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  • 1.
    Abbott, Allan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia.
    Evidence base and future research directions in the management of low back pain2016Ingår i: World Journal of Orthopedics, E-ISSN 2218-5836, Vol. 7, nr 3, s. 156-161Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 2.
    Abbott, Allan
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping. Bond University, Gold Coast, Australia.
    Allard, Michael
    Bond University, Gold Coast, Australia.
    Kierkegaard, Marie
    Karolinska University Hospital, Stockholm, Sweden; Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden; Karolinska Institutet, Huddinge, Sweden.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Dedering, Åsa
    Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden.
    What biopsychosocial factors are associated with work ability in conservatively managed patients with cervical radiculopathy?: A cross-sectional analysis2020Ingår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, PM R, Vol. 12, nr 1, s. 64-72Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    No previous studies have investigated what biopsychosocial factors are associated with self‐reported work ability in conservatively managed patients with cervical radiculopathy.

    Objective

    To develop a theoretical model of factors and potential processes associated with variation in work ability based on a thorough assessment of biopsychosocial variables in conservatively managed patients with cervical radiculopathy.

    Design

    Cross‐sectional observational study.

    Setting

    Tertiary neurosurgery clinic.

    Patients

    A total of 144 conservatively managed patients with cervical pain and radiculopathy participated in the study.

    Methods

    From 64 biopsychosocial candidate variables, significant (P < .05) bivariate correlators with Work Ability Index (WAI) were entered as independent variables in a categorical regression. Elastic net regularization maintained the most parsimonious set of independent variables significantly associated with variation in WAI as the dependent variable. Process analysis of significant independent variable associations with WAI was performed.

    Main Outcome Measurement

    WAI.

    Results

    From 42 bivariate correlates of WAI, multivariate regression displayed a total of seven variables that were significantly (F [25,98] = 5.74, P < .05) associated with 65.8% of the variation in WAI. The Neck Disability Index (NDI) and Fear‐Avoidance Beliefs Questionnaire Work subscale (FABQ‐W) were significant individual factors within the final regression model. Process analysis displayed FABQ‐W having a significant specific indirect association with the direct association between NDI and WAI, with the model associated with 77% of the variability in WAI (F [2,84] = 141.17, P < .001).

    Conclusion

    Of 64 candidate biopsychosocial factors, NDI and FABQ‐W were the most significant multivariate correlates with work ability. FABQ‐W has a significant indirect association with baseline NDI scores and perceived work ability. This warrants future research trialing work‐related fear avoidance interventions in conservatively managed patients with cervical radiculopathy.

    Level of Evidence

    III

  • 3.
    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 radiculopathy2014Ingår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 30, nr 7, s. 500-506Artikel i tidskrift (Refereegranskat)
    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.

  • 4.
    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 trial2013Ingår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 29, nr 4, s. 290-300Artikel i tidskrift (Refereegranskat)
    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.

  • 5.
    Abbott, Allan
    et al.
    Karolinska University Hospital, Sweden; Karolinska Institute, Sweden; Bond University, Australia.
    Kjellman, Görel
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Multidimensional assessment of pain related disability after surgery for cervical disc disease2013Ingår i: APA Conference 2013: New moves, Australian Physiotherapy Association , 2013, s. 2-2Konferensbidrag (Övrigt vetenskapligt)
    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.

  • 6.
    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 surgery2009Ingår i: Oral Presentations: Cervical Spine: The Surgical Treatment of Painful Disorders, Springer, 2009, Vol. 18, Supplement 4, s. S409-S410Konferensbidrag (Övrigt vetenskapligt)
    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.

  • 7.
    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.2011Ingår i: Proceedings of the WCPT Congress, Amsterdam Netherlands. / [ed] Physiotherapy, World Confederation of Physical Therapy , 2011, Vol. 97 (Suppl 1), s. 20-Konferensbidrag (Övrigt vetenskapligt)
    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.

  • 8.
    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 trial2010Ingår i: Abstracts: Oral Presentations, 2010, s. 186-186Konferensbidrag (Övrigt vetenskapligt)
    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.

  • 9.
    Adås, Karolina
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Amrén, Alva
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Landelius, Malin
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Fysioterapeuters upplevelser av teamrond inom slutenvård: en kvalitativ intervjustudie2022Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Bakgrund: Ett vanligt arbetssätt inom slutenvård är teamrond där olika professioner stämmer av vårdarbetet. Fysioterapeuter har en viktig rehabiliterande roll inom slutenvården, vetenskapligt underlag som beskriver fysioterapeuters upplevelser av sin roll i teamronden är mycket begränsat.

    Syfte: Syftet var att beskriva hur fysioterapeuter inom slutenvård på svenska sjukhus upplever teamronden och sin egen yrkesroll i denna.

    Metod: Studien var en kvalitativ semistrukturerad intervjustudie med induktiv ansats och analyserades med kvalitativ innehållsanalys. Sju fysioterapeuter, som alla hade deltagit i minst tre teamronder under de senaste tre månaderna, intervjuades mellan december 2021 och februari 2022. Den första intervjun genomfördes på informantens arbetsplats, resterande intervjuer som videosamtal.

    Resultat: Analysen resulterade i tre huvudkategorier; teamrondens betydelse, fysioterapeuten som en del i teamronden samt faktorer som påverkar teamronden. Huvudkategorierna innefattar tre till fyra subkategorier. Resultatet presenterar informanternas syn på den egna rollen, interprofessionellt samarbete samt huvudsakliga faktorer som påverkar teamrond och dess inverkan på vårdkvaliteten.

    Konklusion: Teamronden upplevs vara ett viktigt forum för det interprofessionella samarbetet där fysioterapeuten har en viktig del. Upplevelser om fysioterapeutens begränsade förutsättningar i teamronden vad gäller prioriteringar och rondupplägg framkom. Vidare forskning bör undersöka hur vårdkvaliteten påverkas av fysioterapeutens deltagande i teamronden samt hur fysioterapeutens roll i teamronden kan stärkas.

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  • 10.
    Agnew, Louise
    et al.
    University of Queensland, Australia.
    Johnston, Venerina
    University of Queensland, Australia.
    Landén Ludvigsson, Maria
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Rehab Väst.
    Peterson, Gunnel
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Uppsala University, Sweden.
    Overmeer, Thomas
    Malardalen University, Sweden; University of Örebro, Sweden.
    Johansson, Gun
    Karolinska Institute, Sweden.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. University of Queensland, Australia.
    FACTORS ASSOCIATED WITH WORK ABILITY IN PATIENTS WITH CHRONIC WHIPLASH-ASSOCIATED DISORDER GRADE II-III: A CROSS-SECTIONAL ANALYSIS2015Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, nr 6, s. 546-551Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To investigate the factors related to self-perceived work ability in patients with chronic whiplash-associated disorder grades II-III. Design: Cross-sectional analysis. Patients: A total of 166 working age patients with chronic whiplash-associated disorder. Methods: A comprehensive survey collected data on work ability (using the Work Ability Index); demographic, psychosocial, personal, work- and condition-related factors. Forward, stepwise regression modelling was used to assess the factors related to work ability. Results: The proportion of patients in each work ability category were as follows: poor (12.7%); moderate (39.8%); good (38.5%); excellent (9%). Seven factors explained 65% (adjusted R-2 = 0.65, p less than 0.01) of the variance in work ability. In descending order of strength of association, these factors are: greater neck disability due to pain; reduced self-rated health status and health-related quality of life; increased frequency of concentration problems; poor workplace satisfaction; lower self-efficacy for performing daily tasks; and greater work-related stress. Conclusion: Condition-specific and psychosocial factors are associated with self-perceived work ability of individuals with chronic whiplash-associated disorder.

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  • 11.
    Ahlqvist, Linn
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Olsson, Lina
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Unga idrottares kunskap om främre korsbandsskada: En kvantitativ enkätstudie2021Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
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  • 12.
    Ahlstrom, Christer
    et al.
    Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Lovgren, Maria Gink
    Volvo Bus Corp, Denmark.
    Nilsson, Mats
    Volvo Bus Corp, Denmark.
    Willstrand, Tania Dukic
    Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Anund, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Rehabiliteringsmedicinska kliniken. Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    The effect of an active steering system on city bus drivers muscle activity2019Ingår i: International Journal of Occupational Safety and Ergonomics, ISSN 1080-3548, E-ISSN 2376-9130, Vol. 25, nr 3, s. 377-385Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    City bus drivers spend hours driving under time pressure, in congested traffic and in a monotonous sitting position. This leads to unhealthy working conditions, especially in terms of physical and psychological stress. The aim of this study is to investigate whether an active steering system can alleviate the musculoskeletal stress involved in manoeuvring a bus. Twenty bus drivers drove a city bus equipped with the Volvo dynamic steering (VDS) support system in real traffic. Steering effort was evaluated with electromyography and with a questionnaire. Compared to baseline, VDS significantly reduced the required muscle activity by on average 15-25% while turning, and up to 68% in the part of the manoeuvre requiring maximum effort. The bus drivers believed that VDS will help reduce neck and shoulder problems, and they expressed a desire to have VDS installed in their own bus.

  • 13.
    Alalawi, Ahmed
    et al.
    Univ Birmingham, England; Umm Al Qura Univ, Saudi Arabia.
    Evans, David W.
    Univ Birmingham, England.
    Liew, Bernard
    Univ Essex, England.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Arbets- och miljömedicin.
    Heneghan, Nicola
    Univ Birmingham, England.
    Rushton, Alison
    Univ Birmingham, England.
    Peterson, Gunnel
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Uppsala Univ, Sweden.
    Barbero, Marco
    Univ Appl Sci & Arts Southern Switzerland, Switzerland.
    Falla, Deborah
    Univ Birmingham, England.
    Does Pain Extent Predict Ongoing Pain and Disability in Patients with Chronic Whiplash-Associated Disorders?2022Ingår i: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 11, nr 3, artikel-id 555Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study investigates whether baseline pain extent, extracted from an electronic pain drawing, is an independent predictive factor of pain and disability measured 1 year and 2 years later in people with chronic WAD. Participants completed questionnaires assessing neck pain intensity, disability via the Neck Disability Index (NDI), psychological features, and work ability. Participants also completed electronic pain drawings from which their pain extent was extracted. A two-step modelling approach was undertaken to identify the crude and adjusted association between pain extent and NDI measured at 1-year and 2-year follow-ups. A total of 205 participants were included in the analysis. The univariate analysis showed that pain extent was significantly associated with the NDI score at the 1-year (p = 0.006, 95% CI: 0.159-0.909) and 2-year (p = 0.029, 0.057-0.914) follow-ups. These associations were not maintained when we introduced perceived disability, psychological health, and work ability into the model after 1 year (p = 0.56, 95%CI: -0.28-0.499) and 2 years (p = 0.401, -0.226-0.544). Pain extent, as an independent factor, was significantly associated with perceived pain and disability in patients with chronic WAD for up to 2 years. This association was masked by neck disability, psychological health, and work ability.

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  • 14.
    Alexanderson, Mikaela
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Borg, Hanna
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Adolphson, Vilma
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Patienters perspektiv på behov av information i samband med behandling inom neurologisk rehabilitering: -        En kvalitativ intervjustudie2022Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Sammanfattning 

    Bakgrund: Neurologisk rehabilitering innefattar ofta livslånga kontinuerliga insatser. För att få ett önskvärt resultat av rehabilitering krävs en god följsamhet från patienten. Forskning har visat att god följsamhet kräver att patienten får information om sin behandling samt känner sig delaktig. Det saknas dock forskning om vilken information och vilken typ av informationsform patienten efterfrågar inom neurologisk rehabilitering. 

    Syfte: Syftet med studien var att beskriva patientens perspektiv på behovet av information vid rehabilitering av neurologiska funktionsnedsättningar, och vad de upplever betydelsefullt för att uppnå följsamhet och delaktighet.

    Metod: En kvalitativ intervjustudie med semistrukturerade frågor (Januari 2022). Data analyserades genom kvalitativ innehållsanalys med induktiv ansats. Inklusive pilotintervju genomfördes 10 intervjuer med patienter som deltagit i neurologisk rehabilitering.

    Resultat: Analys av materialet resulterade i 4 kategorier, Erhållen information, Önskad information, Delaktighet, Fysioterapeuten bemötande och Kommunikation. Varje kategori kompletterades även med underrubriker. 

    Konklusion:  I resultatet framkom det att patienter har behov av en mångsidig information både avseende informationens innehåll och förmedling. Det framkom även att fysioterapeutens bemötande och en god kommunikation var viktiga faktorer för informationsförmedlingen och därmed betydelsefullt för att uppnå delaktighet och följsamhet. 

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  • 15.
    Alexandersson, Markus
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Norin, Sofia
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Kvinnors upplevelser av vård vid graviditetsrelaterad ländrygg- och bäckensmärta: En kvalitativ intervjustudie med fokus på bemötande och omhändertagande2024Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Bakgrund: Graviditetsrelaterad ländrygg- och bäckensmärta drabbar upp till 50% av alla gravida kvinnor. Tillståndet kan skapa stora problem i vardagen med omfattande funktionsnedsättningar, sjukskrivning och oro. Det finns idag flertalet obesvarade forskningsfrågor kring diagnosen varav en är att undersöka om det finns möjlighet att förbättra vårdkvalitén avseende omhändertagande och bemötande för dessa kvinnor.  

    Syfte: Syftet var att beskriva kvinnors upplevelser av vårdkvalitén med fokus på omhändertagande och bemötande vid pågående ländrygg- och bäckensmärta, på engelska pregnancy-related pelvic girdle pain (PPGP), under graviditeten.

