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  • 101.
    Oldfors Engström, Lena
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Att förstå patienters bristande deltagande i individualiserat rehabiliteringsprogram2002Licentiate thesis, monograph (Other academic)
    Abstract [en]

    The aim of this investigation was to elucidate and describe those patients who had discontinued their participation and/or paticipated infrequently in physiotherapy treatment based on their own activity and responsibility. The ambition was to understand the phenomenon of compliance/adherence from various perspectives in behavioural as well as social science.

    In study I the phenomenon compliance/adherence was studied in relation to Health Locus of Control and Health Belief variables. This study was based on a questionnaire that was answered by all patients before beginning of treatment. Questions concerning the patients´conceptions about both health locus of control and health beliefs were the focus.The definitions of compliance/adherence were completed treatment period and exercise frequency, respectively. Those patients who completed the treatment were also studied regarded exercise frequency.

    The results of study I showed that those who discontinued their treatment reported a higher perceived threat from their health condition (higher level of dysfunction (higher pain intensity) and a higher perceived severity of their health condition (higher level of dysfunction, worse general health) than those who completed treatment. The results also showed that those who exercised once a week or less often valued the significance of the caring situation as lower (HLC), perceived a higher threat from their health condition (higher pain intensity), a higher severity of their health condition (higher level of dysfunction, worse general health, greater distrution of impairment), more barriers to treatment (lower expectations), and had certain differences in demographic variables (younger individuals, more women) than those who exercised more often (HB).

    Study II investigated patients´descriptions of their reasons for discontinuing the treatment, whether those reasons varied, and if so how they varied. Sixteen patients who had discontinued their treatment were interviewed with open-ended questions. The inteviews began with a question about the background to the physiotherapy treatment. There were questions concerning carrying out the treatment as well as concerning what they thought about their impairment. The patients were also asked about their priotities in daily life, as these wre presumed to be anobstacle to the treatment over a shorter or longer period of time. The third domain concerned how they experiebced the patient/physiotherapist relationship. The interviews were anlysed qualitatively.

    Analysis of study II resulted in four different descriptions of reasons for treatment discontinuation. A) It was about time to end treatment and continue on alone. B) The treatment was not the most important activity to spend time on. C) An agreement with the physiothreapist to discontinue treatment due to lack of effect. D) No viewpoint as to why they discontinued the treatment. In further analysis of category D, this group appeared to experience varoius forms of powerlessness. They felt their trustworthiness was often questioned. They experienced frustration in their life situation as others made the important descisions and they themselves had little to say.They defended themselves by talking about their own conceptions of the reasons for their impairment and what should be done about them. In comparing category D with categories A, B, C it was found that those in the latter three categories experienced varying degrees of control in different situations, whereas those in category D did not experience a feeling of control.

    Conclusion: The concept of compliance in physiotherapy is ambiguous. The concept involves one part defining what will concern the other part. It is clear that the physiotherapist and the patient do not always agree about the aim of the treatment. Instead, we should develop the concept of concordance in encounters with the patients and abandon the reasoning of compliance.

  • 102.
    Orchard, John
    et al.
    Sydney University, Australia.
    Rae, Katherine
    Sydney University, Australia.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Til, Lluis
    FC Barcelona, Spain.
    Wales, David
    Arsenal FC, UK.
    Wood, Tim
    Tennis Australia, Australia.
    Revision, uptake and coding issues related to theopen access Orchard Sports Injury ClassificationSystem (OSICS) versions 8, 9 and 10.12010In: Open Access Journal of Sports Medicine, ISSN 1179-1543, Vol. 1, p. 207-214Article in journal (Refereed)
    Abstract [en]

    The Orchard Sports Injury Classification System (OSICS) is one of the world’s most commonly used systems for coding injury diagnoses in sports injury surveillance systems. Its major strengths are that it has wide usage, has codes specific to sports medicine and that it is free to use. Literature searches and stakeholder consultations were made to assess the uptake of OSICS and to develop new versions. OSICS was commonly used in the sports of football (soccer), Australian football, rugby union, cricket and tennis. It is referenced in international papers in three sports and used in four commercially available computerised injury management systems. Suggested injury categories for the major sports are presented. New versions OSICS 9 (three digit codes) and OSICS 10.1 (four digit codes) are presented. OSICS is a potentially helpful component of a comprehensive sports injury surveillance system, but many other components are required. Choices made in developing these components should ideally be agreed upon by groups of researchers in consensus statements.

  • 103.
    Palm, Lars
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Jacobsson, Sven-Arne
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Lindholm, Anna
    Öjersjö, Andreas
    Ivarsson, Ingemar
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Acetabular revision with extensive allograft impaction and uncemented hydroxyapatite-coated implants. Results after 9 (7-11) years follow-up2007In: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 22, no 8, p. 1083-1091Article in journal (Refereed)
    Abstract [en]

    This is a clinical and radiographic review of 87 hips in 79 patients 9 (7-11) years after acetabular revision with extensive use of morselized allograft firmly impacted into localized defects as well as the entire acetabular cavity, followed by insertion of an uncemented hydroxyapatite-coated cup with supplementary screw fixation. The 9-year survival rate for the acetabular implant was 90.5% (95% CI, 83.4%-97.6%) with revision for any reason as end point and 94% (95% CI, 89%-99.1%) with revision for aseptic loosening as end point. Acetabular revision with massive allograft impaction and hydroxyapatite-coated implants show very promising results. The limited contact between implant and host bone does not seem to compromise implant survival in the 7- to 11-year perspective.

  • 104.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Almkvist, Cecilia
    Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Dahlberg, Camilla
    Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Lindqvist, Sara
    Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Pettersson, Susanne
    Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Age- and Sex-Specific Reference Values of a Test of Neck Muscle Endurance2007In: Journal of Manipulative and Physiological Therapeutics, ISSN 0161-4754, E-ISSN 1532-6586, Vol. 30, no 3, p. 171-177Article in journal (Refereed)
    Abstract [en]

    Objective

    This study evaluates age- and sex-specific reference values for neck muscle endurance (NME).

    Methods

    In this cross-sectional study, 116 randomly selected, healthy volunteers (ages 25-64 years) stratified according to age and gender participated. Dorsal and ventral NME was measured in seconds until exhaustion in a laying-down position. A weight of 4 kg for men or 2 kg for women was used in the dorsal procedure. The ventral procedure was performed without external load. Background and physical activity data were obtained and used in the analysis of NME performance.

    Results

    Mean values for dorsal and ventral NME were about 7 and 2.5 minutes for men and 8.5 and 0.5 minutes for women, respectively. The cutoff values for subnormal dorsal and ventral NME were 157 and 56 seconds for men and 173 and 23 seconds for women, respectively. Women's NME was 122% of men's NME in the dorsal (P = .17) and 24% of men's NME in the ventral (P < .0001) procedure. There were no significant differences among age groups. In multiple regression analysis, physical activity explained 4% of variability in the performance of the dorsal NME; and sex explained 37% of the variability in the performance of ventral NME.

    Conclusion

    The reference values and the cutoff points obtained could be used in clinical practice to identify patients with a subnormal NME. Sex is an important consideration when using both the test procedure and the reference values.

  • 105.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Brodin, Lars-Ake
    Royal Institute Technology KTH.
    Peolsson, Michael
    Royal Institute Technology KTH.
    A tissue velocity ultrasound imaging investigation of the dorsal neck muscles during resisted isometric extension2010In: MANUAL THERAPY, ISSN 1356-689X, Vol. 15, no 6, p. 567-573Article in journal (Refereed)
    Abstract [en]

    Persons with neck pain exhibit altered patterns of muscle patterning, but limited investigations have been carried out on these alterations or muscle patterning in healthy volunteers. This study investigated the tissue motion of the dorsal neck muscles at the C4 segmental level in 15 healthy subjects during manually resisted head extension. Doppler-based tissue velocity ultrasound imaging (TVI) was used to detect regional tissue deformation, providing indirect evidence of inter-muscular movement patterning. The deep muscles, multifidus and semispinalis, had different muscular movement patterning than the superficial muscles, especially the trapezius muscle. The semispinalis cervicis (SSCerv) was the first deformed upon exercise initiation, followed by multifidus and semispinalis capitis (SSCap). The semispinalis muscles, notably capitis, exhibited a high rate of deformation during the exercise. The trapezius muscle exhibited the least and lowest deformation rate. In conclusion, TVI provided detailed information on regional tissue activity and muscle movement patterning among the dorsal neck muscles. In future studies, data from patients with neck disorders will have to be matched to data from healthy volunteers in a variety of situations and activities.

  • 106.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Hedlund, Rune
    Department of Orthopaedics, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden.
    Vavruch, Ludek
    Department of Neuro-Orthopaedic Surgery, Ryhov Hospital, Jönköping, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Predictive factors for the outcome of anterior cervical decompression and fusion2003In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 12, no 3, p. 274-280Article in journal (Refereed)
    Abstract [en]

    In a prospective study, 103 patients were randomised to anterior cervical decompression and fusion (ACDF) with a cervical carbon-fibre intervertebral fusion cage or the Cloward procedure. Preoperative background variables, active range of neck motion, handgrip strength, radiological evaluation and subjective variables were used in a multiple regression model to find the strongest predictors of postoperative outcome as measured by current pain intensity and the Neck Disability Index (NDI). Male sex, greater kyphosis at the level operated on, non-smoking, a greater neck mobility in right rotation, low disability on NDI, and older age were predictors of pain reduction and explained 30% of current pain intensity at follow-up. Higher educational level, non-smoking, greater kyphosis at the level operated on, a greater flexion mobility, greater right handgrip strength and lower current pain intensity were predictors of improvement, and explained 28% of the postoperative outcome on NDI. The most important predictor for postoperative pain intensity was the magnitude of the preoperative kyphosis. Preoperative pain intensity was the most important predictor for improved NDI. At follow-up about 70% of the patients still had deficit based on current pain intensity and NDI, and 44% had remaining dysfunction based on Odom's criteria. In conclusion, the multivariate analysis shows that male sex, non-smoking, greater segmental kyphosis and a low pain and disability level are preoperative predictors of a good outcome in ACDF. In addition, the study suggests the importance of other predictive variables than those studied for the outcome of ACDF.

  • 107.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kjellman, Görel
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Neck Muscle Endurance in Nonspecific Patients With Neck Pain and in Patients After Anterior Cervical Decompression and Fusion2007In: Journal of Manipulative and Physiological Therapeutics, ISSN 0161-4754, E-ISSN 1532-6586, Vol. 30, no 5, p. 343-350Article in journal (Refereed)
    Abstract [en]

    Objective

    The purpose of this study was to investigate differences in ventral and dorsal neck muscle endurance (NME) among men and women with nonspecific neck pain (NP) or cervical disk disease (who had anterior cervical decompression and fusion [ACDF]) and healthy controls (C). Another purpose was to investigate changes in NME after intervention.

    Methods

    Neck muscle endurance was measured in patients with NP (n = 78) and ACDF (n = 25) before and after the treatment period, and their results were compared to each other and to sex-specific reference values from controls (n = 116) at both the individual and group levels.

    Results

    Patients had significantly decreased (P < .01) NME compared with control subjects, except for ventral NME in female patients with NP before treatment and male patients with ACDF after treatment. Female patients with ACDF had lower ventral NME than female patients with NP (P < .01). Among the patients, 35% to 100% had NME disability, with most of them having a lower rate than the 95% confidence interval of controls. Female patients with NP and male patients with ACDF showed improvement (P < .05) after treatment. Flexion/extension ratio in patients with NP (P = .36), but not in patients with ACDF (P < .0001), returned to normal levels after treatment. There was a significant negative correlation (P < .02) between NME and Neck Disability Index in both patient groups, except for ventral NME in patients with NP before treatment.

    Conclusion

    Many patients had impairment in NME before and after treatment. This suggests that additional exercise of specific training for NME should be incorporated into the rehabilitation program, which may improve treatment outcome.

  • 108.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Landén Ludvigsson, Maria
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Overmeer, Thomas
    Malardalen University, Sweden .
    Dedering, Asa
    Karolinska University Hospital, Sweden .
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Allergy Center.
    Johansson, Gun
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Kammerlind, Ann-Sofi
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Peterson, Gunnel
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Effects of neck-specific exercise with or without a behavioural approach in addition to prescribed physical activity for individuals with chronic whiplash-associated disorders: a prospective randomised study2013In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 14, no 311Article in journal (Refereed)
    Abstract [en]

    Background: Up to 50% of chronic whiplash associated disorders (WAD) patients experience considerable pain and disability and remain on sick-leave. No evidence supports the use of physiotherapy treatment of chronic WAD, although exercise is recommended. Previous randomised controlled studies did not evaluate the value of adding a behavioural therapy intervention to neck-specific exercises, nor did they compare these treatments to prescription of general physical activity. Few exercise studies focus on patients with chronic WAD, and few have looked at patients ability to return to work and the cost-effectiveness of treatments. Thus, there is a great need to develop successful evidence-based rehabilitation models. The study aim is to investigate whether neck-specific exercise with or without a behavioural approach (facilitated by a single caregiver per patient) improves functioning compared to prescription of general physical activity for individuals with chronic WAD. less thanbrgreater than less thanbrgreater thanMethods/Design: The study is a prospective, randomised, controlled, multi-centre study with a 2-year follow-up that includes 216 patients with chronic WAD (andgt;6 months and andlt;3 years). The patients (aged 18 to 63) must be classified as WAD grade 2 or 3. Eligibility will be determined with a questionnaire, telephone interview and clinical examination. The participants will be randomised into one of three treatments: (A) neck-specific exercise followed by prescription of physical activity; (B) neck-specific exercise with a behavioural approach followed by prescription of physical activity; or (C) prescription of physical activity alone without neck-specific exercises. Treatments will be performed for 3 months. We will examine physical and psychological function, pain intensity, health care consumption, the ability to resume work and economic health benefits. An independent, blinded investigator will perform the measurements at baseline and 3, 6, 12 and 24 months after inclusion. The main study outcome will be improvement in neck-specific disability as measured with the Neck Disability Index. All treatments will be recorded in treatment diaries and medical records. less thanbrgreater than less thanbrgreater thanDiscussion: The study findings will help improve the treatment of patients with chronic WAD.

