF REHABILITATION MEDICINE, ISSN 1650-1977, Vol. 43, no 1, p. 8-14Article in journal (Refereed)
    Abstract [en]

    Objective: Goal attainment scaling represents a unique approach to identifying and quantifying individualized, meaningful treatment outcomes, and its use in the rehabilitation medicine setting is increasing. The aim of this paper is to discuss the available literature for goal attainment scaling in patients with acquired brain injury, in terms of its advantages, disadvantages and practical application, including examples of goal setting and scaling.

  • 11.
    Falci, S
    et al.
    Department of Neurosurgery, Craig Hospital, Denver, Colorado.
    Holtz, A
    Department of Neurosurgery, Academic Hospital, University of Uppsala, Sweden.
    Akesson, E
    department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Stockholm, Sweden.
    Azizi, M
    Department of Neurosurgery, Academic Hospital, University of Uppsala, Sweden.
    Ertzgaard, Per
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hultling, C
    The Spinalis SCI Research Unit, Karolinska Institute, Stockholm, Sweden.
    Kjaeldgaard, A
    Department of Clinical Science, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden.
    Levi, Richard
    department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Stockholm, Sweden.
    Ringden, O
    Department of Transplantation Immunology, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden.
    Westgren, M
    Department of Clinical Science, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden.
    Lammertse, D
    department of Physical Medicine and Rehabilitation, Craig Hospital, Denver, Colorado.
    Seiger, A
    department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Stockholm, Sweden.
    Obliteration of a posttraumatic spinal cord cyst with solid human embryonic spinal cord grafts: first clinical attempt.1997In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 14, no 11, p. 875-884Article in journal (Refereed)
    Abstract [en]

    Cystic lesions of the spinal cord (syringomyelia) may occur after spinal cord injury. Posttraumatic syringomyelia may result in a myelopathy causing symptoms of sensory and motor loss, as well as worsening spasticity, pain, hyperhidrosis, and autonomic dysreflexia. Shunting of the cyst cavity along with untethering of the scarred spinal cord is widely accepted as the treatment of choice. However, the long-term stabilization of the progressive myelopathy caused by a posttraumatic cyst is suboptimal because of arachnoidal rescarring, shunt tube blockage, and cyst reexpansion. A new neurosurgical strategy to overcome the complication of cyst reexpansion was designed. Experimental studies have shown the successful use of embryonic spinal cord grafts, including human grafts, to obliterate induced spinal cord cavities in rats. The authors report the first use of solid human embryonic spinal cord grafts to successfully obliterate 6 cm of a large cyst cavity in a patient becoming myelopathic from a posttraumatic cyst. The grafts are well visualized by MRI to the 7-month postoperative follow-up and cyst obliteration is seen in the region where the grafts were placed.

  • 12.
    Gunnarsson, Stina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Lemming, Dag
    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.
    Ertzgaard, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Berntsson, Shala Ghaderi
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Samuelsson, Kersti
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Experiences from intrathecal baclofen treatment based on medical records and patient- and proxy-reported outcome: a multicentre study2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 41, no 9, p. 1037-1043Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate patient satisfaction with intrathecal baclofen treatment, complications from the treatment, and the impact of general expectations on treatment outcome in relation to satisfaction.

    Methods: A multicentre study with cross-sectional design. Data were collected through questionnaires and patient records. Patients were recruited from six outpatient intrathecal baclofen clinics in Sweden. Eighty-three patients who had been treated with intrathecal baclofen for 1–4 years were included. For patients unable to communicate, data were collected through a proxy. The Patient Global Impression of Change was used to measure patients’ general satisfaction with change from intrathecal baclofen treatment. The Life Orientation Test – revised, was used to measure general expectations/optimism.

    Results: General satisfaction with intrathecal baclofen treatment was high; 51/77 patients reported “much improved” or “very much improved.” There was no relationship between the two main outcomes (general satisfaction and general expectations/optimism) (rs = 0.12, p = 0.382). The two groups; those who could and those who could not communicate, did differ regarding personal characteristics and should be evaluated as such.

    Conclusions: Most patients/proxies reported a high level of satisfaction with intrathecal baclofen treatment. The reported satisfaction with intrathecal baclofen treatment was not dependent on general expectations.