    Metod: Studien var en kvalitativ intervjustudie med semistrukturerade frågor. Insamlad data analyserades med en kvalitativ innehållsanalys av induktiv ansats. Totalt genomfördes sex intervjuer med personer som haft vårdkontakt i samband med PPGP. Intervjuerna utfördes mellan januari och februari 2024 som videosamtal och på platser som intervjupersonen själv valde.

    Resultat: Analysen resulterade i tre huvudkategorier: önskade mer vårdkontakt, känslan av att bli sedd och bekräftad samt bristande förtroende mellan vårdpersonal och patient. Huvudkategorierna innehöll två eller tre subkategorier.

    Konklusion: För en upplevd förbättrad vårdkvalitet avseende omhändertagande och bemötande hos kvinnor med PPGP bör mer fokus läggas på en ökad vårdkontakt, en mer personcentrerad vård samt tydligare kommunikation mellan vårdpersonal och patient.

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  • 16.
    Alföldi, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Dragioti, Elena
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Wiklund, Tobias
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Gerdle, Björn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    SPREADING OF PAIN AND INSOMNIA IN PATIENTS WITH CHRONIC PAIN: RESULTS FROM A NATIONAL QUALITY REGISTRY (SQRP)2017Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, nr 1, s. 63-70Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To explore how demographics, pain, psychosocial factors and insomnia relate to the spread of chronic pain. Methods: The study included 708 patients (68% women; median age 46 years; interquartile range 3557 years) with chronic pain who were referred to a multidisciplinary pain centre. Spreading of pain was assessed using a questionnaire covering 36 anatomically predefined pain regions. Data were collected on demographics, pain symptoms, psychological distress, and insomnia (Insomnia Severity Index). Four sub-categories of chronic pain were established: chronic local pain, chronic regional pain medium, chronic regional pain heavy, and chronic widespread pain. Results: The median number of pain regions was 10 (interquartile range 6-18). Prevalence of chronic pain was as follows: chronic local pain 9%, chronic regional pain medium 21%, chronic regional pain heavy 39%, and chronic widespread pain 31%. In the regression models, being a woman and persistent pain duration had the strongest associations with spreading of pain, but anxiety, pain interference, and insomnia were also important factors. Conclusion: Spreading of chronic pain can only partly be explained by the simultaneous levels of insomnia. Female sex, pain duration, pain interference and anxiety appear to have more significant relationships with the spread of pain. Targeting these factors may lead to improvements in treatment and prevention strategies.

  • 17.
    Alin, Christina Kaijser
    et al.
    Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Solna, Sweden.
    Grahn Kronhed, Ann-Charlotte
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Rehab Väst.
    Uzunel, Elin
    Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Solna, Sweden.
    Salminen, Helena
    Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Solna, Sweden; Academic Primary Healthcare Centre Stockholm, Stockholm, Sweden.
    Wearing an Activating Spinal Orthosis and Physical Training in Women With Osteoporosis and Back Pain: A Postintervention Follow-Up Study2021Ingår i: Archives of Rehabilitation Research and Clinical Translation, E-ISSN 2590-1095, Vol. 3, nr 4, artikel-id 100154Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To assess the duration of benefits on back pain and back extensor strength in women with osteoporosis who had previously participated in a randomized controlled trial (RCT) involving either exercise or wearing a spinal orthosis.

    Design: A 6-month postintervention follow-up of women who were involved in the interventions in the RCT.SettingThe study was conducted in a primary health care center in Stockholm, Sweden.ParticipantsIn this follow-up study 31 women participated in the spinal orthosis group, and 31 women participated in the exercise group, with a median age of 76 years in both groups (N=62). All women were diagnosed as having osteoporosis, had back pain with or without vertebral fracture, and were 60 years or older, which were the inclusion criteria in the RCT.

    Interventions: The participants received no controlled supervision. The spinal orthosis group was asked to wear the orthosis, and the training group was asked to follow an exercise program for another 6 months voluntarily.

    Main Outcome Measures: Back extensor strength was measured with a computerized device; back pain was estimated by the visual analog scale and by Borg CR-10.

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  • 18.
    Amiri Arimi, Somayeh
    et al.
    Shahid Beheshti University of Medical Sciences, Physiotherapy Research Center, School of Rehabilitation, Department of Physiotherapy, Tehran, Iran; University of Social Welfare and Rehabilitation Sciences, Department of Physiotherapy, Tehran, Iran.
    Mohseni Bandpei, Mohammad Ali
    Pediatric Neurorehabilitation Research Center, Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan.
    Rezasoltani, Asghar
    Shahid Beheshti University of Medical Sciences, Physiotherapy Research Centre, School of Rehabilitation, Tehran, Iran.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Mohammadi, Masumeh
    Shahid Beheshti University of Medical Sciences, Physiotherapy Research Center, School of Rehabilitation, Department of Physiotherapy, Tehran, Iran.
    Multifidus muscle size changes at different directions of head and neck movements in females with unilateral chronic non-specific neck pain and healthy subjects using ultrasonography2018Ingår i: Journal of Bodywork & Movement Therapies, ISSN 1360-8592, E-ISSN 1532-9283, Vol. 22, nr 3, s. 560-565Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The aim of the study was to compare the dimensions of cervical multifidus muscle (CMM) in different conditions.

    METHODS: Twenty five women with neck pain and 25 healthy subjects participated in this study. The dimensions of the CMM were measured at rest, 50% and 100% maximum isometric voluntary contraction (MIVC) at six directions of neck movements, using ultrasonography.

    RESULTS: The size of multifidus was smaller in patients than healthy individuals at rest state (P < 0.05). A significant smaller CMM dimension was found in the affected side compared with unaffected side in patients group (P < 0.05). The result of ANOVA for MLD showed a significant difference for contraction levels (P < 0.001) and neck movements (P < 0.001) in both groups. The MLD of the CMM was significantly different between CMM at rest and 50%, and 100% MIVC (P < 0.001). No significant differences were found between the groups at 50% and 100% MIVC (P > 0.05 in both instances). The most prominent CMM size change was observed during neck extension, flexion, ipsilateral lateral-flexion, and ipsilateral rotation, respectively (P < 0.05).

    CONCLUSIONS: Results of the present study indicate that the size of CMM was decreased in patients with neck pain in rest state. The size of CMM changes in all directions of neck movements, although the most prominent was during neck extension. This points out CMM stabilization role's in different directions of neck movements.

  • 19.
    Andersen, Pia
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Reg Kronoberg, Sweden.
    Lendahls, Lena
    Reg Kronoberg, Sweden; Linnaeus Univ, Sweden.
    Holmberg, Sara
    Reg Kronoberg, Sweden; Lund Univ, Sweden.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Patients experiences of physical activity on prescription with access to counsellors in routine care: a qualitative study in Sweden2019Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 19, artikel-id 210Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundPhysical activity on prescription (PAP) has been implemented in several countries, including Sweden, to support patients who might benefit from increased physical activity. This study explores the experiences of recipients of PAP in routine health care in Sweden that offers the recipients support from physical activity counsellors. The aim was to explore influences on engagement in physical activity by PAP recipients from a long-term perspective.MethodsWe conducted individual semi-structured interviews using a topic guide with a purposively selected sample of 13 adult PAP recipients 1.5 to 2.5years after PAP. Interviews were recorded, transcribed verbatim and analysed through inductive and deductive content analysis. The questions were informed by Capability-Opportunity-Motivation-Behaviour (COM-B), which was also used as a framework to analyse the data by means of categorizing the factors (influences on the behaviour).ResultsTen factors (i.e. sub-categories) that influenced the participants engagement in physical activity were identified. PAP recipients capability to engage in physical activity was associated with adapting the PAP to the individuals physical capacity and taking into account the individuals previous experiences of physical activity. PAP recipients opportunity to engage in physical activity was related to receiving a prescription, receiving professional counselling and follow-up from a physical activity counsellor, collaboration between prescriber and counsellor, having access to appropriate activities, having a balanced life situation and having support from someone who encouraged continued physical activity. PAP recipients motivation to engage in physical activity was associated with the desire to improve his or her health condition and finding activities that encouraged continuation.ConclusionsPAP recipients engagement in physical activity was influenced by their capability, opportunity and motivation to undertake this behaviour. Numerous extraneous factors influence capability and motivation. Physical activity counsellors were found to be important for sustained activity because they use an individual approach to counselling and flexible follow-up adapted to each individuals need of support.

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  • 20.
    Andersson, Agnes
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Runsten Fitz, Eddie
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Gannholm Johansson, Oskar
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Främre korsbandsruptur - Patienters upplevelse kring vårdprocessen i det preoperativa skedet: En kvalitativ intervjustudie2023Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Sammanfattning

    Bakgrund: En skada på det främre korsbandet (ACL) är relativt vanligt och kan ha betydande fysiska och känslomässiga effekter på patienter. Ungefär hälften av patienter med en ACL-skada genomgår en rekonstruktion (ACLR). Att förstå patienternas perspektiv på vårdprocessen är avgörande för att förbättra vårdens kvalitet.

    Syfte: Att utforska samt beskriva upplevelser och erfarenheter av mottagande och bedömning, mellan skadetillfälle och operationstillfälle, med fokus på en säker och patientfokuserad hälso- och sjukvård, för patienter som genomgått ACLR maximalt ett år innan intervjutillfället, utan att ha fått en diagnos "främre korsbandsskada" vid första vårdbesöket.

    Metod: En kvalitativ ansats användes och data samlades in genom individuella intervjuer med patienter som genomgått ACLR senast ett år före intervjun. Intervjuerna transkriberades och analyserades tematiskt med en manifest innehållsanalys.

    Resultat: Patienterna uppskattade att bli hörda, känna sig respekterade och vara delaktiga i sina egna vårdprocesser. Tydlig och heltäckande kommunikation var viktig för att underlätta för patienten att förstå sin skada och behandlingsalternativ. Patienterna hade ofta höga förväntningar på sin återhämtning, vilket kunde leda till frustration och besvikelse när framstegen gick långsamt. Patienterna blev ofta förbisedda, vilket ledde till förvärrade skador, sena diagnoser och längre tid till korrekt hjälp. Konsekvenserna av den utdragna processen inkluderade förlust av arbete, ekonomiska påfrestningar och social isolering, vilket skulle kunna påverka self-efficacy negativt. Patienterna önskade även att vårdgivare inte bara skulle fokusera på fysisk rehabilitering utan också ta itu med de psykologiska och känslomässiga utmaningar som följer med en långvarig återhämtningsprocess.

    Slutsats: Studien belyser vikten av patientfokuserad vård, tydlig kommunikation och att ta itu med de multidimensionella behoven hos patienter med knäskador, som sedan genomgår ACLR. Fynden belyser vikten av utvecklingen av insatser som syftar till att förbättra patientupplevelsen under bedömningsprocessen för knäskador.

    Nyckelord: Främre korsbandsskada, främre korsbandsrekonstruktion, patientfokuserad vård, kommunikation, copingstrategier.

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    ACLR - Patienters upplevelse
  • 21.
    Andersson, Elin
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Haldén, Josefin
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Ahlberg, Ellen
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Fysioterapeuters erfarenheter och tankar kring om och när multimodal rehabilitering ska erbjudas som behandling i primärvården hos patienter med långvarig smärta: En intervjustudie2022Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Bakgrund: Långvarig smärta är ett vanligt förekommande besvär och de flesta patienterna söker vård i primärvården, vilket betyder att primärvården har en viktig roll i att identifiera och bedöma smärtproblematik. MMR har visat sig vara den mest effektiva behandlingen vid långvariga smärttillstånd, men det är oklart hur fysioterapeuter väljer ut patienter för behandling med MMR.

    Syfte: Att beskriva fysioterapeuters erfarenheter och tankar kring om och när multimodal rehabilitering ska erbjudas som behandling i primärvården hos patienter med långvarig smärta.

    Metod: En kvalitativ intervjustudie med induktiv ansats bestående av semistrukturerade intervjuer med sex legitimerade fysioterapeuter inom primärvården i Region Östergötland. Datan analyserades med kvalitativ innehållsanalys.

    Resultat: Analysen resulterade i fyra kategorier: MMR i relation till unimodal behandling; faktorer som stödjer eller motsäger erbjudande av MMR; primärvårdens roll vid erbjudande av MMR och slutgiltigt beslut till remittering av MMR.

    Konklusion: Fysioterapeuter i primärvården hade både lika och olika erfarenheter och tankar gällande arbetet med erbjudande av MMR. Förbättring på individ- och verksamhetsnivå skulle kunna skapa samsyn i hur remitteringen ska bedrivas och kan bidra till säkrare fysioterapeuter och en mer kvalitativ och jämlik vård för patienter med långvarig smärta. Resultatet av studien kan därför vara värdefull för fysioterapeuter och verksamhetsansvariga i primärvården.

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  • 22.
    Andersson, Hugo
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Hedestad, Louise
    Linköpings universitet, Institutionen för hälsa, medicin och vård.
    Effekter av muskelstärkande träning på smärta hos individer med osteoporos och kotkompression: en systematisk litteraturöversikt2024Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Syfte: Syftet var att sammanställa evidens och bedöma evidensstyrka för effekter av muskelstärkande träning på smärta hos individer med osteoporos och kotkompressioner. 

    Metod: En systematisk sökning genomfördes i de valda databaserna Cohrane Liberly, CINAHL, PubMed, Pedro och Scopus. Nio studier uppfyllde samtliga inklusions- och exklusionskriterier. Studiernas kvalitet bedömdes med granskningsmall av Fowkes & Fulton (1991) med tillägg av två områden ifrån SBU:s metodbok, och bedömningen av den sammanställda evidensen utfördes med stöd av GRADE. 

