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

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

  • 2.
    Abbott, Allan
    Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Physiotherapeutic rehabilitation and lumbar fusion surgery2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Over the last two decades, the economic costs and rates of lumbar fusion surgery for chronic low back pain has risen dramatically in western industrialized countries. Data from the Swedish National Spine Register suggest that 25% of patients experience unimproved pain and up to 40% are not satisfied with the outcome of lumbar fusion surgery. Thus, there is a definite need to optimize the selection and management of patients to improve lumbar fusion outcomes. Aim: To investigate the role of biopsychosocial factors in explaining disability and health related quality of life in chronic low back pain patients before and after lumbar fusion surgery and to evaluate the effectiveness of post-operative rehabilitation regimes. Methods: At total of 107 patients were recruited, aged 18 to 65 years, selected for lumbar fusion due to 12 months of symptomatic back and/or leg pain due to spinal stenosis, degenerative/isthmic spondylolisthesis or degenerative disc disease. Measures of disability, health related quality of life, pain, mental health, fear of movement/(re)injury, self-efficacy, outcome expectancy, pain coping styles, work status, health care use, analgesic use and sickness leave were collected with self-rated questionnaires at baseline (Studies I-IV), 3, 6, 12 months (Study II) and 2-3 years after surgery (Studies II-III). In Studies II-IV, patients were randomised to psychomotor therapy (N=53) or exercise therapy (N=54) implemented during the first 3 post-operative months. Semi-structured interviews were conducted 3-6 months after surgery on 20 patients including 10 from each rehabilitation group to investigate experiences of back problems before and after surgery, post-operative recovery and expectations of rehabilitation analysed in terms of the International Classification of Functioning, Disability and Health (Study IV). Results: Approximately 50% of the variability in baseline disability and 40% of the variability in baseline health related quality of life could be explained by psychological variables. In particular, catastrophizing, control over pain, self-efficacy and outcome expectancy had significant mediation roles (Study I). For the short and long term outcome of lumbar fusion surgery, post-operative psychomotor therapy is significantly more effective than exercise therapy with approximately 10-20% better outcome in measures of disability, fear of movement/(re)injury, pain catastrophizing, self-efficacy, outcome expectancy sickness leave, health care utilization and return to work (Study II). A model with good outcome predictive performance which significantly predicts disability, back pain and health related quality of life outcomes 2-3 year after lumbar fusion surgery, was shown to involve pre-operative screening of disability, leg pain intensity, mental health, fear of movement/(re)injury, outcome expectations, catastrophizing, control over pain and the implementation of post-operative psychomotor therapy (Study III). Lumbar fusion patient s experiences of back problems before and after the operation as well as experiences of recovery and outcome expectations correspond well with the content of outcomes measures used in the study suggesting good content validity (Study IV). Conclusion: Psychological factors strongly influence levels of disability and health related quality of life in lumbar fusion candidates as well as predicts post-operative outcomes. Early post-operative rehabilitation focusing on cognition, behaviour and motor control is recommended for improved lumbar fusion outcomes.

  • 3.
    Abbott, Allan
    Karolinska Institute, Sweden.
    The Coping Strategy Questionnaire2010In: Journal of Physiotherapy, ISSN 1836-9553, E-ISSN 1836-9561, Vol. 56, no 1, p. 63-63Article in journal (Other academic)
  • 4.
    Abbott, Allan
    et al.
    Department of Physical Therapy, Neuro R1:07, Karolinska University Hospital, Stockholm, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Huddinge, Sweden; Institute of Health and Sport, Bond University, Queensland, Australia.
    Ghasemi-Kafash, Elaheh
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Huddinge, Sweden.
    Dedering, Åsa
    Department of Physical Therapy, Neuro R1:07, Karolinska University Hospital, Stockholm, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Huddinge, Sweden.
    The validity of using an electrocutaneous device for pain assessment in patients with cervical radiculopathy2014In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 30, no 7, p. 500-506Article in journal (Refereed)
    Abstract [en]

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

  • 5.
    Abbott, Allan
    et al.
    Physiotherapist, Department for Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
    Halvorsen, Marie
    Physiotherapist, Department for Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
    Dedering, Åsa
    Physiotherapist, Department for Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
    Is there a need for cervical collar usage post anterior cervical decompression and fusion?: A randomized control pilot trial2013In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 29, no 4, p. 290-300Article in journal (Refereed)
    Abstract [en]

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

  • 6.
    Abbott, Allan
    et al.
    Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Division of Orthopaedics, Karolinska University Hospital, Karolinska Institute, Stockholm , Sweden.
    Hedlund, Rune
    Department of Orthopaedics, Institute for Clinical Science, University of Gothenburg, Gothenburg, Sweden.
    Tyni-Lenné, Raija
    Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.
    Patient’s experience post-lumbar fusion regarding back problems, recovery and expectations in terms of the international classification of functioning, disability and health.2011In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 15-16, p. 1399-1408Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    To describe within the context of the International Classification of Functioning, Disability and Health (ICF), patient's experiences post-lumber fusion regarding back problems, recovery and expectations of rehabilitation and to contrast with the content of outcome measures and the ICF low back pain (LBP) core sets.

    METHODS:

    The study has a cross-sectional and retrospective design and involves 20 lumbar fusion patients. Using the ICF, qualitative content analysis of semi-structured interviews 3-6 months post-surgery was performed. This was compared with the ICF related content of the Oswestry Disability Index (ODI), Medical Outcome Study Short Form 36 (SF-36), European Quality of Life Questionnaire (EQ5D) and the ICF LBP core sets.

    RESULTS:

    Patient's experiences were most frequently linked to psychological, sensory, neuromusculoskeletal and movement related body function chapters of the ICF. The most frequently linked categories of activity and participation were mobility, domestic activities, family relationships, work, recreation and leisure. Environmental factors frequently linked were the use of analgesics, walking aids, family support, social security systems, health care systems and labour market employment services.

    CONCLUSIONS:

    This study highlights important ICF related aspects of patient's experiences post-lumber fusion. The use of the comprehensive ICF core sets is recommended in conjunction with ODI, SF-36 and the EQ5D for a broader analysis of patient outcomes post-lumbar fusion.

  • 7.
    Abbott, Allan
    et al.
    Karolinska University Hospital, Sweden; Karolinska Institute, Sweden; Bond University, Australia.
    Kjellman, Görel
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Multidimensional assessment of pain related disability after surgery for cervical disc disease2013In: APA Conference 2013: New moves, Australian Physiotherapy Association , 2013, p. 2-2Conference paper (Other academic)
    Abstract [en]

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

    Design: Cross-sectional observational study.

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

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

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

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

    Key Practice Points:

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

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

  • 8.
    Abbott, Allan
    et al.
    Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden; Bond University, Gold Coast, Australia.
    Möller, Hans
    Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    Gerdhem, Paul
    Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    CONTRAIS: CONservative TReatment for Adolescent Idiopathic Scoliosis: a randomised controlled trial protocol2013In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 14, article id 261Article in journal (Refereed)
    Abstract [en]

    Background:

    Idiopathic scoliosis is a three-dimensional structural deformity of the spine that occurs in children and adolescents. Recent reviews on bracing and exercise treatment have provided some evidence for effect of these interventions. The purpose of this study is to improve the evidence base regarding the effectiveness of conservative treatments for preventing curve progression in idiopathic scoliosis.

    Methods/design:

    Patients: Previously untreated girls and boys with idiopathic scoliosis, 9 to 17 years of age with at least one year of remaining growth and a curve Cobb angle of 25–40 degrees will be included. A total of 135 participants will be randomly allocated in groups of 45 patients each to receive one of the three interventions.Interventions: All three groups will receive a physical activity prescription according to the World Health Organisation recommendations. One group will additionally wear a hyper-corrective night-time brace. One group will additionally perform postural scoliosis-specific exercises.Outcome: Participation in the study will last until the curve has progressed, or until cessation of skeletal growth. Outcome variables will be measured every 6 months. The primary outcome variable, failure of treatment, is defined as progression of the Cobb angle more than 6 degrees, compared to the primary x-ray, seen on two consecutive spinal standing x-rays taken with 6 months interval. Secondary outcome measures include the SRS-22r and EQ5D-Y quality of life questionnaires, the International Physical Activity Questionnaire (IPAQ) short form, and Cobb angle atend of the study.

    Discussion:This trial will evaluate which of the tested conservative treatment approaches that is the most effective for patients with adolescent idiopathic scoliosis.