  • 109.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Lofstedt, Tommy
    Umeå University, Sweden .
    Trygg, Johan
    Umeå University, Sweden .
    Peolsson, Michael
    Umeå University, Sweden .
    Ultrasound imaging with speckle tracking of cervical muscle deformation and deformation rate: Isometric contraction of patients after anterior cervical decompression and fusion for cervical disc disease and controls2012In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 17, no 6, p. 519-525Article in journal (Refereed)
    Abstract [en]

    There is currently a lack of information regarding neck muscle activity during specific exercises. The purpose of the present study was to investigate deformation and deformation rate in different layers of dorsal and ventral neck muscles during isometric neck muscle contraction in individuals after anterior cervical decompression and fusion and in healthy controls. This study included 10 individuals (mean age 60 years; SD 7.1) with a verified, long-standing neck disorder and 10 healthy, age- and sex-matched controls. Ultrasonography and post-process speckle tracking analysis was used to investigate the degree and the rate of neck muscles motions at the C4 segmental level during sub-maximal, isometric resistance of the head in a seated position. None of the analyses performed showed significant differences between groups (p greater than 0.05). In the dorsal muscles, both groups exhibited a higher deformation rate in the multifidus than in the trapezius, splenius, and semispinalis capitis (p less than= 0.01). In the neck disorder group, the multifidus also showed a higher deformation rate compared to the semispinalis cervicis (p = 0.02). In the ventral muscles of patients with neck disorders, the longus colli had a higher deformation rate than the sternocleidomastoid (p = 0.02). Among the healthy controls, the multifidus showed a higher degree of deformation (p = 0.02) than the trapezius. In conclusion, our results showed no significant differences between the two groups in mechanical neck muscle activation. Larger studies with different exercises, preferably with a standardized measure of resistance, are needed to investigate whether patients and controls show differences in deformation and deformation rates in neck muscles.

  • 110.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Peolsson, Michael
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Predictive factors for long-term outcome of anterior cervical decompression and fusion: a multivariate data analysis2008In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 17, no 3, p. 406-414Article in journal (Refereed)
    Abstract [en]

    We conducted a prospective randomized study to investigate predictive factors for short- and long-term outcome of anterior cervical decompression and fusion (ACDF) as measured by current pain intensity on the Visual Analogue Scale (VAS) and by disability using the Neck Disability Index (NDI). Current understanding about how preoperative and short-term outcome data predict long-term outcome is sparse, and there are few studies involving analysis of short-term follow-up using multivariate approaches with quantification of the relative importance of each variable studied. A total of 95 patients were randomly allocated for ACDF with the cervical intervertebral fusion cage or the Cloward procedure. The mean follow-up time was 19 months (range 12-24) for short-term follow-up and 76 months (range 56-94 months) for long-term. Background factors, radiologically detected findings, physiological measurements, treatment type, pain, and disability were used as potential predictors. Multivariate statistical analysis by projection to latent structures was used to investigate predictors of importance for short- and long-term outcome of ACDF. A "preoperative" low disability and pain intensity, non-smoking status, male sex, good hand strength, and an active range of motion (AROM) in the neck were significant predictors for good short- and long-term outcomes. The short-term outcome data were better at predicting long-term outcome than were baseline data. Radiologically detected findings and surgical technique used were mainly insignificant as predictors. We suggest that the inclusion criteria for ACDF should be based on a bio-psycho-social model including NDI. NDI may also be regarded as an important outcome measurement in evaluation of ACDF.

  • 111.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Söderlund, Anne
    Mälardalen University, Västerås, Sweden.
    Engquist, Markus
    Ryhov Hospital, Jönköping, Sweden.
    Lind, Bengt
    University of Gothenburg, Sweden.
    Löfgren, Håkan
    Ryhov Hospital, Jönköping, Sweden.
    Vavruch, Ludek
    Ryhov Hospital, Jönköping, Sweden.
    Holtz, Anders
    Uppsala University Hospital, Sweden.
    Winström-Christersson, Annelie
    Ryhov Hospital, Jönköping, Sweden.
    Isaksson, Ingrid
    Ryhov Hospital, Jönköping, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Physical Function Outcome in Cervical Radiculopathy Patients After Physiotherapy Alone Compared With Anterior Surgery Followed by Physiotherapy: A Prospective Randomized Study With a 2-Year Follow-up2013In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 38, no 4, p. 300-307Article in journal (Refereed)
    Abstract [en]

    Study Design. Prospective randomized study.

    Objective. To investigate differences in physical functional outcome in patients with radiculopathy due to cervical disc disease, after structured physiotherapy alone (consisting of neck-specific exercises with a cognitive-behavioral approach) versus after anterior cervical decompression and fusion (ACDF) followed by the same structured physiotherapy program.

    Summary of Background Data. No earlier studies have evaluated the effectiveness of a structured physiotherapy program or postoperative physical rehabilitation after ACDF for patients with magnetic resonance imaging–verified nerve compression due to cervical disc disease.

    Methods. Our prospective randomized study included 63 patients with radiculopathy and magnetic resonance imaging–verified nerve root compression, who were randomized to receive either ACDF in combination with physiotherapy or physiotherapy alone. For 49 of these patients, an independent examiner measured functional outcomes, including active range of neck motion, neck muscle endurance, and hand-related functioning before treatment and at 3-, 6-, 12-, and 24-month follow-ups.

    Results. There were no significant differences between the 2 treatment alternatives in any of the measurements performed (P = 0.17–0.91). Both groups showed improvements over time in neck muscle endurance (P ≤ 0.01), manual dexterity (P ≤ 0.03), and right-handgrip strength (P = 0.01).

    Conclusion. Compared with a structured physiotherapy program alone, ACDF followed by physiotherapy did not result in additional improvements in neck active range of motion, neck muscle endurance, or hand-related function in patients with radiculopathy. We suggest that a structured physiotherapy program should precede a decision for ACDF intervention in patients with radiculopathy, to reduce the need for surgery.

  • 112.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Vavruch, Ludek
    Department of Neuro-Orthopedic Surgery, Ryhov Hospital, Jönköping, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Can the results 6 months after anterior cervical decompression and fusion identify patients who will have remaining deficit at long-term?2006In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, no 2, p. 117-124Article in journal (Refereed)
    Abstract [en]

    Purpose. There is no knowledge if short-term outcome in patients after anterior cervical decompression and fusion (ACDF) can be used to identify which patients have remaining deficit in long term. This study investigates if 6-month outcome with a broad assessment after ACDF with a cervical intervertebral fusion cage can be a guide for the 3-years outcome.

    Method. A prospective study. Questions about background data, pain, numbness, neck specific disability, distress, sick leave, health, symptom satisfaction and effect of and satisfaction with surgery were asked 28 patients 3 years after ACDF. Measurements have earlier been obtained before and 6 and 12 months after ACDF.

    Results. Compared with the results before surgery patients had improved in pain intensity (p = 0.001), neck pain (0.001), numbness (p = 0.02) and were more ‘satisfied’ with having their neck problems (p = 0.01). Except for a worsening in expectations of surgery fulfilled (p = 0.04) there were no significant differences between 6-month and 3-year outcome. Three years after ACDF about two-thirds of the patients had remaining deficit with regard to pain intensity, Neck Disability Index, Distress and Risk Assessment Method and general health. According to the parameters studied 50 – 78% of those who at the 6-month follow-up were without deficit were still healthy at the 3-year follow-up. For patients with deficit at 6-month follow-up, still 83 – 100% had deficit 3 years after surgery.

    Conclusions. Despite a rather small study obtained the stability of 6-month and 3-year results indicates that short-term results might be sufficient for evaluating effects of the treatment. Since the patients in this study clearly demonstrate broad problems array of development of more structured multi-professional rehabilitation models including exercises which improve neck muscle strength, endurance and proprioception need to be introduced.

  • 113.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Vavruch, Ludek
    Department of Neuro-Orthopedic Surgery, Ryhov Hospital, Jönköping, Sweden.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Disability after anterior decompression and fusion for cervical disc disease2002In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 4, no 3, p. 111-124Article in journal (Refereed)
    Abstract [en]

    Few prospective studies on outcome have been conducted with respect to disability after anterior cervical decompression and fusion (ACDF), and the need for further rehabilitation after surgery is unknown. Thirty-four patients with cervical disc disease verified by magnetic resonance imaging were included before ACDF with a cervical carbon fibre intervertebral fusion cage. Measurements took place the day before, 6 months and 1 year after surgery, and consisted of both objective and subjective measurements. The results showed a significant improvement from surgery in neck muscle endurance in flexion, neck strength in lateral flexion, some of the pain variables, numbness, neck specific disability, change in general health and symptom satisfaction at the 1-year follow-up. Except for worsening in general health, there were no significant differences between the 6-month and the 1-year follow-up. Despite improvement in several of the variables, about one-third of the patients had deficits in the objective measurements and about two-thirds had deficits in the subjective variables. Only five patients were without neck problems according to average pain, the Neck Disability Index and general health. This suggests that there is still a great need for improvement both of the surgical procedure and the rehabilitation afterwards.

  • 114.
    Peolsson, Michael
    et al.
    KTH.
    Brodin, Lars-Ake
    KTH.
    Peolsson, Anneli
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Tissue motion pattern of ventral neck muscles investigated by tissue velocity ultrasonography imaging2010In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 109, no 5, p. 899-908Article in journal (Refereed)
    Abstract [en]

    We designed this experimental study to investigate tissue motions and thus infer the recruitment pattern of the ventral neck muscles [sternocleidomastoid (SCM), longus capitis (Lca), and longus colli (Lco)] at the C4-C5 level in healthy volunteers during isometric manual resistance of the head in flexion in a seated position. This exercise is used in the physiotherapeutic treatment of neck pain and is assumed to activate the deep ventral muscles, but the assumption has not been clearly evaluated. Neck flexors of 16 healthy volunteers (mean age 24 years, SD 3.7) were measured using ultrasonography with strain and strain rate (SR) tissue velocity imaging (TVI) during isometric contraction of flexor muscles. TVI involves using Doppler imaging to study tissue dynamics. All three muscles showed a deformation compared to rest. Except for the initial contraction phase, Lco exhibited a lower strain than Lca and SCM but was the only muscle with a significant change in SR between the phases. When the beginning of the contraction phase was analysed, Lco was the first to be deformed among most volunteers, followed by Lca and then SCM. The exercise investigated seems to be useful as a "stabilizing" exercise for Lco. Our suggestion is that in further research, Lco and Lca should be investigated as separate muscles. TVI could be used to study tissue motions and thus serve as an indicator of muscle patterning between the neck flexors, with the possibility of separating Lco and Lca.

  • 115.
    Persson, Ingrid
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Pharmacology .
    Lindén, Erica
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Andersson, Malin
    Östergötlands Läns Landsting.
    Persson, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Pharmacology .
    Effects of Ginkgo biloba extract EGb 761 and its terpenelactones on angiotensin converting enzyme activity and nitric oxide production in human endothelial cells2008In: Journal of traditional medicines, ISSN 1880-1447, Vol. 3, no 2, p. 42-51Article in journal (Refereed)
    Abstract [en]

    The effects of Ginkga bi/aba (Ginkgoaceae), its terpene-Iactones (ginkgolide A, B, C and bilobalide), biflavonols (quercetin), biflavones (sciadopitysin) and proanthocyanidins (procyanidin) on angiotensin-converting enzyme (ACE) activity and nitric oxlde (NO) production in cultured human endothelial cells from umbilical veins (HUVEC) were investigated. A dose-dependent significant inhibition of the ACE activity was observed arter 10 min incubation with Ginkga bi/aba extract EGb  761 and quercetin. No significant effects due to terpene-Iactones or sciadopitysin were seen. Incubation with Ginkga bi/aba extract, quercetin, sciadopitysin and procyanidin for 24 hr significantly Increased NO production. No significant effects were seen with ginkgollde A, B and C, while bilobalide induced a dose-dependent decrease in NO production. In conclusion, this study shows that Ginkga bi/aba extract Inhibits ACE activlty and increases NO production from HUVEC. A flavonol (quercetin and/or homologs) is the main component responsible for the inhibitory effect ofACE activity. Quercetin and a proanthocyandin (procyanidin) are responsible for the increases seen in NO production. These results may explain the positive effects of Ginkga bi/aba on the cardiovascular system and on cognitive function.

  • 116.
    Sandberg, Margareta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Gott bemötande inte liktydligt med effektiv behandling2006In: Dagens medicin, ISSN 1104-7488Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    2006-12-15REPLIK Legitimerad sjukvårdspersonals goda grundkunskaper gör en två veckor lång kurs tillräcklig som grundutbildning i akupunktur. Det framhåller Margareta Sandberg, som företrädare för en sektion inom Sjukgymnastförbundet i ett svar på ett inlägg av Lina Axelsson.

  • 117.
    Sandberg, Margareta
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Sandberg, Matilda
    Linköping University, Faculty of Health Sciences.
    Dahl, Johanna
    Linköping University, Faculty of Health Sciences.
    Blood flow changes in the trapezius muscle and overlying skin following transcutaneous electrical nerve stimulation2007In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 87, no 8, p. 1047-1055Article in journal (Refereed)
    Abstract [en]

    Background and Purpose: Various researchers have studied the effects of transcutaneous electrical nerve stimulation (TENS) on hemodynamics. The purpose of this study was to examine the effects of TENS on local blood flow in the trapezius muscle and overlying skin.

    Subjects: Thirty-three women who were healthy, aged 25 to 55 years, were randomly assigned to receive 1 of 3 different modes of TENS.