    Resultat: Smärta undersöktes i de två dimensionerna kroppsfunktion (smärtintensitet) och aktivitet-/delaktighetsnivå. Resultatför kroppsfunktion visade en signifikant förbättring i interventionsgruppen jämfört med kontrollgruppen i två av fyra studier. Resultat för aktivitet/delaktighet visade en signifikant förbättring i interventionsgruppen jämfört med kontrollgruppen i fyra av åtta studier. Den sammanställda metodologiska kvalitet och evidensstyrkan bedöms däremot ha för låg tillförlitlighet gällande resultaten för effekten av muskelstärkande träning på smärta i båda dimensionerna hos individer med osteoporos och kotkompression.        

    Konklusion: Denna systematiska kritiska litteraturöversikt visade låg evidensstyrka för att muskelstärkande träning påverkar smärta hos individer med osteoporos och kotkompression, trots att några studier enskilt presenterar en signifikant skillnad mellan interventionsgrupp och kontrollgrupp rörande minskning av skattad smärta. 

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  • 23.
    Andersson, Siv Folkhammar
    et al.
    Unit of Rehabilitation, Kalmar County Council, Oskarshamn, Sweden.
    Bergman, Stefan
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Henriksson Welin, Elisabet
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Divison of Nursing, Department of Neurobiology, Care Sciences and Society,Karolinska Institutet, Huddinge, Sweden.
    Bremander, Ann
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden.
    Arthritis management in primary care: A study of physiotherapists current practice, educational needs and adherence to national guidelines2017Ingår i: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 15, nr 4, s. 333-340Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    With an increasing number of patients with osteoarthritis (OA) and rheumatoid arthritis (RA) in primary care, our aim was to investigate arthritis‐related practice in physiotherapy and to study adherence to evidence‐based care.

    Methods

    Seventy physiotherapists (PTs) working in primary care were emailed a questionnaire to investigate current practice and the number of roles assumed by PTs, the degree of confidence, educational needs and adherence to national guidelines in managing patients with OA or RA. Interventions supported by national guidelines were compared with reports of treatment modalities in the questionnaire.

    Results

    Sixty‐four (91%) PTs responded, and they reported a higher degree of confidence in assessment, treatment and education of patients with OA than for those with RA (p < 0.001). The total number of roles assumed by the PTs was higher in the management of OA than for RA (p < 0.001). PTs who assumed a greater number of roles also reported a stronger degree of confidence in assessing OA (p = 0.036). Those who assumed fewer roles also reported less confidence in RA treatment (p = 0.045). Recommendations in the guidelines were followed by the majority of PTs for eight of 11 treatment modalities in OA and for six of six in RA.

    Conclusions

    PTs reported a lower degree of confidence and the assumption of fewer roles in managing patients with RA compared with OA. There was good adherence to the national guidelines for almost all the treatment modalities listed. Even so, the results indicate a need for education, especially in chronic inflammatory arthritis care.

  • 24.
    Andreae, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Uppsala Univ, Sweden.
    Arestedt, Kristofer
    Linnaeus Univ, Sweden; Res Sect, Sweden.
    Evangelista, Lorraine
    Univ Calif Irvine, CA USA.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Univ Calif Irvine, CA USA.
    The relationship between physical activity and appetite in patients with heart failure: A prospective observational study2019Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, nr 5, s. 410-417Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Physical activity and appetite are important components for maintaining health. Yet, the association between physical activity and appetite in heart failure (HF) populations is not completely understood. The aim of the present study was to investigate the relationship between physical activity, functional capacity, and appetite in patients with HF. Methods: This was a prospective observational study. In total, 186 patients diagnosed with HF, New York Heart Association (NYHA) class II-IV (mean age 70.7, 30% female), were included. Physical activity was measured using a multi-sensor actigraph for seven days and with a self-reported numeric rating scale. Physical capacity was measured by the six-minute walk test. Appetite was measured using the Council on Nutrition Appetite Questionnaire. Data were collected at inclusion and after 18 months. A series of linear regression analyses, adjusted for age, NYHA class, and B-type natriuretic peptide were conducted. Results: At baseline, higher levels of physical activity and functional capacity were significantly associated with a higher level of appetite in the unadjusted models. In the adjusted models, number of steps (p = 0.019) and the six-minute walk test (p = 0.007) remained significant. At the 18-month follow-up, all physical activity variables and functional capacity were significantly associated with appetite in the unadjusted regression models. In the adjusted models, number of steps (p = 0.001) and metabolic equivalent daily averages (p = 0.040) remained significant. Conclusion: A higher level of physical activity measured by number of steps/day was associated with better self-reported appetite, both at baseline and the 18-month follow-up. Further research is needed to establish causality and explore the intertwined relationship between activity and appetite in patients with HF.

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  • 25.
    Anund, Anna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Swedish National Rd and Transport Research Institute VTI, Linkoping, Sweden..
    Ahlström, Christer
    Swedish National Rd and Transport Research Institute, Linkoping, Sweden.
    Fors, Carina
    Swedish National Rd and Transport Research Institute, Linkoping, Sweden.
    Åkerstedt, Torbjorn
    Karolinska Institute, Sweden; Stockholm University, Sweden.
    Are professional drivers less sleepy than non-professional drivers?2018Ingår i: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 44, nr 1, s. 88-95Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective It is generally believed that professional drivers can manage quite severe fatigue before routine driving performance is affected. In addition, there are results indicating that professional drivers can adapt to prolonged night shifts and may be able to learn to drive without decreased performance under high levels of sleepiness. However, very little research has been conducted to compare professionals and non-professionals when controlling for time driven and time of day. Method The aim of this study was to use a driving simulator to investigate whether professional drivers are more resistant to sleep deprivation than non-professional drivers. Differences in the development of sleepiness (self-reported, physiological and behavioral) during driving was investigated in 11 young professional and 15 non-professional drivers. Results Professional drivers self-reported significantly lower sleepiness while driving a simulator than nonprofessional drivers. In contradiction, they showed longer blink durations and more line crossings, both of which are indicators of sleepiness. They also drove faster. The reason for the discrepancy in the relation between the different sleepiness indicators for the two groups could be due to more experience to sleepiness among the professional drivers or possibly to the faster speed, which might unconsciously have been used by the professionals to try to counteract sleepiness. Conclusion Professional drivers self-reported significantly lower sleepiness while driving a simulator than non-professional drivers. However, they showed longer blink durations and more line crossings, both of which are indicators of sleepiness, and they drove faster.

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  • 26.
    Ardern, Clare
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. La Trobe Univ, Australia.
    Ekas, Guri
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway.
    Grindem, Hege
    Norwegian Sch Sport Sci, Norway.
    Moksnes, Havard
    Norwegian Sch Sport Sci, Norway.
    Anderson, Allen
    Chotel, Franck
    Hop Femme Mere Enfant, France.
    Cohen, Moises
    Univ Fed Sao Paulo, Brazil.
    Forssblad, Magnus
    Karolinska Inst, Sweden.
    Ganley, Theodore J.
    Childrens Hosp Philadelphia, PA 19104 USA.
    Feller, Julian A.
    Epworth Healthcare, Australia; La Trobe Univ, Australia.
    Karlsson, Jon
    Univ Gothenburg, Sweden.
    Kocher, Mininder S.
    Boston Childrens Hosp, MA USA; Harvard Med Sch, MA USA.
    LaPrade, Robert F.
    Steadman Philippon Res Inst, CO USA; Steadman Clin, CO USA.
    McNamee, Mike
    Swansea Univ, Wales.
    Mandelbaum, Bert
    Santa Monica Orthopaed and Sports Med Grp, CA USA.
    Micheli, Lyle
    Boston Childrens Hosp, MA USA; Harvard Med Sch, MA USA; Micheli Ctr Sports Injury Prevent, MA USA.
    Mohtadi, Nicholas
    Univ Calgary, Canada.
    Reider, Bruce
    Univ Chicago, IL 60637 USA.
    Roe, Justin
    North Sydney Orthopaed and Sports Med Ctr, Australia.
    Seil, Romain
    Ctr Hosp Luxembourg, Luxembourg; Luxembourg Inst Hlth, Luxembourg.
    Siebold, Rainer
    Ruprecht Karls Univ Heidelberg, Germany; HKF Int Ctr Hip Knee Foot Surg and Sportstraumatol, Germany.
    Silvers-Granelli, Holly J.
    FIFA Med Ctr Excellence, CA USA.
    Soligard, Torbjorn
    Int Olymp Comm, Switzerland; Univ Calgary, Canada.
    Witvrouw, Erik
    Univ Ghent, Belgium.
    Engebretsen, Lars
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway; Int Olymp Comm, Switzerland.
    2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries2018Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, nr 4, s. 989-1010Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric anterior cruciate ligament (ACL) injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery and Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America, and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis, and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions.

  • 27.
    Ardern, Clare
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. La Trobe University, Melbourne, Australia.
    Glasgow, Philip
    Sports Medicine, Sports Institute of Northern Ireland, Newtownabbey, UK.
    Schneiders, Anthony G
    School of Human, Health and Social Sciences, Central Queensland University, Branyan, Australia.
    Witvrouw, Erik
    Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Clarsen, Benjamin
    Oslo Sports Trauma Research Center, Oslo, Norway.
    Cools, Ann Mj
    Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Gojanovic, Boris
    Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Switzerland; Sports Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
    Griffin, Steffan
    College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
    Khan, Karim
    Department of Family Practice, The University of British Columbia, Vancouver, Canada; Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada.
    Moksnes, Håvard
    Oslo Sports Trauma Research Center, Oslo, Norway.
    Mutch, Stephen
    SPACE Clinics, Edinburgh, UK; Scottish Rugby, Edinburgh, UK.
    Phillips, Nicola
    Postgraduate Healthcare Studies, Cardiff University, Cardiff, UK.
    Reurink, Guus
    Sports Medicine, Sports Physicians Group, Amsterdam, The Netherlands.
    Sadler, Robin
    Sports Medicine, Manchester City Football Club Ltd, Manchester, UK; Derby County FC, Derby, UK.
    Gravare Silbernagel, Karin
    Department of Physical Therapy, University of Delaware, Newark, USA.
    Thorborg, Kristian
    Sports Orthopaedic Research Center Copenhagen (SORC-C), Amager-Hvidovre Hospital, Copenhagen, Denmark; Department of Orthopaedic Surgery and Physical Therapy, Amager-Hvidovre Hospital, Copenhagen, Denmark.
    Wangensteen, Arnlaug
    Oslo Sports Trauma Research Center, Oslo, Norway; Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
    Wilk, Kevin
    Champion Sports Medicine, Birmingham, USA.
    Bizzini, Mario
    Schulthess Clinic, Zürich, Switzerland.
    Infographic: 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern2017Ingår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 51, nr 13, s. 995-995Artikel i tidskrift (Övrigt vetenskapligt)
  • 28.
    Ardern, Clare
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. La Trobe Univ, Australia; Univ British Columbia, Canada; Sophiahemmet Univ, Sweden.
    Hooper, Nicholas
    Virginia Commonwealth Univ, VA USA.
    O´Halloran, Paul
    La Trobe Univ, Australia.
    Webster, Kate E.
    La Trobe Univ, Australia.
    Kvist, Joanna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Karolinska Inst, Sweden.
    A Psychological Support Intervention to Help Injured Athletes "Get Back in the Game": Design and Development Study2022Ingår i: JMIR Formative Research, E-ISSN 2561-326X, Vol. 6, nr 8, artikel-id e28851Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: After a serious knee injury, up to half of athletes do not return to competitive sport, despite recovering sufficient physical function. Athletes often desire psychological support for the return to sport, but rehabilitation clinicians feel ill-equipped to deliver adequate support. Objective: We aimed to design and develop an internet-delivered psychological support program for athletes recovering from knee ligament surgery. Methods: Our work for developing and designing the Back in the Game intervention was guided by a blend of theory-, evidence-, and target population-based strategies for developing complex interventions. We systematically searched for qualitative evidence related to athletes experiences with, perspectives on, and needs for recovery and return to sport after anterior cruciate ligament (ACL) injury. Two reviewers coded and synthesized the results via thematic meta-synthesis. We systematically searched for randomized controlled trials reporting on psychological support interventions for improving ACL rehabilitation outcomes in athletes. One reviewer extracted the data, including effect estimates; a second reviewer checked the data for accuracy. The results were synthesized descriptively. We conducted feasibility testing in two phases-(1) technical assessment and (2) feasibility and usability testing. For phase 1, we recruited clinicians and people with lived experience of ACL injury. For phase 2, we recruited patients aged between 15 and 30 years who were within 8 weeks of ACL reconstruction surgery. Participants completed a 10-week version of the intervention and semistructured interviews for evaluating acceptability, demand, practicality, and integration. This project was approved by the Swedish Ethical Review Authority (approval number: 2018/45-31). Results: The following three analytic themes emerged from the meta-synthesis (studies: n=16; participants: n=164): (1) tools or strategies for supporting rehabilitation progress, (2) barriers and facilitators for the physical readiness to return to sport, and (3) barriers and facilitators for the psychological readiness to return to sport. Coping strategies, relaxation, and goal setting may have a positive effect on rehabilitation outcomes after ACL reconstruction (randomized controlled trials: n=7; participants: n=430). There were no trials of psychological support interventions for improving the return to sport. Eleven people completed phase 1 of feasibility testing (technical assessment) and identified 4 types of software errors, which we fixed. Six participants completed the feasibility and usability testing phase. Their feedback suggested that the intervention was easy to access and addressed the needs of athletes who want to return to sport after ACL reconstruction. We refined the intervention to include more multimedia content and support access to and the use of the intervention features. Conclusions: The Back in the Game intervention is a 24-week, internet-delivered, self-guided program that comprises 7 modules that complement usual rehabilitation, changes focus as rehabilitation progresses, is easy to access and use, and includes different psychological support strategies.