    Trial registration: NCT01761305

  • 9.
    Abbott, Allan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Schröder, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Enthoven, Paul
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Effectiveness of implementing a best practice primary healthcare model for low back pain (BetterBack) compared with current routine care in the Swedish context: an internal pilot study informed protocol for an effectiveness-implementation hybrid type 2 trial2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 4, article id e019906Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 10.
    Abbott, Allan
    et al.
    Department of Physical Therapy, Karolinska University Hospital; Department of Clinical Science, Intervention and Technology, Division of Orthopaedics, Karolinska Institute, Stockholm, Sweden.
    Tyni-Lenné, Raija
    Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.
    Hedlund, Rune
    Department for Orthopaedics, Institute for Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Early rehabilitation targeting cognition, behaviour and motor function after lumbar fusion: A randomized controlled trial2010In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 35, no 8, p. 848-857Article in journal (Refereed)
    Abstract [en]

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

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

    Summary of Background Data - Postoperative management after lumbar fusion commonly focuses on analgesic pain control and activities of daily living. After 3 months, exercise therapy is often implemented. No randomized controlled trial has investigated early rehabilitation techniques conducted during the first 3 months after surgery.

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

    Results - Follow-up rates were 93% at 12 months and 81% at 2 to 3 years after surgery. Psychomotor therapy improved functional disability, self-efficacy, outcome expectancy, and fear of movement/(re)injury significantly more than exercise therapy at respective follow-up occasions. Similar results occurred for pain coping but group differences were nonsignificant at 2 to 3 years follow-up. Potentially clinical relevant higher reoperation rates occurred after psychomotor therapy but rates were within normal ranges.

    Conclusion - The study shows that postoperative rehabilitation can be safely implemented during the first 3 months after lumbar fusion and should include measures to modify psychological as well as motor functions.

  • 11.
    Abbott, Allan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Department of Physical Therapy, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Division of Orthopaedics, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
    Tyni-Lenné, Raija
    Department of Physical Therapy, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Hedlund, Rune
    Department for Orthopaedics, Institute for Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Leg pain and psychological variables predict outcome 2-3 years after lumber fusion surgery2011In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 20, no 10, p. 1626-1634Article in journal (Refereed)
    Abstract [en]

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

  • 12.
    Abbott, Allan
    et al.
    Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Division of Orthopaedics, Karolinska Institute, Stockholm, Sweden.
    Tyni-Lenné, Raija
    Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.
    Hedlund, Rune
    Institute for Clinical Sciences, Department for Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    The influence of psychological factors on pre-operative levels of pain intensity, disability and HRQOL in lumbar spinal fusion surgery patients2010In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 96, no 3, p. 213-221Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    To assess the extent to which perceived pain and psychological factors explain levels of disability and health-related quality of life (HRQOL) in patients scheduled for lumbar fusion surgery, and to test the hypothesis that relationships between pain intensity, mental health, fear of movement/(re)injury, disability and HRQOL are mediated by cognitive beliefs and appraisals.

    DESIGN:

    Cross-sectional, correlation study.

    SETTING:

    Orthopaedic outpatient setting in a tertiary hospital.

    PARTICIPANTS:

    One hundred and seven chronic back pain patients scheduled for lumbar fusion surgery.

    MEASURES:

    Visual analogue scale for pain intensity, Short Form 36 mental health subscale, Tampa Scale for Kinesiophobia, Back Beliefs Questionnaire, Self-efficacy Scale, Coping Strategy Questionnaire, Oswestry Disability Index and European Quality of Life Questionnaire.

    RESULTS:

    The group effect of multiple mediators significantly influenced the relationships between pain intensity and mental health, fear of movement/(re)injury, functional disability and HRQOL. Pain catastrophising significantly mediated the relationship between pain intensity and mental health, control over pain significantly mediated the relationship between mental health and functional disability, self-efficacy and pain outcome expectancy significantly mediated the relationship between mental health and HRQOL, and self-efficacy also significantly mediated the relationship between pain intensity, fear of movement/(re)jury and functional disability. The model explained 28, 30, 52 and 42% of the variation in mental health, fear of movement/(re)injury, functional disability and HRQOL, respectively.

    CONCLUSIONS:

    This study highlights the strong influence and mediation roles of psychological factors on pain, mental health, fear of movement/(re)injury, disability and HRQOL in patients scheduled for lumber fusion. Future research should focus on screening as well as pre- and post-operative interventions based on these psychological factors for the potential improvement of lumber fusion surgery outcomes.

    Copyright 2010 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  • 13.
    Abbott, Allan
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Tynni-Lenne, Raija
    Karolinska Institute, Stockholm, Sweden.
    Hedlund, Rune
    Karolinska Institute, Stockholm, Sweden.
    Early physiotherapeutic rehabilitation following lumbar spinal fusion surgery2009In: Oral Presentations: Cervical Spine: The Surgical Treatment of Painful Disorders, Springer, 2009, Vol. 18, Supplement 4, p. S409-S410Conference paper (Other academic)
    Abstract [en]

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

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

    Study design/setting: Randomized controlled clinical trial.

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

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

    Methods: Analysis of mean differences between groups.

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

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

  • 14.
    Abbott, Allan
    et al.
    Karolinska University Hospital, Stockholm, Sweden.
    Tynni-Lenné, R
    Karolinska University Hospital, Stockholm, Sweden; Karolinska Institute, Stockholm, Sweden.
    Hedlund, R
    Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    The effectiveness of physiotherapeutic rehabilitation and issues of outcome prediction after lumber fusion surgery.2011In: Proceedings of the WCPT Congress, Amsterdam Netherlands. / [ed] Physiotherapy, World Confederation of Physical Therapy , 2011, Vol. 97 (Suppl 1), p. 20-Conference paper (Other academic)
    Abstract [en]

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

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

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

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

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

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

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

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

  • 15.
    Abbott, Allan
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Tynni-Lenné, Raija
    Karolinska Institute, Stockholm, Sweden.
    Hedlund, Rune
    Gothenburg University, Gothenburg, Sweden.
    Early rehabilitation targeting cognition, behaviour and motor function after lumbar fusion: A randomised controlled trial2010In: Abstracts: Oral Presentations, 2010, p. 186-186Conference paper (Other academic)
    Abstract [en]

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

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

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

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

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

  • 16.
    Carter, Josh
    et al.
    Bond Institute of Health and Sport, Faculty of Health Science and Medicine, Bond University, Australia.
    Marshall, Nick
    Surflife Physio, Miami, Australia.
    Abbott, Allan
    Bond Institute of Health and Sport, Faculty of Health Science and Medicine, Bond University, Australia / Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden / Department of Physiotherapy, Karolinska University Hospital, Sweden.
    Shoulder Pain and Dysfunction in Young Surf Lifesavers2015In: Physical Therapy in Sport, ISSN 1466-853X, E-ISSN 1873-1600, Vol. 16, no 2, p. 162-168Article in journal (Refereed)
    Abstract [en]

    Objectives

    To determine the incidence and prevalence of significantly interrupting shoulder pain (SIP) in young surf lifesavers and to determine association with training dosage and the ‘combined elevation test’.

    Participants

    54 surf lifesavers aged 10 – 18 from the Gold Coast, Australia.

    Methods and Outcome Measures

    Retrospective survey of SIP and training dosage. Cross-sectional measures of the combined elevation test.

    Design

    Retrospective.

    Results

    56.5% of female surf lifesavers reported a history of SIP compared to males with 48.5%. Females had a higher combined elevation score compared to males, 28.32±SD8.52cm and 26.09±SD6.64cm, respectively. Young surf lifesavers had an incidence rate of 2.1 SIP episodes per thousand hours of training, an incidence proportion of 51.9% and prevalence of 18.5%. Combined elevation had low level positive trends with training dosages and statistically significant negative correlation with board paddling sessions per week (r= -0.287, p=<0.05). Those with a history of SIP had a statistically significant higher number of sessions (p=0.008), duration (p=0.015) and distance (p=0.005) swimming per week.

    Conclusion

    Young surf lifesavers with a history of SIP have greater swimming dosage not associated with decrease in combined elevation score. More board paddling sessions per week decreased the combined elevation score of young surf lifesavers.

  • 17.
    Daley, M
    et al.
    Bond University, Australia.
    McDonald, M
    Ozcare, Robina, Australia.
    Irwin, J
    Ozcare, Robina, Australia.
    Abbott, AD
    Bond University, Australia.
    Factors effecting participation rates in chronic disease self-management programmes.2013In: APA Conference 2013: New moves, Australian Physiotherapy Association , 2013, p. 2-2Conference paper (Other academic)
    Abstract [en]

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

    Design: Descriptive study

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

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

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

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

    Key Practice Points:

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

  • 18.
    Diarbakerli, Elias
    et al.
    Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
    Grauers, Anna
    Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Orthopaedics, Sundsvall and Härnösand County Hospital, Sundsvall, Sweden.
    Danielsson, Aina
    Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy at Göteborg University, Sweden.
    Abbott, Allan
    Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Gerdhem, Paul
    Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
    Quality of life in males and females with idiopathic scoliosis2018In: Spine, ISSN 0362-2436, E-ISSN 1528-1159Article in journal (Refereed)
    Abstract [en]

    Study Design. Cross-sectional.

    Objective. To describe quality of life in males and females with idiopathic scoliosis.

    Summary of Background Data. Idiopathic scoliosis is a three-dimensional deformity affecting the growing spine. The prevalence of larger curves, requiring treatment, is higher in females.