    Methods: Skin and muscle blood flow were monitored noninvasively using a new application of photoplethysmography for 15 minutes of TENS applied at high frequency (80 Hz) and sensory-level intensity and at low frequency (2 Hz) and motor-level intensity and for 15 minutes after stimulation. Subliminal 80-Hz TENS was used as a control. Blood flow was monitored simultaneously on stimulated and nonstimulated shoulders.

    Results: Blood flow in the trapezius muscle, but not skin blood flow, increased significantly with motor-level 2-Hz TENS, whereas no increase occurred with sensory-level 80-Hz TENS or subliminal 80-Hz TENS.

    Discussion and Conclusion: Muscle contractions induced by motor-level 2-Hz TENS appear to be a prerequisite for increasing blood flow in the trapezius muscle. However, high stimulation intensity may prevent increased blood flow in the overlying skin.

  • 118.
    Sandström, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Physiotherapy. Östergötlands Läns Landsting, Reconstruction Centre, Department of Rehabilitation Medicine UHL.
    Adults with Cerebral Palsy: living with a lifelong disability2009Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Although Cerebral Palsy (CP) is a lifelong disability, the research has mainly focused in children with CP. However, in recent years new studies have examined the different aspects of being an adult with a congenital disability.

    The overall aim of this thesis is to contribute to increased knowledge and understanding in living with cerebral palsy as an adult, with special focus on the lived body and physiotherapy/physical activity.

    The thesis is based on two populations. The first population (study I) consists of 48 individuals with a variation in gross motor function equivalent to the general CP‐population, including all five levels according to a gross motor classification (Gross Motor Function Classification System, GMFCS). The second population (study II and III), consists of 22 individuals, representing level II to IV according to the gross motor classification (GMFCS).

    Study I comprises structured questions and clinical investigations with well‐recognized assessment instruments and are analysed according to quantitative methods. Study II and III are based on in‐depth interviews and are analysed using qualitative methods.

    The overall result is that there is a deterioration of motor function in many individuals already early in adulthood. These deteriorations are preceded and/or followed by musculoskeletal problems such as pain and limited range of motion, often in combination with fatigue. Despite deteriorations many people maintain daily personal activities, but are often forced to prioritize among societal activities.

    The deterioration is often perceived as slow and imperceptible, but it also results in a change in self‐image with new thoughts about otherness and being different. This can be experienced in relation to activity limitations with difficulties in taking part in other people’s activities, but also in relation to attitudes and treatment from other people. The process of deterioration also influences autonomy, with limited ability to determine one’s own daily life.

    Important prerequisites for carrying out physical activity in a longer perspective is that it has to be enjoyable, give effects, be comprehensible and integrated in daily life. In addition it is important with support from competent professionals in health care. Experiences of these prerequisites vary and, above all, in adulthood the lack of competent support is a factor which is illuminated of the majority of the interviewed and assessed individuals.

    List of papers
    1. Descriptions of functioning and health and relations to a gross motor classification in adults with cerebral palsy
    Open this publication in new window or tab >>Descriptions of functioning and health and relations to a gross motor classification in adults with cerebral palsy
    2004 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 26, no 17, p. 1023-1031Article in journal (Refereed) Published
    Abstract [en]

    Purpose: The aim of this study was to describe functioning and health, and explore the use of the Gross Motor Function Classification System (GMFCS) in an adult population with cerebral palsy (CP).

    Methods: From a cohort of 199 persons, 48 persons were selected for structured interviews and functional assessments regarding activities of daily living, motor function, range of motion, pain and general health.

    Results: A third of the population had deteriorated in function from adolescence to adulthood according to the GMFCS. The majority were independent in personal ADL, but many of those were dependent in instrumental ADL. Motor function scores reflected problems in walking ability, and limited ROM and pain were common in all functional levels. General health was lower than in a general population. GMFCS seems valid for classifying adults with CP since it is correlated with instruments measuring motor function and ADL in terms of dependence.

    Conclusion: Decreased functional ability and secondary musculoskeletal problems are common in adults with CP and general health can be associated with those problems. It is important to further explore health aspects and relations between health status and self-perceived health. The GMFCS is a useful tool, especially for comparisons throughout the life span, but in order to use in an adult population further development is needed.

    Place, publisher, year, edition, pages
    Taylor & Francis Group, 2004
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16369 (URN)10.1080/09638280410001703503 (DOI)
    Available from: 2009-01-19 Created: 2009-01-19 Last updated: 2017-12-14Bibliographically approved
    2. The lived body: experiences from adults with cerebral palsy
    Open this publication in new window or tab >>The lived body: experiences from adults with cerebral palsy
    2007 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 21, no 5, p. 432-441Article in journal (Refereed) Published
    Abstract [en]

    Objective: To get a deeper understanding into how adults with cerebral palsy experience living with a disability and how they manage daily life.

    Design: Interviews with open-ended questions were carried out. They were analysed by one person according to the Empirical Phenomenological Psychological method (EPP).Setting and subjects : Twenty-two community-living adults (35—68 years) with cerebral palsy from five counties in Sweden participated. All had mobility problems and all had cognitive abilities making it possible to carry on a conversation.

    Results: The varied experiences resulted in themes including (1) perceptions of living with a disability and (2) strategies used for managing the described perceptions. The perceptions were: a dys-appearing body, a not-appearing body, difference, being in-between, normality, restricted autonomy and autonomy. The strategies were: to fight one's way, to plan, to get used to it, to hide and to give one's all.

    Conclusion: These interviews expressed heterogeneity in lived experiences showing the importance for professionals to meet people with cerebral palsy as individual subjects in relation to functional problems, self-image and autonomy together with seeing the consequences of different coping strategies.

    Place, publisher, year, edition, pages
    Sage Journals online, 2007
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16370 (URN)10.1177/0269215507073489 (DOI)
    Available from: 2009-01-19 Created: 2009-01-19 Last updated: 2017-12-14Bibliographically approved
    3. Prerequisites for carrying out physiotherapy and physical activity: experiences from adults with cerebral palsy
    Open this publication in new window or tab >>Prerequisites for carrying out physiotherapy and physical activity: experiences from adults with cerebral palsy
    2009 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 3, p. 161-169Article in journal (Refereed) Published
    Abstract [en]

    Purpose: The aim of this study was to get a deeper understanding into how adults with cerebral palsy (CP) experience physiotherapy and physical activity in a perspective from childhood to adulthood; and how personal and environmental factors influence possibilities for physiotherapy and physical activity.

    Method: Data was collected through interviews with 22 community-living adults (35 - 68 years) with CP, from five counties in Sweden. The questions were open-ended and the interviews were taped and transcribed to written language. The material was analysed through qualitative content analysis, a classification process resulting in different themes.

    Results: The narratives from the 22 informants, based on experiences from childhood to adulthood, resulted in a description of prerequisites for carrying out physiotherapy and physical activity. Five different themes were identified: (i) Being enjoyable, (ii) Giving effects, (iii) Being comprehensible, (iv) Being integrated in daily life, and (v) Supportive healthcare with competent professionals.

    Conclusion: The information from the interviews elucidates the importance of a lifelong support from healthcare professionals. Physiotherapists with attentiveness to different life situations in combination with good understanding and knowledge in CP could facilitate continuous physical activity in people growing up and ageing with CP.

    Keywords
    Ageing, cerebral palsy, healthcare, physical training, well-being
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16371 (URN)10.1080/09638280701850934 (DOI)
    Note
    This is an electronic version of an article published in:Karin Sandström, Kersti Samuelsson and Birgitta Öberg, Prerequisites for carrying out physiotherapy and physical activity: experiences from adults with cerebral palsy, 2009, Disability and rehabilitation, (31), 3, 161-169.Disability and rehabilitation is available online at informaworld:http://dx.doi.org/10.1080/09638280701850934Copyright: Taylor Francis http://www.informaworld.com/Available from: 2009-03-10 Created: 2009-01-19 Last updated: 2017-12-14Bibliographically approved
  • 119.
    Sandström, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Östergötlands Läns Landsting, Reconstruction Centre, Department of Rehabilitation Medicine UHL.
    The lived body: experiences from adults with cerebral palsy2007In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 21, no 5, p. 432-441Article in journal (Refereed)
    Abstract [en]

    Objective: To get a deeper understanding into how adults with cerebral palsy experience living with a disability and how they manage daily life.

    Design: Interviews with open-ended questions were carried out. They were analysed by one person according to the Empirical Phenomenological Psychological method (EPP).Setting and subjects : Twenty-two community-living adults (35—68 years) with cerebral palsy from five counties in Sweden participated. All had mobility problems and all had cognitive abilities making it possible to carry on a conversation.

    Results: The varied experiences resulted in themes including (1) perceptions of living with a disability and (2) strategies used for managing the described perceptions. The perceptions were: a dys-appearing body, a not-appearing body, difference, being in-between, normality, restricted autonomy and autonomy. The strategies were: to fight one's way, to plan, to get used to it, to hide and to give one's all.

    Conclusion: These interviews expressed heterogeneity in lived experiences showing the importance for professionals to meet people with cerebral palsy as individual subjects in relation to functional problems, self-image and autonomy together with seeing the consequences of different coping strategies.

  • 120.
    Sandström, Karin
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Östergötlands Läns Landsting, Reconstruction Centre, Department of Rehabilitation Medicine UHL.
    Alinder, John
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Rehabilitation Medicine UHL.
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Descriptions of functioning and health and relations to a gross motor classification in adults with cerebral palsy2004In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 26, no 17, p. 1023-1031Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to describe functioning and health, and explore the use of the Gross Motor Function Classification System (GMFCS) in an adult population with cerebral palsy (CP).

    Methods: From a cohort of 199 persons, 48 persons were selected for structured interviews and functional assessments regarding activities of daily living, motor function, range of motion, pain and general health.

    Results: A third of the population had deteriorated in function from adolescence to adulthood according to the GMFCS. The majority were independent in personal ADL, but many of those were dependent in instrumental ADL. Motor function scores reflected problems in walking ability, and limited ROM and pain were common in all functional levels. General health was lower than in a general population. GMFCS seems valid for classifying adults with CP since it is correlated with instruments measuring motor function and ADL in terms of dependence.

    Conclusion: Decreased functional ability and secondary musculoskeletal problems are common in adults with CP and general health can be associated with those problems. It is important to further explore health aspects and relations between health status and self-perceived health. The GMFCS is a useful tool, especially for comparisons throughout the life span, but in order to use in an adult population further development is needed.

  • 121.
    Sandström, Karin
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Östergötlands Läns Landsting, Reconstruction Centre, Department of Rehabilitation Medicine UHL.
    Samuelsson, Kersti
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Rehabilitation Medicine UHL.
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Prerequisites for carrying out physiotherapy and physical activity: experiences from adults with cerebral palsy2009In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 3, p. 161-169Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to get a deeper understanding into how adults with cerebral palsy (CP) experience physiotherapy and physical activity in a perspective from childhood to adulthood; and how personal and environmental factors influence possibilities for physiotherapy and physical activity.

    Method: Data was collected through interviews with 22 community-living adults (35 - 68 years) with CP, from five counties in Sweden. The questions were open-ended and the interviews were taped and transcribed to written language. The material was analysed through qualitative content analysis, a classification process resulting in different themes.

    Results: The narratives from the 22 informants, based on experiences from childhood to adulthood, resulted in a description of prerequisites for carrying out physiotherapy and physical activity. Five different themes were identified: (i) Being enjoyable, (ii) Giving effects, (iii) Being comprehensible, (iv) Being integrated in daily life, and (v) Supportive healthcare with competent professionals.

    Conclusion: The information from the interviews elucidates the importance of a lifelong support from healthcare professionals. Physiotherapists with attentiveness to different life situations in combination with good understanding and knowledge in CP could facilitate continuous physical activity in people growing up and ageing with CP.

  • 122.
    Schepull, Thorsten
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Norrman, Hanna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics.
    Trinks, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Aspenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Autologous Platelets Have No Effect on the Healing of Human Achilles Tendon Ruptures A Randomized Single-Blind Study2011In: AMERICAN JOURNAL OF SPORTS MEDICINE, ISSN 0363-5465, Vol. 39, no 1, p. 38-47Article in journal (Refereed)
    Abstract [en]

    Background: Animal studies have shown that local application of platelet-rich plasma (PRP) stimulates tendon repair. Preliminary results from a retrospective case series have shown faster return to sports. Hypothesis: Autologous PRP stimulates healing of acute Achilles tendon ruptures. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Thirty patients were recruited consecutively. During surgery, tantalum beads were implanted in the Achilles tendon proximal and distal to the rupture. Before skin suture, randomization was performed, and 16 patients were injected with 10 mL PRP (10 times higher platelet concentration than peripheral blood) whereas 14 were not. With 3-dimensional radiographs (roentgen stereophotogrammetric analysis; RSA), the distance between the beads was measured at 7, 19, and 52 weeks while the patient resisted different dorsal flexion moments over the ankle joint, thereby estimating tendon strain per load. An estimate of elasticity modulus was calculated using callus dimensions from computed tomography. At 1 year, functional outcome was evaluated, including the heel raise index and Achilles Tendon Total Rupture Score. The primary effect variables were elasticity modulus at 7 weeks and heel raise index at 1 year. Results: The mechanical variables showed a large degree of variation between patients that could not be explained by measuring error. No significant group differences in elasticity modulus could be shown. There was no significant difference in heel raise index. The Achilles Tendon Total Rupture Score was lower in the PRP group, suggesting a detrimental effect. There was a correlation between the elasticity modulus at 7 and 19 weeks and the heel raise index at 52 weeks. Conclusion: The results suggest that PRP is not useful for treatment of Achilles tendon ruptures. The variation in elasticity modulus provides biologically relevant information, although it is unclear how early biomechanics is connected to late clinical results.