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  • 29.
    Ardern, Clare
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Karolinska Inst, Sweden; La Trobe Univ, Australia.
    Kvist, Joanna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Karolinska Inst, Sweden.
    BAck iN the Game (BANG) - a smartphone application to help athletes return to sport following anterior cruciate ligament reconstruction: protocol for a multi-centre, randomised controlled trial2020Ingår i: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 21, nr 1, artikel-id 523Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Sustaining injury is a common consequence of playing sport. At least one in every three recreational athletes with anterior cruciate ligament (ACL) reconstruction do not return to their preinjury sport following treatment. Psychological factors including confidence and fear of new injury exert large effects on returning to sport. The primary aim of this trial is to test whether a custom smartphone application delivering cognitive-behavioural therapy is effective for improving the number of people who return to their preinjury sport and level following ACL reconstruction. Methods: Participants scheduled for primary ACL reconstruction are recruited prior to surgery from one of six trial sites in Sweden. We aim to recruit 222 participants (111 in each group) for the BANG trial. Participants are randomly allocated to receive either usual rehabilitation care alone or usual rehabilitation care plus the Back in the Game smartphone application intervention. Back in the Game is a 24-week Internet-delivered programme, based on cognitive-behavioural therapy. The primary outcome is return to the preinjury sport and level at 12 months follow-up. The secondary outcomes assess physical activity participation, new knee injuries, psychological factors, quality of life and physical function. Physical activity participation and new injuries are self-reported every two weeks for 12 months, then every 4 weeks to 24 months follow-up. Psychological readiness to return to sport, knee self-efficacy, motivation to participate in leisure time physical activity, knee-related quality of life, and self-reported knee function are also assessed at 3, 6, 9, 12 and 24 months after surgery. A clinical assessment of strength, knee range of motion, effusion and hopping performance is completed by a blinded assessor at 12 months to assess physical function. Discussion: This protocol outlines how we plan to assess the efficacy of a custom smartphone application, delivering cognitive-behavioural therapy to address fear, confidence and recovery expectations, for improving return to sport following serious sports-related musculoskeletal injury. The BANG trial employs a pragmatic design to best reflect the reality of, and inform, clinical practice.

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  • 30.
    Ardern, Clare
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    What is the evidence to support a psychological component to rehabilitation programs after anterior cruciate ligament reconstruction?2016Ingår i: Current Orthopaedic Practice, ISSN 1940-7041, Vol. 27, nr 3, s. 263-268Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    One of the main indications for anterior cruciate ligament reconstruction is the athlete’s desire to return to his or her preinjury level of sports. Postoperative rehabilitation has a strong focus on recovery of the physical capabilities necessary to manage a return to sports. On average, athletes achieve good physical function after surgery, based on standard impairment-based and activity-based measures. Yet the return to sports rate is disappointingly low; only two in every three return to their preinjury level sport and only half of the athletes return to competitive sports after surgery. There are a range of factors, many of them nonmodifiable (e.g. age, sex, and preinjury level of competition), that affect returning to a specific sport. However, recent research has identified psychological factors as key influences on returning to sports after anterior cruciate ligament reconstruction. This is particularly important for clinicians given that these factors may be modifiable with appropriate intervention. However, they are not systematically discussed during standard postoperative rehabilitation. In this review, we examine the evidence for the effect of psychological factors on return to sport outcomes after anterior cruciate ligament reconstruction and provide a rationale for the inclusion of interventions that specifically and systematically affect these factors during postoperative rehabilitation.

  • 31.
    Ardern, Clare
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Aspetar Orthopaed and Sports Medical Hospital, Qatar; La Trobe University, Australia; Uppsala University, Sweden.
    Peterson, Gunnel
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Uppsala University, Sweden.
    Landén Ludvigsson, Maria
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Rehab Väst. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Satisfaction With the Outcome of Physical Therapist-Prescribed Exercise in Chronic Whiplash-Associated Disorders: Secondary Analysis of a Randomized Clinical Trial2016Ingår i: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 46, nr 8, s. 640-+Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    STUDY DESIGN: Secondary analysis of a randomized clinical trial. BACKGROUND: Patient perception of the benefits gained from treatment is important, yet satisfaction with the outcome of treatment for chronic whiplash-associated disorders (WADs) has not been investigated. OBJECTIVES: To investigate whether satisfaction with the outcome of treatment for chronic WAD changed over time, and whether there were group differences. METHODS: Two hundred sixteen people with chronic WAD (66% women; mean age, 40.4 years) participated in a 3-month program of physical therapist-led neck-specific exercises with or without a behavioral approach, or received a prescription of general physical activity. The main outcome was satisfaction with the outcome of treatment, assessed at baseline and 3, 6, and 12 months later. Additional outcomes were enablement and expectation fulfillment. RESULTS: Satisfaction improved over time in the 3 groups (odds ratio = 1.15; 95% confidence interval: 1.10, 1.20; P amp;lt; .001). There was a significant group-by-time interaction (P amp;lt; 001), with increased odds of being satisfied in the groups receiving neck-specific exercises compared to general physical activity. Enablement increased after completion of the intervention in all groups (P amp;lt; .001). People who received neck-specific exercises reported greater enablement and expectation fulfillment than people prescribed general physical activity (P amp;lt; .01). CONCLUSION: Exercise interventions for chronic WAD led to increased satisfaction for 12 months following treatment that was unrelated to the type of exercise intervention received.

  • 32.
    Ardern, Clare
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. School of Allied Health, La Trobe University, Melbourne, Australia, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
    Tagesson (Sonesson), Sofi
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Rörelse och Hälsa.
    Forssblad, M
    Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden. Capio Artro Clinic, Sophiahemmet, Stockholm, Sweden..
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Comparison of patient-reported outcomes among those who chose ACL reconstruction or non-surgical treatment.2017Ingår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 27, nr 5, s. 535-544Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of our study was to cross-sectionally compare patient-reported knee function outcomes between people who chose non-surgical treatment for ACL injury and those who chose ACL reconstruction. We extracted Knee Injury and Osteoarthritis Outcome Score (KOOS) and EuroQoL-5D data entered into the Swedish National ACL Registry by patients with a non-surgically treated ACL injury within 180 days of injury (n = 306), 1 (n = 350), 2 (n = 358), and 5 years (n = 114) after injury. These data were compared cross-sectionally to data collected pre-operatively (n = 306) and at 1 (n = 350), 2 (n = 358), and 5 years (n = 114) post-operatively from age- and gender-matched groups of patients with primary ACL reconstruction. At the 1 and 2 year comparisons, patients who chose surgical treatment reported superior quality of life and function in sports (1 year mean difference 12.4 and 13.2 points, respectively; 2 year mean difference 4.5 and 6.9 points, respectively) compared to those who chose non-surgical treatment. Patients who chose ACL reconstruction reported superior outcomes for knee symptoms and function, and in knee-specific and health-related quality of life, compared to patients who chose non-surgical treatment.

  • 33.
    Ardern, Clare
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Österberg, Annika
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet. Uppsala Univ, Ctr Clin Res Sormland, Eskilstuna, Sweden.
    Tagesson (Sonesson), Sofi
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Gauffin, Håkan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Webster, Kate E.
    La Trobe University, Australia.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction2014Ingår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, nr 22, s. 1613-U50Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background This cross-sectional study aimed to examine whether appraisal of knee function, psychological and demographic factors were related to returning to the preinjury sport and recreational activity following anterior cruciate ligament (ACL) reconstruction. Method 164 participants completed a questionnaire battery at 1-7 years after primary ACL reconstruction. The battery included questionnaires evaluating knee self-efficacy, health locus of control, psychological readiness to return to sport and recreational activity, and fear of reinjury; and self-reported knee function in sport-specific tasks, knee-related quality of life and satisfaction with knee function. The primary outcome was returning to the preinjury sport or recreational activity. Results At follow-up, 40% (66/164) had returned to their preinjury activity. Those who returned had more positive psychological responses, reported better knee function in sport and recreational activities, perceived a higher knee-related quality of life and were more satisfied with their current knee function. The main reasons for not returning were not trusting the knee (28%), fear of a new injury (24%) and poor knee function (22%). Psychological readiness to return to sport and recreational activity, measured with the ACL-Return to Sport after Injury scale (was most strongly associated with returning to the preinjury activity). Age, sex and preinjury activity level were not related. Conclusions Less than 50% returned to their preinjury sport or recreational activity after ACL reconstruction. Psychological readiness to return to sport and recreation was the factor most strongly associated with returning to the preinjury activity. Including interventions aimed at improving this in postoperative rehabilitation programmes could be warranted to improve the rate of return to sport and recreational activities.

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  • 34.
    Areskoug Sandberg, Elin
    et al.
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Duberg, Anna
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Lorenzon Fagerberg, Ulrika
    Centre for Clinical Research, Department of Paediatrics, Västmanland Hospital, Region Västmanland, Uppsala University, Västerås, Sweden; Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Mörelius, Evalotte
    School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia; Perth Children’s Hospital, Nedlands, WA, Australia.
    Särnblad, Stefan
    Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Saliva Cortisol in Girls With Functional Abdominal Pain Disorders: A Randomized Controlled Dance and Yoga Intervention.2022Ingår i: Frontiers in Pediatrics , E-ISSN 2296-2360, Vol. 10, artikel-id 836406Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Functional abdominal pain disorders (FAPDs) are common among girls and has been associated with stress. Cortisol is one of the major stress hormones. Dance and yoga have been shown to reduce abdominal pain among girls with FAPDs.

    AIM: To investigate the effect of an 8-month intervention with dance and yoga on cortisol levels in saliva among girls with FAPDs.

    METHODS: A total of 121 girls aged 9-13 years with irritable bowel syndrome (IBS) or functional abdominal pain were included in the study. Participants were randomized into an intervention group and a control group. The intervention group attended a combined dance and yoga session twice a week for 8 months. Saliva samples were collected during 1 day, in the morning and evening, at baseline, and at 4 and 8 months. Subjective pain and stress were assessed as well.

    RESULTS: No significant effects on saliva cortisol levels between groups were observed after completion of the intervention at 8 months. However, evening cortisol and evening/morning quotient were significantly reduced at 4 months in the intervention group compared to the control group (p = 0.01, p = 0.004). There was no association between cortisol quota and pain or stress.

    CONCLUSION: Improvements in cortisol levels were seen in the intervention group at 4 months but did not persist until the end of the study. This indicates that dance and yoga could have a stress-reducing effect during the ongoing intervention.

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  • 35.
    Arundale, Amelia
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Hägglund, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Fältström, Anne
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.
    Jumping performance based on duration of rehabilitation in female football players after anterior cruciate ligament reconstruction2019Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, nr 2, s. 556-563Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    To determine if female football players who had longer durations of rehabilitation, measured in months, after anterior cruciate ligament reconstruction would have lower tuck jump scores (fewer technique flaws) and smaller asymmetries during drop vertical jump landing.

    Methods

    One-hundred-and-seventeen female football players, aged 16ᅵ25 years, after primary unilateral ACL reconstruction (median 16 months, range 6ᅵ39) were included. Athletes reported the duration of rehabilitation they performed after anterior cruciate ligament reconstruction. Athletes also performed the tuck jump and drop vertical jump tests. Outcome variables were: tuck jump score, frontal plane knee motion and probability of peak knee abduction moment during drop vertical jump landing.

    Results

    There was no difference in tuck jump score based on duration of rehabilitation (n.s.). No interaction (n.s.), difference between limbs (n.s.), or duration of rehabilitation (n.s.) was found for peak knee abduction moment during drop vertical jump landing. No interaction (n.s.) or difference between limbs (n.s.) was found for frontal plane knee motion, but there was a difference based on duration of rehabilitation (P?=?0.01). Athletes with >?9 months of rehabilitation had more frontal plane knee motion (medial knee displacement) than athletes with <?6 months (P?=?0.01) or 6ᅵ9 months (P?=?0.03).

    Conclusion

    As there was no difference in tuck jump score or peak knee abduction moment based on duration of rehabilitation, the results of this study press upon clinicians the importance of using objective measures to progress rehabilitation and clear athletes for return to sport, rather than time alone.

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    Jumping performance based on duration of rehabilitation in female football players after anterior cruciate ligament reconstruction
  • 36.
    Asker, Martin
    et al.
    Karolinska Inst, Sweden; Scandinavian Coll Naprapath Manual Med, Sweden.
    Waldén, Markus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Hassleholm Kristianstad Ystad Hosp, Sweden.
    Kallberg, Henrik
    Publ Hlth Agcy Sweden, Sweden.
    Holm, Lena W.
    Karolinska Inst, Sweden.
    Skillgate, Eva
    Karolinska Inst, Sweden; Scandinavian Coll Naprapath Manual Med, Sweden; Sophiahemmet Univ, Sweden.
    Preseason Clinical Shoulder Test Results and Shoulder Injury Rate in Adolescent Elite Handball Players: A Prospective Study2020Ingår i: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 50, nr 2, s. 67-+Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To investigate whether adolescent elite female and male handball players with shoulder muscle weakness, deficits in shoulder rotation range of motion (ROM) or in joint position sense (JPS), or scapular dyskinesis in the preseason had a higher rate of new shoulder injuries compared to players without these characteristics. DESIGN: Prospective cohort study. METHODS: We studied 344 uninjured players (452 player-seasons, 50% female). We measured their shoulder strength in isometric external rotation (IER), isometric internal rotation (IIR), isometric abduction, and eccentric external rotation, as well as their shoulder ROM, JPS, and scapular dyskinesis, during the preseason. Players were monitored weekly regarding match and training hours and shoulder injuries during 1 or 2 seasons. We used multivariable Cox proportional hazard models to calculate hazard rate ratios related to the first injury and 95% confidence intervals (CIs). RESULTS: During 2 seasons, the participants reported 48 new shoulder injuries. In female players, the hazard ratio was 2.37 (95% CI: 103, 5.44) for IER weakness and 2.44 (95% CI: 106, 5.61) for IIR weakness. The hazard rate ratio was 0.85 (95% CI: 0.39,183) for an IER/IIR ratio of less than 0.75 and 1.53 (95% CI: 0.36, 6.52) for scapular dyskinesis. In male players, the hazard rate ratio was 1.02 (95% CI: 0.44, 2.36) for ER weakness, 0.74 (95% CI: 0.31,1.75) for IIR weakness, 2.0 (95% CI: 0.68, 5.92) for an IER/IIR rati of less than 0.75, and 3.43 (95% CI: 1.49, 7.92) for scapular dyskinesis. There were no associations between new shoulder injuries and deficits in ROM or JPS. CONCLUSION: In adolescent elite handball, male players with preseason scapular dyskinesis and female players with preseason IIR or IER shoulder weakness had an increased shoulder injury rate.