    Methods. This cross-sectional study comprised 1519 individuals with idiopathic scoliosis (211 males) with a mean (SD) age of 35.3 (14.9) years. They all answered the Scoliosis Research Society 22 revised (SRS-22r) questionnaire and EuroQol 5-dimension-index (EQ-5D). Five hundred twenty eight were surgically treated (78 males), 535 were brace treated (50 males), and 456 were untreated (83 males). The SRS-22r subscore (excluding the satisfaction domain), the SRS-22r domains and the EQ-5D index score were calculated. Subgroup analyses based on treatment and age were performed. Statistical comparisons were performed using analysis of covariance with adjustments for age and treatment. A P-value less than 0.05 was considered as statistical significant.

    Results. The mean (SD) SRS-22r subscore was 4.19 (0.61) in males and 4.05 (0.61) in females (P = 0.010). The males had higher scores on the SRS-22r domains function (4.56 vs. 4.42), pain (4.20 vs. 4.00), and mental health (4.14 vs. 3.92) (all P < 0.05). The mean (SD) EQ-5D index score was 0.85 (0.22) for males and 0.81 (0.21) for females (P = 0.10). There were minor differences when comparing males and females in treatment and age groups, but both treated and untreated groups had reduced quality of life compared with the national norms.

    Conclusion. When compared with females, males with idiopathic scoliosis tend to have slightly higher scores in the scoliosis specific SRS-22r but not in the generic quality of life measurement EQ-5D. Quality of life is overall similar between males and females in treatment and age groups, but reduced in comparison with the general population.

    Level of Evidence: 3

  • 19.
    Diarberkali, Elias
    et al.
    Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden ; Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
    Grauers, Anna
    Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Orthopaedics, Sundsvall and Härnösand County Hospital, Sundsvall, Sweden.
    Möller, Hans
    Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden ; Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Faculty of Health Science and Medicine, Bond University, Gold Coast, Australia.
    Gerdhem, Paul
    Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden ; Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
    Adolescents with and without idiopathic scoliosis have similar self-reported level of physical activity: a cross-sectional study2016In: Scoliosis and Spinal Disorders, ISSN 2397-1789, Vol. 11, no 17, p. 1-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

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

    METHODS:

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

    RESULTS:

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

    CONCLUSION:

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

  • 20.
    Dufvenberg, Marlene
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Adeyemi, Fisayo
    Department of Clinical and Rehabilitation Services, Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Australia.
    Rajendran, Isabelle
    Department of Clinical and Rehabilitation Services, Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Australia.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Department of Clinical and Rehabilitation Services, Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Australia.
    Does postural stability differ between adolescents with idiopathic scoliosis and typically developed?: A systematic literature review and meta-analysis2018In: Scoliosis and Spinal Disorders, ISSN 2397-1789, Vol. 13, no 1, article id 19Article in journal (Refereed)
    Abstract [en]

    Background

    Postural stability deficits have been proposed to influence the onset and progression of adolescent idiopathic scoliosis (AIS). This study aimed to systematically identify, critically evaluate and meta-analyse studies assessing postural stability during unperturbed stance with posturography in AIS compared to typically developed adolescents.

    Methods

    Studies from four electronic databases (PubMed, Scopus, CINAHL, PEDro) were searched and case-control methodological quality assessed using a risk-of-bias assessment tool and a posturography methodological quality checklist. Pooled data regarding centre of pressure (COP) parameters such as sway area, Mediolateral (ML) and Anteroposterior (AP) position and range were compared for AIS and typically developed adolescents using Cohen’s d effect size (ES) and homogeneity estimates.

    Results

    Eighteen studies for quality analysis and 9 of these for meta-analysis were identified from 971 records. Risk-of-bias assessment identified 6 high, 10 moderate and 2 low risk-of-bias studies. The posturography methodological quality checklist identified 4 low, 7 moderate and 7 high-quality studies. Meta-analysis was performed for sway area whereas ML and AP are presented in three different meta-analyses due to divergent measurement units used in the studies: ML position 1 (MLP1), ML position 2 (MLP2) and ML range (MLR); AP position 1 (APP1), AP position 2 (APP2) and AP range (APR). Cohen’s d showed a medium ES difference in sway area 0.65, 95% CI (0.49–0.63), whereas ML showed no (MLP1, MLP2) and large (MLR) ES differences; MLP1 0.15, 95% CI (0.08–0.22); MLP2 0.14, 95% CI (0.08–0.19); and MLR 0.94, 95% CI (0.83–1.04). Cohen’s d for AP showed small ES (APP1) and large ES difference (APP2 and APR); APP1 0.43, 95% CI (0.31–0.54); APP2 0.85, 95% CI (0.72–0.97); and APR 0.98, 95% CI (0.87–1.09). Cochran’s Q and Higgins I2 showed homogeneity between studies.

    Conclusions

    There is moderate quality evidence for decreased postural stability in AIS measured as COP parameters sway area, ML and AP range with a positional shift posteriorly in the sagittal plane. The findings support studying postural stability in early stage AIS and also prospectively identify cause and effect of the curvature as well as effectiveness of postural control interventions in the prevention of scoliosis progression.

  • 21.
    Folmli, Brookes
    et al.
    Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia.
    Turman, Bulent
    Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia.
    Johnson, Peter
    Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia.
    Dose-response of somatosensory cortex repeated anodal transcranial direct current stimulation on vibrotactile detection: A randomized sham controlled trial2018In: Journal of Neurophysiology, ISSN 0022-3077, E-ISSN 1522-1598Article in journal (Refereed)
    Abstract [en]

    This randomized sham-controlled trial investigated anodal transcranial direct current stimulation (tDCS) over the somatosensory cortex contralateral to hand dominance for dose-response (1mA-20 minutes x 5 days) effects on vibrotactile detection thresholds (VDT). VDT was measured before and after tDCS on days 1,3&5 for low (30hz) and high (200hz) frequency vibrations on the dominant and non-dominant hands in 29 healthy adults (mean age = 22.86; 15 males, 14 females). Only the dominant hand 200Hz VDT displayed statistically significant medium effect size improvement for mixed model analysis of variance time x group interaction for active tDCS compared to sham. Post Hoc contrasts were statistically significant for dominant hand 200Hz VDT on day 5 after tDCS compared to day 1 before tDCS , day 1 after tDCS and day 3 before tDCS. There was a linear dose-response improvement with dominant hand 200Hz VDT mean difference decreasing from day 1 before tDCS peaking at -15.5% (SD=34.9%) on day 5 after tDCS. Both groups showed learning effect trends over time for all VDT test conditions but only the non-dominant hand 30Hz VDT was statistically significant (p=0.03) though Post Hoc contrasts were non-significant after Sidak adjustment. No adverse effects for tDCS were reported. In conclusion, anodal tDCS 1mA-20 minutes x 5 days on the dominant sensory cortex can modulate a linear improvement of dominant hand high frequency VDT but not for low frequency or non-dominant hand VDT.

    The full text will be freely available from 2019-05-05 13:17
  • 22.
    Furness, James
    et al.
    Bond University. Gold Coast, Queensland, Australia.
    Climstein, Mike
    Bond University. Gold Coast, Queensland, Australia; The University of Sydney, Lidcombe, NSW, Australia.
    Sheppard, Jeremy M
    Edith Cowan University, Joondalup, Australia; Hurley Surfing Australia High Performance Centre, Casuarina Beach, Australia.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Bond University. Gold Coast, Queensland, Australia.
    Hing, Wayne
    Bond University. Gold Coast, Queensland, Australia.
    Clinical methods to quantify trunk mobility in an elite male surfing population2016In: Physical Therapy in Sport, ISSN 1466-853X, E-ISSN 1873-1600, Vol. 19, p. 28-35Article in journal (Refereed)
    Abstract [en]

    Background

    High numbers of acute shoulder and chronic lumbar injuries have been identified in a surfing population. A simple screening tool could be used to determine whether thoracic spine dysfunction is a possible contributor to shoulder or lumbar injuries. Importantly, thoracic mobility in the sagittal and horizontal planes are key requirements in the sport of surfing; however to date the normal values of these movements have not yet been quantified in a surfing population.

    Objectives

    To develop a reliable method to quantify thoracic mobility in the sagittal plane; to assess the reliability of a thoracic rotation method, and quantify thoracic mobility in an elite male surfing population.

    Design

    Clinical Measurement, reliability (repeated measures) and comparative study. Methods: 27 subjects were used to determine the reliability of a new method to assess thoracic mobility in the sagittal plane and 30 subjects were used to confirm the reliability of an existing thoracic rotation method. A total of 15 elite surfers were used as part of a comparative analysis with age and gender matched controls. Results: Intra-rater reliability (within and between session) intraclass correlation coefficient (ICC) values ranged between 0.95 - 0.99 for both thoracic methods in the sagittal plane and between 0.95 – 0.98 for the rotation method. There was no significant difference in the amount of thoracic mobility in the sagittal plane between groups; however the elite surfing group had significantly (p ≤ 0.05) greater rotation than the comparative group (mean rotation 63.57° versus 40.80° respectively). Symmetry was also confirmed between left and right thoracic rotation in the elite surfing group (63.06 versus 64.01). Conclusion: This study has illustrated reliable methods to assess the thoracic spine in the sagittal and horizontal planes. It has also quantified ROM in a surfing cohort; identifying thoracic rotation as a key movement. This information may provide clinicians, coaches and athletic trainers with imperative information regarding the importance of maintaining adequate thoracic rotation and symmetry. From a screening perspective thoracic rotation should be assessed for performance purposes and to limit the potential for injury in the thoracic spine or in surrounding regions.