  • 123.
    Schepull, Torsten
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion.
    Kvist, Joanna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Physiotherapy.
    Andersson, Christer A
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Aspenberg, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Mechanical properties during healing of Achilles tendon ruptures to predict final outcome: A pilot Roentgen stereophotogrammetric analysis in 10 patients2007In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 8Article in journal (Refereed)
    Abstract [en]

    Background. There are presently few methods described for in vivo monitoring of the mechanics of healing human tendon ruptures, and no methods for prediction of clinical outcome. We tested if Roentgen stereophotogrammetric analysis (RSA) can be used to follow the restoration of mechanical properties during healing of ruptured Achilles tendons, and if early measurements can predict clinical results. Methods. Achilles tendon repair was studied with RSA in 10 patients with a total rupture. Tantalum beads were implanted in conjunction with surgical repair. The patients were evaluated at 6, 12 and 18 weeks, and after 1 year. RSA was performed with two different mechanical loadings, and the strain induced by increasing load was measured. The transverse area was determined by ultrasound. CT scan at 12 weeks confirmed that the tantalum beads were located within the tendons. Functional testing was done after 1 year. A heel raise index was chosen as primary clinical outcome variable. Results. The strain was median 0.90, 0.32 and 0.14 percent per 100 N tendon force at 6 weeks, 18 weeks and one year respectively. The error of measurement was 0.04 percent units at 18 weeks. There was a large variation between patients, which appears to reflect biological variation. From 6 to 18 weeks, there was a negative correlation between increase in transverse area and increase in material properties, suggesting that healing is regulated at the organ level, to maximize stiffness. Modulus of elasticity during this time correlated with a heel raise index at one year (Rho = 0.76, p = 0.02). Conclusion. We conclude that the RSA method might have potential for comparing different treatments of Achilles tendon ruptures. © 2007 Schepull et al, licensee BioMed Central Ltd.

  • 124.
    Schepull, Torsten
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Aspenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Early E-modulus of healing Achilles tendons correlates with late function: Similar results with or without surgery2012In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 22, no 1, p. 18-23Article in journal (Refereed)
    Abstract [en]

    Non-operative treatment of Achilles tendon ruptures is associated with an increased risk of rerupture. We hypothesized that this is due to inferior mechanical properties during an early phase of healing, and performed a randomized trial, using a new method to measure the mechanical properties. Tantalum markers were inserted in the tendon stumps, and tendon strain at different loadings was measured by stereo-radiography (Roentgen stereophotogrammetric analysis) at 3, 7 and 19 weeks and 18 months after injury. Thirty patients were randomized to operative or non-operative treatment. The primary out-come variable was an estimate for the modulus of elasticity at 7 weeks. Strain per force, cross-sectional area and tendon elongation were also measured. The functional outcome variable was the heel-raise index after 18 months. There was no difference in the mean modulus of elasticity or other mechanical or functional variables between operative and non-operative treatments at any time-point, but strain per force at 7 and 19 weeks had a significantly larger variation in the non-operative group. This group, therefore, might contain more outliers with poor healing. The modulus of elasticity at 7 weeks correlated with the heel-raise index after 18 months in both treatment groups (r2=0.75; P=0.0001). This correlation is an intriguing finding.

  • 125.
    Siebers, Agneta
    et al.
    Rehabiliteringsmedicinska kliniken Länssjukhuset Ryhov.
    Öberg, Ulrika
    Futurum Länssjukhuset Ryhov.
    Skargren, Elisabeth
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    The effect of modified constraint –induced movement therapy on spasticity and motor function of the affected arm in patients with chronic stroke.2010In: Physiotherapy Canada, ISSN 0300-0508, E-ISSN 1708-8313, ISSN 0300-0508, Vol. 62, no 4, p. 388-366Article in journal (Refereed)
    Abstract [en]

     

    Purpose: The purpose of this study was to explore the effect of modified constraint-induced movement therapy (CIMT) in a real-world clinical setting on spasticity and functional use of the affected arm and hand in patients with spastic chronic hemiplegia.

    Method: A prospective consecutive quasi-experimental study design was used. Twenty patients with spastic hemiplegia (aged 22–67 years) were tested before and after 2-week modified CIMT in an outpatient rehabilitation clinic and at 6 months. The Modified Ashworth Scale (MAS), active range of motion (AROM), grip strength, Motor Activity Log (MAL), Sollerman hand function test, and Box and Block Test (BBT) were used as outcome measures.

    Results: Reductions (p<0.05–0.001) in spasticity (MAS) were seen both after the 2-week training period and at 6-month follow-up. Improvements were also seen in AROM (median change of elbow extension 5°, dorsiflexion of hand 10°), grip strength (20 Newton), and functional use after the 2-week training period (MAL: 1 point; Sollerman test: 8 points; BBT: 4 blocks). The improvements persisted at 6-month follow-up, except for scores on the Sollerman hand function test, which improved further.

    Conclusion: Our study suggests that modified CIMT in an outpatient clinic may reduce spasticity and increase functional use of the affected arm in spastic chronic hemiplegia, with improvements persisting at 6 months.

     

  • 126.
    Sjödahl, Jenny
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Pregnancy-related pelvic girdle pain and its relation to muscle function2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Pregnancy-related lumbopelvic pain affects approximately 50% of all pregnant women. For the majority the pain disappears during the first  months after delivery; however, for a significant number of women, the pain is persistent, with little improvement for more than three months after delivery. Moreover, women who experience persistent lumbopelvic pain three months postpartum are at substantial risk for new episodes or for chronic lumbopelvic pain later in life. Hence, pregnancy-related lumbopelvic pain should be considered a major public health issue. In order to develop and offer specific treatment strategies, it is important to identify different subgroups of lumbopelvic pain based on different clinical presentations. Pelvic girdle pain (PGP) is one of the major subgroups of pain related to pregnancy. There is no consensus regarding the underlying mechanisms although instability in the pelvis has been proposed as one of the possible mechanism; thus, further studies are necessary to determine how to treat these women. The local lumbopelvic muscle system, including the pelvic floor muscles (PFM) is thought to contribute to the stabilization of the pelvis and they are also the target for many treatment strategies for lumbopelvic pain.

    The overall aim of this thesis was to improve rehabilitation for women with persistent postpartum PGP by investigating three areas, including: 1) the postural response of the PFM, 2) the effect of home-based specific stabilizing exercises (SSE) that target the local lumbopelvic muscle system and, 3) predictors for disability at 15 months postpartum.

    The thesis comprises three studies: A) a methodological study, B) an experimental study, and C) a clinical randomized controlled trial (RCT). The data is mainly based on muscle function, including recordings of electromyographic (EMG) activation, muscle endurance, and muscle strength. We also collected subjective ratings of disability, healthrelated quality of life, and pain.

    The methodological study showed that the designed protocol, which included limb movements performed at a comfortable speed in both standing and supine positions, was useful for detecting a postural response in the PFM. The experimental study demonstrated that women with persistent postpartum PGP and those free of pain exhibited a feed-forward mechanism in the PFM that responded in anticipation to leg lifts performed in a supine position. However, we cannot rule out the possibility that women with difficulties in transferring load between the trunk and legs (i.e., those with functional pelvic instability) might have a different postural response in the PFM. In the present study, one woman with persistent postpartum PGP failed to present a feed-forward mechanism in the PFM, in agreement with previous studies on other parameters of the PFM from other similar groups.

    The clinical RCT demonstrated that the concept of home-based SSE with visits every second week with the treating physiotherapist was not more effective than the clinical natural course for improving subjective ratings or muscle function in women with persistent postpartum PGP.

    A linear regression analysis revealed a complex picture that suggests that disability 15 months postpartum in women with persistent PGP could be partially predicted by two interaction effects comprising factors from different dimensions: biological, physical functioning, and self-rated function. The proposed association between muscle function and PGP was strengthen. New approaches are most likely needed to further identify subgroups of patients with persistent postpartum PGP that can be considered homogeneous for treatment.

    List of papers
    1. The postural response of the pelvic floor muscles during limb movements: A methodological electromyography study in parous women without lumbopelvic pain
    Open this publication in new window or tab >>The postural response of the pelvic floor muscles during limb movements: A methodological electromyography study in parous women without lumbopelvic pain
    2009 (English)In: CLINICAL BIOMECHANICS, ISSN 0268-0033, Vol. 24, no 2, p. 183-189Article in journal (Refereed) Published
    Abstract [en]

    Background: Pregnancy-related lumbopelvic pain is common. More than 30% of women have persistent pain 3 months after giving birth. There is no consensus regarding the pathology. However, coordination of muscle activity by appropriate timing and amplitude is necessary for maintaining adequate stability in the lumbopelvic area. The aim was to develop a method using surface electromyography to detect a feed-forward response in the pelvic floor muscles during limb movements performed at a comfortable speed applicable in future studies for women with lumbopelvic pain.

    Methods: Ten parous women with no lumbopelvic pain in the past 12 months were included. Surface electromyographic activity was recorded from the pelvic floor muscles and unilaterally from transversus abdominis/internal oblique, rectus abdominis, erector spinae, hip adductors, rectus femoris and deltoid. The subjects performed leg lift in supine and arm lift from standing. The electromyographic onset was related to the initiation of the movement.

    Findings: In the majority of the women the electromyographic onsets of the pelvic floor muscles occurred before the movement was initiated, regardless of whether it was a leg or an arm lift. In addition. electromyographic onsets for the other muscles, except the rectus abdominis during the arm lift, also occurred prior to the movements.

    Interpretation: The findings suggest a feed-forward response in the pelvic floor muscles during leg and arm lifts in women who had previously given birth and were without lumbopelvic pain. Movements performed at a comfortable speed seem to be useful in order to detect such a response.

    Keywords
    Low back stability, Feed-forward, Abdominal muscles, Temporal parameters
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-17289 (URN)10.1016/j.clinbiomech.2008.11.004 (DOI)
    Note
    Original Publication: Jenny Sjödahl, Joanna Kvist, Annelie Gutke and Birgitta Öberg, The postural response of the pelvic floor muscles during limb movements: A methodological electromyography study in parous women without lumbopelvic pain, 2009, CLINICAL BIOMECHANICS, (24), 2, 183-189. http://dx.doi.org/10.1016/j.clinbiomech.2008.11.004 Copyright: Elsevier Science B.V., Amsterdam. http://www.elsevier.com/ Available from: 2009-07-02 Created: 2009-03-16 Last updated: 2015-03-24Bibliographically approved
    2. The Postural response of the pelvic floor muscles during the active straight leg raise test in women with and without persistent postpartum pelvic girdle pain: an experimental study
    Open this publication in new window or tab >>The Postural response of the pelvic floor muscles during the active straight leg raise test in women with and without persistent postpartum pelvic girdle pain: an experimental study
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    The hypothesis was that women with pelvic girdle pain (PGP) would lack a feedforward mechanism in the pelvic floor muscles (PFM) in relation to a functional instability problem. Eight women with PGP and 10 pain-free women were included. A clinical examination was performed to verify that participants with PGP fulfilled the diagnostic criteria used in this study. Surface electromyographic activity was recorded from the PFM and unilaterally from abdominal muscles and the rectus femoris muscle. Participants performed leg lifts (performed as Active Straight Leg Raise (ASLR) tests), first with one leg and then with the other. The lift was also performed with an extra weight strapped on one leg. Median onset of PFM activity occurred before the initiation of the lifts in both groups. One woman experienced more severe PGP/dysfunction demonstrated by a higher score on the ASLR test during the clinical examination. This woman presented onset of PFM activity after the initiation of the lifts. The findings suggest that a feed-forward response of the PFM is present during leg lifts in women with and without postpartum PGP. However, one can speculate that a lack of feed-forward in the PFM may be associated with a load transfer problem.

    Keywords
    Low back pain; joint instability; electromyography
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-60188 (URN)
    Available from: 2010-10-07 Created: 2010-10-07 Last updated: 2015-03-24
    3. Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial
    Open this publication in new window or tab >>Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial
    2010 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 10, p. 929-935Article in journal (Refereed) Published
    Abstract [en]

    Objective: To investigate the efficacy of home-based specific stabilizing exercises focusing on the local stabilizing muscles as the only intervention in the treatment of persistent postpartum pelvic girdle pain (PGP).

    Design: A prospective, randomized, single-blinded, clinically controlled study.

    Subjects: Eighty-eight women with PGP were recruited 3 months after delivery.

    Methods: The treatment consisted of specific stabilizing exercises targeting the local trunk muscles. The reference group had one telephone contact with a physiotherapist. Primary outcome was disability measured with Oswestry Disability Index. Secondary outcomes were pain, health-related quality of life (EQ-5D), symptom satisfaction, and muscle function.

    Results: No significant differences between groups could be found at 3- or 6-month follow-up regarding primary outcome in disability. Within-group comparisons showed some improvement in both groups in terms of disability, pain, symptom satisfaction and muscle function compared to baseline although the majority still experienced PGP.

    Conclusion: Treatment with this home-training concept of specific stabilizing exercises targeting the local muscles was no more effective in improving consequences of persistent postpartum PGP than the clinically natural course. Regardless of treatment with specific stabilizing exercises or not, the majority still experiences some back pain almost a year after pregnancy.

    Place, publisher, year, edition, pages
    Foundation for Rehabilitation Information, 2010
    Keywords
    Low back pain; postpartum; physical therapy; exercise therapy, pelvic floor; specific stabilizing exercises; trunk muscles
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-60189 (URN)10.2340/16501977-0615 (DOI)000284748600006 ()
    Note
    Original Publication: Annelie Gutke, Jenny Sjödahl and Birgitta Öberg, Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial, 2010, Journal of Rehabilitation Medicine, (42), 10, 929-935. http://dx.doi.org/10.2340/16501977-0615 Copyright: Foundation for Rehabilitation Information http://www.medicaljournals.se/jrm/ Available from: 2010-10-07 Created: 2010-10-07 Last updated: 2017-12-12
    4. Predictors for disability in women with persistent postpartum pelvic girdle pain
    Open this publication in new window or tab >>Predictors for disability in women with persistent postpartum pelvic girdle pain
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    The majority of studies on postpartum lumbopelvic pain have investigated predictors for women experiencing lumbopelvic pain during pregnancy. Since the majority of women recover within the first months of delivery it is unknown if the same predictors are valid for disability in women with persistent postpartum pelvic girdle pain (PGP). The aim of this study was to identify predictors for disability in women with persistent PGP 15 months postpartum. Factors were obtained by clinical tests and questionnaires 3 months postpartum. Outcome 15 months postpartum was disability measured with Oswestry Disability Index. A multiple linear regression analysis identified two significant two-way interaction effects that predicted for disability in women with persistent PGP at 15 months postpartum: a) age + trunk flexor endurance, b) disability + hip extensor strength.