  • 37.
    Barth, Cornelia
    et al.
    International Committee of the Red Cross, Geneva, Switzerland.
    Wladis, Andreas
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionledningskontoret, Katastrofmedicinskt centrum.
    Blake, Catherine
    School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
    Bhandarkar, Prashant
    Doctors For You, Mumbai, India.
    O’Sullivan, Cliona
    School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
    Users of rehabilitation services in 14 countries and territories affected by conflict, 1988–20182020Ingår i: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 98, s. 599-614Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To analyse the demographic and clinical characteristics of people attending physical rehabilitation centres run or supported by the International Committee of the Red Cross in countries and territories affected by conflict.

    Methods Of 150 such rehabilitation centres worldwide, 38 use an electronic patient management system. We invited all 38 centres to participate. We extracted de-identified data from 1988 to 2018 and categorized them by sex, age, country or territory and reason for using rehabilitation services.

    Findings Thirty-one of the 38 rehabilitation centres in 14 countries and territories participated. We included data for 287 274 individuals. Of people using rehabilitation services, 61.6% (176 949/287 274) were in Afghanistan, followed by 15.7% (44 959/287 274) in Cambodia. Seven places had over 9000 service users each (Afghanistan, Cambodia, Gaza Strip, Iraq, Myanmar, Somalia and Sudan). Overall, 72.6% (208 515/287 274) of service users were male. In eight countries, more than half of the users were of working age (18–59 years). Amputation was the most common reason for using rehabilitation services; 33.3% (95 574/287 274) of users were people with amputations, followed by 13.7% (39 446/287 274) with cerebral palsy. The male predominance was greater in the population aged 18–34 years (83.1%; 71 441/85 997) and in people with amputations (88.6%; 84 717/95 574) but was evident across all places, age groups and health conditions.

    Conclusion The considerably lower attendance of females at the rehabilitation centres highlights the need to understand the factors that affect the accessibility and acceptability of rehabilitation for women and girls in conflict settings.

  • 38.
    Battista, Simone
    et al.
    Lund Univ, Sweden; Univ Genoa, Italy.
    Kiadaliri, Ali
    Lund Univ, Sweden.
    Jonsson, Therese
    Lund Univ, Sweden.
    Gustafsson, Kristin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Ryhov Cty Hosp Jonkoping, Sweden.
    Englund, Martin
    Lund Univ, Sweden.
    Testa, Marco
    Univ Genoa, Italy.
    DellIsola, Andrea
    Lund Univ, Sweden.
    Factors Associated With Adherence to a Supervised Exercise Intervention for Osteoarthritis: Data From the Swedish Osteoarthritis Registry2023Ingår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 75, nr 10, s. 2117-2126Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    ObjectiveTo explore how lifestyle and demographic, socioeconomic, and disease-related factors are associated with supervised exercise adherence in an osteoarthritis (OA) management program and the ability of these factors to explain exercise adherence. MethodsA cohort register-based study on participants from the Swedish Osteoarthritis Registry who attended the exercise part of a nationwide Swedish OA management program. We ran a multinomial logistic regression to determine the association of exercise adherence with the abovementioned factors. We calculated their ability to explain exercise adherence with the McFadden R-2. ResultsOur sample comprises 19,750 participants (73% female, mean +/- SD age 67 +/- 8.9 years). Among them, 5,862 (30%) reached a low level of adherence, 3,947 (20%) a medium level, and 9,941 (50%) a high level. After a listwise deletion, the analysis was run on 16,685 participants (85%), with low levels of adherence as the reference category. Some factors were positively associated with high levels of adherence, such as older age (relative risk ratio [RRR] 1.01 [95% confidence interval (95% CI) 1.01-1.02] per year), and the arthritis-specific self-efficacy (RRR 1.04 [95% CI 1.02-1.07] per 10-point increase). Others were negatively associated with high levels of adherence, such as female sex (RRR 0.82 [95% CI 0.75-0.89]), having a medium (RRR 0.89 [95% CI 0.81-0.98] or a high level of education (RRR 0.84 [95% CI 0.76-0.94]). Nevertheless, the investigating factors could explain 1% of the variability in exercise adherence (R-2 = 0.012). ConclusionDespite the associations reported above, the poorly explained variability suggests that strategies based on lifestyle and demographic, socioeconomic, and disease-related factors are unlikely to improve exercise adherence significantly.

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  • 39.
    Baunsgaard, Carsten Bach
    et al.
    Univ Copenhagen, Denmark.
    Nissen, Ulla Vig
    Univ Copenhagen, Denmark.
    Brust, Anne Katrin
    SPC, Switzerland.
    Frotzler, Angela
    SPC, Switzerland.
    Ribeill, Cornelia
    Ulm Univ, Germany.
    Kalke, Yorck-Bernhard
    Ulm Univ, Germany.
    Leon, Natacha
    FLM, Spain.
    Gomez, Belen
    FLM, Spain.
    Samuelsson, Kersti
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Rehabiliteringsmedicinska kliniken.
    Antepohl, Wolfram
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Rehabiliteringsmedicinska kliniken.
    Holmstrom, Ulrika
    Uppsala Univ Hosp, Sweden.
    Marklund, Niklas
    Uppsala Univ Hosp, Sweden.
    Glott, Thomas
    Sunnaas Rehabil Hosp, Norway.
    Opheim, Arve
    Sunnaas Rehabil Hosp, Norway; Univ Gothenburg, Sweden.
    Benito, Jesus
    Neurorehabil Hosp, Spain.
    Murillo, Narda
    Neurorehabil Hosp, Spain.
    Nachtegaal, Janneke
    Heliomare Rehabil Ctr, Netherlands.
    Faber, Willemijn
    Heliomare Rehabil Ctr, Netherlands.
    Biering-Sorensen, Fin
    Univ Copenhagen, Denmark.
    Gait training after spinal cord injury: safety, feasibility and gait function following 8 weeks of training with the exoskeletons from Ekso Bionics2018Ingår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 56, nr 2, s. 106-116Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study design Prospective quasi-experimental study, pre-and post-design. Objectives Assess safety, feasibility, training characteristics and changes in gait function for persons with spinal cord injury (SCI) using the robotic exoskeletons from Ekso Bionics. Setting Nine European rehabilitation centres. Methods Robotic exoskeleton gait training, three times weekly over 8 weeks. Time upright, time walking and steps in the device (training characteristics) were recorded longitudinally. Gait and neurological function were measured by 10 Metre Walk Test (10 MWT), Timed Up and Go (TUG), Berg Balance Scale (BBS), Walking Index for Spinal Cord Injury (WISCI) II and Lower Extremity Motor Score (LEMS). Results Fifty-two participants completed the training protocol. Median age: 35.8 years (IQR 27.5-52.5), men/women: N = 36/16, neurological level of injury: C1-L2 and severity: AIS A-D (American Spinal Injury Association Impairment Scale). Time since injury (TSI) amp;lt; 1 year, N = 25; amp;gt; 1 year, N = 27. No serious adverse events occurred. Three participants dropped out following ankle swelling (overuse injury). Four participants sustained a Category II pressure ulcer at contact points with the device but completed the study and skin normalized. Training characteristics increased significantly for all subgroups. The number of participants with TSI amp;lt; 1 year and gait function increased from 20 to 56% (P=0.004) and 10MWT, TUG, BBS and LEMS results improved (P amp;lt; 0.05). The number of participants with TSI amp;gt; 1 year and gait function, increased from 41 to 44% and TUG and BBS results improved (P amp;lt; 0.05). Conclusions Exoskeleton training was generally safe and feasible in a heterogeneous sample of persons with SCI. Results indicate potential benefits on gait function and balance.

  • 40.
    Baunsgaard, Carsten Bach
    et al.
    Univ Copenhagen, Denmark.
    Nissen, Ulla Vig
    Univ Copenhagen, Denmark.
    Brust, Anne Katrin
    SPC, Switzerland.
    Frotzler, Angela
    SPC, Switzerland.
    Ribeill, Cornelia
    Ulm Univ, Germany.
    Kalke, Yorck-Bernhard
    Ulm Univ, Germany.
    Leon, Natacha
    FLM, Spain.
    Gomez, Belen
    FLM, Spain.
    Samuelsson, Kersti
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Rehabiliteringsmedicinska kliniken.
    Antepohl, Wolfram
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Rehabiliteringsmedicinska kliniken.
    Holmstrom, Ulrike
    Uppsala Univ Hosp, Sweden.
    Marklund, Niklas
    Uppsala Univ Hosp, Sweden.
    Glott, Thomas
    Sunnaas Rehabil Hosp, Norway.
    Opheim, Arve
    Sunnaas Rehabil Hosp, Norway; Univ Gothenburg, Sweden; Reg Vastra Gotaland, Sweden.
    Benito Penalva, Jesus
    Neurorehabil Hosp, Spain.
    Murillo, Narda
    Neurorehabil Hosp, Spain.
    Nachtegaal, Janneke
    Heliomare Rehabil Ctr, Netherlands.
    Faber, Willemijn
    Heliomare Rehabil Ctr, Netherlands.
    Biering-Sorensen, Fin
    Univ Copenhagen, Denmark.
    EXOSKELETON GAIT TRAINING AFTER SPINAL CORD INJURY: AN EXPLORATORY STUDY ON SECONDARY HEALTH CONDITIONS2018Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, nr 9, s. 806-813Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To explore changes in pain, spasticity, range of motion, activities of daily living, bowel and lower urinary tract function and quality of life of individuals with spinal cord injury following robotic exoskeleton gait training. Design: Prospective, observational, open-label multicentre study. Methods: Three training sessions per week for 8 weeks using an Ekso GT robotic exoskeleton (Ekso Bionics). Included were individuals with recent (amp;lt;1 year) or chronic (amp;gt;1 year) injury, paraplegia and tetraplegia, complete and incomplete injury, men and women. Results: Fifty-two participants completed the training protocol. Pain was reported by 52% of participants during the week prior to training and 17% during training, but no change occurred longitudinally. Spasticity decreased after a training session compared with before the training session (pamp;lt; 0.001), but not longitudinally. Chronically injured participants increased Spinal Cord Independence Measure (SCIM III) from 73 to 74 (p= 0.008) and improved life satisfaction (p= 0.036) over 8 weeks of training. Recently injured participants increased SCIM III from 62 to 70 (pamp;lt;0.001), but no significant change occurred in life satisfaction. Range of motion, bowel and lower urinary function did not change over time. Conclusion: Training seemed not to provoke new pain. Spasticity decreased after a single training session. SCIM III and quality of life increased longitudinally for subsets of participants.

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  • 41. Beställ onlineKöp publikationen >>
    Bendelin, Nina
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Internet-Delivered Acceptance and Commitment Therapy for Chronic Pain: Feasibility, patients’ experiences and implementation process2023Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    Långvarig smärta medför ett lidande för den drabbade individen och konsekvenser för samhället. Internetbaserade psykologiska behandlingar är evidensbaserade in-satser som ger patienter tillgång till kvalificerad vård vid den tid och på den plats som passar dem. Internetbaserad Acceptance and commitment therapy (IACT) kan påverka smärtintensitet samt hur mycket smärtan hindrar individen. IACT påverkar också psykologiska faktorer som katastrofiering, rädsla/undvikande och smärtacceptans. Multimodala smärtrehabiliteringsprogram (MMR) består av flera behandlingsinsatser som ges parallellt av ett team där vårdpersonal från olika professioner samarbetar. MMR har medelstor påverkan på flera faktorer och är den rekommenderade behandlingen för personer med långvarig smärta.  

    IACT skulle kunna vara hjälpsamt för smärtpatienter som komplement till MMR, genom att ge individuell psykologisk behandling via internet. IACT har ännu inte implementerats rutinmässigt i sjukvården. I denna avhandling är syftet att studera om IACT uppskattas av smärtpatienter och om IACT är tillämpbart och effektivt som tillägg till MMR. Tre olika metoder används, nämligen kvalitativ analys, implementeringskunskap och en kontrollerad studie av effektivitet på en smärtrehabiliteringsklinik.   

    Studie I visade att internetbaserad eftervård hjälpte smärtpatienter att förändra sin uppfattning om sin kropp och sin smärta samt sin attityd till sin framtid och sig själva. Därtill tycktes patienternas autonomi påverkas av motiverande mål och acceptansstrategier. Resultatet talar för att IACT är tillämpbart som eftervård efter MMR. Studie II visade att smärtpatienters upplevelser av IACT varierar, både avseende att vara i behandling och behandlingens konsekvenser. Kontakten med en terapeut via internet (e-terapeut) och deadlines för hemuppgifter tycktes på-verka patienternas förändring och autonomi. Patienternas förväntningar, motivation och begränsningar kan förklara deras upplevelser och hur de deltar i behandling. Studie III visade att IACT som tillägg kan förbättra den effekt som MMR har på patienters smärtacceptans och hur påverkade de är av känslor. IACT som tillägg efter MMR kan förstärka den långsiktiga effekten av MMRP på psykologisk flexibilitet och self-efficacy. Studie IV visade att implementering av IACT på en smärtrehabiliteringsklinik kan underlättas av likriktning med kontextfaktorer och anpassningar utifrån patienters behov. Noggrann testning av tekniken bakom IACT och att matcha syftet med IACT med klinikens behov är viktigt för att inte försvåra implementeringen. Ett ramverk för implementering kan underlätta såväl planering som utvärdering av processen.   