  • 23.
    Furness, James
    et al.
    Bond University, Gold Coast, Queensland, Australia.
    Hing, Wanyne A.
    Bond University, Gold Coast, Queensland, Australia.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Bond University, Gold Coast, Queensland, Australia.
    Walsh, Joe
    Bond University, Gold Coast, Queensland, Australia.
    Sheppard, Jeremy M.
    Hurley Surfing Australia High Performance Centre.
    Climstein, Mike
    Retrospective analysis of chronic injuries in recreational and competitive surfers: injury, location, type and mechanism2014In: International Journal of Aquatic Research and Education, ISSN 1932-9997, E-ISSN 1932-9253, Vol. 8, no 3, p. 277-287Article in journal (Refereed)
    Abstract [en]

    Only two studies have reported on chronic musculoskeletal surfing injuries. They found over half of the injuries were non-musculoskeletal, but did not consider mechanisms of injury. This study identified the location, type, and mechanisms of chronic injury in Australian recreational and competitive surfers using a cross-sectional retrospective observational design. A total of 1,348 participants (91.3% males, 43.1% competitive surfers) reported 1,068 chronic injuries, 883 of which were classified as major. Lower back (23.2%), shoulder (22.4%), and knee (12.1%) regions had the most chronic injuries. Competitive surfers had significantly (p < .05) more lower back, ankle/foot, and head/face injuries than recreational surfers. Injuries were mostly musculoskeletal with only 7.8% being of non-musculoskeletal origin. Prolonged paddling was the highest frequency (21.1%) for mechanism of injury followed by turning maneuvers (14.8%). The study results contribute to the limited research on chronic surfing injuries.

  • 24.
    Furness, James
    et al.
    Water Based Research Unit, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD, Australia.
    Hing, Wayne
    Water Based Research Unit, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD, Australia.
    Walsh, Joe
    Medical Health and Fitness Clinic, Five Dock, Sydney, NSW, Australia ; Charles Darwin University, Darwin, NT, Australia .
    Abbott, Allan
    Water Based Research Unit, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD, Australia .
    Sheppard, Jeremy M
    Centre for Exercise and Sport Science Research, Edith Cowan University, Joondalup, Australia .
    Climstein, Mike
    Water Based Research Unit, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD, Australia .
    Acute Injuries in Recreational and Competitive Surfers: Incidence, Severity, Location, Type, and Mechanism2015In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 43, no 5, p. 1246-1254Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    There are an estimated 37 million surfers worldwide, with 2.5 million recreational surfers in Australia. The recreational activity and sport of surfing has grown dramatically since the 1960s, but scientific research has been poorly mirrored in comparison with most other mainstream sports.

    PURPOSE:

    To identify the incidence, severity, location, type, and mechanism of acute injuries in recreational and competitive surfers over a 12-month period.

    STUDY DESIGN:

    Descriptive epidemiology study.

    METHODS:

    An online survey using an open-source survey application was utilized. The survey consisted of 2 primary sections: Section 1 included demographic information and participation levels (age, height, weight, hours surfed, competitive level); section 2 incorporated injury type, mechanism, severity, and injury management.

    RESULTS:

    A total of 1348 participants (91.3% males; 43.1% competitive surfers) were included in data analysis. A total of 512 acute injuries were classified as major, providing an incidence proportion of 0.38 (CI, 0.35-0.41) acute injuries per year. The incidence rate was calculated to be 1.79 (CI, 1.67-1.92) major injuries per 1000 hours of surfing. The shoulder, ankle, and head/face regions had the highest frequencies of acute injury, representing 16.4%, 14.6%, and 13.3%, respectively. Injuries were predominantly of muscular, joint, and skin origin, representing 30.3%, 27.7%, and 18.9%, respectively. Skin injuries were primarily a result of direct trauma, while joint and muscular injuries were mainly a result of maneuvers performed and repetitive actions. Key risk factors that increased the incidence of sustaining an acute injury included competitive status, hours surfed (>6.5 hours/week), and the ability to perform aerial maneuvers. The incidence proportion for surfers completing aerial maneuvers was calculated to be 0.48 (CI, 0.39-0.58) major injuries per year, this being the highest incidence proportion irrespective of competitive status.

    CONCLUSION:

    This is the largest surfing-specific survey that included both recreational and competitive surfers conducted in Australia to date. The shoulder, ankle, head, and face were identified as the key regions where acute injuries occur in surfers. This research may aid in reducing the occurrence of injury through musculoskeletal screening in these key injury-prone regions and through the use of sport-specific strength training and conditioning.

  • 25.
    Furness, James
    et al.
    Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia.
    Johnstone, Scott
    Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia.
    Hing, Wayne
    Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia.
    Abbott, Allan
    Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia.
    Climstein, Mike
    Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia.
    Assessment of shoulder acitve range of motion in prone versus supine: a reliability and concurrent validity study2015In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 31, no 7, p. 489-495Article in journal (Refereed)
    Abstract [en]

    Background: As swimming and surfing are prone dominant sports, it would be more sport specific to assess shoulder active range of motion in this position. Objectives: To determine the reliability of the inclinometer and HALO© for assessing shoulder active range of motion in supine and prone and the concurrent validity of the HALO©. Concurrent validity is based on the comparison of the HALO© and inclinometer. To determine if active range of motion (AROM) differences exists between prone and supine when assessing shoulder internal (IR) and external rotation (ER). Design: The design included clinical measurement, reliability and validity. Methods: Thirty shoulders (mean age = 26.8 years) without pathology were evaluated. Measurements were taken in supine and prone with both an inclinometer and HALO© device. Results: Active ER ROM in prone was significantly higher than in supine when using both devices. Intra-rater reliability (within and between session) intraclass correlation coefficient (ICC) values ranged between 0.82–0.99 for both devices in supine and prone. An ICC test revealed a significant (p < 0.01) correlation for both devices in IR and ER movements (ICC3,1 = 0.87 and ICC3,1 = 0.72), respectively. Conclusion: This study has shown prone assessment of active ER and IR ROM to be a reliable and appropriate method for prone dominant athletes (swimmers and surfers). In this study greater ER ROM was achieved in prone compared to supine. This finding highlights the importance of standardizing the test position for initial and follow up assessments. Furthermore the HALO© and inclinometer have been shown to be reliable tools that show good concurrent validity.

  • 26.
    Green, A
    et al.
    Bond University, Australia.
    Gilbert, P
    Bond University, Australia; Physiomax, Gold Coast, Australia.
    Scott-Young, M
    Gold Coast Spine, Gold Coast, Australia.
    Abbott, Allan
    Bond University, Australia.
    The effect of physiotherapeutic rehabilitation following lumbar total disc replacement2013In: APA Conference 2013: New moves, Australian Physiotherapy Association , 2013, p. 2-2Conference paper (Other academic)
    Abstract [en]

    Question: What is the effect of physiotherapeutic rehabilitation post total disc replacement?

    Design: Retrospective cohort study.

    Participants: Six hundred patients who received lumbar disc replacement (TDR) or hybrid surgery (TDR + fusion) between 1997 and 2008.

    Intervention: Group 1 received no post-surgical physiotherapy. Group 2 received one to three physiotherapy sessions. Group 3 received four or more physiotherapy sessions.

    Outcome Measures: Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMQ), Short Form-36 Physical (SF-36 PCS). Preoperative measures taken at baseline, and again at follow-up at 3, 6, 12 and 24 months postoperatively were audited.

    Results: RMQ demonstrated a significant better improvement in Group 3 compared to Group 1 after 3, 6, 12 and 24 months (p = 0.001, <0.001, 0.001 and 0.04, respectively), and for Group 2 compared to Group 1 after 3 and 6 months (p = 0.01 and 0.01, respectively). A significant better change in Group 3 compared to Group 1 was seen in the ODI after 3, 6 and 12 months (p = 0.007, p = 0.006 and 0.003, respectively). A significant better change in Group 2 compared to Group 1 was observed in the SF-36 PCS after 6 months (p = 0.01). A significant better change in Group 3 compared to Group 1 for SF-36 PCS at 6, 12 and 24 months (p = <0.001, 0.012 and 0.004, respectively) was observed.

    Conclusion: Four or more sessions of post-operative physiotherapy demonstrated consistent statistically significant improvements in functional disability outcomes. However, these results were not considered clinically significant.

    Key Practice Points:

    •  Four or more sessions of post-operative physiotherapy may improve functional disability outcomes in patients post TDR surgery.