    Keywords
    Muscle function; pregnancy-related low back pain; prognostic factor
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-60190 (URN)
    Available from: 2010-10-07 Created: 2010-10-07 Last updated: 2010-10-07Bibliographically approved
  • 127.
    Sjödahl, Jenny
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Gutke, Annelie
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    Predictors for disability in women with persistent postpartum pelvic girdle painManuscript (preprint) (Other academic)
    Abstract [en]

    The majority of studies on postpartum lumbopelvic pain have investigated predictors for women experiencing lumbopelvic pain during pregnancy. Since the majority of women recover within the first months of delivery it is unknown if the same predictors are valid for disability in women with persistent postpartum pelvic girdle pain (PGP). The aim of this study was to identify predictors for disability in women with persistent PGP 15 months postpartum. Factors were obtained by clinical tests and questionnaires 3 months postpartum. Outcome 15 months postpartum was disability measured with Oswestry Disability Index. A multiple linear regression analysis identified two significant two-way interaction effects that predicted for disability in women with persistent PGP at 15 months postpartum: a) age + trunk flexor endurance, b) disability + hip extensor strength.

  • 128.
    Sjödahl, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Gutke, Annelie
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Predictors for long-term disability in women with persistent postpartum pelvic girdle pain2013In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 22, no 7, p. 1665-1673Article in journal (Refereed)
    Abstract [en]

    Purpose

    The majority of prognostic studies on postpartum lumbopelvic pain have investigated factors during pregnancy. Since the majority of women recover within the first few months of delivery, it is unknown if the same predictors are valid for long-term consequences. It is also important to investigate predictors within subgroups of patients with pregnancy-related lumbopelvic pain due to their different clinical courses. The aim of this study was to identify predictors for disability 15 months postpartum in women with persistent postpartum pelvic girdle pain (PGP).

    Methods

    Data were obtained by clinical tests and questionnaires 3 months postpartum. The outcome 15 months postpartum was disability measured with the Oswestry Disability Index.

    Results

    A multiple linear regression analysis identified two significant two-way interaction effects that were predictive of disability 15 months postpartum: (a) age + trunk flexor endurance, and (b) disability + hip extensor strength.

    Conclusions

    Age, muscle function and disability seem to influence the long-term outcome on disability in women with persistent postpartum PGP. It may be important to consider the possibility of different variables impact on each other when predicting long-term disability. In addition, further studies are needed to investigate the impact of interaction effects on long-term consequences in women with persistent postpartum PGP.

  • 129.
    Sjödahl, Jenny
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Gutke, Annelie
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    The postural response of the pelvic floor muscles during limb movements: A methodological electromyography study in parous women without lumbopelvic pain2009In: CLINICAL BIOMECHANICS, ISSN 0268-0033, Vol. 24, no 2, p. 183-189Article in journal (Refereed)
    Abstract [en]

    Background: Pregnancy-related lumbopelvic pain is common. More than 30% of women have persistent pain 3 months after giving birth. There is no consensus regarding the pathology. However, coordination of muscle activity by appropriate timing and amplitude is necessary for maintaining adequate stability in the lumbopelvic area. The aim was to develop a method using surface electromyography to detect a feed-forward response in the pelvic floor muscles during limb movements performed at a comfortable speed applicable in future studies for women with lumbopelvic pain.

    Methods: Ten parous women with no lumbopelvic pain in the past 12 months were included. Surface electromyographic activity was recorded from the pelvic floor muscles and unilaterally from transversus abdominis/internal oblique, rectus abdominis, erector spinae, hip adductors, rectus femoris and deltoid. The subjects performed leg lift in supine and arm lift from standing. The electromyographic onset was related to the initiation of the movement.

    Findings: In the majority of the women the electromyographic onsets of the pelvic floor muscles occurred before the movement was initiated, regardless of whether it was a leg or an arm lift. In addition. electromyographic onsets for the other muscles, except the rectus abdominis during the arm lift, also occurred prior to the movements.

    Interpretation: The findings suggest a feed-forward response in the pelvic floor muscles during leg and arm lifts in women who had previously given birth and were without lumbopelvic pain. Movements performed at a comfortable speed seem to be useful in order to detect such a response.

  • 130.
    Sjödahl, Jenny
    et al.
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Gutke, Annelie
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Public Health Sciences.
    The Postural response of the pelvic floor muscles during the active straight leg raise test in women with and without persistent postpartum pelvic girdle pain: an experimental studyManuscript (preprint) (Other academic)
    Abstract [en]

    The hypothesis was that women with pelvic girdle pain (PGP) would lack a feedforward mechanism in the pelvic floor muscles (PFM) in relation to a functional instability problem. Eight women with PGP and 10 pain-free women were included. A clinical examination was performed to verify that participants with PGP fulfilled the diagnostic criteria used in this study. Surface electromyographic activity was recorded from the PFM and unilaterally from abdominal muscles and the rectus femoris muscle. Participants performed leg lifts (performed as Active Straight Leg Raise (ASLR) tests), first with one leg and then with the other. The lift was also performed with an extra weight strapped on one leg. Median onset of PFM activity occurred before the initiation of the lifts in both groups. One woman experienced more severe PGP/dysfunction demonstrated by a higher score on the ASLR test during the clinical examination. This woman presented onset of PFM activity after the initiation of the lifts. The findings suggest that a feed-forward response of the PFM is present during leg lifts in women with and without postpartum PGP. However, one can speculate that a lack of feed-forward in the PFM may be associated with a load transfer problem.

  • 131.
    Steentoft, A
    et al.
    University of Copenhagen.
    Teige, B
    University of Oslo.
    Holmgren, Per
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
    Vuori, E
    University of Helsinki.
    Kristinsson, J
    University of Iceland.
    Hansen, A. C.
    University of Aarhus.
    Ceder, Gun
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Wethe, G
    Norwegian Institute of Public Health.
    Rollmann, D
    University of Odense.
    Fatal poisoning in Nordic drug addicts in 20022006In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 160, no 03-Feb, p. 148-156Article in journal (Refereed)
    Abstract [en]

    The present study from 2002 includes medicolegally examined fatal poisonings among drug addicts in the five Nordic countries: Denmark, Finland, Iceland, Norway and Sweden. A common definition "drug addict" is applied by the participating countries. The number of deaths, age, sex, place of death, main intoxicant and other drugs present in the blood are recorded in order to obtain national data, as well as comparable Nordic data and data comparable to earlier studies from 1997 and 1991. The Icelandic results are commented on separately due to the low number of cases The most fatal overdoses are seen in Norway, in both the death rate (number per 100,000 inhabitants = 8.44) and in absolute number (n = 232). The comparable figures for the other four countries are Denmark 5.43 (n = 175), Iceland 3.6 (n = 6), Finland 2.93 (n = 94) and Sweden 2.56 (n = 136). In earlier studies from 1991 and 1997, the highest death rate is seen in Denmark, with Norway as number two. Denmark is the only country where the death rate decreases from 1997 to 2002. A relatively large increase in deaths in the younger age groups(less than 30 years) is noted from 1997 to 2002, except in Denmark, where only a small increase in overdose deaths in very young people (15-19 years) is observed. Females account for 12-20% of the overdoses (three out of six deaths in Iceland). Relatively fewer deaths are recorded in the capital areas in 2002 than in 1997 and 199 1, suggesting more geographically widespread drug use in the Nordic countries Heroin/morphine is the single most frequently encountered main intoxicant, varying from 10% of the cases in Finland to 72% of the cases in Norway. Finland differs from the other countries in that a high percentage of the fatal overdoses in Finland are not caused by an illicit drug; buprenorphine, overdoses are seen, and relatively few deaths resulting from heroin are seen. Methadone is the main intoxicant in 41% of the Danish overdose cases, 15% of the Norwegian cases, 4% of the Swedish cases and none of the Finnish overdose cases, an observation probably linked to different national prescription rules for methadone The analytical screening reveals extended polydrug use. Frequently seen substances, in addition to the main intoxicant are amphetamine, tetrahydrocannabinol (THC), benzodiazepines and ethanol.

  • 132.
    Tagesson (Sonesson), Sofi
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Dynamic knee stability after anterior cruciate ligament injury: Emphasis on rehabilitation2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Anterior cruciate ligament injury leads to increased sagittal tibial translation, and perceptions of instability and low confidence in the knee joint are common. Many patients have remaining problems despite treatment and are forced to lower their activity level and prematurely end their career in sports. The effect of ACL reconstruction and/or rehabilitation on dynamic knee stability is not completely understood. The overall aim of this thesis was to study the dynamic knee stability during and after rehabilitation in individuals with ACL injury. More specific aims were 1) to elaborate an evaluation method for muscle strength, 2) to evaluate the effect of exercises in closed and open kinetic chain, and 3) to evaluate dynamic knee stability in patients with ACL deficiency or ACL reconstruction.

    Sagittal tibial translation and knee flexion angle were measured using the CA‐4000 computerised goniometer linkage. Muscle activation was registered with electromyography.

    The intra‐ and inter‐rater reliability of 1 repetition maximum (RM) of seated knee extension was clinically acceptable. The inter‐rater reliability of 1RM of squat was also acceptable, but the intra‐rater reliability was lower. The systematic procedure for the establishment of 1RM that was developed can be recommended for use in the clinic.

    One specific exercise session including cycling and a maximum number of knee extensions and heel raises did not influence static or dynamic sagittal tibial translation in uninjured individuals. A comprehensive rehabilitation program with isolated quadriceps training in OKC led to significantly greater isokinetic quadriceps strength compared to CKC rehabilitation in patients with ACL deficiency. Hamstring strength, static and dynamic translation, and functional outcome were similar between groups. Five weeks after ACL reconstruction, seated knee extension produced more anterior tibial translation compared to the straight leg raise and standing on one leg. All exercises produced less or equal amount of anterior tibial translation as the 90N Lachman test.

    Five weeks after the ACL reconstruction the static and dynamic tibial translation in the ACL reconstructed knee did not differ from the tibial translation on the uninjured leg. Patients in the early phase after ACL injury or ACL reconstruction used a joint stiffening strategy including a reduced peak knee extension angle during gait and increased hamstring activation during activity, which reduces the dynamic tibial translation. Patients with ACL deficiency that completed a four months rehabilitation program used a movement pattern that was more close to normal.

    List of papers
    1. Passive and dynamic translation in the knee is not influenced by knee exercises in healthy individuals
    Open this publication in new window or tab >>Passive and dynamic translation in the knee is not influenced by knee exercises in healthy individuals
    2005 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 15, no 3, p. 139-147Article in journal (Refereed) Published
    Abstract [en]

    No evidence exists that repeated isolated quadriceps contractions lead to increased sagittal plane tibial translation. The purpose was to analyze passive and dynamic tibial translation before, during and after a specific exercise session, including cycling and a maximum number of knee extensions and heel-raises, in healthy individuals. Passive and dynamic sagittal tibial translation was measured on 18 healthy individuals (nine men and nine women) before, during and after a specific exercise session with heavy load, including cycling and maximum number of knee extensions and heel-raises. Sagittal tibial translation during the Lachman test, maximal isometric quadriceps contraction, one-legged squat and gait was registered with the CA-4000 electrogoniometer. The electromyographic (EMG) activity of m. vastus medialis and lateralis, m. gastrocnemius and mm. hamstrings was registered. There was no difference in passive or dynamic sagittal tibial translation during or after the exercise session. No difference could be detected in EMG activity during squat after compared with before the exercise session. In conclusion, the knee exercises did not influence the amount of translation in healthy individuals. The findings indicate that isolated strength training of quadriceps may be included in anterior cruciate ligament rehabilitation programs, even if further specific studies on injured individuals most be performed.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2005
    Keywords
    knee kinematics; EMG; ACL rehabilitation; exercise; squat; knee extension
    National Category
    Physiotherapy
    Identifiers
    urn:nbn:se:liu:diva-22680 (URN)10.1111/j.1600-0838.2004.00425.x (DOI)15885034 (PubMedID)1970 (Local ID)1970 (Archive number)1970 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    2. Intra‐ and interrater reliability of the establishment of one repetition maximum on squat and seated knee extension
    Open this publication in new window or tab >>Intra‐ and interrater reliability of the establishment of one repetition maximum on squat and seated knee extension
    2007 (English)In: Journal of Strength and Conditioning Research, ISSN 1064-8011, E-ISSN 1533-4287, Vol. 21, no 3, p. 801-807Article in journal (Refereed) Published
    Abstract [en]

    The purpose of the present study was to develop a systematic procedure for the establishment of 1 repetition maximum (1RM) in order to describe an easily accessible test procedure that is applicable for physical therapists and athletic trainers who manage strength training for healthy individuals and patients. Another purpose was to investigate the intra- and interrater reliability of 1RM of squat on 1 leg and seated knee extension on 1 leg. Estimates of leg strength and ratings of perceived exertion formed the basis of the amount of load selected. The reliability of the procedure was assessed by a test–retest design. One RM was established for 16 and 27 healthy individuals, for squat and knee extension, respectively. The intrarater reliability of 1RM of squat on 1 leg was questionable (intraclass correlation [ICC] 0.64, measurement error 13.1 kg). The interrater reliability of 1RM of squat on 1 leg was clinically acceptable (ICC 0.94, measurement error 5.2 kg). The intrarater and interrater reliability of 1RM of seated knee extension on 1 leg was clinically acceptable (ICC 0.90, measurement error 5.1 kg and ICC 0.96, measurement error 3.2 kg, respectively). In conclusion, both exercises can be used to determine the load in exercise programs. In addition, seated knee extension may be used to evaluate strength. In contrast, squat on 1 leg is more uncertain to use at assessments between different days, which may be due to the complexity of this exercise. The test, performed in the described manner, is suitable for physical therapists, athletic trainers, and strength and conditioning coaches in clinical practice working with strength training and rehabilitation.