    Delarbeten
    1. Internet-delivered aftercare following multimodal rehabilitation program for chronic pain: a qualitative feasibility study
    Öppna denna publikation i ny flik eller fönster >>Internet-delivered aftercare following multimodal rehabilitation program for chronic pain: a qualitative feasibility study
    2018 (Engelska)Ingår i: Journal of Pain Research, E-ISSN 1178-7090, Vol. 11, s. 1715-1728Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Purpose: Methods for delivering aftercare to help chronic pain patients to continue practice self-management skills after rehabilitation are needed. Internet-delivered cognitive behavioral therapy (ICBT) has the potential to partly fill this gap given its accessibility and emphasis on self-care. Methods for engaging and motivating patients to persist throughout the full length of treatment are needed. The aim of this study was to describe how chronic pain patients work in an ICBT program, through their descriptions of what is important when they initiate behavior change in aftercare and their descriptions of what is important for ongoing practice of self-management skills in aftercare. Patients and methods: Following a multimodal rehabilitation program, 29 chronic pain patients participated in a 20-week-long Internet-delivered aftercare program (ACP) based on acceptance-based cognitive behavioral therapy. Latent content analysis was made on 138 chapters of diary-like texts written by participants in aftercare. Results: Attitudes regarding pain and body changed during ACP, as did attitudes toward self and the future for some participants. How participants practiced self-management skills was influenced by how they expressed motivation behind treatment goals. Whether they practiced acceptance strategies influenced their continuous self-management practice. Defusion techniques seemed to be helpful in the process of goal setting. Mindfulness strategies seemed to be helpful when setbacks occurred. Conclusion: Self-motivating goals are described as important both to initiate and in the ongoing practice of self-management skills. Experiencing a helpful effect of acceptance strategies seems to encourage participants to handle obstacles in new ways and to persist throughout treatment. Research on whether tailored therapist guidance might be helpful in stating self-motivating goals and contribute to ongoing practice of self-management skills is needed.

    Ort, förlag, år, upplaga, sidor
    DOVE MEDICAL PRESS LTD, 2018
    Nyckelord
    Internet-delivered cognitive-behavioral therapy; chronic pain; acceptance and commitment therapy; qualitative analysis; self-management
    Nationell ämneskategori
    Sjukgymnastik
    Identifikatorer
    urn:nbn:se:liu:diva-151536 (URN)10.2147/JPR.S157939 (DOI)000443450600002 ()30233229 (PubMedID)
    Anmärkning

    Funding Agencies|County Council of Ostergotland (forsknings-ALF); AFA insurance

    Tillgänglig från: 2018-09-24 Skapad: 2018-09-24 Senast uppdaterad: 2024-01-17
    2. Patients experiences of internet-based Acceptance and commitment therapy for chronic pain: a qualitative study
    Öppna denna publikation i ny flik eller fönster >>Patients experiences of internet-based Acceptance and commitment therapy for chronic pain: a qualitative study
    Visa övriga...
    2020 (Engelska)Ingår i: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, BMC MUSCULOSKELETAL DISORDERS, Vol. 21, nr 1, artikel-id 212Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background: Chronic pain is a globally widespread condition with complex clusters of symptoms within a heterogeneous patient group. Internet-delivered Acceptance and Commitment Therapy (IACT) has shown promising results in the treatment of chronic pain. How IACT is experienced by patients is less well known. Qualitative studies of patients experiences are needed to further understand factors behind both engagement and negative effects. The aim of this study was to explore how IACT was experienced by chronic pain patients who had participated in a controlled trial. Methods: Through an open and exploratory approach this study aimed to investigate how IACT was experienced when delivered as a guided self-help program to persons with chronic pain. Eleven participants were interviewed over telephone after completing IACT. Results: Qualitative analysis based on grounded theory resulted in 2 core categories and 8 subcategories. In treatment: Physical and cognitive restraints, Time and deadline, Therapist contact, and Self-confrontation. After treatment: Attitude to pain, Image of pain, Control or Command, and Acting with pain. Individual differences as well as specific conditions of the treatment may explain variations in how the treatment was approached, experienced and what consequences it led to. Therapist guidance and deadlines for homework play complex roles in relation to autonomy and change. Conclusions: Adjusting treatment content and format based on participants characteristics, such as expectations, motivation and restraints, might positively affect engagement, autonomy and change. Further research on attrition and negative effects of treatment might clarify what enables chronic pain patients to benefit from IACT.

    Ort, förlag, år, upplaga, sidor
    BioMed Central, 2020
    Nyckelord
    ICBT; ACT; Person-based approach; Motivation; Change; Engagement; Attrition; Constructivist grounded theory
    Nationell ämneskategori
    Sjukgymnastik
    Identifikatorer
    urn:nbn:se:liu:diva-165330 (URN)10.1186/s12891-020-03198-1 (DOI)000525521300001 ()32252707 (PubMedID)2-s2.0-85083071771 (Scopus ID)
    Anmärkning

    Funding Agencies|County Council of Ostergotland

    Tillgänglig från: 2020-04-27 Skapad: 2020-04-27 Senast uppdaterad: 2024-01-17Bibliografiskt granskad
    3. Internet-Delivered Acceptance and Commitment Therapy Added to Multimodal Pain Rehabilitation: A Cluster Randomized Controlled Trial
    Öppna denna publikation i ny flik eller fönster >>Internet-Delivered Acceptance and Commitment Therapy Added to Multimodal Pain Rehabilitation: A Cluster Randomized Controlled Trial
    Visa övriga...
    2021 (Engelska)Ingår i: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 10, nr 24, artikel-id 5872Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Internet-delivered interventions hold the possibility to make pain rehabilitation more accessible and adaptable by providing qualified individualized psychological care to chronic pain patients in their homes. Acceptance and commitment therapy (ACT) has shown promising results on psychological functioning and pain acceptance. Internet-delivered ACT (IACT) added to multimodal pain rehabilitation program (MMRP) in primary care has, so far, not shown better results than MMRP alone. The aim of this cluster randomized controlled study was to investigate the effects of adding IACT during and after MMRP in specialist care on psychological outcomes. In total, 122 patients who enrolled in a specialist pain clinic were cluster randomized groupwise to either MMRP (n = 12 groups) or to MMRP with added IACT (n = 12 groups). The IACT addition included 6 weeks of treatment during MMRP and 11 weeks of aftercare following MMRP. Online and paper-and-pencil self-report measures of pain acceptance, psychological inflexibility, self-efficacy, and psychosocial consequences of pain, were collected at four occasions: prior to and post MMRP, post aftercare intervention and at 1 year follow-up. Dropout was extensive with 25% dropping out at post treatment, an additional 35% at post aftercare, and 29% at 1 year follow-up. Medium treatment between-group effects were found on pain acceptance in favor of the group who received IACT added to MMRP, at post treatment and at post aftercare. Large effects were seen on psychological inflexibility and self-efficacy at post aftercare. A medium effect size was seen on affective distress at post aftercare. Moreover, a medium effect on self-efficacy was found at 1 year follow-up. The results indicate that IACT added during MMRP may enhance the treatment effects on pain-related psychological outcomes. Results also suggest that IACT as aftercare may strengthen the long-term effect of MMRP. However, adding a second pain treatment, IACT, to an already extensive pain treatment, MMRP, could be perceived as too comprehensive and might hence influence completion negatively. Further research on adverse events and negative effects could be helpful to improve adherence. Next step of implementation trials could focus on adding IACT before MMRP to improve psychological functioning and after MMRP to prolong its effect.

    Ort, förlag, år, upplaga, sidor
    MDPI, 2021
    Nyckelord
    chronic pain; internet-delivered acceptance and commitment therapy (IACT); multimodal pain rehabilitation program (MMRP); aftercare; implementation; internet-delivered cognitive behavioral therapy (ICBT); booster intervention; combined treatment
    Nationell ämneskategori
    Sjukgymnastik
    Identifikatorer
    urn:nbn:se:liu:diva-182224 (URN)10.3390/jcm10245872 (DOI)000737821800001 ()34945167 (PubMedID)
    Anmärkning

    Funding Agencies|REHSAM; Swedish Social Insurance Agency; Ministry of Health and Social Affairs; Swedish Association of Local Authorities and Regions; Vardal Foundation [99368-2009/RS10]; Lions Ostergotland Sweden [2020-01334]; City Council of OEstergoetland, Sweden [LIO-938308, SC-2019-00155-39]

    Tillgänglig från: 2022-01-12 Skapad: 2022-01-12 Senast uppdaterad: 2023-04-11
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  • 42.
    Bendelin, Nina
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Björkdahl, Pär
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Risell, Mimmi
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Zetterqvist Nelson, Karin
    Linköpings universitet, Institutionen för tema, Tema Barn. Linköpings universitet, Filosofiska fakulteten.
    Gerdle, Björn
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Inst, Sweden.
    Buhrman, Monica
    Uppsala Univ, Sweden.
    Patients experiences of internet-based Acceptance and commitment therapy for chronic pain: a qualitative study2020Ingår i: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, BMC MUSCULOSKELETAL DISORDERS, Vol. 21, nr 1, artikel-id 212Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Chronic pain is a globally widespread condition with complex clusters of symptoms within a heterogeneous patient group. Internet-delivered Acceptance and Commitment Therapy (IACT) has shown promising results in the treatment of chronic pain. How IACT is experienced by patients is less well known. Qualitative studies of patients experiences are needed to further understand factors behind both engagement and negative effects. The aim of this study was to explore how IACT was experienced by chronic pain patients who had participated in a controlled trial. Methods: Through an open and exploratory approach this study aimed to investigate how IACT was experienced when delivered as a guided self-help program to persons with chronic pain. Eleven participants were interviewed over telephone after completing IACT. Results: Qualitative analysis based on grounded theory resulted in 2 core categories and 8 subcategories. In treatment: Physical and cognitive restraints, Time and deadline, Therapist contact, and Self-confrontation. After treatment: Attitude to pain, Image of pain, Control or Command, and Acting with pain. Individual differences as well as specific conditions of the treatment may explain variations in how the treatment was approached, experienced and what consequences it led to. Therapist guidance and deadlines for homework play complex roles in relation to autonomy and change. Conclusions: Adjusting treatment content and format based on participants characteristics, such as expectations, motivation and restraints, might positively affect engagement, autonomy and change. Further research on attrition and negative effects of treatment might clarify what enables chronic pain patients to benefit from IACT.

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  • 43.
    Bendelin, Nina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Gerdle, Björn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Inst, Sweden.
    Internet-delivered aftercare following multimodal rehabilitation program for chronic pain: a qualitative feasibility study2018Ingår i: Journal of Pain Research, E-ISSN 1178-7090, Vol. 11, s. 1715-1728Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Methods for delivering aftercare to help chronic pain patients to continue practice self-management skills after rehabilitation are needed. Internet-delivered cognitive behavioral therapy (ICBT) has the potential to partly fill this gap given its accessibility and emphasis on self-care. Methods for engaging and motivating patients to persist throughout the full length of treatment are needed. The aim of this study was to describe how chronic pain patients work in an ICBT program, through their descriptions of what is important when they initiate behavior change in aftercare and their descriptions of what is important for ongoing practice of self-management skills in aftercare. Patients and methods: Following a multimodal rehabilitation program, 29 chronic pain patients participated in a 20-week-long Internet-delivered aftercare program (ACP) based on acceptance-based cognitive behavioral therapy. Latent content analysis was made on 138 chapters of diary-like texts written by participants in aftercare. Results: Attitudes regarding pain and body changed during ACP, as did attitudes toward self and the future for some participants. How participants practiced self-management skills was influenced by how they expressed motivation behind treatment goals. Whether they practiced acceptance strategies influenced their continuous self-management practice. Defusion techniques seemed to be helpful in the process of goal setting. Mindfulness strategies seemed to be helpful when setbacks occurred. Conclusion: Self-motivating goals are described as important both to initiate and in the ongoing practice of self-management skills. Experiencing a helpful effect of acceptance strategies seems to encourage participants to handle obstacles in new ways and to persist throughout treatment. Research on whether tailored therapist guidance might be helpful in stating self-motivating goals and contribute to ongoing practice of self-management skills is needed.