    •  Prospective randomised controlled trials evaluating the effectiveness of specific physiotherapy interventions post-TDR surgery are indicated.

  • 27.
    Green, Adeline
    et al.
    Faculty of Health Science and Medicine, Bond University, Queensland, Australia; Physiomax, Gold Coast, Australia.
    Gilbert, Philippa
    Faculty of Health Science and Medicine, Bond University, Queensland, Australia; Physiomax, Gold Coast, Australia.
    Scott-Young, Matthew
    Karolinska University Hospital, Sweden; Gold Coast Spine, Gold Coast, Australia.
    Abbott, Allan
    Faculty of Health Science and Medicine, Bond University, Queensland, Australia; Department of Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Physiotherapeutic rehabilitation following lumbar total disc replacement: A retrospective study2016In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 21, no 3, p. 155-163Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE:

    This study sought to answer the following questions: What are the outcomes of physiotherapy post lumbar total disc replacement (LTDR) compared with patient self-mediated rehabilitation? Is a difference in outcomes related to the number of physiotherapy sessions?

    METHODS:

    This is a retrospective observational study of 600 patients post TDR. Patient outcomes for self-mediated rehabilitation (Group 1), 1-3 sessions of clinic-based physiotherapy (Group 2) and ≥4 sessions of clinic-based physiotherapy (Group 3) were analysed. Outcomes measures included the Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMQ), Short Form-36 Physical (SF-36 PCS) and Mental Subscale Components (SF-36 MCS), Visual Analogue Scale (VAS) for back and leg pain intensity. Patient's pre-operative baseline measures and post-operative follow-up measures at 3, 6, 12 and 24 months post-operatively were analysed.

    RESULTS:

    Oswestry Disability Index and RMQ had significantly lower scores in Group 3 compared with Group 1 at 3, 6, 12 and 24 months follow-up. Significantly lower scores for Group 2 compared with Group 1 were observed for the ODI at 3 months follow-up and for the RMQ at 3 and 6 months follow-up. Significantly lower scores were observed in Group 3 compared with Group 1 for VAS back pain at 3 months and VAS leg pain at 6 months follow-up. Significantly higher scores in Group 3 compared with Group 1 were also observed in the SF-36 PCS at 6, 12 and 24 months. Significantly higher scores in Group 2 compared with Group 1 were observed at 6 months follow up. These trends were also observed when investigating the percentage of patients with a greater 50% improvement in the outcome measure.

    CONCLUSIONS:

    Physiotherapy post-LTDR produces statistically significant and possibly clinically important improvements in functional disability, pain and quality of life outcomes compared with self-mediated rehabilitation. Copyright © 2015 John Wiley & Sons, Ltd.

  • 28.
    Halvorsen, Marie
    et al.
    Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden .
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden; Bond University, Gold Coast, Australia .
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. University of Queensland, Brisbane, Australia .
    Dedering, Åsa
    Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden .
    Endurance and fatigue characteristics in the neck muscles during sub-maximal isometric test in patients with cervical radiculopathy2014In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 23, no 3, p. 590-598Article in journal (Refereed)
    Abstract [en]

    Purpose

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

    Methods

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

    Results

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

    Conclusion

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

  • 29.
    Halvorsen, Marie
    et al.
    Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Abbott, Allan
    Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Stephansson-Dedering, Åsa
    Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Endurance and fatigue characteristics of static test of the neck muscles in patients with cervical radiculopathy2012In: Proceedings of the XIXth Congress of the International Society of Electrophysiology and Kinesiology / [ed] Kylie Tucker; Bianca Butler; Paul Hodges, The International Society of Electrophysiology and Kinesiology (ISEK) , 2012, p. 55-55Conference paper (Other academic)
    Abstract [en]

    INTRODUCTION: Neck muscle function is important for support and control of the cervical spine. With the application of frequency analysis of the electromyography (EMG) signal, the fatigue rate of muscles can be monitored. In several EMG studies, the neck muscles have been shown to fatigue faster in subjects with neck pain. This can be seen when the median frequency (MF) decreases when a contraction is sustained.

    AIM: In this experimental study the purpose was to evaluate patients with cervical radiculopathy compared to healthy subjects regarding changes in neckZmuscle fatigue during static endurance test in prone and supine.

    METHODS: A total of 33 patients (19 women and 14 men) with cervical radiculopathy and 28 healthy subjects (17 women and 11 men) were included in the study. Neck muscle fatigue was studied using EMG with surface electrodes bilaterally on cervical paraspinal and sternocleidomastoid muscle groups with electrode placement according to SENIAM. Measurements of neck muscle fatigue were performed in supine and prone positions until patient perceived time till exhaustion. Subjective neck muscle fatigue was rated on a Borg CRZ10 scale while subjective neck pain was measured on 0Z10 Visual analogue scale (VAS). Patients with cervical radiculopathy even completed the Neck Disability Index (NDI).

    RESULTS: The mean endurance time during static extension between groups was significantly different (p<0.001) with cervical radiculopathy patients recording 190 seconds (Sd=119) and the healthy subjects 509 seconds (Sd=213). Differences in mean endurance time during static flexion between groups were nonZsignificant with cervical radiculopathy patients recording 64 seconds (Sd=40) and the healthy subjects 96 seconds (Sd=69). Cervical radiculopathy patients MF EMG slope (Z0.039) for the right cervical paraspinal muscles significantly decreased (p=0.009) more the healthy subjects (Z0.017) during the extension test. NDI significantly correlated with MF EMG slope for both left (r=Z0.631 p= 0.001) and right side (r=Z0Z496 p=0.014) cervical paraspinal muscles during extension for the patient group.

    CONCLUSION:  Patients with cervical radiculopathy perform similar to healthy subjects with regards to static supine flexion endurance time and cervical muscle fatigue. Patients with cervical radiculopathy however have significantly lower endurance times and fatigue faster in the right side cervical paraspinal muscles during static prone extension.

    ACKNOWLEDGEMENT: The authors declare no conflicts of interest. The present study was supported by funds from Karolinska Institute.

  • 30.
    Imbesi, S
    et al.
    Bond university, Australia.
    Murnane, A
    Peter MacCallum Cancer Institute, Melbourne, Australia.
    Patchell, S
    Peter MacCallum Cancer Institute, Melbourne, Australia.
    Columbe, M
    Peter MacCallum Cancer Institute, Melbourne, Australia.
    Keogh, J
    Bond university, Australia.
    Abbott, Allan D
    Bond university, Australia.
    Functional decline and quality of life in the inpatient oncology setting.2013In: APA Conference 2013: New moves, Australian Physiotherapy Association , 2013, p. 3-3Conference paper (Other academic)
    Abstract [en]

    Question: What effect does inpatient oncology treatment have on patient quality of life and physical functioning? Does recent weight loss associated with inferior physical functioning in patients admitted for inpatient oncology treatment? What are the implications for physiotherapy practice?

    Design: Prospective observational cohort study

    Participants: Thirty-two patients receiving inpatient oncology treatment.

    Outcome Measures: EORTC-30, SF8, isometric muscle strength, 30 second arm curl, sit to stand and timed up and go.

    Results: The EORTC-30 and SF-8 physical functioning and fatigue scales as well as timed up and go and sit to stand functional measures showed a trend of weekly decline in performance during inpatient oncology treatment but changes were not statistically different from baseline. Emotional and cognitive functioning and the 30 second arm curl however improved compared to baseline (p = <0.05). Social functioning showed a decline at two weeks compared to baseline (p = <0.05). Bivariate correlation analysis of baseline data showed sit to stand (r = -0.52), isometric knee extension (r = -0.39) and foot dorsiflexion (r = -0.42) strength to be significantly negatively associated with weight loss (p = <0.05).

    Conclusion: Despite non-significant decline in physical functioning during inpatient oncology treatment, comparison to healthy aged matched normative values showed obvious inferiority in quality of life and physical functioning at time of admission to hospital.

    Key Practice Points:

    •  Physiotherapy management of patients in the inpatient oncology setting should focus on preventing decline in physical and social functioning.

    •  Patients with greater reported weight loss may be more prone to larger declines in physical functioning in the inpatient oncology setting.