    Place, publisher, year, edition, pages
    Lippincott Williams & Wilkins, 2007
    Keywords
    exercise, lower extremity, rehabilitation
    National Category
    Sport and Fitness Sciences
    Identifiers
    urn:nbn:se:liu:diva-12864 (URN)17685713 (PubMedID)
    Available from: 2008-01-28 Created: 2008-01-28 Last updated: 2017-12-14Bibliographically approved
    3. A comprehensive rehabilitation program with quadriceps strengthening in closed versus open kinetic chain in patients with anterior cruciate ligament deficiency: a randomized clinical trial evaluating dynamic tibial translation and muscle function
    Open this publication in new window or tab >>A comprehensive rehabilitation program with quadriceps strengthening in closed versus open kinetic chain in patients with anterior cruciate ligament deficiency: a randomized clinical trial evaluating dynamic tibial translation and muscle function
    2008 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 36, no 2, p. 298-307Article in journal (Refereed) Published
    Abstract [en]

    Background: There is no consensus regarding the optimal rehabilitation regimen for increasing quadriceps strength after anterior cruciate ligament (ACL) injury.

    Hypothesis: A comprehensive rehabilitation program supplemented with quadriceps strengthening in open kinetic chain (OKC) exercise will increase quadriceps strength and improve knee function without increasing static or dynamic sagittal tibial translation, compared with the same comprehensive rehabilitation program supplemented with quadriceps strengthening in closed kinetic chain (CKC) exercise, in patients with acute ACL deficiency.

    Study Design: Randomized controlled trial; Level of evidence, 1.

    Methods: Forty-two patients were tested a mean of 43 days (range, 20–96 days) after an ACL injury. Patients were randomized to rehabilitation with CKC quadriceps strengthening (11 men and 9 women) or OKC quadriceps strengthening (13 men and 9 women). Aside from these quadriceps exercises, the 2 rehabilitation programs were identical. Patients were assessed after 4 months of rehabilitation. Sagittal static translation and dynamic tibial translation were evaluated with a CA-4000 electrogoniometer. Muscle strength, jump performance, and muscle activation were also assessed. Functional outcome was evaluated by determining the Lysholm score and the Knee Injury and Osteoarthritis Outcome Score.

    Results: There were no group differences in static or dynamic translation after rehabilitation. The OKC group had significantly greater isokinetic quadriceps strength after rehabilitation (P = .009). The hamstring strength, performance on the 1-repetition-maximum squat test, muscle activation, jump performance, and functional outcome did not differ between groups.

    Conclusions: Rehabilitation with OKC quadriceps exercise led to significantly greater quadriceps strength compared with rehabilitation with CKC quadriceps exercise. Hamstring strength, static and dynamic translation, and functional outcome were similar between groups. Patients with ACL deficiency may need OKC quadriceps strengthening to regain good muscle torque.

    Place, publisher, year, edition, pages
    Sage Publications, 2008
    Keywords
    ACL rehabilitation, knee laxity, muscle strength, dynamic stability, electromyography
    National Category
    Surgery
    Identifiers
    urn:nbn:se:liu:diva-12865 (URN)10.1177/0363546507307867 (DOI)17940146 (PubMedID)
    Available from: 2008-01-28 Created: 2008-01-28 Last updated: 2017-12-14Bibliographically approved
    4. Tibial translation and muscle activation during rehabilitation exercises 5 weeks after anterior cruciate ligament reconstruction
    Open this publication in new window or tab >>Tibial translation and muscle activation during rehabilitation exercises 5 weeks after anterior cruciate ligament reconstruction
    2010 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 20, no 1, p. 154-164Article in journal (Refereed) Published
    Abstract [en]

    Background: It is unclear which rehabilitation exercises involve adequate muscle activationwithout excessive anterior tibial translation after ACL reconstruction.

    Hypothesis: ACL reconstruction will reduce dynamic tibial translation to the level observedin the uninjured knee. The muscle recruitment pattern will be altered 5 weeks after ACLreconstruction, and some rehabilitation exercises will be more beneficial than others due tovarying amounts of dynamic tibial translation and muscle activation.

    Study Design: Descriptive Laboratory Study.

    Methods: Sagittal tibial translation and muscle activation were measured with the Lachmantest (static translation) and 7 rehabilitation exercises (dynamic translation) in 19 patients.Results obtained 5 weeks after ACL reconstruction were compared to those obtained beforethe injury (ACL-deficient knee) and in the uninjured knee.

    Results: Five weeks after ACL reconstruction the seated knee extension producedsignificantly more anterior tibial translation than the straight leg raise and standing on one leg.The static and dynamic tibial translations measured in ACL reconstructed knees were similarto those measured in uninjured knees. After ACL reconstruction, the patients used a jointstiffening strategy that employed more hamstring activation and reduced the dynamic tibialtranslation.

    Conclusions: ACL reconstruction reduced dynamic tibial translation compared to thatobserved before treatment. The muscle recruitment pattern in exercises was altered after ACLreconstruction.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2010
    Keywords
    Rehabilitation, ACL reconstruction, Knee laxity, Knee kinematics, Functional joint stability, Electromyography
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-12866 (URN)10.1111/j.1600-0838.2009.00903.x (DOI)000273823400019 ()
    Note

    On the day of the defence day the status of this article was: Submitted.

    Available from: 2008-01-28 Created: 2008-01-28 Last updated: 2017-12-14Bibliographically approved
  • 133.
    Tagesson (Sonesson), Sofi
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Stabilitet i knäleden efter främre korsbandsskada2008In: Svensk idrottsmedicin, ISSN 1103-7652, Vol. 2, p. 26-29Article in journal (Other (popular science, discussion, etc.))
  • 134.
    Tagesson (Sonesson), Sofi
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Intra‐ and interrater reliability of the establishment of one repetition maximum on squat and seated knee extension2007In: Journal of Strength and Conditioning Research, ISSN 1064-8011, E-ISSN 1533-4287, Vol. 21, no 3, p. 801-807Article in journal (Refereed)
    Abstract [en]

    The purpose of the present study was to develop a systematic procedure for the establishment of 1 repetition maximum (1RM) in order to describe an easily accessible test procedure that is applicable for physical therapists and athletic trainers who manage strength training for healthy individuals and patients. Another purpose was to investigate the intra- and interrater reliability of 1RM of squat on 1 leg and seated knee extension on 1 leg. Estimates of leg strength and ratings of perceived exertion formed the basis of the amount of load selected. The reliability of the procedure was assessed by a test–retest design. One RM was established for 16 and 27 healthy individuals, for squat and knee extension, respectively. The intrarater reliability of 1RM of squat on 1 leg was questionable (intraclass correlation [ICC] 0.64, measurement error 13.1 kg). The interrater reliability of 1RM of squat on 1 leg was clinically acceptable (ICC 0.94, measurement error 5.2 kg). The intrarater and interrater reliability of 1RM of seated knee extension on 1 leg was clinically acceptable (ICC 0.90, measurement error 5.1 kg and ICC 0.96, measurement error 3.2 kg, respectively). In conclusion, both exercises can be used to determine the load in exercise programs. In addition, seated knee extension may be used to evaluate strength. In contrast, squat on 1 leg is more uncertain to use at assessments between different days, which may be due to the complexity of this exercise. The test, performed in the described manner, is suitable for physical therapists, athletic trainers, and strength and conditioning coaches in clinical practice working with strength training and rehabilitation.

  • 135.
    Tagesson (Sonesson), Sofi
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Good, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    A comprehensive rehabilitation program with quadriceps strengthening in closed versus open kinetic chain in patients with anterior cruciate ligament deficiency: a randomized clinical trial evaluating dynamic tibial translation and muscle function2008In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 36, no 2, p. 298-307Article in journal (Refereed)
    Abstract [en]

    Background: There is no consensus regarding the optimal rehabilitation regimen for increasing quadriceps strength after anterior cruciate ligament (ACL) injury.

    Hypothesis: A comprehensive rehabilitation program supplemented with quadriceps strengthening in open kinetic chain (OKC) exercise will increase quadriceps strength and improve knee function without increasing static or dynamic sagittal tibial translation, compared with the same comprehensive rehabilitation program supplemented with quadriceps strengthening in closed kinetic chain (CKC) exercise, in patients with acute ACL deficiency.

    Study Design: Randomized controlled trial; Level of evidence, 1.

    Methods: Forty-two patients were tested a mean of 43 days (range, 20–96 days) after an ACL injury. Patients were randomized to rehabilitation with CKC quadriceps strengthening (11 men and 9 women) or OKC quadriceps strengthening (13 men and 9 women). Aside from these quadriceps exercises, the 2 rehabilitation programs were identical. Patients were assessed after 4 months of rehabilitation. Sagittal static translation and dynamic tibial translation were evaluated with a CA-4000 electrogoniometer. Muscle strength, jump performance, and muscle activation were also assessed. Functional outcome was evaluated by determining the Lysholm score and the Knee Injury and Osteoarthritis Outcome Score.

    Results: There were no group differences in static or dynamic translation after rehabilitation. The OKC group had significantly greater isokinetic quadriceps strength after rehabilitation (P = .009). The hamstring strength, performance on the 1-repetition-maximum squat test, muscle activation, jump performance, and functional outcome did not differ between groups.

    Conclusions: Rehabilitation with OKC quadriceps exercise led to significantly greater quadriceps strength compared with rehabilitation with CKC quadriceps exercise. Hamstring strength, static and dynamic translation, and functional outcome were similar between groups. Patients with ACL deficiency may need OKC quadriceps strengthening to regain good muscle torque.

  • 136.
    Tagesson (Sonesson), Sofi
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Tibial translation and muscle activation during rehabilitation exercises 5 weeks after anterior cruciate ligament reconstruction2010In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 20, no 1, p. 154-164Article in journal (Refereed)
    Abstract [en]

    Background: It is unclear which rehabilitation exercises involve adequate muscle activationwithout excessive anterior tibial translation after ACL reconstruction.

    Hypothesis: ACL reconstruction will reduce dynamic tibial translation to the level observedin the uninjured knee. The muscle recruitment pattern will be altered 5 weeks after ACLreconstruction, and some rehabilitation exercises will be more beneficial than others due tovarying amounts of dynamic tibial translation and muscle activation.

    Study Design: Descriptive Laboratory Study.

    Methods: Sagittal tibial translation and muscle activation were measured with the Lachmantest (static translation) and 7 rehabilitation exercises (dynamic translation) in 19 patients.Results obtained 5 weeks after ACL reconstruction were compared to those obtained beforethe injury (ACL-deficient knee) and in the uninjured knee.

    Results: Five weeks after ACL reconstruction the seated knee extension producedsignificantly more anterior tibial translation than the straight leg raise and standing on one leg.The static and dynamic tibial translations measured in ACL reconstructed knees were similarto those measured in uninjured knees. After ACL reconstruction, the patients used a jointstiffening strategy that employed more hamstring activation and reduced the dynamic tibialtranslation.

    Conclusions: ACL reconstruction reduced dynamic tibial translation compared to thatobserved before treatment. The muscle recruitment pattern in exercises was altered after ACLreconstruction.

  • 137.
    Thomee, Roland
    et al.
    Sahlgrens University Hospital.
    Kaplan, Yonatan
    Hebrew University of Jerusalem.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Myklebust, Grethe
    Oslo Sport Trauma Research Centre.
    Arna Risberg, May
    Oslo University Hospital.
    Theisen, Daniel
    Public Research Centre Heatlh.
    Tsepis, Elias
    Institute Educ Technology.
    Werner, Suzanne
    Stockholm Sports Trauma Research Centre.
    Wondrasch, Barbara
    Vienna Sports Medical Centre.
    Witvrouw, Erik
    University of Ghent.
    Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction2011In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 19, no 11, p. 1798-1805Article in journal (Refereed)
    Abstract [en]

    Purpose The purpose of this article is to present recommendations for new muscle strength and hop performance criteria prior to a return to sports after anterior cruciate ligament (ACL) reconstruction. less thanbrgreater than less thanbrgreater thanMethods A search was made of relevant literature relating to muscle function, self-reported questionnaires on symptoms, function and knee-related quality of life, as well as the rate of re-injury, the rate of return to sports and the development of osteoarthritis after ACL reconstruction. The literature was reviewed and discussed by the European Board of Sports Rehabilitation in order to reach consensus on criteria for muscle strength and hop performance prior to a return to sports. less thanbrgreater than less thanbrgreater thanResults The majority of athletes that sustain an (ACL) injury do not successfully return to their pre-injury sport, even though most athletes achieve what is considered to be acceptable muscle function. On self-reported questionnaires, the athletes report high ratings for fear of re-injury, low ratings for their knee function during sports and low ratings for their knee-related quality of life. less thanbrgreater than less thanbrgreater thanConclusion The conclusion is that the muscle function tests that are commonly used are not demanding enough or not sensitive enough to identify differences between injured and non-injured sides. Recommendations for new criteria are given for the sports medicine community to consider, before allowing an athlete to return to sports after an ACL reconstruction. less thanbrgreater than less thanbrgreater thanLevel of evidence IV.