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  • 44.
    Bendelin, Nina
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Gerdle, Björn
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Blom, Marie
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Södermark, Martin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Karolinska Inst, Sweden.
    Internet-Delivered Acceptance and Commitment Therapy Added to Multimodal Pain Rehabilitation: A Cluster Randomized Controlled Trial2021Ingår i: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 10, nr 24, artikel-id 5872Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Internet-delivered interventions hold the possibility to make pain rehabilitation more accessible and adaptable by providing qualified individualized psychological care to chronic pain patients in their homes. Acceptance and commitment therapy (ACT) has shown promising results on psychological functioning and pain acceptance. Internet-delivered ACT (IACT) added to multimodal pain rehabilitation program (MMRP) in primary care has, so far, not shown better results than MMRP alone. The aim of this cluster randomized controlled study was to investigate the effects of adding IACT during and after MMRP in specialist care on psychological outcomes. In total, 122 patients who enrolled in a specialist pain clinic were cluster randomized groupwise to either MMRP (n = 12 groups) or to MMRP with added IACT (n = 12 groups). The IACT addition included 6 weeks of treatment during MMRP and 11 weeks of aftercare following MMRP. Online and paper-and-pencil self-report measures of pain acceptance, psychological inflexibility, self-efficacy, and psychosocial consequences of pain, were collected at four occasions: prior to and post MMRP, post aftercare intervention and at 1 year follow-up. Dropout was extensive with 25% dropping out at post treatment, an additional 35% at post aftercare, and 29% at 1 year follow-up. Medium treatment between-group effects were found on pain acceptance in favor of the group who received IACT added to MMRP, at post treatment and at post aftercare. Large effects were seen on psychological inflexibility and self-efficacy at post aftercare. A medium effect size was seen on affective distress at post aftercare. Moreover, a medium effect on self-efficacy was found at 1 year follow-up. The results indicate that IACT added during MMRP may enhance the treatment effects on pain-related psychological outcomes. Results also suggest that IACT as aftercare may strengthen the long-term effect of MMRP. However, adding a second pain treatment, IACT, to an already extensive pain treatment, MMRP, could be perceived as too comprehensive and might hence influence completion negatively. Further research on adverse events and negative effects could be helpful to improve adherence. Next step of implementation trials could focus on adding IACT before MMRP to improve psychological functioning and after MMRP to prolong its effect.

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  • 45.
    Bendtsen, Marcus
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Garnett, Claire
    UCL, England.
    Toner, Paul
    Queens Univ Belfast, North Ireland.
    Shorter, Gillian W.
    Queens Univ Belfast, North Ireland.
    The Effect of Question Order on Outcomes in the Core Outcome Set for Brief Alcohol Interventions Among Online Help-Seekers: Protocol for a Factorial Randomized Trial2020Ingår i: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 9, nr 11, artikel-id e24175Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A core outcome set (COS) for trials and evaluations of the effectiveness and efficacy of alcohol brief interventions (ABIs) has recently been established through international consensus to address the variability of outcomes evaluated. Objective: This is a protocol for studies to assess if there are order effects among the questions included in the COS. Methods: The 10 items of the COS are organized into 4 clusters. A factorial design will be used with 24 arms, where each arm represents 1 order of the 4 clusters. Individuals searching online for help will be asked to complete a questionnaire, and consenting participants will be randomized to 1 of the 24 arms (double-blind with equal allocation). Participants will be included if they are 18 years or older. The primary analyses will (1) estimate how the order of the clusters of outcomes affects how participants respond and (2) investigate patterns of abandonment of the questionnaire. Results: Data collection is expected to commence in November 2020. A Bayesian group sequential design will be used with interim analyses planned for every 50 participants completing the questionnaire Data collection will end no more than 24 months after commencement, and the results are expected to be published no later than December 2023. Conclusions: Homogenizing the outcomes evaluated in studies of ABIs is important to support synthesis, and the COS is an important step toward this goal. Determining whether there may be issues with the COS question order may improve confidence in using it and speed up its dissemination in the research community We encourage others to adopt the protocol as a study within their trial as they adopt the ORBITAL (Outcome Reporting in Brief Intervention Trials: Alcohol) COS to build a worldwide repository and provide materials to support such analysis.

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  • 46.
    Berger-Estilita, Joana
    et al.
    CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal; b Department of Emergency and Intensive Care Medicine , Algarve University Hospital Centre , Faro , Portugal.
    Granja, Cristina
    CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal; b Department of Emergency and Intensive Care Medicine , Algarve University Hospital Centre , Faro , Portugal; c Department of Biomedical Sciences and Medicine , University of Algarve , Faro , Portugal.
    Gonçalves, Hernâni
    CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal; d Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine , University of Porto , Porto , Portugal.
    Dias, Claudia Camila
    CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal; d Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine , University of Porto , Porto , Portugal.
    Aragão, Irene
    Intensive Care Unit, Hospital Santo Antonio , Porto University Hospital Center , Porto , Portugal.
    Costa-Pereira, Altamiro
    CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal; d Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine , University of Porto , Porto , Portugal.
    Orwelius, Lotti
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, ANOPIVA US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine , University of Porto , Porto , Portugal.
    A new global health outcome score after trauma (GHOST) for disability, cognitive impairment, and health-related quality of life: data from a prospective cross-sectional observational study2019Ingår i: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 33, nr 7, s. 922-931Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:Trauma patients experience morbidity related to disability and cognitive impairment that negatively impact their health-related quality of life (HRQoL). We assessed the impact of trauma on disability, cognitive impairment and HRQoL after intensive care in patients with and without traumatic brain injury (TBI) and created a predictive score to identify patients with worse outcome. Methods:We identified 262 patients with severe trauma (ISSamp;gt;15) admitted to the emergency room of a level 1 trauma center. Patients above 13 years were included. After 6 months, patients were assessed for disability, cognitive impairment, and HRQoL. A global health outcome score after trauma (GHOST) was obtained through the combination of these domains. Logistic regression analysis was considered for the effect of demographic, trauma and hospital factors on global outcome. p amp;gt; 0.05. Statistics performed with SPSS 23.0. Results:Patients with the worst outcomes were older and had a longer length of Intensive Care Unit (ICU) stay. The effect of gender was found in all "GHOST dimensions". TBI was not significantly associated with worse outcome. Conclusions:No significant differences were seen on disability, cognitive impairment and decreased HRQoL in patients with or without TBI. Our GHOST score showed that female gender, older age, and longer ICU stay were significantly associated with the worst outcome. Abbreviations: AIS: Abbreviated Injury Scale; EQ-5D: EuroQol 5-dimensions; EQ-5D-3L: EuroQol 5-dimensions 3-levels; GCS: Glasgow Coma Scale; GOSE: Glasgow Outcome Scale Extended; HRQoL: Health-Related Quality of Life; ICU: Intensive Care Unit; ISS: Injury Severity Score; MMS: Mini Mental State; NICE: National Institute for Health and Care Excellence; RTS: Revised Trauma Score; TBI: Traumatic brain injury; TRISS: Trauma Injury Severity Score; VAS: Visual Analogue Scale.

  • 47.
    Bergström, Maria
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten.
    Ahlstrand, Inger
    Jönköping University, Sweden.
    Thyberg, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Falkmer, Torbjörn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum. Jonköping University, Sweden; Curtin University, Australia.
    Börsbo, Björn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Björk, Mathilda
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Like the worst toothache you've had - How people with rheumatoid arthritis describe and manage pain2017Ingår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 24, nr 6, s. 468-476Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease often associated with disability. Despite new treatments, pain and activity limitations are still present. Objectives: To describe how persons with RA experience and manage pain in their daily life. Methods: Seven semi-structured focus groups (FGs) were conducted and analyzed using content analysis. Results: The analysis revealed four categories: 1) Pain expresses itself in different ways referred to pain as overwhelming, aching or as a feeling of stiffness. 2) Mitigating pain referred to the use of heat, cold, medications and activities as distractions from the pain. 3) Adapting to pain referred to strategies employed as coping mechanisms for the pain, e.g. planning and adjustment of daily activities, and use of assistive devices. 4) Pain in a social context referred to the participants social environment as being both supportive and uncomprehending, the latter causing patients to hide their pain. Conclusions: Pain in RA is experienced in different ways. This emphasizes the multi-professional team to address this spectrum of experiences and to find pain management directed to the individual experience that also include the persons social environment.

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  • 48. Beställ onlineKöp publikationen >>
    Bernhardsson, Susanne
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Advancing evidence-based practice in primary care physiotherapy: Guideline implementation, clinical practice, and patient preferences2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Research on physiotherapy treatment interventions has increased dramatically in the past 25 years and it is a challenge to transfer research findings into clinical practice, so that patients benefit from effective treatment. Development of clinical practice guidelines is a potentially useful strategy to implement research evidence into practice. However, the impact of guideline implementation in Swedish primary care physiotherapy is unknown. To achieve evidence-based practice (EBP), research evidence should be integrated with clinical expertise and patient preferences, but knowledge is limited about these factors in Swedish primary care physiotherapy.

    The overall aim of this thesis was to increase understanding of factors of importance for the implementation of EBP in Swedish primary care physiotherapy. Specific aims were: to translate and adapt a questionnaire for the measurement of EBP and guidelines; to investigate physiotherapists’ attitudes, knowledge and behaviour related to EBP and guidelines; to examine clinical practice patterns; to evaluate the effects of a tailored guideline implementation strategy; and to explore patients’ preferences for physiotherapy.

    The thesis comprises four studies (A-D), reported in five papers. In Study A, a questionnaire for the measurement of EBP and guidelines was translated, cross-culturally adapted, and tested for validity (n=10) and reliability (n=42). Study B was a cross-sectional study in which this questionnaire was used to survey primary care physiotherapists in the county council Region Västra Götaland (n=271). In Study C, a strategy for the implementation of guidelines was developed and evaluated, using the same questionnaire (n=271 at baseline, n=256 at follow-up), in a prospective controlled trial. The strategy was based on an implementation model, was tailored to address the determinants of guideline use identified in Study B, and comprised several components including an educational seminar. Study D was an exploratory qualitative study of patients with musculoskeletal disorders (n=20), using qualitative content analysis.

    The validity and reliability of the questionnaire was found to be satisfactory. Most physiotherapists have a positive regard for EBP and guidelines, although these attitudes are not fully reflected in the reported use of guidelines. The most important determinants of  guideline use were considering guidelines important to facilitate practice and knowing how to integrate patient preferences with guidelines. The tailored, multi-component guideline implementation significantly affected awareness of, knowledge of, and access to guidelines. Use of guidelines was significantly affected among those who attended an implementation seminar. Clinical practice for common musculoskeletal conditions included interventions supported by evidence of various strengths as well as interventions with insufficient research evidence. The most frequently reported interventions were advice and exercise therapy. The interviewed patients expressed trust and confidence in the professionalism of physiotherapists and in the therapists’ ability to choose appropriate treatment, rendering treatment preferences subordinate. This trust seemed to foster active engagement in their physiotherapy.

    In conclusion: The adapted questionnaire can be used to reliably measure EBP in physiotherapy. The positive attitudes found do not necessarily translate to guideline use, due to several perceived barriers. The tailored guideline implementation strategy used can be effective to reduce barriers and contribute to increased use of guidelines. The clinical practice patterns identified suggest that physiotherapists rely both on research evidence and their clinical expertise when choosing treatment methods. Patients’ trust in their physiotherapist’s competence and preference for active engagement in their therapy need to be embraced by the clinician and, together with the therapist’s clinical expertise, integrated with guideline use in the clinical decision making. Further research is needed on how the EBP components and different knowledge sources can be integrated in physiotherapy practice, as well as on implementation effects on patient outcomes.

    Delarbeten
    1. Measuring Evidence-Based Practice in Physical Therapy: Translation, Adaptation, Further Development, Validation, and Reliability Test of a Questionnaire
    Öppna denna publikation i ny flik eller fönster >>Measuring Evidence-Based Practice in Physical Therapy: Translation, Adaptation, Further Development, Validation, and Reliability Test of a Questionnaire
    2013 (Engelska)Ingår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 93, nr 6, s. 819-832Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background. Evidence-based practice (EBP) and evidence-based clinical practice guidelines are becoming increasingly important in physical therapy. For the purpose of meeting the goals of designing, implementing, and evaluating strategies to facilitate the development of more EBP in primary care physical therapy, a valid and reliable questionnaire for measuring attitudes, knowledge, behavior, prerequisites, and barriers related to EBP and guidelines is needed. less thanbrgreater than less thanbrgreater thanObjective. The 3 objectives of this study were: (1) to translate and cross-culturally adapt a questionnaire to a Swedish primary care context for the purpose of measuring various aspects of EBP and guidelines in physical therapy, (2) to further develop the questionnaire to examine more aspects of guidelines, and (3) to test the validity and reliability of the adapted Swedish questionnaire. less thanbrgreater than less thanbrgreater thanDesign. This was an instrument development study with validity and reliability testing. less thanbrgreater than less thanbrgreater thanMethods. A previously used questionnaire about EBP was translated and cross-culturally adapted to a Swedish primary care physical therapy context. Additional items were constructed. A draft version was pilot tested for content validity (n=10), and a revised version was tested for test-retest reliability (n=42). The percentage of agreement between the 2 tests was analyzed. less thanbrgreater than less thanbrgreater thanResults. The development process resulted in a first questionnaire draft containing 48 items. The validation process resulted in a second draft with acceptable content validity and consisting of 38 items. The test-retest analysis showed that the median percentage of agreement was 67% (range=41%-81%). After removal or revision of items with poor agreement, the final questionnaire included 31 items. less thanbrgreater than less thanbrgreater thanLimitations. Only face validity and content validity were tested. less thanbrgreater than less thanbrgreater thanConclusions. The final translated and adapted questionnaire was determined to have good face and content validity and acceptable reliability for measuring self-reported attitudes, knowledge, behavior, prerequisites, and barriers related to EBP and guidelines among physical therapists in primary care settings.