    • Implications for Rehabilitation
    • Patients with intrathecal baclofen treatment report low levels of health and quality of life at the same time as they are highly satisfied with their treatment.

    • Intrathecal baclofen should be equally offered to both optimistic and less optimistic patients.

    • Patients who are able to/not able to communicate, differs in characteristics and should be informed and followed up in different ways in daily clinical practice.

  • 13.
    Landtblom, Anne-Marie
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Ertzgaard, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Tillståndet inte läkemedlet- ska avgöra frågan om subventionering. Ökad saklighet krävs i debatten om rabatterade "livskvalitetsmediciner".2000In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, p. 2612-2614Article in journal (Other (popular science, discussion, etc.))
  • 14.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Ertzgaard, Per
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Förvärvade ryggmärgsskador2015In: Rehabiliteringsmedicin: teori och praktik / [ed] Jörgen Borg, Kristian Borg, Björn Gerdle, Katharina Stibrant Sunnerhagen, Lund: Studentlitteratur AB, 2015, 1, p. 375-388Chapter in book (Other academic)
    Abstract [sv]

    Rehabiliteringsmedicinsk kunskap är relevant vid alla sjukdomar och skador som medför långvariga, komplexa funktionshinder och är därför relevant inom stora delar av sjukvården. Inom den rehabiliteringsmedicinska specialiteten handläggs idag främst patienter med skador och sjukdomar i nervsystemet respektive med långvariga smärttillstånd.

    Denna reviderade upplaga inleds med en sektion som avhandlar rehabiliteringsmedicinens utveckling och nuvarande plats i sjukvården, centrala rehabiliteringsmedicinska koncept, mät- och arbetsmetoder. Följande sektioner omfattar rehabiliteringsmedicinsk funktionsdiagnostik, läkningsmekanismer och behandling vid långvariga smärttillstånd respektive vid skador och kroniska sjukdomar i nervsystemet. Bokens omfång har ökat något. Några kapitel har fått större utrymme och nya kapitel om beteendestörning och medicinska komplikationer efter svår hjärnskada liksom om anoxisk hjärnskada har tillkommit. Andra kapitel, som inte rör dagens kärnverksamhet inom praktisk rehabiliteringsmedicin, har utgått.

    Rehabiliteringsmedicin är avsedd för grundutbildning av läkare, arbetsterapeuter och sjukgymnaster, logopeder samt för läkare under ATtjänstgöring. Den är också lämplig som introduktion i specialistutbildningen i rehabiliteringsmedicin, geriatrik, neurologi och smärtlindring, i vidareutbildningar av olika vårdyrkesgrupper och som referenslitteratur av yrkesverksamma med intresse för rehabiliteringsmedicin.

  • 15.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Ertzgaard, Per
    Karolinska Institute, Sweden.
    Quality indicators in spinal cord injury care: a Swedish collaborative project. The Swedish Spinal Cord Injury Council 1998.1998In: Scandinavian journal of rehabilitation medicine. Supplement, ISSN 0346-8720, Vol. 38, p. 1-80Article in journal (Refereed)
  • 16.
    Norrbrink, Budh C
    et al.
    Spinalis SCI Unit, Karolinska Hospital and Faculty of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Lund, I
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Hultling, C
    Spinalis SCI Unit, Karolinska Hospital and Faculty of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Levi, Richard
    Frösunda Center, Solna and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Werhagen, L
    Spinalis SCI Unit, Karolinska Hospital and Faculty of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Ertzgaard, Per
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Lundeberg, T
    Spinalis SCI Unit, Karolinska Hospital and Faculty of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Gender related differences in pain in spinal cord injured individuals.2003In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 41, no 2, p. 122-128Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN:: Out of a population of 456 patients with spinal cord injuries (SCI), 130 having pain were selected after matching, based on gender, age, American Spinal Injury Association (ASIA) impairment grade and level of lesion. OBJECTIVE:: To investigate whether gender differences with regard to pain perception and prevalence exist in a population of patients following spinal cord injury. SETTING:: Spinalis SCI Unit (out-patient clinic), Stockholm, Sweden. METHOD:: 130 patients suffering from pain were assessed over a 12-month period in a yearly health control. RESULTS:: SCI women had a higher prevalence of nociceptive pain than men and their use of analgesics was greater. However, no differences between the sexes could be seen regarding pain and localization, onset, distribution, factors affecting pain, number of painful body regions, pain descriptors, ratings of pain intensities or in pain and life satisfaction. CONCLUSION:: This study showed that SCI men and women describe their pain very similarly. However, SCI women had a higher prevalence of nociceptive pain than men and their use of opiates and non-steroid anti-inflammatory drugs (NSAIDs) was greater.Spinal Cord (2003) 41, 122-128. doi:andlt;highlightandgt;10.1038andlt;/highlightandgt;/andlt;highlightandgt;sj.scandlt;/highlightandgt;.andlt;highlightandgt;3101407andlt;/highlightandgt; [ABSTRACT FROM AUTHOR]