  • 138.
    Waldén, Markus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Atroshi, Isam
    Hassleholm Kristianstad Ystad Hospital.
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Wagner, Philippe
    Lund University.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial2012In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 344Article in journal (Refereed)
    Abstract [en]

    Objective To evaluate the effectiveness of neuromuscular training in reducing the rate of acute knee injury in adolescent female football players. less thanbrgreater than less thanbrgreater thanDesign Stratified cluster randomised controlled trial with clubs as the unit of randomisation. less thanbrgreater than less thanbrgreater thanSetting 230 Swedish football clubs (121 in the intervention group, 109 in the control group) were followed for one season (2009, seven months). less thanbrgreater than less thanbrgreater thanParticipants 4564 players aged 12-17 years (2479 in the intervention group, 2085 in the control group) completed the study. Intervention 15 minute neuromuscular warm-up programme (targeting core stability, balance, and proper knee alignment) to be carried out twice a week throughout the season. less thanbrgreater than less thanbrgreater thanMain outcome measures The primary outcome was rate of anterior cruciate ligament injury; secondary outcomes were rates of severe knee injury (andgt;4 weeks absence) and any acute knee injury. less thanbrgreater than less thanbrgreater thanResults Seven players (0.28%) in the intervention group, and 14 (0.67%) in the control group had an anterior cruciate ligament injury. By Cox regression analysis according to intention to treat, a 64% reduction in the rate of anterior cruciate ligament injury was seen in the intervention group (rate ratio 0.36, 95% confidence interval 0.15 to 0.85). The absolute rate difference was -0.07 (95% confidence interval -0.13 to 0.001) per 1000 playing hours in favour of the intervention group. No significant rate reductions were seen for secondary outcomes. less thanbrgreater than less thanbrgreater thanConclusions A neuromuscular warm-up programme significantly reduced the rate of anterior cruciate ligament injury in adolescent female football players. However, the absolute rate difference did not reach statistical significance, possibly owing to the small number of events.

  • 139.
    Waldén, Markus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Physiotherapy.
    Magnusson, Henrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Physiotherapy.
    Ekstrand, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Sports Medicine .
    Anterior cruciate ligament injury in elite football: a prospective three-cohort study.2011In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 19, no 1, p. 11-19Article in journal (Refereed)
    Abstract [en]

    Anterior cruciate ligament (ACL) injury causes long lay-off time and is often complicated with subsequent new knee injury and osteoarthritis. Female gender is associated with an increased ACL injury risk, but few studies have adjusted for gender-related differences in age although female players are often younger when sustaining their ACL injury. The objective of this three-cohort study was to describe ACL injury characteristics in teams from the Swedish men's and women's first leagues and from several European men's professional first leagues. Over a varying number of seasons from 2001 to 2009, 57 clubs (2,329 players) were followed prospectively and during this period 78 ACL injuries occurred (five partial). Mean age at ACL injury was lower in women compared to men (20.6 ± 2.2 vs. 25.2 ± 4.5 years, P = 0.0002). Using a Cox regression, the female-to-male hazard ratio (HR) was 2.6 (95% CI 1.4-4.6) in all three cohorts studied and 2.6 (95% CI 1.3-5.3) in the Swedish cohorts; adjusted for age, the HR was reduced to 2.4 (95% CI 1.3-4.2) and 2.1 (95% CI 1.0-4.2), respectively. Match play was associated with a higher ACL injury risk with a match-to-training ratio of 20.8 (95% CI 12.4-34.8) and 45 ACL injuries (58%) occurred due to non-contact mechanisms. Hamstrings grafts were used more often in Sweden than in Europe (67 vs. 34%, P = 0.028), and there were no differences in time to return to play after ACL reconstruction between the cohorts or different grafts. In conclusion, this study showed that the ACL injury incidence in female elite footballers was more than doubled compared to their male counterparts, but also that they were significantly younger at ACL injury than males. These findings suggest that future preventive research primarily should address the young female football player.

  • 140.
    Waldén, Markus
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science.
    Hägglund, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Physiotherapy.
    Werner, Jonas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Sports Medicine.
    The epidemiology of anterior cruciate ligament injury in football (soccer): a review of the literature from a gender-related perspective.2011In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 19, no 1, p. 3-10Article, review/survey (Refereed)
    Abstract [en]

    Football (soccer), the most popular sport worldwide, is associated with a high injury risk, and the knee joint is often affected. Several studies have found female players to be more susceptible to knee injury, anterior cruciate ligament (ACL) injury in particular, compared to their male counterparts. There is, however, some controversy regarding the magnitude of this risk increase and a few studies have found no differences. The influence of age and activity type on gender-related differences in injury risk is only scarcely investigated. In this paper, the literature reporting gender-specific ACL injury risk in football is reviewed. A literature search yielded 33 relevant articles that were included for review. These show that female players have a 2-3 times higher ACL injury risk compared to their male counterparts. Females also tend to sustain their ACL injury at a younger age than males, and a limiting factor in the existing literature is that age is not adjusted for in comparisons of ACL injury risk between genders. Furthermore, the risk increase in females is primarily evident during match play, but type of exposure is also rarely adjusted for. Finally, the studies included in this review share important methodological limitations that are discussed as a starting point for future research in the field.

  • 141.
    Wentz, Elisabet
    et al.
    University of Gothenburg, Sweden Swedish Institute Health Science, Sweden .
    Nyden, A
    University of Gothenburg, Sweden .
    Krevers, Barbro
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Development of an internet-based support and coaching model for adolescents and young adults with ADHD and autism spectrum disorders: a pilot study2012In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 21, no 11, p. 611-622Article in journal (Refereed)
    Abstract [en]

    The aims of this paper were to develop an internet-based support and coaching model for young people with autism spectrum disorder (ASD) and/or attention-deficit/hyperactivity disorder (ADHD), and to validate the model. A user-centred design was applied to develop a model for internet-based support and coaching, where individuals received 8-week support via internet (chat). The model was validated by 10 individuals, 15-26 years of age, with ASD and/or ADHD. Self-report questionnaires [Sense of Coherence (SOC), the Rosenberg Self Esteem Scale, the Manchester Short Assessment of Quality of Life, Montgomery sberg Depression Rating Scale, and the Hospital Anxiety and Depression Scale] were distributed before and after intervention. A structured interview regarding the quality of the model, the Patient perspective of Care and Rehabilitation process (POCR), was used after the intervention. The validation showed significant improvement of SOC, self-esteem and subjective Quality of Life at follow-up and the majority perceived high fulfilment/importance on the POCR. In conclusion, The model can be an important complement to other interventions for young people with ASD and/or ADHD.

  • 142.
    Wiese Simonsen, K
    et al.
    University of Copenhagen.
    Normann, P T
    Norwegian Institute of Public Health.
    Ceder, Gun
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Vuori, E
    University of Helsinki.
    Thordardottir, S
    University of Iceland.
    Thelander, G
    National Board of Forensic Medicine.
    Hansen, A C
    University of Aarhus.
    Teige, B
    University of Oslo.
    Rollmann, D
    University of South Denmark.
    Fatal poisoning in drug addicts in the Nordic countries in 20072011In: FORENSIC SCIENCE INTERNATIONAL, ISSN 0379-0738, Vol. 207, no 1-3, p. 170-176Article in journal (Refereed)
    Abstract [en]

    The frequency of medico-legally examined fatal poisonings in 2007 among drug addicts was investigated in five Nordic countries; Denmark, Finland, Iceland, Norway, and Sweden. The number of deaths, age, sex, place of death, main intoxicant, and other drugs present in blood samples were recorded to obtain national and comparable Nordic data, as well as data to compare with earlier studies in 2002, 1997, and 1991. Norway had the highest incidence of drug addict deaths by poisoning followed by Denmark, with 8.24 and 6.92 per 100,000 inhabitants, respectively. The death rates in Finland (4.02), Iceland (4.56), and Sweden (3.53) were about half that of Norway and Denmark. Compared with earlier studies, the death rates were unchanged in Denmark and Norway, but increased in Finland, Iceland, and Sweden. In all countries, fewer deaths (29-35%) were recorded in the capital area compared with earlier studies. Females accounted for 11-19% of the fatal poisonings. Iceland deviates with a more equal distribution between men and women (40%). Deaths from methadone overdoses increased in all Nordic countries, and methadone was the main intoxicant in Denmark in 2007, accounting for 51% of the poisonings. In Norway and Sweden, heroin/morphine was still the main intoxicant with a frequency of 68% and 48%, respectively. In Iceland, 3 deaths each were due to heroin/morphine and methadone, respectively. Finland differs from other Nordic countries in having a high number of poisonings caused by buprenorphine and very few caused by heroin/morphine. The total number of buprenorphine deaths in Finland doubled from 16 in 2002 to 32 in 2007, where it constituted 25% of deaths. The general toxicological screening program showed widespread multi-drug use in all countries. The median number of drugs per case varied from 3 to 5. The most frequently detected substances were heroin/morphine, methadone, buprenorphine, tramadol, amphetamine, cocaine, tetrahydrocannabinol, benzodiazepines and ethanol. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

  • 143.
    Wressle, Ewa
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Öberg, Birgitta
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Arts and Sciences.
    Henriksson, Chris
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    The rehabilitation process for the geriatric stroke patient: an exploratory study of goal setting and intervention1999In: Disability and Rehabilitation, ISSN 0963-8288, Vol. 21, no 2, p. 80-87Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim was to describe and analyse the rehabilitation process of the geriatric stroke patient from two perspectives; the treatment goals expressed by the staff and the patient and the treatment interventions chosen by the physiotherapist and occupational therapist. A secondary aim was to test whether the process, treatment goals and interventions could be classified according to the International Classification of Impairments, Disabilities and Handicaps (ICIDH).

    Method: Qualitative interviews were performed with patients and personnel; diaries were used to register treatment interventions. The 30 interviews were categorized according to the goals expressed by physiotherapists, occupational therapists, physicians and patients. The diaries (n= 22) were analysed to describe how treatment interventions were connected in time, at what levels (impairment, disability and handicap) the interventions were directed, and finally, whether certain decisions were made in order to change the rehabilitation process.

    Results: The patients talked more about attaining their prestroke status than about their goals. The therapists set goals according to functional level, whereas the doctors expressed themselves in general terms. Three patterns of rehabilitation processes were found: one with clearly identified decision points, one with a set programme which was not changed through the process, and one where the goal was changed according to changes in medical status.

    Conclusions: The patient does not participate in the goalsetting process, and the vaguely expressed goals are not measurable. The rehabilitation process and reason for discharge demonstrate different patterns. Treatment interventions, if related to the ICIDH, give a clear picture of the process, though certain interventions do not fit in the classification.

  • 144.
    Wåhlin, Charlotte
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    The Rehabilitation Process for Individuals with Musculoskeletal and Mental Disorders: Evaluation of Health, Functioning, Work Ability and Return to Work2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Musculoskeletal disorders (MSD) and mental disorders (MD) are common among working-age individuals, and reduced work ability is often a problem that influences functioning in working life. Having MSD and MD is also a common cause of seeking health care and these conditions account for the majority of sick leave in most western countries. The overall aims of the thesis were to increase knowledge about biopsychosocial assessment of health, functioning and work ability for individuals with MSD and MD seeking care. A further aim was to gain better understanding of praxis behaviour in the rehabilitation process for sick-listed patients by evaluating patient-reported work ability, type of interventions given, usefulness of interventions, and return to work.

    This thesis comprises four studies based on two different cohorts. A cross-sectional design was used for studies I and II, which included 210 individuals diagnosed with MSD and MD seeking occupational health services. Data collection consisted of questionnaires to patients on self-reported health, functioning, work conditions, work ability and reports of professional assessment of diagnosis, main clinical problem, recommended intervention and sick leave. Studies III (n=699) and IV (n=810) were based on a longitudinal cohort study, ReWESS, with a 3-month follow-up comprising individuals who sought primary health care or occupational health services for MSD or MD and were sick-listed. The data collection included repeated questionnaires to the patients on self-reported health, functioning, work conditions, work ability, type and usefulness of intervention and return to work.

    There was an association between the professional biopsychosocial assessment and patients’ self-reported measures of health, functioning and work ability in clinical reasoning. Self-reported health and work measures can complement the expert-based diagnosis. Patients who had MSD and MD with co-morbid conditions reported more problems with mental functioning, had higher psychological demands at work and reported poorer work ability compared with those with MSD only. Patients with co-morbid conditions also had worse outcome compared to having mental disorders only. Psychosocial problems and activity limitations concerning social interaction skills were a frequent problem. This can be identified in clinical screening by physiotherapists in dialogue with the patient using the Patient-Specific Functional Scale. Three-quarters of sick-listed individuals with MSD or MD returned to work within 90 days. The treatment approach to sick-listed persons is still very medical and clinically oriented. Access to work-related interventions seems to be limited in the early rehabilitation process and may not be equal in practice. Those who were younger, had higher educational level and reported stronger health resources were favoured. There is a need to strive for access to work-related interventions.

    Return to work was associated with receiving combined clinical- and work-related interventions for patients with MD, and with better health-related quality of life, positive return to work expectations and better work ability for patients with MSD. Factors associated with return to work can be identified using self-reported measures. Patients with MD who received a combination of work-related and clinical interventions perceived best usefulness and best effect of health care contacts on work ability. Patients with MSD did not report as good usefulness. There seems to be a gap between scientific evidence and praxis behaviour in the early rehabilitation process; unimodal rehabilitation was widely applied, use of a multimodal treatment approach was limited and only one-third received work-related interventions. For patients with MSD, behavioural treatment seems to be underutilized in clinical practice considering the effect it may have on developing coping strategies and reducing symptoms. In order to meet recommendations in guidelines, physical activity needs to increase as a treatment strategy for patients with MD. A clinical implication is that the rehabilitation process needs to adopt a broader perspective for patients with MSD and MD to include patients’ individual health-related needs, aspects of employment and work conditions. Still, it remains a challenge to understand who needs what type of intervention.

    List of papers
    1. Is an expert diagnosis enough for assessment of sick leave for employees with musculoskeletal and mental disorders?
    Open this publication in new window or tab >>Is an expert diagnosis enough for assessment of sick leave for employees with musculoskeletal and mental disorders?
    2011 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 13-14, p. 1147-1156Article in journal (Refereed) Published
    Abstract [en]

    Purpose. The aim of this study is to determine differences in self-reported work ability, work conditions, health and function between ICD-10 groups with musculoskeletal disorders (MSD), mental disorders (MDs) and MSD+MD and to determine which variables are associated with sick leave.