  • 31.
    Karlsson, Linda
    et al.
    Barn- och ungdomshabiliteringen, Region Skåne, Kristianstad, Sverige.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Effekter av styrketräning för barn med cerebral pares2015In: Fysioterapi, ISSN 1653-5804, Vol. 9, p. 38-42Article, review/survey (Other academic)
    Abstract [sv]

    I Sverige föds ungefär 200 barn med cerebral pares (CP) varje år. CP innebär en störning av rörelseförmågan orsakad av skada som drabbar den icke färdigutvecklade hjärnan. Personer med CP har rätt till habiliterande insatser, där fysioterapeut är en av professionerna. Vilka insatser som ges utgår från barnens behov och deras grovmotoriska förmåga. Gross Motor Function Classification System är ett sätt att klassificera grovmotorisk förmåga hos barn med cerebral pares. Klassificeringen är främst inriktad på funktionen att sitta och gå. Denna översiktsartikel fokuserar på den bästa tillgängliga kunskapen om effekterna av styrketräning för barn med CP med en funktionsnivå på GMFCS 1–3. Fokus läggs mot områdena muskelstyrka, förflyttningsförmåga och smärta. Dessutom redovisas i artikeln vilka rekommendationer kring upplägg av träning gällande frekvens, intensitet och duration som finns i den granskade litteraturen. Effekter av styrketräning på muskelstyrka hos barn med cerebral pares visar olika resultat i litteraturen, från ingen signifikant förbättring till ökning i knäextensorer, höftextensorer, höftabduktorer och knäflexorer. Vad gäller förflyttningsförmåga visar litteraturen ingen signifikant effekt av styrketräning. En studie har visat effekt på gånghastighet, samt ökad extension av höft och knä i ståfasen under gång. Det saknas litteratur som undersöker effekter på smärta. Studier som ger klarhet i hur träningen bör läggas upp gällande frekvens, intensitet och duration finns inte. Vidare forskning behövs inom dessa områden.

  • 32.
    Kyhlbäck, Maria
    et al.
    Sjukgymnastikavdelningen, Akademiska sjukhuset, Uppsala.
    Kjellby Wendt, Gunilla
    Sjukgymnastik och Arbetsterapiverksamheten, Sahlgrenska Universitetssjukhuset, Göteborg.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Sjukgymnastikkliniken, Karolinska Universitetssjukhuset, Huddinge.
    Millisdotter, Monica
    VO Rehabiliteringsmedicin, Universitetssjukhuset i Lund.
    Grönlund, Per
    Ortopedens ryggkirurgiska mottagning, Östersund.
    Johansson, Mia
    Ortopedkliniken, Norrlands Universitets Sjukhus, Umeå.
    Johansson, Ann -Christin
    Mälardalens Högskola/Centrum för klinisk forskning, Centrallasarettet, Västerås.
    Postoperativ rehabilitering vid ländryggsdiskbråck2011In: Fysioterapi, ISSN 1653-5804, no 1, p. 32-37Article in journal (Refereed)
    Abstract [en]

    Sedan några årtionden tillbaka är diskbråcksoperation en standardoperation som utförs på liknande sätt vid Sveriges ortopedkliniker. Det postoperativa omhändertagandet och rehabiliteringen av opererade patienter kan dock se olika ut, beroende på var operationen skett. Under 2008/09 har en grupp sjukgymnaster från olika delar av landet tagit fram nationella riktlinjer, baserat på vetenskaplig evidens och klinisk erfarenhet, vilket tidigare saknats för dessa patienter. Konklusionen är att sjukgymnastiken efter diskbråcksoperation bör vara inriktad på tidig, aktiv träning för att förbättra patienternas ryggfunktion och höja aktivitetsgraden efter operation, även om de positiva effekterna av den postoperativa träningen måste betraktas som kortsiktiga. En tidig återgång till aktiviteter som inkluderar ett aktivt förhållningssätt ger, förutom de kortsiktiga förbättringarna, troligen en positiv påverkan på patienternas inställning till smärta och aktivitet. Förhoppningen är att den aktuella, systematiskt sammanställda kunskapen ska bidra till diskussioner på enskilda arbetsplatser och att behandlingsrekommendationerna kan anpassas till lokala förhållanden.

  • 33.
    Lindbäck, Yvonne
    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, Primary Health Care in Central County.
    Tropp, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Spinal Surgery. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Enthoven, Paul
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Bond University, Queensland, Australia.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    PREPARE: presurgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial2018In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 18, no 8, p. 1347-1355Article in journal (Refereed)
    Abstract [en]

    Background Context

    Surgery because of disc herniation or spinal stenosis results mostly in large improvement in the short-term, but mild to moderate improvements for pain and disability at long-term follow-up. Prehabilitation has been defined as augmenting functional capacity before surgery, which may have beneficial effect on outcome after surgery.

    Purpose

    The aim was to study if presurgery physiotherapy improves function, pain, and health in patients with degenerative lumbar spine disorder scheduled for surgery.

    Study Design

    A single-blinded, two-arm, randomized controlled trial (RCT).

    Patient Sample

    A total of 197 patients were consecutively included at a spine clinic. The inclusion criteria were patients scheduled for surgery because of disc herniation, spinal stenosis, spondylolisthesis, or degenerative disc disease (DDD), 25–80 years of age.

    Outcome Measures

    Primary outcome was Oswestry Disability Index (ODI). Secondary outcomes were pain intensity, anxiety, depression, self-efficacy, fear avoidance, physical activity, and treatment effect.

    Methods

    Patients were randomized to either presurgery physiotherapy or standardized information, with follow-up after the presurgery intervention as well as 3 and 12 months post surgery. The study was funded by regional research funds for US$77,342. No conflict of interest is declared.

    Results

    The presurgery physiotherapy group had better ODI, visual analog scale (VAS) back pain, EuroQol-5D (EQ-5D), EQ-VAS, Fear Avoidance Belief Questionnaire-Physical Activity (FABQ-PA), Self-Efficacy Scale (SES), and Hospital Anxiety and Depression Scale (HADS) depression scores and activity level compared with the waiting-list group after the presurgery intervention. The improvements were small, but larger than the study-specific minimal clinical important change (MCIC) in VAS back and leg pain, EQ-5D, and FABQ-PA, and almost in line with MCIC in ODI and Physical Component Summary (PCS) in the physiotherapy group. Post surgery, the only difference between the groups was higher activity level in the physiotherapy group compared with the waiting-list group.

    Conclusions

    Presurgery physiotherapy decreases pain, risk of avoidance behavior, and worsening of psychological well-being, and improves quality of life and physical activity levels before surgery compared with waiting-list controls. These results were maintained only for activity levelspost surgery. Still, presurgery selection, content, dosage of exercises, and importance of being active in a presurgery physiotherapy intervention is of interest to study further to improve long-term outcome.

    The full text will be freely available from 2018-12-17 11:55
  • 34.
    Lindbäck, Yvonne
    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, Primary Health Care in Central County.
    Tropp, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Enthoven, Paul
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Faculty of Health Science and Medicine, Bond University, Australia.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    PREPARE: Pre-surgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial protocol2016In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 17, no 270Article in journal (Refereed)
    Abstract [en]

    Background: Current guidelines for the management of patients with specific low back pain pathology suggest non-surgical intervention as first-line treatment, but there is insufficient evidence to make recommendations of the content in the non-surgical intervention. Opinions regarding the dose of non-surgical intervention that should be trialled prior to decision making about surgery intervention vary. The aim of the present study is to investigate if physiotherapy administrated before surgery improves function, pain and health in patients with degenerative lumbar spine disorder scheduled for surgery. The patients are followed over two years. A secondary aim is to study what factors predict short and long term outcomes. Methods: This study is a single blinded, 2-arm, randomized controlled trial with follow-up after the completion of pre-surgery intervention as well as 3, 12 and 24 months post-surgery. The study will recruit men and women, 25 to 80 years of age, scheduled for surgery due to; disc herniation, spinal stenosis, spondylolisthesis or degenerative disc disease. A total of 202 patients will be randomly allocated to a pre-surgery physiotherapy intervention or a waiting list group for 9 weeks. The waiting-list group will receive standardized information about surgery, post-surgical rehabilitation and advice to stay active. The pre-surgery physiotherapy group will receive physiotherapy 2 times per week, consisting of a stratified classification treatment, based on assessment findings. One of the following treatments will be selected; a) Specific exercises and mobilization, b) Motor control exercises or c) Traction. The pre-surgery physiotherapy group will also be prescribed a tailor-made general supervised exercise program. The physiotherapist will use a behavioral approach aimed at reducing patient fear avoidance and increasing activity levels. They will also receive standardized information about surgery, post-surgical rehabilitation and advice to stay active. Primary outcome measure is Oswestry Disability Index. Secondary outcome measures are the visual analogue scale for back and leg pain, pain drawing, health related quality of life, Hospital anxiety and depression scale, Fear avoidance beliefs questionnaire, Self-efficacy scale and Work Ability Index. Discussion: The study findings will help improve the treatment of patients with degenerative lumbar spine disorder scheduled for surgery.