  • 17.
    Scott Burns, Anthony
    et al.
    University of Toronto, Canada; University of Health Network Toronto Rehabil Institute, Canada.
    Lanig, Indira
    Northern Colorado Rehabil Hospital, CO USA.
    Grabljevec, Klemen
    University of Rehabil Institute, Slovenia.
    Wayne New, Peter
    Caulfield Hospital, Australia; Monash University, Australia.
    Bensmail, Djamel
    University of Versailles St Quentin, France.
    Ertzgaard, Per
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Vishwanath Nene, Anand
    Roessingh Centre Rehabil, Netherlands; Roessingh Research and Dev, Netherlands.
    Optimizing the Management of Disabling Spasticity Following Spinal Cord Damage: The Ability Network-An International Initiative2016In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 97, no 12, p. 2222-2228Article in journal (Refereed)
    Abstract [en]

    Optimizing the treatment of disabling spasticity in persons with spinal cord damage is hampered by a lack of consensus regarding the use of acceptable definitions of spasticity and disabling spasticity, and the relative absence of decision tools such as clinical guidelines and concise algorithms to support decision-making within the broader clinical community. Many people with spinal cord damage are managed outside specialist centers, and variations in practice result in unequal access to best practice despite equal`need. In order to address these issues, the Ability Network an international panel of clinical experts was initiated to develop management algorithms to guide and standardize the assessment, treatment, and evaluation of outcomes of persons with spinal cord damage and disabling spasticity. To achieve this, consensus was sought on common definitions through facilitated, in-person meetings. To guide patient selection, an in-depth review of the available tools was performed and expert consensus sought to develop an appropriate instrument. Literature reviews are guiding the selection and development of tools to evaluate treatment outcomes (body functions, activity, participation, quality of life) as perceived by people with spinal cord damage and disabling spasticity, and their caregivers and clinicians. Using this approach, the Ability Network aims to facilitate treatment decisions that take into account the following: the impact of disabling spasticity on health status, patient preferences, treatment goals, tolerance for adverse events, and in cases of totally dependent persons, caregiver burden. (C) 2016 by the American Congress of Rehabilitation Medicine

  • 18.
    Skogberg, Olle
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Samuelsson, Kersti
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Ertzgaard, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Levi, Richard
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    CHANGES IN BODY COMPOSITION AFTER SPASTICITY TREATMENT WITH INTRATHECAL BACLOFEN2017In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, no 1, p. 36-39Article in journal (Refereed)
    Abstract [en]

    Objective: To assess changes in body composition, body weight and resting metabolic rate in patients who received intrathecal baclofen therapy for spasticity. Design: Prospective, longitudinal, quasi-experimental, with a pre/post design. Patients: Twelve patients with spasticity, fulfilling study criteria, and due for pump implantation for intrathecal baclofen therapy, completed the study. Methods: Data were obtained before, 6 months and 12 months after commencement of intrathecal baclofen therapy as regards body composition (by skinfold calliper), body weight, and resting metabolic rate (by resting oxygen consumption). Spasticity was assessed according to the Modified Ashworth Scale (MAS) and Penn Spasm Frequency Scale (PSFS). Results: A reduction in spasticity according to MAS occurred. Mean fat body mass increased and mean lean body mass decreased. Mean body weight showed a non-significant increase and resting metabolic rate a non-significant decrease. Conclusion: This explorative study indicates that unfavourable changes in body composition might occur after intrathecal baclofen therapy. Since obesity and increased fat body mass contribute to an increased cardiovascular risk, these findings may indicate a need for initiation of countermeasures, e.g. increased physical activity and/or dietary measures, in conjunction with intrathecal baclofen therapy. Further studies, including larger study samples and control groups, are needed to corroborate these findings.