    Method. A cross-sectional study of 210 employees was conducted at an occupational health service unit. Physiotherapists and physicians classified the employees’ health problems according to ICD-10 and the employees answered a questionnaire with questions on demographic variables, health, functioning, work ability and work conditions.

    Results. Forty-four per cent of the employees had MSD, 22% had MD and 34% had a MSD+MD. The group on sick leave had worse results for all health and work measures. Belonging to the MD group, belonging to the MSD+MD group, having poor work ability and functioning were associated with being on sick leave. The value for the model explaining being on sick leave was 0.63 (Nagelkerke R2).

    Conclusions. Having a diagnosis of MD based on a professional opinion and having poor work ability and functioning based on self-reports are associated with being on sick leave. The results suggest that self-reported data could be used to complement the expert-based diagnosis.

    Place, publisher, year, edition, pages
    Informat Health Care, 2011
    Keywords
    Work ability, musculoskeletal disorders, mental disorders, sick leave, ICD-10, work ability index
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-65843 (URN)10.3109/09638288.2010.523509 (DOI)000290950400008 ()
    Funder
    FAS, Swedish Council for Working Life and Social Research, 2004-0582
    Note

    Original Publication: Charlotte Wåhlin Norgren, Kerstin Ekberg and Birgitta Öberg, Is an expert diagnosis enough for assessment of sick leave for employees with musculoskeletal and mental disorders?, 2010, Disability and Rehabilitation. http://dx.doi.org/10.3109/09638288.2010.523509 Copyright: Informa Healthcare http://informahealthcare.com/

    Available from: 2011-02-22 Created: 2011-02-22 Last updated: 2017-12-11
    2. Clinical reasoning in occupational health services for individuals with musculoskeletal and mental disorders
    Open this publication in new window or tab >>Clinical reasoning in occupational health services for individuals with musculoskeletal and mental disorders
    2012 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 14, no 4, p. 155-165Article in journal (Refereed) Published
    Abstract [en]

    Aims: To investigate whether there are associations between the professional assessment of a patient's main clinical problem and the patient's self-reported health among patients with musculoskeletal disorders and/or mental disorders. To investigate differences in self-reported health and work-related measures in patients who were recommended clinical versus work-related interventions. Method: A cross-sectional study, including a convenience sample of 210 patients, visiting occupational health service. Patients answered a questionnaire on demographic variables, dimensions of health, functioning, work ability and working conditions. Patients’ main clinical problem and type of intervention was classified by physiotherapists. Activity limitations were identified using the Patient-Specific Functional Scale. Findings: The main clinical problems were: medical/organic problems (39%), psychosocial problems (46%) and physical work-related problems (15%). The psychosocial group reported more problems in mental functioning and the medical/organic group had worse physical functioning. There were significant differences for the main clinical problem, educational level, work ability, social interaction skills and mobility in patients who were recommended clinical versus work-related interventions. Conclusions: There are associations between the professional biopsychosocial classification and the patient's self-reported health and functioning. Clinical reasoning may be improved by including systematic biopsychosocial assessment of specific health and working conditions, and activity limitations according to Patient-Specific Functional Scale.

    Place, publisher, year, edition, pages
    London, UK: Informa Healthcare, 2012
    Keywords
    Musculoskeletal disorders, mental disorders, biopsychosocial model, occupational health services, professional assessment, self-report, work ability, Patient-Specific Functional Scale, intervention.
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-76145 (URN)10.3109/14038196.2012.729609 (DOI)
    Funder
    Forte, Swedish Research Council for Health, Working Life and Welfare, 2004-0582
    Available from: 2012-03-29 Created: 2012-03-29 Last updated: 2017-12-07Bibliographically approved
    3. Association between clinical and work-related interventions and return to work for patients with musculoskeletal or mental disorders
    Open this publication in new window or tab >>Association between clinical and work-related interventions and return to work for patients with musculoskeletal or mental disorders
    Show others...
    2012 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 4, p. 355-362Article in journal (Refereed) Published
    Abstract [en]

    Objective: The aim of this study was to explore what characterizes patients receiving clinical interventions vs combined clinical and work-related interventions in a cohort of sick-listed subjects with musculoskeletal or mental disorders. Factors associated with return-to-work were also analysed.

    Design: A prospective cohort study.

    Methods: A total of 699 newly sick-listed patients responded to a questionnaire on sociodemographics, measures of health, functioning, work ability, self-efficacy, social support, work conditions, and expectations. The 3-month follow-up questionnaire included patients' self-reported measures of return-to-work, work ability and type of interventions. The most frequent International Classification of Diseases-10 diagnoses for patients' musculoskeletal disorders were dorsopathies (M50-54) and soft tissue disorders (M70-79), and for patients with mental disorders, depression (F32-39) and stress reactions (F43).

    Results: Patients with mental disorders who received combined interventions returned to work to a higher degree than those who received only clinical intervention. The prevalence of work-related interventions was higher for those who were younger and more highly educated. For patients with musculoskeletal disorders better health, work ability and positive expectations of return-to-work were associated with return-to-work. However, combined interventions did not affect return-to-work in this group.

    Conclusion: Receiving combined interventions increased the probability of return-to-work for patients with mental disorders, but not for patients with musculoskeletal disorders. Better health, positive expectations of return-to-work and better work ability were associated with return-to-work for patients with musculoskeletal disorders.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-73425 (URN)10.2340/16501977-0951 (DOI)000303850800010 ()
    Funder
    FAS, Swedish Council for Working Life and Social Research, 2004-0582
    Note

    funding agencies|FAS (Swedish Council for Working Life and Social Research)||

    Available from: 2012-01-03 Created: 2012-01-03 Last updated: 2017-12-08Bibliographically approved
    4. Evaluation of self-reported work ability and usefulness of interventions among sick-listed patients
    Open this publication in new window or tab >>Evaluation of self-reported work ability and usefulness of interventions among sick-listed patients
    Show others...
    2013 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 23, no 1, p. 32-43Article in journal (Refereed) Published
    Abstract [en]

    Aim To describe the types of intervention offered, to investigate the relationship between the type of intervention given, patient-reported usefulness of interventions and the effect on self-reported work ability in a cohort of sick-listed patients with musculoskeletal disorders (MSD) or mental disorders (MD).

    Methods A prospective cohort study was performed including 810 newly sick-listed patients (MSD 62 % and MD 38 %). The baseline questionnaire included sociodemographic characteristics and measures of work ability. The 3-month follow-up questionnaire included measures of work ability, type of intervention received, and judgment of usefulness.

    Results Twenty-five percent received medical intervention modalities (MI) only, 45 % received a combination of medical and rehabilitative intervention modalities (CRI) and 31 % received work-related interventions combined with medical or rehabilitative intervention modalities (WI). Behavioural treatments were more common for patients with MD compared with MSD and exercise therapy were more common for patients with MSD. The most prevalent workplace interventions were adjustment of work tasks or the work environment. Among patients with MD, WI was found to be useful and improved work ability significantly more compared with only MI or CRI. For patients with MSD, no significant differences in improved work ability were found between interventions.

    Conclusions Patients with MD who received a combination of work-related and clinical interventions reported best usefulness and best improvement in work ability. There was no difference in improvements in work ability between rehabilitation methods in the MSD group. There seems to be a gap between scientific evidence and praxis behaviour in the rehabilitation process. Unimodal rehabilitation was widely applied in the early rehabilitation process, a multimodal treatment approach was rare and only one-third received work-related interventions. It remains a challenge to understand who needs what type of intervention.

    Place, publisher, year, edition, pages
    Springer Verlag (Germany), 2013
    Keywords
    Musculoskeletal disorders; Mental disorders; Sick leave; Self-reported; Work ability; Usefulness; Interventions, Sweden
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-76147 (URN)10.1007/s10926-012-9376-y (DOI)000314505200004 ()22760957 (PubMedID)
    Funder
    FAS, Swedish Council for Working Life and Social Research, 2004-0582
    Available from: 2012-03-29 Created: 2012-03-29 Last updated: 2017-12-07Bibliographically approved
  • 145.
    Wåhlin, Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Association between clinical and work-related interventions and return to work for patients with musculoskeletal or mental disorders2012In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 4, p. 355-362Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to explore what characterizes patients receiving clinical interventions vs combined clinical and work-related interventions in a cohort of sick-listed subjects with musculoskeletal or mental disorders. Factors associated with return-to-work were also analysed.

    Design: A prospective cohort study.

    Methods: A total of 699 newly sick-listed patients responded to a questionnaire on sociodemographics, measures of health, functioning, work ability, self-efficacy, social support, work conditions, and expectations. The 3-month follow-up questionnaire included patients' self-reported measures of return-to-work, work ability and type of interventions. The most frequent International Classification of Diseases-10 diagnoses for patients' musculoskeletal disorders were dorsopathies (M50-54) and soft tissue disorders (M70-79), and for patients with mental disorders, depression (F32-39) and stress reactions (F43).

    Results: Patients with mental disorders who received combined interventions returned to work to a higher degree than those who received only clinical intervention. The prevalence of work-related interventions was higher for those who were younger and more highly educated. For patients with musculoskeletal disorders better health, work ability and positive expectations of return-to-work were associated with return-to-work. However, combined interventions did not affect return-to-work in this group.

    Conclusion: Receiving combined interventions increased the probability of return-to-work for patients with mental disorders, but not for patients with musculoskeletal disorders. Better health, positive expectations of return-to-work and better work ability were associated with return-to-work for patients with musculoskeletal disorders.

  • 146.
    Wåhlin, Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Evaluation of self-reported work ability and usefulness of interventions among sick-listed patients2013In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 23, no 1, p. 32-43Article in journal (Refereed)
    Abstract [en]

    Aim To describe the types of intervention offered, to investigate the relationship between the type of intervention given, patient-reported usefulness of interventions and the effect on self-reported work ability in a cohort of sick-listed patients with musculoskeletal disorders (MSD) or mental disorders (MD).

    Methods A prospective cohort study was performed including 810 newly sick-listed patients (MSD 62 % and MD 38 %). The baseline questionnaire included sociodemographic characteristics and measures of work ability. The 3-month follow-up questionnaire included measures of work ability, type of intervention received, and judgment of usefulness.

    Results Twenty-five percent received medical intervention modalities (MI) only, 45 % received a combination of medical and rehabilitative intervention modalities (CRI) and 31 % received work-related interventions combined with medical or rehabilitative intervention modalities (WI). Behavioural treatments were more common for patients with MD compared with MSD and exercise therapy were more common for patients with MSD. The most prevalent workplace interventions were adjustment of work tasks or the work environment. Among patients with MD, WI was found to be useful and improved work ability significantly more compared with only MI or CRI. For patients with MSD, no significant differences in improved work ability were found between interventions.

    Conclusions Patients with MD who received a combination of work-related and clinical interventions reported best usefulness and best improvement in work ability. There was no difference in improvements in work ability between rehabilitation methods in the MSD group. There seems to be a gap between scientific evidence and praxis behaviour in the rehabilitation process. Unimodal rehabilitation was widely applied in the early rehabilitation process, a multimodal treatment approach was rare and only one-third received work-related interventions. It remains a challenge to understand who needs what type of intervention.

  • 147.
    Wåhlin, Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Clinical reasoning in occupational health services for individuals with musculoskeletal and mental disorders2012In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 14, no 4, p. 155-165Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate whether there are associations between the professional assessment of a patient's main clinical problem and the patient's self-reported health among patients with musculoskeletal disorders and/or mental disorders. To investigate differences in self-reported health and work-related measures in patients who were recommended clinical versus work-related interventions. Method: A cross-sectional study, including a convenience sample of 210 patients, visiting occupational health service. Patients answered a questionnaire on demographic variables, dimensions of health, functioning, work ability and working conditions. Patients’ main clinical problem and type of intervention was classified by physiotherapists. Activity limitations were identified using the Patient-Specific Functional Scale. Findings: The main clinical problems were: medical/organic problems (39%), psychosocial problems (46%) and physical work-related problems (15%). The psychosocial group reported more problems in mental functioning and the medical/organic group had worse physical functioning. There were significant differences for the main clinical problem, educational level, work ability, social interaction skills and mobility in patients who were recommended clinical versus work-related interventions. Conclusions: There are associations between the professional biopsychosocial classification and the patient's self-reported health and functioning. Clinical reasoning may be improved by including systematic biopsychosocial assessment of specific health and working conditions, and activity limitations according to Patient-Specific Functional Scale.

  • 148.
    Wåhlin Norgren, Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Return to work interventions for patients with musculoskeletal and mental disorders – The gap between best and clinical practice.2010Conference paper (Refereed)
  • 149.
    Wåhlin Norgren, Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Department of Medical and Health Sciences.
    Do patients with Musculoskeletal and Mental disorders receive recommended interventions to promote RTW? - How do they perceive what they get?2009Conference paper (Refereed)
  • 150.
    Wåhlin Norgren, Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Is an expert diagnosis enough for assessment of sick leave for employees with musculoskeletal and mental disorders?2011In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 13-14, p. 1147-1156Article in journal (Refereed)
    Abstract [en]

    Purpose. The aim of this study is to determine differences in self-reported work ability, work conditions, health and function between ICD-10 groups with musculoskeletal disorders (MSD), mental disorders (MDs) and MSD+MD and to determine which variables are associated with sick leave.

    Method. A cross-sectional study of 210 employees was conducted at an occupational health service unit. Physiotherapists and physicians classified the employees’ health problems according to ICD-10 and the employees answered a questionnaire with questions on demographic variables, health, functioning, work ability and work conditions.

    Results. Forty-four per cent of the employees had MSD, 22% had MD and 34% had a MSD+MD. The group on sick leave had worse results for all health and work measures. Belonging to the MD group, belonging to the MSD+MD group, having poor work ability and functioning were associated with being on sick leave. The value for the model explaining being on sick leave was 0.63 (Nagelkerke R2).

    Conclusions. Having a diagnosis of MD based on a professional opinion and having poor work ability and functioning based on self-reports are associated with being on sick leave. The results suggest that self-reported data could be used to complement the expert-based diagnosis.

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