  • 35.
    Lindbäck, Yvonne
    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, Primary Health Care in Central County.
    Tropp, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Spinal Surgery.
    Enthoven, Paul
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Bond University, Australia.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Altered somatosensory profile according to quantitative sensory testing in patients with degenerative lumbar spine disorders scheduled for surgery2017In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, article id 264Article in journal (Refereed)
    Abstract [en]

    Background: Somatosensory profiling in affected and non-affected body regions can strengthen our insight regarding the underlying pain mechanisms, which can be valuable in treatment decision making and to improve outcomes, in patients with degenerative lumbar spine disorders pre-surgery. The aim was to describe somatosensory profiles in patients with degenerative lumbar spine disorders, to identify the proportion with altered somatosensory profile, and to analyze demographic characteristics, self-reported function, pain, and health pre- and 3 months post-surgery. Methods: In this prospective cohort study in a Spine Clinic, 105 patients scheduled for surgery for spinal stenosis, disc herniation, degenerative disc disease, or spondylolisthesis were consecutively recruited. Exclusion criteria were; indication for acute surgery or previous surgery at the same spinal level or severe grade of pathology. Quantitative sensory testing (QST) and self-reported function, pain, and health was measured pre- and 3 months post-surgery. The somatosensory profile included cold detection threshold, warmth detection threshold, cold pain threshold, heat pain threshold and pressure pain threshold in affected and non-affected body regions. Results: On a group level, the patients somatosensory profiles were within the 95% confidence interval (CI) from normative reference data means. On an individual level, an altered somatosensory profile was defined as having two or more body regions (including a non-affected region) with QST values outside of normal ranges for reference data. The 23 patients (22%) with altered somatosensory profiles, with mostly loss of function, were older (P = 0.031), more often female (P = 0.005), had higher back and leg pain (P = 0.016, 0.020), lower mental health component summary score (SF 36 MCS) (P = 0.004) and larger pain distribution (P = 0.047), compared to others in the cohort. Post-surgery there was a tendency to worse pain, function and health in the group with altered somatosensory profile pre-surgery. Conclusions: On a group level, patients with degenerative lumbar spine disorders scheduled for surgery were within normal range for the QST measurements compared to reference values. On an individual level, an altered somatosensory profile outside of normal range in both affected and non-affected body regions occurred in 22% of patients, which may indicate disturbed somatosensory function. Those patients had mostly loss of sensory function and had worse self-reported outcome pre-surgery, compared to the rest of the cohort. Future prospective studies are needed to further examine whether these dimensions can be useful in predicting post-surgery outcome and guide need of additional treatments.

  • 36.
    Lindbäck, Yvonne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Tropp, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Spinal Surgery.
    Enthoven, Paul
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Faculty of Health Science and Medicine, Bond University, Gold Coast, Australia.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Association between pain sensitivity in the hand and outcomes after surgery in patients with lumbar disc herniation or spinal stenosis.2017In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 26, no 10, p. 2581-2588Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 37.
    Murnane, Andrew
    et al.
    Peter MacCallum Cancer Centre, Melbourne, Vic, Australia.
    Keogh, Justin
    Peter MacCallum Cancer Centre, Melbourne, Vic, Australia.
    Magat, Fiona
    Faculty of Health Science and Medicine, Bond University, Gold Coast, QLD, Australia.
    Imbesi, Sonya
    Faculty of Health Science and Medicine, Bond University, Gold Coast, QLD, Australia.
    Coulombe, Marie
    Peter MacCallum Cancer Centre, Melbourne, Vic, Australia.
    Patchell, Sharni
    Peter MacCallum Cancer Centre, Melbourne, Vic, Australia.
    Abbott, Allan
    Faculty of Health Science and Medicine, Bond University, Gold Coast, QLD, Australia.
    The impact of an inpatient hospital admission on patient’s physical functioning and quality of life rate in the oncology setting2014In: COSA’s 41st Annual Scientific Meeting: Poster Abstracts, Clinical Oncology Society of Australia , 2014, Vol. 10 (Suppl. 8), p. 204-204Conference paper (Other academic)
    Abstract [en]

    Introduction: Prolonged bed rest is often associated with acute inpatient hospital admissions, has been shown to significantly decrease patient’s physical function and health related quality of life (HRQoL). The aim of this study was to investigate the effects of hospitalisation and to describe the pattern and prevalence of functional decline in oncology patients over the course of their inpatient admission.

    Methods: This was a prospective observational study of 55 consenting inpatients recruited over a 10 week period.  Assessment measures were undertaken bi-weekly until discharge from hospital or they became too unwell to continue. Functional status and HRQoL data were collected using the, timed up and go test (TUG), 30-second chair sit to stand (STS), 30-second arm curl, isometric muscle strength testing, EORTC-C30 and SF-8.

    Results: 55 patients (28 male), median age 64 years (± SD 10.8) with an average length of stay of 18 days participated in the study. Reason for hospital admission included; symptom management (36%) or delivery of cancer treatment (35%). A number of subscales on the EORTC-C30 including physical functioning and functional assessments (TUG, STS and knee extension) showed a trend of weekly decline in performance but were not statistically significant. Compared to the general population 87% and 82% of the cohort scored below the norm in physical functioning and mental health respectively; 43% recorded TUG indicative of falls risks; 76% were below age matched norms for STS and 20% were below in upper limb strength.

    Conclusion: Despite non-significant declines in physical functioning and HRQoL during their hospital admission, participants demonstrated substantially reduced HRQoL and physical functioning at time of hospital admission and at discharge compared to healthy age-matched normative data. Despite this low level of function very few received rehabilitation follow-up. Screening programs using simple functional assessment measures (STS, TUG) could be useful in identifying patients at risk of deconditioning and those who require specialised input on discharge to prevent further declines in function and hospital re-admissions.

  • 38.
    Murnane, Andrew
    et al.
    ONTrac at Peter Mac, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Physiotherapy Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
    Keogh, Justin
    Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia; Human Potential Centre, AUT University, Auckland, New Zealand; Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sunshine Coast, Australia.
    Magat, Fiona
    Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
    Imbesi, Sonya
    Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
    Coulumbe, Marie
    Physiotherapy Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
    Patchell, Sharni
    Physiotherapy Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
    The impact of an inpatient hospital admission on patients’ physical functioning and quality of life in the oncology setting2015In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 5, no 7, p. 75-82Article in journal (Refereed)
    Abstract [en]

    Objective: Cancer can affect an individual’s level of physical function and health related quality of life (HRQoL). Those requiring hospital admission may be at risk of further decline during hospitalisation. The aim of this study was to investigate physical functioning and HRQoL of cancer patients on admission and over the course of their hospital admission.

    Methods: A prospective observational study was undertaken on the inpatient wards of a specialist oncology hospital. Assessment measures were taken bi-weekly until discharge from hospital or if they became too unwell to continue. Functional outcome measures included timed-up and go test (TUG), 30 second sit to stand test (30SST), 30 second arm curl test and isometric muscle strength (30ACT). HRQoL was assessed via the EORTC-C30 and SF-8 and distress was measured using the Distress Thermometer.

    Results: Fifty-five patients (28 males), mean age 64 years ± 10.8, with an average length of stay of 19 days participated in the study. Primary reasons for hospital admission included; symptom management (36%) or delivery of cancer treatment (35%). On hospital admission, the majority of patients scored worse than normative levels on the EORTC-C30 and SF-8. Similarly, 65%, 69% and 35% recorded below age norms for TUG, 30SST and 30ACT. Most measures showed a trend towards worsening during hospitalisation with up to 59% of patients experiencing ± 10% worsening over time. However, only role and social functioning (p < .05), as well as financial difficulty showed statistically significant worsening (p < .05) during hospitalisation.

    Conclusions: Participants demonstrated substantially reduced HRQoL and physical functioning at time of hospital admission which tended to worsen during hospitalisation. Despite this low level of function, very few received rehabilitation follow-up. Screening programs using HRQoL and functional assessment measures could be useful in identifying patients who are deconditioned or at risk of deconditioning and require specialised therapy to prevent declines in function and hospital re-admissions.

  • 39.
    Palak, A
    et al.
    Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
    Smith, C
    Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
    Abbott, Allan
    Health Sciences, Bond University, Gold Coast, QLD, Australia.
    Rizkallah, N
    Health Sciences, Bond University, Gold Coast, QLD, Australia.
    Motor assessment score. Is it fit for the future?2014In: Special Issue: SMART STROKES 2014 Conference, 28-29 August 2014, Sheraton on the Park, Sydney, NSW, Australia, John Wiley & Sons, 2014, Vol. Vol 9 (Suppl. 2), p. 10-10Conference paper (Other academic)
    Abstract [en]

    Background: The Motor Assessment Scale (MAS) is commonly used to assess functional change in stroke patients. Anecdotal evidence suggests that the scale does not accurately reflect patient outcomes potentially impacting on physiotherapists’ use of the scale.

    Aims: This study aims to investigate physiotherapists use and perceived utility of the MAS to measure functional performance of stroke survivors undergoing rehabilitation.

    Method: A purpose-designed 29-item online survey was distributed to Queensland Rehabilitation Physiotherapy Network members. Open and closed questions were asked regarding demographics, MAS implementation, perception of item subtest hierarchy and levels of difficulty and adherence to scoring guidelines.

    Results: Thirty-one surveys were received; 63% were from physiotherapists in metropolitan centers, 84% from public hospitals and 61% insubacute settings. Approximately half (45%) had been practicing in neurological rehabilitation for 5–10 years. More than 70% of respondents routinely used the MAS. The majority (80%) reported using the recommended guidelines when scoring the MAS, though 55% did not score all subsets of Item 8. Most were dissatisfied with hierarchy and levels of difficulty of item subtests, with no item scoring 100% satisfaction by respondents. Thirty percent of respondents did not use the MAS. Common reasons included: too time consuming (56%), not sensitive to change (22%), lack of confidence in administration (33%), items not relevant for patient function (45%) and ceiling effect (44%).