    Ort, förlag, år, upplaga, sidor
    American Physical Therapy Association (APTA), 2013
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-95503 (URN)10.2522/ptj.20120270 (DOI)000319546800010 ()
    Tillgänglig från: 2013-07-05 Skapad: 2013-07-05 Senast uppdaterad: 2017-12-06
    2. Determinants of Guideline Use in Primary Care Physical Therapy: A Cross-Sectional Survey of Attitudes, Knowledge, and Behavior
    Öppna denna publikation i ny flik eller fönster >>Determinants of Guideline Use in Primary Care Physical Therapy: A Cross-Sectional Survey of Attitudes, Knowledge, and Behavior
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    2014 (Engelska)Ingår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 94, nr 3, s. 343-354Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background. Understanding of attitudes, knowledge, and behavior related to evidence-based practice (ESP) and use of evidence-based clinical practice guidelines in primary care physical therapy is limited. Objectives. The objectives of this study were: (1) to investigate self-reported attitudes, knowledge, behavior, prerequisites, and barriers related to EBP and guideline use among physical therapists in primary care and (2) to explore associations of self-reported use of guidelines with these social cognitive factors along with demographic and workplace characteristics. Design. This was a cross-sectional survey. Methods. A web-based survey of 419 physical therapists in primary care in western Sweden was performed. Multiple logistic regression analysis was performed to examine factors associated with guideline use. Results. The response rate was 64.7%. Most respondents had positive attitudes toward EBP and guidelines: 90% considered EBP necessary, and 96% considered guidelines important. Approximately two thirds reported confidence in finding and using evidence. One third reported being aware of guidelines. Thirteen percent knew where to find guidelines, and only 9% reported having easy access to guidelines. Fewer than half reported using guidelines frequently. The most important barriers to using guidelines were lack of time, poor availability, and limited access to guidelines. Young age and brief work experience were associated with positive attitudes toward EBP. A postgraduate degree was associated with higher application of EBP. Positive attitudes, awareness of guidelines, considering guidelines to facilitate practice, and knowing how to integrate patient preferences with guideline use were associated with frequent use of guidelines. Limitations. Data were self-reported, which may have increased the risk of social.desirability bias. Conclusions. Use of guidelines was not as frequent as could be expected in view of the positive attitudes toward EBP and guidelines among physical therapists. Awareness of and perceived access to guidelines were limited. The identified determinants can be addressed when developing guideline implementation strategies.

    Ort, förlag, år, upplaga, sidor
    American Physical Therapy Association (APTA), 2014
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-106033 (URN)10.2522/ptj.20130147 (DOI)000332351300008 ()
    Tillgänglig från: 2014-04-17 Skapad: 2014-04-17 Senast uppdaterad: 2023-12-28
    3. Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial.
    Öppna denna publikation i ny flik eller fönster >>Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial.
    Visa övriga...
    2014 (Engelska)Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 14, nr 1, s. 105-Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    BACKGROUND:

    Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence-based practice (EBP). There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy. The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden.

    METHODS:

    An implementation strategy based on theory and current evidence was developed. A tailored, multi-component implementation intervention, addressing earlier identified determinants, was carried out in three areas comprising 28 physical therapy practices including 277 physical therapists (PTs) (intervention group). In two adjacent areas, 171 PTs at 32 practices received no intervention (control group). The core component of the intervention was an implementation seminar with group discussions. Among other components were a website and email reminders. Data were collected at baseline and follow-up with a web-based questionnaire. Primary outcomes were the self-reported awareness of, knowledge of, access to, and use of guidelines. Secondary outcomes were self-reported attitudes toward EBP and guidelines. Analyses were performed using Pearson's χ2 test and approximative z-test.

    RESULTS:

    168 PTs (60.6%) in the intervention group and 88 PTs (51.5%) in the control group responded to the follow-up questionnaire. 186/277 PTs (67.1%) participated in the implementation seminars, of which 97 (52.2%) responded. The proportions of PTs reporting awareness of (absolute difference in change 20.6%, p = 0.023), knowledge where to find (20.4%, p = 0.007), access to (21.7%, p < 0.001), and frequent use of (9.5%, NS) guidelines increased more in the intervention group than in the control group. The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2% (p = 0.043) higher than the proportion in the control group. A higher proportion considered EBP helpful in decision making (p = 0.018). There were no other significant differences in secondary outcomes.

    CONCLUSIONS:

    A tailored, theory- and evidence-informed, multi-component intervention for the implementation of clinical practice guidelines had a modest, positive effect on awareness of, knowledge of, access to, and use of guidelines, among PTs in primary care in western Sweden. In general, attitudes to EBP and guidelines were not affected.

    Ort, förlag, år, upplaga, sidor
    BioMed Central, 2014
    Nyckelord
    Implementation; Physical therapy; Evidence-based practice; Practice guidelines
    Nationell ämneskategori
    Sjukgymnastik
    Identifikatorer
    urn:nbn:se:liu:diva-105610 (URN)10.1186/1472-6963-14-105 (DOI)000333535400002 ()24589291 (PubMedID)
    Tillgänglig från: 2014-03-28 Skapad: 2014-03-28 Senast uppdaterad: 2023-12-28
    4. Clinical practice in line with evidence?: A survey among primary care physiotherapists in western Sweden
    Öppna denna publikation i ny flik eller fönster >>Clinical practice in line with evidence?: A survey among primary care physiotherapists in western Sweden
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    2015 (Engelska)Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, nr 6, s. 1169-1177Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Rationale, aims and objectives

    Evidence-based practice is becoming increasingly important in primary care physiotherapy. Clinical practice needs to reflect current best evidence and be concordant with evidence-based clinical guidelines. There is limited knowledge about therapeutic interventions used in primary care physiotherapy in Sweden. The objectives were to examine preferred treatment interventions reported by publicly employed physiotherapists in primary care for three common musculoskeletal disorders (low back pain, neck pain and subacromial pain), the extent to which these interventions were supported by evidence, and associations with demographic variables.

    Methods

    419 physiotherapists in primary care in western Sweden were surveyed using a validated web-based questionnaire.

    Results

    The survey was completed by 271 respondents (65%). Median number of interventions reported was 7 (range 1–16). The most common treatment interventions across the three conditions were advice on posture (reported by 82–94%), advice to stay active (86–92%), and different types of exercise (65–92%). Most of these interventions were supported by evidence. However, interventions with insufficient evidence, such as advice on posture, TENS and aquatic exercise, were also used by 29–96%. Modalities such as laser therapy and ultrasound were sparingly used (<5%), which is in line with evidence. For neck pain, use of evidence-based interventions was associated with gender and for subacromial pain, with work experience.

    Conclusions

    Advice and exercise therapy were the interventions most frequently reported across the three diagnoses, illustrating an active treatment strategy. While most reported interventions are supported by evidence, interventions with unclear or no evidence of effect were also used to a high extent.

    Ort, förlag, år, upplaga, sidor
    John Wiley & Sons, 2015
    Nyckelord
    clinical practice, evidence, evidence-based practice, interventions, physical therapy, treatment
    Nationell ämneskategori
    Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi Allmänmedicin
    Identifikatorer
    urn:nbn:se:liu:diva-122555 (URN)10.1111/jep.12380 (DOI)000371414500032 ()25988993 (PubMedID)
    Anmärkning

    Funding agencies: local Research and Development Board for Gothenburg and Sodra Bohuslan; Linkoping University

    Tillgänglig från: 2015-11-09 Skapad: 2015-11-09 Senast uppdaterad: 2023-12-28Bibliografiskt granskad
    5. “In the physio we trust”: A qualitative study on patients’ preferences for physiotherapy
    Öppna denna publikation i ny flik eller fönster >>“In the physio we trust”: A qualitative study on patients’ preferences for physiotherapy
    2017 (Engelska)Ingår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, nr 7, s. 535-549Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background: Patient preferences are suggested to be incorporated in clinical decision making, but little is known about preferences for physiotherapy treatment of patients with musculoskeletal pain. This study aimed to explore preferences regarding physiotherapy treatment and participation in decision making, of patients who seek primary care physiotherapy for pain in the back, neck or shoulder.

    Methods: A qualitative study set in an urban physiotherapy clinic in Sweden. Individual, semi-structured interviews were conducted with a purposeful sample of 20 individuals who sought physiotherapy for back, neck or shoulder pain. The interviews were digitally recorded, transcribed verbatim and analysed with qualitative content analysis.

    Results: An overarching theme, embracing six categories, was conceptualised: Trust in the physiotherapist fosters active engagement in therapy. Most informants preferred active treatment strategies such as exercise and advice for self-management, allowing them to actively engage in their therapy. Some preferred passive treatments, primarily acupuncture (because they had heard that it works well) or massage therapy (because “it feels good”). Preferences were consistent across the three musculoskeletal conditions. Key influencers on treatment preferences were previous experiences and media. All informants wanted to be involved in the clinical decision making, but to varying extents. Some expressed a preference for an active role and wanting to share decisions while others were content with a passive role. Expectations for a professional management were reflected in trust and confidence in physiotherapists’ skills and competence, expectations for good outcomes, and believing that treatment methods should be evidence-based.

    Conclusions: Trust in the physiotherapist’s ability to choose appropriate treatment and confidence in the professional skills and competence of physiotherapists, as well as a desire to participate in clinical decision making, fostered active engagement in physiotherapy. Preferences for particular interventions were subordinate, although a preference for active treatments dominated. Preferences for active engagement need to be embraced by the physiotherapist. Awareness of these preferences can facilitate clinical decision making and contribute to increased quality of care for patients with musculoskeletal pain.

    Ort, förlag, år, upplaga, sidor
    Taylor & Francis, 2017
    Nyckelord
    Physical therapy, patient preferences, shared decision making, primary care, guidelines
    Nationell ämneskategori
    Sjukgymnastik Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Identifikatorer
    urn:nbn:se:liu:diva-122556 (URN)10.1080/09593985.2017.1328720 (DOI)000403937700003 ()
    Anmärkning

    Funding agencies: Local Research and Development Board for Gothenburg; Local Research and Development Board for Sodra Bohuslan

    Previous status of this publication was Manuscript

    Tillgänglig från: 2015-11-09 Skapad: 2015-11-09 Senast uppdaterad: 2023-12-28Bibliografiskt granskad
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  • 49.
    Bernhardsson, Susanne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Larsson, Maria E. H.
    Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden / The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    “In the physio we trust”: A qualitative study on patients’ preferences for physiotherapy2017Ingår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 33, nr 7, s. 535-549Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Patient preferences are suggested to be incorporated in clinical decision making, but little is known about preferences for physiotherapy treatment of patients with musculoskeletal pain. This study aimed to explore preferences regarding physiotherapy treatment and participation in decision making, of patients who seek primary care physiotherapy for pain in the back, neck or shoulder.

    Methods: A qualitative study set in an urban physiotherapy clinic in Sweden. Individual, semi-structured interviews were conducted with a purposeful sample of 20 individuals who sought physiotherapy for back, neck or shoulder pain. The interviews were digitally recorded, transcribed verbatim and analysed with qualitative content analysis.

    Results: An overarching theme, embracing six categories, was conceptualised: Trust in the physiotherapist fosters active engagement in therapy. Most informants preferred active treatment strategies such as exercise and advice for self-management, allowing them to actively engage in their therapy. Some preferred passive treatments, primarily acupuncture (because they had heard that it works well) or massage therapy (because “it feels good”). Preferences were consistent across the three musculoskeletal conditions. Key influencers on treatment preferences were previous experiences and media. All informants wanted to be involved in the clinical decision making, but to varying extents. Some expressed a preference for an active role and wanting to share decisions while others were content with a passive role. Expectations for a professional management were reflected in trust and confidence in physiotherapists’ skills and competence, expectations for good outcomes, and believing that treatment methods should be evidence-based.

    Conclusions: Trust in the physiotherapist’s ability to choose appropriate treatment and confidence in the professional skills and competence of physiotherapists, as well as a desire to participate in clinical decision making, fostered active engagement in physiotherapy. Preferences for particular interventions were subordinate, although a preference for active treatments dominated. Preferences for active engagement need to be embraced by the physiotherapist. Awareness of these preferences can facilitate clinical decision making and contribute to increased quality of care for patients with musculoskeletal pain.

  • 50.
    Bernhardsson, Susanne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet. Region Västra Götaland.
    Larsson, Maria
    Region Västra Götaland, Göteborgs universitet.
    Eggertsen, Robert
    Region Västra Götaland, Göteborgs universitet.
    Fagevik Olsén, Monika
    Göteborgs universitet.
    Johansson, Kajsa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Nordeman, Lena
    Region Västra Götaland.
    van Tulder, Maurits
    VU University, Amsterdam, The Netherlands.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial.2014Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 14, nr 1, s. 105-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence-based practice (EBP). There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy. The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden.

    METHODS:

    An implementation strategy based on theory and current evidence was developed. A tailored, multi-component implementation intervention, addressing earlier identified determinants, was carried out in three areas comprising 28 physical therapy practices including 277 physical therapists (PTs) (intervention group). In two adjacent areas, 171 PTs at 32 practices received no intervention (control group). The core component of the intervention was an implementation seminar with group discussions. Among other components were a website and email reminders. Data were collected at baseline and follow-up with a web-based questionnaire. Primary outcomes were the self-reported awareness of, knowledge of, access to, and use of guidelines. Secondary outcomes were self-reported attitudes toward EBP and guidelines. Analyses were performed using Pearson's χ2 test and approximative z-test.

    RESULTS:

    168 PTs (60.6%) in the intervention group and 88 PTs (51.5%) in the control group responded to the follow-up questionnaire. 186/277 PTs (67.1%) participated in the implementation seminars, of which 97 (52.2%) responded. The proportions of PTs reporting awareness of (absolute difference in change 20.6%, p = 0.023), knowledge where to find (20.4%, p = 0.007), access to (21.7%, p < 0.001), and frequent use of (9.5%, NS) guidelines increased more in the intervention group than in the control group. The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2% (p = 0.043) higher than the proportion in the control group. A higher proportion considered EBP helpful in decision making (p = 0.018). There were no other significant differences in secondary outcomes.

    CONCLUSIONS:

    A tailored, theory- and evidence-informed, multi-component intervention for the implementation of clinical practice guidelines had a modest, positive effect on awareness of, knowledge of, access to, and use of guidelines, among PTs in primary care in western Sweden. In general, attitudes to EBP and guidelines were not affected.

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