  • 19.
    Svensson, Erik
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology.
    Ertzgaard, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Reconstruction Centre, Department of Rehabilitation Medicine UHL.
    Forsum, Urban
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology.
    Bacteriuria in spinal cord injured patients with neurogenic bladder dysfunction2004In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 109, no 1, p. 25-32Article in journal (Refereed)
    Abstract [en]

    The occurrence of bacteriuria in spinal cord injured patients with neurogenic bladder dysfunction who used clean intermittent catheterisation to empty their bladders was studied in order to examine cut-off concentration breakpoints for significant bacteriuria in this group of patients using procedures of the European Urinanalysis Guideline. 344 samples were cultured, yielding 285 isolates. Coagulase-negative staphylococci (27 %), Enterococci (25 %), Klebsiella spp (19 %), and Escherichia coli (12 %) were the most common findings. Bacteria grew at concentrations of 105-108 cfu/L, but only a few at 104 cfu/L. It is concluded that low bacterial concentrations in the urine (105 cfu/L) of patients with neurogenic bladder dysfunction who are on intermittent catheterisation might be as significant for bladder contamination with bacteria as a high bacterial concentration and can possibly be responsible for bladder infections.

  • 20.
    Ward, Anthony B.
    et al.
    Haywood Hospital, Burslem, Stoke on Trent, UK.
    Wissel, Jörg
    Vivantes Klinikum Spandau, Berlin, Germany.
    Borg, Jörgen
    Danderyd Hospital, Stockholm, Sweden .
    Ertzgaard, Per
    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, Department of Rehabilitation Medicine.
    Herrmann, Christoph
    Asklepios Clinics Schildautal, Seesen, Germany.
    Kulkarni, Jai
    Manchester Royal Infirmary, UK.
    Lindgren, Kristina
    Central Hospital, Karlstad, Sweden .
    Reuter, Iris
    Justus-Liebig University, Giessen, Germany.
    Sakel, Mohamed
    Kent and Canterbury Hospital, UK.
    Säterö, Patrik
    Sahlgrenska University Hospital, Gothenburg, Sweden .
    Sharma, Satyendra
    Sunnybrook Health Science Centre,Toronto, Canada .
    Wein, Theodore
    Montreal General Hospital, Canada .
    Wright, Nicola
    Allergan Ltd, Marlow International, Buckinghamshire, UK.
    Fulford-Smith, Antony
    Allergan Ltd, Marlow International, Buckinghamshire, UK.
    Functional goal achievement in post-stroke spasticity patients: The BOTOX® Economic Spasticity Trial (BEST)2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 6, p. 504-513Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    Evaluate changes in active and passive function with onabotulinumtoxinA + standard of care within goal-oriented rehabilitation programmes in adults with focal post-stroke spasticity.

    METHODS:

    Prospective, 24-week double-blind study with an open-label extension. Subjects were randomized to onabotulinumtoxinA + standard of care or placebo + standard of care, at baseline and at 12 weeks, if judged appropriate, with follow-up to 52 weeks. The primary endpoint was the number of patients achieving their principal active functional goal at 24 weeks (or 10 weeks after an optional second injection). Secondary endpoints included achievement of a different active or a passive goal at this timepoint.

    RESULTS:

    The intent-to-treat population comprised 273 patients. The proportion of patients achieving their principal active functional goal and secondary active functional goal with onabotulinumtoxinA + standard of care was not statistically different from placebo + standard of care. Significantly more patients achieved their secondary passive goal with onabotulinumtoxinA + standard of care (60.0%) vs. placebo + standard of care (38.6%) (odds ratio, 2.46; 95% confidence interval, 1.18-5.14) as well as higher Goal Attainment Scaling levels for upper limb and ankle flexor subgroups.