    Conclusion: MAS use varies across rehabilitation units in Queensland. Difficulties were identified with all items, including use of recommended scoring guidelines. Further research is required to address these issues.

  • 40.
    Prowse, Ashleigh
    et al.
    Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia.
    Aslaksen, Berit
    Department of Physiotherapy, Karolinska University Hospital, Huddinge, Sweden.
    Kierkegaard, Marie
    Department of Physiotherapy, Karolinska University Hospital, Huddinge, Sweden; Department of Neurobiology, Care Sciences and Society (NVS), Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.
    Furness, James
    Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia.
    Gerdhem, Paul
    Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Huddinge, Sweden.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia.
    Reliability and concurrent validity of postural asymmetry measurement in adolescent idiopathic scoliosis.2017In: World Journal of Orthopedics, ISSN 2218-5836, E-ISSN 2218-5836, Vol. 8, no 1, p. 68-76Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate the reliability and concurrent validity of the Baseline(®) Body Level/Scoliosis meter for adolescent idiopathic scoliosis postural assessment in three anatomical planes.

    METHODS: This is an observational reliability and concurrent validity study of adolescent referrals to the Orthopaedic department for scoliosis screening at Karolinska University Hospital, Stockholm, Sweden between March-May 2012. A total of 31 adolescents with idiopathic scoliosis (13.6 ± 0.6 years old) of mild-moderate curvatures (25° ± 12°) were consecutively recruited. Measurement of cervical, thoracic and lumbar curvatures, pelvic and shoulder tilt, and axial thoracic rotation (ATR) were performed by two trained physiotherapists in one day. The intraclass correlation coefficient (ICC) was used to determine the inter-examiner reliability (ICC2,1) and the intra-rater reliability (ICC3,3) of the Baseline(®) Body Level/Scoliosis meter. Spearman's correlation analyses were used to estimate concurrent validity between the Baseline(®) Body Level/Scoliosis meter and Gold Standard Cobb angles from radiographs and the Orthopaedic Systems Inc. Scoliometer.

    RESULTS: There was excellent reliability between examiners for thoracic kyphosis (ICC2,1 = 0.94), ATR (ICC2,1 = 0.92) and lumbar lordosis (ICC2,1 = 0.79). There was adequate reliability between examiners for cervical lordosis (ICC2,1 = 0.51), however poor reliability for pelvic and shoulder tilt. Both devices were reproducible in the measurement of ATR when repeated by one examiner (ICC3,3 0.98-1.00). The device had a good correlation with the Scoliometer (rho = 0.78). When compared with Cobb angle from radiographs, there was a moderate correlation for ATR (rho = 0.627).

    CONCLUSION: The Baseline(®) Body Level/Scoliosis meter provides reliable transverse and sagittal cervical, thoracic and lumbar measurements and valid transverse plan measurements of mild-moderate scoliosis deformity.

  • 41.
    Prowse, Ashleigh
    et al.
    Department of Physiotherapy, Faculty of Health Science and Medicine, Bond University, Robina, Australia.
    Pope, Rodney
    Department of Physiotherapy, Faculty of Health Science and Medicine, Bond University, Robina, Australia.
    Gerdhem, Paul
    Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Department of Physiotherapy, Karolinska University Hospital, Huddinge, Sweden.
    Reliability and validity of inexpensive and easily administered anthropometric clinical evaluation methods of postural asymmetry measurement in adolescent idiopathic scoliosis: a systematic review2016In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 25, no 2, p. 450-466Article, review/survey (Refereed)
    Abstract [en]

    PURPOSE:

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

    METHODS:

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

    RESULTS:

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

    CONCLUSIONS:

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

  • 42.
    Saraste, Helena
    et al.
    Karolinska University Hospital, Stockholm, Sweden.
    Abbott, Allan
    Katashev, A
    Murans, G
    3D analysis of spine and chest wall form and mobility. Application of a new method to evaluate treatment outcome in pediatric spine deformities2012Conference paper (Other academic)
    Abstract [en]

    Summary

    A new optical scanning method is applyed for a static and dynamic analysis of thorax and spine deformities in brace and surgically treated scoliosis patients to capture intervention dependent changes over time. The costs and additional information captured by the method is analysed.

    Introduction

    To evaluate the intervention dependent changes in spine and chest wall deformities, such as mobility of thorax, volume, symmetry of growth, and possible growth distorting factors are poorly known and should be studied. In patients with neuropathic spine deformities, the seat loading is of importance to enhance balanced sitting and preventing pressure problems. Quantitative methods to be used for over time comparisons need to be further developed.

    In adolescents the decision to treat a spine deformity is mainly based on radiographic findings, whereas many patients are more interested in how their body configuration deviates from the normality. There is a need to implement and evaluate a method for this purpose. In brace treated children and adolescents, a non-radiation producing examination is to prefer for repeated follow-up controls.

    Methods

    A consequtive series of children with spine deformity, who are enrolled in the treatment protocol, are invited to take part in the tests. In surgery group, tests are performed before and 3 months after surgery aimed to correct the spine and/or thorax deformity. In brace treatment and follow-up groups tests are made at the same time points as x-rays. The static and dynamic recordings are performed by and optic scanenr Artec 3D (Artec Group, San Diego, CA), and the sitting load distribution measurements with a sensor mat (Clin-seat Type 5315 by Tekscan, Boston, Massachusetts, USA). 60 children/year in brace treatment, 40 in surgery, and 50 in the follow-up group are estimated to be included. These methods´ costs and benefits as well as their added value for the clinical decision making will be evaluated after 2-3 years.

    Results

    A feasibility test shows that clinically small enough differences can be recorded and numerically expressed and analysed. An application on a consecutive, clinical patient group will be carried on.

    Conclusion

    The optical scanning method by Artec, allows a static and dynamic capturing of respiratoryassociated thorax movements and the changes of a spine deformity over time. The new method will be applied in a consecutive series of patients.

  • 43.
    Theis, Jennifer C
    et al.
    Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University; Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital.
    Grauers, Anna
    Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital; Department of Orthopaedics, Sundsvall and Härnösand County Hospital.
    Diarbakerli, Elias
    Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital.
    Savvides, Panayiotis
    Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University; Department of Physical Therapy, Karolinska University Hospital; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
    Gerdhem, Paul
    Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital.
    An observational study on surgically treated adult idiopathic scoliosis patients' quality of life outcomes at 1- and 2-year follow-ups and comparison to controls.2017In: Scoliosis and spinal disorders, ISSN 2397-1789, Vol. 12, no 11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Prospective data on health-related quality of life in patients with idiopathic scoliosis treated surgically as adults is needed. We compared preoperative and 1- and 2-year follow-up data in surgically treated adults with idiopathic scoliosis with juvenile or adolescent onset. Results were compared to untreated adults with scoliosis and population normative data.

    METHODS: A comparison of preoperative and 1- and 2-year follow-up data of 75 adults surgically treated for idiopathic scoliosis at a mean age of 28 years (range 18 to 69) from a prospective national register study, as well as a comparison with age- and sex-matched data from 75 untreated adults with less severe scoliosis and 75 adults without scoliosis, was made. Outcome measures were EuroQol-5 dimensions (EQ-5D) and Scoliosis Research Society (SRS)-22r questionnaire.

    RESULTS: In the surgically treated, EQ-5D and SRS-22r scores had statistically significant improvements at both 1- and 2-year follow-ups (all p  < 0.015). The effect size of surgery on EQ-5D at 1-year follow-up was large (r = -0.54) and small-medium (r = -0.20) at 2-year follow-up. The effect size of surgery on SRS-22r outcomes was medium-large at 1- and 2-year follow-ups (r = -0.43 and r = -0.42 respectively). At the 2-year follow-up, the EQ-5D score and the SRS-22r subscore were similar to the untreated scoliosis group (p = 0.56 and p = 0.91 respectively), but lower than those in the adults without scoliosis (p < 0.001 for both comparisons).

    CONCLUSIONS: Adults with idiopathic scoliosis experience an increase in health-related quality of life following surgery at 2-year follow-up, approaching the health-related quality of life of untreated individuals with less severe scoliosis, but remain lower than normative population data.

  • 44.
    Theis, Jennifer
    et al.
    Department of Clinical and Rehabilitation Services, Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Australia.
    Gerdhem, Paul
    Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Abbott, Allan
    Department of Clinical and Rehabilitation Services, Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Australia; Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Quality of life outcomes in surgically treated adult scoliosis patients: A systematic review2015In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 24, no 7, p. 1343-1355Article, review/survey (Refereed)
    Abstract [en]

    PURPOSE:

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

    METHOD:

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

    RESULTS:

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

    CONCLUSION:

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

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