    CONCLUSIONS:

    Addition of onabotulinumtoxinA to standard of care as part of goal-oriented rehabilitation in post-stroke spasticity patients significantly increased passive goal achievement and was associated with higher levels of active function.

  • 21.
    Wissel, J
    et al.
    Kliniken Beelitz.
    Ward, A B
    Haywood Hospital.
    Borg, J
    Danderyd Hospital.
    Reuter, I
    University of Giessen.
    Kulkarni, J
    Withington Hospital.
    Ertzgaard, Per
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Rehabilitation Medicine.
    Sharma, S
    Sunnybrook Health Science Centre.
    Sakel, M
    E Kent University.
    Wright, N
    Allergan Ltd.
    GOAL SETTING PERTAINING TO UPPER LIMB FUNCTION IN POST-STROKE SPASTICITY (PSS) PATIENTS: THE BOTOX (R) ECONOMIC SPASTICITY TRIAL (BEST) in EUROPEAN JOURNAL OF NEUROLOGY, vol 18, issue SI, pp 445-4452011In: EUROPEAN JOURNAL OF NEUROLOGY, Wiley-Blackwell , 2011, Vol. 18, no SI, p. 445-445Conference paper (Refereed)
    Abstract [en]

    n/a

  • 22.
    Wissel, Joerg
    et al.
    Vivantes Klinikum Spandau, Germany.
    Ganapathy, Vaidyanathan
    Sunovion Pharmaceut Inc, MA USA.
    Ward, Anthony B.
    Haywood Hospital, England.
    Borg, Jorgen
    Danderyd Hospital, Sweden.
    Ertzgaard, Per
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Herrmann, Christoph
    Asklepios Kliniken Schildautal, Germany.
    Häggstrom, Anders
    Örebro University Hospital, Sweden.
    Sakel, Mohamed
    East Kent University Hospital NHS, England.
    Ma, Julia
    Allergan Plc, CA 92612 USA.
    Dimitrova, Rozalina
    Allergan Plc, CA 92612 USA.
    Fulford-Smith, Antony
    Marlow Int, England.
    Gillard, Patrick
    Allergan Plc, CA 92612 USA.
    OnabotulinumtoxinA Improves Pain in Patients With Post-Stroke Spasticity: Findings From a Randomized, Double-Blind, Placebo-Controlled Trial2016In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 52, no 1, p. 17-26Article in journal (Refereed)
    Abstract [en]

    Context. Patients with post-stroke spasticity (PSS) commonly experience pain in affected limbs, which may impact quality of life. Objectives. To assess onabotulinumtoxinA for pain in patients with PSS from the BOTOX (R) Economic Spasticity Trial, a multicenter, randomized, double-blind, placebo-controlled trial. Methods. Patients with PSS (N = 273) were randomized to 22- to 34-week double-blind treatment with onabotulinumtoxinA + standard care (SC) or placebo injection + SC and were eligible to receive open-label onabotulinumtoxinA up to 52 weeks. Assessments included change from baseline on the 11-point pain numeric rating scale, proportion of patients with baseline pain amp;gt;= 4 achieving amp;gt;= 30% and amp;gt;= 50% improvement in pain, and pain interference with work at Week 12, end of double-blind treatment, and Week 52. Results. At baseline, most patients (74.3%) experienced pain and 47.4% had pain amp;gt;= 4 (pain subgroup). Mean pain reduction from baseline at Week 12 was significantly greater with onabotulinumtoxinA + SC (-0.77, 95% CI -1.14 to -0.40) than placebo + SC (-0.13, 95% CI -0.51 to 0.24; P amp;lt; 0.05). Higher proportions of patients in the pain subgroup achieved amp;gt;= 30% and amp;gt;= 50% reductions in pain at Week 12 with onabotulinumtoxinA + SC (53.7% and 37.0%, respectively) compared with placebo (28.8% and 18.6%, respectively; P amp;lt; 0.05). Reductions in pain were sustained through Week 52. Compared with placebo + SC, onabotulinumtoxinA consistently reduced pain interference with work. Conclusion. This is the first randomized, placebo-controlled trial demonstrating statistically significant and clinically meaningful reductions in pain and pain interference with work with onabotulinumtoxinA in patients with PSS. (C) 2016 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine. This is an open access article under the CC BY-NC-ND license.

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